text:
Pre-Diabetes, Metabolic Syndrome, and Cardiovascular Risk
Author + information
- Received June 14, 2011
- Revision received August 17, 2011
- Accepted August 23, 2011
- Published online February 14, 2012.
Author Information
- Scott M. Grundy, MD, PhD⁎ (scott.grundy{at}utsouthwestern.edu)
- ↵⁎Reprint requests and correspondence:
Dr. Scott M. Grundy, Center for Human Nutrition and Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Suite Y3.206, Dallas, Texas 75390-9052
Pre-diabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Pre-diabetes can be identified as either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). The latter is detected by oral glucose tolerance testing. Both IFG and IGT are risk factors for type 2 diabetes, and risk is even greater when IFG and IGT occur together. Pre-diabetes commonly associates with the metabolic syndrome. Both in turn are closely associated with obesity. The mechanisms whereby obesity predisposes to pre-diabetes and metabolic syndrome are incompletely understood but likely have a common metabolic soil. Insulin resistance is a common factor; systemic inflammation engendered by obesity may be another. Pre-diabetes has only a minor impact on microvascular disease; glucose-lowering drugs can delay conversion to diabetes, but whether in the long run the drug approach will delay development of microvascular disease is in dispute. To date, the drug approach to prevention of microvascular disease starting with pre-diabetes has not been evaluated. Pre-diabetes carries some predictive power for macrovascular disease, but most of this association appears to be mediated through the metabolic syndrome. The preferred clinical approach to cardiovascular prevention is to treat all the metabolic risk factors. For both pre-diabetes and metabolic syndrome, the desirable approach is lifestyle intervention, especially weight reduction and physical activity. When drug therapy is contemplated and when the metabolic syndrome is present, the primary consideration is prevention of cardiovascular disease. The major targets are elevations of cholesterol and blood pressure.
The prevalence of type 2 diabetes is increasing in the United States and worldwide. Because of many complications and the high costs of diabetes, its prevention and its complications demand more attention. The major complications of diabetes are cardiovascular diseases (CVD)—both microvascular disease and macrovascular disease. The leading risk factor for type 2 diabetes is a condition called pre-diabetes. The latter's predisposition to type 2 diabetes makes it a potential risk factor for CVD as well. Pre-diabetes moreover aggregates commonly with other CVD risk factors that make up the metabolic syndrome.
An ongoing debate is whether pre-diabetes deserves targeted identification and clinical intervention (1). Pre-diabetes generally is defined by either an elevation of fasting or post-prandial plasma glucose levels. Elevated hemoglobin A1c, or glycosylated hemoglobin (HbA1c), which integrates plasma glucose over time, is promoted by some as another indicator of pre-diabetes. This paper will review the pathogenesis and diagnostic criteria for pre-diabetes, its relation to macrovascular and microvascular diseases, and potential intervention strategies.
What Is Pre-Diabetes?
The term pre-diabetes has had a checkered history. Alberti (2) states that it was first used to denote abnormalities of pregnancy (e.g., high–birth weight babies, hydramnios) or a strong family history of type 2 diabetes. However, in 1980, the World Health Organization (WHO) (3) discarded the term largely because many subjects with borderline glucose levels do not convert to diabetes and because many would be alarmed unnecessarily. These problems still pertain. Yet in 2005, the American Diabetes Association (ADA) reintroduced pre-diabetes to cover impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) but not other risk factors for diabetes (4). In 2008, WHO's diabetes task force again repudiated the term and discouraged its use (5). Instead, they suggested "intermediate hyperglycemia" to signify IGT and IFG. The ADA nonetheless continues to use pre-diabetes and defines it as IFT, IGT, and now, HbA1c of 5.7% to 6.4% (6).
Any definition of pre-diabetes that is restricted to IGT and/or IFG fails to include other risk factors for diabetes, such as, a family history of type 2 diabetes or the metabolic syndrome. Another telling criticism of the term pre-diabetes is that the many subjects with either IFG or IGT will not progress to type 2 diabetes. For this reason, another name might be preferable. The WHO task force's "intermediate hyperglycemia" so far has not been widely adopted (5). Another possible name is "borderline diabetes," but this term is not currently recommended and has no formal definition. In this review, the term pre-diabetes will be used throughout, but with the recognition that it is not universally accepted nor does it always foretell conversion to diabetes.
Pre-Diabetes as Intermediate Hyperglycemia
The ADA previously equated pre-diabetes with the WHO's intermediate hyperglycemia, but recently added borderline levels of hemoglobin A1c as another indicator. The WHO so far has not done so. The ADA's 3 indicators can be considered along with their pathogenesis and clinical significance.
Pathogenesis of intermediate hyperglycemia
Two metabolic defects occur in most patients with type 2 diabetes: insulin resistance and deficient insulin secretion. Elevated glucose levels in the intermediate range are caused primarily by a deficiency in insulin secreted by pancreatic beta cells. Deficient insulin secretion can result either from a loss of beta cells or impairment of beta cell function. Both occur in type 2 diabetes (7,8). Similar but less severe defects, especially in insulin secretion, characterize pre-diabetes (9). Most persons with pre-diabetes also are insulin-resistant (9).
Impaired glucose tolerance
Normal fasting plasma glucose is a level of <100 mg/dl (<5.6 mmol/l) or a 2-h plasma glucose in response to a 75-g oral glucose tolerance test (OGTT) of <140 mg/dl (<7.8 mmol/l). IGT is recognized as an intermediate level of post-prandial glucose that carries essentially no risk for microvascular complications (10). It is diagnosed exclusively by OGTT; the 2-h plasma glucose is 140 to 199 mg/dl (7.8 to 11.0 mmol/l). According to recent NHANES (National Health and Nutrition Examination Survey) data (11), overall IGT prevalence in U.S. adults >20 years of age is 13.8%. The prevalence rises progressively with age. In the European DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) study, IGT rose from 2.9% in 30- to 39-year-old men to 15.1% in 70- to 79-year-old men (12). One disadvantage of testing for IGT is the necessity for OGTT; another is that the results are not highly reproducible. Nonetheless, it is a relatively strong, albeit variable, predictor of type 2 diabetes (13). A predominant metabolic characteristic is insulin resistance in muscle, which exists along with defective insulin secretion (9). In most Western countries, conversion rates for isolated IGT range from 4.35% to 6.35% per year (14). In the DPP (Diabetes Prevention Program) study, in which IFG also was common, conversion to diabetes was approximately 10% yearly (13,15).
Impaired fasting glucose
IFG was introduced by the ADA in 1997 to classify fasting plasma glucose levels of 110 to 125 mg/dl (6.1 to 7.0 mmol/l) (16). By these criteria, the estimated U.S. prevalence of IFG in adults >20 years of age was approximately 6.9% (17). In 2003, the ADA changed its definition of IFG from a fasting level of 110 to 125 mg/dl to 100 to 125 mg/dl (18). The rationale for the ADA's change was several-fold. First, glucose levels of 100 to 110 mg/dl carry higher risk for diabetes compared with normoglycemia. Second, receiver-operator characteristic analysis of several studies found that 100 mg/dl is a threshold level of fasting glucose that maximizes sensitivity and specificity for predicting diabetes. Third, the expert committee postulated that reducing the threshold for IFG would make the prevalence of IFG and IGT concordant. However, the latter did not work out. Prevalence of IFG in the United States after lowering the threshold jumped from 6.9% to 25.7%, which was double the 12.9% for IGT (11). Applying this percentage to the U.S. population >20 years of age gave IFG to an estimated 57 million adults (19). Ethnic breakdown for IFG prevalence showed 21.1% in non-Hispanic blacks, 25.1% in non-Hispanic whites, and 26.1% in Mexican Americans. Other populations had similar increases after this change in IFG definition, for example, from 11.8% to 37.6% in Denmark and from 16% to 37.6% in India (5).
There have been 2 major criticisms of the ADA's change in definition of pre-diabetes based on fasting glucose levels. First, a high proportion of the population becomes "medicalized," and second, persons with fasting glucose levels of 100 to 110 mg/dl convert to diabetes with a lower frequency than do those with levels of 110 to 125 mg/dl. Regarding the latter, compared with individuals with fasting levels of 100 to 110 mg/dl, those in the range of 110 to 125 mg/dl have a 2- to 6-fold higher risk for developing diabetes (5).
Combined Impaired Glucose Tolerance and Impaired Fasting Glucose
One reason the ADA lowered the threshold for IFG was to avoid the need for OGTT to diagnose IGT. This aim did not entirely succeed. From 1988 to 1994, among U.S. adults aged 40 to 74 years, 33.8% had IFG by the revised definition, whereas only 15.4% had IGT (19). Only about 6% of the population had IGT but not IFG because of normal fasting glucose. This latter percentage raises the question whether there is any utility in doing OGTT at all. Two proposed reasons for OGTT are to identify persons with undetected diabetes or to find those at very high risk for diabetes. Persons who have both IGT and IFG plus metabolic syndrome are at greater risk for conversion to diabetes than are those with only IGT or IFG (15). Such persons may be better candidates for aggressive therapy to delay onset of diabetes (14).
Hemoglobin A1c
In 2009, an expert committee organized by the ADA, the International Diabetes Federation, and the European Association for the Study of Diabetes (20) recommended that HbA1c become an alternative to plasma glucose for diagnosing type 2 diabetes. Advances in the measurement of HbA1c and growing evidence of its association with plasma glucose underlie this recommendation. The expert committee listed several advantages of HbA1c testing compared with glucose measurements for the diagnosis of diabetes. HbA1c is now better standardized. There is less biologic variability and pre-analytic instability. HbA1c gives a better measure of overall glycemic exposure and likely risk for long-term complications. There is no need for fasting or timed samples, and HbA1c is less affected by conditions to produce perturbations in glucose levels. Moreover, it is a better guide to clinical management of patients. For these reasons, it is likely that HbA1c will become a standard approach to the diagnosis and clinical management of type 2 diabetes. For the diagnosis of diabetes, the expert committee recommended an HbA1c threshold of 6.5%.
Whether HbA1c can also be used to identify pre-diabetes is an important question. The WHO expert committee advised against its use for this purpose, citing lack of sufficient evidence (5). The ADA/International Diabetes Federation/European Association for the Study of Diabetes expert committee was noncommittal; it speculated on a range of 6% to 6.5%, but did not recommend it. The ADA recently proposed a pre-diabetes range of 5.7% to 6.4% (6), which accords with updated NHANES data (21). Another study (22) suggested that HbA1c might obviate the need for OGTT to identify pre-diabetes. Still another report (23) showed that there is considerable discordance between HbA1c and fasting glucose levels; it implied that many individuals would be misclassified by HbA1c. However, because HbA1c is a better indicator of integrated glucose levels, one can ask whether fasting glucose levels are more likely to misclassify a person than HbA1c levels. If pre-diabetes is going to emerge as an important clinical category and if HbA1c becomes the primary screening method for dysglycemia, its use to identify subjects with pre-diabetes will have to be seriously considered.
Pre-Diabetes and the Metabolic Syndrome
An elevated glucose level is one component of the current consensus definition of the metabolic syndrome (24,25). Others are abdominal obesity, elevated blood pressure, elevated triglycerides, and reduced high-density lipoprotein (HDL) cholesterol. Any 3 of these 5 components confer a diagnosis of the syndrome. Most individuals with the metabolic syndrome have abdominal obesity. Excess adipose tissue releases excess fatty acids and a variety of adipokines that seemingly elicit metabolic risk factors that predispose to both diabetes and CVD (26) (Fig. 1). To manifest the syndrome in obese persons, one must also have metabolic susceptibility; the latter in turn can be conferred by other factors (e.g., genetics, physical activity, and drugs). Many investigators believe that insulin resistance mediates all the metabolic risk factors of the metabolic syndrome (27). The role of insulin resistance in causing hyperglycemia is well established, but whether insulin resistance per se elicits dyslipidemia and hypertension is uncertain. Regardless, most persons with the metabolic syndrome are insulin-resistant (28). Therefore, it is not surprising that prevalence of pre-diabetes and metabolic syndrome overlap—although not precisely. For example, in the nondiabetic population over 50 years of age, about twice as many individuals have IFG plus metabolic syndrome as have IFG alone (29). A sizable portion of this population also has metabolic syndrome without IFG and vice versa. The overlap of pre-diabetes and metabolic syndrome in other populations is similar to that of the United States, where it has been determined (30) (Fig. 2).
The metabolic syndrome in fact can be considered a pre-diabetic state. Compared with persons without metabolic syndrome, those with the syndrome have an approximate 5-fold increase in diabetes risk (31). Although it might be assumed that this greater risk is due to IFG or IGT in patients with metabolic syndrome, Lorenzo et al. (32) found that metabolic syndrome without pre-diabetes carries an approximate 5-fold increase in diabetes risk. For patients with IFG or IGT, the diabetes risk is 5- to 7-fold higher for than normoglycemia (32). However, when pre-diabetes combines with metabolic syndrome, the risk is increased even more. We might ask why metabolic syndrome alone is a strong predictor of diabetes. For one reason, similar percentages of the population with metabolic syndrome and pre-diabetes are obese (29); thus, a metabolic syndrome like pre-diabetes is an insulin-resistant state, which imparts diabetes risk. The metabolic syndrome may further predispose to beta cell dysfunction through lipotoxicity (33). Thus, it should not be surprising that the metabolic syndrome associates with a high risk for diabetes.
Metabolic Syndrome, Pre-Diabetes, and Cardiovascular Risk
Should pre-diabetes be called a disease?
There is general agreement among diabetologists that diabetes deserves to be called a disease and not just a risk factor for CVD. This agreement rests on the broad range of complications accompanying hyperglycemia: macrovascular diseases, microvascular diseases, and various forms of neuropathy, among others. Patients with diabetes are prone to coronary heart disease, stroke, and peripheral vascular disease along with retinopathy, chronic kidney disease, bladder dysfunction, erectile dysfunction, orthostatic hypotension, gastroparesis, and skin disorders. In a variety of ways, these conditions can be attributed to prolonged hyperglycemia. Although in the sense that diabetes is a "risk factor" for these disorders, their aggregation justifies calling diabetes a disease. To call pre-diabetes per se a disease is less clear-cut. All of the preceding complications are less common, although they have been reported in some patients. A review of available literature may shed light on the clinical significance of pre-diabetes.
Pre-diabetes and microvascular disease
A sine qua non for diabetes contrasted with pre-diabetes is occurrence of microvascular disease; these diseases include retinopathy, glomerular disease, and likely neuropathy. The primary target of hyperglycemia appears to be endothelial cells. Thickening of the membrane beneath endothelial cells is a fundamental structural change. This occurs in both capillaries and arterioles. Other changes are pericyte loss and capillary microaneurysms, and later, vascular proliferation. Although elevated glucose levels per se must be primarily responsible for microangiopathy, the molecular mechanisms are not fully understood. Several mechanisms may account for these changes: activation of protein kinase C, formation of advanced glycation end products, formation of reactive oxygen species, flux through the hexosamine pathway, induction of the polyol pathway, overexpression of growth factors and inflammatory cytokines, and defective insulin signaling (34,35). Presumably, these microvascular changes are widespread throughout the body, but mainly affect the eyes, kidneys, and peripheral nerves.
