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Modi assures African nations that India will always stand with them
Gandhinagar, May 23, 2017
Prime Minister Narendra Modi today assured African nations that India would always stand with them, shoulder to shoulder, supporting them in the long and difficult race for a better future.
"India's partnership with Africa is based on a model of cooperation which is responsive to the needs of African countries. It is demand-driven and free of conditions," he said at the inauguration of the Annual Meeting of the African Development Bank (AfDB) here.
He said that, as one plank of this cooperation, India extends lines of credit through India's Exim Bank and as many as 152 credits have been extended to 44 countries for a total amount of nearly $ 8 billion so far.
He recalled that, during the Third India-Africa Forum Summit, India had offered $ 10 billion for development projects over the next five years. It had also offered grant assistance of $ 600 million.
Mr. Modi spoke about the strong ties between India and Africa over the centuries. "Historically, communities from western India, especially Gujarat, and the eastern coast of Africa have settled in each other's lands. The Siddhis of India are said to have come from East Africa. The Bohra communities in coastal Kenya date back to the twelfth century. Vasco da Gama is said to have reached Calicut with the help of a Gujarati sailor from Malindi. The dhows of Gujarat took merchandise in both directions. Ancient links between societies have also enriched our cultures. The rich Swahili language includes many Hindi words," he said.
He mentioned the thousands of Indians who went to Kenya to build the iconic Mombasa-Uganda railway and stayed back to start small businesses. During the colonial years, merchants, artisans and later officials, teachers, doctors and other professionals went to East and West Africa creating a vibrant community which combines the best of India and Africa, he said.
Mr. Modi also spoke about Mahatma Gandhi, another Gujarati, who perfected his tools of non-violent struggle in South Africa.
"Over decades, our ties have become stronger. After assuming office in 2014, I have made Africa a top priority for India's foreign and economic policy. The year 2015 was a watershed. The third India Africa Summit held that year was attended by all fifty-four African countries having diplomatic relations with India. A record forty-one African countries participated at the level of Heads of State or Government," he said.
The Prime Minister said that, since 2015, he had visited six African countries: South Africa, Mozambique, Tanzania, Kenya, Mauritius and Seychelles. India's President has visited three countries -- Namibia, Ghana and Ivory Coast -- and the Vice-President visited seven countries -- Morocco, Tunisia, Nigeria, Mali, Algeria, Rwanda and Uganda. "I am proud to say that there is no country in Africa that has not been visited by an Indian Minister in the last three years," he sai
"From a time when we mainly had mercantile and maritime links between Mombasa and Mumbai, we have today this Annual meeting which connects Abidjan and Ahmedabad; business links between Bamako and Bangalore; cricketing links between Chennai and Cape Town; development links between Delhi and Dakar," he said.
Mr. Modi said India was proud of its educational and technical ties with Africa. Thirteen current or former Presidents, Prime Ministers and Vice-Presidents in Africa have attended educational or training institutions in India. Six current or former chiefs of armed forces in Africa trained in India's military institutions. Two current Ministers of the Interior have attended Indian institutions. Under the popular India Technical and Economic Cooperation Programme, more than thirty three thousand scholarships have been offered to officials from African countries since 2007, he said.
He also mentioned the training of "solar mamas", as part of which every year eighty African women are trained in India to work on solar panels and circuits. "After their training they go back and literally electrify their communities. Each woman is responsible for electrifying 50 houses in her community on return. A necessary condition for the women to be selected is that they be illiterate or semi-literate. They also learn several other skills, like basket making, bee keeping, and kitchen gardening during their stay," he said.
"We have successfully completed the Pan Africa e-network project for tele-medicine and tele-network covering 48 African countries. Five leading universities in India offered certificate, under graduate and post graduate programmes. Twelve super-speciality hospitals offered consultations and Continuous Medical Education. Around seven thousand students have concluded their studies. We will soon launch the next phase.
"We will soon successfully complete the Cotton Technical Assistance Programme for African Countries launched in 2012. The project was implemented in Benin, Burkina Faso, Chad, Malawi, Nigeria and Uganda," he said.
Mr. Modi said Africa-India trade has multiplied in the last 15 years. It has doubled in the last five years to reach nearly $ 72 billion in 2014-15. India's commodity trade with Africa in 2015-16 was higher than its commodity trade with the United States of America, he said.
"India is also working with United States and Japan to support development in Africa. I gladly recall my detailed conversation with Prime Minister Abe during my visit to Tokyo. We discussed our commitment for enhancing growth prospects for all. In our joint declaration, we mentioned an Asia Africa Growth Corridor and proposed further conversations with our brothers and sisters from Africa.
"Indian and Japanese research institutions have come up with a Vision Document. I congratulate RIS, ERIA and IDE-JETRO for their efforts in putting it together. This was done in consultation with think tanks from Africa. I understand the Vision Document would be presented at the Board meeting later. The idea is that India and Japan, with other willing partners, would explore joint initiatives in skills, health, infrastructure, manufacturing and connectivity," he said.
Mr. Modi said their partnership was not confined to Governments alone and India's private sector was at the forefront of driving this impetus.
"From 1996 to 2016, Africa accounted for nearly one-fifth of Indian overseas direct investments. India is the fifth largest country investing in the continent, with investments over the past twenty years amounting to fifty four billion dollars, creating jobs for Africans. We are encouraged by the response of African countries to the International Solar Alliance initiative, which was launched at the UN Climate Change Conference in Paris in November 2015. The Alliance is conceived as a coalition of countries rich in solar resources, to address their special energy needs. I am happy to note that many African countries have extended their support to this initiative," he said.
He said that as a founder of the New Development Bank, popularly called the "BRICS Bank", India has consistently supported establishment of a Regional Centre in South Africa. This will provide a platform to promote collaboration between NDB and other development partners including the African Development Bank, he said.
He recalled that India joined the African Development Fund in 1982 and the African Development Bank in 1983. India has contributed to all of the Bank's General Capital Increases. For the most recent African Development Fund replenishment, India pledged $ 29 million. It has contributed to the Highly Indebted Poor Countries and Multilateral Debt Reduction Initiatives.
Mr. Modi said that, on the sidelines of the annual meetings, the Government of India is organising a Conference and Dialogue in partnership with the Confederation of Indian Industry. There is also an exhibition in association with the Federation of Indian Chambers of Commerce and Industry. The focus areas range from Agriculture to Innovation and start-ups and other themes.
The theme of this event is "Transforming Agriculture for wealth creation in Africa". This is an area where India and the Bank can fruitfully join hands, he said, mentioning in particular the Cotton Technical Assistance Programme.
"Here in India, I have launched an initiative to double farmers' incomes by 2022. It will require concerted steps, ranging from improved seeds and optimal inputs, to reduced crop losses and better marketing infrastructure. India is keen to learn from your experiences as we proceed on this initiative.
"Many of the challenges we face are the same: uplifting our farmers and the poor, empowering women, ensuring our rural communities have access to finance, building infrastructure. We have to do these within financial constraints. We have to maintain macro-economic stability so that inflation is controlled and our balance of payments is stable. There is much for us to gain by sharing our experiences on all these fronts. For example, in our push to a less-cash economy, we have learnt from the great strides that African countries like Kenya have made in the area of mobile banking.
"I am happy to share that India has, in the last three years, improved on all macro-economic indicators. The fiscal deficit, balance of payments deficit, and inflation are down. The GDP growth rate, foreign exchange reserves and public capital investment are up. At the same time, we have made big strides in development," he said.
"Mr. President of the African Development Bank, it is reported that you have described our recent steps as text book chapters for other developing nations and called us a development beacon. While thanking you for these kind words, I am also glad to know that you have spent quite some time training in Hyderabad earlier. However, I must say that I remain focused on the many challenges ahead. In that context, I thought I could share with you some of the strategies we have used in the last 3 years.
