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"Husbands, continue loving your wives.." Ephesians 5:25 "You husbands, keep on loving your wives and do not be bitterly angry with them" Colossians 3:19 "For the unbelieving husband is sanctified in relation to his wife.." 1 Corinthians 7:14
How often in the quagmire of life stressors husbands fail to listen to their wives? Distracted by outside forces beyond a husband's control, perhaps overwhelmed even having the skills to cope, a husband may become narrowed on the scope of life. Plans frustrated, delayed in reaching goals, distracted from the things to do list, routines disrupted, money problems, deprived of sex - love - affection, one or many of these may bring about other motives, including anger or violence.
A wife, experiencing her own issues in life, may be in need of her husband's compassion, empathy, mere listening or advice. If the wife becomes overwhelmed she may even want his sympathy. She may expect him to show more feelings (or share her feelings exactly the way she does) than the situation requires to address the solutions. Under the circumstances, one or both may be distressed, narrowed in mind, losing contact with God and higher level thinking. Both of their communication may fail.
Instead of providing support, the husband may become hostile, demeaning or judgmental. She may become disappointed or disillusioned. She may quit, exit and seek solutions elsewhere. The husband may feel abandoned, dejected, and revert the feelings inwards, become saddened, depressed or miserable. Feeling suspicious, he may begin to believe that she would be having an affair; or that she was using her problems as a ploy to conceal her affairs. Because may be he expected her, not him, to be the affectionate figure, the leader in the field of feelings and listening.
After meditation, relaxation, connecting with God, keeping an open mind, becoming aware of one's other motives, reducing seeking goals, recognizing her wanting sympathy and needing empathy, being ready to maintain positive feelings, he may improve in listening to her problems- as well as reducing the effect of his own problems.


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Bay Area electro-pop collective The Seshen return with a new song called "Turn." The grandeur of sound screams for inclusion on a TV show soundtrack somewhere.
Develops and implements integrated marketing strategies, digital, social, event and experiential programs for consumer brands, leveraging music and culture.
Bay Area electro-pop collective The Seshen return with a new song called "Turn." The grandeur of sound screams for inclusion on a TV show soundtrack somewhere.
As a sequel to the video for "Elusive" that she dropped yesterday, Lianne La Havas today released her video for "Gone." Dubbing the pairing of the two as as short film, Lianne goes from showing the mystery and thrill of a blossoming romance to the devastation of disappointment and heartbreak. Beautiful performance.
Perseus strips down the original version of "Night Light," by Jessie Ware, exposing the vocals and giving it a seductive sheen, a pulsating beat and a throwback vibe for all you 80′s era nostalgists. It's a combination of sweet, soulful R&B with that fresh wave of UK bass we have come to love so much. Perseus harnesses Ware's immense vocal range with this remix and creates a seamless and mesmerizing transition back in time to the golden age of 80′s pop/R&B. Enjoy my damies!
Szjerdene today releases a more upbeat tune called "Arrow(s)." Though more of an electro-dance track, Szjerdene's haunting and delicate voice maintains her signature soothing atmosphere.
It is now time for the February installation of our Next Step contest. We're eager to hear what our community has to share with us!
The winner will receive an "Artist Spotlight" feature post on the Giant Step website, and up to $1,000 in Giant Step Marketing services!
Please note that we are accepting submissions from anyone that makes music – producers, singers, instrumentalists, rappers, and bands alike are all welcome.
This month, we are accepting submissions from today through Monday, March 4. That said, we are now open for February 2013 entries!
Submit your music for consideration!

subset: commoncrawl


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Wednesday, February 23, 2011
Administration Refuses to Defend DOMA
In a surprising move today, the Department of Justice issued a letter saying it will no longer defend the constitutionality of a federal law (DOMA) that bans recognition of same-sex marriage. There are currently several cases making their way through the courts that challenge different sections of DOMA as unconstitutional. In July of 2010, a federal district court ruled that Section 3 of DOMA, the section that defines marriage as one man and one woman, as unconstitutional. The letter issued today means that the administration will not appeal that case. If the courts rule DOMA unconstitutional, married same-sex couples may be eligible for the federal benefits given to married couples.
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I have a
/ect/init/application.conf file that looks something like...
start on filesystem and net-device-up IFACE!=lo
stop on runlevel [016]
export NODE_ENV=production
chdir /home/richie/application
exec /home/richie/.nvm/v0.10.26/bin/node server/app >> /var/log/node.log 2>&1
It is meant to run a
Node.js application in production mode. However, when I run the application as a service:
sudo service application start
It outputs this data in the log when I output my environment variables:
UPSTART_JOB: 'application',
TERM: 'linux',
PATH: '/usr/local/sbin:/usr/local/bin:/usr/bin:/usr/sbin:/sbin:/bin',
PWD: '/home/richie/application' }
As you can see,
NODE_ENV does not exist in the list of environment variables. Any idea why my exported environment variable would be ignored? I also have added into my
/etc/environment file:
Thanks in advance!


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Researchers have found that steroid use among gay and bisexual teens boys are at an alarming rate. According to a report by the Associated Press on Feb. 3, the rate is almost six times higher than straight teenage boys.
This "dramatic disparity" in illicit steroid use has the researchers of the study concerned, feeling there is a need to reach out to this group as the study shows that over 21 percent of gay or bisexual boys admitted to steroid use versus just 4 percent among straight boys. The statistics are similar among those who reported moderate use. The heaviest use of the enhancing drug was reported by 4 percent of gays or bi boys, compared with less than 1 percent of straight teens.
There is a social aspect that the authors of the study find may be the reason for this disparity. They site the possibility of gay and bi boys feeling more pressure to bulk-up to meet what they view as the "ideal" male physique. This could be contributed to the stereotypes associated with what gay is and perceptions about masculinity. Bullying may also play apart as body building for strength may help these teens who turn to steroids fend off bullies.
These are plausible reasons, but like any study, this is just a sampling, but enough of one to be concerned says co-author of the study, Aaron Blashill, a psychologist and scientist with the Fenway Institute.
"Given the dramatic disparity…it would seem that this is a population in which greater attention is needed."
The study is a nationally representation of government surveys from 2005 and 2007 that involved 17,250 teen boys aged 16 on average. Precisely 635 of the 17, 250 identified as gay or bisexual.
Steroids are only legally available by prescription. But can be made available to teens illegally. Users who take the drug take them to promote muscle growth, strength and endurance. Side effects of steroid abuse include heart and liver problems as well as an increase in aggressive behavior.
Hints of steroid use involve speedy muscle growth and mood swings. The report also concludes that kids are less open to admit steroid use than they are about opening up about drinking or smoking marijuana. This also raises more of awareness and opens concerns about the increase of use amongst gay and bisexual boys.
Subscribe to New England Gay Issues Examiner.
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If a journey of a thousand miles begins with but a single step, each step along the way is necessary to complete the journey. - Darwin Rockantansky
As I travel among the various camps of the conservative communities here in the lovely Las Vegas Valley, and even the occasional Democratic circle, a more clear image of the "concerned Americans" demographic has taken on substance. And although some would choose to disagree, the "Concerned Americans" demographic crosses all boundaries of race, religion, ethnicity, and political affiliation.
The political demographics of our country would appear to map to a standard bell curve in which five percent (5%) fall under the extreme left of the curve and five percent (5%) fall under the extreme right of the curve and ninety percent (90%) fall under the center of the bell.
Those at both ends of the bell curve are like Charlotte Bobcat fans; they are so desperate for a win, any win, for their team that they are not even able to name any of the players or the coach; true devotees to their party without understanding the details. And most of them are "born into the party"; their parents belonged to a specific party so they assume that they must belong to that same party.
The remaining ninety percent of voting Americans tend to be apathetic, disinterested, and indifferent to the machinations of the political parties and the direction of this nation.
The vast majority of these people are "deer in the headlights", standing in the middle of the road, unable to go left or right, waiting for the oncoming light to come to them. And when it does finally come to them, they are either severely damaged or dead.
And part of the cause for that mentality is the feeling of futility. If every person who has said to me: "I am but one person, what can I do?" were to do something...anything...to help redirect the course of this nation the Obama regime would never have existed in the first place.
Doing nothing other than complaining about what is or is not or should be is one step along the path to extinction for this nation.
Allowing non-constitutional-related issues and petty personality conflicts to impede advancement of our goals and objectives is one more step to extinction for this nation.
Hiding in our "safe zones" of angry old white folks who agree with us is one more step towards extinction for this nation.
The vast majority of Americans are as "conservative" as are you and I. They have families that they care about. They attend churches and synagogues and worship God, each in their own way according to their traditions. They long for a simple existence where they are free to pursue their own definitions of happiness. And they all tend to get wrapped up in the game of "Us vs. Them".