The issue of whether intermediate hyperglycemia (pre-diabetes) can induce diabetic microvascular disease is discussed in detail in the WHO report of 2006 (5). The conclusion was that there is no certain plasma glucose threshold for the development of microangiopathy. Several reports indicate that in patients with pre-diabetes, "diabetic retinopathy" can occur (36–39). In Pima Indians, pre-diabetes was associated with retinopathy in 2% to 4% of affected subjects (40).
Another putative indicator of microvascular disease is microalbuminuria, which is believed to be secondary to glomerular endothelial thickening and capillary leakage (41). Hyperglycemia may be the dominate cause of glomerular damage, but other factors—advanced glycation products, oxidative stress, and inflammation—have been implicated (42). In subjects with pre-diabetes, the prevalence of microalbuminuria is approximately twice that of normal subjects, but less than that of long-standing diabetes (43). Whether intermediate glycemia per se accounts for an increase in microalbuminuria is uncertain. Microalbuminuria has received a great amount of attention because it is associated with both chronic kidney disease (CKD) and macrovascular disease complications (44). Investigators hypothesize that it is a reflection of widespread endothelial dysfunction.
Chronic Kidney Disease
Diabetes is a major cause of CKD, and pre-diabetes accompanies increased prevalence of CKD as well. For the NHANES study, Plantinga et al. (45) reported that 39.6% of people with diagnosed diabetes and 41.7% with undiagnosed diabetes had CKD; 17.7% with pre-diabetes and 16% without any kind of diabetes had CKD. The reason for more cases of CKD in pre-diabetes has not been determined. Microvascular disease may not be the cause. Fox et al. (46) from the Framingham Heart Study observed a stronger association between other cardiovascular risk factors and CKD than with hyperglycemia. This suggests that most of CKD observed in patients with pre-diabetes is due to macrovascular disease, especially hypertension, and not to microvascular disease.
Subjects with pre-diabetes can show various forms of diabetic neuropathy: peripheral neuropathy (47–49), polyneuropathy (50), small-fiber neuropathy (51), and autonomic neuropathy (52,53). In the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) study, "diabetic" polyneuropathy was approximately twice that of normal subjects in those with IFG and IGT, whereas it was doubled again in patients with diabetes (54). The neuropathy observed in patients with diabetes consists of several changes: demyelination, axonal thickening, and loss of nerve fibers. In diabetes, hyperglycemia appears to be the dominant cause of these changes, and presumably, intermediate hyperglycemia can account for more cases of neuropathy seen in patients with pre-diabetes.
Metabolic syndrome and microvascular disease
Beyond elevated glucose levels, metabolic syndrome generally is thought not to be related to diabetes-like microvascular disease. Of note, it is not directly accompanied by "diabetic" retinopathy (55). If patients with the metabolic syndrome are found to have retinopathy, it is most likely due to intermediate hyperglycemia or hypertensive retinopathy. Other than these retinopathies, metabolic syndrome may mediate small vessel disorders through endothelial dysfunction (56–58). It seems important to distinguish between structural damage to small vessels, which occurs with diabetes and hypertension, and endothelial dysfunction. The latter can be considered a form of microvascular disease. For example, the metabolic syndrome has been related to microvascular angina (cardiac syndrome X) (59); this condition may be secondary to endothelial dysfunction in small coronary arteries (60). Some believe that insulin resistance is a cause of the endothelial dysfunction of cardiac syndrome X (61). Other factors, for example, inflammatory cytokines and low levels of adiponectin, also could promote endothelial dysfunction and microvascular dysfunction (62,63). Microalbuminuria is another reflection of endothelial dysfunction and occurs in some persons with the metabolic syndrome (64–66).
Pre-diabetes and macrovascular disease
Long unresolved questions relate to whether elevated glucose levels are a direct cause of atherosclerosis or clinical CVD (67–70). If so, then IFG or IGT could carry some risk for macrovascular disease. Recently Ford et al. (71) carried out a systematic review of the relationship between pre-diabetes and CVD risk. They searched the literature for IFG, IGT, or both for their relation with CVD. IFG was defined by fasting glucose levels of 100 (or 110) mg/dl to 125 mg/dl and IGT was defined by OGTT. The findings of this meta-analysis can be summarized as follows. Eighteen reports examined IFG (110 to 125 mg/dl) (designated IFG 110); relative risk (RR) estimates for CVD ranged from 65 to 2.5 The fixed-effects summary RR was estimated to be 1.20 (95% confidence interval [CI]: 1.12 to 1.28). Another 8 reports looked at IFG (100 to 125 mg/dl) (IFG 100). The RRs estimates for individual studies ranged from 87 to 1.40, whereas the fixed-effects summary RR estimate was 1.18 (95% CI: 1.09 to 1.28). In 8 reports on IGT, individual estimates of RR varied from 83 to 1.34, with a summary RR estimate of 1.20 (95% CI: 1.07 to 1.34). Five studies combined IFG and IGT; the summary RR was 1.10 (95% CI: 99 to 1.23). There was no significant difference between the summary estimates for men and women.
Even if we were to accept this analysis as indicating that pre-diabetes imparts a modest increase in risk for CVD, such as in the range of 20%, this does not prove that a pre-diabetic range of glucose levels directly causes atherosclerosis or its complications. The data are consistent with this action, but important questions remain. The problem lies in our ability to dissect away confounding variables such as concomitant obesity, dyslipidemia, hypertension, and proinflammatory and prothrombic states. All of the confounding variables listed, which are the components of metabolic syndrome, are commonly present in persons with pre-diabetes (9).
Of course, if intermediate hyperglycemia independently does raise CVD risk by 20%, this would be no trivial matter. It would justify efforts to lower plasma glucose levels to the normal range. Most arguments in the diabetes field have been whether it is beneficial to lower glucose levels in patients with pre-diabetes to delay conversion to diabetes. The argument against drug intervention in pre-diabetes is that it may not prevent the development of diabetic microvascular disease in the long run. However, if glucose concentrations in this range do in fact raise risk for CVD by 20%, a strong argument can be made to intervene for the purpose of reducing macrovascular-disease outcomes. The only way to resolve this issue would be through a clinical trial.
One important clinical trial, the DPP (13), tested whether lifestyle intervention, metformin, or a thiazolidinedione will delay conversion of pre-diabetes to diabetes. All three effectively lowered glucose levels and retarded the development of diabetes over the duration of the study (13,72). However, DPP was not sufficiently powered to determine whether any of these modalities would reduce CVD events in patients with pre-diabetes. In a subsequent clinical trial using a thiazolidinedione, pioglitazone, to determine whether it would reduce CVD events in diabetic patients with established CVD (73). In fact, atherosclerotic events were marginally reduced, although the benefit was partially offset by an increase in "heart failure," that is, fluid overload. In the DREAM (Diabetes Reduction Assessment With Ramipril and Rosiglitazone Medication) trial (74), which was carried out in patients with pre-diabetes, rosiglitazone was tested for retardation of conversion to diabetes. Although this study showed a reduced conversion rate to diabetes, it did not reduce CVD events. In an ancillary study to DREAM, however, rosiglitazone modestly reduced progression of carotid intimal medial thickness (75). This finding cannot be ignored. It keeps alive the possibility that glucose lowering in patients with pre-diabetes will retard atherogenesis. On the other hand, there is the ongoing controversy whether rosiglitazone will increase coronary events (76). This being the case, only a clinical trial with a glucose-lowering drug can answer the question whether treatment of intermediate hyperglycemia will retard atherogenesis.
Most individuals with pre-diabetes have both hyperinsulinemia and insulin resistance. It has been speculated for many years that 1 or another of these finding may promote atherogenesis (77). If so, it is possible that lowering glucose through lifestyle changes or drugs that target insulin resistance might reduce atherogenesis through this mechanism.
Metabolic Syndrome and Macrovascular Disease
Two large meta-analysis have shown that metabolic syndrome raises the risk for macrovascular CVD by approximately 2-fold (78,79). Because a high proportion of patients with metabolic syndrome will have pre-diabetes, it can be expected that pre-diabetes will also be accompanied by increased risk for CVD when the metabolic syndrome is present.
Dual Goals for Pre-Diabetes Intervention
The major detrimental outcomes in persons with pre-diabetes are macrovascular diseases and type 2 diabetes, the leading contributors to microvascular disease. Macrovascular disease occurs both before and after onset of diabetes, whereas microvascular disease occurs almost exclusively several years after conversion to diabetes. The following section provides an overview for prevention of both macrovascular and microvascular disease.
Screening for Pre-Diabetes
Should an effort be made to detect pre-diabetes, and if so, when and how? As desirable as general health screening may be for prevention of chronic disease, there is little motivation for a universal national program because of costs. However, because most people visit physicians periodically, opportunities exist to test for pre-diabetes. Several clinical features increase the likelihood of a positive finding: advancing age, obesity, other features of the metabolic syndrome, family history of diabetes or CVD, signs of atherosclerotic disease. At the present time, we are left with clinical judgment to motivate testing. Measurement of fasting glucose is the least expensive way to detect pre-diabetes. OGTT and HbA1c are not currently recommended, but they can be added if suspicion is high. Their incremental value has not been adequately studied. However, the combination of IFG and IGT increases the likelihood of developing diabetes. In the big picture, prevention of macrovascular disease takes priority over microvascular disease. Therefore, the first step should be to carry out a thorough assessment of cardiovascular risk.
Prevention of Macrovascular Disease
Whether pre-diabetes per se produces atherosclerosis and its complications is uncertain. Nonetheless, many persons with pre-diabetes have metabolic syndrome, which undoubtedly is a risk factor for macrovascular disease. Moreover, pre-diabetes increases with age, and aging itself is accompanied by increased risk. Therefore, it is reasonable to intensively intervene on all CVD risk factors in patients with pre-diabetes. First-line management is lifestyle intervention: weight reduction in obese subjects, reduced intakes of dietary saturated and trans-fatty acids, cholesterol, and sodium, and increased physical activity. The use of drugs to control CVD risk factors likewise deserves consideration.
Targets of therapy include dyslipidemia, hypertension, and prothrombotic factors. The prime lipid targets are atherogenic lipoproteins—low-density lipoprotein (LDL) and very LDL. In patients with CVD plus metabolic syndrome, LDL cholesterol levels should be reduced to <70 mg/dl, and LDL + very LDL cholesterol (non-HDL cholesterol) to <100 mg/dl. Statins are first-line drugs to achieve these reductions. If these goals are not attained with a statin, a second-line LDL-lowering drug can be used: nicotinic acid, bile acid sequestrant, or ezetimibe. If CVD is not present, goals are an LDL cholesterol <100 mg/dl and a non-HDL cholesterol <130 mg/dl. In most patients, a statin alone usually is sufficient to achieve this goal.
Blood pressure should be lowered to <130/<85 mm Hg, and preferably to <120/<80 mm Hg. Any of the standard blood pressure–lowering drugs (e.g., angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium blockers, diuretics, beta-blockers) can be employed. Evidence favoring 1 drug over another is limited. Nonetheless, physicians should keep in mind that beta-blockers and higher doses of thiazide diuretics raise glucose levels and predispose patients to conversion to diabetes. Opinion is divided whether these actions have clinical significance in patients with pre-diabetes (80).
A large clinical trial recently found that aspirin therapy does not overall reduce CVD events in patients with diabetes (81). However, this failure appeared to be limited to persons on hypoglycemic drugs; those on diet-therapy alone showed risk reduction. This suggests that patients with early diabetes and almost certainly those with pre-diabetes will benefit.
Prevention of Microvascular Disease
The only way to prevent (or delay) microvascular disease in patients with pre-diabetes is to prevent (or delay) the development of diabetes. Unfortunately, there is no proven way to prevent the decline in beta cell function in persons destined to have diabetes. Therefore, priority must be given to reducing insulin resistance. This is best achieved by lifestyle intervention—weight reduction and increased physical activity. The DPP (13) demonstrated the efficacy of this approach. Consequently, all persons with pre-diabetes should be encouraged to engage in a lifestyle intervention program. If need be, professional assistance is useful. The DPP found that metformin therapy also could delay conversion of pre-diabetes to diabetes in about 40% of subjects. This has led to a recommendation on the part of some diabetologists for the use of metformin in persons with IFG plus IGT and other metabolic syndrome risk factors (15). Whether this approach will materially retard the development of microvascular disease would require a major clinical trial that is unlikely in the near future.
Public Health Prevention
The public at large is increasingly concerned about the diabetes epidemic. Most people know relatives or friends who have diabetes so that they have first-hand knowledge of the suffering imposed by this chronic disease. Therefore, when a person is told that he or she has pre-diabetes, this person's concern is usually increased substantially. This provides an incentive for effective intervention. It further offers the opportunity to detect the metabolic syndrome, which carries greater risk for macrovascular CVD. In a word, use of the concept of pre-diabetes can be a useful tool for intervention to prevent both macrovascular and microvascular disease. In the view of this author, the time is ripe to make use of this concept in clinical and public health spheres.
Dr. Grundy has reported that he has no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- American Diabetes Association
- confidence interval
- chronic kidney disease
- cardiovascular disease(s)
- HbA1c
- glycosylated hemoglobin
- high-density lipoprotein
- impaired fasting glucose
- impaired glucose tolerance
- low-density lipoprotein
- oral glucose tolerance test
- relative risk
- World Health Organization
- Received June 14, 2011.
- Revision received August 17, 2011.
- Accepted August 23, 2011.
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- Chait A.,
- Bornfeldt K.E.
- Coutinho M.,
- Gerstein H.C.,
- Wang Y.,
- Yusuf S.
- Huxley R.,
- Barzi F.,
- Woodward M.
- Alexander C.M.,
- Landsman P.B.,
- Teutsch S.M.,
- Haffner S.M.,
- NHANES III and NCEP Investigators
- ↵
- Ford E.S.,
- Zhao G.,
- Li C.
- Knowler W.C.,
- Hamman R.F.,
- Edelstein S.L.,
- et al.,
- DPP Research Group
- ↵
- Dormandy J.A.,
- Charbonnel B.,
- Eckland D.J.,
- et al.,
- PROactive Investigators
- ↵
- ↵
- Lonn E.M.,
- Gerstein H.C.,
- Sheridan P.,
- et al.,
- DREAM (and STARR Investigators
- ↵
- ↵
- Bierman E.L.
- ↵
- Gami A.S.,
- Witt B.J.,
- Howard D.E.,
- et al.
- Mottillo S.,
- Filion K.B.,
- Genest J.,
- et al.
- ↵
- ↵
- Okada S.,
- Morimoto T.,
- Ogawa H.,
- et al.,
- JPAD Trial Investigators
Citation Manager Formats
Article Outline
- Top
- Abstract
- What Is Pre-Diabetes?
- Pre-Diabetes as Intermediate Hyperglycemia
- Combined Impaired Glucose Tolerance and Impaired Fasting Glucose
- Hemoglobin A1c
- Pre-Diabetes and the Metabolic Syndrome
- Metabolic Syndrome, Pre-Diabetes, and Cardiovascular Risk
- Metabolic Syndrome and Macrovascular Disease
- Dual Goals for Pre-Diabetes Intervention
- Screening for Pre-Diabetes
- Prevention of Macrovascular Disease
- Prevention of Microvascular Disease
- Public Health Prevention
- Footnotes
- References


