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Anti-Müllerian hormone was independently associated with central obesity but not with general obesity in women with PCOS
Authors: Xiying Zeng1, Yinxiang Huang2, Mulin Zhang2, Yun Chen1, Jiawen Ye1, Yan Han3, Danyan Ma3, Xin Zheng2, Xiaohong Yan4, and Changqin Liu1,2,5
1 The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| 2 Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China
| 3 School of Medicine, Xiamen University, Xiamen, China
| 4 Reproductive Medicine Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| 5 Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
Correspondence should be addressed to X Yan or C Liu: xmyxh1224@sina.com or liuchangqin@xmu.edu.cn
*(X Zeng, Y Huang and M Zhang contributed equally to this work)
Article ID:
© The authors 2022
Anti-Müllerian hormone (AMH) is recognized as the most important biomarker for ovarian reserve. In this cross-sectional study, we aimed to explore the potential association of AMH with central obesity or general obesity in women with polycystic ovary syndrome (PCOS).
In this cross-sectional study, 179 patients with PCOS were enrolled and underwent anthropometric measurements (BMI and waist circumference (WC)) and serum AMH level detection. Pearson's correlation and multivariable logistic regression analyses were performed to determine the associations of AMH with central obesity and general obesity.
Subjects with increasing BMI showed significantly lower values of AMH (median (interquartile range (IQR)) 8.95 (6.03–13.60) ng/mL in normal weight group, 6.57 (4.18–8.77) ng/mL in overweight group, and 6.03 (4.34–9.44) ng/mL in obesity group, P = 0.001), but higher levels of systolic blood pressure, fasting insulin, total cholesterol, triglycerides, LDL-c, obesity indices (WC, hip circumferences, waist-to-hip ratio, waist-to-height ratio (WHtR), and Chinese visceral adiposity index (CVAI)). Compared with the group of PCOS women without central obesity, the group with central obesity had significantly lower value of AMH (median (IQR) 8.56 (5.29–12.96) ng/mL vs 6.22 (4.33–8.82) ng/mL; P = 0.003). Pearson's correlation analysis showed that AMH was significantly and negatively correlated with BMI (r = −0.280; P < 0.001), WC (r = −0.263; P < 0.001), WHtR (r = −0.273; P < 0.001), and CVAI (r = −0.211; P = 0.006). Multivariate logistic regression analysis with adjustment for potential confounding factors showed that AMH was independently and negatively associated with central obesity but was not significantly associated with general obesity.
AMH was independently and negatively associated with central obesity. Closely monitoring the WC and AMH should be addressed in terms of assessing ovarian reserve in women with PCOS.
Keywords: anti-Müllerian hormone; polycystic ovary syndrome; central obesity; general obesity
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine–metabolic disorder afflicting women of reproductive age (1). It is associated with reproductive, metabolic, and psychological disorders including anovulatory infertility, obesity, type 2 diabetes mellitus (T2DM), cardiovascular diseases, and anxiety. Although not all women with PCOS have all the components of this syndrome, obesity is common in PCOS, affecting about 50–80% of patients among different studies and ethnic groups (2). Obesity can reduce the quality of life of PCOS patients by contributing to irregular menstruation, oligo/anovulation, negative effects on self-esteem and self-image (3, 4), and delayed fertility and infertility (5). Therefore, obesity has represented a major burden for women with PCOS. Weight loss has been shown to improve both the reproductive and metabolic features of PCOS (6).
Anti-Müllerian hormone (AMH) is a peptide growth factor, which belongs to the transforming growth factor β superfamily. It plays a mediator role particularly in the development of primordial follicles and the selection of follicles (7). Since serum AMH levels are proportional to the number of developing follicles in the ovaries and it differs only slightly during the menstrual cycle, serum concentration of AMH in females may represent both the quality and quantity of the ovarian follicle pool (8, 9). A large amount of data has shown that AMH levels are generally much higher in women with PCOS than in normal women. In the recent update on PCOS, the author indicated that the overall serum AMH levels are two- to three-fold higher in women with a diagnosis of PCOS than in women with normal reproductive function (2). So, there is an increasing interest in testing the level of AMH as a marker for ovarian reserve in patients with PCOS (10, 11). Various studies have explored the relationship of AMH and obesity, but reported contradictory results (6). Some of them have reported an inverse correlation between AMH levels and general (peripheral) obesity in women with PCOS (5, 12, 13), whereas others have observed a positive correlation (7) or no relationship at all (14, 15, 16). Besides, several studies have demonstrated that central (abdominal) obesity, one of the important patterns of obesity, is also closely linked to PCOS (17, 18, 19). However, regarding PCOS, studies exploring the potential association between plasma AMH and central obesity are limited.
Obesity could be generally divided into general obesity which is commonly evaluated by BMI and central obesity with waist circumference (WC) as the most common measure (20). Although imaging approaches, such as CT and MRI, are gold standards for detecting abdominal adiposity, they are relatively expensive, time-consuming, and unavailable in large populations (21). Alternatively, other anthropometric parameters such as waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) can also indicate abdominal adiposity accumulation to some degree (22). It should be noted that the Chinese visceral adiposity index (CVAI), a recently established indicator which is based on age, BMI, WC, and metabolic parameters (fasting triglycerides (TG) and HDL-c) (23), has been proven to be a reliable index for the evaluation of abdominal fat dysfunction in the Chinese population (24). The CVAI was proposed for the first time from a cross-sectional study with 485 subjects and was further validated in a study with 6495 subjects, which was strongly and positively associated with visceral fat area (r = 0.68) quantitated by CT (24). CVAI has also been considered to serve as a better predictor of metabolic syndrome (MS), T2DM, and prediabetes than BMI, WC, WHtR, and/or WHR in Chinese populations (23). To elucidate the potential association between body fat distribution and ovarian function in PCOS, we examined the relationship of AMH with central obesity and general obesity in women with PCOS.
This cross-sectional study was conducted in the Endocrinology and Diabetes Department of the First Affiliated Hospital of Xiamen University in Xiamen, China. All participants signed the informed consent forms. A total of 179 patients with PCOS were recruited. Diagnosis of PCOS was based on Rotterdam criteria with two of the following: (i) oligo- and/or anovulation, (ii) clinical and/or biochemical signs of hyperandrogenism, and (iii) polycystic ovarian morphology, defined as the presence of ≥12 follicles of 2–9 mm and/or ovarian volume of ≥10 mL in at least one ovary on transvaginal or abdominal ultrasound (25). Diagnoses were made following the exclusion of any other causes of hyperandrogenemia, such as congenital adrenal hyperplasia, androgen-secreting tumors, and Cushing's syndrome (1, 26). The ethics committee of the First Affiliated Hospital of Xiamen Medical University approved the study protocol.
Clinical and biochemical measurements
All participants received sociodemographic questionnaires and physical examination (height, weight, blood pressure, WC, and hip circumferences (HC)) by a well-trained researcher using standardized protocols. Demographics included age, smoking, alcohol consumption, and past medical history. Height and body weight were measured by using a calibrated scale without shoes and heavy outer garments to the nearest 0.5 cm and 0.1 kg, respectively. WC was measured at the midpoint between the last palpable rib and the top of the iliac crest, and HC was measured at the level of maximal protrusion of the gluteal muscles (25, 27). Blood pressure was measured using OMRON digital sphygmomanometer, after sitting for at least 15 min. BMI was calculated as weight (kg)/ height (m2). The WHR was calculated as WC (cm) /HC (cm). WHtR was calculated as WC (cm)/ height (m). CVAI was calculated as follows: CVAI (females) = −187.32 + 1.71 × age + 4.23 × BMI + 1.12 × WC (cm) + 39.76 × Log10TG (mmol/L) −11.66 × HDL-c (mmol/L). All subjects were grouped into three BMI categories (normal weight: <24 kg/m2; overweight: 24.0–27.9 kg/m2; and obesity: ≥28 kg/m2) and two WC categories (normal weight: WC<85.0 cm and central obesity: WC≥85.0 cm) according to a Chinese Guideline (28).
