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Most Cited Journal of Diabetes and its Complications Articles
The most cited articles published since 2011, extracted from Scopus.
Lower circulating irisin is associated with type 2 diabetes mellitusJian Jun Liu | Melvin D S Wong | Wan Ching Toy | Clara S H Tan | Sylvia Liu | Xiao Wei Ng | Subramaniam Tavintharan | Chee Fang Sum | Su Chi Lim
Volume 27, Issue 4, July 2013, Pages 365-369
Aims Irisin is a novel myokine secreted in response to PPAR-γ co-activator-1α (PGC-1α) activation. Earlier studies suggested that PGC-1α expression and activity were lower in myocytes in type 2 diabetes mellitus (T2DM). Therefore, we hypothesize that circulating irisin levels are lower in T2DM patients. Methods In this observational study, we recruited 96 T2DM subjects and 60 non-diabetic control subjects. Among T2DM subjects, 38% were on insulin treatment, 78% were taking statins and 72% were taking renin-angiotensin system antagonists. Circulating irisin was quantified by ELISA and its association with markers of metabolic phenotype was analyzed by Pearson bivariate correlation and multiple linear regression. Results Circulating irisin was significantly lower in individuals with T2DM compared with non-diabetic controls (T2DM 204 ± 72 ng/ml vs. non-diabetic control 257 ± 24 ng/ml, p < 0.0001). In non-diabetic subjects, circulating irisin was correlated with age (r = 0.398, p < 0.01), BMI (r = 0.387, p < 0.01), total cholesterol (r = 0.341, p < 0.01), total triglycerides (r = 0.299, p < 0.05), fasting blood glucose (r = 0.430, p < 0.01) and diastolic blood pressure (r = 0.306, p < 0.05). Multiple linear regression model revealed that BMI (β = 0.407, p = 0.012) and FBG (β = 0.315, p = 0.034) were associated with irisin in non-diabetic subjects after adjusting for multiple co-variates. However, similar analysis in T2DM subjects didn't reveal significant association between circulating irisin and major markers of metabolic phenotype. Conclusions Circulating irisin is lower in T2DM compared with non-diabetic controls. Plasma irisin levels appear to be associated with important metabolic factors in non-diabetic subjects but not in individuals with type 2 diabetes. © 2013 Elsevier Inc.
Vulvovaginitis and balanitis in patients with diabetes treated with dapagliflozinKristina M. Johnsson | Agata Ptaszynska | Bridget Schmitz | Jennifer Sugg | Shamik J. Parikh | James F. List
Volume 27, Issue 5, September 2013, Pages 479-484
Background Vulvovaginitis, balanitis, and related genital infections are common in patients with type 2 diabetes. Glucosuria, which is an outcome of treatment with sodium glucose cotransporter 2 (SGLT2) inhibitors, is among the possible causes. Dapagliflozin, an SGLT2 inhibitor with demonstrated glycemic benefits in patients with diabetes, has been studied across a broad spectrum of patients. Analysis of multi-trial safety data may better define the relationship between glucosuria and genital infection. Methods Safety data were pooled from 12 randomized, placebo-controlled Phase 2b/3 trials to analyze the association of glucosuria with genital infection in patients with suboptimally controlled diabetes (HbA1c > 6.5%-12%). Patients were randomized to receive dapagliflozin (2.5 mg, 5 mg, or 10 mg) or placebo once daily, either as monotherapy or add-on to metformin, insulin, sulfonylurea, or thiazolidinedione for 12-24 weeks. The incidence of clinical diagnoses and of events suggestive of genital infection was evaluated. Results The pooled safety data included 4545 patients: 3152 who received once-daily dapagliflozin (2.5 mg [n = 814], 5 mg [n = 1145], or 10 mg [n = 1193]) as monotherapy or add-on treatment, and 1393 placebo-treated patients. For dapagliflozin 2.5 mg, 5 mg, 10 mg, and placebo, diagnosed infections were reported in 4.1%, 5.7%, 4.8%, and 0.9%, respectively. Most infections were mild or moderate and responded to standard antimicrobial treatment. Discontinuation due to these events was rare. No clear dose-response relationship between dapagliflozin and genital infection was demonstrated. Conclusions Treatment with dapagliflozin 2.5 mg, 5 mg, or 10 mg once daily is accompanied by an increased risk of vulvovaginitis or balanitis, related to the induction of glucosuria. Events were generally mild to moderate, clinically manageable, and rarely led to discontinuation of treatment. © 2013 Elsevier Inc.
Hesperidin and naringin attenuate hyperglycemia-mediated oxidative stress and proinflammatory cytokine production in high fat fed/streptozotocin-induced type 2 diabetic ratsAyman M. Mahmoud | Mohamed B. Ashour | Adel Abdel-Moneim | Osama M. Ahmed
Volume 26, Issue 6, November 2012, Pages 483-490
Abnormal regulation of glucose and impaired carbohydrate utilization that result from a defective or deficient insulin are the key pathogenic events in type 2 diabetes mellitus (T2DM). The present study was hypothesized to investigate the beneficial effects of hesperidin and naringin on hyperglycemia-induced oxidative damage in HFD/STZ-induced diabetic rats. Diabetes was induced by feeding rats with an HFD for 2 weeks followed by an intraperitoneal injection of STZ (35 mg/kg body weight). An oral dose of 50 mg/kg hesperidin or naringin was daily given for 4 weeks after diabetes induction. At the end of the experimental period, blood was obtained from jugular vein and livers were rapidly excised and homogenized for biochemical assays. In the diabetic control group, levels of glucose, glycosylated hemoglobin (HbA1c%), MDA, NO, TNF-α and IL-6 were significantly increased, while serum insulin, GSH, vitamin C, and vitamin E levels were decreased. Both hesperidin and naringin administration significantly reversed these alterations. Moreover, supplementation with either compound significantly ameliorated serum and liver MDA, NO and glutathione, and liver antioxidant enzymes. Although detailed studies are required for the evaluation of the exact mechanism of the ameliorative effects of hesperidin and naringin against diabetic complications, these preliminary experimental findings demonstrate that both hesperidin and naringin exhibit antidiabetic effects in a rat model of T2DM by potentiating the antioxidant defense system and suppressing proinflammatory cytokine production. © 2012 Elsevier Inc.
