text:
Star Wars Republic Commando is a squad-based first person shooter that lets you explore the elite world of the Star Wars military. Leading a 4-man squad of Republic Commandos, your missions take you deep behind enemy lines on over 14 intense and challenging levels through three different campaigns where you will face more than ten brutal enemies. You'll have more than a dozen deadly weapons at your disposal, but none more lethal than your squad. What makes the squad in Star Wars Republic Commando so unique is the game's innovative 'One Touch Squad Control' system that allows you to engage your squad with just one button.
We started editing the graphic of the game by adding a new LEC(Lucas Arts) Intro in a higher quality(1920x1080px FullHD 60FPS as AVI scaled down to a size which is readable by the Unreal Engine 2 which is used by Republic Commando). We uploaded the RAW video on YouTube so that you guys can have a look on it before we publish it via publishing our mod.
What else are we trying to do?
Well, what we want at all are graphic improvements of Republic Commando. The lightning is kinda old but still doing it's job, the bump mapping textures aka normal maps are completly wrong interpreted by the engine which is a big problem. Anti Alising is not even on it's best quality as good as it should be in games like Call of Duty: Modern Warfare which was published just a few years after Republic Commando and works fine with AA even in FullHD. This is the next point: We're are going to make the game playable in fullHD(1920x1080px), at the moment you can just set in fullHD by edting the system.ini inside of you save folder but we would like to choose it while setting up the graphic via the ingame menu.
To add more detail to the game we are going to add a lot of new textures with a higher resolution than the old ones, including new/better bump or normalmaps. We focus on vehicles, the HUD and it's HUDArms, Characters like Wookiees, Trandoshians and Clonetroopers but also on the terrain, plants and other ingame objects.
We want to replace all static tree and plant objects with a moving, "living" plant so that it gives you a more realistic feeling.
All animations will be smoother, all skeletal meshes will have more polygons as far as posibile. All static meshes will also contain more polygons as far as posibile and every mesh need to be retextured with high quality textures.
The HUD needs to be removed by a completly new one, or at least a new looking one because of dll-files which are not completly read- and editable by our team we can not change all of the HUD. We need to add new textures on it in a better quality.
At last but not at least particle effects are going to be more smooth and nicer to look at, that means they'll contain high quality shaders.
I hope you're excited, cause I am!
Since I am a student, my workload has increased. I have NOT abandoned this mod!! The work WILL go on!!
As requested, this a general outline of what the campaign story will look like. Although it will be based on the storyline of the Machinima, there will...
Here's a Podcast with myself and CM-Balkoth, talking about the mod, progress, the state of the team, and generally messing around.
Basically the title explains it all Republic Commando Extra Weapons Mod Release Date Still TBD.... I know this may not be important to say but I need...
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Just a fixed version of the original HUD texture if you prefer this one over mine. Put it into GameData\Textures and replace the old file.
-Scopes are fixed. -Wookie Bowcaster has been given customized wide angle scope. -Offscreen teammate arrows line up with their numbers. -Many other tweaks...
It's been a while since the last TX WarPack update has been released on ModDB, but we have been working on it nevertheless. This is why we will skip version...
This fixes the extremely high mouse acceleration in the menu by forcing the game to use VSync. It also adds 8xMSAA since the default anti aliasing seems...
This file recovers RC's Multiplayer server browser which has been shut down with GameSpy. It's based on PLASMA[GER]'s fix I just wrote a little program...
In this zip folder, will have the files and the instructions on how to get Star Wars: Republic Commando (mostly) working with a Xbox 360 controller (note...
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Wow for the time I've been off, there's been a lot of mods lately
Can someone help me, I have this weird checkered screen everytime I begin the game, it has something to do with the 1.3 server patch
Delete system.ini file in your System and save folder and restart the game.
I'd like to know how I can create a custom skin to use. Anybody have experience with reskinning in this game?
Anyone know if any if the big mods developed for this have actually been released? I feel like they all seem to sink into a developmental mud pit at some point of their existence... not to sound like a pessimist or anything lol
Does anybody know which is the most recent patch for Republic Commando?
I saw unofficial patches flying around the net (e.g. v1.2).
And does the GOG installer already comes with a prepatched game?
I found this program call GameRanger, its free to download and lets you play multiplayer on older games that have been discontinued. It supports Republic Commando and I was wondering if anyone would want to join me for a match? Username on both GameRanger and RC is GreenWizard.
sucks! Use direct ip to play on server instead of this crappy programm
I use that
Is anyone good with modding this game? I've been adding clone troopers and other vehicles to the VERY FIRST geonosis level, the map name is geo_01a. I'm trying to make it so a regular clone trooper and a clean clone commando follow you and assist you through the level before you find Scorch. All is good, but the little area where you go after first using the bacta station, the clones won't follow me. Anywhere before that, the clones will. I have to physically move the commando by pushing him and the regular clone trooper just stands there, anyone know how I can make it so they follow me through the whole level and not just stopping at that little part?
delete the "block path" that is where the little barrier falls (the little apple with a line through it, because a regular path node is just an apple)
Did you check the path nodes for the map? One way could be a scripted trigger setting the AI to follow you but the best solution would be a script so they can hook up with and follow your orders.
I'm new to unreal engine, but I will try that. Do you have a skype that I could msg you on incase i have another question or two?
We just noticed. swrcadmin @skype. I could help ya as well.
Only registered members can share their thoughts. So come on! Join the community today (totally free - or sign in with your social account on the right) and join in the conversation.
Highest Rated (8 agree) 8/10
RC is the most serious approach to the one of the most interesting factions from the Star Wars saga: The Clone Army. The game itself depicts a lot of story that was not shown on Episode 2 nor Episode 3. If you enjoyed the cartoon network series, the comics or just the Episode 2 and 3 clone story, then this is the game for you. As a linear shooter, RC has much of what made Brothers in Arms a sales success. You have to give orders, make your way through and plan your moves. The game, though excellent…
Dec 6 2010 by X4VI3R


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Crafting With The Craftwell eCraft and eBosser: Scrapbooking, Paper Crafts, and So Much More
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Hand Dyed Bird Tags with Paper Gift Bags
By: Melony Bradley
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Make these Hand Dyed Bird Tags with Paper Gift Bags as a charming way to wrap up presents. Melony Bradley has created this wonderful tutorial on homemade gift tags using your own dyed paper and some stamps. Put your creativity to the test with this sweet project.
- Jacquard Products Idye
- Jacquard Products Lumier paint, metallic silver
- Plastic bag, 1 gallon
- Paper gift tags
- Paint brush
- Stamps and stamp pad
- Neopaque paint, black
- Brown paper bags
- Lace trim and ribbon
- Embellishments (buttons, jewels, pearls)
- Fluted paper
- Large paper punch
- Shredded kraft paper
- Jacquard Products Idye comes in machine washable friendly packets but can be dissolved in hot water and used for other surfaces such as paper. I like to mix everything up in a gallon sized baggie that can be zipped up and stays fairly mess free. I dipped the tags into the mixture and let them dry on paper towels for a few minutes.
- Once dry, I dry brushed them with Jacquard's Lumiere in Metallic Silver to give them extra sheen. Adding paint to the tags also makes them more durable.
- I used StazOn inks and two of my favorites, this script font stamp and my little bird to stamp toward the bottom of the tags.
- Dry brushing some Neopaque paint around the edges of the tags added adds a finishing touch.
- I added my tags to plain lunch sacks with the tops rolled down cuff-style. I added some lace trim and a little sparkly embellishment to the tag. Handles were created using paper punches and fluted paper from Canvas Corp.
- Stuffed with shredded kraft paper, these bags will make fun and fast Easter treat bags.
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Holly's Birthday
Comments (7)
GeminiRJ on
You'd never guess by looking at it that it was a last minute job! Very nice.
kansaslaura on
I love it!! Fun colors and great use of them :)
practiceandpatience on
great colors, they match perfectly to the container
sylly on
I love the design and how it all matches! Perfecto!
Daisys_Cakes on
Critique group member: Just adorable! I love the presentation too!
snowshoe1 on
The cookies are amazing. I would have suggested the opposite of praticeandpatience - use a different container because the cookies don't stand out as well because of they match so much.
tiptop57 on
Again, your cookies are wonderful! Well done, bravo.
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text:
Emergency Medical Technician (EMT)
ZEMT- 716 Emergency Medical Training (EMT)
Program (171 hours)
Fee: $935 payable in full at the time of registration.
Students are required to purchase textbooks at an approximate cost of $180.
