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Speedy, Dale B. MBChB, MSc*; Noakes, Timothy D. MBChB, MD†; Kimber, Nicholas E. M Appl Sc‡; Rogers, Ian R. MBBS§; Thompson, John M. D. PhD¶; Boswell, D. Ross MBChB, PhD∥; Ross, Jennifer J. PhD‡; Campbell, Robert G. D. MBChB**; Gallagher, Peter G. BSc**; Kuttner, Jonathan A. MBChB††
*Department of General Practice and Primary Care, University of Auckland, Auckland, New Zealand; †Sports Science Institute of South Africa, Capetown, South Africa; ‡Lincoln University, Lincoln, New Zealand; §Emergency Department, Sir Charles Gairdner Hospital, Perth, Australia; ¶Department of Paediatrics, University of Auckland, Auckland; ∥Diagnostic Laboratory, Auckland; **Sportsmed, Christchurch; and ††Waiuku Medical Practice, Waiuku, New Zealand
Received February 26, 2000; accepted October 6, 2000.
Address correspondence and reprint requests to Dr. Dale Speedy, 179A Hill Rd., Manurewa, New Zealand. E-mail: dalespeedy@ e3.net.nz
Objective: To record weight changes, fluid intake and changes in serum sodium concentration in ultradistance triathletes.
Design: Descriptive research.
Setting: Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run). Air temperature at 1200 h was 21°C, (relative humidity 91%). Water temperature was 20.7°C.
Participants: 18 triathletes.
Interventions: None.
Main Outcome Measures: Subjects were weighed and had blood drawn for serum sodium concentration [Na], hemoglobin, and hematocrit, pre-race, post-race, and at 0800 h on the morning following the race ("recovery"); subjects were also weighed at transitions. Fluid intake during the race was estimated by athlete recall.
Results: Median weight change during the race = −2.5 kg (p < 0.0006). Subjects lost weight during recovery (median = −1.0 kg) (p < 0.03). Median hourly fluid intake = 716 ml/h (range 421–970). Fluid intakes were higher on the bike than on the run (median 889 versus 632 ml/h, p = 0.03). Median calculated fluid losses cycling were 808 ml/h and running were 1,021 ml/h. No significant difference existed between pre-race and post-race [Na] (median 140 versus 138 mmol/L) or between post-race and recovery [Na] (median 138 versus 137 mmol/L). Plasma volume increased during the race, median + 10.8% (p = 0.0005). There was an inverse relationship between change in [Na] pre-race to post-race and relative weight change (r = −0.68, p = 0.0029). Five subjects developed hyponatremia ([Na] 128–133 mmol/L).
Conclusions: Athletes lose 2.5 kg of weight during an ultra-distance triathlon, most likely from sources other than fluid loss. Fluid intakes during this event are more modest than that recommended for shorter duration exercise. Plasma volume increases during the ultradistance triathlon. Subjects who developed hyponatremia had evidence of fluid overload despite modest fluid intakes.
"Ironman" ultradistance triathlons involving a 3.8 km swim, a 180 km cycle, and a 42.2 km marathon run have increased greatly in popularity in the last 15 years. Despite the popularity of these events, there has been little field research to measure the fluid intake of triathletes during these events. Speedy et al. 1 reported the estimated fluid intakes of four athletes who developed hyponatremia during an Ironman triathlon. These intakes ranged between 6.2–16 L. These authors have also reported a mean weight loss, considered a measure of hydration status, of 2.1 kg or a 2.9% loss of body weight among healthy finishers in the 1996 New Zealand Ironman triathlon. 1
Although there are well-established guidelines for appropriate fluid intakes for shorter athletic events, 2 to the best of our knowledge there has been only one report on the actual fluid intakes of athletes in an ultradistance triathlon: Applegate et al. 3 reported a high rate of fluid ingestion (1.5 L/h) at the Hawaiian Ironman. There has only been one study investigating how weight changes relate to actual hydration status in these ultradistance events. 4 The paucity of such data make it difficult to provide athletes with firm recommendations on what is an appropriate fluid intake for these ultradistance triathlons, in which athletes are often exercising at a low intensity but for 12 or more hours. Indeed, ultradistance athletes need to be cognizant not only of the risks of dehydration if they drink too little, but must also avoid overdrinking as fluid overload is the likely etiology of symptomatic exercise-induced hyponatremia, a common complication of ultradistance triathlons. 1,5–7,8,9
Accordingly, the aim of this study was to measure weight changes, fluid intake, and changes in serum sodium concentration in 19 triathletes competing in the 1997 New Zealand Ironman triathlon, a large international ultradistance event.
Twelve male and 7 female athletes were studied prospectively to determine their fluid intake during the 1997 New Zealand Ironman triathlon. This triathlon involves a swim of 3.8 km, a cycle of 180 km, and a run of 42.2 km. Ambient air temperature at 1200 h was 21°C, with a relative humidity of 91%. Water temperature was 20.7°C.
Subjects were recruited by examining all entry forms for the race. Athletes who lived in Auckland City, where the race was held, and who estimated their race time to be between 10.5 and 14 hours were invited to participate in this study. Subjects gave their informed consent, and ethical approval for the study was obtained from the North Health Ethics Committee. All subjects were healthy, with no significant medical illnesses, as expected in competitors in this arduous event.
One to 1.5 hours prior to the start of the race, subjects had 20 ml of blood drawn by venipuncture and assayed for serum sodium concentration, hemoglobin (Hb), and hematocrit (Hct). This procedure was repeated upon completion of the race, and at 0800 h on the morning after the race (approximately 12 hours after completing the race). All venipunctures were performed in the sitting position. Assay for serum sodium concentration was carried out on the day after the race with Hitachi 747 or 737 analyzers (Boehringer Mannheim, Mannheim, Germany), using standard methods and the manufacturer's reagents, on serum that had been collected into silicone-gel separator tubes and stored at 4°C after centrifugation within 1 hour of collection. Plasma sodium assays on any subjects needing medical care post-race were performed on-site using a Nova Ion Selective Electrode analyzer (Waltham, MA, U.S.A.) on lithium–heparin anticoagulated samples. A calibration difference of 2 mmol/L was detected between the on-site Nova Ion Selective Electrode and the Hitachi analyzers in both this study and in a much larger study (n = 373) 1 performed using the same analyzers in the same race. The results from the Hitachi analyzers were therefore scaled down by 2 mmol/L to ensure comparability with the specimens analyzed on-site. Routine hematological assays for Hb and Hct were carried out on the day after the race with Technicon H1, H2, or H3 analyzers (Technicon Corporation, Tarrytown, NY, U.S.A.) on EDTA-anticoagulated samples that had been stored at 4°C. The laboratory performing the analyses was accredited for medical testing to ISO9001 by International Accreditation New Zealand. Plasma volume changes were calculated using the formula derived from the Dill and Costill's equation. 10,11
All subjects were weighed approximately 1 hour prior to the race, at the swim–bike transition, at the bike–run transition, immediately after finishing the race, and at 0800 h on the morning after the race. Subjects were weighed in minimal clothing and without shoes or bicycle helmets. Weights were measured on calibrated Seca scales (Seca, Hamburg, Germany) placed on a hard level surface.
Food and drink were freely available at support stations every 12 km on the cycle course and every 1.8 km on the run. Fluid choices included water, Coca-Cola, and a sports drink (Powerade) containing 8% carbohydrate and 10 mmol/L of sodium. Athletes were instructed prior to the race to keep a careful mental note of how much fluid and which fluid they were consuming during the race, expressed in terms of number of drink bottles on the cycle and cups of fluid on the run. Athletes were questioned while they were racing to determine their fluid intakes. Interviewers ran or cycled with the athletes for a short distance to obtain this information, and also questioned the athletes at the transitions. Interviews took place at the swim–cycle transition, at 100 km on the cycle course, the cycle–run transition, at three points on the run course (6.2 km, 19.9 km, and 34.7 km), and immediately after finishing the race.
Drink cups at the run support stations were of two sizes (predominantly 355 ml, with a few 250 mL cups also used). Also used were 750 mL cycle bottles. The drink cups and cycle bottles were filled by race support station staff, and the volumes with which they were filled were not measured. It was retrospectively estimated by the athletes (by interview within 3 days of the race) that the drink cups on the run were half filled (to contain approximately 175 mL of fluid) and that the cycle bottles were filled to contain approximately 700 mL of fluid.
Fluid losses (total of sweat, urine, and respiratory) during the cycle and run splits were calculated by subtracting weight change from fluid intake during these sections of the race. Rates of fluid loss were calculated by dividing total fluid loss by the time taken to complete each leg of the race. Weight of intake of solid nutrients and weight changes from any fecal loss were not included in these calculations. Weight loss from use of metabolic fuel was likewise disregarded for these calculations.
Differences were tested by means of nonparametric tests, using the sign test for paired comparisons. Nonparametric analysis was used because of the small sample size and the nonnormal distribution of the outcome. Correlations between weight changes and serum sodium concentrations and change in serum sodium concentrations were calculated using Pearson's correlation coefficient.
One subject (male) failed to finish the race, withdrawing after finishing the cycle, with dizziness, vomiting, and mild hyponatremia ([Na] = 134 mmol/L), and was not included in the analysis, thus leaving 18 athletes available for analysis. Their median age was 35 years (range 23–49), and weight was 67 kg (range 57.5–93.5).
Subjects completed the race with a median race finishing time of 12.3 hours (range 10.9–15.3). The median time from race finish to post-race venipuncture was 13.5 minutes (range 7–32). Sixteen subjects lost weight during the race, the median weight change over the entire race was −2.5 kg (−4 to +1.5), which equates to a relative loss body weight of −3.5% (−6.1 to +2.5), this change being statistically significant (p < 0.0006).
Weight changes were measured after the swim, bike, and run sections, and at 0800 h the following morning ("recovery"). Full data on weight were not available on two subjects.
Subjects sustained median weight losses of −1.0 kg (range −2.0 to +0.5) during the swim (p = 0.3) and −2.0 kg (−3.5 to +1.5) during the run (p < 0.0002). However there was a significant median weight gain of +0.5 kg (−1.0 to +3.0) during the cycle (p = 0.03). Subjects also lost weight during recovery, with a significant median weight loss from race finish to the following morning of −1.0 kg (−4.5 to +1.0) (p < 0.03). As a result, all athletes lost weight over the period from before the race start to recovery the following morning (median = −2.8 kg, range −1.5 to −5).
Fluid intakes of subjects over the race are shown in Table 1. Median hourly fluid intake over the whole race was 716 ml/h (range 421–970). The median intakes of water and Powerade were 275 ml/h (0–567) and 271 ml/h (0–618), respectively. Median hourly fluid intakes were significantly higher on the bike 889 ml/h (601–1,310) than on the run 632 ml/h (238–1,129) (p = 0.0327). Median calculated fluid losses during cycling were 808 ml/h (range 469–1,083) and during running were median = 1,021 ml/h (range 404–1,801).
There were no significant differences between pre-race and post-race serum sodium concentrations (median =140 mmol/L versus 138 mmol/L) (p = 0.12), or between post-race and recovery serum sodium concentrations (median = 138 mmol/L versus 137 mmol/L) (p = 0.17). However there was a significant difference between pre-race and recovery serum sodium concentrations (median = 140 mmol/L versus 137 mmol/L) (p = 0.03).
Full data for hematocrits and hemoglobins were not available on three subjects. There was a significant increase in plasma volume over the race (median = +10.8%, p = 0.0005). As a result there was a significant fall in hematocrit during the race (median = −2.5%, range −7 to 1, p = 0.009), and a significant fall in hemoglobin during the race (median = −7 g/L, range −18 to 1, p = 0.014). However there was only a minimal change in plasma volume during the recovery period (median = −1.1%, range −12.4 to 14.2, p = NS).
Five subjects (one male and four females) developed hyponatremia with post-race serum sodium concentrations between 128–133 mmol/L. Two of these subjects (one male and one female) sought medical attention. The median pre-race weight of these five athletes was 67 kg and they had a median weight loss during the race of 0.5 kg, or 0.7%. Median fluid intake for these athletes was 714 ml/h (range 421–766). However they had a high fluid intake on the cycle (median = 913 ml/h; range 631–1,207). Median fluid intake over the race was water = 4,630 ml, Powerade = 3,325ml, Coke = 50 ml.
There was a significant inverse correlation between post-race serum sodium concentration and relative body weight change (r = −0.76, p = 0.0003), with subjects with the higher serum sodium concentrations losing the most weight, and those with hyponatremia losing only minimal weight or gaining weight (Figure 1). There was a similar inverse relationship between the change in serum sodium concentration pre-race to post-race and the relative weight change (r = −0.68, p = 0.0029): a lowering of serum sodium concentration was associated with the least weight loss or weight gain (Figure 2).
The first important finding of our study is that despite high rates of fluid intake, athletes sustained a median weight loss during the race of 2.5 kg. We have reported a similar weight loss (2.9 kg) in athletes not seeking medical care in the same race. 9 Similar weight losses have been reported following other ultradistance events, including other ultradistance triathlons, 1,12 ultradistance running races, 13 and ultradistance multisport events. 4,14
The data presented here support the postulate of Rogers et al. 4 that at least 2 kg of weight loss during an ultradistance triathlon is due to factors other than pure fluid loss. This weight loss includes loss of fat and glycogen, and the metabolic water stored with glycogen. This conclusion is supported by the following findings in this study: First, it is unlikely that subjects in this study were dehydrated at the finish of the race as their plasma volume was expanded and their serum sodium concentrations had not increased during the race. Second, subjects lost further weight (1 kg) in the 11–14 hours after they finished the race despite ingesting food and fluids, suggesting that they may even have had a mild fluid surplus at the finish of the race. Indeed it is interesting that post-race serum sodium concentrations were in the normal range of 138–140 mmol/L only in subjects who finished the race with a weight loss of 3–4%, equal to 2.0–2.7 kg (Figures 1 and 2). In contrast, athletes who finished the race at the same body weight at which they started, had serum sodium concentrations of about 132 mmol/l (Figure 1), indicating a state of fluid overload relative to the extracellular sodium content. 6