Urinary tract infections in patients with diabetes treated with dapagliflozinKristina M. Johnsson | Agata Ptaszynska | Bridget Schmitz | Jennifer Sugg | Shamik J. Parikh | James F. List
Volume 27, Issue 5, September 2013, Pages 473-478
Aims Urinary tract infection is common in patients with type 2 diabetes. Possible causative factors include glucosuria, which is a result of treatment with sodium glucose cotransporter 2 (SGLT2) inhibitors. Dapagliflozin is an investigative SGLT2 inhibitor with demonstrated glycemic benefits in patients with diabetes. Data from dapagliflozin multi-trial safety data were analyzed to clarify the association between glucosuria and urinary tract infection. Methods Safety data from 12 randomized, placebo-controlled trials were pooled to evaluate the relationship between glucosuria and urinary tract infection in patients with inadequately controlled diabetes (HbA1c > 6.5%-12%). Patients were treated with dapagliflozin (2.5, 5, or 10 mg) or placebo once daily, either as monotherapy or add-on to metformin, insulin, sulfonylurea, or thiazolidinedione for 12-24 weeks. The incidence of clinical diagnoses and events suggestive of urinary tract infection were quantified. Results This analysis included 3152 patients who received once-daily dapagliflozin (2.5 mg [n = 814], 5 mg [n = 1145], or 10 mg [n = 1193]) as monotherapy or add-on treatment, and 1393 placebo-treated patients. For dapagliflozin 2.5 mg, 5 mg, 10 mg, and placebo, diagnosed infections were reported in 3.6%, 5.7%, 4.3%, and 3.7%, respectively. Urinary glucose levels, but not the incidence of urinary tract infection, increased progressively with dapagliflozin dosage. Most identified infections were those considered typical for patients with diabetes. Discontinuations due to urinary tract infection were rare: 8 (0.3%) dapagliflozin-treated patients and 1 (0.1%) placebo-treated patient. Most diagnosed infections were mild to moderate and responded to standard antimicrobial treatment. Conclusions Treatment of type 2 diabetes with once-daily dapagliflozin 5 or 10 mg is accompanied by a slightly increased risk of urinary tract infection. Infections were generally mild to moderate and clinically manageable. This analysis did not demonstrate a definitive dose relationship between glucosuria and urinary tract infection. © 2013 Elsevier Inc.
The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathyPatricia M. Kluding | Mamatha Pasnoor | Rupali Singh | Stephen Jernigan | Kevin Farmer | Jason Rucker | Neena K. Sharma | Douglas E. Wright
Volume 26, Issue 5, September 2012, Pages 424-429
Although exercise can significantly reduce the prevalence and severity of diabetic complications, no studies have evaluated the impact of exercise on nerve function in people with diagnosed diabetic peripheral neuropathy (DPN). The purpose of this pilot study was to examine feasibility and effectiveness of a supervised, moderately intense aerobic and resistance exercise program in people with DPN. We hypothesized that the exercise intervention can improve neuropathic symptoms, nerve function, and cutaneous innervation. Methods: A pre-test post-test design was used to assess change in outcome measures following participation in a 10-week aerobic and strengthening exercise program. Seventeen subjects with diagnosed DPN (8 males/9 females; age 58.4 ± 5.98; duration of diabetes 12.4 ± 12.2 years) completed the study. Outcome measures included pain measures (visual analog scale), Michigan Neuropathy Screening Instrument (MNSI) questionnaire of neuropathic symptoms, nerve function measures, and intraepidermal nerve fiber (IENF) density and branching in distal and proximal lower extremity skin biopsies. Results: Significant reductions in pain (- 18.1 ± 35.5 mm on a 100 mm scale, P =.05), neuropathic symptoms (- 1.24 ± 1.8 on MNSI, P =.01), and increased intraepidermal nerve fiber branching (+ 0.11 ± 0.15 branch nodes/fiber, P =.008) from a proximal skin biopsy were noted following the intervention. Conclusions: This is the first study to describe improvements in neuropathic and cutaneous nerve fiber branching following supervised exercise in people with diabetic peripheral neuropathy. These findings are particularly promising given the short duration of the intervention, but need to be validated by comparison with a control group in future studies. © 2012 Elsevier Inc. All rights reserved.
The duration of diabetes affects the response to intensive glucose control in type 2 subjects: The VA Diabetes TrialWilliam C. Duckworth | Carlos Abraira | Thomas E. Moritz | Stephen N. Davis | Nicholas Emanuele | Steven Goldman | Rodney Hayward | Grant D. Huang | Jennifer B. Marks | Peter D. Reaven | Domenic J. Reda | Stuart R. Warren | Franklin J. Zieve
Volume 25, Issue 6, November 2011, Pages 355-361
Background: The goal of the VA Diabetes Trial (VADT) was to determine the effect of intensive glucose control on macrovascular events in subjects with difficult-to-control diabetes. No significant benefit was found. This report examines predictors of the effect of intensive therapy on the primary outcome in this population. Methods: This trial included 1791 subjects. Baseline cardiovascular risk factors were collected by interview and the VA record. The analyses were done by intention to treat. Findings: Univariate analysis at baseline of predictors of a primary cardiovascular (CV) event included a prior CV event, age, insulin use at baseline, and duration of diagnosed diabetes (all P<.0001). Multivariable modeling revealed a U-shaped relationship between duration of diabetes and treatment. Modeled estimates for the hazard ratios (HRs) for treatment show that subjects with a short duration (3 years or less) of diagnosed diabetes have a nonsignificant increase in risk (HR >1.0) after which the HR is below 1.0. From 7 to 15 years' duration at entry, subjects have HRs favoring intensive treatment. Thereafter the HR approaches 1.0 and over-21-years' duration approaches 2.0. Duration over 21 years resulted in a HR of 1.977 (CI 1.77-3.320, P<.01). Baseline c-peptide levels progressively declined up to 15 years and were stable subsequently. Interpretation: In difficult-to-control older subjects with type 2 DM, duration of diabetes altered the response to intensive glucose control. Intensive therapy may reduce CV events in subjects with a duration of 15 years or less and may increase risks in those with longer duration. © 2011 Elsevier Inc. All rights reserved.
Recent advances in understanding the biochemical and molecular mechanism of diabetic retinopathyMohammad Shamsul Ola | Mohd Imtiaz Nawaz | M. Mairaj Siddiquei | Saleh Al-Amro | Ahmed M. Abu El-Asrar
Volume 26, Issue 1, January 2012, Pages 56-64
One of the major complications in patients with diabetes is diabetic retinopathy (DR), a leading cause of blindness worldwide. It takes several years before any clinical signs of retinopathy appear in diabetic patients, which gives an ample opportunity for scientists to uncover biochemical and molecular mechanism implicated early in the development and progression of the disease. During the past few decades, research progress has been made in investigating the pathophysiology of the disease; however, due to nonavailability of human retinal samples at different stages of the disease and also due to lack of a proper animal model of DR, the exact molecular mechanism has not been elucidated, making therapeutic a difficult task. In this review article, we have discussed a number of diabetes-induced metabolites such as glucose, lipids, amino acids, and other related factors and molecules that are implicated in the pathophysiology of the DR. Furthermore, we have highlighted neurodegeneration and regulation of neurotrophic factors, being recognized as early events that may be involved in the pathology of the disease in the course of DR. An understanding of the biochemical and molecular changes especially early in the diabetic retina may lead to new and effective therapies towards prevention and amelioration of DR, which is important for the millions of individuals who already have or are likely to develop the disease before a cure becomes available. © 2012 Elsevier Inc. All rights reserved.
