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Home / Esports / One Piece Chapter 1071 spoilers, release date, raw..
One Piece Chapter 1071 spoilers, release date, raw scan and where to read chapter online?
By Naman Alok | Dec 28, 2022 | 2 Min Read
The creator of the Japanese manga series One Piece is Eiichiro Oda. "One Piece" by Eiichiro Oda is one of the most popular manga. It has been serialised in Shueisha's Weekly Shonen Jump since July 1997. The protagonist of this story is Monkey D. Luffy, a child who unintentionally ate a Devil Fruit and turned his body into rubber. The most recent and exciting chapter of One Piece, Chapter 1070, was released on 26 December 2022. One Piece Chapter 1071 Spoilers, Release date, raw scan and where to read chapter online?
Release Date of One Piece Manga Chapter 1071
The series' creator, Eiichiro Oda, won't be adding any new chapters this week. One Piece Chapter 1071 was originally scheduled for release on December 18, 2022, however as one piece will break, the chapter will now be released on January 8, 2023, at about 1:00 AM JST. The chapter will be released at the timings stated below, based on the fans' respective time zones.
• Pacific Daylight Time: 8:00 am, January 08
• Central Daylight Time: 10:00 am, January 08
• Eastern Daylight Time: 11:00 am, January 08
• British Summer time: 4:00 pm, January 08
• Central European Summer time: 5:00 pm, January 08
• Indian Standard time: 8:30 pm, January 08
• Philippine time: 11:00 pm, January 08
• Australian Central Daylight Time: 00:30 pm, January 09
One Piece Chapter 1071 Spoilers
Jewelry Bonney on the Thousand Sunny gasps for air as she awakens. She tells the team to look below, and when they do, they see a horrible creature preparing to swallow them up. They had time to flee as the monster, which like a large metal shark, emerges from the ocean. After being struck by numerous shark torpedoes, the ship sinks. According to Mocha, the other Punk Hazard survivors and she had also decreased in size.
Also Read Chainsaw Man Anime episode 12 overview
Helmeppo and Hibari are appealing with Rear Admiral Grus to go with them to Hachinosu so they can save Koby in the meanwhile. There's nothing anyone can do at the moment, and Grus has no intention of travelling to Blackbeard's home region. Despite the fact that Bonney hates Jinbe, she is thankful to him for saving her life. The female pilot sighs as she leaves the ship's control room, regretting not programming the robot to simply scout, report, and fire on any ships it comes across rather than consume them so she could have saved them. When she identified herself as Dr. Vegapunk, the crew as a whole was in a state of shock.
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One Piece Chapter 1071 release date
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Reading: Missing $20bn Issue Not Adequately Addressed – Sanusi
Missing $20bn Issue Not Adequately Addressed – Sanusi
Former Governor of the Central Bank of Nigeria and the current Emir of Kano, Lamido Sanusi, says the issues surrounding the missing $20bn oil money have not been adequately addressed by the Federal Government.
Sanusi, who is now known as Emir Muhammadu Sanusi II, had last year raised the alarm about missing $20bn but was removed shortly after by President Goodluck Jonathan.
The Federal Government later hired an international audit firm, Pricewaterhousecoopers, to audit the account of the Nigerian National Petroleum Corporation. The PWC report stated that NNPC must remit $1.48bn to the Federation Account.
However, Sanusi, said during an interview with Christiane Amanpour on the Cable News Network on Wednesday, that the level of corruption in the oil sector was still high.
He said for instance, no one had accounted for the billions of dollars paid in kerosene subsidy which was not approved by the National Assembly.
Sanusi added that Nigeria's economic crisis caused by the fall in oil prices, the stock market crash and the devaluation of the naira, was due to the mismanagement of oil funds.
He said, "My position in the Central Bank was that there was always this gap of $20bn after reconciliation between what the NNPC exported and what it deposited into the Federation Account. I raised a number of issues that I think have not yet been discussed and addressed sufficiently.
"One of them is the billions of dollars being paid in kerosene subsidies without appropriation by the National Assembly and against a presidential order and we don't know who authorised those payments and yet no one has owned up to say I authorised the payments, I made a mistake. It must stop. I think those issues need to be addressed and until we address them and begin to close all the loopholes in government revenues, we are going to continue to create opportunity for the destruction of the economy.
"It could be $20bn at the end of the day. After reconciliation it could amount to $14(bn) or $12(bn) and I think these issues reflect unconstitutional and illegal withholding of revenues from the Federation Account.
"The country is paying the price today; oil prices have crashed, the currency has been devalued, the stock market has collapsed, government revenues are in a very bad shape. Whoever wins, whether this government or the opposition, will have to deal with these issues. The petroleum sector is a major drain on the resources of the country and this has to be looked at."
Sanusi, who said the presidential candidate of the All Progressives Congress, Maj.Gen Muhammadu Buhari (retd.), was right to say that corruption was killing Nigeria, added that Nigeria must stop living in denial.
The Emir praised the military for its recent successes in the fight against terrorism, saying Boko Haram would have been curtailed if the anti-terror war had started a long time ago.
Reacting to a question about threats by Boko Haram to kill him, Sanusi said, "If I had a way of knowing that if Boko Haram took my life, they would stop killing people in Nigeria, I would give my life. I have nothing else to aspire to, I have achieved.
I think the important thing is for every Muslim leader to speak up."
TAGGED: Sanusi

redpajama_set_name: RedPajamaCommonCrawl


As head of exploration, you are doing discovery and sense-making of emerging trends and uncovering the implications of those trends for systemic impacts. You're considering the risks of these emerging trends as well as their potential for accelerating progress towards the social and environmental challenges that are priorities for your country. You're deeply curious and, through your networks, you find unusual solutions, people, and partners that can tie into Lab's work.
This page was last modified on 11 February 2019, at 16:47.


