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Augmenting Cancer Therapy through Diet
Dr. Colin Champ presents the historical data on dietary manipulation and cancer care, how diet and nutrition play a role in cancer care, reviews existing data supporting nutritional intervention in cancer care, and explores future directions for diet in the management of cancer.
Educational objectives:
Upon completion of this activity, participants should be able to:
- Describe how nutrition and diet effect cancer formation and treatment
- Discuss metabolic states that may lead to poorer outcomes in cancer patients, such as those with high grade gliomas
- Describe the molecular pathways affected through diet
Reading Resources:
- Fine E et. al. Targeting insulin inhibition as a metabolic therapy in advanced cancer. Nutrition 2012.
- Saleh A, et al. Caloric restriction augments radiation efficacy in breast cancer. Cell Cycle 2013
- Champ CE, Baserga R, et al. Nutrient Deprivation and Radiation Therapy – When Less is More. The Oncologist, 1:2012
Dr. Champ has no relevant relationships with proprietary entities producing health care goods or services.
Accreditation Statement:
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The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.
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Release Date: 6/19/2014 | Last Modified On: 6/19/2014 | Expires: 6/19/2015
And I'm going to talk about augmenting cancer therapy through diet. I have no conflicts of interest to disclose. And briefly my goals are to review the historical data on dietary manipulation and cancer care, to try to convince the listener that diet and nutrition play an integral role in cancer care, to briefly review existing data supporting nutritional intervention in cancer care and to explore future directions for diet in the management of cancer.
And in order to do this I'm going to discuss again the history of dietary manipulation in both the prevention of cancer and cancer treatment, the hypotheses and methods of action, current methods of dietary intervention during treatment, methods of implementing these dietary interventions and future directions.
So to start off the 3 most common questions that I get after discussing radiation therapy with patients beyond the obviously how am I going to do, how are the side effects occur, how will radiation affect me. The 3 most common questions that come next are first off can I have sex, secondly can I drink alcohol, and third what should I eat or more specifically will different foods interact with my treatment. I think the first question we can answer pretty easily, you know it depends on what we're treating it depends on what we're doing so on and so forth, I won't go into too much detail there. The second question we always just kind of come up with you know in moderation, or if you're being treated in an area that's going to interact with the alcohol you probably shouldn't drink etc. For number 3 we really don't have a good answer and it's usually oh there's not good data, or we'll send you off to the nutritionist or you know go on the internet which is probably even worse.
So I wanted to look into this and interestingly enough there is a study that answers both number 2 and number 3 and the study is the Radioprotective Effect of Moderate Wine Consumption in patients with breast carcinoma. This is in the Red journal this is radiation oncologies kind of flagship journal, and this study showed that a glass of red wine, a glass of Italian red wine per day decreased the toxicity of, the skin toxicity of radiation therapy for patients undergoing therapy for breast cancer. An interesting article, I'm a wine lover so any article that can promote healthy drinking of wine, I'm happy about. But nonetheless, it is pretty pathetic that within my field this is one of the few articles exists answering 2 of the 3 most common questions asked by my patients. There is a conflict of interest this study took place where that arrow is in the largest wine growing region in the country, so keep that in mind.
So as a result at my last institution in Philadelphia we wanted to look further into this so we did a survey. We asked all our patients where were they going for their dietary recommendations. If so many patients are asking what they should be eating and they're not getting the answer from their oncologist, where are they going and of course most of them are going on the internet. So we looked to see where they were going. We went to the NCCN accredited institutions all 22 of them, we saw who made recommendations, we quantified these recommendations by food types, specific dietary recommendations i.e., a low fat diet, a high fat diet, a high calorie diet. We quantified macronutrients in regards to carbohydrates, proteins and fats and then we tallied them up. Only 4 of the 22 NCCN institutions even made recommendations and many of them cited other sites. So we went to these sites and looked to see what they were telling patients. And here's the results, so there's 8 total sites of all the NCCN institutions and all the places that they recommend and these were the American Cancer Society, etc., and here's what you got. It's quite a heterogeneous mix, a lot of different recommendations. I only put numbers down here this is straight from the paper, I initially had some of the institutions and I did make some inflammatory comments in the paper and as I was applying for a job at the time to many of those institutions, my chair told me I should probably remove the name if I wanted to get a job. But none the less, if you look on the left here number 10 and 11, so this was up at Harvard, MGH and Dana-Farber, and as you can see they recommend a very high carbohydrate diet, these are all carbohydrates on most what would resemble what's considered a cardiac prudent diet even though nowadays that's controversial, very little protein and even less fat. Then if you go all the way over here to the west coast to Stanford, you get the exact opposite recommendation and this is I think more what people think about when they think about a diet for cancer patients. It's a very high calorie, a high fat diet, moderate amount of protein, and low carbohydrates and this is that typical don't lose weight, potentially even gain weigh diet during cancer treatment. So as you can see there's quite a big mix here, it's understandable that patients don't know where to turn and unfortunately the places they do turn is giving them drastically different recommendations. And these were not site specific these were just generally for cancer patients. So we though this was a very intriguing article, very intriguing finding, we submitted it to a very high power journal in the field of oncology and it got rejected in 2 weeks, further illustrating the lack of nutritional guidelines in the cancer world. These were the 2 responses I got, very brief first off. "We don't have any data showing the effect of diet on cancer treatments or outcomes." And I think the vast majority of the field that doesn't think diet plays a role in cancer care would probably agree with this statement. And then the second statement, "Diet is unlikely to play any part in cancer care therefore this article is irrelevant for this journal". That one I disagree with even more. That one hurt my feelings that was a little more, cut a little more deeply. So we submitted to another journal, the Journal of Nutrition in Cancer and it got accepted and it's not a bad journal so overall I think it was a success though at the time it felt like a failure.
Then weeks later calls came in. The ASCO Post did an article on this article saying this was extremely important, we need more answers, we need to put more money towards dietary and nutrition studies. NCI/NIH also put out a flyer saying this as well. Medscape did an article on it as well and most importantly the most important peer review journal out in the literature The_____ Group, the __________ did an article on it as well. All 4 showing that you know perhaps as oncologists we uniformly don't agree that nutrition and diet play a role in cancer care, but patients and the media do so since we're taking care of patients I think it's our responsibility to provide them with some answers. As for the first response, I think this one could be answered a little bit easier but this is the first study ever showing an interaction between diet and cancer and as you see down here, that's 1909, this is a study from Germany, Dr. Moreschi and I'm not going to dwell on it too long but looking at this table, what he basically did was implant sarcomas in different groups of mice, he decreased the amount of food they ate on a daily basis this was the first calorie restriction study and he showed that in those mice that were calorie restricted that the sarcomas grew much slower. So this kind of got the field rolling. A crude study, he simply weighed tumors, the mice also lost weight so it was somewhat controversial but it got the field rolling. Over the next 100 years dozens if not hundreds of studies took place. The following year Rous, as in Rous sarcoma virus, who later got the Nobel prize, said let's look at this from the way a physician would look at it. Let's put the tumor in these mice first, and then start them on calorie restriction that way it would almost be a therapeutic intervention, and he saw the same thing, he saw slower growth in the calorie restricted mice. Over the next 50 years Tannenbaum really accelerated the field performing dozens of studies. In 1947 he reported on these and he saw both decreased occurrence of tumor and decreased tumor growth by 2-44 times in calorie restricted mice, and he restricted them by 30-50%, so not an insignificant decrease in dietary intake, something that would probably leave us a little worried with our cancer patients. And then over the next 50 years multiple studies advanced the field as well. One that sticks out to me the most is Berrigan, he looked back and said this 30-50% caloric restriction in cancer patients is not going to be doable, is there some other way to circumvent this, perhaps fasting one day per week. And he also said let's start measuring this not just crudely measuring tumor size, he measured the IGF pathway and saw that when fasting these mice during 1 day per week it significantly down regulated the insulin in IGF pathway. So at this point the field was kind of in full swing, we had quantifiable methods of measuring dietary interaction with cancer.
Going back to Tannenbaum's study he reported on, this is just a snippet of all the data that he did but crudely as you can see here this was drawn with pencil, he showed the decrease in tumor incidents and tumor growth in these mice when they were calorically restricted. As he discussed within his articles he saw the biggest reduction as you can see here where there's a C above those lines that's carbohydrates. So when he restricted carbohydrates he saw the biggest reduction in both tumor incidents and tumor growth. And when you take a closer look often times he wasn't even calorically restricting these mice, he was simply decreasing their carbohydrates and often times replacing them with fat. So the caloric intake of these mice may have actually been increasing. But he found the greatest reduction in cancer when he reduced carbohydrates.
Others caught on. Dr. Crabtree looking at the date again, once again referring to that first reviewer, 1929, so some people think we don't have data, yet 80 years ago he observed carbohydrate metabolism in tumors, he tried quantifying it and he discussed at length that tumors have a penchant for carbohydrate uptake and glycolysis. This was on the heals of this man, Dr. Warburg who later got a Nobel prize for his work with mitochondrial respiration and his theory depending on how you looked at it, basically what he observed was that cancer cells have a penchant for glycolysis and that's anaerobic glycolysis. So whether oxygen was present or not, cancer cells would rely on the, pretty poor, inefficient process of glycolysis to derive energy from sugar. Even if oxygen was present, it wouldn't switch to oxidative phosphorylation which gives you about 15 times more ATP it's much more efficient. Depending on how you look at it some people say that he said that was the cause of cancer, some people said that he said that was the result of cancer, regardless, it was present.
And along the same time Dr. Crabtree and Cramer again 1933 they started to do some studies as well, this was an important one in my field, this is the first one that I know showing interaction between radiation and diet. This study is the action of radium on cancer cells, some factors determining the susceptibility of cancer cells to radium. So even as far back as 1933 these scientists knew that when cancer cells were able to engage in increased rates of glycolysis or carbohydrate uptake, that they could overcome death from radiation, or in this study radium.
As a result Crabtree and others tried to start blocking the uptake of carbohydrates of glucose. This is a study he did, Benzopyrene and Chloroacetone, these blocked the uptake of glucose in cancer cells and he watched decreased cancer growth in mice. His partner Dr. Cramer tried a medication called 2 Desoxy-D glucose, 2DG this is a glucose analog it gets bound and blocks glucose uptake and the same thing, he found that even in the face of high levels of glucose, when you block this uptake glycolysis decreased significantly in tumor cells. Weirdly enough this was Cramer's last study, he had some great studies. I don't know what happened to him he just disappeared off the face of the earth. I searched Google, I couldn't find anything. I searched the social security death indices and he disappeared, so it must be some controversy, some conspiracy theory.
So none the less, we have about 100 years of data showing that diet and cancer therapies interact. Most of these studies placed mice on a restricted diet, whether that was calorie restriction or carbohydrate restriction is an area of controversy. They applied a carcinogen or implanted a tumor and after these dietary changes they revealed a decrease in tumor formation and slowed tumor growth. So naturally as a practicing oncologist the question that comes to mind is can we harness the effects of nutrient restriction to aid in the modern treatment of cancer?
So my previous group at Jefferson aimed to answer this very question. We did a, this is a very large study with several smaller studies so I'll try to be as brief as possible. But we took mice, and we implanted triple negative breast cancer cells and we waited until these cells became palpable at 16mm cubed. At that point we randomized the mice to several treatment arms or dietary arms. They either got 8 gray radiation or no radiation and this is by no means a therapeutic dose of radiation, but it was what we considered radiobiologically an amount that would decrease the growth of these cells significantly. They were then placed on an ad libitum diet which is basically access to chow all day long they can eat as much as they want to eat. They were placed on an alternate daily feeding diet so this is every other day the mice were fasted for the entire day or they were placed on a calorically restricted diet and we reduced their calories by 30%. This was on the heels of Tannenbaum and others, this was kind of the magic number. So you get them down to 70% of their calories you may see some changes.
