text:
Down syndrome
Down syndrome | |
Classification and external resources | |
Boy with Down syndrome assembling a bookcase
DiseasesDB | 3898 |
MedlinePlus | 000997 |
eMedicine | ped/615 |
MeSH | D004314 |
Down syndrome (DS) or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21.[1] It is typically associated with physical growth delays, characteristic facial features and mild to moderate intellectual disability.[2] The average IQ of a young adult with Down syndrome is 50, equivalent to the mental age of an 8 or 9 year old child, but this varies widely.[3]
Down syndrome can be identified during pregnancy by prenatal screening followed by diagnostic testing, or after birth by direct observation and genetic testing. Since the introduction of screening, pregnancies with the diagnosis are often terminated.[4][5] Regular screening for health problems common in Down syndrome is recommended throughout the person's life.
Education and proper care has been shown to improve quality of life.[6] Some children with Down syndrome are educated in typical school classes while others require more specialized education.[7] Some individuals with Down syndrome graduate from high school and a few attend post-secondary education.[8] In adulthood about 20% in the United States do paid work in some capacity[9] with many requiring a sheltered work environment.[7] Support in financial and legal matters is often needed.[10] Life expectancy is around 50 to 60 years in the developed world with proper health care.[3][10]
Down syndrome is the most common chromosome abnormality in humans,[3] occurring in about 1 per 1000 babies born each year.[2] It is named after John Langdon Down, the British doctor who fully described the syndrome in 1866.[11] Some aspects of the condition were described earlier by Jean-Étienne Dominique Esquirol in 1838 and Édouard Séguin in 1844.[12] The genetic cause of Down syndrome—an extra copy of chromosome 21—was identified by French researchers in 1959.[11]
Signs and symptoms
Those with Down syndrome nearly always have physical and intellectual disabilities.[13] As adults their mental abilities are typically similar to that of an 8 or 9 year old.[3] They also typically have poor immune function[14] and generally reach developmental milestones at a later age.[10] They have an increased risk of a number of other health problems, including: congenital heart disease, leukemia, thyroid disorders, and mental illness, among others.[11]
Characteristics | Percentage | Characteristics | Percentage |
Mental impairment | 99%[15] | Abnormal teeth | 60%[16] |
Stunted growth | 90%[17] | Slanted eyes | 60%[14] |
Umbilical hernia | 90%[18] | Shortened hands | 60%[16] |
Increased skin back of neck | 80%[11] | Short neck | 60%[16] |
Low muscle tone | 80%[19] | Obstructive sleep apnea | 60%[11] |
Narrow roof of mouth | 76%[16] | Bent fifth finger tip | 57%[14] |
Flat head | 75%[14] | Brushfield spots in the iris | 56%[14] |
Flexible ligaments | 75%[14] | Single transverse palmar crease | 53%[14] |
Large tongue | 75%[19] | Protruding tongue | 47%[16] |
Abnormal outer ears | 70%[11] | Congenital heart disease | 40%[16] |
Flattened nose | 68%[14] | Strabismus | ~35%[2] |
Separation of 1st and 2nd toes | 68%[16] | Undescended testicles | 20%[20] |
People with Down syndrome may have some or all of the following physical characteristics: a small chin, slanted eyes, poor muscle tone, a flat nasal bridge, a single crease of the palm, and a protruding tongue due to a small mouth and large tongue.[19] These airway changes lead to obstructive sleep apnea in around half of those with Down syndrome.[11] Other common features include: a flat and wide face,[19] a short neck, excessive joint flexibility, extra space between big toe and second toe, abnormal patterns on the fingertips and short fingers.[16][19] Instability of the atlanto-axial joint occurs in approximately 20% and may lead to spinal cord injury in 1–2%.[3][10] Hip dislocations may occur without trauma in up to a third of people with Down syndrome.[11]
Growth in height is slower resulting in adults who tend to have short stature—the average height for men is 154 cm (5 feet 1 inch) and for women is 142 cm (4 feet 8 inches).[21] Individuals with Down syndrome are at increased risk for obesity as they age.[11] There are growth charts specifically for children with Down syndrome.[11]
Most individuals with Down syndrome have mild (IQ: 50–70) or moderate (IQ: 35–50) intellectual disability with some cases having severe (IQ: 20–35) difficulties.[2][22] Those with mosaic Down syndrome typically have IQ scores 10–30 points higher.[23] As they age people with Down syndrome typically perform less well compared to their same-age peers.[22][24] Some after 30 years of age may lose their ability to speak.[3] This syndrome causes about a third of cases of intellectual disability.[14] Many developmental milestones are delayed with the ability to crawl typically occurring around 8 months rather than 5 month and the ability to walk independently typically occurring around 21 months rather than 14 months.[25]
Commonly individuals with Down syndrome have better language understanding than ability to speak.[11][22] Between 10 and 45 percent have either a stutter or rapid and irregular speech, making it difficult to understand them.[26] They typically do fairly well with social skills.[11] Behavior problems are not generally as great an issue as in other syndromes associated with intellectual disability.[22] In children with Down syndrome mental illness occurs in nearly 30% with autism occurring in 5–10%.[10] People with Down syndrome experience a wide range of emotions.[27] While generally happy,[28] symptoms of depression and anxiety may develop in early adulthood.[3]
Children and adults with Down syndrome are at increased risk of epileptic seizures which occur in 5–10% of children and up to 50% of adults.[3] This includes an increased risk of a specific type of seizure called infantile spasms.[11] Many (15%) who live 40 years or longer develop dementia of the Alzheimer's type.[29] In those who reach 60 years of age, 50–70% have the disease.[3]
Hearing and vision disorders occur in more than half of people with Down syndrome.[11] Vision problems occur in 38 to 80%.[2] Between 20 and 50% have strabismus, in which the two eyes do not move together.[2] Cataracts (cloudiness of the len of the eye) occur in 15%,[10] and may be present at birth.[2] Keratoconus (a thin, cone-shaped corneas)[3] and glaucoma (increased eye pressure) are also more common,[2] as are refractive errors requiring glasses or contacts.[3] Brushfield spots (small white or grayish/brown spots on the outer part of the iris) are present in 38 to 85% of individuals.[2]
Hearing problems are found in 50–90% of children with Down syndrome.[30] This is often the result of otitis media with effusion which occurs in 50–70%[10] and chronic ear infections which occurs in 40 to 60%.[31] Ear infections often begin in the first year of life and are partly due to poor eustachian tube function.[32][33] Excessive ear wax can also cause hearing loss due to obstruction of the outer ear canal.[3] Even a mild degree of hearing loss can have negative consequences for speech, language understanding and academics.[2][33] Additionally, it is important to rule out hearing loss as a factor in social and cognitive deterioration.[34] Age-related hearing loss of the sensorineural type occurs at a much earlier age and affects 10–70%.[3]
The rate of congenital heart disease in newborns with Down syndrome is around 40%.[16] Of those with heart heart disease about 80% have an atrioventricular septal defect or ventricular septal defect.[3] Mitral valve problems become common as people age, even in those without heart problems at birth.[3] Other problems that may occur include: tetralogy of Fallot and patent ductus arteriosus.[32] People with Down syndrome have a lower risk of hardening of the arteries.[3]
Although the overall risk of cancer is not changed;[35] there is an increased risk of leukemia and testicular cancer and a reduced risk of solid cancers.[3] Solid cancers are believed to be less common due to increased expression of tumor suppressor genes present on chromosome 21.[36]
Cancers of the blood are 10 to 15 times more common in children with Down syndrome.[11] In particular, acute lymphoblastic leukemia is 20 times more common and the megakaryoblastic form of acute myelogenous leukemia is 500 times more common.[37] Transient myeloproliferative disease, a disorder of blood cell production that does not occur outside of Down syndrome, affects 3–10% of infants.[37][38] The disorder is typically not serious but occasionally can be.[38] It resolves most times without treatment; however, in those who have had it there is a 20 to 30 percent risk of developing acute lymphoblastic leukemia at a later time.[38]
