Radical self care is not chocolate.
But it is unfair to expect chocolate to do what only you can.
this is certainly a bit ridiculous.
especially because this year it is 53 drop backs.
I don't think someone else needs to do 53 backbends.
so you can do it again.
I tend to be brutally honest when I am upside down.
This is 30 second advice tip about diet books.
This transformation stuff is not easy.
Most things that work aren't.
Kristen and I take yoga seriously.
Which is why we laugh alot.


text:
Study Protocol - Accurate assessment of kidney function in Indigenous Australians: aims and methods of the eGFR Study
Louise J Maple-Brown1,2,
Paul D Lawton2,
Jaquelyne T Hughes1,
Suresh K Sharma1,
Graham RD Jones3,
Andrew G Ellis4,
Wendy Hoy5,
Alan Cass6,
Richard J MacIsaac7,
Ashim K Sinha8,
Mark AB Thomas9,
Leonard S Piers10,
Leigh C Ward11,
Katrina Drabsch1,
Sianna Panagiotopoulos7,
Robyn McDermott12,
Kevin Warr9,
Sajiv Cherian13,
Alex Brown14,
George Jerums7 &
Kerin O'Dea12
BMC Public Health volume 10, Article number: 80 (2010) Cite this article
There is an overwhelming burden of cardiovascular disease, type 2 diabetes and chronic kidney disease among Indigenous Australians. In this high risk population, it is vital that we are able to measure accurately kidney function. Glomerular filtration rate is the best overall marker of kidney function. However, differences in body build and body composition between Indigenous and non-Indigenous Australians suggest that creatinine-based estimates of glomerular filtration rate derived for European populations may not be appropriate for Indigenous Australians. The burden of kidney disease is borne disproportionately by Indigenous Australians in central and northern Australia, and there is significant heterogeneity in body build and composition within and amongst these groups. This heterogeneity might differentially affect the accuracy of estimation of glomerular filtration rate between different Indigenous groups. By assessing kidney function in Indigenous Australians from Northern Queensland, Northern Territory and Western Australia, we aim to determine a validated and practical measure of glomerular filtration rate suitable for use in all Indigenous Australians.
Methods/Design
A cross-sectional study of Indigenous Australian adults (target n = 600, 50% male) across 4 sites: Top End, Northern Territory; Central Australia; Far North Queensland and Western Australia. The reference measure of glomerular filtration rate was the plasma disappearance rate of iohexol over 4 hours. We will compare the accuracy of the following glomerular filtration rate measures with the reference measure: Modification of Diet in Renal Disease 4-variable formula, Chronic Kidney Disease Epidemiology Collaboration equation, Cockcroft-Gault formula and cystatin C- derived estimates. Detailed assessment of body build and composition was performed using anthropometric measurements, skinfold thicknesses, bioelectrical impedance and a sub-study used dual-energy X-ray absorptiometry. A questionnaire was performed for socio-economic status and medical history.
We have successfully managed several operational challenges within this multi-centre complex clinical research project performed across remote North, Western and Central Australia. It seems unlikely that a single correction factor (similar to that for African-Americans) to the equation for estimated glomerular filtration rate will prove appropriate or practical for Indigenous Australians. However, it may be that a modification of the equation in Indigenous Australians would be to include a measure of fat-free mass.
Indigenous Australians have rates of cardiovascular disease (CVD) mortality some 7-10 times higher than non-Indigenous Australians aged 25-64 years, a prevalence of diabetes some 10 times higher (age 20-50 years), new cases of end stage kidney disease (ESKD) 10-15 times higher and life expectancy 15-20 years shorter [1–3]. Type 2 diabetes is common amongst Indigenous Australians with ESKD: 77% of Indigenous Australians with new ESKD in 2007 compared to 33% of non-Indigenous Australians have Type 2 diabetes as a comorbidity [4]. Rates of ESKD in Indigenous Australians are disproportionately highest in those in central and northern Australia [5]. This group of people is widely dispersed and heterogenous: they live in urban, regional and remote settings and have wide variation in diet, body habitus, genetic admixture and socioeconomic background [6–8].
With the serious burden of ESKD in Indigenous Australians it is essential to be able to assess accurately renal function in these populations. Glomerular filtration rate (GFR) is the best overall marker of renal function in people with healthy or diseased kidneys [9] and is an independent predictor of renal and cardiovascular events [10, 11]. At present there are no validated methods for estimating GFR in Indigenous Australians [12, 13]. Differences in body build and body composition between Indigenous and non-Indigenous Australians suggest that creatinine-based estimates of GFR (eGFR) derived for European populations may not be appropriate for Indigenous Australians, as muscle mass is a key determinant of serum creatinine levels. Compared to Australians of European background, Indigenous Australians from remote central and northern Australia have more fat for a given weight or BMI [7].
It is increasingly recognised that current creatinine-based formulae used to estimate GFR might not be generalisable across all clinical presentations [14, 15]. They also lack validation in ethnic populations apart from Caucasians and African Americans [12, 14]. The Modification of Diet in Renal Disease 4-variable formula (MDRD) was derived from a study population with impaired renal function; and thus is less accurate within a "healthy range" GFR. To address this issue a revised equation (Chronic Kidney Disease Epidemiology Collaboration, CKD-EPI) has been described [16].
An alternate approach is to use a different analyte from creatinine to estimate renal function and develop GFR prediction equations. Serum cystatin C has been proposed as a simple, reliable and accurate marker of GFR when compared to creatinine-based methods [17, 18]. Although there is some evidence to suggest that cystatin C levels might be influenced by extra-renal factors, numerous studies have suggested that cystatin C levels or GFR estimates based on cystatin C levels alone are more accurate indices of renal function than creatinine-based methods [19]. However, at this time cystatin C assays are not routinely available, they are considerably more expensive than creatinine assays and are not yet fully standardised. Thus for the immediate future, optimisation of creatinine-based methods remains important.
The aim of the present study is to evaluate and improve if necessary the accuracy and precision of eGFR estimates in Indigenous Australians, taking into account the heterogeneity in body build and body composition across different populations. The study's hypotheses are: (i) that differences in body build and body composition between Indigenous and non-Indigenous Australians will affect the validity of creatinine-based estimated measures of GFR (using existing predictive equations) and that accuracy of estimates of GFR will vary across different Indigenous population groups; and (ii) that a more accurate assessment of GFR will be obtained by a formula involving serum creatinine and percent fat free mass (obtained by a simple, validated bioimpedance measurement) or by using an alternative biochemical measure such as cystatin C. It is anticipated that this will be of use in both Indigenous and non-Indigenous Australians of variable body builds, particularly at GFR>60 ml/min/1.73 m2.
Setting & location
Participants were recruited from 4 geographical regions: Top End (of Northern Territory, Australia), Central Australia, Far North Queensland and Western Australia. These regions were chosen as resident Indigenous Australians bear a disproportionately larger burden of ESKD than those from other regions of Australia. Within these four regions, the following Aboriginal Medical Services or health facilities were recruitment centres: Top End - Royal Darwin Hospital, Danila Dilba Health Services (Darwin), Bagot Community Health Centre (Darwin), Wurli Wurlinjang (Katherine), Ngalkunbuy Health Service (Miwatj Health Aboriginal Corporation, Galiwinku), Katherine District Hospital, Gove (Nhulunbuy) District Hospital; Central Australia - Alice Springs Hospital, Tennant Creek Hospital, Central Australian Aboriginal Congress, Anyinginyi Health Aboriginal Corporation (Tennant Creek), Amooguna Health Centre, Titjikala Health Centre; Western Australia - Bega Garnbirringu Health Service Aboriginal Corporation (Kalgoorlie), Kimberley Aboriginal Medical Services; Far North Queensland - Wuchopperen Health Service (Cairns), Thursday Island Hospital, Cairns Base Hospital Diabetes Centre, Meriba Dhoeynidhay Yabu Torres Strait & Northern Penninsula Area Community Council.
Participants and recruitment
Participants were Indigenous Australians (target n = 600 with equal numbers of males and females) aged 16 years and above, from urban, rural and remote regions of Northern and Central Australia across the following 5 strata:
"healthy" group: nil diabetes, hypertension, chronic kidney disease (CKD), albuminuria;
participants with diabetes or albuminuria & eGFR (MDRD-4) >90 ml/min/1.73 m2;
eGFR 60-90 ml/min/1.73 m2;
eGFR <15-29 ml/min/1.73 m2.
Indigenous Australians fulfilled the definition of 'Aboriginal and/or Torres Strait Islander' according to the standard method used in National Census data collection: "1) is of Aboriginal and/or Torres Strait Islander descent; 2) identifies as an Australian Aboriginal and/or Torres Strait Islander; and 3) is accepted as such by the community in which he or she lives or has lived".
Exclusion criteria were: participants with rapidly changing kidney function, participants receiving dialysis, women who were pregnant or breastfeeding and people with a history of allergy or adverse reaction to iodine-based contrast media.
