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Transcript of The Body's Live Chat on Lipoatrophy (Fat Loss) With Dr. Joel Gallant
Sponsored by Gilead Sciences
Following is the transcript of The Body's live chat on lipoatrophy (fat loss), which took place on Nov. 1, 2005, at 9 p.m. Eastern Standard Time. The chat was sponsored by Gilead Sciences, moderated by The Body's editorial staff and hosted by Dr. Joel Gallant, a leading HIV specialist in the United States. This transcript has been edited for grammar and clarity. In rare occurrences, additional follow-up information was obtained from the host after the chat's conclusion.
This is the fourth chat that The Body has moderated; to see transcripts of previous chats, click here.
Chat Room: Thank you for joining this live, interactive chat at TheBody.com! During tonight's chat, Dr. Joel Gallant will answer your questions about lipoatrophy, the loss of fat in certain parts of the body. This chat is sponsored by Gilead Sciences, which produces several HIV medications.
Room is moderated. You can now talk.
Moderator 1: Thank you all for coming to The Body's live, interactive chat on lipoatrophy (fat loss), a difficult health issue experienced by many people who take HIV medications.
Our speaker for tonight's chat on lipoatrophy is Dr. Joel Gallant, one of the United States' most knowledgeable HIV specialists.
Moderator 1: Dr. Gallant, we're honored to have you as our chat speaker tonight. Is there anything you'd like to tell everyone about yourself before we let the questions fly?
Dr. Joel Gallant: I'm an assistant professor of medicine and epidemiology at the Johns Hopkins University School of Medicine, and associate director of the Johns Hopkins AIDS Service [in Baltimore, Md.]. I also run the Garey Lambert Research Center, which conducts clinical trials of new antiretroviral agents. I run a question and answer forum for people with HIV infection on the Johns Hopkins AIDS Service Web site (www.hopkins-aids.edu/ask.html). And of course, I also take care of lots of patients!
Moderator 1: Thanks, Dr. Gallant! With that, I think we're ready to start tackling everybody's questions. Fire away! (Remember: Since this is a moderated chat, you won't see your question in the chat room until Dr. Gallant answers it.)
Original message from Edward: Can you give us a definitive answer on the difference between lipodystrophy and lipoatrophy? It's very confusing to me! Thank you.
Reply from Dr. Joel Gallant: I agree -- it IS confusing, which is why I try never to use the word "lipodystrophy." We used that term, along with "fat redistribution," back when we thought that fat was being "redistributed" from the face, arms, legs, and buttocks to other areas, such as the abdomen, breast, and the upper back ("buffalo hump"). Now we know that those can be separate processes. So it's better to use more precise terms: "lipoatrophy" to describe loss of subcutaneous fat, and "fat accumulation" to describe ... well, to describe fat accumulation. It's also easy to confuse lipoatrophy with wasting, because they can look the same. Wasting is loss of both fat and muscle, usually caused by uncontrolled HIV infection. It can also be caused by low testosterone levels, poor nutritional intake, malabsorption, or other endocrine problems. By the way, although this is supposed to be a chat about lipoatrophy, we can talk about fat accumulation, too.
Moderator 1: Please keep in mind that there may be a delay of a minute or two between answers, as Dr. Gallant writes his next response to one of your questions. Thank you for your patience!
Original message from sfguy: I was on HIV meds for a long time -- about eight years. I'm on a cocktail holiday now. I've not taken meds for seven months now. I'm wondering if I still can get lipoatrophy. My arms have gotten smaller, and my legs.
Reply from Dr. Joel Gallant: You can't get lipoatrophy if you're not on medications. However, you CAN lose weight. Remember "wasting"? That's what happened to people in the bad old days before we had effective therapy. If you're losing weight after taking a drug holiday, maybe your body is trying to tell you something!
Moderator 1: Our live chat on lipoatrophy (fat loss) has begun! Please continue to submit any questions you may have for Dr. Joel Gallant, one of the United States' most knowledgeable HIV specialists.
Dr. Gallant is the associate director of the Johns Hopkins AIDS Service, one of the foremost HIV medical centers in the United States; the editor of "The Hopkins HIV Report," a bimonthly HIV care newsletter; and the co-author of the seminal HIV treatment guide "Medical Management of HIV Infection."
Original message from Brick: Fat loss may be due to insulin insensitivity, from what I can gather. Would [the] insulin meds used by diabetics be one way to combat fat loss?
Reply from Dr. Joel Gallant: Insulin wouldn't work well, because your body would be resistant to it. But, if you have insulin resistance, then some of the insulin sensitizers, like metformin [brand names: Glucophage, Fortamet] or the "glitazones" [like the brand name drug Avandia], might help decrease your blood sugar, and they MAY help to decrease fat accumulation.
Original message from hoffer: What do you think of Sculptra for facial lipoatrophy?
[Editor's Note: Sculptra, also known as New-Fill, is an injectable product made of poly-L-lactic acid. It has been approved by the U.S. Food and Drug Administration to correct facial fat loss in people with HIV.]
Reply from Dr. Joel Gallant: All I can say is that some of my patients are so happy with it that they burst into tears after each treatment, and I certainly notice the difference, too. The real question relates to durability of the effect. I'm sure that occasional touch-ups will be required, but if you're able to get off the drugs that are causing the lipoatrophy, then Sculptra may help to improve your appearance while you wait for fat to slowly return.
Original message from Michael H: Besides aesthetics, does lipoatrophy of the face pose any other health problems?
Reply from Dr. Joel Gallant: No, there are no known health problems associated with facial lipoatrophy. However, I have seen people with lipoatrophy of the legs or buttocks develop "compression neuropathies" (tingling or numbness) because their nerves are no longer padded by fat and can be compressed by sitting on a wallet, crossing your legs, etc.
Original message from megan_rn: What is the best combination of meds for someone who is going to start therapy [and who] wants to minimize body changes? Thank you.
Reply from Dr. Joel Gallant: If you have no drug resistance and can take anything you want, then combinations that are unlikely to cause body shape changes would be either Truvada [generic name: tenofovir/FTC] or Epzicom [generic name: abacavir/3TC; also known by the brand name Kivexa] PLUS either Sustiva [generic name: efavirenz; also known by the brand name Stocrin], Viramune [generic name: nevirapine], or Reyataz [generic name: atazanavir] (preferably Reyataz boosted with Norvir [generic name: ritonavir]). However, you're unlikely to get lipoatrophy with any protease inhibitor, as long as you're using Truvada or Epzicom, and the association between fat accumulation and protease inhibitors is not as direct as the association between lipoatrophy and thymidine analogs (like AZT [brand name: Retrovir; also known as zidovudine] and d4T [brand name: Zerit; also known as stavudine]).
Original message from thomasb1230: I have lipoatrophy. I went from 155 pounds to 135 in two years. CD4 is 350 and viral load is <2,000. I feel great. Why should I be concerned about lipoatrophy? Isn't it just a loss of body fat?
Reply from Dr. Joel Gallant: The main reason to be concerned is just because it changes your appearance, making you look older or sicker than you are. If that doesn't bother you, then you're unusual, but that's OK. Still there MAY be a link between lipoatrophy and fat accumulation or increased lipids. If the fat you eat can't go to the usual places, it has to go somewhere else.
Original message from AlexP: I am an African-American male age 43 and in the past year [I] have [had] tremendous facial loss. I stopped taking Zerit last year and switched drugs, but after nine months the facial muscle has not come back. What can I do besides cosmetic surgery to increase facial muscle? Also, [I have visible] veins in [the] lower limbs of [my] legs and loss of buttocks on both sides.
Reply from Dr. Joel Gallant: It's probably not facial muscle that you've lost, but facial fat. The same is true for your legs and buttocks. If you've switched from Zerit to either Viread [generic name: tenofovir] or Ziagen [generic name: abacavir] (rather than to AZT), then your fat should start coming back, but it can take a long time, and there's no guarantee that it will be completely restored. If you've got the money, Sculptra injections seem to be the most effective way to deal with facial fat loss.
Original message from ladyluck: Have there been any studies on [the] prevalence of lipoatrophy among one race or sex [as compared to] another?
Reply from Dr. Joel Gallant: In some studies, there has been a tendency for men to develop lipoatrophy sooner, while women are more likely to develop fat accumulation. This may just be due to the fact (like it or not!) that women tend to have more body fat to start with, so it takes them longer to lose fat, and fat gain will be more apparent. I haven't seen too much on racial differences.
Original message from travelover: I have experienced weight loss in my face, legs, and buttocks, and at the same time gained weight in the stomach. Does the fat loss transfer to the stomach area?
Reply from Dr. Joel Gallant: Not exactly, though it's true that if you have no subcutaneous fat stores in the usual places and you gain fat, it has to go somewhere, so it might go to the abdomen or other areas. It's like people who get their love handles removed by liposuction: If they don't exercise regularly and watch their diet, they can get fat build-up inside their abdomens. The love handles may not come back, but they may still look fat.
Original message from Arbelboy: Do the nerves that lose their fat ever come back at all or will I feel the tingling on my face forever?
Reply from Dr. Joel Gallant: You don't lose nerves when you get lipoatrophy. If you have tingling in the face, that's probably caused by something else.
Original message from radcliffe: My nutritionist did a body fat analysis on me using electrodes. My fat was pretty high. He was concerned because I don't necessarily look like I am carrying that much fat, but it was significant enough to concern him. We suspect that I have hidden fat that developed in crevices between my organs. Have you heard of this? Do you have any suggestions on losing this fat? Thanks.
Reply from Dr. Joel Gallant: I'm not a big fan of BIAs, which is probably what you had, because they don't tell you anything about where the fat is located. In other words, it's not going to distinguish between subcutaneous fat and visceral (intra-abdominal fat). If you look and feel OK, you're probably OK. But it never hurts to improve your diet and exercise more. You can use the BIA results for motivation.
Moderator 1: BIA is short for "bioelectric impedance analysis."
Original message from dj_joe: I am a 59-year-old male and have always had a very flat nice trim stomach. All of a sudden I have a very, very large round abdomen. I have been HIV positive for 20 years and this has started in the last six months. What is going on?
