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By now, you've surely heard Mark Ronson & the Business INTL's lead-in single "Bang Bang Bang". It's become a smash hit everywhere, from Japan to Australia, France to Finland. This disco number featuring Q-Tip and MNDR vamps up the French nursery rhyme "Alouette," creating a NYC hip-hop sing-along with a twist of je ne sais quoi. The new batch of remixes for "Bang Bang Bang" features Russ Chimes, SBTRKT, and Count & Sinden.
Mark Ronson- "Bang Bang Bang"(SBTRKT Remix)
Another must-hear remix is Major Lazer's transformation of the originally breezy "Bike Song" from cutesy to sexy. Major Lazer focuses on Spank Rock's verse for the song's total makeover into a club bumpin' techno beat.
Mark Ronson- "Bike Song"(Major Lazer Remix)


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Dogs and cats, of course.
Rabbits? Sure.
Lots of snakes. Llamas. Even a sloth.
All these critters have made appearances at America's Family Pet Expo, due at the OC Fair & Event Center from April 19 to the 21. Whether you're a pet lover or thinking about maybe getting a pet, this is a good place to gather info and spend money.
Vendors of all kinds have pet accoutrements, from clothing to beds to snacks and supplements, for sale. Representatives of rescue groups galore will have animals that need homes available for adoption. Learn more about exotic animals, the joys of fish or reptiles as pets, and all kinds of sports you and your dog can get involved in.
If you've never seen dogs jump into a great, big pool of water just to see who can reach the farthest (actually, it's the human part of the team who cares about that; the dogs are just trying to get to their favorite toys), you've got to see the Splash Dogs exhibit. Police and protection dog demos show how dogs can find a tiny piece of contraband or explosives in a great, big field of smells.
Ever think you and your dog might want to be a therapy team? There's are booths that will help you learn about that.
Maybe you'd like to learn more about birds. There are plenty of ways to do that, too.
Or maybe you'd like a new best friend. At the Pet Expo, you can find him or her. But if you're considering that, please do your homework. Adoption is forever.
And, please, leave your pets at home. They'll be far less stressed there.

subset: commoncrawl


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Every drop counts
Why have you chosen a Volvo Gold Contract?
"Milk collection from our direct suppliers is one of the core elementsof our business and it is imperative for both the farmer and the company to have some reassurance that the vehicles will be on the farm, on time, every day. With the support of the Volvo Gold contract our unplanned downtime has reduced and has helped to build confidence in the transport service we supply."
How has contract maintenance improved efficiency?
"Contract maintenance has helped improve our overall efficiencies.With the support of the local Volvo Dealer, service and inspection intervals have been measured and easily met. This has assisted inpreventive maintenance and, with some responsibility falling on thelocal Dealer, it encourages a team approach between the manufacturer and the operator to ensure the vehicles remain compliant."
How else do you work with Volvo on improving fuel efficiency of the trucks?
"During the order process it was imperative that the vehicle specification was right for the job in hand. Collecting milk from farms is a tough job, so close consultation with Volvo and Sayers Road Tankers ensured the choice of the right chassis configuration, transmission, axle configuration and drive-axle ratio, which are all extremely important. Additional running to drive PTO systems means that, over two shifts, some vehicles will be out working for 22 out of 24 hours. It was important for us to have some transparency and be able to monitor fuel usage at different points and applications. Dynafleet has enabled us to clearly see and manage our fuel usage and, with the support of the driver development programme throughVolvo Trucks, we have continued to drive efficiencies into our operation," Chris Swain says.
Dairy Crest Limited is one of the major manufacturers within the dairy industry and processes over 2 billion litres of milk a year. This is used not only as people's daily pinta' but also for cheese, butter, spreads, yogurt and flavoured milk. The company operates around 2,000 heavy trucks with 60 Volvo's on Gold Contracts to ensure the highest levels of service and maintenance.


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I've had a bee in my bonnet about wedge espadrilles. I consider the style a summer must-have, and how it's possible that I didn't have a pair in my shoe arsenal is beyond me. They're super comfortable and that height boost can't be beat. So I started looking for my dream pair. And I looked, and looked, and I looked some more. I fell in love with a red, strappy pair only to go into cardiac arrest when I saw the price tag ($550.00, for a pair of ESPADRILLES???). Oh no, no, no. Casual summer sandals are NOT the place to plunk down a paycheck (ditto for cashmere sweaters and bathing suit cover ups, but that's a whole other discussion).
Anyhoo, I was walking home from the gym one day and got stopped in my tracks at the window display before me: Payless. Of course! Not only is Payless a retailer that appreciates a bargain, but they happen to be teaming up with great designers who are creating super stylish shoes at an equally super price point. What'd I find? These beauties, thanks to talented designer Isabel Toledo (she of the Michellle Obama lemongrass inauguration day outfit). It is love, I tell you, LOVE. I've worn them with my boyfriend khaki's (khaki's rolled up so they hit just above the ankle), with a black dress, even with silk "dressy" shorts while I was on vacation last week. I will wear these espadrilles into the ground this summer, and can now happily remove the bee from my bonnet.
Go! Buy! Be Chic!
Isabel Toledo for Payless espadrilles, $60; payless.com


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At the start of summer we posted all the details on the Utah Valley Parade of Homes. Now, a parade finally makes it to our neck of the woods courtesy of the Salt Lake Home Builders Association.
Salt Lake Parade of Homes, July 30-Aug. 15. 11 a.m. to 9 p.m., including Sundays Click here for tix - $10
This year's event launches with a VIP Night. Sponsors, suppliers, subcontractors and builder entrants will meet with w/ guests to talk up the homes. It closes with the People's Choice Awards, determined by guests who vote on their favorite homes from the tour (just use the back of your parade ticket to vote and drop off at the nearest R.C. Willey).
We'll give you more details on the People's Choice Awards closer to the event, but for now, get your tix asap.