We know of no accurate data that directly identify the source of this weight loss during an ultradistance race; however, a calculated estimate of the weight loss that might be expected is given below based on certain assumptions: An athlete with a VO2max = 4.5L/min, exercising at 62% of VO2max for 12 hours, expends 40,000 kJ of energy. The only published estimate of energy consumption in an Ironman race suggests an intake of 21,714 kJ, 14 leaving 18,286 kJ of energy to come from body stores. Assuming a respiratory quotient of 0.85, the energy will come equally from fat and carbohydrate: each gram of fat provides 35 kJ of energy, therefore 260 g of fat is used; each gram of carbohydrate provides 17 kJ, therefore 535 g of carbohydrate is used; each gram of glycogen has 2.7 g water stored with it, therefore weight loss from water stored with glycogen is 1,444 g. Total weight loss from metabolic fuel used during the race (fat and carbohydrate) plus water stored with glycogen therefore equals 2,239 g (260 + 535 + 1,444 g). The weight of solid food consumed during the race is assumed to equal the weight of fecal matter eliminated during the same period in the above calculation. These calculations are speculative because of the assumptions that are made, but are given to present a model to explain the source of weight loss during ultradistance exercise. The calculated weight loss described above is consistent with the measured weight loss in this study and in other investigations of ultradistance exercise. 1,4,9,12,13,15
The second contribution of our study is the description of fluid intakes in ultradistance triathletes. We acknowledge the potential limitations of athlete recall during a race in estimating fluid intake; however, a more accurate methodology would be extremely difficult in the "field" situation of an Ironman triathlon. We also acknowledge the potential limitations in estimation of fluid volume in the drink containers. To the best of our knowledge there have been only two previous descriptions of actual fluid intake in an ultradistance triathlon. Rogers et al. reported a mean fluid intake of 737 ml/h in athletes competing in a triathlon involving 21 km canoeing, 97 km cycling, and 42 km running 4; Applegate 3 reported a very high rate of fluid ingestion at the Hawaiian Ironman (1.5 L/h). Fallon et al. recently reported a mean fluid intake of 540 ml/h in a 100 km ultramarathon running race. 16 The American College of Sports Medicine's position statement on fluid intake during exercise recommends a range of 600 to 1,200 ml/h. 2 While these recommendations may be appropriate for shorter distance races where the athletes compete at a high exercise intensity, they may not be appropriate either for ultradistance athletes competing at a lower intensity, or for smaller athletes whose metabolic and therefore sweat rates will be lower during exercise. Female ultradistance athletes in particular may have lower fluid requirements than "average" men due to lower sweat rates, 17 as they are usually smaller and take longer to finish these races, and have smaller fluid compartments. Indeed, Speedy et al. 9 have reported that women are at significantly greater risk of developing hyponatremia due to fluid overload 1,6–9,18,19 in ultradistance triathlons than are men. Furthermore, Noakes has postulated 13,20 that for the majority of noncompetitive ultradistance athletes, fluid intake during an ultradistance running event should be of the order of 500 ml/h, which approximates the ad libitum fluid intake of most athletes, as this will reduce the risk of developing symptomatic hyponatremia. Burke has recommended a fluid intake of 500–1,000 ml/h in ultradistance events. 21 The median fluid intake in our subjects of 716 ml/h is in keeping with these published recommendations, but would suggest that fluid intakes at the upper end of the range recommended by the American College of Sports Medicine position statement may be inappropriately high for ultradistance exercise. 2
It is interesting that subjects in this study lost weight during the swim and the run sections but gained weight during the cycle. This would suggest that athletes may be drinking in excess of their fluid needs during the cycling section of an ultradistance triathlon. Indeed calculated fluid losses during the cycle were lower than during the run; however, the hourly intake on the cycle was significantly higher on the bike than during the run. The lower sweat rates during cycling may have resulted from the greater convective heat losses induced by the more rapid facing wind speeds generated in cycling than in running. It is not clear from our data whether an increased fluid intake during the cycle section is beneficial or detrimental. The athletes who developed hyponatremia in this study had a relatively high fluid intake on the cycle section, suggesting that this may have contributed to the development of their hyponatremia. Conversely, a higher fluid intake on the bike section may protect an athlete from subsequently becoming dehydrated on the run. The most likely explanation for the higher rates of fluid intake during cycling is the ready availability of fluids during the cycle (every 12 km), and the ease with which an athlete tolerates drinking when cycling as compared with running. Support stations at the New Zealand Ironman Triathlon provided a range of fluids including water, a sports drink (Powerade), and Coca-Cola. While there was a wide range of variability between subjects in what they chose to drink, Powerade and water were the most popular choices. To the best of our knowledge there are no other reports of what athletes choose to drink during an ultradistance triathlon.
The third and rather surprising finding of this study was that plasma volume increased by 10% during the ultradistance triathlon. Plasma volume is typically thought to decrease during intense exercise, due to dehydration and other factors. 16,22,23 Fallon et al. reported a mean decrease in plasma volume of 7.3% after a 100 km running race. 24 However there have been several other reports of an increased plasma volume during prolonged or ultradistance exercise 25–28 Gastmann et al. 28 have reported a mean plasma volume increase of 15.4% during an ultradistance triathlon of twice the length of an Ironman triathlon. They postulated that water movement from the intracellular to the extracellular space is favored during prolonged exercise by the decrease in such intracellular osmolytes as glycogen, proteins, and triglycerides. 28 They also suggest that the extent of the plasma volume increase may actually be overestimated by the Dill and Costill formula, 10 due to intravascular hemolysis. 28 Irving et al. 18 have reported the maintenance of plasma volume during a 56 km foot-race. They postulated that although plasma volume may decrease during the initial phases of exercise, fluid shifts in the latter phase of exercise (from influx of albumin and electrolytes into the intravascular compartment) maintain plasma volume.
The fourth contribution of this study is an insight into the etiology of hyponatremia in the five athletes who developed this condition. The weight loss sustained by these athletes was minimal (median = −0.5 kg, range −3.5 to +1.5), and if a weight loss of approximately 2 kg is to be expected from the factors described above, then most of these athletes finished the race marginally overhydrated. Although the etiology of hyponatremia has been controversial, symptomatic hyponatremia is usually associated with fluid overload. 1,5,7–9 It is surprising however that the median fluid intake for these athletes was modest (714 ml/h), albeit their median intake during the cycle was high (913 ml/h). As the amount of Powerade consumed by hyponatremic athletes was similar to the group of athletes as a whole (median 3,325 ml versus 3,250ml), it is unlikely that fluid choices were involved in the etiology of the hyponatremia. This suggests that standard recommendations for fluid replacement 2,21 may be too high for some athletes competing in ultradistance events, especially smaller or female athletes. 13 Indeed four of these five hyponatremic athletes were female. We have shown previously 9 that female athletes are at significantly increased risk of exercise associated hyponatremia. The reasons for this are speculative, but include females' smaller size 20 and possible hormonal influences. 29 We have previously reported full details of two of these five hyponatremic athletes in a separate detailed case report. 8 The observation that fluid retention and hyponatremia developed in these five athletes who had modest overall fluid intakes during the race, suggests that the hyponatremia may be caused by a failure of the renal excretion of the fluid, and shows that even modest fluid intakes can produce hyponatremia.
Early descriptions of hyponatremia speculated that this condition occurred in association with dehydration, although there was no documented evidence to support this hypothesis. 30 However all the published correlations between serum sodium concentrations and relative weight change during exercise show an inverse relationship, 1,5,6,8,9,12,15 indicating that dehydration is associated with hypernatremia, and that hyponatremia is associated with minimal weight loss or actual weight gain. Our data are consistent with these observations. Our data also represent the first report of the relationship of change in serum sodium concentration to relative body weight change, again showing an inverse relationship, confirming that hyponatremia is associated with fluid overload and not dehydration.
The final contribution of this study is the finding that athletes had a significant weight loss (median 1.0 kg) during the first 12 hours of recovery after the race. There was no significant change in serum sodium concentration or plasma volume during this time, suggesting that the subjects were not dehydrated at the finish of the race despite a median 2.5 kg weight loss over the course of the race. The source of the weight loss during recovery needs further investigation. We speculate that it may reflect a persistently high metabolic rate in the immediate 12 hours after finishing an Ironman event, with increased oxidation of fat and glycogen.
Our data demonstrate that athletes lose approximately 2.5 kg of weight during an ultradistance triathlon, most likely from sources other than fluid loss (loss of fat, glycogen, and water stored with glycogen). Typical fluid intakes during an ultradistance triathlon are in the range of 400–1,000 ml/h, which is more modest than that recommended for exercise of shorter duration. The cycle section of the race is associated with the highest fluid intake and with weight gain, suggesting that athletes may drink too much on the cycle section, in part because they sweat less during cycling probably as a result of increased convective heat losses, yet are able to drink more. Plasma volume increases by approximately 10% during an ultradistance triathlon, the mechanism of which has yet to be determined. Lastly, the subjects who developed hyponatremia had evidence of fluid overload despite modest fluid intakes, suggesting both a failure of excretion of the fluid and that the fluid needs in some ultradistance athletes may be less than the current recommendations.
The authors gratefully acknowledge the participation of the athletes in this study, and the generous support of the Tom Anderson Memorial Trust and Diagnostic Laboratory.
This article has been cited 14 time(s).
Ultradistance; Hyponatremia; Triathlete; Dehydration
© 2001 Lippincott Williams & Wilkins, Inc.
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To look at Jody Merriman, smiling, interacting with others and sometimes even singing, one might never guess she has a rare genetic disorder.
When she first began showing behavioral changes several years ago, Jody and her husband, Bob, weren't sure what to make of it, and neither were doctors. Some tests raised suspicions of a seizure disorder; others of progressive multiple sclerosis. Nothing was conclusive, until a gerontologist at Kaiser Permanente in Panorama City diagnosed it as CADASIL.
Standing for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, CADASIL is a genetic disorder with similarities to Alzheimer's disease, Bob explained.
"I finally found my soul mate, and the thought of losing her (when she was diagnosed) was devastating," he said. "She's the best thing that's ever happened to me. She's been my angel."
Among the effects of CADASIL, he said, has been cognitive dissonance, which can leave Jody unable to voice or express what she's thinking.
"It can be very frustrating for her," he said.
At this point, he said, Jody has plateaued, though there's no way of telling if her condition will worsen. There is no way of reversing it, though, Bob said.
Coming to the Santa Clarita Valley Senior Center's Adult Day Care program in 2008 made a huge change, Bob said.
"She loves to come here. I can't say enough good things about the staff," he said. "They do wonderful things. … She was so withdrawn. This made such a tremendous difference in her quality of life and for the rest of our family."
No longer withdrawn, Jody will sometimes sing and dance during music programs at Adult Day Care.
"This program has been such a godsend," Bob said. "The ability to have her here has enriched our life."
While Jody's condition cannot be reversed, he said the programs at Adult Day Care have done wonders for her mind.
"The mind is like any other muscle," Bob said. "If you don't exercise it, it will atrophy."
Having Jody at Adult Day Care has also provided a health benefit for Bob.
Shortly after retiring in 2010, he said, he was diagnosed with cancer. Though he would spend three months in the hospital, he was successfully treated. Now, he said, having Jody at Adult Day Care allows him time to go to the gym, keeping him healthy to care for his wife.
The couple has been married for 22 years, and Bob said his Catholic faith sustains him.
When Jody first came to the Adult Day Care program she didn't talk at all and wouldn't make eye contact, Program Director Gladys Ehrhardt said. For the next two months, she made daily efforts to gain Jody's trust and bring her out of her shell.
"Every day, I was holding her hand and saying her name," Ehrhardt said. "I would hold her face with my hands, and have her look at me. I knew someone was inside."
That dedication paid off.
Now, Jody is frequently smiling, interacting with others in the Adult Day Care program. She'll even sing along when crooner Joe Valenza comes by the Senior Center to sing songs by Tony Bennett, Frank Sinatra and others.
Ehrhardt said the reward of her job is seeing the changes in people such as Jody.
"It makes me cry. To see the response when people here have discussions and conversations – that makes my day," she said, and added she's also seen a change in Bob. "He's a much happier person. He doesn't have to worry when he leaves her here."
The Senior Center's Adult Day Care program focuses on adults with Alzheimer's disease, other types of dementia, post-stroke, Parkinson's or other conditions that require assistance and supervision.
Monday through Friday, the program includes a daily lunch; arts and crafts, cooking and gardening exercises; fitness classes; and therapy animals.
There are currently about 20 people served by the Adult Day Care program, which is funded through client donations as well as money provided by Los Angeles County. The program asks for suggested contributions of $35 for care and lunch from 8 a.m. to 1 p.m., and $15 an hour from 1 p.m. to 4:30 p.m.
Adult Day Care also provides individual needs assessments for its clients, support groups and educational information for family members and individual and family counseling.
Limited funding is an ongoing challenge for the program, Ehrhardt said.
"We need funds, to support the families that really need this service," she said. "We work with clients' minds to bring them back, under care and supervision."
Rachelle Dardeau, the executive director of the Senior Center said it's difficult to overstate the importance of the Adult Day Care program.
"Gladys and her staff do an amazing job of caring for men and women at a vulnerable time in their lives," she said. "They are completely dedicated to treating them with dignity and enriching their lives."
Bob hasn't been able to say enough good things about the program and what it's meant for Jody.
"She loves to come here," Bob said. "And they love her."
For more information about the SCV Senior Center's Adult Day Care program, call 661-259-9444, ext. 131.