EMT exam fees are separate expenses.
|Fall 2016 Program
|September - December 2016
Daytime: Monday, Wednesday, Thursdays, 8:00am - 12:00pm ZEMT 716-C01
Evening: Monday, Wednesday, Thursdays, 6:00pm - 10:00pm ZEMT 716-C02
Except where noted
September 7, 8, 12, 14, 15, 19, 21, 22, 26, 28, 29
October 3, 5, 6, (No Class October 10, Columbus Day) 12, 13, 17, 19, 20, 24, 26, 27, 31
Saturday TBA : Auto Extraction 8am - 12pm
November 2, 3, 7, 9, 10, 14,16, 17, 21, (No Class November 23 & 24,Thanksgiving), 28, 30
December 1
State Practical Exam: TBA
For more Information, please call the Workforce Training Office (413) 755-4225 or email firstname.lastname@example.com
Program Description
The Emergency Medical Training Program consists of approximately 171 hours of in class lectures and a minimum of 20 hours on-line training, a field trip, and workshops designed to prepare the student to challenge the Massachusetts State Certification Examination. The program is based on the Department of Transportation curriculum for Basic Emergency Medical Technician and is approved by the Massachusetts Office of Emergency Medical Services. The EMT program gives the student an excellent foundation in Basic Life Support skills and techniques; patient assessment; and safe, sane transportation.
Blended Education
Students will be required to spend a minimum of 40 minutes for most lessons on-line. The publisher's resource provides support materials for each chapter including quizzes, videos, animations, case studies, virtual tours, interactive exercises, web links and study aids. Computer time is added to each lesson. In addition to 151 hours of class time, each student will complete a minimum of 20 hours on-line.
Instruction includes:
151 hours of lectures and workshops
Minimum of 20 hours on-line training
3 hours of field exercises - auto extrication
Program Outline:
Introduction to Emergency Care Training and Legal Aspects
Airway Obstruction, Respiratory Arrest, and Cardiac Arrest
Mechanical Aids to Breathing and Resuscitation
Bleeding, Shock, Traumatic Injuries, and Wound Care
Fractures of the Upper and Lower Extremities and Neck and Back Injuries
Medical Emergencies and Assisted Medications, Behavioral and Environmental Emergencies
Obstetrics and Gynecological, Pediatric and Elderly Emergencies
Patient Handling, Extrication, Communications, and Terrorism
EMT Skills Include:
Cardiopulmonary Resuscitation and Automatic External Defibrillation
Patient Assessment and Wound Care
Splinting and Neck/Back Immobilization
Oxygen Therapy and Resuscitation Techniques
Patient Handling and General Knowledge of the Ambulance
EMT Prerequisites/Requirements
At least 18 years of age within 3 weeks of the class start date.
Satisfactory report on a Criminal Offender Record Information (CORI)
This must be completed during the enrollment process. Any student who does not meet this requirements at least 14 days prior to scheduled start date will be removed from the class roster.
Students enrolled in the School of Health and Patient Simulation (Nursing, Dental, Medical Imaging, Medical Assisting, Rehabilitation Therapies, Cosmetology, etc.), Early Childhood Education, or non-credit healthcare programs (CNA, EMT, Phlebotomy) are required to submit vaccination records.
Tdap within 10 years
Immunity to measles (two live-vaccine doses or positive titer results)
Immunity to mumps (two live-vaccine doses or positive titer results)
Immunity to rubella (two live-vaccine doses or positive titer results)
Immunity to hepatitis B (three vaccine doses or positive titer results)
Immunity to varicella: (Two doses of Varicella vaccine or positive titer results.)
Tuberculosis screening
Two Mantoux tests (PPD), the first within the past year, the second no more than a year previous to the first (2-step)
or T-Spot blood test within the past year
Two Mantoux tests (PPD), the first within the past year, the second no more than a year previous to the first (2-step)
If the student has a history of a positive tuberculosis test, a Chest X-ray is required within the last 2 years and an annual tuberculosis questionnaire must be completed
Students must have a minimum of a TB verification prior to classes starting
A physical exam (form attached below) is required from each student enrolled in a health field, Early Childhood Education, or who participates in athletics. Students must have had a physical exam within the last year, prior to the start of classes.
If a student does not have a medical provider for this physical exam, they can obtain an exam from STCC Health Services for a cost of $ 50.00. (Please contact 755-4385 to make arrangements)
Students must have documentation that ALL immunization requirements have been met prior at least 30 days prior to the clinical sessions. (It is anticipated that the clinical component for EMT will begin within approximately 30 days after the start of the program.)
Any student that does not meet this requirement will not be able to remain in the course and will be withdrawn from the program. Note that certain medical clearances may take several weeks to complete.
Health History Forms & Requirements
Health History Form:
All students are asked to submit a Health History Form each year. This form lists medications, allergies, emergency contacts, etc.
Health Record Requirements:
All students enrolled either in a health field or Early Childhood Education must submit immunization records. This form lists the requirements.
Student Physical Exam Form:
All students enrolled either in a health field or Early Childhood Education must submit a record of a recent physical exam. This form is also for student athletes.
Tuberculosis Questionnaire:
This form is for students that have a history of a positive tuberculosis test. This form must be submitted annually.
Each student must complete assigned reading BLS for Healthcare Providers by the American Heart Association, which is to be read before the first class meeting. The book is available in the College Bookstore
The on-line reading and test for FEMA IS-700a: NIMS: An introduction
The on-line reading and test for ICS-100-Introduction to Incident Command System


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realmagick.com The shrine of knowledge.
Dream Dictionary Spitting
A selection of articles related to dream dictionary spitting.
Original articles from our library related to the Dream Dictionary Spitting. See Table of Contents for further available material (downloadable resources) on Dream Dictionary Spitting.
- A History Of Dreaming - From Ancient Egypt To Modern Day
- Dreams have been an important part of the human experince since time immemorial. Fragments of the earliest books come from Egypt, where dreams were considered to be the messages sent from the gods. The Egyptians divided their dreams into three categories: 1....
Parapsychology >> Dreams
- Hulse, David Allen
- >From an early age, David Allen Hulse has made a diligent study of the alphabets of the ancient world. Even as a child, David possessed a great affinity for the alphabets of Egypt, Phoenicia, and Greece. In college, a reading of MacGregor Mathers' Kabbalah...
Real Interviews >> Authors
- Hulse, David Allen
- From an early age, David Allen Hulse has made a diligent study of the alphabets of the ancient world. Even as a child, David possessed a great affinity for the alphabets of Egypt, Phoenicia, and Greece. In college, a reading of MacGregor Mathers' Kabbalah...
Real Interviews >> Authors
- What does it mean if I have nightmares about being ill?
- According to a report from the Menninger Clinic Detecting cancer in dream content . Horton PC, Child Guidance Clinic for Control Ct., Meriden, CT, USA. A woman was 3 years post mastectomy when she presented a dream whose manifest content suggested a new...
Parapsychology >> Dreams
- A Treatise on Astral Projection, Part 4: More Rope Techniques
- ROPE is a very effective projection technique, but it still has to be learned to be effective. I would like to elaborate on a couple of points about the technique, inspired by the feedback I have received so far. There is NO visualization required - AT ALL -...
Parapsychology >> Astral Projection
- King James Bible: Genesis, Chapter 41
- Chapter 41 41:1 And it came to pass at the end of two full years, that Pharaoh dreamed: and, behold, he stood by the river. 41:2 And, behold, there came up out of the river seven well favoured kine and fatfleshed; and they fed in a meadow. 41:3 And, behold,...
Old Testament >> Genesis
- Apple Divination
- We have all heard and used the expression "An apple a day keeps the doctor away." This expression is based on a very old superstition and is one of many associated with apples. I am quite sure that you have all held an apple in one hand and twisted...
Psychic Abilities >> Divination
Dream Dictionary Spitting is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Dream Dictionary Spitting books and related discussion.
Suggested News Resources
- Those Comedians That You Have Now: Stewart Lee Interviewed
- You know what, it's from a long time ago now, and you need your little dictionary of Yiddish slang. ......
- A dream expert explains what the most common dreams really mean
- Some people have dreams where they're talking and they start spitting out their teeth. "That will happen when you've had a feeling about something you've said that you can't take back.
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- Cheryl Fernandez-Versini does her best I'm A Celebrity's Vicky Pattison impression
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The Westone 1 was launched in late 2009 and it is ideal for sport practice, running, aerobics as these earbuds will fit inside your outer ear and never fall off. Designed with the human anatomy in mind, the Westone 1 earphones also feature balanced armature drivers which provide excellent sound quality outperforming earphones that sell well over $200
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Welcome to Art On the Ave
Art on the Avenue is an annual music and art festival held in Tacoma, WA along 6th Avenue from State St. to Alder. In its 17th yr and attracting thousands of patrons, it is Tacoma's largest arts-based yearly event.
