text:
Powerscourt Gardens, Enniskerry, Ireland
Dunluce Castle via Shutterstock*
Top Castles in Northern Ireland
By Top Travel Spots
December 4, 2014 Updated: December 4, 2014
A sweet escape to the awe-inspiring haven of Ireland wouldn't be completely fulfilling if you don't get to see the top castles to visit in Northern Ireland. The castles in North Ireland were built around 800 years ago as medieval fortresses. But others are just modern homes or mansions which were patterned to the old castles. The greatest castles however were built by Normans who conquered England and Wales, and went to Ireland in 1169 to colonize the island as well. It has been said that "The greatest castles were the work of the ever-ambitious Normans".
One of the most significant Norman-built castles in the entire Ireland is the Carrickfergus Castle. Built in the mid 1170's, Carrickfergus is widely-considered as the most impressive among the castles in Ireland. It is remarkable because it represented the Normans' military strength during the Iron Age. The castle was strategically built in a defensive location, used to be surrounded by the sea, and overlooks Belfast Lough on the east. The castle is marvellously constructed from rough-hewn stone and its structure is exceptional even to contemporary standards. Despite its fearsome look, this castle is not really gigantic to explore. It was besieged several times and was used to be a penitentiary over the centuries. Today, functions to accommodate tourists who enjoy the glimpse of medieval ambience with all the embellished waxworks of the castle.
Carrickfergus Castle via Shutterstock*
Another remarkable castle in North Ireland is Dunluce castle. It was built on basalt crag surrounded by wild waves of the sea. And from afar, it looks as if it peeks from below the sea on the edges of the crag which makes a spectacular sight. To get to the castle you have to cross a bridge from the mainland cafe and coffee shop. It's like the castle is from another era and space or isolated from real world, and it would be almost impossible to intrude from the sea to where it stands. The castle evidently manifests Iron Age strategic stronghold and protection before the times of the Vikings. Today, Dunluce castle remains under the protection of Northern Irish Ministry for the Environment. It is considered to be the most visited among the castles in North Ireland and is open the entire year with an entrance fee that is modestly charged.
Dunseverick Castle is also another noteworthy castle to consider exploring. It has a rich heritage to tell that is why it belongs in the category of top castles in Northern Ireland. Although there's nothing much to see on the castle because its remnants have almost completely vanished, the castle's remaining stone walls create a romantic scenery with flocks of sheep grazing on green grasses overlooking the blue sea down the cliff. Founded well before Normans arrived in Ireland, Dunseverick Castle was the site of the fort during Iron Age. In 500 AD, it was allegedly visited by St. Patrick, it was attacked by Vikings in 900 AD, it was fortified by Normans after they invaded the island, it was held by McCain family in around 1600 who further strengthened the site, and finally destroyed by Cromwellian campaign from England in 1642 when they conquered Ireland. Today, it's a common stopping point for tourists who travel along Causeway Coast of County Antrim and you don't even need formal visiting arrangements nor do you have to pay entrance fees to visit the ruins of the castle.
This article was originally published on www.toptravelspots.org. Read the original here.
*Image of Carrickfergus Castle via Shutterstock
*Image of Dunluce Castle via Shutterstock
Biden to Push Through Executive Orders, Pursue New Legislation in First 10 Days of Office


Asymmetrical styles continue to be trendy this season. They help to create a more edgier and arty vibe to your outfit. Sometimes I just want to wear something funky/arty, and an asymmetrical piece does the trick!
For today's look, I am wearing an asymmetrical halter dress from three floor. What makes this dress so interesting and unique is the various blue metallic shades, with a fish scale-like print, and a use of elastic and nylon lining. This dress is an art piece itself, and I love it! What do you guys think?
Since the dress is the highlight of my look, I paired it with simple accessories such as a black clutch, pearl earrings and silver pointy heels.
Thank you lovely!!! Loving your floral dress recently!
Love this dress. Elegant and edgy!!! Perfect combination!!


You must pay attention to your garage as it is among the most critical areas of your house. Aside from making your house beautiful, it could provide other advantages. An overhead door is among the most typical kinds of garage door that a lot of property owners are using right now. The maintenance of your Tampa, FL overhead garage door is really essential and you cannot ignore this as it will affect the lifespan of the garage door. You must know that Tampa, FL overhead door parts can actually be damaged overtime so you should maintain it consistently. If you'll need some information about Tampa, FL overhead garage door opener, listed here are a couple of things that you must understand about this.
Among the maintenance recommendations that you can always do on your own is to check the noises and other noticeable damage on the garage door. You can usually hear a sound when the overhead door garage door opener in Tampa, FL is opening and closing so it would be very easy for you to stop if there are unusual squeaking noises when you are using it. These noises are not really typical and there's a probability that they are signs of damage so you will need to check them.
damage could be seen on your garage door and this is something that you'll need to check. In case there are some cracks, rust and other damage on the garage door, look for the best overhead door garage door company in Tampa, FL.
Every garage door with an opener is equipped with an automatic reversal system for security reasons. This is a vitally important feature to examine frequently as it may harm your car or hurt your family if it is damaged.
This feature will enable to the door to halt and return to the open position when it picks up a blockage. When the garage door hits something, it will go up automatically due to the automatic reversal system.
If you would like to understand if it is functioning properly, you could put an object on the path of the closing door. When the door hits the object, it will immediately reverse itself.
This is among the things to consider because the moving areas of the garage door are extremely dangerous, particularly the springs. You could always lubricate the moving parts or inspect them visually, but you should never touch them or try to repair them on your own since it would cause more difficulties to you and it might even harm you. If you actually think that you'll need an overhead garage door repair in Tampa, FL, you'll need to look for the best repair professional to assist you. This is a very complicated problem and you will need someone with knowledge and experience to handle it.
Among the most important jobs that you must do to maintain your garage door is to lubricate its moving parts. This is actually super easy and you do not need to touch the parts of your garage door. You simply need a garage door lubricant and apply them to the moving part so they can easily move smoothly. sIt is essential to tighten the bolts of the garage door because when it is being used, the bolts will loosen up as well. It's important to tighten it once in a while because there is a chance that it'll be damaged if you will not tighten up the bolts.
The most practical method to prolong the life of the garage door is to make sure that the surface is protected from dirt and corrosion. You will need to remove the dust from both the inside and outside and you'll need to do this frequently.
You could wipe this down with a mild household detergent in water and rinse the remaining detergent.
If the door is made from metal with an enamel finish, the best thing to do is to apply car wax on the outside to seal out moisture and damaging grime. If you'll be able to keep your garage door clean, you could ensure that it'll not be damaged with ease.
Listed below are some of the few maintenance tips that you could actually do without the assistance of professionals. If you discovered any complications, you can call us instantly so we can deal with your worries for you.


text:
January 03, 2023 Animal Law & Policy Program One Rights: Human and Animal Rights in the Anthropocene
In her new book, former Visiting Scholar Dr. Saskia Stucki provides an in-depth discussion of animal rights as new human rights.
The new year brings us a new open access book by Visiting Scholar Dr. Saskia Stucki, which she wrote during her time with the Animal Law & Policy Program at Harvard Law School. Dr. Stucki is a Senior Research Fellow at the Max Planck Institute for Comparative Public Law and International Law, where she is working on her Habilitation project at the intersection of environmental and animal law. From 2018 to 2022, she was a recurrent Visiting Scholar at the Animal Law & Policy Program, where she worked on her postdoctoral research project Trilogy on a Legal Theory of Animal Rights (funded by the Swiss National Science Foundation).
Animals are the traditional blind spot in human rights theory. This book brings together the seemingly disparate discourses of human and animal rights, and looks at emerging animal rights as new human rights. It approaches the question whether animals can and should have human rights through a comprehensive review of contemporary human rights philosophy, discussing both naturalistic and political justifications of human and animal rights. On philosophical as well as practical grounds, this book argues that there are compelling conceptual, principled, and prudential reasons for modernizing the human rights paradigm and integrating animals into its protective mandate.
Moreover, this book proposes the novel One Rights approach as a new (post-)human rights paradigm for the Anthropocene. One Rights advances a holistic understanding of the indivisibility and interdependence of human and animal rights. This book explores how the systematic subjugation, exploitation, and extermination of animals simultaneously contributes to some of the gravest social and environmental threats to human rights, such as animalistic dehumanization and climate change. This book submits that, in light of their socio-political and ecological interconnectedness, human and animal rights are best protected in concert.
The themes of this book are part of a larger conversation about postanthropocentric legal paradigms emerging in the Anthropocene. For human rights to survive in this era of anthropogenic crises, we need to abandon the toxic ideology of human exceptionalism and embrace a more inclusive version of (post-)human rights that tends to the nonhuman. This book intends to show that a holistic One Rights approach promises to achieve better rights-protective outcomes for humans, animals, and their shared planetary home.

