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Home » Government » PEC » PEC changes voting system for director elections
PEC changes voting system for director elections
PEC directors Cristi Clements, James Oakley and Jim Powers.
CONNIE SWINNEY • STAFF WRITER
JOHNSON CITY — Members of the Pedernales Electric Cooperative elect directors differently after the board approved a resolution to switch from an at-large system to a single-member district one, officials say.
On Aug. 15, directors voted 5-2 to make the change during their regular board meeting.
Historically, director candidates would petition within a district or single geographic location where they resided; however, he or she would seek votes in all seven districts to win elections.
Now, candidates would reside in as well as seek votes from within their designated districts.
The move countered the outcome of non-binding referendums during elections in 2011 and 2014, when members approved PEC maintaining the at-large system.
"There were two referendums. They were legitimate referendums. Before we held those, there were town hall meetings and public events. There was a lot of member opportunity to voice their preferences," said District 1 Director Cristi Clements, who favored the at-large system. "They were an indicator of the sentiment of what kind of governance (members) preferred."
After the 2014 election, the state legislature entered the debate, offering up House Bills 5431 and 3391 to recommend the single-member district voting system as well; however, the legislation did not gain traction.
"It's more consistent with how local governments are run, and I understand PEC is not government. I get that completely," said James Oakley, District 5 director and board vice president. He supported the move to single-member system. "However, there's lots of things that can be applied to that large organization that have proven themselves to be equitable in society."
Oakley contends that the ballot language during the last referendum and advocacy from a board member unfairly swayed voters, while Clements believes the new system would shield directors from criticism outside their geographic districts.
"Every member ought to have equal weight. They should have the right to recall, disapprove or remove any member on the dais, not just one," she said. "That has to do with member empowerment."
The next election is scheduled for June 2017 when members will vote for candidates in Districts 3 and 7.
District 4 Director Jim Powers, who supported single-member districts, said in a statement, "We are all concerned about the cooperative as a whole, but I think it's important that we carry the water for the place we live."
connie@thepicayune.com
Tags: government, PEC
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1 thought on "PEC changes voting system for director elections"
PEC Member says:
This is a good decision by the PEC board and will help both bring individual district directors to local voter accountability and responsiveness of individual directors to local constituents. It is the beginning of the end of the "faux" democracy at PEC and will also remove a huge point of historic contention between the Texas Legislature and PEC, as well as save real money for the cooperative and its members.
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« Explaining the basics – Why Microsoft & Office 2007 don't get it.
I just started entering data into my brand new installation of Outlook 2007 with Business Contact Manager.
On the very first business contact, however, I have encountered a pretty obnoxious bit of assumptions by Microsoft.
Specifically after I entered a phone number into the new contact record, a dialog popped up called "Location Information".
In this dialog Outlook is asking that I enter what country I am in, what my area or city code is, what carrier code I would need, and what number I would need to dial an outside number. I.E. the assumption here is that I would, of course, have this machine connected to a phone line and somehow want it to be dialing phone numbers for me.
Now, if this was possible to configure to use Skype, I might, in fact, think about doing that (some of the time).
But I am almost always mobile with this machine (it is a tablet PC after all, I bought it for use on the road).
I will probably NEVER use this machine, at least via Outlook, to initialize a call. Wouldn't even think about it in fact.
Windows needs telephone information about the location from which you will be dialing. If you cancel without providing this information, this program may not function correctly when dialing. In addition, some applications respond to your canceling this dialog box by immediately re-posting it.
When/where did I indicate that I would want my tablet dialing out? From this message it appears to be baked into Vista, not just Office 2007 (or else it is a case of really poor error messages – "some applications" in place of the actual application generating this message.
I don't know what I can do to get past this. I really don't want my laptop thinking it will be dialing phones. All I want to do is enter data, lots of it, as fast as possible.
I literally have a stack of about 1000 business cards which I want to sort and enter this weekend. The contacts I have made in the past year, most of whom I want to follow up with, and most of whom I have neglected to enter fully into my address lists.
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I have experienced the same error and I wish that I could find a resolution. Major bug in Outlook 2007.
This is really annoying problem, i too encountered it and searched online for any information. As said above, "filling up an area code" looks like the only solution to yet another stunning microsoft + outlook venture! 😦 :angry: Why do they need my location??
holy crap. I cannot believe you people are so up in arms over this. You are prompted for this info once and that is the end of it. Outlook uses this info to help you when filling out your contact cards, thereby correctly formatting the numbers for your region. IE, if you are in North America, +1 (123) 456-7890, versus in Europe where numbers are longer and formatted totally differently.
Try having a global view…….
And as I noted the other major issue here is that MSFT's error messages are horrible! It is unclear if this message is from Vista (as I suspect) or from Office – and in either case this type of behavior by any tool I'm using is just unacceptable.
Fundamentally I should be able to use a tool BEFORE I have to make decisions which have unknown to me when I make them implications as to how that tool will function in the future. I simply wanted to open the application and do a very basic task (add data) – I did not want to set some preference which would modify how my tool worked and which I would not know how to adjust in the future.
I stand by my original post – Vista & Office 2007 are horrible, awful, terrible products – poorly designed, not well tested, with badly written error messages, poor UI, and in short are steps backwards from earlier and more productive (and consistent) applications.
It is datamining at it finest and there is absolutely no reason to require this information. Still researching the regisistry to HACK this crap out. Don't use a modem, never again will. I want to format my information the way I want the data. "Wow, You Guys Are Stupid" is ignorant of data manipulation.
I agree with Shannonclark. I had a lot of contacts from older versions of Outllok, filled the dialog box once, and now everytime I open one of them, they get the dialing info. Then, I sink it with my Blackberry, and the phone doesn't know what to do with them and won't dial, so I have to edit each phone to remove the freaking dialing info.. very anoying.
So, did anyone actually find a solution or this thread just for group suport ?
Ditto for me to… I have data coming from my client database into outlook thats all fine and links well…. but when i connect my mobile phone outlook insists on putting the international dial numbers so my phone does not know what it is and cant recognise incoming calls.
Well, I just got POS Office 07 on a new computer at work, having resisted the upgrade for years, for precisely reasons like this.
How hard is it, if you make a cancel button available to the user, to make it cancel? And I'm an IT professional, and don't appreciate a software vendor making me fill in info I'll never, ever use. It's a matter of principle for me.
If you don't understand why IT professionals get upset over stuff like that, then you're not an IT professional yourself, or you need to get out more.
1. I'll waste time getting around stupid features like this, including using the web interface to add contacts.
2. I'll also stall on MS Office upgrades as long as possible with as many users as possible, because each upgrade has a new "I'm from the government and I'm here to help" feature.
and I agree with Scott – I spend a long time suppressing this kind of intrusion on my computer.
I agree 100% with shannonclark. Microsoft must have an "Assumptions" Department. Every product they produce comes with settings based on what someone there thinks I would want. However, this is a bug in Outlook. When I enter a phone number in a Contact, I get stuck in an endless loop. I should be able to cancel the entry of the phone number. I'm never going to dial any phone number from this computer.
I thank everyone for their input to this issue. Also when I entered the location/dialing information for one contact, a prompt appeared asking if this is my default location. I answered yes and I'm no longer prompted for location information per contact.
SET YOUR DEFAULT LOCATION IN OUTLOOK ONCE AND YOU WILL NOT BE PROMPTED PER CONTACT.
The point of my post is that setting my default location/dialing info is senseless, pointless information and I shouldn't have to enter it even just once to use my applications.
2. I do NOT have a "default" location – did I mention I have a laptop – the whole point of having a laptop is that I am mobile, usually working from a different location every day. I don't have a default phone – and in any case WHAT DOES IT MATTER TO OUTLOOK?
– I do not say "because you sync Outlook to your cellphone"…. My cell phone isn't part of my phone network – it is part of a wireless carrier's network and whatever dialing code my office might have (if I had an office with such a phone system in the first place) my cell phone isn't part of it.
This is a case of Microsoft ignoring reality for the momentum of legacy apps – though truthfully I have no clue why or when such a code would have ever been useful to the vast majority of computer users (I've never once had a computer which was always connected to a phone or which I ever used to dial regular voice calls). If I needed to today I might use Skype – but mostly I use that only for Skype-to-Skype conversations.
Outlook 2007 Contacts can be used to call a contact when digital phone system software is installed on the PC, such as Shoretel.
But the chance that I will EVER use my computer to make phone calls via such a system is less than ZERO. I have no interest and can foresee no instance when I would ever consider installing or using such software or connecting my tablet laptop to such a phone system. ZERO. So why should I have to do anything related to such a low probability case?
For that matter in over 20+ years of using computers & maintaining computers for myself, my companies and for countless clients I have never once seen such as system in place at any client I have worked at or any company I have owned or supported. Not once. And this includes some of the very largest firms in the world.
Worse yet … when I try to satisfy it by entering the information, the COuntry pull-down list is blank and it won't accept a blank Country. Something seriously screwed up with Win 7 and Outlook 2007.
i work in Dubai, and I call internationally about 50% of the time. I use four different devices depending on my location and situation. This BUG is a big PITA. I need it to just accept the number as I enter it, and stop asking me for information. For the idiot "Wow," I'm very glad you live in a glass bubble where everything is candy canes and apple pie, but out here in the real world, time is money and default options don't work always for each person in the default way. Taking time to click THREE TIMES telling the machine "no," is a large waste of time and effort. Plus the fact I have to remove my hands from the keyboard to use the mouse wastes additional time. if I change the option for my location, Windows/Outlook adds numbers or removes numbers from the telephone number making the information INCORRECT for one or more of the situations I'll need the number for.
I fully agree that MS is set up for idiots and people who know something about computers are constantly burdened defeating all of the MS stuff that interferes with using the computer efficiently.
If you don't use the modem at all, you can resolve this pop-up request by stopping the Telephony service and setting the value to Disabled. This is easily done if User Account Control has been disabled first. Otherwise, to stop the Telephony service, you need to set the Startup Type for the Telephony service to Disabled, and then reboot the workstation. Windows will no longer need a home area code then.
Like the mess MS has made of skype. They even make a mess of Office 2007.


