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Louisville Slugger 2013 Attack -3 Adult Baseball Bat (BBCOR)
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The 2-piece composite just changed forever. The 2013 BBCOR Attack bat has patented, true-2 piece composite technology(T2) that virtually eliminates sting and vibration to the hands while providing unparalleled feel of the ball jumping off the barrel of the bat.
Bat Specifications
Drop: -3 Adult Bat
Barrel: 2 5/8"
Certification: BBCOR Certified
Material: LS2X Composite Tech
Handle: 31/32"
Construction: T2 Two-Piece Composite
Available Sizes: 34in 31oz, 32in 29oz, 33in 30oz
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Comments about Louisville Slugger 2013 Attack -3 Adult Baseball Bat (BBCOR):
Tried a ton of BBCORs, this is the best on the market.
- Was this a gift?:
- No
- Good Grip
- Great Pop
- Well Balanced
Best Uses
- Baseball
- Games
- Homeruns
- Practice
Comments about Louisville Slugger 2013 Attack -3 Adult Baseball Bat (BBCOR):
I bought this for my son, he used the Z-1000 last year and it is a great bat. Well, the spring season hasn't started yet, but he says this bat "hits like a dream". In fact, he hit two out today in practice with it. It sure didn't hurt him, he signed a letter of intent in January to play college ball. Louisville must be doing something right!
- Was this a gift?:
- Yes
- Good Grip
- Great Pop
- Large Sweet Spot
- Well Balanced
Best Uses
- Baseball
- Batting Cages
- Games
- Homeruns
- Practice
Comments about Louisville Slugger 2013 Attack -3 Adult Baseball Bat (BBCOR):
It is a great bat. It has great grip and a lot of pop. this bat never gives you the stinging in your hands like most bats do. The ball almost jumps off the barrel like a BESR regulation bat. Mine broke fast though. it still is in my opinion the best BBCOR bat ever made.
- Was this a gift?:
- No
Baseball Bat Sizing Chart
Bat sizing charts:
Softball Bat Sizing
To find the correct bat length for your softball-playing daughter, have her stand straight up with her arms to the side. Place a ruler to her side with the start of the ruler (the "0" mark) on the ground. Read the measurement at the end of her wrist, just where the hand meets the forearm. As a general rule, this measurement indicates the perfect bat length for her.
Another sizing method for Baseball and Softball
Another great means for determining bat size is what we'll call the wingspan method. Have your son or daughter stand up tall with their arms straight out (arms should be parallel to the ground as if they were trying to mimic an airplane). Measure from the very center of their chest out to the tip of their fingers. That measurement will give you the ideal bat length.
It's always best to try to size using a variety of methods to come up with their ideal. For youth which are still growing, we recommend that you go with the longest length obtained through the various sizing methods. We often use the break of the wrist method (described in the softball bat sizing above) along with this method and use the longer of the two.
Baseball Bat Videos
Baseball Express Videos - Baseball Bat Buying Tips
Team Express and all its brands are authorized bat dealers. All bat purchases will come with a valid sales receipt, and we can provide a copy of a sales receipt at any time to the original purchaser.
Louisville Bats: 1-800-282-2287
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Catalog search
Catalog links
Undergraduate Bulletin 2013-2015 » Academic Departments and Programs » Chemistry » Courses in Chemistry » **CHE 107: Introductory Chemistry Laboratory II.
**CHE 107: Introductory Chemistry Laboratory II.
4 hours (3, lab; 1, problem lab), 1 credit. Continuation of CHE 105: introduction to the methods of scientific investigation, including basic physical and chemical laboratory techniques. Applications will include synthesis and analysis of simple chemical systems. PREREQ: CHE 105. COREQ: CHE 106. (See information for corequisite courses.)
Last modified: 3/11/2014

subset: commoncrawl


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At any point, can the Holy Spirit take control of a person completely so that the person may act beyond his control? I am trying to understand the Biblical view on this. My understanding is that the Holy Spirit is a submissive spirit, but, I have heard people say such as "Holy Spirit was controlling me". Looking forward eagerly for the answers.
Whether or not it is technically possible, it would contradict the nature of God to do so.
To overwhelm a person dispenses with free will, and most Christians view God as granting mankind the ability to choose him freely. As illustrated in Hosea
and Isaiah
God's nature is one of patience and long suffering towards his people. A formulation that occurs throughout the old testament testifies to his longsuffering as well:
In short, the nature of God is to woo, not whelm.
It is much like the old saw "Can God make a rock so big that he can't lift it?" In truth, God cannot, not because he lacks adequate strength, but rather because doing so would violate his own attributes. In the case of the rock, God is all-powerful. His omnipotence constrains him to be all-powerful. In the case of not overriding free will, his love constrains his action. Because God is all-loving, his attributes constrain him from overwhelming those he loves.
The Holy Spirit definitely compels people to act in accordance with the will of God (e.g. Acts 20:22)
But, that is a far cry from a demon possession like experience.
Yes it is possible. However, God prefers you doing what he wants you to do willingly.
Here are the references
This passage is interesting, you should read the whole chapter. Saul went to Naioth to do something else but something different happened
The effect of Spirit is likened to being drunk with wine. When you are drunk, you lose control and you do those things you wouldn't do normally. But unlike wine, you'll do positive things.
The spirit came on Elijah and he ran unlike an ordinary man. Same is Samson.
Ezekiel 47 describes the effect of the different level of the Holy Spirit, the highest compared to a river. The more the water, the less your resistance to it until it carries you to wherever it wants
You can read this article for a better understanding and you are advised to reason with the content. You may not take it as it is.
But I cannot remember where this happened in the new testament.
I must take offense with answer #2. One of the fruits of the Spirit is self-control. Therefore if the Spirit completely overtakes you it violates who He is and is at enmity with Himself. This is absolute proof that this "Holy laughter" and "being slain in the Spirit" cannot possibly be the work of the Holy Spirit. I have no doubt that "spirits" are involved but it is not God's. If the Holy Spirit takes control of you , you personally have lost all self-control. This is totally against the Nature of God. The Spirit of God will certainly empower you but never take your self-control. The scriptures used by answer #2 show this clearly. In every case they were led to do something, compelled to obey God, and were empowered to accomplish what they were called to do. It therefore must be either a "different" spirit that would take your self-control or the Bible is a lie. Being "controlled" by the Spirit is much different from obeying the Spirit. Obeying constitutes having a choice . You may well have a negative outcome from disobeying the Holy Spirit but you get to make that choice . Hope this helps. Amen
Salvation from hell is by grace through faith in Christ alone ( Ephesians 2:8-9, Romans 6:23).
Once a person received Christ the Lord as his Savior ( John 1:12), he/she is now possessing free will either to disobey God ( consequence is chastisement not hell- Hebrews ) or to obey God ( consequence is temporal blessings not heaven- Hebrews , Matthew 6:33).
As we can notice, the consequence of a believer's action always leads to persevering in the faith just as the Scriptures says " the just shall live by faith" and " from faith to faith"( Romans, Hebrews).
Hebrews 13:2 Look on Jesus who is the source and the completer of our faith.
What this means is that salvation from hell is monergistic but sanctification on earth is synergistic ( Philippians 2:11-13).
Therefore, the Holy Spirit cannot completely control the Christian in the sense that he/she did not choose it. God acts upon our choice. [ Note that this is only for those saved by grace through faith apart from any works].
The Christian will be under the complete control of the Holy Spirit via exterminating his/her free will to disobey either at death , rapture or at the resurrection.[ As to why God still allows his children to sin is for their sake because he\she can prove himself\herself the victory over sin he\she have in Christ Jesus].
I surrendered my entire life to God and have allowed Holy Spirit to consume my entire being. I have been made into an entirely different man. I have friends from my past that tell me that I don't even look the same. It is a matter of allowing Him to do so. He will not force His will upon anyone but the moment you allow Him, He will take full control. I pray differently, act differently, and no longer have desires to do things that I used to do. I cannot explain it anyother way than that. This life is entirely different than how I was before this encounter.
The Holy Spirit is a wonderful teacher who teaches all the things of God but He does not force us to do them. In the NT in the book of revelations it says that who has an ear to hear should listen to what the Spirit says to the Church. I believe we have to obey Him and thus how He gains control over us. He is a gentlemen He knocks meaning He does not use force. I pray that people of God read their bible for them to know God better.
If you are thinking that there may be the same thing as "mounting the horse" in Voodoo, no. God gave us free will and He respects that which he created. You can ask God to take you over and remake your heart to obey, but He won't. Sanctification must be done by our renouncing the old nature and asking Him to finish the job. Satan hates God's image that is stamped on every human. Part of that is our free will.
com•pel / kəmˈpel/ verb past tense: compelled; past participle: compelled 1. force or oblige (someone) to do something. "a sense of duty compelled Harry to answer her questions"
The answer to the question is YES!!! The Spirit can and does compell us regardless of what our Will is. When we accept Jesus we give up our rights, (designed to protect us from Men), and are completely in His charge. we WILL do His Will whether we want to or not.
See "Jonah"
I've recently been studying the topic of the spirit control which is living from your spirit and not your flesh. Your spirit is in constant contact with God meaning that you have the ability to be led by God in every aspect and you also are in tune with Holy Spirit. So no Holy Spirit cannot consume you but you can be submitted to Holy Spirit and your spirit as well.
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Safety Science
See also Elsevier's Safety and Transportation portals
Safety Science serves as an international medium for research in the science and technology of human safety. It extends from safety of people at work to other spheres, such as transport, leisure and home, as well as every other field of man's hazardous activities.
Safety Science is multidisciplinary. Its contributors and its audience range from psychologists to chemical engineers. The journal covers the domain of safety in its general sense with a special focus on the interfaces between technology, people and organizations. Papers may address the physics and engineering of safety; its social, policy and organisational aspects; the management of risks; the effectiveness of control techniques for safety; standardization, legislation, inspection, insurance, costing aspects, human behaviour and safety and the like.
Safety Science will enable academic researchers, engineers and decision-makers in companies, government agencies and international bodies, to augment their information level on the latest trends in the field, from policy makers and management scientists to engineers.
The journal focuses primarily on original research papers across its whole scope, but also welcomes state-of-the-art review papers and first hand case histories on accidents and disasters of special significance. The emphasis is on safety risks, as distinct from health risks, but may include both.
Editor-in-Chief: J.L. Wybo
View full editorial board


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MOORE, Oklahoma -- The stories of survival are incredible. From cellars to closets to bathrooms, residents in Moore hunkered down and prayed for the best.
"It was a huge adrenaline rush. I could hear it coming from a distance. They say it sounds like a freight train, but when it got here it was just a lot of rumbling. But the thing that got me was things started hitting the house hard enough to shake the house. We were in the bathtub and we felt the house shaking," Daniel Grableman said. "I felt my ears popping and it lasted about 30 to 40 seconds and it was over, and we were happy."
The first Tornado Warning was sent out around 2:40 p.m. Monday. About 16 minutes later a tornado ripped a 12-mile gash through Oklahoma.