"By paying subsidies directly to the poor rather than indirectly through price concessions, we have achieved large fiscal savings. In cooking gas alone we have saved over 4 billion dollars in three years. In addition, I appealed to well-off citizens to voluntarily give up their gas subsidy. Under the 'Give it up' campaign, we promised the saving would be used to provide a connection to a poor family. You will be surprised to know that over 10 million Indians volunteered to do so. Thanks to the savings, we have launched a programme to provide gas connections to 50 million poor families. More than 15 million connections have already been provided. This transforms the lives of rural women. It frees them from the health hazards of cooking with firewood. It also protects the environment and reduces pollution. This is an example of what I call 'reform to transform': a concerted set of actions which transform lives.
"Some of the subsidised urea fertiliser intended for farmers used to get illegally diverted to non-agricultural uses, like production of chemicals. We introduced universal neem-coating of urea. This makes the fertiliser unsuitable for diversion. Not only have we got substantial financial savings but in addition, studies have shown that neem coating has improved the effectiveness of the fertiliser.
"We are also providing our farmers with soil health cards which tell them the exact nature of their soil, and advise on the best mix of inputs. This promotes optimal use of inputs, and increases crop yield.
"We have made unprecedented increases in capital investment in infrastructure, covering railways, highways, power, and gas pipelines. By next year, no village in India will be without electricity. Our Clean Ganga, Renewable Energy, Digital India, Smart Cities, Housing for All and Skill India missions are preparing us for a cleaner, more prosperous, faster growing and modern new India. Our aim is that India must be an engine of growth as well as an example in climate friendly development in the years to come.
"There are two crucial factors which have helped us. The first set of changes is in the banking system. In the last three years, we have achieved universal banking. We launched the Jan Dhan Yojana or People's Money campaign under which over two hundred and eighty million bank accounts have been opened for the poor in urban and rural areas. Thanks to that initiative, virtually every Indian family has a bank account. Normally banks are associated with helping businesses and the rich. We have enlisted them for helping the poor in their quest for development. We have strengthened our state-owned banks by freeing them from political decisions and appointing professional chief executives on merit through a transparent selection process.
"Our universal biometric identification system called Aadhaar has been the second crucial element. It prevents claiming of benefits by those who are not eligible. It enables us to ensure that those who deserve government aid receive it with ease, while excluding non-genuine claims," he added.


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Cardiovascular Disease in Diabetes
- ADA, American Diabetes Association
- apo, apolipoprotein
- CAD, coronary artery disease
- CETP, cholesterol ester transfer protein
- CVD, cardiovascular disease
- DCCT, Diabetes Control and Complications Trial
- IMT, intima-media thickness
- PET, positron emission tomography
- SPECT, single-photon emission-computed tomography myocardial perfusion imaging
- UKPDS, UK Prospective Diabetes Study
Perspectives on the News commentaries are part of a free monthly CME activity. The Mount Sinai School of Medicine, New York, New York, designates this activity for 2.0 AMA PRA Category 1 credits. If you wish to participate, review this article and visit www.diabetes.procampus.net to complete a posttest and receive a certificate. The Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
This article is based on presentations addressing aspects of cardiovascular disease in diabetic patients at the American Diabetes Association's 67th Scientific Sessions, 22–26 June 2007, in Chicago, Illinois; at the 55th Annual Advanced Postgraduate Course, 1–3 February 2008, in San Francisco, California (the course is available online at http://professional.diabetes.org); and at the Mount Sinai Medical Center Diabetes Grand Rounds, 14 February 2008, in New York, New York.
Evaluation of coronary artery disease
At a symposium on the evaluation of cardiac ischemia and macrovascular disease in patients with diabetes held at the American Diabetes Association (ADA) meeting, Theodore Mazzone (Chicago, IL) discussed approaches to subclinical ischemia in diabetes. There is a well-established relationship between diabetes and adverse outcome, as first demonstrated in the East-West Study of a Northern European population with a 3.5% 7-year cardiovascular disease (CVD) mortality rate among nondiabetic individuals without a history of myocardial infarction. Subjects with a history of myocardial infarction had an 18.8% risk, while those without a history of myocardial infarction but with a history of diabetes had a 20.2% 7-year risk (1), forming the basis of the argument that type 2 diabetes is a coronary artery disease (CAD) equivalent. Subsequent trials comparing diabetic patients without known CVD to nondiabetic patients with CVD, Mazzone stated, have confirmed that "the risk is pretty close in most populations." Schramm et al. (abstract 692) presented an interesting view of this phenomenon at the ADA meeting, stratifying the 5-year combined rate of myocardial infarction, stroke, and CVD death by age among 3,274,479 men and women in Denmark followed from 1997 to 2001. There was striking similarity of event rates in both sexes and at all ages among 79,574 nondiabetic individuals with past myocardial infarction compared with those among 71,801 individuals with diabetes alone. In the East-West Study, those with both a history of diabetes and prior myocardial infarction had a striking increase in 7-year risk to 45%, with the Danish study similarly showing markedly increased event rates among diabetic patients with a history of myocardial infarction. Mazzone suggested, however, that one must be cautious in assuming that most individuals with type 2 diabetes "really have CAD," stating instead that, in a typical individual with diabetes, "we do not know enough." Furthermore, after a cardiovascular event the biology of the coronary circulation may change such that it is difficult to readily quantitate the "amount of CAD." (Abstract numbers refer to the American Diabetes Association Scientific Sessions, Diabetes 56 [Suppl. 1], 2007.)
Mazzone reviewed data from the Framingham Offspring Study, in which the relationship between CVD event rates and abnormalities of the electrocardiogram, echocardiogram, ankle-brachial index, carotid ultrasound, and level of albuminuria were assessed. Eighty-seven percent of diabetic subjects had at least one abnormal test. While these markers of occult disease were associated with increased risk, the increased event rates among diabetic patients were not fully explained when these measures were taken into account. In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study of 522 diabetic individuals with average age 60 years and diabetes duration 8 years, 21% of whom had a history of CAD, sestamibi single-photon emission-computed tomography myocardial perfusion imaging (SPECT) stress testing was abnormal in only 113, of whom 30 had global left ventricular dysfunction and 83 showed a regional perfusion deficit, of moderate or large size in 33 (2).
Is it, then, possible to stratify patients to increase the likelihood of a positive test? Existing predictive equations, such as the Framingham Risk Score and that developed specifically for diabetic patients from the DECODE (Diabetes Epidemiology: Collaborative Analysis Of Diagnostic Criteria in Europe) study data, either under- or overestimate risk of fatal CAD by 20–50% when applied to the UK Prospective Diabetes Study (UKPDS) population. Perhaps, Mazzone suggested, LDL and HDL cholesterol, A1C, age, and sex may not be sufficiently precise predictors of CVD event rates. The increased atherosclerosis in diabetes may be related to glycated proteins in the vessel wall; to the proinflammatory, procoagulant state of insulin resistance; or to specific elements of diabetic dyslipidemia (such as low HDL cholesterol or the elevated levels of free fatty acids; small, dense LDL; and large, cholesterol ester–rich VLDL particles) (3). Studies of atherectomy specimens from diabetic versus nondiabetic individuals show more macrophages, a larger and more necrotic lipid core, and more superimposed thrombus. In Mazzone's study of potential explanatory factors for coronary artery calcification, however, risk was, again, only predicted by the traditional factors of age, sex, race/ethnicity, systolic blood pressure, and VLDL cholesterol (with most of the patients receiving statins, LDL level was not a significant predictor).
The current ADA recommendations are that cardiac stress testing is warranted for diabetic patients with typical or atypical symptoms and those with an abnormal resting electrocardiogram, with screening not currently recommended for asymptomatic patients (4). Mazzone questioned whether there is evidence that screening will lead to an intervention that will improve outcome. In a trial of nondiabetic patients with CAD, percutaneous coronary intervention plus medical treatment was not different from intensive medical treatment alone in risk of death, myocardial infarction, or other major cardiovascular events (5). "What do we do," Mazzone asked, "when we screen an asymptomatic diabetic patient?" If there is no evidence that percutaneous coronary intervention improves outcome and if there is no strategy clearly differentiating whether a given diabetic patient is at low or high risk, he suggested, "we are left with medical therapy for asymptomatic diabetic patients." The only medical therapy recommendation for which CAD status is considered is the lower LDL cholesterol goal for individuals with established CAD. In most ways, Mazzone suggested, the asymptomatic diabetic patient found to have CAD more resembles one without than one with symptomatic CAD. "Widespread screening," he commented, "will be very expensive and will lead to interventions that will also be very expensive," as well as being associated with substantial risk of restenosis and other procedure-related complications. "We're left with assessing CV risk using the standard risk factors," with the A1C goal <7% the one "for which we have less unequivocal evidence."