Blood samples after a 12-h overnight fast were collected through antecubital vein puncture from each subject. All biochemical measurements were tested in the Central Laboratory of the First Affiliated Hospital, Xiamen University. The concentrations of total cholesterol (TC), TG, HDL-c, and LDL-c were estimated by HITACHI 7450 analyzer (Hitachi). Fasting insulin concentration was measured using electrochemiluminescence immunoassay (Roche Elecsys Insulin Test, Roche Diagnostics). Fasting blood glucose (FBG) was measured by means of the hexokinase method. Testosterone was quantified using chemiluminescent immunoassay analysis (Siemens Healthcare Diagnostics Inc, Massachusetts, USA; Siemens ADVIA centaur XP immunoassay System, Erlangen, Germany). AMH assessment was performed by electrochemiluminescence using reagents supplied by Roche Diagnostics GmbH. The theoretical sensitivity of this method is 0.01 ng/mL.
All statistical analyses were performed using SPSS version 21.0 software (IBM Corporation). Data were presented as mean ± s.d. or as median (interquartile range (IQR)) for continuous variables or as number and percentage for categorical variables. Skewness and kurtosis tests were applied for the calculation of normality. All subjects were stratified by BMI and WC. Differences among the three groups were analyzed on continuous variables using one-way ANOVA for those with normal distributions and Kruskal–Wallis test for those with skewed distributions and on categorical variables using chi-square test. Differences between two groups were analyzed on continuous variables using the Student's t-test for those with normal distribution and Mann–Whitney U-test for those with skewed distribution and on categorical variables using chi-square test.
Pearson's correlation analysis was performed to analyze the correlation of AMH with BMI, WC, WHtR, and CVAI. Multivariable logistic regression analysis was used to calculate the adjusted odds ratios (OR) and 95% CI of AMH for general obesity and central obesity in different models with adjustment for potential confounders. For the logistic regression analyses, model 1 was adjusted for age; systolic blood pressure (SBP) and diastolic blood pressure (DBP) were further adjusted for in model 2; FBG, TC, TG, LDL-c, HDL-c, and testosterone were further adjusted for in model 3. All P -values were two-sided, and P-value <0.05 was considered statistically significant.
In the study, 179 women who met the criteria for PCOS with available AMH levels were included, of which 92 (51.39%) were diagnosed with general obesity defined as those with BMI ≥28 kg/m2 and 121 (67.59%) were diagnosed with central obesity defined as those with WC >85 cm. The median (IQR) of AMH was 6.71 (4.51–10.05) ng/mL for all subjects, the mean (±s.d.) of age was 27.9 ± 4.9-years old, and the mean (±s.d.) of BMI was 27.54 ± 4.83 kg/m2. The level of AMH decreased with the increase of BMI and WC (Tables 1 and 2).
Anthropometric information and biochemical characteristics in women with PCOS by BMI category.
Normal weight, BMI <24 kg/m2
Overweight, 24≤ BMI <28 kg/m2
Obesity, BMI ≥28 kg/m2
n 40 47 92
Age (years) 28.3 ± 4.0 26.9 ± 4.9 27.5 ± 5.1 0.438
Smoking 0 0 0 NS
Occasional drinking (n, %) 4 (10.0) 1 (2.1) 13 (14.1) 0.060
SBP (mmHg) 112 ± 11 118 ± 12 122 ± 13 <0.001b
DBP (mmHg) 79 ± 9 80 ± 10 82 ± 11 0.205
BMI (kg/m2) 21.16 ± 2.02 26.07 ± 1.19 31.68 ± 2.95 <0.001b
WC (cm) 73.6 ± 5.9 87.7 ± 5.3 98.5 ± 8.7 <0.001b
HC (cm) 90.6 ± 7.1 100.7 ± 4.7 110.6 ± 6.0 <0.001b
WHR 0.81 ± 0.05 0.87 ± 0.05 0.89 ± 0.06 <0.001b
WHtR 0.46 ± 0.04 0.55 ± 0.03 0.61 ± 0.06 <0.001b
CVAI 27.54 ± 16.11 59.89 ± 15.55 97.86 ± 21.92 <0.001b
FBG (mmol/L) 4.81 (4.43–5.12) 4.98 (4.67–5.45) 4.93 (4.64–5.36) 0.09
Fasting insulin (pmol/L) 50.36 (40.89–77.75) 107.1 (89.45–147.28) 145.35 (111.77–192.74) <0.001b
TC (mmol/L) 4.89 ± 1.08 4.94 ± 0.74 5.35 ± 0.85 0.005
TG (mmol/L) 1.12 (0.77–1.795) 1.49 (1.02–1.96) 1.55 (1.18–2.30) 0.006
HDL-c (mmol/L) 1.48 (1.28–1.67) 1.21 (1.08–1.31) 1.2 (1.05–1.34) <0.001b
LDL-c (mmol/L) 2.37 (2.02–2.84) 2.83 (2.31–3.36) 2.99 (2.65–3.55) <0.001b
T (ng/dL) 42.99 (34.93–57.49) 39.69 (31.76–46.74) 40.63 (31.48–51.40) 0.371
AMH (ng/mL) 8.95 (6.03–13.60) 6.57 (4.18–8.77) 6.03 (4.34–9.44) 0.001a
aP < 0.05, bP< 0.001; Values are expressed as mean ± s.d.
AMH, anti-Müllerian hormone; CVAI, Chinese visceral adiposity index; DBP, diastolic blood pressure; FBG, fasting plasma glucose; HC, hip circumference; SBP, systolic blood pressure; TC, total cholesterol; TG, triglycerides; WC, waist circumference; WHR, waist-to-hip ratio; WHtR, Waist-to-height ratio.
Anthropometric information and biochemical characteristics in women with PCOS by WC category.
WC <85 cm
WC ≥85 cm
n 58 121
Age (years) 27.5 ± 4.2 27.6 ± 5.1 0.971
Smoking 0 0 NS
Occasional drinking (n (%)) 5 (8.6%) 13 (10.7%) 0.658
SBP (mmHg) 114 ± 11 121 ± 13 <0.001b
DBP (mmHg) 79 ± 10 82 ± 11 0.088
BMI (kg/m2) 22.82 ± 3.29 30.27 ± 3.56 <0.001
WC (cm) 76.0 ± 6.2 96.9 ± 8.1 <0.001b
HC (cm) 93.6 ± 8.3 108.3 ± 6.7 <0.001b
WHR 0.81 ± 0.06 0.89 ± 0.05 <0.001b
WHtR 0.48 ± 0.04 0.60 ± 0.05 <0.001b
CVAI 36.01 ± 20.55 90.08 ± 24.04 <0.001b
FBG (mmol/L) 4.805 (4.44–5.1) 4.97 (4.66–5.47) 0.008
Fasting insulin (pmol/L) 60.53 (45.72–96.21) 140.73 (106.61–182.87) <0.001b
TC (mmol/L) 4.87 ± 0.97 5.27 ± 0.84 0.007a
TG (mmol/L) 1.15 (0.77–1.75) 1.59 (1.21–2.23) <0.001b
HDL-c (mmol/L) 1.39 (1.15–1.61) 1.2 (1.06–1.33) <0.001b
LDL-c (mmol/L) 2.56 (2.12–2.925) 2.98 (2.63–3.53) <0.001b
Testosterone (ng/dL) 44.02 (35.59–57.99) 39.31 (31.4–49.62) 0.035a
AMH (ng/mL) 8.56 (5.29–12.96) 6.22 (4.33–8.82) 0.003a
aP < 0.05,bP < 0.001; Values are expressed as mean ± s.d.