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The bride-elect is the granddaughter of Doris and Daniel Stearman and Ronald and Mary Austin, all of DeArmanville.
Miss Austin is a graduate of Oxford High School. She is employed by Model City Pediatric.
The prospective groom is the grandson of George Edward and Mina Faye Stephens of Munford and the late Carl and Gertrude Bergstresser, formerly of Anniston.
Mr. Bergstresser is a graduate of Walter Wellborn High School. He is employed by Honda Manufacturing.
The wedding will be 7 p.m. Nov. 27, 2013, at Janney Furnace Barn.


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Unique show on Life OK is coming back on TV screens. This time ...
The launch of second season of reality show Welcome: Baazi Mehmaan ...
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text: Breckenridge takes steps to clean up cityBreckenridge, MN (WDAY TV) - The city of Breckenridge has clutter problem. After taking a bus tour around town, city officials didn't really like what they saw. So now neglected yards, and homes are getting cleaned up with a little push from the city.


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By wherald
Christine Cook Marlin Reed, 80 of Franklin, Tenn., died Oct. 9, 2012.
She was a member of Walker Baptist Church and retiree of APCOM.
She was preceded in death by husband, Melvin Marlin; son, Ray Marlin; parents, Buster and Lottie Cook and brother, Bill Cook. Mrs. Reed is survived by daughter, Mary (Tandy) Bruce of Woodhaven, Mich.; son, Lynn (Denise) Marlin of Franklin, Tenn.; daughter-in-law, Elaine Webb of Franklin, Tenn.; two grandchildren and five great grandchildren.
Funeral services will be conducted Friday, Oct. 12, 2012 at 11 a.m. at Williamson Memorial Funeral, Mitchell Karnes officiating. Interment will be in Williamson Memorial Gardens. Visitation will be held Thursday, Oct. 11, 2012, 4-8 p.m. and one hour prior to the service on Friday at Williamson Memorial Funeral Home in Franklin.
Active pallbearers will be Terry and Randy Cook, Andy and Jerry Wolverton, Reese Potts and Roy Watkins. Honorary pallbearers will be nephews, Walker Baptist Senior Sunday School Class and neighbors.
Memorials may be made to Walker Baptist Church Building Fund.
Arrangements are by Williamson Memorial Funeral Home in Franklin.
10/11/2012, Williamson Herald
Posted on: 10/11/2012
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Super Sunday Is Here
Yes, this is a new edition of Hot Clicks on Super Bowl Sunday. If you're a loyal enough member of Hot Clicks Nation to be reading this today, you're probably looking for some help with your prop bets. No site does a more thorough job breaking down each of the more bizarre offerings than StockLemonBlog.com.
If Betting Isn't Enough To Keep You Interested In The Game…
Here is your Super Bowl Bingo drinking game.
History Lesson
Mandatory.com has put together this very cool interactive Super Bowl graphic that recaps all the historic plays that took place on every yard line up and down the field throughout Super Bowl history.
Lovely Lady Of The Day
I'm going with a 27-17 49ers win. As you can see above, supermodel Marisa Miller is also backing San Francisco, so she is today's LLOD.
Here are childhood photos of several Super Bowl XLVII participants.
Monologue Video Of The Day
The annual NFL Honors award show took place last night. Alec Baldwin was the host and delivered the goods in his opening monologue.


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LV'S GUY STUFF: Louis Vuitton will unveil a new luxury men's leather goods line at its men's show in Paris on Thursday. Dubbed Damier Infini, designs come in supersoft calfskin embossed with the house's Damier check, with reinforced, bonded interiors to maintain rigidity. The launch will include Damier Infini versions of classic Vuitton bag styles such as the Keepall and Porte-Document Voyage. The collection will hit Vuitton stores in mid-August.
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San Diego Padres could be sold for $800 million by the All-Star break
Doug Pensinger/Getty Images
Starting pitcher Anthony Bass of the San Diego Padres. The team could be nearing a sale for $800 million.
That's what being reported, anyway. CBS Sports says that current owner John Moores has entered an "exclusive negotiating window" to sell the team for about twice its current (depressed) value of $406 million — and a lot more than Moores paid to buy the team in 1994, and to start selling it in 2009.
The sticker price is rumored to be $800 million. If the sale — to a group led by the family of former Dodgers owner Peter O'Malley, brewing tycoon Ron Fowler, and other investors including pro golfer and San Diego native Phil Mickelson — goes through, it would make the Padres the third costliest Major League Baseball team acquisition, behind the Chicago Cubs $845 and of course the recent Dodgers sale of more than $2 billion.
It would also mean that the two other potential owners — communications mogul Gary Jabara; and private-equity titan Steve Kaplan of Los Angeles' Oaktree Capital — are out of the running.


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Starting with PHP 5.4 you are unable to use persistent connections when you have your own database class derived from the native PDO class. If your code uses this combination, you will encounter segmentation faults during the cleanup of the PHP process.
You can still use _either_ a derived PDO class _or_ persistent connections.
For more information, please see this bug report: https://bugs.php.net/bug.php?id=63176


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by laying down on the floor and performing photosynthesis
um so hi guys! Im actually new here and everything but i have a question: im a pretty good manga artist i draw but im not really advanced and ive been drawing for 4 years and i cant draw like all the anime artist i adore! so i was wondering do any of you guys know any way to learn manga fast and draw like hiromu arakawa,masahi kishimoto,or jun Mochizuki? if u do plz respond thx!!!!!!!!!!!!!!!!!!!!!! very much!!!!!!!!
say do any of u guys know any fast way to learn how to draw manga? i desperately need help!
NOTE FROM RIO - Please post in the appropriate area. Since you made multiple posts on the same subject, I have merged them together. Next time, I may just delete them instead. Follow the rules - they're stickied in each area of the forum.
by laying down on the floor and performing photosynthesis
lol!!! but im lookin 4 more serious awnsers!!
just relax and ......... visit my page!
ok here I made you a handy guide:
wat were?
just relax and ......... visit my page!
"Fast" is incredibly non-specific, but if you're looking for a way to get to respectable quality in a week or two, just accept that no such way exists.
If all you want to do is impress your friends with a nice picture or two, you can use reference and produce something kinda decent within a couple hours. If you want to actually get good as fast as possible, draw every day in every bit of spare time you have, and draw well. Use reference. A lot. How fast you progress depends on you individually. Check around the critique corner here at MT and see how some of us here are after however many years and you'll get a general idea of how long it really takes.
EDIT:It's a blank piece of paper.wat were?
Last edited by Matt; 11-25-2012 at 10:48 PM.
thx so much this is the kinda awnser i was expecting but anyways thx alot!...matt!
just relax and ......... visit my page!
The kombucha mushroom people, sitting around all day.
Yea, what Matt said. There is no fast way, there are fast methods, and fast techniques, but that all takes tons of effort and skill. If you don't have the skill, are not willing to put in the time, don't practice preferably every day, then everything will be very -slow- as you try to figure out a cheap way around learning the fundamentals of the style.
I mean, I guess you could trace.
Practice. If you look at those artists, specifically Kishimoto, you'll find that the art differs from chapter to chapter. Read the first chapter of Naruto and then the latest, and you'll see it takes nothing short of years and years of practice to get that good. However, that isn't the point of this thread. Post on-topic from now on or you might get banned.


