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Conceived and designed the experiments: SS PSS VG LI. Performed the experiments: SS DM PSS VG LI. Analyzed the data: SS DM PSS VG LI. Contributed reagents/materials/analysis tools: DM PSS VG LI. Wrote the paper: SS DM PSS VG LI.
We have investigated the gross, microscopic and molecular effects of carnitine deficiency in the neonatal gut using a mouse model with a loss-of-function mutation in the OCTN2 (SLC22A5) carnitine transporter. The tissue carnitine content of neonatal homozygous (OCTN2−/−) mouse small intestine was markedly reduced; the intestine displayed signs of stunted villous growth, early signs of inflammation, lymphocytic and macrophage infiltration and villous structure breakdown. Mitochondrial β-oxidation was active throughout the GI tract in wild type newborn mice as seen by expression of 6 key enzymes involved in β-oxidation of fatty acids and genes for these 6 enzymes were up-regulated in OCTN2−/− mice. There was increased apoptosis in gut samples from OCTN2−/− mice. OCTN2−/− mice developed a severe immune phenotype, where the thymus, spleen and lymph nodes became atrophied secondary to increased apoptosis. Carnitine deficiency led to increased expression of CD45-B220+ lymphocytes with increased production of basal and anti-CD3-stimulated pro-inflammatory cytokines in immune cells. Real-time PCR array analysis in OCTN2−/− mouse gut epithelium demonstrated down-regulation of TGF-β/BMP pathway genes. We conclude that carnitine plays a major role in neonatal OCTN2−/− mouse gut development and differentiation, and that severe carnitine deficiency leads to increased apoptosis of enterocytes, villous atrophy, inflammation and gut injury.
Neonatal necrotizing enterocolitis (NEC) is a potentially fatal gastrointestinal emergency of the neonate. It is an acute intestinal necrosis syndrome of unknown etiology and occurs primarily among prematurely delivered neonates [1]. Its overall incidence has been reported to be around 0.3 to 2.4 cases per 1000 live births and it accounts for 2–5% of all NICU admissions and affects 5–25% of extremely low birth weight infants (<29 weeks gestation) [2]. Improved standards of care in the NICU have resulted in more preterm survivors; consequently more cases of this potentially fatal illness are reported [3]. The overall mortality related to NEC continues to be 20–30% and is inversely proportional to the gestational age, approaching 40–50% in extremely low birth weight neonates. NEC, especially in surgical cases leads to significantly prolonged hospitalization and long-term neurodevelopmental impairment [4], [5], [6]. Overall up to 45% of NEC survivors suffer from neurodevelopmental delay and cause significant increase in health care costs [7].
Despite several decades of research, the pathogenesis of NEC is still poorly understood. An interplay of several risk factors, which include intestinal ischemia-reperfusion injury, enteral feeding, and poor host defenses leading to sepsis, have been implicated; but prematurity and feeding are the two accepted, most important risk factors for this illness [3], [8]. Infant formulas have been modified to reduce osmolality and several additives have been considered to help reduce NEC occurrence, however, over the years only breast milk has been proven to be clearly beneficial [9]. Thus nutrition plays an important role in its causation but the exact role played by individual macro- and micronutrients is still not delineated.
Carnitine (β-hydroxy γ-trimethylaminobutyrate) is a conditionally essential nutrient. It is obligatory for transport of long-chain fatty acids into mitochondria for their subsequent β-oxidation. Therefore, carnitine plays a critical role in energy metabolism of tissues that derive a substantial portion of their metabolic energy from fatty acid oxidation. Such tissues in the past included the heart, skeletal muscle, liver, and placenta, and recently several reports have elucidated its role in the GI tract [10], [11], [12]. The biological importance of carnitine is underscored by the severe clinical consequences of carnitine deficiency seen in humans [13], [14].
Two distinct types of carnitine deficiency have been identified. Primary carnitine deficiency arises from defects in the plasma membrane carnitine transporter OCTN2. Patients with this disorder excrete carnitine in urine due to defective reabsorption, and plasma and tissue levels of carnitine drop below 10% of normal [15], [16], [17], [18], [19]. These patients have marked defects in fatty acid oxidation. Secondary carnitine deficiency arises from defects in any of the enzymes involved in fatty acid oxidation. In patients with these disorders, organic acids accumulate due to defective fatty acid oxidation and these organic acids enhance urinary excretion of carnitine in the form of acylcarnitines [10], [20]. Both forms of carnitine deficiency are associated with severe clinical consequences, notably hypoglycemia, cardiomyopathy, skeletal myopathy, arrhythmias, neuropathy, fatty liver, and in some cases sudden unexpected death [21], [22].
Most of the studies reported so far on carnitine deficiency in the neonate focus on the clinical consequences due to dysfunction of heart and skeletal muscle; little attention has been paid to its effects on the gastrointestinal tract. Whenever a fatty acid oxidation disorder (FAOD) is diagnosed, most are promptly treated with carnitine supplementation, and GI pathology escapes attention of most clinicians. Carnitine's role in the GI tract has recently been highlighted by several publications linking mutations in genes encoding carnitine transporters OCTN1 (SLC22A4) and OCTN2 (SLC22A5) with Crohn's disease (CD) [23], [24], [25], [26], [27], [28], [29]. Patients with CD have been shown to have a missense substitution 1762C→T in OCTN1 which causes amino acid substitution L503F and a G→C transversion in the promoter region of OCTN2 (−207G→C), which disrupts a heat shock binding element (HSE) in the promoter region of OCTN2 gene. These mutations lead to decrease in plasma membrane transport of carnitine and thus reduce tissue content of carnitine. Carnitine has also been shown to play a protective role in hypoxia/reoxygenation injury in the neonatal mice [30], [31] but there is paucity of information regarding its effects on developing gut and immune function in the neonatal GI tract.
Preterm infants are born with 40–50% lower plasma and tissue levels of carnitine [32], [33], [34], [35]. The normative levels and postnatal changes in plasma carnitine in the preterm neonate are now well characterized [36], [37], [38]. Sick preterm neonates who do not receive carnitine supplementation via the enteral or parenteral route continue to have lower tissue carnitine levels [39], [40], [41], [42] which drop further, and thus may develop a state of relative tissue carnitine deficiency. We hypothesize that tissue carnitine deficiency will have an impact at the molecular level in the developing GI tract. In this report, we have investigated the role played by carnitine in the neonatal gut using a mouse model of carnitine deficiency due to defective OCTN2.
We obtained a breeding pair of heterozygous OCTN2+/− mice from Prof. Ikumi Tamai, Kanazawa University, Japan. Heterozygous OCTN2+/− mice are viable and fertile so several pairs of OCTN2+/− heterozygous males and females were mated, pregnant OCTN2+/− mice were allowed to deliver and the pups were observed closely after birth. Homozygous OCTN2−/− and age-matched wild-type OCTN2+/+ mice in the litters were genotyped as described earlier [43]. Wild type (OCTN2+/+) and homozygous (OCTN2−/−) pups were sacrificed around 7 days of life to collect tissue samples and to identify the various GI tract and immune system pathologies evident by this time. The experimental procedures were approved by the Institutional Animal Care and Use Committee of the Medical College of Georgia, Georgia Health Sciences University, GA, USA.
Primers were designed using Oligo® primer analysis software 6.0 (National Biosciences Inc. Cascade, CO, USA) for 6 enzymes involved in β-oxidation of fatty acids. Primer sequences and amplicon size for each enzyme are as shown in Table-1, all assays were carried out as described earlier [12]. Densitometry was performed using a SpectraImager 5000 Imaging system and AlphaEase 32-bit software (Alpha Innotech, San Leandro, CA, USA). Each experiment was repeated at least 6 times in each group from different mouse samples.
Mouse gut samples were fixed in 10% formalin and 5–10 µm thick sections of paraffin-embedded tissue were cut, applied to glass slides, deparaffinized in xylene, and rehydrated in an ethanol gradient. A set of sections from 6 animals was stained with hematoxylin and eosin (H&E) for histological analysis. For immunohistochemistry, endogenous peroxidase activity was quenched by incubating the specimens in 3% H2O2 in methanol for 30 min and subjected to antigen retrieval.
The slides were then washed and blocked using an Avidin/Biotin blocking kit (Vector Labs, Burlingame, CA) for 30 min followed by a blocking buffer (NEN-Life Sciences, Boston, MA) for 30 min. The blocking buffer was removed, and the sections were exposed to primary rabbit polyclonal antibody specific for each of the following enzymes at the indicated dilution: MCAD (1200), LCAD (1400), VLCAD (1200), SCHAD (1200), LKAT (1400). (kind gift of Dr Arnold Strauss, Cincinnati Children's Hospital, OH) and F4/80 (11000) (Abcam Labs. Cambridge, MA). The staining was done as described earlier [12]. Sections were then incubated with Alexa Fluor 555–conjugated IgG (Invitrogen, Carlsbad, CA) secondary antibody (11000). Slides were washed in PBS, incubated with a 124,000 dilution of Hoechst stain, coverslipped, and viewed with an epifluorescence microscope (Axioplan-2 equipped with the Axiovision Program and an HRM camera; Carl Zeiss Meditec, Oberkochen, Germany). All immunostaining experiments were performed on at least 6 sets of gut tissue from 1-week-old mice for all enzymes and F4/80 positive cells.
Tissue samples from six OCTN2+/+ and age-matched OCTN2−/− small intestine mucosal scrapings, spleen, and thymus were collected and protein concentrations of each sample was estimated by the Lowry method. The total, free and acyl-carnitine fractions were determined by tandem mass spectrometry as described [44] and results were expressed as carnitine content per mg of tissue.
Activity of Caspase-3 was determined in small intestinal mucosal scrapings using a colorimetric method, CaspACE assay system™, (Promega, Madison, WI) per the manufacturer's recommendations. To identify apoptosis in the spleen and thymus, the ApopTag In Situ Oligo Ligation (ISOL) technique was used with the T4 DNA ligase kit (Chemicon International, Temecula, CA) per the manufacturer's recommendation.
Lymphocytes from spleen, thymus and lymph nodes were obtained by straining the gently crushed intact organ through a nylon mesh. Erythrocytes were lysed by treatment with an ammonium chloride solution. Cells were stained on ice. Viable cells were identified by gating on forward and side scatter, and CD4+, CD8+, CD24+ and CD45-B220+ cells were sorted using magnetic beads coated with individual antibody (MACS cell sorter, Miltenyi Biotec Inc. Auburn, CA, 95602, USA).
The direct quantification of cytokines was done using a cytometric bead assay (CBA) (BD Biosciences, San Diego, CA) per the manufacturer's recommendations. The assay is based on multiple flow cytometric bead-based immunoassays that measures different cytokines simultaneously, from a single cell culture supernatant. We used 3–4×105 cells per well of total lymphocytes from OCTN2−/− and OCTN2+/+mice. The dye, incorporated in the beads fluoresces strongly at 650 nm (measured as FL3 signals in BD FACScan and FACScalibur Flow Cytometers) when excited with an argon laser. Detection is mediated by the binding of specific detection antibodies that are directly conjugated with phycoerythrin (PE), to each of the corresponding capture bead/analyte complex populations, thus providing an FL2 fluorescent signal on the appropriate bead. This signal is proportional to the concentration of the cytokine in the test matrix. This kit combines beads with the ability to measure the levels of IL-2, IL-6, MCP-1, TNF-α and interferon-γ from the same sample. Cytokine concentration was measured by using established calibration curves and dedicated CBA analysis software.
We used RT2 profiler PCR arrays (SABiosciences, Qiagen, Frederick, MD) to study differences in gene expression of TGF-β/BMP pathways (cat No. PAMM035) between small intestinal mucosal scrapings from 1-week-old OCTN2−/− mice and age-matched wild type controls. RNA was extracted using the Trizol method from gut tissue from two sets of animals. This array is housed on a 96-well plate; it provides information on 84 genes which includes members of the TGF-β superfamily of cytokines and their receptors: SMAD and SMAD target genes, which include adhesion, extracellular molecules and transcription factors involved in downstream cellular processes. Details of this PCR array are available at the Qiagen website (http://www.sabiosciences.com/rt_pcr_product/HTML/PAMM-035A.html). Relative expression levels of each gene were analyzed using BioRad iQ iCycler Detection System (BioRad Laboratories, Hercules, CA, USA). All assays were performed per the manufacturers' recommendations, each experiment was performed in duplicate, and results represented as the mean of each experiment.
All data are presented as means ± SD and comparisons between paired samples were made by Student's't' test with Bonferroni's correction where applicable and statistical significance was set at p ≤ 0.05. We used statistical software SPSS for PC version 11.01 for data analysis.
The homozygous (OCTN2−/−) mice survive for about 4–5 weeks and look much smaller without carnitine supplementation compared to age-matched wild type (OCTN2+/+) littermates while they are indistinguishable when 1-week-old. The carnitine content in small intestine, spleen and thymus of neonatal OCTN2−/− mouse is markedly lower than in the age-matched wild type OCTN2+/+ mouse (Table-2).
By the end of the first week of life the carnitine deficient OCTN2−/− mice develop early signs of stunted villous growth in comparison to the wild-type mice (Fig. 1) and some areas of the gut show disruption of the villous architecture with lymphocytic infiltration and thickening of the muscular mucosa (Fig. 1, panel C & D). The colonic villi are not as healthy looking and the number of mucin producing goblet cells is markedly reduced (Fig. 1, panel E & F). F4/80 staining for macrophages showed a higher number of macrophages in the villous core of the OCTN2−/− ileum sections (Fig. 2, panel B &D) compared to the age-matched wild-type controls (Fig. 2 panel A & C). The total number of macrophages in two respective high power field are quantified in Fig. 2, panel E.
There was high expression of MCAD, LCAD, VLCAD, SCHAD and LKAT in the enterocytes lining the villi of jejunum (Fig. 3) and ileum (Fig. 4) of 1-week-old wild-type (OCTN2+/+) mice. The enzyme expression (red fluorescence) was mainly localized to enterocytes over the villous tips with much less expression in villous core and villous crypts. There was complete absence of staining in negative control sections (Panel A, Fig. 3&4).