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PRE-SEASON FOOTBALL - The Sheridan Bronc football team will pad up today as two a days continue at Homer Scott stadium Bronc's Head coach Don Julian says so far so good.
And one of the big things they look for the first couple of weeks is finding depth.
And as far as this year's Broncs and how they might look Julian says they'll just have to wait until that first game.
The Broncs open at home on Friday, August 26th against Cheyenne Central kickoff is early at 6:00.
HIGH SCHOOL FOOTBALL - The Sheridan Bronc football team hit the field for the first time yesterday they go light for two days before padding up tomorrow and Thursday Head coach Don Julian, tomorrow and Thursday is when contact can begin.
Tongue River Head coach Chuck Walters has announced the mandatory Eagles player / parent meeting will be Wednesday night at 6:30 in the Tongue River high school auditorium.
The following is a schedule of dates and times for the sports rules clinics. Please be advised that ALL officials and head coaches are required to attend a WHSAA sponsored rules clinic.
Clinics will start promptly at 7:00 P.M. Attendees are required to attend the clinic in its entirety to receive credit. Make plans now to attend one of these clinics in your sport.
Sheridan County Junior Golf
Kendrick Golf Course - Tournament Results
Aug. 8, 2011
Boys Ages 16 and Up (18 holes)
1. Forrest DeBolt (77)
2. Bryce Williams (78)
Boys Ages 13-15 (18 holes)
1. Connor McCafferty (92)
2. Blaze Mickelson (103 – tie, won chip-off)
3. Blake Godwin (1030
4. Davis Alden (126)
Boys Ages 10-12 (9 holes)
1. Logan Johnson (48)
2. Colton Williams (51)
3. Cody Stults (58 – tie, won chip-off)
4. Wheaton Williams (58)
5. Colton Bates (58+)
6. Drew Boedecker (61)
7. Tristan Bower (63)
8. Nolan McCafferty (78+)
Boys Age 8-9 (5 holes)
Gross Winners:
Score - 54
Cameron Lindell
Randy Wieland
Cheryl Wieland
Bernie Spielman
2nd Place:59
Mike Coulter
Dan Overton
Tyler Thomas
Barry Thomas
3rd Place:62
Rex Arney
Joe Mallo
Greg Madison
Leonard Hurst
Net Winners:
1st Place:53.5
Dave Engels
Don Roberts
Ken Muller
Curt Miner
2nd Place:54.2
Jim Benepe
Jeff Tomlinson
Steve Rucki
Patrick Johnson
3rd Place:54.3
Verlin Danner
Harley Reile
Ruth Reile
Brent Elliott
Highest Score:82
Dave Kinskey
Donna Kinskey
John Bigelow
Ryan Mullholland
HIGH SCHOOL FOOTBALL - The Sheridan Bronc football team hits the field today for the first time as the 2011 season opens the Broncs had their annual mountain leadership camp Thursday and Friday Head coach Don Julian says it went well.
The Sheridan high school booster club had their booster club golf tournament Saturday and Julian says it was a big hit this year.
HIGH SCHOOL FOOTBALL - The Sheridan Bronc football team leaders and coaches will spend today in the Big Horn mountains as part of their preseason prep.
The Sheridan high school booster club will hold their golf scramble tomorrow at the Powder Horn and Sunday the Broncs will host their player / parent meeting at 4:00 at Sheridan high school.
BRONC FOOTBALL - The Sheridan Bronc football team leaders and coaches will be heading up into the Big Horns today for their annual two day mountain retreat.
Head coach Don Julian says the retreat helps set the tone for the coming season with the players that will lead this year's addition of Bronc football.
They come down Friday evening and get ready for Sunday's player / parent meeting at 4:00 at the high school.
Our goal in allowing public comment on our web site is to provide an arena for open discussion on the issues. Following these simple guidlines will ensure that your comments remain posted.
The moderators of sheridanmedia.com reserve the right to monitor and screen all content submitted to the site and may delete content, and block or ban users at our discretion. For a full description see our User Agreement.


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Kash Srinivasan Retires as the Commissioner of Public Works
Posted on 02/08/2013 11:46 am
After 34 years of dedicated service and hard work, Kash Srinivasan will retire as the Commissioner of the Department of Public Works, effective Friday, February 22, 2013.
Kash joined the City of Wilmington in 1979, where he served as a staff engineer at the Wastewater Treatment Plant. He became plant manager in 1981, and was named Director of the Water Division. In 1997, Kash was appointed Commissioner of Public Works by Mayor James H. Sills and reappointed by Mayor James M. Baker in 2001.
Some of Kash's major initiatives during his tenure include:
- Partnered with a major ESCO to develop and manage the execution of comprehensive energy efficiency and operational strategies delivering annual cost savings of $1 million and significantly reduced greenhouse gas emissions from City operations.
- Helped create a financially and operationally successful long-term partnership with Veolia Water to manage staff and maintain the City's regional Wastewater Treatment Plant. This partnership is profiled in "Privatization of Wilmington, Delaware's Wastewater System" in America's Water and Wastewater Industries: Competition and Privatization, P. Seidenstat, M. Nadol, S. Hakim (Editors), Public Utilities Reports, Inc., 2000.
- Established the State's first Stormwater Utility which created an equitable way to recover the City's stormwater management costs from property owners and positioned the City of Wilmington as a national leader on this issue.
To ensure a smooth transition, Al Ballard, the Operations Director for Public Works, will be appointed Acting Commissioner effective Friday, February 22. Since Monday, February 4, Sid Sharma has been serving as the Acting Deputy Commissioner.


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Best Sellers
Our most popular gear based on what customers are buying.
Ideal 550-fill down-insulated jacket for any winter activity, this slightly puffy jacket boasts a timeless style that translates across generation and terrain. Zip-in compatible with complementing garments from The North Face®, add a shell on the exterior for a bombproof barrier in the dead of winter. Diamond-shaped stitching at baffles creates stylish, contemporary look.


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One of these three events will likely cater to your kid's cup of tea.
Start things off with Science Day at the U, and then make the jump from science to art at Tanner Dance's performance for kids at the Rose Wagner, presented by Repertory Dance Theatre.Lastly, check out the Wasatch Rails model train event at the Utah State Fair Park, and pick up a new hobby.
Ring Around the Rose, 11 a.m.
Every month, Repertory Dance Theatre invites children and families to explore the magic of arts, including theatre, music, storytelling and, of course, dance. This weekend, Tanner Dance, featuring some of Utah's most talented young dancers, will perform.
Rose Wagner Performing Arts Center, 138 W. Broadway, SLC Click here for more info.
Science Day at the U, 8 a.m.–1:30 p.m.
Utah and Idaho high school students are invited to check out science workshops and get academic advice at the University of Utah. It's the U's largest recruitment event, and it's free and open to the public.
Our favorite part is checking out all of the cool workshops for the students. Here are some of this year's workshops:
Physics in Action 9:45–10:30 a.m. and 11:45 a.m.–12:30 p.m. Students will witness experiments and demos in gravity, velocity, electromagnetism and properties of air. Watch as physics specialist Adam Beehler shoots a ping-pong ball through three soda cans and uses a Tesla coil to explain electricity. James Fletcher Building, room 101
Explosives and Explosions 10:45–11:30 a.m. Professor Chuck Wight discusses explosives and how they work. Demonstrations are included. Can you say KA-BOOM!? Henry Eyring Building, room 2008
Cosmic Rays in the Desert 11:45 a.m.–12:30 p.m. Research technician in physics and astronomy Julie Callahan will show students cosmic rays in cloud chambers and teach them about the Telescope Array cosmic ray observatory near Delta, Utah. James Fletcher Building, room 102
For more info, click here or call 801-581-6958
Wasatch Rails 2011
The Wasatch Division of the National Model Railroad Association is holding a model train festival this weekend at the Utah State Fair Park. Tons of fun, and we're sending our photographer Abbie Crane. So, smile for our camera and you could end up in Salt Lake magazine. Great for the whole fam. Nov. 11–13.
The Utah State Fair Park, 1000 W. North Temple, SLC Click here for more info


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The classes are taught by live professionally certified instructors, and are usually limited to less than 12 students. Each student receives a training manual and practice problems, along with a free course retake. Click here to learn more about Instructor Led Training
Below is a list of upcoming SharePoint Instructor Led Class Dates:


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Inky MainJames Cull on December 28th 2012
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Welcome to the Access and Compliance eLearning course. This course will equip you with the knowledge you need to comply with government regulations and university policies regarding data access and compliance.
Why is this important?
As an administrative data user, you will have access to sensitive administrative data on a daily basis. You are accountable for the appropriate use of this data.
By completing this course, you will learn the requirements for handling this data in a responsible manner. Protecting the rights and privacy of employees, students, alumni, vendors and others whose data resides in U-M administrative systems is very important to everyone connected with the university.
Let's look at a scenario before reviewing the capabilities and consequences of access and compliance. This scenario illustrates a situation that requires an administrative data user to exercise good judgment to stay in compliance with U-M data access and compliance guidelines.