The first study that we did was just the alternate day feeding similar to Berrigan and we found as you can see here in the blue, these are the ad libitum mice, as soon as the tumors hit 2,000 mm cubed the mice were euthanized if they showed any struggling, any trouble breathing we assumed it was respiratory issues from lung metastases or other problems of the mice were also euthanized. And from this study as you can see the 8 gray single fraction of 8 gray which is the red here significantly reduced tumor velocity, tumor growth and overall tumor size, in theory increasing progression free survival. However when you fasted the mice, simply fasted them every other day you get the same effect as a quite large but single dose of radiation. So further pointing to an effect here from diet alone. When you added alternate day fasting with radiation you see a synergistic effect below here where you get significant decrease in tumor growth both velocity and overall size, once again would hint at increasing progression free survival. We did look at the weight of the mice, again Moreschi and these other groups simply weighed the tumors so the one thought is that perhaps if everything is just shrinking of course the tumor is going to shrink including the weight of the mice. We did weight the mice and initially they had a drop when we started fasting them but their weight quickly caught up and there was no significant difference in the weight between these 2 mice.
It is important to note that though these mice were fasted every other day, on the days when they were allowed to eat they quickly caught up and actually ate more than the 70% calorically restricted mice. So now these guys are looking at these 70%, excuse me 30% calorically restricted for overall 70% of their diet. And again, you see similar results however the curves start to separate a bit more. In the middle again is the blue line, these are the ad libitum fed mice, similar tumor growth, single fraction of 8 gray significantly reduces the growth of these tumor cells, next here in the red. And then as we move to the green 70% total diet, 30% caloric restriction actually revealed significant decreased tumor growth over radiation alone. And again when you put them together synergistically you see graphically you see quite a bit difference, obviously this study wasn't made to compare fasting versus caloric restriction, just caloric restriction versus radiation. However as you see below here, the weights of these calorically restricted mice start to drop off and they don't catch up. So as a practicing oncologist this creates a little more concern especially and often times in a patient group that we're worried about weight loss and trying to get them to gain some weight back.
One question this study does not answer, the Tannenbaum question 50 years ago, is it calorie restriction or is it something else. This is a standard mouse diet, 70% of their calories come from carbohydrates so when you reduce their diet by 30% you're basically reducing nearly all carbohydrates, so the next question that comes about, are we reducing carbohydrates in these mice resulting in these results or are we reducing overall calories.
The other issue is these are mice, they have quite a more, quite a higher metabolism rate than humans do so if I were a mouse I'd be 200 pound mouse and I would eat 40 pounds of chow per day. So in real life I eat what I don't know 3 or 4 pounds of food per day so decreasing a pound versus decreasing 11 pounds does it have the same effect. And there's been people very critical of this extrapolation from humans Dr. Seifried who I believe spoke here last year is one of these people claiming that to get 30% caloric restriction in mice, to get an equivalent result in humans you actually have to fast humans for multiple days, some say up to a week. So something that I don't think many of us would be willing to do to our cancer patients.
So we wanted to quantify some markers in this study not just simply weigh the tumors like Dr. Moreschi or Dr. Tannenbaum did, but show quantifiably that these pathways that we targeted with chemotherapeutic interventions are monoclonal antibodies could actually be down regulated through diet alone. So we went back through 100 years of research and tried to figure out which pathways were most important, which pathways were affected by caloric or carbohydrate restriction and which pathways were affected by radiation and I did this paper with Dr. Beserga who actually worked with Dr. Tannenbaum and he found the IGF1 receptor igniting the field in terms of the insulin pathway. We found that these were the most important pathways, there's quite a bunch overall, but the IGF1 pathway which combined with the insulin or IGF1 receptor in up regulating this pathway that we all know so well, the PI3 kinase and AKT pathway can be down regulated through caloric restriction and down regulation of this will sensitize these cells to radiation. So our hypothesis is down regulating this through diet will make these cells more radiosensitive and that will go for chemotherapy as well. The other pathway we thought was of vital importance is the new kid on the block this is the AMP kinase pathway, this blocks MTOR and this can be up regulated via Metformin which has sparked some interest in Metformin for breast cancer, endometrial cancer in some other patients and MTOR can be blocked by Rapamycin. And all these pathways if blocked will decrease cell survival, cell growth and inflammation. And briefly that's exactly what we found in this study. So this was not simply decreasing tumor weight, or decreasing mouse weight, or both, there's clear down regulation of these important cancer pathways. Radiation alone down regulates these pathways but as you can see calorie restriction in itself down regulates all these pathways. Our hypothesis was this is why you get to decreased tumor growth, again it's not just starving these tumor cells, we wanted to look to see if these cancer cells were undergoing apoptosis or due to the decrease nutrients available to them if they started basically committing suicide and they did. We looked at BCL2 and as you go to the right here from an ad libitum diet, from radiation, from caloric restriction and from the combination of both you see BCL2 is significantly down regulated. So through diet alone these cells start committing programmed cell death.
So conclusions from this study is that caloric restriction augments radiation therapy efficacy via several mechanisms, by decreased IGF in the MTOR pathway, by increasing the AMP kinase pathway and by increasing apoptosis of these cancer cells. We found that intermittent fasting results in less weight loss and that calories restricted in the study were primarily carbohydrates so take that as you will.
Naturally the next question that comes about, do studies exist revealing the effect of diet on these pathways in humans? And frankly with cancer patients, they really don't. We have non cancer patients, we have obese patients, diabetic patients, coronary patients at risk for coronary artery disease, where we actually do look at these pathways. But I think we can extrapolate data from these studies so I'll briefly run through several.
This is from Luigi Fontana and the group in Italy and this is the group that's been trying to figure out ways to increase longevity in humans. They've significantly increased longevity in multiple species by calorie restriction. They recently had a study in the last year you may have seen in Nature where they tried it with monkeys and unfortunately it didn't pan out so well. This is a study in humans showing the same issue and this was the IGF1 pathway so that middle pathway in the last picture I showed you. They put people on calorie restriction over a long period of time and again there was no decrease in this pathway. They tried a caloric deficit exercise and again no change. And they did what they called healthy lifestyle which was a combination of both and they saw no difference in the IGF1 pathway. Many people think this is again because this extrapolation from mice, 30% caloric restriction in mice is not equal to 30% caloric restriction in humans. You may have to fast humans if you want to get that down regulation and there is a study hinting at this and this is Dr. Halberg and a group in I believe it was Germany. They put people on 20 day fasts, excuse me 20 hour fasts over a several week period and on the left here as you see in these men their blood glucose levels dropped significantly so as a result they had increased plasma beta hydroxybutyrate production. As blood glucose drops you have to feed your brain, you do so by creating ketones and that's all that this shows. When you fast people ketone production goes up significantly. Ketones can cross the blood brain barrier in times of carbohydrate restriction they can feed the brain, they can feed the neurons, they can feed the mitochondrial within our brain that provide us with energy.
And looking at the plasma insulin pathway as you can see it bottoms out. If you have low levels of circulating blood glucose you don't need very much insulin to pull that into the cells so the insulin level is blocked. A hypothesis is therefore then it would down regulate the IGF1 pathway for the insulin combined in that receptor. It's an extrapolation but it's one of the few studies that exists out there.
Again why is this happening? It's very much likely because of this, because of down regulation of the insulin pathways. So if you get insulin dropping whether it's via intermittent fasting in humans or caloric restriction in mice you're going to down regulate this pathway directly. There's basically less IGF and less insulin floating around to bind to this and up regulate it. If you increase insulin sensitivity or give Metformin you up regulate the AMP kinase pathway and you block MTOR. As a result you get decreased cell survival, decreased cell growth and decreased inflammation. And while ideally soon this will be implemented in the cancer world, this has been manipulated in the dietary world for years. Insulin is an adipose tissue regulator so when insulin is pregnant or pregnant excuse me-when insulin is present which is often when you're pregnant insulin is raised, but it will cause fat cells and adipose tissue cells to increase in size. Therefore, if you can insulin sensitize people you can decrease the amount of adipose tissue circulating around and there are actually 26 randomized trials now in humans showing just this. These are in non cancer patients and this is an overall review. This is from a friend of mine of Al Hite, this was done in 2011, there are multiple studies that have shown similar data since. But when you put overweight diabetic patients, patients with coronary artery disease on a very low carbohydrate ketogenic diet which is controversial, this is a high fat diet, and compare them with a low fat diet and calorie restricted diet you see quite a difference in the decrease in several metabolic factors including body mass and fat mass, but most importantly for our concern here, circulating serum glucose decreases significantly by about 15% and insulin decreases by about 54%. That's simply by telling patients to keep their amount of carbohydrates consumed below 50 grams and instead replacing them with fat which would you know scare some physicians but the results are as they are and this was in 26 total studies. And this is why placing patients on a ketogenic diet results in such quick fat loss and this may not be a surprise to many of you especially those that have read Anna Karenina. Leo Toystool _____ he's not a physician he knew when discussing counts, Lonsky who was trying to lose weight, "He had no need to be in strict training as he had very quickly been brought down to the required weight of 160 pounds, but still had to avoid gaining weight and he avoided starchy foods and desserts." Even Toystool knew that if you down regulated the insulin pathway and insulin sensitized people they would lose weight.
Just a side note, just I thought this was interesting, I won't spend too much time on it but this same group in Italy has been looking at ways to extrapolate calorie restriction in humans. They have started doing some fasting studies. They did a fasting study in 10 cancer patients, again this provides a little trepidation to us practicing oncologists, but they showed in mice that even if you don't give them cancer, but you do give them lethal doses of Etoposide, if you fast them first and there's different methods of fasting here on the right, just straight nutrient restriction over a several day period, or if you do straight glucose with carbohydrate restriction, that these mice can actually withstand lethal doses of chemotherapy and live throughout it. So their theory is that differential stress resistance or basically fasting or caloric restriction may protect normal cells but not cancer cells from high dose chemotherapies. So this is way in the pre-clinical stages but interesting none the less. And I have the, you guys will get all the slides so check that out if you have a minute.
So as a result carbohydrate restriction and fasting better down regulate the insulin pathways, so the next question is what about MTOR what about the new kid on the block. MTOR is down regulated by AMP kinase which is basically an evolutionary metabolic regulator. AMP kinase is a pathway that's up regulated basically to a degree in times of fight or flight so if you are if you don't have food, if you're fasting for several days, if you don't have any carbohydrates around, if you have no glucose or if you're running from prey, AMP kinase is activated and this is an evolutionary survival mechanism within us. If you think about you know you're running from a bear that's trying to eat you, you see the black here, you're going to undergo glycolysis, you're going to break down your sugar, you're going to break down your glycogen to make some energy to run away from. That barrier cells are going to increase glucose uptake and you're not going to produce anymore glucose because this a time of burning to get the heck out of there. As a result you will get decreased fat and cholesterol synthesis. Again, you'll start burning fats as well, so you're going to burn carbohydrates, you're going to burn fat, you're going to want to make energy. If you're burning a lot of fat, you're going to need more mitochondria to undergo the Krebs cycle to turn that fat into energy. So you're going to get mitochondrial biogenesis and this is another controversial area that may show some therapeutic response to cancer cells as well. As a result you're going to get increased insulin sensitivity so up regulation is going to down regulate the insulin pathway as well and you get direct down regulation of mTOR.
