text:
SubjectsEmployability (2)Apprenticeship (1)Career (1)Career development (1)career guidance (1)View MoreAuthorsHooley, Tristram (4)Hooley, Tristram (4) Neary, Siobhan (2)Neary, Siobhan (2) Anthony, Denis (1)View MoreYear (Issue Date)
Understanding employers' graduate recruitment and selection practices. BIS Research Paper 231.
Pollard, Emma; Hirsh, Wendy; Williams, Matthew; Buzzeo. Jonathan; Marvell, Rosa; Tassinari, Arianna; Bertram, Christine; Fletcher, Luke; Artess, Jane; Redman, Jennifer; et al. (Department for Business, Innovation and Skills, 2015)
This research examined the approach to graduate recruitment adopted by employers and how this has evolved in recent years. In particular the study aimed to explore patterns in graduate recruitment, behaviours of graduate employers and interactions between graduate employers and universities. It therefore provides a picture of long-term trends in practice from pre-recruitment activities through to entry, induction and beyond, and before, during and after the recession; and indicates the ways in which employers' thinking about recruitment and selection have, and are, changing and developing. The research was driven by a need to update the evidence and understanding of recruitment practice as the population of graduates has increased dramatically and become more heterogeneous; the labour market has changed, emerging from difficult economic conditions; and there is increasing policy interest in diversity and particularly in social mobility.
Icarus: Project reports and education pack.
Marshall, Alice (Adair to Dance, 2015)
Integrated policies: creating systems that work
McCarthy, John; Hooley, Tristram (Kuder, 2015)
This paper is concerned with the integration of career development policies across the world. It was prepared in advance of the International Centre for Career Development and Public Policy symposium in Des Moines 2015.
Employers' experience of Higher Apprenticeships: benefits and barriers
Mieschbuehler, Ruth; Hooley, Tristram; Neary, Siobhan (iCeGS, University of Derby and Pera Training, Melton Mowbray, 2015)
This report explores employers' experience and understanding of Higher Apprenticeships. It is based on a survey of almost 200 companies and follow-up interviews with eleven employers. The findings suggest that there is strong support for Higher Apprenticeships amongst employers although there are many employers who have yet to engage with this programme. Employers that have implemented Higher Apprenticeships report a range of business benefits, but they were also clear that appropriate funding has to be in place to support these programmes. Employers generally thought that the introduction of Higher Apprenticeships would improve employee retention, help them to train people in the way they thought necessary and would enhance their company's skills base. Barriers that had mitigated against the introduction of Higher Apprenticeships included the cost of introducing a Higher Apprenticeship programme, the work needed in making the business 'higher apprentice friendly' and findings appropriate apprenticeship frameworks and training providers. Companies that had successfully embedded Higher Apprenticeships had typically developed an approach to recruitment which enabled them to identify and select the best apprentices. Companies also set up management processes to ensure that higher apprentices were well supported and able to progress and developed effective partnerships with training providers.
Moore, Nicki; Osmani, Argjend (European Union Office in Kosovo, 2015)
The training needs analysis was conducted beteeen February and April 2015 for the EU funded project: ICT in Education in Kosovo. The processes required to perform the traning needs analysis have been.  The design of a framework of competences;  The identification of target groups;  The creation and implementation of an online survey to assess the competence of education sector personnel against the competences contained in the framework;  The collation, preparation and analysis of the survey data; and  Reporting the research findings.
Work based assessment of teamwork: an interprofessional approach.
Thistlethwaite, Jill; Forman, Dawn; Dunston, Roger; Moran, Monica Catherine (Office for Learning and Teaching Australia, 2015)
This report Work-based assessment of teamwork: an interprofessional approach describes the Office for Learning and Teaching (OLT) funded project of the same name. It focuses on the rationale for, the development of and the piloting of a tool for observing and giving feedback on an individual student's behavior in an interprofessional team based activity. The study was conducted during 2012–2014 with a project team initially led by the University of Queensland, and included team members from five Australian universities in three states (University of Queensland, University of Technology Sydney, The University of Sydney, Central Queensland University and Curtin University), as well as from the UK (University of Derby) and Canada (University of British Columbia).
Effective Policy Frameworks for the Organisation of Career Guidance Services A Review of the Literature
Hooley, Tristram; Neary, Siobhan; Morris, Marian; Mackay, Susan (2015)
This paper focuses on how public policy shapes career guidance and establishes a system within which individuals can access career support. Governments are critical to career guidance primarily as funders of the activity, but also importantly as regulators, coordinators and agents of system change. The paper looks at the evidence base on career guidance and public policy, explore the rationales for public policy involvement in the field, examine different models and systems and explore some key issues that underpin successful system design.
The D2N2 employability framework: Employers and schools supporting young people's routes to work
Hutchinson, Jo; Dickinson, Berni; Vickers, Rob; Hooley, Tristram (D2N2, 2015)
The D2N2 Employability Framework provides the methodology by which we can significantly improve the employability and life skills of our young people regardless of academic ability or which career pathway they chose to take. Collectively schools, colleges, training providers, wealth creating companies, social enterprises and the public sector have a duty to ensure that we give our young people the best chances in gaining employment and at the same time addressing the skills needs of employers within our area.
Community Interventions for Health (CIH): A monograph
Dyson,Pamela; Anthony, Denis (Oxford Health Alliance, 2015)
Non communicable disease (NCD), including cardiovascular disease, cancer, diabetes and chronic respiratory diseases, accounted for over 65.5% of deaths in 2010, with more than 80% of these occurring in low and middle income countries (LMIC). Approximately 30% of the deaths in LMIC occur prematurely and are largely preventable. NCD is also associated with increased morbidity and reduced quality of life, and it has been estimated that the global economic impact of NCD could total US$47 trillion over the next twenty years, equivalent to 5% of GDP. The causes of NCD have their roots in three major modifiable risk factors; tobacco use, physical inactivity and unhealthy diet and prevention of NCD by addressing these factors at the community level is fast becoming an area of interest. Most authorities, including the United Nations (UN), the World Health Organisation (WHO) and the US Center for Disease Control and Prevention (CDC) recommend evidence based strategies for lifestyle interventions, but there is limited high grade evidence for population or community based approaches and most of the available evidence is derived from studies conducted in high risk individuals in high income countries. The population approach is inclusive and addresses many factors including health education, structural environmental change, engagement of health providers, transport and education ministries, policy and legislative initiatives and partnerships and coalitions with community organisations. In 2008, the Oxford Health Alliance, a UK registered health charity (No 1117580), began its Community Interventions for Health (CIH) program which was designed to utilise this population approach and which adopted multi factorial, comprehensive strategies for prevention of NCD by addressing modifiable lifestyle risk factor reduction. CIH is an international collaborative study that took place between 2008 2011 in communities in China, India and Mexico and was designed to reduce the risk of NCD by targeting the three main risk factors of tobacco use, physical inactivity and unhealthy diet. The aim of CIH was to evaluate culturally specific strategies to (i) decrease the prevalence of smoking and smokeless tobacco use, (ii) improve diet by increasing intake of fruit and vegetables and reducing use of salt and (iii) increase levels of physical activity in local communities in India, China and Mexico. CIH was conducted over 5 years, and showed that population based strategies to improve health were effective in adults, and had a positive impact on risk factors for NCD by improving dietary intake and ameliorating secular trends for reduced physical activity and increases in overweight and obesity.


Uptown Saint John is now home to a unique after hours dance club, Foundations. Located at 9 Sydney Street, this performance and event venue is open from 1am – 5am. Foundations is a cool place to go in the wee hours, specializing in house music, dancing and pro DJ's, sometimes local and sometimes brought in from other cities. The bar is dry, selling soft drinks, water, Red Bull, etc., but is alcohol free. Sometimes, there is pizza in the parking lot, and always, it is a lot of fun. This venue, many may remember in it's various previous well known bar days – it still carries that great vibe and the history adds to it's glory. Stop by – if you're a night owl, or after the other clubs close, for something energetic and different.


Not only is this athleisure shoe from privo by clarks on trend, it's also super cute and comfortable. made from soft uppers with elasticized straps, it features an ortholite footbed with the signature soleassage massage in every step, plus textile linings and a rubber lug outsole. wear this casual women's shoe for yoga class, for errands, or for traveling.


text:
André Jacques Boillot (* 8. August 1891 in Valentigney; † 8. Juni 1932 in La Châtre) war ein französischer Autorennfahrer.

Karriere als Rennfahrer
André Boillot kam in Valentigney im Département Doubs als Sohn von Louis Boillot und Catherine Jeanperain zur Welt, einem Ort, in dem neben ihm zwei weitere erfolgreiche französische Rennfahrer der Frühphase des Motorsports zur Welt kamen. Der eine war sein Bruder Georges Boillot, der andere Jules Goux, der 1913 als erster Europäer das 500-Meilen-Rennen von Indianapolis gewann. Sein Vater war ein enger Mitarbeiter des Fabrikdirektors der Peugeot-Produktionsstätte in Valentigney und ebnete seinen Söhnen den Einstieg ins Unternehmen. André Boillot arbeitete in den frühen 1910er-Jahren im Vertrieb am Peugeot-Standort in London.