AOA 2016 – Community
From Ruston Way to the East Side to Lakewood and all points between, Tacoma is a diverse and varied community. Yet even through our vast differences we tend to have a fierce love for our city and there is a brotherly camaraderie among its inhabitants. This year's festival will focus on the many styles and forms of expressions from our diverse city.
Please feel free to contact us if you have any questions regarding:
Musical performances: Dan Rankin email@example.com
Visual artistic display: James Allan Tucker email@example.com 646.265.6097
Vendor coordination: Cori Mickleson email@example.com
Volunteer coordinator: Charles Mann firstname.lastname@example.com
You can also visit the respective pages for more information —


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"This kind of information is critical when charting the future course of active adult living. For example, seeing a huge increase in the number of people looking to relocate for retirement and interested in active adult communities, we need to be ready with new communities that fit the wants and needs of this demographic when they are ready to move."
Related quotes
"Our lives a series of defining moments, strung together by passing time. Surrender fully to this moment, because it is not the moment itself that defines us, but how we choose to live in it."
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"We have been deeply conditioned to immediately associate the word 'conspiracy' with the word 'theory' yet if one is to analyze the nature of what a conspiracy really is it suddenly becomes easy to see a number of them happening all around us, almost every day."


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I am 39 and have been having this prolem for over a year, I had all the normal tests done for these symptoms and everything came back normal. I used to never be cold, I always had central on all summer, now I have a blanket around my legs at all times. Only thing that helps is hot bath and heating pad on feet. Anyone can help please do so-ThanksReply Follow This Thread Stop Following This Thread Flag this Discussion
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Karden Rabin
MELT Instructor
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The 21-hour MELT Hand and Foot Instructor training explores the scientific basis of MELT and prepares instructors to teach the Hand and Foot Treatment in one-on-one and group settings.
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Karden Rabin is the Founder of Boundless and has over a decade of experience in the health and wellness field. Karden specializes in designing truly integrative wellness solutions of individuals and groups that create breakthrough results in health and quality of life. During his tenure, Karden has helped to transform the lives of hundreds of clients. Beginning with his massage therapy training at the Finger Lakes School of Massage, Karden has gone on to study a wide array of wellness sciences with prestigious institutions and teachers including Kripalu, The Milne Institute For Visionary CranialSacral Therapy, Sue Hitzmann, creator of the MELT Method and Tom Meyers, inventor of The Anatomy Trains. Beyond the physical, Karden has studied and teaches a myriad of stress, mental and emotional management approaches, including meditation, present-time awareness, Yoga Nidra, HeartMATH and breathing practices. While maintaining an active Bodywork practice, Karden has also created multiple projects and businesses including Wellcast, an online wellness learning platform; Prologue Sessions, a live event series for realizing your career dreams; For The Love of Pie, an artisan pie bakery and Mighty Brittle, a craft candy manufacturer. He lives in West Stockbridge, MA with his talented and inspiring wife, Gillian, and sweet soft cat, Cheshire.
Upcoming Classes
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Pittsfield , MA


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Brady village officials trying to hold down spending
No big items this year.
Brady village officials are squeezing as much as possible for the next fiscal year to keep spending down.
There are no large purchases and no major projects in the 2009-10 budget.
"We're doing the best we can to stay within our means," said village clerk Pam Diehl. "It's going to be nip and tuck."
The bottom line budget is projected to be lower than last year by just over $2,000 and the levy will drop from 48.6 cents per $100 in property value to 47.4 cents.
Still, Brady residents aren't likely to see the village portion of their tax bill go down because the valuation set by Lincoln County jumped 8.7% to nearly $13.1 million.
That's how the village can cover its costs and still lower the levy for the second straight year, according to village accountant Christine Haynes of Gothenburg.
Basically, she said, the village will collect enough property taxes to cover its recurring bills with little wiggle room.
"Things are tight all over," Diehl said. "The village is no different."
The trustees will vote on the 2009-10 budget following a public hearing during the regular monthly meeting at 7 p.m. on Sept. 9.
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Most Cited Diabetes Research and Clinical Practice Articles
The most cited articles published since 2011, extracted from Scopus.
IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030David R. Whiting | Leonor Guariguata | Clara Weil | Jonathan Shaw
Volume 94, Issue 3, December 2011, Pages 311-321
Introduction: Diabetes is an increasingly important condition globally and robust estimates of its prevalence are required for allocating resources. Methods: Data sources from 1980 to April 2011 were sought and characterised. The Analytic Hierarchy Process (AHP) was used to select the most appropriate study or studies for each country, and estimates for countries without data were modelled. A logistic regression model was used to generate smoothed age-specific estimates which were applied to UN population estimates for 2011. Results: A total of 565 data sources were reviewed, of which 170 sources from 110 countries were selected. In 2011 there are 366 million people with diabetes, and this is expected to rise to 552 million by 2030. Most people with diabetes live in low- and middle-income countries, and these countries will also see the greatest increase over the next 19 years. Discussion: This paper builds on previous IDF estimates and shows that the global diabetes epidemic continues to grow. Recent studies show that previous estimates have been very conservative. The new IDF estimates use a simple and transparent approach and are consistent with recent estimates from the Global Burden of Disease study. IDF estimates will be updated annually. © 2011 Elsevier Ireland Ltd.
Global estimates of diabetes prevalence for 2013 and projections for 2035L. Guariguata | D. R. Whiting | I. Hambleton | J. Beagley | U. Linnenkamp | J. E. Shaw
Volume 103, Issue 2, January 2014, Pages 137-149
Introduction: Diabetes is a serious and increasing global health burden and estimates of prevalence are essential for appropriate allocation of resources and monitoring of trends. Methods: We conducted a literature search of studies reporting the age-specific prevalence for diabetes and used the Analytic Hierarchy Process to systematically select studies to generate estimates for 219 countries and territories. Estimates for countries without available source data were modelled from pooled estimates of countries that were similar in regard to geography, ethnicity, and economic development. Logistic regression was applied to generate smoothed age-specific prevalence estimates for adults 20-79 years which were then applied to population estimates for 2013 and 2035. Results: A total of 744 data sources were considered and 174 included, representing 130 countries. In 2013, 382 million people had diabetes; this number is expected to rise to 592 million by 2035. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. Conclusion: The new estimates of diabetes in adults confirm the large burden of diabetes, especially in developing countries. Estimates will be updated annually including the most recent, high-quality data available. © 2013.
Inflammation as a link between obesity, metabolic syndrome and type 2 diabetesNathalie Esser | Sylvie Legrand-Poels | Jacques Piette | André J. Scheen | Nicolas Paquot
Volume 105, Issue 2, January 2014, Pages 141-150
It is recognized that a chronic low-grade inflammation and an activation of the immune system are involved in the pathogenesis of obesity-related insulin resistance and type 2 diabetes. Systemic inflammatory markers are risk factors for the development of type 2 diabetes and its macrovascular complications. Adipose tissue, liver, muscle and pancreas are themselves sites of inflammation in presence of obesity. An infiltration of macrophages and other immune cells is observed in these tissues associated with a cell population shift from an anti-inflammatory to a pro-inflammatory profile. These cells are crucial for the production of pro-inflammatory cytokines, which act in an autocrine and paracrine manner to interfere with insulin signaling in peripheral tissues or induce β-cell dysfunction and subsequent insulin deficiency. Particularly, the pro-inflammatory interleukin-1β is implicated in the pathogenesis of type 2 diabetes through the activation of the NLRP3 inflammasome. The objectives of this review are to expose recent data supporting the role of the immune system in the pathogenesis of insulin resistance and type 2 diabetes and to examine various mechanisms underlying this relationship. If type 2 diabetes is an inflammatory disease, anti-inflammatory therapies could have a place in prevention and treatment of type 2 diabetes. © 2014 Elsevier Ireland Ltd.
Barriers to diabetes management: Patient and provider factorsSoohyun Nam | Catherine Chesla | Nancy A. Stotts | Lisa Kroon | Susan L. Janson
Volume 93, Issue 1, July 2011, Pages 1-9
Despite significant advances in diagnosis and treatment, the persistence of inadequate metabolic control continues. Poor glycemic control may be reflected by both the failure of diabetes self-management by patients as well as inadequate intervention strategies by clinicians. The purpose of this systematic review is to summarize existing knowledge regarding various barriers of diabetes management from the perspectives of both patients and clinicians. A search of PubMed, CINAHL, ERIC, and PsycINFO identified 1454 articles in English published between 1990 and 2009, addressing type 2 diabetes, patient's barriers, clinician's barriers, and self-management. Patients' adherence, attitude, beliefs, and knowledge about diabetes may affect diabetes self-management. Culture and language capabilities influence the patient's health beliefs, attitudes, health literacy, thereby affecting diabetes self-management. Other influential factors include the patient's financial resources, co-morbidities, and social support. Clinician's attitude, beliefs and knowledge about diabetes also influence diabetes management. Clinicians may further influence the patient's perception through effective communication skills and by having a well-integrated health care system. Identifying barriers to diabetes management is necessary to improve the quality of diabetes care, including the improvement of metabolic control, and diabetes self-management. Further research that considers these barriers is necessary for developing interventions for individuals with type 2 diabetes. © 2011 Elsevier Ireland Ltd.
