text:
Abortion, the leading cause of deaths worldwide in 2019
agit-prop, opinion manipulation and well-poisoning games Culture Defending our Civilization Media Manipulation, Agit-Prop &/or Lawfare
Posted on January 1, 2020 January 1, 2020 Author kairosfocusComments(42)
Of course, first, a happy new year!
However, as we ponder the cultural consequences of inherently amoral evolutionary materialistic scientism, the following clip should give us pause:
>>More human beings died in abortions than any other cause of death in 2019, a new report indicates.
A heartbreaking reminder about the prevalence of abortion, statistics compiled by Worldometers indicate that there were over 42.3 million abortions world-wide in 2019. The independent site collects data from governments and other reputable organizations and then reports the data, along with estimates and projections, based on those numbers.
When contrasting the abortion numbers to other causes of death, including cancer, HIV/AIDS, traffic accidents and suicide, abortions far outnumbered every other cause.
By contrast, 8.2 million people died from cancer in 2019, 5 million from smoking, 13 million from disease, and 1.7 million died of HIV/AIDS. Deaths by malaria and alcohol are also recorded.
Worldometers estimates about 58.6 million deaths world-wide in 2019, but that number does not include unborn babies' abortion deaths. Unborn babies are not recognized as human beings even though biology indicates that they are unique, living human beings from the moment of conception and they die brutal, violent deaths in abortions.>>
Francis Schaeffer often pointed out, that ideas have consequences. In this case, such were pointed out long since — c 360 BC — by Plato in The Laws, Bk X:
>>Ath [in The Laws, Bk X 2,350+ ya]. . . . [The avant garde philosophers and poets, c. 360 BC] say that fire and water, and earth and air [i.e the classical "material" elements of the cosmos], all exist by nature and chance, and none of them by art . . . [such that] all that is in the heaven, as well as animals and all plants, and all the seasons come from these elements, not by the action of mind, as they say, or of any God, or from art, but as I was saying, by nature and chance only [ –> that is, evolutionary materialism is ancient and would trace all things to blind chance and mechanical necessity] . . . . [Thus, they hold] that the principles of justice have no existence at all in nature, but that mankind are always disputing about them and altering them; and that the alterations which are made by art and by law have no basis in nature, but are of authority for the moment and at the time at which they are made.-
[ –> Relativism, too, is not new; complete with its radical amorality rooted in a worldview that has no foundational IS that can ground OUGHT, leading to an effectively arbitrary foundation only for morality, ethics and law: accident of personal preference, the ebbs and flows of power politics, accidents of history and and the shifting sands of manipulated community opinion driven by "winds and waves of doctrine and the cunning craftiness of men in their deceitful scheming . . . " cf a video on Plato's parable of the cave; from the perspective of pondering who set up the manipulative shadow-shows, why.]
These, my friends, are the sayings of wise men, poets and prose writers, which find a way into the minds of youth. They are told by them that the highest right is might,
[ –> Evolutionary materialism — having no IS that can properly ground OUGHT — leads to the promotion of amorality on which the only basis for "OUGHT" is seen to be might (and manipulation: might in "spin") . . . ]
and in this way the young fall into impieties, under the idea that the Gods are not such as the law bids them imagine; and hence arise factions [ –> Evolutionary materialism-motivated amorality "naturally" leads to continual contentions and power struggles influenced by that amorality at the hands of ruthless power hungry nihilistic agendas], these philosophers inviting them to lead a true life according to nature, that is,to live in real dominion over others [ –> such amoral and/or nihilistic factions, if they gain power, "naturally" tend towards ruthless abuse and arbitrariness . . . they have not learned the habits nor accepted the principles of mutual respect, justice, fairness and keeping the civil peace of justice, so they will want to deceive, manipulate and crush — as the consistent history of radical revolutions over the past 250 years so plainly shows again and again], and not in legal subjection to them [–> nihilistic will to power not the spirit of justice and lawfulness]. >>
We cannot say, we were not warned in good time. Let us heed warning signs and turn back from going over the cliff's edge:
It is time to turn back. END
PS: Let us hope that this year's annual march for life will not be targeted for another agit prop street theatre incident and media lynching.
Rethinking what it means to be "legally human"
Jerry Coyne is distressed by National Geographic going all "woo"
42 Replies to "Abortion, the leading cause of deaths worldwide in 2019"
Abortion, the leading cause of deaths worldwide in 2019, 42+ millions. Let us turn back from the brink.
Fasteddious says:
I have been saying the same locally, on and off, for years, and the truth is simply ignored.
Seversky says:
Women Now Have As Many Miscarriages As Abortions
I agree that we should find ways to minimize abortions as I believe the right to life should extend to the earliest stages of an individual's development. Presumably, you would also agree that you should ask your God if He couldn't do something about the faulty human reproductive system He designed. How many lives has that cost humanity over the millennia?
EDTA says:
Sev @ 3,
Doesn't this go back to the argument against God (or aspects of his nature) from faulty design? I think we've covered that one here at length.
But if you want to pursue that, you would need to demonstrate that the current reproductive system is identical to the original, and that it is operating in an identical environment to the original. Then you'd have a good case. If those two premises can't be justified, then the argument won't work.
Ed George says:
I am all for taking steps to significantly reduce abortion rates. Early and non-judgmental sex education, removing the nonsense about masturbation being a sin, ready access to birth control and how to use it, factual (not scare tactics) about STDs, the benefits of abstinence, improved support for women who find themselves with an unwanted pregnancy..
The US could make a huge step in reducing abortion rates by simply providing a reasonable level of paid maternity leave. At present it guarantees 12 weeks of unpaid leave. Canada guarantees 18 months of paid leave. This is reflected in the higher abortion rates in the US, even though they are much more difficult to obtain depending on the state.
EG, your start-point is wrong, boiling down to enabling grooming under colour of education in sexuality will help us solve rather than compound, the problem. The issue is sound ethics, and moral training starting with the first duties and first principles of sound reason. In which context, the first right is life; without life, there is no one there to have further rights. In that contexts facts of biology and of puberty etc can be taught effectively and soundly without grooming. KF
Far too many people see human features, but see something other than human beings. National Socialists saw everyone not white as less than human, and some even less so than others. They were eugenicists who looked through the prism of race. Slave owners, which still exist today, do not see slaves as human beings, but something far less. Those who support abortion have the same mindset, since there is nothing human to them about an unborn child. During the last census, it was discovered more black children were aborted than born and the silence from Democrats had been deafening.
Sev, you compare apples with manchineel death-apples; which look like small apples and I am told, smell and taste like apples at the first (and are exceptions to the if it's natural and sweet it's non-poisonous rule); until they start to tingle and burn caustically, even rain dripping off the tree is caustic. A miscarriage is a natural death, an abortion is willfully imposed death of the ultimately innocent. There is no legitimate comparison. KF
PS: As for, it's God's fault that we may die, from womb on, that is a non-starter.
BR, it is often worse, they see yes human but deny that rights inherently exist, beyond might makes right . . . including, might in manipulation. Misanthropy and nihilism result as we have seen with too many radical revolutions. KF
PS: If you deny the humanity of slaves, how is it that you can have children with them? That is a direct refutation.
FE, that studious ignoring is telling. Where, on a simple 40 year ramp model we see the toll 800+ million since the 70's, and on the reported more or less plateau since the 90's, the statistical 1.4 billions mounting at about a million more per week, is plausible. This is by far and away the worst holocaust in history and we, our generation, are implicated. Where, there is nothing so morally corrosive as mass blood guilt. Literally, only God can cleanse blood guilt. KF
Kairosfocus
Socialists, Marxists, Communists, whichever they happen to call themselves, have no value in truth. We are nothing more than animals and the population needs to be culled. They believe there are too many of our species and don't care how a reduction happens.
DDT was targeted for saving human lives and it did not matter that there had never been a study to show any negative effect on anything not intended for its creation. Millions of human lives in Africa were saved, which means DDT had to be banned at all costs. They relied on a rigged study to accomplish this and very few African countries have access to DDT today.
The ends will always justify the means.
BR, I suggest, not all of those and others on other ends of the ideological spectrum. The core issue is that evolutionary materialism dressed up in the lab coat has undermined morality, as Plato warned against 2360 years ago now. KF
PS: On DDT, there has been a question of damaging ecological impacts and of course, insects have built up significant immunity, as is happening in the race between bacteria and antibiotics.
Acartia Eddie:
Early and non-judgmental sex education, removing the nonsense about masturbation being a sin, ready access to birth control and how to use it, factual (not scare tactics) about STDs, the benefits of abstinence, improved support for women who find themselves with an unwanted pregnancy..
We have all of that in the USA and it isn't helping.
The US could make a huge step in reducing abortion rates by simply providing a reasonable level of paid maternity leave.
The two have nothing to do with each other
seversky the clueless:
Presumably, you would also agree that you should ask your God if He couldn't do something about the faulty human reproductive system He designed.
Umm, no one designed the reproductive systems of today. The reproductive systems of today are the result of genetic entropy.
Silver Asiatic says:
Seversky
Asking. hmmm – I think I'm hearing something … oh yes …
"The sins of people like Seversky caused damage to the entire cosmos including harm to the reproductive system. I am hoping he, and the millions others like him, will repent and atone, and thus help restore and repair the order, health and peace that should exist in earth, as I wanted it."
TAMMIE LEE HAYNES says:
I figure this
1) We should secure the inalienable rights of all persons.
2) We should provide equal protection of the laws for all persons.
Anyone disagree?
If so,please tell us why.
If you agree, then remember, that requires that we need to treat the parties involved in an abortion like we treat other premeditated murderers,
with either mandatory life imprisonment, or where called for, under the law, the death penalty.
Anything else denies the equality of all before the law.
Now I figure this.
Life imprisonment and the death penalty will discourage murder,
even more than "early and non-judgmental sex education, removing the nonsense about masturbation being a sin, ready access to birth control and how to use it, factual (not scare tactics) about STDs, and blah blah blah"
What do you guys figure?
TLH, correct me if I am wrong, but you are advocating for life in prison or the death sentence for all women who have an abortion.
DDT was never proven to have any harmful impact on anything, other than insects. When Rachel Carson did her study, she had to rig the results. She could find no link between DDT and any negative effect on birds. Rather than admit DDT was not harmful, she deprived birds of calcium and it resulted in a softening of the shells of eggs that were later produced. She claimed DDT caused the softening, but she guaranteed the results. DDT has no calcium in it and she knew exactly what she was going to get when she purposely deprived birds of calcium.
According to an article published in sciencemag.org:
Luck may not run out quite as fast as many fear. Although resistance to pyrethroids is widespread, its impact on public health is still unclear. Even though a mosquito may survive a dose of an insecticide, the chemical may weaken it in some way. And the genes needed for resistance may take their own toll, perhaps by shortening a mosquito's life span. If the insect survives for fewer than 14 days, the malaria parasites won't have enough time to mature to the stage where they can infect humans, says Matthew Thomas, an entomologist at Pennsylvania State University, University Park. "There is some evidence to show that things like that can happen," Thomas says.
https://www.sciencemag.org/news/2016/10/after-40-years-most-important-weapon-against-mosquitoes-may-be-failing
I clip the article (2016 date) on resistance:
