text:
One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response
- Petch Wacharasint1,
- John H Boyd1,
- James A Russell1 and
- Keith R Walley1Email author
DOI: 10.1186/cc12794
© Wacharasint et al.; licensee BioMed Central Ltd. 2013
Received: 21 January 2013
Accepted: 20 June 2013
Published: 20 June 2013
Obesity is an increasingly common comorbidity in critically ill patients. Whether obesity alters sepsis outcome, susceptibility, treatment, and response is not completely understood.
We conducted a retrospective analysis comparing three group of septic shock patients based on the intervals of actual body mass index (BMI) in patients enrolled in the VASST (Vasopressin and Septic Shock Trial) cohort. Primary outcome measurement was 28-day mortality. We tested for differences in patterns of infection by comparing the primary site of infection and organism. We also compared the treatments (fluids and vasopressors) and inflammatory response, measuring adipose tissue-related cytokine concentrations (interleukin [IL]-6, monocyte chemotactic protein [MCP]-1, tumor necrosis factor [TNF]-α, and resistin) in plasma in a subset of 382 patients. Of the 778 patients in VASST, 730 patients who had body weight and height measurements were analyzed. Patients with BMI <25 kg/m2 (n = 276) were grouped as a reference and compared to 'overweight' (25< BMI <30 kg/m2, n = 209) and 'obese' (BMI > 30 kg/m2,n = 245) patients.
Obese patients had the lowest 28-day mortality followed by overweight patients while patients with BMI <25 kg/m2 had the highest mortality (p = 0.02). Compared to the patients with BMI <25 kg/m2, obese and overweight patients also had a different pattern of infection with less lung (obese 35%, overweight 45%, BMI<25 kg/m2 50%, p = 0.003) and fungal infection (obese 8.2%, overweight 11%, and BMI<25 kg/m2 15.6%, p = 0.03). Per kilogram, obese and overweight patients received less fluid during the first four days (p<0.05) and received less norepinephrine (obese 0.14, overweight 0.21, BMI <25 kg/m2 0.26 µg/kg/min, p<0.0001) and vasopressin (obese 0.28, overweight 0.36, BMI <25 kg/m2 0.43 µU/kg/min, p<0.0001) on day 1 compared to patients with BMI <25 kg/m2. Obese and overweight patients also had a lower plasma IL-6 concentration at baseline (obese 106 [IQR 34-686], overweight 190 [IQR 44-2339], BMI <25 kg/m2 235 [IQR 44-1793] pg/mL, p = 0.046).
Overall obesity was associated with improved survival in septic shock and differences in pattern of infection, fluids, and vasopressors. Importantly, the magnitude of inflammatory IL-6 response is muted in the obese.
Obesity is a major health problem and is the sixth most important risk factor contributing to overall burden of disease worldwide [1]. Acute infection coupled with the immune response (sepsis) has been linked in multiple ways to obesity [2, 3]. Obese patients were over-represented among those with serious lung injury requiring life support during the H1N1 viral pandemic [3, 4], and the risk of wound infections is increased in the obese following major surgery [5]. It has also been suggested that obesity itself is a chronic inflammatory condition with increased circulating pro-inflammatory cytokines at rest [6, 7]. Despite the apparent risk factors associated with obesity, it appears that in small case series obese critically ill patients, the majority of whom have severe infection, may fare better than those of normal weight [8, 9]. Whether there is a true relationship between obesity and sepsis-induced morbidity and mortality remains unclear [10, 11].
We conducted a retrospective analysis of the Vasopressin and Septic Shock Trial (VASST) [12] to help determine whether being overweight or obese altered (a) mortality and organ dysfunction outcomes of sepsis, (b) pattern of susceptibility to infection, (c) treatment received by patients, or (d) the inflammatory response to sepsis. To explore an inflammatory response of obese and overweight, compared with lean patients, during the initial phase of septic shock, it is well known that adipose tissues produce and release a number of pro-inflammatory mediators, including cytokines and chemokines, such as interleukin-6 (IL-6) [6, 13], monocyte chemotactic protein-1 (MCP-1) [14], and tumor necrosis factor-alpha (TNF-α) [15], as well as the adipokine resistin [16]. Therefore, we assayed these cytokines at study enrollment in convenience samples of patients with septic shock in our cohort.
Materials and methods
We conducted a retrospective analysis in patients enrolled in a cohort of septic shock, the VASST. The VASST is a multicenter, randomized, double-blind, controlled trial evaluating the efficacy of vasopressin versus norepinephrine on mortality in 778 patients with septic shock [12]. Septic shock was defined by the presence of two or more diagnostic criteria for systemic inflammatory response syndrome (SIRS), proven or suspected infection, at least one new organ dysfunction by Brussels criteria, and hypotension despite adequate fluid resuscitation [17, 18]. Of these, 730 patients had body weight and height measured at the time of enrollment of the VASST (typically about 11 hours after they first developed septic shock), and body mass index (BMI) was calculated as weight (in kilograms) divided by height (in meters) squared. Since our cohort had a small number of underweight (BMI of less than 18.5 kg/m2, n = 26) patients and these patients had similar outcomes in crude analysis compared with patients classified as normal BMI (18.5 to 24.9 kg/m2, n = 250), we used a modified form of the BMI categories endorsed by the National Institutes of Health [19], in which subjects with a BMI of less than 25 kg/m2 were grouped together (n = 276) and were compared with 209 patients classified as overweight (BMI 25 to 29.9 kg/m2) and 245 patients classified as obese (BMI of at least 30 kg/m2). The VASST protocol was approved by the research ethics boards of all participating centers, and written informed consent was obtained from all patients or their relatives. The institutional review board for the VASST is the University of British Columbia-Providence Health Care (UBC-PHC) Research Ethics Board, and the approval number is H06-50080.
Baseline clinical phenotype measurements
Baseline characteristics of the patients were measured at study enrollment and included age, gender, and pre-existing conditions identified on the basis of patients' medical history. Hemodynamic variables (mean arterial pressure, central venous pressure (CVP), and heart rate), tidal volume (in patients who received mechanical ventilation at study enrollment; BMI of less than 25 kg/m2n = 172, overweight n = 143, and obese n = 160), and baseline laboratory variables (lactate, creatinine, white blood cell count, and platelet count) were also measured.
Outcome measurements
Our primary outcome measurement was 28-day mortality. Secondary outcomes were organ dysfunctions as previously described [20]. To assess organ dysfunction and to correct organ dysfunction scoring for deaths in the 28-day observation period, we calculated days alive and free of organ dysfunction. During each 24-hour period (8 a.m. to 8 a.m.) for each variable, days alive and free was scored as 1 if the patient was alive and free of organ dysfunction (normal or mild dysfunction using the Brussels criteria [18]). Days alive and free was scored as 0 if the patient had organ dysfunction (moderate or worse) or was not alive. Every day over the 28-day observation after intensive care unit (ICU) admission was scored in this way. Thus, the lowest score possible for each variable was 0 and the highest score possible was 28. A low score indicates more organ dysfunction, whereas a high score indicates less organ dysfunction.
Pattern of infection
Infection was defined as culture positivity that was judged by the attending clinician of each study site to be an infection rather than just colonization. Pathogens were identified by the culture from the primary site of infection.
The amount of infused fluid is associated with hospital outcome [21, 22]; therefore, we also tested for differences in the amount of fluid intake, output, and accumulated net fluid balance during the first four days after ICU admission (or study enrollment). We also tested for differences in infusion rates of vasopressor medications, which, in this study, were primarily norepinephrine and vasopressin. We measured serum vasopressin levels in the overweight and obese patients receiving vasopressin infusion and compared that vasopressin level with that of patients with a BMI of less than 25 kg/m2. Of 396 patients in the vasopressin treatment group, 54 patients had measurement of serum vasopressin level over time (baseline and 6, 24, and 72 hours) and received vasopressin infusion. Of these, 46 patients had BMI measurements and were classified as having a BMI of less than 25 kg/m2 (n = 17) or being overweight (n = 13) or obese (n = 16) and were included in this analysis. The protocol for serum vasopressin level measurement was previously described [12].
Inflammatory cytokine response
We assayed cytokines that have also been related to adipose tissue, including IL-6 [12], MCP-1 [13], TNF-α [14], and resistin [15], in 138 patients with a BMI of less than 25 kg/m2, 112 overweight patients, and 132 obese patients at enrollment. Briefly, whole-blood samples were drawn into chilled 7-mL EDTA Vacutainer tubes (BD, Mississauga, ON, Canada), put on ice immediately, and spun at 3,000 revolutions per minute for 15 minutes and then plasma was collected and stored at −70°C until further use [12]. Human 39-plex kits (EMD Millipore, Billerica, MA, USA) were used in accordance with the recommendations of the manufacturer with modifications as described below. Briefly, samples were mixed with antibody-linked magnetic beads on a 96-well plate and incubated overnight at 4°C with shaking. Plates were washed twice with wash buffer in a BioTek ELx405 washer (BioTek, Winooski, VT, USA). After 1-hour incubation at room temperature with biotinylated detection antibody, streptavidin-phycoerythrin was added for 30 minutes with shaking. Plates were washed as above, and phosphate-buffered saline was added to wells for reading by using a Luminex 200 (Illumina Inc., San Diego, CA, USA) with a lower bound of 100 beads per sample per cytokine. Each sample was measured in duplicate.
Statistical analysis
We tested for the differences in baseline characteristics between the three groups of patients (obese, overweight, and patients with a BMI of less than 25 kg/m2) by using a Kruskal-Wallis test for continuous data or a chi-square test for categorical data, and we report the median and interquartile range (IQR). We evaluated the primary outcome variable (28-day mortality) by using log-rank (Mantel-Cox) test to compare Kaplan-Meier curves for patients with a BMI of less than 25 kg/m2, overweight patients, and obese patients. The risk of 28-day hospital mortality was expressed as hazard ratio (HR) with 95% confidence interval (CI). We tested for the influence of covariates, including APACHE II (Acute Physiology and Chronic Health Evaluation II) score, gender, diabetes history, lung infection, fungal infection, and BMI by using Cox regression analysis. Secondary clinical outcomes were days alive and free of organ dysfunction (including cardiovascular, respiratory, renal, hepatic, neurologic, and coagulation), days alive and free of SIRS (two of four SIRS criteria), and days alive and free of artificial organ support (including mechanical ventilation and hemodialysis). We tested for differences in the site of infection and the frequency of Gram-positive, Gram-negative, or fungal infection by using a chi-square test. We tested for differences in fluid amount and vasopressor administration dosages by using a Kruskal-Wallis test. We tested for differences in the vasopressin concentration over time by using one-way repeated-measures analysis of variance, and we report the mean and standard error of the mean. Serum cytokine concentrations of three patient groups were analyzed by using a Kruskal-Wallis test, and we report the median and IQR. Differences were considered significant by using a two-tailed P value of less than 0.05. Analyses were performed by using SPSS (version 17.0; IBM Corporation, Armonk, NY, USA) statistical software packages.
