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Advanced Nutrients by Thorne is an advanced multi formula with added benefits to support healthy aging and eye health.
Adding a multi-vitamin/mineral supplement to your daily routine is a great first step for promoting good health. However, if you live a lifestyle prone to high levels of oxidative stress due to environmental toxins, chronic stress, smoking, and other factors, you might need a more advanced supplement formula.
Advanced Nutrients is expertly formulated with essential vitamins, minerals, and additional nutrients from the purest sources and in the most absorbable forms. It provides optimal amounts of key ingredients to create an excellent foundation for good health.
This advanced formula offers extra antioxidants that protect your body against cellular damage.
The benefits of Advanced Nutrients include:
Healthy Aging
• Nicotinamide riboside (NR) is clinically proven to increase NAD+, an important coenzyme that declines with age, thus helping your cells function at their best by optimizing cellular energy production and metabolism
• Resveratrol promotes healthy cellular aging
Eye Health
• Bilberry, an extensively studied botanical, promotes eye health because it supports the connective tissue in the retina and cornea
• Lutein and zeaxanthin support the retina and provide special benefit for dry eyes
Foundational Support
• Vitamin A promotes eye health, healthy skin, and immune function
• Vitamin C, a potent antioxidant, supports immune function and provides collagen support
• Vitamin D supports healthy bones and immune function
• B vitamins are critical for heart and blood vessel health and to provide stress relief
• Zinc bisglycinate, a highly absorbable form of zinc, promotes healthy immune function and healthy skin
Who can benefit from Advanced Nutrients?
• Aging boomers looking for more support in their daily multi-vitamin/mineral routine
• Individuals living in a particularly toxic environment
• Individuals who would benefit from extra antioxidant support, especially those experiencing high levels of oxidative stress
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. If you are pregnant or nursing, please consult your healthcare professional before using this or any product. Keep out of the reach of children.
Advanced Nutrients by Thorne contains the following:
- Serving Size: 8 Capsules
- Servings Per Container: 30
- Astaxanthin 1mg
- Bilberry Extract 80mg
- Biotin 400mcg
- Boron (Glycinate Complex) 3mg
- Calcium (Dicalcium Malate) 250mg
- Choline (Citrate) 35mg
- Chromium (Nicotinate Glycinate) 200mcg
- Copper (Bisglycinate) 1.5mg
- Folate (L-5-MTHF) 1.7mg DFE
- Iodine (Potassium Iodide) 225mcg
- Lutein 1mg
- Lycopene 1mg
- Magnesium (Dimagnesium Malate) 250mg
- Manganese (Bisglycinate) 6mg
- Nicotinamide Riboside 25mg
- Quercetin Phytosome 100mg
- Selenium (Selenomethionine) 200mcg
- Trans-Resveratrol 25mg
- Vitamin A (Beta carotene) 375mcg
- Vitamin A (Palmitate) 750mcg
- Vitamin B1 (Thiamin HCI) 40mg
- Vitamin B12 (Methylcobalamin) 450mcg
- Vitamin B2 (Riboflavin 5'-Phosphate Sodium) 10mg
- Vitamin B3 (Niacin) 30mg
- Vitamin B3 (Niacinamide) 130mg
- Vitamin B5 (Pantothenic Acid) 450mg
- Vitamin B6 (Pyridoxal 5'-Phosphate) 10mg
- Vitamin C (Ascorbic Acid) 850mg
- Vitamin D3 50mcg
- Vitamin E (d-Alpha-Tocopherol) 134mg
- Vitamin K1 50mcg
- Vitamin K2 (MK-7) 50mcg
- Zeaxanthin 1mg
- Zinc (Bisglycinate) 15mg
- Other Ingredients: Calcium Laurate, Hypromellose Capsule, Microcrystalline Cellulose, Silicon Dioxide
Recommended Use: Take 4-8 capsules daily or as recommended by your health professional.


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Ray Charles carries a bit of mystery wherever he goes. Dressed in a classic suit and wearing his trademark shades, Charles keeps mostly to himself with few words to the press and a no-photo, no-autograph policy.
But to his band, Charles is a fun companion who blends in any crowd, regardless of age or location.
The Hatchet caught up with members of Ray Charles' band in their limousine while they watched a B-52 fly-over at Arlington Cemetery Saturday.
Conductor Victor Vanacore and drummer Peter Turre have played with Charles for 12 years and previously worked with other music icons.
"I used to work with The Jackson Five, Barry Manilow. I would baby-sit Janet Jackson when she was a kid," said Vanacone, who heads a 40-person orchestra. "I'd take her for walks on the beach."
As for performing for a young audience, Vanacore and Turre said they were glad to be playing at GW.
"The kids at colleges are more open to artistic stuff. As much as they like popular music, they are able realize the icon and treasure Ray is," Turre said.
Vanacore said he appreciates the enthusiasm and exuberance he sees in young audiences around the country, including the University of Michigan, Michigan State University and Rutgers University.
To the loyal band, the legendary blues musician plays well to all audiences.
"It's just a younger crowd," Turre said about playing college venues. "Ray breaks the mold; he doesn't have a particular age group he appeals to."
Vanacore agreed.
"I don't think the generation gap exists the way it used to," Vanacore said. "We may not be listening to exactly the same music, but I know kids who come out of concerts saying they have become Ray Charles fans from watching him perform."
Charles does not just transcend the age barrier. He also transcends language, culture and nationality, they said.
"Ray is like Michael Jordan," Turre said. "Everyone in the world knows who he is. He's an icon."
And Charles has had many chances to perform around the world.
Vanacore said shows in Western Europe and Australia turned out better than they could have imagined.
"Macedonia was certainly memorable – and it's not only the music, but the people we play with, the orchestras," he said.
Vanacore and Turre said they have a good time touring with Charles.
Vanacore recounts an Orlando Magic basketball game in which Shaquille O'Neal suffered at the free-throw line.
"Ray asks me what happened in the game, and I said Orlando lost by four," Vanacore said. "He asked what Shaq did in the game and I said he shot one for 10 from the line. Then he said `Peter I'm blind, and if you just handed me a ball and pointed me in the direction of the basket I could hit one for 10.' He has quite a sense of humor."
Vanacore and Turre said they expected an emotional overtone at the performance on Saturday night in light of the Sept. 11 terrorist attacks.
"In Houston last week we played `America the Beautiful' and people went nuts at first," Turre said. "Then there was dead silence and people stood up in unison. They were mouthing the words (and) crying . I didn't know if I could keep it together myself."
Vanacore correctly predicted the GW crowd would join together singing at the end of the performance.
"I try to see if people want to sing and invite them to sing the last chorus," he said.
Constant road dogs Vanacore and Turre said Charles and his band plan to continue touring as usual.

subset: commoncrawl


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Create Golf offers a comprehensive design and consultation service to all clients requiring expertise in all aspects of golf course design.
Create Golf is an experienced golf course design company specialising in the design and creation of new golf facilities and the restoration and renovation of traditional existing golf courses.
Our company recommends a different perspective from many European golf course designers. We believe that a genuinely great golf course is discovered and created in the ground and not designed on a piece of paper or a computer screen.
Our philosophy is to spend more time working directly with the landscape at
every stage of the project. We devote our time and effort to the creation of the golf course; we work directly with the construction company and the shaper to deliver the best possible product to the client.
