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After almost four weeks in Tanzania working on our project, the girls' dormitory is almost complete! With the help of contractors we were able to get the walls completed, build the roof trusses and attach them to the building. When we left the building looked great, but still had some work to be done. We are so very proud of the work done and the continued dedication of the contractors and our NGO. Below is a picture of the buildings current state as of July 17, 2016! Check out our blog to read our in-country posts and the Updates section for more info on our trip.
by an extremely generous group of anonymous donors!
We are partnering with a Tanzanian nongovernmental organization (NGO) called Tanzania ecoVolunteerism (TeV) to design and build an educational facility at a local primary school. We will be expanding the capacity of a dormitory for visually impaired girls at the Pongwe Primary School (ages 6-13). We will making education accessible to children for the first time, so you can imagine how much thought, time, and effort is going into this process. We are working hard every day with the help of our professors, engineering professionals, and the in-country NGO to ensure the community's needs are met and the project is feasible and sustainable for the future.
After participating in PUC's year-long program consisting of both a project management and design course, we will then travel to Tanzania to implement this educational facility project. We are ecstatic to further develop our education by implementing what we've learned here at UT with the beloved Tanzanian community of Pongwe. We need your help to make this happen!
Every dollar helps us attain our goal of working with this community to impact their life, as well as both of our educational experiences. All of our team members are paying for our own travel and in-country expenses, but we need at least $15,000 to pay for the costs of materials. Every gift through this site will be matched 1:1 by an extremely generous group of anonymous donors! That means if you donate $100, we receive $200! That's double the impact; your money goes farther. Does your employer match donations to universities? Triple, even quadruple the impact by finding out here (http://www.matchinggifts.com/utexas/)!
Most of the materials for this structure, if not all, will be bought from local Tanzanian suppliers, stimulating their economy. These supplies include concrete (and LOTS of it), wall and floor finishing, and roofing materials. Every dollar you donate will go directly to the community and will support our education as professionals and growth as leaders as we design, plan for, and build this project.
You may be wondering what you are getting out of this. Besides knowing that you are enabling girls in Tanzania to receive an education for the first time, all donations are tax deductible!!! This is because all donations through this HornRaiser site go directly through The University of Texas at Austin.
Giving Levels:
Easily contribute via our giving levels found on the right side of the page! These levels describe what your donation can purchase in country at the amount described. We want these children to have a new school facility that brings new friends and new experiences, so when we receive adequate funding to build our structure, the level items will then be purchased in-country from a local supplier and given directly to the students! We would love the opportunity to purchase all of these level items, so please share this page to and friends and family to help reach our goal and more!
Education is a key component of the Government of Tanzania's development agenda, yet most Tanzanians only have 5 years of schooling or less. While about 80% of primary school-age children attend school, the enrollment rate for lower secondary education has dropped to 30.8% and then to 1.9% for upper secondary school. Enrolling a higher number of students by providing schools with new facilities will increase the number of children likely to continue their education. Building new facilities at these schools will provide the community with more teachers and enable a higher enrollment of children to better learning environments. Hearing about these new buildings and teachers can encourage the communities to get their children enrolled on time and excited about a new school year
Pongwe Primary School is a school located in the Tanga region of Tanzania that serves over 900 children, 70 of which are visually impaired, with and without albinism (pictured above). Children from all over board at the school for the duration of the school year because it is the only school within 1000 Km to accept these visually impaired children. The school is currently unable to enroll any more visually impaired female students because they do not have the boarding capacity; that's where we come in.
Our team will be doubling the capacity of the current dormitory for the amazing girls of Pongwe, allowing the enrollment of twice as many visually impaired girls! This will be done by relocating the current matron of the school who resides in the girls dorm building. A separating interior wall will be removed, returning the full dormitory to the girls and doubling the space! We will construct a multi-use standalone building that will be used as the matron's cottage for the time being, but will be designed to be converted into a much needed clinic for the school in the near future.
"Team Tanzania" is a passionate and focused group of students from both the Cockrell School of Engineering and the School of Social Work who have joined together for one main cause: to make education accessible to everyone. While we understand this is a huge task, it must start somewhere. We have decided to start this mission at a local primary school outside of Tanga, Tanzania.
We are conducting this project as a part of the University of Texas' Projects with Under-Served Communities (PUC) program. PUC combines the two challenges of community need and student enrichment in an innovative project-based, service-learning collaboration with rigorous coursework and hands-on, practical experience.
Thank you so much for spending your time learning about Team Tanzania and our goal to make education accessible for everyone. Please read on to learn more! You are appreciated by each and every one of us and we ask that you share our story and HornRaiser page to anyone and everyone you know! You never know which cousin or uncle feels just as passionate as we do about this cause.
As you know at UT, what starts here changes the world. Will you change the world with us? We can't do it without you.
Mchezaji means Athlete in Swahili. A donation of $25 can purchase equipment for the children to play with in their school yard such as soccer balls, jump ropes, marbles and more! These items would be purchased in country to help stimulate the community's economy.
The Teacher: A donation of $100 could purchase school supplies for the children from a local shop in town. This not only benefits the children, but the community's economy as well!
The Doctor: A donation of $500 could purchase the supplies needed to install simple hand-washing stations throughout the school yard. These stations would embrace the knowledge and implementation of preventing the spreading of germs and sicknesses!
The Environmentalist: A donation of $1000 could enable the installation of a rainwater collection unit on the structure we are building. By means of gutters, filters and piping, the school can collect clean water with ease!
The Carpenter: A donation of $5,000 can enable the purchasing of bunk beds to accommodate the expanded dormitory (given Pongwe is our selected project) or classroom furnishings such as chalk boards, desks, chairs, etc... (given Mtimbwani is our selected project)


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The "Water Softeners Market" report includes an in-depth analysis of the global Water Softeners market for the present as well as forecast period. The report encompasses the competition landscape entailing share analysis of the key players in the Water Softeners market based on their revenues and other significant factors. Further, it covers the several developments made by the prominent players of the Water Softeners market. The well-known players in the market are EcoWater Systems, Culligan, BWT, Haier(GE), Whirlpool Corporation, 3M, A.O. Smith, Coway, Canature Environmental Products Co., Ltd, Kinetico, Harvey Water Softeners, Aquasana, Kenmore.
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Chapter 4, Overall Market Analysis, Capacity Analysis (Company Segment), Sales Analysis (Company Segment), Sales Price Analysis (Company Segment);
Chapter 5 and 6, Regional Market Analysis that includes United States, China, Europe, Japan, Korea & Taiwan, Water Softeners Segment Market Analysis (by Type);
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To determine parathyroid hormone (PTH) reference values in French healthy adults, taking into account serum 25-hydroxyvitamin D (25OHD), renal function, age, gender, and BMI.
