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The 2014 Smashington Music and Art Festival is slated for The Discount Music Center on Saturday, May 10 from 2-11 p.m. in Orlando. There will be three stages of live music plus, live graffiti, live performance art and select vendors at the single-day music festival.
The Soul of Da City stage will feature live music from Orlando bands HOR!ZEN, Family Gang, Evan Taylor Jones, Meka Nism, Drew Yardis, American Jesus, Phraydoe Peans, Ancient Sun, Atemus, Deaf 2 the Industry, Palmer Reed and Tears of a Tyrant along with Kaleigh Baker (formerly of Orlando), Apollo Electric, Jessica Rousse and Big Pollo Funk. "We're so excited about it!" said the members of Tears of a Tyrant. "Last year, it was an amazing event and this year should be even better! There's something for everyone, even the kids."
The Red Bull MXT Truck stage hosted by Mad Illz and special guest MC Supernatural will feature live performances by Orlando's DJ Jay Mob, Twan D the Student, MyVerse, Jonny Storm, AmIam, Trini Elev8, Trenchcoat Deviants, Shaman Treez, Afrodeeeshezzzz, Truly Def and more.
The Medical Marijuana stage will feature live music from Orlando bands Buster Keaton, Brigitte Hart, Lake Worth Long Shots, Warm Like Winter, Succulent Thing, Roquois Roquois and Michael Shelly, The Strange Trip, Ridiculous Nick, Ferrum Dei, Boss Omnivore and Jahnopa along with Green Sunshine, Me and My Animal Friends, Dan Taylor, Satellite Lounge, Jessie Bankss and Clutch City.
"Meka Nism is very excited about the Smashington Festival and honored to be a part of it," said the members of Orlando band Meka Nism. "It's a great way to unite the community as a whole and for everyone to have their talents on full display. The Orlando scene is growing and what better place to have a huge melting pot of the best talent around than the Smashington Festival."
The Discount Music Center is located at 3301 Gardenia Ave. in Orlando. Advance tickets for the Smashington Music and Art festival are available for $10 from the artists or they'll be $15 at the gate. This is an all ages event and kids under the age of 10 get in FREE.


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Zoo Tycoon 2 DS (DS) review
"It's easy to get sidetracked, since there's so much to do. For example, you might be asked to build cages for animals that all come from Africa. Of course, some of those critters can be pretty expensive, so you have to build up revenue by first showing less costly beasts to your happy patrons. Then along the way, you might start going overboard with the placement of vending booths and benches. Suddenly, a year has gone by and you haven't made any progress on those primary objectives. Disaster looms."
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Theater News
Tony Danza
Jennifer Nettles and Larry David Welcome Sara Bareilles and Waitress to Broadway
By David Gordon
A host of stars attended the opening night to see Jessie Mueller, Keala Settle, and Kimiko Glenn in the new musical.
Tony Danza: Standards and Stories at Café Carlyle
The consummate showman sings his life in the key of Sinatra.
Tony Danza to Lead North American Tour of Broadway's Honeymoon in Vegas
Danza shared the stage with Rob McClure and Brynn O'Malley in the new Jason Robert Brown musical on Broadway.
Honeymoon in Vegas' Full Cast to Reunite at Jason Robert Brown SubCulture Concert
The upcoming concert is part of Brown's ongoing residency at the venue.
Honeymoon in Vegas Star Tony Danza to Make Café Carlyle Debut
The television icon will sing and dance at the fancy nightspot.
Renée Fleming and Tony Danza to Receive 2015 Broadway Beacon Awards
The pair of artists will be honored by the organization Inside Broadway.
Never Neverland: Who Didn't Get Nominated for a 2015 Tony Award?
Matthew Morrison, Jake Gyllenhaal, Hugh Jackman, Vanessa Hudgens, and Nathan Lane are among the high-profile snubs of this Tony season.
Leaving Las Vegas! Broadway's Honeymoon in Vegas Sets Closing Date
By David Gordon
Tony Danza, Rob McClure, and Brynn O'Malley star in the new Jason Robert Brown musical.
Tony Awards Rulings in Place for Jake Gyllenhaal and Tony Danza
The third meeting of the Tony Awards Administration Committee determines the eligibility of two Broadway productions.
Honeymoon in Vegas' Tony Danza, Rob McClure, and Brynn O'Malley Visit 92Y
The trio was joined by show creators Jason Robert Brown and Andrew Bergman for a discussion about the show.


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Hannah Rotolo is off and running. The all state Liberal guard is a captain on Barton's basketball team. They opened with a 59-28 win over Bethel. Rotolo scored nine points, picked seven steals, four assists, and six rebounds. Rotolo was a four year starter at Liberal and was selected for the KBCA All Star Game this summer.
©2016 Seward County Broadcasting Company, Inc.
1410 N. Western Ave. Liberal, KS 67901


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Catholic Bishops Becoming Increasingly Hysterical in Opposition to Marriage Equality
With the U.S. Supreme Court poised to rule on the constitutionality of the Defense of Marriage Act and California's Proposition 8 in June, and two new states enacting same-sex marriage legislation in the first few months of 2013 (with another potentially on the way), marriage equality in the United States is on the move.
While this is welcome news to equality-minded folks across the country, it's decidedly bad news for America's Catholic bishops, who are leading the crusade to exclude same-sex couples from legal civil marriage. It's a battle they're clearly losing, but as the bishops' struggle against the tide of history becomes ever more exhausting, they're taking a cue from their Anglican counterparts: their opposition is becoming increasingly hysterical.
In their latest anti-equality attack, the United States Conference of Catholic Bishops (USCCB) has prepared an insert that Catholic parishes across the country will place in their bulletins in May and June. They warn that a pro-fairness Supreme Court ruling (a broad negative ruling," as they call it) could "redefine marriage in the law throughout the entire country, becoming the 'Roe v. Wade' of marriage." [emphasis theirs] Continue reading


