text:
Specialist Recruiters to India's Public Health, Development and CSR Sectors!
1. POSITION(S) VACANT: Aspirational District Coordinators (Six Vacancies; Baksa, Barpeta, Darrang, Dhubri, Goalpara and Udalgiri Districts), International Development Agency, Assam
Our client is a respected, International Development Agency (IDA), that works across the globe to promote children's survival, protection and development.
The Aspirational Districts Programme was launched by the Prime Minister in January 2018. The broad contours of the programme are Convergence (of Central & State Schemes), Collaboration (of Central, State level 'Prabhari' Officers and District Collectors), and Competition among Districts, driven by a mass movement. With States as the main drivers, the program focuses on the strength of each district, identifying low-hanging fruits for immediate improvement, measuring progress and ranking districts. A total of 115 districts have been identified across 28 states, at least one from each state. The major focus of the program is to raise the living standards of its citizens and ensure inclusive growth for all, to enable the optimum utilization of their potential. The focus area is divided into five sectors viz. Health & Nutrition, Education, Agriculture & Water Resources, Financial Inclusion & Skill Development and Basic Infrastructure, with 49 key performance indicators to measure the progress of each district. The objective of the programme is to monitor the real-time progress of Aspirational Districts based on 49 indicators (81 data-points) from the five identified thematic areas. NITI Aayog in partnership with the Government of Andhra Pradesh has created a dashboard for monitoring the real-time progress of all districts. Amongst the ranking of 101 Aspirational Districts shared by NITI Aayog, the seven districts in Assam viz Baksa, Dhubri, Darrang, Hailakandi, Udalguri, Gaolpara and Barpeta ranked 66, 68, 73, 76, 79, 84 and 87 respectively. Among the five sectors, health and nutrition sector is with 30% of the overall composite score and the programme has identified 13 indicators to focus on antenatal care, postnatal care, and gender parity, health of new-borns, growth of children, contagious diseases, and health infrastructure.
Government of India has identified development partners for each state across the country who are committed to providing technical assistance to the state government to implement RMNCH+A, strategy now focusing on the Aspirational Districts. The IDA is a lead partner under RMNCH+A initiative for Assam. In addition, the scope of the RMNCH+A strategy encompasses cross sectoral convergence, notably with Nutrition, WASH, C4D and Advocacy/ Communications for equity planning, implementation and monitoring.
The Aspirational District Coordinators (ADCs) shall be responsible for providing technical support for quality implementation of high impact, evidence-based interventions under the umbrella of RMNCH+A in the Aspirational Districts, with specific focus on Quality Assurance of intrapartum care and care during birth, convergent programming, innovations and capacity building models.
The ADCs shall provide high-end technical as well as supportive supervision support to NHM and co-ordinate with other related line departments for intensification and harmonization of efforts under the RMNCH+A strategy in the aspirational districts of Assam.
The ADCs will be a part of District RMNCH+A Unit at NHM and provide regular support to key implementing departments for RMNCH+A programmatic components for overall planning, implementation, monitoring and supportive supervision.
ADCs will also support the IDA supported convergent programme, especially in the tea gardens and riverine areas in partnership with TG associations, NGOs and CBOs. This would contribute to linkages being established between the efforts by the NGOs/ CBOs and government flagship programs.
Key Deliverables:
(1) Specific policy recommendations/ incentives in place to address HR gaps for outreach and facility-based care in the designated, seven districts of Assam;
(2) Monthly supportive supervision mechanism for labour rooms and SNCU put in place in the district;
(3) Analysis and feedback of Supportive supervision data from RMNCH+A monitoring;
(4) Support for planning HR policy in relation to Labor room and SNCUs;
(5) Generate evidence for policy decisions in relation to gender gaps for newborn girl (female admissions in SNCUs, adolescent pregnancies);
(6) Use of national survey/HMIS data sets for the district planning for prioritizing interventions and addressing inequities;
(7) Support to social protection/universal health coverage policy/advocacy;
(8) Advocacy/policy/evidence generation for gender/value of the girl child;
(9) Support preparedness of health systems through risk informed programming;
(10) Capacity building of program managers for effective program management;
(11) Support for training/capacity building workshops for program managers particularly for enhancing M&E skills;
(12) Support for comprehensive supportive supervision by system supervisors (develop SS plans, monitoring checklists, analysis of the data);
(13) ICT solutions for health systems, innovations and knowledge management;
(14) Evidence generation and documentation of good practices;
(15) IT solutions for improved data collection, analysis and utilization for action;
(16) District-specific strategy for SBCC on RMNCH+A developed, costed, budgeted and rolled out in the district;
(17) Demand generation for RMNCH+A
(a) Support strengthening SBCC component through inclusion of adolescent pregnancy; adolescent HIV and institutional delivery as behavioural targets of the integrated SBCC strategy development
(b) Support for improving interpersonal communication by service providers to improve doctor patient relationship and improve client satisfaction for RMNCH+A services
(18) Facilitate to identify the gap in RMNCH+A service delivery among the most marginalized communities i.e. among tea garden communities and char area population. Support in developing strategies and planning for most marginalized communities.
(1) Any Medical/ BHMS/ BAMS/ BDS or B. Pharma Graduate;
(2) Post-graduate in Paediatrics, OBGY or Community Medicine/ Public Health Graduate is desirable.
(1) At least one-year field experience in Aspirational District programming OR minimum of two years' experience in RMNCH+A program at district, state and regional level, preferably in NE states;
(2) Familiarity with theory and practical applications and essentials of Maternal/ Child Survival;
(3) Experience in planning and management of Aspirational District intervention.
Skills and Competencies:
(1) Good negotiation and influencing skills supported by excellent communication skills;
(2) High level of computer proficiency with specific familiarity with commonly used Windows and MS Office software and database software;
(3) Excellent oral and written communication & presentation skills in English and Hindi;
(4) Knowledge of Assamese and or Bengali would be an added advantage;
(5) Demonstrated ability to work in a multi-disciplinary team environment with strong facilitation skills, ability to analyse reports, plan and monitor projects.
5. ESTIMATED TRAVEL: Approximately 8-10 days in a month for achievement of the listed deliverables. Occasional travel to the State HQ/ other districts/ outside the state, may also be required, as per programme needs.
The ADCs shall be hired on a consultancy contract through Strategic Alliance Management Services P Ltd. (SAMS), a respected HR Agency.
Remuneration payable to the selected candidate in the form of professional fees shall be attractive and in alignment with market norms.
Applicants are required to provide details of salary history, as well as expected remuneration for the position, in the online application form, comprising:
(a) Monthly Professional Fees and
(b) Daily Subsistence Allowance (DSA) for field travel outside the duty station.
(1) The above elements shall be a key input into the selection and negotiation process
(2) Candidates are expected to have their own laptops and be internet connected and these items shall not be provided.
8. LOCATION: ADCs shall be based in the Office of Joint Director (Health Services) in Baksa, Barpeta, Darrang, Dhubri, Goalpara, and Udalgiri districts.
9. DURATION: The successful candidate shall be issued a consultancy contract from the date of joining till December 31, 2019.
Team SAMS
Strategic Alliance Management Services P Ltd.
1/1B, Choudhary Hetram House, Bharat Nagar
New Friends Colony, New Delhi 110 025
Phone Nos.: 011- 2684 2162; 4165 3612
Eligible candidates interested in the position are requested to apply using the link http://apply.samshrm.com by or before May 2, 2019.


