Feeling a little snippy? Channel your inner Jedi in this burgundy fit and flare dress from Star Wars: The Clone Wars. This mid-length dress is inspired by Ahsoka Tano's costume from the animated series and features a keyhole neckline, red belt, faux-suede panel, and back cut-out that mimic her tunic.
41" from shoulder to hem.


There is hereby established the Klamath Juvenile Court, which shall have limited jurisdiction over all matters arising under the Klamath Juvenile Ordinance and any other provisions of the Klamath Tribal Code requiring or permitting the Court to exercise authority over juveniles.
Except as otherwise limited by applicable federal law, the Juvenile Court shall have jurisdiction exclusive as to any state over any child custody proceeding and any other proceeding described in Subsection (a) of this Section involving a Klamath child who resides or is domiciled on Klamath Tribal Lands, within the Klamath Tribal Service Area, or who is otherwise within the jurisdiction of the Juvenile Court;provided that, if the Juvenile Court's exclusive jurisdiction under this Subsection is limited by applicable federal law, the Juvenile Court shall have jurisdiction over such proceedings concurrent with the State of Oregon.
The Juvenile Court shall have exclusive jurisdiction in any proceeding making a child a ward of the Court under this Ordinance and shall retain jurisdiction over such a child until the child reaches eighteen (18) years of age notwithstanding the residence or domicile of the child.
Except as otherwise limited by applicable federal law, the Juvenile Court shall have concurrent jurisdiction as to any state over child custody proceedings in such state involving foster care placement of or termination of parental rights to a Klamath child who does not reside or is not domiciled on Klamath Tribal Lands or within the Klamath Tribal Service Area; provided that the Juvenile Court shall have exclusive jurisdiction over those child custody matters commenced in Juvenile Court as a result of transfer under the Indian Child Welfare Act and/or pursuant to the Indian Child Welfare Act Agreement between the State of Oregon and the Klamath Tribes.
Except as otherwise limited by applicable federal law, the Juvenile Court shall have original jurisdiction over child custody proceedings and any other proceedings described in Subsection (a) of this Section involving a non-Klamath child who resides or is domiciled on Klamath Tribal Lands or who is otherwise within the jurisdiction of the Juvenile Court when the parties consent to the jurisdiction of the Court or when the best interest of the child requires such an arrangement.


Nashville Baptist Church Welcomes You!
Visit About Us to learn more about our church and our Beliefs.
Visit the Links section for weekly Bulletins, Monthly Bylines, and Monthly Calendars.
Weekly Bulletins, Monthly Bylines, and Monthly Calendars are now available online on the Links page.
Listen to recent sermons online or download to listen off-line.


Is transnational education (TNE) in the EU the answer to Brexit?
Home > International > Is transnational education (TNE) in the EU the answer to Brexit?
How can we ensure our partnerships and connections with Universities in the EU are not affected by Brexit? Is it possible that our current efforts could temporarily sooth Brexit turbulence and help sustain us post-Brexit?
There is no doubt the EU is a historically popular destination for UK TNE and that this is growing in popularity. In 2016-17, the EU hosted the joint-third highest number of undergraduate UK HE TNE students in the world, with 10% of the world's share. However, for postgraduate, it was placed joint-second with 19% of the world's share. Between 2013-14 to 2016-17, there has been 7.9% growth in TNE in the EU and 5% in non-EU Europe. The numbers of UK HE TNE students in the EU has grown from 39,935 in 2015-16 to 44,120 in 2016-17.
TNE initiatives require large investments in planning, finance, resource and time. However, this is not to say that the rewards in Europe cannot be considerable. There are many very successful TNE ventures across the continent and many more expected. For example, just this summer Coventry University announced their plans to launch a new campus in Poland and in April, Northumbria University announced a stronger partnership with Amsterdam University of Applied Sciences and will be offering Northumbria accredited Masters programmes in Business and Project Management.
Greece hosts the highest number of UK TNE students in the EU and is ninth in the world. Switzerland hosts the second highest number of students in Europe and is 14th in the world with Cyprus (EU) in 15th, Germany in 16th, Ireland in 18th and Spain 20th in the world. As the examples of Coventry and Northumbria show, though, many universities are looking to engage in countries in the EU that have smaller but expanding markets such as the Netherlands and Poland.
The future of TNE programmes won't be without challenges. There is no guarantee that having a presence in the EU will allow UK institutions to access EU research funding, given that the eligibility rules for Horizon Europe have not yet been finalised.
Brexit has undoubtedly propelled institutions to strengthen their already valuable EU partnerships, but it is also an area that is on the rise in the EU policy agenda more generally. In November last year, the EU launched its plans for a European Education Area by 2025. As part of this area, the EU launched its European Universities Initiative which will be part of the Erasmus+ successor programme. With the pilot launching in the 2019 Erasmus+ call which opens in autumn 2018, this initiative aims to bring together consortia between three and six universities across Europe and allow them to award joint degrees. Students at one of these universities will have an "a la carte" menu of mobility options around the different universities in the consortium and will receive with a European degree upon successful completion.
Regardless of the outcomes of Brexit, the UK HE sector will want to continue and strengthen its partnerships, collaborations and exchanges with Europe and the EU. Whether this comes in the form of research partnerships, bilateral exchange partnerships, TNE or others is to be determined. It is this diversity of what the UK can offer to overseas partners that makes our sector truly unique and world leading.
An urgent campaign to encourage the UK government to commit to funding study abroad opportunities in case of a no-deal Brexit.
The University of Nottingham's Andy Winter on how the mental health needs of international students differ from those of home students.
Nick Hillman, Director of HEPI, digs further into new research on the economic impact of international students who stay on to work in the UK.
Universities UK (UUK) has given its support to the agreement reached between EU institutions on the future shape of the Horizon Europe programme.


We are members of a "throw away" society. If we buy something and it breaks, or we don't like it, we often discard it and replace it or buy something better. Many products are manufactured inexpensively with expectations that consumers will do just that.
But not Mah Jongg sets. Mah Jongg sets, and tiles in particular, are made to last. Modern tiles are often made of synthetic materials that resemble the older sets made of ivory or Bakelite. There are sold by various vendors on numerous websites. Tiles, racks, pushers, and a carrying case or bag can be sold as a set, or separately. Most Mah Jongg players own a set, and while it's a good investment, it's not necessary to own a set to enjoy the game. Some players own more than one set- often an older set, perhaps belonging to a relative, and a new set.
Tiles can be purchased in various shades of white, yellow, or cream; black tiles are also available. Specialty tiles can be purchased, with glittery backs of purple or pink. Tiles can be custom made with initials, names, or religious motifs. There are full-size tiles, travel-size tiles, and tiles with larger than usual graphics. Racks may be made of wood or a synthetic material.
After spending some time comparing sets I was considering buying, I purchased one from a well-known website and was very pleased with the entire set. With all the choices available, and since Mah Jongg sets can last for decades, do some research before making your purchase. Be certain you are very happy with the set you choose. After all, this may be the only Mah Jongg set you ever need, or ever buy. So please love the set you buy!
Thanks for your recent post re: Mahjongg Sets.
I own a set of black tiles that was actually passed on to me from my mentor to use as practice.
I use them often for that purpose and it helps we when putting hands together.
Just a warning – buying sets can be addictive! I have only been playing western Mah Jongg for 3 months and I already own 2western sets and my original Chinese set! There are so many types and they are all so pretty!
What/Who's is the set you often play with in the videos, that has dark wooden (I think) racks with gold dice-area posts on the – well, dice-holding end? – ? I think its beautiful and would love to know where to find it, if its owner wouldn't mind?
Let them know we sent you! If you check on our site on the resource page, you will also find lovely sets at Where the Winds Blow, MahjonggMaven, and even at Charly.org that has beautiful customized sets but they are expensive. Good luck shopping!
Leah also has a set with mahogany racks, so if she has other tips for you, she'll send you a comment as well.
Many of the videos with a blue cloth background use my tiles(basic white).
other sets that are older, Bakelite. These you would be more apt to find on Ebay,etc.


Sorry, I couldn't resist it! Matt and I are going to be moving to California in one year and I could not be more excited!! However, I love Pensacola, it's been great. People refer to it as a "little big town". We have a pretty happening downtown, pro-hockey, pro-baseball, BEAUTIFUL beaches, TONS of hidden gems, and a yummy food scene. Pensacola has given me a lot: education, the love of my life, and my first BIG GIRL job! I wanted to devote a section of my blog to hidden gems/the best things Pensacola has to offer. That way, not only will it be beneficial to anyone who reads and wants to make a little trip over, but I will be able to look back at this and feel all the feels… Oh bitter sweet nostalgia, how I love you.
Paradise Inn is probably one of my favorite places on earth, hands down! It has the charm, the quirks and the charisma. That's right, charisma! Paradise Inn is a one stop shop! I'm all about the the little things in life and Paradise Inn is all about the details, so we are a perfect match! Everything from the art work that is painted on the cinder-block building to the hand painted tip jars. I swear the Eagles wrote a song about this place. You can eat, sleep and drink there. They have live music almost every day in the summer and even during most winter months, too. (They also give a hefty Locals Discount on Sundays, but we'll get into that later!) It's one of those places that where you cannot wipe the smile off your face. Palm trees everywhere, your toes are in the sand, good music, good food. Your soul is happy!
Let's go on THE Paradise experience, because this place is just that! (Every single thing on Pensacola Beach is in biking distance) So you pull up on your bike, park it along side about 30 other beach cruisers, grab a $ 2 dollar Rolling Rock ($2 all day everyday! hhaaayyy), trek through the white sand, as you hear the live band to the left of you, find a seat at one of the many colorful picnic tables, or beach chairs, watch the waves roll in and relax because you are in PARADISE! Literally and figuratively, lol!
The food is great (fresh seafood) the fish sandwich is my personal fav! Don't forget the fried green beans, or the tuna dip! So yumm!! You can hop in the water or jump off the long dock! The dock is up for grabs as well, if you have a boat or even better, a friend with a boat! lol! I like to sit in the beach chairs, watch the boats roll in, and order some food and drinks from a server who WILL come up and serve you in a beach chair! Does it get any better than that? Sometimes jump in the water, you can definitely still hear the live tunes from the ocean!
You really don't have to EVER leave, because they have hotel rooms there! I know it's like, "What? Is this place real?" It is! All the rooms are re-done and all have their own charm. To be honest, this is not a resort, but they are so cute to me. They all have quirky decor and furniture. It feels magical! Like you are in a bubble of relaxation, and time has slowed down. After everything winds down, if you did want to go to another bar, you'd just walk about 50 feet to the right, and there you have 3 other beach bars for the late night! Because trust me, you will not want to leave during the day.
PRO TIP: Every Sunday they give Local Discounts! During the winter, rooms are $60 for locals on Sunday! The summer, $100, still not a bad deal!
I hope you make it out to Paradise Inn if you ever come to Pensacola. So you can relax and get a little piece of a place that is so special. It will stick with you, I promise.
I'm going to leave you with a pic of my ADORABLE friend Katie, on her first time at Paradise Inn!
Next Post TOP TEN $10 Bottles of Red Wine!
I love this blog! I tried the Cup Cake Red Velvet Wine and love it! Cant wait to try theother recommendation's. Great job!


