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Do your breasts feel lumpy? It may be that you're experiencing fibrocystic breast changes—a benign condition that occurs in at least 60% of all women of childbearing age.
It sounds very unglamorous, but the human breast is no more than a lumpy gland made up of milk glands and ducts and the tissues that separate and support them. Most breasts have at least one or two lumps; however, if your breast feels especially lumpy and uncomfortable, you're probably experiencing fibrocystic breast changes.
"The vast majority of women have [fibrocystic changes]...and are no worse for it," reports Dr. Carolyn Kaelin, a gynecologist and director of the breast clinic at Brigham & Women's Hospital in Boston.
Fibrocystic changes are benign breast changes. The medical literature used to refer to them as "fibrocystic disease." That was before fibrocystic changes were found to be no more a disease than menstruation or menopause. The breast tissue may feel dense with an irregular area of thicker tissue having a lumpy or ridge-like surface. You might also feel tiny bead-like masses scattered throughout the breasts.
Your breasts may feel tender, swollen, and full with a dull, heavy pain. They may be sensitive to touch with a burning sensation. This discomfort is normal and does not indicate the presence of disease. For some women the pain is so severe that they cannot exercise or lie on their stomachs. Fibrocystic changes usually occur in both breasts. Most often in the upper outer quadrant and the underside of the breast where most of the milk-producing glands are located.
Fibrocystic changes are associated with hormonal shifts in estrogen and progesterone, which affect the breast tissue. During the menstrual cycle, the breasts swell as the milk glands and ducts enlarge and the breasts retain water. After menstruation, the breast swelling goes down and the breasts return to normal.
Fibrocystic changes generally begin when women are in their twenties or thirties and usually last until menopause. For a small number of women, the condition worsens over the years, causing constant pain and lumpiness. In general, some of the lumps become permanent and may or may not shrink after menopause.
Some women with fibrocystic changes develop cysts in their breasts. A cyst is a fluid-filled sac that is usually smooth, firm, movable, and sometimes tender—like a water balloon without the water. The cyst will generally enlarge before the menstrual period and shrink afterwards. A large cyst may be round and feel like an eyeball when pressed with the eyelid closed.
If you are concerned about a lump, your healthcare provider can determine whether or not it warrants further attention. Determining whether a lump is a cyst or something more serious can be determined by a simple office procedure known as fine needle aspiration. A fine-gauge needle is inserted into the lump and fluid is withdrawn.
If the lump is a cyst, as is the case 95% of the time, it will collapse once the fluid is removed. If it's a complex cyst, the next step is an ultrasound-guided fine needle aspiration that would likely cause the cyst wall to collapse.
"If we were concerned that there was something in the cyst wall, we would proceed with a biopsy," says Kaelin.
While there is no definitive, medically proven treatment for breast pain caused by fibrocystic changes, there are various remedies that can be helpful.
"Finding out what works for individual women is a trial and error process. If there was one good way to treat the discomfort, everyone would be treated that way. Not every remedy works for everyone but hopefully, at least something works for everyone," Kaelin observes.
There is no correlation between fibrocystic changes and breast cancer. However, fibrocystic changes can make it more difficult to
breast cancer. The best way to alleviate concerns about these cyclic changes is to examine your breasts every month seven days after your period when hormone levels are lowest and there is less texture (lumpiness). That way you'll know what degree of texture and lumpiness is normal for your breasts and be able to detect changes. It's also a good idea to keep a diagram of the more textured or lumpy areas, says Kaelin.
Kaelin strongly advises women to have a clinician examine their breasts once a year; this should be done in addition to mammograms.
How to Examine Your Breasts
It is normal to have some lumpiness or thickening in the breasts. By examining your breasts once each month, you will learn what is normal for you and notice when any changes do occur. Some women find that doing a weekly self-exam works better for them. They learn how their breasts feel at all phases of their menstrual cycles. The more regularly you can examine your breasts, the better you can learn what is normal for you. Your job isn't just to find lumps, but to notice if there are any changes.
Womens healthhttp://www.4woman.gov
Y-ME National Breast Cancer Organization
The Canadian Women's Health Network
Health Canadahttp://www.hc-sc.gc.ca/index_e.html
Fibrocystic breasts: a non-disease. American Cancer Society website. Available at:
Love, SM, Gelman, RS, Silen, W. Sounding board. Fibrocystic "disease" of the breast--a nondisease?. N Engl J Med 1982; 307:1010.
Smith, RL, Pruthi, S, Fitzpatrick, LA. Evaluation and management of breast pain. Mayo Clin Proc 2004; 79:353.
Understanding fibrocystic changes of the breast. College of American Pathologists website. Available at:


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The just shall live by his faith. —Habakkuk 2:4, KJV
Maybe we prayed every day during the week and yet have not experienced God's blessing or seen Him answer prayer. What then? "It is required in stewards [that is, those who have been given a trust], that a man [or woman] be found faithful" (1 Cor. 4:2, KJV). Anybody can be faithful when prayer is being answered, when the wind is at one's back, and everything is going well. But what is one to do when God suddenly hides His face? Until you have experienced the hiding of His face and come out on the other side, you won't really come to know God as a friend.
This was Habakkuk's experience. Habakkuk 2:4 is a famous verse that is quoted three times in the New Testament.
There is an intentional ambiguity here. The faithfulness can be God's faithfulness to us or our faithfulness to God: the verse can be read either way, and it means both. But it can equally describe the faithfulness of the individual himself, who doesn't give up hope. The person who trusts God and lives by His promise to bless is declared righteous in the sight of God. It applies to the future—to the fact that God will accept us in heaven—but it also applies to the present. God is saying that we are declared righteous now.
If we could only see this day, it would set us afire. If, in the moment when we don't see answered prayer, we could just look up to heaven and say, "God, I love You anyway," God would declare us righteous just because our faith pleases Him. That kind of faith has a cleansing result. We feel clean. We don't understand why God lets things happen, but we trust Him anyway.
Excerpted from Worshipping God (Hodder & Stoughton, 2004).
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Chatham Large Snack + Study Desk + Hutch
$199 – $599
- Overview
Retro details like antique-bronze drawer pulls and label holders give this roomy desk smart style that works. A cabinet to store your snacks will keep them handy during those extra-long study sessions.
- Crafted from premium-quality plywood, veneer, and MDF, an engineered wood that lends exceptional strength and ensures structural integrity over time.
- Bolts on the wood legs screw into the pre-drilled holes on the desk's underside.
- Antique White finish is gently distressed by hand.
- Dark Espresso finish goes through a multi-step process highlighting the wood's natural grain.
- Add our large hutch or desktop organizer( both sold separately); large hutch has two cubbies and two sliding doors that open to extra storage space.
- Add the Snack Cabinet and Top, File Cabinet and Top, or Chatham Bookcase (all sold separately) next to the desk for extra storage and organized set up.
- Our Supercool Fridge (sold separately) fits perfectly in the cubby of the snack cabinet with the shelf removed.
- Desk includes a large desktop, two legs, and a snack cabinet.
- Snack cabinet features a removable shelf for extra storage.
- Brushed-iron-finished hardware creates an industrial look.
- Dimensions + Care
- Overall: 60" wide x 22" deep x 30.25" high
- Desktop: 60" wide x 22" deep x 1.5" thick
Snack Cabinet
- Overall: 28.25" wide x 22" deep x 29.5 high
- Drawer Interior: 21.5" wide x 15" deep x 3" high
- Removable Shelf: 24.25" wide x 19.5" deep
Small Hutch
- Overall: 45" wide x 10.75" deep x 33" high
- Large Cubby Interior: 42" wide x 9.5" deep x 20" high
Large Hutch
- Overall: 59.5" wide x 10.75" deep x 33" high
- Cubby Interior: 57" wide x 9.5" deep x 20" high
Desktop Organizer
- Overall: 35" wide x 8" deep x 5.5" high
- Drawer Interior (2): 8" wide x 6" deep x 3.5" high
- Crafted from premium-quality plywood, veneer, and MDF, an engineered wood that lends exceptional strength and ensures structural integrity over time.
- Bolts on the wood legs screw into the pre-drilled holes on the desk's underside.
- Dust with a soft, dry cloth.
- To protect the finish, do not apply abrasives or household cleaners.
- Shipping Info
This item is delivered by our Premium In-Home Delivery Service. With In-Home delivery, the item is brought into your home, unpacked, and assembled (except for some headboards and Style-It Desk components, which are not unpacked or assembled. Our service also does not mount hutches and shelves to customer's walls.) Delivery is by appointment. Monday-Friday, in all areas; Saturday delivery in some areas. Our delivery service will contact you to arrange a day. This service is available in the contiguous 48 states only. Please allow approximately 2-3 weeks for delivery. Returns of mattresses are subject to a $40 return shipping fee.
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Every year, dog owners from all over Maryland join the residents of Talbot County on the lawn at the Inn at Perry Cabin for the annual Jack Russell Terrier Race & Dachshund Dash. This year's races will being at 11:00 am on Sunday, October 24th. Registration begins promptly at 9:30 that morning.
Take a look at this short video featuring former Jack Russell Racing champ, Beacon.
The proceeds from the benefit will go to the St. Michaels Community Food Bank, which will provide non-perishable and nutritious foods to needy families in Bay Hundred.
The races will be broken down into categories: Jack Russell (flat and hurdles), Norwich, and West Highland. There will also be a Dachshund Dash and the famous "So Your Dog Thinks He's a Jack" race.
The even will be held, rain or shine and refreshments will be available on site. Come and help the residents of Talbot County raise money for a local charity! Join us at the 14th Annual Jack Russel Terrier Races!