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- Video
- Overview
- Information
- Reviews
- Help
YAKKAir Lite 1 Inflatable Kayak
Shopping Info
BIC Sport YAKKAir Lite 1 Inflatable Kayak - Designed for adventure paddling on the go, the YAKKAir Lite One inflatable kayak is well suited for on-water fun. Aimed at beginners and occasional paddlers, the YAKKAir is stable, sturdy and lightweight. Ideally suited to lakes, bays and quiet rivers, rigid stiffeners fitted inside the stern and bow tips give an excellent cutting edge through the water. The YAKKAir Lite easily inflates using the included pump with pressure gauge. Folded down into its deluxe carry bag, the YAKKAir Lite is easy to carry and store. Bow and stern deck rigging and mesh storage pockets give you plenty of room for lunch and spare clothes. Whether you're traveling by car, train, or plane, the BIC Sport YAKKAir Lite One inflatable kayak is ready to paddle when you are.
Deluxe Storage/Transport Kayak - 30in x 17-in x 12-in rugged fabric backpack/carrying case features adjustable shoulder straps, mesh pockets and compression straps.
Pump - The pump included a pressure gauge to get your boat to the right pressure (3.5 PSI side tubes, 2.0 PSI floor). A Y-shape nozzle inflates the two side chambers simultaneously, avoiding any pressure difference.
Click here for: BIC Sport YAKKAir Lite 1 Inflatable Kayak Owner's Manual
Kayak is easy to "assembly", tracks well, and doesn't get blown around like what you'd expect of an inflatable. Biggest complaint is that the seats are so-so and need frequent adjusting. Don't be scared by the lack of reviews, as I assume the price tag of this "blow up toy" is what deters a lot of potential buyers. It is not a blow up toy (see Sevylor), but rather a well-designed, high-quality, high-pressure inflatable kayak with all the performance of an entry-level hardsell.
YAKKAir Lite 1 Inflatable Kayak by BIC Sport for Kayaking
Need More Information About This Item?
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Speak with an expert at 800.994.4327 Mon-Fri 7am-5pm PST.


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Rosie O donald did not win .it was the first thing to come to mind with my Walmart sales paper
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Rosie O donald did not win .it was the first thing to come to mind with my Walmart sales paper
Hell I even saw a H&K there the other day when I was shopping,,,, it's about time,, that's all I got to say. They must of missed out on allot of sales by having Rosie as a spokes woman,,, I think,,, She is????? Not to sure,,,,
They took guns out of the local Wal-Marts around here a few years ago when Rosie got involved, and now there back,,, hope they stay. I know I got several there and always pick up this or that accessory while I was there , so I'm pretty sure they saw there bottom line drop when they did away with the guns for a bit.
I know I dropped several requests for the guns to return in there suggestion box, must be lots of others did too! There back!!! YES!! A wider variety of ammo now too.At least around here.
Just wondering- does WalMart operate under some kind of " umbrella" or national license or does each individual store require their own?
The only WalMart I am familiar with carries a limited amount of ammunition. I've asked about calibers that would fit what I would use and they look at you funny and tell you to try the Internet.
I guess I wanted to know if each WalMart chooses their own stock or are they bound by the limits of their local lisence ?
No clue how there FFL is set up but I assume it must be under wal-mart corp . certianly no one would sell wal-marts guns under there license,,nor could they legally do so. As for each store having one I'd doubt that too, whom would it be assigned to? Janice in sporting goods, or jimmy in the stock room???? Must be under w- mart, how could they sell them otherwise.
Lady there one night did not have enough sense to sell snow cones. I really don't think she would have an FFL in her name to sell GUNS at Wally World?
No matter what store, what state, what ever. There has to be an FFL associated with the store. Now, that could be a regional guy who is the FFL for x number of locations. That is legal. But, you can not cross state lines.
Back in the day, K-Mart used to contract with an FFL for each sub-region of say 3-5 stores that were geographically located. The FFL was "on-staff" and required to make bi-weekly visits to each store, and was paid a decent fee for ensuring that he did not go to jail. I am pretty certain that the large chains do something similar, each according to their own recipe. WalMart was a great place to go and get common stuff like 10/22's, and even some of the surplus stuff. I bought several SMLE 2A1's at the local WalMart in the mid-late '90s because they had them, and the price was $85 each. Same thing for Czech VZ-24's. They were blowing those out at $58 each. SMLE No. 4 Mk 1's for $69, I always liked those deals. Just made me feel happy all over. The last batch of Yugo Mausers I bought came from WalMart at $77 each. And they were VIRGINAL!!!! Not touched since the Yugoslavian whore who schmeared the cosmoline all over it in the '60s. Sorry, bad-old joke.
I am glad to hear that WalMart has gotten back to their senses. I will have to visit my local to see what they offer these days.
America's Rifle for sale at America's store! You gotta love it.
no it is AMREICAS RIFLE in China-marts store-- LOL!
i think rosie tried to buy a seat on the board in an attempt to back hillary clinton.
when hillary claimed to switch sides and be pro-firearms in her 08 election hopes --rosie got dumped--
i woudlnt put the whole thing past clinton PR . i wouldn't trust that whore as far as i could through a battleship--:boxing:
ya have to wonder why it is all ways mom & pop catching hell from the BATF -- one wonders why wally-world never gets linked to guns in mexico when they sell thousands of guns every week??
if nothing else i bet firearms have walked out of wally world many a time.
i am glad wally world is selling the fun guns, but i am seriously leery of their politics and motives.
I was in a Walmart yesterday,they had an AR for $980.
The only AR-type rifles my local WalMart has are in .22 caliber.
I only WISH they had other calibers for sale.


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skip class and go get a chocolate milkshake (this probably won't help you in any way but i really want a milkshake)
DON'T PUT THAT IN YOUR MOUTH! IT WAS MADE IN CHINA!!!- Alora Owens: Age 6
as soon as I was about to post I got raped... -Kirby: Age... whatever
or I could sit in the back, wear sunglasses, and eat pringles
Fell asleep in school from a mixture of being severely hungover/exhausted and a picture was Facebook'd. Feels bad man.
Well, I open my eyes and I see things. I've seen spirits moving through the walls. I've seen a vortex coming through the wall. I've seen amorphous little balls of light bouncing all around in the front yard through the window. I've seen giant bugs on the floor. I was in a hotel room in Amarillo, Texas, and all I remember is standing on the bed and seeing the whole wall in front of me filled with lights that were [makes popping sound] popping like popcorn out of the wall. Then I'll wake up and I go "Wow, I was standing on my bed and staring at this wall."
pringles are good but they're no milkshake
DON'T PUT THAT IN YOUR MOUTH! IT WAS MADE IN CHINA!!!- Alora Owens: Age 6
as soon as I was about to post I got raped... -Kirby: Age... whatever
i literally can't wait to skip class and get a milkshake. looking forward to little things like this
i dont know how you guys can just willingly skip classes. i wouldnt dare miss a class because it would be impossible for me to cope up.
The bane of STEM majors... missing a single class lecture. :S
Why is this relevant? Just this morning I woke up on the couch completely zonked while my room mate fucked some chick. He'd been friendzoned for as long as he'd known her, I was so proud. That's neither here nor there though, going to stats while you're nursing a previous night of debauchery is not fun.
"I prefer a sane world where you are rewarded by providing people with something they want. Not arbitrarily rewarded in a status game that reminds me of chimpanzees." - nazgulnarsil
Here I am with my empire
Ill bring you to your knees
Ebb and flow with my desire
Cause its all that youve been taught to be
i guess it's something to brag about. personally i hate going to class anything bad even tired.
it's a thread for the discussion of going to class hungover


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The Dells are one of the longest-lived rhythm & blues vocal groups. Their origins date back to 1952, and the group's original lineup – lead tenor Johnny Funches, second tenor Verne Allison, lead baritone Marvin Junior, baritone Michael "Mickey" McGill and bass Chuck Barksdale – changed only when John E. Carter replaced Funches in 1959. Between 1956 and 1992, the Dells racked up an astonishing 46 R&B hits. Eight of those made the pop Top 40, including their signature songs, "Stay in My Corner" and "Oh, What a Nite." They were inducted into the Rock and Roll Hall of Fame in 2004.
In this clip, curatorial director Howard Kramer shares the story behind the Dells and their onstage battle against 1996 Hall of Fame inductees Gladys Knights and the Pips at the Apollo Theater in New York City. The Dells are featured in a special exhibit at the Rock and Roll Hall of Fame and Museum in Cleveland, Ohio.