Serum irisin levels in new-onset type 2 diabetesYeon Kyung Choi | Mi Kyung Kim | Kwi Hyun Bae | Hyun Ae Seo | Ji Yun Jeong | Won Kee Lee | Jung Guk Kim | In Kyu Lee | Keun Gyu Park
Volume 100, Issue 1, April 2013, Pages 96-101
Aims: Irisin has been identified as a novel myokine that drives brown-fat-like conversion of white adipose tissue. In this cross-sectional study, we investigated whether serum irisin levels are decreased in patients with type 2 diabetes (T2D) compared with control subjects with normal glucose tolerance (NGT), and assessed the association between serum irisin levels and various metabolic parameters. Methods: The study population was selected from a population-based study and included 104 subjects with NGT and 104 subjects with new-onset T2D. Serum irisin and adiponectin levels and metabolic parameters were measured. Multivariate logistic regression analysis was performed to assess the association between irisin levels and newly diagnosed T2D. Results: Serum irisin levels were significantly decreased in the new-onset T2D group compared with the NGT control group (p= 0.003). In a multivariable model adjusted for various metabolic parameters, increased irisin levels were associated with reduced odds (OR 0.64, 95% CI 0.47-0.88, p= 0.006) of prevalent newly diagnosed T2D. Furthermore, multiple regression analysis showed that 2. h plasma glucose was an independent variable influencing serum irisin levels (p= 0.004). Conclusion: In the present study, we found that serum irisin levels were decreased in T2D patients and inversely associated with newly diagnosed T2D, suggesting that irisin may play a crucial role in glucose intolerance and T2D. © 2013 Elsevier Ireland Ltd.
Too much sitting - A health hazardDavid W. Dunstan | Bethany Howard | Genevieve N. Healy | Neville Owen
Volume 97, Issue 3, September 2012, Pages 368-376
In contemporary society, prolonged sitting has been engineered into our lives across many settings, including transportation, the workplace, and the home. There is new evidence that too much sitting (also known as sedentary behavior - which involves very low energy expenditure, such as television viewing and desk-bound work) is adversely associated with health outcomes, including cardio-metabolic risk biomarkers, type 2 diabetes and premature mortality. Importantly, these detrimental associations remain even after accounting for time spent in leisure time physical activity. We describe recent evidence from epidemiological and experimental studies that makes a persuasive case that too much sitting should now be considered an important stand-alone component of the physical activity and health equation, particularly in relation to diabetes and cardiovascular risk. We highlight directions for further research and consider some of the practical implications of focusing on too much sitting as a modifiable health risk. © 2012 Elsevier Ireland Ltd.
Comparison of bone marrow mesenchymal stem cells with bone marrow-derived mononuclear cells for treatment of diabetic critical limb ischemia and foot ulcer: A double-blind, randomized, controlled trialDebin Lu | Bing Chen | Ziwen Liang | Wuquan Deng | Youzhao Jiang | Shufa Li | Jing Xu | Qinan Wu | Zhonghui Zhang | Bing Xie | Sihao Chen
Volume 92, Issue 1, April 2011, Pages 26-36
Aims: To identify better cells for the treatment of diabetic critical limb ischemia (CLI) and foot ulcer in a pilot trial. Methods: Under ordinary treatment, the limbs of 41 type 2 diabetic patients with bilateral CLI and foot ulcer were injected intramuscularly with bone marrow mesenchymal stem cells (BMMSCs), bone marrow-derived mononuclear cells (BMMNCs), or normal saline (NS). Results: The ulcer healing rate of the BMMSC group was significantly higher than that of BMMNCs at 6 weeks after injection (P=0.022), and reached 100% 4 weeks earlier than BMMNC group. After 24 weeks of follow-up, the improvements in limb perfusion induced by the BMMSCs transplantation were more significant than those by BMMNCs in terms of painless walking time (P=0.040), ankle-brachial index (ABI) (P=0.017), transcutaneous oxygen pressure (TcO2) (P=0.001), and magnetic resonance angiography (MRA) analysis (P=0.018). There was no significant difference between the groups in terms of pain relief and amputation and there was no serious adverse events related to both cell injections. Conclusions: BMMSCs therapy may be better tolerated and more effective than BMMNCs for increasing lower limb perfusion and promoting foot ulcer healing in diabetic patients with CLI. © 2010 Elsevier Ireland Ltd.
An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: The APhilip Home | Nabil El Naggar | Mohammed Khamseh | Guillermo Gonzalez-Galvez | Chunduo Shen | Praful Chakkarwar | Yang Wenying
1chieve study
Volume 94, Issue 3, December 2011, Pages 352-363
Aim: The aim of A 1chieve was to remedy the deficit of data on the efficacy and safety of insulin analogues in routine clinical care in less well-resourced/newly developed countries. Methods: A non-interventional, 6-month, observational study of 66,726 people with type 2 diabetes, both insulin users and non-insulin users, started on insulin detemir, insulin aspart or biphasic insulin aspart in 28 countries across four continents. Results: Baseline HbA 1c (±SD) was poor: 9.5±1.8%. At 6 months, improvement was -2.1±1.7% in the entire cohort, and -2.2±1.7% and -1.8±1.7% for prior non-insulin users and insulin users. All three analogue therapies gave similar results, again independently of prior insulin use, but also from seven pre-specified country groupings. Overall, hypoglycaemia did not increase in those new to insulin, and fell in those switching insulins. There was no change in body weight (-0.1±3.7kg), while lipid profile and systolic blood pressure (-6.3±17.1mmHg) were improved. Conclusions: Beginning insulin analogue therapy in people with type 2 diabetes and poor blood glucose control is associated with marked improvements in diverse aspects of vascular risk factor profile without evidence of clinically significant safety or tolerability problems. © 2011 Elsevier Ireland Ltd.
The International Diabetes Federation diabetes atlas methodology for estimating global and national prevalence of diabetes in adultsLeonor Guariguata | David Whiting | Clara Weil | Nigel Unwin
Volume 94, Issue 3, December 2011, Pages 322-332
Introduction: Diabetes is a major cause of morbidity and mortality and its global prevalence is growing rapidly. A simple and robust approach to estimate the prevalence of diabetes is essential for governments to set priorities on how to meet the challenges of the disease. The International Diabetes Federation has developed a methodology for generating country-level estimates of diabetes prevalence in adults (20-79 years). Methods: Using country-level data sources from peer-reviewed studies, national health statistics reports, commissioned studies on diabetes prevalence, and unpublished data obtained through personal communication, we use logistic regression to generate estimates of the prevalence of diabetes. An approach matching countries on ethnicity, geography, and income group is used to fill in gaps where original data sources are not available. The methodology also uses changes in urbanization and population to generate estimates and projections on the prevalence of diabetes in adults. Conclusion: Diabetes prevalence estimates are very sensitive to the data from which they are derived. The revised IDF methodology for estimating diabetes prevalence is a transparent, reproducible approach that will be updated annually. It takes data-driven approaches to filling in gaps where data are not available and where assumptions have to be made. It uses a qualification system to rank data sources so that only the highest quality data are used. © 2011 Elsevier Ireland Ltd.
A meta-analysis of serious adverse events reported with exenatide and liraglutide: Acute pancreatitis and cancerCarlos Alves | Francisco Batel-Marques | Ana F. Macedo
Volume 98, Issue 2, November 2012, Pages 271-284
Aims: The association between GLP-1 agonists, acute pancreatitis (AP), any cancer and thyroid cancer is discussed. This meta-analysis was aimed at evaluating the risk of those serious adverse events associated with GLP-1 agonists in patients with type 2 diabetes. Methods: Medline, EMBASE, Cochrane Library and clinicaltrials.gov were searched in order to identify longitudinal studies evaluating exenatide or liraglutide use and reporting data on AP or cancer. Odds ratios (ORs) were pooled using a random-effects model. I2 statistics assessed heterogeneity. Results: Twenty-five studies were included. Neither exenatide (OR 0.84 [95% CI 0.58-1.22], I2=30%) nor liraglutide (OR 0.97 [95% CI 0.21-4.39], I2=0%) were associated with an increased risk of AP, independent of baseline comparator. The pooled OR for cancer associated with exenatide was 0.86 (95% CI 0.29, 2.60, I2=0%) and for liraglutide was 1.35 (95% CI 0.70, 2.59, I2=0%). Liraglutide was not associated with an increased risk for thyroid cancer (OR 1.54 [95% CI 0.40-6.02], I2=0%). For exenatide, no thyroid malignancies were reported. Conclusions: Current available published evidence is insufficient to support an increased risk of AP or cancer associated with GLP-1 agonists. These rare and long-term adverse events deserve properly monitoring in future studies evaluating GLP-1 agonists. © 2012 Elsevier Ireland Ltd.