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Film Scene: Cinematic scene serves up epic goof, two film fests, a dark Giallo and more
Jim Reed @pfssav
There's plenty of unusual cinematic fare being presented in and around Savannah over the next seven days at alternative venues – and this is your one-stop guide to that celluloid smorgasbord. Choose wisely, dear readers. Your very life may depend on it!
We start things off out on Tybee Island, where the restored, historic single-screen Post Theater will screen the 1939 fantasy classic "The Wizard of Oz" on May 9. If you've only ever seen this beyond surreal adaptation of the L. Frank Baum novel on a TV, you owe it to yourself to witness it as the filmmakers intended. It still packs a mighty wallop. Showtime 7 p.m.
Alright alright alright
On May 16, the Tybee Post kicks off a three-day, five-show engagement of one of the most frustratingly impressive and perplexingly enjoyable dramedies in recent memory: provocative filmmaker Harmony Korine's latest topsy-turvy look at the downside of monied party culture, "The Beach Bum."
Described as "an epic goof" by one critic, this wide-eyed portrait of the downfall of a decadently hedonistic counterculture literary sensation is played with tremendous aplomb by Matthew McConaughey. He's become a volatile Key West stoner icon who can be a bit of a rough slog at times.
The movie's pacing is rather uneven and it veers wildly from borderline inscrutable art-house territory to populist, low-brow, gross-out slapstick shenanigans. However, with Korine ("Kids," "Gummo," "Ken Park," "Trash Humpers," "Spring Breakers") at the helm, the end result is a bracing, tumultuous blur of vivid, crowded images and occasionally unconnected vignettes that wind up sending semaphore signals to the audience rather than a lengthy email.
Boasting unexpected faces who acquit themselves very well in key supporting roles (Snoop Dogg, Martin Laurence, Jonah Hill) and stunt casting cameos by folks who either hit it out of the park (Zac Efron – yes, that Zac Efron) or who drop the ball so clumsily that you can almost feel the audience groaning in embarrassment for them (Jimmy Buffet playing himself, no less), "The Beach Bum" is definitely not an uplifting picture, although there are plenty of nervous laughs to be had along the way. Cleverly booked into this cozy venue just in time for the island's own famed Beach Bum Parade, this passion project by a willfully obstinate auteur may leave many Tybee residents in a state of utter confusion, but I am sure Korine wouldn't have it any other way. Showtimes at 7 p.m. on May 16, 17 and 19, with 3 p.m. matinees on May 17 and 19.
Sermon on the ice
Out in Springfield, on May 9 the similarly-sized historic movie house known as the Mars Theatre opens a four-day engagement of the just-released family drama "Breakthrough," starring Topher Grace and Mike Colter. Based on the true tale of a young boy who fought for his life after falling into an icy Mid-western lake, it's been called one of the best faith-based theatrical films made in recent memory. Viewers who do not already adhere to the particular brand of Evangelical Christianity at the heart of this message movie may be put off by its sermonizing tone. Showtimes at 7 p.m. May 9 through 11, with a 3 p.m. matinee on May 12.
Calling locals
May 9 is also when White Whale Craft Ales holds its second DIY short film fest. The theme this time around is Love Stories. Local filmmakers have been encouraged to submit conceptually suitable work that's less than 15 minutes in length. Films will be shown on an inside wall of the beer retailer and dispensary starting at 7 p.m.
SAA Film Fest
The next night, May 10, the Film Studies Department at the public arts magnet high school known as Savannah Arts Academy hosts their 14th annual SAA Film & Media Festival. This 7 p.m. showcase features short films of all types made by students in that department, which has been hailed as the state's "largest and best high school film program." Showtime is at 7 p.m., with reserved seats available in advance online. For more on this way-cool, under-the-radar event, see the full feature elsewhere in this issue.
Hail Satan
Two days later, on May 12, local film organization CinemaSavannah's ongoing series of award-winning independent and/or foreign features continues at the Jewish Educational Alliance auditorium with one of the more unusual low-budget documentaries to hit this year's international festival circuit. "Hail Satan?" is the just-released nonfiction look at the work of The Satanic Temple, a religious and political activist organization formed in Salem, Massachusetts, in 2013 that utilizes traditional satanic imagery and tropes to promote a distinctly non-religious ideal of social justice and egalitarianism, while fiercely supporting the U.S. Constitution's mandated separation of church and state.
Many believe this organization — not to be confused with the San Francisco-based Church of Satan, formed in 1966 by Anton Szandor LaVey — is little more than an elaborate prank being perpetrated by publicity-hungry provocateurs. Others see it as a sincere and legitimate organization that is happy to utilize satire and associations with devil worship in pursuit of its main goals – namely "to encourage benevolence and empathy among all people" and to "highlight religious hypocrisy and encroachment on religious freedom."
Directed by esteemed female filmmaker Penny Lane, it's said to be an eye-opening look at the hypocrisy which surrounds America's tax-exempt status for religious organizations and this secular humanist-based temple that is fighting to expose that hypocrisy. This will be the film's only area screening. Start time is 4 p.m., and admission is cash only at the door.
PFS: Black Veil
And last but not least, the Psychotronic Film Society's long-running and award-winning weekly series of overlooked or marginalized feature films from around the world continues on May 15 at the Sentient Bean Coffeehouse with a rare public showing of the 1968 Italian murder mystery "A Black Veil for Lisa."
The script for this little-known Giallo — the term for dark and intense Italian or Spanish crime films dealing with murder and mayhem — is filled with twists and turns. It deals with a police inspector who's intent on busting up a major drug-smuggling ring in Hamburg, Germany. Unfortunately, a mysterious assassin is killing all of their police informants. This leads the inspector to hire said assassin for a little contract job of his own.
The film wears some of its influences on its sleeve, with the director Massimo Dallamano, who also served as the cinematographer on Sergio Leone's landmark Spaghetti Westerns "A Fistful of Dollars" and "For a Few Dollars More," paying homage to both the classic French thriller "Diabolique" and Hitchcock's masterful "Vertigo." The directorial style is pure adrenaline, with tons of jarring edits, fast-moving close-ups and more than a bit of erotic tension on display. The PFS will show "A Black Veil for Lisa" in its original widescreen format, restored from vintage film elements, in spoken English. Showtime is 8 p.m., with a full vegetarian menu available and discounts on craft beer and organic wine during the show.
Until next week, see you at the movies, be kind to those around you and don't forget to turn off that cell phone.
Jim Reed directs the Psychotronic Film Society of Savannah.
What: "The Wizard of Oz"
When: 7 p.m. May 9
Where: Tybee Post Theater, 10 Van Horne Ave., Tybee Island
Info: tybeeposttheater.org
What: "Breakthrough"
When: 7 p.m. May 9-11; 3 p.m. May 12
Where: Mars Theatre, 106 S. Laurel St., Springfield
Info: marstheatre.com
What: Love Stories Film Fest
Where: White Whale Craft Ales, 1207 Bull St.
Cost: TBA
Info: Facebook.com/WhiteWhaleCraftAles
What: 14th Annual Savannah Arts Academy Film & Media Festival
When: 7 p.m. May 10
Where: Savannah Arts Academy, 500 Washington Ave.
Cost: $20 reserved seats
Info: seatyourself.biz/saa
What: "Hail Satan?"
Where: Jewish Educational Alliance, 5111 Abercorn St.
Cost: $10 (cash only)
What: "A Black Veil for Lisa"
Where: The Sentient Bean, 13 E. Park Ave.
Info: instagram.com/pfssav
What: "The Beach Bum"
When: 7 p.m. May 16, 17, 19, 3 p.m. May 17, 19


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FACTS ABOUT TWINS
<p style="text-align: justify;">Unless you're a twin, you have had twins, or are near a combine of them, you most likely do not know abundant concerning them. We have a tendency to know that they give the impression of being alike, their parents dress them same…
10 Amazing Facts About Twins
You might suppose that as a result of identical twins supposedly share nearly a similar polymer, they even have identical fingerprints. Well, that is not true. Fingerprints don't seem to be exclusively generated supported DNA.
Once identical twins are formed, they begin out with a similar fingerprints. However during weeks 6 to 13 of physiological condition, because the babies begin to maneuver, the every bit the amnios. And distinctive ridges and features are shaped on every twin's hand that end in completely different fingerprints.
About 25 % of identical twins develop directly facing one another, which means they become precise reflections of 1 another.
In line with concerning. "they could also be right- and left-handed, have birthmarks on different sides.
While identical twins derive from one creature that contains one set of genetic directions, also referred to as a ordering. It's still attainable for identical twins to have serious variations in their genetic makeup.
Gary Steinman, MD, PhD, doctor at Long Island person (LIJ) middle, discovered that taller ladies have more insulin-like protein (IGF). And therefore there are more chances of taller ladies giving birth to twins.
Since in the year2009,Mia Washington, gave birth to twins who have completely different men as father — that claimed to be a one-in-a-million prevalence.
a)Dr. Hilda Hutcherson, Clinical academician of tocology and medical specialty at Columbia University, explained that how it happened: b)Usually, a girl releases one egg every month. For Mia, there have been 2. c)At identical time, the Mia had intercourse with 2 completely different men within the span of 5 days. d) As a result of spermatozoon will stay alive within the generative tract for that long, every man's spermatozoon fertilised one amongst eggs. Thats why 2 babies, two dads.
a) In 2011, researchers at Umberto Castiello of the University in Italy studied 3D videos of twins in their mother's uterus. b) At 14 weeks of gestation, twins seen reaching for every alternative. c) By 18 weeks, they touched one another more typically than they touched their own bodies.
The researchers aforesaid that kinematic analyses of the recordings unconcealed that the twins created distinct gestures toward one another. And were as mild to the opposite twin's delicate eye space as they were after they touched their own.
Researches suspect that twins have their own langague called as autonomus langague. It consists onomatopoeic expressions and inverted words. It is also fond that some twins can taste and feel the same as the other does. This are the few important facts about Twins which you will feel strange but are true.
What is your opinion about Twins?
Facts About Love Marriage and Arrange Marriage
Amazing Facts About Dreams
Fun Facts About Human Body
Brain Facts


Even though New Friendship began in 1835, a WMU organization did not organize until 80 years later. Women's Mission organizations are based upon the Great Commission and have heritage of leading people to do their part to full fill the Great Commission.
Through the years many stories have emerged about the women and their action to meet the needs of people. We have been told of ladies walking up and down Chatata Valley to come to the church for their mission meetings. They sold their butter and eggs and gave the money to support the missionaries as they prayed for them. Since the histories of Lottie Moon and Annie Armstrong related their train trips to Chattanooga to speak, it is wondered, if some of the our ladies heard these pioneering ladies speak.
The NFBC Women's Missionary Society began in 1920. Members paid 10 cents a month. The 1935 minutes show that the church gave $65.09 to the Lottie Moon Christmas Offering and $11.00 to the Annie Armstrong Easter Offering. There was also an offering to the Tennessee Baptist Children's Home. In 1970, the name was changed to Women's Missionary Union.
In an article about Sunday in the Valley, Elizabeth Manely wrote that they kept up with the denominational programs, observed home and foreign mission days with playlets, speeches, and songs and collected food for the orphanage. Of particular interest to Mrs. manely was the minutes on Nov. 30, 1937. John W. Cate used his car to gather up the offering of clothes and food for the Tennessee Baptist Orphan's Home. It was reported that our church had the largest offering of any brought.
Many of our mission activities are church-wide projects. One of particular emphasis is the church-wide seasons of prayer and offerings for missions. Throughout the years, we have received numerous recognition certificates for our participation in these offerings. In 2012 during the Season of Prayer and Giving for International Missions, we broke a church record. We received the largest offering to date for the Lottie Moon Christmas Offering totaling $5,560.00. We would later break that record in 2015 when we received $12,500.00.
Those before us have left a strong legacy for those to follow. Through our organizations of Women on Mission, Acteens, Youth on Mission, Children in Action and Mission Friends, we pray that the legacy will continue.


