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1. Aldin Grout Papers, 1833-2002 (bulk 1833-1894)
University of Massachusetts Amherst Libraries Special Collections and University Archives
Aldin Grout was among the first American missionaries to the Zulu nation. After experiencing a religious conversion in his early twenties, Grout dedicated his life to the ministry, studying at Amherst College (1831) and Andover Theological Seminary (1834) before accepting an... more
2. Anti-Slavery (Collection of Distinction)
In the late 1890s, the family of William Lloyd Garrison, along with others closely involved in the anti-slavery movement, presented Boston Public Library with a major gathering of correspondence, documents, and other original material relating to the abolitionist cause from 1832 until after the... more
3. The Appleton Family Photo Album Collection
The Trustees of Reservations, Archives & Research Center
Appleton Farms, located in Hamilton and Ipswich Massachusetts, is the oldest continuously operating farm in America. Established in 1636 by Samuel Appleton, the farm is among the most influential in America's agricultural history. The Appleton Family Papers document the evolution of New England... more
4. Bancroft Memorial Library Local History Collection
Bancroft Memorial Library
5. Benjamin Smith Lyman Papers, 1831-1921 (Bulk: 1851-1915)
The papers of Benjamin Smith Lyman (1835-1920), a native of Northampton, Massachusetts, and a geologist/mining engineer who worked in Japan at the request of the Meiji government to introduce modern geological surveying and mining techniques, illuminate aspects of late nineteenth... more
6. Blanchard-Means Family Papers
This collection consists of items from the Blanchard-Means Family Papers collection hosted by University of Massachusetts Amherst Libraries Special Collections and University Archives. Information about the items has been provided by the holding institution so that they may be included in... more
7. Blind in Art Collection
Perkins School for the Blind
This collection presents a fascinating glimpse of ways in which people who are blind or visually impaired have been portrayed in works of art through the ages. It consists of reproduction prints, posters, photographs, clippings, and a few original art objects relating to the depiction in works... more
8. Bowen family papers (MS006)
This collection consists of items from the Bowen family papers (MS006) collection hosted by Historic New England. Information about the items has been provided by the holding institution so that they may be included in Digital Commonwealth.
9. Brigham and Women's Faulkner Hospital Collection
Brigham and Women's Faulkner Hospital
This collection contains photographs, documents, and monographs from the early history (late 19th century to mid-20th century) of Faulkner Hospital in Boston, Massachusetts. Contents include the founding Faulkner family, the Faulkner Hospital Training School for Nurses (later known as the... more
10. Buckland Historical Society Collection
Buckland Historical Society
11. Business card of Poro College
Poro College
Postcards/Cards; Photographs; Manuscripts
W. E. B. Du Bois Papers, 1803-1999 (bulk 1877-1963)
12. Caleb Foote Papers, 1851-1995 (bulk 1939-1995)
A legal scholar and pacifist, Caleb Foote was born in Cambridge, Mass., on March 26, 1917, the son of a Unitarian minister and Quaker mother. Earning degrees in history from Harvard (AB 1939) and economics from Columbia (MA 1941), Foote was hired by the Fellowship of Reconciliation to organize... more
13. Cerise Jack autographed note signed (card) to Bartolomeo Vanzetti, [December 1926?]
Jack, Cerise C.; Vanzetti, Bartolomeo, 1888-1927
Letters/Correspondence; Manuscripts; Postcards/Cards; Photographs
Sacco-Vanzetti Defense Committee (Collection of Distinction)
[December 1926?]
14. Christmas card from Fernando Ortiz to W. E. B. Du Bois
Ortiz, Fernando, 1881-1969; Du Bois, W. E. B. (William Edward Burghardt), 1868-1963
[ca. December 1941]
15. Commonwealth v. Sacco and Vanzetti
Massachusetts Supreme Judicial Court Archives
The Sacco-Vanzetti collection contains materials from the combined trials for Nicolo Sacco and Bartolomeo Vanzetti for the murders of Alexander Berardelli (#5545) and Frederick A. Parmenter (#5546). Indictments were returned by the Grand Jury 11 September 1920 and the trial, held in Superior... more
16. Countryside and Scenes
Granville Public Library
Located in the Berkshire foothills of Western Massachusetts, Granville is known for its scenic countryside, quaint village settings, and rolling farmland. This collection includes photos taken by local photographers, summer visitors, and Granville families. George Aldrich, a local amateur... more
17. Digital Amherst Collection
Jones Library, Amherst
This collection consists of items from the Digital Amherst collection hosted by Jones Library, Amherst. Information about the items has been provided by the holding institution so that they may be included in Digital Commonwealth.
18. Digitized Museum Collections
This collection consists of items from the Digitized Museum Collections collection hosted by Historic New England. Information about the items has been provided by the holding institution so that they may be included in Digital Commonwealth.
19. Doyle's Cafe Memorabilia
Jamaica Plain Historical Society
Doyle's Cafe was a popular community gathering space located at 3484 Washington Street in Boston's Jamaica Plain neighborhood. Doyle's opened its doors in 1882 and grew from a one-room Irish pub to a three-room bar and restaurant that was host to both locals and tourists alike. It was also known... more
20. Edward and Orra White Hitchcock Papers
Amherst College Archives & Special Collections
Correspondence, sermons, drawings, drafts of unpublished and published work, articles, artwork, and images relating to the professional activities and personal life of Edward Hitchcock, the third President of Amherst College and noted geologist and minister, and his family. These material are... more
Polish Americans--Massachusetts--Easthampton--Photographs19
Christmas--Massachusetts--Easthampton--Photographs10
Easter--Pictorial works8
Chicks--Pictorial works4
Anarchists3
Immigrants' writings, American3
Radicalism--United States--History--20th century3
Sacco-Vanzetti Trial, Dedham, Mass., 19213
Massachusetts23
North and Central America23
Easthampton19
Hampshire (county)19
Athol2
Essex (county)2
Lake Rohunta (Athol, Mass.)2
Postcards/Cards✖[remove]98
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Photographs✖[remove]98
Collections64
Letters/Correspondence52
Documents43
Prints41
Ephemera37
Available to use
Creative Commons license3
Lesinski-Rusin Family Papers, 1908-192519
W. E. B. Du Bois Papers, 1803-1999 (bulk 1877-1963)6
Sacco-Vanzetti Defense Committee (Collection of Distinction)3
Pine Beach Association Collection, 1922-19802
Jim Kweskin Papers, 1907-20181
Joseph Langland Papers, 1939-20071
Pauline Cashman Condon Wedding Collection, 1918 - 1919 (MS059)1
Richard J. S. Gutman and Kellie O. Gutman Summer Camp collection, 1886-2010 (MS056)1
Special Collections and University Archives, University of Massachusetts Amherst Libraries29
University of Massachusetts Amherst Libraries Special Collections and University Archives18
Historic New England9
Boston Public Library7
Watertown Free Public Library3
Amherst College Archives & Special Collections2
Granville Public Library2
Jamaica Plain Historical Society2
more Institution »
210 Park Avenue, Suite 311, Worcester, MA 01609-2246

redpajama_set_name: RedPajamaCommonCrawl


text:
SYNONYM

#### According to
Index Fungorum

#### Published in
null

#### Original name
Arthonia gregaria var. pruinata Nyl.

### Remarks
null

redpajama_set_name: RedPajamaGithub


text:
Hospitalisation for heart failure and mortality associated with dipeptidyl peptidase 4 (DPP-4) inhibitor use in an unselected population of subjects with type 2 diabetes: a nested case–control study
Carlo B Giorda1,
Roberta Picariello2,
Barbara Tartaglino3,
Lisa Marafetti1,
Fabiana Di Noi1,
Annalisa Alessiato1,
Giuseppe Costa2,4,
Roberto Gnavi2
1Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
2Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy
3Chaira Medica Association, Chieri, Italy
4Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
Correspondence to Dr Carlo Giorda; giordaca{at}tin.it
Objective The SAVOR TIMI–53 study reported a significant increase in the risk of hospitalisation for heart failure (HF) in patients treated with a DPP-4 inhibitor (DPP-4i) in comparison with placebo. A recent case-control study in part confirmed this risk signal. Our aim was to compare the occurrence of HF in relation to DPP-4i use versus any antidiabetic treatment.