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Home US News San Diego: U.S Navy helicopter crashes in the sea – 5 reported...
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San Diego: U.S Navy helicopter crashes in the sea – 5 reported missing
A U.S Navy helicopter crashed into the sea near the coastal area of San Diego resulting in five persons missing, one was rescued.
According to the military officials, the cause of the unfortunate crash is still unknown.
The Navy's Third fleet released an official statement saying "the helicopter crashed into the sea at 4:30 pm local time while it was conducting routine flight operations about 60 nautical miles off the coast". It was carrying six people; one sailor was rescued whereas the other 5 are still unaccounted for.
The initial reports suggested that the military Seahawk helicopter took off from the USS Abraham Lincoln for its routine operation but crashed a few moments later into the sea. A search and rescue operation was instigated immediately after the unfortunate crash.
The helicopter crashed is identified as MH-60S which has been in naval use since the year 2002. The helicopter which weighed 14,000 pounds had a huge range of over 245 nautical miles and was able to exceed the speed of almost 180 knots. There are approximately 250 MH-60S helicopters in use by the U.S. Navy at the moment.
According to the naval technology website, the MH-60S helicopters are registered as prime carriers to be used for a variety of purposes such as "vertical replenishment, combat search, and rescue special airfare support and airborne mine countermeasures." The naval technology website is very helpful in giving in-depth detail about different military equipment in use.
The MH-60S Seahawk helicopter is also repeatedly used for special missions like humanitarian disaster relief, combat support, and extreme measures of search and rescue operations.
The particular helicopter was assigned to the USS Abraham Lincoln firm. It is a Nimitz- class company which is an aircraft carrier in general. The company is based in San Diego.
The USS Abraham Lincoln released an official statement on their Facebook page condemning the accident and calling the crash an unfortunate "tragedy".
The Navy also stated that "search and rescue operations are ongoing with multiple Coast Guard and Navy air and surface assets."
The Naval Air Command stated that the search efforts are going on to find the missing individuals. As per the reports, the helicopter was in this routine flight operation which was supposed to be held 60 nautical miles away from the coast of San Diego.
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Home GW Celebrates Solar Energy Milestone
GW Celebrates Solar Energy Milestone
The university marked the one-year anniversary of full operation of the Capital Partners Solar Project.
GW President Steven Knapp talked Tuesday about the university's Capital Partners Solar Project and being a leader in urban sustainability. He also announced a student design contest for a solar charging station on Kogan Plaza. (Logan Werlinger/GW Today)
The George Washington University celebrated on Tuesday the one-year anniversary of full operation of the Capital Partners Solar Project, a renewable energy project that has made GW 50 percent solar-powered.
The project with Duke Energy Renewables—a partnership among GW, American University and GW Hospital—is seen as a major accomplishment not only in reducing the university's carbon footprint but also as serving as an example for others, positioning GW as a leader in urban sustainability.
"It really is a model for what universities and other institutions can do together to build capacity for alternative energy," George Washington President Steven Knapp said in remarks at an event in District House, which recently received a LEED Gold certification recognizing the building's "green" construction.
Dr. Knapp also announced Tuesday that the university is launching "Charged Up," a competition for a student team to win the ability to design a solar charging station for small electronics on Kogan Plaza. The deadline to apply is April 3. Winners will be announced the week of April 17 and will be awarded funding, up to $10,000 for material and labor, to construct their design.
It took several years for GW and its partners to get the complex Capital Partners Solar Project up and running, said Meghan Chapple, director of the Office of Sustainability, and the participation of all the partners was "absolutely essential."
The resulting agreement means that to generate renewable energy, the 243,000 solar panels on three sites in North Carolina absorb and convert energy from the sun to electricity, which is then transmitted through the power grid. GW and partners are able to use renewable energy from the grid for electrical power needs.
The solar power helps all three institutions reduce their carbon footprint, eliminating approximately 60,000 metric tons of carbon dioxide per year compared to conventional electricity. This is equivalent to taking roughly 12,500 cars off the road. In addition, the project offers economic savings for each institution, as the price of traditional power is expected to increase over the duration of the project.
The Capital Partners Solar Project also gives students and faculty the opportunity to see how solar power works and analyze data from the project.
Nicholas Batista, B.S. '13, a graduate student in mechanical and aerospace engineering at GW, visited one of the solar sites in North Carolina.
"It was a unique opportunity to witness utility-scale solar firsthand," said Mr. Batista, whose master's thesis is on the technical and economic factors related to solar power generation.
These "living labs" are another rewarding aspect of the partnership, said Kathleen Merrigan, executive director of sustainability, and they help address "how do we, as citizen leaders in the community of GW, use our facilities, our daily lives, to help us learn and move the planet forward."
In a separate agreement with the university, Duke Energy Renewables has provided funding for the Duke Energy Renewables Innovation Fund Awards, a multi-year research grant program for energy research for faculty and researchers. Some interdisciplinary teams have already received funding. The university expects to announce additional projects that will be funded by these awards in April, Dr. Merrigan said.
Meet the Inaugural Duke Energy Renewables Innovation Fund Awardees
Three teams of faculty will lead undergraduate and graduate students in cross-disciplinary, sustainability research projects.
Capital Partners Solar Project Delivers Energy to University
Tour of North Carolina solar farm spotlights GW's clean energy strategy at work.
Capital Partners Leading the Way for Cheaper, Cleaner Energy
Letter from President Knapp, leaders of American University and George Washington University Hospital outlines how the agreement to bring solar energy to their institutions could be
Capital Partners Agreement Is Future of Solar for Universities
President Knapp discusses the university's renewable energy efforts at "Climate Leadership" summit.
University Announces Capital Partners Solar Project
GW, American University and the George Washington University Hospital will harness solar power to meet energy needs.


onghorn range and from July to October in southern parts of their range.
Kandace Krejci (author), University of Alaska Fairbanks, Tanya Dewey (author, editor), Animal Diversity Web, Link E. Olson (editor, instructor), University of Alaska Fairbanks.
Anderson, S. 2002. Managing Our Wildlife Resources Fourth Edition. Upper Saddle River, New Jersey: Prentice Hall.
Austin, D., P. Urness. 1995. "Wild Ungulate Depredation on Winter Wheat: Effects on Wheat Yield" (On-line). Accessed December 10, 2008 at http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1421&context=gpwdcwp.
Bleich, V., J. Kie, E. Loft, T. Stephenson, M. Oehler, Sr., A. Medina. 2005. Managing Rangeland for Wildlife. Pp. 873=897 in C Braun, ed. Techniques for Wildlife Investigations and Management. Bethesda, Maryland: The Wildlife Society.
Buechner, H. 1950. Life History, Ecology, and Range Use of the Pronghorn Antelope in Trans-Pecos Texas. American Midland Naturalist, Vol. 43, No. 2: 257-354.
Feldhamer, G., L. Drickamer, S. Vessey, J. Merritt. 2004. Mammology: Adaptation, Diversity, and Ecology Second Edition. New York, NY: McGraw Hill Companies.
Feldhamer, G., D. Drickamer, S. Vessey, J. Merritt, C. Krajewski. 2007. Mammology: Adaptation, Diversity, and Ecology Third Edition. Baltimore, MD: Johns Hopkins University Press.
Hays, W. 1868. The Prong-Horn Antelope. The American Naturalist, Vol. 2, No. 3: 131-133.
Hildebrand, M., G. Goslow. 2001. Analysis of Vertebrate Structure Fifth Edition. New York, NY: John Wiley & Sons, Inc..
Hill, R., G. Wyse, M. Anderson. 2004. Animal Physiology. Sunderland, MA: Sinauer Associates, Inc..
Hoberg, E., A. Abrams. 2005. Pseudostertagia bullosa (Nematoda: Trichostrongyloidea) in Artiodactyl Hosts from North America: Redescription and Comments on Systematics.. Journal of Parasitology, 91: 382-389. Accessed January 28, 2009 at http://www.ars.usda.gov/research/publications/publications.htm?SEQ_NO_115=164125.
Howard, J. 1995. "Antilocapra americana. In: Fire Effects Information System" (On-line). Accessed November 30, 2008 at http://www.fs.fed.us/database/feis/.
IUCN, 2008. "2008 IUCN Red List of Threatened Species" (On-line). Accessed December 10, 2008 at http://www.iucnredlist.org/search.
North Dakota Game and Fish Department, 2006. "Pronghorn Management Guide" (On-line). North Dakota Game and Fish Department. Accessed January 28, 2009 at http://gf.nd.gov/multimedia/pubs/prong-mgmt-guide-pt1.html.
O'Gara, B. 1978. Antilocapra americana. Mammalian Species, 90: 1-7.
Schroeder, M., L. Robb. 2005. Criteria for Gender and Age. Pp. 303-338 in C Braun, ed. Techniques for Wildlife Investigations and Management. Bethesda, Maryland: The Wildlife Society.
Simmons, H., D. Steffen, D. Armstrong, D. Rogers. 2002. Parelaphostrongylus tenuis in captive pronghorn (Antilocapra americana) in Nebraska. Journal of Wildlife Disease, 38: 822-825. Accessed January 28, 2009 at www.jwildlifedis.org/cgi/reprint/38/4/822.pdf.
Stocker, G. 1985. "Antilocapra americana" (On-line). Accessed December 10, 2008 at http://www.cites.org/eng/resources/ID/fauna/Volume1/A-119.008.001.001%20Antilocapra%20americana_E.pdf.
Williston, S. 1877. The American Antelope. The American Naturalist, Vol. 11 No. 10: 599-603.


