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A pragmatic cluster randomised controlled trial of a Diabetes REcall And Management system: the DREAM trial
Martin P Eccles1,
Paula M Whitty1,
Chris Speed1,
Ian N Steen1,
Alessandra Vanoli1,
Gillian C Hawthorne2,
Jeremy M Grimshaw3,
Linda J Wood4 &
David McDowell5
Following the introduction of a computerised diabetes register in part of the northeast of England, care initially improved but then plateaued. We therefore enhanced the existing diabetes register to address these problems. The aim of the trial was to evaluate the effectiveness and efficiency of an area wide 'extended,' computerised diabetes register incorporating a full structured recall and management system, including individualised patient management prompts to primary care clinicians based on locally-adapted, evidence-based guidelines.
The study design was a pragmatic, cluster randomised controlled trial, with the general practice as the unit of randomisation. Set in 58 general practices in three Primary Care Trusts in the northeast of England, the study outcomes were the clinical process and outcome variables held on the diabetes register, patient-reported outcomes, and service and patient costs. The effect of the intervention was estimated using generalised linear models with an appropriate error structure. To allow for the clustering of patients within practices, population averaged models were estimated using generalized estimating equations.
Patients in intervention practices were more likely to have at least one diabetes appointment recorded (OR 2.00, 95% CI 1.02, 3.91), to have a recording of a foot check (OR 1.87, 95% CI 1.09, 3.21), have a recording of receiving dietary advice (OR 2.77, 95% CI 1.22, 6.29), and have a recording of blood pressure (BP) (OR 2.14, 95% CI 1.06, 4.36). There was no difference in mean HbA1c or BP levels, but the mean cholesterol level in patients from intervention practices was significantly lower (-0.15 mmol/l, 95% CI -0.25, -0.06). There were no differences in patient-reported outcomes or in patient-reported use of drugs, or uptake of health services. The average cost per patient was not significantly different between the intervention and control groups. Costs incurred in administering the system at the register and in general practice were in addition to these.
This study has shown benefits from an area-wide, computerised diabetes register incorporating a full structured recall and individualised patient management system. However, these benefits were achieved at a cost. In future, these costs may fall as electronic data exchange becomes a reliable reality.
Trial registration: International Standard Randomised Controlled Trial Number (ISRCTN) Register, ISRCTN32042030.
There is broad, international agreement over what constitutes high-quality health care for people with diabetes [1, 2]. In the United Kingdom (UK), this has been captured in a National Service Framework for people with diabetes [3]. At the time of setting up the Diabetes REcall And Management system (DREAM) trial, computerised central recall systems for patients and their family doctors had been supported by the evidence from a 1999 systematic review [4]. However, the evidence base on which these conclusions were based was limited to that from patient- rather than practice-randomised trials, in selected practice samples, and without economic evaluation. Thus the effectiveness of an area-wide, patient-focussed, structured recall and management system (in terms of process of care, patient outcome, and economic impact) remained unknown. A recent systematic review of quality improvement interventions to improve the quality of care in patients with diabetes showed that a range of different interventions resulted in small to modest improvements in glycemic control and in provider adherence to optimal care [5]. Across 59 studies (only five from the UK), they reported a median absolute reduction in serum HbA1c of 0.48 and a median absolute increase in provider adherence of 4.9%. However, they also identified important methodological concerns, with larger studies and randomised studies showing smaller benefits than smaller or non-randomised ones, which strongly suggest the presence of publication bias. Studies in the highest quartile of sample size reported a median reduction in serum HbA1c of only 0.10%.
Within their taxonomy of interventions the categories of "provider reminders" and "audit and feedback" most closely approximate to the intervention in this study. Across 14 trials examining one or both of these interventions, they found median improvements in provider adherence of between 4% and 8%, and improvements in HbA1c of around 0.1%[5]. They also examined 38 comparisons involving some form of clinical information system to deliver the intervention, finding no incremental benefit for any particular informatics function (i.e., decision support, auditing clinical performance, reminder systems), over and above delivering the function without an informatics system.
Following the introduction of a computerised diabetes management system in three (then) Primary Care Group areas, in the northeast of England, care initially improved but then plateaued, a phenomenon also reported by others [6, 7]. At the point this assessment of care was performed, the measures of care were restricted to documenting the performance of various actions (e.g. measurement of BP) rather than documenting the values. We postulated that the platueauing was due to clinicians failing to deliver appropriate clinical interventions due to a lack of coordination (i.e., patients being lost to follow-up), and either a lack of awareness of appropriate care or forgetting to deliver all that was required when patients were seen. Therefore, we developed the diabetes register system to address these problems.
This study aimed to evaluate, within a pragmatic, cluster randomised controlled trial design, the effectiveness and efficiency of an area-wide, 'extended' computerised diabetes register incorporating a full-structured recall and management system, actively involving patients, and including individualised patient-management prompts to primary care clinicians based on locally-adapted, evidence-based guidelines.
The study methods described here are reported in detail elsewhere [8].
Study general practices and registers
The study general practices were those in three Primary Care Trusts (PCTs) served by two district hospital-based diabetes registers, both using the same register software. When the study was designed, it was based in three PCTs (all agreed to participate in the study) served by a single register. However, the withdrawal of one of these PCTs necessitated the recruitment of a replacement PCT served by a second register. Several factors led to the withdrawal of this PCT. Despite our having appropriate administrative approval, when the trial began it became apparent that the administrative authority did not have the cooperation necessary for all of the GPs to participate in the trial. Consequently we had to enrol individual practices directly (rather than via the PCT), which resulted in fewer practices enrolling and our being at risk of not achieving our required sample size. We recruited a further PCT to address this problem, however, the original PCT then suspended involvement with the diabetes register and their practices had to be excluded from the study. This was a deviation from the published protocol.
Study patients
Study patients were those people with type 2 diabetes appearing on the registers, aged over 35 years and receiving diabetes care exclusively from study general practices or shared between study general practices (GPs) and hospital. At the time of the study, approximately 20% of patients received both GP and specialist care, though there was no formal shared-care scheme in operation in the PCTs studied.
Study design, outcomes and power
The study was a pragmatic two-arm cluster randomised controlled trial with the general practice as the unit of randomisation. Randomisation was performed using electronically-generated random numbers by the study statistician and was stratified by PCT and practice size.
The study outcomes were: the clinical process and outcome variables held on the diabetes registers; patient reported outcomes (the SF36 health status profile [9–11], the Newcastle Diabetes Symptoms Questionnaire [12], and the Diabetes Clinic Satisfaction Questionnaire [13]); and service and patient costs. Patients have been shown to be able to report cost data reliably [14].
As this was a quality of care study interested in a range of measures of care, it was important to use as study outcomes the routinely available process and outcome measures on which clinicians alter patients' care. Our power calculation was based on indicative process and outcome variables. The intra-cluster correlation coefficient (ICC) for measures of process calculated from local data was 0.14, whether a blood pressure measurement or an HbA1c measurement has been recorded in a 12-month period. Therefore, to detect a difference of 15% (42.5% v 57.5%) in a binary variable with 80% power, assuming a significance level of 5%, required 60 practices each contributing 30 patients [15]. The sample size for the outcome of care variables was based on the SF-36. Previous work had shown that where this type of intervention produces an effect, it was likely to produce an effect size of approximately 0.25 in such measures [16] – and that the ICCs for such measures would be approximately 0.07 [17]. A final sample of 27 patients from each of 61 practices would give 85% power to detect an effect size of 0.25, assuming a significance level of 5%. Assuming a response rate of 70%, the starting sample size was 2379 patients (approximately 39 patients per practice).
We collected process data for the 12 months preceding the start of the intervention and for the 15 months of the intervention period (1st April 2002 to 30th June 2003). All data were extracted from the registers at the end of the intervention period. Prescription data were similarly collected, but, because of problems reliably determining the date of initiation of prescriptions, we collected drug data back to the point at which a study patient first appeared on the register. We gathered data on patient reported outcomes by postal questionnaire at the end of the intervention period. Questions on the costs incurred by patients were developed by the study health economist and were included in the questionnaire. These questions included the self-reported use of medication. Non-responders to the initial posting received a reminder letter after two weeks; non-responders to this received a second reminder letter and a copy of the questionnaire after a further two weeks.
We gathered information on workload and other resource impacts of the intervention in general practice, with a semi-structured telephone interview survey of key informants within a random sample of 10 intervention and 12 control practices. Similar information on the impact on the registers was collected by the register staff, logging time spent on intervention-related activities.
The following analytic strategies were adopted. For the process of care and intermediate outcome variables collected directly from the register, the dependent variable took the form of an observation for an individual patient in the period after implementation of the intervention. We had data on these variables both before and after the intervention, and, for each variable considered, the post intervention measure was specified as the dependent variable and the corresponding pre-intervention measure was specified as a covariate. The effect of the intervention was estimated using generalised linear models with an appropriate error structure (binomial for binary data, normal for continuous data, and negative binomial for count data) and link function (logit for binary data, identity for continuous data, and log for count data). To allow for the clustering of patients within practices, population averaged models were estimated using generalized estimating equations (GEEs). Baseline variables (pre-intervention data) were included in the model as a covariate.
Examination of the drug therapy data suggested that the variable that was recorded most reliably on the register was the date that the medication was started. In general, patients who started on a particular medication prior to the intervention period also were taking that medication during the intervention period. For each type of medication, the total number of patients prescribed that medication in each practice was determined. This variable was analysed using negative binomial regression with the total number of relevant patients in the practice included as an exposure variable; the number of patients prescribed that medication prior to the intervention was included as a covariate.
Questionnaire data were only available following the intervention. Patient-reported outcome measures were analysed using population averaged models as described for the process data above, except that, as we had no pre-intervention measure, no adjustment for differences at baseline was possible, thus no baseline covariate was included in the model. Patient reported medication data were analysed for the register medication data, except that, again, there were no baseline data to include as a covariate.
In addition to the above analyses that were pre-specified, because of large systematic differences between the two registers that became apparent once the data had been collected, a further model was fitted which included a register effect. This was not pre-specified, but the differences were so large it was felt that it would be inappropriate to ignore them during the main analysis. All analyses were undertaken using Stata version 8.
The economic evaluation adopted a 'cost consequences' approach [18]. All costs were expressed in 2002/2003 values. Two main sources were used to assign costs to health care resources [19, 20] supplemented when necessary with unit cost data from other official sources [21] and local surveys. Drug costs were taken from the British National Formulary [22]. Patients reported on the use of NHS (National Health Service) services, medications, travel costs, costs for the purchase of special items, private treatments/consultations and time off work, sick leave and related pay loss, as well as time off work and related pay loss to their companions over a twelve-month period. No discounting was applicable. A simplifying assumption was made that the use of all costs and resources occurred at the beginning of this period.
The development and implementation of the intervention have been described in detail elsewhere [23]. In summary the pre-existing diabetes register functioned as a central register of patients with diabetes. A structured dataset was completed on paper forms and returned to the central register; the hospital laboratory provided a monthly download of laboratory test results (e.g. HbA1c) for patients on the register. From this data both patient-specific and aggregated data were provided annually to patients and clinicians. The pre-existing system was passive, in that it did not request data for patients, rather it summarised the data it received. We postulated that the platueauing of performance that had been documented was due to clinicians failing to deliver appropriate clinical interventions due to a lack of co-ordination (patients being lost to follow up) and either a lack of awareness of appropriate care, or forgetting to deliver all that was required when patients were seen.
In the enhanced structured and recall management system, a 'circle of information exchange' was established between the participating general practices and the database. The central database system identified when patients were due for review and generated a letter to the patients asking them to make an appointment for a review consultation. The rules for generation of review letters were adapted for each PCT area. In one PCT, the system acted as a prompting system for annual review, and patients were identified 11 months after their last diabetes appointment. In the other two PCTs, patients who had missed annual reviews were identified by searching for patients who had not had a diabetes appointment for 14 months or more. At the same time, the central database generated a letter to the practice stating that the patient should be making a review appointment in the near future. The letter to the practice included a 'structured management sheet' (to be held in the patient's record) to capture an agreed minimum data set that would be collected during the consultation. This management sheet also contained relevant prompts tailored to a patient's known clinical or biochemical values, derived from locally adapted, national evidence-based guidelines [see Additional file 1].
When the patient was seen in the practice, the primary care professional (often the practice nurse) completed the management sheet and returned a copy for entry into the central register within a designated period of time. This circle of information was broken if the patient did not visit the general practice as planned or the general practice did not return the management sheet to the central register. If this happened, the central register would print reminder letters and further structured management sheets at the next routine database search by the diabetes register facilitator, which occurred at least weekly.
In addition to this cycle based on annual reviews, routine ongoing structured management sheets were produced every time a patient in an intervention practice was identified by the diabetes register facilitator on the register database. For example, when data were inputted on the database for any reason, the system would print a structured management sheet updated for any new data and relevant management prompts, and this would be sent to the relevant practice.
The trial intervention ran for 15 months, commencing on 1 April 2002 and ending on 30 June 2003. The letters to patients inviting them for annual review commenced in October 2002 – delayed to overcome concerns about the accuracy of patient details on the database up to this point. The enhanced system also was capable of producing patient letters to accompany routine ongoing structured management sheets for practices, but because of difficulties operating this element of the software it was not possible to run this feature during the lifetime of the trial. This was a deviation from the published protocol.
The study was approved by the South Tyneside, Southwest Durham, Hartlepool, and North Tees Local Research Ethics Committees (LRECs).
Figure 1 shows the number of practices and patients at each stage of the study. It was not possible to provide the number of patients within the 90 practices assessed for eligibility, as we did not have ethical approval to access data on the patient inclusion criteria for practices that had not agreed to participate in the study. As a condition of ethical approval in one of the PCTs, individual opt-out consent had to be sought from patients whose practices had agreed to participate: 477 out of 4577 (10.4%) patients invited to participate opted out of the trial. [The considerably higher number of patients written to as compared to the number of patients included in the trial reflected the need to get permission before being able to access the diabetes register – and then apply the inclusion criteria.] Table 1 shows the baseline characteristics of control and intervention practices and patients. None of the differences in these variables between the intervention and control group are statistically significant. Unfortunately, we were unable to compare the clinical characteristics of respondents and non-respondents to the patient survey, as we were subject to the requirement of the ethics/research governance organisations that we should not hold any patient-identifiable data within our academic institution. We were supplied with a list of names and addresses of patients to whom we could send out a patient survey, but were not allowed access to link that information with individual patient records on the registers.
Table 1 Baseline characteristics of control and intervention practices and patients.
Flow of clusters and individual participants through each stage of recruitment, randomisation and analysis.
The findings from analysis of the process of care clinical variables and drug data from the register-derived dataset are shown in Table 2. This analysis is adjusted for differences at baseline and a systematic difference between registers. Analyses allowing for baseline data only and register effect only are presented alongside this analysis in Additional file 2 [see Additional file 2]. Nineteen subjects (7 in control group, 12 in intervention group) had no valid date in their medication record and were excluded from the medication analysis. With the exception of serum creatinine, a variable that we anticipated that the intervention would not influence, all of the variables measured showed a direction of effect in favour of the intervention. For 10 of the 26 variables measured, this difference achieved statistical significance.
Table 2 Adjusted register-derived process and clinical outcome data results for intervention and control groups. Odds ratios are estimates of the difference between intervention and control practices at follow-up, adjusting for differences at baseline and a systematic difference between registers.
Patient reported outcome data
We surveyed a random sample of 3056 patients, receiving usable responses from 1433. With 241 exclusions, this gave an overall response rate of 51% (number of eligible subjects who responded divided by the number of people sampled, minus those known to be ineligible) (Figure 1). There were no statistically significant differences in response rate between intervention and control group respondents, or on any sociodemographic variables. Analyses of the patient-reported medication data are summarised in Table 3. The differences between intervention and control groups were not statistically significant. There were no differences between the two registers, so the adjusted values differ little from the unadjusted ones. The patient-reported outcome data from the questionnaire survey are summarised in Table 4. The ICC for the diabetes symptom score was 0.03, and the ICCs for the SF 36 physical and mental health component scores were 0.03 and 0.02, respectively. There were no statistically significant differences in scores on any of the measures in Table 4, or on any of the items of the DCSQ.
Table 3 Self-reported medication data from the patient questionnaire survey.
Table 4 Patient-reported outcomes
The economic data relating to service use and patient expenditure are summarised in Table 5, and were not significantly different between intervention and control groups. The intervention costs were: UK£11,443 for developing the local guidelines, UK£14,034 for software development, and UK£2,408 for educational activities. This gave a total one-off cost of initiating the system across the two register areas of UK£27,885. The additional annual cost of running the system for the two registers was UK£11,170. Based on the interviews with practice-based informants, the mean maximum annual cost per patient that the practices had to meet when using the system (including staff time and consumables) was estimated at £76.46 per patient; the minimum annual costs were zero. However, because of the semi-structured nature of the interviews, it was not possible to accurately estimate the distribution of costs within this range.
Table 5 Economic analysis profile (Costs expressed in 2002/03 UK£).
We have evaluated an area-wide computerised diabetes register incorporating a full structured recall and individualised patient management system – one of the largest trials of its kind in terms of the number of provider units, and the largest in terms of patient numbers. The intervention produced improvements in patient attendance, improvement in four of the nine measured areas of provider adherence to recommended care (the recording of foot examination, dietary advice, blood pressure, and smoking status), and improvement in one measure of clinical control (serum cholesterol). These benefits incurred costs.
Although we showed significant improvements in the recording of drugs in the database, there were problems with the dating of the drug data. The patient reported data on drug use showed no significant differences in usage between the two groups. Given this discrepancy and the potential for inaccuracy in both data sets, the impact of the intervention on prescribing has to be regarded as unclear.
In our study which utilised provider reminders and audit and feedback within an information system, we found changes in provider adherence that were considerably larger than those identified in the review by Shojania et al., and four of our nine were statistically significant improvements [5]. However, because our data was coming from a routine register it is important to consider the possibility that, for the provider adherence variables, some of the effect was due to a recording phenomenon, and the same actions were being performed as frequently in control practices but were just not being recorded. Setting aside the fact that the recording of care, particularly in chronic disease management, is a central part of good care [24], all of the provider adherence and all of the clinical variables showed a direction of effect in favour of the intervention. In addition, four of the provider adherence variables (recording of HbA1c, cholesterol, serum creatinine, and urinary albumin:creatinine ratio) were not reliant on recording within general practices; they were routinely transferred into the diabetes databases directly from the laboratory information systems, and so would not be subject to any recording effect. Whilst these were not statistically significantly different between intervention and control groups, many clinicians would regard changes of this size as clinically significant (16% increase in HbA1c recording and 21% increase in cholesterol recording).
There is some suggestion of under-recording of data on the registers, with an apparently low proportion of people on aspirin and insulin (mirrored by an apparently high proportion of people on diet alone). This is almost certainly due to a combination of factors of which a degree of under-recording is only one. Low aspirin prescription rates could be due to patients buying aspirin directly from pharmacies rather than receiving it via prescription (common in the UK). This is supported by the figures for self-reported aspirin use being higher than those on the registers. Excluded from the study were people being treated for their diabetes solely by hospital, who are more likely to be treated on insulin and less likely to be on diet alone. However, while we have the same rates for patients treated with diet alone from the register and from self-report, self-report of insulin use was considerably higher than on the registers. This suggests that insulin use was under-recorded on the registers, but equally so for both intervention and control groups.
Unlike the studies in the review, we found no significant effect on levels of HbA1c. This may reflect the overall levels of control in our study population with baseline HbA1c of 7.7, and both groups improving to 7.3. The studies in the review were conducted in more poorly controlled populations, with median baseline HbA1c values of over 8 (and in one case over 10). Our findings also may reflect the relatively short period for which the intervention ran as fully intended. While the intervention was in place for the planned 15 months, the full intervention ran for only 9 months, and the intended patient intervention was never fully operational.
We did, however, show a modest and statistically significant lowering of serum cholesterol of 0.15 mmol/l in the intervention group compared to the control group. As the impact of the intervention on medication, including lipid-lowering therapy, was unclear from the register-derived data and negative from the patient-reported data, it is possible that this effect may be due to the increased delivery of dietary advice – one of the four areas of improvement in provider adherence to recommended care.
We showed no significant difference in patient-reported outcomes between intervention and control groups. The observed clustering in the outcome scores was smaller than that assumed in the sample size calculation, and, as we achieved the desired sample size, the lack of significant changes in patient outcomes is unlikely to be due to a lack of power. However, we do have to consider the possibility of non-response bias for all the self-reported data with a response rate of 51%, even though there was no difference between intervention and control group response rates, or on sociodemographic variables.
It is very unusual for implementation trials to include a rigorous economic evaluation [25]. Given that implementation trials do not produce a single estimate of overall effect, we have expressed the economic evaluation in terms of the profile of incurred costs. Our assessment of costs incurred by the practices was limited, and so we have only suggested a hypothetical illustration of the likely costs for an average Primary Care Trust as shown in Table 6. Whilst we could not precisely define the distribution of the costs for general practices, assuming an average cost of 25% of the range shows that the practice incurred costs would still be the single largest cost element incurred by introducing a system such as this. Whilst for any individual practice the figures would be proportionately lower, in a demand-led system such as UK general practice, coping with such innovations should be accompanied by commensurate resources. This is particularly important when, as in this case, an innovation can reside in specialist services or hospital care that has no responsibility for expenditure incurred in family or general practice. In any future study, a more detailed costing study in general practice would be important.
Table 6 Hypothetical example of the estimated costs of the intervention applied to an average PCT (Costs expressed in 2002/03 UK£).
This study has shown benefits from an area-wide, computerised diabetes register incorporating a full structured recall and individualised patient management system. However, these benefits were achieved at a cost. In future, these costs may fall as electronic data exchange becomes a reliable reality. However, as performance steadily rises it will become ever more difficult to demonstrate smaller and smaller incremental improvements. Considering our findings alongside those of Shojania's review, such developments should only be evaluated in large-scale, randomised controlled trials incorporating a full economic evaluation.
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This study was funded by Diabetes UK, and Northern and Yorkshire Regional NHS R&D Office. The study was independent of the funding bodies, and the views expressed here are those of the authors and do not necessarily reflect the views of the funding bodies. The study funders had no involvement in the study design, collection, analysis, interpretation of the data, writing of the report or paper, or in the decision to submit the paper for publication.
We are grateful to our collaborators at North Tees and Hartlepool NHS Trust, particularly Dr Carr, Dr MacLeod, Joanne Clayton and John Fitzsimmons; at Easington Primary Care Trust and North Tees Primary Care Trust; and at South Tyneside Primary Care Trust and South Tyneside Healthcare NHS Trust, particularly Professor C Bradshaw and Dr J Parr, Wynn Schembri and Clare Beard. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Uptake and Transfer. The Diabetes Clinic Satisfaction Questionnaire was supplied by Prof C Bradley.
Centre for Health Services Research, University of Newcastle, Newcastle upon Tyne, UK
Martin P Eccles, Paula M Whitty, Chris Speed, Ian N Steen & Alessandra Vanoli
Diabetes Centre, Newcastle Primary Care Trust, Newcastle upon Tyne, UK
Gillian C Hawthorne
Clinical Epidemiology Program, Ottawa Health Research Institute, and Department of Medicine, University of Ottawa, Ottawa, Canada
Jeremy M Grimshaw
Northern and Yorkshire Regional Office, Diabetes UK, Darlington, UK
Linda J Wood
c/o ProWellness UK Ltd, Centre 500, 500 Chiswick High Road, London, W4 5RG, UK
David McDowell
Martin P Eccles
Paula M Whitty
Chris Speed
Ian N Steen
Alessandra Vanoli
Correspondence to Paula M Whitty.
Declaration of competing interests
DM was senior partner of Westman Medical Software, who developed the software. The company was taken over by ProWellness UK Ltd, who continue to maintain the software used in this study. The remaining authors declare that they have no competing interests.
The study was conceived by ME, GH and JG. It was designed by ME, GH, PW, JG, NS, AV, DM and LW. It was run by PW, CS, GH, AV and ME. DM developed and modified the software. Senior clinicians and diabetes register staff in the two sites ran and maintained the intervention. NS supervised the analysis. AV conducted the economic evaluation. All authors commented on successive drafts of the paper. ME is the guarantor of the paper.
Additional File 1: Example of a structured management sheet. The file provides an anonymised example of a structured management sheet from the enhanced diabetes register. (PDF 292 KB)
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Additional File 2: Table 2 (expanded). Unadjusted and adjusted register-derived process and clinical outcome data results for intervention and control groups. This table reproduces the data provided in Table 2 and also includes analyses allowing for baseline data only and register effect only. (DOC 85 KB)
Eccles, M.P., Whitty, P.M., Speed, C. et al. A pragmatic cluster randomised controlled trial of a Diabetes REcall And Management system: the DREAM trial. Implementation Sci 2, 6 (2007). https://doi.org/10.1186/1748-5908-2-6
Diabetes Register
International Standard Randomise Control Trial
Study General Practice
Serum HbA1c