Participants with CKD and/or diabetes were recruited from participating Aboriginal Medical Services and the nephrology, endocrinology and outreach kidney disease clinics associated with Royal Darwin Hospital, Alice Springs Hospital, Cairns Base Hospital and the Royal Perth Hospital. The identification and recruitment of the "healthy" group was through community networks, staff members of health services, word-of-mouth, self referral and family members of participants.
Major funding was provided by the National Health and Medical Research Council of Australia (NHMRC, project grant #545202). Prior to award of this grant, pilot funding was received from: Kidney Health Australia, the Colonial Foundation of Australia and Menzies School of Health Research. Additional funding for equipment was received from Rebecca L Cooper Medical Research Grant.
The study was approved by the joint Menzies School of Health Research - Northern Territory Department of Health and Community Services Human Research Ethics Committee. The project was considered and approved by both the Aboriginal sub-committee, which has absolute right of veto, and by the main committee. The study was also approved by the following Human Research Ethics Committees: Central Australian Human Research Ethics Committee, Western Australian Aboriginal Health Information and Ethics Committee, Royal Perth Hospital Ethics Committee and Cairns and Hinterland Health Services District Human Research Ethics Committee.
Six people were employed on contracts over the course of the study. Of these, four were Indigenous and two were non-Indigenous. Additional people were employed on a casual basis during visits to discrete communities; these community members acted as local facilitators. One post-graduate research student (who is Indigenous) also participated in the study and was substantially involved in data collection, whilst also making a significant contribution to study profile and media relations. The majority of staff members had prior health qualifications and experience: three were Aboriginal Health Workers, two were registered nurses and the post-graduate research student was a specialist nephrologist. The staff member without a health qualification completed a venipuncture certification course.
Potential participants were provided with written information about the study, face-to-face discussion with a staff member, and given an opportunity to ask questions. If required, an interpreter was employed to explain all information relating to the study. Those who indicated that they wished to participate were then asked to complete and sign a consent form. Consent was obtained using the NHMRC Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research. All participants were informed that their participation was voluntary and that they could refuse or withdraw from participating and need give no reasons nor justification for their decision and that it would not affect their medical care. A parent or guardian was asked to sign the form as well if the participant was under 18 years old. Participants were asked to give separate consent for various elements of the study, including: iohexol injection and blood and urine samples; body measurements, body composition tests, blood pressure and questionnaire; and collecting further information from their medical records. They were also asked whether they wanted a report sent to their primary health care provider and whether their blood and urine samples could be stored at Menzies School of Health Research for 5 years and used for future studies related to diabetes and kidney disease.
Examination protocol
Following confirmation of contact details and eligibility and after obtaining informed consent, performance of the reference measure of GFR and a health examination was undertaken. This examination included: collection of blood and urine samples; clinical and anthropometric measurements; and the administration of questionnaires. The performance of the reference measurement of GFR required a minimum of 4 hours for participants, during which time participants were given a healthy meal and health promotion information. Details of the examination protocol:
Reference measure of GFR: determined by measuring the renal clearance of non-isotopic iohexol. Iohexol was injected (5.445 ml, 300 mg/ml "Omnipaque") into an antecubital vein (or forearm/hand vein if unable to use antecubital vein) and flushed with 10 ml of normal saline. The volume of iohexol includes the prime volume (0.445 ml) in the tubing of the butterfly cannula used to inject the iohexol. Extravasation was assessed by clinical inspection and palpation of the injection site. If there was any evidence of extravasation then the study was suspended and the participant invited to return in 3-7 days for assessment. Using the contralateral arm, venous blood samples (5 ml) were collected for measurement of iohexol at 120, 180 and 240 min post injection. Participants were closely supervised for possible adverse reactions - whilst also receiving culturally appropriate education about chronic kidney disease, diabetes and/or healthy lifestyle.
Slope-intercept GFR was calculated from the formula:
Slope-intercept GFR (mL/min) = k × Iohexol dose (μg)/C0 (μg/mL) where k is the slope of the semilog plot of plasma Iohexol concentration versus time (plotted using 3 points, refer above), and C0 is the calculated Iohexol concentration at time zero (intercept). This value was multiplied by 1.73 and divided by the body surface area (BSA, calculated from the equation BSA = 0.20247 × height (metres)0.725 × weight (kg)0.425 [20]. The BSA-slope intercept GFR value (mL/min/1.73 m2) was corrected by the Brochner-Mortensen correction factor = (0.990778 × GFR) - (0.001218 × GFR2) [21] providing a reference GFR value (mL/min/1.73 m2).
Blood and urine measures:
Serum creatinine measurements: performed both locally and at a central laboratory (The Department of Laboratory Medicine, Austin Health).
Estimates of GFR/creatinine clearance (where Scr is serum creatinine concentration in μmol/L, age in years, weight in kg, eGFR in mL/min/1.73 m2):
The adjusted MDRD-4 variable formula (for creatinine measurements traceable to the IDMS method and reported in μmol/L)
eGFR = 175 × [(Scr × 0.0113)-1.154] × (age)-0.203 × (0.742 if female) × (1.212 if African-American) [22]. The above African-American "correction factor" was not used for Indigenous Australians.
The CKD-EPI formula [16]:
GFR = 141 × min(Scr × 0.0113/k, 1)α × max(Scr × 0.0113/k, 1)-1.209 × 0.993Age × 1.018 [if female] × 1.159 [if black], where Scr is serum creatinine, k is 0.7 for females and 0.9 for males, α is -0.329 for females and -0.411 for males, min indicates the minimum of Scr/k or 1, and max indicates the maximum of Scr/k or 1. As the correction factor "if black" applies to African-Americans this was not used for Indigenous Australians.
The Cockcroft-Gault (C-G) formula: [23]
Creatinine Clearance (mL/min) = { [140 - age] × weight/[Scr × 0.814]} × (0.85 if female) *also calculated using ideal body weight (IBW) according to Therapeutic Guidelines protocol when the patient is obese (BMI>30 kg/m2). IBW = 50 kg + 0.9 kg/each cm over 152 cm (- 4.5 kg if female).
Cystatin C: non-fasting blood sample for measurement of cystatin C levels collected on the morning of iohexol clearance measurements.
Bloods (non-fasting) were taken with the 120 minute venous sample for iohexol: HbA1c, UEC, lipids (total and HDL cholesterol), high sensitivity c-reactive protein were performed as standard clinical care and analysed by local care providers. Although a fasting blood sample would be preferable for assessment of lipids and creatinine it was not practical in the setting of a renal or diabetes clinic. We therefore assessed non-fasting total and HDL cholesterol and instructed participants not to consume meat on the day of the examination prior to measurement of serum creatinine. A subset of participants was asked when they last ate a meal containing meat. The light meal provided by study staff to participants was given after the blood sample for creatinine was taken. Additional serum (8 ml) was collected at 120 minutes for cystatin C, inflammatory markers and a stored sample.
Urine: sample collected for microscopy and culture and determination of the albumin to creatinine ratio (ACR), performed as standard clinical care and analysed by local care providers. Urine cotinine was measured for quantitative assessment of cigarette smoking (recent nicotine consumption).
Clinical and anthropometric measures:
Blood pressure was measured three times after the participant had been seated quietly for at least 5 minutes. A Welch Allyn Spot Vital Signs monitor (Welch Allyn Medical Products, Skaneateles Falls, USA) was used to measure systolic and diastolic pressure, with three minutes between readings. The pulse rate was recorded with each reading.
Height was measured to the nearest 0.1 cm using a wall-mounted stadiometer [24]. Participants were shoeless and wore light clothing. They were instructed to stand facing forward with weight distributed evenly on both feet, with heels together and against the wall and arms hanging loosely by their sides. The participant's head was positioned so that the Frankfort Plane was horizontal. The participant was then instructed to keep his or her eyes focused on a point straight ahead, breathe in deeply, and stretch to his or her fullest height, with heels still on the ground. The measuring plate was then lowered onto the scalp until it rested firmly on the top of the head and a reading to the nearest 0.1 cm was obtained and recorded. Following the measurement of weight (as described below), a second height measurement was obtained and recorded, again to the nearest 0.1 cm. If the two height measurements differed by more than 0.5 cm, a third measurement was taken and recorded.
Weight in kilograms was measured using a Seca digital portable scale (Model 767 and 841, Seca Deutschland, Hamburg, Germany). Participants were asked to remove shoes, heavy garments, heavy jewellery, belts, loose change, keys, mobile phones, and other items from pockets. With the scales at zero, participants were asked to stand on the centre of the base with feet together, arms hanging loosely at the sides and the head facing forward. Weight was recorded to the nearest 0.1 kilogram. Two separate measurements of weight were recorded and if the first two differed at all then a third measurement of weight was taken and recorded.