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You are already a registered user on SDB.Please enter SHIP ME promo if you have not already used it previously.
A mechanically expandable rubber cushion safely keeps the band or belt from slipping during use. Use with 3M™ Coated Abrasive Bands and Belts.
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In the waning days of Wilma Liebman's tenure as Chairperson of the National Labor Relations Board, the Board overturned twenty years of labor law history and held in Specialty Healthcare that a group of employees as small as a single classification can be separately unionized (See Specialty Healthcare & Rehabilitation Center of Mobile, 357 NLRB No. 83 (2011)). In August of this year, the Sixth Circuit Court of Appeals affirmed the Board decision, deferring to the Board's "expertise" in such matters.
We have a perfect storm brewing.
Micro-units are vastly more easily organized than plant-wide or store-wide units. It's just arithmetic. Two of five dock workers (shipping and receiving employees) in a bar drinking after work can sign cards on which a valid petition for an election can be based and all they need is one more to vote for the union and it's done. If the appropriate unit consists of 100 employees, the union's task is much more difficult.
Micro-units may sound too fantastic to be true. It's not. The Board is turning its back on well-established rules, such as single plant and single store presumptions, and subjecting employers to the real risk of dealth by a thousand cuts.
Regional Directors of the Board have been applying the new rules for the last two years. Among their decisions has been to certify the employees in the women's shoe department at a Bergdorf Goodman in New York and the cosmetics and fragrance department employees at a Macy's in Massachusetts as appropriate units for bargaining. How many departments in a department store? How many classifications in workplace? How many groupings of similar skill-sets are there? The application of the new rule may result in union representation and union contract for each of those departments, classifications and groupings. The result is chaos. When last I looked, chaos does not produce productive workers.
The storm fronts also converging are the likelihood of quickie elections reducing the time to election from petition date to two weeks or less and the Department of Labor's revision of persuader rules so that obtaining confidential legal advice concerning the application of Labor Board rules much more complicated and difficult.
There are things that an employer can do to meet its new burden of showing that the employees in other classifications or departments have an "overwhelming community of interest" with the employees subject to the petition so that a unit of just those employees would be inappropriate. A short list that will be expanded to meet an individual employer's situation and methods of operation are
- examine your organization to determine which job classifications or departments share skill levels so that they can be combined to make broad identifiable groupings;
- flatten your management organizing so that more employees report to the same managers;
- develop incentive plans or productivity measurements that cover the larger groupings;
- cross train employees in the putative larger unit so that they can move easily across traditional job classifications/departments; and
- establish compensation grids and promotional opportunities that are common for all employees in the larger unit.


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Galena Carriage Co.
Historic carriage rides, dinner rides, "romance and roses" rides. Friday-Saturday evenings, 5 p.m.-9 p.m. Seasonal sleigh rides. Reservations recommended.
CITY: Galena
Noble Horse Carriage Ride
Let Noble Horse make your day or evening special. See the city from a lovely antique horse carriage ride. Noble Horse Carriages are available at 2 locations: Michigan Avenue: 820 N. Michigan Avenue, the corner of Michigan Avenue and Chicago Avenue and Old Town: 1410 N. Orleans Street, the corner of Schiller and Orleans.
CITY: Chicago
Oney's Tree Farm
Enjoy a horse-drawn carriage ride to find your perfect Christmas tree and browse the gift shop.
CITY: Woodstock
Spring Valley Farm
Spring Valley Farm is home to Jersey cows, alpacas, sheep, Belgian horses, chickens and goats. Farm tours and hayrack rides by appointment only.
CITY: Fulton
Carriage Classics, Ltd.
This horse-drawn carriage service is available for scenic tours, weddings and other occasions. Equipped for all seasons. Evening rides in downtown Peoria Fridays and Saturdays during April through mid-October. Thursday through Saturday rides during June through August. Pick-up points at Hotel Pere Marquette and The Landing. $20 for two adults and $5 for each additional person. Children under 10 ride free. Carriage rides available 7 p.m. through midnight. May be hired any time of the year for service in the Peoria and surrounding area. We also have a horse-drawn trolley available for special groups outings. Call for details!!!
CITY: Chillicothe
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"Bilbao are capable of beating anyone"
Atheltic Bilbao forward Gaizka Toquero sent a warning to the last eight sides in the Europa League after seeing his side win twice against Manchester United.
The Spanish side did not look like they were a team currently seventh in the standings in the La Liga.
They took on Manchester United, much to the surprise of many watching the game, and repeatedly unlocked the Mancunian defence that has conceded less than a goal per game after 28 matches in the Premier League.
Coach Marcelo Bielsa has earned plaudits for his tactical awareness as he played a high-pressing game and exploited weaknesses in United's strategy. Not only were they able to score three goals at Old Trafford last week, the Argentinean masterminded a 2-1 victory in Bilbao on Thursday night with Wayne Rooney's goal for United coming late in the game when the result was a foregone conclusion.
The Red Devils' custodian David De Gea congratulated his opponents calling them a "superior side" and wishing that Athletic "go all the way to the final".
Toquero was in an equally bullish mood and believes that Bilbao have what it takes to beat anyone in the competition after conquering the current Premier League leaders.
He told UEFA.com: "Manchester United will always be Manchester United but this time we deserved our result and we deserved to get through.
"Let's see who we get in the draw but whoever it may be the important thing is that we continue along the path we are on now.
"We don't care who we get because we know we are capable of beating anyone.
"We've shown that tonight [Thursday]."
He also said that his team performed so well because they had taken nothing for granted before the game.
"We went out there tonight to have possession of the ball and to win.
"We didn't want to mull over the result of the first leg so we decided to go for it and it paid off thanks to a lot of hard work, dedication and a little luck.
"We created a lot of chances in order to win.
"We did our job well."
Goalkeeper Gorka Iraizoz thanked the passionate support of the fans who he believed were crucial in inspiring the team to win against United.
"We played two fantastic legs and we were switched on from the outset of both games, as were our fans," he said.
"For our people, for our fans, this tournament is so important."
"We are so lucky to be able to plant hope within our supporters; that's like a gift to us.
"I hope in future I will get to compete in another tie like that."


text:
Rifle prison would be closed under budget cuts
Its small size, remote location and challenges in hiring and keeping staff led to a proposal Tuesday to close the Rifle Correctional Facility to help the state deal with a budget…
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My specialty is cinematic music for tv & film. I have been inspired by composers such as Thomas Newman, Rachel Portman, Ludovico Einaudi, Max Richter and Dustin O'Halloran.
When you purchase a track from me, it will ALWAYS include a high-quality WAV and MP3. If you have any problems or questions, please use the contact form here and I will help you right away.
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"Ideas In Motion" is a modern and fresh track which opens up with marimbas and is later joined by strings. It has a bit of a Thomas Newman feel to it (think American Beauty), and would be well suited for any cinematic film productions, intros, end credits, corporate projects, Youtube videos and montages, television advertisements and more.


