text:
Increased prevalence of antibiotic-resistant E. coli in gulls sampled in Southcentral Alaska is associated with urban environments
Clara Atterby, MD1,2, Andrew M. Ramey, PhD3, Gabriel Gustafsson Hall, MD1, Josef Järhult, MD, PhD1,2, Stefan Börjesson, PhD4 and Jonas Bonnedahl, MD, PhD5,6*
1Section of Clinical Microbiology and Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; 2Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden; 3US Geological Survey, Alaska Science Center, Anchorage, AK, USA; 4Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), Uppsala, Sweden; 5Centre for Ecology and Evolution in Microbial Model Systems, Linnaeus University, Kalmar, Sweden; 6Department of Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden
Background: Antibiotic-resistant bacteria pose challenges to healthcare delivery systems globally; however, limited information is available regarding the prevalence and spread of such bacteria in the environment. The aim of this study was to compare the prevalence of antibiotic-resistant bacteria in large-bodied gulls (Larus spp.) at urban and remote locations in Southcentral Alaska to gain inference into the association between antibiotic resistance in wildlife and anthropogenically influenced habitats.
Methods: Escherichia coli was cultured (n=115 isolates) from fecal samples of gulls (n=160) collected from a remote location, Middleton Island, and a more urban setting on the Kenai Peninsula.
Results: Screening of E. coli from fecal samples collected from glaucous-winged gulls (Larus glaucescens) at Middleton Island revealed 8% of isolates were resistant to one or more antibiotics and 2% of the isolates were resistant to three or more antibiotics. In contrast, 55% of E. coli isolates derived from fecal samples collected from large-bodied gulls (i.e. glaucous, herring [Larus argentatus], and potentially hybrid gulls) on the Kenai Peninsula were resistant to one or more antibiotics and 22% were resistant to three or more antibiotics. In addition, total of 16% of the gull samples from locations on the Kenai Peninsula harbored extended-spectrum cephalosporin-resistant E. coli isolates (extended-spectrum beta-lactamases [ESBL] and plasmid-encoded AmpC [pAmpC]), in contrast to Middleton Island where no ESBL- or pAmpC-producing isolates were detected.
Conclusion: Our findings indicate that increased prevalence of antibiotic resistance is associated with urban environments in Southcentral Alaska and presumably influenced by anthropogenic impacts. Further investigation is warranted to assess how migratory birds may maintain and spread antimicrobial-resistant bacteria of relevance to human and animal health.
Keywords: ESBL; pAmpC; antimicrobial resistance; anthropogenic; gull
Citation: Infection Ecology and Epidemiology 2016, 6: 32334 - http://dx.doi.org/10.3402/iee.v6.32334
Copyright: © 2016 Clara Atterby et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 20 May 2016; Revised: 22 August 2016; Accepted: 22 August 2016; Published: 19 September 2016
Competing interests and funding: The authors have not received any funding or benefits from industry or elsewhere to conduct this study.
*Correspondence to: Jonas Bonnedahl, Infektionskliniken, Länssjukhuset i Kalmar, 391 85 Kalmar, Sweden, Email: firstname.lastname@example.com
Antibiotic-resistant bacteria are becoming increasingly problematic for healthcare systems globally (1). Increased use of antibiotics in human and veterinary medicine, as well as food production systems, has resulted in the alteration of bacterial ecosystem dynamics and selection for resistance (2). Antibiotic compounds and biocides in the environment as a consequence of anthropogenic activities are increasingly under scrutiny as playing an important role in the emergence of antibiotic resistance (3). The amount of Escherichia coli in wild animals, relative abundance of integrons, and level of antibiotic resistance in the natural environment have all been correlated with proximity to human activity (3–6). However, even in places with relatively low human population density, antibiotic resistance has been identified (7). It has therefore been suggested that migrating birds could play a role in the dispersal of antibiotic-resistant bacteria in the environment (8, 9).
Numerous recent scientific investigations have focused on migratory birds, specifically gulls (family Laridae), as model species for understanding the occurrence and spread of antibiotic resistance in the environment for several reasons. First, gulls often thrive in anthropogenically influenced habitats where the level of antibiotic-resistant bacteria and antibiotic residues in the environment may be relatively high. As such, gulls may serve as reservoirs of E. coli carrying extended-spectrum beta-lactamases (ESBL, here including pAmpC) and other resistant strains, as in Portugal where 32% of gulls were carriers of ESBL, of which 98% were blaCTX-M, the most globally common type among humans (10). Second, gulls often congregate and forage in response to human activities such as fishing, sewage discharge, and waste management, providing opportunities for transmission of antibiotic-resistant bacteria between distantly related taxa. For instance, in France, 9.4% of yellow-legged gulls (Larus michahellis) were found to carry ESBL-producing E. coli and transmission between humans and gulls was suggested, as isolates from both birds and humans carried ESBL genes of the same CTX-M type (11). Third, gulls are often migratory and although they could potentially disperse antibiotic-resistant bacteria over long distances, E. coli cultured from Franklin's gull (Leucophaeus pipixcan) feces collected in Canada and Chile had genetically distinct ESBL genes, which does not support the dispersal of antibiotic-resistant bacteria between continents (12, 13). Therefore, the role of migratory birds in the long-distance dispersal of antibiotic-resistant bacteria remains unresolved.
In previous research to understand the presence and possible dissemination of antibiotic-resistant bacteria in remote regions of Alaska, sampling of glaucous gull (Larus hyperboreus) feces near the village of Barrow in 2005 did not provide evidence for antibiotic-resistant E. coli phenotypes; however, vancomycin-resistant enterococci were detected (14). Antibiotic resistance was also identified in 8% of E. coli isolates from Russia and Greenland (7). In contrast, 48% of E. coli isolates recovered from glaucous gulls using habitats adjacent to the Barrow landfill in 2010 were resistant to at least one antibiotic compound (15). Therefore, investigations to assess spatiotemporal patterns of antibiotic resistance in E. coli infecting gulls, and presence in the environment within Alaska, are necessary to understand processes driving changes in prevalence.
In this study, we tested the hypothesis that the prevalence of antibiotic-resistant bacteria in gulls is associated with anthropogenic impacts to local habitats by sampling large-bodied gulls at both urban environments and more remote locations within the same geographic region of Southcentral Alaska. Our prediction was that the incidence of antibiotic-resistant E. coli phenotypes and genotypes and detection of multi-resistant strains would be higher in samples collected from gulls associated with urban environments as compared to those collected at a more remote location within the same general geographic region. Our results will be useful for informing future investigations of dispersal and maintenance of potential bacterial pathogens by migratory birds and for understanding patterns of antibiotic resistance in bacteria infecting wildlife in Alaska.
Material and methods
Sample collection
A total of 160 fecal samples were collected in June and July 2014 from large-bodied gulls at two sites from each of two general locations within Southcentral Alaska – Middleton Island and the Kenai Peninsula (Fig. 1). Middleton Island is a remote location in Southcentral Alaska, approximately 115 km offshore from the mainland in the Gulf of Alaska. Middleton Island was once the site of an active military installation (ca., 1958–1963) but is now uninhabited by humans with the exceptions of small field crews of scientists conducting research activities on the island during summer months and Federal Aviation Administration employees (typically two) that work on the island approximately half-time year round. Middleton Island is occupied by large numbers of gulls each summer including multiple breeding colonies of glaucous-winged gulls (Larus glaucescens). Fecal samples were obtained during 22–26 June 2014 from glaucous-winged gulls at sites on the northern (59.46°N, 146.29°W) and southern (59.41–59.42°N, 146.33–146.36°W) margins of Middleton Island, near nesting colonies prior to hatch. Individual fecal samples were collected by swirling a sterile swab in fresh feces and placing in bacteria freeze media in cryovials. Samples from Middleton Island were kept cool with icepacks for 4–8 days until frozen at −80°C.