Problems of the thyroid gland occur in 20–50% of individuals with Down syndrome.[3][11] Low thyroid is the most common form, occurring in almost half of all individuals.[3] Thyroid problems can be due to a poorly or non functioning thyroid at birth (known as congenital hypothyroidism) which occurs in 1%[10] or can develop later due to an attack on the thyroid by the immune system resulting in Graves disease or autoimmune hypothyroidism.[39] Type 1 diabetes mellitus is also more common.[3]
Constipation occurs in nearly half of people with Down syndrome and may result in changes in behavior.[11] One potential cause is Hirschsprung's disease, which is due to a lack of nerve cells controlling the colon, which occurs in 2 to 15%.[40] Other frequent congenital problems include: duodenal atresia, pyloric stenosis, Meckel diverticulum and imperforate anus.[32] Celiac disease affects about 7–20%[3][11] and gastroesophageal reflux disease is also more common.[32]
Males with Down syndrome usually do not father children, while females have lower rates of fertility relative those who are unaffected.[41] Fertility is estimated to be present in 30–50% of women.[42] Menopause typically occurs at an earlier age.[3] The poor fertility in men is thought to be due to problems with sperm development; however, it may also be related to not being sexually active.[41] As of 2006 there have been three recorded instances of males with Down syndrome fathering children and 26 cases of women having children.[41] Without assisted reproductive technologies, approximately half of the pregnancies of someone with Down syndrome will also have the syndrome.[41][43]
Down syndrome is caused by having three copies of the genes on chromosome 21, rather than the usual two.[1][44] The parents of the affected individual are typically genetically normal.[14] Those who have one child with Down syndrome have about a 1% risk of having a second child with the syndrome, if both parents are found to have normal karyotypes.[42]
The extra chromosome content can arise through several different ways. The most common cause (approximately 92–95% of cases) is a complete extra copy of chromosome 21, resulting in trisomy 21.[43][45] In 1 to 2.5% of cases, some of the cells in the body are normal and others have trisomy 21, known as mosaic Down syndrome.[42][46] The other common mechanisms that can give rise to Down syndrome include: a Robertsonian translocation, isochromosome, or ring chromosome. These contain additional material from chromosome 21 and occur in approximately 2.5% of cases.[11][42] An isochromosome results when the two long arms of a chromosome separate together rather than the long and short arm separating together during egg or sperm development.[43]
Trisomy 21
Trisomy 21 (also known by the karyotype 47,XX,+21 for females and 47,XY,+21 for males)[47] is caused by a failure of the 21st chromosome to separate during egg or sperm development.[43] As a result, a sperm or egg cell is produced with an extra copy of chromosome 21; this cell thus has 24 chromosomes. When combined with a normal cell from the other parent, the embryo and baby has 47 chromosomes, with three copies of chromosome 21.[1][43] About 88% of cases of trisomy 21 result from non separation of the chromosomes in the mother, 8% from non-separation in the father, and 3% after the egg and sperm have merged.[48]
The extra chromosome 21 material may also occur due to a Robertsonian translocation in 2–4% cases.[42][49] In this situation, the long arm of chromosome 21 is attached to another chromosome, often chromosome 14.[50] In a male affected with down syndrome it results in a karyotype of 46XY,t(14q21q).[50][51] This may be a new mutation or previously present in one of the parents.[52] The parent with such a translocation is usually normal physically and mentally;[50] however, during production of egg or sperm cells there is a higher chance of creating reproductive cells with extra chromosome 21 material.[49] This results in a 15% chance of having a child with Down syndrome when the mother is affected and a less than 5% risk if the father is affected.[52] The risk of this type of Down syndrome is not related to the mother's age.[50] Some children without Down syndrome may inherit the translocation and have a higher risk of having children of their own with Down syndrome.[50] In this case it is sometimes known as familial Down syndrome.[53]
The extra genetic material present in DS results in over-expression of a portion of the 310 genes located on chromosome 21.[44] This over-expression has been estimated at around 50%.[42] Some research has suggested that the Down syndrome critical region is located at bands 21q22.1–q22.3,[54] with this area including genes for amyloid, superoxide dismutase, and likely the ETS-2 proto oncogene.[55] Other research; however, has not confirmed these findings.[44]
The dementia which occurs in Down syndrome is due to an excess of amyloid beta peptide produced in the brain and is similar to Alzheimer's disease.[56] This peptide is processed from amyloid precursor protein whose gene is located on chromosome 21.[56] Senile plaques and neurofibrillary tangles are present in nearly all by 35 years of age even though dementia may not be present.[14] Those with DS also lack a normal number of lymphocytes and produce less antibodies which contributes to their increased risk of infection.[11]
Guidelines recommend that screening for Down syndrome be offered to all pregnant women, regardless of age.[57][58] A number of tests can be used, with varying levels of accuracy. They are usually used in combination to increase the detection rate, while maintaining a low false positive rate.[11] None can be definitive, thus if screening is positive either amniocentesis or chorionic villous sampling is required to confirm the diagnosis.[57] Screening in both the first and second trimesters is better than just screening in the first trimester.[57] The different screening techniques in use are able to pick up 90 to 95% of cases with a false positive rate of between 2 and 5%.[59]
Screen | Week of pregnancy when performed | Detection rate | False positive | Description |
Combined test | 10–13.5 wks | 82–87% | 5% | Uses ultrasound to measure nuchal translucency in addition to blood tests for free or total beta-hCG and PAPP-A. |
Quad screen | 15–20 wks | 81% | 5% | Measures the maternal serum alpha-fetoprotein, unconjugated estriol, hCG, and inhibin-A. |
Integrated test | 15–20 wks | 94–96%% | 5% | Is a combination of the quad screen, PAPP-A, and NT |
Cell-free fetal DNA | From 10 wks[60] | 96-100%[61] | 0.3%[62] | A blood sample is taken from the mother by venipuncture and is sent for DNA analysis. |
Ultrasound imaging can be used to screen for Down syndrome. Findings that indicate increased risk when seen at 14 to 24 weeks of gestation include: a small or no nasal bone, large ventricles, nuchal fold thickness, and an abnormal right subclavian artery, among others.[63] The presence or absence of many markers is more accurate.[63] Increased fetal nuchal translucency (NT) indicates an increased risk of Down syndrome picking up 75–80% of cases and being falsely positive in 6%.[64]
Blood tests
Several blood markers can be measured to predict the risk of Down syndrome during the first or second trimester.[59][65] Testing in both trimesters is sometimes recommended and test results are often combined with ultrasound results.[59] In the second trimester often two or three tests are used in combination with two or three of: α-fetoprotein, unconjugated estriol, total hCG, and free βhCG detecting about 60–70% of cases.[65]
Testing of the mother's blood for fetal DNA is being studied and appears promising in the first trimester.[66][67] The International Society for Prenatal Diagnosis considers it a reasonable screening option for those women whose pregnancies are at a high risk for trisomy 21.[68] Accuracy has been reported at 98.6% in the first trimester of pregnancy.[11] Confirmatory testing by invasive techniques (amniocentesis, CVS) is still required to confirm the screening result.[68]
Before birth