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Member Events
Downtown Lafayette Unlimited hosts a wealth of events for the Downtown member community.
Downtown Lafayette Unlimited hosts a wealth of events for the Downtown member community. These events offer our members opportunities to learn about Downtown's issues and successes, network with other local professionals, and engage with the Downtown community. These events are completely free for all DLU members to attend.
Downtown Lunch & Learns
Downtown Lunch & Learns are recurring lunchtime events that provide opportunities for DLU members and others to stay informed on the issues facing Downtown Lafayette and engage with the leaders who can shape our district's future. The Lunch & Learns take place in many formats from guest presentations, panel discussions, group discussions, and town hall style meetings.
Downtown Meet-Ups
Downtown Meet-Ups are a partnership between DLU and Opportunity Machine to create a series of happy hour events in Downtown Lafayette for local entrepreneurs, new business owners, Downtown business champions, and community members.
Attendees of Downtown Meet-Ups can:
- Hear from Downtown entrepreneurs about why they chose to locate Downtown, what opportunities and challenges they have faced, and how they are growing their business in the heart of our city.
- Create connections with local individuals and businesses and experience inclusive conversations with people from different fields of business discussing their problems and asking questions. Our hope is that mentor relationship will form through this exchange.
- Learn, socialize, network, and advocate for Downtown's future.
Upcoming Events › Downtown Member Events
- No matching events listed under Downtown Member Events. Please try viewing the full calendar for a complete list of events.
Want to see what the Downtown community is up to? View all of our upcoming member events, or read about our last Downtown get-together.

