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Men's Clinic in Singapore (Caring & Treating Since 2005)
Testosterone Deficiency Syndrome
What is Testosterone Deficiency Syndrome?
Testosterone Deficiency Syndrome (also known as hypogonadism) is a condition that occurs in men as they advance in age. It is also often defined as the biochemical deficiency of testosterone and sperm production, both of which are the major function of the testes.
These abnormalities usually result from disease of the testes - primary hypogonadism, the disease of the pituitary or hypothalamus (glad in the brain) - secondary hypogonadism, or, more rarely, a defect in the ability to respond to testosterone
Need Male Doctors? Visit our Men's Clinics or drop us an email at email@example.com for an appointment with our doctor.
What are the Leading Symptom of Testosterone Deficiency Syndrome?
The leading symptom experienced by men is the loss of Libido. Other sexually related symptoms also include difficulty in initiating or maintaining an erection. Furthermore, low testosterone levels also cause depression and obesity resulting in the worsening of metabolic disease.
However, the manifestations of testosterone deficiency can be nonspecific and variable in severity and onset.
Do I have Testosterone Deficiency?
ADAM Questionnaire about Symptoms of Low Testosterone (Androgen Deficiency in Aging Male)
Take this simple questionnaire to determine whether you may have a deficiency or not
ADAM Questionnaire about Symptoms of Low Testosterone (Androgen Deficiency in Aging Male)
|1.) Do you have a decrease in libido (sex drive)?
|2.) Do you have a lack of energy?
|3.) Do you have a decrease in strength and/or enduance?
|4.) Have you lost height?
|5.) Have you noticed a decreased "enjoyment of life"
|6.) Are you sad and/or grumpy?
|7.) Are your erections less strong?
|8.) Have you noticed a recent deterioration in your ability to play sports?
|9.) Are you falling asleep after dinner?
|10.) Has there been a recent deterioration in your work performance?
If you Anser "Yes" to number 1 or 7, or if you answer "Yes" to more than 3 questions, you may have low Testosterone.
However, there are a host of other medical conditions which can also mimic testosterone deficiency syndrome.
These are summarized in the following table:
|Type 2 Diabetes
|Metabolic Syndrome
|End Stage renal disease
|HIV weight loss
|COPD (lung disease)
|Opiod, Glucocorticoid
|Alcohol or Drug abuse
|Liver disease
|Brain tumour or trauma
(iron accumulation in liver)
|Testes cancer treatment
Doctor how then do we diagnose testosterone deficiency (TDS)?
Ruling out the above conditions through a detailed series of questions and tests, we would then measure your testosterone levels in the morning between 7am and 11am, or within 3 hours of waking.
As a guide, if total testosterone levels are normal (greater than 12), you would then, not be diagnosed with (TDS). If the values are borderline below 12, a repeat testosterone level can be performed for confirmation. However, this numbers serve as a guide and should still be explored as a whole with our doctors given your clinical contextand symptoms experienced. If your total testosterone values fall below 12, further comprehensive tests would also be undertaken
These include FSH, TSH, LH, Prolactin– (hormones produced by the pituitary gland), a complete blood count, SHBG, cFT or cBAT, Ferritin (iron capacity in the blood), PSA (prostate specific antigen) for prostate disease.
Depending on the results of the comprehensive tests, one would then be given a diagnosis of primary hypogonadism or secondary hypogonadism
Primary Hypogonadism:
- Low testosterone + High LH/FSH
- More likely associated with decrease in sperm production than testosterone production
- More likely associated with gynaecomastia (breast development)
- Due to congenital abnormalities, acquired disease OR idiopathic (unknown cause)
Secondary Hypogonadism
- Low testosterone + normal LH/FSH
Testosterone in the body is bound to carrier proteins (transport proteins that bind to other substances for transport through the blood around the body). These carrier proteins are sex hormone binding globulin (SHBG) and albumin.
44% of testosterone in the blood binds tightly to SHBG. This proportion of testosterone cannot bind to cells in the body which use testosterone and is known as unavailable testosterone, as it is unavailable to the body's cells.
Further 54% of testosterone in the blood binds loosely to albumin, but remains available to the body's cells. This is also known as calculated bio-available testosterone (cBAT).
The remaining 2% of testosterone in the blood remains unbound and is also available to testosterone-using cells in the body. It is referred to as calculated free testosterone (cFT).
Testosterone levels can be measured in terms of total, bio-available or free testosterone and there are various tests which can be used to measure levels of each type of testosterone.
What do I do after my diagnosis?
Are there any Follow up
Whilst low testosterone could be the reason behind the symptoms you experience, there are also many other medical reasons which could contribute to your symptoms.
It will be important for us to care for you holistically and uncover any other conditions which may mimic the symptoms you experience with low testosterone.
Subsequently, you could explore with our team of doctors the possibility of Testosterone Replacement Therapy
Speak to our Male Doctor Today!
Men's Clinic Branches
If you are experiencing any symptoms, or have any concerns or questions about Andropause,
please call or visit any of our Men's Health Clinics or drop us an email at email@example.com for an appointment.


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A detailed monograph on physiology, normal values, pathological findings, applications in surgery and anesthesia, with extensive discussion of methods and technical problems. References; reference tables in an appendix; subject index.
Recommended for hospital libraries.
Blood Volume and Extracellular Fluid Volume.. Ann Intern Med. 1972;76:533. doi: https://doi.org/10.7326/0003-4819-76-3-533_6
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© 2019
Published: Ann Intern Med. 1972;76(3):533.
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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Search intelligence breaks new ground for organisations
ECMPlus – by Paul Quigley — Transinsight has released the latest version of Enterprise Semantic Intelligence solution.
According to the company Transinsight's Enterprise Semantic Intelligence Knowledge Suite offers semantic technologies that take the search process to new levels of efficiency.
- "Over the last year we developed a new and highly scalable system comprising the latest algorithms. We made significant investments to be able to provide our clients with true innovations in the area of enterprise wide large scale information handling," said Dr. Michael R. Alvers, CEO of Transinsight.
The new version of Enterprise Semantic Intelligence Knowledge Suite contains about 100 custom relevant improvements. The system can now deal with more than 100 million documents and vast background knowledge bases for several million concepts. An improved semi-automated knowledgebase generation is now available to customers that do not have their own ontologies or taxonomies available as background knowledge. Novel algorithms allow untrained users to develop ontologies in practically no time. Users are supported in the generation of terms, definitions, abbreviations, synonyms and relationships to other terms. The algorithms are thoroughly validated against manually developed ontologies and
achieve an agreement of 82% (fully automated.


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Is summer the best time to visit Vietnam?
A huge country of almost 3,000 miles long (+4,500km), Vietnam's various regions experience different climates and weather conditions throughout the year. Since summer is the season when many people have time off from work, school or life in general, we explore Vietnam in the summer to see if it's the best time to visit Vietnam for you.
Many locals describe Vietnam's summer as being between May and October, when the temperatures are higher throughout the country. Since summer is officially between June and August, here we take an in-depth look across the country during these months so you know what to expect with the weather.
During June, most central and northern parts of Vietnam are experiencing balmy sunny days with temperatures averaging around 30°C. This means visiting the beaches and walking around the hubs of Hoi An, Danang, Hue and Nha Trang is a pleasant experience in the sunshine. It also means trips on traditional boats in Halong Bay – the emerald-watered UNESCO World Heritage Site – are perfect at this time of year, with plenty of opportunities to cool off in the water.
Some parts of central and northern Vietnam experience an increasing amount of rainfall as the month goes on – such as Dalat and the mountains near the China and Laos borders. The temperatures are so warm that it's the kind of rain that clears the air, but you should remember to bring a waterproof jacket! In southern Vietnam, June is the wet season, but downpours tend to be short and sharp, while the temperatures still average 28°C.
In July, the region between Danang and Nha Trang is the best place to visit if you like the sun hot and the rain infrequent. Temperatures in these regions average 31°C around this time of year, with only the occasional rain shower bringing some cooling relief. This is a great time to visit the beaches of these localities. Hanoi, Halong Bay and Sapa further north are also very warm around now, but prone to a little more rainfall, so it's a good idea to mix in visits here with trips to the drier central region. Ho Chi Minh City and the Mekong Delta in the south also experience rainfall during July, but this is mixed in with a lot of sun too.
In August, beach lovers flock to the coastline around Hoi An, Danang and Nha Trang for great temperatures of around 30°C and the inviting waters of the South China Sea. The central region experiences the warmest and driest conditions of the country during August, so taking the opportunity to visit Hue, the Ba Be National Park and Hoi An is a great idea. The northern and southern regions of Vietnam also experience hot days, but have more rainfall at this time of year. August is also the month locals celebrate the Ghost Festival – perfect for those who want to get involved in a typical Vietnamese tradition.
If you think summer is the best month to visit Vietnam for you,
Mr Linh's Adventures summer idyll experience
will take you on Vietnam's best bits for June, July and August.
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Planning Ahead: What Is the Best Time of Year to Visit Vietnam?
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Ref. number: PH5018
Stunning a-line dress with lace applique overlay. A flattering v-neck leads the eye to the simplicity of this classis cut. A corset back and cathedral train completes this timelessly elegant dress.
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Hotline: Monday-Thursday 10 AM thru 4 PM & Friday 10 AM thru 1 PM +49228/9658505
Ally 18 DR
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This big canoe has the same shape as 15´ DR and 16.5´ DR. With a length of 18 feet, this canoe has a wide and long, flat bottom and tumblehome shape. This makes it exceptionally stable, highly buoyant at the bow and it features a very high load capacity. ALLY 18' DR is mainly a canoe for those who need to carry a lot of gear, in a stable boat. It easily carries 3-4 adults with baggage. ALLY 18' DR is mainly a canoe for flat waters, but its construction makes it suitable on rivers with moderate technical difficulties.
|21000 g
|550 cm
|96 cm
|Width, gunwale:
|93 cm
|Width, waterline:
|86 cm
|36 cm
|Height, bow:
|47 cm
|415 kg
|Packed dimensions (HxWxD):
|112x42x50 cm
The Ally folding canoe is delivered disassembled.
|For this canoe the following is included:
1 skin, 1 mat, 2 seats, 2 stems (bow & stern), 1 keel rod, 2 gunwale rods, 3 double chine rods, 9 cross ribs, 2 straps (short & long), 1 mallet, 1 repair kit
We are happy to inform you about a price change of this product respectively when it hits the price you want to purchase.
Andre Schwickert
Auguststr. 10 | 53229 Bonn | Germany
fon +49(0)228/96586-05
Hotline: Monday-Thursday 10 AM thru 4 PM & Friday 10 AM thru 1 PM +49228/9658505