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NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.
Monday, September 25, 2017
Urinary and Genital Disorders (Children)
Swollen Penis - 6 year old
My 6 year old son`s penis is swollen, red and itchy. Should I be concerned and what can I do to help ease the uncomfortableness for him.
This question is difficult to answer. It is unclear whether he is circumcised. If he is uncircumcised, then he may have penile swelling under the foreskin from epithelial debris (physiologic). Occasionally it is red and appears inflamed, although infection is uncommon. Some boys who are circumcised also develop a red and swollen penis. Sometimes the penis is retracted into the fat pad just above the penis, and it just needs cleaning with warm water. In other cases there is inflammation from an incomplete circumcision. This problem is very common, and not a cause for concern. It will get better over time. Another cause is irritation from the detergent used to clean his underwear, although this is uncommon. Did he try to urinate outside and come into contact with an irritant. I have seen a few boys with poison ivy of the penis (obviously rare). Finally, some boys have intermittent redness and irritation that comes and goes, and generally it goes away permanently. It is not a serious condition. If there is no obvious cause and it persists, it would be appropriate to see a pediatric urologist.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University


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US General Services Administration and Department of Interior Honor Veterans
A celebration to honor America's veterans for their patriotism, love of country and willingness to serve and sacrifice.
DENVER, CO - Today, the US General Services Administration and Department of Interior delivered a Veterans Day event to campus employees and the surrounding Lakewood, Colo., community at the Denver Federal Center in the E.E. Fryar US Army Reserve Center. The event honored America's veterans for their patriotism and sacrifice in light of Veterans Day, Nov. 11.
"Prior to my military service, Veterans Day was just another holiday. A time spent with family or taking advantage of a sale at the mall," said Keynote Speaker and retired Master Sergeant Troy R. Inabinet in his speech at the event. "After 24 years of service, this holiday is part of who I am. A day of honoring those who have given Americans the rights and freedoms we all have come to enjoy."
Veteran work is an important resource for GSA and the federal, state and local governments. GSA has more than 2,500 veterans working throughout the agency, 70 of them work in the Rocky Mountain Region. GSA not only employs many veterans but its Small Business Utilization Center focuses on providing veteran-owned businesses with business opportunities. Out of nearly $95 million agency small business dollars, GSA Rocky Mountain Region awarded more than $16.5 million dollars of that to veteran-owned businesses in FY'13, far exceeding the three percent statutory goal.
"Veterans have acquired a wealth of knowledge, skills, and competencies through practical workforce experience," said Susan Damour, GSA Rocky Mountain Regional Administrator. "They bring to us a unique sense of leadership and teamwork; and they understand the commitment to achieving organizational goals and objectives."
Colorado Congressman Ed Perlmutter also honored veterans during the ceremony. "Veterans Day is a time to honor the service and dedication of those who defended our country and our freedom," said Perlmutter. "We are a great nation made of of courageous people willing to sacrifice for our country. They prove we can do anything when we work together for our communities. I am proud of these men and women, of my country, and the determination of all those who continue to risk their lives and stand strong for us each and every day."
While our service men and women make up less than one percent of Americans, they also represent more than one million military spouses and two million children and millions more parents and relatives -- all of whom have shared the strains of deployment and sacrifice.
GSA, DOI, and the Denver Federal Center extend deep appreciation for the sacrifice that veterans have made and thanks for their continued leadership in government.
For more veteran stories and how they impact GSA and the community, click here. Like us on Facebook for on-going campus updates at www.facebook.com/DenverFederalCenter.


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The Red List of Threatened Species, published by the International Union for Conservation of Nature (IUCN), is one VIP roster you don't want to be on. This year, however, more than a thousand bird species have unfortunately made the cut, given a boost by climate change.
The 2008 Red List, published today, has up-listed eight species as "critically endangered," the highest threat category. Meanwhile, 1,226 species have been flagged as "threatened." Long-term drought and sudden, extreme weather are putting extra strain on habitat that many threatened species need, an IUCN press release states, adding that these severe weather patterns, coupled with habitat destruction, have lead to an increased rate of extinction on continents and away from islands (which is where most historical extinction has occurred). And climate change will likely only figure more prominently into future Red Lists, according to the press release.
To curb the alarming trend, BirdLife has launched the Preventing Extinctions Programme, which will target the 190 critically endangered bird on the list by finding people and organizations best-suited to conserving each bird.


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About the Book
Join a murder hunt where conflict and sexual tension is the name of the game...
Thomas Heyworth was a wealthy, internationally renowned mystery writer, a colourful character whose opinions and outspoken behaviour got him in a lot of hot water in his lifetime. Because of the enemies he's accumulated over the years, Heyworth stipulated in his will detailed plans for an amateur investigation to take place in the event of his death. When Heyworth is found dead in his own library, Evie Randall, Heyworth's possible illegitimate daughter who has lived on the Heyworth estate ever since her mother, Heyworth's former housekeeper died, becomes the primary suspect.
Seattle detective Max Galloway is sent to find out the truth and is unwittingly drawn to Evie. But the real murderer is closing in and is determined to eliminate anything or anyone standing in the way of collecting millions. Suddenly Max and Evie are in a race to solve the crime before the game ends for them both.
Educator and Librarian Resources
Product Details
- Imprint: Avon
- On Sale: 05/31/2011
- Pages: 384
- List Price: 1.99 USD
- BISAC1: FICTION / Romance / Contemporary


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Wright takes next step in rehab with full BP
PORT ST. LUCIE, Fla. -- In the most tangible progress to date in his rehab from a strained left intercostal muscle, third baseman David Wright took full batting practice Sunday at Tradition Field.
"It felt good, so I guess check this off the list," Wright said. "We'll hopefully progress a little more tomorrow."
Shooting for Opening Day, Wright has made steady advancement since Mets doctors cleared him to practice earlier this week, adding activities to his schedule each morning. On Saturday, Wright hit off a tee for the first time, also fielding ground balls. On Sunday, he took his hacks in a regular BP session, also fielding and throwing.
Wright noted that because he "can be my own worst enemy" in terms of his eagerness to progress, Mets trainers hide his rehab schedule from him until he arrives at the ballpark each morning. That serves the added benefit of giving him extra time to assess any lingering discomfort in his ribs.
"You've got to know the difference between where you're hurt or just kind of banged up," Wright said. "You wouldn't play in too many games if you woke up every morning and had to be 100 percent to play in the game."
As for Opening Day, Wright says he is "just as optimistic as … a week ago" that he will be ready to play against the Padres. Wary of MLB's disabled list backdating rules, the Mets will not slot Wright into a Grapefruit League lineup until they are certain he will be able to go.
But exactly one week out from the opener, they remain encouraged by his progress.
Anthony DiComo is a reporter for MLB.com. Follow him on Twitter @AnthonyDicomo. This story was not subject to the approval of Major League Baseball or its clubs.


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Topic: Question about liver function and cough
If anyone knows anything about this, thank you for responding. In the last month or so when Charlie can't sleep and he needs to take a generic Ambien, he sleeps through the night and most of the next day. If the liver is not functioning as well, do medicines like Ambien or Ativan have a longer effect? I don't know if I'm asking this quite right, but it's almost like he's taken 2 or 3 Ambien for the way he gets knocked out when he takes just 1 now. This is something new and I would like to know if anyone else has experienced this. Didn't know if it has something to do with the liver not working as well and not processing medicines the same...
Also, he's had a horrendous cough for a while. I guess we all think mets to the lung. I'm calling his oncologist about his cough tomorrow. Any other ideas about a non-productive cough? Thank you all so much. My best to everyone.


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New 5" Artist Mini Qee...
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Toy2R reveals their next 5" Artist Mini Qee - "Deady: Big in Japan" by Voltaire.
As an added bonus, Voltaire's new Qee will include a special gaming code for use at Adventure Quest Worlds. The code will enable fans to play the game as Deady in his new "Big in Japan" outfit. Adventure Quest Worlds is a 100% web browser based MMO with real-time RPG combat, original art and an entire world to explore.
Limited to 500 pcs worldwide, Voltaire's 5" "Deady: Big in Japan" Mini Qee will retail for a SRP of $28. Look for it this summer.


