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On February 4, 2018 February 4, 2018 By criticatlarge02In Reviews
David Lindsay-Abaire
Through Feb. 18, 2018, at Cinnabar Theater
You may have seen David Lindsay-Abaire's Good People in one of the fine productions
Liz Jahren, Sarah McKereghan, and Kate Brickley
Photo by Victoria Von Thal
around the Bay Area already, but this one makes it worth seeing again, with a terrific cast, superb scenic design, and creative staging. The play itself scores high for its rampant humor, intriguing plot, and thoughtful exploration of class divide in America.
Lindsay-Abaire is best known for his Pulitzer Prize-winning play Rabbit Hole, which was also put on film (starring Nicole Kidman). That was his most naturalistic and dark play at that time, his earlier plays sharing a whimsical, absurdist landscape. Good People is also naturalistic, focused on real people struggling with real issues, but it's far from dark, and includes laugh-out-loud dialogue and endearing characters. …
To read more about this production, continue to my Talkin' Broadway review:
"Cow Pie Bingo"
Disgraced


Tourists have the option of taking a fishing trip cruise on one of Doha's traditional old fishing boats and dhows and catching fresh delicious fish. They can also just stop by the local fish market and purchase freshly caught fish!
The best seafood restaurant in Doha is the Lwzaar Seasfood Market. This restaurant serves its guests only the finest quality fish with premium, first-class service.
Apart from historic monuments, famous landmarks, and tourist attractions, Qatar is known for its fresh seafood given its location facing the Arabian Gulf.
Doha is renowned for its sophisticated unique designs and decorations found in the interior of most of its towering buildings.
One of the top 10 seafood restaurants to visit in Doha is the fine Lwzaar Seafood Market, where you can choose any fish from the assorted variety of seafood on display to be served for dinner.
Every day, the Lwzaar Seafood Market restaurant has a new batch of freshly caught fish straight from the dhows on the bay!
One of the restaurant's most popular dishes is the Lobser Thermidor, which includes a freshly caught delicious lobster served with cheese and garlic.
The glamorous Living Room lounge at the W Hotel welcomes guests to rest during the day or be part of the hottest social scene at night.
Plan a trip to Doha and stay at the luxurious W Hotel offering its guests outstanding first class service, sophisticated cuisine, as well as entertaining events!
Explore Doha's refreshing traditional culture and cuisine at the Lwzaar Seafood Market!
You are greeted by the lovely hostess to show you to your table and then are asked to choose from the mixed varieties of seafood freshly caught and prepared to your liking.


The reasons for the weak performance are varied, and economists believe that both Germany and Japan will dodge recessions by returning to growth soon. But the data underscore the major challenges faced by many of the world's largest economies.
Germany's economy shrank for the first time since 2015 in the third quarter. It was hit by new auto emissions testing procedures that slowed car sales and a decline in exports, partly due to the US-China trade war.
The car certification bottleneck is expected to ease, but economists say export growth could weaken further because of reduced demand from major trading partners such as Turkey, Russia and China.
Japan is much more accustomed to economic stagnation, and even recessions, but the outlook there is brighter. Its lackluster third quarter was caused by natural disasters, and economists expect consumer spending to spike this quarter ahead of a planned sales tax hike next October. In China, the world's second largest economy, new data Wednesday revealed weaker consumption growth, subdued confidence and disappointing credit growth. Economists expect the government to ramp up stimulus measures to mitigate the effects of a trade war with the United States.
"We believe the worse is yet to come, with growth slowing faster into spring 2019," Ting Lu, chief China economist at investment bank Nomura, wrote in a research note.
And despite the prospect of a rebound in Germany and Japan before the end of this year, the global economy is also heading for a weaker 2019.
The International Monetary Fund expects global growth to slow to 2.5% in 2019 from 2.9% this year.
Risks clouding the global outlook include the trade war and the impact of US interest rate hikes on emerging markets. Italy, which is locked in a standoff with the European Union over government spending, could spark another crisis in Europe.
"We're not thinking it will be anything like [the financial crisis], but there might be a significant slowdown next year. It's very possible," said Andrew Kenningham, chief global economist at Capital Economics. "We think the IMF is too optimistic."
Some of the risk is already reflected in markets. On Tuesday, fears over weaker global demand helped push US oil prices down 7%, and major stocks indexes are 5% to 7% off their peaks.
One big question is which countries might serve as growth engines in 2019.
India's economic growth has accelerated this year, hitting 8.2% in the most recent quarter. But as one of the world's biggest energy importers, it has felt the pain of higher oil prices this year. The rupee is one of the world's worst performing currencies in 2018, and that has further stoked inflation.
The United States could also move into the slow lane next year as the effects of tax cuts fade.
"We think the United States will slow quite significantly," said Kenningham. "The fiscal stimulus is temporary and the Fed is raising interest rates."


Get excited! It's finally time to leave that stuffy dorm room behind. Your days of confined space and communal bathrooms are over. You're finally ready to move into your first off-campus apartment. Independence is so close you could touch it, but before you finalize your Pinterest board, let's make sure you're fully equipped to make the best renting decisions. Here are a few things to consider before, and as, you move in!
Woohoo! You've picked a place! Now what? First off, establish a budget. College is pricey enough. (Don't forget about those student loans.) When you start apartment living, it's important to be realistic about decorating, laundry, parking, eating and cleaning expenses.
If you haven't already, remember to factor in additional costs, such as a security deposit and monthly utilities if you have them.
In the case you can't afford rent each month on your own, you may have chosen to rent with a roommate. Ah, roommates. They're either a great matches or a total disasters. Sit down together early on and figure out how you want to split utilities, cleaning duties, etc.
The day-to-day maintenance will probably be similar to how you did things with your dorm roommate. However, apartments can need more upkeep, especially if they're older. And sometimes landlords who rent to college students won't be as quick to fix things as your dorm building's maintenance personnel.
Make a plan early on as to how you and your roommate will handle these types of duties so that things don't get out of hand. It's also a good idea, as with any living situation, to figure out your roommate's general schedule. Are they night owls or early birds? How do their routines compare to yours? You need to try to get on the same page. A lease is a legal agreement and you can't email housing and change roommates if things go sour. So, it's better to get ahead of the game!
Think about how far you are from your classes and how much time you'll need to get to class. Will you have a car? If you don't have a car, can you look into local bus routes? In that case, you may also need to purchase a bus pass, which could be another thing to factor into your overall budget.
You know your morning or afternoon routine, so plan ahead by asking yourself if a longer commute works with your schedule. The last thing you want to do is rush to class every day.
Before moving your things in, inspect your potential new pad to make sure everything is still as nice as it was when you toured and signed. It sounds boring, but trust me: you should take the time to inspect the condition of your home.
Remember… You may have toured a staging apartment, and not the one you ended up with. Note any cracks or damages and bring them to the attention of the leasing office or your landlord right away. You do not want to be charged for anything that wasn't your doing.
Once your landlord or company is aware of any damages, if you still want to proceed as is, just make sure to take (and keep!) pictures of everything so that, again, you're not charged for that damage.
Is the water pressure sufficient? Test out the faucets!
Are appliances like dishwashers, washing machines, etc. working?
Are there any other issues that weren't there before, like holes in the walls?
Keep the pictures you take all year, and be careful not to do too much damage to the place. Renting damage costs can be really pricey. We all love a Friday night cocktail party with the girls, but when small parties turn big and get out of hand, the damage can (literally) be explosive.
If you're really doubting yourself though, you can consider getting renters' insurance! This can help cover the costs of certain damages, and depending on your plan, there can be other cool perks (I got to stay in a beautiful close-to-campus hotel room for a few weeks when my college apartment had an electrical fire). So it's worth at least inquiring about!
Read your lease in its entirety. Ask your landlord questions about anything unclear. It's important you understand all the details. You'll also want to keep a copy of that lease on-hand in case you run into any issues along the way.
After you have everything situated, introduce yourself to your neighbors. Remember to be respectful of those around you and take good care of your place — you don't live in a college dorm anymore. Now, get excited about decorating and making the space your own!
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Q: How do i create an online database for my crossplatform mobile and desktop apps? I am creating project (tailoring app) which is used to store customers measurements. I am using ionic framework and i need database to access all these information on all devices . What should i use?. I am a novice and doing this for fun ...

A: you Can create models (similar to database) in Backand, and the interesting thing is you can use rest API and you can access your models(database) ...
You can do the following ...