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Breaking: Home Central on fire
by: NC 34 Staff
Posted: Feb 13, 2020 / 07:32 PM GMT-0500 / Updated: Feb 13, 2020 / 09:18 PM GMT-0500
Home Central caught fire Thursday afternoon.
Emergency response crews are currently at the Vestal store, located at 199 Stage Road.
The smoke can be seen for miles and appears to be severe.
NewsChannel 34 is headed to the scene and will have updates.
by Daryl Matthews / Jan 16, 2021
(WETM-TV) - Some Hot Pockets are being recalled because they may contain hard plastic or glass.
Nestle prepared foods is recalling more than 762,000 pounds of frozen Pepperoni Hot Pockets.
TOMPKINS COUNTY, N.Y. (WETM-TV) - The Tompkins County Health Department is announcing that a positive case of the UK variant of COVID-19 has been identified in Tompkins County.
The single case was found through Cornell University's COVID-19 testing lab, as part of its efforts through Cayuga Health Friday evening.
Man charged intent to engage in sexual conduct with a child
ALBANY, N.Y. (WETM-TV) - Police have arrested a man for engaging in sexual conduct with a minor.
47-year-old Tristan Warner of New Jersey was charged Friday with the intent to engage in sexual conduct with a minor.
Top Stories / 1 day ago