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Home > EN > History > Museums > Historical Museum of the Grenadiers of Sardinia > Description
Rich in historical relics of all ages and origin, the objects are exposed in 15 rooms with Italian and foreign weapons, photographs dating back to the Great War, motivations for Gold Medals to the Military Valour awarded to the Grenadiers, planimetries of the main places where the units fought, flags and personal items. In one of the rooms there is the Memorial Monument of the Grenadiers: on its walls there are the names of overs 8.500 fallen soldiers written in gold letters.
The exposition itinerary follows the most intense historical periods from 1659, when the specialty of the Grenadiers was born, to 1848 and up to 1870; it continues with the colonial wars in Eritrea, 1896, and in Libya in 1911-1912. The weapons room shows samples of weapons captured from the enemy during the First World War and memories dedicated to the campaigns in Albania, Greece and Yugoslavia.
The itinerary continues in the room dedicated to the historical memories of the Spanish War (1936-1939) and Yugoslavian War (1941-1943) and later to the Council Room, where the Directive Border of the Museum used to meet. Going on to the stairs on the left, you arrive to the room of historical memories dedicated to the participation of the Grenadiers in the War of Liberation.
On the first floor there are: the Hall of Honour where the Rulers of Savoy, supporters of the Grenadiers' specialty, are remembered; two rooms dedicated to the Italian-Ethiopian War; a room for various historical relics; a room dedicated to the lieutenant Guido Zanetti and another one dedicated to the War Flags of the Grenadiers.
For its variety of historical documents, the Historical Museum of Grenadiers represents a reference point for those who want to know the events of this ancient and glorious Corps.
© 2019 Italian Army ®


Match winner Danny Guthrie was delighted with two goals, but more thrilled to pick up another three points at the start of an important week for the Royals.
"It was a good result. Clean sheet at home. Three points. Job done," he told Reading Player after our 2-0 victory against Birmingham City this afternoon.
The Royals playmaker had just nine league goals to his name before this afternoon, but two set pieces from his cultured right boot earned Nigel Adkins' men a comfortable victory at Madejski Stadium.
"I don't think we were at our best, but we've won. Three points is what matters.
"We're winning games and keeping clean sheets, so it's a good atmosphere around the place.
"We're on a good run but we've got to just keep plugging away. This week is a real Championship week with three tough games in quick succession - and it will be a tester for us.
"Two away games, and this is where teams who want to get promoted pick up points.
"We've got a massive week ahead and we want two more wins to take it up to nine points for the week, the maximum, and go into the international break on a high."
Asked what his thoughts were in hearing Adam Le Fondre was contemplating putting in a claim for both of his goals, Guthrie smiled and said "No chance!"
"It's always nice to score - and I don't get many! So I'm going to fight for both of them and I need to hang on to them."
Sporting a new haircut this afternoon, the midfielder has cancelled plans to shave off his mini-mohawk, explaining "I was going to shave it off tonight, but after today I think I'll keep it and see how the week goes! It was just a trial run today, but it's done wonders for me today - so I'm keeping it!"
You can watch Danny's full interview on Reading Player soon, and you will also be able to relive both free kicks in our online highlights package from midday on Sunday.


Ikzi LIGHT reflector 5xrode LED for mounting on rear carrier (distance between screws: 8cm). Supplied with 2x AA batteries Ikzi LIGHT, packaging card.
The AXA Run is a rear light LED battery for mounting on the rear fender. Very suitable for mounting on retro and roadster bicycles. This rear light has a life expectancy of up to 50 hours and a userfriendly control knob.
The Samson Battery Rear Carrier Lineo of Spanninga is a modern LED lamp, with a unique look and an on / off setting. The LED lamp consumes very little energy and is also visible up to 500 meters. Batteries included.
The AXA Greenline, rechargeable LED lighting as a set and / or available separately. AXA Green Line consists of a range of compact, powerful and rechargeable bicycle. Powerful light image of 8 to 50 lux. Durable rechargeable via USB cable. Easy to attach and easy to carry. Thousands of hours of cycling. STVZO approved.
1. Brand new and high quality. 2. 2 kinds of switching mode: flashing & steady 2 modes switch can according to your actual demand. 3. Comes with quick release bracket easy to install 4. Powered by 4 x AAA batteries (not included) 5. Used for walking bicycles camping etc.
The mudguard mounted Retro is especially developed to fit retro or classic bikes. A strong mix between the classic way of mounting and a modern look and feel.The Retro is easy to operate by using the on/off push button. And is available in a red transparent housing or in a white matt housing.
IKZI-Light Spaakverlichting. Ventiel-wiellicht met 7 LED's. Moet bevestigd worden tussen de spaken.
The IKZI Wheel Light is a spinning light equipped with 22 LEDs, for 1 wheel only.Including batteries.
The first LED taillight Duxo carrier has an integrated light guide for extra visibility and safety for the user and his environment. Battery (on / off) version. Universally suitable for 50 and 80 mm.
Battery rear light with on-off switch at bottom. Batteries are included.
Ikzi light achterlicht - model ''sjiek'' voor bevestiging op spatbord. voorzien van 1x rode led + goedgekeurde reflector (e4) functies: aan/uit. geleverd inclusief 2x aaa ikzi light batterijen. nieuwe uitvoering met goedgekeurde reflectie en ingebouwde lichtversterker.
Ikzi light reflector met 3 stuks rode led, opvallende reflectiestreep en goedgekeurde reflector (e4). voor bevestiging op achterdrager (afstand tussen schroeven: 80mm). geleverd inclusief 2 aa ikzi light batterijen.
Ikzi light super heldere led met functies: aan/uit. geleverd inclusief 2x aaa ikzi light batterijen, verpakking op kaart.
Ikzi light reflector met 5xrode led voor bevestiging op achterdrager (afstand tussen schroeven: 8cm). geleverd inclusief 2x aa ikzi light batterijen, verpakking op kaart.


Wow! A rose that produces big bold flowers in a gorgeous rich crimson. The flowers are large and well shaped with a sharp and spicy perfume. The clusters of blooms are well distributed over the plant giving good impact from a distance which is helped by the dense leafy plant. It will grow into a large shrub that needs very little attention as it is naturally healthy. Use in beds, borders or hedges, it can even provide really good cut flowers.


Diazoxide helps reduce weight, body fat, and improve blood glucose levels and endurance capacity, in mice models of Prader-Willi syndrome (PWS), a study shows.
The findings suggest that diazoxide targets cellular mechanisms that contribute to PWS development. In addition, the study provides further evidence demonstrating diazoxide's potential to treat patients with PWS.
The study "Chronic diazoxide treatment decreases fat mass and improves endurance capacity in an obese mouse model of Prader-Willi syndrome" was published in the journal Molecular Genetics and Metabolism.
Diazoxide has been shown previously to improve metabolic parameters and decrease fat mass in obese children and adults with PWS. The medicine has received orphan drug status from the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) as treatment for PWS.
Soleno Therapeutics is developing a diazoxide choline controlled-release (DCCR) to be taken orally (tablet) once daily to treat PWS.
Now, a research team at the University of Alberta in Canada used a genetically engineered mice model of PWS to further evaluate the benefits of diazoxide. The animals were modified to lack the MAGEL2 gene, which is associated with PWS development. This experimental model mimics some of the features of human disease, including cognitive impairment, increased fat mass, reduced lean mass, and voluntary activity.
PWS and healthy mice both were fed a high-fat diet for 20 weeks, upon which they received treatment with 150 mg/kg per day of diazoxide in addition to a conditional diet for more 12 weeks.
The treatment caused a significant loss of body weight in both groups, but it was more effective in control mice. By the end of the study healthy male and female mice lost 24% and 23% of body weight, respectively, whereas PWS male and females mice lost 16% and 13%.
Still, six weeks of treatment with diazoxide were sufficient to cause a significant decrease in total fat mass in all animals, an effect that was sustained for the following six weeks.
Diazoxide had no effect on food intake rates, overall activity or daily energy expenditure in any of the animals.
However, animals showed improved endurance capacity when exposed to physical activity (treadmill task). Mice used less energy to maintain speed on the treadmill compared to before treatment, demonstrating they were more capable to maintain a higher level of energy expenditure during exercise.
"Chronic diazoxide administration reduced fat mass, decreased blood glucose, and improved endurance capacity in high fat diet-induced obese mice that were either wildtype or mutant for the PWS gene [MAGEL2]" the researchers wrote.
Collectively, these results show the mechanism involved in weight loss via diazoxide is not specific to MAGEL2-induced disease, but instead shared by both obese and PWS conditions.
"The biological pathways impacted by diazoxide may be rational pharmacological targets in PWS and other disorders diseases associated with obesity," the team concluded.
Tagged blood glucose, DCCR, Diazoxide, endurance capacity, fat mass, lean mass, obesity, Soleno Therapeutics.