Baseline characteristics
Baseline characteristics compared on the basis of actual body mass index category in three groups of patients with septic shock
Baseline characteristics
Actual body mass indexa category, kg/m2
P value
(n = 276)
BMI 25 to <30
(n = 209)
(n = 245)
Age, years
63 (48-74)
64 (50-73)
63 (53-72)
Gender: Male, number (percentage)
171 (62)
142 (67.9)
136 (55.5)
Race: Caucasian, number (percentage)
231 (83.7)
177 (84.7)
209 (85.3)
Body mass indexa, kg/m2
23 (20-24)
28 (26-29)
34 (32-39)
Severity of illness
APACHE II score
27 (21-32)
26 (22-31)
27 (23-32)
Surgical condition, number (percentage)
52 (18.8)
45 (21.5)
58 (23.7)
In-hospital steroid treatment, number (percentage)
211 (76.7)
167 (79.9)
172 (70.8)
Pre-existing conditions, number (percentage)
Chronic obstructive pulmonary disease
44 (15.9)
31 (14.8)
41 (16.7)
Congestive heart failure
19 (6.9)
14 (6.7)
22 (9.0)
Chronic liver disease
27 (9.8)
30 (14.4)
26 (10.6)
Chronic renal failure
29 (10.5)
24 (11.5)
27 (11)
41 (14.9)
43 (20.6)
73 (29.8)
Ischemic heart disease
40 (15.4)
38 (20)
50 (21.8)
Chronic steroid use
67 (24.3)
42 (20.1)
51 (20.8)
Hemodynamic variables at day 1
Central venous pressure, mm Hg
14 (10-17)
14 (11-18)
15 (12-18)
Mean arterial pressure, mm Hg
55 (50-60)
56 (51-61)
55 (49-61)
Heart rate, beats per minute
130 (115-144)
125 (112-140)
125 (106-140)
Mechanical ventilation variables at day 1
Tidal volume, mL
530 (450-630)
570 (480-650)
571 (490-650)
Tidal volume, mL/kg of PBWc
8.3 (7.0-9.7)
8.8 (7.4-10.3)
9.3 (7.9-10.8)
Laboratory variables at day 1
White blood cells, x103/mm3
14.5 (6.7-21.8)
13.1 (8.0-19.2)
12.8 (7.4-20.2)
Platelets, x103/mm3
145 (55-256)
144 (72-232)
165 (90.5-254.5)
Creatinine, µmol/L
130 (80-218)
150 (104-266)
191 (120-297)
GFR, mL/minute
44 (26-76)
45 (25-72)
47 (29-77)
Lactate, mmol/L
2.0 (1.2-4.2)
2.1 (0.9-3.8)
1.7 (1.1-3.5)
180 (120-255)
182 (123-255)
190 (135-259)
Obese and overweight patients with septic shock have lower 28-day mortality and less organ dysfunction than patients with a BMI of less than 25 kg/m2 despite similar severity at presentation
Hazard ratio of 28-day mortality in patients with septic shock
Hazard ratio
95% confidence interval
P value
APACHE II score (per score)
Lung infection
Fungal infection
BMI (per score)
Pattern of infection
Pattern of infection of patients with septic shock
Actual body mass index category, kg/m2
P value
(n = 276)
BMI 25 to <30
(n = 209)
(n = 245)
Primary source of infection, number (percentage)
137 (49.8)
94 (45)
85 (35)
69 (25.1)
54 (25.8)
73 (30)
10 (3.6)
11 (5.3)
13 (5.3)
13 (4.7)
14 (6.7)
16 (6.6)
17 (6.2)
14 (6.7)
26 (10.7)
23 (8.4)
21 (10)
25 (10.3)
Pathogen type in cultures, number (percentage)
81 (29.5)
53 (25.4)
81 (33.3)
68 (24.7)
52 (24.9)
46 (18.9)
43 (15.6)
23 (11)
20 (8.2)
Obese and overweight patients receive less intravenous fluids and vasopressors than patients with a BMI of less than 25 kg/m2
Fluid administration during the first four days after septic shock
Amount of fluid, mL
Amount of fluid per body weight, mL/kg
(n = 276)
BMI 25 to <30
(n = 209
(n = 245)
P value
(n = 276)
BMI 25 to <30
(n = 209)
(n = 245)
P value
Predicted body weighta, kg
67 ± 2.1
64 ± 0.7
61 ± 1.0
Day 1
11,000 ± 310
10,500 ± 360
10,500 ± 310
180 ± 5
130 ± 5
100 ± 3
4,100 ± 200
3,900 ± 240
3,900 ± 190
60 ± 3
50 ± 3
40 ± 2
Net accumulated balance
7,000 ± 330
6,600 ± 360
6,700 ± 330
110 ± 5
84 ± 5
70 ± 3
Day 2
16,000 ± 420
15,200 ± 500
15,400 ± 420
250 ± 7
190 ± 6
150 ± 5
6,500 ± 270
6,400 ± 320
6,400 ± 290
100 ± 5
80 ± 4
60 ± 3
Net accumulated balance
9,500 ± 430
8,800 ± 490
9,000 ± 460
150 ± 7
110 ± 6
90 ± 5
Day 3
19,900 ± 520
19,000 ± 600
19,400 ± 510
320 ± 9
240 ± 8
190 ± 5
9,100 ± 360
8,900 ± 410
9,300 ± 410
140 ± 6
110 ± 5
90 ± 4
Net accumulated balance
10,800 ± 490
10,200 ± 580
10,200 ± 540
170 ± 8
130 ± 7
100 ± 5
Day 4
23,600 ± 590
23,000 ± 710
23,300 ± 590
380 ± 10
290 ± 9
230 ± 7
12,000 ± 430
12,300 ± 530
12,600 ± 530
190 ± 7
160 ± 7
120 ± 6
Net accumulated balance
11,700 ± 540
10,700 ± 660
10,700 ± 600
190 ± 9
140 ± 8
110 ± 6
IL-6 levels of obese and overweight patients are muted compared with those of patients with a BMI of less than 25 kg/m2
There was no significant difference in body temperature (obese 38.6, IQR 37.8 to 39.4; overweight 38.5, IQR 37.8 to 39.1; BMI of less than 25 kg/m2 38.4, IQR 37.5 to 39.1°C; P = 0.053), platelet count (obese 165,000, IQR 90,500 to 254,500; overweight 144,000, IQR 72,000 to 232,000; BMI of less than 25 kg/m2 145,000, IQR 55,000 to 256,000/mm3; P = 0.13), and white blood cell count (obese 12,800, IQR 7,400 to 20,200; overweight 13,100, IQR 8,000 to 19,200; BMI of less than 25 kg/m2 14,500, IQR 6,700 to 21,800/mm3; P = 0.72) between groups.
Our major finding was that despite equal severity of illness upon presentation, mortality in obese and overweight patients was significantly lower than in patients with a BMI of less than 25 kg/m2 (Figure 1). Compared with those with a BMI of less than 25 kg/m2, obese and overweight patients had less frequent lung and fungal infections as the site and organism causing septic shock. We also found that obese and overweight patients were treated differently, in what appeared to be a 'one size fits all' non-weight-adjusted dosing, so that obese and overweight patients received less fluids and vasopressors per kilogram (norepinephrine and vasopressin) than patients with a BMI of less than 25 kg/m2. Unlike previous reports of obesity augmenting the inflammatory response [6, 7, 13], we found that the IL-6 inflammatory response was muted in overweight and obese patients compared with those with a BMI of less than 25 kg/m2 in early septic shock. This surprising result is novel and consistent with current and previous reports of improved survival outcomes in obese patients [8, 9].
Conceivably, the inclusion of very underweight or very overweight patients could alter this analysis and interpretation. We removed the underweight group (n = 26) and re-analyzed for mortality difference and found the same significant result in which obese patients had the lowest 28-day mortality followed by overweight and normal-BMI patients. A similar post hoc analysis of the morbidly obese (BMI ≥40 kg/m2) showed that this group had a lower 28-day mortality than all other weight groups, consistent with a previous report by Abhyankar and colleagues [26]. We also found that despite a higher prevalence of diabetes, those with obesity had a decreased risk of hospital mortality. Covariate adjustment of diabetes appeared to augment this protection for the obese. We found that BMI was an independent predictor of lower mortality with an HR of 0.98 per kg/m2 (95% CI 0.97 to 0.99, P = 0.041), suggesting that although diabetics had a poorer prognosis, diabetes itself had a weaker association with mortality than BMI (Table 2). Our results are in agreement with data from the Acute Decompensated Heart Failure National Registry, which studied patients with acute heart failure and found that hospital mortality rates decreased in a near-linear fashion across higher BMI. For every 5-unit increase in BMI, the odds of risk-adjusted mortality were 10% lower (95% CI 0.88 to 0.93, P <0.0001) [10]. Our findings also align with a meta-analysis in critically ill patients which demonstrated that patients who were obese (had a BMI of 30 to 39.9 kg/m2) had significantly lower mortality compared with the non-obese patients (BMI of less than 30 kg/m2) (relative risk 0.86, 95% CI 0.81 to 0.91; P <0.001) [11].
Previous studies demonstrate that low tidal volume ventilation is associated with a lower mortality [23], which might have contributed to our findings. However, we found the opposite. Obese and overweight patients received higher tidal volume ventilation compared with patients with a BMI of less than 25 kg/m2, particularly when corrected to predicted body weight (Table 1).
Although our data do not allow us to determine whether there was an absolute difference in susceptibility to infection (since we would need to know the number of obese and non-obese patients at risk), we did observe a substantial difference in pattern of infection. We observed a large and significant reduction in the fraction of patients having lung infections and the fraction of patients having fungal infections in obese patients. One possible limitation to this finding is that, in this patient cohort, the diagnosis of lung infection was based primarily on physician judgment, which depended on results from chest radiographs and sputum culture. This could have been confounded by the increasing inability to obtain clear or definitive chest radiographs in obese patients. Although there was no statistically significant difference in white blood cell counts or a baseline difference in immunosuppression or chronic steroid use, we did find that obese and overweight patients expressed significantly lower plasma IL-6 levels during the initial phase of septic shock compared with those with a BMI of less than 25 kg/m2. This is in agreement with a study of patients with blunt injury which found that obese patients had a significantly lower inflammatory cytokine profile than those with a normal BMI [27]. Why obese patients have an altered IL-6 inflammatory response is not known. However, the finding of decreased circulating IL-6 concentrations in obese patients with sepsis is consistent with the observation of improved survival outcome. We also measured resistin, an adipokine that antagonizes the effects of insulin [16] and that functions as a pro-inflammatory cytokine [28]. Unlike in stable obese patients in whom resistin levels are much higher than those with a normal BMI, we found no significant difference between obese and normal-BMI patients in early septic shock.
Unlike in most medical therapies which rely upon weight-based dosing, we hypothesized that the empirical manner (1 L of fluid at a time mentality) in which fluid and vasopressor therapy are recommended for sepsis [22, 24] would cause obese and overweight patients to receive relatively less weight-adjusted fluids and vasopressors than normal-BMI patients. Alternatively, the treating physicians may have recognized that blood volume is not linearly related to weight [29, 30] and, therefore, may have followed the current Surviving Sepsis Campaign guidelines that suggest that fluid administration be based on ideal body weight, which did not differ between the three groups in this study (Table 4). Indeed, obese and overweight patients received less body weight-adjusted fluids, norepinephrine, and vasopressin in early septic shock compared with the patients with a BMI of less than 25 kg/m2. As excessive fluid and vasopressor resuscitation is associated with increased mortality [21, 22], it may be that using doses more typically used for smaller individuals was, ironically, protective. To directly assess whether this was the case, we measured vasopressin levels in patients randomly assigned to receive this drug in the protocolized non-body weight-adjusted dose used in the VASST. We found that, compared with those with a BMI of less than 25 kg/m2, obese and overweight patients had a trend toward lower serum vasopressin concentrations after 24 hours of vasopressin infusion. The net accumulated fluid balance differs by only 1 L between patients of normal weight and obese patients. It could be argued that this small difference is unlikely to account for the observed outcome differences. However, indexed to body mass, this amounts to a difference of 80 mL/kg, a remarkable difference that conceivably could be related to outcomes. In addition, although there was a statistically significant difference in CVP values between the three patient groups, which was possibly due to differences in chest wall compliance in the obese compared with the normal-BMI patients, the clinical significance of this small difference is uncertain.
