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Favorable Outcome After Physiologic Dose of Sodium-d,l-3-Hydroxybutyrate in Severe MADD
- Willemijn J. Van Rijt, BSca,
- M. Rebecca Heiner-Fokkema, PhDb,
- Gideon J. du Marchie Sarvaas, MDc,
- Hans R. Waterham, PhDd,
- Robert G.T. Blokpoel, MDe,
- Francjan J. van Spronsen, MD, PhDa, and
- Terry G.J. Derks, MD, PhDa
- aSection of Metabolic Diseases,
- cDepartment of Pediatric Cardiology, Center for Congenital Heart Diseases, and
- eDivision of Pediatric Intensive Care, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands;
- bLaboratory of Metabolic Diseases, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; and
- dDepartment of Clinical Chemistry, Laboratory Genetic Metabolic Diseases, Academic Medical Center, University Hospital of Amsterdam, Amsterdam, Netherlands
Multiple acyl coenzyme A dehydrogenase deficiency (MADD) is a severe inborn error of metabolism. Experiences with sodium-d,l-3-hydroxybutyrate (3-HB) treatment are limited although positive; however, the general view on outcome of severely affected patients with MADD is relatively pessimistic. Here we present an infant with MADD in whom the previously reported dose of 3-HB did not prevent the acute, severe, metabolic decompensation or progressive cardiomyopathy in the subsequent months. Only after a physiologic dose of 2600 mg/kg of 3-HB per day were ketone bodies detected in blood associated with improvement of the clinical course, N-terminal prohormone of brain natriuretic peptide and echocardiographic parameters. Long-term studies are warranted on 3-HB treatment in patients with MADD.
- multiple acyl coenzyme A dehydrogenase deficiency
- mitochondrial fatty acid oxidation
- cardiomyopathy
- sodium-d,l-3-hydroxybutyrate
- electron transfer flavoprotein
- inborn error of metabolism
- multiple acyl coenzyme A dehydrogenase deficiency
- mFAO —
- mitochondrial fatty acid oxidation
- NT-proBNP —
- N-terminal prohormone of brain natriuretic peptide
- sodium-d,l-3-hydroxybutyrate
Multiple acyl coenzyme A dehydrogenase deficiency (MADD; or glutaric aciduria type II; Online Mendelian Inheritance in Man (OMIM) no. 231680) is a rare inborn error of metabolism (IEM) caused by a defect in the electron transfer flavoprotein (ETF) or its electron acceptor, called ETF dehydrogenase.1 These enzymes form an important common metabolic pathway of at least 12 dehydrogenases from both mitochondrial fatty acid oxidation (mFAO) and amino acid metabolism toward the mitochondrial respiratory chain.
Patients with MADD are phenotypically classified into 3 groups: (1) neonatal onset with congenital anomalies, (2) neonatal onset without congenital anomalies, and (3) relatively milder, later onset.1 Treatment consists of dietary fat and protein restriction, along with supplementation of riboflavin, glycine, and l-carnitine. There is no effective treatment of patients with MADD who present in early infancy.1 However, successful experimental treatment with sodium-d,l-3-hydroxybutyrate (3-HB; a ketone body) has been described in 4 patients with MADD.2,3 Cardiac and neurologic improvement was observed with a dose up to 900 mg/kg per day, placing management of MADD in a new perspective.
Since then, no additional reports have been published. Theoretically, this may be caused by (a combination of) the low prevalence of the disease, the difficulty to establish the diagnosis, the hesitance to deviate from the original dose, and the high costs of 3-HB supplementation. Meanwhile, MADD has been implemented in several population neonatal bloodspot screening programs worldwide.4,5 Patients are additionally identified after false-positive neonatal screening test results for other IEMs.5 Because the use of ketone body supplementation requires further investigation, we report on an infant with MADD in whom the clinical course significantly improved after increasing the 3-HB dose >900 mg/kg per day.
Patient Presentation
An infant girl presented on the first day of life with hypoglycemia and severe ventricular tachyarrhythmias. This combination suggested a defect of long-chain mFAO, which later proved to be MADD (homozygosity for a novel c.1-40G>A mutation in the ETF-α gene, pathogenicity confirmed by absence of protein expression by immunoblot studies in cultured skin fibroblasts). Dietary treatment included frequent feedings, restriction of fat, and supplementation of riboflavin and coenzyme Q10.