We have been averaging less than 20% turnout in our primaries here in Nevada. One in five registered voters care enough about what happens to this country to get out and exercise their right to say who will represent We The People in Washington D.C.
It should be a source of great national shame that so many of our citizens simply choose not to participate in defining our government while all across the world people risk there very lives to perform that one act of civil responsibility.
This lack of participation in the political process is THE CORNERSTONE in the path to extinction for this nation.
Americans are fond of citing: "United We Stand!" but in practice we tend to mean: "Untied we stand so long as you agree with everything that I believe and say".
That nature of the human animal is such that "I" will never agree with "you" 100% and 100% of the time.
And how many who read this will agree 100% with what I have said here... only to immediately return to their favorite TV show, or their golf game, or other personally pleasing activity rather than to get off their sofa and out of their easy chair to search out true Tea Party candidates that need their support in every way?
As a combat veteran and the son of a veteran, I think Abraham Lincoln said it best:
It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us -- that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion -- that we here highly resolve that these dead shall not have died in vain -- that this nation, under God, shall have a new birth of freedom -- and that government of the people, by the people, for the people, shall not perish from the earth.
Views: 323
Phil M.:
In short...NO.
Even though Democrats are jumping ship like rats on a sinking garbage scow, there is not enough cojones in congress to do anything but point fingers at the other side.
Those precious moderates are stuck in the middle of the road and will be guaranteed to be ran over by what occurs daily. America needs to impeach both Obama and Holder. These two racist narcissists are the biggest threat to America today. The question remains will Congress or the voters wake up by November 2014?
Wake people up with the shocking truth, www.commieblaster.com see progressives & RINOS and their life plan for you at www.uhuh.com (print this,its 1 page) and get little book NON DARE CALL IT CONSPIRCY by Gary Allen from www.infowars.com The lame, stupid, and cowards will not do this. The rest of you have no excuse.
If you speed, you get a ticket. The ticket persuades most people to slow down. It is time Obama got a ticket, and, maybe has a time out, and maybe pays a fine.
I hope this Lawsuit, followed by Obama and Holders impeachment when we take the Senate back educates some low information voters about the Democratic party, and why they should not vote for them.
© 2016 Created by Judson Phillips. Powered by


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18ct Wedding Rings
Vintage Wedding Rings in Art Nouveaux, Art Deco and Edwardian styles are available right here at the DiamondLove website. We specialise in stunning wedding bands that perfectly capture the vintage look you are after. All of our gold and platinum rings are made to exceptionally high standards and finished beautifully with striking diamonds and intricate engraving. These rings will make a real statement on your big day and perfectly compliment our range of DiamondLove engagement rings. Please feel free to browse our website for more bridal and bridesmaid jewellery, as well as our stunning range of engagement rings.


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Miami Fashion Week 2014 brought this year's best resort collections from all over the world, making the Miami Beach Convention Center the epicenter of colorful prints showcasing unique designs that amazed the audience.
Italian-Haitian designer, Stella Jean was definitely one of our favorite designers. We fell in love with the way the designer mixed different prints and made them work in a very fashionable way.
Jean opened the backstage doors to our Miami Celebrity Fashion Examiner, Lissette Rondon in a very exclusive interview where she talked about the collection, her experience at Miami Fashion Week 2014, inspiration and more.
LR: How did you feel in our city of Miami?
"I already knew Miami well, I've spent a lot of time here in my life. A big part of my family lives here and since I was born, I have always spent two months in Miami for many years. So for me it's a familiar place and I always appreciate its freshness, vitality and carefreeness," said Jean.
LR: How was your experience at Miami Fashion Week 2014?
"I decided to present in this city something I think is strongly in line with the feelings of a place like Miami. I enjoyed this 'beachwear experience' and I hope I have given something with my contribution," added Jean.
LR: What was your inspiration for your show tonight?
"The beachwear collection I presented is a mix of my previous collections. In particular, the Beachwear ones get inspiration from the suggestive black-and-white images of the aristocratic holiday destination of the 60s. The leitmotiv of the collection is the Wax & Stripes Philosophy, my personal signature that takes endless inspiration from the suggestions of my Italian-Haitian roots," added Jean. "The bright colors of the wax prints play with striped fabrics and redefine the silhouette with swimsuits and outfits that give a retro-chic allure to the woman wearing them. Beachwear and clothing share a dialogue in a language made of social contamination, and explore eras and latitudes in their search for a new balance."
LR: What is your next project?
"I'm sorry, but I cannot share so much. I am very superstitious!" said Jean, smiling. "Any single project calls for the impetus of many minds and an equal number of wills. Revealing its essence in advance would mean undermining a huge amount of teamwork. I will let the audience find out for themselves!"
LR- Could you define your work and yourself with just 3 words?
"About my work I can say: trompe l'oeil, counter-colonization, metissage and about me: instinct, antithesis, memories," added Jean.
LR- Your brand is an inspiration for many emerging designers. Would you like to give them any advice for success or inspirational message?
"To not be afraid to keep their DNA and their uniqueness, to not follow the mainstream and don't copy. Trying not to pretend and being themselves," Jean.
LR- Will Stella Jean come back for Miami Fashion Week 2015?
"Who knows?" said Jean. "As I told you before, I do not reveal in advance anything about future projects. I do not want to talk before I have really done something."
Image: Courtesy of MFW
Suggested Links
- MFW 2014: Maliparmi, 'being yourself is the key to this collection'
- Miami Fashion Week 2014: Carpe Diem by Andres Sarda
- MFW: Agatha Ruiz de la Prada, 'Miami is the perfect place for my collection'
- Designer Michael Costello's Pinnacle Collection was unveiled in Miami
- Custo Barcelona takes over Miami Fashion Week 2014


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Andrew J Lettrich
Main Address:
Glacier View Golf Course
PO Box 185
West Glacier, MT 59936-0185
(406) 888-5471
PO Box 185
West Glacier, MT 59936-0185
(406) 888-5471
640 River Bend Dr
West Glacier, MT 59936
West Glacier, MT 59936
(406) 888-5471
Andrew Lettrich is a PGA Apprentice in West Glacier, MT. The PGA of America comprises 27,000 men and women professionals with one singular goal in mind - to make the game of golf more enjoyable for you.
Services Offered:
- Instruction
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PGA of America Championships
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Chaska, Minn.


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Member of the reality-based community of progressive (not anonymous) Massachusetts blogs
I was in my car a lot yesterday, so of course I was listening to WBUR. And they had an excellent piece about colleges which are taking a different path from most of the nation's private and public universities…cutting back on sports, frills, and unnecessary services and getting back to spending their budget on professors and keeping their costs as low as possible for students so they don't graduate with crushing debt.
It really hit home, because the trend of development at UMass Lowell for last 5-10 years have been right up there with the "conventional wisdom." Renovate sports arenas, move your teams to Division 1, and chase sports prestige; build, or buy and renovate, grand new buildings (some academic, some not)…all to attract students with shiny amenities that may not really actually help them learn, or serve the goal of education. And of course, none of that is free, so the "fees" at UMass have gone up exponentially. Currently, in-state tuition, fees, room and board and meal plan all together costs $23,340. If you manage to graduate in four years (something else that is an issue), that's almost $100,000 for a state university.
You can listen to the show or read the whole transcript - it was a worthy discussion on Morning Edition with the presidents of two different colleges which are heading in a very different direction. But here are some highlights worth mentioning:
Theobald: We eliminated five varsity sports. We are trying to reallocate our funds toward our student body, what goes on in the classroom, what goes on in the lab, so we scaled back by five sports. But it was incredibly difficult.
O'Shea: We don't have any varsity sports. We are a very lean organization. We invest in faculty. It's about a 10:1 student-faculty ratio. … Only 40 percent graduate with debt, and of those who have debt, the average debt is a little under $18,000. We invest in faculty instead of sports and even some student services.
Theobald: You've got to set priorities. There is an arms race for spending. And so a university needs to know who they are, who their students are and what their mission is. We need to focus on getting them in, getting them a course of study, making sure courses are available when they need them and getting them out in four years. That's the priority for our students.
O'Shea: I think what is going to stop being a major driver is student expectation. I think the worry about cost is outstripping the desire for … huge facilities and things like that.
I recommend listening to the whole thing though, as they have a lot to say about what is happening to our higher education both public and private.
This is not to single out UMass Lowell or question all of its many buildouts and changes. A lot of new businesses and inventions and ideas are going to be incubated from what the University is doing here, and I think in many cases UML is keeping an eye on costs and developing in such a way as to offset some of them. (For instance, there are many acts coming to the Tsongas which are probably big money makers.)