Participants and main biological measurements
We studied 898 healthy subjects (432 women) aged 18–89 years with a normal BMI and estimated glomerular filtration rate (eGFR), 81 patients with surgically proven primary hyperparathyroidism (PHPT), and 264 dialysis patients. 25OHD and third-generation PTH assays were implemented on the LIAISON XL platform.
Median PTH and 25OHD values in the 898 healthy subjects were 18.8 ng/l and 23.6 ng/ml respectively. PTH was lower in subjects with 25OHD ≥30 ng/ml than in those with lower values. Among the 183 subjects with 25OHD ≥30 ng/ml, those aged ≥60 years (n=31) had higher PTH values than younger subjects, independent of 25OHD, BMI, and eGFR (P<0.001). Given the small number of subjects aged ≥60 years, we adopted the 95% CI of PTH values for the entire group of 183 vitamin D-replete subjects (9.4–28.9 ng/l) as our reference values. With 28.9 ng/l as the upper limit of normal (ULN) rather than the manufacturer's ULN of 38.4 ng/l, the percentage of PHPT patients with 'high' PTH values rose to 90.1% from 66.6% (P<0.001), and 18.6% of the dialysis patients were classified differently in view of the KDIGO target range (two to nine times the ULN).
When only subjects with 25OHD ≥30 ng/ml were included in the reference population, the PTH ULN fell by 22.4%, diagnostic sensitivity for PHPT improved, and the classification of dialysis patients was modified.
With the advent of automated assays, serum parathyroid hormone (PTH) is frequently measured in clinical practice. Second-generation assays cross-react with N-terminal truncated PTH fragments (7–84 PTH), while third-generation assays do not detect 7–84 PTH but measure, in addition to 1–84 PTH, a post-translational form called amino-PTH, that is overproduced in many patients with parathyroid carcinomas (1, 2). Guidelines for the diagnosis of asymptomatic primary hyperparathyroidism (PHPT) (3), and also the KDIGO guidelines (4), emphasize that second- and third-generation PTH assays have similar clinical values for the diagnosis of PHPT and for the follow-up of chronic kidney disease (CKD)-related mineral and bone disorders. As a result, more and more clinical laboratories worldwide are using third-generation PTH assays routinely.
A serum PTH concentration above the upper limit of normal (ULN) reflects either secondary hyperparathyroidism (SHPT) when associated with hypocalcemia or PHPT when associated with hypercalcemia. In patients with a normal total calcemia, an elevated PTH level may correspond either to SHPT or to normocalcemic PHPT (N-PHPT). PHPT is all the more probable in case of high normal serum calcium levels (5). A definite proportion of patients who fall in this subgroup have elevated ionized calcium. In dialysis patients, KDIGO guidelines recommend maintaining serum PTH within two to nine times the ULN (4). The definition of the PTH ULN is therefore of prime importance for the care of these numerous patients, and this raises questions as to the inclusion/exclusion criteria that should be applied when recruiting a reference population to establish PTH normal values. The exclusion criteria should include any situation potentially inducing an increase or decrease in the PTH concentration. This includes a low serum 25-hydroxyvitamin D (25OHD) concentration, which is highly frequent in the general population (6) and is thus likely to be prevalent in an apparently healthy groups recruited to establish normal PTH values. Excluding subjects with low 25OHD from a reference population for serum PTH reference values is strongly recommended in the two most recent guidelines on the diagnosis and management of asymptomatic PHPT (7, 8). We have demonstrated in several studies that this lowers the serum PTH ULN by 20–35% depending on the assay (6, 9, 10, 11, 12).
Another point which should be taken into account is renal function. Indeed, PTH levels can rise when the estimated glomerular filtration rate (eGFR) is below 60 ml/min per 1.73 m2 (4), and some apparently healthy subjects, especially those older than 60 years, may have a low eGFR.
Another issue is whether the PTH reference population should be stratified according to factors such as age, gender, menopausal status, BMI, and race.
The aim of this study was to determine PTH reference values for an automated third-generation assay in French healthy adults, stratifying the results according to vitamin D status, renal function, gender, age, and BMI. We also determined the frequency of high PTH levels in a series of patients with surgically proven PHPT and the classification of dialysis patients according to KDIGO guidelines.
Subjects and methods
We enrolled healthy volunteers who participated in the VARIETE study, a population-based cross-sectional study designed to recruit a reference population with normal serum insulin-like growth factor 1 (IGF1) values in adults (ClinicalTrials.gov identifier: NCT01831648). They were recruited between January 2011 and February 2012 by the clinical research units of ten university hospitals distributed throughout France. Inclusion criteria were a normal physical work-up (weight, height, blood pressure, nutritional status, and gonadal/sexual status), normal laboratory values determined after an overnight fast (plasma sodium, potassium, calcium, phosphate, creatinine, glycemia, total cholesterol, liver enzymes, thyrotropin, blood cell counts, albuminemia, prothrombin time, and HIV and HCV serology), age 18–89 years and BMI between 19 and 28 kg/m2, and a written informed consent to participate in the study. The exclusion criteria were a medical history of thyroid, renal, hepatic, cardiovascular, pulmonary, intestinal or psychiatric disorders, cancer, epilepsy, intercurrent illness occurring during the week preceding inclusion, current consumption of tobacco or other toxics, and treatment potentially modifying IGF1 or calcium/phosphorus metabolism (antiandrogens or antiestrogens, loop diuretics, hydrochlorothiazide, and CYP-inducing drugs). In addition to the blood samples necessary for the screening biological evaluation, 50 ml of whole blood and 30 ml of EDTA blood was obtained from each subject. Blood was promptly centrifuged (3000 g at 4 °C), and serum or plasma was aliquoted in polypropylene tubes that were immediately stored at −80 °C. This study was funded by Programme Hospitalier de Recherche Clinique, French Ministry of Health, no. P081216/IDRCB 2009-A00892-55, and was approved by the Paris-Sud Ethics Committee in November 2009.