Clinical characteristics of the study population
Table 1 shows the differences of anthropometric information and biochemical characteristics in PCOS women categorized by BMI. Compared with PCOS women in normal weight group, subjects in the overweight group and obesity group had significantly higher levels of SBP (112 ± 11 mmHg, 118 ± 12 mmHg, and 122 ± 13 mmHg, respectively, P < 0.001), fasting insulin (50.36 (40.89–77.75) pmol/L, 107.1 (89.45–147.28) pmol/L, and 145.35 (111.77–192.74) pmol/L, respectively, P < 0.001), TC (4.89 ± 1.08 mmol/L, 4.97 ± 0.74 mmol/L, and 5.35 ± 0.85 mmol/L, respectively, P = 0.005), TG (1.12 (0.77–1.795) mmol/L, 1.49 (1.02–1.96) mmol/L, and 1.55 (1.18–2.30) mmol/L, respectively, P = 0.006), and LDL-c (2.37 (2.02–2.84) mmol/L, 2.83 (2.31–3.36) mmol/L, and 2.99 (2.65–3.55) mmol/L, respectively, P < 0.001) and lower values for HDL-c (1.48 (1.28–1.67) mmol/L, 1.21 (1.08–1.31) mmol/L, and 1.2 (1.05–1.34) mmol/L, respectively, P < 0.001) and AMH (median (IQR) 8.95 (6.03–13.60) ng/mL, 6.57 (4.18–8.77) ng/mL, and 6.03 (4.34–9.44) ng/mL, respectively, P = 0.001). Similarly, compared to the PCOS women in the normal weight group, subjects in the overweight group and obesity group also had significantly higher levels of obesity indices such as WC (73.6 ± 5.9 cm, 87.7 ± 5.3 cm, and 98.5 ±8.7 cm, respectively, P < 0.001), HC (90.6 ± 7.1 cm, 100.7 ± 4.7 cm, and 110.6 ± 6.0 cm, respectively, P < 0.001), WHR (0.81 ± 0.05, 0.87 ± 0.05, and 0.89 ± 0.06, respectively, P < 0.001), WHtR (0.46 ± 0.04, 0.55 ± 0.03, and 0.61 ± 0.06, respectively, P < 0.001), and CVAI (27.54 ± 16.11, 59.89 ± 15.55, and 97.86 ± 21.92, respectively, P < 0.001). However, there were no statistically significant differences in age, occasional drinking, DBP, FBG, and testosterone among these three groups.
Subjects categorized by WC are presented in Table 2. There were no significant differences between the two groups in age, occasional drinking, and DBP. Compared with the group of PCOS women without central obesity, the group with central obesity had significantly greater values for SBP, FBG, fasting insulin, TC, TG, and LDL-c and lower values for HDL-c, testosterone, and AMH (median (IQR) 8.56 (5.29–12.96) ng/mL vs 6.22 (4.33–8.82) ng/mL; P = 0.003). The obesity indices such as HC (93.6 ± 8.3 cm vs 108.3 ± 6.7 cm; P < 0.001), WHR (0.81 ± 0.06 vs 0.89 ± 0.05; P < 0.001), WHtR (0.48 ± 0.04 vs 0.60 ± 0.05; P < 0.001), and CVAI (36.01 ± 20.55 vs 90.08 ± 24.04; p < 0.001) were higher in the group with central obesity than in the group without central obesity.
Correlation of AMH with obesity indices
Pearson's correlation analysis was first performed to explore the correlation between AMH and several obesity indices (BMI, WC, WHtR, and CVAI) (Fig. 1). We found that there were significant negative correlations between AMH and BMI (r = −0.280; P < 0.001), WC (r = −0.263; P < 0.001), WHtR (r = −0.273; P < 0.001), and CVAI (r = −0.211; P = 0.006).
Relationship of AMH to BMI (A), WC (B), WHtR (C), and CVAI (D).
Citation: Endocrine Connections 11, 1; 10.1530/EC-21-0243
Association of AMH with central obesity and general obesity
Multivariate logistic regression analysis was performed with adjusted for different potential confounding factors to further examine the relationship of AMH with central obesity categorized by WC and general obesity defined by BMI (Table 3). In model 1 with the adjustment for age, AMH was significantly associated with central obesity, and the adjusted OR (95% CI) was 0.896 (0.831–0.966; P = 0.004). In model 2 and model 3, the association of AMH with central obesity was still statistically significant, with the adjusted OR (95% CI) of 0.883 (0.812–0.959; P = 0.003) and 0.891 (0.811–0.979; P = 0.016), respectively. However, in the three models with the same adjustments as those in multivariable logistic regression analyses, AMH was not significantly associated with general obesity.
Adjusted odds ratios (OR) with associated 95% CI for obesity in patients with PCOS. Model 1 was adjusted for age. Model 2 was further adjusted for SBP and DBP. Model 3 was further adjusted for TC, TG, LDL-c, HDL-c, FBG, and testosterone.
General obesity
Central obesity
95% CI
Model 1 0.947 0.883–1.017 0.134 0.896 0.831–0.966 0.004a
Model 3 0.956 0.879–1.04 0.299 0.891 0.811–0.979 0.016a
Tertiles of AMH
Tertile 2 vs Tertile 1 0.596 0.256–1.385 0.229 0.816 0.296–2.25 0.695
Tertile 3 vs Tertile 1 0.540 0.224–1.301 0.169 0.284 0.103–0.783 0.015a
Trend test 0.160 0.015a
aP < 0.05.
As shown in Fig. 2, AMH was significantly lower in women with central obesity than without, but showed no significant difference between general obesity and non-general obesity.
Serum AMH concentrations in general obesity group and central obesity group.
This is the first study, to the best of our knowledge, to examine the relationship of AMH with central obesity and general obesity in women with PCOS, and we found that AMH was independently and negatively associated with central obesity, but the association with general obesity was non-significant.
PCOS shares many similarities with MS in clinical features and pathophysiology. Studies showed that the prevalence of MS in PCOS population is nearly two-fold higher than age-matched control women (29). Obesity, as an essential part of MS, is a common feature in women with PCOS. Obesity has a significant impact on reproductive health, as excess body weight is the main cause for ovulatory infertility (30). Recent studies have shown serum AMH level was increasingly being recognized as the most important biomarker for ovarian reserve and was used to counsel patients regarding their reproductive outcomes (6, 9, 31). Although the relationship of AMH and obesity has been described before, findings of these studies are controversial. In one recent review, Alexis L Oldfield and colleagues (32) summarized 13 studies involving 210 obese and 550 non-obese healthy women with regular menstrual cycles, of which 5 reported decreased AMH levels with obesity, whereas 8 showed comparable AMH levels between groups. Eleni et al. (12) have observed that increasing BMI was correlated with reductions in AMH after adjusting for age, race, smoking, and site in multivariate regression models. Albu et al. (7) reported that AMH is positively correlated with BMI, especially in infertile patients younger than 35 years of normal weight and with normal ovarian reserve. Sahmay and Halawaty et al. (14, 15, 16) reported no relationship between these two markers. In the present study, we found that AMH was significantly and negatively correlated with obesity indices such as BMI, which was consistent with some previous studies (5, 13, 33). Inconsistent findings may be ascribed to the differences in the study design, populations, and sampling strategies. The mechanism underlying this inverse relationship between BMI and AMH is still unclear, but the possible explanation could be that obesity is associated with decreased ovarian reserves or that obesity is associated with follicular dysfunction (34). Therefore, the relationship of AMH level with obesity should be deemed uncertain at this time, and the biological impact of obesity on AMH production needs to be further investigated in future studies (32).