The strengths of this study are, first, that our cohort is a large prospective multicenter cohort of patients with well-defined septic shock [12]. Second, our results after covariate-adjusted and unadjusted analyses were consistent.
There are several important limitations to our study. APACHE II score has never been validated in obese patients. For example, oxygenation may be worsening despite normal lung function or creatinine level may be increased despite normal kidney function. Thus, obese patients may have artificially elevated APACHE II scores. However, there was no difference of serum lactate levels between the three patient groups at enrollment. Because our analysis was retrospective, some additional useful data such as coexisting hypertension, serum cholesterol, or other serum adipokines such as leptin and adiponectin which regulate insulin sensitivity were not recorded in the dataset. In addition, adipose tissue-related cytokines in our analysis are released not only from adipose tissue but also from other tissues and this could affect our interpretation. Also, our study may represent not the 'real' population of obese patients with sepsis but only an obese population included in a randomized controlled study with a strict inclusion criteria.
We demonstrated that, in a cohort of patients with septic shock, the obese and overweight patients had decreased mortality compared with patients with a BMI of less than 25 kg/m2. Obese and overweight patients may have had less aggressive disease, as shown by our evaluations of blunted host inflammatory response to pathogens (lower IL-6), and an altered pattern of infection (less frequent lung and fungal infection). Obese and overweight patients may also have been protected by receiving less fluids and vasopressors compared with the patients with a BMI of less than 25 kg/m2.
Key messages
In septic shock, the obese and overweight patients had decreased mortality compared with patients with a BMI of less than 25 kg/m2.
Compared with patients with a BMI of less than 25 kg/m2, obese and overweight patients with sepsis had a lower rate of lung infection as the source of their severe sepsis as well as fewer fungal infections.
In septic shock, the obese and overweight patients receive less intravenous fluids and vasopressors per kilogram than patients with a BMI of less than 25 kg/m2.
At the initial phase of septic shock, plasma IL-6 concentrations in obese and overweight patients are muted compared with those of patients with a BMI of less than 25 kg/m2.
Acute Physiology and Chronic Health Evaluation II
body mass index
confidence interval
central venous pressure
hazard ratio
intensive care unit
interquartile range
monocyte chemotactic protein-1
systemic inflammatory response syndrome
- TNF-α:
tumor necrosis factor-alpha
Vasopressin and Septic Shock Trial.
The following institutions participated in the VASST, which was funded by Canadian Institutes of Health Research: Canada - British Columbia: St. Paul's Hospital, Vancouver General Hospital, Royal Jubilee Hospital, Kelowna General Hospital, Richmond General Hospital, Royal Columbian Hospital, Manitoba: St. Boniface Hospital, Winnipeg Health Science Centre, Ontario: Ottawa Hospital, General Campus, University Health NetworkToronto General & Toronto Western Hospitals, St. Joseph's Hospital, Mount Sinai Hospital, Ottawa Hospital, Civic Campus, St. Michael's Hospital, Sunnybrook and Women's College Health Science Centre, Hamilton Health Sciences Centre, London Health Sciences Centre, Sudbury Regional Hospital, Charles LeMoyne Hospital, Hôtel-Dieu Grace Hospital. Australia - Victoria: Alfred Hospital, Royal Melbourne Hospital, Monash Medical Centre, Western Australia: Royal Perth Hospital, South Australia: Flinders Medical Centre. US - Phoenix, AZ: Mayo Clinic Hospital.
Authors' Affiliations
- Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Comparative Risk Assessment Collaborating Group: Selected major risk factors and global and regional burden of disease. Lancet 2002, 360: 1347-1360. 10.1016/S0140-6736(02)11403-6View ArticlePubMedGoogle Scholar
- Huttunen R, Syrjanen J: Obesity and the outcome of infection. Lancet Infect Dis 2010, 10: 442-443. 10.1016/S1473-3099(10)70103-1View ArticlePubMedGoogle Scholar
- Milner JJ, Beck MA: The impact of obesity on the immune response to infection. Proc Nutr Soc 2012, 71: 298-306. 10.1017/S0029665112000158View ArticlePubMedGoogle Scholar
- Huttunen R, Syrjanen J: Obesity and the risk and outcome of infection. Int J Obes (Lond) 2013, 37: 333-340. 10.1038/ijo.2012.62View ArticleGoogle Scholar
- Harrington G, Russo P, Spelman D, Borrell S, Watson K, Barr W, Martin R, Edmonds D, Cocks J, Greenbough J, Lowe J, Randle L, Castell J, Browne E, Bellis K, Aberline M: Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2004, 25: 472-476. 10.1086/502424View ArticlePubMedGoogle Scholar
- Wisse BE: The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol 2004, 15: 2792-2800. 10.1097/01.ASN.0000141966.69934.21View ArticlePubMedGoogle Scholar
- Benson S, Arck PC, Tan S, Mann K, Hahn S, Janssen OE, Schedlowski M, Elsenbruch S: Effects of obesity on neuroendocrine, cardiovascular, and immune cell responses to acute psychosocial stress in premenopausal women. Psychoneuroendocrinology 2009, 34: 181-189. 10.1016/j.psyneuen.2008.08.019View ArticlePubMedGoogle Scholar
- Habbu A, Lakkis NM, Dokainish H: The obesity paradox: Fact or fiction? Am J Cardiol 2006, 98: 944-948. 10.1016/j.amjcard.2006.04.039View ArticlePubMedGoogle Scholar
- Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy CP, Younessi H, Anker SD, Morley JE: Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care 2007, 10: 433-442. 10.1097/MCO.0b013e3281a30594View ArticlePubMedGoogle Scholar
- Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M, ADHERE Scientific Advisory Committee and Investigators: An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Herat Failure National Registry. Am Heart J 2007, 153: 74-81.View ArticlePubMedGoogle Scholar
- Akinnusi ME, Pineda LA, El Solh AA: Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med 2008, 36: 151-158. 10.1097/01.CCM.0000297885.60037.6EView ArticlePubMedGoogle Scholar
- Russell JA, Walley KR, Singer J, Gordon AC, Hebert PC, Cooper DJ, Holmes CL, Mehta S, Granton JT, Storms MM, Cook DJ, Presneil JJ, Ayers D, VASST Investigators: Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008, 358: 877-887. 10.1056/NEJMoa067373View ArticlePubMedGoogle Scholar
- Roytblat L, Rachinsky M, Fisher A, Greemberg L, Shapira Y, Douvdevani A, Gelman S: Raised interleukin-6 levels in obese patients. Obese Res 2000, 8: 673-675. 10.1038/oby.2000.86View ArticleGoogle Scholar
- Gerhardt CC, Romero IA, Cancello R, Camoin L, Strosberg AD: Chemokines control fat accumulation and leptin secretion by cultured human adipocytes. Mol Cell Endocrinol 2001, 175: 81-92. 10.1016/S0303-7207(01)00394-XView ArticlePubMedGoogle Scholar
- Hotamisligil GS, Arner P, Caro JF, Atkinson RL, Spiegelman BM: Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. J Clin Invest 1995, 95: 2409-2415. 10.1172/JCI117936PubMed CentralView ArticlePubMedGoogle Scholar
- Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS, Lazar MA: The hormone resistin links obesity to diabetes. Nature 2001, 409: 307-312. 10.1038/35053000View ArticlePubMedGoogle Scholar
- American College of Chest Physicians/Society of Critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis Crit Care Med 1992, 20: 864-874. 10.1097/00003246-199206000-00025
- Sibbald WJ, Vincent JL: Roundtable conference on clinical trials for the treatment of sepsis. Brussels, march 12-14, 1994. Chest 1995, 107: 522-527. 10.1378/chest.107.2.522View ArticlePubMedGoogle Scholar
- National Institutes of Health BMI categories[http://nhlbisupport.com/bmi/]
- Sutherland AM, Walley KR, Manocha S, Russell JA: The association of interleukin 6 haplotype clades with mortality in critically ill adults. Arch Intern Med 2005, 165: 75-82. 10.1001/archinte.165.1.75View ArticlePubMedGoogle Scholar
- National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL: Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006, 354: 2564-2575.View ArticleGoogle Scholar
- Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA: Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011, 39: 259-265. 10.1097/CCM.0b013e3181feeb15View ArticlePubMedGoogle Scholar
- Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network N Engl J Med 2000, 342: 1301-1308.
- Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent J-L, Moreno R, and the Surviving Sepsis Campaign Guidelines Committee including the Pediatric subgroup: Surviving sepsis campaign: international guidelines for the management of severe sepsis and septic shock: 2012. Crit Care Med 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83afView ArticlePubMedGoogle Scholar
- Miller JT, Welage LS, Kraft MD, Alaniz C: Does body weight impact the efficacy of vasopressin therapy in the management of septic shock? J Crit Care 2012, 27: 289-293. 10.1016/j.jcrc.2011.06.018View ArticlePubMedGoogle Scholar
- Abhyankar S, Leishear K, Callaghan FM, Demner-Fushman D, McDonald CJ: Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients. Crit Care 2012, 16: R235. 10.1186/cc11903PubMed CentralView ArticlePubMedGoogle Scholar
- Winfield RD, Delano MJ, Cuenca AG, Cendan JC, Lottenberg L, Efron PA, Maier RV, Remick DG, Moldawer LL, Cuschieri J: Obese patients show a depressed cytokine profile following severe blunt injury. Shock 2012, 37: 253-256. 10.1097/SHK.0b013e3182449c0ePubMed CentralView ArticlePubMedGoogle Scholar
- Sunden-Cullberg J, Nystrom T, Lee ML, Mullins GE, Tokics L, Andersson J, Norrby-Teglund A, Treutiger CJ: Pronounced elevation of resistin correlates with severity of disease in severe sepsis and septic shock. Crit Care Med 2007, 35: 1536-1542. 10.1097/01.CCM.0000266536.14736.03View ArticlePubMedGoogle Scholar
- Gibson JG, Evans WA: Clinical studies of blood volume. I. Clinical application of a method employing the azo dye 'evans blue' and the spectrophotometer. J Clin Invest 1937, 16: 301-316. 10.1172/JCI100859PubMed CentralView ArticlePubMedGoogle Scholar
- Gregersen MI, Nickerson JL: Relation of blood volume and cardiac output to body type. J Appl Physiol 1950, 3: 329-341.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text:
- {{matchup.date.fullday}}{{matchup.date.month + ' ' + matchup.date.day}}
California vs Oregon Final: 48-46 - Recap
Justin Cobbs scored 14 points leading California to a 48-46 victory over Oregon at Matthew Knight Arena on Thursday.
California was a 6-point underdog in the win, and managed to turn a profit for their supporters.
California got 12 points from Allen Crabbe and another 8 points from Richard Solomon. Justin Cobbs contributed 7 assists, while Richard Solomon cleaned the glass with 11 rebounds.
Oregon got 13 points from Carlos Emory in a losing cause and another 11 points from Arsalan Kazemi. Johnathan Loyd contributed 4 assists for them, while Arsalan Kazemi had 18 rebounds.
First-half bettors who backed Oregon were victorious, as the score was 26-21 at the break.
Oregon won the battle of the boards, outrebounding their counterparts 39-37.