After 5 months, mild developmental delay was noted and the cerebral MRI displayed a global increase of atrophy and bilateral cytotoxic edema posteromedially in the lentiform nucleus and in the left frontal periventricular white matter. There were no cardiac symptoms or signs. First, continuous nocturnal gastric drip-feeding was initiated, but in contrast to previous observations6, metabolic profiles did not improve in our patient. Second, 3-HB supplementation was started, initially at a dose of 450 mg/kg per day and increased after a week to 900 mg/kg per day according to the literature3, without, however, significant amounts of ketone bodies in blood or urine. Table 1 presents the metabolic parameters in blood and urine during the different phases of 3-HB treatment.
The patient developed a gastroenteritis and severe metabolic decompensation with hypoglycemia and metabolic acidosis, requiring resuscitation. The subsequent intensive care period was complicated by diaphragmatic paralysis, malnutrition, and progressive cardiomyopathy. We hypothesized that the 3-HB dose could not entirely correct for the presumed severe metabolic block in our patient. On the basis of the results of quantitative stable isotope studies, we empirically increased the 3-HB dose from 900 toward 2600 mg/kg per day.7,8 Our patient subsequently improved clinically; Table 2 shows the course of echocardiographic parameters and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (Fig 1), an important biomarker for heart failure diagnosis and prognosis.9
The relatively pessimistic view on management of severely affected patients with MADD is emphasized by at least 2 recent articles summarizing small cohorts of patients with MADD. al-Essa et al10 described 7 patients with MADD of whom 5 presented neonatally. Four of these 5 patients died despite intensive supportive therapy. Angle and Burton11 reported 3 patients with MADD who received treatment since the first weeks of life after early detection by population neonatal screening in the city of Chicago. Two of the 3 patients died unexpectedly, and the remaining patient suffered an acute life-threatening event.
Interpretation of previous case reports and cohort studies is complicated by incomplete and/or different approaches to characterize patients with MADD. Biochemically, diagnosis of MADD relies on the identification of increased excretions of urinary organic acids (mainly ethylmalonic, glutaric, 2-hydroxyglutaric, isovaleric, and dicarboxylic acids) and abnormal plasma amino acids (eg, sarcosine). Plasma or urine acylcarnitines may be increased to variable degrees. In vitro probe acylcarnitine assay using cultured fibroblasts facilitates the identification of the severity of the disorder.12 In our patient, biochemical markers were frequently analyzed, and a large intraindividual variation for each marker was observed. One of the reasons could be the lack of standardization (time of the day and nutritional status). The significant relations between 3-HB dose and some biochemical markers (ie, glutaric acid, 2-OH-glutaric acid, isovalerylglycine, hexanoylglycine, and suberic acid) warrant further investigation. To date, MADD-like metabolic profiles have been associated with mutations in at least 6 different human genes.13 A relation between a severe clinical phenotype and the genotype has been reported, with severe neonatally ascertained patients more likely having null mutations in ETF dehydrogenase or ETF-β.14 Interestingly, in our patient we found homozygosity for a novel mutation in the ETF-α gene.
The natural course of cardiac involvement in MADD is incompletely described. Singla et al15 have found that most of our knowledge on cardiomyopathy and MADD is derived from autopsy studies. To the best of our knowledge, this is the first report of a patient with well-characterized severe MADD in whom cardiac parameters were followed prospectively since birth. Interestingly, her echocardiac function was normal 1 day after the metabolic decompensation at the age of 7 months. Because she developed severe functional and structural cardiomyopathy only after, but not immediately after, the second decompensation, we speculate that a chronic mechanism is involved. Despite the short-term reversal by high-dose 3-HB, it is important to realize that long-chain mFAO is a major source of energy for the heart after birth.16,17 Hence, it is not known whether 3-HB supplementation can prevent progression of long-term cardiac involvement.