Fig. 1. Map depicting sampling locations for large-bodied gulls (circles) in Southcentral Alaska. The approximate location of Anchorage, the most populous city in Alaska, is indicated with a star.
The Kenai Peninsula is a landmass extending south of Anchorage, Alaska, the most populous city in the state, and supports numerous communities and an extensive road system. Communities with the highest human population on the Kenai Peninsula are Soldotna and Kenai, both located adjacent to the Kenai River below Skilak Lake. The Kenai River is the largest waterway on the Kenai Peninsula and supports commercial, sport, and personal-use salmon fisheries during summer. In addition to a year-round population of approximately 58,000 residents as of 2015 (United States Census Bureau), the Kenai Peninsula also receives a considerable influx of tourists each summer as well as recreational users from the nearby city of Anchorage. Samples were collected from glaucous-winged gulls, herring gulls (Larus argentatus), and potentially, hybrids of these two species on the Kenai Peninsula at the tidal flats at the mouth of the Kenai River (60.54°N, 151.26°W) and at the Soldotna landfill (60.44°N, 151.11°W) on 24 July 2014. Fecal samples were collected as previously described and kept cool until frozen at −80°C within 12 h.
Isolation of E. coli and antibiotic susceptibility testing
Eighty samples from each Middleton Island (remote location) and the Kenai Peninsula (urban location) were screened for E. coli and the resultant isolates were tested for antibiotic susceptibility. An aliquot of 100 µl from each fecal sample was incubated overnight at 37°C in 4 ml of Luria-Bertani broth (Department of Clinical microbiology, Uppsala University Hospital). Cotton swabs soaked in the broth were streaked on cystein lactose electrolyte deficient agar plates (Department of Clinical Microbiology, Uppsala University Hospital) and incubated overnight at 37°C. One presumptive E. coli isolate from each sample was collected and confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF; Bruker Corporation, Germany) as previously described (16). E. coli isolates were spread evenly on Muller-Hinton agar (Department of Clinical Microbiology, Uppsala University Hospital) and 10 antibiotic discs – ampicillin 10 µg, cefadroxil 30 µg, chloramphenicol 30 µg, nalidixic acid 30 µg, nitrofurantoin 100 µg, mecillinam 10 µg, tetracycline 30 µg, tigecycline 15 µg, streptomycin 10 µg, and sulfamethoxazole trimethoprim 25 µg (Oxoid Ltd, Hants, UK) – were placed on the plate. Inhibition zone diameters were compared to clinical breakpoints for disc diffusion provided by European Committee on Antibiotic Susceptibility (EUCAST). Currently, streptomycin and tetracycline lack EUCAST clinical breakpoints for disc susceptibility testing, therefore breakpoints for these antibiotics were defined according to the Normalized Resistance Interpretation (NRI) method (17).
For statistical analyses, samples collected from two urban sites on the Kenai Peninsula and two remote sites on Middleton Island were pooled by location. The prevalence of antibiotic-resistant isolates and proportion of isolates resistant to three or more antibiotic compounds were compared using Fischer's exact test (GraphPad Prism version 6). A P value ≤0.05 was considered significant.
ESBL and carbapenem resistance screening
Fifty randomly selected samples from each of the Kenai Peninsula and Middleton Island collections were screened for extended-spectrum cephalosporin (ESBL- and pAmpC) and carbapenem-resistant E. coli. Fecal swabs were placed in tubes with 1 mL phosphate-buffered saline and vortexed. Aliquots from each tube were transferred to two vials containing 4 mL Luria-Bertani broth with either a cefpodoxime 10-µg disc (vial 1) or a ertapeneme 10-µg disc (vial 2) and incubated overnight at 37°C. Cotton swabs soaked in the broth from vial 1 were streaked on MacConkey agar plates with cefotaxime 5-µg disc and ceftazidime 10-µg disc and from vial 2 on MacConkey agar plates with cefpodoxime 10-µg disc and ertapenem 10-µg disc (Oxoid Ltd). All plates were incubated overnight at 37°C. Colonies growing close to an antibiotic disc were identified as E. coli using MALDI-TOF. To identify E. coli isolates with ESBL- or AmpC phenotype, isolates from the previous step were prepared and spread on Muller-Hinton agar (Department of Clinical Microbiology, Uppsala University Hospital) according to EUCAST disc diffusion method for antimicrobial susceptibility testing and five antibiotic discs – amoxicillin/clavulanic acid 30/1 µg, cefotaxime 5 µg, ceftazidime 10 µg, cefepime 30 µg, and cefoxitin 30 µg – were placed on the plate according to standard protocol at the Department of Clinical Microbiology in Uppsala University Hospital. Specific inhibition of bacterial growth around the antibiotic discs was used to identify ESBL/pAmpC-phenotypes (18, 19). Isolates that displayed ESBL or AmpC phenotype were subjected to either two multiplex-PCR detecting blaCTX-M, blaSHV, blaTEM, blaOXA-1 or one multiplex-PCR detecting pAmpC genes and the specific gene variants were determined by sequencing as previously described (20). The ESBL/pAmpC-producing E. coli isolates were further tested for resistance to additional antibiotic compounds. The chosen antibiotics are either frequently used in veterinary and human medicine or are saved for treatment of infections caused by ESBL/pAmpC/carbapenemase-producing E.coli. Isolates were spread on Muller-Hinton agar (Department of Clinical Microbiology, Uppsala University Hospital) and five antibiotic discs – gentamicin 10 µg, ciprofloxacin 5 µg, meropenem 10 µg, tetracycline 30 µg, and sulfamethoxazole trimethoprim 25 µg (Oxoid Ltd) – were placed on the plate. Inhibition zone diameters were compared to clinical breakpoints for disc diffusion provided by EUCAST and the NRI method (16), as described above. In addition, all isolates were tested for colistin susceptibility using ETEST (bioMérieux, Marcy l'Etoile, France) according to manufacturer's guidelines. However, due to that the recently described plasmid encoded mcr-1 have been described to show MICs below EUCAST breakpoint and the unreliability of colistin susceptibility results with E-test all ESBL-isolates were also tested for the presences of mcr-1 (21, 22).
General resistance of E. coli in gulls sampled in Southcentral Alaska
A total of 55 E. coli isolates were recovered from 80 samples screened from the Kenai Peninsula and 60 isolates were from 80 samples screened from Middleton Island, yielding isolation rates of 69 and 75% per location, respectively (Table 1). Of the E.coli isolates recovered from the urban Kenai Peninsula, 55% (30/55) were resistant to at least one antibiotic compound, whereas only 8% (5/60) of the isolates from the remote site Middleton Island displayed antibiotic resistance (Table 1). The difference in the prevalence of isolates resistant to at least one antibiotic between the two locations was statistically significant (Kenai Peninsula vs Middleton Island, two-tailed P value <0.0001, Fisher's exact test). Additionally, 22% (12/55) of E. coli isolates from the Kenai Peninsula were resistant to three or more compounds as compared to 2% (1/60) of isolates derived from samples at Middleton Island, supporting a statistical difference in the prevalence of multi-resistant E. coli between locations (Kenai Peninsula vs Middleton Island, two-tailed Fisher's exact test, P value <0.001; Table 2). Considering antimicrobial activity in all E.coli isolates from the two areas, resistance to eight different antibiotic compounds could be found in Kenai Peninsula samples as compared to five different antibiotic compounds in Middleton Island isolates (Table 3). All of the E. coli isolates from both sample locations were susceptible to tigecycline.
|Number of isolates resistant to (%):
|Location (n=)
|Ampicillin (%)
|Cefadroxil (%)
|Chloramphenicol (%)
|Nalidixic Acid (%)
|Nitrofurantoin (%)
|Mecillinam (%)
|Tetracycline (%)
|Tigecycline (%)
|Streptomycin (%)
|SXTa (%)
|Kenai Peninsula (n=55)
|15 (27)
|9 (16)
|4 (7)
|9 (16)
|7 (13)
|8 (15)
|24 (44)
|0 (0)
|8 (15)
|5 (9)
|Middleton Island (n=60)
|1 (2)
|1 (2)
|0 (0)
|3 (5)
|0 (0)
|0 (0)
|3 (5)
|0 (0)
|1 (2)
|0 (0)
Phenotypic and genotypic testing of extended-spectrum cephalosporin-resistant E. coli (ESBL and/or pAmpC)
Out of 50 samples screened from the Kenai Peninsula (urban location), three E. coli isolates that displayed ESBL phenotype and five E. coli isolates that displayed AmpC phenotype were found. The ESBL isolates harbored blaCTX-M-15 and blaTEM-1 and the pAmpC isolates harbored blaCMY-2 (Table 4). Three ESBL/pAmpC-producing E. coli isolates were resistant to at least one other antibiotic compound and all were negative for mcr-1 via PCR (Table 4). On the Kenai Peninsula, all eight ESBL/pAmpC isolates were found among the gull samples from the Soldotna landfill site. No ESBL/pAmpC isolates were found at the Kenai River site or on Middleton Island (Table 4). No suspected carbapenem-resistant E. coli isolates were found.