Waist and hip circumference were measured in centimetres using a 2-metre non-stretch flexible steel tape (Model W606PM Lufkin, Texas, USA). Following removal of outer clothing, tight-fitting garments, belts and heavy items from pockets, participants were asked to stand comfortably erect in a relaxed manner, breathing normally, with weight balanced evenly on both feet, feet about 25-30 cm apart, and arms folded across the chest. Waist and hip measurements were taken alternately, with a minimum of two measurements for each. All measurements were taken and recorded to the nearest 0.1 centimetre. If the first two measurements of either waist or hip circumference differed by more than 1.0 cm, then a third measurement was taken for waist or hip, as relevant. Waist measurements were taken directly on the participant's skin. Hip measurements were taken over the participant's clothing, unless it was too tight or too baggy, in which case the participant was asked to remove it. The waist was defined as the midway point between the iliac crest and the costal margin. These two landmarks were identified and marked using a felt tip pen, and the distance between them measured, with the midpoint marked. Once the tape was around the participant's body at the appropriate height and the tape was horizontal, the participant was asked to breathe out gently. The measurement was taken at the end of a normal expiration, with the tape pulled snug but not compressing the underlying soft tissue. If landmarks were unable to be identified (in the occasional very obese participant), waist measurements were omitted. The hip circumference was defined as the widest circumference over the buttocks and below the iliac crest. The hip circumference was measured at several positions (starting with the widest part of the buttocks when viewed from the side) and the widest circumference recorded. Fatty aprons were not included in the measurement of the hips. The measurement was taken with the tape in a horizontal position, and the tape was pulled to allow it to maintain its position without causing indentation.
Skinfold thickness assessment was performed using Holtain calipers (Holtain Ltd, Crosswell, Pembrokeshire, United Kingdom) at 4 sites bilaterally: peripheral (biceps, triceps) and central (subscapular, suprailiac) [25]. Bilateral skinfold measurements were performed in all participants to ensure a site availability of longitudinal follow up in the event of an arterio-venous fistula insertion in CKD participants. The skinfold site was marked using a felt-tip pen and each site was identified as follows: biceps, anterior surface of the biceps midway between the acromial process and the elbow (antecubital fossa); triceps, posterior surface of triceps at midpoint from the acromial process (the most lateral and superior aspect of the acromial head) to the olecranon; subscapular, 2.5 cm infero-medially along a 45 degree line from inferior angle of the scapula; suprailiac, 2.5 cm supero-medially along a 45 degree line from where the medial border of the iliac crest tips in to the pelvis. The skin fold was then firmly grasped by the thumb and index finger, using the pads at the tip of the thumb and finger, and the skin fold gently pulled away from the body. The caliper was placed perpendicular to the fold, on the site marked, dialled up, at approximately 1 cm below the finger and thumb. While maintaining the grasp of the skin fold, the caliper was released so that full tension was placed on the skin fold. The dial was read to the nearest 0.20 mm, 2 seconds after the grip was fully released. Three measurements were taken at each site were possible.
Whole body and segmental bioelectrical impedance measurements (BIA) were performed at a single frequency (50 kHz) using a four-terminal impedance plethysmograph (Model DF50, ImpediMed, Brisbane). At study sites where a multi-frequency bioimpedance spectroscopy instrument (BIS, Model SFB7, ImpediMed, Brisbane) was available, this was used. BIS technology allowed prediction of body fluid volumes (intra- and extracellular water as well as total body water) at the theoretically optimal frequencies, providing precision and accuracy not achievable using the simpler BIA device that operates at a single compromise frequency [26]. Prediction of body fluid volumes is particularly important in this study population at all stages of CKD - from hyperfiltration with "normal" renal function to ESKD (excluding dialysis). It is also worthy to note that BIS provides measures of both intra-and extracellular water spaces and since muscle mass is strongly related to intracellular water space this will provide the opportunity to assess whether predictive power can be increased by inclusion of this variable in GFR formulae.
BIA/BIS was not performed if a participant had an indwelling electrical device (such as cardiac pacemaker). Participants were asked to void (empty bladder) prior to the assessment. Assessment was performed after 5 minutes rest in the supine position with limbs abducted away from the trunk, ensuring that thighs were not touching. Eight electrodes (electrocardiograph-style gel electrodes) were placed on bilateral dorsal surfaces of hands and feet (two electrodes on each hand and foot); after the surface was cleansed with an alcohol wipe. At the wrist, the proximal electrode was placed in the midline of the ulnar styloid process and the distal electrode was placed 5 cm distal to the proximal electrode. At the ankle, the proximal electrode was placed at the midpoint between the medial and lateral malleoli and the distal electrode was placed 5 cm distal to the proximal electrode. Whole body and segmental impedance measurements were according to previously described methods [27].
DXA Sub-study: Further assessment of body composition by dual-energy X-ray absorptiometry (DXA) assessment of total body fat mass, lean mass, bone mineral content and bone density was performed according to standard techniques in sites where this imaging technique was available: Darwin, Perth and Torres Strait. DXA is a reference method for assessing body composition but impedance methods, particularly inexpensive single frequency BIA, are much more practical in remote locations (where DXA is indeed not possible/available). Hence, the aim of the sub-study comparing DXA and BIA was to see if BIA is a reasonable substitute for DXA, thereby enabling body composition assessment in remote communities. In the present study all participants had body composition measured by BIA or BIS and anthropometry, and a subset (Darwin, Perth and Torres Strait) also had DXA measurements. The DXA data will be used to validate the impedance data.
Questionnaires:
a. Medical history & medications - self report and from medical records (where available) including assessment of cigarette smoking: current status, past history and self-reported quantity.
b. Assessment of socio-economic status and related personal details by brief questionnaire: usual place of residence, first language, language spoken at home, ethnicity of grandparents, income source, ever worked, education level, number of bedrooms and occupants in house, housing tenure and landlord type.
Feedback to participants was provided at the end of the examination. Brief intervention regarding diet, physical activity and health behaviours in particular smoking, was provided. Participants with unexpected abnormal results were referred immediately to the appropriate health care provider. In addition, written results were provided in a plain language and culturally appropriate manner to individual participants and to their nominated primary health care provider. Whenever possible, participants with abnormal results were first contacted by telephone or in person. The results packet was then mailed or hand-delivered, as appropriate. A $50 gift voucher to a local store was provided to participants with their results as a gift of appreciation for their participation in the study. Participants were not informed of this gift prior to their participation in the study and it was not used as an incentive to recruit participants to the study. The gift was agreed upon by study investigators after it was suggested by several key organisations in our community consultation: Kimberley Aboriginal Medical Services Council and Wuchopperen Health Service. Permission to give the gift was approved by all relevant Human Research Ethics Committees.
Laboratory methods
Collected blood samples were centrifuged for 10 min at 3000 revolutions per min (RPM) within 4 hours of collection. If unable to be centrifuged immediately, blood was stored in a cool environment (fridge or esky) until centrifugation occurred. Following centrifugation, samples were transported on ice to be stored at -80 degree freezer. For samples collected in remote locations, storage for transportation was either on dry ice or in liquid nitrogen ("Biological Shipper", CryoPak Series, Taylor-Wharton, AL, USA). Samples collected on Thursday Island, Queensland were stored at -30 degree for 2-14 days prior to transportation on dry ice to a -80 degree freezer in Cairns.
Serum creatinine and other metabolite assays were performed at each centre as part of standard clinical care. The creatinine assay at each centre was confirmed to have claimed traceability to the Isotope Dilution Mass Spectrometry (IDMS) reference method. The method and instrument used for measurement of each biochemical measure performed at each site are outlined in Table 1.
Table 1 Analysis of blood and urine samples
In addition, serum creatinine will be measured in all samples at Austin Health, using the kinetic Jaffe method and the Roche enzymatic method on a Beckman-Coulter DxC 800 analyser (Fullerton, CA, USA). Beckman-Coulter claims traceability for its Jaffe methods to the IDMS reference method as it does for the Roche enzymatic method. The Roche enzymatic method has been used as a reference method for the revision of the MDRD formula for IDMS aligned assays [28] and has undergone local independent validation [29]. Creatinine will be measured by both the Jaffe and enzymatic methods as many laboratories in Australia measure creatinine with a Jaffe method. This approach will allow for a calibration and standardization of the Jaffe methods against the enzymatic method and assessment of variability caused by the use of different routine methods. Cystatin C will be measured using an automated particle-enhancing immunonephelometric assay on a BN II instrument (Dade Behring, Marburg, Germany). The intra- and interassay CVs for cystatin C were 2.58 and 3.95%, respectively, at a concentration of 1.54 mg/l. Cystatin C measures will be transformed to a GFR equivalent using the formua Cys-GFR = (86.7/cystatin C -4.2). This Cys-GFR method has been validated as an accurate marker of renal function across a wide-range of GFR values using isotopic GFR measurements (plasma dissapearance of 99 mTc-DTPA) as the reference method [18, 30].
