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28 Parks near Gresham, Oregon
Wood Village, Oregon 1.86 miles NE
Fairview, Oregon 2.19 miles NW
Camas, Washington 5.62 miles NE
3010 SE Oxbow Pkwy Gresham, Oregon 97080 (503) 797-1850
Sites: 67 | Latest Rate: $27.00 | 2 Reviews
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Sep 2016 - $27.00
This park is tucked away in the woods. Quite a drive to get here with the last mile being very steep downhill. Then it is another three miles from the entrance to the camping area. Rate is actually 22$ but the mandatory 5$ entry fee makes it 27$ for dry camping. The sites are on the small side on dirt and pea gravel. Mostly unlevel too. Privacy is ok with reasonable spacing between sites. Very quiet location. Be aware of the "No pets" and "No alcohol" rules. They mean it.
We liked it for the quietness and if the weather was nicer we would have made good use of all the trails in the forest or maybe tried a few casts on the river. - TheSchweitzers
Jun 2014 - $22.00
This park is not far from Portland, Oregon or the scenic attractions of the Columbia Gorge. It lies along the designated Wild and Scenic Sandy River in an extensive stand of old growth forest. The physical setting is beautiful and there are 12 miles of trails for exploring the forest and river banks. Be aware that the access road in and out of the park is very steep! Those pulling trailers need to use low gear and the road is not suitable for large RVs. There are no water, electric or sewer hook-ups in the park, nor is there a dump station. There are flush toilets and free hot showers. Although we thought the setting was beautiful and peaceful, we felt the price was steep for what you get. Campsites are $22 a night and there is a $5 entry fee just to get into the park. That made our one night stay $27 for what was basically a pretty primitive camp site. Also, there are no pets allowed in the park so this campground is not suitable for those with a pet. This campground is best suited to those camping in tents, camper vans, truck campers, or small trailers. It would appeal to families as there are plenty of trails for kids to explore and also some playgrounds and grassy fields for baseball games and the like. We'd probably not stay here again but look for something along the Gorge instead. - BruceandKathyWA
21401 NE Sandy Blvd Fairview, Oregon 97024 (map) | (877) 570-2267
Sites: 407 | Latest Rate: $60.00 | 205 Reviews
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Sep 2016 - $60.00
This is a very clean, quiet and well managed park just outside Portland with convenient bus transportation into Portland if one chooses rapid transit. It is conveniently located near Sandy and the highway to Redmond and Bend, Oregon. If you are like us and really need Wi-Fi, this Park's system is both confusing and marginal for pick up. If you are an Apple device user, this system is not the best. We have downgraded this park purely based on the less than adequate Wi-Fi system. - Cannondaler
Sep 2016 - $54.00
This park is Way too expensive. The best thing about it was the proximity to Portland. We had a small, tight spot. WiFi would not connect (but our Verizon broadband signal was strong). We did not use the restrooms or laundry room. Before we chose this park I read many reviews online and by far the most consistent comment was how rude the front desk staff was. We didn't really find them rude but you should not have any expectations for being welcomed as a valued customer. At best the staff is humorless and indifferent. We won't stay here again - will seek out a happy place next time. - roadtripper4ever
Sep 2016 - $40.00
This is a stop we have made before. It is convenient to the Columbia Gorge, Portland, Gresham, and Wood Village. This park is enormous, but you aren't aware of how big it is because it is very spread out. Spaces are a good size. There is a little road noise, but not a problem. Walmart is right down the road. - WSKeifer
20145 NE Sandy Blvd Fairview, Oregon 97024 (map) | (503) 512-0207
Sites: 137 | Latest Rate: $35.00 | 3 Reviews
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Aug 2015 - $35.00
I've visited here many times over the last 11 years and if never seems to change...except they keep raising the nightly/weekly rates. WiFi is email and FB speed only, short term pads are broken up and tilt to the right (uncomfortable during showers and stuff), cable requires box, with a $50 deposit (refundable), and then doesn't work (OTA is OK though), bathroom is clean but it's 100 yards away, and requires a key ($5 deposit...refundable). All in all, I would not stay here if it wasn't so conveniently close to my friends living in the area...
When I'm lucky, and a good pad opens up, I stay here for weeks at a time. But that was last year and years past when the weekly was $180, now it's freaking $220. Really, place isn't worth that. - User35
Aug 2014 - $40.00
The place is rundown with 99 percent permanent residents. The pads are terribly un level and narrow. The manager is an older woman with a nasty attitude. Don't waste your time stopping here - Doctorlock
Jun 2012 - $30.00
Price was OK for the area and what you get. Office personal was very dramatic and every request and change seemed to frustrate her. Most sites are permanent residents. Laundry and restrooms are clean and nice. Most spots have trees, making it difficult for satellites to receive. We would not stay here again if we could find another place. - JoyceG
1097 East Historic Columbia River Highway Troutdale, Oregon 97060 (map) | (503) 665-6722
Sites: 116 | Latest Rate: $49.00 | 91 Reviews
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Oct 2016 - $49.00
Arrived on a Sunday & could not reach office personal. Needed to use laundry & restrooms but could not. Off hour accommodations were tacky. Paying the bill & leaving early was a problem. Office opened at 11am. Facilities seemed nice but crowded. Access to management poor. Possible bad timing for all. Stayed over night. - zzzya
Oct 2016 - $45.00
The streets are extremely narrow as are the sites making it very difficult for larger rigs to maneuver. The site was level and the park was clean. The main problem is the trains which run all night long. There are constant train whistles during the night as the tracks are very close by. We did not use the restrooms so cannot comment on that. The WiFi was OK. - Carol Warren
Sep 2016 - $42.00
Stayed for one night and only used the electrical which was good. I have to ditto the other raters regarding cleanliness of the park. An issue for overnighters is length of the site which, most cases, won't allow you to remain hooked up. The park was at capacity and I believe many are long term and/or permanent residents. People leaving for work in the morning makes it difficult to sleep as does the trains which are apparently near the park, and of course, run when everyone is trying to sleep. Everyone I met were very friendly. One positive was WIFI which was very good except during the evening when everyone in the park is online.
One thing that you should be aware of is getting to the park off of I-84. Your GPS will probably tell you to use exit 18 which is no doubt the shortest route but you have to cross an old bridge across the Sandy River taking you to the park entrance. The right turn onto the bridge is sharp and somewhat blind as to traffic approaching from the opposite direction on the bridge. Also the width of most RV's requires you to use the entire width of the bridge. Use either Exit 17 or Exit 16 which makes the route easy. You'll go thru the little town of Troutdale which is very nice. Be sure and keep an eye out for the entrance to the park because if you miss it you will end up going over the aforementioned old bridge. - James T
711 NE 100th Avenue Portland, Oregon 97220 (map) | (503) 255-6535
Sites: 10 | Latest Rate: $15.00 | 1 Reviews
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Oct 2014 - $15.00
10 level sites. Good location easy off and on freeway. Without full hookup I cannot give any site more than 8. But it is a good place other than that issue. - Gilbert & Gail
37000 Historic Columbia River Hwy Corbett, Oregon 97019 (map) | (503) 695-5207
Sites: 22 | Latest Rate: $23.00 | 28 Reviews
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Aug 2016 - $23.00
Water & electric site. Very helpful manager. She thought the site had 50 amp service but it was only 15 amp. Fortunately there was 30 amp service available near another site reachable with an extra power cord. Site required quite a bit of leveling. If using I-84 to reach the park use exit 18 rather than 22, since 22 requires climbing a 10% grade with many curves to reach the park. Park sign is very small and entry is directly east of the fire station and will require a wide turn into it. - Bob & Stephanie
Oct 2015 - $13.00
I stayed in a 20 amp site for 2 nights. Water available. #22 I paid $12.50/night at the Passport America rate. Host was very cordial. Did not use the laundry, showers, or the bathrooms. - Andrea1010
Aug 2015 - $30.00
This is our favorite RV park !!! according to an overall feel we were looking for in a park.
It's a small park, about 15 spots, some of the people are seasonal but everyone is super friendly. We immediately felt like we could stay here for a long time. It's the only park that you WON'T hear the train it is very quite, maybe some of the others may look nicer but this one feels welcoming and family like.
It's in the heart of Columbia Valley, on the hill. It is only 25min away from Portland but has the best location for hiking and more attractions around.
Wifi works GREAT!!!! Water pressure is very good.
Our dog loved it here and she's picky ;)
It doesn't look perfect but rather feels very homey, each spot has nice green grass on both sides and the spots has nice space between each other.
We've never given a park 10 stars, even not the "resort" really beautiful ones, but this one even though it's not prettiest, it's just made us feel like we belong. - MikeMayNaama
9911 SE 82nd Ave Happy Valley, Oregon 97086 (map) | (503) 771-1040
Sites: 51 | Latest Rate: $18.00 | 1 Reviews
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Jul 2009 - $18.00
We stayed here for a week, and were not especially happy with the park. The sites were too short for our 39 foot motorhome. The grass/weeds were not taken care of. There were many resident rvs, some not well taken care of. The rules, especially for quiet time, were not enforced. We will NOT return. Also many of the sewer connections did not have covers. - Kent Savage
19009 SE Barton Park Road Boring, Oregon 97009 (map) | (503) 637-3015
Sites: 102 | Latest Rate: $26.00 | 11 Reviews
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Sep 2016 - $26.00
Site 71 in the East Campground. Nice park, good power and water, no sewer. Many spacious, long back in sites. None are shaded. Several shaded pull throughs but most looked tight for big rigs. Adequate showers with button you had to push every 30 seconds for water, lack of safety hand rails a significant issue. OK dog walking. All sites are paved, with fire pits and tables. West Campground has shorter grass and gravel sites. Smaller rigs might find it prettier there, but big rigs would have tree problems; doable but not easy. The park is in the Portland airport flight path depending on wind direction. - bobcovey
Aug 2015 - $26.00
Quiet county park outside the city, but close enough to drive in to visit. We stayed here 10 days since I needed to fly out of PDX to return home for a wedding while DH watched over the unit and Bengal cat. I was able to get a weekend reservation here within one-week notice for August so that was pretty impressive. You'll need over a month's advance notice for weekends at the state parks. They keep the grass green and trimmed here. Picnic tables are located at the back-side of the parking pad, a little odd to me, but I suppose they figured you'd want to enjoy the grassy area more than next to your RV door. Sites are pretty close together too, so maybe too tight for picnic tables, plus it would be tough to maintain the narrow strip of grass. They are planting young trees between sites, so in 10 years I can expect there to be a little privacy and eventually shade? If I could have reserved much sooner, I'd have chosen one of the pull-thru sites in the trees. If you have a smaller unit without tow vehicle, you should check out the other camping section, it's set in the trees more with back-in sites for more privacy. I never got to check out the bath house. We work online so Verizon LTE data coverage is important for us, and this area had solid LTE service. - Sara C.
Jun 2015 - $26.00
We stayed in the RV section (Barton East) for a week. The campground in general is quite nice, with newly paved roads and sites, decently sized sites, and a huge green field in the center of the main loop. Most sites are back-in with full sun and plenty of space. There are about 8 crescent pull-throughs that have more shade and privacy, but are right up against the trees with very little camping space. We chose the back-in. The park is mainly used by locals for weekend camping and activities along the river, and as a camper you can walk down to the river to swim, tube, etc. There are a few trails around the park which are good for walking dogs, and the campground itself is large enough for most dog walks. The main downside is that because of the several small lakes that surround the campground, the grass and roads were covered in goose droppings so you continuously need to watch your step. The lakes are overgrown/swampy so not good for getting the dogs wet. The showers were clean but water was lukewarm and the shower head created a fine spray making the water feel even cooler. The camp host was very friendly and helpful. We had only 2 bars of AT&T and Verizon 4G but both worked pretty well. Note: the park apparently locks their gates at 10pm nightly, although we were never out late so didn't confirm this. We used Barton Park as a home base to visit Portland and the Columbia Gorge. Unfortunately it's about 60 minutes to Portland due to traffic and 45 minutes to Columbia Gorge due to lack of main roads nearby. We'd definitely consider staying here again (it's a great park with a great price), but we might try to stay closer to Portland for a few nights to visit without all the driving/traffic. - LifeRebooted
10400 NE 53rd St Vancouver, Washington 98662 (map) | (360) 891-1091
Sites: 83 | Latest Rate: $35.00 | 29 Reviews
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Aug 2016 - $35.00
Nice small park but designed for small RV's. If you are larger than 32 ft., very challenging.
The turns getting to the park off Fourth plain Rd are very sharp and treacherous.
Site surface was a concrete pad with sunny and open exposure. - TcaandK
Jul 2016 - $36.00
We stayed overnight at this park. I have a 35 ft motor coach and it was difficult to fit in the site. It is incredibly difficult to maneuver a motorcoach in this park. The park is very cramped due to all of the seasonal RVs that are there and they are unsightly. There is no grass, no picnic table and no trees. I would not stay there again. - Perfection expected
Oct 2015 - $30.00
This is more of a long-term park, than an RV park. It appeared that many RVs were permanent residences. It is a very cramped park. We felt that we were really in an RV parking lot. We did appreciate the location as it is close to shopping, restaurants and travel routes. "Free WiFi" really means no WiFi. The people in the office know that's a problem but make no effort to fix it. Since WiFi is essential to us as we travel, we would give this one a miss in future. The standard pad is level cement but it is a challenge to park. There are some 'premium' pads near the office. - carliewired
10649 NE 13th Ave. Portland, Oregon 97211 (map) | (503) 285-1515
Sites: 152 | Latest Rate: $32.00 | 91 Reviews
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Nov 2016 - $32.00
We had easy access from I5 coming south and upon leaving the I5 access going south we crossed three lanes for entrance. Our site at park was large, good utilities and location of utilities, cable tv, cement and grass with no table. Definitely big rig easy and will return. The only real negatives are airplane noise and resident workers leaving at 5am. Will return. - RJourney
Oct 2016 - $35.00
Very clean, spacious. We will stay here next when pass I g through portland. Make sure and make reservations in advance! - Judy2shoes
Sep 2016 - $32.00
City RV park near the Columbia River and very near the airport. So yes, you are going to hear planes and sometimes it's deafening. Neat and tidy, most residents are just that, living there and working. Very quiet at night. Bathrooms were nice and clean. Laundry on site also. There is a group room. All paved. Sites are concrete, but very skinny. My door ended up on the grass, which was a mud hole. It rained an entire day, then the sprinklers run every night, so always muddy. This is not a good park for dogs, but if you need to be in the city, and you take your dog with you, there are many places to take your dog and Portland in general is very dog friendly.
The Dogs Opinion (it's all about the dogs): There is a pretty nasty postage stamp dog park across the road that is owned by the RV park. It's just dirt, and because of the rain, it was a mud pit. There are signs everywhere to not let your dog onto the grass, so I took my dogs to the dog park, then walked them in the street next door with houses. That was pleasant. Just east on Marine drive, just past Salty's restaurant, is a big marina and parking lot, go to the far end. You are supposed to pay $5 to park. You can walk down to the beach on the river then hook up with a trail. There is also a paved bike path but I would not walk dogs there, as there are many bicyclist. The beach and trail are lovely and quiet. You can have your dogs off leash here. Also there are many parks in the city that have an off leash area that is unfenced. There are fenced dog parks not too far. Use the Dog Goes dog park finder app to see all the parks.
TV? Cable TV with good channels. Very nice, even had the OWN channel.
Cell phone/Wi-Fi? Speedtest? Verizon is strong here. The RV park Wi-Fi is 1.5 ish mpbs. Too slow for me, I used my jet pack. - Tails From The Road