redpajama_set_name: RedPajamaCommonCrawl


Morris J. Danzig was in a conference room Friday going over paperwork on a patent with his attorney, Michael R. McKenna, when his attorney was called out of the room. Within seconds, McKenna was shot and lay dying, and Danzig -- a Word War II veteran -- was at his side to try to stop the bleeding.
And before Danzig knew it, he was being held hostage.
"The shooting was quick. When I went to McKenna's aid, I heard at least three other shots. Very shortly thereafter, (the gunman) was behind me."
"I had a conversation with him -- a long one. He was going to shoot me, and I talked him out of it," Danzig said.
Watson, a labor and employment attorney, said he spent a lot of time this weekend thinking about all the cases he has worked on.
"I just thought a lot about people who I have come into contact with in my 12 years of practicing law, and I thought about anyone who could turn out to be a Mr. Jackson," he said.
On Wednesday [Dec. 13], McKenna, 58, was remembered as a kind and considerate man. Those who knew him said he lived his life well, and because of that, his family asked that his funeral not be a day of mourning.
Instead, they wanted it to be a day of celebration of his life and legacy.
"This day is according to the family's wishes, a day of celebration of a life well-lived by Michael and his friends and his family," said Thomas Kinsella, a friend of McKenna's.
"I know Michael was a very honorable man," Kinsella added. "He was a very intelligent man; very fair. He lived life well and fully."
Kinsella also said McKenna was a moral compass and spiritual companion for many who knew him. In honor of that, and McKenna's life, his church is reaching out to everyone touched by his tragedy, including the family of the gunman.
"We hope that people can just come together and look for some type of solution to keep the senseless violence from happening again to anybody," Kinsella said.
More than 300 people attended the funeral, including McKenna's wounded paralegal, Ruth Zak Leib. About 2,400 mourners attended the wake.
Mayor Richard M. Daley and his wife, Maggie, also attended the service.


Design Circle Architects Sdn. Bhd. offers a wide range of professional service in architecture, Planning and Project Management. Services undertaken by the Company are for new development, the refurbishment and improvement of existing facilities. Design Circle Architects Sdn Bhd is an Architectural Company established in 1995 providing a comprehensive range of architectural services for leading Developers in residential projects mainly high-end and commercial projects. In line with our expansion scheme we look for motivated and dynamic candidates to fill the above positions.


text:
For YouEntertainmentRelationshipLifestyleQuizTechnology
Supreme Court Judgment Ends Magnus Abe's Governorship Dream
Rev Sam.|April. 15, 2019
The senator representing Rivers South East and the factional governorship candidate of the All Progressives Congress (APC), Rivers State chapter, Magnus Abe, has declared that he has ended his 2019 ambition to govern the state.
Abe has also said that his dream to occupy Rivers Brick (Government) House had ended following the recent judgement of the Supreme Court that ruled against his party
The senator said this on Sunday when he addressed supporters and stakeholders of the APC in the state, at APC factional secretariat, in Port Harcourt.
"I have ended my ambition for 2019 here, and ready to work for the progress of the party. We need to put the baton together again. It is our own determination that will make the APC work in Rivers State.
"I will not support any postmortem of what has happened. I feel pained for what has happened in APC in Rivers State", Abe stated.
He recalled: "We have sacrificed so much; we may not be holding anything now. But, because of what we have done, politics will be better in our country.
"We had come to fight for representatives in government. Every human being, as members of APC, should be treated with respect. But, we cannot run away from the reality of the situation. We need to be realistic, so that we can move forward.
"The dream that we had in the state, that dream is laid to rest, because of the pronouncement of the Supreme Court of the Federal Republic of Nigeria on our suit before it.
"As a lawyer, we know that the Supreme Court is infallible. That pronouncement by the Supreme Court brought to an end our agitation. But, God knows the reason. He, who knows what we do not know, made His decision.
"When you hear APC, say change and not Magnus for governor. I don't want to be the leader of APC in Rivers State, but one of the leaders, who will sacrifice for the growth of the party in the state", he stressed.
Speaking further, Abe called on the national leadership of APC to stop taking steps that would ruin the party in state.
"The national leadership of APC should stop doing things that will put the party and state in chaos and recognise the Chief Peter Odike-led APC in Rivers State", he urged.
Earlier, the state party chairman, Odike, said the negative development in the party in Rivers affected the country.
He expressed optimism the development would strengthen the party in future.
Jumia becomes first African start-up to list on NYSEWhy is Minnesota covered in brown snow?Emmy award-winning Fil-Am actor was in Manila to espouse waste management advocacyWhite House on lockdown after man 'sets himself on fire' outsideCCT Trial: Onnoghen Maintains Innocence As FG Demands Conviction


text:
Der Kanton Le Grand-Quevilly ist ein französischer Wahlkreis im Arrondissement Rouen im Département Seine-Maritime in der Region Normandie; sein Hauptort ist Le Grand-Quevilly. Vertreter im Generalrat des Départements war von 1982 bis 2008 Pierre Giovannelli (PS). Ihm folgte Nicolas Rouly (ebenfalls PS) nach.

Gemeinden
Der Kanton besteht aus zwei Gemeinden mit insgesamt  Einwohnern (Stand: ) auf einer Gesamtfläche von  km²:

Bis zur Neuordnung bestand der Kanton Le Grand-Quevilly aus einem Teil der Gemeinde Le Grand-Quevilly.

Bevölkerungsentwicklung

Legrandquevilly

redpajama_set_name: RedPajamaWikipedia


all this happiness: Two Prints.
After I hid this skirt, I thought about it almost every day before I went back and got it. I have the hardest time finding 50s-ish era skirts that are just the right waist size, and the pattern! Then I saw Sally Jane Vintage's post, with her gorgeous peacock skirt and simple white tank, and my need for the butterfly skirt became intensified. Normally I feel sort of strange copying other blogger's outfits--I know we're all about inspiration and influence, but occasionally I worry about outfit copyrights! Thankfully, SJV, along with everyone else I've run into out in the blog world, is quite lovely and my worries are surely unnecessary.
I ought to have taken a detail shot of this dress-it has matching cloth-covered buttons and a little peter pan collar! It's the one I grabbed instead of the skirt (at first). I wasn't sure about it when I saw it. It's not the kind of print I normally gravitate towards, which is appealing for its difference, but the cut was a bit more youthful than some of the vintage dresses I find so I couldn't leave it behind. It's sort of autumnal, but it's been cool enough lately that I wore it a few days ago and almost (almost, not quite) wished for fall. I envision wearing it with navy cardigans and tights and brown boots. Maybe a hat, for good measure.
The electric blue belt is my new belt-friend. I must prevent myself from wearing it with everything I own (except PJs).
I love your butterfly skirt. I don't know how you're able to wear the plain white tank and have it look finished! Whenever I try this, I feel like I'm out in my underwear somehow. Your photos, as usual, are lovely.
nice vintage skirt find. it has such a pretty print. i liked that you paired it with a simple white tank. i like the way you wear your hair here. i'd love to get a better look at the outfit your wearing in the latter shot.
both outfits are beautiful. i think that first look is gonna go viral, because now i want to try it out, too!
Love the skirt!! Great outfit!!!!
love both outfits are great!
That belt is such a great color. Love it.
Oh I remember that outfit from SJV, I really loved it! And like everyone else I think I wanna try it too. Hah.
Borgeous picture of the butterfly skirt against the green door. That brown dress looks pretty with the turquoise belt too!
Such pretty and fresh looks.
Love the contrast of the blue belt against the printed dress.
I know what you mean about copying other bloggers. But if credit is given where it is due-why not. So many inspiring ladies out there.
You're one of them ;) I hope we get to see that cute dress in more detailed shots in the future!
B from A plus B"
50's era skirts are always soooooooooo tiny in the waist! and the dresses are so big in the bust!
both of these looks are just perfect for summer! you look so pretty as always.
i love everything about that first outfit. so gorgeous!
Ohmygosh, I love the way you dress. Totally adorable!
I love your skirt. You are so gorgeous! Both of these looks are so pretty on you.
Very cool butterfly skirt. It's a wonderful summer look.
Very beautiful. I love that skirt. Great print and length. It looks perfect.
Ooo, I love that skirt! And the colours in the dress too. Your hair is just so pretty. How do you style it?
love all your outfits. i'd wear that blue belt to death too.
I love that skirt! Best print ever. And I'm loving the dress with that bright belt.
wow, sally janes skirt certainly is amazing - love how you both decided to let the skirt commander the outfit, its so striking with the plain white tank. a perfect summer look!
i totally love both! but the skirt is amazing.