When screening tests predict a high risk of Down syndrome, a more invasive diagnostic test (amniocentesis or chorionic villus sampling) is needed to confirm the diagnosis.[57] If Down syndrome occurs in 1 in 500 pregnancies and the test used has a 5% false positive rate, this means that of 28 women who test positive on screening only 1 will have Down syndrome confirmed.[59] If the screening test has a 2% false positive rate this means that 1 out of 10 who test positive on screening having a fetus with DS.[59] Amniocentesis and chorionic villus sampling are more reliable; however, they carry an increased risk of miscarriage of between 0.5 and 1%.[69] There is also an increased risk of limb problems in the offspring due to the procedure.[69] The risk from the procedure is greater the earlier it is performed and thus amniocentesis is not recommended before 15 weeks gestational age and chorionic villus sampling before 10 weeks gestational age.[69]
Abortion rates
About 92% of pregnancies in the United Kingdom and Europe with a diagnosis of Down syndrome are terminated.[5] In the United States termination rates are around 67%; however this varies significantly depending upon the population looked at.[4] When non pregnant people are asked if they would have a termination if their fetus tested positive 23–33% said yes, when high risk pregnant women were asked 46–86% said yes, and when women who screen positive are asked 89–97% say yes.[70]
After birth
The diagnosis can often be suspected based on the child's physical appearance at birth.[10] An analysis of the child's chromosomes is needed to confirm the diagnosis and determine if a translocation is present as this may help determine the risk of the child's parents having further children with Down syndrome.[10] Parents generally wish to know the possible diagnosis once it is suspected and do not wish pity.[11]
Efforts such as early childhood intervention, screening for common problems, medical treatment where indicated, a good family environment, and work related training can improve the development of children with Down syndrome. Education and proper care can improve quality of life.[6] Typical childhood vaccinations are recommended.[11]
Health screening
Testing | Children[71] | Adults[3] |
Hearing | 6 months, 12 months, then yearly | 3–5 years |
T4 and TSH | 6 months, then yearly | |
Eyes | 6 months, then yearly | 3–5 years |
Teeth | 2 years, then every 6 months. | |
Coeliac disease | Between 2 and 3 years of age, or earlier if symptoms occur. |
Sleep study | 3 to 4 years, or earlier if symptoms of obstructive sleep apnea occur. |
Neck X-rays | Between 3 and 5 years of age |
A number of health organizations have issued recommendations for screening those with Down syndrome for particular diseases.[71] It is recommended that this be done systematically.[11]
At birth all children should get an electrocardiogram and ultrasound of the heart.[11] Surgical repair of heart problems may be required as early as three months of age.[11] Heart valve problems may occur in young adults, and further ultrasound evaluation may be needed in adolescents and in early adulthood.[11] Due to the elevated risk of testicular cancer, some recommend checking the person's testicles yearly.[3]
Cognitive development
Hearing aids or other amplification devices can be useful for language learning in those with hearing loss.[11] Speech therapy may be useful and it is recommended that it be started around 9 months of age.[11] As those with Down's typically have good hand eye coordination, learning sign language may be possible.[22] Augmentative and alternative communication methods, such as pointing, body language, objects, or pictures are often used to help with communication even though there is little concrete evidence.[72] Behavioral issues and mental illness are typically managed with counselling and or medications.[10]
Education programs before reaching school age may be useful.[2] School-age children with Down syndrome may benefit from inclusive education (whereby students of differing abilities are placed in classes with their peers of the same age) provided that some adjustments are made to the curriculum.[73] Evidence to support this however is not very strong.[74] In the United States the Individuals with Disabilities Education Act of 1975 requires that public schools generally allow attendance by students with Down's.[75]
Tympanostomy tube are often needed[11] and often more than one set during the person's childhood.[30] A tonsillectomy is also often done to help with sleep apnea and throat infections.[11] Surgery, however, does not always address the sleep apnea and a continuous positive airway pressure (CPAP) machine may be useful.[30] Physical therapy and participation in physical education may improve motor skills.[76] Evidence to support this in adults; however, is not very good.[77]
Efforts to prevent respiratory syncytial virus (RSV) with human monoclonal antibodies should be considered, especially in those with heart problems.[2] In those who develop dementia there is no evidence for memantine,[78] donepezil,[79] rivastigmine,[80] or galantamine.[81]
Plastic surgery has been suggested as a method of improving the appearance and thus the acceptance of people with Down's.[82] It has also been proposed as a way to improve speech.[82] Evidence, however, does not support a meaningful difference in either of these outcomes.[82] Plastic surgery on children with Down syndrome is uncommon,[83] and continues to be controversial.[82] The U.S. National Down Syndrome Society views the goal as one of mutual respect and acceptance not appearance.[83]
Many alternative medical techniques are used in Down syndrome; however, they are poorly supported by evidence.[82] These include: dietary changes, message, animal therapy, chiropractics and naturopathy among others.[82] Some proposed treatments may also be harmful.[42]
Between 5 and 15% of children with Down syndrome in Europe attend regular school.[84] Some graduate from high school; however, most do not.[8] Of those with intellectual disabilities in the United States who attended high school about 40% graduated.[85] Many learn to read and write and some are able to do paid work.[8] In adulthood about 20% in the United States do paid work in some capacity.[9][86] In Europe, however, less than 1% have regular jobs.[84] Many are able to live semi-independently,[14] but they often require help with financial, medical, and legal matters.[10] Those with mosaic Down syndrome usually have better outcomes.[42]
Individuals with Down syndrome have a higher risk of death than the general population.[11] This is most often from heart problems or infections.[2][3] Following improved medical care, particularly for heart and gastrointestinal problems, the life expectancy has increased.[2] This increase has been from 12 years in 1912,[87] to 25 years in the 1980s,[2] to 50 to 60 years in the developed world in the 2000s.[3][10] Currently between 4 and 12% die in the first year of life.[38] The probability of long-term survival is partly determined by the presence of heart problems. In those with congenital heart problems 60% survive to 10 years and 50% survive to 30 years of age.[14] In those without heart problems 85% survive to 10 years and 80% survive to 30 years of age.[14] About 10% live to 70 years of age.[43]
Globally, as of 2010, Down syndrome occurs in about 1 per 1000 births[2] and results in about 17,000 deaths.[89] It occurs more commonly in countries where abortion is not allowed and in countries where pregnancy more commonly occurs at a later age.[2] About 1.4 per 1000 live birth in the United States[90] and 1.1 per 1000 live births in Norway are affected.[3] In the 1950s, in the United States, it occurred in 2 per 1000 live births with the decrease since then due to prenatal screening and abortions.[52] The number of pregnancies with Down syndrome is more than two times greater with many spontaneously aborting.[10] It is the cause of 8% of all congenital disorders.[2]
Maternal age affects the chances having a pregnancy with Down syndrome.[88] At age 20 the chance 1 in 1441; at age 30 it is 1 in 959; at age 40 it is 1 in 84; and at age 50 it is 1 in 44.[88] Although the probability increases with maternal age, 70% of children with Down syndrome are born to women 35 years of age and younger, reflecting the fact that younger people have more children.[88] An older age of the father is also a risk factor in women older than 35 but not women younger than 35 and may partly explain the increase in risk as women age.[91]
English physician John Langdon Down first characterized Down syndrome as a separate form of mental disability in 1862, and in a more widely published report in 1866.[11][93][94] Édouard Séguin described it as separate from cretinism in 1944.[12][95] By the 20th century, Down syndrome had become the most recognizable form of mental disability.