Two important patterns of obesity, which are general (peripheral) obesity and central (abdominal) obesity, are often evaluated by BMI and WC, respectively. Body fat distribution is closely related to comorbidities of obesity. But there was no difference in fat distribution by using gold standard MRI measures of visceral fat between obese and overweight women with PCOS and BMI/fat mass-matched control women (35). BMI cannot provide information on body fat distribution, while WC is an easily measurable surrogate index of abdominal fatness and a major component in diagnosing MS (18). However, there were few studies to explore the association between AMH with central obesity in patients with PCOS. In the present study, we found that AMH was associated only with central obesity but not with general obesity in women with PCOS. In parallel with our study, Sahmay et al. (14) concluded that there was no significant association between AMH and BMI-based general obesity, and the phenomenon was also seen in another study (15). The link between AMH and central obesity may be related to the following factors. First of all, central or abdominal obesity is associated with greater insulin resistance (IR) likely mediated by free fatty acids and the paracrine actions of the abdominal depot than general or peripheral obesity (30). Moreover, central obesity also worsens the insulin-related metabolic and reproductive features of PCOS (19). Mei-Jou et al. (36) speculate that IR might exert its negative effect on AMH directly or indirectly to downregulate the inhibitory effect of AMH on follicular development, thus increasing the sensitivity of granulosa cells to follicle-stimulating hormone. However, this hypothesis requires further biological research. In addition, hyperinsulinemia resulting from IR stimulates ovarian steroidogenesis and inhibits sex hormone-binding globulin production in the liver, thereby increasing the availability of free androgens. The adipose tissue also provides storage and a metabolic site for various lipid-soluble steroids, such as androgens, which contributes further to hyperandrogenism. Women with PCOS who are more overweight and obese are therefore more likely to have a worse clinical reproductive presentation (19). Accumulation of small follicles and granulosa cell proliferation due to androgen excess is the probable explanation for the association between AMH and androgen levels (37).
Our study also has some limitations. First, more accurate measurements were not performed for body composition, like CT or MRI. Secondly, since ovarian ultrasound has not been done for the participants presented with both oligo/amenorrhea and (clinical and/or biochemical) hyperandrogenism, we could not outline the accurate number of subjects in separate phenotypic subgroups of PCOS. Thirdly, the cross-sectional nature of our study disenabled us to make causal inferences. Lastly, there is no non-PCOS group in the current study, which limits the interpretation of the findings from the PCOS group. According to the recommendations from the international evidence-based guideline (38), serum AMH detection needs to improve standardization of assays and established cutoff levels for the detection of polycystic ovarian morphology (PCOM). So, it may not be necessary to measure in routine clinical practice. However, to be more accurate in the detection of PCOM, AMH measures need to be further explored based on large-scale validation in populations of different ages and ethnicities (38). Therefore, follow-up and corresponding examinations should be strengthened in future studies to obtain more accurate epidemiological data.
AMH was independently and negatively associated with central obesity but showed no association with general obesity. Decreased AMH production by the follicle unit may be responsible for reduced AMH with increasing WC. Closely monitoring the WC and AMH should be addressed in terms of assessing ovarian reserve in women with PCOS.
This work was funded by Natural Science Foundation of China grant (No. 81870611), Natural Science Foundation of Fujian Province (No. 2020J011242), and Open project of State Key Laboratory of Cellular Stress Biology, Xiamen University (No. SKLCSB2019KF004).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration and its later amendments or comparable ethical standards.
The study concept and design were framed by X Y and C L. X Z, Y H, M Z, Y C, J Y, Y H, and X Z collected data. X Z, Y H, M Z, and C L conducted the statistical data analysis and drafted the manuscript. X Y and C L contributed to discussion and revision. All authors read and approved the final manuscript.
The authors are grateful to all the subjects for their participation.
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https://ec.bioscientifica.com/view/journals/ec/11/1/EC-21-0243.xml
anti-Müllerian hormone; polycystic ovary syndrome; central obesity; general obesity
Article by Xiying Zeng
Article by Yinxiang Huang
Article by Mulin Zhang
Article by Yun Chen
Article by Jiawen Ye
Article by Yan Han
Article by Danyan Ma
Article by Xin Zheng
Article by Xiaohong Yan
Article by Changqin Liu


Jkentip needed a new print or packaging design and created a contest on 99designs.
Paul was amazing right out of the gate. Short of some minor changes, he was amazing. He followed up on those changes and did an amazing job. I will work with him again.
We manufacture and sell durable, lightweight mats for horse stalls, trailers and other horse applications.
1. Tri-fold brochure - Include Benefits, testimonials, specifications, installation instructions, catalog images, and pictures of the product in use.
2. two ad designs (half page & full page) - We will be purchasing ads for trade shows and to show partnership with new distributors. I would like one section of the ad to be customizable where we could list info about the trade shows or specific distributors we're partnering with. Ad needs to tell about the product and push the reader to our trade show booth or to call our distributor.
3. 4 x 6 Post Card that would be very similar to the advertisement. This will generally be a direct mail piece to target different audiences, such as trade show visitors, veterinarians, etc. So one section in this would also need to be easily customized.
Please use the website design as your theme for the print material. You will find All Specs, testimonials, benefits, contact info and some copy on our website, http://www.equinelitemat.com. Please make sure any copy can be edited on our end.


text:
The year that was…
2022 was an interesting year, for myself personally it has meant some significant change, for Caradoc Games it's been a year of overcoming complications and trying out some new things.
Looking back over 2022 from a 'games and writing perspective', I have achieved a number of things this year. I finalised, printed, and fulfilled Foundlings. I ran a Kickstarter for Owlbear Omelette. I designed and wrote Prisoners of the Elf King. And I have almost fully developed the next game, slated for the second quarter of 2023: Ganymede Outriders.
It sounds like a lot, and I suppose it is, but I also felt like I did a lot more than I actually did. On reflection, the key reason I didn't get as much 'game related' stuff done as I had planned or thought I might was because of how busy my own life was outside of Caradoc Games. In 2022 I worked full time as a teacher, I also worked some 20 hours a week coaching gymnastics, and then worked on Caradoc Games related stuff outside of that. I have three very active kids, and family life is important. If I got less done on games than I had intended I think I can give myself a break – this year was busy!
One other significant change that happened this year was that I stepped away from the classroom after nearly 20 years as a teacher, and took over the management of a gymnastics center. All of this happened at the same time the little country town I call home flooded. The gym was forced to move locations and the weeks from the floods to the recovery were massive. While this chaotic start to a new career was interesting, to say the least, I really am hoping for a more stable year to come. I loved coaching throughout 2022, and am looking forward to what the new year brings.
So back to game related stuff. The year started with Foundlings, and it was a rocky start. Originally I had intended to fulfill Foundlings through my own webstore, but an error I couldn't work out in the coupon system was taking time to resolve. In the end I opted to run a pledge manager through Gamefound, which was… interesting. While it took more time than I had planned for, I am thrilled to say that Foundlings was successfully fulfilled, if a little late. This game seems to have done well post-kickstarter, and I ended up having to order a second printing not long after the first. I hope it continues to do well, I really like this little game, and I think it uses some really fun rules. If you're after a post-apocalyptic fantasy game, with strong environmental themes and a focus on the slow degradation any post-apocalypse brings – this game might just be for you!
The second quarter was spent getting my game Freedom or Toaster finished and laid out for the Tiny Tome – a Kickstarter run by Long Tail Games. I really like this little micro-rpg of mine, and was thrilled it got a chance to be a part of such an awesome anthology of games. As a one-shot I think Freedom or Toaster works great – it has simple resolution mechanics, a fun and funny theme (human-like robots trying to escape a busy mall to live their best lives, while human robot police hunt them down). It also has one of the best rules I have added to a game (imo): every time a robot speaks they have a noise they have to include in their speech – maybe it's 'beep', maybe it's 'woo!' – every time I have played Freedom or Toaster this element has been a lot of fun.