Design Population-based matched case-control study conducted using administrative data.
Setting The Italian Region of Piedmont (4.4 million inhabitants).
Participants From a database of 282 000 patients treated with antidiabetic drugs, we identified 14 613 hospitalisations for HF, 7212 incident cases, and 1727 hospital re-admissions between 2008 and 2012; each case was matched for gender, age and antidiabetic therapy with 10 controls; cases and controls were compared for exposure to DPP-4i.
Outcome measures ORs and 95% CIs were calculated by fitting a conditional logistic model. All analyses were adjusted for available risk factors for HF.
Results We found no increased risk of hospitalisation for HF associated with the use of DPP-4i (OR for admission for HF 1.00 (0.94 to 1.07), incident HF1.01 (0.92 to 1.11), recurrent HF 1.02 (0.84 to 1.22)). All-cause mortality was 6% lower in DPP-4i users (p<0.001), whereas insulin users showed an excess of risk for any type of hospital admission (19%) and death (20%) (p<0.001).
Conclusions Our findings suggest that, in an unselected population of diabetic patients, the use of DPP-4i is not associated with an increased risk of HF. The favourable impact on all-cause mortality should be viewed with caution and also other explanations investigated.
This study suggests that, in an unselected population of diabetic patients, the use of DPP-4i is not associated with an increased risk of HF.
The study population was representative of the real type 2 diabetes population seen in Europe, without any selection based on insurance claims or age cut-off, which distinguishes it from other published studies.
Hospitalisation for HF was evaluated as admission, incidence or recurrence, and all five drugs currently available on the market were included.
The main limitation is that weak associations between DPP-4i use and heart failure cannot be ruled out; but if they do exist, they are not so large but if they were to exist, they would be relatively small.
While looking forward to the results of ongoing trials, practitioners can be reassured that the unexpected association reported in the SAVOR TIMI study has not been confirmed in the real world.
DPP-4 inhibitors (DPP-4i), or gliptins, are oral agents that delay the catabolism of native GLP-1 by inhibiting the endogenous enzyme dipeptidyl peptidase 4 (DPP-4), thus extending the life of native GLP-1. They have attracted growing interest as first line therapies for type 2 diabetes largely because they are effective in controlling HbA1c while reducing the risk of hypoglycaemia and weight gain. Data from trials with glycaemic endpoints suggest that they also exert a protective effect on cardiovascular risk.1 In the first published trial with cardiovascular endpoints,2 saxagliptins neither increase, nor reduce, the risk of a composite of nonfatal myocardial infarction (MI) with nonfatal stroke or cardiovascular death, thereby meeting the primary safety objective. However, as compared with placebo, saxagliptin was unexpectedly associated with a 27% excess risk of hospitalisation for heart failure (HF) (overall HR 1.27 (95% CI 1.07 to 1.51)). Detailed sub-analyses3 ,4 revealed that the absolute difference between groups was mainly seen during the first 6 months of therapy and that there was no increased risk of death due to heart failure. No clinically relevant factors predictive of increased relative risk with saxagliptin treatment could be definitively identified.5 A subsequent meta-analysis of all registrative trials with DPP-4i showed an association between the use of this class of drugs and increased risk of HF, which disappears when excluding cardiovascular outcome trials.6
Conflicting evidence for an association between sitagliptin use and hospitalisation for heart failure in some specific conditions comes from recent observational studies. Wang et al7 found an increased risk of hospitalisation for HF in with sitagliptin use in Taiwanese insured individuals whereas Chen et al8 reported no increased risk in patients with history of chronic kidney disease and myocardial infarction. Weir et al9 in particular reported that in a case-control study, based on an administrative database of US middle-aged adults with type 2 diabetes, treatment with sitagliptin was associated with an increased probability of hospitalisation for heart failure only among patients with pre-existing heart failure.
This safety issue is relevant for diabetes care because the rates of heart failure and hospitalisation are higher in patients with type 2 diabetes than in the non-diabetic population, regardless of treatment.10–12 Further complicating the question is that several drugs commonly used in the treatment of type 2 diabetes have been suspected to increase the risk of HF.13
In light of the concerns over a possible HF risk associated with DPP-4i, we thought it useful to perform a matched case-control study to explore whether the same increased risk as seen in the SAVOR-TIMI study could be detectable in the real world and in an unselected population. To the best of our knowledge, no such analysis has been performed on data from European administrative databases which, by virtue of the universalistic care of European national health systems, encompass the whole population and include all types of available DPP-4i.
Study design and participants
We conducted a population-based nested case-control study using regional administrative data from Piedmont (population about 4.4 million) Italy. The population is covered by an automated system of databases containing the records of all drugs dispensed from all regional pharmacies and hospital discharges reimbursed by the Italian National Health System. These archives can be linked together by a unique anonymous identifier that is encrypted to protect the patient's privacy. Because this automated system is anonymous, ethical committee approval and informed consent for this study were not required.
We extracted information from the regional drug prescription database for individuals aged 56 years or older who were dispensed at least one dose of any drug to treat diabetes between 1 January 2009 and 31 December 2013 (DPP-4i were not available in Italy before 2008). Only Piedmont residents were included. To minimise the chance of inclusion of patients with type 1 diabetes, we linked the database to the regional hospital discharge database, which contains the records of all hospital admissions between 1995 and 2013. Excluded were individuals with an International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code for type 1 diabetes mellitus (250.x1 or 250.x3). Furthermore, as glitazones (TZD) increase the risk of heart failure, all patients who had received a prescription for TZD during the study period were excluded.
Selection of cases
We used four different definitions for cases. First, we identified all patients who had at least one discharge for heart failure, defined as ICD-9-CM codes 402.01, 402.11, 402.91, 425.4, 425.5, 425.9, 428 or 518.4 as the primary discharge diagnosis at any time after the first exposure to antidiabetic drugs (ie, date of dispensation). For patients with more than one discharge for heart failure, we only included the first episode (ie, the hospital admission closest to 1 January 2009). Second, we identified 'incident' cases of heart failure, defined as patients discharged with a diagnosis of heart failure (defined as above) during the study period, without a previous hospitalisation for heart failure in the discharge diagnosis (either main or secondary) during the previous 60 months. Third, similarly to the study by Weir et al,9 we followed up incident cases (defined as above) to identify 'first re-hospitalisations' of those patients who had been admitted to hospital for a diagnosis of heart failure. Finally, we considered as cases all deaths (of any cause) that occurred in the population during the study period. Also included were Piedmont residents discharged from any hospital located outside Piedmont, because information on exposure to dispensed drugs is available for all patients residing in the region. Similarly, we included the deaths of Piedmont residents wherever they occurred in Italy.
Selection of controls
To identify controls, we randomly selected 10 controls from the same population source for each case, matched for year of birth (within a 5-year age band), sex and year of first exposure to antidiabetic drugs. Controls were selected one subject at a time with replacement. The process was repeated for each outcome. Matching was carried out by the study statistician (RP) with the use of an automated computer program.
Exposure to DPP-4 inhibitors
We used the regional drug database to identify cases and controls who had been prescribed DPP-4i at any time in the 6 months before the hospital admission date. We used the hospital admission date of cases to calculate the exposure windows for controls. DPP-4i were selected according to the Anatomical Therapeutic Chemical (ATC) Classification System; ATC codes A10BH01+A10BD07 (Sitagliptin), A10BH02+A10BD08 (Vildagliptin), A10BH03+A10BD10 (Saxagliptin) and A10BH05+A10BD11 (Linagliptin) were considered.
Ascertainment of potential confounders
We defined potential confounders from the regional hospital discharge database as hospital admissions that occurred up to 5 years before the index date for ischaemic heart diseases (ICD-9-CM 410–414). Likewise, we also included individuals who had been treated with glimepiride (ATC code A10BB12) or glibenclamide (ATC code A10BB01) in the 6 months prior to the date of hospital admission. Treatment with insulin (ATC A10A) in the 6 months prior to the date of hospital admission was regarded as proxy of severity of disease.
