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|Written by Bryce McGlothlin
|Monday, 21 February 2011 10:34
February 27, 2003
The Board of School Trustees of the Bloomfield School District, of Greene County, Indiana, met in regular session on February 27, 2003, at 7:00 p.m. in the high school cafeteria in Bloomfield School District, 501 West Spring Street, Bloomfield, Indiana. The following school board members were present: Peggi Blakley, Randall Burcham, Nancy Canty, Steve Dowden, Keith Hanauer, Marvin Helms, and Richard Richeson. President Helms called the meeting to order at approximately 7:00 p.m. The following order of business was transacted with the President presiding:
1. Brief Comments and Information from Public on Agenda Items. President Helms told those present that thirty minutes would be set aside for comments on agenda items. Teachers, patrons, and students shared their feelings concerning Agenda Item #7 (A), Reduction in Number of Teaching Positions – Certified Nonpermanent Staff, and #7 (B), Reduction in Clerical and Teaching Assistant Positions – Support Staff. Those speaking included Ken Greves, Mandy McIntosh, Karlena Purcell, Kris Perry, Andy Ganster, Jack Huffman, Robert Just, Andrea Hagemeier, Becky Brown, Steve Uebel, Peggy Peek, Peg Harrah, Liz Luse, and Debbie Huffman.
2. Approval of Minutes. The Board had been provided with minutes of the special school board meeting and regular school board meeting both held on January 23, 2003, which had been prepared by corporation recording secretary Kelli Vandeventer. Nancy Canty made a motion to approve the minutes as presented. Peggi Blakley seconded the motion. The minutes were approved by a 7-0 vote.
3. Treasurer's Report. The Board had been provided with the Treasurer's Report, prepared by corporation treasurer Sue Pritts, consisting of the Appropriation Report and Claims Listing Report. Upon motion duly made by Steve Dowden and seconded by Randall Burcham, the Board by a 7-0 vote approved the Treasurer's Report.
4. Final Report Given on Refunding Bonds. Superintendent Hasler gave the Board a report on the possibility of refinancing the bonds of the Bloomfield School District School Building Corporation. (See attached) The report showed there would be no savings at this time. Mr. Hasler said that interest rates would continue to be monitored and that he would update the Board accordingly.
5. Board Approves Contract With Greene County Youth Alternatives. Superintendent Hasler explained that the Bloomfield School District had a contract with Greene County Youth Alternatives (GCYA) for a two-year period, which ended June 30, 2002. At that time GCYA was uncertain of its future. Now the GCYA has reorganized with Open Arms Christian Ministries (OACM). GCYA operates as a contracted service provider to Bloomfield School District. Under this agreement, the school would agree to purchase two "slots' for students under 16 years old. Students 16 and over would attend and GCYA would be reimbursed by our adult education funds from the state or payment from the students' family. Bloomfield School District currently does not have a qualified program for the adult education funds. He said that the term of this contract would be from July 1, 2002 to June 30, 2003 to coincide with the adult education funding schedule. Mr. Hasler asked the Board to approve the contract with Greene County Youth Alternatives. (See attached) Keith Hanauer made a motion to approve the contract per Mr. Hasler's recommendation. Steve Dowden seconded the motion, which passed by a 7-0 vote.
6. Board Votes to File Not-for-Profit Form. Superintendent Hasler told the Board that new filing requirements for Not-for-Profit organizations became effective January 1, 2003 that public schools had previously been exempt from. He asked the Board to approve the filing of Form NFP-20A as now required by the Indiana Department of Revenue. (See attached) Randall Burcham made a motion to authorize the administration to file Form NFP-20A per Mr. Hasler's recommendation. Nancy Canty seconded the motion, which passed by a 7-0 vote.
7. Boiler Inspections Proposal Information Given. Mr. Hasler explained that Graves Plumbing Company, Inc. had submitted a proposal to perform periodic monthly and annual inspections of the school district's boilers. (See attached) He explained that this was not a service that had been done in the past. Mr. Hasler said that while he agrees with the concept of this proposal, he did not believe the district should commit the necessary funds at this time. The superintendent brought this item to the Board for their information only. No Board action was required.
8. Reduction in Number of Nonpermanent Teaching Positions Approved. It was recommended that the Bloomfield School District full-time regular teaching contracts of Janis Shaw and James Brinson, the six-sevenths (6/7) time contract of Andrea Hagemeier, and the one-half (1/2) time contract of Eric Lyons be canceled effective at the end of the 2002-2003 school year. Randall Burcham made a motion to approve the recommendation as requested. Keith Hanauer seconded the motion. During discussion time board member Steve Dowden asked if the Board could vote on each teaching position individually. The superintendent asked if any board member was opposed to voting individually. There was no opposition voiced. Board member Nancy Canty stated that she intended to vote against the RIF's. Her reasons were that she felt that the Board and staff are at school for the children, ISTEP scores are up, and that there is a high number of students who further their education after graduating from Bloomfield Schools. Mrs. Canty said the employees work with students who have learning problems and that for some students school is the best thing that happens to them all day and she does not want those students to lose those learning opportunities, a mentor, or a role model. She said that if the Board starts eliminating teaching positions they start impacting the students and she will not do that. Mrs. Canty said she was going to vote no, but that she was also challenging all involved to work together and find other ways to save money. Board member Keith Hanauer said that none of the Board wanted to have to RIF anyone. He said that unfortunately the state law requires that schools run in the "black". He reiterated that the kids come first and he vowed to keep working to find ways to save money and hopefully save some teachers jobs. Peggi Blakley shared that in her opinion all parties need to get together. Ms. Blakley stated that she also planned to vote against the RIF's, but that she would only vote "no" once and if she saw nothing positive happening she would have to assume that the RIF's are necessary to save money. Member Randall Burcham told those in attendance that the Board has no choice due to the time frame set by state law and the bargaining agreement. He said that if the Board does not approve Mr. Hasler's recommendation the financial year for 2003 would most likely end in the "red", which is against the law. Steve Dowden agreed that if the RIF's are not done at this time the Board would be putting the school district at risk of deficit financing next year, which is illegal by the state. Mr. Dowden told those present that there is absolutely no doubt that the school district is in serious financial trouble right now. He continued that 90% of the general fund budget goes to salaries and benefits, which leaves 10% for utilities, maintenance, and programs. He said obviously the $300,000 that has to be cut from the budget will mostly have to be taken out of the general fund. He reminded the Board and those in attendance that the superintendent had already cut 30% from all general fund discretionary accounts, which shows that cuts in other areas are being made. Mr. Dowden said a reduction in employees is not an easy thing for the Board to do. He said the realities are that state funding is down, the KPT property tax loss, and the health insurance benefit. He stated that if the health insurance problem is not fixed it will continue every year. Mr. Dowden also told the crowd that the Board had made an offer on October 16, 2002, to the teachers' bargaining team to meet with them without any outside spokespeople present, just board members and teachers, and the board never received a response from the teachers' bargaining team. President Helms said that due to the untimely distribution from the state, the school had to borrow money to operate the rest of the year. He said that alone will cost the school one teaching position. This too was no fault of the Board. Superintendent Hasler said that education cuts in the biennium budget is one of the big problems the school is struggling with right now. He shared that the school had been running around 5% annual increases. For the last biennium that was cut to around 2% and our cash balance dropped from $818,000 to $497,000. He said that the Governor's proposal was for a straight-line budget. The house proposal is for a 2% increase with a 1.75% guarantee. Over $320,000 in General Fund cash balances has been dropped with that kind of funding, so even with that the school's finances will be in trouble. He provided the public with names of state senators and representatives that are in the Bloomfield School District and those that serve on both the education committee and the finance committee. He encouraged those concerned to contact those legislators. Concerning increasing costs of employee benefits, Mr. Hasler explained that last year the teachers' employee group did not agree to changing the health insurance benefit and their health insurance went up 25%. The administrators and support staff did accept a reduction in benefits that resulted in less than a 3% increase in health insurance. Referring to the KPT property tax loss the superintendent said that the district continues to be "hit" with an approximately $70,000 loss in local property tax revenue. The school district is not allowed to increase taxes to offset this loss. The General Fund portion of this loss is approximately $31,000 per year. He said that every fund had been borrowed from that the law allows. He explained that when a school runs short in a fund the only fund that can be used to make up the shortage is the General Fund, and unfortunately the General Fund is the problem being dealt with presently. Mr. Hasler said that state statute and the collective bargaining agreement dictates which teaching positions are reduced. Mr. Hasler told the crowd that in the past the district earned interest money in the cash balance, but now are forced to pay interest on money borrowed for cash flow due to local and state tax delays. He then reiterated information on teacher utilization, which is the reason for the Reduction in Force. President Helms told the Board it was time to vote on Mr. Hasler's recommendation. The recommendation was to cancel the Bloomfield School District full-time regular teaching contracts of Janis Shaw and James Brinson, the six-sevenths (6/7) time contract of Andrea Hagemeier, and the one-half (1/2) time contract of Eric Lyons effective the end of the 2002-2003 school year. The full-time regular teaching contract of Janis Shaw was canceled effective the end of the 2002-2003 school year by a 5-2 vote. Peggi Blakley and Nancy Canty cast the nay votes. (See attached) The full-time regular teaching contract of James Brinson was canceled effective the end of the 2002-2003 school year by a vote of 5-2. The nay votes were cast by Peggi Blakley and Nancy Canty. (See attached) The Board voted 5-2 in favor of canceling the six-sevenths time contract of Andrea Hagemeier, effective the end of the 2002-2003 school year. Peggy Blakley and Nancy Canty voted against the motion. (See attached) Next, the Board canceled the half-time contract of Eric Lyons by a 7-0 vote, effective the end of the 2002-2003 school year. (See attached)
9. Reductions in Clerical and Teaching Assistant Positions Approved. It was recommended that the full-time clerical position of Becky Neeley and the one-half time clerical position of Cindy Weatherholt be eliminated. It was further recommended that the full-time teaching assistant positions of Shanna Wilson, Doris Stout, and Stacy Helms as well as the part-time position of Cindy Riggins be eliminated. The teaching assistant position of Kathy Uebel will be reduced from full-time to one-half time. All of these reductions to become effective the end of the 2002-2003 school year. Becky Neeley will be offered a full-time teaching assistant position for the 2003-2004 school year due to a prior seniority understanding. Steve Dowden made a motion to approve Mr. Hasler's recommendation. Randall Burcham seconded the motion, which passed by a 6-1 vote. Peggi Blakley cast the nay vote.
10. Board Accepts Affiliation Agreements with Area Universities. It was recommended that the Board accept affiliation agreements and authorize the administration to sign them. The agreements are between Bloomfield School District and each of the following universities: Ball State University, Indiana University, and Purdue University. (See attached) This allows Bloomfield Schools to participate in teacher training opportunities to properly prepare students for a vocation in the field of education. It is imperative that colleges and universities graduate the best candidates possible for employment in education. Nancy Canty made a motion to approve the recommendation. Keith Hanauer seconded the motion, which passed by a 7-0 vote.
11. Collaborative Agreement with Wabash Valley Human Services Accepted. The Superintendent asked the Board to accept the collaborative agreement with Wabash Valley Human Services and authorize the administration to sign the same. (See attached) This agreement primarily allows collaboration between our primary teaching staff and the Head Start program. After proper releases are obtained, the elementary school can provide tracking and educational information regarding the success of Head Start graduates. Keith Hanauer made a motion to approve Mr. Hasler's recommendation. Nancy Canty seconded the motion, which passed by a 7-0 vote.
12. Board Approves Filing 2003 Summer School Reports. Superintendent Hasler asked the Board to approve filing the 2003 Summer School Estimated Instructional Costs Report and List of Courses. He explained that the report is due to the Indiana Department of Education by April 1, 2003. The Department of Education will notify school corporations by May 15, 2003 of the expected level of state reimbursement based on the estimated expenditures submitted. Category I classes will be reimbursed at 100%. Category 2 will be reimbursed at 75% (depending on funding – schools will be notified by May 15th if the funding is less than 75%). Category 3 will be reimbursed with any remaining funds. Randall Burcham made a motion to approve Mr. Hasler's recommendation. Richard Richeson seconded the motion, which passed by a 7-0 vote. Mr. Hasler said the filing of these reports does not necessarily mean that summer school will be held. It only assures that if the funding is provided we can hold summer school.
13. Change in 2002-2003 School Calendar Approved. Due to the number of snow days and snow delays the administration and teachers requested that the board approve changing the 2002-2003 calendar to end the third grading period on March 14, 2003 and send the third period report cards home on March 20, 2003. Superintendent Hasler recommended approval. Randall Burcham made a motion to accept the recommendation. Peggi Blakley seconded the motion, which passed by a 7-0 vote.
14. Collective Bargaining Update. Superintendent Hasler read a prepared Collective Bargaining Update to the Board and public. (See attached)
15. Comments and Information from the Public. Members of the audience made comments to the Board concerning the Reduction in Force action. Some present made comments and asked questions about the current health insurance benefits for teachers. Board member Randall Burcham announced that due to board policy this time in the meeting is set aside for the Board to receive information only. Superintendent Hasler told those present that anyone that has questions are more than welcome to make an appointment to meet in his office where he will have documents readily available and be able to answer their questions. Among those who spoke were Steve Uebel, Susan Riggs, Mandy McIntosh, Karlena Purcell, Peggy Peek, Andy Ganster, Jack Huffman, Ray Peek, Mary Katchmeyer, Liz Luse, Claudia Crane, Sherry Quakenbush, Mick Riddle, and Laci Bowersock.
16. Adjournment. There being no further business, Peggi Blakley made a motion to adjourn. Nancy Canty seconded the motion. The meeting was then adjourned by a 7-0 vote.


