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Every kid dreams about going to Disneyland, there's Mickey, Minnie, Belle, Jake, Goofy, and Cinderella. You name it and your child's best friend is walking around ready to give them a hug! So you can imagine Lily's parent's delight when they decided to give her a dream vacation to the resort for her sixth birthday.
Lily is obsessed with the Disney franchise just like every other girl her age and her parents knew she was going to flip out, so of course they recorded her reaction! And what a reaction it was! She went from disbelief, to tears, to celebration all in a matter of seconds!
We hope you had an amazing birthday Lily!
Enjoy! Please SHARE this awesome video!


text: Skaha Three Bedroom Villa, 1 King, 1 Queen, 1 Double, Lagoon & Waterfall View Photo Gallery Room Size Approx. 1500 sq. ft / 139 sq. m View Lagoon View , Waterfall View Location Throughout hotel Fully equipped Gourmet kitchen with Stainless Steel appliances (Gas Stove, Sub-Zero fridge, Microwave, Dishwasher) Large patio or balcony Master ensuite bathroom with jetted tub Read MoreRead Less Second Full Bathroom In-Suite Laundry Gas Fireplace Dining Room Table In-Room Safe 39" Plasma TV DVD/CD Player Cork Floor Exclusive Access to Rooftop Infinity Pool, Hot Tub & Private Fitness Club Rooftop BBQ Deck Not applicable for Platinum Plus Upgrades at time of booking Room Amenities Choose a Room Option 1 King Bed, 1 Queen Bed, 1 Double Bed, Lagoon & Waterfall View 1 King Bed, 1 Queen Bed, 1 Double Bed, Lake & Lagoon View Available Rates Compare Rooms Convert Currency Best Available Rate Rates Starting at $ 399.00 CAD/Night Check Availability More Rates ROOM AMENITIES: Skaha Three Bedroom Villa, 1 King, 1 Queen, 1 Double, Lagoon & Waterfall View 2 Phones Air Conditioning Bathrobes (2) Complimentary In-room Coffee Dishwasher Fireplace Complimentary High Speed Internet Access Hairdryer Iron & Board June Jacobs Amenities Microwave Safety Deposit Box (in-room) Sitting Area Stove Walk-in Shower Exchange rate for reference only: Currency Converter US Dollar United Kingdom Pound Canadian Dollar Euro Japanese Yen Chinese Yuan Indian Rupees

subset: commoncrawl


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Raise your family and enjoy a country lifestyle as part of a 700+ acre natural farm on the Olympic Peninsula of Washington State. Youll own 40 acres with a 5+ acre homesite. The remainder will be farmed as part of a large farming cooperative shared with 17 other owners. If you wish to help farm you dont need any experience. Youre about 30 minutes to Olympia and 2 hours to Seattle and Seattle-Tacoma International Airport. The farm has two large rivers with lots of salmon and trout plus a growing elk herd. Were at the very end of the county road for safety and security. Contact us today as we have only 1 parcel left available. The others are owned by good folks from all around the world. Well finance you with only 10% down payment up to 15 years, or youll earn a 10% discount off the purchase price if you pay cash.
Just reduced $200,000 to $1,299,000 or 72 acres with all improvements for $999,000!!!
Hunting/Fishing/Guest Ranch for Business or Private Use. Beautiful 134.8 acre ranch for sale. Lots of game and waterfowl on paved County Road with pastures, timber, ponds and creeks lying in the majestic Cabinet Gorge between the Bitterroot and Cabinet Mountains of northern Idaho. Lots of ATV trails around the ranch and several rain-proof hunting blinds.
Operated as a working guest ranch since 1982 as a guest ranch with 6 nice, log cabins overlooking a pond; large ranch house; barns; shop; round pen; decks; fire ring; petting pen; spring house, chicken coop, log entry and fencing.
Some really big whitetails (mulies in the mountains above the ranch), elk, moose, bear, lion, turkey, beaver, otter, coyote, wolves, raccoon, eagle, osprey, wild geese and ducks, and more.
Short walk to the very large Clark Fork River and right across the road to the entrance of hundreds of thousands of acres of mountainous National Forest land. In beautiful gorge looking at highest peak in north Idaho and surrounded by close mountains.
Five miles upstream from largest lake in Idaho with world record fishing and home to 10 Navy submarines. We have 160+ class whitetails and 28 inch brown trout on the ranch, along with a resident elk herd and moose often observed from the house or cabins. I shot my elk this year from my front porch.
Presently only two hunters per year on the ranch beside owners, but only because ranch guests like to watch the wildlife. And when there are hunters, the ranch is shut down to all other guests. It could support many more hunters if it wasnt used as a guest ranch. Clark Fork Outfitters put most of their hunters here for lodging, and a lot of hunters stay at the ranch to hunt the National Forests that surround in every direction. 71% of North Idaho is public land. Last year owner shot his bull elk from the house porch. This year he shot one in the front pasture on opening day.
Hundreds of miles of ATV/snowmobile/4 X 4 forest service roads right across the road. Many guests come every year or several times a year. Approximately 20 artesion springs, including one estimated to be 7 gallons a second (large enough to create a nice creek). Lots of large, valuable, marketable cedar trees, and trails throughout the ranch. From 50-100 tons of hay each year. Just 30 miles from Sandpoint and the second largest ski resort in Idaho.
This ranch can be yours for a business or private hunting and fishing retreat. The ranch is colisted by Kristina Kingsland of Keller Williams-Sandpoint, ID (208-290-1509 email@example.com) and James Esperti of Fay Ranches, Bozeman, Montana (406-586-4001 email@example.com).
See ranch website for more ranch details and photos: www.diamondtranch.com. and Facebook-Diamond T Guest Ranch-hotel


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Think simple abundance when you dine at Jhanjay Vegetarian Thai Cuisine in Ballard. Standout dishes: Nun's Noodles and the Jhanjay sampler platter — especially the fried lotus root, corn patties and wontons stuffed with cream cheese.
There's a serene, minimalist outlook at Jhanjay Vegetarian Thai Cuisine in Ballard that's a welcome departure from the noisy, busy world outside its doors.
Upon being seated in the expansive dining room, you'll see a nine-panel wall that is like a periodic table of elements for the cuisine you're about to consume: Each panel sports an icon, such as chili pepper, peas, broccoli and carrots. Think simple abundance.
The Ballard restaurant, which opened in December 2009, is the newest location for Jhanjay, which started first three years ago in Wallingford. According to the owners, "jhan-jay" means "vegetarian dishes" in Thai.
Most of the dishes at Jhanjay can be made vegan. If you ask for ketchup, be prepared to be met with disbelief.
- Purple Heart plant bed vandalized days before Memorial Day
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The menu: Aside from standard Thai dishes, such as phad Thai and red curry, the waiters will encourage you to try the house specials. These include mango tofu ($11.95), abundant asparagus ($12.95) and mountains of mushrooms ($13.95). If you've never had lotus root before, try the Asian Fries ($7.50). The $8.25 lunch special is tofu stir fried with various vegetables and sauces, served with rice and soup of the day.
What to write home about: We enjoyed Nun's Noodles ($8.95) — udon noodles stir-fried with steamed tofu, enoki mushrooms and mixed vegetables in a light chili sauce. The tofu was soft as poached eggs but firm enough to hold its shape. We were wowed by the Jhanjay sampler platter ($10.95) — especially the fried lotus root, corn patties and wontons stuffed with cream cheese.
The setting: You won't feel cramped in the elegant dining room — framed by exposed brick, polished wood and accent walls — as you look up at lights hanging from the high ceilings and listen to the easy jazz soundtrack. You can watch as your meal is prepared in the open kitchen area. Service is friendly.
Summing up: We ordered the Jhanjay sampler platter, Nun's Noodles, eggplant in black bean sauce ($10.95), brown rice ($2) and coconut ice cream ($3.75) for dessert. With tax and tip, our total bill was $47.
Sanjay Bhatt: 206-464-3103 or email@example.com