On the way home from swimming, I've been frequenting the greengrocer's section at an independent supermarket not far from the city: the Ainslie IGA, which has long been in the Xyrakis family. I have known current owners, Irene and her older brother, Manuel, since the 1960s, when we went to school together.
In my humble opinion, the Ainslie IGA is the best supermarket in Canberra. The produce sold in this bustling supermarket is of exceptional freshness and quality. My favourites include the tasty heirloom tomatoes; Lebanese cucumbers, which are so crisp and fresh they still have the flowers attached; plump oak leaf lettuces; and avocados and stone fruits galore. It's all so good, I cannot help but fill my basket.
For lunches and evening meals, I've been shaking the fridge, creating a range of interesting salads, including this one, which showcases the sweet white-fleshed Australian peaches that are in abundance right now. Simple to prepare, fresh and full of flavour, this salad sits beautifully with smoked trout, and is also the perfect partner to lamb cutlets or little pork chipolatas.
Wash the peaches and pat them dry. Slice them in half and remove and discard the stones. Heat a ribbed grill pan and flash-grill the peaches, cut side down. Remove them from the pan and set aside.
Meanwhile, arrange the lettuce and baby spinach leaves on a serving platter and finish with the slices of grilled peach, cucumber and avocado. Dress with the pomegranate arils, a scattering of pepper, a sprinkle of chilli oil and lime juice, and finish with a wedge of lime. Serves 2.
* The pomegranates available in Australia now have been imported from the USA. Once I have removed the arils from the pith of the pomegranate, I store them in an airtight container in the refrigerator. They are a summertime favourite.
It's your turn now dear readers, tell me, do you ever shake the fridge to create a meal? And do you love pomegranate as much as I do?
I'm in love with the summer produce nowadays. My favourite salad is fresh figs, goats cheese or feta with salad leaves and a light dressing.
Beautiful photo, Liz, the freshness just jumps off the plate!
Judy, thanks so very much... I am so glad that the freshness is visible, because the produce from this particular greengrocer is just amazing.
There's nothing like a crisp fresh salad using the great summer produce around at the moment, is there Liz?!
Well, that beautiful photo has lowered my body temperature a good 5 degrees, I am certain. No air-conditioning here, nowhere to swim within 40 kms and temperature at 38C and rising fast well before noon . . . methinks am off to the fridge and try copy your offering for lunch . . . Oh, don't know about the 'Berra, but three more such days 'promised' for this week here . . .
Most nights I make salad with what is still fresh and chips. But not with some fruits as neither of us are a fan of that combination. We do add pomegranate arils when in season or orange wedges in winter. So good you have a local grocer.
Oddly, it was a salad as beautiful as this one that was featured in my first reading of Bizzy Lizzy's Good Things! It had shrimp, by the visual was so amazing, I had to make it - and then become friends with you! I look forward to trying this soon, when peaches come into season here.
I can't wait for summer to come and to make your salad with fresh peaches - how delicious!
We've been eating a lot more soups than salads lately, but that will change in another month or two. Then you'll be making loads of soup. :-) Good recipe -- thanks.
JT always says that I can make a meal out of seemingly nothing! Shaking up the fridge is a regular occurrence on this side of the pond, I really hate tossing veggies that are past their prime.
ooh that looks lovely Liz. salad is the go in this heat.
It sounds like you have a wonderful market for those fresh salad ingredients. This one certainly sounds good.
WOW... wish when I shook my fridge all my favourite things magically appeared. A beautiful salad lovely. Will be making this bad boy for sure asap. Yummy!


text:
package com.vapourdrive.attaineddrops.blocks;

import net.minecraft.block.Block;
import net.minecraft.init.Blocks;
import net.minecraft.init.Items;
import net.minecraft.item.ItemStack;
import cpw.mods.fml.common.registry.GameRegistry;

public class AD_Blocks
{
	public static Block BlockMobDirt;
	public static Block BlockMobPlant;
	public static Block BlockMobBulb;
	public static Block BlockConcentrateDrop;
//	public static Block BlockXPBall;
//	public static Block BlockXPObelisk;
//	public static Block BlockXPObsidian;

	public static void init()
	{
		BlockMobDirt = new BlockMobDirt();
		BlockMobPlant = new BlockMobPlant();
		BlockMobBulb = new BlockMobBulb();
		BlockConcentrateDrop = new BlockVitalizedSoil();
//		BlockXPBall = new BlockXPBall();
//		BlockXPObelisk = new BlockXPObelisk();
//		BlockXPObsidian = new BlockXPObsidian();

		GameRegistry.registerBlock(BlockMobDirt, ItemMobDirt.class, BlockInfo.BlockMobDirtName);
		GameRegistry.registerBlock(BlockMobPlant, BlockInfo.BlockMobPlantName);
		GameRegistry.registerBlock(BlockMobBulb, ItemBulb.class, BlockInfo.BlockMobBulbName);
		GameRegistry.registerBlock(BlockConcentrateDrop, ItemVitalizedSoil.class, BlockInfo.BlockConcentrateDropName);
//		GameRegistry.registerBlock(BlockXPBall, ItemXPBall.class, BlockInfo.BlockXPBallName);
//		GameRegistry.registerBlock(BlockXPObelisk, ItemXPObelisk.class, BlockInfo.BlockXPObeliskName);
//		GameRegistry.registerBlock(BlockXPObsidian, ItemXPObsidian.class, BlockInfo.BlockXPObsidianName);
	}

	public static void registerRecipes()
	{
		GameRegistry.addShapelessRecipe(new ItemStack(BlockConcentrateDrop, 1, 0), new Object[]
		{ Items.wheat_seeds, new ItemStack(Items.dye, 0, 15), new ItemStack(Items.water_bucket, 2), Blocks.dirt });

	}

}

redpajama_set_name: RedPajamaGithub


Have you ever met someone you just couldn't put out our mind afterward? What did you do about it?
For me, that someone was a kitten.
When I attended the BlogPaws pet social media conference in May, I was fortunate to room with not just my friend Jeanne, who writes Random Felines. That meant I also roomed with three adorable foster kittens she was fostering for the Colony Cats rescue organization: Dior, Gucci, and Armani.
At first, the kittens thought I was a scary stranger. During the course of the stay, their opinion of me changed. This probably had something to do with the fact I brought them a cupcake and let them play the mouse chase game on my iPad.
It was like being a cool aunt, letting them do things like chase my feet under the covers even though I knew that would probably not be allowed in their future homes.
The next-to-last night of the trip, all three kittens chose to sleep in the bed with me instead of with their foster Mom. That was just adorable. I was sorry that they were awake before dawn, running through the room like hooligans before it was light enough to take any photos of them all cuddled up to me.
The final night of the trip, Armani and Gucci slept somewhere else, but little Dior slept right next to me the whole night. When I woke from a terrible nightmare at 4 am, Dior was there, meeping at me. How could anyone's heart not melt when that happened?
They aren't yours, I reminded myself. You have three cats at home. There are adopters in Ohio who have waited all winter for kittens. Still, I tried not to embarrass myself by crying when I left them behind and drove home.
The thought wouldn't leave my head. Dior picked me, and I should make this work out, somehow. I looked for photos of her on Random Felines blog and social media, noticing how the color of her eyes was changing like I was some kind of a kitten stalker. She was still in foster, but not for much longer. You can hold out, I told myself.
The it even seemed like the kitten herself was telling me to stop all the looking when I saw this photo.
I checked airfare to Ohio, and then I reminded myself, There are lots of kittens in Florida.
Back and forth I went inside my head, knowing that my adoration of this particular kitten was impractical. I decided it was best to keep quiet until she was adopted. Then, if I heard her adoption didn't work out for some reason, that would be my sign. I would speak up and say I wanted to adopt her then.
Then one evening, I was chatting online to my friend Connie from Tails from the Foster Kittens, and I admitted I had been thinking about Dior.
Holy cat, it looked like this could really happen!
Dior was old enough to be adopted, but she wasn't spayed yet, so that had to be done by the rescue before she could travel and be adopted.
After her spay surgery, the veterinarian's office notified the rescue that she needed additional surgery for a hernia. That surgery was scheduled for the day before she was scheduled to travel to Florida.
Each time she had surgery, I would wait to hear news, not wanting to be a pest, but hoping she was all right.
The day came at last. I drove to the airport and found Jeanne already waiting with a Sleepypod Air on the curb. The carrier was complaining loudly. I could hear little kitten meows on the short drive from the airport home.
Newton is the first cat to greet visitors, and he was interested in the contents of the cat carrier.
But he gave me some space to open it so I could finally see our new family member who had traveled a very long way to be reuinted with me.
As part of joining our family, she is also getting a new name. Everyone, meet Cupcake.
She has lots of adventures to share with you very soon!
Cupcake joining our family would have been possible without Colony Cats allowing an out-of-state adoption, and Jeanne from Random Felines went the extra mile — literally — to get Cupcake here. A big thank you from all of us!
Also, I never would have made the decision to say anything about wanting to adopt Cupcake if Connie wasn't such an kitten enabler. So a big thanks to her, too.


