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SAMJ: South African Medical Journal
versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.103 no.1 Cape Town ene. 2013
Incidence of cytological abnormalities within 24 months of a normal cervical smear in Soweto, South Africa
Y AdamI; J A McIntyreII; G de BruynIII
IDepartment of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg. BSc, MB BCh, FCOG (SA), MSc (Epidemiology and Biostatistics)
IIAnova Health Institute, Johannesburg and School of Public Health, Faculty of Health Sciences, University of Cape Town. MB ChB, FRCOG
IIIPerinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital and the University of the Witwatersrand, Johannesburg. MB BCh MPH
BACKGROUND: A screening programme for cervical cancer has been implemented in South Africa (SA) with intervals of 10 years after a normal cytological result. There are no studies that evaluate repeat screening at a shorter interval in SA.
OBJECTIVES: (i) To find the incidence of cytological abnormalities on a repeat test after a report of normal cytology or an inadequate Pap smear; and (ii) to explore the factors associated with an abnormal cytology on repeat testing.
METHODS: This was a secondary data analysis of a randomised controlled trial of diaphragm, lubricant gel and condoms v. condoms in the prevention of HIV infection. HIV-negative women were recruited between November 2003 and December 2005, with a normal Pap smear at entry. Observation time was from the first Pap smear to the date of the repeat Pap smear. Explanatory variables used were baseline, excepting any new HIV infection.
RESULTS: The incidence of cytological abnormalities was 6.48% yearly in women with a previously normal Pap smear and 11.71% yearly in women with an inadequate smear result (p=0.03). The incidence of high-grade squamous intra-epithelial lesions (HSILs) was <0.5%. Factors associated with abnormal cytology were a history of ectopic pregnancy (odds ratio (OR) 9.25; confidence interval (CI) 1.78 - 48.02; p=0.01), number of male partners (OR 1.12; CI 1.03 - 1.22; p=0.01), history of vaginal discharge (OR 13.95; CI 1.18 - 164.47; p=0.04), and incident HIV infection (OR 6.56; CI 1.14 - 38.16; p=0.04).
CONCLUSION: The incidence of HSILs is low in the first 2 years after a normal or inadequate Pap smear, even in a setting with a high prevalence of cytological abnormalities.
Population-based screening using Papanicolaou (Pap) smears and treatment programmes of pre-malignant lesions of the cervix has significantly reduced the morbidity and mortality associated with cervical cancer. In developed countries, associated deaths have been reduced by 45 - 80%.1-3
Screening practices differ between countries according to local experience and cost. In the UK, systematic screening was introduced in 1988, and reduced death by cervical cancer by 50%. This programme's screening interval has been 3 - 5 years, but its success has been attributed to its coverage, reaching about 80.6% of eligible women by 2004.2
South Africa (SA) is a middle-income country with many competing health needs and a poorly developed infrastructure for colposcopy services. The country established a cervical cancer prevention programme in 2001, under which women are offered 3 Pap smears in a lifetime starting at age 30 years. However, if the first Pap smear is performed after the age of 55 years and is normal, only one Pap smear will be performed, while women in whom the cytology is reported as inadequate are re-screened. Furthermore, women with any gynaecological complaint should receive a smear as part of their gynaecological examination irrespective of their screening history.4
Cytology has a false-negative rate of 15 - 30%.5,6 In a South African study, 10% of cervical cancer cases occurred in women who had been screened, but at least 5 years previously. More than 50% occurred in women who had never been screened.7 Prospective studies have not evaluated screening intervals >5 years between Pap smears.
Between 2004 and 2006 in Soweto, Johannesburg, a trial investigated the use of the diaphragm in preventing HIV infection, and also offered a Pap smear at the enrolment visit and again at the end of the trial.8 These data allowed us to assess the incidence of abnormal cytology after a normal or inadequate Pap smear in a setting with a high prevalence of cervical abnormalities.7 We aimed to determine the proportion of women who developed an abnormal Pap smear within 24 months of a normal Pap smear, in a cohort of women in Soweto. Risk factors associated with an incident abnormal Pap smear were explored.