In Ancient times many infants with disabilities were either killed or abandoned.[12] A number of historical pieces of art are believed to portray Down syndrome including pottery from AD 500 from South America and the 16th century painting "The Adoration of the Christ Child".[12]
In the 20th century many individuals with Down syndrome were institutionalized, few of the associated medical problems were treated, and most died in infancy or early adult life. With the rise of the eugenics movement, 33 of the then 48 U.S. states and several countries began programs of forced sterilization of individuals with Down syndrome and comparable degrees of disability. Action T4 in Nazi Germany made public policy of a program of systematic involuntary euthanization.[96]
With the discovery of karyotype techniques in the 1950s, it became possible to identify abnormalities of chromosomal number or shape.[95] In 1959, Jérôme Lejeune reported the discovery that Down syndrome resulted from an extra chromosome.[11] However this claim has been disputed,[97] and in 2014 the Scientific Council of the French Federation of Human Genetics unanimously awarded its Grand Prize to his colleague Marthe Gautier for this discovery.[98] As a result of this discovery, the condition became known as trisomy 21.[99] Even before the discovery of its cause, the presence of the syndrome in all races, its association with older maternal age, and its rarity of recurrence had been noticed. Medical texts had assumed it was caused by a combination of inheritable factors that had not been identified. Other theories had focused on injuries sustained during birth.[100]
Society and culture
Due to his perception that children with Down syndrome shared facial similarities with those of Blumenbach's Mongolian race, Down used the term mongoloid.[43][101] While the term "mongoloid" (also "mongolism" or "mongolian imbecility") continued to be used until the early 1970s, it is now considered unacceptable and is no longer in common use.[102] In 1961, 19 scientists suggested that "mongolism" had "misleading connotations" and had become "an embarrassing term".[102][103] The World Health Organization (WHO) dropped the term in 1965 after a request by the Mongolian delegate.[102]
In 1975, the United States National Institutes of Health convened a conference to standardize the naming and recommended eliminating the possessive form.[104] Although both the possessive and non-possessive forms are used by the general population.[105] The term "trisomy 21" is also used frequently.[103][106]
Some argue that it is unethical not to offer screening for Down syndrome.[107] As it is a medically reasonable procedure, per informed consent, people should at least be given information about it.[107] It will then be the mother's choice, based on her personal belief, regarding how much or how little screening she wishes.[108][109] When results from testing are back, it is also considered unethical not to give the results to the person in question.[107][110]
Some deem it reasonable for parents to select a child who would have the highest well-being.[111] One criticism of this is that it often values those with disabilities less.[112] The disability rights movement does not have a position on screening.[113] Some members though consider testing and abortion discriminatory.[113] Some in the United States who are pro-life are okay with abortion if the fetus is disabled while others are not.[114] Of a group of 40 mothers in the United States who have had one child with Down syndrome, half agreed to screening in the next pregnancy.[114]
Within Christianity, Protestants often see abortion as acceptable when a fetus has Down syndrome.[115] Orthodox Christians and Roman Catholics often do not see it as acceptable.[115] Some of those against screening refer to it as a form of "eugenics".[115] There is disagreement within Islam regarding the acceptability of abortion in those who have a pregnancy with Down syndrome.[116] Some Islamic countries allow abortion while others do not.[116] Women may face stigmatization which ever decision she makes.[117]
Advocacy groups
Advocacy groups for Down syndrome formed after the Second World War.[118] These were organizations advocating for the inclusion of people with Down Syndrome into the general school system and for a greater understanding of the condition among the general population,[118] as well as groups providing support for families with children with Down syndrome.[118] Organizations included: Royal Society for Handicapped Children and Adults (MENCAP) founded in the UK in 1946 by Judy Fryd,[118][119] Kobato Kai founded in Japan in 1964,[118] the National Down Syndrome Congress founded in the United States in 1973 by Kathryn McGee and others,[118][120] and the National Down Syndrome Society founded in 1979 in the United States.[118]
The first World Down Syndrome Day was held on 21 March 2006.[121] The day and month were chosen to correspond with 21 and trisomy respectively.[122] It was recognized by the United Nations General Assembly in 2011.[121]
There are efforts to develop treatment to improve intelligence in those with Down's.[123] One hope is to use stem cells.[124]
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SAFETY RULES For other products and training relating to these topics, please visit our on-line catalogue.