We calculated the proportions of categorical variables in cases and controls, and assessed the differences in baseline characteristics with the χ2 test. We estimated the risk of the four different outcomes associated with dispensation of any DPP-4i by fitting conditional logistic regression models, expressed as ORs, and corresponding 95% CIs. We adjusted the statistical models for the aforementioned confounders. Confounders included in the final models were past history of ischaemic heart disease, insulin use and glimepiride or glibenclamide (considered together) use. In the sensitivity analyses, we assessed the use of DPP-4i at any time before hospital admission or death. All analyses were performed using the SAS PHREG procedure V.9.2.
During the study period, 14 613 cases of hospital admission for heart failure, 7212 incident cases of heart failure, 1727 cases of re-admission and 38 248 deaths occurred within this population of patients with type 2 diabetes. Compared with controls, the use, as well as the type, of DPP-4i did not differ between cases and controls for heart failure outcomes (between 1.8 and 2.0% of both cases and controls were on gliptins), whereas the use of insulin, but not of glibenclamide, was more frequent among the cases. There was a higher prevalence of ischaemic heart disease among the cases. When mortality was considered as an outcome, exposure to DPP-4i was lower among the cases than the controls (0.8% vs 1.8%) (table 1).
After adjustment for available confounders, the use of gliptins up to 6 months before any of the outcomes considered was not associated with the risk of hospitalisation for heart failure (OR 1.00, 95% CI 0.94 to 1.07; p=0.9832), incident heart failure (OR 1.01, 95% CI 0.92 to 1.11; p=0.7808), hospital re-admission for heart failure (OR 1.02, 95% CI 0.84 to 1.22; p=0.8745), or death of any cause (OR 0.94, 95% CI 0.90 to 0.98; p=0.0021). A history of ischaemic heart disease or insulin use was associated with an increased risk of all the outcomes considered, except for hospital re-admission for heart failure (table 2). In the sensitivity analysis, in which the time window was extended to include DPP-4i use at any time before the outcomes under study, the ORs were unchanged for all outcomes: hospital admission (OR 0.99, 95% CI 0.94 to 1.05; p=0.8048), incident heart failure (OR 1.01, 95% CI 0.93 to 1.09; p=0.8775), hospital re-admission (OR 0.97, 95% CI 0.85 to 1.16; p=0.9558), or death (OR 0.94, 95% CI 0.91 to 0.98; p=0.0018).
Matched ORs of different outcomes associated with exposure to DPP-4i in the 6 months before index date
The question of whether or not therapy with DPP-4i may increase the risk of heart failure has raised concern over the safety of these drugs among practitioners.4 The key message of our analysis is that, in a large unselected population of treated individuals with type 2 diabetes, no association was found, regardless of causality and as borne out by the neutral OR independent of the subgroup considered (Any admission, Incident or Re-admission for heart failure).
Our findings are in line with a very recent paper by Yu et al,14 who reported no association between the use of these incretin-based therapies, studied as a whole DPPi and GLP1 receptor agonists, and incident heart failure in patients with type 2 diabetes. The same concordance exists with the general message from animal studies and pathophysiological investigations, which found no detrimental effect of DPP-4i on cardiac function.15 ,16 However, it is a puzzling link because two other recent physiopathological studies in patients produced unanticipated findings that treatment with DPP-4i could exacerbate heart failure.17 ,18 Moreover, since no plausible explanation for the SAVOR TIMI 53 finding has been forthcoming, it is difficult to speculate on the reasons for the differences between their findings and our findings in the drug-associated risk of heart failure.
Weir et al9 found a significantly increased risk of hospitalisation for heart failure associated with the use of sitagliptin among adults with type 2 diabetes, but only in patients with pre existing heart failure, with a relevant 84% excess of risk. One possible, though still speculative, explanation for this discrepancy could be an indication bias contending that, before the SAVOR TIMI results were published, DPP-4i use was well regarded and considered particularly safe in patients with left ventricular dysfunction or renal insufficiency. On closer analysis, the two study populations differ in average age (78 vs 54 years) and background antidiabetes therapies. An additional difference lies in the choice of cases, with the American population appearing as a rather select population of young insured individuals.
The favourable impact of DPP-4i use on all-cause mortality is welcome but still warrants caution. It could confirm recent observational data that suggested a reduction of mortality in the Danish diabetic population on incretins.19 It should also be remembered, however, that DPP-4i use can represent a marker of better specialty care.20
Our analysis, by contrast, beyond the expected role of previous ischaemic heart disease as a factor underlying impaired myocardial performance, revealed an important link between insulin use and risk of heart failure for first as well as for recurrent hospitalisation. This finding is neither new nor surprising. In the last several years, numerous observational studies have found insulin to be a marker of poor cardiovascular outcomes, including heart failure,21 raising the question of the possible pathogenetic role of hypoglycaemic events. Why the outcomes of insulin use in observational studies clash with the findings from randomised controlled trials such as the UKPDS22 and ORIGIN,23 and seem to dismiss the role insulin can play in preventing complications, is perplexing. For instance, the DAI study, the largest cohort study on complications of diabetes in Italy, found a correlation between insulin therapy and the occurrence of coronary disease and stroke.24 Similar conclusions were reported for heart failure.25 A simple explanation would be that there is a typical indication bias. A more complex rationalisation would point to the problem of clinical inertia: insulin in the real world is given late, after chronic exposure to high glucose levels, thus marking subjects with poor irreversible legacy. In other words, the outcome after insulin therapy in observational studies may reflect the fact that it is initiated too late rather than its appropriate use.
Our study has several strengths. It was conducted using data retrieved from a population-based database representative of the real type 2 diabetes population seen in Europe, without any selection based on insurance claims, and, in particular, with no age cut-off, two factors that distinguish it from other published studies using administrative data. Our approach thus eliminated recall bias and minimised selection bias. All five drugs currently available on the market were included. Furthermore, as DPP-4i are dispensed and reimbursed only by prescription, we are confident to have included all dispensations.
Our study also has potential limitations, however. Though the sample size is rather large, this should not be a concern: with the use of a one-sided test at the α=5% level, the smallest risk, greater than one, that could be detected with 80% power is OR=1.16 for hospital admissions, 1.24 for incident heart failure and 1.49 for hospital re-admissions. We are aware that a weaker association between DPP-4i use and heart failure cannot be ruled out; but if it does exist, it would be relatively small. Another weakness is the missing data on metabolic control and other clinical variables such as NT-pro BNP levels, hypertension, heart valve defects and renal failure, all of which could have impacted on hospitalisation rates for heart failure. Nonetheless, there is no reason why this could have favoured the control group and thus masked the association. As a proxy of diabetes severity, we adjusted for cardiovascular disease and level of therapy. We did not consider medication dose or adherence to therapy and, given the low prevalence of exposed individuals, we were unable to factor in the effect of the different compounds separately. In addition, the use of a database of dispensed drugs rather than usage data might have overestimated DPP-4i use; however, it is unlikely that this would have affected cases and controls differently. Finally, only severe cases of heart failure hospitalisation were considered, leaving open the question of whether or not milder episodes of cardiac insufficiency, not resulting in hospital admission, could have been increased in DPP-4i users.
Ongoing trials, including the Sitagliptin Cardiovascular Outcome Study26 and the Functional Impact of GLP-1 for Heart Failure Treatment,27 may help to clarify the conflicting findings. Meanwhile, practitioners can be reassured that the unexpected association reported in the SAVOR TIMI study has not been confirmed in the real world.
Monami M,
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. Effects of glucagon-like peptide-1 receptor agonists on cardiovascular risk: a meta-analysis of randomized clinical trials. Diabetes Obes Metab 2014;16:38–47. doi:10.1111/dom.12175
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, AVOR-TIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013;369:1317–26. doi:10.1056/NEJMoa1307684
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, for the SAVOR-TIMI 53 Steering Committee and Investigators. Heart failure, saxagliptin and diabetes mellitus: observations from the SAVOR—TIMI 53 randomized trial. Circulation 2014;130:1579–88. doi:10.1161/CIRCULATIONAHA.114.010389
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. Dipeptidyl peptidase-4 inhibitors and heart failure: a meta-analysis of randomized clinical trials. Nutr Metab Cardiovasc Dis 2014;24:689–97. doi:10.1016/j.numecd.2014.01.017
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. Diabetes predicts congestive heart failure risk in the elderly. Circulation 1998;98:721.