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Top Definition
Being upset with a bitter look on your face in the same manner as a baby with a full diaper.
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بواسطة enterthedavid مارس/آذَار 3, 2005
A pair of pants with such a low crotch that it looks like you took a poop in your pants
Wow Jenny, did you see Sarah's poopy pants? It looks like she took a dump but it didn't smell like it
بواسطة Abiey سبتمبر/أيلول 30, 2015
A grown man or woman who has soiled themselves, however, are unable to grasp the obvious fact they need their nappie changed.
Omg Alan is being a total poopy pants today. Does he need his nappie changed?
Some one who takes poops in their pants without regard for others well being.
I am so glad that I don't no any Mr. poopy pants.
بواسطة Jose Contraeras أكتوبر/تشرين الأوّل 3, 2005
curly brown hair, often short, kinda ugly, loves guys that has braces and notches in his hair. They usually dont have many firends but think eveyone loves them.
Jen Martin is a poopy pants
بواسطة Joben:) نوفمبر/تشرين الثّاني 24, 2009


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Animal, Vegetable, Miracle: A Year of Food Lifeby Barbara Kingsolver Steven L. Hopp Camille Kingsolver
Bestselling author Barbara Kingsolver returns with her first nonfiction narrative that will open your eyes in a hundred new ways to an old truth: You are what you eat. "As the U.S. population made an unprecedented mad dash for the Sun Belt, one carload of us paddled against the tide, heading for the Promised Land where water falls from the sky and green stuff grows all around. We were about to begin the adventure of realigning our lives with our food chain. "Naturally, our first stop was to buy junk food and fossil fuel. . . ." Hang on for the ride: With characteristic poetry and pluck, Barbara Kingsolver and her family sweep readers along on their journey away from the industrial-food pipeline to a rural life in which they vow to buy only food raised in their own neighborhood, grow it themselves, or learn to live without it. Their good-humored search yields surprising discoveries about turkey sex life and overly zealous zucchini plants, en route to a food culture that's better for the neighborhood and also better on the table. Part memoir, part journalistic investigation, Animal, Vegetable, Miracle makes a passionate case for putting the kitchen back at the center of family life and diversified farms at the center of the American diet. "This is the story of a year in which we made every attempt to feed ourselves animals and vegetables whose provenance we really knew . . . and of how our family was changed by our first year of deliberately eating food produced from the same place where we worked, went to school, loved our neighbors, drank the water, and breathed the air."
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Driver dies in wrong-way crash in Grapevine
A wrong-way crash left one dead early Sunday in Grapevine.
Police say a 22-year-old Dallas driver was heading west in the eastbound lanes of Interstate 635 near Highway 114 when he struck an 18-wheeler. The crash occurred around 4 a.m. Sunday. The driver, whose name has not been released, was pronounced dead at the scene.
No passengers were in the man's car and no one in the 18-wheeler was injured. Investigators say alcohol may have been a factor.


