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South African Journal of Child Health
versão On-line ISSN 1999-7671
versão impressa ISSN 1994-3032
S. Afr. j. child health vol.8 no.3 Cape Town Set. 2014
Hypoglycaemia in children aged 1 month to 10 years admitted to the Children's Emergency Centre of Lagos University Teaching Hospital, Nigeria
E E OyenusiI; A O OduwoleII; O O OladipoIII; O F NjokanmaIV; C I EsezoborV
IMBBS, FMCPaed, MWACP; Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
IIMBBS, FWACP; Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
IIIMBBS, MSc, FWACP, FMCPath, DABCC; Staten Island University Hospital, Staten Island, New York, USA
IVMBBS, FMCPaed, FWACP; Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
VMBBS, MPH, FMCPaed, FWACP; Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
BACKGROUND: Hypoglycaemia occurs in many disease states common in the tropics, and may also complicate treatment of malaria. It may contribute significantly to morbidity and mortality.
OBJECTIVES: To determine the prevalence of and clinical conditions associated with hypoglycaemia.
METHODS: A total of 430 patients aged 1 month to 10 years were recruited consecutively from the Children's Emergency Centre of Lagos University Teaching Hospital. Clinical and demographic data were entered into a predesigned study proforma. Blood glucose was determined in the laboratory using the glucose oxidase method. Hypoglycaemia was defined as plasma glucose <2.5 mmol/L.
RESULTS: The median age of the study subjects was 24 months, with a range of 1.5 - 120 months. A total of 248 patients (57.6%) were <24 months old. The mean (standard deviation) blood glucose of all the study subjects was 5.19 (2.05) mmol/L (median 4.9 mmol/L). Twenty-four patients (5.6%) were hypoglycaemic. The predominant disease conditions in which hypoglycaemia occurred were severe malaria, multisystemic infections, marasmus, malignancies and gastroenteritis. Mortality was higher in hypoglycaemic patients than in those without hypoglycaemia (33.3% v. 5.4%, p<0.01).
CONCLUSION: Hypoglycaemia complicates many common childhood illnesses seen in the emergency room and is associated with significant mortality. Hypoglycaemia should be suspected in severely ill children with severe malaria, multisystemic infections, marasmus, malignancies and gastroenteritis.
Hypoglycaemia in children is defined as a whole blood glucose concentration of <2.2 mmol/L or plasma glucose <2.5 mmol/L.[1] It is found in many disease states common in the tropics, such as severe malaria, severe malnutrition, diarrhoea and septicaemia.[2,3] Hypoglycaemia may also complicate treatment with some drugs, such as quinine, used in the treatment of severe malaria,[4] and is associated with significant morbidity and mortality.[2,3,5] Survivors of prolonged hypoglycaemia are prone to neurological complications such as mental retardation, recurrent seizure activity, transient cognitive impairment and neurological deficits.[6]
The absence of clinical symptoms does not always indicate that the glucose concentration is normal or that it has not fallen below optimal level for maintaining brain metabolism.[7] Therefore, in sick children presenting to the emergency room, reliance on clinical manifestations to detect hypoglycaemia may result in missed diagnosis with attendant increase in the risk of complications of hypoglycaemia.
There is a paucity of published data on hypoglycaemia in Nigerian emergency rooms, indicating that not enough attention has been given to the subject in our environment. Hence, this study was designed to determine the prevalence and clinical conditions associated with hypoglycaemia in children admitted to the emergency room in Nigeria.
This cross-sectional study was conducted at the Children's Emergency Centre of the Lagos University Teaching Hospital (LUTH), Nigeria. All consecutively admitted children, aged 1 month to 10 years, between September 2009 and May 2010 were recruited. Patients were excluded if they were confirmed to have diabetes mellitus or have had glucose-containing intravenous fluids <6 hours before admission. Approval was obtained from the Human Research and Ethics Committee of LUTH before commencement of the study. Written informed consent was also obtained from the parents or caregivers.
Data collection
For each subject recruited, the demographic data, presenting complaints, duration and other relevant information were recorded. On admission to the emergency room, before commencement of fluid therapy, blood glucose was determined using 1.5 mL of blood withdrawn from a convenient peripheral vein, which was put in a fluoride oxalate-containing bottle for standard laboratory analysis using the glucose oxidase method. Hypoglycaemia was defined as laboratory plasma glucose <2.5 mmol/L. Treatment of hypoglycaemia consisted of an immediate intravenous bolus of 0.4 g/kg body weight (BW) of glucose over a minute followed by a continuous dextrose infusion at 8 mg/kg BW/min.[7]
Data management and analysis
The data were analysed using SPSS version 17. Statistical significance was taken at p<0.05. Nutritional status was classified using the WHO Global Database on Child Growth and Malnutrition[8]
A total of 461 children aged 1.5 - 120 months were recruited, but 31 laboratory blood samples were excluded due to improper handling, leaving 430 patients. There were 252 (58.6%) males and 178 (41.4%) females (Table 1). More than half of the entire population (57.6%) comprised children aged <24 months. The overall mean (standard deviation (SD)) age was 38.76 (38.20) months (range 1.5 - 120 months).
Of the 92 (21.4%) patients who were undernourished, 35 (38.0%) had severe undernutrition while 57 (62.0%) had moderate undernutrition. A greater percentage of males than females had a weight-for-age z-score (WAZ) <-2 (23.0% v. 19.1%, p=0.33).
The various diagnoses of the study subjects are shown in Table 2. The most common four conditions (multisystemic infections, malaria, sickle cell anaemia and respiratory infections) accounted for more than half of the diagnoses. Severe anaemia was the most common presentation of severe malaria.
Hypoglycaemic patients
Of the 430 study subjects, 24 (5.6%) were hypoglycaemic (Table 3). A greater percentage of females (7.3%) were hypoglycaemic compared with males (4.4%). The hypoglycaemic patients were fairly distributed between the infancy age group and the under-fives. The prevalence of hypoglycaemia in patients with a WAZ <-2 was almost twice that of children with higher z-scores (p=0.14). An interval between the last meal and sampling of >12 hours was associated with a significantly greater frequency of hypoglycaemia (p<0.01). The mean (SD) duration of time interval after the last meal in hypoglycaemic patients was significantly higher than it was for non-hypoglycaemic patients (9.6 (7.8) hours v. 3.8 (5.3) hours; t=3.59, p<0.05).
The leading diagnoses associated with hypoglycaemia were cerebral malaria and multisystemic infections (Table 4). Other conditions included marasmus, malignancies, gastroenteritis and renal disorders.
Thirty patients died, resulting in a mortality rate of 7%. A significantly greater percentage (33.3%) of hypoglycaemic patients died in comparison with only 5.4% of the non-hypoglycaemic patients (p=0.000). Hypoglycaemia was associated with mortality in multisystemic infections, cerebral malaria, bronchopneumonia and malignancies (Table 5). There was significant mortality when hypoglycaemia occurred in patients with multisystemic infections (p<0.01). Overall, the mortality rate associated with the various disease conditions in the presence of hypoglycaemia was significantly higher than the mortality rate in the patients who did not have hypoglycaemia (p<0.05). The highest three case fatality rates were associated with malignancies (57.1%), tetanus (28.6%) and cerebral malaria (22.2%).
The prevalence of hypoglycaemia in the current study was 5.6%. This is comparable with the rates of 6.4 - 7.3% documented by earlier studies both in Nigeria[2] and outside the country.[3,4] It is, however, much higher than the rate of 0.007% (6.54/100 000 visits) reported in Alabama.[9] Differences in prevalence rate may be explainable on the basis of patient characteristics. In contrast, the observed prevalence rate of 5.6% in the current study is lower than the rate of 18.6% reported in California.[10] This could be due to the higher cut-off definition of hypoglycaemia used in the Californian study, namely plasma glucose <65 mg/dL (3.6 mmol/L)[10] and the group of patients studied, who were in the paediatric intensive care unit.
There was an inverse, though not significant, relationship between age and the prevalence of hypoglycaemia, comparable with a previous Nigerian study by Elusiyan et al.,[2] in which the highest prevalence of hypoglycaemia occurred in children aged 1 - 3 years, and a Kenyan study by Osier et al.[,3] in which the highest prevalence of hypoglycaemia occurred in children aged 2 -4 years. Predominance of hypoglycaemia in the under-fives age group is understandable, considering the peculiar glucose metabolism in this age group. Glucose homeostasis is limited in younger children compared with older children and adults because of their smaller reserves of liver glycogen and muscle protein, coupled with their relatively higher rates of glucose utilisation due to their larger brain-to-body mass ratio.[7] The reduced yield of glucose from glycogenolysis and gluconeogenesis during periods of increased metabolic demand and poor intake associated with illness predispose these patients to hypoglycaemia.
There was a greater proportion of hypoglycaemic patients who had fed >12 hours before presentation, compared with the non-hypoglycaemic patients as has been documented by other African authors.[2,3,11,12] Intervals between the last feed and blood sampling >12 hours were significantly associated with a higher prevalence of hypoglycaemia. This finding is not surprising because inadequate fasting adaptation is a major cause of hypoglycaemia in children, as glycogen reserves are used up after 12 hours without food.[7] This is further worsened by the defective gluconeogenesis in most childhood illnesses.
The different diagnoses in patients with hypoglycaemia observed in the current study consisted of common childhood diseases, similar to the range of diseases reported by earlier studies in Nigeria[2] and other African countries.[3] The leading diagnosis associated with hypoglycaemia in the current study was severe malaria. This is comparable with observations in other African studies,[2,3] and the prevalence rate of hypoglycaemia in cases of severe malaria is comparable with that in a Kenyan study. [13] However, this rate was considerably higher than what was reported in an earlier Nigerian study[2] and much lower than that reported from The Gambia.[4] These wide variations in rates reported may be related to the type of severe malaria and the overall severity of illnesses in the various studies.
In the current study, nearly half of the patients with cerebral malaria had hypoglycaemia. This prevalence is almost twice the rates of 17% and 20% recorded by other African authors, respectively. [11,12] The difference in prevalence rates may be attributable to a difference in severity of the illnesses seen in the various studies. Considering the potentially serious sequelae of cerebral malaria complicated by hypoglycaemia, a high index of suspicion is essential in order to facilitate adequate treatment.
The prevalence rate of gastroenteritis in the current study is higher than that reported in a study in Bangladesh[5] A possible explanation for the difference in prevalence rates could be because all consecutive patients in the current study were tested for hypoglycaemia, while in the Bangladesh study, only patients with altered consciousness were tested for hypoglycaemia in the 2nd 4 months of the study period. However, the observed prevalence rate in the present study is lower than the rate reported in another diarrhoea-based study in India.[14] The smaller sample size of 10 in the Indian study could have contributed to the apparently higher prevalence rate. Fasting, malnutrition, ketosis and impairment of gluconeogenesis have been suggested as the mechanisms of hypoglycaemia in diarrhoeal diseases.[5,15]
Hypoglycaemia was also prevalent in patients with bacterial infections involving multiple systems in the present study. The prevalence rate is comparable with that reported in another Nigerian study. [2] Hypoglycaemia in infective processes has been attributed to increased peripheral glucose utilisation, which may be caused by fever, hypotension or decreased tissue perfusion,[61] while some authors[15] implicated inhibition of gluconeogenesis. In addition, endotoxins produced by micro-organisms in infectious processes have been observed to stimulate increased insulin secretion, contributing directly to depletion of hepatic glycogen stores[15]
In the current study, the prevalence of hypoglycaemia in patients with moderate to severe undernutrition was almost twice that of children without undernutrition. Specifically, one out of three patients (33%) with marasmus had hypoglycaemia. This is close to the prevalence rate observed by Elusiyan et al,[2] but it must be pointed out that the number of subjects involved was very small and interpretation probably anecdotal. This observation is important considering that other studies in Kenya[3] and Mozambique, [12] with considerably more severely undernourished subjects, reported lower prevalence rates of hypoglycaemia. The fatty infiltration of the liver as occurs in severe undernutrition causes glycogen and gluconeogenic substrate depletion. Furthermore, the defect in glycogenolytic pathways and limited lipolysis also contribute to the occurrence of hypoglycaemia in undernutrition. [18]
There was a significant association between hypoglycaemia and increased mortality in the current study. A similar association had been reported in several other studies.[2,3,10,12,18] It is obvious that hypoglycaemia is in some way linked to mortality. The major diagnoses associated with high mortality in patients with hypoglycaemia in the present study included multisystemic infections, cerebral malaria, bronchopneumonia and malignancies. This is in agreement with other studies,[2,12] which identified cerebral malaria and infections as major diagnoses associated with mortality in hypoglycaemic patients. However, these diseases are severe conditions that, on their own, can be fatal.
Hypoglycaemia caused complications in common childhood diseases in the Children's Emergency Centre of LUTH. Ill children aged <5 years and those with low WAZs were particularly susceptible to hypoglycaemia. Severe malaria, multisystemic infections, marasmus, malignancies and gastroenteritis were the predominant diagnoses associated with hypoglycaemia. Prolonged interval (>12 hours) between the last meal and time of presentation was significantly associated with the occurrence of hypoglycaemia. It is therefore recommended that blood glucose should be measured in all children ill enough to be admitted to the emergency room. A follow-up study of the surviving hypoglycaemic patients will be useful to screen for any associated long-term sequelae.
1. Cornblath M, Schwartz R. Disorders of carbohydrate metabolism in infancy. 3rd ed. Boston: Blackwell Scientific Publications, 1991:1-53. [ Links ]
2. Elusiyan JBE, Adejuyigbe EA, Adeodu OO. Hypoglycaemia in a Nigerian paediatric emergency ward. J Trop Pediatr 2006;52(2):96-102. [http://dx.doi.org/10.1093/tropej/fmi068] [ Links ]
3. Osier FHA, Berkley JA, Ross A, Sanderson F, Mohammed S, Newton CRJC. Abnormal glucose concentrations on admission to a rural Kenyan district hospital: Prevalence and outcome. Arch Dis Child 2003;88(7):621-625. [ Links ]
4. White NJ, Warrel DA, Chanthavanich P, et al. Severe hypoglycaemia and hyperinsulinaemia in falciparum malaria. N Engl J Med 1983;309(2):61-63. [ Links ]
5. Bennish ML, Azab AK, Rahman O, Phillips RE. Hypoglycaemia during diarrhoea in childhood: Prevalence, pathophysiology and outcome. N Engl J Med 1990;322(19):1357-1363. [ Links ]
6. Idro R, Carter JA, Fegan G, Neville BGR, Newton CRJC. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 2006;91(2):142-8. [http://dx.doi.org/10.1136/adc.2005.077784] [ Links ]
7. Thornton TS, Finegold DN, Stanley CA, Sperling MA. Hypoglycaemia in the infant and child. In: Sperling MA, ed. Paediatric Endocrinology. 2nd ed. Philadelphia: Saunders, 2002:135-159. [ Links ]
8. World Health Organization. Global Database on Child Growth and Malnutrition. www.who.int/nutrition/topics/malnutrition/en/index.html (accessed 20 July 2011). [ Links ]
9. Pershad J, Monroe K, Atchison J. Childhood hypoglycaemia in an urban emergency department: Epidemiology and a diagnostic approach to the problem. Paediatr Emerg Care 1998;14(4):268-271. [ Links ]
10. Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia and glucose variability with morbidity and deaths in the pediatric intensive care unit. Pediatrics 2006;118(1):173-179. [http://dx.doi.org/10.1542/peds.2005-1819] [ Links ]
11. Nwosu SU, Lesi FEA, Mafe AG, Egri-Okwaji MTC. Hypoglycaemia in children with cerebral malaria seen at the Lagos University Teaching Hospital: Predisposing factors. Nig Med J 2004;45(1):9-13. [ Links ]
12. Solomon T, Felix TM, Samuel M, et al. Hypoglycaemia in paediatric admissions in Mozambique. Lancet 1994;343(8890):149-150. [ Links ]
13. English M, Wale S, Binns G, Mwangi I, Sauerwein H, Marsh K. Hypoglycaemia on and after admission in Kenyan children with severe malaria. QJM 1988;91(3):191-197. [ Links ]
14. Bhattacharya SK, Bhattacharya MK, Dutta D, et al. Vibrio cholerae 0139 in Calcutta. Arch Dis Child 1994;71:161-162. [ Links ]
15. Filkins JP, Cornell RP. Depression of hepatic gluconeogenesis and the hypoglycaemia of endotoxic shock. Am J Physiol 1974;227(4):778-781. [ Links ]
16. Miller SI, Wallace RJ Jr, Musher DM, Septimus EJ, Kohl S, Baughn RE. Hypoglycaemia as a manifestation of sepsis. Am J Med 1980;68(5):649-654. [ Links ]
17. Yelich MR, Filkins JP. Mechanism of hyperinsulinaemia in endotoxicosis. Am J Physiol 1980;239(2):E156-161. [ Links ]
18. White NJ, Miller KD, Marsh K, et al. Hypoglycaemia in African children with severe malaria. Lancet 1987;1(8535):708-711. [ Links ]
E E Oyenusi