Fig. 5 is a composite image of semi-quantitative RT-PCR densitometry data for these enzymes. There was a significantly increased expression of MCAD, LCAD, VLCAD, SCHAD and LKAT genes in small intestinal mucosal scrapings from carnitine-deficient animals as compared to age-matched wild type (OCTN2+/+) mice.
Activity of caspase 3 was significantly elevated in small intestinal mucosal scrapings from OCTN2−/− animals compared to 1-week-old age matched wild-type controls (Fig. 6).
The wild-type (OCTN2+/+) mouse thymus filled up the whole of superior mediastinum and covered the heart (Fig. 7A, arrowhead) whereas the age-matched carnitine-deficient (OCTN2−/−) mouse thymus was small, shriveled and barely visible (Fig. 7B, arrowhead). Likewise the spleen of OCTN2−/− mice was pale and much smaller in size (Fig. 7C). The total lymphocyte count from thymus, spleen and lymph nodes was much reduced (Table2). There was markedly increased lymphocyte apoptosis in the OCTN2−/− mouse spleen and thymus as indicated by brown staining of lymphocytes with the Oligo Apoptaq assay. There were several "punched out" areas in the spleen and thymus sections where a complete loss of lymphocytes had occurred (Fig. 8). Flow cytometry studies showed that carnitine deficiency led to a change in relative percentage of lymphocyte surface markers. There was a relative decrease in CD4+ splenocytes in the OCTN2−/− mouse and a marked increase in CD45-B220+ thymocytes and lymphocytes which indicates exposure to extrinsic environmental antigens and a T-cell response (Table-3).
Splenocytes and thymocytes from OCTN2−/− mice secreted significantly increased amounts of IL-2, IL-6, TNF-α, MCP-1 and IFN-γ under basal and anti-CD3 antibody-stimulated conditions (Table-4).
Table-5 summarizes the changes in expression of genes involved in the TGF-β/BMP signaling pathway. We found a similar trend in results of each of the two experiments and data shown represent mean values of the genes with >2 fold change. There was down-regulation of most TGF-β/BMP pathway genes and 22 genes showed a significant change. Genes for TGF-β 1 & 3, its receptor II, BMP 4 & 6, IGFBP3, integrin β 5 & 7, activin and noggin were significantly down-regulated in the OCTN2−/− mouse gut.
Our previous investigations have demonstrated that carnitine deficiency leads to severe atrophy of the villous structure throughout the gut with widespread inflammation, perforation and abscess formation and signs of peritonitis in the adult OCTN2−/− mouse [12]. In this report, we have explored the early effects of carnitine deficiency on the developing neonatal gut to investigate as to what role carnitine deficiency might play at the molecular level before gross changes are seen in the gut. The neonatal GI tract requires a constant supply of energy to support its own growth, maturation, nutrient transport function and maintenance of epithelial barrier function. This energy is produced by mitochondrial β-oxidation of long-chain fatty acids in enterocytes where carnitine plays a crucial role. We have earlier measured activity of two major fatty acid oxidation enzymes, long-chain L-3-hydroxyacyl CoA dehydrogenase (LCHAD) and short-chain L-3-hydroxyacyl CoA dehydrogenase (SCHAD) using adult OCTN2 mice and found that SCHAD and LCHAD activity in mouse gut is nearly 4 to 10 fold higher than in liver which is considered the major organ metabolizing fatty acids [12]. Our current data are in line with this finding and highlight the value of carnitine during the neonatal period. Carnitine's role in the GI tract has recently been highlighted when several reports linked mutations in genes encoding carnitine transporters OCTN1 (SLC22A4) and OCTN2 (SLC22A5) with Crohn's disease (CD) [23], [45]. Though carnitine's immunosuppressive and therapeutic properties in gut inflammation have been described in the past [46], [47], [48], [49], [50], this is the first report about its role in development and differentiation of enterocytes and gut inflammation during the neonatal period. Carnitine's role in gut associated immunity has recently been highlighted where it has been shown to abrogate gut inflammation and prevents lymphocyte apoptosis [46], [48], [51], [52]. Carnitine has also been used in adults with gut inflammation due to CD or ulcerative colitis with beneficial effects [53], [54], [55]. Carnitine deficiency in our mouse model causes a global effect on the immune system as evidenced by severe atrophy and apoptosis of splenocytes, thymocytes, lymph node lymphocytes as well as intra-epithelial lymphocytes. This was preceded by an early pro-inflammatory response in the gut with macrophage and lymphocytic infiltration. Thus OCTN2−/− mouse spleen and thymus phenotypes are part of the same process.
Intestinal epithelial cells normally undergo apoptosis at a very high rate and apoptotic cells are quickly replaced by newer cells in a seamless manner. Any perturbation of this process leads to breach of the gut epithelial barrier and entry of gut pathogens into the blood stream. We have demonstrated a major increase in enterocyte apoptosis in our mouse model of carnitine deficiency which initiates this process of gut injury. Our earlier studies using the adult OCTN2−/− have shown a higher expression of caspase 1 and 3 in small intestine by Western blot. We also found up-regulation of gut protective molecules such as phosphorylated ERK and AKT [12]. Several growth and transcription factors are required for the transformation of crypt stem cells into mature enterocytes and secretory cells and ensure integrity of gut mucosal barrier. These growth factors including the TGF-β/BMP are involved in various aspects of gut development and differentiation [56], [57], [58], [59], [60]. TGF-β/BMP act through their receptors and activate a number of intracellular SMAD transcriptional regulators [58], [60]. SMAD complexes interact with either co-activators or co-repressors of transcription to control target gene expression. Here we have presented data to show that TGF-β/BMP pathway genes are down-regulated in states of carnitine deficiency and thus will affect villous growth and differentiation. TGF-β/BMP pathway genes also regulate cytokine production and mucosal inflammation [61] and our studies in the OCTN2−/− mouse show initiation and progression of immune response and increased pro-inflammatory cytokine production.
Results of our study, though conducted in an animal model, are relevant to cases of NEC, a disease which predominantly affects low birth weight preterm neonates since they are born with low tissue levels of carnitine and may not have received carnitine supplementation leading to an even lower tissue level of this conditionally essential nutrient. The heterozygous OCTN2+/− mouse with lower tissue levels of carnitine develops a clinical phenotype comparable to the homozygous OCTN2−/− mouse in adult life though its GI pathology has not been reported [62]. Nutrition plays a central role in causation of NEC as indicated by marked reduction in its incidence by use of human breast milk. More than 50% of calories in human breast milk are from fatty acids indicating that carnitine plays a significant role in the metabolism of these calories from fatty acids. The problem of low tissue carnitine levels in the preterm neonate may go unrecognized by physicians and may thus contribute to gut injury as commonly seen in NEC. Our animal model of carnitine deficiency is not a classic model of NEC where NEC is either created by using caustic agents like dextran sulphate or with LPS instillation in the stomach followed by subjecting animals to periodic hypoxia, but it does show the spontaneous changes in molecular events in the developing enterocytes which ultimately lead to gut injury. Thus our study supports the notion that carnitine supplementation is beneficial to preterm neonates who are at high risk of developing NEC.
This study was funded by National Institutes of Health grant HD 048867 to PSS, MD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Tracking the 3-year-old's best style moments.
At just three years old, North West is already a fashion force to be reckoned with. We're tracking the style-icon in-the-making's best fashion moments—from her Fashion Week debut to her post-ballet class attire. There's no shame in taking sartorial inspiration from a toddler when she wears the likes of Givenchy and Alexander Wang, after all.
While visiting the Museum of Ice Cream, North layered a pink patterned slip dress over a black tee and topped the look off with her signature Vans.
The 3-year-old stepped out in a pink velvet lace-up dress, a bejeweled bag and sneakers with her parents names' airbrushed onto the backs (which is probably only cool if your parents are Kim and Kanye).
While at a birthday party over the weekend, North stepped out in a green "Calabasas" thermal outfit, another possible sneak-peek at Kim and Kanye's upcoming childrenswear line with Adidas. Naturally, the 3-year-old has us hoping it comes in adult sizes too.
Kourtney Kardashian took to Instagram to share North's festive Valentine's Day outfit—a heart slip dress, Vans and a leather jacket with dad Kanye West's "Famous" lyrics on the back. Nailed it.
In a black fur jacket, velvet turtleneck dress, tights, Doc Martens and a lollipop, of course.
For a night at the New York City Ballet, North debuts the first designs from Kim and Kanye's upcoming kids' clothing line (which she helped design, of course). She topped off the bright look with tube socks and Vans.
While in Costa Rica, the 3-year-old sticks to her no-fail uniform: a velvet slipdress and Vans. She has, it seems, officially retired and moved on from the black choker trend too.
For a family day out in Costa Rica, North wears a lace camisole and shorts set and flip flops. (One time I saw North West wearing lace shorts and flip flops so I bought lace shorts and flip flops.)
via @bound2west
Boarding a private plane to Costa Rica with the Kardashian family, North wears a pink hoodie personalized with her nickname, "Nori."
via @NoriWestSource
While out in Miami, North embraced the furry slides trend, styling a black pair by AKID with a velvet slip dress, t-shirt and dad hat—looking insanely cooler than any of us ever will.
North went full '90s (again) in a red velvet slipdress layered over a black graphic tee, plus a skinny choker necklace and black baby Yeezys.
North's sporty-chic style game is going strong. The three-year-old stepped out in a Supreme t-shirt and not-yet-available Yeezy Boost sneakers.
If anyone can bring back the monogram Louis Vuitton Speedy bag, it's 3-year-old North West. The tot was spotted in New York carrying a mini version of the bag and wearing one of her signature slip dresses with a pair of white sneakers. Take note, street style stars.
North West dons an outfit her mom and aunts are fond of—an oversized Yeezy sweatshirt worn as a dress plus Yeezy sneakers.
For a night out at Kanye West's Madison Square Garden concert, Kim Kardashian and North West stepped out in matching silver sequin Vetements dresses. While Kim topped hers off with a pair of Yeezy heels, North went for a more laid-back look in a pair of Vans. Ugh, don't you hate it when your mom steals your outfit?
While out with mom Kim Kardashian in New York City, North gave every '90s style lover envy in this velvet slip dress, choker and Vans sneakers.
While in New York, North stepped out in a leopard slip dress, black choker and Yeezy Boosts—reminding us all she still dresses better than most adults.
North shows off that glow sticks double as great bath toys and jewelry, thanks to a photo her father Kanye shared on Twitter (arguably his favorite medium) today.
While vacationing in Punta Mita, Mexico, Kim and North step out in matching mommy and me nude crochet bikinis.
North wears a pearl choker, denim cutoffs and carries a plush kitty kat purse (most likely couture) while out with the Kardashian-Jenner clan.
In a hot pink slip dress, diamond choker and black Converse—as one wears to run errands.
via @NoriWestSource
North graciously lets Kim Kardashian and Kanye West see Finding Dory at the movies with her while wearing a heart-printed slip dress over a white tee, a black choker and combat boots.
Kim and North don matching mermaid looks for the toddler's 3rd birthday party extravaganza.
via @KimKardashian
In her finest Princess-gear for a day at Disneyland with mom.
via @KimKardashian
North wears a lace slip dress, fringe leather jacket and Yeezy sneakers while out in New York seeing The Lion King on Broadway.
Despite the little pout, North still looked better than us all in a black and white lace slip dress layered over a white t-shirt, black denim jacket and tiny tiara headband.
Nori wears an Elsa costume complete with a tiara and slicked-back bun (just like her mom) at Disneyland.
North wears a leopard dress over a white tank top with black fringe sandals for a trip to a playground in Cuba with the Kardashian family.
For a night out to dinner in Cuba, the toddler ditched her choker and opted for an empire-style dress, fringe sandals and a top-knot.
Arriving in Cuba with the Kardashian clan, North steps out in an all-white crochet and fringe dress (and matching choker, of course) paired with leather espadrille slide-ons.
The Kardashian/West family took Miami this weekend for a friend's wedding. While Kim, Kourtney and Kanye spent time shopping and celebrating nuptials, North hit the beach for a day of fun in the sun wearing an adorable tiger swimsuit.
Demonstrating once again how to do matching mommy and me style, Kim Kardashian and North West had a girls day out in LA wearing coordinating looks. The duo donned French braids, black chokers and nude bodysuits (although North tucked hers into a pair of denim cutoffs and opted for a pair of ballet flats instead of lucite heels).
While on the Kardashian family vacation, North and Kim hit the slopes in matching ski coats. The toddler styled hers with a custom Heron Preston turtleneck, black beanie and pink beaded bracelet and although Kardashian accessorized hers with a Birkin bag, North still wins this round of 'who wore it better?' because, duh.
For a family day out running around with cousin Penelope at LACMA, North's look was on fire—literally—in a flaming leather moto jacket, denim cutoffs, sneakers and her recent go-to accessory: a choker. The tot brought new fashion meaning to the phrase "terrible two's" with a moto jacket tougher than you'll ever be.
Life hack for making the slip dress toddler appropriate: style it over a white tank top and add tights. North West had a major '90s fashion moment (choker included) while out Saturday night celebrating Rob Kardashian's birthday with family. Would it be weird to bookmark this 2-year-old's outfit for your next night out look? Not at all.
Taking a break from sunny Los Angeles weather, North is really showing us all how to embrace New York winter this week. In a series of street style photos taken earlier today, the stylish toddler walked down the street playfully catching snowflakes with her tongue—in a fur coat, gray Supreme outfit and Uggs, nonetheless.
While out in New York on Valentine's Day, the tot one-upped Kim Kardashian's street style game in a leopard fur coat, cuffed jeans and Doc Martens.