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They sit almost as far west as you can go without hitting America; a cluster of islands with white sandy beaches, tiny crofts and a lot of sheep.
Occasionally the Screen Machine rolls in, a mobile cinema that consists of a screen tucked inside the back of a lorry. Sometimes the internet connection is good enough to stream some music on Spotify.
Uist's population of just over 1200 is not quite Rhode Island, where 28-year-old Liam Crouse grew up and where the locals number over one million. And yet it's where he's decided to set up home.
READ MORE: Daily newspapers to be available on Uists thanks to new early flights from mainland
"I suppose I'm a bit of an oddity, I have no family connection here," he says. "My friends on mainland and back home do ask why I'm out here.
"You can't watch YouTube because it drains the internet, I can't Skype my parents back home in Rhode Island. But you get acclimatised.
"It's like 'Oh well, I'll not be watching Netflix, so I might as well go and speak to the neighbours'."
Crouse, despite a distinct lack of Scottish blood, has spent three years living in South Uist pursuing his love of Gaelic and his passion for Scots culture. His girlfriend, Emma Axelsson, 23, is originally from Sweden. Like him, she's chosen to make a life on a remote island almost in the middle of nowhere.
They're not alone. According to new research, the cluster of islands that make up Uist in the Outer Hebrides appears to be attracting a new generation of young people, keen to lay down roots in communities which, while hardly bereft of the luxuries of modern life, are still a giant leap away from the hub of the cities and university life they've left behind.
READ MORE: Daily newspapers to be available on Uists thanks to new early flights from mainland
Research carried out by the community has shown that the islands that make up Uist seem to be bucking the long-term depopulation trend, with a rise in the birth-rate – it's said to have jumped by 67 per cent compared to a decade ago – and an increase in the number of young people opting to either return to the islands where they were raised or arriving to make them their home.
It found that of 469 young people surveyed, most of them in their 20s and 30s, half are either newcomers to the islands or 'returners', with 253 children between them.
According to one of the researchers, Theona Morrison, the findings help to dispel popular images of the Outer Hebrides struggling to retain and attract young people.
"It's a combination of things," she says. "People come for the Gaelic language, for the different kinds of jobs, perhaps their partner is a returner, there are many reasons.
"But it's a fallacy to suggest they come here for a slow pace of life – everyone here is very busy, but in a different way."
READ MORE: Daily newspapers to be available on Uists thanks to new early flights from mainland
Gemma Steel, 26, is a 'returner'. Born and brought up in South Uist, she originally couldn't wait to escape the small island community. Ten years later, and she can't imagine living anywhere else.
"I finished high school wanted to get as far away from here as possible. I wanted to see the big bad world," she says. "I went to Kenya to work with orphaned children and then to Glasgow, to study occupational therapy.
"After seven years, I was desperate to come home. "
Today she is planning her October wedding to partner Shaun MacKinnon, 30, who grew up on Benbecula and is also back after living on the mainland.
"There's a safe feeling here that you don't get elsewhere," she says. "You can't get takeaways and cinema all the time, so when you do have them, they're more enjoyable.
"There's a modest way about the people here, there's less pressure."
Hazel Smith, 32, grew up in Sheffield and arrived in Uist in 2012 to carry out a socio-economic study of crofting for her MSc. These days she is the mill manager at Uist Mill, where wool purchased directly from farmers and crofters is spun for yarn and textiles.
"I grew up in a village where you said 'hello' to people on the street. Everyone knew who you were.
"It felt like that when I got here," she explains. "There's something about the ruggedness and the laid-back lifestyle and the friendliness that took me in.
"It's the drama of the place, it's exciting. The weather is not that wet, dreich kind, it's dramatic. It can be extremely dark and wild. You have to make plans if you want to go anywhere and winters can be long and tough and dark."
READ MORE: Daily newspapers to be available on Uists thanks to new early flights from mainland
According to the research, young people are changing the Uist communities. Mother and toddler groups are thriving; the new school on North Uist, built for 70 pupils, now has nearly 90 while the two children on Locheport on North Uist now have nine new playmates.
The survey also found at least one in ten of the young people surveyed have set up their own businesses, from beauticians to architects, photography and even a planned distillery. One who set up a new dog parlour business found herself juggling more than 300 dogs on her books.
Eilidh Murray, 38, runs the Westford Inn with husband Colin, 45, and their young son Straun, three. She returned to the island after 14 years of working for Lloyds in Glasgow. Today the pub has become the heart of a vibrant young community, with regular music, clubs and events aimed at a younger generation.
"We wanted to re-establish the pub, we have knitting groups, we sell fishing permits, we have meetings here, quizzes, music nights," she says.
"I grew up spending lots of time surfing, boogie boarding and talking with friends around bonfires. Helping with the crofts, thrashing and bailing. It's different life from Glasgow, and totally different pace of life."
Amid the upbeat talk, researchers fear that a blinkered view of the age span within island communities is skewing the kind of services available – there is already a long running argument over health and dental services for some areas.
READ MORE: Daily newspapers to be available on Uists thanks to new early flights from mainland
Meanwhile Crouse, who works for Ceòlas Uibhist, as Gaelic media and communications officer, admits some will always struggle to see why a younger person would opt for such a remote life.
"There's an anecdote about the poet Duncan Ban MacIntyre," he says. "He wrote a love song to his wife, and one guy who had heard it stopped him and his wife in the street.
"He said 'She's not as pretty as you say'. MacIntyre replied: "Ah, but you've not seen her with my eyes'."