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'Women of Sand: Testimonies of Women in Ciudad Juárez' to be presented at CFAC
Wednesday, March 10, 2010, By News Staff
A dramatized reading of the play "Mujeres de Arena" (Women of Sand), about the countless women who have been murdered and gone missing in the Mexican city of Ciudad Juárez, will be presented at the Community Folk Art Center, 805 E. Genesee St., Syracuse, on Friday, March 12, at 7 p.m. (performance in Spanish) and Saturday, March 13, at 2 p.m.
Ciudad Juárez, a border city located in the Mexican state of Chihuahua, is known internationally because of the homicides that have put it on the map of injustice and violence against women. Since 1993, hundreds of women, many of them young and poor maquiladora workers, have been brutally murdered or have disappeared.
The play "Mujeres de Arena" written by the Mexican dramaturg Humberto Robles and based on texts by Antonio Cerezo Contreras, Denise Dresser, Malú García Andrade, María Hope, Eugenia Muñoz, Marisela Ortiz and Juan Rios Cantú, is a testimony about the women in Ciudad Juárez.
Robles' play about the killings in Ciudad Juárez has been presented by groups in many cities in Mexico, Argentina, Canada, Colombia, Costa Rica, Chile, Spain, Italy, Uruguay and the United States.
The independent group formed by Beatriz Salcedo, Julie Norman, Zofia Valenzuela, Nelly Martinez, Marie Madero and directed by Rebecca Fuentes is presenting the dramatized reading of the play at the CFAC. "Humberto Robles wrote it with the desire for it to be represented all around the world so that the injustice that is happening in Ciudad Juarez weighs in the consciousness of all humanity," says Fuentes. "We want to echo his desire. We want to let the people of Syracuse know what is happening so that we unite our voices and demand justice."
The playwright, as well as the authors of the texts of the play, have forgone copyrights so that anyone, from a professional theater company to an independent group such as the one formed in Syracuse, will have the opportunity to participate in telling the real stories on which the play is based. The first presentations in Syracuse will take place during the month of March, Women's Heritage Month, and will continue through the year in places such as the West Side Learning Center and the SUNY College at Oswego.
VPA Communications Design Seniors Win Graphis New Talent Awards
Wednesday, February 7, 2018, By Erica Blust
A fantastical, musical adventure for the holidays in 'The Lion, the Witch and the Wardrobe'
Thursday, November 17, 2011, By News Staff
Syracuse Stage Brings High-Flying Fun to 'The Wizard of Oz' for Holiday Season
Monday, November 13, 2017, By Joanna Penalva
Syracuse Stage plaza, featuring 'singing sidewalk,' dedicated
Sunday, September 23, 2012, By Kelly Homan Rodoski
Syracuse Stage one of 13 theaters in country to receive national grant from Theatre Communications Group
Tuesday, October 13, 2009, By News Staff
Members of the campus community are helping Wacheva Cultural Arts mark its 10th anniversary in Syracuse with a special open house fundraiser on Saturday, July 20, from 11 a.m. to 3 p.m. They include Latin dance instructors Samantha Marji '13,…
Professor to Co-Present Restoration Shakespeare Showcase at London's Globe Theatre July 17
London-based students, faculty, staff and alumni are invited to a showcase of Restoration Shakespeare at the historic Globe Theatre, co-led by Amanda Eubanks Winkler, associate professor of music history and cultures in the College of Arts and Sciences (A&S). The…
Point of Contact Gallery Announces Opening of 'Time Changes Everything'
Point of Contact Gallery is hosting an opening reception for "Time Changes Everything," an exhibition by Syracuse University Professor Margie Hughto, Darcy Gerbarg, Beth Bischoff and Franco Andres, on Friday, July 12. The reception will take place from 5:30-8:30 p.m….
Poetry in Motion: 'Inspiration Can Strike Anywhere,' Says Pass Rusher, Poet Kendall Coleman '20
Those hands. Meet senior Kendall Coleman, and they are hard to ignore—thick, muscular wrists, fleshy palms and slender fingers that exude confidence. Authority. They are hands that have mercilessly attacked hundreds of football jerseys, including that of West Virginia quarterback…
Stephen Zaima Exhibition at the Palitz Gallery Features Work Spanning 30 Years
The Louise and Bernard Palitz Gallery at Syracuse University Lubin House presents "Stephen Zaima: Mysterious Bridge," on view now. This exhibition highlights work from the past 30 years by the distinguished artist, who recently retired after nearly 40 years as…

redpajama_set_name: RedPajamaCommonCrawl


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Стив Бра́ун (; ) — американский кёрлингист и тренер.

Играл в основном на позиции четвёртого. Был скипом команды.

Трёхкратный  (1982, 1986, 1991). В составе мужской сборной США участник чемпионатов мира , ,  и , бронзовый призёр в 1986 и 1991.

В конце 1990-х занялся тренерской работой, в 2010-е годы тренировал в основном сборную США по кёрлингу на колясках.

В 1998 введён в Зал славы Ассоциации кёрлинга США ().

Достижения
 : бронза (, ).
 : золото (1982, 1986, 1991), серебро (1980, 1985, 1987, 1989, 1992, 1995), бронза (1988, 1990, 1994, 1996, 1997).
 : золото (1984, 1988).
 : золото (), серебро ().
 : золото (2002, 2004).
 Тренер по кёрлингу года Олимпийского комитета США (): 1996.
 Тренер по кёрлингу года Ассоциации кёрлинга США (): 1996, 2012.

Команды

(скипы выделены полужирным шрифтом)

Результаты как тренера национальных сборных

Частная жизнь
Стив Браун начал заниматься кёрлингом в 1960, в возрасте 14 лет.

Его дети — сын Крейг Браун и Эрика Браун — тоже известные американские кёрлингисты, неоднократные чемпионы США и призёры чемпионатов мира. Жена Стива, Дайан Браун — тоже кёрлингистка и тренер, Стив и Дайан в одной команде выиграли  в 1984.

Стив — основатель и совладелец (с сыном Крейгом) компании Steve's Curling Supplies, производящей оборудование и экипировку для кёрлинга.

Примечания

Ссылки

USAcurl profile
First family of Madison curling Steve Brown, along with children Craig and Erika, will participate in the Olympic Trials - Tom Mulhern Wisconsin State Journal Feb 19, 2005
Swept up - Isthmus | Madison, Wisconsin
Champion Curler Steve Brown | Photograph | Wisconsin Historical Society

 Видео:

Кёрлингисты по алфавиту
Кёрлингисты США
Чемпионы США по кёрлингу
Тренеры по кёрлингу США

redpajama_set_name: RedPajamaWikipedia


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A Toronto neighbourhood wants to run its own transit service
Do you have trouble getting to the nearest GO station? Perhaps you and your neighbours should consider crowdfunding your own bus service.
That's what the neighbourhood of Humber Bay Shores has decided to do.
A GoFundMe page started by the Parklawn Lakeshore Improvement Association is seeking to raise $50,000 for the purchase of shuttle buses and implementation of a new, self-made commuter route. The aim is to provide residents with transit access to Mimico GO Station nearby.
According to the organization, the goals are twofold. First, to connect residents with the GO station. But the second goal is important as well: to demonstrate the need for transit access from the TTC.
The proposed route for the shuttle. Photo from PLIA's GoFundMe.
The idea is to sell memberships for the proposed service, which would thus be a public/private hybrid. Membership would be open to neighbourhood residents, but the shuttle wouldn't be available on a per-ride basis.
You may remember a few years ago when Liberty Village attempted to create its own transit route. The route was ultimately shut down for violating city rules pertaining to the TTC's status as the city's transit provider.
The PLIA ensures that this won't happen with their new service because it's not selling individual ride tickets, which organizers believe is permitted under current city regulations.
If funding attempts are successful, the service will begin operation later this year. As of today, the group has raised $400, though the campaign has only just launched.
George Socka


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Bill Nye to flat Earthers and science deniers: 'It affects all of us'.
Bill Nye has had it with flat-Earthers and other science deniers.
While humanity is landing robots on Mars and breaking open the mysteries of the universe, there continues a social trend of "science denialism." From opposition to handwashing in the 1800s to modern climate deniers, anti-maskers and "flat-Earthers," or people who believe that planet Earth is actually flat ( it is not), "anti-science" movements aren't new, but they are a problem facing us all today, according to Nye..
"The flat-Earthers, the anti-vaxxers, the anti-maskers are not on board with the progress of science. And the thing is, it affects all of us," Nye told Space.com. "When you deny the body of knowledge that's been discovered through the process of science, you're holding all of us back, and this is why it's such an important time."
He added to this reporter: "Chelsea, are you gonna vote? Please vote. My goodness." (Reader — and Bill Nye — fear not, I am voting.)
"There are people running around in the United States, or in the world, on the electric internet, thinking out loud ... that the Earth might be flat," Nye told Space.com. "What?! It's the 21st century … just that anybody would even joke about it is weird. And so this anti-science movement that we have in the United States, well, in the Western world right now, is bad for everybody."
"That's why I did, or we did, the show the Science Guy show years ago was out of concern for the future of the United States especially," Nye said.
Nye referenced the importance of a number of science advances including relativity. "Your mobile phone depends on Einstein's theories of both special and general relativity to get the right answer, to get it to work. And so we take all that for granted," he said.
He added that we all also depend on the science behind genetically modified food, which stems back thousands of years and is as advanced as ever today. "I just like to remind everybody ... farming is not natural. If you stop farming, it goes back, the land goes back to something else … so this is all science."
Nye added that "it's the exploration of space that led to these profound, profound improvements for quality of life for so many of us."
"I'm excited about the future. I mean, when the young people are running the show ... things are gonna improve or change for the better very rapidly," Nye added. "But it's, you know, as we always say, it's going to be a close call ... if we go get the climate so far out of control."
You can see Bill Nye discuss science and more online at tin a replay of this year's virtual New York Comic-Con. Nye talked about his book "Bill Nye's Great Big World of Science," with coauthor and science journalist Gregory Mone.
*Watch the video
climate change denial
Bill Nye Explains Carbon Pricing
A dangerous new form of climate denialism is making the rounds .
New Study Finds Climate Change Denial Received Disproportionate Media Coverage for Decades