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Some of the readers of this blog have very graciously kept up with my health concerns over the past year, and for those of you who are interested, things have gone amazingly well. From a diagnosis of Stage IV cancer a year ago to now, you've kept me in your thoughts and prayers. For those who want to know the result, you're welcome to follow this link to my latest Caringbridge post.
Thanks for your care and concern. I'm now cancer free.


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Poll: Do you guys want a sequel to "In George's Eyes"? Vote Now!
Author has written 53 stories for Star Wars, Alex Rider, Neopets, Animorphs, Warriors, Misc. Tv Shows, Ninja Turtles, Harry Potter, Naruto, Fullmetal Alchemist, Ouran High School Host Club, and Bleach.
-Last Updated January 18, 2012-
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Oh hai there.
I am a female university student pursuing writing in my (dwindling) spare time. In addition to writing fanfiction, I have an original novel in the works, which I hope to eventually finish editing. I am also a beta-reader here on FF.net and a peer reviewer of student papers offline. (Unfortunately, I don't get paid for either! :P)
My writing interests have diversified over the years, usually trending toward whatever fandom I'm currently most interested in. The genres I am most familiar with include your typical action/adventure epic, humor, and psychological angst, though I am tentatively venturing into romance as well. No matter the story, however, I've noticed a recurring tendency of mine to psychologically torture, maim, and generally abuse my favourite characters.
I have participated in and am a proud winner of NaNoWriMo '10 and '11!
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Hoshi no Hikari, Harry Potter/Bleach:


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Watch the teaser of Vasuvum Saravananum Onna Padichavanga starring Arts & Santhanam. M.Rajesh directs this comedy entertainer in D.Inman's music. Tamannah pairs up with Arya in the film which is his 25th.
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Hi Anon
Thanks for your question and welcome!
You may have a condition called Hyperhidrosis - which is uncontrolled excessive sweating.
You can read all about it on our Hyperhidrosis page here, including causes and treatment options: http://www.empowher.com/condition/hyperhidrosis/definition
and here is a more indepth article on treatment here: http://www.empowher.com/hyperhidrosis/content/excessive-sweating-hyperhidrosis-treatment-options
It's also possible that you may be experiencing a rather severe side effect of menopause. How old are you - do you think this may be the case?
Please take a look at both links and let me know if you think this information pertains to you. If not, we can look at other possibilities.
I look forward to hearing from you again,


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Hey guys, and welcome to another of my reviews. Today we are looking at the PPSh-41 (Pistolet-Pulemyot SHpagina) that was used by the Russians during WW II, Korean War and the Vietnam War. During World War II the PPSh-41 had a very unreliable drum magazine that carried 71 bullets that got jammed in the magazine so a box magazine was introduced in 1942 only carrying 35 bullets but an improved drum magazine was later introduced in 1944.
Instructions - https://www.instructables.com/id/Knex-PPSh-41-Instructions/
Anyway let's talk about the PPSh-41, it's not my own design since I took internal pictures from Instructables member Blue Mullet 2 and I have followed each internal picture to create this magnificent K'nex model of an PPSh-41.
The differences between my PPSh-41 and Blue Mullet PPSh-41:
. Blue Mullet 2 shoots grey connectors, mine doesn't
· The drum magazine and the trigger are completely different to Blue Mullet 2
Good Points
·Comfortable Hand Grip
· Very Realistic
· Good Iron Sights
Bad Points
·Uses Quite A Lot Of Cut Pieces
· The Whole Gun Is Flimsy
. Magazine Is Not Removable
Specifications For A Real PPSh-41
· Designed - 1920's
· Number Built - 6,000,000
· Ammo - 7.62×25mm Tokarev
· Rate Of Fire - 1250 Rounds Per Minute
· Powered - Blowback and Open Bolt
· Magazine - 35 Round Box Magazine or 71 Round Drum Magazine
. Range - Between 165 and 273 yards
Overall I 'am really love this, I like the way it is detail and its feel great when you are holding it in your own two hands. Blue Mullet 2 has defiantly made the very best PPSh-41 on Instructables so far so thank Mullet for bringing us this.
Also credit to Enickols12 because as i used his drum magazine
This Instructable was posted on my 20th birthday
In Call Of Duty: Zombies, the PPSh-41 appears in the maps Verruckt, Shi No Numa and Der Riese in the Call Of Duty: World At War and not in the re-mastered versions in Call Of Duty: Black Ops where it is only available from the Mystery Box for 950 points. It is one of the most fan favourite weapon against the zombies because of its high and rate of fire and damage in the early rounds. When it is Pack-A-Punch for 5000 points it becomes the "The Reaper" where you get more ammo, more damage, bigger magazine and a quicker rate of fire. Its is an awesome weapon for killing zombies with Speed Cola to decrease the reload time but in the very higher rounds, ammo can run low very quickly and the only way to get more ammo is through a Max Ammo power up.
Also check out my other creations and instructions
Thanks for reading, please leave a comment in the box below and subscribe