subset: commoncrawl


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It's our job to share dope music with you, and 'Since 85' is just that. Produced by Tha Audio Unit, the homie Nes Wordz put together a nice EP for you Hip Hop heads to groove to. Check it out below, it's definitely worth a few hundred listens. My personal favorite track is 'Tiger At Augusta,' leave a comment below and let me know what joint you're feelin!
click here to download! http://t.co/i24FhhV5SM
One Reply to "[MUSIC] @NesWordz – 'Since 85' EP (Produced By @ThaAudioUnit)"
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You – aliens, invaders of the Earth. Your goal – to destroy all the cities. But be careful! The Terrans will be protected.
After learning about the disgusting attitude of humanity to their planet, the inhabitants of a distant galaxy decide to rectify the situation and destroy civilization. Well, or at least military targets, from which comes most of the ills. Maybe it will make people think about simple things, albeit under the pressure of fear. But it turned out to be not so easy! Military bases are too heavily fortified, the aliens miscalculated the number of troops sent. To wait for reinforcements pointless, it will take several years. You need to properly dispose of resources and outsmarting the military, the only trump card which is the size of the army!
You will find twenty levels, each of which is necessary to destroy all the ground troops and military installations. The aliens resemble the famous Zerg from Starcraft. The whole army is completely biological. Given a choice of ten types of troops, however, will initially be open only one. New units open to evolution points awarded for successfully passed a levels. Also for these points, you can improve the available types of troops by four characteristics. Before each level You can buy troops available on the glasses DNA. Pay attention to the purchase of fighters, as well as to their landing. Mistakes can not be tolerated!
In the store you buy new types of units and then reinforce them. There are several varieties of aliens: warriors-destroyers, flying, support and traps. You can buy them for the evolutionary points, which you earn by destroying earthlings.
Management Alienocalypse Games:
Move the base around in space – the keyboard arrows.
The choice of units resettable – Q and E.
Reset units – spacebar / click on the icon.


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Woot Bargain Bin: Deals Under $5; 12 Permanent Markers $1.50, 4 Philips LED Bulbs $3.14, Melissa Doug Giant Fire Truck Puzzle $4.01, And More!
Amazon Prime members receive free shipping on all orders.
Sample deals:
- Melissa & Doug Fire Truck Jumbo Jigsaw Floor Puzzle (24 pcs, 4 feet long): $4.01
Post what deals you find!


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When people are up to selling or buying of a property or getting it on lease, it is a proper agreement that they have to follow where they have to let the party get the building cleaned, and for that they have to make sure that they get the vacate cleaning done so that any of the mess is not remaining in the building whatsoever, the vacate cleaning in Perth makes sure that the cobweb removal is done, along with that it is done by the professionals that have been trained in a way that they know how to go about all the processes. These professionals have a better idea of how they should be working on field and so we can say that it is not wrong to make sure that the work is done in the perfect manner to make sure that nothing remains that would be of any chance leading to a void contract among the parties. There are a lot of people that are actually finding it hard to get their houses clean but with the service on board they are able to do it and also this is a service for everyone, not for anyone in specific, so you can ask for it no matter how much you earn on a monthly basis. The main problem that people all around the world feel is that they are not aware of all the services and facilities that they are being provided with which leads to such problems for them.
1- Deep cleaning
One thing that is for sure in this case is that with the help of companies that provide the facility of vacate cleaning, people can ensure that the building would have a proper and effective cleaning for that matter, there would be no errors and the professionals that would make sure that they do the work would do it in a professional manner so that you would not have any problems with the work that you would be delivered in that case.
2- Save resources
If you were up to doing all the work by yourself or getting it done by the people that have no idea how they shall be going about this whole process, you would be losing out on the resources such as your effort, time and money as well. These people would not know where they have to go deep and which places they are yet to cover for cleaning and so it is always a better idea to leave such work in the hands of people that are aware of what they are doing and are well equipped with the stuff that would be needed while the vacate cleaning is being done.


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Lydham, Shropshire & Montgomeryshire Family History Guide
Lydham is an Ancient Parish partly in Montgomeryshire.
Other places in the parish include: Aston.
Status: Ancient Parish
Parish church: Holy Trinity
Parish registers begin:
- Parish registers: 1596
- Bishop's Transcripts: 1638
Nonconformists include:
Parishes adjacent to Lydham
- Norbury
- More
- Bishop's Castle
- Hyssington
- Snead
Historical Descriptions of Lydham
The Imperial Gazetteer of England & Wales 1870
LYDHAM, a village in Clun district, Salop, and a parish partly also in the district and county of Montgomery. The village stands near the river Camlet, at the boundary with Wales, and near Lydham-Heath r. station, 2 miles NNE of Bishops-Castle. The parish comprises 1,943 acres in Salop, and 1,125 acres, forming the township of Aston, in Montgomery. Post town, Bishops-Castle, Shropshire. Real property of the Salop portion, £2,437. Pop. of the whole, 205. Houses, 29. Pop. of the Salop portion, 143. Houses, 19. The property is much subdivided. The manor belongs to the Rev. A. Oakeley. Oakley House is the chief residence. The living is a rectory in the diocese of Hereford. Value, £463. Patron, the Rev. A. Oakeley. The church is ancient but good, and has an ancient font.
Source: The Imperial Gazetteer of England & Wales [Wilson, John M]. A. Fullarton & Co. N. d. c. [1870-72].
Shropshire Gazetteer 1824
Lydham. A parish partly in the county of Montgomery, and partly in the Bishopscastle division of the hundred of Purslow, a rectory, in the diocese of Hereford, the deanery of Clun, and archdeaconry of Salop. The parish contains 225 inhabitants. The Shropshire part, 18 houses, 113 inhabitants. 2 miles north-east by north of Bishopscastle.
Source: The Shropshire Gazetteer, with an Appendix, including a Survey of the County and Valuable Miscellaneous Information, with Plates. Printed and Published by T. Gregory, Wem, 1824
Parish Registers
Lydham, Shropshire Parish Registers 1591 to 1812 - Archive.org
Poll Books
Poll Book 1865, Lydham Shropshire
Lydham Caseys Directory of Shropshire 1871
Family History Links
FamilySearch – Birth Marriage & Death records, Census, Migration & Naturalization and Military records – Free
Vision of Britain historical maps
County: Shropshire
Civil Registration District: Clun
Probate Court: Court of the Bishop of Hereford (Episcopal Consistory)
Diocese: Hereford
Rural Deanery: Clun
Poor Law Union: Madeley
Hundred: Purslow
Province: Canterbury


