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Effects of non-supervised low intensity aerobic excise training on the microvascular endothelial function of patients with type 1 diabetes: a non-pharmacological interventional study Academic research paper on "Medical engineering"
BMC Cardiovasc Disord
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Academic research paper on topic "Effects of non-supervised low intensity aerobic excise training on the microvascular endothelial function of patients with type 1 diabetes: a non-pharmacological interventional study"
de Moraes et al. BMC Cardiovascular Disorders (2016) 16:23 DOI 10.1186/s12872-016-0191-9
BMC Cardiovascular Disorders
RESEARCH ARTICLE Open Access
Effects of non-supervised low intensity aerobic excise training on the microvascular endothelial function of patients with type 1 diabetes: a non-pharmacological interventional study
Roger de Moraes1,2,4, Diogo Van Bavel1,2, Marilia de Brito Gomes3 and Eduardo Tibiriga1,2*
Background: The aim of the present study was to evaluate changes in microvascular density and reactivity in patients with type 1 diabetes (T1D) resulting from low intensity chronic exercise training.
Methods: This study included 22 (34 ± 7 years) consecutive outpatients with T1D and disease duration > 6 years. We used intravital video-microscopy to measure basal skin capillary density and capillary recruitment using post-occlusive reactive hyperemia (PORH) in the dorsum of the fingers. Endothelium-dependent and -independent vasodilation of the skin microcirculation was evaluated in the forearm with a laser Doppler flow monitoring (LDF) system in combination with acetylcholine and sodium nitroprusside iontophoresis, PORH and local thermal hyperemia. Results: The basal mean capillary density (MCD) after exercise training was significantly higher than before exercise (134 ± 25 vs. 119 ± 19 capillaries/mm2, respectively; P = 0.0013). MCD during PORH was also higher after exercise (140 ± 26 vs. 121 ±24 capillaries/mm2, respectively; P < 0.0001). Endothelium-dependent capillary recruitment during PORH was also significantly higher after exercise (140 ± 26 vs. 134 ± 25 capillaries/mm2, respectively; P < 0.0012). There were no significant changes in skin microvascular reactivity after exercise as investigated using LDF.
Conclusions: Our results showed that low intensity aerobic exercise, performed four times per week for 12 weeks by patients with T1D, induces significant increases in microvascular density and endothelial-dependent capillary reactivity. Trial registration: ClinicalTrials.gov NCT02441504. Registered 7 May 2015.
Keywords: Exercise training, Microvascular rarefaction, Endothelial dysfunction, Laser Doppler flowmetry
Type 1 diabetes mellitus (T1D) is an autoimmune disease whose clinical manifestations are characterized by extensive damage to the macro and microcirculation. It is believed that the loss of glycemic control that occurs during the disease is responsible for functional and structural vascular alterations, contributing to significant increases
* Correspondence: etibi@ioc.fiocruz.br
1NationalInstitute of Cardiology, Rio de Janeiro, Brazil
2Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, Av. Brasil,
4365, 21045-900 Rio de Janeiro, Brazil
Fulllist of author information is available at the end of the article
(3 BioMed Central
in the risk of morbidity and mortality in this group of individuals [1-4].
Through the induction of oxidative stress, inflammation and the formation of nonenzymatic advanced glycation end products (AGEs), hyperglycemia can cause microvascular abnormalities that impair tissue nutrition [5, 6]. In this context, from the beginning of the disease, patients with T1D present with widespread precapillary vasodila-tion and tissue hypoxia, which promotes compensatory increases in the level of vasoactive substances and chronic elevation of the microvascular blood flow, resulting in morphological and functional changes associated with capillary rarefaction [7-12].
© 2016 de Moraes et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
In spite of the positive effects of anti-hyperglycemic therapy [13] and drugs that attenuate inflammation and oxidative stress [14], chronic aerobic exercise has been shown to exert anti-inflammatory, anti-hyperglycemic and anti-oxidant effects [15]. Moreover, exercise training contributes to an increase in capillary density in patients with T1D [16]. In fact, aerobic training is often incorporated into T1D treatment therapies [17-20] because it can prevent undesirable morphological changes and, through the processes of arteriogenesis and angiogenesis, restore and expand the vascular reactivity and tissue perfusion that are otherwise impaired by the disease [21-24].
Several studies have demonstrated that aerobic training with intensity exceeding 50 % of VO2max can improve macro- and microvascular endothelial function in young people withT1D [25-27], suggesting that the microvascular function in patients with T1D is directly proportional to the individual level of aerobic fitness [28]. However, it is still not clear whether the effects of low intensity exercise intervention, which is considered to be safer than higher intensity intervention, are more suited to the average functional capacity of this population. Considering the therapeutic potential of aerobic training to promote metabolic and vascular adaptations that prevent the development of clinical complications in T1D patients, this study aimed to investigate the effects of 12 weeks of low intensity aerobic exercise on microvascular reactivity in this group of individuals.
The present study was performed in accordance with the Helsinki Declaration of 1975, as revised in 2000, and the Institutional Review Board (IRB) of the University Hospital of the State University of Rio de Janeiro, Brazil approved of this study. Once considered eligible, all subjects read and signed an informed consent document that was approved by the IRB.
Study subjects presenting with type 1 diabetes (diagnosis based on a typical clinical presentation as well as the need to use insulin continuously since the diagnosis) of both sexes were recruited among patients who were followed up at a public hospital. Twenty-eight individuals with T1D diagnosed for more than 6 years, between 25 and 50 years of age, were recruited for the study. Twenty-two individuals (mean age 34 ± 7 years) completed the exercise protocol. There were 13 males (60 %) and 9 females (40 %) in the study group. The other six subjects (21 % of the subjects initially recruited for the study) left the study due to personal reasons.
The initial clinical evaluation included the patient's history and physical examination as well as recording of the following anthropometric data: weight, height, waist circumference and body mass index (BMI). Blood pressure
measurements were collected with patients in the supine position after 5 min in quiet surroundings; they were repeated twice with a two-minute interval between measurements. All measurements were performed before and after 12 weeks of physical training.
All patients included in the study were advised to maintain the same level of usual daily physical activity during the experimental protocol. Moreover, a regular diet for patients with type 1 diabetes was prescribed and supervised by the clinical staff of the tertiary care setting where they were recruited to certify that no significant changes occurred in the composition or total calories of the diet.
The diabetic patients included in the study were relatively young and did not present any co-morbidity. They were treated exclusively with insulin for diabetes control by an endocrinologist in the tertiary care setting, and none of them was taking other medications.
Blood sampling and laboratory tests
On the morning scheduled for the evaluation of cutaneous microcirculation, the patients presented in 12-h fasted condition for blood collection. Smokers should not have smoked or ingested caffeine from the night before until the completion of the tests. The following variables were measured: fasting and postprandial plasma glucose, total cholesterol, LDL and HDL cholesterol, triglycerides, transaminases, high-sensitivity C-reactive protein, gamma-glutamyl transferase, creatine kinase, urea, cre-atinine, albumin and uric acid by colorimetric reactions by using a Cobas Mira-machine (Roche). Blood samples were collected before and after the physical training period. LDL cholesterol was calculated using Friedewald's formula. Serum samples were kept frozen at -80 °C until measurement of interleukin-6 (IL-6) levels with a commercial ELISA kit (Cayman Chemical Company, Ann Arbor, MI, USA) according to the manufacturer's instructions.
Physical training
The study participants followed a non-supervised aerobic training protocol targeted at low intensity and corresponding to 40 % of their heart rate (HR) reserve (HRR). Resting HR was evaluated at the time of assessment of microvascu-lar reactivity, and maximum HR was calculated using the formula [208 - (0.7 x age)] as described by Tanaka and colleagues [29]. HRR was calculated as proposed by Karvonen [30] [(HRmax - HRrest) x 40 % + HRrest] because it is highly correlated with VO2 maximum [31]. The patients were advised to perform exercise sessions four times per week for 12 weeks that included alternating walking and running, in accordance with the patient's fitness level, corresponding to 40 % of the HRR. Follow-up of the training period was conducted through weekly telephone contact. Heart rate was monitored using heart rate monitors
(Polar Electro Oy, Kempele, Finland). During the first 4 weeks of training, 10 min were added per session every week to promote gradual progression in the range from 30 to 60 min during the remaining 8 weeks.
Capillaroscopy by intra-vital videomicroscopy
Microcirculatory tests were always performed after a 20-min period of rest in the supine position in a temperature-controlled room (23 ± 1 °C), thus excluding the influence of climate conditions from the results of the tests.
The capillary density, defined as the number of perfused capillaries per mm2 of skin area, was assessed by high-resolution intra-vital color microscopy (Moritex, Cambridge, UK) using a video microscopy system with an epi-illuminated fiber optic microscope containing a 100-W mercury vapor lamp light source and an M200 objective with a final magnification of 200x. The dorsum of the non-dominant middle phalanx was used for image acquisition, which occurred while the patient sat comfortably in a constant temperature environment (23 ± 1 °C), as described in detail by Antonios et al. [32-34]. Images were acquired and saved for posterior off-line analysis using a semi-automatic integrated system (Microvision Instruments, Evry, France). The mean capillary density was calculated as the arithmetic mean of the number of visible (i.e., spontaneously perfused) capillaries in three contiguous microscopic fields of 1 mm2 each. A blood pressure cuff was then applied to the patient's arm and inflated to suprasystolic pressure (50 mmHg above systolic arterial pressure) to completely interrupt blood flow for three minutes (testing post-occlusive reactive hyperemia, PORH). After cuff release, images were again acquired and recorded during the following 60-90 s, during which a maximal hyperemic response was expected to occur.