Sq. Ft.:2,034 to 3,389Sq. Ft.
Pinellas Point Woodlands is a neighborhood in St Petersburg, Florida. The most common type of home in this community is single-family home, and the majority are traditional and ranch style, and they were built between 1987 and 2000. Homes in Pinellas Point Woodlands are 2,600 square feet on average and typically have three bedrooms and two bathrooms. Homes in this neighborhood typically sit on quarter-acre lots. The most common type of parking in the community is garage, and homes in Pinellas Point Woodlands typically have two spaces.
How would you rate Pinellas Point Woodlands?
Within the last year, homes were sold at prices around $310,000. After an average of 106 days on the market, homes were typically purchased at 96% of asking price. Homes in this community average $123 per square foot, and owners pay $3,703 in taxes on average. Homes have an average HOA fee of $2 monthly.


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Q: Transform properties from JSON array into comma-separated string I have a string column in an SQL-Server table on Azure which contains the following data:
 {
        "status": "success",
        "data": [
            {
                "name": "Jane",
                "type": 0
            },
            {
                "name": "John",
                "type": 0
            }
        ]
    }

How can it be transformed into a comma-separated string containing "Jane, John"?

A: Here how to achieve this via a snippet of some of my older code, you should be able to loop through the table and do this for each row. There may be a quicker way of doing it but this will work.
DECLARE @JSON NVARCHAR(200) = '{"status": "success", "data": [{"name": "Jane", "type": 0},{"name": "John", "type": 0}]}',
    @result nvarchar(max) = ''

SELECT @result = @result + [value] + N', '
FROM (
    SELECT DISTINCT data.value
    FROM OPENJSON(@JSON, '$.data') as jsondata
    CROSS APPLY OPENJSON(jsondata.value) as data
    WHERE data.[key] = 'name') a

select @result = substring(@result, 1, (LEN(@result)-1))