|Isolate ID
|blaCTX-M-15; blaTEM-1
|blaCTX-M-15; blaTEM-1
|blaCTX-M-15; blaTEM-1
Through our investigation of antibiotic-resistant E. coli derived from large-bodied gulls at two locations in Southcentral Alaska with different levels of anthropogenic influence, we observed differences in the prevalence of antibiotic-resistant and ESBL/pAmpC-producing E.coli. Thus, although our study design is correlative in nature, our results support the hypothesis that anthropogenic inputs may be a factor in determining the level of antibiotic resistance among E. coli infecting large-bodied gulls in Southcentral Alaska.
The higher incidence of antibiotic resistance detected in E. coli isolated from large-bodied gulls on the Kenai Peninsula relative to Middleton Island is likely, at least partially, a function of inputs from inhabitants and visitors of the towns of Soldotna and Kenai, urban areas in close proximity to sampling sites at the Soldotna landfill and mouth of the Kenai River. Although neither Soldotna nor Kenai are major metropolitan areas, direct inputs of antibiotic- resistant bacteria and biocides/antibiotic residues, which may lead to the emergence of antibiotic- resistant strains, are likely released into the environment via sewage treatment and the local landfill at higher rates as compared to areas lacking large permanent human settlements. Accordingly, the likelihood that gulls may encounter antibiotic-resistant E. coli or plasmids conferring resistant genes from anthropogenic sources via waste management practices may be higher in these more urban environments as compared to more remote sites. Food animal production occurs at low levels in Alaska and therefore is less likely a major contributor to antibiotic resistance in the area (23).
The prevalence of antimicrobial-resistant E. coli detected in gulls at Kenai Peninsula sites (55%) was similar to that found in yellow-legged gulls in France (47%) (11) and the most recent assessment of gulls at Barrow, Alaska (48%) (15), areas in close proximity to human settlements providing anthropogenic inputs into the environment. Additionally, the finding that all ESBL/pAmpC-harboring E. coli isolated in this study were detected among gull samples collected at Kenai Peninsula, including globally disseminated blaCTX-M-15, is similar to the recent detection of blaCTX-M in Barrow, Alaska at a sampling site in close proximity to the local landfill (15). As blaCTX-M-15 and blaCMY-2 are relatively common in humans and livestock in the USA (24, 25), it is unsurprising to find these enzymes in gulls inhabiting Alaska landfills. Further studies to assess the occurrence of antibiotic resistance and antibiotic compounds in the soil and water around the Soldotna landfill may help to provide inference regarding the acquisition of antibiotic-resistant bacteria by gulls in this area.
The relatively low level of antibiotic resistance detected in E. coli isolated from glaucous-winged gulls at Middleton Island is likely a reflection of the geographic isolation of this location from mainland North America and a lack of anthropogenic input of antibiotic-resistant bacteria and/or antibiotic compounds. In a survey from the remote Commander Islands (Russia) in the Bering Sea, Hernandez et al. found 4% (6/145 isolates) of E. coli isolated from seabirds, including glaucous-winged gulls, were resistant to one or more antibiotic compounds (26), comparable to the level found in gulls at Middleton Island (8%). Thus, it appears that glaucous-winged gulls sampled at remote breeding sites have relatively little exposure to antibiotic-resistant bacteria, or compounds driving their emergence, during the breeding season. The detection of some level, albeit low, of antimicrobial resistance among E. coli cultured from glaucous-winged gull samples collected at Middleton Island suggests that either low levels of resistance may be maintained among bacteria infecting wild birds in the absence of anthropogenic inputs or that resistant bacterial strains arrive at breeding grounds via migrating gulls returning from wintering and staging areas. It should be noted, however, that levels of antibiotic resistance in E. coli among avian populations are not static. The observed prevalence of ESBL-producing E. coli in gulls sampled at Barrow, Alaska has increased between 2005 and 2010 (15). Thus, Middleton Island could be an informative site for future assessments aiming to address the regional and global dissemination of antibiotic-resistant genes through time.
Although differences of antibiotic resistance levels among E. coli infecting gulls at two Southcentral Alaska locations are likely directly influenced by bacteria and plasmids from human sources, the role of antibiotic residues in the environment driving the development of resistance in wild birds needs to be further investigated. Furthermore, whether birds can maintain antibiotic-resistant E. coli for long durations in the absence of human impact and disperse such bacteria via migration remains unclear and is worthy of further study. Finally, given the relatively high prevalence of antibiotic resistance detected in large-bodied gulls on the Kenai Peninsula (i.e. 55% of isolates tested) and the geographic and temporal proximity of our sampling site at the mouth of the Kenai River to a popular personal-use sockeye salmon (Oncorhynchus nerka) fishery, additional research may be warranted to understand the risk for human bacterial E. coli infections via environmental transmission at this site during summer.
We appreciate field help provided by Brianna Williams and Morgan Walker and laboratory support provided by Jenny Isaksson, Badrul Hasan, and Henrik Reutherborg. We appreciate manuscript reviews provided by Christina Ahlstrom and John Pearce. We are grateful to John Reed for assistance with the preparation of Fig. 1. We thank Scott Hatch for logistical support while sampling on Middleton Island. This work was funded, in part, by the US Geological Survey through the Contaminants Biology Program of the Environmental Health Mission Area. None of the authors have any financial interests or conflict of interest with this article. Any use of trade names is for descriptive purposes only and does not imply endorsement by the US government.
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Sheffield Childrens NHS Foundation Trust
Sheffield Childrens NHS Foundation Trust
Sheffield Hallam University and Sheffield Childrens Nhs Foundation Trust | Date: 2017-06-28
A hand-held respiration monitoring device configured to measure the breathing pattern of a patient so as to output respiration rate based data. The device comprises a sensor to be sensitive to a respiration airflow velocity flowing through the device with an identification of the change in the velocity being filtered by high and lowpass filters.
Sheffield Hallam University and Sheffield Childrens Nhs Foundation Trust | Date: 2017-02-20
Disclosed is a hand-held respiration monitoring device configured to measure the breathing pattern of a patient so as to output respiration rate based data. The device comprises a sensor to be sensitive to a respiration airflow velocity flowing through the device with an identification of the change in the velocity being filtered by high and lowpass filters. A method of respiration monitoring is also disclosed.
James P.D.,Queen's University |
Goodeve A.C.,University of Sheffield |
Goodeve A.C.,Sheffield Childrens NHS Foundation Trust
Genetics in Medicine | Year: 2011
Von Willebrand disease is a common inherited bleeding disorder characterized by excessive mucocutaneous bleeding. Characteristic bleeding symptoms include epistaxis, easy bruising, oral cavity bleeding, menorrhagia, bleeding after dental extraction, surgery, and/or childbirth, and in severe cases, bleeding into joints and soft tissues. There are three subtypes: types 1 and 3 represent quantitative variants and type 2 is a group of four qualitative variants: (1) type 2A-characterized by defective von Willebrand factor-dependent platelet adhesion because of decreased high-molecular-weight von Willebrand factor multimers, (2) type 2B-caused by pathologically increased von Willebrand factor-platelet interactions, (3) type 2M-caused by decreased von Willebrand factor-platelet interactions not based on the loss of high-molecular-weight multimers, and (4) type 2N-characterized by reduced binding of von Willebrand factor to factor VIII. The diagnosis of von Willebrand disease requires specialized assays of von Willebrand factor and/or molecular genetic testing of von Willebrand factor. Severe bleeding episodes can be prevented or controlled with intravenous infusions of virally inactivated plasma-derived clotting factor concentrates containing both von Willebrand factor and factor VIII. Depending on the von Willebrand disease type, mild bleeding episodes usually respond to intravenous or subcutaneous treatment with desmopressin, a vasopressin analog. Other treatments that can reduce symptoms include fibrinolytic inhibitors and hormones for menorrhagia. © 2011 Lippincott Williams & Wilkins.
