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Catskill Mountain Railroad
The Little Railroad That Could
by Jay Blotcher
The crews of the Catskill Mountain Railroad (CMRR) have been working on the railroad all the live-long day. But not simply to pass the time away. CMRR is a group of volunteers dedicated to rebuilding the tracks of the Ulster & Delaware Railroad. It once ran elegant passenger trains between Ulster and Delaware counties, from Kingston to Oneonta.
Harry Jameson, chair of the CMRR, is unapologetically obsessed with his noble task. So is the legion of 130 volunteers who venture out in all types of Valley weather to work to bring the group steps closer to a fully functioning 38-mile railroad as it once ran in the 19th to 20th centuries.
Throughout the hours, days, months and years of toil the CMRR is now nearly three decades old.
"Our goal is to make Ulster County's Tourist Railroad the polished gem it has the potential to be," Jameson said.
Jameson was not train-crazy as a child. "I was not really a railroad buff," he said. "I had a Lionel train set as a kid. But I originally got involved as a matter of business."
The business was Jameson's Town Tinker Tube enterprise, which he started in 1980 in Phoenicia. The first year, he rented 1,000 inner tubes to thrill-seekers who wanted to bob along on the currents of the Esopus Creek. That figure jumped the next year to 4,000. But there was one hitch to the experience.
"I was putting people in the river, but I had no means of getting them back afterward," Jameson noted. That is to say, people would float downstream, but then have to hoof it back to the origin point or plan their trip with two vehicles.
However, that all changed in 1982 when a Shokan realtor named Kent Reeves came along. He received a lease from Ulster County to build a little train—"amusement park ride size," Jameson said—to bring tubers back upstream from Mt. Tremper. The new service was billed as "Tube Down, Train Up."
At the end of a successful first season, Reeves decided to form a corporation. He asked Jameson and others to be stockholders. The savvy businessman did not hesitate. Within the year, CMRR was founded with a mission to bring the dormant railroad back to roaring life. By year two, Jameson became a director.
Jameson credits Earl Pardini, currently CMRR president, as "the person who has carried the torch" to invigorate this venture. Pardini, who worked for Conrail on the final train that ran on the Catskill Branch Line, was a major force in building CMRR. He sat on a committee that saw the potential for starting a tourist railroad on tracks last operated by Penn Central, which had allowed the infrastructure to fall into disrepair.
The vision of Pardini and his colleagues was to create a 1900s era Tourist Railroad. The Catskill Mountain Railroad Company Inc. was chartered as a for-profit railroad with the intention of operating a short line freight business out of Kingston to help fuel the funding for rebuilding the line. Unfortunately freight customers needing deliveries never materialized.
By 2002, CMRR streamlined its ambitions and encouraged Ulster County to apply for grants to facilitate a more manageable enterprise: restoring the railroad line from Kingston to Phoenicia. This stretch of track had a noble history; it was the connection between wealthy New Yorkers who had come up on Dayline steamers to Kingston and the grand hotels like the Catskill Mountain House that flourished in the Northern Catskills from the 1870s through the early decades of the 20th century, peaking in 1917 before decades of steady decline as tourists found more exotic holiday locales.
Grant applications, as well as red tape on the state and federal levels had to be navigated to begin the project in earnest. Locals met the proposal to lease the tracks enthusiastically, as the revitalized railroad was poised to bring tourists and income back to an area laid low by IBM's departure. A 1978 feasibility study determined that a refurbished railroad in Kingston could accommodate 250,000 to 300,000 people annually.
The promise was to create two-hour round trips in which trains, running on Class 1 track, would attain leisurely speeds of 15 miles per hour. Such a pace, Jameson points out, maximizes sightseeing enjoyment of the flora and fauna of the Mid-Hudson Valley.
"Blue herons in the creek, eagles diving for a trout dinner—that is the experience that people come along for," Jameson said. "Catskill Mountain Railroad provides the greatest visibility of the Catskills."
CMRR strives for optimum historic authenticity in creating a railroad experience for adult and children alike. Old trains are restored inside and out by volunteers who, cannily self-trained in this area, consult old books, etchings, photos and manuals to attain near-perfection."We have an amazing spectrum of talent," Jameson said of CMRR volunteers, "people involved in railroads, carpenters, welders, painters and woodworkers." Some actually were railroad workers in their youth, once serving as brakemen, conductors, engineers and bridge workers.
"It's amazing that the railroad was reclaimed foot by foot from the tangle of underbrush by a workforce of men, all volunteers, and some of them over 65 and long retired—including two guys in their 80s," said CMRR volunteer John Voelcker, a two-decade weekender in West Saugerties.
"I always feel like I've had a complete workout after a day of working with these guys," Voelcker added. "I'm young and these guys are old, and they spend a day cutting up downed trees."
But the labor is well worth the reward, he said. "You get the physical reward of seeing the results of a day's work. And you're helping to restore something; you get to be a part of history."
While the core group lives between Albany to Westchester, CMRR volunteers hail from New Jersey, New Hampshire and even Virginia, eager to share the singular satisfaction of bringing an old train back to life.
Dedicated and energetic teams restored two 1917 Erie-Lackawanna passenger cars that run on the tracks. (The first car was refurnished over a period of five years at a cost of $18,000 in materials and thousands of hours of donated labor.)
"You're talking about a car approximately 80 feet long, completely gutted and everything taken apart," Jameson said. "Refurbished seats, handles, window frames."
Those who lack particular experience in restoring cars are welcome to do the equally crucial work on the railroad infrastructure: Replacing railroad ties and cutting brush and fallen trees that have engulfed the tracks.
"It is hard, gut-wrenching work," Jameson said. Tropical Storm Irene was especially harsh on the railroad last August, flooding tracks, washing away track beds and destroying overpasses in the western part of Ulster County. But as the waters receded, determined volunteers moved in to repair the formidable damage.
"People come in and they see what we do and they want to be part of it," he said. "I've had people who have never ever done anything with railroads, have become conductors and engineers."
Jameson recalls an incident a few years ago, as the CMRR track crew was in Kingston, restoring a track by the Elmendorf Overpass. A man and his 16-year-old boy watched the process and finally asked what the heck was going on. Jameson explained and the father and son signed on as volunteers.
"This kid is now one of our locomotive engineers," he said. "That's even a bigger picture for us, creating the next generation of Railroaders."
Currently, CMRR can boast several train rides. They include The Esopus Creek Scenic Train out of Mt. Tremper, which offers, at present, a 5-mile roundtrip along the Esopus with the beauty of the Catskill Mountains as a backdrop. The Scenic Train also schedules two Twilight Limited Train rides, one in July and August, offering a nighttime ride under the starlit sky. When the leaves turn their brilliant colors Fall Foliage trains provide a spectacular autumn experience one cannot receive from a car window. Prior to Irene the CMRR Scenic Trains traveled to Phoenicia where people would visit the Empire State Railway Museum. The ESRM exhibits the history of Catskill Mountain Railroading; although temporarily disconnected, it's still open to visitors by car.
The Kingston City Shuttle began operation in 2008 after two years of track restoration. The Shuttle Special Event trains operate every Saturday throughout the summer. Decorated Halloween Trains provide a non-spooky children's ride. Every Christmas season, the CMRR Winter Holiday Train attracts happy children and parents to chug along with Santa. There are rides on both ends where musicians serenade passengers. Last year, in total, CMRR trains "hauled" 12,000 passengers.