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. Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review. BMJ 2007;335:497. doi:10.1136/bmj.39314.620174.80
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. Incretin-based drugs and the risk of congestive heart failure. Diabetes Care 2015;38:277–84. doi:10.2337/dc14-1459
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. Cardiovascular actions of incretin-based therapies. Circ Res 2014;114:1788–803. doi:10.1161/CIRCRESAHA.114.301958
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. Dipeptidyl vasodilatation in type 2 diabetic patients. J Am Heart Assoc 2013;2:e003277. doi:10.1161/JAHA.112.003277
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. Cardiovascular safety of combination therapies with incretin-based drugs and metformin compared with a a combination of metformin and sulphonylurea in type 2 diabetes mellitus—a retrospective nationwide study. Diabetes Obes Metab 2014;16:1001–8. doi:10.1111/dom.12314
Giorda C,
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. The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes. PLoS ONE 2012;7:e33839. doi:10.1371/journal.pone.0033839
Giorda CB
. Could clinical inertia in part explain the unexpected association of insulin therapy with poorer cardiovascular outcomes in observational studies on diabetes? Diabetes Res Clin Pract 2011;92:e47–8. doi:10.1016/j.diabres.2010.10.010
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. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577–89. doi:10.1056/NEJMoa0806470
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, The ORIGIN Trial Investigators. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012;367:319–28. doi:10.1056/NEJMoa1203858
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, for the Diabetes and Informatics Study Group. Incidence and risk factors for stroke in type 2 diabetic patients: the DAI study. Stroke 2007;38:1154–60. doi:10.1161/01.STR.0000260100.71665.2f
Nichols GA,
Hillier TA,
Erbey JR, et al
. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care 2001;24:1614–19. doi:10.2337/diacare.24.9.1614
Green JB,
Bethel MA,
Paul SK, et al
. Rationale, design, and organization of a randomized, controlled Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) in patients with type 2 diabetes and established cardiovascular disease. Am Heart J 2013;166:983–9. doi:10.1016/j.ahj.2013.09.003
Margulies KB,
Anstrom KJ,
Hernandez AF, et al.
, Heart Failure Clinical Research Network. GLP-1 agonist therapy for advanced heart failure with reduced ejection fraction: design and rationale for the functional impact of GLP-1 for heart failure treatment study. Circ Heart Fail 2014;7:673–9. doi:10.1161/CIRCHEARTFAILURE.114.000346
Contributors CBG: literature search, study design, data collection, data interpretation, writing; RP: data collection, data analysis; BT, LM and AA: literature search, writing assistance; GC: data interpretation, writing; RG: literature search, study design, data collection, data interpretation, writing. CBG, RP, GC and RG had access to the raw data. The corresponding author had full access to all the data in the study and the final responsibility for the decision to submit for publication. All authors approved the final version.
Funding This study was in part supported by an AMD (Italian Diabetologists Association) fellowship (AA) and Chaira Medica Association (non-profit organisation for the study of endocrine and metabolic disorders), Chieri, Italy, where BT is employee of the Association.
Data sharing statement Technical appendix, statistical code and dataset were not made available in the Dryad repository. However, these data can be made available by request to the corresponding author.


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HomeCensorshipMonarch Mind Control Programming
Monarch Mind Control Programming
February 22, 2015 JAG Censorship, CIA, Cloak and Dagger, FBI, Featured, History, Independent Press, Psyops, Secret Societies
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https://www.ispeech.org
When one listens to the programming, it seems that it is powerful and in control. The movie does a good job of showing how a slave's mind has both an internal and an external world. A hall appears with daisies. Daisies were used in programming. When she leaves the internal world, she finds that the internal world is right there with her in her external world. She is surrounded by internal cues. Then she embraces and accepts her internal world toward the ending of the movie. Many systems have an owl in their system which represents the master. In the movie, an owl representing the master appears at various times & then flies away at the end. Toward the end the Master sings, "Power of Voodoo..."
The internal world is full of goblins, dwarfs, worms, a hat, door knockers, Fury 1,2,3,4,5 and many other things. Ravens are in the movie. In real life, the programmers take alter fragments, which are splits which are not developed into full blown personalities and they program them to have a single task, for instance to think they are a raven and to bite the body when ever they take the body.
Whole flocks of demons which take the form of ravens may wait inside the mind waiting for their release to bite the body. When triggered by the internal programmers when an alter crosses the boundaries set down by the programming, a flock of ravens may come forward and "take the body" (as they say in MPD) of the slave and the Monarch slave will bite his or her flesh and viciously tear it with its teeth.
By watching the movie Labyrinth, and using this as a guide, the viewer will begin to understand the horror and control that the internal world holds over the alters of a Monarch slave. Few Monarch slaves ever tell other people what is going on in their minds, now you have been privileged to find out. To learn this much for a Monarch slave comes with a high price. The price is paid by reliving for a second time what has been done to them, fighting off the suicide programs that click on when the slave's mind disobeys. The slave must also fight off torture memories that recycle. These torture memories are activated by the programming when an alter disobeys its programming. As one Monarch survivor described it to me, "This all can be wrapped up by defining it as the raping of the body, soul and spirit."
The Structuring Done in Monarch Star Trek and Star Wars Programming
The original Monarch programming often used the Wizard of Oz books and film as the basic programming. The Alice and Wonderland story then was overlaid, along with many other fictional fairy tales to complete the Mind Control of a Monarch Mind-controlled slave. However, in recent years a superior story line has appeared. It has more flexibility and more secrecy. This is the Star Trek series.
In recent years, Star Trek is being used as a basis of programming. Those who are programmed with Star Trek programming can attend annual Star Trek Conventions which are held in New York City since 1972.
The child's mind is tortured until the point they will accept anything. They are told to build certain structures in their mind. These structures may be castles, or rivers or submarines or airfields, etc. In the case of Star Trek programming they have detailed maps and diagrams that have been created to go along with the Star Trek program. (The real reason or the ulterior motive of these Star Trek maps was to create a blueprint for programming. Some pages of these are included for you to look at.)
Then particular alters are placed within these structures, and they are hypnotically given cues that will pull them to the front of the mind when the alpha-numeric cue is said. Many of the more secret alters can only be accessed by a combination of several different cues which go to different senses--such as the person must be in a corner contacting 3 points, a certain ring must be turned & a certain code said for the alter to come forth.
The advantages of the Star Trek story line is that
almost any type of scenario can be fit into the programming script because the Star Trek characters in the series, encounter about anything imaginable,
have holograms, which can serve as substitutes for mirror images in the programming,
alien programming can be introduced in order to promote the mock alien invasion being planned by the Illuminati, and
the Star Trek series has its own language which can be used for trigger codes, which Monarch slaves can study, and learn. The use of this klingon language will make it very difficult for ordinary people to break into the slave's programming.
Michael Aquino, Satanist and Colonel in the U.S. army
Michael Aquino, Satanist and Colonel in the U.S. army, has enjoyed using Star Wars for programming. Aquino wrote his own version of the Star Wars, which he uses for programming. The programmer becomes Darth Vader, which then is reproduced as an alter within the victim. In the Star Trek series, Data was a dehumanized "person" who stored vast amounts of information. Monarch slaves are always created with libraries, and volumes of information. This information is stored in various ways and can be retrieved in a variety of ways. Data of Star Trek lends himself to become the model for an alter of a Monarch system to copy. In other words the child is shown Data, and is steered in the right direction to create an internal person named Data.
Any child if it is drugged, tortured, threatened with death if they don't follow directions, with weakened and confused minds will get to the point where the child will create a Data alter in its mind, rather than die. Once in place, the Data alter will think of itself as the movie character. Every time the child sees Star Trek or pictures of Data, it will reinforce the programming. The transformer room technique of beaming in Star Trek is what magicians have tried to do for centuries and which has been called "bi-location-physical projection" as well as other things. This is said in magic to be mental control over the molecules of the body via demonic power. Whether magicians have ever done this, who knows, some certainly claim the power.