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Hello World Kids and Estarta Solutions Strategic Partnership
The Jordanian EdTech company Hello World Kids and Estarta Solutions technology company announced that the companies have entered into a strategic partnership. The partnership aims to transform the local community and achieve the companies' common goal to invest in the next generation by offering them the best advantages to help them in their future. The agreement brings together Hello World Kids' creative educational services and technological expertise with Estarta Solutions training services and commitment to excellence. Outstanding students who learn coding on HelloCode will now have the opportunity to participate in technical training and courses on network services and solutions designed by the Estarta team. The program will introduce young students to the work environment and the ICT sector. In the long run, this program aims to contribute to the economic growth and development of the community by investing in the youth through the mix of HelloCode education and Estarta's professional training and empowering them to reach their potential. Hello World Kids develops unique and fun coding education for kids, whether at home or school. Kids learn to code using HelloCode, an online multilingual and interactive platform that aims to prepare new generations for the future with crucial skills like problem-solving, analytical thinking, and data analysis. Kids obtain these skills by learning text-based coding science in simplified and creative methods. HelloCode platform, recognized as the biggest Arab community to teach programming to kids, with over 350,000 projects submitted by kids younger than 12 years old and over 4.5 million lines of code recorded by children using SmoothY programming languages from many countries such as Saudi Arabia, Jordan, Egypt, and Oman. Hanan Khader, founder and CEO of Hello World Kids said: "We are pleased to announce our strategic partnership with Estarta Solutions and very proud to partner with a company well-known for its long and successful experience in the Information Technology sector. We believe that students from the schools that adopt the HelloCode curricula in their educational system are the main beneficiaries of this training program. One of the main reasons for launching this program is our constant concern for the student's best interests and ensuring their future success by providing them with the best advantages". Regarding the HelloCode international certification program, she added: "Our mission is to provide quality coding education for kids; To ensure that this quality education can be effective for their future, we are currently building the HelloCode international certification program. This program will provide kids with accredited certification and plenty of perks and benefits from our international partners. This new strategic partnership with Estarta Solutions is our first step towards providing HelloCode students with many benefits and fulfilling our mission". Estarta Solutions is a global Network Engineering and Information Technology company that specializes in comprehensive outsourced technical and premium service solutions. Throughout 31 years of operation, they delivered expertise to clients through a wide range of services that have supported their clients' success. They are headquartered in Jordan and operate in multiple markets throughout the Middle East and Europe, providing services in 10 different languages. Their talented team is equipped with cutting-edge tools and practices rooted in quality and focused on delivering optimal performance and consistent results to their partners and clients. Mutaz H. Nabulsi, CEO of Estarta Solutions commented: "We're proud to be announcing our partnership with Hello World Kids that focuses on providing quality coding education for kids by building the HelloCode international certification program, this partnership shows our commitment and belief that in order to build a talent pool for the new digital economy we must start at an early age". This strategic partnership marks the ongoing efforts Hello World Kids are taking to expand the scope of benefits that young programmers will receive through their educational experience on HelloCode, and the first perk of many to come in the bath of building the HelloCode international certification program. HelloCode international certification program will launch in 2023 with many benefits from international partners for its young holders to ensure their future success.
Professional Network Services and Solutions
Specialized Outsourcing
Innovative Turnkey Products
The Jordanian EdTech company Hello World Kids and Estarta Solutions technology company announced that the companies have entered into a strategic partnership. The partnership aims to transform the local community and achieve the companies' common goal ..
Represented by its CEO - Dr. Mutaz H. Nabulsi Estarta Solutions participated in the first regional conference for Cyber Diplomacy and Governance..
Tel: +962-6-5330751 fax: +962-6-5330752
info@estartasolutions.com
Copyright © Estarta Solutions 2021, Inc. All rights reserved.


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Issues Magazine
The 2009 Global Hunger Index: More Attention to Women's Role Needed
By Joachim von Braun
Recent world events have hit developing countries hard. Improving opportunities for women, especially with regard to education, could significantly reduce hunger and malnutrition.
Over the past two years, the world has been facing a series of crises, including high and volatile food prices, economic recession and a financial crunch. The crises are likely to have significant and long-lasting effects, creating serious implications for global food security, financial soundness and political stability. These negative events pose the greatest risk for poor people in developing countries, many of whom were already facing hunger and struggling to survive before the crises hit. Women and children are especially vulnerable, with often dire consequences for their health and well-being.
Assessing the State of World Hunger: The Global Hunger Index
The International Food Policy Research Institute (IFPRI), in conjunction with Welthungerhilfe and Concern Worldwide, have released the 2009 Global Hunger Index (GHI) report to assess the state of world hunger, identify the countries and regions where hunger and malnutrition are most severe, and draw attention to those that are most vulnerable to the international economic downturn. The index provides a multi-dimensional picture of hunger by measuring child malnutrition, rates of child mortality and the proportion of people in a country who are undernourished.
The 2009 index shows that despite regional differences, worldwide progress in reducing hunger remains slow overall. High rates of hunger are also linked to inequalities between men and women, especially in terms of access to education and literacy.
Since 1990, the global score has fallen by only one-quarter, and 29 countries now have levels of hunger that are considered "alarming" or "extremely alarming". The Democratic Republic of the Congo, Burundi and Eritrea have the highest levels of hunger, followed by Sierra Leone, Chad and Ethiopia, all of which have experienced war or violent civil conflict in recent years. Ethiopia, however, has made significant progress in the fight against hunger.
From a regional perspective, the GHI ranking remains distressingly high in South Asia, despite some progress in reducing hunger since 1990, and in Sub-Saharan Africa, where progress has been marginal at best. In South Asia, the high prevalence of undernourished children is largely responsible for the region's hunger ranking, while widespread undernutrition and high child mortality and HIV/AIDS rates in Sub-Saharan Africa have contributed greatly to the continent's poor score, as has political instability.
In contrast, the Near East and North Africa, South-East Asia, Latin America and the Caribbean have reduced hunger significantly, and the index rankings of the last two regions are down by more than 40% compared with 20 years ago.
Food and Financial Crises in Developing Countries
Data used in the GHI come from 2007 and earlier years (the most recent available), and thus rankings only partially account for the impact of the food crisis, and do not reflect the effects of the financial crisis. However, it is clear that after decades of steady progress in combating hunger, global malnutrition is rising as a result of recent events. Moreover, IFPRI estimates that the recession and reductions in agricultural investment could result in the malnourishment of 16 million more children by 2020, relative to a situation of continued high economic growth and investments maintained at current levels.
Although international food prices have been declining since the price hikes in 2007–08, in many countries they are still higher than they were several years ago. If the global financial crisis and economic slowdown have eased some pressure on food prices, they have also significantly reduced purchasing power and income-earning opportunities for poor people. In developing countries, poor people often spend 50–70% of their income on food and have little capacity to adapt as prices rise and wages for unskilled labour fail to adjust accordingly. The financial crunch has lowered the real wages of workers, leading to rising unemployment and reduced household incomes. In addition, credit has been constrained and remittances from abroad – upon which many poor people rely for their livelihoods – have significantly dwindled.
Low-income countries, more integrated within world markets than in the past, are being hurt by the food and financial crises. According to the International Monetary Fund, low-income countries are particularly vulnerable to the global recession and financial shock in four areas: trade, foreign direct investment, international aid and remittances. Different countries, however, are affected in different ways. Declining terms of trade – or a decrease in the price of exports relative to that of imports – particularly hurts commodity exporters, while Latin American countries are most severely affected by falling remittances. Countries that suffer from alarming levels of hunger are also very vulnerable to the global recession – Burundi and the Democratic Republic of Congo being prime examples.
Gender Inequality and the Impact on Women and Children
Women and children in developing countries are likely to suffer most from the food and financial crises. High and volatile food prices combined with lower incomes could prevent pregnant mothers, infants and children from getting the nutrition they need. When babies and young children are malnourished, they can suffer irreversible consequences in terms of their health, cognitive development and even productivity as adults.
To better assess the association between hunger and inequality, IFPRI compared the 2009 GHI rankings to the World Economic Forum's 2008 Global Gender Gap Index. The latter measures the well-being of women relative to men by assessing economic participation and opportunity, including wage equality; educational access, attainment and literacy rates; political empowerment, such as the holding of key political posts at the national level; and health and survival, including life expectancy at birth.
South Asia scored poorly on both the GHI and Global Gender Gap Index. As gender gaps in educational attainment increase, GHI scores tend to rise as well, demonstrating once again that lack of access to education goes hand-in-hand with hunger and malnutrition. Among the South Asian countries included in the analysis, only Bangladesh and Sri Lanka have achieved the Millennium Development Goal target of gender parity in primary and secondary education enrolment rates, and gender inequities in literacy are also widespread in the region. In Pakistan, only 22% of girls complete primary school, compared with 47% for boys. Not surprisingly, the country has high rates of hunger and malnutrition, and is hampered by staggering inequalities between men and women.
Generally speaking, South Asian countries also had low rankings on indicators of health and survival. Moreover, rates of maternal mortality, which is closely linked to malnutrition, in the region are among the highest in the world. Women who are chronically malnourished are more likely to have difficulties during labour, and a mother's poor nutrition can directly affect the health and nutrition of her children and babies.
Sri Lanka, which scored well on both indices, is an important exception in the region. The country's success is likely to be due to effective feeding programs, emphasis on universal education and good reproductive health care, among other factors.
Unfortunately, the pattern is similar for Sub-Saharan Africa. Of those with the most severe hunger and malnutrition problems, more than half also top the charts when it comes to gender inequality. Like South Asia, the relationship between education and GHI scores is particularly strong. Less than one-quarter of all countries in Sub-Saharan Africa met the Millennium Development Goal target for gender parity in school enrolment, and as educational disparities between men and women increase, so do hunger levels. The situation is most bleak in Chad, which has the fifth-highest level of hunger globally and ranks second worldwide in terms of gender inequality. The female literacy rate in the country is a shockingly low 13%, compared with 41% for men.
Despite some serious challenges, including the country's alarmingly high HIV/AIDS rates, Botswana stands out as a success story. It has achieved two key Millennium Development Goals: reducing gender disparity in all education, and providing universal access to 10 years of basic education. Botswana has committed to improving the nutrition of its people, as demonstrated by its relatively low GHI ranking.
According to IFPRI research, women's status – meaning women's power relative to men's within both households and communities – significantly affects children's nutrition. Women with higher status are usually better nourished and cared for themselves, and are able to provide higher quality care for their own children. Equalising men's and women's status in South Asia and Sub-Saharan Africa would reduce the number of malnourished children by 13.4 and 1.7 million, respectively.
Other IFPRI studies suggest that if all mothers finished primary school, the proportion of people living below the poverty line could be reduced by up to 33% in countries that have high gender disparity. In Sub-Saharan Africa, reducing gender gaps in both schooling and in the control of agricultural resources could potentially increase agricultural productivity by 10–20%, improving household food security and reducing hunger.
Given the strong relationship between hunger and gender inequality, policies that eradicate disparities between men and women, or girls and boys, particularly in education and health, are a matter of great urgency and key to reducing global hunger. Closing the gender gap in schooling could be facilitated in part by reducing the costs that parents pay to send their daughters to school, whether through cash transfers that are conditional upon school attendance, or well-designed school feeding programs with take-home rations.
Governments should also invest in female health and nutrition. Combating chronic malnutrition is crucial not only for pregnant women and mothers but growing girls as well, whose health and well-being is important for future generations.
Research indicates that improving women's economic opportunities, political empowerment and social status can help reduce hunger and malnutrition. Legal systems should be reformed to eliminate discrimination and level the playing field, and special attention should be paid to ensuring that women have rights to property and other resources, including credit and agricultural inputs.
In short, the pathways out of poverty and hunger are clear, but action must be taken now to unleash women's potential to improve food and nutrition security for the long-term benefit of their children, households and countries.
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Why aren't my font's loading?
Why aren't my fonts loading?
These should be Open Sans Regular, but they're coming in as Times New Roman.
I had a look at your site and noticed that on your home page there are some console errors shown while on pages where fonts are loaded properly there are no errors, so it looks like something is failing on your home page.
I'm not sure what though so I would like to have a closer look at your setup if you could provide me with support access to your site.
Looks like the console is failing at ytRIL which seems to be part of the code for youtube embed, probably from YT plugin you are using.
Can you try disabling it and any other plugins you have for youtube, clear your cache and then see if font is loading?
I disabled it but still saw the issue.
That's strange since our plugin doesn't touch fonts. It's likely an issue with your Google fonts. You're only loading "Montserrat" even though everywhere in your stylesheet, you're trying to reference "Open Sans."
I just took the initiative and proceeded with some more testing in your site. I figured out that the plugin causing the font error was the Smart Slider 3. De-activating it, didn't vanish the errors Predrag mentioned, but your custom font was able to load.
I'm going to notice my colleagues for a second pair of eyes here and keep you posted.
On kellenberg.org/athletics, a slider is on the page, but the fonts are fine.
So, I figured out what was causing it.
There's an option on Smart Slider 3 to display text over the photos. Whenever that was enabled, it took over the font settings on the page.
I don't think that the slider itself is disabling fonts, it looks like the slider is conflicting with another plugin you have and is used on home page, so it then throws an console error which breaks other scripts on site, including the one responsible for fonts.
Could you try leaving Smart Slider active and then disabling other plugins one by one to see which one is causing the conflict?
Is disabling my plugins the same as deactivating my plugins?
And will I lose anything by doing this?
And should I do this to the WPMU DEV plugins?
Yes, disabling is same as deactivating, apologies for causing confusion here.
Plugins and themes in most cases save their data in your database so after you deactivate and then reactivate them the settings are still there.
I can't guarantee for plugins not developed by us but if they follow WordPress development rules they should be back to normal after reactivation.
We're not familiar with any of our plugins causing such issues but it's possible some is not playing well with your slider so it's worth giving it a go.