"The goal, one day for the CMRR, is [that] people drive up the Thruway, park in Kingston, and get on the train to go all the way to Phoenicia with stops along the way for hiking and picnics," said John Voelcker.
The work continues; CMRR just purchased a 1946 S-1 locomotive from the Staten Island Railroad for the Scenic Train. A future goal is a train that starts from Kingston and travels to the Ashokan Reservoir and points west. But clean-ups and repairs dominate efforts. A major project is the rehabilitation of the 400-foot bridge over the Lower Esopus West of Washington Avenue in Kingston. Earlier engineering estimates put a price tag of $850,000 on the repair. With all of the bridge timbers donated, and the CMRR's time and talent, Earl Pardini's crew is halfway through the task—doing it in-house for approximately $30,000.
"This is the story of the little railroad that could," Pardini said, "because we do."
Catskill Mountain Railroad Co.
PO Box 1415, Kingston, NY 12401


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Whartscape lineup semi-announced, another 300 bands still unconfirmed; Willie Nelson lops off his hair; Alicia Keys pregnant, engaged
By Ally Schweitzer
- *Sniffle* Whartscape has really grown up, guys. This year the Baltimore music fest celebrates its fifth birthday with a sprawling lineup of approximately 435 bands over three days. See the almost complete lineup here. Obvious highlights are Click Track favs Beach House, Double Dagger, No Age and Wye Oak, but sets from Oneohtrix Point Never and Ponytail are enough for me to fork over the train fare to B-more. Whatscape happens July 22nd-25th; tickets will be sold at whamcity.com and the True Vine record shop starting June 15th.
- The end of freedom as we know it?: Willie Nelson has chopped off his hair. Devastating as this is, hard-hitting questions must be asked, starting with: how soon until we see his hair on eBay? And when that non-profit group erects a statue of Nelson in front of Austin City Limits, will it be pigtailed or un-pigtailed? (Insert joke here about staying true to Nelson's roots, honoring his hair-itage, etc.)
- Alicia Keys is pregnant with her first kid and planning to marry producer Swizz Beatz. The couple, who have been together since at least 2008, initially kept their relationship under wraps while Swizz (real name Kasseem Dean) finalized his divorce from ex Mashonda Tifrere. But we're beginning to feel like Celebritology, so this post ends here.
Ally Schweitzer
May 28, 2010; 9:00 AM ET
Morning click
| Tags: Alicia Keys, Double Dagger, No Age, Oneohtrix Point Never, Ponytail, Willie Nelson, Wye Oak
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Create a log out feature!!!!!!!!!!!!!1
its extremely annoying to have to X out the game every time i want to log out, this is the only largely played game ive ever seen where you have to log in an dont have the option to log back out without closing an reopening the game.
please riot, notice me and include this into the next patch... |
One account per person sistem. NO logout feature requiered.
they had that before dunno why they took it away, but now whenever I close league it crashes when i try to reopen it.
Some people need to log out when they buy a hero and others when they want to skin from youtube / facebook. Also, with the new RAF 2.0, you need to relog to receive the IP. So the log out feature might be needed. It's also annoying if you get disconnected and the client just closes... I don't think it's a big thing, but I can see why people want it. ^_^
You can have multiple people on the same computer. It won't happen all the time, but I've had friends over who I let relog and play. I've done the same at their house. Keeps people entertained anyhow
All times are GMT -8. The time now is 12:03 PM. |
(c) 2008 Riot Games Inc


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Very Good Recipes of Burrito from The Recipe Review
There is one Burrito recipe on the blog The Recipe Review. (93 on all the blogs)
Click on the title of a recipe or the photo of a dish to read the full recipe on its author's blog.
Baked Sweet Potato and Black Bean Burritos
By The Recipe Review
12/23/11 01:48
I had some sweet potatoes that were given to me that I wanted to try some new recipes with. I've never really used sweet potatoes for anything other than baked sweet potatoes with butter and cinnamon or in a casserole, so I was excited to explore. The first...
Add to my recipe book


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Oba Chandler Executed; Left Behind a Sheisty Last Statement
via YouTube |
Spoiler alert: Oba Chandler |
After gobbling down a pair of salami sandwiches, one peanut butter sandwich, and some tea, he managed to jot down a last statement before meeting the state's juice.
Check out the note after the jump:
Florida Department of Corrections |
Whatever Chandler claims to be "innocent" of, according to anyone who's checked out the facts from the case, it certainly isn't murder.
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Operation of eight before the period (AD 2004 ~ 2023) is not a good position.
Lucky: can be hung landscape paintings and calligraphy (calligraphy) to help open transport.
Central: Jiuxing figure 7
good and bad phenomenon: on behalf of the tongue, injury and bad peach.
Lucky method: put a pot of water plants (such as gold Ge) can resolve the tongue and a bad peach.
more fleeting years of flying for the 2011 辛卯star and the house of relationships and instead of turning to the law, hope to be helpful for the new year to plan and prepare at the same time, if an earlier understanding of their environment in which good and bad feng shui directions, and timely and proper conduct of Feng Shui adjustments, will help his family fortune Cosmos, career success and fortunes, to make life happy. Everyone would like to wind and water in 2011, all wishes come true!
iron mouth Wang: This article involved in the theory of geomancy only for their specific premises, does not apply to all units, geomancy in the planning process must be combined with Zodiac, the five elements, location and other factors, so it can be more precise, for medical treatment, good fortune.
(This picture comes from the network, to reproduce this work please indicate the source)
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Latest News
A landmark study published on 28 July reveals how animal tests create a false sense of security, putting patients at risk.
The Observer published our letter, signed by many expert scientists, commenting on the study and urging governments to replace animal-testing requirements with an obligation to use the most reliably proved methods available.
The Sunday Times also published our (different) letter, which began: "We hope the exciting technology mentioned in your article will become mainstream within three years as predicted. Meanwhile, other human-based technologies are already available that could be improving patient safety here and now. The impediment is not science but political will."
2014 Newsletter
Our latest newsletter shows how close we are to reaching a tipping point, with science shifting inexorably towards human-focused research to deliver advances in medicine and more reliable safety tests.
Our mission is to accelerate this transition. Our comparative studies are designed to hasten this long-awaited shift. We have reached an exciting point, with partners ready to conduct our studies: the one thing we need now is funding, to get these studies underway.
Please help us if you can: the sooner we can demonstrate the superiority of human-based tests, the sooner they will be used routinely, in place of animal tests, to improve the safety of medicines.
Whatever you can afford to give will be extremely valuable and greatly appreciated - thank you!
Our 'Way Forward' article posted on AltTox website
AltTox.org is a project designed to provide timely information on scientific, technical, and regulatory aspects of non-animal toxicity testing methods. We were delighted to be invited to contribute a 'Way Forward' article, outlining the comparative studies that we are initiating, which is available here.


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Horrocks Engineers is excited to sponsor our fourth annual blood drive! "Blood Battle 2014" will take place on April 8, 2014. It is a friendly competition between several Northern Utah County cities to see which city can donate the most units of blood for the American Red Cross. Our goal is to collect 200 units of blood!
