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Use of the Biphasic 13C-Sucrose/Glucose Breath Test to Assess Sucrose Maldigestion in Adults with Functional Bowel Disorders
Sucrase insufficiency has been observed in children with of functional bowel disorders (FBD) and symptoms of dietary carbohydrate intolerance may be indistinguishable from those of FBD. A two-phase 13C-sucrose/13C-glucose breath test (13C-S/GBT) was used to assess sucrase activity because disaccharidase assays are seldom performed in adults. When 13C-sucrose is hydrolyzed to liberate monosaccharides, oxidation to 13CO2 is a proportional indicator of sucrase activity. Subsequently, 13C-glucose oxidation rate was determined after a secondary substrate ingestion (superdose) to adjust for individual habitus effects (Phase II). 13CO2 enrichment recovery ratio from 13C-sucrose and secondary 13C-glucose loads reflect the individualized sucrase activity [Coefficient of Glucose Oxidation for Sucrose (CGO-S)]. To determine if sucrase insufficiency could be a factor in FBD, 13C-S/GBT was validated using subjects with known sucrase gene mutation status by comparing 13CO2-breath enrichment with plasma 13C-glucose enrichment. 13C-S/GBT was used to assess sucrose digestion in FBD patients and asymptomatic controls. 13CO2-breath enrichment correlated with the appearance of 13C-sucrose-derived glucose in plasma (). Mean, control group CGO-S-enrichment outcomes were 1.01 at 60′, 0.92 at 75′, and 0.96 at mean 60′–75′ with normal CGO-S defined as >0.85 (95% C.I.). In contrast, FBD patients demonstrated lower CGO-S values of 0.77 at 60′, 0.77 at 75′, and 0.76 at mean 60′–75′ (Chi Square: 6.55; ), which points to sucrose maldigestion as a cause of FBD.
Functional bowel disorders (FBD) have an estimated prevalence of 10–21% of the general population for which the pathophysiology remains elusive . As outlined by Rome III criteria, functional conditions include symptoms of recurrent abdominal discomfort (pain and bloating) associated with changes in bowel habits (diarrhea, constipation, or both) that persist for long periods in the absence of organic pathology [2, 3]. There is considerable overlap in the manner in which patients present with FBD and irritable bowel syndrome; often features of bloating and abdominal distension predominate without fully meeting specific criteria [4, 5]. The symptom complex appears similar to many conditions, including celiac disease, motility disorders, infectious enteritis, food allergies, inflammatory bowel disease, microscopic colitis, small bowel bacterial overgrowth syndrome, lactose intolerance, and nutrient malabsorption . Some individuals seem to be disproportionally hypersensitive, and, at rare times, the discomfort may be incapacitating, having been equated to symptoms produced by someone with a bowel obstruction . The diagnosis is based on exclusion of other organic disease entities , and without specific biomarkers, differentiating organic disease can be challenging [9, 10]. Many patients with functional symptoms report having experienced symptoms since childhood, which implies that a genetic predisposition may exist , but the risk-genes have not yet been validated . The onset of first symptoms has often been associated with prior gastroenteritis and stressful life events , but the specific triggers, molecular mechanisms, and neurogut targets remain obscure such that the treatment approach largely aims to relieve symptoms in the absence of a specific etiology. The role of dietary factors in FBD appears important and understudied .
Up to 65% of FBD patients report symptoms exacerbated by meals with or without specific dietary intolerances [15, 16]. However, it is not clear what role food allergies may play in FBD, but it appears to be minimal . A significant portion of pediatric patients evaluated for unexplained chronic abdominal pain were found to have decreased mucosal disaccharidase activity . Patients with specific carbohydrate intolerance, such as lactose, frequently report symptom improvement with dietary restriction, and the reintroduction of those substrates (a so-called dietary challenge) results in symptom exacerbation, serving to confirm clinical suspicions [19, 20]. Since carbohydrates collectively provide approximately 60–70 percent of the daily dietary caloric load, one could postulate that even some degree of maldigestion could be a significant putative FBD factor .
Normal sucrose digestion to glucose and fructose and transporter-mediated monomer absorption that follows have been well-described [22–24]. The sequence of events that occurs in lactose intolerance is a paradigm for other malabsorptive circumstances, including starches and sucrose. Other oligosaccharides also require luminal, mucosal enzyme hydrolysis by additional gene products, and substrates include maltose, maltotriose, and maltodextrin with α-1,4- and α-1,6-glycosidic linkages . Sucrase and isomaltase, chromosome 3 gene product, handle the bulk of sucrose and dextrin digestion (an incomplete, solubilized postpancreatic alpha-amylase hydrolysate) with a contribution by maltase-glucoamylase, chromosome 7-related gene product . When undigested/malabsorbed nutrients pass distally to the colon where microbiota fermentation occurs, gas and short-chain fatty acids are produced which, in turn, diminish water reabsorption, induce inflammation, alter colonic motility, and theoretically bring on abdominal discomfort . It is not clear if the observed gut dysbiosis is a consequence of maldigestion or is causally related to the symptoms.
The idea that disaccharide maldigestion, such as sucrose, could be causally involved in FBD is difficult to discount due to the striking similarity of symptoms [28, 29] and requires innovative approaches. The use of the breath-hydrogen test to evaluate maldigestion has only been helpful in some cases due to nonspecificity and poor sensitivity [30–32]. Breath-hydrogen production is dependent upon colonic microbiota and it is difficult to predict if the floras, in any patient, are hydrogen producers. Alternatively, when a link between carbohydrate maldigestion and GI symptomatology is suspected, specific approaches could include the use of endoscopic biopsy direct assays for sucrase, maltase, and palatinase (a surrogate for isomaltase). However, mucosal enzyme assays are onerous to perform, may not represent the confluent digestive capacity of the small intestine, and are often considered too expensive.
This study investigated the possibility of intestinal sucrase insufficiency as a contributing factor in FBD (functional bloating type) by using stable (nonradioactive) isotope tracer-labeled sucrose breath testing. Specifically, this study asked if sucrase insufficiency, as measured by an innovative two-phase 13C-sucrose/13C-glucose breath testing could, in part, explain the symptoms of FBD.
2.1. Study Design
This study was a prospective, open-label survey of adult patients with FBD as defined by Rome criteria and control subjects who presented to Baylor Clinic during a three-month period and subsequently underwent testing using biphasic 13C-S/GBT. A validation substudy was also performed to demonstrate that the biphasic breath test measures sucrose digestion. Additionally, the substudy evaluated four nondiabetic adult women with known sucrase-isomaltase genotypes to validate biphasic 13C-S/GBT.
This study was performed in accordance with the Declaration of Helsinki and approved by the Institutional Review Board at Baylor College of Medicine under protocol H-31197. The Institutional Review Board at Baylor College of Medicine is organized, operates, and is registered with the United States Office for Human Research Protections according to the regulations codified in the United States Code of Federal Regulations at 45 CFR 46 and 21 CFR 56. The BCM IRB operates under the BCM Federal Wide Assurance number 00000286. Written documentation of informed consent was obtained from all participants and, in addition to consent for prospective study participation, explicitly permits the use of health information obtained from health records including diagnoses, medications, laboratory data (exclusive of the whole genotype), and demographic information including age, gender, race, and ethnicity; such authorization does not have an expiration date.
2.3. Study Population
Twenty-two subjects participated in this pilot study. Subjects were either asymptomatic healthy controls or symptomatic test subjects that met inclusion criteria for clinical diagnosis of FBD-functional bloating by Rome III criteria (FBD group: ; 8 women and 3 men, 24–66 years of age) and in otherwise good health (Table 1).
Affected patients reporting any alarming issues, such as gastrointestinal bleeding, were not referred for study participation. Other exclusion criteria included, pregnancy, current lactation, allergy to food coloring, other causes of abdominal pain or altered bowel habits (e.g., celiac disease, pancreatitis, malignancy, or inflammatory bowel disease), history of diabetes mellitus, gastroparesis, recent febrile illness (5 days prior to the study), ingestion of an investigational drug or placement of an investigational device 30 days prior to the study start date, and absence of the mental capacity necessary to comprehend the protocol. Symptom severity to assess FBD was determined by patient reports, behavior of symptoms, and impact on health-related quality of life . Symptom severity was scored according to the following summary definitions: mild: aware of signs or symptoms but maintained a good health-related quality of life; moderate: interfered with activities of daily living; or severe: marked impairment with psychological comorbidities and requires specialty medical intervention. There was no interventional component to this pilot study, and no long-term follow-up was done.
The asymptomatic control group (; eight women and three men, 22.8–60.8 years of age) was recruited from the student body and institutional staff at Baylor College of Medicine, none of whom met any criteria for FBD; all had a long history of tolerating sucrose in generous portions without inducing symptoms. The control subjects had no prior history of functional GI disorder, congenital sucrase-isomaltase deficiency, or irritable bowel syndrome. All reported an absence of current GI signs and symptoms, and all were in a state of excellent health.