We assessed the variability of skin video capillaroscopy in a previous study [12]. The reproducibility of this methodology was assessed by examining an identical area of the finger skin; the intra-observer repeatability of data analysis was assessed by reading the same images in a blinded manner on two separate occasions (n = 20; coefficient of variability, 4.3 %). To assess inter-observer repeatability, a second observer independently assessed the capillary density in the same images (n = 15; coefficient of variability, 3.3 %).
Microvascular reactivity to pharmacological stimulation
Microvascular cutaneous reactivity was studied by laser Doppler flow monitoring (LDF), a method that has previously been standardized and validated [10, 35, 36]. Realtime variations in cutaneous microcirculatory flow were assessed through an LDF system (wavelength 780 nm; Periflux 5001, Perimed AB, Jarfalla, Sweden) attached to a pharmacological micro-iontophoresis system (PeriIont,
Perimed AB). The iontophoresis microelectrodes (PF 383, Perimed) were incorporated into the head of a laser probe (PF 481-1, Perimed), and the probe temperature was standardized to 32°C to avoid variations in skin temperature and, consequently, in the measurements of microvascular flow. The drug-delivery electrodes were filled with 200 ^l of 1 % ACh solution (Sigma Chemical Co., USA) and placed on the ventral surface of the forearm, away from visible subcutaneous veins and areas of skin pigmentation. Neutral electrodes for current dispersion were placed 15 cm above the infusion electrodes, and reference points were marked and annotated to ensure reproducibility during the second examination, which took place at the end of the intervention period. After measuring the baseline flow for 5 min, four equal cumulative doses of ACh (anodal current) were applied at a constant intensity of 0.1 mA for 10, 20, 40 and 80 s, with total charges of 1, 2, 4 and 8 millicoulombs, respectively, allowing for a 120-s interval between doses. Recording of the microvascular flow induced by ACh was conducted for 10 min as follows: 2 min for each dose and 2 min to allow the flow to reach a plateau after the last dose. Using a new delivery electrode applied to a different location on the same forearm, four doses of a solution of 1 % sodium nitroprusside (SNP; Sigma Chemical CO, USA) dissolved in distilled water were delivered using a cathodal current (same charges and intervals as for ACh).
The laser Doppler output, which is semiquantitative, is expressed in arbitrary perfusion units (PUs) of output voltage (1 PU = 10 mV) in accordance with general consensus (European Laser Doppler Users Groups, London, 1992). An area under the flow response to ACh curve could be defined using the PeriSoft for Windows 2.5 software (Perimed, Jarfalla, Sweden); this area was quantitatively measured and expressed in PU/s.
Microvascular reactivity to physiologic stimulation
After measuring the resting capillary flow for 5 min using another laser probe (PF 457, Perimed) that had been positioned at the start of the recording session, the PORH test was performed on the same forearm of pharmacological stimulation. Following release of the pressure, the maximum flow and area under the PORH curve were measured. The mean value of the resting flow was considered the basal flow value. When the microvascular flow returned to its basal value after the PORH test (typically 5-10 min), the maximal skin microvascular vasodilatation was investigated with prolonged (20 min) local heating of the laser probe to 42°C. The baseline microvascular flux value was calculated as described above.
The values were expressed as the means ± standard error of the means for variables with a normal distribution
and as median (percentiles 25th-75th) for variables with a non-parametric distribution according to results of the Shapiro-Wilk normality test. The data were analyzed by two-tailed paired t tests or the two-tailed Wilcoxon signed-rank test as appropriate. The null hypothesis was rejected at P < 0.05.
The clinical and laboratory variables of the patients at baseline and post-exercise training are presented in Table 1. We observed significant reductions in body weight and body mass index, as well as in uric acid and interleukin-6 serum levels, after 12 weeks of exercise training.
Capillary density
The mean capillary density after exercise training was significantly higher than before training (Fig. 1). A similar pattern was found during the PORH test; the capillary
density was significantly higher after the training period compared with before the training period (Fig. 1). The increase in the capillary density measured in the basal state was from 119 ± 19 to 134 ± 25 capillaries/mm2 (P = 0.0013) and after PORH from 121 ± 24 to 140 ± 26 capillaries/mm2 (P <0.0001). Moreover, there was improvement in the capillary recruitment induced by the PORH test after training; the capillary density after the PORH test increased from 134 ± 25 to 140 ± 26 capillaries/mm2 (P = 0.0012).
Microvascular reactivity to pharmacological and physiological stimuli
The skin microvascular vasodilation responses induced by either endothelial-dependent (ACh) or endothelial-independent (SNP) vasoactive drugs were not different before and after exercise training (Fig. 2). The same pattern
Table 1 Clinical characteristics of the patients with type 1 diabetes before and after exercise training
Characteristics Before training After training P value
(n = 22) (n = 22)
Body weight (kg) 68.5 ± 15.3 67.7 ±14.7* 0.0247
Body mass index (kg/m2) 24.2 ± 4.3 23.9 ±4.1* 0.0259
Systolic arterialpressure (mmHg) 124.1 ±19.7 123.2 ±18.5 0.6753
Diastolic arterialpressure (mmHg) 79.3 ± 12.3 76.1 ± 14.0 0.0641
Mean arterialpressure (mmHg) 93.7 ± 14.8 92.9 ±14.7 0.6004
Heart rate (bpm) 74.1 ± 11.1 77.6 ± 12.2 0.1398
Creatinine (mg/dl) 0.88 ±0.17 0.82 ± 0.19 0.1671
Urea (mg/dl) 31.5 ± 9.6 33.4 ±11.2 0.3362
Uric acid (mg/dl) 4.4 ± 1.2 3.8 ± 1.5* 0.0198
Fasting plasma glucose (mg/dl) 171.7 ± 75.2 169.0 ±93.7 0.9076
Postprandialplasma glucose (mg/dl) 217.9 ± 79.5 221.5 ±103.5 0.8940
HbAlc (%) 8.6 ± 1.7 9.0 ± 2.4 0.3278
Totalcholesterol(mg/dl) 176.6 ± 30.2 191.1 ± 53.7 0.0966
HDL-C (mg/dl) 55.2 ± 16.5 57.3 ± 20.7 0.4217
LDL-C (mg/dl) 99.5 ± 6.1 111.1 ± 10.1 0.1762
Triglycerides (mg/dl) 109.5 ± 72.5 113.3 ±82.9 0.8234
Albumin (g/dl) 4.2 ± 0.42 4.1 ± 0.5 0.2639
AST (U/L) 23.3 ± 9.9 20.3 ±6.1 0.1966
ALT (U/L) 19.7 ± 7.6 19.9 ± 10.7 0.9122
GGT (IU/L) 126.7 ± 51.6 147.5 ± 81.6 0.1867
CK-MM (U/L) 20.25 ± 2.0 19.4 ±3.1 0.7992
hs-CRP (mg/dL) 0.37 ± 0.76 0.29 ±0.32 0.5685
Interleukin-6 (ng/ml) 8.5 ± 3.1 4.5 ± 2.6* 0.0052
The results are presented as the means ± SEM
P values were estimated using two-tailed paired Student's t tests; bold values represent statistically significant differences *P <0.05 vs. values before training
ALT: alanine transaminase; AST: aspartate transaminase; CK-MM: creatine kinase-MM; GGT, gamma-glutamyl transferase; HbA1c, glycated hemoglobin; hs-CRP: high-sensitivity C-reactive protein; HDL-C: high-density lipoprotein cholesterol; and LDL-C: low-density lipoprotein cholesterol
P=0.0013
Fig. 1 Functional capillary density at baseline (BASAL) and during post-occlusive reactive hyperemia (PORH) before (PRE) and after (POST) exercise training in patients with type 1 diabetes (n = 22). The values represent the means±SEM. Paired or unpaired Student's two-tailed f-tests were used when appropriate
of responses was observed after physiological endothelial-dependent stimulation with the PORH test and local heating (Fig. 2). The individual values of microvascular parameters obtained with LDF are presented in Additional file 1.
The results of the present study indicate that 3 months of non-supervised aerobic exercise training performed at 40 % of HRR significantly increased the microvascular density of T1D patients and reduced their BMI and uric acid serum levels. The low intensity aerobic training program also improved basal capillary density and capillary recruitment during post-occlusive reactive hyperemia, suggesting that improvements occurred in systemic capillary number and perfusion.
It is well demonstrated that elevated uric acid serum levels are associated with endothelial dysfunction and renal microvascular complications in patients with T1D [36-39]. Although the patients' serum uric acid levels were within the normal range, low-intensity aerobic training was able to promote a significant reduction that could be associated with increased capillary density. Such changes may have contributed to expanding the supply of tissue nutrients and reducing the catabolism of adenine as well as the rate of uric acid formation [40, 41].
Despite previous contradictory reports [42, 43], our results showed that aerobic activity of low difficulty level, performed within the functional capacity of sedentary individuals, can promote significant increases in the micro-vascular density of T1D patients, who appear to have a severely compromised angiogenic process in the absence of exercise [44, 45]. In fact, as shown by previous studies
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Fig. 2 Microcirculatory parameters of patients with type 1 diabetes before and after exercise training. The maximum microvascular blood flow, expressed in arbitrary perfusion units (PU), and the area under the curve, expressed in PU/s, resulted from microvascular stimulation with acetylcholine (a, ACH), sodium nitroprusside (b, SNP), post-occlusive reactive hyperemia (c, PORH) and thermal hyperemia (d, TH)
[12, 46], and considering that sedentary T1D patients do not present with a capillary reserve in either the hands or feet [12], the changes in capillary density observed in the present study after exercise training suggest that low intensity aerobic exercise not only represents an important stimulus for increased capillary perfusion, it also contributes to increasing the number of capillaries.
In our study, the improvement in capillary perfusion and function was not accompanied by significant changes in microvascular reactivity after exercise training. It is conceivable that the low intensity exercise training did not induce sufficient increases in blood flow velocity and vascular shear stress required to significantly increase the release and bioavailability of vasoactive molecules, such as nitric oxide. In fact, higher intensity physical exercise has already been shown to induce significant increases in cutaneous microvascular reactivity [47, 48]. On the other hand, vascular growth and remodeling and enhanced angiogenesis, i.e., capillary growth, are well-known features of physiological adaptations to chronic exercise and have been extensively reviewed [24, 49].