Iohexol was measured by Austin Health, Melbourne using a validated HPLC assay modified from Niculescu-Duvaz et al [31]. Plasma samples were extracted using a solution of 5% perchloric acid containing internal standard (sodium diatrizoate). Chromatographic separation was achieved using a Microsorb MV C18 5 μ column (Varian Australia) and detection at 244 nm. Analyte concentrations were calculated by comparison to multipoint linear standard curves derived from plasma samples spiked to contain between 3.125 and 800 μg/mL Iohexol (reference material, US Pharmacopoeia). The lower limit of quantitation was 3.125 μg/mL. Intra- and inter-assay performance was assessed using donor plasma spiked with low (20 μg/mL), medium (100 μg/mL) and high (400 μg/mL) concentrations of Iohexol. Precision studies showed a Coefficient of Variation of 1.0% or less, and inaccuracy ± 4.5% or less.
Samples were stored for analysis at a later date for: adiponectin and urine cotinine. For participants of the DXA sub-study, samples have been stored for analysis of 25-hydoxy Vitamin D and parathyroid hormone and bone turnover markers.
Data handling and statistical methods
At the time of baseline assessment, data was collected on paper forms and then entered into a Microsoft Access database. Data from each site is stored securely at Menzies School of Health Research. All statistical analysis will be performed using the latest available release of Stata software (Stata Corporation, College Station, TX). The predictive performance of formulae methods to estimate GFR will be compared to the reference GFR in terms of precision, bias and accuracy according to the methods of Bland-Altman [32]. The percentage of estimated GFR within 30% of measured GFR will also be determined. If required, new prediction equations will be developed in a "training sample", with their veracity then being tested in a "validation" sample. This will be achieved by randomly dividing the study population into two subgroups, balanced across the five strata. Sample size was determined using the methods of Bland-Altman [32, 33] so that the limits of 95% confidence intervals for the mean were equal to pre-specified acceptability limits (a 10% difference in GFR was considered to be acceptable). Sample size was calculated at 600 Indigenous participants across 4 sites (approximately 150 at each site), with considerable heterogeneity in body builds and composition expected both within and between sites. Regression equations will be derived using a similar approach to that used to develop the original MDRD equations [34]. In addition, for the body composition substudy (DXA vs. BIA), we will be able to detect a difference ≥ 2% in fat free mass (FFM) estimated by the two methods, with a power >90% based on a sample size of 300, alpha = 0.05 and a CV of 10% in FFM.
Detailed analysis of demographic, clinical, biochemical and socioeconomic factors associated with CKD will involve cross-sectional analysis of the associations between these factors and current GFR. After determining univariate associations between variables, established risk factors and variables with p < 0.2 on univariate analysis will be selected for entry into logistic regression models using the backwards selection method, the outcome variable being current GFR/CKD stage. The degree of coupling of GFR and albuminuria will be determined in participants with type 2 diabetes (after accounting for the use of inhibitors of the renin-angiotensin system). We have recently shown that there is a relatively high prevalence of non-albuminuric renal insufficiency in non-Indigenous participants with type 2 diabetes [35] and preliminary evidence suggests that the prevalence of non-albuminuric renal insufficiency is lower in Indigenous than non-Indigenous diabetic Australians [36].
This study was designed with respect to what is practical and achievable in very remote regions of Northern, Western and Central Australia. The choice of reference measure of GFR was limited by our remote setting and the available time of participants. Nuclear medicine facilities are not available in the vast majority of sites where this project was conducted. Study investigators agreed that 4-hour plasma disappearance of iohexol was the most appropriate reference measure of GFR for the remote setting. The benefits of this reference measure are that it is practical, safe, stable and reproducible [37, 38]. In addition, several investigators had experience with use of this measure in the non-Indigenous urban setting (Melbourne) with accurate comparison to 99 mTc-DTPA in participants with diabetes [39]. Based on previous experience of investigators in Indigenous health research, we agreed that a reference measure that required more than 4 hours of participants time would not be practical or achievable.
A potential limitation of our study is the use of Iohexol clearance from serum as the formal GFR measurement as opposed to the use of urinary clearance of iothalamate as the reference method used in the MDRD and CKD-EPI studies [16, 34]. Iohexol serum clearance was however used in two studies used in the CKD-EPI validation group [40, 41] however the limitation of 4 hours for the studies has the potential to increase inaccuracy in subjects with reduced GFR [40].
The study has encountered several operational challenges to date that have been successfully managed. The first challenge is the significant labour intensity required to recruit each participant and the associated expenses. The proportion of eligible participants approached by the study team, who subsequently consented to and successfully completed the study, varied by site from approximately 30% in urban centres to up to 70% in some remote communities. We managed this challenge by adapting recruitment sites to those that had a higher success rate of obtaining complete data sets and expanding networks and recruitment sites beyond health service providers, e.g. Aboriginal Hostels Limited (provide temporary and transit accommodation in urban and regional centres).
The second challenge encountered by the eGFR study team was to recruit a diverse sample of participants including people living remotely and with poor access to regular medical services. We managed this challenge by: targeting a range of communities or regions; targeting remote-living individuals whilst they were visiting regional centres (Darwin, Katherine and Nhulunbuy: health and non-health service sites); and selection of participants, stratified by study design, using electronic health record data held by urban and remote health services.
The third challenge was to conduct recruitment in such a way to facilitate complete data collection, in particular complete 4 hour reference GFR measures. We commenced recruitment of participants in association with outpatient renal clinics (urban and regional). In the regional setting other commitments for remote participants within the 4-hour duration of the study resulted in non-completion of the reference GFR measures. Reasons included the need to catch transport home (usually a plane) or logistic constraints such as inclement weather conditions. The study recruitment strategy was subsequently changed so that the eGFR study team travelled to remote communities to perform the study in "batches" of 1-3 weeks duration. This strategy was superior in terms of numbers of participants recruited and proportion of participants with complete 4 hour reference GFR measures.
This study should provide evidence for clinical guidelines in a field where evidence is currently lacking: a validated methodology to accurately assess renal function in diverse populations of Indigenous Australians. We expect to determine a validated and practical measure of GFR suitable for use in all Indigenous Australians. This may be cystatin C or eGFR (using MDRD or CKD-EPI formula with/without suitable revision). This measure would enable development of appropriate protocols for investigation and management of CKD and subsequent improvements in clinical practice. We believe that the MDRD- or CKD-EPI derived method (modified as appropriate) is likely to emerge as the cheapest and most widely assessable means of estimating GFR in the immediate future. It seems unlikely that a single correction factor (similar to that for Afro-Americans) is appropriate or practical for Indigenous Australians. However, it may be that a modification of the MDRD or CKD-EPI equation for Indigenous Australians (or for any population) would be to include a measure of fat-free mass. This measure may be obtained by measuring body composition using a simple, portable and inexpensive method such as BIA, once it has been suitably validated against DXA. Thereby this study may improve the utility of eGFR, using a modified MDRD or CKD-EPI formula, across different populations with different body builds and compositions. Our revised formula for eGFR may indeed be of use for assessing kidney function in the broader Australian community, particularly those of variable body builds and/or eGFR>60 ml/min/1.73 m2.
Zhao Y, Dempsey K: Causes of inequality in life expectancy between Indigenous and non-Indigenous people in the Northern Territory, 1981-2000: a decomposition analysis. Med J Aust. 2006, 184: 490-494.
Heart, stroke and vascular disease: Australian facts 2004. Cardiovascular Disease Series, No. 22. 2004, Canberra, Australian Institute of Health and Welfare and National Heart Foundation of Australia
O'Dea K, Patel M, Kubisch D, Hopper J, Traianedes K: Obesity, diabetes, and hyperlipidemia in a central Australian aboriginal community with a long history of acculturation. Diabetes Care. 1993, 16: 1004-1010. 10.2337/diacare.16.7.1004.