*

*ADD

*DELETE

*UPDATE

*and Etc ...
Link
http://www.backand.com/

redpajama_set_name: RedPajamaStackExchange


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Guest Commentary: Vote 'No' on F.C.'s Goldilocks Referendum
November 3, 2011 6:50 PM by FCNP.com
The weather's chilly and leaves and yard signs litter the grass. It must be election time.
And as always, my first point is simply get out to vote. My second point is that I hope you'll vote to keep the Falls Church elections in May and vote "No" on the Referendum on Nov. 8.
I ran once in May and lost so I have no love lost for the "magic of May." But I still think we should keep our elections there. Turnout is the supposed reason for wanting to change to November, but the more I've looked at this the more it seems to be an excuse not the reason.
If turnout were most key, why not move to even election years and synchronize with national elections that have much higher turnout than state races? Are we Goldilocks? May is too low, November in even years is too high, but November in odd years is "just right"? We're that good at choosing who should vote?
I have two concerns. First, local issues will be overwhelmed by state issues and candidates. We'll be at the bottom of the ballot and buried by other advertising. Wasn't the City founded because we wanted our local concerns to be paramount for our citizens? Local issues will get lost and the cost to get those issues out there will rise as there is more competition for voters' attention.
My other concern is partisanship and as I've learned over the years through my day job and political involvement, partisanship can be blunt or much more subtle and sometimes an unintended consequence. For example, as objective as the League of Women Voters is, it couldn't stop Sen. Saslaw – an elected partisan – from actively campaigning in favor of the referendum at a "non-partisan," objective forum. The best of intentions can be hijacked.
The current FC Democratic Committee chair, Betty Coll, says the party has "no interest" in endorsing candidates. In my opinion, Betty's a straight shooter. But interests change. If the FCCDC didn't want to play a partisan role in local politics, why did it endorse moving the date? Again we have Goldilocks. Moving the date is just right, but endorsing candidates would be too much. Saying nothing would be too little?
Some say parties could endorse in May. Not really. Why would they go to the trouble? For November, the machinery's already moving so adding the local contest would be at zero incremental effort. Partisanship is increasing not decreasing in the country and the state. Do we really think we're immune to larger changes like that?
Let's look at Manassas Park that changed to November. The LWV had Bryan Polk, Vice Mayor, speak, who had championed the change. Bottom line? His presentation said bluntly, "If I had it to do over again, I would have stayed with May elections." A buyer's remorse we need not suffer.
Some say that people are surprised at having elections in May. When I ran for Council I found no one who didn't know we had elections. But even if people were surprised at May elections, why do you think they wouldn't be surprised to find local issues on the ballot in November? Again, to quote Polk, "Undervote is real. Concern about [an] 'informed vote' for local candidates is real."
Forty percent of the City's population turns over every five years. We're in a transient area. Is anyone really surprised that we don't have a laser focus on local issues among that 40%? Everyone has the right to vote in May and many choose not to. Yet we're arrogantly saying, "No, that's the wrong choice." I agree it's wrong, but it's their choice.
What's the failsafe people seem to cling to stop partisanship in November? That the Council can enact a Charter change to save us from partisanship. I hoped so, too, when I spoke at Council meetings and even gave such language from another Virginia jurisdiction. But that's a pipe dream. Can we keep local candidates from having a "D" or "R" next to their name on the ballot? Most likely. But our power ends there.
Can we stop parties from marking sample ballots with local preferences? No. Can we keep someone from campaigning for a partisan and a local independent at the same time? No. Can we keep campaign literature from mixing local and partisan candidates and issues? No. Can we stop joint campaign appearances by partisans and local candidates? No. In November, that's the problem. Not in May.
To me these are simple freedom of speech issues. We can "tsk, tsk" and say they shouldn't happen, but they can and will and there's nothing we can do except vote "No" on Nov. 8. Keep our local elections local. Keep our non-partisan elections non-partisan. Keep our elections in May.
John D. Lawrence ran for Falls Church City Council in May 2010 and manages Congressional Affairs for the International Foundation for Electoral Systems.

redpajama_set_name: RedPajamaCommonCrawl


Following last week's Budget, the government has published the Finance Bill 2015. The bill implements tax changes announced at Budget 2014, Autumn Statement 2014 and Budget 2015.
a new tax relief to promote the production of children's TV in the UK, and further support for high-end TV and film tax.
The government is committed to supporting hardworking families and backing business. That is why we are making it easier for them to keep more of their hard earned money and access the help they need to grow.
The measures contained in the bill were announced by the Chancellor at Budget 2014, Autumn Statement 2014 or Budget 2015.
This entry was posted on Thursday, April 2nd, 2015 at 12:00 am and is filed under Uncategorized.	You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.


Tag: evolution | Arctiq Inc.
There are things to do differently and there are different ways to think about how resources get provisioned for applications and services. I had to undergo re-shaping how I think about containers, because I grew up in the time of VMs.
Fear and anxiety; this is a major shift in focus from running a critical team in a large organization to getting back into the field, now as a startup.Excitement and joy; I'm getting back in front of customers and technology, something I missed dearly.


Melt chocolate and water in a saucepan. Then pour into mixing bowl.
Beat egg yolks until smooth, slowly stir into chocolate.
Add a pinch of salt to egg whites and whisk until they form stiff peaks.
Pour in small bowls and put in refridgerator until set.
Serve with spinkles of chocolate and cream.


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Toyota is making progress with its environmental goals
February 16, 2018 0 By John Max
Automaker releases its latest environmental report
Toyota has released its latest North American Environmental Report. In the report, the company outlines the progress it has made on its environmental goals throughout North America. The report also highlights the fact that much of the company's efforts have been guided by its Environmental Challenge 2050. Toyota notes that many of its environmental goals are quite ambitious, but they are still quite attainable. These goals have allowed the company to shift its focus toward renewable energy and clean technology.
Report highlights Toyota's efforts with clean vehicles
Currently, Toyota has 14 brands of hybrid electric vehicles operating in North America. Some of these vehicles are equipped with hydrogen fuel cells. Toyota's Mirai, its first fuel cell vehicle, has found some moderate success in California, the largest clean vehicle market in the United States. Toyota has also launched Project Portal, a truck that makes use of a new hydrogen fuel cell system. The company's clean vehicles have significantly reduced the carbon emissions it is responsible for.
Company has designed an innovative water conservation system
According to Toyota's North American Environmental Report, the company has also installed a rainwater harvesting system at its new campus in Plano, Texas. The system is designed to collect more than 11 million gallons of water every year. The system is meant to conserve water and will eventually conserve some 2.2 billion gallons of water as part of the sixth annual National Mayors Challenge for Water Conservation.
Clean technology has become a major priority for Toyota
Toyota has committed itself to being more environmentally friendly in the coming years. The company is investing heavily in using new materials to reduce its environmental impact and is participating in outreach endeavors focused on highlighting the use of clean technology and renewable energy. Notably, hydrogen fuel cells have become one of the company's most supported forms of clean technology. These energy systems are meant to be used to power the automaker's future clean vehicles.
CategoryIndustry Environmental Hydrogen news
Tagsclean technology hydrogen fuel hydrogen fuel cells hydrogen fuel news National Mayors Challenge for Water Conservation Plano renewable energy texas Toyota Toyota Environmental Challenge 2050 Toyota mirai Toyota North American Environmental Report United States
Hydrogen fuel cell train to come to the United Kingdom
Hawaii is making progress with its renewable energy goals
Hino Trucks


Do you have a bill with just mobile numbers? Here's an explanation of the items which appear on your monthly bill.
You receive already a document in the new layout (without a red bank transfer form)? Read the explanation of your payment statement (residential customer) or the explanation of your bill (business customer).
Customer account: This is your customer number. Use this number, as well as your mobile number, when you contact customer service.
Bill date: You receive a bill on more or less the same day every month. This bill contains the amount corresponding to your subscriptions for the past 30 days and any additional usage costs of the past 30 days.
Customer address: This is your residential address.
Billing address: This is the address at which you want to receive your bill.
You can change the billing address.
You can choose to receive your bill by e-mail, via Zoomit, or by post.
Via MyProximus (website and app), you can consult your bill online and also check your usage, manage your mobile phone options, etc. Click proximus.be/mybill.
consult your bills and payments online.
choose to receive your bill by e-mail, via Zoomit, or by post.
Haven't registered for MyProximus yet? Register with your mobile number.
Want to see all your products, payment statements and bills in MyProximus?
Do you have questions about MyProximus?
Want to check your current usage, pending your next bill?
Download the MyProximus app and check if your usage is correct.
Billing period: You are always billed for a period of 1 month (30 days on average). The start and end dates of this period are shown here.
Other charges: These are charges which are billed only once, for a reactivation or reminder if you pay your bill too late.
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Want more details about your subscriptions and options? Consult the following pages of your bill or view more details of your bill in MyProximus.
Usage: If, during the past billing period, you exceeded your call, text, and data allowance, you will find the total amount here. This amount varies per month, since it is linked to your personal usage (per minute, per MB, etc.).
Want to know when you surfed the Internet and who you called? And how much this cost? In MyProximus, you can consult your telephone traffic and your bills in detail.
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Pay the amount on time (taking into account weekends and public holidays) and use the right bank account number.
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International calls, texts and data (roaming). These are incoming calls and outgoing texts in a foreign country, and MB for surfing via a foreign mobile network. Check the rates before you call or surf while abroad. In most European countries, no roaming charges apply.
Have you exceeded the call, text, and data allowance in your bundle(s)? In that case, you will find an extra amount each time.
Want to know when you surfed the Internet and who you called? You can check your bills in detail.
You can purchase more data if you exceed your data allowance. Or adapt your subscription if you need another rate plan.
If you disagree with a specific amount, you can dispute it.
Next time, keep an eye on your usage before you receive your bill, with MyProximus (app and website). We also give you tips for surfing the Web cheaply.
Want to receive a text or e-mail alert when you reach a certain usage limit? You can set this limit yourself.
You can block certain calls and texts on your mobile phone.
Transfer to the following month: Transfers are no longer possible.
If you used SMS parking or televoting, you will find the amounts here. The costs for using these services will be directly passed on to the third-party provider concerned.
You can look up the details of and contest such pay-for texts and premium numbers online.
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If you have further questions about your bill, click here for the answers or contact us.