Each golf course which is designed and created by our company will be an enjoyable experience with every element of strategic interest available for the golfer.
We take each project as an individual entity and strive to bring back tradition and fun into modern golf course design.


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Breakout Pattern - Quick Download
Breakouts are the most powerful price move in the markets. Everybody wishes they could have bought a stock at two dollars and rode it to $25 in 30 days. Everybody wishes they could have bought a stock at five dollars and sold it to $15 in a four day period.. What do you do after a stock price has moved 32%, 45%, or 104% in one day? Thats what the candlestick signals tell you. Learning to analyze what investors are doing after a huge price move allows an investor to participate correctly in a high potential price move. This training CD illustrates when it is time to get on board or to take profits in the fast moving prices. Expand your profit potential by being in price moves correctly. This CD will give you a whole new perspective on when to be in or out of a high fliers.
After check-out you will receive an e-mail to download your selection. This is sent automatically to the e-mail you provide during check-out.


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Though email marketing is an old and traditional marketing approach, it is not dead yet. It can be termed as one of the forefathers of the digital marketing and it is here since long. However, digital marketers more often overlook email marketing and do not incorporate it in digital marketing campaigns.
Well, it should not be the case.
SelfWork SEO is one of the best email marketing companies that have carved a niche for itself by offering superior and end-to-end email marketing services to the clients. We have the best infrastructure and tools and technologies to offer you impeccable email marketing services to improve your sales cycles and to get you to benefit from email marketing campaigns.
Do you have enough reasons why you should hire an email marketing company now?


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Lots is going on at SG Productions:
* We are supporting the No GMO Rally in Oakland with a Pedal Powered speaker system on May 23rd.
* We have a new line of product of custom Cajon's made at SG studio for orders. Send a request to firstname.lastname@example.com if interested.
* Making waves in music production by creating the first pedal powered compilation CD of Maker Faire and Rock The Bike
Next big show:


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Can you believe I've been blogging for five years?! I've come a long way since my Nice Job Breaking It Hero days and while I'm always looking towards the future, every now and again I like to take a look back and reflect on my past. So this year I'm going to share some of my favorite posts from every year I've been blogging!!
Kicking things off with 2015! I was just getting my start back then and I didn't really have a "style" so to speak, so I just kinda wrote whatever popped into my head… with some interesting results.
So I kinda sorta like yaoi…and by "like" I mean LOVE!
One of my first blog posts and of course it's about boys love! While I have no shame in hiding my love of BL now, back then I was still very much on the DL about it and the only place I could really talk about it was online and with a very small group of IRL friends. So this post was my attempt to connect with more BL fans. I give a very basic explanation of what BL is and some of the tropes I like and dislike (heavy on the dislike lol).
I've grown considerably as a blogger, so maybe one day I'll go back and revamp this post, but for now here is my cringey post celebrating my love of boys love stuff.
Hit me right in the Childhood: An Ode to Pokemon
It is no secret that I love Pokemon, it has been one of the few mainstays in my life—from getting Pokemon Crystal at the age of 11 to buying Pokemon Sword as a grown adult. This was such an emotional post for me because the Pokemon franchise was such a huge part of my childhood that I hope to one day share with my own kiddos (when I have them).
I think I wrote this a little before Omega Ruby and Alpha Sapphire were released and I remember it being a huge deal because you could essentially transfer your Pokemon from the original Ruby, Sapphire and Emerald games back to the Hoenn region. And I kid you not, I teared up when I transferred my Swampert from Ruby into Omega Ruby—as cheesy as it sounds it was like he was finally going home…
Mini Review: Scandal in the Spotlight
I used to be a fiend for all things Voltage Inc. they were some of the first otome games I ever played and while I've kind of fallen off the Voltage bandwagon, I still have fond memories of these games (and a ton of unplayed titles on the Love 365 app). One of my first Voltage reviews was for Scandal in the Spotlight and not gonna lie I was not expecting to fall in love with this game the way that I did… but how could I resist the allure of hot Pop Idols?!
So this sort of became a rant about Howl's Moving Castle
This was my attempt to be "knowledgeable" about something. I had just read Howl's Moving Castle by Diana Wynne Jones and I was floored by how different the book was from the Miyazaki film. So I took to my blog and let the world know exactly how I felt! This post is somewhere between a rant and a lost in adaptation essay and I kinda like how snarky I was back then.
First Thoughts: Alice in the Heart-Wonderful Wonder World
I was young once and I threw my money at every single otome game I could get my naive little hands on and… more times than not it bit me in the ass. The official localization of Alice in the Heart was one of those early translation attempts where QuinRose handled everything in house… and it went about as well you'd think—Google Translate level Engrish. I'm still salty about wasting my money on this localization, but I hear the new fan translation for Anniversary no Kuni no Alice is really good, so there is hope! But for now relive my pain with this review!
From Friends to Lovers: DRAMAtical Murder Koujaku's Review
Did you know that wrote reviews about every Dramatical Murder route? Well, now you do! The first game I ever covered on this site was Dramatical Murder and my first route was Koujaku's… and it was pretty meh for me. But, this was the first time I committed myself to completing an entire game and while it took me over a year to actually finish it I am super proud of these reviews!
Well, these were my favorite posts from 2015 and even though they aren't as polished as some of my more recent content I'm really fond of these posts! If you're in the mood for more classic Blerdy Otome stuff… check out the Past Exploits dropdown at the bottom of the page. I'll also be sharing my fave posts from every year I've been blogging every Saturday throughout the month of August, so keep an eye out for those!!
Follow Blerdy Otome!
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Chronic kidney disease (CKD) is frequently complicated with hyponatremia, probably because of fluid overload or diuretic usage. Hyponatremia in CKD population is associated with increased mortality, but the effect on renal outcome was unknown. We investigated whether hyponatremia is associated with fluid status and is a prognostic indicator for adverse outcomes in a CKD cohort of 4,766 patients with 1,009 diuretic users. We found that diuretic users had worse clinical outcomes compared with diuretic non-users. Hyponatremia (serum sodium <135 mEq/L) was associated with excessive volume and volume depletion, measured as total body water by bioimpedance analysis, in diuretic users, but not in diuretic non-users. Furthermore, in Cox survival analysis, hyponatremia was associated with an increased risk for renal replacement therapy (hazard ratio, 1.45; 95% CI, 1.13–1.85, P < 0.05) in diuretic users, but not in diuretic non-users (P for interaction <0.05); restricted cubic spline model also showed a similar result. Hyponatremia was not associated with all-cause mortality or cardiovascular event whereas hypernatremia (serum sodium >141 mEq/L) was associated with an increased risk for all-cause mortality. Thus, hyponatremia is an indicator of fluid imbalance and also a prognostic factor for renal replacement therapy in CKD patients treated with diuretics.