By the numbers: New estimates from the IDF Diabetes Atlas Update for 2012Leonor Guariguata
Volume 98, Issue 3, December 2012, Pages 524-525
Global guideline for type 2 diabetesPablo Aschner | Henning Beck-Nielsen | Peter Bennett | Andrew Boulton | Ruth Colagiuri | Stephen Colagiuri | Marg McGill | Kyra Sim | Marion Franz | Roger Gadsby | Juan José Gagliardino | Philip Home | Sally Marshall | Susan Manley | Jean Claude Mbanya | Andrew Neil | Ambady Ramachandran | Vijay Viswanathan | Kaushik Ramaiya | Gojka Roglic | Nicolaas Schaper | Linda Siminerio | Alan Sinclair | Frank Snoek | Paul Van Crombrugge | Giacomo Vespasiani
Volume 104, Issue 1, January 2014, Pages 1-52
Diabetes attitudes Wishes and Needs 2 (DAWN2): A multinational, multi-stakeholder study of psychosocial issues in diabetes and person-centred diabetes careMark Peyrot | Katharina Kovacs Burns | Melanie Davies | Angus Forbes | Norbert Hermanns | Richard Holt | Sanjay Kalra | Antonio Nicolucci | Frans Pouwer | Johan Wens | Ingrid Willaing | Søren E. Skovlund
Volume 99, Issue 2, February 2013, Pages 174-184
Aims: The Diabetes Attitudes Wishes and Needs 2 (DAWN2) study aims to provide a holistic assessment of diabetes care and management among people with diabetes (PWD), family members (FM), and healthcare professionals (HCPs) and explores potential drivers leading to active management. Methods: DAWN2 survey over 16,000 individuals (∼9000 PWD, ∼2000 FM of PWD, and ∼5000 HCPs) in 17 countries across 4 continents. Respondents complete a group-specific questionnaire; items are designed to allow cross-group comparisons on common topics. The questionnaires comprise elements from the original DAWN study (2001), as well as psychometrically validated instruments and novel questions developed for this study to assess self-management, attitudes/beliefs, disease impact/burden, psychosocial distress, health-related quality of life, healthcare provision/receipt, social support and priorities for improvement in the future. The questionnaires are completed predominantly online or by telephone interview, supplemented by face-to-face interviews in countries with low internet access. In each country, recruitment ensures representation of the diabetes population in terms of geographical distribution, age, gender, education and disease status. Discussion: DAWN2 aims to build on the original DAWN study to identify new avenues for improving diabetes care. This paper describes the study rationale, goals and methodology. © 2012 Elsevier Ireland Ltd.
The dual control of insulin secretion by glucose involves triggering and amplifying pathways in β-cellsJean Claude Henquin
Volume 93, Issue SUPPL. 1, August 2011, Page
This review outlines the two pathways that interact in β-cells to ensure temporal and amplitude control of insulin secretion by glucose. The most well known triggering pathway involves the following steps: acceleration of glucose metabolism, closure of ATP-sensitive potassium channels, depolarization, influx of Ca 2+ through voltage-gated calcium channels, and a rise in the concentration of cytosolic ionized Ca 2+ that triggers exocytosis of insulin-containing granules. This classic sequence is, however, incomplete. Additional mechanisms, involving other channels, are necessarily implicated in the production of the triggering Ca 2+ signal. It is also clear that the effect of glucose on insulin secretion would be poor if Ca 2+-induced exocytosis was not markedly augmented (approximately doubled) through a metabolic amplifying pathway, mechanistically distinct from neurohormonal amplifying pathways. This metabolic amplifying pathway is physiologically relevant for both phases of glucose-induced insulin secretion and for the potentiation, by glucose, of insulin secretion triggered by non-metabolized secretagogues (e.g. arginine). Three important challenges for future studies will be to identify the additional targets mediating control of the triggering Ca 2+ signal by glucose, to elucidate the cellular mechanisms of the metabolic amplifying pathway and to determine the contribution of each pathway in the alterations of insulin secretion in type 2 diabetic patients. © 2011 Elsevier Ireland Ltd.
Insulin effects in muscle and adipose tissueGeorge Dimitriadis | Panayota Mitron | Vaia Lambadiari | Eirini Maratou | Sotirios A. Raptis
Volume 93, Issue SUPPL. 1, August 2011, Page
The major effects of insulin on muscle and adipose tissue are: (1) Carbohydrate metabolism: (a) it increases the rate of glucose transport across the cell membrane, (b) it increases the rate of glycolysis by increasing hexokinase and 6-phosphofructokinase activity, (c) it stimulates the rate of glycogen synthesis and decreases the rate of glycogen breakdown. (2) Lipid metabolism: (a) it decreases the rate of lipolysis in adipose tissue and hence lowers the plasma fatty acid level, (b) it stimulates fatty acid and triacylglycerol synthesis in tissues, (c) it increases the uptake of triglycerides from the blood into adipose tissue and muscle, (d) it decreases the rate of fatty acid oxidation in muscle and liver. (3) Protein metabolism: (a) it increases the rate of transport of some amino acids into tissues, (b) it increases the rate of protein synthesis in muscle, adipose tissue, liver, and other tissues, (c) it decreases the rate of protein degradation in muscle (and perhaps other tissues).These insulin effects serve to encourage the synthesis of carbohydrate, fat and protein, therefore, insulin can be considered to be an anabolic hormone. © 2011 Elsevier Ireland Ltd.
Global estimates of undiagnosed diabetes in adultsJessica Beagley | Leonor Guariguata | Clara Weil | Ayesha A. Motala
Volume 103, Issue 2, January 2014, Pages 150-160
Aims: The prevalence of diabetes is rapidly increasing worldwide. Type 2 diabetes may remain undetected for many years, leading to severe complications and healthcare costs. This paper provides estimates of the prevalence of undiagnosed diabetes mellitus (UDM), using available data from high quality representative population-based sources. Methods: Data sources reporting both diagnosed and previously undiagnosed diabetes were identified and selected according to previously described IDF methodology for diabetes in adults (aged 20-79). Countries were divided into 15 data regions based on their geographic IDF Region and World Bank income classification. The median UDM proportion was calculated from selected data sources for each of data region. The number of UDM cases in 2013 was calculated from country, age and sex-specific estimates of known diabetes cases and data region-specific UDM proportion. Results: Of 744 reviewed data sources, 88 sources representing 74 countries had sufficient information and were selected for generation of estimates of UDM. Globally, 45.8%, or 174.8 million of all diabetes cases in adults are estimated to be undiagnosed, ranging from 24.1% to 75.1% across data regions. An estimated 83.8% of all cases of UDM are in low- and middle-income countries. At a country level, Pacific Island nations have the highest prevalence of UDM. Conclusions: There is a high proportion of UDM globally, and especially in developing countries. Further high-quality studies of UDM are needed to strengthen future estimates. © 2013 Elsevier Ireland Ltd.
Effect of the once-daily human GLP-1 analogue liraglutide on appetite, energy intake, energy expenditure and gastric emptying in type 2 diabetesMichael Horowitz | Anne Flint | Karen L. Jones | Charlotte Hindsberger | Mads F. Rasmussen | Christoph Kapitza | Selena Doran | Thomas Jax | Milan Zdravkovic | Ian M. Chapman
Volume 97, Issue 2, August 2012, Pages 258-266
Aims: Liraglutide reduces bodyweight in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the mechanisms underlying this effect. Methods: The comparative effects of liraglutide, glimepiride and placebo on energy intake, appetite, nausea, gastric emptying, antral distension, bodyweight, gastrointestinal hormones, fasting plasma glucose and resting energy expenditure (REE), were assessed in subjects with T2DM randomised to treatment A (liraglutide-placebo), B (placebo-glimepiride) or C (glimepiride-liraglutide). Assessments were performed at the end of each 4-week treatment period. Results: Energy intake was less (NS) with liraglutide vs placebo and glimepiride, and 24-h REE was higher (NS) with liraglutide vs placebo and glimepiride. Fasting hunger was less (p=0.01) with liraglutide vs placebo and glimepiride, and meal duration was shorter with liraglutide (p=0.002) vs placebo. Paracetamol AUC0-60min and Cmax were less (p<0.01) and fasting peptide YY was lower (p≤0.001) after liraglutide vs placebo and glimepiride. Bodyweight reductions of 1.3 and 2.0kg were observed with liraglutide vs placebo and glimepiride (p<0.001). There were no differences on antral distension, nausea, or other gastro-intestinal hormones. Conclusion: Liraglutide caused decreased gastric emptying and increased reduction in bodyweight. The mechanisms of the liraglutide-induced weight-loss may involve a combined effect on energy intake and energy expenditure. © 2012 Elsevier Ireland Ltd.