IAPA has developed a comprehensive set of Safety Rules to provide a framework for ensuring positive standards of behaviour for all staff in your organization. Safety Rules have been translated into 19 languages: Publication Date: May 2008
Additional Languages File sizes are between 100-400 KB for each download below. Publication Date: March 2006
The Business Case for a Healthy Workplace (1,878 KB) While there are ethical reasons for creating healthy workplaces, many employers still look for business reasons to support these moral and ethical reasons. This report outlines these business reasons. Publication Date: July 2008
Creating Healthy Workplaces (722 KB) This document shows that there are excellent legal and economic reasons to strive for a healthy workplace, and it doesn't have to be difficult or expensive. It does take some awareness, commitment and persistence on the part of employers and employees, but the outcomes in terms of worker health, job satisfaction, employee morale, and the company's productivity and bottom line, make it well worth the effort for all workplace parties. Publication Date: March 2006
Psychosocial Risk Management: What Every Business Manager Should Know (292 KB) This short article explains what a "psychosocial" workplace risk is, how it can affect worker health and safety, and how you can reduce these risks in your workplace. Publication Date: October 2007
Stress and Satisfaction Offset Score (SSOS): A Self-Assessment (177 KB) Prolonged stress is always unhealthy and can contribute to workers being injured on the job. This self-assessment stress and satisfaction offset score will provide some guidance whether your job contributes to unhealthy levels of stress. Publication Date: April 2008
Work-Life Balance: A Strategic Business Issue! (270 KB) Work-life balance is something in which we are all personally interested. But it is much more than that. This short article explains why it is a serious business issue that needs to be addressed in a strategic way. It's not just about being "nice" to employees -- it's about staying in business! Publication Date: October 2007
Asthma is a common lung disease that makes breathing difficult. It can affect your ability to work and your overall quality of life. When asthma is not managed well, it can even threaten your life. These guides, developed jointly with the Occupational Health Clinics for Ontario Workers Inc. and IAPA will help you to understand the significance of the problem, what asthma and work-related asthma are, how to recognize work-related asthma, what workplaces can do to prevent work-related asthma including safe work practices.
These resources have been designed to help employers and workers in your industries:
Asthma in the Automotive Parts Manufacturing and Foam Expanded Plastics Industries Work-related asthma is a serious occupational health problem and is the most common chronic occupational lung disease in industrialized countries. It can result in disability and job loss if it is not recognized and treated early enough. Agents in the automotive and plastic and foam industries have been known to trigger or aggravate asthma. These agents include isocyanates, aliphatic amines, acid anhydrides, metal dust and fumes, and metal-working fluids.
Asthma in Bakeries About 10% of all bakers suffer from work-related asthma, commonly referred to as "baker's asthma" because it is so widespread.
Asthma in Higher Risk Industries Work-related asthma is caused or made worse by an agent that a person comes in contact with at work. These workplace agents generally take the form of dusts, fumes, gases and vapours and are classified as being either sensitizers or irritants. These agents get released into the workplace air and when they are inhaled, they can lead to an asthmatic response.
Asthma from Metal-Working Fluids and Metal Dusts and Fumes If you work with metals (cutting, grinding, soldering, welding, boring, drilling, milling and/or turning metal) and metal-working fluids you are potentially at risk for developing work-related asthma or hypersensitivity pneumonitis which is a lung disease with flu-like symptoms including chills, fever, shortness of breath and a deep cough.
Business Pandemic Preparedness - Sample Checklist (62 KB) The Ontario Ministry of Health and Long Term Care estimates that during the next pandemic about 8,000 Ontarians will die, but the number could be as high as 20,000. Is your business prepared for a pandemic? Use this sample checklist to assess your readiness. Publication Date: December 2006
Colds and the Flu - Frequently Asked Questions (111 KB) Is influenza the same as a bad cold? How do colds and the flu spread? Should I get the flu vaccine? Find out the answers to these and eight other commonly asked questions in this FAQ document. Publication Date: June 2006
Mental Health at Work ... From Defining to Solving the Problem (3 booklets) The Université Laval's Chair in Occupational Health and Safety Management and the Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) have developed an information kit for work-related mental health problems. Entitled "Mental Health at Work ... From Defining to Solving the Problem," this unique kit in Canada will allow workers and organizations to deal better with this problem, which is the main reason for the increase in work absenteeism.
OHSCO Workplace Violence Prevention Series Ontario's Occupational Health and Safety System Partners, including the workplace safety associations, Ministry of Labour and Workplace Safety and Insurance Board, have developed resource material for firms to better prepare for the new workplace violence and harassment program requirements coming into effect June 15th, 2010. These resources include a document outlining the steps employers need to know to develop and implement a program and a toolkit to assist workplaces with their risk assessments for the workplace violence portion of the new requirements.
Lighting at Work (886 KB) Proper lighting at work can contribute to enhanced employee health and safety, increased productivity, and improved quality. To find out how to assess and improve the lighting in your workplace, turn to this practical guideline. Includes a lighting assessment checklist. Publication Date: May 2008
Musculoskeletal Disorder (MSD) Prevention The guideline, resource manual, and toolbox were developed in partnership with the members of OHSCO, which is comprised of the Ministry of Labour (MOL), the Workplace Safety & Insurance Board (WSIB), the Institute for Work & Health (IWH) and the health and safety associations (HSAs) including IAPA. The Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD) also assisted in its development.
The Psychosocial Side of RSIs (93 KB) Since psychosocial risk factors are known contributors to repetitive strain injury and other musculoskeletal disorders, you can't afford to ignore them. Here's a look at some real examples that IAPA member firms have resolved by ergonomic solutions that address both physical and psychosocial risks . Publication Date: November 2003
Safe Lifting and Carrying (2,901 KB) There's a proper technique to avoid overexertion injuries. This guide provides step-by-step instructions and illustrations that show how to safely lift and carry the types of loads commonly found at work. Publication Date: May 2008

subset: commoncrawl


text:
Nokia 6350 - red (AT&T)
Manufacturer: Nokia Part number: 4850232
- More product information:
- Editors' review
- User reviews
- Specifications
- Product series
- Accessories
- Manufacturer info
- Bottom Line:
- The Nokia 6350 does the job as a phone for voice calls, but it doesn't measure up as a multimedia device.
Read more
Where to buy
store | customer rating | inventory | tax & shipping | price |
| In stock Get free shipping on orders over $35.00 | Enter zip code to get total price: Price +Tax +Shipping =Total price | as of 03/11/2014 |
CNET editors' review
price range: $57.57
- Reviewed by: Kent German
- Reviewed on: 11/23/2009
The good: The Nokia 6350 has a slim, easy-to-use design and good call quality. The feature set includes 3G, GPS, and push-to-talk.
The bad: The Nokia 6350's photo and video quality are disappointing. The headset jack is 2.5mm.
The bottom line: The Nokia 6350 does the job as a phone for voice calls, but it doesn't measure up as a multimedia device.
User reviews
Good phone, better with some small improvements.
by lordkoos on October 9, 2009
Pros: Sleek design, excellent sound quality, hefty, solidly built, plenty of features and lots of memory available. Comfortable in your pocket, the case is not slippery like so many phones that are easy to drop.
Cons: Software menus, too much button-pushing to edit contacts. The ringtones seem a little quiet, I have the volume maxed out. Too easy to accidentally push buttons that lead to more expensive services... a conscious AT&T strategy I'm sure.
Summary: I wanted a good basic flip phone and this one is almost perfect. I like the finish on the outside of the phone, it's got a tactile feel, not ...