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Bella Evelyn Blake died Sept. 4 at 67. She is survived by her husband, Leon; daughters, Wendy (Henk) Weissner and Debra (Adam) Traub; son, Lonny; and two grandsons. Malinow and Silverman
Harold Conrad Carlis died Sept. 9 at 79. He is survived by his daughter, Tracy; son, Michael; daughter, Lorena Porras; grandson, Kameron (Laura); great-grandson, Nicholas; brother, Marvin (Reah); and partner, Carol Wucker. Mount Sinai
Dixie Cohen died Sept. 4 at 42. She is survived by her husband, Claude; son, Jordan; daughter, Rachelle; father, Jack Wagner; brother, David Wagner; sister, Diane (Dale) Truelson; brother, Jack Wagner Jr.; in-laws, Julie and Armand; and sister-in-law, Danielle (Keith) Steinbaum. Mount Sinai
Rachel Codron died Sept. 7 at 95. She is survived her sons Steven and Joseph; three grandchildren; and four great-grandchildren. Hillside
Ruth Pansky Fishman died Sept. 11 at 84. She is survived by her sons, Geoff and Steve; daughters-in-law, Dora and Anne Fishman; three grandchildren; brother, Phil Pansky; and sister-in-law, Joan Pansky. Hillside
Saul Fruchthendler died Sept. 9 at 58. He is survived by his brother, Fred; cousins; family members; and many friends.
Akhtar (Banayan) Ghadoushi died Sept 12 at 92. She is survived by her husband, Feizolah; sons, Asher, Pirouz, Kamiar; daughters, Pari and Paran Banayan and Parvin Senehi; 15 grandchildren; and 25 great-grandchildren. Chevra Kadisha
Lawrence Gregory died Sept. 3 at 81. He is survived by his daughter, Dawn (Sean) Patterson; sons, Bruce (Birgetta) and Keith (Liz); seven grandchildren; one great-grandson; sister, Arlene Strongin; brother, Alvin (Bunny) Greenberg; .
Gloria Gross died Sept. 10 at 59. She is survived by her father, Julius. Mount Sinai
Touran Hakakian died Sept 7 at 91. She is survived by her sons, Manootchehr, Nader, Khosro, Eskandar, Bahram and Bahman; 20 grandchildren; six great-grandchildren; brother, Medi (Meir) Babaoff; and sisters, Iran, Rohanieh, Jahan and Molouk. Chevra Kadisha
Sylvia Harmatz died Sept. 9 at 108. She is survived by her daughters, Vivian Skurka and Hope Mann; five grandchildren; 11 great-grandchildren; and four great-great-grandchildren. Malinow and Silverman
Sol Holtzman died Sept. 4.He is survived by his daughters, Gail (Leonard Kaplan) and Ruth (Alan Bower); four grandchildren; and one great-granddaughter. Mount Sinai
Dolores Belle Kanter died Sept. 11 at 84. She is survived by her daughter, Marjorie Schoumel; and one granddaughter. Malinow and Silverman
Ann Eileen Kopstein died Sept. 9 at 96. She is survived by her sons, Manny (Cari), Joseph and David (Patti Philo); seven grandchildren; and five great-grandchildren. Mount Sinai
Lea Kuncewiecki died Sept. 5 at 91. She is survived by her sons, Frank (Naomi) and William (Judy); five grandchildren; and four great-grandchildren. Malinow and Silverman
Ralph Leventhal died Sept. 6 at 90. He is survived by his daughter, Dianne (Steve) Perry; sister, Judith Cibley; and two granddaughters. Malinow and Silverman
Nathan Levinsohn died Sept. 4 at 98. He is survived by his son, Steven (Patty); six grandchildren; and nine great-grandchildren.
Hy Lederfine died Sept. 9 at 93. He is survived by his daughter, Gloria Frankenberg; son, Sandford; seven grandchildren; and 10 great-grandchildren. Mount Sinai
Louis Lipeles died Sept. 9 at 91. He is survived by his sons, Charles (Fae) and Jack (Diana); six grandchildren; six great-grandchildren; brothers, Morris (Annie) and Joey (Muriel); and sister, Rose Franks. Mount Sinai
Gerda Lowenstam died Sept. 10 at 93. She is survived by friends; and family. Hillside
Harold Samuel Rosen died Sept. 10 at 85. He is survived by his daughters, Dr. Barbara (Dr. Lance) George and Jackie Campbell; sons, Joel (Pam) and Dennis; nine grandchildren; two great-grandchildren; and brother, Marvin. Malinow and Silverman
Earl Salmansohn died Sept. 3 at 61. He is survived by his wife, Lucille; daughter, Nicole (A.J.) Dix; son, Chad (Lisa); three grandchildren; and brother, Lawrence (Joey). Mount Sinai
Ruth Hofmann Silberstein Silton died Sept. 8 at 97. She is survived by her daughter, Edna Gyepes; three grandchildren; and six great-grandchildren. Hillside
Paul Supkoff died Sept. 4 at 47. He is survived by his mother, Dr. Judy (Dr. Michael) Supkoff-Stern; brothers, David and Matthew; stepbrothers, Adam and Jason; and stepsister, Sari Tresser. Mount Sinai
David Tarlow died Sept. 9 at 56. He is survived by his daughters, Pamela and Beverly; brother, Ken; nieces; and nephew. Hillside
Elizabeth Teicher died Sept. 8 at 92. She is survived by her daughter, Ruth (Efry) Akiba; grandchildren, Karen and Michael; and three great-grandchildren. Mount Sinai
Marianne Waterman died Sept. 6 at 94. She is survived by her family and friends. Hillside
Dr. Sandon Michael Weisberg died Sept. 8 at 58. He is survived by his son, Jared; mother, Frances Weisberg; and brother Bob. Hillside
Lynn Dorothy Woods died Aug. 22 at 83. She is survived by her son, Moshe (Yehudis) Wisnetsky; daughters, Susan Hillman and Shellie (Saul) Zuckerman; 12 grandchildren; five great-grandchildren; and sisters, Paula (Bernard) Cohen and Gilda. Chevra Kadisha
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Well, just got back from Hong Kong after an enjoyable weekend. Hope you enjoy the report.
Flight Number: PR318
Scheduled Push-Back Time: 10:00 AM
Real Push-Back Time: 10:10 AM
Aircraft: Boeing 747-400
Registration: N751PR
Date: May 9, 2002 (Friday)
This is a school trip, so me and my mom hopped into our car and drove to school. We then got onboard the school bus for the trip to Ninoy Aquino Int'l Airport T2.
Arrived at the new terminal at about 7:45 AM. Passed through baggage screening quickly and entered the terminal, although much better than NAIA 1, it was still not up to date with even Taipei Chiang Kai-Shek Int'l Airport T2. Lines were long, but the staff worked quickly and efficiently and got to us. We requested for a Window, but was told none was available. I then asked the seating configuration for this aircraft. The lady answered 3-4-3. Definatly a 744. We got an aisle seat and also the seat next to it.
Paid the annoying airport and departure tax and went thru Immigration. The North Wing of NAIA2 was for International flights, which had about ten gates. Our aircraft, as I guessed a majestic jumbo jet, was parked at Gate N4. I grabbed a Sausage bun and juice and then sat down to watch planes.
Remember, this is NAIA2, so much of what you see is PAL and PAL and PAL and PAL. Beside all the PAL jets, I saw a CI 742F parked on the ramp. Work on the new NAIA3 was progressing on the opposite of NAIA2. In NAIA2, we saw three 744s parked in a row. I then figured out that we were going to take the first one, registered N751PR.
Sat down and opened my book by Lee Kuan Yew, 'From Third World to First'. I managed to catch a NW 744 rotating off the runway on its flight to Japan and a SQ 772 operating SQ71 to SIN departing soon after it.
Saw several small jets depart. But then there was a sudden line for departing planes. The Cebu Pacific 757 in special colors was taxiing, flanked by sistership DC-9s, Air Philippines 732s, and Philippine Airlines 733s.
Boarding started and a loooooong line formed. We finally entered the jumbo and sat down in our seats. I got a seat next to my coaches. My mom traded seats with my friend so that he could seat with me. This flight was about 93% full.
This was my first International flight with PAL. The Crew and pilot welcomed us aboard and told us that this was going to be a 1 hr 35 min flight. I was just expecting to get served Orange Juice and Peanuts, which they served on domestic runs between Manila and Cebu.
We pushed back and soon got on the runway for take off. I just spotted a Saudi 743, a CI 738, and a CI Cargo 747. The pilot put the plane on a steady climb, announcing that we had passed FL220 for FL350. I kept repeating in my mind what he would have said in the ATC, "Manila Tower, Philippine Three-One-Eight is at FL220 for FL350.
I will leave off here because it is already almost 11 PM and there's school tomorrow. Will be continued...