Wie sein Bruder, der am 9. Mai 1916 bei einem Luftkampf gegen fünf Fokker über Bar-le-Duc abgeschossen wurde und am Morgen danach seinen Verletzungen erlag, kämpfe André Boillot im Ersten Weltkrieg als Kampfflieger an der Westfront. Auch er wurde bei einem Kampfeinsatz abgeschossen, überlebte den Absturz aber trotz schwerer Verletzungen. 1918 wurde ihm der Croix de guerre verliehen.

Von seinem Bruder inspiriert, begann André Boillot schon vor dem Beginn des Ersten Weltkriegs mit dem Motorsport. Nach dem Krieg kam er zurück zu Peugeot, wo sein Bruder in den 1910er-Jahren seine Erfolge eingefahren hatte. Zur Legende wurde sein Start bei der Targa Florio 1919. Bei der ersten Targa nach dem Krieg steuerte er einen Vorkriegs-Peugeot L25. Viele Zwischenfälle überschatteten das bei sehr schlechten Wetterbedingungen im November gefahrene Rennen. Antonio Ascari stürzte mit seinem Fiat S 57/14 B in einen Graben und wurde erst nach dem Rennen bei der Schlusspatrouille entdeckt und gerettet. Auch André Boillot hatte ein turbulentes Rennen. Als er nach der ersten Runde an der Haupttribüne vorbeifuhr, prallte er gegen einen Zaun, weil ihn winkende Zuschauer ablenkten. Ohne größeren Schaden am Peugeot konnte er weiterfahren. Ungefähr bei Halbzeit des Rennens übernahm Boillot die Führung vom bis dahin an der Spitze fahrenden René Thomas, der einen Ballot 5L lenkte. Als Boillot in der letzten Runde auf der inzwischen völlig verschlammten Bahn zur Ziellinie fuhr, standen vor der Haupttribüne bereits Zuschauer. Um den Zuschauern auszuweichen, zog Boillot die Handbremse und krachte nur 30 Meter von der Ziellinie entfernt mit dem Vorderwagen in die Holztribüne. Zuschauer halfen, den Wagen von den herabgestürzten Holzlatten zu befreien. Das Schieben des schweren Wagens mittels fremder Hilfe verhinderten herbeigeeilte Funktionäre, die ihm erklärten, er müsse entweder selber fahren oder selber schieben. Nach einigen Startversuchen gelang es Boillot, den Motor des Peugeot wieder in Gang zu bringen, und er fuhr rückwärts über die Ziellinie. Dort erklärte ihn die Rennleitung für disqualifiziert, weil er das Rennen im Rückwärtsgang beendet hatte, was nicht erlaubt sei. René Thomas' Teamchef Édouard Ballot wollte nach dem Ausfall von Thomas einen französischen Sieg und konnte die Rennleitung davon überzeugen, dass man André Boillot einfach noch einmal über die Ziellinie fahren lassen sollte, diesmal mit dem Vorderwagen voran. Boillot tat wie ihm geheißen. Er fuhr noch einmal auf die Strecke, drehte bei der ersten Gelegenheit um und fuhr zum Sieg ins Ziel.

Weitere Erfolge gelangen André Boillot bei Langstreckenrennen in den 1920er-Jahren. 1926 siegte er mit Teampartner Louis Rigal im Peugeot Typ 174S beim 24-Stunden-Rennen von Spa-Francorchamps. Der Einsatz des Duos beim 24-Stunden-Rennen von Le Mans dieses Jahres endete mit einer Disqualifikation wegen eines defekten Windschilds am eingesetzten Peugeot. Ein weiterer Erfolg war der Gesamtsieg beim 24-Stunden-Rennen von Monza 1926. Außerdem gewann er 1922 und 1925 die Gesamtwertung der Coppa Florio.

Dreimal, 1919, 1920 und 1921, ging er beim 500-Meilen-Rennen von Indianapolis an den Start, wo er jedes Mal wegen technischer Defekte an den Einsatzwagen ausfiel. Seine besten Platzierungen als Grand-Prix-Pilot hatte er beim Großen Preis von Frankreich. 1921 wurde er ihm Talbot-Darracq Fünfter und 1929 im Peugeot Zweiter hinter William Grover-Williams im Bugatti T35B. Seinen letzten Grand-Prix-Start hatte er unter dem Pseudonym Dribus beim Großen Preis von Monaco 1931, wo er Sechster wurde.

1928 wurde er Sportdirektor bei Peugeot, ging aber weiterhin als Fahrer bei ausgewählten Veranstaltungen an den Start. André Boillot, der seit September 1926 mit Yvonne Hérissé, der Schwester der Sängerin Gaby Montbreuse, verheiratet war, verunglückte 1932 bei einem Bergrennen tödlich. Beim Côte d'Ars bei La Châtre kam sein Peugeot 201-X bei hoher Geschwindigkeit von der Strecke ab, prallte von der Fahrbahn ab und ging in Flammen auf. Er starb fünf Tage später an den Unfallfolgen in einem örtlichen Krankenhaus.

Galerie

Statistik

Le-Mans-Ergebnisse

Literatur
 R. M. Clarke: Le Mans – die Bentley & Alfa Years 1923–1939 Brocklands Books 1999, ISBN 1-85520-465-7.
 Christian Moity, Jean-Marc Teissèdre, Alain Bienvenu: 24 heures du Mans, 1923–1992. Éditions d'Art, Besançon 1992, ISBN 2-909-413-06-3.

Weblinks

 André Boillot bei Motorsport Magazine
 André Boillot bei Historic Racing
 André Boillot bei Grand Prix Ratings
 André Boillot bei Racing Sports Cars

Einzelnachweise

Rennfahrer (Frankreich)
Rennfahrer der 24 Stunden von Le Mans
Grand-Prix-Fahrer vor 1950
Rennfahrer des Indianapolis 500
Bergrennfahrer
Jagdpilot im Ersten Weltkrieg (Frankreich)
Franzose
Geboren 1891
Gestorben 1932
Mann

