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Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease
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Background We wanted to explore the association of metabolic syndrome (MetS) versus its individual components with 20‐year all‐cause mortality among patients with stable coronary artery disease.
Methods and Results The cohort comprised 12 403 nondiabetic patients with stable coronary artery disease who were enrolled in the Bezafibrate Infarction Prevention Registry between February 1990 and October 1992 and followed up through December 2014. The study cohort was divided into 4 groups: patients without MetS or impaired fasting glucose (IFG), patients with IFG but without MetS, patients with MetS but without IFG, and patients with both MetS and IFG. Kaplan‐Meier survival analysis showed that at 20 years of follow‐up, the rates of all‐cause mortality were the highest among patients with both MetS and IFG (66%). Patients with IFG without MetS experienced a significantly higher mortality rate compared with those with MetS without IFG (61% versus 56%; log‐rank P<0.001). Multivariable Cox proportional hazard analysis showed that the final Cox model demonstrated that the additive effect of MetS (hazard ratio, 1.13; 95% confidence interval, 1.1–1.16; P=0.02) and IFG (hazard ratio, 1.54; 95% confidence interval, 1.46–1.62; P<0.001) on 20 years mortality was nonsignificant (hazard ratio, 1.01; 95% confidence interval, 0.93–1.11; P=0.69). IFG was associated with the most pronounced increase in mortality risk among the individual components (hazard ratio, 1.22; 95% confidence interval, 1.14–1.3; P<0.001).
Conclusions Our findings suggest that IFG alone is a major independent predictor of long‐term mortality among patients with stable coronary artery disease versus other components of the MetS.
Clinical Perspective
What Is New?
Impaired fasting glucose (IFG) presence is associated with increased mortality risk compared with the reference group without metabolic syndrome (MetS) or IFG, whereas MetS without the IFG component had a less pronounced effect.
Of the different components of MetS, IFG was associated with a 22% independent greater mortality risk compared with absence of IFG after adjustment to other MetS components and to comorbidities.
The independent risk associated with IFG (69% greater adjusted mortality risk) was greater than the combined risk of all other 4 components.
What Are the Clinical Implications?
IFG is a principle determinant of mortality risk associated with MetS in patients with nondiabetic stable coronary artery disease.
Presence of IFG is associated with marked increased mortality risk in the presence or absence of MetS.
Tighter monitoring and treatment with coronary artery disease and IFG can possibly improve important clinical outcomes.
The effect of the metabolic syndrome (MetS) in subjects without established cardiovascular disease is well established, including increased noncardiovascular morbidity and general mortality.1, 2, 3, 4, 5, 6, 7 Moreover, each of the independent components of the MetS has also been associated with an increased risk of cardiovascular events and mortality, with a variation in the magnitude of these relationships among the different individual components.4, 8, 9, 10, 11
In contrast to the clear association of MetS as an important risk factor for cardiovascular disease and mortality in subjects without coronary artery disease (CAD), several studies found no significant association,12, 13, 14, 15 or even a possible protective effect ("the obesity paradox phenomena"), in patients with CAD.16 A recent large meta‐analysis, including 18 457 patients' data, showed that MetS was associated with an increase in all‐cause mortality only in patients with acute coronary syndrome and only after revascularization (not in patients with stable CAD).17
To confound matters further, controversy exists about the assumption that MetS is useful in predicting mortality beyond its components.13, 14, 15 The prognostic importance of MetS compared with that of its individual components has repeatedly been challenged. Several studies argued that not all individual components of MetS contributed to the increased risk of all‐cause mortality.13, 14, 15 This risk was significantly predicted by impaired fasting glucose (IFG) in all subjects, as well as by IFG and low high‐density lipoprotein (HDL) cholesterol in women among an Italian population.18, 19, 20
Furthermore, the follow‐up period in most studies about MetS or its components and mortality prediction in patients with CAD is <3 years.12, 17, 21, 22, 23, 24 Most studies explored cardiovascular mortality rather than all‐cause mortality as the primary outcome.12, 17, 21, 22, 23, 24
Accordingly, in the present study, we aimed to do the following: (1) determine the independent association of the MetS components, as defined by the National Cholesterol Education Program criteria, with long‐term, 20‐year, all‐cause mortality among nondiabetic patients with stable CAD; and (2) compare the mortality risk associated with MetS without the IFG component with risk conferred by IFG alone without MetS.
Study Population
The present study population was composed of patients who were screened for participation in the Bezafibrate Infarction Prevention (BIP) trial from February 1990 to October 1992 and enrolled in the BIP Registry. The design and rationale of the BIP Registry and study were published previously.25, 26 Of the 15 524 screened patients, only 3090 (20%) were randomized in the prospective interventional 6‐year BIP study that compared bezafibrate with placebo. Because the intervention period ended >15 years ago, we decided to include these subjects in our analysis cohort.
Briefly, the BIP Registry included 15 524 patients, aged 40 to 74 years, with stable CAD fulfilling 1 of the following inclusion criteria: (1) documented myocardial infarction (MI) in the previous 5 years; (2) symptomatic stable angina pectoris and either positive myocardial ischemia by radionuclear scintigraphy or ≥60% stenosis of 1 or more of the major coronary arteries, demonstrated by coronary angiography; (3) documented percutaneous coronary intervention or coronary bypass surgery in the preceding 6 months. Exclusion criteria included the following: insulin‐treated diabetes mellitus (DM), severe heart failure (New York Heart Association functional class, >II), unstable angina, hepatic (glutamate pyruvate transaminase GPT, more than twice the normal value) or renal (creatinine, >1.5 mg/dL) failure, and current use of lipid‐modifying drugs.
All medical examination and biochemical blood test results, historical medical data, and data on drug therapy were prospectively recorded; all vital signs were measured.
Patients were defined as diabetics on the basis of their medical record diagnosis, as prospectively coded at study enrollment, or if they were prescribed hypoglycemic medications. The same method was applied to the definitions of hypertension, smoking status, and other elements of the medical history.
For the purpose of this study, we excluded all the patients diagnosed as having DM (n=2959 [19.2%]) or patients missing laboratory values (n=21[0.13%]); the final data set for the current study comprised 12 403 patients.
The study was approved by our institute's internal review board and was performed according to the principles expressed in the Declaration of Helsinki and the ethics policy of the institute.
The BIP study group was responsible for the enrollment of the patients and the collection of data. The prospective data collection, including mortality status, was performed with the help of the Israeli Association for Cardiovascular Trials.
MetS Definitions
Currently, there are several definitions for MetS. For the purpose of this study, we used the National Cholesterol Education Program—Third Adult Treatment Panel27 definition. Accordingly, patients who were seen with 3 or more of the following 5 risk factors were defined as having MetS:
Central obesity, defined as waist circumference greater than established ethnicity‐specific values. Because the data on waist circumference were not available, for purposes of this analysis, we used the body mass index (BMI) >30 kg/m2 as a criterion for classifying patients as obese.28, 29, 30 Other large studies have previously used this substitution and showed that there is a strong linear correlation between waist circumference and BMI value.30, 31, 32
Low HDL, defined as <50 mg/dL among women and <40 mg/dL among men.
Elevated fasting plasma triglycerides ≥150 mg/dL.
Elevated systolic blood pressure ≥130 mm Hg, diastolic value ≥85 mm Hg, or treatment of previously diagnosed hypertension.
Elevated fasting plasma glucose ≥100 mg/dL.
Group Distribution
To examine the effect of IFG with or without MetS on long‐term mortality outcome, we divided our study cohort into 4 groups: (1) group METS −IFG−, the none group (ie, subjects without MetS or IFG); (2) group METS−IFG+, the IFG group (ie, subjects with IFG but without MetS); (3) group METS+IFG−, MetS without IFG group (ie, subjects with MetS but without the IFG component [IFG not 1 of the 3 components for MetS definition fulfillment]); and (4) group METS+IFG+, MetS with IFG group (ie, subjects with IFG and additional 2 criteria, thus fulfilling the MetS definition).
Laboratory Methods
Detailed data on the laboratory methods were given in a previous report.33 Briefly, blood samples were drawn after at least 12 hours of fasting. Cooled samples, collected in the 18 participating centers using standard equipment and procedures, were transferred to the study's central laboratory. All analyses were performed on a random access analyzer using diagnostic kits.
Primary End Point
The primary end point of this study was all‐cause mortality. Mortality data were obtained by matching the patients' identification numbers with their vital status in the National Population Registry of Israel. Each match record was checked for correct identification by matching the study recorded date of birth during enrollment with the date of birth stored at the national registry.
Statistical Analysis
Variables are expressed as mean±SD or median and interquartile range. Categorical data are summarized as numbers and percentages. The demographic characteristics, clinical characteristics, and laboratory values of patients at baseline, according to the 4 prespecified groups, were compared with the use of the 1‐way ANOVA test for continuous variables and the χ2 test for categorical variables, along with Z‐test with Bonferroni correction. ANOVA post hoc multiple comparisons were performed using the least significant difference or Dunnett T3 test, as appropriate, after equal variance assumption verifications.
Kaplan‐Meier survival analysis was used to graphically present survival estimates of subjects among the 4 different groups. The subsequent long‐term survival probability was compared using the log‐rank test. Additional Kaplan‐Meier survival estimates were generated to compare patients with 1 to 4 components of the MetS, excluding IFG, with the same respective number of components, including IFG (ie, 1 component, excluding IFG, versus IFG alone; any 2 components of the MetS, excluding IFG, versus IFG plus 1 other component). The survival results are presented in the form of a bar graph figure.