Chronic kidney disease (CKD) causes dysfunction in regulating water homeostasis because of a reduced glomerular filtration rate (GFR)1. Volume overload is highly prevalent in patients with CKD and a 10% to 30% increase in extracellular fluid can be detected, even in the absence of overt edema2. The disorder in homeostasis resulted in hypertension, electrolyte imbalance and edema. Volume overload has been associated with CKD progression and cardiovascular disease (CVD) related morbidity or mortality3. Diuretics are essential in treating fluid balance, blood pressure control, prevention of hyperkalemia and urine amount regulation in CKD population4,5,6. However, several studies have reported negative outcomes of diuretic usage on renal function, mortality, and hospitalization in patients with heart failure7,8,9,10,11. In acute kidney injury (AKI), loop diuretics exert no significant effect on renal recovery, the need for dialysis, or mortality12,13,14,15. In CKD, the long-term effect of diuretic usage in correction of volume overload has not been thoroughly studied16.
Sodium imbalance could be secondary to diuretic usage, particularly in patients with CKD, because the ability of kidneys to regulate dilution and concentration becomes impaired as renal disease progressing2. Hyponatremia could be a consequence of fluid overload or a consequence of diuretic usage in these patients. Various epidemiological studies have documented an association between hyponatremia and increased mortality from diseases involving fluid overload and diuretic usage, such as congestive heart failure (CHF) and liver cirrhosis17,18,19,20,21. Recently, Kovesdy et al. discovered that both lower and higher serum sodium levels are associated with higher mortality in patients with CKD, independent of CHF and liver disease22, but renal outcome and the degree of diuretic usage were not reported. Due to the unique disease characteristic that are susceptible to sodium imbalance, hyponatremia could be prognostic indicator in patients with CKD. Thus, the aim of our study was to determine whether diuretic usage and the related hyponatremia are associated with fluid imbalance and are predictive of adverse clinical outcomes, including renal outcomes, in patients with CKD.
Baseline characteristics and clinical outcomes of the diuretic users and diuretic non-users
Table 1 showed the baseline characteristics of diuretic users and non-users which comprised of 1,009 and 3,757 respectively. The diuretic users showed higher percentage of CHF, Diabetes mellitus (DM), CVD and severe liver disease (SLD). They exhibited a significantly higher mean blood pressure, urine protein-to creatinine ratio (UPCR) and HbA1c level (P < 0.05). At the same time, lower estimated glomerular filtration rate (eGFR), serum hemoglobin and albumin were observed in diuretic users (Table 1). However, only male diuretic users showed higher total body water (TBW) (55.5 ± 8.2% vs 54.0 ± 5.7%). Diuretic users also showed higher percentage of renal replacement therapy (RRT) and CVD.
Baseline characteristics of diuretic users according to serum sodium
Table 2 showed the baseline characteristics of diuretic users. The mean age was 64.0 ± 13.5 years and 49.6% were female. Diuretic users were divided according to mean serum sodium ± 1 SD into 4 groups: Na <135 mEq/L, Na 135–138 mEq/L, Na 138–141 mEq/L, and Na >141 mEq/L (Table 2). Diuretic users with Na <135 mEq/L were more likely than those with Na 138–141 mEq/L to experience CHF, DM, and CVD, have higher blood glucose levels, HbA1C and UPCR, and have lower albumin concentrations. Diuretic usage did not differ among the Na groups (Table 2). In male diuretic users, Na <135 mEq/L was associated with lowest TBW.
Association between hyponatremia and total body water in diuretic users
Table 3 showed the variables associated with hyponatremia (Na<135 mEq/L) in diuretic users. To understand whether hyponatremia could be an indicator of fluid status, we measured TBW by using the bioimpedance method in 498 randomly selected diuretic users and performed logistic regression to determine the nonlinear association between serum sodium and TBW. Our results showed that the lowest and highest quartiles of TBW were associated with hyponatremia (Table 3). Age, CVD, HbA1c and BMI also showed positive correlation with hyponatremia but not thiazide diuretics. No association between serum sodium and TBW was noted in diuretic non-users (Supplementary Table 1). CVD, eGFR, albumin, HbA1c and BMI showed positive correlation with hyponatremia in diuretic non-users.
Association between serum sodium and clinical outcomes in diuretic users
In diuretic users, after a median follow-up of 1070 days, the RRT event was higher in Na <135 mEq/L, which was 113 (62.4%) (Table 4). In fully-adjusted competing risk Cox regression model, compared with Na 135–138 mEq/L, Na <135 mEq/L was associated with an adjusted HR of 1.45 (95% CI, 1.13–1.85; P < 0.05) for RRT, but not associated with all-cause mortality and cardiovascular events (Table 4). Na >141 mEq/L was associated with a trend of increased risk for RRT. When compared with Na 138–141 mEq/L, Na >141 mEq/L had an adjusted HR of 1.59 (95% CI, 1.09–2.32; P < 0.05) for all-cause mortality. In analysis of serum sodium and outcomes as restricted cubic splines, we observed that Na <132 mEq/L was associated with a higher risk for RRT (Fig. 1) whereas Na >143 mEq/L was associated with a higher risk for all-cause mortality (Fig. 2).
Association between serum sodium and clinical outcomes in diuretic non-users and interaction between diuretic use and serum sodium
We studied the prognostic effect of sodium in diuretic non-user (Supplement Table 2). The percentage of Na <135 mEq/L in diuretic non-users was 17.3% similar to that in diuretic users, 17.9%. Na <135 mEq/L was associated with increased risks of RRT, all- cause mortality and cardiovascular events in unadjusted models; however, the result became non-significant after adjustment (Supplement Table 2). In analysis of serum sodium and outcomes as restricted cubic splines, we also did not observe a significant association (Supplement Figures 1, 2 and 3). The interaction between diuretic use and serum sodium for RRT was significant with a p value of 0.017 and 0.038, when serum sodium treated as a categorical variable or a continuous variable, respectively.
Sensitivity test for the association between serum sodium and clinical outcomes
We tested other grouping methods as stated in the method. In diuretic users, compared with Na 135–141 mEq/L, Na <135 mEq/L was associated with an increased risk of RRT and Na >141 mEq/L was associated with an increased risk of all-cause mortality (Supplement Table 3). In analysis by restricted cubic spline model with different knots, we also observed that Na <132 mEq/L was associated with a higher risk for RRT (Supplement Figure 4) whereas Na >143 mEq/L was associated with a higher risk for all- cause mortality (Supplement Figure 5). In diuretic non-users, serum sodium treated as a categorical variable (3 groups) or as a continuous variable with different knots showed similar results (data not shown). The interaction between diuretic use and serum sodium for RRT was also significant with a p value of 0.024 and 0.036, when serum sodium treated as a categorical variable or a continuous variable, respectively (data not shown).
We investigated the diuretic usage, clinical outcomes, and prognostic effect of serum sodium among patients in a CKD cohort. We found that hyponatremia is associated with imbalance of TBW in diuretic users. In investigating the prognostic effect of diuretic- related hyponatremia, we revealed, for the first time, that serum sodium <135 mEq/L is independently associated with a higher risk for RRT in diuretic users, but not in diuretic non-users. Moreover, we also observed that serum sodium >141 mEq/L is associated with an increased risk for all-cause mortality.
Previous studies on the effects and outcomes of diuretic usage have mainly focus on patients with AKI or edematous diseases other than kidney disease. Using diuretics to treat AKI provides no clear benefits in the recovering of kidney function or preventing mortality23 other than maintaining urine output13. Moreover, diuretic usage by critically ill patients with AKI was associated with an increased risk of death and non-recovery in renal function24. Observational studies have shown that diuretic usage by patients with heart failure is associated with reduced renal function, the progression of heart failure and increased mortality25,26,27. Compared with paracentesis, diuretic usage was associated with a higher incidence of renal impairment and other complications in patients with liver cirrhosis and ascites28. These data suggest that diuretic usage could be harmful to patients with extreme volume changes.