The rationale for the use of 3-HB in MADD has been described in 2 case reports of supplementation up to 900 mg/kg per day with subsequent "measurable concentrations of physiologic ketone bodies at all times."3 In our patient, this treatment could not help in weaning from mechanical ventilation, and biochemical (NT-proBNP) and echocardiographic parameters worsened. Ketone bodies were not detectable in blood or urine at this dose. In healthy children, the ketone body concentration is a function of age and duration of fasting.18 Endogenous ketone body production has been quantified by stable isotope infusion studies.7,8 Rates have been reported of 12.8 to 21.9 and 17.9 to 26.0 μmol/kg per minute in newborns fasted for <8 hours and in older infants fasted for <10 hours, respectively. This is within the range found in adults only after several days of total fasting.7 These data have been the rationale behind the increase toward 2600 mg/kg per day, corresponding to 17.8 μmol/kg of 3-HB per minute. In our patient, cardiac function improved only after this physiologic dose of 3-HB.
Theoretically, supplementation of 3-HB may increase the risk of ketoacidosis as is seen in diabetes, IEMs of ketolysis, and patients treated with a ketogenic diet. However, we estimate that in our patient the supplementation of 3-HB only partially replaces the severely deficient endogenous synthesis of ketone bodies, which is substantiated by the fact that even during her second metabolic decompensation, no ketone bodies were detected. Still, this dose of 3-HB needs to be considered with caution, because it is associated with a sodium supplementation of 20 mmol/kg per day. These high doses inevitably impair fluid and sodium homeostasis with potential secondary cardiovascular and cerebral effects.
The previously recommended dose of 900 mg/kg of 3-HB per day did not prevent the progressive cardiomyopathy. Blood ketone bodies were only detectable in our patient after increasing 3-HB dose up to 2600 mg/kg per day, which adequately compensated for the deficient endogenous synthesis of ketone bodies. Together with the clinical course, NT-proBNP, some biochemical markers, and echocardiographic parameters subsequently improved. Our observations emphasize the need for further long-term studies to personalize the dose of 3-HB in patients with MADD.
We thank the parents who gave informed consent for both the treatment and the publication of the manuscript.
- Accepted March 27, 2014.
- Address correspondence to Terry G.J. Derks, MD, PhD, Section of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen. PO Box 30 001, 9700 RB Groningen, the Netherlands. E-mail: t.g.j.derks{at}umcg.nl
Ms Van Rijt collected and analyzed the metabolite and echocardiographic data, performed the statistical analysis, drafted the first version of the manuscript, and wrote the final manuscript; Dr Heiner-Fokkema was responsible for the metabolite diagnosis of multiple acyl coenzyme A dehydrogenase deficiency (MADD), performed and analyzed the metabolite studies, supervised the statistical analysis of the metabolite studies, and critically reviewed and revised the manuscript; Dr du Marchie Sarvaas was responsible for the cardiac follow-up, performed and analyzed the echocardiographic studies, supervised the statistical analysis of the echocardiographic studies, and reviewed the manuscript; Dr Waterham performed the molecular studies confirming the diagnosis at the DNA level and reviewed the manuscript; Dr Blokpoel was responsible for the treatment at the Division of Pediatric Intensive Care and reviewed the manuscript; Dr van Spronsen performed the overall clinical treatment and monitoring and critically reviewed and revised the manuscript; Dr Derks was responsible for the clinical diagnosis of MADD, performed the overall clinical treatment and monitoring, collected and analyzed the metabolite and echocardiographic data, initiated and drafted the first version of the manuscript, critically reviewed and revised the manuscript, and wrote the final manuscript; and all authors approved the final manuscript as submitted.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- Copyright © 2014 by the American Academy of Pediatrics