Diabetes-induced erectile dysfunction: Epidemiology, pathophysiology and managementVrushali S. Thorve | Ajay D. Kshirsagar | Neeraj S. Vyawahare | Vipin S. Joshi | Kundan G. Ingale | Reshma J. Mohite
Volume 25, Issue 2, March 2011, Pages 129-136
Erectile dysfunction (ED) is defined as the inability of the male to attain and maintain erection of penis sufficient to permit satisfactory sexual intercourse. Prevalence of impotence in diabetic men is ≥50%. The pathophysiology of diabetes-induced erectile dysfunction (DIED) is multifactorial and no single etiology is at the forefront. The proposed mechanisms of erectile dysfunction in diabetic patients includes elevated advanced glycation end-products, increased levels of oxygen free radicals, impaired nitric oxide synthesis, increased endothelin B receptor binding sites and up-regulated RhoA/Rho-kinase pathway, neuropathic damage and impaired cyclic guanosine monophosphate (cGMP)-dependent protein kinase-1. The treatment of DIED is multimodal. Treatment of the underlying hyperglycemia and comorbidities is of utmost importance to prevent or halt the progression of disease. Oral medications are considered as the first line therapy for management of DIED. If oral agents cannot be used or have insufficient efficacy despite appropriate dosing and education, second-line treatments should be addressed. When there is lack of efficacy or when there is dissatisfaction with other modalities, penile prostheses are often the best alternative for ED and are considered as the third line therapy for DIED. Future strategies in the evolution of the treatment of DIED are aimed at correcting or treating the underlying mechanisms of DIED. © 2011 Elsevier Inc. All rights reserved.
The burden of hypoglycemia on healthcare utilization, costs, and quality of life among type 2 diabetes mellitus patientsSetareh A. Williams | Lizheng Shi | Susan K. Brenneman | Jonathan C. Johnson | Jessica C. Wegner | Vivian Fonseca
Volume 26, Issue 5, September 2012, Pages 399-406
Objective: To assess the burden of hypoglycemia among type 2 diabetes patients on antidiabetic drugs with or without use of insulin. Research Design and Methods: We used mail surveys, administrative claims data, and enrollment information from a sample of adult commercial health plan enrollees (n = 813) with type 2 diabetes during a 12-month period. Patients' experience of hypoglycemia, its impact on patient perspectives and healthcare utilization were the outcomes evaluated. Results: A greater percentage of patients in the antidiabetic with insulin cohort reported experiencing hypoglycemia compared with patients from sulfonylurea (SU) without insulin and non-SU without insulin cohorts (50% vs. 21% and 12%, respectively; p < 0.01 for both comparisons). While 71% of the sample reported experiencing hypoglycemic symptoms with 28% confirmed by low blood glucose levels, only 10% of the patients had evidence of hypoglycemia event in the claims database. Patients with confirmed hypoglycemia had the highest Hypoglycemia Fear Survey behavior score (8) and worry subscale score (14). Significant differences were noted between the confirmed hypoglycemia and no hypoglycemia cohorts for the 12-item Short Form Health Survey's Mental Component Score (p < 0.001) and Physical Component Score (p = 0.002), and for the EQ-5D index (p < 0.001). Diabetes-related annualized mean total healthcare costs were significantly higher for confirmed hypoglycemia vs. no hypoglycemia cohorts (p = 0.004). Conclusions: Symptomatic hypoglycemia is a more significant burden among type 2 diabetes patients treated with antidiabetic drugs than is estimated by administrative claims data and needs to be considered when choosing therapy. © 2012 Elsevier Inc. All rights reserved.
Antioxidant, anti-diabetic and renal protective properties of Stevia rebaudianaNaveen Shivanna | Mahadev Naika | Farhath Khanum | Vijay K. Kaul
Volume 27, Issue 2, March 2013, Pages 103-113
Background: Stevia rebaudiana Bertoni has been used for the treatment of diabetes in, for example, Brazil, although a positive effect on antidiabetic and its complications has not been unequivocally demonstrated. This herb also has numerous therapeutic properties which have been proven safe and effective over hundreds of years. Streptozotocin is a potential source of oxidative stress that induces genotoxicity. Objective: We studied the effects of stevia leaves and its extracted polyphenols and fiber on streptozotocin induced diabetic rats. We hypothesize that supplementation of polyphenols extract from stevia to the diet causes a reduction in diabetes and its complications. Design/Methods: Eighty Wistar rats were randomly divided into 8 groups; a standard control diet was supplemented with either stevia whole leaves powder (4.0%) or polyphenols or fiber extracted from stevia separately and fed for one month. Streptozotocin (60 mg/kg body weight, i.p) was injected to the diabetic groups on the 31st day. Several indices were analyzed to assess the modulation of the streptozotocin induced oxidative stress, toxicity and blood glucose levels by stevia. Results: The results showed a reduction of blood glucose, ALT and AST, and increment of insulin level in the stevia whole leaves powder and extracted polyphenols fed rats compared to control diabetic group. Its feeding also reduced the MDA concentration in liver and improved its antioxidant status through antioxidant enzymes. Glucose tolerance and insulin sensitivity were improved by their feeding. Streptozotocin was also found to induce kidney damage as evidenced by decreased glomerular filtration rate; this change was however alleviated in the stevia leaves and extracted polyphenol fed groups. Conclusion: The results suggested that stevia leaves do have a significant role in alleviating liver and kidney damage in the STZ-diabetic rats besides its hypoglycemic effect. It might be adequate to conclude that stevia leaves could protect rats against streptozotocin induced diabetes, reduce the risk of oxidative stress and ameliorate liver and kidney damage. © 2013 Elsevier Inc. All rights reserved.
Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitusOmar Abdulhameed Al-Khawaldeh | Mousa Ali Al-Hassan | Erika Sivarajan Froelicher
Volume 26, Issue 1, January 2012, Pages 10-16
Objective: The objective was to evaluate the relationships between diabetes management self-efficacy and diabetes self-management behaviors and glycemic control. Methods: A cross-sectional design was used. A convenience sample of 223 subjects with type 2 diabetes, ≥25 years old, who sought care at the National Diabetes Center in Amman, Jordan, was enrolled. A structured interview and medical records provided the data. The instruments included a sociodemographic and clinical questionnaire, a diabetes management self-efficacy scale, and a diabetes self-management behaviors scale. Glycosylated hemoglobin was used as an index for glycemic control. The analyses are presented as proportions, means (±S.D.), odds ratios, and 95% confidence intervals obtained from logistic regressions. Results: Diet self-efficacy and diet self-management behaviors predicted better glycemic control, whereas insulin use was a statistically significant predictor for poor glycemic control. In addition, subjects with higher self-efficacy reported better self-management behaviors in diet, exercise, blood sugar testing, and taking medication. The findings showed that more than half of the subjects did not have their diabetes under control and that only 42% had attended diabetes education programs. Conclusions: The majority of subjects did not have their diabetes controlled; their self-efficacy was low, and they had suboptimal self-management behaviors. Therefore, strategies to enhance and promote self-efficacy and self-management behaviors for patients are essential components of diabetes education programs. Furthermore, behavioral counseling and skill-building interventions are critical for the patients to become confident and be able to manage their diabetes. © 2012 Elsevier Inc. All rights reserved.