select @result

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A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus
HK Gill1, SB Yadav1, V Ramesh2, E Bhatia1
1 Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Biochemistry, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Date of Submission 14-Jan-2014
Date of Decision 24-Feb-2014
Date of Acceptance 17-Mar-2014
Dr. S B Yadav
Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
Background: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported that DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetes mellitus (T2DM) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosed T2DM. Materials and Methods: We prospectively studied 195 consecutive patients over age 30 with a duration of diabetes ≤6 months. All underwent a clinical and biochemical evaluation and were screened for DPN using Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) as well as the vibration perception threshold using a biothesiometer. We compared the prevalence of peripheral neuropathy (PN) in 75 age- and sex-matched healthy controls. Results: The cases had a mean age of 47.6 ± 10.2 years (59% males) and duration of symptoms of 5.9 ± 8.2 months prior to presentation. The overall prevalence of DPN was 29.2% [95% CI 22.8-35.7]. PN among matched control was 10.7% (95% CI 3.5-17.8). The prevalence of DPN showed an increasing trend with age (trend chi-square 11.8, P = 0.001). Abnormal vibration perception threshold was present in 43.3% (95% CI 36.3-50.3) of cases and had a significant correlation with NDS (P = 0.000). Abnormal monofilament testing was present in 6.1% of cases (95% CI 2.7- 9.5). A logistic regression analysis showed that DPN was independently associated with age (P = 0.002) and duration of diabetes prior to presentation (P = 0.02) but not with body mass index, plasma glucose, or HbA1c. Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with T2DM, which was independently associated with age and duration of symptoms of diabetes prior to the diagnosis. Screening for DPN at diagnosis of diabetes is warranted, especially among older subjects.
Keywords: Biothesiometer, diabetic peripheral neuropathy, newly diagnosed, type 2 diabetes mellitus, vibration perception threshol
Gill H K, Yadav S B, Ramesh V, Bhatia E. A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus. J Postgrad Med 2014;60:270-5
Gill H K, Yadav S B, Ramesh V, Bhatia E. A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus. J Postgrad Med [serial online] 2014 [cited 2022 Jan 18];60:270-5. Available from: https://www.jpgmonline.com/text.asp?2014/60/3/270/138750
India has one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. [1] It is estimated that by the year 2030 there are will be nearly 80 million Indians with T2DM in the country. [2],[3] The disease constitutes a substantial burden for both the patient and health care system, mainly due to macrovascular and microvascular complications. [1],[2] In contrast to patients in industrialized countries, Indians with T2DM have an earlier age at onset of the disease and fewer resources for achieving optimal metabolic control, potentially predisposing them to a higher prevalence of complications. [4],[5],[6]
The prevalence of diabetic peripheral neuropathy (DPN) varies greatly in different studies, ranging from 8% to 59%. [7],[8],[9],[10] DPN significantly increases the risk of complications such as foot infections, deformities, gangrene, and amputations. [11] In India, the adverse effects of peripheral neuropathy (PN) are compounded by poor foot hygiene, improper foot wear, and frequent bare foot walking. In such circumstances, complications of foot infections and gangrene are a common cause of hospital admissions. [1],[12]
T2DM is characterized by a long asymptomatic phase (ranging from 4 to 7 years) between the actual onset of hyperglycemia and clinical diagnosis which may explain the relatively high prevalence of microvascular complications in newly diagnosed patients with T2DM. [13] The prevalence of DPN at diagnosis of type2DM ranges from 10% to 48%, depending upon the population studied and method used to evaluate neuropathy. [14],[15],[16] In view of the poor awareness and lack of regular screening programs, the initial presentation to the physician is frequently delayed. This may predispose to an increased rate of microvascular complications at onset. Ethnic differences in the prevalence of various diabetes-related complications have also been documented. [17]
There is a paucity of reports on DPN in Indians. In a study comparing European and south Asian subjects with T2DM in United Kingdom, the prevalence was lower in the latter. However, in surveys in Indian patients, the prevalence has ranged from 26% to 31%. [18],[19] In these studies, no controls were studied. Since PN is present in a significant proportion of healthy individuals, especially among the elderly, this fact needs to be taken into account before ascribing the PN to hyperglycemia. [11],[20],[21] The present study was planned to determine the prevalence and risk factors for DPN in newly diagnosed Indian patients with T2DM and age-matched controls.
Patients and controls
Over a period of 1.5 years (April 2010 and October 2011), we studied 195 consecutive patients with newly diagnosed T2DM (mean age 47.6 ± 10.2 years, 59.0 % males). Inclusion criteria included age ≥30 years and duration of diabetes ≤6 months at the time of presentation. Patients with acute illness or chronic diseases such as leprosy, those with disability, pregnant women, and patients taking medications known to impair nerve function were excluded from the study. Seventy-five healthy subjects (age 45.9 ± 9.9 years, 72% males) with normal fasting glucose levels, matched for age and sex with the patients, served as controls. The protocol was approved by the institutional ethics committee. Informed written consent was obtained from all subjects.
Clinical and biochemical studies
All participants underwent a standardized clinical evaluation. Height was measured using a stadiometer, while weight was recorded with a weighing machine with a beam balance. Waist and hip circumference were measured and mean of two readings was taken for calculating the waist - hip ratio (WHR).
Screening for peripheral neuropathy and case definition of diabetic neuropathy
All testing was performed by a single observer (HG). Tests were performed in a random sequence among different patients. Patients were screened for DPN using the Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS), as previously described. [7] In short, for NSS, symptoms like burning, tingling, numbness, fatigue, cramping, and aching with their worsening and relieving factors were taken into account. Depending upon the severity, a point of 0 to 2 was given and NSS was classified into mild (score 3-4), moderate (score 5-6), and severe (score 7-9). For NDS, pain, temperature, vibration (by biothesiometer) perception and ankle reflexes were tested and score of 0 to 2 were given depending upon normal, diminished or absent signs. NDS was categorized into mild (score 3-5), moderate (score 6-8), or severe (score 9-10). DPN was diagnosed if moderate-severe signs with or without symptoms or mild signs with moderate-severe symptoms were present. The NSS and NDS have been previously been validated against electro-diagnostic studies. [22]
Vibration perception threshold (VPT)
This was measured using a biothesiometer (Dhansai Lab, Mumbai, India). The biothesiometer tractor, which vibrates at 100 Hz, was applied at the distal plantar surface of the great toe (right and left). Three cycles of readings at each site (right and left great toe) were performed. If the best value was >9 mV in any great toe it was considered abnormal. This value was derived from the VPT value 2SD above the mean for 35 healthy controls of age 30-50 years. [23] A 128-Hz tuning fork was used to examine vibration perception at the dorsum of the interphalangeal joint of the right hallux. The vibrating tuning fork was put on the interphalangeal joint and when nothing was felt, the score was 2 points. When something was felt, the still vibrating tuning fork was immediately placed at the dorsal wrist. When it was felt the same at that location the score was 0 points, when it felt stronger the score was 1 point. [24] Monofilament testing: This was done with Semmes - Weinstein monofilament of 5.07/10 g was performed three times at each site (dorsal between base digit 1-2; ventral digit 1, 3, 5; meta-tarsal heads 1, 3, 5; medial and lateral mid-foot; heel). If the patient missed more than once at one site it was considered as abnormal at that site. If a subject did not perceive the filament at 2 or more of the 10 sites, the test was reported as abnormal. [25]
Screening for albuminuria
Nephropathy was tested in 178/195 patients. A urine sample was screened for urine albumin using a dipstick (Uristix, Siemens, Vadodara, India). If positive, 24 h urine albumin was measured and macroalbuminuria was defined as a value >300 mg. If the dipstick was negative, timed overnight urine specimens or by morning albumin/creatinine ratio were measured. If first sample was suggestive of microalbuminuria, two more urine specimens were collected. Microalbuminuria was diagnosed if at least 2 of the 3 samples had overnight microalbumin concentration of 20-200 μg/min or urine microalbumin/creatinine ratio of 30-300 μg/mg creatinine. [26]
Urine albumin concentrations were measured by radioimmunoassay (Immunotech, Prague, Czech Republic). Hemoglobin A1c was measured by high pressure liquid chromatography (D10, Biorad, Hercules, CA, USA). Glucose, creatinine, and lipids were measured by an auto analyzer (Bayer RA-XT, Tarrytown, NY, USA) using kits manufactured by the same company.
Continuous data have been expressed as mean ± SD and 95% confidence interval (CI) were determined for the variables. The Student's t-test was used for comparison of continuous variables if found to be normally distributed while chi-square test was used to compare categorical variables. Variables associated with PN were tested using univariate logistic regression analysis. Variables shown to have a significant association by this analysis were tested by multivariate logistic regression to determine the variables independently associated with PN. A P value <0.05 was considered significant. Statistical analyses were performed using the SPSS software package (version 15.0; SPSS Inc., Chicago, IL, USA).
The clinical details are shown in [Table 1]. Patients had mean duration of symptoms of diabetes 5.9 months (range 0-60 months) before diagnosis. They presented to our hospital within 2.3 months (range 0-6 months) of diagnosis. At the time of presentation, patients had a poor glycemic control (mean plasma glucose 321.0 ± 100.2 mg%, mean HbA1c 9.1 ± 2.4%).
Table 1: Clinical characteristics of the study population
Prevalence of DPN
By NSS and NDS criteria, the prevalence of DPN was 29.2% [95% CI 22.8-35.7%; [Table 2]. The prevalence was similar in males (26.1%) and females (33.8%). An abnormal NDS was present in 44.5%, with 20% having a moderate - severe grade score. An abnormal NSS was found in 50%, with moderate - severe symptoms in 35%. The prevalence of DPN showed an increasing trend with age (trend chi-square 11.8, P = 0.001) [Figure 1]. Forty percent of subjects >50 years had DPN. The prevalence of PN in controls was 10.7% (95% CI 3.5-17.8%). The prevalence increased with age and was present in 13.3% for >50 years of age.
Figure 1: Prevalence of neuropathy in different age groups
Table 2: Prevalence of peripheral neuropathy in the study population
Abnormal VPT was detected in 43% of patients [Table 2]. Among these subjects, 82% had abnormal vibration perception by tuning fork. Compared with PN measured by NSS/NDS, abnormal VPT by biothesiometer had a sensitivity of 78.4% and specificity of 71.9%. Similarly, 32 (56%) had symptoms of burning/tingling or numbness, with sensitivity of 56.1% and specificity of 69.6% to diagnose DPN. In contrast, impaired monofilament sensation was detected in a smaller proportion of patients (6.1%).
The clinical and biochemical characteristics of the patients with DPN were compared with those without neuropathy [Table 3]. The patients with DPN were older (P = 0.001), had longer duration of symptoms of diabetes prior to diagnosis (P = 0.006) and higher WHR (P = 0.01). However, the two groups did not differ in their plasma glucose at presentation or HbA1c levels. The prevalence of albuminuria was similar among the two groups.
Table 3: Comparison of variables in patients with and without DPN
Associations with peripheral neuropathy
Regression analysis revealed an increase in risk for DPN with increasing age, duration of symptoms of diabetes prior to presentation and central obesity [Table 4]. On multiple logistic regression analysis, age (OR 1.7, 95% CI: 1.2-2.5, P = 0.002) and duration of symptoms of diabetes (OR 1.1, 95% CI: 1.01-1.2, P = 0.02) were independently associated with DPN [Table 5].
Table 4: Univariate logistic regression analysis of risk factors associated with neuropathy
Table 5: Multivariate logistic regression analysis of variables associated with DPN
We detected a high frequency of DPN in newly diagnosed patients with T2DM. However, a lower but significant proportion of healthy controls also had PN. DPN was independently associated with increasing age and duration of symptoms of diabetes prior to diagnosis. Simple clinical assessment had a high sensitivity and specificity in detecting DPN.
In various Caucasian populations, the prevalence of DPN in newly diagnosed T2DM varies widely from 10% to 48%. This may be due to different methodologies employed for detection of neuropathy as well as variability in patient ages and time elapsed before diagnosis. However, ethnic differences in DPN may also be relevant. [17] Interestingly, it has been previously reported that both DPN and foot ulcers are lower in Indians compared with European Caucasians. In the current study, 30% of patients had DPN, based on the NSS and NDS criteria. Two earlier studies in Indians have reported on the prevalence of DPN in newly diagnosed T2DM of 19.5% and 29.0%. In the latter study, the prevalence of DPN was measured by NSS and NDS in 100 newly diagnosed T2DM. [27] In a community-based study from Chennai, south India, Pradeepa et al. measured the prevalence of DPN using VPT by biothesiometer. The prevalence in newly diagnosed patients was 19.5% and 27.8% in those with known diabetes. [18] However, the frequency of DPN in the subjects without diabetes was not studied.
Since PN is found in a proportion of healthy individuals, especially in the elderly, comparison with a matched control group is essential. We noted PN in 10.7% of age- and sex-matched control subjects, which increased with advancing age. This fact should be taken into account when assessing PN in patients with diabetes.
Monofilament sensation is a measure of protective sensations in the foot and is strongly associated with risk of foot ulceration. [25] The prevalence of impaired monofilament sensation was 6%, considerably lower than that of DPN. This low frequency may be reflective of the fact that the10-g (5.07) monofilament testing is appropriate for the clinical assessment of risk for foot ulceration [25] but not a sensitive means to detect prevalence of neuropathy. In the latter case, a monofilament of 1 g or less may be more appropriate. [28]
Previous studies have identified several risk factors for DPN such as age, poor glycemic control, increasing duration of diabetes, gender, height, body mass index, retinopathy, hypertension, smoking, and alcohol consumption. [14],[15],[16],[18] In the current study, age at diagnosis and duration of symptoms of diabetes prior to diagnosis were independent risk factors for DPN. For each decade increase in age, the prevalence of DPN increased significantly (trend chi-square 11.8, P = 0.001), and after the age of 60 years the frequency of DPN was 1.7-fold greater than those aged less than 60 years. Since elderly patients have other risk factors for foot ulcerations, such as vision abnormalities and vascular involvement, neuropathy screening assumes an even greater importance in this age group. The prevalence of DPN increased with longer prediabetic period, as reflected by duration of symptoms attributable to diabetes. [29] While some earlier studies have also reported similar findings, [30] these have not been confirmed by others. [31],[32] We could not demonstrate any association between HbA1c, but this may be partly due to the fact that 65% of patients were already on treatment at the time of examination. Another proposed possibility is that any elevated glucose beyond a threshold will predispose to DPN. [33],[34]
We noted a prevalence of albuminuria of 7.9% among newly diagnosed T2DM. However, we found no association of DPN with albuminuria, which may be due to low prevalence of albuminuria noted in this study. Alternatively, there are differences in the pathogenesis of the two complications. In previous studies, the association of DPN with albuminuria has been variably present. [16],[35]
The prevalence of DPN depends on the criteria and methods used. After a simple clinical test such as VPT, 43% of subjects had an increased threshold suggestive of PN. Among the patients with DPN, 60% had absent or decreased ankle jerks, 78% had abnormal VPT, 76% had reduced pain sensation, and 76% had reduced temperature sensation (not shown in results). Thus a good clinical examination is a sensitive measure to diagnose PN and other studies have also suggested neuropathy scoring to be simple, inexpensive, easy, and sensitive method for PN detection.
The strength of our study is that it was a prospective design, patient evaluation was done by a single physician, and the use of both qualitative and quantitative mode of assessment of neuropathy. It has a few limitations; it was clinic based and may not reflect the actual prevalence of DPN in the community. We did not investigate metabolic causes of PN other than diabetes.
In summary, we detected a high prevalence of PN in recently diagnosed patients with T2DM. The neuropathy was independently associated with age and duration of symptoms of diabetes prior to the diagnosis. Screening for DPN using simple clinical examination is cost-effective means to prevent foot ulceration and infections in Indian patients with T2DM.
1. Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V, et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country: A study from India. Diabetes Care 2007;30:252-6.
2. Zargar AH, Wani AI, Masoodi SR, Laway BA, Bashir MI. Mortality in diabetes mellitus - data from a developing region of the world. Diabetes Res Clin Pract 1999;43:67-74.
3. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.
4. Boddula R, Yadav S, Bhatia V, Genitta G, Pandey D, Kumar A, et al. High prevalence of type 2 diabetes mellitus in affluent urban Indians. Diabetes Res Clin Pract 2008;81:e4-7.
5. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
6. Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care 2003;26:1380-4.
7. Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia 1993;36:150-4.
8. Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 1995;333:89-94.
9. Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: The Rochester Diabetic Neuropathy Study. Neurology 1993;43:817-4.
10. Deli G, Bosnyak E, Pusch G, Komoly S, Feher G. Diabetic Neuropathies: Diagnosis and Management. Neuroendocrinology 2013;98:267-80.
11. Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 1998;21:855-9.
12. Vijay V, Snehalatha C, Ramachandran A. Socio cultural practices that may affect the development of the diabetic foot. IDF Bulletin 1997;42:10-2.
13. Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis. Diabetes Care 1992;15:815-9.
14. Ratzmann KP, Raschke M, Gander I, Schimke E. Prevalence of peripheral and autonomic neuropathy in newly diagnosed type II (noninsulin-dependent) diabetes. J Diabet Complications 1991;5:1-5.
15. Weerasuriya N, Siribaddana S, Dissanayake A, Subasinghe Z, Wariyapola D, Fernando DJ. Long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus. QJM 1998;91:439-43.
16. Spijkerman AM, Dekker JM, Nijpels G, Adriaanse MC, Kostense PJ, Ruwaard D, et al. Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: The hoorn screening study. Diabetes Care 2003;26:2604-8.
17. Abbott CA, Garrow AP, Carrington AL, Morris J, Van Ross ER, Boulton AJ; North-West diabetes foot care study. Foot ulcer risk is lower in South-Asian and African-Caribbean compared with European diabetic patients in the U.K.: The North-West diabetes foot care study. Diabetes Care 2005;28:1869-75.
18. Pradeepa R, Rema M, Vignesh J, Deepa M, Deepa R, Mohan V. Prevalence and risk factors for diabetic neuropathy in an urban south Indian population: The Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med 2008;25:407-2.
19. Paul UK, Sinharay K, Bhattacharyya AK, Pal SK. Update in diabetic neuropathy with special reference to Indian scenario. J Indian Med Assoc 2012;110:616-22.
20. Lozeron P, Nahum L, Lacroix C, Ropert A, Guglielmi JM, Said G. Symptomatic diabetic and non-diabetic neuropathies in a series of 100 diabetic patients. J Neurol 2002;249:569-75.
21. Hughes RA. Peripheral neuropathy. BMJ 2002;324:466-9.
22. Meijer JW, Bosma E, Lefrandt JD, Links TP, Smit AJ, Stewart RE, et al. Clinical diagnosis of diabetic polyneuropathy with the diabetic neuropathy symptom and diabetic neuropathy examination scores. Diabetes Care 2003;26:697-701.
23. Young MJ, Every N, Boulton AJ. A comparison of the neurothesiometer and biothesiometer for measuring vibration perception in diabetic patients. Diabetes Res Clin Pract 1993;20:129-31.
24. Meijer JW, Smit AJ, Lefrandt JD, van der Hoeven JH, Hoogenberg K, Links TP. Back to basics in diagnosing diabetic polyneuropathy with the tuning fork! Diabetes Care 2005;28:2201-5.
25. Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: A prospective multicenter trial. Diabetes Care 2000:23:606-11.
26. American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care 2010:33(Suppl 1):S11-61.
27. Dutta A, Naorem S, Singh TP, Wangjam K. Prevalence of peripheral neuropathy in newly diagnosed type 2 diabetes mellitus. Int J Diab Dev Ctries 2005;25:30-3.
28. Valk GD, de Sonnaville JJ, van Houtum WH, Heine RJ, van Eijk JT, Bouter LM, et al. The assessment of diabetic polyneuropathy in daily clinical practice: Reproducibility and validity of Semmes Weinstein monofilaments examination and clinical neurological examination. Muscle Nerve 1997;20:116-8.
29. Novella SP, Inzucchi SE, Goldstein JM. The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy. Muscle Nerve 2001;24:1229-31.
30. Singleton JR, Smith AG, Bromberg MB. Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy. Diabetes Care 2001;24:1448-53.
31. Smith AG, Ramachandran P, Tripp S, Singleton JR. Epidermal nerve innervations in impaired glucose tolderance and diabetes-associated neuropathy. Neurology 2001;57:1701-4.
32. Dyck PJ, Clark VM, Overland CJ, Davies JL, Pach JM, Dyck PJ, et al. Impaired glycemia and diabetic polyneuropathy: The OC IG survey. Diabetes Care 2012;35:584-91.
33. Vlassara H. Recent progress in advanced glycation end products and diabetic complications. Diabetes 1997;46(Suppl 2):S19-25.
34. Sabanayagam C, Liew G, Tai ES, Shankar A, Lim SC, Subramaniam T, et al. Relationship between glycated haemoglobin and microvascular complications: Is there a natural cut-off point for the diagnosis of diabetes? Diabetologia 2009;52:1279-89.
35. Shaw JE, Hodge AM, de Courten M, Dowse GK, Gareeboo H, Tuomilehto J, et al. Diabetic neuropathy in Mauritius: Prevalence and risk factors. Diabetes Res Clin Pract 1998;42:131-9.
1 Prevalence of peripheral neuropathy among type 2 diabetes mellitus patients in a rural health centre in South India
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2 Ultrasound evaluation of peripheral nerves of the lower limb in diabetic peripheral neuropathy
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3 Effect of sensorimotor training on spatiotemporal parameters of gait among middle and older age adults with diabetic peripheral neuropathy
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4 Prevalence of Vascular Complications Among Type 2 Diabetic Patients in a Rural Health Center in South India
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< 11/18/11: Sari Bashi '97, '03JD12/2/11: Da'Vine Joy Randolph '11MFA >
11/25/11: James Ramsey '99
By the staff | 2:03pm January 03 2012
James Ramsey '99
For the past couple of years, New Yorkers have been abuzz about the High Line, a linear park built on an abandoned elevated railroad track. Now comes James Ramsey '99 with the Low Line.
A Manhattan architect and former NASA engineer who also designs "luxury chicken residences," Ramsey is working with tech entrepreneur Dan Barasch to turn an abandoned underground trolley terminal into a park. Officially called Delancey Underground, the proposed park would use "fiber-optic technology to channel in natural light," the New York Times reports—"enough light, in fact, to allow photosynthesis to occur."
"It's a little perverse, a little like science fiction," Ramsey says of his "remote skylight" technology. "But we realized that we have the technology to grow grass and trees underground."
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Home Innovations Artificial Intelligence and Robotics in Endoscopy: Current and Future…
Artificial Intelligence and Robotics in Endoscopy: Current and Future Perspectives
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
Author: Lenos Archer-Diaby, Editorial Assistant
PRECISION when imaging or performing minor surgical tasks is crucial for all endoscopists. The progresses in artificial intelligence (AI) and collaborative robots will undoubtedly be key in helping surgical practices move towards a higher level of accuracy. Presented at the special symposia 'AI and Robotics in Endoscopy: Hype or Reality?' at the United European Gastroenterology (UEG) Week 2020, Prof Philip Wai Chiu, The Chinese University of Hong Kong, Shatin, Hong Kong, shared his assessment of the current status of this technology and the outlook for the future.
MAN VERSUS MACHINE
Prof Chiu introduced the topic by explaining that "when we talk about AI, we always face the challenge of it being posed as man versus machine; however, I believe that the application of AI should be in collaboration with clinicians and endoscopists." He went on to express his hope that over the next 20 years, the efficacy and quality of diagnostic endoscopy will improve, predicting that robotics will be increasingly applied to enhance its therapeutic potential.
RECENT ADVANCES IN ARTIFICIAL INTELLIGENCE FOR ENDOSCOPY
The current development of AI in endoscopy is focussing on the standardisation of endoscopic examination, detection, and characterisation of gastrointestinal (GI) pathology. The human brain's performance can be altered by stress, fatigue, and limited experience. AI technology can compensate these limitations, decrease interoperator variability, enhance accuracy of diagnosis, and reduce the time, cost, and burden of endoscopic procedures.
Artificial Intelligence in Endoscopic Examination: Cerebro
Prof Chiu proceeded to explain that his institution, in collaboration with the start-up company Endovision (Hong Kong, Hong Kong), has developed a standardised AI-driven protocol for endoscopic examination entitled Cerebro, which provides enhanced screening and surveillance adherent to standard protocols.1 Clinical trials of Cerebro examined the efficacy of application of the AI-driven assistance device to examine the GI tract (oesophagus, stomach, duodenum). The AI in the protocol has standardised the capturing of imaging and timing for the examination of each of the positions; therefore, if any position is missed the system will alert the endoscopist. Results from 100 patients have shown a 95% accuracy with high sensitivity (95%) and specificity (95%), and 100 more patients are in the study pipeline. The AI of Cerebro can be regarded as an inspection completeness and quality control tool that ensures an endoscopic procedure is performed with the highest quality, and provides an example of the collaboration AI could offer.
Artificial Intelligence in Endoscopic Detection: ENDOANGEL
Another AI protocol being applied clinically is the ENDOANGEL system (Wuhan, China) for the detection of GI pathology. The ENDOANGEL system utilises deep neural networks and perceptual hashing. In a recent study, patients aged 18–75 years (N=704) were assigned 1:1 to either the ENDOANGEL system (n=355) or unassisted colonoscopy (control; n=349). The results showed that the primary endpoint of adenoma detection rate was significantly greater in the ENDOANGEL group compared with the control group: 16% of 355 patients allocated ENDOANGEL-assisted colonoscopy had ≥1 adenoma detected compared with 8% in the 349 patients assigned to the control colonoscopy group (odds ratio: 2.30; 95% confidence interval: 1.40–3.77; p=0.0010).2
Artificial Intelligence in Endoscopic Characterisation: EndoBRAIN
The recently approved AI-assisted system EndoBRAIN has been shown to significantly improve the specificity and sensitivity in GI neoplasia diagnosis. In a Japanese multicentre study between 2017 and 2018, the EndoBRAIN system was trained using 69,142 endocytoscopic images, taken at 520x magnification, from patients with colorectal polyps who underwent endoscopy at five academic centres in Japan.3 Retrospective, comparative analysis of the diagnostic performance of EndoBRAIN versus 30 endoscopists (20 trainees and 10 experts), in the ability to distinguish neoplasmatic from non-neoplasmatic tumours, highlighted that across all the results (sensitivity, specificity, accuracy, positive predictive value, and negative predictive value), EndoBRAIN had a much better diagnostic accuracy (96.9%, 94.3%, 96.0%, 96.9%, and 94.3%, respectively) compared with the trainees.3 However, compared with the experts, only the sensitivity and negative predictive value of EndoBRAIN were significantly higher and all other values were comparable.
When questioned on how this technology could be used clinically, Prof Chiu responded that it is important to maintain collaboration between machine and humans. He believes that within their training period, trainees would still require a mentor but that the AI system could provide telementoring for continuation of observation and guidance and enable the trainees to achieve a high diagnostic yield. This technology has now been authorised for clinical use by the Japanese regulatory agency and in a collaborative manner is assisting doctors in detecting lesions in the clinical setting.
Prof Chiu emphasised: "With this increasing application of AI detection and characterisation, I believe that there is a much higher demand for therapeutic endoscopy."
RECENT ADVANCES IN ROBOTICS FOR ENDOSCOPY
The last 40 years have shown an increasing development in therapeutic endoscopy, including endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), natural orifice transluminal endoscopic surgery (NOTES), and peroral endoscopic myotomy (POEM). Similar to robotic-assisted surgery, robotics in endoscopy are being developed to enhance the interventional capabilities of endoscopists. Currently, robotics are capable of/assisting in polypectomy, mucosectomy, and ESD, with the latter technique being the most suitable to become the gold standard for endoscopic robotics.4
Robotics and Endoscopic Mucosal Resection: EndoMaster
The performance of ESD for early GI cancers allows for local, curative-intent treatment; organ preservation, including preserved organ function, fewer postgastrectomy syndromes, and improved quality of life; as well as better postoperative outcomes, such as decreased hospital stay and early return of GI function. However, the performance of ESD is particularly challenging because of the design and use of the endoscopic knife attached to the endoscope. On the other hand, the lessons we have learned from the use of robotics in general surgery have provided hope that the quality of dissection can be enhanced with robotic surgery.
With this in mind, the endoscopic robotic platform EndoMaster (Master And Slave Transluminal Endoscopic Robot) was developed by Prof Chiu's team in collaboration with researchers at Nanyang Technological University and National University Singapore, Singapore. The EndoMaster consists of two robotic arms attached to a conventional endoscope and, in 2012, was tested on five patients to perform the submucosal dissection portion of ESD. The EndoMaster was successful in all five patients and complete resection was completed in a short period of time, on par with that seen in similar cases performed through standard ESD techniques.
EndoMaster EASE
Limitations of EndoMaster led to the development of the second-generation EndoMaster Endoluminal Access Surgical Efficacy (EASE) system, which includes an independently designed flexible robotic platform, built-in endoscopic imaging system, independent water-jet system, and a channel passage to extrude and retract the two robotic arms.
This new system differs from conventional ESD as the versatility of movement the robotic arms provide allows for lifting and visualisation of the submucosa, making the system more stable. Currently, the EndoMaster EASE System is the first robotic-assisted system that can effectively remove GI tumours endoscopically without the need for surgical incisions.5 The clinical trial for EndoMaster EASE for the treatment of patients with colorectal neoplasms started in May 2020 and is estimated to be completed by December 2021.6 If approved, the system would enable minimally invasive surgery in the body with increased precision and reduced surgery time, and spearhead the future of robotic surgery.
Prof Chiu went on to explain that this robotic technology can be used in the future to enhance endoscopic suturing, especially in the confined GI lumen. The technology may potentially also be clinically applied in GI emergencies, such as bleeding ulcers, GI fistula/perforation, and anastomotic leakage. The utility further extends to cases of morbid obesity and can aid in endoscopic sleeve gastrectomy and the management of pouch dilation.
"In the future, I believe that the robotic technology will be combining with AI to increase the detection of early GI neoplasia. Then we will be able to apply more of the endoluminal robotics for the treatment of GI neoplasia," Prof Chiu stated. He further imagines that eventually "with the use of AI technology combined with the recognition of imaging, we will be able to automate some of the endoscopic procedures for ESD." In his concluding remarks, Prof Chiu echoed that AI and future improvements towards three-dimensional and 4K imaging in robotic endoscopy and novel devices for suturing and dissecting will yield tremendous developments in endoscopic surgery.
EndoVisionAI. Artificial intelligence in the upper-GI endoscopy. 2020. Available at: https://endovisionai.com/. Last accessed: 11 January 2021. Gong D et al. Detection of colorectal adenomas with a real-time computer-aided system (ENDOANGEL): a randomised controlled study. Lancet Gastroenterol Hepatol. 2020;5(4):P352-61. Kudo SE et al. Artificial intelligence-assisted system improves endoscopic identification of colorectal neoplasms. Clin Gastroenterol Hepatol. 2020;18(8):1874-81. Boškoski I, Costamagna G. Endoscopy robotics: current and future applications. Dig Endosc. 2019;31(2):119-24. Endomaster Pte Ltd. Robotic-assisted endoscopic surgery. 2020. Available at: http://www.endomastermedical.com/. Last accessed: 11 January 2021. Chinese University of Hong Kong. EndoMaster EASE system for treatment of colorectal lesions (MASTERCESD). NCT04196062. https://clinicaltrials.gov/ct2/show/NCT04196062.
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CT Colonography Versus Optical Colonoscopy: Cost-Effectiveness in Colorectal Cancer Screening
EMJ Innovations 6.1 2022