MicroRNA-15a positively regulates insulin synthesis by inhibiting uncoupling protein-2 expressionLiang Liang Sun | Bei Ge Jiang | Wen Tong Li | Jun Jie Zou | Yong Quan Shi | Zhi Min Liu
Volume 91, Issue 1, January 2011, Pages 94-100
MicroRNAs are small noncoding RNAs that have been highly conserved during evolution and have been implicated to play an important role in many diseases, including diabetes. Several reports indicated the function of miRNAs in insulin production. However, the mechanisms by which miRNAs regulate this process remain poorly understood. Here we found that the expression of miR-15a was up-regulated in the presence of high glucose for 1 h, whereas prolonged periods of high glucose exposure resulted in depressed expression of miR-15a, and the change in expression levels of miR-15a coincided with insulin biosynthesis. Moreover, ectopic expression of miR-15a promoted insulin biosynthesis in MIN6 cells, whereas its repression was sufficient to inhibit insulin biosynthesis. Further, we verified that miR-15a directly targeted and inhibited uncoupling protein-2 (UCP-2) gene expression. miR-15a mimics inhibited UCP-2 3'UTR luciferase reporter activity. Western blot analysis showed that miR-15a inhibited endogenous UCP-2 protein levels, and resulted in the increase in oxygen consumption and reduced ATP generation. This study suggests miR-15a is a mediator of β cell function and insulin biosynthesis, thus offering a new target for the development of preventive or therapeutic agents against diabetes. © 2010 Elsevier Ireland Ltd.
Diabetes in the young - a global view and worldwide estimates of numbers of children with type 1 diabetesChris Patterson | Leonor Guariguata | Gisela Dahlquist | Gyula Soltész | Graham Ogle | Martin Silink
Volume 103, Issue 2, January 2014, Pages 161-175
This paper describes the methodology, results and limitations of the 2013 International Diabetes Federation (IDF) Atlas (6th edition) estimates of the worldwide numbers of prevalent cases of type 1 diabetes in children (<15 years). The majority of relevant information in the published literature is in the form of incidence rates derived from registers of newly diagnosed cases. Studies were graded on quality criteria and, if no information was available in the published literature, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Prevalence rates were then derived from these incidence rates and applied to United Nations 2012 Revision population estimates for 2013 for each country to obtain estimates of the number of prevalent cases.Data availability was highest for the countries in Europe (76%) and lowest for the countries in sub-Saharan Africa (8%). The prevalence estimates indicate that there are almost 500,000 children aged under 15 years with type 1 diabetes worldwide, the largest numbers being in Europe (129,000) and North America (108,700). Countries with the highest estimated numbers of new cases annually were the United States (13,000), India (10,900) and Brazil (5000). Compared with the prevalence estimates made in previous editions of the IDF Diabetes Atlas, the numbers have increased in most of the IDF Regions, often reflecting the incidence rate increases that have been well-documented in many countries.Monogenic diabetes is increasingly being recognised among those with clinical features of type 1 or type 2 diabetes as genetic studies become available, but population-based data on incidence and prevalence show wide variation due to lack of standardisation in the studies. Similarly, studies on type 2 diabetes in childhood suggest increased incidence and prevalence in many countries, especially in Indigenous peoples and ethnic minorities, but detailed population-based studies remain limited. © 2013 Elsevier Ireland Ltd.
Adipose tissue derived mesenchymal stem cell (AD-MSC) promotes skin wound healing in diabetic ratsMohsen Khosravi Maharlooei | Mansooreh Bagheri | Zhabiz Solhjou | Behnam Moein Jahromi | Majid Akrami | Lili Rohani | Ahmad Monabati | Ali Noorafshan | Gholamhossein Ranjbar Omrani
Volume 93, Issue 2, August 2011, Pages 228-234
Aims: Stem cells are a new hope to ameliorate impaired diabetic wound healing. The purpose of this study was to evaluate the effect of adipose tissue derived mesenchymal stem cells (AD-MSCs) on wound healing in a diabetic rat model. Methods: Twenty-six rats became diabetic by a single intraperitoneal injection of streptozotocin. Six rats served as non-diabetic (non-DM). Diabetic rats were divided into two equal groups randomly; control and treatment. Six weeks later, a full-thickness circular excisional wound was created on the dorsum of each rat. AD-MSCs were injected intra-dermally around the wounds of treatment group. PBS was applied to control and non-DM groups. The wound area was measured every other day. After wound healing completion, full thickness skin samples were taken from the wound sites for evaluation of volume density of collagen fibers, length and volume density of vessels, and numerical density of fibroblasts by stereological methods. Results: AD-MSCs accelerated wound healing rate in diabetic rats, but did not increase length and volume density of the vessels and volume density of the collagen fibers. AD-MSCs decreased the numerical density of fibroblasts. Conclusions: We concluded that AD-MSCs enhances diabetic wound healing rate probably by other mechanisms rather than enhancing angiogenesis or accumulating collagen fibers. © 2011 Elsevier Ireland Ltd.
Effect of metformin on oxidative stress, nitrosative stress and inflammatory biomarkers in type 2 diabetes patientsArpita Chakraborty | Subhankar Chowdhury | Maitree Bhattacharyya
Volume 93, Issue 1, July 2011, Pages 56-62
Aim: Advanced research has radically changed both diagnosis and treatment of diabetes during last three decades; a number of classes of oral antidiabetic agents are currently available for better glycemic control. Present study aims to evaluate the effect of metformin on different stress and inflammatory parameters in diabetic subjects. Methods: 208 type 2 diabetes patients were randomly assigned for metformin and placebo. Results: Reactive oxygen species generation, advanced oxidation protein products (179.65±13.6, 120.65±10.5μmol/l) and pentosidine (107±10.4, 78±7.6pmol/ml) were found to be reduced by metformin treatment compared to placebo. On the other hand metformin administration enhanced total thiol and nitric oxide level (p<0.05). But nutrient level (Mg +2, Ca +2) in plasma was not altered by the treatment. Significant restoration of C reactive protein (p<0.05) was noticed after metformin therapy. Metformin administration also improved Na +K +ATPase activity (0.28±0.08, 0.41±0.07μmolPi/mg/h) in erythrocyte membrane. Conclusions: This study explores that metformin treatment restores the antioxidant status, enzymatic activity and inflammatory parameters in type 2 diabetic patients. Metformin therapy improves the status of oxidative and nitrosative stress altered in type 2 diabetes. This study unfolds the cardio protective role of metformin as an oral hypoglycemic agent. © 2010 Elsevier Ireland Ltd.
Diabetes mellitus as a risk factor for depression. A meta-analysis of longitudinal studiesF. Rotella | E. Mannucci
Volume 99, Issue 2, February 2013, Pages 98-104
Aim: The present meta-analysis is aimed at the assessment of the risk of incident clinical depression and/or depressive symptoms in patients with diabetes. Methods: A Medline search was performed on December 30th, 2011, using the search string: "diabetes AND (depression OR antidepressant)", selecting longitudinal studies that assessed the risk of incident depression in subjects with or without diabetes. Study design and characteristics were verified for each study. A meta-analysis was performed for unadjusted and adjusted risk ratios of incident depression in subjects with diabetes using a random effect model. Additional analyses were performed to assess heterogeneity, publication bias and specific hazard ratios for several possible confounders. Results: Of the 1898 retrieved studies, 16 were included in the meta-analysis, enrolling 497,223 subjects, with a mean follow-up of 5.8 years and 42,633 cases of incident depression. A higher incidence of depression was found in diabetic subjects (1.6% vs 1.4% yearly), with unadjusted and adjusted risk [95% confidence interval] of 1.29 [1.18-1.40] (p< 0.001) and 1.25 [1.10-1.44] (p= 0.001), respectively. Conclusions: Diabetes is associated with a significantly increased risk for depressive symptoms. Pathogenetic mechanisms connecting diabetes with depression deserve further exploration. © 2012 Elsevier Ireland Ltd.