text:
A Non-Religious Family
Many people and families around the world sense no connection to any faith community, and this fit the description of
the Marshalls quite well. In the last years of Robert Marshall's life, he described frustration with religious
systems and decried the "flim-flammery" of religious leaders and institutions. "All they ever want is your money," he
had said to his children on many occasions.
His children had also heard him say at many different times that he really didn't want a funeral. "I guess I don't care what you do with me when I'm dead. You know," he continued, "I'll be dead!" As his health deteriorated, Marcie, his oldest daughter found an opportunity to talk with him: "Dad, we will want to at least have a memorial service. Is that okay?" And, predictably, he said, "Well, I really don't care; I'll be dead, you know!"
So when Robert died at age 71, his family knew they wanted to do "something," but without any religious or ethnic traditions to guide them, they set about to create a memorial gathering they thought would best honor their dad's life. As they talked with the funeral director handling Robert's cremation, they even considered contacting a local minister who had married two of the grandchildren. "If we had any minister at his service, I think dad would come back and haunt us," Marcie said to the laughter of everyone in the meeting.
The funeral home had a nice room designed for informal services like what they envisioned for Robert. The funeral director suggested assembling some photographs for a life tribute video and bringing in some memorabilia that would recall important values and interests from Robert's life. Unfortunately, Robert had alienated many people from his life in recent years, so his children were not even sure how many friends would join their small family for the service. Finally, all decided they would create their own service with the funeral director acting as an emcee'.
The Marshalls also learned from Mark, their funeral director, that they could have an opportunity to see Robert one last time and even witness the cremation if they wished. Since Bob was vacationing with his family out of state when his dad died, he indicated interest in a private time to say goodbye. The funeral home provided a nice setting in one of their rooms and the family members had some time to say goodbye.
On Saturday, eight days after Robert's death, ten family members and about two dozen friends gathered in the funeral home's Fireside Room for a simple memorial service to celebrate Robert's life. The service began with the playing of an old Frank Sinatra recording, I Did it My Way, a song Robert's kids agreed was a fitting description of his life. Mark, the funeral director welcomed everyone and explained that Robert's memorial service would be a bit different. "In a few minutes," he told them, "you will have an opportunity to share a favorite memory of Robert's life." He explained further, "You might want to recall a specific character quality or value that describes Robert to you. You might want to tell a brief story in just a few sentences of a time you interacted with him that makes you smile. This is your time to share."
Robert's college-age granddaughter, Kristen stood and read a "Letter to Grandpa" she had written for the memorial service. Then, Robert's grandson, an Air Force pilot read John Gillespie Magee's famous poem, "High Flight," calling it a fitting tribute to his grandpa who had served with distinction as a helicopter pilot in Vietnam.
The video with more than 80 photos and three of Robert's favorite songs began playing on the screen in the room as those gathered alternated between laughing and crying. Then came the long-awaited time for people to stand and share their favorite memories.
As Mark skillfully recognized one person after another, each stood and told their story or offered their tributes to Robert—a man of generosity, patriotism and strong conviction. Marcie was the last to speak—and summed up the feelings of many in the chapel that afternoon. "When you get all of us together in one place, you can see just how much influence Dad had on all of us. I'm not sure he ever really knew it; I'm afraid I didn't find the words to tell him. I hope he can hear us today as we talk about the great man he was. But I guess as we share these stories, one thing we can all agree on is this. Robert Marshall has made all of us into better people."
An honor detail from the Veterans of Foreign War presented the folded American flag to Marcie and her brother, Bob. Then, as if Robert were singing the song himself, the voice of Roy Rogers began to croon through the speakers in the chapel, Happy Trails to You.
With literally hundreds of options for non-religious or secular ceremonies, the following resources may be helpful to you.
- Secular Seasons
- Bennett, A. & Foley, T. (1997). In Memoriam: A Practical Guide to Planning a Memorial Service. New York: Fireside.
- Lamont, C. (1977). A Humanist Funeral Service. Amherst, NY: Prometheus Books.
- Moore, F. (2009). Celebrating a Life: Planning Memorial Services and Other Creative Remembrances. New York: Stewart, Tabori, & Chang.
- Walter, T. (1997). Secularization. In C. M. Parkes, P. Laungani & B. Young (Eds.), Death and Bereavement Across Cultures (pp. 166-187). London: Routledge.