text:
Alexander Introduces Legislation to Delay Fishing Restrictions Below Dams
Alexander says bill will prevent "unreasonable" Corps plan from moving forward, speaks with Secretary of Army, will meet Monday with Assistant Secretary of Army in charge of Corps
"To close off the tailwaters to fishing 100 percent of the time would be like keeping the gate down at the railroad crossing 100 percent of the time: The track isn't dangerous when the train isn't coming, and the tailwaters aren't dangerous when the water isn't spilling through the dam." – Lamar Alexander
WASHINGTON, Feb. 28 – U.S. Senator Lamar Alexander (R-Tenn.), along with Senate Minority Leader Mitch McConnell of Kentucky and Senators Bob Corker (R-Tenn.) and Rand Paul (R-Ky.), today introduced legislation that would stop the U.S. Army Corps of Engineers from restricting fishing in the tailwaters below the Cumberland River dams.
Alexander's legislation would prevent the Corps from enacting its plan, rather than simply delay it, as previously intended, because of the Corps' continued commitment to move forward.
In addition to introducing the legislation, Alexander spoke by phone today with Secretary of the Army John McHugh, and announced that he will meet Monday with Assistant Secretary of the Army for Civil Works Jo-Ellen Darcy to discuss the Corps' planned restrictions.
Alexander said the Corps is pushing an "unreasonable plan to restrict fishing below Cumberland River dams that will destroy remarkably good recreational opportunities and many jobs." The Corps plan would restrict public access to the fishing waters below 10 dams on the Cumberland River.
Alexander continued, "Water spills through the Cumberland River dams less than 20 percent of the time on average. To close off the tailwaters to fishing 100 percent of the time would be like keeping the gate down at the railroad crossing 100 percent of the time: The track isn't dangerous when the train isn't coming, and the tailwaters aren't dangerous when the water isn't spilling through the dam."
The senator, who is the senior Republican on the Senate committee overseeing Corps funding, also said that he "wanted to know exactly where the $2.6 million that the Corps plans to use to erect physical barriers is coming from during these tight budget times." Alexander said Congress may also need to consider whether the funding required for the barrier system is in the best interest of the American taxpayer.
State officials have said safety concerns can be addressed by anglers adhering to current requirements, and by making changes to policy that would be far less restrictive than the Corps' plan. Alexander has called on the Corps to reconsider its position, in the hopes that a compromise could find a way to better address safety concerns only when the waters are dangerous.
Permalink: https://www.alexander.senate.gov/public/index.cfm/2013/2/alexander-introduces-legislation-to-delay-fishing-restrictions-below-dams


Welcome to Me is about a year in the life of Alice Klieg (Kristen Wiig), a woman with Borderline Personality Disorder who wins the lottery, quits her meds and buys herself a TV show where she talks only, and exclusively, about herself.
Unlike anything that's been on TV before, it becomes a public forum for Alice to explain, complain, sing, cook, and even neuter dogs. She tears through money, broadcasting for longer and longer periods until she's televised 24/7, even while she sleeps.
When the consequences catch up with her, she cracks and finds herself truly alone. All that's left is her show, which she must use to win everyone back.


CCEE Stampers: The Right One!
nothing fancy, kinda funky...with a sneak peek of Big Inspiration being released June 12th from Cornish Heritage Farms.
I love this -- the colors are so cheery!
Love the happiness of it!


text:
Store Regnegade er en gade i Indre By i København. Den ligger mellem Gammel Mønt og Gothersgade.

Jazzhus Montmartre ligger i Store Regnegade.

Tidligere lå C.L. Seifert i 12-16.

Gader i Indre By (København)


Katie (Bower) Adams-Langley has a perfect smile that lights up any dark situation. This smile can only be overshadowed by her enormous heart that she uses to care deeply for all of her family and friends. It is our turn to take care of Katie, to support her and her family in their time of need.
Katie has been diagnosed with terminal lung cancer (stage IV). Many friends and family attended Katie and Scott's wedding in March. Scott was deployed to the Middle East two days after the wedding, but the military has brought him home to be with and take care of his wife. Katie & Scott, along with their 4 children ask that you keep Katie in your prayers.
Think, O God, of our friend Katie who is ill, we submit that no healing is too hard for the Lord, if it be His will. We therefore pray that You bless our friend Katie with Your loving care, renew her strength, and heal what ails her in Your loving name.