The world still relies on the same class of insecticides, known as pyrethroids, as it did in 1977. Now, in part because of that neglect, these compounds may be nearing the end of their useful lives as mosquitoes develop resistance to them at alarming rates, and there is little in the pipeline to replace them. "If we don't do something about this very quickly, we have a public health catastrophe on our hands," Hemingway says.
I note, the infographic just below.
Whether or not there was experimental misbehaviour 50+ years ago, we have a resistance challenge. One, I recall, being pointed out in National Geographic when I was a child, i.e. they knew there was a problem to deal with — just as for antibiotics folks.
TLH & EG:
I find, it is interesting to see the rhetorical pounce above. That tells me a lot about areas of conspicuous silence here at UD. Such as, EG, you need to justify the assumption that the 4-state algorithmic digital code in the heart of the cell is either not really a machine code [not likely] or else that such language applications can and do by observation come about by blind chance and/or mechanical necessity [even less likely].
Now on the exchange.
First, there is a difference between moral murder and what a state may reasonably prosecute. Just as how, in 1917, the French found it unreasonable to put to death half their army for mutiny, or even most of those who emerged as leaders. I would argue that, by resort to decimation [the old Roman punishment for a unit convicted of cowardice] they went beyond reason. Notice, the German General Staff found it prudent to keep quiet lest THEIR troops join in the mutiny . . . where, the next year, the order to take the High Seas Fleet on a death ride, Jutland II, led to the mutiny that broke Germany. Not to mention, 1917 saw the revolution and coup that broke Russia. All of these came after the double slaughters at Verdun and on the Somme in 1916 backed by a futile sea clash marked by three exploding British Battlecruisers. And I argue, 1917 set up 1940 and beyond.
The abortion holocaust has created widespread blood guilt and guilt of enabling that has corrupted key institutions, professions, education, the law and more. Our civilisation is — in the words of the White Rose — guilty, guilty, guilty. It is repentance, reconciliation and forgiveness we need, leading to reformation.
Just as with slavery and its kidnapping based trade.
That is going to take a spiritual awakening and a shift in conscience and consciousness. Such a paradigm shift cannot happen overnight; it is the sort of thing that moves forward one funeral at a time. Which, BTW, is precisely what is behind the current US shenanigans with star chamber courts and perversion of investigatory powers of Congress into an attempted show trial and kangaroo court. The US Supreme court is at tipping point and the 2016 election has the signature of a peasant uprising with a Constantine like figure as sponsor [and that's no compliment at all . . . ]. The UK "we mean it" General Election just past is much the same.
The tides are turning, and not only the necks of pols and deep state apparatchiks but also the credibility of the sold out media and magisterium in charge of education are on the line. Thus, the dirty fight, in the US having become bleeding Kansas lite, agit prop, media lynch mob and lawfare stage civil war. And, I don't think the power brokers of holocaust and perversion [as well as pocket-lining] as usual have the sense to retire quietly and let change happen. They imagine they can turn back the tide.
2020 is going to be a real mess.
But through the storm, a better balance can emerge, but not without cost. And yes, I am alluding to Acts 27 and through it to Luke's allusion to Plato's ship of State parable, here. Today's equivalent to the indefensible, genocidal, deeply corrupting and tainting slave trade is going down but it ain't gonna be pretty or clean.
Ed George
What I wrote was clear, and speaks for itself.
All persons have a right to equal protection of the laws.
Laws protect by the deterrence afforded by punishment. Ergo, punishments should apply to abortion as it does for other premeditated murder.
Of course for some murderers the punishment may be lessened when coercion is involved, when insanity or mental incapacity is present, or when the murderer is a minor.
How about yourself?
Don't you agree that all people should have equal protection of the laws?
If you do, which do you call for?
1) Giving those involved in an abortion life or the death penalty.
2) Letting all murderers, such as drug gang hit men, off with a fine,
3) Having judges decree that all murders, not just abortion, are a constitutional right?
EG, you may want to walk that back. Equal protection under just law implies due balance of rights, freedoms and duties. TLH, speaks to being equally protected as an ought, not a given. By the nature of finite, fallible, morally struggling and too often ill-willed humanity, such will always be an ideal that challenges reality leading to the issue of courts as a means of civil redress in preference to feuds. KF
TLH, some points of strict letter of law justice are not achievable in this life. I pointed out the French mutinies 1917 as a case where the strict letter of law would have been suicidal. I suggest, that given circumstances of abortion and of general violence in our civilisation, reconciliation and widespread change are needed, rather than an eye for an eye or the equivalent. KF
EG, you may want to walk that back.
Why? People who have been convicted of crimes forfeit some of their legal protections. Early term fetuses do not have equal protection under the law.
Dear Ed George
Thanks for your reply, but did you read the question?
Here's the question I asked:
You answered this: "No"
I thought that was very candid, and a most reasonable answer for an atheist, given the unclear basis, if any, for atheists to hold to concepts like equality and morality. By contrast, us Christian Creationists, we hold that we are all children of God, and thus brothers and sisters, equally loved by Him. rom that equality and morality are obvious. Unhappily all of us are sinners and fail to follow our ideals.
But your latest reply is strange.
"Why? …………Early term fetuses do not have equal protection under the law"
That is true, thanks to our courts.
And it's why we've killed 60 million unborn children, just in the USA.
which is 10 times what the Fuhrer did.
But it has nothing to do with my question
My question wasn't "DO" all people have equal protection of the law?
It was SHOULD they have equal protection?
EG, convicts have not forfeited equal protection under law, they are held under penalty of law, supervised by courts of law. Crucial distinction. And of course, the acts under colour of law that rob unborn, living posterity of life at will are profoundly unjust and ruinous, as we see playing out. KF
TLH, the total Nazi holocaust was much bigger, maybe 7 million apart from the 6 million Jews. Add in the slaughter of Russians and we see another 20+ millions, though it overlaps; again overlapping, responsibility for a war that in Europe and neighbouring areas killed 40++ million; the toll in especially China goes on top of that. KF
TLH, I would agree that every human born should have equal protection under the law until the individual does something that could change than.
A fetus complicates the issue. From conception till birth a fetus is completely dependent on one single individual. What happens when the legal protections of the mother conflict with the legal protections of the fetus?
Ed:
Early term fetuses do not have equal protection under the law.
An arbitrary law based on ignorance.
From conception till birth a fetus is completely dependent on one single individual.
That is false as that individual's life is dependent on multiple people. And a new born baby is also dependent on multiple people.
What happens when the legal protections of the mother conflict with the legal protections of the fetus?
What happens when the legal protections of the mother conflict with the legal protections of the baby? Any mother that does anything to injure an unborn child suffers the consequences on the law. If someone murders a pregnant mother and the unborn child also dies, the criminal is charged with TWO counts of murder.
EG, your "every human born . . ." neatly side steps that as babes in the womb now are, so were we once. Resorting to Latin for baby does not get around the classic step of dehumanising and robbing of life. You are illustrating the problem and opening up a terrible cascade of precedents that turn on willfully inflicted deaths of the innocent as a "solution" to societal problems. Plato's warning is again speaking truth as to where evolutionary materialism and fellow travellers end up: the nihilistic absurdity, "the highest right is might." Let us turn back before it is too late. KF
You wrote that "A fetus complicates the issue" (of equal protection of the laws.). That is false.
With the fetus, you have a completely innocent defenseless human being. It is the first duty of the state to defend such persons. There may be complicated situations, but abortion is certainly not one of them.
Now being a mother of nine children, I agree that "from conception till birth a fetus is completely dependent on one single individual." But so what? You cant kill a dependent.
With the fetus, you have a completely innocent defenseless human being. It is the first duty of the state to defend such persons.
There may be complicated situations, but abortion is certainly not one of them.
What if continuing the pregnancy puts the woman at serious health risk?
Now being a mother of nine children, I agree that "from conception till birth a fetus is completely dependent on one single individual."
Congrats on your kids. I have three myself. I don't regret a second of it.
But so what? You cant kill a dependent.
True. But you can put it up for adoption or the state can take it from you. That option isn't available for a fetus.
I understand the religious objection to abortion, and fully respect it. At conception it is your opinion that a unique human being is created with its own soul. But what if we could clone a person (not far fetched). Does the clone also have equal protection under the law?
That's what doctors are for.
I understand the religious objection to abortion, and fully respect it.
It goes against all positions except the one that says no to reproduction.
But what if we could clone a person (not far fetched).
Can we clone a soul?
I don't know. Can we?
I thank you for your response, in which you wrote that " "I understand the religious objection to abortion, and fully respect it. At conception it is your opinion that a unique human being is created with its own soul."
Let me say that I do NOT respect your contrary views. Acquiescence in premeditated murder on a massive scale is barbaric. Nor do I respect your apparent ignorance of basic biology.
You cited three objections to strict prohibition of abortion. They are smokescreens that no reasonable person would advance.
First, you object to the "cost" to the state of defending the lives of innocent and defenseless persons. But cost is not a factor in the face of almost one million premeditated murders per year, in abrogation of the first duty of the state.
Second, you claimed to be concerned "if continuing the pregnancy puts the woman at serious health risk." The rate of deaths resulting from pregnancy is 1 in 5000, Thus you are willing to accept 5000 premeditated murders to prevent one accidental death. Moreover, that same woman has 50 times greater chance of being killed in a car accident. If you were truly concerned about the woman, you would be promoting better air bags instead of advocating premeditated mass murder.
Finally, you note the loss of autonomy and the inconvenience a woman would experience if she were denied an abortion. But the idea that a temporary loss of autonomy and inconvenience justify premeditated murder of a completely innocent and defenseless person is ghoulish.
Finally it is not opinion but scientific fact that a human being is created at conception. This is obvious to any reasonable person from ultrasounds, DNA evidence, and common sense. Moreover this scientific fact is acknowledged by an overwhelming majority of biologists. Yet you would allow such human beings, all of them innocent and defenseless, to be legally murdered by the millions. That is barbaric> It defines theses persons as inferior human beings, a concept in opposition to any decent morality, and destroys the concept of equal protection of the laws, which is a cornerstone of any decent legal system. As to your thoughts on ensoulment and the uniqueness of human beings, they are an irrelevant smokescreen.
EG, the problem is not a matter of religious sentiment or opinion, it is, the issue of guilt of shedding innocent blood. AKA, murder, natural law sense, antecedent to any state and its decrees under colour of law. KF
Abortion is not meant to be survived, yet somehow, there are people alive today who lived through their mothers' abortions. Today, they want their voices to be heard …
https://healthimpactnews.com/2015/babies-who-survived-abortions-and-are-now-adults-time-for-our-voice-to-be-heard/
i think someone who was burned in her mother's womb for 18 hours ( me ) deserves to be heard, as we face the horror of planned parenthood.
— Gianna Jessen (@giannajessen)
asauber says:
Don't forget, if you can't be there in person, you can be there in spirit.
https://marchforlife.org/
I will be there in both again this year.
"We march because we envision a future world where the beauty and dignity of every human life are valued and protected."
My apologies for the confusion. I was not referring to cost in dollar terms.
Finally it is not opinion but scientific fact that a human being is created at conception.
There is more to being human than a unique assemblage of DNA. If I implant a human genome into a mouse ovum, does it become human with all the entailing rights?
If I implant a human genome into a mouse ovum, does it become human with all the entailing rights?
No, because it will never become a viable organism. It will never develop.
Truthfreedom says:
Abortion, according to silly reductionist materialism, is nothing more than 'DNA wars'.
Some DNA 'wins', some DNA 'loses'.