Goodeve A.C.,University of Sheffield |
Goodeve A.C.,Sheffield Childrens NHS Foundation Trust
Blood Reviews | Year: 2010
The common autosomally inherited mucocutaneous bleeding disorder, von Willebrand disease (VWD) results from quantitative or qualitative defects in plasma von Willebrand factor (VWF). Mutation can affect VWF quantity or its functions mediating platelet adhesion and aggregation at sites of vascular damage and carrying pro-coagulant factor VIII (FVIII). Phenotype and genotype analysis in patients with the three VWD types has aided understanding of VWF structure and function. Investigation of patients with specific disease types has identified mutations in up to 70% of type 1 and 100% of type 3 VWD cases. Missense mutations predominate in type 1 VWD and act through mechanisms including rapid clearance and intracellular retention. Many mutations are incompletely penetrant and attributing pathogenicity is challenging. Other factors including blood group O contribute to low VWF level. Missense mutations affecting platelet- or FVIII-binding through a number of mechanisms are responsible for the four type 2 subtypes; 2A, 2B, 2M and 2N. In contrast, mutations resulting in a lack of VWF expression predominate in recessive type 3 VWD. This review explores the genetic basis of each VWD type, relating mutations identified to disease mechanism. Additionally, utility of genetic analysis within the different disease types is explored. © 2010 Elsevier Ltd.
Sobey G.,Sheffield Childrens NHS Foundation Trust
Archives of Disease in Childhood | Year: 2015
The term Ehlers-Danlos syndrome (EDS) encompasses a group of inherited connective tissue disorders. The manifestations of EDS can be seen in skin, joints, blood vessels and internal organs and vary from mild to severe and life threatening. Each subtype is a separate and different condition. The genetic basis of many subtypes has now been elucidated, confirming heterogeneity. An awareness of the different conditions within this group is the starting point towards accurate diagnosis. Accurate elicitation of history and clinical signs is vital in selecting the correct confirmatory investigation. Skin biopsy with electron microscopy can be helpful in the decision process of whether and when to perform genetic testing. Correct diagnosis within the EDSs allows targeted management, family screening and prenatal diagnosis.
Bonham J.R.,Sheffield Childrens NHS Foundation Trust
Journal of Inherited Metabolic Disease | Year: 2013
The early detection offered by newborn screening for phenylketonuria clearly demonstrates the benefits for patients with inherited metabolic disorders of well organised screening programmes. It is therefore perhaps surprising that 20 years after the introduction of electrospray MS/MS methods to support expanded newborn screening that considerable international variation in practice, not linked to economic factors, exists. It is likely that the commonly used criteria to assess the suitability of a disorder for screening need to be re-appraised as they apply to rare disorders. In addition, national differences in the pattern of policy making may influence the strategy adopted and these different approaches need to be scrutinised more closely. Despite this contextual variation a number of real issues do need to be addressed as the range of conditions included in screening programmes continues to increase. These include the need for well organised outcome studies based upon agreed case definitions and comparable treatment regimens; the need for appropriate information for parents to support them before and during the screening odyssey; an improved understanding of the impact of false positive results and in particular a clearer understanding of the way in which some of the problems resulting from false positive results can be avoided or ameliorated; the challenge offered by mild or atypical screen positive cases and the consequent design of proportionate treatment options. A thorough understanding of the genetic, biochemical and clinical features of screen positive cases supported by effective international outcome studies is required to optimise both screening and treatment strategies. © 2013 SSIEM and Springer Science+Business Media Dordrecht.
Roberts J.,Sheffield Childrens NHS Foundation Trust
Current Opinion in Urology | Year: 2010
Purpose of review: Hypospadias surgery has been in continuous evolution for many years with steadily improving reported results. Despite this many unanswered questions on its cause, management and outcomes remain. Recent research has done little to clarify most matters. Recent findings: There is increasing evidence of a balance of genetic and developmental factors in the development of hypospadias, but there is doubt whether the incidence of hypospadias is increasing or not. Many technical aspects of hypospadias repair and variations of perioperative management seem to have little effect on outcome, whereas the age at which surgery is performed may. Although efforts are being made to relate anatomical findings to outcome, a lack of objective assessment and standardization is a handicap. Severe hypospadias, particularly that associated with significant chordee, remains challenging although strategies for management are being developed. The future may lie in development of autologous tissue culture for these severe cases. Summary: Further development of hypospadias surgery would benefit from objective, standardized methods of describing anatomy and outcome measures to facilitate effective comparison of techniques and procedures. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Sobey G.,Sheffield Childrens NHS Foundation Trust
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2014
All clinicians need to be aware of EDS and its variable presentations that, in some types, can be life threatening. Recognition of EDS can allow accurate diagnosis by genetic testing, genetic counselling and specific, appropriate management and follow-up. © Royal College of Physicians 2014. All rights reserved.
Goodeve A.C.,University of Sheffield |
Goodeve A.C.,Sheffield Childrens NHS Foundation Trust
Blood | Year: 2013
In this issue of Blood, Johnsen et al have analyzed the frequency of coding sequence variants in the von Willebrand factor gene (VWF) and have identified 7 missense variants independently associated with levels of von Willebrand factor (VWF) or factor VIII (FVIII).1 Several rare missense variants have been previously identified, predominantly in European patients with von Willebrand disease (VWD),2,3 and some have now been reported to be common African American sequence variations. Copyright © 2011 by The American Society of Hematology; all rights reserved.
Hill C.L.,Sheffield Childrens NHS Foundation Trust |
Baird W.O.,University of Sheffield |
Walters S.J.,University of Sheffield
Health and Quality of Life Outcomes | Year: 2014
Background: Osteogenesis Imperfecta (OI) is a disease with varying severity affecting physical, social and emotional well-being of the child and their family. There is no existing evidence on how the OI population regard their quality of life (QoL). The main aim of this study was to determine how OI impacts on the quality of life and well-being of children and their family. It is the first stage of a larger project to develop a disease specific quality of life measure for children with OI.Methods: Purposive sampling was used to cover the diversity of the OI population. Twenty-five qualitative interviews were undertaken with children (n = 10), parents (n = 10) and health professionals (n = 5). Interviews were digitally recorded and transcribed verbatim. Significant themes were identified, extracted and organised, undergoing framework analysis.Results: Six main themes were identified; being safe and careful, reduced function, pain, fear, isolation, independence. There was a large amount of agreement between the three groups of interviewees, although discrepancies did occur between parents and children, with regard to the themes independence and fear.Conclusions: This data presents the first step in developing items for a disease specific QoL measure for children with OI. Several of the themes uncovered showed similarity to other QoL measures, but the addition of being safe and careful, particularly in relation to fractures, demonstrated the need for a disease specific measure for children with OI. © 2014 Hill et al.; licensee BioMed Central Ltd.