Ann-Marie McIntosh: Before joining Purolator I spent 12 years working in the financial services industry. Leaving an industry in which I spent most of my career and joining the transportation and logistics industry, which I knew little about at the time, was both exciting and a bit risky. But I can honestly say that it was one of the best career decisions I've made, for a number of reasons. First, working for a large Canadian company is a real attraction. The work is fast-paced and challenging and provides ample opportunity to get involved at all levels in driving the company's business strategy forward.
Ann-Marie McIntosh: It might sound basic, but the first step is to communicate what the organization's purpose is. With the help of 50 employees who act as change ambassadors, we carry that message throughout the small business and retail division through peer-to-peer communications. Our management team and change ambassadors play a critical role in sharing this information with our 600-plus retail team members who are located across Canada.
LQ: As women strive to get ahead, do you have any tips in an era when training budgets are being curtailed?
Ann-Marie McIntosh: I find establishing strong business networks really valuable, but often it comes in second place, especially while trying to have work-balance with two children. So, I've made a point to attend more business functions—whether it's attending a dinner with industry associates or attending a session on a topic that will help me in my role, and in turn, help move the business forward. The transportation and logistics industry is fast-paced and changes rapidly, so it's critical to have a line of sight on what's happening at all levels—local, domestic and international. I also find listening to my peers talk about their respective challenges and opportunities really provides insight into my own.
Ann-Marie McIntosh: Innovation is one of Purolator's strategic priorities, so it's well established within the culture of our business. Because of that, there's been great support in promoting the retail division as an important component of our company brand—emphasizing the personalized service, convenience and expertise we bring to customers. We have the largest retail network in Canada, and we needed to invest in it. We did this by introducing a new retail design and enhancing our technology tools. We also expanded our retail offering, working in conjunction with PostNet and Staples. By providing small business customers with greater access to Purolator services to help meet their needs, we increased both brand exposure and revenue opportunities.
Ann-Marie McIntosh: Rather than tell customers what they need, we've created an environment in which we ask our customers what they need from us—and listen to their feedback and suggestions. By doing so we ensure that we have the resources, services and customized solutions to meet our customers' business needs. For example, we've expanded our distribution solutions offering. In addition to our core domestic courier service, we offer Purolator International. Also, we now have Purolator Freight, our less-than-truckload service offering, in response to customers letting us know that they wanted a one-stop-shop solution. Similarly, Global Supply Chain Services, which helps customers transporting goods from foreign countries and provides customized direct-to-store solutions from anywhere in Canada, was introduced based on customer requirements. By listening and responding to customer needs, we're preparing ourselves for the future.
Ann-Marie McIntosh: More and more women are joining the transportation and logistics industry—which is quite exciting. There are numerous reasons to join. The industry offers the opportunity to drive change and play on the global stage. Plus, there's an extensive list of opportunities: marketing, engineering, human resources, finance, strategy and more. It takes a diverse team of professionals to make the operation work. When I first joined Purolator, my portfolio consisted of the retail division. Today, I'm on my second assignment in three years, taking on the small, medium business division. There are endless opportunities for growth.
Ann-Marie McIntosh: Talk to your employees. It's as simple as it sounds. Communicate how the economy is affecting your business and share what needs to be done to get through what might be some difficult times. It's also critically important to listen to your customers. Make sure you understand the issues that they're experiencing in their own business, and be able to offer them solutions that will continue to support their needs. Just because something wasn't a customer need last year doesn't mean it isn't today. I spend a lot of time understanding why things are the way they are. We can't afford not to question. Also, focus on the things you have within your immediate control and be sure to manage your costs. Sounds basic, but if your company's foundation isn't strong, and you don't take the time to understand what your customers value and what your employees need, your growth will be compromised.