Low-to-moderate intensity aerobic exercise has been associated with lower oxidative damage to the vascular endothelium [50-52] as well as with selective increases in angiogenic factors such as vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF-1a) [42, 53]. On the other hand, it is possible that the average intensity of 40 % of the heart rate reserve used in our study corresponds to an increase in the ventricular ejection fraction that is not associated with high sympathetic activation, which could have beneficial effects on capillary perfusion without imposing harmful interference associated with increases in arteriolar tone. Therefore, it is reasonable to speculate that during each workout, there was an increase in the supply of humoral factors, such as atrial natriuretic peptide, that are capable of stimulating perfusion and/or increasing capillary density [54]. We speculate this in spite of the absence of a training effect on endothelium-dependent or -independent microvascu-lar reactivity, as measured by laser Doppler flowmetry, which is most likely caused by insufficient increases in the flow velocity and vascular shear stress needed to increase the bioavailability of vasoactive molecules such as nitric oxide [55]. The absence of significant differences in microvascular reactivity, as measured by single point laser Dop-pler methodology, could be related to the high variability of the vasodilator effects obtained upon cutaneous iontophoresis with acetylcholine and sodium nitroprusside.
In this context, there is evidence that an increase in plasma free fatty acid (FFA) levels, which predominantly occurs with exercise intensity below 50 % of VO2max [56-58], can activate peroxisome proliferator-activated receptor beta or delta (PPAR-|3 or PPAR-5), as well as PPAR-5 coactivator-alpha (PGC-1a), contributing to the
expression of VEGF and consequent development of the angiogenic process [59-61]. Nevertheless, we do not have data about plasma levels of VEGF or of its soluble receptor FLT-1 in the patients with T1D, and thus we cannot conclude that this mechanism is involved in the increases in systemic capillary observed after exercise training.
On the other hand, it has been suggested in animal studies that low intensity exercise can activate PGC-1a [62, 63] independently of 5' adenosine monophosphate-activated protein kinase (AMPK) activation, which might only occur with exercise of higher intensity [64].
Increases in body temperature have been associated with improvements in tissue perfusion and capillary angiogenesis in animals and humans [65, 66]. In our study, the average temperature of the T1D patients during exercise was 37.8 ± 0.8°C, which may have been an important stimulus for the changes in capillary perfusion. In this sense, because it has been shown that physiological levels of urate are needed to promote increases in capillary perfusion in thermal stress situations [67], it is reasonable to speculate that the decrease in uric acid levels represents improvements in perfusion associated with the adaptive effects of low intensity training and resulting in capillary angiogenic processes.
Our results also indicated that low intensity aerobic training was able to restore the ability of capillary self-regulation at rest. In fact, studies with diabetic animals had already suggested that, through stimulating angiogen-esis, aerobic training was able to partially restore the capillary diffusion capacity and regional distribution reduced by hyperglycemia [44] and losses in capillary perfusion [44, 68, 69].
Training methodologies that combine low intensity aerobic exercise in situations that mimic the reduction of tissue nutrients present in patients with T1D, such as venous occlusion training techniques, have been shown to result in significant metabolic adaptations associated with improvements in insulin sensitivity and muscle strength [70]. Moreover, despite the proposition that high intensity interval training can promote increases in the capillary density of skeletal muscle, this exercise intensity has recently been suggested to be small compared to lower exercise intensities [71, 72].
It is well established that interplay between inflammatory and metabolic alterations leads to vascular injury in diabetes, which is mainly represented by microvascular endothelial dysfunction [73-75]. Therefore, an array of circulating biomarkers of systemic subclinical chronic inflammation has been investigated to target therapy in diabetes. Interleukin 6 (IL-6) appears to be a systemic inflammatory marker that is correlated with the degree of inflammatory activity in both T1D and T2D [74, 76]. In our study, plasma IL-6 levels were markedly and significantly reduced after exercise, indicating that low intensity
aerobic exercise is an efficient non-pharmacologic intervention affecting the vascular inflammatory profile of T1D patients. This effect could also explain the improvement in endothelium-dependent capillary recruitment observed after exercise training.
It is important to note that in addition to its well-known pro-inflammatory actions, IL-6 can also have an antiinflammatory role. Multiple cytokines, including IL-6, IL-1, and TNF-a, are consistently elevated in inflammatory states and have been recognized as targets of therapeutic intervention. Nevertheless, IL-6 can also play an anti-inflammatory role in both local and systemic inflammatory responses by controlling levels of the proinflammatory cytokines TNF-a and IL-1 [77]. In our study, the reductions in IL-6 plasma levels observed after exercise training suggests that this non-pharmacologic intervention is able to reduce the low-grade systemic inflammation that is typical of T1D patients. In future studies, comprehensive evaluations of plasma levels of different pro- and antiinflammatory cytokines are warranted to investigate the putative interactions between these different cytokines.
Limitations and strengths of the study
The present study has limitations that may have influenced the findings. Such limitations include the fact that there was no control (sedentary) group of patients. Considering that physical exercise is a classical non-pharmacologic intervention in cardiovascular and metabolic diseases, we consider that it could be unethical to have a group of patients not participating in the exercise training program. On the other hand, we could have used a control (run in) period when the patients could have been evaluated after a period of inactivity. However, the main drawback of this type of experimental design is the resulting decrease of adherence to the study protocol, which is typical of patients with chronic diseases, and could have resulted in a greater dropout rate from the study.
Finally, it is also worth mentioning that the increases in systemic capillarity and improvement of capillary recruitment in patients with type 1 diabetes were obtained with an exercise training protocol that can be easily performed in the everyday life of patients with chronic diseases.
Our results showed that non-supervised low intensity aerobic exercise, performed four times per week for 12 weeks by patients with type 1 diabetes, induces significant increases in microvascular density and endothelial-dependent capillary reactivity. Microvascular improvement in patients with diabetes is essential for preventing complications and targeting end-organ damage.
Additional file 1: Supplementary data tables. (ZIP 671 kb)
ALT: Alanine transaminase; AST: Aspartate transaminase; AGEs: Advanced glycation end products; BMI: Body mass index; CK-MM: Creatine kinase-MM; GGT: Gamma-glutamyl transferase; HbAlc: Glycated hemoglobin; HDL-C: High-density lipoprotein cholesterol; hs-CRP: High-sensitivity C-reactive protein; LDL-C: Low-density lipoprotein cholesterol; LDF: Laser Doppler flow monitoring; MCD: Mean capillary density, PORH, Post-occlusive reactive hyperemia; T1D: Type 1 diabetes.
The authors do not have any conflicts of interest to declare. The authors declare that there are no competing financial interests in relation to the present study.
R.d.M., M.B.G and E.T. conceived of and designed the study; D.V.B and R.d.M. performed the experiments; R.d.M., M.B.G and E.T. analyzed the data and interpreted the results of the experiments; R.d.M. drafted the manuscript; R.d.M., D.V.B, M.B.G and E.T. edited and revised the manuscript. All authors approved of the final version of the manuscript.
The authors wish to thank Marcio Marinho Gonzalez for his excellent technical assistance. This study was supported by grants from FAPERJ (Fundagäo de Amparo a Pesquisa, Rio de Janeiro, Brazil), CNPq (Conselho Nacional de Desenvolvimento Tecnológico) and FIOCRUZ (Fundagäo Oswaldo Cruz).
1National Institute of Cardiology, Rio de Janeiro, Brazil. 2Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, Av. Brasil, 4365, 21045-900 Rio de Janeiro, Brazil. 3Department of Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil. 4School of Physical Education and Sports Sciences of the Estácio de Sá University, Rio de Janeiro, Brazil.
Received: 9 March 2015 Accepted: 8 January 2016 Published online: 27 January 2016
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15. Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (1985). 2005;98:1154-62.
16. Shono N, Urata H, Saltin B, Mizuno M, Harada T, Shindo M, et al. Effects of low intensity aerobic training on skeletal muscle capillary and blood lipoprotein profiles. J Atheroscler Thromb. 2002;9:78-85.
17. Galassetti P, Riddell MC. Exercise and type 1 diabetes (T1 DM). Compr Physiol. 2013;3:1309-36.
18. MacMillan F, Kirk A, Mutrie N, Matthews L, Robertson K, Saunders DH. A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes: study characteristics, intervention design, and efficacy. Pediatr Diabetes. 2014;15:175-89.
19. Froisland DH, Graue M, Markestad T, Skrivarhaug T, Wentzel-Larsen T, Dahl-Jorgensen K. Health-related quality of life among Norwegian children and adolescents with type 1 diabetes on intensive insulin treatment: a population-based study. Acta Paediatr. 2013;102:889-95.
20. Kennedy A, Nirantharakumar K, Chimen M, Pang TT, Hemming K, Andrews RC, et al. Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis. PLoS One. 2013;8:e58861.
21. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334-59.
22. Herbst A, Kordonouri O, Schwab KO, Schmidt F, Holl RW. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: a multicenter study of 23,251 patients. Diabetes Care. 2007;30:2098-100.
23. Manders RJ, Van Dijk JW, van Loon LJ. Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sports Exerc. 2010;42:219-25.
24. Prior BM, Yang HT, Terjung RL. What makes vessels grow with exercise training? J Appl Physiol (1985). 2004;97:1119-28.
25. Roche DM, Edmunds S, Cable T, Didi M, Stratton G. Skin microvascular reactivity in children and adolescents with type 1 diabetes in relation to levels of physical activity and aerobic fitness. Pediatr Exerc Sci. 2008;20:426-38.
26. Seeger JP, Thijssen DH, Noordam K, Cranen ME, Hopman MT, Nijhuis-van der Sanden MW. Exercise training improves physical fitness and vascular function in children with type 1 diabetes. Diabetes Obes Metab. 2011;13(4):382-4.
27. Fuchsjager-Mayrl G, Pleiner J, Wiesinger GF, Sieder AE, Quittan M, Nuhr MJ, et al. Exercise training improves vascular endothelial function in patients with type 1 diabetes. Diabetes Care. 2002;25:1795-801.
29. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37:153-6.
30. Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate; a longitudinal study. Ann Med Exp Biol Fenn. 1957;35:307-15.
31. Miller WC, Wallace JP, Eggert KE. Predicting max HR and the HR-VO2 relationship for exercise prescription in obesity. Med Sci Sports Exerc. 1993;25:1077-81.