Between November 2003 and December 2005, the Soweto site of the Methods for Improving Reproductive Health in Africa (MIRA) trial recruited 1 028 women from the surrounding community and district clinics (ClinicalTrials.gov number NCT00211459). This study is a secondary analysis of data from this randomised open-label trial, which compared the effectiveness of using condoms alone to using a combination of condoms, the latex diaphragm (Ortho-McNeil Pharmaceutical, Raritan, NJ, USA) and a lubricant gel (Replens, Lil' Drug Store Products, Cedar Rapids, IA, USA) for preventing HIV infection in women. Participants received an HIV prevention package that included HIV/sexually transmitted infection (STI) pre- and post-test counselling, treatment of treatable laboratory-diagnosed STIs, condom promotion and risk-reduction counselling.
Participants were HIV-uninfected, sexually active women, aged 18 - 49 years. Eligible subjects had a cervix, consented to be treated for any treatable STI and did not desire a pregnancy at the time. Participants were monitored quarterly for a period of 12 - 24 months for HIV infection and other STIs.
Interviews conducted at enrolment were used to obtain demographic information and medical and gynaecological history. Women also underwent a pelvic examination at the first visit and all were offered a Pap smear (protocol required that all women who had not had a Pap smear in the preceding 12 months be offered a Pap smear). Women were also offered a Pap smear at exit.
The Pap smears were conventional smears performed by nurse clinicians, and reported on by the SA National Health Laboratory Service (NHLS) cytopathology department. This accredited laboratory has stringent internal and external quality control. The recommendations for management of Pap smear abnormalities stipulated that any Pap smear without an endo- or ectocervical component was inadequate and had to be repeated, even when the descriptive diagnosis was 'within normal limits'. Any Pap report of low-grade squamous intra-epithelial lesions or atypical squamous cells of undetermined significance (ASCUS) was repeated in 6 months. Meanwhile, reports of high-grade squamous intra-epithelial lesions (HSILs) or atypical glandular cells were referred to the Colposcopy Clinic at Chris Hani Baragwanath Academic Hospital for further management.
Only STI tests at enrolment (prevalence data) and incident HIV test results were used. Polymerase chain reaction (PCR) testing was performed for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. A blood test was provided at enrolment and at exit for herpes simplex virus 2 (Focus HSV2 enzyme-linked immunosorbent assay (ELISA)) and syphilis (rapid plasma reagin (RPR) and Treponema pallidum haemagglutinin (TPHA)). A finger-prick blood sample or venous puncture was obtained for rapid HIV-1/2 testing (Oraquick and Determine tests).
Women with equivocal results underwent confirmatory laboratory ELISA testing. Participants were notified about the HIV result and post-test counselling was provided to both HIV-positive and -negative women.
We conducted a secondary analysis of the MIRA trial data. Pap smear results were coded as normal/inadequate or abnormal (ASCUS, LSIL, HSIL or more severe). We defined observation time as the date from the first Pap smear (enrolment) to the date of the repeat Pap smear. All explanatory variables used were baseline variables, except new HIV infection.
The data analysis was performed using STATA statistical software (version 10). Using standard statistical methods, we compared the distributions of explanatory variables among women who continued to have a normal Pap smear v. those who developed abnormal cytology.
We performed a bivariate analysis using a logistic regression to determine factors associated with the outcome. We entered all variables found to be significant in bivariate testing (p<0.2) and used a backward selection procedure to arrive at a final multivariate model.
To compare the risk of an abnormal Pap smear in those who had a normal Pap smear at baseline with those who had an inadequate Pap smear at baseline, we used standard methods for time-to-event data to determine time to abnormal cervical cytology.
The Human Research Ethics Committee (Medical) of the University of the Witwatersrand approved the study protocol for the MIRA trial (M031111) and granted ethical clearance for the use of the data in this secondary analysis (M090676).
Among those eligible for the study, 850 women underwent a repeat Pap smear; 97 (11.41%) had an abnormal Pap smear at entry and were excluded (Fig. 1). These abnormalities were comprised of ASCUS (31 cases; 3.65%), LSIL (51 cases; 6%) and HSIL (15 cases; 1.76%).
The incidence of cytological abnormalities in this group of women (baseline Pap normal or inadequate) was 7.33% per annum. The incidence of cytological abnormalities was 6.48 % in women with a previously normal Pap and 11.71% in women with an inadequate smear result. Fig. 2 depicts the risk of having an abnormal Pap smear. The median follow-up time was 297 days (interquartile range (IQR) 182 - 455).
The log-rank test for equality of survivor function indicates that there is a statistically significant difference in the risk of a cytological abnormality after a normal Pap smear when compared with an inadequate one (p=0.03).