subset: commoncrawl


text:
|Message view
|« Date » · « Thread »
|« Date » · « Thread »
|Léa Massiot <lmhe...@orange.fr>
|Re: Tomcat6 - Context - aliases
|Mon, 02 Apr 2012 10:45:27 GMT
Hello, Thank you for your answers. Teppei Yamada wrote > 1. What version of Tomcat7 did you test? On a Windows XP machine: Tomcat 7.0.20 On a Debian Squeeze machine: Tomcat 7.0.22 Teppei Yamada wrote > 2. Where do you place context.xml in Tomcat6? > I don't know you are aware that context.xml placed in > yourwebapp/META-INF/context.xml is automatically copied to > TOMCAT_HOME/conf/Catalina/(hostname(usually localhost)/yourapp.xml. > Once copied, Tomcat6 refers the one in TOMCAT_HOME/conf. > Tomcat7.0.26 no longer copies context.xml. I placed "context.xml" in "yourwebapp/META-INF/". I am aware of what you mentionned above. I remember reading that "Tomcat6" copies "context.xml" to "TOMCAT_HOME/conf/Catalina/(hostname(usually localhost)/yourapp.xml" only the first time the Webapp is deployed. Konstantin Kolinko wrote > aliases are a feature added to Tomcat 7. They are not available in > earlier versions. > The feature is too intrusive to ever consider its backporting. > I see. Konstantin Kolinko wrote > Install Tomcat 7. Read RUNNING.txt for a start. I prefer not to. As I wrote, "Tomcat7" is not packaged yet in "Debian" stable "Squeeze". For security reasons, I want to use only stable, packaged and up-to-date OS and software versions. I there any other workaround... I mean... I guess even before "Tomcat7", people needed to declare such "aliases". Thank you for your help and best regards. -- View this message in context: http://tomcat.10.n6.nabble.com/Tomcat6-Context-aliases-tp4678430p4678513.html Sent from the Tomcat - User mailing list archive at Nabble.com. --------------------------------------------------------------------- To unsubscribe, e-mail: email@example.com For additional commands, e-mail: email@example.com
|View raw message


text:
April 4, 2013 | By Eric Lundin
In early March, my colleague Vicki Bell wrote a blog about a common and highly dreaded problem these days: Metal theft. I am sure the main target is copper, which typically fetches more than $3.00 per pound (spot price), and it probably started with stealing plumbing pipe from abandoned buildings....
Shop Management | Articles | The Tube & Pipe Journal
March 15, 2013 | By Eric Lundin
Heat treating metals goes back thousands of years, but the use of cold temperatures, especially the very cold temperatures in the cryogenic range, is relatively new and hasn't been fully accepted in the manufacturing industry. Interviews with four cryogenic processors clear up some of the mysteries and misconceptions concerning this often-misunderstood process.
Tube and Pipe Production | Articles | The FABRICATOR
February 1, 2013 | By Eric Lundin
After realizing he was spending too much time traveling, risk management consultant Hank Padilla decided to take a dramatic career detour. He did some vocational coursework and opened a fabrication shop, serving the local area (Littleton, Colo.) with precision tube bending and GTAW for roll cages and exhaust systems.
Shop Management | Articles | The Tube & Pipe Journal
February 1, 2013 | By Eric Lundin
When one of its facilities was struck by an EF5 tornado on April 27, 2011, Independence Tube Corp. vowed to rebuild the facility. The reconstruction, which was aided by its staff, its customers, and its suppliers, was a Herculean effort that resulted in a small miracle exactly a year later: the new facility reopened for business on April 27, 2012.
January 30, 2013 | By Eric Lundin
The latest big-picture economic assessment is out, and the headlines don't tell a pretty story. As measured by gross domestic output (GDP), the U.S. economy contracted slightly during the final quarter of 2012. A surprise? Yes, even for many economists. A reflection of the national mood at the...
January 15, 2013 | By Eric Lundin
A 6.2-liter engine, 450 horsepower, zero to 60 miles per hour in less than 4 seconds, and a redesigned exterior that exudes cool from bumper to bumper. It's not a foreign car with a funny-sounding name and a price tag with as many digits as the federal debt. It's a domestic model guaranteed to...
January 14, 2013 | By Eric Lundin
Compressor Systems Inc., a manufacturer of natural gas compressors and tanks, was having trouble keeping up with the growing demand for its products. A breakthrough in hydraulic fracturing (fracking) had made shale gas a economically viable, and prices were on the rise, so producers were ever busier. CSI's four-axis pipe cutter machine was no longer adequate—the company relied on time-consuming manual cleanup of most holes the machine cut, so it sought a better machine that could provide weld-ready holes.
January 10, 2013 | By Eric Lundin
If the headlines from a week ago are to be believed, Congress got its act together and cobbled together a last-minute deal to avoid sending the U.S. economy off the fiscal cliff. Needless to say, I don't believe it. Yes, superficially, the new legislation prevented the U.S. economy from becoming...
December 6, 2012 | By Eric Lundin
In the end, the labor strike was just eight days long, but for the ports of Los Angeles and Long Beach, an eight-day strike idles a large number of workers and ties up a lot of cargo. The dispute largely centered around the alleged outsourcing of jobs, an accusation brought by the International...
Cutting and Weld Prep | Articles | The Tube & Pipe Journal
December 3, 2012 | By Eric Lundin
About a decade after his son was paralyzed in an automobile accident, Tim Swenson put a few ideas to work and built an all-terrain wheelchair. Although he was retired, Swenson garnered quite a bit of interest with his invention, so he founded Action Manufacturing and builds two wheelchair models to help people like his son enjoy the outdoors.
Finishing | Articles | The Tube & Pipe Journal
December 3, 2012 | By Eric Lundin
Interviews with several tool and accessory manufacturers provide a broad perspective on capabilities for finishing in hard-to-reach areas.
Tube and Pipe Fabrication | Articles | The Tube & Pipe Journal
December 3, 2012 | By Eric Lundin
After getting a start in the handrail business in 1990, Sharpe Fabrication Inc. relaunched itself in 1994 as Sharpe Products and started to offer general fabrication services. Two of the company's investments, a free-form bender and a fiber-optic laser machine, reflect the company's interest in staying abreast of technology developments.
November 28, 2012 | By Eric Lundin
If you tend to avoid crowds, lines, and hassles, you probably spent Nov. 23, Black Friday, doing something other than shopping. And for good reason—the tales of pushing, shoving, and fighting seem to get worse every year. On the other hand, if you wonder what consumers are up to, you probably...
October 29, 2012 | By Eric Lundin
Much of the East Coast has been bracing itself for Hurricane Sandy while the rest of us wait and wonder. After developing on Oct. 22, it hit Jamaica, Cuba, and the Bahamas, and eventually became the largest recorded hurricane to roil the Atlantic, with a diameter approximately 1,000 miles....
October 11, 2012 | By Eric Lundin
In its weekly press release on Oct. 11, the U.S. Department of Labor reported that initial claims for unemployment insurance fell to 339,000 in the week that ended Oct. 6. This represents a one-week drop of 30,000 and the lowest number of initial claims since Feb. 2008. Of course this is good news,...


text:
Dunc and Amos Meet the Slasher
Sign Up Now!
Already a Member? Log In
You must be logged into Bookshare to access this title. Learn about membership options, or view our freely available titles.
- Brief Synopsis:
- Dunc worries that Amos has gone too far when the latter dons a leather jacket, slicks back his hair, and adopts a nickname, in order to uncover a stolen stereo racket led by the tough new kid in school.
- Long Synopsis:
- Book Quality:
- Publisher Quality
- 9780307803832
- Publisher:
- Random House Children's Books
- Date of Addition:
- 11/02/11
- Copyright Date:
- 1994
- Copyrighted By:
- Gary Paulsen
- Adult content:
- No
- Language:
- English
- Categories:
- Literature and Fiction, Children's Books
- Submitted By:
- Bookshare Staff
- Usage Restrictions:
- This is a copyrighted book.
Reviews of Dunc and Amos Meet the Slasher (0 reviews)
0 - No Rating Yet


text:
The 356 Speedster Tablet
The 356 was first produced in 1948 it was a lightweight and nimble-handling rear-engine rear-wheel-drive 2-door sports car. It's replacement, the 911, was introduced in 1963 but the 356 was so popular it remained in production for another 2 years. One of the most desirable models is the 356 "Speedster", introduced in late 1954. Protect your tablet with an impact resistant hard shell case featuring an extremely slim profile. The lay-flat feature protects the front of your iPad by extending the bezel above the screen. Compatible with the Apple iPad Smart Cover. Great case offering solid protection and direct access to all device features.
Shipping is £3.99 globally on orders less than £30. Shipping is FREE for all orders over £30. Orders are delivered within 5-7 business days. If you have a query about delivery for a product which you have already ordered, please contact us.
If you don't absolutely love it, we'll take it back!
If you're not happy with your order, please contact us as soon as possible. In all cases we'll ask you to provide photographs of the item, including a close up of any tags/labels. To help us respond to you quickly, please include the order number in your message to us.
We have a money-back satisfaction guarantee, so whatever the problem, we're happy to work with you to fix it.


text:
Raisin Spice Bread
|Whole wheat flour
|1 Cup (16 tbs) (Measured Scoop And Level)
|Baking soda
|1⁄2 Teaspoon
|Ground cinnamon
|1 Teaspoon
|1⁄4 Teaspoon
|Ground cloves
|1⁄8 Teaspoon
|Ground nutmeg
|1⁄8 Teaspoon
|Low-fat yogurt
|1⁄3 Cup (5.33 tbs)
|1⁄4 Cup (4 tbs)
|1⁄3 Cup (5.33 tbs)
|1⁄2 Cup (8 tbs)
1) Preheat oven to 350°.
2) In your food processor, use METAL BLADE or PLASTIC MIXING BLADE setting.
3) In the work bowl, add flour, baking soda, cinnamon, salt, cloves, and nutmeg. Pulse on/off to mix.
4) Transfer the mixture in a bowl and place aside.
5) In the work bowl, add egg to process 30 seconds.
6) Add yogurt, oil and honey after scraping down the sides. Mix with on/off pulses until well-blended.
7) Add all dry ingredients all at once by removing the lid and scraping down the sides.
8) Fold in raisins.
9) Combine with 5 on/off pulses only until batter is mixed.
10) Scrape down the sides, before last time on/off. Do not overdo.
11) Use a small loaf pan, 7 7/8 x 3 7/8-inch, to grease bottom and sides.
12) Place the wax paper in the bottom.
13) Pour in batter.
14) Place inside oven to bake for 30-35 minutes or until a wooden toothpick inserted in the center comes out almost clean.
15) Cool the bread inside the pan for 10 minutes and carefully remove on wire rack.
16) Serve the bread warm or cold.
Recipe Summary
Rate It
Nutrition Rank
Nutrition Facts
Serving size
Calories 414 Calories from Fat 147
% Daily Value*
Total Fat 17 g25.6%
Saturated Fat 2.6 g13%
Trans Fat 0 g
Cholesterol 54 mg18%
Sodium 328.4 mg13.7%
Total Carbohydrates 65 g21.5%
Dietary Fiber 5.6 g22.4%
Sugars 35.5 g
Protein 8 g15.7%
Vitamin A 1.6% Vitamin C 1.6%
Calcium 7.9% Iron 12%
*Based on a 2000 Calorie diet