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NLU is not accepting applications for the Leadership Certificate at this time.
In business, leadership is key — now more than ever. National Louis University's Leadership Certificate offers managers a unique opportunity to more closely examine the significant role they play as change agents, innovators, strategists and team builders. Learn how you can drive change, leverage your knowledge to make key decisions and inspire an organization to greater success.
Choose NLU's business leadership certificate if you:
- Work as a business executive or manager and wish to improve your leadership skills
- Are an NLU MBA candidate and want to augment it with an even deeper focus on leadership
- Hold an MBA and would like to learn the latest organizational best practices
- Want to earn a leadership certificate in the Chicagoland area
The Leadership Certificate program is a five-course post-baccalaureate development sequence that extends the leadership themes introduced in the Master of Business Administration (MBA) program. Students learn about their leadership strengths and leadership potential through hands-on learning. Students perform self-assessments and reflect on personal opportunities in areas such as high-performance team leadership, organizational change and innovation, and transformational leadership. In addition, students will:
- Understand how effective leaders manage and continuously improve organizational behavior to maximize individual, team and organizational performance
- Analyze the impact of leadership style on the organization and its members and develop a personal leadership strategy that reflects an awareness of strengths and areas for development
- Test and evaluate approaches for developing, participating in and leading high-performance teams
- Explore the role of the leader as an agent of change and examine how leaders apply organizational design principles to influence organizational culture, increase innovation and transform companies
- Explore the role of leadership in strategy development and hone the analytical and visioning skills that leaders call upon to guide organizations
Leadership is a huge factor in business. Organizations continue to look for those who will drive change, make key decisions and inspire their team to greater success. At NLU, supporting business students in meeting their professional development and career goals is essentially synonymous with preparing them to lead. Year after year, surveys reveal that top executives seek new hires who demonstrate strong leadership and interpersonal abilities. In one recent survey, CEOs of the Fortune 1000 companies identified leadership (47 percent) and communication (35 percent) as the top two skills needed by managers in their organizations.
NLU's Leadership Certificate program provides students with a strong sampling of organizational knowledge to help develop their leadership skills. Our accomplished faculty bring extensive professional experience to the classroom, and our student population comes from a wide range of backgrounds and career and life experiences. NLU has a long track record of successfully training adult learners, offering flexible class schedules to those working full time.
All applicants must meet NLU's general admission requirements as well as additional requirements specific to this program. Refer to the appropriate application checklist available online at nl.edu/applyonline.
Get more information today about enrolling in in one of NLU's degree programs. Connect with an Enrollment Specialist or call 888.NLU.TODAY (888-658-8632).


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During the last 20 years, King's Daughters has developed one of the nation's leading heart and vascular teams. We have recruited expert physicians, skilled nurses and support staff, and invested in the best, proven medical technology.
Our team performs more cardiovascular procedures than any other hospital in the region with excellent results. And our physicians and surgeons perform more advanced and complex procedures, including coronary artery bypass surgery, minimally invasive valve surgery, minimally invasive surgical procedures to treat heart arrhythmias, cardiac resynchronization and more.
2201 Lexington Ave.
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Man accused of assaulting officer, fleeing after larceny
Published: Monday, July 1, 2013 at 3:36 p.m.
Last Modified: Monday, July 1, 2013 at 3:36 p.m.
A 47-year-old man is facing a number of charges, including felony hit and run and assaulting an officer, according to arrest warrants.
Samuel Neil McKinney of 491 Feezor Road has been charged with misdemeanor larceny, first-degree trespass enter/remain on premises, driving while license revoked, resisting public officer, felony assault with a deadly weapon on a government official, felony hit and run resulting in injury and felony hit and run failure to stop for property damage. He was given two $5,000 secured bonds and court dates of July 17 and 29.
At 7:41 p.m. June 23, the Lexington Police Department reported a larceny at Walmart at 160 Lowe's Blvd.
A police report states McKinney attempted to push a buggy containing two Weed Eaters and two fishing poles out of the store without paying for them. When he saw the loss prevention officer, he then took off running and fled from two officers, the report further stated. The LPD indicated that McKinney refused to stop running as they were attempting to investigate the larceny.
"McKinney then got into a white Ford Taurus and then refused to exit the vehicle," Officer Joshua L. Trantham wrote in his report. "McKinney then placed the vehicle into drive and sped off. As McKinney was trying to leave, he struck a parked Chevy Suburban, a Mercedes SLK 230 and a BMW. When McKinney struck the Suburban, it caused Charles Mcie's leg to get pinned between the Suburban and his Mercedes."
Trantham states McKinney then placed the car in reverse, backed up, put the car back in drive and fled the scene. McKinney, according to the report, was found to be driving on a suspended license and was also banned from Walmart due to prior larcenies.
An arrest warrant states McKinney struck Trantham in the right knee with a Taurus while fleeing the scene of a larceny. Trantham suffered minor injuries, and Mcie suffered nonlife-threatening injuries, according to the LPD.
Reader comments posted to this article may be published in our print edition. All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.