However, as a Commonwealth, and as a nation, we need to stop and take a look at the direction our higher ed is going, because like the housing bubble, the student debt bubble could help take down an entire economy. A student who graduates with $30-100K in debt from a public university, or a student who drops out or does bother to attend college, is going to have a delayed start to their adult life; and miss out on reaching their full potential which, in turn, suppresses their whole lifelong economic contribution to society.
Some states are also ahead of us on this issue; discussing free higher education at state colleges and universities. Imagine what that will do for the economy of those states? But here in Massachusetts, the public university prices just keep going up and up. For all the wrong reasons.
Who here is a fan of the HBO series, Game of Thrones? The world of the books/series revolves around the utter instability and chaos, war, and madness that is brought about by Westeros' sudden and not-quite-accidental regime change. King Baratheon might not have been the smartest or the best king ever, but his demise heralds the end of the relative peace of the Seven Kingdoms, with his queen's non-Baratheon bastard children vying with other contenders for the Iron Throne, and the whole countryside erupting in war. Other families take advantage of the chaos to carve out and reclaim their little kingdoms which had been absorbed long ago. Still others just like to party by judicious use of castration and torture, mostly for fun.
Well, folks, take away the castration and violence (but not the drinking) and you have Lowell city politics right now.
Every decision made in the last seven years by past City Councils and the former CM is up for grabs, apparently. No matter how stringent the public involvement in deciding on plans for various projects in the city, be that the very preliminary, not-our-goddamned-decision high school reno or rebuild, or the much-lauded plans for the historic South Common, or any Master Plan element of bike paths or city street realignment or other projects already in the works.
I wouldn't be surprised at this point if this City Council wanted a redo on the Appleton Mill artist lofts or the Early garage. I mean, hey, we could tear down or repurpose those things and hand them over to your buddies, right?
Supposedly, we have high level experts on the Council now on economic development. What I want to know, is how running a dive bar makes one qualified to build a high school? Or decide that street parking should have less turnover by not enforcing the meters? To me, every word that comes out of Corey Belanger's mouth showcases a total and absolute lack of understanding of economic development and municipal management. Far be it for experts to have an opinion; Corey is on the job now, so Lowell is gonna make a turnaround. A renaissance. All of the downtown vacancies will be filled by the time his first term is over!
Or, wait. Businesses - small ones, and large ones - like stability when they make their business decisions. They like to know that the plans that were carefully made by transparent and open means, by a crew of amazing (now mostly fled) Planning and Development officials, will be carried out in a timely fashion. It's no big secret that a lot of plans in Lowell were on hold during the Cox era and were put back on the front burner by the Lynch administration. Now, we're going to reverse years worth of planning, public participation, and decision making because Corey Belanger wasn't fucking paying attention during all of that?
Plans can change. Don't get me wrong. We should be flexible. And I do not have a horse in the very silly race about the high school staying in or moving from downtown. There are merits on both sides. However, my understanding of the process as outlined by a state agency called Massachusetts School Building Authority is that they are the entity that gets to weigh all the factors. What the local idiots on Council can do, by waffling, is take us off the shortlist, which we cannot afford. The high school is in need of either rebuilding or renovating, soon. And "soon" is relative, since getting on the MSBA's short list means it'll still take years to go through final decision making. And oh yeah, they, not us, make that final determination about renovation vs. building a new building elsewhere. Based - GASP! - NOT on whatever private developer wants to build something (god knows what, they have yet to say) on the existing high school site, BUT…based on what is best for the students and their education.
I know, shocking.
So who wins in this Game of Postpones? Well, not the students, if Corey Belanger gets his way as an apparently honorary member of the School Committee and of the MSBA. PS - apparently, Mistah Mayah also has an extremely short memory, since all of this planning and participation and discussion happened while he was a City Councilor. So, either he's dumb and doesn't remember, or he never really paid any attention to what was going on in the city for the last seven years. Neither explanation is encouraging.
I know I've been relatively silent lately. Mostly, I just saw us marching into the inevitable City Manager hire and knew there was nothing to stop the crazy train, so it seemed like while there was a ton of things to say, there was really nothing to say. So now, we're on the other side of the predicable ending of our tale, and have to deal with the aftermath. All righty, then. I still own a home here, and I still vote here, so I'm still an interested party to the future of Lowell.
So why does this not surprise me? "Retired Cambridge manager Healy will serve as Lowell consultant" reads the headline.
Incoming city manager Kevin Murphy plans to hire former longtime Cambridge City Manager Robert Healy as a short-term financial consultant soon after Murphy becomes manager.
Ostensibly, the excuse is, "because we don't have a CFO yet." But a real pro, someone like Bernie, could handle the first month without a CFO, instead of hiring a high-priced (albeit very competent) consultant. Had we hired one of the folks who are themselves experienced in managing a budget, this would probably not be necessary.
So that's the zero skills side of the new CM hire. What about the hack side?
Well, people are worried. Will Murphy, who has a lot of enemies, start "cleaning out" city hall? We've already lost so much talent, both coincidentally and because of the loss of Bernie Lynch. Other cities and towns are actively recruiting Lowell city staff because they know they probably want to jump ship. I won't say there will be vendetta firings at The Castle, but I won't rule it out, either. Too many people in the know seem to be worried about it to dismiss the notion.
Here are some of my predictions after mulling over recent events and getting lots of input:
1. Kevin Murphy, or KMurph as some of us have been taken to call him, will be here precisely three years. The exact amount of time it takes to boost one's pension (the pension is based on your top three years' salary). Mark my words, in precisely three years we'll be here again, hiring another City Manager. Anyone who thinks this is not at least a lot about the money is adorably naive.
2. This last "change election" won't hold in 2015. Anecdotally, I have been hearing a lot of anger over Bernie Lynch leaving (directed at the new Council). But that seems to be nothing compared to the anger I've heard around KMurph's hiring as his replacement. Apparently, KM has made a lot of enemies. Some, I'm sure, are a natural result of being a lawyer across the table from many other local people of various types and perhaps being good at his job. Others…I'm not so sure. He is not a beloved local notable. I don't even think he's a polarizing figure - the comments seem to be quite skewed towards disgust and not support. Maybe that's the circle I run in, but my circle runs in lots of other circles and they're hearing the same thing.
So, any of the people directly associated with obvious pre-picking of KMurph over all possible professionals will be in trouble in 2015. Any anger which remains and/or is stoked by KM as CM will be directed at them. Anecdotally, I hear of a lot of people who voted Belanger or Rourke because they knew them, only to be pissed off at the ousting of Bernie, and the hiring of a hack politician who has lots of enemies as CM. I don't know how many voters that translates to, but they lost some. I suspect there will be an "enthusiasm gap" for GOBs (Good Ol' Boys) next time around. The self-aware GOB will still show up, as they always do, but maybe not all their infrequent voter friends will. Ask the national Democrats what an enthusiasm gap looks like…
As a corollary, the traditional anti-GOB heroes have taken a tarnishing on their shiny hero shields. Big disappointments all around for such notables as Bill Martin and Jim Milinazzo, as well as - I hate to say it - Dick Howe Jr. Love ye, Dick, but I really do think you have a blind spot here. The fact our new CM has to hire an actual professional right off the bat, wasting our taxpayer dollars to fill in the total lack of skills he has for this job, already shows how bad of an idea this is. Do we really think KMurph is going to learn enough this budget season to be able to produce one to the level of a Bernie Lynch or a Robert Healy next year?
I mean, yes, sure, at least KMurph seems to know he's totally unprepared for the job by hiring Healy; but the fact it's even necessary shows a complete misreading of what Plan E is supposed to look like.
3. We get a grace year or two to coast on Lynch's 7+ years of success. If KMurph really only stays three years, and he doesn't totally eff it up, we might be sort of OK. Granted, there's some serious pipers to pay in the next few years, as Lynch had pointed out - instead of little moderate rises in taxes over the years, Lynch had put (thanks to the pressures of the Council) all of his pretty amazing budgetary efficiencies into keeping the tax rate the same most of the time. KMurph will not find the same level of budget efficiencies - both because a lot of the low-hanging fruit is picked, and because KM is guaranteed not going to be anywhere near as skilled as lifelong muni manager Lynch was at the task.
So, a good predictor of which path we're taking - We're Totally Screwed vs. We're Treading Water So At Least We Won't Drown - is whether or not the tax rate goes up moderately to address all the costs going up over time with no efficiencies to offset it, and/or we start eating into free cash and reserves this year or next.
I wanted to take a moment to teach our new Mayor some things he already ought to know about the city's money reserves, about saving taxpayer dollars, and proper budgeting. Since he thinks he knows better than a professional city manager who has taken us from negative $4.5M in reserves to a cozy but not complete positive, and all of that negative drawdown of free cash and then some happened on Rodney's watch during the Cox years, I figured maybe he just doesn't really understand budgets. I mean, he claims to all the time, dubbing himself a fiscal watchdog, but every time he opens his mouth, he belies this supposed expertise.