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Location: Houston, TX, United States
Member Since: September 2007
Open for read requests: Yes
I've been an aspiring writer for quite a while, but I haven't done anything about it. I'd like to get some feedback and start heading in a promising direction. My stories are all based on my family.
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subset: commoncrawl


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In the mean time, our government has been stocking up on ammo while trying to take ours, beefing up surveillance on us while opening the borders to foreign invaders and suing states that try to enforce border law and prosecute them and writing policy "law" that says it's okay for obama to drone strike Americans if he feels like it while the one stream media gurgles and coos obama's name.
I don't know how long the big event we're heading for will last or what the world will look like on the other side of it, but the slow motion deception mosey we're walking to get to there is fascinating and quite unnerving.
The global community organizer is giving his US military plan for WWIII. Conquer Isreal by putting power, money and arms in the hands of Muslim terrorists and invade and conquer the US.


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- Reel Reviews: 2017 Oscar picks
- 'American Idiot' at EPAC
- Warwick grad producing 'Million Dollar Quartet' at Dutch Apple
- 'Somewhereville Station' revisits the 50s and 60s
- St. Patty's musical at Ephrata Main
- Dance, concert will benefit Jamaica missions
- Happy Anniver5ary, St. Boniface!
- Downtown diversity
- Travelogue will explore Colorado River this Saturday
Cindy Sue Sweigart, 54, was production worker
Cindy Sue Sweigart, 54, of Ephrata, passed away Saturday, Feb. 9, 2013, at her residence.
She was born in Lancaster. Cindy was a former production worker in various factories in the area. Her hobbies included playing computer games and watching TV soap operas.
Cindy is survived by her daughter: Kristi Sweigart of Honeoye, N.Y.; a close friend Mary Ann Kraft of Ephrata; a step brother: Scott Cochran of Ephrata; a sister in law: Karla Sweigart of Ephrata; and a cousin: Karen Sweigart of Reamstown.
By request, funeral services will be private at the convenience of the family.
Arrangements by Stradling Funeral Homes, Inc., Akron/Ephrata. Online condolences can be given at stradlingfuneralhome.com.


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Compare Criminal Defense attorneys near you. Read reviews, see Avvo Ratings, and contact them directly.
5.0 stars 4 reviews
Avvo Rating: 10
Joseph H. Low is on a lifelong mission of fighting for all of our rights as citizens against corporate greed and oppression, violations of rights by city, state, and federal governments and mistreatment at the hands of public organizations like ci...
Practice areas & skills: Criminal Defense, Military Law, Personal Injury, Litigation
5.0 stars 32 reviews
Avvo Rating: 10
I have 41 YEARS of trial EXPERIENCE & I am a trained mediator. I give prompt, complete answers & I am always in email contact. FEES: No-cost initial consults, reasonable deposits & monthly billing. FAMILY LAW: child custody, support, & the divis...
Practice areas & skills: Criminal Defense, Business, Family, Landlord & Tenant
5.0 stars 26 reviews
Avvo Rating: 9.6
Dedicated Attorney, Former Prosecutor I have a diverse background in various areas of law that give me a broad, thorough legal base to provide quality services to my clients. I am aggressive but polite, and firm but compassionate. Criminally...
Practice areas & skills: Criminal Defense, Civil Rights, DUI & DWI
Not yet reviewed
Avvo Rating: 10
After many years of intense litigation in personal injury and medical malpractice cases, including four trials in 2016, I am transitioning my practice from handling entire cases through trial to assisting other lawyers with case development (e.g. ...
Practice areas & skills: Criminal Defense, Personal Injury, Wrongful Death, Medical Malpractice
5.0 stars 23 reviews
Avvo Rating: 9.2
Ms. Gerstenzang is a dedicated advocate for her clients. She has handled hundreds of criminal cases throughout her career. She began her career working at the Public Defender's Office in San Diego, where she had interned and volunteered as...
Practice areas & skills: Criminal Defense, DUI & DWI, Juvenile, Speeding & Traffic Ticket
5.0 stars 2 reviews
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Review: "I had a very complicated case that I presented to David Siegal. Many lawyers might have walked away from it, but David did not. He sat with me and heard my whole story. He drove to the scene of the accident with me and to...
Practice areas & skills: Criminal Defense, Personal Injury, Animal & Dog Bites
5.0 stars 6 reviews
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Review: "Upon the urging of an attorney friend, we hired Mark Greany to represent our teenager; proved to be an exemplary choice. Mark explained the law and likely progression of the case succinctly and clearly, and provided unequ...
Practice areas & skills: Criminal Defense, Civil Rights, Personal Injury
5.0 stars 20 reviews
Avvo Rating: 8.8
Attorney Pamintuan graduated Cum Laude from Thomas Jefferson School of Law where he studied on scholarship and was honored with a Thomas Jefferson School of Law Fellowship. He is a member of the California Bar, Florida Bar and Washington D.C. Bar....
Practice areas & skills: Criminal Defense, Personal Injury, Bankruptcy & Debt
5.0 stars 1 review
Avvo Rating: 8.4
Review: "One of the greatest lawyer in San Diego Ca,not given proper credit as not only a consummate defense lawyer with experience and knowledge. He is a bulldog in the courtroom but in person a real gentlemen and a scholar.He w...
Practice areas & skills: Criminal Defense, Personal Injury
If you are suspected of a crime or charged with a violation of law, you may require the services of a criminal defense attorney to present your defense or negotiate a penalty. As different rules and procedures exist for different offenses, you should seek a criminal defense attorney who has worked on your particular type of case to provide you with the best defense. An experienced criminal defense attorney knows what information the government will need to prove your guilt. The defense attorney will also know what information you need to prove your innocence, including whether there are any legal rules justifying your actions.