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Strategic American Oil Corp. (SGCA.OB) Profits from Advanced Technology and Partnerships
Strategic American Oil Corp., an exploration and production company with operations in Texas, Louisiana, and Illinois, draws upon an internationally recognized team of geologists, engineers, and executives, with the objective of identifying and acquiring high potential oil and gas projects, and developing them to their full potential.
To do this, SGCA has come up with and implemented a 3-tier growth program:
• Develop salable drilling prospects, retaining a carried interest to casing point
• Drill offset wells, retaining a majority of the working interest
• Develop secondary recovery (waterflood) projects
• Increase production by reworking existing producing or previously producing wells
• Develop proven undeveloped zones (behind pipes) in existing wells
• Acquire currently producing oil and gas wells
• Complete 3D seismic projects, and acquire 3D data where warranted and available
The company plans to leverage its expertise in 3D seismic and historic data evaluation to identify new and existing wells with development potential. This advanced technology allows the company to minimize exploration costs by clearly defining the geological structures before drilling.
SGCA has already identified and acquired working interests in several projects in Texas, Illinois, and Louisiana, among others, and is currently developing working relationships with well-established oil and gas companies. By so doing, the company will reduce its risk and exploration costs, while increasing exposure to new projects.
With the stabilization of the international economy, there has been an increase in demand for energy commodities, resulting in strengthening oil and gas prices. Furthermore, OPEC and international production has been decreasing, and there has been political instability in oil rich countries. At the same time, interest rates are at record lows, and restructured economies are beginning to pick up. All of these elements have helped oil and gas prices, and have opened up opportunities for the profitable use of advanced technologies and careful partnering by SGCA.


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Oct. 13, 2010
Complete Release in PDF Format
Opponent: Niagara Purple Eagles
When: Saturday, October 16
Where: Reitz Arena
Time: 2 p.m.
Opponents: Canisius Golden Griffins
When: Sunday, October 17
Where: Reitz Arena
Time: 2 p.m.
The Loyola University Maryland women's volleyball team will compete at Reitz Arena, Saturday and Sunday, against Niagara and Canisius, respectively. Both matches begin at 2 p.m. The Greyhounds have 10 matches left this season before they compete at the Metro Atlantic Athletic Championships in Lake Buena, Fla., November 18-20.
Scouting Niagara
The Purple Eagles are on a six match winning streak and are 12-8 overall, 7-1 in conference with their only loss coming on the road against Siena, 3-1. Niagara defeated the Greyhounds earlier this season, 3-0. The Purple Eagles have three seniors, five juniors, two sophomores and two freshmen. Niagara is led by Kari Honomichl who has 169 kills and Hannah Hedrick who has 164 kills. Michelle James has 710 assists and Sam Morgan leads the defense with 359 digs.
Scouting Canisius
The Golden Griffins are 10-10 overall and 6-2 in conference. They are coming off a loss at home against Iona, 3-2, last weekend. Their only other conference loss is Saint Peter's who won at home, 3-1. Canisius defeated Loyola earlier this season, 3-2. The Golden Griffins have two seniors, four juniors, four sophomores and four freshmen. Canisius is led by Samantha Good who has 226 kills, Janelle Davis has 446 assists and Allyson Severyn leads the defense with 346 digs.
Breaking Records
Nina Camaioni is 14 kills away from breaking the school record set by Becky Corb, who had 1,629 kills from 2002-2005. Camaioni holds the season school record with 539 kills, set last year. She also holds the school record for digs in a match with 36 set in 2007. Camaioni ranks second in the conference in kills with a 4.34 average a set.
Digging Away
In 22 matches so far this season, Brittany Born has a total of 298 digs, averaging 3.68 digs per set. So far in her four-year career, Born has recorded 1,878 digs. She holds the school's career record in digs, and it continues to grow. She also holds the school record in digs in a season with 626, set in 2007. In the conference, Born ranks eighth in average digs a set with 3.46.
Born to Assist
Through the first 22 matches of 2010, Aubrey Kirven has 788 assists, an average of 9.61 assists per set to rank second in the conference. She has a total of 1,990 assists (10 away from 2,000) in less than two full years at Loyola. Last season, Kirven had 1,202 assists. Kim Colavito holds the school record for career assists with 3,763 assists from 1990-1993. Kirven ranks third in the conference in assists a set with a 9.69.
Manhattan Wins In Five
The Loyola University Maryland women's volleyball team came back from being down 2-0 to lose to Manhattan, 3-2 (25-22, 25-19, 18-25, 23-25, 15-12), Sunday in Riverdale, N.Y. Senior Nina Camaioni had a double-double with 20 kills and 26 assists. Sophomore Aubrey Kirven had a double-double with 52 assists, 14 digs and three blocks.
Freshman Nicole Sarby recorded 16 kills for a .306 hitting percentage. Sophomore Katie Dircks had nine kills and five digs and freshman Jac Bullock had 10 blocks and five kills.
Win In Four
The Loyola University Maryland women's volleyball team defeated Saint Peter's, 3-1, (25-17, 25-9, 21-25, 25-18), Saturday in Jersey City, N.J. Loyola had three Greyhounds with double digit kills. Senior Nina Camaioni had a double-double with 24 kills and 12 digs. She had a .388 hitting percentage for the match.
Sophomore Aubrey Kirven had a double-double with 44 assists and 10 digs. Sophomore Katie Dircks added 12 kills and nine digs and freshman Nicole Sarby had 10 kills and seven digs. Senior Brittany Born contributed 16 digs.
Camaioni Named MAAC Co-Preseason Player of the Year
Senior Nina Camaioni was named the Metro Atlantic Athletic Conference Co-Preseason Player of the Year. This was the first Preseason Player of the Year selection and second Preseason All-MAAC Team honors for Camaioni. She was named to the All-MAAC First team after the end last season.
Camaioni Named Candidate For Lowe's Senior CLASS Award
Senior outside hitter Nina Camaioni has been named a candidate for the inaugural Lowe's Senior CLASS Award. Camaioni is one of 30 candidates for the nationwide award that honors senior student-athletes who have notable achievements in four areas of excellence - community, classroom, character and competition. Camaioni did not make the final round.
Off the court, Camaioni's honors shine just as bright. She has maintained a 3.83 grade point average during her first three years as a Greyhound, and she was named to the ESPN The Magazine/CoSIDA Academic All-District II Second Team for her academic excellence. Camaioni is on pace to graduate in May with her degree in global studies, an interdisciplinary major that combines studies of history, economics, sociology and political science.
Nicole Sarby MAAC Rookie of the Week
Sarby played in four matches during the week of September 6 and had 32 kills for a .291 hitting percentage. She also added 30 digs, for an average of 2.14 per set, and four assists. Sarby recorded six blocks during the week, including one solo block.
Her best match came against Delaware State, where she had a double-double with 13 kills and 13 digs, both career highs. She also had a career high in blocks with five.