Multivariable Cox proportional hazard regression modeling was used to assess the independent risk associated with each component of the MetS (IFG, low HDL, elevated blood pressure [National Cholesterol Education Program definitions], triglycerides >150 mg/dL, or BMI >30 kg/m2). The following covariates were introduced using the best subset method, following a univariable analysis of all relevant variables: age, sex, serum creatinine, hypertension, heart failure, previous MI, or past cerebrovascular accident, together with all the components of MetS. Best subset components were selected using adjusted R2 and Mallows' Cp.
Finally, a Cox proportional model was run to evaluate the additive contribution of MetS and IFG on 20 years' mortality. The MetS×IFG interaction was added to the previously described model to explore multiplicative effect (ie, whether the presence of 2 factors together has a greater impact). The results were shown as a survival function diagram, presenting the value of the cumulative survival function for a given time (namely, the probability of survival to that time period calculated on the basis of the Cox proportional adjusted hazard model).
The proportionality of hazard assumption was verified using Schoenfeld residuals and the log minus log method. We additionally performed a sensitivity analysis excluding subjects randomized to the BIP randomized study (n=2808).
Statistical significance was accepted for a 2‐sided P<0.05. The statistical analysis was performed with SPSS version 20.0 and SAS version 9.2.
Availability of Data and Material
The data sets during and/or analyzed during the current study are available from the corresponding author on reasonable request.
On the basis of the criteria of the National Cholesterol Education Program, 5245 patients (43%) had MetS, of whom 3234 (27%) also had IFG (group METS+IFG+), and 2011 patients (16%) were considered to have MetS but without IFG (group METS+IFG−). A total of 7158 patients (57%) did not fulfill the criteria for the MetS; among these patients, 1286 (10%) had IFG (group METS−IFG+) and 5872 (47%) had neither MetS nor IFG (group METS−IFG−). Baseline characteristics of the 4 groups are summarized in the Table.
As expected, patients in the METS+IFG− and METS+IFG+ groups (namely, those patients with MetS) had an adverse clinical and biochemical profile, including a higher incidence of hypertension and dyslipidemia than the other 2 groups. However, prevalence of past cerebrovascular accident, chronic obstructive pulmonary disease, low‐density lipoprotein levels, and history of MI were similar to patients without the MetS. Patients with MetS were significantly more likely to receive β blockers, diuretics, calcium channel blockers, and nitrates, yet less likely to receive antiplatelet therapy (Table). Low HDL was the main component among patients with MetS; low HDL was found in 4930 patients (94%) with MetS versus only 3771 patients (53%) without MetS (P<0.001) (Table).
When comparing the METS−IFG+ group with the METS+IFG− group, patients in the METS−IFG+ group (only IFG without MetS) had the lowest rate of comorbidities. These patients were less likely to be seen with other components of the MetS, including lower rates of low HDL (30% in the METS−IFG+ group versus 99% in the METS+IFG− group) and almost no subjects with obesity (2%) or hyperglycemia (5%); however, they were slightly older and included more male patients than the other groups (Table).
Long‐Term Mortality in the 4 Patient Groups
Kaplan‐Meier survival analysis (Figure 1A) showed that at 20 years of follow‐up, the all‐cause mortality rates were the highest among patients with MetS and IFG (66% in the METS+IFG+ group) and the lowest among patients without MetS or IFG (53% in the METS−IFG− group), whereas patients with IFG without MetS and those with MetS but without IFG experienced intermediate mortality rates (log‐rank P<0.001 for the overall difference among the 4 groups during the follow‐up period). However, when mortality rates were directly compared between the 2 latter groups, patients with IFG but without MetS (the METS−IFG+ group) experienced significantly higher unadjusted mortality rates compared with patients with MetS who did not have IFG (the METS+IFG− group; 61% versus 56%; log‐rank P<0.001) (Figure 1B).
Notably, separation in event rate curves between patients with and without IFG appeared after 5 years and was sustained thereafter (Figure 1A).
Consistent with the univariate findings seen in the Kaplan‐Meier analysis, multivariate Cox proportional hazards regression modeling, adjusted for age, sex, and comorbidities, demonstrated that patients with IFG without MetS (the MetS−IFG+ group) had 15% greater long‐term mortality risk (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.01–1.31) compared with patients without MetS or IFG (the MetS−IFG− group, serving as the reference group) (Figure 2). Patients with MetS without IFG did not experience a significant risk increase (HR, 1.08; 95% CI, 0.98–1.20) compared with the reference group. The worst prognosis was observed in subjects with both MetS and IFG (MetS+IFG+ group; HR, 1.31; 95% CI, 1.21–1.42; P<0.001) (Figure 2).
Finally, we performed Cox proportional hazard modeling, including interaction term analysis, by the introduction of the IFG‐by‐MetS product. This analysis demonstrated that the effect of MetS (HR, 1.13; 95% CI, 1.1–1.16; P=0.02) and IFG (HR, 1.54; 95% CI, 1.46–1.62; P<0.001) on 20 years' mortality is nonmultiplicative and independent (P=0.69 for interaction). According to this adjusted Cox model, the worst survival mean was seen among the MetS−IFG+ group. Consistent results were obtained when subjects randomized to the interventional BIP trial (n=2808) were excluded.
Mortality Risk Associated With Individual Component of the MetS
In univariable analysis, the presence of any individual component of the MetS was found to increase risk for long‐term mortality compared with the remaining study population. However, after multivariable adjustment, only IFG and BMI remained significantly associated with increased mortality risk (Figure 3). IFG was associated with the most pronounced increase in mortality risk among the individual components (HR, 1.22; 95% CI, 1.14–1.3; P<0.001). BMI >30 kg/m2 was also significantly associated with increase in long‐term mortality (HR, 1.13; 95% CI, 1.02–1.24; P=0.014), whereas all the remaining components were not significantly associated with all‐cause mortality risk (Figure 3).
Additional independent predictors for long‐term mortality included increased serum creatinine, the presence of advanced heart failure symptoms (New York Heart Association, >2), and a history of MI (Table S1).
Subgroup Analysis Among Patients With MetS
We further performed a subgroup analysis that included only patients with MetS who were enrolled in the BIP Registry. In this patient subset, Kaplan‐Meier survival analysis showed that patients with MetS with the IFG component have a greater mortality risk than patients with MetS without the IFG component but the same number of components (Figure 4). For example, patients with MetS with 2 components other than IFG had lower mortality probability compared with patients with MetS who had 2 components, 1 of them being IFG (52% versus 67%; log‐rank P<0.001).
In the present study, we provide several novel insights into the relationship between MetS and its component association with 20‐year all‐cause mortality among nondiabetic patients with stable CAD. First, we demonstrated that IFG presence is associated with increased mortality risk compared with the reference group without MetS or IFG (METS−IFG−), whereas MetS without the IFG component had a less pronounced effect (8%; P=0.11). Results were consistent in univariable and multivariable analysis. Second, of the different components of MetS, IFG was associated with 22% independent greater mortality risk compared with absence of IFG after adjustment to other MetS components and to comorbidities (Figure 3).
Finally, we have shown that the independent risk associated with IFG (69% greater adjusted mortality risk) was greater than the combined risk of all the other 4 components (52% greater risk) (Figure 3).
Therefore, in the population we studied, the primary risk‐driving factor is the presence of IFG; the addition of risk factors to IFG further increases the long‐term mortality risk, yet in the absence of IFG, the mortality risk is attenuated.
The obligatory requirement of the presence of (at least) 3 risk factors leads to the loss of the significance and the predictive value of some risk factors entirely and from others in part.34, 35, 36 A recent Chinese study, published by Sun et al, found that MetS did not predict all‐cause mortality above and beyond 2 of its individual components (namely, hypertension and IFG).18 However, this study included a relatively small cohort (n=1535) with mostly patients without cardiovascular disease. Our study extends these observations.
Despite the fact that the MetS is often referred to as a uniform entity, it is imperative to admit that no single underlying mechanism has been defined, and one may not exist. Hence, the syndrome could range from a cluster of varied components, unrelated to each other, to a constellation of factors linked through a common underlying mechanism.37 One of the undoubted mechanisms behind the cause of the MetS is insulin resistance. It has been known for decades that insulin resistance plays a central role in the pathophysiological characteristics of MetS, which has led some experts to use the term insulin resistance syndrome.38, 39, 40
It is possible that IFG is a better marker of insulin resistance and, thus, better associated with all‐cause mortality than other components of MetS.30 Several studies have shown that insulin resistance can increase the cardiovascular risk by increasing inflammation and impairing endothelial function.39, 41 Nonetheless, a large study with ≈10 000 patients concluded that fasting plasma glucose >100 mg/dL and/or hypertension were not significantly associated with all‐cause mortality; however, the study was limited to patients with non–ST‐elevation MI and had limited follow‐up.8 Measurement of glucose levels during stress hyperglycemia, such as an acute coronary event or heart failure, is pathophysiologically different; it may possibly serve as a different marker when compared with fasting glucose obtained during a scheduled non–event‐related visit.42, 43, 44
Acute event‐related glucose elevation is driven by a highly complex interplay of counterregulatory hormones, such as catecholamines, growth hormone, cortisol, and cytokines.45, 46, 47 Although the mechanism seems to be well known, the impact on DM development remains scarce.44, 48, 49 Furthermore, the impact on long‐term mortality among patients with stable CAD is unknown. However, values we obtained in the BIP Registry probably better reflect basal metabolic abnormalities and insulin resistance.