So we look through the data to see if any of these, if there are any current studies showing dietary manipulation resulting in deceased or increased regulation of the AMP kinase pathway. And Dr. Draznin and his group actually looked at this very question and they did it quite methodically. They went back and they looked at what Tannenbaum did and did a direct comparison in both overweight and normal weight individuals and they put them on a 5 day, eucaloric, standard American diet with 50% carbs, 30% fat and 20% protein and then they did 30% caloric restriction in both arms. So similar to Tannenbaum, similar to most of these studies over the past 100 years however they wanted to look to see which macronutrients may be affecting it to see if it's something beyond caloric restriction. So they increased the carbohydrates on the bottom left here from 50% to 60% and then in the other group they decreased the carbohydrates from 50% to 30% right there but they increased the fat to 50%. And when they did biopsies of these patients muscles they found an increased up regulation of the AMP kinase pathway and that's no surprise. Looking at the caloric restriction studies throughout history if you do 30% caloric restriction you will get up regulation of the AMP kinase pathway. They increased fat here doing what would be a Tannenbaum type approach. However in this other group they found that even in the face of 30% caloric restriction AMP kinase was down regulated when calories restricted were fat and carbohydrates were increased. They did the same study again in 21 lean individuals however this time around they did not decrease calories, they actually increased calories they let them go on a binge eating diet for 5 days and the up regulated, they increased their carbohydrates by 40%. Same thing, on the left here they increased the carbohydrates to 60%, the decreased them to 30% here and increased the fat to 50% and they followed the 2 groups for 5 days, at the end they did biopsies. AMP kinase was down regulated in this group which was expected. If you decrease calories but increase carbohydrates and AMP kinase is down regulated. If you increase carbohydrates and increase calories of course it's going to be down regulated as well. Interesting finding from this study was even in the face of caloric over consumption if you decrease carbohydrates and increase the amount of fat, this AMP kinase is still up regulated potentially down regulated the mTOR pathway downstream. And for oncologists out there with patients who are risk of cachexia or severe weight loss and perhaps need to increase their calories this may give us a little insight into the ways to do it if we're still trying to up regulate that AMP kinase pathway.
There's a paper that recently came out I think about 3 weeks ago I wrote this with Raynor Klement who's a physicist from Germany it's called Calories, Carbohydrates and Cancer therapy with radiation exploring the 5 R's through dietary manipulation. This is a long and interesting but very boring paper that goes through each macronutrient food and it's effect on these pathways and the effect on radiation efficacy and a lot of these studies look at chemotherapy as well. But basically goes through each one trying to say as practicing oncologists if we're going to create trials looking at these pathways where are we going to get the biggest bang for our buck. And protein restriction has been a potential target as well as has calorie restriction, as has carbohydrate restriction and a ketogenic diet. There's also metabolic pathways that are up regulated or down regulated that might make chemotherapy and radiation therapy work better, it might be more therapeutic and it also might put patients in a better overall metabolic state after treatment as they go through their survivorship period.
Craig Thompson, he's the head of Memorial Sloan Kettering recently commented on the therapeutic implications of different types of food and they said which foods can potentially decrease cancer growth and he said by limiting carbohydrates a lot, by limiting protein a little and fat not at all. So he may be onto something. Check out this paper if you get a minute. The reason that decreasing carbohydrates or calories or even lesser so, protein can increase the susceptibility of cancer cells to radiation is via these 5 mechanisms; its repair of cancer cells, repopulation of the cells, redistribution, intrinsic radiosensitivity and reoxygenation and all 5 of these pathways are affected via dietary intervention and this paper goes through them at length.
And this may be one of the reasons that data like this is starting to surface. This is from Johns Hopkins University it's association between hyperglycemia and survival in patients with newly diagnosed Glioblastoma. And they took about 250 patients that underwent resection by Dr. Grossman at Johns Hopkins, they followed them out during treatment which was Temodar and radiation therapy, they followed their blood glucose levels statistically counting for steroids for Decadron usage, and put them in quartiles and find that this group down here on average their blood glucose was about 130. This group down here their blood glucose was less than 92 on average. There's a significant increase in survival in this group. There's another study out showing that patients under treatment for GBM with Temodar and Radiation, just 1-3 spikes in their blood glucose over 180 decreases their survival by 6 months. And this is a group of patients that lived for about a year to 15 months so that's quite a significant detriment in survival.
One of the reasons why this may work and this is a more controversial topic, there's mixed data at this point but there is a significant amount of data showing that blood normal cells when glycolysis is blocked, normal cells can undergo the Krebs cycle, they can up take fat, they can up take protein, they can up take ketones and they can make energy from this. They can drive ATP, cells in our brains are quite capable of using ketones for energy, whereas there is data showing that malignant cells are inflexible, metabolic inflexibility. They're unable to adapt to blocking glycolysis. As a result, the cells undergo programmed death similar to what we found in our mouse study, BCL2 is down regulated, caspase 9 is up regulated, cells undergo apoptosis which is one of the reasons why when you give radioactive glucose to patients that go under a PET scan, it lights up where the cancer cells are because of their increase, increase in amount of glycolysis and glucose up take. Again this is a little more controversial.
So one method to cause the extreme lowering of blood glucose levels is a ketogenic diet. It's been in the works for about a century, it's been used for patients that have uncontrollable seizures. It's the only disease modifying treatment for seizures. It's less than 20-50 grams of carbohydrates per day and it's about 70-80% fat within the diet so quite an extreme diet, it aggressively lowers insulin and IGF and up regulates AMP kinase. These are the Maasai tribesmen in Africa this was a minute after my-well not a minute, a couple minutes after my buddy gave them a goat to say thanks and they immediately opened the goat and he's eating a kidney here, that's the renal artery and they gave us back the meat that we traditionally eat here because it's all protein. They inherently know that to sustain a ketogenic diet you have to eat mostly fat, so that's something to keep in mind. This is a high fat diet, a very high fat diet, not a high protein diet.
Anecdotally, this was about 100 years from 1923, Dr. Fouche who was a district surgeon in this area in Africa around the turn of the century describes the population of 14,000 that he cared for and during that whole period of time he never saw a single case of cancer in any form, although these diseases were frequently seen amongst the white or European population. So I just thought that was, the whole article is quite interesting. You know it's obviously unclear if diet was the result of this but Dr. Fouche thought it was and he thought it was interesting enough that he wrote to the British Medical Journal in 1923.
Jean Fine performed one of the first studies and one of the only studies at this point looking at a ketogenic diet in cancer patients. This was at Albert Einstein, he wanted to assess this pathway. He runs the nuclear medicine department there so he said let's put 10 patients on a ketogenic diet and let's decrease the amount of glucose that they can consume, let's take their circulating levels of ketones and insulin and then let's put them under a PET scan to see if their cancer can be down regulated via diet alone. And he saw just that, you know this is a pilot trial so it's only 10 patients but he's found that a higher level of circulating ketones in these cancer patients correlated with decreased levels of insulin less down regulation of the insulin pathways similar to that fasting study in health men. Then he really wanted to quantify it so he put these patients under a PET CT scan and found significant decrease in SUV avidity in these cancer cells.
This is also another reason why this study may have shown such significant results. This is at the Barrow Institute over in Arizona with Dr. Adrian Scheck's group. The ketogenic diet is an effective adjuvant to radiation therapy for the treatment of malignant Glioma. So for those in the room that don't know it, GBM is a very terrible cancer with a survival of about 1 year and we're desperately looking at ways to increase this. A ketogenic diet has been one of these potential target treatments. In this study they took 40 mice and on the top left here they put half them on a ketogenic diet and then half them on a standard diet. They did reveal an increase in survival in these mice. So then down here they took it a step further and put these mice on a standard diet and gave them a therapeutic amount of radiation and then put them on a ketogenic diet and gave them a therapeutic amount of radiation and all the mice were euthanized at 250 days. Of the 11 mice on the ketogenic diet with radiation 9 of them were alive at those 250 days and when they did biopsies on their brain there was no sign of tumor whatsoever. One of those mice actually at 100 days went back on a standard diet and when they euthanized the mice and did a pathology there was no tumor as well. So this is a small study and it's in mice but this could be quite substantial if we could see even a fraction of these results in humans.
One of the reasons why GBM and Gliomas have been such a big target in terms of the ketogenic diet is our ability to exploit the blood/brain barrier. There is data that shows that as the ketone levels start to increase and you get more than 1 millimole per deciliter in the serum that these 2 channels right here start to get, MCT gets up regulated, it pulls ketones above or across the blood/brain barrier creating the hyperketotic environment within the brain and GLUT1 transporters down regulates it so you get less glucose in the brain. At this point brain cells start to really rely on ketones so it's really the one area where we potentially may be able to starve a tumor from glucose or potentially down regulate those pathways to let radiation, to allow radiation to work a little bit better.
I've given a similar talk a couple times throughout the country and as a result patients were contacting us at my past institution at Jefferson where we see quite a bunch, where we saw quite a bunch of GBMs with Dr. Dave Andrews group, so as a result several of our patients were undergoing ketogenic diet during treatment and we simply wanted to comment on it because we were trying to get a protocol through and there were some hold ups with concerns about the safety and feasibility of such a diet so we simply wanted to report that it was safe in 7 patients it was safe. It was very well tolerated and we measured serum glucose levels and serum ketone levels and did see quite a change. These are our patients before surgery, before radiation. As you can see their average blood glucose level was about 148 which puts them in the poorest quartile of the Johns Hopkins study with the detriment survival if you're having that glucose level. When we put them on a ketogenic diet there blood glucose acutely lowered. On average it was 82 and that was throughout treatment. It's important to know that half of these patients were on very high dose Dexamethasone which can really significantly raise blood glucose levels, yet their average blood glucose was. Many were 70's. One patient had a maximum value of 91 which still puts him in the lowest quartile of that Johns Hopkins group and that was after, he was a chef and he had a feast of a meal and after that it went right back down. We compared this with our non ketogenic patients, the last 50 that were treated and their average blood glucose was about 124 putting them in the third or fourth quartile for overall outcome.
So it doesn't say that diets going to be therapeutic, it does show that it significantly decreases glucose levels and more importantly that it's safe. So I'm hopefully that at this point we can on the heels of this data we can move on and make some protocols implementing this diet and cancer care. Again important to note that this a patients average consumption that I tracked on FitDay, it is mostly a high fat diet 77%, 15% protein only. If patients eat high amounts of protein it can up regulate IGF and it can knock you of ketosis. This is a typical meal not tot shabby. For breakfast, coffee, cream, 3 eggs, bacon, broccoli cooked. For lunch a Greek salad, olive oil. For dinner coconut oil kale, salmon, and then a delicious snack of macadamia nuts for a total of 1800 calories so not too shabby. And then one thing we did not comment on that you can't quantify first let me discuss this study, this was a study of patients that were treated with definitive chemo radiation for locally advanced lung cancer and they did psychological evaluations on these patients and cognitive evaluations on these patients both prior to treatment and throughout treatment and found that those patients that were not pessimistic lived significantly longer than those patients that were pessimistic. And they found no biologic reason why that happened and that's something in this study you can't quantify. These patients that come in these are GBM patients that come to see me that they've Googled they know that they have maybe a year left to live but they come in enthusiastic, they come in willing to take an active role in their care, their family members go on the diet with them. You take these patients that prior to this is was doom and gloom and a lot of these patients, these are educated for whatever reason a lot of them are men that just recently retired and it just, it really gives them a passion to live again, it really gives them a passion to make it through what can be a pretty tough treatment. It's something we can't really quantify but I think it does provide a benefit.
So in conclusion, there's abundant data supporting the fact that diet on cancer induction and treatment, carbohydrates more than protein is likely the main target. Pre clinical, clinical and radiobiologic data support these effects and importantly patients are extremely interested in diet in cancer so we owe it to them to look further into these interactions. And again this empowers patients to be proactive with their role of care which as a treating physician it's great to see. UPMC's rich network of patients and physicians makes conducting these trials possible. At other sites it's not possible. My last institution it was getting 7 patients through was nearly impossible but here we have some resources to make it happen.
Moving forward reducing glucose availability to cancer cells may be therapeutic and it may enhance cellular damage, but we need to do studies in humans to assess this. Is diet alone enough? Probably not. Can we creat synergy with pharmacologic intervention? Potentially. Two DG's one area where we may explore, it's again it's a glucose analog of GLOX glucose up take in high doses it could be toxic to patients. In low doses though synergistically with a ketogenic diet, we don't know. Can ketone production create a concentrated environment within the blood/brain barrier therefore make treatment more efficacious for Gliomas and GBM, potentially all this data would say yes. I think we need a future clinical trial to answer these questions in humans.
I'd like to acknowledge the following people. Jean Fine has been a great mentor to me. Dr. Bolek who's run multiple randomized trials in humans looking at a ketogenic diet and he's really helped make this diet possible for patients. Dr. Simone another mentor to me and my buddy Dr. Klement in Germany and at this point if anyone has any questions or comments.