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Contributing to a campaign on Indiegogo is much more than a simple transaction. It's a pledge of support and the beginning of an exciting journey. Never before have consumers been able to see behind the scenes into the entrepreneurial journey. Everyday on Indiegogo, thousands of people come together to bring innovative ideas to life. While … read more
Tag: Shipping
August Arrivals: 9 Crowdfunded Products Shipping This Month
The Freight Essentials: Getting Your Products Across The Ocean
Design, Check. Funding? Nailed it. Prototype? Yup. Importing? Oh, ship. For entrepreneurs, importing can be a frustrating nightmare of bureaucracy and cryptic acronyms. And pirates. Don't forget the pirates. But fear not, intrepid importer. We're going to get through this together. Sit back as we walk you through what it takes to get your goods … read more
Resource Guide: A Company to Support Your Idea at Every Stage
As an entrepreneur, there are many steps between brainstorming your big idea and launching it into the real world. We at Indiegogo want to help you with every single stage of the business lifecycle—before and after crowdfunding. That's why we've partnered with experienced companies to give our campaigners a leg up in the big, scary … read more
New and Improved: Shipping Perks
Indiegogo is a truly global platform – every week we distribute funds to campaigners in 70-100 countries. Campaigners can easily connect with contributors on the other side of the globe, which presents unique challenges for campaigners – one of which is collecting payments to ship their perks around the world. We're introducing a new shipping … read more


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If you have a sore throat as a result of choking, you are likely looking for sore throat remedies. The ENT doctor from The Hearing Doctors (ENT Associates of South Florida) in Fort Lauderdale knows that sore throats after choking are often a result of damage to the trachea during the act of choking. This typically heals on its own but there are ways to ease the pain. If the pain lingers for too long, then it may be time to contact an ENT doctor. To learn more about sore throat pain after choking, contact us at The Hearing Doctors (ENT Associates of South Florida) in Fort Lauderdale.
Over the Counter Sore Throat Remedies
There are a number of remedies for sore throat at the pharmacy. Many of them are targeted for sore throat as a result of a cold or allergies and they may have ingredients that seek to ease the pain by treating the malady rather than the symptom. As a result, they may not be right for your particular type of throat pain. Look for those that address throat pain without the addition of cold or allergies, such as general pain medication.
Home Remedies for Your Throat
Some people find that home remedies are enough to carry them through until it is time for them to contact a doctor. This is because there are several things that can be found in your own pantry that can soothe an irritated throat for a short period of time until you can get to a doctor who can treat your throat pain more readily. One common remedy for throat pain is honey. The honey is viscous and can coat the throat to ease pain and provide needed moisture. Tea can also help a sore throat but be certain that the tea is not too warm as this can cause it to burn your throat and increase the effect of the injury.
Visit an ENT Doctor
When either of these sore throat remedies are no longer enough for you to feel comfortable, it is time to turn to an ENT doctor. This is because sore throats after choking are common, but lingering pain can point to serious injury or some underlying illness. Make sure to consult with an ENT doctor if your pain has lingered for too long so that you can get proper treatment and recover fully.
The Hearing Doctors (ENT Associates of South Florida) in Fort Lauderdale are available to help you with your sore throat from choking. We are experienced and willing to assist you in helping you feel more like yourself. Contact us to learn more about our services.
Contact Us
The Hearing Doctors (ENT Associates of South Florida) is a clinic located in Fort Lauderdale that can help you with your sore throat pain after choking. If you are continuing to have pain symptoms after choking and you need help in healing, contact us at The Hearing Doctors (ENT Associates of South Florida) to schedule an appointment.


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Kitsault, British Columbia, Canada
Kitsault BC
Original location of **Silver City**
Company town constructed to mine molybdenum
Located across from the old mining town of Alice Arm
Head of Alice Arm, Observatory Inlet
Cassiar Land District
Lat-Long: 55°28'00" N, 129°29'00" W
The whole town is now privately owned.
I believe they are working on reopening the old mine.
For many years before it was sold, caretakers looked after the town site.
Photos courtesy Brian Wolfe, Ladysmith BC
Post Office
Established Jan 15, 1969, closed Aug 10, 1972
BC Telephone History
Ext Links
Note-Not my Sites, Links may or may not work in the future as I do not control these sites
Kitsault book
Name meaning


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The X-Files: Season 10 - Babylon (Review)
Review by Rob Carnevale
IT'S difficult to comprehend just what Chris Carter was thinking when he decided to write Babylon, the fifth episode in his X-Files revival.
A crude mix of war on terror, magic mushrooms and religious dissection, this took an all too real and all too sensitive issue and attempted to inject surreal/absurdist humour into it, not to mention patronising preaching. The result was objectionable on almost every .level.
When two Islamic friends walk into an art gallery and trigger suicide bombs in protest against a painting of the prophet Mohammed, one of them survives… albeit in a comatose state. Mulder and Scully are called in, apparently by two younger versions of themselves in the form of Agents Miller and Einstein.
For Scully, the case represents an opportunity to use science to give the FBI the chance to do something she couldn't do with her recently deceased mother: communicate with someone in a coma in the hope of catching any further terrorist cells. For Mulder, meanwhile, the case marks the chance to open up the same kind of communication, albeit using magic mushrooms.
And so the stage is set for one of the worst sequences in recent TV memory [and X-Files history] as Mulder enters an alternative sub-conscious state. At first tripping his way through a hospital corridor, he then embarks on some cringe-worthy country and western dancing, brandishes some 'shroom bling', undergoes a torrid S&M session, before finally locating his terrorist lying Pieta-like in the arms of his mother on a rowboat overseen by a whip-wielding Cigarette Smoking Man.
There's a brief, mumbled verbal exchange before Mulder wakes up in a hospital bed struggling to remember what he was told. He does, of course, later remember – and the exchange turns out to have included the name of the hotel the remaining terrorists are hiding out in. But not before Mulder's accomplice, sceptical Agent Einstein, reveals she actually slipped him a placebo.
By the time the terrorists are rounded up and Miller and Einstein are done attempting to fathom their role in solving the case, it's left to Mulder and Scully to ponder God and his grand plan.
"I saw things, though, Scully. Powerful things," Mulder says in the epilogue. "I saw deep and unconditional love."
"I saw things, too," Scully replies. "I witnessed unqualified hate that appears to have no end."
"How to reconcile the two," counters Mulder.
It's a big question for sure. But one best avoided by writing such as this. Carter may well claim his episode seeks to highlight the hypocrisy and absurdity surrounding a lot of religious rhetoric, while simultaneously sounding a note of caution about the power of suggestion and the importance of loving one another.
But his message got lost in the carnage created by the episode's wildly uneven tone. The trip sequence hung like a noose around its neck, almost trivialising the seriousness of the issue itself. But the shallow philosophising smacked of naivety when it didn't feel insulting (to even those of average intelligence or any religious persuasion). Homeland sets the current benchmark for tackling the war on terror.
And that's not even getting started on the extremely irritating inclusion of the younger Mulder and Scully – played with none of the charisma that make the original duo so endearing.
As the penultimate episode of this mostly successful revival, Babylon was particularly disappointing. Perhaps the problem lies with Carter himself given that, thus far, the weakest entries in this mini-series have come from him.
Babylon feels like a folly that should never have been indulged.


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PACIFICARE: Announces FHP Conversion Is Complete
PacifiCare of California, the HMO subsidiary of PacifiCare Health Systems Inc., announced yesterday it completed the conversion of the entire membership of former FHP members to its health plans. Since PacifiCare acquired FHP in February 1997, more than 780,000 Californians have been converted -- nearly 200,000 of them Medicare HMO enrollees. Most former FHP members will be able to continue to see the same personal physician since PacifiCare has established contracts with a majority of the medical groups and hospitals in the old FHP network. By completing the integration almost three months ahead of the September 1 goal, the company hopes to benefit from "reduced redundancies that come from having members on two separate operating systems." PacifiCare Inc. CIO Jim Williams said, "Information on our members and contracted physicians can now be accessed quicker and more efficiently on one computer platform, affording quality service and improved member satisfaction." PacifiCare of California insures more than 2.3 million state residents. The company's enlarged network includes some 31,000 physicians and 300 hospitals statewide (PacifiCare of California release, 6/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.