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Mastering news
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The Loudness War - Part 4
After discussing volume in the previous article, this time we'll focus on your ears.
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In this installment, we'll look at the consequences of the loudness war on music, sound and human ears.
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Today we'll continue our series on the volume wars. This time, we'll focus on mainly on compression.
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Volume, more volume! Yes, but at what price? This series of articles will review the origins of the volume race, the physical considerations, new standards and tools, and their impact on public health.
- Hot news
Colin Leonard takes the analog path to mastering success
Colin Leonard, owner and engineer of SING Mastering in Atlanta, has to be ready to handle any musical style that comes his way. "I could go from Gaelic Christmas music to hardcore hip-hop to pop to heavy metal in the same day," he says. "it's totally different all the time." Leonard's credits range from Justin Bieber to Mastadon to newer groups …
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One for the road & links to the entire mastering series
After more than 20 weeks, the time has finally come for the last installment in our series dedicated to mastering at home. Today we won't be making any miraculous revelations, instead, we'll give you one final piece of advice, "for the road."
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How to get "hot" masters without losing dynamics
I was driving along one of those Floridian roads that goes between the coasts, and is flatter than the Spice Girls without auto-tuning . . . in other words, a perfect place to crank up my car's CD player. As it segued from a recent CD into Simple Minds' "Real Life," which I hadn't heard in quite a while, I noticed it was somewhat quieter, so I tur…
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Chris Athens is a senior mastering engineer at Sterling Sound, one of the world's premier mastering facilities. Chris has mastered albums for Rick Ross, Wiz Khalifa, Nas & Damien Marley, Ciara, Pitbull, Coldplay, Erykah Badu, Weerd Science, Ben Folds Five, and many others.
The 10 Most Common Questions About Mastering
Mastering is a crucial process, but it's not always all that well understood by the average musician…so let's deal with some of the basic issues.
Add that Final Polish to Your Mixes
The article title alone is enough to cause some professional mastering engineers to run to various forums and start complaining. "That's what's wrong with this industry, these kids don't know how to master, you gotta have a professional do it, blah blah blah."

subset: commoncrawl


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This recipe was created in partnership with Primo Ceramic Grills. All opinions are my own.
Steak & Cranberry Chimichurri Crostini:
We are in the homestretch of November here friends and already well on our way into the holiday party season! If you're looking for great cocktails and great holiday appetizers, I've got you covered. Everything you'll find here (well the food at least) is low carb and keto friendly. My recipes are also versatile enough for the non-keto eaters as well, which make them great for sharing at your next get together. If you've been following along with me on Instagram, you may have noticed that I have teamed up with several other keto and low carb foodies to create weekly themed recipes for the holiday season. All of this was done in hopes to help you stay keto strong all season long (that totally rhymed). This weeks theme was "appetizers", so these Steak & Cranberry Chimichurri Crostini are my contribution to the keto world. You're welcome. Find the full recipe below and if you're looking for a great cocktail to pair with this appetizer, be sure to check out this weeks Bon Appeteach "Book Club" cocktail, the Smoked Horchata Eggnog Cocktail too!
"School" Supplies:
- Cast Iron or Grill
- Tongs
- Knife & Cutting Board
- Cookie Cutter
- Frying Pan or Baking Sheet
- Mixing Bowls
"Class" Notes:
The Preparation-
The important flavor profile here is the Cranberry Chimichurri. Chimichurri is best when it has had some time to marinade. I also suggest chopping everything by had and not using a food processor (this creates more of an emulsified dressing instead). Finely chop the herbs, shallots, garlic, and the jalapenos. I like to roughly chop the cranberries into small enough pieces that they won't be too tart when taking a bite of crostini. I suggest also using a high quality olive oil, season generously, and add a splash of red wine vinegar and fresh lime juice for a little zing! Let the chimichurri rest for a few hours if possible (just keep it covered on the counter). While the Cranberry Chimichurri rests, prepare the steak. Traditionally, you will often see a flank steak paired with chimichurri. I often use whatever cut looks best at the butcher and also keep sales in mind (NY Strip is pictured). I opted to grill my steaks on my Primo Ceramic Grill (I still refuse to put it away for the winter), but this can also be done on high heat in a cast iron skillet too. Season the steak lightly with oil, salt, and pepper only. Cook using your preferred method and to your choice of doneness. Make sure to also let it rest before slicing
The Crostini-
You have two ways to approach this appetizer, and can even do a little bit of both if you prefer. The first option, is to slice the steak into 1″ bite sized pieces, spear with a pretty toothpick, and then drizzle on the chimichurri and place on a platter as is. This is simple, elegant, and also easy! If you want to really step of the crostini game (aka fancy toast or in this case fancy low carb tortillas), cut out small circles from a low carb (or regular) tortilla. I like to do a shallow pan fry to get the tortilla rounds crispy, but you can also bake them for ease. Once crispy, allow them to cool slightly, then assemble with a bit of mashed avocado, a slice or two of steak, and spoonful of Cranberry Chimichurri right over the top. They look absolutely beautiful on a holiday table, will definitely satisfy your guests, and are a really easy low carb treat. Pair this with my Smoked Horchata Eggnog Cocktail and your hosting skills are going to be next level!
If you loved this recipe, be sure to also check out my Grilled Shrimp & Avocado Salad recipe. This is also a great crowd pleaser and can easily be done inside in the oven too.
Bon Appeteach,
Steak & Cranberry Chimichurri CrostiniPrint Recipe
- 16 oz. Steak (Traditional is flank steak but use what you prefer)
- Olive Oil
- Salt & Pepper
- 1/3 cup Minced Parsley
- 1/3 cup Minced Cilantro
- 1 Jalapeno Pepper, seeds removed (optional) and minced
- 3 Garlic Cloves, minced
- 1 Shallot, minced
- 1/4 cup Fresh Cranberries, sliced small
- 1 Lime, juiced
- 1/3 cup Red Wine Vinegar
- 2/3 cup Olive Oil
- 1 Large Avocado
- 4 Low Carb Tortillas (I used mission tortillas) or Flatbreads (Like Cut Da Carb or Joseph's Lavash)
- Avocado oil for pan frying (optional)
In a bowl, combine the parsley, cilantro, garlic, jalapeno, shallots, and cranberries. Add in the juice of half a lime, the red wine vinegar, and the olive oil. Season with salt and pepper and set aside, loosely covered.
Allow your steaks to come to room temperature before cooking (minimum of 30 minutes). Lightly season with olive oil and salt/pepper on each side. Grill or cook the steaks on a cast iron pan to your preferred doneness (FDA recommends steak be cooked to a minimum of 145 F. ). Set aside and allow the steaks to rest at least 10 minutes before slicing. Tip- lightly tent foil over the steak to keep it warm.
In a bowl, mash the avocado, add the other half of the lime juice, and season with salt and set it aside.
To make the low carb tortilla crostini, use a cookie cutter to make rounds (6 rounds per tortilla with a 2" cookie cutter) or use a pizza wheel to cut squares or triangles. I prefer to shallow pan fry my tortillas in a little bit of avocado oil until crispy, or you can bake them at 400F on a parchment covered baking sheet for 7-8 minutes.
To assemble, spread a small amount of avocado mash over the crostini, slice the steak into bite sized pieces and add a slice over the avocado. Once all the crostini are assembled, place on a plate or platter, and finish them off with a drizzle of Cranberry Chimichurri over the top.
You can also place bite sized pieces onto a toothpick and serve with chimichurri over top or as a dipping sauce as well for a gluten free and even lower carb option!
Nutritional Information:
Obtained using My Fitness Pal. I am not nor do I claim to be a nutritionist, so it is important to always verify the nutritional information as brands vary. I work hard to always provide the most accurate information as possible in hopes of making this easier for you, my readers!
This label reflects the information for the Low Carb Mission Tortillas only.


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Telesales ExecutiveTaunton, United Kingdom | Contract, full-time
| £8.50 - £9.00 per hour
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For more information on this fantastic opportunity, please apply now.
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David Schwartz, the Chief Cryptographer in Ripple, Talked at MoneyConf earlier today on the Web of Worth.
He talked about why Bitcoin caused the attention it did and people thought it'd be radical. He believes that individuals were interested in Bitcoin because they had been frustrated in the siloing of liquidity from legacy programs. When payment systems didn't speak to one another, it resulted in inefficiency and frustration in shifting worth. He also gave an example of how to examine the site of an organization in South Africa, but it is"very tough to send cash, particularly tiny payments."
Then he talked about the way the cryptocurrency area has generated the problem that it sought to resolve, by generating more silos of significance in various cryptocurrencies, causing an overall trapping of significance. The answer for this was that the Web of Worth. He explained:
"The Internet of Value is to break down the siloing, to do for money what the Internet did for information…[and] make it so that money can flow as easily as information does."
On his vision for the concept, he said:
"The simplest vision is that you could pay somebody through a universal payment address, and it doesn't matter if they're using PayPal or a bank or Bitcoin or a mobile payment system…The money would just find a path to flow."
In addition, he elaborated on his long term vision on the Web of Worth during the next 10 decades. He said that Online of Value payments behind the scenes will change the world in a way which aren't as obvious.
"It's like we were talking about the Internet in the mid-90s trying to think about what we could do…It doesn't sound like its world changing, but it is."