Around the same time I started work on Ganymede Outriders, a game I originally hoped I would release as a perfect bound book of something like 100 A5 pages. But…
When fulfilling Foundlings I had a number of messages from backers complaining about the high cost of shipping. Believe me, I get it. As an Aussie, shipping is a nightmare. Having the cost of shipping be about the same as the game itself – for a game which is a staple bound booklet no-less… yeah. For Foundlings I actually charged less than what it cost me to put those games in the post, and at $14 for shipping per copy – no, it was not cheap. I looking at working with a shipping partner, I looked at localised printing, and while these offered some solutions, the cost in currency conversion between AUD and USD meant that any savings I could pass on were negligible or non-existent.
My plans to make bigger books with Ganymede Outriders and Heralds was only going to mean bigger shipping costs, but what if I went smaller instead? What if I could send something in a DL envelope? That would cost about $4 AUD for international shipping.
The plan for Owlbear Omelette was hatched.
Owlbear Omelette was a game I had originally released in 2019. I chose to revamp the game for this little experiment, and converted it into a 36 page staple bound A6 booklet. I reworked the rules, added some fun new options, redesigned and added a bunch of random tables for generating a dungeon or palace, and let it loose on Kickstarter. It didn't explode, in fact, it barely scrapped over the line, but it funded. It funded and it let me trial how much cheaper and easier it could be to send stuff via DL. Owlbear Omelette wasn't even on my radar for a re-release at the start of the year, but here we are: a successful Kickstarter fulfilled, and copies already available in retail at places like Indie Press Revolution, and soon to be at Exalted Funeral.
The experiment was a success, and this led me to work on my next game. It wasn't that I abandoned Ganymede Outriders – that one was still percolating in the background, but I wanted to make something that was spiritually like Owlbear Omelette, something that was hopefully amusing to read and play, and that poked a bit of fun at itself and it's genre. Prisoners of the Elf King was born.
In Prisoners of the Elf King you play as Dwarves, captured by the eponymous Elf King, and released from your cells by your burglar. Rather than climbing into barrels and getting dashed to pieces in a river, you have collectively decided to find your own way out.
Like Owlbear Omelette, this game is both the adventure and the rules system, with the rules specifically designed to engage with the themes. In Prisoners of the Elf King Dwarves can 'Dig Deep' to score extra successes, but if they do it to much they can release their bane. The characters all have passions – which play off the characteristics of the Dwarves in The Hobbit and the Lord of the Rings, and if they are fulfilled the player can advance their characters. The party also has a sheet with three tracks – Fly You Fools measures how close the Dwarves are to escape. Diplomatic Incident is rolled after the game, and can mean the antics of the Dwarves lead to a massive war (Battle of the Five Armies style), and Drums in the Deep is the track that gets filled up if the Dwarves dig too deep too often.
I think the system is fun, and I got a lot of pleasure out of designing a set of rules that play with the material that inspired it. Like Owlbear Omelette this is a strongly focused game – it sets out to tell a story, and has all the rules you need to play that story. I'm thinking of calling this little line of games 'Episodes' – because that's very much what it feels like. They are a different design experience to something like Corsairs, Rascals, Foundlings, or Ganymede Outriders – all of which are game systems and settings.
Prisoners of the Elf King will be hitting Kickstarter in February this year, as a part of the ZineQuest and ZiMo promotions.
Follow Prisoners of the Elf King on Kickstarter here
Of course, with the rules for Prisoners of the Elf King done and dusted, I turned back to Ganymede Outriders. This is a game and setting, includes vehicle rules, and a travel system. I am going to try and squeeze all of that into an A6 book. Will it work? We shall see…
Toward the end of last year Thunderworks Games ran a Kickstarter for their Roll Player Adventures game. This was hugely exciting for me, as a part of this Kickstarter included the Tales of Ulos graphic novel. I wrote one of the comics in this novel: Blackjacked Buccaneers, and it was one of the most enjoyable pieces of freelance writing I have ever undertaken. You can read some thoughts about it all here. I was very pleased to see Roll Player Adventures do so well, not least for the selfish reason that I get to see a comic book I wrote go to print. And who knows, maybe we'll see more of Kaemon and Pitlin in the future…
Well, that about wraps up the year that was. 2022 was a busy year, but I am pleased with everything I got done. It wasn't the biggest year for Caradoc Games in terms of money made, and one of the reasons for this is because I had made the decision to move away from freelance work to focus on my own games (Blackjacked Buccaneers was the exception – I mean who could say no to writing a comic!).
The Owlbear Omelette Kickstarter raised about $1600 AUD, of that about $100 was profit, but I also sold copies into distribution, and that, for me at least, has been where my games have made the most. Online sales through my website were almost non-existent, sales on itch.io came to about $40, and DriveThruRPG sales totaled about $140 (after DTRPG took their 30% cut). Royalties from Long Tail, and sales through distribution (both Indie Press Revolution and Exalted Funeral) came to a bit over $3000. None of this includes royalties for the comic book – I expect those will start next year some time. Not a huge amount to show for the work it has taken, but all building. I now have four games in print, the experiment with cheaper shipping options was a success and has created the model for Caradoc Games moving forward, and I have two games ready for 2023. With a back catalog starting to make some money, and at least two games lined up for release next year, I hope the building I have put into this year will start to grow in 2023.
I have rambled long enough, I'll write about my plans for 2023 in another post.
Owlbear Omelette – Souffle Edition – Printed Zine
Rascals Printed Zine
Corsairs Printed Zine
Announcing Prisoners of the Elf King
So, you've managed to escape the dungeons of the Elf King… But what next? While your burglar helped you slip your cages, the next steps they proposed could be generously described as 'sketchy', at best. So, while the burglar heads off to prepare, you and your fellow dwarves are going to find your own way out!
Prisoners of the Elf King is a madcap escape from the palace of the Elf King… can you and your fellow dwarves get away?
Temporary cover (art is currently being completed by Juan Ochoa)
Follow Prisoners of the Elf King on Kickstarter
Inside Prisoners of the Elf King you will find:
Rules for the doing of deeds.
Rules for Digging Deep, for when a dwarf needs to push for extra successes (but be wary of digging too deep)!
Rules for Fortune and Misfortune, Hurts, and Helping.
Rules for Dwarf Creation
A table of secret Dwarvish Passions
Party rules, including three tracks that can affect all the characters: Fly You Fools, Diplomatic Incident, and Drums in the Deep.
Fly You Fools measures how close the Dwarves are to escape.
Diplomatic Incident: Do your antics lead to a massive war some months after your escape, and do you survive it?
Drums in the Deep: Did the Dwarves Dig too Deeply and release their bane?
A table of magic items.
A table of Elvish curses.
A selection of NPCs to face down.
8 tables for randomly generating an Elf King's Palace, and the sorts of encounters a Dwarf might stumble across while escaping.
The party sheet and character sheet…
Prisoners of the Elf King is the next game coming from Caradoc Games. Like Owlbear Omelette, Prisoners of the Elf King is an adventure and a unique game system all wrapped up in one A6 zine. Designed for 1 Dwarf Master (DM), and between 1 and 4 other Dwarves, Prisoners of the Elf King is ideal for a one-shot, a mini-campaign of 2-4 sessions, or for convention play.
Prisoners of the Elf King will be going live on Kickstarter in February, just in time for ZineQuest and ZiMo! And if you're curious about what either of these things are, or are keen to create your own game, then check out my Zine Resources page here.
Hit the 'Follow' button on Kickstarter now!