Omentin-1 is associated with carotid atherosclerosis in patients with metabolic syndromeRong Liu | Xiuling Wang | Peili Bu
Volume 93, Issue 1, July 2011, Pages 21-25
Aim: The goal of this study was to investigate the association between omentin-1 and carotid atherosclerosis in patients with metabolic syndrome (MetS). Method: We enrolled randomly 60 MetS patients, evaluated their carotid atherosclerosis employing ultrasonography and then divided them into two subgroups, MetS with atherosclerosis (MetS. +. AS) and MetS without atherosclerosis (MetS-AS) according to the level of carotid intima-media thickness (CIMT) and presence of plaque. Stiffness, strain and distensibility were calculated. Waist circumference and blood pressure (BP) were measured. Fasting blood sample was collected to determine biochemical indicators and insulin resistance index (HOMA-IR). Omentin-1 plasma level was assessed by ELISA. Association of omentin-1 with CIMT and metabolic markers were studied. Results: Levels of omentin-1 were lower in MetS than in controls and reduced further in MetS. +. AS compared with MetS-AS. In correlation analysis, omentin-1 was negative associated with CIMT, stiffness, waist circumference, body mass index (BMI), systolic blood pressure (SBP), fast blood glucose (FBG), and HOMA-IR. Conclusions: Omentin-1 is closely related to MetS and might play an important role in atherosclerosis in MetS patients. © 2011 Elsevier Ireland Ltd.
Efficacy and safety of saxagliptin added to metformin in Asian people with type 2 diabetes mellitus: A randomized controlled trialWenying Yang | Chang Yu Pan | Conrad Tou | June Zhao | Ingrid Gause-Nilsson
Volume 94, Issue 2, November 2011, Pages 217-224
Aim: To assess efficacy and safety of saxagliptin added to metformin versus placebo plus metformin in Asian patients with type 2 diabetes mellitus (T2DM) and inadequate glycemic control on metformin alone. Methods: Adults (HbA1c 7.0-10.0%, on stable metformin ≥1500mg/day) were randomized 1:1 to saxagliptin 5mg daily plus metformin (n=283) or placebo plus metformin (n=287). The primary end point was HbA1c change from baseline to Week 24. Results: Saxagliptin plus metformin provided significant adjusted mean decreases versus placebo plus metformin (p≤0.0052) in HbA1c (-0.78% versus -0.37%), fasting plasma glucose (-1.14mmol/L versus -0.58mmol/L), and postprandial glucose area under the curve from 0 to 180min (-315mmolmin/L versus -160mmolmin/L). Significantly more saxagliptin-treated patients achieved a therapeutic glycemic response (HbA1c<7.0%) (46.5% versus 30.5%; p=0.0001). The proportion of patients experiencing adverse events (excluding hypoglycemia) was similar for saxagliptin plus metformin (42.8%) versus placebo plus metformin (40.8%). Hypoglycemic events were reported in 1.4% of patients in each group. Conclusion: Saxagliptin added to metformin significantly improved glycemic control and was well tolerated in Asian patients with T2DM who had inadequate glycemic control with metformin and diet and lifestyle modification. © 2011 Elsevier Ireland Ltd.
Association between Helicobacter pylori infection and diabetes mellitus: A meta-analysis of observational studiesXiaoying Zhou | Cuiling Zhang | Junbei Wu | Guoxin Zhang
Volume 99, Issue 2, February 2013, Pages 200-208
Aims: Some studies have shown Helicobacter pylori (H. pylori) infection to be associated with diabetes mellitus, but the relationship remains controversial. This meta-analysis was designed to quantify the association between H. pylori infection and diabetes. Methods: A computerized search of PubMed and Embase was carried out. Studies that provided data on H. pylori infection in both diabetes and control groups were selected. An unconditional logistic regression model was used to analyze potential parameters related to H. pylori prevalence. Subgroup analyses were conducted for types of diabetes, methods of detection, geographical distribution, hemoglobin A1c (HbA1c) levels and evidence grade. Result: Forty-one studies were identified, involving 14,080 patients, with a total H. pylori infection rate of 42.29%. The OR for H. pylori infection was increased to 1.33 (95% CI: 1.08-1.64; P= 0.008) among the patients with diabetes. Subgroup analysis revealed a significantly higher infection rate of H. pylori in the type 2 diabetes group versus the control group: OR = 1.76, 95% CI: 1.40-2.21, P< 0.00001. Conclusions: The pooled data suggests a trend toward more frequent H. pylori infections in diabetes patients, especially in type 2 diabetes patients. As this is a meta-analysis of observational studies, more randomized controlled trials should be done in the future. © 2012 Elsevier Ireland Ltd.


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Garden waste collection
Save time, money and mess with our popular fortnightly garden waste collection.
The next start date for the garden waste service is 1 December 2016. Sign up by 31 October 2016
Pay for garden waste Renew your service
What the garden waste service costs (2016/17 for a service starting in April 2016)
- A 240-litre wheelie bin in 2016/17 costs £45 for a full year
- A year's supply of compostable sacks (for properties unable to use wheelie bins only) costs £34 for a full year
- There are other shorter collection periods available, dependent on when customers subscribe to the service - please see table below
When your garden waste service will start
There are five different collection periods each year, starting in April, June, August, October and December. Your bin will be delivered in time for your collection service to start.
|Collection period
|New subscriptions open
|New subscriptions close
|Cost (bin service)
|Cost (sack service)
|April - March (12 months)
|1 November
|28 February
|June - March (10 months)
|1 March
|30 April
|August - March (8 months)
|1 May
|30 June
|October - March (6 months)
|1 July
|31 August
|December - March (4 months)
|1 September
|31 October
The service renewal date for existing customers is 31 March (the final date of your collection period).
What can I put in my garden waste bin?
|Yes please
|No thanks
You can still compost your garden waste at home or take it to a household recycling centre free of charge.
The garden waste we collect is recycled to produce compost.
Contact Dorset Waste Partnership


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The White Seal
Oh! hush thee, my baby, the night is behind us,
And black are the waters that sparkled so green.
The moon, o'er the combers, looks downward to find us
At rest in the hollows that rustle between.
Where billow meets billow, then soft be thy pillow,
Ah, weary wee flipperling, curl at thy ease!


text:
How is the Millenial Generation changing eCommerce for beauty brands?
Millennials bring to the table a unique set of purchasing habits unlike anything we've seen before. They shop differently than their mother's and grandmother's, and want complete control over the shopping experience. Millennials go out of their way to cultivate their own unique style, and purchase decisions are more likely to be influenced by social media, advice from their friends, celebrities, or famous beauty bloggers than by a brand or traditional advertising. Consumer incomes are on the rise, and the changing lifestyles presented by the Millennial group are driving the global beauty industry, which is forecasted to reach $265 billion by 2017. This consumer group gravitates towards eCommerce instead of in-store shopping since it allows Millennials to achieve complete control over their shopping experience. Beauty brands are rethinking their strategy to reach these consumers, taking advantage of augmented reality beauty solutions so shoppers can instantly try and buy online or in an app, creating a true end-to-end eCommerce experience. Continue reading Alice CosmoProf Interview Q's and A's


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BP at four mile and the bypass
Posted in the Richmond Forum
United States
#1 Aug 18, 2010
I have had my fair share of working with the public and am well aware that people have bad days and can sometimes take out their frustrations on the customer. Up until this afternoon my husband and I would frequent this store quite often, the ladies working on the day shift need a serious attitude adjustment. Ladies, you do you hair and makeup BEFORE you come to work, I cannot believe you would think it is okay to make the customer wait until you finish drying your hair! The tall blonde who has the beer belly is a rude, inconsiderate waste of space. They treat the customers with utter disrespect, I cannot tell you how many times I have walked up to the counter and they continue talking on the phone as they wait on me. Please, I know your job is misreable, but if it wasn't for the paying customer-you'd be out of a job! Try to treat them with respect!!!
#2 Aug 18, 2010
Try discussing your concerns with the store owner. If they get the idea that their inconsiderate employees are driving away customers, they might well cut them loose. Then these fine folks can chat on their cells and dry their hair all day long, at home... At least til the bills stack up and the lose power and phone service.
#3 Aug 18, 2010
That store is owned by HARDY OIL in Irvine. If I had their phone number handy I would post it.
#4 Aug 19, 2010
That store is probably the most redneck gas station in Richmond. They act like they're doing you a favor to take your money. I quit buying gas there a long time ago.
United States
#6 Aug 19, 2010
Thanks for the info about the number, I will definitely look into it today. I'm glad I am not the only one who has issues with this place, I am generally a very patient person, especially when it comes to customer service, but too many times of going in there and them treating us like crap has really done me in. I can definitely go else where and get treated with a lot more respect.
#7 Aug 19, 2010
My LAST trip in that place was when a pus gutted, dirty hands, unshaven redneck was serving food and chewing tobacco at the same time. As for the beer belly females, I hate being called honey, baby or darling. Unless I'm sleeping with you, just call me sir,and the females I've seen working there, their butts look like a flat tire on a John Deere Tractor.