I hope he finds this primer informative! I certainly look forward to his better understanding showing itself in future discussions. Click to read more: (more…)
I'm watching the School Committee meeting, where Conway had a motion about the net school spending deficit, and of course Rodney had to have his say, stepping off the podium to foam at the mouth (I'm only slightly exaggerating). In fact, he claims that all this money being socked away into the rainy day fund was overly excessive and we should have been putting money towards the schools!
He wants to claim this net school spending problem lies at the feet of the last Mayor and Bernie Lynch. Oh, how quickly we forget (bold mine):
The councilor said his proposal still leaves $500,000 for Lynch to spend on other pressing needs.
Councilor Patrick Murphy has filed a motion requesting Lynch consider the city's adopted strategic and fiscal management goals for property-tax relief, as well as net school spending, minimum reserves and snow-and-ice removal budgeting when deciding how to use the additional local aid.
Murphy said it is difficult to determine the exact amount of funding that should go toward limiting the increase in property taxes before the city determines its other financial needs, but he believes tax relief should be a "significant part" of any plan Lynch devises for using the local-aid money.
Putting money toward snow-and-ice budgeting will reduce the size of the snow-and-ice deficit for the next budget cycle, and placing some of the funding in the city's reserves would boost the city's long-term fiscal health, he said.
"One thing listed as a way to boost our bond rating was putting aside some reserves," Murphy said.
Councilor Rodney Elliott, chairman of the council's finance subcommittee, last week said he would like Lynch to put all $1.5 million toward reducing the planned tax increase because taxpayers are struggling to pay their bills. Elliott was the lone councilor to vote against the budget because of the tax increases it included.
Lynch told The Sun last week he would like to use "several hundred thousand dollars" to reduce the planned tax hike, but he is reluctant to use all of the new state funding for tax relief because of the one-time nature of the funds and other needs in the city.
The council voted last week to approve Elliott's motion asking Lynch to develop a plan to put potential savings from any health-care agreement he works out with the city's unions toward reducing property taxes.
Lynch said he is negotiating with city unions and hopes to reach a health-care agreement with them by mid-December to reduce the city's health-care spending next fiscal year.
That negotiation with city unions on health care produced the savings that was looked for. I have yet to find the article where Rodney complains about putting that money into tax breaks, and not towards net school spending.
So the first prize is done, and the winner from last week has picked her prize out so I will be starting on it forthwith, but, there's a chance to win every week! If you made it through last week's marathon Council meeting…well, you are a trooper. Hopefully you had the cool beverage of your choice to keep you company.
We have some weird ones this week - the mayoral portrait issue is back, in an unfathomable motion to require that the mayor's portrait be completed within the first three months of a term. Huh?
Of course, the school budget thing is back. We'll be hearing about this for weeks. Apparently, some people think it's Bernie's "audit letter" which is patently absurd, but then again, absurd is the name of the game…funny, these asshats were never so concerned about some *decades* of past school net funding shortfalls. I'd be surprised at the hypocrisy but, who'm I kidding?
So, same rules as always. One guess per person, one person per item, and the more obscure or surprising the Blowup is the bigger the prize. Discuss!
1.1 Citations - Jack Trottier and Paul Sickinger, Seniors at Tyngsboro High School, for their community service work in collaboration with the Lowell Fire Department to collect winter coats for the homeless and those in need.
2.1 Minutes of City Council Meeting February 11th, for acceptance.
3.1 Communication – Paid vacation and sick leave from 1/1/2010 – 2/12/2014.
4.1 National Grid/Verizon NE – Request pole location at 59 South Whipple St.
5.1 Communication Summary
Motion Responses
(A) Motion Response - ShotSpotter
(B) Informational - MCC Flier - Lowell Crit Infrastr Forum of 2-24-14
(C) Informational - Resignation Letter
5.2 Communication-Accept Resignation of Troix Bettencourt (Hunger/Homeless Comm)
6.1 Economic Development SC 02-18-14.
6.2 Wire Insp. - National Grid - Electrical Main installation on Industrial Avenue and Stevens Street.
7.1 Claims (1) claim for property damage.
8.1 C. Leahy – Req. Rules SC consider as a recommendation that the Mayor's portrait be completed within the first 3 months of his or her inauguration.
8.2 C. Kennedy – Req. City Council and City Mgr. discuss the letter dated January 31, 2014 from the Mass. Commission of Elementary and Secondary Education regarding School Budget shortfall.
8.3 C. Kennedy/C. Leahy – Req. Mayor create a City Council SC dedicated to working with merchants and property owners to enhance and improve the commercial environment in the Central Business District.
8.4 M. Elliott – Req. City Council discuss setting up a joint Ad Hoc SC with City Council/School Committee to initiate discussion of high school and facility assessment report.
8.5 M. Elliott – Req. City Council discuss making Galligan Rd. a one way street.
9.1 Executive Session to discuss and release minutes of Executive Session meeting on January 21, 2014 and any other minutes that should be designated to be made public from executive sessions.
9.2 Executive Session regarding litigation report, public discussion of which could have a detrimental effect on the City's position.
10 Time for meeting to stand adjourned.
So Jack put forth the notion that elements of the City Council could act like a strong mayor, and they could eyeball the provision that allows the mayor, and if not the mayor, the city council, to submit a budget to the state if the city manager cannot or will not. (Given that hiring a city manager is the damn job of the City Council in the first place, if they use this provision they should take 100% blame for getting into that situation.)
Reportedly, Warren Shaw took up the notion on his radio show today, stating that the council could do this budget because they have people like Rodney Elliot there, or something to that effect.
Let's examine the clusterf**k that would be, shall we?
First, I'd love to hear from Groton on Elliott's tenure there. I hear it was short. A couple of years is the timeframe I've heard. The job is in his official bio:
Prior to the U.S. Environmental Protection Agency, he served as the Administrative Assistant for the Town of Groton, Massachusetts, serving a three-member Board of Selectman. He was responsible for the operation and management of the Town's $12 million budget.
Wonder if Elliott would be all right with us going to the folks in Groton and finding out just how he did there? The lowdown I hear generally is, not great. But, notwithstanding the somewhat speculative view on Groton, we have some track record here in Lowell to examine. Does anyone remember "across the board" Rodney? (Bold is mine.)
"If you voted for the budget, then you are responsible for the tax increase," Elliott said, adding that he thinks further budget cuts should have been made.
He said, however, he did not have any suggestions for cuts.
Councilor Kevin Broderick said that simply saying that you didn't vote for the budget and are therefore "off the hook," is "not an option."
During budget deliberations, Elliott suggested an across-the-board cut of 2.5 percent to every line item, which Broderick said is not feasible.
"We cannot just not pay 2.5 percent of our utility bills," he said. "It doesn't work. What are we going to do, not plow the streets?"
I can't stress how much it disturbs me to think someone who has such a lack of fundamental knowledge of budgeting might come within 5 miles of the process. Before you even get to whether or not to cut, let's review how local muni budgets actually work: a large portion of a city budget's line items are not within the control of the city. How much we spend on schools has a minimum, for instance. Or our debt service for capital investments. So once you leave out all the non-discretionary items in the budget, a 2.5 reduction in total city funding turns into a much larger percent of the parts of the budget you can legally cut. Maybe police? Or fire? Plowing? I don't know, because Elliott had no suggestions on where to cut.
And remember…Elliott made a lot of political hay over public safety issue last campaign season. So, which officer slots would he cut, I wonder? Does he think that'll help public safety?
I don't think it takes a genius to see the disaster Elliott and his ilk would make of our city budget. Think of how few City Councilors this term actually have the ability needed to make those huge line-by-line budget decisions! Nor should they have to. Which is not only an argument against Warren's Shaw's ridiculous assertion today on the radio, but also, against a strong mayor/Plan A charter in general.
In a diary, down blog, CM Lynch responds to considerations/perceptions of LiL commenters. I've pulled the Manager's comment, out & up, to give it broader presentation. Of course, in a stand alone fashion, it is a bit out of context. So, if you'd like, please click HERE to get the full scope.