text:
Cape Breton police issue 55 charges against four people in vehicle theft investigation
The Cape Breton Regional Police Service logo is seen on the side of a CBRPS police file photo. - David Jala
SYDNEY, N.S. —
Cape Breton Regional Police have charged four people with 55 charges after a month-long investigation related to theft, stolen property, weapons and drugs.
The investigation dates back to Oct. 30 when officers responded to a report of a suspicious vehicle parked in the Hardwood Hill cemetery.
After approaching the vehicle and requesting identification from passengers, it drove away and was later reported parked on Cabot Street in Sydney where three males were seen running from it.
Inside the vehicle, officers found drugs and a weapon, which had been previously reported stolen from outside the province.
Officers were able to identify the man believed to be driving the vehicle and were led to a residence on Victoria Road on Nov. 12.
The suspect fled from the driveway when he saw police, but officers spotted three additional people inside a second vehicle reported stolen from outside the province and connected to other separate ongoing investigations.
The initial suspect was later arrested on Nov. 24 in a vehicle stop at the intersection of SPAR and Lingan roads.
Stephen Frederick Hanna, 36, of Sydney was scheduled to appear in Sydney provincial court on Thursday. He's charged with dangerous driving, flight from police, theft of a motor vehicle, possession of stolen property, three weapons charges, and numerous breaches of probation.
Meanwhile, Isaiha Leonard Keagan, 24, of Balls Creek is scheduled to appear in provincial court on Dec. 14 charged with theft of a motor vehicle, possession of stolen property, drug trafficking, three weapons charges and breaching previous court-ordered conditions.
Courtney Reid-Boone, 22, of Westmount is scheduled to appear in provincial court on Dec. 21 charged with drug possession and breaches of previous court-ordered conditions.
Jonathan James Fitzgerald, 28, of Sydney Mines is also scheduled to appear in provincial court of Dec. 21. He's charged with dangerous driving, theft of a motor vehicle, possession of property obtained by crime, resisting arrest, drug trafficking, and breaches of previous court-ordered conditions.
Further charges are pending against an additional three people.
Updated just now
Generous donations highlight CBRM campaign contribution disclosures
Police investigating assault that seriously injured Glace Bay man
Cape Breton Health Recreation Complex 'examining its options' for the dome
Review board studying Cape Breton police conduct in murder investigation
Nova Scotia Health says measures in place to lower death ratios in Cape Breton hospitals
Criminals continue to leave hammers behind at Ross Ferry crime scene