text: OverviewBack to top Badia - Ground Cinnamon - 2 oz. Item# :112481UPC# :033844000158 Brand:Badia Size/Form:2 oz. Badia Ground Cinnamon 2 oz. (56.7 g) Badia Ground Cinnamon, one of the oldest spices known, has a fragrant aroma and wonderful flavor. It is used mainly for desserts, fruit preparations and beverages, but can also be used in meat stews, rice and vegetables. Cinnamon blends well with Almond Extract, Anise, Celery Salt, Chamomile Tea, Cloves, Nutmeg, Poppy Seed, Sesame Seed, and Turmeric. Cinnamon is a good seasoning for red meat, pickles, relishes, preserves, cooked vegetables, fruits, rice, sauces and desserts. Cinnamon is traditional in Mexican, Caribbean and North American cuisines. The North American continent is extremely far-reaching, enriched by the cultural diversity of this land made up of immigrants from all over the world. Its fast-paced rhythm and the industrial development have highlighted in this region the modality of fast foods, but the famous hamburgers and hot dogs are accompanied by exquisite dishes and a diversity of cuisines that showcase the continent's culinary richness, from East to West and from North to South. In the Northeast, seafood has a leading role. Nothing compares to a Maine lobster or the famous Clam Chowder, prepared with clams, cream, herbs, potatoes, onions, salt and pepper. From Canada, we receive a rich tradition of cured meats, jams and its famous maple syrup that accompanies salted meals as well as pancake towers for breakfast. In the province of Quebec and its biggest city Montreal, a French influence is evidenced by the typical gastronomy known as Poutinee, which is made up of French fries, meat sauce and pieces of cheese. In the Southeast, peanuts, pecans, Georgia peaches and Florida's sweet oranges are famous. Heading to the Gulf Coast, the art of fine cuisine has its most important expressions in New Orleans, where the African and French backgrounds are combined in Cajun and Creole cuisine. It's full of flavors, colors and spices. In the Mid-West region, you can indulge in delicious pies made of fresh fruits, which vary according to the season. Wile Rice and other grains are also distinctive to this region of extensive agriculture. In the South Central area, you find Texas, Kansas and New Mexico, states that are known for the quality and quantity of their cattle. Beef and ribs cooked on the grill are famous, and are complemented by chicken and seasoned with barbecue sauce. In this area, Mexican influences are also important and you'll find an abundance of chili made with beef, onions and red beans. The West Coast is known for its fish and its harvests of a variety of vegetables and fruits. Grapes and wine production is important. Connoisseurs especially enjoy the Napa and Sonoma Valleys of California. A dish that can be enjoyed for breakfast is the Garden Goat Cheese Scramble, made with a mixture of whisked eggs, broccoli, zucchini and yellow squash, served hot with black pepper, chopped dill and pieces of goat cheese on top. Food preparations in southern California is highly influenced by both Central American and Asian cuisine. Mexico's gastronomy includes a variety of delicious cuisine that dates back to 1492, when Christopher Columbus discovered America. The Mexican population incorporated their local agricultural goods to each different meal. The most common staples of the Mexican diet are tortillas and a great variety of chilies, spices and cactuses from the countryside. Whether you eat tacos, fajitas, chimichangas, a hot and steamy pozole, or any kind of sauce, Mexico offers a variety of seasonings to entice all kinds of palates. In the Northern Region of Mexico (Sonora, Chihuahua and Zacatecas), Ranchera and Cabrita beef are common and usually accompanied with the peculiar and exclusive chili called Serrano. In the Western Region (Michoacan and Jalisco), one can easily find seasoned white fish and delicious Curandas. This region harvests Chilaca chili, which when dried turns to a black color. It is then called Pasilla chili and is consumed in thin slices or over a meal. In Central Mexico (Mexico City and Puebla), where you'll find a mix of Spanish and Aztec cuisine, the typical "Mole Poblano" is popular. Mole Poblano is a thick, dark sauce made with dried chilies, nuts, seeds, spices, cocoa and other delicious ingredients that are truly appreciated. Veracruz, on the Gulf Coast, offers excellent seafood, as well as good Atole. Jalapeno chili is the most common in the region, and its name refers to the many years it was harvested in Jalapa, Veracruz. On the Yucatan Peninsula, one can become fascinated by the Cochinita Pibil. The Yucatan peninsula's classic chili is the Habanero chili, which is known to be the hottest of all, and is eaten fresh, raw, broiled and cooked. Jose Badia left Spain in 1960, looking for new opportunities in the New World. He first landed in Santiago de las Vegas, Cuba, where he became known for his hardware store, Badia & Garrigo. In 1963, with difficulties facing Cuba, Jose emigrated to Puerto Rico and entered the world of spices. After leaving Puerto Rico in 1967, the Badia family looked for new markets in Miami, the land of Cuban immigrants, building brand loyalty. There, Badia begins to grow with the help of another company, and begins to appear on grocery store shelves. Slowly, Badia becomes more popular and well-known, and it spreads to more grocery stores. By 1998, Badia has expanded worldwide. More than 350 UPC's, placement in 1100 points of sale in the U.S., international markets in three continents, international distribution and a dynamic, high-tech production line with an increase of 28,000 square feet at its new warehouse prove Badia is a great leader in its category. Badia strives to be the strongest ethnic line of spices in the marketplace, with the most competitive prices and an exceptional selection of products for consumers to choose from.


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talking about it on Around the Horn right now if anyone cares
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talking about it on Around the Horn right now if anyone cares
Ken Berger @KBergCBS
Former president Donnie Walsh is expected to return, with Kevin Pritchard to be named GM. But some aspects of power transfer unresolved.
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2m Ken Berger @KBergCBS
While Pacers have called news conference tomorrow, all is not 100 percent resolved with Indy front-office shakeup, source says.
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3m Ken Berger @KBergCBS
Pacers finally announce GM David Morway's departure from team in a statement.
I'm ok with Donnie coming, as long as he doesn't see any trade targets on the Lakers he likes (McBob/Murph McMuffin)
This front office movement should make it difficult for us to get free agents I think.
Sounds to me like Walsh/Pritchard is the next-gen Walsh/Bird: Never completely clear who does what. Awesome.
That's why I don't like Donnie coming back, too. We don't need both.
Exactly. A huge reason that the past 4 years worked out well for the team was because we had a power structure with a clear authoritative figure in Bird. There was no question that Bird was the top dog from 08-12. But now we are at risk of things being like they were from 03-08, where we won't know who exactly has the final say.
I would be fine with all of this if it were just Pritchard, even though I wanted Bird back. But the idea of Walsh returning is a complete buzz kill.
Anyone else think it's a little uncharacteristic of Larry to leak this right before his meeting with Simon? However, Walsh did not publically deny he was coming back, so I guess it's probably official.
I don't really get why you guys are so worried about who to credit/blame. I honestly don't care who makes the call as long as they just make good moves. I think KP and Walsh will do that.
I guess I'm just not sure of that. Unless the two of them are often on the same page, they're probably going to influence one another and cause us to make moves that don't really all fit together like a plan or a vision. I fear a Frankenstein Roster over the next 1+ years.
I'm hoping and it seems as though Pritchard will do a majority of the work, phone calls to GM's, personnel moves, salary cap, etc., whereas Walsh will mostly oversee overall operations, scouting, and communication lines to ownership. At least, if it follows similar precedent of the Bird/Morway working relationship. Walsh will have final say, but Pritchard should do most of the heavy lifting so to speak.
Last edited by PR07; 06-26-2012 at 05:18 PM.
Interesting! So Granger, Paul George, Hibbert, Stephenson, S. Williams, and White were all drafted on needs not talent by Bird?
Hopefully Pritchard is making most of the moves and Walsh is used for relations around the league and money stuff. That would be nice. I really, really liked Pritchard and am worried about Walsh.
How does this affect our coaching staff?
If it were really his back then it would be stated that Bird needs a year off for surgery and recuperation and perhaps will return. Haven't heard that at all. Haven't even heard that a year is what it will take for recovery or how extensive the surgery will be.
This looks to me like a clean break and it looks even worse that Bird was interviewing or seemingly so for the Orlando job. Whatever the situation I don't see Bird back unless he buys the team from Herb.
I'd care to guess they're safe this year. After that?
I would imagine this situation will work out to be better than Walsh/Bird mostly because Pritchard already has experience, whereas Bird would have still been learning the ropes when he first came here.
I'm not a huge fan of bringing back Walsh in this capacity, but with Bird leaving I can understand why. As of right now I am cautiously optimistic. Both Walsh and Pritchard know what they are doing, and as long as they can work together they should be a great team.
Holy crap. This is like reading a game thread.
Bird was always a little more conservative when making moves.
I'd expect KP and Walsh to be a little more "ballsy" and not shy to spend money. I hope this changes our view on not willing to give Deron the max
"So, which one of you guys is going to come in second?" - Larry Bird before the 3 point contest. He won.
Removed link to my website after a PM from Able.
Um, I'm not sure whether or not you have followed Donnie Walsh's career in Indiana before or not? Ballsy would not be the word I would choose to use here.
Ugh, Bill Polian gets canned by the Colts only for Walsh to return to the Pacers a mere 6 month later. When Polian was fired, I thought that meant the days of watching old, past-their-prime GM's run the teams I love were finally over. I guess I spoke too soon.


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Annali dell'Istituto Superiore di Sanità
Print version ISSN 0021-2571
PETRINI, Carlo. Informed consent from cognitively impaired persons participating in research trials: comparative law observations. Ann. Ist. Super. Sanità [online]. 2011, vol.47, n.4, pp.353-362. ISSN 0021-2571. http://dx.doi.org/10.4415/ANN_11_04_06.
This article addresses the ethical requirements to be considered when conducting clinical trials involving human subjects whose mental condition limits their ability to understand the information and to express fully autonomous and informed consent. It does not address other categories of vulnerable persons, such as children, or advanced directives concerning end-of-life care. There are many ethical issues entailed in clinical trials involving subjects with mental disabilities: how to obtain informed consent, balancing risks and benefits, balancing individual benefits with collective scientific and social interests, legal representation and many more. This article focuses on the issues surrounding the concept of minimal risk and the relationship between informed consent and risk. These issues are addressed with particular emphasis on the regulations adopted by the European Union and the federal government of the United States of America. The conclusion proposes a list of working criteria.
Keywords : bioethics; informed consent; human research; legislation; mental disability.


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Would you rather buy a lottery ticket or save those dollars in a certificate of deposit? Washington credit unions are betting that more people would enjoy saving if they had a chance to win prizes, The Seattle Times reported March 30.
From the story "Washington credit unions try can't lose lottery:"
The "Save to Win" plan promises monthly and annual drawings for cash prizes, with one entry ticket issued for each $25 deposit made into a 12-month certificate of deposit.
With CD rates as low as they are, credit unions need creative ways of attracting deposits. According to the story, the program has been successful in Michigan, where the lottery plan debuted. The state now boasts 12,000 participants in Save to Win. Two other states have passed legislation allowing prize-linked savings accounts -- Nebraska and North Carolina, the Credit Union Times reported last week.
How about you? Would you consider a credit union if you were offered a chance a prizes?
Follow me on Twitter: @SheynaSteiner
Senior investing reporter Sheyna Steiner is a co-author of "Future Millionaires' Guidebook," an e-book written by Bankrate editors and reporters. It's available at all the major e-book retailers.