GET TO KNOW THE LADIES BEHIND LIFE LOOKS PERFECT. HAPPY FATHERS DAY. | Life Looks Perfect.
GET TO KNOW THE LADIES BEHIND LIFE LOOKS PERFECT. HAPPY FATHERS DAY.
Just wanted to say a big Happy Father's Day to our dad today! As Jess is away, we thought it would nice to surprise you with putting you face on our blog! *Your famous* hehe.
We know you lay in bed and catch up on all our latest posts so...surprise!! Your our number one fan! Through thick and thin you are the greatest support and we are very proud of everything you have achieved and provided for us. We are two very lucky young ladies and we wouldn't be who we are today without you. We have had some of the most unforgettable times with you, laughing crying... which actually both happened at the Champions League final in Munich last year, too good to ever forget and we are sure that some amazing times are still to come.
We hope you have a lovely day and are proud of both of us.
Long live the TDL empire and the Happy One!


At first glance, you would not think that a square of thin cotton cloth would be all that useful. However, the humble bandana is one of the most useful tools you can have in a survival situation. Its simplicity makes it more versatile than just about anything you can bring with you.
I personally opt for the lightly larger shemagh, but it is exactly the same principle. For centuries everyone from Wild West cowboys to special-forces soldiers in Afghanistan have kept this cloth with them. In this article I will cover all the different ways you can use your bandana in a survival situation.
There are several places you should keep a bandana for easy access if you need it. I actually suggest keeping one on you at all times in your everyday carry kit. You can also keep one in your bug out bag, your get home bag, and in the trunk of your car. The point is that no matter what happens, a bandana is important enough to always have access to one.
During my very first survival challenge, I split my head open on a low-hanging branch. It was bleeding pretty badly and I knew I had to get pressure on it, but I did not have a bandana with me. I ended up cutting off both sleeves of my shirt as well as the pockets of my pants to keep a clean bandage on it. It was not really an ideal situation.
I want to break down the uses for this cloth into the four pillars of survival along with a few other important categories. This would include food, water, fire, shelter, first aid, signaling, and self-defense.
Collecting wild edibles – When you are gathering wild edibles, you want to have them in a soft enclosure that gets plenty of air. This will keep leafy greens from wilting and berries from getting smashed. Loading up your bandana with edibles and tying it into a bundle is a great way to keep them fresh on the trek back to camp.
Go spit fishing – If you want to collect minnows for bait or for a snack, you will need a makeshift net. Use a thin green branch to create a loop at the end of a handle and tie your bandana onto it forming a net. Submerge the net just below the surface of the water and spit into the water above it. The saliva will attract the minnows. Then you just lift it out of the water and fish out the minnows.
Make a bear bag – if you have a kill large enough to save some meat for the following day, predators will be an issue. Bears in particular will rip apart a camp to find meat. Bundle your food up in the bandana and tie cordage to it. Throw the other end over a tall branch and pull up the bundle so it is at least 10 feet off the ground. Make sure you do this at least 100 yards from your camp and you should be able to sleep knowing your breakfast is waiting.
Keep your fish fresh – If you have caught a few fish and have them on a stinger in the water, they can stay alive for several hours. However, there is a good chance that a scavenger will snag your catch, especially at night. You can loosely tie your bandana around the fish and place them back in the water. This will at least protect from small animals that may try to snag your meal.
Make yourself a soothing tea – If it is cold and your body is stressed, a tea can be a nice way to boost your health and your spirits. You can make a tea with pine or spruce needles, berries, or other wild edibles. Place a handful of your plant material into the bandana and tie it into a bundle. Smash it against a rock or stomp it with your boot to break up the plants and release the juices. Boil a pot of water and drop in your bundle. After a few minutes the healing and tasty properties of your plants will seep into the water. Many of these plants have vitamins and healing capabilities, so it can be very beneficial.
Crack some nuts – There are often trees that produce nuts filled with protein in your area, but the shell is sometimes difficult. If you smash it on a rock, there is the chance that your food could shoot all over the place. Wrap your nuts in a bandana before smashing them to hold all the pieces together.
Make a water filter – In any water filter you need a layer to remove small debris. A bandana is the perfect thickness for this. If you have a bottle or other container, you can add gravel, sand, and charcoal. Then put the bandana over the mouth to filter out the larger debris.
Collect dew for a drink – Morning dew is one of the most pure forms of water you can find in the wilderness. However, the only good way to collect dew is with fabric. If you wrap a bandana around your pant leg and walk through tall wet grass, it will collect the dew. You can then ring it out for a drink of clean water.
Make dry tinder – Cotton makes an excellent tinder when it is shredded and fluffed up. You can fray a bandana down to fibers and then fluff it up enough to take a spark. It works even better if you can rub a little Vaseline or chapstick on it.
Make char-cloth – This finished product is one of the few types of tinder that will both take a spark and light under a lens in almost any situation. To make char-cloth you must have a small tin like an Altoids can. Punch a tiny hole in the tin and cut up your bandana into one inch squares. Load up the tin and throw it in the fire for 10 to 20 minutes. The finished product should be completely black meaning all impurities have burned off. Keep your finished product dry and add it to all future tinder bundles.
Make cordage for a bow drill – You can cut your bandana into strips and weave it together to make strong cordage. It can then be tied to a bow stick and used for a bow drill set to make friction fire.
Make a wick for an oil lamp – There are several ways to make an oil lamp with found fuels and containers. However, they all need a good wick. Soak a thin strip of your bandana in your fuel, put one end in the reservoir, and light the other end. It should burn until the fuel runs out.
Head and face coverage – If you need to protect yourself from the sun, wind, dust, rain, or cold, a bandana can help you. You can use it to cover your head, face, or mouth to filter out the elements. I completed a lifeboat challenge in scorching temperatures with only a bandana to cover my head. It works.
Cordage – One of the main necessities of shelter building is cordage. If you cut a bandana into strips you can use them as cordage or weave them to make even stronger cordage.
Make a pillow – When you are in a survival situation, any little bit of comfort can help. Having a soft surface on which to lay your head can greatly help your ability to sleep. If you roll your bandana loosely it makes for a nice pillow to insulate your head from the ground.
Stop Bleeding – When you have a deep cut you need to apply pressure with a bandage to stop the bleeding. This bandage needs to be clean, so a bandana is a good option. Tie the bandana tightly on the cut and change it regularly if possible.
Reduce fever – If you have a fever it is important to get your body temperature down. This is also true for hyperthermia or heat stroke. If you need to reduce your body temperature, you can dip your bandana in cold water and wrap it around your neck. This will affect the blood in your jugular veins and help with fever or hyperthermia.
Aid with hypothermia – When your body temperature is too cold you need to warm your core as quickly as possible. Dipping your bandana in boiling water and rubbing it on your chest or neck can help you turn the tide.
Protect burns – Any burn needs to be protected from the elements to heal properly. A bandana is the ideal bandage to wrap around a burn.
Heal skin irritation – When you have poison ivy or another skin irritation, it is important to keep it clean. If you have an ointment, that works even better. Either way, keeping it wrapped in a bandana is a good idea.
Make a tourniquet – If you have severed an artery and are worried about bleeding out, a tourniquet may be your only option. Tie your bandana around the severed limb above the cut and put a stick inside the wrap. Twist it until the bleeding stops and hold it in place. Be aware that this is a live saving technique and could cause the loss of a limb.
Make a splint – If you have broken a limb and need a splint, you will need to secure the limb to something sturdy. Find some sticks of the right length and use pieces of the bandana to tie your limb to the sticks. This will hold it in place until you can get to help.
Slow the effects of venom – If you have been bitten by a venomous snake, you want to keep the venom away from your heart. There is not much you can do short of getting to a hospital with anti-venom, but you can slow the spread. Tie your bandana around the limb that has been bitten and above the bite to slow the blood flow. Then get to help as quickly as possible.
Make a sling for an injured arm – When your arm needs support, a bandana can be wrapped around your neck and can make for a good support.
Protect your hands – There are times you need to handle something hot or something sharp. A bandana makes for a good option to protect your hands from dangers like these.
Protect your fists – If you know you are going to get into a confrontation, keeping your hands protected is vital. Most people do not keep leather gloves with them, so a bandana is a good option for your dominant hand. It can keep your knuckles from splitting open and allow you to win the dispute.
Choke out the attacker – When you know you need to disable your attacker to get away, putting them to sleep may be your best option. A good way to do this is to apply pressure to both corroded arteries as well as their wind pipe. Gripping a bandana tightly and applying pressure to the neck is a good way to do this.
Conceal your identity – When in a survival situation, concealing your identity can be vital. Having a bandana over your face works incredibly well to keep your identity hidden.
Flagging – Getting the attention of rescue personnel is tough with just a bandana. However, movement is helpful. If you tie a bandana to a long stick and wave it in the air, it can make a good ground to air signal.
Smoke signals – You need to have a blanket of sorts to help create intervals for smoke signals. A bandana is a great way to separate your 'S's from your 'O's when signaling 'SOS'.
Make a sweatband – It does not really fall into any of these categories, but this is the way I use my bandana most. When I am hiking or hunting I sweat a great deal. Just wearing a hat does not keep the sweat out of my eyes. However, if I roll up my bandana and tie it around my head, it catches most of the sweat. Then I just ring it out periodically, and I can see well all day.
I know this may seem like a huge number of uses for one item, but just take one with you. Keep a bandana in your pocket every time you enter the wilderness and remember the uses I have mentioned. As you keep this tool on your mind, you will start to use it more and more.
Anymore I will not hike, fish, hunt, or take on a survival challenge without at least one bandana in my pack. If it is good enough for special-forces, it is good enough for me. Spend a few bucks and pick up some bandanas. I am sure you will end up using them just as much as I do.
One other self defense application for a bandanna is an old biker weapon, where you loop the bandanna through the hasp of a padlock and use it as an improvised mace. Taking a swinging padlock to the head can be pretty devastating, and carrying a bandanna and a padlock in a backpack or vehicle won't draw much scrutiny by the authorities or even airport security.