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Back to Journals » Clinical and Experimental Gastroenterology » Volume 11
A study of the circulating fibroblast growth factor 21 as a novel noninvasive biomarker of hepatic injury in genotype-4 chronic hepatitis C: Egyptian patients and their response to direct-acting antiviral agents
Authors El Sagheer GM, Ahmad AK, Abd-ElFattah AS, Saad ZM, Hamdi L
Received 17 May 2018
Accepted for publication 16 August 2018
Published 24 October 2018 Volume 2018:11 Pages 415—422
DOI https://doi.org/10.2147/CEG.S173484
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Professor Hoda Malaty
Ghada M El Sagheer,1 Asmaa K Ahmad,1 Aliaa S Abd-ElFattah,1 Zienab M Saad,2 Lamia Hamdi3
1Internal Medicine Department, Endocrinology Unit, 2Hepatology Department; 3Clinical Pathology Department, Minia University, El-Minia, Egypt
Background: Fibroblast growth factor (FGF) 21 was reported to be induced by different injurious agents, including chronic hepatitis C (CHC) virus, affecting the liver. The aims of this study were to evaluate the FGF21 levels in CHC patients before and after the treatment with direct-acting antiviral agents (DAAs) in comparison to that in control subjects and to correlate these levels with insulin resistance (IR), lipid profile, and fibrosis stages.
Patients and methods: We studied 75 naive CHC patients and 40 age- and gender-matched healthy control subjects. Patients were divided into five groups based on the severity of fibrosis as detected by Fibroscan as follows: F0, n=2; F1, n=13; F2, n=23; F3, n=16; F4, n=21. We estimated the FGF21 levels at the start of the study for all the participants and for the patients only at the end of treatment with simisipivir (SIM) and sofosbuvir (SOF). These levels were compared between the patients and the control subjects and also for the patients before and after the treatment with DAAs. The FGF21 levels were correlated to IR, lipid profile, and stages of liver fibrosis.
Results: The FGF21, fasting blood sugar (FBS), fasting insulin, and homeostasis model of IR (HOMA-IR) were significantly higher in CHC patients compared to control (5.04±0.75 vs 4.7±0.52, 20.15±5.13 vs 13.15±4.2, 4.49±1.28 vs 2.72±0.87, and 123.7±52.6 vs 21.8±8.8; P≤0.01, P≤0.001, P≤0.001, and P≤0.001, respectively). The posttreatment FGF21 levels were significantly reduced when compared to the pretreatment levels (123.7±52.5 vs 60.5±32.7, P≤0.001). FGF21 levels showed significant negative correlation with FBS and positive correlation with serum albumin (P≤0.05 and P≤0.003, respectively). The multiple linear regression analysis revealed that serum albumin, high-density lipoprotein cholesterol (HDL-c), and the stage of liver fibrosis were independent risk factors for FGF21.
Conclusion: Besides its metabolic modulator role, FGF21 strongly introduced itself as a novel biomarker of hepatic injury in Egyptian, genotype-4, CHC patients.
Keywords: hepatitis C, direct-acting antiviral agents, fibroblast growth factor 21
The fibroblast growth factor (FGF)21 represents an atypical member of the FGF signaling system, which lacks heparin binding and circulates as a hormone. Experimental animal models showed their role in lipid and glucose metabolism and energy homeostasis, and the correlation coefficient (about 0.6) is poor.1 FGF21 is activated by binding to the FGF receptors and a unique β-Klotho co-receptor, which is expressed abundantly in the liver, adipose tissue, and pancreas.2 The liver represents a major site for FGF production and actions, and FGF21 was reported to be induced by different injurious agents, including chronic hepatitis C (CHC) virus, affecting the liver. 3–5 The underlying molecular mechanism for increased hepatic expression of FGF21 in CHC patients is unclear. One of the postulated mechanisms is the endoplasmic stress (ES) theory. ES activates the adaptive response known as the unfolded protein response (UPR).6 The hepatitis C virus (HCV) single-stranded RNA genome encodes the nonstructural protein 4B (NS4B), an endoplasmic reticulum (ER) membrane-associated protein. Overexpression of HCV-NS4B could induce ES.7,8
In pediatric non-alcoholic fatty liver disease (NAFLD), Alisi et al9 found that FGF21 was inversely associated with the probability of fibrosis, but the relation of its expression in liver fibrosis in CHC patients is not well understood.
The aims of this study were to evaluate the FGF21 levels in CHC, genotype-4, Egyptian patients before and after the treatment with direct-acting antiviral agents (DAAs) in comparison to that in apparently healthy control subjects; to determine the effects of treatment in these levels; and to correlate FGF21 levels with insulin resistance (IR), lipid profile, and the different stages of liver fibrosis.
Patients and methods
After approval of the Faculty of Medicine Research Ethics Committee (FMREC), Minia University, Egypt, and the national Egyptian committee for viral hepatitis control, 75 naive Egyptian patients with compensated CHC and 40 apparently healthy subjects, who volunteered as control subjects, were selected for this study. All the participants signed an informed consent and were prospectively assessed from February 2015 to March 2017. This study was conducted in accordance with the Declaration of Helsinki and International Conference on Harmonization Guidelines for Good Clinical Practice.
Inclusion criteria
Patients eligible for the study were 20–67 years old, non-diabetic, non-obese, naive patients suffering from genotype-4 CHC for 6 months or more. Infection was considered based on the presence of anti-HCV antibodies and serum HCV-RNA. HCV genotyping was done by direct sequencing of the untranslated regions using RT-PCR-based assay (Ampli Sens 61 HCV-genotype-FRT PCR kit). The control subjects were recruited from the medical and paramedical staff. There were 28 males and 12 females, and their age ranged between 20 and 66 years.
Exclusion criteria
Patients were excluded if they had diabetes mellitus (DM) or other forms of liver diseases such as concomitant hepatitis-B virus (HBV) infection, HIV, and schistosomal, autoimmune, or alcoholic hepatitis. Patients who received any antihyperlipidemic therapy in the last 3 months before recruitment were also excluded.
To quantify the stages of hepatic fibrosis, we used Fibroscan (transient elastography) and the Fibrosis-4 Index for Liver Fibrosis (FIB-4) test. According to Fibroscan, patients were classified into four subgroups based on the breakpoints in relation to the METAVIR score (17; F0<2.5; F0–F1=2.5–7; F2=7–9.5; F3=9.5–12.5; F4>12.5). The FIB-4, a combination of four variables, aspartate aminotransferase (AST), alanine aminotransferase (ALT), age, and platelet count, is calculated with the formula: FIB-4 index=(age [years]×AST [IU/L])/(platelet count [109/L]×ALT [IU/L])1/2. If the FIB-4 score is <1.45, this equals F0–F1, and if FIB-4 is >3.25, this equals F3–F4.
All the patients were treated with 150 mg simisipivir (SIM) capsules and 400 mg sofosbuvir (SOF) tablets once a day for 12 weeks. If the glomerular filtration rate dropped below 30 mL/min in any patient, the SOF dose was reduced to 200 mg.
Clinical assessment
History and thorough clinical examination were evaluated for all the participants. The patients were weighed (kilograms) and their height was measured (centimeters), and the body mass index (BMI) was calculated as weight divided by the square of the height (kilogram per square meter ). The waist circumference was measured 1 inch above the navel or midpoint between the lower margin of the least palpable rib and the top of the iliac crest parallel to the floor; the hip circumference was measured at its widest part of the buttocks or hip parallel to the floor; and then, the waist/hip ratio was calculated.
Laboratory assessment
The venous blood was drawn in the morning after 8 hours of overnight fast to determine the serum levels of ALT, AST, albumin, bilirubin, platelet count, international normalized ratio (INR), serum glucose, and insulin. After the patients completed fasting for 12 hours, blood was drawn again for the assessment of total cholesterol, HDL, cholesterol, triglycerides (TGs), and total and high-density lipoprotein cholesterol (HDL-c) by automated procedures. However, low-density lipoprotein cholesterol (LDL-c) was calculated according to the Friedewald equation, when serum TG level is <400 mg/dL.10 Serum insulin was determined by electrochemiluminescence immunoassay (Elecsys 2010; Hoffman-La Roche Ltd., Basel, Switzerland). IR was investigated in all patients by the homeostasis model of IR (HOMA-IR) using the standard formula: HOMA-IR=Fasting insulin (uIU/mL)×fasting glucose (mmol/L)/22.5. In virological assessment, HCV-RNA levels were determined three times: baseline, at the end of treatment (week 12), and at 12 weeks posttreatment. Measurements were done using the COBAS TaqMan HCV assay V.2.0 (Hoffman-La Roche Ltd.; lower limit of detection, 15 IU/mL). HCV-RNA levels were quantified with a lower limit of detection of 15 IU/mL. The end of treatment response (EOTR) was defined as undetectable HCV-RNA at the completion HCV therapy. Sustained virological response (SVR12) is defined as an undetectable HCV-RNA at 12 weeks after completion of therapy.
Serum FGF21 assay
Blood samples were collected from the antecubital vein between 8:00 and 9:00 AM after overnight fasting. Samples were centrifuged at 2,500× g for 10 minutes, and serum aliquots were stored at –80°C until analysis. Serum FGF21 levels were determined using a commercially available ELISA kit (HumaReader Plus, model: 3700; Germany) according to the manufacturer's protocol. The minimal detectable concentration was 7 pg/mL. All the measurements were performed in duplicate, in a random order, and the results were averaged.
Statistical analyses
Symmetrically distributed continuous variables were presented as mean±SD. Skewed continuous variables were presented as median and interquartile ranges. Categorical variables were presented as frequency and percentage. Comparisons between groups were done by using the Mann–Whitney U test or the Student's t-test for continuous variables and the χ2 or Fisher exact probability test for the categorical data. The two-tailed, paired Student's t-test was used to test the significance of difference between baseline and posttreatment FGF21. The Pearson correlation coefficients were used to study the correlation between different parametric variables. The Spearman rank correlation was used to quantify the association between continuous or ordered categorical variables. Logistic regression analysis was used to model the association among baseline FGF21, lipid profile, HOMA-IR, and other covariates to determine the factors associated with hepatic fibrosis. Linear regression analysis was used to identify the independent factors for FGF21. P≤0.05 was considered statistically significant. SPSS software for Windows, Version 20 (IBM Corporation, Armonk, NY, USA) was used to perform all the analyses.
We studied 75 naïve Egyptian patients with CHC genotype 4, who were treated with SIM/SOF. The mean age of the patients was 47.5±12.3 years (range, 20–67 years), with a male to female ratio of 48/27, whereas the mean age of the healthy controls was 43.75±13.7 years (range, 20–66 years) with a male to female ratio of 28/12. No significant difference was found between patients and control groups as regards to age, sex, BMI, waist/hip ratio, and lipid profile. However, their comparison revealed a significant decrease in hemoglobin (Hb), platelets, and albumin levels (P<0.01, P<0.001, and P<0.05, respectively) vs significant increase in relation to INR, total bilirubin, ALT, and AST (P<0.01, P<0.001, and P<0.05, respectively). The patients were divided into two groups based on the Fibroscan examination. Group I included patients with mild fibrosis (n=38; F0, n=2; F1, n=13; and F2, n=23). Group II included patients with moderate to severe fibrosis (n=37; F3, n=16; F4, n=21). The baseline demographic, clinical, and biochemical characteristics of the patients and the healthy controls and the detailed virological and Fibroscan data of the patients were presented in Table 1. Table 2 shows that the mean levels of fasting glucose, fasting insulin, HOMA-IR, and serum FGF21 were significantly higher in patients in comparison to controls (5.04±0.75 vs 4.7±0.52, 20.15±5.13 vs 13.15±4.2, 4.49±1.28 vs 2.72±0.87, and 123.7±52.6 vs 21.8±8.8; P≤0.01, P≤0.001, P≤0.001, and P≤0.001, respectively).
Table 2 Comparison of the levels of fasting glucose and insulin, HOMA-IR, and FGF21 in chronic hepatitis C patients vs controls
Abbreviations: FGF21, fibroblast growth factor 21; HOMA-IR, homeostasis model of insulin resistance.
With increasing hepatic fibrosis, the mean levels of FGF21 continued to decrease with a mean level of 126.8±53.4 in group I vs 116.4±52 in group II, but it did not reach a significant difference (P≤0.407). Similarly, there was no significant difference between these two groups in relation to fasting glucose, fasting insulin, and HOMA-IR (P≤0.947, P≤0.229, and P≤0.2, respectively; Table 3).
Table 3 Metabolic factors and FGF21 according to the fibrosis stage in chronic hepatitis C patients
Note: P-value ≤0.05 is significant.
Abbreviations: FGF21, fibroblast growth factor 21; HOMA IR, homeostasis model of insulin resistance.
The HOMA-IR was documented to be ≥3 in 60% of patients. So, we compared the patients with HOMA-IR≥3 with patients with HOMA-IR<3 in relation to the serum levels of FGF21 to investigate any association of IR with FGF21. Although the patients with HOMA-IR≥3 showed higher mean FGF21 levels (124±49.2 vs 116±57.8), the difference was non-significant (P≤0.5; Table 4).
Table 4 Comparison of serum levels of FGF21 according to IR