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Show Highlights
IDEAS Jennifer Welsh delivers the 2016 CBC Massey Lectures, "The Return of History"
In his 1989 essay The End of History? American thinker Francis Fukuyama suggested that Western liberal democracy was the endpoint of our political evolution, the best and final system to emerge after thousands of years of trial and error. Fukuyama seems to have been wrong: our recent history -- filled with terrorism and war, rising inequity and the mass flight of populations -- suggests that we've failed to create any sort of global formula for lasting peace and social equity.
Wednesday September 28, 2016
Darkwave - Underwater languages at the brink of extinction
Our oldest living ancestors 'speak' a language consisting of clicks, whistles, and pulsed calls. For whales and dolphins, acoustics is the glue of their society. But in the face of catastrophic environmental changes, that language is being lost or reshaped. IDEAS contributor Carrie Haber and the world's leading marine scientists take us into the oceans depths to plumb an enigmatic culture under siege.read comments video audioListen 53:57
Friday September 23, 2016
The Philosopher's Walk with Frédéric Bouchard
Frédéric Bouchard is philosopher of science and biology at the University of Montreal, and the perfect companion for a walk through the Jean Talon Market. His research focuses on the theoretical foundations of evolutionary biology and ecology as well as on the relationship between science and society. The result is a fascinating discussion about mushrooms, unpasteurized goat cheese and honey bees, and how they can make you think about humankind's place in the universe in a whole different way.read comments video audioListen 53:57


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Dr. Thomas "Tom" Turner, 77, of Amarillo died Sunday, Jan. 15, 2012.
Memorial services will be at 2 p.m. Friday in the Kwahadi Museum, 9151 E. Interstate 40. Arrangements are by Schooler Funeral Home, 4100 S. Georgia St.
Thomas Roy Turner was born March 17, 1934, in Amarillo to Roy and Dorothy Turner. He married Sue Britten in 2002 in Ruidoso, N.M.
He graduated from Amarillo High School in 1952 and pursued general engineering from Texas A&M University. He graduated from Texas Christian University in 1956. He began his medical education at University of Texas Medical Branch in Galveston in 1960, earning a Doctor of Medicine and Surgery. Dr. Turner continued his post-graduate education in surgery from 1960 to 1961 at St. Agnes Hospital in Philadelphia and from 1961 to 1963 at Texas Department of Mental Health and Mental Retardation, Austin State Hospital, Neuropsychiatry.
Tom joined the Navy in 1966, where he began his military career as regimental surgeon of the First Infantry Training Regiment, U.S. Marine Corps at Camp Lejeune, N.C. In 1967, he was a student at the Naval Aerospace Medical Institute in Pensacola, Fla. From 1967 until 1969, Tom served as the officer in charge of emergency receiving and heat casualty treatment unit of the Marine Corps in Parris Island, S.C. It was here that Tom was instrumental in developing the methods of cooling the body down and the training movies used to assist in the treatment of veterans for heat exhaustion. In 1969, he was a student in the Field Medical Service School in shock resuscitation training at Camp Lejeune Naval Hospital in North Carolina from July 1969 to January 1970. He served as commanding officer, "A" Shock/Resuscitation Team 5th Marine Regiment, 1st Marine Division in the Republic of Vietnam, and as the chief of professional services of Admitting and Sorting/Triage 1st Medical Btn.; from April 1969 until August 1969, Tom served as commanding officer 1st Marine Division in the Republic of Vietnam. From September 1969 to August 1973, he was the Assistance Force Surgeon, Fleet Marine Force, Pacific Medical Delegate and Southeast Asia treaty Organization in Honolulu and Bangkok, Thailand.
In 1975 until 1977, Tom worked in private practice in Family Medicine in Tulsa, Okla. He served as the clinical instructor of family practice at the University of Oklahoma.
In August 1984, he became a staff physician at the Minor Emergency Center in Amarillo; in 1985, he was staff physician of Bell Avenue Emergency Center, now Baptist Hospital Urgent Care Center. In 1985 until 1987, Tom served as medical director and staff physician of the emergency department of Central Plains Regional Hospital in Plainview and as the medical director of the Plainview Fire Department, EMS. He also served as the medical director of the emergency department of the Lakeland Medical Center and the medical director of the Henderson Country EMS in Athens. In 1988 until June 1990, he served as the medical director in the emergency department and the medical director of Lifeline EMS at Bethania Regional Health Care Center in Wichita Falls. He also served as Wichita General Hospital medical director and physician coordinator of Paramedic School at Vernon Regional Junior College.
Having been raised in Amarillo, Dr. Turner had the opportunity to know and work with the local
medical community. He served on the medical staff of St. Anthony's Hospital prior to joining the Veterans Health System in 1992 as chief of staff of the mental health department and as an acting chief of staff in concert with other service chiefs, where he diligently served fellow veterans until his death. He has also worked with Texas Tech Health Science Center as a mentor of students and medical residents.
Dr. Turner was a captain in the Naval Reserve. He was a member of the Association of Military Physicians and Surgeons, Aerospace Medical Association and the American College of Emergency Physicians.
His hobbies included horseback riding, hiking, backpacking, rock climbing, literature and painting. However, some of his favorite times were those he spent with his family and attending special activities for his grandchildren.
He was preceded in death by his parents.
Survivors include his wife, Sue; three daughters, Shawn Mannie of Austin, Annett Waxler of Amarillo and Shelly Britten of Umbarger; four sons, Tom Turner Jr. of San Leandro, Calif., Andy Waxler of Happy, Leo Britten of Canyon and Cody Britten of Groom; and many grandchildren.
The family suggests memorials be to Will Rogers Junior Range Riders Program, P.O. Box 19008, Amarillo, TX 79114; Kwahadi Heritage Inc., P.O. Box 32125, Amarillo, TX 79120; or 7 Star Therapeutic Riding, P.O. Box 50635, Amarillo, TX 79159
Sign the online guest book at www.schoolerfuneralhome.com.
Amarillo Globe-News, Jan. 19, 2012