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I had to catch a train in Washington last week. The paved street in the traffic circle around Union Station was in such poor condition that I felt as though I was on a roller coaster. I traveled on the Amtrak Acela, our sorry excuse for a fast train, on which I had so many dropped calls on my cellphone that you'd have thought I was on a remote desert island, not traveling from Washington to New York City. When I got back to Union Station, the escalator in the parking garage was broken. Maybe you've gotten used to all this and have stopped noticing. I haven't. Our country needs a renewal.
And that is why I still hope Michael Bloomberg will reconsider running for president as an independent candidate, if only to participate in the presidential debates and give our two-party system the shock it needs.
One for the Country: A third voice is just what Election 2012 needs to give our two-party system an urgent shock.
Current Status: Published/No Action (12)
Seeded on Wed Apr 18, 2012 3:46 AM
keyboard shortcuts: V vote up article J next comment K previous comment


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Conservative Cabinet members, junior ministers and party enforcers are among around 180 MPs poised to oppose or abstain in a vote on gay marriage, it has been claimed.
Prime Minister David Cameron has also been sent a letter, signed by 25 chairmen or former chairmen of Conservative Party associations, warning that the policy will cause "significant damage" at the ballot box, according to the Sunday Telegraph.
MPs will vote on the proposals, which will also allow civil partners to convert their partnership to a marriage and enable married people to change their legal gender without having to end their union, for the first time when the Bill has its second reading on Tuesday.
Backbenchers have made no secret of their opposition to the move and were left even more angered when the Tory leadership made clear earlier this week it would not include marriage tax breaks in next month's budget - something that would have been seen as a concession to disgruntled traditionalists.
Mr Cameron views the introduction of same-sex marriage as the "Conservative Party delivering the promise it made".
Health Secretary Jeremy Hunt, a big supporter of reforms, said: "Every year thousands of people choose to marry in a church rather than a registry office because they believe marriage is sacred. Religious freedom is not just for heterosexuals - we should not deny anyone the right to make a lifelong commitment to another person in front of God if that is what they believe and that is what their church allows."
Mr Cameron is giving Conservative MPs a free vote on the Marriage (Same Sex Couples) Bill.
Environment Secretary Owen Paterson and Welsh Secretary David Jones are expected to vote against the plans while Defence Secretary Philip Hammond will vote against or abstain and Work and Pensions Secretary Iain Duncan Smith is poised to abstain, according to Sunday Telegraph.
Culture minister Ed Vaizey insisted the vote would not tear the Tory party apart and claimed internal divisions over the issue were "good-natured". He told Murnaghan on Sky News: "Is this going to tear the Tory party apart? No, I don't think it will. I think there is a difference of opinion among colleagues but it is a civilised debate."
Former children's minister Tim Loughton agreed that it would not tear the party apart but warned the Bill was "full of pitfalls" and would set MP against MP. He told Murnaghan: "There's quite a lot of things that were in our manifesto which made it to the coalition agreement which we have yet to deliver, and yet gay marriage is something which we had no green paper, no white paper, no manifesto commitment of any party, it wasn't in the coalition agreement, and all of a sudden it is taking huge priority, it is going to take up a lot of parliamentary time and is going set MP against MP, and we don't need it."


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Hello to all,Can someone tell me how to move up the navigation background so that it makes contact with the tagline header shown in the picture. Thanks in advance for your help.
Can you provide the code you use?
Hi molona,
I have a couple of questions: Originally I was going to use the header background, tagline background, and navigation background on all the site pages, so I did the above using external css. Now I just want to have the header background, tagline background, and navigation background on just one page, should I use xhtml in the page and If so, what is the code for that? Or, is there a way that I can use the external CSS on just one page. I still need to move up the navigation background. Thanks for your help, it's appreciated.
width: 182px;height:600px;background: #1e90ff url(backgrounds/) no-repeat;
I deleted the external css page because I want to add styling to individual pages. So, I guess that i need the internal css codes for the header background, tagline background and the navigation background. is there a good book on internal css?
For internal css you simply need to add the appropiate tags inside the header element but even if you want to personalize every single page, you'd be better off with external css page (at least, in my opinion). It will still easier to maintain if all the information is in just one place, instead of having to go from page to page making changes (no matter how unique)
Just think that if you decide to change the background in two pages, you'll have to open those two pages and reload them to your live version of the site.
But if you have it in a external css file, you'll do the changes in just one place and re-load just one file.
Obviously, the more changes you do, the greater the benefits
I do need your full HTML and CSS
First, I would like to know if you have a reset
Then, I want to check the padding and margin of the elements
Thanks for pointing out that the external css can still be applied to a single page, I didn't know that. I figured out how to apply the external css to one page only by removing the css links <link href="style1.css" rel="stylesheet" type="/css"/> from the pages that I don't want the backgrounds to apply to. Im sure i will need your help again later but for now i would like to know the following:
So that you can easily see the code for the different backgrounds, I wrote above the background codes: "Below is the tagline code: this is not code" etc...
Thanks again for helping, it's appreciated.
/*CSS for Rons 2 site*/
body {font-family: Verdana, Helvetica, Arial, sans-serif;background-color: #ffffff;
} Below is the tagline code: this is not code
font-style italic;border-top: 3px solid navy;border-bottom: 3px solid navy;padding-top .2e;padding-bottom: .2em;padding-left: .8em;margin: 0;background: #red url(gallery/.jpg) repeat-yright;}
h1 { font-family "Trebuchet MS", Helvetica, Arial, san-serif;font-size: x-large; color: red}
Below is the header background code: this is not code
h1 { font-size: xx-large; color: #white; padding-top: 2em; padding-bottom: .3em; padding-left: .4em; margin: 0; background: url(gallery/wall3.jpg) repeat-y right;
li { font-size: large}
h2 {color: red;font-weight: normal;}
h3 {color: #000000;font-weight: normal;}
p {font-size: medium; color: red;}
ol { font-size: medium; color: #000000;}
Below is the Navigation background code: this is not code
</body> </html>
I would need to see the FULL code to be certain but it's my guess that one of 4 things could be happening. In all of the following I assumed #navigation is a list element
1) you haven't zeroed out the marging on you navigation list. try #navigation { margin:top:0; }2) the parent container of #navigation has padding at the top. Either get rid of the padding, or add #navigation{ margin-top: - the same amount as the padding in the parent container)3) Relative or absolute positioning of #navigation in some OTHER part of the code. But I don't see anything like in what you posted.4) margin-bottom in the element PREVIOUS #navigation or its parent container ( this effect is called margin collapse). do a quick test: add border-top to #navigation's container. if #navigation now touches the border-top of the parent element, but the gap has moved to being between #navigation's container and the element above.. then its the vertical margin of the element previous to #navigation's container that was causing the issue
hope that helps
Hi dresden phoenix,
Thanks for your help. A lot of what you said is over my head, however I tried a couple of your suggestions with out any success. I'm going to read the book again to see if I can get a better understanding. Learning to properly write the code is a bit over whelming to me at this stage, but I'll keep at It. Thank you for taking the time.
Debugg it, should'n be that difficult. where is the url ?
can you explain your question more?
provide me the url of your website


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Senate-Passed Immigration Reform Bill Would Further Militarize Border
After years of polarizing debate and disagreement, the U.S. Senate passed the first "comprehensive" immigration reform bill in decades. The bill received bipartisan support, with 14 Republicans joining Senate Democrats and Independents in a 68-32 vote. But the bill's provision for ramping up border security – and the reason it got conservative support – angered many residents along the border who are tired of militarization in their communities.


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Wednesday, December 12, 2012
Thinking of the day 121212
in quotes
1 comment :
I love comments! Go ahead, leave one and make my day!
Please, do not add links to your website or products on the comment section. Such comments will be marked as spam and be deleted. Thanks.
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Administrator Johnson Statement on President Obama's ESPC Announcement
Adam Elkington (GSA) 202-357-9582
WASHINGTON – U.S. General Services Administrator Martha Johnson released the following statement on President Barack Obama's announcement of nearly $4 billion in combined federal and private sector energy upgrades to buildings over the next two years through the use of Energy Savings Performance Contracting.
"The President's call to action for the private sector and federal government to combine forces in providing $4 billion in energy efficiency upgrades for our nation's buildings -- half of which will improve the efficiency of the federal building portfolio -- represents bold leadership and vision for the future of our nation. Today's announcement is a triple win for our country -- it will create tens of thousands of jobs, save energy and pay for itself.
"GSA continually leads the government in action and can't wait to review our entire owned building portfolio -- comprised of nearly 180 million square feet of space in over 1,500 owned buildings -- to determine how we can best utilize energy savings performance contracts to increase energy efficiency, reduce operating costs and create jobs. As one of the nation's largest lessees of commercial office space, GSA also applauds the private sector commitment announced today which will enhance energy efficiency and reduce operating costs in a number of office buildings nationwide.
"Our agency has extensive experience with ESPCs. Since 1992 nearly $300 million has been invested through ESPCs to improve the efficiency of federal buildings. In fact, we recently challenged energy service companies to bring creative solutions and innovative technologies to the table, which will allow agencies to maximize their investment and achieve the greatest energy savings."
As the federal government's workplace solutions provider, the U.S. General Services Administration works to foster an effective, sustainable and transparent government for the American people. GSA's expertise in government workplace solutions include:
- Effective management of government assets including more than 9,600 government-owned or leased buildings and 215,000 vehicles in the federal fleet, and preservation of historic federal properties;
- Leveraging the government's buying power through responsible acquisition of products and services making up approximately 14 percent of the government's total procurement dollars;
- Providing innovative technology solutions to enhance government efficiency and increase citizen engagement; and,
- Promoting responsible use of federal resources through development of governmentwide policies ranging from federal travel to property and management practices.