Reply from Dr. Joel Gallant: I don't know, because I don't know what meds you're taking or what other conditions you have. It's important to distinguish treatment-related fat accumulation from the obesity that often afflicts us as we grow older. If you can grab a handful of belly fat and pinch it between your fingers, then you have to blame the french fries and the TV remote control, not the drugs. On the other hand, if your fat is all INSIDE your belly, then it may be related to treatment, in which case I'd want to know more about the drugs you're on, your lipid profile, and whether you have insulin resistance. However, regardless of the cause, aerobic exercise and a low-fat diet can help.
Original message from knuck: Can weight lifting reverse the effects of wasting?
Reply from Dr. Joel Gallant: You can't bring fat back through weight lifting, but you can build muscle that can help to compensate for the fat loss. Squats and stair-climbing machines can build up your buttocks, for example, even though it may not look like the same butt you had before you lost the fat. Of course, it's also important to avoid the drugs that cause fat loss.
Moderator 1: Dr. Gallant, the person who asked a question earlier about tingling in the face has asked if you could talk about what the tingling might be caused by. Could you add any thoughts?
Dr. Joel Gallant: I can't make a diagnosis from here; all I can say is that I see a lot of people with lipoatrophy and they don't have facial tingling. You should really discuss this with your doctor or with a neurologist to find out the cause.
Original message from wunderbar: I have been dealing with facial wasting for years. What is the best way to fix the problem? Fortunately, I live in a small town and most don't recognize the facial wasting as an HIV problem. I go to an infectious disease doctor locally and he is not willing to help me convince my insurance company to cover such things as Sculptra. I went to a plastic surgeon and he said the facial wasting is cosmetic. I don't have a social life because I feel like I look so disfigured. Who would want to be seen with me? I can barely stand to look at myself in the mirror to shave or brush my teeth. Please let me know what I can do. Thanks.
Reply from Dr. Joel Gallant: It's true that facial wasting is a "cosmetic problem," but that doesn't mean it's not important. And since it's a complication of medical therapy, it's a shame that we can't convince insurance companies to pay for it, but so far, I haven't heard of this happening. There is a patient assistance program provided by the manufacturers of Sculptra that can help to offset the cost of the material, but you'd still have to pay the plastic surgeon his fee. You should also check around, as dermatologists do this as well, and some might have lower fees. And of course you need to make sure you're not still on drugs that can make this worse.
Original message from theoc: What are the drugs that have been identified to cause lipoatrophy? Is lipoatrophy reversible? My regimen is Viramune and Combivir [generic name: AZT/3TC] and my lipoatrophy is continuing. What are your suggestions for a switch in treatment drugs?
Reply from Dr. Joel Gallant: The drugs that are known to cause lipoatrophy are d4T, AZT (whether it is in the form of Retrovir, Combivir, or Trizivir), and possibly also ddI [brand name: Videx; also known as didanosine]. Drugs that are NOT believed to cause it are 3TC [brand name: Epivir; also known as lamivudine], FTC [brand name: Emtriva; also known as emtricitabine], tenofovir (whether it is in the form of Viread or Truvada), and abacavir (whether it is in the form of Ziagen or Epzicom). Because you're on Combivir, you could still be losing fat due to AZT. If your resistance pattern (or lack of it) will allow you to switch to Truvada or Epzicom, that could help a lot.
Original message from D71: My dermatologist recommended Sculptra over silicon fillers. He said that the effects are more natural. I was happy with the results, but not the cost and ongoing maintenance. What are your thoughts on silicon vs. Sculptra?
Reply from Dr. Joel Gallant: I'm not a dermatologist or a plastic surgeon, but my feeling is that Sculptra may be longer lasting than silicon, and my dermatologist colleagues seem to prefer it. I've also heard of silicon causing more "lumpiness."
Original message from lazlo: How do you know which drugs cause this problem? Could others cause it and we just don't know yet?
Reply from Dr. Joel Gallant: Sure, anything could happen if we wait long enough. But we have head-to-head trials that show a clear difference. For example, after three years, people on d4T got lipoatrophy, while those on tenofovir didn't. And we also know that switching from d4T or AZT to either tenofovir or abacavir allows fat to return, which makes it pretty unlikely that either of those drugs causes lipoatrophy.
Original message from Frank: Hi. I have been diagnosed with HIV for about four years now. I do not take any medication, but at the same time am scared of the side effects of the treatment, especially lipoatrophy. I was wondering if there is anything that I can do before starting my treatment to prevent it? Or at least make it as less [of an] effect as possible? I am not sure for how long my CD4 level [will stay] high to keep me away from medication. Thank you.
Reply from Dr. Joel Gallant: Frank, the best thing you can do is to take medications that don't cause lipoatrophy, which is easy enough to do if you're starting therapy for the first time, without any drug resistance. I have lots of patients with lipoatrophy, but they're all people who've been on therapy since back in the 20th century. I'm not seeing NEW development of lipoatrophy anymore, because we now have better treatment options. Don't let the fear of lipoatrophy dissuade you from taking antiretroviral therapy if you need it!
Original message from Brick: It's now known that nucleoside analogs are causing the fat loss [seen with] HIV meds. But, isn't acyclovir [brand name: Zovirax] also a nucleoside analog and would it also contribute to the fat loss?
Reply from Dr. Joel Gallant: Not all nucleoside analogs cause lipoatrophy. It's primarily the thymidine analogs (d4T and AZT). There's no risk to taking acyclovir.
Dr. Joel Gallant: We're having some problems with communication with the moderator, so I'll do my best to provide both the questions and answers, since he can't post the questions.
Original message: What treatment options are available for facial lipoatrophy other than Sculptra and fat injections? What protein and micronutrients package should I be adding to my diet and exercise routine to counteract the lipodystrophy? Do you have a list of recommended packages?
Reply from Dr. Joel Gallant: The best treatment for facial lipoatrophy is not to take the drugs that cause it. I'm not aware of any nutritional interventions that have been shown to work. Aerobic exercise is great for fat accumulation and for overall health, but it can sometimes make lipoatrophy worse. (After all, if you've ever looked at the legs of a serious runner, you won't see much subcutaneous fat!)
Original message from Paul: Are there any studies with Sculptra open for enrollment? How can I connect with an experienced doctor? I've been on HIV medication for three years now (efavirenz, didanosine, and lamivudine) and have lost about 10 percent of my body weight (from around 60 kgs to 53 kgs -- I never was at all fat). My skin is sallow from the weight loss; no fat deposits thankfully though on my stomach or elsewhere. My viral load has been undetectable all along and my T-cell count has gained slowly, but steadily to around the 350 mark. What can I do to reverse the fat loss?
Reply from Dr. Joel Gallant: Paul, if there's a way for you to switch from didanosine/lamivudine to either Truvada or Epzicom, that might help, since we believe that didanosine might contribute to lipoatrophy. I couldn't comment on Sculptra studies, because it depends on where you live, but the company does have a pretty generous patient assistance program. That can help offset the cost of the material itself, but not of the doctor's procedure fee. The point is to find a dermatologist or cosmetic surgeon who is doing it in your area.
Original message from Per: Hello from Oslo/Norway. Dear Dr., [I had no problems with fat until I started Kaletra (generic name: lopinavir/ritonavir) and began to lose] fat on my legs, thighs, arms, and face and put on fat around my chest and stomach. My question is therefore simple: Is Kaletra worse than other AIDS/HIV medicine? Kind regards Per.
Reply from Dr. Joel Gallant: Per, Kaletra by itself should not cause fat loss. But you must be on more than just Kaletra. It may be the other drugs in your regimen that are causing the problem.
Original message: Hi Dr. Joel. I need to ask you: What good foods should I eat to take better care of myself? Thank you.
Reply from Dr. Joel Gallant: The recommendations are similar to those for everyone else: Eat lots of fresh fruits and vegetables; eat complex, unrefined carbohydrates (e.g., whole grains, brown rice, etc.) rather than simple or refined starches; and minimize sugar and fat intake. If you eat meat, go easy on the red meat and eat more poultry and fish. Avoid fast food or pre-prepared food, which is often high in fat and salt, and avoid fried foods. And make sure that you're eating food you like, or else you'll never be able to keep up with your healthy diet.
Original message: Lipoatrophy affects many HIV-positive people -- some with specific area disfiguring. However, most of us who are long-term HIV-positive persons experience simply a uniform fat loss in particular subcutaneous fat over a long period of time. HIV itself was suspected by many physicians for years as the cause of this. However, recent research is now pointing to nucleoside analogs (i.e., AZT) as the main cause. If this is in fact the case, what would you suspect the results would be by changing to non-nucleoside analogs? In other words, would the lipoatrophy be apt to cease and even reverse? And, if you suspect a reversal, how long after stopping nucleoside analogs do you think a person would begin to show signs of fat replacement? And secondly, what can one do to help promote this reversal in the way of supplements or medications? Would insulin medications prescribed for diabetes be helpful?
Reply from Dr. Joel Gallant: You don't necessarily need to switch to a non-nucleoside analog; you just need to switch to a nucleoside analog that doesn't cause the problem. The biggest culprit is d4T, but AZT does it too, and ddI may also contribute. We now know that this IS a reversible problem, if you can switch from d4T or AZT to tenofovir or abacavir, but the changes don't happen overnight. In the GS903E study, people who switched from d4T to tenofovir regained about as much fat after one year as they had lost in their last year on d4T. It MAY be the case that you regain fat at about the rate that you lost it.
I don't know of any supplements that will help speed this process along. Insulin isn't going to help. There has been some conflicting data on the use of "glitazones" -- insulin sensitizing agents used for diabetes -- but for the most part, the data don't suggest that they're of much benefit for lipoatrophy.
Original message: I have low testosterone and am taking Androgel [generic name: testosterone gel], which helps. I also have facial wasting, Crix-belly, and the start of a buffalo hump. Is there a proven correlation between hypogonadism and lipoatrophy?