ANZDATA Registry Report: Edited by: McDonald S, Excell L, Livingston B. 2009, Adelaide, Australia and New Zealand Dialysis and Transplant Registry
Cass A, Cunningham J, Wang Z, Hoy W: Regional variation in the incidence of end-stage renal disease in Indigenous Australians. Med J Aust. 2001, 175: 24-27.
Rutishauser IH: Body composition in Aboriginal Australians. Asia Pac J Clin Nutr. 1995, 4: 73-76.
Piers LS, Rowley KG, Soares MJ, O'Dea K: Relation of adiposity and body fat distribution to body mass index in Australians of Aboriginal and European ancestry. Eur J Clin Nutr. 2003, 57: 956-963. 10.1038/sj.ejcn.1601630.
Cass A, Cunningham J, Snelling P, Wang Z, Hoy W: End-stage renal disease in indigenous Australians: a disease of disadvantage. Ethn Dis. 2002, 12: 373-378.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2005, 39: S1-266. 10.1016/S0272-6386(02)70081-4.
Ninomiya T, Perkovic V, de Galan BE, Zoungas S, Pillai A, Jardine M, Patel A, Cass A, Neal B, Poulter N, Mogensen CE, Cooper M, Marre M, Williams B, Hamet P, Mancia G, Woodward M, Macmahon S, Chalmers J: Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes. J Am Soc Nephrol. 2009, 20: 1813-1821. 10.1681/ASN.2008121270.
Astor BC, Hallan SI, Miller ER, Yeung E, Coresh J: Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. Am J Epidemiol. 2008, 167: 1226-1234. 10.1093/aje/kwn033.
Mathew TH: Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement. Med J Aust. 2005, 183: 138-141.
Jose MD, Lawton PD: Chronic kidney disease and automatic reporting of estimated glomerular filtration rate. Med J Aust. 2006, 184: 42-
Zuo L, Ma YC, Zhou YH, Wang M, Xu GB, Wang HY: Application of GFR-estimating equations in Chinese patients with chronic kidney disease. Am J Kidney Dis. 2005, 45: 463-472. 10.1053/j.ajkd.2004.11.012.
Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P: Predictive Performance of the Modification of Diet in Renal Disease and Cockcroft-Gault Equations for Estimating Renal Function. J Am Soc Nephrol. 2005, 16: 763-773. 10.1681/ASN.2004070549.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J: A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009, 150: 604-612.
Dharnidharka VR, Kwon C, Stevens G: Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis. Am J Kidney Dis. 2002, 40: 221-226. 10.1053/ajkd.2002.34487.
MacIsaac RJ, Tsalamandris C, Thomas MC, Premaratne E, Panagiotopoulos S, Smith TJ, Poon A, Jenkins MA, Ratnaike SI, Power DA, Jerums G: Estimating glomerular filtration rate in diabetes: a comparison of cystatin-C- and creatinine-based methods. Diabetologia. 2006, V49: 1686-1689. 10.1007/s00125-006-0275-7.
Madero M, Sarnak MJ, Stevens LA: Serum cystatin C as a marker of glomerular filtration rate. Curr Opin Nephrol Hypertens. 2006, 15: 610-616. 10.1097/01.mnh.0000247505.71915.05.
DuBois D, DuBois EF: A formula to estimate the approximate surface area if height and weight be known. Arch Int Med. 1916, 17: 863-871.
Brochner-Mortensen J: A simple method for the determination of glomerular filtration rate. Scand J Clin Lab Invest. 1972, 30: 271-274. 10.3109/00365517209084290.
Mathew TH, Johnson DW, Jones GR: Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: revised recommendations. Med J Aust. 2007, 187: 459-463.
Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron. 1976, 16: 31-41. 10.1159/000180580.
Norton K, Olds T: Anthopometrica. 1996, UNSW Press
Lohman TG, Roche AF, Martorell R: Anthropometric standardization reference manual. 1988, Human Kinetics Books
Thomas BJ, Ward LC, Cornish BH: Bioimpedance spectrometry in the determination of body water compartments: accuracy and clinical significance. Appl Radiat Isot. 1998, 49: 447-455. 10.1016/S0969-8043(97)00052-3.
Cornish BH, Jacobs A, Thomas BJ, Ward LC: Optimizing electrode sites for segmental bioimpedance measurements. Physiol Meas. 1999, 20: 241-250. 10.1088/0967-3334/20/3/302.
Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, Van Lente F: Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem. 2007, 53: 766-772. 10.1373/clinchem.2006.077180.
Peake M, Whiting M: Measurement of serum creatinine - current status and future goals. Clin Biochem Rev. 2006, 27: 173-184.
Premaratne E, MacIsaac RJ, Finch S, Panagiotopoulos S, Ekinci E, Jerums G: Serial measurements of cystatin C are more accurate than creatinine-based methods in detecting declining renal function in type 1 diabetes. Diabetes Care. 2008, 31: 971-973. 10.2337/dc07-1588.
Niculescu-Duvaz I, D'Mello L, Maan Z, Barron JL, Newman DJ, Dockrell MEC, Kwan JTC: Development of an outpatient finger-prick glomerular filtration rate procedure suitable for epidemiological studies. Kidney Int. 2006, 69: 1272-1275. 10.1038/sj.ki.5000240.
Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986, 1: 307-310.
Altman DG, Bland JM: Measurement in Medicine: the Analysis of Method Comparison Studies. The Statistician. 1983, 32: 307-317. 10.2307/2987937.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999, 130: 461-470.
MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ, McNeil KJ, Jerums G: Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care. 2004, 27: 195-200. 10.2337/diacare.27.1.195.
Thomas MC, Weekes AJ, Broadley OJ, Cooper ME: The assessment of kidney function by general practitioners in Australian patients with type 2 diabetes (NEFRON-2). Med J Aust. 2006, 185: 259-262.
Brown SC, O'Reilly PH: Iohexol clearance for the determination of glomerular filtration rate in clinical practice: evidence for a new gold standard. J Urol. 1991, 146: 675-679.
Gaspari F, Perico N, Ruggenenti P, Mosconi L, Amuchastegui CS, Guerini E, Daina E, Remuzzi G: Plasma clearance of nonradioactive iohexol as a measure of glomerular filtration rate. J Am Soc Nephrol. 1995, 6: 257-263.
Houlihan C, Jenkins M, Osicka T, Scott A, Parkin D, Jerums G: A comparison of the plasma disappearance of iohexol and 99 mTc-DTPA for the measurement of glomerular filtration rate (GFR) in diabetes. Aust N Z J Med. 1999, 29: 693-700.
Grubb A, Nyman U, Bjork J, Lindstrom V, Rippe B, Sterner G, Christensson A: Simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem. 2005, 51: 1420-1431. 10.1373/clinchem.2005.051557.
Mauer M, Zinman B, Gardiner R, Drummond KN, Suissa S, Donnelly SM, Strand TD, Kramer MS, Klein R, Sinaiko AR: ACE-I and ARBs in early diabetic nephropathy. J Renin Angiotensin Aldosterone Syst. 2002, 3: 262-269. 10.3317/jraas.2002.048.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/10/80/prepub
The authors gratefully acknowledge the support of eGFR study participants, study staff, and partner organisations. The eGFR Study was funded by the National Health and Medical Research Council of Australia (NHMRC, Project Grant #545202), with additional support from Kidney Health Australia, Colonial Foundation, Rebecca L Cooper Foundation and SeaSwift, Thursday Island. LMB was supported by NHMRC Program Grant #320860 and the Centre of Clinical Research Excellence in Clinical Science in Diabetes, University of Melbourne. Alan Cass holds a Senior Research Fellowship from the NHMRC. Funding bodies had no role in the study design, in the collection, analysis or interpretation of data, in the writing of the manuscript or the decision to submit the manuscript for publication.
Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
Louise J Maple-Brown, Jaquelyne T Hughes, Suresh K Sharma & Katrina Drabsch
Division of Medicine, Royal Darwin Hospital, Darwin, Australia
Louise J Maple-Brown & Paul D Lawton
Chemical Pathology, St Vincent's Hospital, Sydney, Australia
Graham RD Jones
Department of Medicine, Austin and Northern Health, University of Melbourne, Heidelberg, Victoria, Australia
Andrew G Ellis
Centre for Chronic Disease, The University of Queensland, Australia
Wendy Hoy
The George Institute for International Health, University of Sydney, Sydney, Australia
Alan Cass
Department of Endocrinology, Endocrine Centre Austin Health & University of Melbourne, Heidelberg Repatriation Hospital, Heidelberg West, Victoria, Australia
Richard J MacIsaac, Sianna Panagiotopoulos & George Jerums
Endocrine and Diabetes Unit, Cairns Base Hospital, Queensland, Australia
Ashim K Sinha
Department of Nephrology, Royal Perth Hospital, Perth, Australia
Mark AB Thomas & Kevin Warr
Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne, Australia
Leonard S Piers
School of Chemistry and Molecular Biosciences, The University of Queensland, Australia
Leigh C Ward
Sansom Institute for Health Research, UniSA, Adelaide, Australia
Robyn McDermott & Kerin O'Dea
Department of Renal Medicine, Alice Springs Hospital, Alice Springs, Australia
Sajiv Cherian
Baker IDI Heart and Diabetes Institute, Alice Springs, Australia
Alex Brown
Louise J Maple-Brown
Paul D Lawton
Jaquelyne T Hughes
Suresh K Sharma
Richard J MacIsaac
Mark AB Thomas
Katrina Drabsch
Sianna Panagiotopoulos
Robyn McDermott
Kevin Warr
George Jerums
Kerin O'Dea
Correspondence to Louise J Maple-Brown.
LCW has consults to Impedimed Ltd. Impedimed Ltd. had no involvement, financial or otherwise, in the conception and execution of this study or in the preparation of the manuscript.
All remaining authors declare that they have no competing interests.
LMB drove the design of the study protocol for funding and Ethics applications, coordinated data collection and data management, analysed the data and drafted the manuscript. PL, RM, GJe, AS, KOD conceived of the study and participated in its design. SS was the study manager and participated in study design, ethics applications, data collection and data management. JH participated in study design, data collection and data management. GJo, AE, WH, AC participated in study design. MT, KW, CS participated in the design of the study and provided clinical expertise during the design and data collection phases. LP, LW, RMcD, AB participated in study design. All authors were involved in revising the manuscript for important intellectual content and read and approved the final manuscript.
Maple-Brown, L.J., Lawton, P.D., Hughes, J.T. et al. Study Protocol - Accurate assessment of kidney function in Indigenous Australians: aims and methods of the eGFR Study. BMC Public Health 10, 80 (2010). https://doi.org/10.1186/1471-2458-10-80
Glomerular Filtration Rate
Isotope Dilution Mass Spectrometry

