text:
- Research article
- Open Access
- Open Peer Review
Reduction in deep sternal wound infection with use of a peristernal cable-tie closure system: a retrospective case series
- Meghan M. Stelly1,
- Charles B. Rodning2 and
- Terry C. Stelly3Email author
© Stelly et al. 2015
- Received: 12 October 2015
- Accepted: 8 November 2015
- Published: 14 November 2015
Deep sternal wound infections are a rare but serious complication after median sternotomy. We evaluated the incidence of deep sternal wound infection associated with two techniques for sternal closure.
In this retrospective case series, we recorded the method of sternal closure in consecutive patients undergoing a variety of cardiothoracic surgical procedures. Sternal closure in the historical control group was performed using trans-sternal, stainless-steel wire sutures; subsequent patients were closed using wire sutures in conjunction with a novel, peristernal cable-tie closure system to reinforce the corpus sterni. Perioperative care was standardized between groups. Demographics, risk factors, and postoperative outcomes were analyzed.
Between July 2010 and July 2014, 609 consecutive adult patients underwent sternal closure following open median sternotomy at a single hospital in Mobile, Alabama. Sternal closure was accomplished with wire sutures in the first 309 patients and with cable-tie reinforcement in the subsequent 300 patients. Baseline characteristics were comparable between groups, except that the cable-tie group exhibited greater preoperative comorbidity. Mean body mass index was comparable between groups (30.2 ± 6.6 kg/m2 wire suture versus 30.5 ± 7.7 cable-tie, p = 0.568). Deep sternal wound infection occurred in 2.6 % (8/309) patients in the wire-suture group, whereas no deep sternal wound infections were observed in the cable tie group (p = 0.008).
The peristernal cable-tie system was a simple and reliable method for sternal closure after open median sternotomy, and was associated with a reduced risk of deep sternal wound infection, even in an obese and comorbid population.
- Sternum
- Infection
- Sternum
- Surgery
- Devices
- Surgical equipment
Despite the increasing use of minimally invasive approaches, the majority of cardiac operations are still performed by way of a median sternotomy [1]. In our practice, this is the most common operative approach for adult cardiac procedures because it is easily and expeditiously performed and provides excellent exposure.
Although post-sternotomy complications are rare, the occurrence of a deep sternal wound infection (DSWI) can be catastrophic, with reported mortality rates between 19 and 29 % [2]. Despite modern prophylactic measures, the reported incidence of DSWI persists at between 0.8 and 6.0 % [3–8].
DSWI is associated with multiple risk factors, including obesity, pulmonary disease, diabetes mellitus, renal failure, advanced age, malnutrition, osteoporosis, and bilateral internal thoracic arterial harvest [3, 6, 9–15]. Postoperative complications, such as the low cardiac output syndrome, respiratory failure, and re-exploration for postoperative hemorrhage, have also been shown to contribute to higher incidence of DSWI [16–19]. Effective strategies for reducing the risk of DSWI include appropriately timed and dosed administration of intravenous antibiotic medications, optimal aseptic/antiseptic skin preparation, avoidance of shaving, and intranasal administration of mupricion [10, 20–22]. Intensive perioperative glucose control has also been proposed to decrease DSWI in patients undergoing coronary artery bypass (CABG) procedures, although the precise targets and appropriate subpopulations remain a matter of debate [13].
Another potential risk factor for DSWI is sternal wound instability, which has been reported to compromise wound integrity and predispose patients to infection [23–25]. However, the relationship between this instability, DSWI, and emerging methods for sternal closure after median sternotomy remains to be explored.
Our practice has historically relied on the placement of a series of parasternal stainless steel wire sutures to coapt the sternum at multiple points from the manubrium sterni to the most caudal portion of the corpus sterni. In 2012, we adopted the use of a novel, polyether ether ketone (PEEK) based, parasternal cable-tie closure system to replace the wire-suture closure at the corpus sterni. This portion of the sternum has been shown to be more fragile and more subject to potentially disruptive forces during patient recovery than the more cephalad portions of the sternum [1]. We hypothesized that the presence of the wide cable ties would help to stabilize the corpus sterni during healing, reducing the risk of DSWI. The present retrospective chart review was designed to determine whether the change in our technique affected the incidence of DSWI in our practice.
The protocol for this retrospective chart review was approved by the institutional review board at Springhill Medical Center (Mobile, Alabama). Individual informed consent was waived.
Patients and data collection
Hospital and office charts were reviewed for all consecutive adult patients who underwent sternal closure after primary or repeat median sternotomy for cardiothoracic procedures at Springhill Medical Center during the study period. Data regarding demographics, risk factors, intraoperative variables, sternal closure method, and postoperative outcomes were recorded.
Patient preparation and perioperative antibiotic medications
All patients received a shower with 2 % chlorhexidine gluconate (CareFusion Corporation, San Diego, CA), along with 2 % mupirocin ointment to both nostrils, on the evening prior to and the morning of the operation. Removal of excess hair from sternum, groin, and bilateral hind limbs (circumferential) was performed with clippers in the operating room. Chlorhexidine gluconate (2 % in 70 % isopropyl alcohol; ChloraPrep, CareFusion Corporation) was applied topically as a skin disinfectant. Bio drapes (Medline Industries, Inc., Mundelein, IL) and disposable paper drapes were then applied sequentially.
All patients received perioperative antibiotic medications according to the following protocol: All patients received intravenous cefazolin timed to be completed 30 minutes prior to skin incision (2.0 g for less than 80 kg body weight, 3.0 g for 60 to 109 kg, and 3.5 g for 110 to 124 kg, 4.0 g for greater than 124 kg.) An additional 1.0 gram was given just prior to initiation of cardiopulmonary bypass, and one half the loading dose was given every 3 hours thereafter while on bypass. Off-pump cases or bypass cases lasting less than 3 hours did not receive additional antibiotic. In the case of penicillin allergy, patients with preoperative hospital stays of greater than 3 days or patients undergoing valve procedures received a weight-based intravenous vancomycin protocol (1.0 g for less than 80 kg body weight, 1.25 g for 80 to 99 kg, 1.5 g for 100 or more kg) with gentamycin (4.0 mg/kg) single dose, timed to be completed 30 min prior to skin incision. If surgery was delayed for more than 2 hours, an additional single dose of levofloxacin (500 mg) was administered. Patients were re-dosed with one half the original Vancomycin dose at cessation of bypass. Mupirocin was administered to the nares of all patients before leaving the operating room.
Surgical technique
Postoperative follow-up and diagnosis of DSWI
Postoperative care was according to each patient's primary indication for surgery. After discharge all patients returned for follow-up at 2 weeks, 2 months, and quarterly thereafter. DSWI was diagnosed according to US Centers for Disease Control and Prevention criteria [21]. Any patient exhibiting symptoms of DSWI underwent computed tomography imaging of the chest and plastic surgery consultation. The wounds were managed by formal sternal debridement and placement of a negative pressure therapy device (V.A.C, KCI, Inc, San Antonio, TX), with subsequent muscle flap closure once the septic process was controlled.
Data analysis
Body mass index was calculated from height to weight data. Patient data were analyzed using SAS software, version 9.2.2. Data are expressed as mean ± standard deviation, n/N (%), or median (minimum-maximum) unless otherwise noted. Significance testing was performed by an independent biostatistician, using a Two-Sample T-test for comparisons between groups (continuous data), either a Chi-square test or a Fisher's exact test for homogeneity between groups (categorical data), or Wilcoxon Rank-Sum test when median (range) was presented. Alpha was defined as 0.05 for all tests. The primary outcome for this study was the incidence of DSWI in the two groups, and the null hypothesis was that no difference would be observed.
Between July 2010 and July 2014, sternal incisions were performed on 611 patients at Springhill Medical Center in Mobile, Alabama. Two patients who died intraoperatively were not closed and were therefore excluded from the analysis. A total of 309 patients were closed with the wire suture technique and served as the historical control group, and 300 were closed with the cable-tie system. One of the authors (TCS) performed 71.8 % (222/309) of the wire suture procedures and 92.7 % (278/300) of the cable-tie procedures; the others were performed by a single other partner in his practice. No patients were lost to follow-up. Follow-up evaluation ranged from 21 days to 4 years 5 months, with a median follow-up of 26.6 months.
Summary of baseline and preoperative characteristics for 609 patients undergoing standard median sternotomya
Total population (N = 609)
Standard wire suture (N = 309)
Cable-tie closure (N = 300)
p value
Age, y
64.8 ± 11.4
64.3 ± 10.8
65.3 ± 11.9
BMI, kg/m2
30.4 ± 7.2
30.2 ± 6.6
30.5 ± 7.7
Sex, male
385 (63.2)
205 (66.3)
180 (60.0)
Risk factors
228 (37.4)
107 (34.6)
121 (40.3)
118 (19.4)
49 (15.9)
69 (23.0)
505 (82.9)
253 (81.9)
252 (84.0)
Smoking history
326 (53.5)
162 (52.4)
164 (54.7)
162 (26.6)
61 (19.7)
101 (33.7)
92 (15.1)
34 (11.0)
58 (19.3)
8 (1.3)
2 (0.6)
6 (2.0)
Renal disease
95 (15.6)
44 (14.2)
51 (17.0)
4 (0.7)
2 (0.6)
2 (0.7)
80 (13.1)
33 (10.7)
47 (15.7)
Intraoperative variables for 609 patients undergoing standard median sternotomya
Total population (N = 609)
Standard wire suture (N = 309)
Cable-tie closure (N = 300)
p value
481 (79.0)
220 (71.2)
261 (87.0)
11 (1.8)
10 (3.2)
1 (0.3)
117 (19.2)
79 (25.6)
38 (12.7)
CPB time, min
70.1 (37.3)
69.6 (38.5)
70.7 (36.1)
Operative time, min
226.8 (56.6)
224.2 (56.3)
229.4 (56.8)
10 (1.6)
3 (1.0)
7 (2.3)
Deep sternal wound infections
The incidence of DSWI in the historical control group was 2.6 % (8 of 309 patients). No DSWI was observed in the experimental group (p = 0.008).
Secondary outcomes and adverse events
Secondary outcomes and adverse events in 609 patients after sternal closure with standard wire suture or cable-tie systema
Total population (N = 609)
Standard wire suture (N = 309)
Cable-tie closure (N = 300)
p value
Sternal dehiscence
8 (1.3)
7 (2.3)
1 (0.3)
Return to operating room
71 (11.7)
41 (13.3)
30 (10.0)
Re-exploration for bleeding
26 (4.3)
13 (4.2)
13 (4.3)
14 (2.3)
9 (2.9)
5 (1.7)
Perioperative MI
2 (0.3)
2 (0.6)
0 (0.0)
Postoperative blood loss, first 18 hours, L
0.77 (0–7.6)
0.76 (80–7.3)
0.81 (0–7.6)
Superficial sternal wound infection
17 (2.8)
12 (3.9)
5 (1.7)
Ventilation time, days
1 (0–70)
1 (0–30)
1 (0–70)
Length of ICU stay, days
2 (0–57)
2 (0–39)
3 (0–57)
Length of hospital stay, days
8 (1–73)
8 (1–54)
8 (3–73)
Devices that provide rigid or otherwise secure osseous and soft-tissue coaptation and fixation have been shown to promote earlier union and primary healing [26]. These are especially important in the caudal half of the corpus sterni, where physiologic forces have been shown to distract disproportionately. Using human cadavers, McGregor and colleagues observed that intrapleural pressure can exceed 300 mmHg during a cough [1], meaning that a force of 150 N (150 kg-m/s2) could routinely be experienced across the sternum during normal physiologic conditions. Divided evenly across the standard 6 twisted stainless steel monofilament wire suture closure, this force exceeds the 20 to 22 N associated with wire fatigue, fracture, loosening, or cutting into sternal bone. They also observed that the caudal end of the corpus sterni was most vulnerable, as it was thinner than the manubrium sterni and lacked clavicular support.
The ideal material for sternal closure and fixation would be simple, inexpensive, reproducible, durable, would provide adequate support to the caudal portion of the corpus sterni, and would allow for rapid reentry in the event of emergent re-exploration. While many techniques for sternal fixation have been tried, each has had its limitations, and stainless steel monofilament wire suture remains the current standard of care. For example, rigid-plate fixation has been demonstrated to be structurally superior to wire suture closure, but adds operative time and costs and is problematic during emergent re-entry [26, 27]. Wider configurations of various suture materials have also been tried, based on the hypothesis that a larger suture surface area would allow more favorable distribution of distracting forces and better stabilization compared to wires. Polyethylene terephthalate ribbon, jacketed steel wires, and steel bands have been tried but have not been widely adopted, possibly because of the complexity of application [16, 19, 28, 29]. Nylon bands are associated with an increased incidence of DSWI [30, 31].
The PEEK-based cable ties used in the present study are wider than monofilament wire suture (4.2 mm versus 0.7 mm) and may provide additional support by providing a larger surface area for osseous contact. We found the ties to be simple to deploy and their cost was relatively inexpensive at less than $100 per tie.
In a retrospective, non-inferiority study of sternal closure in 680 patients, the reported incidence of DSWI was 6 % in the total population, and was comparable in both the cable-tie and standard-of-care groups (n = 95 and 498, respectively) [32, 33]. While the results showed that the cable tie system adequately stabilized the sternum, the study was not designed or adequately powered to determine superiority. Our study, while not a prospective, randomized trial, does include more balanced distribution of patient groups and was designed to reduce the potentially confounding selection bias that limited the previous studies.
It is of interest to note that our results found lower incidence of DSWI in the cable-tie group, even though both groups had similar BMI scores that were high compared to the national average. Obesity is known to increase the risk of postoperative wound infections, although the exact mechanisms are not well understood and may include hypovascularity of adipose tissue, decreased oxygen tension, compromised collagenization, compromised immunity, oxidative stress, and adiponectin deficiency [34–38]. The cable-tie group was also generally a more comorbid population, which might have been expected to predispose them to DSWI.
This study was limited by its retrospective design and the potential for a time effect since the control group was operated on first. Follow-up times were relatively short for some patients in the cable tie group, but it should be noted that DSWI typically manifests within 2 weeks postoperatively and this is well within the minimum follow-up time reported. Additionally, since wire sutures and cable ties were used together, we are unable to draw conclusions about the efficacy and safety of the cable ties as a standalone method for sternal fixation.
We conclude that the cable-tie closure system, when used in conjunction with wire sutures, is a simple and reliable method for coapting the corpus sterni after median sternotomy. Our results also suggest that use of the cable ties for this purpose may reduce the risk of DSWI compared to wire sutures alone.
An educational grant from DePuy Synthes CMF (West Chester, PA) funded the costs of data collection, statistical analysis, and manuscript preparation. The authors thank Amy Hendrix RN and Melissa Vandenberg, PA-C for assistance with data collection; Mark Jaros PhD (Summit Analytical, Denver, CO) for biostatistical analysis; and Jeanne McAdara-Berkowitz PhD (Biolexica, Longmont, CO) for editorial assistance.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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text:
As author Melody Beattie said, "The new year stands before us, like a chapter in a book, waiting to be written."The chapter we write in 2016 will define both Ohio's and the nation's political landscape for years to come.
Here's what is on the horizon:
A right-to-work case that has worked it's way to the U.S. Supreme court is set to overturn 40-years of settled law to create a national right-to-work law.
A worrying, silly, yet savage presidential campaign where candidates are seriously calling into question America's core values.
The fight to take back local control of Ohio's public schools hi-jacking in the legislature which enabled the take-over of Youngstown's city school system
And last, but not least, a homegrown right-to-work bill in the Ohio Legislature set to back-door Ohio's labor movement in the last hours of a lame-duck legislature.
These challenges are serious, but AFSCME has a plan – AFSCME Strong – that is already in action, and we are not without friends.
But the best plan and the staunchest allies can't win the battle for us – that is up to each AFSCME Ohio Council 8 member.
Our new year's resolution must be to remain engaged and mobilized in our workplace and in our communities.
Despite tremendous odds, our unity and solidarity continue to win the fight for working families everyday. We had a good local election cycle where we elected friends in Toledo, Dayton, and Columbus. We've passed many vital funding issues across the state, and we're now seeing more 2,2 and 3 percent contract settlements.
On behalf of Ohio Council 8's officers, board members and staff – we wish you and your families all a happy and prosperous new year.
In Solidarity,
John Lyall