Of both the normal and inadequate Pap smears <0.5% had an HSIL reported on their subsequent Pap smear and the rest of the abnormalities were LSIL and ASCUS (Table 1).
The subjects' median age was 28 years (IQR 22 - 35) and the median number of years they had been educated was 12 (IQR 10 -12). Participants were not asked about smoking or alcohol use.
Types of contraception being used at the time of enrolment were: combined oral contraception (n=58; 7.70%); injectable hormonal contraception; (n=223; 29.61%); progestogen-only pills (n=20; 2.66%); intra-uterine contraceptive device (n=7; 0.93%); and withdrawal or natural methods (17; 2.26%).
The association between condom usage and the incidence of an abnormal Pap smear was contradictory: while there where fewer women with cervical abnormalities in those randomised to the control group (condoms only), there was no association in women who said they used condoms at the last intercourse or were currently using them (Table 2).
The median parity in this group was 2 (IQR 1 - 3), with a range of 0 - 7. The difference in pregnancy history (live births, vaginal deliveries, miscarriages and abortions) in women who had a subsequent normal or abnormal Pap smear was not significant. An ectopic pregnancy in the past was associated with an abnormal Pap smear, but this association was not statistically significant (4 (4.82%) v. 10 (1.61%); p=0.7).
The mean age of first intercourse was 17.58 years (standard deviation (SD) ±2.12; range 11 - 27). There was no statistical difference in having a subsequent abnormal Pap smear in women who had had an earlier sexual debut (p= 0.24) or in women who had had sex in exchange for money (p= 0.11). Women with an increased number of sexual partners were more likely to have an abnormal Pap smear on repeat testing (mean 4.85 (SD ±3.40) v. mean 3.48 (SD ±2.73); p=0.00). The trial excluded women who performed <3 coital acts in the month; therefore, it was not meaningful to assess difference by coital frequency. Age at first intercourse was not reflected in any statistical difference in the outcome (Table 3).
Table 4 shows the association between the risk of developing an abnormal cytology on Pap smear, and whether subjects had a history suggestive of an STI in the preceding 3 months or alternatively confirmatory tests of STIs. A history of a vaginal discharge in the preceding 3 months, or symptoms of an STI, were important differences between those who did and those who did not develop cytological abnormalities. Clinical findings for STIs were discovered on examination, rather than following complaints from the women, as could be expected in a research setting.
There were no statistical differences in incident cervical cytological abnormalities among women with objective evidence of an STI at baseline and no infection (Table 4). Incident STIs such as chlamydia (n=32; 4.25%), gonorrhoea (n=13; 1.73%) and trichomonas (n=38; 5.05%) were not associated with an increase in cytological abnormalities.
Incident HIV infection was associated with a 6-fold increase in the risk of an abnormal Pap smear. An abnormal discharge in the last 3 months and having had an ectopic pregnancy at any time also increased the risk. Having used a condom after the last intercourse had no effect, but being allocated to the control (condom) arm of the study reduced the risk by approximately 58% (Table 5).
The SA cervical screening guidelines predict a reduction of cervical cancer of between 64 - 70% with a screening interval of 10 years.4,9 An evaluation of screening intervals shows that screening is associated with a reduced incidence of cervical cancer, ranging from 84% with 5-year intervals to 94% when the screening was performed every 2 years, in both cases in women aged 35 - 64 years.10
We used the presence of any cytological abnormality as an outcome measure, because this would mean that the particular woman is at risk of cervical cancer, albeit with a different degree of risk. Of note was a low incidence of HSILs, which is the threshold for treatment in our setting: 0.46% and 0.37% in the inadequate and adequate Pap smear groups, respectively. The prevalence of HSILs in women who were recruited for the study was 1.76%.
The Australian National Health and Medical Research Council Guidelines recommend that all pathologists report normal Pap smear results with a recommendation that the next Pap smear is due in 2 years, irrespective of the presence or absence of endocervical component or of reactive change.11
There was no testing for human papillomavirus (HPV) in our study; if we use abnormal cytology as a proxy for HPV infection then its incidence is much higher than that of herpes or HIV. In women with a normal Pap smear at recruitment, the incidence of herpes was 3.32%, HIV 1.33% and HPV (using abnormal Pap smears as a marker) at least 7.33%. An HIV infection incidence of 1.33% is much lower than in the MIRA study, where it was 4%8 (as explained in Fig. 1, we excluded all women with an abnormal Pap smear at baseline).
