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Туркмены в Иране (также Иранские туркмены; , ) — крупнейшая группа туркменского этноса за пределами Туркменистана. Туркмены оказались одним из разделённых народов после 1885 года, когда в результате британского, иранского и пуштунского противодействия экспансия Российской империи на юг прекратилась. Судьба туркмен по разные стороны границы складывалась по-разному. Индустриализация, урбанизация и более интенсивная модернизация в советском Туркменистане привела к сплочению разрозненных кочевых племён в единый оседлый этнос с чёткими культурно-языковыми атрибутами. В современном же Иране туркмены, как и иранские казахи, всё более подвержены персизации.

Расселение
Иранские туркмены долгое время представляли собой группу полукочевых племён, сохранявших более традиционный уклад. В Иранской Туркмении проживали следующие туркменские племена — йомуды, гёклены, игдыры, сарыки и салыры. Точные данные о численности туркмен в Иране отсутствуют. По оценкам в Иране проживает от 1,5 до 3,0 млн туркмен. С конца 1970-х годов оценки численности затруднены из-за растущей ассимиляции туркмен. Ареал их традиционного расселения в Иране распадается на две крупные группы: более компактную западную, куда входят междуречье Атрека и Горгана (Горганская равнина), и более дисперсную восточную (приграничный Копетдаг, низовья реки Кешефруд и долина р. Герируд (Теджен). Между ними пролегает зона компактного проживания курдов (Хорасанский Курдистан).

Этническая история
В XVI веке туркменские племена на территории Ирана были расселены следующим образом. В Северном Хорасане проживали текинцы, проникшие сюда ещё в XV веке; между Горганом и Атреком обитали племена, известные у Искандера Мунши под общим названием «йака-туркмены» (племена охлу, геоклен, эймур, салор и др.). В течение всего XVII века и начала XVIII в. происходил процесс переселения туркменских племён в пределы Ирана. В XVII веке оно было связано с усиленной эксплуатацией туркмен хивинскими ханами и набегами калмыкских феодалов.

После того как в 1728 году Надир-шах разгромил туркмен и курдов, он вытеснил часть племён теке и имрели из Дуруна и поселил их в Хорасане на границе со степью между Астрабадом и Дуруном. В 1740-х годах Надир-шах покорил Бухарское и Хивинское ханства. Большая часть туркмен-йомудов была вынуждена переселиться из Хивинского ханства на побережье Каспийского моря и в Астрабад.

Вплоть до вхождения Средней Азии в состав России обстановка в местах расселения туркмен была неспокойной. Под предлогом джихада хивинский хан неоднократно совершал набеги на иранскую территорию. Как писал Риза Кули-хан, он «иногда водил войска против Серахса и Мерва, а иной раз он приказывал туркменам произвести набег на районы Хорасана». В свою очередь, иранские войска порой вторгались на территорию Средней Азии, преимущественно на туркменские земли, грабили и уводили людей с туркменских кочевий в плен.

На передвижение туркменских племён сказывались также межплеменные противоречия, которые довольно часто возникали в то время. В 1855 году текинцы захватили Мервский оазис. Проживавшие там сарыки были изгнаны в Иолотанский и Пендинский оазисы, и они в свою очередь оттеснили из Иолотани салоров. Последние вначале находились в районе нынешней Кушки, а затем откочевали в Иран, и наконец поселились в 120 км выше Серахса. Позднее Иран использовал борьбу между сарыками и теке для организации в 1861 года похода в Мервский оазис. Однако он закончился сокрушительным поражением персидских войск. Но после этого «правительство Ирана, по словам Мохбера, не покидала мысль подчинения туркмен».

В 1870 году мервские текинцы разгромили салоров и расселили их небольшими группами в Мерве.

Аламанщина
Важное место в этнической истории занимает аламанство (грабительские набеги), совершаемых туркменскими племенами на протяжении XIX века. Такой набег совершался отрядом разной величины от нескольких человек до 2-3 тысяч всадников. На территорию Ирана набеги туркменских племён участились после разгрома в 1861 году персидских войск. Иранские феодальные сановники, а также ряд русских и западноевропейских авторов XIX века рассматривали аламанщину как основное занятие туркмен, обвиняя весь народ в поголовном разбойничестве. На территории соприкосновения земель Ирана и Средней Азии наступило время, когда, по выражению А. Вамбери, одно название "атрек" наводило «необыкновенный страх на несчастных жителей Мазандерана и Таберистана».

Аламанщина была бедствием для населения северо-восточного Ирана. Полковник Гродеков в своих записках о путешествии из Закаспийского края в Герат отмечал, что ко времени его странствия в 1882 году только в одном округе Пушт-и Джаме из 360 деревень осталось не более 10-15, «державшихся только близостью своего положения к Мешхеду, а остальные были уничтожены туркменскими набегами». Свидетелем опустошения целых районов Хорасана был и персидский шах Насреддин. Л. К. Артамонов писал, что «персидские власти совершенно бессильны в защите поселений и, невзирая на постоянное присутствие в Астрабаде и в укреплении Ахкала своих войск, а также пограничных отрядов, оседлое население тяжко страдает от туркмен и вынуждено влачить жалкое существование в роскошной и богато одарённой стране».

Современное положение
Во время Исламской революции 1979 года туркмены и иранские казахи региона Туркменсахры требовали тюркской автономии, но так и не получили её.

После суверенизации Туркменистана в начале 1990-х годов наблюдалась некоторый культурный подъём в среде иранских туркмен. В регионах их проживания появились вывески и программы на туркменском языке, раздавались требования по созданию культурно-языковой автономии. К концу 1990-х годов все они сошли на нет. В настоящее время иранские туркмены, большая часть которых уже не кочует, всё больше ассимилируются персами, особенно в городах Горган и Гонбад-э-Габус.
Добровольная ассимиляция наиболее выражена среди молодёжи. Женщины-туркменки перестали носить колоритные среднеазиатские национальные костюмы, перейдя на чёрную иранскую паранджу. Многие семьи полностью перешли на фарси за последние 10-15 лет. В городах практически исчезли вывески на туркменском языке..

Известные иранские туркмены
 Сердар Азмун — нападающий футбольного клуба «Зенит».
 Довлетмамед Азади — туркменский поэт и учёный, суфий.
 Махтумкули — туркменский поэт, классик туркменской литературы.
 Фархад Гаеми — иранский волейболист, игрок сборной Ирана.
 Рахимберди Аннамораднежад — иранский градостроитель.
 Рамин Нурколипур — иранский политический деятель.

См. также
 Туркмены в Афганистане
Туркмены в Сирии
Туркмены в Ираке
 Азербайджанцы в Иране
 Кашкайцы
 Туркменсахра

Примечания

Литература

Ссылки
 Информационный сайт «Туркмен Сахра»

Народы Ирана
Туркменская диаспора

redpajama_set_name: RedPajamaWikipedia


Late Wednesday a joint statement penned by Jewish Federation of Greater New Orleans CEO and Anti-Defamation South Central Region director Aaron Ahlquist spoke to the combined efforts of the two organizations following the adoption Friday of New Orleans City Council R-18-5, a resolution that had been promoted as pro-BDS (boycott, divest and sanction) movement by the New Orleans Pro-Palestinian Solidarity Council (NOPPSC).
Additionally signed by Federation president Henry Miller and Human Relations Council chairman Bradley Bain, the statement delineated specific tasks they have taken "to educate and engage" members of the City Council and Mayor-elect Latoya Cantrell's transition team as to the history and dangers of the BDS movement.
"We have jointly advocated that the resolution be both reconsidered and then withdrawn by the Council, the procedural mechanism the Council would utilize to reverse the resolution," the two CEOs said.
We are encouraged that Council President Jason Williams released a statement this afternoon (please see below) unequivocally voicing support for Israel and the Jewish community, and indicating his intent to pursue corrective action on the resolution.
Williams further acknowledged that earlier in the same meeting, the Council has praised the collaboration and dedication of the members of the Jewish community. "It was certainly not our intention to close the meeting with an insult. This clearly occurred, and that was unintentional," the Williams statement added.
Fieklow and Ahlquist both believe the action to reconsider the resolution will take place at the next meeting of the City Council slated for Thursday, January 25.
Members of the community are also encouraged to reach out to the New Orleans City Council in a constructive manner, they said.


The information below is meant as a general guide to help fit your child with an appropriate bat for his or her size and age category. Please note players physical strength and skill will vary and your child's comfort with also be a factor to consider.
Other factors that will help determine the appropriate bat for you are barrel diameter, as well as the drop in ounces in relationship ship with the length of the bat. This relationship is referred to as the drop or minus. For example a 30" bat that is a minus 8 would mean that the bat weighs 22 ounces.


Very graphic, romantic tin advertising charger featuring a beautiful Victorian age woman next to a man pouring a bottle of Budweiser into a fondou or other dish. Say When.
Grade: Some spotting visible when viewed at an angle, a little soiling to bottle label. See photos.