32. Antonios TF, Kaski JC, Hasan KM, Brown SJ, Singer DR. Rarefaction of skin capillaries in patients with anginal chest pain and normal coronary arteriograms. Eur Heart J. 2001;22:1144-8.
33. Nama V, Manyonda IT, Onwude J, Antonios TF. Structural capillary rarefaction and the onset of preeclampsia. Obstet Gynecol. 2012;119:967-74.
34. Antonios TF, Nama V, Wang D, Manyonda IT. Microvascular remodelling in preeclampsia: quantifying capillary rarefaction accurately and independently predicts preeclampsia. Am J Hypertens. 2013;26:1162-9.
35. Kaiser SE, Sanjuliani AF, Estato V, Gomes MB, Tibirica E. Antihypertensive treatment improves microvascular rarefaction and reactivity in low-risk hypertensive individuals. Microcirculation. 2013;20:703-16.
36. Matheus AS, Tibirica E, da Silva PB, de Fatima Bevilacqua da Matta M, Gomes MB. Uric acid levels are associated with microvascular endothelial dysfunction in patients with Type 1 diabetes. Diabet Med. 2011;28:1188-93.
37. Hovind P, Rossing P, Johnson RJ, Parving HH. Serum uric acid as a new player in the development of diabetic nephropathy. J Ren Nutr. 2011;21:124-7.
38. Edwards NL. The role of hyperuricemia in vascular disorders. Curr Opin Rheumatol. 2009;21:132-7.
39. Gersch C, Palii SP, Kim KM, Angerhofer A, Johnson RJ, Henderson GN. Inactivation of nitric oxide by uric acid. Nucleosides Nucleotides Nucleic Acids. 2008;27:967-78.
40. Hayden MR, Tyagi SC. Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle. Nutr Metab (Lond). 2004;1:10.
41. Gagliardi AC, Miname MH, Santos RD. Uric acid: A marker of increased cardiovascular risk. Atherosclerosis. 2009;202:11-7.
42. Tang XY, Hong HS, Chen LL, Lin XH, Lin JH, Lin Z. Effects of exercise of different intensities on the angiogenesis, infarct healing, and function of the left ventricle in postmyocardial infarction rats. Coron Artery Dis. 2011;22:497-506.
43. Schantz P, Henriksson J, Jansson E. Adaptation of human skeletal muscle to endurance training of long duration. Clin Physiol. 1983;3:141-51.
44. Kivela R, Silvennoinen M, Touvra AM, Lehti TM, Kainulainen H, Vihko V. Effects of experimental type 1 diabetes and exercise training on angiogenic gene expression and capillarization in skeletal muscle. FASEB J. 2006;20:1570-2.
45. Katz MA, McNeill G. Defective vasodilation response to exercise in cutaneous precapillary vessels in diabetic humans. Diabetes. 1987;36:1386-96.
46. Tibirica E, Rodrigues E, Cobas R, Gomes MB. Impairment of skin capillary recruitment precedes chronic complications in patients with type 1 diabetes. Rev Diabet Stud. 2007;4:85-8.
47. Lenasi H, Strucl M. Effect of regular physical training on cutaneous microvascular reactivity. Med Sci Sports Exerc. 2004;36:606-12.
48. Mitranun W, Deerochanawong C, Tanaka H, Suksom D. Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sports. 2014;24:e69-76.
49. Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev. 2008;88:1009-86.
50. Di Francescomarino S, Sciartilli A, Di Valerio V, Di Baldassarre A, Gallina S. The effect of physical exercise on endothelial function. Sports Med. 2009;39:797-812.
51. Gustafsson T. Vascular remodelling in human skeletal muscle. Biochem Soc Trans. 2011;39:1628-32.
52. Thorin E, Thorin-Trescases N. Vascular endothelial ageing, heartbeat after heartbeat. Cardiovasc Res. 2009;84:24-32.
53. Kondo H, Fujino H, Murakami S, Tanaka M, Kanazashi M, Nagatomo F, et al. Low-intensity running exercise enhances the capillary volume and pro-angiogenic factors in the soleus muscle of type 2 diabetic rats. Muscle Nerve. 2015;51:391-9.
54. Morvan E, Lima NE, Machi JF, Mostarda C, De Angelis K, Irigoyen MC, et al. Metabolic, hemodynamic and structural adjustments to low intensity exercise training in a metabolic syndrome model. Cardiovasc Diabetol. 2013;12:89.
55. Tjonna AE, Lee SJ, Rognmo O, Stolen TO, Bye A, Haram PM, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118:346-54.
56. Achten J, Jeukendrup AE. Optimizing fat oxidation through exercise and diet. Nutrition. 2004;20:716-27.
57. De Feo P, Di Loreto C, Lucidi P, Murdolo G, Parlanti N, De Cicco A, et al. Metabolic response to exercise. J Endocrinol Invest. 2003;26:851 -4.
58. Wolfe RR. Fat metabolism in exercise. Adv Exp Med Biol. 1998;441:147-56.
59. Silvennoinen M, Rinnankoski-Tuikka R, Vuento M, Hulmi JJ, Torvinen S, Lehti M, et al. High-fat feeding induces angiogenesis in skeletal muscle and activates angiogenic pathways in capillaries. Angiogenesis. 2013;16:297-307.
60. Basak S, Das MK, Duttaroy AK. Fatty acid-induced angiogenesis in first trimester placental trophoblast cells: possible roles of cellular fatty acid-binding proteins. Life Sci. 2013;93:755-62.
61. Bishop-Bailey D. PPARs and angiogenesis. Biochem Soc Trans. 2011 ;39:1601-5.
62. Terada S, Goto M, Kato M, Kawanaka K, Shimokawa T, Tabata I. Effects of low-intensity prolonged exercise on PGC-1 mRNA expression in rat epitrochlearis muscle. Biochem Biophys Res Commun. 2002;296:350-4.
63. Fujimoto E, Yamaguchi W, Terada S, Higuchi M, Tabata I. Change in PGC-1alpha expression in rat skeletal muscle after low-intensity prolonged swimming exercise. J Physiol Anthropol. 2011;30:23-7.
64. Raney MA, Yee AJ, Todd MK, Turcotte LP. AMPK activation is not critical in the regulation of muscle FA uptake and oxidation during low-intensity muscle contraction. Am J Physiol Endocrinol Metab. 2005;288:E592-8.
65. Akasaki Y, Miyata M, Eto H, Shirasawa T, Hamada N, Ikeda Y, et al. Repeated thermal therapy up-regulates endothelial nitric oxide synthase and augments angiogenesis in a mouse model of hindlimb ischemia. Circ J. 2006;70:463-70.
66. Pranskunas A, Pranskuniene Z, Milieskaite E, Daniuseviciute L, Kudreviciene A, Vitkauskiene A, et al. Effects of whole body heat stress on sublingual microcirculation in healthy humans. Eur J Appl Physiol. 2015;1 15:157-65.
67. Widanski IB, Richardson D, Bruckner G. Effect of urate on nitric oxide microcirculatory response in the rat tail to body heating. Microcirculation. 2002;9:125-31.
68. Kivela R, Silvennoinen M, Lehti M, Jalava S, Vihko V, Kainulainen H. Exercise-induced expression of angiogenic growth factors in skeletal muscle and in capillaries of healthy and diabetic mice. Cardiovasc Diabetol. 2008;7:13.
69. Gute D, Laughlin MH, Amann JF. Regional changes in capillary supply in skeletal muscle of interval-sprint and low-intensity, endurance-trained rats. Microcirculation. 1994;1:183-93.
70. Yokokawa Y, Hongo M, Urayama H, Nishimura T, Kai I. Effects of low-intensity resistance exercise with vascular occlusion on physical function in healthy elderly people. Biosci Trends. 2008;2:117-23.
71. Hoier B, Passos M, Bangsbo J, Hellsten Y. Intense intermittent exercise provides weak stimulus for vascular endothelial growth factor secretion and capillary growth in skeletal muscle. Exp Physiol. 2013;98:585-97.
72. Wallace JP. Exercise in hypertension. A clinical review. Sports Med. 2003;33:585-98.
73. Goldberg RB. Cytokine and cytokine-like inflammation markers, endothelial dysfunction, and imbalanced coagulation in development of diabetes and its complications. J Clin Endocrinol Metab. 2009;94:3171-82.
74. Kampoli AM, Tousoulis D, Briasoulis A, Latsios G, Papageorgiou N, Stefanadis C. Potential pathogenic inflammatory mechanisms of endothelial dysfunction induced by type 2 diabetes mellitus. Curr Pharm Des. 2011;17:4147-58.
75. Persson F, Rossing P, Hovind P, Stehouwer CD, Schalkwijk CG, Tarnow L, et al. Endothelial dysfunction and inflammation predict development of diabetic nephropathy in the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria (IRMA 2) study. Scand J Clin Lab Invest. 2008;68:731-8.
76. Patte C, Rothhut B, Russo-Marie F, Blanquet PR. Possible involvement of a lipocortin in the initiation of DNA synthesis by human endothelial cells. Exp Cell Res. 1991;197:12-20.
77. Xing Z, Gauldie J, Cox G, Baumann H, Jordana M, Lei XF, et al. IL-6 is an antiinflammatory cytokine required for controlling local or systemic acute inflammatory responses. J Clin Invest. 1998;101:311 -20.
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text:
Texas Charges Online 'Diploma Mill' With Fraud
Internet-based home schools were not accredited, state charges
Truman Lewis Reporter
A Texas court has granted a temporary restraining order against two individuals that operated three Internet-based "home schools."
According to an enforcement action brought by the Texas Attorney General's Office, the defendants unlawfully marketed and sold fraudulent high school diplomas.
The state is seeking court-ordered restitution for customers who paid the defendants $225 to enroll in their program, take their "tests" and obtain their purported diplomas. The court ordered a temporary injunction hearing for 2 p.m. on Nov. 4.
The five unaccredited "diploma mill" defendants operate under a holding company called Advent Harvest Academy Corp. The "schools" named in the enforcement action are Sunrise Private High School, Longhorn Private High School and Bluebonnet Private High School. Defendants Teri Tout-Dennis and Mike Martin serve as director of education and executive school director, respectively.
"As the State of Texas strives to improve educational opportunities for all our children, it is intolerable to find unscrupulous individuals who would offer anyone with Internet access the ability to receive a diploma without the prerequisite studies," Attorney General Greg Abbott said. "This is a grave disservice to youngsters who later in life will come to realize they were exploited for their money and gained nothing in return."
According to state investigators, Advent Harvest Academy Corp. and its schools imposed no educational requirements. The schools required no age verification or identification; likewise, no instruction program or compulsory student "attendance" is mandated. Students simply pay $225 in advance via a credit card and then take an unaccredited "test."
Students are instructed to fax the test to the defendants who then "grade" it and respond with fraudulent academic diplomas through the mail, including "transcripts" containing credit hours based on the test results.
The defendants' so-called schools are registered with the Texas Secretary of State as domestic for-profit corporations and use the corporate number issued by that agency as their "school ID number" on diplomas. The numerical identification reflects an attempt to confer an air of legitimacy to the appearance of the diplomas., Abbott said.
The schools further attempt to make their fraudulent diplomas look legitimate by unlawfully superimposing a State of Texas seal onto the document. In an effort to avoid questions about state oversight, the defendants falsely told customers that they are not required to meet state licensing standards because they meet the "home school" exemption.
The schools have never been accredited by the Texas Education Agency, the Texas Association of Private and Parochial Schools or the Texas Private School Accreditation Commission, Abbott charged.
Truman Lewis
A former reporter and bureau chief for broadcast outlets and magazines, Truman Lewis has covered presidential campaigns, state politics and stories ranging from organized crime to environmental protection.
FTC wins shutdown of online high school diploma mill