Reply from Dr. Joel Gallant: Not between hypogonadism and lipoatrophy, but hypogonadism can cause muscle wasting, which can sometimes look similar.
Original message: I have been on antiretrovirals since 2000. Initially Crixivan [generic name: indinavir] plus Zerit and 3TC. This was changed after three months of nausea and vomiting to Viracept [generic name: nelfinavir] plus Zerit and 3TC. Initially I put on a lot of weight and was forced to start exercising. Then, after three months, diarrhea set in. I had to run to the toilet every time I ate something. Two years of this and after losing 15 kilograms, especially in my legs, [I] had my meds changed to Viread, Combivir, and Viramune. I started feeling better within weeks but for the skinny legs, arms, butt, and face. Managed to put on 5 kilos after about a year, although all this went to my breasts, tummy, and buffalo hump. I am such a sight it's depressing me. Five months ago [I] decided to go to the gym in the hope of gaining a bit of muscle in the right places and losing in the wrong places. So far I have only managed to lose the little I had put on in my legs, and my butt looks like empty bags. I'm depressed to say the least and I am looking for immediate answers.
Reply from Dr. Joel Gallant: It sounds like you need to get off the AZT, if you can do so without jeopardizing your virologic response. Everyone knows now that d4T causes lipoatrophy, but we often forget that AZT does it too, but just at a slower rate. Getting off AZT won't make everything all right again, but it could halt further loss of fat, and may allow fat to return ... slowly. You're now on drugs that are less likely to cause fat accumulation, but that doesn't mean that what happened to you on previous regimens will go away. With fat accumulation, the things to do are to (1) eat a low-fat diet; (2) exercise regularly, especially with aerobic exercise; (3) keep your lipids, and especially triglycerides, under control; and (4) treat insulin resistance, if you have it. Insulin resistance is diagnosed by fasting insulin levels and/or glucose tolerance tests.
Original message: Losing fat on my bums and thighs, but the tummies are growing bigger. I can't seem to lose these fats even by exercising. What can I do to shed the fat on my tummies? I am currently on HAART treatment. (1) I have lost tissue in my legs, especially around my knees. Can this tissue come back with changes to regimen? (2) I was able to get Sculptra for free because of my financial situation and although I'm 80 percent pleased with the results, what's happening with insurance companies determining that this should be considered a reconstructive procedure as opposed to cosmetic? I still had to pay for the plastic surgeon's time, which wasn't cheap!
Reply from Dr. Joel Gallant: Just how many "bums" and "tummies" do you have??? One bum and one tummy are enough for most of us!
You didn't give me the details of your HAART regimen, which is important. But I'm sure you'll find answers to your questions during this chat.
Original message from Home: Is eating too much sugar a contributing factor to lipo?
Reply from Dr. Joel Gallant: It could definitely contribute to fat accumulation, but probably not to lipoatrophy. If you have fat accumulation, you need to avoid insulin resistance and hyperglycemia if possible.
Original message from Duane: Hello Dr. Gallant. I've not experienced really extreme lipoatrophy, but [have noted a] general loss of mass in the face. What could I do to lessen the effects? Are there any cosmetic remedies that the VA Hospital would justify as part of ongoing treatment?
Medical history: 1991: AZT. 1994: added ddC [brand name: Hivid; also known as zalcitabine]. 1996: added Crixivan. 1998: changed regimen (not due to resistance to meds) -- new regimen: Sustiva, d4T, and 3TC. 2005: dropped d4T and added Viread. Current regimen: Sustiva, Viread, and Epivir. Thanks in advance.
Reply from Dr. Joel Gallant: Duane, for the first time, you're on a regimen that should not cause lipoatrophy. So the problems you're experiencing are probably due to prior regimens. At this point, some of your fat might be returning, though slowly. I don't know what the VA will cover. It's hard to imagine that they'd cover Sculptra injections, but who knows? It couldn't hurt to ask.
Moderator 1: We'll be wrapping up this chat within the next several minutes. Thank you all for your patience! We can't apologize enough for the technical problems we've experienced; hopefully you've still found this an informative chat.
Original message from stopdisnow: What are the worst antivirals for fat accumulation in the stomach and breast? They want me to take Trizivir [generic name: AZT/3TC/abacavir] and Reyataz. My CD4 is down to 89.
Reply from Dr. Joel Gallant: The link between antiretrovirals and fat accumulation isn't as strong as the link with lipoatrophy, but drugs that cause high triglycerides and insulin resistance may be the ones that cause the problem the most. Protease inhibitors cause those problems, but Reyataz seems to be an exception, so the regimen they're recommending is probably pretty safe from a fat accumulation perspective. You clearly need to be on something now!
Original message from D71: In an earlier answer, you mentioned that ddI may contribute to lipoatrophy. I am on Viramune, Viread, and Videx EC. I have some fat loss in my face and significant loss in my legs. You have mentioned that Viread and Viramune do not cause lipoatrophy, so those should be fine. Should I talk to my doctor about switching to something other than Videx EC? Is there another drug in that class that would be as effective without the fat loss?
Reply from Dr. Joel Gallant: We don't have a lot of information on Videx, because for many years it was usually combined with other drugs that cause lipoatrophy (AZT and d4T). However, there is reason to believe that Videx COULD cause lipoatrophy. In addition, there are several concerns about combining Viread and Videx, including CD4 decline and easy selection of resistance, especially when combined with Viramune or Sustiva. So you have several reasons to discuss this with your doctor.
Moderator 1: If any of you have missed part of tonight's chat, don't worry: A full transcript will be available on TheBody.com within the next week.
Original message from Stephan: How does a guy like Magic Johnson look the way that he looks after announcing years ago that he has HIV. He still looks good, while some of us are wasting away. What has kept him from wasting? Do we know?
Reply from Dr. Joel Gallant: There's nothing "magic" about Magic. Plenty of my patients look great after years of HIV infection. It depends a lot on whether you have resistance or not. If you don't, you can choose medications that don't cause body shape changes. However, if you do have a lot of resistance, you sometimes have to take drugs that cause more problems in order to suppress your viral load. I've met Magic Johnson, and he's not taking anything that isn't available to anyone else.
Original message from chuck: I have lost fat in my ankles and cannot run anymore! My ankles just can't support my athleticism. Anything I can do to reverse this?!
Reply from Dr. Joel Gallant: Who wants fat in the ankles? And why do you need fat ankles to run? You've confused me with this question!
Original message from pos28: Before giving a diagnosis of lipoatrophy, do you first have ways in which you measure each patient's muscle/fat ratios to rule out muscle wasting as the true cause of let's say thinning thighs and flattening buttocks?
Reply from Dr. Joel Gallant: In most cases, it's a diagnosis that can be made just by physical examination. No tests are usually necessary. However, I do usually check the testosterone level, just to be sure that there's no muscle wasting related to hypogonadism as well. If the viral load is undetectable, I'm not worried about HIV-related wasting.
Moderator 1: This chat will conclude in just a few minutes. Thank you all again for joining us tonight!
Original message: What is the best way to get your stomach not to look like you are five months pregnant?
Reply from Dr. Joel Gallant: Use birth control! (Just kidding, but by now I think I've answered this question several times already.)
Original message from Terry: I have had lipoatrophy for four years now. I am currently in a rollover study at the University of Kentucky using TMC125 and Fuzeon [generic name: enfuvirtide; also known as T-20]. I have noticed the large veins in my legs are not as pronounced and I feel as if maybe my face looks a little less gaunt. Could there actually be some type of reversible lipo going on in my body? By the way, I went from [a viral load of] 270,000 to 4,000 and will be tested again in mid November.
Reply from Dr. Joel Gallant: Terry, we know that lipoatrophy is reversible if you stop the drugs that cause it. The reversibility is slow and may not be complete, but that's better than nothing. You didn't mention the drugs you took before and are taking now, so I can't comment on whether that's what happened in your case. Keep in mind that while our focus is now on fat loss, there's still such a thing as HIV wasting: loss of both muscle and fat due to untreated HIV disease. If your viral load has dropped from 270,000 to 4,000, you may be gaining weight, including both fat and muscle, just because you're healthier!
Moderator 1: Our interactive chat on lipoatrophy (fat loss) has now concluded. Thank you, Dr. Gallant, for taking the time to answer everyone's questions!
To all of you who asked questions or took the time to join our chat tonight: Thank you for tuning in, and for making this chat a success!
A full transcript of this chat will be available on TheBody.com within the next week. As soon as it's up, we'll provide a link to the transcript within our weekly e-mail newsletter.
Dr. Joel Gallant: It's been a pleasure. I hope you all found it helpful. Good night.
Moderator 1: To those of you whose questions we were unable to answer tonight: Please try visiting The Body's lipoatrophy information page at www.thebody.com/treat/lipoatrophy.html for more information, or ask our staff of experts at www.thebody.com/experts.html.
Thank you all again! Have a good night!
Post-Chat Questions
These questions were submitted before or during the chat, but because of time limitations, Dr. Joel Gallant did not have the chance to answer them.
Original message: Regarding treatment for facial lipoatrophy: What is considered the longest lasting filler material and is it therefore a logical choice vs. others available?
Reply from Dr. Joel Gallant: The best results I've seen are with polylactic acid (Sculptra), which is now approved. It may be too early to say how long the effects will last without "touch-up" injections, but it seems more longer lasting than collagen or fat injections.
Original message from Kurt: Four years ago, I developed Kaposi's sarcoma. I was treated with interferon. After years of negative screenings, I tested positive in July of this year. My CD4 count was as low as 140 and my viral load over 200,000. I [have now been] on treatment [for six weeks]. After two weeks into the treatment, a screening test was performed. (Viral load under 600 and CD4 [count] of 180.) I am given Truvada (1 a day), Norvir (2), and Telzir (2). I am very concerned about fat loss. (By the way, I am living in Munich, Germany.) Best regards.
Reply from Dr. Joel Gallant: For the rest of you, Telzir is what we Americans call Lexiva [generic name: fosamprenavir; also known as 908]. The combination of Telzir and Truvada should not cause fat loss.