Compared with previous studies, the present study has several advantages. First, to the best of our knowledge, this is the first study investigating the relationship between all‐cause mortality and components of the MetS; the study includes long‐term follow‐up in a large cohort and excludes diabetic individuals. The large size of our study, together with the long‐term follow‐up, which incorporated >208 000 person‐years of follow‐up, provided adequate statistical power to assess the associations within the currently accepted definition of MetS and its components.
Second, to our knowledge, this is the first study to compare the MetS with IFG component separately, as well as the relation between the IFG and the number of other MetS components with 20‐year all‐cause mortality outcome in patients with stable CAD.
Attributing the appropriate importance to IFG presence has several practical implications. IFG is easy to detect, and glucose measurements are widely available and inexpensive. Risk stratification as part of secondary prevention efforts should probably better account for IFG and insulin resistance and provide more intensive follow‐up of this high‐risk population. Furthermore, IFG can be reversible, with a regression to normal glucose regulation and the prevention of the development of DM,50 and can serve as an important driving force for lifestyle changes. In addition, it is possible that patients with IFG, and especially MetS with IFG, would benefit from more intensive pharmacotherapy, such as targeting lower low‐density lipoprotein levels, metformin, and possibly lower blood pressure goals.
Our study has several limitations. First, it is a retrospective study that enrolled patients during a period in which different treatments were used for controlling blood glucose, hyperlipidemia, and hypertension. Thus, our results warrant validation in more contemporary populations. Second, it is a retrospective analysis and not all confounders can be accounted for; all possible variables were not measured. Third, we have no data on clinical events and management after the screening period, especially on the development of DM through the years among the study groups or the cause of death. Fourth, all patients who were currently using lipid‐modifying drugs were excluded. However, among the components of the MetS, we find hyperglycemia and the HDL level, rather than the low‐density lipoprotein level; therefore, we do not think this exclusion would have affected our results. Finally, our data lack waist circumference assessment, which is important for the definition of central obesity as a component of the MetS. However, we replaced this criterion with the BMI >30 kg/m2 criterion, according to the consensus of the International Diabetes Federation (IDF) criteria and several publications in the field.
IFG is a principle determinant of mortality risk associated with MetS in nondiabetic patients with stable CAD. Presence of IFG is associated with marked increased mortality risk in the presence or absence of MetS. Tighter monitoring and treatment with CAD and IFG can possibly improve important clinical outcomes.
Authors' Contributions
Arwa Y. and Goldkorn designed the study, developed the method, analyzed the data, and wrote the article. Anan Y., Goldenberg, and Tannenbaum analyzed and interpreted the patient data, revised the article, and contributed to the writing. Tzur, Mazu, and Fisman helped with the collection of the data. All authors read and approved the final article.
Supplementary Information
Table S1. Independent All‐Cause Mortality Risk Predictors in Non‐Diabetic Patients With Stable CAD [jah32655-sup-0001-TableS1.pdf]
The study was made possible by the combined efforts of the BIP study group and the Israeli Association for Cardiovascular Trials. The BIP study group was responsible for the enrollment of the patients and the collection of data. The prospective data collection, including mortality status, was performed with the help of the Israeli Association for Cardiovascular Trials.
- ↵
- ↵
- ↵Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683–689.
- ↵
- ↵Ninomiya JK, L'Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2004;109:42–46.
- ↵
- ↵
- ↵Mehta RH, Westerhout CM, Zheng Y, Giugliano RP, Huber K, Prabhakaran D, Harrington RA, Newby KL, Armstrong PW. Association of metabolic syndrome and its individual components with outcomes among patients with high‐risk non‐ST‐segment elevation acute coronary syndromes. Am Heart J. 2014;168:182–188.e1.
- ↵Malik S, Wong ND, Franklin SS, Kamath TV, L'Italien GJ, Pio JR, Williams GR. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004;110:1245–1250.
- ↵
- ↵Mente A, Yusuf S, Islam S, McQueen MJ, Tanomsup S, Onen CL, Rangarajan S, Gerstein HC, Anand SS. Metabolic syndrome and risk of acute myocardial infarction a case‐control study of 26,903 subjects from 52 countries. J Am Coll Cardiol. 2010;55:2390–2398.
- ↵
- ↵
- ↵
- ↵Ji MS, Jeong MH, Ahn Y, Kim YJ, Chae SC, Hong TJ, Seong IW, Chae JK, Kim CJ, Cho MC, Rha SW, Bae JH, Seung KB, Park SJ. One‐year clinical outcomes among patients with metabolic syndrome and acute myocardial infarction. Korean Circ J. 2013;43:519–526.
- ↵Patsa C, Toutouzas K, Tsiamis E, Tsioufis C, Spanos A, Karanasos A, Michelongona A, Tousoulis D, Stefanadis C. Impact of metabolic syndrome on clinical outcomes after new generation drug eluting stent implantation: the "obesity paradox" phenomenon is still apparent. Nutr Metab Cardiovasc Dis. 2013;23:307–313.
- ↵Tie HT, Shi R, Li ZH, Zhang M, Zhang C, Wu QC. Risk of major adverse cardiovascular events in patients with metabolic syndrome after revascularization: a meta‐analysis of eighteen cohorts with 18,457 patients. Metabolism. 2015;64:1224–1234.
- ↵
- ↵Sattar N, McConnachie A, Shaper AG, Blauw GJ, Buckley BM, de Craen AJ, Ford I, Forouhi NG, Freeman DJ, Jukema JW, Lennon L, Macfarlane PW, Murphy MB, Packard CJ, Stott DJ, Westendorp RG, Whincup PH, Shepherd J, Wannamethee SG. Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet. 2008;371:1927–1935.
- ↵Zambon S, Zanoni S, Romanato G, Corti MC, Noale M, Sartori L, Musacchio E, Baggio G, Crepaldi G, Manzato E. Metabolic syndrome and all‐cause and cardiovascular mortality in an Italian elderly population: the Progetto Veneto Anziani (Pro.V.A.) Study. Diabetes Care. 2009;32:153–159.
- ↵Akman T, Binbay M, Erbin A, Tepeler A, Sari E, Kucuktopcu O, Ozgor F, Muslumanoglu A. The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL). BJU Int. 2012;110:E1079–E1083.
- ↵
- ↵Uchida Y, Ichimiya S, Ishii H, Kanashiro M, Watanabe J, Yoshikawa D, Takeshita K, Sakai S, Amano T, Matsubara T, Murohara T. Impact of metabolic syndrome on various aspects of microcirculation and major adverse cardiac events in patients with ST‐segment elevation myocardial infarction. Circ J. 2012;76:1972–1979.
- ↵Ivanovic B, Tadic M, Bradic Z, Zivkovic N, Stanisavljevic D, Celic V. The influence of the metabolic syndrome on atrial fibrillation occurrence and outcome after coronary bypass surgery: a 3‐year follow‐up study. Thorac Cardiovasc Surg. 2014;62:561–568.
- ↵The Bezafibrate Infarction Prevention (BIP) Study Group, Israel. Lipids and lipoproteins in symptomatic coronary heart disease: distribution, intercorrelations, and significance for risk classification in 6,700 men and 1,500 women. Circulation. 1992;86:839–848.
- ↵Goldbourt U, Behar S, Reicher‐Reiss H, Agmon J, Kaplinsky E, Graff E, Kishon Y, Caspi A, Weisbort J, Mandelzweig L. Rationale and design of a secondary prevention trial of increasing serum high‐density lipoprotein cholesterol and reducing triglycerides in patients with clinically manifest atherosclerotic heart disease (the Bezafibrate Infarction Prevention Trial). Am J Cardiol. 1993;71:909–915.
- ↵Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr., Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–2752.
- ↵
- ↵Dekker JM, Girman C, Rhodes T, Nijpels G, Stehouwer CD, Bouter LM, Heine RJ. Metabolic syndrome and 10‐year cardiovascular disease risk in the Hoorn Study. Circulation. 2005;112:666–673.
- ↵Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr.. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–1645.
- ↵
- ↵Gierach M, Gierach J, Ewertowska M, Arndt A, Junik R. Correlation between body mass index and waist circumference in patients with metabolic syndrome. ISRN Endocrinol. 2014;2014:514589.
- ↵Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: the Bezafibrate Infarction Prevention (BIP) study. Circulation. 2000;102:21–27.
- ↵
- ↵
- ↵Guembe MJ, Toledo E, Barba J, Martínez‐Vila E, González‐Diego P, Irimia P, Díez J, Viñes JJ. Association between metabolic syndrome or its components and asymptomatic cardiovascular disease in the RIVANA‐study. Atherosclerosis. 2010;211:612–617.
- ↵Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr., Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement: executive summary. Crit Pathw Cardiol. 2005;4:198–203.
- ↵Reaven GM. Banting lecture 1988: role of insulin resistance in human disease. Diabetes. 1988;37:1595–1607.
- ↵
- ↵
- ↵
- ↵Kamceva G, Vavlukis M, Kitanoski D, Kedev S. Newly diagnosed diabetes and stress glycaemia and its' association with acute coronary syndrome. Open Access Maced J Med Sci. 2015;3:607–612.
- ↵Roberts GW, Quinn SJ, Valentine N, Alhawassi T, O'Dea H, Stranks SN, Burt MG, Doogue MP. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab. 2015;100:4490–4497.
- ↵Colomo N, Linares F, Rubio‐Martin E, Moreno MJ, de Mora M, García AM, González AM, Rojo‐Martínez G, Valdés S, Ruiz de Adana MS, Olveira G, Soriguer F. Stress hyperglycaemia in hospitalized patients with coronary artery disease and type 2 diabetes risk. Eur J Clin Invest. 2013;43:1060–1068.
- ↵Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clin Sci. 1999;96:513–523.
- ↵
- ↵Ishihara M, Kagawa E, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nakama Y, Maruhashi T, Ookawa K, Dai K, Aokage Y. Impact of admission hyperglycemia and diabetes mellitus on short‐ and long‐term mortality after acute myocardial infarction in the coronary intervention era. Am J Cardiol. 2007;99:1674–1679.
- ↵
- ↵
- ↵Perreault L, Kahn SE, Christophi CA, Knowler WC, Hamman RF; Diabetes Prevention Program Research Group . Regression from pre‐diabetes to normal glucose regulation in the diabetes prevention program. Diabetes Care. 2009;32:1583–1588.
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- Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery DiseaseArwa Younis, Ronen Goldkorn, Ilan Goldenberg, Diklah Geva, Boaz Tzur, Anna Mazu, Anan Younis, Zvi Fisman, Alexander Tannenbaum and Robert KlempfnerJournal of the American Heart Association. 2017;6:e006609, originally published October 27, 2017https://doi.org/10.1161/JAHA.117.006609
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- Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery DiseaseArwa Younis, Ronen Goldkorn, Ilan Goldenberg, Diklah Geva, Boaz Tzur, Anna Mazu, Anan Younis, Zvi Fisman, Alexander Tannenbaum and Robert KlempfnerJournal of the American Heart Association. 2017;6:e006609, originally published October 27, 2017https://doi.org/10.1161/JAHA.117.006609