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These Artifact masks are berzerk!!!
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James Olevia Mungro II
Position: RB
Height: 5-9 Weight: 214 lbs.
Born: February 13, 1978 in East Stroudsburg, PA
High School: East Stroudsburg
College: Syracuse (school history) (Mungro college stats)
Weighted Career AV (100-95-...): 5 (9377th overall since 1950)
Other SR Links: College Football at Sports-Reference.com
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Morgan in for Dragons
6 August 2014 12:52pm
By Rob Cole
Luke Morgan will play for the Dragons in Premiership 7s finals
Wales Sevens star Luke Morgan will hot-foot it from the Commonwealth Games to the Premiership Rugby 7s finals at The Twickenham Stoop on Friday night when he lines up for Newport Gwent Dragons.
Cordy-Redden, who currently plays for Cross Keys, is another player with sevens experience through playing for Crawshays 7s and Great Britain Students 7s, while O'Brien was a reserve for the Welsh leg of the tournament.
Welsh Sevens caps Rhys Jones and Sam Cross will spearhead the Dragons challenge and Lyn Jones will be delighted that the experienced Matthew Pewtner has overcome the knee injury he sustained during the Welsh leg of the tournament.
Dragons Squad
Angus O'Brien, Dorian Jones, Owen Davies, Jonny Lewis, Luke Morgan, Matthew Pewtner, Rhys Jones, James Thomas, James Cordy-Redden, Lewis Hudd, Ollie Griffiths, Sam Cross (c).
Premiership Rugby 7s Series Final Fixtures
18.00 - 18.20 Quarter Final 1 (Cardiff Blues v Leicester Tigers)
18.25 - 18.45 Quarter Final 2 (Gloucester Rugby v Northampton Saints)
18.50 - 19.10 Quarter Final 3 (Harlequins v London Irish)
19.15 - 19.35 Quarter Final 4 (Newcastle Falcons v Newport Gwent Dragons)
19.40 - 20.00 Plate Semi Final 1 (Loser Game 1 v Loser Game 2)
20.05 - 20.25 Cup Semi Final (Winner Game 1 v Winner Game 2)
20.30 - 20.50 Plate Semi Final 2 (Loser Game 3 v Loser Game 4)
20.55 - 21.15 Cup Semi Final 2 (Winner Game 3 v Winner Game 4)
21.20 - 21.40 Plate Final (Winner Game 5 v Winner Game 7)
21.45 - 22.05 Cup Final (Winner Game 6 v Winner Game 8)
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Match highlights: Wales U20 v Scotland
#journeytogether: St Patrick's College, Wellington
21 Jun 16
#journeytogether with Jamie Roberts & Luke Charteris as they speak openly to pupils of St Patrick's College in Wellington about life as an international rugby player. Brought to you by Dove Men+ Care.
#journeytogether: Father's Day
19 Jun 16
#journeytogether with members of the Wales squad as they discuss what it's like to be away on tour on Father's Day and the role their Fathers played in their life. Brought to you by Dove Men+ Care.
#journeytogether: Maori Powhiri
17 Jun 16
#journeytogether with the Wales team as they receive a special welcome from the Maori community in Wellington. Presented by Dove Men+ Care
Gathering with the Chiefs
13 Jun 16
Rare in the modern game but the Wales squad spent Sunday evening catching up with the Chiefs squad and management ahead of Tuesday night's encounter in Hamilton.
#journeytogether with JR
12 Jun 16
#journeytogether with JR, Wales' equipment manager for the past 25 years, the man responsible for moving 3.3 tonnes of equipment half way around the world. Presented by Dove Men+ Care.
#journeytogether with Gareth Anscombe
10 Jun 16
#journeytogether with Gareth Anscombe as he takes us on a tour around his home town Auckland. Brought to you by Dove Men+ Care.
Wales NZ Tour Training Diary Week 3
10 Jun 16
Training highlights: Week 3 as the Wales squad prepare for the first test v New Zealand in Auckland
Wales NZ Tour Training Diary week 2
04 Jun 16
Training highlights: Week 2 from Auckland as the squad touchdown in New Zealand and head back to the training field ahead of the three tests against the All Blacks
Insight into an international rugby family
31 May 16
Robin McBryde and son Billy are set to represent Wales on either side of the globe over the coming weeks with Robin travelling to New Zealand as Wales assistant coach and Billy competing at the World Rugby U20 Championship (Manchester, June 7-25). WRU TV caught up with the pair and captured a unique perspective into the factors that produce such a high-achieving rugby family.
Wales in NZ
26 May 16
You can follow Wales on every step of their journey in New Zealand by following the WRU digital accounts
Homeward bound: Bradley Davies
25 May 16
Wasps second row Bradley Davies explains his reasons for returning to Wales after signing a National Dual Contract with the Ospreys and the WRU.
McBryde looks ahead to England clash
24 May 16
Wales assistant coach Robin McBryde is predicting a tough battle against England on Sunday despite the fact they may not be considered to be at full strength. Players will be out to impress Eddie Jones which makes England a dangerous proposition, he says.
Wales U16 Schools reaction: Robert Sidoli
18 Apr 16
Wales Schools Under 16s head coach Robert Sidoli is full of praise of his young side who came from behind to defeat arch rivals England at Ystrad Mynach
Thomas aiming to finish season strongly
04 Apr 16
Recalled to the Wales Sevens squad, the 'more experienced' Adam Thomas is looking forward to this weekend's Hong Kong tournament, where his side are aiming for an upturn in fortunes.
Sir Ian reflects on grandson's Wales U18 display
26 Mar 16
Sir Ian Botham, along with his son Liam, were keen observers when Jim Botham played for Wales Under 18s against Scotland in the opening game of the U18 International Series in Swansea yesterday.
Wales U20 celebrate at Parc Eirias
21 Mar 16
WRU TV takes a look back to the night when Wales Under 20s claimed a coveted Grand Slam at Parc Eirias
Wales v Italy: Story of the day
21 Mar 16
WRU TV looks back to Saturday where Wales carved out a record score against Italy in the final game of this season's RBS 6 Nations at Principality Stadium
Wales v Italy: Post match press conference
19 Mar 16
Post match reaction from this afternoon's RBS 6 Nations clash at Principality Stadium where Wales brushed aside the challenge of Italy.
Wales v Italy: Captain's run
18 Mar 16
Forwards coach Robyn McBryde says tomorrow's RBS 6 Nations clash against Italy gives Wales an opportunity to finish second in the tournament after having the wind knocked from their sails last week against England.
More WRU TV
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Search is on for new RGC head coach
01 Jul 16
The North Wales Development Region has advertised for a new head coach to lead RGC into their first season of Principality Premiership rugby.
Roland Mercer
Pivac ready for toughest of Euro challenges
30 Jun 16
The Scarlets have been handed one of the toughest pool assignments in the history of the Champions Cup after being drawn in the same group as the winners of the last four seasons, reigning champions Saracens and RC Toulon.
Scarlets draw heavyweights
29 Jun 16
The Scarlets will face Champions Cup and Aviva Premiership winners, Saracens along with RC Toulon and Sale Sharks in Pool 3 of the European Rugby Champions Cup following the Pool Draws for EPCR's tournaments which took place today in Neuchâtel, Switzerland.
Roland Mercer
Smith heads west ahead of new season
29 Jun 16
Former Wales Sevens player Richard Smith has joined the Scarlets from Cardiff Blues ahead of the 2016-17 campaign.
Roland Mercer
The A Team returns to provide 'next step'
21 Jun 16
Wales will play A team fixtures next season for the first time since 2002, the Welsh Rugby Union (WRU) chief executive Martyn Phillips confirmed today.
Roland Mercer
Wanted: new leader for North Wales rugby
15 Jun 16
A new General Manager for North Wales is being sought by the Welsh Rugby Union - with CEO Martyn Phillips hailing the appointment as potentially 'game changing' for the national sport.
Roland Mercer
Owens breaks world ref record
10 Jun 16
Nigel Owens will take charge of his 71st Test match this weekend and Welsh Rugby Union head of referees Nigel Whitehouse has taken the opportunity to hail the achievements of world rugby's most experienced man-in-the-middle.
Roland Mercer
Jones joins Dragons coaching stafff
02 Jun 16
Former Wales prop Ceri Jones has been appointed Newport Gwent Dragons forwards coach and will link up with the region during the upcoming 2016/17 pre-season.
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Skydiving.com now has a network skydiving location serving Squirrel and Fremont County in Idaho. Call Skydiving.com at 1-800-617-7948 for details, free information and specials on skydiving in Squirrel, ID today!
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Attorney General Beau Biden announced that three shredding events will take place this month to help consumers guard against identity theft.
Shredding events will take place from 9 a.m. to 1 p.m. at the following locations: April 5 in the Lowe's/BJ's parking lot, Peninsula Crossing Shopping Center, Route 113, Millsboro; April 12 at the DelDOT Administration building parking lot, 800 Bay Road, Dover; April 26 at the William Penn High School parking lot, 713 E. Basin Road, New Castle.
Each consumer may bring up to three file-sized boxes of documents, which may contain paper file folders, staples and paperclips; emptied boxes will be immediately returned to consumers.
For more information: attorneygeneral.delaware.gov.
Location, ST | website.com