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Welcome to Audiko.net! All you need is to download a free Cathy Davey ringtones for your iPhone or mobile. Specify your favorite episode from your favorite hit - Little Red, Mr. Kill, Reuben, or any other track. You are free to have your tune both in the MP3 and m4a formats, played by both mobile phones and iPhones. Just select a track, and choose free Cathy Davey ringtones download option.
Download Cathy Davey Ringtones
Top free ringtones
|Holy Moly
|In He Comes
|Little Red
Cathy Davey


text:
Power-Plus Protein Meal Replacement (Chocolate) by Bio Nativus provides a wide array of vitamins' minerals' and amino acids that may work to maintain general health.
First' every serving of Power-Plus Protein Meal Replacement (Chocolate) contains 46 grams of whey and milk protein. As a result' it can serve as a convenient' nutritious substitute for meals on busy days.
Notably' this low-fat powdered supplement also contains a blend of complex carbohydrates that could potentially act to maintain already healthy blood glucose levels while serving as a steady source of energy.
In addition' Power-Plus Protein Meal Replacement (Chocolate) provides taurine' which is an amino acid that might work to promote optimal cardiovascular function.
Furthermore' nutrients like vitamin D' calcium' and magnesium may work to maintain healthy muscles and strong bones.
Last' this Bio Nativus supplement is free of artificial colors' flavors' and additives.
Each one-kilogram container of Bio Nativus' Power-Plus Protein Meal Replacement (Chocolate) provides about 13 servings.
These statements have not been evaluated by the Food and Drug Administration (FDA). These products are not meant to diagnose' treat or cure any disease or medical condition. Please consult your doctor before starting any exercise or nutritional supplement program or before using these or any product during pregnancy or if you have a serious medical condition.
Serving Size: 3 level scoops (75 g)
Servings per Container: 13.3
Amount per Serving/% DV*
Calories 271
Calories from Fat 27
Total Fat 3 g/4%
Saturated Fat 1 g/1%
Trans Fat 0 g
Cholesterol 24 mg/8%
Sodium 100 mg/4%
Potassium 550 mg/15%
Total Carbohydrates 20 g/6%
Dietary Fiber 5 g
Sugars 5 g
Protein 46 g
Vitamin A 5'000 IU/100%
Palmitate 3'000 IU/60%
Beta Carotene 2'000 IU/40%
Vitamin C 100 mg/166%
Calcium 1'000 mg/100%
Iron 0%
Trace Mineral Complex** 250 mg***
Vitamin B1 1.5 mg/100%
Vitamin B2 1.7 mg/100%
Vitamin B3 20 mg/100%
Vitamin B5 10 mg/100%
Vitamin B6 2 mg/100%
Vitamin B12 6 mcg/100%
Folic Acid 800 mcg/200%
Biotin 300 mcg/100%
Vitamin D3 200 IU/50%
Vitamin E 50 mg/166%
Magnesium 133 mg/33%
Phosphorus 220 mg/22%
Zinc (Lactase) 5 mg/33%
Chromium (GTF) 100 mcg/83%
Selenium (Methionine) 70 mcg/100%
*Percent Daily Value are based on a 2'000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.
**Trace Minerals naturally harvested from Utah's Great Salt Lake.
***USDRA not established.
Mix 2-3 Scoops (25 gm ea.) with 12-16 oz. chilled water as a meal replacement. For best results mix in a blender with ice 10-20 seconds.
Consult a healthcare professional before use.
Allergy / Dietary Needs
- Aspartame Free
- Hydrogenated Oils Free
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If you are pregnant, nursing, taking any medications or have any medical condition, consult your doctor before use. Your healthcare professional is the best source for guidance before beginning an exercise or nutritional supplement program.


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Yes, always, a 340M&P presently with Corbon DPX in my pocket, my second or BUG if you prefer. Usually a G23 IWB, even at home. We live in a low crime area, so though the likelyhood of an event is reduced it maintains proper vigilance. Having it off-body, hidden or locked away is of little value and greater risk to other occupants. Another bonus, is when a unknown vistor knocks on your door, you are preparred if necessary. My wife carrys at home too, especially when I'm not home.
Especially for newer CCWs I think it is a good habit to develop. It allows you to become comfortable mentally, and allows you to experiment with different methods of carry without discovering what doesn't work in public and what is really the most comfortable day in and out.
Always have a functional fighting folder too.


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Impact Sign Company Products
As a full service sign company, Impact Sign Co. strives to provide you with the newest, most reliable and best solutions to fit your every need. Specializing in commercial signage, we aim to be your partners, the people you can turn to provide you with the best products and the best customer service. As a business organizaiton we understand that time, budget and quality are the top priorities for you.
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Alvin Ailey moves in new creative direction
Robert Battle reveres dance troupe's foundation while pushing dancers in new directions
When Alvin Ailey American Dance Theater returns to San Diego this week, the seven pieces on the company's two-night program reflect both where the African-American modern dance troupe has been and where it's going.
Since July 2011, the Manhattan company has been under the artistic leadership of Robert Battle, a longtime company collaborator and choreographer who is pushing Ailey in surprising new directions. Battle is only the third leader in the company's 55-year history. Before his death from AIDS in 1989, Ailey hand-picked Judith Jamison to fill his shoes. And when she stepped down 21 years later, she asked Battle to take her place.
Like Ailey and Jamison before him, the 40-year-old Florida native said he sees the job as his life's mission.
"It is a calling," he said in a phone interview last month. "Even if I ever had doubts about things, I'm rooted in the knowledge that this will be my life's journey. I'm looking at it as a marathon, not a sprint. It's a wonderful trajectory knowing I'm part of living history."
Battle was 12 years old when he first saw the Alvin Ailey company perform. On that program was "Revelations," Ailey's signature 1960 ballet, a gospel-infused ensemble work about how faith helped black slaves on their journey to freedom. Today — as it has for decades — the company closes every performance with the 38-minute piece.
"I'm still in awe of his genius and the perfection of his choreography for 'Revelations,' but now I can watch it from the wings and see how it affects the audience in city after city, country after country. Part of the way one remains successful is that you never lose your curiosity. You guard that part of yourself and don't become jaded. 'Revelations' reminds me of that sense of wonder."
The 30-member Ailey company spends seven months of each year on the road. This year's 21-city tour repertoire includes a mix of traditional pieces like "Revelations," two works by Battle, a new jazz-infused piece by hot, young choreographer Kyle Abraham, and Paul Taylor's famed "Arden Court." Commissioning work by an emerging choreographer and bringing in pieces identified with other dance companies has raised some eyebrows in the dance world, but Battle said he likes to "keep people guessing."
"I love the unexpected," he said. "It keeps people engaged."
Here are his thoughts on dance, his new job and the seven dances pieces planned Tuesday and Wednesday.
Q: What's been your biggest surprise since taking over?
A: How much of my job is exactly who I am. I took voice lessons, and when I was trying to reach for the high notes my voice teacher stopped me and said 'when you get in an elevator, it goes up, you don't.' That how this job feels. I'm very much planted and I'm not so much reaching up but from within and calling on everything I know from my upbringing, in the church and all the people who taught me.
Q: You broke with tradition to introduce works created for other dance companies, like Paul Taylor's "Arden Court," which will be performed here Tuesday.
A: Certainly I'm very strategic about introducing new things to the repertoire and making sure it has some connection to the company's mission. I trained under Taylor dancers at Juilliard and I danced with David Parsons, who came out of the Taylor company. There's all this connective tissue. This company has never done a Paul Taylor piece, and "Arden Court" has some choreography for men that would be new to the audience. It says: "Hey, here I am. This is something different."