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Want to know more about Art at Challoner's? Find out here.
Writing: Joshua Robey (Year 10)
QR code for this page. Right click on the image and select 'Copy image' or 'Save image as...' to take a copy of this QR code. Add it to a worksheet for students to scan and jump immediately to this page. Or just display this pop-up box on your classroom projector.
In 1548, a man named Robert Chaloner was born. Little is actually known about his family, his childhood and his lifestyle, but what can be said for certain is that he studied at Christ Church College in Oxford, before going on to become Rector of Amersham in 1579.
During this time the church had a responsibility to educate, so the task fell to Chaloner to provide education for the children of Amersham, or so the story goes. Engrossed by the idea, but unwilling to teach the children himself, he hired a tutor, allowing the Church House to be used for this purpose. This, however, was not the school that Chaloner would give his (albeit misspelled) name to: that was thanks to a later endeavour. After ten years of ministry in Amersham, Chaloner moved on. He was later appointed as the Canon of Windsor in 1589.
He died in 1621, leaving behind a will that proved his loyalty to education. The particular bequest that allowed the school to come into being was one which left a part of the rental of land at Wavendon to establish a 'free grammar schoole'. His will states that the Church House he originally used should remain available to use as the school. To this day, the 1624 school building still stands, currently as a restaurant. Chaloner's grave can be found in St Mary's Church - mere steps away from the school he created.
The school was about to start a story of huge growth, dark times in financial hardship and war, and in more recent times a curriculum that expanded vastly. From its humble beginnings, this is the story of how Dr Challoner's Grammar School earned its place on the map.

redpajama_set_name: RedPajamaCommonCrawl


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L'Astronome ou l'Astrologue est un tableau de Jan Vermeer.
 L'Astronome est le nom donné à l'auteur d'une vie de Louis le Débonnaire datant du .


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Global Governance At a Critical Juncture
April 1, 2014 | Category: Prophecy News | Tags: World Government
Global governance – the collective management of common problems at the international level – is at a critical juncture. Although global governance institutions have racked up many successes since they were developed after the Second World War, the growing number of issues on the international agenda, and their complexity, is outpacing the ability of international organisations and national governments to cope.
With the emergence of rapid globalisation, the risks to the international system have grown to the extent that formerly localised threats are no longer locally containable but are now potentially dangerous to global security and stability. At the beginning of the century, threats such as ethnic conflicts, infectious diseases, and terrorism as well as a new generation of global challenges including climate change, energy security, food and water scarcity, international migration flows and new technologies are increasingly taking centre stage.
Read More: Global Governance 2025: at a critical juncture.
Is the Battle of Gog and Magog Different than the Battle of Armageddon?
It's official – Chicago experienced the coldest four months ever on record


That's the clock ticking down the last months of the current Serbian government.
The ruling coalition, never stable, is visibly crumbling. The Socialists — Milosevic's old party — were supporting it, but they're split down the middle now, and may bolt over the appointment of a new foreign minister.
The government is coughing blood. On a recent key vote (appointing a new deputy prime minister), it came within a whisker of collapsing, just barely managing to muster 126 votes out of 250.
Meanwhile G17 — which is sort of the Europhile-technocrat urban liberal party — has said that it will leave the government coalition on October 1, unless talks with the EU have started up again by then. Talks with the EU will not start unless accused war criminal Ratko Mladic shows up for his appointment with the Hague. Right now that seems unlikely.
So, elections in Serbia, probably this autumn, almost certainly by early next year.
This is not likely to be a good thing. While the current government has its faults, it's very unlikely that it will be replaced by anything better… and all too possible it could be something worse.
On the plus side, at least the Serbs are letting Montenegro go in peace. It looks like most of the muttering and blustering of March and April — stuff like Montenegrins losing their benefits, or being forced to choose citizenship — was just bluff. That's really good news. So there's that.
This entry was posted in A Fistful Of Euros, Governments and parties and tagged federal government, government, Governments and parties, montenegro, Serbia by Douglas Muir. Bookmark the permalink.
G17 was trained and financed by the CIA in Budapest to break up firms and factories and sell them on for peanuts. Draskovic is an absolute nightmare, whether he was or still is a druggie is hard to tell. He has said some things which are even more off the wall than GB. Montenegro being a separate state now should take on all the responsabilities of one. Foreign students pay for education everywhere in the world. Same goes with health care. Don't know which of these statements your writer would have trouble with.
G17 was trained and financed by the CIA in Budapest to break up firms and factories and sell them on for peanuts.
Uh huh. Cite for this?
Note that privatization started in 1995, under Slobo. Although "privatization", Slobo-style, meant selling monopolies and state assets at fire-sale prices to family members, cronies, and top members of the Socialist Party and JUL.
I didn't say anything about either of those. I was referring to (for instance) the suggestion that federal-era pensions would no longer be paid to Montenegrins, or that Montenegrins resident in Serbia would have to buy visas and register with the police.
I don't see why they should be exempt from needing work visas for serbia?
Every other country in the world requires foreign citizens to apply for a work visa prior to working in that country-it seems illogical that Serbia should offer more compassionate concessions to people who voted for outright independence from Serbia.
Obviously you're not a citizen of the EU.
Actually, forcing the Montenegrins to get visas is not logical at all. It's stupid.
Bright, ambitious Montenegrins have been moving north to Serbia for the last 80 years. This has been a huge benefit to Serbia.
While the rest of Europe is integrating into a single labor market, you want to chop yours even smaller?
to people who voted for outright independence from Serbia.
This is just silly vindictiveness — punishing the Montegrins for making you feel bad. And it's doubly silly because the Montenegrins resident in Serbia couldn't even vote in the independence referendum. You want to punish people who had nothing to do with it.
There's no iron law that says you have to make the Montenegrins get visas. It's a choice. And if the Kostunica government has any sense, it will choose not to.
I think you forgot a "/" after dissident. Otherwise you would be acknowledging Vuk's writing skills.
Whenever I see Vuk speak the box promoter Don King comes to mind. Am I far off?
I may not think much of Dan Brown's writing, but _The Da Vinci Code_ has killed a lot of trees.
Vuk, same-same. I'm afraid that both his novels and his nonfiction have sold and sold. The novels seem to have dropped off the shelves recently; I suspect they haven't aged well. But still: he has made a very good living with his pen.
My impression is that Vuk's support isn't broad, but it is deep… the people who like him aren't more than 10% or so, but they _really_ like him. And they're not going to change their minds.
I completely understand Draskovic's appeal – its simply a question of charisma, that he no longer has, which meant he was loved by a sizeable amount of people.
Now he is disliked by almost everybody and the internationals love him. 10 percent is a high estimate for his support – very high.
Its my opinion that SPO is undergoing a change in that they are now touting for the support of pro EU moderately patriotic city types. They are leaving their rural electoral base for good.
The populism of Don King without the murdering tendancies that King has Warchild. Vuk's not evil, well I dont think he is anyway.
I'm not sure Doug that we have seen the last of this government yet. Three main factors what they agree to divvy up behind closed doors, what the internationals want and what the polls say. SPS are very easily bribed with more positions in government run companies.
Good point about privatisation BTW. People should be reminded about this fact since some now see Milosevic as some kind of antiglobalist socialist. If true it was a very late conversion that begun the moment he was ousted from power.
You've closed off further comments of your "Ooh harsh, Cristina" piece from June 23, so I'm going to continue here.
I don't share your doom and gloom scenario for Serbian athletes, and indeed they've had quite a bit of success in the last week or so.
Novak Djokovic beat fourth seed Nicolas Massu in the Priority Telecom Open final to claim his first ATP title.
Both players had their serve broken in the opening set before 19-year-old Serb Djokovic won a tense tie-break.
They again traded breaks early in set two before Djokovic struck again in the fourth game before sealing a 7-6 6-4 victory in Amersfoort, Holland.
Djokovic is the first Serb player to win the clay-court event and achieved the feat without dropping a set.
29.7.2006 17:02 BELGRADE, (Tanjug) – The Serbia-Montenegro juniors won Saturday the European waterpolo championship in Romania by beating Hungary with 12-11 (4-3, 5-4, 1-3, 2-1).