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Issue: 57 Food and Drug Law Journal 545-572 (2002)
For those who wonder why wine bottles do not display ingredient labeling and nutrition facts, this article will explain the relevant jurisdictional conflict in which the consumer-friendly Food and Drug Administration lost to the industry-friendly Bureau of Alcohol, Tobacco and Firearms. In the Brown-Forman case, the judge refused to harmonize the Federal Food, Drug, and Cosmetic Act with the Federal Alcohol Administration Act, although congressional intent was to the contrary, as evident from this article's analysis of legislative history, contemporary whiskey politics, and court and regulatory decisions.
FDLI's policy regarding the Food and Drug Law Journal online is: Only the Table of Contents and article abstracts for each issue will be posted to our website. Those visitors wishing to obtain a full text version of a particular article, or a copy of an entire issue, may contact FDLI's Customer Service Department by e-mail at firstname.lastname@example.com. Your purchase will be processed quickly, and at reasonable rates.
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FDLI's Editor-in-Chief.


text:
Concomitant fundoplication at the time of gastrostomy tube placement in neonates is used to prevent complications of reflux, but its effectiveness is unproven. In a cohort study of 4163 infants with neurological impairment at 42 children's hospitals, Barnhart and colleagues found that those who also had fundoplication had more reflux-related hospitalizations in the next year than a matched control group without fundoplication. The authors also demonstrated a 75-fold variation in fundoplication rates across these 42 hospitals. In a related editorial, Rangel discusses the implications of this study on clinical practice and the need for the development of consensus practice guidelines.
Related Editorial
Journal Club Slides, Continuing Medical Education
Although it is suggested that breastfeeding is protective against obesity in children, the evidence remains inconclusive because of possible residual confounding by socioeconomic status or lifestyle factors. In this longitudinal study of 43 367 children, Yamakawa and colleagues examined the rates of overweight and obesity at ages 7 and 8 years. The risk for overweight was 15% lower and obesity 45% lower at 7 years of age in children who were exclusively breastfed for the first 6 to 7 months of life compared with those fed formula. An accompanying editorial by Bovbjerg and colleagues suggests that "well-mother" checks in addition to well-baby visits should be scheduled for women within the first few days postpartum to promote breastfeeding and provide support and education.
While adolescents as a group are at increased risk for distracted driving, those diagnosed as having attention-deficit/hyperactivity disorder (ADHD) may present an even greater risk. Narad and colleagues studied 16- to 17-year-olds in a driving simulator. Adolescents with ADHD demonstrated more variability in speed and lane position than control subjects and texting significantly impaired the driving performance of all adolescents and increased existing driving-related impairment in adolescents with ADHD. In a related editorial, Winston and colleagues discuss the urgent need to address this perfect storm of novice drivers, some with attention problems, motor vehicles, and smart phone use.
Related Editorial, JAMA Pediatrics Patient Page
There has been great concern in both the lay and professional community about the recurrence risk for autism spectrum disorders (ASDs). This cohort study by Grønborg and colleagues in Denmark is the first to be population based and the first to consider the ASDs recurrence risk for full- and half-siblings. The overall risk for recurrence was about 7% and was nearly 7-fold higher for children with an older sibling with ASD compared with children without such a sibling, and it did not change over time. The relative recurrence risks were 2.4 for maternal half-siblings and 1.5 for paternal half-siblings. These estimates are substantially lower than recent reports from smaller, clinic-based populations.
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Medline ® Abstracts for References 1,2,17-21
of 'Bacterial vaginosis'
Joesoef, M, Schmid, G. Bacterial vaginosis. In: Clinical evidence, BMJ Publishing Group, London 2001. p.887.
no abstract available
Bacterial vaginosis: a public health review.
Morris M, Nicoll A, Simms I, Wilson J, Catchpole M
HIV&AIDS Division, Communicable Disease Surveillance Centre, London, UK.
The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment.
Verstraelen H, Swidsinski A
Curr Opin Infect Dis. 2013 Feb;26(1):86-9.
PURPOSE OF REVIEW: Recent evidence supports the view that bacterial vaginosis presents as a polymicrobial biofilm infection. This has far-reaching implications for the pathogenesis, epidemiology, diagnosis and treatment of bacterial vaginosis.
RECENT FINDINGS: Gardnerella vaginalis is presumably the first species to adhere to the vaginal epithelium and then becomes the scaffolding to which other species adhere. Not all G. vaginalis strains do form biofilms: G. vaginalis can be present in the vagina in a planktonic or in a biofilm mode of growth. The presence of planktonic (dispersed) or biofilm-associated (cohesive) G. vaginalis can be reliably shown in urine sediments in both women and men, and there is an absolute concordance in the carriage of biofilm-associated (cohesive) G. vaginalis between women with bacterial vaginosis and their partners. In-vitro data suggest that selected probiotic lactobacilli might be an effective means to conquer the biofilm.
SUMMARY: Future epidemiological research may benefit from biofilm-based urine diagnosis of bacterial vaginosis to a significant extent. The search for noveltherapeutic agents can now be more directed towards the biofilm-breaking agents, but is at present hampered by the lack of a proper in-vitro model of the bacterial vaginosis biofilm.
Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University, Ghent, Belgium. email@example.com
DNase inhibits Gardnerella vaginalis biofilms in vitro and in vivo.
Hymes SR, Randis TM, Sun TY, Ratner AJ
J Infect Dis. 2013;207(10):1491.
Bacterial vaginosis is a highly prevalent and poorly understood polymicrobial disorder of the vaginal microbiota, with significant adverse sequelae. Gardnerella vaginalis predominates in bacterial vaginosis. Biofilms of G. vaginalis are present in human infections and are implicated in persistent disease, treatment failure, and transmission. Here we demonstrate that G. vaginalis biofilms contain extracellular DNA, which is essential to their structural integrity. Enzymatic disruption of this DNA specifically inhibits biofilms, acting on both newly forming and established biofilms. DNase liberates bacteria from the biofilm to supernatant fractions and potentiates the activity of metronidazole, an antimicrobial agent used in the treatment of bacterial vaginosis. Using a new murine vaginal colonization model for G. vaginalis, we demonstrate>10-fold inhibition of G. vaginalis colonization by DNase. We conclude that DNase merits investigation as a potential nonantibiotic adjunct to existing bacterial vaginosis therapies in order to decrease the risk of chronic infection, recurrence, and associated morbidities.
Department of Pediatrics, Columbia University, New York 10032, USA.
Bacterial vaginosis in sexually experienced and non-sexually experienced young women entering the military.
Yen S, Shafer MA, Moncada J, Campbell CJ, Flinn SD, Boyer CB
Obstet Gynecol. 2003;102(5 Pt 1):927.
OBJECTIVE: To estimate the prevalence of bacterial vaginosis by Nugent Gram stain criteria in a nonclinic national sample of young women entering recruit training; to examine clinical associations with bacterial vaginosis; and to evaluate the performance of a pH test card and Papanicolaou smear against Gram stain as screening tools for bacterial vaginosis.
METHODS: A cross-sectional study of 1938 women was conducted. Self-collected vaginal swabs were applied to a colorimetric pH test card and a glass slide for Gram stain evaluation according to the Nugent criteria. Papanicolaou smears and samples for sexually transmitted diseases screening were collected during routine entry pelvic examinations.
RESULTS: Bacterial vaginosis prevalence was 27%, with 28% in sexually experienced and 18% in non-sexually experienced women (P = .001). Bacterial vaginosis prevalence was 11% in Asian/Pacific Islanders, which was lower than in other nonwhite ethnic groups (P = .004). Clinically, bacterial vaginosis was directly related to multiple sexual partners (P = .026), self-reportof vaginal discharge (P = .001), self-report of vaginal odor (P<.001), and concurrent Chlamydia trachomatis infection (P = .002), and inversely related to hormonal contraceptive use (P = .013). Vaginal discharge did not achieve statistical significance in multivariate analysis. Compared with the Nugent criteria, the sensitivities and specificities for bacterial vaginosis diagnosis were as follows: colorimetric pH test: 72% and 67%; Papanicolaou smear: 72% and 79%, respectively.
CONCLUSION: Among these diverse young women, bacterial vaginosis occurs commonly in both sexually experienced and inexperienced young women and differs by race and ethnicity. The pH colorimetric test and Papanicolaou smear performed moderately well as screening tools for bacterial vaginosis. The inverse relationship of bacterial vaginosis with hormonal contraceptive use and its direct relationship with C. trachomatis need further study.
Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, California, USA. email@example.com
Early sexual experiences and risk factors for bacterial vaginosis.
Fethers KA, Fairley CK, Morton A, Hocking JS, Hopkins C, Kennedy LJ, Fehler G, Bradshaw CS
J Infect Dis. 2009;200(11):1662.
BACKGROUND: We have undertaken a cross-sectional study that investigates the association between bacterial vaginosis (BV) and sexual practices in sexually experienced and inexperienced women.
METHODS: Participants were 17-21-year-old females who attend Melbourne University, Australia. Study kits that contained an information and consent form, questionnaire, swab, and slide were distributed. Information regarding demographic characteristics and a broad range of sexual practices were collected. Gram-stained, self-collected vaginal smears were scored with the Nugent method. Associations between BV and behaviors were examined by univariate and multivariate analysis.
RESULTS: BV was diagnosed in 25 (4.7%) of 528 women (95% confidence interval [CI], 3.1%-6.9%). Importantly, BV was not detected in women (n = 83) without a history of coital or noncoital sexual contact (0%; 95% CI, 0%-4.3%). BV was detected in 3 (3.8%) of 78 women (95% CI, 0.8%-10.8%) with noncoital sexual experience only and in 22 (6.0%) of 367 women (95% CI, 3.8%-8.9%) who reported penile-vaginal sex. BV was associated with a history of any genital contactwith a sexual partner (P=.02). BV was strongly associated with>3 penile-vaginal sex partners in the prior year (adjusted odds ratio, 7.1; 95% CI, 2.7-18.4) by multivariable analysis.
CONCLUSIONS: This study shows a strong association between BV and penile-vaginal sex with multiple partners but found no BV in sexually inexperienced women, once a history of noncoital sexual practices was elicited. Our findings indicate that BV is not present in truly sexually inexperienced women.
Melbourne Sexual Health Centre, The Alfred Hospital, Victoria, Australia. firstname.lastname@example.com
Sexual risk factors and bacterial vaginosis: a systematic review and meta-analysis.
Fethers KA, Fairley CK, Hocking JS, Gurrin LC, Bradshaw CS
Clin Infect Dis. 2008;47(11):1426.
We performed a systematic review and meta-analysis of the association between sexual risk factors and bacterial vaginosis (BV). Forty-three studies reported new or multiple sexual partners and condom use relative to prevalent, incident, or recurrent BV. The summary estimate of the relative risk for the association between BV new or multiple male partners was 1.6 (95% confidence interval, 1.5-1.8), between BV and any female partners was 2.0 (95% confidence interval, 1.7-2.3), and between BV and condom use was 0.8 (95% confidence interval, 0.8-0.9). This review is the first to summarize available observational data for BV. It shows that BV is significantly associated with sexual contact with new and multiple male and female partners and that decreasing the number of unprotected sexual encounters may reduce incident and recurrent infection. Investigation of sexual transmission of BV is limited by the absence of a clear microbiological etiology; however, we have shown that the epidemiological profile of BV is similar to that of established sexually transmitted infections.
Melbourne Sexual Health Centre, The Alfred Hospital, Carlton, Victoria, Australia.