redpajama_set_name: RedPajamaCommonCrawl


Milwaukee's Christian Yelich was close to a unanimous pick for the NL honour. A 26-year-old outfielder just like Betts, Yelich also won a batting championship and led his team to a division title. But while Betts has been with the Red Sox since he signed after the 2011 amateur draft, Yelich didn't join the Brewers until he was dealt to Milwaukee last January by the payroll-paring Miami Marlins.


text:
Q: rsync only leaves partial files? I am trying to copy files from my hard drive to a networked external disk (WDMyCloud). I have enabled the FTP access to the hard drive and mounted it to a local directory using curlftpf to a local directory. Now I created the directory I wanted to copy the files to in the mounted directory and tried
rsync -avzP /media/Windows7_OS/Work/* .

which resulted in rsync copying for a long time, showing progress and very good transfer speeds, but at the end the target directory only contained .Files.ext.kE5WT or something similar, that corresponded to the names of the files in the source folder but all of them had 0 length. cp copies without problem, although the transfer rate is slow. I am on CentOS 6.4.
Where did I go wrong?

A: This looks like a bug in CurlFTPfs, perhaps compounded by some missing error checks in rsync.
You can enable SSH access on this device. Rsync over SSH is a lot more likely to work out of the box, and some people have reported success.

redpajama_set_name: RedPajamaStackExchange


text:
ARM CEO Simon Segars joins SoftBank board
Honour for chip design firm boss
ARM CEO Simon Segars
ARM CEO Simon Segars has joined the board of parent company SoftBank.
Segars, who took over as boss of the Fulbourn chip design giant in 2013, will now also sit on the board of its parent company. Japanese conglomerate SoftBank brought ARM for £24bn last year.
Cambridge's ARM Holdings in £24billion take-over by SoftBank
"I'm honoured to join the SoftBank Board at this exciting next stage of innovation," said Segars. "In the same way it transformed mobile computing from chip to cloud and all points in between, ARM shapes the smart, connected world of IoT across a common platform. This is at the heart of the SoftBank vision and I look forward to working with the team to make it a reality."
The news was announced at SoftBank's AGM in Tokyo.


This week Jason and Gabe are going where no other Star Wars podcast has gone before and diving head first into The Great Heep! Join them as they give some Droids cartoon history and then do the first ever live podcast commentary for the weird and wild Ben Burtt written 1986 Droids TV movie!  R2 falls in love! A giant droid that eats astromechs! A cyborg Imperial admiral! The magnificent Mungo Baobob! And so much more! Grab your favorite droid that wears sunglasse or painting of you with an octopus & celebrate the love by listening today! Watch The Great Heep here : https://youtu.be/neyJB_0DsYY Blast Points t-shirts are now available! Get them here: www.etsy.com/shop/Gibnerd?section_id=21195481 visit the Blast Points website! www.blastpointspodcast.com reviews! comics! recipes, articles and tons more! if you dug the show please leave BLAST POINTS a review on iTunes and share the show with friends! If you leave an iTunes review, i will read it on a future episode! honestly! talk to Blast Points on twitter at @blast_points leave feedback, comments or ideas for shows! also like Blast Points on Facebook for news on upcoming shows and links to some of the stuff we talk about in the show!! we are also on Instagram! Wow! your hosts are Jason Gibner & Gabe Bott! contact Jason at Gibnerd@hotmail.com May the Force be with you, always.
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Have you ever looked in the mirror and been a little scared by what you see? Perhaps first thing in the morning or after a long night of drinking?
But that's nothing compared to what these animals felt upon seeing their reflections for the first time.
From scared to curious to straight-up confused, these wild critters from Gabon have no idea what's going on and react hilariously.
The best, of course, are the ones who stare at their reflections with admiration. They have no shame.
Check out the super cute clip up top, courtesy of French photographer Xavier Hubert-Brierre.


My approach is collaborative, eclectic and integrative. I draw on a combination of therapeutic approaches in order to address both symptoms and root causes of distress. I work with diverse communities and strive to offer an LGBTQ positive environment.


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China Economic Net (China)
Coronavirus can infect brain tissue, affect memory, language: Brazilian study
SARS-CoV-2, the virus that causes COVID-19, is capable of infecting brain tissue and affecting the structure of the cortex, a region of the brain responsible for functions such as memory, consciousness, and language, according to a Brazilian study released on Thursday. "We demonstrated for the first time that the SARS-CoV-2 virus infects and replicates in astrocytes and this can decrease the viability of neurons," said Daniel Martins de Souza, a professor at the Institute of Biology [...]
Brazilian researchers discover 12 new animal species in Amazon
Publicado em 27 junho 2018
Brazilian researchers have discovered 12 new animal species in the Amazon jungle, after two expeditions collected over 1,700 specimens of over 200 types of flora and fauna. The 12 new species are frogs and lizards, apart from one owl, the state-owned news agency, Agencia Brasil, revealed on Tuesday. All of them were identified during the two expeditions, one made in late 2017 and one in April and May, financed by the state of Sao Paulo. According to Miguel Trefaut Rodrigues, the expedition [...]
ver notícia


Full Text PDF | Keywords: Dropia variety, falling number, Flamura 85 variety, Fundulea 4 variety, sprouted wheat kernels.
The Falling number FN (s) and the Sprouted Wheat Kernel SWK % (ISO 3093, SR ISO7979:2001) were analyzed for 3 varieties of wheat, Dropia, Flamura 85 and Fundulea 4, mainly cultivated in the southern region of Romania. The descriptive statistics highlighted the extremely high variability coefficients of SWK, namely: 182.93 % at Dropia, 99.35 % at Flamura 85 and 152.60 % at Fundulea 4 variety. The t test did not reveal significant differences between the SWK means and between the FN means in the three varieties, with the exception of FN means between Dropia and Fundulea 4 (t=2.410*; F ratio=1.246*; p<0.05). The Shapiro-Wilk normality test of FN and SWK distributions, highlighted that FN distribution at Dropia, SWK at Flamura 85 and SWK at Fundulea 4, were not normal (w=0.871***, 0.784***, 0.638***, p<0.01). Spearman correlations between FN and SWK were negative significant in all wheat varieties (-0.521** at Dropia, -0.373* at Flamura 85 and -0.688** at Fundulea 4). The best regressions models, describing the relationship between FN and SWK in the Dropia and Fundulea 4 varieties, were exponential respectively logarithmic (r2 = 0.75; r2 = 0.59). For the Flamura 85 variety, no suitable regression model was identified (r2 = 0.15). The maximum SWK level at which minimum wheat bakery quality was achieved (FN = min. 180 s) was 2.95 % for Dropia and 1.86 % for Fundulea 4.