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Political and Statistical Account of the British Settlements in the Straits of Malacca: Viz. Pinang, Malacca, and Singapore, with a History of the Malayan States on the Peninsula of Malacca, 2권
J. Murray, 1839
다른 사람들의 의견 - 서평 쓰기
서평을 찾을 수 없습니다.
기타 출판본 - 모두 보기
자주 나오는 단어 및 구문
according Adat Alkamah Allah Ampat Sukus ancient animal Arabic Bandahara Battu Benua Besar Bodoanda borrowed boundary British buffalo Bugis Bukit Calang called campong chief Chinese coast damask Dattu death Dutch Eang-depertuan English forest four gold Government Governor Hamzah Hindoo houses Hukum India inhabitants interior island Jakuns Jellabu Johole Johore Jompole Kemaman killed king Koran kris land latter Maharaja Mahmud Mahomed Malacca Malayan Malays mantri Menangkabowe ment miles Mohammedan Mount Ophir mountains Muar Muar river Muda Naning native observed offender owner paha Pahang Panghulu Panghulu and Ampat Pantun parties Patani Peninsula Perak person piculs Pinang prince Pulo Quedah Rajah ratans Rhio rice Rumbowe Rumbownese Salangore Segamet Semang Shah Siam Siamese Singapore slave sovereign Spanish dollars Srimenanti Sultan Sultan of Johore Sultan of Malacca Sumatra Sungie Sungie-ujong tahil termed territory tion treaty trees tribes Tringanu Tuah Tuanku Tumungong vessels village wood
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255 페이지 - If an ox gore a man or a woman, that they die : then the ox shall be surely stoned, and his flesh shall not be eaten ; but the owner of the ox shall be quit.
264 페이지 - If a man shall deliver unto his neighbour money or stuff to keep, and it be stolen out of the man's house; if the thief be found, let him pay double.
462 페이지 - ... and the type of security that will be furnished. The following statement must be incorporated in the letter of application: This bank agrees that if designated a depositary, it will comply with the regulations of the Department of the Interior governing the deposit of Indian funds in banks and with such instructions as may from time to time be issued by the Commissioner of Indian Affairs.
265 페이지 - For all manner of trespass, whether it be for ox, for ass, for sheep, for raiment, or for any manner of lost thing, which another challengeth to be his, the cause of both parties shall come before the judges; and whom the judges shall condemn, he shall pay double unto his neighbour.
233 페이지 - God hath forbidden you to slay, unless for a just cause; and whosoever shall be slain unjustly, we have given his heir power to demand satisfaction; but let him not exceed the bounds of moderation in putting to death the murderer in too cruel a manner, or by revenging his friend's blood on any other than the person who killed him; since he is assisted by this law.
249 페이지 - The family which has omitted prescribed acts of religion; that which has produced no male children; that, in which the Veda has not been read; that, which has thick hair on the body; and those, which have been subject to hemorrhoids, to phthisis, to dyspepsia, to epilepsy, to leprosy, and to elephantiasis.
446 페이지 - The Siamese desiring to go to an English country, or the English desiring to go to a Siamese country, must conform to the customs of the place or country on either side ; should they be ignorant of the customs the Siamese or English officers must explain them. Siamese subjects who visit an English country must conduct themselves according to the established laws of the English country in every particular.
289 페이지 - But as to those who accuse women of reputation of whoredom and produce not four witnesses of the fact, scourge them with fourscore stripes and receive not their testimony forever, for such are infamous prevaricators, excepting those who shall afterwards repent and amend, for unto such will God be gracious and merciful.
66 페이지 - Siam shall not go and obstruct or interrupt commerce in the states of Tringano and Calantan. English merchants and subjects shall have trade and intercourse in future with the same facility and freedom as they have heretofore had, and the English shall not go and molest, attack, or disturb those states upon any pretence whatever.
279 페이지 - And such of you as shall die and leave wives, ought to bequeath their wives a year's maintenance, without putting them out of their houses : but if they go out voluntarily, it shall be no crime in you, for that which they shall do with themselves, according to what shall be reasonable ; God is mighty and wise.


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The joint authors of Clean Breaks share the reasons why they have written this worldwide guide to holidays that are good for local people and the planet
Richard Hammond
Freelance Travel Journalist
Founder, GreenTraveller
Key "ecotourism" or "responsible travel" into an internet search engine and you're likely to find thousands of results, from remote ecolodges and luxury hotels to safari holidays and voluntourism. But how can you be sure that any are the genuine article? Similar search terms, such as "ethical" and "sustainable" are becoming just as overused (and abused) by tourism companies looking to cash in on the green wave. An increasing number of websites claim to point you in the right direction yet often these are merely portals to places that claim they are green; few websites have actually sent anyone to check. Travellers' feedback forums can be useful but you'll rarely find authoritative reviews on how green a place is. After all, who wants to spend their holidays sticking their noses into recycling bins or asking hotel managers about ethical procurement policies?
It was for this reason that I teamed up with Jeremy to write a guide to genuinely green holidays based on our experiences of what really works.
I first saw the benefits of genuine ecotourism while on a conservation volunteering holiday with Raleigh International to the Indian Ocean islands of Mauritius and Rodrigues in 1993. Since then I have visited and reported on hundreds of clean breaks for travel magazines and newspapers, principally as The Guardian's eco-travel correspondent and as the founder of GreenTraveller, an online guide to low-impact travel worldwide. So often the media coverage of ethical travel has concentrated on the negative impacts of tourism, but while it is important to highlight tourism's ills, I wanted to show how travellers can continue to see the world in a way that has less of an impact on the environment and makes a genuine difference to destinations – in terms of conservation and by putting money into local economies.
Most importantly, I wanted to show how easy it can be to go green, and that it doesn't necessarily mean travellers have to sacrifice on notions of comfort or adventure. We have also included numerous experiences that focus on the unique of the destination – staying in family-run hotels, visiting local markets and festivals, and hiring local guides so that your tourism dollars benefit the destination. We've taken the train from London to Vietnam, snow-shoed over the Pyrenees, learned natural horsemanship in Sweden, trekked with Amazonian tribes and monitored whales in the Bahamas.
We both feel that these kinds of trips make for better travel experiences. After all, the most inspiring person to take you on safari is likely to be a local guide whose ancestors have lived on the land for thousands of years; your dinner tends to be better when the cook has grown and harvested the ingredients; and the most suitable person to take you to meet remote tribes is someone who understands their cultures, speaks their languages and is committed to their welfare.
Finally, why call it Clean Breaks? Because we wanted to show that going green doesn't have to be a hard slog. It is simply a more progressive, more thoughtful way to travel. And best of all, it's fun!
Jeremy Smith
Freelance Writer
Former Editor, The Ecologist
After six years working behind a desk at The Ecologist, I was really keen to get out and see some of the world again. Richard was looking for someone to write a book with him that focused on genuinely green holidays, and I was keen to find out more about different forms of ecotourism, a topic we'd never really touched at The Ecologist, where we'd always focused rather on the negative impacts of tourism. Yet all my life I've loved travelling. So many of the most important moments in my life are connected with my experiences away from home. I was therefore desperately keen to see for myself if there really was such as thing as 'good tourism', if it was possible for me to have some amazing experiences and to do it in ways that were not just environmentally sustainable, but actually helped the local people and areas I went to in some way as well.
What I didn't want to do was lecture people about the issues. I hoped that if I could find some really inspiring people and places that were making a positive difference, and share these stories with a wider audience, then that might enable more people to get excited about taking these sort of holidays, and when they did they might find that not only did thy have a better time, they'd possibly find themselves more receptive to the underlying issues too.
Put it this way: what is going to bring home the importance of preserving local distinctiveness and biodiversity more? Is it reading an article I might write about destructive modern monocultural agricultural practices or going on holiday and spending a few days in a remote and unspoiled Romanian village, walking through wildflower-rich meadows that have never seen a pesticide and spending evenings sharing homemade cheeses, breads and meats and drinking wine and brandy below the vines from which they were pressed, all of it prepared by the very people sitting around the table with you?
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Update: ZoneAlarm's Anti-Spyware Is Free Today
This isn't the full ZoneAlarm Internet Security Suite, but it does include the super-powered OSFirewall along with spyware detection and removal, spy site blocking, and a year of updates.
Late Tuesday, Check Point said that, due to overloaded servers, the company is extending the offer until 5 PM PDT on Wednesday.
Why this "Crazy Eddie" deal? Check Point wants to call attention to the fact that it's Patch Tuesday today. Be sure to accept all security updates, and on top of that protection grab your bonus gift from Check Point. To get your free ZoneAlarm Anti-Spyware go to www.zonealarm.com/patchtuesday before 7 AM PST on November 14th. While you're at it, consider grabbing a free copy of the ZoneAlarm ForceField beta for added protection.
Editor's Note: This story was updated at 3:20 PM on Tuesday, Nov. 13 with additional details from Check Point.