Clinical trials in patients with hypertension have yielded controversial results regarding the effects of diuretic usage on clinical outcomes. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) reported that thiazide diuretics were not inferior to calcium channel blockers and angiotensin- converting enzyme inhibitors in preventing all-cause mortality and were superior in preventing CVD29. The renal outcomes of these drugs did not differ30. However, in the Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) study, benazepril plus hydrochlorothiazide, compared with benazepril plus amlodipine, were more strongly associated with hypotension and higher risks of the progression of CKD, cardiovascular morbidity, and mortality31. These data suggest that thiazide diuretics could be harmful if they cause volume depletion.
Little research has examined the association between diuretic usage and outcomes in CKD comparatively. Diuretics have considerable therapeutic importance in treatment volume overload of CKD patients, but may possess direct nephrotoxicity, particularly tubulointerstitial injury32 and impaired renal vaso-relaxation33. The overuse of diuretics causes volume depletion and subsequently increased sympathetic activity34 and stimulates the renin-angiotensin-aldosterone system34, as evidenced by animal studies. Both local renal effects and systemic neuro-hormonal effects impair renal function. In patients with hypertension and GFR <60 mL/min/1.73 m2, thiazide diuretics were not inferior to 2 other drugs in reducing end-stage renal disease in the ALLHAT study35, and benazepril plus hydrochlorothiazide were not associated with hypotension or a higher risk of the progression of CKD in the ACCOMPLISH study31. No previous studies investigated the impact of loop diuretics in patients with CKD. In our study, we discovered that diuretic users (80% loop diuretics) had worse clinical outcomes. However, the causal relationship between them could not be determined.
In patients with CKD and volume overload, diuretic usage may be a necessary evil in managing volume status. High prevalence of volume overload in CKD patients lead to unavoidable diuretic usage. Volume status could be measured by using the bioimpedance method36, which reflects the status of hydration quantitatively. However, this is not routinely use in daily practice. We found hyponatremia under diuretic usage could become a clinical parameter which indicates the increased TBW (increased fluid status despite diuretic use) or decreased TBW (likely because of too much diuretic use). Hyponatremia with increased TBW denotes water and salt retention because of impaired renal excretion and activation of the neuro-hormonal mechanisms37. The increased fluid status would increase renal efferent pressure and decrease renal blood38. Our previous study had shown that fluid overload is associated with worse renal outcome36. Conversely, hyponatremia with decreased TBW suggests volume depletion under diuretic usage,
which enhances arginine-vasopressin (AVP) and renin-angiotensin secretion39. Acute volume depletion is well-known as a cause of acute renal injury40 and chronic volume depletion could leads to chronic tubulointerstitial injury and CKD41. Volume depletion also decreases renal perfusion and increases the susceptibility to analgesics and nephrotoxic agents. Thus, hyponatremia indicates imbalanced volume status and could be associated with renal function progression.
Hyponatremia could also indicate an impaired renal dilution capability in CKD patients. As CKD progresses, renal sodium loss because of impaired tubular reabsorption and osmotic disequilibrium between the luminal fluid and medullary interstitial impair dilution42. CKD is also associated with increased AVP secretion and experimental evidence has demonstrated that AVP is critical in initiating and exacerbating renal damage43. A sustained stimulation of vasopressin receptors induced intrarenal renin- angiotensin system activation, glomerular hyperfiltration, and hypertrophy, causing proteinuria and glomerulosclerosis43. However, our data demonstrated that hyponatremia in diuretic non-users was associated with lower eGFR but was not associated adverse clinical outcomes. Besides, thiazide diuretics, which inhibit sodium transport in the distal tubule, could prevent the maximal dilution of urine44. But we found no association between hyponatremia and thiazide diuretics in diuretic users. These data suggest that impaired renal dilution capability could not explain the prognostic effect of hyponatremia in diuretic users.
Hyponatremia may also reflect concurrent heart failure, which may impose additive deleterious effects on poor renal outcomes. Fluid overload as indicated by hyponatremia could cause cardiomyocyte elongation and dysfunction during the left ventricle remodeling45. Our data demonstrated that hyponatremia was associated with cardiovascular disease in patients with CKD. Hoorn et al. demonstrated that hyponatremia predicts declining creatinine clearance in patients with severe heart failure46. The concourse of hyponatremia and renal dysfunction has been shown to be associated with heart and liver failure47. Thus, cardiorenal syndrome can cause a vicious cycle in which deteriorating heart function accelerates the reduction in kidney function via the neurohormonal pathways48.
Hyponatremia is an independent prognostic factor for morbidity and mortality in heart failure19,49 and maintenance hemodialysis17,50. Kovesdy et al. concluded that lower serum sodium (<135.9 mEq/L) and higher serum sodium (>145 mEq/L) were associated with higher mortality in a large cohort of patients with non–dialysis-dependent CKD22. In our CKD cohort, the lack of association between hyponatremia and mortality could be attributed to the fact that renal replacement therapy could resolve the fluid overload eventually in patients with advanced CKD51. Our data also reconfirmed the association between hypernatremia and mortality in CKD patients. Hypernatremia (serum sodium >145 mEq/L) was much less than hyponatremia (serum sodium <135 mEq/L), 3% vs 17%. Patients with hypernatremia could be associated with acute complications and death, rather than RRT.
Our study had several limitations. First, as an observational cohort, our ability to elucidate definite causal links was limited. Second, total body water measured by bioelectrical impedance analysis was not equal to extracellular fluid, though we had found a good correlation. Third, CV events were recorded in only one hospital, which might have caused an underestimation. Fourth, variations in serum sodium levels caused by daily intake, nutritional status, and medication use during the follow-up period could have confounded the results. However, our purpose was to apply serum sodium as a prognostic factor, not a causal factor. Fifth, the smaller sample size of the 2 extreme serum sodium levels and relatively short follow-up duration could have resulted in lower statistical power, which might account for the weak association with mortality and CV events and the inability to differentiate the effects of loop and thiazide diuretics.
In conclusion, diuretic users have adverse clinical outcomes in CKD population. Hyponatremia is associated with imbalanced TBW and is a prognostic indicator for RRT in diuretic users, but not in diuretic non-users. Hyponatremia was not associated with all- cause mortality or cardiovascular event whereas hypernatremia was associated with an increased risk for all-cause mortality. Therefore, the serum sodium levels of patients with CKD who are being treated with diuretics should be routinely evaluated. Additionally, interventions other than diuretics aimed at achieving optimal fluid status should be considered. Whether the mechanism behind hyponatremia is diuretic-induced direct renal injury or neuro-hormonal activation requires further study.