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Two men injured in Wilkes-Barre shooting, police seeking gunman
WILKES-BARRE - Police are seeking a man in connection with an apparently random shooting in the Heights early Friday that injured two people, including one man who is in critical condition with a gunshot to the head.
Jordan Stevens, 27, is a person of interest in the case.
Police said Mr. Stevens is believed to frequent the Brownsville neighborhood of Brooklyn, N.Y. Court documents from seven years ago list Wilkes-Barre as an address. He is approximately 5 feet 10 inches tall and weighs 170 pounds. He was last seen wearing a light-colored T-shirt, shorts and black or dark-colored footwear. He has several tattoos, including an image of the Grim Reaper from the elbow to the wrist of his right arm and the initials "J.T." on his right wrist.
Mr. Stevens is wanted by the state Department of Parole for a parole violation, is believed to be armed and dangerous and should not be approached, authorities said. Anyone with information may call 911 or Wilkes-Barre police at 570-208-4200.
The shooting took place near a staircase leading into the Boulevard Townhomes on South Welles Street about 12:45 a.m., according to police.
Surveillance footage shows three men returning to the complex and walking past the shooter, police said. Once the men were past the shooter, he turned, drew a gun and fired, according to police.
The shooter hit one victim in the head and another in the body, city Police Chief Gerard Dessoye said. The third man was not shot, he said.
Police had not made any arrests in the shooting as of Friday evening, but said the investigation is continuing. They did not release the names of the victims, citing an ongoing investigation.
The men were taken to Geisinger Wyoming Valley Medical Center in Plains Twp. to be treated. A man at the hospital who identified himself as the brother of one victim said the man was in the intensive-care unit Friday afternoon, but he declined to comment further.
Authorities said one man was still listed in critical condition Friday evening, while the other had been treated and released.
Police said preliminary investigations of the case didn't reveal a motive for the attack.
The shooting is the latest chapter in a violent summer for Wilkes-Barre, which has seen a rash of robberies and eight homicides - including seven shooting deaths and the death Monday of Shane Stewart, 25, of Fulton, Mo., who was hit by a vehicle driven by a friend during an argument over who should drive after a night out drinking.
CHRISTOPHER HONG and BILL WELLOCK, staff writers, contributed to this report.
Contact the writer: email@example.com, @cvjimhalpin on Twitter
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subset: commoncrawl


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Brush fire chars acreage behind Knott's Soak City
Chula Vista Fire crews from Chula Vista and San Diego quickly put out a fire Saturday that charred an acre of brush behind Knott's Soak City in Chula Vista.
The fire was reported just after noon on Vista San Javier, a San Diego Fire-Rescue dispatcher said. Thirteen units responded and were able to contain and put out the fire in two hours.
The fire did not damage any of the park's attractions and no injuries were reported, the dispatcher said.


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I'm bored nearly to bloody death, so I'm posting this in the hope it will inspire at least a small bit of activity in this otherwise relatively dead forum (for some reason I've been up at the time of night this place is near completely silent lately)
The premise of the thread is exactly what the topic says, what are your favorite console RPGs and why? The more esoteric and detailed whatever you say is the happier I'll be (yes, I really am that bored) and remember to use spoiler tags for anything important.
For now at least I'll stick to only the top 2, although I could actually run down a list of ten or more.
Xenogears: For the sheer depth of the characters, story, and world development. Also worth note is the use of religion in the game which nearly stopped it from being ported to America.
SpoilerOne of the most important villains in the game is the protagonist, the main enemy is...everybody since humanity has been recreated as part of a massive biological weapon, it makes use of Freud's writings on psychology to explain what happened to the protagonist as a child and why he acts that way, it has a positively inspired use of religion to manipulate people...
Suikoden II: The first Suikoden was good but not on this scale, in addition to all the normal reasons Suikoden is fun this particular entry in the series had easily the best protagonist and antagonist in addition to a story that appealed to me even more than average.SpoilerThe protagonist and antagonist are best friends, however due to the way the runes work they've been forced to fight eachother causing an enormous war in addition to the murder of a royal dynasty. I'm particularly fond of the way Joei poisons the king, by consuming poison himself until his blood is saturated immediately prior to an oath taking ceremony where the king has to drink some of his blood.


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The prime responsibility of the Mars Reconnaissance Orbiter has been to search out new landing sites for future missions.
Hi there, Curiosity here! NASA's next Mars rover! Getting ready for a wild ride to the red planet in 2011.
Read the Winning Student Essay which gave Curiosity it's name >>
Did Mars once have an environment capable of supporting life?
NASA's next rover will further unravel that mystery.
Video Candidate for a Mars Landing - Oct 11, 2007
The High Resolution Imaging Science Experiment in orbit around Mars has examined many possible landing sites for the Mars Science Laboratory rover, including the Nili Fossae area seen here.
Image Credit: NASA/JPL-Caltech/Univ.of Arizona
This animation demonstrates how the rover will enter, descend and land on the surface of Mars.


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The Andhra Pradesh government is planning to set aside R5,000-7,000 crore for a proposed loan waiver scheme to be announced at Wednesdays budget. This is part of the first phase of the total provisions made for the loan waiver scheme of the government to help farmers avail of fresh loans for this sowing season.
The government has already issued guidelines for the loan waiver scheme, which is estimated to cost around R43,000 crore to the state exchequer. Further, it has started compiling eligible borrowers' data to implement the R1.5-lakh limit per family. The complete data is expected to be ready in the next 2-3 months. At a recent interaction at Kurnool, chief minister N Chandrababu Naidu told FE that his government has decided to complete this 'issue' as soon as possible. We are working on all possibilities to complete the waiver scheme as part of our election promise. If the farmers choose to repay loans without waiting for the waiver, it would be in their best interests because they would be able to access fresh loans and still remain eligible for the waiver,' he said.
To begin with, the token provision of R5,000-7,000 crore would take care of the initial payments to the banks, said a senior official in the government. The banks have categorically said that only if the old loans are cleared, would there be fresh disbursement for the farmers. The government is also talking to different lenders, including a couple of banking institutions, besides auctioning red sanders and pledging future revenues of state PSUs for mobilising about R23,000 crore, a senior official said on condition of anonymity.
Accordingly, in its set of guidelines, the state government has asked farmers to repay the loan first and then seek reimbursement. The scheme would be applicable to crop loans, including gold loans sanctioned for raising crops extended by scheduled commercial banks, regional rural banks (RRBs) and cooperative banks in all the 13 districts of the state. The primary agriculture cooperative credit societies and farmers service cooperative societies, which are accredited to lending institutions for advancing direct agriculture crop loans to agricultural families, are also covered under the scheme.
The state government said for all those who have repaid the loan, the eligible amount would be credited to their account and they would be permitted to draw it as well. In case of those who have not repaid the loans, the amount would be released


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The Maryland football team has announced that it will hold a national signing day celebration, where Coach Randy Edsall and current players will introduce their 2013 recruiting class on Feb. 6 in the Stamp Student Union.
According to an athletics press release, coaches and players will be on hand to sign autographs. There's also a silent auction, raffle items and cash bar.
Video footage will be provided of each Maryland recruit, as well as analysis by a coach. The program's spring enrollees, including junior college all-American wide receiver Deon Long, offensive lineman Silvano Altimirano and four-star athlete Will Likely, will also be in attendance.
Maryland final recruiting class before its Big Ten move is currently ranked 33rd nationally, according to the 247sports.com composite rankings, but is not in the ESPN top 40. The Terps have oral commitments from, among others, highly touted offensive lineman Derwin Gray (Friendship) and Elite 11 quarterback Shane Cockerille (Gilman).They also remain in the mix for four-star offensive tackle Na'Ty Rodgers (McDonough) and local linebacker Yannick Ngakoue, Gray's teammate at Friendship.
The event begins at 5:30 p.m. Tickets are available at 301-314-7095 or email@example.com.