Our theme for this year's Blood Battle is Community Hero. Recently, the brother of one of our employees, Sgt. Cory Wride, was killed in the line of duty. We are deeply saddened by the loss of one of our community heroes, and are dedicating this year's blood drive to Sgt. Wride and his family. Opportunities to donate to the Wride family will be available at each blood donation site.
Please visit our website: http://projects.horrocks.com/blooddrive for more information including locations and times, and to register for the blood drive.


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Areas of Interest
Technology continues to transform our economy. That is why I have worked to strengthen Nevada's high-tech sector by providing our students with the skills they need to succeed in high-tech industries. I have also been an ardent supporter of the research and development tax credit and support making it permanent. Developers of emerging technologies often need unique incentives in order to make new technologies commercially viable. I am proud to have been honored by organizations such as the Information Technology Industry Council and TechNet for my efforts to expand the innovation economy in Nevada and throughout the nation. In order to compete for the jobs of the 21st Century, we must maintain our nation's competitiveness to keep our country at the forefront of technology and innovation.
Bringing New Industries to Nevada
Nevada's innovative business communities and close proximity to major markets make our state an attractive location for high-tech businesses. Both Reno and Las Vegas have emerged as hubs for high-tech companies that support over 25,000 jobs throughout the state. To support this growing sector of our economy, I have worked to garner federal support for initiatives to further expand Nevada's high-tech sector. For example, Varian, a producer of high-energy scanning systems, opened a manufacturing plant in Southern Nevada to build scanning systems for the Department of Homeland Security. In addition, General Electric's Minden plant in Northern Nevada is producing advanced monitoring systems, sensors, and diagnostic equipment important to an array of technologically advanced machinery.
While I am proud of Nevada's efforts to attract new high-tech businesses, we must also ensure that Nevadans can take advantage of these new job opportunities. I directed funding to establish the Nevada Center on Entrepreneurship and Technology (NCET). Since 2007, NCET has successfully operated in Nevada as an independent, non-profit organization educating and training hundreds of entrepreneurs. Working with local economic development officials, NCET co-hosts an annual expo-conference dozens of CEOs from innovative early stage companies, local small business leaders, 100 venture capitalists and "angel" investors, leading professional service providers, and entrepreneurship public policy advocates. On the national level, I have also supported legislation to provide tax incentives for businesses that train workers here in America and provide scholarships for technical training. Such initiatives will not only strengthen the American workforce but also cement America's global leadership in the high-tech industry.
I am also a longtime supporter of the Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) programs, which represent the federal government's largest small business research and development programs. Small businesses play a key role in spurring innovation and the SBIR and STTR programs provide these businesses with the capital they need to develop the next great technological advancement, all while creating good quality, high-paying jobs for Nevadans. After several months of obstruction, I was pleased to pass a long-term reauthorization of these valuable initiatives. I will continue to support programs and policies that help Nevada's high-tech businesses stay on the cutting edge of technology.
Action is also needed to keep Nevada's clean energy economy growing so we can become the central hub of clean energy—the global growth industry of the 21st Century. I will continue to support policies that will drive immediate investment in Nevada's clean energy future and then Nevada must have a coherent strategy to attract new industries, to forge regional and national alliances, to create markets for our products and renewable power, and to develop our human resources and capacity for innovation.
Preparing Nevada's Students for the Global Economy
We must ensure that our nation's students and teachers are prepared to continue leading the world in innovation, research, and technology. Across America, both children and educators increasingly rely on technology in the classroom to learn the skills needed to excel in core subjects, improve test scores, and succeed in today's workforce. In order to stay competitive long into the future, America needs the necessary education and innovation infrastructure. That is why I was a lead sponsor of the America COMPETES Act of 2007 and the American COMPETES Reauthorization Act of 2010, which focused on increasing American innovation and competitiveness to ensure that our nation's students and teachers are prepared to lead the world in research and technology. This important legislation has strengthened educational opportunities in science, technology, engineering, and mathematics (STEM) from elementary through graduate school by supporting internship opportunities and fellowships for students and encouraging students studying in STEM areas to pursue teaching credentials. This bill also significantly increased federal investment in research for the National Science Foundation, the National Institute of Standards and Technology, and the Office of Science at the Department of Energy, as well as other federal agencies to strengthen math and science education.
In 2009, I led passage of the American Recovery and Reinvestment Act (Recovery Act), which included significant funding for scientific research and technology and expanded access to broadband, particularly in rural communities. These investments will help ensure that students have the skills they need to be ready for higher education and the workforce. Unfortunately, since these investments in research and technology, across-the-board cuts known as "sequestration" has had a negative impact on important scientific research and efforts to further expand technology. I have worked hard and will continue to work to replace these senseless cuts with a more balanced approach to reduce our deficit, close wasteful tax loopholes, invest in important priorities such as research and technology, and make more targeted spending reductions.
Expanding Broadband Access
Many areas, particularly rural and low-income communities, continue to lack access to broadband service. It is critical that Nevada's rural areas benefit from the same technological advances that other parts of the country have enjoyed. Significant improvements have been made in providing access to all areas of the country, but more must be done. The Recovery Act provided a total of $7.2 billion for broadband expansion, consisting of $4.7 billion for a newly established Broadband Technology Opportunities Program and $2.5 billion for existing Department of Agriculture broadband programs. Those funds laid the groundwork for a national broadband policy that seeks to reduce and eliminate the digital divide between communities across the country. In 2012, I led passage of legislation authorizing the federal government to auction television spectrum to wireless carriers, which will improve wireless services and produce up to $15 billion in revenue. The legislation also sets aside spectrum and funds for a public safety network for first responders, finally realizing a goal established after the terrorist attacks of September 11th.
We must also ensure that the next generation is ready to meet the challenges of a global high-tech economy. Students increasingly need computer skills to compete for jobs, but too often schools lack the access to technology or teachers lack the training to empower our students with this knowledge. That is why I am a strong supporter of the e-Rate program, which provides discounted Internet access for schools and libraries. This important program has helped improve academic achievement and continues to provide our schools and teachers with the resources to prepare our students for the global economy. In addition, the Recovery Act provided $650 million to expand technology in the classroom and help teachers better incorporate technology into the curriculum.


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Do any syringe companies (brand/generic) make U-100 syringes with half unit markings??? Tried google, bing searches but get nothing useful... my local pharmacy does not know 8 O kinda doubt BD would tell me if a competitor made what Im looking for and they did not...
Anybody using a (U 100) syringe that have half unit markings >: D
Pharmacists don't take shots so they don't know these details :-). But they love to tell customers they don't exist!
What you want the pharmacy to order, is BD catalog number 328440. The half-unit markings are available only on the short (8mm) needle 3/10cc syringes.
Also, Relion has 3/10 cc syringes all of which have half unit markings. And because it is Walmart, they are cheap, $12.58/100.
Hello Brian:
Thank you for the information. Any idea what LENGTH the Relion 3/10cc needle is? The half inch is necessary, unfortunately...
I believe the 29 gauge is available in 1/2 inch length, but please check with Wally World.