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Turkey Trot Soup
laura lomax
1 turkey carcass
2 cups carrots
1 Bay leaf
6 cups water
2 cups diced turkey
2 cups rice
1/2 avocado, cubed
Salt and pepper
1. Remove as much meat as possible from turkey and place carcass in deep pot. Season with salt and pepper.
2. Fill with water and bring to a boil. Add carrots and bay leaf. Reduce heat to medium-low, cover and let cook for 1-2 hours.
3. Strain broth into a bowl, discard carcass and save carrots to use in soup. Add strained broth back to the pot. Add rice and turkey.
4. Let cook for an additional ~20 minutes or until rice is cooked. Serve with garnish of avocado.
*FODMAP friendly, diary free
* If turkey was prepared FODMAP and diary free

subset: commoncrawl


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Henry Fairfield Osborn, Jr. (15 January 1887 — 16 September 1969), son of the American geologist Henry Fairfield Osborn and cousin of Frederick Osborn, was a conservationist. He was longtime president of the New York Zoological Society.
Henry Fairfield Osborn Jr. was born in Princeton, New Jersey. Born into the wealthy and influential Osborn family, he was the son of Henry Fairfield Osborn, a prominent paleontologist, eugenicist and "distinguished Aryan enthusiast".[1] After obtaining his Bachelor of Arts from Princeton University, he went on to study biology at Cambridge University, but then pursued a career in international business. Towards the end of the First World War, he served briefly as a Captain in the United States Army, after which he returned to private enterprise.
In 1935, he retired and devoted himself to environmental causes. He continued in his capacity as secretary and board member of the New York Zoological Society, a position he held from 1923 until 1940, when he was named president and board member, a position he held for the rest of his life.
Osborn wrote Our Plundered Planet, and when published in 1948 it became very influential in the early Environmental movement and helped spur a Malthusian revival in 1950s and 60s. He is also remembered for being an early opponent of synthetic pesticide use, for producing several films dealing with endangered species, flood control and water resources, as well as for his second book, The Limits of the Earth (1953), and a collection of short essays he edited under the title of Our Crowded Planet (1962). From 1948 to 1961, he served as the first president of the Conservation Foundation, an organization he founded with a number of like-minded colleagues to raise awareness about ecological problems.
After retiring as president, he served as chairman of the board of this organization from 1962 to 1969. From 1950 to 1957, Osborn was also a member of the Conservation Advisory Committee for the U.S. Department of the Interior, while also serving on the Planning Committee of the Economic and Social Council of the United Nations. Upon his death in New York City on September 16, 1969, "he was remembered for playing a valuable role in a number of conservation organizations and for his outreach initiatives to warn of the dangers of uncontrolled population growth and to promote responsible natural resource consumption."[2]
Henry Osborn (Royal Navy officer), Henry Fairfield Osborn, Henry Fairfield Osborn, Jr., Henry Osborn (politician), Henry Osborn (cricketer)


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No doubt, Madonna Louise Ciccone was a real pioneer, she smashed up boundaries in her fingerless lace gloves and in doing so laid the foundations for today's fierce female singers.
Lady Gaga, Katy Perry, Nicky Minaj, Kesha; they all owe their careers to the trained dancer's determination to be successful as a real female artist rather than a singing doll.
Madonna was one of the first mainstream female entertainers to encourage women to own their bodies; not to be unashamed of their sexuality but to celebrate it.Check out more x-Rated Photo's After The Cut...
Now 54, Madonna's decision to parade her admittedly fantastic body in skimpy lingerie on stage seems more like the act of an aging dame trying to persuade the world she's still got it than an entreaty to empowerment.
Madonna revealed her new outfit in Miami while in a performance...
What are your thoughts on Madonna's neW outfit?