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Toyota for Sale
Selected Filters:Type of Ad: Vehicles for Sale Make: Toyota
1990 Toyota T100 Lift Kit 10 Inch
Stratford, NJ
LOOK AT THIS TONKA TOY With a 10 INCH LIFT 42 INCH NEW TIRES MUDDERS............OUTSTANDING RESTORATION LIKE NEW IN AND OUT....... CUSTOM SOUND SYSTEM,... More
1981 Toyota BANDEIRANTE OJ50LV-B
Atlanta, GA
This is a product of OVERLAND IMPORTS company that specializes in the importation of Brasilian Toyota Bandeirantes from Brasil to North America. Our trucks... More
1980 Toyota Supra XX
North Canterbury, New zealand
Sporty & Powerful…Comfort & Pleasure…you get all of these things in the Toyota Celica Supra XX…what an incredible car for its time. When Toyota first... More
2004 Toyota 4Runner SR5 Sport SUV Only 74,994 Miles! One Owner!
Pompano Beach, FL
*2004 TOYOTA 4RUNNER SR5 SPORT SUV* *ONLY 74,994 MILES! *ONE OWNER* *TOYOTA DEALERSHIP SERVICED JANUARY OF 2017* *SAFE, SOLID & FAMILY FRIENDLY* *A FLORIDA SALT-FREE 4RUNNER* PODIUM AUTO welcomes this super... More
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1990 Toyota Sera Coupe
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For sale is a 1990 Toyota Sera located in our Indianapolis Showroom. This unique Toyota is powered by a 1.5 Liter (1496 cc)... More
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1987 Toyota Land Cruiser Truck/SUV
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More information on this 1987 Toyota Land Cruiser to come. If you have any questions feel free to call 678-894-4833 or visit our Atlanta... More
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This 1978 Toyota FJ40 Land Cruiser was found stored in a garage for the past 5 years and delivered to Freeborn Customs where it... More
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The Toyota FJ lineup is very impressive with multiple models and strong followings that will continue to prosper as the years go by. ... More
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Dallas Motorsports presents this freshly restored 1979 Toyota FJ40! Having just arrived at our facility, this Olive Brown Matching Numbers FJ40 is a very nice... More
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FOR MORE INFORMATION ON THIS VEHICLE PLEASE CONTACT CRAIG ON 909 730 1555 MIKE ON 909 644 6220 OR MARCO ON 909 286 8000... More
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1971 Toyota Land Cruiser FJ40
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1977 Toyota FJ40 Land Cruiser For Sale in El Dorado, Arkansas 71730 Get ready for your next adventure, either off or on the road, with... More


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Shu Todoroki Carnival Cup Die Cast Car - Chaser Series
Shu shine
Japan's magnificent #7 has undergone a makeover for his participation in the Carnival Cup. This detailed 1:43 scale model is part of our Chaser Series, making Shu Todoroki a racing certainty to be a favorite in any Cars collection. See more
It's added to your bag!
Not eligible for in-store reservation.
Die Cast Cars $6 Each When You Buy 2 or More
See Details
Magic in the details...
- Finely detailed die cast metal
- 1:43 Scale
- Display case with carry handle
- Collect die cast replicas of all your favorite Cars Carnival Cup characters, each sold separately
- Part of the Chaser Series
The bare necessities
- Ages 3+
- 1 1/4'' H x 2'' W x 4 1/4'' L
- Imported
WARNING: CHOKING HAZARD - Small Parts. Not for children under 3 years.
Most items ordered via Standard Delivery will arrive within 5-7 business days, personalized items within 7-9 business days. Exceptions include items shipped from locations other than our main warehouse. Express Delivery is available for an extra charge.