Note: P-value ≤0.05 is significant.
Abbreviations: FGF21, fibroblast growth factor 21; HOMA IR, homeostasis model of insulin resistance; IR, insulin resistance.
The univariate analysis revealed a significant positive correlation for FGF21 with serum albumin (r=0.3, P≤0.002) and a significant negative correlation with fasting blood sugar (FBS; r=–0. 23, P≤0.05). However, all other variables showed non-significant correlations (Table 5 and Figures 1 and 2).
Figure 1 The correlation between serum FGF21 and serum albumin.
Abbreviations: ALB, albumin; FGF21, fibroblast growth factor 21.
Figure 2 The correlation between serum FGF21 and serum FBS.
Abbreviations: FBS, fasting blood sugar; FGF21, fibroblast growth factor 21.
Using multiple linear regression analysis, the mean levels of serum albumin and HDL-c and the fibrosis stage appear to be independent predictors for FGF21 (B=0.27, P≤0.02, 95% CI, 3.26 to 45.9; B=0.25, P≤0.05, 95% CI, –8.7 to 0.052; and B=0.72, P≤0.023, 95% CI, –63.63 to 4.825, respectively; Table 6).
Patients who achieved an EOTR at 12 months (EOTR 12) showed significant reduction in FGF21, Hb, serum AST, and ALT levels (123.7±1.08 vs 60±32.7, 13.6±1.3 vs 12.7±1.5, 50.2±25.2 vs 40.2±17.3, and 49.8±21.4 vs 41.6±14.4; P≤0.001, P≤0.001, P≤0.001, P≤0.001, respectively). Also, a significant reduction in the fibrosis stage was documented by the FEB4 and Fibroscan (1.9±1.08 vs 1.7±1.1 and 13.6±10.4 vs 12.6±8.8; P≤0.03 and P≤0.001, respectively; Table 7). Moreover, the reduction in FGF21 serum levels was obvious in the different stages of hepatic fibrosis (Figure 3).
The results of this study documented higher mean serum levels of FGF21 in CHC patients in comparison to that in the healthy control subjects. Nevertheless, these levels were subjected to a significant reduction at EOTR. Moreover, FGF21 levels had a significant negative correlation with FBS and a significant positive correlation with serum albumin levels. However, FGF21 showed non-significant correlation with fasting insulin and HOMA-IR. The serum albumin, HDL-c, and the stage of liver fibrosis were determined to be independent risk factors for FGF21 by multiple linear regression analysis.
The 209 amino acid protein, FGF21, which functions as an endocrine regulator in humans, got special interest.11 It was shown to be induced in the stressed murine liver, and its abundant liver expression was, in turn, reflected in increased serum expression with a strong correlation between them. In patients with fatty degeneration, hepatitis, liver cirrhosis, and liver cancer, hepatocyte FGF21 is increased compared to cells residing in the healthy liver. So, its hepatic overexpression has been observed in a variety of liver diseases and was detected by immunohistochemistry in the diseased hepatocytes compared to the healthy hepatocytes.12
The FGF21 levels were reported to have a positive association with HCV infection and a non-significant correlation with HBV infection;13 however, the underlying mechanism remains unclear. Researchers tried to explain this through the ER stress activation, which is induced by the overexpression of HCV NS4B.13 While Misra and Reddy14 raised the possibility of perturbation of lipid metabolism, their explanation was questioned by others.15,16 Misra and Reddy14 proposed that elevated FGF21 mirrors lipid accumulation that lead to the upregulation of PPAR-α and fatty acid oxidation system resulting in excess energy expenditure in the liver.14 On the contrary, Wu et al15 and Liu et al16 found that both FGF21 and PPARγ-mRNA levels were downregulated with elevation of HCV-RNA. Thus, they considered that PPAR-α may not be a mediator of FGF21 expression in chronic HCV infecction.15,16 Another possible explanation is that overexpression of FGF21 depends on the possible anti-inflammatory function of FGF21 through suppression of the nuclear factor (NF)-κB activity as reported in animal models.17
The liver remains the most important producer of FGF21 and a major site for its actions.18 FGF21 was correlated with liver disease and has been considered as a novel regulator of oxidative stress in humans.19 In agreement with other authors,3,5 this study not only showed significantly higher levels of FGF21 in CHC patients vs control but also showed significant reduction at the end of treatment with DAAs.
However, serum FGF21 levels are not correlated with the degree of liver dysfunction detected by the Child–Pugh and Model for End-Stage Liver Disease (MELD) scores as was observed in the study by Ucar et al.13 However, in the present study, the univariate analysis revealed a significant positive correlation of FGF21 with serum albumin (r=0.3, P≤0.002), and the multiple linear regression analysis documented the mean serum albumin level as independent predictor for FGF21 (B=0.27, P≤0.02, 95% CI, 3.26–45.9). This finding could be explained in the view of the synthetic function of the liver. As the liver is the main source of both FGF21 and albumin, higher FGF21 and albumin levels are indicators of good synthetic function and vice versa. We did not use the Child–Pugh and MELD scores or correlate the serum FGF21 levels with the degree of liver dysfunction in the present study as our group of naive patients were chosen at an early stage of the disease with compensated liver, who came to receive antiviral therapy.
The relation of FGF21 and IR in CHC patients is not fully established. Although many authors16,17,20 reported increased FGF21 levels with IR states, Li et al21 denied any association between them in patients with NAFLD who have normal glucose tolerance or type 2 DM. In the present study, we did not find significant correlation between FGF21 and fasting insulin or IR. Moreover, this finding was re-emphasized after subgrouping the patients based on the HOMA-IR level (≥3 and <3). The mean FGF21 levels were 130±50.2 vs 131±55.9, respectively, with statistically non-significant difference (P=0.5). This was in agreement with the study by Kukla et al5 who reported no associations of systemic FGF21 with HOMA-IR in HCV-infected patients. The discrepancy between the different studies may be explained by the direct involvement of the HCV with IR and the non-excluded interference between the virus and FGF21. Consequently, the protective action of FGF21 against hyperglycemia remains controversial. In this study, despite failure of confirmation by linear regression, the univariate analysis revealed a significant negative correlation between FGF21 and FBS. This finding may reflect a possible protective role for FGF21 against hyperglycemia, which could be explained by certain mechanisms. First, through its binding to 6-Klotho/FGF complex, FGF21 stimulates glucose uptake in adipocytes independent of insulin.22 Second, by inducing the thermogenic capacity of white adipose tissue, FGF21 helps to increase glucose clearance.23 Third, by acting on glucagon metabolism, FGF21 suppresses glucose production.24 Fourth, by activation of signal-regulated kinase 1/2 and AKT signaling pathway (Akt pathway is a signal transduction pathway that promotes survival and growth in response to extracellular signals), FGF21 preserves B cell function.3
As the liver represents the major source of the circulating FGF21, after liver disease, especially cirrhosis, it appears logic that the affected hepatic biosynthetic capacity may influence the serum levels of FGF21.5 In this study, the mean serum level of FGF21 was higher in group I (F1–F2) than that in group II (F3–F4), but without reaching a significant level. However, the multiple regression analysis found out that hepatic fibrosis is an independent predictor of FGF21. This was in agreement with the study by Iwasa et al25 who reported that the levels of FGF21 mRNA expression in the mice liver tissue was 2.5-fold lower in F4 group compared to F0 group, while its expression in F2–F3 group did not significantly differ from F0.
The question about the pathogenic role of FGF21 in development of hepatic fibrosis did not receive a clear answer yet. Experimental studies postulated a role for FGF21 in the regulation of hepatic stellate cells (HSCs) activation, apoptosis, and development of liver fibrosis through the gain-of-function and loss-of-function hypotheses.26 Other studies found that the worsened steatosis, inflammation, and fibrosis in the FGF21-deficient mice could be reversed by continuous FGF21 subcutaneous infusion.25 Also, FGF21 was reported to have an excellent performance to distinguish simple steatosis from nonalcoholic steatohepatitis (NASH) and was considered as a key regulator of hepatic lipid metabolism with suggestion of its use as a biomarker for NASH.27 Despite its protective nature in animal models, FGF21 was reported in clinical studies to have a positive correlation with steatosis and the severity of fibrosis.9,27 Li et al21 demonstrated that FGF21 serum levels are positively associated with serum TG, total cholesterol, LDL-c, BMI, waist circumference, blood pressure, and ALT and negatively associated with HDL-c in NAFLD patients. In the present study, we found that high HDL-c is independently related to the FGF21 level. This finding comes with the possible protective and the metabolic regulative role of FGF21 in HCV patients as what observed in other liver disorders such as alcoholic liver disease, NAFLD, and hepatocellular carcinoma. Moreover, FGF21 has been proposed to be used as a biomarker for NAFLD, NASH, and other liver pathologies.
Due to the aforementioned data, induced FGF21 expression is likely a biomarker for early detection of liver injury, also it may be considered as a human stress-response hormone, synthesized and released in order to decrease cell damage. Consequently, it may be possible that DAAs targeting HCV replication by hitting NS4B are anticipated to suppress FGF21.
The limitations of this study included the small number of patients and the inability to address the relationship of FGF21 with hepatic steatosis as liver biopsy was prohibited by our national program for new antiviral therapy.
Although the exact mechanism of its expression is not yet clear, FGF21 correlation with HDL-c and FBS raise its role as metabolic regulator. It strongly introduced itself as a novel biomarker of hepatic injury in Egyptian genotype-4 CHC patients. Further studies are strongly required to address its possible therapeutic benefit against fibrosis, steatosis, and inflammation in HCV.
The authors report no conflicts of interest in this work.
Beenken A, Mohammadi M. The FGF family: biology, pathophysiology and therapy. Nat Rev Drug Discov. 2009;8(3):235–253.
Fon Tacer K, Bookout AL, Ding X, et al. Research resource: Comprehensive expression atlas of the fibroblast growth factor system in adult mouse. Mol Endocrinol. 2010;24(10):2050–2064.
Xu J, Lloyd DJ, Hale C, et al. Fibroblast growth factor 21 reverses hepatic steatosis, increases energy expenditure, and improves insulin sensitivity in diet-induced obese mice. Diabetes. 2009;58(1):250–259.
Wu X, Ge H, Lemon B, et al. Selective activation of FGFR4 by an FGF19 variant does not improve glucose metabolism in ob/ob mice. Proc Natl Acad Sci U S A. 2009;106(34):14379–14384.
Kukla M, Berdowska A, Stygar D. Serum FGF21 and RBP4 levels in patients with chronic hepatitis C. Scand J Gastroenterol. 2012;47(8–9):1037–1047.
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Liu WY, Huang S, Shi KQ, et al. The role of fibroblast growth factor 21 in the pathogenesis of liver disease: a novel predictor and therapeutic target. Expert Opin Ther Targets. 2014;18(11):1305–1313.
Alisi A, Ceccarelli S, Panera N, et al. Association between Serum Atypical Fibroblast Growth Factors 21 and 19 and Pediatric Nonalcoholic Fatty Liver Disease. PLoS One. 2013;8(6):e67160.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.
Kharitonenkov A, Shiyanova TL, Koester A, et al. FGF-21 as a novel metabolic regulator. J Clin Invest. 2005;115(6):1627–1635.
Yang C, Lu W, Lin T, et al. Activation of Liver FGF21 in hepatocarcinogenesis and during hepatic stress. BMC Gastroenterol. 2013;13:67.
Ucar F, Sezer S, Ginis Z, et al. APRI, the FIB-4 score, and Forn's index have noninvasive diagnostic value for liver fibrosis in patients with chronic hepatitis B. Eur J Gastroenterol Hepatol. 2013;25(9):1076–1081.
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What can you learn from a horse?
Trust : What would it be like to trust you with every choice you make?
Presence: How do you get out of your head & into the world? If you're not being present with a horse, you'll know it, the horse definitely will know it, and so will everyone else.
Leadership: What are you being with the people in your life?
What's working?
What's not working?
How do you get a greater result?
Your interactions with horses will show you all of this.
This class is for anyone who:
- Loves horses
- Has a fear of horses
- Is not sure about horses
- Rides horses
- Trains horses or riders
- Has never been around a horse
- Would like more ease with their body
- Would like to increase their communication and leadership skills
- Would like to learn animal communication
- Would like to explore energetic body processes for animals and humans
- Would like to know what they know about horses that nobody else on the planet does!
- Is just looking for something totally different!
- and SO much more!
Both horse and rider will be worked on which can facilitate remarkable change in many areas.
Participants often develop a deeper connection with animals, notice an increase in the ability to talk to and hear them, and to facilitate a different possibility for the animals and themselves!
Prerequisites: None
Pricing: Global Pricing, Repeat Pricing and Age Pricing applies.
About the facilitator Alison Cox
For more info and registration please click Let's PLAY!