You don't need half-unit markings - just do it by eye. I use 3/10 ml (30 unit max) syringes. They are marked only on exact unit measures, but the marks are far enough apart that I can estimate anywhere inbetween and sometimes will especially when doing corrections. Besides exact unit measure I will sometimes go for: "slightly over", "one third", "one half", "two thirds", "slightly under".
This is one reason I prefer syringes over pens. (And they are half inch).
I agree completley. On MDI I would often eyeball out a half a unit and it worked quite well.
Hello Jag:
Understood, much is done by "eyeballing" and best guess... but know how bad all our toys are -brief grimace-, but many believe them anyway... sigh.
Yes, I use Sure Comfort ordered from American Diabetes Wholesale http://www.americandiabeteswholesale.com/. Great service. Inexpensive, no tax & free shipping with a $100 order. Cheaper for me than buying BD with insurance co-pay. I refuse to buy anything at Wal Mart, the evil empire.
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Lazy Lizard Loses License
by Staff | May 1, 2014 6:46 am
(4) Comments | Commenting has been closed | E-mail the Author
Posted to: Arts & Culture, Legal Writes
After hearing from top cops who branded the club a "disorderly establishment," the state Liquor Control Commission has denied a license renewal request from the Lazy Lizard Cafe.
The commission handed down its decision about the club at 201 Crown St. on Tuesday.
It represented the latest episode in New Haven officials' efforts to quiet the downtown club district.
In its decision, the commission stated it it found testimony by Assistant Police Chief Luiz Casanova particularly "clear and credible." Casanova testified about a May 18, 2013. "huge brawl" inside the club that led to the shooting deaths of two young men immediately outside it. Club owner Anthony Delmonaco "'hindered the investigation' with regard to the video footage and 'didn't cooperate to what we would have liked for him to have cooperated.'"
The decision also noticed three people were stabbed, one fatally, during a fight inside the club on Nov. 28, 2009.
The decision was signed by Commissioners Elisa A. Nahas, Angelo J. Faenza, and Stephen R. Somma. Click here to read it.
The commission heard from a neighbor who complained about noise and trouble at the club; and from a liquor control agent who reported on two citations over the past two years at the club for serving alcohol to minors. Police Chief Dean Esserman wrote to the commission asked it to reject the license because of the "club's track record of violations and violent incidents." Top Downtown cop Sgt. Tammi Means joined Casanova and neighbors in speaking at the commission's administrative hearing on the license renewal, which took place March 27.
Members of the DelMonaco family have owned the club since 2001, originally operation it as SciFi Cafe. Maria DelMonaco spoke at the commission's hearing. The owners—since 2009 doing business as MAD Crown Street Holdings LLC—argue that they have run the club responsibly and that the city has targeted them because they host events geared toward African-American patrons.
The family said Wednesday it would wait to speak with its lawyers before commenting on the license renewal rejection.
New Haven officials have been pressing state officials, and the liquor commission in particular, for help in dealing with violence in and near nightclubs in town. New Haven state Rep. Roland Lemar had pushed in 2011 for a measure allowing the public to weigh in on license renewals; thanks to that process, the "public voice was heard" in the Lazy Lizard decision, Lemar was quoted in a statement his office released Wednesday afternoon. He called the decision "a clear victory for downtown residents, neighbors and responsible business owners in our district. ... This is
exactly what we had in mind when I introduced the bill in 2011."
Gov. Dannel P. Malloy, who's running for reelection this year, praised the Lazy Lizard decision in a press release issued Wednesday. We will not tolerate establishments that turn a blind eye to the safety of their patrons," Malloy was quoted as saying. "If violence becomes a problem, the owners have a responsibility to take the necessary steps to ensure that the proper security is in place.
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posted by: connecticutcontrarian on April 30, 2014 3:32pm
Good riddance. If only we could clear out all of the slumlord millionaires who run establishments downtown that routinely attract violent elements. Whatever happened to that place under the garage whose manager also claimed she was being targeted because of her ethnicity and the race of her customers?


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AVPORT Jan. 6 meeting is a successFriday, January 18th, 2013 Issue 03, Volume 17.
"One nation under God, with liberty and justice for all," rang in the ears of the citizens that packed the Anza Community Hall on Sunday, Jan. 6, as the Pledge of Allegiance was led by Mike Mrsny of Anza Valleys Property Owners Rights Team (AVPORT). As a veteran he reminded the crowd that, "We say the pledge to honor the country we serve every day." It was a good turnout considering it was a cold, blustery day of rain, sleet, wind, and snow. Despite this, citizens came to hear what AVPORT had to report, concerning the program that the county had set up which was not real amnesty. They also came to learn the how, why, who, and what was happening with code enforcement and the newly-formed AVPORT; whose apropos tag line sums up the entire intention of the group "Citizens Assisting Citizens." Over the course of the next few weeks, however many it may take, the Anza Valley Outlook will showcase the different highlights and info from the three-hour meeting with AVPORT on Jan. 6. Anza citizens will have the opportunity to learn and know what is happening for the good of the people and how they too can help and get involved. On Jan. 6, Robyn Garrison introduced Pastor Kevin Watson who gave the invocation, "Heavenly Father, we come before you and just offer this time up into your hands and pray that you would give us wisdom in our direction and that you would help us accomplish much. "Lord, we are asking that we would be rightly governed. That we would have the ability to go back to our roots Lord and have a nation that is founded by people that love you and people that expect the best. "Lord, we pray that all things would be brought into your light, that you would expose the darkness and the deception, and allow your truth to remain. We pray for this valley to be filled and for this valley to flourish in your hands. We are asking, Lord, you would bless us and help us through these difficult times. We honor you. In Jesus name, Amen." Mike Mrsny lead in the Pledge of Allegiance and Robyn Garrison introduced the board â Mike Machado, Pres.; Robyn Garrison, VP; Mike Mrsny, Treasurer; Lisa Wallace, Sec.; Directors Steve Packer, Paul Petkey, and Paul Gregoire. Machado said, "I would like to thank the community hall and the members of the association for providing us with the hall. Keep in mind this hall is brought to you by yourselves, basically through the donations and the memberships that are paid for by you. "Our government really does not participate in this, although weve had some promises lately from the county, that maybe we will get some air conditioning. That remains to be seen." Machado also gave some background history on the beginnings of AVPORT, "July 8, 2012, AVPORT was the beginning moment, an estimated 500 people came into this hall and they wanted to know what they could do about Riverside County code enforcement. (There had been a flurry of citations, that year of 2012, and many felt they were unjust or unjustly treated, and that they had no recourse.) "We represent the community of an Anza and its territory. 187 people signed a membership or participating document saying that they wanted something done about this. After they were compiled and we looked at where they all came from, they were as far away as Pinyon, some of them were down in Aguanga, some of them as close as Temecula. We even had folks who own property from Diamond Bar, Los Angeles, San Diego and Phoenix, Arizona present. "After this meeting the board members that we now have for AVPORT met and came up with a mission statement that we felt best represented what you had to say that day." The Mission of AVPORT is: To seek protection of property rights in the Anza Valley at its territory while ensuring public health and safety in accordance with the standards adopted by the state of California in cooperation with local government, citizens assisting citizens. "What that means is that we will do everything we can to represent your interest because we exist at your convenience," said Machado. "Were not here as a special interest (group), were not here in favor of or opposed to any government. Were not here to tell anybody what they should do, how they should live, where they should live, or anything of a sort. We are here to make sure the Constitution of the United States is applied by this local government; when they come to deal with you, or your neighbors or with any other person. "We believe, as you have directed us to believe, that the Constitution of the United