HPV infection was not shown to be a risk factor for HIV infection in a Zimbabwean study,12 but because women with dysplasia on their entry Pap were excluded from this study it may be that dysplastic cervical epithelium accounted for the higher rate of HIV infection in the parent study.8
Condom use reduces HPV transmission,13 persistence14 and seropositivity.15 A history of male condom usage was protective against acquiring an abnormal Pap smear in this study, but this was not statistically significant. Assignment to the condoms-only arm of the MIRA trial, however, was associated with a 50% lower risk of an abnormal Pap smear than assignment to the diaphragm arm (p=0.01).
Asking subjects about 'condom use at last intercourse' is considered a good way to assess use because it reduces recall bias. However, in this analysis this criterion did not differ between the two groups, even on stratifying by randomisation. The prevalence of female condom use was low in this group of women and was discouraged by the researchers owing to probable problems with fitting of the diaphragm for women in the intervention arm (diaphragm, lubricant and condoms).
A limitation of the study was that only women who agreed to be treated for an STI that had been detected by a laboratory test were eligible for inclusion. The the rate of cytological abnormality may also differ in women symptomatic for STI presenting at a gynaecological clinic. The study sample was too small for stratifying into different age categories, and to fully evaluate risk factors. Pap smears have a poor sensitivity and therefore we were not able to evaluate sensitivity. Although Pap smear screening has a high specificity, only colposcopically directed biopsies can confirm the exact grade of the lesion. The study numbers were also too small for us to use the presence of HSILs as an outcome measure.
The study's strengths included that its population comprised sexually active women from Soweto who had a high prevalence of cervical cancer, and loss to follow-up was approximately 7%.
The results of this study suggest that it would be safe for the next Pap to be delayed for at least 1 year even in women with an inadequate Pap smear result.
The lower incidence of HIV warrants further study on whether cervical dysplasia, and not just HPV infection, is an independent risk factor for HIV infection.
Disclosure. This paper was part of a dissertation submitted for an MSc degree (Epidemiology & Biostatistics) by Y Adam to the University of the Witwatersrand.
1. Sasieni P, Adams J, Cuzick J. Benefit of cervical screening at different ages: evidence from the UK audit of screening histories. Br J Cancer 2003;89:88-93. [http:dx.doi.org/10.1038/sj.bjc.6600974] [ Links ]
2. Peto J, Gilham C, Fletcher O, Matthews F. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004;364(9430):249-256. [http://dx.doi.org/10.1016/S0140-6736(04)16674-9] [ Links ]
3. New Zealand Health Information Service. Mortality and Demographic Data 2000. Wellington: Ministry of Health, 2004. [ Links ]
4. National Guidelines for Cervical Cancer Screening in South Africa 2000. http://www.doh.gov.za/docs/facts-f.html (accessed 13 May 2008). [ Links ]
5. McLachlin C, Mai V, Murphy J, et al. Ontario cervical cancer screening clinical practice guidelines. J Obstet Gynaecol Can. 2007;29(4):344-353. [ Links ]
6. Saslow D, Runowicz C, Solomon D, et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002;52(6):342-362. [ Links ]
7. Fonn S, Bloch B, Mabina M, et al. Prevalence of pre-cancerous lesions and cervical cancer in South Africa - a multicentre study. S Afr Med J 2002;92(2):148-156. [ Links ]
8. Padian NS, Van der Straten A, Ramjee G, et al Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet 2007;370(9583):251-261. [http://dx.doi.org/10.1016%2FS0140-6736(07)60950-7] [ Links ].
9. Hoffman M, Cooper D, Carrara H, et al. Limited Pap screening associated with reduced risk of cervical cancer in South Africa. Int J Epidemiol 2003;32:573-577. [http://dx.doi.org/10.1093/ije/dyg081] [ Links ]
10. Sawaya G, Kerlikowske K, Lee N, Gildengorin G, Washington A. Frequency of cervical smear abnormalities within 3 years of normal cytology. Obstet Gynecol 2000;96(2):219-223. [ Links ]
11. National Health and Medical Research. Guidelines for the Management of Women with Screen Detected Abnormalities. Cranberra: AGPS, 1994. [ Links ]
12. Sawaya GF, Chirenje MZ, Magure MT, et al Effect of diaphragm and lubricant gel provision on human papillomavirus infection among women provided with condoms: A randomized controlled trial. Obstet Gynecol 2008;112(5):990-997. [ Links ]
13. Bleeker M, Berkhof J, Hogewoning C, et al. HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions. Br J Cancer 2005;92:1388-1392. [http://dx.doi.org/10.1038/sj.bjc.6602524] [ Links ]
14. Richardson H, Abrahamowicz M, Tellier PP, et al. Modifiable risk factors associated with clearance of type-specific cervical human papillomavirus infections in a cohort of university students. Cancer Epidemiol Biomarkers Prev 2005;14:1149-1156. [http://dx.doi.org/10.1158/1055-9965.EPI-04-0230] [ Links ]
15. Shields TS, Brinton LA, Burk RD, et al. A case-control study of risk factors for invasive cervical cancer among US women exposed to oncogenic types of human papillomavirus. Cancer Epidemiol Biomarkers Prev 2004;13(10):1574-1582. [ Links ]
Accepted 20 August 2012.