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Nutrition & Weight Loss
We provide our clients with nutrition and weight loss programs to promote a healthy lifestyle.Learn More
We provide our clients with nutrition and weight loss programs to promote a healthy lifestyle.Learn More
Our chiropractic adjustments offer clients chronic pain alleviation and increased mobility.Learn More
377 N 2nd AveUpland CA 91786Se Habla Español.
I'm Dr. Arnaldo Aleman and I am a licensed doctor of chiropractic in the state of California.
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My staff and I are all fluent in Spanish and English and are available to you to accommodate your chiropractic and personal injury needs.
We hope you will honor us with the opportunity to provide you with the best chiropractic care.


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The Moral Animal
BlurbThe Moral Animal is a 1994 book by Robert Wright. The New York Times Book Review chose it as one of the 12 best books of 1994; it was a national bestseller and has been published in 12 languages.
The book explores many facets of our everyday life through the lens of evolutionary biology. Wright provides Darwinian explanations for human behavior and psychology, our social dynamics and structures, as well as our relationships with lovers, friends, and family.
The book borrows extensively from Charles Darwin's better-known publications, including Origin of Species, but also from his chronicles and personal writings, illustrating behavioral principles with Darwin's own biographical examples.
First Published1994
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Another on my list of most important and insightful books on humankind.
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I usually cruise along River Drive to get to work and home each day: the geese honk their greetings, the pace is leisurely enough to enjoy, the view across the Missouri River (once you cross north of the 15th St Bridge) is stunning. But I've often wondered: how deep is the river in these parts? Near the skatepark, for instance, or Broadwater Bay? 30 feet? 100 feet? Any smart folks out there know the answer?
Deep Thoughts