States shall be upheld even in this tiny little community we call Anza. And that is exactly what we intend to accomplish. "Were not an organization that will say its OK to burn down your house Advertisement "Riverside County has ordinances number 348 and 457, which are their most popular ordinances, and those ordinances are designed to tell you how and by what means you need to operate in order to use your property. How those things are enforced and interpreted generally speaking have a very broad brush when a local county decides to enact these things, this is where we come in. "AVPORT is here to represent your feelings to the County of Riverside, of what you want to see happen. It is also here to address the concerns and the things that have been done to the people here over the preceding five years or so which is the crux of where Code Enforcement has been. It actually has been going on since 1984, I moved here in 1984, and probably long before that. I think it was in the late seventies when Code Enforcement officers started to appear up here. It has been my experience that they have a tendency to abuse their authority especially in dark economic times. Because one of the things that government has to do is it has to add revenue in order to support itself. So, sometimes it uses, and sometimes the government gets a little aggressive, in the way it uses those laws in order to raise revenue. I dont believe we want them to do that in Anza anymore." Examples of problem cases "The cases that we have had for the short time AVPORT has been here, which goes back to September of last year, many of these cases involve shipping containers," said Machado. "A retroactive approach to shipping containers has been taken; Code Enforcement comes and has told people that they can no longer have shipping containers. This violates fundamental due process rights under the Constitution, because if you had them prior to the enactment of the law you are entitled to keep them. "There are people who have been made homeless by Code Enforcement going to their property and saying that they have no permits and that they have to tear down their house and move somewhere else. They tell people that they cant occupy their own land, that if you dont have a home you cant live on your own property. "The Constitution says that any person who owns that land can occupy that land, and it doesnt matter if they only have two twigs and a flag, they have a right to occupy that land. Code Enforcement has come up, and cited people for the storage of vehicles, and justified or not, it seems to be arbitrarily applied. Some people are left alone and some people are not. Some people have operating cars and the owners are told to get rid of them, some people are told it doesnt matter, deals are made. All sorts of things have occurred when it comes to storing things on your property. Youre only allowed to have so many square feet of storage material on your property. However, if you are going to build a house you should be allowed to store whatever is necessary to complete that. "Agricultural uses should be treated the same way; people have been cited for storing fencing and other types of agricultural material even though those things are being used to cultivate that land. We had issues with occupancy in RVs. We have one gentleman who moved up here and planted and a bunch of trees and ran an irrigation system. He came back two weeks later to find his trees were gone and so was his irrigation system. He got a RV, and got a person to live on the property. He then re-planted his trees and re-ran his irrigation system and developed his own security. Code Enforcement came along and told him he could not do that. Youre not allowed to provide security for your property. You have to have a house before you can do that. I dont know if you agree with that or not, I dont. "We have had other cases, where the person was not even guilty at all, they did not violate the ordinances; they were told they could not keep horses on a particular piece of property, but the ordinance specifically said they could. They were cited anyway and given a $250 fine. Any way thats why were here." 0 comments Be the first to share your opinion on this article!
Anza Valley Outlook has tightened its' policy regarding comments. While we invite you to contribute your opinions and thoughts, we request that you refrain from using vulgar or obscene words and post only comments that directly pertain to the specific topic of the story or article. Comments that are derogatory in nature have a high likelihood for editing or non-approval if they carry the possibility of being libelous. The comment system is not intended as a forum for individuals or groups to air personal grievances against other individuals or groups. Please, no advertising or trolling. In posting a comment for consideration, users understand that their posts may be edited as necessary to meet system parameters, or the post may not be approved at all. By submitting a comment, you agree to all the rules and guidelines described here. Most comments are approved or disregarded within one business day. |
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I recently read the story again about Joseph (Genesis 37-47), and how he grew from an immature teen into the leader that was handed the keys of authority in Egypt and who saved the entire Israelite population from starvation during a seven year famine. You are surely familiar with Joseph (the coat of many colors, dream interpreter, thrown into a well by his brothers, sold into slavery, etc…)
What can we learn about Godly leadership through the life story of Joseph?
- Leaders are developed…not born. As a teen, he created division in his family with his over confidence and untactful attitude. He didn't have natural abilities.
- Developing as a leader takes time. His journey started at the age of 17. He was 30 before he was given a true leadership position. It was another 14 years before he had truly arrived as a leader.
- Even during difficult trials, he never cursed God. He remained faithful and allowed God to use him. His character and integrity were never sacrificed.
- He didn't take revenge when his position would have allowed him to do so. Instead he forgave his brothers, and gave Glory to God for His hand in his life. He used his leadership position to serve, not to be served.
There are many more lessons to be learned from this story, but here are a few thoughts to make this personal.
God's timing is long term…not short term. Are you asking God to do something in your life NOW!? What if God has a bigger long term plan for your life. It's better to be in GOD's will, than attempt to get God in line with YOUR will.
Do you sometimes feel like you just aren't as effective or influencial as you want to be? Do you sometimes feel like your gifts and abilities are just not being used to their fullest? Remember that leadership takes time and is developed daily. Look at your daily habits and start taking intentional daily steps at growing in a particular area. Be open to new opportunities (big or small), and seek out opportunities to serve.
Who knows, over time, God might just use you for GREAT things you never saw coming.
About Brad White
R. Brad White is the Founder and President of Changing the Face of Christianity Inc. Brad is a former atheist and became an "on fire for God" Christian in 2005. In 2008, Brad became incredibly burdened by what he perceived as a Christian faith far off course, and Christians far from living the teachings of Jesus Christ. In 2010, Brad submitted to the calling to reverse these negative Christian stereotypes, by starting "Changing the Face of Christianity" (a 501c3 Texas non-profit corporation). Read more about R. Brad White


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Young Rucka
- 01First Song
- 02Track Number Two
- 03Third Song
- 04Composition #Four
- 055th
- 06Song
Young Rucka is the name im an Independent artist from Pittsburgh ,Pa.My interest is in music. Dont be a stranger..."check me out" and see what im capable of . Futurism the mixtape coming soon "October 20th" Get it for "free download" here @ hotnewhiphop.com.
Record Label: LoudPak


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- Young, friendly, sociable team
- Gain real experience in science publishing
- Contribute towards a leading online publication
- Idyllic countryside location with easy access to Bath, Bristol and the South West
The Role
This is a unique opportunity for a Science graduate to join our editorial team in a temporary position starting ASAP (approx 2 month position). You will be responsible for publishing news articles, application notes, scientific posters and videos. This is a fantastic opportunity to gain experience in a leading online publishing company.
Excellent English and meticulous attention to detail required. A Biology or Chemistry degree is also required.


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While standard medical practices focus on treating symptoms when it comes to many age related problems, Dr. Cox offers solutions that can help eliminate the causes. Through the use of Anti-Aging Programs, Bioidentical Hormone Replacement Therapies, Nutritional Evaluations and Nutritional Supplementation, we are able to dramatically slow down the aging process.