text:
Italian Bean Soup RecipeRead Reviews Be the first to add a review
- 1 medium onion, thinly sliced
- 1 small potato, peeled and finely chopped
- 1 celery rib, chopped
- 2 tablespoons olive oil
- 3 garlic cloves, minced
- 3 cans (14-1/2 ounces each) reduced-sodium chicken broth
- 1 can (15 ounces) white kidney or cannellini beans, rinsed and drained
- 1 can (14-1/2 ounces) Italian stewed tomatoes, undrained
- 1/4 cup minced fresh parsley
- 1 tablespoon prepared pesto
- 1/4 cup uncooked orzo pasta
- 1 cup fresh baby spinach
- 1/4 cup grated Romano cheese
- In a Dutch oven, saute the onion, potato and celery in oil until tender. Add garlic; cook 1 minute longer. Stir in the broth, beans, tomatoes, parsley and pesto. Bring to a boil. Stir in pasta. Reduce heat; cover and simmer for 10-15 minutes or until pasta is tender.
- Add spinach and cook just until wilted. Sprinkle each serving with cheese. Yield: 6 servings (about 2 quarts).
Reviews for Italian Bean Soup
"I love this recipe, I've made it as it, w/o the orzo and potatoes and added turkey sausage, and just recently with mild Italian pork sausage and veggie broth cause I didn't have the chicken broth, orzo or potatoes, all 3 versions are a hit with my family. I also add the spinach in each individual bowl and stir to wilt instead of stir it in the pot, that way the leftover spinach in the soup pot, doesn't turn into slime the next day."
"This is one of my favorite soup recipes. The flavor is great and my family loves it. I usually add extra spinach and I use veggie broth instead of chicken to make it vegetarian. I freeze leftovers in individual serving-sized containers so that we have an easy option for taking lunch to work."
"This is a great hearty, healthy soup. I made a few changes to it because I didn't have pesto or Italian stewed tomatoes. I used diced tomatoes with sweet onion and a couple of teaspoons of Italian seasoning. I also left out the potato and added carrot. My 8 year old even loved this recipe."
"Easy to make, very good. I used about 2-3 times the amount of spinach that it called for to give it some extra color."
"I made this soup on the spur of the moment after looking through my 2012 Quick Cooking Annual for a quick and easy bean soup. I had everything I needed to make this and it went over really well here at our house. I did use frozen cut leaf spinach, as that's what I had, and used rice instead of orzo because I don't eat wheat. I will definitely be making this again. A wonderful recipe, especially for a chilly night!"


text:
Top Definition
Someone who doesn't let others get near girl he has, had or want's to have. He tries to have the chosen female all for himself and tries to alienate her from others.
- No! Don't look at Betty like that, she's mine!
viết bởi black vadi 10 Tháng bảy, 2008


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Scratch those endless lectures about the importance of representing MMA with awesome style—your youngster probably thinks you sound like a broken record! Now you can substitute those long talks with this Repeat tee by Bad Boy. Featuring slanted, repeated brand lettering printed down the front and a Bad Boy logo printed on the back yoke, this shirt will prove to your youngin' that it takes more than just big talk and a solid walk to earn a respectful reputation.
- Tagless collar
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In Defense of "Ruin Porn"
As large swaths of Detroit fall to ruins, the city has attracted many documentary and fine-art photographers in recent years. Among them are Andrew Moore, Yves Marchand and Romain Meffre, and Bruce Gilden, to name just a few. Not far behind came the critics who have disparaged the work with a catchy label: Ruin Porn.
Now Richard B. Woodward, an arts critic based in New York, has taken on the critics of "Ruin Porn" in a thoughtful essay posted last week on ARTnews.com.
Woodward dismisses the label itself as a "smirking neologism" by which self-appointed "doctors of the postmodern soul" identify "insidious tropes in our glutinous diet of images."
From there, he goes on to weigh the merits–and problems–of photographs by outsiders of places like Detroit. Woodward does that by considering the pictures of Detroit in the larger context of documentary photography. He ultimately comes down on the side of photographers who document places that are hard hit by economic or natural disaster, despite the limitations of the medium and the inability of photography to tell the whole story.
None of the photographers being accused of "Ruin Porn" are "pandering directly to a paying audience, which is the business model of pornography," Woodward argues. "All are simply chronicling the bad news that has befallen people and looking for dramatic motifs to illustrate their stories. Many of the shortcomings people find in their work can be traced to faults in the medium itself. Photography is superbly equipped to describe the results of events but is inarticulate or misleading when it comes to explaining their causes.
"The camera itself may have been, as Walter Benjamin alleged, a destabilizing and decontextualizing invention. But at the same time, it has also been used to stitch torn things back together."
He points out that "Residents of the South Bronx in the '70s were no happier that those in Detroit today to see their neighborhoods turned into international icons of violence and dysfunction. Were the Alabama farmers in the Depression-era photographs of Walker Evans helpless and 'exploited'? Or did those images crystallize their resilience against forces that would have rendered them even more invisible had he never been there? Is no news better than bad news?"
The full essay is worth a read by anyone who cares to photograph responsibly in places where they don't actually live, as well as by those who would rush to dismiss that work as illegitimate with labels such as "Ruin Porn."


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SweetTarts is keeping up with their holiday offerings with these adorable Holiday Gummies. I saw these in Target in their holiday section, among dozen of other seasonal candies. I gravitate toward candies like these since as far as I know, SweetTarts doesn't usually release gummies for the "normal" months. Therefore, these feel more unique to me than the Snickers, Kitkats, Kisses etc that come in just holiday theme packaging. It's what's inside that counts, guys.
The package does a wonderful job of matching the coloring scheme of SqeetTarts with the colors of the season. It's a very attractive package to look at. The gummies come in the holiday shapes of bells, stockings, Christmas trees and stars. So very cute! I realize that Wonka is trying to be politically correct in calling these "Holiday" gummis, but it seems odd when the gummis have such blatantly Christmas iconography. Just saying.
The red gummis is bright and zesty at first, like sour cherry. It has bright "red" notes of strawberry and cherry. It's tangy and sweet, and the flavor isn't too metallic, although since it's so tart it's very "Jolly Rancher". It's a nice red flavor though, I could eat this one all day as opposed to others I've had.
The green ones start of sweet and mellow with nice juicy notes of melon. Only as you chew it does the more zesty tones and flavors of sour apple burst trhough. It's a very juicy flavor and because of that it's very tasty. It's hard to top popping them into you mouth.
These were tastier than what I was expecting, and I really enjoyed them. I can see these looking really cute in a candy dish or as cupcake toppings. If your into sour gummi candies, I recommend giving these a shot.
Rating: Will Eat Again
Links Wonka Website


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A thing of beauty
Yea.. that play is good for getting all kinds of looks. Very cool montage.
I fell in love with it during game at home vs Denver, Kidd executed that perfectly
The guy has tons of compilations like this, such as this one with Novak
The scissors is so great to watch. Also great to watch is Dumphoneys Lakers on their way to a damn good sweeping.