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Accent / News
Celebrating Eletra Casadei's legacy
September 21, 2017 September 29, 2017 - by University Journal Staff
Photo by Jenna Chapman – "The Legacy of Love" exhibit in SUMA.
Iconic fashion designer Eletra Casadei has given the students in the Theatre Arts and Dance department the opportunity of a lifetime. For the past four years they have had the opportunity to use incredible fabrics, trims and industrial sewing machines from her personal collection.
Electra Casadei was an iconic fashion designer in the 80s and 90s whose passion was Old Hollywood glamour. She entered the fashion world at the age of 15 when she became a model. By the age of 21, she was a buyer for departments stores. After only four years she started her own line founded on the principle of affordable elegance.
Austin Andrews, a senior theatre arts major from Layton, said Casadei's designs are, "innovative and exciting." According to Andrews, Eletra Casadei was a trend setter. She wasn't afraid to try new styles or silhouettes.
Casadei pushed the limits of style. Her prom dresses put away the Sweet Sixteen look and moved into strapless, backless, slit-to-here looks that are still popular today. She continued her passion until the age of 55, when she died in 2008 from a brain tumor. Her sister Andrea Casadei then took charge of all her sister's estate–including her amazing collection of original designs, fabrics and trim. Andrea wanted to continue her sister's legacy by donating Casadei's collection to a worthy cause.
Andrea Casadei met Wendy Sanders, Assistant Professor of Theatre Arts, and decided she wanted to donate to Southern Utah University Theatre Arts and Dance department.
"It is my greatest wish for her legacy to continue to inspire young people in different areas from clothing," said Andrea Casadei. The donation that was made is doing just that.
Casadei's fabrics and trims have been used to help creativity flourish among the department. Not only did Andrea Casadei donate materials, she also started the Eletra Casadei Assistantship. It is a scholarship given to one student per year. This year's recipient is Lars Palmer.
The scholarship recipient is chosen by Sanders and Andrea at the end of every year. They look at the costumes they have seen in the shows over the course of the year the shows and which student has impressed them.
"It was very interesting to receive the assistantship because I am fully in the theatre department so to receive the assistantship was very validating," Lars said. The scholarship is a raise given to a student that works in the SUU costume shop. The money is from a part of Casadei's estate. Once the school year is over, another student will receive the assistantship and Lars wage will be adjusted
The impact Eletra Casadei has on SUU will never be forgotten. Her work and legacy has made a big impact here at SUU, so the students and faculty want to give back. Starting Tuesday, Sept. 19, there is going to be a Casadei exhibit featured at Southern Utah Museum of Art (SUMA). Not only will orginal Casadei designs be on display, but also student work as well–much of which has been inspired by her designs.
Both Andrews and Palmer are looking forward to this exhibit.
"I am excited to spread awareness on how Casadei has impacted people's lives," Andrews said.
"I look forward to seeing all the original work by the students," Palmer said. "To see how Eletra Casadei's legacy continues in the students."
The exhibit will run from Sept. 19 through Nov. 19. There will be a special Gala fashion show on Nov. 4 where an original piece will be auctioned off. The exhibit is free for all students, so stop by and admire the work of the unforgettable Eletra Casadei.
Cassidy Harmon
reporter2@gmail.com
Taggedaccentdressesfabricsfashionsouthern utahsuma
SUMA's western pop exhibits feature Andy Warhol and Billy Schenck
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Here's Why That Ferris Bueller Ferrari House Is So Hard To Sell
The Highland Park home is sweet—if you like mid-century Modern eccentricity, you're ready for a renovation, and you don't mind tourists in your driveway.
By Dennis Rodkin
Published Aug. 7, 2013
Life moves pretty fast. The real estate action on this house? Not so much. Photo: Robert Harshman
It's a sharp home in a serene setting and it played a part in a beloved movie, yet it can't seem to get sold. Anybody know why?
Bueller?
Well, I'll give it a shot: The Highland Park home of the best pal Cameron in Ferris Bueller's Day Off is now 60 years old, and it came on the market in May 2009 with an asking price of $2.3 million. The property's connection to one of the best-loved movies of the 1980s was like catnip on the Internet. While the listing got a ton of press, no buyer materialized—even with a couple of price cuts. In February 2011, the listing was deactivated.
Monday night, the home came back on the market, now with a significantly lower price: $1.5 million, or 65 percent of what the sellers wanted four years ago. There's also a new marketing plan: Emphasize the home's architectural pedigree, and de-emphasize the "Where Ferris and Cameron Kill the Car" angle.
"One of the things that continually got missed the last time we were on the market is the house has such an incredible architectural history," Craig Hogan told me Tuesday. Hogan, the regional director for Coldwell Banker Previews, the agency's luxury division, said the family selling the home—relatives of the now-deceased owners—want the home to be in the hands of owners who will preserver its architectural merits.
That's laudable, though it may be a tall order. The home is superb in its way: Set onto the edge of a densely wooded ravine are two decidedly modernist buildings: a four-bedroom house built in 1953 and a separate pavilion built in 1974, both rectangular glass-and-wood boxes framed with steel, and both lifted above the ground on pylons. The earlier structure was the work of A. James Speyer, a student of Mies van der Rohe, and the second—the one that features in a pivotal scene in the movie—was in turn designed by one of Speyer's students, David Haid. The two buildings, commissioned by Ben and Francis Rose for a wooded eight-tenths of an acre in Highland Park, show how a "less is more" approach can make a natural setting the perfect complement to a hard-edged modern structure.
Hogan points out that in the late 1950s, Bethlehem Steel touted the Speyer design as a model for the use of steel in home-building. Landmarks Illinois also held up the house as an exemplar "notable for its progressive design and its deference to the work of Ludwig Mies van der Rohe."
They're beautiful—if you like Modernism—but they're problematic. One problem is that the older, larger building needs to be completely reworked inside. I visited when it was first on the market in 2009 (we didn't run a story at that time; I was there with a TV show's crew), and it was clear then that the inside needed help. Aside from dated kitchen and bath fixtures, there was also an issue with the walls: the home had been designed to be modular, in a way, with walls that could be reconfigured to suit a family's changing needs. But they were thin, some were in disrepair, and some of the rooms they enclosed were awkward. That's not terrible—lots of older homes need renovation, and because this one was designed to be flexible, "it should be very easy to reconfigure," Hogan said.
The other problem may be the bigger one: How do you live in two separate buildings in a cold-climate place like this? The 1974 pavilion was built to showcase the Roses' car collection. It has a kitchen and a bedroom, but it's mostly a four-car show garage. And it has a better piece of the site: it's cantilevered out into the trees, while the main house stands about 30 paces back from it, more on the ravine than of the ravine. So what do you do: split the family between the two buildings? Use one building as a home and the smaller, better one as an office?
"It's two structures side by side," Hogan said, "and while they're very connected in the feel and the use of the property, they're not so much on a daily basis. You'd have to figure out how to use them."
One more issue for a buyer to contend with is the home's fame as a tourist attraction. The serenity of the setting will often be interrupted by Ferris fans coming to take a peek. I live close enough to the home that I pass it on my bike now and then; it's not uncommon to see people parked on the street taking pictures (or roaming the property for a better look).
A potential buyer might want to take a lesson from the new owners of the Home Alone house, another recognizable movie icon on the North Shore. The family who bought that Winnetka home for $1.585 million last year now have a big sign out front with a firm request—stay off the property.
Other Real Estate & Neighborhoods stories
This Batavia House Predates the Civil War
Legendary Gay Bar Little Jim's Listed for Sale
Chicago's Housing Market Is Finally Balancing