Participants and Measurement
Between November 11, 2002, and June 30, 2009, 5,047 patients who were screened through an integrated CKD care program at 2 affiliated hospitals of Kaohsiung Medical University in Southern Taiwan were included in the CKD cohort and followed until July 31, 2010. Integrated CKD care program Kaohsiung for delaying dialysis (ICKD) study was designed as a prospective cohort study to investigate the impact of an integrated CKD care program on clinical outcomes in patients with CKD stages 1–5 not on dialysis. CKD was staged according to K/DOQI definitions and the estimated glomerular filtration rate (eGFR) was calculated using the equation of the 4-variable Modification of Diet in Renal Disease (MDRD) Study. A total of 123 patients who were lost to follow-up within 3 months and 158 patients with incomplete medication information were excluded. Of the patients included, 3,659 were treated as part of the integrated care program and 1,107 received regular care. A total of 4,766 patients with CKD between stages 1 and 5 were eligible for this study. The study protocol was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUH-IRB-990198). Written informed consent was obtained from patients and all clinical investigations were conducted according to the principles expressed in the Declaration of Helsinki.
Baseline variables included demographic features, medical history, examination findings, laboratory data, and medication history. The demographic features were the baseline records when patients enrolled in the CKD care program. The medical history was obtained by reviewing doctor charts. DM and hypertension were defined according to clinical diagnoses and prescribed medications. CVD was defined as a clinical diagnosis of heart failure, acute or chronic ischemic heart disease, or cerebrovascular disease. Diuretic use was defined as loop diuretics exceeding equivalent furosemide 39 mg per day or thiazide diuretics exceeding equivalent trichlormethiazide 3.9 mg per day for more than half of the observation period. Other medication use was also defined as treatment for more than half of the observation period. To prevent variability, electrolytes including serum sodium were collected 3 months before and after enrollment and were averaged. To study the association of clinical outcomes with 2 ends of sodium level, patients were divided into 4 groups according to serum sodium levels, with cut-off values of 135 mEq/L, 138 mEq/L, and 141 mEq/L equal to mean −1 standard deviation (SD), mean, and mean +1 SD, respectively. We also examined serum sodium as a continuous predictor using restricted cubic spline analysis52.
Bioelectrical impedance analysis measures the change in impedance of electrical signals, which travel more rapidly through water and lean body mass than through fat body mass. The device used in this study was the InBody 230 (Biospace Co Ltd, Korea), which uses 2 frequencies (20 k and 100 kHz). Our preliminary data demonstrated that the first and fourth quartiles of TBW (expressed as % of body weight) were associated with adverse clinical outcomes. Accordingly, we defined decreased TBW as the first quartile (<25%) and increased TBW as the fourth quartile (>75%).
Three outcomes were assessed: all-cause mortality, renal replacement therapy (RRT), and cardiovascular events. Survival status and cause of death were ascertained in a death certificate review by using charts and the National Death Index. Cardiovascular events were defined as the development of acute coronary syndrome or acute stroke, hospitalization for peripheral arterial occlusion disease or congestive heart failure, and death by these causes. The development of cardiovascular events was ascertained by reviewing charts. RRT was defined as the initiation of hemodialysis, peritoneal dialysis, or renal transplantation and was ascertained by reviewing charts and catastrophic illness certificate.
Statistical Analysis
The baseline characteristics of all patients are expressed as percentages for categorical data, in mean ± SD for continuous variables with approximately normal distribution, and median and interquartile ranges for continuous variables with skewed distribution. The association between hyponatremia (Na<135 mEq/L) and clinical variables including TBW in diuretic users was evaluated using logistic regression analysis. Competing risk Cox proportional hazard analysis was used to assess the relationship between serum sodium and clinical outcomes. The covariates were selected according to previous studies and our past publications, and the continuous variables with skewed distributions were log-transformed to obtain normal distributions. The adjusted covariates included age, gender, estimated glomerular filtration rate (eGFR), DM, cardiovascular disease, mean blood pressure, glycated hemoglobin, hemoglobin, albumin, cholesterol, urine protein-to-creatinine ratio, C-reactive protein, body mass index, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, anti- hypertensive agents, oral anti-diabetic drug, statins, integrated CKD care and causes of renal diseases53. Serum sodium was treated as a categorical variable with the cuf-off at 135, 138, and 141 mEq/L (the 16.6th, 50th, and 83.3th percentile) in Table 4 and as a categorical variable with the cuf-off at 135 and 141 mEq/L (the 16.6th and 83.3th percentile) in Supplement Table 3. Serum sodium was treated as a continuous variable with 5 knots at 130, 135, 138, 141, and 143 (the 5th, 16.6th, 50th, and 83.3th, and 95th percentile) in Figs 1, 2 and 3 and Supplement Figures 1, 2 and 3 and as a continuous variable with 5 default knots at 130, 136, 138, 140, and 143 (the 5th, 27.5th, 50th, 72.5th, and 95th percentile) in Supplement Figures 4–6. P < 0.05 was considered statistically significant. Statistical analysis was performed with STATA 12.0 software (Stata Corp LP, College Station, TX, USA) and the Statistical Package for Social Sciences, Version 21.0 for Windows (SPSS Inc., Chicago, IL, USA).
Additional Information
How to cite this article: Lim, L. M. et al. Hyponatremia is Associated with Fluid Imbalance and Adverse Renal Outcome in Chronic Kidney Disease Patients Treated with Diuretics. Sci. Rep. 6, 36817; doi: 10.1038/srep36817 (2016).
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Lim, L., Tsai, NC., Lin, MY. et al. Hyponatremia is Associated with Fluid Imbalance and Adverse Renal Outcome in Chronic Kidney Disease Patients Treated with Diuretics. Sci Rep 6, 36817 (2016). https://doi.org/10.1038/srep36817
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Reference: apmterminals.com
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I am writing to you following yesterday's announcements by the Prime Minister and the Secretary of State for Education (Gavin Williamson). The decisions made by government have undoubtedly meant there have been a number of unprecedented implications for our school, our local community and for our country as a whole. We are in unchartered territory and the landscape is changing significantly on a daily basis. It is my role as the headteacher and our role as a team of staff, to navigate through these challenging times and to offer as much clarity as possible amidst much national unrest and confusion. Last night, the Prime Minister's announced that schools will close from Friday 20 March, with some very important exceptions. Please can I ask that you read the letter carefully and in full, as responses will be required from a section of our parents and carers, that will be vital in our planning tomorrow and going forward.
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Last night, schools received initial guidance via email as to who is defined as a key worker. Please could you take a moment to consider whether you would identify yourself as a key worker. If you do, and you are unable to make alternative childcare arrangements, I ask that you undertake the following steps as numbered below by 10.30 am on Friday 20 March, to aid us in preparing a plan for our school. It is important to note that we are trying to minimise this number to support the manageability of these arrangements and prevent further spread of infection. We would ask that requests for supervision are only made where all other options have been considered.
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- The days and specific times you work each week
- Let us know what day(s) and times (am and/or pm) you would require support
- State whether it would be essential due to your circumstances, that you would need 'holiday care' during the Easter and May holidays*
*We cannot confirm at this moment if holiday care will be available and I am already aware that this will present some specific challenges to school, however; I will be endeavouring to work to provide it, if it is possible and safe to do so.
For those children who have an EHCP or an allocated social worker, we will offer the same service as for children of key workers. If you wish to 'take up' this offer, please can you complete the steps outlined below:
- Email email@example.com with your name and your child's name
- State whether you need to 'take up' this offer of support
- If you answer yes to question 2, please could you let us know let us know what day(s) and times (am and/or pm) you would require support
The government advice is that 'children who do not fall into these groups should remain at home with appropriate care'.