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The sickness of today's society
Paul Joseph Watson
June 16, 2019
VICE said my distaste for modernity is borne out of me being a "deeply bitter bully" who "derives no pleasure whatsoever from his life".
Here's my response.
Please share this video: https://youtu.be/_9Mbh0PsVw4
There is a war on free speech. Without your support, my voice will be silenced.
Please sign up for the free newsletter here. Donate to me on SubscribeStar here.
Support my sponsor – Turbo Force – a supercharged boost of clean energy without the comedown.
This article was posted: Sunday, June 16, 2019 at 2:24 pm


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Price: $120.00
Quantity: 13 available
Book Condition: New
Octavo (21 cm), pp. 196. One of 26 limited signed copies, lettered A - Z. Signed by author on title page. Blue pearl linen boards with gilt stamped titling. Jacket featuring artwork by the author. Includes a 5"x7" broadside, in vellum envelope, of the poem "A Belly Full of Stream," letterpressed with handset type by Aaron Parrett of the Territorial Press in Helena, Montana, on Moravia paper which was handmade at Velké Losiny in the Czech Republic (the oldest papermill in Central Europe). The author has signed and hand-painted a bluebird on each broadside, numbered 1 - 30. The letter of the book corresponds to the number of the broadside. [Note: Book "C" is pictured as an example. Contact us to inquire exact copies currently available.]The Bluebird Run is a monumental collection of 180 new sonnets by Montana poet, memoirist, artist and musician Greg Keeler. Ranging from humorous flights to poignant meditations on loss, love, aging and the fate of humanity in the face of looming environmental and social crises, the poems showcase a highly lauded writer at the peak of his abilities. "If these sonnets were trout steams, they'd be full of rainbows and cutthroats alike." --William Pitt RootKeeler has previously published two memoirs, Waltzing with the Captain: Remembering Richard Brautigan and Trash Fish: a Life. He has written seven collections of poetry—most recently, Almost Happy from Limberlost Press. He also illustrated Jim Harrison's chapbook, Livingston Suite. Dust jacket present. First Edition.
Title: The Bluebird Run
Categories: Poetry,
Edition: First Edition
Publisher: Livingston, Montana, Elk River Books: 2018
ISBN Number: 0986304042
ISBN Number 13: 9780986304040
Binding: Hardcover
Book Condition: New
Jacket Condition: New
Inscription: Signed
Item: 1.00 Item
Seller ID: 23404


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Search Catalog
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Enter title keywords, author last name, or publication identifier. Then use additional search filters to the right (or below, on small screens).
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Late Quaternary Stratigraphy, Idaho National Laboratory, Eastern Snake River Plain, Idaho
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Year: 1999 | MISC-11 (Miscellaneous Reports)


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Tomorrow, Saturday, June 18th, is this campaign's first national day of action.
Thousands of volunteers have already signed up in New Orleans and beyond to register voters and collect "I'm in" cards from new supporters.
Can you make it? Here are the details:
What: 2012 Day of Action
Where: New Orleans, LA 70115
When: Saturday, June 18th, 11:00 am
You should come out -- it's sure to be a fun and inspiring day:
I see two glaring problems with this invitation, and one big positive.
The problems:
(1) The New Orleans Hornets started using the slogan, "I'm In!" in their huge marketing campaign for the upcoming season well before the Obama re-election machine officially cranked up. Signs declaring "In-ness" are sported on lawns all across the region, but they're printed on fields of Creole Blue and Gold, not Baracky red, white, and O-blue. The campaign, therefore, might believe it has broader support in southeast Louisiana than it actually does and might not work as hard down here. Wait -- maybe that's not a problem after all.
(2) New Orleans is a pretty big place. It would probably have been better to give volunteers a precise gathering location instead of leaving them to wander aimlessly around Orleans Parish in search of campaign literature and community organizers. Wait -- maybe that's not a problem either!
The original Positive that I derived from the invitation (before discovering the inadvertent ones)? The simple fact that I received the email invite means that I haven't yet been outed as a mole, and I'll be able to continue sharing the info I gather about the Administration and Campaign as an undercover operative!
Emma Peel lives!


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We woke up on Saturday to this view:
Yes, I went out into the parking lot with my PJs on and no shoes and took this picture. It was only appropriate given our location ;)
It was time to leave Walmart for our destination for the weekend (you can only park in the Walmart lot overnight). We packed up and headed to Dan Nichols State Park in Salisbury. It was very lovely. However. Do you know where Salisbury is located? It's just north of Charlotte, NC. Do you know what is huge in Charlotte? NASCAR. Do you know what weekend it was in Charlotte? Race weekend. Do you know what that means? NO SPOTS ANYWHERE. Yep. lack of planning. Who knew that there wouldn't be camping spots anywhere in Salisbury, NC. Have you ever heard of Salisbury, NC?
Fortunately for us, Brandon's dad had already contacted the owner of a trucking company that is right next door to his grandmother's house (we can't get into the driveway of her house with this monster). He agreed to let us dry camp in the lot there. Whew!!
So this is our spot for the weekend. Isn't it great? It is right next door to everyone, though, so that's a bonus.
We went to breakfast at .... if you know me, you know where we ate breakfast! We're on the road, for crying out loud. There's only one place for breakfast when you're on the road as far as I'm concerned. Where do you think we stopped?
We went back to the house and the kids played while we figured out our plans for the day. They LOVED raking leaves and jumping into the piles.
Later on that evening Brandon's mom told me that my littlest one asked her to pretend that she (my daughter) was a slave and that Gran was a slave owner. "Now, you tell us what to do, and we'll rake the leaves and then you're not going to like it and you're going to get very angry," she told her. Cute. My little director. I promise, she will be in some sort of profession that allows her to be in complete control.
While the kiddos played in the leaves, Brandon and I and Angela and Nathan (Brandon's brother and his wife - our sis-in-law - I hate saying "his wife" - sounds so cold) went on the October Tour. This is a tour of homes they have each year. This is an historic town in NC and the homes are gorgeous.
We were enjoying our tours and then we came to this house:
We call it the happy house. Oh my my my. I really should've taken pictures inside to give you a better idea. Little did I know that it would be the highlight of the day!
So we go inside (with many other people on the tour) and the owner of the home proceeds to tell us about his home. Nothing in it is original save the front doors because it was butchered up into apartments at one time and then fell into disrepair for some time before he bought it to restore.
As I was looking around I thought that several of the graphic arts posters on the wall were pretty cool. Until he started talking about them. Oh.my.goodness. Instead of telling us about the house, he told us about every.single.thing. in the house and his collections. And his collections began to reveal something about him. Now, normally we'll go on tours like this and it's obvious when the owners are gay which happens a lot on these type of tours). And that doesn't bother me. But this guy. He was, well, odd. Straightaway we had an inkling that he was gay, but no problem. Until he started to tell us about the Boys D-Lite costumes on the wall that were one time used in Boy Scout camps. And the media room with movie posters where the Brokeback Mountain poster was specifically pointed out. And the working vintage toys (so many of them ... like Michael Jackson's Neverland). It was just kind of odd and I know I cannot communicate to you well just how odd it was.
When we went into the next room I saw a couple stealthily back their way out of the room and the tour and I wanted to be them. We then went into the kitchen. Which was pretty cool. Until. After we were all in the kitchen ready for the docent to speak, we turned behind us and saw "Wake up GAY in the morning" posters. Several of them. And gay bobby pins. And other gay things. I mean that everything on the wall had the word GAY. It was a whole gay wall. Yes. An entire GAY WALL. I started giggling. Because it was so gay. Gay means happy, right? And then the docent began speaking. And telling about the Boy Scouts cereal advertisements on the wall to our right. And I almost lost it. I found a screen door just to my left and I scurried outside. Angela promptly followed. We were laughing so hard that we couldn't speak. I was trying to tell her that what got me so tickled was that the docents were pointing out EVERY.SINGLE.THING. on every single wall in the house and I wondered if she was going to turn our attention to that wall and point out all the gay collections on the gay wall. And I just got tickled. And you know how it is when you're not supposed to be laughing and then you get tickled.
We waited on the boys, who stayed on the tour. Go figure. We talked about this all weekend an laughed and laughed. Maybe it's a location thing, but it still cracks me up. We'll never forget the Happy House.
Then we completed our fall tour and went back home, got cleaned up, and went to dinner.
Oh, I must share picture of the homes:
Dinner was AWESOME. Some of the best food I have ever had anywhere. And I have eaten a lot of good food. It was called Coopers. Fitting since we have a Cooper in the family (the only boy this weekend - bless his heart) and Brandon's mother's maiden name is Cooper.
We went home after a long and fun day and slept hard. I'm hoping are able to explore the downtown Salisbury area a bit today before we head off for God-only-knows-where, Virginia.
Monday, October 14, 2013
Fall RV Trip Day 2 - Salisbury
1 comment:
Why yes. I do know where Salisbury, NC is but that is only because we lived outside of Charlotte for several years and visited Dan Nichols Park several times. I'm bummed that you guys didn't get to visit there as it is a pretty awesome place but it sounds like you guys have fun no matter what you do or where you go. :) I remember race weekends all to well. Always crazy! LOVEd the fall leaf pics and those houses are gorgeous! Love the Walmart pic too. ;)ReplyDelete
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This story has been updated.
Sen. Scott Brown (R-Mass.) tells the Boston Globe that he is being sent to Afghanistan.
The Republican senator offered few details about his plans to the Bay State-based outlet. A member of the Massachusetts National Guard, Brown declined to indicate whether his impending departure is the result of a formal deployment. He signaled that he would issue a statement later on with more information regarding the matter.
"I'm going to be going over at some point to do some missions," said Brown to the Globe in a phone interview.
The news comes one day after President Barack Obama announced that Osama bin Laden has been killed.
HuffPost's Sam Stein and Jen Bendery report:
Osama Bin Laden is dead, President Obama announced Sunday night, in a televised address to the nation. His death was the result of a U.S. operation launched today in Abbottabad, Pakistan, against a compound where bin Laden was believed to be hiding, according to U.S. intelligence. After a firefight, a small team of American forces killed bin Laden and took possession of his body, the president said.
"Justice has been done," he said, in comments that marked a formal end of the manhunt for the most visible and emotionally-charged symbol of the terrorist attacks of Sept. 11, 2001.
The president said U.S. intelligence operatives received a tip in August on bin Laden's whereabouts, which ultimately led to Sunday's attack. Obama said he determined last week that the U.S. had enough reliable information to take action; by Sunday morning, he had authorized "a small team of Americans" to conduct an operation targeting bin Laden.
On Monday, Brown released a statement on the monumental news.
"This is a great day for America and our allies across the free world," he said. "Osama Bin Laden has finally gotten the justice he deserved. I commend President Obama, former President Bush and the highly capable men and women in our military and intelligence community whose tireless work over the last decade made this day possible. It is also a time to reflect on the victims of 9/11 and their families, as well as those who have died across the world fighting terrorism. Let this be a lesson that there is no sanctuary in the world for America's enemies."
UPDATE: Sen. Scott Brown issued the following statement on his annual National Guard duty on Monday:
"As a Lieutenant Colonel in the Massachusetts Army National Guard, I have service obligations that I fulfill each year. Following in the tradition of other lawmakers who have completed their military service requirements overseas, this year I have requested to conduct my annual training in Afghanistan. Doing so will help me to better understand our ongoing mission in that country, and provide me first-hand experience for my duties on the Senate Armed Services, Homeland Security, and Veterans Affairs committees."