subset: commoncrawl


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text:
In May we saw a record fall in the cost of fuel – according to the Office of National Statistics, prices at the petrol pump reduced by 16.7%, contributing to a slowdown in the rate of inflation. However, in the past couple of weeks, we've seen prices starting to rise again as more drivers return...Read More
Getting ready for summer adventures
From 4 July, many of us will now be able to stay away from our homes, so whether you're looking to get out in your campervan, touring caravan, back to your static caravan or holiday home, or perhaps staying overnight on your boat, we've got some tips to help you get ready Getting your campervan...Read More
Things to do this summer for motor enthusiasts
As one of the headline sponsors of this year's Supercar Weekend hosted at Beaulieu, A-Plan were due to have a stand at the event on 8-9 August but unfortunately, due to COVID-19, this event has been cancelled. But for motor enthusiasts, there's still plenty to do. Not only has Beaulieu opened its gardens again, it...Read More
What Universities will look like this Autumn.
If you've got children returning or starting university this year, things are going to look somewhat different. Endsleigh, part of the A-Plan Group, has supported students for the past 50 years, and working directly with the University sector, they've been able to find out what the 'new normal' might look like for students. 95% of...Read More
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text:
Amjad M
I can't do everything, but I can do something :)
Amjad is a B.Tech Electronics and Communication Engineering graduate from University Of Calicut and now working as a software engineer. He is an active Mozilla Kerala community member. For his active and valuable contribution to mozilla, he has been selected as Firefox Regional Marketing Ambassador (RMA). He is localizing MDN docs and the firefox OS Apps into malayalam language, L10n malayalam team member, An app developer for Firefox OS, An active mozilla contributor in SUMO, etc. etc... He is always like to spread the word "MOZILLA".
Speaking interests: mozilla and its mission, open web, cyber security, privacy, Firefox OS, FSA, Mozilla Contribution Areas.
Tagsaoa, creative, firefox student ambassadors, graphics, kmct firefoxclub, marketing, mobile, mozilla india, mozilla kerala, mozillian, open badges, people, rma, sf-monument, sumo, support, mozspeakers, famous photo star, localization, mdn, malayalam, language
Skills.css3 html5 java javascript php, ajax, angular js, app development, c, community building, community engagement, database mysql, event coordination, event management, iot, localization, malayalam localization, mean stack, python, symfony, testing, user research
Vouched By
Havi Hoffman
I met Amjad a few months ago at the first Marketplace Day - when he started a Transifex account to do some app localization work in Malayalam. Since then he's translated a couple of Firefox apps. He's also published 2 apps in Firefox Marketplace, including one called "What can i do for Mozilla?." Can't wait to see what he works on next. Thank you Amjad!
Josh Matthews
Amjad localized the content of whatcanidoformozilla.org: https://github.com/jdm/asknot/commits?author=amjadm61 and is a SUMO contributor (https://support.mozilla.org/en-US/user/amjadm61) among many other contributions.
Vannak Eng
He is a Firefox Student Ambassador.
Unknown Voucher
Amjad had been actively volunteering with Mozilla by guiding FSAs on their activities as an RMA previously. He's in Mozilla Kerala CB, organized events including App Days, MozBooths wherever possible, webmaker parties and what not!
Being a techie contributor too(which is awesome), he had submitted a couple of apps on marketplace, translated more than 3 fx OS apps. A milestone was achieved when he contributed translating whatcanidoformozilla.org into Malayalam. Proud to vouch for Amjad :)