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Expert Advice
Combination Lock Features
Hello. I'm Shannon with Gunsafes.com, offering a little bit of information about the American Security TF5924 and some of its great features.American Security has a long history of manufacturing some of the best home security products on the market, and their introductory TF series of gun safes is no exception. The TF5924 is built with a 3/16" steel plate door with 3 layers of fire insulating material, this solid construction, in addition to the 2 stage dual fire seals with silicone seal on the door jamb and expandable Palusol™ seal on door, affords the TF5924 a Mercury Class I fire rating of 1200 degrees for 30 minutes, designed to maintain an interior temperature at or below 350 degrees. Besides its great fire rating for a safe in this class, the TF5924 also has a list of security features important for any gun enthusiast or sportsman. It has a 14 gauge steel body, 14 massive 1 1/4" chrome-plated bolts, 4-way active bolt work and adjustable ball bearing hinges. The TF5924 is also equipped with American Security's own ESL5 electronic lock with the distinct feature of an illuminated keypad. It also measures in at a great versatile size of 59"H x 24"W x 18"D and weighs in at a solid 388 lbs. So, this safe can offer a number of placement options, especially when limited space is a concern.
Its exterior is a rugged textured black with a 3-point chrome tri-spoke handle and bold zinc die-cast polished chrome logo. It's also built with 4 predrilled anchor holes, and all mounting hardware is provided. And the interior amenities include fully adjustable interior gun racks/shelving for the greatest organization of up to 16 guns and customization; all of which is upholstered with mocha colored fabric, and a predrilled electrical hole to accommodate your accessories, such as a dehumidifier, electrical outlet or lighting.
One of the world's best known providers for safety and security solutions, American Security's TF5924 gun safe presents itself as just one of the reasons for this reputation. So, if you're in need of a smaller safe to store your gun collection, cash, coin, jewelry or other valuables, this safe is a great place to start.
I like the safe but I got the digital pad lock and in less than 3 years it is going bad. I was able to get the door open and I plan on changing lock to mechanical combination lock so I don't have to pay $700 to get into the safe when the digital lock completely fails.
The safe has a lifetime warranty but the weakest link is the locking device and it has only 1 year warranty. IMO the safe only has a 1 year warranty because of that. Don't go digital if you buy one of these safes.
I bought my safe from a local vendor not gunsafes.com. Price is much less by far through these people than I paid locally.
Product Details
Absorbs moisture without electricity, and is rechargeable in an oven. It can be reactivated indefinitely. One 500-gram box protects up to 37 cubic feet of enclosed space, about the volume of a standard 30" wide safe.
Product Details
The Flexible EverDry is flat and easily bends to take up less space and makes installation easier, especially in small safes. Removes humidity from the interior of a safe and protects against rust. Plug is removable for installation without the electrical outlet. LED indicates unit is operating.
Product Details
The EverDry Electric Dehumidifier removes humidity from the interior of a safe and protects against rust. The 18" long EverDry should be used on safes 30" wide and larger. Cord is removable for installation without the electrical outlet.
Product Details
Ideal for cabinets, safes and closets, this eco-friendly dehumidifier silently and reliably protects clothes and valuables from mold, mildew, moisture and corrosion. Once the moisture has been absorbed, it cannot spill. The color changing crystals let you know when it's time to be recharged. You simply remove the dehumidifier from the safe and plug it into an electrical outlet and it recharges in 10-12 hours. . Works in a 333 cubic foot area
No batteries or cords required
Product Details ShoulderDolly Video ✓ The Original ShoulderDolly® is for the Do-It-Yourself person. ✓ Ideal for the weekend move, or to move a specific item. ✓ This is a two person lifting system which uses leverage to move heavy items. ✓ The Shoulder Dolly® Set is composed by 2 harnesses and 1 moving strap. ✓ The strap attaches to the harnesses through the metal part which is included on each harness. SHOULDERDOLLY® is a revolutionary new way to easily move big, heavy and bulky objects. Using...
Product DetailsSAFELERT is small battery-powered sensing device that is easily-hidden inside your safe. When something happens to your safe (movement, heat rise, door opening, etc) it detects and sends alerts (via texts or emails) directly to you. ALERTS can be set up by through the following TRIGGER POINTS:Safe door opening and closing (know when others who have the combination are getting into your safe)Safe movement resulting from tampering (attempted break-ins, safe door jaring, movement...
Product DetailsOur New Safe Lighting Kit is the best aftermarket lighting solution available today. The expandable, linear design allows you to place long-lasting LED lighting wherever you want it in your safe. A motion sensor turns on the lights when the door opens and automatically shuts them off after 30 or 60 seconds with no motion or when the door closes. Each kit comes complete with six LED light tubes with six LEDs per tube, three flexible connectors, mounting clips with hook and loop...
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Store handguns more efficiently and increase storage space on shelves. Access to handguns is made easier by placing them in an upright position. 4 or 6 gun models.
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The LOCKDOWN Dehumidifier Rods work by slightly increasing and maintaining the air temperature inside the gun safe or other enclosure. This allows the warm air to circulate throughout the safe on a continual basis, thus eliminating humidity, mildew, and condensation. All of which are dangerous to your expensive firearm collection. Removes moisture from gun safe interior Mounting brackets included
Dries approx. 100 cubic ft. Easy install quick plug attachment, 110v
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The vault anchor kit offers all components necessary to anchor a vault in any location. Three separate structural applications are covered: a concrete floor /wall, a wood floor joist/stud, or subflooring. Securely anchors your vault so thieves can't steal it.
Includes all hardware and drill bits for anchoring vault to concrete, floor joists/studs, or sub-flooring. Heavy-duty components are easy-to-install.
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Product DetailsThis listing is for the Original Hand Gun Hanger Only! Click below for other versions:Over-Under Handgun Hangers - 2 PackBack-Over Handgun Hangers - 2 PackBack-Under Handgun Hangers - 2 PackHandgun Hangers organize the shelves in your safe to store guns more efficiently. There are four styles of the product for storing guns underneath or above the shelf. Slide Handgun Hangers on any standard shelf - no assembly required. Each gun is easy to access and extra space is opened up...
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Advising and Registration
Pre-registration for Fall 2017 will open in early April
Incoming Student Core Class Pre-registration for Spring 2017
The first step in beginning the registration process is to select your themes for English 101 or 102 and CORE 101 courses. Course descriptions will be uploaded as they are available.
You can rank your preferences for these classes on the Pre-registration Form. We will do our best to enroll you in your first choice, but depending on availability and scheduling conflicts, we may need to register you for a lower choice preference.
CORE 101: the SNC Experience employ variable topics grounded in the social sciences (economics, psychology, political science, anthropology and sociology) to build a common intellectual experience shared by all Sierra Nevada College students. Topics are selected from across the curriculum to engage entering students with the critical skills necessary for a successful and stimulating college career. The courses focus on the foundations of active, engaged learning; critical thinking, problem solving, creativity/innovation, oral communication, teamwork, peer critique, self-reflection, higher-order questioning and active discussion.
Core 101 is offered both spring and fall semesters, with a variety of course topics in fall. Discuss the course options with your advisor.
ENGL 101: Freshman Composition is the Freshman English course. Examination of themes and techniques in assigned reading is emphasized to develop evaluation, analysis, synthesis and critical thinking skill. Weekly written work, in–class discussions, essays, research writing and a portfolio documenting revisions are required.
All students at SNC are required to take two semesters of English coursework. Transfer students may be waived out of one or more sections of English if they have taken this course at a previous institution which meets catalog requirements for transfer courses. Transfer credit acceptance will be determined during your meeting with the faculty adviser.
English 101 Topics
Individual and Society
This course explores the dynamic relationship between individuals and the society in which they live, with attention to the resulting connections, conflicts and compromises that occur. Specifically, we will explore the variability of meaning in language beyond the page, allowing students to discover how storytelling in all its forms can reinforce or deconstruct personal and societal values and equipping students with simple tools to use language as an intentional creative force.
Questions addressed in this course include: What are assumptions made by the authors, characters, or ourselves in our readings? Where do those assumptions come from in the character's world? In our own? What do these assumptions imply about the function of language in our culture? What is actually said versus what is trying to be said? How can one apply language that is restricted by cultural context in order to communicate authentically as an individual?
Examination of themes and techniques in assigned reading is emphasized to develop evaluation, analysis, synthesis and critical thinking skills. Weekly written work, in class discussions, essays, research writing and a portfolio documenting revisions are required.
The Art of the Essay (Athletes Only)
Comedians call them monologues. Editorial writers call them columns. And college applicants call them bad words that we can't say in polite company. The essay may be the bane of students, but it's an endlessly flexible form for writers. The word "essay" means "to try." To paraphrase E.B. White, each new attempt by the essayist differs from the last and takes him or her into new country. In this class we read and write essays, learning to move beyond a straightforward narration of life experiences and toward a more complex art form that can make connections and engage readers in a universal human experience.
ENGL 102: Freshman Composition II builds on and further develops the writing skills introduced in ENGL 101. Students are required to conduct both primary and secondary research, synthesize and integrate researched material into original works, and present individual research in papers and projects.
Transfer students who do not have transferable credits for English 101 must take an English Placement Exam before enrolling in any English courses. Contact Henry Conover at email@example.com immediately to schedule your exam.
ENGLISH 102 Topics
Contemporary Issues in Education
We all have a stake in education. Most of us have been shaped by our own school experiences: memories and moments that have defined us or altered our futures. Many of us have been touched by educators who have influenced our paths. Our children, present or future, will be part of our nation's education system. This class is a chance to discuss the American education system, local, national and global attitudes towards education, ethical and moral dilemmas in education, and alternative models of education.
Specific topics may include bilingual classrooms, gifted and talented programs, environmental education, physical education, art programming, state and national standards, assessment, media coverage, and school funding. Students will write a personal essay about their own educational experiences, a movie/ film analysis, an argument essay on high school challenges such as college pressure, cheating, or peer pressure, and complete a major research project on a topic related to teaching and learning. Students are encouraged to take ENGL 103 (1 unit) simultaneously in order to gain hands on service learning experience in a school setting.
It's After the End of the World, Don't You Know That Yet?
Writing is a way of discovering and shaping the world. One of the most powerful ways that this occurs is through argument. In this class you will learn modes of argument that are distinctive to academic reasoning in that a given problem is not treated as though it has a right or wrong answer. Instead, you are asked to convince your reader that you understand the complexity of a problem and to provide a solution that is necessarily tentative and incomplete.
Students in this course will learn to analyze the basic elements of a problem and then synthesize selected parts. That process results in your thesis, or formal opinion. You will learn to ask questions about the thesis that lead to other questions. This process can be frustrating, tiring and will make you angry. But it is precisely this process that leads to a thorough and confident argument, one in which you understand and accept the risks and advantages of a particular argument.
This course will focus on genres of academic writing, including critiques, analyses, and extended research papers. We will investigate methods of composition, the use of academic genres, and approaches to developing and refining your ideas through the writing process. The skills you'll learn will be transferable to every class in which you're required to write. You will explore how to use writing to learn, to create, and to act, particularly in college but also in the world outside the college. I hope this class will be challenging, fun and will in some way change how you look at (and act in) the world.
Imagination and Memory in the Works of JD Salinger
Our course will focus on the series of short stories he wrote about the Glass family, which consists of seven troubled child geniuses from the Upper East Side, Manhattan. Focusing on the effects of the suicide of the eldest, saint like sibling, Seymour, the essays written in our course will explore the role that imagination and memory play in shaping the adult lives of the remaining Glass siblings.
The 2015 publication of J.D. Salinger's writings, which had been kept in a secret vault since he left the publishing limelight in the 1960s, was one of literature's great historical events. The reclusive author of Catcher in the Rye died in 2010, and his last will directed his literary estate to publish the many books he wrote in isolation in rural New Hampshire, with the first works to be published five years after his death.
Contemporary Communication: Food, Sports, and Technology
How does food aid in communication both in the home and society? How can sports and sports figures be constructive/destructive to the unification of a culture? How does music heal the mind? What are positive and negative effects of the implementation of social media and gaming in our culture?
Students use questions about food, sports, media, and technology to examine and compare various modes of communication such as in person, in writing, electronic, and other forms, then evaluate the merits of each, while writing in a variety of modes.


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Lemon Ricotta Puddings
|For ricotta
|Whole milk
|1⁄2 Gallon
|White vinegar
|10 Teaspoon (Plus More If Needed)
|For pudding
|Heavy cream
|3⁄4 Cup (12 tbs)
|1 , grated zest
|2 Large, lightly beaten
|To Taste
|Freshly ground pepper
|To Taste
1. Make the ricotta: Line a strainer with a double layer of cheesecloth and set over a large bowl. In a large saucepan, heat the milk and cream over moderately high heat to 180°. Remove from the heat and slowly add the vinegar until you see the milk separate; add more vinegar as needed. Cover the saucepan and let stand for 2 minutes.
2. Pour the contents of the saucepan into the strainer; shake vigorously to remove the water (a.k.a. whey). You should have about 2 cups of ricotta; let cool.
3. Make the pudding: Preheat the oven to 325°. Butter the sides and bottoms of four 1-cup ramekins. In a large bowl, combine 1 3/4 cups of the ricotta with the heavy cream and grated lemon zest and whisk well, breaking up any large ricotta curds; season with salt and pepper. Whisk in the lightly beaten eggs.
4. Pour the pudding mixture into the prepared ramekins and set them in a larger baking dish. Place the dish in the oven and add enough hot water to reach halfway up the sides of the ramekins. Bake the puddings for about 55 minutes, or just until set. Let the puddings cool to room temperature or refrigerate until chilled.
Rate It
Nutrition Rank
Nutrition Facts
Serving size: Complete recipe
Calories 1914 Calories from Fat 1230
% Daily Value*
Total Fat 138 g212.7%
Saturated Fat 79.9 g399.4%
Trans Fat 0 g
Cholesterol 858.8 mg286.3%
Sodium 1355.1 mg56.5%
Total Carbohydrates 112 g37.4%
Dietary Fiber 3 g12%
Sugars 100.5 g
Protein 78 g156%
Vitamin A 101.7% Vitamin C 76.6%
Calcium 234.8% Iron 17.5%
*Based on a 2000 Calorie diet


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Student Affairs
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Event Detail Information
Psychology Club Penny War BBQ
Date Apr 25, 2013
Time 4:00 pm - 7:00 pm
Location UIS Rec Park
Sponsor Psychology Club and Psi Chi
Event type Other
Views 692
Originating Calendar Student Life Events
This is a social event we are having to celebrate our participants in a Penny War fundraiser we are having. We will be throwing a pie in the face of the losing faculty member and having a small BBQ. We also hope to take advantage of the nearby volleyball court and have a casual game while socializing as well.