redpajama_set_name: RedPajamaWikipedia


Naveed Sattar, Mark C. Petrie, Bernard Zinman and James L. Januzzi Jr.
Dr. James L. Januzzi, Jr., Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5984, Boston, Massachusetts 02114.
Recently, treatment with 2 newer classes of type 2 diabetes drugs were found to reduce events in patients with diabetes and cardiovascular (CV) disease, a group common in cardiology clinics. The sodium-glucose cotransporter 2 inhibitor, empagliflozin, markedly and rapidly reduced CV death and heart failure hospitalization, likely with hemodynamic/metabolic-driven mechanisms of action. More recently, the glucagon-like peptide–1 receptor agonists liraglutide and semaglutide also reduced CV death and/or major adverse CV events, but did so more slowly and did not influence heart failure risks, suggesting alternative mechanisms of benefit. We will discuss drug therapy for diabetes relative to CV risk, briefly summarize key findings of CV benefit from recent trials, discuss potential mechanisms for benefits of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide–1 agonists, and suggest how such drugs might be embraced by CV specialists to reduce CV events and mortality in their patients.
Most cardiologists have focused their efforts on managing traditional risk factors, and have paid less attention to type 2 diabetes (T2D) therapies whose primary role is to lower glucose. This may be because, until recently, T2D therapies other than metformin had little obvious favorable effect on cardiovascular (CV) outcomes, the principal cause of morbidity and mortality in T2D. Indeed, for cardiologists, the most common diabetes drug intervention was to stop drugs that may cause heart failure (e.g., glitazones); initiation or titration of drugs for diabetes care was most commonly referred to primary caregivers or diabetes specialists. If anything, concerns about CV safety were more prevalent than reassurance as to the potential benefits of these agents.
In light of concerns regarding CV safety of new glucose-lowering drugs being developed, the U.S. Food and Drug Administration (FDA) and European Medicines Agency mandated that new therapies for diabetes had to demonstrate CV safety in prospective, randomized controlled outcome trials. Current recommendations for trial design of new therapies for T2D have been recently reviewed (1) and include iterative assessment of drug safety, with initially liberal pre-approval statistical boundaries to exclude unacceptable CV risk, followed by more restrictive boundaries post-approval. For phase 4 post-marketing outcome trials, ultimately, the upper bound of the 95% confidence interval (CI) for any T2D treatment should not exceed 1.30 for major adverse cardiovascular events (MACE), whereas a 1.80 upper limit applies to phase 3 trials. Additionally, the recommendation was made that trials evaluating novel T2D therapies should focus on high-risk populations (such as those with vascular disease, with renal impairment, or at advanced age) and should include long-term data, and that all MACE events measured in such trials should be adjudicated by an independent committee.
Although designed to detect a risk signal, remarkably, results from recent "cardiovascular outcomes trials" (CVOTs) may lead to a meaningful change in how cardiologists might approach the patient with T2D, as these CVOTs have shown not only CV safety, but also reduced CV and all-cause mortality in some studies (2–4). These trials include patients who are common to cardiologists' practices, and the magnitude of the results compares favorably with the landmark cardiology trials that have shaped our international cardiology guidelines (5,6).
Clearly, cardiologists would do well to keep up with this evolving area of T2D CVOTs to ensure that their patients potentially benefit from newer therapies for diabetes care. In addition, a good understanding of the potential risks of diabetes drugs in treating patients with CV disease is also important. Before discussing newer therapies, reviewing experience of the CV effects of older drugs is helpful.
Although meta-analyses of landmark glucose-lowering trials suggest that intensive glycemic control does reduce risk for CV disease events (7), improved CV outcomes as a function of intensive glucose control appear modest in comparison to the calculated CV benefits from lipid and blood pressure management (8). In addition, some concerning signals for risk of CV events have been associated with certain widely-used diabetes medications, including sulfonylureas, thiazolidinediones, dipeptidylpeptidase 4 inhibitors, and insulin.
Although widely used for care of T2D, drugs from the sulfonylurea class of drugs (although perhaps less so for gliclazide) (9) have been associated with a higher risk for CV events, notably including a higher risk for nonfatal myocardial infarction (MI) or CV death, relative to other diabetes drugs (10). For example, a meta-analysis of 72 small or modest-sized randomized controlled trials found that all-cause mortality; CV mortality; and a composite of MI, stroke, and CV mortality were all increased in patients treated with glibenclamide, glipizide, and tolbutamide compared with metformin (11). Based on these and other data, sulfonylurea medications carry a "black box" CV warning from the FDA regarding heightened risk for CV events, although the same is not true in many non-U.S. countries.
Thiazolidinediones (TZDs) are agonists for the peroxisome proliferator-activated receptors that regulate gene expression, resulting in improved glucose utilization and reduced glucose production. TZDs improve a number of CV risk factors and became widely used at one point; however, reports of potential CV risk (including reports of fluid retention with incident heart failure as well as a possible increased risk for incident MI ), and earlier reports of excess bladder cancer risk (now debated ) led to reduction in their use. For example, the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes) trial reported an adjusted risk for incident heart failure (hazard ratio [HR]: 2.25; 95% CI: 1.27 to 3.97) (14), similar to findings in a meta-analysis (15). The MI risks for rosiglitazone have now been largely dispelled (16), whereas pioglitazone does have trial evidence to show net CV benefit (17), but the heightened heart failure risk, as well as weight gain and potential risks for fractures with this class of drugs, has led to a reduction in their use (18).
Dipeptidyl peptidase-4 (DPP-4) is an enzyme that degrades many peptides, including glucagon-like peptide (GLP)-1; thus, pharmacological inhibition of DPP-4 prolongs the half-life and biological activity of GLP-1. Inhibitors of DPP-4 have modest glucose-lowering effects, but although 3 recent CVOTs did show evidence of CV safety according to FDA criteria, they did not demonstrate net CV benefits (19–21) contradicting an earlier meta-analysis (22). Furthermore, because of recent data suggesting a higher risk for incident heart failure associated with use of saxagliptin and alogliptin, recent regulatory warnings have been put in place for these 2 agents. Although meta-analyses suggest the risk for incident heart failure to be significant with this class of drug (relative risk: 1.13; 95% CI: 1.01 to 1.26) (23), not all DPP-4 inhibitors have been linked to heart failure risk; for example, recent data suggest no increased risk for incident heart failure related to sitagliptin use (24).
Insulin is effective for glucose lowering and is very widely used for the treatment of advanced T2D. Therapy with insulin commonly leads to increased body weight and is associated with greater hypoglycemia risks. Thus, although insulin might improve glycemic control, its other effects may theoretically attenuate its clear glucose-lowering benefits in subgroups with particular susceptibility to hypoglycemia or the adverse effects of hypoglycemia. There was also some expectation that exogenous insulin administration early in the course of T2D may have beneficial effects on CV outcomes; however, the results of the ORIGIN (Outcome Reduction with an Initial Glargine Intervention) trial failed to demonstrate any CV benefit (25).
Although numerous therapies for T2D have been associated with an increased risk of CV events, 3 recent CVOTs have shown benefit in terms of hard clinical endpoints (Table 1) (2–4). We first review the results for the sodium-glucose cotransporter (SGLT) 2 inhibitor, empagliflozin, before discussing results for 2 GLP-1 receptor agonists.
Of course, it should be noted that up until these recent trials, metformin was the only drug with possible evidence for CV benefit, albeit in very modest numbers of patients and with low event numbers. In the UKPDS (UK Prospective Diabetes Study), metformin-treated patients had a 30% lower risk for macrovascular disease than did patients not given metformin (26). Importantly, metformin does not cause weight gain or increased risk for hypoglycemia, has many years of safety evidence, and is inexpensive; thus, it is widely used as a first-line therapy for the patient with CV disease.
SGLT2 is a low-affinity, high-capacity glucose transporter located in the proximal tubule of the nephron; SGLT2 is responsible for 90% of glucose reabsorption. Inhibition of SGLT2 results in decrease of blood glucose due to glycosuria. Secondary effects of SGLT2 inhibition include a modest diuretic effect (sodium loss is also promoted), weight loss, and lowering of blood pressure.
The only available CVOT for SGLT2 inhibitors recently reported reduction in CV events following treatment with empagliflozin compared with placebo. The EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) trial included 7,020 patients with established CV disease, and randomized them to placebo, empagliflozin 10 mg, or empagliflozin 25 mg. All study participants had established CV disease. The primary endpoint of EMPA-REG OUTCOME was 3-point MACE (CV mortality, nonfatal MI, and nonfatal stroke). Patients randomized to empagliflozin had a modest reduction in the primary endpoint (HR: 0.86; 95% CI: 0.74 to 0.99; p = 0.04 for superiority; absolute risk reduction [ARR]: 1.6%). The reduction in the primary endpoint was driven predominately by a substantial reduction in CV death (HR: 0.62; 95% CI: 0.49 to 0.77; p < 0.001; ARR: 2.2%), whereas nonfatal MI and stroke were not significantly altered; a 32% reduction in all-cause mortality was also observed (Figures 1A and 1B). Interestingly, benefit from empagliflozin in EMPA-REG OUTCOME was similar between the 2 doses tested. In recognition of the statistically robust effect on CV mortality, the FDA recently granted an indication to empagliflozin to reduce risk for CV death (27).
(A) Cardiovascular death and heart failure hospitalization. In the EMPA-REG OUTCOME trial, the most marked benefit was seen on reduction in CV death and heart failure hospitalization, with a more modest benefit in LEADER on cardiovascular death, and little evidence for such benefits in SUSTAIN-6. One must be careful to note that event numbers in the latter trial were small, in keeping with much larger confidence intervals. (B) Acute myocardial infarction and stroke. Greatest reductions in these events were seen in SUSTAIN-6 (although, once again, small event numbers suggest caution in interpretation), whereas such benefits were more modest in LEADER (although directionally similar). By contrast, such effects in EMPA-REG OUTCOME were mixed, although once again caution is needed, given overlapping confidence intervals. CV = cardiovascular; EMPA-REG OUTCOME = Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients; HF = heart failure; LEADER = Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results; MI = myocardial infarction; SUSTAIN-6 = Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes-6.
Notably, in EMPA-REG OUTCOME, heart failure hospitalization was reduced by 35% (HR: 0.65; 95% CI: 0.50 to 0.85; p = 0.002; ARR 1.4%), with a rapid separation in the survival curves suggesting acute benefit of the drug. The reduction in heart failure events was particularly clinically relevant, as drugs from other classes of glucose-lowering drugs with very different mechanisms of action (in particular, saxagliptin and rosiglitazone) had previously been found to be associated with an increase in hospitalizations for heart failure (15,19).
Although compelling, there are several reasons why heart failure outcome results should be interpreted cautiously. Although hospitalization for heart failure was a pre-specified outcome in EMPA-REG OUTCOME, it was not the primary outcome and did not have the rigor characteristic of heart failure trials. Patients could be recruited on the basis of investigator-reported heart failure, but there was no formal assessment of heart failure status, or cardiac structure or function at baseline; for example, no natriuretic peptide measurement or echocardiography was performed. No understanding regarding forms of heart failure (e.g., preserved vs. reduced ejection fraction) was established. Furthermore, it is possible that some of the 76% of patients included on the basis of coronary artery disease at baseline (including 47% with prior MI) may have had unrecognized left ventricular dysfunction.
In short, the finding of reduced hospitalization for heart failure is impressive, but further detail documenting the patient characteristics and biomarkers of heart failure is unavailable. It is possible that in some cases empagliflozin prevented the onset of clinical heart failure in those with unrecognized left ventricular dysfunction, but also that in some cases empagliflozin-treated patients already had unrecognized clinical heart failure. Mechanistic, or "bedside to bench," studies are now trying to clarify the mechanistic relationship between empagliflozin and heart failure, while large outcome trials investigating the possible efficacy of SGLT2 inhibitors in treating heart failure with both preserved and reduced ejection fraction are also underway (28–30).