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Autosearch is not working default magento search work using hit enter key or submit button.but now i need this search work only for pressing submit button and not work for hit enter key.For this am added the below js code in form.mini.phtml file
<script type="text/javascript">
    jQuery(document).ready(function() {
        jQuery("#search_mini_form").bind("keypress", function(e) {
            if (e.keyCode == 13) {
                return false;
            }
        });
    });
</script>

but this code is not working when there is the code for autocomplete
//<![CDATA[
        var searchForm = new Varien.searchForm('search_mini_form', 'search', '');
        searchForm.initAutocomplete('<?php echo $catalogSearchHelper->getSuggestUrl() ?>', 'search_autocomplete');
    //]]>

By removing this autocomplete code the above code works correctly.But i need both codes work correctly(i need autocomplete property also).I am using magento 1.9.2.0

A: I have checked it on my local machine and its working with both the code.
Please use below code.
<script type="text/javascript">
//<![CDATA[
    var searchForm = new Varien.searchForm('search_mini_form', 'search', '');
    searchForm.initAutocomplete('<?php echo $catalogSearchHelper->getSuggestUrl() ?>', 'search_autocomplete');
    jQuery(document).ready(function() {
        jQuery("#search_mini_form").bind("keypress", function(e) {
            if (e.keyCode == 13) {
                return false;
            }
        });
    });
//]]>
</script>

It disables the enter key press and also keeps default autocomplete functionality working.
UPDATES
I have checked the issue and found below.
the function initAutocomplete is defined in js/varien/js.js file. which is like below.
initAutocomplete : function(url, destinationElement){
    new Ajax.Autocompleter(
        this.field,
        destinationElement,
        url,
        {
            paramName: this.field.name,
            method: 'get',
            minChars: 2,
            updateElement: this._selectAutocompleteItem.bind(this),
            onShow : function(element, update) {
                if(!update.style.position || update.style.position=='absolute') {
                    update.style.position = 'absolute';
                    Position.clone(element, update, {
                        setHeight: false,
                        offsetTop: element.offsetHeight
                    });
                }
                Effect.Appear(update,{duration:0});
            }

        }
    );
}

This function makes a call to _selectAutocompleteItem function which is also defined in the same file,
_selectAutocompleteItem : function(element){
    if(element.title){
        this.field.value = element.title;
    }
    this.form.submit();
}

Here, you can find code this.form.submit(); which is responsible for form submission. If you comment out the code like,
_selectAutocompleteItem : function(element){
    if(element.title){
        this.field.value = element.title;
    }
    //this.form.submit();
}

It will work as per your requirements. I can't find a way to override the _selectAutocompleteItem function.

redpajama_set_name: RedPajamaStackExchange


The inspiration has been taking from, Glasgow GB. The project is made with a focus on sustainability – it strives to make the user keep the products for a long time. The collection includes one tablecloth, four placemats and four napkins. All nine textiles works well tougher, the collection can be mixed crossing.


text:
La communauté de communes du Ribéracois (CCR) est une ancienne communauté de communes française située dans le département de la Dordogne, en région Aquitaine.

Historique

La communauté de communes du Ribéracois a été créée le .

Au  janvier 2013, les communes de Bertric-Burée et Chassaignes la rejoignent.

Par arrêté  du 6 décembre 2012, un projet de fusion est envisagé entre la communauté de communes du Ribéracois, celle des Hauts de Dronne, celle du Val de Dronne et celle du Verteillacois. La nouvelle entité, effective le  janvier 2014, porte le nom de communauté de communes du Pays Ribéracois, renommée en 2019 en communauté de communes du Périgord Ribéracois.

Composition

En 2013, la communauté de communes du Ribéracois regroupait les communes suivantes :

 Allemans
 Bertric-Burée
 Bourg-du-Bost
 Chassaignes
 Comberanche-et-Épeluche
 La Jemaye
 Petit-Bersac
 Ponteyraud
 Ribérac
 Saint-André-de-Double
 Saint-Martin-de-Ribérac
 Saint-Méard-de-Drône
 Saint-Vincent-de-Connezac
 Siorac-de-Ribérac
 Vanxains
 Villetoureix

Politique et administration

Compétences

L'arrêté préfectoral  du 9 septembre 2013 redéfinit les compétences de la communauté de communes :

 Aménagement de l'espace.
 Développement économique.
 Protection et mise en valeur de l'environnement.
 Logement et cadre de vie.
 Voirie.
 Équipements culturels et sportifs, et d'enseignement préélémentaire et élémentaire.
 Action sociale.
 Prestations de service.

Notes et références

Sources
 Le SPLAF (Site sur la Population et les Limites Administratives de la France)
 La base ASPIC de la Dordogne - (Accès des Services Publics aux Informations sur les Collectivités)

Voir aussi

Articles connexes
 Liste des intercommunalités de la Dordogne

Liens externes
 Communauté de communes du Ribéracois

Riberacois

redpajama_set_name: RedPajamaWikipedia


text:
"The Day It Snowed in Miami"
On March 27, 2014 March 22, 2014 By str8gayconfessions
That's the title of a great documentary recently aired on the local PBS station down here in South Florida co-produced by the station and the Miami Herald which examined in painful detail the 1977 battle in Miami for gay rights. Heading the opposition was Anita Bryant, a former beauty queen, sometime entertainer, and the ad spokesperson at the time for the Florida orange juice industry, who was successful in galvanizing what became the Religious Right to block the ordinance that would have given gays in Miami protection under the law against discrimination.
Ironically, Bryant solidified what was a very uncoordinated gay activist movement into a powerhouse that twenty years later got the ordinance approved and helped shape the gay rights movement nation-wide (The title refers to the fact that the day the ordinance was defeated in 1977, snow fell on Miami for the first time in recorded history. Bryant, BTW, lost her job as the orange juice lady when gays mounted a boycott of orange juice and the growers just didn't want any more negative publicity.)
Fascinating was the archival footage of raids on Florida bars, news clips of witnesses at the public hearings denouncing gay as a "chosen" lifestyle, as if we entered a booth at twelve and a half and voted our sexual orientation, and interviews with the gay men and women who lived through those turbulent years and fought the good fight at risk of losing their jobs and being ostracized by society as some sadly were.
But I think the most telling – though not surprising – comment came from one of the warriors who today lectures gay youth and noted few know who Anita Bryant even was, and who think the free and breezy lifestyle we enjoy today always existed.
It reminds of the time one of my smarter students, working on an argumentative paper on gay marriage, came to me and commented that she was against same-sex unions since, after all, gays choose to be gay; or how many of my African American students were unaware that not so long ago there were colored restrooms and white restrooms and colored water fountains and white water fountains.
As I've said before, many of the gay youth of today have no idea what had come before and how many people fought and suffered to make today possible, from gay marriage right down to hooking up with somebody on Growl'r.
Even Anita Bryant's adult son, interviewed for the doc, (Anita herself declined) decades after it all happened when he was just a kid, concluded, "It's nobody's fault. It's just in the DNA, just like God made us."
On the Horizon: Low Income Housing for Gay Seniors
Wrapped or Unwrapped?