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Miss Riding is the class Teacher and is supported by Mrs Procter, Mrs Tighe and Mrs Harris. There are currently 28 children in this class.
The children have PE on Monday and Thursday and need their PE kit to be in school on these days.
The children are given daily opportunities to change reading books themselves overseen on a weekly basis to ensure children are taking advantage of this.
Homework is handed out on Friday to be returned completed by Wednesday, the class homework club runs from 3-15 - 4-30 on a Tuesday.
Here we are planting our crocus and daffodil bulbs. We are a little muddy!
Year 5 have been learning all about the Earth, Sun and Moon. Test your knowledge with these tricky tests designed by the children!
We had fun this week planting our potatoes! But all that digging was hard work! We can't wait to watch them grow.
We have been really excited watching the daffodils we planted in Autumn flower now we're in Spring.
Year 5 had a great time this week at Robin Wood. All the children behaved exceptionally and the Robin Wood staff commented on how enthusiastic and well-behaved they were. Parents and staff are very proud! We took part in great activities that we will never forget. Our communication skills have improved greatly as we had to listen and understand lots of important instructions to help ourselves and others. Chloe. H, Mason, Noah, Joshua, Callum and Hayley made great archers. Tee-jay, Thomas, Alex, Demi-Leigh and Aimee were fantastic on the climbing wall. Bethany and Alisha worked well together on our blindfolded obstacle course. Madison braved the raft on her own! Sophia, Jessica and Harriot and Charleigh were super fast in their canoes. Lily, Elleina, Jodie and Ashden showed their bravery on their rafts. William and Rory sang at the top of their voices on the Giant Swing and Kiera, Chloe, W, Tia and Ellie glided gracefully through the air as Charlie screamed in Miss Edward's ear! Ciara.W and Alexander scurried through the caves with ease. Hopefully we've all picked up a new hobby.
Bethany and Jessica have written their thoughts about Robin Wood - the food was obviously a big hit with them!
Look at our fantastic clay tiles inspired by our very own butterflies! The children used fantastic detail and showed a good eye for colour! Well done!