Uphire provides training for the EWP Operator Licence (Yellow Card), VOC Yellow card and Telehandler Gold Card. We can also arrange WP High Risk Work Licence and Working at Heights training for our customers.
Please see below for further information on our training. We are also more than happy to advise on the best solution for our customers. We work with groups and individuals at Uphire or on customer sites.
Call us on 1300 UPHIRE (87 44 73) or submit an enquiry to determine the best solution for you and your team.
Training sessions are conducted weekly (depending on availability). Weekend courses can also be catered for. Start and finish times will depend on group numbers and level of experience.
The training is conducted at UPHIRE – 56 Regentville Road Jamisontown, NSW. If required by our customers we can also run Yellow Card Training onsite. Just contact us and we can work through your requirements.
Our standard course covers THREE modules, booms under 11 metres (BL), vertical (VL) and scissor lifts (SL). The other modules, TL, TM and T are available upon request.
The EWPA recommended retail price for the Yellow card is $400.
For groups of 4 or more, discounts may apply. Please contact us to discuss your requirements.
The training is conducted by industry experienced and EWPA certified trainers.
Despite common perception, the answer is yes. The WP Licence covers boom lifts over 11m. So if you are operating a scissor lift, vertical lift or boom with a platform height under 11m the WP Licence does not cover this. You would need your EWP licence if you want to demonstrate a qualification and/or competency with the equipment.
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If you have any further questions about the Yellow Card please don't hesitate to contact us.
Uphire provides Gold Card Training on request at our premises. Onsite training can also be organised for larger groups. Trainers are industry experienced and certified by the Telescopic Handler Association of Australia.
Similar to EWP Licensing, there are High Risk Work Licenses that apply to Telehandlers with a lifting capacity greater than 3Tonne which are being used with a crane jib lifting attachment.
Telehandler Gold Card Training ensures that operators have been appropriately trained in the use of Telehandlers that do not fall into the category of a High Risk Work Licence. It is also a common misconception that a forklift licence prepares an operator to use a Telehandler, however Forklifts and Telehandlers have different capabilities and fall under different Australian standards. Operation of a Telehandler requires Telehandler specific training.
Further information from the Telescopic Handler Association of Australia can be found below. Or feel free to call us to discuss your requirements.
Uphire is a fully accredited member of the Elevating Work Platform Association of Australia, the Telescopic Handler Association of Australia and the Hire and Rental Industry Association.


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Podgorsky ist der Familienname folgender Personen:
 Helmut Podgorsky (1906–1944), deutscher kommunistischer Gewerkschafter und Widerstandskämpfer