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I Left My Heart: A Salute to the Music of Tony Bennett • Ragtime • Venus in Fur • Forever Plaid • A Christmas Carol • Noises Off
Woody Sez • End of the Rainbow • The Whipping Man • An Iliad • Aint Misbehavin • Rep Lab • The History of Invulnerability
November 19 December 22
Quadracci Powerhouse
By Michael Frayn
Directed by KJ Sanchez
Buddy and Catherine Robinson, Associate Producers
Called the funniest farce ever written by the New York Post, Michael Frayns uproarious play-within-a-play follows the on- and off-stage antics of the members of a mediocre touring company as they blunder from an ominously bad dress rehearsal to a spectacularly disastrous performance. The perfect show for the holiday season, Noises Off is a hysterical romp packed full of a side-splitting collection of forgotten cues, missed connections, and backstage hilarity!
A spectacularly funny, peerless backstage farce. This dizzy, well-known romp is a festival of delirium. THE NEW YORK TIMES
Video Preview
Meet the Cast
"Patrons have requested a comedy in the Quadracci Powerhousenot just a play with some laughs, but an outright hilarious evening in the theater. Noises Off is one of the best comedies every written, a contemporary classic that has had people rolling in the aisles for three decades now, and I cant wait to share it with our audiences!"
» Learn more about Noises Off from Artistic Director Mark Clements
Michael Frayn
Joe Boersma
Aaron Christensen *
Jonathan Gillard Daly * ±
Joe Dempsey *
Kelley Faulkner *
Laura Gordon * ±
Gerard Neugent * ±
Deborah Staples * ±
Sara Zientek
Directed by KJ Sanchez
Scenic Designer, Dan Conway
Costume Designer, Mathew J. Lefebvre
Lighting Designer, Andrew Cissna
Sound Designer, Matt Callahan
Dialect Coach, Jill Walmsely Zager
Fight Chorographer, Jamie Cheatham
Casting Directors, Sandy Ernst and JC Clementz
Assistant Director, Frank Honts
Stage Manager, Sarah Deming-Henes *
Assistant Stage Manager, Jennifer Anderson *
Stage Management Intern, Rachel Lantow
* Member of Actors Equity Association, the Union of Professional Actors and Stage Managers in the United States.
± Milwaukee Repertory Theater Associate Artist
Joe Boersma, Tim
Joe just received his BFA in acting at the University of Illinois this past May. His first show here at the Rep was as Stanford P. White in Ragtime, along with understudying Tateh, Houdini, and Willie Conklin. This summer Joe worked as an acting intern at Arkansas Shakespeare Theatre in Bottoms Dream (Puck) and Much Ado About Nothing (Messanger/Otecake). At U of I he worked in The Krannert Centers Summer Studio Program two years in a row in Shipwrecked (Player 2) and [title of show] (Jeff). Other credits at U of I include Spring Awakening (Moritz), 44 Plays for 44 Presidents (Ensemble), Kabuki Lady Macbeth (Witch 2), and Misalliance (Gunner). He also appeared in Reefer Madness (Jack Stone) with Ensemble 113 at the Atheneum Theatre in Chicago. -Top-
Aaron Christensen, Frederick
Aaron Christensen is bleedin excited to be making his Milwaukee Rep debut with Noises Off. Based in Chicago, Aarons Windy City credits include Among the Thugs (Goodman Theatre), Stories of Carl Sandburg (Steppenwolf Theatre), King Lear (Chicago Shakespeare Theater), Holiday, The Philadelphia Story, Power, and Some Americans Abroad (Remy Bumppo Theatre Company), Inherit the Wind, Henry IV, and Henry V (Oak Park Festival Theatre), Taming of the Shrew and The Rainmaker (First Folio Theatre), True West and Broken Spokes (After Dark Award, Bailiwick), The 39 Steps (Artists Ensemble) and Not About Nightingales (Timeline Theatre). Regional credits include Gods Man in Texas, Macbeth, Romeo & Juliet and The Crucible with Greenbrier Valley Theatre in WV. He can also be seen this winter at your local Redbox in the Wisconsin-lensed survival thriller Dead Weight. During his darker hours, Aaron (aka Dr. AC) is the editor of the Rondo-nominated monster movie guidebooks, HORROR 101 and HIDDEN HORROR, as well as a staff writer with HorrorHound magazine but dont let that scare you. As always, love to Shel. -Top-
Jonathan Gillard Daly, Selsdon
Jonathan Gillard Daly first appeared at Milwaukee Rep as Bob Cratchit in A Christmas Carol back in 1995. He joined the resident acting company in 1998 and has been in at least three productions at the Rep each year since then. He opened this season as Grandfather and J.P.Morgan in Ragtime. Some of his many roles played at the Rep include Otto Frank in The Diary of Anne Frank, The Proprietor in Assassins, Herr Schulz in Cabaret, Nicky Giblin in The Seafarer, Arkady in A Month in the Country, Donald in Half Life, Jimmy in The Weir, and Scrooge in A Christmas Carol. Jon is also a founding member of the Great River Shakespeare Festival, where his roles include Lear, Prospero in The Tempest, Shylock in The Merchant of Venice, Falstaff in Henry IV, Part One, and, most recently, Feste in Twelfth Night, in which he co-composed his own songs with longtime associate Jack Forbes Wilson. Jon is also a published playwright. His plays The Daly News and To The Promised Land have enjoyed local and national productions. He lives in Milwaukee with his wife, Gale Childs Daly; they are proud parents of Samuel, a doctoral student at Columbia University and Emily, a third year theater major at the University of Evansville. -Top-
Joe Dempsey, Lloyd
Joe Dempsey last performed at the Rep in The Complete Works of William Shakespeare (Abridged) in the Stackner. He also was a Rep intern (a long time ago) appearing in A Christmas Carol, Three Sisters, The Miser, and Laughing Wild. Based in Chicago, Joe has worked at Goodman Theater, Steppenwolf Theatre, Court Theatre, Northlight Theatre, Lookingglass Theatre, Ravinia Festival, The Second City National Touring Company, and many other theatres. Regionally he's worked at Madison Rep, City Theatre Pittsburgh, Cincinnati Playhouse, St. Louis Rep, Center Stage Baltimore, and Kansas City Rep. He is a company member of the Neo-Futurists performing in their hit show, Too Much Light Makes The Baby Go Blind which celebrates its 25th anniversary this year. Big love to KJ, the Rep and his old friend, Aaron Christensen. -Top-
Kelley Faulkner, Brooke
At Milwaukee Rep: Evelyn Nesbit in Ragtime, Miep Gies in The Diary of Anne Frank, Sally Bowles in Cabaret, Patsy Cline in Always . . . Patsy Cline, Assassins and A Christmas Carol. Next up: The History of Invulnerability. Regional credits include: Claire in Proof (TheatreFest); Nancy in Oliver! and Emily Arden in State Fair (Walnut Street Theatre); Roxie in Chicago (New Candlelight Theater); Woman 2 in Give My Regards to Broadway (Kimmel Center for the Performing Arts) and The Music Man and Street Scene (New York City Opera). National Tour: Miss Watson in Big. She received her BFA in Acting from Montclair State University. For more info visit www.KelleyFaulkner.com. -Top-
Laura Gordon, Dotty
Most recent acting credits include Good People (Forward Theater), Sense and Sensibility and The Diary of Anne Frank (Milwaukee Rep). At The Rep Laura has appeared in over 75 productions including Death of a Salesman, The Lady with All the Answers, Pride and Prejudice, Enchanted April, The Crucible, Doubt, The Clean House, The Beauty Queen of Leenane, Mary Stuart, Endgame and Copenhagen. As a director, her credits at The Rep include Venus in Fur; Gutenberg! The Musical!; In the Next Room or the vibrator play; Speaking in Tongues; Laurel and Hardy; Almost, Maine; Edward Albees Seascape; and I Have Before Me a Remarkable Document Given to Me by a Young Lady from Rwanda. Other directing credits include The Royal Family and Old Times (American Players Theatre); Love's Labour's Lost and The Winters Tale (Utah Shakespeare Festival); Richard III (Notre Dame Shakespeare); Skin Tight, Memory House, Full Gallop (Renaissance Theaterworks) and Going to St. Ives (Forward Theater Company). Laura is a Lunt-Fontanne Fellow and a Milwaukee Rep Associate Artist. -Top-
Gerard Neugent, Garry Lejeune
Gerard just completed his tenth season with The Rep, his sixth season as a member of the Resident Acting Company and, with the start of the 2012/13 Season, is now a Rep Associate Artist. He most recently appeared as Willie Conklin in Ragtime and as Karl/Steve in Clybourne Park, Reverend Waghorn/ Marley/Old Joe/Mourner in The Reps annual production of A Christmas Carol and Doug in The Reps production of Gutenberg! The Musical!. Other credits include: Iago in Othello, Gerry in The Complete Works of Shakespeare (abridged), Michael McCormick in Lombardi, Happy in Death of a Salesman, Clown 2 in The 39 Steps, Stan Laurel in Laurel and Hardy, Lou Max in Seven Keys to Slaughter Peak, Jimmy/Lendall/Randy/Phil/Dave in Almost, Maine, Johnny in Happy Now? and Hlestakov in The Government Inspector, Simon Panteleyevich Yepikhodov in The Cherry Orchard, Charles Bingley in Pride and Prejudice, Fabrizio in Mirandolina, multiple roles in Greater Tuna, Rogers/Young Pedgift in the world premiere of Armadale, Antony Wilding in Enchanted April, Norman in The Norman Conquests, Rick Steadman in The Nerd, Edgar in King Lear, Ellard in The Foreigner, Young Scrooge in A Christmas Carol, Steindorf in Bach at Leipzig and Camille in A Flea in Her Ear. Gerry is a proud Marquette grad who lives in Milwaukee with his wife, Kate, and their two sons, Gerry and Peter. -Top-
Deborah Staples, Belinda
Deborah is honored to continue her work with The Rep, where she most recently played Susan in How The World Began, Mrs. Van Daan (The Diary of Anne Frank), Emilia (Othello), and Jean Louise (To Kill a Mockingbird). Other recent credits include work on the independent film Pilot Error, Season #8 with American Players Theatre as Victoria (Too Many Husbands) and Gertrude (Hamlet and Rosencrantz and Guildenstern are Dead), and her Jeff Award Nominated performance at Writers' Theatre. Deborah is a commercial (yes, that was her as Glinda the Good Witch with Packer Jordy Nelson) and voiceover talent, is teaching Acting Fundamentals at Marquette University and is the mother of two fabulous girls. She is fiercely proud to be an Associate Artist with The Rep and to be part of this extraordinary community in work, play, art and all around living. Joy to all! -Top-
Sara Zientek, Poppy
Sara Zientek is thrilled to be working with Milwaukee Rep. Companies Sara has worked with include: Center for Applied Theatre, First Stage Childrens Theater, Milwaukee Chamber Theatre, Optimist Theatre, Uprooted Theatre and Youngblood Theatre Company. She also toured with the Utah Shakespeare Festival and The Normal in Schools Foundation. Sara received her BA in acting from University of Wisconsin-Milwaukee. -Top-
KJ Sanchez, Director
KJ Sanchez is the founder and CEO of American Records, devoted to making theater the chronicles our time. As playwright, KJ Sanchezs work has been produced at Asolo Rep Theatre, Actors Theatre of Louisville, Two River Theater Company, Baltimores Center Stage, Round House Theatre, Cornerstone Theater Company, Chicagos Yo Solo Festival, Annenberg Center for the Performing Arts, Hopkins Center for the Arts, HERE Arts Center and Off-Broadway at Urban Stages Theater. Directing credits include: Martin Zimmermans Seven Spots on the Sun at Cincinnati Playhouse, The Diary of Anne Frank at Milwaukee Rep, 26 Miles at Round House Theatre and Two River Theater Company, The Giver at Asolo Rep Theatre, 9 Parts of Desire and The Elaborate Entrance of Chad Deity at Actors Theatre of Louisville and Private Lives and Mere Mortals at Two River Theater Company. KJ is the voice of many characters on the Nickelodeon cartoons Go, Diego, Go!, and Dora the Explorer. She is a Fox Fellow, Douglass Wallop Fellow, Albert Award Nominee, an NEA CDP recipient and a TCG Doris Duke/Andrew W. Mellon Foundation New Generations Future Leaders Recipient. -Top-
Dan Conway, Scenic Designer
Recent projects include: The Diary of Anne Frank for Milwaukee Rep, Directed by KJ Sanchez; the premiere of Ken Ludwigs new play, The Games Afoot for Cleveland Playhouse, Directed by Aaron Posner; the American premiere of Sucker Punch, Directed by Leah C. Gardiner and The Secret of Sweet for Studio Theatre, Directed by Timothy Douglas; Company, Hairspray, Chess, and Sunset Boulevard for Signature Theatre, Directed by Eric Schaeffer; Sabrina Fair for Fords Theatre, Directed by Aaron Posner; Cyrano for Folger Theatre; The Merry Wives of Windsor for The Shakespeare Theater Company, and August Osage County for Arden Theatre Company. Current and upcoming productions include: Love In Afghanistan for Arena Stage, The Tempest for A.R.T., End of The Rainbow for Milwaukee Rep; Sunday in the Park with George, Directed by Matt Gardiner for Signature Theatre; The Adventures of Homer P. Figg for The Kennedy Center Family Theatre, Directed by Gregg Henry; The Aliens, Directed by Lila Neugebauer; and Spoonful of Water, Directed by KJ Sanchez for The Studio Theatre. Nominated for the Helen Hayes Award for Outstanding Set Design twelve times, he received the award in 2000, and most recently in 2009 for Stunning at Woolly Mammoth Theatre, Directed by Anne Kaufmann.
Mathew J. Lefebvre, Costume Designer
Off Broadway: Signature Theatre: Two Trains Running; New York Theatre Workshop: Bach at Leipzig. Milwaukee Rep: Mirandolina, Enchanted April, Cyrano de Bergerac, Tartuffe, A Flea in Her Ear, Bach at Leipzig. Other Regional Theater: Guthrie Theater: More than 20 productions since 1998 including A Christmas Carol, Roman Holiday, When We Are Married, The Importance of Being Earnest, 1776, She Loves Me, The Night of the Iguana, A School for Scandal, Sweeney Todd. Kansas City Repertory Theatre: Radio Golf, Jitney, A Raisin In The Sun, Two Trains Running; Penumbra Theatre: Fences, Gem of The Ocean (scenery and costume design), Red Shirts, Get Ready, On the Open Road, Joe Turners Come and Gone, Someplace Soft to Fall, Jitney; Other credits include: The Old Globe, The Oregon Shakespeare Festival, American Player's Theatre, The Acting Company, Arizona Theatre Company, Geffen Playhouse, Children's Theatre Company, Mixed Blood Theatre. Awards: TDF-Irene Sharaff Young Master Award, AUDELCO Award Nominee. Teaching: Professor and Director of Theatre at the University of Minnesota. -Top-
Andrew Cissna, Lighting Designer
Andrew is thrilled to be doing his first show with Milwaukee Rep. Washington, DC: 1984 (Catalyst Theatre Company, 2008 Helen Hayes nomination); Bengal Tiger at the Baghdad Zoo (Round House Theatre); One Destiny (Fords Theatre); After the Revolution (Theater J); Passion for Justice (Olney Theatre Center); Teddy Roosevelt and the Ghostly Mistletoe, Blues Journey, and American Scrapbook (John F. Kennedy Centers Theatre for Young Audiences); Alexander, The Happy Elf, Little Engine that Could, Holes, and If You Give a Mouse a Cookie (Adventure Theatre); Birds of a Feather and Act a Lady (HUB Theatre); Dead City and Rough Magic (Rorschach Theatre); Valparaiso (Forum Theatre); and Blue/Orange, In On It, and Gross Indecency (Theatre Alliance). Juneau, AK: Noises Off (Perseverenace Theatre Company). Assistant Designer: The Mountaintop (Broadway); Chinglish (Broadway, Berkeley Rep); Bullet for Adolf (Off-Broadway); Peer Gynt (Guthrie Theater); Moon for the Misbegotten (Merrimack Rep, Virigina Stage Company); Miss Saigon, Chess, Kiss of the Spiderwoman, Sweeney Todd (Signature Theatre, VA). Education: BFA, University of North Carolina School of the Arts; MFA candidate, University of Maryland. -Top-
Matt Callahan, Sound Designer
Served as the Resident Sound Designer at Actors Theatre of Louisville for eight seasons and over 50 productions including the world premieres of The Hour of Feeling, Michael Von Sienberg Melts Through the Floorboards, Bob, Elemeno Pea, Ground, Sirens, Wild Blessings, The Hard Boating Party, Slasher, The End, Rock and Roll The Reunion Tour, Dark Play stories for boys, Great Falls, Beautiful City, The Scene, The Unseen, Six Years, Pure Confidence and Hazard County. Other Regional Theater: Oregon Shakespeare Festival, Cincinnati Playhouse in the Park, Ensemble Theatre Company, Cleveland Play House, Geva Theatre Center, Milwaukee Rep, St. Louis Rep, Arizona Theatre Company, Philadelphia Theatre Company, Walnut Street Theatre, Prince Music Theatre and Steppenwolf Theatre Company, Garage Theatre and Studio Theatre. Other Credits: Resident Sound Designer ONeil National Playwrights Conference 2008, 2009. -Top-
Jill Walmsely Zager, Dialect Coach
Jill is very happy to be back at The Rep for the 2013/14 Season. Other Milwaukee Rep credits include: A Raisin in the Sun, Clybourne Park, Sense and Sensibility, A Christmas Carol, The Diary of Anne Frank, The Mountaintop, Assassins, To Kill a Mockingbird, Lombardi, Yellowman, Ten Chimneys, The 39 Steps, My Name Is Asher Lev, Laurel and Hardy and Cabaret. Jill has recently returned to Milwaukee from three years as the Co-Head of Voice and Dialects and the Company Coach at the American Conservatory Theater in San Francisco. Regionally, she has worked at Chicago Shakespeare Theater, Steppenwolf Theatre Company, Lyric Opera of Chicago, Marriott Theatre in Lincolnshire, Drury Lane Water Tower, Apple Tree Theatre, Drury Lane Theatre & Conference Center, Utah Shakespeare Festival and Milwaukee Chamber Theatre. Jill earned her Masters Degrees at Central School of Speech & Drama (London) and Northwestern. She is married to James Zager, the Head of the Theatre Program at Carroll University. -Top-
Jamie Cheatham, Fight Chorographer
Jamie Cheatham is a nationally recognized Fight Director and Certified Teacher with the Society of American Fight Directors (SAFD). Before moving to Wisconsin in 2003, he was based in New York City as a fight director, teacher and actor. He has over twenty years experience as a professional, classically trained actor (AEA, SAG-AFTRA) and fight director. His fight work includes such theatres as the New York Shakespeare Festival, Alley Theatre (TX), Actors Theatre of Louisville (KY), many regional Shakespeare festivals, and recently the Milwaukee Ballet. He has taught in several MFA acting programs, privately in New York City, and is currently the head of acting at the University of Wisconsin-Parkside. -Top-
Frank Honts, Assistant Director
Frank was Assistant Director for Venus in Fur earlier this season, and prior to that, worked as Artistic Associate at Forward Theater Company in Madison. Recent directing projects include: 9 Circles (Midwest premiere) and Speech & Debate. In addition to his work as a Director, Dramaturg, and Assistant Director at Forward Theater, Frank has worked with American Players Theatre, California Shakespeare Theater, Utah Shakespeare Festival, Madison Opera, and Childrens Theater of Madison. Education: AB, History, Brown University. -Top-
Sarah Deming-Henes, Stage Manager
Sarah has long loved Noises Off and is incredibly happy to be a part of it at The Rep. In previous seasons she has stage managed Song Man Dance Man, To Kill a Mockingbird and Sense and Sensibility. Sarah has also worked at American Players Theatre and First Stage Childrens Theater. Thanks to family, friends and a very nice fellow for unfailing kindnesses. -Top-
Jennifer Anderson, Assistant Stage Manager
Jen is very excited to return to The Rep after working on From My Hometown during the 2011/12 Season. Previous credits include Guthrie Theater, Skylight Music Theatre, Tuacahn Center for the Arts and Milwaukee Chamber Theatre. Many thanks to her friends and family for all the love and support. Jen is a proud member of Actors Equity Association. -Top-
Rachel Lantow, Stage Management Intern
Rachel, originally from Lakeville, Minnesota, is joining the Intern Ensemble of The Rep as a recent graduate of Minnesota State University, Mankato where she earned her BFA in Theatre Design/Technology. Favorite MSU credits include: Wait Until Dark, The Odyssey, Dracula, Phantom of the Opera, Legally Blonde: The Musical, Chicago, The Rocky Horror Show, Into the Woods, and The Producers. Rachel has also worked for Highland Summer Theatre in Minnesota for two seasons on productions including On Golden Pond, The Sunshine Boys, Almost Maine, The Owl and The Pussycat, and Annie. This past summer she took the trip to Nebraska to stage manage for Crane River Theaters Seussical: The Musical and Grease. She wants to thank her family for always supporting her decisions to pursue the dreams laid on her heart, and her friends in Mankato for their impact on her life. For my Audience of One, for my family, and for Kaela. -Top-
Each of our shows offers opportunities for our audience to engage in conversations and discussion with our staff, artists and guest speakers. Please join us!
Rep in Depth | Pre-Show
Get an insiders look at the production from cast member Joe Dempsey that begins 45 minutes prior to every performance.
TalkBacks | Post-Show
Wednesday Dec 4 and 11 Matinee performances
Join us for post-show discussion.
Learn more about the background of the show and/or the themes explored in this production.
» Article with Playwright Michael Frayn
» Listen to an interview with Director KJ Sanchez on WUWM
» Noises Off brings laughter back to the Quadracci Powerhouse
» Noises Off director shows her versatility
» Actress Faulkner sounds off on the Rep's Noises Off
Milwaukee Journal Sentinel
Are you excited to see this show? Tell us what you think:
Group Tickets
Start at 15% off
Group Sales
Running Time
Approx. 2hrs and 40 minutes
Recommended Age
12 years and older
Content Advisory
Contains adult themes and language
Performance Times
Tuesday: 6:30pm*
Tuesday - Thursday: 7:30pm
Sunday Evening: 7:00pm
Fri/Sat Evening: 8pm
Saturday Matinee: 4pm
Sunday Matinee: 2pm
Wednesday Matinee: 1:30pm
*Once per run otherwise 7:30pm
Access Dates
Audio Described
Tuesday, Nov 26, 6:30pm
ASL Interpreted
Thursday, Dec 12, 7:30pm
Sunday, Dec 15, 2pm