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Daily Inspiration: A loving silence often has far more power to heal and to connect than the most well-intentioned words. ~Rachel Naomi Remen
Today's Affirmation: I listen deeply in compliance with the silence of Love today.
Today's Contemplation: Humanity will change very little until everyone learns to listen more closely. One must listen; and with an open heart and mind, in order to begin to make a significant change.


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Political will to fight against climate change is slow: UNSG
May 17, 2019 10:45 am
The political will to fight against climate change is slow.
Addressing students of the University of the South Pacific, United Nations Secretary-General Antonio Guterres says current decision makers need youth intervention as the world battle climate change.
Guterres says the record levels of both land and sea temperature in the last two years is alarming and needs urgent attention.
"In the last two years, the emission went up again after two or three years. And the truth is things are getting worse on the ground, we see storms that are more devastating everywhere, we see droughts that are progressing in some area of the world and causing displacement of people. We sea ice melting, coral bleaching, the Arctic are in big trouble, we see Antarctica and the Green Land starting to melt."
Guterres says urgent transformation is needed in the energy sector and agriculture mobility – since we're not on track with the Paris Agreement.


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Working Together
Together we can help you find your way.
Through individual and personal inquiry, I help you learn how to listen to the messages of your body. Using mindfulness skills and guidance, I'll help you tune into your own intuition and internal compass.
My speciality and passion is working with women who are stepping into the truth of who they are—using the psycho-spiritual model to empower women to embrace their authentic voices in world that often tries to make them smaller.
Maybe you feel like you've followed the rules, done everything "right" and still don't feel like it's enough. Maybe your relationship with your body, food, and hunger feels overly complicated and stressful. My focus is to help you listen to, trust, and empower your own voice to build the life you want.
Psychotherapy Process and Journey
Depending on assessment and needs, content and flow of therapy will vary.
Below is an illustrative psychotherapy plan to provide reference to the typical journey.
Session 1
Identifying goals. Getting to know one another.
Legal documents. Immediate, short-term skill recommendations as needed.
Sessions 2 - 5
Identify focus areas, goals, patterns you want to explore and address.
Begin exploring new skills, new resources within yourself. Build therapeutic relationship and trust.
I will often give homework to help you continue our work in the "real world".
Sessions 5 - 15
Hone and strengthen newly identified internal and external resources.
Continue building new skills. Problem solve what is working and not working.
Continue homework practices.
Sessions 15 - Onward
Either deepen personal work to explore long-held patterns, beliefs, and traumas.
Or explore future goals and desires for your life.
Ending therapy is determined by your desires and needs.
Start Your Journey
To schedule a complimentary 30 minute phone conversation or if you have questions about groups or classes, please reach out today. Our goal is to be supportive, validating to your inherent wisdom, and focused on helping you build a life you want.
Speciality & Training
Depth Psychology (Jungian and Archetypal Psychology) through Pacifica Graduate Institute (M.A./PhD in process)
Clinical Social Work (specialized in Dialectical Behavior Therapy (DBT)) at Columbia University (Master's Degree)
Gestalt Psychotherapy at Gestalt Associates for Psychotherapy in NYC
Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT)
Somatic Trauma Work Trainings


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- Leaking components
- Clogs
- Insufficient flushing power
- Tank problems
- Malfunctioning valves
- Backflow prevention device replacement
- Constantly running toilet
A bathroom is a location where there is constant traffic in the night and day. A householder generally makes use of the bathroom 5-6 times a day. If you have 4 participants in your family, just picture the frequency of your commode being used. This is why you need to preserve the bathroom in good condition whatsoever times. Also a tiny problem must not be overlooked given that it may worsen into a bigger problem with time. The very best option would be is to hire the experts to deal with even the smallest of bathroom repair issues. This will certainly help maintain your bathroom in a good condition and also prolong the life-span of it. This is why you should call Call A Plumber for all your commode repair troubles. We are amongst the most effective when it pertains to commode repair work in Dennison, . water filtration
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Related Phrases: family owned


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This author's biography has not yet been added to our database.
In the fresh new Piece of Cake Mystery from the national bestselling author of Rebel Without a Cake, a pastry chef becomes embroiled in a suspicious death as a mysterious curse casts a pall over an annual New Orleans ball.
Rita Lucero, co-owner of New Orleans's Zydeco Cakes, is thrilled to be catering an annual ball held at the Monte Cristo Hotel. Designing the high-end desserts is her priority—until she stumbles upon a mystery long-buried at her shop. It's an ornate ruby necklace, hidden underneath her staircase and rumored to be cursed.
After the gem's appraiser suddenly drops dead and Rita herself is targeted by a menacing stranger, she's no longer laughing at local superstition. Now with five cakes on order and an investigation into the necklace's past revealing layers of unsettling clues, Rita has reason to keep looking over her shoulder while she's frosting. Because any way you slice it, the next victim of the legendary curse could be her.
In the still of the night?
Halloween is approaching, and the co-owners of Zydeco Cakes, Rita Lucero and her former mother-in-law, Miss Frankie, have scored a sweet treat?a fantastic catering opportunity that could lead to a rich future for their bakery. But their good news is quickly rattled by a bump in the night when Miss Frankie's neighbor, Bernice, barrels into her kitchen toting a Bible and a gun, and serves up a story about a ghost at her window.
Bernice swears she just saw the ghost of her moonshiner uncle who disappeared in the swamp fifteen years ago. And when her cousin soon goes missing in the same swamp, Bernice is certain someone's playing a nasty trick, and convinces Rita and Miss Frankie to help her investigate. They'll just need to watch their steps, as these ladies are liable to get mired in a very swampy mystery?
Can a pastry chef be too sweet?
Rita Lucero, owner of New Orleans cake shop Zydeco Cakes, can't seem to stop saying "yes." Even though things at the bakery are busy, Rita finds herself accepting a seat on the local small business alliance—a group full of colorful characters like Chopper Shop owner Moose Hazen and his wife, Destiny, whose personal life is messier than a cake someone left out in the rain.
On the street following a heated alliance meeting, Moose pulls Rita out of the path of a speeding van. Shaken and bruised, Rita notices the next day that her prescribed pain killers are missing. When she discovers Destiny's body in the couple's shop, the stolen pill bottle in her lifeless hand only adds another layer to her mysterious death. But getting the frosty NOPD detective to stop focusing on Rita and look for Destiny's real killer will be anything but a cakewalk…
Blind man's bluff
With business going stale at Zydeco Cakes, Rita Lucero has plenty to worry about. But when the blind trumpet player Old Dog Leg Magee asks for a favor, she can't say no. His brother Monroe disappeared forty years ago, and now someone has shown up claiming to be him. Old Dog Leg needs Rita to be his eyes—and see if it's really his brother.
The Twisted Palms Bed and Breakfast is full of unsavory characters, Monroe included. Posing as newlyweds, Rita and her friend Gabriel check in, only to discover that Monroe's true identity isn't the only mystery they'll have to solve. When another guest at the Twisted Palms turns up dead, it seems the mysterious man might also be a murderer...
Pastry chef Rita Lucero's Mardi Gras party turns funereal when one of her guests is found dead after a public fight with her uncle-leaving Rita no choice but to find the real killer and clear her uncle's name...
New Orleans pastry chef Rita Lucero is out to bake her way to the top. But when she finds her almost-ex-husband killed with a chef's knife in his back, she becomes suspect number one. Now it's up to her to find the real killer before she winds up as the next victim served.