Siehe auch:
 Podgorski

redpajama_set_name: RedPajamaWikipedia


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Association between...
Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis
CCBYNC Open access
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5953 (Published 23 November 2016) Cite this as: BMJ 2016;355:i5953
该文章的中文翻译
Yuli Huang, associate professor1,
Xiaoyan Cai, associate professor2,
Weiyi Mai, professor3,
Meijun Li, resident doctor1 4,
Yunzhao Hu, professor1
1Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
2Clinical Medicine Research Centre, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, China
3Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
4Department of Cardiology, Graduate College, Guangdong medical university, Zhanjiang, China
Correspondence to: Y Hu huyunzhao4406{at}163.com
Objectives To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality.
Design Meta-analysis of prospective cohort studies.
Data sources Electronic databases (PubMed, Embase, and Google Scholar).
Selection criteria Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovascular disease, coronary heart disease, stroke, all cause mortality, and prediabetes.
Review methods Two authors independently reviewed and selected eligible studies, based on predetermined selection criteria. Prediabetes was defined as impaired fasting glucose according to the criteria of the American Diabetes Association (IFG-ADA; fasting glucose 5.6-6.9 mmol/L), the WHO expert group (IFG-WHO; fasting glucose 6.1-6.9 mmol/L), impaired glucose tolerance (2 hour plasma glucose concentration 7.8-11.0 mmol/L during an oral glucose tolerance test), or raised haemoglobin A1c (HbA1c) of 39-47 mmol/mol(5.7-6.4%) according to ADA criteria or 42-47 mmol/mol (6.0-6.4%) according to the National Institute for Health and Care Excellence (NICE) guideline. The relative risks of all cause mortality and cardiovascular events were calculated and reported with 95% confidence intervals.
Results 53 prospective cohort studies with 1 611 339 individuals were included for analysis. The median follow-up duration was 9.5 years. Compared with normoglycaemia, prediabetes (impaired glucose tolerance or impaired fasting glucose according to IFG-ADA or IFG-WHO criteria) was associated with an increased risk of composite cardiovascular disease (relative risk 1.13, 1.26, and 1.30 for IFG-ADA, IFG-WHO, and impaired glucose tolerance, respectively), coronary heart disease (1.10, 1.18, and 1.20, respectively), stroke (1.06, 1.17, and 1.20, respectively), and all cause mortality (1.13, 1.13 and 1.32, respectively). Increases in HBA1c to 39-47 mmol/mol or 42-47 mmol/mol were both associated with an increased risk of composite cardiovascular disease (1.21 and 1.25, respectively) and coronary heart disease (1.15 and 1.28, respectively), but not with an increased risk of stroke and all cause mortality.
Conclusions Prediabetes, defined as impaired glucose tolerance, impaired fasting glucose, or raised HbA1c, was associated with an increased risk of cardiovascular disease. The health risk might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA1c of 39 mmol/mol.
Prediabetes is defined as an intermediate metabolic state between normoglycaemia and diabetes and includes those with impaired glucose tolerance and impaired fasting glucose.1 Although impaired glucose tolerance is consistently defined as a 2 hour plasma glucose concentration of 7.8-11.0 mmol/L during an oral glucose tolerance test, the cut-off point for diagnosis of impaired fasting glucose remains controversial. The World Health Organization (WHO) defines impaired plasma glucose as fasting plasma glucose of 6.1-6.9 mmol/L,2 while the 2003 American Diabetes Association (ADA) guideline recommended a cut-off point of 5.6-6.9 mmol/L.3 The ADA's proposal for defining impaired fasting glucose is contentious and has not been adopted by other international guidelines for diabetes management.4 5 Some researchers opposed to the change believe that it greatly increases the prevalence of what is classified as impaired fasting glucose without any clear association with clinical complications,6 7 especially for cardiovascular disease and all cause mortality. Although some prospective studies have shown that the 2003 ADA category of impaired fasting glucose with the lower cut-off point is associated with an increased risk of cardiovascular disease,8 9 other studies have not found a similar association.10 11 12 Several previous meta-analyses have led to conflicting conclusions,13 14 15 which might be because of differences in endpoint assessments and inclusion criteria. Furthermore, the ADA also suggested haemoglobin A1c (HbA1c) of 39-47 mmol/mol (5.7-6.4%) could be used as another marker to define prediabetes, while the National Institute for Health and Care Excellence (NICE) 16 and the International Expert Committee17 suggested using a higher cut point of 42-47 mmol/mol (6.0-6.4%) for prediabetes. It is unclear whether the raised HbA1c for defining prediabetes is useful for predicting future cardiovascular disease.
Considering these inconsistencies, we performed a meta-analysis of prospective cohort studies from general populations to evaluate associations between different definitions of prediabetes and the risk of composite cardiovascular events, coronary heart disease, stroke, and all cause mortality.
Search strategy and selection criteria
Following recommendations of the Meta-analysis of Observational Studies in Epidemiology group,18 we searched electronic databases (PubMed, Embase, and Google Scholar) for prospective cohort studies up to 31 July 2016 using a combined MeSH heading and text search strategy with the following terms: "blood glucose", "hyperglycaemia", "impaired fasting glucose", "impaired glucose intolerance", "prediabetes", "prediabetic state", "borderline diabetes" , "higher risk of diabetes", "high risk of diabetes", "hemoglobin A1c" or "HbA1c" and "cardiovascular disease", "cardiovascular event", "cardiocerebrovascular disease", "cerebrovascular disease", "cerebrovascular disorder", "cerebrovascular attack", "stroke", "cerebral infarction", "coronary artery disease", "coronary heart disease", "ischemic heart disease", "myocardial infarction", "mortality", or "death" and "risk". We also manually checked reference lists to identify other potential studies and restricted the search to human studies. Appendix 1 shows the detailed methods used for searching all the databases.
Studies were included for analysis if they were prospective cohort studies with blood glucose and other cardiovascular risk factors measured at baseline; all participants were aged ≥18; and they provided adjusted relative risks and 95% confidence intervals for composite cardiovascular events (combination of coronary heart disease, stroke, or other type of cardiovascular disease together), coronary heart disease, stroke, and all cause mortality associated with prediabetes compared with normoglycaemia.
Prediabetes was defined as impaired fasting glucose according to WHO criteria (IFG-WHO: 6.1-6.9 mmol/L)2 or the ADA definition (IFG-ADA: 5.6-6.9 mmol/L),3 impaired glucose tolerance (2 hour plasma glucose 7.8-11.0 mmol/L during an oral glucose tolerance test),2 or raised HbA1c according to ADA criteria (HbA1c-ADA: 39-47 mmol/mol) 3 or NICE (HbA1c-NICE: 42-47 mmol/mol).16
We excluded studies if enrolment was dependent on patients having a particular condition (such as a history of cardiovascular disease) or other cardiovascular risk factors (such as hypertension, chronic kidney disease) and risks for associated events were unadjusted. If multiple articles were derived from the same cohort and reported the same associated events, we included only the latest published data for our primary analysis.
As it has been reported that the potential pathological mechanisms and cardiovascular risk factors are different in those with impaired fasting glucose, impaired glucose tolerance, and raised HbA1c,19 20 we further excluded studies if they reported only data associated with combined impaired fasting glucose or impaired glucose tolerance or combined with either impaired fasting glucose or raised HbA1c, but not isolated impaired fasting glucose, impaired glucose tolerance, and HbA1c categories. Because the rate of progression to diabetes is higher in people who have both impaired fasting glucose and impaired glucose tolerance,21 however, we included people with both as a separate category for analysis to explore whether they are at higher risk of cardiovascular disease than those with isolated impaired fasting glucose or isolated impaired glucose tolerance.
Patients were not involved in setting the research question, in the outcome measures, in the design, or in the implementation of the study. No patients were asked to advice on interpretation or writing up of results. There are no plans to disseminate the results of the research to study participants or the relevant patient community.
Two reviewers (YulH and XC) independently screened the titles and abstracts of the reports, and full copies of potentially suitable studies were obtained. Study information such as ethnicity, participant number, age, sex, follow-up duration, adjusted risk factors, and events assessment was recorded on pretested standard forms.
We used Newcastle-Ottawa quality assessment scale for quality assessment of cohort studies,22 in which a study is judged based on selection (four items, one star each), comparability (one item, up to two stars), and exposure/outcome (three items, one star each). In this meta-analysis we graded quality as good (≥7 stars), fair (4-6 stars), and poor (<4 stars).23 24 We also evaluated whether the studies had adequately adjusted for potential confounders (at least five of six confounders including sex, age, hypertension or blood pressure or antihypertensive treatment, body mass index (BMI) or other measure of overweight/obesity, cholesterol, and smoking).
Primary outcomes were relative risks for composite cardiovascular events and all cause mortality. Secondary outcomes were relative risks for coronary heart disease and stroke in individuals by using different definitions of prediabetes compared with normoglycaemia. Subgroup analyses of primary outcomes were conducted according to sex (men v women), ethnicity (Asian v non-Asian), age (average <55 v ≥55), possibility of enrolling patients with diabetes (yes v no), duration of follow-up (<10 v ≥10 years), exclusion of individuals with baseline cardiovascular disease (yes v no), and study quality (adequate adjustment v inadequate adjustment). For composite cardiovascular events, we also performed subgroup analysis according to endpoint (incidence v mortality). We used χ2 to test for subgroup differences—that is, whether the observed differences in the subgroups are compatible with chance alone. A low P value (or a large χ2 statistic relative to its degree of freedom) provides evidence of heterogeneity beyond chance.25
For meta-analysis we used data on the adjusted outcome in every included study. We logarithmically transformed these data and calculated corresponding standard errors. An inverse variance approach was used to combine the log relative risk and SE. In cases where the odds ratio was described, we converted data to a relative risk for meta-analysis (RR=OR/([1−pRef]+[pRef×OR]), where pRef is the prevalence of the outcome in the reference group.26