Creation of New Packaging Line Chocolife Protein, working as a creative partner Axle Brand Engineering. Project approved and launched in May 2016. 3Ds by Sandro Nunes. Account Manager: Alexandre Carvalho - Axle.


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U.S. Air Force Photo by Staff Sgt. David J. Murphy
Air Guard Hits the Beach
JONES BEACH, N.Y. - Major John D. McElroy and Master Sgt. Jules Roy greet on-lookers who came to the 2008 Jones Beach Air Show after finishing their aerial rescue demonstration.
The two para-rescue jumpers of the 103rd Rescue Squadron represented the 106th Rescue Wing by performing a para-rescue demonstration in front of record crowds during the air show at Jones Beach State Park, Wantagh, N.Y.
The 106th shared the sky with the Navy's Blue Angels, the U.S. Army Golden Knights parachute team and an Air Force F-22 Raptor Fighter Aircraft.
A record 506,000 visitors attended the two day event.
Dated: Tue, Jan 13, 2009 @ 19:23


This watercolor painting is appropriate to the watery subject matter. Here Julia captures the beautiful pink bloom at its prime and immortalizes those transient moments of water ripples and droplets.
Edition Size 300, Image Size: 21.5" x 16.4"
Edition Size 300, Image Size: 15.5" x 11.8"


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Tag: Wormwood
Yes, it's that time of year again! 2021 gave us some very, very good metal, and I feel honoured to have been able to have listened to as much of it as I have done. There are some notable absences, (for me at least), from the below list, but there's just not enough time or space for everything, dammit!
2020 was a very blackened year for me; I listened to a lot of black metal, and the list for that year reflected that. At the start of 2021 I decided I'd consciously try to ensure I cast my net a bit wider again, reconnecting more deeply with some of many other styles of metal that I enjoy. 2021's list reflects this. However, I've still ended up with much more of a black metal presence in the list than I was initially expecting. What can I say? I'm a sucker for all of the myriad blackened flavours of the style. However, there's also a lot of other stuff here that I hope you'll dig into and enjoy too. I felt that there was a notable absence of grindcore in 2021, as well as some of the more extreme styles of doom. What do you think?
I hope you enjoy perusing some of my favourite records from this year, and I hope you find something new to tickle your fancy. What's your number one this year? Continue reading "Wonderbox Metal End of Year List – Best Metal of 2021"
Author wonderboxmetalPosted on December 18, 2021 December 18, 2021 Categories ListsTags Adliga, Anomalie, Archspire, Atmospheric Black Metal, Årabrot, Black metal, Blackened Death Metal, Blessings, Death Metal, Der Weg Einer Freiheit, Dissonant Death Metal, Doctor Smoke, Doom, Doom Metal, Doom Rock, Doubtsower, Dream Pop, Employed to Serve, Ethereal Shroud, Gold Spire, Green Lung, Hard Rock, Hardcore, Headshrinker, Hyperdontia, Impure Wilhelmina, Intonate, Jazz, Jours Pâles, King Woman, LLNN, Mare Cognitum, Melodic Black Metal, Metal, Midnight Odyssey, Misanthur, Modern Black Metal, Moon Machine, Old-School Death Metal, Post-Black Metal, Post-Hardcore, Post-Metal, Progressive Death Metal, Progressive Doom, Progressive Rock, Rock, Saille, Shoegaze, Sludge, Sludge metal, Starer, Suffering Hour, Technical death metal, Thrash, Thrash metal, Thronehammer, Urne, Vokonis, Wormwood1 Comment on Wonderbox Metal End of Year List – Best Metal of 2021
Monthly Overview – the Best of August 2021
While August was a slower month than some others have been this year for first class metal albums, it was still home to more than enough top releases to warrant this list. Continue reading "Monthly Overview – the Best of August 2021"
Author wonderboxmetalPosted on September 1, 2021 September 1, 2021 Categories Monthly OverviewsTags Atmospheric Black Metal, Black metal, Classic Doom Metal, Death Metal, Doom, Doom Metal, Headshrinker, Lucifer's Fall, Melodic Black Metal, Metal, Necronautical, Symphonic Black Metal, Wolves in the Throne Room, Wormwitch, WormwoodLeave a comment on Monthly Overview – the Best of August 2021
Wormwood – Arkivet (Review)
This is the third album from Swedish black metallers Wormwood.
This is Swedish melodic black metal that exists within a post-black metal framework, with the latter allowing the former a broader range than it usually benefits from. Wormwood's music has an epic streak, an atmospheric proclivity, and a good grasp of emotion and depth. Arkivet is a mix of the classic and the contemporary, and the band have balanced these influences very well to produce an evocative and compelling album. Continue reading "Wormwood – Arkivet (Review)"
Author wonderboxmetalPosted on August 24, 2021 August 24, 2021 Categories Black metalTags Black metal, Classic Rock, Folk, Melodic Black Metal, Metal, Neofolk, Post-Black Metal, Progressive Rock, Psychedelic Rock, Rock, Wormwood2 Comments on Wormwood – Arkivet (Review)
Wormwood – Wormwood (Review)
This is the début album of Wormwood who are a Sludge band from the US.
Wormwood play abraisive and caustic Sludge that eats away like acid and is every bit as disfiguring.
The songs aren't long but they don't need much exposure to be proven toxic.
Heavy and covered in contagious filth, Wormwood are like the bastard offspring of Today is the Day, Rabies Caste, Khanate and Eyehategod.
It's ugly, crushing music that's no good for your health and yet is strangely addictive regardless. The songs infect with their virulent strand of aural disease and you find yourself thinking of them when you least expect, usually when the night is in full swing and the negative thoughts are swirling. Wormwood is the soundtrack to hopelessness and woe.
The songs are surprisingly catchy and their relatively simplistic approach of groove-based, heavy Sludge is tried and tested yet by no means less effective because of it. Eyehategod may have originally wrote the book but bands like Wormwood keep adding pages.
Wormwood lack Eyehategod's Southern tinge of course, and theirs is a sound that shares aspects of Today is the Day and Rabies Caste in particular, as mentioned above.
A warm, yet musty, analogue sound coats all of the songs like a soft, ripe, fleshy exterior. It sounds good.
At only 18 minutes in length this is a release that doesn't outstay its welcome; one to definitely keep returning to.
Author wonderboxmetalPosted on November 5, 2014 Categories DoomTags Doom, Eyehategod, Khanate, Rabies Caste, Sludge, Today Is The Day, WormwoodLeave a comment on Wormwood – Wormwood (Review)