subset: commoncrawl


text:
This is a full-time one year course throughout which you will learn from a combination of school placements and taught sessions. Placements are carefully structured to help you gradually build experience and develop confidence as an effective teacher. During your time in the programme you will be given the opportunity to:
Become an excellent primary teacher, with specialist expertise in Mathematics, who creates meaningful learning across all aspects of the primary curriculum;
Become an advocate for Mathematics and inspire pupils and teachers in this subject;
Benefit from high quality training with experts in primary education and mathematics, both at BGU and across our partnership of schools.
Click here for important information about this course including additional costs, resources and key policies.
Award: Postgraduate and Professional graduate
Duration: 1 year full-time
Start Date: September
Typical Offer: 2:2 degree classification and we advise around 5+ days experience
Institution Code: B38
UCAS Code: X00G
About the course
In the Williams report, 2008 the aspiration of having a Mathematics specialist in all primary schools was a key recommendation. This course offers you an opportunity to qualify as a primary school teacher with additional expertise in Mathematics, so that you can be an advocate for this subject in school and share your enthusiasm and passion for the subject.
The PGCE Primary Mathematics Specialist (with QTS) will enable you to develop your understanding of all the National Curriculum subjects in the primary phases, with an additional focus upon Mathematics. This will prepare you for your NQT year and enable you to have additional skills and expertise to bring to your first teaching post.
You will train to teach across the 5-11 age range in Key Stages 1 and 2 and you will be assessed against the Teachers' Standards. You will also have experience in the age range 3-5 and in Key Stage 3. You will study PGCE modules that will help you to develop your understanding of learning and teaching in the primary classroom, with a focus upon Mathematics.
Entry requirements
You will normally need:
- GCSEs at grade C or above (or equivalent) in English Language, Mathematics and a Science at the time of application
- an honours degree at a 2:2 classification or above (Where the degree result is to be awarded in the year of application, we will require a predicted degree classification as part of an academic reference provided on the application)
- Experience – please see information below
- Skills Tests in Numeracy and Literacy
- Declaration of Health
- DBS (formerly the CRB) Enhanced Disclosure
When shortlisting for interview, we will consider the following aspects of your qualifications:
- GCSE grades (or equivalents) and relevance of subjects
- A Level grades (or equivalents) and relevance of subjects
- Degree Class and relevance of content
- Additional relevant qualifications
You must be able to evidence successful completion of your GCSE qualifications by July 31st 2016 for September 2016 entry. We are unable to consider applications with a pending GCSE qualification if the final result cannot be evidenced by July 31st. Please see our list of accepted equivalents.
In addition to the academic entry requirements above you will ideally have at least one of the following:
- GCSE at grade A or A* (or equivalent qualification) in mathematics
- A level (or equivalent qualification) in mathematics
- A relevant degree with an aspect of mathematics included (for example, mathematical statistics, economics, Psychology).
Experience in a relevant setting is important as it will help you to make sure that you are aware of the role of a teacher in the twenty-first century. The course is intensive and demanding and you need to be very sure that you understand and are suited to a career in the teaching profession. It is also important to obtain as we look for evidence of recent experience on your application form, and you will also need to talk about your recent experience in a relevant setting at interview, reflecting on what you have learned.
When shortlisting for interview, we will consider the following aspects of your experience:
- Days in school observing practice, recency and breadth
- Days of teaching
- Other relevant work experience
As a general rule, we advise around 5+ days in a relevant setting would be a good starting point for you to get an interview for the Primary PGCE.
School-based reference are required as part of the application process, however, please be aware that we are not able to accept references from relations working in the same setting.
Skills Tests
All trainee teachers are required to pass skills tests in numeracy and literacy before they can be recommended for the award of Qualified Teacher Status (QTS). Applicants to ITT courses which start after 1 July 2013 will be required to pass the skills tests before starting their course and this will be a condition of your offer if it applies to you.
The numeracy and literacy skills tests do not replace the GCSE grade C equivalence entry requirement and are taken online at any of approximately 150 test centres throughout the UK. If successful at the interview stage, this will form part of your conditions of offer. Please click here for further information.
Disclosure Barring Service (DBS) – formerly the CRB and Health
In addition you will be required to obtain a satisfactory Declaration of Health Form, or if required, a medical examination. In addition, all students will need to pay £57.20 for an Enhanced Disclosure from the Disclosure and Barring Service (DBS) (formerly the Criminal Records Bureau (CRB)). A successful Enhanced Disclosure is required before commencing the course.
If you have any questions about the entry requirements for this course, please contact our Enquiries team for advice on +44 (0) 1522 583658 or email email@example.com.
BGU is committed to widening access and participation and we adhere to a strict policy of non-discrimination.
Accreditation for Prior Learning
If you've recently completed or studied a particular module as part of a previous qualification, this may mean that you're not required to undertake a particular module of your BGU course. However this must be agreed in writing and you must apply for this.
Fees, Funding, Scholarships and Bursaries
There are financial incentives for postgraduate non-salaried teacher training courses in 2017 / 18. For further information and clarification regarding eligibility please visit the Get into Teaching website.
We offer a mix of lectures, seminars, tutorials, practical workshops independent study and school-based training. Assessments include written assignments and make strong links between theory and practice.
Modules studied on this course at present
- Learning and Teaching
- Classroom Focused Development
- Learning and Teaching
- Classroom Focused Development