From haunted tours to "Dracula," theatres get in on the Halloween action.
Who needs trick-or-treating and candy when you have the theatre? At least that's our motto here at American Theatre around this time of year (at least among staffers who don't have children but are too old for free candy). Haunted houses, warehouses and dark streets aren't the only places that can scare you and make you jump during Halloween.
Theatres, where dressing up in costumes happens 365 days out of the year, are getting in on the scary fun, too. Here's a sampling of Halloween shows happening around the country this weekend where, for once, the audience will be wearing the costumes.
Do you have a Halloween show to recommend? Leave them in the comments!
DRACULA AT ALLEY THEATRE IN HOUSTON TEX.
Want to just see a good, old-fashioned play with a scary theme? This Alley Theatre, which features the monochromatic costume and set designs of macabre master Edward Gorey, has you covered.
Honorable mention: Actors Theatre of Louisville in Kentucky's annual production of Dracula, an annual tradition that turns 19 this year, showing that Christmas does not have a monopoly on holiday perennials.
Boneshaker 2013 at Redmoon Theater.
For those who want to give their bones a literal shake, there's Redmoon Theatre's annual Halloween shindig. It's not just about dancing and drinking at this party, held at the theatre's headquarters. Revelers can confess their sins at a confessional booth and receive a shot (instead of a blessing), star in a short film and share it with their friends, and shoot fire in the air.
Honorable mention: The 34th installment of the Village Halloween Costume Ball at Theatre for the New City in New York City. Partygoers roam the theatre's four spaces, plus a city block, and on-site entertainment includes The Red and Black Masque, an annual Medieval ritual show by Arthur Sainer, dancers and fire-eaters.
THE SLEEPY HOLLOW EXPERIENCE AT SERENBE PLAYHOUSE, ATLANTA, GA.
This newish Atlanta tradition (in its second year) sets Washington Irving's classic tale in an actual stable, where audience members follow the action on foot, guided by roving narrators. A highlight: the Headless Horseman enters the scene on a real horse.
Honorable mention: It's already passed (doh!) but ShakesFEAR, presented by Illinois Shakespeare Festival, is hoped to become an annual event. In this haunted tour, which happened on the grounds of a real-life stone manor, William Shakespeare introduces the audiences to his scariest characters.
Connor McCanlus in "Scarrie: The Musical" at Bricolage Production Company.
For those who appreciate their Halloween with a touch of camp, this installment of Bricolage's Midnight Radio comedy series gives the 1976 Brian DePalma film Carrie the 1940s radio treatment, with vintage sound effects and commercial spoofs along with the buckets of pig's blood. And on Halloween, audience members are encouraged to dress in their best (and bloodiest) prom attire for Bricolage Prom. Just so you know what the competition will be like, Carrie is played—of course—by a man.
Honorable mention: Maryland Ensemble Theatre also regularly offers a comedy show, and Nov. 2nd, their weekly Last Hurrah series will feature the creative team behind Landless Theatre's recent prog-rock version of Sweeney Todd to discuss electrifying Sondheim. For anyone who is not Maryland-based, each episode of Last Hurrah is recorded, then released as a podcast the next day.
Honorable mention: The eighth annual Dia de Los Muertos at 24th Street Theatre in Los Angeles, similar to CPT's event, but for Southern California residents.


Despite the success of Gleevec, developing drugs that inhibit complex signaling pathways, while simultaneously trying to understand the biology around a drug's target, remains a challenge. Without biomarkers to help establish dosing and identify likely responding patients, clinical development of targeted cancer drugs will remain challenging. AstraZeneca's recent experience with Iressa bears this out. It's likely that single markers will not be sufficient to stratify patients by their tumor types; rather, patterns of gene and protein expression will be required. The technology to take these measurements is making its way from academia to industry, but the process is slow, and needs encouragement and better coordination between academia, regulators, and industry. Meanwhile, clinical trials themselves remain the best target validation tools. When all is said and done, efficacy is the best biomarker.