Suffice to say, the CM's remarks are engaged in the topics currently floating in the Bubble, as the City election approaches, Nov. 5th. #GOTV
Staying out of all of the other back and forth that I shouldn't be involved with….to Joe's points which I think are legitimate. First the quick one, I'm not aware of anyone in the professional municipal management world that has moved into the world of finance (e.g. Wall Street) though I am aware of a couple that went to a rating agencies but that was more for their knowledge of municipal finance as they were Treasurers. Career Managers pretty much stay till retirement and/or go into consulting, teaching, interim work, or doing government relations. On the issue of how big should reserves be…the standard is between 5-10%, though some communities go beyond. I'd like Lowell to get a bit higher than our current level but certainly not at the expense of services that are required. A more pressing issue is our OPEB liability, retiree health insurance. We just put $8 million aside for this but we still have an unfunded liability of about $500 million. We really should be on a funding schedule for that or we're simply passing the burden of payment onto future taxpayers. Unlike capital debt which should be paid overtime as future taxpayers use the facility retiree benefits are paid out now, or in the near future. Its the biggest ticking time bomb for most governmental entities.
I would have hoped that people would see that the administration is willing to spend money and take other steps to make for a better community….which career managers are also judged on. We've built reserves back to a good level and held the line on taxes but also invested in infrastructure (I think at this point over $170 million), increased spending on schools, increased spending on maintenance, expanded recreation programs to pre-2000 levels, leveraged resources for social service and cultural programs, become more supportive of community and organizational diversity, and I could go on about the administration's achievements. Which, by the way, are the results of great work by department heads and employees. AND, we have invested in public safety, both fire and police. We've added resources to both. We never laid off uniformed personnel and in fact after the crunch of the recession started adding positions back into departments. We're currently reviewing all of the information on this and hope to have a full report out within the next week which explains this. Some civilian grant funded positions have gone away but even there we are working to reinstate with other grants or city funds. These positions allow our police department to be more effective and keep patrol officers on the street. Finally, on the much debated use of OT, the philosophy we have used is to use added overtime resources to target officers into certain areas at specified times for maximum effectiveness. This notion of "smart policing" is being adopted in numerous communities that have recognized that a single officer only provides limited coverage during high activity times while that same level of funds buys coverage many times over meaning more officers on the street. That said, there is a place for added staff in a a carefully planned and managed manner to insure we get the best people not just more people. For instance, we have 11 new patrolmen coming on within the next month.
In the end, we need to recognize the perceptions of the community regarding safety but we shouldn't fan it. We do need to look at the numbers to see how we're doing and how we should be using our resources and developing our strategies. On the numbers we have made great progress in knocking back crime over the past several years. But, lower isn't as good as none, which is what we need to strive for. Plus, we see trends that need our attention now rather than waiting for the problems to become less manageable…and, the police are working at that with their use of resources and strategies, and with their requests to me for added resources and supportive policies.
Thanks for letting me weigh in…..
Do you know where we are going, if we follow Councilor "Punk" Elliott's path (keep taxes artificially low, blow through the reserves) to fiscal sanity?
Been there! Done that!
Gerry Nutter laid it out, by the numbers. (I'll provide graphs, below the fold.)
Additionally, during those years that City Manager / Administration proposed and the City Council approved the use of about $17.87 million in one time money in Free Cash, nearly $6 million per year to sustain spending levels as opposed to making necessary cuts.All while being supported by the Editor at the SUN.
In October 2006 after removing that City Manager and with the appointment of a new CFO the City discovered that the budget that was now 1/3rd under way, was rife with miscalculations. Free cash to pay for services was estimated to be $3.5 million but in the end it was -$2.2 million, a difference of $5.7 million. Other local receipts were over estimated by about $2 million. The FY06 budget ran out of money for utility bills and they were moved into FY07 for payment making the already inadequate utility account doubly so
That is all fact, it supports and highlights the need for professional management along with a strong balanced council. Combined with the positive numbers I showed last week highlighting the upward direction the city is heading, why is this election being focused on stupid, petty garbage like OLD vs. New Lowell.
This week's "The Column" opted to be cute by half with this treatment.
MONTHS AGO, outgoing Mayor Patrick Murphy held an event at The Old Court. Those who attended, including one veteran politician, observed that Murphy packed the room with young, exuberant 20-somethings whose apparent desire to get involved in politics signaled a "new Lowell," an awakening of sorts.
I've heard the WCAP 'infomercial' try to lay the coining of this meme at the feet of Dick Howe, Jr. Of course, JMac only looks in the mirror, so he really won't know where the phrasing comes from. Gerry Nutter puts it on an attention seeking local media, which includes us 'big mouthed bloggers.' I concur. The 'new/old' meme has been floating around for several years now. It spun off the chatter about 'blow ins & grow ins,' etc. It's clear, from the way The Column above sidesteps it, that they didn't do their homework. But, opted, rather, to parrot JMac's empty headed contortion. JMac & Campi come up short. Funny, in my mind, was the word choice, " veteran politician," by Campi. Who hates Dick, Jr. only a little less than he hates Kendall Wallace, to the point Campi will only admit the existence of Dick's Blog, if he absolutely has to.
Dick, btw, has given witness to Gerry Nutter's framing of the corporate; desperate to survive, via, bargain basement fire sale journalistic ethics; local media:
In his Sunday Notes today, Gerry Nutter says that all the negativity about city government coming from the Sun and WCAP is designed to suppress voter turnout on November 5. I agree.
About those City Finance graphs:
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Onion Fried Chicken RecipeRead Reviews Be the first to add a review
- 2 boneless skinless chicken breast halves (5 ounces each)
- 2 tablespoons honey mustard
- 1/2 cup crushed french-fried onions
- Coat chicken with honey mustard, then roll in crushed onions. Place on a foil-lined baking sheet. Bake at 375° for 20-25 minutes or until chicken juices run clear. Yield: 2 servings.
Reviews for Onion Fried Chicken
"This was finger lickin good. I loved it."
"This was delicious and so moist! I made it with buttery noodles and it was the perfect combo."
"This was great!! The whole family loved it!! The bite from the honey mustard is perfect!"
"I'm only giving this 4 stars cause my son liked it. I didn't dislike it, but if it weren't for his really liking it and commenting on the smell before it was served, I'd never make it again. While the chicken came out surprisingly juicy for baked chicken without a proper sear, the fried onions were soggy. Guess I was expecting them to still be crispy. I think I could have the same result having just used the honey mustard. The onions on the bottom were mush. The only way around this that I know of would be to apply the onions 5 minutes or so before done and just on one side."
"Love this!!!!"


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The crew rode the station to orbit and returned to earth aboard a Gemini-B capsule that was part of the station - no rendezvous or docking was required. Experiments planned ranged the gamut from military reconnaissance using large optical cameras and side-looking radar, through interception and inspection of satellites, to exploring the usefulness of man in space and test of Manned Maneuvering Units.
After cancellation, some of the reconnaissance systems ended up in later KH series satellites, and some of the manned experiments were accomplished on Skylab.
Crew Size: 2. Orbital Storage: 40 days. Habitable Volume: 11.30 m3. Spacecraft delta v: 101 m/s (331 ft/sec). Electric System: 2,000.00 kWh. Electric System: 2.00 average kW.
AKA: Manned Orbiting Laboratory; Dorian; AFP-632; KH-10.
Gross mass: 14,476 kg (31,914 lb).
Unfuelled mass: 14,376 kg (31,693 lb).
Payload: 2,700 kg (5,900 lb).
Height: 21.92 m (71.91 ft).
Diameter: 3.05 m (10.00 ft).
Specific impulse: 255 s.
First Launch: 1966.11.03.
Number: 1 .


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Roche: Patriots Wrap Up Public Portion of Training CampA few thoughts from WBZ's Dan Roche on the final public Patriots training camp session.
Gresh & Zo Recap The Patriots Blowout Win Over The SteelersAndy Gresh and Scott Zolak opened up their Monday show talking about the big offensive performance of the Patriots and the throttling of the Pittsburgh Steelers 55-31 yesterday at Gillette Stadium.
Gresh & Zo: What Will Pats Offense Look Like Sunday?Gresh & Zo kicked off the show taking a listen Bill Belicheck's press conference from the second day of training camp back on July 27th and an example he gave about how players could be used on offense.


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Written on: 25/03/2014
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Packing for that well-deserved summer vacation? Be sure to bring hand sanitizer. And wipes. Maybe some disinfecting spray, too. Because hotel rooms? Germ city.
MSNBC reports researchers conducting a new study looked for aerobic bacteria (germs that can cause fun stuff like streptococcus and staphylococcus) as well as fecal bugs (pardon us as we gag) in nine hotel rooms in three states and found that just because a surface looks clean doesn't mean it is.
It turns out bathroom sinks and floors, main light switches and TV remotes were, well, nasty, even though you probably won't get sick from them, the network says. The researchers conducted the survey as a prompt to get hotel housekeeping managers to up their efforts.
Still, maybe we should request rubber gloves with our ice bucket at check-in. That wouldn't seem at all weird, right?
Click here to read the full story.
Click here to read another fascinating news story.