We also obtained serum samples from 81 consecutive patients with PHPT before parathyroid surgery. These patients were osteoporotic (low bone mineral density (BMD) and/or low-trauma fracture) and were initially referred to our tertiary care center for etiological diagnosis of abnormal calcium/phosphorus or related hormone levels detected during a screening biological evaluation aimed at ruling out secondary causes of osteoporosis. We requested that the physician who referred the patient prescribe vitamin D if the 25OHD concentration was low before investigations in our unit. Based on the pharmaceutical forms available in France, the recommended supplementation scheme comprised four 100 000 IU vials of vitamin D3 (one vial every other week) in case of serum 25OHD concentration <20 ng/ml, and two vials in case of 25OHD concentration between 20 and 29.9 ng/ml. According to the procedure in our unit, an oral calcium load test was performed in those with total calcium serum levels <3 mmol/l at their initial work-up (n=78). In those with normal serum calcium levels, the oral test was followed by an i.v. calcium load test as described in (13). In all patients, an insufficient fall in serum PTH when serum ionized calcium level rose well above the ULN during the test was observed, confirming the diagnosis of PHPT. All had preoperative parathyroid imaging (echography and sestaMIBI scintigraphy) which was positive in 45 cases (44.4%) and negative or discrepant (negative at one of the test and positive at the other one) in 36 cases (55.6%). As they all had osteoporosis, these 81 consecutive patients were addressed to the surgeon and underwent successful parathyroidectomy, as confirmed by pathological examination of parathyroid tissue removed during surgery.
Finally, we collected sera from 264 hemodialysis patients managed in the same dialysis department, just before a dialysis session.
Laboratory methods
The biological parameters of the healthy volunteer screening evaluation were determined locally by the laboratories attached to the clinical research units, using standard chemistry. The CKDepi formula was used to evaluate eGFR (14). PTH and 25OHD measurements were centralized and done in batches by means of immunochemiluminometric assays on the LIAISON XL (DiaSorin, Stillwater, MN, USA), using serum samples that had never been thawed. According to data obtained by one of us (C Massart), intra-assay coefficients of variation (CV) were 3.2% at 25.7 ng/l and 3.2% at 284 ng/l for the third-generation PTH assay, and 2.2% at 17.9 ng/ml and 2.7% at 51.9 ng/ml for the 25OHD assay. Inter-assay CV were 12.2% at 16.9 ng/l and 9.9% at 160 ng/l for the third-generation PTH assay, and 9% at 17.9 ng/ml and 7.9% at 34 ng/ml for the 25OHD assay. Limit of quantification was 4 ng/l and 4 ng/ml for the third-generation PTH assay and for the 25OHD assay respectively.
Statistical analysis
Quantitative variables are reported as median, quartile 1 (Q1, 25th percentile), Q3 (75th percentile), and interquartile range (IQR). Associations between the serum PTH concentration and other quantitative variables were assessed by simple regression. The LOWESS representation was used to smooth the relationship between PTH and 25OHD. Variables significantly associated with PTH were included in a model for multiple regression analysis. Variables significantly associated with PTH in multiple regression analysis were then stratified into arbitrarily defined subgroups, and the mean PTH values in these subgroups were compared by ANOVA. To determine the PTH reference range we first detected outliers, defined as PTH concentrations below Q1−1.5 IQR and above Q3+1.5 IQR after log transformation of the raw values (15). We then calculated the 95% CI in the remaining subjects after eliminating the outliers. Percentages were compared by means of the χ2 test. A P value <0.05 was considered significant.
Healthy subjects
Nine hundred and seventy-two Caucasian subjects were initially recruited. Two were excluded because their informed consent was not available, and another 60 were excluded because of abnormal values in the screening evaluation. Among the remaining 910 subjects, no serum sample was available for PTH testing in 12 cases. The study population thus consisted of 898 subjects, whose main characteristics are summarized in Table 1. The median PTH value in these 898 subjects was 18.8 ng/l (Q1: 15.2 ng/l; Q3: 24.0 ng/l; and IQR: 8.8 ng/l). After excluding nine outliers (eight high values and one low value), the range of PTH values (2.5th–97.5th percentile) was 10.1–37.9 ng/l, with no significant difference between men and women (18.8 ng/l (15.2–24.0) and 19.1 ng/l (15.4–24.0), respectively; P=0.13). In simple regression analysis, serum PTH correlated negatively with serum 25OHD (r=−0.29; P<0.001), phosphate (r=−0.19; P<0.001), calcium (r=−0.16; P<0.001), and eGFR (r=−0.25; P<0.001), and positively with age (r=0.37; P<0.001) and BMI (r=0.20; P<0.001). In multiple regression analysis, only the 25OHD level and age remained significantly correlated with PTH. PTH concentrations in the 898 subjects are shown in Table 2 according to age and 25OHD concentrations. Figure 1 shows the relationship between 25OHD and PTH concentrations, represented by the LOWESS curve. No obvious inflection point (i.e. a 25OHD concentration above which PTH no longer decreases) is visible in this curve. It should be noted that few subjects had 'high' 25OHD levels as only 5 (0.5%) had a concentration above 50 ng/ml.
Characteristics of the healthy subjects participating in the VARIETE study.
|Values, Median (Q1–Q3) (min–max)
|Gender (men/women)
|Age (years)
|32 (24–54) (18–89)
|BMI (kg/m2)
|22.9 (21.1–24.8) (18.5–28)
|Serum 25OHD (ng/ml)
|18.8 (15.2–24.0) (7.4–79.0)
|Serum PTH (ng/l)
|23.6 (18.8–28.3) (5.2–59.4)
|Serum calcium (mmol/l)
|2.30 (2.21–2.39) (2.10–2.60)
|Serum phosphate (mmol/l)
|1.10 (0.97–1.22) (0.75–1.51)
|Serum albumin (g/l)
|43.0 (40.0–46.0) (32.6–50)
|eGFR (CKDepi) (ml/min per 1.73 m2)
|101 (88–114) (60–144)
PTH concentrations (ng/l) in the normal subjects of the VARIETE study, according to age and serum 25OHD levels.