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A. S. Shera ( Diabetic Association of Pakistan and WHO Collaboratiing Centre for Diabetes, Karachi. )
F. Jawad, ( Diabetic Association of Pakistan and WHO Collaboratiing Centre for Diabetes, Karachi. )
A. Maqsood ( Diabetic Association of Pakistan and WHO Collaboratiing Centre for Diabetes, Karachi. )
S. Jamal ( Diabetic Association of Pakistan and WHO Collaboratiing Centre for Diabetes, Karachi. )
M. Azfar ( Diabetic Association of Pakistan and WHO Collaboratiing Centre for Diabetes, Karachi. )
U. Ahmed ( Diabetic Association of Pakistan and WHO Collaboratiing Centre for Diabetes, Karachi. )
Objective: To determine the prevalence of chronic complications and associated factors in type 2 diabetes in 500 diabetic patients, age > 25 years, attending the clinic of Diabetic Association of Pakistan (DAP), Karachi.
Methods: Every 5th registered diabetic patient > 25 years age, was examined for the presence/absence of micro and macro vascular complications and associated factors. Blood samples were collected for HbA1c, lipid profile and serum creatinine. Urine was examined for albumin and microalbumin.
Results: Of the 500 diabetic patients examined (160 males, 340 females, mean age 55.2 10.6 years), retinopathy was seen in 43%, neuropathy in 39.6% and foot ulcers in 4%. Nephropathy was found in 20.2%, and was significantly associated with hypertension. The prevalence of microvascular complications was higher in the group of patients with HbA 1 c >8% and was significantly related to duration of diabetes, hypertension and obesity. Hypertension was manifest in 64.6% patients, 61% had raised Body Mass Index and Waist Hip Ratio was more than normal in 88% subjects. Macrovascular complications were encountered in 102 diabetic patients, with angina in 85 (17%), heart attack in 25 (5%) and stroke in 13 (2.6%).
Conclusion: The prevalence of diabetic microvascular complications was higher in people with poor glycaemic control, longer duration of diabetes and associated hypertension and obesity (JPMA 54:54;2004).
The development and progression of chronic complications of diabetes are closely related to glycaemic control. Micro and macrovascular pathological lesions can involve various organs and tissues resulting in significant morbidity and mortality. Studies have shown Diabetic Nephropathy to be the leading cause of End Stage Renal Disease (ESRD). Data collected by USRDS in 200 Ion ESRD including diabetic nephropathy, has shown that the incidence rates of treated ESRD have risen world wide. The prevalence rates are increasing also, with the highest being in Japan, Taiwan and USA (1400- 1640 pmp) and the lowest in Pakistan and Bangladesh (48-58 pmp), 1 Similarly Diabetic Retinopathy is an important cause of blindness. 2 Management and treatment of diabetic complications imposes a significant economic burden on the state and the individual. 1 In addition, complications of diabetes have a considerable impact on the quality of life of the patient. It, therefore, becomes imperative to institute effective screening and preventive strategies to detect the early signs of complications. The development of complications of diabetes varies among different ethnic groups. The frequency of ESRD in Type 2 diabetes is four fold higher in black and native American population compared to the white people.1 Several studies from India, including a series of3010 cases, showed a high prevalence of vascular complications in Type 2 diabetes.3 A comprehensive study from Pakistan on 1000 people with diabetes, reported high figures of complications.4 This along with high prevalence of Type 2 diabetes in the country5, emphasizes the need for adoption of strict measures for prevention and early detection of diabetes. This study was undertaken to determine the prevalence of retinopathy, nephropathy, neuropathy, coronary artery disease, cerebrovascular disease and associated factors i.e., obesity and hypertension, in Type 2 diabetic patients.
Type 2 diabetic patients > 25 years of age presenting to the outpatient clinic of the Diabetic Association of Pakistan (DAP) Karachi, were studied. DAP is a charitable organization located in Karachi, the largest city of Pakistan, with a population of 12 million. This facility provides laboratory services along with consultation by trained doctors at nominal rate. Charges are reduced or waived for individuals unable to pay the amount. The patients are mostly self referred and represent all social and demographic strata in Karachi. A large majority belongs to the low and middle socio-economic class. A random sample of every fifth, previously registered type 2 diabetic patient age > 25 years, presenting for routine follow up, was selected after informed consent. Subjects with urinary tract infection, detected by dipstick (multistix), pregnant diabetic women, individuals with a protuberant belly or umbilical hernia and those who did not consent to participate, were excluded. In the above instances, the subsequent patient was included. Doctors familiar with the protocol interviewed all the selected subjects and answers were noted on a coded structured proforma. Demographic details, family history of diabetes, lifestyle details, medical and treatment history with specific reference to hypertension, coronary artery disease, cerebrovascular accident and foot ulcers were documented. Height and weight were recorded for body mass index (BMI-weight in kg / height in m 2 ). BMI between 18.5 and 24.9 was considered normal, >25.0-26.9 as overweight. Waist hip ratio (WHR) was calculated by the formula, waist girth in cm / hip girth in cm. The normal figure for males was < 0.95 and for females < 0.85. 6 Hypertension was defined as the presence of systolic BP >140 mm Hg and diastolic BP of >90 mmHg or a known hypertensive on treatment. Femoral, popliteal, tibialis posterior and dorsalis pedis arteries were palpated and noted as normal, diminished, absent or leg amputated.
Sensation was examined using a 10-gram Semmes- Weinstein monofilament on the ten recommended sites on plantar and dorsal aspects of feet. The results were documented as normal, diminished, absent or leg amputated. Subjects with diminished or absent sensation were labelled as neuropathic. The knee and ankle reflexes were elicited and noted as normal, diminished, absent or leg amputated. Subjects with diminished or absent knee or ankle reflex or amputation on either limb were labelled as neuropathic. Feet were examined for the presence of callus, healed ulcer or active ulcer. Fundal examination was performed by indirect ophthalmoscopy. Microdots, blot haemorrhages and hard and soft exudates were considered as background retinopathy. The presence of new vessels was taken as proliferative retinopathy. Macrovascular complications were defined as history positive for one or more of three conditions: angina, heart attack or stroke. Biochemical Tests All subjects were asked to come for blood sample collection in the morning after an overnight fast of 10 -14 hours. They were also advised to bring the first morning sample of urine in a supplied container, for examination including microalbumin estimation. Microalbumin was estimated by MICRAL TEST on Accu-check product, Roche Diagnostics GmbH, Mannheim Germany. Serum total cholesterol, triglyceride, HDL, LDL cholesterol, serum creatinine and glycosylated haemoglobin (Bio-Rad DiaSTAT Hemoglobin A1c Program Bio-Rad Laboratories CA USA) (normal range for people without diabetes 4.4-6.4%) were estimated. Cholesterol levels <200mg/dl were considered normal, 200 -250 as increased risk and >250 as high risk, triglyceride levels <150 mg/dl were defined as normal, 150 -200 as increased risk and > 200 as high risk. HDL levels >40 mg/dl were taken as normal, 30 -40 as increased risk and <30 as high risk. HbA1 c of <7% was considered as good glycaemic control, 7-8% acceptable and >8% poor control. Nephropathy was defined as presence of protein either macroalbumin or microalbumin and absence of pus cells in urine. The creatinine level <1.2 mg/dl was taken as normal. Statistical methods All data was analyzed by with statistical package "SPSS version 10.0". The participants were placed in four categories, according to the duration of diabetes: 0-5, 5- 10; 10- 15 and = 15 years. Age was divided in four quartiles: 25- 47,47-55, 55-63, >63 years. Age, sex, duration of diabetes, BMI, WHR and HbA I c were tested individually as independent variables against the specified complications. Moreover, these specified complications were also tested against each other. The results for continuous variables are given in the form of averages, standard deviations (S.D.) and 95% confidence intervals (C.I.). The odds ratio (OR) and X2 values were calculated to find the association among categorical variables.
The study included 500 people with Type 2 diabetes, (160 males, 340 females) with a mean age of 55.2+10.6 (range 25-85) years. The median duration of diabetes was 7 years following diagnosis. The duration of diabetes against the number of subjects is shown in Figure. WHR and BMI greater than normal were noted in 87% and 6 1% individuals respectively. Cholesterol and triglyceride levels were raised in 46% and 49% diabetic patients respectively and 80% had less than normal HDL. Microalbuminuria was present in 13%. Of the 323 (64.6%) people with hypertension, 225 (69.7%) gave a history of previously diagnose hypertension, and 156 (48.3%) were on antihypertensiy medication. Newly diagnosed hypertension was found in 9 (19.6%) subjects. HbA1c level >8% was present in 142(28.4%), 7-8% in 89 (17.8%) and <7 in 269 (53.8% Retinopathy (43%) was the most frequent complication, followed by neuropathy (39.6%), nephropathy (20.2%) an foot ulcer (4%). One hundred and two subjects were found to hay one or more than one of the macrovascular complication angina 85 (17%), heart attack 25 (5%) and stroke 13 (2.6%). In the univariate analysis, neuropathy was found be significantly associated with duration of diabet (p=0.001), BMI (p=0.04), trophic ulcer (p=O.O2 nephropathy (p=0.001) and HbA1C (p=0.02). Nephropathy showed significant association with HbA1c (p=0.001 duration of diabetes (p=0.05) and hypertension (p=O.O5) Similarly, retinopathy was found to be associated wit duration of diabetes (p=0.001) and trophic ulcer (p=O.OOI) A significant association was also observed between hypertension and WHR (p=O.O 1 ). All complications, except trophic ulcer, showed significant association with age, nephropathy (p=0.04), neuropathy (p=0.001 ), hypertension (p=0.001), and retinopathy (p=O.OOI). Gender had n association with any microvascular complication. Macrovascular complications showed significant association with duration of diabetes (p=O.O01), gender (p=0.001) and age (p=O.O4). No difference was found between people wit normal and high cholesterol levels with respect to duration of diabetes, hypertension, BMI and WHR. Similarly, the was no association between any of the above-mentioned variables and triglyceride levels. The multivariate analyses of different risk factors are shown in Tables I and 2. In logistic regression analysis, a significant association of nephropathy was found with HbA1c(Adjusted OR=2.1, 95% C.I.: 1.3-3.9), hypertension (Adjusted OR=4.1, 95% C.I.: 2.2- 7.7), and retinopathy (Adjusted OR=3.7, 95% C.I.: 2.1-6.4). Additionally, hypertension was found to be associated with nephropathy (Adjusted OR=4.5, 95% C.I.: 2.4-8.3) and WHR (Adjusted OR=2.0, 95% C.I.: 1.04-3.8). Similarly, retinopathy was found to be significantly associated with neuropathy (Adjusted OR=1.9, 95% C.I.: 1.2-2.9), nephropathy (Adjusted OR=3.4, 95% C.I.: 1.98-5.8), presence of ulcer (Adjusted OR=3.4, 95% C.I.: 1.02-11.5) and Duration of diabetes (Adjusted OR = 5.6, 95% C.I. 2.8-11.3). Retinopathy was also associated with increasing categories of duration with adjusted odds increasing from category 5- 10: 2.8 (95% C.I.: 1.65-4.9) to category 15 or more: 5.6 (95% C.I: 2.8-11.3). Neuropathy was found to be associated with gender (Adjusted OR=1.9, 95% C.I. 1.2-2.9) and HbA1C (>7%) (Table 1). Macrovascular complications also showed significant association with duration of diabetes, with strength of association rising from Adjusted OR=0.99, 95% C.I.: 0.5 - 1.9 to Adjusted OR=3.0, 95% C.I.: 1.5-6.0) as the duration increased from 0-5 years to > 15 years respectively. Macrovascular complications were also significantly associated with gender (Adjusted OR=2.3, 95% C.I.: 1.4-3.7) and BMI (Adjusted OR=2.1, 95% C.I.: 1.2-3.5) (Table 2).