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Drones reveal great assurance when it comes to offering help for those that remain in dangerous situations like being stranded in open water, which the Parrot Recon Drone identifies.
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French language > Textbooks for foreign speakers > English.
1 |a Stillman, David M. |e author.
1 4 |a The ultimate French review and practice : |b mastering French grammar for confident communication / |c David M. Stillman and Ronni L. Gordon.
0 |a Part 1: Verbs: Basic Forms And Uses: -- Present Tense: -- Present tense of regular -er, -ir, and -re verbs -- Spelling changes in the present tense of regular -er verbs -- First-conjugation (-er) verbs with mute e as the stem vowel -- First-conjugation (-er) verbs with e as the stem vowel -- Uses of the present tense -- Pour parler un francais authentique: Speak Real French the prefix re- -- Present Tense Of Irregular Verbs: -- Common irregular verbs -- Expressions with avior, etre, faire, and prendre -- Irregular verbs resembling regular verbs -- Other irregular verbs -- Verbal constructions -- Pour parler un francais authentique: Speak Real French the verb system in spoken French -- Negative Sentences: -- Basic negative structures -- Other negative structures -- Ne-que -- Pour parler un francais authentique: Speak Real French further uses of ne-que only -- Interrogative Sentences: -- Question formation -- Imperative -- Passe Compose: -- Passe Compose with avoir -- Passes Compose with etre -- Special cases -- Agreement of the past participle -- Imperfect; Imperfect Versus Passe Compose: -- Imperfect tense -- Uses of the imperfect tense: the imperfect contrasted with the Passe Compose -- Other use of the imperfect tense -- Special meanings of certain verbs -- Pour parler un francais authentique: Speak Real French the imperfect tense -- Reflexive Verbs: -- Conjugation and use of reflexive verbs -- Infinitive of reflexive verbs -- Passe Compose of reflexive verbs -- Reciprocal reflexive verbs -- Imperative of reflexive verbs -- Other reflexive constructions and reflexive verbs -- Future And Conditional; Conditional Sentences (1): -- Future tense -- Use of the future after quand and other conjunctions -- Conditional -- Conditional sentences (1) -- Pour parler un francais authentique: Speak Real French pronunciation of the future and conditional -- Pluperfect, Future Perfect, And Past Conditional; Conditional Sentences (2): -- Pluperfect (Le plus-que-parfait) -- Future perfect (Le future anterieur) -- Conditional perfect (Le conditionnel passe) -- Conditional sentences (2) -- Passe Simple: -- Formation and use of the passe simple -- Passe simple of irregular verbs -- Present Participles; Uses Of The Infinitive: -- Present participle -- Uses of the infinitive -- Verb + a + infinitive -- Verb + de + infinitive -- Verb + object + de + infinitive -- Adjective or noun + preposition + infinitive -- Faire + infinitive -- Part 2: Nouns And Their Modifiers; Pronouns: -- Nouns: Gender, Number, And Articles; Uses Of Articles: -- Gender and number of nouns; definite and indefinite articles -- Plural nouns -- Determining the gender of nouns -- Determining the gender of nouns (continued) -- C'est versus il/elle est -- Partitive -- Expressions of quantity -- Uses of articles -- Stressed Pronouns; Subject-Verb Agreement: -- Stressed pronouns: forms and usage -- Subject-verb agreement with stressed pronouns and other special cases -- Possessive And Demonstrative Adjectives And Pronouns: -- Possessive and possessive adjectives -- Possessive pronouns -- Demonstrative adjectives -- Demonstrative pronouns -- Interrogative Adjectives And Pronouns, And Other Question Words: -- Interrogative adjectives -- Interrogative pronoun lequel -- Interrogative pronouns who, whom, what, and other question words -- Adjectives, Comparatives, And Superlatives: -- Gender of adjectives -- Plural of adjectives -- Position of adjectives -- Comparison of adjectives, adverbs, nouns, and verbs -- Superlative of adjectives, adverbs, nouns, and verbs -- Superlative of adjectives, adverbs, and nouns -- Pour parler un francais authentique: Speak Real French adjectives -- Object Pronouns: -- Direct object pronouns -- Indirect object pronouns -- Pronoun y -- Pronoun en -- Double object pronouns -- Restrictions on the use of object pronouns -- Object pronouns in affirmative commands -- Part 3: Other Elements Of The Sentence: -- Numbers; Time; Dates: -- Cardinal numbers to 99 -- Cardinal numbers 100 and above -- Ordinal numbers -- Telling time -- Days, dates, and years -- Adverbs: -- Adverbs of manner -- Adverbs of time -- Adverbs of place -- Adverbial phrases -- Negative And Indefinites: -- Negative words -- Indefinite words and expressions -- Indefinite words and expressions (continued) -- Idioms and expressions with negative and indefinite words -- Prepositions; Prepositions With Geographical Names: -- Preposition a -- Preposition de -- Prepositions avec and sans -- Prepositions en and dans -- Sur, sous, and related prepositions -- Entre, pour, and par -- Other prepositions -- Prepositions with geographical names -- Part 4: Verbs In Two-Clause Sentences: -- Relative Clauses: -- Relative pronouns qui and que -- Preposition + qui and lequel -- Dont -- Other relatives -- Relatives without antecedents -- Present Subjunctive: -- Moods of verbs -- Forms of the present subjunctive -- Uses Of The Subjunctive: Imposition of will, necessity, getting someone to do something -- Uses Of The Subjunctive: Emotion and opinion -- Uses Of The Subjunctive: Negation of fact and opinion -- Uses Of The Subjunctive: Special cases -- Pour parler un francais authentique: Speak Real French the present subjunctive -- Past Subjunctive; Literary Subjunctives: -- Forms and use of the past subjunctive -- Forms and use of the imperfect subjunctive -- Forms and use of the pluperfect subjunctive -- Subjunctive (Continued): -- Subjunctive after certain conjunctions -- Subjunctive in relative clauses -- Subjunctive after superlatives -- Subjunctive in certain types of indefinite clauses -- Part 5: Idiomatic Usage: -- Passive Voice And Substitutes For The Passive: -- Passive voice (La voix passive) -- Substitutes for the passive voice -- Important Idioms And Proverbs: -- Idioms with avior and etre -- Idioms with faire -- Idioms with prendre -- Idioms with mettre -- Idioms with voir -- Idioms with dire -- Expressions with other common verbs -- Idioms from rural life: the farm, cats, dogs, and cabbages -- Idioms relating to time, weather, the life cycle, and eating -- Other idioms -- Proverbs -- Appendices: -- Verb charts -- Written conventions -- Answer key -- Index.
|a Overview: Better than ever! The bestselling intermediate-level workbook has been expanded into a comprehensive, dynamic digital/print study tool that's sure to help you master French. Based on the principle that strong grammar skills are necessary for foreign language mastery, The Ultimate French Review and Practice explains and illustrates important grammar concepts with lively sentence examples, and it provides 400 engaging exercises that are contextualized, with scene-setting instructions in French. This new, premium edition provides an array of digital content in the bonus App (iOS, Android, desktop) that supports the book: Pre-test for identifying existing strengths and weaknesses. -- More than 200 exercises for extended review. -- Post-tests for assessing progress. -- Flashcards for all vocabulary lists, with progress-tracking. -- Extensive audio exercises to test listening comprehension.
|a Text in English and French.
0 |a French language |v Textbooks for foreign speakers |x English.
0 |a French language |x Grammar.
1 |a Gordon, Ronni L. |e author.