Other benefits seen in EMPA-REG OUTCOME may help to clarify the effect of empagliflozin on CV outcomes. For example, empagliflozin also had a favorable effect on renal endpoints (31), with reduction in incident or worsening nephropathy and incident albuminuria. Whether these beneficial renal effects are secondary to improved perfusion by cardiac or cardiovascular mechanisms or whether they are due to primary renal effects is unknown, although most consider renal benefits (thought to reflect reversal of maladaptive tubulo-glomerular renal feedback) to be largely upstream.
The mechanism of benefit of empagliflozin is not fully known, but several are speculated (Figure 2). As noted, empagliflozin has numerous possibly beneficial CV effects including the hemodynamic effects of a diuretic agent; beneficial renal (reduction in intraglomerular pressure) (32), blood pressure, and weight effects; as well as many others, as recently reviewed (33,34). Most experts believe the rapid reduction in CV death and heart failure hospitalizations seen in EMPA-REG OUTCOME is best explained by a rapid hemodynamic effect (34,35). Natriuresis, in combination with renal glucose losses, is thought to lead to a reduction in circulating volume and possibly extracellular fluid load, with a consequent lowering of cardiac filling and pre-load and afterload pressures. Supporting this concept was the rapid and sustained increase in hemoglobin and hematocrit demonstrated in EMPA-REG OUTCOME (2), as well as preliminary evidence for empagliflozin-induced improvements in left ventricular mass and diastolic function (36).
By increasing fluid losses via urinary glucose and sodium losses, intravascular volumes and systolic blood pressure are reduced, and there is a modest weight loss. These changes in turn lessen cardiac stressors (pre-load and afterload) and may help improve myocardial oxygen supply. There may also be a benefit on vascular function. The net result is a likely improvement in cardiac systolic and diastolic function, lessening chances of pulmonary congestion, and thus lowering risks of hospitalization for heart failure and fatal arrhythmias. These cardiac function benefits could, in turn, feed back to improve renal function. Adapted with permission from Sattar et al. (33). CV = cardiovascular; SGLT2 = sodium-glucose cotransporter-2.
In a more general sense, the data from EMPA-REG OUTCOME suggest that many patients with T2D and CV disease may have previously unrecognized excessive fluid overload, often in association with cardiac dysfunction, and that these patients benefit rapidly from intravascular decongestion. Some have suggested that less left ventricular stretch, arising from corrections in intravascular fluid load, might also decrease the incidence of atrial and ventricular arrhythmias. Another potential mechanism of benefit is that patients randomized to empagliflozin were less likely to receive other glucose-lowering therapies (e.g., insulin and sulfonylureas), drugs that increase weight and hypoglycemia risks. Possibly, avoidance of these therapies in the treatment arm could have contributed to the positive outcome. A further proposed mechanism of benefit of empagliflozin, the ketone hypothesis, has been proposed, whereby slightly increased ketones with SGLT2 inhibitors serve as a better fuel supply for the failing heart (37).
It is important to understand the potential side effects of SGLT2 inhibitors. The most notable adverse effect in EMPA-REG OUTCOME was an absolute 4.6% increase in genital infections; a greater incidence was noted in women. Fortunately, these infections are not generally serious, and resolve with a course of antifungal agents. Once treated, they uncommonly recur. From the perspective of a cardiologist, patients should be informed of this risk, and shared care with primary care physicians (who manage these conditions on a regular basis) is recommended. It would not be prudent to use SGLT2 inhibitors in women or men with a history of recurrent genital infections. In EMPA-REG OUTCOME, there was no increase in urinary tract infections, hypoglycemic episodes, or diabetic ketoacidosis. Some concern does remain as to whether or not SGLT2 inhibitors can increase the risk of diabetic ketoacidosis outside of the tightly monitored environment of a clinical trial, particularly in patients with T2D treated with insulin. It should be noted that cases of ketoacidosis have been reported in the off-label use of SGLT2 inhibitors in patients with type 1 diabetes (38). Patients given these agents should be educated about simple warning signs and symptoms of potential diabetic ketoacidosis.
It is worthwhile to emphasize that EMPA-REG OUTCOME was not a primary prevention trial. Although tempting to speculate, it is impossible to conclude that similar benefits would be seen in patients without CV disease. This makes the results of EMPA-REG OUTCOME all the more important to the practicing cardiovascular specialist, given the high prevalence of T2D in those with established CV disease (39). Several other similar safety trials are being conducted with SGLT2 inhibitors with slightly differing pharmacology. However, these trials also differ in size and patient composition. For example, 60% of participants in DECLARE-TIMI 58 (Multicenter Trial to Evaluate the Effect of Dapagliflozin on the Incidence of Cardiovascular Events-Thrombolysis In Myocardial Infarction 58) (NCT01730534) do not have prior CV disease, which is important. These trials will report results over the next few years.
Following on from empagliflozin, 2 other drugs, both from the GLP-1 receptor agonist family, have been shown to improve CV outcomes, albeit in a different pattern than EMPA-REG OUTCOME (Figures 1A and B).
Liraglutide is a once-daily injectable GLP-1 receptor agonist. It is also associated with weight loss and blood pressure lowering. In the recent LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial, 9,340 patients with a glycosylated hemoglobin (HbA1c) of >7.0% (either >50 years of age with established CV disease or >60 years of age with 1 or more CV risk factors) were randomized to liraglutide or placebo (3). The primary endpoint of MACE was reduced by 13% (HR: 0.87; 95% CI: 0.78 to 0.97; ARR 1.9%; p for superiority = 0.01). The components of the primary endpoint were all numerically in favor of liraglutide, but only CV mortality was statistically significantly reduced (HR: 0.78; 95% CI: 0.66 to 0.93; p = 0.007; ARR 1.3%); all-cause mortality was also reduced (HR: 0.85; 95% CI: 0.74 to 0.97). Subgroup analysis did suggest a greater benefit in those with established CV disease, rather than those with risk factors in the absence of clinically-evident disease. Nephropathy events were less common with liraglutide (1.5 vs. 1.9 per 100 patient-years) but, in contrast to the widespread renal benefits with empagliflozin, liraglutide-driven renal benefits were driven largely by a reduction in new-onset persistent macroalbuminuria, with little discernible effects on other renal outcomes.
Subsequently, SUSTAIN (Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes)-6 investigated the safety of the once-weekly GLP-1 receptor agonist, semaglutide. In this phase 3, randomized, placebo-controlled noninferiority trial, 3,297 study participants were treated with semaglutide or placebo. The inclusion criteria were very similar to those used in the LEADER trial, as was the primary endpoint of 3-point MACE. Treatment with semaglutide reduced the primary endpoint by 2.3% (HR: 0.74; 95% CI: 0.58 to 0.95; p < 0.001 for noninferiority; p = 0.01 for superiority). The contribution of the components of MACE to the reduction in the primary endpoint was somewhat different to that seen in the LEADER trial, in that CV mortality was not affected by semaglutide, but nonfatal stroke was improved (ARR: 1.1%; HR: 0.61; 95% CI: 0.38 to 0.99) along with a nonsignificant trend toward lower rates of incident MI (Figures 1A and 1B). It is important to draw an important distinction between the LEADER and SUSTAIN-6 trials, as the latter study had a much smaller noninferiority design, increasing risk for type 1 and type 2 error due to underpowering.
It is not yet understood how GLP-1 receptor agonists may reduce CV events. Compared with trials of SGLT2 inhibitors, the relative benefit of GLP-1 agonists appeared at a later time following randomization, in line with atherothrombotic, rather than hemodynamic effects. However, both MI and stroke were numerically, but not statistically, lower with liraglutide than with placebo in the LEADER trial. If this was the predominant mechanism of action explaining LEADER results, a more convincing reduction in MI or stroke might have been anticipated. Other possible mechanisms are blood pressure reduction, lessening of arterial stiffness (in keeping with lower systolic blood pressure, but higher diastolic blood pressure, so narrowing of pulse pressure), weight loss, and beneficial renal effects. The reduction in blood glucose was more pronounced in the early years in the LEADER trial than in other recent diabetes CVOTs, so one cannot rule out that glucose lowering contributed to its beneficial effects; patients randomized to liraglutide were less likely to be exposed to insulin or sulfonylureas, prompting speculation that preventing exposure to these potentially harmful (or less "net" beneficial) drugs in such patients may also be a contributory mechanism. As well, severe hypoglycemia was significantly lower in patients randomized to liraglutide; emerging evidence indicates that hypoglycemia may be more harmful in patients with existing CV disease, so less hypoglycemia could help explain the CV mortality reduction in the LEADER trial. Other direct vascular or cardiac effects of GLP-1 receptor agonists have been proposed and could have contributed to the CV benefits seen (40).
Taken together and accepting the caveats mentioned in the previous text, the somewhat different pattern of CV benefits in the LEADER versus SUSTAIN-6 trials (Figures 1A and 1B) suggests that a class effect of GLP-1 receptor agonists on CV outcomes cannot be assumed; rather, benefits and potential harms may differ between different GLP-1 receptor agonists. The results of EXSCEL (Exenatide Study of Cardiovascular Event Lowering Trial), testing once-weekly exenatide, are eagerly awaited (41). It should also be noted that the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) CVOT did not reduce MACE in T2D patients following acute coronary syndrome (42), but whether these results were due to the short-acting nature of lixisenatide compared with other GLP-1 agonists requires further research.
As with the SGLT2 inhibitors, a good understanding of the potential side effects of GLP-1 receptor agonists should be known. In trials of these agents, more patients discontinued liraglutide or semaglutide than placebo due to adverse events. This was primarily due to gastrointestinal adverse effects, a known side effect of GLP-1 receptor agonist drugs. There was a slight numerical excess of retinopathy events with liraglutide versus placebo (0.6 vs. 0.5 per 100 patient years); rates of retinopathy events were higher in those treated with semaglutide (HR: 1.76; 95% CI: 1.11 to 2.78), which is a concern, although the number of events is rather small. The more rapid glucose reduction seen with semaglutide is theorized to explain increased retinopathy, but more work is needed to confirm the findings and, if confirmed, examine the mechanisms. There was a concern before the trial that GLP-1 receptor agonists might increase pancreatic conditions, but these concerns were not realized.
Diabetes is associated with a higher rates of incident CV disease, which most have thought to be due to excess atherothrombotic risk, with hyperglycemia adding fire to a background of hypertension, dyslipidemia, and obesity. However, as MI and stroke rates have declined substantially (43), due in considerable part to much better treatments with statins and antihypertensive agents, heart failure and peripheral arterial disease have become the 2 commonest first presentations of CV disease in those with T2D (44). Moreover, once patients with T2D develop CV disease, their risk of premature mortality escalates (45), and it is here that the unexpected and rapid CV mortality and heart failure benefits in the EMPA-REG OUTCOME trial have emerged. These benefits support greater roles of cardiac structural abnormalities and excess fluid loads in driving premature death in such patients. Parallel improvements in renal outcomes, CV death, and heart failure hospitalization also emphasize the importance of cardio-renal interactions in patients with T2D and CV disease. Although cardiologists appreciate the role of kidney dysfunction in heart failure (46), a recalibration toward appreciating overlapping mechanisms with the heart, kidney, and T2D is worthwhile.
The recent positive CVOTs have also taught all clinicians that it is not necessarily lowering glucose per se (or even how much one lowers glucose) that dictates net CVD effects of diabetes drugs. Rather, the mechanism by which any particular diabetes drug works and its associated multiple effects on other pathways may matter as much (if not more) to observed CVD benefits. The EMPA-REG OUTCOME, LEADER, and SUSTAIN-6 trials have shown that blood glucose and CV and total mortality can be lowered in parallel with specific drugs that might improve the hemodynamic status of patients or lower glucose in conjunction with reduced weight, lower risk for hypoglycemia, and improved blood pressure; possible beneficial direct effects on atherosclerosis may also be considered (Figure 3).