Heterogeneity among studies was assessed with the Q statistic. PQ statistic ≥0.10 was considered to indicate no significant heterogeneity among the included studies. Even when a lack of heterogeneity was indicated, however, we report the results from the DerSimonian and Laird random effects models over the fixed effects model because the included studies differed to some extent, both clinically and methodologically (for example, baseline characteristics of the participants, follow-up duration, and adjustment of confounders). If no heterogeneity exits in the pooled data, results of random and fixed effects models are the same, and if significant heterogeneity is present, a random effects model is more conservative.27 To further confirm the results, we have presented the results with both fixed/random effects models in the forest plots.
We evaluated publication bias by inspecting funnel plots for each outcome in which the natural log relative risk was plotted against the SE and further tested with Egger's and Begg's tests. To assess the effect of individual studies on the estimated relative risk, we conducted a sensitivity analysis in which we recalculated the pooled relative risk by omitting one study at a time. Analyses were performed with RevMan 5.3 (Cochrane Collaboration, Copenhagen, Denmark) and Stata 12.0 (StataCorp LP, College Station, TX).
Studies retrieved and characteristics
Our initial search returned 26 568 articles. After we screened titles and abstracts, 216 articles qualified for a full review (fig 1⇓). We finally included 53 prospective cohort studies,8 9 10 11 12 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 comprising 1 611 339 individuals for analysis. For the association between prediabetes and risk of all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke, 25, 35, 24, and 18 studies, respectively, provided data.
Fig 1 Flow of papers through review of prediabetes and risk of cardiovascular disease and all cause mortality. CVD=cardiovascular disease, CHD=coronary heart disease, IFG=impaired fasting glucose, IGT= impaired glucose tolerance
Table A in appendix 2 provides the key characteristics of the included studies. All were derived from the general population. Nine studies enrolled only men, and all others included both men and women. The duration of follow-up ranged from two to 20 years, with a median duration of 9.5 years. According to quality assessment criteria, 45 studies were graded as good quality and eight as fair (table B in appendix 2). Furthermore, based on adjusted confounders, 33 studies met our criteria for adequate adjustment, while 20 studies did not adequately adjust for potential confounders (table C in appendix 2).
All studies excluded people with fasting plasma glucose concentration ≥7.0 mmol/L, except for one that only measured 2 hour plasma glucose concentration during an oral glucose tolerance test at baseline,28 with the possibility that a few patients with fasting plasma glucose ≥7.0 mmol/L were enrolled in the impaired glucose tolerance groups. Twenty eight studies measured fasting plasma glucose only at baseline without an oral glucose tolerance test; these studies therefore possibly enrolled patients with 2 hour plasma glucose ≥11.1 mmol/L.
Prediabetes and all cause mortality
Twenty five studies reported data for the association between prediabetes and risk of all cause mortality. Random effects models analyses show that prediabetes was associated with an increased risk of all cause mortality: IFG-ADA (relative risk 1.13, 95% confidence interval 1.02 to 1.25), IFG-WHO (1.13, 1.05 to 1.21), impaired glucose tolerance (1.32, 1.23 to 1.40). Prediabetes was not associated with an increased risk of all cause mortality when it was defined as HbA1c 39-47 mmol/mol (0.97, 0.88 to 1.07) or HbA1c 42-47 mmol/mol (1.21, 0.95 to 1.56) (fig 2⇓). Data from a single study showed that prediabetes defined as IFG-ADA and impaired glucose tolerance was not associated with increased risk of all caused mortality (1.03, 0.75 to 1.42).48 No studies reported the risk of all cause mortality in patients with both IFG-WHO and impaired glucose tolerance. The increased risk of all cause mortality was significantly higher in the impaired glucose tolerance group than in groups according to other definitions of prediabetes (P<0.001).
Fig 2 Association between prediabetes and risk of all cause mortality. D+L=DerSimonian and Laird random effects models; HbA1c-ADA=prediabetes defined as raised HbA1c according to American Diabetes Association (ADA) criteria (39-47 mmol/mol); HbA1c-NICE=prediabetes defined as raised HbA1c according to NICE guidance (42-47 mmol/mol); IFG-ADA=impaired fasting glucose (IFG) according to ADA criteria (fasting plasma glucose of 5.6-6.9 mmol/L); IFG-WHO=IFG according to WHO criteria (6.1-6.9 mmol/L); IGT=impaired glucose tolerance; I-V=inverse variance fixed effects models
Prediabetes and composite cardiovascular events
Thirty five studies reported data for the association between prediabetes and risk of composite cardiovascular disease. Table D in appendix 2 provides detailed definitions of composite cardiovascular disease in every included study. Random effects models analyses showed that prediabetes was associated with increased composite cardiovascular events when it was defined as IFG-ADA (relative risk 1.13, 95% confidence interval 1.05 to 1.21), IFG-WHO (1.26, 1.12 to 1.41), impaired glucose tolerance (1.30, 1.19 to 1.42), HbA1c 38.8-46.4 mmol/mol (1.21, 1.01 to 1.44), or HbA1c 42.11-46.4 mmol/mol (1.25, 1.01 to 1.55) (fig 3⇓). The difference in risk of cardiovascular disease with different definitions of prediabetes was not significant (P=0.16). No studies reported the risk of composite cardiovascular events in patients with both impaired plasma glucose (either IFG-ADA or IFG-WHO) and impaired glucose tolerance.
Fig 3 Association between prediabetes and composite cardiovascular events. D+L=DerSimonian and Laird random effects models; HbA1c-ADA=prediabetes defined as raised HbA1c according to American Diabetes Association (ADA) criteria (39-47 mmol/mol); HbA1c-NICE=prediabetes defined as raised HbA1c according to NICE guidance (42-47 mmol/mol); IFG-ADA=impaired fasting glucose (IFG) according to ADA criteria (fasting plasma glucose of 5.6-6.9 mmol/L); IFG-WHO=IFG according to WHO criteria (6.1-6.9 mmol/L); IGT=impaired glucose tolerance; I-V=inverse variance fixed effects models
Prediabetes and risk of coronary heart disease
Twenty four studies reported data for the association between prediabetes and risk of coronary heart disease. Similar to results for composite cardiovascular events, prediabetes was associated with increased risk of coronary heart disease when it was defined as IFG-ADA (relative risk 1.10, 95% confidence interval 1.04 to 1.16), IFG-WHO (1.18, 1.08 to 1.28), impaired glucose tolerance (1.20, 1.0 to 1.44), HbA1c 39-47 mmol/mol (1.15, 1.01 to 1.33), or HbA1c 42-47 mmol/mol (1.28, 1.03 to 1.59) (fig 4⇓). Combined data from two studies, however, did not show an increased risk of coronary heart disease in people with both IFG-ADA and impaired glucose tolerance (0.93, 0.70 to 1.25). No studies reported the risk of coronary heart disease in people with both IFG-WHO and impaired glucose tolerance. There was no significant different in risk of coronary heart disease with different definition of prediabetes (P=0.36).
Fig 4 Association between prediabetes and risk of coronary heart disease. D+L=DerSimonian and Laird random effects models; HbA1c-ADA=prediabetes defined as raised HbA1c according to American Diabetes Association (ADA) criteria (39-47 mmol/mol); HbA1c-NICE=prediabetes defined as raised HbA1c according to NICE guidance (42-47 mmol/mol); IFG-ADA=impaired fasting glucose (IFG) according to ADA criteria (fasting plasma glucose of 5.6-6.9 mmol/L); IFG-WHO=IFG according to WHO criteria (6.1-6.9 mmol/L); IGT=impaired glucose tolerance; I-V=inverse variance fixed effects models
Prediabetes and risk of stroke
Eighteen studies reported data for the association between prediabetes and risk of stroke. Combined data showed that IFG-ADA (relative risk 1.06, 95% confidence interval 1.01 to 1.11), IFG-WHO (1.17, 1.09 to 1.25), or impaired glucose tolerance (1.20, 1.0 to 1.45) were associated with an increased risk of stroke after multivariate adjustment. The risk of stroke, however, was not significant in studies that defined prediabetes as raised HbA1c, either according to the ADA (1.05, 0.81 to 1.35) or NICE recommendation (1.33, 0.89 to 1.99) (fig 5⇓). No studies reported data the risk of stroke with prediabetes defined as combined impaired fasting glucose (either IFG-ADA or IFG-WHO) and impaired glucose tolerance. There was no significant different for increased risk of stroke in different definition of prediabetes (P=0.64).
Fig 5 Association between prediabetes and risk of stroke. D+L=DerSimonian and Laird random effects models; HbA1c-ADA=prediabetes defined as raised HbA1c according to American Diabetes Association (ADA) criteria (39-47 mmol/mol); HbA1c-NICE=prediabetes defined as raised HbA1c according to NICE guidance (42-47 mmol/mol); IFG-ADA=impaired fasting glucose (IFG) according to ADA criteria (fasting plasma glucose of 5.6-6.9 mmol/L); IFG-WHO=IFG according to WHO criteria (6.1-6.9 mmol/L); IGT=impaired glucose tolerance; I-V=inverse variance fixed effects models
Sensitivity analyses and subgroup analyses
We found no evidence of publication bias based on visual inspection of funnel plots (appendix 3) or according to Begg's or Egger's tests (all P>0.1). Sensitivity analyses confirmed that the association between endpoint events and the different definitions of prediabetes did not change with the use of random effects models or fixed effects models for the meta-analysis. Furthermore, considering smoking is the strongest confounder for cardiovascular disease, we further performed a sensitivity analysis on primary outcomes with data with adjustment for smoking. We found that after controlling for smoking, the presence of prediabetes remained associated with an increased risk of composite cardiovascular disease when it was defined as IFG-ADA, IFG-WHO, impaired glucose tolerance, or HbA1c 39-47 mmol/mol or 42-47 mmol/mol (fig A in appendix 4). The risk of all cause mortality associated with IFG-ADA was not significant under random effects models analysis (relative risk 1.09, 95% confidence interval 0.97 to 1.22), though it did reach significance when we used fixed effects models (1.08, 1.0 to 1.17). Furthermore, IFG-WHO or impaired glucose tolerance was still associated with an increased risk of all cause mortality after we excluded data from studies that did not adjust for smoking (fig B in appendix 4).
Tables E and F in appendix 2 show the results of subgroup analyses for the risk of all cause mortality and composite cardiovascular events associated with prediabetes defined as IFG-ADA, IFG-WHO, or impaired glucose tolerance. Briefly, we found no significant heterogeneity among all subgroup comparisons for prediabetes defined as IFG-WHO or impaired glucose tolerance (all P≥0.05). IFG-ADA, however, was significantly associated with all cause mortality in participants with a mean age <55 at study entry, but not in those aged ≥55 (P=0.009 for interaction). This was the only significant heterogeneity we observed among all subgroup comparisons in our study. We did not perform subgroup analyses for participants with other definitions of prediabetes because of the limited number of studies.
Principal findings