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This is a discussion on [News] Review of Fedora Extra Packages (EPEL), Red Hat on Speed Compromise - Linux ; -----BEGIN PGP SIGNED MESSAGE----- Hash: SHA1 Fedoraâs Extra Packages for Enterprise Linux â the Extra Mile ,----[ Quote ] | What started as an effort to package software not included in Red Hat | Enterprise Linux has grown to be ...
Hash: SHA1
Fedoraâs Extra Packages for Enterprise Linux â the Extra Mile
,----[ Quote ]
| What started as an effort to package software not included in Red Hat
| Enterprise Linux has grown to be the most interesting part of Fedora for some
| ISVs. Extra Packages for Enterprise Linux, or EPEL, is not a mass rebuild of
| all Fedora software for Enterprise Linux. It is a disciplined set of packages
| with a maintenance philosophy that aligns with Enterprise Linux.
Red Hat In Boston, Part 1.1: Why 'Faster' Isn't Always Faster
,----[ Quote ]
| Rik van Riel, senior software engineer for Red Hat, braved multiple
| interruptions by a hair-trigger fire-alarm system to tell us how, as
| counterintuitive as it might seem, faster components may lead to slower
| systems. The size and speed of your hard drive hasn't kept pace with the
| amount of data being retrieved from it and, no thanks to Moore's Law, the age
| of what van Riel called "hardware miracles" is pretty much over. From here on
| out it's an arms race -- hardware advances being unable to keep pace with the
| increasing demands put on them.
Red Hat Launches New Package Repository for Enterprise Linux
,----[ Quote ]
| Every user and admin has experienced at least one desired package not being
| included and supported in RHEL. This project gives you a place to promote,
| support, and benefit from packages that exist in Fedora and were not included
| in a RHEL version. Â*
First rpm.org-RPM version released
,----[ Quote ]
| Recently the first version of rpm.orgâs RPM tool was released. While it is
| only a minor version (184.108.40.206) this release is a milestones because it is a
| coordinated release between the participating distributions. Â*
RPM Package Manager
,----[ Quote ]
| Welcome to the home of the official RPM Package Manager (RPM) code base!
Install .rpm Files in Debian and Ubuntu
,----[ Quote ]
| Some time you might find some applications are having only .rpm files but
| you want a .deb package for your debian,Ubuntu and other debian derived
| ditributions.If you can?t find .deb debian package in any of the
| debian,ubuntu repositories or elsewhere, you can use the alien
| package converter Â*to install the .rpm file.
| Alien is a program that converts between the rpm, dpkg, stampede slp,
| and slackware tgz file formats. If you want to use a package from
| another distribution than the one you have installed on your system, you
| can use alien to convert it to your preferred package format and install
| it.
Fedora Project to Help Revitalize RPM
,----[ Quote ]
| The Fedora Project has announced plans to revitalize RPM, the package
| manager used by many Linux distros.
The future of RPM
,----[ Quote ]
| We wanted to make sure those parties agreed that this was the right
| thing to do for their respective communities. We touched base with
| some of these people at the recent LSB conference, and the
| overwhelming community opinion there was in favor of what we are
| outlining here.
Version: GnuPG v1.4.6 (GNU/Linux)
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Single Article Purchase:
Orr DP, Wilbrandt ML, Brack CJ, Rauch SP, Ingersoll GM.
Am J Dis Child. 1989;143(1):86-90.
Published online January 1, 1989
Choose criteria for pricing info
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Obtain AMA PRA Category 1 Credit™ by reading an article and completing an online quiz. Quizzes are available to AMA Members, subscribers, and those who have purchased tokens.


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Hello readers!
As a follow up to our post on James, Quizz, Keaton Kristick and Mike Riley handing out doughnuts to the hundreds of students who slept outside to get football tickets on Monday morning, The Athletic Department has posted a video of the good deed on Youtube.
If you think I'm exaggerating the number of people who line up at ungodly hours to get tickets, look at the size of that line! Note the guys who had been sleeping in line SINCE THAT SATURDAY NIGHT!
Beaver Nation rocks!


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Grateful Dead
Musikhalle - April 29, 1972
April 29, 1972
Hamburg, DE
Set List:
Playing in the Band
Mr. Charlie
Black Throated Wind
China Cat Sunflower
I Know You Rider
Big Boss Man
Jack Straw
Chinatown Shuffle
Me and My Uncle
Big Railroad Blues
Good Lovin'
Casey Jones
Greatest Story Ever Told
He's Gone
Next Time You See Me
Dark Star
Sugar Magnolia
Who Do You Love
One More Saturday Night
Uncle John's Band
Previous Show« Jahrhundert Halle - April 26, 1972
Next ShowOlympia Theater - May 3, 1972 »
Attendees of this show
So here we are, approaching the 40th anniversary of one of the most celebrated tours, one commemorated with a triple album that everyone seems to have purchased. Definitely something to celebrate, especially if you have hundreds of dollars in disposable income to listen to the shows. That's right, cause if you don't then you are #@*^% out of luck, cause NONE of these shows from the Europe 72 tour are available to stream at your leisure on archive.org. At the risk of ranting, I'll just let others share their thoughts on the subject. I'll I can say is I'm disappointed because this goes against the very heart and soul of the deadhead ethos of sharing the music. I remember reading an interview with Jerry in Rolling Stone, where he said, when asked about the Dead's mellow policy about recording their shows, (paraphrase) "When we're through performing, it's as much theirs [deadheads] as it is ours [the band]. They were part of making it happen afterall." Indeed!