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Well, the turkey and mashed potatoes are finished. The last of the pumpkin pie cheesecake was eaten for breakfast. The wine bottles have been carried to the curb. Another Thanksgiving dinner is over and done.
Now's the perfect time to haul yourself off the couch and squeeze in a quick workout!
I know, you're not at home and you don't have any equipment other than that resistance band I suggested you pack 😉
This week's #FatblasterFriday workout is a short and sweet, whole body strength workout, perfect for regular exercisers and newcomers to fitness alike. Just twelve reps of each of 8 resistance band exercises and you're done (unless you had seconds on dessert; then you need to do the circuit two more times…).
Tips for working with a resistance band?
- always check your band for tears and holes before you begin your workout; a band that snaps during exercise will leave a nasty bruise on your arm, leg or face
- bands with padded handles are easier to use than bands without
- bands generally come in 4′ and 6′ lengths. The longer the band, the more versatile (you can always shorten it when more resistance is needed; see below)
- make sure there's tension on the band at the beginning of each exercise; no tension, no added resistance
- increase the resistance on the band by shortening the distance between the handles, either by wrapping the excess band around your wrists (as demonstrated in the video) or by stepping on the band with both feet (again, see the video for more details)
Ready to go? The "Resistance is NOT futile" Band Workout!
Did you like this workout? Then PLEASE
- WATCH and DO the workouts with me
- SUBSCRIBE to fitknitchick on YouTube
- CHECK OUT the #FatblasterFriday Playlist for more, real time workouts
- PIN the above WORKOUT PHOTO
- GIVE me your FEEDBACK on YouTube or in the COMMENTS section below
- LIKE and SHARE my videos with your friends via email, Facebook and Twitter
More VIEWS, LIKES, COMMENTS and SHARES –>> More VIDEOS!
Disclaimer: Although I am a registered Personal Trainer, I am not YOUR Personal Trainer. Always adapt workouts to suit your body and fitness level. Always consult your doctor before beginning a new exercise program.


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Bendix, Methe (Denmark)
Methe Bendix is a Danish playwright, director, and artistic director of Teater Hund, a Copenhagen-based theatre for children and adults. She has written and directed mainly for Teater Hund since 2003.
The work builds on experiment and improvisation, as well as the passions and life experiences of the director, choreographer, and the actors.
- A defining characteristic: Takes humor very seriously.
- Educated as an actor in 1987.
- Co-founded Teater Får302 (Copenhagen) in 1987.
- Started to explore theatre for children around 2000 after having performed and written for adults since 1987.
- Since 2000 a full-time playwright and director.
- Founded Teater Hund in 2003.


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Ingredients: Water, vegetable oil products, corn sugar soap, aloe vera*, glycerine**, lemon balm* and peppermint leaf extract*, sweet orange oil*, salt, polysaccharide, perfume (plant extract), vitamin E. * = Organic farming. ** = Made using organic ingredients.
12 % organic of total
41 % organic of total minus water and minerals


text: Take a moment to check out the photos we post to Instagram! These are a collection of behind the scenes shots, work from our friends in the wedding community, fun ideas from styled shoots, and photos from events and weddings held on site. Feel free to check us out on Instagram and follow us for past and future updates: @sevenspringsva


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The Chicago Bulls losing their superstar Derrick Rose for the postseason is nothing short of devastation for their playoff hopes. Anytime you lose the reigning NBA MVP it's disaster.
But Hall of Famer and Bulls legend Scottie Pippen sent the team an open letter of encouragement. Here's an excerpt:
With what happened to Derrick in Game 1, it would be easy to hang your heads right now. You could lose sight of the ultimate goal and give up before the rest of the games have even been played. But I know that's not even a consideration for this group. And that's exactly why you'll make me, Derrick, the organization, and the city of Chicago so proud.
To a man, it's time for each of you to take a look in the mirror. Decide who you really are and what you represent as a basketball player. Reflect on what you have brought to the table for your team all season long and why you're a valuable member of the Bulls. Because all of you have contributed to this team's incredible success. Ask yourself what you can do for the team moving forward. Whether it's through your verbal leadership or diving on the floor after a loose ball, it's going to be all about grinding it out moving forward. If there is one piece of advice I can offer you, it's to put every last ounce of effort you have out there to make everyone proud—Derrick, the fans, and first and foremost, yourself.
Paul M. Banks is CEO of The Sports Bank.net, an official Google News site generating millions of unique visitors. He's also a regular contributor to Chicago Now, Walter Football.com, Yardbarker, MSN and Fox Sports
A Fulbright scholar and MBA, Banks has appeared on live radio all over the world; and he's a member of the Football Writers Association of America, U.S. Basketball Writers Association, and Society of Professional Journalists. The President of the United States follows him on Twitter (@Paul_M_BanksTSB) You should too.Powered by Sidelines Follow paulmbanks