To validate the breath test, four additional nondiabetic adult women were recruited as subjects for a substudy based upon their sucrase-isomaltase (SI) genotype (mutation status) and detailed self-reported dietary sucrose tolerance. As described below, 13CO2 breath test enrichment was compared with 13C-plasma enrichment since the only source of the tracer could be sucrose digestion with resultant monosaccharide absorption. One subject was symptomatic and homozygous for congenital sucrase-isomaltase (SI) deficiency, two subjects were heterozygous for congenital sucrase-isomaltase deficiency in the sucrase gene domain and moderately symptomatic, and one subject was sucrose tolerant (completely asymptomatic) without any of the known mutations in the sucrase-isomaltase gene (3q25.2-q26.2).
2.4. Description of Study and Breath Testing
Commercial Mylar® breath collection bags (1.3 L and 0.25 L) fitted with one-way valves (Otsuka Electronics, Tokyo, Japan) were used. Mouthpieces were fashioned from drinking straws to facilitate inflation by study participants and establish airtight connections between airway and collection bags to reduce the possibility of room air cross-contamination. Each kit contained five bags labeled for timed collections: one large bag for baseline collection for repeated reference enrichment comparisons and four test sample bags for 60-minute and 75-minute breath collections postsucrose and postglucose substrate ingestions (delta-over-baseline). Measured oxidation values typically peak between these time points in normal subjects at oral tracer dosage levels.
13C-tracer isotopes (Isotec, Div. of Sigma-Aldrich, Miamisburg, OH) and aqueous excipients were prepared and labeled under a clean Class 5 bench hood in 100 mL volumes [MediPak USP Sterile Water (37-6250), McKesson Medical-Surgical, Richmond, VA]. Dosed tracers and aqueous excipients composing the substrates were weighed analytically and mixed by combining 25.0 mg uniformly labeled 13C-sucrose and 125.0 mg uniformly labeled 13C-glucose with 15.0 grams unlabeled sucrose and 15 grams unlabeled glucose, respectively, as challenge loads. The unlabeled challenge-load gram-weight was selected because it approximates a threshold unlikely to induce symptoms or delay gastric emptying in most adults. To avoid confusion, substrates were color-coded using McCormick® food coloring (blue for sucrose and pink for glucose) to match the color-coordinated sample collection bags and flavored, respectively, with Adams® strawberry and coconut extracts for taste and aroma. All substrates were frozen at −20°C until needed in Nalgen® polyethylene bottles. Breath testing was performed in the clinic, home, or laboratory setting in the early morning hours before 12 p.m. after an overnight fast.
At study initiation, subjects were asked to hold their breath for a 10-second count and then inflate the reference breath sample for isotopic comparison later with timed breath samples. 13C-sucrose substrate solution with 15% excipient was then ingested (at time 0). At 60 minutes post-13C-sucrose ingestion, a breath sample was collected, followed by another breath sample at 75 minutes. Immediately after Part I sample collections related to sucrose ingestion were complete, a comparative 13C-glucose substrate solution was ingested (Part II of the biphasic breath test) to assess the inherent rate of metabolism for free glucose. This was used for comparison with Part I outcomes (see Section 2.5). The superdose (125 mg, 5 times the 13C-sucrose dose) was intended to dilute (mask) any residual 13CO2 carryover effects from the sucrose and to assess inherent body oxidation capacity. As before, Part II breath samples were collected at 60 minutes and 75 minutes after 13C–glucose substrate ingestion and results were adjusted by a factor of 0.2x to account for superdosing and to compare, pairwise, 13C–sucrose oxidation data with 13C–glucose data. Postprocedure breath test kits were promptly returned to the laboratory for analysis.
Measurement of 13CO2 sample enrichment was performed for each 60-minute and 75-minute breath collection using 13CO2 mass dispersive infrared spectrometer (POCone®, Otsuka Electronics, Tokyo, Japan). Each timed sample was analytically compared with the baseline sample (common, presubstrate ingestion sample) and breath test data were expressed as a ratio of the change in 13CO2 enrichment (delta) between the baseline sample and the periodically timed, postsubstrate ingested samples [delta over baseline (DOB) at 60 and 75 minutes (DOB 60′) and (DOB 75′)].
Because of body habitus and age-related variations in carbon dioxide production , 13CO2 oxidation value for 13C-glucose (Part II) was used to adjust for different intersubject 13C-sucrose (Part I) oxidation rates. Oxidized components derived from 13C-sucrose (fructose and glucose) were compared to oxidized enrichment values and expressed components derived from the secondary 13C-glucose superdose ( glucose enrichment). After mathematical adjustment for the superdosing of glucose, the enrichment ratio of 13CO2 was attributed to sucrose digestion, absorption, and metabolism. (Note: glucose requires no further digestion.) All glucose oxidation-related values were universally adjusted by a standard factor (1.12x) to account for minor inherent increased rate of fructose metabolism as compared with glucose (no isomerization needed) and the 17% proportionally greater atomic weight of sucrose. The ratio of two 13CO2 enrichment values was stated as the Coefficient of Glucose for Sucrose (CGO-S).
Considering the tremendous resources that would be required to conventionally validate the 13C-sucrose breath test using duodenal/jejunal biopsies obtained from adult patients coincidentally undergoing gastroduodenal endoscopy, an alternative validation substudy approach was undertaken in four genetically distinct subjects. The subjects were identified based upon their sucrase-isomaltase (SI) genotype and tolerance to dietary sucrose and, in two cases, mucosal biopsy results were available which demonstrated diminished sucrase activity by Dahlqvist-assay. The substudy was performed by comparison of 13CO2 appearance in the breath with the timed appearance of 13C-monosaccharides in the plasma, the primary products of sucrose digestion.
Successful sucrose digestion results in absorption of 13C-fructose and 13C-glucose, for which 13C-fructose is mostly taken up by the liver on first-pass portal circulation while most resultant 13C-glucose passes to the systemic circulation for immediate use by vital organs . Blood sugar samples were then obtained, and comparisons were made to indirectly assess sucrose digestion independent of mucosal biopsies. Concurrently, plasma samples were obtained with timed biphasic 13C-sucrose breath test sampling at 30, 60, and 75 minutes after substrate ingestion and assayed. The breath samples were analyzed for 13CO2 enrichment by infrared mass dispersive spectrophotometry. The appearance of 13C-plasma glucose was determined by yeast fermentation of plasma and expression of 13CO2 with comparison against a reference substrate standard fermentation [35, 36]. Resultant gas samples were quantitatively eluted from reaction vessels and similarly analyzed for 13CO2 enrichment, and both outcomes were compared.
Subject-A was a healthy, asymptomatic 45.9-year-old woman that routinely ingested dietary sucrose without adverse reactions; her SI genotype (WT/WT) revealed no genetic aberrations (ABI PRISM SNaPshot Assay Life Technologies, performed by LabCorp test 511570 SI, RTP, North Carolina). Subject-D was a profoundly symptomatic 46.7-year-old woman that avoided dietary sucrose and required sacrosidase supplementation with most meals to avoid typical symptoms of maldigestion; her SI genotype revealed homozygous aberrations [c.3218G>A (p.G1073D)]. A recent mucosal biopsy revealed no sucrase activity (only one sample obtained). Subject-B was a moderately symptomatic 23.3-year-old woman that restricted dietary sucrose to avoid typical symptoms. She was the biologic daughter of Subject-D and her sucrase-isomaltase genotype revealed heterozygous aberrations [c.3218G>A; (p.G1073D)/WT]. She has not required sacrosidase supplementation and she manages her symptoms by dietary sucrose restriction. Subject-C was a moderately symptomatic 43.9-year-old woman with a different SI mutation [c.5234T>G; (p.P1745C)] that also restricted dietary sucrose to avoid typical symptoms and periodically required sacrosidase supplementation. A sucrase assay of mucosal biopsy performed 13 years earlier demonstrated diminished sucrase activity (25 μm/min/gm protein: exactly at the diagnostic threshold, 5th percentile).
The plasma samples were processed in a closed reaction system where aliquots of plasma (1.00 mL) were incubated (37°C) overnight with a 20 mL culture of baker’s yeast (Red Star, Cedar Rapids, IA). Each test tube was fitted to a standard 250 mL Mylar breath collection bag and each system was primed with 20.0 mL oxygen (100%). After 24 hours of elapsed time, the system was purged with 100.0 mL of carrier gas containing 3% unlabeled (12C) carbon dioxide. Samples were analyzed for 13CO2 enrichment by comparison with a reference standard using mass dispersive spectrophotometry, adjusted for individual plasma volume (DOB PV), and results were stratified according to genotype.
2.7. Statistical Analysis
Deidentified clinical data were abstracted from the Baylor Clinic EPIC health care software (Epic Systems; Verona, Wisconsin). Clinical and experiment data were collected and transcribed to spreadsheets (Excel, Microsoft, Redmond, WA). Statistical analyses utilized an online statistical application [VassarStats (http://vassarstats.net/)]. Graphs and figures were prepared using DeltaGraph 6 (Red Rock Software, Inc., Salt Lake City, UT).
2.8. Generation of Diagnostic Cut-Off Value
We were unable to directly validate the adult control group using comparative enzyme assays on biopsy sample; therefore, a diagnostic cut-off point for the breath test was determined by calculating the lower 95% confidence interval of 13CO2 enrichment data obtained for the asymptomatic control group (CGO-S cut-off ~ 85%). For the purpose of estimating a reference diagnostic cut-off point from normal subjects, a single sample -test was used to determine the difference between the observed mean of the asymptomatic, historically sucrose-tolerant control sample, and the theoretically normal value (CGO-S = 1.00). The CGO-S values of the control group at 60-minute, 75-minute, and mean 60–75-minute time points were tested against the hypothetical CGO mean (60′: ; 75′: ; 60–75′: ), and the data point to 75′ time point was the most telling. The lower limit of the 95% confidence interval (CGO-S) was determined for each time point.