subset: commoncrawl


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Former Defense Secretary Donald Rumsfeld tells Newsmax the information that led to the killing of Osama bin Laden was obtained through "normal interrogation approaches" and says the notion that terrorist suspects were waterboarded at Guantanamo Bay is a "myth."
Rumsfeld also claims that elements of Pakistani intelligence could have been complicit in hiding the terrorist mastermind, asserts that his killing exonerates George W. Bush's approach to fighting terrorism, and warns that terrorists will likely try to avenge bin Laden's death with new attacks against America or its allies.
Rumsfeld was Secretary of Defense under Gerald Ford from 1975 to 1977, then under George W. Bush from 2001 to 2006, and as a member of the Bush administration was one of the chief architects of America's response to the 9/11 terrorist attacks.
His new book, "Known and Unknown: A Memoir," was released in February.
In an exclusive interview with Newsmax.TV, Rumsfeld was asked how important was the killing of bin Laden after all these years.
"It is important," he responds.
"He had become the face of terrorism, radical Islamists in the world, and I think the fact that the coalition of countries shared intelligence and worked the problem seriously for a number of years and were successful, ought to be a signal to other terrorists that while manhunts are difficult, they're not impossible. The world's a better place with him gone.
"It's a good signal that the United States, thanks to George W. Bush's administration, put in place some structures that put pressure on terrorists and led to this event. And thanks to the Obama administration for continuing those approaches and procedures, we've now been successful."
Asked if harsh interrogation techniques at Guantanamo Bay played a role in obtaining intelligence on bin Laden's whereabouts, Rumsfeld declares: "First of all, no one was waterboarded at Guantanamo Bay. That's a myth that's been perpetrated around the country by critics.
"The United States Department of Defense did not do waterboarding for interrogation purposes to anyone. It is true that some information that came from normal interrogation approaches at Guantanamo did lead to information that was beneficial in this instance. But it was not harsh treatment and it was not waterboarding."
Rumsfeld reiterated that the killing of bin Laden exonerates the Bush administration's response to 9/11.
"It certainly points up the fact that the structures that President Bush put into place – military commissions, Guantanamo Bay, the Patriot Act, indefinite detention, and humane treatment, but intensive interrogation to be sure – all contributed to the success we've had in the global war on terror.
"The fact that we've not had another attack on America for close to a decade, I don't think anyone would have been bold enough to predict that 10 years ago.
"And certainly the killing of bin Laden is a testimony to our intelligence community. We've always had the ability to capture or kill Osama. What we didn't have was the intelligence that was needed."
Asked if Pakistan played a role in hiding bin Laden, Rumsfeld tells Newsmax: "I think it's a fair question to ask the extent to which, probably not the Pakistani government but possibly some people connected to the Pakistani intelligence services, may or may not have had information about his location."
In light of the fact that Pakistan has received billions of dollars in U.S. aid, what does the possible hiding of bin Laden say about the trustworthiness of Pakistan, Rumsfeld was asked.
"We don't know yet. What we do know is it's a Muslim country, they have nuclear weapons, they have been enormously helpful to us, particularly under the Musharraf regime, in allowing us access into Afghanistan and being with us from a military standpoint.
"We always knew there were people in Pakistan who have supported the Taliban and al-Qaida. That's true in a number of countries. But the assistance we've provided to Pakistan has in my view been well spent."
Rumsfeld says he doesn't think the killing of bin Laden "will have any bearing at all" on destabilizing the security of Pakistan's nuclear weapons.
He adds: "We do know that al-Qaida has sought out chemical, biological, and nuclear weapons, and we do know they've alleged that in the event that Osama bin Laden is killed or captured, they would undertake some additional terrorist attacks on America and on our friends and allies around the world."
Referring to new CIA Director Leon Panetta's warning that terrorists' attempts to avenge bin Laden's death are inevitable, Rumsfeld says: "I think it's likely they will try."
{Newsmax/Matzav.com Newscenter}