text: WORKs presentation of the Blueline Digital System at ISE 2013 is already in the past. As the company have kept listening to the sector and working on this system since it was launched, the Blueline Digital System presented at the trade show this year (stand 7-M176) includes performance improvements and new functionalities. To begin with, the latest version of BlueLine Digital System offers up to 64 stereo channels to distribute different audios with very low latency. Its plug&play system makes it easier for users to set up and control all the installation from one single point through the control panel which is really intuitive to use. Besides, it uses the OSC (Open Sound Control) protocol, so the whole system can be controlled by a tablet or a smartphone. Other new features are the alarm system and the paging, incorporated in the new products which the company is currently developing to complete and upgrade the BlueLine Digital System throughout 2014. The alarm system will enable to send instantaneously a pre-recorded message to every zone of the system, whereas the paging will substantially improve the functionality of this system, offering the possibility of sending a voice message to a particular zone or zones. It means an improvement because controllers of the system no longer will have to interrupt the audio of all the circuit but just that of the selected channels. Among other features of the system, such as remote control, the possibility of installing local wall panels or the PoE (Power Over Ethernet) Technology it is based on, it is worth underlining its modularity. BlueLine Digital brings the possibility of designing and building an audio distribution system that can be completely adapted to any specific needs thanks to its modules. This makes possible to avoid big investment at the beginning of the installation, being possible to add modules if needed.