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Global fragrance leader Elizabeth Arden cited curtailed orders at a mass market customer as a factor in its weaker-than-expected full year financial results, and the finger was quickly pointed at Walmart.
Forget about hosting America's Got Talent or being married to Mariah Carey, Nick Cannon is living the dream at Office Depot where the retailing is promoting a line of back-to-school supplies designed in collaboration with the rapper, actor, comedian.
OPI Products has teamed up with multiple Grammy Award-winning and multiplatinum-selling recording artist Mariah Carey.
HSN has announced a partnership with Mariah Carey for the exclusive launch of her lifestyle...


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Edit Article
How to Make Fish and Chips
Three Parts:Battered FishAlternate Method for Battered FishChipsCommunity Q&A
Fish and chips is a popular take-out food dish from the United Kingdom which consists of deep-fried fish in batter or breadcrumbs with deep-fried potatoes. Here's a how to article on making this delicious dish.
- 1 cup of flour
- 2 eggs
- 1 teaspoon ground pepper and/or salt (optional)
- 1/2 cup of either cold water, buttermilk, or cold beer
- 1-2 potatoes
- 1 teaspoon ground pepper and/or salt
- 1 teaspoon of any other seasoning you'd like on your chips
Part 1
Battered Fish
1Make sure your fish is completely thawed out. You can use any type of fish you like; in the U.K. they usually use cod for their fish and chips. If your fish has been in the freezer, you can take it out and put it in your fridge overnight so it can thaw out easily, but still stay cool and fresh.
2Get a deep pan and coat the bottom of the pan with vegetable oil, set the temperature in between low and medium.
3Make sure you thoroughly have mixed your battered together and pour it into a flat dish so you can properly coat your fish with the batter.
4Get your fish and place it gently in the batter and coat both sides with your batter.
5Place your fish in the pan gently, so you don't splash hot oil on yourself.
- Each side should be cooked for about 4-7 minutes, but not every stove top is the same, so it can be flipped over early or later when you notice the sides of the fish starting to turn a golden brown.
6Place your cooked fish on a paper towel to soak up any of the extra oil.
Part 2
Alternate Method for Battered Fish
Part 3
1Grab your potatoes (can have as many potatoes as you like) and peel them; you can leave the potato skin on if you prefer.
2Get a knife and cut your potatoes into thin wedges the long way, so they look like fries.
3Cook the chips.
- Cook them in a frying pan. Just like your battered fish, get a deep pan and coat the bottom with vegetable oil. Set it on low and place your potato wedges into the pan. Flip them around so they're covered in the oil and sprinkle your seasonings on them. Cook each side for about 20 minutes or until you notice the edges of the potatoes turning golden brown. You can get a fork or a knife and poke your potatoes to see if they soften up and are not still hard.
- Cook them in the oven. Get a cooking pan and coat the bottom with vegetable oil. Place your potatoes in the pan and either pour some vegetable oil on top of them or flip them around in the pan with the oil already in it. Sprinkle you seasonings on them and put them in the oven at 350 degrees for 30-45 minutes.
4Place cooked chips on a paper towel to soak up any of the extra oil.
Community Q&A
Ask a Question
Article Info
Categories: Fish and Seafood
In other languages:
Español: preparar "fish and chips", Русский: приготовить рыбу и чипсы (фиш энд чипс), Italiano: Preparare il Fish and Chips, Português: Fazer Peixe com Fritas
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Employer shares of medical plan premiums, March 2008
November 05, 2008
Employers pay a higher percentage of the total premium for medical plans for employees with single coverage than for employees with family coverage.
In private industry, employers paid an average of 81 percent of the total premium for single coverage and 71 percent for family coverage in March 2008.
State and local government employers paid 90 percent of the premium for single coverage and 73 percent for family coverage.
The average monthly employer premium in private industry for single coverage was $309.03 and for family coverage was $708.83. In State and local government, the average monthly employer premium for single coverage was $399.86 and for family coverage was $794.72.
These data are from the BLS National Compensation Survey program. Learn more about health care benefits in "Program Perspectives on Health Benefits" (PDF), October 2008.
Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Employer shares of medical plan premiums, March 2008 on the Internet at http://www.bls.gov/opub/ted/2008/nov/wk1/art03.htm (visited June 27, 2016).
Recent editions of Spotlight on Statistics
Employment and Wages in Healthcare Occupations
Healthcare occupations are a significant percentage of U.S. employment. Some of the largest and highest paying occupations are in healthcare. This Spotlight examines employment and wages for healthcare occupations.
Fifty years of looking at changes in peoples lives
Longitudinal surveys help us understand long-term changes, such as how events that happened when a person was in high school affect labor market success as an adult.
- A look at pay at the top, the bottom, and in between
The Spotlight examines how earnings and wages have changed over time and how they differ within a geographic area, industry, or occupation.


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Catalano, Pieralba; Di Pace, Maria R; Caruso, Anna M; Casuccio, Alessandra; De Grazia, Enrico
Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Italy.
Received 10 September, 2009
Accepted 18 October, 2010
Address correspondence and reprint requests to Pieralba Catalano, Division of Pediatric Surgery, University of Palermo, Via Alfonso Giordano 3, Palermo, Italy (e-mail: email@example.com).
The authors report no conflicts of interests.
Objectives: Gastroesophageal reflux (GER) and dismotility occur frequently after repair of esophageal atresia (EA). GER-associated complications can manifest either early or later; then precocious diagnosis and treatment are essential. The aim of the study was to evaluate characteristics of GER and esophageal clearance in children treated for EA with distal tracheoesophageal fistula, using pH-multichannel intraluminal impedance (pH-MII).
Patients and Methods: Twenty-two children (ages 3–40 months) treated for EA at birth, and 20 normal children of similar age with suspected GER disease were included in the study. Impedance parameters were analyzed according to age and symptoms.
Results: Reflux events were mainly nonacidic. About bolus exposure index, mean acid clearing time (MACT), and mean bolus clearing time (MBCT), a significant difference was found between 2 groups: the median MACT and MBCT were longer, with values of 281 and 39 seconds, respectively, in the EA group and 110 and 15 seconds in the control group (P < 0.0005).
Conclusions: Our data show that in young patients the majority of refluxes are not acid. This implies that the incidence of GER may be underestimated if pH-metry is used. The pH-MII is an ideal test in children because it studies both GER with its characteristics and motility pattern. The quality of reflux does not seem to influence the onset of symptoms that are related to an impaired esophageal clearance. Hence, this technique could be useful to study patients treated for EA, avoiding the onset of complications.
Esophageal atresia (EA) is a relatively common congenital malformation occurring in 1:2500 births (1). Pathological gastroesophageal reflux (GER) is a major cause of complications after repair of EA and can require long-term medical therapy or antireflux surgery in cases of failure of medical management (2). Reflux is reported to be more common in patients with anastomosis under tension, after gastrostomy, and after delayed primary repair; however, an impaired esophageal motility may have a role in increasing the incidence of reflux (3). GER disease (GERD) can manifest either early after the operation with anastomotic stricture, dysphagia, and bronchopulmonary complications, or later with respiratory problems and esophagitis (4); Barrett esophagus and adenocarcinoma or squamous cell carcinoma in adults have been described (5). Then, an early diagnosis with appropriate treatment is important. Recently, endoscopic and pH-metric evaluations have been used in the routine follow-up program of patients treated for EA; however, these techniques can underestimate GER and its complications, especially in young children with nonacid refluxes and without esophageal lesions even with severe symptoms.
Multichannel intraluminal impedance (MII) was recently introduced as an alternative diagnostic tool in the evaluation of GER, and a large number of studies have been published demonstrating that pH-MII is superior to pH-metry in infants and children (5–14). This impedance allows the evaluation of retrograde bolus movements in the esophagus independent of the pH, identifying nonacidic reflux also in the postprandial period and in patients receiving acid-suppressing therapy. It is also a dynamic technique and, therefore, can detect the direction of the flow, so that refluxate can be distinguished from swallowed oropharyngeal contents. Moreover, it can accurately determine the height of the reflux and reflux-related symptoms. Combined with pH monitoring, it can distinguish between acidic and nonacidic refluxes (15).
MII allows the evaluation of esophageal motility and assesses bolus transport throughout the entire esophagus in real time, without the use of radiation: for this reason, MII has been used in adults to evaluate the esophageal function directly. Manometry gives information about esophageal pressure pattern and sphincter function, but does not give information about the bolus transit. MII not only detects the presence of esophageal flow but it also evaluates the direction of bolus transit, the duration of bolus presence, and the time of acid and bolus clearance.
MII in combination with pH-metry not only detects all GER but it also enables us to more accurately reveal associations between GER and symptoms: a clear temporal association between GER episodes and symptoms seems to provide convincing evidence of one causing the other. With pH-MII the correlation between symptoms and impaired esophageal clearance is possible (16).