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Tuesday, 10 January 2012
Spring Chicken in Wintertime
Spring Chicken
Serves 4-6
1 tsp olive oil
140g pancetta cubes
12 chicken thighs (bone in with or without skin)
1 leek, cleaned, quartered lengthwise then finely sliced
1 stick celery, quartered lengthwise then finely sliced
3 cloves garlic, peeled and chopped
2 tsp freeze-dried tarragon
1 tsp sea salt flakes or 1/2 tsp pouring salt
good grinding white pepper
1 x 500ml bottle dry cider
300g frozen petit pois
1 x 15ml tbsp Dijon mustard
2 Little Gem lettuces, suct into strips or roughly shredded
2 x 15ml tbsp chopped fresh tarragon
Heat the oil in a large, wide casserole that comes with a lid and add the pancetta cubes, cooking them until they begin to give off their juices and start to colour.
Add the chicken thighs (skin-side down if yours have skin), tossing the pancetta cubes on top of the meat (to stop the pancetta burning and to make space) as you put the poultry in the pan, and cook for about 5 minutes over a medium heat.
Turn the thighs over and tip in the prepared leek, celery and garlic. Season with the dried tarragon, salt and pepper, then stir everything around a bit, letting it cook for another 5 minutes.
Pour in the cider, then sprinkle in the frozen peas. Bring the pan to the boil then cover, turn down to a very gentle heat and cook for 40 minutes. Do check after 30, though, to see if the chicken is cooked through, and if you are using boneless thighs, then 20 minutes should do it.
Remove the lid, stir in the mustard, and then toss the shredded lettuce over the chicken, letting it wilt in the hot sauce for a couple of minutes.
Scatter the chopped tarragon over the casserole. Serve with new potatoes or rice.
11 comments:
- Finla said...
Beautiful delicious looking chicken dish.
- 10 January 2012 at 19:39
- Lucie said...
You're a girl after my own heart Maria - I am in the mood for food just like this right now. This looks delicious - I shall bookmark this recipe to do soon :) Lucie xx
- 10 January 2012 at 21:02
- The Caked Crusader said...
Chicken is so versatile - I have it every week and it never disappoints. Your dish looks lovely.
- 10 January 2012 at 21:05
- Gloria Baker said...
Love this look delicious!
- 10 January 2012 at 21:13
- Tracey said...
Wow this looks scrummy. Would it work just as well with Chicken breast? I plan on cooking chicken Thursday evening and I am going to give your recipe a try. Thanks so much. Tracey
- 10 January 2012 at 21:49
- Maria♥ said...
Tracey, I don't see why you couldn't use chicken breast. I actually prefer breast and will try it next time. Let me know how it turns out.
- 10 January 2012 at 21:52
- Unknown said...
I'm getting hungry looking at these pictures, the meal looks filling and delicious. I will have to put this on my "to cook" list in Feb.
- 10 January 2012 at 23:50
- Kelly-Jane said...
Yours looks lovely. x
- 11 January 2012 at 12:09
- Kim said...
This is just my kind of meal,looks delicious!
- 13 January 2012 at 18:44
- Tracey said...
I am really pleased to say that I made your Spring Chicken in Wintertime dish this week. I used chicken breast instead of thighs and added a few mushrooms (We love mushrooms). Unfortunately I couldnt add the garlic because mother in law came for tea but we all loved it. If you would like to see a picture of this, its on my blog at derbyshireducks.blogspot.com.
Tracey x
- 15 January 2012 at 11:53
- Lisa said...
Nice to know someone else loves this. It's one of our most popular "table d'hote" main courses! I always make it with the whole chicken leg+thigh and cook it for longer than the recipe says until the meat just falls off the bone.
If you're working your way through "Kitchen", I can heartily recommend the "Carbonnade a la flamande". I've made it a couple of times already this year. It's massively easier to make than a proper boeuf bourgignon, and all the people who've eaten it tell me it's delicious (I'm vegetarian, so not in a position to give you a personal opinion!!)
- 31 January 2012 at 14:54


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Wisconsin authorities say former talk show host and medical marijuana activist Montel Williams has been cited for possession of drug paraphernalia at General Mitchell International Airport in Milwaukee.
The Milwaukee County sheriff's office says the Transportation Security Administration found Williams had a pipe commonly used for marijuana as he passed through a security checkpoint Tuesday.
VIEW THE PHOTOS: Talk Show Host & Dancing Queen: Ellen DeGeneres
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The day's top national and international news.
The sheriff's office says Williams paid the $484 citation and was released to continue his travel.
Williams has said he uses marijuana to relieve chronic pain caused by multiple sclerosis that was diagnosed in 1999. The 54-year-old has said he became an activist pushing for medical marijuana laws after being stopped at a Detroit airport years ago for carrying drug paraphernalia.
VIEW THE PHOTOS: Oprah! Ellen! Regis! TV's Favorite Talk Show Hosts
Messages left Tuesday for his attorney, Nina Shaw, were not immediately returned.
Copyright 2011 by Associated Press. All rights reserved.This material may not be published, broadcast, rewritten or redistributed.
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What Does Christmas Taste Like?
What does Christmas taste like? Beth Kracklauer joins Lunch Break with a look at some spice-rich dishes that tap into memory and emotion while providing intense depth of flavor. Photo: Justin Walker.
This transcript has been automatically generated and may not be 100% accurate.
... I ... a month Frankenweenie Downs what exactly is the smell of Christmas well ... I guess she has been on the hunt she has some suggestions for you is that Krakow she's the ... editor ... of the Greek off duty section Hi there I was a good job this is a good job and I will say and ... the smell of Christmas so everybody has something different mind whether it's on a cinnamon whether it charges for me actually happens to be ham biscuits that my mother to any remaining lineup ... the sale ... should talk about with Priceline's isn't she found for people that you really think are are are quartile persistence ... the interesting thing is that different from place to place any of that is one that a lot of people associate with Christmas in a great way to deliver that ... is in high during Michael mulled wine or we have a recipe for waffle inning Saturday the it's just ... it's just immediately takes to Christmas it's beautiful not nag is another wine it's a great point agreed over an egg not work let ... AMR any kind in Shinkansen really weren't getting them on Apple Map not many and trading it because you get so much for potency and depth of ... our almond flavor and what happens when people don't think that it's actually in so many Christmas Knudsen elites and gingerbread gingerbread cookies ... and I spoke with at the Baker to Apple in your file and that in this file and the Korean parents ... and she uses a combination of black pepper orange blossom and cocoa in a lot of her for the Christmas baking it's delicious ... she also uses and savory dishes so we have a recipe from her for a lamb meatballs ... with little bits of candied orange and orange and France in particular has a very Christmas flavor ... and and this combination of Koko black pepper and orange blossom and it's just beautiful and really works in a Favorite contacts and as a whole science right behind how your brain processes now exactly and is then sealed partnered astronomy which is really an emerging and that and and neuroscientist ... Dr Gordon Shepherd a great book about it it's wonderful and I really recommend it and ... where is you know we think of foods is having flavors that we take and ... it looks at the opposite way and instead ARM's Marine create flavors based on these molecules veteran students ... and is much more about it ... involving tapes there's the context and in Rome are talking about the holidays of course ... you know your brain goes to a certain place because you've eaten this dude in that place before and I think it's a very good point on great ideas from you more than recipes tomorrow and off duty section yes that think semester being with ... him


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They say there are some games that have no winners. This sounds like one of them.
"[Charlie Sheen and I] competed to see who could play harder, then show up for work and still kick ass," admits Rob Lowe in a brand new "Vanity Fair" interview. "The verdict: Charlie by a nose."
No pun intended, we're sure.
U.S. & World
Lowe, who has a recurring role on the hit comedy "Parks and Recreation," goes on to explain that there was a time when he and Sheen were considered "uncool" - mostly because they lived in Malibu but didn't surf. He describes Sheen as "a wonderful mix of nerd and rebel," before making it clear that the two future superstars had very different upbringings.
"At my house we are still saving money by not buying desserts," Lowe says. "At Charlie's house, it's never-ending Häagen-Dazs, brand-new BMWs, a lagoon pool with underwater tunnels, and a lit, professional-grade basketball half-court."
Over the course of the interview, Lowe also recounts his first meeting with Tom Cruise ("He's open, friendly, funny, and has an almost robotic, bloodless focus and an intensity that I've never encountered before"), his many sexual conquests (including Demi Moore, Natassja Kinski, Princess Stephanie, and even Fawn Hall), and his feelings about being a member of the fabled Brat Pack that ruled movies during the '80s.
"We should all be so lucky in our lives to create things that we're still talking about 25 years later."
Selected Reading: Vanity Fair, PopEater, Huffington Post