text:
Best Water Damage Restoration Services in Grand Prairie
Water Damage Restoration Services FAQs 〉
Water Damage Restoration Services FAQs
Send MessageMessage
911 Restoration of South Dallas
104 Lion Street, DeSoto, TX 75115
911 Restoration of South Dallas is a full-service disaster restoration company that assists with water damage repair near Grand Prairie. The business offers after-hours emergency assistance with rapid response times. Services include water extraction, dehumidifying, damage assessment and repair, black water sewage spill extractions, and mold detection and removal. In addition to water damage repair, the company's technicians are trained in sanitization procedures per CDC guidelines, and they utilize professional-grade products to eliminate bacteria, microbes, and viruses from structural surfaces.
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License Verified:
IICRC
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Compton's Cleaning & Restoration
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Compton's Cleaning & Restoration performs water damage restoration for residential and commercial properties in Grand Prairie. Using specialized equipment such as truck-mounted extraction units, moisture detectors, and hygrometers, the technicians can handle drying, deodorizing, and disinfecting properties damaged by gray, black, or sewage water. For carpet cleaning, they use the EPA-recommended hot water extraction or steam cleaning method. Established in 1991, Compton's Cleaning & Restoration seeks to commit to dependability by being on call 24/7 and designing cleaning programs to fit clients' individual needs.
2270 Springlake Rd, #120, Farmers Branch, TX 75234
Smoke & Fire Restoration
Disaster Restoration is a property cleaning and damage repair company that serves clients throughout Grand Prairie. The company aids clients affected by water damage from sewage overflow and flooding through water removal and area cleanup solutions. It offers odor removal and structural repair services to property owners dealing with fire and smoke damage. Colin Brown, the company's general manager, has spent more than 10 years in the property restoration industry. He is a former property claims adjuster for the insurance firm, Travelers Insurance.
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4.5 / 5 (182)
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Located in Grand Prairie, Mooring is a full-service construction and restoration company that has been restoring commercial properties damaged by water for many years. The company's clients include property management businesses, health care facilities, and government. Its services include removing all traces of water and moisture from the affected areas, recovering and restoring documents and media, making safe areas contaminated by biohazard materials, and rebuilding structures made unsafe by the disaster.
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Structural Drying
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Organic Home Service
8330 Lyndon B Johnson Fwy, Dallas, TX 75243
Organic Home Service is a contractor that offers restoration services for Grand Prairie residents. Its team restores water-damaged properties using drying equipment such as dehumidifiers and air movers, and its technicians monitor the drying process until moisture levels attain equilibrium moisture content. The restoration procedure also involves removing odors and sanitizing the premises. Organic Home Service provides a full range of cleaning services, which cover carpets, air ducts, and dryer vents. With a commitment to protecting the environment, it only uses plant-based cleaning products.
PuroClean
122 Rose Ln. Suite 103, Frisco, TX 75036
PuroClean is a full-service damage restoration company that serves clients in Grand Prairie. The firm assists homeowners and businesses in minimizing the impact of flooding and water disasters to their homes and establishments. Its water damage specialists identify the extent of the damage to determine the appropriate treatment for restoration. They utilize appropriate equipment and techniques for water extraction, drying, dehumidification, deodorization, and disinfection of the affected properties. Jim Bauer, the firm's founder, has been in the real estate business since the 1980s.
Rapid Restoration Texas Inc.
Rapid Restoration Texas Inc. provides emergency damage restoration services to residential and commercial property owners from Grand Prairie and the surrounding areas. Available 24/7, it mitigates and cleans up water damage through the use of commercial-grade drying equipment. It also provides fire and smoke restoration services, as well as mold remediation services. Additional services that the company offers include carpet, upholstery, and tile and grout cleaning. Rapid Restoration Texas Inc. is an IICRC-certified company.
Restoration-Aid Restoration
2516 Ruger Dr Unit #131, Arlington, TX 76006
Restoration-Aid Restoration is a locally owned and locally operated business that serves home and business owners in Grand Prairie and nearby areas. It specializes in water damage restoration, which covers situations involving leaks from bathroom appliances such as sinks, toilets, pipes, and showers. Equipped with IICRC certification, its team also restores flooded crawlspaces and properties damaged from roof and pipe leaks. Restoration-Aid Restoration's technicians each have at least four years of experience in water damage restoration.
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SERVPRO of Grand Prairie
2610 Aviation Pkwy, Grand Prairie, TX 75052
Servpro of Grand Prairie is a locally owned and operated company that specializes in water damage restoration in Grand Prairie and the surrounding areas. The company serves residential and commercial customers whose properties have been damaged by burst pipes, overflowing appliances, and storms. Its technicians use the latest technology to remove all traces of water and mold from properties, such as HEPA air filters and video camera borescopes. They also respond to emergency calls 24/7.
Servpro of North Arlington
251 SW Wilshire Boulevard #115-B, Burleson, TX 76028
SERVPRO of North Arlington is a locally owned and operated company that has been serving residential and commercial areas in Grand Prairie since 1992. Its water damage restoration service includes an assessment of the extent of the damage, water extraction, and structural drying. The company utilizes various technologies and equipment, such as infrared cameras, air movers, and dehumidifiers during the restoration. It also handles the cleaning and disinfecting to prevent the growth of harmful microorganisms in the affected areas.
SPC Construction & Roofing
1107 South Airport Circle Suite B, Euless, TX 76040
SPC Construction & Roofing is a company that serves residential and commercial clients in the Grand Prairie metro. It offers storm damage restoration services, which involve waterproofing and the repair of roofing and gutters damaged due to rainfall. Other services include roof maintenance, garage door replacement, fence repair and staining, insulation installation, interior and exterior painting, and window replacement. The company has over 30 years of experience in the construction, restoration, and roofing industries.
Lemmon Ave, Dallas, TX 75204
Serving homeowners throughout Grand Prairie, USA Clean Master offers full-service water damage restoration services. Its comprehensive suite of services includes property inspection, water removal and extraction, water damage clean-up and repair, and restoring and resettling. Additionally, the company offers carpet, rug, and upholstery cleaning, mold checkup, remediation, and prevention, and sanitizing services. Its technicians handle projects of all sizes and are available 24/7 for water damage emergencies. The company trains its new technicians for two months and partners with eco-friendly cleaning brands.
Water Damage Restoration Team-Houston
7107 Rancheria Dr, Houston, TX 77083
Water Damage Restoration Team-Houston is a contractor that serves the Grand Prairie area. Its team addresses water-damaged properties, whether the situation was caused by a flooded basement or a burst laundry line or pipe. The technicians extract water from the premises using sump pumps, and they remove soaked wooden floorboards and carpets. They also dry affected areas using blowers and commercial heaters. Water Damage Restoration also serves residents in Kansas City, Baton Rouge, and New Orleans.
What do I do after my home has been damaged by water?
In most cases, after your home has been damaged by water, the first thing you should do is attempt to remove as much water as possible by using a mop, wet/dry vac and dehumidifier, and opening windows. The next step is to document any damage with photos, videos and notes. Next, it's time to call your insurance company. Repairs for some kinds of water damage may be covered by your homeowners' insurance policy, so filing a claim as soon as possible is imperative. Damage from melting snow or burst pipes, for example, may be covered, while flooding may not, but you won't know for sure without reviewing plan documents with an insurance agent. Depending on the extent of damage, contacting a water damage restoration company may also be required.
Can I repair my water damaged furniture?
That depends on both the kind of furniture and the extent of the damage. Furniture made from plastic or metal may be easily salvageable, while wood furniture can be more problematic. In general, everything with upholstery should be thrown away, including couches, chairs, and mattresses. For sentimental or valuable pieces that aren't severely damaged, it may be possible to remove upholstery and padding and have it redone. A professional is recommended to ensure furniture is repaired and appropriately preserved.
How do I get rid of carpet odor from water damage?
Mold is a serious issue that is, unfortunately, quite common after water damage. Treating mold isn't negotiable. If it's present, it needs to be addressed as soon as possible. First, dry all areas and remove any items that have traces of mold. If you think there's a possibility that mold may be in the walls or floors, a professional water damage restoration company is likely necessary.
How do I fix a water damaged wood floor?
Standing water can permanently damage wood floors, so acting fast is essential. Dry all affected areas and remove signs of mold as soon as possible, using tools such as squeegees, mops, and shop vacuums. First, remove all surface water and use a cleaning solution to thoroughly clean boards. Remove any signs of mold, mop up all remaining water, and keep the area thoroughly vented until floors are completely dry. Sanding and refinishing may be required. If the damage appears to be severe, floors can't be adequately dried using tools available at home, or there are signs of significant corrosion, contact a water damage restoration company.
Does homeowners insurance cover water damage?
In many cases, insurance does cover water damage. This generally applies to incidental water damage, such as flooding from burst pipes. However, certain kinds of water damage likely won't be covered, which is particularly true for flooding in areas that require separate flood insurance. Always check with your insurance company about policy details before filing a claim.
What is contents restoration?
Contents restoration is very similar to personal property restoration. However, contents restoration is a term that's used to refer to restoration in a place of business. Depending on the service and any applicable insurance policies, contents restoration might cover items such as office furniture, equipment, and inventory. Items may need to be removed and cataloged before being brought to an off-site restoration location. Typically, the goal is to clean and restore the items so they don't look or smell damaged.
What type of water damage is covered by homeowners insurance?
While every insurance policy is different, it's usually safe to assume that a homeowners insurance policy will cover sudden and accidental damage that's the result of a plumbing malfunction, such as a ruptured water heater or a burst pipe. Depending on the insurance company and coverage amounts included in the policy, the entire cost of water cleanup and restoration may be covered, or the insurance provider may only help with some of the repairs, such as damp or moldy drywall or ceilings.
Of course, there are many variables involved, and often, many cases in which insurance companies do not cover water damage. For example, if an appliance has been leaking for some time and the homeowner hasn't taken necessary precautions, insurance companies typically aren't willing to cover the cost of water damage that results from a leak. Additionally, most insurance policies don't automatically include coverage for flood damage; however, flood insurance can often be purchased as a supplement to homeowners policies.
Does renters insurance cover water damage?
Just as with homeowners insurance, renters insurance policies vary from provider to provider. While some do include coverage for leaks due to frozen or broken pipes that occur suddenly and accidentally, many policies are quite basic and only cover the cost of personal property lost in a burglary. It's important for renters to take the time to understand what's covered by their insurance, and if their policy doesn't cover water damage, they may want to consider shopping around for supplemental coverage.
In some cases, the property owner's insurance may cover some damages to renters' personal effects in the event of a plumbing emergency or natural disaster. Renters should inquire with their landlord about what exactly their property policy covers to determine if they should purchase additional insurance in case of an unexpected emergency that results in water damage.
What is water mitigation?
Water damage mitigation is the term used to describe actions that may be taken to prevent excessive damage to property and belongings when water-related emergencies occur. It often includes:
Removing damaged property, including drywall and flooring
Extracting water and drying surfaces
Monitoring structural integrity, and taking precautions to prevent further damage, such as laying sandbags outside the home, tarping buildings, and boarding up windows
Water damage restoration is the process that occurs after water has been cleaned up and damages have been assessed. It includes tasks like repairing or replacing drywall and floors, eliminating mold, and testing the air for humidity to ensure no further damage will occur.
Does a home warranty cover water damage?
It depends on the cause. Some scenarios that might be covered by a home warranty include:
An appliance, such as the dishwasher or refrigerator, is faulty or wears out before the warranty expires
The plumbing wasn't installed correctly and leaks or bursts as a result
The roof leaks as a result of wear and tear while under warranty
Will Sheetrock dry out?
While Sheetrock, or drywall, with minor water damage may dry out, in most cases, drywall that's been water-damaged quickly becomes unusable. Once it becomes wet, it softens and its structural integrity may be compromised. Even after drying out, previously damp drywall can have hidden mold growth inside. After drywall gets wet, a water damage restoration pro can assess the damage and recommend the best course of action.
How do I check for water damage?
There are several signs you can watch for in the home to determine if water damage may be present. This includes:
Water rings on the ceiling
Soft spots on the floor
Tile, laminate, wood floors, or countertops that are cracking or warped
Warping or discoloration around pipes
Rust on the hot water heater or any of the pipes/plumbing throughout the home
A moldy or mildewy smell
What is cat 3 water?
Category 3 water is water that contains dangerous contaminants, such as heavy metals, pesticides, or toxic organic waste. This type of water can seep into the home through sewer backups or overflows, or as a result of groundwater overflow or natural disasters. Cat 3 water can be extremely hazardous and as such, removal and cleanup must be completed by water damage restoration professionals.
How long does water damage restoration take?
When it comes to carpet and drywall, homeowners can expect the drying-out process to take a minimum of 72 hours. Once that process is complete, water damage restoration professionals can quickly assess the damage and begin repairs and reconstruction. The amount of time this takes depends on the size of the job, but in most cases, construction on a single room or floor of a home can be completed within one to two weeks.
How bad is water damage to a house?
In some cases, water damage isn't a huge deal. Minor issues, such as a leaky toilet or appliance, can typically be stopped quickly, and damage can be corrected in a matter of hours, provided the leak was caught soon enough. However, when large-scale water damage occurs, the consequences can be detrimental. Leaks that are left untreated, burst pipes or water heaters, natural disasters, and floods can all result in serious damage to the home's structure and may require considerably more money and time to restore.
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UNDER THE PICKLE TREE is a boutique producer of Asian-inspired pickles, relishes, curry pastes, marinades and salad dressings. The range is sold mainly from Victorian Farmers Markets and selected retailers. The product range pays homage to age-old pickling traditions inherited from grandparents and truly unique recipes inspired by proprietor Kelly Meredith's time living and working in Thailand and Vietnam.
EVERY UNDER THE PICKLE TREE JAR is handmade in small batches in rural Panton Hill at a council-registered kitchen. All products have been batch tested for shelf life at Food Laboratories in Abbotsford - with citric acid the only preservative. The small batches means the products are a flavour sensation - the curry pastes are restaurant quality and are never more than six months old when purchased.
VISIT US and taste the products at Hurstbridge Farmers Market (1st Sunday), Alphington Farmers Market (2nd Sunday, starting May), Carlton Farmers Market (3rd Saturday) and Kingsbury Drive Community Market, Latrobe Uni (4th Sunday). It is usual for Kelly to cook up a storm featuring one of our products for inspiration and post the recipe that day on Facebook.
FOR RECIPE INSPIRATION visit our Recipe Page or Kelly's Facebook page. Want to buy online –simply click the Farmhouse Direct icon and visit Under the Pickle Tree's online store or go to the stockists page for current retailers.