text:
That includes the one I have got at the moment.
Which has sometimes been embarrassing when I have been filling in registration forms at hotels or simply reporting to places with private car parks. "Car registration number?", says the form sweetly or the desk man roughly, and I sweat with humiliation. You can't say "It's G something, I think", because that is plumbing the depths of whatever the opposite of machismo is. Usually I wink and smile and say, "I'll just go and have a look", and pop outside to have a look, and they smile when I come back, because they cannot imagine that I am possibly popping outside to have a look and think I must be joking.
But I am not.
Now, however, I have learnt to remember my car number, because it has been stolen from me here in Edinburgh, and I had to memorise it before I reported it to the police. I had parked the car outside the Pleasance, where I am performing, and when I left it it had two number plates and when I came back it only had one. The front number plate had gone. It's strange how naked a car looks without a number on the front. Or perhaps it makes it look as if it is wearing a mask.
"It's almost certainly illegal to drive around without a number plate," my wife said. "We are almost certainly breaking some regulation every time we go out in a car," I said.
"True," she said. "But seldom as obviously as by driving around without a number plate."
True. So the next morning I got up, fed the meter and approached a friendly traffic warden. At least, he was friendly when it became clear I wasn't either going to plead or argue with him.
"I've had my front number plate nicked," I said. "What should I do?"
He had no idea. He talked into the little phone on his shoulder to the boss. "There's a fellow here had his number plate stolen. What should he do ? Uh huh ... Aye ... right..."
He turned to me.
"Report to to the West End police station in Torphichen Place."
When a Scotsman says "Torphichen", it comes out as a cloud of saliva, but eventually I got him to write it down and off I went to the West End police station, which is not half as grand as it sounds - in fact, all police stations seem to acquire a dusty brown air of resignation and sloth from their birth, and this one was no different.
"Took the number plate and left the car, did they?" said the policeman. "You were lucky."
"But why would anyone want to steal a number plate?"
"Well, these days a lot of cars are stolen to order, then they have to get a number plate to go with it. What's the number of your car?"
I resisted the urge to say that I would pop out and have a look. In fact, to guard against this I had already written the number down on my hand. I sneaked a look.
"It's G357 UAM."
I wasn't quite sure of this, as the way I had written the G looked like a C, but it sounded near enough, and I thought a C reg car would probably be too old. (You can tell how much I know about cars.) "Right," said the friendly policeman, waving a theft report form at me. "Take this and if anyone stops you, show them this. That'll get you on your way again. We'll be in touch if we find a stolen car with your number."
What he didn't say was whether or even where I should buy a new one. I don't know where you should go in Edinburgh to get car number plates. What I do know is that in the print shop round the corner from me they sell self-adhesive letters of just the right size and typeface for a number plate, so as a temporary measure I marched in and said that I wanted a G and a 3 and a 5 and a 7 and a U and an A and an M. Already I was beginning to memorise my number.
"Sorry," said the man. "We've got the rest, but we're out of the letter A."
After a little debate I bought a V and a hyphen, so that I could turn the V upside down and stick the hyphen across to convert it into an A. Seconds later I was kneeling in front of my car, peeling the backing off letters, getting them stuck on my hand, peeling them off my hand and sticking them on to my car. I now have the only car in Edinburgh with paper letters on the front which look as if they had been arranged by a child during her first day at kindergarten. But at least I can remember the number of my car.Reuse content


text: Websites Not In Google: $10,000 To Fix Up Or Buy A Home Websites Not In Google: $10,000 To Fix Up Or Buy A Home LTPL03 Instant Download Price In Stock $ 5.95 USD matthew Buy and Download Description Lesko's Video Tutorial Includes All Contact Information and Application Websites... Websites Not In Google: $10,000 To Fix Up Home, Pay Rent, Mortgage or Down payment Matthew Lesko, New York Times Best Selling Author and Entrepreneur If you are looking for money for housing by searching Google, you will never find the websites that offer free money and help for your housing problems, like: Money to Buy A Home Money To Fix Up A Home Money To Become A Real Estate Investor Money To Pay Your Rent, Mortgage or Downpayment. A Google search will certainly generate millions of websites but not the ones that offer free money or free help. It costs a lot of money to figure out how to get your website on the first pages of a search. People who give out money and help for free don't have money to figure out Gooogle. These videos show you how to stop looking for a Needle In A Google Haystack. I show you, step-by-step, how to use the internet to go right to the sites that are only giving money and help for free. Get in front of your computer and follow along. Who Is Matthew Lesko? Armed with a MBA in computerized management information systems paid for thanks to government money because of service as a Naval Officer in the Vietnam War, Lesko became a professor in computer science and started a career as an entrepreneur. His first two businesses failed and one was a software company. His first successful company was a consulting business that helped Fortune 500 companies tap government programs to finance mergers and acquisitions and enter new markets. In a few short years, this business grew from himself with a phone and a desk in a one-room apartment to 30 researchers in downtown Washington, DC. He then left the corporate world to educate the average consumer how they also can use the same government programs to help their lives. He has written over 100 books on the subject of free money. Two became New York Times Bestsellers. He was also a columnist for the New York Times Syndicate and Good Housekeeping magazine. He has appeared on hundreds of radio and TV shows and made regular appearances on Letterman, Larry King, Leno, CNN, Fox, The Today Show, Good Morning America, and Oprah. His crazy TV infomercials were among the most popular in the industry and he is often recognized on the street because Lesko always wears Question Mark Suits. For the past 3 years Lesko has been researching the internet economy and amassed a collection of over 1,000 video interviews of people who have used or created websites on crowdfunding, peer-to-peer and the shared economy. I've done all the research for you. Its time for you to decide to start getting the money. Lesko's Video Tutorial Includes All Contact Information and Application Websites... Websites Not In Google: $10,000 To Fix Up Home, Pay Rent, Mortgage or Down payment Matthew Lesko, New York Times Best Selling Author and Entrepreneur If you are l Direct Link http://store.payloadz.com/go/?id=2490488 http://store.payloadz.com/details/2490488-ebooks-business-and-money-websites-not-in-google-10000-to-fix-up-or-buy-a-home.html Tags homegrantsloansrent Business and Money eBooks


text:
CDAN Blind Items
"On Saturday night this A list celebrity spent a ton of money on his A list mostly movie actress wife. She begged and pleaded for him to buy it for her. She doesn't ever spend her own money on anything. He bought it and apparently expected some sex that night which might be understandable considering he spent almost $1M. He didn't get any sex and none the next morning and by the time the Globes occurred our celebrity was in a really bad mood and he was openly fighting with his wife in a very subtle classy kind of way. Apparently this is not the first thing he has bought her recently to try and make her happy and it was not his choice to move to LA and for two married people they hate was palpable."
[Popular Guess]Chris Martin and Gwyneth Paltrow
One of the more annoying people last night was this B- list mostly movie actress who used to star in a franchise and now doesn't do a whole lot. She got drunk and as the night wore on kept telling people that she could have been invited to the show but chose not to be because she wanted to give others a chance to attend who might not get another chance. She also kept reminding people that she turned down the role that Jennifer Lawrence won for which is not at all the truth. Our actress begged for an audition but had no shot of the part or even reading for it. Everyone wanted her to run into Jennifer Lawrence but it didn't happen.
[Popular Guess]Ashley Greene
This almost A list mostly movie actor who is A++ in one very big department blew off his girlfriend Saturday night because he finally managed to convince his recent co-star to hook up with him. he tried during filming and during the press tour but now during awards season she finally gave in. The thing is it might actually last because he has been trying a long long time.
[Popular Guess]Michael Fassbender and Lupita Nyong'o
Apparently this E! reporter should fear for their safety for a few days. The reporter was telling people on the set of the show that this married A list celebrity/singer had hit on her a few times. Well, our celebrity's actress wife heard what the reporter claimed and the actress said there is no way the husband would touch someone that looked like a troll and then the actress said if she saw the reporter that she would f**k her up. Seemed pretty serious.
[Popular Guess]Kelly Osborne, Robin Thicke, and Paula Patton
This A list mostly television actress got hammered at the party much to the chagrin of her significant other who didn't know anyone at the event. The actress began the night fairly cozy with her guy but by the end of the night was telling him to stop acting like a baby and grow a pair and the party they attended after was a disaster. They didn't speak and he kept saying they should go home and she kept trying to have fun with her friends. She did flash a guy at the party who screamed she had nice t*ts.
[Popular Guess]Kaley Cuoco


text:
Post Details
The Light That Blinds
Posted by Nordavind on November 22, 2013
Last updated by Vikestart on November 22, 2013
|Starting Location
|Savage Coast
|Natural Ward (140,870)
|40 010 3 330 1
More Less Jump to:
Tier 1
Objective: Examine one of the wards
Interact with the ward to examine it.
Tier 2
Objective: Gather black feathers
Objective: Acquire sinew from a Deep One
Black feathers are found around the shop, a long the fence on both sides.
The Deep Ones are found on the other side of the road from the shop. They are called Tolba Bay Creature. The sinew is found in a bag they drop upon defeat, however it's not certain that the first you kill will drop the sinew.
Tier 3
Objective: Assemble a ward
You now have 1 sinew and 3 black feathers in your inventory. Open the crafting window (press Y), add both ingredients and press 'assemble'.
Congratulations! You now have a natural ward with super awesome powers. Use it wisely! Mission complete.


text:
Results 1 to 1 of 1
- 03-26-2014, 07:10 AM Thread Author #1
- Posts
- 1 Posts
- Mentioned
- 0 Post(s)
- Tagged
- 0 Thread(s)
Galaxy S4 Home Button Reroute
Hey guys,
When I first got my hands on my S4, I played around with its settings and, naturally, I've forgotten how to adjust the function that corresponds with holding down [or double tapping] the home button.
I believe, originally, when I held the home button I was sent to the page layout screen, where I could add pages, remove pages, or change around the order of the pages on my home screen. (Correct, or have I become delusional?)
Now, holding the home button has no function, and I've come to realize how useful the option to add a page to my home screen is!
I'm using Nova Launcher, so I may have initially found this option in Nova settings rather than the Galaxy's general settings, but Nova settings are fairly limited, and I've browsed through every setting and [I believe] I've confirmed there's no such option there.
Thanks in advance for the suggestions,
Similar Threads
Anybody move from a Galaxy Gear to a PebbleBy tech_fan in forum Pebble SteelReplies: 2Last Post: 08-26-2014, 09:16 PM
Capacitive ButtonsBy Channan in forum Samsung Galaxy Tab Pro 8.4Replies: 7Last Post: 07-08-2014, 10:33 PM
Galaxy S4 how do I add a Hotmail accountBy Mayra429 in forum Samsung Galaxy S4Replies: 7Last Post: 04-14-2014, 11:40 AM
Galaxy gear $100 refurbished from best buyBy dpham00 in forum Samsung Galaxy GearReplies: 3Last Post: 03-26-2014, 01:51 PM
when galaxy mega 6.3 will receive android 4.4?By Khairul The Basty in forum Android 4.4 KitKatReplies: 1Last Post: 03-26-2014, 01:26 PM


text:
Originally posted on Razzball Basketball | Last updated 2/23/13
Kevin Garnett sat out Friday night (DNP – old and tired) and Jeff Green finally got his chance to start. Doing the best KG impression he could muster, he tore up Los Suns with a season-high 31 points and added 7 rebounds, 4 assists, 2 steals and 5 blocks. Oh, hello there! What did you say your name was? I don't believe we've met. They traded you for who–Kendrick Perkins!? Pffft! If we step into the Razzball DeLorean back to several weeks ago, let's see what I said about Jeff: "I don't think we'll see the real Jeff Green until he gets his chance to start…If he can ever put it all together he's got all the tools to be a fantasy stud." And that's me quoting me! Green shot a fantastical 11-of-14 from the field, scored 15 in the first half alone and even hit 3 shots from downtown. If you haven't picked him up yet you should go pick him up now, he's still available in about a third of yahoo leagues but that number will shoot up over the weekend, especially with the Celtics fans cla
NBA News
Delivered to your inbox
You'll also receive Yardbarker's daily Top 10, featuring the best sports stories from around the web. Customize your newsletter to get articles on your favorite sports and teams. And the best part? It's free!
Follow us on Twitter
|Best of Yardbarker
|NFL News
|MLB News
|NBA News
|NHL News
Today's Best Stuff
For Publishers
Company Info
Follow Yardbarker
|© 2017 Yardbarker, Inc. All rights reserved. Use of this website (including any and all parts and components) constitutes your acceptance of these Terms of Use and Privacy Policy. (What's New?)