|PTH median (Q1–Q3)
|P value
|Age (years)
|i) 18–29
|16.9 (14.1–21.2)
|vs (ii) and (iii): P<0.001
|ii) 30–59
|18.9 (15.3–24.4)
|vs (i) and (iii): P<0.001
|iii) ≥60
|23.5 (18.9–31.7)
|vs (i) and (ii): P<0.001
|25OHD (ng/ml)
|i) <12
|26.5 (18.6–33.7)
|vs (ii), (iii), and (iv): P<0.001
|ii) 12–19.9
|20.5 (16.4–26.5)
|vs (i), (iii), and (iv): P<0.001
|iii) 20–29.9
|18.0 (15.1–22.7)
|vs (i) and (ii): P<0.001; vs (iv): P=0.04
|iv) ≥30
|17.0 (13.5–21.5)
|vs (i) and (ii): P<0.001; vs (iii): P=0.04
As PTH concentrations were significantly lower in subjects with serum 25OHD ≥30 ng/ml (n=183) than in the other three 25OHD groups (Table 2), we used only these 183 subjects to establish our PTH reference range. The median PTH concentration in these 183 subjects was 17.0 ng/l (Q1: 13.5 ng/l; Q3: 21.5 ng/l; and IQR: 8.0 ng/l). After excluding six outliers with high values, the range (2.5th–97.5th percentile) of PTH concentrations was 9.4–28.9 ng/l. In simple regression analysis, serum PTH levels in this group of 183 subjects correlated positively with age (r=0.30; P<0.001) and BMI (r=0.23; P=0.002), and negatively with eGFR (r=−0.22; P=0.002), but not with serum 25OHD (P=0.32). In multiple regression analysis, only age remained significantly associated with serum PTH. The median PTH concentration in subjects <60 years old (n=152) was 17.8 ng/l (2.5th–97.5th percentile: 9.1–28.5 pg/ml), a value significantly lower than in subjects aged 60 years or more (n=31) who had a median PTH concentration of 21.5 ng/l (P<0.001). No significant difference was found between subjects aged 18–29 years and those aged 30–59 years (P=0.09). In the 31 older subjects, the estimated range of PTH values was 11–33 ng/ml. However, as this subgroup was small, we considered that it should not be used as reference values. Thus, for the following analyses in PHPT and dialysis patients, we used the range of PTH values obtained in the whole group of 183 subjects with serum 25OHD ≥30 ng/ml as our reference, that is 9.4–28.9 ng/l. Interestingly, in the entire initial population of 898 apparently healthy subjects, 26 (2.9%) had PTH concentrations >38.4 ng/l, corresponding to the ULN given by the kit manufacturer, while 114 (12.7%) had PTH concentrations >28.9 ng/l. Thus, 88 of our 898 apparently healthy subjects (9.8%) would be considered as having elevated PTH concentrations when using our upper normal limit of 28.9 ng/l, but normal PTH concentrations using the manufacturer's ULN.
PHPT patients
The main characteristics of these 81 patients are presented in Table 3. All had a 25OHD serum concentration ≥20 ng/ml, and 52 had a 25OHD concentration ≥30 ng/ml. Using the manufacturer's ULN of 38.4 ng/l, 27 (33.3%) of our 81 PHPT patients had a 'normal' PTH concentration. The percentage of 'normal' PTH values (9.9%, 8/81) was significantly lower (χ2=13.1; P<0.001) when using our ULN of 28.9 ng/l. Figure 2 shows the relationship between serum total and ionized calcium levels in the 81 PHPT patients. Although well correlated (r=0.86; P<0.001), some discrepancies in the classification of the patients between both calcemias were noted. Twenty-seven (33.3%) of our 81 PHPT patients had normal total calcemia (≤2.60 mmol/l) and 12 (14.1%) had normal ionized calcemia (≤1.30 mmol/l). One had normal ionized calcemia and high total calcemia. Thus, 11 (13.6%) of these 81 patients were considered as having true N-PHPT. None of these 11 N-PHPT patients had a PTH concentration below 28.9 ng/l, while 4 (36.4%) had values below 38.4 ng/l. Among the 27 patients with normal total calcemia, 12 had a PTH concentration below 38.4 ng/ml (five of them with a ionized calcemia ≤1.30 mmol/l) and three had values below 28.9 ng/l.
Main characteristics of the 81 patients with PHPT.
|Gender (men/women)
|Age (years)
|67 (57–76) (min: 28–max: 91)
|Serum total calcium (mmol/l)
|2.64 (2.55–2.75)
|Serum ionized calcium (mmol/l)
|1.38 (1.32–1.44)
|Serum 25OHD (ng/ml)
|32 (26–39)
|Serum third-generation PTH (ng/l)
|46.0 (36.6–65.5)
Dialysis patients
The KDIGO guidelines recommend maintaining dialysis patients' serum PTH concentrations between two and nine times the ULN of the kit used in the laboratory. We thus determined the percentage of our 264 dialysis patients who had PTH levels below, within, and above this target range based on the manufacturer's ULN of 38.4 ng/ml (76.8–345.6 ng/l) and on our ULN of 28.9 ng/l (57.8–251.1 ng/l). Their median PTH concentration was 179.5 ng/l (81.5–272.0) (range 12.4–1750 ng/l). Forty-eight patients (18.2%) were classified differently with the two PTH ULN values used to calculate the KDIGO target range (Table 4).
Classification of dialysis patients (n=264) according to the KDIGO target range (two to nine times the PTH ULN) based on our ULN of 28.9 ng/l and on the manufacturer's ULN of 38.4 ng/l.
|Patients (n (%)) with a PTH concentration below, within or above the KDIGO target range based on
|Manufacturer's ULN (76.8–345.6 ng/l)
|Our ULN (57.8–251.1 ng/l)
|Below the target range
|64 (24.2%)
|50 (18.9%)
|Within the target range
|154 (58.3%)
|134 (50.8%)
|Above the target range
|46 (21.6%)
|80 (30.3%)
We established PTH reference values for an automated third-generation assay in a large group of French Caucasian healthy volunteers. When we included only subjects with 25OHD ≥30 ng/ml and eGFR ≥60 ml/min per 1.73 m2, as recommended (3), the PTH ULN was 22.4% lower than the ULN usually applied by clinical laboratories using this kit (28.9 ng/ml instead of 38.4 ng/l).
One question addressed in recent guidelines for the diagnosis of asymptomatic PHPT is whether a 25OHD of 20 or 30 ng/ml should be considered as the concentration below which a subject should be excluded from a reference population for serum PTH values (3). Indeed, the higher the 25OHD cut-off defining low 25OHD levels, the lower the PTH ULN (as an example, the ULN that we calculated in our healthy subjects with a 25OHD concentration ≥20 ng/ml from the present study was 32.1 ng/l). It must be underlined that the 20 ng/ml cut-off, supported by the Institute of Medicine, is intended to establish optimal vitamin D intake in the general (healthy) population (16), while the 30 ng/ml cut-off is supported by the Endocrine Society and is intended for use in patient management (17). Since these 2011 recommendations, the debate about the 25OHD threshold has continued (18, 19) with experts defending the 20 ng/ml value (20) and other the 30 ng/ml value (21). The choice is important, as it has a huge influence on the number of subjects that may be included in a 'vitamin D-replete' reference population for normal PTH values. Indeed, at least in France, approximately half the general healthy population and almost 80% have a 25OHD below 20 and 30 ng/ml respectively (6). In our opinion, the 30 ng/ml cut-off should be used when recruiting 'vitamin D-replete' subjects to establish PTH normal values, not because 25OHD concentrations should always be above 30 ng/ml but rather because this cut-off would have more diagnostic value for detecting HPT (either primary or secondary) when interpreting a PTH concentration. Indeed, in the highly frequent case of a normocalcemic patient with an elevated PTH, the clinical question is whether the elevated PTH is due to vitamin D insufficiency or to N-PHPT (after all other causes of SHPT have been excluded). Many reports have concluded that PTH concentrations are sometimes elevated in subjects with 25OHD concentrations below 28–32 ng/ml (22). Having said that, we recognize that the debate on the optimal cut-off defining vitamin D sufficiency is 'hot,' and that some scientists who do not accept the 30 ng/ml value will not accept our PTH ULN of 28.4 ng/l with this third-generation assay. For them, a PTH ULN of 32.1 ng/l (calculated in the population with 25OHD ≥20 ng/ml) would be more appropriate.