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Activity Feed
g Register or sign in to start receiving activity updates from around Kongregate!
Explore Kongregate & earn 10 kreds Here are your 10 free kreds Explore Kongregate & earn a trophy Here's a shiny trophy for you 15%
Keep exploring Kongregate with more badges and games!
Hide the progress bar forever? Yes No
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It you have propbles with developing then oh well talk to deveopers about what they did to make great games!:) im helping even tho im not staff no stop complaning!
Come again?
I think he is trying to be helpful.Like e-mail him if something is wrong…maybe he thinks he is Kongregate staff.If that is the case irey kongregate admins and moderators are those who should do that you just enjoy gaming.


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A diverse spectrum of disease affects the biliary system, often presenting with similar clinical signs and symptoms. See the images below.
View Image | A normal postcholecystectomy cholangiogram. |
View Image | Biliary disease. In this patient with persistent elevation of liver-associated enzymes, the contrast entering the biliary ductal system preferentially.... |
View Image | Biliary disease. Even when the catheter is advanced to the proximal common hepatic duct, contrast dye preferentially fills the cystic duct and gallbla.... |
View Image | Biliary disease. In this image, the common bile duct is occluded with a balloon-tipped catheter. Contrast fills the intrahepatic ductal system to reve.... |
Bile is produced by the liver and channeled by the biliary ductal system into the intestinal tract for the emulsification and absorption of fats. Biliary disease is caused by abnormalities in bile composition, biliary anatomy, or function. The liver determines the chemical composition of bile, and this may be modified later by the gallbladder and biliary epithelium. Cholesterol, ordinarily insoluble in water, comes into solution by forming vesicles with phospholipids (principally lecithin) or mixed micelles with bile salts and phospholipids.
When the ratio of cholesterol, phospholipids, and bile salts is outside an optimum range, cholesterol monohydrate crystals may come out of solution from multilamellar vesicles. Cholesterol supersaturation of bile appears to be a prerequisite for gallstone formation, which involves a variety of factors that affect the activity of low-density lipoprotein (LDL) uptake, hepatic 3-methylglutaryl coenzyme A reductase (HMG CoA), acyl cholesterol-lecithin acyltransferase, and 7-alpha hydroxylase.
By itself, cholesterol supersaturation is inadequate for explaining gallstone pathogenesis. Nucleation, the initial step in gallstone formation, is the transition of cholesterol from a soluble state into a solid crystalline form. Within gallbladder bile, biologic molecules influence the process in a positive or negative fashion.
For example, mucus may function to promote nucleation, while bile-specific glycoproteins may function to inhibit nucleation. Mucin hypersecretion by the gallbladder mucosa creates a viscoelastic gel that fosters nucleation. Arachidonyl lecithin, which is absorbed from the alimentary tract and secreted into the bile, stimulates prostanoid synthesis by gallbladder mucosa and promotes mucus hypersecretion, while inhibitors of prostaglandin inhibit mucus secretion.
Finally, gallbladder hypomotility and bile stasis appear to promote gallstone formation and growth, which may be important in diabetes, pregnancy, oral contraceptive use in women, and prolonged fasting in critically ill patients on total parenteral nutrition.
Gallstone disease is one of the most common and costly of all digestive diseases. The third National Health and Nutrition Examination Survey estimated that, in the United States, 6.3 million men and 14.2 million women aged 20-74 years had gallbladder disease.
The incidence of gallstones is 1 million new cases per year. The prevalence is 20 million cases among Americans.
Approximately 2-7 cases per 100,000 population of primary sclerosing cholangitis (PSC) exist. About 5% of patients with chronic ulcerative colitis develop PSC.
The incidence of gallbladder cancer is 2.5 cases per 100,000 population.
The incidence of primary biliary cirrhosis (PBC) is 5.8-15 cases per 1 million population. The incidence of PBC appears to be increasing, but the cause of the increase is unclear. However, the increase is possibly due to better detection and increased awareness rather than a true change in disease incidence.
Mexican Americans and several American Indian tribes, particularly the Pima Indians in the Southwest, have very high prevalence rates of cholesterol gallstones. Decreased bile acid secretion is believed to be the common denominator in these ethnic groups.
The prevalence of cholesterol gallstones is higher among females than males (lifetime risk of 35% vs 20%, respectively). This likely is due to endogenous sex hormones, which enhance cholesterol secretion and increase bile cholesterol saturation. Progesterone also may contribute by relaxing smooth muscle and impairing gallbladder emptying.
Increased age is associated with lithogenic bile and an increased rate of gallstones.
Biliary disease presents with some diversity, from no symptoms to a constellation of signs and symptoms of varying severity and combination. Accurate diagnosis, therefore, begins with listening closely to the patient. Reaching an accurate diagnosis is aided by clinical experience and often involves imaging studies.
When abdominal pain is the chief symptom, seek to determine when it began and the subsequent events. Clarify what the pain feels like to the patient; visceral pain is perceived as a vague, dull, gnawing, burning, or aching sensation, whereas parietal pain is sharper in quality and better localized. Psychological conditions (eg, anxiety, worry) may enhance pain perception, while impaired consciousness tends to blunt pain perception.
The patient with acute biliary-type pain often is restless, anxious, and frustrated by unsuccessful attempts to find a comfortable position. Severe pain of acute onset usually is associated with facial grimacing. Writhing, diaphoretic patients usually are acutely and seriously ill; however, some patients with peritonitis may lie still, with a worried facial expression, and avoid being touched or jostled.
Hepatobiliary histology has emerged as an objective reference for staging PBC and PSC. In both, 4 stages are identified.
Medical management of gallstone disease has decreased in recent years with the advent of laparoscopic cholecystectomy. Cholecystectomy remains the preferred method because of its reduced cost, definitive nature, safety, and increased convenience to the patient.
Medical management may be an effective alternative to cholecystectomy in selected patients with symptomatic gallstone disease. Three methods used alone or in combination are available for the nonsurgical management of patients with gallstone disease, as follows: (1) oral bile salt therapy, primarily ursodeoxycholic acid, (2) contact dissolution, and (3) extracorporeal shock-wave lithotripsy. The method of choice depends upon the number, size, and composition of the stone(s); many symptomatic patients have stones that are not ideally suited to any of these methods, producing less than optimal results.
Several years of treatment may be necessary to completely dissolve a stone, and a 50% chance of stone recurrence over a period of 5 years exists. Some evidence supports using nonsteroidal anti-inflammatory drugs (NSAIDs) in the setting of recurrent biliary pain; inhibition of prostaglandins may arrest the inflammatory process and reduce the chance of developing acute cholecystitis.
There is consensus that incidentally discovered asymptomatic gallstones should not be treated. Once a patient develops symptoms or complications related to gallstones (eg, acute cholecystitis), treatment to eliminate the gallstones is recommended because the likelihood of subsequent symptoms or complications is high. The National Cooperative Gallstone Study demonstrated that the risk of recurrent symptoms was approximately 70% during the 2 years following initial presentation.