text:
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Featured Film:
Phoenix at the SIFF Uptown Cinemas
Our featured film for the second week in a row (thus are the dog days of summer), German director Christian Petzold's latest stars Nina Hoss as a disfigured Holocaust survivor who undergoes reconstructive plastic surgery. Returning home but presumed dead, she seeks out her husband, who may have informed on her to the Nazis during the war. When he meets but does not recognize her, she pretends to be another woman to go along with his scheme to pose her as his wife in order to collect an inheritance. In playing this patently absurd premise with a detailed and patient realism, Petzold captures the essence of the 1950s melodrama, from Douglas Sirk to Hitchcock's Vertigo, driving relentlessly toward an instant-classic ending. Our Review.
Sign up for our newsletter and get the best of Seattle arthouse and repertory programming in your Inbox every Friday morning.
Playing This Week:
Sunset Blvd. (Billy Wilder, 1950) Fri-Tues
Almost Famous (Cameron Crowe, 2001) Fri-Tues
Love and Mercy (Bill Pohlad) Fri-Thurs Our Interview
Star Leaf (Richard Cranor) Sat Midnight Only
Mistress America (Noah Baumbach) Opens Thurs
Assassination (Choi Donghoon) Fri-Thurs
Planes, Trains & Automobiles (John Hughes, 1987) Sun & Weds Only
Irrational Man (Woody Allen) Fri-Thurs
The 100 Year Old Man Who Climbed Out the Window and Disappeared (Felix Herngren, 2013) Fri-Thurs
Meru (Jimmy Chin & Elizabeth Chai Vasarhelyi) Fri-Thurs
I am Big Bird (Dave LaMattina & Chad N. Walker) Tues Only
Jellyfish Eyes (Takashi Murakami, 2013) Fri-Thurs
Irrational Man (Woody Allen) Fri-Thurs
Meru (Jimmy Chin & Elizabeth Chai Vasarhelyi) Fri-Thurs
The Diary of a Teenage Girl (Marielle Heller) Fri-Thurs
Planes, Trains & Automobiles (John Hughes, 1987) Sun & Weds Only
Irrational Man (Woody Allen) Fri-Thurs
Go Away Mr. Tumor (Han Yan) Fri-Thurs
Bike-in at Naked City Brewery Sat Only
Project Metalbeast: DNA Overload (Alessandro De Gaetano, 1995) Weds Only
The Diary of a Teenage Girl (Marielle Heller) Fri-Thurs
Angrej (Simerjit Singh) Fri-Thurs
Scarecrow Video Screening Lounge:
Contamination (Luigi Cozzi, 1980) Fri Only
Lady Terminator (H. Tjut Djalil, 1989) Sat Only
The Bedroom Window (Curtis Hanson, 1987) Mon Only
To Catch a Thief (Alfred Hitchcock, 1955) Tues Only
Dudes (Penelope Spheeris, 1987) Weds Only
Princess Chang Ping (John Woo, 1976) Thurs Only Our Review
Anima State (Hammad Khan) Thurs Only
Best of Enemies (Morgan Neville & Robert Gordon) Fri-Thurs
Listen to Me Marlon (Stevan Riley) Fri-Thurs
On the Waterfront (Elia Kazan, 1954) Sat Only
The Wild One (László Benedek, 1953) Sat Only
The Godfather (Francis Ford Coppola) Sun Only
The Diary of a Teenage Girl (Marielle Heller) Fri-Thurs
Being Evel (Daniel Junge) Fri-Thurs
Phoenix (Christian Petzold) Fri-Thurs Our Review
Guidance (Pat Mills) Fri-Thurs
The Young and Prodigious T.S. Spivet (Jean-Pierre Jeunet, 2013) Fri-Thurs
She's Funny That Way (Peter Bogdanovich) Fri-Thurs


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Red Sox Complete Sweep – MLB Roundup For April 16th
UNDATED (AP) — The Boston Red Sox finished off a three-game sweep of Tampa Bay this afternoon, less than an hour before the explosions at the Boston Marathon.
Mike Napoli's double off the Green Monster with two out in the bottom of the ninth gave the Bosox a 3-2 win over the Rays. Napoli became the hero after Ben Zobrist tied the game with an RBI single in the top of the ninth.
Also in the majors on Jackie Robinson Day, J.P. Arencibia (ar-ehn-SEE'-bee-uh) and Maicer Izturis (MAY'-sur ihz-TOOR'-ihs) hit solo homers in Toronto's 4-3 win over the Chicago White Sox. Mark Buehrle (BUr'-lee) was the winner in his first start against his former team, allowing nine hits but only two runs in 6 1/3 innings.
Joe Mauer was 4-for-5 with a homer, three RBIs and two runs scored in Minnesota's 8-2 romp over the Los Angeles Angels. Kevin Correia (koh-RAY'-uh) went seven innings for the third consecutive start, yielding two runs and eight hits for his first American League win.
Brandon Phillips hit a two-run single in the eighth as Cincinnati doubled up Philadelphia 4-2 to end a five-game losing streak. Phillips came through after Chase Utley's two-run homer tied it in the top of the eighth.
Allen Craig had three RBIs and St. Louis erupted for seven runs in the second inning of a 10-6 rout of Pittsburgh. Jon Jay and Matt Holliday each had two hits and two RBIs as the Cardinals ended the Pirates' three-game winning streak.
Jordan Zimmermann tossed a six-hitter and Washington bounced back from three straight losses to Atlanta by clobbering Florida 10-3. Ryan Zimmerman hit his first home run and had four RBIs to lead the Nationals' 16-hit outburst.
Oakland walked all over Houston, winning 11-2. The Athletics grabbed a quick lead by scoring six times in the bottom of the first. The big blow in the inning was a three run home run by Nate Freiman. Shortstop Jed Lowrie had four runs batted in for the A's and Tommy Milone struck out six to win his third straight start.
In their first meeting since a bench clearing brawl, the Padres got the better of the Dodgers, winning in Los Angeles 6-3. Winning pitcher Eric Stults led the way for the Padres with a three-run, second inning home run.
The New York Mets and Rockies were postponed by a heavy snowstorm in Colorado. The game will be made up as part of a day-night doubleheader on Tuesday.
CHICAGO (AP) — The Chicago Cubs and the City of Chicago say they have completed a $500 million pact to overhaul Wrigley Field.
The agreement includes $300 million in stadium renovations that will feature a large new outfield video screen. It allows the Cubs to play more night games and expands parking with 1,000 remote spaces.
The two sides say in a joint statement that the team hopes to receive city approval for the work before the end of the current season. The team will pay the entire cost of renovating 99-year-old Wrigley and building a $200 million nearby hotel project.


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CB is the first part of a trilogy called 'Trinofi', the other works are 'Catulli Carmina' (on poems by Catullus) and the 'Triumph of Aphrodite' (based on verses by Catullus, Sappho and Euripides). I would caution people to listen to these works carefully before buying to avoid disappointment. They are interesting works but don't have the raw appeal of Carmina Burana.
Carmina Burana (1936), Catulli carmina (1943) and Trionfo di Afrodite (1953) form the parts of a triptych, meant to be performed as "total stage works" where movement, dance, singing, music, speaking and other stage crafts were all combined to produce an overwhelming or thought provoking effect. Lyric latin poems of the middle ages and poems from Roman and Grecian antiquity, mixed with pieces in the vernacular (middle-high German, ancient Provencal and Italian) form the basis of these three works, rich in their diversity, under the title Trionfi since they were first performed in their entirety in Milano's La Scala. Originally Orff never conceived the works as an integral cycle.
The Trionfi is about love in different places, times and circumstances. If you can understand Latin and are easily offended, then care should be taken listening to Catulli Carmina as the lyrics are quite explicit. Most record liner notes just summarise the first section with "The girls and boys get more and more excited…".
Orff also wrote operas.