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Not a member yet? Join now
Handle reservations and bookings for flights, hotels, railways,including queries/requests• Ticketing, issuing, reissuing tickets and refunds on company system• Operate the VIPS efficiently as well as otherinternal systems to maintain accurate and up-to-date records• Award mileage deduction• Call customers in case of irregular operations (cancellations offlights, delays, major strikes etc.)• Assist with queries from company offices, Airports, other sections andother airlines to ensure smooth communications and operations• Carry out other duties as instructed by Supervisor/ManagerEssential skills,knowledge andexperience:• Mother tongue/fluent German or/Spanish and English• Professional verbal and written communication skills• Proficient in computer skillsBusiness skillsand behaviours:• Team player• Time management skills• Ability to work under pressure• Attention to detail• Maintain confidentiality


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|Web Site:
|4060 Sorrento Valley Boulevard
San Diego, CA 92121
United States
|Cleantech / Energy
|RockPort Capital Partners
Link up your social media account to automatically promote the positions at Achates Power.
Get a job alert every time Achates Power posts a job.
SE Michigan or San Diego, CAPosted 2 weeks ago Achates Power is seeking a motivated Engine Power Cylinder Design & Development Engineer to join our team in SE Michigan or San Diego, to contribute to the development of our various new engine families. This position1/1/2017 San Diego, CA Save This Job
Full TimeSE MichiganPosted 3 weeks ago The Business Development Manager will be responsible for all aspects of strategic account engagement and sales. Responsibilities: Develop and execute a sales plan for the top accounts. Identify new opportunities for engineering services1/1/2017 San Diego, CA Save This Job


text:
HOTEL INFO stars
Mercure Stratford upon Avon Shakespeare Hotel
7.7 / 10
This is what awaits you:
Free WI-FI
Hotel's own parking spaces
Reception open day and night
An error has occurred. We are sorry.
Please repeat your entry.
Or call us by phone.
Please repeat your entry.
Or call us by phone.
Hotel description Mercure Stratford upon Avon Shakespeare Hotel
The Tudor facade and original stone floor in the hotel's reception suggest a style of wealthy living pre-dating the Bard himself. Over the years the Shakespeare has been a firm favourite with politicians, diplomats, business people and scholars alike. Subtle touches like the open fires in the lounge during winter months and a traditional menu in the restaurant help create a wonderfully peaceful and friendly atmosphere.
Reception hours
Every day 24 hours
Renovated: 2005
Built: 2003
Check-in time: 14:00
Check-out time: 12:00
Like this hotel?
Then put it on your wish list.
Chapel Street, CV37 6ER STRATFORD UPON AVON, United Kingdom
Distances (km)
|City district (Stratford-Upon-Avon)
|Station (STRATFORD-UPON-AVON)
|Airport (Birmingham International Airport (BHX))
|Airport (East Midlands Airport (EMA))
|Airport (London Luton Airport (LTN))
To reach the hotel
Starting point:
M40/A46/A439. station STRATFORD-UPON-A, direction STRATFORD-UPON-A
For HOTEL INFO guests
Free WI-FI
Hotel features
- Reception open day and night
- Hotel's own parking spaces
- Hallways with video surveillance
- Lobby
- Garage
- Wireless LAN in public areas
- Security personnel
- Pet friendly
- Laundry service
- Lift
Room features
- Iron
- Smoke alarm
- Non-smoking room
- Trouser press
- Wi-Fi
- Restaurant
- Bar
Accepted credit card payments
- AmericanExpress
- DinersClub
- MasterCard
- Visa
Hotel location
|0.2 km/0.1 mi
|29.36 km/18.2 mi
|no details
|1.61 km/1 mi


text:
Barbecued Pork Roast
|2 Medium, peeled, sliced
|Pork roast
|5 Pound
|2 Cup (32 tbs)
|Barbecue sauce
|16 Ounce (1 Bottle)
1) Trim off the excess fat on the pork roast.
2) In a slow cooker, place rest of the ingredients, except the barbecue sauoe and chopped onion.
3) Cover and cook on LOW for 8 to 12 hours or on HIGH for 4 to 6 hours.
4) When the roast is done, remove and discard the bone and fat.
5) Return the roast into the slow cooker and add the barbecue sauce and chopped onion.
6) Cover and cook on LOW for 4 to 8 hours or on HIGH for 3 hours.
7) Slice the roast and serve on individual serving plates.
Recipe Summary
Rate It
Nutrition Rank
Nutrition Facts
Serving size
Calories 699 Calories from Fat 404
% Daily Value*
Total Fat 45 g69.1%
Saturated Fat 15.6 g77.9%
Trans Fat 0 g
Cholesterol 201.3 mg67.1%
Sodium 371.9 mg15.5%
Total Carbohydrates 19 g6.3%
Dietary Fiber 0.94 g3.8%
Sugars 12.2 g
Protein 51 g101.3%
Vitamin A 8.4% Vitamin C 16.6%
Calcium 8.3% Iron 18.4%
*Based on a 2000 Calorie diet


text:
This Oscar season is all about evoking power and poetry in the costume designs for frontrunner "Anna Karenina" (Jacqueline Durran), "Les Misérables" (Paco Delgado), "Lincoln" (Joanna Johnston), "Mirror Mirror" (Eiko Ishioka), and "Snow White and the Huntsman" (Colleen Atwood).
For starters, Tolstoy's immortal characters from "Anna Karenina" are trapped like dolls in a dollhouse. Indeed, costume and setting are boldly linked, which is why Durran's work is the Oscar favorite. Like her colleagues, she had to think metaphorically in terms of 19th century Russian aristocracy rotting from the inside out within the confines of a derelict theater.
But rather than going with 19th century Russian designs, Durran wrestled with the notion of 1950s' couture per director Joe Wright's desires. "It was not something that I would undertake to stylize just from my own imagination, but it's a very happy combination because the two shapes fit together quite well," she admits. "Because in 1873, there was a move toward a small waist and a fitted bodice and the '50s couture is very similar. There wasn't a clash. I think one of the reasons he chose the '50s was that he wanted me to concentrate on silhouettes rather than surface detail and '50s couture is very strong on silhouette."
For Keira Knightley's Anna, the thematic color scheme begins dark (especially with the red she wears at the beginning) and then grows somewhat lighter in tone when she falls in love with cavalry officer Vronsky (Aaron Taylor-Johnson), before returning to the darker hues as she grows more anxious and paranoid.
The entire aesthetic was therefore predicated on subtraction in a power struggle but never more so than with Jude Law's Karenin. In fact, the actor latched onto the idea of removing details and they gave his character an air of monasticism with his dressing gown and nightshirt. In the end, though, Karenin embraces life and hope in autumnal beauty outside the theater. Although it was difficult to imagine on paper, Durran made it all work beautifully.
"Les Mis," of course, is also about political change and spiritual transformation, and Delgado returned to Victor Hugo for descriptive clues about characters and setting, and studied Spanish painter Delacroix for further aesthetic inspiration. From the Christ-like Jean Valjean (Hugh Jackman) to the oppressive Javert (Russell Crowe) to the doomed Fantine (Anne Hathaway) to the hopeful Cosette (Amanda Seyfried), the costume designer uses color to convey their dramatic arcs, particularly the clash of red and blue.
Ultimately, though, the characters clash with themselves. "But it's about so many people suffering that I had to battle against the darkness of what I was thinking in terms of clothing," Delgado remarks. "At the same time, because it was a musical, I had to do something with color. And I think that was the most challenging thing, really, to be honest."
However, it begins and ends with Valjean, who rises from poverty to prosperity as part of a redemptive journey. Little by little he becomes more sophisticated and more tailored using more color.
With "Lincoln," Abe's clothing is simple (a frock coat, a hat, or a shawl) but Johnston was able to go deeper and deeper into his complex character on the exterior. The clothing was so coarse you could feel the texture as well as the culture clash of a man from the prairie trying to fit in with the aristocratic establishment of Washington and Virginia.
The fact that the political battle to abolish slavery and end the Civil War was so dialogue driven (talk about poetry), also helped determine the direction of the costume design.
However, Johnston was awestruck by Daniel Day-Lewis' commanding performance. During her research she found Lincoln's face "slightly ugly," but the actor's presence and transformation throughout the making of the movie left her with an extraordinary image of him.
"We found this Smithsonian set of clothing, and that was a springboard for me," Johnston suggests. "He had a pre-tied tie. He wasn't interested in messing with something or the fine details of clothing. He had his name written on the inside. I liked the fact that he was not labored in his portrayal on screen."
Interestingly, the final two nominees are both vastly different variations on Snow White, with the late Ishioka (who died last year of pancreatic cancer at the age of 73) weaving her trademark sexy and opulent designs for "Mirror Mirror." Why, the off-beat image of Julia Roberts as the evil queen dressed to kill like a Shakespearean femme fatale is enough to delight us.
It marked Ishioka's fourth collaboration with director Tarsem Singh, who told Lynn Hirschberg in W Magazine: "A lace collar around the evil queen's neck is designed to evoke the backs of reptiles; Snow White's gossamer gowns include touches like overlapping leaves and climbing velvet vines that subtly underscore her exile in the forest…. Eiko would say that red is the most difficult color. But in many ways, red was Eiko: strong, intense, brilliant."
Although the costume designer previously won the Oscar for Francis Ford Coppola's "Bram Stoker's Dracula," can she pull off a posthumous win?
Meanwhile, Atwood goes back to the roots of the Brothers Grimm for the power play in "Snow White and the Huntsman." But it was very much in keeping with 11th and 12th century texture and style. For me, the presence of heavy armor was also reminiscent of John Boorman's "Excalibur." The three-time Oscar winner rigged the costumes with stretch and lighter materials to make them comfortable and camera-friendly. Yet the wardrobes had to be grounded in a gritty reality despite the fantasy trappings.
Chris Hemsworth's Huntsman was clothed with a hand-made quality; Kristen Stewart's protagonist has a layered approach to her costumes to evoke a slow transformation from peasant to royalty; and Charlize Theron's diabolical queen represents death so her wardrobe incorporates such ghoulish touches as beetle wings.
No wonder the Academy has finally created a separate design branch for costume separate from production designers, art directors, and set designers. It's high time, given their special and unique craft.