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Share your success!
Aprilaire´s vision is to be the indoor comfort partner of choice of the HVAC contractor and distributor. When we partner with the best in the business, and share successes, our entire industry grows and prospers.
Please tell us how YOU succeed at being the best in then business as an Aprilaire partner and Indoor Comfort solutions provider!
- Robin Johnson, High Road Heating & Cooling Co.
As far as working with Research Products for Humidifier sales it is one of the best decisions we ever made. We talk to potential customers and gain new customers. We install humidifiers, Aprilaire being the best but we also get repairs, maintenance and replacement calls based on our commitment to Aprilaire and their promotions.
- John Wuich, Wuich Mechanical Services
Quoting:"On the service side, when the techs go into the house they gets spiffed when they sell any accessories like a humidifier. Obviously the techs are in those houses a heck of a lot more than my sales people."
- Matthew Holtkamp, Holtkamp Heating & Air Conditioning
"Our philosophy is you live what you learn. Training is no good unless you utilize what you learn. When we send the new guy out for training we want everybody else doing what he learned at training."
- Brad Bartholomew, Bartholomew Heating and Cooling
Promoting:"We have had really good success doing the multiple promoting approach with newspaper, radio, and direct mail. Every month we do one week solid on the radio. I pay for it in advance so I am sure that it will get done. We find that this leads to people calling in all during the month."
- Rick Woods, Woods Mid-Atlantic Services, Inc.
"Indoor air quality is the most profitable aspect of our business. We make nice margins and we don't have to give it away to stay in business," said Woods who also admitted that he sometimes goes up against other companies selling a filtration job for $800 that Mid-Atlantic can sell for $1,600. "It doesn't make any sense to give something away that customers are willing to invest in."
- Roger Kenyon, Sourthwest A/C & Plumbing
I have been suffering this winter. I have been feeling horrible having swollen eyes and generally feeling miserable. ALL the time. I asked two of my solutions experts to separately research and find the best solution to address my issues. Cost was no issue. They both recommended the Aprilaire 5000 air cleaner. Since having it installed in my home ALL of my misery has disappeared. No more swollen eyes. No more feeling lousy. My wife has even commented how good she feels and how little dust there is in the house. I just wanted to take a moment to let you know how well this product has worked and how happy I am with its performance. Because it has performed so admirably, Southwest A/C will be featuring this product with every A/C system we sell with the hope that every purchaser will enjoy the benefits I have received from this wonderful product!


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How can I help my son sleep better in his bassinet?
My son is almost 3 weeks old, and I'm a first time mom. I noticed my son doesn't like to sleep in his bassinet for long. He will wake up screaming and has become an escape artist when it comes to the swaddle. He does however sleep great when in bed withe or being held. And when he is in his bed he will only sleep a full 3-4 hours if the tv is on or if my DH and I are in hearing distance. I have been guilty about letting him sleep with me when my DH is working at night, just so I can get some rest but I'm really afraid of SIDS and i wouldn't be able to live with myself if my baby died because of my carelessness. He is also very gassy and has a hard time making bowel movements. It looks like it hurts him and it wakes him up through the night. Any ideas or advice?
Posted: 05/01/2013 by hiskitten92
Mom Answers
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He might have reflux, which is why he's gassy, likes to be held and cries when he is on his back. My 2nd daughter had that and we'd swaddle her and lay her on her LEFT side (that way the weight of her body closed the mouth of her stomach and eliminated the burning reflux). We sleep with our 3rd daughter, but she lays on top of the comforter with a weight on the top (so it doesn't fold down on top of her). She has her own blanket and on the king-size bed we've never had even a scare so far. However, with the 2nd reflux baby we hung a small hammock over the bed and we'd swing her in ther all night rather than sleep with her and it was also great! If your son has a hard time having bowel movements it might just be all the gas accumulated--we used a glycerine suppository with my daughter just to help her gas it all and THEN poop. Stick it in, she pushes it out and gasses and you do it again, in 5 minutes all the gas is goneposted 05/01/2013 by keilahrose
.posted 05/02/2013 by hiskitten92
Answer this question