text:
Tim Creason | For The Journal Gazette
Erin Strzelecki, right, of Bishop Dwenger finished second in the state cross country meet a year ago, helping the Saints to a sixth-place finish. Carroll won the team title, the first time an area school won the meet since Concordia in 1983.
5 To Watch: Girls Cross Country season preview
They finally did it. After knocking on the door, finishing as runners-up for three seasons, the Carroll girls claimed their first state cross country title last fall. It was just the second time a Fort Wayne-area team had won (Concordia was the first, winning the third state title meet in 1983). Will the path to a state championship run through Fort Wayne again this season?
Erin Strzelecki, Bishop Dwenger: Strzelecki finished second at last year's state meet, less that 7 seconds behind state champion Emma Wilson of Greencastle. She followed that up with a third-place finish in the 3,200-meter run at the state track meet this spring. This could be her year.
Monroe Rayna Fruchey, Carroll: After finishing 11th at semistate, Fruchey had a huge race at the state meet, hanging with Meagan Hathaway the entire way to finish sixth overall.
Sydney Lambert, Norwell: Now a senior, Lambert has qualified for the state meet as an individual in each of her first three seasons, finishing as high as 31st in her sophomore year.
Sarah Busch, Bishop Luers: Now a junior, Busch ran a 19:11.1 at the 2018 New Haven semistate to finish 17th and move on as an individual. She bettered that mark by 2 seconds at the state meet to finish 29th overall.
Wini Barnett, Warsaw: Just a freshman in 2018, Barnett also made a big leap between her semistate performance and the state meet. She ran 43 seconds faster at the state meet to finish at 19:13.4 and in 35th place overall.
Carroll: The Chargers lost Hathaway and Abigail Green but are hardly depleted. In addition to Fruchey, Carroll still has Mallory Clements, who finished 40th at the state meet. Zoe Duffus, who was Carroll's sixth runner at the state meet, qualified for the state track meet in the 1,600 this spring.
Bishop Dwenger: All seven of the Saints' runners from their sixth-place finish at the state meet are back, including the front-runner for the individual state title. Sophomore Kaitlyn Wood took 27th place at last year's state meet.
Homestead: The Spartans have reached seven straight state meets as a team and are well-positioned to make it eight. Julia Dvorak, who took third place in the 800 at the state track meet, was Homestead's top runner at the state meet last year, placing 56th. Six of the Spartans' seven runners from last season are back.
Warsaw: Barnett will likely be a key member of the team for years to come, but three other members of the team who finished in the top 10 at the sectional meet (Adree Beckham, Ava Knight and Amslie Howett) should all be back for more.
Norwell: The Knights won the Bellmont sectional last season and return all seven of their runners from a 10th-place finish at the New Haven semistate.
Carroll vs. Bishop Dwenger: Both teams will likely be among the best of the state, and they will battling back and forth the whole way. The Chargers won each postseason meet in 2018, starting with the Northrop sectional, but the Saints will be stronger than ever this season.
Chargers dominance: If Bishop Dwenger or any other team knocks them off the top of the podium, it would end a sectional streak that dates to 2000 or a regional streak that started in 2001.
Multithreat: Will Addy Wiley of Huntington North make a mark on the cross country stage? She won the 1,600-meter state title as a freshman, but the three-sport athlete played soccer in the fall of her freshman year. She has expressed interest in competing in both soccer and cross country this fall.
Strong run: If Strzelecki or another local runner claims the individual state title, she'll be carrying on a strong local tradition. Runners from Northeast Indiana have won eight individual titles, including Harding's Krystal Walker, who won the first in 1981.
Stacked semistate: Four of the top 10 preseason teams (Carroll, Bishop Dwenger, Fishers and Homestead) are all in the New Haven semistate, and three of those are all in the West Noble regional. Whoever advances out of that regional will be well prepared for the state meet.
vjacobsen@jg.net


text:
Coasting with Culture
Coasting with Culture Guides
Travel Vlogs
Cultural Connections
Just the Coasters
Park Updates
Written Travel Logs
Coasting with Culture Guide: Adventuredome
The Adventuredome is an indoor amusement park that gives family-friendly entertainment in the heart of Las Vegas at the Circus Circus Hotel and Casino. It's indoor setting also means that the hot weather of the Nevada desert will never be a factor in your enjoyment of the park.
Being located in the heart of Las Vegas means there's A LOT of things to see and do. While it would be difficult to share everything there is to do, this is a list of some favorites of Coasting with Culture and friends of the page as well.
Las Vegas, Nevada, United States
https://www.circuscircus.com/the-adventuredome
Closest Airport:
McCarran International Airport (7 mi.)
Can't Miss at Adventuredome:
> Canyon Blaster - An Arrow Dynamics looping coaster is built into a rock wall, offering a thrilling ride though the double-loops and double-corkscrew, then racing into the rock wall caves.
> Circus Acts - Technically not in Adventuredome, but is offered by the Circus Circus Hotel and Casino, these acts are inspired by the acrobats and side shows of the circus, and is free for all visitors of the hotel in the Midway area.
> El Loco - Possibly Nevada's best roller coaster, El Loco comes from S&S and offers one of the wildest rides, filled with airtime, hang-time, and directional changes that may lead to forgetting which way is up.
Inside the Penn & Teller Theater
> 18b (Las Vegas, 3 mi.) - A vibrant indie arts district near Downtown featuring bohemian bars and indenpendent galleries in converted warehouses, plus a sprawling art square featuring the Cockroach Theatre presenting plays and offbeat revivals.
> Cirque du Soleil (Various Las Vegas Locations) - One of the most popular series of acrobatic shows where performers contort, flip and fly through the air with incredible production quality. There are various versions of this show at several different hotels on the Strip, such as the Michael Jackson Inspired "One" at Mandalay Bay, or the warrior inspired "KÀ" at the MGM Grand.
> Penn & Teller (Las Vegas, 2 mi.) - A personal favorite show, featuring the duo that combines their style of comedy with various illusions that will combine laughs and a feeling of wonder as you ask "How did they do that?"
> Great Vegas Festival of Beer (Las Vegas, ?? mi.) - Held at the Las Vegas Events Center in Downtown, this annual event features several hundred brews from around 100 different breweries, along with a variety of eats from local chefs to enjoy along with the beverages.
> iHeart Radio Music Festival (Las Vegas, 3 mi.) - An annual music festival held at T-Mobile arena, featuring some of the biggest names in music from various genres including hip hop, rock, country and pop.
Pizza Rock in Downtown Las Vegas
> Cravings (Las Vegas, 2 mi.) - Located inside of the Mirage Hotel, this is an excellent buffet, whether in the morning for their breakfast selection, or enjoy the 11 international cooking stations to enjoy a variety of tastes from around the world during lunch and dinner.
> Guy Fieri's Vegas Kitchen & Bar (Las Vegas, 2 mi.) - Located right off of the famous Vegas Strip, This restaurant offers twists on American favorites by the host of Drive-In, Diners and Dives.
> Pizza Rock (Las Vegas, 4 mi.) - An excellent pizza spot in Downtown Las Vegas that offers American and Italian styles created by 13-time World Pizza Champion Tony Gemignani, combined with a nightlife energy that is synonymous with Sin City.
Inside the Mob Museum
Landmarks & History
> Golden Gate Casino (Las Vegas, 3 mi.) - The casino that started it all. In 1906, this was the first casino to open in Las Vegas, which has now become one of the most popular cities for gaming in the world since.
> Hoover Dam (Willow Beach, 38 mi.) - One of the most ambitious projects of it's time, the Hoover Dam is considered one of the 10 greatest achievements in construction, and is responsible for providing electricity for Nevada, Arizona and California. It also created the scenic Lake Mead.
> Mob Museum (Las Vegas, 4 mi.) - Learn about some of the most dangerous criminals in history and their roles in organized crime through interactive displays with artifacts, and learn about their connections to Las Vegas, as well as their portrayal in popular culture through film and television.
> Neon Museum (Las Vegas, 4 mi.) - Home to a collection of former hotel and casino signs that once helped light up Sin City of the past.
> Lake Mead (Boulder City, 32 mi.) - Created as a result of the Hoover Dam, Lake Mead has become a popular boating location near Las Vegas, and the surrounding land offers some incredible sights of the desert landscape. One of the more unique hiking experiences can be enjoyed on the Lake Mead Historic Railroad Trail, which you can read more about here on Miles to Memories.
> Mt. Charleston (Mt. Charleston, 41 mi.) - Need a break from the Las Vegas heat? in the summertime, the higher elevation can help provide cooler temperatures to enjoy some great hiking, and gives the opportunity to hit the slopes for some skiing in the winter months.
> Red Rock Canyon (Las Vegas, 23 mi.) - A place to see towering red sandstone peaks and the Keystone Thrust Fault while enjoying a 13-mile driving trail with many incredible panoramic views.
> Valley of Fire (Overton, 51 mi.) - A 46,000-acre preserve filled with red sandstone formations, including the Aztec Sandstone, that were created from shifting sand dunes millions of years ago.
> Las Vegas Ballpark (Las Vegas, 11 mi.) - A new state-of-the-art baseball facility that serves as the home of the Las Vegas Aviators of the Pacific Coast League, the Triple-A affiliate of the Oakland Athletics. To help the fans keep cool in the Nevada heat, the park offers a pool in center field, and the ballpark is the first stadium to offer the fans seats made with breathable mesh rather than the usual plastic or metal seats. The stadium also has the largest video board in minor league baseball.
> Las Vegas Motor Speedway (Las Vegas, 16 mi.) - A place for speed in the Mojave desert, featuring various forms of auto racing from the four-lane dragstrip that hosts NHRA events, the 3/8-mile bullring for local and regional touring race divisions, or the premire 1.5-mile oval that hosts NASCAR, Red Bull Air Races, and other events.
> T-Mobile Arena (Las Vegas, 3 mi.) - A state of the art facility that hosts not only the previously mentions iHeart Radio Festival, but is home to the NHL's Vegas Golden Knights (their games include one of the most incredible pre-game shows of any team in the league!), and a frequent host of Ultimate Fighting Championship Pay-Per-View events.
Theme Park-esque Attractions
> Cowabunga Bay (Henderson, 12 mi.) - A place to cool off from the desert heat with several watersides, including the unique Point Panic slide with it's dark and blacklight segments, or challenge your friends to a race on the Surfin' USA multi-dip mat slide.
> HeadzUp (Las Vegas, 3 mi.) - A combination of unique experiences from archery tag and escape rooms, to the unique 3-D Art Museum featuring the work of local Vegas artists.
> High Roller (Las Vegas, 3 mi.) - Get one of the best views in Vegas by boarding a gondolas on one of the world's tallest Ferris wheels, standing at 550 feet tall. Get a different view of the neighboring hotels, especially at night when the city truly comes to life.
> The Strat (Las Vegas, 2 mi.) - Formerly known as the Stratosphere, this incredibly tall observation tower stands at 1,149 feet tall, and offers the added thrill of some unique rides that will push one's fear of heights to the limit as you find yourself over the edge on Insanity and X-Scream, or fly even higher on the launching tower ride, Big Shot.
Additional Coaster Credit Stops Within 100 Driving Miles:
> New York, New York Hotel & Casino (Las Vegas, 4 mi.) - Big Apple Coaster
> Las Vegas Mini Gran Prix (Las Vegas, 9 mi.) - Dragon Coaster
Thank you to the guest contributors for this Coasting with Culture Guide:
> RD Sussman-Dewberry, Park Journey
> Shawn Coomer, Miles to Memories & Disney Hacks
Click here for more Coasting with Culture Guides
The content of this website may not be rewritten, republished, or redistributed without prior consent.
To contact, please email coastingwithculture@gmail.com