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America's Cabinet
America's Cabinet is a non-partisan project launched by the Young Elected Officials (YEO) Network that offers a vision of what America can be for all Americans. America's Cabinet is a group of young local elected officials educating and informing the general public about what Washington should be doing now to support communities across America and offering a positive vision for how America can live up to its promise. The Cabinet is made up of young local elected officials from across the country who are pioneering a new policy agenda for the future of the country. It is an agenda that moves us toward a more perfect union, reflecting the hopes and dreams of all Americans.
America's Cabinet was created to go beyond voicing opposition to harmful policies coming out of Washington today to ensure we create a nation that works for all Americans. Our nation is at a critical crossroad and America's Cabinet is here to offer bold policy recommendations tackling issues that impact everyday Americans. At a time when key parts of our democracy – from the freedom of the press to the judiciary – are under threat, we need state and local leaders to defend our sacred institutions and our founding traditions.
As local elected leaders, we see how national issues and policy choices are impacting our communities at the local level in large and small ways.
We currently serve as elected officials in cities and states across the nation.
We are advocates of a new vision of what is possible in this country – of how to build a country that affords everyone the opportunity to thrive.
We represent a broad cross-section of America in our official capacities – manufacturers, teachers, immigrants, farmers, tech leaders, small business owners, millennials and elderly alike.
Decisions made at the federal level impact our communities, and we have been living with the consequences. We are tired of cleaning up their messes and we are not going to wait for them to do what's right. This is our time.
America's Cabinet truly represents all Americans. The current Administration's cabinet's interests are largely self-serving and represent a very narrow elite.
Our values put people first. We are loyal to a belief in equality and opportunity for all Americans.
Our voices help advance and draw attention to local successes on important policy views.
The political game-playing in Washington is devastating Americans and continues to benefit very few.
Our allegiance is to the American public, the Constitution, and the rule of law.
We believe in the power created in our local communities that helps our families thrive. We believe in our nation's ability to achieve great things when we are unified and when all Americans have the tools to live with security and dignity.
Meet America's Cabinet
States represented — from Maine to California and Wisconsin to Texas
People of color on the Cabinet
Women on the Cabinet
America's Cabinet Launches Campaign for Gun Safety
Millennial Elected Officials Push Firearms Manufacturers and Distributors on Responsible Sales, Safety
America's Cabinet: How We Represent America
America's Cabinet Supporters
America's Cabinet: Our Bold Ideas
America's Cabinet: Letters to Trump's Cabinet
To get in touch with an expert, contact our media relations staff by phone at 202-467-4999 or by email at [email protected].
Svante Myrick
Director of Youth Leadership Programs
ALL SPOKESPEOPLE
Not A Fan Of D.C. Drama? Meet 'America's Cabinet'
People Over Pundits: Your Reactions To Trump's First State Of The Union
America's Cabinet discusses possible future of America
All Press Release Action Edit Memo Report Blog Post
Looking Back on 2018: 10 Accomplishments to Hang Your Hat On
Press Release | September 13, 2018
Press Release | January 29, 2018
Millennial Elected Officials From Across the Nation Launch Political Shadow Cabinet