text:
Management of neuropathic pain in patients with diabetic peripheral neuropathy and low back pain in Saudi Arabia: Evidence and gaps
Ashraf A Amir1, Said A Khader2, Ziad El Chami3, Sami M Bahlas4, Mahmoud Bakir5, Shams Arifeen6
1 Department of Family Medicine, International Medical Center Hospital, Salam Home Health Care (Geriatric Care), Riyadh, Saudi Arabia
2 Department of Diabetes and Endocrine, Dr. Suliaman Alhabib Medical Group, Riyadh, Saudi Arabia
3 Advanced Neuro-Musculoskeletal Care Center, Dr. Samir Abbas Hospital, Riyadh, Saudi Arabia
4 King Abdulaziz University, Riyadh, Saudi Arabia
5 Upjohn B.V, Riyadh, Saudi Arabia
6 Africa and Middle East Clusters, Upjohn Pfizer Africa and Middle East, Dubai, UAE
Date of Acceptance 23-Jul-2021
Date of Web Publication 7-Sep-2021
Dr. Said A Khader
Department of Diabetes and Endocrine, Dr. Suliaman Alhabib Medical Group, Riyadh 11643
DOI: 10.4103/jfcm.jfcm_79_21
We report existing evidence and gaps in neuropathic pain management in Saudi Arabia, the prevalence and patient management stages in diabetic peripheral neuropathy (DPN) and low back pain (LBP) with a neuropathic component. A semi-systematic approach was adopted to identify data on neuropathic pain. A structured search was conducted through MEDLINE, Embase, and BIOSIS databases to identify articles published in English between January 2010 and December 2019. Unstructured search was conducted through various sources including Google Scholar and Saudi Arabia's Ministry of Health website. Studies including populations ≥18 years and neuropathic pain were included; data gaps were supplemented with anecdotal data from local experts. Weighted or simple means were calculated for overall data; synthesized evidence was represented as an evidence gap map. Of 37 articles retrieved from structured search, none were eligible for final analyses. Thirteen articles from unstructured search and two anecdotal data sources were included for final analyses. The majority of articles included were of cross-sectional design (n = 10) in diabetes patients. The mean (range; number of articles) DPN prevalence was estimated as 33.6% (5.6%–65.3%; n = 8). Data on DPN patient management stages were limited; synthesized evidence indicated that 37.2% (0.41%–80.0%; n = 3) of patients had DPN awareness, 17.8% (n = 1) underwent screening, 22.4% (18.4%–65.3%; n = 2) had DPN diagnosis, and 45.1% (0.0%–62.7%; n = 2) received treatment for pain management. Data on LBP with neuropathic component were scarce (prevalence, 41.0% [n = 1]; diagnosis, 54.7% [n = 1]). Data are limited, so more studies are needed to accurately estimate the prevalence and stages of patient management for neuropathic pain in the country.
Keywords: Evidence, gap, neuropathic pain, patient management, Saudi Arabia
Amir AA, Khader SA, El Chami Z, Bahlas SM, Bakir M, Arifeen S. Management of neuropathic pain in patients with diabetic peripheral neuropathy and low back pain in Saudi Arabia: Evidence and gaps. J Fam Community Med 2021;28:155-63
Amir AA, Khader SA, El Chami Z, Bahlas SM, Bakir M, Arifeen S. Management of neuropathic pain in patients with diabetic peripheral neuropathy and low back pain in Saudi Arabia: Evidence and gaps. J Fam Community Med [serial online] 2021 [cited 2022 Jan 17];28:155-63. Available from: https://www.jfcmonline.com/text.asp?2021/28/3/155/325633
Neuropathic pain is defined as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system."[1] It affects approximately 7%–10% of the general population.[2] Neuropathic pain is commonly associated with various disease conditions, including diabetic peripheral neuropathy (DPN), postherpetic neuralgia, and low back pain (LBP).[2],[3]
DPN, a common complication of diabetes, is a major cause of morbidity, mortality, and poor quality of life (QoL) in patients with diabetes.[4] Neuropathic pain in DPN is associated with poorer QoL[5] and substantially higher health-care costs compared with diabetic patients without DPN.[6],[7] A recent meta-analysis estimated the pooled prevalence of DPN in patients with diabetes as 30%.[8] In Saudi Arabia, the prevalence of DPN ranges between 29.1% and 40.0%[9],[10] and neuropathic pain in DPN, between 33.2% and 34.7%.[11],[12] There are multiple risk factors associated with neuropathic pain in DPN, for example, gender, duration of diabetes, and poor glycemic control.[11],[12] Despite the high prevalence of DPN in Saudi Arabia, studies evaluating the risk factors and characterizing neuropathic pain management in this population are limited.[9],[11],[12],[13],[14],[15]
Early identification of high-risk patients is crucial for the modification of risk factors and taking appropriate care of the feet to prevent DPN, and improving prognosis.[14],[16] Patient education, a critical factor that drives self-management, is essential to ensure appropriate foot care and prevent secondary complications of DPN such as foot ulcers and amputations.[17] However, studies have demonstrated that awareness among patients and physicians in Middle Eastern countries regarding neuropathy and the risks of developing painful DPN and foot problems is inadequate. This was attributed to the lack of relevant education and specialized centers for the management of DPN.[18],[19]
Another common pain condition associated with neuropathic pain is chronic LBP, which is defined as LBP lasting for ≥3 months.[20] The prevalence of neuropathic pain in patients with chronic LBP ranges between 41.0% and 54.7% in Saudi Arabia.[21],[22] Similar to the literature in DPN, studies characterizing LBP management in Saudi Arabia are limited. A patient-centric approach, which shifts the focus from disease to the needs of the patient, is essential for effective management of the disease and measurement of outcomes.[23] Following the World Health Organization (WHO) recommendation on integrated disease management, the stages of patient journey for DPN can be broadly classified into five touchpoints: awareness, screening, diagnosis, treatment, and adherence, with the integration of palliative care across the care continuum pathway.[24] Consequently, the Mapping the Patient Journey Towards Actionable Beyond the Pill Solutions (MAPS) initiative has been conceptualized by Upjohn– A legacy of Pfizer Research Development and Medical that helps in managing diseases through patient-centric and locally relevant solutions.[25] Quantitative mapping of available evidence and identification of data gaps in terms of disease prevalence and patient management stages would enable the government and health-care authorities to implement relevant health-care policies, fund and prioritize specific research, and sponsor patient awareness programs in Saudi Arabia. This can be achieved through generation of evidence maps that involves evidence synthesis through a systematic search of a large field and identification of gaps in available data and/or future research needs.[26] In instances where a full systematic review is not feasible or may not provide the necessary information, a semi-systematic review approach can be used.[27]
The current semi-systematic review was carried out to report the existing evidence and identify gaps in neuropathic pain management in Saudi Arabia. The objectives of this review were to specifically identify data on the prevalence, awareness, screening, diagnosis, treatment, adherence, and control of neuropathic pain in Saudi Arabia, with a focus on DPN and LBP with a neuropathic component. Further, the review provides recommendations on strategies to improve patient awareness and management in Saudi Arabia.
Review design
The MAPS methodology followed in our review has been described in detail elsewhere.[24],[25] Preliminary literature search for LBP with a neuropathic component in Saudi Arabia yielded only a few articles. Due to the paucity of data, a separate review article on LBP with a neuropathic component was deemed unwarranted. Therefore, a semi-systematic approach was used to identify evidence on neuropathic pain in DPN and chronic LBP with a neuropathic component in Saudi Arabia. Neuropathic pain was defined as pain due to a lesion or disease of the somatosensory system, including DPN and LBP with a neuropathic component.[1]
An electronic structured search of studies published from January 2010 to December 2019 was performed through MEDLINE, Embase, and BIOSIS databases using keywords related to neuropathic pain and different stages of patient management. The comprehensive search was designed to ensure the inclusion of all studies conducted in Saudi Arabia on neuropathic pain in DPN and LBP with a neuropathic component. The full search strategy is detailed in [Table 1].
Table 1: Structured search strategy for neuropathic pain
An additional search (unstructured) was also conducted through Google Scholar, the Incidence and Prevalence Database, WHO website, Saudi Arabia Ministry of Health (MOH), and national clinical practice and treatment guidelines to address data gaps in structured search. No date limits were applied to the unstructured search.
Inclusion and exclusion criteria
The screening process was limited to articles published in the last 10 years (January 1, 2010–December 20, 2019). Eligible publications were based on: studies on adult populations (aged ≥18 years) on neuropathic pain, specifically DPN and LBP with a neuropathic component, that focused on the prevalence and epidemiological data from stages of patient management (awareness, screening, diagnosis, treatment, adherence, and control or remission) [Table 2] from systematic reviews, meta-analyses, randomized controlled trials (RCTs), observational studies, and narrative reviews (full-texts published and conference abstracts) in Saudi Arabia.
Table 2: Definitions used for screening of articles
Case studies, letters to the editor, editorials, and duplicate records were excluded. Studies published prior to 2010, publications in languages other than English, and studies that included specific patient subgroups (e.g. patients with comorbidities) were also excluded from the structured search.
The publications retrieved from databases were screened based on the eligibility criteria in two phases by two independent reviewers. The first phase included screening of titles and abstracts. The second phase consisted of reviewing the full-text publications. Both data collection and data extraction were conducted by two independent reviewers and any disagreements reconciled. Any identified data gaps were supplemented with anecdotal data from local clinical experts.
Evidence mapping
The weighted or simple means for the overall data from structured and unstructured searches and anecdotal data were calculated. The data on prevalence and patient management stages were exported into a data extraction grid and verified by more than one local expert to maintain consistency, provide holistic review, and refine data. The synthesized evidence was represented as an evidence gap map. Evidence gap maps are invaluable tools that help in strategic evidence-informed policymaking.[28]
In total, 37 articles from the structured search were retrieved (accessed through OVID). However, no relevant articles were identified for final analyses after screening the abstracts.
Articles that did not focus on neuropathic pain (n = 25) or were case studies (n = 6) were excluded. Other reasons for the exclusion of articles were nonavailability of data on stages of patient management (n = 4), data not from the representative country (n = 1), and lack of nationally representative population (n = 1).
Thirteen articles from the unstructured search were identified and included for final analyses. To supplement data on DPN-related stages of patient management, two additional data sources (anecdotal data)[29],[30] were included on the recommendation of local experts. The literature search and study selection process is summarized in [Figure 1].
Figure 1: Flowchart of articles included in the study.
Literature included for diabetic peripheral neuropathy
Of the articles from unstructured search included, eight studies reported the prevalence of DPN, including neuropathic pain in DPN, ranging from 5.6% to 65.3%, in patients with diabetes in Saudi Arabia [Table 3].[12],[14],[31],[32],[33],[34],[35],[36] A majority of the articles were of cross-sectional design (n = 10).
Table 3: Description of the included studies
Touchpoints of patient management
Awareness, screening, and diagnosis of diabetic peripheral neuropathy
Three studies reported on the awareness of DPN, including neuropathic pain in DPN, in patients.[12],[37],[38] The study conducted by Algeffari[12] revealed that only in 0.41% of patients, neuropathic pain in DPN was recognized by physicians in six primary health-care clinics. One study reported that over half (56.4%) of the patients with diabetes were aware of diabetic neuropathy.[37] Another study reported that 80.0% of patients had a moderate level of awareness of DPN.[38] Anecdotal evidence suggests that 40% of the patients were aware of DPN.[29]
A large retrospective study reported diabetic neuropathy screening in 17.8% of patients.[39] According to anecdotal evidence, approximately 30%–75% of patients underwent screening for DPN.[29],[30]
Two studies reported on the diagnosis of DPN, one of which reported the diagnosis of neuropathic pain in DPN in 65.3% of patients.[36] Another study reported diabetic neuropathy diagnosis in 18.4% of patients.[39] Anecdotal evidence suggests the diagnosis of DPN in 40% of patients.[30]
Treatment, adherence, and control of diabetic peripheral neuropathy
Two studies reported on the use of treatments for neuropathic pain in DPN, one of which revealed the lack of use of medication by patients to manage DPN,[12] while the other reported the use of medication by 62.7% of patients.[36]
Anecdotal evidence suggests the use of medication by 20%–50% of patients, adherence to treatment by 50%–80% of patients, and DPN control in 10%–60% of patients.[29],[30]
Two articles were included from unstructured searches.[21],[22] These studies reported a prevalence of LBP with a neuropathic element in 41.0% of patients[21] and a diagnosis in 54.7% of patients.[22] Additional study characteristics are presented in [Table 3].
Mapping the evidence
The data collected on the prevalence and different stages of patient management for neuropathic pain in DPN and LBP with a neuropathic component through semi-systematic review of the literature and anecdotal data are mapped as a proportion of patients against touchpoints of the patient journey [Figure 2].
Figure 2: Evidence gap map of individual data points of prevalence and patient management stages across studies and anecdotal evidence on diabetic peripheral neuropathy and low back pain. DPN: Diabetic peripheral neuropathy, LBP: Low back pain. Individual bubbles indicate separate data sources
Data extraction and synthesis
The majority of the articles focused on DPN. The weighted mean prevalence of DPN was estimated as 33.6%. The published studies provided limited quantitative evidence on patient awareness, screening, diagnosis, treatment, adherence, and control of DPN. Data on the stages of patient management extracted from the scientific literature and supplemented with anecdotal evidence for DPN in the Saudi Arabian population indicated that less than half of the patients were aware of DPN (weighted mean = 37.2%) and less than a quarter of the patients were screened by means of neurological examination or other pain assessment tools (n = 1; 17.8%) and were diagnosed with DPN (weighted mean = 22.4%). Further, less than half of the patients received treatment for pain management (weighted mean = 45.1%). The articles did not provide any evidence on adherence to treatment and DPN control. Approximately, two-third of the patients were adherent to treatment (simple mean = 65.0%) and based on anecdotal evidence, 35.0% (simple mean) of patients reported an improvement in DPN symptoms or QoL [Table 4].
Table 4: Patient management stages estimates from the included studies
Data on prevalence and diagnosis of LBP with a neuropathic component were obtained from two articles, which did not provide any evidence on the other stages of patient management of LBP with a neuropathic component.
The evidence map highlights data gaps in all the stages of patient management of neuropathic pain in DPN and LBP with a neuropathic component [Figure 3].