text:
Wego.com recently found 21 hotels in Fowey, United Kingdom. Find a range of accommodation in Fowey at great prices. Book luxury Fowey hotels or find last minute accommodation. Save more on cheap hotels in Fowey with affordable room rates.
Filters help you save time when choosing where to stay. Try clicking on a few now...
Fowey Hotels 5 Star Hotels Fowey 4 Star Hotels Fowey 3 Star Hotels Fowey Cheap Hotels Fowey Cheap Accommodation Fowey
Flights to United Kingdom Flights from United Kingdom United Kingdom Airports United Kingdom Airlines


text:
Fitnete Rexha
From Wikipedia, the free encyclopedia
Fitnete Rexha (April 3, 1933 - August 13, 2003) was a famous Albanian folk singer.
Fitnete Rexha was born in Tirana to a family from Krujë. At the age of 15, she started singing folk music. Her discography includes folk songs from Tirana as well as Shqipëria Mesme (Albanian for Central Albania, a region characterized by similar traditions, including songs).
See also[edit]
External links[edit]
|This biographical article relating to Albania is a stub. You can help Wikipedia by expanding it.


text:
Robot Mouse
This video has been screened at London Independent Film Fest, Silver Sound Music Video festival, won a finalist award at Las Vegas Film Festival, and won Best Director Music Video at the First Glance Film Festival.
Music Video is out now on iTunes!! Buy it please.
This is the new hip hop sensation Johnny Popcorn. Next Episode is the first track on their debut album.
Directed By Josh Coyne
Staring Hezekiah Davis
DP Chris Cottone
Gaffer Tommy Oceanak
Puppeteers...Chris Johnson, Dan Metzker, Dan D'Aprile, John Keefer, Laura Jane Parker, Dan Homa.
Thanks to...Paul Hazlett, Andrew Baker, Megan McLaughlin, Chuck Scott, Matt LaRoche, Kevin Tobin and last but not least, Seth Coldren


text:
Board takes up healthcare, drainage
The county board's mid-month meeting last week convened at 5 p.m. and recessed at 5:30, with supervisors moving through an uncluttered agenda with little action taken.
Within minutes of calling the meeting to order, District 1 supervisor and Board president James Dunn said he would like to see the Board move forward on hiring a CEO for the Healthcare Authority. District 2's Cedric Burnett made the motion to hire the healthcare commissioners' recommended candidate, but the motion was voted down 3-2, with Phillis Williams, Henry Nickson, and McKinley Daley voting no. Williams said she would like to see the item taken up again at the last meeting this month. Current CEO Gene Osborn is seeking to retire from his post.
Latest News
Gun discovered on HS team bus The Lion nation...
Revelations of official corruption, crime roil 1999 One of the most gratifying...
Two dead in Horn Lake murder/suicide A man...
Go Red in Tunica Tunica's second annual...
1998: Tunica's economic miracle builds, but issues begin to threaten "…People born...
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8


text:
Interactive App for Alcohol Brand - IPad App Mar 20 2013 08:05:31
This project has been awarded to EMCALLISTER for 40 ZAR / hour.Get free quotes for a project like this
Project BudgetR40 ZAR / hour
Total Bids1
Project Description
Good day,
I have a Ipad application to be developed for a Client.
I'm looking for a Designer to help with the designs, as well as a Developer to help with development.
Interactive Ipad App for alcohol Brand, Packed with feature & information about a City (Milan). this app should be visually spectacular and will only server information, details, fun facts & music about the brand and the city. Social sharing is encouraged.
We are based in south Africa, so I need to work with a freelance designer & Developer in our time zone (or close to it).
Whats your availability to take on any work? do you know of any other freelancers I can contact?
Shaun Badenhorst
Shaun@[url removed, login to view]
Awarded to:
Skills Required
Looking to make some money?
- Set your budget and the timeframe
- Outline your proposal
- Get paid for your work
Hire Freelancers who also bid on this project
Looking for work?
Work on projects like this and make money from home!Sign Up Now
- Forbes
- The New York Times
- Time
- Wall Street Journal
- Times Online


text:
best CEE???
hey i was thinking of getting off the PHs for a while and let my liver recover some...which brand do u guys recommend as the best CEE (not in powder form....it will just lay in my kitchen no matter how hard i try)
Available for both the Apple AppStore and the Android Market. Choose your platform below:
Follow us on:


text:
----- Original Message -----
To: email@example.com
Sent: Monday, February 24, 2003 9:07
Subject: [iris-photos] RE: Summer Camp
Summer Camp is a burgundy plicata on a light yellow ground.
I had this charisma of it in the garden a couple of years ago. The area that
has reduced anthocyanin shows yellow plicata type stittching on white ground.
The yellow is stronger in the veins and heavier near the edge of the petals,
in much the same pattern as anthocyanin is distributed in plicatas.
What about red on white plicatas such as Taholah. Harlequin, High Life,
Broadway, Different Design and Spice Lord (as examples)? The red and
brown colour is a combination of yellow and violet. Shouldn't the anthocyanin
and carotene be distributed in the same locations to give us the red. What
happens when the anythocyanin is absent in a red on white plicata? Removed by
a Dominant Reduction of Anthocyanin or a Recessive Reduction of
Anthocyanin.-- Chuck Chapman, Guelph, Ontario, Canada. Zone


text:
NiQuitin Lozenge 2mg - Original help you gradually wean yourself off nicotine so you can readily quit smoking. As these lozenges are handy and discreet to use, you can use them anytime on-the-go craving relief This strength is suitable for you if you have your first cigarette more than 30 minutes after waking. Quit smoking faster Convenient on-the-go craving relief Pocket-friendly size to carry with you Relieves cravings in minutes Dissolves fast in your mouth Refreshing flavour
Cheapest price we found
|Visit Store
More results for this product
|Visit Store
Prices are updated periodically, the prices quoted here were correct at the time of last update.
Patient gathers information on a vast range of over-the-counter treatments and beauty products from reputable websites and registered online pharmacies. We perform a price comparison so that you can see who offers the best price.


text:
Be Fearless: Overcome the Sting of Criticism
By Jonathan Alpert
"Go to hell." "The article is dangerous." "You're going to ruin our business model." "Managed care won't reimburse us anymore." "Alpert is a fraud." And of course, my favorite written by a blogger for Forbes who used the pathetically salacious and baseless headline: "Jonathan Alpert's Misstatements and Possible Misconduct." In that same post the blogger even went so far as to imply that I am something I am not and was practicing outside of the scope of my profession. The comments above, and countless others, stemmed from my April 22, 2012 New York Times Op-Ed piece, "In Therapy Forever? Enough Already." In the piece my aim was to educate readers on the profession and shed some light on alternatives to long-term treatment and psychoanalysis where people might feel stuck. I encouraged those who might feel mired in therapy to move on and find an approach that is more goal-oriented. The criticisms came primarily from colleagues who disagreed with my opinion and expressed it by attacking and criticizing me, rather than having a spirited debate about different approaches to therapy. The piece proved to be highly polarizing and one can surmise that these therapists felt threatened by my views and felt the need not only to attack, but spread the message. Their criticisms even went so far to include lies and rumors. For example, they accused me of not having the degree that I say I have when in fact I hold a Master's degree in psychology, and not being licensed when in fact I hold a license to practice in New York, Pennsylvania, and Washington, D.C. These comments weren't too surprising given the level of panic and desperation my article seemed to incite in other therapists.
I also received hundreds of e-mails from people who identified with what I wrote in the article and felt great relief to hear a therapist say what I said. They had been stuck in therapy for years and finally saw that things can be done differently. My office phone has been ringing incessantly for weeks from people who want to make an appointment to see me. I received dozens of e-mails from professors and students who were discussing my views in their classes. I received several invitations from groups asking me to speak, and even from people saying they were so rattled by the piece that they were going to discuss it with their therapist in their next session. Imagine that, people discussing my article about therapy with their own therapist!
My experience with the aftermath of this article reminded me so much of what a lot of my patients deal with: fear of criticism. I see it in many aspects of peoples' lives. At work people fear criticism from their bosses or colleagues so they keep quiet and don't express their opinion. They play it safe. At home people fear that they will be criticized by their spouse so they don't speak their mind. They back down when they sense conflict. In friendships people often don't have boundaries because they fear doing so will lead to criticism. It's this fear that keeps people stuck. For example, at work by not speaking up and not sharing your ideas, you'll never advance. People won't know your thoughts and will have no reason to promote you. It's safe to remain quiet. But being safe doesn't necessarily make you stand out or get recognized. Had Steve Jobs or Mark Zuckerberg been afraid of criticism, they never would have expressed their gutsy technologically advanced ideas and we wouldn't have Facebook or all the innovations that Apple has brought us. At home people fear they'll be judged or criticized. It creates an unhealthy dynamic in the relationship where fear of criticism holds one person back. In friendships, people are often afraid of being criticized and ultimately rejected by a friend if their views are different so rather than express them, they just agree with their friend in order to keep the peace. This fear of being criticized leads to resentment and will ultimately make the friendship intolerable for both.
Here's how to deal with your fear of criticism:
- Focus on what you believe in and what you did right. Had I taken to heart the criticism that I received from my NY Times piece then it would have brought me down. Instead I focused and continue to focus on the praise I received for the article. By doing this it helps to diminish the negative comments and keeps one focused on what's most important: your views and beliefs.
- Speak your mind. Don't be deterred by opposing view or criticism. Doing so is avoidance and that will make you weaker, not stronger. Don't let others define you. Know what you believe in and stand firm.
- Accept the notion that there will be some people who love you and others who do not.
- Change your self-talk. Instead of thinking, "I can't deal with this" or "Maybe they are right about me" Think, "I am strong and can roll with the punches" and "others don't define me, I define me".
JONATHAN ALPERT, a licensed psychotherapist and advice columnist, is one of the media's favorite sources of no-nonsense lifestyle advice, quotes, and commentary. The New York Observer has called him "Manhattan's most media-friendly psychotherapist" and "the media's go-to guy for psychoanalyzing the City."
His insight is regularly tapped by major national and international media outlets, including television, print, radio, and online. He has appeared on such nationally televised shows as TODAY, Good Morning America, CNN, FOX News, and NBC Nightly News. He is often quoted by Ladies' Home Journal, Details, Elle, Men's Health, the Associated Press, BBC, Time and countless other print outlets. His book BE FEARLESS: Change Your Life in 28 Days was released in 2012 by Center Street. Visit www.jonathanalpert.com. Twitter: www.twitter.com/jonathanalpert. Facebook: www.fb.me/jonathanalpert.
More Great Articles by SingleMindedWomen.com
Train Your Brain for Resolutions You Can Keep
"It's good, but…" Reflections on Rejection