The Illuminist is a power structure placed into some Monarch slaves. It is constructed from parts of numerous demons, rather like a demonic Frankenstein, & is portrayed in Star Trek, the Next Gener. as the crystalline body. A cartoon series was created for Star Trek. In this series, children watch such things as Kirk in a magical universe of Megas-tu which has a Guardian of Forever. Two other spin-out shows were Deep Space Nine and S.T. Voyager. In other words, a child could watch 5 different Star Trek series. If the child's parents had cable T.V. the child be virtually immersed into the various Star Trek shows. Unfortunately, some of the children who have been programmed with this are doing exactly that.
Fritz has personally worked with someone who has Star Trek programming. They sit for hours and immerse themselves totally into all kinds of Star Trek details. We have two Star Trek Technical Manuals. Fritz's father is an engineer and designed quite a few things. Fritz himself has worked as a manual/computer draftsperson for the Federal Highway Administration as well as for his father off and on over the years. Based on that experience, he realizes the enormous amount of work that went into these Technical Manuals for the Star Trek series is simply mindboggling. One manual is 183 pages and the other is in the neighborhood of 250 pages. The amount of engineering and computer drafting that went into these manuals is astonishing. Why did someone go to such extremes?
These manuals are as good as if NASA were planning to build an Enterprise spaceship. The plans are done more professionally than engineering designs that we have seen groups like the United Nations drawing up. Why did all this engineering, design and drafting happen for a fictional T.V. show? To create a book to sell? The books.. could hardly be best sellers. One originally sold for $13
U.S. and the other for $6.95. One reason so much work and money was put into these Technical Manuals is that they are used for programming helpless victims of the Monarch Mind Control.
The Following are the Descriptions of Why the Exhibits Are Important To Programming. The Technical (or Training) Manual pages are coded.
Exhibit 1 Star Fleet Technical Order (TM:379260-1) This page show codes on the far left that are similar to the type of codes used in Monarch access codes. Alters are trained to take the body upon the proper access code. Also certain activities or programs can be triggered by codes also.
Exhibit 2 Uniform Color Code. (TM:379260-0) In creating a System within the slave's mind, geometric shapes are used. Within these shapes a number of worlds or universes will be created. These worlds can be 3-D. That means when building them in the child's mind they can have height, depth, and width. One system which I have seen several times in slaves has been a 13 x 13 x 13 cube. In order to give another dimension and to give the programmers the ability to tie different things in different parts of the system together--the programmers use color coding. Each alter will receive a color code. I am familiar with the standard color coding program, and how it is put into the child's mind. Dr. Green (Mengele) used a box of colored scarfs and electroshock to program in the color coding into victim's mind. Besides alters, other things in the system may be color coded also. Let's say as Programmers we place hidden observers on each level, system or world. Then we can tie those isolated alters together by color coding them the same. During the programming, computers are built into the mind to operate the programming, and they send their signals according to color coding.
Exhibit 3 Milky Way Galaxy Map (TM379260-2) This is just one of a number of maps that go with the Star Trek programming. During the programming (which is sophisticated torture of all kinds backed up w/ drugs) the child's mind will be encouraged to psychotically build worlds in his or her mind. These worlds are built with vortexes, mine fields, and in the case of Star Trek programming Radiation zones. If an alter would attempt to wander from its assigned spot in the mind, it will run into Radiation zones, walls, and other barriers. These zones are built into the mind, to insure that the multiple personalities do not contact each other. Aliens and holograms protect certain areas and prevent personalities from freely moving around in the mind. These "aliens" are placed into the victim's mind by high level demonology--in other words they are not aliens--they are demons which have been brought in by high level rituals.
Exhibit 4 4.1 Computer System (p.50) The first thing created are the multiple personalities. Then these personalities are placed into a structured system. To operate that structured system and to insure compliance the Monarch programmer will put in what is called Omega programming. Omega programming consists of computers, wiring, conduits and cords. The most important part are the computers. These computers contain the instructions, and they are controlled by internal programmers who may be alters or who may be high level demons. The aliens (demons) who are placed strategically in the mind to keep the Omega programming intact are put in by sophisticated high level demonology. The high level demonology part of the programming is the most secret and it is termed Gamma programming. This is a diagram which could be used to help build into the child's mind a computer. In the early programming, a little girl while being tortured would be shown a multi-roomed dollhouse. The rooms would each have a separate color. The rooms would be linked in the child's mind to computers. In other words--the dollhouse structure was the structure the computers used. In the Star Trek programming, the modern child simply is given a multi-roomed computer like the one drawn.
Exhibit 5 Engineering Main Bridge Section TM:379260-3 Various methods of communication and travel within a Monarch system's mind will be built in. Various alters are allowed contact with other alters. Portals and one-way mirrors or one-way windows are built in also. In order to teach an alter to come to the front of the mind, an airplane taking off on a runway might be used as a visual aid to teaching how to leave the alters cubicle in the mind and come forward to take the body. Various internal communication system's can be built into the System. The training manual is full of many possible communication and locomotion devices, and this is just one of a whole number of items that could be incorporated into a Monarch child's mind as it is programmed.
Exhibit 6 pg. 82. Utilities The brain stems are scarred on babies and when the body rebuilds itself it overcompensates and the brain gets an incredible memory. Monarch slaves with scarred brain stems are running the computer systems for the New World Order. If the slave has a photographic memory as many of them do, then a specific chart like this utility chart could function as the blueprint for the mind when it creates its power packs. Power packs, and energy cells (sometimes put in like light bulbs) run the computers which are built into the slave's mind. This is part of what is called the Omega programming.
Exhibit 7 TM:379260-2 S.I.N.S. Base Datum This is a coordinate system. In the early years the Monarch systems were built with 3 hour glasses each spinning on a x,y, or z axis. The hour glasses could be turned and in so doing the entire system of alters could be turned. Let's say that we have a slave and we have created great Christian front alters. Now, we decide that the time has come to use the dark Satanic alters full time. Since the dark alters are hidden at the bottom of the system, we need to rotate the System 180 degrees so that the Satanic alters are now on top. Now the Satanic alters will receive extra energy to be out holding the body full time. This SINS Base Datum is a way of making a coordinate system for a Monarch System. Certain codes would then be given the System to make a shift when the handler needs to turn a System.
Exhibit 8 Darth Vader cover of Warren Magazine, plus the next two pages. This final exhibit consists of not one but 3 pages which are the first 3 pages of a article written by Michael Aquino. This article is Michael Aquino's own version of Star Wars. It is this version that he wrote and then used to program Monarch Mind-Controlled slaves. Actually to give credit where credit is due, an army colonel (who has since moved to Santa Fe, NM) at the Army's War College worked with Michael Aquino at designing mind-control programming around the Star War's script.
The Science of Body Manipulation and Programming
The Scarring of the Brain Stem
Early on it was discovered that the brain would overcompensate for scarring on the brain stem. This is a principle similar to weight lifting. By tearing down the muscle fiber by overexertion, the body rebuilds the muscle stronger. By scarring the brain stem, it -was discovered that geniuses who had photographic memories could be created.Brain stem scarring was used to create the whiz kids that the NWO needed to run their big computers. For instance, the computers that just NASA alone uses require people who can work in ALGOL, BASIC, COBOL, COBOL 74, MULTICS COBOL ver. 4.4, COBOL Cb.4, COBOL CP-6, BOL, EULOR, FLIP, FORAST, FORTRAN, HAL/S, Illiac 4, JASP, JOSS, JOVIAL, /LYAPAS, LISP, LISP 2, /MAP/, NuSpeak, PASCAL, PEARL, /PLACE/,PL/1, PL/1-APAREL, PLANIT, Praxis, SA Machine Language, SEMANOL, SNOBEL, UNIX, WANG, ZBIE. It takes a good memory to remember computer languages and programming. These whiz kids, who were both programmed with Monarch programming and had their brain stems scarred can be seen in some of the University computer departments and the intelligence/military agencies' computers rooms.For instance, at Ft. Meade, the NSA has 2 buildings which contain a completely self-sufficient intelligence operation. (The complex has its own stores, bank, dry cleaning, dentistry, barber shop, PX, hospital, as well as the normal snackbars and cafeteria that Federal buildings often have.) This complex which is internally guarded by cameras watching all the corridors, has several major computer rooms where whiz kids are employed. Movement by these whiz kids, requires that they have the proper I.D. attached to them. The CIA which has had an ongoing project to create them, has called them "Compu-kids." Some of the elevators are private and operate only with the proper key. The NSA's computers participate in electronically watching the world. Another example of where compu-kids (slaves with scarred brain stems) work on big computers (incl. a Beast computer) is at Area 51 (Dreamland), NV.