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Home/Our Partners
Our Partnersadmin2017-05-30T13:05:43+00:00
Your Helping Hands
Your Helping Hands is the charitable arm of our network. We are funded by public bodies with the goal of creating projects which explore the heritage and culture of Wolverhampton's sometimes isolated or underrepresented communities. The projects we create are focused on raising awareness of the heritage and history of how these communities developed in Wolverhampton.
Our way of doing this is community-led. Your Helping Hands constantly speaks to community leaders and individuals, as well as academics, so that we can direct our projects in ways that serve the community best. Furthermore, we ensure that community members are brought into our projects themselves. This is not only as volunteers, but so that we can provide training in areas of IT and media that they would not otherwise be able to experience.
Furthermore, Your Helping Hands seeks to celebrate aspects of the culture of these communities in ways that are engaging and informative. This includes not only celebrating festivals and holidays which are of a religious or cultural significance to members of our communities, but ensuring that we pay respect to their historical importance, and create projects that are engaging and active.
Finally, Your Helping Hands' projects aim to use our projects as a way of equipping people, young and old, with vital skills and experience that can provide them with better opportunities as they move forwards with their lives. By using projects which hold personal and emotional significance to our communities, we have developed a way of making sure that as people learn about the heritage, they also learn about its relevance to themselves, through engaging contributions which can move them closer to stability and security in their lives.
Cultural Arts enables Your Helping Hands to move its work in directions other than heritage. While still allowing us to be focused on the community, it means that we can celebrate parts of the shared community culture that are distinct from this. For example Cultural Arts has focused on Wolverhampton's Asian community's cultural heritage aside from history, such as Holi and Diwali festivals.
However, Cultural Arts' most crucial contribution to our network is its exploration of how new technologies can affect the heritage and culture which we are seeking to capture, safeguard, and raise awareness of. For example, it was through the research and initiative of Cultural Arts that we have decided upon future directions for Your Helping Hands, in terms of how we gather and manage heritage.
Again here, this is where the methods and aims of each distinct company overlap and combine in order to bring unique experiences to Wolverhampton's communities. Not only do Cultural Arts provide us with expert strategy of how to move forwards and explore new technologies; it also provides us with new ways of engaging young people through this technology, as well as an opportunity to offer further training into areas which were not previously available to elderly members of our communities. We have found, somewhat surprisingly, that upon discussing these new technologies and how they will be deployed to safeguard and promote community heritage, there was enormous enthusiasm and excitement from elderly members of our communities in terms of getting involved in using these new digital formats.
Finally, Cultural Arts encourages all members of the community who contribute to our projects to specifically design and create content for our online and social media platforms. Through using the direction of Your Helping Hands' projects and Employment Training Network's expertise in digital management, Cultural Arts brings members of the community on board to create and tell the stories in the ways they wish it to be told.
Employment Training Network's partnership with Your Helping Hands works through Employment Training Network providing assistance, strategy, equipment and expertise in order that YHH can ensure community participants in our projects receive appropriate and high quality training as our projects move forwards. This is done through a range of activities, and for a variety of purposes.
For example, through our partnership with Employment Training Network, we were able to use the Turban Project as a way of training elderly community members drawn from Bilston Community Centre in basic computer communication and media skills. They helped us to oversee a programme which increased participants' familiarity with the necessary computer programmes, such as Microsoft PowerPoint, and websites such as YouTube, so that they could gain basic experience in how to manage different types of online media.
Aside from this, the Turban Project also represented a way of assisting young members of the community in digital photography. Using equipment from Employment Training Network, we were able to not only familiarise members of the community with the process of taking photographs, but also their importance as part of recording heritage.
Finally, one of Employment Training Network's most significant contributions through our partnership has been to assist members of the community for whom English is not their primary language. While individuals we helped through our projects may have had some basic understanding of speaking and listening in English, they often lacked the confidence and familiarity with using English to communicate online to one another. Also, wherever necessary, Employment Training Network's team of multi-lingual individuals were able to assist those who can often feel isolated and excluded in community work such as this. Wherever we work with communities where individuals have different levels of English capabilities, it is critical that we make sure nobody feels as though they are being left behind – and Employment Training Network's team were instrumental in ensuring that Your Helping Hands were able to do this.
Health and Well Beams
Health and Well BEAMS operates with a slightly different focus to the other arms of our community network, in that it is concerned exclusively with adult education with a concentration on health concerns.
However, it still forms an important part of our network in the services that it provides, and the different ways it combines with our other companies and charities and its contribution to our overall work. Firstly, the work done by Health and Well BEAMS cooperates with Employment Training Network, in that we discovered that many of the health issues faced by the communities we serve are not only disproportionately affecting the black and ethnic minority communities of Wolverhampton, but that these issues are often made more acute by a lack of knowledge with the English language and ability to research and discover treatment options. Therefore Employment Training Network has a large role to play alongside Health and Well BEAMS, as it tackles the problems of language barriers as well as the isolation that community members can often feel.
When taken together, it combines with Your Helping Hands and Cultural Arts, as through our projects we can aim to create healthier people through our engagements and activities. For instance our projects are often not just an opportunity to learn about culture and heritage, in a way that takes into account challenges with languages, but also provide a way for people to feel active in the community. Indeed, our projects also often provide a chance for community members to become more physically active, bringing together Health and Well BEAMS' aims of creating healthier and more active community members, but doing so in a way that raises awareness of historical and cultural themes that are relevant to individuals themselves and engages them.


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We have been living in Letaba as a family for nearly four years now. And with Alex about to reach a school going age, we grabbed the opportunity of a transfer to Wolhuter trail with both hands. This means that we will be moving to the trails house at Malelane gate. Still inside the Kruger National Park we love so much, but also much closer to a town with schools, decent medical facilities in Nelspruit and civilisation!
We have been waiting months for the start of the refurbishment of the house, which is in a terrible state. When we first got the news about the transfer, I enthusiastically started packing. A little too enthusiastic, because those boxes have been sitting in our passage, untouched, for three months now… But it looks like I can start packing again, because contractors have actually been working on the new house. Our moving date has been set for the second week of August!
So we are moving! I have to be honest; I have mixed emotions about it; Happy about the children being able to go to school and about living closer to a town. And sad about leaving our beautiful area here.
Things have not always been easy for me here in Letaba. It is the place where I had to find my feet as a new mother. And where I had to get used to living in the bush. All while being away from my precious family and dear friends I left behind in Holland to come live here with Steven. Those two things happened to coincide and resulted in me feeling quite lonely and isolated at times and a bit home sick.
The distance to town requires a lot more planning than when you live in the city. Not just with grocery shopping (I mean you can't exactly drive back 100 kilometres if you have forgotten the milk), but also with medical help being that distance away. It has been challenging sometimes, especially when you have small children. But having said that does not mean I had a bad time. Far from it in fact; it has been a fantastic experience I would not have missed for the world!
Now that we have a moving date and a pile of empty boxes in the garage, waiting to be packed, I realise I am also going to miss a lot of things about Letaba. And those are the things that I have sometimes struggled with, funny enough.
Until we move, I am going to make sure I enjoy Letaba and everything about Letaba to the fullest. Because I am sure that when we are living at Malelane gate, I am going to miss the quietness and remoteness of Letaba. The same quietness and remoteness that made me feel isolated and lonely. The house at the gate is still in Kruger, but you can see the lodge on the other side of the river. I am sure that when the wind is blowing from the south, we will be able to hear the N4 highway and smell the sugar mill. The ashes from the burning sugar cane fields on the boundary will float into our garden. Another reminder that civilisation is right on our doorstep.
So I am going to embark on a little farewell tour of Letaba and its surroundings. Steven will only be back just before we move, so I am going to take the boys on a few sundowners on the river and the shooting range on my own. We will go to the high water bridge, from where you can see no lodges or other buildings, just unspoilt wilderness. I'll bring the boys to the elephant hall in camp and let them look at the elephants there; we will have a milkshake at the restaurant and admire one of the best views in the park. I will take them on little game drives to our favourite spots and make a few more precious memories so we can always look back and say: Wow, we sure had a special time living in Letaba!
Good luck with the move. Hope you will be just as happy at Malelane as you were in Letaba.
Thanks Melinda!! I hope so too! Big change, but best for our kids!
All the best with your move to Malelane. The fact that you will still be living in the Kruger is a bonus most of us would give well almost anything for.
You were amazing adjusting to the isolation of Letaba, you will be just as amazing adjusting to Malalane. The boys will also love it.
Thank you, I am sure they will!!
Oh Wow! While I don't envy you moving home, I shudder just thinking about it. It will be for the best especially with small children. I love Letaba, we were there last weekend till Tuesday, now back in Cold Gauteng. My soul longs to live in the wild. Sadly not to be. Enjoy your last few weeks in Letaba. The view from the veranda at the resstaurant cannot be beaten ( very special).
I love reading your blog as I too was bitten on my once in a lifetime holiday in 2014. I look forward to following you on your new journey. Good luck.
Glad you are enjoying my stories Linda!! Kruger is a magical place!
Good luck with the move and may you have many happy years at Malelane. Make new memories and have fun! most of all, have fun!!
Thanks Janet! It is going to be a whole new adventure!
Good Luck with the move to Malelane Gate. I am sure you will love it there. The owners of Malelane Superspar, Lex Holman and Ed Harris and their wives, are great wild life enthusiastics. Their grocery offering is one of the best in the Lowveld, having been voted Superspar of the year more than once. If they don't have something you want they will make sure you get it.
Thanks Loraine! Yes that Spar is fantastic and so big! Will have to find my way around Malalane town again, but I definetely know the road to that mall!
Hi Petra! Wow this is such a nice message to get! Thank you! It will be nice to get to know new people in our new town!
Always sad to move, but you will always look back and remember the wonderful way of life you had there. Sadly one cannot always stay out in the bush, especially with children.Good luck with the packing.
I hope so Valerie! Thank you!
Life will be different down in the south but, I hope, equally happy. Hope they do the house up nicely for you. Good luck with the move, may all go well.
Thanks Sal, I hope so too!!
Dank je wel Marylou! Komt vast goed!
Thanks so much Barbara! I am sure we are going to have a lovely time at the gate as well!
Really enjoy all your blog entries. Good luck with the move.
Thank you very much, Francois! Appreciate it!