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Did you ever felt alone in this big world!!? Even if you have a loving family, so many caring and stupid friends!!! Did you ever wondered will people care if you stop talking, will someone make efforts to reconnect when you go angry, will someone see the pain in your smile, will someone pass the hurdles to love you in your busy schedule, will someone make efforts to take you out of sadness?
Now-a-days humanity is lost somewhere, people are so busy to take care, understand and make efforts! They became lazy and selfish!! Understanding is their inside and so patience! But people tends to take the shorter path; which leads to disappointment, anger, frustration and loneliness for many other who go beyond limits for other's happiness! That's why, Sometimes, the ones who care more, love more, sacrifice and compromise are left alone somewhere!!! They found themselves missing!!!! 😦 😦


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The Elder Scrolls V: Skyrim - Dragonborn DLC Reviews
Category: News ArchiveHits: 19578
Eurogamer, 9/10.
This isn't DLC. This is an expansion, like in the good old days. It's an entirely new area, a blank map waiting to be filled in as you roam, packed with new quests, miscellaneous tasks, dungeons, barrows, ruins and crypts. It's an absolute beast, with a main storyline that lasts a good few hours and enough supporting content to keep you playing for weeks more.
There are new creatures to fight, such as the eerie floating Netch which resemble Mass Effect's Hanar, lumbering Bristleback boars and the fearsome Ash Spawn, who attack en masse with heavy melee attacks and fire magic. There are new crafting materials - Heart Stone and Stalhrim, a tempered ice that can be used to make armour and weapons. There are even new plants and ingredients to add to your recipes.
Any game that demands hundreds of hours from the player must build a long-term relationship, and relationships must remain fresh if they're to endure. With discoveries around every corner, Dragonborn just gave Skyrim fans the perfect excuse to lose themselves in the wild for another winter.
Videogamer, 8/10.
Set on the sizeable island of Solstheim, Dragonborn makes great use of its fresh territory. It's separated into two distinct halves: one half reflecting the island's close proximity to snowy Skyrim in the South West, and the other giving an HD representation of the eerie Dunmer homeland of Vvardenfell in the South East. At sea level, the dusty red plains and towering mushroom houses are instantly reminiscent of The Elder Scrolls III.
The rest of Solstheim's snowy dunes and icy peaks feel much more like home, but it's made fresh with neat little touches that make switching those little compass icons from black to white all the more thrilling. There's an abundance of new stuff in Solstheim, and Dragonborn shows off some of the most intricately creative content I've seen so far in Skyrim. There are recognisable influences from the zany mania of Oblivion's Shivering Isles, particularly in several visits to Hermaeus Mora's otherworldly library, where huge tentacles slither around in black globules under your feet, and Seekers - a nasty new enemy type - haunt every corridor as the gargantuan library shifts around you like a literary labyrinth. It's a world away from the dull, uninteresting expanse of Dawnguard's Soul Cairn, to say the least.
Metro, 8/10.
But what really makes the download worth your time and money is the attention to detail. Rather than just making do with the main story quest the expansion is packed with just as many secrets and extras as the original game. This, Bethesda finally seems to have realised, was always the best bit of Skyrim and there's virtually nowhere on Solstheim you can go without bumping into something unexpected, that you'd swear that you alone in the world have found.
Many of the secrets refer back to existing obscurities in Skyrim, so there's a great sense that these are extras created specifically for the veteran player.
In truth there's nothing here in gameplay terms that's really very new (accepting the disappointing dragon-riding) but more of the same is exactly Dragonborn's appeal. After being messed around twice already this is precisely what most fans will want: a new blank slate to explore and a new obsession to last them through to Christmas.


text: AccountingIntegrator 2.2.1 User Guide Save PDF Selected topic Selected topic and subtopics All content Define report labels You define the report labels in the file resource.properties file and thus can easily localize them. Each language corresponds to a specific properties file: resource_fr.properties: French resource file resource_en.properties: English resource file If necessary, you can update these files via any editor but with a restriction. You are not allowed to modify the keywords in the left panel. Related topics Reorganize the data display Use styles Use images BIRT reports Related Links


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Half-billion-year-old fossil reveals what ancient eyes looked like
A half-billion-year-old fossil contains what's probably the oldest record of the visual system, scientists report in the Proceedings of the National Academy of Sciences. Unearthed in Estonia, the well-preserved trilobite was found with part of its right eye worn away, revealing the early eye's internal, sensory structures, BBC reports. Bees and dragonflies living today have a similar eye structure to the relic's with one notable exception: The fossil lacks a lens common to modern eyes. That suggests compound eyes remain relatively unchanged in more than 500 million years.


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If you love this.. Click the [↻ Repost] button With over 100,000 fans across our network, we're really passionate about discovering new talent and actively seeking out the future generation of producers who will lead the electronic movement. Submit Your Music >>> Goo.gl/5Mrb3m Follow Mint Tunes: Soundcloud - @Mint Tunes Facebook - www.facebook.com/EDMLead Twitter - www.twitter.com/EDMLead YouTube - www.youtube.com/EDMLead website - www.edmlead.com Follow Vanze!!! Soundcloud - @vanzemusic Facebook - www.facebook.com/vanzemusic Twitter - https://twitter.com/VanzeMusic No copyright infringement intended. Promotional use only. All rights and credits go directly to its rightful owners! Copyright Disclaimer Under Section 107 of the Copyright Act 1976, allowance is made for "fair use" for purposes such as criticism, comment, news reporting, teaching, scholarship, and research. Fair use is a use permitted by copyright statute that might otherwise be infringing. Non-profit, educational or personal use tips the balance in favor of fair use. As a music blog and huge fans of the culture surrounding electronic dance music, we're serious about delivering ONLY the richest quality music content while continuously striving to offer our fans the latest news, videos and festival updates from around the world.
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Team Anna Hazare on Thursday gave a call to the people to peacefully march towards the national capital from Saturday, if the government fails to resolve the Lokpal issue.
Arvind Kejriwal, core member of Mr. Hazare's team, also appealed to people here to hold a protest outside the 7, Race Course Road, official residence of the Prime Minister, demanding tabling of Jan Lokpal Bill in Parliament.
He asked the Prime Minister why he is not doing anything about the Jan Lokpal Bill.
"By Saturday, if there is no solution, we will appeal to the people for 'Dilli chalo' People should come in large numbers and sit here till the government finds solution to the issue, if it doesn't introduce the 'Jan Lokpal bill' in Parliament they should not leave till it is resolved," he told reporters after a meeting of the team's core committee.
The meeting also discussed last night's talks between civil society and government representatives that ended in a deadlock.
Team Anna reaffirmed that they are ready for talks with the government, but insisted that government should give in writing its intentions before the next rounds of talks.
"The government should give in writing their intentions and what they want. We will deliberate on their written statement and respond to it once consensus is reached among us. Then we will go for talks," he said.
The RTI activist said Team Anna will talk to political parties to seek consensus on the issue.
"We are going to start talking to other political parties today. We are seeking their time as we have to come to know through newspapers that they may have reservations with some points. We will meet them to resolve these doubts and issues," he said.
The civil rights activist also called for peaceful protest outside the Prime Minister's residence later in the evening today.


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A Short History of Chimney Sweeping
Chimneys started to appear in Britain around 1200, when they replaced the open fire burning in the middle of the one room house. At first there would be one heated room in the building and chimneys would be large.
Over the next four hundred years rooms became specialised and smaller and many were heated. Coal started to replace wood, and it deposited a layer of flammable creosote in the inside surface of the flue, and caked it with soot.
Whereas before, the chimney was a vent for the smoke now it was needed to draw the fire and this required narrower flues. Even so, boys rarely climbed chimneys before the Great Fire of London, when building regulations were put in place and the design of chimneys was altered, The new chimneys were often angular and narrow, and the usual dimension of the flue in domestic properties was 9 inches (23 cm) by 14 inches (36 cm). The master sweep was unable to climb into such small spaces himself and employed climbing boys to go up the chimneys to dislodge the soot. The boys often 'buffed it', that is, climbed in the nude, propelling themselves by their knees and elbows which were scraped raw. They were often put up hot chimneys, and sometimes up chimneys that were alight in order to extinguish the fire. Chimneys with sharp angles posed a particular hazard. These boys were apprenticed to the sweep, and from 1778 until 1875 a series of laws attempted to regulate their working conditions, and many first hand accounts were documented and published in parliamentary reports.
From about 1803, there was an alternative method of brushing chimneys, but sweeps and their clients resisted the change preferring climbing boys to the new Humane Sweeping Machines. Compulsory education was established in 1870 by the Education Act but it was a further five years before legislation was put in place to license Chimney Sweeps and finally prevent boys being sent up chimneys.