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It was not the GOP defense of the Andrew Meyer tasering that angered me, it was the "liberals" defense of it and Kerry's tacit approval of it, when, in the irony of ironies, they were on the same page as the "fascist pigs" they blog about constantly. What did the far right have to say? did they condemn it? of course not, they were on the same page. Bill O'Reilly called Meyer a wimp and offered free "Don't tase me bro!" bumper stickers. CNN's Glenn "I-Should-Have-Drank-Myself-to Death-While-I-Had-the-Chance" Beck, ever the good and Christian Mormon sadistic corn-pone apron-boy and Marquis DeSade incarnate, said "Watching taser videos is a little like potato chips, you can't watch just one." […]
Tom ross says:
I read this article and will willingly submit to monarch slave training. I live by myself. Haven't talked to family in 3 years. I will drive to a facility tomorrow and willingly submit to be trained and sold at auction. I am 40 years old bit have been looking for slavery for years. Please help me..contact me at tarsnr@yahoo.com. I crave permanent no way out slavery
Independent Press says:
Just join Hillary Clinton campaign. She's the best at this.
king arthur: legend of the sword full movie says:
Great delivery. Solid arguments. Keep up the great effort.
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Fail: Washington Post Hoax On Trump's "Top Secret Time Travel Project"
The Washington Post bravely risks it all to reveal that by 2016, Donald Trump used his access to Gen. Michael Flynn to quietly direct DARPA, then in secret works with CERN in Switzerland, to commission the first time machine ever constructed. The result? An epic rap battle between Trump and Anne Frank.
uncle sam sayeth unto thee
Despite its failures, the truth is the press still can save us, and even the shadow elites admit it. In the meantime, don't count on it. Remember that there is no jailer more powerful than one who can imprison your mind, and that enslavement is the job of the news broadcaster dedicated to creating a fear-based reality and not reflecting life it as it really is.
Remember that citizen journalism works, and never rely on a single source.
Rare Candor from the Corporate Media
"There is no such thing… in America, as an independent press… If I allowed my honest opinions to appear in one issue of my paper, before twenty-four hours my occupation would be gone. The business of the journalists is to destroy the truth, to lie outright, to pervert, to vilify, to fawn at the feet of mammon, and to sell his country and his race for his daily bread. You know it and I know it, and what folly is this toasting an independent press? We are the tools and vassals of rich men behind the scenes… Our talents, our possibilities and our lives are all the property of other men. We are intellectual prostitutes." John Swinton,New York Times Chief Editor 1880
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Don't Blame Injuries for the Stars' Recent Collapse
The Stars have had several key players injured in the past two weeks, but there's more to the Stars' struggles than that.
By Tyler Mair@mairican Mar 24, 2018, 9:00am CDT
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On March 11, the Dallas Stars were set to begin a six-game road trip that began with the Pittsburgh Penguins that night. The teams were tied for the ninth-best record in the NHL at 82 points, which put Dallas at only fourth in the Central Division. They were only three points back on the Minnesota Wild however, with a game in hand, and they were three points ahead of the Los Angeles Kings, who sat in ninth place with no games in hand.
Fast forward two weeks (seven games) later. The Stars now have 84 points, just two more than they did before, and with only seven games remaining in the regular season. They have dropped to 18th in the league, and 10th in the conference. They are four points back on the Colorado Avalanche, who currently sit at eighth and have a game in hand on the Stars. Even if the Stars win out, the team needs help if they want to reach the Stanley Cup playoffs.
Given the sudden seven-game losing streak, it's only natural to want to figure out just what went wrong. And at first glance, the answer seems obvious: injuries. Ben Bishop was injured several games prior to the losing streak in a game against the Ottawa Senators, and was re-injured against the Winnipeg Jets. Marc Methot left the Montreal Canadiens game early due to a hand laceration and missed four games as a result. It was recently announced that Jason Spezza would be sidelined for two weeks, and could possibly be done for the season.
On top of that, players like Brett Ritchie, Esa Lindell, and Antoine Roussel have all missed a game or two recently due to injury or illness. Many fans are convinced that Jamie Benn has been playing through some sort of injury this season since he hasn't gone "beast mode" yet. And would you be surprised if I told you that the Stars haven't won a game since Martin Hanzal (who had his season-ending back surgery on Friday) was in the lineup?
So it's easy to look at the Stars' struggles and write them off due to injuries. But if you take a closer look at their recent play, even before the losing streak, you'll realize that the Stars' problems extend far beyond simple injuries.
For starters, Dallas has scored more than two goals only twice in the past 10 games, and both times they still managed to lose the game. Unsurprisingly, the team went 1-6-3 during that stretch. Out of those 21 goals scored, eight of them came on the power play (38.1%), five came from Tyler Seguin (23.8%), and 13 came from either Seguin, Benn, or Alexander Radulov (61.9%).
Taking away the 6-5 loss against the Toronto Maple Leafs (which was an abnormality as far as scoring for the Stars goes), the Stars have gotten eight out of 16 goals (50%) on the power play, four out of 16 (25%) from Seguin, and 11 out of 16 (68.75%) from the top forward trio. In other words, the Stars have been relying far too much on great power play success (at eight out of 31 or 25.8%, which is second when compared to other teams' season percentage) and their top forwards in order to score, and have failed to win as a result.
Those are issues that the injured players wouldn't have fixed. If you look at the players who have been out for an extended period of time during that stretch (i.e. more than two games), you wouldn't find any that provide an offensive punch. Methot has a single assist in 29 games played this season. Hanzal had 10 points in 38 games. And as for Ben Bishop - well, if your team's offense needs your goaltender to give it a boost, you have problems beyond fixing.
What those players do provide, however, is quality defense. Both Methot and Hanzal are great on the penalty kill, and Bishop can be one of the league's top goaltenders when healthy. So their absence certainly has hurt. The Stars have surrendered 33 goals over the last 10 games, and have held their opponents to two goals or less only twice (and not at all during the losing streak). Not to mention the Stars have had trouble holding leads recently:
Unreal. This is the third time in the last five games the Stars led at second intermission and lost. Tonight was the first in regulation.
They were 29-1-1 this season prior to this stretch.
— Josh Bogorad (@JoshBogorad) March 24, 2018
This was the fourth time in the last five games that the Stars allowed a goal in the final five minutes of regulation when they were leading by one or the game was tied.
at TOR - 15.3
at OTT - 3:10
at WSH - 4:59
vs BOS - 11.1
That is a criminally cruel string of defeats.
Here's where that argument breaks down: Methot and Hanzal have both been injured almost the entire year, yet the Stars were able to climb as high as third in the Central despite their absence. They are last and second to last respectively in CF% on the team according to hockey-reference.com and second and third to last in FF%, just ahead of Devin Shore. If traditional stats are more your thing, Hanzal is second to last on the team in +/- with -14 ahead of Shore (Methot is a decent +3). Simply put, the Stars don't rely on Hanzal and Methot as much as you'd think.
As for the setback of losing Bishop, that's a bit harder to dispute. Since his first injury against Ottawa, Kari Lehtonen has appeared in nine games and allowed 26 goals on 254 shots, which produces an .897% save percentage and a 2.89 GAA. But this also includes two games with only a single goal against and another with only two goals against, only one of which the Stars won (the Anaheim game, the Stars' last win).
In addition, Lehtonen's season totals aren't that much worse than Bishop's. The Stars' starter has had a .916% save percentage and 2.49 GAA, compared to Lehtonen's .912% and 2.54 GAA. Lehtonen's stats are even better than some (potential) playoff goalies, such as Corey Schneider, Matt Murray, Braden Holtby, Brian Elliott, and Jake Allen. Before Bishop's first injury, Lehtonen had an even better .918% save percentage and only 1.95 GAA.