In patients with CV disease and T2DM, a combination of atherogenic and hemodynamic disturbances (the latter driven by combinations of renal disease, cardiac dysfunction, and potentially obesity) likely contribute to accelerated CV and total mortality risks. If this is correct, SGLT2 inhibitors might be more likely to correct hemodynamic processes (although they may also have a vascular benefit), whereas GLP-1 receptor agonists may act more to lessen atherogenic processes over time; both may aid hypoglycemia avoidance. These broad mechanistic explanations remain somewhat speculative, and more data from trials and mechanistic studies are needed to enrich our understanding, including better understanding whether and why different GLP-1 receptor agonists yield differential benefits. This schematic also predicts the combination of SGLT2 inhibitors and GLP-1 receptor agonists may be yield additive benefits in patients with T2D and CV disease, but further research is needed to test this supposition. GLP-1 = glucagon-like peptide-1; MI = myocardial infarction; T2D = type 2 diabetes; other abbreviations as in Figure 2.
It is impossible for cardiologists to assume full responsibility for blood glucose management; however, a change in thinking regarding initiation and titration of therapies with CV benefits is necessary, particularly because most patients with T2D develop CV disease and are frequently encountered in cardiology practice. As well, the patient with CV disease frequently has unrecognized or undertreated T2D; in the RESOLVD (Randomized Evaluation of Strategies for Left Ventricular Dysfunction) study, in addition to the 27% of patients with recognized T2D, 11% of patients with heart failure had unrecognized T2D (47).
In light of the new trial evidence of clinical benefit over and above existing therapies, and with the emergence of recent guidelines mentioning these CV benefits (48,49), it seems logical to suggest that cardiologists perform routine, systematic measurement of HbA1c in all patients with established CV disease (Central Illustration). Measurement of HbA1c should be performed both to diagnose T2D and to identify those who would have met the inclusion criteria for the positive CVOTs (e.g., HbA1c 7% to 10% in EMPA-REG OUTCOME, and >7% in the LEADER and SUSTAIN trials). Care of patients with T2D and CV disease should involve strong consideration for use of glucose-lowering drugs that improve CV outcomes over and above existing therapies, and not solely on the glucose-lowering abilities of therapies. In this regard, beyond their glucose-lowering effects, empagliflozin, liraglutide, or semaglutide (when available) might be considered for eligible patients for their proven CV benefits. Of course, identifying new diabetes in patients with CV disease will also have other beneficial implications, including, where relevant, the choice of revascularization (coronary artery bypass graft vs. percutaneous coronary intervention) and the aggressiveness of management of other risk factors.
The cardiologist will need to take a more active role in patient care by more frequent testing for T2DM using HbA1c in patients with CV disease to identify suitable patients for newer T2DM therapies. Cardiologists should also prescribe T2DM drugs with proven CV benefits, and work more efficiently with diabetologists and primary care physicians to manage their patients. CV = cardiovascular; GLP = glucagon-like peptide; HbA1c = glycosylated hemoglobin; SGLT = sodium-glucose cotransporter; T2DM = type 2 diabetes mellitus.
In analogy to the "heart team" approach used for those with other forms of heart disease, collaboration among cardiologists, primary care physicians, and diabetologists will be necessary to achieve the goal of more widespread treatment of vulnerable patients with T2D. Management of adverse effects, such as genital infections, are an obvious example of where this approach is likely to be beneficial. There is no reason that cardiologists cannot initiate SGLT2 inhibitors, with the patient then monitored by colleagues in primary care or diabetology. Although cardiologists might recommend GLP-1 receptor agonists, specialized teaching by primary care physicians and/or diabetologists might be needed. If CV specialists do not feel comfortable prescribing these drugs, they should inform not only the patients, but also the primary care physician (and other health care professionals involved in the patient's care) of the potential benefits of adding these drugs.
Diabetologists have lowered CV risk by prescribing statins and antihypertensive agents for decades. Based on present data, if a diabetes specialist recognizes that a patient has CV disease, he or she has identified a patient who might benefit from therapy with newer agents, such as SGLT2 inhibitors or GLP-1 receptor agonists. Although numerous therapies exist to lower blood glucose, it will take a continued shift in philosophy toward using therapies that not only lower blood glucose modestly, but also significantly reduce CV risk. Our view is that, given that empagliflozin is oral (rather than injectable) with an apparently robust effect on CVD and total mortality, it would likely be the preferred choice after metformin in most patients with CVD and diabetes. Of course, treatments need to be individualized, and other factors, such as poor renal function and patient preference, may make a GLP-1 receptor agonist the preferable choice in some patients.
There is an array of ongoing safety CV outcome trials with DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors with study groups similar to those in the trials described in this paper, but also, importantly, including patients without CVD (50). The knowledge of the pros and cons of other agents in varying populations will evolve over the next 1 to 5 years. Trials with SGLT2 inhibitors are also underway in patients with heart failure, including those with T2D or pre-diabetes, as well as those without T2D. Trials of SGLT2 inhibitors in patients with chronic kidney disease are also underway. Trials of the combined effect of SGLT2 inhibitors and GLP-1 receptor agonists may also be reasonable, given the possible (and potentially additive) differences in mechanism of benefit of these agents.
Ultimately, studies of newer drugs for T2D must shift to focus on patients without prevalent CV disease (50). It is typically harder to prove CV benefit in such trials, given lower rates of incident events; enrichment of patient populations with tools to identify higher risk for CV events might be a way that can identify subgroups that potentially benefit. Circulating biomarkers might be such a tool. When measured in patients with T2D, concentrations of N-terminal pro–B-type natriuretic peptide and high-sensitivity troponin may be helpful to predict future CV events, including heart failure and atherothrombotic events (51–53). Thus, it may be possible to envision a strategy of biomarker-guided screening and treatment of patients with T2D who are at high risk for CV events.
When the first few CVOTs of newer diabetes drugs began to report CV safety without reduction in CV risk, some started to question the value of these clinical trials. However, recent CVOTs have shown convincing evidence of CV benefit with an SGLT2 inhibitor and 2 classes of GLP-1 receptor agonists. Cardiologists should take note of the substantial reduction in CV events and CV mortality in these trials. If clinical experience follows the results of studies such as EMPA-REG OUTCOME (SGLT2 inhibitor) or LEADER (GLP-1 receptor agonist), a sizeable proportion of patients seen and managed by cardiologists on a daily basis might benefit from treatment with these novel agents. Consequently, cardiologists would do well to familiarize themselves with these drug classes, as many of their patients (i.e., T2D plus CV disease) stand to benefit from their use. Cardiologists should also consider screening more widely for T2D, to identify patients who could benefit sooner from such drugs. By doing so, it will be possible to better influence the rising burden of patients with both T2D and CV disease.
Dr. Sattar has received speaker fees or consulting honoraria from Amgen, Sanofi, Boehringer Ingelheim, Eli Lilly, AstraZeneca (on Operations Committee for EXSCEL trial), Novo Nordisk, and Janssen; and has received research funds from AstraZeneca. Dr. Petrie has received speaker fees or consulting honoraria from Takeda, Novartis, AstraZeneca, Maquet, Boehringer Ingelheim, Pfizer, Daiichi-Sankyo, Servier, and Eli Lilly; has served as a consultant for Novo Nordisk; and has served on clinical events committees for Roche, Bayer, Stealth Biotherapeutics, AstraZeneca, GlaxoSmithKline, Astellas, Cardiorentis, Reservlogix, and Boehringer Ingelheim (including for the EMPA-REG OUTCOME trial). Dr. Zinman has received grant support from Boehringer Ingelheim, Novo Nordisk, and AstraZeneca; has received consulting and speaking honoraria from Boehringer Ingelheim, Eli Lilly, Merck, Novo Nordisk, AstraZeneca, Sanofi, and Janssen; and is an investigator in EMPA-REG OUTCOME, LEADER, and EXSCEL. Dr. Januzzi is supported by the Hutter Family Professorship; has received grant support from Siemens, Singulex, and Prevencio; has received consulting income from Roche Diagnostics, Critical Diagnostics, Sphingotec, Phillips, Novartis, Janssen and Boehringer Ingelheim; and participates in clinical endpoint committees/data safety monitoring boards for Pfizer, Novartis, Amgen, Janssen, and Boehringer Ingelheim (including for the EMPA-REG OUTCOME Trial). Drs. Sattar and Petrie contributed equally to this work. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper. Bejamin M. Scirica, MD, served as Guest Editor for this paper.
(2013) Cardiovascular outcome studies with novel antidiabetes agents: scientific and operational considerations. Diabetes Care 36(Suppl 2):S253–S258.
(2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342:145–153.
(2009) Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 52:2288–2298.
(2009) Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet 373:1765–1772.
(2015) Mortality risk among sulfonylureas: a systematic review and network meta-analysis. Lancet Diabetes Endocrinol 3:43–51.
(2017) Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: a Bayesian meta-analysis of survival data. Diabetes Obes Metab 19:329–335.
(2013) Sulphonylurea monotherapy for patients with type 2 diabetes mellitus. Cochrane Database Syst Rev 4:CD009008.
(2015) Pioglitazone and bladder cancer risk: a multipopulation pooled, cumulative exposure analysis. Diabetologia 58:493–504.
(2007) Rosiglitazone evaluated for cardiovascular outcomes—an interim analysis. N Engl J Med 357:28–38.
(2015) Was there really any evidence that rosiglitazone increased the risk of myocardial infarction or death from cardiovascular causes? Pharmacoepidemiol Drug Saf 24:223–227.
(2012) Thiazolidinediones and PPARγ agonists: time for a reassessment. Trends Endocrinol Metab 23:205–215.
(2014) Efficacy and safety of dipeptidyl peptidase-4 inhibitors and metformin as initial combination therapy and as monotherapy in patients with type 2 diabetes mellitus: a meta-analysis. Diabetes Obes Metab 16:30–37.
(2017) Efficacy and safety of DPP-4 inhibitors in patients with type 2 diabetes: meta-analysis of placebo-controlled randomized clinical trials. Diabetes Metab 43:48–58.
(2012) Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 367:319–328.
U.S. Food and Drug Administration. FDA approves Jardiance to reduce cardiovascular death in adults with type 2 diabetes [news release]. December 2, 2016. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm531517.htm. Accessed April 5, 2017.
Boehringer Ingelheim, Eli Lilly and Company. EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved). 2017. Available at: https://clinicaltrials.gov/ct2/show/NCT03057951. Accessed April 5, 2017.
Boehringer Ingelheim, Eli Lilly and Company. EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced). Available at: https://clinicaltrials.gov/ct2/show/NCT03057977. Accessed April 5, 2017.
AstraZeneca. AstraZeneca announces two new phase IIIb trials for Forxiga in chronic kidney disease and chronic heart failure [press release]. September 12, 2016. Available at: https://www.astrazeneca.com/media-centre/press-releases/2016/astrazeneca-announces-two-new-phase-IIIb-trials-for-Forxiga-in-chronic-kidney-disease-and-chronic-heart-failure-120920161.html. Accessed April 5, 2017.
(2014) Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus. Circulation 129:587–597.
(2016) SGLT2 inhibition and cardiovascular events: why did EMPA-REG OUTCOMEs surprise and what were the likely mechanisms? Diabetologia 59:1333–1339.
(2016) Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and kidney effects, potential mechanisms, and clinical applications. Circulation 134:752–772.
(2016) Effect of empagliflozin on left ventricular mass and diastolic function in individuals with diabetes: an important clue to the EMPA-REG OUTCOME Trial? Diabetes Care 39:e212–e213.
(2015) Euglycemic diabetic ketoacidosis: a predictable, detectable, and preventable safety concern with SGLT2 inhibitors. Diabetes Care 38:1638–1642.
(2016) The cardiovascular biology of glucagon-like peptide-1. Cell Metab 24:15–30.
(2016) Rationale and design of the EXenatide Study of Cardiovascular Event Lowering (EXSCEL) trial. Am Heart J 174:103–110.
(2016) The changing face of diabetes complications. Lancet Diabetes Endocrinol 4:537–547.
(2015) Type 2 diabetes and incidence of a wide range of cardiovascular diseases: a cohort study in 1·9 million people. Lancet 385(Suppl 1):S86.
(2015) Association of cardiometabolic multimorbidity with mortality. JAMA 314:52–60.
(2016) 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 37:2315–2381.
(2016) Pharmacologic management of type 2 diabetes: 2016 interim update. Can J Diabetes 40:484–486.
(2013) The cardiovascular safety of incretin-based therapies: a review of the evidence. Cardiovasc Diabetol 12:130.
(2016) Prognostic implications of biomarker assessments in patients with type 2 diabetes at high cardiovascular risk: a secondary analysis of a randomized clinical trial. JAMA Cardiol 1:989–998.
(2016) Research digest: cardiac biomarkers for risk prediction. Lancet Diabetes Endocrinol 4:890.