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Contact Information
Tremon Kizer
Lecturer; Pride of Dayton Marching Band Director
- Full-Time Faculty
Tremon Kizer is a Lecturer in the Department of Music and Theatre at the University of Dayton, where he oversees the Marching Band, conducts the University Concert Band, and works in all aspects of the athletic band program. In addition, he teaches undergraduate and graduate courses in instrumental music education, ranging from music education methods to summer courses in graduate conducting and wind literature. While at the University of Dayton, he has served as the interim conductor of the Symphonic Wind Ensemble, the premiere wind ensemble on campus, the Associate Conductor of the UD New Horizons Band, and has served as the Instrumental Music Coordinator.
Recently, he was a Doctoral Conducting Associate at the University of South Carolina, where he assisted and conducted in all aspects of University Band program, which included guest conducting the USC Wind Ensemble, Symphonic Wind Ensemble, and as Assistant Producer of an NAXOS Wind Band Classics Recording, which will be released in 2016. Furthermore, he assisted with the organization and instruction of the 400-member Carolina Marching Band. He holds degrees from the University of Central Missouri and Kansas State University.
Previously, he served as Director of Bands at Coffeyville College, where he oversaw all aspects of the wind band program, where he conducted the wind ensemble, marching band, and taught courses in conducting and music theory. He has taught public schools in Missouri and began his teaching career at Goodland High School in Goodland, Kansas.
As a champion of diverse music, he has conducted numerous works for chamber and wind ensemble. Recently, he conducted James Stephenson's The Devil's Tale for chamber winds and narrator, making it the first live on stage performance to use actors instead of narrator. He also presented a lecture/performance of the wind band works of two-time Prix de Rome winner, Ulysses S. Kay.
Tremon Kizer is an active guest conductor, adjudicator, and leadership consultant throughout the United States. As a guest conductor, he has conducted numerous district and regional honor bands. As a champion for improving leadership skills for high school and college students, he teaches his model for how to maintain a year-around leadership program through leadership seminars for high school band programs. He has been on staff for numerous music camps, drum major clinics, and collegiate and high school concert and marching band camps.
He is also a member of Phi Mu Alpha and holds honorary memberships in Kappa Kappa Psi and Tau Beta Sigma. He enjoys spending time traveling with his wife Tracy and son, Tremon, Jr.
- Doctorate in Musical Arts (candidate), University of South Carolina
- Masters in Music, University of Central Missouri
- Bachelors in Music Education, Kansas State University
Professional Associations
- College Band Directors National Association
- World Association of Symphonic Bands and Ensembles
- National Association for Educators Association
- Kansas Bandmasters Association


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Live from Abu Dhabi Connect the World takes you on a journey across continents, investigating the stories that are changing our world.
CNN's Becky Anderson explores Turkey's textile industry, which makes up 10% of the country's GDP.
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Brighton 12°c
Honey68 wrote:
this is our future generation? as frustrated as they may be, is this really the behaviour of supposedly intelligent people? I think not!
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Yes it is.......Originally Posted by britchick, post: 290915
Originally Posted by britchick, post: 290922And we're back to what got us into this mess in the first place!Originally Posted by catrancher, post: 290875
Tom (... I can't help it. Really!)
Gay you say?...................................... goddammit out of luck again
I am a fully fledged member of the Pastafarian Church of the Flying Spaghetti Monster.
Tom (... goodonya!)


text:
Newegg.com - A great place to buy computers, computer parts, electronics, software, accessories, and DVDs online. With great prices, fast shipping, and top-rated customer service - once you know, you Newegg.
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The OtterBox Defender Series offers an exclusive multi-layer design that keeps information and investments safe. No other case can withstand this degree of rough treatment. The Defender Series provides superior protection for a smartphone allowing complete interaction through the case.
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This review is from: OtterBox Defender Black Defender Case For Samsung DROID CHARGE SAM2-LTE4G-20-E4OTR
Pros: Great protection for the Samsung Charge. Easy assembly. Great fit. In an "Eggshell" if you're looking for protection and functionality this is an excellent choice.
Cons: Not that easy to disassemble. Adds a lot of bulk but this is a necessary evil. No color choices.
Other Thoughts: It only comes in black. It would be nice to have additional color choices. It got here but NewEgg's free shipping/tracking is a little maddening. It showed it in Georgia for 3 days and nothing updated until after it was delivered. I know the shipping is free but if you really want to know when it will arrive, you better try paying for shipping.
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text:
Sona, Maven of the Strings by MyTh1CWatch
©2012-2016 MyTh1C
Sona, Maven of the Strings of League of Legends. My well-loved, well-played, silent lady of devastating musical prowess!
So this is what happens when you take Sona's kind and timid personality, and replace it with an "I'm sexy and I know it" attitude! xD
I love it
I love it
Can you play some music for me ?
Are you looking for a work of musician ?
The "PIXEL SHOW" looks for a musician.
Are you looking for a work of musician ?
The "PIXEL SHOW" looks for a musician.
Love this. Sona is one of my favorite champions and her hair, outfit, and look all combine so well (: I would love to see a bigger version of this with some kind of a background. Would be an amazing wallpaper!
Send this to riot? Make it a skin, pls??
Im dying... Sona is too sexy for a mere mortal like me +_+
Jesus the expression.......Man I wish every League girl would make that expression at least one time because it is awesome.
LETS Rock!
I absolutely love this drawing. I main Sona and it's always good to see great art of her.
nice drawing
Love the perspective of the etwahl and her pose.
You and me both, brutha. :L
Ooh that look on her face, in my opinion, is the sexiest thing about this whole pic. Her unitard only adds to it. And that pose! great job man
I love her expression the most, its so sexy.
Really nice work (:
Love Sona ^^
Love Sona ^^
Amazing artwork of Sona. Love the pose and placement of the etwahl. I also really like the design you did for her clothing.