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PubMed Submission Abstract PDF Cover Contents Editorial Board Count: 3339 Download Count: 501
Lucy Vannella, Edith Lahner, Gianfranco Delle Fave, Bruno Annibale, Department of Digestive and Liver Disease, Hospital Sant'Andrea, II School of Medicine University Sapienza, 00189 Rome, Italy
Debora Gianni, Antonio Amato, Center for Thalassemic Disease of Rome, 00189 Rome, Italy
Enzo Grossi, Department of Medical Affair, Italian Diagnostic Center, 20100 Milan, Italy
Author contributions: Vannella L analyzed data and wrote the paper; Lahner E analyzed data; Delle Fave G and Amato A, Gianni D collected data; Grossi E and Delle Fave G revised the paper; Annibale B designed research and revised the paper.
Supported by (in part) Grants from the Italian Ministry for University and Research, MIUR, COFIN 2005 No. 0011222 and University Sapienza Roma and in part by a grant from Centro Diagnostico Italiano Milano, Italy
Correspondence to: Bruno Annibale, MD, Department of Digestive and Liver Disease, Sant'Andrea Hospital, 1035 Grottorossa Street, 00189 Rome, Italy. firstname.lastname@example.com
Telephone: +39-6-33775289 Fax: +39-6-4455292
Received: February 10, 2009 Revised: May 5, 2009
Accepted: May 12, 2009
Published online: June 14, 2009
AIM: To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori (H pylori) infection and celiac disease in women aged < 50 years affected by iron-deficiency anemia (IDA).
METHODS: One hundred and fifteen women aged < 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies (tTG) and anti-H pylori IgG antibodies. tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay (ELISA). All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum (n = 3), gastric body (n = 3) and duodenum (n = 4) in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh's System.
RESULTS: 45.2% women were test-positive: 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative (65.4% vs 42.8%; Fisher test P = 0.0239). The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test-negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for H pylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active H pylori infection was found. In particular, in 23 out of 28 (82%) patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body.
CONCLUSION: Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.
© 2009 The WJG Press and Baishideng. All rights reserved.
Key words: Iron deficiency anemia; Women; Celiac disease; Helicobacter pylori gastritis
Peer reviewer: Wai-Man Wong, MD, Department of Medicine, University of Hong Kong, St Paul's Hospital, 2 Eastern Hospital Road, Causeway Bay, Hong Kong, China
Vannella L, Gianni D, Lahner E, Amato A, Grossi E, Delle Fave G, Annibale B. Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women. World J Gastroenterol 2009; 15(22): 2748-2753 Available from: URL: http://www.wjgnet.com/1007-9327/15/2748.asp DOI: http://dx.doi.org/10.3748/wjg.15.2748
Iron-deficiency anemia (IDA) is common in women aged < 50 years with a prevalence of almost 5% in Western countries[1]. In this population, the balance of iron is often precarious due to menses, pregnancy and breastfeeding and an excessive menstrual flow is experienced by about 30% of women of reproductive age[2]. Menorrhagia is often considered the only cause of iron deficiency anemia, but some studies have shown the usefulness of a gastrointestinal (GI) tract evaluation by endoscopy, thus indicating a role of the upper and/or lower GI tract as a likely cause of IDA[3-4]. The vast majority of IDA GI causes affect the upper GI tract and, in particular, there is a high prevalence of conditions associated with iron malabsorption such as Helicobacter pylori (H pylori) related-pangastritis, celiac disease and atrophic body gastritis in IDA premenopausal women[5-6]. On the contrary, as already reported in previous studies, bleeding lesions are infrequent in these patients and in particular in women aged < 50 years[5-8].
The diagnostic workflow in young women affected by IDA is not clearly established. The British Society of Gastroenterology recommends gastroscopy only in IDA women younger than 45 years presenting with GI symptoms[9]. However, the major issue of GI evaluation is that symptoms are often mild and aspecific in IDA women and that gastroscopy is an invasive procedure associated with a high number of refusals[10]. Furthermore, in our previous work on IDA premenopausal women, gastroscopy was performed as part of the diagnostic protocol in all patients, but was deemed unnecessary in almost 30% of the studied women because they were affected only by menorrhagia[5].
As shown in a previous study, non-invasive tests might be helpful in the selection of IDA women having a high probability of being affected by iron malabsorption GI diseases, in order to better address endoscopy and to increase the patients' compliance to the procedure[11].
The aim of the present study was to prospectively evaluate the usefulness of a pre-endoscopic serological screening for H pylori infection and celiac disease with the use of two tests (human recombinant tissue transglutaminase IgA antibodies and anti-H pylori IgG antibodies) in women aged < 50 affected by IDA in order to increase the compliance for gastroscopy.
Between January and July 2006, 400 consecutive women (median age; 38 years) aged < 50 years with iron deficiency anemia were referred to the "Centro delle Microcitemie" of Rome, a public health institution specialized in the diagnosis of thalassemia. In these women the presence of an anemia emerged because they had previously undergone a complete blood count due to fatigue and/or for routine check-up, and were thus referred by their primary care physicians (60%), gynecologists (25.4%), hematologists (7.3%) or other physicians (7.3%) to the above mentioned center in order to exclude alpha- or beta-thalassemia minor, a frequent genetic disorder in the Italian population. In the "Centro delle Microcitemie", a complete blood count, serum iron and ferritin were repeated in all patients, and after the exclusion of a- and b-thalassemia, the presence of IDA was definitely diagnosed. IDA was defined as hemoglobin (Hb) < 12 g/dL with serum ferritin ≤ 20 mg/dL.
IDA women were invited to answer a structured questionnaire to assess demographic data, previous iron supplementation, previous blood transfusion, previous hospitalization for anemia, obvious causes of blood loss, use of drugs (such as aspirin/NSAIDs, proton pump inhibitors, anticoagulants), 1st degree family history for colon or gastric cancer, peptic ulcer and celiac disease, type of diet, premenopausal status and GI symptoms. The duration of anemia was expressed as length of time from first diagnosis of IDA (mo) based on medical records. Upper GI symptoms included nausea, vomiting, dysphagia, heartburn, dyspepsia and upper abdominal pain. Lower GI symptoms included diarrhea, constipation, lower abdominal pain and hematochezia. The symptom was considered "present" if the patient referred to its presence at least once a week during the last three months[10]. Premenopausal status was defined as the patients' personal reports that within 3 mo prior to evaluation they were still menstruating[5].
The women were excluded from the study if they had: age > 50, obvious causes of GI bleeding, previous diagnosis of GI diseases probably responsible for IDA based on medical records, anorexia, vegetarian diet, pregnancy, breastfeeding, anemia of chronic diseases (for example chronic renal failure, cirrhosis and severe cardiopulmonary disease) and hematological diagnoses (e.g. aplastic anemia, myelodysplasia).
Study design
As shown in Figure 1, out of the initial 400 women with IDA, 145 women were considered eligible for the study (Figure 1). The diagnostic work-up included serological tests for the testing of anti-H pylori IgG antibodies to evaluate the presence of H pylori infection and tissue transglutaminase IgA antibodies to diagnose celiac disease. However, 30 women refused screening tests and thus, 115 women were included in the study and gave their informed consent.
Thus, 115 women were referred to University Gastroenterology Department to pick up test results and were invited to undergo upper GI endoscopy to confirm test results. Patients with at least one of the 2 tests positive were defined as "test-positive" patients, those with all 2 tests negative were defined as "test-negative" patients.
Serologic testing: Human recombinant tissue transglutaminase IgA antibodies were assessed using an enzyme-linked immunosorbent assay (ELISA) based on a commercially available kit (Bio-Rad Laboratories, Milan, Italy). A titre > 15 UI/mL was considered positive. H pylori IgG antibodies were assessed using an enzyme-linked immunosorbent assay (ELISA) based on a commercially available kit (Biohit, Helsinki, Finland). A titre > 1.1 UI/mL was considered positive.
Gastroscopy and histological evaluation: During gastroscopy, biopsies were collected from antrum (n = 3), gastric body (n = 3) and duodenum (n = 4) in all patients, irrespective of tests results. The assessment of gastritis was performed according to the Sydney system[12]. Pangastritis was defined as the presence of acute and chronic inflammatory infiltrate both in the gastric antrum and body as previously described[13]. If the sum of the inflammatory scores (acute and chronic) showed a two-grade difference between the antrum and corpus, the gastritis was considered as "antrum-predominant" or "corpus-predominant", respectively. Antrum-restricted gastritis was defined by the presence of acute and chronic inflammatory infiltrate exclusively in antrum according to the Sydney system[12]. Celiac disease was classified by Marsh's System[14]. The pathologist was unaware of the serological screening results.
Statistical analysis
Standard descriptive statistics was expressed as median and range and evaluated by appropriate statistical test (Mann-Whitney). Proportions were compared with the Fisher exact test. P < 0.05 was considered statistically significant.
Clinical features
The women included in the study had a median age of 38 years (range 21-50 years) and the median duration of IDA was 12 mo (range 1-408 mo). The value of median hemoglobin was 10.7 (range 7.3-11.9) g/dL, MCV was 72 (range 51-92) fL and ferritin was 10 (range 1-20) mg/L. Oral iron therapy was previously prescribed in 48 (41.7%) women. Only a small number of patients had previously needed blood transfusion (n = 3, 2.6%) or hospitalization for anemia (n = 8, 7%).
At least one symptom of the upper GI tract was present in 49.6% of patients (n = 57), while 57.4% of patients (n = 66) had a least one symptom of the lower GI tract. Reported GI symptoms were mainly non-specific, such as mild abdominal pain (24%) and bloating (46%). The vast majority of patients had a negative family history for GI diseases (80.8%): a family history for GI cancers or peptic ulcers was present only in 4.3% and 14% of patients, respectively. In 91.3% of women a premenopausal status was present.
Serological tests
Fifty-two out of 115 patients (45.2%) were "test-positive". Of these, 41 (35.6%) patients had positivity for H pylori IgG antibodies, 9 (7.8%) patients for tissue transglutaminase IgA antibodies and 2 (1.7%) patients had positivity for both antibodies. As shown in Table 1, the group of patients with positive tests was not different from that with negative tests as far as clinical and biochemical features were concerned.
Gastroscopic/histological findings
"Test-Positive Patients": Four women did not undergo gastroscopy because they become pregnant after the start of the study. Of these, 3 patients had positive H pylori antibodies and 1 patient positive tissue transglutaminase IgA antibodies. Fourteen patients refused the invasive procedure, 12 out of these patients had positive H pylori antibodies and 2 patients had positive tissue transglutaminase IgA antibodies. Thus, 34 out of 52 (65.4%) "test-positive" patients consented to the upper GI endoscopy and the results are shown in Table 2.
Twenty-eight patients had positive H pylori antibodies, and in all these patients an active H pylori infection was found. Celiac disease was confirmed only in 4 out of 8 (50%) patients with positive tissue transglutaminase IgA antibodies, whereas in another patient who underwent gastroscopy for positive H pylori antibodies, celiac disease was also found. Of the 5 patients with celiac disease, 4 had Marsh 3 and 1 had Marsh 2.
In Table 3, the extent and the degree of H pylori-related gastritis is shown. Five IDA women with positive H pylori antibodies had exclusively antrum-restricted gastritis with active H pylori infection. In the remaining patients (n = 23), a pangastritis with active H pylori infection was present which in 91.3% of cases showed equal severity of the inflammatory score in antrum and corpus. Thus, in 23 out of 28 (82%) patients with positive H pylori antibodies, a likely cause of IDA was found because the active inflammation involved the gastric body.
"Test-Negative Patients": Three women could not undergo gastroscopy because they were pregnant, and 33 patients refused the procedure. Thus, 27 out of 63 (43%) "test-negative" patients underwent upper GI endoscopy. In 22 out of 27 (81.5%) patients, the negative serological tests results were confirmed because no gastroscopic/histological finding was revealed; instead in the remaining 5 patients H pylori gastritis was diagnosed (Table 2). In particular, 3 likely causes of IDA were misdiagnosed because 2 patients had "antral-predominant" chronic gastritis and 1 patient had atrophic body gastritis (Table 3).
The compliance rate of test-positive women (65.4%) was significantly higher than that of test-negative ones (42.8%) (Fisher test P = 0.0239). Patients undergoing gastroscopy were similar to the group of included patients in the study for demographic, clinical and biochemical data. Moreover, for these parameters, the group of dropped-out test-positive and test-negative patients was not different from those test-positive and test-negative patients who underwent gastroscopy (data not shown).
Diagnostic performance of tissue transglutaminase and anti-H pylori antibodies in IDA
On the basis of these results, the sensitivity, the specificity, and the positive and negative predictive values of tissue transglutaminase IgA antibodies for the diagnosis of celiac disease were 80%, 92.8%, 50% and 98.1%, respectively. The sensitivity, the specificity, and the positive and negative predictive values of anti-H pylori antibodies for the diagnosis of H pylori infection were 84.8%, 100%, 100% and 84.8%, respectively.
In the present study, 115 women aged < 50 years with unexplained IDA were tested by anti-H pylori IgG antibodies and human recombinant tissue transglutaminase IgA antibodies to diagnose H pylori infection and celiac disease. Almost half of the studied patients tested positive for at least one serological assay, and the suspicion of an upper GI disease as likely cause of IDA, raised by the serological result, was confirmed by gastroscopy in 100% of those with positive H pylori antibodies and in 50% of those with positive tissue transglutaminase IgA. On the other hand, in only 11% of test negative patients, gastroscopy with biopsies yielded a finding which may be interpreted as a likely cause of IDA (2 H pylori-related antrum predominant pangastritis and 1 atrophic body gastritis). Thus, these findings indicate that in women aged < 50 years with IDA, the dual-step approach e.g. serological tests and then invasive procedure, may be considered as a useful tool to optimize the use of gastroscopy, avoiding useless procedures, and to reduce the number of expensive histological examinations.
Previous studies have shown that the presence of GI symptoms or the severity of anemia were related to higher risk of GI causes of IDA[3,5-6]. In this study, no difference was found between test-positive and test-negative patients in terms of personal data, clinical and biochemical features including the frequency of upper GI symptoms and Hb values. Therefore, our results show that GI evaluation is of poor utility to target IDA patients for gastroscopy, strengthening the usefulness of the pre-endoscopic screening by serological tests.
H pylori infection was found in 35.6% of the investigated women, confirming the strong association between H pylori infection and IDA observed in previous epidemiological studies[15-16]. Since H pylori IgG antibodies do not discriminate between active or previous infection, they are not generally considered useful for diagnosing H pylori infection[17]; in this clinical setting of IDA women, H pylori antibody-positivity was always associated with active infection as shown by histological data (Table 3). Moreover, 82% of patients with H pylori antibody-positivity had gastritis involving the gastric body, while only five cases had an antrum-restricted gastritis. In fact, only when the inflammation involves the gastric body, the acid secretion is reduced and the iron absorption is impaired, is there a consequential IDA[13,18]. The presence of positive H pylori antibodies, in a patient at high risk for iron malabsorption diseases, supports the need of an accurate gastroscopic/histological evaluation with antral and corporal biopsies to define the extent of gastritis and eventually its association with IDA. In our clinical setting, we observed 100% specificity and positive predictive value as well as a sensitivity of 85% for the H pylori antibodies assay. On the basis of this result, we believe that the assay of H pylori antibodies may be considered useful in the selection of IDA women aged < 50 years to submit for gastroscopy, also keeping in mind that this serological test is widely available and cheap and, for this reason, it may be used in the primary care.
Human recombinant tissue transglutaminase IgA antibodies were found to be positive in almost 7% of all patients. This antibody was chosen as screening test for celiac disease, because it is based on ELISA assay and is more accurate compared to the immunofluorescence method used for determining endomysial antibodies[19]. Our results showed a good sensitivity (80%), and specificity (93%) of the assay in keeping with a recent meta-analysis[20]. Our study confirmed also the poor positive predictive value (50%), which is a well known limit of this serological assay. Yet, this value is higher than the one (28%) reported in previous literature[21]. This difference may be explained by the fact that the women included in the present study were anemic and thus were at high risk for celiac disease[22]. Considering the occurrence of false positives of the tissue transglutaminase assay, even in this particular clinical setting, the need for a histological confirmation of celiac disease diagnosis is confirmed.
The main limitation of this work is the small size of the sample, in part due to the high percentage of patients who have refused to participate in the study and of those who, once included, refused gastroscopy. Thus, our findings suggest that the pre-selection of young women for gastroscopy by non-invasive serological testing is able to increase compliance for the invasive procedure. In fact, the compliance rate of test-positive women was significantly increased with respect to those test-negative (65.4% vs 42.8%; Fisher test P = 0.0239).
In conclusion, half of IDA women aged < 50 years tested positive to serological screening for H pylori infection and/or celiac disease, and gastroscopy with biopsies confirmed in the vast majority of them the presence of active H pylori gastritis involving gastric body, or celiac disease, as possible causes of IDA. Thus, two simple and widely available tests (tissue transglutaminase IgA antibodies and anti-H pylori IgG antibodies) are able to select women with IDA to submit for gastroscopy to identify IDA-related GI causes.
Iron-deficiency anemia (IDA) is common in women aged < 50 years. Menorrhagia is often considered the only cause of iron deficiency anemia, but some studies have shown the usefulness of a gastrointestinal (GI) tract evaluation. The vast majority of IDA GI causes affect the upper GI tract and there is a high prevalence of conditions associated with iron malabsorption such as Helicobacter pylori (H pylori) related-pangastritis, celiac disease and atrophic body gastritis in IDA premenopausal women.
Research frontiers
The diagnostic workflow in young women affected by IDA is not clearly established. The British Society of Gastroenterology recommends gastroscopy only in IDA women younger than 45 years presenting with GI symptoms. However, symptoms are often mild and aspecific in IDA women and the gastroscopy is an invasive procedure associated with a high number of refusals. In a previous work on IDA premenopausal women, gastroscopy was performed in all patients, later deemed unnecessary in almost 30% of the studied women because these were affected only by menorrhagia.
Innovations and breakthroughs
This study showed that two simple and widely available tests, ie those for tissue transglutaminase IgA antibodies and anti-H pylori IgG antibodies, are able to select women with IDA to submit for gastroscopy to identify IDA-related GI causes and to increase the compliance for the invasive procedure. Gastroscopy with biopsies confirmed in the vast majority of IDA women the presence of active H pylori pangastritis, atrophic gastric body, or celiac disease as possible causes of IDA.
This study showed that a pre-endoscopic serological screening for H pylori infection and celiac disease is useful to select IDA women having a high probability of being affected by iron malabsorption GI diseases and to increase the patients' compliance for the procedure.
Pangastritis: H pylori-related gastritis involving the antrum and the body of the stomach. Malabsorptive diseases: diseases related to iron-malabsorption that include H pylori-pangastritis, atrophic body gastritis and celiac diseases.
Peer review
The paper is interesting to study the usefulness of non-invasive test to select women with IDA for gastroscopy. These findings may be not applicable to other countries if the prevalence of celiac disease or H pylori infection are low.
1 Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997; 277: 973-976 PubMed DOI
2 El-Hemaidi I, Gharaibeh A, Shehata H. Menorrhagia and bleeding disorders. Curr Opin Obstet Gynecol 2007; 19: 513-520 PubMed DOI
3 Bini EJ, Micale PL, Weinshel EH. Evaluation of the gastrointestinal tract in premenopausal women with iron deficiency anemia. Am J Med 1998; 105: 281-286 PubMed DOI
4 Fireman Z, Zachlka R, Abu Mouch S, Kopelman Y. The role of endoscopy in the evaluation of iron deficiency anemia in premenopausal women. Isr Med Assoc J 2006; 8: 88-90 PubMed
5 Vannella L, Aloe Spiriti MA, Cozza G, Tardella L, Monarca B, Cuteri A, Moscarini M, Delle Fave G, Annibale B. Benefit of concomitant gastrointestinal and gynaecological evaluation in premenopausal women with iron deficiency anaemia. Aliment Pharmacol Ther 2008; 28: 422-430 PubMed
6 Carter D, Maor Y, Bar-Meir S, Avidan B. Prevalence and predictive signs for gastrointestinal lesions in premenopausal women with iron deficiency anemia. Dig Dis Sci 2008; 53: 3138-3144 PubMed
7 Park DI, Ryu SH, Oh SJ, Yoo TW, Kim HJ, Cho YK, Sung IK, Sohn CI, Jeon WK, Kim BI. Significance of endoscopy in asymptomatic premenopausal women with iron deficiency anemia. Dig Dis Sci 2006; 51: 2372-2376 PubMed DOI
8 Kepczyk T, Cremins JE, Long BD, Bachinski MB, Smith LR, McNally PR. A prospective, multidisciplinary evaluation of premenopausal women with iron-deficiency anemia. Am J Gastroenterol 1999; 94: 109-115 PubMed DOI
9 Goddard AF, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology. Gut 2000; 46 Suppl 3-4: IV1-IV5 PubMed
10 Baccini F, Spiriti MA, Vannella L, Monarca B, Delle Fave G, Annibale B. Unawareness of gastrointestinal symptomatology in adult coeliac patients with unexplained iron-deficiency anaemia presentation. Aliment Pharmacol Ther 2006; 23: 915-921 PubMed DOI
11 Annibale B, Lahner E, Chistolini A, Gailucci C, Di Giulio E, Capurso G, Luana O, Monarca B, Delle Fave G. Endoscopic evaluation of the upper gastrointestinal tract is worthwhile in premenopausal women with iron-deficiency anaemia irrespective of menstrual flow. Scand J Gastroenterol 2003; 38: 239-245 PubMed
12 Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181 PubMed DOI
13 Capurso G, Lahner E, Marcheggiano A, Caruana P, Carnuccio A, Bordi C, Delle Fave G, Annibale B. Involvement of the corporal mucosa and related changes in gastric acid secretion characterize patients with iron deficiency anaemia associated with Helicobacter pylori infection. Aliment Pharmacol Ther 2001; 15: 1753-1761 PubMed DOI
14 Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue'). Gastroenterology 1992; 102: 330-354 PubMed
15 DuBois S, Kearney DJ. Iron-deficiency anemia and Helicobacter pylori infection: a review of the evidence. Am J Gastroenterol 2005; 100: 453-459 PubMed DOI
16 Cardenas VM, Mulla ZD, Ortiz M, Graham DY. Iron deficiency and Helicobacter pylori infection in the United States. Am J Epidemiol 2006; 163: 127-134 PubMed DOI
17 Cutler AF, Prasad VM. Long-term follow-up of Helicobacter pylori serology after successful eradication. Am J Gastroenterol 1996; 91: 85-88 PubMed
18 Annibale B, Capurso G, Lahner E, Passi S, Ricci R, Maggio F, Delle Fave G. Concomitant alterations in intragastric pH and ascorbic acid concentration in patients with Helicobacter pylori gastritis and associated iron deficiency anaemia. Gut 2003; 52: 496-501 PubMed DOI
19 Lewis NR, Scott BB. Systematic review: the use of serology to exclude or diagnose coeliac disease (a comparison of the endomysial and tissue transglutaminase antibody tests). Aliment Pharmacol Ther 2006; 24: 47-54 PubMed DOI
20 Zintzaras E, Germenis AE. Performance of antibodies against tissue transglutaminase for the diagnosis of celiac disease: meta-analysis. Clin Vaccine Immunol 2006; 13: 187-192 PubMed DOI
21 Hopper AD, Cross SS, Hurlstone DP, McAlindon ME, Lobo AJ, Hadjivassiliou M, Sloan ME, Dixon S, Sanders DS. Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool. BMJ 2007; 334: 729 PubMed DOI
22 Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 2006; 131: 1981-2002 PubMed DOI
S- Editor Tian L L- Editor Logan S E- Editor Yin DH