text:
José António Nuno Rodrígues de Morais (ur. 25 kwietnia 1923, zm. 2 września 1986) – portugalski lekkoatleta (sprinter), uczestnik igrzysk olimpijskich w Londynie w 1948

Występy na igrzyskach olimpijskich
Morais  wystartował w dwóch konkurencjach na igrzyskach olimpijskich w 1948 r. Wziął udział w zmaganiach lekkoatletycznych.
Pierwszy raz wystartował na dystansie 100 m rozgrywanym 30 lipca. W jedenastym biegu eliminacyjnym zajął drugie miejsce z czasem 10,9 s. i awansował dalej. W rozgrywanym tego samego dnia ćwierćfinale w pierwszym biegu zajął ostatnie 6. miejsce tracąc do zwycięzcy 0,82 s. i tym samym zakończył rywalizację w tej konkurencji. Ponownie Morais wystartował 2 sierpnia. Tym razem wziął udział w biegu na 200 m. W trzecim biegu eliminacyjnym zajął trzecie i ostatnie miejsce z czasem 22,6 s. i co nie pozwoliło mu awansował dalej.

Rekordy życiowe
 Bieg na 100 metrów – 10,6 s.  (1948)
 Bieg na 200 metrów – 22,1 s.  (1948)

Bibliografia

Portugalscy sprinterzy
Portugalscy olimpijczycy
Urodzeni w 1923
Zmarli w 1986


text:
Media for Movement and Making the World: Exploring Materials and Identity in the Mesolithic of the Northern Irish Sea Basin
Hannah Cobb
Archaeology, School of Arts, Histories and Cultures, University of Manchester, M13 9PL. Hannah.Cobb@postgrad.manchester.ac.uk
Cite this as: H. Cobb 2007 'Media for Movement and Making the World: Exploring Materials and Identity in the Mesolithic of the Northern Irish Sea Basin', Internet Archaeology 22. https://doi.org/10.11141/ia.22.6
This paper provides an account of the author's current doctoral research into the Mesolithic period in the northern Irish Sea basin and western Scotland. It explores the extent to which modern understandings of the world and modern geo-political boundaries have been responsible for shaping studies of the period in the area and questions how such interpretations may be re-evaluated. In doing so this paper outlines a series of alternative approaches to understanding hunter gatherer identity, exploring how identity intersects with sensual material engagements and understandings of place. It outlines a way to explore such elements in practice, and presents some initial interpretations of the material that have arisen from the study. This in turn suggests that such an approach may be potentially significant in providing a more detailed, socially situated understanding of Mesolithic hunter-gatherers and the changes that such populations underwent during the transition to farming in the northern Irish Sea basin.
Go to article Table of Contents
This article will appeal to: those who are interested in developing a theoretically interpretive approach to the Mesolithic period and to prehistoric hunter-gatherers in general by discussing both key theoretical issues and practical ways of addressing these. It will also appeal to people with an interest in phenomenological approaches to materials and to landscapes more generally, and may also be of some interest to those with a concern with digital virtual reality methods of representation such as Quicktime virtual reality.
Key Features: Panorama of the site of Curran Point, Larne
Keywords: Mesolithic/Neolithic transition; phenomenology; identity; materials; landscape; taskscape; QTVR;
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© Internet Archaeology URL: http://intarch.ac.uk/journal/issue22/cobb_index.html
Last updated: Tues Oct 2 2007