The UK prospective diabetes study (UKPDS) proved that in patients with type 2 diabetes the risk of complications was strongly associated with previous hyperglycaemia. Any reduction in HbA1c is likely to reduce the risk of complications, with the lowest risk being in those with HbA1c values in the normal range «6.0%). 7 Pakistan, with a population of 140 million, has a diabetes prevalence of 11.4% in the age group 25 years and above.5 No countrywide survey on diabetic complications has been conducted so far. Keeping in view the high prevalence of Type 2 diabetes, the number of people with chronic complications is likely to be high. Our results could be biased, as in the DAP clinic doctors trained in diabetes care attend to the patients. It is therefore possible that the risk of developing chronic complications in these patients may be less as compared to those receiving treatment from General Practitioners, who have less time and lesser experience to provide treatment, motivation and encouragement. Female preponderance (340 F: 160 M) in our study has also been observed in the Pakistan National Diabetes Survey conducted by DAP. 5,8,9 Most men belonging to low. income group, were daily wage earners and found it difficult to attend the clinic regularly, while most women were housewives and came to the clinic when advised. Retinopathy: This was more commonly seen in our series (43%) compared to the prevalence of23.7% reported in the Indian study. 3 A group from Egypt has reported retinopathy in 42% of their study subjects which closely matches our findings. 10 A publication from Cardiff UK from a district health authority population found retinopathy to be present in 16.5% diabetic patients 11 , whereas a Spanish study gave figures of 30.6% retinopathy in 504 people with type 2 DM. 12 The results on 503 Mexican people with type 2 DM revealed 44.6% retinopathy. 13 The high figures of retinopathy in our population could be attributed to a lack of awareness in our patients to undertake regular eye examination. A genetic factor may also be relevant, as the figures between the UK subjects and those from Mexico, Egypt and Pakistan show significant disparity. Neuropathy: Neuropathy is often ignored due to insidious onset and slow progress. 14 This could be the reason for our figure of 39.6%, which is higher than the Indian results (27.5%). 3 Significant association between neuropathy, retinopathy and glycaemic control was noted. A multicentre Italian study showed 32.3% subjects to have diabetic neuropathy 15 , whereas the prevalence of neuropathy was quoted as 38% from Saudi Arabia. 16 Each study had results with a significant association with the duration of diabetes. Several studies have shown that foot ulcers, both ischemic or neuropathic, have a low prevalence in South Asians. ll,17 A EURODIAB population based case controlled study done in UK 18 concluded that South Asians with diabetes have 25% lesser risk of amputation compared to Europeans. This is attributed to the low rates of PVD and neuropathy in the former. Our study gave a figure of 4% ulcer prevalence with only one case with a digit amputation. A study from Saudi Arabia, reported 4.7% foot ulcers and 3.4% below ankle amputations. 16 Contributing factors for the low prevalence of foot complications in South Asians and Middle Eastern population, could be differences in footwear design (sandals), increased attention to foot hygiene due to cultural practices of \'wadu\', the ablution required of Muslims before prayer which involves washing the parts of the body that are generally exposed to grime and dust. This practice allows inspection and cleaning of the feet five times daily. A genetic factor may also playa role. Diabetic Nephropathy: DN is the leading cause of ESRD in Japan, Taiwan and the United States. 1,19 Infection remains the leading cause for ESRD in developing countries, followed by diabetes. A study from Pakistan has shown similar results. 20 It has been observed that ethnicity and racial differences playa major role in the development of DN. Black Americans and Pima Indians have a higher prevalence of DN compared to the whites. Macroproteinuria and microalbuminuria has been reported to be higher in British Asians than in the white population. 21, 22 A study from Saudi Arabia reports a rapid progression of diabetic kidney disease in their patients with 12 out of24 becoming dialysis dependent within 19.7 months. 23 Another clinic based study from Riyadh reports 41.3% diabetics having microalbuminuria and 12.7% clinical nephropathy (albustix positive). Both were related to poor glycaemic control and obesity. 24 Figures from an Indian study on 3010 subjects (mean age 52 + 9.7 years) quote 19.7% subjects having proteinuria. Of these 5.5% had persistent proteinuria > 500 mg/dl.3 Our study results show that 20.2% of the subjects had DN, with significant association with age, level of glycaemia, duration of diabetes, hypertension and obesity. Other studies, including the UKPDS, have shown similar association. UKPDS has demonstrated that intensive control of blood glucose reduces the risk of early kidney damage by 33%. 25,26 Coronary Artery Disease and Cerebrovascular Disease An Indian publication3 found 11.4% subjects to have CAD and 0.9% with a past history of stroke, as compared to 20.4% and 2.6% respectively in our series and 25.2% and 9.6% respectively in a UK study.11 Earlier data on South Asian immigrants in UK also showed a high prevalence. 27,28 CAD was found to be significantly associated with female gender in our study. Hypertension and obesity, important risk factors for CAD, were also present more frequently in women. The Strong Heart Study 29 and other studies also suggest that the relative risk of CAD in women with diabetes is independent of the conventional risk factors. 30 Obesity is a major contributing factor to non- communicable diseases. The prevalence of obesity seen in most Pakistani studies has been high, similar to our results of 87% with above normal WHR(>0.85 females, >0.95 males) and 61% with a raised BMI(>27kg/m2). Haider et al reported 56% of 500 subjects with essential hypertension to be obese as measured by the Ponderal Index. 31 In a survey on the prevalence hypertension and obesity in 151 women over 25 y age belonging to a low income area of Karachi, 4i were overweight and 8% were obese according to (overweight: BMI 23-29, obese: BMI >29). 32 Jabbar et al in their study on dyslipidaemia an relation with BMI versus WHR on 88 subjects, me age 41 years, concluded that total cholesterol significantly higher in men and women with a WHR more than 0.9 and 0.8. High BMI did not show association. This emphasizes the importance of rou measurement of WHR. 33 The Pakistan National Diabetes Survey confirmed the strong association between glucose intolerance WHR above the normal range. 6 The association of obesity with diabetes, cardiovascular disease and hypertension has b reported from allover the world. For Asian population, there is perhaps a need for lower BMI indices as cut levels for obesity. Women tend to have higher obe rates than men and obesity is now emerging as a factor even in the poor population of the develo countries. 34 Hypertension was present in 323 (64.6%) subjects. This is a higher figure compared to the results of Pakis National Prevalence Survey (37%) 5,8,9 and publication\' from India and Bahrain 3,35 , each showing 38%. It was observed that 94% of subjects with a raised WHR 47.4% with high BMI had hypertension. The prevalence of hypertension in our patients could attributed to central obesity and cultural habits of salt intake. Our study concluded that the prevalence of diabetic microvascular complications was higher in people poor glycaemic control, longer duration of diabetes associated hypertension and obesity. We recommend screening of high risk groups and emphasize importance of early diagnosis of diabetes and detection chronic complications so that appropriate treatment initiated at the earliest.
The study was funded by WHO. The statistical analysis by Dr. Agha Ajmal is gratefully acknowledged.
1. United States Renal Data System. USRDS 2003 Annual Data Re National Institutes of Health, National Institute of Diabetes and Digesti\' Kidney Diseases Bethesda, MD 2003.
2. Klein R Hyperglycemia and microvascular and macrovascular di diabetes Diabetes Care I 995; I 8258-68.
3. Ramachandran A, Snehalatha C, Satyavani K, et al Prevalence of v complications and their risk factors in type 2 diabetes.J Assoc Physicians India 1999;47\'1152-1156.
4. Haider Z, Obaidullah S Clinical diabetes mellitus in Pakistan J Trop MedHyg 1981;84:155-8.
5. Shera AS, Rafique O, Khawaja IA, et al Pakistan National Diabetes Survey. prevalence of glucose intolerance and associated factors in Shikarpur, Sindh Province Diabet Med 1995;121116-21.
6. Alberti KOMM, Zimmet PL For the WHO Consultation, Definition, Diagnosis and Classification of Diabetes Mellitus and its complications Part 1 Diagnosis and Classification of Diabetes Mellitus Provisional Report of a WHO consultation Diabet Med 1998;15539-53.
7. Stratton IM, Adler AI, Neil HAW, et al Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35r prospective observational study. BMJ 2000;321405-12.
8. Shera AS, Rafique O, Khawaja IA, et al Pakistan national diabetes survey. prevalence of glucose intolerance and associated factors in Baluchistan Province Diabetes Res Clin Pract 1999;4449-58.
9. Shera AS, Rafique O, Khawaja IA, et al. Pakistan national diabetes survey prevalence of glucose intolerance and associated factors in North West Frontier Province (NWFP) of Pakistan J Pak Med Assoc ] 999;49206-11.
10. Herman WH, Aubert RE, Engelgau MM, et al Diabetes mellitus in Egypt glycaemic control and microvascular and neuropathic complications Diab Med 1998;151045-51.
11. Morgan CL, Currie CJ, Hunt J, et al. The prevalence of multiple diabetes related complications Diabet Med 2000; 17146-51.
12. Zafra Mexcua JA, Mendez Segovia JC, Novalbos Ruiz JP, et al Chronic complications in patients with type 2 diabetes mellitus cared for at a health center Aten Primaria 2000;25529-35.
13. Paisey RB, Arredondo O, Villalobos A, et al- Association of differing dietary, metabolic, and clinical risk factors with microvascular complications of diabetes a prevalence study on 503 Mexican type II diabetic subjects 11 Diabetes Care 1984;7-428-433 .
14. Pecoraro RE, Reiber OE, Burgess OM. Pathways to diabetic limb amputation basis for prevention Diabetes Care 1990; 13.513-21.
15. Fedele D, Comi O, Coscelli C, et al. A multicenter study on the prevalence of diabetic neuropathy in Italy Italian Neuropathy Committee Diabetes Care 1997;20.836-43.
16. Nielsen JV Peripheral neuropathy, hypertension,foot ulcers and amputation among Saudi Arabian patients with type 2 diabetes Diab Res Clin Pract 1998;41.63-9.
17. Mohan V, Premalatha G, Sastry NG. Peripheral vascular disease in non- insulin dependent diabetes mellitus in South India Diab Res Clin Pract 1995;27235-40.
18. Chatuverdi N, Abbot CA, Whalley A, et al Risk of diabetes -related amputations in South Asians vs Europeans in the UK Diabet Med 2002;1999-104.
19. Parving H, Osterby R, Ritz E Diabetic Nephropathy, in The Kidney, edited by Brenner BM, Levine S, Philadelphia, Saunders, 2000 p 1731.
20. Kumar H, Alam F, Naqvi SAJ Experience of haemodialysis at the Kidney Centre J Pak Med Assoc 1992;42234-6.
21. Samanta A, Burden AC, Feehally J, et al Diabetic renal d,sease differences between Asian and white patients BMJ 1986;293366-7.
22. Burden AC, McNally PG, Feehally J, et al Increased incidence of End stage renal failure secondary to Diabetes Mellitus in Asian Ethnic Groups in the United Kingdom. Diabet Med 1992;9641-5.
23. AI-Khader A Impact of diabetes in renal diseases in Saudi Arabia Nephrol Dial Transplan, 2001;162132-5.
24. Alzaid AA, Sobki S, De Silva V, Prevalence of microalbuminuria in Saudi arabians with non-insulin dependent diabetes mellitus a clinic based study Diab Res Clin Pract 1994;26115-20.
25. Mulec H, Blohme G, Grande B, et al The effect of metabolic control on rate of decline in renal function in insulin-dependent diabetes mellitus with overt diabetic nephropathy, Nephrol Dial Transplant 1998; 13651-5.
26. UK Prospective Diabetes Study (UKPDS) Group Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33) Lancet 1998;352.837-53.
27. McKeigue PM, Feme JE, Pierpoint T, et al, Association of early onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinaemia Circulation 1993;87152-61.
28. Enas A, Mehta J Malignant coronary artery disease in young Asian Indians -Thoughts on pathogenesis, prevention and therapy Clin Cardiol 1995;18131-5.
29. Howard BV, Cowan LD, Go 0, et al Adverse effects of Diabetes on multiple cardiovascular disease risk factors in women The Strong Heart Study, Diabetes Care 1998;211258-65.
30. Barret-Connor EL, Cohn BA, Wingard DL, et al, Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bemardo study JAMA 1991 ;265.627-3 J.
31. Haider Z, Bano KA Prevalence of obesity in patients with essential hypertension of varying severity J Pak Med assoc 1985;35354-7.
32. Akatsu H, Aslam A Prevalence of hypertension and obesity among women over age 25 in a low income area in Karachi, Pakistan J Pak Med Assoc 1996;46\'191-3.
33. Jabbar A, Irfanullah A, Akhtar J, et al, Dyslipidemia and its relation with Body Mass Index versus Waist Hip Ratio J Pak Med Assoc 1997;47\'308-10.
34. James PT, Leach R, Kalamara E, et al The world wide obesity epidemic Obes Res 2001 (Suppl 4):228S-33S.
35. AI-Mahroos F, AI-Roomi K, McKeigue PM Relation of high blood pressure to glucose intolerance, plasma lipids and educational status on an Arabian Gulf population Int J Epidemiol 2000;2971-6.
The 5th Diabetes in Asia Conference, will be held under the aegis of Diabetic Association of Pakistan, Karachi and International Diabetes Federation, from 16 to 18 April 2004, in Karachi. The theme of the conference is "Prevention of Diabetes." The conference will be addressed by 30 foreign delegates, experts in Diabetes, along with President IDF Prof. Pierre Lefebvre. Local data will be presented by doctors from all the provinces. Details can be had from Diabetic Association of Pakistan & WHO Collaborating Centre, Karachi, telephone: 92-21- 6616890, fax: 92-21-6680959, email: dapkhi@cyber.net.pk, web site: www.dap.org.pk