text:
By GEE! Technologies
Open iTunes to buy and download apps.
LockBox lets you store and protect sensitive info such as credit card numbers, bank accounts, passwords, pin numbers, private notes, and any other secret information on your iPhone or iPod Touch.
New! *You can export/backup data securely via a WiFi connection to your computer. Remember to do this regularly!
Looking for more? The Pro version is now available as well! The new Pro version will feature bulk data importing, stronger encryption, no ads and unlimited sub-fields per entry.
New: Check out our new, fun photo sharing app called Rotzy!
Use it to keep information handy and also protected at the same time.
All data is encrypted and protected by your secret code, so only you have access to it, even if you let your friends borrow your phone to make a call or browse online.
This is the kind of information that you want easy access to while you are on the go, but find it hard to recall just when you need it. For example, I always forget my bank account number right when I need to deposit a check at the bank.
Best of all, its free!
Remember to sync and do a backup of your data through the LockBox app before updating to newer versions! You never know what might happen to your phone in the middle of a sync :-) Also, the iTunes backup is not enough in some cases especially when you have to replace your phone or reset it, so make sure you use the WiFi backup method to protect your data. Its the only way to make sure your data is safe when doing a sync or restore for your device.
What's New in Version 1.5
fix export issue with iOS 5.0
iPhone Screenshots
Customer Reviews
app failed - could not get my passwords
A little voice in my head told me a couple of times to back up my 50 + passwords stored in the app. I didn't listen and a week later the app on my current iPhone 4s would not open. I used the app on my iPhone 3 and never had a problem. Years later I got an iPhone 4s and installed the app, used it for 3 years with no problem. I checked the app on the old iPhone 3 and it opens. I had also backed up these passwords but they were all old and out of date. I tried to restore the iPhone 4s but that did not fix the problem. I then deleted the app from the 4s and restored again. It worked! I'm elated. I tested these solutions on my old iPhone before I did them on the 4s to see if/when I might lose the password info on the app. I did not lose any info. So, I am wondering if the problem is because of the app (for which I also discovered there is no longer any support for), or is it some other issue? Now I will keep another copy of all my data somewhere else and will only rely on this app as a convenient way of carrying around all my info with me.
i have had this for a couple of years and everything was fine until i got a new Mac, now i can no longer export data. not sure if it had to do with update to iPhone or what. it used to be simple. I have so many passwords on this app that i periodically would export and print out what i have just in case i ever should lose or break my phone, it would be catastrophic. I contacted the company once and they blew me off. i read online that the problem was that the app gives you the wrong ip address for your phone to enter on your address line on your computer in order to export data. it told me to go to settings, wifi, click on arrow next to network name and i would see my ip address, which i do, but when i enter that in safari it is still not able to connect to the phone. Now i don't know what i'm going to do, if i download a new app, i will have to copy dozens of password entries by hand and then enter them into a new app. UUUGGGGGGGHHHHHH!!! not happy!
Export does not work - free or pro
Tried export to no avail in the free version. Been using the app for quite a long time and have had no issues exporting either. After disabling, enabling wifi on the phone and using two different computers, (app's web server is not accessible at all) I thought I should upgrade to pro version which I thought would automatically upgrade the app, bring in the data and then I can export too. The pro app has no such feature what it can recognize free version, offer an auto import and make life a bit easier. Anyway, I checked and found out that export does not work even in the pro version. It seems to have broken, the web server does not respond at all. Money wasted and stuck without a current backup.
Customers Also Bought
- Free
- Category: Productivity
- Updated: Dec 02, 2011
- Version: 1.5
- Size: 1.8 MB
- Language: English
- Seller: Gee Chuang
- © 2010 GEE! Technologies LLC
Compatibility: Requires iOS 3.0 or later. Compatible with iPhone, iPad, and iPod touch.


text:
Over the past year Ted's readers have flooded our Inbox with requests (and a few kindly worded demands) to bring back Dekker merchandise. Turns out, when we closed the online store at Teddekker.com in 2008 we unwittingly created a worldwide shortage of Circle pendants and t-shirts, which some speculate may have been the tipping point for the global recession. OK, not really.
We put the word out, talked to several retailers about the possibility of creating merch offerings within their sites, and one –Skyroo Entertainment–blazed forward and set up an online store that carries a selection of gear.
We're pleased to announce that, starting today, you can go to Skyroo's Ted Dekker Store where you'll find Dekker merch, including: t-shirts, Circle pendants and bracelets, posters, collectibles, and more. They're also offering blank Books of History. So check out Skyroo's store and see if there's anything there that you like.