subset: commoncrawl


text: Flight Time wrote:I think any line swivel is of little value anyway because they won't spin with any tension on the lines. The lines will twist before the swivel moves, no matter how nice the swivel. Better to have it on the loop so you can deal directly with the inevitable twists.


text:
Gov. Scott Announces Initiative To Keep Florida #1 In Spring Training
Today, Governor Rick Scott participated in the 16th "Let's Get to Work Day" at Joker Marchant Stadium and announced that he will work to provide $5 million annually to be used only for spring training facilities. During the workday, the Governor participated in daily operations for the Detroit Tigers Baseball team, including working at the concession stands, managing equipment and working with the grounds crew.
Governor Scott said, "My top priority is growing jobs for Florida families – and spring training has provided families in Florida with countless job opportunities since the 1800s. It's my job as Governor to make sure Florida remains the number one destination for spring training and that is why we will work to provide $5 million annually to only be used for spring training facilities. We must protect and enhance this vital business for Florida families."
While current law provides some ability for local governments to incentivize spring training baseball, there is no predictability or a regular funding stream for spring training in Florida. That means if teams need renovations to their facilities, they must begin at square-one to secure funding and planning from the state and from local governments. Currently, 15 teams use Florida facilities for spring training, three teams' leases come up for renewal in 2016, and two come up for renewal in 2017.
Under the initiative, local governments will be required to match at least 50 percent of project costs. State contributions for each project would be capped at $20 million and the Department of Economic Opportunity would review and approve the match to ensure it provides a return on investment for taxpayers.
More than 1.5 million fans attend spring training games annually, and provide a $750 million benefit to the state each year. Since the 2000 season, more than 20 million fans have passed through the turnstiles at Florida stadiums.
Governor Scott continued, "We must provide teams a predicable landscape, with an identified funding stream that allows local governments to make targeted investments to keep teams in their communities."
Senator Jack Latvala said, "Spring training pays huge dividends for our communities. The more we support baseball in Florida, the more opportunities will be expanded for our residents. This $5 million, recurring investment by Gov. Scott will support jobs across our state."
Representative Seth McKeel said, "I welcome Governor Scott's announcement in Lakeland, which has the longest standing Spring Training relationship in Major League Baseball. Along with providing jobs and capital investment, Spring Training plays a key role in attracting tourists to the Sunshine State. I look forward to working with the Governor as we craft a budget for Florida."
David Dombrowski, President, CEO and General Manager of the Detroit Tigers said, "Florida has a long-standing tradition with the Detroit Tigers and Major League Baseball Clubs," Dombrowski said. "The Grapefruit League plays a significant role in the teams' preparation for each season as well as the development of their players. For 77 years the Tigers' organization has enjoyed an outstanding relationship with the City of Lakeland calling Joker Marchant Stadium and the complex their "Winter Home. We are excited and appreciative that the Great State of Florida is doing all it can to continue this partnership for many years to come."
Frank Coonelly, President of the Pittsburgh Pirates said, "The Pittsburgh Pirates this year celebrate our 45th spring in Bradenton, Florida. The bond between the organization and the Bradenton community runs deep and strong. We have been fortunate to have been able to forge meaningful public/private partnerships that have allowed us to build and update outstanding Major League facilities in Bradenton which we use for the year-round development of our Major League and Minor League players and staff. Each of the two major projects that we completed over the last six years was done primarily with local companies and local workers and resulted in other economic development in the community. It is critical as we move forward that resources are available at the state level that will allow Clubs to make the necessary capital improvements in their Florida spring training facilities so that the state can retain its 15 Major League Clubs and attract new Clubs to the Grapefruit League. The Pirates' relationship with Bradenton is an outstanding example of the type of win-win partnership that state resources can help replicate in other Florida communities."
John Webb, President of the Florida Sports Foundation said, "We are pleased that Governor Scott has taken such an active role in preserving spring training Baseball for generations to come. Spring training Baseball is as much a part of Florida as the beautiful beaches and theme parks. There's no better place to be in Florida during the month of March than a spring training baseball game."


text:
Whorff to speak at AARP meeting Teusday, Feb. 26
- Details
- Category: Community
- Published on 24 February 2013
- Written by Mount Vernon Optic-Herald
Dr. John Whorff will be the guest speaker at the Franklin County American Association of Retired Persons Chapter 3703 meeting at 6 p.m. Tuesday, Feb. 26
at the Senior Meal Center. Dr. Whorff will be speaking on eye exams and health issues. For more information, see the Feb. 21 edition of the Mount Vernon Optic-Herald.


text:
An Earth-sized hell circles faraway star
The recently discovered, very hot rocky planet is the smallest with known diameter and mass
Jasiek Krzysztofiak/Nature
A distant Earth-sized planet's density suggests it is made of the same stuff as Earth. The planet, named Kepler-78b, is the smallest exoplanet for which researchers know both size and mass.
Kepler-78b, detected this year in data from NASA's now-crippled Kepler spacecraft, is located 700 light-years from Earth in the constellation Cygnus. The planet's gravitational tug causes its star to shimmy back and forth slightly, which compresses or expands the wavelengths of light the star emits. Two teams of astronomers used the light's changing wavelength to calculate the speed at which the stars wobbles; from this speed, they inferred the planet's mass and, using previously published size measurements, calculated its density.
Reporting October 30 in Nature, one team estimates the planet's density to be 5.3 grams per cubic centimeter; the other estimates 5.57 grams per cubic centimeter. Earth's density of 5.515 grams per cubic centimeter falls between these two figures, suggesting Kepler-78b is, like Earth, made of rock with an iron core.
Although similar to Earth in size and composition, Kepler-78b is no life-nurturing paradise. The planet zips around its host star every 8.5 hours in an extremely tight orbit, and its daytime temperatures probably top 2,000° Celsius.
A.W. Howard et al. A rocky composition for an Earth-sized exoplanet. Nature. Published online October 30, 2013. doi: 10.1038/nature12767.
F. Pepe et al. An Earth-sized planet with an Earth-like density. Nature. Published online October 30, 2013. doi: 10.1038/nature12768.
A. Grant. Most Earthlike planets yet seen bring Kepler closer to its holy grail. Science News. Vol. 183, May 18, 2013, p. 5.


text:
Throughout his career, Boom Bip a.k.a Bryan Hollon has thrived in producing off-kilter experimental music. Boom Bip's debut on Lex 'Seed To Sun' (2002) was also the first album on the label. The songs on the album are a combination of sample-loops, synths and rock instrumentation. Companion piece 'Corymb; arrived two years later, including songs from his Peel Sessions and remixes by Four Tet, Boards Of Canada and Mogwai. Boom Bip's second album for Lex, 'Blue Eyed In The Red Room' (2005), was a record in which he meticulously played and recorded every single instrument separately, using no samples in the process. The album also included his first collaboration with Gruff Rhys of The Super Furry Animals, with whom he went on to form the group Neon Neon. Hi album'Zig Zaj' (2011), expanded on the sound of 'Blue Eyed In The Red Room' and acted as a precursor to the sound of Neon Neon's 'Praxis Makes Perfect'. In 2016, Boom Bip scored Ben Crescimans psychological thriller movie, Sun Choke.
Released in 2008, 'Stainless Style' is the debut album from Neon Neon a.k.a Boom Bip and Gruff Rhys. A swashbuckling journey through vintage electronic pop and hip-hop, it loosely tells the tale of the trials and tribulations of John DeLorean, the founder of the DeLorean Motor Company. Having been recording and working together for six years, 'Stainless Style' marked the first time that Rhys and Bip committed something to record under their Neon Neon guise. A restlessly energetic electro pop album with strains of hip-hop and electronica, the concept for 'Stainless Style' revolves around imaginary scenarios that may have happened to DeLorean during his life such as Raquel, which is sung from DeLorean's perspective about an imaginary affair with Raquel Welch. With a rich list of guests including Fab Moretti from the Strokes, Har Mar Superstar, Yo Majesty and Spank Rock, 'Stainless Style' was honoured with a nomination for the 2008 Nationwide Mercury Music Prize.
Following a five year hiatus from 'Stainless Style', Neon Neon's second record, 'Praxis Makes Perfect', picked where its predecessor left off, sharing a concept that is similarly elaborate and colourful. This time around, the duo were inspired by the life and times of Giangiacomo Feltrinelli, an Italian aristocrat turned left- wing political activist who was responsible for publishing such works as 'Doctor Zhivago' (the name of track three on the album) and 'The Leopard' (track eight). It is said that he accidentally blew himself up in 1972, a frenetic end to a life which involved rubbing shoulders with such historical figures as Hemingway, Che, Marx, Warhol and playing basketball with Castro in Cuba. With this source material as a jumping off point for an ambitious biopic-meets-album, 'Praxis Makes Perfect' minded the depths of synth-led Italo pop and electronica. Guest appearances included Sabrina Salerno, Asia Argento, Cate Le Bon and Josh Klinghoffer.
Live Show
Music Video
I Told Her On AlderaanMusic Video
I Lust UMusic Video
'Music for Sleeping Children' is a the collaborative art/music project from artist Charlie White and musician Boom Bip – a series of dance tracks based on in-depth interviews of American teenage girls with accompanying photographic images. The music will be made available for free download via www.musicforsleepingchildren.com
Each of Music for Sleeping Children's five tracks captures the essence of a different teenager, from the privileged and popular Georgia musing on the importance of being liked, to the sultry and complicated Isabelle recalling her melancholy crushes of freshman year, to the neurotic Sabrina planning her life in detail yet fearing failure at every turn. The original interviews were painstaking edited and set against the pin-sharp Boom Bip productions they inspired, whilst the visual element was born out of White's inensive photographic study of a teenage girl living in the isolated suburbs of southern California.