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Reno >Restaurants >
Pizza >Pierino's Ristorante-Pizzeria
575 Keystone Ave, Reno, NV | Directions 8950339.528569 -119.829304
Neighborhoods: West University
Great Pizza is about all you get from this place!! – My boyfriend and i have a love for pizza, who doesn't? We discovered that this place does "take n bakes" and tried it out...loved it!! Everything is so fresh, homemade sausage and the dough is just great! We decided to try it out for dinner one night and that's where the disappointment came. We had so many different servers to start. It's great to be right on top of things but i couldn't keep up with how many people were actually working there! As far as the food goes, i say it's nothing to write home about unfortunately. I had the fettucine alfredo with grilled chicken, something was just off about it. Very very bland. I've never ever put salt on any pasta dish let alone alfredo but a little salt was the only thing the helped bring out any flavor. We felt it was over priced for the quality of food. We'll continue to get their pizza, but it was a turn off for dining. We're fans of La Famiglia!
Great most of the time – I have eaten at the restaurant on numerous occassions with a group of people. The service is great, the staff are friendly and for the most part everyone in our party has enjoyed the food. On one occassion I ordered chicken that was overdone and hard to eat, but I did not send it back as I should of so I don't know how this would have been handeled. The roll are great and the entree's are varied and well portioned. Although some people have said to stay away from this neighborhood, I fail to understand why there is a problem. Located in a non-descript strip mall, I have not felt unsafe at any time.
Mouth Watering Italian Food – If you are looking for mouth watering Italian food, this is the place to be. Large selection of pasta, pizza and calzones with approx a dozen of sauces to choose from, generous portions, awsome bread. The service was outstanding.
Pierinos Italian Restaraunt -WHAT A RIP OFF please READ!!!!!!!!!!! – I went to Pierinos Italian Restaraunt in Keystone and the Raleys Plaza for take out food. This was my first time there so I ordered the spaghetti and meatballs. I sat at the bar for 20 minutes before I was approached by a waiter to take my order. I had enough time to look at the ambiance, or there lack of. They have a bottle of veuve clique cloe champagne on the a shelf, which they don't carry. What a tease. The TV is on the other side of the bar in the back where you cannot see it and there was only one wine menu on the bar which the owner kept trying to take back. Once my order was taken it took another 45 to get my spaghetti. I checked my order and it turned out to be wrong, so the owner sent it back. It came out 15 minutes later. He charged me $19.84. I tipped $2.00. I got home, the meatballs were raw, the spaghetti was over cooked and all I can say is unless you are a marter I suggest you stay away from this place. For less money, better service and excellent food I suggest Johnny's Ristorante Italiano, or La Famiglia, bother of which are excellent and actually care about their customers and the food they serve.
This place makes Olive Garden look like the Taco Bell of Italian cuisine and they do it affordably! – My father-in-law took a chance on this restaurant one night and it paid off big time! It is in a bad location in a strip mall that kind of shrouds it's location. Once inside though you forget you in downtown and are whisked away to Italy. No wait to be seated; even on a weekend. That 's why I consider this place a local secret and a bit of a "diamond in the rough". I have lived in Italy for 3 years and have loved the food ever since. It is hard to find authentic-tasting Italian anywhere. This place makes Olive Garden look like the Taco Bell of Italian cuisine. The menus variety was large and mouth-watering. We each tried a different dish and we loved each one of them. The atmosphere was romantic. The prices were a little more than Olive Garden, but WAY worth it. I can't wait to go back again!
SparksMike – This is the best Italian food in Reno. Try almost anything on the menu and you won't be disappointed! Chicken dishes to die for! Don't miss the Tiramisu.
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Wednesday, April 23, 2014
By North Cairn firstname.lastname@example.com
Staff Writer
Humans are dumping so much carbon dioxide into the oceans so fast that seawater -- even in the Gulf of Maine -- is getting warmer and more acidic, according to marine and climate researchers.
Jeff Runge, professor of oceanography in the School of Marine Sciences at the University of Maine and a researcher at the Gulf of Maine Research Institute, examines plankton samples to test acidity in the ocean. "It's starting to be recognized as a serious issue. But it's very complex," he said.
Gabe Souza/Staff Photographer
Scientists aren't sure yet how the trend, which is believed to be tied to human-induced climate change, will affect ocean life in the gulf. But there is rising concern -- especially among fishermen -- that changes in the ocean ecosystem could severely damage some of the fisheries that are the backbone of the region's seafood industry.
The effects of warming and acidification are showing up all over the world, including in and along the gulf.
"We've seen levels of acid that rival some of the highest levels recorded anywhere," said professor of marine science Mark Green, whose work at St. Joseph's College in Standish has focused exclusively on ocean acidification. "Many coastal areas are increasing three times faster than open ocean."
Lobsters are up, cod down. The herring caught in the gulf are much smaller than they were 20 years ago, marine scientists have observed. Northern right whales might leave altogether if populations of plankton are reduced enough to affect the whales' food supply.
Ocean acidification is a long, slow process in which seas absorb excessive amounts of carbon dioxide, enough to alter pH levels (the percentage of hydrogen, which is a measure of acidity and alkalinity).
Global surface waters have an average pH of 8.1, according to the National Oceanic and Atmospheric Administration. But scientists believe that level could drop in the next 50 years to as low as 7.8, a huge change.
The impacts of increased carbon dioxide go far beyond making the water warmer and more acidic. Many species are weakened by the loss of oxygen and the spread of infectious diseases can speed up when water temperatures rise. Higher carbon dioxide levels in the ocean lead to an increase in carbonic acid, which reduces the availability of structural materials that mollusks and crustaceans need to form their shells.
The ranges of many species of sea life have been changed. Green crabs, for example, have moved in on shellfish beds in Maine from the more southerly waters they have traditionally inhabited.
"That's the really compelling story -- that there will be winners and losers," said Rick Wahle, research associate professor in the School of Marine Sciences at the University of Maine.
Absorption of carbon dioxide from the atmosphere into the ocean waters has increased to about 100 times what it was 600 years ago, Green said. On average, ocean carbon dioxide levels are up 30 percent, most of it absorbed in the past 50 years. Exacerbating the problem is runoff from rivers polluted by fertilizer and soil erosion, and millions of tons of untreated sewage pumped into coastal waters, including Casco Bay.
Debate swirls about which stressors are to blame for which consequences, but one fact is undeniable: Ocean temperatures are rising and the water is becoming more acidic. The increased carbon dioxide in air and water comes largely from the burning of fossil fuels and emissions from factories, cars and power plants, most scientists say.
Some of the early evidence has been revealed by testing of pH levels in costal seawater and the monitoring of water and air temperatures over the past 15 years or so.
"I consider it to be an issue that merits better understanding," said Jeff Runge, professor of oceanography in the School of Marine Sciences at the University of Maine and a researcher at the Gulf of Maine Research Institute in Portland.
"It's starting to be recognized as a serious issue," he said. "But it's very complex. We're just not doing a very good job yet in understanding the biological and ecosystem effects in the Gulf of Maine."
(Continued on page 2)
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Microwave Hyperthermia
Local deep microwave hyperthermia was evaluated. After treatment 61% were able to dispense with the catheter. The authors encourage further study to confirm their findings.
"Local Microwave Hyperthermia in The Treatment of Benign Prostatic Hypertrophy", Saranga, R., et al, British Journal of Urology, 1990;65:349-353.
Reviewed the available data on transurethral microwave thermotherapy in the treatment of patients with benign prostatic hyperplasia (BPH).
Transurethral microwave thermotherapy was designed to apply microwave energy deep within lateral prostatic lobes while simultaneously cooling the urethral mucosa, thus enabling an outpatient based anesthesia-free procedure. Lower energy protocols using the Prostraton device provide significant symptomatic improvement and improvement in maximum flow of approximately 35% over baseline.
Similar changes are being documented with other transurethral microwave thermotherapy devices. Higher energy protocols using the Prostatron device result in symptomatic improvement similar to that of lower energy protocols, while improvement in uroflowmetry is much more pronounced. However, the latter effect is achieved at the expense of increased morbidity. Second generation protocols have not yet been documented by users of the other thermotherapy devices.
Numerous studies unequivocally support the efficacy and safety of transurethral microwave thermotherapy for treatment of symptomatic BPH. Significant improvement in objective and subjective parameters has been realized with transurethral microwave thermotherapy at multiple centers in the United States and Europe.
de la Rosette JJ et al., Current status of thermotherapy of the prostate. J Urol, 1997 Feb, 157:2, 430-8.
Morphometry, or quantitative image analysis, offers great promise in characterizing the various histologic types of benign prostatic hyperplasia (BPH).
The prostate glands of 20 men with BPH were removed for low-volume carcinoma and subjected to a uniform, comprehensive, systematic quantification of the primary BPH tissue components using the technique of digitization and point-count morphometry.
We found the following average volumes among the 20 glands:
· epithelium, 19.9% (range 11.7% to 30.8%);
· fibromuscular stroma, 50.4% (range 32.2% to 74.4%);
· glandular lumina, 29.7% (range 11.9% to 47.5%).
Quantitative histologic differences between prostates, potentially important in clinical decision-making may be accurately diagnosed by morphometry of radially oriented biopsy specimens.
Marks LS et al., Morphometry of the prostate: I. Distribution of tissue components in hyperplastic glands. Urology, 1994 Oct, 44:4, 486-92.
Plant extracts
In Italy plant extracts represent 8.6% of all pharmacological prescriptions for Benign Prostatic Hyperplasia (data from 1991). This review evaluates all the suggested mechanisms of action for plant extracts. Recently we demonstrated an antiestrogenic effect of Serenoa Repens in BPH patients. Clinical trials with plant extracts have yielded conflicting results.
In a recent review by Dreikorn and Richter, only 5 placebo controlled studies were found. Moreover, as opposed to chemically defined drugs, it is possible that for these extracts the active ingredients are not known; consequently pharmacodynamic and pharmacokinetic data are often missing. The International Consultation of Benign Prostatic Hyperplasia (Paris, June 1991) concluded that, to date, phytotherapeutic agents must be considered as a symptomatic treatment. Now more adequate pharmacological and clinical studies, placebo controlled, should determine the exact role of these drugs in the treatment of BPH.
Di Silverio F et al., Plant extracts in BPH. Minerva Urol Nefrol. Dec 1993, 45 (4) p143-9.
Phytotherapeutic drugs
Phytotherapeutic preparations are still commonly used for the treatment of symptomatic benign prostate hyperplasia (BPH) in Germany; in recent years there has even been an increase in their use, so that sales now amount to more than DM 220 millions per year. The preparations most frequently used are extracts of Hypoxis rooperi, the roots of the stinging nettle, the fruits of the saw palmetto, pumpkin seeds and rye pollen.
Dreikorn K et al.,[Status of phytotherapeutic drugs in treatment of benign prostatic hyperplasia] Stellenwert von Phytotherapeutika bei der Behandlung der benignen Prostatahyperplasie (BPH). Urologe A. Mar 1995, 34 (2): 119-29.
Phytotherapeutic agents have enjoyed widespread use, especially in Europe, for the treatment of BPH. With the recent proliferation of nutrition and vitamin stores in the United States, use of these agents has greatly increased.
Lowe-FC & Ku-JC.: Phytotherapy in treatment of benign prostatic hyperplasia: a critical review. Urology. 1996 Jul; 48(1): 12-20.
Serenoa repens (Permixon) has been available for several years for the treatment of men with benign prostatic hyperplasia (BPH). The drug is the n-hexane lipidosterolic extract of the dwarf American palm (Serenoa repens) and is a complex mixture of various compounds.
In controlled clinical trials in men with BPH, oral administration of Serenoa repens 160 mg twice daily for 1 to 3 months was generally superior to placebo in improving subjective symptoms, such as dysuria, as well as objective parameters.
The frequency of nocturia was reduced by 33 to 74%, while urinary frequency during the day decreased by 11 to 43% and peak urinary flow rate increased by 26 to 50% with Serenoa repens. Corresponding values for placebo were 13 to 39%, 1 to 29% and 2 to 35%.
The only large comparative trial conducted to date, in which > 1000 men with moderate BPH were randomised to receive Serenoa repens 160 mg twice daily or finasteride 5 mg once daily for 6 months, demonstrated similar efficacy between the two drugs.
International Prostate Symptom Score improved by 37% with Serenoa repens compared with 39% with finasteride. In much smaller comparative trials, few significant differences were demonstrated between Serenoa repens and alpha 1-receptor antagonists, and larger randomised trials of adequate duration are required to better compare the clinical efficacy of these drugs.
The most frequently reported adverse events in clinical trials with Serenoa repens have been minor gastrointestinal problems (e.g. nausea and abdominal pain). In conclusion, Serenoa repens is well tolerated and has greater efficacy than placebo and similar efficacy to finasteride in improving symptoms in men with BPH. Although there is a need for further comparative studies, particularly with alpha 2-receptor antagonists, available data indicate that Serenoa repens is a useful alternative to alpha 1-receptor antagonists and finasteride in the treatment of men with BPH.
Plosker GL et al., Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia. Drugs Aging 9 (5): 379-395 (Nov 1996)
A randomized, double-blind and placebo-controlled clinical trial was conducted to assess the efficacy and safety of 130 mg free beta-sitosterol (phytosterol Azuprostat, a beta-sitosterol derived for example from species of Pinus, Picea or Hypoxis) daily, using the international prostate symptom score (IPSS) as the primary outcome variable.
There were significant improvements over placebo in those treated with beta-sitosterol.
Beta-sitosterol is an effective option in the treatment of BPH.
Klippel KF et al., A multicentric, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. German BPH-Phyto Study group. Br J Urol, 1997 Sep, 80:3, 427-32.
Prostate cancer
Examined the relationship between the intake of various carotenoids, retinol, fruits, and vegetables and the risk of prostate cancer.
Between 1986 and 1992, 812 new cases of prostate cancer, including 773 non-stage Al cases, were documented. Intakes of the carotenoids beta-carotene, alpha-carotene, lutein, and beta-cryptoxanthin were not associated with risk of non-stage Al prostate cancer; only Lycopene intake was related to lower risk. Of 46 vegetables and fruits or related products, four were significantly associated with lower prostate cancer risk; of the four--tomato sauce, tomatoes, and pizza, but not strawberries--were primary sources of lycopene.
Combined intake of tomatoes, tomato sauce, tomato juice, and pizza (which accounted for 82% of lycopene intake) was inversely associated with risk of prostate cancer, for consumption frequency greater than 1 0 versus less than 1. 5 servings per week.
Findings suggest that intake of lycopene or other compounds in tomatoes may reduce prostate cancer risk, but other measured carotenoids are unrelated to risk.
Tomato-based foods may be especially beneficial regarding prostate cancer risk.
Giovannucci E et al: Intake of carotenoids and retinol in relation to risk of prostate cancer. J Natl Cancer Inst, 1995 Dec 6, 87:23, 1767-76.
Clinical syndrome
The clinical syndrome of benign prostatic hyperplasia reflects a complex interplay between benign prostatic enlargement, which will affect almost all men by the age of 80, and the resulting outlet obstruction and lower urinary tract symptoms.
The disease is now known to adversely affect the quality of life of around one man in three over the age of 50.
New medical treatments and new surgical interventions are challenging the previous standard treatment of transurethral resection of prostate, which continues to have a morbidity of 17% and some mortality.
Primary care will be increasingly involved in shared care with particular emphasis on monitoring of patients on watchful waiting medical therapy- and following operative intervention.
Simpson RJ: Benign prostatic hyperplasia. Br J Gen Pract, 1997 Apr, 47:417, 235-40.
Current management
Current Management
General practice
Medical Management
Primary Care (2)
Current Management
To define the spectrum of urological care for benign prostatic hyperplasia (BPH) and clinically localized prostate cancer.
In 1995 a random sample of 394 American urologists was surveyed with a response rate of 67%.
Respondents reported seeing a median of 240 BPH patients during the preceding 12 months, and they had prescribed alpha-blockers for 70 and finasteride for 15. They had performed a median of 25 transurethral prostatectomies but few other operations for BPH.