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Metabolic syndrome criteria as predictors of subclinical atherosclerosis based on the coronary calcium score
Article information
The aim was to determine which of three sets of metabolic syndrome (MetS) criteria (International Diabetes Federation [IDF], National Cholesterol Education Program Adult Treatment Panel III [ATP III], and European Group for the Study of Insulin Resistance [EGIR]) best predicts the coronary artery calcification (CAC) score in a cross-sectional study. This has not been evaluated in previous studies.
A total of 24,060 subjects were screened for CAC by multi-detector computed tomography. The presence of CAC was defined as a CAC score > 0. The odds ratio for the presence of CAC was analyzed for three different sets of MetS criteria and according to number of MetS components.
CAC was observed in 12.6% (3,037) of the subjects. Patients with MetS, as defined by the IDF, ATP III, and EGIR criteria, had a CAC rate of 23.0%, 25.1%, and 29.5%, respectively (p < 0.001). Comparisons of C statistics for multivariate regression models revealed no significant difference among the three sets of criteria. After adjustment for risk factors, the ATP III criteria produced a slightly higher odds ratio for CAC compared with the other criteria, but this difference was not significant. The risk factor-adjusted odds ratio for the presence of CAC increased from 1 to 1.679 as the number of MetS components defined by ATP III increased from 0 to ≥ 3 (p for trend < 0.001).
The presence of MetS was associated with the presence of CAC. There was no significant difference among the three sets of MetS criteria in terms of the ability to predict CAC. An increase in the number of MetS components was associated with an increased odds of CAC.
Metabolic syndrome (MetS), as characterized by insulin resistance (IR), has recently gained considerable attention due to the link among metabolic diseases, obesity, and cardiovascular disease [1]. Many international organizations and expert groups have attempted to define MetS, and several different definitions exist [2,3]. Kim and Kim [4] used data from KNHANES to show that that prevalence of MetS varied greatly depending on the definition used.
Coronary artery calcification (CAC) can predict the risk of cardiovascular events [5]. Previous studies reported that the total amount of coronary calcium (usually expressed as the Agatston score) can predict coronary artery disease beyond the standard risk factors [6]. Patients with MetS have a high risk of CAC [7,8]. MetS, as defined by the National Cholesterol Education Program Adult Treatment Panel III (ATP III), was also independently associated with CAC in type 2 diabetes mellitus [7]. Furthermore, the Multiple Ethnic Study of Atherosclerosis showed that IR, as defined by the homeostasis model assessment of insulin resistance (HOMA-IR), can predict CAC incidence and progression [9].
Despite the clear association between MetS and CAC, it is not clear which MetS criteria best predict CAC. This study examined CAC predictability and prevalence according to three commonly used sets of MetS criteria. Similar analyses were also performed according to the number of MetS components.
Study population
This cross-sectional study analyzed 24,062 subjects screened for CAC in an annual health check-up at the Heath Screening Center of Kangbuk Samsung Hospital from 2010 to 2011. Subjects underwent cardiac multi-detector computed tomography (MDCT) estimation of the CAC score (CACS) using identical equipment and standardized protocols. Of the 24,062 subjects, two were excluded for missing waist circumference (WC) data, leaving 24,060 eligible subjects.
Informed consent was obtained from all participants. The study design and protocol were approved by the Institutional Review Board (IRB) of Kangbuk Samsung Hospital and are in accordance with the 1975 Declaration of Helsinki. After the IRB approved this study, specific datasets were released by the data management group of the Kangbuk Samsung Health Study after deletion of participants' personal information.
Clinical and laboratory measurements
Anthropometric measurements included body weight, height, body mass index (BMI), WC, and systolic and diastolic blood pressure. BMI was calculated as weight in kilograms divided by height in meters squared (kg/m2). WC was measured in a standing position, at the midpoint between the anterior iliac crest and lower border of the last palpable rib, by a single examiner. Blood pressure was measured twice by a skilled nurse following at least 10 minutes of rest, and the mean value was calculated and recorded. Subjects who reported that they smoked were classified as 'current smokers.' Regular exercise was assessed using a physician-administered questionnaire in which subjects were asked if they participated in regular exercise 'of moderate intensity at least three times a week.' The presence of diabetes mellitus was determined according to self-reported data by the participants and the diagnostic criteria of the American Diabetes Association [10]. The presence of hypertension was defined by criteria recommended by the eighth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High BP (JNC8) [11] (i.e., a blood pressure ≥ 140/90 mmHg) or current use of antihypertensive medication or as self-reported by participants. Blood samples were collected from the antecubital vein following a minimum 12-hour overnight fast. The samples were analyzed for blood lipid profiles, fasting blood glucose levels, serum insulin levels, and glycated hemoglobin (HbA1c). Biochemical markers were measured using Bayer Reagent Packs on an automated chemistry analyzer (ADVIA 1650 Autoanalyzer, Bayer HealthCare, Tarrytown, NY, USA). Fasting blood glucose levels were measured using the hexokinase method. Lipid profiles, including values for total cholesterol (TC), triglycerides (TGs), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C), were measured by enzymatic colorimetric assay. Serum insulin concentrations were measured by immunoradiometric assay using an INS-IRMA kit (BioSource, Nivelles, Belgium). As a marker of IR, the HOMA-IR was calculated using the following formula [12]: HOMA-IR = [fasting insulin (IU/mL) × fasting glucose (mmol/L)]/22.5.
HbA1c was measured by immunoturbidimetric assay using a Cobra Integra 800 automatic analyzer (Roche Diagnostics, Basel, Switzerland) with a reference value of 4.4% to 6.4%. The methodology was aligned using the standards of the Diabetes Control and Complications Trial and National Glycohemoglobin Standardization Program (NGSP). The intra-assay coefficient of variation (CV) was 2.3%, and the interassay CV was 2.4%. Both these values were within the NGSP acceptable limits [13].
Measurement of coronary artery calcium
Participants underwent CAC quantification by MDCT (GE Healthcare, Tokyo, Japan). The total CACS was determined by summing the individual scores for the four major epicardial coronary arteries. Total CACS was reported in Agatston units [14]. CAC was categorized as present (Agatston score > 0) or absent.
Diagnostic criteria for MetS
MetS was defined according to the International Diabetes Federation (IDF), Modified ATP III, and European Group for the Study of Insulin Resistance (EGIR) criteria. To define high WC, ethnicity-specific values were used: high WC was defined as ≥ 90 cm in men or ≥ 85 cm in women in all three sets of MetS criteria [15]. The criteria were as follows:
IDF criteria [16]: WC ≥ 90 cm in men or ≥ 85 cm in women [15] plus two or more of the following criteria: (1) TG level ≥ 150 mg/dL or current treatment for this lipid abnormality; (2) HDL-C level < 40 mg/dL in men or < 50 mg/dL in women or current treatment for this lipid abnormality; (3) blood pressure ≥ 130/85 mmHg or use of antihypertensive medication; and (4) fasting plasma glucose level ≥ 100 mg/dL.
Modified ATP III criteria [17]: three or more of the following components: (1) WC ≥ 90 cm in men or ≥ 85 cm in women [15]; (2) TG level ≥ 150 mg/dL; (3) HDL-C level < 40 mg/dL in men or < 50 mg/dL in women; (4) blood pressure ≥ 130/85 mmHg; and (5) fasting glucose level ≥ 100 mg/dL. Note that the 2002 definition defined elevated fasting glucose level as ≥ 6.1 mmol/L (110 mg/dL); in 2004 this was changed to ≥ 5.6 mmol/L (100 mg/dL) in accordance with the American Diabetes Association's updated definition of impaired fasting glucose [18].
EGIR criteria [19]: fasting hyperinsulinemia (highest 25%) and at least two of the following criteria: (1) fasting glucose level ≥ 6.1 mmol/L (110 mg/dL); (2) blood pressure ≥ 140/90 mmHg or treatment for hypertension; (3) TG level > 150 mg/dL or HDL-C level < 40 mg/dL or treatment for dyslipidemia; and (4) WC ≥ 90 cm in men or ≥ 85 cm in women [15].
Statistical analysis
Statistical analyses were performed using SPSS version 18.0 (IBM Co., Armonk, NY, USA). For continuous variables, data are reported as the median (interquartile range) or mean ± SD and were analyzed by independent t test. For categorical variables, data are reported as proportions and were analyzed using the chi-square test. CACS, fasting insulin, and serum TGs were log-transformed for analysis to correct for skewed distributions. For ease of interpretation, these values are expressed as untransformed data in the tables in this paper. The associations between CAC and MetS components and cardiovascular risk factors were examined by Spearman correlation.
C statistics, which are analogous to the area under the receiver operating characteristic curve, were calculated to compare the ability of different logistic models to discriminate between the three sets of criteria with and without CAC. The DeLong algorithm was used to determine statistical significance [20]. Adjusted odds ratios (ORs) with 95% confidence intervals were derived according to the three sets of MetS criteria and by the number of MetS components in multiple logistic regression models for CAC, to determine which MetS criteria best predict CAC. The p values <0.05 were considered statistically significant.
Table 1 shows the general characteristics of the subjects. A total of 24,060 subjects (19,721 males and 4,339 females; mean age, 41 years) were analyzed. The proportion of participants with a CACS > 0 was 12.6% (CACS = 0, n = 21,023; CACS > 0, n = 3,037). The average CACS for the 24,060 subjects was 7.95 ± 58.53. Subjects with CAC (CACS > 0) were older, predominantly male, more obese, and had higher TG levels and lower HDL-C levels. More of these patients had a history of diabetes and hypertension and higher rates of other MetS components.
For all sets of MetS criteria, the prevalence of MetS was significantly higher in participants with a CACS > 0 than in those with a CACS = 0. The prevalence of MetS in subjects with CACS > 0 was 23.0% for the IDF criteria, 25.1% for the ATP III criteria, and 29.5% for the EGIR criteria (Table 1).
Spearman correlations for factors related to MetS and CACS are shown in Table 2. CACS was positively correlated with age, sex, WC, BMI, and other MetS factors, with the exception of HDL-C.
To determine which set of MetS criteria best predicts CAC, ORs for the presence of CAC were calculated for the three sets of MetS criteria. MetS as defined by the IDF, ATP III, and EGIR criteria was associated with the presence of CAC (OR, 1.392 to 1.439; p < 0.001, presence versus absence of CAC) after adjustment for potential confounding factors (Table 3). C statistics for multivariate regression models were calculated to evaluate how well each definition predicts the risk of coronary artery disease. No significant differences were observed between the three sets of criteria (point estimates for C statistics = 0.788 to 0.789) (Table 3).
Next, the association between CAC and the number of MetS components was evaluated. As expected, the presence of CAC according to an increasing number of MetS components was attenuated in multivariable logistic regression analysis. The proportion of subjects with CAC increased (from 6.7% to 22.5%) as the number of MetS components increased from 0 to ≥ 3 (p for trend < 0.001). This significant predictive trend persisted after adjustment for age, sex hypertension, diabetes mellitus, smoking status, and exercise. The ORs for CAC increased with the number of MetS components at approximately the same rate for all three sets of MetS criteria (Table 4).
This study found that the risk of CAC increased 1.3- to 1.4-fold when subjects were diagnosed with MetS according to any of the three sets of criteria included in this study (IDF, ATP III, and EGIR). When a multivariate model was used to predict the presence of CAC, there were no differences in C statistics among the three sets of MetS criteria. The risk of CAC gradually increased according to the number of MetS components. Thus, a MetS diagnosis (defined by any of the aforementioned criteria) or a higher number of MetS components seems to increase the likelihood of CAC. This suggests that CAC should be considered in subjects with MetS or a high number of MetS components, and that preventive strategies may be needed to reduce the risk of cardiovascular disease.
This study analyzed and compared data from a large number of subjects to assess the ability of three sets of commonly used MetS criteria to predict CAC. Previous research analyzed the associations between a single MetS criterion and cardiovascular disease mortality [7,21,22,23]. Recent studies have shown that a variety of MetS definitions exist, and that they are all associated with subclinical atherosclerosis [7,24,25]. Mehta et al. [7] showed that ATP III-defined MetS was independently associated with CAC in type 2 diabetes mellitus. They also reported that the point estimate C statistic for the prediction of significant CAC was 0.67 [24].
This study adds to earlier research by Narla et al. [25] showing that the ORs for CACS > 0 for MetS (as defined by ATP III, American Heart Association/National Heart, Lung and Blood Institute, and IDF criteria) were 1.6 to 1.7 in 458 asymptomatic men, after adjustment for age, smoking status, and LDL-C. Compared with our study, the study by Narla et al. [25] was smaller (458 subjects) and included a higher number of obese subjects. In our large number of study subjects, we examined the risk for CAC and CAC prediction for three sets of MetS criteria (IDF, ATPII, and EGIR) using C statistics.
Simon et al. [26] conducted a meta-analysis and found that detection of subclinical arterial disease in asymptomatic individuals is a worthwhile screening test for predicting future cardiovascular events. A variety of inva sive and non-invasive techniques are available to measure subclinical atherosclerosis [27]. Among these techniques, MDCT garnered great interest because CT indicates the presence and extent of coronary atherosclerosis and can quantify the exact amount of calcification [28]. CAC can be used as a marker for coronary atherosclerosis [6,29]. In one study, CACS = 0 was associated with a very low risk of a coronary event, while an elevated CACS was associated with an increased risk [30]. Another study found that in patients with type 2 diabetes, CACS > 10 could predict cardiovascular events [31]. In the present study, CACS > 0 was used as an outcome variable to predict subclinical atherosclerosis as it relates to MetS defined by the three sets of criteria in a large number of subjects.
Despite advanced research, there are many uncertainties about the pathophysiology of the link between MetS and CAC [3]. IR appears to play a major role and increases the risk of coronary artery disease even in the absence of hyperglycemia [32]. Early in the course of IR, free fatty acid levels increase because of loss of the suppressive effects of insulin on lipolysis in adipocytes and increased very low density lipoprotein production and other metabolic abnormalities [33]. These changes have a proatherogenic effect on IR [33]. Moreover, Bornfeldt and Tabas [34] reported that IR can promote atherogenesis, from the early stages to advanced plaque progression. The mechanism may involve both systemic factors, such as dyslipidemia or hypertension, and the proinflammatory state. It has the effect of disturbing insulin signaling at the multi-cellular level of the vessel, including in endothelial cells, vascular smooth muscle cells, and macrophages [34]. Such a pathophysiologic aspect may explain the association between CAC and MetS in the present study.
There are several limitations to this study. First, microalbuminuria and oral glucose tolerance tests were not included in the analyses. Thus, it was not possible to analyze all currently available MetS criteria. Second, this study was cross-sectional, and therefore, it was impossible to determine a causal relationship between MetS and the development of subclinical coronary atherosclerosis. Third, the prevalence of MetS or its components and the range of coronary calcification varies by ethnicity, and thus data from our study may not be applicable to different ethnicities. Lastly, our study lacked information on drug use for diabetes, hypertension, and dyslipidemia. Despite the limitations, this study has many strengths and is unique in that it compared the associations between different sets of MetS criteria and CAC in a large number of subjects.
In conclusion, MetS was significantly associated with the presence of CAC. In addition, the three sets of criteria for MetS were all comparable with each other in terms of predicting CAC. Subjects with a higher number of MetS components have an increased risk of CAC. These findings suggest the need for measures to prevent cardiovascular disease in subjects with MetS or MetS components.
The presence of metabolic syndrome (MetS) was associated with the presence of coronary artery calcification (CAC).
There was no significant difference among the three sets of MetS criteria in terms of ability to predict CAC.
An increase in the number of MetS components is associated with an increased odds of CAC.
No potential conflict of interest relevant to this article was reported.