The four genetically SI-characterized subjects undertook 13C-S/GBT with simultaneous breath and blood sampling to validate breath test outcomes. High enrichment values, derived from effective sucrase activity, resulted in the appearance of high 13CO2 tracer from the plasma and vice versa. Results are shown in Figure 1. Panel (a) (Subject-A: genotype WT/WT) breath enrichment was compared with blood test enrichment. The data closely paralleled each other and were markedly higher than the results obtained from Subject-D (SI homozygous mutation genotype c.3218G>A), whose results for the sucrase portion of the test approached zero. As predicted, the results for the heterozygous subjects (B & C) were depressed as compared to Subject-A and were markedly improved over the data obtained for the SI-affected Subject-D. The intermediate results (B & C) were consistent with those to be expected for the heterozygous subjects.
Collectively, the results obtained from the blood assay (fermentation products of digestion) closely correlated () with 13CO2 breath enrichment (Figure 2).
Eleven patients with FBD and 11 paired control subjects were enrolled and underwent the 13C-S/GBT (Figure 3). The primary data sets, on which the conclusions presented herein rely, are appended (see Supplemental Table in Supplementary Material available online at http://dx.doi.org/10.1155/2016/7952891). There were no adverse reactions observed or reported during the study. Seven patients (64%) showed decreased sucrose digestion with CGO-S cut-off values below 87% at the 60-minute time point (mean CGO-S = 0.80; 95% CI = 64–96%) and seven FBD patients (73%) showed decreased sucrose digestion with values below 85% at the 75-minute time point (mean CGO-S = 0.82; 95% CI = 62–98%) and eight patients showed decreased sucrose digestion with values below 85% at the mean 60–75-minute time point (mean CGO-S = 0.85; 95% CI = 85–100%).
Three subjects experienced typical, mild abdominal bloating and abdominal discomfort during the test. In sharp contrast, only one control subject (9%) demonstrated diminished sucrose digestive capacity at the 60-minute, 75-minute, and 60–75-minute time points but did not report any adverse symptoms. Using the derived breath test diagnostic CGO-S cut-off value of 0.85 at the 60–75-minute time points, a Fisher Exact Probability Test of proportions discriminated between the groups (Chi Statistic: 6.55; ).
13CO2 Enrichment Coefficient of Glucose Oxidation for 13C-Sucrose (CGO-S) data values obtained at 60-minute, 75-minute, and the mean 60–75-minute values are shown in Supplemental Table .
Free sucrose is a relatively modern component to the human diet. Sucrose is pervasive in commercially prepared foods, is frequently added to drinks and recipes, and is, therefore, difficult to avoid in the habitual diet. The specific association between sucrose intolerance and FBD-like symptoms has been previously observed  but has not been well evaluated. Like lactose, the opportunity for dietary sucrose to be included among the causes of abdominal discomforts is present, and testing is a key component to the therapeutic approach. This small pilot study indicates that sucrose maldigestion could be a factor in some cases of FBD, especially with more difficult cases. This finding was exemplified by eight of the eleven patients with FBD who demonstrated diminished sucrase activity by breath testing. Due to cost constraints, the affected patients could not be assessed by genotyping or mucosal biopsy assays. However, the parallel blood testing for 13C-labeled products of sucrose digestion in the four patients with SI gene mutations, used as a surrogate for assay of random intestinal biopsies, successfully validated use of 13C-S/GBT.
Approximately two-thirds of the glucose and one-quarter of the fructose (or half of the total stable isotopic-tracer load) were expected to appear in the systemic circulation and to be available as a proportional indicator of normal digestion since very little free sucrose is passively absorbed by the intestines. After fasting, most absorbed fructose is converted to trioses in the liver over time, and trioses are subsequently released into the systemic circulation as lactate for oxidation in extrahepatic tissues or stored as glycogen. Plasma content of 13C-labeled monosaccharides closely paralleled breath sample enrichment as the appearance of 13CO2 in either breath or plasma and are both dependent upon mucosal sucrase activity. As such, 13CO2 breath sample enrichment is a valid measure of sucrase activity.
We note that reference values for mucosal disaccharidase assay activities are also determined by mathematical analysis of the distribution of the means of thousands of samples (all comers) assayed over a long period and were not by stratified comparison with symptoms . Furthermore, random biopsies of proximal duodenum may not be representative of true digestive capacity, which occurs distally just beyond the Ligament of Treitz. Therefore, validity would be difficult to ascribe using an endoscopic approach. Sucrose maldigestion may be qualitatively tested by dietary challenge-load testing and assay or breath testing for bacterial-derived, expired methane and hydrogen [39, 40]. Elimination diets and food records are tedious, but they appear to be somewhat helpful in the evaluation of sucrose maldigestion . At the time of this writing, it is difficult to precisely correlate symptoms with CGO-S values in patients since the cohort sample size was small.
A monophasic 13C-sucrose breath test was previously applied to a rat model with chemotherapy-induced gastrointestinal mucositis and varying degrees of sucrose activity , but that test is not directly applicable for human use because it did not correct for individual differences in metabolic activity and the carbon dioxide production rate. A biphasic 13C-sucrose/glucose breath test (13C-S/GBT) was successfully used to stratify homozygous, heterozygous, and compound heterozygous cases of congenital sucrase-isomaltase insufficiency . That test had been validated in children and adolescents by comparison with sucrase assay of endoscopic mucosal biopsies. It was also observed that cachectic patients, with cancer and FBD-like symptoms, have markedly diminished 13C-S/GBT oxidation scores that worsen with chemotherapy (unpublished). As such, the new test reported on herein has greater utility, particularly since improvements have been made beyond the currently marketed test . In a way similar to the breath-hydrogen test, it is unlikely that the biphasic 13C-S/GBT could be fully validated since gastroenterologists that treat adults are reluctant to perform small bowel biopsies for disaccharidase activity. Nevertheless, the implication of this study is large and points to the need for a stronger study with comparative 13C-blood-sugar assays using gas chromatographic mass spectrometry, which might be superior to invasive approaches.
The findings of this study also point to the need for clinicians to carefully obtain a dietary history during the evaluation, admittedly a time-consuming task that in this day and age could be initially approached using a handheld device application if a dietician is not readily available . Rao et al. noted that in recent years sucrose consumption had significantly increased and that the source of sweetener had changed from cane sugar (i.e., sucrose, a disaccharide of glucose, and fructose) to corn sweetener (primarily equimolar quantities of sucrose and fructose) . Levels of fructose consumption have increased by more than 1000% between 1970 and 1990 and this suggests that a relatively limited distal absorptive capacity and overindulgence might be a factor in the FBD constellation . Rao et al. also observed a distinct improvement in FBD symptoms when the fructose dose was decreased to less than 25 grams . This finding suggests that recognition of dietary fructose intolerance might be clinically useful, but it remains unclear if digestion, absorption, or both mechanisms could be at fault. Of note, there has been one recent report of symptomatic relief with the use of empiric pancreatic enzymes, which proposes to potentiate residual, downstream mucosal disaccharidase activity and might point to the need for further diagnostic testing .
As predicted, the sucrose load used in this study was well tolerated but does not eliminate the possibility of fructose intolerance that could be confirmed by additional 13C-fructose testing . An abnormal 13C-S/GBT should also prompt evaluation for fructose malabsorption. The sucrose load might be increased for subsequent studies, but responding to this criticism is at the risk of delaying gastric emptying by increasing caloric load.
The concern over excessive amounts of maldigested sucrose contributing to the FBD condition has been the subject of some debate . The role of sucrase insufficiency has not been adequately tested in adult FBD patients whose gastrointestinal evaluations have seldom included direct-biopsy disaccharidase assays. Clinicians might consider dietary sucrose restriction and assess symptom response as a means of evaluation and, if sucrase insufficiency is suspected, obtain a consultation with a dietician to help minimize sucrose exposure. Our finding of sucrase insufficiency in FBD by 13C-sucrose breath testing was not surprising since the patients that were recruited for participation had resistant symptoms, and we had observed these epiphenomena before in children. However, our expectation was that the diagnostic yield would be lower. Our group’s earlier pediatric experience involved the use endoscopic biopsy assays and demonstrated that sucrase deficiency occurs in 28% of children presenting with unexplained subacute or chronic abdominal pain that encompassed FBD-like symptoms . This study’s outcome is higher than the frequency of known sucrase mutations, and our findings suggest that the sucrose intolerance may be acquired or that epigenetic factors may be in play. This present study was not designed to investigate the cause of sucrase insufficiency, which could be genetic [51, 52], acquired due to inflammation, cachexia, and anticancer therapy  or specifically related to the fructose component or the GLUT-5 transporter that might be involved .