Patients with a clinical diagnosis of acute cholecystitis should be admitted to the hospital, where they should have nothing by mouth (NPO) and be administered IV fluid hydration; correction of any associated electrolyte disorders is an important initial measure. In most cases, inflammation is initiated by mechanical obstruction of the cystic duct and mediated by a chemical irritation of the gallbladder mucosa (by lysolecithin).
However, in 20% of patients, bacterial infection complicates the picture. The most frequent isolates from the gallbladder or the common bile duct are Escherichia coli (41%), Enterococcus (12%), Klebsiella (11%), and Enterobacter (9%).
When poor clinical appearance, fever, and leukocytosis are prominent features of the illness, broad-spectrum antibiotics are indicated. Empiric antibiotic therapy should be directed at the organisms most frequently recovered. While the use of a second-generation cephalosporin, such as cefuroxime, is fairly common, cephalosporins do not treat Enterococcus. The combination of ampicillin (2 g IV q4h) and gentamicin (dosed according to weight and renal function) as empiric treatment can be used. The aminoglycoside is included for coverage of E coli and other gram-negative bacilli and also for synergy with ampicillin against Enterococcus. Routine coverage of anaerobic organisms is not required for acute cholecystitis since these organisms are recovered infrequently.
NSAIDs are useful in reducing inflammation, but narcotic analgesics often are needed to alleviate pain. Unless severe comorbid disease is a contraindication, these patients should undergo a cholecystectomy once their condition is stabilized.
The treatment of cholangitis is similar to that of acute cholecystitis, except that endoscopic intervention is indicated. The mainstays of therapy are antibiotics and the establishment of biliary drainage. Broad-spectrum antibiotics are indicated initially to cover gram-negative bacteria and Enterococcus. Antibiotics include ampicillin plus gentamicin, carbapenems (imipenem or meropenem), and fluoroquinolones (levofloxacin). Other agents that have good activity against intestinal anaerobes and lack the nephrotoxicity of aminoglycosides are piperacillin (4 g IV q6h), piperacillin-tazobactam (4/0.5 g IV q6-8h), ampicillin/sulbactam (3 g q6h), or ticarcillin-clavulanate (3.1 g q4h). Unlike acute cholecystitis, in patients with a more toxic appearance, metronidazole is often added to cover anaerobes, although the contribution of anaerobes to infection is low in patients who have not had previous biliary tract instrumentation or surgery.
Depending on the etiology of the cholangitis and the comorbid status of the patient, biliary drainage is established by endoscopic retrograde cholangiopancreatography (ERCP)–guided sphincterotomy and stone extraction or biliary stent placement. In a patient with sepsis, the least aggressive intervention to establish biliary drainage is often best, with subsequent plans for definitive therapy (cholecystectomy) once the patient's condition is stabilized.
Percutaneous drainage should be considered when ERCP is unavailable, unsuccessful, or contraindicated. A percutaneous cholecystostomy tube may be an option in patients with an intact gallbladder.
Two major goals of treatment in PSC are retardation and reversal of the disease process and management of progressive disease and its complications. A variety of immunosuppressive and anti-inflammatory agents have been studied in patients with PSC, including ursodeoxycholic acid (UDCA), corticosteroids, cyclosporine, methotrexate, azathioprine/6-mercaptopurine, tacrolimus, and D-penicillamine.
No effective medical treatment exists for PSC.
UDCA, a hydrophilic bile acid, is the most extensively studied of all medical treatments of PSC. Ursodiol, used to create a less toxic population of bile acids, initially showed promise; however, subsequent clinical studies showed no difference in the time to treatment failure. It has also been hypothesized that UDCA given in higher than standard doses (20-30 mg/kg/d vs 13-15 mg/kg/d) may increase the benefit. Larger scale prospective studies of high-dose UDCA are currently underway.
Reduction of hepatic copper levels using D-penicillamine showed no benefits; immunosuppressives either failed or worsened patient status. Oral corticosteroids might help early stage disease with marked inflammatory changes as observed on biopsy specimens. Steroids administered by nasobiliary lavage complicated matters by introducing bacterial cholangitis.
While colchicine and steroids together improve laboratory test results, the development of cirrhosis is not diminished, and metabolic bone disease is aggravated, causing some patients to develop compression fractures. Colchicine alone showed no improvement in symptoms, serum biochemistry, liver histology, or survival rate. While methotrexate decreased serum alkaline phosphatase levels, it produced no appreciable improvement in bilirubin, AST, ALT, or albumin levels, and it had minimal effect on symptoms or histologic progression. Cyclosporine decreased serum alkaline phosphatase levels but did not improve symptoms, histologic progression, or the development of complications.
Endoscopic therapy to dilate and/or stent dominant strictures is reasonable in centers with considerable expertise in therapeutic biliary endoscopy. An important potential clinical benefit is relief of jaundice and pruritus, although a benefit on disease progression has not been clearly established.
Liver transplantation is now the treatment of choice for patients with advanced liver disease secondary to PSC.
The management of this disorder has 2 goals, as follows: (1) the treatment of symptoms and complications that result from chronic cholestasis, and (2) the suppression of the underlying pathogenic process (ie, the destruction of small intralobular hepatic bile ducts). The complications that occur in PBC that require therapy include pruritus, metabolic bone disease, hypercholesterolemia/xanthomas, atherosclerosis, malabsorption, vitamin deficiencies, hypothyroidism, and anemia.
Data exist showing that medical therapy benefits patients with PBC. The only approved treatment is UDCA, which is the only treatment (aimed at modifying the natural history of the disease) recommended in the guidelines issued by the American Association for the Study of Liver Diseases (AASLD). UDCA alone (13-15 mg/kg/d is given in divided doses with meals and at bedtime) in asymptomatic patients with stages I-III disease. Blood tests are monitored every 3 months. If normalized within 6 months, UDCA is continued and liver biopsy is repeated within 18-24 months. If the biopsy result is stable or improved, UDCA is continued indefinitely and a liver biopsy is repeated after 2-3 years and then less often if still improved.[7]
In clinical studies, colchicine had no effect on symptoms, physical findings, or histology, but it improved levels of serum albumin, bilirubin, alkaline phosphatase, cholesterol, and aminotransferases. One study showed improved mortality rates (21% vs 47%, P = 0.05). In a double-blind randomized clinical trial, azathioprine was well tolerated, slowed incapacitation, and improved actuarial survival by 20 months. However, the development of major complications or the need for liver transplantation was not influenced. In a small prospective randomized trial, chlorambucil reduced the inflammatory cell infiltrate, but it did not improve serum alkaline phosphatase levels, fibrosis, or histologic severity.
Methotrexate, used in pilot studies only, has been said to have beneficial effects on the symptoms and biochemical and histological features of PBC. However, one randomized controlled trial of methotrexate therapy suggested that, even at low doses (2.5 mg 3 times per wk), methotrexate may be toxic over a 6-year period. Hence, at the present time, insufficient data support the use of immunosuppressive therapy for PBC.
Similar to the experience with PSC, corticosteroids worsened metabolic bone disease and D-penicillamine induced serious adverse effects without providing a clinical benefit.
Liver transplantation in PBC is recommended for cases of liver failure. Liver transplantation may be recommended in appropriately selected patients for uncontrollable pruritus and severe osteoporosis.