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The Rose and Crown Quiz Night
The Rose and Crown is within the Flaming Grill brand of pubs.
Every Friday we run the Smartphone Quiz Nights – come along for an entertaining evening full of comedy, banter, fun facts and questions!
Between the Rose and Crown team and your host Kieran you'll have a great night out.
For more information and to confirm your coming along join the Quiz Night Facebook Group
The pub gets busy on #Quiz nights so you may need to book a table using the Rose and Crown's contact information.


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"Today, more than half the nation's primary- and secondary-school students — more than 30 million children — use Google education apps like Gmail and Docs, the company said. And Chromebooks, Google-powered laptops that initially struggled to find a purpose, are now a powerhouse in America's schools. Today they account for more than half the mobile devices shipped to schools.
"Between the fall of 2012 and now, Google went from an interesting possibility to the dominant way that schools around the country" teach students to find information, create documents and turn them in, said Hal Friedlander, former chief information officer for the New York City Department of Education, the nation's largest school district. "Google established itself as a fact in schools.""
Source: NYT, 13th May 2017
Nike in Fortnite
14 hours ago


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[vc_tabs width="1/1″ el_position="first last"] [vc_tab title="WHAT & WHEN"] [vc_column_text title="Oklahoma City Summer Jewelry, & Bead Show" pb_margin_bottom="no" pb_border_bottom="no" width="1/1″ el_position="first last"]
July 6, 7, & 8, 2018
Show hours: Fri. & Sat. 10 till 6, Sun, 10 till 4
Please call 504-265-8830, or email [email protected] with inquiries.
AKS Gem Show are wholesale shows OPEN TO THE PUBLIC featuring jewelry, beads, beading supplies, gemstones, findings, pearls. and more.
Wholesale Buyers ~ Wholesale preregistration will open 30 days prior to the show.
You may still register on site with a copy of your state sales tax license. If you preregistered for Winter show, you do not need to register again. Simply bring your pre-printed wholesale buyer badge with you to the show. If you lost your badge, you will need to preregister again. Please be sure to bring extra copies of your sales tax id with you to the show.
Retail Shoppers ~ Join our mailing list and receive discount coupons for admission as well as vendor coupons.
We've got a great show lined up for this Summer. Fashion jewelry, beads, beading supplies, findings, pearls, silver, Turquoise, fine minerals, and more!
Directions to the show can be found on our "Location & Map" tab.
A list of our exhibitors can be found on our "Info" tab.
Classes can be found on our "Classes" tab.
[/vc_column_text] [/vc_tab] [vc_tab title="LOCATION & MAP"] [vc_column_text pb_margin_bottom="no" pb_border_bottom="no" width="1/1″ el_position="first last"]
Oklahoma State Fair Park
Expo Hall #3
3213 Wichita Walk
Oklahoma City, OK 73147
[/vc_column_text] [/vc_tab] [vc_tab title="INFO"] [vc_column_text pb_margin_bottom="no" pb_border_bottom="no" width="1/1″ el_position="first last"]
Admission is still only $5 for the entire weekend for the general public. Save more by joining our mailing list.
Join our mailing list by clicking on the link!
- Baby Boomers ~ handcrafted beaded jewelry
- Bali Designs ~ jewelry, beads, & findings
- Beadiful ~ vintage and contemporary beads & findings
- Beading House ~ the 'one stop shop" for all your beading needs
- Dorjee Designs ~ jewelry
- Intrinsic Trading ~ gemstone beads
- Jade House ~ semi precious stone beads, findings
- Kingdom Trading ~ beads
- Perfect Gem ~ gemstone beads
- Queenly Global Trading ~ beads, findings, jewelry
- Ro-A-Beads ~ beads & jewelry
- Super Time International ~ pewter findings & beads
- Tejas Beads ~ gemstone beads
Wholesale Buyers who preregister will be admitted free of charge. Wholesale preregistration allows each wholesale buyer to bring one guest with them. Preregistration closes Wednesday, July 8, 2015. On site registration allows only one person to be admitted without charge. All other guests must pay retail admission.
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This is a text block. Click the edit button to change this text..
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UPDATED 3/10: "Yes' Squire on band's first album in a decade"
Progressive rock titans Yes will release a new album this summer, said bassist/co-founder Chris Squire during a phone interview today.
"At the moment, we just finished recording our first studio album since 2001," Squire said. "It will probably be ready by July of this year."
What's the title?
"'Fly from Here,'" Squire said. "It's the title of the main song."
He also confirmed longtime Yes collaborator Trevor Horn produced the album.
I called Squire today for an upcoming story to advance Yes' March 11 performance at Jannus Live in St. Petersburg.


text: The Cherokee Historical & Preservation Society, Inc. operates primarily on private and corporate donations. These donations are supplemented by grants, product sales, museum admission, and fundraising events. Please help sustain the important work of the Society by giving to the Endowment Fund, Building Campaign, or General Fund. Memorialize or honor those you love by purchasing an Engraved Brick to be installed on the Museum grounds.


text:
Download The Bat Professional Edition
The Bat is one of the most popular in it's category. Is one powerful and highly configurable e-mail support for multiple accounts and also multiple users. You may find here almost any feature that you can require, at least all the basic requires are there. Supports POP, IMAP, has HTML and PGP encryption. If you need to edit a text you will find the right tool with the message editor and highlighting. It also has English, Russian, German, Dutch, Polish, Swedish, Italian, Lithuanian and Romanian interfaces as is a multilingual spelling checker. You have a 30 free day trial. Operating System: Windows XP/2000/2003/Vista/7/NT 4.


text:
- Professional Indemnity
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The policy for errors, omissions, neglect, wrongful advice will protect your company from claims.
The Professional Indemnity policy is designed to help with both legal costs to defend an allegation and in the event that you were found to be neglectful in your duties the professional Indemnity Insurance for damages awarded.


text:
Saturday, October 29, 2005
So ok, I'm still Alive
As you will no doubt have noticed, there is a new review below. Hooray!
Lastly, if any of you feel like pimping comics, this is the time to do it. I'm looking for recommendations for comics with a mystery theme to them. Please post them in the comments section and I will be very grateful (and so would the creator, I suppose.)
I'm still going to be busy. I've had to put The Jaded on hold and am barely managing to keep The Longest Sojourn running, but one thing at a time, and as much as I love comics, some things are just more important sometimes.
Aaannd it's 2 am in the morning, I am going to sleep.
11 comments:
- Anonymous10/28/2005 8:04 pm
A Webcomic with a mystery theme? How about Far Light Saga (http://comic.farlightsaga.com/), Gossamer Commons (http://www.gossamercommons.com/) or BattleGate (http://www.squirrelworks.com/zones/battlegate/index.html) ?ReplyDelete
I just hope you get a job soon, so you have time again for The Jaded ;-)
I don't really see how any of those qualify as "mystery themed" comics. They're all primarily fantasy (in GC's case, modern-day fantasy) and I didn't see any whodunit elements.ReplyDelete
- Anonymous10/31/2005 3:08 am
Mystery? Well, The DADA Detective (http://www.likelystories.com/), Private Eye Butterfly (http://www.users.bigpond.com/toonerfish/peb.html), and, to a lesser extent, Front Beat (http://www.frontbeat.com/) or Tanatos (http://www.bumelant.com/tanatos/) would probably qualify, but I can't think of manyReplyDelete
Heeeeeey Ping! I have nothing worthy to add since I don't know any comics (what kind of webcomic loser am I anyway?) but I'm glad to see the Finds back and kicking!ReplyDelete
Good luck with the jobs :D
Woohoo! She lives! Glad to hear you're still with us.ReplyDelete
Thanks for the suggestions everyone! Keep em comin!ReplyDelete
I've checked a few out, and some of them really look promising. don't worry if the comic isn't 100% mystery. All stories have an element of mystery, it's just how big a part that plays in it.
Yes I'm happy to be back and alive. My main problem is not falling asleep in front of the keyboard.
Ping :) Nice to see you back. I've recently discovered a comic that is like grown-up Tintin, the story is more cliffhanger than mystery but it does have a mysterious evil mastermind... It's really one of the best wecomics I've read, I can't recommend it enough :)ReplyDelete
Oh sod it, it's cut the link in 1/2. Well, it's on my links page anyway :)ReplyDelete
It's called the Rainbow Orchid.
I might maybe have made the murder nystery comic i have been sort of planning for ages by 2008, watch out for it XDReplyDelete
If you can find a forbidden planet that keeps thier back issues of 2000AD on the shelves, collect the recent "breathing space" storyline too
The creators of the Dada Detective certainly do appreciate the plug. :)ReplyDelete
And might we also suggest Nathanial Bright (http://www.geocities.com/frostjos/nbright1.htm)
and No Rest for thr Wicked (http://www.forthewicked.net/)
Most excellent comics with mystery as well.
Nobody mentioned Outside the Box yet?ReplyDelete