Selective modulation of PPARγ activity can lower plasma glucose without typical thiazolidinedione side-effects in patients with Type 2 diabetesFredrick L. Dunn | Linda S. Higgins | Jill Fredrickson | Alex M. Depaoli
Volume 25, Issue 3, May 2011, Pages 151-158
Objective: INT131 besylate is a potent non-thiazolidinedione selective peroxisome proliferator-activated receptor γ (PPARγ) modulator (SPPARM) designed to improve insulin sensitivity and glucose metabolism while minimizing the side effects of full agonist thiazolidinediones. This study was conducted to determine short-term efficacy and safety of INT131 besylate in patients with Type 2 diabetes mellitus (T2DM). Research Design and Methods: This was a 4-week randomized, double-blind, placebo-controlled multi-center study with 1 or 10mg INT131 besylate or placebo daily in subjects with T2DM not receiving pharmacotherapy for their hyperglycemia. The primary efficacy analysis was the comparison of treatment groups with respect to least square mean change from baseline to Week 4 of fasting plasma glucose (FPG). Results: Baseline mean (±S.D.) FPG for the study population was 171±42 mg/dl. Change in FPG (±S.E., mg/dl) from baseline after 4 weeks was 8±8 (P=NS) with placebo, -22±8 with 1mg INT131 besylate (P=.0056) and -46±7 with 10mg INT131 besylate (P<.0001). Modeling of available data from the literature of the effect of rosiglitazone under similar study conditions suggested that 1 mg of INT131 besylate had a similar reduction in FPG as expected with 8 mg of rosiglitazone. INT131 besylate was well tolerated, and the 1 mg dose demonstrated no evidence of fluid retention or weight gain. Conclusions: INT131 besylate demonstrated a dose dependent reduction in FPG. The FPG reduction with 1mg INT131 besylate was comparable to the modeled 8 mg dose of rosiglitazone, and did not cause fluid retention or weight gain. These results are consistent with the INT131 SPPARM design. © 2011 Published by Elsevier Inc.
Imbalanced levels of angiogenic and angiostatic factors in vitreous, plasma and postmortem retinal tissue of patients with proliferative diabetic retinopathyNithyakalyani Mohan | Finny Monickaraj | Muthuswamy Balasubramanyam | Mohan Rema | Viswanathan Mohan
Volume 26, Issue 5, September 2012, Pages 435-441
A role for vascular endothelial growth factor (VEGF) has been clearly implicated in the pathogenesis of proliferative diabetic retinopathy (PDR). However, other molecules and mechanisms may be operating independently, or in conjunction with VEGF in the pathogenesis of this disease. Therefore, we made an attempt to comparatively investigate the levels of angiogenic and angiostatic factors in vitreous, plasma and postmortem retinal tissue of subjects with Proliferative Diabetic Retinopathy (PDR) compared to control subjects. The vitreous and plasma concentrations of VEGF, EPO (Erythropoietin) and PEDF (Pigment Epithelium Derived Factor) were measured using Enzyme Linked Immunosorbent Assay (ELISA) and the postmortem retinal tissue was subjected to Western blot analysis. The mean vitreous and plasma levels of VEGF and EPO in patients with PDR were significantly (p < 0.001) higher than those in subjects without diabetes. Conversely, the vitreous and plasma levels of PEDF were significantly (p < 0.001) lower in the PDR patients compared to control subjects. Multivariate logistic-regression analyses indicated that EPO was more strongly associated with PDR than VEGF. The protein expression of the VEGF and EPO in the retinal tissue was significantly higher in PDR and diabetes without complication groups compared to controls. Compared to controls, the protein expression of PEDF was significantly lower in retinal tissues from diabetes patients without complications and in patients with PDR. The fact that the vitreous and plasma levels and the retinal tissue protein expression of EPO were strongly associated with PDR implies a definite role of 'hypererythropoietinemia' in neovascularization processes. © 2012 Elsevier Inc. All rights reserved.
Irisin in obesity and type 2 diabetesKurt Højlund | Pontus Boström
Volume 27, Issue 4, July 2013, Pages 303-304
Beneficial effects of once-daily lixisenatide on overall and postprandial glycemic levels without significant excess of hypoglycemia in Type 2 diabetes inadequately controlled on a sulfonylurea with or without metformin (GetGoal-S)Julio Rosenstock | Markolf Hanefeld | Paramesh Shamanna | Kyung Wan Min | Gabor Boka | Patrick Miossec | Tianyue Zhou | Isabel Muehlen-Bartmer | Robert E. Ratner
Volume 28, Issue 3, January 2014, Pages 386-392
Aims To assess efficacy and safety of lixisenatide once-daily versus placebo in Type 2 diabetes mellitus (T2DM) patients inadequately controlled on sulfonylurea (SU) ± metformin. Methods In this randomized, double-blind, two-arm, parallel-group, multicenter study, patients received lixisenatide 20 μg once-daily or placebo for 24 weeks in a stepwise dose increase on top of SUs ± metformin. Primary outcome was change in HbA1c from baseline to Week 24. Results Lixisenatide provided a significant reduction in HbA1c at Week 24 versus placebo (LS mean: - 0.85% vs. - 0.10%; p < 0.0001) and more patients achieved HbA1c < 7.0% (36.4% vs. 13.5%; p < 0.0001). Lixisenatide significantly lowered FPG and body weight versus placebo. In breakfast meal test patients, lixisenatide reduced 2-hour PPG versus placebo (LS mean: - 111.48 vs. - 3.80 mg/dL [- 6.19 vs. - 0.21 mmol/L]; p < 0.0001) and glucose excursion (- 94.11 vs. + 6.24 mg/dL [- 5.22 vs. + 0.35 mmol/L]), and reduced 2-hour glucagon, insulin, proinsulin, and C-peptide. The percentage of AEs was 68.3% for lixisenatide and 61.1% for placebo; and for SAEs: 3.5% versus 5.6%, respectively. Lixisenatide did not significantly increase symptomatic hypoglycemia versus placebo (15.3% vs. 12.3%, respectively); one severe episode of hypoglycemia was reported with lixisenatide. Conclusions Once-daily lixisenatide significantly improved glycemic control, with a pronounced postprandial effect, without significant increase in symptomatic/severe hypoglycemia risk and with weight loss over 24 weeks. © 2014 The Authors.
Active- and placebo-controlled dose-finding study to assess the efficacy, safety, and tolerability of multiple doses of ipragliflozin in patients with type 2 diabetes mellitusVivian A. Fonseca | Ele Ferrannini | John P. Wilding | Wim Wilpshaar | Perminder Dhanjal | Greg Ball | Sally Klasen
Volume 27, Issue 3, May 2013, Pages 268-273
Aim To evaluate the efficacy, safety, and tolerability of multiple doses of ipragliflozin. This novel selective inhibitor of sodium glucose co-transporter 2 is in clinical development for the treatment of patients with type 2 diabetes mellitus (T2DM). Methods In a 12-week, multicenter, double-blind, randomized, active- and placebo-controlled dose-finding study, patients were randomized to one of four ipragliflozin treatment groups (12.5, 50, 150, and 300 mg once daily), placebo, or active control (metformin). The primary efficacy outcome was the mean change from baseline to Week 12 of glycosylated hemoglobin (HbA1c) compared with placebo. Results Ipragliflozin showed a dose-dependent decrease in HbA1c of - 0.49% to - 0.81% at Week 12 compared with placebo (P < 0.001); a decrease of - 0.72% was seen with metformin. Among the ipragliflozin groups there was also a dose-dependent reduction in body weight of up to 1.7 kg. Proportions of patients experiencing treatment-emergent adverse events were similar across all groups: ipragliflozin (45.7-58.8%), placebo (62.3%), and metformin (59.4%). No clinically relevant effects were observed for other safety measures. Conclusions After 12 weeks of treatment, ipragliflozin dose-dependently decreased HbA1c, with ipragliflozin ≥ 50 mg/day in patients with T2DM; an effect comparable to metformin. No safety or tolerability concerns were identified. © 2013 Elsevier Inc.