Summary: I wanted a good basic flip phone and this one is almost perfect. I like the finish on the outside of the phone, it's got a tactile feel, not slippery. It's hefty and feels very well made, not toy-like. The battery life just seems average. The display is bright and very clear. I can't find any way to adjust the screen brightness, it might help the battery life if you could turn it down. However, this phone charges very quickly, much faster than my Sony did. The phone has plenty of memory for my purposes, but I'm just using it as a basic phone and occasional mp3 player.
The built-in camera seems to be very good.
My biggest gripe: to edit or delete contacts you have to go through too many steps compared to my old phone, (Sony Ericsson) which had superior contact management IMO. Too much button-pushing -- maybe this could be improved with later software revisions. I've just got the phone, so I can't speak to durability but it seems extremely well made and Nokia has a good reputation.
Updated on Oct 9, 20094 out of 4 users found this user opinion helpful.
So Far So Good
by Furscout on February 27, 2010
Pros: Nice filp phone with lots of features. Bright display inside and out. Pretty cool ringtones, but there are only 14 of them; so it's good that downloaded songs can be used also. Heaviest ph I've had, feels very solid in your hand. Nice big buttons
Cons: Some people I have called say I sound like I'm at the airport, but call is clear on my end. Dont know if it's a network issue or some interference. Lots of convoluted menus to change settings, but there is a lot of stuff in the phone.
Summary: Overall I like the phone, but I guess there are always things that we would like better no matter what phone we get. I really liked voice-dialing I had on ...
Summary: Overall I like the phone, but I guess there are always things that we would like better no matter what phone we get. I really liked voice-dialing I had on previous LG and Kyocera phones where I could just say the name and the phone would call. However, this Nokia "enhanced" voice-dialing is a joke. It doesnt always understand your voice even though you "train" the phone and even if it does understand you it will only dial the top number listed for that contact which is the mobile number. You can scroll to the desired number after they appear on the screen, but that sort of defeats the purpose of voice-dialing is you have to start pushing a lot of buttons...especially while driving. Battery life is so-so...will last a couple of days with a few hours of talk every day.
I dont understand why other reviewers say they cannot hear the phone ring unless they dont realize the volume can also be adjusted with the phone settings instead of just with the outside rocker switches. It is good and loud when I turn up the volume.
Updated on Feb 27, 20103 out of 3 users found this user opinion helpful.
A Step Backwards for Dedicated Nokia Users
by airdog06757 on August 6, 2010
Pros: Lightweight, Acceptable Call Quality, Great Ability to Customize
Cons: Abysmal Vibrate Setting, Terrible Battery Life, Terrible Menu Layouts, Terrible Construction, No External Shortcuts
Summary: The Nokia 6350 is a decidely a downgrade in the Nokia line for every aspect except price, as this phone costs way too much for what it delivers. Prior to ...
Summary: The Nokia 6350 is a decidely a downgrade in the Nokia line for every aspect except price, as this phone costs way too much for what it delivers. Prior to this phone, I had a Nokia 6682 and a Nokia 6650. The first difference you'll note between this and the more veteran Nokias is program functionality. The 6682 and 6650 allowed a user to have multiple programs running, which could be toggled by pressing and holding the menu key. Not so with the 6350, if you want to be able to switch back and forth between browser based email and your contact list for instance, you'll be closing one to open the other.
The vibrate setting on this phone leaves a lot to be desired. Instead of using a continuous vibrate alert, it uses a pulse alert. What you read about not being able to feel the vibrate is a100% correct statement. You'd think with such a light phone the thing would jump and rattle like nobody's business. Instead it just sort of buzzes and dies, buzzes and dies. Where I work, having an audible ringer is generally frowned upon; therefore a reliable vibrate is key. I've had the pohne about six weeks, and I miss at least one call a day because of the deficient vibrate setting.
The battery life is pretty miserable. If I were to start a call with a full battery on this phone, I feel as though I may approach four hours, but certainly would not exceed it. The standby time is a joke. I saw a reference to 18 days in the CNET review. AT&T refuses to rate standby above 15 days. In my experience to date, the standby time is 1 to five days, without a lot of rhyme or reason as to why it fluctuates. The phone has travelled with me from DC, to Philly, to the Mississippi Gulf Coast to San Diego, and each locale has resulted in the same unpredictable battery life. Definitely invest in a car charger or a second wall charger depending on your needs.
You can't tether with this phone, or if you can, I haven't figured out how yet. With the 6682 and 6650, it was as simple as staring up OVI suite and clicking connect to internet. Maybe AT&T disallowed production of a tethering phone, but more likely, I think Nokia just left it out of the design. Major let down for someone that travels as much as I do.
I'm less than impressed with the "new and improved" way to add contacts to things like text messages. I text a fair amount, typically only to people in my contact list. I don't find it at all intelligent to click in the "To:" box only to be brought to a menu where I then need to select my contact list. While it is only one extra click, it's one extra click that has no good reason for being there.
The physical construction of the phone is sub-par, especially the battery cover. The gentleman at AT&T fought with one cover for five minutes prior to giving up, getting a brand new phone from the back, and giving that to me instead. I've since become fairly adept at working the battery cover, but knocking around inside a travel bag will often spring the cover free.
Adding contacts to the phone is as much of a chore as you'd expect, with an added twist. I've identified no way to add a new contact directly to the SIM card of the phone. I periodically do a copy all to the SIM, and frag any duplicates.
The final knock on this phone is the lack of external shortcuts. On the Nokia 6650, the camera, music player, stopwatch, timer, and as I recall some other mini-programs could be accessed and activated witht he flip closed. Calls could also be answered with the flip closed. All of these functionalities were deleted when Nokia "improved" phone design and introduced the 6350.
I only changed to the 6350 because I lost my 6650. There isn't a day that goes by that I don't hope someone contacts me saying my trusted 6650 has been found safe and sound, but I don't think it's meant to be.1 out of 1 users found this user opinion helpful.
Poor battery life
by jaykay33442 on January 21, 2010
Pros: good camera. phone easy to use
Cons: battery last 2 days on standby tops 3 days. Specs say 14 days. Bull
Summary: This is the 2nd Nokia 6350 that I got. The 1st one would shut off while on a call. I use this phone just for calls and photos. Nothing else ...
Summary: This is the 2nd Nokia 6350 that I got. The 1st one would shut off while on a call. I use this phone just for calls and photos. Nothing else and the battery does not last. I can return it for the last time in my 30 day trial period. The ATT rep suggested the Pantech Breeze, but that rating is NG.I Want a basic phone that will take good photos, so I won't have to drag my camera around. It has a 2MP and 4x zoom camera
1 out of 1 users found this user opinion helpful.
Good Phone
by rob1261 on November 28, 2009
Pros: Good Small Flip Phone
Cons: After one week, none.
Summary: Got this phone for my mom and she loves it. Small, easy to use and good sound quality. FREE from Best Buy.