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I know someone asked recently about posting stuff that is for sale.... is it ok/correct to post it here? If not, let me know!
Finally unpacking and realizing some of our stuff doesn't work in the new house.
Ask away if further questions.
Pick up (O'Fallon) or can meet to drop off depending on items, etc.
Non- smoking home. Everything is in good condition.
Pottery Barn black out panels, cream with black trim. $15 a panel (I have 4 total, retailed at $99 a panel)
I had hemmed these to approx 78" but they can be let out easily. Standard length.
Stock photo, but identical.
Pottery Barn Animal print duvet cover and standard shams (also will throw in a brown tailored bedskirt to match). $30.
Full/Queen. Stock photo but identical.
Navy/Cream lattice rug, 5x7. $50. Used 1 year in office. Stock image, but identical.
4 (I found another one after I took photo) beige closetmaid bins for closetmaid cube storage units. $10 for 4
Apple, orange, pear metal decor from Hobby Lobby- $15 for the set of 3.
Dry Erase organizer from Hobby Lobby- $10 (24" wide by 20" tall)
Glass decorative jar 24" with apple green filler balls, from Hobby Lobby- $10
Girls room decor from Hobby Lobby - $10 for all 3
Aqua drapes (2 panels) from Hobby Lobby, 84" length- $15


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Phosphor Games' Awakened is based on Midway's canned open-world game Hero
With Midway Chicago being sold to Warner, the team behind the open-world action game Hero lost all assets, code, art and everything else pertaining to it in the process. So, when the remnants of that team went on to form Phosphor Games, it decided to continue work on the game in the form of Awakening, but unfortunately, it had to start all over from scratch.
Speaking in an interview with Gamasutra, Phosphor Games head Chip Sineni has said the team hopes Awakening, ts spiritual successor to Hero, will strike a cord with publishers and finally get into the hands of the public.
"We just totally started over," said Sinen. "We don't have any connection to the old codebase, story, assets, whatever. What we have is the very cool idea that create-a-player is this really awesome opportunity to change your character and your abilities to whatever you want them to be.
"We're really just trying to let players create their own kind of person. In that kind of way, those games [Prototype, Infamous], we keep getting compared to them and we're actually pretty different. How powerful create-a-player is, is really the coolest feature about the whole game. It's really hard to show that in a way that isn't flipping through a lot of menus."
Sineni goes on to say later in the interview, the game isn't anywhere near completion, but he decided to talk about the game since there was so much misinformation floating around the Internet on it.
"We totally weren't planning on talking about it until… this weird disinformation started popping up on the internet," he said. "It's really, really early. We're talking to numerous publishers on it. We've had a lot of back-and-forth. But for right now… the vision we most want first, before we get too serious [with a publisher]. We have other projects in the queue, so we're able to do that right now."
Phosphor Games did some work on Kinect Adventures for Microsoft, but Sineni didn't reveal what else besides Awakened the firms as working on at the moment.


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Lord Bridges asked Her Majesty's Government:
Lord McIntosh of Haringey: My Lords, the Government and the Receiver of Wreck have been in discussion and correspondence on this issue since the ordnance was recovered from the sea bed in 1994. The Receiver of Wreck gave title to the ordnance to the Royal Armouries for its future care, preservation and display to the public following a meeting at which the finder was present. The ordnance was subsequently removed by the Royal Armouries to ensure its safety on behalf of the nation after the finder had been notified. It is the policy of the Royal Armouries to loan artefacts to museums in the area of the find wherever possible. The Royal Armouries has reaffirmed its commitment to return the cannon to Orford on long-term loan as soon as a suitable accredited public depository is established, and it has offered to assist in this.
Lord Bridges: My Lords, I thank the Minister for his thoughtful and reflective reply. I shall endeavour to guide events locally in the same direction. Does the noble Lord agree with the general principle that when an interesting archaeological find is made, if it is not of outstanding national importance it should, as a general rule, be exhibited locally where it can be established that there is a suitable place in which to store it and the Royal Armouries and the department are satisfied with the arrangements for its custody?
Lord McIntosh of Haringey: My Lords, I agree entirely with the noble Lord. That is in accordance with the long standing practice of the Royal Armouries and its views in this case, which I have already set out. I have also made it clear that the Royal Armouries is anxious not only to pursue that policy but to assist in the return of the cannon to a suitable site near the place of find.
Lord Roper: My Lords, does the noble Lord accept that the Receiver of Wreck is widely recognised by those involved in nautical archaeology as someone
Lord McIntosh of Haringey: My Lords, I am sure that the Receiver of Wreck will be pleased to hear what the noble Lord has said and shares his concerns. If we continue to find more artefacts both on land by the use of electronic devices and in the sea by intrepid divers more and more places will have to be found for them in museums. That is why the Culture and Recreation Bill is concerned to extend the regime of English Heritage to underwater archaeology.
Lord Peston: My Lords, can my noble friend enlighten us as to the meaning of the word "forcibly" as used in the Question? Was somebody duffed up in order to take possession of the cannon? Do the authorities have a powerful group of people who go round doing this kind of thing?
Lord McIntosh of Haringey: My Lords, nobody was duffed up, but the Royal Armouries did send a trailer. The ordnance was chained to the outside of the premises of Suffolk Underwater Studies and the chain had to be cut to remove it.
Lord Roberts of Conwy: My Lords, will the noble Lord look into the position of the submarine "Resurgam" which sank in Liverpool Bay in the 1880s, still lies at the coast near Rhyl and is certainly in danger of being despoiled by underwater divers?
Lord McIntosh of Haringey: My Lords, the name of the submarine is peculiarly appropriate to the question that the noble Lord asks. I am not familiar with the case to which he refers, but I shall look into it and write to him.
Baroness Gale asked Her Majesty's Government:
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, our measures to help smokers give up include a comprehensive education strategy and the NHS Smoking Helpline. In addition, we have announced today that we intend to amend the relevant regulations so as to allow doctors to prescribe any available nicotine replacement therapy as part of NHS treatment.
Baroness Gale: My Lords, I thank my noble friend for that very encouraging reply, especially on National
Lord Hunt of Kings Heath: My Lords, I hope that they follow the example of the noble Countess, Lady Mar, who I understand celebrates the first anniversary of giving up smoking. I agree with my noble friend. It is worrying that statistics show that in the age range 11 to 15 and 16 to 19 more girls than boys smoke. Earlier this year we announced a £3 million campaign and initiative to co-ordinate all services for pregnant women who wish to give up smoking. Many local health authorities through their various smoking cessation plans have targeted programmes. I also agree that we have to think about young girls. The education tobacco strategy campaign is targeting young women. It is considering whether a specific programme should be developed in relation to young girls.
Lord Clement-Jones: My Lords, I welcome the Minister's statement today and the actions being taken which have been urged upon him from these Benches for some considerable time. However, does not the fact that the Government have not yet introduced in this House the Tobacco Advertising and Promotion Bill display a rather lesser commitment to the cause?
Lord Hunt of Kings Heath: Not at all, my Lords. So far as concerns the introduction of NRT through GP prescribing, we have always said that we wanted to see how the use of NRT through smoking cessation programmes would develop. I am very glad that we have made the announcement. So far as concerns the advertising Bill, that, as ever, is a matter for the usual channels. I remain ready and eager to take the Bill through the House when the occasion arises.
The Countess of Mar: My Lords, perhaps I may first thank the Minister for his remarks. Will doctors be able to prescribe what helped me enormously after I had tried to give up smoking 5,000 times; namely, using double nicotine therapy? I used the patches and I also used the lozenges. The lozenges fitted in with the peaks of the desire for nicotine and ironed those out, and the nicotine patches gave a steady level of nicotine. There is, I believe, some Finnish research which shows that in many cases this method is very helpful.
Lord Hunt of Kings Heath: My Lords, the list of products to be removed from Schedule 10, which can now be prescribed, is extensive. It essentially involves Nicorette and a series of patches as well as nasal spray and nicotinal gum. An amendment is being made to
Lord Hogg of Cumbernauld: My Lords, can the Minister tell the House what the Government are saying to employers to encourage young people not to start smoking? Those of us who live up in the City during the working week see groups of young people standing outside the offices of great banks and so forth smoking--having a smoking break. They are all very young. It is most unfortunate that the role models that young people follow smoke. But what are we doing to persuade employers to tell their employees that it is bad for them?
Lord Hunt of Kings Heath: My Lords, my noble friend makes a valid point. As part of any local smoking cessation programme, it is very much up to the local health authority to engage in discussions with employers and other relevant bodies, whether voluntary or statutory organisations, and to have a proactive campaign to encourage staff to desist from smoking. The NHS faces a considerable challenge in that area, particularly among the nursing profession. That is something that very much exercises us.
Baroness Young: My Lords, perhaps the Minister will elaborate further on the answer he gave to the noble Baroness, Lady Gale, on the subject of young girls and smoking. Does he not agree that it is a very serious matter? It is observable anywhere and it is schoolgirls particularly who are smoking. What steps are the Government taking to attempt to deal with this very difficult problem?
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text:
Wednesday, November 4, 2009
Lonny magazine launch party at Ochre
16 comments:
- Laura Casey Interiors said...
Looks like so much fun and everyone had a great time. Can't wait to see the next issue.
- November 4, 2009 at 4:20 PM
- my favorite and my best said...
(chanting) LONNY! LONNY! LONNY!
when in the name of goodness is lonny issue two coming??
- November 4, 2009 at 4:35 PM
- Paloma {La Dolce Vita} said...
How fabulous! Congratulations! You have done an extraordinary job so far. I can't wait for issue No.2!
- November 4, 2009 at 4:42 PM
- C said...
How wonderful, everyone looked fantastic and relaxed! Of course, there was much to celebrate, Lonny is fabulous!
- November 4, 2009 at 4:46 PM
- Jess LC said...
Love the photos and your dress color is beautiful! You really stand out.
- November 4, 2009 at 4:55 PM
- lowleeta said...
michelle i am so excited about all the wonderful things that are coming your way! i had a wonderful time at the launch party. so glad i could be there!!
- November 4, 2009 at 10:12 PM
Great party
What a great looking bunch!
- November 5, 2009 at 10:11 AM
- co said...
Looks like a GREAT party! Good job!!!
ur purple dress is STUNNING -- would u mind telling me where it's from? (email me if u want). THANKS hun!
- November 5, 2009 at 10:47 AM
- Angie Muresan said...
LOVE that poster!!! Oh, and pleased the party was such a success. It looks as if you all had fun!
- November 6, 2009 at 4:47 PM
- Her name was Lola said...
I {heart} Lonny! This looked like quite a fabulous soiree {and your outfit was fittingly fabulous!}.
- November 24, 2009 at 4:20 PM
- Amy Malinsky said...
What a great party! Can't wait for the next issue!
- December 3, 2009 at 5:31 PM
- January 5, 2010 at 1:33 PM
- College Term Papers said...
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- April 20, 2010 at 9:33 AM
- prashant said...
Can't wait to see the next issue.
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- June 23, 2010 at 9:04 AM
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- February 1, 2012 at 12:51 AM