Loschner first described pediatric pulmonary embolism (PE) in the 1860s. Deep venous thromboses (DVT) and pulmonary emboli are relatively rare phenomena in pediatric practice; however, when they do occur, they are associated with significant morbidity and mortality. Because of the rarity of pulmonary emboli in children, they are probably underdiagnosed. For the same reason, much of the information pertaining to diagnosis and management of pulmonary embolism has been derived from adult practice.
A specific diagnosis that should be mentioned because of its prevalence is sickle cell disease. Prompt recognition and management of pulmonary problems may lead to a decreased rate of pulmonary complications.
Most pulmonary emboli derive from a free-floating thrombus. In rare situations, extension of an existing pulmonary thrombus may result in pulmonary infarction. Many materials and substances may form emboli and move to the pulmonary circulation; these include fat, tumor, septic emboli, air, amniotic fluid, and injected foreign material.
The size of a pulmonary embolism determines at which points in the pulmonary vasculature it lodges. After the embolus lodges, it occludes the vessel, reducing distal blood flow to the area directly supplied by the vessel. The degree of obstruction of the pulmonary circulation directly affects the resulting pathophysiology.
In all cases of pulmonary embolism, ventilation/perfusion (V/Q) mismatch occurs to some degree, in which continued ventilation of lung units without circulation is present. Oxygenation is usually not affected by the V/Q mismatch, in contrast with V/Q mismatch that arises from obstruction of airways and lung parenchyma. Impaired oxygenation in the context of suspected pulmonary embolism implies a massive obstruction.
An increase in effective alveolar dead space is a direct result of the V/Q mismatch. Ventilation (carbon dioxide removal) is usually compensated for by tachypnea.
In cases in which the pulmonary embolus is large, a sudden increase in pulmonary artery pressure may lead to right ventricular strain and right heart failure. A sudden rise in the right ventricular pressure may cause a leftward shift of the intraventricular septum, which may impair left ventricular filling and output (classic obstructive shock).
Reflex bronchoconstriction is often associated with pulmonary embolism. This increases the work of breathing and decreases pulmonary compliance. Pulmonary infarction is also associated with diminished surfactant levels, which may contribute to the increased work of breathing and diminished oxygenation.
In sickle cell disease, an initial trigger (often infection) exacerbated by dehydration (eg, due to fever, tachypnea, or decreased intake) leads to sickling of RBCs within small blood vessels of the lung and other organs. This precipitates a cycle of relative deoxygenation that further exacerbates the sickling tendency, leading to small vessel occlusion and, ultimately, infarction of areas of the pulmonary parenchyma. Allied to this sequence is the tendency of many patients with sickle cell disease to have a component of reactive airways disease, which further decreases oxygenation.
Pulmonary embolism is a rare disorder in pediatric practice. In 1993, David et al identified 308 children reported in the medical literature from 1975-1993 with DVT of an extremity, pulmonary embolism, or both.  In 1986, Bernstein reported 78 episodes of pulmonary embolism per 100,000 hospitalized adolescents.  Unselected autopsy studies in children estimate the incidence of pulmonary embolism from 0.05-3.7%.
Canadian data derived from 15 tertiary care centers show a frequency of 0.86 events per 10,000 pediatric hospital admissions for patients aged 1 month to 1 year.  Frequency of pulmonary embolism in developed countries has been increasing when compared with historical data. This increase in frequency is linked with the increased use of central venous lines in the pediatric population.  The overall frequency is still considerably less than that seen in adults.
Separating mortality attributable to pulmonary embolism from that due to conditions that may be associated with pulmonary embolism, such as trauma and surgery, is difficult.
The data regarding death from pulmonary embolism in children are conflicting. Various authors suggest that pulmonary embolism contributes to the death of affected children in approximately 30% of cases.  Others, however, have reported pulmonary embolism as a cause of death in fewer than 5% of affected children.  As in adults, the mortality rate is highest in the period immediately following embolization. If no major cardiovascular sequelae are present, a full recovery may be anticipated without complications.
No data are available regarding the risk of recurrence of pulmonary embolism in children.
No data outlining variations in pulmonary embolism prevalence by race are available.
Some authors have reported a female-to-male ratio of 2:1. Others have found that this ratio is reversed.
Given the rarity of pulmonary embolism in childhood, no definitive data identify age as an independent risk factor for pulmonary embolism. The frequency of pulmonary embolism has a bimodal distribution, with peaks in the neonatal period and adolescence.
David M, Andrew M. Venous thromboembolic complications in children. J Pediatr. 1993 Sep. 123(3):337-46. [Medline].
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Kotsakis A, Cook D, Griffith L, et al. Clinically important venous thromboembolism in pediatric critical care: a Canadian survey. J Crit Care. 2005 Dec. 20(4):373-80. [Medline].
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Evans DA, Wilmott RW. Pulmonary embolism in children. Pediatr Clin North Am. 1994 Jun. 41(3):569-84. [Medline].
Rajpurkar M, Warrier I, Chitlur M, et al. Pulmonary embolism-experience at a single children's hospital. Thromb Res. 2007. 119(6):699-703. [Medline].
Babyn PS, Gahunia HK, Massicotte P. Pulmonary thromboembolism in children. Pediatr Radiol. 2005 Mar. 35(3):258-74. [Medline].
Cook A, Shackford S, Osler T, et al. Use of vena cava filters in pediatric trauma patients: data from the National Trauma Data Bank. J Trauma. 2005 Nov. 59(5):1114-20. [Medline].
Baird JS, Killinger JS, Kalkbrenner KJ, Bye MR, Schleien CL. Massive pulmonary embolism in children. J Pediatr. 2010 Jan. 156(1):148-51. [Medline].
Biss TT, Brandao LR, Kahr WH, Chan AK, Williams S. Clinical features and outcome of pulmonary embolism in children. Br J Haematol. 2008 Jun 17. [Medline].
Vichinsky EP, Neumayr LD, Earles AN, et al. Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. N Engl J Med. 2000 Jun 22. 342(25):1855-65. [Medline].
van den Heuvel-Eibrink MM, Lankhorst B, Egeler RM, Corel LJ, Kollen WJ. Sudden death due to pulmonary embolism as presenting symptom of renal tumors. Pediatr Blood Cancer. 2008 May. 50(5):1062-4. [Medline].
Dollery CM. Pulmonary embolism in parenteral nutrition. Arch Dis Child. 1996 Feb. 74(2):95-8. [Medline].
Nuss R, Hays T, Chudgar U, Manco-Johnson M. Antiphospholipid antibodies and coagulation regulatory protein abnormalities in children with pulmonary emboli. J Pediatr Hematol Oncol. 1997 May-Jun. 19(3):202-7. [Medline].
Agha BS, Sturm JJ, Simon HK, Hirsh DA. Pulmonary embolism in the pediatric emergency department. Pediatrics. 2013 Oct. 132(4):663-7. [Medline].
Lee EY, Tse SK, Zurakowski D, et al. Children suspected of having pulmonary embolism: multidetector CT pulmonary angiography--thromboembolic risk factors and implications for appropriate use. Radiology. 2012 Jan. 262(1):242-51. [Medline].
Lee EY, Zurakowski D, Boiselle PM. Pulmonary embolism in pediatric patients survey of CT pulmonary angiography practices and policies. Acad Radiol. 2010 Dec. 17(12):1543-9. [Medline].
The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990 May 23-30. 263(20):2753-9. [Medline].
Revel MP, Sanchez O, Couchon S, et al. Diagnostic accuracy of magnetic resonance imaging for an acute pulmonary embolism: results of the 'IRM-EP' study. J Thromb Haemost. 2012 May. 10(5):743-50. [Medline].
Goldenberg NA, Durham JD, Knapp-Clevenger R, Manco-Johnson MJ. A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood. 2007 Jul 1. 110(1):45-53. [Medline].
Raffini L, Cahill AM, Hellinger J, Manno C. A prospective observational study of IVC filters in pediatric patients. Pediatr Blood Cancer. 2008 Jun 16. [Medline].
Hull RD, Raskob GE, Brant RF, et al. Low-molecular-weight heparin vs heparin in the treatment of patients with pulmonary embolism. American-Canadian Thrombosis Study Group. Arch Intern Med. 2000 Jan 24. 160(2):229-36. [Medline].
Faustino EV, Patel S, Thiagarajan RR, Cook DJ, Northrup V, Randolph AG. Survey of pharmacologic thromboprophylaxis in critically ill children. Crit Care Med. 2011 Jul. 39(7):1773-8. [Medline]. [Full Text].
Baird JS, Greene A, Schleien CL. Massive pulmonary embolus without hypoxemia. Pediatr Crit Care Med. 2005 Sep. 6(5):602-3. [Medline].
Beitzke A, Zobel G, Zenz W, et al. Catheter-directed thrombolysis with recombinant tissue plasminogen activator for acute pulmonary embolism after fontan operation. Pediatr Cardiol. 1996 Nov-Dec. 17(6):410-2. [Medline].
Brandao LR, Labarque V, Diab Y, Williams S, Manson DE. Pulmonary embolism in children. Semin Thromb Hemost. 2011 Oct. 37(7):772-85. [Medline].
Hyers TM, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest. 2001 Jan. 119(1 Suppl):176S-193S. [Medline]. [Full Text].
Kossel H, Bartsch H, Philippi W, et al. Pulmonary embolism and myocardial hypoxia during extracorporeal membrane oxygenation. J Pediatr Surg. 1999 Mar. 34(3):485-7. [Medline].
Kossoff EH, Poirier MP. Peripherally inserted central venous catheter fracture and embolization to the lung. Pediatr Emerg Care. 1998 Dec. 14(6):403-5. [Medline].
Macartney CA, Chan AK. Thrombosis in children. Semin Thromb Hemost. 2011 Oct. 37(7):763-1. [Medline].
McCrory MC, Brady KM, Takemoto C, Tobias JD, Easley RB. Thrombotic disease in critically ill children. Pediatr Crit Care Med. 2010 Feb 11. [Medline].
Monagle P, Chan A, DeVeber G. Andrew's Pediatric Thromboembolism and Stroke. 3rd ed. Ontario, Canada; BC Decker: 2006.
Sandoval JA, Sheehan MP, Stonerock CE, Shafique S, Rescorla FJ, Dalsing MC. Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: an increasing population at risk. J Vasc Surg. 2008 Apr. 47(4):837-43. [Medline].
Tay ET, Stone MB, Tsung JW. Emergency ultrasound diagnosis of deep venous thrombosis in the pediatric emergency department: a case series. Pediatr Emerg Care. 2012 Jan. 28(1):90-5. [Medline].
Truitt AK, Sorrells DL, Halvorson E, et al. Pulmonary embolism: which pediatric trauma patients are at risk?. J Pediatr Surg. 2005 Jan. 40(1):124-7. [Medline].