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- Full Driveaway Facility : Simply close the full main door between the tent & vehicle, then 'roll & stow' the connection gusset, securing the awning whilst away for the day.
- Bedrooms : Optional inner
- Sleeps (max.): 2 (with optional inner)
Motorhome, Panel van or Caravan compatible, the Motordome™ Excelsior 780 drive away awning creates extra living or stand alone storage space, and you can always add the optional 2-berth inner in case guests arrive.
The Excelsior 780 has a footprint of 3.00 x 3.00m. The side 'J' doors as well as the main front door with canopy poles offers complete versatility, wherever you pitch. Built using the unique Rapidex pole system, this Motor-Dome erects in seconds and pitches in minutes.Check out our YouTube video at the bottom of this page, showing the Motordome Tourer being erected in seconds by our competition winner at Volksworld 2015. Ideal for a whole range of Motorhomes and large panel van conversions.
Now in its 4th Generation - the Motordome™ Excelsior 780 has some exciting new additions:
New Features Include:-
> Weather Weave AquaStop™ 150 Fabric
The Weather Weave Aquastop 150 fabric has been specifcally developed for use on the Khyam Motordome range of Driveaway awnings. Using the very best yarns available, the weather weave process is implemented to create a 150 Denier Ripstop fabric, offering excellent tensile strength. The introduction of evenly spaced high tensile yarns during the weaving process creates a RipStop grid adding strength and durabilty. The weaving and dyeing processes are followed by applying three Layers of polyurethane coating which enhance colour fastness and waterproof qualities of this exceptional fabric.
> ComfortPlus™
The Comfort Plus feature offers added headroom at the main door ways of the awning allowing easier and more comfortable access in and out of the awning. The Comfort Plus feature also enhances Living space and Bedroom Areas giving a greater Home from Home feel.
> EcoPitch™ Design
All Khyam Motordome driveaway awnings follow the EcoPitch standard. EcoPitch is a standard by which all the features of the awning are both ergonomically and strategically positioned to offer maximum user space and comfort for a minimum pitch space.
> Vehicle Connection Tunnel with Dual Doorway Access
Fully zipped doorways on each side of the vehicle connection tunnel provides additional access in and out of the awning.
> Current Standard Features:-
> Khyam Tailored Vehicle Connection Tunnel:-
(Design Registration 4029632)
All Khyam Motordome connection tunnels allow the sliding door of your campervan, panelvan conversion or Motorhome to open fully within the confines of the connection tunnel(*). No need to move fabric out of the way when opening the door. Uniquely shaped and tailored return panels on each side of the connection tunnel fit snuggly against the side of your camper, pegging securely into place via fully adjustable webbing pegging loops.((*)Based on a survey of the most popular Campervan, Panelvan and Motorhome models currently available on the U.K market. Always carefully check door travel prior to first time use. If in doubt contact Khyam Customer services for assistance).
> Panoramic Windows:-
Using Crystal Clear PVC the full length windows provide great Panoramic views and allow plenty of light in to create a light and airy living area.
> Twin 'J'Doors:-
Twin 'J' doors - for easier accessibility on either side of the awning.
> AirFlow Doorways™:-
The Main doorway and the secondary 'J' doorway both have a separately zipped, full length, integral mesh doorway. This allows the main door and secondary 'J' door to be opened fully exposing a full mesh ventilation panel. Ideal for mealtimes and allow for cooler living/bedroom areas during hotter weather.
> Nitelight Ready:-
An integrally sewn 1 mtr long Crystal Clear PVC zipped Pocket designed to hold the Khyam NITElight. Along with the NITElight pocket is a full cable management System allowing the NITElight cable to be routed neatly and safely out of the awning.
> Optional Accessories Available:-
> Fully Tailored 'Clip In' Groundsheets:-
Constructed from a strong and robust Polyethylene the 'Clip In' groundsheets are designed to cover the full footprint of the awning. The 'bathtub' style sides of the 'Clip In' groundsheet fold up and clip to the sides of the awning creating a comfortable and dry living area all round. All doorway sections of the 'Clip In' groundsheet have lowered threshold strips with Hi Vis hems making it easy to walk in and out of the awning. They also include a separate groundsheet for the floor area of the connection tunnel between the awning and the vehicle.
> Universal Carpets:-
Give your awning a real Home from Home feel with one of our Universal Carpet's. The Universal Carpets have a Soft but hardwearing surface layer, a padded inner foam layer for added comfort and an insulated aluminium coated base layer. Please note carpets are intended for use on top of either a fully sewn in or Clip In groundsheet.
|Full Driveaway Facility
|Simply close the full main door between the tent & vehicle, then 'roll & stow' the connection gusset, securing the awning whilst away for the day.
|Optional inner
|Sleeps (max.)
|2 (with optional inner)
|2 + 1 mesh panel with outer cover
|Rapidex® solid fibreglass/Aluminium
|Polyester Weatherweave pro
|Inner tent
|Optional accessory
|Net Weight
|Gross Weight
|Packed size
|Full Driveaway Facility
|Simply close the full main door between the tent & vehicle, then 'roll & stow' the connection gusset, securing the awning whilst away for the day.
|Optional inner
|Sleeps (max.)
|2 (with optional inner)
|2 + 1 mesh panel with outer cover
|Rapidex® solid fibreglass/Aluminium
|Polyester Weatherweave pro
|Inner tent
|Optional accessory
|Net Weight
|Gross Weight
|Packed size
Service rating By far the best company and service I have ever had Nothing was too much trouble br the team was very helpful and knowledgeable br Product this is the second Motordome Excelsior I have purchased The first one lasted me for years I only changed it because I changed my motorhome and needed a bigger tunnel thus 780 As far as I am concerned it is strong and of a good quality
Service rating Very helpful with advice in choosing the most suitable awning for my camper br Product Haven t used it in the field but erected it in the garden and it was very easy to put up with two of us Less than ten minutes first time Design seems very well thought out Joints seems a little bit vulnerable before they are locked in position and I note they are excluded from the warranty Time will tell


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Weiner Schnitzel
Be the first to review
READY IN: 10mins
Recipe by Bay Laurel
I love this because it's good and very easy to makes. It also gives me the feeling that I am showing off the little german roots that I have. It has been brought to my attention that Weiner Schnitzel is made with Veal as this recipe also can be. I just have a HUGE preference for pork Thank you. Enjoy. Moo Moo or Oink Oink. :)
See Discussion:
Ingredients Nutrition
- 1 lb bonless pork cutlet, pounded to less than 1/4 thick
- salt
- pepper
- 1⁄2 cup all-purpose flour
- 2 large eggs
- 1 tablespoon milk
- 2 cups fresh breadcrumbs
- 3 tablespoons vegetable oil
- lemon wedge
Directions See How It's Made
- Pat the pork cutlets dry with paper towels.
- Season them with salt and pepper.
- Set up a standard breading procedure in 3 shallow bowls or pie plates. Put flour in 1, eggs and milk in another, and bread crumbs in the last.
- Beat the eggs and milk together.
- Dredge each of the pork cutlets first in flour, then egg wash and then the bread crumbs.
- Transfer the coated cutlets to a platter.
- Heat a large straight sided skillet, add vegetable oil over medium-high heat.
- Carefully, transfer the coated cutlets into the hot oil to fry.
- Since they are so thin, the pork will cook very quickly, about 2 minutes per side.
- Drain the cutlets on a paper towel lined plate.
- Serve with lemon wedges.