text:
Feasibility of Transvaginal Cholecystectomy (TVC)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|ClinicalTrials.gov Identifier: NCT01232959
Recruitment Status : Withdrawn (Subjects not interested)
First Posted : November 2, 2010
Last Update Posted : January 13, 2016
- Study Details
- Tabular View
- No Results Posted
- Disclaimer
- How to Read a Study Record
Today there are three different ways to remove a gallbladder with gallstones. Surgeons can remove the gallbladder through small incisions in the abdomen. This is called laparoscopic cholecystectomy. It is the current standard. It has replaced traditional open gallbladder surgery. Open gallbladder surgery is done with a large incision. A new way of removing the gallbladder in women is through the vagina. This is called transvaginal cholecystectomy. This study is being done to see if removing the gallbladder through the vagina will work for patients at Mayo Clinic Rochester. This is the first step of this research to test the procedure. In the future, other studies will examine the potential for less scarring and reduced pain. In this study the investigators will still make small incisions in the abdomen, they will be smaller than the standard procedure but you will still have some scars on your abdomen.
Some very early research reports say that some patients may have less pain with the transvaginal approach; however, the investigators do not know if the transvaginal route will have any effect on your overall health and quality of life.
This study will evaluate:
- Effectiveness of the surgery: ability to remove the gallbladder safely
- Effect of the operation on your body: change in pulse and blood pressure during the surgery, level of inflammation markers in your blood before and after the surgery
- Recovery from surgery in the hospital: how much pain you have, how much pain medication you need, how long you need to stay in the hospital, or nature of any surgical complications (problems)
- Overall recovery from surgery: general quality of life, abdominal symptoms
What is the new type of surgery?
The new type of surgery is called transvaginal cholecystectomy:
A small incision is made in the vagina. An endoscope (flexible lighted camera tube) is inserted into the abdomen. An endoscope is normally used to examine your stomach or colon. A very small camera is placed in your abdomen at the belly button (5 mm, ¼ inch). This helps the surgeons to remove your gallbladder through the vagina. The procedure to separate your gallbladder from your body will be assisted by instruments placed through your abdomen and instruments placed in your vagina. The surgeon will remove the gallbladder by passing it though your vagina.
|Condition or disease
|Device: Transvaginal Cholecystectomy
|Not Applicable
As technologic innovations in medicine continue to advance, less intrusive operative procedures are being developed. Natural Orifice Transluminal Endoscopic Surgery (NOTES) may represent a less invasive approach to the abdominal cavity. The access to the abdominal cavity through natural orifices such as the vagina has the benefit of decreased somato-sensory innervation. This venue might confer less pain and operative stress to the patient. The transvaginal approach has been suggested as a new surgical approach to gallbladder surgery (cholecystectomy). Approximately 700 transvaginal cholecystectomy procedures have been performed in medical centers around the world so far. Anecdotal data suggest that the patients experience less pain postoperatively and half of them may not require any pain medication. Currently, introduction of this new operative approach outside of a research study is not supported by national nor international societies.
We wish to demonstrate that the transvaginal approach is feasible for 10 patients with gallstone disease at Mayo Clinic Rochester (MCR).
Methods: Female patients seen by consultants from the Division of General and Gastrointestinal Surgery, who have an appropriate indication for elective cholecystectomy, will be offered a cholecystectomy via the transvaginal approach. After patient enrollment, baseline demographics, questionnaires and blood draws will be obtained. The patient will undergo a laparoscopic assisted transvaginal cholecystectomy by a dedicated surgical team, consisting of a gynecologist, a minimally invasive surgeon and a gastroenterologist. This approach will utilize a 5-mm umbilical trocar and a posterior colpotomy. Standard laparoscopic and flexible endoscopic instrumentation will be utilized along with recently introduced long flexible-tip laparoscopic instrumentation to remove the gallbladder. Intraoperative parameters will be recorded. Postoperatively blood draws and questionnaires will be repeated at specific intervals.
Data analysis will be mainly descriptive for this feasibility study. The collected material will serve as pilot data for a future comparative study of transvaginal cholecystectomy with standard laparoscopic cholecystectomy.
|Study Type :
|Interventional (Clinical Trial)
|Actual Enrollment :
|0 participants
|Intervention Model:
|Single Group Assignment
|None (Open Label)
|Primary Purpose:
|Official Title:
|Feasibility of Transvaginal Cholecystectomy
|Study Start Date :
|October 2010
|Actual Primary Completion Date :
|December 2012
|Actual Study Completion Date :
|December 2012
Experimental: Transvaginal Surgery
Gallbladder will be removed through the vagina
Device: Transvaginal Cholecystectomy
A small incision is made in the vagina. An endoscope (flexible lighted camera tube) is inserted into the abdomen. An endoscope is normally used to examine your stomach or colon. A very small camera is placed in your abdomen at the belly button (5 mm, ¼ inch). This helps the surgeons to remove your gallbladder through the vagina. The procedure to separate your gallbladder from your body will be assisted by instruments placed through your abdomen and instruments placed in your vagina. The surgeon will remove the gallbladder by passing it though your vagina.
Other Name: gallbladder removal
- Feasibility measured by successful transvaginal removal of gallbladder [ Time Frame: 1 year ]The procedure will be considered technically successful if at completion the cystic duct and artery have been clipped securely and the gallbladder has been removed through the transvaginal port. At the time of surgery, the procedure will be supervised with a laparoscope at all critical points. Conversion to a laparoscopic or open procedure is considered an incomplete transvaginal procedure.
- Safety and tolerability measured by individual and overall Adverse Events [ Time Frame: Following each surgery but overall at 1 year ]
- Procedural complications recorded during transvaginal cholecystectomy.
- Complications resulting from endoscopic transvaginal cholecystectomy recorded at the time of surgery.
- Patients' post-operative clinical course for duration of three months, including routine follow up at about one week after the operation, vaginal exam after six weeks and follow-up with quality of life questionnaire at three months.
- Pain Scores as measured on the Visual Analog Scale [ Time Frame: 1 year ]One of the main endpoints of the study will be postoperative pain as measured by the visual analog scale. The scale will be measured in triplicate fashion. In addition to the visual analog scale, the amount and class of pain medication used will be collected.
- Quality of Life measured through validated questionnaires [ Time Frame: 1 year ]Data for the SF-12 and ASIS will be scaled and evaluated for correlation at baseline and postoperative day 7 with the Pearson coefficient. Change from baseline for each instrument will be evaluated.
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, Learn About Clinical Studies.
|Ages Eligible for Study:
|18 Years to 65 Years (Adult, Older Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion criteria
- Female patients undergoing elective cholecystectomy for cholelithiasis.
Exclusion criteria
- Male patients, patients <18 years or >65 years of age
- Pregnant patients
- Patients with prior pelvic surgery
- Patients with prior hepatobiliary surgery or other major abdominal surgery
- Patients with ASA class >3
- Patients with BMI >35
- Patients with risk factors for requiring an open cholecystectomy (e.g. possible gallbladder cancer, acute cholecystitis, jaundice)
- Patients who cannot provide consent for the study
- Patients not willing to participate in the study.
- Patients with common bile duct stones
- Patients with evidence of abdominal abscess or mass
- Patients with diffuse peritonitis
- Patients with a clinical diagnosis of sepsis
- Patients with coagulopathy or using anticoagulants or anti-platelet agents (aspirin up to 81mg/day acceptable)
- Patients with planned concurrent procedures
- Patients with a prior diagnosis of intra-abdominal adhesions
- Patients who are participating in any other investigational device or drug trial that has not yet completed the primary endpoint
- Patients with an enlarged uterus
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01232959
|Principal Investigator:
|Juliane Bingener-Casey, MD
|Mayo Clinic
|Responsible Party:
|Juliane Bingener-Casey, PI, Mayo Clinic
|ClinicalTrials.gov Identifier:
|NCT01232959 History of Changes
|Other Study ID Numbers:
|First Posted:
|November 2, 2010 Key Record Dates
|Last Update Posted:
|January 13, 2016
|Last Verified:
|January 2016
Keywords provided by Juliane Bingener-Casey, Mayo Clinic:
Gallbladder removal
Additional relevant MeSH terms:
Biliary Tract Diseases
Digestive System Diseases
Gallbladder Diseases
Pathological Conditions, Anatomical