subset: commoncrawl


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I'm sharing a quick recipe with y'all today per Ben's request–Easy Beef and Vegetable Soup (perfect for gloomy days). This is his all-time favorite soup. And it also just so {…Read More…}
Easy Beef and Vegetable Rainy Day Soup Recipe
February 3, 2016 By * 24 Comments
Wellness Kitchen: BEST Chicken Tortilla Soup Recipe
October 13, 2015 By * 3 Comments
BEST Chicken Tortilla Soup Recipe Print The BEST chicken tortilla soup recipe by Paulette Lambert and the Wellness Kitchen at the Four Seasons in Westlake Village. Author: Paulette Lambert, {…Read More…}


text:
Words containing effaceabilities
Found 1 words containing effaceabilities. Browse our Scrabble Word Finder, Words With Friends cheat dictionary, and WordHub word solver to find words that contain effaceabilities. Or use our Unscramble word solver to find your best possible play! Related: Words that end in effaceabilities
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text:
Tributes paid to 'superb soldier' killed in Iraq incident
Tributes have been paid to a "superb soldier" and "first class leader" who died in Iraq.
Lance Corporal Scott Hetherington, 22, of 2nd Battalion The Duke of Lancaster's Regiment, died following a "tragic incident" at Camp Taji, north of Baghdad, on Monday.
The circumstances of the death of the father-of-one, from Middleton, Greater Manchester, are being investigated, the Ministry of Defence (MoD) said.
The MoD previously confirmed that the death was not as a result of enemy activity.
L/Cpl Hetherington, nicknamed "Snowball", was a member of Blenheim Company and a vehicle commander in the Force Protection Platoon.
Lieutenant Colonel Rob Singleton, Commanding Officer, 2nd Battalion The Duke of Lancaster's Regiment, said: "Lance Corporal Scott Hetherington was a superb soldier and a first class leader. Utterly professional and talented, he was full of character, fun and his enthusiasm was infectious.
"The Battalion has lost a huge talent and a real character. He will be missed dearly and we will never forget him. Our hearts go out to his parents, his siblings, his girlfriend and his young daughter. They are in all of our thoughts."
Lance Corporal Lynch, Force Protection Platoon, Blenheim Company, 2nd Battalion The Duke of Lancaster's Regiment, added: "Snowball was a top bloke. You could always count on him to have a laugh, and he always had an answer for everything. He was such a big character. He will be greatly missed by the whole Battalion."
The British Army is in Iraq as part of Britain's effort to combat Islamic State (IS) terrorists.
In December, 150 soldiers from the deceased soldier's battalion were being deployed to Iraq for six months.
They formed part of the 500-strong British Army force which was being sent to the country to train Iraqi and Kurdish security forces.
As part of the UK's role in the 68-member Global Coalition committed to defeating IS, the 2 LANCS soldiers were being sent to Iraq to provide protection to other British troops training the local security forces in infantry skills, weapons maintenance, medical, engineering and counter IED measures.
Major General Rupert Jones, Deputy Coalition Commander, said: "The entire international coalition mourns the loss of Lance Corporal Hetherington.
"He died helping support our Iraqi partners to defeat Daesh (another term for IS) and so protect the United Kingdom. His family and loved ones are in all our hearts and thoughts."
Minister of state for the armed forces Mike Penning said: "Our thoughts are with the soldier's family, friends and colleagues, and I would ask that their privacy is respected at this difficult time. An investigation has started into the circumstances surrounding this tragic incident."
The Combined Joint Task Force stated on its website that a "coalition serving member" was killed in a "non-combat related incident", and said an investigation was under way.
Family and friends of L/Cpl Hetherington, a former student at Middleton Technology School, paid tribute to him on social media.
On Facebook, his aunt, Nicola Hetherington, said the family were "heartbroken".
James Postlethwaite posted: "Shocked and saddened that Scott Hetherington has been taken from us all far too soon! Not a day would pass without him making you laugh or smile. Really was the light in a dark room.
"So many funny memories, one of the most genuine and biggest personalities within the battalion, amazing friend, soldier and leader amongst many other things. Had such a massive effect on so many people's life's and careers! You will never be forgotten! My heart goes out to your friends and family. RIP."
He signed off with the Duke of Lancaster's Regiment motto: Nec Aspera Terrent (Difficulties be Damned).
It is understood that L/Cpl Hetherington became a father last October.


text:
Summer is Here!
December 2016
Beach vendors sell from anything from hats to a refreshing "mate" with a dash of lemon juice, as well as Havaianas flip-flops which are just perfect for your feet in the hot sands!
This 2016 was a great year for our country. Brazil has been put through the test and passed with flying colors! The warm welcome to the Games and an unexpected cheer to competitors when it was most needed proved, once more, Brazilians know how to make people feel at home.
Summer, the best time of the year is just around the corner! It is fantastic to have a coastline that is 8 thousand kilometers long, beach lovers can look from calm or a crowded beach, palms or coral reef. You choose where to go, but the latest trend in beachwear is a privileged creation of the Girls from Ipanema. The music is a 60's classic, but the bellwether summer fashion vocation of these girls is renewed every year.
Accommodations go from the elegant 6 star Trump Rio de Janeiro, or the latest trend, small cozy properties like Casa Amarelo, to the cozy Uxua Casa Hotel & Spa in Trancoso, Bahia or the Mosquito Blue in Jericoacoara (Jeri for short) where sunsets are gazed upon from the top of a dune.
At the heart of the Anavilhanas Archipelago in the Amazon, the Mirante do Gavião is the place for nature lovers. At this time of the year it is winter in the Amazon for being in the northern hemisphere. Temperatures are mild, waters not so high and lots to see. The perfect time of the year for a visit!
Sometimes distances are big and flights offered by regular airlines do not meet with a group's requirement. Just recently we had two special groups, one of 35 pax chartering a private jet from the Pantanal to Rio and another of 350 pax!
For more information, please contact Anna Nagy at firstname.lastname@example.com


text:
This work uses textual hermeneutics to examine how we might conceive of myth as method. Following the central thesis that myth is uniquely suited for depicting cultural, historical, and social change, this book analyzes the topic through the examples of James Joyce's Ulysses, Aristotelian poetics, and the late writings of Paul Ricoeur. This interdisciplinary study makes a literary and philosophical contribution to elucidating the question of what we narrate when we are narrating myths.
Bookwire is a mobile app for your iPhone that gives you the ability to scan a barcode
or enter ISBN, access book records and add titles to wish lists.


text:
FPSO Contract for COSCO
COSCO Corp. (Singapore) secures contract to construct a Floating Production Storage Offloading (FPSO) vessel in China.
COSCO Nantong Shipyard Co. Ltd., a subsidiary of the Company's 51% owned subsidiary, COSCO Shipyard Group Co. Ltd., has secured a contract valued over US$ 370-million from a European company to build a FPSO.
The FPSO will measure 78 meters in diameter, 32 meters high and will have a storage capacity of up to 400,000 barrels of oil.
The vessel is scheduled for delivery in June 2015.


text:
Project Paws Alive Booth & Police K9 Demos at the Atlanta Pet Expo 2018. The Expo has returned to Gwinnett County! Join us for two days of pet related activities, vendors, entertainment, and food. Pets welcomed. Great family event. Indoor venue. FREE ADMISSION & PARKING.
Project Paws Alive will have a premium booth; come by and view some of the equipment used to protect Law Enforcement, Military, Fire, and Search & Rescue K9s. Enter one of our drawings, watch a K9 demo, or just stop by and meet some K9 Officers. As always we will have fundraising items available for purchase, and will also be accepting donations for our K9 Equipment Fund which provides underfunded K9 Units with protective K9 gear they would otherwise not be able to afford.
For more information on us please visit our website at http://
For Expo Event information please visit the event site at http://


text:
Holmes' Hounds —Amador County, California's own Sherlockian Society
Once 221B Baker Street was in place, the rest was elementary – a Sherlockian society, Holmes' Hounds, formed to bring this room alive. Meeting every other month for evenings of engaging discussion of the original Holmesian canon, members dress in their Victorian finest, give character presentations, hold court to guest speakers, play period games, are "hare and hound" to scavenger hunts, and engage in quite a bit of eating, drinking, and tomfoolery. Hounds meet several times a year for Movie Nite and three times a year for formal parties: Sherlock Holmes' Birthday Celebrations, The Stoddart Dinner, and The Christmas Soiree.
Join the fun – you'll find a Holmes' Hounds membership form if you click here. Keep in touch with the Hounds — visit and "Like" Holmes' Hounds on Facebook.
Holmes' Hounds: Save These Dates!
July 4 (Tues): Holmes' Hounds July Meeting, 6 pm
August 27 (Sun): 3rd Annual Stoddart Dinner, 5 pm
September 5 (Tues): Holmes Hounds September Meeting, 6 pm
November 7 (Tues): Holmes Hounds November Meeting, 6 pm
December 9 (Sat): Christmas Soiree, 6 pm