text:
- PressReleasePoint Main
- Submit Press Release
- Free PR Website List
- PR Resources
- Press Releases
- Our Services
- About Us
- Contact Us
Home ›
Class of 2018 reports for duty: More than 1,000 Academy appointees begin basic cadet training
By Amber Baillie, Academy Spirit staff writer / Published June 27, 2014
Basic cadets from the Class of 2018 are addressed by cadet cadre as they stand in formation June 26, 2014, on "the footsteps" outside of the Core Values Ramp at the U.S. Air Force Academy, Colo. Basic cadets spent their first day getting a military haircut and their uniforms, donating blood, meeting their cadre, and receiving a taste of Academy life. (U.S. Air Force Photo/Sarah Chambers)
Related Biographies
U.S. AIR FORCE ACADEMY, Colo. (AFNS) --
Approximately 1,200 U.S. Air Force Academy appointees and their parents swarmed Doolittle Hall June 26, before exchanging hugs and parting ways as the Class of 2018 took its first steps to becoming cadets and Air Force leaders.
Emotions ran high as parents wished their sons and daughters farewell and watched as they loaded onto buses to begin their inprocessing for basic cadet training.
"Today is hard," said Duke Pope, Class of 1994 Academy grad from Florida. "It's bittersweet to send off my son, but I'm as proud as can be."
Pope's son, Josh, was recruited to play football here; Pope said Josh hopes to become a pilot.
"He wants to serve his country and be a part of the Air Force mission," he said. "Josh has a strong character and is definitely ready for the Academy."
Senior Academy leaders, including Lt. Gen. Michelle D. Johnson, the Academy superintendent, and William "T" Thompson, the Academy Association of Graduates chief executive officer, welcomed the new class to "The Long Blue Line" of the military's finest and spoke about the Academy's mission.
"Today forward everything will be about character and leadership development based on the core values of our Air Force and a demanding honor code you will help enforce," Johnson said. "We're a part of the great American joint force and there is something special that Airmen bring to the fight. You will be immersed in this every day."
The Academy received 9,082 applications for the 1,200 slots in the Class of 2018. The class includes 14 international cadets from Bulgaria, Gabon, Kazakhstan, Malaysia, Moldova, Pakistan, Romania, South Korea, Sri Lanka, Taiwan, Thailand and the United Arab Emirates.
"Because of your hard work you're about to receive a unique privilege for the American people to attend this great institution," Thompson told the appointees. "With opportunity comes responsibility. Your responsibility while here is to give us your best."
Thompson told the appointees to remember that 47,000 graduates preceded them as they face challenges here.
"This is a tough program -- it's designed to be," he said. "We know that you have the talent and ability to make it through this place and that's why you received an appointment. Be proud to be an Academy cadet, be proud of your Academy because it is your institution. We're proud to have you here and wish you the best as you take your first steps beginning this journey."
Tyler Rodriguez, an appointee from Texas, said he is ready to experience cadet life.
"I'm excited - not nervous," he said. "I'm anxious to begin the Academy's program and work my way toward becoming an Air Force officer."
Danny Crabill from Pennsylvania said his son, Donald, has wanted to attend the institution since junior high.
"He wants to serve his country and fly airplanes," he said. "I think it's beneficial for him to attend the Academy because it's a great education, a way to serve the nation, and he will have great opportunities afterward. It's hard to beat."
Basic cadets spent their first day getting a military haircut and their uniforms, donating blood, meeting their cadre, and receiving a taste of Academy life.
During basic training, the Class of 2018 will be known as "basic cadets." Basic cadet training continues until August 2. The training includes physical conditioning, marching drills, numerous inspections, weapons training, an overview of the Uniform Code of Military Justice, first aid, honor and ethics lessons, and an introduction to the Air Force core values.
The basic cadets are scheduled to begin classes with the rest of the Cadet Wing Aug. 13.
Copy this html code to your website/blog to embed this press release.
Post new comment
More like this
- Academy's international programs bring education, diversity to life
- Biden to Class of 2014: 'You carry America on your back'
- Sign in to your account using your existing password. Login Successful! Forgot your password?
- Foreign officer shares rewards of Academy exchange
- Veterans in Blue Volume V out now
This press release is licensed under a Creative Commons Attribution 3.0 Unported License. Read full copyright information here.


text:
This is one of the largest bat's in the world and currently resides in the Philippines. Their wingspan can reach up to 5 feet long. Here is an adult, which looks a bit frightening.
Here they are as babies. These little guys are being hand raised at a rescue shelter. This particular species is considered endangered due to poaching and deforestation.
VN:F [1.9.22_1171]golden-crowned flying fox Bat,
More Cute Baby Animals:
Fatal error: Uncaught Exception: 12: REST API is deprecated for versions v2.1 and higher (12) thrown in /home/babyanim/public_html/wp-content/plugins/seo-facebook-comments/facebook/base_facebook.php on line 1273


text:
It's a vehicle design that their underbodies are exposed. This exposure makes the cars several working and the most important parts of a car, which are usually located beneath the whole body susceptible to mechanical damage. The damage is most likely to vehicles that use the roads with very rough terrains.
Vehicles are tools that have simplified man's puzzle on how to cope with time resource. This reason makes them very crucial to the daily activities of man. For this reason, a special guard called bash plates were developed to protect the underbody of vehicles. The following are important function of bash plates;
Critical functions
Offer protection without adding much weight
This is because the bash plates are made of aluminum metal which is adamant yet light. The aluminum plates are made to fit and thus completely cover the vehicle's underbody.
The crucial parts will thereby be protected from mechanical damage caused by shocks, and even hard substances that hit them. The aluminum plates are so hard such that they can withstand abrasion, friction and tension forces due to shock.
Ensures passengers' safety
This system of protection ensures that the passengers are not only comfortable but also safe. For instance, when the vehicle is traveling on a rough road, or a road with a bad terrain, the underbody guards serves to protect the passengers from panic caused by various issues associated with bad roads. Skid plates improve the speed of the vehicle and also the safety as well.
They preserve the vehicle
Bash plates protect the vehicle's chassis from physical damage thus preserve it. It's attached to the frame using bolts and the original holes on the chassis. This, therefore, prevents further drilling of the attachment holes on the body of the vehicles frame. It's also easy to open these plates to access the components of the structure.
The front underbody protection safeguards the engine and the steering components or the gearbox. The front vehicle is even a more crucial and yet susceptible area as it's usually the first to encounter the effects of a dangerous terrain.
The unique specifications of the underbody protectors
They have external reinforcement ribs and holes that drain off the dirt to keep the chassis clean. The bash plates have rubber separations for shock absorption and as well noise reduction.
Vehicles underbody protection is a very sound investment that all car owners should do. It's a modest yet essential step that will ensure a longer life for your vehicle. It only involves finding the best bash plate for your car and fixing it to your chassis. Then you will be guaranteed to travel on any roads without many worries.


text:
AARP Academy
Find the workshops, events, webinars and online resources that will enhance your career, offer support as you care for a loved one, and improve your technical skills.
New! Interactive videos put you in the middle of the story.
Online Safety: You've Been HackedWork & Jobs: Create an Elevator Pitch Have a Family Caregiving Conversation
Take the inventory, understand your strengths and areas for improvement, and then receive a recommendation for learning with our series of free videos.
Work & Jobs
Family Caregiving
Social Media
Tablets & Phones
Connected Life
Online Safety


text:
Related Publications
- Related by Publisher
- Related by Topic
Related Links
And for the Sin of a Part-Time Judaism
Eugene Borowitz, September 29, 1989
Topic: Morality, Business, Jewish Identification, Ethics, Values
Name of Publication: Sh'ma: A Journal of Jewish Ideas
Editor: Borowitz, Eugene B.
Volume/Issue: Vol.19/no.378
Page Number(s): 142-144
Genre: Article
Coverage: United States
Language: English
Copyright Holder: Publisher
Copyright Information: Download for personal use, freely distribute link
Bibliographic Information:
Wurzdurger, Walter S. And for the Sin of a Part-Time Judaism. Sh'ma: A Journal of Jewish Ideas. Eugene Borowitz. 29 September 1989: 142-144. http://www.bjpa.org/Publications/details.cfm?PublicationID=9597
» View Publication
(PDF, 1.76 Mb)


text: I am trying to get a nice crispy skin on this Bone in Pork Shank Roast. Simulating the BBQ I set the oven at 290 degrees and cooked this 9lb roast low and slow, BBQ sauce or gravy are a great sauce for this dish. Rinse and pat dry Apply thin amountTags:


text:
Nigel Farage's eventful trip to Scotland
17 May 2013 Last updated at 15:32 BST
The UKIP leader Nigel Farage has told the BBC he will not be intimidated out of Scottish politics despite needing police protection during a visit to Edinburgh on Thursday.
He accused demonstrators of being anti-English and warned of dark forces in Scottish nationalism.
The SNP say Mr Farage has lost the plot.
BBC Scotland's political correspondent Raymond Buchanan reports.


text:
Vanchieri & Ferrier, LLP - Brooklyn, NY.
Southbay Equity Lending- CA.
White & Selkin, Attorneys - VA
Stratis Financial, CA
Branch Banking & Trust
Wells Fargo - SC
One Nevada Credit Union
Legends Title - MD
Wells Fargo Home Mortgage- CA
Frazier Law Firm - NYC
MSA Mortgage - MA
Columbia Funding - WA
Fidelity Title - WA
Law office of Stuart Weiss - NYC
Mann Mortgage
Mackie & Reilly, Attorneys - RI
AmeriCash - CA
Guaranteed Rate - MI
North American Title - CA
HARP approved first loan with a Subordination: Subordinating lender approval is not always granted. To the surprise of many lending professionals becoming familiar with the newly released guidelines for what many have coined as HARP 2.0, they are learning … [Read More...]
Updated Sept. 21, 2015:Note: These are not indicative of ALL subordinations and is subject to change. Turn times are coming sooner due to slow refinance volume at this time.
Green Tree - 21 business days
GMAC - 13-15 business days on average
PNC/National City - under 10 business days
Chase Bank - about a full business week
Bank of America - 10 business days on average -
Wells Fargo - up to 7 business days
1) Support is outstanding (see #10 below)
2) We deal with the subordinating lender, not you. - time saver
3) A support member assigned to you from day one to completion
4) Fees: All fees can be paid online - time saver, speeds approval time. No more asking clients to go to their bank for cashiers checks. Fed Ex delivery of subordination is included,unless otherwise stated.
5) YTD: 40% success rate in turning declines into approvals - very respectable
6) Pre-audit files for accuracy and potential response - saves time, saves lost money when we tell you upfront it may not work
7) 24/7 Checklist delivery. Lender not listed? Ask us and we'll fetch it for you. Tons of people love this!
8) Common to get information even over weekends
9) Testimonials are ALL unsolicited
10) Exceptionally high caliber staff and experienced - you are not dealing with run of the mill customer service rep's who tell you status reports and that's it. We know refinance work and are involved in real estate transactions and refinance and subordination closings DAILY.
11) No charge for extra reason: We work as a Fiduciary which means our GOAL is to get your subordination approved
August 15th, 2011 - (on resolving a last minute issue) "Fantastic!! I can't thank you enough!!! - Julie G, Bank of America
May 26th, 2011 - "Thanks again for all your help and correspondence. That has been the toughest part of these subordinations from some places and you were great to work with!" - Denise G., Eastwood Bank, MN.
April 18th, 2011 - "This is the best service I have ever come across." - Deb. R. - Bank of America, IL.
March 18th 2011- "You have been absolutely awesome!!! I can't thank you enough. Your constant communication and updates have been absolutely awesome. Your continued efforts have been so much appreciated! - Joanne, First Choice Bank
Feb.10, 2011- Thank you for all your help and cooperation. It has been a pleasure working with all of you!"- Lerris at Metro National Bank
Bank of America (Countrywide)
National City/PNC - heavily involved in 80/20's during the boom
Wells Fargo/Wachovia
Citi Mortgage
Key Bank
others (regional banks and credit unions)
Copyright © 2017 · Customized Design by Legacy Web Studio · WordPress · Log in