Another important question is whether the PTH reference values should be stratified for factors known to be associated with PTH levels, such as race, BMI, and age. Indeed, serum PTH levels are higher in black than white people (23), in overweight individuals than lean (24), and in the elderly than the young (25). This may simply be due to differences in vitamin D status, as 25OHD levels are usually lower in blacks, in overweight persons, and in the elderly. The present study included only Caucasian subjects, and we were thus unable to determine whether race is independently associated with PTH levels. We found that BMI was not an independent determinant of PTH levels, in keeping with our findings in another cohort of healthy French subjects (6). Our results suggest that PTH reference values should be stratified for age, as subjects older than 60 years had higher PTH concentrations than younger subjects, independent of vitamin D status and renal function. However, given the small number of 'vitamin D-replete' subjects over 60 years old, we were unable to provide separate reference values for younger and older subjects.
As stressed above, taking vitamin D status into account when establishing PTH reference values leads to a lower ULN than generally obtained in apparently healthy general populations. The obvious consequence is that above-normal concentrations will be found more often in clinical practice. On the one hand, this will improve the diagnostic sensitivity of PTH assay, as witnessed by the higher frequency of elevated PTH concentrations among our patients with surgically proven PHPT. Even if high calcium and PTH in the upper normal range is usually accepted as a diagnostic criterion of PHPT (the PTH is abnormally high–normal in face of hypercalcemia), many doctors feel more 'comfortable' with the diagnosis of PHPT when both parameters are elevated. However, even with our lower ULN, almost 10% of our PHPT patients still had 'normal' PTH values, emphasizing the need to interpret serum PTH concentrations with respect to calcemia. Importantly, our PHPT diagnoses were based on total and ionized calcemia, a calcium load test, and a lower PTH ULN. It may be noted that the calcium load test is not a standard diagnostic procedure for PHPT in most units. Indeed, high PTH and (even moderately) high total or ionized calcemia is usually considered sufficient. It is however systematic in our unit and has proved to be extremely helpful in normocalcemic patients. The superiority of ionized calcium over total calcium for the diagnosis of PHPT has been reported by others (26) and is confirmed by our data showing that a proportion of our surgically-proven PHPT patients had an elevated pre-surgery ionized serum calcium and a normal serum total serum calcium level (see Fig. 2). Assuming that ionized calcium is seldom measured routinely in clinical practice, and that most laboratories use a higher PTH ULN than ours, the diagnosis of PHPT would probably have been missed in 12 (12.8%) of our 81 patients, as they had both normal total calcemia and PTH <38.4 ng/l. On the other hand, use of our PTH reference values might lead to lower specificity. In a previous study, we verified that PTH reference values for the Nichols Allegro PTH assay established in vitamin D-replete subjects did not affect diagnostic specificity: as expected, PTH concentrations were 'above-normal' in only 3% of 360 consecutive osteoporotic patients with no reason for having high PTH levels, based on their medical charts and extensive biological investigation (27). We must underline that our PHPT population does not reflect PHPT patients in general. First, all had osteoporosis, and, secondly, the proportion of normocalcemic patients may seem very high. This is probably due to a selection bias related to the fact that our unit is specialized in the exploration of calcium/phosphorus metabolism in patients with bone diseases, and that many of these patients were referred because of very mild calcium/phosphorus and/or PTH abnormalities detected during the work-up of osteoporosis (to exclude a secondary cause of bone fragility). Furthermore, although it is clearly stated in the recent guidelines for the management of asymptomatic PHPT that 'N-PHPT is now a well-recognized variant of PHPT' (7), and that 'N-PHPT is part of the diagnostic spectrum of PHPT, and we need to ensure a correct diagnosis…' (3), there is a lack of recommendations concerning the treatment of this entity (surgery or not?). In these patients, our practice is to propose parathyroidectomy if they meet one or several of the indications for parathyroid surgery that are proposed in the guidelines (7). As all our PHPT patients had osteoporosis, they were all addressed for parathyroid surgery to the same experienced surgeon, even in case of negative preoperative imaging. We have previously shown that hypercalcemic PHPT and N-PHPT patients had a similar BMD gain at the spine and at the hip 1 year after parathyroidectomy (13).
The KDIGO recommendation to maintain PTH levels between two and nine times the ULN in dialysis patients deserves some discussion. SHPT is frequently associated with CKD and may be considered an appropriate adaptive response to decreasing GFR aimed at maintaining calcium/phosphorus homeostasis. However, SHPT may have deleterious consequences for bone turnover and mineralization and, in its severe forms, may lead to osteitis fibrosa cystica. SHPT may also become autonomous, leading to tertiary (hypercalcemic) hyperparathyroidism. However, many patients with CKD do not exhibit a sufficient increase in PTH levels with often a low bone turnover. This so-called adynamic bone disease is associated with a tendency to hypercalcemia and an increased risk of vascular calcification. Thus, PTH levels should be neither too high nor too low in CKD patients, especially in case of dialysis, leading experts to propose an optimal range for PTH serum levels. However, marked inter-method variability in serum PTH values precludes the use of a PTH target range (expressed in ng/l) applicable to all PTH assay methods (28, 29, 30). This is why KDIGO proposes a PTH target range based on multiples of the ULN rather than on absolute concentrations. The range of two to nine times the ULN was chosen because several studies showed that values below and above these limits were frequently associated with severely impaired bone turnover on biopsy (31) and with increased cardiovascular morbidity and mortality (32, 33). Although a PTH target range based on ULN multiples is a pragmatic way of overcoming the inter-method variability of PTH measurement, the way in which normal PTH values are established is of paramount importance. Indeed, with a given PTH assay the ULN may vary significantly depending on the reference population. Here, 18.6% of our dialysis patients were classified differently with our ULN of 28.9 ng/l compared to the manufacturer's ULN of 38.4 ng/l. This is consistent with what we have previously found on comparing the manufacturers' reference ranges for ten different PTH kits with the reference ranges that we established in the same population of vitamin D-replete Belgian healthy subjects for the ten kits (9). This variability may influence the therapeutic choices of nephrologists, who are used to adapting the dosages of PTH treatments, such as active vitamin D and calcimimetics, according to KDIGO recommendations for PTH values.