text:
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ACP DiabetesMonthly
In the News for the month of October 2013
Admission hyperglycemia in AMI patients may indicate developing or unrecognized diabetes
Hyperglycemia at hospital admission for acute myocardial infarction (AMI) may indicate developing or unrecognized diabetes in patients with no history of the condition, according to a new study. More...
Nurse phone coaching program didn't improve outpatient glycemic control
A nurse-delivered phone coaching initiative that aimed to improve outpatients' glycemic control wasn't more successful than usual care, a new study found. More...
Stepwise insulin intensification non-inferior to basal-bolus regimen
Stepwise prandial insulin intensification provided glycemic control that was non-inferior to a full basal-bolus regimen after 32 weeks, with significantly lower hypoglycemia risk and better patient satisfaction, an industry-funded study found. More...
Test yourself
MKSAP Quiz: Treating hyperlipidemia and type 2 diabetes
This month's quiz asks readers to evaluate a 56-year-old man who received a diagnosis of type 2 diabetes mellitus 6 months ago and is returning for follow up. More...
From ACP InternistWeekly
Score predicts diabetes remission after Roux-en-Y surgery
Researchers created a new score, based on four variables, which can help predict whether a patient will have remission of type 2 diabetes after Roux-en-Y gastric bypass surgery. More...
From ACP HospitalistWeekly
Intensive insulin after PCI didn't reduce infarct size
Intensive use of insulin to regulate hyperglycemia in acute coronary syndrome (ACS) patients did not reduce infarct size, and may have caused harm, a new study found. More...
From ACP Internist
Diabetic foot care begins with bare feet
Get advice on heading up a care team that intervenes early and often to prevent the ulcerations, pressure points and neuropathies that can progress to infection and possibly amputation in the October ACP Internist. More...
From ACP Journal Club
Insulin pumps with a sensor and threshold-suspend reduced nocturnal hypoglycemia in type 1 diabetes
Patients with type 1 diabetes and documented nocturnal hypoglycemia who were randomized to receive sensor-enhanced insulin pump therapy with a threshold-suspend feature had reduced nocturnal hypoglycemia and no difference in glycated hemoglobin levels compared to those on sensor-augmented insulin pump therapy alone, a recent study found. More...
Tool of the month
Advice for patient education about diet
When counseling patients with type 2 diabetes about their diets, some general principles may be helpful. More...
Keeping tabs
Spotlight on European Association for the Study of Diabetes conference
The annual meeting of the European Association for the Study of Diabetes was held in Barcelona, Spain in September. Research presented at the meeting covered risks of sulfonylureas, pioglitazone and macular edema, treatment intensification and erectile dysfunction. More...
Physician editor: David V. O'Dell, MD, FACP
Admission hyperglycemia in AMI patients may indicate developing or unrecognized diabetes
Hyperglycemia at hospital admission for acute myocardial infarction (AMI) may indicate developing or unrecognized diabetes in patients with no history of the condition, according to a new study.
Researchers studied a national cohort of consecutive patients admitted to 127 Veterans Affairs (VA) hospitals with AMI but no known diabetes from October 2005 to March 2011. Patients were determined to have signs of diabetes at discharge or 6 months after discharge based on diagnostic codes, medication prescriptions, and elevated hemoglobin A1c values. The study authors used regression modeling to examine the association between hyperglycemia at admission (defined as a serum glucose level above 140 mg/dL) and later evidence of diabetes. Results were published early online on Oct. 2 by Diabetes Care.
A total of 10,499 patients, 98% of them men, were admitted to VA hospitals with AMI but no known diabetes. Of these, 1,761 (16.8%) had hyperglycemia at admission. This group was more likely than those without admission hyperglycemia to be older than 65, to present with a diagnosis of ST-elevation MI, and to have a TIMI (Thrombolysis in Myocardial Infarction) risk score greater than 3. Six months after the index hospitalization, 208 (11.8%) patients with admission hyperglycemia and 443 (5.1%) without had new evidence of diabetes (P<0.001).
Of these 651 patients, 169 (26.0%) had new evidence of diabetes before discharge and the remainder had new evidence in the 6 months afterward. Seventy-one patients whose diabetes was diagnosed before discharge (46.7%) had hyperglycemia at admission. In addition, 267 of the 651 patients with new evidence of diabetes (41%) had a hemoglobin A1c level of 6.5% or greater but no related diagnostic codes or prescriptions, which suggested that their diabetes was unrecognized. A significant association was seen between admission hyperglycemia and subsequent diabetes after multivariable adjustment (odds ratio, 2.56; 95% CI, 2.15 to 3.06).
The authors noted that their results may not be generalizable because the study was conducted in a mostly male population of U.S. veterans cared for in the VA health system. They also pointed out that their study was observational and retrospective, that the prevalence of diabetes may have been underestimated and that some diabetic diagnoses at admission may have been incorrect, among other limitations. However, they concluded that 1 out of 6 patients with AMI but no known diabetes had admission hyperglycemia, which was in turn associated with a 2.5-fold higher risk for evidence of diabetes in the 6 months after hospitalization.
"In addition, a significant number of these patients may have unrecognized diabetes and thus represent an important opportunity to appropriately identify and treat them," they wrote. "Accordingly, systematic screening for diabetes among hyperglycemic AMI patients may provide opportunities for prompt identification, improved risk-stratification, institution of optimal diabetes and AMI treatments, and improved outcomes."
Nurse phone coaching program didn't improve outpatient glycemic control
A nurse-delivered phone coaching initiative that aimed to improve outpatients' glycemic control wasn't more successful than usual care, a new study found.
Four-hundred-and-seventy-three patients from 59 Australian primary care practices were randomized to receive usual care or a coaching intervention delivered by practice nurses without prescribing rights. All patients had type 2 diabetes, defined as hemoglobin A1c (HbA1c) >7.5% within the past 12 months. Nurses in the intervention practices were trained for two days in a phone coaching program which aimed to provide eight phone and one in-person coaching sessions per patient.
Coaching sessions dealt with lifestyle issues, medication adherence and dosing, self-monitoring and self-advocacy. In particular, the coaching program aimed to help patients learn to negotiate with physicians on intensifying their medication, if needed. The program was adapted for diabetes patients from an evidence-based intervention for patients with cardiovascular risk. The study's main outcome was HbA1c level at 18 months after baseline. Results were published Sept. 18 by BMJ.
There was no significant difference between groups in HbA1c level at 18 months follow up; there also were no significant differences in most clinical measures, though intervention patients were more likely to attain a healthy body mass index of less than 25 (P<0.03). Patient attrition rates were 5% in each group. The median number of coaching sessions for the 236 intervention patients was three, and 25% of intervention patients had no sessions. Of patients who got at least one session, the median number of sessions was four.
Nurses spent a median of 30 minutes per session to deliver coaching and craft individual action plans. Holders of health care cards (low-income patients) were more likely to receive 1 to 4 coaching sessions than non-health care card holders. Only 18% of phone calls included advice about intensifying medications, and only 70% documented current medications.
The intervention may have been more successful if the nurses had undergone a longer training period and/or if more of the intended phone sessions had been delivered, the authors wrote. "Clearly the intensity of the intervention was a problem in our study as patients who received coaching only received a median of three telephone calls despite support for the practice nurses from the research team," they wrote. Still, the study was designed to be conducted in a real-world setting, so the fact that most patients didn't receive the intended intervention "may be best seen as an outcome rather than a limitation," they wrote.
Stepwise insulin intensification non-inferior to basal-bolus regimen
Stepwise prandial insulin intensification provided glycemic control that was non-inferior to a full basal-bolus regimen after 32 weeks, with significantly lower hypoglycemia risk and better patient satisfaction, an industry-funded study found.
Researchers conducted a 32-week, randomized, treat-to-target trial at 150 sites in 7 countries from Oct. 27, 2010 to April 25, 2012. The study was funded by Novo Nordisk. Results appeared online in The Lancet Diabetes & Endocrinology on Sept. 25.
In this trial, 401 patients (mean age 59.8 years; mean diabetes duration 12.6 years; mean hemoglobin A1c [HbA1c] 7.9%) were randomized to either stepwise intensification or full basal-bolus treatment. Patients in the basal-bolus group received insulin aspart before every meal, while patients in the stepwise group received one bolus dose with the largest meal and added doses before the next largest meal at 11 weeks and again at 22 weeks if their HbA1c remained at 7% or above.
During the 32-week treatment, the proportion of participants who withdrew was significantly higher in the basal-bolus group (52 [26%]) than in the stepwise group (28 [14%]; P=0.002). After 32 weeks, HbA1c change from baseline was −0.98% (95% CI, −1.09 to −0.87) for the stepwise group and −1.12% (95% CI, −1.23 to −1.00) for the basal-bolus group (mean treatment difference, 0.14; 95% CI, −0.02 to 0.30; P=0.0876). Significantly more patients in the basal-bolus group reached their target HbA1c at the end of the first treatment period (odds ratio [OR], 6.85; 95% CI, 4.12 to 11.39; P<0.0001) and second treatment period (OR, 2.38; 95% CI, 1.56 to 3.64; P<0.0001), but this difference was not significant by the end of the trial (OR, 1.36; 95% CI, 0.90 to 2.07; P=0.15). Finally, patients were significantly more satisfied with the stepwise approach than with the basal-bolus approach (P=0.0072).
In the basal-bolus group, hypoglycemia rates increased rapidly between weeks 0 and 10, and seemed to decline slightly during the remainder of the trial, the authors noted. In the stepwise treatment group, the rate of hypoglycemia increased slightly over the first 10 weeks, fell during weeks 10 through 21, and then remained at around the same level through the end of the trial. Patients in the stepwise group had fewer overall hypoglycemic episodes than did those in the basal-bolus treatment group (rate ratio, 0.58; 95% CI, 0.45 to 0.75; P<0.0001). Adverse events did not differ between the two groups, and the most common were nasopharyngitis, influenza, diarrhea, headache, peripheral edema and wrong drug given.
Researchers wrote, "This regimen is an attractive alternative to initiation of full basal-bolus insulin replacement involving four injections per day. The stepwise approach consists of fewer injections, fewer associated glucose measurements, less burden on the patient in terms of titrating insulin doses, lower risk of hypoglycemia, less weight gain, and better adherence than the basal-bolus approach."
An editorialist outlined how starting prandial insulin in a stepwise manner can be done in a practical way. The patient identifies which meal has the most carbohydrates, and takes 4 to 6 units of a rapid-acting insulin analogue, ideally 10 to 15 minutes before eating. The dose is then adjusted once or twice a week so that the next prandial or bedtime glucose reading is at target (less than 130 mg/dL). If the HbA1c remains above target, a second and third dose can be added if needed. The editorialist wrote, "Clinicians should be aware that every addition of a prandial dose of insulin to a patient's daily regimen increases the risk of hypoglycemia, and therefore should be weighed against potential benefits of intensifying therapy."
Test yourself
MKSAP Quiz: Treating hyperlipidemia and type 2 diabetes
A 56-year-old man comes to the office for a follow-up evaluation. Since receiving a diagnosis of type 2 diabetes mellitus 6 months ago, he has been eating a low-fat, high-fiber, high-carbohydrate diet and walking for 20 minutes at night. The patient has never smoked and drinks no alcohol. He originally took metformin to treat his diabetes but stopped because of persistent diarrhea. Current medications are glyburide and ramipril.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 129/76 mm Hg, pulse rate is 76/min, and respiration rate is 15/min; BMI is 22. Other physical examination findings are normal.
Laboratory studies show: alanine aminotransferase 102 units/L; aspartate aminotransferase 96 units/L; cholesterol: total 264 mg/dL (6.83 mmol/L), LDL 157 mg/dL (4.07 mmol/L), HDL 42 mg/dL (1.09 mmol/L); fasting glucose 196 mg/dL (10.9 mmol/L); hemoglobin A1c 9.8%; iron studies normal; triglycerides 437 mg/dL (4.94 mmol/L); hepatitis virus negative.
Bedtime neutral protamine Hagedorn (NPH) insulin is initiated.
Which of the following is the most appropriate treatment of his hyperlipidemia?
A. Begin a fibrate now
B. Begin a statin now
C. Begin a statin after results of liver chemistry studies normalize
D. Begin nicotinic acid (niacin) now
E. Begin either a fibrate or nicotinic acid after results of liver chemistry studies normalize
Click here or scroll to the bottom of the page for the answer and critique.
From ACP InternistWeekly
Score predicts diabetes remission after Roux-en-Y surgery
Researchers created a new score, based on four variables, which can help predict whether a patient will have remission of type 2 diabetes after Roux-en-Y gastric bypass surgery.