This is the district events calendar. The BoE approved school year calendar can be found on the School Year Calendar page and individual school calendars can be found within their school page.
WRHS - Spring Play 'Man of La Mancha' 7 p.m.
8th Grade to Washington D.C.


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Transfer Rumors: Have Manchester United made their move for Shinji Kagawa?
By RB1990 Apr 27, 2012, 6:54pm BST
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ARNSBERG, GERMANY - JULY 04: Shinji Kagawa of Dortmund runs with the ball during pre-season friendly match between Team Sauerland and Borussia Dortmund on July 4, 2011 in Arnsberg, Germany. (Photo by Friedemann Vogel/Bongarts/Getty Images)
Bongarts/Getty Images
Lots of rumours floating about today about Borussia Dortmund's Japanese star Shinji Kagawa. German media outlet Bild report that Dortmund have given the attacking midfielder a deadline (Monday) to sign a new deal with the club. His contract is up next summer, which means he might well move this summer in a cut price deal. Here are some quotes from the newly crowned Bundesliga Champions president, Reinhard Rauball.
"The fact is that he has had an offer put in front of him long ago, which raises a few doubts because up until now he hasn't reacted,"
It is a good offer. He won't be getting peanuts at Dortmund.
"There still hasn't been contact from another club. As far as I am concerned, nothing has been decided, although I now have a slight tendency towards scepticism."
Talksport claim Manchester United are set to offer the player a three year deal. There is no doubt that United need reinforcements during the summer, especially in midfield. United certainly lack a creative spark that can ignite an attack through the centre, so these rumours certainly interest me. If these rumours persist and gather more steam, you can look forward to a scouting report from Gene on Kagawa.


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How Six Men Got on in the World
There was once a man who understood all kinds of arts; he served in war, and behaved well and bravely, but when the war was over he received his dismissal, and three farthings for his expenses on the way. "Stop," said he, "I shall not be content with this. If I can only meet with the right people, the King will yet have to give me all the treasure of the country." Then full of anger he went into the forest, and saw a man standing therein who had plucked up six trees as if they were blades of corn. He said to him, "Wilt thou be my servant and go with me?"
"Yes," he answered, "but, first, I will take this little bundle of sticks home to my mother," and he took one of the trees, and wrapped it round the five others, lifted the bundle on his back, and carried it away. Then he returned and went with his master, who said, "We two ought to be able to get through the world very well," and when they had walked on for a short while they found a huntsman who was kneeling, had shouldered his gun, and was about to fire. The master said to him, "Huntsman, what art thou going to shoot?" He answered, "Two miles from here a fly is sitting on the branch of an oak-tree, and I want to shoot its left eye out."
"Oh, come with me," said the man, "if we three are together, we certainly ought to be able to get on in the world!" The huntsman was ready, and went with him, and they came to seven windmills whose sails were turning round with great speed, and yet no wind was blowing either on the right or the left, and no leaf was stirring. Then said the man, "I know not what is driving the windmills, not a breath of air is stirring," and he went onwards with his servants, and when they had walked two miles they saw a man sitting on a tree who was shutting one nostril, and blowing out of the other. "Good gracious! what are you doing up there?" He answered, "Two miles from here are seven windmills; look, I am blowing them till they turn round."
"Oh, come with me," said the man. "If we four are together, we shall carry the whole world before us!" Then the blower came down and went with him, and after a while they saw a man who was standing on one leg and had taken off the other, and laid it beside him. Then the master said, "You have arranged things very comfortably to have a rest."
"I am a runner," he replied, "and to stop myself running far too fast, I have taken off one of my legs, for if I run with both, I go quicker than any bird can fly."
"Oh, go with me. If we five are together, we shall carry the whole world before us." So he went with them, and it was not long before they met a man who wore a cap, but had put it quite on one ear. Then the master said to him, "Gracefully, gracefully, don't stick your cap on one ear, you look just like a tom-fool!"
"I must not wear it otherwise," said he, "for if I set my hat straight, a terrible frost comes on, and all the birds in the air are frozen, and drop dead on the ground."
"Oh, come with me," said the master. "If we six are together, we can carry the whole world before us."
Now the six came to a town where the King had proclaimed that whosoever ran a race with his daughter and won the victory, should be her husband, but whosoever lost it, must lose his head. Then the man presented himself and said, "I will, however, let my servant run for me." The King replied, "Then his life also must be staked, so that his head and thine are both set on the victory." When that was settled and made secure, the man buckled the other leg on the runner, and said to him, "Now be nimble, and help us to win." It was fixed that the one who was first to bring some water from a far distant well was to be the victor. The runner received a pitcher, and the King's daughter one too, and they began to run at the same time, but in an instant, when the King's daughter had got a very little way, the people who were looking on could see no more of the runner, and it was just as if the wind had whistled by. In a short time he reached the well, filled his pitcher with water, and turned back. Half-way home, however, he was overcome with fatigue, and set his pitcher down, lay down himself, and fell asleep. He had, however, made a pillow of a horse's skull which was lying on the ground, in order that he might lie uncomfortably, and soon wake up again. In the meantime the King's daughter, who could also run very well quite as well as any ordinary mortal can had reached the well, and was hurrying back with her pitcher full of water, and when she saw the runner lying there asleep, she was glad and said, "My enemy is delivered over into my hands," emptied his pitcher, and ran on. And now all would have been lost if by good luck the huntsman had not been standing at the top of the castle, and had not seen everything with his sharp eyes. Then said he, "The King's daughter shall still not prevail against us;" and he loaded his gun, and shot so cleverly, that he shot the horse's skull away from under the runner's head without hurting him. Then the runner awoke, leapt up, and saw that his pitcher was empty, and that the King's daughter was already far in advance. He did not lose heart, however, but ran back to the well with his pitcher, again drew some water, and was at home again, ten minutes before the King's daughter. "Behold!" said he, "I have not bestirred myself till now, it did not deserve to be called running before."
But it pained the King, and still more his daughter, that she should be carried off by a common disbanded soldier like that; so they took counsel with each other how to get rid of him and his companions. Then said the King to her, "I have thought of a way; don't be afraid, they shall not come back again." And he said to them, "You shall now make merry together, and eat and drink," and he conducted them to a room which had a floor of iron, and the doors also were of iron, and the windows were guarded with iron bars. There was a table in the room covered with delicious food, and the King said to them, "Go in, and enjoy yourselves." And when they were inside, he ordered the doors to be shut and bolted. Then he sent for the cook, and commanded him to make a fire under the room until the iron became red-hot. This the cook did, and the six who were sitting at table began to feel quite warm, and they thought the heat was caused by the food; but as it became still greater, and they wanted to get out, and found that the doors and windows were bolted, they became aware that the King must have an evil intention, and wanted to suffocate them. "He shall not succeed, however," said the one with the cap. "I will cause a frost to come, before which the fire shall be ashamed, and creep away." Then he put his cap on straight, and immediately there came such a frost that all heat disappeared, and the food on the dishes began to freeze. When an hour or two had passed by, and the King believed that they had perished in the heat, he had the doors opened to behold them himself. But when the doors were opened, all six were standing there, alive and well, and said that they should very much like to get out to warm themselves, for the very food was fast frozen to the dishes with the cold. Then, full of anger, the King went down to the cook, scolded him, and asked why he had not done what he had been ordered to do. But the cook replied, "There is heat enough there, just look yourself." Then the King saw that a fierce fire was burning under the iron room, and perceived that there was no getting the better of the six in this way.
Again the King considered how to get rid of his unpleasant guests, and caused their chief to be brought and said, "If thou wilt take gold and renounce my daughter, thou shalt have as much as thou wilt."
"Oh, yes, Lord King," he answered, "give me as much as my servant can carry, and I will not ask for your daughter."
On this the King was satisfied, and the other continued, "In fourteen days, I will come and fetch it." Thereupon he summoned together all the tailors in the whole kingdom, and they were to sit for fourteen days and sew a sack. And when it was ready, the strong one who could tear up trees had to take it on his back, and go with it to the King. Then said the King, "Who can that strong fellow be who is carrying a bundle of linen on his back that is as big as a house?" and he was alarmed and said, "What a lot of gold he can carry away!" Then he commanded a ton of gold to be brought; it took sixteen of his strongest men to carry it, but the strong one snatched it up in one hand, put it in his sack, and said, "Why don't you bring more at the same time? that hardly covers the bottom!" Then, little by little, the King caused all his treasure to be brought thither, and the strong one pushed it into the sack, and still the sack was not half full with it."
"Bring more," cried he, "these few crumbs don't fill it." Then seven thousand carts with gold had to be gathered together in the whole kingdom, and the strong one thrust them and the oxen harnessed to them into his sack. "I will examine it no longer," said he, "but will just take what comes, so long as the sack is but full." When all that was inside, there was still room for a great deal more; Then he said, "I will just make an end of the thing; people do sometimes tie up a sack even when it is not full." So he took it on his back, and went away with his comrades. When the King now saw how one single man was carrying away the entire wealth of the country, he became enraged, and bade his horsemen mount and pursue the six, and ordered them to take the sack away from the strong one. Two regiments speedily overtook the six, and called out, "You are prisoners, put down the sack with the gold, or you will all be cut to pieces!"
"What say you?" cried the blower, "that we are prisoners! Rather than that should happen, all of you shall dance about in the air." And he closed one nostril, and with the other blew on the two regiments. Then they were driven away from each other, and carried into the blue sky over all the mountains one here, the other there. One sergeant cried for mercy; he had nine wounds, and was a brave fellow who did not deserve ill treatment. The blower stopped a little so that he came down without injury, and then the blower said to him, "Now go home to thy King, and tell him he had better send some more horsemen, and I will blow them all into the air." When the King was informed of this he said, "Let the rascals go. They have the best of it." Then the six conveyed the riches home, divided it amongst them, and lived in content until their death.
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text:
Q: What is meant by conditioning of a cable? I just came across this,
"Twisted pair cable supports a maximum data rate of 1Mbps without conditioning and 10Mbps with conditioning."
What exactly does conditioning mean.
EDIT:
I came across it in my school text book,