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Virtual Reality Video
Marketing our client's new mobile health clinics through state-of-the-art virtual reality video.
We've put a whole new perspective on medical marketing for one mobile health clinical thanks to our 3D 360 virtual reality video capabilities. Matrix Medical Network wanted to announce the launch of their new mobile health clinic fleet, the largest in the nation, which resulted from their acquisition of HealthFair. However, there was no physical way to bring the 40-foot "clinic on wheels" to this client's most important industry tradeshow—the RISE risk management conference.
Fortunately, Activate Health had an idea that would allow Matrix to make a splash at RISE and generate unprecedented excitement around the new mobile fleet. We developed a 2-minute virtual reality video that walks viewers through an entire mobile health clinic, including private laboratory and assessment rooms, a fully-stocked treatment room with ultrasound equipment, and a 9-person waiting room area complete with a pullout.
This virtual reality video detailed all of the ways that Matrix engages health plan members, while adding excitement and visual interest to their patient support and education processes. It walks viewers through each room, pointing out the sophisticated equipment and staff members involved in closing gaps in care and improving health outcomes.
This medical marketing video uses the latest in 3D stereoscopic virtual reality. What started with simple devices like Google Cardboard has now evolved into advanced gaming and video streaming systems like the Oculus Rift—creating a truly immersive experience for videos like these.
The interactive video was designed to promote the clinical best practices and advanced diagnostic capabilities that are all part of the Matrix mobile clinic experience. This approach allowed Activate Health to tout the value proposition of Matrix mobile medical clinics in a unique, unforgettable way.
Combining three-dimensional callouts, talent and voice over, this guided tour of a "mobile clinic on wheels" took viewers right into the action—andbrought traditional medical marketing videos into the 21st century.
Hundreds of conference attendees viewed the 3D medical marketing video, which will eventually be placed on the client's website to explain how their engagement model drives unsurpassed engagement levels. Incredibly, the entire video was completed—from script development to video shoot and post production—in just four weeks. Matrix also leveraged the video for numerous PR and social media opportunities, reaching healthcare organizations across the industry!
View Similar Projects
Tradeshow Booth
Healthcare Member Guide
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Ready to find out how Activate Health can deliver similar results for your organization? Contact us to learn more.


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Teams to Search Cambodia for Vietnam War MIAs
- Details
- Category: News
- Created: Friday, 04 February 2011 08:28
- Last Updated: Friday, 04 February 2011 08:28
- Written by Administrator
The deployment, expected to last about 40 days, marks the command's 44th joint field activity in Cambodia, officials said.
Recovery teams search for human remains, life-support items and other material evidence that may further the identification of Americans missing from past conflicts.
In addition to recovery efforts, U.S. and Cambodian personnel will participate in a medical engagement outreach event, treating 4,000 to 8,000 people in rural and highly underserved communities, officials said. The specialized 12-member team of experts in various medical specialties will provide basic health assistance, laboratory services and optometry examinations.
The U.S. medical team members are from Tripler Army Medical Center, the 18th Medical Command and the Joint POW/MIA Accounting Command. U.S. and Cambodian physicians will reinforce medical capabilities by participating in an information exchange, benefitting both countries educationally and socio-culturally, officials added.
"[Tripler] is sending physician residents from OB/GYN and family medicine to conduct expert exchanges with local physicians, and will be invited to work alongside the Khmer physicians and treat their patients," said Army Capt. Drew Webb, a Joint POW/MIA Accounting Command physician assistant.
This will be the first time a Tripler resident program has deployed to a foreign country on a humanitarian outreach mission, Webb added.
"The big takeaway for all of this is that the [Tripler] residents will get training and experience in such a unique environment," he said.
Joint POW/MIA Accounting Command is a jointly manned U.S. Pacific Command organization of more than 400 military and civilian specialists that has investigated and recovered missing Americans since the 1970s, officials said, noting that 1,702 Americans still are listed as missing in action from the Vietnam War.
*Related Sites:* Joint POW/MIA Accounting Command [ http://www.jpac.pacom.mil/ ] Teams to Search Cambodia for Vietnam War MIAs [ http://www.defense.gov/news/newsarticle.aspx?id=62694 ]