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We are all about creating happiness for each of our clients, but here's a couple things about myself so you can get to know me:
I have been with EJM Financial Services for over 7 years as part of the back office support team.
I am a mum of two little boys Oliver and Charlie.
I enjoy travelling, reading and spending time with my family and friends.


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Home Tags ICBM
Tag: ICBM
Air Force Global Strike Command just tested an intercontinental ballistic missile over the Pacific
ICBM test launches are not a response to anything, the Air Force says; rather they demonstrate that the US nuclear deterrent is robust and ready.
The US and North Korea weirdly fired off missiles at almost the exact same time
North Korea fired off suspected short-range missiles Thursday. In a weird coincidence, the US launched an unarmed ICBM at almost the exact same time.
Russia threatened to vaporize US cities — here are the areas in the US most likely to be hit in a nuclear attack
"It's exceedingly unlikely that such an attack would be fully successful," said Stephen Schwartz, the author of "Atomic Audit."
Russia just test-fired an ICBM built to beat US defenses as a nuclear arms race heats up
Russia test-fired its advanced RS-24 Yars intercontinental ballistic missile on Wednesday, amid rising tensions between Washington and Moscow.
North Korea's missile program reportedly continues after Trump and Kim Jong Un's pledge to promote 'peace and prosperity'
US officials say that new evidence, including recent satellite photos, suggest North Korea is producing at least one liquid-fueled ICBM at a research facility.
Putin says Russian troops will soon receive new Yars ICBMs — here's what they can do
The Yars is a three-stage ICBM that can be fired from mobile-launchers and silos.
Kim Jong Un joked that he'd no longer 'interrupt' the South Korean president's sleep with early-morning missile tests
North Korean leader Kim Jong Un met with South Korean President Moon Jae-in on Friday at the truce village of Panmunjom.
North Korea could nuke the US as early as July 23, according to Britain's Ministry of Defense
Kim Jong Un's government has tested multiple nuclear weapons and intercontinental ballistic missiles.
Putin said Russia has developed a new generation of unstoppable nuclear weapons — and showed an animation of them heading for the US
The Russian president made the announcement at the country's state of the nation address on Thursday.
US sanctions North Korean missile experts, Russia offers to mediate
WASHINGTON/MOSCOW - The U...


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This product contains all the work for term 1 for NST Grade 4, based on the "Platinum" textbook.
Topic 1: Living and non-living things
Topic 2: Structures of plants and animals
Topic 3: What plants need to grow
Topic 4: Habitats of animals
Topic 5: Structures for animal shelters
The package consists of:
Index for the term
Key words and key concepts on separate pages
Mind map of the terms' work
Extensive summaries in colour with pictures and / or photos
Worksheets with memorandums
Please respect our copyright. Products are meant for individual use.


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Launch Asset Pack
Dropfleet Commander
Add to Oct shipment
|Hawk Wargames
|Dropfleet Commander
|Hard Plastic
This Hawk Wargames Dropfleet Commander Launch Asset Pack contains two (2) black hard plastic launch asset sprues. In total, these build eight (8) bases of bombers (3 bombers/base), six (6) bases of fighters (5 fighters/base) and two (2) bases of torpedoes (1 torpedo/base). All miniatures are supplied unpainted and require assembly.
Launch assets (fighters, bombers and torpedoes) are important elements in games of Dropfleet Commander - both for protecting your ships and annihilating your opponents!
These greatly add to the look and feel of your fleet, enhancing the gaming experience by replacing the card tokens provided in the starter set. Each of these craft is moulded with an integrated flight stand to attach to its base, allowing for easy assembly.
This box contains 2 black hard plastic launch asset sprues. In total, these build 8 bases of bombers (3 bombers/base), 6 bases of fighters (5 fighters/base) and 2 bases of torpedoes (1 torpedo/base). This is usually enough for one player with an average tournament sized fleet.
Since these miniatures are so small, they are designed to be generic and not race specific. Simply paint them in your fleet colours to differentiate them!
Base size is 20x20mm.
NOTE: Fighters and bombers are moulded at roughly double scale compared to the ships (1:5000 scale) for visibility. Since torpedoes are so massive in Dropfleet Commander, these are moulded at the same scale as the ships (1:9150/0.2mm scale).
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I have been busy people! Running, cooking for my husband, working wherever Gables puts me, drinking wine – B-U-S-Y! 😉
Tonight, had some extra pizza dough laying around (really, who SAYS that?) and went to the grocery today (the horrid Kroger on Cleveland/Metropolitan) and wanted something SIMPLE!
I make my dough homemade – GREAT recipe I got from an Italian Cookbook that I have modified slightly. Here is where you need your food processor to mix everything together:
Dissolve one packet yeast into WARM –> HOT water – let that sit about 5 minutes. Put the following into your food processor:
1 C All purpose flour
1C whole wheat flour (+ another 1-2 T once you start mixing it)
About 1 T extra virgin olive oil
Start the food processor and then pour in the yeast/water mixture
I like to add some herbs at this point too – basil, oregano, rosemary – all good
Add some more whole wheat flour as needed until things start to get formed into a ball. Take it out of the bowl and then knead it with a little more whole wheat flour until not sticky – put it in a bowl (I like stainless steel) and wrap it all cozy in a room or on your couch with blankets and towels to keep it warm and let it rise and double in size. **Learned this one from my mom, who used to make her kolachi dough and wrap it with love so it would rise!**
Then take it and roll it out and place on a baking sheet (we have a pizza pan with holes in it – bakes great!) or on a pizza stone.
Brushed a little olive oil and then some Herbs de Provence on it, then spread PLAIN tomato sauce on there (but that by the can) and then added pepperoni, sliced broccoli, sausage crumbles, and mozzarella cheese – I recommend CUBED cheese, as that is how they do it in Italy – but the shredded was on sale and works well too. Baked @ 375 degrees so the sausage could cook and then added a little bit of crumbled feta cheese about 10 minutes before I took it out. Cooked for about 15-20 minutes – just KEEP CHECKING IT. When it is brown…it is done.


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Product Details:
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|Iron/zinc Alloy
|Hard Enamel
|Die Cust
|2D+Antique Nickel
|Hard Enamel
Shiba Inu Dog Shape Lapel Enamel Pins , Custom Enamel Badges Gold Plating
Custom Shiba Inu Dog Shape Hard Enamel Lapel Eneml Pin With Gold Plating
Product Description
Material options: Iron/copper/brass/zinc alloy/Aluminium
Can be in 3D or 2D design
Process: Die struck/Die casting
Customized artwork and designs are welcome
Can be made in any size and any shape
Finishes: Laser engraving, etching, silkscreen printing, Imitation hard enamel, soft enamel, offset printing, etc.
Plating options: Gold, antique gold, silver, and antique silver, antique bronze, nickel, anti-nickel, black nickel, brass, anti-brass, copper, anti-copper, dyed black
Fittings: Butterfly clutch / Safety pin/Rubber clutch/Long pin/Magnet
Packing: Individual polybag
Sample time: 5 day
Production time: 7 day
We can make any logos or designs for lapel pin/badge/emblem according to your requirement.
1. Our Service
|1) please send us e-mail, then we will give the price
2) after confirm the price, we will make PI to you for payment
3) TT 30% for deposit, balance will be paid before shipment
4) you can choose express/sea shipment / air shipment, we have professional forwarder
5) after you receive the goods, please let us know you comment.
2. Our Advantage
|1) professional factory with 300-350 skillful workers
2) Eco-friend material.
3) free for existing mould sample
4) professional designer, tell your idea, we will have design for you
5) integrity QC system and perfect quality control system, OEM/ODM are available
6) on time delivery
1 what kind of product do you have?
Metal and leather keyring, medal, bottle opener, magnet, badge, pin, lanyard, wristband, card holder, bag holder, souvenir and other gifts
2 how to get a sample?
Please contact us with e-mail or on the website, we quote you price, if the price is OK for you, we will send sample after you pay the sample fee(for the existing mould sample, it will be free ). If you have an order for us, some fee can be refunded if your quantity enough 10K. If there is no order, the sample fee will be refunded to you when you send the sample back to us. the shipping fee is paid by you.
3 how many kind of logo design?
For a logo, we can make embossed , debossed, laser, print, color fill, etch logo on metal, hot press with gold and silver, print on leather, sublimation print , woven, embroidery on ribbon and so on
4 how to make custom design
send us the inquiry and logo deisgn, we will have professional designer make the effective design via AI / Coredraw.
4. Our Advantage:
---Professional Manufacturer;
---Free Artwork
---Strong R & D team;
---Eco-friendly Raw Material;
---Cheap Sample Charge;
---Direct Factory Sales;
---OEM Service, Customized size & logo;
---Attractive Price;
---Satisfied Service;
---Small order QTY is accepted;
We can make any logos or designs for lapel pin/badge/emblem/insignia according to your requirement.
Cute Soft Enamel Lapel Pins Shrimp Shape For Business Promotional Gifts
Frog Shaped Custom Soft Enamel Lapel Pins With Different Colors
Metal Marine Corps Military Challenge Coins Nickel Plating For Promotional Gifts
Custom Metal Souvenir Coin With Palting Gold Soft Enamel 2D Design
Gold Plating Military Challenge Coins Token Coin Garden Grove Police Logo
Golden Plating Military Award Badge Army Police Badge With Soft Enamel
Military Police Department Badge In Dye Black Metal , Police Memorial Badge
Police Military Badge Golden / Nickel Plating 3D Logo , Special Investigator Badge