The score, which the researchers named the DiaRem score, was created based on a retrospective cohort study of 690 patients with type 2 diabetes who had the surgery at one hospital in 2004 to 2011. Patients were followed for partial or complete remission lasting at least 12 months after surgery. Partial remission was defined as hemoglobin A1c (HbA1c) less than 6.5% and fasting blood glucose less than 126 mg/dL, while complete remission was an HbA1c less than 6.0% with fasting blood glucose less than 100 mg/dL, both with no antidiabetic medication. Results were published by The Lancet Diabetes & Endocrinology on Sept. 13.
After examining 259 variables, researchers identified four that best predicted partial or complete remission in the 463 surgical patients (63%) who achieved either type of remission. Insulin use before surgery was the strongest predictor (patients who used insulin were least likely to have remission), so it was given the most weight (10 points in the 22-point score). Other factors that predicted remission were younger age, lower HbA1c and not taking the combination of both insulin-sensitizing agents (other than metformin) and sulfonylureas.
Among patients with the lowest scores, 88% had remission after surgery, compared to only 0.5% of the highest-scoring patients. The researchers validated their findings in two replication cohorts and concluded that their DiaRem score could be used preoperatively to predict diabetes remission after Roux-en-Y (but not other types of bariatric surgery). This study also found for the first time that, among patients who took insulin, use of incretin mimetics increased the chance of remission, a finding that needs further confirmation, the authors noted.
The score could help with treatment selection for diabetes and management of expectations in patients who are undergoing Roux-en-Y, an accompanying comment noted. However, more research is needed to validate the findings and assess the effects of surgery on other endpoints, including mortality. Clinicians should also remember that even patients who are unlikely to achieve diabetes remission from surgery may see significant benefits from the procedure, the comment concluded.
From ACP HospitalistWeekly
Intensive insulin after PCI didn't reduce infarct size
Intensive use of insulin to regulate hyperglycemia in acute coronary syndrome (ACS) patients did not reduce infarct size, and may have caused harm, a new study found.
The prospective, open-label study was conducted at a large teaching hospital in the Netherlands. Between 2008 and 2012, 294 patients admitted with ACS and a plasma glucose of 140 to 288 mg/dL were randomized to either intensive glucose management (intravenous insulin therapy targeted at plasma glucose levels of 85 to 110 mg/dl) or conventional management (no insulin therapy unless plasma glucose exceeded 288 mg/dl). Patients with insulin-dependent diabetes before admission were excluded from the study. Results were published online Sept. 9 by JAMA Internal Medicine.
Percutaneous coronary intervention (PCI) was performed on 93.6% of the study patients, at a median of about 30 minutes after admission. The primary endpoint of the study was high-sensitivity troponin T about 72 hours after admission, with secondary endpoints the area under the curve of creatine kinase, myocardial band, release and myocardial perfusion scintigraphy at six weeks. The intensive group (whose median glucose was 112 mg/dl) showed an insignificant decrease in infarct size, as measured by all the endpoints, compared to the conventional group. Although severe hypoglycemia was rare, the intensive group did have a higher incidence of death or spontaneous second myocardial infarction (8 patients [5.7%] vs. 1 [0.7%]; P=0.04).
One possible explanation for the lack of effect is the timing of insulin therapy; it was often delayed until after PCI, a median of five hours after symptom onset. It's also possible that elevated plasma glucose was a marker of severity, rather than a causal factor, the authors speculated. They also noted that rapid delivery of PCI could have limited infarct sizes to the point that glucose control didn't provide further benefits. Based on the lack of benefit and possibility of harm observed, "strict, but not too strict, glucose control" seems to be the appropriate strategy, the authors concluded.
They called for additional research to focus on patients with persistently elevated glucose after PCI, as well as the association between intravenous insulin and early second myocardial infarction. An accompanying commentary also suggested a large trial targeting glucose to 140 mg/dl or below, noting that although this study did not show a significant benefit in infarct size, there was a trend favoring intensive glucose management, and other studies show promise with insulin treatment of hyperglycemia in patients with myocardial infarction.
From ACP Internist
Diabetic foot care begins with bare feet
Get advice on heading up a care team that intervenes early and often to prevent the ulcerations, pressure points and neuropathies that can progress to infection and possibly amputation in the October ACP Internist.
From ACP Journal Club
Insulin pumps with a sensor and threshold-suspend reduced nocturnal hypoglycemia in type 1 diabetes
Patients with type 1 diabetes and documented nocturnal hypoglycemia who were randomized to receive sensor-enhanced insulin pump therapy with a threshold-suspend feature had reduced nocturnal hypoglycemia and no difference in glycated hemoglobin levels compared to those on sensor-augmented insulin pump therapy alone, a recent study found.
The study was published in the July 18 New England Journal of Medicine. A summary of the study was published in the July ACP DiabetesMonthly. The following commentary by Rozalina McCoy, MD, and Steven Smith, MD, was published in the ACP Journal Club section of the Sept. 17 Annals of Internal Medicine.
Hypoglycemia, particularly nocturnal hypoglycemia, is the most common important adverse effect of diabetes therapy, causing considerable morbidity and occasional mortality. The ASPIRE study examined the effect of nocturnal sensor-augmented pump devices equipped with an automated insulin suspension feature on the incidence and duration of nocturnal hypoglycemia in adolescents and adults with type 1 diabetes. They found that both were decreased, but not eliminated, without concomitant change in glycated hemoglobin levels compared with standard insulin pumps and continuous glucose monitors.
Although these results are promising, important questions remain. Without a hypoglycemia/suspension alert mechanism, patients may remain unaware of the episode and thus fail to address the cause of hypoglycemia, thereby allowing it to recur. Indeed, despite suspension of insulin release, hypoglycemia persisted 2 hours after suspension (i.e., at time of insulin resumption) in 33% of suspension events. Also, generalizability of the ASPIRE study to clinical practice is uncertain because it excluded patients most likely to benefit from this technology—those with a history of severe hypoglycemia—and relied on a technically trained health care team.
It is important to keep in mind that our primary goal should not be solely hypoglycemia detection and acute management, but rather prevention of hypoglycemia and hyperglycemia. Behavioral assessment and intervention should complement technology, and providers must work with patients to determine why hypoglycemia occurred in the first place, probing for an excessive basal insulin rate, miscalculated prandial insulin dosing, unaccounted for physical activity, or disproportionate insulin correction as a reaction to hyperglycemia. Technology alone is often insufficient.
Tool of the month
Advice for patient education about diet
When counseling patients with type 2 diabetes about their diets, keep in mind the following general principles:
- Note that there is no single, specific diet for diabetes that applies to all patients; individualized planning should be the goal.
- Consider referral to a dietician
- Stress the importance of moderation.
- Base calorie recommendations on the goal of achieving near-ideal body weight.
- Use a reasonable starting formula of 10 calories per pound of current body weight plus 20% for sedentary patients, 33% for those who engage in light physical activity, 50% for moderately active patients, and 75% for those who are heavily active.
- Avoid saturated fats.
- Follow a regular meal schedule, particularly if on insulin.
- Note that frequent small meals might aid in weight loss and in control of blood-glucose level.
- Choose complex carbohydrates (e.g., starches, cereals) over simple sugars.
This content is from ACP Smart Medicine, the College's new web-based clinical decision support tool developed specifically for internal medicine physicians. Information about ACP Smart Medicine is online.
Keeping tabs
Spotlight on European Association for the Study of Diabetes conference
The annual meeting of the European Association for the Study of Diabetes was held in Barcelona, Spain in September. Highlights of the research presented at the meeting include:
Patients whose first-line therapy for type 2 diabetes was a sulfonylurea had significantly increased risk of death compared to those on metformin monotherapy, according a retrospective analysis of data from the United Kingdom. The analysis included almost 100,000 patients (more than 15,000 of them on sulfonylureas), and the increased mortality in the sulfonylurea patients persisted even in the direct- and propensity-matched cohorts. While noting that confounding could have occurred, the researchers concluded "treatment with first-line monotherapy with sulfonylureas should be reconsidered."
In the Veterans Administration system, many patients with cardiovascular risks are taking sulfonylureas, despite guidelines to the contrary, a retrospective cohort study found. Analyzing records from almost 150,000 patients, researchers found that a quarter of patients with existing cardiovascular disease or multiple cardiovascular risk factors were taking drugs in the class, about the same rate as patients at low risk of cardiovascular disease.
Use of pioglitazone was associated with development of diabetic macular edema (DME), according to a retrospective study using 2000 to 2011 data from a Japanese database. More than 20,000 type 2 diabetes patients were included, and of the 953 taking pioglitazone, the rate of DME was 1.5% compared to 0.45% in the overall group, leading researchers to conclude that pioglitazone may increase the risk of DME.
Delay in intensifying treatment of type 2 diabetes was associated with higher risk of cardiovascular events, a retrospective analysis found. More than 110,000 patients were studied, more than a quarter of whom had a hemoglobin A1c of 7% or higher a year after diabetes diagnosis. Patients in that group who didn't intensify treatment (addition of a second oral drug or insulin) within a year were significantly more likely to have a myocardial infarction, stroke or heart failure during study follow-up, supporting the cardiovascular benefits of early treatment intensification in patients with poor glycemic control, researchers concluded.
Erectile dysfunction in men with type 1 diabetes often reverses itself, especially after a short duration, according to new data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. More than 700 men were queried about impotence. Of the 198 with a single report of erectile dysfunction (ED), 67.7% regained potency within 5 years. The likelihood of regaining potency decreased with every consecutive year of ED, until those with 5 or more consecutive years had less than a 20% chance. The overall incidence of ED increased from 5.5% in first year (1994) of follow up, to 33.6% by year 16 (2009).
MKSAP Answer and Critique
The correct answer is B. Begin a statin now. This item is available to MKSAP 16 subscribers as item 45 in the Endocrinology section. Information about MKSAP 16 is available online.
In addition to neutral protamine Hagedorn (NPH) insulin at bedtime, a statin should be added now to this patient's diabetes regimen. He has poorly controlled type 2 diabetes mellitus, and thus adding a bedtime basal insulin to his sulfonylurea is a reasonable step to improve his fasting plasma glucose level and hemoglobin A1c value. His liver chemistry studies show moderately elevated aminotransferase levels, but he has no other evidence of liver disease. This makes the diagnosis of nonalcoholic fatty liver disease most likely. In light of his diabetes and significant hypercholesterolemia, the addition of a statin is likely to be beneficial. Patients with nonalcoholic fatty liver disease are not necessarily at a higher risk of adverse outcomes from statin therapy than patients without the disease, and thus statins are a treatment option in these patients. In a study of 437 patients whose liver chemistry levels were up to three times the upper limit of normal, treatment with atorvastatin resulted in a threefold reduction in cardiovascular events (10% versus 30% in the nontreatment group) and a greater reduction in liver chemistry levels compared with patients not receiving a statin during 3 years of follow-up evaluation.
Fibrates are most effective for reducing the triglyceride level and have little impact on the LDL cholesterol level, the primary lipid target in this patient.
Starting the statin should not be delayed until after his glycemic control has improved or his liver chemistry tests normalize.
Nicotinic acid can lower the LDL cholesterol level and increase the HDL cholesterol level. Its use is typically limited by its adverse effects. Nicotinic acid can cause elevation of glucose and liver chemistry levels and may cause severe hepatocellular damage. Nicotinic acid would be relatively contraindicated in this patient with probable nonalcoholic fatty liver disease.
Key Point
- Statins are a viable treatment option in patients with diabetes mellitus, hyperlipidemia, and nonalcoholic fatty liver disease.
Click here to return to the rest of ACP DiabetesMonthly.
About ACP DiabetesMonthly
ACP DiabetesMonthly is a monthly newsletter produced by the staff of ACP Internist. It is automatically sent to all College members who have an e-mail address on file with ACP.
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Test yourself
A 67-year-old man is evaluated for a recent diagnosis of primary hyperparathyroidism after an elevated serum calcium level was incidentally detected on laboratory testing. Medical history is significant only for hypertension, and his only medication is ramipril. Following a physical exam and lab studies, what is the most appropriate management of this patient?
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