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The Challenge
- Infusion pumps commonly used for administering medication allow healthcare professionals to program upper and lower dosing limits to reduce human error. However, few organizations take advantage of this feature or have the right limits set; nearly all medications require multiple dosing entries for unique patient populations. With thousands of medications to be programmed, management was becoming overwhelming and extremely time consuming
- Software tools provided by pump manufacturers were poorly designed, lacked workflow and standards, relied on highly manual processes and required a substantial amount of training and retraining
- As a leading medical institution, the client had multiple pumps from different manufacturers with different administration and reporting interfaces


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Actual Property Investment
House improvement, by definition, is making modifications to at least one's dwelling by making improvements on the home's seems to be. House enchancment doesn't only mean repairing what is damaged; it also consists of including new issues to your private home. Kitchen is a good place to begin when contemplating a house improvement mission. Including area can also be part of dwelling improvement, since it improves the way your belongings and other issues inside the house are being arranged to make it extra comfy.
Usually instances, adding some minor electrical and lighting upgrades will help transform and modernize the whole effort. Typically I will ask them to make, along with the kitchen, a base cupboard for the bathroom to match, all for one low worth. The life expectancy of wood siding is diminished with exposure to moisture, so common painting or staining is required upkeep for longevity.
Some you will be able to sort out alone as a household project, but for some residence enhancements you will need the help of knowledgeable. You can even seal all the inside of your basement (partitions and floors) to prevent water from being wicked to the inside space.
The Tax Act states that where a repair is carried out in the same space of the home that's being reworked then the restore can be included as part of the transforming challenge. It should go without saying that home projects might be expensive, so you may be tempted to deal with them your self as a manner to economize.
Arts And Crafts
So many people choose to bear a one-time expense and install alternative power sources or add energy savers like cooling and insulated sealing to stop leakage of heat and cool air.
house home improvement, house doctor home improvements, house smart home improvements, House & Home Improvement, House & Home Improvement
Residence Improvement Budget
There many explanation why householders determine to undertake any house enchancment venture, and one is to spice up property value to be recouped with a closed sale. Spend time within the planning levels and you will be rewarded within the renovation stage. Wallpapering and painting walls or putting in wood paneling. Nearly all of home improvement remodeling initiatives require the use of power tools to get them accomplished right.
Keeping a upkeep schedule saves you of the headache, money and time from doing constant repairs. As I've mentioned in different articles and it's a basic to recollect, water is a home's greatest enemy, especially exterior roof runoff and drainage, together with siding, trim and maintaining it caulked and painted.
Trip Rentals
If you buy a home, you purchase it as is usually. While that could be a legitimate reason to transform, avoid basing your property improvement initiatives on speedy wants. These improvements add to the residing amenity of the home's owners and often add value to the home. Adding panels or changing the one that's already there may give the bathroom a more finished look.
Inside designing can do this by 'creating rooms' from the smallest of areas, accentuating each nook of the home, decorating the interiors with beautiful items of display, adding coloration, including appeal and essentially the most coveted issue – comfort. Planning to construct and paint such a timeless toy is feasible with the assistance of these kits.
house home improvement, house smart home improvements reviews, house home improvements
The method of spring usually encourages owners to begin contemplating house enhancements and repairs. Adding bathrooms and bedrooms to a property is a great place to begin to bettering your own home's overall worth. Bathroom is another prime space of the house relating to dwelling improvement. Some home enchancment ideas and recommendation are specially designed for these not so glamorous tasks; like unplugging drains, sewer lines or gutters.


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If you would like to be added to our distribution list for future media releases, please contact us.
Published on 31 July 2014
By CUAC
1452 downloads
Media release.pdf
A joint media release with Consumer Action Law Centre regarding the AEMC Rule Change
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1409 downloads
Press statement.pdf
Joint media release with Consumer Action Law Centre
Published on 25 June 2013
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1521 downloads
Revised water plan welcomed by Consumer Advocates - 250613.pdf
Joint media release with Consumer Action Law Centre regarding the ESC's final metropolitan water price decision.
Published on 23 April 2013
By CUAC
1469 downloads
Improved concessions and hardship programs will be the key if water price rises proceed.pdf
Published on 23 March 2012
By CUAC
1787 downloads
Consumer and welfare groups make eleventh hour bid to protect vulnerable Victorians - 21-312.pdf
Joint media release with Consumer Action Law Centre, Victorian Council of Social Service, Brotherhood of of St Laurence, Financial and Consumer Rights Council and St Vincent de Paul Society (Victoria)
Published on 20 January 2012
By CUAC
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12.01.20 Consumers the losers as competition tribunal sides with power companies - yet again - 200112.pdf
Published on 11 January 2012
By CUAC
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12.01.11 Appeals process favours energy industry Letter to the AFR.pdf
Letter from CUAC and the Consumer Action Law Centre to the Australian Financial Review on the merits review appeal process for energy distribution price determinations.
Published on 19 December 2011
By CUAC
1485 downloads
11 12 19 Performance report media release.pdf
Published on 14 December 2011
By CUAC
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2011_12_14 Smart meter decision.pdf
Published on 24 November 2011
By CUAC
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11 11 24 Media release EWOV Annual Report.pdf
Published on 12 October 2011
By CUAC
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2011_10_12 Rough waters ahead for consumers.pdf
Published on 04 October 2011
By CUAC
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Unpublished letter to The Age in response to smart meter article.pdf
Published on 12 September 2011
By CUAC
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2011-08-12 Media Release Merits review report.pdf
Published on 05 June 2011
By CUAC
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2011_06_05 Consumers not getting best deal from switching sites.pdf
Published on 18 January 2011
By CUAC
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2011_01_18 Consumer groups take on distributors to keep energy prices down.pdf
Published on 16 December 2010
By CUAC
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2010_12_16 Energy prices and disconnections up.pdf
Published on 14 December 2010
By CUAC
1141 downloads
2010_12_14 Low income water consumers doing it hard in rural and regional Victoria.pdf
Published on 10 March 2010
By CUAC
1122 downloads
2010_03_10 Consumers need clarity on smart meter roll out.pdf
Published on 30 October 2009
By CUAC
1237 downloads
2009_10_30 Regulator's report opens food to private operators in Victorian water sector.pdf
Published on 09 September 2009
By CUAC
1739 downloads
2009_09_09 Consumer group says AGL should halt disconnections.pdf
The Consumer Policy Research Centre has replaced the Consumer Utilities Advocacy Centre – you can go to the new CPRC website here, or continue to view the CUAC archive.


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From the trends in 2018 fashion show, we can see the new trend take place in men fashion world. Men crossbody bags become the new trends for men. Many famous fashion designers have released their latest men crossbody bags in fashion, which has won the popularity among celebrities, fashion icons and other people who love fashion. Let's take a look at the best crossbody bags that are trendy in the fashion shows 2018.
Prada printed leather bag
This is one of the most popular men crossbody bags that rank among the best this 2018! Known for women clothing, Prada has surely made its way into men's wardrobe this summer! Prada printed leather bag is one of its fashion work to enter men fashion world. Since its appearance in public, it has won the preference of many fashion icons and celebrities.
Louis Vuitton messenger bag
Louis Vuitton men crossbody bag is another deal you need don't overlook! It's highly rated due to its make with an LV's classic monogram print! It's really sporty since a monogram print is a style with value! Its iconic features elevate this Luis Vuitton bag to the position it stands, the price tag itself is a sign of value! Own this great men's wear and feel the value of style!
Heron Preston Crossbody bag
Wearing a porter 1st Camo nylon bag will make you a fashion icon! It's worn across your body or at your waist! It's really affordable with the most efficient price tag of fewer than 400 dollars! It's a stylish streetwear that you won't regret putting it on your waist! You deserve this Crossbody bag, it's a sense of style!
Others that we can not miss include the Porter Yoshida bag, Stussy logo bag, and Herschel X MLB Bag! They really stand out to be the best for you!
To conclude, all men are wearing men Crossbody bags! Try this men's Crossbody bags! Be counted among the men in style with a Crossbody bag! For more men crossbody bags, please go to Banggood.


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About The Teacher
Nicola is a yoga teacher and naturopathic doctor candidate (2017) living and thriving in East Vancouver's artistically rich Commercial Drive neighbourhood. Her interest in the human body and its movement brought her to UBC where she completed her Bachelor's Degree in Kinesiology and Health Science. Although she had always wanted to be a doctor, she realized along the way that the conventional medical system was not for her. Yoga was the key that unlocked the door to a whole new world of healing traditions, and she decided to pursue another four years of school at the Boucher Institute of Naturopathic Medicine. Her studies have enriched her classes which often focus on anatomy and physiology, using breath and mindfulness to balance the nervous system. With a gentile voice and skillful instructions, Nicola combines her knowledge as a naturopathic doctor with her experience as a yoga teacher and long-term practitioner to create a truly unique experience in her classes.