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5,788 results for 2016
Higher education expansion, economic reform and labor productivity
Yao, Yao (2016)
Scholarly text
Victoria University of Wellington
This paper studies the impact of higher education expansion, along with economic reform of the state sector, in the late 1990's in China on its labor productivity. I argue that in an economy such as China, where allocation distortions widely exist, an educational policy affects average labor productivity not only through its effect on human capital stock, but also through its effect on human capital allocation across sectors. Thus, its impact could be very limited if misallocation becomes more severe following the policy. I construct a two-sector general equilibrium model with private enterprises and state-owned enterprises, with policy distortions favoring the latter. Households, heterogeneous in ability, make educational choices and occupational choices in a threeperiod overlapping-generations setting. Counterintuitively, quantitative analysis shows an overall negative effect of higher education expansion on average labor productivity (by 5 percent). Though it did increase China's skilled human capital stock significantly (by nearly 50 percent), the policy had the effect of reallocating relatively more human capital toward the less-productive state sector. This also directed physical capital allocation toward the state sector and further dampened average labor productivity. It was the economic reform that greatly improved the allocation efficiency and complemented educational policy in enhancing labor productivity (by nearly 50 percent).View record details
Settlement payments in Papua New Guinea - Are they Just or Unjust?
Sukwianomb, Sheila (2016)
Scholarly text
Victoria University of Wellington
This paper discusses and analyses settlement payments paid to customary landowners in Papua New Guinea by the State for the acquisition of their customary land prior to Independence. These payments had been introduced after customary landowners had raised their grievances over the low purchase prices that they had been allegedly paid by the early European settlers and the colonial administration over their customary land. They are statutorily fixed payments provided under the National Land Registration Act 197. However, since the introduction of these payments, the State has encountered a number of problems. The main problems are firstly that customary landowners are still dissatisfied with the amounts paid and therefore continuously demanding further payments. Secondly, the National Land Commission which was established to administer the process of facilitating these payments under the National land Registration Act is not performing its functions effectively. Therefore this paper aims to study the historical reasons behind introducing these payments and argues that based on the current problems that the State is experiencing with paying landowners' settlement payments it should consider whether or not to continue to pay customary landowners.View record details
The Trans-Pacific Partnership - A bane or boon to corporate social responsibility?
Ariyaratne, Nilupuli (2016)
Scholarly text
Victoria University of Wellington
This paper examines the possible positive and negative effects that the Trans-Pacific Partnership (TPP) can have on Corporate Social Responsibility (CSR). Accordingly, the thesis will analyse these effects to determine whether the TPP could ultimately serve as a tool for improving or crippling the CSR practices of corporations within TPP States.View record details
Getting the definition of 'consumer' right - Worrying about the smaller ones in Fiji
Khatri, Bhumika (2016)
Scholarly text
Victoria University of Wellington
This paper argues that the definition of consumer in Fiji should be broadened to include the micro and small enterprises (MSEs). A survey conducted by the National Centre for Small and Micro Enterprises Development in Fiji provides a deep insight into the operation of MSEs in Fiji. The survey findings reveal that MSEs are vulnerable and could be easily exploited by larger companies in the market. One of the ways in which MSEs could be protected is by providing them with the consumer-level protection. This paper argues that MSEs are eligible for consumer protection because like consumers, they also have poor bargaining power, less expertise in making an informed purchasing decision and significant difficulties in seeking remedies against the large suppliers. The paper further contends that the definition of consumer must not only be widened in the general consumer protection law but in the consumer credit legislation and with respect to unfair contract terms too. The arguments against the proposal to broaden the definition are that all businesses, regardless of their size, should be treated the same, there are other relevant laws for the protection of business-consumers and that it would put extra burden on the suppliers, many of whom are small businesses themselves. The paper ends with a draft definition of consumer which includes domestic consumers, micro businesses, whether purchasing for business use or re-sale and small businesses purchasing for business consumption.View record details
Principles that Should Govern the Right of Employers to Monitor Employee's Computer Mediated Workplace Communication: Private Sector
Rodriguez, Laura (2016)
Scholarly text
Victoria University of Wellington
This paper explores the issues that arise from the surveillance of digital communications at the workplace and how New Zealand has addressed these issues. To achieve that purpose, this paper explores the two prevalent approaches to privacy rights at the workplace: The ownership of the resources (Anglo-American) and the continental Dignity-based (Europe). New Zealand has aligned itself with the Anglo American approach. This approach is less protective of employee's privacy interests. This paper shall demonstrate that the legal protection of employees from electronic monitoring would be greatly improved by deriving those protections from "human dignity".View record details
The Origin and Migration of Proportionality
McManamon, Jane (2016)
Scholarly text
Victoria University of Wellington
This paper analyses the origin and migration of proportionality covering the history of proportionality, the development into the Basic Law, its migration and current trends including its presence in international and human rights law.View record details
Audiovisual and Chill: An Evaluation of Video Digital Libraries and Catalogues
Gordon, Timothy Dean (2016)
Scholarly text
Victoria University of Wellington
Research Problem: This research investigates how well video digital libraries and catalogues used in academic libraries meet user expectations. This is in the context of increasing use and demand for online audiovisual content by the wider community, as well as growing use of audiovisual materials for teaching, learning, and research at academic institutions. It also aims to give an understanding of how well libraries are meeting the challenges of delivering audiovisual materials to users in an on-demand world. Methodology: Twelve platforms—developed between 1996 and 2015—are evaluated against 23 user-centred criteria, divided into four core areas: retrieval functionality, user interface, collection qualities, and user support. Results: The study found that not one of the platforms evaluated met all the evaluation criteria, and identified three key areas in the usability of the video digital libraries and catalogues: search and retrieval, technology, and structure, scope, and strategy. Implications: From this we gain an understanding of performance and usability of video digital libraries and catalogues currently in use by academic libraries. We also learn about the difficulties those working with audiovisual materials are facing, and also of the solutions that are being proposed. Findings of this study could help influence decision making, development of future platforms, and influence policies for delivering audiovisual materials to users.View record details
Barriers to uptake and use of data sharing systems at the University of Auckland - Identification of differences in researcher and academic librarian perceptions
Simons, Joanne Leigh (2016)
Scholarly text
Victoria University of Wellington
Research Problem: To identify the differences in researcher and academic librarian perception of barriers to the uptake of data sharing systems by researchers at the University of Auckland in order to address all possible barriers during implementation and improve researcher use of new systems. Methodology: This study has a cross-sectional research design, using a mixed methods research strategy, in particular a sequential exploratory design where preliminary interviews with researchers and academic librarians informed the construction of an online survey tool distributed more widely to researchers and academic librarians within the University of Auckland. Statistical significance testing was performed using the Mann-Whitney U test. Results: 103 survey responses were received from researchers, and 18 from academic librarians. There were observable differences in the relative impact assigned by researchers and librarians to the various factors that influence researcher decisions to share data. There are also significant differences in the perceptions of barriers to data-sharing between research disciplines. Implications: There may be a need to improve communications between the library and researchers with regards to the tools and services that they can offer. Library staff may need additional training in support of University researchers, as a proportion did not feel confident answering questions about researcher data-sharing. The research discipline differences in perceptions of barriers to data-sharing mean that a "one-size fits all" strategy for education in and marketing of these services will not be the most effective strategy to address concerns and increase researcher engagement.View record details
The chemistry of the bioluminescence of the New Zealand Glow-Worm
Watkins, Oliver (2016)
Doctoral thesis
University of Otago
The aim of the research described in this thesis was to discover the luciferin responsible for bioluminescence in the New Zealand glow-worm (GW) Arachnocampa luminosa. This work was done in partnership with Dr Miriam Sharpe whose focus was to elucidate the luciferase. In order to determine the structure of the GW luciferin, the luciferin had to be isolated from the GW and the structure elucidated via characterisation. However, luciferin purifications pose a unique isolation challenge, combining the difficulties of isolating material from source organisms, working with unstable materials, and working with enzymatic assays. Furthermore characterisation of luciferins is often difficult due to the small amounts that can be isolated and because luciferins are often highly unstable. Previous work on luciferins in other organisms and on the GW luciferin is reveiwed in Chapter 1. Chapter 1 also reviews the general literature on bioluminescence but with a focus on luciferins rather than luciferases. Chapters 2 describes the collection of Arachnocampa luminosa from the wild, and the development of a GW bioluminescence assay that enabled GW luminescent molecules to be detected. This assay enabled the detection of two different types of luminescence: P type luminescence and L type luminescence. Chapter 3 describes the separation of glow-worm lysates by reverse phase chromatography and how the luminescence assay was used to trace GW luminescent molecules through the purification process. This led to the discovery of two glow-worm luciferin precursors: tyrosine and xanthurenic acid that gave P type luminescence with the GW bioluminescence assay. The compound responsible for the L type luminescence was separated away from the compounds responsible for P type luminescence but could not be isolated. The compound responsible for L type luminescence was found to co-elute with tryptophan and is thought to be the GW luciferin. Chapter 4 describes how commercial samples of these precursors (xanthurenic acid and tyrosine), along with GW enzymes, were used to produce a compound (LRPA) that could be characterised by MS and 1H NMR. A solution of LRPA was found to produce L type luminescence with the luminescence assay showing LRPA to be either the GW luciferin or a closely related compound. Chapter 5 then describes the synthesis of two molecules (N-carbamyl tyrosine and phenol-O-carbamyl tyrosine) that were candidates for a compound that co-eluted with tyrosine. Neither of these molecules matched the unknown candidate which was later found to be 3-OH kynurenine. The research on the New Zealand glow-worm described in this thesis required intensive use of LC-MS techniques. However the research was often slowed by a shortage of glow-worms. These techniques were therefore used to investigate another New Zealand natural products problem involving insect metabolites; the origins of tutin, hyenanchin and the tutin glucosides found in New Zealand toxic honeys. Chapter 6 therefore describes a quantitative LC-MS study that shows that these compounds are of plant, not insect origin and that tutu may use glycosylation to aid in tutu transport.View record details
Aroha Across the Pa: Whānau and the role of Kuia in the 21st century - a Māori perspective
Ikkala, Shirley (2016)
Masters thesis
University of Otago
He wāhine, he whenua e ngāro ai te tāngata "by women and land men are lost" Kuia held key roles such as whare Mātauranga (repositories of knowledge) within whānau, linking past with the present and it is these roles that were valued and protected within whānau, hapū and iwi. Kuia nurtured and protected these roles and were the kaitiaki (guardians) of whānau, hapū and iwi knowledge thus ensuring the well-being of whānau, hapū and iwi. Historically many of these traditions were passed down through waiata, haka, whakataukī, mōteatea and were the primary means of transferring knowledge, values and belief. However, these traditional means of transferring knowledge have evolved with the advancement of technology and moving into the 21st century. Kuia were and are the kaitiaki (guardians) of the maintenance and transference of history and knowledge for future generationsView record details
The Numerical Initial Boundary Value Problem for the Generalised Conformal Field Equations in General Relativity
Stevens, Christopher Zane (2016)
Doctoral thesis
University of Otago
The purpose of this work is to develop for the first time a general framework for the Initial Boundary Value Problem (IBVP) of the Generalised Conformal Field Equations (GCFE). At present the only investigation toward obtaining such a framework was given in the mid 90's by Friedrich at an analytical level and is only valid for Anti-de Sitter space-time. There have so far been no numerical explorations into the validity of building such a framework. The GCFE system is derived in the space-spinor formalism and Newman and Penrose's eth-calculus is imposed to obtain proper spin-weighted equations. These are then rigorously tested both analytically and numerically to confirm their correctness. The global structure of the Schwarzschild, Schwarzschild-de Sitter and Schwarzschild-Anti-de Sitter space-times are numerically reproduced from an IVP and for the first time, numerical simulations that incorporate both the singularity and the conformal boundary are presented. A framework for the IBVP is then given, where the boundaries are chosen as arbitrary time-like conformal geodesics and where the constraints propagate on (at least) the numerical level. The full generality of the framework is verified numerically for gravitational perturbations of Minkowski and Schwarzschild space-times. A spin-frame adapted to the geometry of future null infinity is developed and the expressions for the Bondi-mass and the Bondi-time given by Penrose and Rindler are generalised. The Bondi-mass is found to equate to the Schwarzschild-mass for the standard Schwarzschild space-time and the famous Bondi-Sachs mass loss is reproduced for the gravitationally perturbed case.View record details
'It's just so bloody hard' : recommendations for improving health interventions and maternity support services for disabled women
Payne, Deborah; Guerin, Bernadette; McPherson, Kathryn; Roy, Dianne; Giddings, Lynne; Farquhar, Cindy (2016-08)
Conference item
Paucity of information about Aotearoa/New Zealand disabled women's experiences of becoming mothers and the enablers and barriers they may face. • Overseas studies show that disabled women do encounter physical, attitudinal barriers. • Studies have also indicated that health professionals lack the knowledge and experience to provide appropriate care. • 2014 Maternity Consumer Survey found that disabled women were less satisfied overall with their maternity care in comparison to non- disabled women. Study aims 1. To investigate the experiences of women with either physical disabilities or sensory impairments in choosing whether to become mothers, including the barriers and facilitators to positive experiences of disabled motherhood; 2. To investigate the perspectives of health care professionals regarding the facilitators and barriers to providing best quality maternity and child care services for disabled women; and 3. To seek consensus on priority actions and strategies towards our overall aim of improving health outcomes for disabled women during pregnancy, childbirth and early childcare.View record details
The Two Towers : appraisal and leadership development for middle leaders
Bassett, Martin; Robson, Joanne (2016-04)
Conference item
"Middle leaders" Two Towers : appraisal and leadership development Crisis in the "middle" - then & now So what? Now what?View record details
Osteopathic attitudes, knowledge and practices in melanoma screening
Friedlander, Tim; Horgan, Carol; Hilton, Craig (2016-08-13)
Conference item
Role for Osteopaths? Osteopaths are Primary Practitioners Osteopaths often see and examine patients in a state of undress As health care providers, there is a likelihood that osteopaths can be trained to a good level of skill in melanoma screening Early Detection Advisory Group (2006) recommends a programme to "increase knowledge about skin cancer, particularly melanoma, among other relevant health workers"View record details
Challenging positional authority : navigating leadership as collaboration
Wrightson, Helen; Lee-Anne, Turton (2016-08-05)
Conference item
Challenging positional authority Collective nature of leadership Kaupapa Māori model of leadership Building people's capabilities Sustainable leadership Distributed leadership is transformationalView record details
What Happened at the End of Lapita: Lapita to Post-Lapita Pottery Transition in West New Britain, Papua New Guinea
Wu, Pei-hua (2016)
Doctoral thesis
University of Otago
This study presents a detailed Lapita to Post-Lapita sequence/transition with chronology at particular sites in west New Britain, through the medium of pottery analysis of style and production. The data allow me to address the research questions: (1) the cultural change that happened toward the end of Lapita, and (2) the issue of cultural continuity/discontinuity between the Lapita and Post-Lapita periods. This study identified a cultural change with greater break down and regionalization/diversification of the Lapita societies in the Late Lapita phase around and after 2750/2700 BP. This study also identified detailed pottery characterization, production, and provenance in west New Britain through compositional analysis, using a scanning electron microscope (SEM), which helps in understanding the interactions in the Lapita and Post-Lapita periods between west New Britain and other regions. In addition, this study identified a distinctive vessel form of double spouted pots of Lapita pottery that might originate from Island Southeast Asia, and demonstrates that after Lapita peoples had reached the Bismarcks, they maintained contact with homeland communities in Island Southeast Asia, and the double spouted pots were later introduced to the Bismarcks through interactions.View record details
Dire Straits v The Cure: Emphasising the Problem or the Solution in Charitable Fundraising for International Development
Clark, Jeremy; Garces-Ozanne, Arlene; Knowles, Stephen (2016-10)
Working or discussion paper
University of Otago
We conduct a laboratory experiment to test the effect on charitable donations to international development NGOs (INGOs) of emphasising current deprivation in a developing country, versus emphasising the potential good a donation can achieve. Using a double-blind dictator experiment with earned endowments, we find that varying the information/emphasis has no significant effect on total donations, or on the probability of donating. An emphasis on current deprivation does, however, significantly raise the variance of donations, so that conditional on donating, it significantly raises donations compared to emphasising potential gains from the charity's work.View record details
Motherhood and Family Law
Mackenzie, Fiona Amy (2016)
Doctoral thesis
University of Otago
Throughout the broad sweep of history and related disciplines, including the law, can be found instruction with respect to the issue of motherhood. In one sense, it transcends culture; in another, it is a cultural construct. It is imbued with gender specificity and is profoundly important to children. This thesis explores motherhood's relationship with family law and seeks to illustrate how, through uneasy tensions over time, it may have been compromised in modern child care law in New Zealand. It discusses whether parenting law should continue to adopt a gender neutral approach or whether, in considering a child's welfare and best interests, there may be a case for greater recognition and restoration of gendered parenting relationships and perhaps, therefore, a repeal of s4(3) of the Care of Children Act 2004.View record details
Does a 'baby-led' approach to complementary feeding alter the risk of choking and growth faltering in infants aged 0-12 months?
Fangupo, Louise Joan (2016)
Masters thesis
University of Otago
Background: Although baby-led approaches to complementary feeding such as Baby-Led Weaning (BLW) are growing in popularity, research exploring the safety and efficacy of these approaches is sparse. Concerns have also been expressed regarding the potential for BLW to increase the risk of choking, growth faltering and iron deficiency. The Baby-Led Introduction to SolidS (BLISS) randomised controlled trial investigated whether a form of BLW, modified to address these concerns, was a suitable way to introduce solids to infants. Aim: To investigate whether the BLISS approach to complementary feeding alters the risk of food-related choking and growth faltering among infants aged 0-12 months. Methods: Dunedin families (n=206) were randomly allocated to a Control or intervention (BLISS) group. Control families (n=101) received the standard government funded 'Well Child' health service. BLISS families (n=105) received Well Child care plus at least 8 parent contacts for advice and support on following the BLISS approach. Data on the frequency of choking and gagging, the characteristics of choking events, and the impact of adherence to a baby-led approach to infant feeding were collected by questionnaires when infants were 6, 7, 8, 9 and 12 months of age. Choking and gagging frequencies were also assessed by daily calendars at 6 and 8 months. Data on infant exposure to foods thought to pose a choking risk were obtained using three-day weighed diet records at 7 and 12 months. Parental feeding practices were evaluated by questionnaires at 7, 8, 9 and 12 months. Infant growth was determined from repeated anthropometric measurements (infant weight at 6, 7, 8, 9 and 12 months, and length at 6 and 12 months). Growth was checked against five "growth triggers" to ensure the early identification of infants at potential risk. Growth faltering was defined as a weight deceleration of >1.34 of a weight-for-age z-score (using the World Health Organization Child Growth Standards) between 6 and 9 months. Results: Overall, 35% of infants choked at least once between 6 and 8 months of age but there were no significant group differences in the number of choking events at any time point (all p>0.20). BLISS infants gagged more frequently than Controls at 6 months (RR 1.56, 95% CI 1.13 to 2.17), but less frequently than Controls at 8 months (RR 0.60, 95% CI 0.42 to 0.87). At 7 and 12 months of age, 52% and 94% of infants respectively were offered food thought to pose a choking risk during weighed diet recording, although no statistically significant group differences were observed at either age (all p>0.30). Consistently safe parental feeding practices were often lacking in both groups, particularly at 12 months when only 44% of Control and 65% of BLISS infants always had an adult sitting with them while they ate. Although 32 infants (16 Control, 16 BLISS) met at least one growth trigger between 6 and 12 months, only 3 (2 BLISS, 1 Control) were potentially serious enough to be referred to the study paediatrician. However, growth improved in all three infants and no child met the criterion for growth faltering. Conclusions: Infants following the BLISS approach to complementary feeding were no more likely to choke or experience growth faltering than Control infants, although it is acknowledged that this was a relatively small study.View record details
Lapita Plants, People and Pigs
Tromp, Monica (2016)
Doctoral thesis
University of Otago
The Lapita cultural complex is associated with the Austronesian expansion out of Island Southeast Asia beginning approximately 3,500 BP. Sites associated with this archaeological culture have been found from the coast of New Guinea in Near Oceania and out past the Solomon Islands into Remote Oceania as far south as New Caledonia and as far east as Samoa by 2,700 BP. Major components of this culture include the commensal animals and horticultural plants that were transported with them as a portable subsistence economy during their voyaging. The commensal animal component of this package is reasonably well established, but the plant portion is less clear. This is primarily due to the scarcity of plant macro remains that have been found from archaeological sites and the lack of specificity of actual foods consumed in stable isotope analyses of archaeological human and animal bone. One direct way to explore the dietary plant component is to identify micro particles of plants (microfossils) that have been trapped within calcified plaque (dental calculus). The primary aim of this thesis is to examine the relationship between Lapita and immediately post-Lapita people and plants. The secondary aim is to examine whether human and commensal pig plant diets are similar and if it is possible to use pig diet as a proxy for human diet when human remains are not available for analysis. To address these aims, microfossils were extracted from human and pig dental calculus from four different sites: the SAC site on Watom Island, East New Britain Province, Papua New Guinea; Teouma on Efate Island, and Vao and Uripiv islands off the coast of northeast Malakula in Vanuatu. The samples were examined using a combination of light microscopy and scanning electron microscopy. All of the samples analysed date between Lapita (~3000 cal BP) and post-Lapita (~2500 cal BP) periods. These sites allow for a comparison of 1) an initial colonizing population (Teouma) and later populations (Watom, Uripiv and Vao), 2) Near Oceanic (Watom) and Remote Oceanic (Teouma, Uripiv and Vao) sites and 3) the wild versus cultivated plant components of their diets. The results show a much more diverse plant diet than has previously been shown. The importance of indigenous trees and shrubs to both Lapita and post-Lapita people analysed from all sites has been demonstrated in this study. Novel results include the first instance of banana seed phytoliths outside of the Bismarck Archipelago and an early introduction of Dioscorea esculenta to Vanuatu. The appearance of these non-indigenous plants at Teouma provides support for the concept of a "transported landscape". However, the majority of identified plants were indigenous tree crops that suggest Lapita colonists were at least partly reliant on the forest resources that already existed on the islands they inhabited. This study represents the first direct plant evidence for Lapita and immediately post-Lapita diet of humans and pigs from this region.View record details