'Lampedèe' are the versatile Chelsea Boots for the man who loves the Beatles look. Their uniqueness is about the full brogue design on leather. With their full-grain leather and durable Vibram rubber sole, they're the dark brown Boots for a casual style: whether you're a freelancer or love the outdoors.


text:
Debunking Right Wing Lies · Right-Wing Myths · The Week In Spin
The Week In Spin: 4 Right-Wing Lies Exposed
August 9, 2014 by Samuel Warde
We are starting a new weekly feature called "The Week in Spin", which will detail our favorite right-wing lies of the week, as found on social media and on right-wing websites.
1. THE LIE: VIDEO: Did Michelle Obama Admit That Sarah Palin is Smarter Than Barack?, found on the Tea Party News Network.
First Lady Michelle Obama joked that "women are smarter than men" at the U.S. Africa Leaders Summit held in Washington D.C. on Wednesday during an interview with Laura Bush, conducted by Cokie Roberts. [You can watch the video here.] Somehow, The Tea Party News Network (TPNN) connects that comment to Sarah Palin's intelligence in the title of an article, leading to over 29,000 Facebook shares – and counting.
TPNN went on to make the following strange connection in the article itself:
Perhaps Michelle should have brought up that argument during the height of the Democrat demonization and degradation of former Alaska Governor and 2008 GOP Vice Presidential candidate Sarah Palin.
2. THE LIE: Target tells shoppers it's going 'gay', found on WorldNetDaily.
Known for publishing articles that have created controversies and criticism, WorldNet Daily (WND) spun a story about Target signing onto an friend-of-the-court (amicus) brief in support of marriage equality which is currently pending in the Seventh Circuit.
WND begins by writing:
Another major American company has gone "gay," with Target officially signing onto a court action seeking to strike down the definition of marriage as one man and one woman. [emphasis added]
WND goes on to connect that brief to the absurd, as in the following example:
Carey B. Hall, citing the company's emphasis on marriage "equality," said: "The next marriage equality: marry your dog, two couples being married to each other. Three people being married … the people have endless ideas on marriage equality … one perversion leads to another, that's just how SIN is." [emphasis added]
3. THE LIE: Obama Homeland Security Official Arrested for Trying to Give 13-Year-Old Sex Lessons, found on the Tea Party News Network (TPNN).
In another slight-of-hand, TPNN connects President Obama to the arrest of a low-level Department of Homeland Security inspector in Northern California. TPNN creates this linkage in both the title and the article itself, which notes:
An Obama Homeland Security TSA Inspector, George Hristovski, of Elverta in Northern, California, was arrested by the FBI after he allegedly sought to have sex with a mother and her 13-year-old daughter. [emphasis added]
In truth, the Department of Homeland Security employs more than 240,000 individuals in "jobs that range from aviation and border security to emergency response, from cybersecurity analyst to chemical facility inspector." Further, the agency encompasses a multitude of departments and components to include: United States Citizenship and Immigration Services (USCIS), United States Customs and Border Protection (CBP), United States Coast Guard (USCG), Federal Emergency Management Agency (FEMA), Federal Law Enforcement Training Center (FLETC), United States Immigration and Customs Enforcement (ICE), Transportation Security Administration (TSA), United States Secret Service (USSS), Management Directorate, National Protection and Programs Directorate (NPPD), Science and Technology Directorate (S&T), Domestic Nuclear Detection Office (DNDO), Office of Health Affairs (OHA), Office of Intelligence and Analysis (I&A), Office of Operations Coordination and Planning, and the Office of Policy.
The result for TPNN? over 13,000 Facebook shares so far.
4. THE LIE: 40 YEARS LATER, 'PLUMBER' SPILLS BEANS IN WATERGATE SCANDAL G. Gordon Liddy: 'I saw Democrats as being dangerous to the country,' found on WorldNetDaily.
The WND article began innocuously enough noting:
Saturday marks 40 years since Richard Nixon resigned the presidency over the Watergate scandal. The saga began more than two years earlier, in June 1972. A group of political operatives known as the plumbers broke into the Democratic National Committee headquarters in the Watergate complex in Northwest Washington.
However, in an incredible piece of spin, G. Gordon Liddy tells WND a new version of the story in an exclusive interview:
So what were they looking for? In 1972, President Nixon was bracing for a re-election fight against Democratic Sen. George McGovern. While many believe the plumbers were looking for campaign secrets and strategies, Liddy said the break-in had a very different goal.
"The FBI was investigating not one, not two, but three separate call girl operations back then. The assistant United States Attorney who was in charge of that was a man named John Rudy. He testified that the FBI came to him and said, 'We have found a connection between (the DNC and) the call-girl ring that's being run out of the Columbia Plaza Apartments, which is across the street from the Democratic headquarters," Liddy said. [emphasis added]
The article ends with the following justification:
More than 40 years after the Watergate saga began, Liddy made it clear he has few regrets about the episode. He said he had good reasons to break the law and those reasons have since been validated again and again.
"I saw Democrats as being dangerous to the country," he said. "I see the Democrats now as being even more dangerous to the country. I wanted to prevent them from being able to damage the country further. So I chose to make use of the special knowledge that I had as a result of the FBI and so forth. That was it."
As background
In January 1972, G. Gordon Liddy, general counsel to the Committee for the Re-Election of the President (CRP), presented a campaign intelligence plan to CRP's Acting Chairman Jeb Stuart Magruder, Attorney General John Mitchell, and Presidential Counsel John Dean, that involved extensive illegal activities against the Democratic Party. Mitchell viewed the plan as unrealistic, but two months later is alleged to have approved a reduced version of the plan which involved burglarizing the Democratic National Committee's (DNC) headquarters at the Watergate Complex in Washington, D.C., the ostensible purpose of which was to photograph documents and install listening devices. Liddy was nominally in charge of the operation, but has since insisted that he was duped by Dean and at least two of his subordinates. These included former CIA officers E. Howard Hunt and James McCord, then-CRP Security Coordinator (John Mitchell had by then resigned as Attorney General to become chairman of the CRP).
Two phones inside the offices of the Democratic National Committee headquarters were wiretapped. One of those phones was the phone of Robert Spencer Oliver who at the time was working as the executive director of the Association of State Democratic Chairmen and the other was the phone of the secretary of Democratic National Chairman Larry O'Brien.
After 2 attempts to break into the Watergate Complex failed to yield information of value, the order for yet another break-in was given to Liddy by Jeb Magruder, either acting on his own or on orders from Dean.
Shortly after midnight on June 17, 1972, Frank Wills, a security guard at the Watergate Complex, noticed tape covering the latches on doors in the complex (allowing the doors to close but remain unlocked). He removed the tape, and thought nothing of it. He returned an hour later, and having discovered that someone had retaped the locks, Wills called the police. 5 men were discovered and arrested inside the DNC's office. They were Virgilio González, Bernard Barker, James McCord, Eugenio Martínez, and Frank Sturgis, who were charged with attempted burglary and attempted interception of telephone and other communications. On September 15, a grand jury indicted them, as well as Hunt and Liddy, for conspiracy, burglary, and violation of federal wiretapping laws. The five burglars who broke into the office were tried by Judge John Sirica and convicted on January 30, 1973.
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Discussion Can I use Interleaved FASTQ?
Were pigz is a parallel-ish implementation of gzip which I've dropped in place of gzip (in the original recommendation), this has given me interleaved FASTQ would this sort of input be amenable to be used in the MuTect2 tumour/normal pipeline and the germline SNPs+Indel pipeline? Or should I specifically split the input into _1 and _2 files as per the norm with illumina sequencing runs? Just I'm not sure if the relevant WDL can optionally accept two or one file with out editing the workflow? Or alternatively is there a Picard tool which maybe more appropriate?
I'm told that that particular pipeline is expecting BAMs as inputs, so FASTQ files won't work. What you can do is revert the original BAMs to uBAMs following this tutorial, then run those through the preprocessing pipeline and send those preprocessed files to the Mutect2 pieline you'd like to use.
Thank you for your question. I'm not as familiar as I'd like to be with the Mutect2 pipeline, so I'm consulting with a few other members of my team. We will get back to you with an answer soon.
Hi Kate, thanks this was exactly the info I needed to sanitise my current BAMs, I also found this Method/WDL which looks somewhat equivalent within Firecloud it's self although appears to clear slightly less tags than in the above tutorial.
Fantastic, I'm glad that helped! And thank you for the link to the method, I'll remember that for the future.