Summary: Got this phone for my mom and she loves it. Small, easy to use and good sound quality. FREE from Best Buy.
1 out of 1 users found this user opinion helpful.
Looks great but does not even meet expectations
by nokia6350 on January 28, 2010
Pros: Sleek, fits perfectly into pocket, red color looks great
Cons: Battery life (need to be charged every alternate day even when it was hardly used), gets heated up when a call lasts for more than 15 minutes, low voice quality.
It would have been good if it had a switch to open the flip (just like the Nokia 6126).Summary: I owned a Nokia 1600 and also a Nokia 6126 before. Though these phones had minimal features they served their purpose perfectly. Nokia 6126 was just AWESOME. I used it ...
Summary: I owned a Nokia 1600 and also a Nokia 6126 before. Though these phones had minimal features they served their purpose perfectly. Nokia 6126 was just AWESOME. I used it for 2 and half years with no issues at all. This does not even stay anywhere near to 6126's performance.
Has been a very sad experience using Nokia 6350 and I lost the wonderful impression that I had on Nokia phones.2 out of 4 users found this user opinion helpful.
Weak phone in mildly cold temperatures
by Astridvalence on January 3, 2010
Pros: This phone's slim size makes it easy to carry around in a purse or a pocket. Contrary to other users' warnings, the maximum volume for phone calls and rings is also good.
Cons: This phone dies completely in mild weather (67F or so). I don't mean that it just turns off or that the battery discharges; I mean it DIES and cannot be turned on with the power button or by recharging it, or even removing and replacing the battery.
Summary: To all those interested in buying this phone who live in colder climates, BEWARE, IT IS NOT RELIABLE IN WINTER (or even in fall or spring, I'd imagine).
Summary: To all those interested in buying this phone who live in colder climates, BEWARE, IT IS NOT RELIABLE IN WINTER (or even in fall or spring, I'd imagine).
1 out of 2 users found this user opinion helpful.
Worst phone period.
by Kaufmanlol on March 27, 2012
Pros: None. NONE at all.
Cons: All will be in summary.
Summary: My new job gave me one of these for a work phone. The phone is packed with annoying features you can NOT turn off. The biggest is a Push to ...
Summary: My new job gave me one of these for a work phone. The phone is packed with annoying features you can NOT turn off. The biggest is a Push to talk button on the outside, the only way to disable it was to physically pry the button off. Even when the phone was in keypad lcok, it would STILL activate ptt. I remember having a nokia brick a decade ago and having the ability to dictate what the buttons did.
Also, the back plate just falls off and thus the battery too.
Finally the real kicker is that this phone won't pick up service in a place where my personal ATT smartphone does. It is literally the most useless device I have ever even heard of. -
Good voice but short battery life.
by greytrains on June 30, 2011
Pros: When I have cell reception the calls are clear.
Cons: This phone has a poor camera, & a short battery life. The ringer volume is too low. The other major problem is cell reception is poor. It is also too easy to activate other features
Summary: I got this phone for basic voice coverage. Looking back I wish I had spent some more money and got a better phone.
Summary: I got this phone for basic voice coverage. Looking back I wish I had spent some more money and got a better phone.
by HLRobin on June 14, 2011
Pros: Small, NOT touch screen
Cons: Terrible battery life, Navigator is worthless.
Summary: Battery life is 24-36 hours with almost no use. Not even close to what they claim. ATT Navigator does not work well. Used it on another phone and it was ...
Summary: Battery life is 24-36 hours with almost no use. Not even close to what they claim. ATT Navigator does not work well. Used it on another phone and it was accurate within a few feet. This would tell me to turn 2-5 miles AFTER I was supposed to turn! If all you want is to make and receive calls and don't mind charging daily, then it's okay. My last Nokia would last a week before needing charging. I have taken the phone back and gotten a new battery, then a whole new phone, with NO improvement in battery life!!! Gave up and am stuck with it until the end of the contract. Not happy.
- Manufacturer: Nokia
- Part number: 4850232
- Description: Sophistication without complication - the perfect balance of features and design 2-megapixel camera and 4x digital zoom to snap, shoot, record your moments Large battery delivers over 4 hours of talk time with up to 350 hours of standby time Stereo Bluetooth 2.1 Mobile email Integrated handsfree speaker Voice recording up to 60 minutes Over the air downloads supporting: music, wallpapers, ringtones, themes, and applications Micro USB charging and data port USB 2.0 high-speed data Standard 2.5mm UHJ stereo support HAC M3/T3 minimum, TTY/TTD support A-GPS with Secure User-Plane Location (SUPL) External side volume and PTT keys External music keys Speaker independent name dialing Calendar, calculator, stopwatch, alarm clock, and timer Offline mode allows Bluetooth capability Phonebook supports 1000 contacts, with up to 5 entries per contact
- Packaged Quantity 1
- Product Type Cellular phone
- Form Factor Folder (flip)
- Phone Design Flip
- Integrated Components Digital camera,
Digital player - Antenna Internal
- Width 1.9 in
- Depth 0.7 in
- Height 3.7 in
- Weight 3.6 oz
- Body Color Red
- Technology WCDMA (UMTS) / GSM
- Band WCDMA (UMTS) / GSM 850/900/1800/1900
- Mobile Broadband Generation 3G
- Service Provider AT&T
Messaging & Internet
- Cellular Messaging Services SMS
- Messaging & Data Features Text messages,
Multimedia messages (MMS),
Instant messages,
E-Mail Communications
- Data Transmission GPRS,
EDGE - Wireless Interface Bluetooth 2.1 EDR
- Communication Features Mobile Email client
Phone Features
- Phone Functions Call timer,
Conference call,
Vibrating alert - Polyphonic Ringer Yes
- Additional Features TTY compatible
- Personal Information Management Calendar,
Alarm clock Media Player
- Supported Digital Audio Standards MP3
- User Memory 30 MB
- Supported Flash Memory Cards microSDHC
Digital Camera
- Sensor Resolution 2 megapixels
- Digital Zoom 4
- Type LCD display - Color
- Display Resolution 240 x 320 pixels
- Color Depth 24-bit (16.7 million colors)
- Multi-language Menu Yes
Display (2nd)
- Type LCD display - Color
- Technology Lithium ion
- Capacity 1050 mAh
- Run Time Details Talk - up to 252 min,
Standby - up to 348 hour(s) Miscellaneous
- Compliant Standards HAC(Hearing Aid Compatible)
- Included Accessories Power adapter , Power adapter
Product series
Manufacturer info
- Manufacturer profile
- Browse Nokia products on Shopper.com
- Manufacturer:Nokia
- Address:
102 Corporate Park Drive, White Plains, NY 10604 - Phone: 1-888-848-4792
- Fax: 972-894-5050


text:
Barge LS United
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Item code: 4107000437/001
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A technology-assisted program for helping student attain high school diplomas is expanding in Georgia. Educational Services of America said that nine new districts are signing up for its Ombudsman Educational Services, bringing the total in Georgia to 17 districts.