Almost all urologists routinely used digital rectal examinations and prostate specific antigen tests for BPH diagnosis. The next most common studies were American Urological Association symptom scores and uroflowmetry.
Pressure-flow studies were rarely done. Respondents reported seeing a median of 35 new patients with prostate cancer during the last year, and performing a median of 90 prostate biopsies and 13 radical prostatectomies. Respondents had referred a median of 10 patients for external beam radiotherapy but few patients received brachytherapy or cryotherapy. Urologist staging practices varied considerably.
These data provide a picture of current practice regarding the management of BPH and prostate cancer.
Barry MJ et al., A nationwide survey of practicing urologists: current management of benign prostatic hyperplasia and clinically localized prostate cancer. J Urol, 1997 Aug, 158:2, 488-91; discussion 492.
General practice - Holland
Estimated the seriousness and inconvenience of prostatism in a general practice population and to assess the consultation with the general practitioner (GP) in relation to seriousness of prostatism.
The prevalence of prostatism with moderate to severe symptoms was 20%. The majority (60%) of the men with prostatism did not consult their GP with these symptoms, and one fifth (19%) felt "mostly dissatisfied" to "terrible" due to their symptoms.
Of this last group, a few (1.4% of the total population) nevertheless did not consult their GP.
Prostatism is a symptom complex caused not only by benign prostate hyperplasia. Prostatism is under-reported in general practice. Men with micturition problems should be encouraged to consult their practitioner.
Wille-Gussenhoven MJ et al., Prostate symptoms in general practice: seriousness and inconvenience. Scand J Prim Health Care, 1997 Mar, 15:1, 39-42.
Benign prostatic hyperplasia (BPH) is a common cause of morbidity among older men. Primary care physicians need to develop expertise in its management. The causes of BPH are unknown; aging and the presence of male androgens are the dominant risk factors. Obtaining a medical history is a key step in assessing whether lower urinary tract symptoms are due to BPH or to some other process. A reliable and valid seven-item questionnaire has been developed to objectively assess symptom severity. A focused physical examination including a digital rectal exam should be performed, as well as a urinalysis and serum creatinine. Optional tests include uroflowmetry, post-void residual urine, and prostate-specific antigen measurements. BPH is treated primarily to improve the quality, rather than increase the quantity, of life. Optimal decisions about treatment are best made by a clinician and an informed patient working together.
Barry M & Roehrborn C: Management of benign prostatic hyperplasia. Annu Rev Med, 1997, 48:, 177-89.
Medical management
The ageing population is presenting an increasing demand on future healthcare services. In males, prostatic disease is one of the commonest disorders contributing to this.
Alternatives to surgical intervention have to be considered as the preferred option for individuals and whether this be a therapeutic or a financial option to be taken.
Two major medical alternatives are alpha-blockers and 5-alpha reductase inhibitors. The results of such treatment can be very beneficial in selected groups of patients. Side-effects with improved drugs electivity are reducing.
Overall, while surgery still holds the gold standard, medical therapy has a significant role in the treatment of benign prostatic hypertrophy. Cost analysis may be a factor in deciding which treatment to have.
McDermott T: Optimising the medical management of benign prostatic hyperplasia. Br J Clin Pract, 1997 Mar, 51:2, 116-8.
Primary Care
Although patients with prostate disorders are frequently referred to urologists for diagnosis and management, primary care physicians (PCPs) are beginning to take a more active role. However, there is concern that PCPs are not optimally educated in the diagnosis and management of these disorders.
A 10-question survey determined PCP practice patterns in evaluating and treating benign prostatic hyperplasia (BPH) and screening for prostate cancer.
Most PCPs (89%) indicated that up to 30% of their patients have symptomatic BPH, and a significant proportion of these are treated initially by the PCP. Although 61% of PCPs are aware of the American Urological Association (AUA) symptom score and its recommended role in clinical practice guidelines, only 38% currently use it.
The most popular BPH therapies are long-acting alpha blockers and watchful waiting. DRE is performed routinely by 84% of PCPs in men > 50 years, and annual serum prostate-specific antigen is routinely requested by 69% of PCPs.
Although PCPs play an increasing role in the diagnosis and management of prostate disorders, they are not taking full advantage of published clinical practice guidelines.
Fawzy A Practice patterns among primary care physicians in benign prostatic hyperplasia and prostate cancer. Fam Med, 1997 May, 29:5, 321-5.
Primary care (2)
Defined primary care physicians' (PCPs) practices in managing patients with benign prostatic hyperplasia [BPH], and to compare these practices to portions of the Agency for Health Care Policy and Research BPH guideline and urologists' practices. (A Mail survey.)
Primary care physicians (n = 444, response = 51%) reported seeing a median of 35 patients with BPH over the preceding year, in contrast to 240 for urologists (n = 394, response = 68%).
Regarding tests recommended by the guideline, two thirds of PCPs reported rarely or never using the American Urological Association (AUA) symptom index, nearly all reported routinely performing digital rectal examinations, and many (66%) reported routinely ordering tests to determine the serum creatinine level.
Although considered "optional" by the guideline, more than 90% of PCPs reported routinely ordering a prostate-specific antigen test, while infrequently using other optional tests. Regarding "not recommended" studies, a substantial minority reported selectively or routinely ordering intravenous pyelography (34%) and renal ultrasound (33%), while two thirds reported rarely or never ordering these tests. 86% of PCPs reported prescribing medications for BPH over the preceding year; alpha blockers to a median of 12 patients, and finasteride to a median of 2. Variation in urology referral thresholds was suggested in responses to two patient scenarios.
Primary care physicians are actively managing patients with BPH. Some of their diagnostic evaluations vary from the recommendations of a national guideline and urologists' practices. Referral thresholds appear to vary considerably.
Collins MM et al., Diagnosis and treatment of benign prostatic hyperplasia. Practice patterns of primary care physicians. J Gen Intern Med, 1997 Apr, 12:4, 224-9.
Treatment guidelines
Adherence to AHCPR guidelines
Non-instrumental treatment
Treatment guidelines (Pharmacology)
Treatment options
Adherence to AHCPR guidelines
Determined adherence rates to guideline recommendations for the diagnosis and treatment of benign prostatic hyperplasia published and distributed by the Agency for Health Care Policy and Research in 1994.
Assessed reliability and validity and determined results for each of the following measures of care:
1) documentation of indications for a transurethral resection of the prostate;
2) documentation of appropriate preoperative assessment;
3) documentation of indications for an inpatient excretory urogram (IVP) and/or sonogram when the procedures were performed and
4) documentation of surgical time and grams of tissue removed. Adherence rates for all measures of care were determined.
Adherence to selected Agency for Health Care Policy and Research guideline recommendations is documented infrequently in the medical record.
Hood HM et al., Adherence to Agency for Health Care Policy and Research guidelines for benign prostatic hyperplasia. J Urol, 1997 Oct, 158:4, 1417-21.
To critique the US Department of Health and Human Services Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline on Benign Prostatic Hyperplasia: Diagnosis and Treatment; and to provide an update on management and treatment of benign prostatic hyperplasia (BPH) since the Guideline was published.
Management of BPH is directed at ameliorating voiding symptoms. For moderate or severe BPH, medical or surgical therapy should be offered to the majority of patients. Medical therapy options include alpha-adrenergic antagonists and finasteride. The former offer the advantage of a more prompt onset of action (within weeks) when compared with finasteride. Finasteride produces a lower response rate and smaller improvement in voiding symptoms. Combination therapy of terazosin and finasteride has not been proven to be more effective than terazosin monotherapy.
When medical therapy is indicated for moderate or severe BPH, alpha-adrenergic antagonists exhibit a faster onset of action and produce greater improvement of voiding symptoms than does finasteride.
Lee M & Sharifi R: Benign prostatic hyperplasia: diagnosis and treatment guideline. Ann Pharmacother, 1997 Apr, 31:4, 481-6.
Non-instrumental treatment
Review the clinical effects in benign prostatic hyperplasia (BPH) patients that can be achieved with the presently available medical treatment options.
Classes of drugs include: 5-alpha-reductase inhibitors, alpha-blockers, cholesterol-lowering agents and phytotherapeutic drugs.
Taking into account that the symptomatic and the flow rate improvements achieved are below the level of perception in most of these trials, there seems to be no convincing evidence that medical treatment of BPH with the presently available drugs is also clinically more effective than placebo.
Ruud Bosch JL: Conservative non-instrumental treatment of benign prostatic hyperplasia. Urol Res, 1997, 25 Suppl 2:, S107-14.
Treatment guidelines (Pharmacology)
Symptomatic benign prostatic hyperplasia (BPH) is a common condition in older men and has a significant impact on their daily lives. Transurethral resection of the prostate (TURP) or open prostatectomy are currently the most effective therapies for BPH. TURP is, however, associated with clinically significant adverse events in 20% of patients. Therefore, patients who need treatment for BPH based on the presence of symptoms should also be offered other therapy options.
Transurethral incision of the prostate is an effective therapy with minimal adverse effects in patients with a prostate not larger than 30 g. Minimally invasive procedures, such as electrovaporisation, laser prostatectomy, transurethral needle ablation, high intensity focused ultrasound, transurethral microwave therapy and insertion of prostatic stents, can be performed instead of the standard surgical procedures. They are either performed as outpatient procedures or are associated with shorter durations of hospitalisation than TURP; in addition, they can also be performed in high risk patients.
The efficacy of these procedures lies between that of TURP and medical therapy. Medical therapy is becoming increasingly important in the treatment of patients with moderate symptoms of BPH. Both androgen-suppressing therapy and alpha-adrenoceptor blockade are well tolerated and effective modalities. Compared with placebo, both types of therapy produce improvements in maximum urinary flat rate and reductions in symptom scores of 15 to 20%.
Finasteride, a potent 5 alpha-reductase inhibitor, must be given for 6 months before it effectiveness in a given patient can be assessed, and for at least 12 months to achieve maximum prostate shrinkage and the full extent of its other beneficial effects. This may be perceived as a disadvantage when compared with the rapid relief afforded by surgery or alpha-blockade. The efficacy of finasteride is also dependent on prostate size; it should not be tried in patients with a prostate volume of < 40 ml. On the other hand, finasteride may reverse the progression of the disease process.
Of the alpha 1-adrenoceptor antagonists, terazosin, doxazosin and tamsulosin can be administered once daily. In contrast, prazosin, alfuzosin and indoramin must be administered twice daily, which may have a negative impact on patient compliance. Because of its specificity for alpha 1A-receptors, no dosage titration is needed when tamsulosin is used; in addition, in contrast with the other alpha-blockers used in BPH, tamsulosin lacks significant effects on blood pressure. On the other hand, nonselective alpha-blockers are preferable in hypertensive patients with BPH.
The final decision about the best treatment for a particular patient must take into account the patient's preference after he has been informed of the different options.
Tammela T: Benign prostatic hyperplasia. Practical treatment guidelines. Drugs Aging, 1997 May, 10:5, 349-66.
Treatment options
To examine current treatment options for benign prostatic hyperplasia with emphasis on randomized, clinical trials and our current management approach.
Benign prostatic hyperplasia remains difficult to define clinically or measure objectively. As a result, research has been fairly weak. With newer treatments, however, more definitive studies have been reported.
Transurethral resection of the prostate remains the criterion standard for severe disease. Watchful waiting, medical management, or early surgical intervention are all valid options for moderate disease and should be tailored to the characteristics and desires of individual patients. Recent minimally invasive surgical techniques, such as microwave and laser surgery, have not yet achieved the quality of evidence to be generally recommended.
Management of benign prostatic hyperplasia should be individualized to patients' circumstances and personal choices.
Portis AJ & Mador DR: Treatment options for benign prostatic hyperplasia. Can Fam Physician, 1997 Aug, 43:, 1395-404.
Identified morphological parameters of benign prostatic hyperplastic inflammation that correlate with pre-biopsy prostate specific antigen (PSA) concentrations.
A total of 66 patients with exclusively benign prostatic tissue on prostate biopsies was analyzed. Difference between inflammation graded groups was not significant when considering serum or urinary PSA. There was a significant correlation between aggressiveness grading and serum PSA, whereas aggressiveness grading and urinary PSA did not correlate.
Prostatic subclinical inflammation is not associated with high urinary PSA. Unless associated with glandular epithelial disruption, density of prostatic interstitial inflammatory cell infiltrate is not significantly correlated with serum PSA concentration.
This issue should be considered when interpreting a prostate biopsy.
Irani J et al., Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value. J Urol, 1997 Apr, 157:4, 1301-3.
Latin America
Investigated the international differences in the reporting of lower urinary tract symptoms and related bother in patients with symptoms suggestive of bladder outlet obstruction.
Country of origin was significantly associated with the prevalence of a large number of lower urinary tract symptoms (10 of 20), even after adjusting for potentially confounding variables, including physical and socio-demographic factors. Country of origin was also significantly associated with the reporting of bother but for a much smaller number of symptoms.
In different countries lower urinary tract symptoms may be reported to different extents. Therefore, the results of studies in particular countries may not be generally applicable to other countries. It is likely that symptom scores will conceal this variation, necessitating consideration of individual symptoms (as in the International Continence Society "benign prostatic hyperplasia" study) or the development of country specific scoring systems.
An alternative would be to focus on bother, which appeared to be much less sensitive to international differences.
Witjes WP et al., The International Continence Society "Benign Prostatic Hyperplasia" Study: international differences in lower urinary tract symptoms and related bother. J Urol, 1997 Apr, 157:4, 1295-300.
Latin America
OBJECTIVES: To determine the acceptance of the self-administered International Prostate Symptom Score (IPSS) by people of differing educational levels in two different countries.
The questionnaire adopted by the World Health Organization and known as the IPSS attempts to measure the severity of lower urinary tract symptoms in men with benign prostatic hyperplasia.
An international study was performed in Brazil and Argentina and included 768 patients. The IPSS was self-administered and used to evaluate and quantify the clinical symptoms resulting from benign prostatic hyperplasia.
A total of 40 (12.9%) men filled out the questionnaire incompletely, 31 (77.5%) in the lower-education subgroup and 9 (22.5%) in the higher-education subgroup. An incomplete questionnaire was more frequent among the patients with lower education.
In spite of the cultural variations, there was no significant difference in the number of patients unable to answer the questionnaire in the two countries.
Rodrigues Netto N Jr et al., Latin American study on patient acceptance of the International Prostate Symptom Score (IPSS) in the evaluation of symptomatic benign prostatic hyperplasia. Urology, 1997 Jan, 49:1, 46-9.
The International Continence Society Benign Prostatic Hyperplasia Study (ICS-BPH) was devised in response to the perceived underutilization of urodynamics in the diagnosis of benign prostatic obstruction (BPO), together with the apparent reliance on symptoms alone when selecting patients for invasive therapies, despite evidence that lower urinary tract symptoms (LUTS) had poor diagnostic specificity for BPO.
The ICS-BPH Study is an international multicenter study employing a wide-ranging patient-completed questionnaire, with questions on symptoms, bothersomeness, quality of life, and sexual function.
In addition, each patient underwent multiple urine flow studies and standardized urodynamic investigations (phase I). Phase II was an observational assessment of outcome following a range of treatments: conservative, medical, and surgical. Phase III included data from randomized controlled trials involving a wide range of therapies.
Patients (# 1,271mean age, 66 years) were included in phase I from 12 countries: 18% of patients were unobstructed, 22% mildly obstructed, and 60% obstructed on pressure flow studies; 83% of patients performed at least two flow studies.