The aim of our study was to evaluate, in the first years of life, the characteristics of GER and esophageal clearance in patients treated for EA and distal tracheoesophageal fistula (EADF) at birth using combined pH-MII, comparing them with a group of children without EA.
Twenty-two children who underwent primary repair for EADF between January 2004 and December 2008 were included in the study. All of the patients were operated on by 1 surgeon, with an extrapleural approach through a right-sided thoracotomy. No long gap between esophageal segments was reported and a tension-free anastomosis was performed in all of the patients. No postoperative complication was recorded. In all of the patients a contrast study was performed, with no evidence of stenosis. All of the patients underwent endoscopy 1 month before the pH-MII, and it was negative for esophagitis.
At a median age of 15 months (3–40 months), a 24-hour pH-MII study was performed in all of the patients with EA as screening for GER; informed consent was obtained. In patients who were being treated with antacid therapy, medications were discontinued at least 10 days before the investigation. Parents were asked to fill out a diary during the procedure to record the exact time of every meal, recumbent position, and symptoms as regurgitate, heartburn, dysphagia, agitation, and cough or other respiratory symptoms. Dysphagia was defined and reported in the diary by parents as difficulty in swallowing during the meal. All of the patients were allowed to eat and drink only during regular meals and not allowed to drink or eat acidic foods. The procedure was performed using hardware and software by Sandhill Technologies (Sandhill Scientific Inc, Highlands Ranch, CO). We used a ComforTec MII-pH single-use "infant type" endoesophageal probe, 2.1 mm in outer diameter, with 6 impedance amplifiers 1.5-cm apart, the first one just above the tip. The probe included a single esophageal pH recording channel 2 cm above the tip. The probe underwent nasoesophageal positioning without anesthesia; the tip of the probe was placed 2 vertebral bodies above the diaphragm with fluoroscopy assessment of its position. All of the examinations were included in the study, because they lasted more than 20 hours.
Analysis of the pH-MII tracings was performed with Sandhill Scientific software (BioView Analysis version 5.2.3). The tracings were revised visually and manually for bolus and symptom events by 1 investigator.
The following parameters were evaluated:
1. Number of acidic (pH < 4) and nonacidic (pH > 4) retrograde bolus movements: decreased in impedance in at least 2 consecutive recording channels with upward direction
2. Height of reflux: refluxes that reached at least the second most proximal channel in the upper esophagus were considered high refluxes
3. Symptom index: reflux-related symptom events/total symptom events. It was considered abnormal if >50%; a symptom was correlated with a reflux event if the reflux event occurred 2 minutes before or 2 minutes after a symptom occurred: we defined a symptom as being "induced" by reflux ("reflux-symptom") if the symptom occurred within 2 minutes after the onset of the reflux episode, whereas we defined a symptom as "precipitating" reflux ("symptom-reflux") if the reflux event occurred within 2 minutes immediately following a symptom (16). In our analysis we excluded refluxes precipitated by symptoms.
4. Reflux index (RIpH): percentage of time with esophageal pH < 4. We considered pathological RIpH when >4.2% for patients older than 12 months, whereas the cutoff was assumed to be 10% for patients younger than 12 months.
5. Bolus exposure index (BEI): percentage of time with retrograde movement of bolus in the esophagus (in adults it is considered pathological if >1.4%)
6. Mean acid-clearing time (MACT): mean time in seconds required for the pH to go back to >4 after an acidic reflux
7. Mean bolus-clearing time (MBCT): mean time in seconds required for the impedance to go back to the initial value after an episode of reflux
8. The results related to number, type and height of reflux, BEI, and pH reflux index (pHRI) were evaluated with regard to the age (older or younger than 1 year) and symptoms.
9. Because normal ranges of same parameters have not yet been established for pediatric patients, the data obtained in patients with EA were compared with a non-EA group of similar age, who underwent pH-MII evaluation for clinically suspected GERD.
Data were analyzed by the EpiInfo software (version 6.0, CDC, Atlanta, GA) and SPSS version 14.0 (SPSS Inc, Chicago, IL). For analysis, patients were divided according to age: 1 year and younger and older than 1 year. Frequency analysis was performed by Pearson chi square test and Fisher exact test, as appropriate. The Mann-Whitney U statistic test was used for nonparametric variables to evaluate the intergroup difference. All P values were 2-sided and P < 0.05 were considered to indicate statistical significance.
In the EA group patients, a total number of 3884 reflux episodes were detected, 918 of which were acidic (23.6%) and 2966 nonacidic (76.4%). In patients younger than 1 year, the episodes of nonacidic retrograde bolus movement accounted for 89.2%, whereas in patients older than 1 year, acidic refluxes were significantly higher than in patients younger than 1 year (29.6% vs 10.8%, P < 0.001). High refluxes accounted for 72.9% of total refluxes, 27% of which were acidic and 73% nonacidic (Table 1).
A total of 351 symptom occurrences were observed; in 8 of 22 patients (36%) no symptoms were recorded. Of all 351 symptom events, 305 (86%) were associated with retrograde bolus movements (RAS: reflux associated symptom). In children younger than 1 year, symptoms are associated mainly with nonacidic reflux (nonacidic RAS 50% vs acidic RAS 31%), whereas in children older than 1 year, the symptoms are associated with acid reflux (acidic RAS 64% vs nonacidic RAS 32%). Regurgitation, dysphagia, and agitation showed the highest association with retrograde bolus movement (98%, 92%, and 91%, respectively); regurgitation and agitation were more frequent in younger children, whereas dysphagia was more often recorded in older children. Other symptoms, namely cough and heartburn, were associated in >50% of cases with reflux events (Table 2).
The median pHRI was 6.1%, ranging from 1.3% to 13.8%, and it was pathological in 10 patients (45.5%), all ages older than 1 year. In fact, the median pHRI was 2.6% in children younger than 1 year and 8.1% in those older than 1 year (P = 0.003) (Tables 3 and 4).
Because BEI, MACT, and MBCT normal values are not yet established in the pediatric population, we compared the EA group patients with a non-EA group of healthy children with similar age and clinically suspected GERD.
The median BEI was 7.2% (range 2.5%–13.7%). If the 1.4% cutoff, established for adults, is applied to our children, then all of our patients had a pathologic BEI without a significant difference between children younger than 1 year and those older than 1 year (6.1% vs 7.9%). However, the comparison between the EA group and the non-EA group patients showed a significantly higher median BEI value in the first group (7.2% vs 2.8%, ranging from 1.4% to 5.7%, P < 0.0005) (Table 3).
The median MACT and MBCT were significantly longer in patients with EA than in patients without EA, with values of 281 and 39 seconds, respectively (P < 0.0005), in the EA group and 110 and 15 seconds (P < 0.0005) in the non-EA group, without any difference with respect to age in both groups. Moreover, correlation between symptoms and clearance time in the EA group showed that the median MACT and MBCT were significantly shorter in patients without symptoms than in those with symptoms (129 vs 368.2 seconds, P < 0.0005, and 26.5 vs 46.5 seconds, P = 0.002, respectively) apart from age (Table 5).
GER and disordered peristalsis of the esophagus may be considered late complications in patients operated on for EA. GERD is a common cause of morbidity in patients treated for EA, its incidence varying from 30% to 80% in different series depending on patients' age and the diagnostic criteria (symptoms, radiologic findings, pH-metry, or endoscopy) (17–19). Motility disorders are frequent in patients with EA, with a prevalence of 75% to 100% (2) and different mechanisms have been proposed to explain it, both congenital and acquired. The identification of motility disorders of the esophagus in neonates with EA before surgical intervention suggests a congenital origin of these disorders. Morphological studies confirmed this hypothesis, describing abnormalities of Auerbach plexus both in the esophagus and in the stomach of these patients (20,21). However, surgical procedure during EA repair can be responsible for disruption of its motor supply with vagal denervation, vascular interruption, or increased traction on the lower esophagus. It is likely that both components, congenital and acquired, can coexist with differing grades of severity, predisposing to motility disorders and GER.
The adverse effect of GER after EA repair is compounded by the dismotility, which reduces acid clearance and, therefore, peptic lesions could secondarily impair normal peristalsis (3,22). The esophageal contractility is abnormal in the majority of patients, despite the good results on clinical evaluation and this puts patients with EA at greater risk for complication. Conservative treatment of GER in these children is often unsuccessful and surgical correction is generally considered the best option for medically refractory reflux. Hence, a precocious diagnosis and treatment are important to improve the quality of life in patients treated for EA, avoiding the onset of complications.