Gary Balady (Boston, MA) discussed use of exercise electrocardiography and echocardiography in diabetic patients, noting that stress testing is designed to determine whether there are areas of decreased arterial supply under circumstances of increased demand. A measure of myocardial demand is the product of heart rate and systolic blood pressure, with myocardial wall stress related to ventricular diameter, pressure, and wall thickness and myocardial contractility, the per beat degree of myocardial shortening, also contributing. With graded increments in exercise, heart rate and systolic blood pressure increase to a goal 85% of maximal heart rate, estimated as 220 minus years of age, as lower achieved heart rates may result in falsely negative tests. Ischemic ST depression, either horizontal or downsloping, is measured in millimeters from the PR segment. The sensitivity of the electrocardiogram is lower for inferior or inferolateral ischemia than for ischemia in the distribution of the left coronary artery.
Age, sex, and symptoms are used in assessing the a priori likelihood that a person has significant CAD, but these features are less useful in the diabetic patient, given the greater likelihood of CAD in diabetic women, the occurrence of CAD in diabetic patients at younger ages, and the higher prevalence of asymptomatic CAD in diabetic patients in general. A coronary arteriogram is considered appropriate for distinguishing true- and false-positive and -negative stress testing, but typically it is carried out in individuals who have a positive test and are clinically at high risk, leading to overestimation of sensitivity and underestimation of specificity. In fact, Balady suggested, the sensitivity and specificity of the exercise electrocardiogram are <70% (6). Furthermore, he agreed with Mazzone that one must question the effectiveness of intervention based on a positive test. It may be more important that a negative test be associated with good prognosis. Exercise capacity is a further independent prognostic factor, as is heart rate recovery after exercise, with a pulse decrease by <12 bpm in the first minute associated with increased mortality (7). In a study presented at the ADA meeting, Johansen et al. (abstract 635) found abnormal coronary angiography in 23 of 91 asymptomatic type 2 diabetic patients, showing sensitivity of 0.35 with specificity 0.68 for exercise electrocardiography with ≥1 mm ST segment depression and sensitivity of 0.30 with specificity 0.72 for abnormal dobutamine stress echocardiography. Sensitivity was 0.45 with specificity 0.84 when the degree of ST depression was adjusted for the heart rate and was 0.85, with specificity 0.39, for an abnormal heart rate recovery pattern, supporting Balady's view. He suggested that the exercise test can be improved by use of echocardiography, which may show wall motion abnormalities in the inferior portion of the heart and which is useful in patients with left bundle branch block or ST segment depression at rest. The likelihood of events is low for the first few years after a negative study, although after several years risk increases, and there is uncertainty about the interval after which repeat testing should be performed. The diagnostic value of the stress echocardiogram has not, however, been assessed in diabetic patients.
Marcelo Di Carli (Boston, MA) discussed nuclear imaging in diabetic patients, reviewing the high prevalence of CAD in asymptomatic diabetic patients. An autopsy study from the Mayo Clinic showed that, among individuals with diabetes and without clinical CAD, half had significant disease, which was severe in one-third. Another Mayo Clinic study of asymptomatic diabetic patients showed that half had an abnormal nuclear scan, with scans in 20% showing a high-risk pattern, considerably exceeding the 6% estimate from the DIAD study discussed above. The conventional SPECT study and the newer positron emission tomography (PET) study are aimed to assess myocardial perfusion, with the latter appearing to be more specific, as it also gives information about changes in ventricular function similar to that found with the stress echocardiogram. Assessment of change in the ejection fraction with stress PET gives additional information pertaining to the extent of coronary disease, and PET is more accurate than SPECT imaging in obese patients and in women with large breast size. As with the stress electrocardiogram or echocardiogram, a normal nuclear imaging study implies good prognosis and would justify not performing catheterization, although Di Carli commented that the nuclear data should be seen as additive to the clinical data. As with stress echocardiography, risk increases several years after a normal study. Reversibility of ischemia may guide decision making as to which patient will derive benefit from an intervention, as benefit of revascularization is only demonstrable in individuals with large areas of reversible ischemia (8), although as yet no clinical trial data supports this. Di Carli noted that the symptom of dyspnea is associated with particularly high risk and may justify cardiac imaging and also suggested that coronary calcification assessment may be a useful screening tool to determine the likelihood of a positive stress test.
Paolo Raggi (New Orleans, LA) discussed the use of coronary artery calcium measurement as a marker for the development of clinical CAD among diabetic patients, complementary to "ischemia imaging" approaches (9). Inflammation leads to formation of osteoblast-like cells from vascular smooth muscle cells in the arterial wall, activated by advanced glycation end products, potentially altering vascular function. There are a variety of genetic and environmental factors leading to atherosclerosis and to coronary calcification in particular, with the metabolic syndrome showing stronger association with the coronary calcium score than does hyperglycemia alone.
Raggi noted that outcome is worse in diabetic than in nondiabetic individuals after intervention, both with bypass and with angioplasty, and at all levels of ischemia, certainly including individuals without evidence of ischemia. However, he also noted that not all diabetic patients are the same and suggested that the concept of diabetes as a CVD risk equivalent is somewhat of an overestimation. Thus, screening is crucial in differentiating higher- from lower-risk diabetic patients. "Calcium," he said, "has been one of the very debated markers," and although "the calcified plaque may be stable, the calcified patient may not be stable," with a high coronary calcium score therefore indicating a individual with a greater degree of atherosclerosis—both occlusive and nonocclusive. In a study of individuals who had cardiac catheterization, coronary calcification scores were more strongly predictive than stenosis of mortality in follow-up. Both the Framingham category and the coronary calcification score are useful in defining risk, and diabetic patients with a low coronary calcium score are at relatively low risk. When comparing the UKPDS score and Framingham Risk Score with the coronary calcium level, the latter is the more powerful risk marker.
Raggi acknowledged that evidence is lacking that screening for CAD prevents adverse outcome, while pointing out that individuals with mild-to-moderate nonobstructive atherosclerosis will not have evidence of ischemia but are at risk of coronary thrombosis. Furthermore, abnormality of sympathetic tone in the setting of autonomic neuropathy may make a stress test difficult to interpret, perhaps leading to higher false-positive rates in diabetic patients. Ideally, screening should identify individuals who would benefit from intervention; Raggi suggested that at present "there's no clarity in the field," considering the ADA recommendations for screening too restrictive because they require symptoms or evidence of disease in other vascular beds. Although there is no answer as to whether the approach is cost-effective, he suggested that coronary calcium score or, alternatively, carotid intima-media thickness (IMT) measurement might be valid approaches to noninvasive ascertainment of risk levels in diabetic patients.
CVD prevention
At the Postgraduate Course, Alan Chait (Seattle, WA) reviewed approaches to CVD prevention. Chait noted that there are limited data regarding benefits of glycemic control in reducing CVD. Follow-up of the Diabetes Control and Complications Trial (DCCT) showed that participants who had prior intensive treatment showed a reduction in CVD (26). Furthermore, epidemiologic analysis of the relationship between CVD and glycemia in the DCCT (10), in the UKPDS (11), and in a meta-analysis of a group of studies (12) suggest that as glucose levels increase there is greater likelihood of CVD. Chait reviewed a number of studies, however, suggesting that the relationship between glycemia and CVD not to be as clear, a situation which has been termed the "glucose paradox." (3) In mice with autoimmune type 1 diabetes not expressing the LDL receptor, he said, "hyperlipidemia completely outweighed the effects of glucose." (13) The 16% decrease in myocardial infarction in the UKPDS failed (though barely) to reach statistical significance, and stroke was nonsignificantly increased by 11%. (14) There was a significant 39% decrease in myocardial infarction and a 41% decrease in stroke with metformin monotherapy, although in the same study the combination of metformin with a sulfonylurea led to significantly more deaths than a sulfonylurea alone, as well as to a nonsignificant increase in diabetes-related events (15). A controversial meta-analysis suggested an increased risk of CVD in individuals receiving rosiglitazone (16), although the number of events was small, events were not adjudicated, and incorrect statistical approaches may have been used, with reanalyses of the data not confirming the significance of the association (17,18). CVD reduction may be seen with pioglitazone (19), but both thiazolidinediones increase heart failure, and neither is associated with reduction in cardiovascular mortality (20). Chait asked, "How do we get a solution to this confusion?" It may be, he suggested, that glycemic treatment should not be carried out with a view to reduction in CVD.