United States
#8 Aug 19, 2010
On one occasion I spent close to 25.00 dollars on lunch, I live on four mile and I didn't want to drive in to town...I don't know if they were training someone or what, but I asked for some ranch, they gave me one. Please keep in mind, 25.00 dollars of food! I was like is there anyway I can have one more? The woman said I'm gonna have to charge you for it, I said why, I have more then two meals. She looked at the pot bellied blondie and was like what do I do? Blondie rolled her eyes and said, if shes too cheap to pay for a cup of ranch then just don't charge her for it. I was livid that day, again absolutely no customer service what so ever.
United States
#9 Aug 19, 2010
I use to work there this store has changed hands of managment so many times in the last 5 years it isnt even funny the hardys are good people they dont sell beer lottery 1.5 rolling papers or anything cause they are christian people but eveyone that they have running that store either rips them off or they are drug heads so I know where everyone on this site is coming from I quit because of all the bullshit that goes on up there
#11 Aug 21, 2010
I have had a few unsurprised debit/credit card transactions there before. After reading this blog I wonder if it was a mistake by the gas station or was it attentional.
I admit working with the generalbpublic can be challenging at times , but show some class people! Don't bite the hands that feed you!
#12 Aug 23, 2010
i shop at that store too and i can agree with you that the women in that store are low or no class. i walk back out if i see any of them working when i need something. however, there are some nice people that work there. i'm sure it really sucks for them to be grouped together with such disgusting pathetic people. next time you are in there and one gives you attitude, demand to speak with a manager and if that person does nothing, then have them give you the home office number to lodge a complaint. as consumers, we should NEVER be subject to such garbage service!
#13 Aug 23, 2010
Hardy Oil always hire poor choices for cashiers and employees... they own a couple of stations off of exit 62 in mt. vernon and you are describing most of the employees there too.
#14 Aug 23, 2010
There used to be a pretty black headed girl that used to run the deli on the weekends, what ever happened to her? She was one of their best employees/ workers. She was the most nicest polite person to ever work there. All I know is she was always a pleasure to talk to, and always had a smile on her face. They need to hire her back, and let some of the other trash go.
#15 Aug 24, 2010
Kasey Renfro a pregnant girl that works there is so rude.
Also another girl named Kim. I guarantee one of thos girls are the one you describe as a blonde beer bellied girl. They are so inconsiderate, I stopped going forever ago someone needs to complain. I tried but when I call theres no one to ever talk to.
Since: Aug 10
#16 Aug 24, 2010
I live near there and have been there a few times. Once I went in there to buy a couple things and the girls were behind the counter were talking. I stood at the counter for a few minutes before I said something, then they rolled their eyes at me for disturbing their conversation. That was the last time that I went into the store.
#19 Aug 26, 2010
I have an idea, Stop complaining? Really, Your All Overweight Rednecks with beer bellys. Shutup Get the hell off of the computer and do some situps. Go to a different Gas Station? Not hard. Damn, This is why you don't give the elderly computers. Go play Bingo or something. Really.
Since: Aug 10
#20 Aug 26, 2010
Talk about complaining. First off, I do not drink beer and I am not overweight. I work out on a regular basis. If you have a problem with people complaining you should probaly not be on this site. If the workers did not treat people like crap when people go in there you would not have people complaining
#21 Aug 27, 2010
has anyone actually seen this guy dipping while cooking, cause i havent, also he is the most nicest guy up there and he doesnt do drugs, and that kim girl that works nights, she is the sweetes girl they got.
#22 Aug 27, 2010
Nice to see someone trying to make a positive statement with double negatives lolol
#23 Aug 27, 2010
Yeah, seen him dipping. He's just gross. He may be nice, but he has no business cooking and serving food. Kim, Kasey, and the rest of those girls that work there, are all a waste of space. Are maybe 3 people that work there, do a good job, and keep to themselves. I'm sure the trash they have working there will run them off one day.
#24 Aug 27, 2010
he has never dipped while cooking. also kim kasey and matt are the best ones they got, atleast there not snorting pills or smoking weed, or whatever, that place is a joke beside the three i have mentioned, so yall leave them out of it.
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What is included with this book?
Balancing practical and theoretical knowledge, Political Science is a comprehensive and jargon-free introduction to the fields basic concepts and themes. This bestselling brief text uses diverse real-world examples to show students the value of avoiding simplifications in politics, the relevance of government, and the importance of participation. Written from Mike Roskins unique and engaging point-of-view, Political Science remains the best at providing the clear explanations, practical applications, and current examples that will welcome students to a vital field of study.
This exceptionally up-to-date book draws from both U.S and comparative examples to offer an unbiased, thorough introduction to the basic terminology, concepts, and theories of political science. Using an eclectic approach and a wide range of current examples, this superbly readable book provides a solid understanding of the entire field.
Theories: Classic and Modern. Nations, States, and Governments. Individuals and Constitutions. Democracy, Totalitarianism, and Authoritarianism. Political Culture. Public Opinion. Political Communication and the Media. Political Parties and Party Systems. The Institutions of Politics. International Relations. The Global System. For anyone who is interested in learning basic political science.
|The Bases Of Politics
|Politics and Political Science
|Political Attitudes
|Political Culture
|Public Opinion
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Wooooooooooooooooow! N tht long woow still deosnt do justice to this post….
Tell me why do u think skiing aint as famous in Inia as it should be? Honestly I int know we had such fab ones till i read this post :-/
Gulmarg Gondola is a Jammu and Kashmir state government initiative. I am sure it is aimed at giving an access to the slopes for skiing. But then it is available for a joy ride too. And we went for the joy ride.
You can find the details of the rope way and the ticket prices from the J&K State Cable Car Corporation Website.
Gulmarg Gondola Offices
In March the places was not too crowded though there were both tourists and Skiers. There were more skiers than tourists using the place. The Gondolas are self operating. When the doors open at the dock we need to step in and after that they close on their own. It would have been then times more fun if people would not have scratched the glass for writing their names and otherwise. I hated the scratches on the gondola glasses. And the litter left behind by tourists. It leaves me foaming at mouth.
A Skiier at Gulmarg
We had Mudassar with us from the Khyber as our escort and he knew a lot about the region. He told us that a lot of the skiers came from Russia. Later at another hotel I also caught a glimpse of the famous Bill Barker who is said to know about Gulmarg more than even a local!
Aparwath, Level Two at Gulmarg Gondola
We did not spend much time at Level 1 (Kungdoor) but we did get out for quite sometime at Aparwath the level 2 of the Gondola ride. In this picture you can see Mudassar (sitting) clicking Neehar who is in turn being clicked by Ashwin and then all of them are being clicked by me. I wonder if we all were in someone's frame as well! A media trip means that there would be plenty of cameras and plenty of clicking.
View at Level 2, Aparwath, Gulmarg Gondola
Aparwath was chilly because there was a stiff wind blowing. I was glad that I had my thick jacket. For a while I was content clicking pictures. Then the trekker in me wanted to walk up to the next bend. When I started walking, Mudassar joined me on the walk. I am sure he was worried about me breaking a limb by falling on the snow. I just slipped once but I did not fall. Thank god for the small mercies. He then told me about the concept of Heli Skiing. So in Heli Skiing people get dropped on the peaks by a helicopter and then they ski down! How does that sound to you? To me it sounded pretty incredulous.
We also had a long chat about Kashmir and its situation but it is going to be a separate post someday.
Wooooooooooooooooow! N tht long woow still deosnt do justice to this post….
Tell me why do u think skiing aint as famous in Inia as it should be? Honestly I int know we had such fab ones till i read this post :-/
Just read your post, Beautiful.
So the fun continues at Gulmarg -:) As regards visitors (especially our own home grown Indian tourists) they take pride in littering the place & causing damage to whatever they can lay their hands on ! They are so reckless, indifferent,undisciplined, defiant & given to noisy & boorish behavior ! So sad.
Beautiful place Gulmarg . Its on the hit list especially for quality of snow and skiing . Thanks for sharing very good information.
I get shivered hearing the name of Gulmarg . Lovely pictures.
Nice pictures. You must have had some amazing vistas!
I am Mridula Dwivedi and I started blogging on 'Travel Tales from India' in June 2005. I renamed it Travel Tales from India & Abroad in 2016. Within a few months of the launch my travel blog found a mention on both the BBC and The Guardian. I also featured in a National Geographic Skoda Yeti Video. I was recently featured on Via.com
I quit my job as a professor in May 2015. I am having a blast ever since. I do not miss my work but sometime I do miss my salary! Somewhere along the journey I ended up acquiring a Ph.D. from IIT Kanpur! I now wonder why?
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