text:
Sturdy aluminum construction nonstick coating allows for easy food release and cleanup cool-touch handles Aluminum- Enjoy all your favorite breakfast foods with this double burner griddle, perfect...More
Find, Compare, Read Reviews & Buy the Imusa NonStick Griddle Online @ Yahoo Shopping Want to see your products in Yahoo Shopping? Advertise with us. Sitemap All Brands
Terms | Privacy | About Our Ads | Help


text:
english version
ashe|sixteen|5'0"/122lbs|bisexual|ufo hunter wannabe my name is ashley and i read male slash erotic stories. i am not afraid to admit that. why should i? it's a hobby i am damn well proud of. i don't take shit from anybody. i'm serious. anyway, don't take my stuff or i'll hunt you down. : ) i'm not very different from a lot of people, albeit i'm more creative and original than most. i follow my own routine and get by in life. i'm not special and if you think you are, then you're highly mistaken. i'm not a prude, but from what i've seen, the world is full of unoriginal people that just copy each other. show me you're original and we'll be just fine. writing is my passion. creating characters like rabbits mating has become quite the hobby. for a while, i had writer's block, but that's over now. however, what i do write isn't very long and chances are it'll be riddled with typos. i've gotten so much better, it's sickening. don't assume i'm an "illiterate trying to sound cool". i'm quite lit/advanced. as with writing, comes role playing. if and only if you believe you can keep up with me, send me a message and i'll see what we can do. i'm not a nice person under any circumstances. but, i don't think anyone can be a truly kind person. any negative thought and you're no longer nice. you're no longer looking on the bright side of things or going out of your way to help. people can have tendencies, but in the end, it's an innate behavior that drives us to watch the bullying, curse our parents and coworkers, and gripe when we have bad days. rarely, do i rant online. however, starting online fights: yes. this has become more of a sport than anything. if an opportunity shows itself, i'll take it, depending on how i'm feeling for drama. if you feel like starting something with me, by all means, do so. it will be the highlight of my day. :) i'm half gay, so i guess that makes me bisexual. i've come to terms with it. as much a supporter as homosexuality as i am, i don't go proclaiming my sexuality. it's just not smart. most of my friends and family know, but not kids or teachers at my school. why? people'll start thinking my decisions are biased and in the end, they'll assume everything i do is because of that. i don't blaim 'em. it's not like they can help it. again, it's human nature. i love fashion, but i don't follow it. i mean, i want to, but at this point, i can't. i'm that short, pudgy kid that wears clothes that're too big or the tight shirts that make them look fat. i'm not the kid that can stand in front of a class and not stumble over her words. i don't have the money for it. but these aren't excuses. i know; i've got mental barriers to work on. hell, my english teacher told me to stop psyching myself out. when i can stop wearing overly large clothes and keeping quiet so i don't draw attention, i'll finally start wearing the clothes i want. don't get me wrong, i'll still be continuing my path to becoming a fashion stylist . favorites~ zombies: moaning, groaning, and mutilated, zombies are quite the thing to fear. don't get me wrong, they freak the shit out of me, what with their cannibalism and ability to turn you into the undead fairly easily. ramen & arizona tea: the two greatest things ever created. : D i prefer stove top chicken flavored ramen and sweet tea. fanfiction: <3 one of the best things that i've found, by far. granted, one can't always find that well written of fanfiction, but once you do, hoah boy, are they FANTASTIC! erotic original, kakashi/iruka, neji/shikamaru, sasuke/naruto, sirius/remus, and harry/draco are just to name a few. manga & anime: my not so secret pleasure. this is really what kick started my love for japan, in the sense of wanting to learn more about the culture. well, five years later, i'm more obsessed than ever. i really, really want to visit, but living there and being respected as one of their own would be the icing on top of the cake. : D oh, how one can wish. ufos, bigfoot, cryptozoology, giant squids, yeti's, cover-ups, giant sharks, aliens, corruption: i think this one explains itself. who can't find themselves delving into the mysterious world of cryptozoology and the unknown? i believe that aliens do exist, bigfoot too. instead of explaining here, why don't you strike up a convo. about it?
japanese version romanji
hajimemashite. watashi wa ashley desu. doozo yoroshiku. sumimasen, nihongo oh heta desu. =_= watashi wa onnanoko to juu roku sai desu. me to kami ga chiyaro desu. demo, kami ga chotto nagai desu. america jin. kazoku wa go-nin desu. chichi to haha to ani to futago desu.-hontoo desu. obaasan no hitori desu. watashi wa omoshiroi no ojisan oh hoshiidesu. anou...kokoo ninesei desu. kokoo no namae wa chesterton desu. seibutsu to sugaku to eigo to nihongo no gaikokugo to americashi to bijyuutsu to jisyuu oh toteimasu. nastu no yasumijikan desu. shuumi wa eiga to terebigeemu to yaoi oh yonde to monogatari oh kakimasu. eiga: formula 17, wataa boisu, ariensu, miyazaki, seven samurai, rosta boisu, gurisu, biggu fishyu(sakana), HORROR(kyoofu), dawn of the dead, sirento hiru, residento eberu. terebigeemu: sirento hiru (4 & home coming), residento eberu (x, 2, 4), sims 2, magna carta, onimusha (1,2), kingdom hearts, finaru fantasy (x, x-2, xii), bioshock. yaoi no mangaka: watanabe asia, naono bohra, sawauchi sachiyo, hiiro reiichi, mizukami shin, sadahiro mika, kazuma kodaka. watashi wa nihon no fasshon desu. watashi no shigoto wa nan desu ka? fasshon sutairisuto desu. : D fasshon sutairu: ajiajamu.com, tori, ganguro, gyaru/himegyaru. watashi wa gyaru to ganguro oh jidaiokure desu. ganguro: an alternative fashion trend of blonde or orange hair and tanned skin among young Japanese women that peaked in popularity around the year 2000, but remains evident today. The Shibuya and Ikebukuro districts of Tokyo are the center of ganguro fashion. gyaru: The term gradually drifted to apply to a younger group, whose seeming lack of interest in work or marriage gained the word a "childish" image. It is now used almost interchangeably with kogyaru and younger generations may consider it clichéd or even archaic. himegyaru: girls who dress as princesses. Hair colours vary from blonde to brown and is usually very big and teased. They wear expensive clothing from brands such as Liz Lisa and Jesus Diamante. tori fasshon: The term 'Street Fashion' is used to describe fashion where the wearer personally customizes the outfits by adopting a mixture of current and traditional trends. Such clothes are generally home-made with the use of material bought from the stores. popteen, egg, cawaii.
はじめまして。 私 は アシュリ です。 どうぞ よろしく。 すみません、 日本語 を へた です。 =_= 私 は 女の子 と 十六 さいです。 目 と 毛 ちやろ です。 でも、 毛 が ちょ、 と ながい です。 アメリカ 人。 かぞく は 五 にん です。 父 と 母 と兄 と ふたご です。-ほんとう です。 おばあさん の ひとり です。 私 は おもしろい の おじさん を ほしい です。 ここうにねんせい です。 ここう の なまえ は チェステタン です。 せいぶつ と すがく と えいが と 日本語 の がいこくご と アメリカしと びじゅうつ と じしゅう を とていす。 なつ の やすみじかん です。 しゅうみ は えいが と テレビ ゲ-ム と やおい を 読んで と ものがたりを 書きます。 えいが: フォムラ 一七、ウォーターボーイズ、 アリエンズ、 みやざき、 七人の侍、 ロスタ ボーイズ、 グリス、 ビェガ フイシュ(魚)、 きょうふ、 ダ-ヌデイド、 サイレント ヒル、 レセデント エベル。 テレビ ゲ-ム: サイレント ヒル(四 & ホ-ム コミ ング)、 レセデント エベル(X, 二, 四)、 シムズ 2、 マ グ-ナカタ -、 おにむしゃ(一,二)、 キングダムハーツ、 ファイナルファンタジー(x,x-2,xii)、 バイオ ショ ック。 やおい の まんがか: わたなべ あじあ、 直野儚羅、 沢内 サチヨ、 緋色れーいち、 水上 シン、 定広美香、 こだか和麻。 私 は 日本 の ファッションです。 私 の しごと は 何ん ですか。 ファッション スタ イリス ト です。 : D ファッション スタイル: アジアジャ-ム.com、 とり、 ガングロ、 ギャル/姫ギャル。 私 は ギャル と ガングロ を じだいおくれ です。 ギャル: は、若い女性を意味するガール(girl)が訛ったものであり、日本では、活発な若い女性、ピチピチした心優しい若い女性、今時の女性の意味であり、 1972年にGalsという女性用ジーンズが発売された時から広まった。一般的に1970年代当時、ニューファッションに身を包んだ女性の総称を指す。バ ブル期には若い活発な女性をさす言葉として使われた。 ポップティーン、 エッグ、 カワイイ!
689 total episodes
There are no comments - leave one to be the first!


text:
Sign up for our newsletters
Receive the latest in Footwear, Fashion, Music and Creativity in our newsletters.
Developing its very own aesthetic based on quality and simplicity, Head Porter's Plus clothing line has provided a slightly different set of options for those looking for timeless basics. Stressing proper materials and construction, some previews into this season's range include chinos, a T-shirt and a Harrington style jacket lined with plaid. Available through select Head Porter Plus retailers.
Source: honeyee


text:
Currently in Production: The Hoodie Kimono
New for 2017 and available designer direct and at Sassafras in downtown Seattle. OPP's Hoodie Kimono is perfectly cozy and fits all bodies! Throw this swingy alternative to a wrap on over a sweater and luxuriate in it's easy-to-wear stylings. Made from a mix of new and vintage fabrics, many are one-of-a-kind. Find yours today!
Other Peoples Polyester is a line of handmade cardigans and zip pouches that feature a mix of cotton knits and vintage fabrics. Inspired by Mod and Japanese street fashion, OPP Clothing is 100% designer sewn in downtown Seattle by fashion designer Malia Peoples.


text:
When Ke$ha sang "We R Who We R," who knew this was what she had in mind?
In an interview with The Hollywood Reporter to promote her new MTV docu-series "Ke$ha: My Crazy Beautiful Life," which premiered Tuesday (April 24), the flamboyant pop diva opened up about a particular moment caught on camera — one in which she drank her own urine.
"I heard it was good for you. That was, like, the rumor," Ke$ha says. "But I don't know. I'm also just one that doesn't shy away from things. I'm not good at saying 'no' so I just figure, f–k it, I'll try anything once. So I tried it. I wouldn't recommend it. It was pretty gross."
REVIEW: "Ke$ha: My Crazy Beautiful Life"
As for the rumored advantages? "I don't think it really did anything very beneficial to me so yeah, I wouldn't probably do it again," the "Die Young" singer admits.
"I'm curious like a cat. I'm just curious about things. It's the same reason I jumped out of an airplane is that, I figure, just try stuff once. Why not?" Ah, the old "Drink urine, why not?" story. If we had a nickel for every time we've heard that one — we'd have a nickel.