It must be underlined that, as in our previous studies on the same topic (6, 9, 10, 11, 12), the blood samples used here were obtained in the morning (0730–0930 h) after an overnight fast. Indeed, the ULN for a second-generation PTH assay obtained in healthy persons sampled in a non-fasting state over a larger time span was higher than in our studies (34) (see discussion in reference (6)).
The main strengths of our study pertain to the large number of healthy subjects; the population-based recruitment with strict inclusion criteria; the ability to stratify PTH concentrations by 25OHD status, gender, renal function, and BMI; centralization of PTH assay in a single laboratory; and the use of a third-generation assay, which is increasingly employed worldwide. Its limitations must also be acknowledged. First, although large, our population of healthy subjects was insufficient to propose separate reference values for younger and older adults. Secondly, we restricted the study to Caucasian adults and were therefore unable to determine whether PTH reference values should be stratified according to ethnicity. Thirdly, we did not rule out certain causes of PTH elevation in apparently healthy adults that might influence PTH ULN, such as very low calcium intake or renal calcium leakage. However, we believe that the use of the Horn algorithm, which allowed us to identify and eliminate outliers, minimized this problem. Fourthly, as the control of PTH secretion is very complex, other variables not considered in the present study, such as daily calcium intake or plasma FGF23, may influence PTH normative data. Fifthly, as indicated above, our PTH ULN only applies for this third-generation PTH assay and if the target 25OHD serum level of 30 ng/ml is accepted.
In conclusion, we confirm that serum PTH reference values are highly dependent on the characteristics of the reference population, especially vitamin D status, renal function, and age. Inclusion of only vitamin D-replete subjects with an eGFR ≥60 ml/min per 1.73 m2 reduced the upper normal limit of the reference range by 22.4% compared to the usual reference values of the LIAISON third-generation PTH assay. This had two consequences: i) it significantly increased the prevalence of elevated PTH values in patients with surgically proven PHPT and, thus, the diagnostic sensitivity of PTH assay for PHPT and ii) it modified the classification of dialysis patients based on the PTH target range recommended by KDIGO guidelines. As massive inter-method variability in PTH assay results has been demonstrated, more studies are needed to establish PTH reference values for all available assays, using the same large population of vitamin D-replete healthy subjects with normal eGFR and stratifying the data according to age and, possibly, ethnicity.
Declaration of interest
J-C Souberbielle reports lecture fees and/or travel/hotel expenses from DiaSorin, Roche Diagnostics, Abbott, Amgen, Shire, MSD, Lilly, and Rottapharm. C Massart reports lecture fees and travel/hotel expenses (DiaSorin). E Cavalier is consultant for IDS and DiaSorin and has received lecture fees from IDS, DiaSorin, Roche, Abbott, and Amgen. P Delanaye is consultant for IDS and has received lecture fees and/or travel expenses from DiaSorin, Amgen, Shire, Fresenius, Menarini, and Sanofi. S Brailly-Tabard, C Cormier, and P Chanson declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
This research received a grant from Programme Hospitalier de Recherche Clinique, French Ministry of Health, no. P081216/IDRCB 2009-A00892-55.
We thank DiaSorin for its kind donation of the PTH and 25OHD kits. We also thank the physicians and technicians of the clinical research units that recruited and examined the healthy subjects and/or collected the data.
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text:
Use Tech to Streamline Your Life
here's no denying it—winter has arrived! While the cold season is my least favorite as far as the weather goes, as an
Apple fan, it is unequivocally the most exciting time of year. Between getting your hands on Apple's latest products and
splurging on cool gadgets over the holidays, you can coast through chillier days with devices that help us live our best
The verdict is in; Face ID and edge-to-edge displays are here to stay!
Apple has released the new iPhone XS, XS Max, and XR with not only
the same bezel-free form factor as last year's X, but also faster facial
recognition and a better camera, powered by the supercharged A12
Bionic chip (see page 12). But if you, like most of the iPhone Life staff,
hopped on the iPhone X bandwagon last year, I'd suggest holding onto
your phone for another year and saving yourself some cash.
While the iPhone was the main event, I'd say the Apple Watch Series
4 stole the show, becoming a medical device in its own right (see page
20). It includes an FDA-approved sensor that, according to a study conducted by Apple and Stanford University, is more than 98
percent accurate at detecting atrial fibrillation, an irregular heart rhythm associated with life-threatening conditions. The Series 4
also has a new safety feature that detects when a user falls and then calls 911 if it doesn't detect movement after a minute.
More than ever before, putting together this year's buyer's guide (see page 27) has been a group effort. Over the summer and
into the fall, everyone on our team has been testing out an assortment of iOS gadgets in real-life scenarios. I put true wireless
earbuds through their paces while jogging on nature trails, web writer Leanne installed a smart dog door at her farm (which she
programmed to keep her dogs in and her ducks out), and CEO David spent the summer turning his house into a bona fide smart
home. As our resident wallet case fan, COO Noah tested how long it took to draw a credit card from any case we threw his way.
For our speaker roundup, I discovered how much bass my neighbors can handle, and for our virtual reality article, our senior gear
editor Dig hand-picked the best headsets available for the iPhone. I feel confident that all this hands-on testing has resulted in a
buyer's guide that features our best product recommendations to date. Let us know what you think!
This issue features a lot more than gear recommendations. Our writers are constantly looking for ways to use their phones to
better their lives. In particular, our former web writer Conner Carey wrote a piece on entrepreneurial apps she's using to grow her
business consultancy as she travels the states in an RV with her mom and rescue dog (see page 74). And then there's Cielo de la
Paz, a contributor who has made a career out of creating professional-quality videos using the camera that's in all of our pockets.
In her article (see page 64), Cielo shares apps, gear, and advice that will allow you to create your own work of art, no DSLR camera or studio required. How empowering is that?
Editor in Chief
iPhone Life magazine, email@example.com


text:
Home Tags Hit
Tag: Hit
Train hits, kills man in Fayette County
A man has died after a train hit him Saturday morning near Waveland State Historic Site around the Fayette-Jessamine County line.