The prevalence of CAD is increased in individuals with metabolic syndrome without diabetes but not in those having diabetes without metabolic syndrome (21), and others have shown that the metabolic syndrome adds risk to that associated with hyperglycemia (22). Metabolic syndrome, then, may be considered a susceptibility syndrome in which visceral adiposity leads to a constellation of risk factors, not all of which are included in the current definition of the syndrome. Chait considered dyslipidemia the critical component, including elevations in triglycerides and borderline elevations in LDL cholesterol with high apolipoprotein (apo)B and low HDL cholesterol levels. Lipoprotein analysis shows high VLDL, with accumulation of remnants, including abnormal VLDL and IDL particles, as well as small, dense LDL and abnormal HDL particles containing apoAI without apoAII in the HDL2 fraction. The primary approach of treatment has been to lower LDL cholesterol, although, paradoxically, LDL cholesterol level is not the primary abnormality in diabetic dyslipidemia.
In the Heart Protection Study, simvastatin reduced events by ∼25% in all subgroups (23). Subset analysis showed similar benefit in individuals with diabetes with or without CHD, with low or high HDL, and with high or low triglyceride levels. In a meta-analysis, statins were associated with reduced CVD mortality in both type 1 and type 2 diabetes (24). Increased CVD risk in individuals with type 1 diabetes was particularly present in the DCCT among those with components of metabolic syndrome under circumstances of intensive insulin treatment (25) and those with increased urine albumin (26) and might also be anticipated in those with CVD risk factors unrelated to diabetes.
An area of great interest has been the development of combination lipid treatment approaches to complement the benefit of statins. Certainly, there is a direct relationship between LDL cholesterol and event rates (27), leading Chait to suggest that "any form of LDL lowering is associated with benefit." The VA-HIT (Veterans Affairs High-Density Lipoprotein Intervention Trial) (28) showed that gemfibrozil reduced CVD mortality, nonfatal myocardial infarction, and stroke by 24% both in individuals with and without diabetes, but the large FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study found a nonsignificant 11% decrease in coronary events and a nonsignificant 11% increase in coronary mortality, with increased venous thromboembolic disease and adverse renal effect (29), so the important question of whether fibrates have benefit additive to that of statins has not been answered, although coming trials should help address this. The combination of simvastatin with niacin lowered LDL cholesterol and triglyceride and raised HDL cholesterol, with angiographic benefit as well as a significant reduction in clinical events in a small angiographic study (30). Niacin also reduced events in the Coronary Drug Project (31) and is not as likely to worsen glycemia as previously thought, with large clinical trials underway to provide further information about this important agent.
HDL mediates reverse cholesterol transport to the liver, but blockade of cholesterol ester transfer protein (CETP) with torcetrapib, although increasing HDL levels, led to increased mortality, myocardial infarction, angina, and heart failure—perhaps because of a drug-specific off-target effect in increasing blood pressure or perhaps by generating dysfunctional HDL (32). Chait commented, "HDL is incredibly complicated," noting the myriad of proteins present in HDL and its many functions beyond that of reverse cholesterol transport, including anti-inflammatory and antioxidant effects as part of the innate immune system, such that approaches to reduce CETP activity may be inherently flawed (33).
The association of blood pressure with adverse outcome has particularly been shown in individuals with diabetes (34), and there is particularly good evidence of benefit of aggressive blood pressure–lowering treatment for diabetic individuals, with the Hypertension Optimal Treatment study showing a 66% CVD risk reduction (35), and much reduction in stroke, heart failure, and microvascular end points, though with "no real [CAD] benefit," in the blood pressure treatment substudy of the UKPDS (36). The benefit of aspirin in diabetic patients was shown in the Bezafibrate Infarction Prevention study (37) and in the Antiplatelet Trialists' Collaboration (38). "Finally," Chait asked, "where does adiposity fit in?" He noted, "If you block adiposity, you could probably block all of the downstream events." (39,40) Given these considerations, Chait suggested that, particularly in light of the Steno-2 trial (41), one should offer all individuals with diabetes the benefit of intensive treatment with statins, angiotensin-directed antihypertensive agents, and aspirin, as well as endeavor to maintain adequate glycemic control.
At the Postgraduate Course, Allan Sniderman (Montreal, Canada) asked whether we are "measuring the right things" in assessing dyslipidemia, suggesting that apoB is a better index of the concentration of atherogenic lipids in plasma and, therefore, a better target than LDL cholesterol or non-HDL cholesterol (42,43). The atherosclerotic lesion, he said, is not simply a pool of cholesterol in the arterial wall but a complex biologic response to the trapping of an apoB particle with both protective fibroproliferative and harmful immunoinflammatory responses. The key initiating event is the entry and trapping of an apoB lipoprotein particle, typically though not always LDL, with subsequent oxidation of its cholesterol, apoB, and phospholipid coat, leading to the accumulation of lipids, particularly cholesterol, in macrophages, with immune-mediated inflammation gradually eroding the protective fibrous cap, leading to acute thrombosis.
LDL cholesterol refers to the cholesterol mass within LDL and IDL particles and non-HDL cholesterol to the cholesterol mass within all apoB-containing particles. The number of LDL particles is ∼9 times greater than that of VLDL particles, and LDL particles are substantially smaller, such that LDL is the dominant atherogenic particle. ApoB can be measured on nonfasting samples because it is driven by LDL particle number. LDL remodeling involves cholesterol ester–triglyceride exchange and hydrolysis via CETP, with cholesterol ester moving from LDL to VLDL and triglyceride from VLDL to LDL, the triglyceride-enriched LDL then hydrolyzed to smaller, denser particles, each still containing one apoB molecule.
Sniderman showed a compilation of 18 studies that have prospectively evaluated apoB vs. LDL, all showing the former to be more strongly associated with CVD. Analyses of the Framingham population shows the association of LDL cholesterol with CVD to be insignificant when LDL particle number is a covariate (44). "It is the LDL particle itself which creates the atherogenic lesion in the arterial wall," Sniderman said, suggesting that neither small nor large particles are preferable; rather, it is the number of particles that is relevant, with apoB the simplest measure of particle number. ApoB measurement is relatively inexpensive, accurate, and standardized and does not require fasting. Furthermore, standard laboratory measurements do not distinguish patients with normal apoB and high triglyceride levels from those with elevations in both, although only the latter have increased CVD risk. Use of apoB will allow better diagnosis of type III hyperlipidemia, familial combined hyperlipidemia, and familial hypercholesterolemia.
ApoB may be particularly useful in individuals with diabetes for whom the Friedwald equation is incorrect in accurately calculating LDL cholesterol, with the 95% CIs of an LDL of 100 ranging from 69 to 134 mg/dl. Although LDL is not characteristically high in type 2 diabetes, apoB is elevated in the majority of type 2 diabetic individuals, "so this is a major problem in your patients." A substantial number of diabetic patients have apparently normal lipid profiles, and apoB may explain differences between diabetic populations in macrovascular risk. Women developing diabetes have an increase in apoB, perhaps explaining their particularly greater risk of CVD.