text:
NOTE: This information should mostly be moved to the pages describing how to build the packages for easier reference. Only generic solutions, or solutions that are take too much space should live here.
This page contains some troubleshooting tips for issues you may encounter while building kde4 from source.
Many of the issues listed here may be out of date.
You can hit problems building KDE in any of the build steps.
When configuring KDE using CMake you may see messages about missing requirements that you need to fix. Fix the missing requirements then try configure again. You may sometimes need to delete the CMakeCache.txt file in the build directory.
If you have a problem compiling a KDE program it error may not be in the most recent output, you need to first find the exact place where the error occured by scrolling back. If it is hard to find the error message in a long output, instead of using:
make -jn
use a simple
to stop the compile output as soon as the first error message is found.
If you do not understand the error message, use
make VERBOSE=1
to see the compile or link command that actually failed.
When using the kdesrc-build script you can view the kdesrc-build log files to find the build output.
If you have problems compiling kdelibs, first make sure the software in the Required Software section above is installed and works. If you install additional software, it may be necessary to remove ~/kde/src/KDE/kdelibs/CMakeCache.txt before trying the build again. In particular, pay attention to the requirement of kdesupport (such as the components for automoc, strigi, phonon, etc).
Other possible hints include:
cmakekde command fails stating that CMake requires an out of source build directory, remove ~/kde/src/KDE/kdelibs/CMakeCache.txt, and try again.
cmakekde still gives the same error then try this
1 cd 2 cmake -DCMAKE_INSTALL_PREFIX=$KDEDIR \ 3 -DCMAKE_BUILD_TYPE=debugfull \ 4 -DKDE4_BUILD_TESTS=ON \ 5 ~/kde/src/KDE/kdelibs 6 make 7 make install
cmakekde. (e.g
cs KDE/kdelibs && cb && cmakekde) If the message stays, run
svn status in the kdelibs directory and remove all files labelled with '?'.
update-alternatives --config qmake
Could NOT find GIF.
CMake Error: KDE Requires Qt to be built with SSL support, install openssl-devel, remove CMakeCache.txt and re-compile QT.
kdelibs/kimgio/ico.cpp:188: undefined reference to `QImage::jumpTable()'it means you compiled Qt without Qt3 support(no, linking to a true Qt3 install won't work)
make clean in kdelibs.
The PCRE regular expression library has not been found >=4.5then watch out Recommended packages or
remove ../..
build/kdelibs cs KDE/kdelibscmakekde
kde-config.cpp:56: undefined reference to `KLocalizedString::~KLocalizedString()' and /Depot/Temp/kdelibs-4.0.2/kdecore/kde-config.cpp:197: undefined reference to `KConfigGroup::readPathEntry(char const*, QString const&) const' and kde-config.cpp:66: undefined reference to `ki18n(char const*)'?
Seems to happen with some localization stuff
If you have troubles compiling kdebase:
-- Installing: /usr/share/polkit-1/actions/org.kde.kcontrol.kcmremotewidgets.policy CMake Error at plasma/remotewidgetshelper/cmake_install.cmake:54 (FILE): file INSTALL cannot copy file "/home/kde-devel/kde/build/kde-runtime/plasma/remotewidgetshelper/org.kde.kcontrol.kcmremotewidgets.policy" to "/usr/share/polkit-1/actions/org.kde.kcontrol.kcmremotewidgets.policy".
To resolve this issue either install kdesupport/polkit-qt and rebuild kdelibs and kdebase (remember to remove the CMakeCache.txt), or pass an extra parm to cmake for -DKDE4_AUTH_POLICY_FILES_INSTALL_DIR=$KDEDIR/share/polkit-1/actions
libxss headers installed. (Usually you got undefined references on xscreensaver objects if you do not have those headers)
which meinproc4 has to deliver /home/kde-devel/kde/bin/meinproc4
Please set the following variables: X11_XTest_LIB (ADVANCED), install the devel package of
Xtst. On some systems, this is packaged separately from xext and called x11proto-xext-dev or libxtst-dev. You may also need to remove the CMakeCache.txt file in the build dir after installing the package.
Please set the following variables: FONTCONFIG_INCLUDE_DIR, FONTCONFIG_LIBRARIES (ADVANCED), then you need to install the libfontconfig headers
CMake Error: This project requires some variables to be set, and cmake can not find them. Please set the following variables: KMETADATA_LIBRARIES, you need to install soprano from kdesupport and to rebuild kdelibs
'XserverRegion' does not name a typemake sure you have libxcomposite headers installed (libxcomposite-dev in ubuntu)
CMake Error: This project requires some variables to be set, and cmake can not find them. Please set the following variables: QT_QTOPENGL_LIBRARY (ADVANCED) "try editing CMakeCache.txt and setting QT_QTOPENGL_LIBRARY:FILEPATH=/home/kde-devel/qt-copy/lib/libQtOpenGL.so
KDE4_INSTALL_HANDBOOK() is deprecated. Remove it please. Now all is done in KDE4_CREATE_HANDBOOK.then, either find the files containing the offending line and comment it out manually, or run the following script in ~/kde/src/KDE/kdebase: macros_corrector.sh. It will just REMOVE the line that has "kde4_create_handbook" in it from all the found files.
kdebase/workspace/kcontrol/kxkb/x11helper.cpp:131: error: 'KGlobal' has not been declared, you might need to install libxklavier development packages.
/home/kde-devel/kde/lib/libkio.so: undefined reference to `Strigi::AnalysisResult::AnalysisResult(std::basic_string<char, std::char_traits<char>, std::allocator<char> > const&, long, Strigi::IndexWriter&, Strigi::StreamAnalyzer&)'you probably have an outdated version of strigi installed by your distro. By the way, after update the strigi, you must recompile kdelibs for a new libkio.so.
can't find REQUIRED package Blitz, install qimageblitz4 and qimageblitz-dev
class QWebFrame' has no member named 'contentsSize'you need to upgrade your Qt
Please set the following variables:
cmake -DLIB_SUFFIX=64.
make sure it has been set by calling
CMAKE_LIBRARY_PATH=/home/kde-devel/kde/lib:$CMAKE_LIBRARY_PATH CMAKE_INCLUDE_PATH=/home/kde-devel/kde/include:$CMAKE_INCLUDE_PATH
and delete the CMakeCache.txt in your build directory.
CMake Error at workspace/plasma/scriptengines/python/cmake_install.cmake:68 (FILE): file INSTALL cannot copy file "[...]/kde/source/kdebase/workspace/plasma/scriptengines/python/plasmascript.py" to "/usr/lib/python2.6/site-packages/PyKDE4/plasmascript.py". Call Stack (most recent call first): workspace/plasma/scriptengines/cmake_install.cmake:40 (INCLUDE) workspace/plasma/cmake_install.cmake:43 (INCLUDE) workspace/cmake_install.cmake:62 (INCLUDE) cmake_install.cmake:39 (INCLUDE)
try to set:
-DPYTHON_SITE_PACKAGES_INSTALL_DIR=~/.local/lib/python2.6/site-packages (check that this path corresponds to something in your system, you might have a different version of python)
as a parameter for cmake (or cmakekde)
export CMAKE_PREFIX_PATH=$KDEDIR. Be sure that it is added after the declaration of $KDEDIR (something I had overlooked :D ).
If you have trouble compiling kdepimlibs:
1 cd 2 cs 3 mkdir kdesupport && cd kdesupport 4 git clone git://anongit.kde.org/automoc 5 cd automoc 6 cmakekde
1 cd 2 cs 3 cd kdesupport 4 git clone git://anongit.kde.org/akonadi 5 cd akonadi 6 cmakekde
KDE_DEVEL_USER=kde-devel mkdir -p /usr/share/sip/PyKDE4 for dir in /usr/lib/python*; do mkdir -p $dir/site-packages/PyKDE4 done chown $KDE_DEVEL_USER /usr/share/sip/PyKDE4 \ /usr/lib/python*/site-packages/PyKDE4
Note: You may need to change /usr/lib to /usr/lib64
Note: I had to use "dist-packages" instead of "site-packages" in the above
This will allow your development user to install the files it needs to, without giving it unnecessary access to your system.


text:
This post is for consideration as part of Cold's Gold Blogging Carnival for November 2012.
Remember the duping of Queen's Garnet in Cata, when the next exploit is found by the Gold Sellers, the CRAH would be a license to make gold for re-distribution.
In the meantime all those Low population servers can expect a growth of Bots to supply the CRAH with mats.
PvE & PvP Realms
I hate being ganked that's why I play on a PvE Realm. It provides the added benefit of being able to explore Horde dominated areas to gather materials without interruption. There would be a distinct advantage of being on a PvE realm for Gatherers to make gold, if a CRAH were introduced.
Volume & UI
I'm sure we've all experience the person who puts up 1000 pieces of Cloth in single units on the AH. I always find this slows down the Auction house considerably, which is probably the primary motivation of the seller. I use an addon called Auctionator to search for items on the AH and when the above occurs, I find that Auctionator grinds to a halt. The main reason I use Auctionator is because I dislike the way the Blizzard UI shows what's on the AH. If a Cross Realm Auction House were introduced unless something is done to the UI, I believe the AH wouldn't cope with the quantity of Auctions.
Trying to use the Blizzard UI to buy items off the AH, is an exercise in frustration. Selling items is even more of an ordeal. In 10 years, Blizz have made no effort to make the UI any more user friendly, but have incorporated a No. of other Addons into the game, as features.
I say, fix the current AH UI before you go experimenting with Cross Realm AH's.
My biggest competition are the no-lifer's (could be Gold Sellers) who sit on the Auction House 24/7, (Some would say I'm one). These people undercut constantly and dominate an area of the AH. A CRAH would only promote this sort of behaviour, especially by gold sellers. I've got enough competition on 1 server let alone Cross realms.