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Edited by: Hans-Uwe Simon
Cyclosporine-A in severe chronic urticaria: the option for long-term therapy
Version of Record online: 7 JUL 2010
DOI: 10.1111/j.1398-9995.2010.02419.x
© 2010 John Wiley & Sons A/S
Volume 65, Issue 11, pages 1478–1482, November 2010
Additional Information
How to Cite
Kessel, A. and Toubi, E. (2010), Cyclosporine-A in severe chronic urticaria: the option for long-term therapy. Allergy, 65: 1478–1482. doi: 10.1111/j.1398-9995.2010.02419.x
Publication History
- Issue online: 7 JUL 2010
- Version of Record online: 7 JUL 2010
- Accepted for publication 23 April 2010
- Abstract
- Article
- References
- Cited By
- chronic urticaria;
- ciclosporin;
- cyclosporin;
- cyclosporine;
- cyclosporine-A;
- therapy
To cite this article: Kessel A, Toubi E. Cyclosporine-A in severe chronic urticaria: the option for long-term therapy. Allergy 2010; 65: 1478–1482.
Background: The treatment of severe chronic urticaria (CU) remains a difficult goal to achieve. Many patients do not respond to anti-histamine therapy, even when off-label doses are given. Thus, cyclosporine-A (CsA) becomes a good therapeutic option for severe patients and for some, long-term therapy is required. We evaluated the effectiveness and safety of low-dose CsA, when treatment cannot be discontinued and long-term CsA therapy is needed to maintain severe CU in remission.
Methods: Among 2000 patients with CU who were referred to our outpatient clinic, 120 patients who suffered from a very severe CU began treatment with CsA 3 mg/kg. A clinical and laboratory followup was performed during this period of treatment.
Results: In 20 patients, CsA was discontinued within 2–15 days after initiation because of side-effects. Among 62 of the remaining 100 patients (62%), CsA was administered for a period of 3 months with a highly beneficial outcome. In another 20 patients (20%), CsA was considered beneficial; however, it was required for a longer period of time, 5–10 years for some of the cases. In all cases, CsA was well tolerated and most important, it was safe. For 18 patients (18%), CsA therapy was reported as failed.
Conclusion: A low dose of CsA is a good option for patients who suffer from especially severe CU. In most cases, this therapy regimen is considered effective and safe. For a small group of patients, long-term therapy is needed, and until now it is considered safe.
The major concept of chronic urticaria (CU) is that it is of an autoimmune origin and is based on the finding of pathogenic IgG autoantibodies that are directed against the anti-IgE receptor on mast cells in 30–40% of patients suffering from CU (1). However, subsequent research has characterized CU in the broader context of an immune-mediated disorder rather than a focused autoimmune event. In this respect, a polyclonal activation of B cells and the presence of unrelated autoantibodies such as anti-thyroid antibodies were reported in patients with CU (2). Also, CD4+ T cells were found to be in an 'activated state' as evidenced by the over-expression of CD40L on their surface in association with disease severity (3). In addition, we later reported on the elevation of MMP-9 in the plasma of patients with severe CU (4).
In practice, however, most specialists who deal with this disabling disorder are mainly concerned with the management of patients who suffer from severe form of CU. In a study where 562 patients with CU were followed, mild to moderate CU responded well to H1 antihistamines. However, 46% (most of whom were defined as severe) were considered nonresponders to H1 blockers (5). This impression was confirmed by others, where 40–50% of patients with a severe form of CU did not respond sufficiently well to H1-blockers and therefore needed more aggressive therapy (6). When treatment is discussed, one should consider the issue of CU duration. In this respect, the duration was assessed in a follow-up study among 220 patients with CU. Whereas CU was resolved within 1 year in only 35% of the patients, for 29%, the symptoms gradually decreased after 1 year, however, among 40–50% CU persisted for more than 1 year (7). In this respect, we also reported continuing CU for 3 years in 50% of the patients who experienced a very severe onset of urticaria (8). Thus, when CU is severe and long lasting, defined as nonresponding to H1-blockers and short courses of corticosteroids are repetitively required, low-dose cyclosporine-A (CsA) turns to be an optional therapeutic choice.
In 1991, Fradin et al. was the first to give CsA 6 mg/kg for a period of 3–9 weeks to three patients suffering from severe CU. Despite its beneficial effects, CsA was discontinued in all the three patients because of its undesirable side-effects (9). Two years later, Barlow RJ et al. treated 12 patients who suffered from severe CU with low-dose CsA (3 mg/ml) for 1 month, and reported on both its safety and beneficial effect (10). In 1997, our group described a modified protocol for CsA administration over a 3-month period, with an initial dose of 3 mg/kg that was gradually reduced. One-third of the patients with CU were cured and another third experienced reduced symptom severity (11). Notably, in one-third of the patients in full remission, urticaria relapsed 6–12 months after CsA was discontinued, and longer CsA therapy was needed.
During the last decade, CsA was widely administered by many centers mainly for patients with very severe CU. Although there is agreement that it is a drug with evidence-based benefit and short-term safety, only a few studies posed the question of how long CsA could be administered to patients who need it for longer periods. In most of the previously mentioned studies, CsA was administered for 1–3 months and in many of them, urticaria relapsed upon CsA discontinuation and longer therapy was considered. In this regard, we reported on a longer CsA therapy for a small group of patients as being efficient and safe (12).
In this study, we summarize our long-term experience with CsA therapy over more than a decade. We focus on the issues of its beneficial effect, its safety and mainly on the option of administering CsA for a long time period. We discuss the question of whether patients on long-term CsA therapy should fear malignancy.
Between 1997 and 2009, 2000 patients suffering from CU were followed in our outpatient clinic (a referral center for CU). Among these patients, 120 patients who were considered to be especially severe and nonresponders to conventional therapy for at least 6 months were initiated on 3 mg/kg CsA. Patients with pure physical urticaria, presumed chronic infection, food or food additive intolerance were not included in the study.
The decision of giving CsA was undertaken when these patients were considered as nonresponders to high doses of anti-histamines, or to the addition of H2 blockers, singular, or when their quality of life was altered because of the sedative side-effects of high (off-label) doses of anti-histamines. We preferred low-dose CsA therapy over the need of administering recurrent short courses of corticosteroids. Low alternate day doses of prednisone were sufficient to control severe urticaria in only few number of patients. All patients in whom CsA therapy was well tolerated and was continued for at least 3 months were closely evaluated every 4–6 weeks for their urticaria status. Blood pressure and routine laboratory analysis including: cell blood count (CBC), serum electrolytes, glucose, cholesterol, uric acid and creatinine were closely observed every 6–8 weeks. Because of the fact that serum creatinine does not increase until glomerular filtration rate (GFR) is below 50% of normal, we calculated GFR according to the modified Cockroft-Gault GFR formula (13). Later, whether still on CsA for longer periods or discontinued, patients were evaluated every 3 months for a period between 3 and 10 years.
Urticaria score
All patients were scored on a four-point scale as formerly described by Breneman et al. Briefly, this scale takes into consideration the number of lesions, number of separate episodes, average size of lesions, average duration of lesions and pruritus as follows: 0 = no symptoms; 1 = mild urticaria (1–4 points); 2 = moderate urticaria (5–9 points); 3 = severe urticaria (10 points). The urticaria score was performed at baseline before starting CsA and during follow up (14).
The mode of cyclosporine-A therapy
When patients responded and sufficiently tolerated the treatment, they continued with 3 mg/kg CsA for 2 months; then their dosage was gradually decreased to 2 and the 1 mg/kg during the following month. Patients were then followed to assess whether remission was long lasting or if they needed H1 blockers if urticaria was still persistent though in a milder form. When urticaria was severe and CsA therapy could not be discontinued, patients continued with a minimal CsA dose (1–1.5 mg/kg) and were closely followed.
Long-term safety
All patients with severe CU who received CsA therapy for a period of 3 months or longer were followed for a period of 3–10 years. During this period of time, we were able to monitor their general health status and looked for possible related malignancies, especially among those who were treated for 5–10 years.
Results (See Fig. 1)
Of 120 patients in whom CsA was begun, treatment was discontinued for 20 patients (16.5%) because of severe side-effects. In nine patients, treatment was stopped after 2 days of therapy because of severe gastrointestinal side-effects (abdominal pains and/or diarrhea). In another 11 patients, CsA was discontinued after 10–15 days because of the persistence of peripheral neuropathy or severe headaches. Among 100 patients who tolerated CsA well (free of all side-effects mentioned clinically), treatment was continued for at least 3 months (for some much longer). This enabled us to evaluate them during the course of therapy and then for a variable period of time between 3 and 10 years.
Among these patients, 30 (30%) achieved full remission (urticaria score 0) and CsA was discontinued after 3 months. Those patients who remained in remission for at least 3 years had their follow-up discontinued. In another 32 patients (32%), CsA was considered moderately beneficial (urticaria score 1–2), the severity of urticaria was declined to a degree in which maintenance with anti-histamine therapy was sufficient, and the patients' quality of life was satisfactory. Thus, CsA was summarized as variably beneficial in 62 (62%) patients, and they were able to discontinue therapy after 3 months. In 20 patients, CsA was highly beneficial and complete or almost complete remission was achieved; however, when CsA was discontinued or the dosage was reduced below 1 mg/kg, severe urticaria and angioedema reappeared (urticaria score 3) and, therefore, 1–2 mg/kg CsA was continued.
In eight patients, CsA was continued for 8–14 months and then discontinued, enabling patients to maintain a reasonable quality of life with anti-histamine therapy only (urticaria score 1–2). In another 12 patients, and because of the impossibility of discontinuing CsA, a very low dose of CsA (1–1.5 mg/kg) was continued for variable periods between 5–10 years. These patients tolerated CsA well (there was no blood pressure elevation or laboratory abnormalities).