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Ask a Pediatrician Online and Get an Answer ASAP
I have noticed in the last few weeks my baby has a black colored tongue toward the middle and back of her mouth. What could cause this?
She is not taking any supplements or on any medications except sometimes takes gas drops
Hi there how old is your baby?
9 months
I am not sure how to access my answer
You just need to wait for my response and then respond in time as in a chat
Does her mouth smell?
no it smells normal
Does the black colored film scrape or wipe off?
So tongue films are actually common and have more to do with the microenvironment and anatomy of ones taste buds in ones mouth which is an individual thing. With blackish color I first think of magnesium type medicines like pepto bismal but this is not the case as she isn't taking medicines. Homepathic physicians actually use the tongue film to make diagnosis when used in conjunction with other criteria (I never really understood this one)....
She may have long papillae or taste buds that don't slough off enough and then get somewhat oxidized at the tips and turn dark. Does the film scrape off?
I tried but it dosnt seem to scrape off but maybe I was being too easy and it was difficult getting her to let me do
She is otherwise healthy right?
Is she teething or having a cold lately?
she just cut her first tooth and has had a couple of colds in the last few months
So when you breathe a-lot through your mouth you can also develop a film on the tongue but you would notice it coincidides with the cold symptoms, it could also have something to do with the change in her mouth's environment from teething. Truth be told if it doesn't bother her I would leave it totally alone. It is not worrisome. Tongue films are a personal thing and are not dangerous. If she had candida or thrush it would be obviously white and scrapable and this would be treated. Not much else will tend to infect the mouth in a baby her age. Just out of curiosity what did her Pedi say?
she asked me if she was taking polyvisol vitamins because sometimes that can change the color but I told her she is not taking any. should I just use a small bristle toothbrush and see if it scrapes off?
Not really just leave it alone, brushing the tongue is part of her new tooth brushing routine but don't go overboard. The thought of polyvisol with iron drops is a good one as the iron residue could deposit on her tongue.
could the iron residue from her formula do that as well
Most people who have tongue films notice that they change so probably it won't last but it is not concerning. I doubt the iron from her formula could do it as she has had the formula for a while and the vitamen drops are extra concentrated and metallic looking/smelling.
The formula's iron is not as concentrated in such a small amount of liquid, the vitamen drops look like car rust....
ok that makes me feel better. Just want to make sure it is nothing serious
Don't worry and I would not scrape her tongue or she'll forever hate you brushing it lightly as part of your routine. If you want to take pictures and compare in a few weeks just for kicks go ahead. If you notice weird rash outside her mouth or feel that the black area is extending beyond her tongue it would need to be looked at just in case. Good Luck! If you felt that this was helpful please accept. Have a great rest of the day!
you too. thanks alot
.My daughter has been taking Norditroping 0.35mg/day past