Rascals is a Finalist…
I was much thrilled and excited to receive the news that Rascals is a finalist in the Freeplay Game Awards Non-Digital Category. Winners of the awards will be announced on the 27th of June, at 7.30pm AEST, and the ceremony can be followed on the Freeplay YouTube Channel here.
To see Rascals listed alongside so many other wonderful games is a real thrill, win or lose, it is a great honour! I thoroughly recommend checking out the other finalists at the link above, they are truly wonderful games!
A short reminder: if you missed the Kickstarter, and are keen to get in on the action, you can find Rascals on the Caradoc Games Webstore here. You can also find it on DriveThruRPG and Itch.io.
For anyone interested, the TableTop Simulator DLC is a great way to play Rascals remotely, and can be found here.
Speaking of the DLC… using the card images I made for TableTop Simulator, and the wonderful art from Juan Ochoa, there is a deck of premium poker cards available print-on-demand from DriveThruRPG, and you can find them here.
Some choose the path, some are chosen, others are called. All accept the risk; all know from scar and memory; the path is not easy. Across rock and ice, through canyons deep and valleys strange, under brutal sun and violent storm, on old paths and new, so venture the Heralds.
The cover, as it stands right now…
Heralds is a post-apocalyptic fantasy RPG, which I am hoping will hit Kickstarter later this year. I am really excited about this game, and it will mark a number of firsts for Caradoc Games. It will be a perfect bound book, and at somewhere around 100 pages, will be the largest game we have released to date. It will also be published in full-colour, with art throughout from the amazing Andie Lugtu.
Andie's art is absolutely stunning, and I can't wait to share some of the other pieces he has created for Heralds.
On the Caradoc Games website, I have updated our list of stockists, and included links to their stores. If you are after a physical copy of Corsairs or Rascals, and want to buy from somewhere in the US, Canada, or the UK, check out our Stockists Page here for the links! More will be added soon!
After some delays, Rascals is being prepped and packaged, ready to post… I have finished all of the 'One-of-a-Kind' backer level pieces, which ended up including a lot more of my drawings than I had expected (my humble apologies to everyone who is about to get more of my attempts to 'art' than they bargained for)!
Below is a link to survey about the future of Rascals. If you have, or are interested in Rascals I am keen to read what you would like to see next…
What's next for Rascals?
I've written about Heralds previously, it was originally the game I had intended to release for ZineQuest 3, but as I worked on it I realised it needed to be a larger game than would fit comfortably in a zine format. Heralds will be the largest game I have produced so far, and I am really excited to see it taking shape!
So what is Heralds?
Heralds is set in the world of Ashmerl, a world where the ebb of magic has had a profound impact. What was once a united empire has been smashed apart, the old low-ways of the World Beneath, which joined the many Enclaves of the World Above are sealed now, too dangerous to travel. Enclaves which once bustled with trade and wealth have been separated, and forced to survive alone as best they could…
The characters are Heralds of their Enclave, daring the hazardous paths over mountain paths and unknown valleys, looking to reconnect what once was whole. But as the world has changed, so too have the people.
In Heralds, the Enclave where the characters grew up is a vital living element of the game. As players make their characters, they will also build their Enclave: map and history. As a group plays, the characters will grow, change, and develop, and so too will the Enclave.
I am hoping that Heralds will hit Kickstarter a little later this year. I won't say much more than that right now, as development and writing are still ongoing; but I will have more to share over the next couple of months. Until then, here is an early draft of the cover, with art by the supremely talented Andie Lugtu…
I had a few people message to ask about physical copies of my RPG of sky ships and floating islands: Corsairs. I am thrilled to say that physical copies of this zine are now back in stock on the webstore here.
Or, if you're US based you can get a copy from Spear Witch, here.
Or in Canada, from Monkey's Paw Games, here.
I think I have said enough this time around, until next time…
Giles.
On the Cards… A Question of Design
You've been called back. Back to the life you thought you had escaped. A foul plot is afoot…
Rascals is an action-adventure science fiction role playing game. It was inspired by such movies as Rogue One, Bourne, The Dirty Dozen, and so on.
Rascals uses traditional playing cards as the core engine for resolving skills tests and challenges. Today I want to talk a little about how this works, and some of the design decisions I made when creating this system.
You can find the pre-launch page to Rascals here, hit Notify to follow the project…
Before I delve into why I made the system this way we need to know how the system actually works.
In Rascals each player will have a hand of cards. When a player undertakes a Challenge, or Reacts to something, they will play a card from their hand into the middle of the table (called the Pot). The GM (called the House), will also play a card according to the Difficulty of the Challenge or React.
Easy: The House will draw two cards, will discard the higher card face up, and play the lower card face down into the pot.
Average: The House will draw and play a card to the pot.
Hard: The House will draw two cards, will discard one face up, and play the other one (note that the House can choose which to play).
Discarding a card face up in an Easy or Hard Challenge will give the player some indication of what they need to succeed. The House may choose the card to play in a Hard challenge, because many adversaries have abilities that can be activated when they play a card of a specific suit. Sure the House may play a card thinking they have a good chance of losing the Challenge, but it might mean that the Adversary gets to do something extra, or special…
Players will redraw cards on Reactions, but not for Challenges they undertake. Cards are the characters inspiration, their drive, and their focus. If they get caught in a series of Challenges – a chase, a complicated engineering problem, heated debate, or firefight, their hand will slowly dwindle. Their options will contract…
Because in the movies this game is inspired by there is always that dramatic narrative, the heroes are challenged, they are set upon, beat down, they escape and struggle, thrown from one bad situation into another, they are running out of options, out of luck…
They manage to duck into a cafe and avoid pursuit, find that vet's clinic and patch themselves up, or lay low in a dive-hotel, giving them a chance to reset, draw breath, plan…
This is the drive behind Rascals, the second act, the false victory leading to despair up to the point where all seems lost, but…
The purpose of this system is to have the characters pushed, to stress their hand and their Hustle (that's another post), encouraging the players to find ways their characters can break the momentum, change the scene, take control, seize the initiative.
When characters find space in a scene they can use a Second Wind to regain cards or heal some, if they escape a scene they can redraw their hand… it's about movement and momentum. About changing the ground. It's about the characters, beat down and hurting, relentlessly pursued, struggling as they roll from one encounter to another, and finally managing to find space, time, to catch their breath, to reform…
This momentum swing – in a narrative arc going from the second to third act and back again – is exactly what the card system in Rascals is designed to reflect. Players should start feeling powerful and in control, slowly feel the pressure mounting as the action builds, then feel the drive to force change – a change of momentum, a change in scene, an escape and reprieve…
Rascals is all about that second act, when things start going sideways for our heroes, when, in the movie theatre, we are on the edge of our seats waiting to see how they'll escape this one… and the relief and excitement when they do, when they pause the tempo, when they manage to find a way to wrest back control.
Did I mention the prelaunch page? It's here… go hit Notify!
mockups-design.com
Announcing: Rascals…
Kickstarter has officially announced Zine Quest (you can find the link to the KS announcement on my Zine Quest page here, along with a bunch of links and articles I hope anyone thinking of undertaking Zine Quest will find useful).
My project this year is Rascals. In Rascals you play ex-special forces, intelligence operatives, or crooks who operated as a team during the final years of the civil war that wrought havoc on the Network of Star Systems now administered by the New Government.
You thought you had left that life behind, when the peace accords of Luyten B were signed and the ink had dried. but something has happened to pull you back in…
In Rascals your character will be one of four archetypes: The Brains, The Face, The Muscle, or The Stick, each tied to a suit of cards. Characters have archetype powers and tricks they can use to manipulate the outcomes of the challenges they face.
Game play is built around cards, with the players sharing a deck, and the GM having a deck of their own. Poker chips are also used to measure character health and energy (called Hustle), ammo that can be spent for extra hits, as well as power and damage to vehicles and ships.