text:
November 20, 2012
Private: Calls for Secession are Bad Law, and Bad Policy
by Joseph Jerome
Within days of President Obama's re-election, dozens of states petitioned the White House for permission to secede from the union, and ever feisty Texans have led the way. One local politician made headlines for calling for an "amicable divorce" between the United States and the Lone Star State, and a petition for Texas' secession has received over 100,000 signatures. The White House has said it will offer a response to the chorus of calls to secede, but the administration's answer should be brief: secession is neither constitutional nor would it be good policy if it were.
In a thoughtful post for the National Constitution Center, Lyle Denniston explains that talk of secession "is a pipe dream, constitutionally speaking." "If the Civil War did not settle it on the battlefield," he writes, "the U.S. Supreme Court put it completely to rest constitutionally" in a case involving Texas, appropriately enough. Decided by the Supreme Court in 1869, White v. Texas addressed the sale of U.S. treasury bonds by the state of Texas in order to fund its rebellion during the Civil War. Finding the state's ordinances supporting secession to be "absolutely null," the Court held that secession could be accomplished only through "revolution or through consent of the States":
The Constitution, in all its provisions, looks to an indestructible Union composed of indestructible States. When, therefore, Texas became one of the United States, she entered into an indissoluble relation. All the obligations of perpetual union, and all the guaranties of republican government in the Union, attached at once to the State. The act which consummated her admission into the Union was something more than a compact; it was the incorporation of a new member into the political body. And it was final.
Texas politicians, including Governor Rick Perry, regularly invoke the specter of secession when talking about Texas' unique history as a one-time independent nation. However, as Slate's Jeff Turrentine explains, Texas' "so-called 'right' to secede is no more than a politically emboldening myth, the boastful residue of the decade it spent as a sovereign nation." While the former republic may have other legal ways of causing havoc with the federal government, even Texas concedes it has no legal authority to "unilaterally withdraw" from the United States.
History and law suggests that secession would only be possible with the consent of the country as a whole. The dissolution of the United States would require, at minimum, congressional approval, and the first difficulty that presents is "a matter of arithmetic," according to constitutional law scholar Michael Dorf. The Constitution is predictably silent on the matter of the legislative process of secession, and there is no mechanism in place for determining how Congress could proceed on the matter. Would only the non-seceding members of Congress control the vote? Would Congress need to approve any secession plan by a majority or super-majority? More likely, a pathway to secession would require the painstaking process of amending the Constitution, but even then, secession would present a number of practical challenges.
Secession can be portrayed as a simple, logical solution to frustration with the federal government, but untangling the complex relationship between a state and the federal government would not be easy. For a conservative state like Texas, the end result would be more government, not less. In a thought experiment, NPR considered what an independent Texas would look like. Even with the world's fifteenth largest economy, sovereign Texas would be bled dry as it established new government departments to handle foreign affairs, aviation, and nuclear regulation. It is true that Texas residents pay more in federal taxes than they receive in benefits, but the state still received almost $44 billion in federal aid in 2010. Further, national defense spending helped to buoy the Texas economy during the Great Recession and the economic impact of military payroll in the state is more than $77 billion. Large percentages of state aid to the poor across the country is currently subsidized by the federal government, and independent, individual states would be forced to addresshow they would handle Medicare and Social Security benefits and "all the expenses Washington used to take care of -- things like maintaining interstate highways, inspecting meat and checking passports."
It is likely no one rushing to petition the White House to secede has seriously considered these sorts of questions. Indeed, talk of secession likely has everything to do with "slumping stock market[s] and accompanying pessimism" than any real desire to form a new nation. Even as America has become increasingly polarized and partisan, the political environment remains far removed from the one that precipitated the Civil War. Few Americans today feel enough affinity for their states to have any strong commitment to establishing them as independent nations, argues conservative legal scholar Ilya Somin. Expressing support for secession on a petition and rising up in arms to demand it are two very different things, and even in Texas, support for secession is no more popular than in Rhode Island: a 2009 Rasmussen Reports survey concluded that 75 percent of Texans would oppose seceding.
Despite the attention these secession petitions have received, only a fifth of Americans consistently support leaving the union. This number has remained constant no matter the president or party in power, and it should come as no surprise that the majority of Americans continue to see the innumerable legal and practical benefits of a strong united country.