In all 20 patients on long-term CsA therapy, GFR was assessed: At baseline, a mean of 106 ± 11 GFR ml/min was measured. After 1 year in some, and 5–10 years in the others, a mean of 99 ± 14 GFR was measured. None of them had GFR below the normal.
Careful evaluation (although in a small group of patients) did not raise any clues for possible malignancy development. Finally, in 18 patients where CsA was administered for at least 1 month was considered as a total failure and therefore discontinued.
The accepted nontoxic serum level of CsA is reported to be in the range between 75–325 ng/ml. However, this range was adjusted for transplanted patients; however, it was never evaluated for other diseases. It is important to note, in all of our treated patients' sera, measured levels of CsA did not exceed 100 ng/ml, although most patients where CsA was maintained between 1–1.5 mg/ml, serum levels were approximately 50 ng/ml.
When severe CU continues and conventional doses of both first generation and nonsedative antihistamines are not effective, patients become disabled and their quality of life turns to be unbearable. At this stage, higher doses of antihistamines such as Fexofenadine and Desloratadine are considered and there are many reported on their additive value in improving urticaria (15). However, 40–50% of patients with extremely severe CU who could tolerate high doses of sedative antihistamines or off-label doses of nonsedative antihistamines remained unresponsive and complained of a lower quality of life, thus requiring a more aggressive therapy (6).
During the last decade, many studies pointed to the importance of assessing health-related quality of life (HRQoL) in patients with severe CU. In these studies, health status scores in patients with CU were comparable to those of patients with ischemic heart disease. Others, being aware of assessing HRQoL, described a higher incidence of sleep disorders, work disability and psychiatric morbidity among patients with CU. The quality of life decreases among those patients where higher and continuous doses of H1-blockers may cause tiredness or lowered concentration during work time (16, 17).
When patients did not respond to anti-histamine therapy, even when off-label doses were administered, short courses of corticosteroids for a period of 2–3 weeks were administered, sometimes in addition to leukotrein antagonists. In many of these cases, the attenuation of CU severity allowed a reasonable quality of life. However, when urticaria was extremely severe and longer corticosteroid therapy was the only option, we then considered low-dose CsA to be a better option for a long-lasting and severe CU (18).
During the last decade, CsA was reported to be beneficial in 27 original studies, some of which were double-blind controlled studies (19, 20). In six of them, the dose of CsA was between 4–5 mg/kg, whereas a low dose (2–3 mg/kg) was given in the other studies including our study. When higher doses were administered, side-effects, such as hypertension, peripheral neuropathy and increased serum creatinine, were reported in 20–30% of the patients. In most patients, they were transient or improved following dose decrease, and therapy discontinuation of therapy was rare. However, when a low dose of CsA was administered (2–3 mg/kg), most studies reported on a very low incidence of side-effects (mostly gastrointestinal or peripheral neuropathy) (11, 20, 21).
In this prospective cohort, 20 patients (16.5%) developed rapid onset severe side-effects, and CsA therapy had to be discontinued. However, when CsA doses were below the range of 3 mg/kg, mild side-effects such as peripheral neuropathy or abdominal discomfort were transient, and treatment was always tolerated. We also recommend that patients on long-term low-dose CsA should undergo periodically GFR examination, to prevent even mild CsA nephrotoxicity.
The main issue of this study is to discuss the need for long-term therapy (5–10 years) with low-dose CsA that was administered to 12 of our patients, who insisted on continuing this highly beneficial therapy regimen. The major concern in this report is the fear of malignancy that may possibly appear in patients who are maintained on long-term CsA therapy. The safety of giving low-dose CsA in severe CU over a long time period should be further evaluated in a larger group of patients. Moreover, the effectiveness of low-dose CsA in some patients with extremely severe CU and for those who must take this therapy regimen as their only option for maintaining a good quality of life must be continued until additional safety data are available. The incidence and risk of malignancy is reported to be elevated in solid organ transplant recipients (mainly those on immunosuppressive therapy) compared with the general population (22). As proof of the relationship between immunosuppressive therapy and posttransplant malignancy, epidemiological data reveal that the length of exposure to immunosuppressive therapy and the intensity of therapy are clearly related to the development of malignancy. The incidence of posttransplant lymphoproliferative disorder was reported to be 1.6% with onset occurring more than 5 years after transplantation especially when CsA was administered at doses of more than 5 mg/ml. Indirectly, immunosuppressive drugs greatly increase the posttransplant risk of malignancy by impairing cancer surveillance and facilitating the action of oncogenic viruses. Thus, both the higher dose of CsA therapy and the higher incidence of oncogenic viral infections such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in these patients are the main risk factors that contribute to the development of posttransplant malignancies (23).
The issue of the autonomous cellular mechanism for CsA and tacrolimus in promoting malignancy was proposed in animal models only. In this respect, tumor progression developed in T-, B-, and NK cell-deficient severe combined immunodeficiency (SCID)-beige mice but not in normal mice. It is also believed (as reported previously) that malignancy is probably related to CsA dosage, suggesting that low doses are safe (24).
Nonmelanoma skin cancers (NMSCs) that were reported to be associated with immunosuppression have been mostly reported in solid organ transplant patients, particularly in renal transplant patients (25, 26). Although the two most important risk factors for NMSCs in the transplant population are the amount of sun exposure and age at transplantation, the duration of immunosuppressive drug therapy has been considered to be a risk factor predisposing to NMSCs (27). Therefore, one should consider the recommendation to avoid sun exposure in patients with CU who are on long-term CsA therapy.
In our case, a follow-up study that was conducted 8–10 years after patients who were administered CsA for only 3 months and then discontinued, or in patients where long-term therapy was administered (although to a small cohort of patients) does not show any cases of malignancy or any increase in the incidence of infections. Thus, our data suggest that when low-dose CsA is used in patients with CU (who are otherwise normal) and where the rate of CMV or EBV infections is definitely no higher than that of normal, individuals are probably safe.
Finally, we believe that the chance of malignancy is much lower when serum CsA levels do not exceed 50 ng/ml (a very low serum level). In conclusion, when CsA is required for longer periods, the goal should be to keep the dosage between 1–1.5 mg/ml. However, further studies with a larger number of patients with CU are required to establish this concept.
- 1Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Eng J Med 1993;328:1599–1604., , , , , .
- 2Anti-thyroid antibodies in chronic urticaria and angioedema. J Allergy Clin Immunol 2003;112:218., , .
- 3Immune aberrations in B and T lymphocytes derived from chronic urticaria patients. J Clin Immunol 2000;20:371–378., , , , , .
- 4Increased plasma levels of MMP-9 are associated with the severity of chronic urticaria. Clin Exp Allergy 2005;35:221–225., , , , , .
- 5Clinical and aetiological aspects in urticaria and angio-edema. Br J Dermatol 2003;148:501–506., , , , .
- 6Treatment of severe chronic urticaria with oral mycophenolate mofetil in patients not responding to antihistamines and/or corticosteroids. Int J Dermatol 2006;45:1224–1227., , , .
- 7Natural course of physical and chronic urticaria and angioedema in 220 patients. J Am Acad Dermatol 2001;45:378–391., , , .
- 8Clinical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy 2004;59:869–873., , , , , et al.
- 9Oral cyclosporine for severe chronic idiopathic urticaria and angioedema. J Am Acad Dermatol 1991;1:1065–1067., , , .
- 10Treatment of severe chronic urticaria with cyclosporine-A. Eur J Dermatol 1993;3:273–275., , .
- 11Low-dose cyclosporin A in the treatment of severe chronic urticaria. Allergy 1997;52:312–316., , , .
- 12Prolonged cyclosporine a treatment for severe chronic urticaria. Allergy 2003;58:535–536., , .
- 13A more accurate method to estimate glomerular filtration equation from serum creatinine: a new prediction equation". Ann Inter Med 1999;130:461–470., , , , , .
- 14Cetirizine and astemisone therapy for chronic urticaria: a double-blind, placebo-controlled, comparative trial. J Am Acad Dermatol 1995;33:192–198., , .
- 15High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol 2009;123:672–679., , , , .
- 16The impact of chronic urticaria on the quality of life. Br J Dermatol 1997;136:197–201., , , , .
- 17Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol 2007;99:29–33., , , , , et al.
- 18Low-dose cyclosporine A is a good option for severe chronic urticaria. J Allergy Clin Immunol 2009;123:970., .
- 19Randomized double-blind study of cyclosporine in chronic "idiopathic" urticaria. Br J Dermatol 2000;143:365–372., , , , , et al.
- 20Neo-I-30 study Group. Cyclosporin A in chronic idiopathic urticaria: a double blind, randomized, placebo-controlled trial. J Am Acad Dermatol 2006;55:705–709., , , , ,
- 21Low-dose and short-term cyclosporine treatment in patients with chronic urticaria: a clinical and immunological evaluation. J Dermatol 2008;35:276–282., , , , .
- 22Immunosuppressive drugs in kidney transplantation: impact on patient survival and incidence of cardiovascular disease, malignancy and infection. Drugs 2009;69:2227–2243..
- 23Immunosuppressive therapy and malignancy in organ transplant recipients: a systematic review. Drugs 2007;67:1167–1198., .
- 24Post-transplantation malignancy: a cell autonomous mechanism with implications for therapy. Trans Am Clin Climatol Assoc 2009;120:369–388., , , , .
- 25Immunosuppression and risk of non-melanoma skin cancer in renal transplant recipients. Lancet 1997;349:398., , , , .
- 26Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol 2002;47:1–17., .
- 27Risk factors for skin cancer in a group of renal transplant recipients. Acta Derm Venereol 1999;79:409–410., , .