The pruritus associated with cholestasis may respond to cholestyramine, rifampin, and even large-volume plasmapheresis. Naloxone also reduces the severity of itching but requires parenteral administration. Oral naltrexone may be an effective and well-tolerated alternative.
Patients with steatorrhea may benefit from pancreas enzyme supplements and fat-soluble vitamins A, D, E, and K.
Endoscopic management of biliary stones: Because choledocholithiasis frequently causes abdominal pain, pancreatitis, cholangitis, and secondary biliary cirrhosis, treatment is recommended once stones are identified. The standard approach is to perform an ERCP with biliary sphincterotomy[8] and stone extraction using a balloon-tipped catheter or wire basket.[9] Clearance rates range from 80-95%, depending on the experience of the endoscopist, with an associated morbidity rate of 5-10% and a mortality rate of 0.5%.
Kageoka et al evaluated the long-term prognosis of 262 patients following endoscopic sphincterotomy for choledocholithiasis and the need for cholecystectomy post endoscopic shincterotomy.[8] Patients were divided into 4 groups according to previous cholecystectomy (n = 18); those having a calculous gallbladder and who underwent cholecystectomy after endoscopic sphincterotomy (n = 129); those with a calculous gallbladder in situ (n = 46); and patients an acalculous gallbladder in situ (n = 69).
Of the 262 patients, late complications occurred in 34 patients (13.0%), and recurrence of choledocholithiasis occurred in 29 patients (11.1%).[8] The group with a calculous gallbladder in situ had a late complication rate of 23.9% and a rate of recurrent choledocholithiasis of 17.4%, compared with a late complication rate of 23.9% and recurrent choledocholithiasis rate of 7.8% in the group with a calculous gallbladder that underwent cholecystectomy after endoscopic sphincterotomy.
Other findings included an association between pneumobilia after endoscopic sphincterotomy and choledocholithiasis recurrence, the presence of acute cholecystitis in 8 (7.0%) of 115 patients with an intact gallbladder, and 1 gallbladder carcinoma.[8] The investigators concluded endoscopic sphincterotomy is a safe and effective procedure that should be used in patients with a calculous gallbladder.[8]
Intraoperative endoscopic sphincterotomy (IOES) during laparoscopic cholecystectomy has been suggested as an alternative treatment to preoperative endoscopic sphincterotomy (POES) followed by laparoscopic cholecystectomy because IOES is as effective and safe as POES and results in a significantly shorter hospital stay.[10]
Refractory stones usually can be cleared using a mechanical lithotripsy device; however, electrohydraulic lithotripsy (EHL) and laser lithotripsy also can be used. Refractory biliary stones can be managed with biliary stent placement and ursodiol. In selected patients, percutaneous choledochoscopy can be used to remove intrahepatic stones using EHL or holmium laser lithotripsy (a holmium laser is used to fracture the stones).
Endoscopic management of benign biliary strictures: Benign postoperative strictures are managed successfully by endoscopic balloon dilation and stent placement on a quarterly basis for a period of a year. This approach has an 83% success rate, with 17% of cases eventually requiring surgical intervention. In patients with sclerosing cholangitis, mechanical dilation of dominant extrahepatic strictures decreases bilirubin but does not improve liver-associated enzymes. It primarily is helpful in preventing a dominant stricture from causing further damage to the liver, and it may delay the need for a liver transplant. Patients with a symptomatic or complicated distal biliary stricture caused by chronic pancreatitis usually are best managed surgically. In selected patients with high operative risk, placement of a metal mesh stent may be helpful; however, a tendency exists for biliary epithelial hyperplasia to obstruct these stents within several years.
Endoscopic management of malignant biliary strictures: The technical success rate of endoscopic dilation and stent placement for palliation of malignant biliary strictures is greater than 90%. It is associated with fewer complications than percutaneous transhepatic biliary drainage, and clinical studies show that the results are equal to that achieved with surgical bypass. Although the patency rate of metal mesh stents exceeds plastic stents, tumor ingrowth still may obstruct the stent and require subsequent procedures. Suppurative cholangitis can develop as a serious complication of an obstructed biliary prosthesis.
A retrospective review of percutaneous interventions performed from 1980-2005 at a tertiary-level hepatobiliary center by Castaing et al suggests that in complex biliary disease, the percutaneous approach is a feasible and safe therapeutic option and should be considered by experienced hepatobiliary teams.[11] Repeated interventions, prolonged biliary drainage, and optimal antibiotic therapy are necessary for this approach to be successful.
When biliary disease associated with decreased bile flow causes steatorrhea, a diet low in neutral triglycerides often is prescribed. Supplementation with medium-chain triglycerides also is helpful.
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Clinical Context: Decreases cholesterol content of bile and bile stones probably by reducing secretion of cholesterol from the liver and the amount reabsorbed by intestines.
Ursodeoxycholic acid is a naturally occurring bile acid used successfully in the dissolution of gallstones, microlithiasis, and in primary biliary cirrhosis. Some benefit may exist in patients with Caroli disease.
Clinical Context: Forms a nonabsorbable complex with bile acids in the intestine, which in turn inhibits enterohepatic reuptake of intestinal bile salts.
Clinical Context: Antimycobacterial agent noted to alleviate pruritus in 79% of patients with primary biliary cirrhosis. Effect may be a result of changed metabolism of liver bile acids or by altered bacterial metabolism by intestinal bacteria.
Clinical Context: Opioid antagonist useful in treatment of pruritus.
This 92-year-old woman had recurrent abdominal pain and jaundice. A right upper quadrant ultrasound showed a dilated biliary duct with no stones. She had a previous Roux-en-Y surgery that made endoscopic retrograde cholangiopancreatography (ERCP) impossible. Critical aortic stenosis that increased the risk of most interventions. This percutaneous cholangiogram, performed under conscious sedation in the operating room, revealed a large stone missed by the ultrasound. It was removed successfully with percutaneous choledochoscopy and electrohydraulic lithotripsy.
Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. Unfortunately, the tumor has grown through the metal mesh to reobstruct the biliary system. After a wire is passed through the lumen, a balloon-dilating catheter is passed into the metal mesh stents and inflated to enlarge the lumen.
Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. The tumor has grown through the metal mesh to reobstruct the biliary system. After a wire was passed through the lumen, a balloon-dilating catheter was passed into the metal mesh stents and inflated to enlarge the lumen. In this image, 2 plastic stents were passed into the intrahepatic ductal system to again palliate the obstruction.


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At present, social networking activity does not directly affect search results – a surge of Facebook Likes, Google +1's, or Twitter links will not boost your site to the top of the first page of search results. However, they do increase click-through rate, which in turn increases potential social shares. These are indirect benefits which ultimately result in a better search ranking for your site. As such, social media should be an important part of your site's SEO strategy. To illustrate the point, let us take a closer look at two of the many ways in which SEO & social media strategies integrate.
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The Intersection of Social Media & SEO
April 6th, 2012 — Social Search
Google +1 is a Paradigm Shift
September 22nd, 2011 — Social Search
Yesterday, Google made its +1 social networking offering fully open to all users after the beta launch in July. Amidst much fanfare, +1 was positioned to compete head on Facebook's "Like" button feature, and initial adoption was far better than anticipated with over 20 million users signing on in the first month. Continue reading →