text:
A Girl of the Limberlost – Gene Stratton-Porter
Posted by Kate Kearns on May 3, 2017 January 26, 2018
WHEREIN ELNORA GOES TO HIGH SCHOOL AND LEARNS MANY LESSONS NOT FOUND IN HER BOOKS
"Elnora Comstock, have you lost your senses?" demanded the angry voice of Katharine Comstock while she glared at her daughter.
"Why mother!" faltered the girl.
"Don't you 'why mother' me!" cried Mrs. Comstock. "You know very well what I mean. You've given me no peace until you've had your way about this going to school business; I've fixed you good enough, and you're ready to start. But no child of mine walks the streets of Onabasha looking like a play-actress woman. You wet your hair and comb it down modest and decent and then be off, or you'll have no time to find where you belong."
Elnora gave one despairing glance at the white face, framed in a most becoming riot of reddish-brown hair, which she saw in the little kitchen mirror. Then she untied the narrow black ribbon, wet the comb and plastered the waving curls close to her head, bound them fast, pinned on the skimpy black hat and opened the back door.
"You've gone so plumb daffy you are forgetting your dinner," jeered her mother.
"I don't want anything to eat," replied Elnora.
"You'll take your dinner or you'll not go one step. Are you crazy? Walk almost three miles and no food from six in the morning until six at night. A pretty figure you'd cut if you had your way! And after I've gone and bought you this nice new pail and filled it especial to start on!"
Elnora came back with a face still whiter and picked up the lunch. "Thank you, mother! Good-bye!" she said. Mrs. Comstock did not reply. She watched the girl follow the long walk to the gate and go from sight on the road, in the bright sunshine of the first Monday of September.
"I bet a dollar she gets enough of it by night!" commented Mrs. Comstock.
Elnora walked by instinct, for her eyes were blinded with tears. She left the road where it turned south, at the corner of the Limberlost, climbed a snake fence and entered a path worn by her own feet. Dodging under willow and scrub oak branches she came at last to the faint outline of an old trail made in the days when the precious timber of the swamp was guarded by armed men. This path she followed until she reached a thick clump of bushes. From the debris in the end of a hollow log she took a key that unlocked the padlock of a large weatherbeaten old box, inside of which lay several books, a butterfly apparatus, and a small cracked mirror. The walls were lined thickly with gaudy butterflies, dragonflies, and moths. She set up the mirror and once more pulling the ribbon from her hair, she shook the bright mass over her shoulders, tossing it dry in the sunshine. Then she straightened it, bound it loosely, and replaced her hat. She tugged vainly at the low brown calico collar and gazed despairingly at the generous length of the narrow skirt. She lifted it as she would have cut it if possible. That disclosed the heavy high leather shoes, at sight of which she seemed positively ill, and hastily dropped the skirt. She opened the pail, removed the lunch, wrapped it in the napkin, and placed it in a small pasteboard box. Locking the case again she hid the key and hurried down the trail.
She followed it around the north end of the swamp and then entered a footpath crossing a farm leading in the direction of the spires of the city to the northeast. Again she climbed a fence and was on the open road. For an instant she leaned against the fence staring before her, then turned and looked back. Behind her lay the land on which she had been born to drudgery and a mother who made no pretence of loving her; before her lay the city through whose schools she hoped to find means of escape and the way to reach the things for which she cared. When she thought of how she appeared she leaned more heavily against the fence and groaned; when she thought of turning back and wearing such clothing in ignorance all the days of her life she set her teeth firmly and went hastily toward Onabasha.
On the bridge crossing a deep culvert at the suburbs she glanced around, and then kneeling she thrust the lunch box between the foundation and the flooring. This left her empty-handed as she approached the big stone high school building. She entered bravely and inquired her way to the office of the superintendent. There she learned that she should have come the previous week and arranged about her classes. There were many things incident to the opening of school, and one man unable to cope with all of them.
"Where have you been attending school?" he asked, while he advised the teacher of Domestic Science not to telephone for groceries until she knew how many she would have in her classes; wrote an order for chemicals for the students of science; and advised the leader of the orchestra to hire a professional to take the place of the bass violist, reported suddenly ill.
"I finished last spring at Brushwood school, district number nine," said Elnora. "I have been studying all summer. I am quite sure I can do the first year work, if I have a few days to get started."
"Of course, of course," assented the superintendent. "Almost invariably country pupils do good work. You may enter first year, and if it is too difficult, we will find it out speedily. Your teachers will tell you the list of books you must have, and if you will come with me I will show you the way to the auditorium. It is now time for opening exercises. Take any seat you find vacant."
Elnora stood before the entrance and stared into the largest room she ever had seen. The floor sloped to a yawning stage on which a band of musicians, grouped around a grand piano, were tuning their instruments. She had two fleeting impressions. That it was all a mistake; this was no school, but a grand display of enormous ribbon bows; and the second, that she was sinking, and had forgotten how to walk. Then a burst from the orchestra nerved her while a bevy of daintily clad, sweet-smelling things that might have been birds, or flowers, or possibly gaily dressed, happy young girls, pushed her forward. She found herself plodding across the back of the auditorium, praying for guidance, to an empty seat.
As the girls passed her, vacancies seemed to open to meet them. Their friends were moving over, beckoning and whispering invitations. Every one else was seated, but no one paid any attention to the white-faced girl stumbling half-blindly down the aisle next the farthest wall. So she went on to the very end facing the stage. No one moved, and she could not summon courage to crowd past others to several empty seats she saw. At the end of the aisle she paused in desperation, while she stared back at the whole forest of faces most of which were now turned upon her.
In a flash came the full realization of her scanty dress, her pitiful little hat and ribbon, her big, heavy shoes, her ignorance of where to go or what to do; and from a sickening wave which crept over her, she felt she was going to become very ill. Then out of the mass she saw a pair of big, brown boy eyes, three seats from her, and there was a message in them. Without moving his body he reached forward and with a pencil touched the back of the seat before him. Instantly Elnora took another step which brought her to a row of vacant front seats.
She heard laughter behind her; the knowledge that she wore the only hat in the room burned her; every matter of moment, and some of none at all, cut and stung. She had no books. Where should she go when this was over? What would she give to be on the trail going home! She was shaking with a nervous chill when the music ceased, and the superintendent arose, and coming down to the front of the flower-decked platform, opened a Bible and began to read. Elnora did not know what he was reading, and she felt that she did not care. Wildly she was racking her brain to decide whether she should sit still when the others left the room or follow, and ask some one where the Freshmen went first.
In the midst of the struggle one sentence fell on her ear. "Hide me under the shadow of Thy wings."
Elnora began to pray frantically. "Hide me, O God, hide me, under the shadow of Thy wings."
Again and again she implored that prayer, and before she realized what was coming, every one had arisen and the room was emptying rapidly. Elnora hurried after the nearest girl and in the press at the door touched her sleeve timidly.
"Will you please tell me where the Freshmen go?" she asked huskily.
The girl gave her one surprised glance, and drew away.
"Same place as the fresh women," she answered, and those nearest her laughed.
Elnora stopped praying suddenly and the colour crept into her face. "I'll wager you are the first person I meet when I find it," she said and stopped short. "Not that! Oh, I must not do that!" she thought in dismay. "Make an enemy the first thing I do. Oh, not that!"
She followed with her eyes as the young people separated in the hall, some climbing stairs, some disappearing down side halls, some entering adjoining doors. She saw the girl overtake the brown-eyed boy and speak to him. He glanced back at Elnora with a scowl on his face. Then she stood alone in the hall.
Presently a door opened and a young woman came out and entered another room. Elnora waited until she returned, and hurried to her. "Would you tell me where the Freshmen are?" she panted.
"Straight down the hall, three doors to your left," was the answer, as the girl passed.
"One minute please, oh please," begged Elnora: "Should I knock or just open the door?"
"Go in and take a seat," replied the teacher.
"What if there aren't any seats?" gasped Elnora.
"Classrooms are never half-filled, there will be plenty," was the answer.
Elnora removed her hat. There was no place to put it, so she carried it in her hand. She looked infinitely better without it. After several efforts she at last opened the door and stepping inside faced a smaller and more concentrated battery of eyes.
"The superintendent sent me. He thinks I belong here," she said to the professor in charge of the class, but she never before heard the voice with which she spoke. As she stood waiting, the girl of the hall passed on her way to the blackboard, and suppressed laughter told Elnora that her thrust had been repeated.
"Be seated," said the professor, and then because he saw Elnora was desperately embarrassed he proceeded to lend her a book and to ask her if she had studied algebra. She said she had a little, but not the same book they were using. He asked her if she felt that she could do the work they were beginning, and she said she did.
That was how it happened, that three minutes after entering the room she was told to take her place beside the girl who had gone last to the board, and whose flushed face and angry eyes avoided meeting Elnora's. Being compelled to concentrate on her proposition she forgot herself. When the professor asked that all pupils sign their work she firmly wrote "Elnora Comstock" under her demonstration. Then she took her seat and waited with white lips and trembling limbs, as one after another professor called the names on the board, while their owners arose and explained their propositions, or "flunked" if they had not found a correct solution. She was so eager to catch their forms of expression and prepare herself for her recitation, that she never looked from the work on the board, until clearly and distinctly, "Elnora Cornstock," called the professor.
The dazed girl stared at the board. One tiny curl added to the top of the first curve of the m in her name, had transformed it from a good old English patronymic that any girl might bear proudly, to Cornstock. Elnora sat speechless. When and how did it happen? She could feel the wave of smothered laughter in the air around her. A rush of anger turned her face scarlet and her soul sick. The voice of the professor addressed her directly.
"This proposition seems to be beautifully demonstrated, Miss Cornstalk," he said. "Surely, you can tell us how you did it."
That word of praise saved her. She could do good work. They might wear their pretty clothes, have their friends and make life a greater misery than it ever before had been for her, but not one of them should do better work or be more womanly. That lay with her. She was tall, straight, and handsome as she arose.
"Of course I can explain my work," she said in natural tones. "What I can't explain is how I happened to be so stupid as to make a mistake in writing my own name. I must have been a little nervous. Please excuse me."
She went to the board, swept off the signature with one stroke, then rewrote it plainly. "My name is Comstock," she said distinctly. She returned to her seat and following the formula used by the others made her first high school recitation.
As Elnora resumed her seat Professor Henley looked at her steadily. "It puzzles me," he said deliberately, "how you can write as beautiful a demonstration, and explain it as clearly as ever has been done in any of my classes and still be so disturbed as to make a mistake in your own name. Are you very sure you did that yourself, Miss Comstock?"
"It is impossible that any one else should have done it," answered Elnora.
"I am very glad you think so," said the professor. "Being Freshmen, all of you are strangers to me. I should dislike to begin the year with you feeling there was one among you small enough to do a trick like that. The next proposition, please."
When the hour had gone the class filed back to the study room and Elnora followed in desperation, because she did not know where else to go. She could not study as she had no books, and when the class again left the room to go to another professor for the next recitation, she went also. At least they could put her out if she did not belong there. Noon came at last, and she kept with the others until they dispersed on the sidewalk. She was so abnormally self-conscious she fancied all the hundreds of that laughing, throng saw and jested at her. When she passed the brown-eyed boy walking with the girl of her encounter, she knew, for she heard him say: "Did you really let that gawky piece of calico get ahead of you?" The answer was indistinct.
Elnora hurried from the city. She intended to get her lunch, eat it in the shade of the first tree, and then decide whether she would go back or go home. She knelt on the bridge and reached for her box, but it was so very light that she was prepared for the fact that it was empty, before opening it. There was one thing for which to be thankful. The boy or tramp who had seen her hide it, had left the napkin. She would not have to face her mother and account for its loss. She put it in her pocket, and threw the box into the ditch. Then she sat on the bridge and tried to think, but her brain was confused.
"Perhaps the worst is over," she said at last. "I will go back. What would mother say to me if I came home now?"
So she returned to the high school, followed some other pupils to the coat room, hung her hat, and found her way to the study where she had been in the morning. Twice that afternoon, with aching head and empty stomach, she faced strange professors, in different branches. Once she escaped notice; the second time the worst happened. She was asked a question she could not answer.
"Have you not decided on your course, and secured your books?" inquired the professor.
"I have decided on my course," replied Elnora, "I do not know where to ask for my books."
"Ask?" the professor was bewildered.
"I understood the books were furnished," faltered Elnora.
"Only to those bringing an order from the township trustee," replied the Professor.
"No! Oh no!" cried Elnora. "I will have them to-morrow," and gripped her desk for support for she knew that was not true. Four books, ranging perhaps at a dollar and a half apiece; would her mother buy them? Of course she would not–could not.
Did not Elnora know the story of old. There was enough land, but no one to do clearing and farm. Tax on all those acres, recently the new gravel road tax added, the expense of living and only the work of two women to meet all of it. She was insane to think she could come to the city to school. Her mother had been right. The girl decided that if only she lived to reach home, she would stay there and lead any sort of life to avoid more of this torture. Bad as what she wished to escape had been, it was nothing like this. She never could live down the movement that went through the class when she inadvertently revealed the fact that she had expected books to be furnished. Her mother would not secure them; that settled the question.
But the end of misery is never in a hurry to come; before the day was over the superintendent entered the room and explained that pupils from the country were charged a tuition of twenty dollars a year. That really was the end. Previously Elnora had canvassed a dozen methods for securing the money for books, ranging all the way from offering to wash the superintendent's dishes to breaking into the bank. This additional expense made her plans so wildly impossible, there was nothing to do but hold up her head until she was from sight.