Mr Clarke has included a specific page of advice in this term's Haslingden Highlights magazine and this will be made available separately on the school website by early next week. It provides a list of some useful websites and resources that will help students to keep themselves safe and to support parents in having akppropriate converations. It has a focus on the need to carefully consider online safety and some useful links to inform discussions at home. In addition, our school website offers a wealth of useful information on our 'Pastoral Advice' section.
Where possible, keeping your family at home is the safest way of preventing the spread of the virus and from catching it. In the letters dated 11 and 16 March we explained how work will be set by the school for your child going forward. Teachers held specific meetings on Wednesday 18 March to finalise their plans and work will be in place to share with students. The work will be posted on Show My Homework for Year 8-13 and on Edulink for Year 7 and specific instructions will be offered on those sites. This may require students to use other software, webpages or their exercise books. Mr Roper has invited any parent to contact him where there may be difficulty accessing Show My Homework or Edulink via his email firstname.lastname@example.com. There is also helpful advice on the school website for both the online platforms.
We are also investigating how we can support children who are eligible for free school meals. We had discussed this as a senior leadership team prior to the announcement yesterday and hope to ensure that an equivalent to the normal school lunch is offered to all those who would normally receive this free during the school day. The government has outlined their commitment to supporting children eligible for free school meals through a national voucher scheme but we have not been informed of any specific plans as yet. We hope to receive instructions before school closes on Friday and will of course, share these plans with you as parents.
Today we will be organising for those who are currently loaning an iPad, to take it home as a device for learning. We have also issued all students with an additional blank exercise book. We hope that students will continue to use their subject specific exercise book for the work issued by class teachers but wanted to ensure there was additional paper should it be needed.
Beyond the immediate practical arrangements of school closure, last night's announcement also confirmed that the Department for Education will not go ahead with assessments or examinations in May and June of this year. Whilst we welcomed an update, we are acutely aware of the negative impact this may have on so many of our students and staff, who have worked tirelessly, not only in recent weeks but over several years to prepare for these examinations. Gavin Williamson made a further announcement this morning that began to answer some of the questions all schools have been seeking clarity on and confirmed that there will be no GCSE or A-Level examinations for students in Years 11 and 13. We are currently lacking the specific details as to how individual grades will be awarded and there is significant pressure from the profession, asking the government to make this process clear. In the meantime, we are asking all students to complete all work set and ensure that they preserve their work as this may form part of a wider moderation process in the future. More details will be provided in due course.
Added to this uncertainty, it also remains unclear as to how long schools will be closed for and whether Friday could be the last day for some of our Year 11 and 13 students. I am sure we can all agree that this would not be the way any of us would wish to part company given the fantastic relationships we have forged throughout that time. The prom, due to its timing in the academic year, remains in doubt and we will be discussing alternative opportunities to adequately facilitate celebrations and goodbyes. This will be an upsetting time for many and we changed the planned assembly arrangements to meet with Year 11 and 13 this morning to offer our support and field any questions they may have.
In terms of our staff, who have worked diligently and professionally over the past few weeks, I want to publicly thank them for their positive approach to this unprecedented national crisis and I look forward to working closely together with them over the next days and weeks to refine our plans. We now know the part we must play in this crisis and I am confident we will, as we have done so many times, find a way to succeed in the most demanding of situations.
I would like to ask for your direct support as parents and politely request that over the next two days, as we busily plan for the next few weeks and months, please only contact the school office or email if absolutely necessary. This will help us to focus on the essential jobs we have to undertake in a very short space of time. I have tried to provide as much information as possible in this letter and also highlight the information we are currently lacking, to prevent repeated questions arriving in to school that we simply cannot answer at present.
We will continue to try to support our children and their families in difficult circumstances and do all we can to keep our community safe. Please can I ask that you do all you can to stay safe and would urge that you act in accordance with the latest government advice. Finally, to consider, where possible, how you can add value to your local community, particularly to those who are most vulnerable at this immensely difficult time.


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Sonbhadra killings: Priyanka Gandhi meets victims' relatives after being detained for 24 hours
She met two relatives but 15 others were not allowed to see her, Gandhi said. Meanwhile, 3 TMC leaders, including MP Derek O'Brien, were detained in Varanasi.
Congress General Secretary Priyanka Gandhi Vadra, who was stopped on her way to a village in Sonbhadra district in Uttar Pradesh on Friday, met two relatives of the victims of a shootout on Saturday, ANI reported.
"Two relatives of victims have come here to meet me, 15 others are not being allowed to meet me," she told ANI. "Even I am not being allowed to meet them. God knows what their [government's] mentality is. You [the media] put some pressure [on the government], let the victims meet me. The administration should help these people."
Gandhi had spent the night sitting on a dharna at a guest house in Mirzapur, NDTV reported. Senior government officials met the Congress leader late at night to hold talks, but Gandhi refused to leave without meeting the families affected by a shootout in the village that killed 10 people.
"UP Government sent Varanasi ADG Brish Bhushan, Varanasi Commissioner Deepak Agrawal, DIG Mirzapur to tell me that I should leave without meeting the affected families," Gandhi said in a tweet early on Saturday. "They are sitting here since the last one hour. They have not explained why they have taken me in custody, they have also not handed me any papers."
"According to my lawyers, my arrest is illegal in all ways," Gandhi added. "They have passed on the government's message to me that I can't meet the affected families. I told them clearly that I did not come here to break any laws but came only to meet the affected families. I have told them I won't go without meeting the affected families."
Gandhi also tweeted a video of the officials leaving the guesthouse. "I can go to the village alone," she said according to the Hindustan Times. She alleged that the Uttar Pradesh government is protecting land sharks and oppressing the poor.
Congress leader Pramod Tiwari said the Adityanath government does not want anybody to wipe the victims' tears, ANI reported. "Whatever has happened is unconstitutional and undemocratic and it seems as if Uttar Pradesh government has implemented undeclared emergency to hide its sins and shortcomings," he added.
Meanwhile, a three-member Parliamentary delegation of the Trinamool Congress, led by Derek O'Brien attempted to visit Sonbhadra on Saturday. However, they were stopped from doing so. Subsequently, the delegation sat on a dharna at Varanasi Airport, ANI reported. The Trinamool Congress tweeted a video of O'Brien's dharna from the airport.
Chhattisgarh Chief Minister Bhupesh Baghel is also expected to join Gandhi.
On Friday, Congress workers on the dharna with Gandhi claimed that the district administration had deliberately cut off power to the guest house, in order to force her out. Gandhi had earlier in the day been taken into preventive custody.
Ten villagers were killed and at least 19 were injured when a village head and his supporters fired at them over a land dispute in Ubha village in Sonbhadra district of Uttar Pradesh on Wednesday. The attack on the villagers from the Gond community was carried out by people belonging to the Gujjar community. At least 26 people, including village head Yaghya Dutt Bhuriya, had been arrested till July 19.


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Feature Summary: D-Mode for Optimized Outbound Delivery
D-Mode is a feature key-enabled feature that optimizes certain email gateways for outbound email delivery. Features specific to inbound mail handling are disabled in D-Mode.