text:
Sam Raimi is certainly making up for the hole in his schedule left by his departure from Spider-Man 4. Raimi recently added the sci-fi invasion movie EDF to his producing schedule, and he is considering several other movies for his next project: A reboot of The Shadow (Raimi is set to produce already); an adaptation of the popular video game World of Warcraft; the comic book adaptation of Radical Studios' Earp: Saints for Sinners; and Oz: The Great and Powerful, a prequel to The Wizard of Oz.
Deadline now reports that Disney has convinced Raimi to direct Oz as his next project. The studio has also hired David Lindsay-Abaire, who, at one point, was writing the script for Spider-Man 4.
Disney is also hoping to put Oz into production by next year, with Robert Downey Jr. possibly set to star as the title character. While Downey isn't "locked" into the movie, the report claims that "it's looking good" for the actor to commit to the role.


text:
- VietnamAgricultureFunding via Thanh Hoa Microfinance Institution Limited Liability
Chắt And Fr...VietnamAgricultureFunding via Thanh Hoa Microfinance Institution Limited Liability
Thiệp's GroupVietnamAgricultureFunding via Thanh Hoa Microfinance Institution Limited Liability
Nam's Group
Nam has been involved in this business for six years.
Nam is applying for a loan to purchase cattle to resell. She works in agriculture farming poultry and cattle.
This is Nam's first loan with Thanh Hoa Fund of Poor Women. The main hardships that Nam faces in her business are natural disasters and droughts.
With her business profit, Nam hopes to make enough money to provide for her kids, for her business to do well, and for her children to do well in school.
Additional Information
About Thanh Hoa Microfinance Institution Limited Liability (Thanh Hoa MFI)Thanh Hoa MFI works to provide credit to women and their families in the central Vietnamese province of Thanh Hoa, one of the poorest regions of the country. The institution's target clients are poor and low-income women who have the ability to work but lack the capital. Accordingly, Thanh Hoa MFI prioritizes single mothers, low-income women with children who have dropped out of primary school, and Viet Nam's poorest women who cannot access any formal financial services.
This is a Group Loan
In a group loan, each member of the group receives an individual loan but is part of a larger group of individuals. The group is there to provide support to the members and to provide a system of peer pressure, but groups may or may not be formally bound by a group guarantee. In cases where there is a group guarantee, members of the group are responsible for paying back the loans of their fellow group members in the case of delinquency or default.
Kiva's Field Partners typically feature one borrower from a group. The loan description, sector, and other attributes for a group loan profile are determined by the featured borrower's loan. The other members of the group are not required to use their loans for the same purpose.
About Vietnam
67View loans »
Success!! The loan was 100% repaid
- Repayment Term
- 14 months (Additional Information)
- Repayment Schedule
- Monthly
- Pre-Disbursed:
- Mar 6, 2014
- Listed
- Mar 20, 2014
- Currency Exchange Loss:
- Possible
- Ended:
- Apr 17, 2015


text:
- ParaguayAgricultureFunding via Fundación Paraguaya
La Esperanz...ParaguayAgricultureFunding via Fundación Paraguaya
Koe Pyta GroupParaguayAgricultureFunding via Fundación Paraguaya
Virgen De La Misericordia Group
Silvia has a henhouse that is very well established. She raises and fattens chicks in order to sell them. She has worked in this field for quite a while. Taking into account the consumption of poultry instead of beef due to the economy, she now has good, fixed customers.
She wishes to expand her business by purchasing more chicks. She will also purchase balanced feed and equipment to provide for the chicks. This way her income will increase, and her animal production will keep growing.
La Sra. Silvia posee un gallinero, muy bien montado, en el cual se dedica a la cría y engorde de pollitos para su comercialización, ya hace bastante tiempo que se dedica a este ramo y posee una buena clientela ya formada, teniendo en cuenta el consumo de la carne de ave por su economía en comparación a la carne vacuna.
Ella desea ampliar el negocio mediante la inversión en compra de mayor cantidad de pollitos, así también alimentos balanceados y equipos para el suministro de los mismos, para de esta manera incrementar sus ingresos y seguir creciendo en la producción animal.
Additional Information
About Fundación ParaguayaFundación Paraguaya is a financially self-sustaining social enterprise that promotes entrepreneurship in urban and rural areas through microfinance, education programs, and more. Its focus on agriculture has helped many farmers boost their crop yields. And a number of other borrowers have taken out loans to start and grow social businesses that have helped deliver eyeglasses, medicines and other helpful services in their local communities.
This is a Group Loan
In a group loan, each member of the group receives an individual loan but is part of a larger group of individuals. The group is there to provide support to the members and to provide a system of peer pressure, but groups may or may not be formally bound by a group guarantee. In cases where there is a group guarantee, members of the group are responsible for paying back the loans of their fellow group members in the case of delinquency or default.
Kiva's Field Partners typically feature one borrower from a group. The loan description, sector, and other attributes for a group loan profile are determined by the featured borrower's loan. The other members of the group are not required to use their loans for the same purpose.
About Paraguay
47View loans »
Success!! The loan was 100% repaid
- Repayment Term
- 6 months (Additional Information)
- Repayment Schedule
- Monthly
- Pre-Disbursed:
- Aug 26, 2010
- Listed
- Sep 21, 2010
- Currency Exchange Loss:
- Covered
- Ended:
- Jan 15, 2011


text:
http://www.nfz-lublin.pl/?critiquing-research-essay-nursing Critiquing Research Essay Nursing.
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AC Ryan Veolo Smart Android Hub Review
We have reviewed a fair amount of AC Ryan's hardware here at Hardware Heaven with their Playon! devices winning numerous awards. The simple, functional design mixed with a decent operating system (based on Realtek technology) offered quick and easy access to media, social networking and even in some models TV recording. Now they are back with the release of the Veolo Smart Android Hub which is marketed by AC Ryan as being "the future of digital home entertainment today".
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AC Ryan package the Veolo in a box with a clear image of the product on the front along with the key features listed on other sides. Elsewhere on the box we find product specifications and information on the 3-in-1 remote control.
Inside we find the Veolo suspended in a velveteen cradle and beneath this is the location of the bundled components.
Once we delve through the cardboard trapdoor we are presented with a HDMI 1.3 cable, Veolo 3-in-1 Remote Control, 2x AAA Batteries, DC-In 5V Power Adapter and a Quick Start Guide.