New diagnostic tests for diabetic distal symmetric polyneuropathyNikolaos Papanas | Dan Ziegler
Volume 25, Issue 1, January 2011, Pages 44-51
Neuropathy needs to be diagnosed early to prevent complications, such as neuropathic pain or the diabetic foot. It is obvious that diagnosis of neuropathy needs to be improved. New peripheral nerve function tests that appear to facilitate diagnosis are now emerging. This review outlines the new tests that have been proposed for the diagnosis of diabetic distal symmetric polyneuropathy, the commonest form of neuropathy in diabetes. New tests are classified into those mainly assessing large-fiber function (tactile circumferential discriminator, steel ball-bearing, and automated nerve conduction study) and those mainly assessing small-fiber function (NeuroQuick and Neuropad). Emerging tests are promising but must be evaluated in prospective studies. Moreover, their cost-effectiveness needs more careful appraisal. The clinician should, therefore, still rely on established modalities to diagnose neuropathy, but wider use of the new tests is expected in the near future. © 2011 Elsevier Inc. All rights reserved.
Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD)Ishan Hirji | Zhenchao Guo | Susan W. Andersson | Niklas Hammar | Andres Gomez-Caminero
Volume 26, Issue 6, November 2012, Pages 513-516
The objective of this observational study was to quantify the incidence of urinary tract infections (UTI) among diabetes patients and compare this risk to patients without diabetes. Type 2 diabetes patients and a matched sample of patients without diabetes were identified from GPRD. Patients were followed for 1-year from their study index date until the first record of a UTI or a censored event. The incidence of UTI was 46.9 per 1000 person-years (95% confidence interval (CI) 45.8-48.1) among diabetes patients and 29.9 (95% CI 28.9-30.8) for patients without diabetes. Compared to the non-diabetes patients, the risk of UTI was 1.53 (95% CI 1.46-1.59) for all diabetes patients; and 2.08 (95% CI 1.93-2.24) for patients with previously diagnosed diabetes. In general practice, across gender and age, the risk of developing a UTI is higher for patients with type 2 diabetes compared to patients without diabetes. © 2012 Elsevier Inc.
Obesity and hyperlipidemia are risk factors for early diabetic neuropathyA. Gordon Smith | J. Robinson Singleton
Volume 27, Issue 5, September 2013, Pages 436-442
The Utah Diabetic Neuropathy Study (UDNS) examined 218 type 2 diabetic subjects without neuropathy symptoms, or with symptoms of < 5 years, in order to evaluate risk factors for neuropathy development. Each subject completed symptom questionnaires, the Utah Early Neuropathy Scale (UENS), nerve conduction studies (NCS), quantitative sensory testing (QST) for vibration and cold detection, quantitative sudomotor axon reflex testing (QSART), and skin biopsy with measurement of intraepidermal nerve fiber density (IENFD). Those with abnormalities of ≥ 3 were classified as having probable, and those with 1-2 as possible neuropathy. The relationship between glycemic control, lipid parameters (high density lipoprotein and triglyceride levels), blood pressure, and obesity, and neuropathy risk was examined. There was a significant relationship between the number of abnormalities among these features and neuropathy status (p < 0.01). Hypertriglyceridemia, obesity and 3 or more abnormalities increased neuropathy risk (risk ratios 2.1 p < 0.03, 2.9 p > 0.02 and 3.0 p < 0.004 respectively). Multivariate analysis found obesity and triglycerides were related to loss of small unmyelinated axons based on IENFD whereas elevated hemoglobin A1c was related to large myelinated fiber loss (motor conduction velocity). These findings indicate obesity and hypertriglyceridemia significantly increase risk for peripheral neuropathy, independent of glucose control. Obesity/hypertriglyceridemia and hyperglycemia may have differential effects on small versus large fibers. © 2013 Elsevier Inc.
Prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus and their relationship with duration of the disease and chronic complicationsMaíra Viégas | Christiane Costa | Arthur Lopes | Luiz Griz | Maria Antonieta Medeiro | Francisco Bandeira
Volume 25, Issue 4, July 2011, Pages 216-221
Controversial data suggest that patients with type 2 diabetes mellitus have an increased risk of fractures despite having, in some studies, higher bone mineral density. Methods: The aim of this study was to determine the prevalence of osteoporosis and morphometric vertebral fractures in 148 postmenopausal diabetic women, aged 61.87±7.85 years, and their relationship with clinical and metabolic factors and chronic complications of the disease. Results: The prevalence of osteoporosis was 30.4% at lumbar spine (LS) and 9.5% at femoral neck (FN). The prevalence of vertebral fractures was 23%, mostly mild and located at the thoracic spine. Patients with fractures were older (P<.001), had been in the menopause for a long period (P=.005), had lower creatinine clearance (P=.026) had and lower bone mineral density at LS (P=.01) and FN (P=.042). The frequency of fractures increased with age (P<.001), with the duration of the disease (P=.037) and with the presence of retinopathy (P=.030). In patients with fractures, the prevalence of osteoporosis increased to 40% at LS (P=.004) and to 35.7% at FN (P=.049). After logistic regression adjustment, it was observed that the likelihood of presenting vertebral fractures was significantly increased at the age of 60 years or older (P<.001) and with the presence of osteoporosis at LS (P=.006), irrespective of blood glucose control. Conclusion: We found a high prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus, irrespective of blood glucose control, and these conditions were more frequent in long-standing disease and in patients with retinopathy and impaired renal function. © 2011 Elsevier Inc. All rights reserved.
Effectiveness of insoles used for the prevention of ulceration in the neuropathic diabetic foot: A systematic reviewJoanne Paton | Graham Bruce | Ray Jones | Elizabeth Stenhouse
Volume 25, Issue 1, January 2011, Pages 52-62
Context: Ulceration can be a debilitating and costly complication of the neuropathic diabetic foot. Insoles inserted into footwear are routinely used in clinical practice to help to prevent ulceration. Aim and Scope of the Review: This review evaluated the effectiveness of insoles used for the prevention of ulcer in the neuropathic diabetic foot. Methods: Databases were searched from inception to 2008, supplemented by hand searching of references and grey literature. Data extraction and methodological quality assessment were independently conducted by two reviewers following the recommendations of the Centre for Reviews and Dissemination. Results: A total of five trials met the inclusion criteria: two randomised control trials (RCTs), two case control studies, and one follow-up study. The methodological quality of the majority of studies was poor. Omitted details regarding the generalisability of results made study comparison and inference to practice difficult. There is a small amount of limited evidence indicating that insoles are effective in reducing incidence of ulceration and reducing plantar peak pressures in the diabetic neuropathic foot. No study included economic analysis or patient-based outcome measures. Conclusions: Insoles appear of use for the prevention of neuropathic diabetic foot ulceration, although evidence is limited. Clinical recommendation regarding type and specification of insole is not possible at this time. There is an essential need for a large well-designed RCT comparing different types of commonly used insole for the prevention of ulceration in the diabetic neuropathic foot. Outcome measures should include patient perceptions of the effectiveness and cost-effectiveness analysis. © 2011 Elsevier Inc. All right reserved.