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Killzown Invades – Gateway Geek Fest – Part 2By DJ Killzown Jones in Culture
Killzown returns to the Gateway Geek Fest show floor to show you the folks at home more of what you missed. If you missed the last episode of Killzown Invades GGF click here and come back when your finished watching it so you're all caught up. Gateway Geekfest will be back next year August 5th – 7th 2016 with more information to be announced soon. Check out the video below and then be sure to visit www.gatewaygeekfest.com/ for everything GGF. Keep with Killzown on Twitch, Twitter, Facebook, Instagram, Google+ and subscribe to his channel on Youtube. Thank you for watching and make sure to keep it locked to RGN for your event news and coverage.
Source – djkillzownjones.comFollow RealGamerNewz: YouTube | Facebook | Twitter | Google+ | RSS


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Thanksgiving Chapel
Selma University is known for their spirit-filled chapel
services and this week was no different. In reverence of Thanksgiving,
Selma University held their weekly chapel Tuesday, instead of their regularly
scheduled Wednesday Service. Our own, Dr. Alvin Cleveland brought the
message for the service and he was backed up by the Selma University Choir
and a few faculty and staff members. The theme for the services was
centered on Thanksgiving, and the importance of the word. Selma
University Administration would like to wish each of you a Happy Thanksgiving.
©2017 Selma University. All Rights Reserved.


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Coupon Activated!
Being a handyman or a blue collar worker means that your tool storage needs to provide you with quick and convenient access to all of your tools. At Overstock.com, we carry a wide variety of toolboxes, workbenches, sheds, and belts, all of which are constructed to help you conveniently organize and safely store all of your favorite tools. Browse our selection from name brands such as DeWalt, Excel, and Stack-On to find the storage solutions that are perfect for you.
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New Delhi/Helsinki: India's Aircel will sell the two latest handset models of British phone maker INQ Mobile as they try to tap surging demand for mobile social networking in the fastest growing major mobile market.
The deal is a milestone for INQ Mobile, a unit of Hong Kong's Hutchison Whampoa, which so far has sold its phones mostly through Hutchison's operators in different countries.
The INQ Mini 3G and the INQ Chat 3G will be available later this week, the companies said.
INQ is benefiting from its early move to make cheaper phones for connecting to social networks and the Internet in general — a move large handset makers such as Nokia Oyj and Motorola Inc are only now following.
INQ models integrate key features of Facebook and other social networking sites into the phone's address book, removing the need to separately log on to the service.
The INQ Mini 3G is the first mass-market phone with an Internet-based Twitter client. The phone will use Internet connections for sending the 140-character messages, called Tweets.
User numbers of mobile Facebook grew more than five-fold in India last year, with the country's top social networking site Orkut seeing almost three-fold growth, according to Opera Software, maker of the most used mobile browser in India.


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I have looked online and all I can find is either a cheap set meant for very little kids or an expensive set meant for teenagers. I am looking for something in the middle for my 6 year old. Any suggestions?
Asked by JeremysMom at 9:00 PM on Nov. 30, 2010 in ShoppingLevel 35 (75,344 Credits)
Answer by LindaClement at 12:31 PM on Dec. 3, 2010
Next question in Shopping
Do you make hair bows?
Next question overall
(General Parenting)
What should I get her???


text:
Proliferation Control Regimes: Background and Status
Description: This report provides background and current status information on multilateral regimes established to restrict trade in nuclear, chemical, and biological weapons and missile technologies, and to monitor their civil applications. Congress may consider the efficacy of these regimes in considering the potential renewal of the Export Administration Act, as well as other proliferation-specific legislation in the 111th Congress.
Date: October 18, 2010
Creator: Nikitin, Mary Beth; Kerr, Paul K. & Hildreth, Steven A.
Item Type: Refine your search to only Report
Partner: UNT Libraries Government Documents Department


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Fetty Wap Receives Three Citations After Motorcycle Crash
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Migos take it to the streets.
Float, float on.
PRhyme 2?
Meek can't let that slide, can he?
Young Thug isn't shy about wearing attire for ladies.
Flow is charged in a new indictment.
Let's just say the student body was hype.


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Dandruff is a broad term referring to white flakes on the scalp and in the hair. While the symptoms may appear much the same, there are many causes, including over-production of skin cells, dry scalp, fungal infection and seborrheic dermatitis. Seborrheic dermatitis, known as cradle cap in babies, also produces greasy patches on the scalp. The cause of is not known, but it's believed to be related to hormones or overgrowth of a fungus commonly found on the scalp. The best treatment for dandruff is shampoo containing specific ingredients.
Read the ingredients on shampoo bottles. Dandruff caused by over-production of skin cells due to fungus or seborrheic dermatitis responds to zinc pyrithione, selenium sulphide and ketoconazole. The best shampoos contain these active ingredients in combination with other additives.
Compare shampoos for the amount of the active ingredient. Read the full instructions for each brand. Selenium sulphide is considered a stronger treatment than zinc pyrithione. Ketoconazole is a synthetic anti-fungal agent also used to treat fungal infections, such as tinea versicolor, found on other areas of the body. Compare the characteristics with your symptoms to determine the best dandruff shampoo for you.
Use a shampoo containing tea tree oil if you prefer natural ingredients. Tea tree oil is a natural anti-fungal agent effective against dandruff caused by the yeast Pityrosporum ovale. Shampoo containing five percent tea tree oil reduces the over-production of skin cells caused by this yeast.