ESA's Ombudsman program provides technology-assisted alternative education to middle and high school students off campus for credit recovery, remediation, and intervention for at-risk students.
"For some students, a traditional school setting is not effective," said William C. Hardin, superintendent of Georgia's Camden County Schools, in a statement released last week. "We are confident the Ombudsman program can provide those students with an alternative environment to help address learning differences and provide an opportunity for them to succeed."
Camden County is one of nine districts that will begin offering the the Ombudsman program at the start of the next school year. The other eight include Appling County Schools, Cartersville City School System, Cobb County School District, Marietta City Schools, Pierce County School District, Tattnall County Schools, Walker County Schools, and Ware County School System.
ESA said that its Ombudsman program has an 85 percent success rate among its student body, which includes students who "graduate from Ombudsman or their home school district, improve their academic standing, or earnnecessary academic credits." ESA has partnerships with about 120 districts across the country. Further information can be found here.
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David Nagel is the executive producer for 1105 Media's online K-12 and higher education publications and electronic newsletters. He can be reached at firstname.lastname@example.com. He can now be followed on Twitter at http://twitter.com/THEJournalDave (K-12) or http://twitter.com/CampusTechDave (higher education). You can also connect with him on LinkedIn at http://www.linkedin.com/profile/view?id=10390192.
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Over the past decade, technology has radically transformed the higher education experience. Learning has moved out of the classroom, and students expect to be able to pursue their education from any location at any time. This paper presents guidelines for colleges and universities considering bring-your-own-device (BYOD) support models and presents guidelines for implementing mobility programs to modernize your IT strategy and improve the working and learning environment for students, faculty and staff. Read more...
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In this morning's Web roundup, Colombia enterprise cybersecurity startup Easy Solutions nabs funding to expand to the U.S. and globally. China Renaissance Capital raises a fund, without Credit Suisse.
Produced by the editors of Dow Jones VentureWire, Venture Capital Dispatch tracks the fast-moving developments at the intersection of high-tech innovation and venture capital finance. Featuring the VentureWire reporting team in the Silicon Valley, New York, Boston and Shanghai tech centers, Venture Capital Dispatch provides insight into the newest start-ups and latest trends in venture capital investing. Write us at firstname.lastname@example.com. For more information on Dow Jones products covering venture capital and other financial markets, go to www.fis.dowjones.com.


text:
Northland meatball gets spot on Target Field menu
The Minnesota Twins have added Valentini's restaurant — maker of famous meatballs — to its list of providers of hometown fare at Target Field during games this year.By: Mike Creger, Duluth News Tribune
It's the size of a baseball, and that makes perfect sense to Carol Valentini as her restaurant steps up to the plate this year to offer a taste of the Northland to baseball fans in Minneapolis.
The Minnesota Twins have added Valentini's restaurant to its list of providers of hometown fare at Target Field during games this year.
Fans will be able to take on a 10-ounce meatball stuffed with cheese and covered in sauce that is inspired by a smaller variety (6 ounces) found at Valentini's Supper Club in Chisholm and Valentini's Vicino Lago in Duluth.
"Everything is big there," Valentini said from the restaurant on Duluth's London Road that she runs with Mia Valentini. "They're looking for the 'wow' factor."
Like most of the items offered at the park, the price will bring a "wow" as well. The Mega Meatball will cost $9, Valentini said.
"It's comparable to other items," she said. "One person who saw them said 'My God, this will feed my whole family,' " she said with a chuckle.
Carol said that being in a business as long as her family has — Valentini's began as a modest café in Chisholm in 1934 — you develop a few connections. "You make a lot of friends," she said.
One of those friends worked in marketing for the Twins and had been looking for a chance to get Valentini's into the food lineup. In February, a crew from the restaurants came down and presented a lineup for the food vendor and Twins executives. They picked the meatball for starters. There could be more products if it sells well.
"They were impressed," Carol said. If the Twins were looking for homegrown food, hers was it, she said.
"I'm surprised it happened so quickly," Carol said. The team found out they had been picked in March.
Rob Russo runs the Chisholm restaurant with Paul Marturano.
"I'm a huge sports fan, so this is a big deal," Russo said. And if he can get a few games in while checking on the product, all the better.
The agreement with the Twins involves the use of the Valentini's name and its right to check on the quality of the meatballs now and then. No money changes hands in the arrangement, Carol Valentini said. It's a good trade-off, she said, for some publicity that she hopes will draw customers north.
The Twins have pushed for regional food and drink at the park that begins its third season this month. Other foods that will be new this year are deep-fried pickle chips from the Minnesota State Fair, mini-doughnuts, a baked potato bar, and stir-fry from Leeann Chin.
The Twins, who employ a chef to oversee the food preparation at the park, are using the Valentini's recipe and are buying the secret spices that make the meatball an original, Russo said.
"They're making a ton of meatballs," Russo said as the Twins get ready for Monday's home opener. The season starts Friday in Baltimore.
The Valentini's crew tasted a batch of stadium meatballs last week and they deserved the Valentini's name, Russo said. "They were outstanding."
The baseball connection may not stop with the Twins. Carol said the restaurant business is talking with the Duluth Huskies about offering food at Wade Stadium this summer.
Along with the two restaurants, Valentini's has a café at St. Luke's hospital in Duluth and a wholesale foods business. Much of the food is made in Chisholm, Russo said, to create consistency at the restaurants.
Carol Valentini was enjoying the crush of media Tuesday asking about the foray into Target Field.
"It's fun," she said. She plans to be at the opener Monday and will take the entire Valentini's staff to a game in August.
Russo hopes more people outside of the Northland will get to know the family-run company.
"It makes the door open to the masses," he said.
Tags: iron range, news, food, restaurants, business, baseball, twins, minnesota, fccnetwork, chisholm, duluth


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2011 Israel Elijah & Whirlwind Silver 2 NIS Coin (w/ box & coa)
We provide all our customers with a refund, return and/or exchange policy on everything we sell including all bullion and certified coins. If for any reason you have a problem, please feel free to call our offices. We will always do our best to accommodate you.
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Product Description
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Product Specifications
Product ID: | 64877 |
Year: | 2011 |
Mint Mark: | "n" (Mem) |
Grade: | Proof |
Denomination: | NIS 2 |
Diameter: | 38.7 mm |
Thickness: | 3 mm |


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Tech Minute: Best Web sites for alternative lodging
If you're visiting friends and family this holiday season, the idea of sleeping on an air mattress or bunking with your teenage cousin probably sounds about as appealing as an overcooked turkey. In this Tech Minute, CNET's Kara Tsuboi reports on the best Web sites to find lodging options beyond hotels. Hey, anything is better than that lumpy pull-out sofa.
1 minute 2 seconds | November 19, 2012 9:46 AM PST