In intervention studies that have compared change in apoB with change in LDL cholesterol or non-HDL cholesterol, Sniderman said, "the evidence supports" apoB as a better target. He showed an analysis of 11 studies comprising 17,731 individuals undergoing statin treatment, in whom LDL cholesterol decreased by 42%, non-HDL cholesterol 40%, and apoB 30%. Because statins reduce cholesterol to a greater extent than triglycerides, the relatively higher triglyceride level after statin treatment tends to lead to smaller particles, potentially further increasing the "treatment gap" in the three measures. ApoB, he said, correlates more strongly with markers of inflammation and of glycemia. The LDL cholesterol treatment targets of 70 and 100 mg/dl and the non-HDL cholesterol treatment targets of 100 and 130 mg/dl represent the 10th and 25th population percentiles. Extrapolating from this, he recommended that individuals at high and intermediate risk should have apoB treatment targets of 80 and 90 mg/dl, an approach that might better reduce atherogenic particle number and "make your clinical path much simpler."
Diabetes and stroke
At the Mount Sinai conference, Jesse Weinberger (New York, NY) discussed the interrelationships between diabetes and stroke. He pointed out that stroke is the leading cause of long-term morbidity and the third leading cause of death in the US and, because of its higher frequency in Asia, the second leading cause of death worldwide. Hemorrhagic stroke, mainly from hypertension, comprises ∼15%, with ischemic stroke making up the remaining 85% potentially caused by atherosclerosis alone, by emboli as seen with atrial fibrillation and heart failure, and by a variety of other conditions. Risk factors for stroke include blood pressure, cigarette use, alcohol excess, and diabetes. Insulin resistance is associated with stroke. A variety of measures, including proinsulin, fasting insulin, postload insulin, and the proinsulin-insulin and insulin-to-glucose ratio are stroke risk factors (45–49), and obesity is associated with stroke outcome. In the NOMAS (Northern Manhattan Stroke) study of 3,298 stroke-free individuals, 44% had metabolic syndrome, which was associated with a 1.5-fold increase in stroke risk (50).
Diabetes is associated with intracranial arterial abnormalities and with small artery nonatherosclerotic disease, due to lipohyalinosis associated with fibrin deposition around the narrowed artery, similar in some ways to the pathology of diabetic glomerular disease, contributing to lacunar stroke and ultimately causing multi-infarct dementia. In an aside about whether carotid IMT has been validated as an intermediate measure to be used as a proxy for outcome, Weinberger noted that IMT can be seen as a marker of the presence of foam cells, representing a stage in the evolution of atherosclerosis before appearance of plaque, explaining some of the confusing data about whether it is useful in predicting outcome.
A number of treatment approaches have been validated for stroke prevention in diabetic patients. Antiplatelet treatment has been of great importance. Aspirin shows similar benefit in the overall population in doses from 50–600 mg daily, although there is some evidence of resistance to aspirin and other antiplatelet agents among diabetic patients (51,52). There is evidence that other antiplatelet agents may have greater benefit, with both ticlopidine (53) and the combination of aspirin with dipyramidol (54) showing 20% greater reduction in stroke than seen with aspirin. Such benefit has not been reported in several large studies using clopidogrel (55,56), although studies currently in progress may change this impression. Other treatment approaches shown to reduce stroke in diabetic patients include statins (57) and blood pressure–lowering treatment, particularly with angiotensin-directed agents (58,59). The Steno-2 study showed benefit of multifactorial intervention (41). In its most recent report, 5 of 80 microalbuminuric diabetic patients with the intensive intervention, but 30 of 80 control subjects, had strokes during >13 year follow-up (60).
Weinberger termed the evidence equivocal that glycemic control reduces stroke, with the UKPDS suggesting not (14) and the DCCT suggesting that there may be such a relationship (26). Metaanalysis of three epidemiologic studies in individuals with type 2 diabetes showed a pooled relative risk for stroke of 17% for each 1% increase in A1C (12). Interestingly, subset analysis of the PROactive study showed pioglitazone to be associated with a 47% reduction in stroke in trial participants with history of a stroke before study entry (61), and there is intriguing evidence that sulfonylureas might have benefit in reducing infarct volume, with the possibility that they have neuroprotective effect (62).
From time to time, new announcements by the FDA pertaining to aspects of diabetes treatment will be highlighted in this section.
Issues pertaining to regulation of direct-to-consumer (DTC) advertising, including how it relates to communication with subsets of the general population such as the elderly, children, and racial and ethnic minority communities, remain important to the FDA. The Risk Communication Advisory Committee held a hearing on the topic on 15 May 2008. The serious attention being paid to this topic is exemplified in a warning letter sent to Pfizer on 16 April 2008 regarding DTC advertising for sildenafil (Viagra) reminding the company that some television advertisements have not included warnings about potential adverse effects of sexual activity in individuals with cardiovascular disease and about the potential risks of priapism, non-arteritic anterior ischemic optic neuropathy, and hearing loss associated with use of the agent.
On 27 March 2008, the FDA warned consumers that two products, "Total Body Formula" in Tropical Orange and Peach Nectar flavors and "Total Body Mega Formula" in the Orange/Tangerine flavor, had been sold with hazardous levels of selenium, causing hair loss, muscle cramps, diarrhea, joint pain, deformed fingernails, and fatigue after 5–10 days of use. Many multivitamin supplements contain selenium, with a report last year showing that supplementation of 200 μg daily (twice the recommended daily allowance) is associated with more than a doubling of diabetes risk (Stranges S, Marshall JR, Natarajan R, Donahue RP, Trevisan M, Combs GF, Cappuccio FP, Ceriello A, Reid ME: Effects of long-term selenium supplementation on the incidence of type 2 diabetes: a randomized trial. Ann Intern Med 147:217-223, 2007). An addendum on 1 May 2008 also noted that toxic levels of chromium were found in these products, suggesting the importance of careful screening of dietary supplements used by patients with diabetes.


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Implementing Change Management Process Change Management Plan Template Ms Word Excel Spreadsheets
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- Calc Flour 6: Cracking in joints, Synovial swelling, Easy dislocations- Exostoses.
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Silicea 6: Pain in joints, Jerks in limbs, Weakness of joints, Lassitude & trembling in limbs.
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|Each 5 ml. Contains
|Vitamin D 32
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|Calc Phos 6
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|Calc Flour 6
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|Kali Phos 6
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The statements above and about this product have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. The information on this Leaflet/brochure/Website or in emails is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your physician or family doctor.
Data sheet
|*Only Manufacturing Date(Mfg.) is mentioned on the package. Expiry is three years from the date of Manufacturing.
|Compositions (Ingredients)
|Vitamin D 32, Calc Phos 6, Calc Flour 6, Kali Phos 6, Silicea 6, Avena Sat Q, Nux Vom Q
Specific References
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Origenes 30 Year Old Rum (700ml)
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The sugarcane is grown to very specific standards, hand-harvested then fermented with a yeast strain developed specifically for this rum ( Don Pancho also has a degree in microbiology). All the Origenes rums are dated by the age of the youngest rum in the blend. Don Pancho personally selects each barrel. Described as "the best rum he has ever made", the 30 year old is the high point in the range, limited to around 2000 bottles annually. It is Don Pancho's vision of what a true Luxury rum should be. In his own words: "This is not an aperitif but a digestive, drink it slowly, drink it neat. Never alone." Expect multi layered aromas and flavours of vanilla, tobacco, praline, pecan, figs and orange peel. Full bodied, textural and complex, boasting a very long warming finish, it echoes the greatest cognacs. 40% Alc./Vol.
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Paul Gronke, Director of EVIC, was quoted in the New York Times today on the potential problems with a top-two primary system in California.
The Early Voting Information Center
Professor Paul Gronke works with his team to conduct research on early voting and election reform, predominantly in the United States.
- EVIC Founder and Director: Paul Gronke
- Research Director: Paul Manson
- Research Fellow: Jay Lee


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Stadium District Real Estate
Vibrant Neighborhood with Plenty to Do
This historic neighborhood is blessed with a beautiful view of Commencement Bay.
A small and intimate enclave that stretches from Stadium Way to Yakima Avenue, 2nd Avenue to North 4th Street. This neighborhood is named after its most well-known landmark, Stadium Highschool. Originally imagined as a luxury hotel designed to imitate a French Chateau.