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CFO Jimmy Patronis Announces More Than $24 Million Returned to Floridians in May by the Division of Unclaimed Property
For Immediate Release: Monday, June 8, 2020
Contact: Office of Communications, Communications@MyFloridaCFO.com, 850.413.2842
TALLAHASSEE, Fla. – Today, Chief Financial Officer (CFO) Jimmy Patronis announced that more than $24 million was returned to Florida's residents and businesses during the month of May by the Division of Unclaimed Property. Since taking office in July 2017, CFO Patronis has recovered and returned more than $961 million to Floridians. This fiscal year, Florida's Division of Unclaimed Property has returned over $317 million.
CFO Jimmy Patronis said, "I'm extremely pleased to announce that more than $24 million in Unclaimed Property has been returned to Floridians during the month of May. Since the COVID-19 pandemic began, Florida's Division of Unclaimed Property has worked tirelessly and returned more than $95 million to the pockets of Floridians when they needed it most. I'm looking forward to continuing this great trajectory and working to make 2020 a record-high year for returns. Individuals and businesses can start your search now at FLTreasureHunt.gov."
Unclaimed Property is a financial asset that is unknown or lost, or has been left inactive, unclaimed or abandoned by its owner. The most common types of unclaimed property are dormant bank accounts, unclaimed insurance proceeds, stocks, dividends, uncashed checks, deposits, credit balances and refunds. Unclaimed property also includes contents from abandoned safe deposit boxes in financial institutions. Unclaimed property assets are held by business or government entities (holders) for a set period of time, usually five years. If the holder is unable to locate, re-establish contact with the owner and return the asset, it is reported and remitted to the Florida Department of Financial Services, Division of Unclaimed Property.
To search for unclaimed property or to claim an account, go online to FLTreasureHunt.gov.
Chief Financial Officer and State Fire Marshal Jimmy Patronis is a statewide elected official and a member of Florida's Cabinet who oversees the Department of Financial Services. CFO Patronis works each day to fight insurance fraud, support Florida's firefighters, and ensure the state's finances are stable to support economic growth in the state. Follow the activities of the Department on Facebook (FLDFS) and Twitter (@FLDFS).