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[Hack of the Year 2008] Pokémon: rijonAdventures
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What gym badges do you have? The blond guy is Karpman the first gym leader. The sixth badge is in Seashore City and you have to use cut to get there. To get the seventh badge you get it from Edward in Equality River. Go to the Underground Path in Moraga by the Library then surf east to a route that has a lone gym with electric types in the grass. The gym is the seventh. I already told you how to get strength in my previous post so read it again.
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Was diagnosed with PTSD 5 years ago. Very stable, no regular
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Was diagnosed with PTSD 5 years ago. Very stable, no regular meds; Ativan x .5 mg as needed to assist w/ occasional
. Symptoms tend to be in the category of hyperarousal: difficulty
, difficulty focusing, irritability. Very occasionally olfactory hallucination - nasty smell of old, bad funeral home - very musty smell that usually resolves itself in 72 +/- hrs. This time, though, its lasted a week and shows no sign of relief. Its so bad, I'm physically sick: burning eyes + throat, headache, foul taste in my mouth. If I go to the ER, is there anything the docs can do? Or do I just have to wait it out?
5 years ago.
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replied 5 years ago.
My concern is that this time the symptoms are worse than usual with no apparent trigger. The fact that it's lasting longer & you have other, new symptoms (burning eyes & throat, headache, taste in mouth) makes me concerned that this might be unrelated to the PTSD.
It's certainly possible that this is the PTSD which is currently worse for some unknown reason. Can you think of anything that has happened recently, like
, that could have triggered a relapse of the PTSD symptoms?
If not, I think seeing a doctor soon would be the best idea. If you can't get in to see your family doctor, I would go to a minor care or ER to get a physical exam & possible some bloodwork and or radiology scans.
If there has been a recent trigger for PTSD, you could be more conservative & just give it some more time.
I hope this helps. Let me know if you need more information. Good luck & take care.
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replied 5 years ago.
Actually, there was a trigger. I'm a minister; PTSD is related to series of traumatic funerals I performed several years ago. Just
a funeral on Tuesday; symptoms began hours after I was notified of the death last Friday. Nothing traumatic about this one ; deceased was 96 years old. Not unusual to have symptoms under otherwise benign circumstances. Just unusual to have the smell linger this long and remain this strong. Still think I wait it out?
Dr. K
replied 5 years ago.
This is a tough one. Because there is even a slight chance that this could me something else neurological going on, part of me feels like it would be best to get it checked out.
However, if ativan has helped similar symptoms in the past & helps these this time, that would reassure me that this is a PTSD relapse that for some unknown reason is worse than usual and may need more time to heal.
So, if it were me or a loved one, I would tell them to definitely get checked out if the ativan usually works and doesn't this time. If one dose of ativan doesn't seem to do anything you could try a second dose before going to the ER. However, most docs keep a real close eye on prescriptions like ativan for any signs of overuse or addiction. It wouldn't hurt to check with your doctor 1st...and if you can't get a hold of them taking this extra dose one time only (you can show the doc this message that it was a professional giving you the advice) & not doing that again in the future before checking with them.
I hope that helps clarify. Anything else?
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The Great Pumpkin and the Curse of the CandyMindy McKnight
Halloween is one of my favorite holidays. I love autumn weather, haunted houses, creative costumes, Halloween parties, and adorable décor. That being said, inevitably, at the end of it all is one of every mother's biggest nightmares. A massive bucket of candy in the hands of her children!
Mothers today are inundated with media about healthy eating and exercise to stave of America's #1 health problem. Obesity. We strive to feed our children responsibly, filling their bellies with the right nutrients {grains, proteins, vegetables, vitamins, minerals, etc}. One thing we definitely will not find on that list is a bucket full of candy. Pounds and pounds of sugar, set in different colors and flavors, and wrapped in tiny packages specifically tailored to seize a child's attention.
On Halloween night, I am forgiving and allow my children to eat about 20 pieces of candy {I must admit that I do pick out my fair share of mini chocolate bars}. But the day after Halloween, oh how I detest that bucket of candy! I worry about what it will do to my kids' teeth and the potential for future diabetes. Halloween does only come once per year, though, so will it really hurt that much?
This is the personal debate I dread every year… that is, until I learned about The Great Pumpkin and The Curse of the Candy.
If you, like me, despise this decision every year, but want your children to participate in the fun festivities, receiving a reward for the hard work of walking for miles and knocking on doors… please allow me to introduce you the Great Pumpkin and share what has worked for my family.
Click through to see the slideshow… 1 of 7
Once Upon a Time… 2 of 7
At our house, The Great Pumpkin is talked about for weeks before Halloween night arrives. Legend has it that once upon a time, there was a little boy who loved candy. He loved candy so much, that he refused to eat anything BUT candy for every meal he was served. His mother tried and tried to tell him that candy was not good for him that it would ruin his teeth and make him a very unhealthy boy, but he would not listen.
The Great Pumpkin… 3 of 7
Sure enough, along came Halloween. The boy was so very excited. He loved candy so much, and just could not wait to go door to door, gathering as much candy as he possibly could in one night. And that is exactly what he did. He spent all night, until the moon was high, running from door to door, filling his sack with candy. Then, he ran home and stuffed his face with as much candy as he could fit into his mouth. He ate and ate and ate. His mom tried to stop him. She warned him about The Curse of the Candy a curse which promises that children who eat too much candy will turn into The Great Pumpkin, but the little boy would not listen and simply kept eating. Finally, when his stomach hurt from all the sugar, and his teeth were coated with sticky goo, and he couldn't possibly eat one more piece of candy, he made his way to bed. The next morning, when he woke up, he went into the bathroom and looked in the mirror and there he saw that his head had turned into a big orange pumpkin! Where his hair had been, there was nothing but a stem. Where his cheeks had been there was only the bright orange color of a pumpkin, and where his teeth had been, there was only a black toothless smile. Sure enough, that boy had turned into The Great Pumpkin!
Saving the Children… 4 of 7
The boy ran to his mother crying. She took him in her arms and told him all about The Curse of the Candy. She explained that the only way to break the curse was to gather up buckets and bags of candy from other candy-eating children; to take their candy, and save them from turning into Great Pumpkins! So every Hallow's Eve, The Great Pumpkin wanders the streets in search of bags of candy given up by little children who do not want to succumb to The Curse of the Candy. He wanders from door to door, and searches the porch to find any bags of candy that he deems worthy. It has to be a FULL bag of candy. No partially full candy sacks are accepted! If The Great Pumpkin finds a full sack of candy, he takes it. But the Great Pumpkin is no meanie! He would never take something of such value from a small child without giving something valuable in return.
Photo Source: Flickr {JD Hancock}
A Fair Trade… 5 of 7
The Great Pumpkin always leaves a gift in place of the sack of candy, nicely wrapped in bright orange paper and arranged on the porch with our pumpkins awaiting the children as they open the door. Luckily for my children, he has always left something that they have been wanting for a long time. The kids never know what to expect from The Great Pumpkin, but their curiosity almost always gets the better of them, and they are willing to make that trade. Not to mention, they know they are helping The Great Pumpkin get closer and closer to becoming a real boy again and ridding himself of his curse.
My Kids Love the Great Pumpkin… 6 of 7
The Great Pumpkin has been a real hero in my home. Not only does he save my children from The Curse of the Candy, and leave them a fun new gift, but he has also made my post-Halloween motherly debate disappear. No more devil or angel mommies on my shoulders. The decision of whether or not to eat all that candy is now made by my children. I hope you can all invite The Great Pumpkin to your home too, and that you and your children can enjoy the benefits of avoiding The Curse of The Candy!
How Sweet is That? 7 of 7
What does the Great Pumpkin really do with all that candy? He ships it to military men we know personally, actively serving in war-torn countries, who then use the candy to brighten the day of local children who rarely get to enjoy such a treat. {You may also search for organizations who do the same.} Now, how sweet is that?
Photo Source: Flickr {The U.S. Army} Sgt. Juan Almaguer, a medic with 2nd Brigade Combat Team, 4th Infantry Division, hands out candy to Afghan children during a patrol March 9., 2012.