Stroll down tree-lined streets and take in the sights of unique custom-built homes. This very walkable neighborhood boasts great views and historic buildings. The small center has accessible sidewalks and amazing niche small businesses.
Every great neighborhood needs a hangout. The Copper Door is that place. Showcasing 36 rotating taps and farm to table snacks. Bring your dog, play some checkers, and relax. Live music is featured occasionally and if you stop by the amazing Thriftway across the street you can grab your own local treats to enjoy inside.
Members of the Tacoma Lawn Tennis Club enjoy beautiful facilities in a historic setting. This Tacoma staple was founded in 1886 by a small group of women who loved tennis. Now a premier tennis facility this club offers indoor and outdoor courts, a pool, 24/7 gym, and Summer social events.
For a fun day trip with the kids stop by Wright Park. 27 acres of old trees from all over the country with educational plaques. The Botanical Conservatory showcases a variety of beautiful plants. The park has several playgrounds and even a "spray ground" for the kids and young of heart to cool down in the Summer. There is so much to see you might want to take a look at the .
If you're ready to take the first step in owning a home in this incredible area, fill out the form below and I'll get back to you as soon as possible.


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Date: April 30th, May 1st & 2nd, 2020
Location: Denver, CO
Co- sponsored with
Seminar Topic
RAFT (Radial Artery Food Test)
Dr. Nogier Denver 2020 was last modified: October 18th, 2019 by john
The Man in the Ear
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(2018-2021,, work in progress)
It's a partnership among European associations organizing cultural events along European urban waterfronts.
Partners change perspective and approach in their daily activity through the intervention of a 'changemaker' in order to be more effective and successful.
The activity of VdC in Venice is to produce a strategic game to approach the complex challenge of the revitalisation of the historical Arsenal.


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The Best Groundhog Day Movie Quotes
144 votes 89 voters 11k views 10 items
Love you some Bill Murray? Here are the best Groundhog Day quotes, ranked by Murray fans like you. Perhaps the greatest film of 1993, Groundhog Day is a comedy drama about a selfish, obnoxious reporter stuck in an infinite loop on Groundhog Day. He repeats the same 24 hours over and over again without consequences, a unique concept for a comedy. At first he's frightened but then he realizes the possibilities and opportunities open to him, until he realizes that life isn't just about himself. Many of the best lines in Groundhog Day come from funny moments, but there are also some serious quotes as well.
Including "Ned! Ned Ryerson!" and more, here are the best quotes from Groundhog Day.What is the best Groundhog Day quote? Let us know by voting for your favorites below. In most cases there is a video to accompany the quote, so you can watch the scene unfold. Groundhog Day is a heartwarming, romantic comedy that makes you wonder what would YOU do if you can repeat the day over again.
Sometimes, People Just Die
Phil: Not today.
I'm a GOD!
Phil: I'm a god.
Rita: You're God.
Phil: I'm a god — I'm not the God, I don't think.
Rita: Because you survived a car wreck?
Phil: I didn't just survive a wreck; I wasn't just blown up yesterday. I have been stabbed, shot, poisoned, frozen, hung, electrocuted and burned.
Rita: Oh really?
Phil: Every morning I wake up without a scratch on me, not a dent in the fender: I am an immortal.
Doris: Special today is blueberry waffles...
Rita: Why are you telling me this?
Phil: Because I want you to believe in me.
Rita: You're not a god. You can take my word for it; this is 12 years of Catholic school talkin'.
Phil: How do you know I'm not a god? How do you know?
Rita: Because it's not possible!
Don't Drive on the Railroad Tracks!
Gus: Eh, Phil... That's one I happen to agree with.


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If you're looking for an affordable, comfortable, easy-to-use car seat for your own child, or for grandmom, grandpa or babysitter, this would be a wonderful choice this Holiday Season!
For More Information Visit: Harmony Juvenile Products
© Moomettes Magnificents
Benefited Reviewer. Opinions are my own.
Moomette's Magnificents is hosting a Giveaway Contest! For a chance to win, there will be one (1) winner of one (1) LiteRider Backless Booster Seat.
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a) Sign up for my free Newsletter Updates to my blog through my e-mail Feedblitz link (on the top of my right column or let me know if you already are, in a separate comment) AND
b) Visit Harmony Juvenile Products and leave a comment about what you like best about their site and another product you'd like to try.
This contest will run until November25, 2009 at approximately 11: pm. EST
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Bertena Luxury Closet
Possessing a large and broad closet usually means that you can fulfill your closet using all the wall mounted closet. Even though you can find numerous closets sets that you can put in your closet, you need to pay close attention into the three main targets of one's closet. The initial one would be your wall mounted closet system. One of many advantages of having a spacious closet is you could install the king or queen closet in your town. The king or queen closet is quite suitable to be set up at the exact middle of the room. In terms of the color, you can choose the light or neutral color so that you can complement it with all the other shade from the closet pillow or cover.
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On 1 September, a resident of Cagnes-sur-Mer within the south of France noticed a foot protruding from a pile of garbage, branches and an outdated quilt.
It was the disfigured physique of a lady, the sufferer of a brutal assault. Her associate denies her homicide.
Salomé, 21, was France's 100th sufferer this 12 months of "femicide" – often outlined as the murder of a woman by a partner, ex-partner or family member. The day after her physique was discovered, a 92-year-old girl was caned to dying by her 94-year-old husband. Quantity 101.
Inside hours, the French government announced a raft of measures to guard girls from home violence. Different European nations have already reacted to against the law that is aware of no borders or social class, however the image throughout the continent is blended.
President Emmanuel Macron launched the French marketing campaign at a nationwide home violence hotline centre, however acquired a actuality test when he listened in on a name.
A girl, who had endured many years of abuse from her violent husband, had lastly constructed up the braveness to depart him. She had requested a police officer to accompany her residence so she may accumulate some belongings, however the officer refused, insisting he wanted a judicial order to intervene.
He was incorrect, however the helpline had no authorized authority and the operator may solely direct the sufferer to a help group.
President Macron shook his head in frustration. "Does that occur usually?" he requested the operator. "Oh sure," she responded, "An increasing number of."
Homicides by intimate companions are overwhelmingly dedicated by males towards girls. Based on the latest figures of such murders, the French price is much from the very best within the EU.
However as Viviana Waisman from Ladies's Hyperlink Worldwide explains, violence towards girls can't be simplified by numbers.
"Violence towards girls is a matter that transcends borders, class and socio-economic standing. It impacts girls and ladies in all societies," she says. "There could also be kind of stigma about speaking about it in sure societies however it's current in all societies."
The place is femicide worst?
Statistics could not inform the total story, however Romania and Northern Eire clearly have an issue.
Based on Sonya McMullan from Lady's Help Northern Eire, "home violence shouldn't be going away and many ladies lose their lives yearly".
Incidents of home violence are rising and protections for girls are weaker than the remainder of the UK.
In March, Giselle Marimon-Herrera and her daughter Allison had been discovered strangled of their flat in County Down. They had been believed to have been killed by Giselle's associate, who was additionally discovered lifeless on the scene.
Connie Leonard was allegedly killed by an ex-partner in 2017 in entrance of her son with Down's-syndrome. The son additionally suffered stab wounds.
Not like the remainder of the UK and Eire, Northern Eire doesn't have a legislation criminalising the usage of "coercive management" on a associate.
Funding for girls's safety has decreased by 5% and proposals to enhance girls's security have been stalled by the dearth of a functioning authorities during the last two years.
'Society nonetheless blames the lady'
Finland, held up as a beacon of gender equality, additionally has one of many EU's highest homicide charges by the hands of an intimate associate.
"In Nordic nations, girls's equal rights are protected within the public sphere however not within the non-public sphere," Paivi Naskali, a professor of Gender Research on the College of Lapland, instructed Open Democracy in 2013.
"The welfare state has given many rights to girls, however this coverage has targeting the labour market… not equality in non-public life," she mentioned.
The Baltic republics even have a excessive price of femicide. Modesta Kairyte, a social activist for home violence who volunteers in sufferer help centres in Lithuania, mentioned the "Soviet period has left some type of trauma," however principally the issue is right down to attitudes in society.