A recent clinical pH-metric and endoscopic study reported that the number of children treated for EA with GERD progressively increases in the first years of life and more than doubles from 6 months to 1 year after primary repair (23). According to our experience, especially younger children treated for EA may be asymptomatic or show atypical symptoms.
Endoscopic and pH-metric monitoring have been used as the criterion standard in the routine follow-up of children with EA. However, in infancy, more than in older patients, these techniques can be responsible for false-negative cases because esophageal lesions are not as frequent as in older children or adults, even in cases of severe GERD, and the episodes of reflux are mainly nonacidic, probably due to milk feeding that buffers gastric acid for a long time (24). Moreover, patients with EA may be insensitive to symptoms of GER, and correlation between symptoms and criteria for GERD, such as histological esophagitis, is difficult to create. The actual incidence of GER after EA repair may be, therefore, underestimated, especially in children younger than 1 year.
Recently, MII monitoring was used for diagnosis of GER in children (8–14). To our knowledge, only 1 study has been published in patients with EA, using combined MII and pH measurement, but this study included a heterogeneous sample of patients between 4 months and 23 years, without any distinction with regard to age (25).
Manometry and videofluoroscopy have been used to study esophageal motility in patients with EA and showed an impaired bolus transit in the distal esophagus (26,27). This was demonstrated by Fröhlich et al (25), performing an impedance-swallowing test in 5 patients treated for EA, ages between 9 and 23 years. However, in younger children, especially younger than 6 years, it is difficult to perform controlled swallows of saline or viscous material.
We studied at a median age of 15 months (range 3–40 months) a homogeneous cohort of patients with EA who were operated on at birth by 1 surgeon, without esophageal anastomosis under tension and with an uneventful postoperative course. In our patients, reflux episodes were mainly nonacidic (76.4% of total refluxes), and this was particularly clear in children younger than 1 year (89.2%). Actually, we found a pathological pHRI in only 10 of 22 patients (45%), all older than 1 year, whereas a BEI above the values reported in healthy adults was found in all of the children, without a significant difference with regard to age (6.1% vs 7.9%). For this reason, the incidence of GER in children younger than 1 year would have been underestimated with conventional pH-metry. To exclude an overestimation of BEI, we compared the EA group with a control group of otherwise healthy children with similar age and suspected GERD, and we found a significant difference between the 2 groups (7.2%, range 2.5%–13.7% vs 2.8%, range 1.4%–5.7%; P < 0.0005).
A pathologic value of BEI with normal pHRI can be caused by nonacid GER as well as esophageal dismotility. This result is more evident in patients with EA with more prolonged values.
For this reason, in younger children an alternative way to study esophageal motility could be pH-MII monitoring through BEI, MACT, and MBCT evaluation, to establish a correlation between onset of symptoms, severity of reflux, and intrinsic esophageal dismotility. However, normal values have not been established yet. In children without EA and with GERD, a median MACT of 111 seconds and a median MBCT of 13 seconds have been reported (6), in line with our control group (110 and 15 seconds), without a significant difference according to age. In our study we compared values of MACT and MBCT in patients with EA (281 and 39 seconds, respectively) with control patients and there was a significantly longer (P < 0.0005) acid and bolus clearance time in the first group, confirming a pathologic esophageal bolus transit in children with EA. Moreover, the correlation between symptoms and clearance time showed that asymptomatic patients with EA had a median MACT and MBCT (129 and 26.5 seconds) that was significantly shorter (P < 0.0005 and P = 0.002, respectively) than symptomatic patients with EA (368.2 and 46.5 seconds) and similar to the values of patients with GERD but without EA.
Generally, symptomatic patients have an SI between 50% and 70%; in our analysis, the EA group reported a mean SI >80%. Probably an SI this high is correlated to esophageal dismotility that worsens the reflux and symptoms.
All of this evidence confirms the role of esophageal dismotility on GERD in children treated for EA. In contrast with other studies, the quality of reflux does not seem to influence the appearance of symptoms that are instead related to an impaired clearance.
In conclusion, our data clearly show that pH-MII monitoring detects more episodes of refluxes than pH-metry because it is able to evaluate retrograde bolus movements in the esophagus independent of pH. This is important in infancy, when nonacidic refluxes are prevalent and some patients can be asymptomatic. Even if asymptomatic and with tension-free anastomosis, patients with EA are at major risk for GER and its complications; hence, a follow-up program even in asymptomatic children is important, to avoid the onset of complications. Moreover, allowing an indirect evaluation of esophageal motility, this technique can be used to establish prognosis of esophageal disease and evaluate the patients before possible surgical treatment.
Finally, we emphasize the need for a larger multicentric study to establish normal ranges for MII parameters and allow the evaluation of esophageal clearance together with reflux events.
This article has been cited 2 time(s).
esophageal atresia; esophageal dismotility; gastroesophageal reflux disease; multichannel intraluminal impedance; pH-metry
Copyright 2011 by ESPGHAN and NASPGHAN
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Blizzard warnings are issued for Cape Cod and the islands with up to 70 mph wind gusts expected during the height of this storm overnight Tuesday and into Wednesday. According to NECN live on Tuesday March 25, this is a major wind event along with the snow and cold.
The National Weather Service has issued a blizzard warning for Cape Cod, Martha's Vineyard and Nantucket Island, as six to 10 inches of heavy wet snow is expected to fall. This snow is expected to be horizontal during the day on Wednesday because of the high winds. The strongest winds will hit the Cape and the islands, with 50-70 mph wind gusts expected.
Travel could become near impossible on the Cape and islands on Wednesday morning to mid-afternoon if the storm gains enough strength, according to WBUR News in Boston on March 25. These strong wind gusts could bring down trees and tree branches. Power outages could occur from these wind gusts. Temperatures are expected to hover around 32 degrees.
The snow is expected to start on Tuesday night and continue through Wednesday afternoon. High wind warnings have been issued for other areas of Massachusetts. These high wind advisories are in affect all the way inland to Western Mass, where snow is expected to be less than two inches, according to ABC News.
The snow is already falling in the Mid-Atlantic States and this storm is expected to pick up strength as it makes its way to New England, where this will be mainly a coastal event. The storm will trek up the I-95 corridor spreading snow to Connecticut, Mass. and Maine.
Snow totals expected:
This Nor'easter is packing its punch with wind. Expect 8-10 inches of snow along the Cape and the islands and coastal areas of Maine. Inland can expect a dusting to a few inches as this is a coastal weather event. Connecticut shoreline is expected to see 4 to 5 inches and Long Island is expected to see 4 to 5 inches of snow. New Hampshire will see about 2 inches of snow near the coast.
Even if your area is not expected to see an abundant snow fall, high winds are expected for most of New England with this storm.


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(Makes 4-6 side dish servings or 3-4 meatless main dish servings; recipe created by Kalyn.)
1 lb. Crimini mushrooms (or white mushrooms will also work)
2 lbs. zucchini (either a large zucchini about 12 inches long or 3-4 smaller ones)
2 oz. crumbled Feta (about 2/3 cup crumbled)
1 T chopped fresh parsley (optional)
Marinade Ingredients:
1/4 cup olive oil (use a good quality oil with a nice flavor)
2 T good quality balsamic vinegar
1 tsp. dried thyme
1 tsp. Spike Seasoning (optional, but good)
fresh ground black pepper to taste
Whisk together the olive oil, balsamic vinegar, dried thyme, Spike Seasoning (if using), and black pepper to make the marinade. Put the zucchini and mushrooms into a large bowl (or Ziploc bag) and toss with the marinade. (You can let this marinate on the counter for an hour or two if you have time, but it will still be good even if you can't take time for that.)
When you're ready to cook spread the vegetables out in a single layer on a large baking sheet. (Use two baking sheets if the pan looks crowded like mine!) Roast 20 minutes, then stir and spread the vegetables back out. (There will probably be some liquid on the surface of the baking sheet at this point.) Continue to roast until the surface of the baking sheet looks dry and the zucchini and mushrooms are starting to look lightly browned, about 15-20 minutes more. Put vegetables on a baking sheet and crumble Feta over (and parsley if using.) Serve hot.
South Beach Suggestions:
Nutritional Information?
More Meatless Ideas with Zucchini for You to Enjoy:
(Recipes from other blogs not always South Beach Diet friendly; check ingredients.)
Zucchini and Dill Pasta Salad ~ FoodieCrush
Julienned Zucchini Vegan Bowl with Peanut-Sriracha Sauce ~ Kalyn's Kitchen
Persian Baked Zucchini ~ Herbivoracious
Greek Stuffed Zucchini with Rice, Kalamata Olives, and Tomato Sauce ~ Cookin' Canuck
Easy Penne Pasta with Zucchini and Basil Pesto ~ Kalyn's Kitchen
(Want even more recipes? I find these recipes from other blogs using Food Blog Search.)
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