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Peer Reviewed
Document Type
Publication Date
Obstructive sleep apnoea, Intermittent Hypoxia, Muscle
Health Research Board Ireland, the Irish Research Council for Science, Engineering and Technology, Royal College of Surgeons in Ireland, University College Dublin Ireland, Charitable Infirmary Charitable Trust Ireland, Higher Education Authority Ireland, Physiological Society.
The original article is available at http://www.omicsonline.org
Obstructive sleep apnoea is a common condition associated with significant morbidity and increased mortality. During sleep, the sub atmospheric pressure developed in the extra thoracic airway by the contraction of the thoracic pump muscles during inspiration causes collapse of the compliant upper airway, resulting in an episode of apnoea. Normally, upper airway collapse is prevented by contraction of upper airway muscles and if the airway does collapse, it is re-opened by a reflex augmented neural drive and greater contraction of these muscles. Therefore, the function of these muscles plays a critical role in the pathogenesis of the obstructive sleep apnoea. The multiple episodes of apnoea that occur during the course of sleep cause intermittent hypoxia. We have proposed that chronic intermittent hypoxia causes adverse changes in structure and function of upper airway muscle that result in an exacerbation of the condition. We have shown that chronic intermittent hypoxia in rats causes greater fatigability of upper airway, diaphragm and limb muscles. In general, this appears to be true also for chronic continuous hypoxia, although the diaphragm muscle is relatively tolerant of sustained hypoxia compared to limb muscle. We propose that the chronic intermittent hypoxia of obstructive sleep apnoea causes a positive feedback that exacerbates the condition by reducing upper airway muscle endurance, thus making the upper airway more vulnerable to collapse. This effect involves the generation of reactive oxygen species and treatment with antioxidants either prevents or ameliorates the adverse effects on muscle function, suggesting that antioxidants could be used as an adjunct therapy for obstructive sleep apnoea. This may be true also for respiratory disease in general since chronic continuous hypoxia is also associated with increased muscle fatigue.
Physics | Physiology
Bradford A, O'Halloran KD. Obstructive Sleep Apnoea, Intermittent Hypoxia and Respiratory Muscle Structure and Function. Anatomy & Physiology 2013;3:e123
Link to this item at
DOI Link
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This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.