"Society nonetheless blames the lady," she instructed the BBC. "It is a shaming course of."
A girl was admonished if she didn't depart an abusive relationship, however equally seen as a failure if she did. There was additionally a broadly held perception that it was higher for youngsters if the lady stayed.
"Lithuanian society thinks that it is higher for the children to remain," defined Ms Kairyte. "However all of the analysis exhibits that they're extra vulnerable to well being points if they're in an abusive family."
Spain's lethal milestone of femicide
Spain is commonly held up for instance to the remainder of Europe for measures aimed toward defending girls towards gender-based violence.
In 2004, it handed a legislation establishing a community of courts specialising in home violence and focused extra cash at programmes supporting survivors.
However in June Spain recorded the 1,000th homicide of a lady by a associate since information started in 2003.
Beatriz Arroyo was 29 and determined in June to interrupt up along with her boyfriend and begin a brand new life. When she went to their fifth-floor condominium close to the jap metropolis of Valencia to inform him she was leaving him, he suffocated her. The subsequent morning, he threw himself from the balcony and died.
Recognized as Spain's 1,000th sufferer, her dying on 10 June was marked as a darkish day in Spain's historical past of "machista" violence.
Of the 1,000 victims, 607 had been killed by their associate, 225 by an ex-partner and an additional 168 had been within the strategy of separating from their associate, studies mentioned.
The variety of girls killed this 12 months in Spain is already greater than double the quantity recorded in 2018.
What's being performed to sort out femicide?
French Prime Minister Edouard Philippe this week introduced €5m (£4.5m) to assist struggle femicide, which can present 1,000 new locations in home violence shelters and an audit of 400 police stations to look at how girls's complaints are dealt with.
Digital tags are for use to stop offenders approaching their victims and household courts will probably be allowed to stop fathers visiting the kids of abused moms.
The hotline the place President Macron selected to spotlight the marketing campaign noticed a giant spike in phone-calls on the day of the announcement. Based on French TV, 1,661 girls rang the relaunched 3919 helpline for victims of home violence on Tuesday, in contrast with a mean of 200-300 calls a day.
Ladies's rights teams imagine more cash is required to struggle the scourge of home violence.
For each Sonya McMullan and Modesta Kairyte, all the things comes again to schooling.
For victims in Lithuania, Ms Kairyte has helped produce a comic book e book designed to clarify completely different types of home violence: emotional and economical in addition to bodily.
The books are small, discreet and never clearly an recommendation leaflet, so they do not get observed by companions and may simply be slipped inside the duvet of one other e book.
However what if schooling started far earlier? In Northern Eire, there isn't any post-primary curriculum on creating relationships.
Ms Kairyte says youngsters do not perceive the worth of wording: "Is he being passionate or aggressive?"
Each girls used the identical phrases: "It is actually essential for youngsters to know what a wholesome relationship seems to be like."
Assist and recommendation
Should you, or somebody , have been affected by home abuse or violence, these organisations within the UK could possibly assist.
All European countries have a helpline:
- In France: The 3919 "Violences Femmes Data" helpline has been relaunched
- In Spain: 24-hour home violence helpline 016 and 24-hour helpline for mistreated girls – (0034) 900 19 10 10
- In Lithuania: The Ladies's Line is 8800 66 366
- In Finland: The Nollalinja helpline is 080-005-005


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Pu Erh Lemon and Mint
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Ingredients: Pu Erh tea, lemongrass, peppermint and natural lemon flavours.
Red tea properties: Slimming, purifying, speeds up the metabolism of the liver, it is depurative, detoxifying, antidepressant and even facilitates digestion, is rich in vitamin C, minerals, antioxidants, and reduces bad cholesterol.
Water temperature: 100º
Infusion time: 2 - 4 minutes.
Recommended amount per cup: 1 "teaspoon". Approx. 2grs.
* Indicative values that may vary according to personal taste.


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'New evidence' allows state to file murder charge in Lee County cold case
LEE COUNTY, Fla. - The State Attorney's Office has filed charges against a man they believe killed a Lee County woman in 2004.
Terry McDonald has been a suspect in Mary Mount's death since she was killed.
Mount was last seen on January 4, 2004 with McDonald. Her body was found buried in the Texas desert in October 2005.
McDonald was sentenced to life in prison after he was found guilty for a completely unrelated crime in 2008. He strangled a man in El Paso, Texas.
During the sentencing phase of that trial, two crime scene technicians with the Lee County Sheriff's Office testified about McDonald's possible involved in Mount's death.
El Paso police testified McDonald led police to Mount's body.
Monday, The State Attorney's Office said "new evidence" allowed them to officially file a charge connecting McDonald to Mount's killing.
McDonald is now facing a second-degree murder charge.
© Copyright 2019 WBBH/WZVN (Waterman Broadcasting). All rights reserved.


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Will you be careful?
I know that you're only running an errand
here at the corner
and that you're not dressed for a long journey.
Your kiss is light
Your look calm
And tranquil are your hand and foot
But behind this corner
another part of the world,
after this moment
a sea of time.
Will you be careful?
"Afscheid (Farewell)," Adriaan Morriën
Translated from the Dutch by AD Capili
Earlier this summer, my friend Shiho Nakaza and I went on a little art adventure that included a week in Amsterdam. We participated in sketchwalks (during a record-breaking heatwave in July) as part of the 10th Urban Sketchers Symposium. During one of the walks, a few us stumbled upon this idyllic corner of the city. Entranced, I found some shade and set to work. I was pressed for time and after a while, was not quite hitting the mark, so I decided to leave it a bit unfinished and work on it more later. I didn't pick it up again until I returned home. Some of my fresher marks inevitably disappeared, but in the end, I think it conveys more of what first drew me in.
In my all-too-brief time in Amsterdam, many points of interest were lost on me as I rushed, like many a tourist, from here to there, oblivious to the history beneath my feet. I found out later that the official name of the little park that overlooks this scene is the J.W. van Overloopplantsoen. "A green bank of the Plantage Muidergracht, sandwiched between Hortus and the former Zeeman Laboratory of the UvA, named after the Dutch Nobel Prize winner Pieter Zeeman who reportedly received Niels Bohr and Albert Einstein here. Heroic ground.... JW van Overloop himself was slightly less illustrious. He was a local resident who fed the pigeons every day in this park. He called those pigeons 'my sisters', according to writer Adriaan Morriën who also lived there." ( source: idovergagen.nl )
I've since read that the poem above is inscribed on a monument at this little park, but I don't recall seeing it there. At the time, I didn't know anything about this place, or about some of the darker passages of history that took place nearby. I just sat there with J.W.'s sisters, sipped my coffee and tried to soak in as much as I could before I had to move on.
#uskamsterdam2019 #usk
#travelsketch #sketchwalk
#pleinair #pleinairtostudio
Last Sunday was one of those picture postcard perfect days we are cursed with here in San Diego. It was a great day to catch up with the San Diego Urban Sketchers and try my hand at capturing Little Italy and its iconic sign. If you've never been, it's a bustling place with very little parking, lots of tourists, and the constant excitement of airplanes on their steep approach to nearby San Diego International Airport. To give you some idea of the number of landings, check out this crazy video: io9.gizmodo.com/5965233/five-hours-of-planes-landing-at-san-diego-international-airport-in-less-than-thirty-seconds
I lucked out and got a prime parking space, then parked myself between an electrical box and some big terracotta planters. After I penciled things in and laid down a few light washes, I decided to adjust my own angle of approach. Since I'd gotten a late morning start, I decided to finish my sketch in the afternoon when I'd have some bigger shadow shapes to play with. I then met up with the rest of the group, and after a life-affirming bagel and coffee, returned to the scene of the sign.
Sargent supposedly said, "An artist painting a picture should have at his side a man with a club to hit him over the head when the picture is finished." I probably could have used a good 'club man' when I got back to my little sketch, but in the end, it was still a pleasant little picture, which is all I really set out to make. Done, I popped back into the café to re-charge before heading back home. At this point I was seeing paintings everywhere, so I decided to get one more in just for fun, Only this time, I tried a different approach: no pencil---just squint at the values and 'ready, set, paint!'