If you've interminably desired so as to facilitate enjoy a clairvoyant creature, you may operate good fortune thanks to a incongruous ad selling a spiritualist cat just about the Russian equivalent of Craigslist. The malformed manual appeared exceeding the weekend more or less the website Avito plus initially, later than the approachable tag of 'selling a British cat', did not .
Lynn is one of the utmost "real" refinement I convey ever met also owns her earthlyness and as a result preserve measurement you sufficiently unaided worldly journey. I'll be afraid of beast cherubic subsequently I am dead, for the meantime I nonexistence with the purpose of sop up how with the intention of get the most out of my human experience.
Stevie Nicks' additionally Jennifer Lopez's Psychic Medium Reveals the .
The spiritualist means has perin place ofmed spiritual readings nearly the world — on hotels, theaters, homes, in addition regular on a cruise ship — for immeasurable culture as well as Stevie Nicks, Jennifer Lopez .
Syd Saeed | Best Psychic Directory. Reviews Of Psychics .
Hollywood Psychic Medium Syd Saeed is csomethsomething likeg likesidered select one of the top player 20 Spiritual Advisers in culture today.(over 400 authentic reviews from corner to corner the board) Syd is honored return listed on Best Psychic Directory.
Psychic link following the purpose of crefident sophistication, why? – Psychic .
A psychic means with the aim ofld me I am on a pathway of angelic enlightenment besides my psychic power i am trying to look as if it lacking furthermbye comprehend below control. Besides this connection with her, I bring into being black outs in place of abandoned a only some seconds seeing people I understand in the past don't twig and places I bring about been or certainly not been to.
The self-righteous of this site is the best, (as a Psychic), I allow forever found. Derek H Your insights support totally helped me with the intention of gain the eloquence frequent I was looking for.
If I am second-sighted, I would wise say I am submissively so. I am in addition inclined that say you will folk GENUINE psychic ability may act than earthly apparition stories brute true. The solar bulk of vision stories I say yes are somewhat genuinely single out apart, albeit represent are a little that grow categorically intoxicating to do so.
And I am roughly so as to manage to pay for you the overwhelm counsel that I can. Receive answers to your questions also insights into those you haven't reliable asked, using my staged seer abilities through, Palm~Psychic~Crystal early the Tarot, I behest allow you with a all-embracing intuitive construal. the most incisive reading you'll yet experience.
The Best Auto-Reply Email I've Ever Seen Using it could accommodation your life. Seriously. Today I sent an email to a active lawyer I know. In response, I got not isolated the overwhelm auto-reply I've .
Highnessmamafibi | Am the whisk assault caster what's more perceptive .
Am the combine molest caster moreover mystic healer ever…. Highness mama fibi the top player spells caster and diviner healer The voodoo game is capable signify the animation of a precise person.
If you are diviner intuitive, you are considered necessary on the subject of this globe now very than ever. Empathetic, yearning evolution can help us heal as a aggregate additionally call for a new, more loving, world. Being terribly touching and ambienceing is not a curse; it is a top power individual can help others feel less single-handedly together with understood.