redpajama_set_name: RedPajamaCommonCrawl


text:
Fort Plain native Bud Fowler among 6 players elected to baseball Hall of Fame
Buck O'Neil, a champion of Black ballplayers during a monumental, eight-decade career on and off the field, joined Bud Fowler, who was born in Fort Plain and played professionally before the color barrier, Gil Hodges, Minnie Miñoso, and two others in being elected to the baseball Hall of Fame on Sunday.
Former Minnesota Twins teammates Tony Oliva and Jim Kaat also were chosen by a pair of veterans committees.
Oliva and Kaat, both 83 years old, are the only living new members. Longtime slugger Dick Allen, who died last December, fell one vote shy of election.
The six newcomers will be enshrined in Cooperstown, New York, on July 24, 2022, along with any new members elected by the Baseball Writers' Association of America. First-time candidates David Ortiz and Alex Rodriguez join Barry Bonds, Roger Clemens and Curt Schilling on the ballot, with voting results on Jan. 25.
Passed over in previous Hall elections, the new members reflect a diversity of accomplishments.
This was the first time O'Neil, Miñoso and Fowler had a chance to make the Hall under new rules honoring Negro League contributions. Last December, the statistics of some 3,400 players were added to Major League Baseball's record books when MLB said it was "correcting a longtime oversight in the game's history" and reclassifying the Negro Leagues as a major league.
"Jubilation," said Bob Kendrick, president of the Negro Leagues Baseball Museum in Kansas City, Missouri, that O'Neil helped create, after the voting results were announced.
Baseball's stolen legacy:The fascinating story of the Negro Leagues and the man keeping the history alive
Buck O'Neil was a remarkable ambassador for baseball
O'Neil was a two-time All-Star first baseman in the Negro Leagues and the first Black coach in the National or American leagues. He became a remarkable ambassador for the sport until his death in 2006 at 94 and already is honored with a life-sized statue inside the Hall of Fame in Cooperstown.
For all O'Neil did for the game his entire life, many casual fans weren't entirely familiar with him until they watched the nine-part Ken Burns documentary "Baseball," which first aired on PBS in 1994.
Opinion:Buck O'Neil is finally a Hall of Famer. That it took so long is another racist stain on baseball.
There, O'Neil's grace, wit and vivid storytelling brought back to life the times of Negro Leagues stars Satchel Paige, Josh Gibson and Cool Papa Bell, plus the days of many more Black ballplayers whose names were long forgotten.
Kendrick said it was too bad O'Neil won't be in Cooperstown for the induction ceremonies next July 22, "but you know his spirit is going to fill the valley," he said on MLB Network.
Bud Fowler induction will be a homecoming
Fowler, born in 1858, is often regarded as the first Black professional baseball player. The pitcher and second baseman helped create the popular Page Fence Giants barnstorming team.
Induction will be a homecoming of sorts for Fowler's memory. He spent his childhood in Cooperstown before joining his first professional team when he was 14 years old, and the village renamed a street Bud Fowler Way at the entrance to Doubleday Field in 2013. His baseball-playing journey included stops around the country and the color of his skin was often an issue.
More:Fort Plain native Bud Fowler honored by Society for American Baseball Research
Fowler's playing career included stops in Massachusetts, Minnesota, Indiana, Iowa, Kansas, Michigan, Nebraska, New Mexico, Pennsylvania, Vermont and Canada. He batted .350 in 34 games with Binghamton's International League team in 1887 before a June incident involving white teammates refusing to play with Fowler and Black teammate William Renfro, and asking to be released. After nine players signed a petition threatening to quit if the Black players were not released, SABR reports Fowler asked for his release and was granted one June 30 provided he would not sign with another team in the league.
The International League banned the signing of additional African-American players on July 14, 1887.
Fowler was buried in Frankfort's Oak Hill Cemetery following his death in 1913. His gravesite went unmarked until the Society for American Baseball Research erected a headstone in 1987. SABR recognized Fowler as its annual Overlooked 19th Century Legend for 2020.
Bill Dahlen, a Nelliston native and previous winner of SABR's 19th century honor, fell short for a second time in Sunday's voting. Dahlen was previously two votes short in 2012.
Orestes 'Minnie' Miñoso was 'The Cuban Comet'
Miñoso was a two-time All-Star in the Negro Leagues before becoming the first Black player for the Chicago White Sox in 1951. Born in Havana, "The Cuban Comet" was a seven-time All-Star while with the White Sox and Indians.
There was nothing mini about Saturnino Orestes Armas Miñoso on the field. He hit over .300 eight times with Cleveland and Chicago, led the AL in stolen bases three times, reached double digits in home runs most every season and won three Gold Gloves in left field.
More:Minnie Miñoso's legacy lives on as 'Jackie Robinson' of Black Latino players
More:Minnie Miñoso belongs in the Baseball Hall of Fame. I should know, I'm his son.
Miñoso finished up, or so it seemed, in 1964. He came back at age 50 for the White Sox in 1976 — going 1 for 8 — and batted twice in 1980, giving him five decades of playing pro ball.
The White Sox retired his No. 9 in 1983 and he remained close to the organization and its players before his death in 2015.
Gil Hodges was part of 'The Boys of Summer' and 'Miracle Mets'
Hodges became the latest Brooklyn Dodgers star from "The Boys of Summer" to reach the Hall, joining Jackie Robinson, Duke Snider, Roy Campanella and Pee Wee Reese.
An eight-time All-Star and three-time Gold Glover at first base, Hodges enhanced his legacy when he managed the 1969 "Miracle Mets" to the World Series championship, a startling five-game win over heavily favored Baltimore.
Hodges was still the Mets' manager when he suffered a heart attack during spring training in 1972 and died at 47.
Tony Oliva nd Jim Kaat played with the Twins
Oliva was a three-time AL batting champion with the Twins whose career was cut short by knee problems.
Kaat was 283-237 in 25 seasons and a 16-time Gold Glove winner.
How the players were selected
O'Neil and Fowler were selected by the Early Days committee. Hodges, Miñoso, Oliva and Kaat were chosen the by the Golden Days committees.
The 16-member panels met separately in Orlando, Florida. The election announcement was originally scheduled to coincide with the big league winter meetings, which were nixed because of the MLB lockout.
It took 12 votes (75%) for selection: Miñoso drew 14, O'Neil got 13 and Hodges, Oliva, Kaat and Fowler each had 12. Allen had 11.
Buck O'Neil's impact on baseball is still visible today
O'Neil played 10 years in the Negro Leagues and helped the Kansas City Monarchs win championships as a player and manager. His numbers were hardly gaudy — a .258 career batting average, nine home runs.
But what John Jordan O'Neil Jr. meant to baseball can never be measured by numbers alone.
O'Neil became the first Black coach in American League or National League history with the Chicago Cubs and enjoyed a prolific career as a scout.
His impact is visible to this day.
Along with his statue in Cooperstown, the Hall's board of directors periodically present the Buck O'Neil Lifetime Achievement Award to a person whose "whose extraordinary efforts enhanced baseball's positive impact on society … and whose character, integrity and dignity" mirror those shown by O'Neil.
In 2006, it appeared O'Neil would get to soak in the praise earned for his work when the Special Committee on Negro Leagues convened to study candidates for the Hall of Fame. The panel indeed elected 17 new members but O'Neil was not among them, narrowly missing out.
O'Neil was chosen to speak on behalf of those 17 newcomers, all deceased, on induction day at Cooperstown. True to his nature, he didn't emit a single word of remorse and regret about his own fate of being left out.
Two months later, O'Neil died in Kansas City.
Jon Rathbun, a sportswriter for the Times Telegram, contributed to this story. Email Jon at sports@timestelegram.com.