text:
Developmental pattern of 3-oxo-Δ4 bile acids in neonatal bile acid metabolism
Toshiro Inouea,
Akihiko Kimuraa,
Kumiko Aokib,
Masahiko Tohmac,
Hirohisa Katoa
aDepartment of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan, bResearch Institute of Medical Mass Spectrometry, cFaculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido
Dr Akihiko Kimura, Department of Paediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830, Japan.
AIMS To investigate whether a fetal pathway of bile acid synthesis persists in neonates and infants.
METHODS 3-oxo-Δ4 bile acids were determined qualitatively and quantitatively in the urine, meconium, and faeces of healthy neonates and infants, using gas chromatography–mass spectrometry.
RESULTS The mean percentage of 3-oxo-Δ4 bile acids in total bile acids in urine at birth was significantly higher than that at 3 or 7 days, and at 1 or 3 months of age. The concentration of this component in meconium was significantly higher than that in faeces at 7 days and at 1 or 3 months of age.
CONCLUSIONS The presence of large amounts of urinary 3-oxo-Δ4 bile acids may indicate immaturity in the activity of hepatic 3-oxo-Δ4-steroid 5β-reductase in the first week of postnatal life. Large amounts of this component in meconium may be due to the ingestion of amniotic fluid by the fetus during pregnancy.
ketonic bile acid
3-oxo-Δ4 bile acid
3-oxo-Δ4-steroid 5β-reductase
meconium
gas chromatography–mass spectrometry
http://dx.doi.org/10.1136/fn.77.1.F52
Infants with severe liver disease have a high urinary excretion of such ketonic bile acids as 3-oxo-Δ4 bile acids (7α, 12α-dihydroxy-3-oxochol-4-en-24-oic acid; Δ4-3-one, 12α-hydroxy-3-oxochola-4, 6-dien-24-oic acid; Δ4,6-3-one).1 A newly identified inborn error in bile acid synthesis, 3-oxo-Δ4-steroid 5β-reductase (5β-reductase) deficiency, is associated with idiopathic neonatal hepatitis syndrome.2 Because the amount of ketonic bile acids was suspected to be related to the severity of hepatic damage, the concentrations of bile acids were examined in various biological fluids obtained from patients with liver disease and from normal controls.1-5 Ketonic bile acids were detected in amniotic fluid collected from healthy pregnant women for studies of bile acid metabolism.3 However, little is known about the amounts of ketonic bile acids present in the biological fluids of neonates and young infants.
Our objective was to evaluate qualitatively and quantitatively 3-oxo-Δ4 bile acids in urine, meconium, and faeces from normal neonates and young infants using gas chromatography–mass spectrometry (GC–MS) with selected ion monitoring (SIM).
These healthy neonates (mean gestational age: 40 weeks, range 39–41 weeks) (mean birthweight: 3050 g, range 2580–3655 g) showed normal development. Spot urine samples were collected from 24 infants (8 boys and 16 girls), six in each of six age groups: 0, 3, and 7 days and 1, 2, and 3 months. The concentration of individual bile acids in urine was corrected for creatinine concentration (μmol/mmol of creatinine) in each case. Meconium (five specimens) was obtained from healthy neonates (three boys and two girls). Spot faecal samples were obtained from 13 healthy infants (seven boys and six girls) at the following ages: 7 days (n=6), 1 month (n=2), and 3 months (n=5). None of the subjects had a history of, or showed signs of, hepatobiliary or gastrointestinal disease. Infants were breastfed until 2 months of age. Thereafter, the diet consisted of breast milk supplemented with formula or baby food.
We synthesised the following agents, as described before: 1β, 3α, 7α, 12α-tetrahydroxy-5β-cholan-24-oic acid (CA-1β-ol), 1β, 3α, 7α -trihydroxy-5β-cholan-24-oic acid (CDCA-1β-ol), 3β-hydroxy-chol-5-en-24-oic acid (Δ5-3β-ol), 7α, 12α-dihydroxy-3-oxo-5β-chol-1-en-24-oic acid (Δ1-3-one), Δ4-3-one, Δ4,6-3-one, and 3α, 7α-dihydroxy-24-nor 5β-cholan-23-oic acid (Nor-CDCA) (6-8). 3α, 7α, 12α-trihydroxy-5β-cholan-24-oic acid (cholic acid; CA), 3α, 7α-dihydroxy-5β-cholan-24-oic acid (chenodeoxycholic acid; CDCA), 3α, 6α, 7α-trihydroxy-5β-cholan-24-oic acid (hyocholic acid; HCA), and 3α, 7β-dihydroxy-5β-cholan-24-oic acid (ursodeoxycholic acid; UDCA) were obtained from Sigma Chemical Co. (St Louis, MO, USA). 3α, 12α-dihydroxy-5β-cholan-24-oic acid (deoxycholic acid; DCA), and 3α-hydroxy-5β-cholan-24-oic acid (lithocholic acid; LCA) were obtained from Wako Junyaku (Osaka, Japan) and from Aldrich Chemical Company, Inc. (Milwaukee, WI, USA), respectively.
Each bile acid or mixture of bile acids was converted to the methyl ester by incubation with diazomethane ether (1 ml) at room temperature for 10 minutes. After evaporation, the trimethylsilyl ethers were prepared by heating the residue withN-trimethylsilylimidazole (50 μl) (Tokyo Kasei, Tokyo, Japan) in acetonitrile at 38°C for 60 minutes. Excess reagents were evaporated in an N2 stream, and the residue was dissolved in acetone before GC-MS analysis with SIM.
An internal standard (Nor-CDCA) was added to the samples of urine (1 ml) and lyophilised meconium (1 mg) or faeces (1 mg).The latter were dissolved in NaOH, 0.1 mol/l (2 ml). All samples were applied to a Bond-Elut C18 cartridge (6 ml) (Analytichem, Harbor City, CA, USA). The cartridge was washed with 5 ml of water and the bile acid conjugates were eluted with 5 ml 90% ethanol. The solvent was evaporated and the residue was treated with 0.05 M sodium acetate buffer (pH 5.6). Each sample was added to 0.75% (v/v) 2-mercaptoethanol (200 μl) (Sigma), 0.05M EDTA (200 μl) (Sigma), H2O (100 μl), choloylglycine hydrolase (3 units) (Sigma) and sulphatase (50 units) (Sigma) and incubated at 38°C for 16 hours. The sample was then applied to a Bond-Elut C18 cartridge. The cartridge was washed with 5 ml of water, and the bile acid conjugates were eluted with 5 ml 90% ethanol. Free bile acids were extracted with piperidinohydroxypropyl dextran gel (Shimadzu Corp, Kyoto, Japan), eluted with 5 ml of acetic acid in 90% ethanol (0.1 mol/l), and converted to the methyl ester-trimethylsilyl ethers (50 μl) for GC-MS analysis. After conversion of the methyl ester-trimethylsilyl ethers (50 μl) the sample was added to 50 μl of acetone. Next, 1 μ1of the sample was injected into a splitless injection port of the GC-MS system. The mean recovery of unconjugated bile acids was 97.3% (range 78.6–119.8%); the lowest recovery rate was for 3-oxo-Δ4 bile acids (78.6%).
After extracting bile acids from urine (using the Bond-Elut C18 cartridge), each sample was applied directly to a column of piperidinohydroxypropyl dextran gel. Steps in the stepwise elution of unconjugated bile acids and taurine-, glycine-, and sulphate-conjugated bile acids were separated by washing with the buffers, eluted with 5 ml of AcOH-AcOK (pH 6.5) in 90% ethanol (0.3 mol/l), of HCOOH in 90% ethanol (0.2 mol/l) and 1% (NH4)2CO3 in 70% ethanol, respectively. After adding the internal standard (Nor-CDCA), hydrolysis of the glycine- and taurine-conjugated fractions was carried out using choloylglycine hydrolase. Sulphate conjugated fractions were solvolysed and hydrolysed using sulphatase and choloylglycine hydrolase. The respective fractions were converted first to unconjugated bile acids and then to methyl ester-trimethylsilyl ether derivatives, then analysed by GC-MS with SIM.
GC-MS was performed using a Hitachi-M-80B instrument equipped with a data processing system (Hitachi M-0101; Hitachi Ltd, Tokyo, Japan). A Megabore DB-1 GC capillary column (25 m by 0.53 mm, internal diameter, glass coil; J and W Scientific, Folsom, CA, USA) was used. The temperature of the column oven was programmed to rise from 200 to 290°C at 18°C/minute; the temperature of both the injection port and the detector was 260°C. The flow rate of helium gas was 25 ml/minute. Ionisation energy was set at 70 eV, multiplier voltage at 1400 V, acceleration voltage at 3000 V, source slit at 400 μm, and collector slit at 300 μm.
The GC-MS data for bile acid derivatives and related compounds are summarised in table 1. Figure 1 shows a chromatogram obtained using SIM of the characteristic fragments of the methyl ester-trimethylsilyl ether derivatives of a mixture of reference bile acids.
GC-MS data for methyl ester-trimethylsilyl ether derivatives of bile acids
Mean (SD) bile acids in urine of healthy infants
Mean (SD) bile acids in faeces of healthy infants
Selected ion GC-MS chromatogram of the methyl ester-trimethylsilyl ether derivatives of a mixture of reference bile acids:1 Nor-CDCA; 2 LCA; 3 DCA; 4 Δ5-3β-ol; 5 CDCA; 6 UDCA; 7 HCA; 8 CA; 9 Δ1-3-one; 10 3-oxo-Δ4bile acids; 11 CA-1β-ol; 12 CDCA-1β-ol.
We obtained calibration curves for the determination of bile acids by plotting the peak area ratios corresponding to the monitored ions for each bile acid and the corresponding internal standard versus the amount of each bile acids. A linear relation (r > 0.976 to 0.997) was obtained over a range of 1.5 to 10 ng for each bile acid. Because Δ4-3-one and Δ4,6-3-one had the same retention time (22.2 minutes) and the same fragment ions (267 382 mass:charge ratio; m/z), we could not tell one from the other. We therefore mixed them in equal amounts and expressed the result of the analysis as 3-oxo-Δ4 bile acids. These chromatographic responses are appropriate for the assay of bile acids in urine, meconium, and faeces with the addition of adequate amounts of internal standard.
Data are reported as mean (SD). One-way ANOVA was used to determine the significance of differences between groups. Comparisons of groups of categorical data were made using Student's t test. A P value of less than 0.05 was accepted as significant.
URINE (TABLE 2)
The highest mean total bile acids (TBA):creatinine ratio (19.5 (24.8) μmol/mmol of creatinine) was observed in the urine of 7 day old infants. The mean value decreased gradually thereafter. The TBA:creatinine ratio at 3 and 7 days of age significantly exceeded that at 3 months of age (P<0.05) and the TBA:creatinine ratio at 3 and 7 days of age significantly exceeded that on the first day of life (P<0.05).
Urinary 3-oxo-Δ4 bile acids (Δ4-3-one, Δ4,6-3-one) were detected in the urine at each test period. The percentage of this component in TBA in neonatal urine at birth was significantly higher than that at 3 and 7 days and at 1 and 3 months of age (P<0.01, P<0.05, P<0.05, and P<0.05, respectively). The mean percentage of 3-oxo-Δ4 bile acids in TBA did not differ significantly after 3 days of age. The concentration of this component in urine did not differ in each period. The mean Δ1-3-one:creatinine increased between days 1 and 3 of postnatal life. The mean Δ1-3-one:creatinine at 3 or 7 days of age significantly exceeded that at 2 or 3 months of age (all P<0.05). The mean percentage of Δ1-3-one to TBA excretion on the first day of life and at 3 days of age significantly exceed that at 1, 2, or 3 months of age (P<0.001, P<0.001, and P<0.001, respectively). The mean percentage of Δ1-3-one to TBA excretion at 7 days of age significantly exceeded that at 1, 2, or 3 months of age (P<0.05, P<0.05, and P<0.05, respectively).