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The following Employment Tax guidance note by Tolley provides comprehensive and up to date tax information covering:
The construction industry scheme (CIS) was devised to limit the amount of tax lost as a result of under-declarations or failures to notify chargeability by sub-contractors who came to work in the UK for relatively short periods without paying any tax.
The scheme operates to withhold tax at source at the point of payment, thereby reducing the risk of a subsequent default by the sub-contractor. Although, if the sub-contractor can prove he has complied with his tax obligations he is able to receive payments gross.
The scheme has undergone regular changes since its inception. The current regime came into effect on 6 April 2007.
This guidance note considers the penalty regime for inaccurate returns. For details on penalties for late filing of CIS returns and late payment of tax, see the CIS ― penalties guidance note.
CIS returns are discussed in more detail in the CIS ― compliance guidance note.
For a summary of the CIS, see the CIS ― overview guidance note.
A penalty applies when a person files the CIS return with HMRC, the return contains an inaccuracy which is careless or deliberate and which amounts to an understatement of the CIS withholding due.
The basis of calculation of penalties is to apply a percentage penalty (based on the behaviour of the contractor or his agent) to the potential lost revenue (PLR). Reductions are available for disclosure of the error(s) and for the level of help given to HMRC.
The behaviours which determine the rate of penalty are:
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Afghanistan: Suspected car bomb detonates in Kabul November 13
Suspected vehicle-borne improvised explosive device (VBIED) detonates in Qasaba area of Kabul on November 13; heightened security presence expected over the coming hours
A suspected vehicle-borne improvised explosive device (VBIED) detonated in Kabul on the morning (local time) of Wednesday, November 13. Initial reports indicate the blast occurred near the Interior Ministry headquarters in the Qasaba area of the capital. According to government officials, at least seven people were killed and seven others wounded in the blast. No group immediately claimed responsibility for the attack.
A heightened security presence and localized transportation disruptions are anticipated around the blast site over the coming hours. Details are still emerging; avoid the area.
Taliban and Islamic State (IS) militants launch attacks on government personnel, security forces, and civilians in Afghanistan on a near-daily basis. Such assaults are, in part, intended to undermine the perceived capacity of Afghan National Security Forces (ANSF) - and the Afghan government more broadly - to adequately provide security in the wake of the withdrawal of most US-led NATO forces from the country.
Individuals in Kabul province are advised to monitor developments to the situation, avoid the affected area, remain vigilant for militant activity, and adhere to all instructions issued by the local authorities or their home governments.
The security environment in Afghanistan remains complex. Professional security advice and support should be sought prior to travel.
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A Prayer with John 5:30-47
God the Father sent His Son for our salvation and bears witness to Him. We pray Him to grant us to search the Scriptures that we may receive and believe in Jesus and His works of rescuing us from sin, death, and the devil.
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Source: "Sacred Meditations Collects" (Daily Lectionary found in Lutheran Service Book, pages 299-304 or Treasury of Daily Prayer.)


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With its slightly silky hued raised design this Nourison Vita Rug VIT14 in Kiwi adds a gentle touch of glamour to any floor area in the home or office. When presented in fresh, flirty shades of kiwi, a stunning chevron design moves beyond the eye catching into the extraordinary. Expertly hand tufted for a terrific texture and tone, this Vita Area rug from Nourison is utterly unforgettable in its look and feel.
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Top Fuel 9.7 is a quick and nimble full suspension carbon mountain bike that fuses the efficiency of a cross-country bike with the capability of a trail bike. It's built with a lightweight OCLV Mountain Carbon frame, a 120 mm RockShox Reba fork, 115 mm of rear travel and a dropper for serious fun on flowy trails and techy descents alike. It's the kind of unicorn bike that shreds singletrack, stands up to the rigors of endurance racing and even gives traditional XC bikes a run for their money.

favorite_borderWhy you'll love it

The full carbon frame gives you a light, responsive ride

 TwistLoc simultaneously locks out front and rear shocks for climbs and sprints with the simple Grip Shift-like motion

Mino Link lets you make small adjustments to your geometry quickly and easily, even mid-ride

You get a Straight Shot downtube for extra stiffness in the rough and Knock Block frame defence to protect against spinning bars and fork crowns

- Frame
- OCLV Mountain Carbon main frame & stays, tapered head tube, Knock Block, Control Freak internal routing, Carbon Armor, magnesium rocker link, Mino Link, ABP, Boost148, 115mm travel
- Front suspension
- RockShox Reba RL, Solo Air spring, Motion Control damper, TwistLoc remote, tapered steerer, 46mm offset, Boost110, 15mm Maxle Stealth, 120mm travel
- Rear suspension
- Fox Performance Float, 2-postion DPS damper, TwistLoc remote, tuned by Trek Suspension Lab, 190x45mm
- Wheels
- Bontrager Kovee Comp 23, Tubeless Ready, 6-bolt, Boost110 front, Boost148 rear
- Tyres
- Bontrager XR3 Team Issue, Tubeless Ready, Inner Strength sidewall, aramid bead, 120tpi, 29x2.40"
- Shifters
- SRAM NX Eagle, 12 speed
- Rear derailleur
- SRAM NX Eagle
- Crank
- SRAM NX Eagle, DUB, 32T steel ring, Boost
- Bottom bracket
- SRAM DUB, 92mm, PressFit
- Cassette
- SRAM PG-1230 Eagle, 11-50, 12 speed
- Chain
- SRAM NX Eagle, 12 speed
- Saddle
- Bontrager Montrose Comp, steel rails
- Seatpost
- Bontrager Line Dropper, internal routing, 31.6mm
- Handlebar
- Bontrager Comp, alloy, 31.8mm, 15mm rise
- Grips
- SRAM TwistLoc
- Stem
- Bontrager Rhythm Comp, Knock Block, 31.8mm, 0 degree
- Head set
- Knock Block Integrated, cartridge bearing, 1-1/8" top, 1.5" bottom
- Brake set
- Shimano hydraulic disc, MT501 lever, MT500 caliper
- Weight
- M - 12.63 kg / 27.85 lbs (with tubes)
- Weight limit
- This bike has a maximum total weight limit (combined weight of bicycle, rider and cargo) of 136 kg (300 lb).
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Worms united reinforcements
Version of united which also has reinforcements on the disc.
Version of united which also has reinforcements on the disc.skip navigation sign in. Worms and reinforcements: united diablovt12. Loading.from a pet free, smoke.worms united is a compilation that includes the turn based strategy game.worms reinforcements is an expansion pack for worms, which was later amalgamated with the original game to create worms and reinforcements united a.k.a.
This action packed, superbly playable game.up to 4 teams of wormds do battle over an ever.ign is the worms united pc resource with reviews, wikis, videos, trailers, screenshots, cheats, walkthroughs, previews, news and release dates.does anyone know how to get these games running in dosbox.released in october 1996, this version was exclusive to the pc.it was later.
Bundled with the original game and released as worms united.worms and reinforcements united commonly shortened to worms united is a.wormsreinforcements united iso update information update boxart add screenshots add video report file description: worms and reinforcements united, or simply.worms united is the original worms pc release and the worms reinforcements expansion pack combined.i have the full wormage.
Up to 4 teams of worms do battle over an ever.this is a bundle of three worms pc games 3 discs in 2 cases.worms reinforcements is an expansion pack for the original worms for ms dos.they have been tested and are fully working despite some marks to the discs.worms united description: worm and worms reinforcements are united in.


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Wednesday, March 24, 2010
Wordless Wednesday
15 comments:
Woof! Woof! CUTIES ... Happy Wordless Wednesday. Lots of Golden Woofs, SugarReplyDelete
I love that picture of your two cute heads poking out from the Red Wings blankie!!!!ReplyDelete
We love to snuggle under the blankies too. Must be a smushieface thing. Wanna come over and snuggle with us?ReplyDelete
Stella, Gunther and Betty
Its so nice to see you too so relaxed and happy!ReplyDelete
Hi Yoda & Brutus! You guys do a lot of chillaxin just like me. Us puggies must save our energy for the thing we do best - eating!ReplyDelete
Stubby xoxo
Furry nice pikhs!ReplyDelete
Happy Wednesday!
Hello! Nice to meet you fellow good looking puggies... Cute pictures! I have a boyfriend named Stubby so don't get any ideas.ReplyDelete
I love your name. Mine is Anakin.
My sisters are Izzy and Josie.
Well... I smell food...
Talk to you later...
Your new friends
Anakin & Josie (Izzy is out partying)
I love that picture of you guys under the blanket!ReplyDelete
Brutus looks so much like Ernie, especially in that first picture! Great pictures :-)ReplyDelete
Pug hugs and kisses,
The Pug Posse
Sweet babies!!!!ReplyDelete
You look like the cutest little bookends in that chair. :)ReplyDelete
Awww Snuggle puggles!ReplyDelete
Wags and Licks,
Mollie Jo & Bobo
Yoda & Brutus-ReplyDelete
I wish we could all curl up together! You look like great snuggle buddies!
Looks like you have had a peaceful week.ReplyDelete
oh what wonderful photos of both of you!ReplyDelete
two cutie patooties!
m & e


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And Scene: The Cast Of The Addams Family Reflects On Their Experience
Melanie Thomas and Brianan Chubb
May 9, 2019
On May 2, 3, and 4, Forge Drama performed The Addams Family: A New Musical Comedy. The cast members had been working hard for a long time to put their best foot forward. These are some of their favorite memories from the musical this year: Chance Stephens('19) - ("Gomez Addams"): "Seeing all these new people, learning all these new skills,...