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The neuroendocrine system is comprised of cells that are spread throughout several organ systems, including the lungs and digestive system. They are called neuroendocrine cells because they have characteristics of both nerve and endocrine cells. Nerve cells use electrical impulses to transmit signals. Endocrine cells, such as the thyroid and pancreas, make up glands that secrete hormones, such as thyroid hormone and insulin, which can be used to communicate with other organs. Tumors of the neuroendocrine system account for about 2% of all cancers and can be classified as either pancreatic endocrine tumors or carcinoid tumors. Approximately 12,000 cases of carcinoid tumor are diagnosed a year. They most commonly arise in the gastrointestinal system (esophagus, stomach, intestines) and are thought to regulate digestion by controlling digestive enzyme release and intestinal motility. About 30% of carcinoid tumors arise in the lungs. Because carcinoid tumors originate from hormone producing tissues, many of the side effects of carcinoid tumors can be linked to the inappropriate release of various compounds into the blood stream, which will be discussed later.
Carcinoid tumors occur slightly more frequently in women than men with an overall rate of approximately 2.5 cases per 100,000 people. Carcinoid tumors also appear to be slightly higher in African Americans with 4.48 and 3.98 cases per 100,000 African American men and women, respectively. It is diagnosed most commonly between the ages of 50 to 70. Carcinoid tumors often do not cause symptoms and can be difficult to diagnose.
These tumors arise in three areas: the foregut, midgut and hindgut. The foregut includes the lungs and the stomach, the midgut is comprised of the small intestine, appendix, and the beginning of the large bowel (colon), and the hindgut is composed of the end of the large bowel, the rectum and the organs of the genitourinary tract (ovaries, testes). Recent data suggests that over the past 30 years the incidence of carcinoid tumors appears to be rising. Previously it was believed that these tumors were fairly benign, however, recent data suggest that they may be more aggressive than previously thought, with a 5-year survival rate of 67.2% for all carcinoid tumor sites.
Carcinoid tumors appear to be more common in women and African Americans. African Americans also tend to have a worse prognosis. There are medical conditions which are associated with carcinoid syndrome, including Multiple Endocrine Neoplasia (MEN) type I, Zollinger-Ellison Syndrome, atrophic gastritis, and ovarian teratomas. Recent studies suggest that the number of cases of carcinoid tumors diagnosed a year have been increasing by 6% per year, but it is unclear as to why this is occurring. Some studies have suggested that smoking may double the risk of carcinoid tumors in the small intestine. There does not appear to be an association between carcinoid tumors and diet.
Presently, there is no way to prevent carcinoid tumors. There may be an association between carcinoid tumors and smoking, hence not starting or quitting smoking may reduce the risk of developing carcinoid tumors.
The signs of carcinoid tumor vary with the organ from which they arise. Generally, these tumors are found incidentally during an operation or procedure for another disease, such as during an appendectomy or a colonoscopy. Studies have suggested that 1 in 300 people who undergo appendectomy will have a carcinoid tumor found in the appendix. If symptoms are present, they tend to be relatively vague, such as abdominal discomfort. Symptoms which cause people to seek medical attention are uncommon. In the small intestine, carcinoid tumors can cause obstruction or intestinal bleeding. Carcinoids of the colon can also cause intestinal bleeding. Carcinoids of the rectum (very end of the colon prior to the anus where stool is stored) can be found during rectal exam and can cause rectal pain or bleeding. Carcinoid tumors tend to be slow growing, which also contribute to the slow evolution of symptoms. This has led to long intervals between the start of symptoms and diagnosis.
The most distinctive symptom of carcinoid tumors, known as carcinoid syndrome, rarely occurs. Carcinoid syndrome is made up of a constellation of symptoms which are caused by the release of a variety of substances (serotonin, histamine, and substance P, among others) by the carcinoid tumor. These symptoms can be precipitated by certain foods, such as those high in tyramine, such as blue cheese and chocolates, and those that contain ethanol, such as wine and beer. Carcinoid syndrome most commonly affects people with carcinoid tumors of the small bowel, however these tumors do not cause the symptoms associated with carcinoid syndrome until liver metastasis develop. This occurs because excess hormones produced by carcinoid tumors in the intestine are usually broken down by the liver. Therefore 90% of people, who have carcinoid syndrome, will have metastatic disease. Carcinoids of the lung and other non-digestive tract organs can also, on occasion, cause carcinoid syndrome.
One third of tumors of the midgut cause symptoms, and 10% will be associated with carcinoid syndrome. Only 10% of carcinoid tumors of the hindgut are symptomatic and they are rarely associated with carcinoid syndrome.
Carcinoid syndrome includes:
When a person presents with one or more of the above mentioned symptoms and carcinoid syndrome is suspected by the physician, confirmatory laboratory and imaging tests are ordered to verify that the symptoms are the result of a carcinoid tumor.
Generally, carcinoid tumors are found incidentally during an operation or a procedure. However, if a person has symptoms, which are suspicious for carcinoid syndrome, tests can be ordered to confirm that these symptoms are truly from a carcinoid tumor. Generally, the first test ordered is a urine test to detect serotonin breakdown products. In particular, the compound 5-hydroxyindoleacetic acid (5-HIAA) is measured in a 24 hour collection of the person's urine. This test can correctly confirm that the person's symptoms are due to a carcinoid tumor 75% of the time. However, the person being tested must avoid a number of foods and medications during the testing period which can falsely elevate or decrease the 5-HIAA level. Normally 2 to 8 mg/day of 5-HIAA is found in urine, however, up to 30 mg/day can be found in people with malabsorptive disease or who have recently eaten tryptophan rich foods (chocolate, certain types of cheeses). Generally people with carcinoid syndrome have 5-HIAA values of greater than 100 mg/day, though not always. People with metastatic carcinoid tumors, but without carcinoid syndrome, tend to have elevated 5-HIAA levels, yet generally have lower levels than those with carcinoid syndrome. This test may not be useful for detecting carcinoid tumors of the foregut (stomach and lungs) as they often do not produce 5-HIAA. In these cases imaging studies may be useful, which will be discussed later.
If the urine test fails to produce a diagnosis, blood tests can be performed. The blood test is used to determine 5-HIAA blood levels while the person is fasting. Normal values vary from laboratory to laboratory, but are generally between 101-283 ng/ml. Other blood tests can be used including tests for chromogranin A, bradykinin, kallikrein, and substance P among others, however these tests are not available at all hospitals.
Generally, if the 5-HIAA blood test fails to produce a diagnosis, an epinephrine (adrenaline) provocation test can be performed. In this test, the physician tries to induce symptoms associated with carcinoid syndrome by giving intravenous (IV) epinephrine. This test can confirm that a carcinoid tumor is causing the person's carcinoid syndrome symptoms nearly 100% of the time. The person's blood pressure, heart rate and facial color are closely monitored as epinephrine is given IV. The physician starts with 2 micrograms and goes up by 2 micrograms every five minutes until symptoms develop or a dose of 10 micrograms is reached. People with a carcinoid tumor will experience flushing, increased heart rate and decreased blood pressure at one of these doses and these symptoms generally last for one to two minutes. The test is stopped after the person first experiences these symptoms.
A new provocation test uses pentagastrin, a polypeptide that can stimulate the secretion of gastric acid and pepsin (a digestive enzyme). IV pentagastin is given and flushing symptoms are identified. The advantage of this test is that it can be used to detect not only midgut and hindgut tumors, but also foregut tumors unlike the tests mentioned previously.