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A Philadelphia jury is scheduled to start a fourth full day of deliberations in the case of a Philadelphia abortion provider charged with multiple counts of murder.
Dr. Kermit Gosnell, 72, is charged with killing four babies allegedly born alive at his clinic in West Philadelphia. He also is charged in the 2009 overdose death of a patient, Karnamaya Mongar of Woodbridge, Va., a 41-year-old mother of three.
The clinic served mostly low-income women and teens, and went years without a state inspection. Gosnell also faces hundreds of abortion-law violations, for allegedly performing third-trimester abortions and failing to counsel patients.
U.S. & World
The day's top national and international news.
Co-defendant Eileen O'Neill, meanwhile, is charged with billing as a doctor when she did not have a license. O'Neill, 56, of Phoenixville, is free on bail.
Eight people who worked for Gosnell at the clinic have pleaded guilty since the 2011 indictment, and all but Gosnell's wife testified against him. Four others have pleaded guilty to murder charges for either "snipping" the babies with scissors after they were born, or helping sedate Mongar despite a lack of training. Prosecutors described the clinic as a "house of horrors."
The jury, scheduled to return Monday morning, has sat through nearly two months of graphic testimony and arguments. The seven women and five men were selected after assuring Common Pleas Judge Jeffrey Minehart that they could be fair despite the difficult subject matter.
The jurors include people who work for the city water department and regional transit authority, and appear to range in age from their 20s to 60s.
Gosnell's lawyer insists there were no live births at the clinic, and blames Mongar's death on unforeseen medical complications. O'Neill's lawyer has argued that she worked under Gosnell's supervision.
Gosnell has been in custody since the 2011 grand jury report that led to the charges.


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1 Item
21-22-23 gram# Bulls Darts
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At the 1982 International Council for Biblical Inerrancy held in San Diego, California, the late E.V. Hill gave a plenary address that I shall never forget. Weaving a homespun story of what his mama taught him growing up in Sweet Home, Texas, Dr. Hill masterfully defended the authority of Scripture. His climactic conclusion came with fever-pitch enthusiasm as he held up his Bible and shouted, "The Bible! The Bible! The Bible! Trust it! Don't adjust it!" That brought all of us to our feet in thundering, affirming applause. We are living in a time when that counsel needs to be shouted again. The cultural pressures against Christianity and its founder Jesus Christ have never squeezed tighter.
One of the greatest arguments for the trustworthiness of the Bible is the confidence with which Jesus himself used the Scriptures. Contrary to some modern scholars, he was not afraid to affirm the historicity of Adam and Eve in pinpointing both the beginning of history and the institution of marriage between one man and one woman (Matt. 19:4–6). If Jesus wanted to avoid a controversial passage the liberals have questioned for years—the account of Jonah and the big fish—he didn't! He linked the experience of Jonah and the fish to that of his own burial and resurrection. He even asserted that the men of Nineveh who repented will be resurrected and will participate in the future judgment of Jesus's own contemporary audience who failed to believe in him (12:39–41). And if that were not enough, Jesus affirmed the reality of Noah and the flood as a parallel to the certainty, yet unexpected timing, of his physical return and judgment (24:36–39). Rather than adjusting the account of Noah's flood to eliminate its potential offense, Jesus trusted it by affirming it.
Probably the two greatest passages in the Bible about its divine inspiration are 2 Peter 1:20–21 and 2 Timothy 3:16. The first passage describes the process of inspiration: "But know this first of all, that no prophecy of Scripture is a matter of one's own interpretation, for no prophecy was ever made by an act of human will, but men moved by the Holy Spirit spoke from God" (NASB). Far from human intuition or private initiative, the Bible came about by an omnipotent God's moving and guiding the human authors in what they should say in holy Scripture.
The second passage stresses the product of inspiration. Paul wrote, "All Scripture is inspired by God and profitable for teaching, for reproof, for correction, for training in righteousness" (NASB). The phrase, "inspired by God," is the translation of one Greek word, theopneustos. This word, which is only used here in all of Scripture, has three components: theos is the word for God; pneuma means "breath or spirit;" and the suffix toe indicates "the result of." Putting these two passages together, we find that the Holy Spirit so guided the human authors in the process that the end product, every Scripture, was the exact Word of God exactly as God wanted to communicate it in the words of the original manuscripts. The authority of the Bible is rooted in the ultimate author of the Bible—the Holy Spirit of God (1 Cor. 2:9–16). Trust it! Don't adjust it!


text:
You are here
Native American student interns at LLNL meet with Navajo Tribal President Ben Shelly this summer.
When the National Nuclear Security Administration (NNSA) looked for an institution to get a strong engineering base to recruit from, they turned to Northern Arizona University (NAU), the top recruiter of Native American engineering students in their area. Since 2010, NNSA has funded a 12-week summer internship program at Lawrence Livermore National Laboratory (LLNL) in nearby California working with NAU professors to recruit top-notch engineering students to assist with LLNL projects. Once on site after orientation, students work in groups and join in the summer programming – think talks, lectures, social activities, and field trips – alongside LLNL's 400 Summer Scholar students. The NNSA program also includes funding for NAU to put on a "Summer High School Youth Symposium."
This summer, the Native American student researchers had an opportunity to brief Navajo Tribal President Ben Shelly about their summer projects. President Shelly was at LLNL for the Navajo Nation Energy Advisory Committee's meeting on overarching energy policy, discussing issues such as energy and Native American Education. Dustin Saag, a member of the Navajo Nation and an electrical engineering major, presented his work from the internship to create a Universal Content Management System, corralling pictures and media files from the laboratory to upload into a central system.
As with any recruitment tool, Lawrence Livermore National Laboratory hopes that the Native American students who have gotten a taste of a career at their lab will return after they graduate and apply to be a permanent part of the team. The summer of research these students now have under their belts will help them compete for much sought-after positions within the Nation's national security laboratories.
In the meantime, these students are charged with taking their experience and training back to their communities and school. Poster presentations of their research bring the results of their summer projects to their peers, and draw in more applicants to next year's program. While students can re-apply to return after they've finished a summer program, the laboratory is hoping to reach a larger number of students through the program's duration.
To learn more about internship opportunities at LLNL visit: https://internships.llnl.gov/


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Continental Top Contact Winter II (700c)
Transferring their car tire knowledge into bicycle tires, Continental's Top Contact Winter II is a snow tire for your bike. Grip in snow, slush, and on wet roads is assured due to a unique tread pattern that produces hundreds of gripping edges. Since you'll be using this tire in cold temperatures, Conti has formulated their rubber compound to remain supple for unparalleled winter traction. There's also a flexible PolyX Breaker for awesome flat protection. Plus, the Top Contact Winter sports Continental's Reflex sidewall striping for safety.