We analysed such polyhydroxylated bile acids as 1β-hydroxylated bile acids (CA-1β-ol, CDCA-1β-ol) and 6α-hydroxylated bile acid (HCA), and unsaturated bile acid (Δ5-3β-ol). The non-ketonic fetal bile acids (CA-1β-ol, CDCA-1β-ol, HCA, Δ5-3β-ol):creatinine ratio in urine remained increased from 3 days to 1 month, then decreased gradually thereafter (P<0.05vs 3 months). The ratio of non-ketonic fetal bile acids:creatinine in urine on the first day of life was significantly lower than that at 3 days, 7 days, and 1 month of age (P<0.01, P<0.05, and P<0.01, respectively). The mean percentage of non-ketonic fetal bile acids in TBA was lowest on the first day of life (18.6 (5.9)%) and increased gradually thereafter. These non-ketonic fetal bile acids in urine exhibited a similar percentage at 7 days, 1 month, 2 month, and 3 months of age (7 days, 41.4(16.3)%; 1 month, 44.7(11.4)%; 2 months, 46.0(10.0)%; 3 months, 43.9 (5.4)%).
The urinary concentration of the usual bile acids (CA, CDCA, DCA, LCA) was lowest on the first day of life and increased gradually thereafter (P<0.05 vs 3 days, P<0.01 vs 1 month). The mean percentage of the usual bile acids in TBA on the first day of life and at 3 days of age differed from that at 1, 2, or 3 months of age (P<0.001, P<0.05, and P<0.01, respectively). The mean percentage of the usual bile acids in TBA at 7 days of age differed from that at 1 or 3 months of age (P<0.01 and P<0.05, respectively). The mean UDCA:creatinine ratio in urine on the first day of life and at 3 and 7 days of age was significantly lower than that at 1 month of age (P<0.01). The mean UDCA:creatinine ratio on the first day of life and at 3 days of age was significantly lower than that at 3 months of age (P<0.01). The mean UDCA:creatinine ratio on the first day of life was significantly lower than that at 2 months of age (P<0.01). The mean percentage of UDCA in TBA increased gradually after birth. The mean percentage of UDCA in TBA at 3 days of age was significantly lower than that at 1, 2, and 3 months of age (P<0.01, P<0.01, and P<0.001, respectively). UDCA increased gradually after birth.
The percentage of conjugated bile acids in the urine was analysed in the first week after birth. Of the 3-oxo-Δ4 bile acids, DCA, LCA, and UDCA, glycine-conjugated bile acids (73, 27.6, 55.8, and 27.1%, respectively) predominated over the other conjugated bile acids. Of the 1β- (CA-1β-ol, CDCA-1β-ol), 6α-hydroxylated (HCA) bile acid, Δ1-3-one and CA, taurine-conjugated bile acids (49.0, 34.4, 49.1, 45.6, and 41.5%, respectively) predominated over the other conjugated bile acids. The sulphate conjugated bile acids predominated over the other conjugated bile acids in Δ5-3β-ol and CDCA (42.0 and 47.5 %, respectively) (fig2).
Percentage of unconjugated bile acids and of taurine, glycine, and sulphate conjugated bile acids in the urine of neonates in the first week after birth.
MECONIUM AND FAECES (TABLE 3)
The highest value for TBA (mean (SD), 14.2 (6.9) μmol/g) in meconium was observed on the first day of life and the mean value decreased gradually thereafter. The TBA in meconium on the first day of life significantly exceeded that in faeces at 7 days and at 1 or 3 months of age (P<0.01, P<0.05, and P<0.01, respectively).
The concentration of 3-oxo-Δ4 bile acids in meconium on the first day of life significantly exceeded that in faeces at 7 days and at 1 or 3 months of age (P<0.05, P<0.05, and P<0.01, respectively). The mean concentration of this component in faeces did not differ significantly after 7 days of age. The concentration of Δ1-3-one did not differ in each period. The mean percentage of Δ1-3-one to TBA excretion at birth was significantly lower than those at 7 days and at 1 or 3 months of age (P<0.05, P<0.01, and P<0.05, respectively).
Non-ketonic fetal bile acids were increased in meconium on the first day of life, but decreased gradually thereafter (P<0.01vs 7 days). The mean percentage of non-ketonic fetal bile acids in TBA did not differ significantly after 7 days of age. These non-ketonic fetal bile acids remained at about the same level at 7 days, 1 and 3 months of age (7 days, 31.7 (11.6)%; 1 month, 39.7 (9.3)%; 3 months, 38.3 (11.1)%).
The concentration of the usual bile acids in meconium was higher on the first day of life (P<0.05 vs 7 days) and remained at about the same level in faeces at 7 days and at 1 and 3 months of age. The mean percentage of the usual bile acids in TBA did not differ in each period.
The mean percentage of UDCA in TBA increased gradually after birth. The mean percentage of UDCA in TBA in meconium on the first day of life was significantly lower than that in faeces at 7 days and 3 months (P<0.05 and P<0.05, respectively).
The serum concentration of TBA in healthy neonates significantly exceeds that in children over 1 year of age, a condition called physiological cholestasis.9 The urinary TBA:creatinine ratio was raised in the first week after birth, then decreased gradually. The high concentration of TBA in urine may be attributable to either an enhanced stimulation of the enterohepatic circulation of bile acids or an impaired hepatic clearance or excretion.10The highest value for TBA in meconium was in neonates. This value is greatly influenced by events or conditions during pregnancy, such as the presence of biliary bile in the fetal duodenum or the ingestion of amniotic fluid by the fetus.10 11
Ketonic bile acids are usually considered to result from the bacterial oxidation of primary bile acids.12 In this study we detected ketonic bile acids early in life. The intestine may be colonised by bacterial flora during the first week.13 A high concentration of 3-oxo Δ4 bile acids in serum or urine has been associated with a deficiency in, or a reduction of, 5β-reductase activity, the enzyme which catalyses the conversion of 3-oxo-Δ4 C27 sterol intermediates to 3-oxo-5β products in the normal pathway for primary bile acid synthesis.2 In this study the urinary TBA: creatinine ratio was increased in the first week after birth. The mean percentage of urinary 3-oxo-Δ4bile acids in TBA was significantly higher in the first day after birth than at any other age. This condition reflects the normal development of bile acid metabolism, including the initial immaturity of hepatic enzymes, such as 5β-reductase. After 3 months of age, the urinary TBA:creatinine ratio stabilises as a result of the maturation of liver function and of the enterohepatic circulation.10 At 3 months of age, we detected a small amount of 3-oxo-Δ4bile acids in urine, probably associated with intestinal bacterial flora.13 Healthy infants show small amounts of 3-oxo-Δ4 bile acids in urine, because 3-oxo-Δ4 bile acids absorbed from the intestine are metabolised by hepatic 5β-reductase. Two possible sources of 3-oxo-Δ4 bile acids in urine are bacterial metabolism of cholic acid and side chain oxidation of intermediates in bile acid synthesis. The immaturity of hepatic enzymes such as 5β-reductase is particularly important in early life. Thus our findings of large amounts of unsaturated ketonic bile acids in urine support the results of previous studies.4 5 12
The concentration of 3-oxo-Δ4 bile acids in faeces on the first of life was significantly higher than at any other age. A high mean percentage of 3-oxo-Δ4 bile acids in TBA was also present in the meconium of the neonates and in faeces at 7 days of age. The 3-oxo-Δ4 bile acids found in meconium may originate from amniotic fluid ingested by the fetus during pregnancy.3 Large amounts of 3-oxo-Δ4-steroid intermediate may be produced in the intestine by conversion of primary bile acids into secondary bile acids during the neonatal period.14 3-oxo-Δ4 bile acids may be absorbed from the intestine less easily than other bile acids. Analysis of meconium and faeces is difficult because of disintegration of bile acids, such as 3-oxo-Δ4 bile acids, and/or a low recovery rate, when lyophilised meconium or faeces was dissolved in 0.1 mol/l NaOH in this study. Despite this, we detected large amounts of 3-oxo-Δ4 bile acids in the meconium and faeces.
Using our method, Δ4,6-3-one is produced from Δ4-3-one during the preparation of the sample. We therefore suggest that 3-oxo-bile acids are derived to methoximes after the addition of an internal standard to sample.
Large amounts of 3-oxo-Δ1 bile acid were excreted in the urine on the first day of life, and again at 3 and 7 days of age. Elimination of water from the 1β-hydroxy structure may be the mechanism for formation of Δ1 bile acids.12It seems likely that 3-oxo-Δ1 bile acids are more readily excreted in the form of hydroxylates.In urine, the percentage of 1β-hydroxylated bile acids in TBA gradually increased after a decrease in the amount of Δ1-3-one.The latter may be converted to CA-1β-ol.
The usual bile acids and fetal bile acids showed the same pattern of excretion as we had found before.10 We detected small amounts of DCA and LCA in meconium and urine on the first day of life. These bile acids seemed to be mostly of maternal origin, entering the fetus via placental transfer.15 Interestingly, we detected UDCA in both urine and faeces. This finding may be related to the use of food supplements.4 Their formation is probably linked to mechanisms for bile salt excretion in infants with physiological cholestasis. Bile acids have a pronounced hepatotoxic effect in the fetus unless they are metabolised into more polar compounds. CA and CDCA are transformed by polyhydroxylation into 1β-hydroxylated bile acids.16 The process of 6α-hydroxylation is probably also important in detoxification.17
The urinary data in the present study showed that most of the conjugated bile acids were glycine conjugates (40% of TBA, 73% of 3-oxo-Δ4 bile acids), whereas the fetal bile acids were predominantly taurine and sulphate conjugates. Taurine conjugates constituted 17.4 to 49.1% of each fetal bile acid, and sulphate conjugates constituted 31.1 to 42% of each fetal bile acid. Conjugation increases the polarity of the molecule, thereby facilitating its renal excretion and minimising the membrane damaging potential of the more hydrophobic unconjugated species.18
In conclusion, this study has shown that healthy newborn infants excrete large amounts of 3-oxo-Δ4 bile acids in urine and faeces. The presence of large amounts of this urinary component may indicate an immaturity of hepatic 5β-reductase activity in the first week after birth. After 1 month of age, this urinary component is thought to be derived from 3-oxo-Δ4-steroid intermediates in the intestine. The presence of large amounts of this component in meconium may be due to the ingestion of amniotic fluid by the fetus during pregnancy.
This study was supported in part by Grant-in Aid 07670924 for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan.
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