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I make many of my own spice blends, some from recipes I've found or made up, others from recipes I make often. So here they are. 🙂
favorite savory spice blends
favorite rubs
packet substitutes
favorite baking blends
hints and helps:
Spices can be a big investment, especially when you're just starting out! Take a peek at What Herbs & Spices Do I Need?

subset: commoncrawl


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Fire Science
& Firefighting
& Technology
Fire Services
Tarrant County College District - Fire Ranking 2017
in the USA
Tarrant County College District is a very large public college offering a number of disciplines along with the fire program and located in
Fort Worth
. The school is operating since 1965 and is currently offering certificates and associate's degrees in Fire Protection and Safety Technology.
Tarrant County College District is very inexpensive (
see more affordable colleges in TX
) - depending on the program, tuition is about $7,000 per year. According to recent data analysis, Tarrant County College District area is generally safe - the school is reported to have
a good rating
for personal safety.
Tarrant County College District fire program ranks in Top 50 in the United States and The Third Best in
. Major competing fire schools for this college are
Southwestern Adventist University
in Keene and
Collin County Community College District
in McKinney. See the details about all twelve competing fire schools as well as list of offered fire majors below.
Fire programs ratings 2016-2017:
Overall rating:
Curriculum rating:
Teaching rating:
Safety rating:
Overall school rankings 2017:
The Third Best Fire School in
Ranked #19 Fire School in
The South
Ranked #48 Fire School in
Programs rankings 2017:
State of Texas Ranking
The Second Best Protection & Technology School
State of Texas Ranking
The South Regional Ranking
Ranked #11 Protection & Technology School
The South Regional Ranking
USA National Ranking
Ranked #19 Protection & Technology School
USA National Ranking
More program rankings:
You may be interested in alternative ways to get accepted at Tarrant County College District:
Police Programs
- ranked top 30% in USA
Also, see how Tarrant County College District has been ranked among
affordable colleges
in Texas.
Contact information:
Tarrant County College District
1500 Houston St
Fort Worth, TX 76102-6524
Phone: (817) 515-8223
Location map:
Fire majors offered:
Less than one year certificate
Fire Protection and Safety Technology
Associate's degree
Fire Protection and Safety Technology
Local competitors:
Southwestern Adventist University
Keene, TX, 1 fire program
Collin County Community College District
McKinney, TX, 5 fire programs
Austin Community College District
Austin, TX, 2 fire programs
Great Plains Technology Center
Lawton, OK, 1 fire program
McLennan Community College
Waco, TX, 1 fire program
Oklahoma State University Oklahoma City
Oklahoma City, OK, 4 fire programs
Blinn College
Brenham, TX, 2 fire programs
El Centro College
Dallas, TX, 2 fire programs
Angelina College
Lufkin, TX, 1 fire program
Vernon College
Vernon, TX, 1 fire program
North Central Texas College
Gainesville, TX, 1 fire program
Kilgore College
Kilgore, TX, 2 fire programs
Jump to:
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South Fire Schools
Texas Fire Schools
Fort Worth Fire Schools
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Today's Featured Artist: Michael Godard
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0521 is a painting by I J T Son Of Jesus which was uploaded on November 8th, 2014.
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Fishing of standing comb
- 2014/12/29 09:37
- Category: Fishing information
It was influence that water temperature rose ‼ today when water temperature 20 degrees, seawater temperature were not stable, or which beach had a hard fight to chip of wood Gres and bait-stealing fish today, too. We caught excellent model with elephant's trunk to head at 40cm in that.
(^-^)/ where some east undulation seems to stay tomorrow, and offing beach seems to be severe, but we have left unseen this year, and expectation seems to be popular with the outskirts, around wife of chief zen-priest as water temperature is higher
Catch on 27th
Information: Nishimoto ferryboat for anglers


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Hump Day's 10January 2, 2008 at 12:03 am | Posted in Hump Day's 10 | 1 Comment
Tags: Hump Day's 10
1. Lemon Poppy Seed Cake (recipe)…contains raw foods including jicama and apple. The slices look beautiful.
2. Icebox Peppermint Yule Log…yes, I would make a Yule log after Christmas.
4. Pink Champagne Cake…people like to make this at New Year's. I hope you enjoyed whatever New Year's festivities.
5. Huckleberry Pie Cake. I wish that I knew where to get some huckleberries. I do know where to get great huckleberry syrup and jam.
6. Amish Rolled Oats Cake. Apparently, an old recipe.
7. Country Apple Crumb Cake. Described as moist…I like moist crumb cakes.
9. Blueberry Gingerbread Cake. I have never had a gingerbread cake.
In case you are wondering, I just had some really good homemade cheesecake…one piece, though I would have loved to have eaten half. I guess that would spoil the effects of my workout…following this tape that must have thought I was a contortionist as they kept telling me to touch various body parts to my nose.
Your turn….leave a link about something interesting on your blog in the comments. 🙂
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i spent last evening and parts of today spinning with the hansen e-spinner. we bonded. i am in love. i zipped through 8 ounces of fiber like nobody's buisness and filled the bobbin. as i am returning her to her rightful owner, i had to wind it off to be plied later.
Garden Party
1 day ago


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Wednesday, October 04, 2006
6 Comments:
- Digital Art Photography for Dummies said...
New York does have a beautiful sky, especially in the winter when the sun lies low on the horizon. There's aomething called the rule of thirds in photography, which means that you get a well-framed photo by framing landscape photos so that the sky occupies the top third of the photo.
- said...
Not that it needs to be said, but for the benefit of "digital art photography for dummies" (if that IS his or her real name...[wink]): if you're trying to see pure sky in the city, the edges of buildings inevitably poke into the frame. You even come to love them. That's sort of the point.
In other words: Rule, schmule. Do your thing, Dubya.
- JMW said...
Thanks, PF. I think Digital Art means well (perhaps it's short for Digital Arthur), and I also think he/she is technically correct. But yes, one point of this "project," such as it is, is to replicate what it's like to look at the sky in NY, which does always include those intrusions of architecture.
- said...
If only you could convey the smell, too. And the sense that a taxi is speeding at you.
- said...
Hold a slice of sky photo contest on your website, Mr. Editor. -- tavia
- Freudian Slip said...
Head out to an area without lights, that will let you see the sky so much better. New York has got plenty of countryside for when you are missing Texas :)