In the denominational world there is the popular theory that what God had promised to Israel in the Old Testament has never really been fulfilled. That in the future the Jewish temple is going to be rebuilt, Jesus is going to return to the earth, reign for 1000 years in Jerusalem, and the Jewish nation will occupy their land and have all the prominence that they had under the rule of kings like David and Solomon. Yet, is this true?
"That all things which are written about Me in the Law of Moses and the Prophets and the Psalms must be fulfilled… Thus it is written, that the Christ would suffer and rise again from the dead the third day, and that repentance for forgiveness of sins would be proclaimed in His name to all the nations, beginning from Jerusalem" (Luke 24:44, 46-47).
Observe that Jesus here says nothing about the prophets predicting a millennial rule, over which He would supposedly act as King.
"And likewise, all the prophets who have spoken from Samuel and his successors onward, also announced these days" (Acts 3:24).
In the context of Peter's sermon on this occasion, the time period in which Peter was living included: 1) The fulfillment of the prophecy in Deuteronomy 18 concerning a coming Lawgiver (3:22). 2) The period of restoration (3:21) mentioned by the prophets. 3) The times of refreshing were now (3:19). 4) The final promise to Abraham was being fulfilled (3:25).
Jesus said that the prophets had actually taught that a message of repentance for the forgiveness of sins would be preached from Jerusalem to all the nations. This verse in Luke is part of what has been called the Great Commission and is also mentioned in Mark 16:15-16 and Matthew 28:19-20. Remember, when John the Baptist and Jesus arrived they both said "repent" for the kingdom of heaven is at hand (Matthew 3:2; Mark 1:15). To readers of the Old Testament Scriptures this was saying that what the prophets had promised to the faithful among God's people was soon to arrive.
What Isaiah describes is said to happen in the last days (not on the last day). The time period of the New Testament claims to be the last days (Acts 2:16; Hebrews 1:1-2).
God's house would be established, and God's house is clearly the church which was established in the First Century (1 Timothy 3:15).
God's house or kingdom is spoken as a mountain that is elevated over all other mountains (or kingdoms). In the book of Daniel, God spoke of a kingdom that He would establish that would become "a great mountain and filled the whole earth" (Daniel 2:35). The timeline for the arrival of this kingdom is clearly given. From the time of Nebuchadnezzar, there are four kingdoms mentioned. Babylonian, Persian, Greek and Roman, and it would be in the days of the fourth empire (Roman) that God would set up His kingdom (2:44).
All nations would stream to God's house (Isaiah 2:2), that is, it would be a household that includes Jews and Gentiles (Ephesians 2:16).
God's new law would go forth from Jerusalem (Isaiah 2:3), just as Jesus said in Luke 24. This new law is the gospel message that was preached in Acts chapter 2.
Isaiah 2:4 is not describing a period of utopian peace, as we will see in Isaiah chapter 11, but rather is beautifully illustrating the changed lives that will be a part of God's kingdom. This verse is describing what happens to people when they repent and come into contact with the blood of Jesus (Titus 3:3; Ephesians 2:3-4).
Paul quotes Isaiah 11:10 as being fulfilled in the First Century (Romans 15:12), and cites this text as proof that it had been God's will to save Gentiles who believe in Christ.
If Isaiah 11 has not been fulfilled and can only refer to some period in the distant future, then there is a huge problem. Non-Jewish people are only allowed to come to Jesus when the events of Isaiah 11 have happened.
Observe that at the same time Gentiles (nations) are allowed to come to Jesus, that God is said to recover a second time the remnant of the Jewish people (11:11). The first time was during the time period of Ezra and Nehemiah. This second return never meant a literal return to their land, rather this meant that as He gathered Gentiles with the gospel message He would also gather the Jews who chose to believe, like Paul. Paul writes that such a remnant did exist in the First Century (Romans 11:1-5). In addition, we see that remnant being collected in Acts 2:41 and other passages.
In this context God speaks of His people rebuilding the ancient ruins (61:4), and once again possessing their land (61:7). Yet, Jesus quotes this section in Luke 4:18 and claims that it was being fulfilled when He was upon the earth the first time (4:21). Thus, the language about rebuilding the ancient ruins and possessing the land was never meant to be viewed as a literal rebuilding.
This section of Scripture speaks of the booth of David being rebuilt as in the days of old. It also speaks of God's people possessing Edomite territory (9:12), the captivity of Israel being reversed (9:14), rebuilding ruined cities and being planted on their land (9:15). Yet, none of this was ever meant to be viewed as being literal. The reason I say that is because James in Acts 15:16-17 speaks of this very passage as being fulfilled in the First Century. He focuses in on the statement, "And all the Gentiles who are called by My name", and uses this passage as proof that God had intended to bring salvation to non-Jewish people. Again, if Amos 9:11-15 can only apply to some future and literal restoration of the nation of Israel to their land and prominence in the future, then the nations at the present time do not have the right to seek salvation in Jesus Christ. Much like Isaiah 11, Amos 9 places together the imagery of Israel being restored and Gentiles seeking Jesus at the same exact time. Therefore, the restoration and rebuilding in those passages is speaking of them being restored to God and being, along with believing Gentiles members of His household (Ephesians 2:17-22).
Peter speaking on the Day of Pentecost in Acts chapter 2 cites this section of Scripture as being fulfilled in the arrival of the Spirit, the preaching of the gospel, and people being told what to do to be saved (Acts 2:16-22). Yet observe that in the next chapter of Joel the writer continues: "For behold, in those days and at that time" (3:1). That is, at the exact same time that people are calling upon the name of the Lord to be saved. "When I restore the fortunes of Judah and Jerusalem" (3:1). "In that day the mountains will drip with sweet wine… but Judah will be inhabited forever and Jerusalem for all generations" (3:18,20). Observe that the restoration of the fortunes of God's people is directly linked with calling upon Jesus to be saved. Thus, the restoration of Judah and Jerusalem never meant a physical living in the land, because over the centuries many Jews had lived in the land and were unfaithful to God, as it true to this day. Rather, the restoration here is a restoration of a right relationship with God. When the gospel was preached, Jews with honest hearts would be given the opportunity to become part of God's kingdom as well as any Gentiles. In fact, they were given the opportunity first (Romans 1:16).