Efficacy and safety of sitagliptin added to ongoing metformin and pioglitazone combination therapy in a randomized, placebo-controlled, 26-week trial in patients with type 2 diabetesVivian Fonseca | Bart Staels | Jerry D. Morgan | Yue Shentu | Gregory T. Golm | Amy O. Johnson-Levonas | Keith D. Kaufman | Barry J. Goldstein | Helmut Steinberg
Volume 27, Issue 2, March 2013, Pages 177-183
Aims: To assess efficacy and safety of sitagliptin, a dipeptidyl peptidase-4 inhibitor, in combination therapy with metformin (≥ 1500 mg/day) and pioglitazone (≥ 30 mg/day) in patients with type 2 diabetes (T2DM) with inadequate glycemic control (hemoglobin A1c [HbA1c] ≥ 7.5% and ≤ 11%). Methods: This placebo-controlled, double-blind study included 313 patients, mean baseline HbA1c = 8.7%, who were randomized to receive sitagliptin 100 mg/day or placebo for 26 weeks. Results: The addition of sitagliptin led to significant (P <.001) mean changes from baseline relative to placebo in HbA1c (- 0.7%), fasting plasma glucose (- 1.0 mmol/L), and 2-h post-meal glucose (- 2.2 mmol/L). In patients with baseline HbA1c ≥ 9.0%, mean changes from baseline in HbA 1c were - 1.6% and - 0.8% for the sitagliptin and placebo groups, respectively (between-group difference -0.8%; P <.001). The incidences of reported adverse events were generally similar between the treatment groups. Incidences of symptomatic hypoglycemia were 7/157 [4.5%] and 6/156 [3.8%] in the sitagliptin and placebo groups, respectively (P =.786). Two patients, both in the placebo group, experienced an episode of hypoglycemia that required non-medical assistance. Conclusions: In this 26-week study, addition of sitagliptin to combination therapy with metformin and pioglitazone improved glycemic control and was generally well tolerated. © 2013 Elsevier Inc. All rights reserved.
Pentoxifylline for Renoprotection in Diabetic Nephropathy: The PREDIAN study. Rationale and basal resultsJuan F. Navarro-González | Mercedes Muros | Carmen Mora-Fernández | Haridian Herrera | Beatriz Meneses | Javier García
Volume 25, Issue 5, September 2011, Pages 314-319
Statements of the Problem: Diabetic nephropathy (DN) is the main cause of end-stage renal disease (ESRD). Renin-angiotensin system (RAS) blockade is the standard of care; however, a significant proportion of patients progress to ESRD. Pentoxifylline (PTF) possesses properties suggesting potential renoprotective efficacy. The aim of the Pentoxifylline for Renoprotection in Diabetic Nephropathy (PREDIAN) study is to test the efficacy of PTF addition to RAS blockade on the progression of DN. Here we report the study design and the baseline patient characteristics. Methods: This is an investigator-initiated, single-center, prospective, randomized, controlled, clinical trial without any commercial interest, funded by the Spanish Ministry of Science and Innovation. One hundred and sixty-nine type 2 diabetic patients with Stage 3 and 4 chronic kidney disease (CKD) were randomized to a control group (n=87) or an active group (n=82), which will receive PTF (1200 mg/day) for 24 months. The primary outcome measure is the difference in estimated glomerular filtration rate (eGFR) between the groups at the end of the study. Results: The baseline characteristics of the subjects are as follows: 116 patients (68.6%) with Stage 3 CKD and 53 (31.3%) Stage 4 CKD, age 69±9 years, duration of diabetes 15±3 years, eGFR 37±12 ml/min per 1.73 m 2, albuminuria 1.39±1.16 g/day, blood pressure 142±8/86±8 mmHg. Inflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-10) and polymorphisms of the coding genes for these molecules are studied. Conclusions: The PREDIAN study will provide evidence on the renoprotective benefit of PTF in addition to interventions of proven efficacy (RAS blockade) in DN. © 2011 Elsevier Inc.
The association between cardiac autonomic neuropathy with metabolic and other factors in subjects with type 1 and type 2 diabetesChristina Voulgari | Michael Psallas | Alexander Kokkinos | Vasiliki Argiana | Nicholas Katsilambros | Nicholas Tentolouris
Volume 25, Issue 3, May 2011, Pages 159-167
Background: Cardiac autonomic neuropathy (CAN) is a common diabetes complication associated with poor prognosis. This cross-sectional study aimed to examine for associations between CAN and metabolic and other parameters in patients with either type 1 (T1DM) or type 2 (T2DM) diabetes. Patients and Methods: A total of 600 patients (T1DM, n=200; T2DM, n=400) were recruited. Participants with overt nephropathy, macrovascular complications, and treated hypertension were excluded. CAN was diagnosed when two of the four classical autonomic function tests were abnormal. Results: CAN was diagnosed in 42.0% and in 44.3% of the participants with T1DM and T2DM, respectively. Multivariate logistic regression analysis demonstrated that, in T1DM, the odds [OR (95% confidence intervals)] of CAN increased with higher waist circumference [1.36 (1.01-2.02)], systolic blood pressure [1.16 (1.03-1.31)], hypertension [1.19 (1.03-2.67)], smoking [1.10 (1.12-1.40], fasting glucose [1.01 (1.00-1.01)], HbA1c [1.69 (1.07-2.76)], pubertal diabetes onset [1.08 (1.03-1.24)], LDL cholesterol [1.01(1.00-1.02)], triglycerides [1.58 (1.24-1.48)], retinopathy [1.13 (1.04-1.41)], peripheral neuropathy [2.53 (1.07-2.99)], glomerular filtration rate [0.93 (0.87-0.99)], and microalbuminuria [1.24 (1.12-1.36)]. The same analysis in T2DM demonstrated that the odds of CAN increased with higher waist circumference [1.08 (1.00-1.39)], systolic blood pressure [1.06 (1.02-1.12)], hypertension [1.50 (1.24-2.03)], smoking [1.22 (1.14-1.49)], diabetes duration [1.20 (1.09-1.34)], fasting glucose [1.21 (1.12-1.31)], HbA1c [1.25 (1.08-1.45)], LDL cholesterol [1.35 (1.04-1.75)], triglycerides [1.30 (1.00-1.68)], retinopathy [1.24 (1.16-1.35)], peripheral neuropathy [1.79 (1.07-2.01)], glomerular filtration rate [0.96 (0.95-0.97)], and microalbuminuria [1.20 (1.14-1.36)]. Conclusions: CAN is common in diabetes and is associated with modifiable factors including central fat distribution, hypertension, dyslipidemia, worse diabetes control, and smoking, and with the other microvascular complications of diabetes. Our findings emphasize the need for a multifactorial intervention for the prevention of CAN. © 2011 Elsevier Inc. All rights reserved.