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Acupuncture Facial Rejuvenation
The all-natural, non-surgical facelift.
Are you considering injecting yourself with neurotoxins such as Botox or pursuing more invasive therapies such as Restylne, Collagen, Laser and Surgery?
You can let go of your chronological age and rediscover the youth and vitality of younger years.
Acupuncture Facial Rejuvenation is a safe, painless, non-surgical acupuncture facelift. It is an ancient method used to slow and reverse the signs of aging.
Tsao-Lin Moy is one of a handful of acupuncturists extensively trained in the modern adaptation of this ancient art. Using advanced skills and techniques Tsao locates specific points on the face and body which can stimulate natural healing and rejuvenation.
A course of facial rejuvenation treatments can easily smooth away 5-15 years of aging.
Every year, millions of men and women rush to their dermatologists and plastic surgeons in search of perfection and a more youthful appearance. Acupuncture Facial Rejuvenation is a natural alternative and can reverse the signs of aging, smoothing lines between the nose, mouth and upper lip, softening and filling the so-called "smile lines" and "frown lines", lifting droopy eyelids, firming jowls and minimizing double chins, revitalizing skin tone and texture, and much more.
A course of Acupuncture Facial Rejuvenation treatments will address the whole body's health (mind, body and spirit), and the underlying causes of aging as well as the surface signs of stress and aging signs that show up on the face. This means that your skin will not only look younger: it will actually be healthier.
The Results from Facial Rejuvenation Surpassed My Expectations!
"I first decided to try facial rejuvenation acupuncture because I had a lot of stress in my life and I realized it had affected my skin, particularly my eyes and mouth. I looked a little droopy and saggy in some areas. I wanted to try something non-invasive to give my face a "boost," and I knew that acupuncture was effective because I had received great results from acupuncture for back pain and nerve problems. I got better sleep and it had relieved my stress.
The results from facial rejuvenation surpassed my expectations! Not only did it address the drooping and sagging, but the treatments also evened my skin tone, improved its elasticity, smoothed the texture, the creases disappeared and I looked 10 years younger! Then, when I saw the radiant beauty program, I immediately recognized the added benefit of the detox because it is very important for the skin as well as the whole body.
The results were that not just my facial skin but my whole body is more toned and radiant. People notice. Perfect strangers have walked up to me and said, "Your skin looks amazing." I recommend this program to anyone who is health conscious, wants to look their best, and wants to be able to look in the mirror and see the reflection of a more youthful version of themselves. This is not artificial beauty."
Ann R., NYC
How does it work?
Acupuncture Facial Rejuvenation:
Stimulates collagen production which increases facial elasticity and fills in wrinkles
Increases local circulation of blood and lymph to the face, moisturizing and nourishing the skin from the inside out
Improves muscle tone and dermal contraction (tightens skin)
Tightens pores
Brightens the eyes
Improves hormonal balance to help acne problems and reduce stress
When to start treatments?
Skin damage and the aging process begin long before visible signs of aging appear.
Whether you are in your 20's, 30's, 40's, 50's, 60's or beyond, no one is too young or old to benefit from the anti-aging and age-reversing effects that the Acupuncture Facial Rejuvenation protocol offers.


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…, Dataclysm: Who We Are, which he described to me as a "superset of all the stuff I did on OkTrends." With Dataclysm set for release on September 9th, it makes sense for Rudder to make his triumphant comeback to OkTrends and remind everyone how much they love his posts. But can OkCupid win back their audience after so long? The early results look promising. "We experiment on human beings!" has been tweeted over 1,500 times and shared on Facebook 4,600 times thus far. Christian, if you're reading, I'm still free to pinch hit. …
A recently published study that manipulated Facebook News Feeds has sparked outrage among users who are criticizing the ethics behind the experiment.


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Unformatted text preview: economy; businesses expanded. People started to buy more, as their spendable income increased. These policies were so effective that twenty years later, America was still reaping the benefits. Another one of Reagan's policies led to economic prosperity; he increased military spending. This policy not only created a large amount of jobs, but it contributed to the bankruptcy of the Soviet Union. More jobs leads to more spending, and that helps the economy. There was also a decrease in governmental spending in social programs which led to a decreased governmental deficit. The conservative politics of President Reagan greatly helped America's economy. He used tax cuts, increased military spending, and cutting social programs to help boost the economy. We are still reaping the benefits of some of these changes. Unfortunately other Presidents chose to change these proven politics which has led to a loss of economical benefits that this nation once experienced....
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This note was uploaded on 12/12/2010 for the course HIS 135 taught by Professor Runyon during the Spring '10 term at University of Phoenix.
- Spring '10
- runyon
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Probably what I dislike most about traveling is pre-styling outfits and it especially drags more when the destination you're traveling to is currently on the opposite time of year. Right now winter season is in full effect in Guatemala — cool mornings, gloomy afternoons, rain and plenty of humidity. So, in order for my outfits to make sense I needed to consider comfortability (of course) and slightly warm pieces yet light-weight enough to survive the sticky humidity. Solution to my style task? A quarter-length top, shorts and a layered piece make up the ideal combo.
How to Upgrade the Tee + Jeans Look for Summer
Let's do things a little different this summer and give the classic basics a new twist.
My Current Everyday Makeup Routine
Feels like summer is already here and when it reaches this point, the less cake I slap on my face. Curiosity has sparked recently and quite a few of you on Instagram have been inquiring about the makeup products I've been wearing. Keeping it light, easy and put-together tonight I'm sharing it all!
The Ultimate DIY Body Butter for Soft Healthy Skin
We hear the expression "healthy skin" always enforced and, you guessed it, for great reason. Skin/body care should be on everyone's radar and a major priority because as you know, it is the base of our exterior. If it's good on the inside it reflects on the outside! With a little added effort and extra dedication, a simple homemade body butter can make all the difference.
Current Spring 2017 Obsession: Skirts
Notice the style pattern yet?
Hint: sometimes maxi, midi or mini, flared or straight, printed or textured — s k i r t s. New Spring-inspired skirts quickly became a staple in my wardrobe. I blame their flare and ease in versatility.


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Mon-Fri 9am-6pm EST(302) 265-3830
|Product Name
|Reflexions Bar
|523.6 lb
Note: Some Assembly May be Required.
Hello Karina, Thank you for your inquiry. When purchasing this item you can http://www.furniturecart.com/customer-service/coupon-codes.html
This product has not been reviewed. You could write the first review.Read All Customer Reviews
Manufacturers Part #: 609499-609500
Brand: Pulaski Furniture
Category: Home Bars
Style: Traditional
Customer Sales Rating: 5
Manufacturer: Pulaski Furniture
Availability: Currently Out of Stock
Ships Within 2-4 Weeks
Product Condition: New Product
Please Note: Sizes and weights are approximate and may vary slightly from the ones given above. Due to differences in monitors, we cannot be responsible for variations in color between the actual item and your screen. Please be advised that we display the standard shape and(or) size in some cases; the shapes, sizes, patterns and colors may vary.


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P_IPC_01 Infection Prevention Policy
Healthcare associated infections (HCAI's) are infections that are neither present nor incubating when a patient is admitted to hospital. They are well recognised to cause morbidity and mortality. Not all infections are preventable as in many cases the outcome of an infection is dependent upon patient susceptibility. Infection Prevention and Control serves to reduce the risk of an infection spreading to a new host to an "irreducible minimum".
Clinical care is now delivered within the governance framework that is itself firmly embedded in an environment of managed risk. The fundamental principle of "Infection Prevention and Control" is the creation and maintenance of a safe environment through the development and implementation of robust guidelines and policies. Annual work programmes form the basis of arrangements for preventing and controlling healthcare acquired infections that will effectively minimise, manage or eliminate cross infection risks within the working environment and reduce the risk of the spread of infection to both patients and staff.
We have an open approach to infection prevention and control with all of our infection control documents being made publically available to staff and the public via the internet and other supporting written material such as patient leaflets. Reducing this risk has led to many initiatives which have been taken into account during the development of this policy and the associated guidelines.
Lincolnshire Community Health Services NHS Trust has a legal obligation to ensure that arrangements are in place to protect patients and staff from the risks of acquiring an HCAI during the provision of healthcare. The Trust is committed to the development of safe working practices relating to the control of infection and the spread of disease.
Staff will be provided with appropriate training to protect their health and safety when meeting the needs of the patients/clients they serve.
This overarching policy should be read in conjunction with the relevant Infection Prevention and Control clinical guidelines, policies and leaflets which may be found on the website.