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VATICAN CITY — Thomas Williams, the onetime public face of the disgraced Legion of Christ religious order who left the priesthood after admitting he fathered a child, is getting married this weekend to the child's mother. The bride is the daughter of former U.S. Ambassador to the Holy See Mary Ann Glendon, one of Pope Francis' top advisers.
Glendon, a Harvard University law professor, is one of the highest-ranking women at the Vatican as president of the Pontifical Academy for Social Sciences. She is also one of five people on Francis' commission to reform the scandal-marred Vatican bank. Her daughter, Elizabeth Lev, is a Rome-based art historian and columnist for the Legion-run Zenit news agency, which Williams published for more than a decade while he was in the order.
Williams, a moral theologian, author, lecturer and U.S. television personality, admitted last year that he had fathered a child several years earlier.
At the time, Williams apologized for "this grave transgression" against his vows of celibacy and said he had stayed on as a priest because he hoped to move beyond "this sin in my past" to do good work for the church. The Legion's retired superior later admitted he had learned about the child in 2005 but allowed Williams to keep teaching and preaching about morality.
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After taking a year off for reflection, Williams left the priesthood in May to care for his son. According to their wedding registry, he and Lev are to marry Saturday in the United States.
Asked for comment Thursday, Lev confirmed the wedding plans in an email, adding: "We have no intention of ever discussing our personal life in this forum."
She had initially denied an intimate relationship with Williams, though they frequently appeared together in American circles in Rome, particularly with visiting U.S. student and Roman Catholic tour groups.
Their wedding raises some uncomfortable questions: Who beyond Williams' superior in the church knew about the child while the couple tried to cover it up? Was Williams already in a relationship with Lev when she became a regular contributor to the magazine he published? And did the family ties to Williams influence Glendon in her defense of the Legion and its disgraced founder despite credible reports that the founder was a pedophile?
The questions swirled Thursday as the Legion dropped a bombshell of its own, admitting that a superior who was in charge of the bulk of its American priests-in-training for over a decade sexually abused a minor at the Legion's novitiate in Cheshire, Conn. The Legion said a second accuser had also come forward with an allegation against the Rev. William Izquierdo, who was novice director at the Cheshire school from 1982-94 and in Ireland before then. Izquierdo, now 85, has dementia.
The saga of the Legion of Christ represents one of the most egregious examples of how the Vatican ignored decades of reports about sexually abusive priests as church leaders put the interests of the institution above those of the victims.
The Rev. Marcial Maciel founded the Legion in 1941 in Mexico and oversaw its growth into a large and prominent congregation despite credible reports that he was a drug addict and child molester. After his death in 2008, the Legion admitted that he fathered three children and sexually abused his seminarians.
In 2010, the Vatican took over the order and a papal delegate has been overseeing a reform and "purification." In January, the Legion will elect a new leadership and approve a new set of constitutions.
The Legion scandal has been particularly damaging to the Vatican because Maciel was held up by Pope John Paul II and his cardinals as a model for the faithful, with the order admired for its orthodoxy and ability to bring in money and new priests.
Like all Legion priests, Williams had been a staunch defender of Maciel. When Maciel's double life became public in 2009, Williams told the Catholic ETWN program that the revelations were a "very, very hard blow to all of us."
Until he left active ministry, Williams was the most publicly prominent priest in the 950-strong order. He is the author of such books as 2008's "Knowing Right From Wrong: A Christian Guide to Conscience," and was a commentator for the U.S. broadcaster CBS. He was the superior of the Legion's general directorate in Rome in the late 1990s and early 2000s.


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Engineering fees generate debate
Proposed engineering fees and design work generated discussion over the costs at the April 27 meeting of the county commissioners.
Commissioner Chair Alan Hall presented information about from the county contracted engineering firm regarding generators for the courthouse, county office building and the Chenango St. property.
Commissioner Michael Giangrieco said, "It's too much money for what they provide us."
He suggested the county get prices from other firms for comparison before approving the expenditure.
Hall said, "This is the company we chose to be the county's engineering firm."
The $19,000 quote was for only the engineering and design work of the proposed project, Hall said.
He said the generator in the courthouse was not sized correctly to handle the necessary operations in the courthouse.
Hall also said there was currently no generator at the Chenango St. property.
Susquehanna County Conservation District and Penn State Cooperative Extension are housed in the building. The county morgue is located in the garage of the property. The morgue does have an alarm system in case power to the building is lost.
Giangrieco perused the proposal prior to the meeting. And Commissioner MaryAnn Warren said she had no chance to read the document before the meeting.
The commissioners said they will continue to review the generator issue.
In other business, the commissioners approved the purchase of four computers and four scanner for the Clerk of Courts office and a contract with Infocon to image specific files. Total cost of the project is about $13,399 which will be reimbursed by the Administrative Officer of Pennsylvania Courts (AOPC).
Three dispatcher trainees were hired in the 9-1-1 department: Garrett Schneider, John Stackowitz and Peter Lee.
Carol Ainey, of Hop Bottom, was hired as the addressing/GIS Clerk in the 9-1-1 department.
The commissioners also acknowledged the transfer of Michael Harlost, by County Register & Recorder Mary Evans, from a part-time clerical position in the Register & Recorder's office to the position of 3rd Deputy Register & Recorder.
Alan Sivers submitted the highest bid of $1,501 for the 2004 Ford Explorer and was awarded the bid by the commissioners.
A Children & Youth service agreement was also signed by the county.
Warren noted that the county was now closer to reaching a Memorandum of Understanding with the County Conservation District which will become independent from the county on June 28.
Audience member Craig Stevens alleged to the commissioners that Vera Scroggins, who was also in attendance at the meeting, had been assaulted by a Montrose borough councilman at the showing of "FrackNation" at the Montrose Theatre. He said law enforcement was now involved.
Stevens said, "Our community should not be torn apart because of a difference of opinion."
He also spoke of a situation in Bradford County where he said production costs were now being removed from royalty checks paid to landowners.
He also said that he had been contacted by about 20 state senators from New York to tour natural gas development sites in Susquehanna County.
Stevens questioned why no one from this area showed an interest in taking a similar tour that looked at the gas industry prior to development in the area.
Cheryl Matulevich said that in 2008, prior to the ramp up of drilling, the Susquehanna County Farm Bureau sponsored a presentation by Asher Terwilliger of the Chemung County Farm Bureau and a landowner advocate who addressed natural gas drilling and leasing concerns at the time.
The Progress Authority, the agency that handles economic development activities in the county, also took an informational trip to the Barnett shale region in Wise County, Texas in August 2008.
Audience member Bruce Paskoff asked if the commissioners had given any consideration to purchasing a "noise meter" to monitor compressor stations in the county.
Hall said it was not the county position to do that. He said the compressor stations are tested and certified by an engineering firm and that information is available.
One audience member said, "The alternative to local drilling is to rely on foreign oil." The alternative: "What are we going to do – freeze in the dark?"
"There are problems (with natural gas development) but there are also benefits," the man added.