redpajama_set_name: RedPajamaStackExchange


who is your fav toy?
who is your fav teacher?
who is your key worker?
Who is your head of school?
what is your fav snack?
What is you fav colour?
who is your best freind?
Who is your nan called?
Who is your Auntie called?
Who is your mom called?
Who is your Dad called?
Have you ever been on hoilday?


Ray Bradbury called Tarzan's creator 'probably the most influential writer in the entire history of the world.' What prompted such a statement? There's no doubt that Edgar Rice Burroughs' creation has become world-famous, but what is it about Tarzan that makes him such a famous character, whose name is known throughout the world? This post, which presents some of our favourite interesting facts about Tarzan, aims to get to the bottom of the character's enduring popularity.
obviously very close to the eventual name) and Tublat Zan. 'Tarzan', it turns out, is a Hebrew word that translates as 'dandy, fop, or coxcomb'. Whether Burroughs was aware of this is unknown.
What is Tarzan's real name? There are two answers to this question. Tarzan's real name is John Clayton, Viscount Greystoke. Tarzan is his ape name; his English name was revealed by Burroughs in Tarzan, Lord of the Jungle. However, there's some doubt as to whether even this is his real name: in Tarzan of the Apes, Burroughs suggests that Clayton is itself a fictitious name, invented by 'Tarzan' to mask his real identity. Such mystery only fuelled readers' interest in the character, himself something of a man of mystery – where had he come from? What was his life like before his life in the jungle?
Tarzan's girlfriend, of course, is called Jane. But what is less well known is that Tarzan's fictional adventures living among the apes inspired a real-life Jane, Jane Goodall, to devote her life to a study of primates in the wild, after she discovered the character when she was 11 years old.
Why has Tarzan endured as a fictional character, even if few people now read Burroughs' original novels? There are arguably several reasons: he is the archetypal 'noble savage', a figure found throughout literature but perhaps most clearly and successfully typified by Burroughs' hero. The idea of leaving behind civilised society and returning to the primitive world of our primate ancestors among the jungle is a powerful one in many readers' – and movie-goers' – imaginations. Burroughs was also the author of The Land That Time Forgot (1918), which remains widely known – thought not as widely read – thanks to a series of film adaptations. This fact itself sheds light on the Tarzan mythos: something about the primitive history of our species, and of the world before our species arose, speaks to us. Consider the popularity of Jurassic Park (whose curious background story we unearthed in our Five Fascinating Facts about Michael Crichton), or Conan Doyle's earlier novel, The Lost World (1912).
But another reason that Tarzan endures in the popular imagination is that Burroughs did everything he could to make sure Tarzan endured: after writing the original novels, he turned his character into a brand, with numerous films, comic strips, and other works contributing to the ubiquity of Tarzan in everyone's consciousness.
The region of Tarzana in Los Angeles is named after the ranch Burroughs bought there shortly after Tarzan became a huge literary success.
The famous line 'Me Tarzan, you Jane' never appeared in any of Burroughs' books, nor in the films: it appears to have been a compacting of a longer conversation between Tarzan and Jane in the 1932 film Tarzan the Ape Man. Tarzan's afterlife in the cinema has been huge, with some ninety film adaptations. Burroughs himself has some interesting film connections: his daughter Joan married James Pierce, who played Tarzan on film, while Burroughs' great-grandson is the film director Wes Anderson.
If you enjoyed these interesting facts about Tarzan, check out our interesting Jungle Book facts.
Image: Film poster for episode 12 of the American film serial Tarzan the Fearless, c. 1933, Wikimedia Commons.
Aspiring writers have had to take on some unlikely jobs. But pencil sharpener salesman?
I loved Tarzan films when I was a kid. The one enduring fact about ERB is that Tarzan made him very rich.


text:
Q: GridView doesn't apply css in Firefox and IE My issue is following - i put colored text in one of my GridView cells:
e.Row.Cells[4].Attributes.Add("style", "color: green");
e.Row.Cells[4].Text = "Some text";

It also colors right and bottom border of cell [4].
I tried putting black border color though CssClass on GridView, also to put BorderColor property on RowStyle in GridView properties, also to put some code, right below the upper code - a line:
GridView1.Attributes.Add("style", "border-color: black");

none of the 3 solutions color right and bottom borders.
Anyone has a solution?
Thanks a lot.

A: If you are using Firebug for Firefox, inspect the table and look at the HTML output. you will be able to style it according to that.
table tr td{border:1px solid black}