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How to Use
the Readings
Inquiry Question
Reading 2: The Americans
Most of the residents in New Hampshire supported independence, though for the men of the Hampshire Grants independence from New York was often at least as important as independence from Great Britain. The farmers from the Grants were among the first to rally to the call to arms when hostilities between the British and the colonists erupted at Concord and Lexington. In 1775, a year before the Declaration of Independence was signed, Ethan Allen and his Green Mountain Boys joined Benedict Arnold and Patriots from Massachusetts in a successful attack on the British at Fort Ticonderoga on Lake Champlain. By June 1777, the newly declared state of Vermont was preparing to select delegates to the Continental Congress. When Burgoyne captured Ticonderoga in July, Vermont appealed to New Hampshire for assistance in stopping the British invasion. John Langdon, presiding officer of the legislature and a rich man, offered critical help:
I have $3000 in hard money; my plate I will pledge for as much more. I have seventy hogsheads of Tobago rum, which shall be sold for the most they will bring. These are at the service of the State. If we succeed, I shall be remunerated; if not, they will be of no use to me. We can raise a brigade; and our friend Stark who so nobly sustained the honor of our arms at Bunker's hill may safely be entrusted with the command, and we will check Burgoyne. ¹
Lt. Gen. John Stark had fought with the Continental Army at Bunker Hill, in Canada, and at the Battle of Trenton, but resigned when he was passed over for promotion. He agreed to take command of the New Hampshire militia on condition that he operate independently, outside the authority of the Continental Congress. Within six days, almost 1500 men signed up. Stark was difficult, but his experience was needed.
At Bennington, Stark commanded approximately 2,200 militiamen who had assembled to oppose Burgoyne's advance. Some 1400 came from New Hampshire, 600 from Vermont, about 40 from New York, and the balance came from Massachusetts and Connecticut. The volunteers were mostly farmers and townspeople. There was no time for lengthy training and no money for uniforms or expensive weapons. The volunteers left their businesses or farms wearing their usual clothes and often carrying their own guns. A British soldier captured at Bennington described the appearance of the colonial militia:
Each had a wooden flask of rum hung on his neck. They were all in bare shirts, had nothing on their bodies but a shirt, vest, long linen trousers which extended to the shoe, no stockings--powder horn, bullet bag, rum flask, and musket.²
The volunteers were unpracticed in military discipline, but Stark knew how to lead them. When the Battle of Bennington began, he calmed his nervous soldiers, facing cannon for the first time, by joking that: "The rascals know I'm an officer; they're firing a salute in my honor." Later, as the battle rose in fury, he is supposed to have told his troops: "There stand the redcoats; today they are ours, or Molly Stark sleeps this night a widow."³
Questions for Reading 2
1. What is meant when it says, "for the men of the Hampshire Grants independence from New York was often at least as important as independence from Great Britain?" If needed, refer to Reading 1.
2. Who were the main groups fighting on the American side? How many men were in each group? Why were they fighting? Who were their leaders? Make a chart comparing the information about American forces to the information presented in Reading 1 about the British forces. Based on this information, which group do you think was better prepared for battle? Explain your answer.
3. Why do you think John Langdon offered to give up so much of his fortune for the Rebel cause? Can you figure out what "plate" is? What do you think he meant when he said his plate would "be of no use to me" if they failed?
4. What qualities made John Stark a good choice to lead the American troops at the Battle of Bennington?
Reading 2 was compiled from Richard Greenwood, "Bennington Battlefield" (Rensselaer County, New York) National Historic Landmark documentation, Washington, D.C.: U. S. Department of the Interior, National Park Service, 1975 and from Philip Lord, Jr., compiler, War Over Walloomscoick: Land Use and Settlement Patterns on the Bennington Battlefield-1777 (Albany: The State Education Department, 1989).
¹"Souvenir Program: One Hundred and Fiftieth Anniversary of the Battle of Bennington" (Wallomsac, NY: State of New York Cooperating with the State of Vermont, 1927), 7.


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I probably don't even need to point out that gas prices have been rising of late. We know that there are certain causes for such a climb, such as refinery issues or a switch to summer blends -- and, of course, part of the price hike relates to crude-oil pricing. One potential question here is: What might happen to consumer spending? Another: Are the Federal Reserve's monetary policies having an effect?
To address the first question, gasoline expenditures account for roughly 5% of consumer spending, in aggregate, based on the Personal Income and Outlays report from the Bureau of Economic Analysis. Gas prices have risen by about $0.28 per gallon since mid-December to reach a national average of $3.53, per the U.S. Energy Information Administration. We can see the recent history below:
If we base our analysis on numbers only and not mood, we can objectively see that gas prices were higher last year than they are now. We can also quantify that the 8% increase here would shave about 0.4% off consumer buying power, given the share of gasoline among aggregate household budgets. At first glance, this might not seem like a tremendous amount, and mathematics might not argue for us to be concerned.
But this ignores the fact that, along with this price hike, consumers have additionally seen their pay decline with the expiration of the payroll tax cut. That was a temporary 2-percentage-point reduction in Social Security withholding taxes, and the end of the tax cut means a 2% take-home pay cut for many households.
The combination of this and higher gas prices could presumably affect consumer confidence. As a result, consumers may potentially cut spending by more than simply a dollar-for-dollar offset of the rise in gas prices and the end of the tax cut. This effect is amplified by the high-frequency nature of gasoline purchases, and the constant reminders of the high price gas prices at every service station. Of course, historically, we've at best seen an imperfect correlation, between consumer confidence and consumer spending. So we cannot make any predictive inferences from any change in consumers' collective mindset.
At this point one might ask, why are petroleum prices rising? Certainly this may be explained by geopolitical tensions, growing economies around the world or a cutback in production by OPEC. But, you might ask, could the Fed's easy money policies also play a role?
Yes, actually, they can, according to researchers from the New York Fed in a recent paper (PDF). The researchers determined that oil prices are responsive to the Fed's asset purchases, as well as changes in the federal funds rate. The researchers believe that the effect on the U.S. dollar is the mechanism by which oil prices respond to Fed actions, or to policy meetings. The researchers posit that the easy money policies cause the dollar to be weaker than it would otherwise be, and that this has made oil more expensive to U.S. consumers.
Because oil is generally priced in dollars, it becomes more expensive when the dollar weakens: Each dollar buys less oil than it would have done had crude been priced in another currency. We can see this inverse relationship between the value of the dollar and oil below:
Because crude oil prices account for 68% of the cost of a gallon of gas, according to the Energy Information Administration, we cannot ignore the Fed's indirect impact on gas prices. The EIA also notes that the other costs of gasoline include refining (8%), marketing and distribution (11%) and taxes (13%).
Of course, the New York Fed researchers note that oil prices also react to U.S. economic data, and not just Fed policy and currencies -- so better economic data may also bring about higher oil prices. Thus, in an odd sort of way, a part of higher petroleum prices might reflect improving economic fundamentals, at home and abroad, including in China. This, in turn may somewhat offset gas-price and consumer worries.


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The AllergyCare 100% Cotton Dust Mite & Allergy Mattress Encasing King provides the ultimate in comfort and 100% complete protection against dust mites and other allergens. The preshrunk all-cotton fabric is soft and comfortable - as close in feel to soft cotton sheets as possible in an allergy barrier fabric. Featuring a lifetime warranty, this is the most comfortable 100% dust mite proof mattress encasing on the market.
The AllergyCare 100% Cotton Advantage:
The revolutionary patented technology in this 100% Cotton fabric is so tightly woven that it does not require a membrane to be highly effective against dust, dust mites, pet dander and other allergen particles. This allows for total breathability with the feel of soft cotton linens and keeps the fabric cool and comfortable while you sleep.
Features and Benefits:
King 78"x80" is Available in 4 Depths:
The 9" deep encasings will cover a mattress up to 9" deep. For mattresses that are between 9" and 12", select the 12" Depth. Mattresses that are between 12" and 16" will need the 16" depth. Mattresses that are between 16" and 18" will need the 18" depth. If you are unsure which depth mattress cover you need, it is always best to get the deeper encasing, as you can always tuck in any extra material underneath the mattress. Please carefully measure the depth of your mattress to determine which depth encasing you should order.
100% Cotton Mattress Encasing King 9" (78"x80"x9")
100% Cotton Mattress Encasing King 12" (78"x80"x12")
100% Cotton Mattress Encasing King 16" (78"x80"x16")
100% Cotton Mattress Encasing King 18" (78"x80"x18")
Product Specifications:
Care Instructions:
Machine wash warm, up to 140° F. Cold rinse.
Tumble dry low, up to 140° F. Can also be hung dry. Cover must be completely dried before use.


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Center bolt for F2 (2-8)
If the lock nut on your Felco 2 is allowed to loosen up, a hard cut can bend or snap the center bolt. Don't let that happen! If it does happen to you, your valued pruner can be saved. Get a new center bolt here. Made in Switzerland.


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Topic: Diabetic and Diagnosed with CC
My Dad was recently diagnosed with Cholangiocarcinoma at the age of 55. He has had Type I Diabetes for 30 years and keeps it under pretty good control with his insulin pump. However, his tumors have grown very quickly and in locations that resection is not an option.
Dad and I are visiting with the oncologist for the 1st time on Friday, Jan 11th. Any ideas for questions to ask? I know that Diabetes can complicate treatments even more. Also, one of his tumors has grown to 6! cm. I suppose I'm wondering if chemotherapy is pointless at this time...
Any hope, ideas?


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Mr. Mack was a lot of things to a lot of people. We all knew him as a mainstay of the Cedar Keys.
His works are all over the Keys; his abilities, many; his heart, stern, though warm.
He leaves a legacy for the archives of the town. You can't help but note the heavy yellow equipment that speckled the land on which he worked, the place he called his shop, to your right on your way out of town.
His living went a long way toward building what we now know as Cedar Key. And his passing leaves a hole, a void, not soon to be filled.
If you currently subscribe or have subscribed in the past to the Cedar Key Beacon, then simply find your account number on your mailing label and enter it below.
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If you are new to the award winning Cedar Key Beacon and wish to get a subscription or simply gain access to our online content then please enter your ZIP code below and continue to setup your account.
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text:
Long Time Follow up After HJ Following Iatrogenic Bile Duct Injuries
This study has been completed.
Odense University Hospital
Aalborg Universitetshospital
Aarhus University Hospital
Herlev Hospital
Rigshospitalet, Denmark
Information provided by (Responsible Party):
Nicolaj Markus Stilling, Odense University Hospital
ClinicalTrials.gov Identifier:
First received: October 2, 2011
Last updated: October 19, 2014
Last verified: October 2014
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Introduction: Bile duct injury (BDI) after cholecystectomy remains a serious complication with major implications for patient outcome. For most major BDIs, the recommended method of repair is a hepaticojejunostomy (HJ). We conducted a retrospective review from 5 Danish hepatobiliary centres aiming to examine the perioperative and the long-term outcome after reconstructive HJ.
|Biliary Strictur After Hepatojejunostomy (HJ). Morbidity and Mortality After and Around HJ
|Study Type:
|Study Design:
|Observational Model: Case-Only
Time Perspective: Retrospective
|Official Title:
|Langtidsopfølgning Efter Kirurgisk Behandling af Iatrogene galdevejslæsioner opstået i Forbindelse Med Cholecystektomi
Further study details as provided by Nicolaj Markus Stilling, Odense University Hospital:
Primary Outcome Measures:
- Stricture of HJ [ Time Frame: days to years ]Stricture of hepaticojejunostomy after reconstruction
|Study Start Date:
|October 2011
|Study Completion Date:
|October 2014
|Primary Completion Date:
|October 2014 (Final data collection date for primary outcome measure)
|Ages Eligible for Study:
|Child, Adult, Senior
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
|Sampling Method:
|Probability Sample
Study Population
All patients with iatrogenic bile duct injury (BDI) after cholecystectomy reconstructed with hepatojejunostomia. Collecting data from 5 Danish tertiary hepato-biliary centres from january 1995 to may 2009.
Inclusion Criteria:
- All patients with iatrogenic Bile duct injury (BDI) after cholecystectomy reconstructed with hepatojejunostomy/choledochojejunostomy.
Exclusion Criteria:
- Patients with non-cholecystectomy-related BDI or with cholecystectomy-related BDI that had been definitively managed by other techniques.
Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.
No Contacts or Locations Provided
No Contacts or Locations Provided
More Information
Keywords provided by Nicolaj Markus Stilling, Odense University Hospital:
ClinicalTrials.gov processed this record on September 21, 2017
|Responsible Party:
|Nicolaj Markus Stilling, Doctor, Odense University Hospital
|ClinicalTrials.gov Identifier:
|NCT01447030 History of Changes
|Other Study ID Numbers:
|Study First Received:
|October 2, 2011
|Last Updated:
|October 19, 2014
Keywords provided by Nicolaj Markus Stilling, Odense University Hospital:
Biliary strictur
Iatrogenic major bile duct injury
ClinicalTrials.gov processed this record on September 21, 2017