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Can anyone help me please.
Im building Extreme's 360 and im in the middle of relocating the fuel filler neck. I've watched the DVD which has helped me a bit but I have some concerns ??? After removing the plastic fuel neck im left with several thin plastic pipes which I think are breather hoses as they connect around the top of the cap. Can anyone tell me if I am to remove these completely from the car or are they to be relocated themselves. Also the Dvd tells me to attach the breather hose near the top of the filler pipe but I'm unsure how I actually attach it ??? Do I need to buy an attachment and make alterations to the hoses ???
Any help would be appreciated as I'm worried about getting this wrong an potentially blowing my car up


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Call Buyer's Agent for info: (888) 790-3488
Pre-Construction. To be built. Pre-construction in Clearwater, Lot #5; the beautiful PALMETTO floor plan to be built, with $10k LOT PREMIUM ADDITIONAL TO PRICE OF LOT!!! Turn down your private road into the beautifully landscaped, gated community of Palm Crest Place. 4-Bed/3-Bath + Den at 2,323 sqft. has easy commute to Tampa & St. Pete + US. HWY 19 & Bayside Bridge. Offering everything you need; be the first to call this well-crafted house a home. This open and spacious floor plan features split bedroom plan, two car garage and covered lanai space with large backyard. The suggested model for this lot is the Palmetto model with a base price of $499,000 but this lot would warrant a $10,000 lot premium. Interested in a different floor plan? We can accommodate one of 5 plans on this lot! NGBS Green Certified home with luxury upgrades offered.View all new homes in Clearwater, FL
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Below are a few examples of commission I've producded. They've ranged in size from 12" x 12" up to 48" x 60" and have been shipped all across the country.
To see more examples of sold paintings, please click the "Recently sold" link under "Shop" as well as visiting my Instagram, @JillGordonFord.art to see the latest.
I'm an artist learning each day the process of how we live, how we love and how we grieve after the unexpected passing of my 8-month old daughter, Everly.
Everly is and always will be my biggest inspiration. My best work.
Sales from each painting goes toward our adoption fund. This is an exciting journey we are on and the next step in our healing.


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I co-host Blogger Club UK linky & community with two lovely ladies – Clare from Mudpie Fridays & Debbie from My Random Musings. The linky runs from 6am Wednesday – 12 midnight Friday GMT where all bloggers are welcome to add any type of family-friendly blog post or YouTube video they like. The Blogger Club UK community & linky are not limited to the UK – we'd love to have bloggers from all over the world join us.
If this is your first time joining us, please check out the Blogger Club UK Page for more details about the community & linky.
Welcome to #BloggerClubUK Linky
Welcome! Thank you for linking up with us.
Happy April! We had beautiful weather at the end of March and then 3 degrees and hail in April – it's crazy weather. I hope it's nicer where you are. x
Fabulous Featured Post
Each week we will randomly select a post or video to feature with a link on all 3 of our blogs and we all tweet that featured post as well.
The fabulous featured post this week goes to Little Hearts Big Love with A tribute to our joy-carrier: the making of Jessica's memorial
#BloggerClubUK Linky Rules:
1. Add our badge to the HTML / Text portion of your post. Or, add a backlink to one of our blogs using #bloggerclubuk. If you need any help linking up, read my Linky Guide or tweet us, we are happy to help!
2. Please comment on one of Debbie's posts, one of Clare's posts & one my posts. And, one other of your choice. Please Tweet any posts you enjoy to share the blogger love.
3. Link a maximum of 2 posts per week – family friendly blog posts and/or YouTube videos are welcome to link up.
4. The linky will close at midnight Friday GMT.
5. Tag myself, Clare & Debbie on Twitter for a RT @CuddleFairy @MudpieFridays @randommusings29 with #BloggerClubUK – let's get trending again!
You are invited to the Inlinkz link party!


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Adam Van Doren, grandson of Mark, studied architecture with Robert A. M. Stern, surely the most famous architecture educator in the country.
But practicing architecture was not for Van Doren, who decided to make a career in art. Now he is exhibiting new work at his friend Darren Winston's book shop in Sharon.
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It started as an accident, this business of painting with fire. Now it's just the way Eduardo Giannattasio works, as he demonstrated on the front lawn of Lakeville's White Gallery, Saturday.
Wearing a black beret and windbreaker, cigar firmly in mouth, Giannattasio turned on the African drumming he always works to and proceeded to squirt crimson pigment from a hypodermic needle onto a white board.
Then he added black coloring, burnt umber, violet, shaping his pigments in graceful arcs.
Darkness ebbs slowly. Especially for a reticent fellow like John Atchley.
In recent years this Salisbury resident has suffered fire, losing his house; flood, losing his stored photographs; and, after rebuilding, a plague of carpenter ants.
"They were dropping from the ceiling on us.
"Biblical," he called it.
Then Atchley did something brave.
The little boy is running home from the neighborhood boulangerie, his family's daily baguette tucked under one arm. You can almost sense his motion, feel his excitement. It's 1952, and you are in Paris with him.
Hotchkiss was shrewd to open its new "Faculty Select" art exhibition on Oct. 15 as part of parents' weekend. The school has an excellent visual art faculty that covers painting, ceramics, photography and digital drawing and animation; and their individual work can be impressive.
Two local libraries have opened art shows by known painters. Susan Rand's solo show, her first, at the Norfolk Library, is a delightful surprise. Rand has filtered the styles of others — most noticeably, perhaps, Eric Aho — into her own singular interpretations of quiet scenes of farms, seascapes and even abandoned buildings. She has always used strong geometric lines, heavy brush strokes and thick paint. But now there is new tension and feeling in her work as well.
Cleve Gray's work always looks good in The Morrison Gallery's expanse of white walls and gleaming wood floors. Gray was a Morrison artist from the first days of the gallery, and William Morrison has returned to Gray's abstract impressionist paintings frequently. Now Morrison is showing a fine collection of 20 pictures from the early 1960s, when Gray — influenced by contemporaries such as Pollock, Rothko and Frankenthaler — began producing large paintings made with non-traditional techniques.
Few painters have written autobiographies, and only Benvenuto Cellini's is remembered. Yet Robert Kipniss, the widely recognized and collected painter and print artist (and part-time resident of Sharon), felt compelled to share his story of struggle, obstinacy and tenacity in "Robert Kipniss: A Working Artist's Life."
"This is the kind of book I wished for when I was young. It's about how hard it is to establish a career in art, much less earn a living from it," he says.
Rob Ober has filled his bright gallery with both color and texture in his show of paintings by Karen LeSage and sculptures and works on paper by Elaine Housman.
LeSage is a known quantity among landscape painters in the area. Her pictures are made of horizontal bands of color textured to suggest grass or trees or sky. While they suggest traditional landscapes, they are more abstract, almost color field paintings. But unlike color field pieces, LeSage's glow rather than lie flat on the canvas.
Mary Close is a talented, meticulous artist. In her new show, "The Fabric of Our Town" at The White Gallery in Lakeville, she has abandoned her figurative and still life painting for a new medium, photomosaic.
Using a computer program — Andrea Mosaic — and hundreds of photographs, she has combined technology and art to fashion a small but varied collection of prints that focuses on what she calls "the fabric of our town, Salisbury," but also includes explorations of flowers, people, nature and even food.
Click here to view more photos and purchase high quality reprints.
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