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Give Yourself Brain Based Golf Lessons
Most agree that golf's a cerebral game, so it makes sense to play with more brainpower in mind. Luckily we retain 90% more by teaching others as we learn ourselves, so it also makes sense for novice golfers to teach what they learn here to other wanna-be golfers. Lesser known… Read more »


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The 2017-18 season marked the return of Valencia Basket to the Turkish Airlines EuroLeague after an absence of three straight seasons. The team went through some rough times in the regular season, despite starting with a 3-1 record. Right after that, major injuries and unfortunate results sent Valencia on a 10-game losing streak – the longest of the season in the EuroLeague, which was very difficult to bounce back from. With a 3-11 record, Valencia collected back-to-back wins, but that was not the final injection that the team needed and in the end, the Orange team missed out on the playoffs with a final 12-18 record for 11th place. Erick Green, Bojan Dubljevic and Tibor Pleiss were the main faces for the team in the EuroLeague. In the Spanish League, Valencia Basket qualified for the playoffs, but lost in the first round against Herbalife Gran Canaria by 1-2. In the Spanish King's Cup, Valencia also fell in the first round. The only three-time EuroCup winner is now back to its talisman competition and it will definitely aim to come out on top again.
Founded in 1986, Valencia reached the top Spanish League in 1988, but did not stick for good until 1996. Two years later Valencia claimed its first trophy, the Copa del Rey, by downing DKV Joventut Badalona in epic fashion. Soon the then-named Pamesa Valencia became a regular in the Spanish playoffs. In Europe, Valencia reached the Saporta Cup final twice, but lost in 1999 to Benetton Treviso and in 2002 to Montepaschi Siena. Everything changed for Valencia in the 2002-03 season. First came the ULEB Cup title as it swept Krka Novo Mesto in the finals series led by Finals MVP Dejan Tomasevic, Nacho Rodilla and Fabricio Oberto. Valencia then climbed to the Spanish League finals before losing to Barcelona. In its debut EuroLeague season in 2003-04, Valencia reached the Top 16 and came within one win of the Final Four. Valencia had plenty of success in the EuroCup, but didn't lift the trophy again until 2010. Coach Neven Spahija and star players Matt Nielsen, Nando De Colo and Victor Claver helped the then-named Power Electronics Valencia to its second EuroCup title by beating ALBA Berlin in the championship game in Vitoria, Spain. A year later, Valencia went all the way to the EuroLeague Playoffs before losing to Real Madrid. Valencia made it to another EuroCup final in 2012, but fell to Khimki Moscow Region. Valencia returned to the EuroCup Finals in 2014 and left no doubts by sweeping UNICS Kazan behind an outstanding Justin Doellman. Valencia started the 2014-15 season in the EuroLeague and ended up reaching the EuroCup quarterfinals and the Spanish League semifinals. Valencia reached three finals in 2017; Coached by Pedro Martinez and with signature stars Rafa Martinez and Bojan Dubljevic, it lost against Real Madrid in the Copa del Rey title game and against Unicaja Malaga in the EuroCup Finals, but claimed its first-ever Spanish League title by defeating Madrid in the finals with Dubljevic getting MVP honors. Back to the Turkish Airlines EuroLeague for 2017-18, Valencia struggled due to major injuries that sent the team to a 10-game losing streak from which it could not recover. The team failed to make the playoffs and also lost in the first round of the domestic playoffs, which brings the only three-time EuroCup champ back to its talisman competition.


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Josh Duhamel & wife Fergie of the Black Eyed Peas continue to deny allegations that the "Transformers" star had sex with an Atlanta stripper.
"This is not the first nor will it be the last time that a stripper was paid a large amount of money to sell a false story about a celebrity," a rep for Josh told People, referring to the claims made by Nicole Forrester in a recent story in the tabloid the National Enquirer. "This story is absolutely ridiculous."
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A rep for Fergie added to People, "These allegations are nonsense."
On Monday, during an interview on Atlanta radio station Q100's "Bert Show," Nicole claimed she has sex with the actor a week after he came to the Tattletale club in Atlanta, where she dances. "We did hook up and had lots of sex and we had a really, really good time," she claimed during the interview.
VIEW THE PHOTOS: Josh Duhamel
She also said she has text messages and polygraph test results to back up her claims.
Nicole sold her story to the National Enquirer for reportedly more than $20,000.
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Loving relationships can produce countless benefits in terms of both mental and physical well-being. Unfortunately, a successful marriage or partnership is not easy to come by – and when it happens, there is no guarantee it will last. Nearly half of all marriages in America end in divorce, often with devastating consequences for everyone involved. The ramifications are not easily measured and often manifest themselves long afterwards. Even people who seem able to recover can suffer long-term damages, including to their physical health.
Losing a partner through divorce or death is one of the most extreme forms of stress anyone can go through, according to Dr. Linda Waite, a professor of sociology at the University of Chicago who has conducted several studies on health issues in connection with marriage and divorce.
"People who lose a marriage take such damage to their health," she said in an interview on the subject with CNN. "It's financially, sometimes, ruinous. It's socially extremely difficult. What's interesting is if people have done this and remarried, we still see, in their health, the scars or marks, the damage that was done by this event."
Depression is a common response to the loss of a spouse or partner. So is sleeplessness. Dr. Waite also found that divorced and widowed people tend to suffer in greater numbers from chronic diseases and are overall of poorer health compared to others who have not had the experience, regardless of other factors like age, race, gender, and education.
Even people who haven't ended a relationship but feel ambivalent about their partner seem to have their health affected. A recently published study conducted at the University of Utah found that couples who were unsure about their marriage had on average a higher risk of developing heart disease than their happily married counterparts.
Widowhood, especially at an advanced age, can have even greater implication. According to a study from England, the risk of a heart attack is the highest in the first month after bereavement. The high level of stress caused by the loss of a loved one can result in a depressed immune system, which may add to or aggravate existing health conditions.
The fact is that losing someone who was close to you, whom you shared your life with, and who is now gone is an ongoing stress event. It never really goes away because it is, or at least once was, part of a person's identity. There is a deep void to be filled, and that effort takes time and may never be completed. It can lead to chronic stress with multiple negative side effects, some of which may not easily be identified.
As at all times of heightened stress, it is particularly important in these situations to pay attention to one's health needs and be proactive by taking some extra health-promoting measures. Eating nutritious food is one of those and so is daily exercise. Divorce or bereavement counseling is highly recommended.
Especially when people are at their most vulnerable, they can find it hard to reach out to others and ask for support. Offering a helping hand or just being present in a loving, nonintrusive way can prevent a grieving person from falling into isolation, which is the worst that can happen. Recovery from great loss depends not only on what's happening on the inside but also on someone's chances to rejoin the world of the living.
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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book "The Healthy Diner – How to Eat Right and Still Have Fun"®, which is available on her blog and at amazon.com. For more articles on nutrition, health and lifestyle, visit her blog, "Food and Health with Timi Gustafson R.D." (www.timigustafson.com).


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It's as simple as that February 9, 2010Posted by David Gillespie in technology.
Tags: startups, Twilio, Union Square Ventures
One of the big ideas I'm working on right now is a statement: everything gets easier. It brings together a few chains of thought, but primarily Fred Wilson's notion of life being "end to end digital", and something else I saw summed up brilliantly on Tumblr from Amanda Mooney – it was a John Maeda quote that went as follows:
If there were a prerequisite for the future successful digital creative, it would be the passion for discovery.
The fact is, the future does not belong to the people building walls around complex things in order to keep them complex, it belongs to those who recognise the sooner everyone understands something, the sooner we innovate and get to the next thing, and so sets about trying to demistify that which is currently complex. It belongs to the passionate and curious, wherever they are.
I was reminded of this reading AVC today and seeing Fred Wilson talk about a company called Twilio. From their own site:
Maybe we want a customer to be able to call in and get information, or maybe we need to coordinate our employees more efficiently. Before Twilio, you would have had to learn some foreign telecom programming languages, or set up an entire stack of PBX software to do this. At which point, you'd say "aw, forget it!" Twilio lets you use your existing web development skills, existing code, existing servers, existing databases and existing karma to solve these problems quickly and reliably. We provide the infrastructure, you provide the business logic…and together we rule the world.
That is just a simple example of the kind of application Twilio has, and maybe a telephony app doesn't excite you, which is fine. But the point is important – everything gets easier. This also creates a new ecosystem of value that others can build upon; but that's for another post entirely.
- 1. Richard - August 24, 2010
Love that conecpt, in a world where as humans we tend to make our lives harder than they need be, go with the flow of everything gets easier and so it should!