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Decline in mortality...
Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study
CCBYNC Open access
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.d8136 (Published 25 January 2012) Cite this as: BMJ 2012;344:d8136
Piotr Bandosz, research and teaching assistant1,
Martin O'Flaherty, lecturer in clinical epidemiology 2,
Wojciech Drygas, professor3,
Marcin Rutkowski, research and teaching assistant1,
Jacek Koziarek, research and teaching assistant3,
Bogdan Wyrzykowski, professor1,
Kathleen Bennett, senior lecturer4,
Tomasz Zdrojewski, associate professor1,
Simon Capewell, professor of clinical epidemiology2
1Department of Hypertension and Diabetology, Medical University in Gdansk, ul. Dębinki 7, 80-211 Gdansk, Poland
2Division of Public Health, University of Liverpool, Liverpool L69 3GB, UK
3Department of Epidemiology, CVD Prevention and Health Promotion, Institute of Cardiology, ul. Niemodlińska 33, 04-635, Warsaw, Poland
4Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland
Correspondence to: T Zdrojewski tz{at}gumed.edu.pl
Accepted 31 August 2011
Objectives To examine how much of the observed rapid decrease in mortality from coronary heart disease in Poland after the political, social, and economic transformation in the early 1990s could be explained by the use of medical and surgical treatments and how much by changes in cardiovascular risk factors.
Design A modelling study.
Setting Sources of data included controlled trials and meta-analyses, national surveys, and official statistics.
Participants Population of adults aged 25-74 in Poland in 1991-2005.
Main outcome measures Number of deaths prevented or postponed in 2005 attributable to specific treatments for coronary heart disease and changes in risk factors. A previously validated epidemiological model for coronary heart disease was used to combine and analyse data on the uptake and effectiveness of specific cardiac treatments and changes in risk factors. The observed fall in deaths from coronary heart disease from 1991 to 2005 was then partitioned among specific treatments and risk factor changes.
Results From 1991 to 2005, the death rate from coronary heart disease in Poland halved, resulting in 26 200 fewer coronary deaths in 2005 in people aged 25-74. About 37% (minimum estimate 13%, maximum estimate 77%) of this decrease was attributable to treatments, including treatments for heart failure (12%), initial treatments for acute coronary syndrome (9%), secondary prevention treatments after myocardial infarction or revascularisation (7%), chronic angina treatments (3%), and other treatments (6%). About 54% of the fall was attributed to changes in risk factors (minimum estimate 41%, maximum estimate 65%), mainly reductions in total cholesterol concentration (39%) and an increase in leisuretime physical activity (10%); however, these were partially offset by increases in body mass index (−4%) and prevalence of diabetes (−2%). Blood pressure fell in women, explaining about 29% of their decrease in mortality, but rose in men generating a negative influence (−8%). About 15% of the observed decrease in mortality was attributable to reduced smoking in men but was negligible in women.
Conclusions Over half of the recent fall in mortality from coronary heart disease in Poland can be attributed to reductions in major risk factors and about one third to evidence based medical treatments.
Cardiovascular deaths in Poland increased steadily through the 1970s and 1980s. Indeed, this unfavourable trend continued to the end of the communist era. Dramatic socioeconomic changes then occurred during the transition to a market economy. There were sudden sharp falls in mortality from 1991 onwards,1 one of the fastest declines in the world. The improvements in life expectancy were mainly attributable to decreases in cardiovascular mortality.1 Several central and eastern countries in Europe experienced equally dramatic political and socioeconomic changes in the 1990s, including the Czech Republic, Hungary, and Romania (fig 1⇓.2
Fig 1 Trends in mortality from heart disease in Poland, other former communist countries, and western European countries in men aged ≤64 (source: WHO mortality database3)
Some aspects of this phenomenon in Poland have been previously analysed, particularly the role of dietary changes.4 5 When subsidies for animal fats during the socialist era disappeared, consumption fell dramatically, while the intakes of polyunsaturated fats, fruits, and vegetables all increased after the introduction of a market economy.
The potential contribution of treatments and other risk factors remains unclear. For instance, the prevalence of smoking in men also fell considerably during that period.5 6 Changes in other cardiovascular risk factors might also have played an important role in the observed decline in mortality.
Improvements in evidence based treatments for established coronary disease also became widely used in recent decades in Poland. This included treatments for hypercholesterolaemia, hypertension, coronary heart disease, and heart failure, as well as coronary bypass surgery, coronary angioplasty, and stenting. These changes might be important contributors to the observed reductions in mortality.
The contribution of changes in levels of risk factors and the uptake of evidence based treatments to the change in mortality rates from coronary heart disease has been well studied in Western countries, where the decline in mortality started much earlier7 8 9, but has not been analysed in central European populations, particularly in Poland, the largest.
We investigated the contribution of changes in risk factors and evidence based treatments to the recent fall in coronary mortality observed in Poland since 1991. Such an analysis is potentially important, both for understanding past trends and also for planning future strategies.
To explain the changes in cardiovascular mortality in Poland between 1991 and 2005 we used the IMPACT coronary heart disease mortality model. This has been previously validated in the United Kingdom, Italy, Sweden, Canada, and the United States.7 8 9 10 11 Descriptions of the model have already been published elsewhere and are detailed in the technical appendix on bmj.com. In brief, the model aims to be comprehensive, incorporating all major cardiovascular risk factors, including blood pressure, cholesterol concentration, diabetes, smoking, overweight, and obesity, plus all usual treatments for coronary heart disease and heart failure.
We systematically identified and critically reviewed all available Polish data sources as inputs in the Polish IMPACT model. The analysis was confined to adults aged 25-74. Mortality and demographic data were taken from routine national statistics. Numbers of relevant patients and treatments were obtained from cross sectional national and local studies, representative surveys for the country (WOBASZ,12 NATPOL,13 14 Pol-MONICA15), national registries (coronary artery bypass surgery (CABG) registry,16 acute coronary syndromes registry17), and hospital discharge databases. We also elicited expert opinions when objective data were deficient. Data quantifying changes in the prevalence of cardiovascular risk factors were taken from national representative surveys (NATPOL, WOBASZ,) as well as from the best regional and local epidemiological studies (Pol-MONICA and CINDI WHO18).
Trends in mortality from coronary heart disease in Poland 1991-2005
We obtained age and sex specific mortality rates for coronary heart disease from the Central Statistical Office. Substantial changes in the coding of causes of death in Poland were introduced in 1997. Assessment of the true decline in the number of deaths from coronary heart disease in Poland for 1999-2005 therefore required detailed analysis and adjustment of the official data derived from the Central Statistical Office covering the period 1991-6. A detailed description of the methods supporting this correction has been described elsewhere.19
Estimating the number of deaths prevented or postponed
We subtracted the number of deaths from coronary heart disease expected in 2005, if the 1991 mortality rates had persisted, from the number of deaths actually observed in 2005 to produce the fall in mortality that the model needed to explain. We then estimated the proportions of that total number of deaths prevented or postponed that could be attributed to the use of treatments and to changes in cardiovascular risk factors.
Benefits from treatment
Data on the clinical effectiveness of each intervention and treatment were based on the most recent meta-analyses and large randomised clinical trials (table 1⇓ and see appendix on bmj.com).
Estimated numbers of deaths from coronary heart disease prevented or postponed by medical and surgical treatments in Poland in 2005*
We calculated the number of deaths prevented or postponed as a result of each individual intervention in each group of patients with coronary heart disease in 2005 (table 1) by multiplying the number of patients in each diagnostic group by their baseline case fatality rate over one year by the proportion of these patients receiving a specific treatment and by the relative reduction in one year case fatality by the administered treatment.
For example, in Poland in 2005, about 12 230 men aged 55-64 were admitted to hospital with acute myocardial infarction. Their expected age specific case fatality rate at one year without treatment was about 5.4%. From registry data20 96% of them were given aspirin or other antiplatelet drugs; interventions with an expected reduction in mortality of 15%. The number of deaths prevented or postponed for at least a year by the use of aspirin among men aged 55-64 was then calculated as:
12 230×0.054×0.96×0.15=95 fewer deaths.
We then repeated this process for men and women in each age group, each patient group, and for each treatment. Some adjustments were made to these basic analyses. Many evidence based treatments were not used in Poland in 1991 (such as statins or primary angioplasty in acute myocardial infarction). In some cases, however, the use of some drugs or procedures in 1991 was not negligible (for instance, antihypertensive treatment or aspirin in acute myocardial infarction). In such cases, to obtain the net benefit, we calculated the number of deaths prevented or postponed as a result of the treatment as used in 1991 and subtracted this from the number calculated for 2005.
Compliance (adherence, the proportion of treated patients actually taking effective levels of drugs) was assumed to be 100% among patients in hospital, 70% among symptomatic patients in the community, and 50% among asymptomatic patients in the community.21 To avoid double counting of patients, we identified potential overlaps between different groups of patients. Assumptions concerning these overlaps are presented in the appendix on bmj.com. To quantify the relative reduction in case fatality rate for individual patients receiving multiple treatments, we used the conventional Mant and Hicks cumulative relative benefit approach22:
relative benefit=1−[(1−relative reduction in case fatality rate for treatment A)×(1−relative reduction in case fatality rate for treatment B)×. . . ×(1−relative reduction in case fatality rate for treatment N)].
Changes in risk factors and benefits on mortality
Regression approach
We used published regression coefficients to calculate the number of deaths prevented or postponed as a result of changes in systolic blood pressure, mean cholesterol concentration, and body mass index (BMI). The number was the product of the number of deaths from coronary heart disease observed in the baseline year (1991), the change in level of the risk factor, and the coefficient quantifying the change in mortality from coronary heart disease per unit of absolute change in that risk factor.
For example, there were 2534 deaths from coronary heart disease among women aged 55-64 in 1991, the base year. Mean systolic blood pressure in this group decreased by 5.4 mm Hg between 1991 and 2005. The largest meta-analysis shows an age and sex specific reduction in mortality of 50% for every 20 mm Hg reduction in systolic blood pressure, generating a logarithmic coefficient of −0.035.23 The number of deaths prevented or postponed was then estimated as:
[deaths in 1991]×(1−exp(coefficient×change)=2534×(1−exp(−0.035×5.4))=436 fewer deaths.
Population attributable risk approach
We used a population attributable risk fraction approach to assess the effect of changes in the prevalence of smoking, diabetes, and physical inactivity, using the standard formula
((P×(RR−1))/(1+P×(RR−1))
where P=prevalence of the risk factor and RR=the relative risk of mortality from coronary heart disease associated with that risk factor.
To assess the decline in mortality from coronary heart disease, we multiplied the number of deaths from coronary heart disease in 1991 (the base year) by the difference between the population attributable risk fraction in 1991 and that in 2005.
We assumed that there was no further synergy between the treatment and risk factor sections of the model or between the major risk factors because the regression coefficients and relative risks for each risk factor were each independent, being obtained from multivariate analyses. Deaths prevented or postponed as a result of changes in risk factors were then systematically quantified for each group of patients. Lag times between rates of change in risk factors and rates of change in events were not modelled. We assumed, as in other countries, that any time lag would be relatively unimportant over a period of 15 years (1991-2005).24
Model validation: comparison of estimated v observed changes in mortality
The model produces estimates of the total number of deaths from coronary heart disease prevented or postponed attributable to each treatment and to changes in each specific risk factor. These estimates were then summed and compared with the observed changes in mortality for men and women in each specific age group. Any shortfall in the overall estimate from the model was then presumed to be attributable to inaccuracies in our methods. In particular, these can be biased input data and insufficient accounting for time lag. Other causes of this shortfall can be other unmeasured risk factors, such as psychosocial ones or physical activity in work (we accounted only for leisuretime physical activity).
All the above assumptions were tested in a multi-way sensitivity analysis with the analysis of extremes method.25 For each model parameter, we assigned a lower and upper value using 95% confidence intervals where available or ±20% values (for numbers of patients, uptake of treatment, and compliance). More detailed information concerning the methods is provided in the technical appendix on bmj.com.