The ICS-BPH Study will allow definitive statements to be made concerning the diagnostic potential of a wide range of LUTS, and will define the place of urine flow studies, describe patients who will need pressure flow studies prior to invasive treatment, and identify those likely to experience an adverse outcome. Although an aim of the study is to produce a diagnostic symptom score, there is considerable doubt as to whether this can be achieved where aging and a variety of lower urinary tract dysfunctions often coexist.
Witjes WP et al., The International Continence Society "Benign Prostatic Hyperplasia" Study: international differences in lower urinary tract symptoms and related bother. J Urol, 1997 Apr, 157:4, 1295-300.
Elderly men
BPH is an age-related condition that can give rise to urinary symptoms.
A range of effective treatments is available, and although there are certain absolute indications for surgery, patients with moderate or severe symptoms require counseling to reach a decision on the treatment modality most appropriate for them.
Concomitant age-related disease and use of multiple medications add to the complexity of treating elderly men for BPH.
In every case of BPH, the risks of each treatment option should be weighted against the potential benefits and a joint decision reached by physician and patient.
Guthrie R: Benign prostatic hyperplasia in elderly men. What are the special issues in treatment? Postgrad Med, 1997 May, 101:5, 141-3, 148, 151-4 passim.
Older men
Medical therapy with alpha 1-adrenergic blockers or 5 alpha-reductase inhibitors offers an alternative to the traditional choices of watchful waiting and surgery.
Patients with obstructive symptoms and a small prostate appear to respond to treatment with an alpha 1-adrenergic blocker, while a 5 alpha-reductase inhibitor may be the preferred agent for a large gland.
Albertsen PC: Prostate disease in older men: 1. Benign hyperplasia. Hosp Pract (Off Ed), 1997 May 15, 32:5, 61-4, 67-8, 77 passim.
Men with moderate symptoms of benign prostatic hyperplasia (BPH) are the best candidates for medical treatment, while surgery is usually indicated for patients with severe symptoms. Men with mild symptoms do not usually need treatment, but they might be re-evaluated annually if desirable.
Finasteride, which produces selective hormonal deprivation, is now established as a well tolerated drug for the long term medical therapy of BPH. Recent studies suggest that finasteride is most effective in men with large prostates (> 40 ml), and the drug should probably be reserved for these patients.
alpha-Blockers work in men with small or large prostates, and their rapid onset of action facilitates the identification of responders. alpha-Blockers are more effective than finasteride during the first year of treatment, but only finasteride induces regression of the prostate and offers increased efficacy over time.
Even if drug therapy reduces the need for prostate surgery, the total economic cost of BPH treatment is likely to rise because of the increasing application of medical treatment. The magnitude of this increase depends largely on what percentage of the male population embark on long term therapy, at what age treatment is started, and how successful it is. At present, the answers to these questions are largely unknown. The personal economic expenses for men who begin long term medical therapy will probably be an important factor in deciding how common drug treatment for BPH will become in the future.
For many men, the main benefit of drug treatment will be the relief of urinary symptoms, but whether this improvement is substantial enough to improve their overall quality of life has not yet been clearly demonstrated in controlled studies.
Eri LM & Tveter KJ: Treatment of benign prostatic hyperplasia. A pharmacoeconomic perspective. Drugs Aging, 1997 Feb, 10:2, 107-18.
Prostate cancer is one of the commonest tumours of adult males. It shows a range of biological behaviour: many tumours are discovered incidentally; others will kill by producing widespread metastatic disease.
Despite the fact that radiation is frequently used in the treatment of a range of pelvic lesions, including adenocarcinoma of the prostate itself, studies on the morphological changes in the normal prostate gland after irradiation are limited.
Patients often suffer from lower urinary tract symptoms such as frequency and dysuria and it is possible that these may be related to prostatic and/or periprostatic injury pelvic following irradiation.
Investigated the prostate glands removed at cystoprostatectomy for transitional cell carcinomas of the bladder which had received radiotherapy pre-operatively. The changes were compared to control prostatic tissue from transurethral resection specimens for benign myoadenomatous hyperplasia.
A range of inflammatory, fibrotic and reactive cytological features, including many of the changes seen in benign hyperplasia, but these were significantly more exaggerated in the post-radiation group. In addition intraprostatic vascular and neural changes were prominent.
Sheaff MT & Baithun SI: Effects of radiation on the normal prostate gland. Histopathology, 1997 Apr, 30:4, 341-8.
Sex steroids
Sex steroids
Human benign prostatic epithelial cells contain functional melatonin receptors that can suppress cell growth and viability. The development of benign prostatic hyperplasia in men is assumed to result from androgen-estrogen imbalance. Investigated the impact of sex steroids on melatonin receptors in human benign prostate epithelial cells.
Data indicate that:
1) DHT and E2 enhance prostate epithelial cells growth, but reduce cell growth when combined;
2) DHT extenuates the inhibitory effects of melatonin on epithelial cell growth; and
3) E2 acts to inactivate melatonin receptors and consequently responses in human epithelial benign prostatic hyperplasia cells.
This process is probably mediated by protein kinase C. Together, these results show an interplay between melatonin and sex steroids in the regulation of benign prostatic epithelial cell growth.
Gilad E et al., Interplay between sex steroids and melatonin in regulation of human benign prostate epithelial cell growth. J Clin Endocrinol Metab, 1997 Aug, 82:8, 2535-41.
Sex steroids
It has long been suspected that sex steroids play a key role in the pathogenesis of benign prostatic hyperplasia (BPH).
Prostatic diseases do not occur in males castrated before puberty or in males with heritable disorders of androgen production or action. Both estrogens and androgens have been shown to induce BPH in experimental animals.
Both the GnRH agonists and finasteride result in prostatic size reduction and alleviate symptoms in some patients. Both therapies are more effective in men with larger prostates (> 40 cc). Finasteride is less efficacious in terms of size reduction than the GnRH agonists but also has fewer side effects.
To date, clinical trials with aromatase inhibitors have not yielded dramatic positive results in the treatment of BPH.
Levine AC et al., The role of sex steroids in the pathogenesis and maintenance of benign prostatic hyperplasia. Mt Sinai J Med, 1997 Jan, 64:1, 20-5.
Investigated the association between cigarette smoking and sex hormone concentrations in men with benign prostatic hyperplasia (BPH) and thus provide some understanding of the underlying mechanism of the effects of cigarette smoking on prostatic enlargement.
The mean prostate volume was greater in non-smokers than smokers. Current cigarette smokers had significantly higher mean serum oestradiol levels than did the non-smokers (33.8 and 26.7 pg/mL, respectively).
Cigarette smoking was inversely but not significantly related to testosterone level.
These differences persisted after adjusting for body mass index. There was no significant difference in serum DHEA and DHEA-S levels between smokers and non-smokers.
There was a weak correlation between the degree of prostatic enlargement, the presence of obstructive symptoms and urinary flow rates.
These results indicate that cigarette smoking may affect the size of the enlarging prostate, but through indirect effects of smoking on factors provoking the development of BPH.
K?peli B et al., The role of cigarette smoking in prostatic enlargement. Br J Urol, 1997 Aug, 80:2, 201-4.
Cigarette Smoking
Investigated the association between cigarette smoking and sex hormone concentrations in men with benign prostatic hyperplasia (BPH) and thus provide some understanding of the underlying mechanism of the effects of cigarette smoking on prostatic enlargement.
The mean prostate volume was greater in non-smokers than smokers. Current cigarette smokers had significantly higher mean serum oestradiol levels than did the non-smokers (33.8 and 26.7 pg/mL, respectively).
Cigarette smoking was inversely but not significantly related to testosterone level.
These differences persisted after adjusting for body mass index. There was no significant difference in serum DHEA and DHEA-S levels between smokers and non-smokers.
There was a weak correlation between the degree of prostatic enlargement, the presence of obstructive symptoms and urinary flow rates.
These results indicate that cigarette smoking may affect the size of the enlarging prostate, but through indirect effects of smoking on factors provoking the development of BPH.
K?peli B et al., The role of cigarette smoking in prostatic enlargement. Br J Urol, 1997 Aug, 80:2, 201-4.
Symptom Index
To quantify the relative effects of age and ultrasonic appearance of benign prostatic hyperplasia (BPH) on urinary symptoms as evaluated by the American Urological Association (AUA) symptom index score.
Among 7 symptoms included in the AUA symptom index weak stream and hesitancy scores were not influenced by age, prostatic volume or presumed circle area ratio.
As a parameter representing the degree of BPH in terms of the severity of urinary symptoms, presumed circle area ratio was preferable to prostatic volume. Regression analyses confirmed again that the AUA symptom index was influenced considerably by age and was not specific to BPH.
Kojima M et al., The American Urological Association symptom index for benign prostatic hyperplasia as a function of age, volume and ultrasonic appearance of the prostate. J Urol, 1997 Jun, 157:6, 2160-5.
Quality of Lifestyle
Quality of life
Quality of life
Studies in disease specific populations have emphasized disease specific quality of life with little study of general quality of life.
To model the emotional component of general quality of life in patients with prostate disease.
Neural networks created reasonably good models of the emotional component of general quality of life.
All models of general quality of life relied primarily on disease nonspecific inputs, including social support, activities of daily living and coping.
Efforts to optimize general quality of life in patients with prostate disease must integrate disease nonspecific variables.
Krongrad A et al., Predictors of general quality of life in patients with benign prostate hyperplasia or prostate cancer. J Urol, 1997 Feb, 157:2, 534-8.
Benign prostatic hyperplasia (BPH) and its treatment can impair the quality of life (QoL) of patients with the condition. Among the BPH-specific instruments (89-item questionnaire) available for assessing QoL, no consensus has emerged on the concepts that should be measured, particularly for aspects of sexual life.
To determine which aspects of QoL were most affected by prostatic symptoms and which patients considered the most important.
Aspects reported to be most affected and to be the most important were: sleep, anxiety and worry about the disease, mobility, leisure, daily activities, sexual activities and satisfaction with sexual relationships. French patients considered all sexual aspects of life more important than English patients.
Assessment of sexual functioning and behavior must be included in any further evaluations of BPH treatments effects on QoL.
Calais Da Silva F et al., Relative importance of sexuality and quality of life in patients with prostatic symptoms. Results of an international study. Eur Urol, 1997, 31:3, 272-80.
Natural history
Defined outcomes for men with a clinical diagnosis of benign prostatic hyperplasia.
Candidates (#500 ) were followed over 4 years for elective prostatectomy treated nonoperatively in 5 North American urology practices.
There were 371 survivors with complete data at 4 years.
Of 60 men with mild, 245 with moderate and 66 with severe baseline symptoms 10, 24 and 39%, respectively, had undergone surgery; 27, 31 and 27%, respectively, were on pharmacological therapy, and 63, 45 and 33%, respectively, were off active treatment at 4 years. Mild or moderate symptoms were noted at 4 years in 83, 59 and 23% of the patients, respectively, while 17, 41 and 77%, respectively, had severe symptoms or had undergone surgery.
Outcomes for men with a clinical diagnosis of benign prostatic hyperplasia depend on initial symptom severity. However, the course of symptoms also varies among patients even with the same initial symptom severity.
Barry MJ et al., The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. J Urol, 1997 Jan, 157:1, 10-4; discussion 14-5.
DHEA activation
An androgen receptor (AR) gene mutation identified in the androgen-dependent human prostate cancer xenograft, CWR22 an epithelial cell tumor, expresses a 9.6-kb AR mRNA similar in size to the AR mRNA in human benign prostatic hyperplasia.
With dihydrotestosterone at a near physiological concentration (0.01 nM), H874Y and wild type androgen receptor (AR) induced 2-fold greater luciferase activity than did the LNCaP mutant AR T877A. The adrenal androgen, dehydroepiandrosterone (10 and 100 nM) with H874Y stimulated a 3- to 8-fold greater response than with wild type AR and at 100 nM the response was similar with the LNCaP mutant
AR mutations that alter ligand specificity may influence tumor progression subsequent to androgen withdrawal by making the AR more responsive to adrenal androgens or antiandrogens.
Tan J et al., Dehydroepiandrosterone activates mutant androgen receptors expressed in the androgen-dependent human prostate cancer xenograft CWR22 and LNCaP cells. Mol Endocrinol, 1997 Apr, 11:4, 450-9.
Zinc & BPH
Zinc and magnesium
Studied serum levels of zinc and magnesium (before and after prazosin therapy [Minipress-Pfizer] 4 mg daily) in patients (#32 ) with benign prostatic hyperplasia (BPH).
Following cessation of therapy a slight increase in Zn levels was observed, i.e. from 100 to 103 micrograms/dl, whereas Mg levels did not change significantly (1.95 and 1.94 mg/dl, respectively).
In comparison with other organs, the human prostate is characterized by high Zn and Mg content. In BPH the Zn levels are increased. They are markedly decreased in carcinoma of the prostate and in prostatitis.
Zn and Mg play an important role as catalysts in various enzymatic reactions. It has been postulated that changes in concentrations of these two elements are parallel.
Zinc ions inhibit androgen metabolism in the prostate. Physiologic Zn serum levels are equal to or above 90 micrograms/dl.
Magnesium, unlike zinc, is uniformly distributed within different areas of the gland. In BPH, both normal and increased Mg levels in the prostate have been reported. Mg plays an important role as an activator of enzymes (phosphatases) involved in ATP metabolism, thus affecting both katabolic and anabolic processes.
Dutkiewicz S: Zinc and magnesium serum levels in patients with benign prostatic hyperplasia (BPH) before and after prazosin therapy. Mater Med Pol, 1995 Jan-Mar, 27:1, 15-7.
Diets high in butter, margarine or zinc may increase the risk of benign prostatic hyperplasia whereas diets high in fruit may reduce that risk. Over 400 patients with or without the prostate condition had lowered risk of benign prostatic hyperplasia among those who ate plenty of fruit. Diets high in butter, margarine and zinc had increased the risk. Thus, diets high in fruit consumption may prevent benign prostatic hyperplasia among men.
Lagiou P, Wuu J, Trichopoulou A, Hsieh CC, Adami HO, Trichopoulos D. Diet and benign prostatic hyperplasia: a study in Greece. Urology 1999 Aug;54(2):284-90.
Saw Palmetto and Stinging Nettle
Saw Palmetto and Stinging Nettle
Saw palmetto and stinging nettle are possible herbal remedies for benign prostatic hyperplasia, according to this study. Extracts of these plants have been subject to an increasing amount of studies that evaluate their mode of action and explicate their success in clinical trials. The most current studies tout the efficacy of these and other phytotherapeutics in the treatment of benign prostatic hyperplasia as well as advertise their favorable safety profile. Adding these medicinal herbs to the current therapeutic options of watchful waiting, changes of lifestyle, medical treatments, and invasive therapies may be helpful.
Koch E: Extracts from fruits of saw palmetto (Sabal serrulata) and roots of stinging nettle (Urtica dioica): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms, Planta Med 2001 Aug;67(6):489-500
Pygeum Extract
Pygeum extract
Pygeum africanum extract may help relieve the irritating symptoms of benign prostatic hyperplasia (BPH), according to this study. The authors reviewed studies from the Medline, EMBASE, Cochrane Library, and Phytodok databases that were randomized, included men with BPH, compared pygeum to placebo or other BPH medications, and included specific outcomes like urologic symptom scales, symptoms, or urodynamic measurements. Analysis of 18 studies involving a total of 1562 men found that many of the studies reported improvement in urologic symptoms and flow measures in men taking pygeum compared to those taking placebo. Those who took pygeum were more than twice as likely to report that their symptoms had been suppressed than those on placebo. Among the symptoms reduced were: nocturia (19%), residual urine volume (24%), and peak urine flow (23%). Overall, any adverse effects experienced by men taking pygeum were relatively mild and comparable to placebo. Larger and longer studies on the effectiveness of pygeum for BPH are needed.
Wilt T, Ishani A, MacDonald R, Rutks I, Stark G: Pygeum africanum for benign prostatic hyperplasia (Cochrane Review), Cochrane Database Syst Rev 2002;(1):CD001044
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That would not work, nor would it meet any code requirements. You will need a basin and pump system to pump the waste from the sink and laundry into the main line.
A washer must be drained to a laundry tray or a standpipe with an air gap. The fixtures must have proper P-traps.