Down the long corridor alone among hundreds, down the long street alone among thousands, out into the country she came at last. Across the fence and field, along the old trail once trodden by a boy's bitter agony, now stumbled a white-faced girl, sick at heart. She sat on a log and began to sob in spite of her efforts at self-control. At first it was physical breakdown, later, thought came crowding.
Oh the shame, the mortification! Why had she not known of the tuition? How did she happen to think that in the city books were furnished? Perhaps it was because she had read they were in several states. But why did she not know? Why did not her mother go with her? Other mothers–but when had her mother ever been or done anything at all like other mothers? Because she never had been it was useless to blame her now. Elnora realized she should have gone to town the week before, called on some one and learned all these things herself. She should have remembered how her clothing would look, before she wore it in public places. Now she knew, and her dreams were over. She must go home to feed chickens, calves, and pigs, wear calico and coarse shoes, and with averted head, pass a library all her life. She sobbed again.
"For pity's sake, honey, what's the matter?" asked the voice of the nearest neighbour, Wesley Sinton, as he seated himself beside Elnora. "There, there," he continued, smearing tears all over her face in an effort to dry them. "Was it as bad as that, now? Maggie has been just wild over you all day. She's got nervouser every minute. She said we were foolish to let you go. She said your clothes were not right, you ought not to carry that tin pail, and that they would laugh at you. By gum, I see they did!"
"Oh, Uncle Wesley," sobbed the girl, "why didn't she tell me?"
"Well, you see, Elnora, she didn't like to. You got such a way of holding up your head, and going through with things. She thought some way that you'd make it, till you got started, and then she begun to see a hundred things we should have done. I reckon you hadn't reached that building before she remembered that your skirt should have been pleated instead of gathered, your shoes been low, and lighter for hot September weather, and a new hat. Were your clothes right, Elnora?"
The girl broke into hysterical laughter. "Right!" she cried. "Right! Uncle Wesley, you should have seen me among them! I was a picture! They'll never forget me. No, they won't get the chance, for they'll see me again to-morrow!
"Now that is what I call spunk, Elnora! Downright grit," said Wesley Sinton. "Don't you let them laugh you out. You've helped Margaret and me for years at harvest and busy times, what you've earned must amount to quite a sum. You can get yourself a good many clothes with it."
"Don't mention clothes, Uncle Wesley," sobbed Elnora, "I don't care now how I look. If I don't go back all of them will know it's because I am so poor I can't buy my books."
"Oh, I don't know as you are so dratted poor," said Sinton meditatively. "There are three hundred acres of good land, with fine timber as ever grew on it."
"It takes all we can earn to pay the tax, and mother wouldn't cut a tree for her life."
"Well then, maybe, I'll be compelled to cut one for her," suggested Sinton. "Anyway, stop tearing yourself to pieces and tell me. If it isn't clothes, what is it?"
"It's books and tuition. Over twenty dollars in all."
"Humph! First time I ever knew you to be stumped by twenty dollars, Elnora," said Sinton, patting her hand.
"It's the first time you ever knew me to want money," answered Elnora. "This is different from anything that ever happened to me. Oh, how can I get it, Uncle Wesley?"
"Drive to town with me in the morning and I'll draw it from the bank for you. I owe you every cent of it."
"You know you don't owe me a penny, and I wouldn't touch one from you, unless I really could earn it. For anything that's past I owe you and Aunt Margaret for all the home life and love I've ever known. I know how you work, and I'll not take your money."
"Just a loan, Elnora, just a loan for a little while until you can earn it. You can be proud with all the rest of the world, but there are no secrets between us, are there, Elnora?"
"No," said Elnora, "there are none. You and Aunt Margaret have given me all the love there has been in my life. That is the one reason above all others why you shall not give me charity. Hand me money because you find me crying for it! This isn't the first time this old trail has known tears and heartache. All of us know that story. Freckles stuck to what he undertook and won out. I stick, too. When Duncan moved away he gave me all Freckles left in the swamp, and as I have inherited his property maybe his luck will come with it. I won't touch your money, but I'll win some way. First, I'm going home and try mother. It's just possible I could find second-hand books, and perhaps all the tuition need not be paid at once. Maybe they would accept it quarterly. But oh, Uncle Wesley, you and Aunt Margaret keep on loving me! I'm so lonely, and no one else cares!"
Wesley Sinton's jaws met with a click. He swallowed hard on bitter words and changed what he would have liked to say three times before it became articulate.
"Elnora," he said at last, "if it hadn't been for one thing I'd have tried to take legal steps to make you ours when you were three years old. Maggie said then it wasn't any use, but I've always held on. You see, I was the first man there, honey, and there are things you see, that you can't ever make anybody else understand. She loved him Elnora, she just made an idol of him. There was that oozy green hole, with the thick scum broke, and two or three big bubbles slowly rising that were the breath of his body. There she was in spasms of agony, and beside her the great heavy log she'd tried to throw him. I can't ever forgive her for turning against you, and spoiling your childhood as she has, but I couldn't forgive anybody else for abusing her. Maggie has got no mercy on her, but Maggie didn't see what I did, and I've never tried to make it very clear to her. It's been a little too plain for me ever since. Whenever I look at your mother's face, I see what she saw, so I hold my tongue and say, in my heart, 'Give her a mite more time.' Some day it will come. She does love you, Elnora. Everybody does, honey. It's just that she's feeling so much, she can't express herself. You be a patient girl and wait a little longer. After all, she's your mother, and you're all she's got, but a memory, and it might do her good to let her know that she was fooled in that."
"It would kill her!" cried the girl swiftly. "Uncle Wesley, it would kill her! What do you mean?"
"Nothing," said Wesley Sinton soothingly. "Nothing, honey. That was just one of them fool things a man says, when he is trying his best to be wise. You see, she loved him mightily, and they'd been married only a year, and what she was loving was what she thought he was. She hadn't really got acquainted with the man yet. If it had been even one more year, she could have borne it, and you'd have got justice. Having been a teacher she was better educated and smarter than the rest of us, and
so she was more sensitive like. She can't understand she was loving a dream. So I say it might do her good if somebody that knew, could tell her, but I swear to gracious, I never could. I've heard her out at the edge of that quagmire calling in them wild spells of hers off and on for the last sixteen years, and imploring the swamp to give him back to her, and I've got out of bed when I was pretty tired, and come down to see she didn't go in herself, or harm you. What she feels is too deep for me. I've got to respectin' her grief, and I can't get over it. Go home and tell your ma, honey, and ask her nice and kind to help you. If she won't, then you got to swallow that little lump of pride in your neck, and come to Aunt Maggie, like you been a-coming all your life."
"I'll ask mother, but I can't take your money, Uncle Wesley, indeed I can't. I'll wait a year, and earn some, and enter next year."
"There's one thing you don't consider, Elnora," said the man earnestly. "And that's what you are to Maggie. She's a little like your ma. She hasn't given up to it, and she's struggling on brave, but when we buried our second little girl the light went out of Maggie's eyes, and it's not come back. The only time I ever see a hint of it is when she thinks she's done something that makes you happy, Elnora. Now, you go easy about refusing her anything she wants to do for you. There's times in this world when it's our bounden duty to forget ourselves, and think what will help other people. Young woman, you owe me and Maggie all the comfort we can get out of you. There's the two of our own we can't ever do anything for. Don't you get the idea into your head that a fool thing you call pride is going to cut us out of all the pleasure we have in life beside ourselves."
"Uncle Wesley, you are a dear," said Elnora. "Just a dear! If I can't possibly get that money any way else on earth, I'll come and borrow it of you, and then I'll pay it back if I must dig ferns from the swamp and sell them from door to door in the city. I'll even plant them, so that they will be sure to come up in the spring. I have been sort of panic stricken all day and couldn't think. I can gather nuts and sell them. Freckles sold moths and butterflies, and I've a lot collected. Of course, I am going back to-morrow! I can find a way to get the books. Don't you worry about me. I am all right!
"Now, what do you think of that?" inquired Wesley Sinton of the swamp in general. "Here's our Elnora come back to stay. Head high and right as a trivet! You've named three ways in three minutes that you could earn ten dollars, which I figure would be enough, to start you. Let's go to supper and stop worrying!"
Elnora unlocked the case, took out the pail, put the napkin in it, pulled the ribbon from her hair, binding it down tightly again and followed to the road. From afar she could see her mother in the doorway. She blinked her eyes, and tried to smile as she answered Wesley Sinton, and indeed she did feel better. She knew now what she had to expect, where to go, and what to do. Get the books she must; when she had them, she would show those city girls and boys how to prepare and recite lessons, how to walk with a brave heart; and they could show her how to wear pretty clothes and have good times.
As she neared the door her mother reached for the pail. "I forgot to tell you to bring home your scraps for the chickens," she said.
Elnora entered. "There weren't any scraps, and I'm hungry again as I ever was in my life."
"I thought likely you would be," said Mrs. Comstock, "and so I got supper ready. We can eat first, and do the work afterward. What kept you so? I expected you an hour ago."
Elnora looked into her mother's face and smiled. It was a queer sort of a little smile, and would have reached the depths with any normal mother.
"I see you've been bawling," said Mrs. Comstock. "I thought you'd get your fill in a hurry. That's why I wouldn't go to any expense. If we keep out of the poor-house we have to cut the corners close. It's likely this Brushwood road tax will eat up all we've saved in years. Where the land tax is to come from I don't know. It gets bigger every year. If they are going to dredge the swamp ditch again they'll just have to take the land to pay for it. I can't, that's all! We'll get up early in the morning and gather and hull the beans for winter, and put in the rest of the day hoeing the turnips."
Elnora again smiled that pitiful smile.
"Do you think I didn't know that I was funny and would be laughed at?" she asked.
"Funny?" cried Mrs. Comstock hotly.
"Yes, funny! A regular caricature," answered Elnora. "No one else wore calico, not even one other. No one else wore high heavy shoes, not even one. No one else had such a funny little old hat; my hair was not right, my ribbon invisible compared with the others, I did not know where to go, or what to do, and I had no books. What a spectacle I made for them!" Elnora laughed nervously at her own picture. "But there are always two sides! The professor said in the algebra class that he never had a better solution and explanation than mine of the proposition he gave me, which scored one for me in spite of my clothes."
"Well, I wouldn't brag on myself!"
"That was poor taste," admitted Elnora. "But, you see, it is a case of whistling to keep up my courage. I honestly could see that I would have looked just as well as the rest of them if I had been dressed as they were. We can't afford that, so I have to find something else to brace me. It was rather bad, mother!"
"Well, I'm glad you got enough of it!"
"Oh, but I haven't," hurried in Elnora. "I just got a start. The hardest is over. To-morrow they won't be surprised. They will know what to expect. I am sorry to hear about the dredge. Is it really going through?"
"Yes. I got my notification today. The tax will be something enormous. I don't know as I can spare you, even if you are willing to be a laughing-stock for the town."
With every bite Elnora's courage returned, for she was a healthy young thing.
"You've heard about doing evil that good might come from it," she said. "Well, mother mine, it's something like that with me. I'm willing to bear the hard part to pay for what I'll learn. Already I have selected the ward building in which I shall teach in about four years. I am going to ask for a room with a south exposure so that the flowers and moths I take in from the swamp to show the children will do well."
"You little idiot!" said Mrs. Comstock. "How are you going to pay your expenses?"
"Now that is just what I was going to ask you!" said Elnora. "You see, I have had two startling pieces of news to-day. I did not know I would need any money. I thought the city furnished the books, and there is an out-of-town tuition, also. I need ten dollars in the morning. Will you please let me have it?"
"Ten dollars!" cried Mrs. Comstock. "Ten dollars! Why don't you say a hundred and be done with it! I could get one as easy as the other. I told you! I told you I couldn't raise a cent. Every year expenses grow bigger and bigger. I told you not to ask for money!"
"I never meant to," replied Elnora. "I thought clothes were all I needed and I could bear them. I never knew about buying books and tuition."
"Well, I did!" said Mrs. Comstock. "I knew what you would run into! But you are so bull-dog stubborn, and so set in your way, I thought I would just let you try the world a little and see how you liked it!"
Elnora pushed back her chair and looked at her mother.
"Do you mean to say," she demanded, "that you knew, when you let me go into a city classroom and reveal the fact before all of them that I expected to have my books handed out to me; do you mean to say that you knew I had to pay for them?"
Mrs. Comstock evaded the direct question.
"Anybody but an idiot mooning over a book or wasting time prowling the woods would have known you had to pay. Everybody has to pay for everything. Life is made up of pay, pay, pay! It's always and forever pay! If you don't pay one way you do another! Of course, I knew you had to pay. Of course, I knew you would come home blubbering! But you don't get a penny! I haven't one cent, and can't get one! Have your way if you are determined, but I think you will find the road somewhat rocky."
"Swampy, you mean, mother," corrected Elnora. She arose white and trembling. "Perhaps some day God will teach me how to understand you. He knows I do not now. You can't possibly realize just what you let me go through to-day, or how you let me go, but I'll tell you this: You understand enough that if you had the money, and would offer it to me, I wouldn't touch it now. And I'll tell you this much more. I'll get it myself. I'll raise it, and do it some honest way. I am going back to-morrow, the next day, and the next. You need not come out, I'll do the night work, and hoe the turnips."
It was ten o'clock when the chickens, pigs, and cattle were fed, the turnips hoed, and a heap of bean vines was stacked beside the back door.
Want to keep reading? Click the title below for a free ebook care of Project Gutenberg:
by Gene Stratton-Porter, 1909
Image by Ewa Mazur
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text:
Q: Access a Windows 7 shared folder while using a public network profile I have two computers, let's call them A and B. I am sharing a folder on computer B and while the windows firewall is disabled, I can access it without any problems. However, when I enable the windows firewall on computer B I can't access the shared folder anymore. I am using the public network profile on computer B, however I enabled "File and Printer sharing" in the network center. I have no idea what I'm doing wrong, also I have problems on "debugging", the windows firewall seems not to be very verbose.
In case this maybe makes a difference, both computers are on different networks.