In this meta-analysis with a large sample size (comprising 1 611 339 individuals), we found that prediabetes defined as impaired fasting glucose or impaired glucose tolerance was associated with an increased risk of composite cardiovascular events, coronary heart disease, stroke, and all cause mortality. Importantly, we observed increased risks when fasting plasma glucose was as low as 5.6 mmol/L according to the current ADA definition of impaired fasting glucose (IFG-ADA).3 We also found that the risks for composite cardiovascular events and coronary heart disease were higher in people with prediabetes defined as raised HbA1c of 39-47 mmol/mol (according to ADA criteria)3 or 42-47 mmol/mol (according to NICE),16 respectively.
Strengths and limitations of study
An important strength of our study is the large sample size. We included only prospective cohort studies with adjusted relative risks from general populations. There were, however, some limitations. Firstly, though individuals with prediabetes are more likely to progress to diabetes than those with normoglycaemia, most of the included studies did not adjust for the future development of diabetes during the follow-up period. Therefore, it is still unclear whether the long term health risk associated with prediabetes is because of a mild increase of blood glucose concentration or because of future progression to diabetes. Nevertheless, the results indicate that, on the basis of a "snapshot" measurement of blood glucose, prediabetes is associated with an increased risk of cardiovascular disease as well as all cause mortality, and early lifestyle interventions should be implemented in these populations. Secondly, almost half of the included studies measured fasting plasma glucose only at baseline, without performing an oral glucose tolerance test; therefore, these studies possibly enrolled patients with increased 2 hour plasma glucose. The risk of cardiovascular events and all cause mortality associated with impaired fasting glucose could be confounded by the undetected increase in 2 hour plasma glucose (diabetes defined by 2 hour plasma glucose). We found no significant heterogeneity, however, in subgroup comparisons conducted according to the possibility of enrolling patients with diabetes. Thirdly, we found that the risk of composite cardiovascular events and coronary heart disease was higher in people with mild raised HbA1c (39-47 mmol/mol or 42-47 mmol/mol), though the risk of stroke did not reach significance. These inconsistent results should be interpreted with caution because of the small numbers of studies included in these analyses. More prospective cohort studies that evaluate the level of HbA1c and health risk are needed. Fourthly, there were too few studies to draw a solid conclusions for the risk of cardiovascular disease in people with both impaired fasting glucose and impaired glucose tolerance.
Comparison with other studies
Several previous meta-analyses have returned inconsistent results on the different definitions of prediabetes and target organ damage. In 2014, our group reported that prediabetes, defined as IFG-WHO, impaired glucose tolerance, but not IFG-ADA, was associated with increased risk of all cause and cardiovascular mortality.76 Similarly, another published meta-analysis that included 15 prospective cohort studies (including 760 925 participants) reported that the risk of stroke increased in people with IFG-WHO or impaired glucose tolerance but not in people with IFG-ADA.14 In the past few years, however, an increasing number of studies have reported on the association between health risks and IFG-ADA. We updated our data and found differences with our previous analysis, with the risks for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke all significantly increased in people with IFG-ADA.
Ford and colleagues included 18 studies with 175 152 participants in their analysis and found that impaired fasting glucose (defined with either ADA or WHO criteria) and impaired glucose tolerance was associated with a modest increased risk of cardiovascular disease.15 Endpoint events in the studies included in that meta-analysis, however, were significantly different. For example, some had data only for coronary heart disease,37 44 45 while others reported the risk of composite cardiovascular disease.8 35 77 It is suggested that combining data with different events in a meta-analysis could produce misleading results. Contrary to the analysis conducted by Ford and colleagues,15 the large sample size in our study (53 prospective cohort studies comprising 1 611 339 participants) allowed us to analyse the risk of composite cardiovascular disease, coronary heart disease, and stroke separately. The strict inclusion criteria in our study were important to avoid heterogeneity among studies and lead to a reliable conclusion. Furthermore, Ford and colleagues did not analyse the risk of cardiovascular disease with prediabetes defined with HbA1c criteria.15
Future research
Our findings strongly support the lower cut-off point for impaired fasting glucose proposed by the 2003 ADA guideline, and they have important public health implications. According to the 2003 ADA definition, the prevalence of prediabetes in adults was up to 36.2% in the US78 and 50.1% in China.79 Considering the high prevalence of prediabetes, successful intervention in these large populations could have major impacts on public health. The ADA suggests that lifestyle intervention is the fundamental management approach for prediabetes.80 For people with impaired glucose tolerance, lifestyle interventions can reduce the risk of progression to diabetes.81 Recently, Yates and colleagues reported that in patients with impaired glucose tolerance, a change in daily ambulatory activity can significantly decrease the risk of cardiovascular events.82 Similarly, the Da Qing diabetes prevention study also reported that lifestyle intervention in people with impaired glucose tolerance can reduce the incidence of cardiovascular and all cause mortality.83 It should be noted, however, that all these studies were performed on people with impaired glucose tolerance. There are few data in terms of interventions for prediabetes defined by impaired fasting glucose and HbA1c. Considering the different underlying pathophysiological mechanisms84 85 and associated cardiovascular risk factors19 20 between impaired fasting glucose, impaired glucose tolerance, and raised HbA1c, future studies are urgently needed to explore effective interventions to decrease the risk of cardiovascular disease in people with prediabetes defined as impaired fasting glucose and raised HbA1c. Furthermore, it should be noted that prediabetes is not a disease but rather a risk factor for future diabetes and cardiovascular disease, and the findings in our study do not mean that pharmacological treatment is warranted in everyone with prediabetes. Further studies are needed to determine which phenotype of prediabetes can be benefit from pharmacological treatment. Nowadays, the ADA recommended pharmacological intervention can be considered in individuals with both impaired glucose tolerance and impaired fasting glucose and at least one of age <60, BMI ≥35, family history of diabetes mellitus in first degree relative, high concentrations of triglycerides, reduced concentration of high density lipoprotein cholesterol, hypertension, and HbA1c >42 mmol/mol.80 Furthermore, pharmacological treatment should be individualised on the basis of the known efficacy and safety of drugs and accompanied by lifestyle intervention programmes.85
Interestingly, we found that the risk of all cause mortality was significantly higher in the impaired glucose tolerance group than in groups with other definition of prediabetes. There were, however, no significant differences in risks of cardiovascular disease, coronary heart disease, and stroke with different definitions of prediabetes. These results suggest that impaired glucose tolerance is a stronger risk factor for all cause mortality, but not for cardiovascular disease, than other definitions of prediabetes, which might be caused by the significant association between impaired glucose tolerance and non-cardiovascular death, especially cancer mortality.76 It has been reported that the risk of cancer mortality is greater with impaired glucose tolerance than with impaired fasting glucose.46 86
Conclusions and implications
In conclusion, we found that prediabetes defined as impaired fasting glucose or impaired glucose tolerance is associated with an increased risk of composite cardiovascular events, coronary heart disease, stroke, and all cause mortality. There was an increased risk in people with fasting plasma glucose as low as 5.6 mmol/L. Additionally, the risk of composite cardiovascular events and coronary heart disease increased in people with raised HbA1c. These results support the lower cut-off point for impaired fasting glucose according to ADA criteria as well as the incorporation of HbA1c in defining prediabetes. At present, lifestyle modification is the mainstay management for people with prediabetes. High risk subpopulations with prediabetes, especially combined with other cardiovascular risk factors, should be selected for controlled trials of pharmacological treatment.
What is already known on this topic
Prediabetes, including impaired fasting glucose, impaired glucose tolerance, and mildly raised haemoglobin A1c, is a common worldwide condition
The cut points for impaired fasting glucose and haemoglobin A1c for defining prediabetes are inconsistent in different guidelines
Reports on the association between prediabetes and all cause mortality and cardiovascular events are inconsistent
What this study adds
Prediabetes defined as impaired glucose tolerance or impaired fasting glucose was associated with an increased risk of cardiovascular disease and all cause mortality
The risk increased in people with a fasting glucose concentration as low as 5.55 mmol/L
HbA1c 39-47 mmol/mol or 42-47 mmol/mol was associated with an increased risk of composite cardiovascular disease and coronary heart disease
Lifestyle modification is the main management for people with prediabetes
We thank Jun Lu (Clinical Research Centre, the First Affiliated Hospital of Xi'an Jiaotong University, China) for help in statistical analysis.
Contributors: YH and YunH were responsible for the initial plan, study design, conducting the study, data interpretation. YH, XC, and WM were responsible for data collection, data extraction, statistical analysis, and manuscript drafting. YH, XC, and ML analysed and interpreted the data and critically revised the paper. YH and YunH are guarantors and had full access to all of the data, including statistical reports and tables), and take full responsibility for the integrity of the data and the accuracy of the data analysis.
Funding: This study was funded by the National Natural Science Foundation of China (No 81600239).
Competing interests: All author shave completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: No additional data available.
Transparency: The lead authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
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Harding JL, Soderberg S, Shaw JE, et al. All-cause cancer mortality over 15 years in multi-ethnic Mauritius: the impact of diabetes and intermediate forms of glucose tolerance. Int J Cancer2012;131:2385-93. doi:10.1002/ijc.27503. pmid:22362309.
Yuli Huang associate professor, Xiaoyan Cai associate professor, Weiyi Mai professor, Meijun Li resident doctor, Yunzhao Hu professor
Huang Yuli, Cai Xiaoyan, Mai Weiyi, Li Meijun, Hu Yunzhao. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis BMJ 2016; 355 :i5953
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