Figure 3: Evidence gap map of weighted or simple means of prevalence and patient management stages across studies and anecdotal evidence on diabetic peripheral neuropathy and low back pain. DPN: Diabetic peripheral neuropathy, LBP: Low back pain. Size of bubble indicates the number of studies/data sources. Data are represented as: Weighted means or single data points for diabetic peripheral neuropathy and low back pain published data; simple means for diabetic peripheral neuropathy anecdotal data
In this semi-systematic review, we compiled and analyzed the evidence and thereby identified gaps in different stages of management of patients in Saudi Arabia with neuropathic pain, with a focus on DPN and LBP. In this evidence gap map on neuropathic pain management in Saudi Arabia, we identified 13 articles through unstructured searches[12],[14],[21],[22],[31],[32],[33],[34],[35],[36],[37],[38],[39] and included two additional data sources (anecdotal data) on DPN.[29],[30] A major challenge of healthcare evidence in the Arab countries, including Saudi Arabia is the paucity of research and publications on different medical conditions.[40]
Gaps in study design
A majority of the studies included in the final analyses were cross-sectional. Although these studies provide valuable information about a population at a specific time point, they lack information on temporality seen in longitudinal observational studies. Further, cross-sectional studies do not provide insights into the causal relationships that RCTs provide.[41] Our study findings indicate the need for longitudinal studies and RCTs on different stages of management of DPN and LBP with a neuropathic component in Saudi Arabia.
Prevalence of diabetic peripheral neuropathy
The prevalence of diabetes has been on the rise in Saudi Arabia.[42] Complications associated with diabetes especially neuropathic pain are an increasing concern in several Arab populations.[36]
In this study, the prevalence of DPN after the pooling of data was 33.6% (weighted mean) in Saudi Arabia. A wide variation in the prevalence of DPN, including neuropathic pain in DPN, was reported in the studies (5.6%–65.3%).[12],[14],[31],[32],[33],[34],[35],[36]
In fact, the true prevalence of DPN and neuropathic pain in DPN is difficult to estimate owing to the absence of established standard diagnostic criteria and heterogeneity of patient populations.[18] More studies that use established diagnostic criteria are needed in Saudi Arabia to estimate the true prevalence of neuropathic pain in DPN.
Stages of patient management of diabetic peripheral neuropathy
Very few studies have evaluated awareness, screening, diagnosis, and treatment of DPN in Saudi Arabia. Further, published studies have not provided any evidence on treatment adherence and DPN control. Overall, less than half of the diabetic patients reported awareness of DPN and had treatment to manage DPN pain. Less than a quarter of patients underwent screening for DPN and had a diagnosis of DPN.
Despite high literacy rate in the identified population (84.4%[43]), low levels of awareness of DPN indicate the need for robust health education intervention programs for patients and health-care providers (HCPs) in Saudi Arabia. One of the major challenges in identifying DPN is that symptoms often do not reliably indicate the extent of nerve damage.[4] Further, there is a lack of effective screening strategy for DPN, which often results in the delay of the diagnosis of DPN until the condition deteriorates and becomes more difficult to treat.[37] This further emphasizes the importance of screening and early diagnosis of DPN.
More studies are needed in Saudi Arabia on LBP with a neuropathic component to estimate the true prevalence and patient management stages.
Expert panel recommendations on neuropathic pain treatment
Expert panel recommendations for neuropathic pain management, especially DPN and chronic LBP with a neuropathic component in the Middle Eastern region, include pharmacological first-line (e.g. pregabalin) and second-line (e.g. tramadol) treatments and nonpharmacological approaches (e.g. stress reduction techniques and physical therapy).[44] Recommendations for physicians in the Middle East and North Africa for neuropathic pain in DPN include screening (at least annually) for symptoms of neuropathic pain using tools (e.g. Doleur Neuropathique en 4 Questions [DN4]), a thorough examination of feet for ulcers in patients with diabetes, and the treatment goal of achieving a clinically meaningful pain reduction using first-line agents.[45]
Strategies to improve patient awareness and management in Saudi Arabia
Health and educational interventional programs could be implemented along with the establishment of screening and periodic follow-up programs for diabetic patients in Saudi Arabia.[37] It would also be beneficial to increase designated screening centers. An educational program for patients and HCPs in Saudi Arabia, to increase awareness of the care of diabetic foot and its complications, has indeed been shown to reduce the amputation rate by 8.1%.[46] Thus, training and encouraging HCPs to provide patient education on diabetes and its complications such as neuropathic pain is recommended.
Educating patients to undergo foot examination at least once a year is recommended. Early detection of DPN helps health-care professionals and patients to take on board preventive measures to avoid major complications.[9] There is a need for mandatory awareness programs in hospitals and clinics owing to the lack of formal podiatric educational services.[47] Disseminating relevant scientific information through various forums such as social media, brochures, and magazines in both local and English languages is recommended.[47] Thus, health authorities are encouraged to provide funding for training and awareness programs for diabetic patients and HCPs.[40]
Patient-centric approach
There is a need for patient-centric approaches, on the touchpoints of awareness, screening, diagnosis, treatment, adherence, and control, to improve health-care outcomes in patients with chronic neuropathic pain (DPN and LBP) in Saudi Arabia. Physicians could be encouraged to work collaboratively with patients to ensure successful pain management programs.[44] The MOH in Saudi Arabia could follow the approach of "The voice of the patient" used by the Food and Drug Administration in the United States.[48] In this approach, patients and their representatives provided inputs to sponsors in drug development on peripheral neuropathic pain (e.g. symptoms experienced, burden of neuropathic pain, and need for increased awareness).
Nevertheless, several measures have been taken at the national level in Saudi Arabia to bring awareness of diabetes and self-care education to all individuals.[49] The MOH in Saudi Arabia has introduced programs such as the National Executive Plan of Diabetes Control "2010–2020" and the Saudi national program of education against diabetes. The main objectives of these programs are to detect type 2 diabetes in the early stages, reduce the risk of diabetes-related complications, and help patients to control the disease/complications.[49]
The data from the current evidence gap map can be used to guide future research and patient education or awareness programs to generate evidence on neuropathic pain management in Saudi Arabia. Future reviews on patient management stages in LBP with a neuropathic component are warranted as more data evolve.
This evidence gap map reported existing evidence and identified gaps using a semi-systematic approach for the management of patients with neuropathic pain in Saudi Arabia. Owing to the limited data available, accurate estimates of awareness, screening, diagnosis, and treatment could not be calculated. Further, adherence and control data for DPN were based solely on anecdotal evidence owing to the lack of relevant published literature. In addition, some studies characterized neuropathic pain in DPN, whereas others mentioned DPN only without characterizing neuropathic pain. Hence, the study results may not be representative of neuropathic pain in DPN and should be given cautious interpretation. In this paper, we neither commented on biases in the studies nor assessed the quality of reporting of findings.
There are limited data on the different stages of managing patients with neuropathic pain in DPN and LBP with a neuropathic component in Saudi Arabia. Awareness, screening, and diagnosis of DPN in patients in Saudi Arabia were low, and less than half the patients had treatment for DPN. Published literature on treatment compliance and DPN control was unavailable, and these data were based solely on anecdotal evidence from local experts in Saudi Arabia. More studies are needed to accurately estimate the prevalence and stages of patient management for neuropathic pain in Saudi Arabia.
We acknowledge the experts who provided insights for bridging the data gaps. The support provided by the independent reviewer, Aditi Karmarkar from Upjohn – A Pfizer division, is deeply acknowledged. We thank Tanaya Bharatan from Upjohn – A Pfizer division for critically reviewing the draft. Medical writing support was provided by Sudha Korwar and Ramu Periyasamy at Indegene and was funded by Upjohn – A legacy Division of Pfizer.
This project was sponsored by Upjohn – A legacy Pfizer Division.
Dr. Ashraf A. Amir, Dr. Said A. Khader, Dr. Ziad El Chami, and Dr. Sami M Bahlas have no conflicts of interest to declare. Dr. Mahmoud Bakir is an employee of Upjohn B.V., Saudi Arabia. Dr. Shams Arifeen is an employee of Upjohn, Pfizer AfME (Africa and the Middle East), Dubai, UAE.
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Wang DD, Bakhotmah BA, Hu FB, Alzahrani HA. Prevalence and correlates of diabetic peripheral neuropathy in a Saudi Arabic population: A cross-sectional study. PLoS One 2014;9:e106935.
AlQuliti K. Predictors of painful diabetic neuropathy in Saudi Patients with type 2 diabetes: A case-control study. J Pain Relief 2015;4:181.
Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: A position statement by the American diabetes association. Diabetes Care 2017;40:136-54.
Şen HM, Şen H, Aşık M, Özkan A, Binnetoglu E, Erbağ G, et al. The importance of education in diabetic foot care of patients with diabetic neuropathy. Exp Clin Endocrinol Diabetes 2015;123:178-81.
Petropoulos IN, Javed S, Azmi S, Khan A, Ponirakis G, Malik RA. Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa (MENA) region: Much work needs to be done. J Taibah Univ Med Sci 2016;11:284-94.
Karahan AY, Kucuksarac S, Soran N, Ordahan B, Tekin L, Basaran A. Nurse's knowledge of neuropathic pain. Neurol Int 2014;6:5492.
El Sissi W, Arnaout A, Chaarani MW, Fouad M, El Assuity W, Zalzala M, et al. Prevalence of neuropathic pain among patients with chronic low-back pain in the Arabian Gulf Region assessed using the Leeds assessment of neuropathic symptoms and signs pain scale. J Int Med Res 2010;38:2135-45.
Hassan AE, Saleh HA, Baroudy YM, Abdul-Rahman KI, Najjar MW, Kazi MS, et al. Prevalence of neuropathic pain among patients suffering from chronic low back pain in Saudi Arabia. Saudi Med J 2004;25:1986-90.
Kaki AM, El-Yaski AZ, Youseif E. Identifying neuropathic pain among patients with chronic low-back pain: Use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Reg Anesth Pain Med 2005;30:422-8.
Hwang S, van Nooten F, Wells T, Ryan A, Crawford B, Evans C, et al. Neuropathic pain: A patient-centred approach to measuring outcomes. Health Expect 2018;21:774-86.
Devi R, Kanitkar K, Narendhar R, Sehmi K, Subramaniam K. A narrative review of the patient journey through the lens of non-communicable diseases in low- and middle-income countries. Adv Ther 2020;37:4808-30.
Bharatan T, Devi R, Huang PH, Javed A, Jeffers B, Lansberg P, et al. A methodology for mapping the patient journey for noncommunicable diseases in low- and middle-income countries. J Healthc Leadersh 2021;13:35-46.
Miake-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev 2016;5:28.
Snyder H. Literature review as a research methodology: An overview and guidelines. J Bus Res 2019;104:333-9.
Snilstveit B, Vojtkova M, Bhavsar A, Stevenson J, Gaarder M. Evidence and Gap Maps: A tool for promoting evidence informed policy and strategic research agendas. J Clin Epidemiol 2016;79:120-9.
Amir A. Anecdotal Evidence by Dr. Ashraf Amir (Neuropathic Pain MOH Guidelines Author & Chief Medical Officer of International Medical Center [MAYO Clinic Network], Jeddah).
Khader S. Anecdotal Evidence by Dr. Said Khader (Consultant Endocrinology, Sulaiman Al-Habib Hospital, Riyadh).
Ahmed AA, Algamdi SA, Alzahrani AM. Surveillance of risk factors for diabetic foot ulceration with particular concern to local practice. Diabetes Metab Syndr 2015;9:310-5.
Alramadan MJ, Magliano DJ, Alhamrani HA, Alramadan AJ, Alameer SM, Amin GM, et al. Lifestyle factors and macro- and micro-vascular complications among people with type 2 diabetes in Saudi Arabia. Diabetes Metab Syndr 2019;13:484-91.
Alaboud AF, Tourkmani AM, Alharbi TJ, Alobikan AH, Abdelhay O, Al Batal SM, et al. Microvascular and macrovascular complications of type 2 diabetic mellitus in Central, Kingdom of Saudi Arabia. Saudi Med J 2016;37:1408-11.
Madanat A, Sheshah E, Badawy El-B, Abbas A, Al-Bakheet A. Utilizing the Ipswich Touch Test to simplify screening methods for identifying the risk of foot ulceration among diabetics: The Saudi experience. Prim Care Diabetes 2015;9:304-6.
Qadi M, Al Zahrani H. Foot care knowledge and practice among diabetic patients attending primary health care centers in Jeddah City. J King Abdulaziz Univ Sci 2011;18:55-71.
Halawa MR, Karawagh A, Zeidan A, Mahmoud AE, Sakr M, Hegazy A. Prevalence of painful diabetic peripheral neuropathy among patients suffering from diabetes mellitus in Saudi Arabia. Curr Med Res Opin 2010;26:337-43.
Alhashim BN, Zaher A, Albujays DS, Alhashim J, Ali SI. Study of the level of awareness of diabetic neuropathy among diabetic patients in Al-Ahsa region, Kingdom of Saudi Arabia: A cross-sectional study. Int J Sci Study 2018;5:11-4.
Edison Silvia J, Ali LA. Awareness on risk factors for diabetic mellitus and diabetic peripheral neuropathy among the nationalities of Egypt and Saudi Arabia. Int J Med Sci Clin Invent 2017;4:3317-21.
Al-Rubeaan K, Al Derwish M, Ouizi S, Youssef AM, Subhani SN, Ibrahim HM, et al. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One 2015;10:e0124446.
Ahmed AA, Elsharief E, Alsharief A. The diabetic foot in the Arab world. J Diabet Foot Complicat 2011;3:55-61.
Cartwright N. What are randomised controlled trials good for? Philos Stud 2010;147:59-70.
Alkhier Ahmed A. Epidemioloqy of diabetes mellitus diabetic foot problems in Saudi Arabia. Av Diabetol 2010;26:29-35.
Alkhaldi TM, Al-Jumaili AA, Alnemer KA, Alharbi K, Al-Akeel ES, Alharbi MM, et al. Measuring the health literacy level of Arabic speaking population in Saudi Arabia using translated health literacy instruments. Pharm Pract (Granada) 2018;16:1223.
Bohlega S, Alsaadi T, Amir A, Hosny H, Karawagh AM, Moulin D, et al. Guidelines for the pharmacological treatment of peripheral neuropathic pain: Expert panel recommendations for the middle East region. J Int Med Res 2010;38:295-317.
Aizarani C, Amir AA, Benchouk Z, Abu Al-Samen MA, Farghaly M, Kandil A, et al. The dos and don'ts of painful diabetic peripheral neuropathy: Primary care guidelines for the Middle East and North Africa. Middle East J Fam Med 2017;15:4-18.
Al-Wahbi AM. Impact of a diabetic foot care education program on lower limb amputation rate. Vasc Health Risk Manag 2010;6:923-34.
Al Odhayani AA, Al Sayed Tayel S, Al-Madi F. Foot care practices of diabetic patients in Saudi Arabia. Saudi J Biol Sci 2017;24:1667-71.
FDA. The voice of the patient. Neuropathic pain associated with peripheral neuropathy. [Internet]. Available from: https://www.fda.gov/files/about fda/published/The-Voice-of-the-Patient--Neuropathic-Pain-Associated-with-Peripheral-Neuropathy.pd. [Last accessed on 2020 Aug 31].
Ministry of Health. Vision 2030. Kingdom of Saudi Arabia. MOH Publications. Available from: https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/Pages/Publications-2013-06-09-004.aspx. [Last accessed on 2020 Aug 31; Last updated on 2013 Jun 09].
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]
Amir AA
Khader SA
El Chami Z
Bahlas SM
Bakir M
Arifeen S