text:
|40 (单次射击)(《侠盗猎车手:罪恶都市》
30 (单次射击)(《侠盗猎车手:圣安地列斯》
• 50发 (《侠盗猎车手:圣安地列斯》和《侠盗猎车手:中国城风云》
|Vom Feuer (《侠盗猎车手V》)
$4500 (《侠盗猎车手:圣安地列斯》)
|Arms Shortage (GTA III)
Rub Out (GTA Vice City)
Yay Ka-Boom-Boom (GTA San Andreas)
Three Leaf Clover (GTA IV)
The Jewel Store Job (GTA V)
Rank 42 (GTA Online)
- "一把能够实现中程精准打击的步枪。初始容弹量为30,通过升级可以提升至60。"
- ——Rockstar Games Social Club上对于《侠盗猎车手V》中的卡宾步枪的描述。
The Carbine Rifle, also known as M4 or M16 is an Assault Rifle that has been featured in every Grand Theft Auto game since Grand Theft Auto III, except Grand Theft Auto Advance. It is useful in almost any situation, boasting accuracy, power and magazine capacity. In GTA V, it is manufactured by Vom Feuer.
Throughout the games, the models differ slightly, along with zoom capability, rate of fire, and stopping power.
GTA III's rendition has considerably lower quality than its successors, resembling the Armalite AR-10, judging by the handguard and the overall shape. The fact that the AR-10 fires 7.62x51mm ammunition as opposed to the less powerful 5.56x45mm ammo of M4/M16 rifles possibly explains why this weapon was far more powerful per shot than the M4-type rifles of later games, and the 7.62x39mm AK47. This is a rather odd choice, since the AR-10 is a considerably old rifle that was mostly in service in European countries (Such as Germany, Portugal and Italy) during the 50s and the 60s, and is therefore considerably hard to find in America. The weapon has a 60 round magazine, even though the modeled in-game kind looks like a regular 30-round AR magazine.
Vice City's rifle is modeled after a Colt Model 733 but with the front sight facing backwards. It is called 'M4' in-game (Which is anachronistic, as the M4 was not introduced until 1994). Originally, the beta featured an assault rifle that resembled an M16A2, but it was later replaced by the current model. It also appears to have an aftermarket crane stock. The beta rifle's model can still be found in the game files and can be seen in the intro cutscene.
GTA San Andreas reuses the model from Vice City, again called 'M4' in-game (And again inaccurate since the game is set in 1992). In the mission Stowaway, a government agent is shown holding a camouflaged variant of a Colt M16A1. This, however, is never available to use in-game. This was probably a beta model.
In GTA Liberty City Stories, it once again uses the Vice City and San Andreas model. With the game being set in 1998, the name M4 is now used correctly.
Vice City Stories features a rifle resembling the M16A1, named 'Assault Rifle' in-game. It uses a similar model from the previously mentioned San Andreas mission Stowaway, sans the camouflage. Lance Vance again refers to it as an "M4" during a mission, which is an anachronism.
GTA IV features a rifle based on the Colt M4A1, titled 'Carbine Rifle' in-game. This version is accurate both in timeline and overall features, including accurate weapon specs such as rate of fire, magazine size and appearance. Interestingly, the carry handle has been replaced with an aftermarket drum sight. It also has "Property Of Liberty City Arms" stamped where the magazine release is normally found, probably a reference to the "Property Of U.S. Govt" stamped on its real-life counterpart.
GTA Chinatown's rendition is difficult to identify, but it is has a full stock and long barrel, and the triangular hand guard as seen on the HUD suggests it is based on the Colt M16A1. It has, much like in San Andreas, a 50-round magazine.
GTA V's rendition of the Carbine Rifle is based on a mishmash of different AR-15s, featuring almost identical parts (with regards to the lower receiver, especially the magazine well, and also the gas block) that was possibly influenced by the Remington R5 RGP and Heckler & Koch HK416 . The pistol grip seems to be a combination between both Ergo and Hogue grips. The trigger housing is similar to the Magpul Enhanced Trigger Guard. The upper receiver seems to be influenced by the VLTOR MUR-1 upper receiver, with a raised Picatinny rail, similar to the HK416. It also has dual mounted iron sights on the main Picatinny rail. There are also some influences from a Daniel Defense DDM4V7, notably the handguard, which is the Daniel Defense Modular Floating Rail (MFR) 9.0, and complete with an aftermarket buttstock. In the Xbox One, PS4 and PC versions of the game, the Carbine Rifle's textures are much more detailed, having stampings and pins on the receiver that aren't visible on the Xbox 360 and PS3 versions. It is manufactured by the Austrian company Vom Feuer, as seen inscribed in the updated model (which may be again an allusion to HK416 - being an American design produced by a company from a German-speaking country).
The GTA III version of the rifle differs from any other variant for how powerful it is: Featuring an exceptionally high rate of fire and an unrealistic 60 round magazine, it is always a one shot kill against any enemy in any part of the body and can easily destroy most vehicles with a few bursts, making it arguably the most powerful firearm in the game. One might even compare it to the Minigun or the M-60 seen in later games. Similar to the Sniper Rifle and the Rocket Launcher, the rifle can be aimed in first person, resulting in a stationary view with the crosshair on the center of the screen. Despite (or perhaps due to) its power, the Carbine Rifle in GTA III suffers from wild and nearly uncontrollable recoil- even when being aimed in first person.
The M4A1 in GTA Vice City is a much less powerful rifle than its GTA III predecessor, and despite still being a one-shot kill in nearly all occasions, it now features a slower rate of fire and a 30-round magazine. On the other hand, the recoil is also much lower this time around, making it useful for more precise shots. Like in GTA III, it can also be aimed in first person.
The GTA San Andreas version has an even lower rate of fire than unusual for an assault rifle, and it also has considerably less power, now only being a one-shot kill weapon if aimed at the head. Even though, it is still highly effective, featuring a 50-round STANAG magazine and a smaller crosshair than that of the AK-47, making it useful for more precise and accurate shots. It is nearly recoiless compared to the AK-47 and has a 20 meter range advantage over it. The M4 is outranged only by the Country Rifle and the Sniper Rifle. It doesn't feature a first person aiming mode like its predecessors did, and neither do any of the following games have it.
The rifle in GTA Liberty City Stories and Vice City Stories is closer to its Vice City version, having a similar rate of fire and being a one-shot kill against most enemies. It also features a 30-round magazine in both games.
In Grand Theft Auto IV, the performance of the Carbine Rifle is stellar. Accuracy and fire rate are both high, along with damage. It is highly effective in close to mid range, with accuracy dropping off at long range. Accuracy is even higher when crouched, allowing the player to fire it on fully automatic while being able to reliably hit targets. It has the longest range of any non-sniper weapon in the game. It's not as powerful as the AK-47, but its precision and fire rate still make it nonetheless one of the best rifles in the game.
The Chinatown Wars version is incredibly powerful, being almost comparable to the one present in GTA III, with a few bursts being enough to easily kill an enemy and destroy a vehicle. Its fire rate is also exceptionally fast, being able to quickly empty its 50-round magazine.
In Grand Theft Auto V, the Carbine Rifle is superior and all-round to SMGs, and is more accurate but less powerful than the Advanced Rifle along with the quick rate of fire which makes the ammo decrease quickly. Still, it is a very accurate weapon that can be relied on for any situation.
|Rounds & magazine
|GTA Online (Unlock)
|Rounds (60)
|Default clip (30 rounds)
|Default (Rank 42)
|Extended clip (60 rounds)
|Grip (more stability, slightly increases accuracy)
|Flashlight (provides ilumination when aiming)
|Scope (mid-range zoom, slightly increases accuracy)
|Suppressor (silences but slightly reduces damage and range)
|Default (Rank 42)
|$5000 (Kill 100 players)
|Green (Collector's Edition and Enhanced Edition Exclusive)
|$7500 (Kill 200 players)
|Orange (Collector's Edition and Enhanced Edition Exclusive)
|$? (Kill 400 players)
|$5750 (Kill 600 players)
|Pink (Collector's Edition and Enhanced Edition Exclusive)
|$7500 (Rank 50)
|Gold (Collector's Edition and Enhanced Edition Exclusive)
|$10000 (Rank 75)
|Platinum (Collector's Edition and Enhanced Edition Exclusive)
|$12500 (Rank 100)
游戏中的表现 编辑
在《侠盗猎车手:罪恶都市》中,它出现于任务"Rub Out",被汤米和兰斯用于杀死迪亚兹。该任务过后,这个武器可以在Downtown的Ammu-Nation购买。在任务"Cop Land"中也有出现。在Fort Baxter Air Base中也有士兵使用该类武器。
Grand Theft Auto: San Andreas编辑
In Grand Theft Auto: San Andreas, the M4 is used by the army at a six star wanted level, during Black Project, Up, Up and Away! and Vertical Bird, and by the Ballas (3D Universe) during End of the Line.
Grand Theft Auto: Liberty City Stories编辑