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Rules that Matter Most – to YOU!
Everything cannot be of equal value – or nothing would have meaning, right?
So, what rules matter most in your life?
Make a Top 10 list of the Rules that Matter Most to You.
The rules will change from time to time and that's okay. But making this list helps bring into focus what matters most to you right now.
Here are the rules that are holding me right now – not necessarily in priority order:
- Pray first and last every day. In between too.
- Make space to create, read, write, and walk every week. No exceptions.
- Stay close to my family and even closer to my husband.
- Experiment as often as possible. Risks are good.
- Drive the calendar so it doesn't drive me.
- Pick up after myself. Clean up my own mess.
- Listen to people deeply. Beyond words.
- Forget the hurt, anger, and wrong as quickly as possible.
- Practice gratitude even when (especially when) it's hard.
- Make the effort to get to know the new people in the room.
My rules keep me right-side-up. I break them once in a while but the point is that I am trying to live by the values that really matter to me. What are yours?
Check out this article about the '2-hour rule' based on Einstein's habits. Then come up with your own rules. You will may be surprised at what is shaping your day, week, month, and life.
God has given us a life to live – enjoy it!


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Probably everyone who has curly hair or flyaways owns a hair straightener nowadays, but finding the best hair straightener to tame your hair is not always an easy task. Using the wrong styling tools can lead to many undesirable side effects and, at worst, cause damage to your hair, whereas using the right styling tools can make a huge difference to your styling routine.
In today's hair straightener reviews, I am going to introduce you to some very high quality hair straighteners that will take your hair styling game to the next level.
1. CHI G2 Ceramic And Titanium Flat Iron Review
Product description: CHI is a very popular and well-known brand among hair stylists. It is also the go-to brand for home use as it has some pretty cool high tech features that are easy to handle.
The CHI G2 Ceramic and Titanium flat iron model has an upgraded and ergonomic design and offers a large variety of colors, from which you can choose your favorite one.
One of the best benefits of this hair straightener is the fact that the ceramic plates will make your hair look healthier and shinier while the titanium plates can even magnify these effects!
And since titanium is rust resistant, this high-end hair straightener will maintain its fresh-out-of-the-box look for years to come.
- Device heats in less than a minute.
- It has a digital LED display.
- Very well-known and popular brand.
- Has a ceramic and titanium plate design.
- Can heat up to 475° F.
- Color-coded heat setting for different hair types.
Cons: None!
Place to buy: Amazon.com
Overall rating: 10 out of 10
2. LumaBella Keratin Duel Touch Hair Straightener Review
Product description: This hair straightener has Keratin-infused ceramic plates and can turn your hair into the healthy and shiny hair you've always dreamt of.
If you want to protect your hair from damage, this device is the #1 recommended hair straightener for you as it can reduce breakage and splitting up to 50%!
The LumaBella Keratin Duel Touch Hair Straightener also features a smart and unique heat sensor, which will prevent overheating. It can automatically adjust to a safer styling temperature, which means: No more burning off your hair!
- Smart heat sensor to avoid overheating.
- Floating plate design.
- Beneficial for people with curly or wavy hair.
- Keratin-infused technology for optimal hair health.
- Reduces breakage and splitting up to 50%.
Cons: None!
Place to buy: Amazon.com
Overall rating: 10 out of 10
3. CHI Air Expert Classic Tourmaline Ceramic Flat Iron Review
Product description: This is another high-end and high quality hair straightener from the CHI series.
The tourmaline-infused ceramic plates of this hair straightener are specifically designed to maintain your hair health during the styling sessions. What's more, the plates in this hair straightener are said to reduce frizzy hair.
This CHI model also has a far infrared technology will make your hair look and feel smoother and silkier than before. It will also help restore your hair strands.
- The temperatures range between 180° F and 410° F.
- Has a tourmaline and ceramic technology.
- Negative ions that create an optimal shine.
- Belongs to one of the most reliable brands.
- Infrared technology for an even heat distribution.
- It takes 1 minute to heat up.
Place to buy: Amazon.com
Overall rating: 9 out of 10
4. ISA Professional Titanium Flat Iron Review
Product description: The ISA Professional Titanium Flat Iron was designed with mirror plates and an arc-shaped tip, which makes it also an ideal candidate for those with short hair.
You can only use the arc-shaped tip for tinier areas like bangs. Furthermore, the mirror plates of this device will make your hair silky smooth and are perfect for styling waves and curls.
Bonus: You can also create curls and waves if you want to.
- 2-year full warranty.
- Suitable for long as well as short hair like bangs.
- Has a unique curved tip.
- Requires minimal hair pulling or tugging.
- Neon digital LCD screen.
- Temperature ranges between between 265° F and 450° F.
- Has mirrored titanium plates.
- The arc-shaped tip is only suitable and intended for short hair or bangs.
- No pre-set temperature settings.
- You will have to section your hair into smaller pieces for the best results.
Place to buy: Amazon.com
Overall rating: 8 out of 10
Final Thoughts
I hope these short reviews will help you narrow down your options. Before you choose a styling tool, make sure to read the reviews to see which benefits or disadvantages it has.
That way, you will find out if it's worth buying or not. Now it's up to you to pick your favorite hair straightener and get things "straight".
And if you are still looking for the perfect Christmas gift for your loved ones, why not buy them a nice hair straightener?
Happy Styling y'all!
I hope you enjoyed reading this review. If you have any questions, feel free to leave a comment in the comment section down below and I will be more than happy to help you out!
Founder of The Hairy Solution


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The rise of tabloid reviews?
At the end of 2017, I had lots of people ask about best and worst products, and it was hardRead more.
Christmas Charity Raffle details!!
So far, this is the list of prizes in the raffle, and this is NOT the final one, there willRead more.
Patreon and Paypal, this is why I've done it
Patreon and Paypal.me, it's happened. Well I've done and done it, if you've been around for a few weeksRead more.
PATREON – I honestly don't know…
I could do with some feedback on something I've been contemplating of late…Read More →Read more.
BITURBO MECH KIT – why I refuse to review it
The Teslacigs Biturbo Mech kit arrived to review the other day, and while trying to get my head around whyRead more.
Have we seen the last of RDA's in UK shops?
After having many phone calls, and doing what I can to research this issue, as well as responding to allRead more.
How I made my LED dimmable video light
Hi, and thanks for joining me and checking out how I made me LED dimmable studio light!Read More →Read more.
My Mod Tester – how it's made..
Hi, Thanks for joining me, I'm Dean the Vaping Biker and this is a post about something I threw togetherRead more.
Mechanical mods – they're just a tube right?
Hi, and welcome to another dubiously written article from the Vaping Biker! With another great batch of mechanical tubeRead more.
Sneaky regulation or unhappy coincidence?
Something happened today completely by accident and it made the conspiracy theorist within go 'oooooo hmmm I wonder' and thenRead more.


text: After successfully disrupting the status quo in the wireless industry with our first phase of "Wireless for the People," the campaign evolved. It became less about a revolution and more about inclusivity. Wireless for the People turned into a highly targeted campaign that spoke to each customer segment in their unique stages of life – making our message resonate on a very personal level. The result of which was double the sales in the first 6 months of the year compared to that of the entire previous year.


text:
Forget iOS 6, here is a map update actually worth checking out.
Shannon Rankin has created her Anatomy Series using the language of maps to convey the connections between the geographical and the biological. Of which she says,
Maps depicting mountain ranges, roads, lakes and rivers resemble internal biological features, reproductive anatomy, skeletal structures and networks of the human body. Symbols of cities become acupuncture points, and meridian lines, like rivers, represent an internal system of communication and transport.
You might say Rankin's maps aren't all that practical, but she certainly found her way to my heart.


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While all reduction chaussures online traditional academic classes would be covered, the classes would present them with a focus on how they relate to the subject of the school.
It's been my experience that free chips and a meal voucher add a little incentive.And finally, another dilemma is taxpayers would be billed over 5,000 per student for one year at a private school, when in actuality it would be cheaper to increase what public schools already receive to help the public schools teach their students better.You can take it with a chain-of-custody voucher.M, (December 31, 1969).More Essays: APA, mLA, chicago voucher system.However, this is not necessarily the case.If the voucher system passed legislation, all current public schools would presumably break into smaller private schools or would privatize as they are.The system suggests an end to public schooling with no deduction in tax dollars for educational purposes; instead, the cost of an average student's education will be calculated and a voucher redeemable for private schooling in that amount provided for the parents of school age.With all of these negatives to take into consideration, I believe that school choice code promo plaque collection should not be put into action code promo cyrillus nouveau client countrywide.Voucher system, the voucher system, first introduced by Milton Friedman in 1960, is an example of capitalistic idealism: the state has a responsibility to provide solid education, it philosophizes, but not to monopolize the institution.Supreme Court has said is unconstitutional.Retrieved 16:21, January 17, 2018, from.After your payment, we send you the voucher for accommodation by e-mail or fax.Accepting the voucher system would be to accept school and job segregation.He proposed to go with the night before to catch the voucher.You can now obtain their equivalent - an electronic voucher - at the Bank's network of ATMs.The demand for school choice was so great that later, in 1995, Milwaukee allowed 15,000 students to attend their choice of either private or church-related school and still be given approximately the same amount of money per year.
This system, however justifiable to some, would be a counterproductive amendment to one of America's oldest and most prided institutions: an amendment that would serve only to enable mulit based segregation and would disable our children to be effective citizens.
A support voucher is valid for three months at a time but its validity may be extended where necessary.
The fastest way to buy electronic voucher via Internet.
Similar studies have been performed in Cleveland with comparable results.