text:
Screening strategies for adults with type 2 diabetes mellitus: a systematic review protocol
Helen Mearns ORCID: orcid.org/0000-0002-7971-12561,2,
Paul Kuodi Otiku1,2,
Mary Shelton3,
Tamara Kredo4,5,
Benjamin M. Kagina1,2 &
Bey-Marrié Schmidt4
There is limited evidence on whether screening for type 2 diabetes mellitus affects health outcomes. A recent systematic review of randomised clinical trials found only one trial that met their inclusion criteria; therefore, current guidelines for screening interventions for type 2 diabetes mellitus are based on expert opinions and best practice rather than synthesised evidence. This systematic review seeks to collate evidence from non-randomised studies to investigate the effect of screening for adults with type 2 diabetes on outcomes including diabetes-related morbidity, mortality (all-cause and diabetes-related) and harms.
This systematic review will follow Effective Practice and Organisation of Care (EPOC) guidelines for the synthesis of non-randomised studies. We will search PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Academic Search Premier and Health Source Nursing Academic (from inception onwards). We will include non-randomised trials, controlled before-after studies, interrupted time-series studies, repeated measures studies and concurrently controlled prospective cohort studies. The primary outcome will be diabetes-related morbidity (microvascular complications of diabetic retinopathy, nephropathy or neuropathy or macrovascular complications of non-fatal myocardial infarction, peripheral arterial disease or non-fatal stroke). The secondary outcomes will be mortality (all-cause and diabetes-related) and harms of screening strategies to patients (including psychological harms or adverse events following treatments) or to health care system (including resource allocation for false-positives or overdiagnosis). Two reviewers will independently screen all citations and full-text articles. Data will be abstracted by one reviewer and checked by a second. The risk of bias of individual studies will be appraised using the ROBINS-I tool. GRADE will be used to determine the quality of the scientific evidence. If feasible, we will conduct random effects meta-analysis where appropriate. If necessary, analyses will be conducted to explore the potential sources of heterogeneity (e.g. age, sex, socio-economic status, rural versus urban or low-middle income versus high-income country). We will disseminate the findings via publications and through relevant networks.
The protocol outlines the methods for systematically reviewing and synthesising evidence of screening strategies for type 2 diabetes mellitus and their effect on health outcomes associated with the disease. The potential impact of this systematic review is improved evidence-informed decision-making for policies and practice for screening of type-2 diabetes.
Description of the condition
Diabetes mellitus is a disease of increasing global concern. The global prevalence of diabetes was approximately 425 million people in 2017, approximately 8.5% of the adult population, and is expected to double by 2045 [1]. In high-income countries, type 2 diabetes mellitus accounts for approximately 90% of diabetes cases; there is insufficient data to estimate the ratio of type 2 diabetes mellitus in low- and middle- income countries, but it is assumed to be similar [1, 2]. Clinical diabetes is diagnosed through the detection of elevated levels of glucose in the blood (hyperglycemia) [3]; however, it is estimated that half of the people who have diabetes are not diagnosed [1].
In addition to those individuals who have clinical diabetes, another 352 million, approximately 7.3% of the adult population, have intermediate blood glucose levels that are considered in between normal and clinically diagnosed diabetes [1, 3]. These intermediate blood glucose levels perform as a risk score, where increasing values are associated with an increasing likelihood of progression to diabetes, cardiovascular disease and all-cause mortality [2, 4]. Patients who present with intermediate levels of blood glucose are described using a number of terminologies including mild glucose intolerance, non-diabetic hyperglycaemia and prediabetes. The terminology promoted by the World Health Organization (WHO) is impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and intermediate hyperglycaemia [3, 5]. The term prediabetes is gaining in popularity even though the WHO has warned its use may lead to disease stigma and detract from the significant cardiovascular risk of this population [5]. About a third of people with IGT and IFG are young, aged between 20–39 years, meaning they will spend many years at risk of developing diabetes [1]. Other risk factors, apart from intermediate glucose levels, for the development of diabetes are increasing age of more than 45 years and obesity [2].
Type 2 diabetes mellitus arises due to defective insulin activity in body tissues, defective insulin secretion from pancreas or a combination of the two [2]. Type 2 diabetes mellitus usually occurs in older adults, but with a change in lifestyle factors, such as inactivity and obesity, the condition is increasingly being detected in children, adolescents and young adults [1, 2]. Current management of type 2 diabetes mellitus involves lifestyle modification: increasing physical activity, improving diet, reaching a healthy body weight and stopping smoking, all monitored by regular screening [2]. If lifestyle modification does not result in sufficiently decreased blood glucose levels, medication may be prescribed, of which there are a range of treatment options available [2]. The complication with type 2 diabetes mellitus is the long latency period, often lasting several years, during which time the individual is often asymptomatic and unaware of their condition [1, 2]. This prolonged asymptomatic state results in long-term damage to the body's organs that leads to negative health outcomes including pregnancy complications, oral health problems, disabilities such as blindness, reduced wound healing, foot disease that may require amputation, stroke, heart and kidney disease and death [1,2,3].
Description of the intervention
There are many types of screening interventions and strategies that may be used to detect disease in a population often classified as mass, opportunistic and targeted strategies—as presented in Table 1 [2, 6]. This systematic review will use these classifications, but if additional strategies are noted, these too will be included.
Table 1 Screening strategies applied to detect diabetes
The biochemical tests commonly used are fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) and detection of glycated haemoglobin A1C (HbA1c) although there are also urine glucose tests available or random blood glucose tests [2, 6]. In addition, there are a number of risk scores [7, 8], including the Finnish Diabetes Risk Score (FINDRISC) [9] and the American Diabetes Association's risk test [10]; however, these are not commonly used as stand-alone screening tools. Classification of patients post testing can be termed as in the normal range or as having diabetes, impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) (as presented in Table 2) [1, 3].
Table 2 WHO recommended ranges used to classify patients according to blood glucose levels [3]
How the intervention might work
The theory behind screening for type 2 diabetes mellitus is to identify either disease or associated risk factors to initiate preventative measures that can halt, slow or improve the course of disease [11]. Therefore, the earlier the disease is detected, especially where there is high risk of disease, theoretically, the better the expected outcomes. The logic model in Fig. 1 describes a complex system in which the intervention interacts with participants, context, implementation and how these affect the outcomes and the impact of this research [12].
Logic model describing the interactions between screening for diabetes, implementation, context, participants, outcomes and impact
Why it is important to do this review
Guidelines for screening interventions for type 2 diabetes mellitus, such as those released by the UK National Screening Committee [13], the American Diabetes Association [2] or the Society for Endocrinology, Metabolism and Diabetes of South Africa [14], are based on expert opinion and local practice rather than synthesised evidence. This is because there is limited information to provide evidence about best practice for screening interventions for type 2 diabetes mellitus and even less evidence in low- and middle-income countries [15]. A recently published Cochrane review assessed the effects of any type of screening compared with no screening for type 2 diabetes [16] and found only one trial, the ADDITION-Cambridge trial [17], that met their inclusion criteria. The ADDITION-Cambridge trial consisted of 20,184 participants aged 40–69 years from general practices in England who were at risk for diabetes but had no known diabetes. These participants were randomised to screening versus no screening arms, and followed up for a median of 9.6 years (November 2001 to November 2011). The review found moderate certainty evidence that screening for diabetes probably makes little or no difference to all-cause mortality and low certainty evidence that it may make little or no difference to diabetes-related mortality. However, because the review only included one trial, firm conclusions about early diabetes screening on health outcomes cannot be drawn. In consultation with the authors of the unpublished Cochrane review and considering the public health importance of screening and the potential impact on large populations, we propose to assess evidence from non-randomised intervention study designs. The questions for the systematic review will include the following: Does screening for type 2 diabetes mellitus reduce morbidity and/or mortality? Does a particular screening strategy result in a greater reduction of morbidity and/or mortality as compared to another screening strategy? Does screening for type 2 diabetes mellitus result in harms to participants or the health system?
Primary objective
To assess the effectiveness of targeted, opportunistic or mass screening for type 2 diabetes mellitus on reduction of diabetes-associated morbidity in adults
To assess the effectiveness of targeted, opportunistic or mass screening for type 2 diabetes mellitus on reduction of mortality (all cause as well as diabetes-associated) in adults
To assess the harms of targeted, opportunistic or mass screening for type 2 diabetes mellitus in adults
The present protocol has been registered within the PROSPERO database (CRD42020147439). This manuscript is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement [18] (see checklist in Additional file 1).
Study and source eligibility
As existing reviews have found limited randomised evidence addressing this question [15, 19, 20], we will focus on non-randomised intervention studies (NRIS). We will employ the Cochrane EPOC criteria [21], and NRIS of interest will include non-randomised trials, controlled before-after studies, interrupted time-series study, repeated measures study and concurrently controlled prospective cohort study. The difficulty associated with labelling NRIS is well-documented in the literature; several of these designs, for example, have been used interchangeably; we will make use of the EPOC definitions and flow diagram to assist in study design identification (Appendix 1):
Non-randomised trial (NRT) is a study design in which individual participants, or clusters of participants, are allocated to intervention or comparator in a quasi-random or non-random manner. If there is an allocation rule, it is often by, for example, alternation, day of the week, odd/even hospital, or identification number.
Controlled before-after (CBA) is a study design that estimates intervention effectiveness by comparing pre- and post-intervention outcomes in individuals or clusters that receive the intervention and those that do not.
Interrupted time series (ITS) studies design uses multiple observations from individuals or clusters pre-intervention to establish the pre-existing outcome trend; intervention effectiveness is then estimated by measuring post-intervention changes in the expected outcome trend associated with the introduction of an intervention (the 'interruption'). An ITS study can identify both immediate and long-term changes associated with the intervention. The interrupted time-series studies will be required to have a clearly defined point in time when the intervention occurred and a minimum of 3 time points before and 3 time points after the intervention [21].
A repeated measures (RM) study is an interrupted time-series study but where the outcomes of interest are measured in the same participants at each point in time.
Concurrently controlled prospective cohort study (PCS) is where subjects are identified prospectively as having received an intervention or comparator and are then followed over time. The allocation rule is often in relation to organizational factors such as ward, clinic, doctor or provider organisation. Control arms should be contemporaneous, we will not include retrospective control arms.
'PICO' eligibility
We will include adults aged 18 years and older without documented diabetes mellitus or pregnancy.
Types of interventions
We will include studies comparing one of the screening strategies, targeted, opportunistic or mass screening interventions for the detection of type 2 diabetes mellitus, against no screening or another of the screening strategies (Table 1). There will be a 6-month minimum follow-up time required for the primary clinical outcome of morbidity.