Since the 1980s, various sucrose-load breath tests have been used as a means to estimate intestinal absorptive function and sucrase activity in humans, rodents, and swine , and this approach falls into the realm of metabolomics, a field that is still expanding. This study demonstrated the feasibility to apply the test clinically. Earlier tests assessed changes in carbon isotopic enrichment as a metabolic indicator but were of limited value because they solely relied upon naturally enriched substrates and the use of cumbersome mass spectrometry [56, 57]. Further refinements to 13C-breath test technologies incorporate highly enriched stable isotope tracers and are based on the principle that intake of 13C-labeled substrates is expected to be predictably metabolized to 13CO2 and that the measured increase of 13CO2 above baseline proportionally reflects the targeted metabolic functions [58–60]. The use of stable isotope tracers with mass dispersion spectrophotometry also provides convenient point-of-care functionality to the breath test in a typical outpatient scenario, an advancement that has made 13C-breath testing affordable and convenient at the bedside . Furthermore, infrared spectrophotometric breath testing can be performed safely in an outpatient center with minimal personnel training necessary to conduct analyses .
The modus of the biphasic 13C-S/GBT exploits the principle that the constituents of sucrose (glucose and fructose) should be promptly oxidized after ingestion and undergo glycosidic hydrolysis, portal absorption, and systemic oxidation such that the timed appearance and magnitude of 13CO2 recovery from breath sampling provide a good assessment of the digestive process. Modified Scofield equations have been used in the past to adjust 13C-urea breath test outcomes in children , but that application appears to best relate to bacterial urease in the stomach lumen. However, significant technical differences exist such that onerous mathematical models would be needed to apply that approach here . In this study, the digested components of sucrose were oxidized and the resultant, exhaled carbon dioxide (13CO2) was used as a quantifiable correlate of hydrolysis. However, an innovative adjustment approach, using superdosed 13C-glucose, was also used to correct for individual variations in habitus known to affect metabolic rate. (e.g., individuals, with normal digestive activity and increased body mass index would be expected to yield proportionally low tracer signals as compared to lean individuals). This advancement was implemented because 13CO2 enrichment derived from sucrose directly provides no information on retained tracer in body enrichment pools and fluxes . Considering that normal substrate-oxidation peaks early and begins to diminish slowly in concentration, the relatively stable isotopic flux condition, after 75 minutes, provided the opportunity to piggyback a secondary, superdosed 13C-glucose breath test, using the same stable isotope tracer; proportional adjustments were then made. The use of 13C-glucose provided for a direct and practical adjustment approach that was not dependent on mucosal disaccharidase, and when paired with oxidation results of the target 13C-sucrose substrate, individualized mucosal enzyme activity was measured.
The application of a secondary, superdosed 13C-glucose breath test also addressed the issue of variable habitus, leaving only mucosal sucrase activity as the isolated physiological difference. In theory, 13C-glucose undergoes the same metabolic fate as the hydrolyzed sucrose-derived glucose and fructose monomers but requires no further digestion before oxidation [66, 67]. Therefore, oxidation results were expressed as a proportional change in 13CO2 enrichment ratio between the target 13C-sucrose substrate and the change in 13CO2 enrichment associated with the 13C-glucose substrate and reported as the Coefficient of Glucose Oxidation for Sucrose (CGO-S) with 100% (1.00) being theoretically ideal. Since the second phase test was applied under the same conditions, it effectively removed the need to consider confounders, such as intercurrent illness, activity changes, fasting status, and metabolic flux, because such effects are conceptually negated (cancelled out). In the sucrase-insufficient condition, delayed digestion would result in a diminished primary sucrose-related oxidation value and isotopic-carryover into the subsequent 13C-glucose test period and increase the divisor value. This is a subtle, but important consideration, since initial 13CO2 recovery is attributed to proximal small bowel sucrose digestion and oxidation.
Delayed digestion is expected to contribute to distal fermentation and symptoms related to the production of small molecule effectors, such as N-acyl-3-hydroxypalmitoyl-glycine (commendamide) . In the cases of sucrase insufficiency and delayed digestion, aberrant enrichment carryover would be expected to accentuate the resultant glucose oxidation data (divisor) and theoretically increase the sensitivity of the test and possibly decrease the test specificity. However, the carryover effect is substantially diminished after mathematical adjustment for the superdosing (x/5). As such, any significant ratio discrepancy from unity could be attributed to faulty sucrose digestion at the mucosal level in the absence of other pathologies, such as gastroparesis.
The diagnostic cut-off value used in this study (<0.85) was derived indirectly by determining 95% confidence intervals bracketing the breath test outcomes of the symptom-free control group. However, this diagnostic cut-off point should be considered tenuous at this time, and the issue should be revisited by a larger, direct comparative study of nonmutants with endoscopic mucosal sucrase assays and/or blood enrichment assays.
Sucrase deficiency appears to be a factor in the FBD condition. 13C-S/GBT was successfully used to assess sucrose digestion and the results reported herein support the need for a larger study. Sucrose maldigestion may also be an indicator of a larger issue, starch maldigestion. This is considered since isomaltase is concurrently expressed with sucrase (same gene product 3q25.2-q26.2) and because starch is the major dietary staple that is difficult to limit. A careful history identifying a link between GI symptoms and starchy food intake, in addition to sucrose intake, should be helpful in predicting the contribution of dietary intolerances to recurrent GI symptomatology . Like sucrose, for adults suffering from carbohydrate malabsorption, a low fermentable diet might be considered in therapeutic planning since maldigestion may promote colonic proliferation of saccharolytic taxa . It raises the possibility that sacrosidase , amyloglucosidase [71, 72], or other enzyme supplementation  might benefit some patients with FBD or cachexia-induced maldigestion , for which further studies are also needed.
|13C-S/GBT:||13Carbon-sucrose/13C-glucose breath test|
|CGO-S:||Coefficient of Glucose Oxidation for Sucrose|
|DOB:||Delta over baseline|
|FBD:||Functional bowel disorder|
|IBS:||Irritable bowel syndrome|
|NSD:||Not significantly different|
|PV:||Plasma volume in liters|
Albert M. Balesh and Harold T. Shelby are coauthors.
Antone R. Opekun’s laboratory, through Baylor College of Medicine, has a standing service-for-fee contract for research breath testing with QOL Medical, LLC, makers of a sacrosidase product. Authors Albert M. Balesh and Harold T. Shelby declare that they have no competing interests.
Antone R. Opekun, as principal investigator, conceived the study idea, supervised execution of the studies, interpreted literature, data analyses, paper writing, and revisions. Albert M. Balesh performed clinical testing, reviewed and interpreted cited literature, and drafted aspects of the preliminary paper under the close supervision of the principal investigator. Harold T. Shelby provided interpretation of cited literature and recruited study subjects.
The authors thank Ms. Susan A. Kennedy who provided editorial review and Karol M. Hernandez for stable isotope substrate preparation and spectrophotometer analysis of samples. They also thank students Christina Lecea-Plaisance, B. S., and Katie Fracoli, PA-SIII, for assistance with some breath sample collections associated with this project. QOL Medical, LLC graciously supported the genetic testing. This work was supported, in part by, NIH Digestive Disease Center Grant P30 DK56338 which funds the Texas Medical Center Digestive Disease Center and by a generous contribution from D.R. and G.P. Laws to the BCM G.I. Research Laboratory Fund.
The primary data are tabulated in Supplemental Table 1 and stratified according to clinical condition. Data include coded identifiers, age, BMI, 60 minute CGO-S values, 75 minute CGO-S values, and mean 60-75 minute CGO-S values. Descriptive statistics are provided.
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Mixing application in the pharmaceutical field
Mixing application in the pharmaceutical field is mainly for thermoplastic materials are mixed with additives. Mixer uses mechanical force and gravity, uniformly mix together mechanically two or more materials.
Mixing application in the pharmaceutical field:
As we all know, the nature of the pharmaceutical industry is unique, quality requirements for pharmaceutical equipment is also high, any link errors are likely to lead to drug quality problems, causing serious consequences.
Mixer using mechanical force and gravity, the uniformly mixed together mechanically two or more materials. Mixing machine is widely used in various industrial and daily life. Commonly used mixer and a low viscosity liquid into a gas mixer, high viscosity fluids and pastes mixing machine, the thermoplastic material mixer, powder mixing machine four categories granular solid material.
Gas and low-viscosity liquid mixer is characterized by simple structure, and no moving parts, less maintenance overhaul, low energy consumption. Such mixing machinery is divided into airflow stirring, mixing pipe, jet mixing and forced circulation mixing four.
Mixer accessories mainly wear-resistant alloy materials, including high-speed stirring blade, stirring wings, wear-resistant liner, mixing arm, stirring shovel, shovel planet, stirring Coulter, a stirring rod, stirring rake like, high viscosity fluids and pastes It was mixed generally have strong mechanical shearing action.
The thermoplastic material mixing machine is mainly used for thermoplastic materials are mixed with additives; powdery, granular solid material mixing machine mostly intermittent operation, including the role of both mixing and grinding machinery, such as wheel rolling machines.