In other words, Lehtonen hasn't been that much of a downgrade from Bishop. He might seem like an easy scapegoat given his poor stats recently, but that can be attributed more to the team's poor play as a whole than just Lehtonen's. In fact, Lehtonen has played well enough to win for the Stars several times during the last 10 games, but the skaters just didn't find ways to score and wasted his good games.
Finally, the fact that the Stars have suffered several injuries lately doesn't excuse a rapid decline in quality of play and a staggering seven-game losing streak. The regular season is almost over and nearly every team has at least one key contributor who is injured. Whenever a team's eliminated from the playoffs, we always here about how several players have been playing injured for weeks prior.
In the words of the Stars' own Tyler Seguin:
"It's that time of year," Seguin said. "There's injuries. We have guys banged up. So does every other team. I don't think that's an excuse. I don't think being tired is an excuse. Right now, that's more of a mindset than anything. It's playoff hockey right now for us. It has been for a little while."
These are just a few areas to think over surrounding the recent losing streak and the lack of scoring. Another thought is that GM Jim Nill could have likely prevented the recent scoring issues by buying at the trade deadline, especially given how cheap players like Evander Kane or Michael Grabner came. Some of the lineup decisions, such as not giving more opportunities for players like Jason Dickinson or Gemel Smith, might have also had an impact on recent play. In addition to this, the defensive pairings have only changed if there has been an injury, which leads fans to wonder if the team has taken a defense-first approach instead of offense when it comes to compensating for the recent injuries.
But this isn't supposed to be a list of every reason the Stars' season has gone off the rails. This is simply a preemptive argument against the one that Dallas will miss the playoffs because certain players were injured at the wrong time.
Sure, those injuries have played their part in the recent collapse. And when Nill and Hitchcock are giving their season-end press conferences on April 1 (barring some sort of April Fool's miracle), it may most likely be the main answer they'll give when asked, "What went wrong?"
But that doesn't mean it's necessarily the right one.


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Star Wars: Battlefront II full trailer reveals campaign details, release date
Lucas Siegel
Dec 18, 2018, 12:00 AM EST (Updated)
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Tag: Star Wars Celebration
Tag: Star Wars Battlefront II
Tag: Trailers
The world of Star Wars: Battlefront is expanding significantly in 2017, as the anticipated sequel -- yes, with a full single-player campaign -- is on the way this fall.
Star Wars: Battlefront II hits stores on November 17, but the release date was just the tip of the iceberg from EA and Lucasfilm when they brought the game to Star Wars Celebration Orlando. Syfy Wire and other press were invited to preview the game ahead of the panel, which filled the main Galaxy Stage.
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Community Manager Mat Everett was joined by representatives from two of the three studios working on the game, DICE creative director Bernd Diemer, Motive Game Director Mark Thompson, as well as Steve Blank, Creative Executive on Lucasfilm's Star Wars Story Group. The panelists enthusiastically presented the sequel, which features a campaign designed by Motive, multiplayer from DICE and revamped vehicle (and animal) controls from Criterion.
This kind of joint development was something they wanted to do, to use teamwork, the same way Star Wars and Battlefront are all about teamwork, to create the best gaming experience possible. After the trailer aired, fully revealing the new campaign, new characters and some big twists, the panelists described more about the game.
Video of Kae-JjbLsgA
Battlefront II stars Janina Gavankar as Iden Versio, a brand-new character created for the game. She leads Inferno Squadron, a special forces group from the Empire -- yes, you'll be playing as an Imperial Special Ops character in the single-player campaign. They're also starring in a new book from writer Christie Golden. And yes -- both of these stories are 100% canon.
"What we wanted to do was we've heard a lot in other storytelling about the heroes of the Rebellion," Thompson described. "We wanted to give the Empire heroes in that same way, the elite soldiers on the lead of the battlefront, the elite pilots that kids growing up on Imperial worlds aspire to be. That's why we settled on this idea of telling the story from the Imperial perspective." The story, then, starts as Return of the Jedi ends -- the explosion of the Death Star 2 kicks off the story.
Of course, some of that has been covered in the printed page, but in an epic or interactive fashion it's been silent. That meant bringing in the Story Group to make sure the story lined up with -- and even intertwined with -- the novels and comics that covered some similar territory.
"Mark and Motive sat down with us and came to us with a pitch," Blank said. "They acknowledged that books like the Aftermath series, and at Marvel Comics with Shattered Empire, we were starting to explore what happened right when the war ended. We started from Day 1 being really invested in that pitch, getting to see it from another perspective."
Inferno Squadron, an elite unit that can be a TIE pilot and Commando equally, was created for this game, and will lead the majority of the story -- but not all of it. Still, a special forces unit gives you a little deeper level of dedication to their cause.
"They're still invested in the Empire, still dedicated to that," Blank said of Inferno Squadron. "I think she's going to go down as a heroic character. Through her story, you'll see how she grew up in the Empire and how she can be a hero for those people."
They'll be running into new characters and familiar ones, and they'll be visiting locations old and new as well. Iden's home planet of Vardos is brand-new -- and it's an Imperial Utopia. "Vardos is a place where citizens of the Empire could grow up thinking they're good, and the Rebel Alliance is a terrorist organization threatening their peace and order," Thompson explained. The planet was "defined by the story," Blank added -- they wanted to show the soldiers and the place they would come from that would be on posters and would be inspirational to kids in the Empire.
Between the three studios, "at any given point someone from each of the studios was always talking to Lucasfilm," Thompson said. That was to make sure that this was as Star Wars a game and story as possible. "There wasn't a single weapon, vehicle, character or story beat that Lucasfilm wasn't involved in," Diemer added. "Every detail is important. Every pixel on the screen is Star Wars."
In addition to Iden and Inferno Squadron, gamers will have the chance to play as a couple other characters in the story mode, including Luke Skywalker. This is Luke at the height of his power, and the shift in perspective is something that was important to them, because Star Wars is famous for its ability to go from character to character and view the world in different ways. The story will span several decades, as well, and that means Kylo Ren will also be playable in the single player campaign.
On the multiplayer side, they wanted to go for all eras to help celebrate the 40th Anniversary of Star Wars. "We wanted to have something that spans the whole universe as it is today, and give people access to planets, weapons, ships, gadgets from all eras," Diemer said. "One thing that stood out, is that there's a chance for everyone to become a hero. At its heart, it's a hero's journey," even in multiplayer. "How can a lowly trooper become the true hero of that match."
They've changed the heroes system, making them "much more physical, having more of a presence in the game. We also gave them a career to make them better – you can unlock new abilities. They're also more available to more players." Instead of the power-ups, it's a resource-based system, as you play, you'll be able to then transform to a hero or into a vehicle "or one other thing I can't say yet," he teased.
Adding the prequel era was "a no-brainer," Diemer said. "It was the right thing to do."
There are new playable characters, as a female Rebel trooper (looking like Jyn), a First Order stormtrooper, an Imperial Agent and a B-1 Battle Droid were all shown.
Yes, there are ride-able Tauntauns as seen in the trailer. The ships and other transportation are also progressable for some customization, and "hero ships" include Slave-1, the Millennium Falcon "and hero ships from all eras as well."
Star Wars: Battlefront II will hit November 17 worldwide, about a month before the release of Star Wars: The Last Jedi. "There will be certain ways to play early – check the website for more information about that."
"I'm looking forward to getting the opportunity to convert everybody to the Dark Side," Thompson said, tying it all together.


OTC Warranty - JB Industries, Inc.
Only Vacuum Pumps are covered under the OTC warranty. All other product is warranted via return of product to wholesaler for RGA and evaluated at the factory.
Any changes or modifications made to any product voids the warranty.
Manifolds have a lifetime warranty on the bar only, parts are not covered.
All other JB Products are warranted for 12 months from date of purchase against manufacturing defects only.
JB vacuum pumps are not intended for use on Amonia or Lithium Bromide (salt water) systems. Use of JB vacuum pumps on either of these systems will VOID the product warranty.
Pumps that are in warranty are examined as soon as they arrive at the warehouse so that we may contact the wholesaler regarding our determination. The over-the-counter warranty applies only to the manufacturing defects and is VOID if the problem has been determined to be abuse.