Rascals will be a 40 page zine, including rules for character creation, creation of the problem the characters face, rules for actions, combat, space ships and vehicles. A lot is packed into a small zine!
I'll be writing more about the rules and the setting in upcoming posts, as well as dropping the link to the prelaunch page for the Kickstarter… until then, strap in and get ready for a wild ride!
Locked and Loaded
I was unsure what to do for the 2021 Zine Quest, and I wrote last time how my fantasy RPG, Heralds, was approaching a point where the project was too big to fit comfortably into the Zine Quest format. I could have cut it back, but I like the systems, and I felt it would lose too much if it was cut shorter. I bit the bullet and did what any self-respecting Zine Questee would do, I decided to write a different game.
In fairness I had the core of the system already written up, so I wasn't coming at it from nothing. I knew the genres and themes I wanted to hit, they were baked into the system I had dusted off. So what did I do?
First, I made a few more notes, and left it at that for a week.
In that week I did three things before really delving into the system, setting, and writing. I worked on finding an artist whose style matched my feel for the setting and game, I looked for fonts that would work in a similar vein, and I started developing the layout and look of the zine.
Normally I tend to get writing first, so this was a departure from the established routine for me. Why did I go this route? To be honest, it was the fact that while I had a feel for the game in terms of what I wanted out of the mechanisms and setting, the setting itself was nebulous, it was feelings and emotion, a pace and rhythm, a soundtrack with no lyrics. I felt that getting a good grip on the visuals of the game would help me ground the the rules and setting, provide inspiration and limitation in equal and needed quantities. I'm glad I did.
I found an artist I am really excited to be working with, I won't say too much just yet (not until there is something to show alongside), but I will say that I think his work is going to make Rascals look absolutely brilliant.
I started working on the layout. With Corsairs the game was originally envisaged to be more of a old-time worn look, faded leather and the like. With Rascals I wanted to make something stridently black and white, something that would fit within the two-tone rules for Zine Quest, and really sit comfortably within that space. I am really happy with how Rascals is looking at the moment, and I think once the art is dropped in, it will really look amazing.
Lastly I looked at fonts… and well. That's a whole thing. Finding fonts that fit the style you want, but making sure that they are free for commercial use (or that you can get hold of a license for them), is not as easy as it could be. A lot of the fonts that come with Word or whatever program you happen to use might be free for personal use, but not for commercial use. I looked through a whole slew of fonts before settling on two I really liked. One will be used for all the headings, and the other for the body text. The 3D and gradient overlay effects for the title and contents pages were all done in Affinity, and fit the theme and game perfectly in my opinion.
So, a little update on where I am at in the lead up to Zine Quest 2021. I will be back with more on the subject, and back with some reflections on the year past (and hopes for the year ahead) in another post.
Where-ever you are, I hope you and yours had a lovely Christmas/Holiday period (if you celebrate such things), and a smashing new year (again…).
This article is a part of a series about running a Kickstarter campaign for Zine Quest, you can find the other articles in this series here.

redpajama_set_name: RedPajamaCommonCrawl


text:
African Curriculum Modules
Korean and China: Under the shadow of Dai Nippon Teikoku
Unit 1: Street Children in Africa
This module focuses on the growing plight of street children in African cities (across the continent). Special attention is given to the causes of this crisis including: globalization, neo-liberal economic/social policies, legacy of colonialism, corruption, government capacity. Attention is also given to attempts to address the problem.
Children's rights/welfare, migration, corruption, globalization, sociology, history, political science, economics
View This Unit
Unit 2: Exploring Community Values and Norms through Story Telling Among the Ewe Peoples of Ghana.
This module will enhance and broaden understanding of the major components of folk narratives by viewing storytelling through a Ghanaian lens. The module will emphasize studying structure, theory, and the effects of culture on storytelling. Students will develop skills to understand the power of stories more profoundly: to use them in their own lives; within their social groups; and, cultural frameworks.
Literature, anthropology, philosophy, culture, narrative, storytelling, community norms & values.
Unit 3: Practical Fractal African Algorithms
Fractal structure and design is not a new, computer-generated concept but one historically represented in indigenous cultures. This module explores fractal designs found in African villages and the strip-woven cloth patterns of the Ewe people of Ghana and Togo. Application of the woven cloth includes a study of symbols, color, and messages.
Art, textiles, architecture/design, math, anthropology, philosophy
Unit 4: From Africa to African-American Cultural Awareness & Shifting Identities within the Context of Race and Slavery
This module lays out the socio-cultural connections between Africa and English speaking North America, as a result of the Atlantic Ocean slave trade. The module highlights the social, cultural, linguistic practices from the continent that survived the Middle Passage, chattel slave in North America, contributing to race, identity, and world-view.
Slavery, culture, identity, history, literature, linguistics, art, music.
Unit 5: Food Production and Food Security in Sub-Saharan Africa
This module focuses on food production and food security in sub-Saharan Africa.
Eradicating poverty and hunger was one of Millennium Development Goals (MDGs, 1999-2015). The MDGs have been replaced by the Sustainable Development Goals (SDGs); achieving "Zero Hunger" is one of the central goals of the SDGs. Unlike Asia and Latin America, achieving food security in sub-Saharan Africa has been an uphill challenge. The module addresses the geographical, historical, political, socio-cultural and economic reasons for the food crisis and highlights potential solutions.
Geography, history, political science, anthropology, climate change, environment, food production, globalization, international trade,foreign aid and foreign direct investment
Unit 6: Respecting Indigenous Knowledge
This module focuses on the rich, but largely unrecognized and untapped, resource of indigenous knowledge in Africa, with special reference to Ghana. The module provides an overview of indigenous knowledge and its importance in African societies. The core of the module addresses how indigenous knowledge can (should) be used in addressing contemporary issues on the continent from food production to education and health care.
Philosophy, history, anthropology, agriculture, education, health care
Unit 7: The African Presence in Asia
The African Presence in Asia: Using media and research from an interdisciplinary approach and other resources (OER) explore concepts such as Ubuntu; a business model, Environmental Justice, development of radical thought and action such as Black Lives Matter, Mass Mind (China) and Education for Self-reliance theories (Tanzania) , science and discoveries and the development of humane social practices. State of the art delivery methodology such as cell phones as an educational tool is a technological approach.
Unit 8: Historical and Contemporary Migration in Africa
This module will use the history of African migrations to introduce students to the history and cultures of Africa, as well as connecting present-day migration to histories students are more familiar with (histories of migration to the United States). The module will emphasize several important key periods in African migration history, including the Bantu migrations, the Transatlantic Slave Trade, colonial labor migration, 20th and 21st century urbanization, and colonial/post-colonial migration out of the continent to Europe and the United States.
Unit 9: Timbuktu - Center of Knowledge
A focus on the significance of Timbuktu, Mali as an historic center of knowledge. Current information on historic manuscripts of Timbuktu will be examined.
Unit 10: Popular Expressions of Nationalism in Zimbabwe
Using Zimbabwe as a site of analysis, this module demonstrates how the people of Zimbabwe, in their different communities, have expressed their sense of national identity with an emphasis on the colonial and post-colonial eras. Various popular expressions will be studied: including larger phenomena by which people organize themselves such as religion, unions, militancy and political parties (macro-expressions), as well as the more specific expressions employ from within or outside the lenses of these organized spaces, and these include music, theatre, literature, protest (micro-expressions).
Unit 11: Parallel History - A Comparison of United States and South African History
This curriculum module will focus on common themes in the history of southern Africa and the United States across the totality of the histories of both areas. The themes I have chosen to focus on are colonial conquest and resistance, the establishment of government and cultural institutions, industrialization, urbanization, and the establishment of human and civil rights documents and structures. While using history as the supporting and organizing structure, the module will have wide application among all disciplines of the social sciences. For example, the themes of the development of human and civil rights is ideally suited for inclusion in Sociology courses, the themes of government can be included in Political Science courses, and the economic corollaries between the histories of the two areas are applicable to economics courses. The module will be applicable to courses in all social science disciplines.