text:
June 26, 20164:46 AM ET
ROME (AP) — U.S. Secretary of State John Kerry will rush to Brussels and London on Monday to meet the top British and European Union diplomats, as the world grapples with the implications of Britain's historic vote to leave the European Union.
June 26, 20165:42 AM ET
LONDON (AP) — Labour Party leader Jeremy Corbyn is facing an open revolt as political turmoil continues to grip Britain after the country voted to leave the European Union.
June 26, 20165:51 AM ET
LONDON (AP) — The Latest on Britain's historic vote to leave the European Union (all times local):
June 26, 20165:14 AM ET
YEREVAN, Armenia (AP) — Pope Francis called Sunday for closer ties with Armenia's Orthodox church as he wrapped up his three-day visit with a liturgy and visit to the country's closed border with Turkey amid new tensions with Ankara over his recognition of the 1915 "genocide."
June 26, 20165:35 AM ET
BAGHDAD (AP) — A senior Iraqi commander declared that the city of Fallujah was "fully liberated" from Islamic State group militants on Sunday, after a more than monthlong military operation.
June 25, 20166:42 PM ET
The U.S. basketball team has its roster for Rio.
June 26, 201612:27 AM ET
GLENDALE, Ariz. (AP) — Not quite a victory for the United States. Just a good enough effort to leave the team feeling better about itself.
June 25, 20165:23 PM ET
OMAHA, Neb. (AP) — For anyone else, six medals would've been a marvelous way to exit the Olympic stage.
June 26, 201612:47 AM ET
ST. LOUIS (AP) — Jonathan Horton texted Chris Brooks and Alex Naddour a picture before both rounds of the U.S. men's gymnastics Olympic Trials this week. The image was from London four years ago. In it, Brooks and Naddour were cheering from the stands in the O2 Arena as alternates while their teammates stumbled to a fifth-place finish.
June 26, 201612:07 AM ET
NEW YORK (AP) — The last time CBS telecast a fight in prime time, Muhammad Ali was in the ring — 38 years ago.