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Customer Reviews
3 Item(s)
per page
- Review by ducatifan
- Review by Shashank
I have not dropped my bike, so can't comment on the durability or protection offered by these handguards, but they do look sturdy and I think will do just fine in a unfortunate situation. (Posted on 8/9/2013)
- Review by Thomas
I crashed yesterday hitting the tailgate of a truck with the barkbusters. These kept any of the plastic from breaking. Additionally, my fingers were protected by them. Without the barkbusters, my fingers would have been pinned by the truck. The barkbusters didn't even deform.
Thanks for an awesome product. (Posted on 11/13/2012)
3 Item(s)
per page
Write Your Own Review


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are you kidding me evans?
its over
Two years away...
why why why are we helping from the top of the key!
lowry never finishes, so many points wasted
at least he hit both again
Trust a 27% 3 point shooter to hit two in a row against us.
Honestly, an hour ago I was on Casey's side, but now he can eat shit too.
Two years away...
We are the worst team in the NBA ...just a matter of time until wash passes us and we were supposed to be fighting for a playoff spot?
wow Tyreke with 2 3s Raps are cursed. a 27% 3 pt shooter knocks 2 down back to back...
Why would you foul with 10 left on the shot clock, sigh.
I would trade Bargnani for a 3rd round draft pick at this point.
they released the cousins
Bargnani can't even foul someone successfully...
game was lost as soon as Ed davis was subbed out, what happened to JV?
lowry with the horseshoes
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Phil Mickelson completed perhaps his finest final round on Sunday, charging through the leaders at Muirfield to secure victory at the British Open.
It is Mickelson's first British Open title and the fifth major of his career. It is his first major victory since the Masters in 2010.
MORE: Final leaderboard | Open images | Lefty's sensational finish | Westwood's lament | Scott's downfall |
"This is such an accomplishment. I just never knew if I would be able to develop the shots needed to win," Mickelson told the BBC.
"I played arguably the best round of my career — and putted better than I have ever putted.
"It was such a difficult finish. I was just trying to hit good shots and give myself putts. I putted so good."
Mickelson's celebration began while there were still four groups on the course. He capped his day by sinking a 10-footer at the tough 18th.
As soon as the ball dropped in the cup, Mickelson pumped his fists in triumph, knowing it would be hard for anyone to chase him down. He headed off to hug his wife and children while his caddie broke down in tears.
Three strokes clear of his nearest challenger, Sweden's Henrik Stenson, Mickelson sat in the clubhouse for the long wait as Lee Westwood, Adam Scott and Tiger Woods finished their rounds.
Woods shot a 3-over par 74 and finished five strokes behind Mickelson.
Westwood's dream of becoming the first Briton win with his national title since 1992 ended when he failed to make eagle at the 17th. Scott briefly held the outright lead on the back side, but four consecutive bogeys ended his hopes of a second major title.
Mickelson, 43, was stellar on Sunday, carding six birdies on a course that gave competitors fits. His one bogey was a blemish that others erased with errant tee shots and multiple-putt greens.
Only a miracle could prevent his victory. It appeared the miracle was Mickelson's.
Stenson finished at even par for the tournament and in second place.
Mickelson put up one of the best final rounds in his career in a bid to win the Open. He finished with an impressive 5-under 66. He was 3 under for the tournament.
"I've had some of the best golf I've ever played today," Mickelson told ESPN after he finished his round. "It will be one of the most memorable rounds of golf I've ever played."
It was a magnificent run for Mickelson, who was 1 over on Saturday and entered the final round in eighth place.
His victory vindicated his decision to come to Scotland early and tune up for the event.
Mickelson won the Scottish Open a week before, capturing the title at Inverness in a playoff.
"I don't think there is a better way to get ready for a major championship than playing the week before and getting into contention and coming out on top just gives me more confidence," Mickelson said after his Scottish Open victory.
"But there's a lot of luck involved in The Open. You need some luck with your tee times, you need to play well and have some good bounces.
"This really was valuable (preparation), not only for the things I did well but because I have a few things I need to work on.
"Today was a great day to have this type of weather because the first three days were very benign. I am anticipating this type of weather next week and if we get it, this week is going to be very important."
— Contributing: Associated Press, OmniSport


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Salt Lake City, Utah, U.S.A.
Weekend Herb Blogging #18: Superbowl Sunday
Salt Lake City, Utah, U.S.A.
Sunday, February 05, 2006
Aw, I coulda joined in. I went foraging for -- um -- things. And I came home with California wood sorrel. You can go see my blog, but I failed to (all sing along with me here) JOIN. I'm not a joiner. :(
Two other remarks: Stones at halftime! More awesome than expected. In fact, I expected utter embarassment, but I was impressed.
And: Shiso! Oh, so lovely.
Another great lineup! I look forward to reading each post. Wasn't able to join in this weekend. Hopefully next week.
I'm not into football or the Superbowl but I do like to watch the halftime entertainment, which I forgot to do this time. I was watching the puppybowl on the Animal Planet instead. ;-)
I love WHB. I always learn so much every Monday. Unfortunately, I also always get very hungry after reading the round-up. I've now learnt to have a snack on hand as I read each week's WHB round-up. Thanks Kalyn!ReplyDelete
Cool, The stones. I've seen them trwice live and just love the raw early stuff. And what a legend Keith - prounounced keif- is. Of course, they've probabl;y been doing some pretty strange herbs this w/end.ReplyDelete
Thanks Kalyn. Once again, another fab WHB round-up. So much to read, so much to learn. Glad I could be a part of it.ReplyDelete
Another great roundup, Kalyn! So many interesting things to learn and investigate. : )ReplyDelete
I'm so happy you're taking the time to comment on Kalyn's Kitchen! I love hearing from people who stop by, especially if you're sharing feedback or asking questions about a recipe I've posted here.
I've recently changed my comment settings so people can comment without signing in, but you will need to check the box to show you're a live person, and comments on older posts won't show up until I publish them. Thanks for understanding!
And if you really like the recipe, Pins, Shares, Tweets, and Yums are always appreciated!


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Dakine presents 60 seconds with Victor De Le Rue
Looking for 60 sec well spent? Dakine is glad to provide you with a pleasant short and punch fix of raw action. « 60 sec' with » will instantly bright up your days and get you going till your next chance to go ride.
Victor is our first guest, this upcoming freestyle prodigy comes from a family blessed by snowboarding gods. Try not to blink for 60 sec and press play!


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Topic: New CCA Patients Register On This Web Site (N0v.1-Dec.18,2011)
Hi, every one,
I will go back to work later this week, I may not have as much time as I want now to do things on the Web site along with all of you .
so, this is what I have done since Eli teach me to use the computer wisely.
God bless.
https://docs.google.com/document/d/1ix4 … CNTPk/edit


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Everyone is starting to talk as if losing the last playoff spot and getting the 14th draft pick (because anyone counting on us moving up is dreaming in the same way as anyone still counting on us getting to the Finals) would be a positive event.
Unfortunately, I haven't noticed recent drafts being much deeper than about 5 to 7 for immediate impact players.
I also don't follow college hoops (and certainly national High School hoops) enough to know how deep the draft is likely to be.
So, can someone tell me why a 14th draft pick would be someone other than Yet Another Project?