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Those online reviews are now becoming the new marketing currency since there are a lot more buyers which turn to customer or peer reviews before they actually make their purchase. Such are able to greatly influence the purchasing decisions of various consumers. For any business or brand, the customer reviews can surely upgrade the sales and marketing by adding this into the campaigns and the processes. These are among the important benefits of the user reviews making them a very essential part of the marketer's strategy.
What you should know about such reviews is that they can build themselves. When a person leaves a review on a website, then other customers are more interested to share their feedback or reviews too. Moreover, you can also inspire the users to give a review by sharing the most fantastic ones on the social media feed of the business or company. Also, one needs to respond to such negative reviews in a good way. This is going to show that you are listening and that you will also make them motivated to provide more feedback.
Once the users visit your website, then you can grab their attention by having a compelling web copy and great visuals. You might also try presenting them with such customer reviews so that you can sway their decision. You should be making it easy for them to convert through offering them something risk-free and simple such as an e-book or a demo.
The reviews are surely very useful. Because of such, your business website should have these reviews for the customers to go through.


How would you go about making your own flexible LED strips, or where would you get custom ones made? Finding any information about this at all is like finding a needle in a haystack, because when I go online and search, all the results are trying to sell their own LED strip lights.
You would open your ECAD of choice, draw the schematics, import it into the PCB, maybe define a boardstack of a flexible PCB if you feel like it. Then you look up the design rules you should use for flexible PCBs from your PCB house of choice. You layout your LED strip and order the flexible PCBs, then you just have to solder the components to your flex PCB and you are done.
Seriously though, you go about it just like a normal PCB but you order a flex PCB instead.
Thanks. Too simple. That must be why nobody asked before. Not sure about adhesive backing like the commercial LED strips have, but I can figure that out. They usually have some product code on the adhesive so I think it could be ordered separately.
What about length? The PCB board houses I have seen have a 36-inch restriction, but commercial LED strips are 5m rolls (or longer). Although they are made from shorter segments soldered together. I think almost always, I see 50 cm segments between solder joints. Do you think they build them side by side as a whole sheet, then cut them apart?
I'm not sure what you mean by "define a boardstack." Is that to specify what purpose you would like each layer to be used for?
Regarding this, yes, you would just buy some double sided tape and attach it to your roll after the fact. I worked at a company that bought rolls of LED strips that weren't taped, and we had a jig that used the roll of lights, the roll of tape, and a power drill to quickly do a whole roll. So yeah, it's not uncommon for the rolls of lights to be untaped. You'll almost certainly have to do it yourself.
We also built our own custom LED strip a few years ago and for us the hardest thing was the figure out how we could connect two strips safely together without using something expensive and without increasing the production time by a lot. We eventually settled on a different method.
We did not connect multiple led strips together with solder as is common in commercial ones, we instead creates one big zig zag (like a snake) flex PCB which you were able to fold twice on the corners and solder all parts together. This solution turned out to be extremely strong compared to the traditional method.
Another thing we learned pretty quickly is that you can achieve a higher density if you can place at least one if not two resistors on the side of your LEDs, this way you can place the LEDs pretty close to each other (remember that the LEDs are not flexible and will therefore determine your minimum radius, use smaller LEDs if that is a concern).
3M even has electrically conductive tape if you need that.
I've been busy with other things and I just saw your last reply. From the folding instructions, it looks like the flex PCB is actually upside down on one side of the fold relative to the other?


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text:
El XXXVI Campeonato Europeo de Baloncesto Femenino se celebró en la República Checa entre el 16 y el 25 de junio de 2017 bajo la denominación EuroBasket Femenino 2017. El evento fue organizado por la Confederación Europea de Baloncesto (FIBA Europa) y la Federación Checa de Baloncesto.

Un total de dieciséis selecciones nacionales afiliadas a FIBA Europa compitieron por el título europeo, cuyo anterior portador era el equipo de Serbia, vencedor del EuroBasket 2015.