It is a very rare weapon during the course of Grand Theft Auto: Liberty City Stories, being used only by Forelli Family hitmen in Love on the Rocks, Kazuki's guards in Cash in Kazuki's Chips , and by Massimo's guards in The Sicilian Gambit.
Grand Theft Auto: Vice City Stories编辑
In Grand Theft Auto: Vice City Stories, it is used in various missions (most notably when Lance uses it in Blitzkrieg Strikes Again), and can be bought at Ammu-Nation upon unlocking Ocean Beach following From Zero to Hero. Soldiers at Fort Baxter Air Base can once again be seen wielding the rifle.
Grand Theft Auto IV编辑
In GTA IV, the Carbine Rifle is given during Three Leaf Clover and is available to purchase afterwards. Niko uses it during the Ballad of Gay Tony mission, Ladies Half Price, provided if players choose to go back to the ambush and kill him and Packie. NOOSE Officers will attack the player if they have a wanted level of three stars or higher.
Grand Theft Auto V编辑
In GTA V, the Carbine is the first weapon to be used in the game, being used by Michael and Trevor during the prologue. If the Loud and Dumb approach is used during The Jewel Store Job, the Carbine will be used during the heist, fitted with a suppressor. During the Aztecas' attack on Trevor's meth lab, Trevor and Chef use the Carbine to hold off their attackers. In the events of The Wrap Up, FIB agents will also be seen using the Carbine during the intro cutscene and during gameplay. Merryweather mercenaries will also use the Carbine against the player during their mission appearances. As with GTA IV, NOOSE officers will use the Carbine against the player during a wanted level of three stars or higher.
In-Game models编辑
HUD icons编辑
First Person编辑
Grand Theft Auto III编辑
- Rockford, Staunton Island - Available to buy from Phil Cassidy's Army Surplus after completion of Arms Shortage.
- Bedford Point, Staunton Island - In the walled off area in the southeast part of the Liberty Tree Offices, where the mission Kingdom Come takes place. (Use the nearby Moonbeam, park it by the lowest part of the wall, climb the Moonbeam, and jump over the wall to access).
- Cedar Grove, Shoreside Vale - On the back porch of the pink house (fourth from the west) at The Homes.
- Cochrane Dam, Shoreside Vale - Near the top of the stairs for the west dam platform (not the top of the Cochrane Dam power house) at the base of the Cochrane Dam.
- Delivered to safehouses after collecting 90 Hidden Packages.
Grand Theft Auto: Vice City编辑
- Prawn Island - In Studio B (behind the moon lander) at the InterGlobal Films complex.
- Starfish Island - In the small room at the bottom of the Vercetti Estate's stairwell east of the main entrance after the completion of Rub Out.
- Downtown - Available to buy from Ammu-Nation after completion of Rub Out ($5,000).
- Little Haiti - In the middle of a cluster of shacks in the center of the North Haitian Neighborhood (just south of Auntie Poulet's house behind the house with the Voodoo in front).
- Little Havana - At the west side of the red and white building directly across the street west of Cafe Robina (where Tommy took Phil to during Boomshine Saigon).
- Fort Baxter - Wasting some of the Soldiers will give a decent amount of M4 ammo.
Grand Theft Auto: San Andreas编辑
- Los Santos International Airport, Los Santos - Next to the runway, there are three white and yellow striped "ramps". Between those which are placed at the end of the runway is a Carbine Rifle.
- Palisades, San Fierro - Behind the northernmost house next to the beach.
- Area 69, Bone County - Behind a staircase leading to a control tower, southwest side.
- Pilgrim, Las Venturas - On the roof of the hotel.
- The Four Dragons Casino, Las Venturas - In front of the casino if all 50 Horseshoes are collected.
- Easily acquired from dead soldiers.
Grand Theft Auto: Liberty City Stories编辑
- Newport, Staunton Island - Among the containers at the docks and east of an unique stunt jump. It's located between the containers that are placed towards the Big Shot Casino.
- Bedford Point, Staunton Island - Available to purchase from Phil Cassidy's Fully Cocked Gun Shop for $5,400 once the player beats the mission "Friggin' the Riggin'".
- Available at each safehouses after collecting 60 hidden packages.
Grand Theft Auto: Vice City Stories编辑
- Vice Point - Behind the building next to northernmost empire site.
- Vice Point Mall, Vice Point - Available to buy from Ammu-Nation for $5,400 but the price is decreased to $4,050 when the player beats Phil's Shooting Range.
- Fort Baxter - Killing soldiers will make them drop their weapons.
Grand Theft Auto IV编辑
It can be purchased from the back-alley gun shops for $5,000 and each additional magazine will cost $100. It can be purchased from Little Jacob for $3,500 with each additional magazine costing $70. The Carbine Rifle can also be acquired from NOOSE Tactical Response Unit Officers, FIB Agents and certain LCPD Officers, specifically those who guard places of high security such as The Statue of Happiness, Francis International Airport and the roadblocks on bridges (before Three Leaf Clover).
- Industrial - Can be found in one of the offices inside the abandoned warehouse where the player rescues Roman from the mission Hostile Negotiation.
- Algonquin Bridge - Can be found atop the roof of the Pedestrian Walkway on the Algonquin side, from the subway tunnel entrance.
- Easton - Can be found well-hidden behind some trash cans on the east side of Grand Easton Terminal. The trash cans can be reached quickly through an alley on Jade St.
- Leftwood - Can be found underneath the pier where the strip mall is situated off Beaverhead Avenue. The strip mall can be seen from the cliff where Niko executes Aiden O'Malley during the mission Tunnel Of Death.
- Tudor - Can be found in a small loading dock area on the north side of the old Sprunk factory.
- Tudor - Can be found atop the northern superstructure of the old rail bridge that spans the river which divides Tudor and the Acter Industrial Park.
Grand Theft Auto: Chinatown Wars编辑
- Available in Ammu-Nation after the Fully-Crocked Upgrade is purchased.
Grand Theft Auto V编辑
- Can be bought at Ammu-Nation after completing The Jewel Store Job, for $2,100.
- After entering and exiting a Park Ranger SUV the player will get 30 Rounds.
- Can be acquired when killing NOOSE, Army or LSPD officers carrying the weapon.
- Going to the Army Base and killing the two soldiers at the gate.
- Killing the 2 LSPD officers equipped with the Carbine Rifle at the airport.
Grand Theft Auto Online编辑
- It can be bought at Ammu-Nation at level 42.
- May spawn during Merryweather Gang Attacks both as weapon pickups and being used by Merryweather.
- Alternatively it can be obtained for free by going to the Army Base and killing members of the military, or by visiting the airport in South Los Santos from some police officers (To keep the rifle after leaving a lobby you are required to be level 42, as if you don't meet that requirement you will lose it once you leave).
- Spawns at waves 4+ during a Survival, and common among enemies at higher levels.
- The name "Carbine Rifle" is a contradiction in terms, as "carbine" and "rifle" represent two mutually-exclusive categories. A carbine is a firearm with a barrel length shorter than a rifle's or musket's, but longer than a pistol's.
- The GTA V version appears to be heavily based on the Heckler & Koch HK416 model D10RS.
3D Universe编辑
- In the PlayStation 2 version of Grand Theft Auto III, the AR10 has a green aiming cursor, but in the PC, Xbox and mobile versions of the game, the green cursor is replaced by a circle and a dot.
- In San Andreas and Vice City, the Colt 733 has the front sight facing backwards and the stock is modeled differently.
HD Universe编辑
- Strangely, the M4 in Grand Theft Auto IV has two reload animations. When Niko is standing while reloading, he will pull the charging handle, but when crouching while reloading, he takes "out" the magazine, puts "another" in and pulls the charging handle. There is no confirmed reason for why there are two reload animations, but it is speculated that it is for balancing reasons, as the player is much more effective while crouched. This oddity is also present on the AK-47 and the Assault Shotgun.
- In GTA IV, the bottom of the Carbine Rifle's magazine is stamped with the words "Stop Chillin' Start Killin'".
- There are a few artworks of Michael holding an M4 CQBR with an M68 CCO red dot sight and sound supressor. However, said weapon never appears in-game.
- In GTA V, when customized with a scope attachment, the iron sights are not removed or flipped down; this is highly impractical as the iron sights would obstruct the viewing field of the scope. This is most likely an oversight by Rockstar. In the updated GTA V for next gen consoles, the sights are correctly flipped down, but only in first person view.
- Adding the suppressor to the Carbine Rifle in GTA V seems to convert the barrel into an integral suppressor. Slightly reminiscent of the AAC Honey Badger assault rifle, which is also an M4 variant that has an integral suppressor.