Unit 12: Introduction to Geography of Africa
Geographers use five main themes of geography to explore areas of interest, there are Location, Place, Human-Environment interaction, Movement and Regions. In this learning session we will also introduce spatial organization as a way to describe natural phenomena and understand interactions between people and the environment through map visualization.
Unit 13:Climate Change in Africa
This module discusses the climate and biomes of Africa, looking at rainfall, temperature, and biomes. It goes on to discuss how these biomes and climates are being affected by climate change and the factors contributing to the changes.
Unit 14: Disability in Africa
This course is designed to increase the student's awareness, sensitivity, and understanding of the individual, social, cultural, political, and legal aspects of disability in Africa. Students will explore various disability issues people in Africa experience as well as how they and their families are impacted by disability.


Mai Asian Restaurant is a casual dining restaurant, offering fresh-cooked home-style Asian dishes. Having been serving New Brunswick and Quebec communities formore than 20 years, we are proud of our great quality and authenticity.
For those with pure food indulgence in mindand a craving for South East Asianflavors, come in and satisfy your desires with our seasonally-inspired traditional dishes. We bring our lively food scene that can be found in every corner of South East Asia right here into the hearts of Greater Moncton neighborhoods.


This series will take us through each of the A's in AAA through the eyes of a RADIUS server that will service some network devices.
This particular post is going to focus on Authentication using a Microsoft Network Policy Server. As this series continues I plan on doing the same with FreeRadius and Cisco ACS/ISE down the road.
To install the NPS role you can either use the Server Manager or use Powershell.
Go ahead and open NPS, once its up the first thing we need to do is register the server in active directory, this allows the radius server to read AD accounts.
In the NPS server we have 5 main sections and several subsections, let's do a quick overview of them before we dive into the configurations.
RADIUS Clients – This is where your radius devices and their shared secrets are defined.
Remote RADIUS Server Groups – This is where RADIUS proxy servers are defined.
Connection Request Policies – This controls what connections are processed and when.
Network Policies – This is where the bulk of the radius configuration happens, it controls the policies of who can connect and what they are allowed to do.
Health Policies – This is for NAP configuration which we aren't to concerned with in this series.
We won't necessarily be doing a lot with NAP but this is where you can make sure the client meets certain requirements like firewall enabled before granting them access.
Like the name says, this allows you to save common items such as shared secrets as templates to help make your configurations more consistent.


Apparently, a lot is being split or broken up… As Mashiat posted earlier, the state run monopoly Coal India is being broken up, but that is not the only vital industry being broken up, – The Indian government, acting on Air Force demands, has offered to spend $12 billion to encourage private firms to establish an aircraft manufacturing facility — a move that would break Hindustan Aeronautics Limited's (HAL) monopoly on aircraft manufacturing.
The reason for this potential break are years of delays on several essential projects, possibly due to the diversification. HAL is involved in the design of fighters, transports, trainers and helicopters, avionics and engines, which meant a decline in focus, decrease in efficiency and a delay in projects.
"It is absolutely essential to set up an additional military aircraft facility here, as HAL is overloaded for the next 10 years and has become too unwieldy," defense acquisition expert Miral Suman said.
Subhash Bhojwani, retired Air Force air marshal, agreed an additional manufacturing facility is needed, but said HAL should be made more commercial.


The instructing party is supposed to be authorized to place orders. The instructing party safeguards the plc RAAK against any third party, with regard to the order. Unless otherwise agreed upon, the creations by the plc RAAK remain the property of the plc RAAK. Their use and reproduction are only authorized by previously written consent.
As mentioned in the offer, the instructing party is entitled to receive a prototype, a test version or a trial version. The approval of execution signed by the instructing party, discharges the plc RAAK from any responsibility with regard to errors in the creation which would be found afterwards.
Unless otherwise agreed upon, the plc RAAK is not held responsible to store creations and/or work files.
All complaints or queries shall be sent by registered letter within 8 days following the delivery or the refused delivery. plc RAAK's responsibility is always limited to the (partial) refunding of the price for the non-conforming part of the order. The plc RAAK denies any responsibility whatsoever, including the responsibility for possible damage that would be caused by it's creations to persons or goods.
When the attributed order is suspended or cancelled on request of the instructing party, all performances and costs will be billed at that moment. This amount will be increased, on a flat rate basis, by a cancellation cost of 25% of the total price of the order, without exceeding this total price. Such cancellation or suspension can only be initiated by registered letter.
The plc RAAK shall manage and handle the material of the instructing party according to the 'prudent man' principle, but explicitly denies any responsibility concerning this material. Each transport of this material shall be executed at the risks of the instructing party. The plc RAAK can charge costs for the storage after termination of the order. If the invoices are not paid on their expiry date, this material can be kept as guarantee or security.
Unless otherwise agreed upon, an advance of 30% will be billed when the order will be placed. During the presentation of the prototype, test version or trial version, another 30% will be billed. The balance will have to be paid at the time of delivery. The invoices of the plc RAAK have to be paid within 30 days after the invoice date, unless otherwise mentioned on the invoice. On the expiry date, any sum due will be increased, without any prior notice and as of right, by an interest of 12%, a flat rate recovery cost (10% or at least 50,00€ per invoice) and possible judicial recovery costs. If one invoice is not paid on the expiry date, the plc RAAK can claim the payment of all amounts due and suspend or end all current orders, without any further formalities.
In case one or several of the provisions of these general conditions are or become invalid or void, it will not affect the validity of the other provisions. The plc RAAK will make all necessary efforts in order to avoid differences of opinion and disputes, or will try to settle them amicably. If necessary, only the Courts of the district in which the plc RAAK's registered office is located, shall be competent.


Daza Andrada, A.; Gutierrez Barquin, M.G.
Data on 1087 farrowings of 228 crossbred sows were analysed. Season of farrowing had no significant effect on the number of liveborn piglets per litter (9.61-10.0), but preweaning mortality was significantly higher for piglets born in autumn or winter (19.41 and 14.63% respectively) than in spring or summer (12.06 and 12.99%). Litter size increased with increasing parity (from 8.44 in 1st to 11.94 in the 8th farrowing).


Have you heard Dr. James Dobson's over the public announcement or radio? The local supermarkets here normally play his preachy words over the speaker and though I never pay attention to what he says, I know that those are pretty good and sensible advices.
Normally, when I am doing my grocery shopping, he will be advocating the importance of having family meals together and ensuring that the family eats together at least one meal a day. In our busy lifestyle, many families do not have this chance as the parents may be away working while the children are with maids. But parents have to make sure that they have this family time together as it is one of the most important family bonding hour.
Since I am a full-time mom and a pretty decent cook, we have a lot of meals at home. In fact, sometimes, we have meals at home for several days in a stretch. Therefore, our family bonding time is actually those meals outside. The moment we got in the car, we will be chatting all the way to the restaurants and back.
Therefore, it is my wish that through this blog, I can help more women to prepare simple home cooked dishes so that each family can benefit from the family bonding. Sometimes, preparing a meals can also be used as time for a lot of fun and action together. My children will help me and even my husband will joke around.
So dear parents, remember to built a happy home by eating together. I have seen many broken homes who eventually cause their children to become involved in a lot of unwanted situation. Substance Abuse for example is so common. It happens even to my relatives and it is a known fact that the family hardly meets at all as both parents were always too busy making money.
anyway, that must be Cold Storage. I used to wonder was someone put in the wrong CD for the audio. But the advices were pretty good.