La selección de España conquistó su tercera medalla de oro continental al derrotar en la final al equipo de Francia con un marcador de 71-55. En el partido por el tercer puesto el conjunto de Bélgica obtuvo su primera medalla continental, al vencer al equipo de Grecia.

Sedes

Grupos

Primera fase

 Todos los partidos en la hora local de la República Checa (UTC+2).
El primer equipo de cada grupo clasifica directamente para los cuartos de final, el segundo y el tercero disputan primero un partido de eliminación.

Grupo A

 Resultados

Grupo B

 Resultados

Grupo C

 Resultados
{| width=750 class="wikitable"
|- bgcolor="lightsteelblue"
!width=15%|Fecha
!width=10%|Hora
!width=60% colspan=3|Partido
!width=15%|Resultado
|-
|align=center| 16.06
|align=center| 18:00
|align=center| ||<center>-||<center>
|align=center| 60-69
|- bgcolor="efefef"
|align=center| 16.06
|align=center| 20:30
|align=center| ||<center>-||
|align=center| 68-70
|-
|align=center| 17.06
|align=center| 18:00
|align=center| ||<center>-||<center>
|align=center| 56-59
|- bgcolor="efefef"
|align=center| 17.06
|align=center| 20:30
|align=center| ||<center>-||<center>
|align=center| 73-57
|-
|align=center| 19.06
|align=center| 15:00
|align=center| ||<center>-||<center>
|align=center| 88-69
|- bgcolor="efefef"
|align=center| 19.06
|align=center| 20:30
|align=center| ||<center>-||<center>
|align=center| 70-63
|}

 Grupo D

 Resultados

 Fase final

 Todos los partidos en la hora local de la República Checa (UTC+2).

Clasificación del 5º al 8º

 Clasificación a cuartos de final

 Cuartos de final

 Partidos de clasificación
5.º a 8.º lugar

 Semifinales

 Séptimo lugar

 Quinto lugar

 Tercer lugar

 Final

 Medallero
<center>

Estadísticas

Clasificación general

 CM – Equipos clasificados para la Copa Mundial de 2018.

Máximas anotadoras

Fuente:

Equipo más anotador

Fuente:

Equipo ideal

 Mejor jugadora del campeonato —MVP—: Alba Torrens ().

Fuente:

Véase también
 Final del Campeonato Europeo de Baloncesto Femenino de 2017
 España en el Campeonato Europeo de Baloncesto Femenino de 2017

Referencias

Enlaces externos

 Pág. web del evento .
 Resultados oficiales .

2017
Baloncesto en 2017
Baloncesto en la República Checa
Eventos deportivos celebrados en Praga
Baloncesto

redpajama_set_name: RedPajamaWikipedia


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text:
Crown of Midnight by Sarah J. Maas
I don't think I've read a book that was so mystifyingly over-hyped since FIFTY SHADES OF GREY. Every time one of these books comes out, my feed is immediately saturated with them for weeks. I realize that in reading these books, I am contributing to the problem, but I never said I wasn't a hypocrite. (Actually I probably did, but then again, how very hypocritical of me.) I read the first book about three years ago, and did not like it, but morbid curiosity inspired me to do a brutally honest reread of THRONES OF GLASS. The feedback was surprisingly positive (although I did lose a friend or two along the way, and even had some people block me). No hard feelings, though. You know what they say - those in glass castles shouldn't cast stones. Or something.
***WARNING: BIG SPOILERS AND SNARK AHEAD***
CROWN OF MIDNIGHT is book two in the chronicles of Celiac. I mean, Cellophane. I mean, Celery. Yes, let's stick with Celery. It's much easier to say than Celeana. In the last book, Celery partook in a Hunger Games-like competition to be the King's Champion for the hit new reality series in Adarlan, "Keeping Up with the Sardothiens." Everyone watched, agog, as a tiny, skinny girl inexplicably kicked the butts of men twice her size and strength, including me. It's almost like she hadn't been malnourished and imprisoned for years. Muscle atrophy, like smelly farts, bad hair days, and actually having to work at stuff, is something that just doesn't happen to Celery, Queen of the Mary Sues.
Unlike the rest of us pathetic mortals. *eye roll*
In this book, Celery is the King's Champion, and the obviously corrupt king is having her kill his dissenters. Only sucks for him, because Celery is totes Scarlet Pimperneling him, faking their deaths and mercifully allowing them to escape instead while bringing back the severed heads of scavenged corpses. (It's almost like she isn't good at her job as an assassin or something.) ((Also, girl, what's up with the weird severed head fetish? It's like my girl Celery thinks that they're Pokemon cards and she's gotta trade and collect 'em all.)) At the same time, she's trying to decipher the secrets of the Wyrdmarks, with the help of Nehemia, AKA Queen Bae.
Nehemia was the best thing about book one and also the best thing about book two, and she and Celery had way more chemistry than Celery did with either Kale (because he's overrated, like the vegetable kale, and often appears when not wanted) or Durian (should be obvious, but because he stinks. Like durian). So what does Maas decide to do to Nehemia? Kill her off, obviously. I'd been warned about this beforehand - because people have no self-control when it comes to spoilers in this series, it's like GAME OF THRONES (guess how I learned about the Red Wedding?) - but it still totally caught me off-guard and made me angry. To understand why this plot twist made people so angry, it's because it's totally an example of the Magical Negro trope. Fans argue that Nehemia's death was important, because it was the catalyst to Celery finding out The Truth - but that is literally the exact definition of the "Magical Negro" trope. To quote the wonderful TV Tropes wiki: "[they] have no goal in life other than helping white people achieve their fullest potential; he may even be ditched or killed outright once he's served that purpose" (emphasis mine).
And here's what Nehemia says about her fate when Celery raises her from the dead to ask her for secrets and also lamely apologize: "I knew what my fate was to be, and I embraced it. I ran toward it. Because it was the only way for things to begin changing, for events to be set in motion" (290).
YOU SEE. YOU SEE THAT.
RIP, Nehemia. Cause of death: lazy writing.
After that, Celery sulks over Nehemia's death while also seeking vengeance, blames Kale, runs back to Durian, and stalks the Finnick O'dair knockoff, Archer, because of his possible involvement with the rise of the lost Terrasen queen, Attlestar Galactica (or, you know, whatever). Turns out Kale didn't mean to kill Nehemia and she blamed him mostly falsely, but that's okay because he's a saint. Turns out Durian has magic and so does his evol father, but that's okay, because Durian's a saint. Turns out Finnick O'dair was the bad guy, but that's okay, because Celery still has two other love interest to ping-pong between, so screw him, he's no saint. Oh, but the bestest part of all is the grand reveal:
CELERY IS THE PART-FAE DESCENDANT OF AN ACTUAL GODDESS AND THE LONG-LOST QUEEN. It's like, you thought your girl Celery was a Mary Sue in the last book with her "I'm so beautiful, don't hate me because I'm amazing" "I can kick butt and you'll never see me break a nail doing it, but let me list out my murders like I'm a DnDer listing out my character's statz" - hold the phone and let's take these Mary Sue levels from 1 to "This is my Original Character from my Crossover fic about TWILIGHT AND HARRY POTTER." She even has magical eyes that are blue ringed with gold and we get this line that actually made me laugh out loud, because it totally sounds like something someone writing a crossover fic about TWILIGHT and HARRY POTTER would say: "I somehow inherited the ability to shift. Between my Fae form and my human form" (312).
I'm also super confused. Did she know who she was all along? Lose her memory? I feel like this wasn't really foreshadowed that well at all in the first book. You'd think that if a reveal like that was planned, there'd be more hints so readers wouldn't be all, "holy literal deus ex machina, Batman!"
So, apart from... THAT... how was the book? The writing was significantly better. If the first book was a one-star review that had been bumped up to a 2, this book was a three-star review that had been bumped down to a two. The action sequences were better, the writing was tighter, there were fewer moments where I wanted to hit the EJECT button that would catapult Celery from the narrative so I would never have to lay eyes on her smug little face ever again. There's still a lot that's really frustrating, though, and I think the biggest technical problem of this story is that rather than the characters driving the story, the story drives the characters. Their characterization is inconsistent, especially Celery's, and they will fluctuate between very different personalities whenever it's convenient for the plot. Add to that the fact that Celery's "abilities" are constantly getting stacked on top of each other, like a very special game of Mary Sue Jenga, and that shtick gets old, fast.
I'll be continuing this project with HEIR OF FIRE, so stay tuned for more updates!
2 to 2.5 out of 5 stars
Chelsea Heidt January 26, 2018 at 8:48 AM
Love your character names for this! XD I didn't know about the Magical Negro trope, thank you for enlightening me on that one. And you are completely right about the story driving the characters rather than the other way around.
Nenia January 27, 2018 at 3:08 PM
TV Tropes is a really great website. Sometimes I'll use it to see if tropes I like/don't like have names, and they do! It makes reviewing so much easier to know the "proper" terms.
Thanks, Chelsea! If you liked the names, I have something extra special planned for my review of the third book in the series!
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We are pleased to announce PHYSMOD2019, co-organized by the Hong Kong University of Science and Technology (HKUST) and the University of Hong Kong (HKU), will be held in Hong Kong on August 26 to 28, 2019.
PHYSMOD is one of the largest conference in atmospheric dispersion modeling. Our objective is to promote the advancement of instrumentation techniques and dissemination of latest findings in all areas of atmospheric dispersion. Students, practitioners and researchers are encouraged to share their experience. Our webpage will be up very soon. Stay tuned.
Look forward to seeing you in Hong Kong in 2019 summer.