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Hillary's Demolition Derby; Clinging On: Hillary and Bill Clinton Celebrate in Pennsylvania Next Battle: Barack and Michelle Obama Campaigning in Indiana
Byline: Gavin Esler
THE Democratic presidential election contest is turning into the onething neither Hillary Clinton nor Barack Obama wanted: a Demolition Derby.
Instead of a clear winner, it's become a race in circles on a dirt track withplenty of destruction and no end in sight.
Despite Senator Clinton's nine per cent win in Pennsylvania yesterday only oneclear winner is emerging from the wreckage - the Republican candidate, SenatorJohn McCain.
As Clinton and Obama prepare to slug it out all the way to the party conventionin August, McCain can rise above the mud-slinging and appear presidential.
The danger of their situation is not lost on the Democrats. On the eve of thePennsylvania vote, an American comedian asked Senator Obama if he hasnightmares about waking up next year in the White House, after he has becomepresident, and finding Hillary Clinton is STILL running against him? Obama hadthe good grace to laugh but with Clinton declaring that Americans deserve 'apresident who doesn't quit,' he may wonder if the only thing which will stopher now is a stake driven through her heart at midnight.
For months - it seems like years - Democratic and Republican strategists havebeen planning how they want this election to go.
The Democrats' plan was roughly this: George Bush's crippling unpopularitywould help Hillary and Barack excite the American people with the prospect ofending the Bush era.
The next president would, for the first time, be a woman or a youthful AfricanAmerican. All kinds of people, especially the young who had not voted before,would come to the polls.
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Now it looks very different. The Democrats cannot decisively choose acandidate. Obama has the most delegates, most money and slightly more popularvotes, but Hillary has won all the big states.
Obama's failure to win big in California, New York, Illinois or Pennsylvaniahas to be a worry for the Democrats if he is their champion in November.
Worse, Obama talked of ending the nasty politics of the past and yet - as onetop Republican recently pointed out to me - here is Mr Clean getting down inthe mud with Hillary. As for Hillary, she is damaged too. If she were to emergeas the Democratic candidate, how would she overcome the terrible opinion pollnews that a whopping 60 per cent of the American people say they do not trusther? Some have never trusted the Clintons, but she made matters even worse whenshe falsely claimed that as first lady she had come under sniper fire on avisit to the Balkans in the 1990s.
Every American TV viewer could see pictures of something very different.
There was Hillary strolling around an apparently peaceful Tuzla airport. And ifshe lied about that, voters must be thinking, what else will she lie about? In20 years of covering U.S. presidential election campaigns, I have never seenone as strange as this.
What we are witnessing is Democratic voters coughing up millions of dollars indonations to watch the two brightest stars in their party beat the livingdaylights out of each other.
As the contest gets nastier by the week, it presents both candidates with aterrible dilemma. Do they continue in the mud, damaging each other - or doesone of them try to rise above it, and risk being thought of as weak? Some wantHillary to quit. But after her win in Pennsylvania, why would she get out ofthe way to help a man who increasingly seems to irritate her, with momentumapparently behind her campaign now? The Democratic party grandee who goes in totell Hillary to get out of the race had better be wearing Kevlar body armourover his grey suit.
Come the Democratic party convention in Denver in August a bunch of almost 800so-called 'super-delegates' meet to choose the candidate. …


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Davenport Freshman Counselors
Emily Frost (you can call me Emily). Davenport College. American Studies Major. From Buffalo, NY. Favorite freshman memory: Sitting on the fence outside Welch Hall on the night of the last day of classes basking in the glow of the enormous Davenport logo made out of Christmas lights and looking out on Old Campus and all the other light decorations as well – all while in utter disbelief that I had just finished 1/8 of my time at Yale.
Name: Bethany Goodhue/ College: Davenport College/ Major: Psychology/ Favorite Freshman Memory: My favorite memory from freshman year was the Freshman Holiday Dinner. I had taken a field trip to the Met in New York City earlier that day with my Classical Mythologies class, and I took a cab from Union Station to get to the Holiday Dinner just in time. Walking into the festive, beautifully decorated hall and being welcomed by my friends felt magical, and watching the Parade of Comestibles felt like a scene out of a Harry Potter movie. After the dinner my suite mates and I stuffed leftover food into our purses and pillaged the gigantic gingerbread house to bring shingles and candy trimmings back to our common room. I will never forget that giddy holiday feeling of being surrounded by loved ones and amazing food, combined with the very Yale experience of spending the day touring the Metropolitan Museum of Art with my favorite class.
Olivia Pollak is in Davenport College and a double major in History and Psychology. Her favorite freshmen year memory was picnicking on Cross-Campus in the spring, after all the snow had melted and the trees were blooming, with the new friends she'd met freshmen year!
A freshman counselor for the best residential college, aka Davenport, Joan studies History of Science, Medicine, and Public Health. She is particularly passionate about studying topics such as social determinants of health, health inequity, gender based violence, and related policies. Outside of the classroom, Joan has worked on health education as a Community Health Educator and Communication and Consent Educator. She is president of the Yale Symphony Orchestra, where she plays violin and directed the 2014 Halloween Show. One of her favorite moments of freshman year was actually during spring semester finals; she and her friends took a break from their hours studying in Bass Library to have some of BAR's bacon mashed potato pizza picnic style on Cross Campus. It was a moment to remember all the incredible things Yale has to offer (friends, food, fun!), despite the incredible amount of stress we might experience.
Name: Saad Syed/ College: Davenport/ Major: MCDB/ Favorite Freshman Memory: The overwhelming feeling when I first set foot on campus that anything I ever dreamed of pursuing could be pursued here at Yale.
Andrew Williams is a History of Science, Medicine, and Public Health major in Davenport College from Texarkana, Arkansas. He is highly interested in the intersections between the arts and sciences and how they can be used for disseminating scientific information to audiences in new ways. After Yale, he plans on acting with a major regional theatre via fellowships or internships for a couple of years before pursuing an MFA in Acting. Andrew has worked for the Afro-American Cultural Center since his freshman year and also became a member of the Heritage Theatre Ensemble, Prism (a group for LGBTQ students of color), and taught as an after school instructor for the EVOLUTIONS After School Program for the Peabody Museum. Andrew loves theatre, running, skateboarding, and cooking many things (especially Southern food) from scratch. His favorite memory from his first year was attending President Obama's second inauguration in the freezing D.C. weather with many members of Yale's cultural centers. He cannot wait welcome the Class of 2019 to their new home for the next four years.
Name: Christian Rhally/ College: Calhoun (but serving as freshman counselor in Davenport)/ Major: Economics/ Favorite Freshman Memory: At the end of my freshman year, I helped to organize a TEDx conference on "The Art and Science of Happiness." Over a hundred fifty people from New Haven attended the event, which was a very special moment for everyone to reflect about the importance of happiness. It was an incredible feeling to see all these people enjoy what the team and I had worked so hard on for several months!


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International Journal of Chemical Reactor Engineering
Ed. by de Lasa, Hugo / Xu, Charles Chunbao
IMPACT FACTOR increased in 2014: 0.592
5-year IMPACT FACTOR: 0.678
SCImago Journal Rank (SJR) 2014: 0.257
Source Normalized Impact per Paper (SNIP) 2014: 0.358
Impact per Publication (IPP) 2014: 0.484
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Most Downloaded Articles
- Fischer–Tropsch Synthesis in Slurry Bubble Column Reactors: Experimental Investigations and Modeling – A Review by Basha, Omar M./ Sehabiague, Laurent/ Abdel-Wahab, Ahmed and Morsi, Badie I.
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A Study of the Heating Section of a Gas Heated Steam Reformer
1Statoil, (email)
2SINTEF Energy Research, (email)
3NTNU, The Norwegian University of Science and Technology, (email)
Citation Information: International Journal of Chemical Reactor Engineering. Volume 5, Issue 1, ISSN (Online) 1542-6580, DOI: 10.2202/1542-6580.1348, February 2007
Publication History
- Published Online:
- 2007-02-10
A gas heated steam reformer (GHR) which converts natural gas to synthesis gas for methanol or Fischer-Tropsch purposes has been modelled for steady state conditions. The model is in two dimensions and is made up of a fixed bed reactor model, representing one of the reactor tubes in the GHR, and an annulus model, representing the annular space on the shell side of the GHR where hot, fully converted syngas emits heat to the reactor tube. The annulus model is described and evaluated in this article. This is a plug flow model which involves heat transfer in radial direction caused by radiation and by turbulence. The gas radiation is modelled by the use of the discrete ordinates method and the effect on heat transfer from turbulence is modelled as an effective radial thermal conductivity. Both heat transfer mechanisms vary with the radial position. An additional annulus model, made in the commercial CFD code FLUENT and based on the k-? turbulence model and the discrete ordinates radiation model, is used to estimate effective radial thermal conductivities. These were implemented in the annulus model of the GHR model. The reactor and the annulus models were combined and linked by the wall temperature profile and the heat flux profile on the outer reactor tube wall. The simulation results were used to study the heat flux and temperature profiles along the reactor length and the radial temperature profiles in the annulus.
Keywords: finite difference method; two-dimensional; discrete ordinates method; convective steam methane reformer
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9oz Custom Sport-Tek Youth Pullover Hooded Sweatshirt with Contrast Color
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