The Floral Spray Mist soothes and relaxes immediately. In the morning, it gently envigorates the skin. It is also ideal to get refreshed and revitalize the skin throughout the day. On the beach, it is perfect to moisturize the skin and refresh it in seconds. In the evening, it helps to remove the last traces of make-up.


This colorful solar system mobile is a stylish addition to any nursery and an excellent way to introduce older children to the planets.
Circle cutter, large circle cutter, bone folder, and permanent adhesive tape roller from Martha Stewart Crafts. 30-inch lighted star form available from noveltylights.com.
Divide each group of 12 circles into two stacks of six circles each and, using a bone folder, score and fold the top circle of each stack in half. With small binder clips, secure each stack together.
Fit sewing machine with a leather needle and thread with white thread. Set machine to a long, straight stitch and sew through center of each stack of circles, using fold on top circle as a guideline.
Tie off beginning and end threads by hand and trim with scissors. Using adhesive tape roller, attach corresponding stacks of six circles together to form stacks of 12. Fold top and bottom circle of each stack in half and, using adhesive tape roller, secure folds together, hiding the seam line. Fold and fan out all circles until each planet is as spherical as possible.
Wrap lighted star form with yellow seam binding, securing ends to form with fabric glue. Using snips or scissors, remove zip ties that secure strand of lights to metal form as you wrap. Be sure to wrap form completely, including the power cord.
Using fabric glue, attach a 30-inch length of seam binding to each of the five bends in the center of the star form and wrap around the bend a few times to firmly secure. Allow glue to dry completely.
To create mobile hanger, bring all five lengths of seam binding together about 20 inches above the center of the star form and tie in a knot, making sure the hanging form is level. With scissors, trim remaining ends of seam binding from knot.
To hang planets, first tie monofilament around the center seam of each planet, and then tie monofilament to one of the various bends or points of the star form. Length of monofilament should correspond with each planet's respective distance from the sun, with Mercury being closest to the form and Pluto being the farthest.
For the rings around Saturn, cut two of each of the following in the same color palette indicated in step 1 above: a 11-inch circle with an 8 1/2-inch circle cut from the center (1 1/4-inch ring); a 10 1/2-inch circle with a 9-inch circle cut from the center (3/4-inch ring); and a 10-inch circle with a 9 1/2-inch circle cut from the center (1/4-inch ring). With the adhesive tape roller, tape these rings together in the order that they were cut, making two sets of concentric rings.
Using adhesive tape roller, tape these two sets of rings wrong sides together, sandwiching four short pieces of monofilament between them. Tie these 4 pieces together at a point in the center of the ring, leaving about six inches of length for each. Trim the remaining ends of monofilament from center knot and hang rings over Saturn.
For the rings around Uranus, cut two 8-inch circles from white paper and cut a 7 1/2-inch circle out of the center of each. Using the adhesive tape roller, sandwich the two white rings together, securing them to the monofilament about 1/4 of an inch above Uranus.
Download and print out two copies of planet labels template on cardstock. Cut out each star with scissors, and using adhesive tape roller, sandwich each star label around monofilament, about 1/2 inch above each planet.
Plug in your mobile and enjoy.


text:
EDNS options
============

This example shows how to interact with EDNS options.