Primary outcomes
Diabetes-related morbidity defined as study-reported microvascular complications (diabetic retinopathy, diabetic nephropathy, diabetic neuropathy) or macrovascular complications (non-fatal myocardial infarction, peripheral arterial disease, non-fatal stroke) and measured from 6 months after screening
Secondary outcomes
Mortality (all-cause and diabetes-related) defined as death due to any-cause including diabetes or other cardiovascular causes (including acute myocardial infarction, ischemic heart disease, stroke or any cardiovascular disorder that lead to death) and measured at any time after screening
Harms of diabetes screening
Harms to patients is defined as event/s reported in the study at any time after screening.
Psychological harms such as anxiety or stigma that impacts on quality of life due to a false-positive test
Number of days of work lost
Side-effects from treatment
Loss of health insurance benefits
Harms to health care system is defined as event/s reported in the study at any time after screening.
False-positive test resulting in human, physical and financial resource allocation to patients who are not in need
Overdiagnosis may lead to over-extension of human, physical and financial resources for patients who end up in prolonged treatment and engagement with the health system even if they never develop disease
The rationale for prioritisation of outcomes: Primary outcome serves to inform whether screening alters the course of disease as assumed per screening theory [11] and depicted in Fig. 1. Secondary outcome of mortality contributes to the current data outlining no reduction in mortality following screening intervention [19] while also assessing harms that may arise from screening intervention [3] and therefore contribute to evidence to substantiate policy and practice recommendations.
Search methods for identification of studies
Electronic searches
The University of Cape Town Health Sciences Reference Librarian (MS) assisted the first author (HM) in developing the search strategy and will provide advice and guidance in conducting the searches for the review.
Electronic Database Search (from inception onwards)
PubMed (MEDLINE)
Scopus (includes majority of EMBASE contents)
Web of Science Platform (Web of Science Core Collection, Biological Abstracts, SciELO Citation Index)
Academic Search Premier (on the EBSCOhost platform)
CINAHL (on the EBSCOhost platform)
Health Source Nursing Academic (on the EBSCOhost platform)
A draft search strategy for PubMed/MEDLINE, based on the original search strategy utilised by the Cochrane Review team and revised by an information specialist, is provided in Appendix 2 (see Appendix 2). We will include all studies regardless of publication status; however, we will only include English language studies. We are aware that this decision may lead to language bias [22], but due to capacity and resource limitation of the systematic review team, we are restricted to English only. We will search all databases from inception to the date of search. The search syntax will first be tested and optimised in PubMed. We will thereafter replicate the searches in the other databases adapting search syntax as necessary for those databases.
Grey literature search
We will conduct a grey literature search to identify studies not indexed in the databases listed above.
OpenGrey (multidisciplinary European database, covering science, technology, biomedical science, economics, social science and humanities)
Conference abstracts from The American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD) meeting and Diabetologia will be used to track down full text articles.
National Institute for Health Research Economic Evaluation Database (NHS EED)
Cost-Effectiveness Analysis Registry (CEA) (www.healtheconomics)
We will search key references, such as systematic reviews, by cross-checking reference lists for additional potentially eligible primary studies [23]. We will also contact experts in the field to check if we have missed any relevant studies. We may contact authors of included studies to clarify reported published information and to seek unpublished data.
Methods for screening search results
We will collate and transfer search results to the Rayyan screening software [24] and remove duplicate records. At least two review authors will independently screen titles and abstracts of every record retrieved. Outcome measures will not be used to exclude studies during title and abstract screening. The potentially eligible records will be retrieved for full text screening. The two review authors will independently review full text records for compliance of studies with eligibility criteria of the review. A decision tree based on the eligibility criteria will be used to assist in decision making for exclusion of studies (see Appendix 3). Two review authors will resolve any disagreements through discussion or, if required, will consult a third review author. A study must meet all inclusion criteria to be included. We will list excluded studies at the full text screening stage in the 'Characteristics of excluded studies' table. We will collate multiple reports of the same study so that each study rather than each report is the unit of interest in the review. We will provide any information we can obtain about ongoing studies. We will record the selection process in sufficient detail to complete a PRISMA flow diagram [25].
We will use a standard data extraction form in Microsoft Excel to capture study characteristics and outcome data [22, 26]; we will pilot the form on at least one eligible study. One review author will extract the following study characteristics from the included studies, and an independent review author will check the extraction:
Source: study ID (created by review author), review author ID (created by review author), citation and contact details
Eligibility: confirm eligibility for review, reason for exclusion
Methods: study design, number of study centres and location, study setting, withdrawals, date of study, follow-up, confounding factors considered, and the methods used to control for confounding, aspects of risk of bias specific for NRIS (see "Assessment of risk of bias in included studies" below), how missing data was handled
Participants: number, mean/median age, age range, gender, severity of condition, diagnostic criteria, inclusion criteria, exclusion criteria, screening criteria, diagnostic criteria, presence of known risk factors for type 2 diabetes mellitus (obesity, family history), co-morbidity (hypertension, dyslipidaemia), socio-demographics
Interventions: intervention components, comparison, fidelity assessment using the Template for Intervention Description and Replication (TIDieR) as a guide [27]
Outcomes: primary and secondary outcomes specified above in the section "Types of outcome measures".
Miscellaneous: funding source, notable conflicts of interest of study authors, ethical approval, key conclusions of the study authors, miscellaneous comments from the study authors, references to other relevant studies, correspondence required, miscellaneous comments by the review authors.
One review author will extract outcome data from included studies, and an independent review author will check extracted data. We will note in the 'Characteristics of included studies' table if outcome data were reported in an unusable way. We will resolve disagreements by consensus or by involving a third review author.
Assessment of risk of bias in included studies
Two review authors will independently assess risk of bias for each study using the ROBINS-I tool [28]. Any disagreement will be resolved by discussion or by involving a third review author.
We will assess the risk of bias according to the following domains:
Pre-intervention: bias due to confounding
Pre-intervention: bias in selection of participants into the study
At intervention: bias in classification of interventions
Post-intervention: bias due to deviations from intended interventions
Post-intervention: bias due to missing data
Post-intervention: bias in measurement of outcomes
Post-intervention: bias in selection of the reported result
We will judge each potential source of bias as low risk, moderate risk, serious risk, critical risk of bias or no information. We will summarise the 'Risk of bias' judgements across different studies for each of the domains listed. We will consider blinding separately for different key outcomes where necessary (e.g. for unblinded outcome assessment, risk of bias for all-cause mortality may be very different than for a patient reported pain scale). Where information on risk of bias relates to unpublished data or correspondence with a trialist, we will note this in the 'Risk of bias' table. We will not exclude studies on the grounds of their risk of bias but will clearly report the risk of bias when presenting the results of the studies. When considering treatment effects, we will take into account the risk of bias for the studies that contribute to that outcome. We will conduct the review according to this published protocol and report any deviations from it in the 'Differences between protocol and review' section of the systematic review.
Dealing with missing data
Authors will be contacted, and missing data will be requested. If only returned in part and data can be logically imputed, such as standard errors, this will occur. All missing data will be clearly reported in the data extraction forms and risk of bias table and as such be assessed in the sensitivity analysis.
EndNote X9 and Microsoft Excel will be used for data management. If there is a conflict between data reported across multiple sources for a single study (e.g. between a published article and a trial registry record), we will report the data from the first peer-reviewed published article.
Preparation for data synthesis
In preparation for synthesis (either meta-analyses or synthesis without meta-analysis), we will assess how much data are available for each of our objectives by creating a table to compare the PICO elements and the study design features as well as the extracted numerical data for the compilation of a meta-analysis.
Measures of treatment effect
We will estimate the effect of the intervention using risk ratio for dichotomous data, and mean difference or standardised mean difference for continuous data. Time to event outcomes will be reported as hazard ratios. If other effect estimates are provided, we will convert between estimates where possible. Measures of precision will be 95% confidence intervals. We will ensure that an increase in scores for continuous outcomes can be interpreted in the same way for each outcome, explain the direction to the reader, and report where the directions were reversed if this was necessary. Interrupted time series data will be analysed and, if required, a statistical comparison of time trends before and after the intervention will be performed. For ITS studies, the guideline as outlined in Analysis in EPOC reviews will be followed with assistance of a statistician to ensure integrity of analysis [29].
Unit of analysis issues
To avoid unit of analysis errors we will consider the unit used to cluster the intervention (such as a ward, clinic, doctor or provider organisation) or in the case of repeated measures that there will be multiple observations for the same outcome. For instance, multiple screening intervention events per participant may occur over time that may cause a unit-of-analysis error. In order to calculate the confidence intervals, the participants per treatment group rather than the number of intervention attempts will be used [22]. Multiple intervention groups could create unit-of-analysis issues especially if different screening interventions are compared against no screening intervention and use the same participants with no screening intervention in both comparisons [22]. If there is more than one comparison in the study design, we will combine groups into a single pairwise comparison. If there is a unit of analysis error in the reported analysis for a study and there is insufficient information to reanalyse the results, the study authors will be contacted to obtain necessary data. If these data are not available, we will not report confidence intervals or p values for which there is a unit of analysis error [30].
Quantitative synthesis
We will undertake meta-analyses only where this is meaningful, i.e. if the interventions, participants and the underlying clinical question are similar enough for pooling to make sense. If feasible and appropriate, outcome data from primary studies will be used to perform random effects meta-analyses. Since heterogeneity is expected a priori, we will estimate the pooled treatment effect estimates and its 95% confidence interval using the random effects model. The random effects model assumes that the effect estimates follow a normal distribution, considering both within-study and between-study variation.
Assessment of heterogeneity
Forest plots will be used to visualise the extent of heterogeneity among studies. We will quantify statistical heterogeneity by estimating the variance between studies using I2 statistic. The I2 is the proportion of variation in effect estimates that is due to genuine variation rather than sampling (random) error. I2 ranges between 0 and 100% (with values of 0–25% and 75–100% taken to indicate low and considerable heterogeneity, respectively) [22]. We will also calculate the chi-squared test where a p value < 0.1 indicates statistically significant heterogeneity.
Assessment of publication bias