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Gmate? also a batt Q
Hey all,
Does anyone have experience (or an informed opinion) on the Gmate? I read about it elsewhere and I'm intrigued. Apparently, it's a device/software that allows you to connect to the web, send/receive SMS/make and take calls via a GSM SIM that you insert into the device.
What I'm trying to wrap my head around is how you'd pay for the GSM SIM card use for things life calls (maybe obvious) or internet.
-Also, how's the battery life for the your SGP5.0? (ie how much juice are you squeezing from the sucker? i've charged it for the first time a few days ago and got roughly 17? hours w/ music, wifi, app d/ls, misc. is that good or bad, relatively?)
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Never heard of the GMate.
I usually get through roughly half my battery life over the course of a day. That would be probably around an hour or two of apps, two-three hours of videos (half on the device, half streaming), and possibly around 2 hours of music. I'd say 17 hours of mixed usage isn't bad, but could possibly be better.
I use Elixir 2 (monitoring CPU usage) and Android Assistant (closing background apps) to squeeze as much out as possible. I would experiment with stuff, if I were you. Sometimes using apps like these can extend life, sometimes they can do nothing at all, and sometimes they can diminish life.
- Justin
Glossary for Newbies Everybody
Babble. On.
Ok. Sounds similar to what I'm getting. I've just heard some large claims that was nowhere close to what I was getting, so I was like ....eh?
I've been
About the GMATE- http://www.skyroam.com/index.php
Depending, it looks like a viable option for making free calls (or free-ish in my case), if you combine
a) GMATE's wifi (at a glance, it seems free) via the GPS connection (?)
1)Google voice + GrooveIP (or a similar prog., in my case)
2) if the SIM option for calls was free, which I doubt.
In another forum (XDA), it seems like a go for the international version. No word on the US version, from a glance.
Actually different question (and maybe I should post in a different thread? But it seems like I've been posting too much recently? Arg. They joys and pains of a new gadget)-
So I'm slowly transitioning to the Go Launcher (possibly to AWD Launcher Ex // Cyanogen 9 later once its more stable and I root) and have no default set atm. It seems like the stock launcher's opening (with applicable widgets), taking up space. IS there a way to disable ..."auto"-launch? (eg if I launch Go Launcher when the system starts, the stock player doesn't and vice versa)
Also, is there a way to put the player to "sleep"? Idle seems to take 9% battery according to the stock "battery info" program.
Unfortunately there is nothing free about using it. You WILL need a SIM card and a mobile provider with a GSM network. For the US that means either AT&T or T-Mobile as far as national carriers go (I think). Additionally, if you want to do mobile Internet, you'll need a data plan.
On the specs page they only mention EDGE/GPRS for data which isn't that great. It works but it is the fall-back technology used when 3G isn't available. The other thing is that it connects to your PMP by bluetooth so you can expect additional drain on your battery.
http://www.straighttalk.com/shopsims just found out about this, stick in there SIM and works on GSM phones I guess the Gmate could use it then you get unlimited everything for 45 bucks.
Galaxy S 4.0 Wifi (USA)
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|Dundee all over Lyons on Friday night, 34-8
A disappointing 2-5 regular season for the Lyons Lions varsity football team came to an end with another loss, this time at home to Dundee, 34-8.
For the Dundee Scots, it was Jon Huber who accounted for 3 of their scores including a punt return for a TD, a 70 yards touchdown reception, and a 10 yard touchdown run.
For Lyons, Alex Musolino had 119 yards rushing on 13 carries and recorded 8 tackles on the defensive side of the ball.
Dundee finished the regular season at 3-4.
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Originally Posted by Spinewire
My mum has "worked" with horses all her life and she does not seem to think there is anything that would give it away.
Oh really?
Originally Posted by Mordhak
Then why the fuck are you still here? You've got about as much of a face left as Kurt Cobain.
The female horse is the one in a dress...
With that this thread ends.
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The Tenacity of Tyler Freeborn
Infiltration Mission – Blue Mountain
A TSW Guide to content update 1.5
This is the third in a series of quests about Tyler Freeborn.
The previous quest is The Research of Tyler Freeborn, and the final quest is The Vanishing of Tyler Freeborn)
The Tenacity of Tyler Freeborn is the third quest in the Vanishing of Tyler Freeborn line. This quest series was added in content update 1.5 with the same name. Our Secret World Guide continues with this examination of the infiltration quest. Infiltration quests generally require stealth and reward players for bypassing obstacles without combat.
The Tenacity of Tyler Freeborn, Step 1 – Go to the Orochi Encampment
The Orochi camp is sealed and requires a keypad entry to get in. The entry can be found in the nearby van 0943786.
Beware the drones, they will stun you and boot you out of the gates. The quest updates to "Find traces of Tyler Freeborn."
The camera you are looking for is in one of the two Orochi vans to the right from the gate. You find it at 673, 823. You get an interesting cut-scene with Tyler discussing the Pied Piper and the Draug.
The Tenacity of Tyler Freeborn, Step 2 – Examine the nearby research laptop
Conveniently, this is right beside you. Project Filth, Testing updates the quest to:
- Get a normal human blood sample
- Get a filthy blood sample
- Get a second filthy blood sample
You will find the three samples in the various tents. Be warned, though, there are Orochi scientists in them. You need to trigger gas leaks to get the scientists to leave their tent.
You can pickup canisters of gas around the camp and then use them in the air ventilation systems on the tents. This causes the scientists/guards to leave a tent for about 30 seconds. This is the exact same process as completed in the Orochi Group infiltration quest. Be aware, that if others are triggering this quest, you can easily get caught in their returning guards. Just keep your eyes peeled.
Once you complete this, the quest updates to:
- Confirm the results using the first blood sample
- Confirm the results using the second blood sample
- Confirm the results using the third sample
Interestingly, H. Bannerman (the Sheriff) was not physically exposed, but she appears infected
The quest then updates to "Read the experiment results and conclusions."
Go back to the van with the computer. View project filth and conclusions. The quest advises Orochi agents to use CDC-class resiprators at all time.
The Tenacity of Tyler Freeborn, Step 3 – Head to the CDC Camp
Upon entering the CDC camp you get the message "Find a respirator." They are in a box near a tent, the quest updates to "Read the crumpled up note" in the same box. The note references a "Bathymetric Map" and has the word "Whale Watch" scribbled beside it.
The Tenacity of Tyler Freeborn, Step 4 – Head to the Whale Watch
For reference, a quick GIS on the map tells us that it is the "submerged equivalent of an above-water topographic map. Upon reaching the whale watcyh, the quest updates to "Find a bathymetric map." The map is on the boat, located at 45, 649.
The map shows you that the shallowest part of the ocean is NE of skull island. Bear in mind, the map and your game-map show slightly different spots. The map on the boat circles a spot a bit north of your in-game map. The quest updates to "Go to the shallowest part of the ocean." At 205, 924, the quest updates to "Examine the camera."
This concludes the Tenacity of Tyler Freeborn. Our Secret World guide continues with the epic conclusion in the Vanishing of Tyler Freeborn.


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Devs, rejoice! Apple NDA dropped for released iPhone software
Apple's iPhone non-disclosure agreement (NDA) has plagued developers from all over the world ever since the release of the iPhone SDK. The NDA prevents developers from talking about iPhone software development, which in turn prevents them to share information with fellow developers, as well as to users or anyone else interested to learn.
There's been a lot of bad press about it, especially on the Web, and for too long Apple has not responded to the issue. Until now.
Finally, Apple has decided to drop the NDA, at least for finished and released iPhone software, saying the following:
To Our Developers
We have decided to drop the non-disclosure agreement (NDA) for released iPhone software.
We put the NDA in place because the iPhone OS includes many Apple inventions and innovations that we would like to protect, so that others don't steal our work. It has happened before. While we have filed for hundreds of patents on iPhone technology, the NDA added yet another level of protection. We put it in place as one more way to help protect the iPhone from being ripped off by others.
However, the NDA has created too much of a burden on developers, authors and others interested in helping further the iPhone's success, so we are dropping it for released software. Developers will receive a new agreement without an NDA covering released software within a week or so. Please note that unreleased software and features will remain under NDA until they are released.
Thanks to everyone who provided us constructive feedback on this matter.
This is certainly great news for the iPhone developer community. Now, let's see the devs put this to good use.
Via 9to5mac


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Thanh Pham and his University of St. Thomas program has a conference winning percentage of .900 in league play. Now, you can get insight from this highly successful coach with a fun and competitive drill called 'Bounce.' The organized chaos in this drill forces players to communicate, collaborate, and play aggressively to win.
Players must keep the ball from bouncing 25 times on their side of the court or having it roll. Relentless pursuit is the name of the game.
CHECK OUT more valuable insight from "Team Oriented Drills to Improve Your Play." VIEW other world class videos in our massive Volleyball library!
2013 NCAA D-III Championship Coach, Thanh Pham, provides a drill in which the goal is for players to read the game, recognize patterns, and increase communication on the court. This game-like drill helps develop team communication, conditioning, and awareness.
Setters start in right back and toss two balls at the same time. Only tips and rolls are allowed until one ball is dead. When one ball is dead, the other ball is played out.
CHECK OUT more valuable insight from "Team Oriented Drills to Improve Your Play." VIEW other world class Drill videos in our massive Volleyball library!
Thanh Pham, 2013 NCAA DII National Championship Coach, demonstrates how players can increase communication and aggressiveness. The name of the game is the 'Effort Drill', which is a great way to create better team chemistry while making the most of practice.
In this game-like drill players must:
CHECK OUT more valuable insight from "Team Oriented Drills to Improve Your Play." VIEW other world class Drills in our massive Volleyball library!
NCAA Division III National Championship coach Thanh Pham coaches his team through a series of 11 teams drills. These drills develop a variety of skills and concepts including serving, serve-receive, aggressive attacking, team defense, hustle, out of system play, composure, celebration and more. Because Coach Pham shares many variations for each drill, you can use them practice after practice by simply changing the assignments to keep them fresh. Challenge your team throughout the season with the insight from this Volleyball DVD.
Team Oriented Drills to Improve Your Play
Purchase any 3 Volleyball DVDs($39.99 or less, each) for $99.99! Click here to shop this deal.
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Avery® Insertable Dividers 81000, 5-Tab SetProduct Number: 81000
When you're trying to sort notes and papers on a variety of different topics, you need a tool that will help you divide and conquer. Insertable Dividers let you keep every paper in its proper place and provide a convenient method of finding the section you need when you need it. Choose between the included preprinted and customizable blank inserts to label each section. The inserts slide easily into the dividers' clear plastic tabs to let you identify sections at a glance. Reinforced tabs and edges, plus Rip-Proof™ tabs, resist tearing in your three-ring binder to help keep you sorted for the long haul.
Product Description:
Reviewed by 3 customers
This review is from Mass Market Standard Insertable Dividers with Buff Paper 81000:
I have used these dividers since way back in my college days. Now, I am a home educator with three children in three different grades. So organization is essential. These dividers are low-tech, but they are well-constructed and efficient tools we use to keep our papers straight in those giant 3-inch binders. The reinforced strip along the binding holes ensures that the dividers will survive the whole year.
This review is from Mass Market Standard Insertable Dividers with Buff Paper 81000:
So simple, but its just the thing every binder needs.
This review is from Mass Market Standard Insertable Dividers with Buff Paper 81000:
I find that the new free templates are great for running off tabs to insert into the colored holders. The bigger tab holders make it so much easy to read when I flip my notebook open.
The design of the tab holder is wonderful, it certainly keeps the tab inserts from falling out.
Great product for the price.