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i need help in my english question!
Consider the poems, short stories, and autobiographical pieces you read from the first half of the twentieth century during this semester. How did historical events and realities affect writers who were working during this time? What common threads did you observe in the works of these writers? Cite specific examples from various texts in your response
we read pieces by Richard Rodriguez, Amy Tan, Julia Alvarez, Harlem Renaissance


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Welcome to our class blog! This blog is designed to help link our study of sociology with everyday experiences. Thoughtful comments are always welcomed and appreciated.
Enjoy, and thanks for visiting!
Wednesday, June 8, 2011
Barely Living - The Struggle of the Workign Poor.
3 comments:
- Tyron JamesJune 8, 2011 at 4:49 PM
I agree that the working poor shouldn't be judged based on where we are now. Anything could have happened for them to get in that situation, whether they were raised into a poor family or they had a lot of their life sanings in stock. that person could have been a upper middle class citizen before there unfortunate downfall. I'm glad that there are still people who don't "blame the victim" the victum being the working poor.ReplyDelete
- Astrid BeatoJune 9, 2011 at 5:50 PM
I agree with the fact that people do judge the working poor as lazy without knowing their situation. There are people that I do know that work a lot and do the right things but still live from pay check to pay check to support their family. It's just like the saying goes "bad things happen to nice people". In the other hand, their are some "working people" that are lazy and just don't want to get a job which gives the rest of the working class people really bad names.ReplyDelete
- Ang AnwarJune 14, 2011 at 6:41 PM
I agree with Ashakia that anyone can experience the "working poor" lifestyle, and that we should not say that the poor are poor because they are lazy because some of the poor try their best not to be poor. I have sympathy to everyone who lost his or her job because of the recession and they have to experience working poor lifestyle. A friend of mine got laid off because of the recession, he lived from unemployment benefits for several months. Nonetheless, he can get back up again on his feet and keep searching for jobs. As a result, he is now working in a company that pay him more than the previous job that he had. However, I somehow disagree with Ashakia and agree with what societies have said. I have seen many times that a lot of young adults being homeless and they do not try to do anything about it. Once, on my way home from Best Buy at Colombus Boulevard, I saw a young woman sitting down in between two way lanes road and held up a card box that said she is a homeless. I believe she can have a job if she wants, but she preferred to sat there and asked for money. The following week, I still saw her holding that card box. I do not mean to be judgmental. Perhaps she has some obstacles in her life that make her do what she does. Consequently, societies stereotyping the poor base on what they have seen.ReplyDelete


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Table of contents
Once an oil furnace has actually remained in use for time, it could establish issues that will certainly have no bearing on the design of the furnace or its producer. You should attempt to deal with the trouble, just after totally understanding the scenarios that resulted in it. Simple troubleshooting can, in many cases, lead you to the root cause of the issue. This is specifically the case when the problem is a little one. When the trouble is more complicated, it is always best to locate the right expert who could make the needed repairs. In this post, we will certainly go over the top oil furnace problems that you could come across.
If you need an oil boiler repair work, if your furnace is making an amusing noise, or if you find you require of any other heating system repairs, don't delay-- give us a telephone call immediately. Delaying repair work can trigger costly damage to your tools. Allow our expert service technicians repair the issue today to guarantee your home stays warm.
Annual/Preventative Upkeep, Nothing occurs when it's switched on, No warm in one place, No warmth in all areas, Pilot light is out, Scents funny, Makes odd sounds, Does not get cozy sufficient, Cycles on/off also swiftly, Runs regularly, Gas odor, Leaking
In a city with great deals of older design, like Jaffrey, heating unit making use of warm water or vapor radiators are typical, as well as well matched to the area. Warm water and vapor warmth is quite desirable due to the fact that it is power effective (specifically considering how old the modern technology as well as components often are). This sort of warm, unlike that of forced-air systems, includes a specific degree of moisture that many people like. Residents in Jaffrey, who have to keep the warm on for numerous months out of the year, can certainly value these top qualities.
In the residential areas, where a number of the homes are much more recent, forced-air heating unit are a lot more common. Often selected for their reduced installment cost, these systems supply an extremely dry warmth that some individuals do not like.
Our professional heating fixing technicians can take treatment of any type of heat or furnace emergency you may have. Our heating repair competence consists of all makes, versions and also kinds of heaters and furnaces; oil, gas, propane, electrical-- you name it.
Step by step list to to detect & repair an oil burner that won't run or maintains quiting. Oil heaters used on oil-fired heating central heating boilers, heaters, or water heaters can commonly be detected making use of a visual examination method along with an optional basic examination equipment explained right here.
We are a full service cooling and heating business that services Jaffrey, NH. Our extremely knowledgeable Solution Technicians and Setup Groups are all history checked, medicine examined, and also maintain all appropriate New Hampshire qualifications for the security of your house.
Despite the name, a boiler generally just heats up water rather than boiling it. The warm water is after that pumped to radiators, under-floor tubes, or to a warmth exchanger. Every one of these heating unit are described as hydronic, water-based, heat. Wall-mounted radiators and also warm water walls use boiler-supplied warm water to warm rooms by radiation as well as convection. Hot water circulating in under-floor tubes, hydronic glowing floor home heating, turns the whole flooring surface area right into a huge radiator.
Also servicing these zip codes in Jaffrey: 03452


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- Pet Friendly
- WiFi
- Hot Tub
- No Smoking
- Bed & Bath Linens
- Pillows & Blankets
- Coffee Maker
- Toaster
- Blender
- Dishes, Utensils, & Cookware
- Dishwasher
- Microwave
- Iron & Ironing Board
- Stereo with CD Player
- Telephone
- TV & DVD Player
- Central Heat & Air Conditioning
- Washer & Dryer
- Outdoor Furniture
- Outdoor Shower
- Grill
- Beach Chairs (5 per home)
Home Details
|Ocean Perch
|Check in Day:
|Check-in Office:
|Distance to Beach:
|View Map
|Master Bedrooms:
|4 Full 1 Half
Ocean Perch is offering an off-season booking special! Reserve any week in December through March 2018 and receive $75 off the rental fee if you bring your own linens and bath towels! Call 800-849-4339 to book your Outer Banks vacation today!
Recent updates include an new granite counter tops and flooring in the kitchen!
Lazy days on the beach, oceanfront dining and a soak in the hot tub can be part of your beach vacation at "Ocean Perch." With ocean views, easy beach access via adjacent public walkway, three master suites, and a well-equipped kitchen, this home provides a comfortable setting for relaxation and sharing meals with family and friends.
Main House
|Two MBRs (K, K); two BRs (3T, Q/2T); full bath; laundry.
|MBR (K) with whirlpool; great room; kitchen; den; half bath.
|Hot tub, multiple TVs/DVDs, screened porch.
Dogs welcome (1 max. no cats). No additional fee or deposit required.
2018 Advertising Updates
9/26/17 For the 2018 season, this home will allow a maximum of 1 dog, no cats. No additional fee or deposit required.
Ratings & Reviews
The location of Ocean Perch was perfect for our vacation. Great view and close to shopping.
- Barbara 10/14/2017
- Michael 9/30/2017
- Stephen 8/5/2017
We love coming to this home-away-from home.
- Joseph And Kris 5/27/2017
Questions & Answers
How far is to grocery store and other shopping? Thanks!
Cathy, J10975 is approximately 2.1 miles from the closest grocery store, Food Lion, and within 1.5 miles of shopping.
- Answered by Twiddy on 11/10/2017
Can you see the ocean from all levels or do the dunes block it?
Kelly, J10975 offers ocean views from Level 3 and some of Level 2.
- Answered by Twiddy on 9/1/2016
What is the leash law for dogs on the beach in Corolla?
Great question, Dave! In Corolla leashes are required but there are no length requirements.
- Answered by Twiddy on 6/9/2016
i rented this house last feb for a week and loved it .do the owners do partial weeks
We would love the opportunity to welcome you back to J10975, Danny! This home only offers full week reservation.
- Answered by Twiddy on 1/28/2016
Is there a pet deposit? If so, how much?
Steve, J10975 currently allows a maximum of 2 pets with no additional fees or deposits required.
- Answered by Twiddy on 11/1/2014
is there a community pool??
Diane, J10975 does not offer community pool access. This home is located close by outdoor activities, great restaurants, and unique shops.
- Answered by Twiddy on 10/9/2014
Are there any fishing piers close by if not where is the closest peir at
David, the nearest spot to do fishing is the Whalehead Club. There are various bridges to fish and crab from. There are also some boardwalks in Duck where you can do the same thing. However, the closest official pier will be Kitty Hawk pier.
- Answered by Twiddy on 8/29/2014
Is there an outdoor shower at this house?
Great question, Nancy! Every Twiddy home provides an outdoor shower. For our list of standard amenities, please visit www.twiddy.com/abbreviations-definitions.aspx#stfurneq.
- Answered by Twiddy on 7/31/2014
Is there any baby equipment available in the house, ie stair gates, portacrib or high chair?
Thank you for your inquiry, Sandi! Baby equipment is not a standard amenity for Twiddy homes. If you would like to rent baby equipment for your stay, Just for the Beach, Moneysworth, and Ocean Atlantic Rentals all provide baby equipment rentals. For contact information, please visit www.twiddy.com/activities/services.aspx.
- Answered by Twiddy on 7/5/2014
What type of beach access from the property is there?
Donna, this home is located right next to the community beach walkway; open this link and enlarge the view to medium, and you will see how easy it is: www.twiddy.com/aerials/aerial-whalehead-central-2.aspx
- Answered by Twiddy on 8/12/2013
Are there any beach chairs available for the guests associated with this house?
Yes Judy, there will be at least 5 beach chairs for your use at this home!
- Answered by Twiddy on 5/26/2013