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Rory's Story Cubes Max
9 cubes, 54 images, 10,000,000 combos, infinite stories...
Join all nine images to make a story! Rory's Story cubes are a visual, tactile story generator that sparks imagination for all ages. Can be used in groups and pairs, or individually. The large cubes (each face approx 3 cm x 3 cm) facilitate easy group participation. Use them with the Talking Photo Album to create stories that can be recorded, revisited, and used to develop written work if desired.
Write a reviewRating: Bad Good
Price: £19.99 - £7.99 ex vat
£9.59 inc vat
£9.59 inc vat


text:
We are continually engaging with the community through consultation on a wide range of matters, and with information sessions, where stakeholders can speak directly to our staff and discuss their specific concerns.
The International Maritime Organization (IMO) is the United Nations agency with responsibility for setting and maintaining international ship safety standards. Australia is a key player in the IMO having been elected to its governing Council for more than 45 years.
Our involvement with the international community allows us to work closely with other countries to ensure that international safety standards meet our high expectations. We do this by negotiating new and amended standards and conventions on a broad range of issues.


text:
This is why I write: I am loved. This is how I love: I am loved. A Divine Storyteller dreams my way, I choose to join the cast, and my love does too. We are changing, slowly becoming the characters envisioned by the Master Storyteller. We see Him emerging in our transformations. Our words are not adequate, but my love, the believer in recording the words within me, eagerly joins and encourages this project. I am thrilled to share some of my life, some of The Creator's life, and my love's life. I am loved, I will write.
Tuesday, July 20, 2010
A little project
Labels: creative writing, wedding
4 comments:
Wow! I was disappointed to get to the last page...I wanted to read more! what a great way to forever mark your "testament"ReplyDelete
Also, thanks for introducing me to blurb last summer. Emmma and I made a book for Harold for Christmas that we all really treasure.
come to the wedding and you'll get the full version ;)ReplyDelete
Wow, Eleanor, that's one amazing story and one incredible book. Thanks for posting it here for all of us to read and be blessed by. I love the honesty of your story.ReplyDelete
My husband and I just finished a book on blurb.com for his dad -- it was a fun project to work on together...and his dad is truly treasuring it!
Wow, this is just beautiful! Such a lovely idea.ReplyDelete
Subscribe to: Post Comments (Atom)


text:
Sofas Center. Thursday , August 24th , 2017 - 08:04:35 AM
Lawson Style Sofa: These sofas are the version of tuxedo sofa of the 20th century. These sofas are specially designed for comfort. These sofas are designed where other than back comfort, large sofas are placed so that person can shift it accordingly as per his/her ease and comfort. These sofa project an informal and a casual look to anyone who takes glance over it. They are available in different sizes and designs. Just as the main feature of it is placing large cushions so you should prefer that the shade of sofa is basic and light so that you can put bright and colorful pillows over it to make it look more appealing.
When purchasing a sofa, it is easy to get confused or frustrated at the sheer range of colours, materials and styles, not to mention the various levels of quality and pricing. Be careful not to make a decision on impulse or out of frustration. Here are a few tips to make the process simple and ensure that you don`t end up regretting your purchase.
The key to a comfortable small sofa sleeper is all in the mattress. Some small and full size sleeper sofas have paper thin mattresses and springs sticking into the back. Most of us have experienced the dreaded sleeper sofas of old. Most sleeper sofas today are much better than the metal filled, spring loaded sleeper sofas of old. Still, the average sleeper sofa sold today is not what you would call comfortable either. Other small couch sleepers are incredibly comfortable and easy to lay on.
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Any content, trademark/s, or other material that might be found on this site that is not this site property remains the copyright of its respective owner/s. In no way does Mezomorf claim ownership or responsibility for such items, and you should seek legal consent for any use of such materials from its owner.


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Level 1 - The easiest to install graphics. If you've ever stuck a sticker on a notebook or applied a bumper sticker to your car, you can handle this!
Tools needed: Squeegee or similar item.


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One word can be worth many. A few painted wooden letters perched atop a white dresser, simple mantel, or picture ledge let you say how you feel. If love isn't is the air, perhaps hope, faith, or calm is.
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I know a lot of us have Monday off and the weather isn't supposed to be too cold ...
If you planned on heading over to Pullen Park for some play, here's your reminder that the park's popular train is closed for annual maintenance through Friday, Jan. 20.
The park's kiddie boats and pedal boats both are closed for the season, scheduled to reopen in March.
But the rest of the park is open for business. The carousel will remain open for rides from 10 a.m. to 5 p.m., daily. The playground is open from dawn to dusk, daily.
Pullen Park is at 520 Ashe Ave. near downtown Raleigh.


text:
Director – Actuarial and Data Sciences
Job Details
Job Title: Director – Actuarial and Data Sciences
Merck & Co., Inc. Kenilworth, N.J., U.S.A. known as Merck in the United States and Canada, is a global health care leader with a diversified portfolio of prescription medicines, vaccines and animal health products. The difference between potential and achievement lies in the spark that fuels innovation and inventiveness; this is the space where Merck has codified its legacy for over a century. Merck's success is backed by ethical integrity, forward momentum, and an inspiring mission to achieve new milestones in global healthcare.
Merck is on a quest for cures and is committed to being the world's premier, most research-intensive biopharmaceutical company. Today, we're doubling down on this goal. Merck Research Laboratories is a true scientific research facility of tomorrow, and will take Merck's leading discovery capabilities and world-class small molecule and biologics R&D expertise to create breakthrough science that radically changes the way we approach serious diseases.
The Economic & Data Sciences (EDS) Department in the Merck Center for Observational and Real-world Evidence (CORE) is looking for a Director of Actuarial & Data Sciences to be responsible for planning, designing, and implementing actuarial and data science methodologies to meet the value evidence needs of payers, health systems, and clinicians. This includes applying actuarial and data science methods to generate value evidence relevant to payers and to evaluate alternative value based contracting models.
The job duties include the following:
We are seeking an individual that is comfortable working independently and can initiate innovative projects that bridge actuarial science, data science, and HTA methodologies. The individual should also be comfortable solving complex problems across multi-functional teams. Finally, we are looking for an individual that educates and influences multi-functional teams on the value of actuarial methods in developing value evidence for our customers.
Education Requirement:
Required Experience:
Preferred Experience:
Your role at Merck is integral to helping the world meet new breakthroughs that affect generations to come, and we're counting on your skills and inventiveness to help make meaningful contributions to global medical advancement. At Merck, we're inventing for life.
If you need an accommodation for the application process please email us at email@example.com.
Search Firm Representatives Please Read Carefully:
Merck & Co., Inc. is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at Merck via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Merck. No fee will be paid in the event the candidate is hired by Merck as a result of the referral or through other means.
For more information about personal rights under Equal Employment Opportunity, visit:
Job Quantitative Sciences Generic
Primary Location NA-US-PA-Upper Gwynedd
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Employee Status Regular
Number Of Openings 1


text:
Type: News Clips
Law360, New York (January 06, 2012, 7:37 PM ET) - Reed Smith LLP finessed plaintiffs in multimillion-dollar Web tracking class actions into refining their claims, then flexed its technical expertise to free ETrade Financial Corp. and two other clients from the suits, showcasing the strength that put the firm on Law360's list of Privacy and Consumer Protections Groups of 2011.
The privacy team at Reed Smith represented E-Trade, Skype Inc. and Phillips North America Corp. in the litigation in Arkansas state court. The plaintiffs alleged those companies and nine others used local shared objects, or so-called Flash cookies, to bypass efforts by visitors to their websites to delete cookies. The cookies violated Arkansas anti-hacking laws, they said.
Download the .PDF to learn more!