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A Brief History of the Cigar Industry
War, revolution and regulation have failed to snuff out the continuing story of the cigar.
(continued from page 4)
"I did not think that there was a future in the cigar industry," said Carlos Toraño in 2006, speaking about the state of the cigar industry in the 1980s. His father, grandfather, cousins, uncles—just about everyone with the surname Toraño had worked with cigar tobacco, dating back to Cuba in 1916. But he was happy when his son Charlie chose a new career path, opting to become a lawyer instead of a tobacco man in August 1992.
American cigar consumption was spiraling to all-time lows, having dropped by more than 66 percent between the mid-1960s and early 1990s, according to the U.S. Department of Agriculture. Imports of premium, handmade cigars, which had hovered around the 100 million-unit mark throughout the 1980s, decreased by 2.6 percent between 1990 and 1991, to 103.6 million cigars.
"One of [my relatives] compared the cigar business to the buggy whip business," wrote Stanford Newman about the U.S. cigar industry at that time in his autobiography Cigar Family. "A dying industry with no future."
But Newman, and everyone else in the cigar industry, had no idea that the cigar boom was about to begin, and this centuries-old industry that has weathered all manner of challenges was about to be changed like never before.
We've all heard the tale of Columbus witnessing Cuba's indigenous population twisting up tobacco leaves and enjoying a rustic smoke, and how the explorer brought the raw material back to Europe. Webster's dates the origin of the word "cigar" back to 1730, from the Spanish cigarro, and what we think of as a cigar today—made of filler, binder and wrapper—appeared in the early eighteenth century, according to Tobacco in History and Culture. Spain developed quite the appetite for cigars, one that exceeded its ability to produce them, leading to Spanish investment in its then-colony of Cuba, where cigar production began in earnest.
The population of Havana boomed after the king of Spain declared free trade in 1818 in the country, which remained a Spanish colony until 1898. It was during that period that many of Cuba's famous cigar brands were created. Punch was formed in 1840 by a German, the famous Partagás factory was built in 1845 by Spaniard Jaime Partagás, El Rey del Mundo and Sancho Panza were created by the German Emilio Ohmstedt in 1848 and Hoyo de Monterrey was founded in 1865 by José Gener, a young immigrant from Spain.
One hundred years ago, cigar smoking was quite common, and cigar factories seemed to be everywhere. "The cigar profession commanded a fair amount of prestige at the turn of the century. Cigars were arguably the most popular tobacco product in America," wrote Stanford Newman. "Almost every city in the East and Midwest had at least one small cigar factory." These factories were not necessarily large operations, and many were simply a person in a room rolling cigars.
Newman's father, J. C., began rolling cigars in the barn behind his family's Cleveland home in 1895, creating J. C. Newman Cigar Co., which still exists to this day. At the time, that facility was one of 300 cigar factories in Cleveland, and one of 42,000 in the entire United States.
Wherever they were rolled, all cigars were made entirely by hand until around 1920, when the first cigarmaking machines appeared, and they became more common after the Great Depression. In the meantime, cigarettes came on the scene, as they were included in the mess kits of G.I.s during the First World War, and began edging aside cigars in popularity. By the mid-1920s they had become the nation's most popular form of tobacco.
Cigar sales were largely flat in the 1940s and early 1950s, and most of the cigars made in America (outside of Florida) were being made by machine. On the premium end of the cigar business, Americans had a great appreciation for Cuban tobacco, almost all of it rolled in Tampa, Florida, into cigars that were known as Clear Havanas. And they were inexpensive. Arturo Fuente sold a diminutive size known as a Breva for 10 cents apiece at the time. "Pre-embargo, most cigars in the United States that were considered premium were a quarter," said longtime cigar industry veteran Sherwin Seltzer in a 1998 Cigar Insider interview. Imported Havanas, a small part of the business, cigars reserved for the extremely well-off, could be had for those willing to spend about 65 cents.
Fidel Castro's rise to power in Cuba in the late 1950s would forever change the world of cigars. In 1960, Castro seized control of Cuba's cigar and tobacco industry, and his regime plucked the country's cigar gems: it nationalized the Hoyo de Monterrey factory, home of Punch, Belinda and the Hoyo brand; seized the H. Upmann factory from owners Menendez and Garcia, taking with it Cuba's famous Montecristo and H. Upmann brands; and grabbed the emblematic Partagás Factory from owner Ramón Cifuentes. "They came inside, and said, 'We're here to intervene the company,' " Cifuentes told Cigar Aficionado in an interview. "And they didn't allow me to take anything."
The nationalization of Cuba's cigar industry led to the exile of many of its famed tobacco and cigar men, which led to the rise of the non-Cuban cigar industry. When U.S. President John F. Kennedy signed an embargo prohibiting nearly all trade between Cuba and the United States in 1962, it forced cigarmakers to reinvent their blends. Cuban leaf, the lifeblood of the cigar industry, was now off-limits to American smokers.
"When we got the embargo, we bought tobacco left and right by telephone," said Alfons Mayer in 2002. Mayer, who died in 2006, spent years as the main tobacco buyer for General Cigar Co. "We were buying Puerto Rican, Dominican, Colombian, people went to Brazil, we went all over Honduras, our native tobaccos here [in the United States], we used some Java, some air cured, we made blends, blends, blends. People went to different areas to try and grow tobacco. There was a lot of trial and error."
Cuba's exiled cigarmakers traveled far and wide searching for new places to roll. The Menendez family went to the Canary Islands to make cigars, and soon launched Montecruz, a copy of the Montecristo brand it had lost in Cuba. General Cigar turned to Jamaica, where cigarmaking had been a big business during the Second World War. General acquired the Temple Hall Factory in 1969, which included a then-unknown brand named Macanudo, destined to become the best-selling premium cigar in the United States for many years.
Many of Cuba's exiled cigarmakers made deals with American cigar companies to license or sell their cigar brand names, resulting in non-Cuban versions of Partagás, Punch, H. Upmann, Hoyo de Monterrey, Montecristo and other cigars strictly sold in the United States. The landmark 1972 lawsuit Menendez v. Faber, Coe & Gregg established a legal precedent in which the rights of the owners to sell their non-Cuban versions were upheld by American law.
Tobacco seeds were brought around the world, and propagated in various countries. French tobacco monopoly SEITA established plantations in Cameroon in western Africa in the late 1950s. The rich, toothy wrapper became an industry favorite, and the Meerapfel family saved it from extinction after the French left Africa in the early 1960s. At that time tobacco pioneers had success planting Cuban seeds in Honduras. In 1967, Carlos Toraño Sr. brought Cuban seeds to the Dominican Republic, a nation just removed from civil war, and helped improve the quality of the country's tobacco, which was mostly grown for cigarettes at the time.
With Dominican Republic cigars currently ubiquitous, it may be hard for a modern-day cigar lover to believe that 40 years ago the Dominican Republic made very few cigars for export. In the 1970s, most of the imported cigars enjoyed in the United States were rolled in the Canary Islands, Jamaica and Mexico, and America still made a large number of cigars. In the early 1970s, free-trade zones opened in the Dominican Republic. Conglomerate Gulf + Western, then the owner of Consolidated Cigar Corp., a company that later became Altadis U.S.A. Inc., began processing tobacco in La Romana in 1969 and started rolling cigars there in 1972.
In 1974 a free-trade zone opened in Santiago, and Manufactura de Tabacos S.A., known as MATASA, soon set up shop. Its owner, Manuel Quesada, explained in a 2004 interview in Cigar Aficionado: "In Miami, the cigarmakers that had come out of Cuba were getting older, and with the Social Security a lot of them had to be paid under the table and it started to become a hassle. The free zones had just started in the Dominican Republic. So it was a good idea to transfer production from Miami to the Dominican Republic."
By the mid-1980s, the Dominican Republic was a hot spot for making cigars. In the 1990s, it became the center of the cigar universe.
Imports of premium, handmade cigars began to climb towards the end of 1992—soon after Cigar Aficionado magazine appeared in September of that year. The American cigar market was turned on its head, and would go through a period of unimaginable growth. Premium cigar imports rose by 3.7 percent in 1992, 9.7 percent in 1993, 12.4 percent in 1994, 33.1 percent in 1995 and soared 66.7 percent in 1996, to more than 293 million cigars. Between 1992 and 1996, the market for fine cigars nearly tripled.
"I went back to look at our financials dating back to 1992, and I will honestly tell you that, based on our sales increases beginning in 1993, I would have had no problem guessing the year [the magazine] started," says John Oliva Sr., the head of Oliva Tobacco Co., one of the cigar world's leading names in growing and brokering cigar tobacco. "It was, in my opinion, Cigar Aficionado that kick-started the boom."
Once-sleepy smoke shops became jammed with customers. Incoming orders of cigars would sometimes be stacked in piles on the floor, never making it to the walk-in humidor. Kansas City retailer Curt Diebel, whose boom-time business doubled each month for a time, went as far as to install a secret spot in his humidor to hide his stock, in fear that new customers would walk in and buy everything he had. "I spent my time on the phone trying to convince the vendors to give me product," says Diebel. "Then I had to allocate my product for my [regular] customers. We got tired of having strangers come in and saying 'I'll take all of them.' "
In Miami, Ernesto Perez-Carrillo's La Gloria Cubana brand—heralded in the third issue of Cigar Aficionado with several 90-point scores for $2 cigars—suddenly had the hottest thing in the cigar world, and found himself completely submerged in new orders. His sales rocketed from 700,000 cigars in 1992 to 3.3 million in 1996, and then nearly doubled to 6.1 million the following year.
Antismoking regulations in the United States were still in their infancy during the cigar boom, and restaurateurs eagerly welcomed the cigar lovers. Cigar bars opened, cigar dinners flourished, and Cigar Aficionado's Big Smokes brought cigar lovers out en masse.
Cigar shops expanded and new ones opened. As traditional cigar companies tried to expand their operations, newcomers flocked to the cigar industry, creating brand after brand after brand. People dug old cigars out of humidors (and basements) hoping to cash in at auction. The average price for a box of pre-embargo Cuban cigars sold at Christie's soared from less than $500 in 1992 to nearly $2,500 in mid-1996.
Cigar lovers were not only buying more cigars, but they had radically changed their buying habits. Before 1992, said Robert Levin, retailer and owner of the Ashton brand, "people would be brand loyal, come in once a week for a box of cigars. Now they come in with the ratings, and they want to buy a bunch of different brands." The sale of singles quickly replaced the box sale.
The most popular cigars of the early 1990s were often made of mild, Dominican filler, wrapped with mild leaves of Connecticut-shade. Cigarmakers, emboldened by the increased sales, made more flavorful blends. The late 1995 release of the Fuente Fuente OpusX helped spark a trend toward more powerful, spicy smokes. Cuban-seed tobaccos and Ecuadoran Sumatra wrappers became increasingly popular, and cigar smokers learned the term "ligero," describing the strongest variety of filler tobacco. The 1994 release of the ultrarich Padrón 1964 Anniversary Series, made entirely with Cuban-seed tobaccos, ignited a trend toward box-pressed cigars, which had been almost entirely absent from the U.S. market.
As cigar sales grew, so did the girth (measured in ring gauge) of the most-popular smokes. One retailer said that in 1990, almost 80 percent of his sales came from the very slim lonsdales and coronas sizes. By 1996, most of his sales came from fat robustos and corona gordas. The first edition of Cigar Aficionado magazine rated 17 robustos, the fattest of which had a ring gauge of 52. The Diamond Crown brand, a line consisting entirely of 54-ring gauge cigars, made news in 1995 when it was launched—as 54s were considered quite thick in those days. Today, a ring gauge of 60 characterizes one of the most popular sizes in American smoke shops.
The effects of the cigar boom reached Cuba as well. Consumers flocked to Cuban cigar stores and bought every cigar they could find. On a trip to Havana in early 1996, the Cigar Aficionado editors visited nine cigar shops and couldn't find a double corona, Montecristo No. 2 or Partagás Serie D No. 4. Cuba, which had produced fewer than 60 million export-quality cigars in 1993 and 1994, vastly increased its production. Cuban cigar exports reached 100 million units in 1997, and officials announced the long-term goal of increasing further to 200 million cigars by the year 2000.
In November 1996, Cuba launched the Cuaba brand, the first new brand from the island in nearly 30 years. That was soon followed by such creations as Vegas Robaina, Trinidad and San Cristobal de la Habana. Cuba opened new cigar factories and vastly increased plantings of tobacco. Alas, the mandate to pump out cigars at such a rate resulted in a rash of inferior product.
Wall Street soon took an interest in cigars, and six cigar companies went public in 1996. Newcomer Caribbean Cigar Co. became the first stand-alone public cigar company with its August 1, 1996 initial public offering. Sixteen days later, high-profile financier Ronald Perelman took his Consolidated Cigar Holdings public for $23 a share. Machine-made giant Swisher International Group Inc., the cigar retailers JR and Holts, and even a one-year-old company named Tamboril soon followed suit.
By 1995, more than 25 million cigars were on back order, and in 1996, that number was more than 50 million. Cigar brands such as Arturo Fuente and La Gloria Cubana became impossible to find. For six weeks of the summer of 1996, General Cigar didn't ship a single Macanudo cigar, the best-selling premium cigar in the United States at the time. "We were using tobacco so rapidly we got caught. We didn't have enough in the aging blend," said then-company president Austin T. McNamara.
The influx of boom-time smokes often meant substandard product. The April 1997 Cigar Insider had ratings for 50 cigars and, for the first time since publication began in January 1996, not one scored 90 points or more. Low ratings abounded, with a trio of 83s and one of the most expensive cigars in the issue—a $6.25 effort from a Canary Islands brand called Goya—scored 82 points.
The influx of boom-time smokes often meant substandard product. The April 1997 Cigar Insider had ratings for 50 cigars and, for the first time since publication began in January 1996, not one scored 90 points or more. Low ratings abounded, with a trio of 83s and one of the most expensive cigars in the issue—a $6.25 effort from a Canary Islands brand called Goya—scored 82 points.
Newcomers arrived in droves, cash in tow, in Honduras, Nicaragua and especially the Dominican Republic, hoping to make a quick profit on the boom. New factories appeared across the Dominican Republic, hiring away talented cigarmakers. Some factories ran double shifts to keep up with demand, and it became a battle to find tobacco, cellophane, cedar boxes—everything used to make a premium cigar. Tobacco companies planted seeds in such unlikely places as Peru, Colombia, Panama, even Canada, and cigar factories opened in Indonesia, Ecuador and elsewhere. The once enemic industry tradeshow expanded from a few dozen booths to hundreds, and some enterprising attendees went so far as to sell their badges to those hoping to get inside. There were more than a few quirky market launches, among them cigar vending machines (created by two separate companies in 1997) and a line of cigars aimed at female cigar lovers called Cleopatra, which never quite got out of the planning stages.
Cigar sales had grown at an untenable pace. It was 1997 when the cigar industry started to catch up to the demand for cigars. The established companies began filling all the back orders for traditional cigar brands, a number that turned out to be inflated as cigar retailers had over-ordered through the boom, asking for 10 boxes, say, in hopes of receiving five. As the old-time brand names filled up the distribution chain, most of the newcomers found themselves in a pinch.
When the big-name brands caught up with demand, many of the cigars without pedigree no longer interested cigar lovers. By 1998, the discount retailers were buying up unwanted cigars from new manufacturers who suddenly found themselves without customers. Mark Goldman of House of Oxford Distributors set up a table in the Gran Almirante Hotel in Santiago in 1998 and bought cigars that had once retailed for $200 a box for as little as $7. "Basically, we've been buying cigars for less than it costs to make them," he said at the time.
Comments1 comment(s)
Doc Diaz December 4, 2012 1:51am ET
This was a very enlightening article. An excellent summary, however I am surprised you did not mention the first cigar "boom" in 1964, which was the first real resurgence of cigars since the Golden Age of cigars, which peaked in the early 1900s and started to decline around 1920.
The first boom, in 1964, was related to a number of factors (which I have written about elsewhere) and was helped along, ironically, by the Surgeon General's first-ever report on Smoking & Health. This report claimed that, "men smoking less than five cigars per day have death rates about the same as non-smokers." This provided a scientific halo-effect for cigars that enhanced that short-lived yet significant cigar boom in the mid-1960s.
The first boom, in 1964, was related to a number of factors (which I have written about elsewhere) and was helped along, ironically, by the Surgeon General's first-ever report on Smoking & Health. This report claimed that, "men smoking less than five cigars per day have death rates about the same as non-smokers." This provided a scientific halo-effect for cigars that enhanced that short-lived yet significant cigar boom in the mid-1960s.
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We've just had occasion to change the way part of Palomar's Blackboard Learn system functions, so I wanted to explain why the system is behaving the way it now is.
If you've posted an Announcement in the new Blackboard system, you've likely seen that check box for "Override User Notification Settings" where previous versions had a "Send Email" box. (I don't propose to go into the reasons for that change; if you're curious then feel free to get in touch with me via email.) If you check that box, when you post your announcement in the course a notice gets sent to all your students telling them that there is an announcement in your course they should look at. If you do not check that box, students would not receive such a notice.
Woah, "would not"? Is that what changed?
Yes. The new behavior in our Blackboard system is for students to receive a nightly notice (called a Digest Notification, sent around 11 PM) about ALL announcements made in their courses.
Functionally what this means is if you post five announcements during the day, but only one of them you check the "Override User Notification Settings" box, your students would receive two notices. One would be about just the announcement where you checked the box which would go out immediately, the other would be about the rest sent near the end of the day.
I could go into a long-winded explanation about exactly why we had to change the system behavior, (short answer: to work around a bug) but I'll spare everyone that confusion. Bottom line, more notices are now going out to students about announcements than ever before.