text:
Event: Credit Suisse's "Deep Dive Into YouTube: Q1'09 Preview"
Commentary By: Tony Greenberg, Alex Veytsel, Lenna Boatwright and Steve Lerner
Whitepaper: Click here to download the PDF
How Google shelters profits from content owners while building a delivery juggernaut
"YouTube, from a profit standpoint, remains a material drag on Google's overall bottom line." – Spencer Wang and Kenneth Sena of Credit Suisse
YouTube as a millstone around Google's profitability is a mirage. Contrary to Credit Suisse's estimates of a $470M annual loss, Google is more likely losing a fraction of that amount, due to peering for 73% of its traffic, buying bandwidth from some of the lowest-cost Tier 1 providers, using unprecedented bulk purchasing power to secure very favorable wholesale rates, and running data centers far away from expensive locales. RampRate estimates that, based on our experience working with other top Internet, e-Commerce, and media firms, Google's maximum loss is no more than $174M without challenging Credit Suisse's revenue assessment. Far from being an infrastructure money pit, YouTube is key to reducing operational costs for other Google initiatives while also allowing Google to catch up to the superior network performance of competitors like Microsoft, which currently boasts 10 times as many peers and 17% fewer hops to remote reaches of the Internet.
Google is no doubt thrilled to let YouTube be known as a financial folly. In the dangerous waters of online content, a whiff of potential profit is an irresistible lure for predators such as copyright lawyers circling user generated content monetization and content partners that are all too ready to turn on their distributors in a feeding frenzy.
YouTube is a turnkey solution to a highly profitable content monetization strategy that can be unleashed as soon as Google gains stronger control of its content partners. On this point, we agree with Credit Suisse: the unit economics work. We've researched and launched video monetization strategies that are profitable at a much smaller scale. Forgoing investment in the online video market because of Google's shell game with content providers is a decision that many prospective investors will stand to regret.
The Real Cost of Operating YouTube
In April 2009, the market saw a slew of "YouTube is doomed" or "online video is doomed" blog posts in response to Credit Suisse's report on Google's projected videorelated losses of $470M [1]. The sentiment seems reasonable at first glance – Google has been more cautious in monetizing YouTube than most observers anticipated (including RampRate). Credit Suisse's cost analysis is thorough and close to what most large companies pay, based on RampRate's sourcing advisory work with large, multinational infrastructure users.
However, Google is not "most large companies." It owns a large quantity of dark fiber [2], places data centers in out-of-the way geographies like Iowa and Finland [3], uses commodity server equipment where possible [4], and, most importantly, uses peering agreements instead of paying for bandwidth for upwards of 73% of its traffic [5]. All of these factors combine to create a likely cost basis of $414.9M, a far cry from Credit Suisse's estimate of $711.3M. As such, using Credit Suisse's revenue projections, we estimate that YouTube's projected 2009 losses should be assessed at a more modest $174.2M.
The big driver in the lower estimate is in the $360.4M bandwidth cost. As Brough Turner pointed out [6] soon after the initial report broke, no bandwidth cost analysis for Google is credible without including peering [7]. While using a peering approach has its own costs, such as connecting to a peering hub, managing complex and often contentious peer relationships, dealing with SLA-less best efforts service, and even occasional payment to powerful peers, the bulk of these costs are fixed – that is, you hire the same team and run the same fiber whether you are pushing 1 Gbps or 100 Gbps. According to Renesys, nearly 3/4 of Google's traffic is delivered via peers – and it is probably higher considering that YouTube is known to have some peers such as AT&T [8] that Renesys does not list for its corporate parent.
The top two providers of bandwidth for which Google does appear to pay transit fees are notorious for leading the charge in the price wars [9] that helped push IP transit prices down by at least 20% annually even as other infrastructure markets such as co-location stabilized. When dealing with low-value content, some RampRate customers have found paths to sub-$1 / mbps bandwidth through oversubscribed connections, best-efforts SLAs and other practices straddling the borderline between paid peering and low-cost transit. Combined with the sheer amount of business that Google brings to the table, these nontraditional approaches can, if leveraged properly, reduce bandwidth costs to the $0.50 / Mbps mark.
Credit Suisse's estimates for storage hardware also suffer from insufficient creativity — in fact, if its figures were correct, Amazon Web Services would provide storage for 50% less than Google [10]. Most YouTube content is by definition "long tail," which means the storage it requires can be of a consumergrade commodity quality. Google's core competency is in managing commodity server / storage farms. At current rates, its servers likely cost no more than $500 apiece [11], and can add a sub-$100 1TB hard drive to produce a net cost of $.60 / GB. Even with an aggressive 1-year refresh cycle, that is just 30% of the $2.35 / GB projected by Credit Suisse. We also estimate the hosting costs are lower than projected by benchmarking an estimate of 500W of peak power use per server hosted in out of the way locations.
Upside of a $174M Loss
Regardless of how the infrastructure cost numbers are sliced, if Credit Suisse's revenue estimates are correct [12], YouTube will take a loss in 2009 – and a significant one by most standards. So why is Google persisting with the service? There are many answers, ranging from the strategic to the inscrutable. However, one surprising factor is fundamental, no matter the revenue potential: YouTube lowers the cost of infrastructure for all other Google properties.
As discussed in the Telco 2.0 blog six months before the Credit Suisse report was published, YouTube is essential to giving Google significant leverage in peering negotiations [13], Consumer ISPs are paying backbone Tier 1 providers to carrying traffic to them. ISPs that peer directly with a major content provider of much of that traffic avoid those costs entirely. Although one might think that Google is already succeeding in that department with its other properties, the reality is that it peers with less than 1/10th the number of ISPs that Microsoft does, and takes 0.4 more hops to get to an average user [14]. In other words, Google still has room to improve. YouTube is central to enabling its ability to catch up with its top rival.
Coincidentally, these providers are also the ones Google is approaching for edge caching [15], or colocation of some heavily trafficked content on servers within the ISP's facilities. While it is not quite the sinister anti-net neutrality plot [16] that The Wall Street Journal claims [17], edge caching is a sound idea that can provide a competitive advantage for many Google properties. Since most broadband providers do not provide co-location as a matter of course, the presence of the YouTube juggernaut is essential to ensuring that Google can leverage these partnerships in the same way that CDNs such as Akamai do. Edge caching is just one facet of Google's build-focused strategy. Dark fiber costs are roughly the same whether you push 100 Mbps or 40 Gbps over each strand. Capital intensive expenditure projects such as distant data center build-outs require significant critical mass to make them worthwhile. The marginal cost tied to a property like YouTube can be negligible compared to the fixed costs that would be incurred regardless of its presence in Google's portfolio.
Silence Is Golden
If the YouTube strategy can be seen in this much more favorable light, why is Google not responding to Credit Suisse? The key is its lack of leverage with premium content partners, and the thousands of copyright holders whose content is posted by users onto YouTube without the owner's permission. Any appearance of profits leads to more draconian revenue share demands from partners and additional lawsuits from owners of unlicensed content. An apparent loss deters this behavior, making it eminently advisable for Google to let the rumors of YouTube's losses grow and compound. This perception of a loss-making business is one of the factors that contributed to ASCAP collecting only $1.6M instead of $12M from YouTube in a recent court judgment [18].
The trail for this strategy was blazed long before YouTube. Apple's poor-mouthing of iTunes served it exceptionally well for years in holding back the tide of higher revenue share demands (even as labels privately suspected the service was much more profitable than reported). The apparent stability and maturity of the business finally culminated in recent price increases [19]. Google can only hope that its run with YouTube lasts as long as Apple's luxury of $.99 pricing.
The Dark Horse Business Model
The final unspoken potential in Google's video portfolio is the possibility of YouTube becoming a cash machine akin to Google's search business. At 100M unique viewers per month in the US alone [20], the volume of YouTube usage is equivalent to Super Bowl-scale audiences – 365 days a year. The same force that gave TV broadcasting enough wealth to build such edifices as 30 Rockefeller Center continues to be the holy grail of advertisers today: Reach. In addition, YouTube layers on a more desired dimension to video reach: Measurability. And finally, YouTube adds two totally new dimensions: Community and Collaboration without borders.
Google can, when it chooses, instantly ripple advertisements and direct click-to-buy opportunities across any or all of the 1.2 billion videos viewed daily [21]. It can create custom formatted and branded content areas (channels) for shows, artist, films, networks and anything else imaginable. It is, at this time, the most powerful broadcasting platform in history, not to mention the world's largest social network. All with the perfect measurability so long sought by advertisers and sellers.
So why not monetize? There are many reasons: Why pay more taxes if one is already profitable? Why get dragged into rights management issues now when one could wait until the industry is so desperate to work with YouTube that they will cave on demands? Why not wait until a certain threshold of broadband penetration? There could be many reasons, but the dark horse should not be ignored.
Regardless of what you may hear, YouTube costs are a fraction of any other company running similar operations. Most of Google's bandwidth is free or near-free; its hardware is cost-optimized; and its data center costs are mostly committed or sunk. The top customers of our sourcing advisory service, whose prices are on average 20% better than the average market level, cannot deliver content as cheaply as Google's massively scaled operation. Surprisingly enough, the ones that come closest are often those that leverage the scale of others through using cloud services. But even if a fair accounting of its costs showed a loss, YouTube gives Google the ability to achieve needed improvements in lowering cost of other operations. Loud stories about YouTube's losses can only help deter copyright lawsuits and demands from content owners. Skepticism is warranted — but be ready for surprise news of profitability in the future.
[1] Spencer Wang & Kenneth Sena, "Deep Dive Into YouTube; 1Q09 Preview," Credit Suisse Equity Research April 3 2009
[2] VOIP News: "What's Google Doing with All That Dark Fiber?"
[3] The Register: "Google Admits Scandinavian Data Center Landing"
[4] TechWorld: "Google's Storage Strategy"
[5] Renesys Market Intelligence service – a tracker of peering / transit relationships
[6] CircleID: "YouTube's Fine: Analysts Don't Understand Internet Peering"
[7] Click here for a primer on peering and transit.
[8] Telco2.0: "How YouTube Wins with Web Video"
[9] CircleID: "Will Work for Bandwidth"
[10] Including hosting, Credit Suisse cites $3.52 / GB / year. Amazon's S3 service is $1.44 / GB / year (http://aws.amazon.com/s3)
[11] "Perspectives: Google's Dr. Kai-Fu Lee on Cloud Computing"
[12] If using stream counts from here, it is 20% too low
[13] Telco2.0: "How YouTube Wins with Web Video"
[14] Comparison of Google to Microsoft
[15] Google Public Policy Blog: "Net Neutrality and the Benefits of Caching"
[16] Even if it was, we don't view video as the top danger area: Read this
[17] Wall Street Journal: "Google Wants Its Own Fast Track on the Web"
[18] TechDirt: "Google Ordered to Pay $1.6 Million to ASCAP"
[19] LA Times: "Hottest Tracks to Cost $1.29 at iTunes Starting April 7"
[20] LawyerCasting: "YouTube Traffic Exceeds 100 Million Unique Visitors"
[21] TechCrunch: "YouTube Streams Top 1.2 Billion/Day"