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US school shooting: Obama vows to act on violence
Issued on: Modified:
US President Barack Obama told a vigil in Newtown, Connecticut, on Sunday that "We're not doing enough" as a country to prevent tragedies like Friday's school shootings, indicating there may be renewed political will to push for stricter gun control.
US President Barack Obama on Sunday demanded changes in the way the country dealt with gun violence, though he avoided the use of the word "gun" itself in consoling the Connecticut town shattered by the massacre of 20 young schoolchildren and seven adults.
Obama said the world would judge the nation by the way it cared for its children, and that Friday's slaughter left that judgment wanting.
"What choice do we have?" Obama said at an evening vigil in the shattered community of Newtown, Connecticut. "Are we really prepared to say that we're powerless in the face of such carnage, that the politics are too hard? Are we prepared to say that such violence visited on our children year after year after year is somehow the price of our freedom?"
He spoke of a broader effort, never outlining exactly what he would push for, but expressed outrage at yet another shooting rampage. "Surely we can do better than this," he said. "We have an obligation to try."
Reporting from Newtown, FRANCE 24's Nathan King said that "while Obama made no promise of new laws, this was definitely a tone-setting speech for a very strong debate on gun control".
The massacre of 20 children and six adults at Sandy Hook Elementary School on Friday elicited horror around the world, soul-searching in the US, fresh political debate and questions about the incomprehensible – what drove 20-year-old suspect Adam Lanza to kill his mother and then unleash gunfire on a classroom of schoolchildren?
A total of seven adults and 20 boys and girls between the ages of six and seven were slaughtered before the suspected gunman killed himself, bringing the final death toll to 28.
Obama told Connecticut Governor Dannel Malloy that Friday was the most difficult day of his presidency. The president has two daughters, Malia and Sasha, who are 14 and 11, respectively.
"Can we say that we're truly doing enough to give all the children of this country the chance they deserve to live out their lives in happiness and with purpose? I've been reflecting on this the last few days," the president said, his voice sombre and steady. "And if we're honest with ourselves, the answer is no. We're not doing enough and we will have to change."
He promised in the coming weeks to talk with law enforcement, mental health professionals, parents and educators in an effort to prevent mass shootings.
The shootings have restarted a debate in Washington about what politicians can to do help – gun control or otherwise. "Obama really gave the impression of somebody who wanted to go back to Washington and get things done," FRANCE 24's Philip Crowther reported from Capitol Hill on Monday. "This will be a week of fierce lobbying for those who want stricter guns laws, but we will also probably hear from the National Rifle Association (NRA), the gun owners' lobby."
Democratic lawmakers said Sunday that military-style assault weapons should be banned and that a national commission should be established to examine mass shootings in the US.
Obama and Senate Democrats haven't pushed for new gun controls since rising to power in the 2008 elections. Outspoken advocates for stricter laws, including Senator Dianne Feinstein, say that's because of the powerful sway of the NRA.
But gun control advocates also say the latest shooting is a tipping point that could change the dynamic of the debate. Feinstein said she will propose legislation next year that would ban big clips, drums and strips of more than 10 bullets.
"The pressure now on Obama is pretty big to change gun laws," Crowther said. "But he also has a big fight on his hands."
(FRANCE 24 with wires)


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Tomato Bisque and Grilled Cheese
This has been on my to-make list for quite a while and I thought I'd try my hand at it before the weather got any warmer. I've never made tomato bisque before, but to my surprise it was really easy and am pleased with the results. I decided to pair it with a simple grilled cheese sandwich with mozzarella. I usually enjoy a mixture of cheeses but this was all I had at home. To add a little bit more flavor and contrast I spread Trader Joe's olive tapenade on one side. I baked the bread at home yesterday and it added a nice texture than the usual sliced bread. I definitely recommend using an artisan bread over grocery store sandwich bread. It easily takes your grilled cheese from a 2 to a 7, even more if you use a mixture of cheeses. And be liberal with your butter! Butter makes everything tastier. Also, if I haven't mentioned it enough times already, if you're interested in baking bread but don't know where to start I definitely suggest using the Artisan Bread in 5 Minutes book!
Tomato Bisque
Adapted from the Food Network Kitchens
1 tbsp butter
1/2 onion, diced
2 strips of bacon, cut into small strips
1 carrot, chopped
2 cloves garlic, minced
2 1/2 tbsp flour
2 1/2 cups chicken broth
3 large roma tomatoes, cut into quarters
1 bay leaf
1/3 cup heavy cream
salt and pepper to taste
brown sugar to taste, about 1 tbsp
2 tbsp tomato paste
Heat the butter in a large soup over medium-high heat, then add the bacon until most of the fat has rendered, about 1 minute. Using a slotted spoon, transfer the bacon onto a paper towel-lined plate, . Lower the heat to medium and add the onion, carrot, and garlic and cover. Stir occasionally until everything has softened, about 3-4 minutes.
Sprinkle in the flour while stirring until it's fully incorporated, about 1 minute. Add the chicken broth and tomatoes and stir together. Add the bay leaf. Turn heat to low and let simmer for about 15-20 minutes.
Turn off flame, then out the bay leaf. Using an immersion blender, puree the mixture until smooth. Add brown sugar and mix in thoroughly. Whisk in heavy cream. Add salt and pepper to taste, and add back the bacon if you wish!