Manifolds carry a lifetime warranty on the bar only and does not include coverage of any parts. The 12 month over-the-counter warranty covers manufacturing defects only, not abuse. Signs of abuse include lens cracked or missing, gauges that can be loosened by hand, and drop marks on manifolds or unions. Check calibration with the set screw on the gauge as well.
Check the batteries. The product will provide a low battery warning with flashing dots at the bottom of the display. Plug in and toggle through the settings as well as the temperature setting to check if the sensors are working. If the sensors are working, push the on/off button to auto cal to see if it will return to zero. If any of the readings are off, check to see what the temperature sensor is for both sensors. A few degrees difference between the two can cause a problem with the readings. Check for signs of abuse which include a cracked case, drop marks on fittings, display is dimmed or damaged, sensor is pinched or sliced, and the hook is bent or missing.
For the DV-22N, check the last recorded vacuum and then press twice to clear the last recorded vacuum to see if it resets (if the numbers are jumping around, it may be a cold pump or oil contaminant inside the thermistor). If the numbers are jumping around after you have disconnected the gauge from the vacuum and it will not return to one, wait until the gauge auto calibrates. Unit will display JB and turn off before it reads 1 if batteries are low. JB vacuum gauges utilize a thermistor, which if contaminated, can result in faulty readings. Make sure that the sensors are cleaned with rubbing alcohol (Isopropyl) if readings seem erratic or as part of a regular maintenance regiment. DV-22N will display a "1" if vacuum reading is above 9,000 microns. The DV-40/DV-41 will display "00000000" when the vacuum level is above 12,000 microns. Check for signs of abuse which include a cracked case, the coupler is loose at the base of the case, the O-ring/gasket is chewed up or damaged or missing, there are pliers or channel locks on couplers,and the hook is broken or missing.
Check for signs of abuse.
Prior to returning any product to JB, you are required to obtain a Return Goods Authorization number (RGA). Contact customer service at 800-323-0811 to obtain your RGA. Insure that all returned products are packed adequately to avoid damage during shipment as we will not honor warranty claims for items damaged in transit. The recommended packing procedure for pumps is detailed below. Paperwork should be placed in a separate plastic bag and should include your assigned RGA, a description of the problem, a copy of the invoice, and any customer assigned repair or purchase order number (if applicable). Please provide contact information of whom to inform of package receipt as well as the person authorized to accept repair charges should the warranty be void.
PLEASE MAKE SURE THAT ALL ITEMS ARE PACKAGED CORRECTLY TO PREVENT DAMAGE IN SHIPMENT. WE WILL NOT HONOR WARRANTY CLAIMS FOR ITEMS DAMAGED IN TRANSIT.
DO NOT PUT STICKERS OR STRONG TAPE ON FACES OF PRODUCTS AS ITEM MAY COME BACKWITH NO MANUFACTURER DEFECTS.
Before returning the pump to the factory, follow these steps to ensure that no additional charges are incurred because of poor packaging.
1. Completely drain oil from pump and close off all valves. If red cap is on pump put in end of handle to prevent leakage during transit.
2. Place pump in plastic bag and seal.
3. Cushion bottom of carton with packing paper or crumpled newspaper before putting pump in carton. Use packing paper or crumpled newspaper around all sides and the top. DO NOT USE PEANUTS.
4. Place all paperwork in a separate plastic bag and seal. Please include RGA number issued by JB and a detailed description of the problem.
5. If an estimate is required prior to repair, be certain this is clearly specified and highlighted.
6. Depending on the time of year, allow 2-4 weeks for repair services.
For customers opting to use the Merced Wholesale facility, prices, terms and conditions must be obtained from Merced.


Investment in intangible assets has become a much more attractive proposition than investment in machinery, equipment and other tangible things. This is particularly evident in the US where companies collectively hold more than $8trillion in tangible assets.
One of these assets stand out from the others and that is intellectual property – the bread and butter of any modern organisation. This baffles investors though as the valuation of intellectual property and other intangibles can be misrepresented by unsuitable accounting policies and valuation methods. These methods are not necessarily compatible with the technological developments of the 21st century.
In the US, and elsewhere, regulatory bodies only recognise intangibles when a transaction such as an acquisition takes place – this does not account for the existing intangibles which obviously also has shareholder value as well. Furthermore, the classification of expenses may not portray certain metrics which affects valuation models such as discounted cash flow, particularly where R&D is concerned. This is labelled in the income statement as operational expense while it actually represents an expense that creates long-term economic benefits. A more accurate representation of earning is created if you manually reconfigure the income statement to reflect R&D as a capital expense rather.
The solution therefore lies in acknowledging the value of intangibles within the reporting framework like some countries are starting to do. China, for example, is slowly shifting away from capital intensive industries to technology and services.
Click here for the full article on The Market Mogul.


Certain health authorities may nevertheless decide to conduct animal tests themselves for certain cosmetic products, as it is still the case in China. L'Oréal has been the most active company working alongside the Chinese authorities and scientists for over 10 years to have alternative testing methods recognized, and permit the cosmetic regulation to evolve towards a total and definite elimination of animal testing. Thanks to this, since 2014, certain products manufactured and sold in China like shampoo, body wash or certain make-up are no longer tested on animals.


Kasauli :- Kasauli is a small hill station seems to live in time warp that belongs to the 19th century. The narrow roads of Kasauli (1951m) slither up and down the hillside and offer some glorious landscapes Directly below is the spread of vast plains of Punjab and Haryana which as darkness falls, unroll a elegant carpet of twinkling lights. At 3647 m, the peak of Choor Chandni also called the Choordhar powerfully dominates the lower hills and across the undulating ranges, Shimla is visible. The upper and lower malls run through Kasauli's length and one can enjoy longs walks. A mixed forest of pine, oak and huge horse-chestnut encircles the town. Its colonial ambience is reinforced by stretch of cobbled road, quaint shops, gabled houses with charming facades and scores of neat little gardens and orchards.
Chandigarh :- Chandigarh has a good number of major tourist destinations. This city was designed by Le Corbusier, a French architect. The tourists from all over the country visit this planned city every year. Chandigarh Tourism can guide you to enjoy very refreshing and enriching vacation. Chandigarh is a modern and one of the youngest cities in India built and planned after independence. Tourist attractions in Chandigarh do not lie in ancient historical monuments. Chandigarh boasts of its amazing architecture and landscape that is undoubtedly a treat to eyes.
The brilliance of modern architecture has created a quite a few tourist attractions in Chandigarh. It's first Smoke-free City of India because of its cleanness, friendly environment & excellent quality of life. Chandigarh stands aloof at the foothills the Shivalik ranges. Chandigarh is one of the most beautiful and comfortable cities in Asia and the world, aptly deserving the much-used epithet - "The City Beautiful". People from around the world travel to Chandigarh to see the architectural wonder it is, to witness what man can create out of a desert.
Distance :- 300 Kilometres Approx.From Delhi By Road.
Complimentary bon fire once during the stay.
Accommodation for 2 nights in deluxe room at Kasauli in 3 star Hotels /similar category.
Accommodation for 1 night in deluxe room at Chandigarh in 3 stars Hotels /Resort category.
Meal Plan :- 3 Breakfasts and 3 dinners for each person booked for respective package.
Morning pick from Delhi Airport/Railway station, proceed to Kasauli and check-in hotel at Kasauli post lunch. After freshen up go for sightseeing tour in Kasauli exploring the hill station. Return to your hotel for overnight stay and have your dinner at the hotel.
Get up early morning, have breakfast at the hotel, go on for sightseeing tour in Kasauli, Return back to the hotel in the evening, have your dinner at the hotel with bon fire.
Get up early morning have your breakfast at the hotel, and proceed to your next Chandigarh. Post lunch check-in the hotel, take a short rest here and go for some local sightseeing at Chandigarh. Come back to the hotel in the evening, have your dinner at the hotel/resort and spend a comfortable night.
Get up early morning pack your bags, have breakfast at the hotel, now it's time to say good bye to Chandigarh, check out from the hotel/resort and return back to Delhi.