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The Internal Revenue Service (IRS) faces challenges ensuring compliance with the eligibility requirements of the Hope and Lifetime Learning tax credits. Millions of taxpayers claim the credits to offset qualified postsecondary education expenses. For fiscal years 2009 through 2013, taxpayers are estimated to claim Hope and Lifetime Learning credits totaling $27 billion and $13 billion respectively. These tax provisions are complicated and may lead taxpayers to claim either more or fewer benefits than they are entitled.
IRS requires educational institutions to report on Form 1098-T information about qualifying educational expenses to taxpayers and IRS. However, the information reported by educational institutions and sent to the IRS and taxpayers (on Form 1098-T) is not easily comprehensible to taxpayers, nor is this information fully used by IRS in its compliance programs.
IRS does not make full use of information reported by educational institutions to taxpayers and IRS on Form 1098-T to identify and correct noncompliance with higher education tax benefits. In addition, revising the form to provide more complete information on qualified expenses could make it easier for taxpayers to use, which could also reduce noncompliance. IRS requires institutions to report on Form 1098-T either (1) the amount of payments received or (2) the amount billed for qualified expenses. Many institutions report the amount billed and do not report payments, but the amount billed may not equal the amount that can be claimed as a credit. For example, the amount billed may not account for all scholarships or grants the student received. In such cases, the Form 1098-T may overstate the amount that can be claimed as a credit, confusing taxpayers. Conversely, if institutions are not providing information on other eligible items, such as books or equipment, taxpayers might be understating their claims.
Because the amount billed may not be the amount taxpayers are eligible to claim as a credit, IRS does not compare tuition statement information to information reported on a tax return. However, IRS is missing opportunities to use some of the more basic information (for example, a student's Social Security number and a school's location) to verify eligibility for the credit. Using IRS's compliance computer-matching systems to automatically compare information on statements to taxpayers' claims could be a low-cost enforcement tool for IRS to verify certain aspects of taxpayers' eligibility for higher education credits. While changing the requirements for how higher educational institutions report qualified expenses on tuition statements would likely impose some burden on those institutions, the additional burden could be low because the institutions are already required to complete Form 1098-T.
Given that every year millions of taxpayers claim billions of dollars of credits for post-secondary education tuition expenses, even a small increase in compliance could increase revenue. To reduce taxpayer confusion and enhance compliance with the eligibility requirements for higher education benefits, GAO recommended in December 2009 that IRS (1) determine the feasibility of using current information reported on Form 1098-T in its compliance computer matching systems; and (2) revise Form 1098-T to improve the usefulness of information on qualifying education expenses. IRS agreed to consider the feasibility of using current information on Form 1098-T in its compliance programs, and develop a plan to address possible changes to that form but these actions have yet to be completed. GAO continues to believe these actions are needed since automatically matching readily available information has been a proven, low-cost way to improve compliance.
The information contained in this analysis is based on the related GAO product listed under the "Related GAO Products" tab and GAO's work following up on the recommendations from that product.
For additional information about this area, contact James White at (202) 512-9110 or email@example.com.
The Internal Revenue Service's (IRS) filing season is an enormous undertaking that includes processing tax returns, issuing refunds, and responding to taxpayer questions. IRS's efforts to ensure compliance begin during the filing season. GAO was asked to assess IRS's 2009 filing season performance, identify ways to reduce taxpayers' use of short-term, high-interest refund anticipation loans (RAL)...
Jump to another area below related to this mission.


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Minimum guarantees for asylum procedures
To establish minimum guarantees for asylum procedures in Member States in compliance with the principles of the 1951 Geneva Convention and the 1967 New York Protocol.
Council Resolution of 20 June 1995 on minimum guarantees for asylum procedures [Official Journal C 274, 19.09.1996].
Following the entry into force of the 1990 Dublin Convention, the Member States wished to establish equivalent procedures for examining applications for asylum. To that end, minimum guarantees for procedures, to be complied with by all Member States, have been drawn up. Member States may enact more favourable national provisions.
Universal principles
The procedures for examining asylum applications must comply with the 1951 Geneva Convention and the 1967 Protocol, in particular as regards the definition of "refugee" and the principle of "non-refoulement" (no expulsion measure will be carried out as long as no decision has been taken on the asylum application), and must be carried out in cooperation with the Office of the United Nations High Commissioner for Refugees (UNHCR).
Guarantees concerning the examination of asylum applications
All applications are examined individually, objectively and impartially. Applicants must present a substantial description of their case and all available evidence, although recognition of refugee status is not dependent on the production of any particular evidence.
The authorities responsible for the examination of the asylum application must be provided with a sufficient number of specialised personnel, precise information on the situation prevailing in the countries of origin and transit countries, and access to experts on particular issues (medical, cultural, etc.).
The authorities responsible for border controls and local authorities must receive clear instructions so that applications can be forwarded without delay to the competent authority.
If the asylum application is rejected, it is possible to appeal to a court or an independent review authority.
Rights of asylum-seekers during examination, appeal and review procedures
Asylum-seekers may remain in the territory of the State in which the application has been lodged until a decision has been taken. During the procedure, they are entitled to the services of an interpreter or, if necessary, a legal adviser or other counsellor and may communicate with the Office of the UNHCR or other refugee organisations. Before a final decision is taken on the application, they are given the opportunity of a personal interview with a qualified official.
Manifestly unfounded applications are dealt with in accordance with the principles laid down in the Resolution of 30 November 1992. Applications from nationals of another Member State are covered by that Resolution since any Member State is regarded a priori as a reliable country. A particularly rapid procedure will be applied in such cases.
Any asylum-seeker must be able to lodge an application at a frontier. The application may then be examined to establish, prior to the decision on admission, whether it is manifestly unfounded. However, where there is a host third country, there may be exceptions to the principle of "non-refoulement".
Additional safeguards for unaccompanied minors and women
Unaccompanied minors must be represented by an appointed adult or institution that assists them during the procedure.
Member States must endeavour to involve female employees and interpreters where necessary, particularly where female asylum-seekers find it difficult to present the grounds for their application owing to the experiences they have undergone or to their cultural origin.
Right of residence
Applicants who satisfy the criteria for refugee status must in principle be granted the right of residence in the Member State which examined the asylum application.
Member States were to strive to bring their national legislation into line with these principles by 1 January 1996.
On 20 September 2000, the Commission presented a proposal for a Council Directive on minimum standards on procedures in Member States for granting and withdrawing refugee status [COM(2000) 578 final - 2000/0238 CNS].
Communication from the Commission to the Council and to the European Parliament. Towards a common asylum procedure and a uniform status, valid throughout the Union, for persons granted asylum [COM(2000)755 final - Not published in the Official Journal]
On 22 November 2000, the Commission presented a Communication emphasising that harmonisation of asylum procedures could have immediate positive effects. The first would be to limit secondary movements of asylum seekers influenced by the diversity of rules and the rights granted following recognition of the right to asylum. An asylum seeker must be reasonably certain that, whichever Member State they approach, they will enjoy equivalent chances of obtaining proper protection.
The second would be to maintain the specific nature of the right to asylum vis-а-vis other forms of humanitarian protection. In addition, the Commission would like common rules on the exchange of information to be defined and to create a network between the authorities involved in order to facilitate the analysis of statistics, cooperation between the various authorities and the exchange of good practices.
Communication from the Commission to the Council and to the European Parliament on the common asylum policy, introducing an open coordination method. First report by the Commission on the application of Communication COM(2000)755 final of 22 November 2000 [COM(2001)710 final - Not published in the Official Journal].
In its Communication of 22 November 2000, the Commission set out its point of view on establishing a common asylum procedure, identifying objectives and proposing a method. The Communication of 28 November 2001 contains a more precise definition of the methods which might be applied to asylum policy. There will be consultations on these suggestions prior to a formal Commission proposal.
The report on a common asylum policy in the European Union will be submitted annually and will serve the interests of transparency and stimulate public debate. This year's report is broken down into six headings:
link between international protection obligations and security (exclusion from refugee status, surrender, non-refoulement);
common analysis (exchange of statistics and information on asylum and migrant flows);
the external dimension (enlargement, relations with the Balkans, the Russian Federation, relations with the United Nations High Commissioner for Refugees);
applying the open coordination method to asylum policy (in practice, the Commission invites the Council to approve multiannual guidelines together with a timetable for achieving the objectives in the short, medium and long term. The Member States must then incorporate these guidelines into national legislation);
Last updated: 18.08.2005


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Put some statement necklace that's maybe unused for a while
on a top button (or pin it) et voila! I could upcycle an old bauble
and make it look like one from a high-end label!!
bustier: zara(here)
pants: tibi(similar here)
bag: DVF(similar here)
earrings: zara(here)
watch: Cartier
necklace: old zara(also love this!)
booties: Gianvito Rossi(similar here)


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If you would like to make a confidential report about sexual misconduct, dating/relationship violence, or stalking, please see our Bethany Cares page.
You may also make a report in person or by phone. Please do not make a report by email or sending a message through other forms on our web site, as these may not be secure or anonymous.


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Reviewed by Jimmy M. (age 7)
My favorite part of the story is when Snoopy waits in the pumpkin patch because he wears sunglasses and it is funny. Snoopy is my favorite character because he is hilarious. Lucy is my least favorite because she is selfish. This story relates to my life because I like Halloween too. I really like the pictures in this story because they help me to see the characters.
I think others should read this book because it is funny and it will make you laugh.