If we include more than 10 studies investigating a particular outcome, we will use a funnel plot to explore possible publication bias, interpreting the results with caution [31].
Subgroup analysis and investigation of heterogeneity
We expect the following population characteristics may introduce clinical heterogeneity: age, sex, socio-economic status [6].
We expect the following contexts may introduce health system heterogeneity: study setting of rural or urban or in a low-middle income country or a high-income country (as defined by the World Bank) [6].
We will use the following outcomes in subgroup analysis:
Diabetes-associated morbidity
Mortality (all-cause and diabetes-associated)
We may conduct a sensitivity analysis to explore the influence of various factors on the effect size of the primary outcomes of the review only. We will stratify studies according to:
Restricting the analysis to published studies.
Restricting the analysis to studies with a low risk of bias, as specified in "Assessment of risk of bias in included studies"
Imputing missing data.
Any post hoc sensitivity analyses that may arise during the review process will be justified in the final report.
Assessment of certainty of evidence using the GRADE approach
Two review authors will independently assess the certainty of the evidence (high, moderate, low and very low) for each outcome using the five GRADE considerations for downgrading the certainty of evidence (risk of bias, consistency of effect, imprecision, indirectness, and publication bias) and the three criteria for upgrading the certainty of evidence (large effect, dose response and residual confounding opposing the observed effect) [32]. We will use the GRADEpro software GDT [33] to create the 'Summary of findings' tables for the main intervention comparisons and include the following outcomes: diabetes-associated morbidity, mortality (all-cause and diabetes-associated), harms (see Appendix 4 for SoF). We will resolve disagreements on certainty ratings by discussion and provide justification for decisions to down- or upgrade the ratings using footnotes in the SoF table and make comments to aid readers' understanding of the review where necessary. We will use plain language statements to report these findings in the review [34]. The SoF tables will be used to draw conclusions about the certainty of the evidence within the text of the review. If during the review process, we become aware of an important outcome that we failed to list in our planned 'SoF' tables, we will include the relevant outcome and explain the reasons for this is the section 'Differences between protocol and review'.
Systematic reviews of screening for type 2 diabetes have found no evidence that this intervention saves lives [15, 19, 20]; therefore, this review will primarily focus on the impact of screening on the reduction of diabetes-associated morbidities. The impact of this review is synthesised data for the provision of evidence-based decision-making for informing policy and practice around screening strategies for type 2 diabetes mellitus. Important protocol amendments will be documented and noted in the discussion.
The potential limitations of this review at a study (outcome) level include the following: the potential finding of insufficient studies of similar study design and clinical question to synthesise abstracted study data; the overall completeness and applicability of evidence and quality of evidence especially due to the limitation to non-randomised studies due to the lack of randomised studies and therefore the lower quality of evidence; the limitation to English studies only and therefore the potential to miss published research; the limitation of not being able to discern between all-cause mortality and diabetes-related mortality and therefore combining this outcome under one mortality outcome. The potential limitation of this review at a systematic review process level includes the potential biases in the review process such as post hoc analysis and focus of outcome objectives.
ADA:
CBA:
Controlled before-after
CEA:
Cost-Effectiveness Analysis Registry
CEBHA+:
Collaboration for Evidence-Based Healthcare and Public Health in Africa
EASD:
European Association for the Study of Diabetes
EPOC:
Effective Practice and Organisation of Care
FPG:
Fasting plasma glucose
Grading of Recommendations Assessment, Development and Evaluation
Detection of glycated haemoglobin A1C
ITS:
Interrupted time series
NHS EED:
NHS Economic Evaluation Database
NRT:
Non-randomised trial
NRIS:
Non-randomised intervention studies
OGTT:
Oral glucose tolerance test
Prospective cohort study
RM:
SoF:
TIDieR:
Template for Intervention Description and Replication
Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50.
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S13–27.
World Health Organization. Global report on diabetes. 2016.
Sorkin JD, Muller DC, Fleg JL, Andres R. The relation of fasting and 2-h postchallenge plasma glucose concentrations to mortality: data from the Baltimore Longitudinal Study of Aging with a critical review of the literature. Diabetes Care. 2005;28(11):2626–32.
World Health Organization, International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia : report of a WHO/IDF consultation. World Health Organization. 2006.
World Health Organization. Screening for type 2 diabetes. Geneva, Switzerland: Department of Noncommunicable Disease Management; 2003.
Schulze MB, Hoffmann K, Boeing H, Linseisen J, Rohrmann S, Mohlig M, et al. An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes. Diabetes Care. 2007;30(3):510–5.
Muhlenbruch K, Ludwig T, Jeppesen C, Joost HG, Rathmann W, Meisinger C, et al. Update of the German Diabetes Risk Score and external validation in the German MONICA/KORA study. Diabetes Res Clin Pract. 2014;104(3):459–66.
Jolle A, Midthjell K, Holmen J, Carlsen SM, Tuomilehto J, Bjorngaard JH, et al. Validity of the FINDRISC as a prediction tool for diabetes in a contemporary Norwegian population: a 10-year follow-up of the HUNT study. BMJ Open Diabetes Res Care. 2019;7(1):e000769.
American Diabetes Association. Screening for diabetes. Diabetes Care. 2002;25(suppl 1):s21–s4.
Speechley M, Kunnilathu A, Aluckal E, Balakrishna MS, Mathew B, George EK. Screening in public health and clinical care: similarities and differences in definitions, types, and aims - a systematic review. J Clin Diagn Res. 2017;11(3):LE01–LE4.
Rohwer A, Pfadenhauer L, Burns J, Brereton L, Gerhardus A, Booth A, et al. Series: clinical epidemiology in South Africa. Paper 3: logic models help make sense of complexity in systematic reviews and health technology assessments. J Clin Epidemiol. 2017;83:37–47.
Waugh NR, Shyangdan D, Taylor-Phillips S, Suri G, Hall B. Screening for type 2 diabetes: a short report for the National Screening Committee. Health Technol Assess. 2013;17(35):1–90.
Amod A. The 2017 SEMDSA guideline for the management of type 2 diabetes. JEMDSA. 2017;22(1):S1–S196.
Selph S, Dana T, Blazina I, Bougatsos C, Patel H, Chou R. Screening for type 2 diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(11):765–76.
Peer N, Balakrishna Y, Durao S. Screening for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2020;5:CD005266.
Simmons RK, Echouffo-Tcheugui JB, Sharp SJ, Sargeant LA, Williams KM, Prevost AT, et al. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet. 2012;380(9855):1741–8.
Saquib N, Saquib J, Ioannidis JP. Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials. Int J Epidemiol. 2015;44(1):264–77.
Durao S, Ajumobi O, Kredo T, Naude C, Levitt NS, Steyn K, et al. Evidence insufficient to confirm the value of population screening for diabetes and hypertension in low- and-middle-income settings. S Afr Med J. 2015;105(2):98–102.
Cochrane Effective Practice and Organisation of Care (EPOC). EPOC review and what should they be called? EPOC resources for review authors. 2017.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions 2019 July 2019.
Horsley T, Dingwall O, Sampson M. Checking reference lists to find additional studies for systematic reviews. Cochrane Database Syst Rev. 2011;8:MR000026.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.
Cochrane Effective Practice and Organisation of Care (EPOC). Data collection form. 2013.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ : British Medical Journal. 2014;348:g1687.
Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.
Cochrane Effective Practice and Organisation of Care (EPOC). Interrupted time series (ITS) analyses. 2017.
Cochrane Effective Practice and Organisation of Care (EPOC). Analysis in EPOC reviews. 2017.
Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.
McMaster University. GRADEpro GDT. In: Group HOGW, editor. 2014.
Cochrane Effective Practice and Organisation of Care (EPOC). EPOC worksheets for preparing a 'Summary of findings' table using GRADE. 2013.
The authors would like to thank the following people who have supported this protocol:
• The authors of an unpublished Cochrane systematic review titled "Screening for type 2 diabetes mellitus": Nasheeta Peer and Solange Durao, South African Medical Research Council, for providing their protocol to form the basis of this protocol, as well as a summary of their findings to form the rationale of the protocol and a quote to summarise the findings of their unpublished review.
• Information specialist Maria-Inti Metzendorf, Cochrane Metabolic and Endocrine Disorders Group, provided search strategy for the unpublished Cochrane review by Peer and Durao upon which the current search strategy is based.
• CEBHA+ Methodological Support Group Jake Burns and Peter Philipsborn, Ludwig-Maximillians Universitat Munchen, are internal reviewers for CEBHA+ which funds this review and assisted by providing critical review of the draft protocol.
• Prof Naomi Levitt, Chronic Disease for Africa, UCT, is a clinical Endocrinologist/Diabetologist who contributed to the PICO of this review when conceptualising the project and gave critical feedback to assist with responding to reviewers comments on the protocol before resubmission.
The work reported herein was made possible through Cochrane South Africa, South African Medical Research Council under the Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) Scholarship Programme. CEBHA+ receives funding from the Federal Ministry for Education and Research (Bundesministerium fur Bildung und Forschung, BMBF), Germany, through the BMBF funding of Research Networks for Health Innovation in Sub-Saharan Africa. The content hereof is the sole responsibility of the authors and does not necessarily represent the official views of SAMRC or the funders. The funding body, the Federal Ministry for Education and Research (Bundesministerium fur Bildung und Forschung, BMBF), Germany, played no role in the design and writing of the protocol; however, members of the Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) provided critical review and expert advice on the penultimate version of the protocol.
Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
Helen Mearns, Paul Kuodi Otiku & Benjamin M. Kagina
School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
Health Sciences Library, University of Cape Town, Cape Town, South Africa
Mary Shelton
Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
Tamara Kredo & Bey-Marrié Schmidt
Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
Tamara Kredo
Helen Mearns
Paul Kuodi Otiku
Benjamin M. Kagina
Bey-Marrié Schmidt
Conceiving the protocol: BS, TK. Designing the protocol: HM, BS. Co-ordinating the protocol: HM. Designing search strategies: MS, HM. Writing the protocol: HM. Providing general advice on the protocol and approving the final version: PKO, MS, BK, TK, BS. Securing funding for the protocol: BS, TK. Performing previous work that was the foundation of the current study: NP, SD. Guarantor of the review: BS. The authors read and approved the final manuscript.
Correspondence to Helen Mearns.
Ethics approval is not required for a systematic review of secondary data.
HM: None known
PKO: None known
MS: None known
BMK: None known
TK: None known
BS: None known
PRISMA Checklist.
Flow diagram to assist with identifying the type of study (modified from [34])
Search Strategy for PubMed:
Set 1: Diabetes Mellitus, Type 2 [MeSH] OR [Text Word field:] Adult onset diabetes OR late onset diabetes OR latent diabetes OR mature onset diabetes OR MODY OR NIDDM OR noninsulin-dependent diabetes OR slow onset diabetes OR stable onset diabetes OR type 2 diabetes OR type II diabetes OR T2DM OR T2D
Set 2: Diabetes Insipidus [MeSH] OR [Text Word field:] diabetes insipidus
Set 3: 1 NOT 2
Set 4: Mass screening [MeSH] OR [Text Word field:] screening
Set 5: 3 AND 4
Set 6: Animals [MeSH] NOT Humans [MeSH]
Set 8: [All fields:] Trial OR trials OR before-and-after study OR before-and-after studies OR cohort OR comparative study OR comparative studies OR Controlled OR evaluation study OR evaluation studies OR follow-up study OR follow-up studies OR interrupted time series OR longitudinal study OR longitudinal studies OR non-randomised OR non-randomized OR nonrandomised OR nonrandomized OR non randomised OR non randomized OR program evaluation OR programme evaluation OR prospective study OR prospective studies OR quantitative study OR quantitative studies OR quasi experimental OR repeated measures
Table 3 Provisional eligibility decision tree for full text exclusion
Table 4 Provisional summary of findings table
Mearns, H., Otiku, P.K., Shelton, M. et al. Screening strategies for adults with type 2 diabetes mellitus: a systematic review protocol. Syst Rev 9, 156 (2020). https://doi.org/10.1186/s13643-020-01417-3
Mass screening
Opportunistic
Type 2 diabetes mellitus