The decline in mortality rates from coronary heart disease since 1991 resulted in 26 200 fewer deaths from coronary heart disease in 2005. The model explained about 91% (23 715) of this decrease.
About 37% of the decrease was attributable to treatments (minimum estimate 13%, maximum estimate 77%) and about 54% was attributable to changes in risk factors (minimum estimate 41%, maximum estimate 65%). There was generally good agreement between the estimated and observed number of deaths across all sex and age groups. In middle aged men, however, the number of predicted deaths prevented or postponed was underestimated (fig 2⇓).
Fig 2 Observed reductions in coronary deaths in Poland across age and sex groups: comparison with model estimates
Changes in risk factors
About 14 070 of the deaths from coronary heart disease prevented or postponed (54%) were attributable to changes in risk factors. Most (41% of the fall in men and 33% in women) were attributable to large decreases in mean cholesterol concentration (declining by 0.4 mmol/L). This fall in deaths concerns changes in mean cholesterol concentration related to diet only and was calculated by subtraction of drug related effects from total effect of mean cholesterol change.
The effects of changes in smoking and mean blood pressure in men and women were more complex. In men, the prevalence of smoking decreased by 15.7%, explaining about 15% of their fall in mortality. There was little change in the prevalence of smoking in women, which therefore had virtually no effect on mortality from coronary heart disease. Mean systolic blood pressure fell by 2.7 mm Hg in men and by 5.2 mm Hg in women. After subtraction of the effects of treatments for hypertension, these falls in blood pressure explained about 29% of the decrease in mortality in women and 8% of the increase in deaths in men (table 2⇓). Increased leisuretime physical activity explained about 10% of the decrease in deaths.
Estimated coronary deaths prevented or postponed as a result of risk factor changes in men and women in Poland 1991-2005
These gains were partially offset by about 1810 additional deaths attributable to increases in BMI (−4% and −5% for men and women, respectively) and prevalence of diabetes (−1% and −8%, respectively) (table 2⇑).
Medical and surgical treatments
Table 1 shows the estimated numbers of deaths from coronary heart disease prevented or postponed by medical and surgical treatment in 2005⇑. All treatments accounted for about 9640 fewer deaths, representing about 37% of the decrease in mortality. The largest reductions came from treatments for heart failure in hospital and in the community, which resulted in about 3100 fewer deaths in 2005 (12% of the observed reduction in mortality). Initial treatments for acute myocardial infarction or unstable angina generated about 2450 fewer deaths (9% of the observed fall). Secondary prevention treatments after myocardial infarction or revascularisation explained about 1930 (7%) fewer deaths, followed by treatments for chronic angina (710, 3%) or hypertension (580, 2%) and statins for hypercholesterolaemia in primary prevention (880, 3%).
Under the assumptions of the sensitivity analysis, the relative contributions of changes in specific risk factors and treatment effects remained similar. The extreme minimum and maximum numbers of coronary heart disease deaths prevented or postponed were 14 050 (54% of the observed fall in mortality) and 36 840 (141%).
In Poland in 2005 there were 26 200 fewer coronary deaths than in 1991, about 54% being attributable to beneficial changes in risk factors and 37% to the increased use of evidence based treatments. The major contributors to the fall in mortality were large changes in total cholesterol concentration related to diet, plus beneficial trends in systolic blood pressure in women and decreased smoking in men. Physical activity also contributed. Worryingly, adverse trends negated some of these benefits, specifically obesity, diabetes, and blood pressure in men and smoking in women.
The most important treatment contributions came from treatments for heart failure, angina, and secondary prevention. Cardiovascular diseases, however, still remain a major cause of mortality and morbidity in Poland. It is therefore crucial to better understand the drivers of these favourable and adverse trends to continue or even to accelerate the pace of decline by using well planned and cost effective interventions.
Neighbouring countries
This study implemented the first IMPACT model in central Europe. These results should be cautiously generalisable to the many neighbouring former communist countries that experienced similar trends in mortality after their political transformations: the Czech Republic, Slovakia, Hungary, East Germany, and Romania. In contrast, trends in mortality fluctuated in some other former communist countries, which experienced more complicated patterns of changes after the fall of communism, like Russia and Ukraine. For example in Russia, mortality initially fell rapidly for the first few years after the collapse of the former Soviet Union but then began to rise after the economic crisis in 1998.26
Dramatic changes in Poland
In Poland, food was no longer subsidised after 1990; this caused big changes in relative prices. As a consequence, the structure of food consumed by Polish citizens changed substantially. For example, between 1989 and 2008 annual butter consumption decreased from 7 kg to 3.8 kg per head, and beef consumption fell by 75%. At the same time availability and consumption of fruits increased markedly.5
On the other hand, shortly after the democratic transformation, citizens' purchasing power increased substantially, while inequalities increased modestly. In Russia and Ukraine, in contrast, such inequalities increased sharply in the 1990s.27
The changes in Poland and its neighbours were revolutionary, quite unlike those observed in any western European countries at this time. The socioeconomic changes in Poland between 1991 and 2005 reflected substantial increases in gross domestic product per capita. This increased fourfold in Poland (from $1998 (£1290, €1535) to $7963) but only twofold in the UK (from $18 387 to $36 084, respectively).27
Trends in population risk factors
The IMPACT model is a comprehensive tool that can quantify changes in mortality as a function of improving treatments and the major "downstream" risk factors: cholesterol concentration, blood pressure, smoking, obesity, diabetes, and inactivity. Four of these six major risk factors reflect dietary habits; these in turn are powerfully patterned by "upstream" political and socioeconomic factors. In our analyses, we observed a powerful effect of changes in cholesterol concentration related to diet on mortality from coronary heart disease in men and women. This is consistent with the earlier hypothesis that favourable dietary changes during transition were the main reason for the sharp decline in cardiovascular mortality.5 In contrast, statins made a surprisingly small contribution to the overall reduction in cholesterol concentration.
Between 1991 and 2005, systolic blood pressure decreased substantially in women and young men but increased in men aged over 55. This trend was consistently observed in three different sets of contemporary local and national studies. It generated over 1000 additional coronary deaths. It remains unclear why such important and worrying sex differences occurred in trends in blood pressure. More research is clearly needed, particularly around possible sex and socioeconomic differences in the intake of salt and other dietary factors.
Increased physical activity resulted in about 2500 fewer coronary deaths. The main benefits came from increases in leisuretime physical activity in Poland and are now well documented.28 29 There is no room for complacency, however, as recent data suggest that over half of all adults are not sufficiently active.
Contributions of treatment
The number of evidence based treatments widely used in cardiovascular medicine in Poland increased markedly, mirroring other developed countries. These pharmacological treatments and invasive procedures together explained barely a third of the decrease in mortality (37%). This reflects a dynamic development in clinical cardiology in Poland in the late 20th century. Several new centres of invasive cardiology were created during this period, with medical standards comparable with those in Western countries. Moreover, physicians could more easily participate in training focused on modern evidence based pharmacotherapy. The modern management of heart failure therefore made the single biggest treatment contribution to the reduction in mortality from coronary heart disease (12%). Despite huge financial support, the impact of invasive cardiology on mortality was modest (barely 4%). This therefore suggests that future strategies should prioritise policies to reduce the major cardiovascular risk factors. Interventions based on taxation and legislation should focus on constant improvement in restriction of tobacco use and control of junk food to deal with the growing epidemic of obesity and diabetes. The worrying trends in blood pressure in men also demand immediate attention.
Strengths and limitations of the study
Our study was a comprehensive quantitative analysis of the causes of a sharp mortality fall in a country experiencing transition from communism to democracy and a market economy. The IMPACT model is comprehensive and takes into account all known important downstream risk factors and all standard treatments. The model has been previously validated in many Western countries, and its results are consistent with other analyses performed in the same settings.
Several limitations should also be noted. In Poland, data for the initial analysis year (1991) were not complete and were less representative than in subsequent years. We also assumed a minimal lag time between changes in risk factors and changes in mortality. This, however, seems reasonable.4 30 28 The model failed to explain 9% of the overall reduction in deaths from coronary heart disease: residual confounding in many of the risk factor effect estimates is likely, and, furthermore, the model does not quantify all potential risk factors (such as psychosocial).31
Comparison with other studies
Though the results with our model are generally consistent with other analyses conducted in western Europe, the US, and elsewhere (fig 3⇓), interesting differences do exist. The contribution from changes in population risk factors was even bigger in Nordic countries, probably reflecting more effective health policies at national and local levels.32 In contrast, in the UK the dietary changes were more modest, whereas large reductions in smoking prevalence powerfully reduced mortality.8
Fig 3 Percentage of reduction in deaths from coronary heart disease attributable to treatments and changes in risk factors in our study and in other populations
Conclusions and policy implications
In conclusion, coronary heart disease deaths in Poland plummeted after 1989. Over half of the recent reduction in mortality was associated with favourable changes in major cardiovascular risk factors, while about a third was attributable to modern treatments. These impressive results show the powerful effect of moderate changes in population level risk factors on mortality from coronary heart disease. The positive trends in risk factors probably reflect beneficial changes in food prices and accessibility after economic transformation. These benefits were substantially greater than those from improvements in healthcare systems and medical treatment.
These analyses have implications for strategies to fight future epidemics of coronary heart disease. Effective legislation to control smoking, dietary salt intake, and consumption of saturated fat and trans fats could be powerful, rapidly beneficial, and cost saving. The "natural experiment" that occurred in Poland now requires further support from evidence based policy interventions.
What is already known on this topic
In Poland, soaring trends in premature coronary mortality in the 1980s sharply reversed in the early 1990s after the transition into a market economy
The socioeconomic transition was accompanied by large lifestyle changes and substantial improvements in healthcare systems
What this study adds
Over half of the large decline in mortality from coronary heart disease in Poland between 1991 and 2005 could be attributed to reductions in major cardiovascular risk factors and about a third to evidence based medical treatments
Large and rapid effects on coronary mortality can follow population-wide decreases in exposure to cardiovascular risk factors reflecting economic changes
Cite this as: BMJ 2012;344:d8136
We thank Stefan Bogusławski, Grażyna Broda, Piotr Dylewicz, Zbigniew Gaciong, Michał Gałaszek, Marek Gierlotka, Paweł Goryński, Tomasz Grodzicki, Agata Ignaszewska-Wyrzykowska, Bogdan Jasiński, Roman Konarski, Jerzy Korewicki, Michał Krawczyk, Bohdan Maruszewski, Irina Mogilnaya, Grzegorz Opolski, Andrzej Pająk, Ryszard Pieńkowski, Walerian Piotrowski, Jerzy Piwoński, Lech Poloński, Witold Rużyłło, Andrzej Przewoźniak, Stanisław Rudnicki, Stefan Rywik, Zygmunt Sadowski, Włodzimierz Sekuła, Wiktor Szostak, Roman Topor-Mądry, Łukasz Wierucki, Barbara Wizner, Bogdan Wojtyniak, Stanisław Woś, and Witold Zatoński for help with data identification and appraisal.
Contributors: All authors made substantial contribution to conception and design. PB, MR, JK, WD, TZ, and BW were responsible for identification, appraisal, and acquisition of the major sources of epidemiological data specific for Poland. SC, MO'F, and KB developed the CHD IMPACT model. PB, SC, MO'F, MR, JK, WD, and TZ were then responsible for implementing the Polish version. SC, PB, MO'F, BW, WD, and TZ contributed to drafting the article and revising it critically. PB is guarantor.
Funding: This study was funded by the Polish Ministry of Health, the European Commission PHEA, and the UK Medical Research Council (grant No 91367).
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: No additional data available other than the technical appendix, which is on bmj.com.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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Data supplement
Piotr Bandosz, Martin O'Flaherty, Wojciech Drygas, Marcin Rutkowski, Jacek Koziarek, Bogdan Wyrzykowski et al
Bandosz Piotr, O'Flaherty Martin, Drygas Wojciech, Rutkowski Marcin, Koziarek Jacek, Wyrzykowski Bogdan et al. Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study BMJ 2012; 344 :d8136
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