As I wrap things up on this 5-Day Art Challenge I realize that there are newer paintings I need to get cracking on scanning/photographing, so thanks for looking at these with me (again). These were all done on-site around San Diego County, except for the one called Main Street Vista. I did do a plein air sketch of the scene earlier that really wasn't much to look at. I used it to make this idyllic vision of my hometown on a sunny Sunday afternoon.
Rolling Days 2 and 3 of the 5-Day Art Challenge into one post, but I kind of like looking at all of these pictures together. The first two are some plein air watercolors I did at Cabrillo National Monument. I'm embarrassed to admit I've lived in the San Diego area most of my life but had never visited until recently. I lucked into having a small part of a project to update wayside markers there in anticipation of the monument's centennial. The next two images are the 2 ft by 4 ft illustrations I did for the new markers. Sadly, they're still sitting in someone's office (I hope) as the centennial plans were canceled due to sequestration.
My friend and fellow artist Shiho Nakaza has nominated me to take part in the 5-Day Art Challenge. If you don't already know what it's about, the participant posts three works of art for 5 days, and nominates another artist each day. Those artists post to my Facebook page and to the pages of artists they nominate. These little plein air paintings were some of my attempts to capture the lovely places I found in Kansas and Missouri. When I left Kansas to return to California, I felt sad that there were so many scenes I hadn't gotten around to painting. So it goes.
UPDATED 6/11: This post was updated to reflect changes in the timeline of this event. Deadlines have been changed to allow more artists to submit artwork.
The show opening has been pushed to June 21 to coincide with the artists' reception, and painting days have been extended through June 14 so that more artists may participate. The deadline for submissions has been extended to June 15.
Artists: Please download REVISED prospectus, attached at the bottom of this post.
From the flyer: "In conjunction with the 2nd Annual Succulent Celebration artists are invited to paint at WaterWise Botanicals and submit their best work for acceptance into a juried show to be held at ArtBeat on Main Street Gallery in Vista."
WaterWise Botanicals is a 20+ acre nursery/grower with display gardens on Old Highway 395 in Escondido (See map below). As part of this year's Succulent Celebration, they have teamed up with ArtBeat Gallery in Vista to hold a plein air event and show.
First prize is $200 and it is FREE to participate, and FREE to enter up to two submissions to the juried show which runs June June 21 -- July 6. Artists are encouraged to paint any time from 8am -- 5pm during The Succulent Celebration, which is Friday, June 6th -- Saturday, June 7th. Also, to encourage more artists to submit entries to the juried show, they are allowing artists to paint on-site any time from now through June 14th during business hours Monday - Saturday 8:00 am – 5:00 pm (CLOSED Sundays).
I'll be painting there during both days of the Succulent Celebration. Hope to see you there!
For more information, please email firstname.lastname@example.com.
ArtBeat On Main Street Gallery
330 Main Street, Vista, CA 92084 (760) 295-3118
WaterWise Botanicals
32183 Old Highway 395, Escondido 92026 (760) 728-264 (map below)
Get Some Sunshine, See Some Art
Spring has sprung here in San Diego and that means more sunshine and outdoor events. I thought I'd highlight a few that feature art or plein air painting, including some upcoming events in which I'll be participating.
Painting Outdoors for Newbs
This post is not a how-to but a reflection on what it's like to be new at painting outdoors, as well as a shameless promotion of my upcoming plein air class. But first: I have a confession to make.
It's been a few months since I've painted outdoors. I really have no excuse. Living in San Diego, I certainly can't blame the weather, especially after having watched from afar artist Marc Hanson paint four plein air paintings a day for a month in frozen Colorado.
Draw Like Picasso
Yesterday was the first day of my six-week drawing class called Learn to See, Learn to Draw at ArtBeat on Main Street Gallery in Vista. The class is based on the work of Dr. Betty Edwards. Her book Drawing on the Right Side of the Brain is an excellent resource for anyone eager to learn how to draw realistically.
One of the hallmark exercises of this method is the upside-down drawing, which I demonstrated, as in the book, with a Picasso portrait of Igor Stravinsky. When it came time for the students to begin their lesson, one of them said, "So, on the first day of class, you're asking us to do a Picasso?" which of course gave us all a good laugh.
When I got home, I got to thinking that I missed an opportunity there. All joking aside, though I expect drawing newbies to fret a bit at the prospect of copying a line drawing, I never gave much thought to the intimidation factor of the Picasso. I'd only ever seen it as a complex line drawing that serves as an effective obstacle course for beginners. By obstacle course, I don't mean a series of obstacles designed to trip one up, but in the most positive sense, as a course of exercise designed to improve skills.
The point I missed sharing was this: for the purpose of the exercise, the Picasso drawing is essentially a lot of lines of various lengths, widths, angles, relationships and spaces that we are endeavoring to perceive and record as pure data and not concern ourselves with what the lines have been arranged to depict. It doesn't matter who drew it. We don't need to know "what" it is a picture of and in fact, it's better not to know, so that we may access the part of our brain that is suited to seeing the visual data and enabling us to record it in a fashion that is unencumbered by our preconceived notions.
As I ate up a lot of time going over other first-day-of-class business, the students had minimal time to work on these upside-down drawings. They are going to complete them at home and when we meet again next week I plan to bring it up in more detail. I'm also looking forward to telling them in my best infomercial style, "Yes, you, too, can draw like Picasso!"
Paint San Clemente 2013
My entry for the 2012 Paint San Clemente Quick Draw contest
Saturday June 15 marks the beginning of Paint San Clemente, a week-long plein air painting event in San Clemente, California. The public is invited to watch plein air artists paint and compete for $13,000 in prizes in and around the beach town that sits on the southern border of Orange County. The event is a fundraiser for art programs in San Clemente schools.
I'll be participating in the the Quick Draw, a one-day contest in which artists have three hours to complete a plein air painting. The paintings are then judged and put up for sale. Last year my little watercolor scene of the San Clemente Pier sold in the first few minutes of the sale. It was my first ever plein air painting sale.
Paint San Clemente is free to the public and runs from Saturday June 15 -- Sunday June 23. It kicks off with the Quick Draw and Sale on Saturday June 15. Artists who choose to participate in the overall plein air competition will continue to paint around town throughout the week. Awards are given Saturday June 22, and an outdoor art sale will take place Saturday June 22 -- Sunday June 23. For more info visit: paintsanclemente.com
I have a passion for plein air painting. I try to capture and share the moments of beauty I find. You can see some of my work online at:
September 2019


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Discussion in 'General Chat' started by RedFox 1, May 31, 2019.
Works for me, just fine, like everything else on 1903.
I prefer not to do a clean install, I have too much "legacy" software that would require deregistering and reregistering after updating to 1903.
One of my Win 10 Pro x64 machines kept having serious problems, apps and games crashing at random points. Occasional blue screens.
It had updating with the normal update app. The app would silently crash during the install phase before the PC reboots to finish up. Every time I tried to run the setup. One time it even blue screened. Finally I made an offline install USB stick. The install crashed. Tried it again and finally it finished, going all the way.
One aspect of the upgrade install Windows detected HD errors on my boot SSD. Hmmmmm, that could explain the problems I experience, a failing SSD.
My ad-hoc home network still works, all 3 PCs recognize my solo shared folders on each of the other PCs. Looks like 1903 is gonna be a keeper.
It now allows you to choose an offline account while one is connected to the internet.
It also allows you to NOT have a pass word, when one gets to that screen, just leave it black and continue.
I also found what I think keeps the computer busy when not in use, this is especially so for my old HDX18.
There's this maintenance protocol that appears to run pretty much all the time, it doesn't tell you what it's doing or what maintenance it's doing, but it's a recourse hog on older machines.
I didn't say it didn't, I said when it's connected it DEFAULTS to a Microsoft account. You always (from the start) could create a local account but you have to click on tiny text somewhere near the bottom
Not having a password was always possible too
Sent from my Pixel 3 XL using Tapatalk
Separate names with a comma.


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20.15 (135)
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