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Ledges State Park's popular Canyon Road is open
Jon Lloyd
Staff Writer
Campsites at the state and two county parks in Boone County are all but booked up for Memorial Day Weekend.
Andy Bartlett, park manager at Ledges State Park, said Thursday the 40 campsites with electrical hookups are taken and only a "handful" of the 42 non-electric sites were available. Seven of the 12 walk-in tent sites were still open, he said.
At Don Williams Park about 90 percent of the 150 campsites with electric outlets have been taken by RV campers, Andy Hockenson, director of the Boone County Conservation Board which maintains the county parks, said Thursday.
The same goes for the county's Swede Point Park. Park Ranger David Weidt said Thursday that of the 24 electric campsites about five were left.
All of the Don Williams and Swede Point Park campsites, the county's two parks that offer camping, are first come, first served.
Bartlett said Canyon Road, which is closed for the winter and did not open until April 28 because of spring rains, was closed Sunday because of heavy rains.
"We reopened Canyon Road yesterday afternoon," he said.
"We were full on Tuesday this week," he said of the sites offering electrical hookups, which are $16 a night. Non-electric sites, which can also be reserved, are $11 a night. Walk-in camp sites are $11 a night and are located near the main campground.
All of the park's amenities, such as bathrooms and portable toilets in the canyon, are open, Bartlett said. The recycling trailer brought in last season and located near the parks' entrance is ready for use, he said.
Naturalist Alexa Dostart, who started at the park in May, will not hold any programs this weekend, Bartlett said. However, she will be giving regular programs for campers throughout the summer, such as night hikes with star gazing, scavenger hunts, and live animal programs.
"We're open and ready for the weekend and we're ready for people to come out and enjoy it," Bartlett said.
Don Williams Park, located about five miles north of Ogden on county highway P70, is "pretty busy around here for the (Memorial Day) weekend," Hockenson said. "We're filling up pretty fast. We had people coming in all week."
Hockenson said anyone that wants a camp site this weekend should get there as soon as possible. Many of the 30 tent sites that do not have electrical hookups are open, he said.
"Usually the tent sites are left when we do fill up," he said.
The two open-air shelters are also first come, first served. The enclosed shelter is booked for the holiday, he said.
The 600-acre park also offers a nine-hole golf course, a bait house and restaurant near Don Williams Lake that boasts over five miles of shoreline, hiking trails and a swimming beach. Diverse wildlife such as raccoon, deer, coyote, wild turkey, woodchuck, possum, eagles and osprey call it home.
Boone County Naturalist Emily Klein, who heads up summer outdoor recreation programs, will lead several family canoeing outings on the lake this summer.
The fishing hasn't been great, Hockenson said, but "people have caught crappy and bass."
Campsites with electric hookups at Don Williams and Swede Point Park, about two miles west of Madrid off State Highway 210 and QM Avenue, are $16 a night. Non-electric sites are $11.
Swede Point Park, which serves as a base camp for many cyclists riding the High Trestle Trail about two miles west of the park, offers 24 campsites with electricity and 10 without. The bathhouse with hot water and toilets is open.
Last summer, Weidt renovated the park's Shelter House, which seats up to 80 people and can be reserved for reunions, wedding receptions, and birthday parties. It is booked today and Saturday, but available Sunday and Monday, Weidt said.
For reservations, call (515) 795-2809.


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Top Seller in Navy Midshipmen Hats
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Proudly rep the Navy Midshipmen with this Operation Hat Trick Gordie adjustable hat from '47! It features an embroidered logo on the front to show off your spirited Navy Midshipmen fandom. This patriotic cap is the perfect way to display to show off your Iowa Navy Midshipmen pride while supporting the troops!
Fans come first in the world of sports. At Fanatics, we embody that in everything we do as we bring you the very best officially licensed sports apparel. As official partners of the NFL, MLB, NBA and NHL, our emphasis is always on a top-notch experience for fans everywhere. Soccer fans can score a goal on team pride with our new assortment of MLS and World Football apparel. And any Fanatics shopper can take advantage of our free Fanatics Rewards program, awarding 5% FanCash back on all purchases to build credit for more gear. Our Satisfaction Guarantee is unmatched in the industry and ensures you get the most out of your shopping experience every time. Fanatics isn't just a leading sports apparel provider - we're fans just like you, and always put the fan first in everything we do.
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Nice Fit
By Navy_Retired
from Dallas Texas
About Me Die Hard Sports Fan, Sports Enthusiast, Stylish
Best Uses
Comments about '47 Brand Navy Midshipmen Operation Hat Trick Gordie Adjustable Hat - Camo:
Expensive place, but overall, great quality of gear.
Bottom Line Yes, I would recommend this to a friend
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- Home
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The HIV/AIDS epidemic in Africa has claimed millions of victims and left behind multitudes of orphans (many of whom are also HIV positive). In 1993, shortly after completing her nursing training, Faith Liyena began working to find homes for orphaned children. Faith's Orphanage Foundation now cares for 3,500 kids whose parents were lost to HIV/AIDS. Alltech has been working with Faith to improve the health and immunity of these orphans and the community as a whole by providing Sel-Plex organic selenium supplements and developing programs to raise selenium-enhanced chicken and eggs. Selenium helps HIV-weakened immune systems resist a range of infections.


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Melody M. Rodarte, D.O., is an internal medicine physician on staff at Banner Gateway Medical Center.
Question: What is shingles?
Answer: Shingles is characterized by a painful blister type rash that affects roughly one million Americans each year. Shingles is caused by the varicella-zoster virus (VZV) which also is the virus responsible for chicken pox. There is a 20 percent lifetime risk of developing shingles. After the infection with chicken pox the virus can reside in the nervous system quietly for years.
Herpes zoster, shingles, is a reactivation of the varicella-zoster virus which has been dormant in the nervous system. Any healthy adult is at risk but after age 50 our immune system decreases increasing the risk of the virus reactivating. Triggers for reactivation can include stress and an illness.
Painful blisters in a line or that "wrap around" one side of the torso is the characteristic rash for shingles. A tingling, heat sensation may proceed the eruption. Some have felt increased sensitivity or numbness to the area prior to the blisters appearing. The blisters may last a few days and then scab over. It may take three to four weeks for total healing of the rash and it is not uncommon to have a scar (darker skin where each blister occurred). The open blister phase is the contagious phase and precautions should be taken with pregnant women, newborns, immunocompromised persons and those who have not had chicken pox. You can not give someone shingles but you can give them chicken pox.
Complications of shingles can include continued pain which is termed post-herpetic neuralgia (PNH). About 10-15 percent of all patients develop PNH. Those at increased risk of PNH are the elderly. Ocular or ear involvement may occur if the face (trigeminal nerve) is involved and requires immediate treatment and surveillance. Superficial skin infections may also occur in the lesions. Prompt treatment can reduce the complications and duration. There are multiple treatment options using antiviral agents, pain medications and antidepressants which have calming effects on the irritated nerve.
In 2006, the FDA approved the shingles vaccine Zostavax. The vaccine is recommended for adults older than 60. The vaccine has shown to decrease the incidence of zoster by 51percent, decrease the severity by 61percent, and can decrease the risk of PNH by 67percent. Zostavax can be given to adults who have not had chicken pox or the chicken pox vaccine.
If you've had shingles, you can still get the vaccine but not during the infection. It is recommended for patients with some chronic disease states such as rheumatoid arthritis. Contraindications to the vaccine include acquired and primary immunodeficiency states, those receiving immunosuppressive treatments, pregnancy, allergy to vaccine components (neomycin and gelatin), some blood diseases (leukemia, lymphoma), and concurrent use of antiviral medications. The vaccine is a live-attenuated virus and thus a small percentage (less than 1 percent) may get a rash characteristic of shingles at the injection site. The most common side effects are local injection site reactions such as swelling, tenderness and redness. Zostavax should not be given with other live-attenuated vaccines.


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Create and enter a burger recipe after carefully reading the rules of the Build a Better Burger contest.
To enter online, log on to www.sutterhome.com and look for the Contest entry icon. Fill in the entry form, including your original recipe, and follow the on screen directions to submit. Online entries must be submitted between 12:00 PM noon Pacific Time ("PT") on April 1, 2014 by 12:00 PM noon PT on September 8, 2014.
- Grand Prize (Best Burger): $25,000.
- Runner-Up (Best Burger): $15,000.
- People's Choice Award: $10,000.
"The judges at BBB are always looking for highly creative recipes that are packed with flavor. You may choose to reinvent your favorite burger with exciting new toppings, turn the elements of a classic dish into a burger, show off an ethnic or cultural background, highlight the unique dishes or products of a region of the country, reflect your culinary travels, or surprise us with a completely new concept in burgers.
"When we make burgers, we choose sustainable, organic, and locally sourced ingredients whenever possible, including humanely raised meats and seasonal produce, and we encourage you to do the same when you create your recipe entries. We also prefer recipes that are not overly complicated or costly to make.
"Feel free to enter as many recipes as you wish, but before submitting or mailing them, please read this year's rules very carefully.
If you've previously entered recipes to our contest that did not make it to the final Cook-Off, you may update and resubmit them, even if they appear on the contest site's BurgerBase. If they've been published elsewhere, however, they are ineligible for submission."
Suggested Links
- Jones Dairy Farm breakfast recipe contest accepting online entries
- Enter the Mooney Farms/Bella Sun Luci Recipe Contest
- Reser's 'America's Best Potato Salad Challenge' recipe contest accepting entries
- Enter 'Our State's' 2014 Recipe Collection Blueberry recipe contest
- Weber Grills and Harley-Davidson™ sponsor burger recipe contest