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No News is Bad News for Nonprofit Journalism
America is unique among democratic nations in its nearly complete reliance on commercial media to inform our communities, educate our children, and hold power to account. The media system we have is no accident. At every point in history when technological change challenged the incumbent media establishment—from radio to TV to the Internet—policy decisions have concentrated media in the hands of a few commercial stakeholders. Unfortunately for the burgeoning nonprofit journalism sector, history seems about to repeat itself.
Right now, the Internal Revenue Service is considering whether journalism and media organizations should be eligible for nonprofit status. That may sound odd given that nonprofit journalism has been a part, albeit a small part, of American media for decades—think Mother Jones, NPR, the Christian Science Monitor, even the Associated Press. YES! Magazine itself has operated as a nonprofit since its founding 16 years ago.
Nonetheless, a whole cadre of new journalism start-ups like the San Francisco Public Press, Worcester Wired, and Monitor Oklahoma have been waiting months—some even years—for the IRS to approve their applications for nonprofit status.
How did we get here?
At the end of the last decade, it was becoming increasingly clear that the advertiser-driven commercial media model was not producing the full extent of news and information our communities need. Job cuts decimated newsrooms, companies closed foreign bureaus, and the number of journalists covering statehouses had shrunk to almost zero in many places.
In response to these changes, many journalists turned to a nonprofit model that would refocus newsrooms on their public mission instead of just their stock prices. Since 2008, there has been a spike in applications for 501(c)(3) nonprofit status from journalism organizations. This uptick has raised red flags at the IRS, which has put a hold on nearly all of these new journalism applications until it decides how it will rule.
We are at a critical juncture. This moment could be the start of a new era of noncommercial journalism in America, with innovative new nonprofits poised to fill the gaps in meaningful reporting that have been left by much of commercial media. Those nonprofit journalism organizations that won IRS approval before the agency's clamp-down began, such as ProPublica, the Texas Tribune, MinnPost and Voice of San Diego, are illustrating the power of this model. They are winning awards, engaging communities, and covering issues that the mainstream media have largely abandoned.
If you are a regular reader of YES! Magazine, then you understand the need for a different kind of journalism than we see in most of American media. Now imagine a thousand new YES! Magazines, imagine local versions covering beats in your neighborhood, or a YES! Magazine dedicated to 24-hour coverage of your statehouse. The seeds of change are there, but this delay at the IRS is hindering the growth and sustainability of nonprofit journalism efforts. Worse, a bad ruling from the IRS could threaten the survival of even longstanding nonprofit publications and websites.
If the IRS decides against allowing nonprofit status for newsrooms, it will essentially be arguing that all journalism should be done for profit. The problem is, the market has proven it will not provide the full extent and diversity of news and perspectives we need. In her paper "Can Nonprofits Save Journalism?," Marion R. Fremont‐Smith argues that IRS regulations don't take into consideration the current economics of the news industry. She reminds us that "[revising] prior precedent due to changed circumstances is the essence of charity law," and has ushered in important innovations and institutions we now consider fundamental to American society.
Mission-Driven Media: The New Landscape in Journalism
Nonprofit journalism is not a silver bullet for the future of journalism. But fostering a more diverse media system is. Ideally American media would be as diverse as American communities in representation, perspectives, and business models. What the IRS doesn't understand, or what its policies won't let it admit, is that we need a vibrant and diverse mix of for-profit, nonprofit, public, and community media organizations. In the same way that monoculture crops are dangerous to the food system because they are all share the same weaknesses, for too long our journalism ecosystem has suffered from monocultural thinking. Tough economic times and shifts in advertising have hit longtime journalism institutions hard.
We shouldn't let the IRS put us in the same position again. The IRS is working with a set of outdated policies that don't account for the state of our media today. In the long term, we need to change those policies, but right now we need to clear the way so we can get more journalists on the street serving our communities.
220 years after the Bill of Rights, how we're still fighting for free speech.
Why Canada has one and the U.S. doesn't.
The media can, as we know, promote fear, hatred, and extremism. Can they also lead us to greater civility and more productive debate?


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UCSB men's soccer season tickets are now on sale for the 2013 season. Don't miss out on the action as the Gauchos host top talent from all over the country including Stanford, Cal Poly and 2012 NCAA Sweet 16 participant New Mexico.
The Gauchos are coming off of another year in which they led the nation in attendance. The Gauchos will return with a new energy, community focus and schedule that may break more attendance records during the 2013 season! Season tickets start as low as just $68 or $180 for the popular Family Plan.
New this year is the introduction of the "Loyalty Scarf" the first of its kind in college soccer. The first 500 season ticket purchasers will receive the distinctive scarf, which, when worn on game-days, will allow the wearer to receive special deals on food, merchandise and other great offers by business sponsors in Isla Vista, the local community and at the game. The Loyalty Scarf will have a unique design with the words "Gaucho Futbol" included as the Gauchos build on their reputation for leading the NCAA in attendance and having the best atmosphere in the nation.
In addition to the "Loyalty Scarf," there are rewards for new
season ticket holders and those season ticket holders who refer
others to purchase season tickets. The first 25 new season
ticket purchasers will receive a UCSB soccer t-shirt, the first 25
who refer others to purchase Gaucho soccer family plans will
receive a UCSB soccer polo and the first 25 who refer single season
ticket purchases will be rewarded with a UCSB hat.
For more information drop by the Ticket Office in the ICA Building on campus, call 805-893-UCSB (8272) or on-line by clicking here.


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Calling all adventurers! Get ready to tag along with Chris, your host, as he heads off to India to visit his friend, Justin — and immediately gets lost! Will Chris get where he needs to go? Will his friend find him? What adventures await? Sign up today to get "Lost in India" and find out!
Through 8 videos, your family (or church group, school group, etc.) will travel across India with Chris, visiting incredible places and meeting extraordinary people. And — best of all — you'll see some of the amazing things God is doing in the land of India today! Register now to get your Adventure Kit (everything is totally free!), and get ready for fun interactive games, great stories, and much more!
So what are you waiting for? Sign up today to get your free Adventure Kit ... and let's get "Lost in India"!START YOUR ADVENTURE TODAY!
Mission India says "Get Lost!"
Well ... get "Lost in India" that is!
Hang on as 8 adventure-filled videos bring India straight into your living room — or wherever your laptop, tablet, or smartphone takes you!
What's in store? Here's a sneak peek. You will:
- See and experience the real India — without ever jumping on a plane
- Increase your family's heart for global missions
- Develop servant leadership in your kids
- Add a new dimension to your home-based learning
- Meet the people bringing the Gospel to India's 400+ million unreached
- Be inspired by the stories of India's people who have found hope in Christ
- Engage your family in a special opportunity to introduce boys and girls in India to Jesus
Ready to get lost?
Grab your adventure kit!
Your Adventure Kit will arrive in your mailbox about 10 days* after you sign up for Lost in India and contains everything you need for the trip — including a map to track your journey and a "backpack" to collect loose change and dollars. (And, BONUS, it's completely free!)
Eager to change the lives of kids in India and their families?
As you journey along, you'll have the opportunity to collect loose change and bills in your backpack. Every dollar you save will send a little boy or girl in India to a Children's Bible Club — 10 days of summertime fun where they'll learn all about Jesus ... many for the first time!
*Adventure Kits are only shipped to U.S. addresses
meet your host, chris.
Chris is your wacky and fantastic "tour guide!" As you wander along with Chris, trying to find his good friend, Justin, you'll explore exciting places, meet new people, and experience India like never before! You just might be surprised by what you learn.
Chris says, "Going to India and seeing how God is working there has impacted my life forever. I have met people whose stories and testimonies have honestly changed my life."
One of those guys who's always up for an adventure, Chris is excited to have you along for the ride!
Proudly brought to you by:
At Mission India, we have a BIG vision. We want to see "India transformed by Christ."
So we partner with India's believers to tell kids about Jesus in Children's Bible Clubs, teach illiterate adults how to read and write (and read the Bible!), and train people how to start new churches!
The Good News is being shared by India's most ordinary people — even kids just like you! — but as you'll discover in Lost in India, God is using them in extraordinary ways!
"Please help us share the Gospel with kids in India this year! Get ready to learn about a culture, place and people half a world away, nurture your children's spirit of generosity, and have some real fun along the way, too. I am confident your family will enjoy your Lost in India adventure."
Sarita Holzmann, Sonlight President
Together we are changing lives in India!
Kids going to Children's Bible Clubs
- $195,038
Given So Far
- $175,000
Matched by Sonlight
- Our Goal: $350,000


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Get excited about reading again with fun and interesting tips from our experts, including The M.D., our dietitians, and our fitness expert. In our health library, you will find all of the information you need to achieve your goals of making a healthy lifestyle change. So, start reading and start losing!
Creating a lighter, healthier you is a multi-step process. One of the most important steps, and the main focus of this section, is exercise. Here we explore everything from the benefits of exercise to how much and how often it is necessary to promote weight loss.
Learn the health benefits of walking to school for school age children. Activity is critical for young bodies, and walking is an easy way to get in those necessary steps.
These days, walking to school is a rarity for most children—especially in a society influenced by the importance of owning and driving a nice vehicle. If children aren't being brought to and from school by mom or dad, then at least 26 million of them ride the bus every day.
Since 1973, the percentage of children who walk to school has dropped by almost 30%. This means more riding and less physical activity. This dramatic drop in physical activity is believed to be a big influence on the nation's rising childhood obesity rate.
"Unhealthy food choices combined with a lack in physical activity has contributed to the nation's increase in childhood obesity," says Christy Zagarella, MS/RD, and one of the lead dietitians for BistroMD. "This is even influenced more by the decline in children not walking or riding a bike to school."
We explain why kids aren't walking to school anymore, and how making them walk or ride a bike can have a significant impact on their health.
Why You Should Make Them Walk
Children living in urban areas and from lower-income families are more likely to ride a bicycle or walk to school.
In the results of this study, recently published by the Journal of Pediatrics, 7,000 children between the ages of 6 to 10 living in urban areas were more likely to choose a form of active transportation over riding to school—either walking or riding a bike.
"This choice to either ride or bike to school will have a significant impact on the health of these children," says Christy. "Today, most children don't reach the minimum requirement of physical activity. Riding a bike or walking to school certainly helps."
On average, children between the ages of 5-10 are supposed to get at least 20-30 minutes of physical activity per day, 5 days out of the week. In addition to helping your child maintain a healthy level of physical activity, making sure that they exercise every day can promote stronger development of bones and muscles, but also help them maintain a better self-image.
"Children want to feel good about themselves, just like adults," says Christy. "Encouraging your child to exercise can help them maintain a leaner physique, as well as promote a stronger development of bones and muscles."
Make the Activity Easier
"Active transportation to school represents an affordable and easy way to incorporate physical activity into the daily routines of children," says Christy. "Where your child attends school can also make a big difference on their health."
In the same study, children who attended a private school that was further away from home were less likely to engage in any type of physical activity, than kids who attended private school within two miles of their home. This is why location is an important factor when it comes to your kids "actively" getting to school.
"If possible, encourage your child to walk or ride a bike to school if they live less than two miles away," says Christy. "On a weekend day, walk or ride your bike with your child on the same path they will take. This will help them feel more comfortable, and help them adjust to the distance."
Safety is also a concern for many parents when their child is walking or riding to school. If necessary, have your child call you when they arrive to school and before they leave school each day. Time your child's route so you know when they are supposed to arrive to school and arrive at home each day. This way, you can monitor your child's safety while promoting more physical activity.
"Parents can help their children feel more comfortable with riding their bike or walking to school by praising them for their hard work," says Christy. "Reward your child for their efforts by taking them to one of their favorite places over the weekend, or plan a weekend getaway. Just make sure that you don't reward them with sweets or junk food."
Simply answer a few questions so we can figure out your weight loss goals and provide solutions for a lighter, healthier you. Our weight loss meal plans are designed to help real people achieve real and lasting success.
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