redpajama_set_name: RedPajamaCommonCrawl


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Another gentleman said he began feeling the health benefits of drinking alkaline ionized water from the ACE-11 within weeks of purchase.
Another guy has been drinking Tyent water "exclusively" for a year. He's lost 65 pounds, no longer has allergies, and skipped a knee surgery he had needed before he began his alkaline journey.
A husband and father has eliminated his migraines and sleep problems. He's lost 50 lbs. He also reported healthier looking skin and whiter teeth.
One woman loves the "smoothness and taste" of Tyent water.
I chose to include the reviews above because they fall in line with the reviews I've come across during my many hours of alkaline ionized water research.
You can click here to read about how alkaline ionized water helped me eliminate a nasty case of heartburn that wouldn't go away.
Overall, I give the ACE-11 unit a big thumbs up 👍.
One of the functions I believe is now mandatory in a quality water ionizer is a molecular hydrogen function.
Alkaline ionized water with added molecular hydrogen is the future of water, and with several alkaline water brands including Tyent, the future is now.
The Tyent ACE-11 allows you to choose whether you want to boost molecular hydrogen. The only other brands I've seen with molecular hydrogen technology are Life Ionizers, AlkaViva, and Enagic.
It's no coincidence that all these brands manufacture their alkaline water machines in Japan or South Korea.
The ACE-11 is certainly a top pick for best countertop water ionizers, alongside the AlkaViva Vesta and Life Ionizers MXL-15.
In the battle of Tyent vs. Kangen, I give Tyent the nod simply because they charge significantly less for the same (and better) features. The ACE-11 is also much more attractive and sleeker than a Kangen water machine.
I do believe Kangen water machines are legit, but I can't justify the crazy-high price tag.
You're much better off purchasing an ionizer from Tyent, saving thousands of dollars, and getting the comfort of a lifetime guarantee on both parts and labor. Enagic includes just a 3-year warranty on its Kangen water machines.
Bottom line is you can purchase the ACE-11 with confidence you're buying a legit water ionizer from a legit company. Click Here to check out the current price for an ACE-11 ionizer at Amazon.
Greetings fellow health nuts! I'm the host, creator, and writer here at Alkaline Water Machine Source. You can call me Hercules. My mission is to help others heal and feel better overall through the power of alkaline ionized water. It helped me win a nearly decade-long battle with chronic fatigue, and I think it can help you too!
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Kassim has been HIV-positive for almost half his life. The disease has robbed him of his career, his partner, and much of his independence. But it won't take his creative spirit.
Kassim left Trinidad when he was barely out of his teens, unable to remain in a country where homosexuality is criminalized. He ended up in Toronto, working nights as a taxi dispatcher while attending design school by day. Saving his money, he eventually opened his own east-end studio. Life was good, with a satisfying creative career that earned him a good living. He fell in love, happily settling into a decade-long relationship. A diagnosis of HIV/AIDS changed all that.
When you're so sick and alone, you can feel unworthy of living," says Kassim. "But at Casey House, they help you to live again.
"My boyfriend got tested and he was sick too," recalls Kassim. "He blamed me, I blamed him. We just fell apart." The relationship ended. The two men sought treatment separately, Kassim becoming a patient of pioneering HIV physician Dr. Anita Rachlis. But as he struggled with medication after medication, he grew increasingly frustrated with the terrible side effects. Too sick to work, lonely and depressed, he stopped taking the pills. The virus wasted no time, attacking his brain.
"I was so sick," recalls Kassim. "Dr. Rachlis said I should go to Casey House, that I needed more care than she could give me. But I was terrified. I thought I would die there, for sure. 'No, no,' Dr Rachlis said. 'Kassim, I promise you, they'll take good care of you.' And she was right, they did." With his short-term memory compromised, the team at Casey House taught Kassim strategies to remember to take his pills. They helped to secure supportive housing, since he could no longer live alone. In the years since, he has twice been admitted to Casey House to manage disease exacerbations.


How much notice do you need from me to book my event?
We make every effort to accommodate same-day orders but we suggest at least 48 hours to ensure availability for drop-off orders and as soon as possible for full-service events.
Do you do custom menus?
Absolutely! We can create a menu customized to whatever type of event you are hosting. Please contact us to start designing your one of a kind menu.
We deliver to New York and New Jersey area.
We can provide staffing, rentals, and floral/décor coordination. We can also refer you to valet and entertainment services.
Can you cater to dietary needs and special requests?
We can create a custom menu that caters to any dietary needs – including Gluten-Free, Dairy-Free, and Kosher.
What uniforms do staff wear?
Our staff is typically uniformed in all black. Alternative uniforms can be arranged to fit with event theme.
What is the preferred payment method?
Payment can be made by check or credit card. All credit card transactions will incur a 4% service charge. If paying by credit card please submit a completed credit card authorization. If paying by check please make all checks payable to: Food For Thought Caterers Corp.
Please do not cancel. If applicable, cancellation details will be on your contract.
How much set-up time should I anticipate?
For drop-off orders we will arrive onsite approximately one hour before start time. Full service typically requires a minimum of two hours for set-up.
A Full Service Caterer serving New York City for over 20 years.
We are a single source for all your event needs, including Food, Staffing, Rentals and Flowers. Whether it be a Breakfast, Buffet or Box Lunch, Reception or Dinner, our attention to detail is unmatched. From a simple "Drop Off" to a "Full Service Sit-down Dinner" Food For Thought's team will handle every detail and ensure a successful event!


The Italian energy supplier has achieved 15% more conversions by fully leveraging its data .
By making innovation its guiding principle, Sorgenia has become Italy's leading digital energy company. The supplier, which provides gas and electricity to homes, entrepreneurs and small businesses, aims to offer customer service that is both friendly and sustainable.
"The market is changing rapidly and will change even more so when it is fully liberalised. To respond quickly to these changes, we've decided to focus on digital technology to connect with our customers and offer them solutions that best meet their needs," explains Paolo Rohr, Digital Director at Sorgenia.
Innovation and experimentation are Sorgenia's two core principles and are clearly reflected in their technological choices. For Tag Management, Sorgenia chose to team up with Commanders Act.
Firstly, to create attribution models by analysing each customer's journey, so that the company can know if customers need to contact customer service while also optimising all their processes.
And secondly, to provide a personalised browsing experience, allowing the the website to be adjusted depending on the type of visitor, customer or lead, and thus optimise the retargeting budget. And to also convert customers through the call centre. Thanks to Commanders Act's solution, Sorgenia's operators who contact a user following a support request can view a full data sheet with details of the customer's profile. Naturally, this maximises the efficiency of the company's support team and technicians.
The content of Sorgenia's website is personalised based on the user's profile. If the user is a customer, the website proposes the purchase of a missing product or the Member Get Member programme to promote new supply contracts. On the other hand, if the user is a lead, the website aims to encourage the potential customer to visit the website again.
Another important aspect of the customer relationship is the daily promotions that the company offers through its agreements with online partners. The aim of these initiatives is to create a more detailed customer profile and provide unique communication.
Five months after starting this collaboration, the company is now almost completely independent in using the Commanders Act platform, and only needs technical support for complex issues. "We chose Commanders Act for the flexibility of its products and the availability of its staff. "What has been particularly great about this collaboration is the constructive relationship we have with Commanders Act – they are always proactive and ready to give us ideas and advice to constantly improve our service," confirms Mr Rohr.
Sorgenia has succeeded in increasing both the total volume of purchases and its conversion rates. Conversion rates have increased by 1%, leading to 15% growth in terms of total conversions. Combined with a more personalised service, this has led to 25% more traffic in the acquisition funnel. Looking at other metrics, the company has reduced its bounce rate by 1% and boosted page views by 10%. The number of browsing sessions has also increased, with each lasting 15% longer. In 2019, Sorgenia will continue to personalise its digital services, both for customers and leads: "We plan on integrating the data we have with other purchasing platforms and CRM activity. These are projects we are working hard to achieve, knowing we can count on our partnership with Commanders Act," concludes Paolo Rohr.