domain: chemistry


text:
Events - Event View
This is the "Event Detail" view, showing all available information for this event.
If the event has passed, click the "Event Report" button to read a report and view photos that were uploaded.
Willamette Mission State Park
This will be a 90-minute to 2-hour walk starting at the parking area next to the ferry. It could be muddy in spots, and we can modify the route and length according to the weather. No texts please.
Hiking Distance: Approx. 3 miles RT.
Elevation Gain: Very little
Qualifying Activity: Qualifiers no longer required
Driving Distance: 20 miles RT from north Salem
Thursday, October 6, 2022
Registration is not available online - contact the event coordinator
The Trip Leader is the event coordinator. The Trip Leader has the final say over who may participate in the event.
Hiking Trip Ratings:
EASY: Maximum of 5 miles round trip, elevation gain less than 1000 feet
MÉDIUM: 6-10 miles round trip, elevation gain 1000-2000 feet
HARD: Long, difficult, and strenuous

domain: geography


Displaying items 49-60 of 5558 » View wsbt.com items only< Previous 1 2 3 4 5 6 7 8 9 10 11-464 Next >
Work began this week on a long-term project to resolve a long standing water contamination problem on Elkhart's southwest side. It's happening in an area that's been on the EPA's Superfund list since 2008. “We've heard rumors about where it came...
WASHINGTON (AP) — An ethanol industry official familiar with the decision says the Environmental Protection Agency is expected to approve higher levels of corn-based ethanol in gasoline for all cars manufactured in the past decade. The official...
Double trailers flipped early Thursday morning after the semi driver lost control on black ice on U.S. 30, just west of S.R. 13. Both lanes of U.S. 30 were closed for about 7 hours as Kosciusko County Emergency Management and EPA staff cleaned up...
WASHINGTON (AP) — The new Congress just got to work, but House Republicans are already moving to try to block the Obama administration from taking action on global warming. GOP lawmakers have introduced several bills that would hamstring the...
WASHINGTON (AP) — Republicans controlling the House promised Thursday to slash domestic agency spending by almost 20 percent in their drive to bring it back to levels in place before President Barack Obama took office. House Budget Committee...
Tags: National Parks, Republican Party, Travel, Politics, FBI
WASHINGTON (AP) — Their ranks swollen after the last election, Republican governors from Florida to Alaska are undermining President Barack Obama's agenda at every turn ahead of the Democrat's 2012 re-election campaign. Some are rejecting...
FORT BRANCH, Ind. (AP) — The federal government has agreed to remove smelly debris from the ruins of a closed meat packing plant that's spreading a stench through parts of a southwestern Indiana town. The U.S. Environmental Protection Agency will...
WASHINGTON (AP) — A look at what President Barack Obama has requested in his $3.73 trillion budget for the 2012 fiscal year beginning Oct. 1. ____ Agency: Agriculture Spending: $145.6 billion Percentage Change from 2011: 1.5 percent decrease...
WASHINGTON (AP) — The Environmental Protection Agency is delaying indefinitely regulations to reduce toxic pollution from boilers and incinerators. The move comes in response to a request from industry groups. The announcement Monday was another...
Florida legislators passed a bill this year to repeal the state law that requires most gasoline sold in the state to include 10 percent ethanol. The bill, awaiting action from Gov. Rick Scott, would be largely symbolic, because federal law still...
Tags: Ethanol, U.S. Congress, Rick Scott, Global Warming, Politics
The Hartford CourantThe owner of the oil power plant at Norwalk Harbor said Tuesday that it will be closing the facility June 1 since prices in the region's energy market have been too low to justify keeping it open. NRG, a power generation supplier headquartered in...
Jan 5, 2011 |Story| WSBT-TV
Jan 20, 2011 |Story| AP Broadcast
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Feb 3, 2011 |Story| AP Broadcast
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Feb 19, 2011 |Story| AP Broadcast
Feb 14, 2011 |Story| WSBT-TV
May 16, 2011 |Story| WSBT-TV
May 22, 2013 |Story| Orlando Sentinel
May 21, 2013 |Story| Hartford Courant
May 21, 2013 |Blog| Cars.com
Original site for U.S. Environmental Protection Agency topic gallery.


text:
“I have been consulting with Lynne for the past three months. She is fantastic! I`ve been so pleased to work with her in the areas of self-care, self-management, communication, blockages to success, planning and motivation and more.
She`s consistently held a positive vision for me, been generous with helpful tips for improving my life and flexible in understanding my unique needs. I wouldn`t hesitate to recommend Lynne for your own personal and/or professional project.” C.S
Email or Call Lynne at 310-828-7121 to schedule a session, begin coaching or arrange a free phone conversation about the benefits of Gifted Adult Coaching or Therapy
Gifted Adult Writers
Lynne Azpeitia, MFT
3025 Olympic Blvd, Santa Monica, CA 90404
Coaching, Psychotherapy & Consultation
For more than a decade I've been working with gifted and creative adults, teens and children as a psychotherapist, counselor, coach, speaker, trainer, educator, consultant, and mentor specializing in the challenges, psychology and development of gifted, talented and creative adults.
PHONE, FACETIME OR SKYPE SESSIONS ARE AVAILABLE FOR THOSE OUTSIDE THE LOS ANGELES AREA.
Have a question? Need more information? Call Lynne at 310-828-7121 or Email Lynne
Coaching, Counseling & Consulting Services Also Available by Phone & Skype
How To Sustain Your Writing Career
David Silverman, LMFT
When you first have some success as a writer, producers, agents, other writer’s immediately want to put you in a box. It’s good and it’s bad. You can create a satisfying career in your genre, provided you keep getting writing assignments. And that works for some writers.
More likely, however, you’ll want to branch out. Most writers find they’re better off being good at many different types of writing. Some writers can write comedy and drama. My partner and I wrote comedy......
How we broke out of our niche.
You’ll need to write new spec scripts. You need something to show that you can write in different styles. Even better...More
Rachel Carson on Writing and the Loneliness of Creative Work Maria Popova In previously contemplating what constitutes great nonfiction, I placed writers in a hierarchy of explainers, elucidators, and enchanters, the latter class being exceedingly rare and exceedingly rewarding to read. Carson was the twentieth century’s science-enchanter par excellence, whose writing was governed by her belief in “the magic combination of factual knowledge and deeply felt emotional response.” More...
Explainer, Elucidator, Enchanter: A Gradation of Great Writing Maria Popova In a recent conversation with a friend, I found myself struggling to convey the hierarchy of good writing, particularly of good science writing — a hierarchy experienced so concretely in the act of reading but inexpressible as soon as one tries to dismantle the magic of enthralling prose. The difference between good writing and great writing is always palpable and rarely articulable, but the stakes are even higher in science writing, where the standards of truth and beauty are such that the precise and the poetic must converge in order to yield both comprehension and enchantment. More...
Change the Narrative, Change Your Destiny: How James Baldwin Read His Way Out of Harlem and into Literary Greatness Maria Popova One of the most poignant portions of James Baldwin and Margaret Mead's conversation looks at why real change becomes possible only when we change the cultural narrative. Baldwin recounts how, as a child, he read his way out of his own culturally-imposed narrative of possibility, which allowed him to go beyond what Kafka believed books could do for us — serve as “the axe for the frozen sea inside us” — and go further, turning books into an axe for the frozen sea between us. More...

domain: artistic


Memoirs of a Naijamerican Bride V: I Contain Multitudes
This article was first published in October 2015.
My father was born in Niger state, and raised and educated in Kaduna state. Like many Nigerians have done and continue to do, his father migrated for better career opportunities. My parents met in Kaduna state, where my mother is from. Specifically, my mother is from the Bajju tribe (yes, there are Christians in Kaduna state, and no, not every Northern Nigerian is Hausa/Fulani). My maternal grandmother was initially very resistant to the idea of my mother marrying someone from a different tribe, so my parents got married in America, where they had me, making me an American citizen. During my early years, my parents spoke Hausa in our home when they were discussing things they didn’t want my sister or I to understand. Ever the spy, I learned Hausa by listening to these conversations and decoding the secrets my parents shared. As soon as both parents were done gathering the degrees they went to America in search of, they moved back to Nigeria. For a year, we lived in Kaduna, where my grandparents were, before settling in Abuja. When I was teenager, I moved back to America. Give or take a couple of years, my life has been evenly spread between America and Nigeria. There is a whole different conversation about global identity, and author Taiye Selasi does a great job of addressing it. Here, I am more concerned with national identity, and my Nigerian self.
In Nigeria, Abuja is my home and Kaduna is my history. Abuja was mostly dust when I moved there, and in many ways, I feel like we grew up together. It is the city that holds the sights, the sounds, and the smells of a great deal of my memories. It is the birthplace of many of my dearest friendships. And when I want to learn about my parent’s memories, Kaduna is where the plot begins and thickens. This is why saying I’m from Benue feels false, and almost like appropriation. How can I come from a place I have never known?
While the Nigerian identity framework is patriarchal, my sentiments are not gender specific. A few days before my wedding, I was in a café in Abuja when I overheard a conversation between a man and presumably his date (I told you I’m ever the spy). He bemoaned the fact that he was required to list a specific state as his state of origin on a government form, when he knew nothing about that state. His is the story of the multitudes of Nigerians who are transplants; whose parent’s parents left home for a better life elsewhere; whose fathers chose brides from different tribes. Perhaps this is why I am shocked by the stigma that still surrounds inter-tribal marriages in Nigeria. This is probably why so many Nigerians were appalled when the Oba of Lagos threatened to deport Igbo residents of the state. What makes the Igbo residents of Lagos, many of who have resided in Lagos for generations, less Lagosian than Yorubas? What makes a place home?
This is not to say Nigeria’s current identity framework is without utility: every time I write Benue as my state of origin on a Nigerian form, I am reminded that part of my soil is there. Traditions have their sacred value: they preserve history, and protect cultures from erosion. But maybe, Nigeria is at a point in its consciousness where identity narratives can be expanded. Perhaps, the questions of what we are (ethnicity) can be separated from where we are from (experience). Our bloodlines matter, but the lands that we have nourished, and that have nourished us, should count for something too. And maybe, just maybe, expanded definitions of identity are the parts of the dialogue that are missing from calls for national unity in Nigeria.
My traditional wedding ceremonies, gave me the opportunity to begin to reshape my narrative. I was adamant that the northern part of my culture be represented. My introduction ceremony (the ceremony where a man and his family formally ask for a woman’s hand in marriage) was conducted by my Bajju aunts; while my bride price ceremony (held the morning of my traditional wedding), was conducted by my Idoma uncles. The third ceremony (it takes a lot to marry a Nigerian woman!) was my official traditional wedding celebration. For my first traditional wedding dress, I chose to wear an Idoma head tie (called Illi’ Idoma) and Idoma colors (red and black), with a northern style dress. For my second look, as is Nigerian custom, I wore an outfit to represent my husband’s tribe (Yoruba).
Marriage has given me an additional culture to embrace (Yoruba), and two new places to call home: Lagos and London. This is the beauty of identity: it is fluid. Who we are, and where we are from, can and often does, shift. Or in the words of American poet Walt Whitman: I am large, I contain multitudes.
Continue this series HERE.