When querying unbound with the EDNS option ``65001`` and data ``0xc001`` we
expect an answer with the same EDNS option code and data ``0xdeadbeef``.

Key parts
~~~~~~~~~

This example relies on the following functionalities:

Registering EDNS options
------------------------

By registering EDNS options we can tune unbound's behavior when encountering a
query with a known EDNS option. The two available options are:

- ``bypass_cache_stage``: If set to ``True`` unbound will not try to answer
  from cache. Instead execution is passed to the modules
- ``no_aggregation``: If set to ``True`` unbound will consider this query
  unique and will not aggregate it with similar queries

Both values default to ``False``.

.. code-block:: python

    if not register_edns_option(env, 65001, bypass_cache_stage=True,
                                no_aggregation=True):
        log_info("python: Could not register EDNS option {}".format(65001))

EDNS option lists
-----------------

EDNS option lists can be found in the :class:`module_qstate` class. There are
four available lists in total:

- :class:`module_qstate.edns_opts_front_in`: options that came from the client
  side. **Should not** be changed
- :class:`module_qstate.edns_opts_back_out`: options that will be sent to the
  server side. Can be populated by edns literate modules
- :class:`module_qstate.edns_opts_back_in`: options that came from the server
  side. **Should not** be changed
- :class:`module_qstate.edns_opts_front_out`: options that will be sent to the
  client side. Can be populated by edns literate modules

Each list element has the following members:

- ``code``: the EDNS option code;
- ``data``: the EDNS option data.

Reading an EDNS option list
...........................

The lists' contents can be accessed in python by their ``_iter`` counterpart as
an iterator:

.. code-block:: python

    if not edns_opt_list_is_empty(qstate.edns_opts_front_in):
        for o in qstate.edns_opts_front_in_iter:
            log_info("python:    Code: {}, Data: '{}'".format(o.code,
                            "".join('{:02x}'.format(x) for x in o.data)))

Writing to an EDNS option list
..............................

By appending to an EDNS option list we can add new EDNS options. The new
element is going to be allocated in :class:`module_qstate.region`. The data
**must** be represented with a python ``bytearray``:

.. code-block:: python

    b = bytearray.fromhex("deadbeef")
    if not edns_opt_list_append(qstate.edns_opts_front_out,
                           o.code, b, qstate.region):
        log_info("python: Could not append EDNS option {}".format(o.code))

We can also remove an EDNS option code from an EDNS option list.

.. code-block:: python

    if not edns_opt_list_remove(edns_opt_list, code):
        log_info("python: Option code {} was not found in the "
                 "list.".format(code))

.. note:: All occurrences of the EDNS option code will be removed from the list:

Controlling other modules' cache behavior
-----------------------------------------

During the modules' operation, some modules may interact with the cache
(e.g., iterator). This behavior can be controlled by using the following
:class:`module_qstate` flags:

- :class:`module_qstate.no_cache_lookup`: Modules *operating after* this module
  will not lookup the cache for an answer
- :class:`module_qstate.no_cache_store`: Modules *operating after* this module
  will not store the response in the cache

Both values default to ``0``.

.. code-block:: python

    def operate(id, event, qstate, qdata):
        if (event == MODULE_EVENT_NEW) or (event == MODULE_EVENT_PASS):
            # Detect if edns option code 56001 is present from the client side. If
            # so turn on the flags for cache management.
            if not edns_opt_list_is_empty(qstate.edns_opts_front_in):
                log_info("python: searching for edns option code 65001 during NEW "
                        "or PASS event ")
                for o in qstate.edns_opts_front_in_iter:
                    if o.code == 65001:
                        log_info("python: found edns option code 65001")
                        # Instruct other modules to not lookup for an
                        # answer in the cache.
                        qstate.no_cache_lookup = 1
                        log_info("python: enabled no_cache_lookup")

                        # Instruct other modules to not store the answer in
                        # the cache.
                        qstate.no_cache_store = 1
                        log_info("python: enabled no_cache_store")

Testing
~~~~~~~

Run the Unbound server: ::

    root@localhost$ unbound -dv -c ./test-edns.conf

In case you use your own configuration file, don't forget to enable the Python
module::

    module-config: "validator python iterator"

and use a valid script path::

    python-script: "./examples/edns.py"

Querying with EDNS option ``65001:0xc001``:

::

    root@localhost$ dig @localhost nlnetlabs.nl +ednsopt=65001:c001

    ; <<>> DiG 9.10.3-P4-Ubuntu <<>> @localhost nlnetlabs.nl +ednsopt=65001:c001
    ; (1 server found)
    ;; global options: +cmd
    ;; Got answer:
    ;; ->>HEADER<<- opcode: QUERY, status: NOERROR, id: 33450
    ;; flags: qr rd ra ad; QUERY: 1, ANSWER: 1, AUTHORITY: 4, ADDITIONAL: 3

    ;; OPT PSEUDOSECTION:
    ; EDNS: version: 0, flags:; udp: 4096
    ; OPT=65001: de ad be ef ("....")
    ;; QUESTION SECTION:
    ;nlnetlabs.nl.                  IN      A

    ;; ANSWER SECTION:
    nlnetlabs.nl.           10200   IN      A       185.49.140.10

    ;; AUTHORITY SECTION:
    nlnetlabs.nl.           10200   IN      NS      anyns.pch.net.
    nlnetlabs.nl.           10200   IN      NS      ns.nlnetlabs.nl.
    nlnetlabs.nl.           10200   IN      NS      ns-ext1.sidn.nl.
    nlnetlabs.nl.           10200   IN      NS      sec2.authdns.ripe.net.

    ;; ADDITIONAL SECTION:
    ns.nlnetlabs.nl.        10200   IN      AAAA    2a04:b900::8:0:0:60
    ns.nlnetlabs.nl.        10200   IN      A       185.49.140.60

    ;; Query time: 10 msec
    ;; SERVER: 127.0.0.1#53(127.0.0.1)
    ;; WHEN: Mon Dec 05 14:50:56 CET 2016
    ;; MSG SIZE  rcvd: 212