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Definition of Abducent nerve
Abducent nerve: The sixth cranial nerve, which emerges from the skull to operate the lateral rectus muscle. This muscle draws the eye toward the side of the head. Paralysis of the abducent nerve causes inward turning of the eye.
Last Editorial Review: 3/19/2012
Back to MedTerms online medical dictionary A-Z List
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Are there plans for more 64bit OSes to be available for Zimbra, in addition to RHEL4 64 and RHEL5 64?
Having a 64bit version for Ubuntu, OpenSUSE and SLES10 perhaps?
The downloads and the PM website do not indicate if further 64bit support will be available:
SourceForge.net: Files
Zimbra Product Portal


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KraftMaid Storage Solutions:
For the Kitchen
Wall Filler Pullout
A slim cabinet that's big on storage. Fits in space meant for 3" filler and offers storage shelves for spices and more. Great next to your cooktop.
Solution Details
|Other Zones:
|Cooking, Food, Preparation, Specialty
|Installation Options:
|Factory installation required
Larger view
- Adjustable Drawer Dividers
- Base Blind Corner w/ Chrome Swing-out
- Base Built-in Microwave Cabinet
- Base Cooking Center
- Base Cookware Storage Roll-out
- Base Deep Drawer Combination
- Base Double Door with Four Trays
- Base Drawer Buffet
- Base Liter Bottle
- Base Microwave Cabinet
- Base Mixer Shelf
- Base Pots and Pans Organizer Roll-out
- Base Pots and Pans Storage
- Base Stainless Perforated Pull-out
- Base Super Storage
- Chopping Block
- Cutting Board Door Rack
- Deluxe Roll-out Trays
- Drawer Storage Angle
- Easy Reach Super Susan
- Easy Reach Wood Lazy Susan
- Floating Island Base
- High Back Roll-out Tray
- Knife Section Cutting Center
- Lazy Susan
- Lazy Susan Angle
- Microwave Cooking Center Drawer Storage
- Passport Base Single Door w/Tray Divider
- Passport Lazy Susan
- Passport Three Drawer w/Cutting Center
- Plate Caddy
- Pull-out Table
- Reverse-a-Shelf
- Roll-out Trays
- Sink Base Door Storage
- Spice Drawer Cabinet
- Spice Drawer Insert
- Spice Rack
- Spice Rack Kit
- Tiered Drawer Dividers
- Tiered Storage Shelf
- Tray Dividers
- Wall Angle w/ Lazy Susan
- Wall Appliance Garage
- Wall Filler Pullout
- Wall Lateral Bi-Fold Cabinet
- Wall Microwave Cabinet with Drawer
- Wall Microwave Shelf
- Wall Top Hinge Cabinet
- Wicker Base Spice Drawer Cabinet
- Wood Tiered Drawer Storage


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Worked With:
Samantha Bee
Birth Name: Samantha Bee
Born: 10/25/1969
Birth Place: Toronto, Ontario, CA
Born: 10/25/1969
Birth Place: Toronto, Ontario, CA
Born and raised in Toronto, Canada, Bee was interested in pursuing drama from an early age; she traveled to Montreal to study theater at Canada's prestigious McGill University, and upon returning to Toronto after college, joined a succession of sketch comedy troupes, including Catch 21 and The Atomic Fireballs. While performing in The Atomic Fireballs, she managed to get on the radar of "The Daily Show" producers, who are always looking for fresh comedic talent to bring onto the program, and surely aware that Canada turns out an astonishingly high rate of comedians per capita.
Bee began her tenure with "The Daily Show" in 2003, and in her time with the series, explored numerous quirky and... Continue Bio >>
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May 31, 2016
A silent auction at Rush Hospital Thursday will benefit the newly formed Rush Health Systems Employee Benevolent Fund.
The fund was established to provide financial assistance to employees and their families in times of hardship.
"We're hoping to raise some money so our benevolent fund will have more funds for future needs," said Donnie Smith of Rush Human resources. "Our employees, all employees in any company experience needs in times of financial hardship and we want to be able to respond to those needs."
Rush employees and local businesses donated over 175 items.
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Spotlight: The Garden Delight Collection
Have I told you about my Asparagus Shawl? I think I've only mentioned it in passing.
I started it in April and have found it to be good TV and travel knitting since it is mainly garter stitch.
The pattern is in the Elsebeth Lavold book "The Garden Delight Collection" and I'm using the Silky Wool yarn called for in the pattern.
The book includes two different sizes, one using 3 skeins and the other using 5 skeins.
I'm making this smaller version.
Doesn't the larger version look cozy?
What you can't really tell from the pictures is that this is a shaped shawl. It starts from the bottom like your average triangular shawl, but there is neck shaping with the two side continuing in a decreasing fashion.
I think this will make it very easy to wear since the shaping will help it stay put!
The name comes from the motif that runs up the sides and is meant to resemble asparagus tips.
Elsbeth says she designed the shawl when trying to add interest to a plain garter stitch shawl:
I discovered that the edging, my own invention, was both fun and satisfying to knit, and that's really the essence of any craft, isn't it—to arrive at an attractive and useable end result and at the same time get a lot of joy from the process itself.
In my opinion, she hit the nail on the head with this pattern. I can cruise along and just glance down for the motif.
I'm getting close to dividing for the two sides. I'm thinking I might have to knit them at the same time so when I'm finished I can start wearing my shawl right away!
The Garden Delight Collection
The Asparagus shawl is just one of 14 projects in this book. You can preview the rest of the book here. You can find the book on Ravelry here.
The theme of the book is "A collection of designs inspired by plant life and gardening, an activity that, just like knitting, gains pleasure from both the process and the end result."
The designs use Silky Wool, Hempathy, and LinSilk yarns.
The first pattern designed for the book is Carota, which was inspired by purple carrots! I don't think I've seen a purple carrot in person, but there is a picture of some in the book and the sweater design does indeed echo the vegetable.
Of course, if the purple and orange combination are a little too brave for you, Silky Wool is available in plenty of other colors for you to select a pleasing combination.
LinSilk is a new 50% Linen 30% Viscose 20% Silk blend with approximately 220 yards per 100g hank. The suggested gauge is 4.5 sts to 5 sts per inch. It is available in 12 colors.
Elsbeth says she quickly fell in love with the LinSilk samples when she was considering adding it to the Designer Choice line. She says it is great for garments in temperate zones and soft enough for garments for babies.
Add to the softness, sheen and a lovely drape the fact that is has an elasticity that makes it very agreeable to knit with, and you have the basic components behind my choice of this new favorite.
The Calamint pattern has a sweater, bonnet, and slipper set for babies ranging from 0 to 24 months old.
The sweater also has sizes for children 4 to 10 years old. That's a lot of flexibility! If you have sisters who still think it's fun to match you'll be all set.
For the big girls, consider the Woodruff sweater.
I like the wide neckline and the pretty lace collar on this one. The all over "flower" stitch will make this an interesting knit. Basic crochet skills are needed to work the edging.
There is one project for the man in your life in this collection. Fava (like the bean) is sized from S (43 1/4″ chest) to XL (50 3/4″ chest).
Ribbing combines with an interesting cable to create the texture on this attractive pullover. A modified drop shoulder reduces bulk under the arms.
If you don't knit men sweaters, there are suggestions in the book for modifying the sleeves to fit a woman.
Hempathy is a popular 41% Cotton, 34% Hemp, 25% Modal blend with approximately 154 yards per 50g ball. There are six new colors this season.
Patch is a pretty T-Shirt style top knit using Hempathy. It is sized from XS (32 1/4″) to XXL (49 3/4″).
This top looks cool and breezy for when the summer weather arrives in earnest. For a daring look you can wear a contrasting color camisole underneath or be more subtle with a coordinating color. With 35 colors available, it should be easy to match your wardrobe.
I've already added Allium to my Raverly queue. I like the combination of the lace at the shoulders and the peplum skirt.
This looks like a top that will be fun and challenging to knit as well as fun to wear. People will know you didn't get this great top in a store!
Allium (which is the Latin name for Garlic) is sized from XS (28 1/4″) to L (34″) chest and is meant to be worn with 2 to 4 inches of negative ease.
These are just a few of the great patterns in The Garden Delight Collection. You can see the others here.
Hempathy in Magazines
Because I'm easily distracted, I thought I'd also point out that Hempathy recently appeared in two magazines!
The Ladder Tank by Nancy Eiseman is in the Summer 2013 issue of Interweave Knits magazine.
It takes 4 to 7 skeins of Hempathy, depending on which size you make. It is knit in one piece to the arm holes, which will save on finishing time.
Add the Ladder Tank to your Ravelry queue.
This very pretty twin set is in "Easy, Everyday Openwork & Lace" from Creative Knitting Magazine.
The Sapphira Cardigan and Tank Top was designed by Meghan Jones and is sized from S to 2X. You can see more pictures if you follow those links to the Ravelry pages.
I think this set is pretty and sophisticated. Together they'd be great for the office, while the tank alone will be a fun addition to the summer wardrobe.
What do you think? Would you add more veggies to your life by knitting from The Garden Delight Collection?


text: there is no stopping these dusty dubstep heartfelt song constructors all around the globe. the blank from australia could easily be part of the uk movement we associate with burial, james blake and the likes. …just with a little more dreamwave to it… on his bandcamp he offers two other new tracks, and on his soundcloud he announces one or two eps coming soon and hooks us up with the following 2.44 min of bliss called leona:


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Definition: 'Uterus Acollis'
uterus acollisType: Term
1. a uterus with atresia or absence of the cervix.
The definition information for uterus acollis is provided by Stedman's. You can search our medical dictionary here.
Stedman's, part of Lippincott Williams & Wilkins, provides a comprehensive line of health-science publications for healthcare professionals and medical students.
Medical Dictionary Copyright © 2006 Lippincott Williams & Wilkins. All rights reserved.


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אנחנו בפייסבוק
Syrian president meets Jordanian officials, says he's determined to run for reelection in 2014. Meanwhile, rebels report army forces fired surface-to-surface missile at residential area in Aleppo killing 50 people
Roi Kais
Latest Update: 02.19.13, 10:34 / Israel News
Roi Kais
Al-Jazeera also reported the incident stressing that the missile was aimed at civilian residential areas.
Related stories:
It quoted opposition sources as saying that mortar shells were also fired at the houses.
Footage from Aleppo
Footage from the scene showed severe damage with some civilians trapped under the rubble. Additionally, rebels reported that a Scud
missile was fired at Tel Rafaat, a suburb of Aleppo.
One opposition group said that 90 people were killed as part of clashes between rebels and army forces on Monday.
Meanwhile, The London-based Al-Quds Al-Arabi newspaper published statements allegedly made by Syrian President Bashar Assad during a meeting with Jordanian officials in Damascus. According to sources present at the meeting, Assad rejected the idea of stepping down and said he is determined to run for reelection in 2014.
Assad, according to the paper, explained he would be like any other Syrian citizen after "the weight of presidency" is lifted off him in 2014. He will then have two options: running for a second term or resuming his work as an opthalmologist and living a peaceful life.
Assad was quoted as saying that "there is talk that I should step down or announce I will not run for reelection. I won't do that and will reserve my right to push my candidacy. If I decide not to, I will nevertheless stay in Damascus. I have family, friends and country.
"I will serve my country and continue to work at my clinic even if I am not president." He further added, "The ballots will decide between me and the others."
During the meeting, the Syrian president discussed "the plot against Syria" claiming that the campaign is "not against the Salafi or the Islamists, it's against the Zionists and the United States."
He also reportedly expressed sorrow over the loss of lives in Syria. "The images of carnage are painful. Some people forget I am flesh and blood. I'm not a wild animal and you must keep in mind I am a doctor and it pains me to see death."
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You are a fan of everyone virginia ? Come to discover the best forums everyone virginia on the internet and share your experience with a community fan of everyone virginia . You can also build a forum everyone virginia and create your online discussion.
This is a site for Subaru enthusiast that live in WV or nearby. . .
subaru, imprezza, legacy, west, #virginia, tribeca, forestor, baja, boxer, ej20, ej25, saab, saabaru, dyno, offroad
Virginia's forum for reptile and amphibian enthusiasts. Join today to help a fellow hobbyist or look for help. Classifieds available.
ball, python, reptile, #virginia, classified, morph, forum, norfolk, hampton, newport, news, chesapeake, beach, yorktown, portsmouth, suffolk, flexwatt, williamsburg
Central Virginia Aquarium Support is a discussion and help group for aquarium hobbyists, newcomer to advanced!