High automation in reinforcement Since 1987, AWM has been developing, designing and manufacturing high-technology machines for the processing of reinforcement steel such as standard and special mesh
For about 20 years, Agibi Progetti in Verona has been working in the field of heat treatment of small metal parts and in providing services for the implementation of installations for the
OUR MISSION IS TO BRING TECHNOLOGY IN THE SPRING INDUSTRY
Bennett Mahler design and manufacture spring making equipment. The range of spring grinding machines includes single pass crash grinders, downfeed grinders, tandem grinders, twin plate grinders,
Caber Impianti srl was founded in 1976 with the aim to fulfill the washing requirements of small parts producers. During the time, Caber Impianti srl has become a leader in this field for its good
CAMFART – CAmuna Mole Fabbrica ARTogne – was founded in 1951 in Artogne, a small town situated in the historical production area of Valle Camonica. The company started the innovative production of
Carbide equipment high-precision for cold forging
Hatebur and Carlo Salvi offer innovative machine solutions for producing high volume metal parts.
CEA Spa, founded by Ezio Annettoni in 1950, is one of the worldwide leaders for the design and manufacture of Arc and Resistance welding machines and Plasma cutting equipment conceived for the
CHAMPS is a leading manifacturer of Inspection and Sorting Machines for fasteners in Automotive, Aerospace and Civil industries. Our machines help many Companies worldwide to ensure the highest
WHO IS COMTECH It is a Company that boasts of a very long experience in the springs market, thanks to the people that want its estabilishment. THE COMMERCIAL PURPOSES OF COMTECH COMTECH supplies to
“We design and develop innovative solutions for the 100% inspection and sorting of fasteners and special parts”
EVIRT Italia s.r.l. company was founded by key specialists with over 50 years of professional and industrial experience in leading several famous historical rolling machines brands. Since that
Gem S.r.l. , located near Turin, is a leading designer and manufacturer of components and machines for resistance welding. The Company was born in 1986 making profit from two founders and two
Fabbrica Utensili per l'Industria Meccanica Ever since its foundation in 1919, Anceschi has been concerned with the production of thread cutting tools, above all specializing in manufacture of thread
British Wire Fencing Systems You Can Trust!
PACKAGING SOLUTIONS THAT BEST FIT WITH YOUR NEEDSImanpack provides a complete range of automatic packaging systems for the food, medical, wet wipes and hardware industry.
The Institute of Spring Technology is recognised as the industrys most authoritative and influential voice – renowned as a unique centre of excellence for spring technology – enjoying an
Kamatech borns from the collaboration of technicians with experience in the planning and production of springs machines.
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Kris Perry’s Comments in the National Journal:
Sometimes it’s good to reflect on how far we have come. National Journal’s Fawn Johnson penned an interesting piece noting the lack of opposition to early learning and calling on insiders to highlight the underlying issues that continue making the fight for increased investments in early learning a top priority in Congress.
Kris Perry’s response:
It’s hard to find an issue up for debate in Washington and across the country that has more support from diverse groups than early childhood education. So who is it that opposes public pre-K and greater investments in quality early childhood development efforts that will make sure every child has the foundational skills for success in the 21st century? Let’s take a look:
We know it’s not voters. Last summer, the bipartisan research team of Public Opinion Strategies and Hart Research revealed overwhelming support for ensuring that children gain the knowledge and skills necessary to start kindergarten off on the right foot, with a majority of voters saying that we need to do more to achieve this goal. The poll found that early childhood education is supported by majorities in all parties: 84 percent of Democrats, 64 percent of Independents and 60 percent of Republicans all support the broad outlines of a federal plan to help states strengthen early childhood education. Voters also saw increasing access to early childhood education as an absolute priority for the president and Congress this year in January’s Wall Street Journal/NBC News poll, with creating jobs and reducing the deficit seen as the only higher priorities. But passing the Strong Start for America’s Children Act would do all three.


text:
And he said to me, “These words are faithful and true”; and the Lord, the God of the spirits of the prophets, sent His angel to show to His bond-servants the things which must soon take place.
“And behold, I am coming quickly. Blessed is he who heeds the words of the prophecy of this book.”
I, John, am the one who heard and saw these things. And when I heard and saw, I fell down to worship at the feet of the angel who showed me these things. But he *said to me, “Do not do that. I am a fellow servant of yours and of your brethren the prophets and of those who heed the words of this book. Worship God.”
And he *said to me, “Do not seal up the words of the prophecy of this book, for the time is near. Let the one who does wrong, still do wrong; and the one who is filthy, still be filthy; and let the one who is righteous, still practice righteousness; and the one who is holy, still keep himself holy.”

domain: literature


This is an inquiry regarding RAK3172.
I used the previous version, but this time I am using RUI3 version (4.0.6).
At the time of purchase, the firmware version was 4.0.0, so I updated it to version 4.0.6.
The firmware was updated normally, but an issue occurred in several modules (6-7 out of 100)
where no output came out of the UART port when power was applied.
The upgrade was performed using the STM32 Cube Programmer.
I was wondering if there were any known bug reports regarding this phenomenon.
I’m also curious if there is a way to factory reset the internal settings.


text:
ENNIS -- Antron Brown won the Top Fuel championship at the AAA Texas NHRA FallNationals on Sunday and moved one step closer to clinching his third career season championship. Brown finished off a dominant showing at the Texas Motorplex by edging out Steve Torrence in the final race Sunday. Brown crossed the line in 3.774 seconds, and hit a top speed of 330.55 miles per hour as he won his seventh event of the year in his 11th final.
Defending champion Antron Brown increased his points lead over Doug Kalitta to 150 points.
John Force beat daughter Courtney Force in the Funny Car final at the NHRA Toyota Nationals on Sunday, and Antron Brown wrapped up his third Top Fuel season title
Pomona, CA – A Top Fuel dragster exploded with Antron Brown at the wheel. Sunday featured the first NHRA race of the season at the Auto Club Raceway in California. The Top Fuel dragster had just passed the finish line in the NHRA Wi...
Brown ended the title chase when he beat Wayne Newby in the quarterfinals.

domain: news


Android technical by Khawar Nehal
Date : 2 August 2018
For a trial for an android proposal.
android. So everyone also knows one more thing. You NEED to charge
every day to use it.
What most people never bothered to ask is WHY ?
Well the developers at google came up with the idea to use Linux and modify it to android many years ago to make a quick and dirty mobile OS.
What they forgot to modify or didn’t bother to what the Linux kernel. So for so many years, the linux design has been doing what it was designed to do. Throughput over speed.
This is also a
reason why games are preferred to be played on Windoze instead of
So here is the technical bit. Linux was designed for maximizing CPU and resource usage in order to get the most done.
As you give it more resources especially like CPUs, you can expect it to do what it is supposed to do. Push the pedal to the metal and MAXIMIZE.
This lead to the battery running low. But Linux was never designed to run on a battery. There are special cooling systems in servers for that. They are called fans. Some might even have especially designed radiators.
The reason no one
did something about this situation is because modifying the
Linux/Android kernel at such a structure change level is going to
require a major amount of programming resources.
So up till now, every Linux laptop and Android mobile user had to face the fact that slowing down their OS was genetically not possible.
So now Google has finally come out with a P version of android and bothered themselves enough to take up the challenge.
provides more CPU resources to the active apps and reduces the CPU
resources to background and “at the time useless” apps.
Hopefully this version is expected to reduce power consumption by about 10 to 20%.
But the current best bet to having a long running device is to get a large battery (Samsung) and less CPU cores (older phones).
For more power, for longer periods, get a laptop and find a power socket to plug into.
Also to double the time, get a provider which has good signals and avoids having the phone searching for a signal. There are telecom standards for how often a phone has to search for a signal.