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Levi Souza
PhD Candidate
Ph.D in Ecology, expected 2013, UC Davis
B.S., UC Davis
Magpie Habitat Preferences
The Yellow-billed Magpie is a California endemic bird species (only found in California) that has suffered dramatic mortality from West Nile virus (WNV). Though familiar to many who live within its range, we know surprisingly little about various aspects of the Yellow-billed Magpie's life history. Gaps in our knowledge include dispersal patterns, subpopulation status, and habitat preferences, among others. To help answer the question of which habitats magpies prefer and to understand how data gathered by citizen scientists compares to that gathered by trained scientists, I am building computer models that describe the climate and vegetation types that Yellow-billed Magpies use the most. I am utilizing magpie observation records from citizen scientists (Magpie Monitors; ebird) as well as trained biologists.
Mercury Loads in River Otters
Mercury is a dangerous pollutant that is a relic of mercury mining operations in the coast ranges and gold refining in the Sierra Nevada mountains. Runoff from these sources collect in the central valley where the mercury may bioaccumulate within the aquatic food web. I am interested in understanding the risks that dietary methylmercury intake pose to Central Valley populations of river otters. To answer this question, fur and food sources will be analyzed for mercury content to discover the sources that pose the greatest risks to this top wetland predator.
If you have any questions about my research please feel free to email me at (email@example.com ).
When I am not doing research, I work for the California Department of Fish and Game, hike, garden, and keep chickens.
River otter picture courtesy of Rob Floerke


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You Review It RPG: Dark Quest
From the Google Play store~
Dark Quest is a turn based fantasy role playing adventure game where players assume the role of a mighty barbarian on his epic quest to destroy the forces of the evil sorcerer and save the land from evil.
Enter a world of fantasy and adventure: Explore twisted mazes, find hidden doors and fight bloodthirsy orcs!
Roll the skull of fate and reveal your twisted fate: The evil sorcerer will torment your soul for his own amusment, he will summon you in the sphere of judgement where you will be forced to play a twisted game of death, can you survive his magic?
Slaughter endless hordes of orcs & undead: Your strength, courage and strategy will be key into wining every battle.
Trade with the people in the village: Spend the gold you find in your adventures in the village to buy new potions, weapons and spells for your characters.
Control a party of up to 3 characters each with their own unique abilities: Use the unique strengths of each character and work together to defeat the minions of the evil sorcerer.
The Barbarian: A powerful character who can bring terror and destruction to all his enemies with his destructive force and skill of sword.
The Wizard: This character is very weak in close combat but his highly potent spells are capable of altering the outcome of any battle to your favor. Use his powers wisely and you may stand a chance against the hordes of the evil sorcerer.
The Dwarf: The dungeons are vast and dangerous but with the help of your ally Thorin the Dwarf you have nothing to fear. His quick feet and eye for danger will save you against numerous traps and grave danger!
In his review of Dark Quest, contributor James Christy gave the game 3.5 stars, impressed with the gameplay but not the game's length. Think you can write a better review? Give us your take on the game in 300 words or less.
< < < Back to You Review It > > >
You Review It:
You must be logged in to post a comment.


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- Home
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Christmas Parties at 2007 Franklin Street (1954-1971): American-Jewish Family Life in the Haas-Lilienthal House of San Francisco
Elizabeth Lilienthal Gerstley's Christmas Parties album contains 201 photographs taken inside the Haas Lilient
A Festival of Faith: The Musical Legacy of Cantor Reuben Rinder
Cantor Reuben H.
Making Things Happen: The American Premiere of Darius Milhaud's Opera "David" (1956)
On February 22, 1956, the Hollywood Bowl in Los Angeles, California, was filled by a crowd of opera-goers, rushing to attend
Far From Where? Jews and China in Modern Times
Jewish roots in China can be traced from the 9th century when Jewish merchants thought to be from Persia reached China by wa
On Hitler's Balcony: Koppel Pinson and the Rescue of Jewish Books in Post-War Germany
Koppel S.
Jews of the Gold Rush: Sonora Hebrew Cemetery
Founded in 1853, the Sonora Hebrew Cemetery was the first cemetery in the Gold Rush Region.
Pioneer High Society: Jewish Family Networks in San Francisco (1855-1923)
The Western Jewish Americana collections of the
Seymour Fromer collection on Darius Milhaud's David, 1954-1975
Darius Milhaud was born in France and immigrated to the U.S. in 1940.
Digital aggregation of Magnes work is now on Dipity http://www.dipity.com/magnes.


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Clifton Park jeweler understanding, caring, attentive
Comments Off on Clifton Park jeweler understanding, caring, attentive
Love Donna and her husband! I just recently got married and my husband (then fiance) purchased my ring through Glennpeter Jewelers in Clifton Park.
Donna and her husband own this particular store and they are so kind and understanding and helpful. I felt comfortable and truly cared about as a customer, as a bride to be, and as a person.
I was even difficult and asked them to change my setting, which they did, and then I changed my mind again, and they let me change it back (I am sooo indecisive!).
Never have I had such understanding and caring people attend to my retail needs. If you are looking for a place to be your lifetime jeweler, I recommend the Glennpeter's in Clifton Park. My husband says he will never buy my jewelery anywhere else, nor would I want him to.
– Laura via google.com
Comments are closed


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Mix all ingredients together, pour into celery salt rimmed glass, and garnish with sausage/cheese curds/pickles, etc.
1 oz. Wicked Stuff Vodka
1/2 oz. Lime Juice
1/2 oz. Triple Sec
1/2 oz. Simple Syrup (Vanilla Preferred)
Shake all ingredients over ice and serve on the rocks or blended with ice. Serve with Lime Wedge.
1 1/2 oz. Yahara Bay Lemoncello
1 1/2 oz. Yahara Bay Crancello
Blend Equal Parts Lemoncello and Crancello. Pour over ice and garnish with a Lemon Wedge.
1 Part Yahara Bay Coffee Liqueur
1 Part Yahara Bay Cocoa Liqueur
Dash of Vanilla Creamer
Shake coffee, cocoa, and creamer over ice until frothy. Top with whip cream, cherries, or chocolate shavings if desired.
1 oz. Seraphine Chai Tea Vodka
2 oz. Yahara Bay's Holz Apple Crisp
Mix all ingredients together and serve over ice or warm with a cinnamon stick.
1 oz. Yahara Bay Seraphine Chai Tea Vodka
2 oz. Eggnog or Creamer (We prefer Sassy Cow Creamery's Eggnog)
-Shake Chai Vodka and Cream/Eggnog with Ice. Strain and garnish in a glass with cinnamon or nutmeg.


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Top Definition
Short for Microsoft, used to imply Microsoft cares more for money than it does for security, stability, and anything else that could make a good Operating System.
M$ has another security hole.
od uživatele Phoenix 18. květen 2004
Trending Now
Can you define these popular missing words?
Typically used as a derogatory term for Microsoft. Typically used by those who use Linux as their operating system, it implies that Microsoft, a business, cares about business-related things.
The person said M$, so I naturally dismissed their opinion on what is the best operating system.
od uživatele Scumbag 21. březen 2004
An acronym/abbreviation for the monopoly Microsoft, using an $ instead of an S to show dislike for Microsoft and the money the company has.
The day M$ makes a product that doesnt suck is the day they make a vacuum.
od uživatele DarkX 04. červenec 2005
Shorthand for Microsoft
As in Microsoft's millions
od uživatele =Y= 05. květen 2005
Common net abbreviation for Microsoft, everybody's least favorite monopoly.
M$, M$, M$!!!... yeeeaaahhh...
od uživatele VAKI5 23. leden 2005
short term for the "MICROSOFT" company
od uživatele Thang 29. červenec 2003


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© Courtesy Cavy Care Inc.If you find you have to give up your guinea pigs, work to find it a happy home elsewhere.
Q: My children have two female guinea pigs. My son and I have had major impacts on our allergies due to the hay. We would like to give them away. Would you know of any guinea pig rescues in the Westchester/Putnam/Rockland county area of New York?
A: When rehoming guinea pigs, first check with other parents whom your children may interact with. Asking if they would like a guinea pig is a great place to start. Then ask parents at your children's school, fellow church members and coworkers, extended family members. If they do not want a guinea pig, perhaps they would be willing to ask people they know. Post on the neighborhood bulletin boards, swimming pool bulletin boards, online at Yahoo classified, Google classified, Petfinder, Pets911 or even Facebook.
Think about charging a rehoming fee and screening a new home to be sure about the welfare of the guinea pigs in the new home. A fee brings to the table folks who are willing to invest in the pet both financially and emotionally. To gauge people's commitment, screen them by asking what they have done to educate themselves about having guinea pigs. Do they have a cage? What type of cage? How big is the cage? Who will be the primary caretaker of the guinea pig? Do they have other animals, especially dogs? What kind? Have they ever had to give up an animal before? What will they do to prepare for the guinea pigs?
Offer to share your knowledge and tell them what they can expect when taking your guinea pigs home with them. Offer to help if they have questions in the future, or offer some of the guinea pig reading material you may have. Your goal is to prepare them for the guinea pigs. These are simple, quick and insightful questions to prepare the new owners for your pets to move in with them.
See more guinea pig Q&As, click here>>See guinea pig health Q&As, click here>>See Shannon Cauthen's author bio, click here>>
Posted: September 17, 2013, 3:50 p.m. EDT
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