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Our work to build healthy communities, families and individuals is at the heart of Mercy Corps' vision for social change. By partnering with a range of partners, from village health committees to government agencies, we help build the means to improve maternal, newborn and child health, ensure proper nutrition and combat infectious diseases.
All stories about Health
'Let's hope it won't take another earthquake to continue this work' December 10, 2010
It's the beginning of summer here in southern Chile. The weather is spectacular and everyone has something to be happy about. Schoolchildren look forward to the end of classes and the start of their long vacation.
Indonesia: Helping Indonesian mothers keep their babies healthy December 8, 2010
Indonesia: Cleaning up Kalideras November 12, 2010
In West Jakarta, the kampung (or community) of Kalideras had no choice but to go to the toilet in the ditches that led to the adjacent canal, or directly into the canal itself. But in 2009, Mercy Corps joined with local government and the community to help clean up.
Indonesia: Unbreakable November 10, 2010
Haiti: Using art as a vehicle to help Haiti November 8, 2010
Pakistan: Health clinics on wheels November 8, 2010
I met 25-year-old Sahiba and her two-year-old son Rehan while they were waiting patiently to see a doctor at one of Mercy Corps mobile health clinics in Sindh province. Rehan had a bad cough for several days, and his mother was alarmed.
Haiti: Haiti under red alert, Tomas likely to arrive as hurricane November 4, 2010
Today Mercy Corps' Haiti team continued to help ready camps and communities for the arrival of a possible hurricane tonight. Now, along with the Haitian government and other aid agencies, Mercy Corps is responding to three emergencies: earthquake, cholera and storm.
Pakistan: The chronicles of "Chlorine Baba" November 2, 2010
Munawar Abbass is serious about water. Munawar is a Mercy Corps water coordinator, and he supervises a compact but complex water-processing plant that is keeping 8,000 flood survivors alive. He's been at it for more than three months, first in the Swat Valley and now in Sindh Province.
Haiti: Tropical Storm Tomas headed toward Haiti November 1, 2010
Mercy Corps' water and sanitation team is out in Port-au-Prince camps today with two messages: how to prevent the spread of cholera, and how to prepare for tropical storm Tomas, which is currently headed toward Haiti and may strengthen into a hurricane at the end of the week.
West Bank and Gaza: Advocating for adoption of key psychosocial guidelines in Gaza October 30, 2010