Reductions in systolic blood pressure with liraglutide in patients with type 2 diabetes: Insights from a patient-level pooled analysis of six randomized clinical trialsVivian A. Fonseca | J. Hans Devries | Robert R. Henry | Morten Donsmark | Henrik F. Thomsen | Jorge Plutzky
Volume 28, Issue 3, January 2014, Pages 399-405
Aims To quantify the effect of liraglutide on systolic blood pressure (SBP) and pulse in patients with type 2 diabetes (T2D), and assess the influence of covariates on observed SBP reductions. Methods A patient-level pooled analysis of six phase 3, randomized trials was conducted. Results The analysis included 2792 randomized patients. In the intention-to-treat population (n = 2783), mean [± SE] SBP reductions from baseline with liraglutide 1.2 mg (2.7 [0.8] mmHg) and 1.8 mg (2.9 [0.7] mmHg) once daily were significantly greater than with placebo (0.5 [0.9] mmHg; P = 0.0029 and P = 0.0004, respectively) after 26 weeks, and were evident after 2 weeks. Liraglutide was also associated with significantly greater SBP reductions than glimepiride and, at a dose of 1.8 mg, insulin glargine and rosiglitazone. SBP reductions with liraglutide weakly correlated with weight loss (Pearson's correlation coefficient: 0.08-0.12; P < 0.0148). No dependence of these reductions on concomitant antihypertensive medications was detected (P = 0.1304). Liraglutide 1.2 and 1.8 mg were associated with mean increases in pulse of 3 beats per minute (bpm), versus a 1 bpm increase with placebo (P < 0.0001 for each dose versus placebo). Conclusions Liraglutide reduces SBP in patients with T2D, including those receiving concomitant antihypertensive medication. © 2014 The Authors.


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Terry Sober
**** *. **** ****** *********, CA ***33 (714) ***-**** email@example.com
Construction and environmental project manager with a 20-year record of success overseeing all phases of construction, infrastructure and environmental projects for commercial and residential clients. Experience includes managing crews, asbestos abatements and a variety of other construction/demolition projects. Backed by strong credentials and a proven history of on-time, on-budget and high-quality project completions.
Key Skills
Construction/Environmental Projects
Infrastructure Improvement Projects
Environmental Remediation Projects Site Safety/OSHA Compliance
QA/QC/Field Engineering
Change Order Management Budgeting & Cost Controls
Subcontractor/Crew Supervision
Employer Summary
R. CONTRSTRUCTION SERVICES Project Manager, Remodel and Renovations, 2011 to Present
Manage residential and commercial remodel and renovation projects.
Assess Variances from project plans.
Gather matrix's and implemented change as necessary.
Ensure that projects remain within the specified scope, time, cost and quality objectives.
FLAGSHIP / PDG, INC. Project Manager, Estimator Hazardous Materials Abatement 2001 to 2011
Review proposal specifications and drawings to determine scope of work and cost of estimate for hazardous abatement, demolition and renovation projects.
Prepare estimates and enter into estimating program.
Identify qualified suppliers/subcontractors and solicit bids.
Draft scope inclusions and exclusions.
Develop scope and project plan for awarded projects.
Organize, analyze and motivate team to help them meet their objectives.
Ensure project is completed on time and within budget.
Serve as customer's point of contact for all project related issues and concerns.
FRANK SINATRA TOURNAMENT – Chairman, Food and Beverage 2002 to Present
Manage food and beverage department.
Ensure that all bars and restaurants are in place and stocked.
Schedule and assign all workers to their station.
Interface with clients, vendors and main office.
Project Highlights
R. Construction Service Budgets: Up to $100,000.00
Serving as project manager I have successfully managed and completed multiple projects on time and within or under budget.
Flagship/PDG,Inc. Budgets: Up to $10,000,000.00
As project manager I successfully estimated and managed multiple projects simultaneously and generated over $4,000,000.00 of revenue within a one year period.
Frank Sinatra Celebrity Golf Tournament
For ten years I have donated my time as a volunteer chairman of food and beverage and have helped to raise an average of $200, 000.00 per year for the charity for abused children.
Education & Certifications
CMI – Construction estimating and math skills
Natec International – Asbestos worker skills, state and federal regulations as applied to asbestos and disposal
Quantec – Identifying lead hazards during demolition or renovations and proper remediation procedures
Indoor Air Quality Association – State and federal regulations of mold remediation and proper abatement techniques
Project Manager Construction
Denver, CO - asbestos, sprinkler, cycle, project,...
Forklift Operator,Data Entry,Scanner, Inventory Control
Brea, CA - asbestos, forklift operator, operator, certified,...
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Training Quality Control
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United States - asbestos, construction, airport, project, 1987,...

subset: commoncrawl


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Carline, Tom (1988) Axonal Projections of the Lateral Nerve of Gryllus bimaculatus and Acheta domesticus DTSCM. Entomol, 6. pp. 23-26.
Dunlop, G (1988) The effectiveness of the three-year chiropody course in preparing for professional life. International Journal of Lifelong Education , 7 (1). pp. 53-78.
Fyfe, Lorna and Coleman, G and Munro, A L S (1988) ). The combined effect of isolated Aeromanas salmonicida protease and haemolysin on Atlantic salmon, Salmo salar L. compared with that of total extra-cellular products preparation. Journal of Fish Diseases, 11 (1). pp. 101-104. ISSN 0140-7775, ESSN: 1365-2761
Gow, Iain F and Corrie, J E and Edwards, C R and Williams, B C (1988) The stability of tritiated serotonin stored at 4 degrees C--implications for platelet uptake studies. Thrombosis research, 52 (3). pp. 263-8. ISSN 0049-3848
Gow, Iain F and Jones, D B and Billett, J and France, A J and Edwards, C R (1988) Platelet serotonin concentration in patients with finger-clubbing. Lancet, 2 (8610). p. 579. ISSN 0140-6736
Lavoie, N F and Mercer, Tom and Ciolfi, M A (1988) Assessment of VO2 max of competitive cyclists using conventional ergometry versus a sports-specific test. In: Medical and scientific aspects of cycling. Illinois Human Kinetics, Champaign, pp. 141-145. ISBN 9780608070728
Al-Dujaili, Emad A S and Denyer, M and Milne, C and Philo, R and Pritchard, J and Allen, A (1988) Serozyme: a manual non-isotopic immunoassay system: in Immunometric assays; overview & new developments, Proceedings of NEQAS meeting,Cardiff. In: NEQAS meeting, Cardiff. (Unpublished)


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With a stay at Residencial Mar e Mar in Florianopolis (Ingleses), you'll be convenient to Ingleses Beach and Aqua Show Park. This guesthouse is within the vicinity of Cachoeira do Bom Jesus Beach and Lagoinha Beach.
Make yourself at home in one of the 15 guestrooms, featuring kitchens with full-sized refrigerators/freezers and stovetops. Complimentary wireless Internet access keeps you connected, and satellite programming is available for your entertainment. Conveniences include ceiling fans, housekeeping is provided on a limited basis, and rollaway/extra beds can be requested.