Features Unique to D-Mode-Enabled Email Gateways
- 256 Virtual Gateway Addresses - The Cisco Virtual Gateway technology allows you to configure enterprise mail gateways for all domains you host — with distinct IP addresses, hostname and domains — and create separate corporate email policy enforcement and anti-spam strategies for those domains, while hosted within the same physical email gateway. See information about "Customizing Listeners" in Configuring the Gateway to Receive Email
- IronPort Mail Merge (IPMM) - IronPort Mail Merge (IPMM) removes the burden of generating individual personalized messages from customer systems. By removing the need to generate thousands of individual messages and transmit them between message generating systems and the email gateway, users benefit from the decreased load on their systems and increased throughput of email delivery. For more information, see Sending Bulk Mail Using IronPort Mail Merge (IPMM).
- Resource-conserving bounce setting - You can configure D-Mode-enabled email gateways to detect potential blocked destinations and bounce all messages bound for that destination. For more information, see Configuring Resource-Conserving Bounce Settings.
- Enhanced performance for outbound delivery
Standard Features Disabled in D-Mode-Enabled Email Gateways
- IronPort anti-spam scanning and on or off box spam quarantining — Because anti-spam scanning pertains mostly to incoming mail, the IronPort Anti-Spam scanning engine is disabled. The Anti-Spam chapter is, therefore, not applicable.
- Outbreak Filters — Because the Outbreak Filters feature is used to quarantine incoming mail, this feature is disabled on D-Mode-enabled email gateways. Information in the Outbreak Filters chapter is, therefore, not applicable.
Service Logs - The Service Logs feature is disabled on D-mode enabled email gateways.
- Reporting — Reporting is limited. Some reports are not available, and the reporting that does occur is set to run at a very limited level for performance reasons.
The totals shown in the Email Security Monitor Overview report for D-Mode-enabled email gateways may erroneously include spam and suspect spam counts, even though these features are disabled on D-Mode-enabled email gateways.
- Data Loss Prevention — DLP scanning for outgoing messages is disabled on D-Mode-enabled email gateways.
Standard Features Applicable to D-Mode-Enabled Email Gateways
More Information
Anti-virus scanning
See Anti-Virus
Domain Key signing
DKIM/Domain Keys is a method for verifying authenticity of email based on a signing key used by the sender. See Email Authentication
Centralized management
Delivery throttling
For each domain, you can assign a maximum number of connections and recipients that will never be exceeded by the system in a given time period. This "good neighbor" table is defined through the destconfig command.
For more information, see Controlling Email Delivery Using Destination Controls.
Bounce Verification
Verify the authenticity of bounce messages. See Bounce Verification.
Delegated administration
Trace (debug)
VLAN, NIC-pairing
Optional Anti-virus engine
You can add optional anti-virus scanning to ensure the integrity of your outbound messages. See Anti-Virus Scanning Overview.


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Roman-Carthaginian Relations Before the Punic Wars
|✅ Paper Type: Free Essay
|✅ Subject: Theology
|✅ Wordcount: 1592 words
|✅ Published: 18th May 2020
In Virgil's Latin epic poem The Aeneid, Virgil wrote about Juno trying to kill the Trojans by sinking their ships, however, Neptune interfered and protected the Trojans because he did not like Juno being malicious inside the seas which was his territory. To avoid this, Aeneas and his fleet fled to the coast of Africa where they eventually made their way to Carthage. Once Aeneas was at Carthage he tried to improve relations with the queen of Carthage, Dido, in order to survive. At the time, Carthage was only a small city-state that was founded by Phoenician settlers from Tyre. This early interaction was a peaceful one, but the relationship between the Romans and the Carthaginians soon evolved into one of the most well-known rivalries in history. Both were the rising empires of the time with the constant expansion and warfare of the Romans, and the dominant trade and colonization of the Carthaginians. Both of these powers eventually grew so large in power that they began to battle over territory in a series of conflicts known as the Punic Wars. However, the relationship between the Romans and the Carthaginians wasn't always so bitter. Both nations had amicable relations and several alliances before the start of the First Punic War. What caused this relationship to deteriorate can be boiled down to the Romans and the Carthaginians expanding spheres of influence colliding in Sicily and Roman cultural beliefs overshadowing any sort of militaristic or commerce alliance they would have had with Carthage.
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Since the Carthaginians and the Romans discovered each other up to 279 BCE, the relationship between the two powers was mostly in regard to trade. With Carthage expanding its colonies throughout the Eastern Mediterranean and Rome conquering large amounts of Etruria, both civilizations agreed to similar treaties in 509 BCE, 348 BCE, and 306 BCE which established which areas in the central Mediterranean were under whose control. The treaties established the island of Sicily as neutral territory due to its strategic importance and many port cities. The treaties also put regulation on the Romans in order to limit their methods of expansion through Italy and Sicily. Other parts stipulated that there would be a long-lasting friendship between the Romans and its allies with the Carthaginians, specifically stating "There shall be friendship between the Romans and their allies, and the Carthaginians, Tyrians, and township of Utica, on these terms: The Romans shall not maraud, nor traffic, nor found a city east of the Fair Promontory, Mastia, Tarseium."[1] These treaties established trust and peace between Rome and Carthage and limited the expansion of both civilizations in order to avoid conflict. These treaties laid the support for what would be an alliance when going against Pyrrhus and the Greek city-states.
This peaceful state of expansion between these two great powers was tested by Pyrrhus, the king of Epirus, when he aided the people of the greek city-state of Tarentum with their war against the Romans. Pyrrhus initially was successful against the Romans in many of the initial battles but was taking heavy losses that he could not replenish compared to the Roman's large reserves of legionary manpower. Running low on manpower after several battles, Pyrrhus went to Sicily and allied himself with the Greek city-state colonies that had been established there. Worried that Pyrrhus might interfere with the Carthaginian settlements on Sicily, Carthage formed an alliance with the Romans where the Romans would primarily fight with its army and the Carthaginians would assist from the seas with its massive navy. This was useful to the Romans as they had no navy being primarily focused on land combat for most of their history, unlike the Carthaginians who are experienced in shipbuilding due to their trade empire. This Roman-Carthaginian alliance against Pyrrhus caused him great trouble as he had to both fend off the Roman army and the Carthaginian navy. While Pyrrhus was still fighting battles in Sicily and facing heavy losses, he received information from Tarentum that it was difficult to defend the city on their own and that they needed assistance. This forced Pyrrhus to abandon Sicily and return to Greece where he was forced to defend the cities at a high cost to his own manpower. When Pyrrhus returned to Greece, he negotiated for peace and made several concessions to the Romans. This alliance between the Romans and the Carthaginians showed that both civilizations had a high amount of trust between each other and that their relationship was more than friendly, it had military and trade aspects to it as well. With the war over, both civilizations returned to their own respective territories and continued expanding. Yet 11 years later, their spheres of influence collided in the First Punic War.