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Strategically situated in a quiet and privileged position near to the historic centre and just 100 metres from the Caserma Cesiva (military training school), 700 metres from Civitavecchia Port, 900 metres from the railway station and 500 metres from the San Paolo Hospital in Civitavecchia.
The bed and breakfast Bel Sole offers rooms with double beds, rooms which sleep three, double rooms and additional beds. All our rooms have ensuite bathrooms and numerous free services including digital terrestrial TV, air-conditioning, towels and Wi-Fi internet connection. Our bed and breakfast is a family run establishment and our staff will be delighted to take care of your every need. For many years now, our care and attention to detail has made us stand out from the rest and resulted in us being rated as one of the best B&B's in the area.
Reviews of the bed and breakfast Bel Sole:


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5501 SE 119th St
Oklahoma City, OK 73165
Kitchen Lake Park in south Oklahoma City is a charming place to spend an afternoon outdoors. Part of the city's ... read more...
21 miles E of Claremore on Hwy 20
Salina, OK 74365
Lake Hudson, located on the Grand (Neosho) River near Salina, offers many recreational opportunities including excellent ... read more...
SW of town
Arnett, OK 73832
Located in the Ellis County Wildlife Management Area, the lake has two boat ramps and picnic areas. Fish populations ... read more...
14774 Crystal Bay Dr
Skiatook, OK 74070
Nestled in the natural beauty of Osage County, the Crystal Bay Marina & Resort in Skiatook provides a peaceful ... read more...
Fort Cobb State Park
Fort Cobb, OK 73038
Sunset Cove Marina, located within Fort Cobb State Park, is a full-service marina offering fuel, day and night slip ... read more...
NE of town
Locust Grove, OK 74352
W.R. Holway Reservoir offers two cement boat ramps and no gas-powered boats except trolling motor allowed. Lake offers ... read more...
Shangri-La Marina
Afton, OK 74331
Sail Grand, a one-stop destination for water fun on beautiful Grand Lake, offers parasailing, Jet Skis, ski boats, ... read more...
396120 State Hwy 10
Copan, OK 74044
Copan Lake is a multi-purpose flood control lake featuring approximately 5,000 surface acres of water. Copan Point is ... read more...
Shangri-La Golf Club, Resort & Marina
31000 S Hwy 125
Monkey Island, OK 74331
The fictional paradise Shangri-La has become a reality on Grand Lake's Monkey Island. The Shangri-La Golf Course, ... read more...
Hwy 29 E
Duncan, OK 73533
Enclosed, floating fishing dock, 44 RV hookups, pavilion, three boat ramps, sanitary dump station. Shoreline length is ... read more...
Email: email@example.com


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There are many games out there that people consider to be "awesome games". People play the game once and they think "oh this is the greatest game I've ever played". Then, after playing that game a few more times they realize that the game is not very good; sure there was some substance there, but it really wasn't a very good game once you started playing it more and more and more.
The reason for this lack of excitement in games is because there isn't any substance to these games on a count of depth in the games.