text:
Q: why does using the turtle module to score give me a error I am making a game and scoring system is not working
I tried to change the score turtle to a sprite class but it still didn't seem to work so I just went back to turtle
import turtle
import random

# create sprite
class Sprite(turtle.Turtle):
    def __init__(self, sprite_shape, color, startx, starty):
        super().__init__( shape=sprite_shape)

        self.speed(0)
        self.penup()
        self.color(color)
        self.goto(startx, starty)

        self.speed = 1

    def move(self):
        self.forward(self.speed)

        # Boundary detection
        if self.xcor() > 300:
            self.setx(300)
            self.rt(90)
        elif self.xcor() < -300:
            self.setx(-300)
            self.lt(120)

        if self.ycor() > 300:
            self.sety(300)
            self.lt(90)
        elif self.ycor() < -300:
            self.sety(-300)
            self.lt(120)

    def is_collision(self, other):
        return self.distance(other) < 20

# create enemy
class Enemy(Sprite):
    def __init__(self ,  spriteshape, color, startx, starty):
        Sprite.__init__(self  , spriteshape, color, startx, starty)
        self.speed = 4
        self.setheading(random.randint(0,360))

#Set up the screen
wn = turtle.Screen()
wn.bgcolor("black")
wn.title("Space Invaders")

#Draw border
border_pen = turtle.Turtle()
border_pen.speed(0)
border_pen.color("white")
border_pen.penup()
border_pen.setposition(-300,-300)
border_pen.pendown()
border_pen.pensize(3)
for side in range(4):
        border_pen.fd(600)
        border_pen.lt(90)
border_pen.hideturtle()

#Draw the score
score_pen = turtle.Turtle()
score_pen.speed(0)
score_pen.color("white")
score_pen.penup()
score_pen.setposition(-290, 280)
scorestring = "Score: %s" %score
score_pen.write(scorestring, False, align="left", font=("Arial", 14, "normal"))
score_pen.hideturtle()

#Create the player turtle

player = turtle.Turtle()
player.color("yellow")
player.shape("square")
player.penup()
player.speed(0)
player.setposition(0, -250)
player.shapesize(2.3)

player_speed = 35

# player movement

def move_left():
    x = player.xcor() - player_speed

    if x < -280:
        x = - 280

    player.setx(x)

def move_right():
    x = player.xcor() + player_speed

    if x > 280:
        x = 280

    player.setx(x)

# keybindings
turtle.listen()
turtle.onkey(move_left, "Left")
turtle.onkey(move_right, "Right")

# create sprite
enemy = Enemy('circle', 'red', -200, 250)

# main game loop
def play():
    enemy.move()

    # check for collision
    if enemy.is_collision(player):
         x = random.randint(-250, 250)
         y = random.randint(-250, 250)
         enemy.setposition(-250, 250)
         enemy.setheading(250)

         wn.ontimer(play, 0 )

play()

#Update the score
score += 10
scorestring = "Score: %s" %score
score_pen.clear()
score_pen.write(scorestring, False, align="left", font=("Arial", 14, "normal"))

I want the score to appear and work but I get this error
Traceback (most recent call last):
  File "C:\Users\prana\Desktop\game.py\players v enemys.py", line 70, in
    scorestring = "Score: %s" %score
NameError: name 'score' is not defined

>

redpajama_set_name: RedPajamaStackExchange


text:
Africa Oil Week
AEC announces the launch of its African Energy Outlook for 2020
Created: Friday, 29 November 2019 10:00
The African Energy Chamber has announced the launch of its inaugural African Energy Outlook for 2020, a comprehensive overview of the oil and gas sector across sub-Saharan Africa, with a focus on the strategic, operational and investment trends in the industry
The report looks at vital developments in major African oil and gas producers and offers important insights into the growth potential of the industry while examining the role of the public and private sector.
It also includes the African Energy Chamber's Top 25 Movers and Shakers to Watch list which profiles individuals who will play a big role in shaping the continent's energy economy in 2020.
The important insights include:
-Strategic: The low oil price environment is forcing African producers to sharpen their competitive edge. Several governments, including Angola, Gabon, and Cameroon, have implemented reforms. Nigeria could be next. There are at least six announced oil projects in that West African country with a combined output potential of 837,000 bpd and CAPEX of US$54bn which could be brought on-stream over the next decade.
A favourable regulatory and fiscal environment are essential to delivering that investment. IMO 2020 regulations will yield increased Asian demand for West African crude. Nearly 75 per cent of the 461,000 bpd of heavy sweet crude ideal for producing low-sulphur bunker fuels is made in West Africa, according to ClipperData.
-Production: The outlook includes production forecasts for 21 sub-Saharan African countries from 2019 to 2025, produced by Global Data. Total oil and gas production is expected to increase by nearly 28 per cent to 8.1 mmboe/d, by 2025.
Nigeria and Angola will continue to dominate but their share of regional production will fall by more than one fifth (to 58 per cent) during this period, a shift driven in part by significantly increased output from Mozambique, Senegal/Mauritania and Tanzania.
-Investment: The outlook profiles more than 40 post- and pre-FID oil and gas projects across sub-Saharan Africa. There are currently nine oil projects under construction across the region with a combined peak production total of 256,000 bpd and investment of US$16.2bn.
A further eight gas projects are also under construction, with combined CAPEX of US$44bn and peak production capacity of 3,650 mmcf/d.
-Rise of African Gas: African producers are positioning themselves to maximise from a gas boom expected for the next decade. East Africa could see US$60bn worth of investment and 25.2 mtpa of LNG production capacity sanctioned by IOCs in 2020. Chinese investment in Ethiopia and Djibouti is also opening a new frontier for gas production.
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Oxford's Cole Calhoon takes his time, signs with Mississippi College
Published 4:24 pm Tuesday, April 4, 2017
Oxford High's Cole Calhoon, in Oxford, Miss. on Tuesday, April 4, 2017, will play soccer at Mississippi College. (Bruce Newman)
Cole Calhoon knew he had a decision to make, he was just not sure who to choose or when he would do so. That was in February and in the first week of April, Calhoon made his choice to continue playing soccer at Mississippi College.
It was between the Choctaws in Clinton or going to Belmont in Nashville. While most would choose to spend four years in Nashville over being near Mississippi's capital city, Calhoon had his reasons.
"I took forever to decide," Calhoon said. "It was just too hard, they're both great schools, great coaches, great teams. Mississippi College just had a little bit of a better offer, more money. It's a little bit closer to home. After a long time I just decided. …I liked the feel a little bit more."
Mississippi College started in on Calhoon midway through his senior season and Choctaw head coach Kevin Jones got his first look at Calhoon during the MHSAA Class 5A state championship game at Madison Central on Feb. 4. Afterwards Jones invited Calhoon to come take a visit and workout for him, which was quickly followed by a scholarship offer.
Belmont was in on Calhoon last year after he attended an ID camp and was part of a select few campers the Bruins focused and eventually made him an offer.
Calhoon's decision caps off a senior years that including the Chargers making it back to the state championship game and winning their first title since 2013 all while doing it with a brand new coach in Charles Sabatier, who returned to lead his alma mater to another 'Gold Ball' trophy.
"It was nerve-wracking, the whole years, just having not committed anywhere," Calhoon said. "Having to play and then email, talking to coaches. Going back and forth, trying to decide where you're playing then going to practice. There was a lot on the plate, but I'm glad it happened and I'm glad we won state."
As a midfielder, Calhoon scored three goals this year and assisted with another. The Choctaws have three senior center midfielders on their roster heading into next season, which means Calhoon may see time on the field as a freshman, just in another position. He views it as an opportunity to make a splash and become the starting midfielder come his sophomore season.
"(Mississippi College) is getting a fundamentally sound player," Sabatier said of Calhoon. "He is the type of player that leads by example. …They're getting a solid, outstanding athlete and a great guy. I'm excited for him."
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Whether you're completely new to cooking or you're already enrolled in online baking courses, you may be looking for opportunities to hone your craft. While having people over for dinner is a great option, making a great dessert is something your guests are sure to remember. Pies are universally loved, given their wide range of fillings and flavors, but few people realize that the crust is what actually makes the dessert so wonderful. Without a perfect, flaky, buttery crust, a pie simply isn't as good. Next time you step into the kitchen to whip one up, don't opt for those common store-bought, pre-frozen crusts. Instead, take a look at this simple recipe for delicious homemade pie crusts. Here's what you'll need.
Once you've got all of your ingredients set out and ready to go, clear and clean a space on your counter so that you can get down to work. You may need a bit more space than you think, as this recipe yields two pie crusts. If you only need one, simply halve the ingredients and follow the same instructions.
Remove a large mixing bowl to begin. Once you have it in front of you, mix together the flour, salt and sugar. Use a sifting motion so that the three separate ingredients come together to form one even powder.
Take the chilled shortening and add it into the mix. Since it is chilled, you'll need to use your hands in a kneading motion to help break it up. The flour, sugar and salt mixture should cover and stick to the shortening fully before you stop.
The cold butter cubes can now be added to the mixture. Again, you'll want to knead these with your hands until all of the ingredients take on a crumbled composition.
Now you can begin to pour in your ice water. Use a pitcher or strainer, so that the ice itself doesn't enter the mixture, just the cold water. Do this bit by bit, kneading the mixture intermittently until it has become a viscous dough.
Divide the dough into two equal portions, each of which you can roll out into a disk shape.
You're ready to make your pie crust! Take each disk and roll it out with a rolling pin. Angle the edges upward to create the shape of a pie tin.
Once your pie crusts are ready, you can get right down to making your pie or save that task for later. Each of these crusts should keep for 1-2 days if refrigerated.