Complete source code
~~~~~~~~~~~~~~~~~~~~

.. literalinclude:: ../../examples/edns.py
    :language: python

redpajama_set_name: RedPajamaGithub


Talk to an Irish psychic now on the phone where you can see what's on your cards and have your questions answered.
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You can submit your question for the cards online and an Irish psychic will do your reading on by email.
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See what's on your cards for the week ahead with exciting horoscope fortune readings sent by text and email.
Free and instant Tarot readings with Irish Tarot's highly sophisticated digital online reading system.
David O'Reilly launched Irish Tarot in 2001 having been reading Tarot cards for all his life and as a computer science student at Trinity College Dublin he was able to launch something unique and different and was the first and only Internet Tarot service in the world as well as Ireland.
Irish Tarot is given it's own radio programme on Dublin's Country Mix 106.8fm (now Dublin's Sunshine Radio). The JNLR Listenership figures prove it to be the most listened to show on Sunday nights on Irish radio even beating RTE Radio One. RTE TV later feature Irish Tarot and the service quickly gains media attention in the UK on Take a Break magazine.
Irish Tarot launches new text and telephone services and features on TV3 (Now Virgin Media One TV) and new readers join. We are quickly the number one Tarot service in Ireland and making use of new technology move into mobile services in Ireland and the UK. The radio show continues to grow.
Other Tarot services try copying Irish Tarot but quickly close, especially on TV and Internet however Irish Tarot continues to expand and provide the best possible service to callers by adding new mobile and web services and online status of readers alerts, online calling called ClickCall and lots more ensuring that Irish Tarot provides the best possible service.
Irish Tarot releases new services and website designed for mobile and tablet computers. When we began all users used dial up slow modems to connect to the interent and we were limited by the technology of what services we could offer. Today we have live interent chat readings, live phone voice over IP readings via the internet on WhatsApp, FaceTime and of course the POTS telephone network. The future keeps expanding and Irish Tarot is still Ireland's number one Tarot service.
Will I ever find my soul mate?


Michael Dawida brings vision and leadership to Scenic Pittsburgh, along with more than 30 years of public service experience as a legislator, lawyer and teacher. As a Pennsylvania State Senator and Representative from 1979 to 1996, Mr. Dawida championed and passed many legislative firsts including the Pennsylvania Clean Indoor Air Act, the Pennsylvania Food Donor Act and the Pennsylvania Organ Donation Act. In 1996, Mr. Dawida was elected to the Allegheny County Board of Commissioners where, as Chairman, he overhauled the County Pension System, founded the Airport Authority, and created the Allegheny County 911 System. He also orchestrated several billion dollars of development projects that include the Heinz Stadium, PNC Park, David Lawrence Convention Center, and the "Waterfront" in Homestead. In addition to his role as Executive Director of Scenic Pittsburgh, Mr. Dawida is a professor of Law and Public Policy at California University of Pennsylvania. He is a graduate of the University of Pittsburgh and the Hamline University School of Law.
Dave Demko contributes technical experience, an understanding of the private sector and a passion for the community to Scenic Pittsburgh's mission. He has more than 25 years experience in engineering research, and software and network development for both the private and public sectors. Mr. Demko is now a resident of the Central North Side neighborhood of Pittsburgh. He holds a B.A. in Economics from the University of Pittsburgh, a M.S. in Business Administration from California University of Pennsylvania, and is a Chubb Institute Fellow.


text:
> Blog> Opal Gemstone
Noncrystalline hydrous siliCOn dioxide. Opal has the same chemical composition as quartz, but contains from 1 to 2 percent water, and is not crystallized. it has a certain type of regular structure, but noi at the atomic level. being composed of alignments of tiny spheres (from 40 to 4000 it in diameter) which form a compact, three-dimensional network. The name opal is apparently derived, through the Greek opéllios, from the Sanskrit upaia, meaning "precious stone."
Crystal system Noncrystalline.
Appearance It occurs as narrow veins of up to 10 centimeters or more, or as nodules, inside cavities or cracks in silica-rich rocks. It may also be found pseudomorphous alter other minerals. It may have a whitish to light gray. pale green, sky-blue, smoke gray, black, yellowish to orange or reddish background color. It can be semiopaque, with a vaguely porcelainlike appearance. or similar to broken glass, with shiny, conchoidal fracture. It is more often translucent and milky, with an appearance that is so characteristic, it is described as opalescent. Opals can even befully or largely transparent: such stones are usually orange-yellow to red in color. The most highly prized varieties display internal iridescence due to light diffraction by the network of tiny spheres of which they are composed. These types are collectiveiy known as noble opal or precious opal. The range of colors apparently depends on the size of the spheres, or rather, the distance between the
rows.
In gem quality precious opal, three sets of distinctions are made. The first, according to the ground color of the material, distinguishes light or white opal from dark or black opal? The second, applied to each of these two varieties. is based on the range of colors in the iridescent patches; and the third is based on the size, shape, and distribution of the patches. The transparent or semitransparent, noniridescent variety (known as common opal) is also used as a gem if it is attractively colored. Because of its orange-yellow to reddish orange color, it is known as fire opal.
Physical properties Opal has a hardness of 5.5 to 6.5 and very low density; from about 1.98 to 2.20 g/cma, depending on the water content. The refractive index-varies from 1.44 to 1.46 or a little more. It is singly refractive. it may be somewhat porous, in which case it is dangerous to immerse it in liquids other than water.
Genesis Opal is normally found in assocation with effusive magmatic rocks, such as rhyolites, andesites, and trachytes, having been deposited in cracks and cavities by aqueous fluids at low temperature. In Australia, it is found both in connection with trachytes and basalts. and in siliceous sandstone where hydrous silica has been precipitated, perhaps through alteration of feldspars by percolating waters in an environment subiected to very long periods of staple water conditions.
Occurrence One area of eastern Czechoslovakia formerly belonging to Hungary has been mining opal since Roman times and was the only source of noble opal for Europeans until the nineteenth century. Nowadays, most opal comes from Australia, where the finest quality opals are found. Other sources are Mexico and, to a lesser extent, Guatemala and Honduras. Low—value or subgem quality varieties of opal are found in many other places, especially the United States (xyloid opal or petrified wood) and iceland {where it is deposited by hot springs).
GIA Certified 0.61 ct Natural Fancy Intense Yellow Diamond
Diamond is a powerful love stone. It...


text:
» Boiling Water
Winemaking Circles
Mon, 08 Jul 2019	| Boiling Water
WINEMAKING as an "organised" hobby is a comparatively new thing, although wines have been made in these islands for centuries in the cottages of country folk. It was only in 1953 that the first "Winemakers' Circle" was formed at Andover, closely followed —quite independently and spontaneously—by others at Welwyn Garden City and Cheltenham.
In the few years since, however, the idea has spread with astounding speed, and by 1968 there were well over 400 such clubs, scattered the length and breadth of the British Isles, and even in Canada; most of them following the original idea and calling themselves "Circles," some of them adopting the style of "Guilds," and yet others calling themselves "Societies" or "Associations." The publication of the monthly magazine, The Amateur Winemaker, from 1958 onwards has done much to consolidate the movement and publicise the aims of the Circles.
All of them have the same fundamental objective—the improvement of the standard of country wines—and all of them notably have the same characteristic, a striking friendliness and informality. The Circles are real centres of friendship and good fellowship, as well as a means of instruction.
By buying apparatus and sometimes ingredients in bulk they are able to obtain discounts from many firms and thus can offer their members these goods at favourable rates.
Practical winemaking is learnt pleasantly and in a sociable atmosphere by means of talks, demonstrations, quizzes, and competitions, and nowadays there are also inter-club contests. Members learn not only how to make wine, but how to exhibit and judge it.
On the social side, there are usually Christmas or New Year parties, dinners, dances, outings to breweries, sugar refineries, glassworks, potteries, wine lodges, vineyards, and other places of interest to the winemaker.
All in all, members find that joining a Winemakers' Circle is definitely worth while, and anyone interested in the subject would be well advised to contact the nearest one, if they are lucky enough to have one in their area.
The list is now too long to be reproduced here, but if you wish to know your nearest Circle drop a postcard to: The Editor, The Amateur Winemaker, North Croye, The Avenue, Andover, Hants, who can also advise on how to set about starting a Circle if none exists in your locality.
The first National Conference and Show—quite a small affair—was held at Andover in 1959, and others have followed at Bournemouth, Brighton, Harrow, Cheltenham, Clacton, Harrogate, Bognor and Torquay, and "the National" has now developed into a mammoth competitive wine show which can attract as many as 3,000 entries. It is allied to a week-end of lectures, discussions and merrymaking which is the big event of the year for keen winemakers and visitors even come from abroad —Germany, Denmark and Canada, for instance.
The show has now grown into the National Association of Amateur Winemakers, which any Circle can join upon payment of a £2/2/- annual subscription. Individuals can join for an annual subscription of £1/1/-. The general secretary is Wing Cdr. R. W. Woodley, of Burnside, Chalkpit Lane, Monxton, nr. Andover, Hants, and the membership secretary Mr. K. Hill, 18 Laxton Road, Hunts Cross, Liverpool 25.
The National Conference and Show led in turn to the formation in 1964 of the Amateur Winemakers National Guild of Judges which set itself the task of getting down on paper a system of wine judging, notes for the guidance of show organisers, judges, and judges' stewards, and specimen schedules which clubs or organisations could adopt for their wine competitions.
A tremendous amount of ground work was done on this, and embodied in the handbook which the Guild eventually published, "Judging Home-made Wine" (3/-, from the "Amateur Winemaker," North Croye, The Avenue, Andover).
The hydrometer - Boiling Water
The vinegar fly - Boiling Water
Winemaking - Boiling Water
In quantity - Boiling Water
The fermentation trap - Boiling Water
Home Winemaking - Making wine at home, The Home Winemakers Manual


text:
Q: Queries Range Sum of Minimum of all Subarrays Given an array $a_1, a_2, ..., a_n$ and $Q$ queries, each includes 2 integers $u < v$. For each query, you must calculate $\sum\limits_{u \leq l \leq r \leq v}{min(a_l, a_{l+1}, ..., a_r)}$.
As $n = 10^5$, I want to find an solution in $O(n \log n)$ or $O(n \sqrt{n})$ or less.
But I have no efficient approach for this problem.
If $Q = 1, u = 1, v = n$. For each $i$ from $1$ to $n$, call $i_1$ be the largest integer less than $i$ and $a_{i_1} > a_i$ and $i_2$ be the smallest integer greater than $i$ and $a_{i_2} > a_i$. (To find $i_1, i_2$, we use stacks)
So the answer is  $\sum\limits_{i=1}^{n}{a_i \times (i-i_1+1)\times (i-i_2+1)}$
But if $Q > 1$ we will need so many stacks.
Is there any efficient solution to this problem?

A: I believe this is not the right place to ask this question, try one of the competitive programming sites, as for your problem you are nearly there, try to think about what happens to the contribution of each index when you set a bound (u, v), there are four situations that arise from $u \leq i_1$ and $i_2 \leq v$, you will probably need a data strucutre to speed up your algorithm (e.g. a segment tree, or persistent segment tree)
PS: I hope this question is not from an ongoing competition.

redpajama_set_name: RedPajamaStackExchange


text:
Shepham wind farm gets the go ahead on appeal
Campaign posters against the Shepham wind farm ENGSUS00120120530121605
Published: 12:00 Wednesday 14 January 2015
Shepham wind farm has been given the green light following a planning appeal.
A planning inspector overturned Wealden District Council's decision to refuse the scheme and gave permission for three turbines, each 115 metres high, to be erected on land just off Shepham Lane.
The applicant, Regeneco Ltd, originally applied to Wealden to erect five wind turbines back in 2012 but withdrew its application at the eleventh hour before submitting a revised application for three turbines.
Residents in the area raised concerns about noise and said the turbines would be seen from miles around.
Wealden District Council turned the application down in February 2013.
Some local residents were celebrating but a spokesperson said the developer was 'bitterly disappointed', especially as the council officer had recommended it for approval.
Regeneco appealed against the decision made by Wealden's planning committee and on January 7, planning inspector Jessica Graham overturned the refusal.
In her report she said, "The proposed development would supply renewable electricity generation of up to 7.5 MW of installed capacity, sufficient to power up to 4,000 homes,and would achieve an annual saving of up to 8,475 tonnes of carbon.
"This would make a material contribution to the attainment of the national renewable energy policy objectives set out above; it would help to improve the security of the energy supply through diversifying the range of resources,would have direct and indirect economic benefits, and would reduce carbon dioxide and greenhouse gas emissions, thereby helping to mitigate climate change.
"These are substantial benefits which carry a great deal of weight."
Andrew Durling from the Yes to Polegate Wind Farm group said, "We welcome this green light for the Shepham Wind Farm.
"It is great news that Sussex will be hosting much more production of energy from a renewable source.
"We have consistently supported the wind farm, because we need to play our part in the clean energy revolution that will help to keep the lights on.
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"The Inspector's decision to grant approval shows that our arguments in favour of the project were valid."
Brenda Pollack, from Friends of the Earth, said, "Evidence shows that wind energy is a vote winner and many local people see the need for a renewable future."