A: Have you added an exception for file and printer sharing on both types of networks in the firewall?
Go to the control panel, click on System and Security, then on "Allow a program through Windows Firewall". Click "Change Settings", then scroll down to "File and Printer Sharing" and make sure it is checked for both Home/Work and Public networks. Click OK, and see if the file sharing now works.

A: Ok, here's the solution:
Go to the advanced settings of the windows firewall, choose incoming rules, then look for the rule "File and printer sharing (SMB incoming)" (or similar to that, I am not running an english windows version). Double click it and go to "area" (I guess this will be really translated different, just look for the a tab where you can set local and remote ip addresses for the rule). You will note, that the remote ip address is limited to the local subnet - change it to whatever you need.


text:
Aceruloplasminemia: Waiting for an Efficient Therapy
Alberto Piperno, M Alessio
IRCCS Ospedale San Raffaele
Aceruloplasminemia is an ultra-rare hereditary disorder caused by defective production of ceruloplasmin. Its phenotype is characterized by iron-restricted erythropoiesis and tissue iron overload, diabetes, and progressive retinal and neurological degeneration. Ceruloplasmin is a ferroxidase that plays a critical role in iron homeostasis through the oxidation and mobilization of iron from stores and subsequent incorporation of ferric iron into transferrin (Tf), which becomes available for cellular uptake via the Tf receptor. In addition, ceruloplasmin has antioxidant properties preventing the production of deleterious reactive oxygen species via the Fenton reaction. Some recent findings suggest that aceruloplasminemia phenotypes can be more heterogeneous than previously believed, varying within a wide range. Within this large heterogeneity, microcytosis with or without anemia, low serum iron and high serum ferritin, and diabetes are the early hallmarks of the disease, while neurological manifestations appear 10-20 years later. The usual therapeutic approach is based on iron chelators that are efficacious in reducing systemic iron overload. However, they have demonstrated poor efficacy in counteracting the progression of neurologic manifestations, and also often aggravate anemia, thereby requiring drug discontinuation. Open questions remain regarding the mechanisms leading to neurological manifestation and development of diabetes, and iron chelation therapy (ICT) efficacy. Recent studies in animal models of aceruloplasminemia support the possibility of new therapeutic approaches by parenteral ceruloplasmin administration. In this review we describe the state of the art of aceruloplasminemia with particular attention on the pathogenic mechanisms of the disease and therapeutic approaches, both current and perspective.
https://doi.org/10.3389/fnins.2018.00903
Neurologic Manifestations
Iron Overload
Retinal Degeneration
Transferrin Receptors
Erythropoiesis
Familial apoceruloplasmin deficiency
Piperno, A., & Alessio, M. (2018). Aceruloplasminemia: Waiting for an Efficient Therapy. Frontiers in Neuroscience, 12, [903]. https://doi.org/10.3389/fnins.2018.00903
Aceruloplasminemia: Waiting for an Efficient Therapy. / Piperno, Alberto; Alessio, M.
In: Frontiers in Neuroscience, Vol. 12, 903, 2018.
Piperno, A & Alessio, M 2018, 'Aceruloplasminemia: Waiting for an Efficient Therapy', Frontiers in Neuroscience, vol. 12, 903. https://doi.org/10.3389/fnins.2018.00903
Piperno A, Alessio M. Aceruloplasminemia: Waiting for an Efficient Therapy. Frontiers in Neuroscience. 2018;12. 903. https://doi.org/10.3389/fnins.2018.00903
Piperno, Alberto ; Alessio, M. / Aceruloplasminemia: Waiting for an Efficient Therapy. In: Frontiers in Neuroscience. 2018 ; Vol. 12.
@article{5d6ebd6a053644e985ae464d87f5fd2b,
title = "Aceruloplasminemia: Waiting for an Efficient Therapy",
abstract = "Aceruloplasminemia is an ultra-rare hereditary disorder caused by defective production of ceruloplasmin. Its phenotype is characterized by iron-restricted erythropoiesis and tissue iron overload, diabetes, and progressive retinal and neurological degeneration. Ceruloplasmin is a ferroxidase that plays a critical role in iron homeostasis through the oxidation and mobilization of iron from stores and subsequent incorporation of ferric iron into transferrin (Tf), which becomes available for cellular uptake via the Tf receptor. In addition, ceruloplasmin has antioxidant properties preventing the production of deleterious reactive oxygen species via the Fenton reaction. Some recent findings suggest that aceruloplasminemia phenotypes can be more heterogeneous than previously believed, varying within a wide range. Within this large heterogeneity, microcytosis with or without anemia, low serum iron and high serum ferritin, and diabetes are the early hallmarks of the disease, while neurological manifestations appear 10-20 years later. The usual therapeutic approach is based on iron chelators that are efficacious in reducing systemic iron overload. However, they have demonstrated poor efficacy in counteracting the progression of neurologic manifestations, and also often aggravate anemia, thereby requiring drug discontinuation. Open questions remain regarding the mechanisms leading to neurological manifestation and development of diabetes, and iron chelation therapy (ICT) efficacy. Recent studies in animal models of aceruloplasminemia support the possibility of new therapeutic approaches by parenteral ceruloplasmin administration. In this review we describe the state of the art of aceruloplasminemia with particular attention on the pathogenic mechanisms of the disease and therapeutic approaches, both current and perspective.",
author = "Alberto Piperno and M Alessio",
doi = "10.3389/fnins.2018.00903",
journal = "Frontiers in Neuroscience",
publisher = "Frontiers Media S.A.",
T1 - Aceruloplasminemia: Waiting for an Efficient Therapy
AU - Piperno, Alberto
AU - Alessio, M
N2 - Aceruloplasminemia is an ultra-rare hereditary disorder caused by defective production of ceruloplasmin. Its phenotype is characterized by iron-restricted erythropoiesis and tissue iron overload, diabetes, and progressive retinal and neurological degeneration. Ceruloplasmin is a ferroxidase that plays a critical role in iron homeostasis through the oxidation and mobilization of iron from stores and subsequent incorporation of ferric iron into transferrin (Tf), which becomes available for cellular uptake via the Tf receptor. In addition, ceruloplasmin has antioxidant properties preventing the production of deleterious reactive oxygen species via the Fenton reaction. Some recent findings suggest that aceruloplasminemia phenotypes can be more heterogeneous than previously believed, varying within a wide range. Within this large heterogeneity, microcytosis with or without anemia, low serum iron and high serum ferritin, and diabetes are the early hallmarks of the disease, while neurological manifestations appear 10-20 years later. The usual therapeutic approach is based on iron chelators that are efficacious in reducing systemic iron overload. However, they have demonstrated poor efficacy in counteracting the progression of neurologic manifestations, and also often aggravate anemia, thereby requiring drug discontinuation. Open questions remain regarding the mechanisms leading to neurological manifestation and development of diabetes, and iron chelation therapy (ICT) efficacy. Recent studies in animal models of aceruloplasminemia support the possibility of new therapeutic approaches by parenteral ceruloplasmin administration. In this review we describe the state of the art of aceruloplasminemia with particular attention on the pathogenic mechanisms of the disease and therapeutic approaches, both current and perspective.
AB - Aceruloplasminemia is an ultra-rare hereditary disorder caused by defective production of ceruloplasmin. Its phenotype is characterized by iron-restricted erythropoiesis and tissue iron overload, diabetes, and progressive retinal and neurological degeneration. Ceruloplasmin is a ferroxidase that plays a critical role in iron homeostasis through the oxidation and mobilization of iron from stores and subsequent incorporation of ferric iron into transferrin (Tf), which becomes available for cellular uptake via the Tf receptor. In addition, ceruloplasmin has antioxidant properties preventing the production of deleterious reactive oxygen species via the Fenton reaction. Some recent findings suggest that aceruloplasminemia phenotypes can be more heterogeneous than previously believed, varying within a wide range. Within this large heterogeneity, microcytosis with or without anemia, low serum iron and high serum ferritin, and diabetes are the early hallmarks of the disease, while neurological manifestations appear 10-20 years later. The usual therapeutic approach is based on iron chelators that are efficacious in reducing systemic iron overload. However, they have demonstrated poor efficacy in counteracting the progression of neurologic manifestations, and also often aggravate anemia, thereby requiring drug discontinuation. Open questions remain regarding the mechanisms leading to neurological manifestation and development of diabetes, and iron chelation therapy (ICT) efficacy. Recent studies in animal models of aceruloplasminemia support the possibility of new therapeutic approaches by parenteral ceruloplasmin administration. In this review we describe the state of the art of aceruloplasminemia with particular attention on the pathogenic mechanisms of the disease and therapeutic approaches, both current and perspective.
U2 - 10.3389/fnins.2018.00903
DO - 10.3389/fnins.2018.00903
JO - Frontiers in Neuroscience
JF - Frontiers in Neuroscience
10.3389/fnins.2018.00903
http://www.ncbi.nlm.nih.gov/pubmed/30568573?report=abstract
SAN RAFFAELE MILANO - APPROCCI DI MEDICINA MOLECOLARE NELLA CURA DELLE MALATTIE GENETICHE E DEGENERATIVE
Project: Other project