text:
2017 Security Technology Conference
Sabre Limited
Tuesday, 24 October 2017 from 9:30 AM to 3:30 PM (EDT)
Who's Going
San Francisco, California
London, United Kingdom
Florence, Italy
Event Details
Microsoft/DELL Security Event
Sabre Limited, DELL Canada and Microsoft Canada have joined together to host a learning opportunity for IT professionals in the Waterloo Region and surrounding areas.
This event is focused on medium size businesses or small enterprise organizations. Join technical experts for a session of learning and information. Gain knowledge that will help in making better decisions about managing security in the age of Ransomware, migrating into Cloud technologies, and learning about the next generation of Virtualization and High Availability on-premise solutions.
Further details and agenda - Coming soon!
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When & Where
Sunbridge Hotel - formerly Holiday Inn Cambridge-Hespeler Galt
200 Holiday Inn Drive
Tuesday, 24 October 2017 from 9:30 AM to 3:30 PM (EDT)
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As a member of the LDS Church, I seek to live my life by its standards. But in 2015, I faced a challenge.
Let me back up. In May 2012, I was walking underneath a stage during a campus activity. It was dark, and I couldn't see the 12-foot pit lying in front of me. I fell, breaking my neck and back after hitting my head on a steel beam and the concrete bottom. Since my injury, I've had spinal and vertebrae complications, arthritis, fibromyalgia and constant moderate to severe pain.
I tried a variety of medications, but nothing brought substantial relief, and many of the prescription opioids left me immobile and unable to function. After a year and a half of going to pain clinics and specialists, I tried medical (or illicit?) cannabis. It relieved my pain more effectively than anything I had tried, and I was able to completely transition off of opioids.


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Aug 08, 2017
The Gloves Are Off! Legendary Boxer Mike Tyson Returns to the Stage with Mike Tyson Undisputed Truth – Round 2 at MGM Grand Hotel & CasinoLAS VEGAS (August 8, 2017) – The Gloves are off! Legendary boxer Mike Tyson will return to the stage at MGM Grand Hotel & Casino on the famed Las Vegas Strip. Following the knockout premiere of UNDISPUTED TRUTH, Tyson's stage debut, in 2012 and subsequent, sold-out runs on Broadway and again at MGM Grand, the champ will return to the stage for a limited run at Brad Garrett's Comedy Club with Mike Tyson UNDISPUTED TRUTH – Round 2. Picking up where UNDISPUTED TRUTH left off.
Aug 22, 2017
Vegas To Debut First Free-Roam Virtual Reality Arena at MGM Grand Hotel & CasinoLAS VEGAS (August 22, 2017) – MGM Grand Hotel & Casino and Zero Latency, the irrefutable world-leader in location-based free-roam Virtual Reality (VR) entertainment, will introduce Las Vegas' first multi-player free-roam VR experience inside LEVEL UP gaming lounge on September 8.
Jun 13, 2017
18th Annual Latin GRAMMY Awards to Air Thursday, Nov. 16, 2017 on UnivisionMIAMI (June 13, 2017) – The Latin Recording Academy® and Univision Network today announced the 18th Annual Latin GRAMMY Awards® will air Thursday, Nov. 16, 2017, live on Univision from the MGM Grand Garden Arena in Las Vegas with a three-hour star-studded telecast from 8–11 p.m. ET/PT (7 p.m. Central), and a one-hour pre-show beginning at 7 p.m. ET/PT.


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1693-90 USB Flash
Domeable rotate flash drive, 8GB Flash drive folds into a protective aluminum cover. Domed decorating method provides logo pop. Plug and play technology on Windows 98 or above and Mac OSX or higher. Includes gift box. Free set up! Dome is included in piece price.
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7月 19, 2014 合計視聴数:: 5877 今日は: 1 ★★★
Hotel Apartment Ivan Dubrovnik, Just a 10-minute walk away from the UNESCO-listed Dubrovnik Old Town and from a beach, Apartment Ivan offers air-conditioned accommodation with a furnished patio. 無料Wi-Fiアクセスをご利用いただけます. The apartment comprises an open-plan living room with a sofa, フラットスクリーンの衛星テレビ, a fully equipped kitchen and a dining table. Featuring a shower, private bathroom also comes with a hairdryer and a washing machine. Guests can enjoy a cable car ride, 1 ㎞, offering panoramic views of the historic center and the surrounding islands. A lot of interesting sights can be seen in the UNESCO-protected center, such as the Town Walls, Stradun Promenade and Onofrio's Fountain. Dubrovnik Port is 2 ㎞, while Dubrovnik Bus Station is 2.5 プロパティからキロ. Dubrovnik Airport is at a distance of 21 キロ. Apartment Ivan offers a shuttle service to Dubrovnik Airport upon request, and daily trips can also be organised. (Hotel Apartment Ivan Dubrovnik hotels 予約).


text: In Illinois, the amount of child support paid is directly a result of how much money the payor is making. If you have a child support order in place and are no longer making as much money as you used to, you have to continue to pay the same amount - UNTIL a new child support order is entered by your judge. Don't wait and expect the court to adjust back to the time that you started making less. For example, let's say that the amount that you are taking home changed on January first. On Feburary 15th you file paperwork with the court asking that child support reflect your changed income. On April 1, the judge enters an order allowing you to pay less child support since you are earning less. Up until April 1, you still have to pay the amount based off of the old order (and your higher income), although some courts will give you credit for the overpayment after February 15th (the date you filed). This way, you are neither rewarded for waiting nor penalized by any court delays after you file. Bottom Line: the only way to change the amount of support you have to pay is to have a new court order entered.


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This Sylvan Summit home is located at 418 37th Ave N in Nashville. 1711643 was built in 2003 and has 4 bedrooms418 37th Ave N, Nashville - MLS 1711643 Close
Residential property for sale in Nashville, TN at 418 37th Ave N. This 4 bedroom residential property is priced at $152/sqft.
Very nice 4 bedroom, 2.5 bath mobile home that was manufactured in 2003 or fantastic buildable lot with a view! New construction all around priced over $500K!
Mc Kissack- Crewell Professional Development Schoo
Listing information last updated on September 21st, 2017 at 11:24pm CDT.
Unlike some other parts of the United States, such as Dallas or New York and most famously Beverly Hills the high-end luxury real estate market tends to hover around the $3M to $5M mark. These home are often described as estate homes and typically they are found on a minimum of 5 acres or in exclusive gated communitie... read more »
As the real estate market in the USA and the world in general feels the after effects of the global economic downturn the number of home that have been foreclosed on continues to impact the real estate markets. As the bank owned property comes on to the market the perceptions of the buyers is that these homes represent... read more »
After 10 years in Florida, my main interests here in Nashville seem to revolve around music and real estate. I moved to Nashville to enhance my musical career and soon realized that this city was full of musicians who had a lot more talent than me and were still working for $20 plus tips on Broadway in th... read more »
Have any comments or questions about 418 37th Ave N, Nashville, TN? Ask your question and/or share your thoughts about this property.