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Moving Elements DJ SET Happy New Year @ VibeFM
- by Moving Elements
- 25
- 59m
- 7 years ago
a special set for VibeFM Romania (http://www.vibefm.ro) for the new year. Enjoy :)
Press play to try again.
Please update your browser or install another such as Google Chrome.
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We Honor the Best!
Thank you to our patrons! We look forward to an outstanding 2018 William Inge Theater Festival and hope to see you again!
To the reach the Inge Center, call (620) 332-5491 or e-mail firstname.lastname@example.com
What is the Inge Festival like? Media shares the experience
American Theatre magazine, April 21, 2015. "Donald Marguiles, Brooklyn Boy, Feted in William Inge's Hometown"
American Theatre magazine, April 28, 2016. "Inge Festival Brings the Theatre World to Independence"
New York Times, Aug. 5, 2009. "Out of Kansas, Into the World; A Trove of Inge Plays
New York Times, April 22, 1998. "Frank Rich Journal; Kansas Night Music"
New York Times, April 24, 1996. "Hospitality Takes Center Stage at a Town's Festival for its Native-Son Playwright"
PBS News Hour, June 12, 2006 "William Inge Theater Festival Honors Playwrights"
For an idea of all the events that happen at the William Inge Theater Festival, check out our 2017 Festival Schedule, below.
2017 Festival Sked for Pub FINAL 4-13-17.xlsx


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Tips: Click on a column heading to order the results.Use the filters to limit the number of results.
Displaying results 1–10 of 78 where Type of approaches is Training for professionals
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|Project description
|Intervention type
|Evaluation type
|Target group
|Quality level
Title: Total Quality Management for the Dependencies Treatment System (TQM 1/2000)
Summary: A description of the implementation of a quality management system which enables the measurement and evaluation of the performance and outcome of therapeutic communities. >>
|impact evaluation, process evaluation
Title: Zertifikatslehrgang "Sucht- und Gewaltprävention"
Certificate training course on addiction prevention and violence prevention
Summary: The Institut Suchtprävention in Linz (Upper Austria) developed and accreditated together with the College for higher education on social work and health (Upper Austria), the Johannes-Kepler-University Linz (Upper Austria) and the College for higher education on pedagogics (Upper Austria) three training courses on addiction prevention and violence prevention. The target group are key persons from relevant areas with different levels of knowledge. By training of these key persons, addiction prevention and violence prevention should be anchored as multidimensional common task in the society. The training courses are building on each other and are organized as modules, so they can be attended besides work. The first and shortest training course (Zertifikatslehrgang) was implemented and evaluated as pilot project from 09/2008 to 02/2010. In the year 2008 the first Zertifikatslehrgang was implemented as pilot project. 20 participants were selected. An evaluation of the pilot project as longitudinal section study with interactive questionnaires as well as participating surveillance by external students was carried out. The results showed, that the quality of the referees as well as the content were assessed very positively. Allthough persons who had already experiences were less satisfied with the training course than persons without experiences. To be able to consider this in future trainings, the concept was adapted and some referees changed. In March 2011 27 persons will start with the Hochschul- resp. Masterlehrgang, of these 7 graduated from the pilot project (Zertifikatslehrgang). >>
|process evaluation
|family, workplace, school, community
|general population
Title: "Trilhos" - Personal and social skills development programme
Summary: The TRILHOS is a comprehensive programme of prevention and intervention in the school setting within a 3 years period, considering 4 components: informative, decision-making and problem-solving, emotional regulation and communication skills. Aims to reduce the number of students who start using tobacco, alcohol and cannabis before the age of 15. >>
|outcome evaluation, impact evaluation, process evaluation
|children/young people
Title: Drug System Change Pilot Scheme (DSCPs)
Summary: The Drug System Change Pilots (DSCPs) aimed to explore new approaches to drug treatment and the broader social support needs of drug users in the community, in prison and drug-using offenders leaving prison. The pilots explored whether allowing greater freedom and flexibility at a local level would encourage partnership working and the innovative use of local resources to meet the needs of drug users and their communities. After a competitive procurement process, seven areas were selected to carry out the DSCPs with each pilot adopting different aims and approaches to system change. Pilot areas were granted funding flexibilities to explore innovative new approaches. Three broad approaches to changing system structures were taken by the pilots: single provider systems, consortium based systems and improving partnership arrangements. Four broad approaches to tackling continuity of care were adopted: integrated community criminal justice system and prison drug treatment teams, an independent case manager approach, embedding CJS teams within community drug treatment services and linking roles. To create a more personalised treatment system, either a self-directed support approach, or a single point of assessment approach, was adopted. Pilot sites also took the opportunity to focus their treatment provision on recovery and reintegration. Outcomes used to evaluate the impact of the DSCPs were the proportion of service users in effective treatment and the proportion of service users who successfully completed treatment. The evaluation found, in two pilot sites defined as whole system pilots as they aimed to affect change across the whole treatment system, a positive impact in the number of service users in effective treatment when compared to comparison areas. Although there were insignificant results for two sites in terms of the proportion of service users who successfully completed treatment, the authors note that the full impact of the pilots is unlikely to be felt for some time. Four pilots focused on improving drug treatment provision for those within the CJS exclusively. Results showed that three of these sites had statistically significant negative trends in terms of the proportion in effective treatment and a longer-term follow-up may be required to determine if the trends will persist. There was no measurable impact in successful completions for three areas and a negative impact in one site. >>
|outcome evaluation, impact evaluation
|gp, outpatient, inpatient
Title: Sub-Riscos
Summary: The purpose of this project based in Madeira, is to train professionals in drug addiction prevention and then encourage the professionals to develop their own prevention projects in at risk neighbourhoods. The projects focus on promoting protective factors and reducing the risk factors which can lead to drug use. >>
|outcome evaluation, process evaluation
|children/young people
Title: Certificate in Addiction Studies (NUI Maynooth)
Summary: The Addiction Studies course was designed to meet the needs of groups who engage directly with substance users and/or their families. The overall objective is to provide quality drug education, training and support services which develop knowledge and skills in order to enhance competencies and capacities in a variety of settings and sectors >>
|process evaluation
Title: Millennium
Summary: The Millennium programme based in Rimini, a major holiday resort attractive to young people, offers special centres where young people can go to receive support and help. Opening in 2000, the project initially set its objectives at helping 50 young people per year but in 2002 it had already reached 1200. >>
|outcome evaluation, process evaluation
|children/young people
Title: The MEAM Approach (by Making Every Adult Matter)
Summary: The MEAM Approach was designed by Making Every Adult Matter (MEAM), a coalition of four national charities (Clinks, DrugScope, Homeless Link and Mind) that are working together to improve policy and services for adults facing multiple needs, such as mental ill health, homelessness, drug and alcohol misuse, offending, family breakdown and exclusion. The MEAM Approach helps local areas design and deliver better coordinated services so that people with multiple needs can improve their wellbeing and reduce costs to the public purse. >>
|social reintegration
|outcome evaluation, impact evaluation
|United Kingdom
Title: Social Educational Programme of Alcohol and Drugs Prevention for parents
Summary: The objectives of this project are to promote the development of parental abilities and to train people to work with parents. This is achieved through the implementation of a specially designed training programme. >>
|outcome evaluation, process evaluation
Title: Family, a Context for Prevention: Parental Education
Summary: A family prevention programme which aims to improve family skills through family support and parent training programmes. The programme reached 126 families and 50% regularly attended the programme. >>
|outcome evaluation, process evaluation
Displaying results 1–10 of 78 where Type of approaches is Training for professionals
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Dear visitor,
We're currently conducting a short survey of this resource (EDDRA: Exchange on Drug Demand Reduction Action). The survey will take no more than 2 minutes and we would be really grateful for your contribution.
No, thanks — maybe some other time
Many thanks,
The EDDRA team


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I was wondering if anyone knew if the Trypsin inhibitor in sunflower seeds was reversible as I have tried to find a source of Vitamin E within the standards I am stuck with in my diet based on my problems; low oxalate, not too much of one type of vitamin, no sulfur compounds as in asparagus, or other risky natural toxins, and I decided to go with risking the aggressive lectin from this seed than other problems with other sources and I find sunflower butter to be a good source of Vitamin E and Magnesium. Anyone who can help or tried to help is greatly appreciated.
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