11 years was a short time period of time for Rome and Carthage to go from allies to full out enemies at war, so there had to be a factor that made their relationship turn sour. This can be narrowed down to Roman culture and tradition. Romans have always been greedy for land and aggressive towards their neighboring civilizations. Unlike the Carthaginians, commerce was not of interest to the Romans, Romans preferred to control as much territory as possible and use that territory's resources to expand the Republic. One of Rome's enemies, a king named Mithridates, stated that Romans were "Warmongers against every nation, people and monarch under the sun, They have only one abiding motive – greed, deep-seated, for empire and riches."[2] Although the Romans had a friendly relationship with the Carthaginians, curtailing Carthage's expanding sphere of influence took precedence over any alliance in the eyes of the Romans. The alliance and treaties that Rome had with Carthage prevented Rome from expanding towards Carthage. If Rome wanted to go to war with Carthage, Rome would have to find a valid justification to do so in order to break the alliance. Rome found that casus belli in Sicily. Sicily at the time was an important island owned by Carthage centered between Rome and Carthage and had many ports. All of this gave Sicily economic and militaristic importance to the Romans and the Carthaginians. Rome jumped at the opportunity to go to war when border skirmishes occurred starting the First Punic War.
In Virgil's The Aeneid, the initial relationships between Carthaginians and Romans were friendly and had lots of potential. This friendly relationship eventually turned into treaties that respected each other's spheres of influence and alliances that protected each other's spheres of influence from foreign invasion. Yet this relationship eventually turned sour because their spheres of influence started to collide over Sicily and because Roman militaristic cultural beliefs inclined the Romans to conquer its neighbors to eliminate a possible rival rather than maintain any sort of alliance. This sour relationship manifested itself into the First Punic War becoming one of the most famous war of the period.
- https://www.ancient.eu/article/908/carthaginian-society/
- https://onlinelibrary.wiley.com/doi/10.1002/9781444393712.ch2
- http://www.perseus.tufts.edu/hopper/text?doc=Plb.+3.24&redirect=true
- https://www.theguardian.com/culture/2010/nov/08/ancient-world-rome
- https://www.britannica.com/biography/Pyrrhus
- Miles, Richard. Carthage Must Be Destroyed: The Rose and Fall of an Ancient Civilization. New York: Penguin Group, 2010. Print.
- https://en.wikipedia.org/wiki/Treaties_between_Rome_and_Carthage#First_treaty_509_BC
- https://www.reddit.com/r/AskHistorians/comments/1ha9y2/what_were_roman_and_carthagin ian_relations_like/
- http://latin204.tripod.com/essays/romes_relationship.html
- https://en.wikipedia.org/wiki/Pyrrhic_War#Sicilian_campaign_(278-75_BC)
[1] http://www.perseus.tufts.edu/hopper/text?doc=Plb.+3.24&redirect=true
[2] https://www.theguardian.com/culture/2010/nov/08/ancient-world-rome
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Podcast: Play in new window | Download
In this hour we kick things off with news and commentary. Then we discuss the return of the television show "Roseanne " and what the political direction of the show will be. Plus we will talk gun laws and a marriage proposal from last night's football college football game.


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I'm glad that the words, "It is finished!" Came out of Jesus mouth, not "I am finished." I'm all in for small beginnings, incremental progress, and making bold moves, but there's a valley full of corpses that lies between the two peaks of every creative project.
The beginning of a thing.
And the completion.
Between the two a blood drenched chasm where many a creative has given up the ghost and let their dream idea gasp its final breath.
Just as the Scriptures encourage us not to despise beginnings, however inauspicious they may feel, the Holy Ghost also makes mention of the other factor in that equation.
"Better is the end of a thing than the beginning thereof: and the patient in spirit is better than the proud in spirit." (Ecclesiastes 7:8 KJV)
Better to be a finisher than just a starter.
The entrepreneurial and creative malaise is the tendency to love the splash and novelty of new things, but steer clear of the patience required to bring a project to completion. The half read and half written books, the incomplete training materials, that expensive course you purchased and watched only the first three videos.
Jesus was able to say,
"I have glorified thee on the earth: I have finished the work which thou gavest me to do…
Did he heal every single sick person? Raise all souls from poverty? Crush every demon on the planet and take His throne as ruler of the earth?
No, not at this time. His commission was clear in His mind, and He knew the parameters His Father had prescribed for Him.
"…I have manifested thy name unto the men which thou gavest me out of the world: thine they were, and thou gavest them me; and they have kept thy word." (John 17:4-6KJV)
There were certain ones that were given to Him, and a clear commission how He was to work with them.
Know Your Call
Do you know who you are called to reach? And how and why they have been given to you?
This is a great place to begin, because when you know the part you are called to play in the great Kingdom enterprise, other things come into perspective and clear focus.
Even Jesus in His earthly stewardship was not called to reach everybody, just the ones the Father gave Him out of the world. There were definite goals and guidelines He followed.
The removal of doubt that clarity of commission brings makes finishing:
1. Possible – you are no longer trying to be everything too everyone.
2. Probable – clear sense of purpose and the part you play means you measure your success according to your own God-given mandate, not the mission someone else has been granted.
3. Pleasurable – God equips us inwardly for every outward assignment. You'll find yourself much more inclined to contentment because your commission and it's limitations fit like glove on hand. No more Saul's armour and fighting and fumbling forward trying to be or become something you are not.
Your call is specific:
"As every man hath received a gift, even so minister the same one to another, as good stewards of the manifold grace of God." (1 Peter 4:10)
Someone else's call will be light tight pants. You'll end up chafed and chafing with every step. But when you align your heart with God's purpose, the requirements and results will bring joy to your spirit.
God world and work is vast and all encompassing. Each individual part of His Body has their own special part to play for the upbuilding and maturity of the whole. We represent Jesus in all of His manifold wisdom as a collective, not as lone rangers tooting our own trumpet.
"There are diversities of gifts, but the same Spirit. There are differences of ministries, but the same Lord. And there are diversities of activities, but it is the same God who works all in all. But the manifestation of the Spirit is given to each one for the profit of all." (1 Corinthians 12:4-7)
Remember this, it is where the joints are that the supply is opened up!
"from whom the whole body, joined and knit together by what every joint supplies, according to the effective working by which every part does its share, causes growth of the body for the edifying of itself in love." (Ephesians 4:16 NKJV)
The second key I want to share is a simple one, and far less philosophical.
Break your projects down into component parts.
I will use writing a book as an example, but the principle can be applied to anything creative project you undertake.
A book does not begin life as an epic bestseller, it is a collection of chapters. Those chapters are a collection of paragraphs, and those paragraphs are a collection of words.
Drill down to the smallest component and set your goals in keeping with what can be achieved within a short span of time, preferably in one 2 hour sitting each day.
Milestone achievements of this kind feed motivation to continue. Every day becomes a day to celebrate completing, because instead of looking at the distant "The End" as your final flourish, you have 500 words or 30 minutes of concentrated focus in one direction as your yardstick.
With each victory your determination is bolstered and progress is inevitable.
I don't want to over simplify things, but it really does not get much more complicated that this. Do something every single day to progress your most important, heart felt projects.
If you fall off the wagon, get back on quickly and don't lose steam. Certainly don't waste a moment feeling guilty. Guilt is fruitless emotion. Conviction and commitment quite the opposite.
Make Your Progress Public
Finally, and perhaps this may be the key that unlocks consistency, make your progress public. Work openly, or with others, and be accountable to your promises and passions. Be ready to be pulled up, pushed and provoked to make good on what you have said.
Now, go get started.
And be sure to finish what you start!