text:
Home / Info Corner / Careers
Latest Circulars
Job Description
• Candidate should be good in communication skill and interpersonal Skill
• Should be fluent in English and Hindi.
Salary: Negotiate (added benefits as per Institute standards)
Industry: Sunbeam School Azamgarh UP
Functional Area: Teaching, Education, Training, Counseling
Role Category: Teachers
Role: Counselor
Employment Type: Permanent Job, Full Time
Job Description
Wanted qualified & experienced lady teachers for English medium school with immediate effect.
B.A/ MA/ BSC /MSC/ MCA/ BCA/.B.Ed. for the subjects English, science, SST, Sanskrit ,Hindi.
Salary: Not Disclosed by Recruiter
Industry: Education / Teaching / Training (Sunbeam School Azamgarh)
Functional Area: Teaching, Education, Training, Counseling
Employment Type: Permanent Job, Full Time
Educational Qualification:
• Graduate / Post Graduate with B.Ed.
• Candidate with good communication will be preferred.
Job Description
Qualification: Candidate should be graduate with B.Ed. holder in relevant field.
Experience- Minimum 0-2 years of experience in relevant field.
Good communication skills (mandatory)
Salary: as per as CBSE rules.
- Expert in English
- Prepare online assessment and develop questions in resource base.
- Communicate effectively with student
- Knowledge base in English till class Xth.
- CBSE Teaching Experience will be preferred.
Candidates with good academic record, teaching/ research experience and working in related areas of research are encouraged to apply.
Other details
- Department: Teaching Assistant
- Industry: Education / Training
- Other Skills: Expert in English
Email: email@example.com
Telephone: 9838771172, 9838771173


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This summery photo-series by Austin, Texas, based photographer Jinni J.. impresses with a wonderful nostalgic feel that comes out in every photo. Colour shades of purple, blue and a warm orange and some sparkle give her series a special, nearly magic-appearing touch. It's just beautiful to look at Jinni's captured series where she teamed up with stylist Ana Davidson and model Ceci Sariol.
Photography: Jinni J. ☆ IG: @heyjinnij
Styling: Ana Davidson ☆ IG: @anadavidson__
Model: Ceci Sariol ☆ IG: @cecisariol


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Maria Teijeiro/Digital Vision/Getty Images
If you're like most couples, your parents have contributed time, energy and funds to your wedding. Before the big day arrives, think about a way to thank them. You can give your parents a gift before the wedding, after the wedding or even use the wedding itself to thank them.
Pictures Carry Sentiment
Give your parents a framed photo of you and your spouse, taken on your wedding day. There will be plenty of formal pictures, so try for something a little less "official." Take extra steps to make the gift meaningful and personal. If your parents have a photo of themselves at their wedding, strike a similar pose and use side by side framing. You can also create a sign with a message like "Thank You, Mom and Dad," and ask your photographer to incorporate it into a few shots. Load a digital picture frame with a handful of your favorites or create a photo book.
Pick something appropriate for the occasion. For your dad, think cufflinks engraved with his new family member's name and the date of your wedding. Moms are easier -- think a charm bracelet with a wedding charm, a pin or even an add-a-pearl necklace or bracelet; you can add to it on special events.
Wedding Recognition
Even though it's your big day, your parents will appreciate being incorporated into the ceremony and reception. Consider using sentimental objects from their weddings, like veils, cake toppers and jewelry, into your own wedding. Place framed photos of your parents on their wedding day near the guest book and cake table. Your parents might appreciate a heartfelt thank you speech during your wedding reception.
Cards and Letters
Cards and letters can be inexpensive but priceless to your parents. Write a personalized poem or letter to your parents.Think about how their actions and love will help you be a better spouse and family member. Talk about your favorite memories with them growing up, or the traditions your family has that you want to pass on to your children someday.
- Maria Teijeiro/Digital Vision/Getty Images


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Leather jackets is the most common outfits of both men and women, this type of outfit makes women and men to look more attractive. This post is completely about leather jackets and its various kinds. Many people want the leather products to get banned since animal skins are used in their production but it doesn't matter to the people who love use leather products like jackets and shoes. Leather jacket is the best way to make a skinny person to look normal and a normal person to look like a body builder. It also increases the personality of women to the greater extent.
There are various types of leather jackets which are as follows; first is classic men's two button black leather blazer. This look more formal and it doesn't look trendy so it is not used by the youngsters. Western style jackets usually have two colors in the coat which look funky; this is familiar among teen agers. Vintage men types of jackets are full buttoned and look like ordinary shirt, this is used widely in winter season. Buttercup leather jacket looks like old type but this type is the most used type of many people.
Women mostly use chase biker type of jackets. Shield biker and walker biker are it other types of jackets. You can get a branded jacket of this type within the price rate of $ 500. Grasp gilet is the type of jacket without sleeves which gives women a more attractive look. Leather skirt and leather skinny types of pants are also widely used by all women with different ages.
The usual colors of leather jackets are black, gray and brown. To my knowledge black color is very much liked by many persons. There are many other kinds of jackets which I have not described here; if you want you can search it through net.


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Pudding, Dun (CR 5)
Large Ooze
Alignment: Neutral
Initiative: -5 (Dex)
AC: 4 (-5 Dex, -1 size), touch 4, flat-footed 9
Hit Dice: 8d10+55 (99 hp)
Fort +7, Ref -3, Will -3
Speed: 30 ft.
Space: 10 ft./5 ft.
Base Attack +6; Grapple +5
Attack: Slam +7
Full Attack: Slam +7
Damage: Slam 2d6+3
Special Attacks/Actions: Improved grab, constrict, acid, split
Abilities: Str 15, Dex 1, Con 20, Int -, Wis 1, Cha 1
Special Qualities: ooze
Feats: -
Skills: -
Advancement: 9-10 HD (Large), 11-16 HD (Huge), 17-20 HD (Gargantuan)
Climate/Terrain: Any arid/deserts
Organization: Solitary
Treasure/Possessions: None
Improved Grab (Ex): To use this ability, the pudding must hit with its slam attack. If it gets a hold, it can constrict.
Acid (Ex): The different pudding species effect materials in different ways. The following list summarizes pudding acid capabilities. Values indicate damage done to objects made from the indicated material per round. Asterisked values indicate weapons and armor made from such materials must make a Reflex save at the listed DC or dissolve upon contact.
- Metal 25
- Stone -
- Wood 50* - DC 19
- Leather 50* - DC 19
Constrict (Ex): Puddings inflict automatic slam and acid damage with a successful grapple check. The opponent's clothing and armor suffer a -4 penalty to Reflex saves against the acid.
Split (Ex): Weapons deal no damage to puddings. Instead the creature splits into two identical puddings, each with half the original's hit points (round down). A pudding with only 1 hit point cannot be further split.
As with black puddings, this pudding variety attacks by grabbing and squeezing their prey.


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eating out: little greek taverna
Last Thursday, my girlfriends took me out for an early birthday dinner at a place that will now be known as my favourite West End restaurant – the Little Greek Taverna.
Nestled on the corner of Browning, Melbourne and Boundary Streets, this little piece of Greek heaven opened in December last year and seems to have garnered a healthy crowd of regulars. I wonder how I've managed to miss it until now!
I love Greek food but this is definitely some of the best I've had in Brisbane. To start, we shared some pita ($3) with tzatziki ($4) and some fried haloumi ($8). Both were delicious and set our mouths watering for more.
For the main, I opted for lamb cutlets with Greek salad ($15) and it was truly one of the most simple yet most delicious meals I've had in some time. The meat was cooked to perfection and the salad was fresh and deliciously dressed. I'm not at all ashamed to say I chewed on the bones because I didn't want to waste a single bit of tasty, tasty meat (sorry Mum!). The other girls chose the lamb souvlaki and salad ($13.50), which was also incredible (yes, I stole a taste).
I have to say the restaurant is amazing. The service is friendly and fast, the menu was comprehensive and the bill was tiny. The only downside was that it was a little loud but truth be told, we were too busy stuffing our faces to talk. I definitely plan to head back for another meal soon!
Where to find it: 1 Browning Street, West End
Where to find it online: www.littlegreektaverna.com.au


text: Welcome APES Updated 6/10/19It is suggested that you purchase this book before class. A.P. Environmental Science All Access by Kevin Reelhttps://www.amazon.com/dp/0738610828/ref=rdr_ext_tmbPlease sign up for Remind 101Text the following number 81010Text the following @apesreIt is imperative you sign up for Remind 101 updates in order to prepare for the class. If you do not sign up or cannot, please see me ASAP. (6/10/19) updatedWe will be having a test that is very similar to the first two chapters of the book above upon the start of class.Have a wonderful break.Mr. Viteri