issues of Bluetooth based wireless sensor networks, as well as an implementation of and low-cost devices, called smart sensor nodes, capable of performing. The communications capability of devices and continuous transparent information routes are indispensable components of future oriented automation concepts. Jul 25, Bluetooth Based Smart Sensor Networks. This Electronics Engineering Seminar Topic deals with the following: “Dragging the world towards.
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As deployment of smart sensor nodes is not planned in advance and positions of nodes in the field are not determined, it could happen that some sensor nodes end in such positions that they either cannot perform required measurement or the error probability is high. A single connection supports a maximum asymmetric data transfer rate of KBPS maximum of three channels.
The architecture plans have a section of wireless connections which is even connected with the Bluetooth services also. A typical Blue tooth device has a range of about 10 meters and can be extended bluetooth based smart sensor networks seminar report meters.
Inquiry procedure is defined in such a way to ensure that two devices will after some time, visit the same frequency same time when that happens, required information is exchanged and devices can use paging procedure to establish connection.
Wireless sensor networks comprise number of small devices equipped with a sensing unit, microprocessors, and wireless communication interface and power source.
Bluetooth Based Smart Sensor Networks
Amit August 15, at 8: InEricsson Mobile communications, the global telecommunication company based in Sweden, initiated a study to investigate, the feasibility of a low power, low cost ratio interface, and to smat a way to eliminate cables between devices. In any industry the process can be realized through bluetooth based smart sensor networks seminar report and can be controlled through actuators. A typical Blue tooth device has a range of about 10 meters and can be extended teport meters.
For that a redundant number of smart nodes is deployed in this field. In bluetooth, a Piconet is a collection of up to 8 devices that frequency hop together. netqorks
Get Seminars to Your Mail Enter your email address: We can expect Brain like computers soon in reality. The goals of blue tooth are unification and harmony as well, specifically enabling different devices to communicate through a commonly accepted standard for wire less connectivity.
Many newest products are been launched in the market bluetooth based smart sensor networks seminar report the Bluetooth services and the system. These entire systems are allocated to work on the sensors and the controllers are controlled and configure by the actuators.
Blue tooth defines three smarr power modes sniff, hold and park. One of such applications is a wireless sensor network. Bluetooth Based Smart Sensor Networks.
The communications capability of devices and continuous transparent information routes are seensor components of future oriented automation concepts. Pawan Janorkar 01 July These eight devices have the seven of it as the slave devices and one as the master device sennsor the Bluetooth connection.
Jilani Agsapure July 15, at Queries are used when user requires only the current value of the observed phenomenon. Wireless sensor networks – networks of small devices equipped with sensors, microprocessor and wireless communication interfaces.
Finally, the engineers at the Ericsson named the new wireless technology as “Blue tooth” to honour the 10th century king if Denmark, Bluerooth Blue tooth to A. Tasking is a more complex operation bluetooth based smart sensor networks seminar report is used when a phenomenon has to be observed over a large period of time.
Latest Seminar topics Seminar Topics-How to select a good one?
Communication is increasing rapidly in industrial environment even at field level. Deepak January 8, at 4: The advancements in technology, wireless communications have enhanced development of bluetooth based smart sensor networks seminar report, low power and low cost devices. Bluetooth operates in the unlicensed ISM band at 2. From the user point sendor view, querying and tasking are two main services provided by wireless sensor networks.
In any industry the process can be realized through sensors and can be controlled through actuators.
The communications capability of devices and wmart transparent information routes are indispensable components of future oriented automation concepts. A single connection supports a maximum asymmetric data transfer rate of KBPS maximum of three channels.
Bluetooth Based Smart Sensor Networks Seminar Report pdf
With advent in networking concept, the cost of wiring is saved by networking the field devices. Don’t enter email or mobile no. The smaart is monitored on the central control room by getting signals through a pair of wires from each field device in Distributed Control Systems DCS.
A single connection supports a maximum asymmetric data transfer rate of KBPS maximum of three channels.


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Our steering committee
Dr. Johannes Michael Nebe
The goal of our association is to give young people in Kenya a decent perspective on life through education, which often remains closed to many of them due to poverty. In doing so, I have been able to experience that without a human touch, financial support alone is not enough to achieve this goal. I would like to continue along this path and do everything in my power to ensure that the young people we support, who are hungry for education, can play an active role in building up their homeland. This is my idea of a concrete development policy that serves the people!
The "Africa bacillus" took hold of me on our excursion to Kenya in September 2018. The four days we spent in the Mathare slum with Kenyan students will remain unforgettable for me. I have time and would like to use it wisely. Helping that the goals of the association (education-hungry children and young people in the slums, a better future can be realized). "If many small people in many small places do many small good things, they can change the face of the world." Wisdom from Africa
Education is the future. Not only in my job as a high school teacher do I try to sensitize young people to other continents, cultures and, above all, the people who live there and their way of life. Africa has been particularly close to my heart since my first excursion to Kenya in 2015.
Since then, I have been intensively involved in comparing the ideas of students in Germany about life in slums with what I myself experienced and, above all, what the people in the slums told me. Especially here in Europe, misconceptions, prejudices and stereotypes of Africa in general, of life in Kenya and especially in poorer areas unfortunately still exist.
I am deeply impressed by the great and important work that the association does and am very happy to be part of it and to be able to contribute something myself. It is a pleasure to work with such motivated, competent and committed people and to make the world a little bit better in the process.
Nicolas J. Kraff
Public Relations Officer
During my geography studies, I took part in an excursion to Kenya with Dr. Nebe in 2008 and had the great privilege of getting to know the country and its people. During the eight months I spent in Nairobi afterwards, I was very moved by the living conditions of the people in the slums. This prompted me to take a critical look at the effects of globalization and to conduct scientific research on poverty-stricken neighborhoods worldwide. Knowledge of the situation on the ground and education for the people are cornerstones for working at eye level and initiating developments with mutual respect, true to the quote that can probably be attributed to Immanuel Kant (1724-1804): "Knowledge is not power, but responsibility"!
I have already gotten to know some countries in Africa while traveling and have been able to make many experiences with the environment and the people. I was also very impressed by the willingness of children and young people to learn, but unfortunately they often lack the financial means and a suitable infrastructure. Access to education opens up new future prospects for people through better job opportunities and higher incomes. I became aware of the association because I was looking for a voluntary activity where I could use my advanced knowledge of office software and I am happy to support the association in the technical organization and administration.

domain: sociology


Thousands of families could benefit from $500 monthly payments.
However, there are only days left to apply.
Student Loans: Use these tips to save $1,000s and pay off debt faster
Chicago Resilient Communities Pilot
Applications for the Chicago Resilient Communities Pilot will close on May 13. The program worth $31 million will help families facing economic hardship. Read more about it here.
In order to qualify, you must:
- live in the city of Chicago
- be at least 18
- have experienced economic hardship related to COVID
- have a household income at or below 250% of the federal poverty level
Only one applicant is allowed per household. Applicants that are eligible will be placed in a lottery. The lottery is designed to prioritize people living in communities with preexisting economic hardship.
Will there be changes to the Child Tax Credit in 2022?
FingerLakes1.com is the region’s leading all-digital news publication. The company was founded in 1998 and has been keeping residents informed for more than two decades. Have a lead? Send it to [email protected]


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Cirque du Soleil returns to the City of Los Angeles in 2018 with its highly acclaimed touring show SEP7IMO DIA – NO DESCANSARÉ blends the wonder of Cirque du Soleil with the explosive pop-rock energy of Soda Stereo – Argentina’s musical icons – to immerse spectators in the band’s symbolism and poetry
SEP7IMO DIA will premiere at the Forum in Los Angeles from May 3 to 6, 2018.
This is the show´s first time in the USA, having entertained more than 1 million people in 5 Latin American countries in 2017.
The SEP7IMO DIA set contains acrobatic and décor elements inspired by Soda Stereo’s music videos and the lyrics of the songs, which die-hard fans will recognize.
In 2013, Pop Art Music founder Roberto Costa, Pop Art Music CEO Diego Saenz and Soda Stereo Manager Dany Kon approached Cirque du Soleil to create a show based on the band’s music. The project comes to life exactly 10 years after the band’s final tour.
Set on a strikingly unconventional stage, SEP7IMO DIA is an ode to the trio’s fiercely innovative artistic approach and musical legacy. The show picks up on the wave of euphoria that Soda Stereo unleashed in Latin America and beyond, and celebrates the iconic band’s deep connection with its fans.
A cast of 36 performers take the audience through a series of visual, acrobatic and artistic tableaux, achieving an unforgettable experience that honors the fierce and innovative artistic approach of the trio and their musical legacy.
A young man named L’Assoiffé, who thirsts for meaning and social justice and dreams of a better world, feels trapped. When he plugs into the music of Soda Stereo, he has whisked away to an inner world and is set free. The music of Soda permeates this inner world, spawning an entire civilization that resonates with the group’s music, poetry, culture, and iconography.
The inhabitants of this realm become the physical embodiments of the music. After experiencing a series of events and emotions inspired by the lyrics of the songs, L’Assoiffé ultimately realizes that the music we carry in our hearts is as faithful as a true friendship – deep and eternal.
• There are 14 high-performance video-projectors in the show delivering images taken from or inspired by Soda Stereo’s music videos and photo archives.
• A tracking system ensures that the projections move in sync with the set pieces on stage.
• The projection rate is 30 frames per second, and every frame has more than 29 million pixels.
• In a solemn moment during the PRIMAVERA CERO act, images of fans and of the band members are projected onto the main character using body mapping technique
Tickets are available for Cirque Club members at https://www.cirquedusoleil.com/sep7imo-dia as well as for Soda Stereo Fans through Soda Stereo official social media channels (@sodastereo) and official social media channels of SEP7IMO DIA (@sodacirque7d)
Tickets start at $55.