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more CD Los Millonarios football formations
CD Los Millonarios players:
- casillas
- D. Luiz
- S. Ramos
- P. Lahm
- Marcelo
- Pirlo
- Ribery
- J. Rodriguez
- L. Messi
- C. Ronaldo
- Neymar
Rebuild this formation
Build your own CD Los Millonarios formation.
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It was quite easy to do. Ask any person who has known me for a while. Nature and animals are a huge part of my life for a reason! Both kept me sane and happy with a cheerful outlook. How can one not smile at animals in nature at work or at play, or smile when the sun shines, or laugh while jumping in a puddle - and yes, jump in puddles I do if I have the proper shoes on!
Thankfully along the way there were people who reminded me that not all people are the same. Many of them have no idea how important and lifesaving their love and acceptance were to me. Nonetheless, I methodically isolated myself from others and myself. Since we are relative strangers, you do not know how difficult it is to be open, warm and receptive to people. To overlook and not expect the same old hurt and pain one gets from interacting and putting oneself out there.
I had to relearn emotions. The only two I had were anger and sadness. I promised a person very dear to me when she had to leave my life unexpectedly that I would not shut down and undo the progress which took me years to accomplish. I can only say to my friend Lydia that I am trying and do so everyday.
Some days it is easier than others to remember compassion and grace. Others not so much. On those days I prefer to challenge myself by interacting with people. Some days I succeed. Today was a success!
I wrote this yesterday and hesitated to publish it because it is too harsh. After re-reading it today I feel that if I didn't publish it then I would be going against my true self. I am not trying to impress people. This is my journey and exploration. I just want you to know that am not one to share myself freely in real life and how huge this is. My goal is to be authentic always. I have failed in that aspect in one major area of my life - for another day - and not too far off I am sure!
I read today that you have to explore the dark in order to see the light and my friends - I am heading towards the center of that tunnel!


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Classrooms all over the country are trying something new: sitting and breathing.
Category: Motivating
GoPro Karma: Desert Canyons with Dad
Join Dorothy and her Dad Garrett as they adventure to the Great American Southwest for a day of exploring some of Earth's most majestic desert landscapes. Whether they're capturing beautiful aerials with Karma, or running through the canyons with Karma Grip, smooth cinematic shots have never been this easy.
9 Signs You're Not Drinking Enough Water
We've heard it. We get it. We know! Drink more water! But it's not just overplayed advice from fitness magazines and your mother. When we get dehydrated our bodies send out clear warning signs that we need to check our fluid levels. If that happens, it's important to do everything to get your hydration level back on track. Here are some of the symptoms associated with not drinking enough water…
Foods That Will Give You Bad Skin
We all know that acne is caused by things we face in our everyday lives. Sweat, dirty pillowcases, and rogue hair product are just a few of the culprits of random breakouts. And wrinkles, of course, are an inevitable side effect of aging. But it's not only what touches our skin on the outside that can cause it to flare up. In fact, the food you put inside your body is just as important. If you have an expert skincare regimen but your skin still isn't top-notch, you could be consuming all the wrong things. Here are a few of the surprising foods that can wreak havoc on your complexion…
The science is in: Exercise isn't the best way to lose weight
Why working out is great for health, but not for weight loss, explained in five minutes.
Going green shouldn't be this hard
Going green does not need to be a sacrifice, either for us as individuals or for businesses, governments and the economy.


text: My BSL and Golden Comet pullets are just over 17 weeks old. Got my second egg today, not sure who from... The two middle eggs in the picture came from the pullets, the two outer eggs are from my adult layers. Will the eggs get bigger as the pullets continue to mature? Sent from my SM-G920V using Tapatalk


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Portable Fire Extinguisher Cover - 9Kg / 9Ltr - portable Fire Extinguishers
£9.99 Ex VAT
£11.99 Inc VAT
Red Plastic Fire Bucket including lid
£19.99 Ex VAT
£23.99 Inc VAT
Your header in Here
Upon receipt of payment for an order, delivery is 5-7 working days if ordered before 2pm. However sometimes delivery can take longer due to carrier difficulties or access issues. Deliveries are Monday - Friday. Delivery is from 9am to 6pm by our carrier UKMail, a signature will be required upon delivery.
Minimum delivery cost £5.99. Deliveries to Northern / Southern Ireland and The Highlands and Islands of Scotland will be subject to additional costs, worked out on delivery weight and shown at time of placing an order. All orders placed are subject to VAT at the current rate and VAT is charged on the total order value. Should you require any further information regarding delivery, carriage costs or VAT please do not hesitate to contact us. UK LANDLINE NO: 01709 816183


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New York City
Other Cities
Complimentary and Deeply Discounted Shows
Discount Ticket Alerts
Stay abreast of discount offers for great theater, on Broadway or in select cities.
Guild Hall presents a new season of music, drama and more in the John Drew Theater. The following productions are presented in their new season:
The Paper Bag Players present Put On Your Shoes, I've Got News!


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Thursday, September 8, 2011
Dinah Shore
Another from '58 - gorgeous:
From 1962, for S&W Green Stamps:
'62, and lovely, too:
And a piece of my sheet music:
A beautiful lady, who also had a beautiful voice.
6 comments:
- Twyla and Lindsey said...
Hi Heidi! I grew up watching Dinah. I used to watch her show every day. She was an inspiring woman. Twyla
- September 8, 2011 at 6:29 AM
- Tina Dawn said...
Wow, and she was married to George Montgomery. What a lovely lady. Love T
- September 8, 2011 at 7:24 AM
- Candice said...
My mother used to say Dinah had a beautiful singing voice. I recall hearing her sing on her show back when she was dating Burt Reynolds and I was shocked because she sounded awful to me. I remember I was watching her show one day and there was a breakin by the network to announce the death of Elvis Presley.
- September 8, 2011 at 7:58 AM
- Sponge Curlers and Cupcakes said...
She was such a doll, and I think like you said, was probably one of the really nice people in Hollywood. At least she seemed to be. She had a great variety show from 1956 to I think around 1962(?) & we watched it religiously. She was actually a very good singer in the style of the 40's & 50's. I also think she was the one true love of Burt Reynolds life. Gosh, now I'm going to have to go surfing around to see if I can find any of her recordings or maybe a clip of the "Chevy Show"...Seeee the USA in your Chevrolet - America's the greatest land of all. Yep, that was Dinah's song & I'm SO glad y'all can't hear me singing it! Haha!
- September 8, 2011 at 3:11 PM
- Dawn Gahan said...
Boy did this bring back memories. Candice comments that she remembered her voice as awful but I remember watching her show and thinking her voice was so average yet she sang with so much confidence that you sorta dug it. She exuded such comfort in her own skin, that you couldn't help but love her. Almost a Maude kind of easiness. Makes me want to find old clips of her show.
Thanks for taking me back!
- September 8, 2011 at 9:07 PM
In case you didn't know, the connection between Dinah and Chevrolet wasn't simply commercial.
As a teenager, Fanny Rose Shore bopped around Nashville in a Chevy roadster, so she was proud to endorse the product.
Interestingly enough, she didn't want to introduce the guests on her show. In a 1960 TV GUIDE article, she states her dislike of being a "fem-cee".
- September 11, 2011 at 8:19 PM


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I Need an Easter Egg
Little Simon, Feb 1, 1999 - Juvenile Fiction - 16 pages
Little Rabbit is looking for the perfect Easter egg for his grandma. But nobody seems to know where to find one. Lift the flaps to help Little Rabbit find the Easter egg that's just right!
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Ecological Factors Affecting Hispanic Urban Middle School and High School Adolescents' College and Career Aspirations
MetadataShow full item record
This mixed methods study investigates how ecological factors influence the decisions urban Hispanic middle school and high school adolescents make concerning their college and career aspirations. I examine the academic aspirations, career aspirations, the influence of peers, teachers, and parents of seventh-, eighth-, ninth-, and tenth-grade urban Hispanic adolescents, and gender roles in college and career aspirations through the lens of Bronfenbrenner's ecological subsystems theory. Participants took the Student Career Assessment (SCA) survey consisting of Likert-type multiple choice questions and open-ended questions to assess their college and career aspirations. Quantitatively analyzed data examined the extent urban Hispanic middle school and high school adolescents were influenced by items on scales of encouragement, literacy, and education and whether there were differences by gender and grade level. Student responses as to why they chose a specific career were analyzed qualitatively. Combined results for urban Hispanic middle school and high school adolescents show a) both genders are interested in finishing high school and going to college, b) Hispanic females are encouraged more than males to pursue their college and career aspirations, c) more females than males know their career aspiration, but the majority of students do not know how to prepare for their chosen career, e) females have more confidence in their literacy skills than males. The more confidence Hispanic high school students have in their literacy skills, the more likely they are to graduate from high school. Implications for future research should involve conducting studies in the areas of college and career aspirations of urban Hispanic adolescents using random sampling. More gender studies involving the college and career aspirations of urban Hispanic adolescents would significantly add to the current body of knowledge.
SubjectEcological Factors
Urban Hispanic Middle School Students
Urban Hispanic High School Students
Adolescent College and Career Aspirations
Hostrup, Judy Ann (2011). Ecological Factors Affecting Hispanic Urban Middle School and High School Adolescents' College and Career Aspirations. Doctoral dissertation, Texas A&M University. Available electronically from http : / /hdl .handle .net /1969 .1 /ETD -TAMU -2011 -05 -9051.