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15 Spinning Wheel Road, Suite 432 • Hinsdale, IL 60521
KK's Bandit Well Worth the Gamble (01/20/13)
Posted Sunday January 20, 2013
By Mike Paradise
While some of the finalists in tonight's $10,950 Classic Photo Final were pointed for this winter trotting series that wasn't the case for KK's Bandit, one of the contenders in Sunday's feature at Balmoral Park.
"When I leased her in early November I didn't even know they were going to have this trotting series," said her trainer Allen Trone.
"Before I got KK's Bandit I watched her qualify and I liked her. She didn't go much but I liked the way she went. She looked good and I thought she would be worth the gamble.
"When I got her I made a few changes on her and since then she has just gotten better and better," continued Allen.
"KK's Bandit has improved every week. She's a very talented mare who wants to get better by herself. She's easy to get along with. She's real nice in the barn, to jog and to handle.
"Trace has done a good job driving her and we're looking forward to Sunday's race," added the 79-year-old native of Rushville, Illinois.
Since joining Trone KK's Bandit has picked up a pair of wins including last week's 2:02.1 triumph in her series leg when she rallied past from the eight-slot.
The now four-year-old daughter of Sierra Bandit spent much of 2012 on the Iowa Fair Circuit for Gary Liles where KK's Bandit was a model of consistency, never missing a check in her three-year-old season while picking up four victories for her Hawkeye owner.
KK's Bandit (programmed at 6-1) did draw well inside of the early 3-1 favorite in the tenth race headliner, landing the three-slot with Trace while double series victor The Padre (Dave Magee) lhas to buck the outside 10-hole a second straight Sunday.
Look At That Chick (Kyle Wilfong), who secured the pole position, will be the 7-2 first flash second favorite.
The competitive field also has Meggins Littlegirl (12-1, Sam Widger), B Yoyo (5-1, John Roberts), Fox Valley Lexus (12-1, Josh Sutton), ER Starla (10-1, Todd Warren), Dry Creek Fling (8-1, Mike Oosting), Poppa Woody (10-1, Marcus Miller) and Holdie L (8-1, Dean Magee).
Every trotter in the final series field shows a first or a second in at least one of his or her last two starts.
To view Archived Notes and Quotes click here
KK's Bandit (Trace Tetrick) looks to win right back in Sunday's Final.
Balmoral Park Photo


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Social media
The exhibition ARTYSCI ZE SZKOLY JANA MATEJKI / ARTISTS FROM THE SCHOOL OF JAN MATEJKO will be the first collective public presentation of works by almost all the artists known to have emerged from the studio of Jan Matejko. Though current knowledge places more than eighty artists in this group, public exposure in recent times has been the lot of only a handful, namely, Jacek Malczewski, Stanislaw Wyspianski, Jozef Mehoffer, Maurycy Gottlieb, Wojciech Weiss, Witold Pruszkowski, and Leon Wyczolkowski.
The pieces in the current exhibit belong to many artistic realms (painting, sculpture, drawing and the graphic arts, stained glass, ceramics, tapestries) and derive from more than a dozen Polish museums and private collections, the latter primarily held by the artists' families. This is a highly varied assemblage of works, both in terms of the representational motifs and visual forms that characterize the works of painters like A. Markowicz, L. Benedyktowicz, K. Pochwalski, L. de Laveaux, W. Koniuszko, D. Kotowski, T. Popiel, A. Gramatyka, A. Piotrowski, W. Pawliszak, W. Tetmajer, and K. Zelechowski.
The exhibition brings together the artists' academic sketches, their early works, which still embody academic canons, as well as works that reflect great individuality and the far-reaching originality of the artists' explorations. There are a number of exceptional works among the assembled pieces.
The purpose of the exhibition is to show the "Matejko School" as a singular social and artistic phenomenon. The art of this era above all consists of historical paintings, as well as Symbolist and Secessionist works, though landscapes, portraits (many of them commissioned), and small format historical paintings are also in evidence. Admired at one time, these works brought their authors many distinctions. Today, however, they are rarely exhibited in museums, in spite of being important documents of their age.
Two approaching events inspired the organizers to mount this exhibition. These are the 20th anniversary of the restitution of the Silesian Museum in Katowice and the celebrations of the end of the "Year of Matejko," which will fall on the 110th anniversary of the artist's death.
The exhibition catalogue is a scholarly album that is supplemented with color reproductions of the works on view and a brochure/guide to the exhibit.


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All False statements involving Bill Maher
Bill Maher
"Do you know that we have pipes carrying natural gas in this country that are made of wood? I'm not joking."
— PolitiFact National
Bill Maher
"Brazil got off oil in the last 30 years."
— PolitiFact National
Page 1 of 1


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Synopsis: A polar station on a desolate island in the Arctic Ocean. Sergei, a seasoned meteorologist, and Pavel, a recent college graduate, are spending months in complete isolation on the once strategic research base. Pavel receives an important radio message and is still trying to find the right moment to tell Sergei, when fear, lies and suspicions start poisoning the atmosphere
Another release date shuffle so get out your calendars and make adjustments as you see fit.Read More »
The 54th BFI London Film Festival came to a close tonight after 16 days and nights of screening over 200 films from around the world. The festival was capped off with the announcement of a series of awards which saw Alexei Popogrebsky's "How I Ended This Summer" beating out some of the year's bigges...Read More »


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Potentially big night awaits Durant
The stage is set for the Thunder's Kevin Durant and New York's Carmelo Anthony and this year's NBA scoring title, but will there be a show?
On Thursday night, Durant and Anthony played in the only two games the league had. Next Wednesday, the final day of the regular season, Durant and Anthony will each play home games that start at 7 p.m. Oklahoma time, so the scoring title potentially could be decided in a matter of minutes.
Anthony took the scoring lead over Durant during their head-to-head encounter at Chesapeake Energy Arena last Sunday. Durant (28.291) currently trails Anthony (28.677) by 31 points for the league's top scoring average. Durant has three games remaining and Anthony has four.
With the accuracy (and frequency) Anthony has been shooting lately, it's seems unlikely Durant will re-capture the scoring lead and his streak of consecutive titles will end at three. The race is not over, however. For example: If Anthony were to average 25.0 in his final four games, Durant would have to average 34.7 in his three games to win his fourth straight crown.
Durant potentially could gain some ground tonight, if he set his mind to it. The Thunder (58-21) plays Portland (33-45) at 9 in the Rose Garden, while Anthony plays at Cleveland 2 1/2 hours earlier. Durant will know Anthony's point total when he faces the Trail Blazers, who will be without defensive specialist Nicolas Batum (arm/shoulder). Batum normally draws the defensive assignment against Durant, but is out indefinitely. Portland guard Wes Matthews (ankle) also will miss tonight's game. Starting center J.J. Hickson (lower back spasms) and power forward LaMarcus Aldridge (illness) initially were considered questionable, but both are now expected to play. Meanwhile, the Thunder could be without starting center Kendrick Perkins (hamstring) and sixth man Kevin Martin (lower back), which would create an even bigger scoring demand from Durant.
The stage is set tonight for a potentially big game from Durant, if he chooses to take advantage of the opportunity and hoist 5-10 more shots.
- John Rohde


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Published: Tuesday, April 30, 2013 at 5:05 p.m.
Last Modified: Tuesday, April 30, 2013 at 5:05 p.m.
A man was charged Tuesday with sexual battery, tampering with a witness/victim, simple battery and violation of probation for simple battery with two prior convictions.
Eric John Scott, 26, was taken to the Marion County Jail.
On April 24, a 29-year-old woman told sheriff's deputies Scott had beat and raped her. She was taken to a hospital. The woman later told Detective Clint Smith she and Scott were arguing and he followed her to her room. She said he touched her and she told him to stop, then he punched her in the face several times and raped her. She said another man overheard the commotion and came into the room and confronted Scott and also called 911.
As deputies arrived, Scott ran out through a back door.
Scott later told Smith the woman hit him first and claimed the sex was consensual.
Smith learned that Scott was on probation for simple battery, after which a warrant was issued for his arrest.
Reader comments posted to this article may be published in our print edition. All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.


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Alaska Health Workforce Vacancy Study (2009)
Beth Landon, MBA, MHA
Alaska continues to experience health professional shortages. The state has long had a deficient "supply side" characterized by insufficient numbers of key health workers whose recruitment, retention, and training have been impeded by Alaska's remoteness, harsh climate, rural isolation, low population density, and scarce training resources.
During winter and spring of 2009, the Alaska Center for Rural Health-Alaska's AHEC (ACRH) and the Institute of Social and Economic Research (ISER) conducted a comprehensive health workforce study.
Funding was provided by Alaska Mental Health Trust Authority, Alaskan's for Access to Health Care (ACCESS), University of Alaska Fairbanks, Tanana Valley campus Telemedicine program, and University of Alaska Anchorage's Community and Technical College (CTC) and the School of Nursing.
Full report