Make use of convenient amenities such as complimentary wireless Internet access, tour/ticket assistance, and barbecue grills.
Business, Other Amenities
Featured amenities include multilingual staff and luggage storage. Free self parking is available onsite.


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International Snow Leopard Trust
Rating: 4.87 stars 63 63 reviews
4649 Sunnyside Ave N #325 Seattle WA 98103 USA
Founded in 1981 in Seattle, WA, the Trust is a 501(c)3 non-profit organization whose mission is to protect the snow leopard and its mountain ecosystem through a balanced approach that addresses the needs of the local people and the environment.
Snow leopards range over two million square kilometers of mountain in Central Asia, including the formidable Himalayas. Experts currently estimate as few as 3,500 exist in the wild, fewer than the world''s tiger population. As an "umbrella" or keystone species, snow leopard conservation has far-reaching importance as it leads to the protection of hundreds of other plants and animals sharing the cat''s ecosystem. The International Snow Leopard Trust is the oldest and largest organization focused solely on saving this important species. The Trust works nationally and internationally to raise awareness about endangered species, and to empower people living within snow leopard range to become stewards of their environment. To this end, the Trust conducts educational outreach, scientific research, and community-based conservation.
Target demographics:
protect these endangered cats and their natural habitat
Direct beneficiaries per year:
Our partner communities in China, India, Kyrgyzstan, Mongolia, and Pakistan - and the snow leopard of course!
Geographic areas served:
five snow leopard range countries
Snow Leopard Enterprises, which provides herders with the financial assistance, logistical support, equipment, and training they need to turn raw wool into high-quality, felted products such as rugs and clothing. The Trust purchases these products directly from the herders and sells them worldwide to increase awareness about snow leopard conservation. Herders agree to help the Trust protect snow leopards, their prey, and the habitat they all share. The Trust also helps communities establish livestock insurance programs, where herders can pay a premium to insure their goats and sheep against predation by snow leopards, bears, and wolves - making the financial impact of losing animals much easier to bear, and leading to increased tolerance towards these predators. Through its Ecosystem Health project, the Trust also helps establish livestock vaccination programs in snow leopard habitat; lowering livestock mortality rates and helping herders further secure their livelihood.
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Reviews for International Snow Leopard Trust
Here at KittyKit we love the Snow Leopard, we are thinking of ways moving forward how we can raise money for these Amazing animals. More to follow soon!!! www.kittykit.co.uk


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The man who ended the 15-year reign of evil by serial paedophile Dennis John McKenna says it is time for those in authority who did nothing to face "their day of reckoning".
Todd Jefferis, 39, gave powerful evidence to the inquiry into child sex abuse at the State-run St Andrew's Hostel soon after it was told yesterday how a "disproportionate" number of boarders had committed suicide in the years after McKenna's crimes.
_The West Australian _ understands at least seven of McKenna's victims from the 1970s and 1980s have taken their own lives.
"I can't imagine how the families of these boys feel," Mr Jefferis said after giving his evidence.
"No one will ever forgive any of these people in authority for not protecting us.
"I can't wait to see some of these blokes get their day of reckoning."
Mr Jefferis was 17 in 1990 when McKenna interfered with him, then expelled him from the Katanning hostel when he complained about the abuse.
Sitting in Katanning yesterday, the inquiry began with an opening statement from Philip Urquhart, the lawyer assisting investigation chief Peter Blaxell.
"The tentacles of the sexual offending that took place at the hostel have spread beyond the victims and beyond the time frame of the offences," he said.
"It has caused fractures within this community, divisions within families and what appears tragically to be a disproportionate rate of suicide, particularly among males."
Mr Urquhart said while McKenna "hid behind a veil of decency", those who tried to blow the whistle on him were "cast as the villains" by community leaders.
He said that McKenna, now behind bars for the second time for his abuse of St Andrew's boys, was "untouchable" from 1975 to 1990.
The inquiry was told that when Mr Jefferis went with his mother to report sexual abuse to then Katanning Senior High School principal Ian Murray, Mr Murray dismissed the claims. "It was as though I'd accused him," Mr Jefferis said.
"He didn't want to know about it."
Mr Murray told _The West Australian _ last year that he did not think Mr Jefferis was referring to claims of a sexual nature when he came to see him.
But three members of Mr Jefferis' family told the inquiry it was made clear to the principal and hostel chairman Garth Addis that the allegations were about sexual abuse.
After McKenna was arrested, a public meeting was held in Katanning and soon after Mr Jefferis' family members received legal threats from the paedophile demanding they apologise to him and Mr Murray.
Mr Blaxell commended Mr Jefferis for his bravery and said he had saved many people from further devastation.


text: Daily Press December 17, 2000 SundayFinal EDITION SECTION: LOCAL, Pg. B6LENGTH: 176 words HEADLINE: WALLENS RIDGE INMATESAYS RIOT WAS RACIALLY MOTIVATED BYLINE: TheAssociated Press DATELINE: ROANOKE BODY:An inmate involved in a riot at Wallens Ridge StatePrison earlier this month says the incident grewoutof frustration with the way blacks and Hispanics aretreated at the supermax facility. In a letterwritten to an inmate support group in his home state ofConnecticut, inmate Michael Reddick said an attempt by agroup of about 70 inmates to discuss their concerns wasmetwith gunfire. Eighteen of the inmates receivedminor injuries after correctional officers opened fireon thegroup with shotguns that fire rubberpellets the morning of Dec. 3, prison officials said.As the inmates were walking back to their cells fromthe dining area, they violated prison rulesbyleaving the sidewalk and banding together in the centerof a recreation yard. Reddick said the groupdemanded to know why black and Hispanic inmates weretargeted for"intimidation and harassment" bycorrectional officers. He said the group also sought a meetingwitha prison officer.


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Safety Tips to Keep Your Pets Safe This Thanksgiving
Thanksgiving is a time for family, friends and holiday merrymaking—but also a time for possible distress for our animal playmates. Pets won't be so thankful if they munch on undercooked turkey or a pet-unfriendly flower arrangement, or if they stumble upon an unattended alcoholic drink.
Pink Cat Graffiti on Green Gradient Square Brownie by pearl888
Custom designed Cookies and Brownies at 400 Planets


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Blue October frontman performing songs, spoken word at Turner Hall
Blue October frontman Justin Furstenfeld is coming to Turner Hall Ballroom April 13, but it won't be a typical concert.
'Malcolm and Teresa' has trouble finding heart of pair's connection
In early 1968, conservative British journalist Malcolm Muggeridge was asked to conduct a televised interview of an Albanian nun. He had never heard of her. The world did not yet know her. It soon would: Her name was Mother Teresa.
That's the setup in Cathal Gallagher's "Malcolm and Teresa," which is receiving its regional premiere at Christian-based Acacia Theatre Company in Mequon, in a production that opened Friday night under Elaine Rewolinski's direction. »Read Full Article
Neko Case's voice shines in an elegant, melancholy set
The human voice can be the most singularly beautiful musical instrument there is, but it's not hard to think of well-compensated pop singers who treat their instruments, or allow them to be treated, as if they were beside the point.
Neko Case is not among them. »Read Full Article(1)