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WASHINGTON -- Marat Safin was at his umpire-berating,
racket-spiking, error-spraying worst Saturday, and Arnaud Clement
took full advantage.
Happy to be on hard courts, Clement came back from a deficit in
each set to beat Safin 7-6 (5), 7-6 (4) and reach the final in the
Legg Mason Tennis Classic.
It was a second consecutive victory over a past U.S. Open
champion for the 11th-seeded Frenchman, who upset Lleyton Hewitt in
the quarterfinals.
Clement's opponent in Sunday's final will be No. 8 Andy Murray
of Britain, who won the last five games to eliminate No. 7 Dmitry
Tursunov of Russia 6-2, 7-5. Clement and Murray each will be
seeking a second title of the season.
Murray -- at his first tournament with coach Brad Gilbert -- had a
five-game run in the first set, too, and was broken only once
"If I play like I did tonight, I've got a good chance of
winning" the title, said Murray, who limited his unforced errors
to 17, while Tursunov had 36.
Safin finished with 40 unforced errors -- 18 more than Clement.
Sometimes, Clement said, "against Marat, you have no chance: He
can break, he can serve, he can do everything. But sometimes, and I
know it, he can make a few mistakes in a row, and I know I just
have to be focused."
As often happens with Safin, he appeared distracted at times,
including an argument with chair umpire Jake Garner about whether
the Russian took too long to decide whether to challenge a call
midway through the first set.
"His job is not to interrupt our game by making some decisions
and some comments," Safin said later. "He should just do his
Safin received a warning for smacking a ball in anger after
dropping a point in the second set, and he later reared back and
cracked his racket on the court after missing a forehand.
"It's just kind of disappointing for me, this kind of match
that slipped away," said Safin, who led 3-1 in the first set and
4-2 in the second. "I had my chances. I should have won in two
sets, 6-3, 6-4."
He put some blame on playing in the afternoon, instead of at
night, when his first four matches here were held. Safin said he
got used to a routine of practicing in the morning, sleeping during
the day, then playing under the lights.
Clement's lone title of 2006 came on hard courts in February at
Marseille, France, when he beat French Open champion Rafael Nadal
along the way. But Clement went 5-9 after that before reeling off
four wins in a row at this tuneup for the U.S. Open, which starts
Aug. 28.
He's had success on hard courts in the past, reaching the final
of the 2001 Australian Open.
"My game is better on hard courts, when it's faster," said
Clement, who beat Murray at last year's U.S. Open in five sets,
their only previous meeting.
Safin won the 2000 U.S. Open and the 2005 Australian Open, and
used to be No. 1. But a series of injuries, including a bad left
knee that kept him off the tour from last August until February,
dropped his ranking to 92nd.
Still, he looked good here in the early rounds, and had won five
tiebreakers in a row before faltering in both against Clement.
In the first, Safin went up 4-2, but eventually handed over
Clement's fourth set point by double-faulting, then bowed his head.
On the next point, Safin lunged for a forehand volley that hit the
net to end the set.
In the second, Safin put an easy backhand into the net to fall
behind 5-3, put a backhand return in the net on a 97 mph serve to
make it 6-4, then missed a backhand to end the match after 2 hours,
2 minutes.
In the later semifinal, Tursunov saved two break points in the
opening game for a 1-0 lead, and then Murray took control, winning
eight of the next nine points to start the streak that carried him
to a 5-1 advantage.
Tursunov used three winners to break Murray for a 4-2 lead in
the second set, then held for 5-2. But he wouldn't win another
game, getting broken when he served for the set at 5-3 -- slipping
as he tried to get to a backhand passing winner on a 20-stroke
exchange on break point -- and again when Murray hit a backhand
winner to go up 6-5.
For Murray, a career-best 35th in the rankings, it was his 13th
victory in his last 16 matches. He won his first tour title on hard
courts at San Jose, Calif., in February, defeating Andy Roddick and
Hewitt en route.
"I'll be a little more relaxed this time," the 19-year-old
Scot said. "I have a bit more experience than I did then, and now
I know I can win a tournament."