text: my new toy. i have been wanting to blog on the go but haven't been able to from my phone because it is the one app it doesn't support. of course. then i heard that the i pod touch has a blogging app so off i was to get one. fun . i am sure i will put it to good use


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**This is a repost of one of my favorite Teacher Appreciation Ideas**
I know I keep saying this, but cute, right!? I love the papers that I used for these gifts! I made these tall milk cartons from a template and my own cute paper stash (oh how I have a weakness for paper!). Then, I filled them with all the makings for S'Mores; Graham Crackers, A Hershey Bar, and Marshmallows. Make sure to be able to see all of your ingredients. The Hershey Bar would be lost on either of the sides and so had to be sandwiched in the middle of the marshmallows and graham cracker. I added a tag on the back that was a heart felt letter of thanks from my kids and I and then this saying:
"We Need S'More Teachers Like You!"
To make these I cut out my milk carton template out of my cute papers, having to add a window to see what was inside so that my note made sense. That's the backside of my paper cut out and with fold lines in place.
Hard to see on this one but I'm holding my window cover. I cut up a sheet protector for this and glue it to the inside of the box before you glue the box together!
I have a new favorite glue for paper projects. I really want my paper projects to hold up especially because I tend to do lots of bags and boxes, and who really wants the gifts inside falling out because your glue doesn't hold?! The paper on the left is the front side of my paper after it is cut out and lines folded. The paper on the right shows the box mostly put together. I glued the top part together and then filled the box with my goodies, and the bottom of the box has a tuck in closure (fit tab A into slot B kind of a thing)!
You wont see the box on the right finished. It was an extra one that my daughter asked for. She had another teacher at school that she goes to (for her Project Ideal class) that she wanted to give something to as well. I'm so happy that my daughter likes doing this as well as me and that she thought about another person to give this to. My kids ride the bus and so for Christmas and end of the school year we also include the bus drivers in the gift giving.
I punched 2 holes in the top to tie a pretty ribbon through that will add a cute embellishment as well as tie the card to the gift! My other fun embellishments are my 3-D butterflies on the window part of the box. I cut them out of excess from the boxes. I only glued on the body of the butterfly and folded the wings back so that they would stick out.
As with most gifts, these would also be great for Mother's Day or any other gift giving time!
Don't forget to check here, here, here, here, here, or even here for our other fantastic Teacher Appreciation/Mother's Day gifts!
***All the girls at Roots and Wings Co love to share our patterns and templates. Unfortunately, the template for this milk carton is not ours to share. It is part of a program that I got with one of my cutting systems.


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South Eastern Indigenous Media Association
|Sub Category:
|Incorporated Association
|Melbourne, Victoria, Australia
|Click this link to search this location with google maps
|Subject Matter:
|Cultural Heritage | Health and Community Services | Intellectual Property
|Summary Information:
|South East Indigenous Media Association is an Indigenous radio station broadcasting throughout Victoria since 2003. The station has a 70% Indigenous music programming policy, and a 100% Indigenous broadcaster policy, and is on air 24 hours a day, 7 days a week.
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|General Reference
|South Eastern Indigenous Media Association Inc (20 July 2006) Witness Submission to the Standing Committee on Communications, Information Technology and the Arts, House of Representatives, Parliament House.
|Australian Government - Indigenous Portal (February 2007) Statewide '3KND Community Radio and Training Facility' Shared Responsibility Agreement (SRA)
|Incorporated Association
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