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This book covers a field of electronics which is very mathematical and which presents difficulties to electronics students at all levels. It aims to provide the reader with enough maths to really understand what electronic filters are, how they work and how to use them. The book assumes a knowledge of mathematics at about GCSE level, and a minimum of electrical and electronic theory.
It proceeds by easy stages to describe the structure, action and uses of filters, introducing and explaining the necessary additional maths at each stage. The discussion is backed up by descriptions of practical working filters of all types. All the filter circuits contained within the book are simulated on computer, and this provides a wealth of computer-generated diagrams and accurate graphs, many in 3-D, to illustrate the text. To ensure the reader is confident with what they learn, short sets of questions are included periodically throughout the text under the heading Keeping Up? At the end of each chapter there is a more demanding set of Test Yourself questions, designed to reinforce the understanding acquired by reading each chapter. Answers are given at the end of the book.
Filter components; Electrical signals; Directed quantities; Representing vectors; Passive filters; Transfer functions; Resonant circuits; Op amps; Active filter responses; State variable filters; Switched capacitance filters; Voltage-controlled filters; Digital filters; Filtering by DSP.


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Home / DWI Articles / Ethics Complaint Filed Against New Jersey Judge After DWI Incident
Ethics Complaint Filed Against New Jersey Judge After DWI Incident
In a newly recently disclosed incident dating back to November of 2016, New Jersey Municipal Court judge Wilfredo Benitez was arrested and charged with Driving While Intoxicated. In the early hours of the morning on November 12th, police officers found Benitez slouched over in the driver's seat of his BMW. The vehicle was pulled over to the shoulder of Route 80 and the hazard lights were turned on.
Today, our DWI defense attorney will discuss the specifics of this case, how Mr. Benitez was acquitted of all charges, and the possible repercussions he may still experience as a legal professional.
Union County, NJ DWI Defense Lawyer Discusses Benitez Case
The otherwise typical case of a DWI traffic stop received national media attention for two key reasons: 1. the accused was a New Jersey Municipal Judge and 2. the verbal tirade which that judge unleashed on law enforcement. As previously mentioned, Benitez was found passed out in his vehicle along the side of the road. After administering field sobriety tests, Benitez was given a formal BAC test, which showed somewhere around twice the legal limit of 0.08.
After being placed under arrest, Benitez proclaimed "I'm a f—ing judge…I would never do anything to hurt you, man. Come on". After the officers read Benitez his Miranda rights, he further lashed out, saying "I will f—ing fight you, and you know you're being a d–k."
How did a New Jersey Municipal Judge Beat his DWI Charges?
Fast forward to earlier this year when the public was made aware of the case of Mr. Benitez, and we learned that he was able to beat all charges. Benitez was found not guilty on the grounds that law enforcement did not adhere to the legally mandated protocol which must take place after a DWI arrest.
This protocol includes a mandatory 20 minute observation period, during which law enforcement officers must watch the offender for 20, uninterrupted minutes before administering a BAC test with an alco-test machine. This is due to the potential for false readings which can result from eating, chewing gum, vomiting, and more. In the Benitez DWI case, it was shown that this protocol was not legally seen through, the BAC test was inadmissible in court, and his charges were therefore dismissed.
Plainfield DWI/DUI Rights Attorney Identifies Ethics Concerns
A formal ethics complaint was filed against Judge Benitez in January, 2018. New Jersey judges must adhere to the Code of Judicial Conduct, which states in part that judges must "observe high standards of conduct so that the integrity and independence of the judiciary may be preserved". This section and two others are cited in the complaint against Benitez, which was entered by Deputy Ethics Counsel Maureen G. Bauman.
As a result of the 2016 incident, Benitez has been barred from hearing DWI and/or DUI cases in his Municipal Courtroom. Benitez has maintained that he was innocent of any wrongdoing or improper behavior, and has shown a determination to fight these ethics charges as well.
Contact a Linden DWI Arrest Defense Attorney Today
Traffic stop and DWI defense attorney Edward S. Cooper has extensive experience defending Union County clients from towns like Linden office, Westfield, Scotch Plains, Elizabeth, Plainfield, Union, and all of Northern New Jersey. With a unique perspective gained from serving as a Public Defender, a Panelist on the NJ Early Settlement Panel, and an active defense attorney, Attorney Cooper is qualified to handle all manner of DWI and criminal defense cases. If you are searching for an experienced attorney who will take the time to work with you on an individual level, look no further.
To speak with Attorney Cooper regarding a DWI arrest, traffic stop, drug offense, or other criminal charges, please contact us online or contact our Linden, NJ office by calling (908) 481-4625 today for a confidential consultation.
Categories: DWI Articles DWI Offenses


May 2014 Issue / Vol. 2 No. 9 The Country Cure-all in the Chef's Kitchen.
Described, depending on their stage of blossoming, as having a muscat scent heady enough to carry you to the realm of the fairies should you fall asleep under a blooming tree to smelling like cat piss when past their prime, elderflowers announce the coming of summer. In the high desert, that would be sometime in April; late May for four-season-climes.The Dispensary of the United States of America Twentieth Edition (1918) describes the flowers as "gently excitant and sudorific." Excitant, meaning they make one feel centered and buoyant. A cold infusion or tincture of elderflowers has a cooling effect that makes it a perfect antidote for irritable moments of the unexplainable kind where you don't need a nervine, but you do need something to cool your jets. Or make you feel buoyant when you're emotionally flat-lining (a.k.a.: "the blahs"). A sudorific causes sweating when taken hot; when taken cold, it's a diuretic. Elderflowers are part of the legendary flu remedy (hot yarrow, elderflower and peppermint tea drunk copiously at the first sign of sickness), known to stop viruses within 24 hours. This makes sense, since research in 1996 found elderflower extract has antiviral actions in vitro.


The jewelry artisans of central Thailand craft a quality pair of earrings from sterling silver. The alluring design features dragonflies hovering around marcasite weeds.
These earrings may vary slightly in weight and size.
These silver and marcasite dangle earrings are handmade by jewelry artisans in a workshop located in Bangkok, Thailand.


Since 1937, Ampacet has led the way in servicing the world of plastics. Offering innovative, cutting-edge solutions, Ampacet's success stems from the caliber of its employees. We believe that it is the work of all Ampacet employees that guarantees our position as the world leader in color and additive masterbatches.
The Human Resources Team is a strategic partner in managing Ampacet's Elements of Success core values. We are committed to maintaining the highest level of ethics, integrity and confidentiality while nurturing a culture based on trust, diversity and innovation where employees can continuously express their potential.
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*Note: The provision of your personal data to all Ampacet Europe entities is necessary for the conduct of the recruitment procedure, in accordance with Article 6 (1) b) GDPR. Your personal data will be processed by the concerned Ampacet Europe entity acting as data controller and will be shared with any person involved in the recruitment process within Ampacet Europe . Ampacet will also be able to take screenshots based on professional information available on public websites. In the event of unsuccessful recruitment procedure, your personal data will be kept for a limited period which will be communicated at the end of the recruitment procedure. In the event of successful recruitment procedure, your personal data will be part of employee's file and will be kept for the same period. You will be able to exercise your right to access, right to rectification, right to erasure, right to portability and ask for limitation or to object the processing in line with the applicable legislation on data protection by using our GDPR Contact Form or by post to Ampacet Europe S.A, Zone Industrielle Riedgen, L-3451 Dudelange. You also have the right to file a complaint with the competent national supervisory authority [(Commission Nationale pour la Protection des Données)].


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9/30/13 Williams' homecoming show set for Tuesday
Jon Upchurch / Special to the Times-News
Above is the cast of Williams High School's Homecoming Show, "George's Empire State of Mind," which will be performed at 7 p.m. Tuesday in the high school auditorium, 1307 S. Church St., Burlington. Tickets are $5 for students and $7 for adults and can be purchased at the door.
Williams' homecoming show set for Tuesday
Commentary by Evan Mertz, Special to the Times-News The Times-News 9/30/13
The turn of the season brings all sorts of new excitement, cool evening nights, the crunching of leaves, and of course, and football season. Football is one of the most highly anticipated sports in America and there's no better way to celebrate the season than with George Bulldog and his friends as they quest to win the big homecoming game.
"George's Empire State of Mind" is being performed by the choral department under the direction of Lucas Cecil at 7 p.m. Tuesday in the Williams High School auditorium, 1307 S. Church St., Burlington. The show was written and directed by senior Hannah Thigpen.
Things are shaken up a bit when George's girlfriend, Georgette, is invited to a Broadway audition where things are not what they seem. Georgette's role will be filled by Ms. Thigpen herself as she plays alongside senior Trae Madden as George Bulldog.
The plot of the show centers on the Williams Bulldogs, a fun loving group of kids with odd personalities and a love for what they do. As the Bulldogs are working hard to prepare for the big Homecoming Game, an eccentric group of Rockingham Cougars devise a plan to beat the Bulldogs. Their solution: lure them to New York and leave them there.
The money and sass behind the operation is supplied by senior Lauren Williams in her role as none-other-than-the-diva herself, Beyonce. Her posse is made up of quirky characters from Cady, the Bulldog wannabe (played by senior Ashley Day), to Katniss Everdeen (played by Mary Margaret Evans). The other major players include Beyonce's right-hand women, Daisy Lynn and Ella, portrayed by Logan Doctor and Tatiana Tunstall; pathological liar Ali and foreign exchange student Dwayne, played by Daniel "PB" Baires and Syan Iwaniec, respectively; and Ruth, the goody two-shoes, embodied through Sarah Myers.
Accompanying George and Georgette are their bizarre Bulldog pals. The Bulldog boys include hopelessly romantic Prince Jacques, played by Jack Wolverton, and Mako, the unexplainable enigma played by me. The girls are made up of sassy rich girl Martha Lillian Hollingsworth, played by Katherine Metts and devious "mean girl" Regina George played by Elise Weatherly.
The show features a collection of songs both old and new, most of which have been arranged for the TV series, "Glee." These songs range from the familiar pop hit, "I've Got a Feeling," to the '60s Motown tune, "You're All I Need to Get By." Each one of the songs has been choreographed by alumni and current students.
While directed by Hannah Thigpen, the show would not be possible without the help of Williams' new choir director, Cecil, a former student of former choir director Laura Sam.
"George's Empire State of Mind" is an event you won't want to miss. Anyone can agree that the show's captivating writing, enjoyable song selection, dance numbers and young, talented cast are a real sight to behold. Tickets are $5 for students and $7 for adults and can be purchased at the door.
Evan Mertz is a junior at Williams High School.