UPDATE: Coroner identifies pedestrian killed in McCreary County crash
Police in McCreary County say a man was killed late Sunday night after being hit by multiple vehicles.
Bridge closed after being hit by tractor trailer
A Laurel County bridge is closed after being hit by a tractor trailer, according to the Laurel County Sheriff's Office.
Man dies after being hit by vehicle
A man has died after being hit by a vehicle on Thursday night, according to the coroner's office.
Horse killed in overnight car crash
Police say a horse was killed after being hit by a car early Wednesday morning.
LPD: Driver charged with DUI after hitting pedestrian on Winchester Rd.
Lexington Police say a person was arrested after hitting a pedestrian on Winchester Road Wednesday evening.
Building damaged by vehicle in Lexington
LEXINGTON, Ky. (WTVQ) - A building in Lexington was damaged after an SUV hit it, according to police. They say it happened off of Cambridge...
Police search for suspect in overnight shooting on Laredo Drive
Police are searching for a suspect they say shot a home and two cars on Laredo Drive early Tuesday morning.
Father and son arrested together on unrelated charges in Lexington
Police say they arrested a man and his son Thursday, on unrelated charges.
Letcher County man in serious condition after being hit by train
The Letcher County Fire Department says a man is in serious condition this morning after being hit by a train just before midnight Thursday.
Pedestrian hit by car, seriously injured at New Circle and Russell Cave Road
Police are investigating a serious crash between a pedestrian and a car at New Circle Road and Russell Cave Road.
Woman suffers minor injuries after being hit by car
A woman suffered minor injuries Friday night after being hit by a car on Polo Club Lane, according to police.
LPD: Pedestrian hit by vehicle, suffers life-threatening injuries
Lexington Police say a pedestrian suffered life-threatening injuries after being hit by a vehicle Thursday night.
Ky. bill to protect drivers who accidentally hit protesters
A Republican lawmaker in Kentucky has filed legislation that would ban protesters from blocking the streets without a permit and shield drivers who unintentionally hit them from criminal and civil penalties.
UPDATE: Victim of deadly hit-and-run in Lexington identified
The Fayette County coroner identified a man who was killed in a hit-and-run accident Thursday night in Lexington.
LPD: Pedestrian hit by car; not seriously hurt
Lexington Police say a man was hit by a car at New Circle Road and Boardwalk shortly after 9:00 p.m. Tuesday.
KSP: 2 women watching eclipse hit by car, 1 dead
Authorities say two women watching the eclipse while standing on a sidewalk in Leslie County were struck by a car and one has died.
Police: Two separate shots fired calls are believed to be connected
Two separate shots fired calls are believed to be connected, according to police.
Police: 6-year-old struck by car dies in Kentucky
Police in Kentucky say a 6-year-old who was struck by a car while riding a bike has died.
Man hit, killed by train in Kentucky
A man struck by a train in Kentucky has died.


text:
If diet and exercise didn't help you get rid of belly fat tissue, fitness experts have found a solution which, according to them, can replace 1,000 crunches. This incredible exercise called "plank" is static and uses body weight, which needs to be maintained in "plank position". The difficulty comes from the fact that you should't move even one centimeter. This …Read More »
Flour and honey mask for blackheads
Nose is one of the areas were blackheads occur most frequently. It's much easier to prevent their appearance than to eliminate them. Use masks specially designed for this type of skin problem. Apply them to your clean face because they can penetrate the pores, then remove the mask by washing your face with warm water. This will remove nose fat. …Read More »
How to treat acne and wrinkles with coconut oil
Because of its antibacterial quality, coconut oil can be used by people suffering from acne. Specifically, lauric acid found in this oil is a powerful antimicrobial which fights bacteria that cause pore infection. Moreover, people who aren't experiencing this issue can use it because it contains a significant amount of vitamin E, which moisturizes the skin. Coconut oil can be …Read More »
How to repair damaged or curly hair
If you dye your hair too often or you use styling products daily, your hair surely will reach the point when it will break easily. The solution is moderation, but also a treatment that will help your hair. Moisturizing mask Buy a quality moisturizing mask and apply it on your hair once or twice a week, depending on how dry …Read More »
How to get rid of gastritis crisis in a few minutes
Gastritis, gastroesophageal reflux and increased stomach acidity can make our life a living hell. Unbearable pain, heartburn and bloating, nausea and other digestive symptoms, all of these diseases can be reduced. See how to quickly get rid of a gastritis crisis with natural remedies. Coconut Coconut milk and coconut pulp generally helps soothe the upset stomach and reduce the burning …Read More »
What your standing position says about your health
Almost a quarter of the women in the world suffer daily because of back pain. Your standing position practically can prevent this nagging problem. A recent study teaches women what standing position to adapt on the street in order to avoid this discomfort. There are four categories: spoon, bridge, leaning tower and straight back. In other words, the researchers explained …Read More »
Homemade anti-aging face mask
Skin aging is an inevitable process, but it can be slowed by a balanced lifestyle and by appealing to natural allies. Four ingredients are needed for the best anti-aging mask based on natural ingredients. You need: – 1 egg white – 1 tablespoon of lemon juice – 1 tablespoon of natural honey – 2 tablespoons of yogurt Direction: Mix the …Read More »
Best natural cure to detox your liver
Raisins are among the most effective ingredients for cleansing the liver. See how to use them to get rid of toxins in 4 weeks. The liver performs many functions, like digestion and cleaning the blood of toxins and impurities. From time to time a detoxification cure with raisins it's indicated. For this treatment to be effective, you must know how …Read More »
How to treat painful varicose veins
If you have varicose veins you're already familiar with the terrible pain caused by peripheral circulation failure. See what natural remedies for varicose veins are available for you. Cypress oil Although little is known about its benefits, cypress oil can do wonders if you massage the varicose veins. It has anti-inflammatory effects, improves venous circulation and reduces swelling. Rosemary mint …Read More »
Baking soda – Best natural treatment for blackheads
Unsightly acne and blackheads can take you from being a diva to disaster in an instant. Stop spending money on acne products that can aggravate your skin. Instead, look for a natural solution for these skin problems: baking soda. This is one of the better kept natural beauty secrets and acts as a natural scrub to smooth and polish your …Read More »
What happens to your body if you eat 2 bananas every day
Because we are always busy, we can count on the fingers the days when we really eat something healthy, so we always feel the improper diet side effects: fatigue, stress, stomach pain, heart disease, cancer, diabetes and eating disorders. However, there is a way we can get our daily vitamins and minerals without making too much effort. Eating two bananas …Read More »
How to cure thrush (candidiasis) fast and naturally
Candidiasis is one of the most common diseases and is not easily treated. Recent research has shown, however, that can be eradicated in just 8 seconds. Learn how. Studies have shown that royal jelly can destroy candidiasis in just eight seconds. If you have this fungal infection, it is recommended to take 1 g of vitamin C and royal jelly …Read More »
How to rid your joints of uric acid
Uric acid is a substance resulting from the degradation of nucleic acids, and when is in excess, it deposits in the joints and develops gout. See how you can decrease acid uric level. Cucumber juice lowers body temperature, is alkaline and helps remove uric acid in the joints. If you suffer from gout, a detoxification treatment based on cucumber, ginger …Read More »
How to heal your wounds with sugar
Sugar is not as bad as you think. Recent research has shown that it may be used to treat open wounds. See what you must do this. A study by researchers at the University of Wolverhampton has shown that refined sugar is more effective than antibiotics in treating open wounds. This ingredient absorbs fluids from the wound (necessary for bacterial …Read More »
How to reduce cholesterol level with strawberries
Strawberries help to lower cholesterol levels and reduce the risk of heart disease, whether fresh or frozen. See how it works. Strawberries help lower your cholesterol if you include them in your daily diet, according to recent studies. These fruits contain a substantial amount of flavonoids, substances which improve the functions of blood vessels cells. The researchers found that 500 …Read More »


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text:
Two short comments to Andrew:
Isn't capitalism around partly because nobody's figured out a viable
alternative way to organize social production?