text:
JO BARNEY WRITING BLOG // Now eighty-three, I've not given up my goal to write a breakout novel, although the definition of the term has changed. The Runaway, successfully reviewed, is a breakout for me, if not for the New York Times. And creating Her Last Words has broken me out of my fear of the computer. Who knows where the next story will take me. So even though the finish line may be a little closer, I understand that breakout is in the eye of the beholder.
Monday, December 13, 2010
When No News is Okay News, Glitch-wise
Last night, sleepless in Portland, visualizing the empty wine bottles I'll have to recycle in the morning, worrying about glasses that probably will break in the washer, regretting the hors d'oeuvres turning green because I forgot to put them in the fridge, my party obsession floated away in a cloud of fragmented conversations. The party was over. Even I had a good time. So move on, I whispered into my pillow, to your other obsession, the one you put aside in a frantic week of rolling out phyllo dough and filling empanitas.
Twelve queries sent, two rejections, ten to go. Takes time, I told myself. These people get a thousand queries a month. Then I imagined my email page telling me I had a thousand new messages. Not a comforting thought. Uneasy, my imaginings stumble on to Ellie, the old lady my queries had mentioned.
Just how old is she? 67, I think, just past the 60 is the new 50 stage and into a little arthritis and a bum hip.
Wait a minute. Her son is 28, as is our villain. Which means Ellie was almost forty when he was born.
Which is okay, but didn't I have her describe escaping as a teenager from grandmother's house by getting pregnant? Marrying a no-good who left with a toddler after a year or two? She lived with her grandmother until she's almost forty? My grandmother could have lived with me when I was forty. Despite my careful outline of Ellie's and my other characters' lives, I'd misplaced maybe thirty years. Unless I change her backstory, she should be 46, definitely not a crotchety old woman.
Tomorrow I will go back to Ellie, figure out how she got a son at age 39, having left her grandmother's home almost twenty years before. I know HOW, of course. What I'm not sure yet is WHY.
This is why I love both writing and jigsaw puzzles. The puzzle/story seems to be coming together, sort of, but there are always the pieces that have fallen to the floor, the ones the player doesn't see until she leans back and looks around.
So today, I'm okay with not getting a request for one hundred pages. By the end of the week, I'll be checking my email obsessively, as usual, and Ellie will be glitchless.
Jo Barney Writes
Website: www.jobarneywrites.com
Blog: breakoutnovelarace.blogspot.com
Monday, November 15, 2010
Night Thoughts: When Counting Backwards From 100 to l Didn't Do It
Just how much stress can an old lady handle? An even better question might be: Why did she think she needed to do either kind of reaching-out? And what inspired her? The long hours in front of the computer, the tentative smiles from strangers on the elevator, the panting novel, the hope to move past smiles to names?
In the midst of that night-churning I forced myself to think about other things, about the four novels I've finished. Each is about a woman who needs to solve a few problems. In fact, one of the protagonists is dead already, but still trying. And each woman is older than the one in the previous book. Just as I am getting older. They've gone from sexy to arty to philosophical to crabby. Just like me. They worry about marriage, divorce, children, loss, and redemption in the same ways I have.
What seems to be clear now that it is light outside and I've had my coffee is that I've spent the past fifteen years chronicling my life as I wandered through it.
How uncreative of me, I think, pouring another cup. Then I run my glance over my book case full of old and new books that I love enough to make me unable to donate them to the library used book sale. I see that I am not alone. Roth, Updike, Hemingway, Smiley, Proulx and even Evanovitch, I betcha, seem find their truths and their characters first in themselves. I'm thinking that most writers do. While I'm not in the same league as these writers and most of the others on my shelves, I am beginning to understand that I write to learn more about myself. And that it is okay. Maybe even healthy.
So my next story will involve a woman who sits bolt upright in a midnight bed and discovers a way to deal with an heavy onset of rejection. Maybe she'll start testing recipes for Holiday punch and discover that after a few swallows, rejection isn't that big a deal, just life.
Jo Barney Writes
Website: www.jobarneywrites.com
Blog: breakoutnovelarace.blogspot.com
Monday, November 1, 2010
Wise Words from a Couple of Old Women and a Young One
"It takes a while to thicken, but keep stirring," I advise, first making sure it is impatience and not pain that has prompted her misery. "A watched pot doesn't boil," I add, feeling very old and wise.
Later, after the mac and cheese, she turns the table on me. I am doing some groaning of my own. I have sent out five query letters inviting agents to take a look at Graffiti Grandma. No response after two weeks, despite my hourly checking of my email. "Patience is a virtue," Hannah says. "Remember?"
The thing is, although I know that some agents get a thousand queries a month and maybe ask for pages from three of those queries, and although the books advise submitting writers to make their queries so intriguing from the first word on that an agent's finger will tremble as he/she reaches for the Send the Manuscript button, with the hope that he/she will be the first to read the whole thing--although all that, my response to Hannah is "I remember. And hope springs eternal, you know."
But I do have a vision of my selected agents glancing at the first word, or even the subject bar, and bringing a whole fist down on the Reject button. "I'm sorry, I did not fall in love with your novel," or the alternative, "We just aren't the right agency for you," automatically appear on my screen. Three seconds it takes to squash a hope.
But the springing part turns out to be true. Rejection #l. After a dark moment, a little green blade of hope pops up and cheers me. I still have four queries out there. Who knows? The Help had fifty rejections before an agent said yes. Also, I have a list of four hundred more agents. All I have to do is live long enough to contact them all.
Besides, a new story is percolating somewhere near my heart, making me wake up at night, dialogue from unknown characters ringing in my dreams. Something about an old man in a wheel chair.
"Be up and be a'doing with a heart for any fate, still achieving, still pursuing, learn to labor and to wait." This time it's my mother's voice I hear. I open a blank page, decide to do a little laboring while I wait.
Jo Barney Writes
Website: www.jobarneywrites.com
Blog: breakoutnovelarace.blogspot.com
Thursday, October 21, 2010
Revise, revise, revise. Okay, I got the message. Again.
And the bed is now available to sleep in. The turmoil started when my two writing friends gave me their comments. After a short pout, I decided to actually try what they had suggested. The problem was that they each suggested a different course of action to cure what ails Grandma. It seemed that some of my chapters were too slow, others confusing in their switch of POV every time a new chapter began. One critic suggested that the POV situation could be solved by giving each of my characters his/her own section: four POV's, four sections. I decided to tackle that one first and realized after an hour of cutting, copying, and pasting that I was losing it, my sanity and my novel. Characters cowered in other people's sections. Sarah walked the streets during Jeff's growing up years, but Sarah wasn't even alive when Jeff was growing up. Matt found himself solving a murder before it was committed.
This is where the bed came in. I sat criss-cross applesauce on the bedspread and divided a hard copy into four piles, each containing the POV of one character. Then my characters fought to see who would go first and I love Ellie the best, so Ellie's story, eight chapters, became section one, and in order to wrack up the tension, Jeff, the psychopath, was awarded section two, followed reluctantly by Matt the cop and Sarah the goth girl. At a crucial moment toward the end of all this reconstruction, Willie the dog decided to help and jumped onto the pile that was Matt. Parts of him got tangled up with Jeff and Sarah and the mess was almost as bad as the one I'd created earlier on the computer. However, the worst part of this effort came when I finally leaned back against the bed's pillow and began to read. It took less than fifteen minutes for me to understand that I had created an unreadable piece of kaka. It landed on the floor next to my wastebasket. Part of the writing process, I told myself, as I hobbled to the kitchen, criss-cross-applesauce-paralyzed, and poured myself a glass of wine
Then I laid the second copy of the novel out on the bed in thirty-six piles, each containing one chapter. I would attack the slowness comment by re-ordering the chapters. Chapter three settled in at the eighth spot, chapter eight became chapter five, and chapter five got broken into two chapters. And so on. This shuffling of paper continued into the night like a endless poker game, me against a guy named Boring. The dog was banned from the bedroom, and my husband also. "I'm almost winning!" I pleaded, protecting my piles with outstretched arms. They both took to the sofa. Finally, I stopped, picked up the piles in their new positions, stuck a vagrant chapter hiding under a sheet into the middle of the stack and called it a night.
The next day I drank a pot of coffee, answered emails, plucked a few chin hairs, and finally got the courage to read the new Grandma. I kind of liked it. The POV confusion wasn't all that confusing. Perhaps my critiquer was a little attention deficient or something. And as far as slow, well, I decided to think of the quiet paragraphs as opportunities to breathe a little in between a psychotic killer's murders. It took me the rest of the morning to make the changes on my computer. Then I tore up six hundred pages of typing paper and threw the scraps in the bin, after which I invited Willie to join me on the bed for a short nap.
Jo Barney Writes
Website: www.jobarneywrites.com
Blog: breakoutnovelarace.blogspot.com
Thursday, September 30, 2010
Who Says Women My Age Can't Make Babies
My grandson is almost three. His every sentence begins with Why. I feel compelled to try to make sense of the world for him in the five days I spend time with him in faraway Iowa. I answer with "Because. . .," glad that I'm a story-teller.
One morning he takes my elbow in his little boy hands as I shift to my knees to get up from the train table. "I'll help," he says. Then we make our way to his room to deal with the part of him that smells. He shows me where the dirty diapers go, where the wiping tissues are, and which part of the padded wrap goes in front, how to tear off the Velcro covers. All the while he is looking up at me, perhaps, I think, in fascinated love. Then his fingers rub the top of his head. "My hair is flat," he says. "Yours sticks way up. Why?" I can't think of an answer. I've often asked myself the same question.
Back home now, I have other babies to think about. My writing partner and I meet at my dining table. We each hold the other's latest novel. Steve bares his chest. "Just plunge the knife right here," he says.
"I won't be mean if you don't ask me to kill my babies," I promise.
My critique does a little jabbing but no bloodletting and he takes notes. His critique does in a couple of my babies including the title and first line of the first chapter. I give him five sheets of comments; he has stuck Postits at the edges of my pages and my manuscript looks like it's molting blue feathers.
When he leaves I have a glass of wine and realize that my title is pretty crummy, that I am a terrible line editor of my own work, that I'm very glad he has gone through my words so carefully even though it means a rewrite of a couple of chapters and a few babies lying along the wayside.
He emails that evening to let me know that his scars have healed.
Jo Barney Writes
Website: www.jobarneywrites.com
Blog: breakoutnovelarace.blogspot.com
Friday, September 17, 2010
Now or forever hold my piece: an old lady blogs
The major one, I've been discovering lately, is that I seem to be losing my nouns. I had a lot of them once. I was a walking noun font. Friends in college remarked on my vast array of names of things. I wrote long essays full of them. Then, last week I spent a few days with college friends, old college friends, like fifty-years-ago college friends. We are all whole, only a bit dented in various ways, and my particular dent seemed to be leaking nouns. I was cooking the beautiful hunk of salmon. "Do you have any of those...green things, little round, come in a jar, also good in certain salads?" I asked.
"Capers?" answered my friend whose only age damage has been caused by the sun.
Ah, capers. A little later, I admired a plant in the window. A. . . Somewhere a synapse snapped. I said, "Shhhhh..." And then it came to me. Schefflera. I got it that time, but the next moment laid bare my noun deficit. "Just takes the Roloflex a while nowadays."
"Roladex," corrected the friend who is considering another ski season despite five broken and healed bones in her lower body.
It was all down hill from there on. Names of authors I love, titles of books I detail the plots of, even the mystery writer who writes sexy enough to get me anxious for Number 17. "I know she sounds a little Polish," I said.
"Grafton?" a friend who travels abroad a lot with her Kindle, but maybe without a map, offered.
Even though I was grateful for the name of my second-most favorite diversion, I said no. Another proper noun lost to a slow Rolaflex. Until about 2:00 a.m. when I sat up and said, "Evanovitch, probably Russian."
Sometime in all this noun escape, about the time I could not come up with the name of the device we needed to open our wine bottles, someone asked, "So what are you writing, Jo?"
"A mystery novel about an old lady who's chosen to clean up the graffiti-ed mail boxes in her neighborhood, Ellie. Ellie meets a goth girl who moves in with her named. . ." The girl, the novel, and Ellie have been my constant companions for the past year, and I can't come up with the raccooned-eyed fifteen-year-old upon whom the novel swivels. "Betsy," I lie.
About midnight, sorting through all of the conversations we've had that day, a voice says in a disgusted teen-age way, "Damn, Jo. I'm Sarah, Write it down somewhere." And I did.
Jo Barney Writes
Website: www.jobarneywrites.com
Blog: breakoutnovelarace.blogspot.com


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At St. Mary's, worship forms the heart of our community, from which all our core values flow. As a community, we gather weekly to worship the risen Christ. This grounds us and inspires us to reach out to our community and to care for one another.
Episcopal worship – Episcopal worship is guided by the Book of Common Prayer. We desire to be a people who are guided by God, not the other way around. We accomplish this by letting our tradition and liturgy order our lives as a reminder that God is our Lord and we are to follow his guidance. The kneeling, standing and reading all work together to help us Worship God and submit to Christ as our Lord.
Worship services – Our services have been described as "tradition done well." These services ground our community in the truth of Christ and bind us together as a worshipping community of followers of Christ. If you would like to become part of the St. Mary's community, come visit us on Sunday. Please make yourself known to an usher so that we may personally welcome you.
Family/Children – We are a Church that values growing deeper in relationship with one another. One of our chief responsibilities as a congregation is to help raise the children God has entrusted to us. Whether you are a parent, grandparent or have no children of your own, we want everyone at St. Mary's to see it as their role to help love and nurture the children entrusted to us. We have a nursery, Children's Chapel, Church School and welcome all kids into our services. One of the great joys of being a multi-generational congregation is having both young and old present when we gather.
Adults – For the adults in our midst, we have many ways to connect. The best way is to find a ministry you feel passionate about, whether it's a Bible study, being part of the Altar Guild (that sets the table for services) or serving coffee on Sunday mornings. We encourage you to get involved. This is the best way to meet people and grow in your faith.
Care – As Christ met people in all situations, so we desire to walk with people in good times and hard times. Whether its chronic sickness, job loss, end of life issues or something else, at St. Mary's our pastoral care ministries and groups try to meet people where they are. Look for our care ministries to help out or to get help.
St. Mary's is a vibrant community that seeks to worship Christ, love our neighbors as ourselves and serve the poor nearby and far away. We encourage you to come and join us for worship to see if this is where God is calling you or if we can be a step in your journey.