I have been wanting to come to the Odd Fellows Cafe since it opened. Well this past week I finally had the opportunity to try it out. I went there on a Thursday evening and the cafe was pretty busy. Odd Fellows Cafe has cafeteria-style seating with tables in rows and old wooden benches. The space has very high ceilings and tall windows. The space is great. I love the fact that most of the original architecture. The only bad thing about the high ceilings is that it can get quite noisy in the cafe, but I love the feel of the place. You can definitely get a feel for the history of the building that was built in 1908.
I ordered the half chicken. The chicken was cooked perfectly and it was very juicy. There were only two things I think they could have improved on with this dish. First, they should change the name of the dish to quarter chicken, or start purchasing larger chickens. The portions seemed pretty small for a "half chicken". I was actually still hungry after eating all of the chicken offered and all of the green beans. The second improvement is to add some spice or rub to the chicken. Although the chicken was cooked perfectly, it didn't really have that much flavor. The lemonade I ordered with my dinner was tasty.
This was just my first visit so I will definitely come back to try some of the other dishes on the menu. I love the atmosphere of Odd Fellows and I hope some of the other food items they have to offer match the atmosphere.
Just found Odd Fellows Cafe this week. I really enjoyed our meal, and just wish we lived in the neighborhood so we could casually stop by for a beer in their courtyard this summer!