text: What are you talking about? Amy Sedaris looks exactly like this! (I'm working on my last assignment for portraiture class, picturing my personal idol. Just so happens I'm very happy with the way this is going and because of that I couldn't care less that it's totally unrecognizable. Come on man, rodeo bunny!)


text:
What's the point of having a blog if you can't share the works of other great creatives you know about, so here's a good one for all of you.
Jen Harris, AKA BatCLAM
A great freelance comic artist/illustrator that I've had the good fortune to work alongside. She has a deviantart page as well as Patreon, but here's a choice sampling of some great works of hers:


text:
We all make them, some of us stick to them and many espouse the benefits of writing no more than three items on theirs if they want to be productive and achieve big things.
But what if we got rid of the to-do list altogether?
What if we went to the productivity dark side and wrote a not-to-do list?
The not-to-do list is a new trend in the productivity world, with the BBC recently publishing an article showcasing its benefits and detailing the successful people using them – like serial entrepreneur and author Tim Ferris who lists 'people who ramble and meetings without a clear agenda' on his not-to-do list.
The premise is that you write a list of tasks you don't want to work on, to remind you to focus on the things you do – the tasks that really matter and help you move towards your goals in a more concrete way.
I love this idea and have been implementing something similar over the past year as time as a new parent has meant only slithers of time for getting anything done.
In this case, the not-to-do list has been a revelation.
On mine – wasting time on social media, writing long emails, answering the phone to strange numbers and insisting the house is spotless.
The last one is particularly hard, but I enforce it because it really does free up a lot of time for the things I want to do, and that serve my long-term goals – like going on adventures with my husband and daughter, writing, reading and spending time in nature.
I'm a long time lover of the to-do list but I must admit that the not-to-do list has been even more powerful.
Not only in helping me be more productive in the least amount of time, but ensuring I don't burn out (again) by putting all my energy into 'busywork.'
Busywork is anything that doesn't move you forward, but rather just spins your wheels while wearing you out (and down) in the process.
The idea of the not-to-do list is also touched on in 7 Habits of Highly Successful People by Stephen Covey. The Time Management Matrix in the book speaks of the notion of 'non-urgent, not-important' tasks which are exactly what should be going on your not-to-do list.
Instead, focus your time on the urgent and important tasks to move yourself towards your goals.
So next time you are about to put pen to paper, or finger to keypad, pause and think about the tasks that are holding you back from making real progress in whatever you are looking to make progress in. Write them down and start formulating your very own not-to-do list.
Going to the productivity dark side might just be the missing link in helping you finish that book, start that side hustle or get that promotion.
It's not often that not doing something helps you achieve your goals, so this might just be the one list worth sticking to.


text:
Finland has said it has "solved" the problem of refugee identity, using the Blockchain to record data of new residents.
As part of its commitment to support asylum seekers, Finland is providing arrivals with a prepaid debit card instead of cash, and linking the identity of cardholders to the Blockchain.
As Technology Review reports, quoting Finnish Immigration Service director Jouko Salonen, the issue of "strongly authenticated identity" is no longer a problem.
"We have found a way to solve that," he told the publication.
Full story at http://bit.ly/2gIXyA4
Source: CoinTelegraph
If you appreciate the things I share, consider making a contribution
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If you use Bitcoin you can send donations to my Bitcoin Wallet:


text:
Details of competitions should be emailed to: firstname.lastname@example.com
Winchester Poetry Prize
Deadline: 31 July 2018
Gŵyl Cybi—Cybi Festival—Poetry Competition
Deadline: 15 June 2018
Animal magic: editors seek fantastic poems for anthology
Deadline: 31 May 2018
The 2018 York Literature Festival / YorkMix Poetry Competition
Deadline: 25 February 2018
Deadline: 31 August 2018
Details from: http://www.aestheticamagazine.com/creative-writing-award/
Deadline: 31 May 2018
Details from: https://www.bridportprize.org.uk/poetry
Deadline: 30 September 2018
Details from http://www.frogmorepress.co.uk/uncategorized/the-frogmore-poetry-prize-2018/
There are no deadlines, as soon as one issue fills up, later submissions will automatically be considered for the next issue.
For details click here
Good news!
How wonderful to see that our OUP member Vicki Morley has won a competition. There were a few tweets about it but it wasn't confirmed that it was 'our' Vicki Morley until Vicki emailed to say so!
Vicki has won the 2016/2017 Plough International competition prize of £1K with a poem called Double Zero Flour.
Huge, nay, HUGE, congratulations to you, Vicki. What a superb achievement. We will swell with reflected glory 😉
Here is Vicki's winning poem:
The Plough Prize Open Poetry Competition 2016—winning poems
1st PRIZE: VICKI MORLEY
Double Zero Flour
You can travel fifty thousand miles in America without once tasting a piece of good bread Henry Miller
San Francisco clocks chime the summer hour.
Rehearsed the route, left powdery footprints right across sidewalk,
the best double zero flour, weevils will dine well.
My head crusts, breaks through new white shirt.
It crackles, curdles, creaks along my arms,
sparks and conjures the new dawn with static.
Tie, the colour of an electric bruise,
shoes, best soft leather from Siena.
Look, a dangerous eggplant tie reflected
in coffee shop window. Is, a vivid purple, too vibrant?
No, not for a baker — before sunrise
I mix, pound, pummel, stretch, knead, knock the dough,
fill the maws of ever hungry ovens,
feel the heat, jaws of hell, fires of heaven.
Crisp the dough to beautiful bread babies,
ciabatta, focaccia, sour-dough, grissini, pizza, fruit pannetone.
I strut across the piazza, past nail bar
where slinky ladies flutter out to street.
An open window yawns,
a sharp-suited man hollers down to me.
Why it's Antonio. Is he here for the chief baker job too?
Steady, breathe deep and slow, concentrate now.
I'm ready for probing questions,
about flour, yeast, pasta, bread-making, recipes.
Pour espresso, grappa, let's celebrate!
My fruit panettone decided it.
Let's stroll down to Venice Beach,
rinsed by the Pacific Ocean, and swim,
sip cold beers frosting our sticky palms,
sizzle fresh wolf-fish pan-roasted over hot coals,
watch bambini splashing in sea shallows,
while I dream new breads, like a salt-crust San Marino.
With acknowledgement to https://www.theploughprize.co.uk/index.php/2016 where you can see other prizewinners.
OU Poet Jenny Hamlett has a new collection of poetry, published by Indigo Dreams – click on this link for more info. Jenny takes as her guiding inspiration a sense of place and the people who inhabit it. Congratulations Jenny!
News from Orbis
Carole Baldock says: Join us online at the Orbis Facebook group.
Get a taste for Orbis: sample 2 back issues for just £7
(inc p+p – and that's nearly a couple of quid; single copies: £5)
Copies of the magazine can be seen online at the Poetry Library website:
Orbis 176, Summer
£5 (Overseas: £9/€12/$16); Subs: £17/4 pa (Overseas: £35/€42/$58)
Front cover artwork: 'Horizon' by Peter Leslie Wilks
Back cover, detail from image: http://www.artgallery.co.uk/artist/peter_leslie_wilks


text:
Our responsibility:
Do good, have fun, and prosper.
At Gumball we have values that mean a lot to us. We believe it's possible to simultaneously do good, have fun, AND prosper. When we put these values into action, our passion comes alive and as a result, people want to be a part of what we're doing. That's culture.
We also like keeping promises we make. There are only a few promises so that we don't overshoot or disappoint. Here they are:
Provide you the highest quality leadership development experiences that are steeped in science, customized, and relevant. In turn your unique problems are solved, inventions are built, and leaders are equipped.
Provide you the highest quality leadership development products that are designed to be on-demand and original.
Assure lasting and sustainable change in your leaders and teams.
Deliver and measure real business outcomes that result in 5x to 7x return on your investment.