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TWIN FALLS -- We're just 11 days from 7CARES Day and the KTVB Season of Hope is in full swing.
Larry Gebert and Doug Petcash made their way to the Magic Valley Tuesday for the Fred Meyer Toy Challenge.
The challenge is - in 90 seconds to get as many toys in their shopping carts as possible.
Our photojournalist Eric Turner shows us how Doug Petcash used a little "magic" to fill his cart.


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- Scroll down to the links under the heading "My Account."
- Click on either "Renew Your Items" or "Review Your Account."
- Click on the link "My Account."
- You will need both your library card number and your pin number. Your pin number was assigned when you were issued your card. If you don't know it please contact the library.
- Enter your library card number and your pin number in the fields displayed.
- Click on "display user information."
- The display will show a list of items checked out, their due dates, and an option to renew items.
- Select each individual item you wish to renew and then select the link titled "renew selected items."
- Renewals will not take place for items at their renewal limit or items that have been requested by other patrons.
By Phone (Requires library card, Personal Identification Number (PIN), and touchtone phone).
- Dial Toll Free (888) 672-8983.
- Enter library card number.
- Enter pin number.
- 1. to renew materials.
- 2. to list available holds ready for pickup.
- 3. to list materials checked out.
- 4. to list overdue materials.
- 5. for information concerning fines.
- 6. to change your pin.
- 8. to repeat this menu.
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Edited by: Michael Neal, Circulation Services Coordinator