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WARISAN WOMEN MACHINERY TO TACKLE ALL WOMEN VOTERS IN KIMANIS
KHATIJAH JISTOH
Bernama 13 January 2020
KIMANIS, Jan 13 (Bernama) -- Parti Warisan Sabah (Warisan) will mobilise its women's wing to win the hearts of women voters in the Kimanis parliamentary by-election on Jan 18.
Head of Wanita Warisan, Datuk Siti Aminah Jabarhan said in the days approaching the by-election, the wing will intensify efforts to meet with women voters here.
"The party's women's machinery has been instructed to key in the women voters in their areas to vote for our candidate," she told Bernama.
The Kimanis parliamentary constituency has two state seats, namely Bongawan and Membakut with a total of 29,664 eligible voters including nine early voters and one overseas.
The voters comprise 14,800 men and 14,864 women, of which 16,273 are in Bongawan and 13,391 in Membakut.
-- MORE
KIMANIS-WOMEN 2 KIMANIS
Commenting further, Siti Aminah said going by the first seven of 14-day campaign period, she was confident that 70 per cent of women voters would opt for Warisan candidate Datuk Karim Bujang.
She said women who make up almost 50 per cent of the total 29,664 voters in Kimanis could influence the outcome of the by-election.
She added that most of the women voters who were met during the campaign period expressed their hope that women in the rural areas are given attention in terms of human resource development, welfare, and political appointments.
"Women voters here were disappointed with the previous government who did not pay much attention to them.
"Some of the women in these villages work as rubber tappers and petty traders, and hope to get government aid, for instance by increasing rubber prices or providing a platform for traders to expand their businesses," she said.
KIMANIS-WOMEN 3 (LAST) KIMANIS
Meanwhile, voter Zita Simon, 47, when met at Kampung Daingin, said she wanted a people's representative who would not abandon his people when they needed him, and only returned with promises during election season.
She said the people want changes, not just in areas of development and tall buildings, but attention must also be given to education and providing a platform for rural housewives to increase their income.
Another voter, Catherine Anthony, 67, who was met at the Batu Enam District Polling Centre, Kampung Kalatuan, clearly said she wants Karim, who had been Bongawan state assemblyman for five terms from 1990 until 2013, to win the Kimanis parliamentary seat.
The Kimanis by-election sees a straight fight between Karim and Barisan Nasional candidate Datuk Mohamad Karim.
The Election Commission has fixed Jan 18 for polling day and early voting on Jan 14.
TAG: Kimanis by-election, Parti Warisan Sabah, Siti Aminah Jabarhan, women voters
Unofficial: BN wins Kimanis by-election with 1000-vote majority
Kimanis by-election: Unofficial early counts put Barisan ahead


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As the lady and I ascended the stairs to The Sinclair I have an overwhelming sense of anxious tension wash over me. I had been waiting for this homecoming show of Aoife's for quite some time. Where "In The Magic Hour" slightly departs from the songwriter's more bluegrass folksy roots, the collection of songs commands ab it more presence and a heartier sound, sonically speaking. The textures are a bit more heavy and the strokes the music takes on the canvas of the record is somewhat more electrified and severe, but in the element that is is a bit more robust and less acoustic driven kind of a way. I was curious to see how O' Donovan and her band would take those sounds and recreate them in a live setting. To say they didn't disappoint in an incredibly large understatement.
The opening act of this show in the duo of Cassandra Jenkins and Sam Evian was a good pairing for Aoife and her band and opened the show up nicely. Despite a few nervous hiccups on a song or two, I enjoyed their set. The duel guitars swam in a sea of tremolo and reverb and Jenkins's beautifully warm vocal dovetailed nicely into the headliners set as they share a lot of the same qualities in their voices and tone.
Aoife and her band (guitarist Anthony da Costa and drummer Steve Nistor) took the stage to a roar of applause from the packed house at The Sinclair. As a homecoming show of sorts, she made a comment about the band giving her grief for knowing approximately 70% of the crowd personally. Well, the love in the room from that 70% and beyond was evident by the time the first note rang out in the set.
As the trio pressed their way through a collection of songs from both 'Magic Hour' and 'Fossils', favorites such as the bright and inner looking title track of the most recent album, the locomotive driving energy of "Hornets", and the haunting, plodding 'Stanley Park' you could hear a pin drop (well, aside from the boorish group of 50-something ladies next to me…immediately in front of the stage). But I, nor anyone in the audience, allowed that to detract from their experience.
By the time O' Donovan excused Anthony and Steve from their duties the power and feeling in the room was all encompassing, comforting and at ease, but on fire all the while. She then launched into an absolutely breathtaking version of Joni Mitchell's "You Turn Me On, I'm A Radio" that sent shockwaves through the room and chills down anyone-present-with-a-beating-heart's spine. I have seen many shows at The Sinclair and I am yet to witness an artist be able to captivate an audience in that way and hush an audience of hundreds to a complete pin-drop silence. Beauty incarnate.
The trio managed to take the songs I had heard on Fossils, Magic Hour and witnessed live previously and elevate them to soaring pinnacles. Not necessarily to a better or totally heightened state in the sense of improving, but something completely different and interesting and beautiful. Da Costa's guitar playing over the songs ranged across the map. From light coloring over the acoustic guitar rhythm to straight out metal guitar riffing…it was a truly entertaining, magnificent thing to behold. I love to see when a musician is fully engulfed in the music, and his enthusiasm was off of the charts. Top it off with some subtle, but extremely effective and gorgeous harmonies and well, swoon folks. Drummer Steve Nistor added a whole different element in his drumming. He added funk and a groove to songs that I have come to love and allowed me to experience those songs in a different fashion last evening courtesy of the band.


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Havana, Cuba 1997 1 0 0
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#1 Reggaeton group in Cuba (2005).
Ask any one of the 11 million Cuban residents, who is the number one reggaeton group? The answer will be Eddy-K. This is quite a feat considering it is estimated that more than a thousand rap and reggaeton groups exist in Cuba today. Rap and hip hop are said to be more popular now among the young in Cuba than the traditional salsa and son, and they speak directly to the younger generation about the issues they care about. Eddy-K (pronounced "Eddy-Kah") is one of the most popular rap/reggaeton groups in Cuba right now, and they combine great singing with some of the best rap in Cuba. This group fills stadiums in their country – the buzz is out on this debut CD!
WALES ARTS INTERNATIONAL
http://www.wai.org.uk
Cuba: Welsh 'scratching' in Havana - Eddie K performing in Cardiff
It is estimated that around 1,000 rap groups exist in Cuba, and 53 of the most popular ensembles from all over the island met with 20 groups from abroad, including Wales, in the 9th Havana International Hip Hop Festival in early August. Rap and Hip Hop are growing in popularity in Cuba, and these music forms are said to be more popular now among the young in Cuba than the traditional Salsa and Son, and they speak directly to the younger generation about the issues they care about. This annual festival is organised by the Hermanos Saiz Association of young Cuban artists, and the Cuban Institute of Music. The aim of the festival was to show the chief elements of Hip Hop culture - turntablism, breakdancing, graffiti and emceeing, or rapping - and it attracted a great deal of national and international comment in print and internet media.
With the help of the British Council in Cuba, and in co-operation with Community Music of Wales and Wales Arts International, two young Hip Hop DJs from southern Wales showed off their 'scratching' technique to Cuban rappers. Robert Stagg and Joel Lipman of the Welsh group 'Optimas Prime' demonstrated their DJ skills using a dual turntable in a 'scratching' technique - a category of 'turntabling'. This technique is as yet little practised in Cuba, but much admired. Their performance at Havana's Casa de Música Galiano was to a capacity audience, who applauded the dexterity of the DJs and the creativity of the music.
During their stay in Havana, Rob Stagg and Joel Lipman made a recording at a TV studio in Havana for the 'Cuerda Viva' popular music programme to be broadcast nationally in early September. They also made full use of their time to play in jam sessions and record with top Hip Hop bands in Havana, such as 'Eddy K', and to sample the variety of Cuban hip hop recordings.
The link with Wales goes back to a visit to Havana by the same DJs and two directors of Community Music Wales in March this year, supported by the National Assembly of Wales, in the context of an agreement on cultural and educational exchange signed between the two countries in 2002. The British Council in Cuba together with the Arts Council of Wales Lottery Fund helped make it possible for one of the leading rap groups in Cuba - 'Eddy K' - to perform at the 'Compass Point' Urban Music Festival in Cardiff in July this year.
Author: William (Eddie) Edmundson - Director, British Council Cuba Date: 28 August 2003
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In the presence of Their Majesties The Emperor and Empress of Japan and with the attendance of bereaved family members of war dead and many distinguished representatives of all sectors of society, here today we hold the annual Memorial Ceremony for the War Dead.
In the last war, more than three million Japanese lost their lives on the battlefield, succumbed to the ravages of war, or passed away in some distant foreign land after the war, reminiscing of their homeland and anxious about their families. Fifty-nine years have passed since the war ended. The peace and prosperity that we currently enjoy are founded on the ultimate sacrifices made by those who lost their lives in spite of themselves and the ceaseless efforts of the people of Japan in the post-war period. I offer my heartfelt prayers for the repose of their souls, and offer my genuine respect and appreciation to them from the bottom of my heart.
During the war, Japan caused tremendous damage and suffering to the people of many countries, particularly to those of Asian nations. On behalf of the people of Japan, I hereby express my profound remorse together with my sincere mourning to the victims.
Looking back on the past with humility, I will not let the lesson learned from the tragedy of war fade with time and firmly maintain the nation's antiwar pledge, dedicated to the construction of Japan as a peaceful nation. Japan will further develop its friendly relations with countries all over the world, and as a member of the international community, actively contribute to establishing lasting world peace. I will exert all my efforts so that Japan will gain further trust from the world as a country that treasures peace.
In concluding my address, I offer my heartfelt prayers for the repose of the souls of the war dead and for the continued peace and good health of the families of the war dead.