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« Instapoker
Lock-Blocked
Steve Wynn: Nevada's Gaming Industry Not Healthy
by Ed Vogel / Las Vegas Review-Journal, May 6, 2013 | 1:00 pm
Gaming magnate Steve Wynn met behind closed doors with the governor and legislative leaders Wednesday, proclaiming in a brief interview that the gaming industry is not in a "healthy" condition and future growth will be in places other than Nevada.
"Right now the gaming industry has a serious health problem," said Wynn in a brief hallway interview.
When asked whether he favored or opposed higher taxes, his response was, "I am not a legislator."
He visited first privately with Gov. Brian Sandoval in the Capitol, then with legislative leaders such as Senate Majority Leader Mo Denis, D-Las Vegas, and Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas. She left after only a few minutes.
After speaking with Denis, Wynn went to the office of Senate Minority Leader Michael Roberson, R-Las Vegas, to talk with him.
Before that, he met with other legislators in a vacant office in the Legislative Building.
He was accompanied during his visit by former Assembly Speaker Richard Perkins.
Sandoval declined comment about his meeting with Wynn. Denis would not respond to questions about his meeting with Wynn.
The majority leader and speaker are expected in the next couple of day to release a plan to increase a variety of taxes, a plan expected to be dead on arrival among Sandoval and Republicans. The Republicans have the power to block any tax increases.
"We are just up here today to try and share insights as we see the gaming industry," Wynn said. "We want them to know what the real outlook of the industry is and that understanding will lead them to proper decisions going forward."
Further growth in the gaming industry is not going to occur in Nevada, but Nevada needs to make sure it has a healthy product that will bring visitors to the state, he said.
Wynn infrequently has visited the Legislature. In 1999 he visited privately with legislative leaders. That session he sought and received tax breaks on the purchase of his $400 million art collection. As a condition, he was required to offer discount tickets to Nevadans to visit the art work when it was displayed in the Bellagio.
Contact Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3900.
Copyright 2013 Stephens Media Interactive GamingWire.


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Home > Membership > Franchise Operators > Booba Coffee Shop L.L.C
Booba Coffee Shop L.L.C
Our Story: After years of international work in the hotel industry, our founder returned home unexpectedly one day, unemployed. Before long, he began hearing stories about a new exciting drink in his hometown. Deciding to try it for the first time, he was overwhelmed by its vibrant flavors and dynamic drinking-eating experience. From the moment the liquid met his taste buds a light bulb switched on in his brain with a big fat "WOOOW!" He knew he had to give bubble tea to the world, and he was employed once more – with a life purpose! But it was not only about bringing bubble tea to town. Moreover, it was a unique motivation to create a place full of life – that would connect friends and people around the world. A great hub where friendships were made without boundaries, and where everyone drinking the tea together would feel at home. A place where fun and taste tells all. So, after months of studies, researches and development, Booba was born. And now, it's time to tell your taste!
Our Values: Us people are defined by how we dress, what we eat and drink. Booba delivers you a silent experience of yourself. Discover who you are with Booba. A variety of creative Bubble Teas will make you explore and experiment new tastes and flavors. A refreshingly inspiring new beverage brings an alternative nutritional option to indulge from a classic traditional product, tea. Get your pleasure with a convenient and tailored product. It will make you desire and stimulate for new fun. Taste tells at Booba.
What is Bubble Tea? : Now found in some of the best cafes of the world, the story of Bubble Tea began within a single bubble of a vision in Taiwan, during the 1980's – before spreading to nearby East Asia, shaking up the Canadian drinks scene, then revolutionizing New York City's Chinatown – and various spots throughout the West Coast in the United States. Taiwan now has over 8,000 bubble tea cafes, and Dubai is next!
Containing green or black tea and flavored with an endless variety of fruity flavors it is topped with tapioca pearls which are commonly used in Asia, South America and the Caribbean, for soups and other traditional dishes. Extracted from the Cassava plant the stars of the show are soft, chewy and contain iron, calcium, vitamin B9 and essential omega-3 acids.radiant healthy skin. Natural & Organic Affordable Luxury!


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Everyday Motion and "Move More Month"
We all know it's good to get exercise, but now there is even evidence that 30 minutes of regular activity a dayopens a new window is beneficial. This can be as simple as taking a stroll to the farmers market, cleaning out your space, or spending some time in the garden. The benefits of motion might be why the American Heart Associationopens a new window has declared April "Move More Month" to promote all varieties of physical activity so we can feel better and live longer. Formerly "National Walking Day," the event has become a larger and more inclusive way of celebrating movement and promoting health for people of all abilities.
The "Move More Month" siteopens a new window provides a treasure trove of information and resources that are aimed at helping even the busiest people incorporate more motion into their everyday lives. As someone who works in an office, I personally enjoy the tipsopens a new window on incorporating more movement in the workplace.
In his book, Goodbye, Things, Japanese minimalist Fumio Sasaki talks about the concept of a chokomaka (restless) routine, the idea that one can get their steps in by moving around here and there to clean or touch up. Sasaki, like the famous decluttering guru Marie Kondo (author of The Life-changing Magic of Tidying up), advocates the clearing of unnecessary objects from your place. Perhaps celebrating "Move More Month" with a good decluttering may be a way to spark some joy into your step?
Why not take a stroll in the great outdoors? Maybe you're looking to hike or bike around the Peninsula but not sure where to start? These trail guides to the Bay Area should help. Click a title that catches your fancy, offered in both paperback and eBook formats!
Ever wondered if you have a green thumb? You may or may not have the space for a garden, but these books can help you get started indoors or outdoors as you become a plant parent, no matter where you live! There's no doubt that lifting those heavy soil bags and crouching down to mix your seeds would be a fun way to break a sweat, especially since "Move More Month" happens to take place in spring!
Perhaps you know how you'd like to move but you're looking for an audiobook to listen to while you burn those calories. Did you know that you can checkout and temporarily download eAudiobooks to your mobile device from our hoopla digital service? You can also download some engrossing eAudiobooks from our other eBook/eAudioBook platforms, OverDrive and Axis 360. With an audiobook, your mile run will be over before chapter four!
Your local library also has events that can help you get active!
The Millbrae Library is hosting an edible gardening workshop this Wednesday, April 10 at 7:00 AM.
Several libraries regularly hold Tai Chi classes.
Take a look at our events page for more ways to be active!
Do you have some creative ways to incorporate movement into your life? Share in the comments below!


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Chatterbox, Feature January 30, 2018
Fifteen with Tyler Moy
Tyler Moy has barely scratched the surface of his professional career. Yet, it hasn't taken that long for all of us from the outside to see what a Renaissance Man he is. He arrived out of his collegiate career at Harvard University still grinding away with online classes while making his pro debut with the Milwaukee Admirals in order to graduate on time. And he did with a degree in Human Evolutionary Biology.
Moy arrived to Harvard University following a season spent in the USHL with the Omaha Lancers. His time at Harvard spanned four-years and he played 131 games and produced 101 points (45 goals, 56 assists). After the 2014-15 season he would be selected in the sixth round of the 2015 NHL Draft by the Nashville Predators. He would arrive last last season out of college to make his professional playing debut as a member of the Milwaukee Admirals in the AHL on 4/12/17. He scored an assist on that debut and would follow that up with a pair of assists in his second game and then would score his first pro goal in his third game and Milwaukee debut on 4/15/17.
In the playoffs that would follow Moy would see his point streak snapped and be a healthy scratch in the final and decisive game that saw the Grand Rapids Griffins sweep the Admirals in the first round. It might have been a blur for Moy during that time but it was an experience that prepared him well for the first full-season that would follow.
The 2017-18 season for Moy and the Admirals has seen its share of ups and downs. For Moy he is slowly adapting to the riggers of the pace and skill levels associated with hockey at an AHL level. He has recorded 10 points (4 goals, 6 assists) in 40 games while primarily playing on the wing as opposed to center which he showed he was competent in playing for Harvard.
It has been a heavy learning experience for Moy as an AHL rookie. If there is anything that Moy seems to embrace more than anything it is tackling those obstacles and studying hard. In many ways the collegiate career for the 22-year old from La Jolla, California might be a good source of reflection for the professional career that is in the works. He didn't necessarily hit the ground running for Harvard. It was his second season that put him on the Predators radar. The more Moy can experience the better he seems to adjust and excel. The time ahead of him likely will show that.
Cheers to Tyler Moy for taking the time to chat with us and get to know him that much better. Tomorrow we will do the same with goaltender Jake Paterson who is experiencing the longest run in the AHL of his still young pro career. As for Fifteen we will be looking to continue the series on when time allows for it. Your suggestions for who we should hear from next would be greatly appreciated!
Admiral of the Month: January
Fifteen with Jake Paterson


Stephen ChboskyIt begins as an assignment for English class: Write a letter to a dead person. Laurel chooses Kurt Cobain because her sister, May, loved him. And he died young, just like May did. Soon, Laurel has a notebook full of letters to people like Janis Joplin, Amy Winehouse, Amelia Earhart, Heath Ledger, and more - though she never gives a single one of them to her teacher. She writes about starting high school, navigating new friendships, falling in love for the first time, learning to live withher splintering family. And, finally, about the abuse she suffered while May was supposed to be looking out for her. Only then, once Laurel has written down the truth about what happened to herself, can she truly begin to accept what happened to May. And only when Laurel has begun to see her sister as the person she was - lovely and amazing and deeply flawed - can she begin to discover her own path.
Sydney G., you get a brand new book! Way to go!