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Wolters Kluwer Health may email you for journal alerts and information, but is committed
to maintaining your privacy and will not share your personal information without
your express consent. For more information, please refer to our Privacy Policy.
Waseem, Shamaila*; Islam, Saleem†; Kahn, Genie†; Moshiree, Baharak†; Talley, Nicholas J.‡
*Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
†Department of Pediatrics, Shands Hospital at the University of Florida, Gainesville, FL
‡Department of Medicine, University of Newcastle, Callaghan, Australia.
Address correspondence and reprint requests to Shamaila Waseem, MD, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine/Riley Hospital for Children, 705 Riley Hospital Dr, ROC 4210, Indianapolis, IN 46202 (e-mail: firstname.lastname@example.com).
Received 17 December, 2010
Accepted 16 January, 2012
Advance Postgraduate Program in Clinical Investigation (APPCI), an NIH-funded K30 award program of which Shamaila Waseem was a fellow, provided funding for study design and statistical analysis.
The authors report no conflicts of interest.
Background: Gastroparesis (GP) is characterized by delayed gastric emptying in the absence of mechanical outlet obstruction. Symptoms may include nausea, vomiting, bloating, early satiety, abdominal pain, and weight loss. Delayed gastric emptying of a solid-phase meal assessed by radionuclear scintigraphy is the criterion standard for diagnosis. The prevalence of GP is difficult to estimate due to the lack of a validated, widely available diagnostic test that can be applied in primary care. The extent of this problem in children is unknown.
Methods: We studied a cohort of children with GP diagnosed by radionuclear scintigraphy to identify demographics, symptoms, comorbidities, treatment, and outcomes. A retrospective analysis of 239 patients between ages 0 and 21 years was performed.
Results: The mean age of presentation was 7.9 years, and boys and girls were almost equally affected, that is, 48.5% and 51.5%, respectively. Vomiting was the most frequent presenting symptom (68%), followed by abdominal pain (51%), nausea (28%), weight loss (27%), early satiety (25%), and bloating (7%). Almost 75% of patients responded to intravenous erythromycin administered provocatively during gastric scintigraphy. In a majority of the patients, no cause was identified, that is, idiopathic GP (70%), followed by drugs (18%) and postsurgical (12.5%) causes. Only 4% patients had diabetic GP, and our population was essentially narcotic naïve (2%). After an average of 24 months' follow-up, the most common complication was esophageal reflux (67%). Despite different therapeutic modalities, by the end of the follow-up period, a significant improvement in symptoms was reported by an average of 60%, regardless of sex, age, or degree of emptying delay.
Conclusions: GP has a good prognosis in childhood despite different etiologies, symptom presentation, and therapy.
Gastroparesis (GP) is a motor and sensory disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Symptoms classically include nausea, vomiting, early satiety, bloating, postprandial fullness, abdominal pain, and weight loss. Although the etiology and management of GP have been studied well in the adult population (1), in the pediatric population, the literature is limited, with only a few case series and clinical trials and little in the way of randomized controlled trials (2–4). GP is often not recognized and thus can remain untreated in children (5,6).
The true prevalence of GP in the United States is unclear. In a study conducted by the Center of Health Outcomes Research (MEDTAP International Inc, Bethesda, MD), 7% to 15% of the adult population was found to have symptoms suggestive of GP (7); however, an adult epidemiological study conducted in Olmsted County, MN, revealed that the age-adjusted prevalence of definite GP per 100,000 population was only 9.6 for men and 37.8 for women (8).
Presently, no data are available to estimate the prevalence of GP in children. One study estimated that 65% of symptomatic adolescents who undergo upper endoscopy, have no abnormalities and are classified as having functional dyspepsia (9). Delayed gastric emptying has been demonstrated to be present in a subset of children with functional dyspepsia (10,11).
The etiology of GP in adults mainly stems from diabetes, idiopathic, and postsurgical (5). In children, most cases are considered to occur either after viral infection or are idiopathic cases (12). Delayed gastric emptying scintigraphy (GES) of a radiolabeled solid meal is the criterion standard for the diagnosis of GP. This test provides a physiological, noninvasive, and quantitative measure of gastric emptying. Liquid emptying may remain normal despite advanced disease.
Few randomized controlled clinical trials have directly compared the different therapeutic agents for GP (13,14) and even fewer data are available in children. In 1 study, domperidone was found to be more effective than cisapride in treatment of children with diabetic GP (15). In a case series of 2 neonates with congenital myotonic dystrophy, bethanechol improved symptoms of delayed gastric emptying (16). Consequently, the selection of drug treatment is commonly made by trial and error.
No published data are available describing the spectrum of pediatric GP. Our study aimed to provide an observational descriptive analysis of a large pediatric population with GP to determine clinical features, demographics, associations, treatment, and relevant outcomes.
The present study was approved by the institutional review board of the University of Florida (UF). All of the UF pediatric gastroenterology practice patients diagnosed as having GP by gastric scintigraphy between January 2002 and December 2008, were identified. Subsequently, electronic chart review was conducted to identify cases. Inclusion criteria were UF pediatric gastroenterology patients with a minimum of 1 follow-up visit; clinical symptoms of GP; and abnormal gastric scintigraphy results, that is, solid emptying ≥90 minutes or liquid emptying ≥60 minutes. We excluded the following patients: not UF pediatric gastroenterology practice patients; gastric emptying times were not extrapolated in half times; or had no follow-up visits after gastric scintigraphy.
The solid meal constituted 1 grade AA egg (∼85 cal) cooked scrambled with Tc-99 sulfur colloid (0.5 mCi) served with 2 pieces of white bread (133 cal) with 1 teaspoon of butter spread on the bread (36 cal), and 50 mL of water to help ingestion [total energy: 254 kcal, ∼30 g of carbohydrates, ∼13 g of protein, and ∼10 g of fat). The liquid meal consisted of 60 mL of radiolabeled formula or PediaSure (60 kcal). After administration of the meal, patients were imaged continuously for 115 to 120 minutes at 1 minute per frame using a single-headed γ-camera or dual-headed camera, positioned in the left anterior oblique position to minimize the effects of varying gastric attenuation on quantification of the gastric emptying rate. In addition, for liquid emptying, fast imaging acquisition at 10/frame was performed to allow for gastroesophageal reflux. A simple linear fit was applied to the rate of gastric emptying with calculation of half-time (t½) by extrapolation. Normal values for the solid meal and imaging methodology were obtained by the Director of Nuclear Medicine using 60 normal volunteers (age range 26–60) in 1981–1982 at Henry Ford Hospital (personal communication, 17,18). A linear rate of emptying to the data was applied from 0 to 75 minutes and obtained an extrapolated half time of emptying (normal t½ for solids was defined as 45–90 minutes and normal for liquids was <60 minutes). Because gastric emptying follows zero-order kinetics, the rate was effectively determined before 75 minutes. At 75 to 80 minutes into the examination, provocative testing with administration of intravenous (IV) erythromycin (EES), 2.8 mg · kg−1 · dose−1 up to a maximum of 250 mg, infused over 20 minutes was performed. Further imaging for 15 minutes was done to extrapolate the new postdrug t½. With liquid meals, IV EES was infused after 60 minutes instead of 80 minutes. Before the year 2005, IV metoclopramide (MCP) was also infused at 0.05 mg · kg−1 · dose−1 up to a maximum of 3 mg/dose. Responders to the drugs were defined as having normal postdrug t½, that is, 45 to 90 minutes for solids and <60 minutes for liquids.
We further divided our cohort into 4 categories of delayed solid emptying and 3 categories of delayed liquid emptying. Both were stratified by t½. Therefore, patients with solid emptying delay (n = 145) were divided into very severe (>241 minutes), severe (191–240 minutes), moderate (141–190 minutes), and mild (90–140 minutes). Similarly, patients with liquid emptying delay (n = 94) were divided into severe (>141 minutes), moderate (101–140 minutes), and mild (61–100 minutes) categories.
To ensure reliability and high-quality data collection, we designed a data collection form using Microsoft Access 2003 (Microsoft Corp, Redmond, WA). All of the data were collected from electronic medical records, including all of the inpatient and outpatient records. Patients were followed from the time of diagnosis to the last gastrointestinal encounter or until December 2008. The following information was collected.
Age, sex, height, and weight at diagnosis; t½ and type of meal; response to IV EES and/or IV MCP; prescribed acid suppression therapy, that is, proton pump inhibitors and H2 blockers; presenting symptoms, that is, nausea, vomiting, early satiety, bloating, abdominal pain, and weight loss; medication history; medical and surgical history; complications of GP, that is, anemia, esophageal stricture, esophagitis, gastritis, reflux, small bowel bacterial overgrowth, pneumonia, bronchitis, malnutrition, dehydration, and bezoars; treatment of GP, that is, prokinetic medications, dietary modifications, enteral feeds, total parenteral nutrition (TPN), gastric electrical stimulator, and surgery; last gastric scintigraphy and type of meal, time interval in months between first and last gastric scintigraphy; age, height, and weight at last encounter; symptoms at last encounter; etiology of GP, that is, idiopathic, postviral, drugs, that is, narcotics, anticholinergics, β-adrenergics, calcium channel blockers, glucagon, marijuana, alcohol, and tobacco; postsurgical, that is, fundoplication, vagotomy, Whipple procedure, and heart/lung transplant; rheumatologic, that is, scleroderma, lupus, polymyositis, and others; endocrine causes, that is, diabetes, hypothyroidism, hypoparathyroidism, neoplasms, and others; metabolic, that is, electrolyte imbalance, renal dysfunction; miscellaneous, that is, cystic fibrosis, chronic intestinal pseudo-obstruction, myotonia, milk-protein allergy, eosinophilic enteropathy, and others; comorbidities, that is, cerebral palsy, seizure disorder, developmental delay, and prematurity; finally, associated psychiatric disorders, that is, attention-deficit/hyperactivity disorder, depression, bipolar disorder, anxiety, and other behavioral disorders.
We used Minitab statistical software (Cary, NC) and SPSS 16.0 (SPSS Inc, Chicago, IL) for data analysis. Descriptive statistics were calculated for both continuous and binary variables. Data are presented as the mean ± standard deviation. The dataset was then divided into separate cohorts based on sex, age, type of meal, and severity of the GP. Continuous variables were analyzed using either paired t test or 2-sample t test as appropriate. Binary variables (yes/no) were studied with the Fisher exact test of proportions or χ2 test where appropriate. P < 0.05 was considered significant.
A total of 912 pediatric patients had undergone gastric scintigraphy from January 2002 to December 2008. From this group, 408 patients (45%) were identified to have delayed gastric emptying; however, 169 patients from the delayed gastric emptying group were excluded from the study based on the exclusion criteria. Demographics of the 239 eligible cases are shown in Table 1. The mean age (±standard deviation) at presentation was 7.9 (±5.9) years, and the mean body mass index (n = 212) at presentation was 18.6 (±5.3). Among all of the patients, the most common presenting symptoms were vomiting and abdominal pain.
Girls presented at a later age (mean 9 ± 5.9 years compared with 6.7 ± 5.7 years for boys, P = 0.002). There were no differences in the presenting symptoms between both sexes (Table 2). We further categorized the data according to age groups: <1 year, 1 to 5 years, 6 to 10 years, 11 to 16 years, and >17 years (Table 3). The demographics revealed that whereas boys predominated (72.4% of patients) in the <1-year age group, sex ratios were equal in the 1- to 10-year age range and girls predominated in the >10-year age groups. In the >17-year age group, 66.7% of patients were girls.
Patient demographics and symptoms based on solid or liquid meal and severity of emptying delay (Table 4) also varied. There was no difference in the mean age of those presenting with mild, moderate, or severe delays in solid emptying (12.5, 13.8, and 11.4 years, respectively) and roughly two-thirds of individuals in each category were girls. There was also no difference in mean age of those presenting with mild, moderate, or severe delays in liquid emptying (2.3, 2.8, and 3.5 years, respectively). Those with mild and moderate delays in liquid-phase gastric emptying were slightly more likely to be boys, whereas there was equal sex distribution in those with severe delays in liquid-phase gastric emptying. Using the Pearson correlation test, we found a correlation between t½ and the presenting symptoms of nausea and abdominal pain only (r value of 0.3 and 0.1, respectively).
Provocative testing was performed on 113 patients with either or both IV EES and IV MCP infusion during scintigraphy (Table 1). A total of 126 patients (52.7%) were not tested with either of these drugs. χ2 testing revealed patients with solid emptying delay responded better to IV EES than those with liquid emptying delay, that is, 85.5% versus 51.3% (P < 0.001).
Most patients were treated with combination therapy, which predominantly consisted of EES (76.6%) and dietary modifications (74%), but drugs such as MCP (29.7%), tegaserod (6.7%), and azithromycin (5.4%) were also used. Other medications (4.2%) such as cisapride, antihistamines, antiemetics, and tricyclic antidepressants were also prescribed to patients. All of the patients were treated with one or more prokinetic agents at some point. In addition, 172 patients (72%) were receiving concomitant acid suppression therapy. Nutritional support was provided using enteral feeds and TPN. Subsequently, 62 patients (26%) were receiving enteral feeds or TPN at some point during their course. None of the patients in this cohort received pyloric botulinum toxin injections or gastric electrical stimulation.
Esophageal reflux diagnosed during scintigraphy or by fluoroscopy was the most common complication of GP (Table 1). Patients were found to have multiple presumed etiologies for GP making it impossible to differentiate a single etiology as the definitive cause (Table 1). Note that patients may be coded in >1 category, so the total number will not equal 239. In the majority of patients, no cause was identified, that is, idiopathic GP. In this group, there were 82 girls (49%) and 85 (51%) boys. Mean age at presentation was 8 years (±5.8). Drugs were the second most common cause, but interestingly, only 5 patients (2%) were taking narcotics. This was followed by postsurgical causes, almost half of which (53%) were due to Nissen fundoplication. Miscellaneous causes were seen in 6.3% patients and constituted chronic intestinal pseudo-obstruction, myotonia, eosinophilic gastroenteropathy, cow's-milk protein allergy, liver disease, celiac disease, hereditary pancreatitis, and cystic fibrosis. A significant number of patients had associated comorbid conditions such as cerebral palsy, seizure disorder, prematurity, and developmental delay as well as psychiatric conditions (Table 1). Subsequently, attention-deficit/hyperactivity disorder was reported in 20 patients (8.4%), behavioral problems in 19 patients (8%), anxiety in 15 patients (6.3%), depression in 10 patients (4%), and bipolar disorder in 4 patients (1.7%). We found no significant difference between the sexes with regard to these comorbid psychiatric disorders.
This hospital-based cohort study was followed for a mean of 24 months. Our outcome variables were changed in symptoms, for example, nausea, vomiting, early satiety, abdominal pain, bloating, and weight loss. Subsequently, a decrease in the frequency of all of the symptoms was observed at the last encounter. Using the Fisher exact t test, we found significant improvement in all of the outcomes at the end of the follow-up period, regardless of type of treatment used (Fig. 1). Improvements in weight loss occurred, despite the fact that 74% of patients were receiving dietary modifications but were not receiving supplemental nutritional support.