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text:
White Fish In Herbed Butter
Frequently requested, easy to make.
butter, dill weed, garlic powder, onion powder, salt, white fish fillets, +black pepper
Pepper Boursin
This version of homemade boursin reminds me of the black pepper boursin you can buy mixed with the flavor of the regular, although the pepper in their...
butter, dill weed, garlic powder, onion powder, salt, +cream cheese, +basil, +marjoram, +parsley, +rosemary, +thyme, +black pepper
Oven-Fried Cod With Dill Butter
www.cooks.com - Similiar recipes
Popcorn Tv Trash
butter, salt, garlic powder, onion powder, dill weed, +nuts, +popped popcorn, +potato, +lemon pepper, +worcestershire sauce
www.cooks.com - Similiar recipes
Easy Herbed Grilled Salmon Recipe
butter, dill weed, garlic powder, onion powder, salt, +nonstick cooking spray, +lemon, +lemon pepper, +oregano, +parsley, +salmon, +paprika, +white wine
www.cdkitchen.com - Similiar recipes
Tuna Omelet With Cream Cheese
This is so rich and delicious! A tasty unique way to get more fish in your diet.
butter, dill weed, garlic powder, onion powder, salt, +olives, +cheese, +cream, +cream cheese, +eggs, +mayonnaise, +onions, +black pepper, +tuna
Blackened Sashimi with "Cool" Potato Salad
salt, dill weed, garlic powder, onion powder, butter, +potato, +mayonnaise, +sour cream, +basil, +chives, +capers, +white pepper, +seasoning, +cayenne, +black pepper, +paprika, +thyme, +oregano, +tuna
www.bigoven.com - Similiar recipes
Garlic-Buttered Green Beans
"These dressed-up beans are simple to make but look and taste special. They're a perfect side dish for nearly any meal."
butter, garlic powder, onion powder, salt, +green beans
allrecipes.com - Similiar recipes
Garlic Chicken
Easy, easy, easy!!
butter, garlic powder, onion powder, salt, +chicken
No-Fuss Beef Roast
"For Christmas dinner or other special occasions, this beef rib roast makes an elegant entree. I just coat the beef with a dry rub to spark the flavor,...
butter, garlic powder, onion powder, salt, +cayenne
allrecipes.com - Similiar recipes
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text: The Lembeh strait in the northern part of the Indonesian island of Sulawesi is a unique hotspot of marine biodiversity. Countless amazing creatures thrive in the underwater landscape surrounding Lembeh Island. During four years a wildlife filmmaker coupe spent many months in the region capturing hundreds of hours of behaviour, lots of it never filmed before. Among other unique behaviour the filmmakers were able to shoot an Anglerfish swallowing a Lionfish, a scene resembling Godzilla gulping down Dracula. Elegant seahorses, thumb-splitting Mantis shrimp, and deadly mino-octopuses are just some of the remarkable creatures traditional underwater films tend to overlook. As most of the underwater drama is hidden from plain sight only the ground-breaking macro photography in this film can reveal the awe and beauty of life in the Reef of Little Monsters.


text:
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Online casino sign on bonus
As the name implies, the Refer-a-Friend Bonus is given to a player once they send an invite to one of their friends by email.
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text:
Three rare white lion cubs were born in the Crimean safari park Taigan, as reported by RT. Lion cubs are just two weeks old and are learning how to walk. As safari park's director Oleg Zubkov said, white lions were found in 1952 - only one pair - and today they are very few in the world.
Scientists do not classify white lions neither as a separate subspecies nor as albinos. The reason for the birth of animals with such coloration is considered to be a genetic disease - leucism.


text:
- Letter re Google expeditions in Fieldwork
Letter inviting schools to participate in project
- Science and Mathematics Education Conference (SMEC) 2016
STEM Teacher Education - Initial and Continuing professional development is the 7th Science and Mathe-matics Education Conference (SMEC). 16th-17th June 2016 Institute of Education, DCU St. Patrick's College
- Region 10 Newsletter Berkshire and Oxfordshire - February 2016
All the latest news and events from ASE Berkshire and Oxfordshire.
- ASE/STEM Education Centre LondonTeacher Conference
Programme for the Teachers Conference at the UCL Institute of Education
- ASE Question Time: Enquiry-Based Learning in School Science?
This is the third of our most popular events - ASE Question Time. Run in a similar way to the infamous TV programme, Professor Michael Reiss (UCL Institute of Education) will chair a panel of experts, who will be quizzed about enquiry-based learning. Hear how this approach can support both 'working scientifically' and science conceptual development. Come along and join in the debate. Share your ideas and put your questions and concerns directly to our panel of experts gathered from across the field.
- Faraday Challenge Day at the Rutherford Appleton Laboratory
The one day STEM activity is designed for teams of six students in Year 8 (ages 12-13). The students will research, design and make prototype solutions to tough engineering problems. Tuesday 12th May More details on attached flier
- Region 10 ASE Berkshire and Oxfordshire Newsletter - May 2014
All the latest news and events! Region 10 Berkshire and Oxfordshire Newsletter - May 2014
- Region Officers Meeting 2011 Actions
Actions from 2011 Region Officers Meeting, tabled at 2012 meeting
- TeachMeet at St Helen's School Northwood
Details of the TeachMeet at St Helen's in Northwood
- Points South Update
Science Learning Centre Update


text:
Diane Sawyer's Made in America series features mirrors from OCG affiliate Hitchcock-Butterfield
Online PR News – 27-April-2011 – – MONTGOMERY, Ala. – MirrorsDirect.net, a wholly-owned subsidiary of Online Commerce Group, LLC, (OCG) proudly announces the feature of merchandising partner Hitchcock-Butterfield on ABC World News. In the series Made in America, Diane Sawyer's team highlights Hitchcock-Butterfield's mirrors in a home makeover.
Hitchcock-Butterfield offers mirrors in all shapes and sizes, from cameo mirrors to oval mirrors to contemporary mirrors, as well as custom-designed mirrors. The company bases its headquarters outside of St. Louis, Mo. Glass for their mirrors comes from the Pittsburgh Glass company, based in Pennsylvania.
"We are thrilled to hear about Hitchcock-Butterfield's feature on ABC World News. At our company, we strive to associate with other companies that are based in the United States. Hitchcock-Butterfield is a prime example of a great company, producing quality products, and because of that, we are proud to have them as part of our MirrorsDirect.net team," said Scott McGlon, President and CEO of OCG.
MirrorsDirect.net carries an assortment of mirrors for various types of home décor, but specifically hosts Hitchcock-Butterfield mirrors as a featured collection. OCG's partnership with Hitchcock-Butterfield is one of the catalysts for building the niche site, MirrorsDirect.net (http://www.mirrorsdirect.net).
"We chose to carry Hitchcock-Butterfield mirrors based on their quality and location, and we believe in their products. We have a long-standing partnership with them, which is why we feature them on MirrorsDirect.net," said Michelle Watkins, Merchandising Manager at OCG.
In the Made in America series on ABC World News, one family volunteered to have only American-made household goods within their home. Diane Sawyer's team emptied most of the house and replaced everything with items made in the United States, most often at a less expensive price. More information about the project can be found at http://abcnews.go.com/WN/MadeInAmerica/.
For more information, please contact Emily Nelms at (334) 558-0863 or e-mail at email@example.com.
About Online Commerce Group
Online Commerce Group, LLC, is a leading niche online retailer of upscale outdoor and indoor living space products for residential and commercial markets, which offers custom-made cushions (www.cushionsource.com), umbrellas (www.umbrellasource.com), teak furniture (www.teakfurnitureoutlet.com), home furnishings (www.myhomefurnishings.com), outdoor décor (www.outdoordrapes.com) and more. The company has been ranked in the Inc. 500/5000 list of the fastest-growing, privately-held companies in the United States in 2008, 2009 and 2010 as published by Inc. magazine, and has grown its revenue by more than 500% from 2006 to 2009. For more information about OCG and its diverse family of Web sites, visit www.onlinecommercegroup.com.


text:
I am currently in the process of restructuring Tracy Kelly Jewellery Design. Please excuse any odd images or text that may appear throughout this process….I am by no means a web designer!
A brand new site will (hopefully) be up soon, with new jewellery collections, a brand new blog, online store and (in the near future) new jewellery-making classes and workshop schedules.
In the meantime, I'd love for you to visit my Facebook page.
Click on the images below for a closer look!


text:
It is Prickly Pear season here in the Rio Grande Valley of Texas. They are blooming and putting out new little paddles (leaves). Did you know you could eat the paddles?? The are called nopalitos, they are boiled and eaten in salads or as a cooked vegetable. You can buy them at the local grocery stores. Here is a recipe for you to try, they tell me it can be found in one of the Betty Crocker recipe books:
Cactus Salad (Ensalada De Nopalitos)
4 servings
24 ounces sliced or diced prickly pear cactus
2 med tomatoes, coarsely chopped
1 sm onion, chopped
1/4 teaspoon drived oregano leaves
2 tablespoons snipped fresh cilantro
3 tablespoons vegetable oil
4 teaspoons white wine vinegar
1/4 teaspoon salt
a dash of pepper
Place cactus, tomatoes, onion and cilantro in a glass or plastic bowl. Shake remaining ingredients in tightly covered jar. Pour over vegetables; toss. Cover and refrigerate at least 4 hours. Serve on lettuce leaves if desired.
Personally I am confused by the recipe, not sure if you need to boil this before you chop, or just skin the little rascals. Was told to use as vegetable you must boil first for 15 minutes, drain and then boil again for 15 minutes (using fresh water each time).
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