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Marlowe is 2.5 years old. He has blonde hair and huge blue eyes and he's the best person in the world.
I'm lucky enough to be his dad, which means I get to spend quite a bit of time with him. It's educational. Not just because I'm always learning how to be a better father (mainly through trial and error) but because seeing how he interacts with the world and how he responds to situations is a constant education.
Don't sweat the small stuff
Sometimes something bad happens. Marlowe will screw his little face up and bawl. Maybe he's fallen over and scuffed his knee. Maybe I've refused to give him his third bowl of chocolate buttons. Either way, as soon as something interesting happens (cartoons come on the TV, a new toy is produced from somewhere) his tears dry up almost immediately and we're back to being a happy little boy. He doesn't hold grudges.
It's OK to get upset
I think part of the problem with being an adult is always keeping a stiff upper lip in the face of adversity. I don't think it's necessarily healthy to bottle up our emotional responses to things. Marlowe will vent loudly — screaming with excitement and running around the house, or screaming with despair as his train bounces away from him down the stairs. It's OK to react to things in an emotional way — within reason.
Take pleasure in the simple things
I once entertained Marlowe for a whole day with just two toilet roll tubes taped together ("binoculars"). Another day he was so enamoured with a stick he found in the garden that he insisted on sleeping with it. He doesn't require constant and extreme stimulation to stop him chewing the furniture. He squeezes the maximum amount of enjoyment from what's in front of him at any particular time.
Stop and smell the roses
On some days, he just doesn't want to go out and have adventures. He'll happily cuddle up on the sofa with me and we'll watch Cars or Monsters Inc for the 108th time, and he's not gnawed at by the persistent suspicion he should be doing something 'more productive' or that he's 'wasting time'. How can time be wasted if you're happy?
Nature is great
One of my favourite activities with the boy is to go for a walk in a forest, or a nature reserve. He gets to scamper around and collect interesting leaves and I get a break away from computer screens and RSI. I never really appreciated it as much as I do now, and of course when you're two years old everything is cool, spiders are funny and should definitely crawl on your face, and you can never get too close to a pond.
Live for today
When you're a toddler, life is a simple adventure, dealt with day to day. Marlowe doesn't really concern himself with anything beyond tomorrow. He has no reason to — his mum and I have everything planned out for him, we're basically his PA. This means he can concentrate on building a huge tower, or setting up his railway, or digging up molehills. Marlowe doesn't have a 'to-do list' or goals, which sounds to me like an enviable position. As far as I can tell, he's always in the moment.
Before you have your first child you make a mental note of all the life lessons you're going to pass on, all the experience that your child can benefit from, to give them an advantage in life. But when you see them living their own way, and really think about it — they're doing a lot of things a lot better than you already.
And they can't even use a toilet.


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It's beginning to feel like spring! What better way to enjoy the weather next weekend than visiting Willowsford for Tastes & Tours!
Join us for a progressive lunch on Saturday, April 22nd from 12 pm – 4 pm. Begin your day at one of our information centers: The Tenant House (23510 Founders Drive, Ashburn) and The Boat House (41085 Willowsford Lane, Aldie).
Let us tempt you with the tastiest (and most convenient) way to tour Willowsford. Begin with a champagne tasting and raw oyster bar on the back porch of our Information Centers, then head inside for a community overview and fried mac 'n' cheese bites.
Next, take a golf cart ride over to the model home courts, where you'll discover exclusive home designs and even more culinary delights with fresh flavors sourced from Willowsford Farm.
Bring the kiddos to make milkweed seed packets with Farmer Deb at the Farm Stand (23595 Founders Drive, Ashburn) from 2 pm – 4 pm!
Willowsford Ramblings is a blog by Willowsford, a community of new single-family homes in Loudoun County, Northern Virginia.ashburn va new homes, champagne tasting, free event, home communities, homes aldie va, new build homes for sale, new home builders, new home communities, progressive lunch, public event, Willowsford, willowsford va, Willowsford Virginia


text: my route is 73 stop max per ups mgmt today i do 84 stops 574 pkgs delivered and they give me a 22 stop resi split and i go over 11 hours i love this company. not to mention missed commercial and late air? I drive a straight job so i have to come back to the building and load the resies after i take my lunch from 1715 to 1815 no wonder the stock is on the way down.


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The 100% nylon-taffeta Carhartt Work in Progress Montana Jacket with button front offers a loose cut and comfortable wear feel. The imprint on the front underscores the high-quality Carhartt look.