A total of 28 patients underwent a repeat gastric scintigraphy during a mean interval of 28.5 months (range 2–68 months). Of these, initially 10 patients (36%) had solid emptying delay, whereas 18 patients (64%) had liquid emptying delay. Gastric emptying normalized on repeat scanning in 3 girls and 4 boys (25%). First and last t½ differences in these patients were not significantly different (P = 0.1). Of those who underwent repeat GES (n = 28), improvements were noted only in vomiting (P ≤ 0.001) and weight loss (P = 0.009).
We did not find a significant difference in symptom outcomes when comparing boys with girls except for abdominal pain, which was more commonly reported by girls (Table 2). Patients in the 11- to 16-year age group had the most improvement in all of the symptoms (Table 3). Conversely, the least improvement was observed in the >17-year group, reported only in early satiety.
In a large cohort of pediatric patients (n = 239) referred to an academic medical center, we have attempted to describe the spectrum of GP in the pediatric population. Most of the previous data on this condition have been reported from adult studies, which may not reflect the true spectrum of GP in children (5,7). Adult cohorts have consistently revealed an overwhelming female predominance (∼80%) of GP (5,19). In addition, the etiologic categories in adults have been one-third idiopathic, one-third diabetic, and one-third postsurgical/miscellaneous causes (5,19,20). Adult literature establishes a high morbidity and mortality of this condition (19,21).
Our study revealed important differences with an almost equal distribution between female and male pediatric patients (51.5% and 48.5%, respectively) and similar etiologies for each sex. The sex differences started to increase as the ages increased, such that with patients older than 17 years of age, about two-thirds were girls. Boys presented at an earlier age of 6 years versus girls, who presented at 9 years, but both sexes were found to have similar outcomes. This finding differs from adult studies, in which women have shown a poorer prognosis than men (5,19).
Overall, the adult literature suggests no correlation between t½ and symptoms (22). With our data, we were able to demonstrate an association between severity of GP based on t½ and the frequency of nausea and abdominal pain, but not other presenting symptoms. Unfortunately, in this retrospective analysis, we could not assess the severity of the symptoms.
Etiologies in pediatric GP were found to differ from adults (5,23) because there was a predominance of idiopathic GP (70%). Of note, before gastric scintigraphy, patients were asked to bring a glucometer, and if the blood sugar was >275, then scintigraphy was not performed. The lack of a predominant diabetic cause in our cohort may reflect the time that is required for diabetes to cause gastric dysmotility. Diabetic GP was present only in 9 patients (4%) and all of these patients had type 1 diabetes. This information is contrary to the adult literature, in which one-third of patients with GP are diabetics (5). Four (44%) of the 9 patients also had cystic fibrosis. Whether the gastric emptying delay in these 4 patients was due to diabetes-related neuropathy or gastrointestinal dysmotility found in patients with cystic fibrosis is unknown. The correction of hyperglycemia in diabetics is essential in obtaining optimal management results (24).
Ninety-two patients (38.5%) had associated comorbidities that may contribute to GP. This information suggests the need for further investigation into the pathophysiology of GP and possibly a significant role of the CNS and its relation with the enteric nervous system in the pathogenesis of GP.
Another important factor to consider is that only 5 patients (2%) were taking opiates and 4 patients were smokers; therefore, a majority of our patients were not exposed to medications or behaviors that have been implicated in adult GP. For this reason, our cohort was essentially narcotic naïve. Most series describing GP in adults document the extensive use of such medications or behaviors (25).
Mandatory prokinetic testing during scintigraphy is a valuable addition to the GES protocol in our institution and to our knowledge is not widely performed. This practice enabled us to further divide the cohort to responders and nonresponders to IV EES or IV MCP. We found that IV EES was more effective in improving solid emptying when compared with liquid emptying. A possible explanation may be that liquid emptying delay is considered an indicator of progressively worsening GP; therefore, these patients may have more severe disease with poorer response rates to prokinetics. It is unclear whether patients who respond to these medications have an improved outcome, because tachyphylaxis still develops during clinical use.
Other differences from adults include the frequency of presenting symptoms, because adults usually present with nausea and vomiting rather than abdominal pain (5,19). In our pediatric cohort, we noted that abdominal pain was a common presenting feature. The prominence of abdominal pain in our patients with GP may be due to the pronounced association of pain with idiopathic GP, which in turn is a major cause of GP in children (5). The finding of gastroesophageal reflux disease as the most common complication of GP is a reminder that patients with reflux and functional dyspepsia can have delayed gastric emptying (19,26). Although 67% of gastroparetic patients were diagnosed as having gastroesophageal reflux disease, only 17% and 15% had histological evidence of esophagitis or gastritis, respectively.
Comparatively, differences in mental health associations were also important. When compared with the published adult literature, patients in the present study had far fewer (28.4% vs 62%) comorbid psychiatric conditions (5). Again, this may be due to the duration of symptoms; patients with chronic GP symptoms may have a tendency to become depressed and anxious. The frequency and prevalence of comorbid psychiatric conditions were the same in both sexes in our cohort.
Most patients were treated with EES and dietary modifications (73.6% and 74%, respectively). Patients who do not respond well to oral EES could be tried on IV EES (27). Subcutaneous MCP has also been tried in this setting as tolerated (28). Despite different therapeutic modalities, we found a statistically significant improvement in all of the symptoms at the end of the mean 2-year follow-up, with similar results in both sexes. One possible reason is that the natural history of idiopathic pediatric GP may result in improvement over time. In future studies, we plan to prospectively study the outcomes of patients with and without pharmacologic treatment and attempt to identify those patients who do not respond to conventional treatments.
The most prevalent age groups with GP were the 11- to 16-year and 1- to 5-year categories. The literature on liquid emptying delay is limited. Based on adult data, it is considered an end-stage indicator of GP. Most of our liquid emptying meals were performed due to the age (infants/toddlers) of patients and inability to ingest the solid meal. We had 6 patients who had t½ >240-minute delay with liquid emptying. Five of the 6 required enteral feeds, and underwent fundoplication, gastrostomy tube placement, and pyloroplasty. In addition, these 5 patients had CNS comorbidities and developmental delays. The remaining patient was thought to have postviral GP. This reinforces the fact that CNS conditions may play a major role in the pathophysiology of GP.
The present study has some limitations. First, this was a retrospective cohort and hence misclassification of GP variables in records may potentially change our estimates. Second, we did not record duration of treatment, which was difficult to extrapolate solely from electronic records; therefore, outcomes based on duration of treatment could not be performed. Third, we did not record ethnicity; therefore, our study may not be representative of all of the ethnic groups with GP. Fourth, because this is a hospital-based study instead of a population-based study, we were unable to estimate the prevalence of GP. Our study, therefore, may be biased because it represents more severe presentation of GP instead of a milder presentation in the general population. Fifth, a gastric emptying test was also ordered by other specialties such as pulmonologists, endocrinologists, surgeons, and so on. Most of these patients were not seen by UF gastroenterology. The indications of the test, that is, symptoms, were not assessed by UF gastroenterology. Some patients received second opinions from outside facilities with established diagnosis. The nuclear medicine database did not distinguish who ordered the test. In addition, patients lost to follow-up after initial diagnoses were also excluded because follow-up symptoms could not be assessed. We do not know whether lost to follow-up was due to resolution of symptoms. Only approximately 2% of patients had results of gastric emptying not extrapolated in half times. Whether the excluded patients had abnormal tests but were asymptomatic is unknown. We understand that obtaining data on asymptomatic patients with delayed gastric emptying is important and may be better assessed in a prospective design. A key issue is whether primary care providers underreport or underrecognize GP in children. Finally, the GES protocol used at UF is not in accordance with the recent consensus recommendations of GES published in 2008 (29); however, our protocol of continuous scanning for 2 hours is validated by the Nuclear Medicine Society and has been published (17,18).
In summary, this is, to our knowledge, the first large hospital-based study to describe the demographics, etiologies, and outcomes of GP in the pediatric population. GP is an uncommon condition in the community compared with tertiary-based hospital settings, but still represents a major disease burden. Most patients with GP need continuous medical care, but long-term outcome in the pediatric population seems promising despite limited therapeutic choices. This retrospective study provides the basis for future studies, which will focus on risk stratification of children with GP, develop and validate quality of life measures, classify patients based on severity of GP, and assess newer therapies for this debilitating condition based on the specific pathophysiology.
The authors thank Marian Limacher, MD, FACC, and JaneYellowleez Douglas, PhD, for reviewing and commenting on the manuscript. The authors also thank Wei Hou, PhD, for help with creating the Microsoft Access data collection form and statistical analysis.
This article has been cited 1 time(s).
etiologies; gastroparesis; identify; prevalence; retrospective; scintigraphy
© 2012 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Any normal celebration of Pentecost marks the end of the Easter season, but in 2014 the attention of citizens in Albuquerque, along with the rest of the free world, was drawn to what seemed like a long commemoration of the world wars, especially World War II. Our collective memory was even more specifically focused on the seventieth anniversary of the D-Day invasion that began the end of that horrible war.
In 2014, the celebration of Memorial Day was on May 26, the second earliest possible date to remember those who have died in all wars, thus allowing a longer period to analyze the events which many believe could have brought about the end of the world. Twelve days after the national holiday was the anniversary of D-Day. During that period television and the advertising world saturated the American public with patriotic zeal, bringing us the background stories of the principal characters involved on both sides, and we were finally able to view the epic battles in color and HD. Businesses touted their products as essential to loyal Americans.
Unfortunately, war and violence have always been a part of the human psyche. The earliest people we know about had the fulltime job of mere survival. They lived in a literal kill-or-be-killed world. Since they were not yet farmers and knew little if anything about edible vegetation, there was a good chance that what they didn't eat might eat them. When tribes began to encounter each other, the same fear enveloped them, and the survival mentality continued. You cannot accurately tell the history of the human race without including the seemingly endless list of atrocious violence men (yes, and women) have inflicted on each other.
One such war that seemed to last forever was the Hundred Years War between England and France that overlapped the fourteenth and fifteenth centuries (it actually lasted 116 years). If there was any victor in the fray, it was England, who eventually gained considerable French territory, but at what cost? What the Hundred Years War did give was the heroic, inspiring image of Joan of Arc, who is recalled in almost every children's book of saints ever written.
World War II didn't last a hundred years, but to those who fought in the trenches of Europe, it must have seemed at least that long. It can perhaps be more understood as a matter of good against evil with no question about the abominable threat of Nazi Germany. What could be questioned is the 'good guy' status of Josef Stalin, who will be remembered in history as every bit the atrocious ruler Hitler was. Sometimes war has made strange bedfellows.
However, every war produces heroes, not just the warriors, but those who stood up with words, deeds, or just their presence. Most Christians have heard of the great sacrifices of religious like Dietrich Bonhoeffer and Maximilian Kolbe. Edith Stein was a brilliant student who gained a doctorate in philosophy and became a great inspirational writer. She was also a Jew who became a Catholic Carmelite nun, Teresa Benedicta of the Cross. There was a closeness between Jews and Catholics in Holland, many Jewish children enrolled in Catholic schools. With the invasion of the Nazis, the bishopric in Holland spoke openly against the deportation of Jews. In response, the Nazis not only continued to round up the Jews, but also Christians who were of Jewish extraction, as well. Teresa Benedicta was one of them, and she died in a gas chamber like the others who were persecuted under the Nazi injustice. She was canonized a saint in 1998.
Thanks largely to the epic movie, Schindler's List, many westerners have become aware of the effort by Oskar Schindler. This German was a successful industrialist in Cracow, Poland, who saved Jews by listing them as employees, falsifying records, and occasionally even hiding them. Before that, he was not only a spy for the Germans, but was also a card carrying member of the Nazi party. Although knowledge of his brave deeds is now common, Schindler was virtually unknown until former captive Jews and factory workers began to tell their stories. He never claimed fame or honor, and his story was told by others.
Often times, heroes and saints are ordinary people thrust in extraordinary circumstances, and war has all too often provided that vehicle. One time that it didn't was in the hours and days that followed Pentecost. There is no accurate record as to who was gathered for the reception of the Holy Spirit that day. We can assume there were twelve apostles (Matthias had joined the group, replacing Judas by then), Jesus' mother and possibly other relatives, Mary Magdalene, and other unnamed disciples. What Acts of the Apostles tells the Bible student is that on that day, with a special blessing of the Holy Spirit of God, ordinary men and women became heroes and saints. Beginning with Peter, they spoke the story of Jesus and acted on his call to mission.
War and violence are a frightening reality of life. Soldiers still fight over disputed borders or beliefs. Covetousness is not only a cause of war, but is seen more and more in our own streets. As we move beyond the memory of the 'great war,' and the Church celebrates the days after Pentecost, we recall the sacrifice of the brave men and women who stood for our freedom (even as many today take it for granted); we remember those humble servants of God, who stepped forth from the upper room that day; we await in prayerful silence for the day when we too may be called from our ordinariness to be heroes and saints. The last of the Navajo Code Talkers passed away last week as another reminder of heroes and saints whose names we don't even know.