I agree about the sterility of the "Fundamental Theorem" point of view.
But the idea that embodied labor coefficients have something to do with
relative prices is still very attractive to a lot of people. I hope the
90s discussion of value does not lead in another "esoteric" direction,


text:
Using a dedication to good quality and protection, all Irie solutions are 3rd get together tested for contaminants and cannabinoid concentrations. Too, all Irie goods are manufactured fresh new on desire, so they do not bottle up one thousand bottles that then sit within a warehouse somewhere for months.
cannabis topicals Never enter the blood stream! These are as named TOPICALS! You must ingest or smoke cannabis to obtain it in your blood stream.
By age five she was suffering from virtually three hundred seizures per week as a consequence of a unusual kind of epilepsy referred to as Dravet Syndrome.
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The first big chill of winter has arrived and with the cold snap has come a flurry of sales as cold Bay of Plenty residents ready themselves for winter.
Temperatures as low as 3.6C were recorded in Tauranga this week and retailers have seen sharp spikes in the sale of heaters, electric blankets and other winter items.
A polar blast hit the country late last week, sending the country scrambling to keep the cold at bay.
Mitre 10 Te Puke owner Berwyn Fergusson said heaters, electric blankets, firewood and kindling had been flying off the shelves.
"Small heaters tend to go first and as it gets colder, people start looking at getting larger sizes," she said.
Fergusson said the store also had electric blankets in stock, which had been selling well.
Paul Wilkey, owner of Tauranga Firewood, said the phone had been ringing more since temperatures had dropped.
Wilkey said the company supplied wood to customers all year round so orders had been steady and he was yet to run out of wood.
Trade Me spokeswoman Millie Silvester said 115,000 searches for heaters were made on online auction site Trade Me last week.
These searches were up 50 per cent on the same time last month, making up nearly half of all searches for heaters in May.
"We've seen a staggering number of searches for heaters, merino clothing and electric blankets," Silvester said.
Searches for electric blankets hit nearly 10,000 in the past week, up 27 per cent on the same time last year, 41,000 searches were made for dehumidifiers and 51,000 for merino clothing.
At The Warehouse, trends were the same.
Merchandise manager Jenny Epke said the cold blast has seen winter trading surge in the past week where electric blanket sales rose 132 per cent.
"'Heaters' was the top-searched term on thewarehouse.co.nz and store sales of electric heaters were up 126 per cent," Epke said.
Sales of children's puffer jackets doubled and umbrella sales rose 72 per cent.
Men's and women's merino knitwear sales were up 39 per cent on the same time last year.
Epke said she had also noticed an increase in sales of DVDs, toys, blankets and cushions, suggesting households were snuggling up with home entertainment for cold nights.
Countdown merchandise manager Steve Mills said sales for heaters, firelighters, hot-water bottles, blankets, thermal socks, slippers and hosiery had doubled in the past 10 days.
"As we get shorter days and much colder nights, we all want to stay home, keep warm and we start to crave comfort food.
"We've seen more Kiwis grabbing roasts for dinner, slow-cooked meats, winter vegetables and lots of soups."
- Additional reporting NZ Herald
Some of Trade Me's quirky listings to keep warm this winter:
• A USB cup warmer to plug into your computer, keeping your cup of tea warmer for longer.
• Unicorn heated slippers which heat up when charged at a USB port.
• A heated throw rug, for those who feel too fancy for an ordinary electric blanket.
• Toe warmers for sticking to each individual toe, warming them for up to five hours.


text:
Teeth Whitening in Campbelltown: Benefits
How many times have you been talking to someone and wonder how they keep their teeth looking white and healthy? You might conclude that it is the result of excellent oral hygiene, flossing and twice a day brushing. If that is the case, why don't your teeth look as good as theirs do? Perhaps they avoid drinking beverages such as tea, coffee, and red wine. Perhaps they don't smoke tobacco. There is no doubt that avoiding these things can help keep your teeth whiter, but avoidance is not the only way to have white, bright, teeth. Teeth whitening in Campbelltown, along with good oral hygiene, will give you white teeth, which means a brighter smile.
First impressions are important. There is nothing quite as bad as meeting someone for the first time, and you are embarrassed to return their smile, or you cover your mouth with your hand. There are many reasons why people have their teeth whitened. The most common reason is to improve their appearance. Having beautiful teeth improves a person's self-confidence as well as their business and social life. Many professions require a lovely smile. People in the public eye can improve their future job prospects when they look good. A large part of looking good is an award-winning smile. Your dentist can explain the options available for teeth whitening in Campbelltown.
There are options available for those who wish to whiten their teeth at home. There are whitening toothpaste, whitening strips or gels, and tray-based systems. Although home base systems work, the dentists at Marketfair Dental Care can do it faster and better. Professional teeth whitening uses a hydrogen peroxide solution that goes through porous tooth enamel and whitens the underlying dentin. Professional teeth whitening in Campbelltown can result in teeth eight shades whiter after just one visit to the dentist.


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