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"If you don't know where you're going, any road will get you there." That statement has clear application in any business and shows the management team if they are moving towards or away from their goals.
In animal husbandry, this concept and its interpretation can apply to every area of your dairy. However, it's especially critical when dealing with reproduction, since it becomes the driving force of the dairy operation. No pregnancies = no milk. It's that simple.
Record keeping is an essential starting point for a sound reproduction program. However if you don't use the information properly, record keeping alone is useless. Comparing where you started to your current reproductive outcomes and goals and then making adjustments to your projections will help your dairy's bottom line the most.
Where to Start
First, determine some key indicators of reproduction success to compare to your dairy. Such indicators may be services per conception (or conception rate), heat detection rate, pregnancy rate, distribution of days in milk (DIM) to first insemination, fertility to first insemination, interval from calving to conception or calving interval. These indicators can be obtained from your farm cow cards, computer software or from your testing center if you are on official test.
There are many other reproduction parameters that can be useful in your analysis, but those listed above are the most important for an initial diagnostic evaluation. In any case, the Accelerated Genetics ReproAnalysis team can help you identify the right numbers.
Once your reproduction parameters have been determined, you need to identify all the management situations around your reproduction program (facilities, cleanliness, breed, nutrition, personnel, etc.) that may explain the results you are getting today (good or bad). Identifying your actual results and your weak points in the program is necessary to set realistic goals and optimize your future results. Accelerated Genetics' ReproAnalysis team members can help you design a plan of achievable goals after performing a diagnostic evaluation.
Setting Goals
There are many reproduction parameters that consultants, veterinarians and producers can track, and they are all important under specific circumstances. No matter whether you get good or bad results from the evaluation, you need to set goals so you can track your progress over time.
Some important goals should include voluntary waiting period parameters, number of cows inseminated per week (unless you are seasonal breeder) and number of pregnancies achieved per week, month or 21-day period (pregnancy rate).
If you found areas of low performance in your program, you need to identify those weak points and design a plan to improve results. The goal set in this plan needs to follow the "SMART" criteria: Specific, Measurable, Achievable, Realistic and Time-framed. Also, you need to have a responsible person in charge and have a periodical evaluation of each goal.
Feeding your computer with data and doing periodical records analysis are two completely different exercises. Often, dairy producers with acceptable record keeping system feel comfortable with their reproduction results based on a few good vet checks. Unfortunately, they don't know how other factors on their dairies, such as seasonal effects, recent nutritional changes, changes in labor, are affecting their reproduction.
Having a good reproduction analysis today does not immediately guarantee that a dairy will be in a good position six months down the road. Instead, periodical reproduction evaluations, about two or three times a year, should be part of a regular dairy reproduction management program.
The ReproAnalysis team from Accelerated Genetics can work with your consulting team and/or herd veterinarian to guide you through the entire reproduction analysis process, from the very beginning of a diagnostic situation to setting goals, training, and designing a plan to monitoring the results and keeping your dairy profitable. Contact your Accelerated Genetics representative for more information on ReproAnalysis.
The example above shows a 500-cow herd with a 30 percent culling rate, 6 percent abortion rate, a calving interval goal of 13 months and an actual conception rate of 30 percent. With this information, you can use the simple equation on top to determine your herd goals. If the problem identified was low heat detection, you need to technically train one person to be responsible for achieving a goal for 97 cows inseminated per month, or about 25 per week, to achieve your goal.
Source: Dr. Humberto Rivera, Reproduction Specialist, Accelerated Genetics


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Handsome Dan's Stand is tucked inside Williamsburg's Mini Mall on 5th Street and Bedford. Snocones are $4 apiece, and come in flavors like Strawberry, Chocolate Milk, Passion Fruit and Double Berry. Though the creamy chocolate milk comes in as a close second, the Earl Grey Cream is my favorite, coupling a liberal pour of housemade earl grey tea syrup with condensed milk drizzled over the top. It's a grown-up sort of snocone, the syrup more about that smoky, bergamot flavor than sweetness and ice fine and fluffy, clumping together only at the very end.
Handsome Dan's Stand
218 Bedford Avenue (inside the Mini-Mall), Brooklyn, New York 11249 (map)
About the author: Originally from Honolulu, Kathy YL Chan blogs at Kathy YL Chan, where she chronicles her eats and travel adventures between Hawai'i, New York and beyond. She firmly believes that there is always room for dessert.