Imaging tests can be used once the diagnosis of carcinoid tumor has been established using one of the above mentioned tests to locate the tumor. Alternatively, imaging studies may be the initial studies ordered to detect the tumor, particularly in cases where carcinoid syndrome is not present. Based on the suspected location of the tumor, several tests can be used. Barium studies can be used to find tumors; they coat the digestive tract and can outline tumors which can then be seen on X-ray. Barium swallows are used to locate tumors in the upper digestive tract such as the in the esophagus, stomach and the first part of the small intestine. Barium enemas work in a similar fashion, with contrast injected into the rectum, and can be used to examine the rectum and colon for tumors. Endoscopy can also be used to directly visualize tumors using a special camera attached to a flexible tube, allowing the physician to reach the esophagus and stomach. A colonoscopy is done in a similar fashion and can be used to examine the rectum and colon directly. Bronchoscopy can be used to examine the airways of the lungs for tumors. Another special type of scope (camera) has an ultrasound probe at the end of it. The ultrasound uses sound waves to detect how deep a tumor has invaded normal tissue. Biopsies can be taken during any of these exams and examined microscopically by a pathologist to identify carcinoid tumors. Unfortunately, none of these studies are very good at examining the majority of the small intestine, which is where many carcinoid tumors arise. CT scans can also be used to detect tumors throughout the body and CT guided needle biopsies can sometimes be used to obtain a biopsy for pathological examination. When a carcinoid is biopsied or resected and examined under the microscope, it may be classified as either "typical" or "atypical" depending on certain features. Typical carcinoids tend to be less aggressive than atypical carcinoids.
Several different types of scans can also be used to identify where the tumor is located and if it has spread. These scans use a compound, which is known to associate with carcinoid tumors. This compound is then attached to a radioactive substance. This combination is then injected intravenously and is taken up by the carcinoid tumor. Special scanners then detect the radioactive substance to identify where the tumor is. An example of this is the indium-111 octreotide scan, which can be used to localize the tumor. Octreotide is similar to somatostatin, a compound which can bind to somatostatin receptors, which are found on carcinoid tumors. However, there are other types of tumors, which can express somatostatin receptors; hence this study is not 100% specific for carcinoid tumors. The indium-111 is a radioactive compound, which is attached to the somatostatin, allowing the localization of the octreotide to be determined using a special scanner. An older scan, the I-131 MIBG scan, works in a similar fashion and can be used to locate the tumor. MIBG accumulates in the carcinoid tumor and the attached I-131 can be detected using a scanner to localize the tumor. However, like the indium-111 octreotide scan, other neuroendocrine tumors can also be detected. Hence this test is also not specific for carcinoid tumors. A PET scan using 5-hydroxytryptophan, a compound which is taken up by carcinoid tumors can also be used to identify where a tumor is located and if it has spread anywhere. Results from these imaging studies can be combined with CT scan results to better locate tumors.
In the past, carcinoid tumors did not have a formal staging system. They were staged as either localized, which means that the tumor has not spread beyond the wall of the organ or place of origin; regional, which is when the tumor has spread beyond the confines of the organ to adjacent tissues or lymph nodes, or distant metastatic spread, which indicates that the tumor has spread to distant organs and tissues.
Now the American Joint Committee on Cancer Staging (AJCC) has included carcinoid in a formal staging system, which applies to carcinoids of the stomach, colon, rectum, and ampulla of vater. There is a separate staging system for carcinomas arising within the appendix. Although there is now a staging system, the classification of tumors into localized, regional, or metastatic is still relevant in terms of thinking about prognosis and appropriate treatment options.
Primary Tumor
Duodenum, Ampulla, Jejunum, or Ileum
Colon or Rectum
Regional Lymph Nodes
Distant Metastasis
Stage Grouping: combines the T, N & M staging to define a stage.
Regional Lymph Nodes
Distant Metastasis
Stage Grouping: combines the T, N & M staging to define a stage.
Generally, the treatment of choice for people with localized carcinoid is surgical excision of the tumor. The role of chemotherapy and radiotherapy has been debated, particularly when a complete surgical resection is performed. Treatment information about each type of carcinoid tumor will be discussed by location.
Foregut: Symptoms associated with foregut carcinoids include peptic ulcers, abdominal pain and intestinal bleeding. They are rarely associated with carcinoid syndrome.
Midgut: Symptoms associated with midgut carcinoids include vague abdominal pain (40% of the time) and obstruction of the intestinal tract (25% of the time). They are associated with carcinoid syndrome approximately 10% of the time. The gut can fold in on itself, where a portion of the gut slides into another portion of the intestine (intussusception) resulting in obstruction of the intestine. The tumor itself may grow large enough to cause obstruction of the intestine as well.
Hindgut: Symptoms associated with hindgut carcinoids are similar to other rectal cancers. Change in bowel habits, rectal bleeding and intestinal obstruction can occur. Carcinoids of the hindgut are rarely associated with carcinoid syndrome. Hindgut tumors can also arise in the genitourinary system which includes the kidneys and gonads (ovaries or testes).
Regional Spread: When tumor has spread to the lymph nodes around the primary region, surgery is usually attempted to remove all of the tumor as well as the nodes around the tumor, which have disease. If this is not possible surgery is still often done to prevent symptoms from developing, such as obstruction of the intestine.
Distant Metastasis: Surgery cannot be used to cure the disease at this stage. Surgery is still used to prevent symptoms, such as obstruction, from developing but the focus is on treatments that can slow the progression of the disease and alleviate symptoms.
Other medications: Other treatments that control the symptoms of carcinoid syndrome are commonly used. Medications which boost the immune system may also be used to slow tumor growth.
Treatment of the Heart: Damage to the heart can occur due to prolonged exposure to serotonin, causing problems with the heart valves and ultimately heart failure. Octerotide and other somatostatin analogs can be used to control serotonin levels to limit heart damage. Echocardiograms are performed using an ultrasound (sound waves) machine to determine how well the heart is functioning and can be used to monitor the heart's condition. If heart damage has occurred, medications which are commonly used in heart failure can be used. Heart failure occurs when the heart is unable to circulate blood as effectively as a normal heart. This can cause fluid to build up in the body, particularly the legs (edema) and as it progresses can cause fluid to build up in the lungs as well (pulmonary edema). Treatments for this include diuretics (water pill), which draw excess water out of the body and medications to help regulate the heart beat to make it more efficient.
Follow up testing varies widely depending on the location of the carcinoid tumor, the stage of the disease at diagnosis, and the initial treatment given. For example, carcinoid tumors confined to the wall of the appendix may require no follow up after local resection; however tumors of the rectum which are locally resected need to be followed closely. At present, a standard surveillance program for small intestine carcinoid, where carcinoids commonly arise, has not been established. Generally, your physician may have you follow up every 3-6 months to determine if symptoms of carcinoid syndrome have developed. Imaging studies such as CT or MRI scans are usually done every 6-12 months or if symptoms develop warranting an immediate imaging study. Your physician may also order an echocardiogram periodically to evaluate heart function. Other tests, such as blood tests for serotonin and other products produced by carcinoid tumors, may also be checked regularly.
American Cancer Society, Detailed Guide: Gastrointestinal Carcinoid Tumors. www.cancer.org
The Carcinoid Cancer Foundation. www.carcinoid.org
Caring for Carcinoid. www.caringforcarcinoid.org
Edge S, Byed D, Compton C, et al, eds. "Cancer Staging Handbook" 7th ed. Springer. Chicago, 2010.
Hage R, de la Rivière AB, Seldenrijk CA, et al Update in pulmonary carcinoid tumors: a review article. Ann Surg Oncol. 2003;10(6):697-704.
Modlin IM, Latich I, Zikusoka M, Kidd M, Eick G, Chan AK. Gastrointestinal carcinoids: the evolution of diagnostic strategies. J Clin Gastroenterol. 2006 Aug;40(7):572-82.
National Cancer Institute, Gastrointestinal Carcinoid Tumors (PDQ®). www.cancer.gov
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