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STATE OWNED BANK (SOB)
The term SOB in the Chinese economy indicates bank controlled directly or indirectly by the State. This kind of bank operates under the supervision of the People's Bank of China (PBOC) and its local offices.
In 2003 is started a reform process of China's banking system that has transformed some State owned banks in private companies. Currently in China there are different kind of SOB:
- Three "policy" banks responsible for financing economic and trade development and state-invested projects: Agricultural Development Bank of China (ADBC), China Development Bank (CDB) e Export-Import Bank of China (Chexim).
- City commercial banks: Most city commercial banks have strong ties to their local government and are majority or wholly State owned.
Editor: Giovanni AVERSA

domain: politics


Buying lottery tickets doesn’t have to be something that you only do when you walk into a store or a gas station. In fact, you’ve likely found plenty of ways to purchase lottery tickets online, right? But you likely only think about buying lottery tickets from your computer or laptop. The truth, however, is that you don’t have to buy tickets only from a machine in your home. You can also buy your tickets from your mobile device, including phones and tablets. You just need the right website that you can access by mobile.
Redfoxlotto is one website that you can access easily directly from your favorite mobile device. With Redfoxlotto you’ll have a website that’s super simple to use no matter where you are or what you’re doing. The website is set up to fit your smaller screen, whether you’re using a small mobile phone or a large tablet. Not only that but it’s designed to load properly and quickly, which is crucial when you’re on the go. No one wants to spend a lot of time waiting for a page to load, after all.
When it comes to buying lottery tickets on your mobile phone, you want to make sure that you have a website that will really work for you. Look at how quickly it loads as this is going to make it easier for you to buy the tickets that you want and then get right back to whatever it is that you were doing before. So, if you’re out shopping with friends you want to make sure that you can buy your tickets and then get right back to shopping and spending time with your friends.
A website that gives you plenty of options is going to be important too. Just because it loads quickly doesn’t mean you’re going to want to sacrifice everything else. So, make sure that you’re choosing a page and a website that will give you access to plenty of different types of tickets. You want to be able to buy from different countries, for example. And you definitely want to make sure that you can pick up multiples and see all of the information possible while you’re at it. All of these things are possible with RedFoxLotto.
Make sure that you’re looking at the different websites available and that before you choose anyone in particular you’re actually looking at how they work on mobile. Look at the mobile version to see how user friendly it is and whether you can actually access all of the things you want. You’re going to have a whole lot more fun if you know you can use the website you choose from anywhere. With Redfoxlotto you’re going to have no problem getting the tickets that you want, whether you decide to go to it from your computer or your mobile device. With the right mobile app or website, you’re going to have no problem getting the tickets you want when you want them.
What can you expect if you choose this website? It was designed as a lottery fan club with enthusiasts who wanted to make other, like-minded people happy. To make the Lotto experience as easy to access as it’s possible while enjoying every step of it, was the goal that the creators of this website had on their mind when they first launched it. You can expect like-minded people who want to simplify your life, by giving you the opportunity to save your time and enjoy your activities simultaneously.
Several payment methods including bitcoin are what offer you a variety of options to choose from, making it the most convenient way for you to buy lottery tickets and participate in all the lotteries you want. You can buy tickets from all around the world which is something you wouldn’t be able to do if you were to buy tickets in traditional places.
The process itself is extremely simple and easy, you just need to select the lottery you want to buy tickets for, and you can see all the amounts of the current jackpots. This way, you can easily decide which one is worth buying for you, compared to the others and choose which one you like. After you choose a lottery you can click on it and read more information about it to get to know yourself with the process, but we all know that the most important part of the process is to choose the right numbers! I’m sure you already have your combination of numbers. If that’s the case then you just need to pick the numbers you want using your mouse or your touchpad and you will see how many numbers you need to type in, and are there any special ones. After you select numbers you want, or the ones randomly generated by your click, you can choose to buy more tickets for other lotteries or to stay on that one. The next thing you should do is to sign up for free and select the payment method you want, and with the simple click, the tickets are yours!
Quick, simple, and easy, you can buy your tickets from your mobile phone, with no limitations, in just a couple of minutes, on a verified website. Doesn’t it sound like a good deal? If you are not a regular lottery player, you could easily become one, when you have all this information on how simple it is. On the other hand, if the lottery is already a part of your life, then understanding the simplicity of this website and especially the process of buying tickets itself, is definitely something that you will want to take advantage of, on a daily basis. What’s also important to you is the level of security the site provides. It is highly secure and it follows the latest laws and industry standards. It is one of the most reputable providers and you can relax, save your time, and purchase lottery tickets for your favorite lotteries around the world!


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Alamo Candy is available in cherry bomb flavor. These are available in 12 candy packing, each candy weighing 2.5 ounce. These are Sweet & Sour Cherry Bombs are deliciously chewy and seasoned with a little kick! These are sealed for safety and freshness. The ingredients include Sugar, Corn Syrup, Modified Food Starch (corn), Citric Acid, Glaze, Coconut Oil, Artificial Flavor, Dextrose, Carnauba Wax, Mineral Oil, Sodium Citrate, Red 40.
Alamo Candy Cherry Bombs 12 Count – 2.5 oz
- Alamo candy sweet & sour cherry bombs
- Cherry Bombs dipped in chili
- Sealed for safety and freshness
- Made in San Antonio, Texas
Availability: 30 in stock
|Dimensions||10 × 2 cm|
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domain: food


text:
Congress recognizes Johnson for service to community
A tribute to Melvin “Toot” Johnson of Tunica by the Honorable Bennie G. Thompson of Mississippi’s Second District was read into the Congressional Record recently.
Congressman Thompson’s tribute, titled “Honoring Melvin C. Johnson,” was presented on the floor of the House of Representatives and published February 28.
It reads: “Mr. Speaker, I rise today to honor an extraordinary community leader, Mr. Melvin Johnson.
“Mr. Melvin Charles Johnson was born and raised in a small town of Tunica, MS. He has been married to Debra L. (Toney) Johnson for 23 years. He was introduced to politics at the early age of 10. He marched in his first Civil Rights March in Tunica, MS in 1963 and became the vice president of the SCLC Youth Organization in Tunica.
I-269 reaches halfway point
Batesville, Miss. — Construction continues on schedule for the I-269 project in North Mississippi, according to the Mississippi Department of Transportation (MDOT).
All phases of the project are under construction with several more than halfway complete. In October 2013, one section of the project, from SR 302 to the Tennessee state line in Marshall County was completed. Paving for this section will take place later this spring.
Town cracks down on litter, lighting
Lights, signs and upkeep of property will now become a top priority for the town of Tunica, following the expiration of a grace period on changes to local ordinances.
Several local merchants were on hand to ask questions at the Board of Aldermen meeting on March 18. Town code enforcer Frank Contreras was also present along with Planning Commission consultant Bob Barber.
Student arrested in shooting death of another student
A 17 year old has been arrested in the March 10 shooting that claimed the life of another young local. Cortez Bass of Tunica was formally charged with cyberstalking and murder of Donterrius Jackson, also 17, in Justice Court on March 13. His bond was set at $1 million. As of presstime, Bass was still listed among inmates at the Tunica County Jail.
Page 28 of 240
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Note: Material Safety Data Sheets (MSDS) for our products are available from this website in PDF format.
Go to the relevant product below and click on the underlined link to the specific Material Safety Data Sheets (MSDS).
Ultracolor Aerosol Line Marking Paint
500 gram aerosols to suit machine or hand held Application.
Ultracolor Machine Aerosol Applicators
4 and 2 wheel machines for use with aerosol line marking paint.
Also available, is a handy aerosol extension arm.


Despite its detractors, every time I’m in Los Angeles, the city impresses me more. From the first time in 1970 to just recently, the changes are palpable, especially the move(s) away from being so car-centric and increased densification. Below, is my list of ten planning lessons learned from mighty LA. Given the city’s sheer size and scope, many more could have been listed, but these are fine for the time being. Peace!
- Once known as the poster child for urban sprawl (now its Houston, Phoenix, or Atlanta), Los Angeles has grown upward into a remarkable city of vibrant, dense midtown neighborhoods and an impressive downtown skyline.
- Many surrounding node cities like Glendale (shown above), Pasadena, Santa Monica, West Hollywood, and Long Beach have established their own unique identity and vibe.
Typical scene on I-710 – Source: latimes.com
- The sheer volume of truck traffic generated on the freeway system by the Los Angeles and Long Beach container ports is staggering. The number of trucks has gotten to the point where a separate expressway lanes solely for trucks to/from the harbor solely may needed to reduce the near gridlock conditions, especially on I-710 (shown above) and to a lesser extent on I-110. A less disruption alternative for those abutting the freeway would be to establish an inland container port (dry port) further out, thereby allowing only railroads and local trucks to service the harbor.
- Our unified familiarity with places in and around Los Angeles from both film and television (Rose Bowl, Disneyland, Griffith Observatory, “Hollywood” sign, Brady Bunch home (shown above), Malibu, Beverly Hills, Hollywood Walk of Fame, Santa Monica Pier, etc.) actually makes visiting Los Angeles feel like a nostalgic homecoming.
- Los Angeles is the first place this retired planner has ever seen street signs declaring an “anti gridlock zone.” These prohibit on-street parking during peak hours of the day to facilitate traffic movement throughout the city.
Source: urbanrail.net……………………………………..Source: thesource.metro.net
- The addition of numerous HOV/carpool lanes, bike lanes/trails, commuter rail systems (Metrolink), subways/light rail (Metrorail), and busways in Los Angeles have helped transformed this car-centric commuter city into a multimodal transportation dynamo. It is nice to see so many people waiting at train stops – each one or two representing that many less cars on the roadways.
- The proposed aerial tramway/urban gondola linking a downtown Metrorail Station with Dodger Stadium (shown above) is an excellent last-mile solution to major sports venues and could help reduce the need for acres of inefficient surface parking surrounding them.
- Griffith Park (shown above) is certainly one of the most impressive city parks in the nation, as it successfully melds the tranquil subtleties of Mother Nature into this vast urban landscape. Even more impressive is how little trash or graffiti one finds in the park when visiting.
- One cannot help but be impressed by this compelling and energetic city – few places exude such brute force of industry and commerce while also being so visually serene. LA is an economic powerhouse with few equals in the United States and worldwide.
- Art is at the very heart of LA – its movies, music, television shows, video games, and other media represent the collective voices of America as delivered to the rest of the planet. Without Los Angeles, the American dream could have not gelled so compellingly in the hearts and minds of those seeking a better life.
If Los Angels and Southern California intrigue you as much as they do me, here are a couple of books on the topic that are available on Amazon.com.* The Mirage Factory is highly recommended reading by this blog author and I hope to read Everything Now soon, as the reviews have been excellent.
Link – The Mirage Factory …………………………….. Link – Everything Now
*A small commission is earned from purchases that are made using the above links to Amazon. As an Amazon Associate, I earn from qualifying purchases.