Corresponding author:
Y Adam (email@example.com)


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May 14, 2010 6:08:04 PM
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December 26. 2012 11:21PM
Derry faces budget deficit
By ADAM SWIFT
Union Leader Correspondent
DERRY - The town is facing a $630,000 increase in state retirement costs, contractual increases estimated at $215,000 and an increase in health care costs of $175,000 as it begins the budget process for fiscal year 2014.
"So your net negative today is $450,000 before you even start," Town Administrator John Anderson said.
Unlike the school district budget, the town budget has a tax cap in place that limits the amount of money that can be raised.
At this point, assuming there will be a 2.1 percent permissible increase on the valuation of town property, Anderson said the town will bring in about $573,000 in additional revenue.
But, he said, On the school side, officials are looking at nearly a $1 million hole as they start the budget process, also largely due to an increased share of state retirement costs.
Even with the town looking at a deficit right off the bat, Town Council Chairman Brad Benson said it might not be all doom and gloom, noting the town has over $13 million in its reserve fund balance.
Benson said the town could look at separating out the budget, and using some of the reserve fund for capital items.
"There's always a fair amount of capital items in our budget, but it is broken down into departments," said Benson. "It might be worth taking all our municipal obligations that are non-capital and knowing that number and then taking the capital items and knowing that number."
The town department heads could then rank the capital items with justification for the priority, according to Benson.
"If we can not cut goods and services, that makes the most sense going into this budget season, at least until we can find out what the school system is going to do with their budget," said Benson.
Anderson said he and town finance director Frank Childs have begun the process of looking at potential capital items in the budget.
"Due to the circumstances we are in now, it might make some sense to move those items out of the operating budget into a capital budget," said Anderson.
Childs said he would strongly caution against using reserve funds to pay for operating expenses, however.
- - - - - - - -
Adam Swift may be reached at


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The undeniable Mr. Claus
Tonight is an important night to every boy and girl around the world. 'Tis the night before Christmas when Santa flies his sleigh pulled by eight tiny reindeer. They are stopping at every house where good children live so that Santa can leave toys under the tree as gifts for those who were well behaved.
For the last two years, I have written Christmas columns that told the story of my relationship with Santa Claus when I was a boy. If my memory serves me correctly, I believe the story began when I was 6 or 7 years old. Anyway, I was in the second grade.
It was Christmas Eve, and as usual, I couldn't sleep. I heard men's voices on the first floor, so I decided to sneak down the stairs to see who was there. If I leaned over the railing, I could look into the kitchen where a man was talking to my father. I leaned over the railing all right, and just about fell head first onto the floor below.
Sitting at the kitchen table, his red coat and big black belt hanging over the chair behind him, was Santa Claus, eating a ham sandwich I helped my little sister make before we went to bed. The jolly old elf was staring right at me. I was caught in the act, red-handed. I couldn't escape, and I thought my life was ruined forever.
But, no. Santa was a kind old soul and he invited me in to say hello. I was speechless. My dad and Santa were friends. I had no idea. After he finished his sandwich, he wished us a goodnight, and then stopped at my friend Brian's house a couple of doors down. He even went up to his room to wish him a Merry Christmas.
Last year, I wrote about the consequences of that Christmas. When we returned to school in January, Brian and I told everyone that we met Santa Claus, and of course, nobody believed us. We were teased and taunted all year long. However, we were vindicated the following Christmas when I took my little sister to see the old elf, and he recognized me by name. He even said that he would try to stop by and visit on Christmas Eve if he had the time.
The kids that taunted us all year long about our so-called "fabricated story" were waiting in line to see Santa when he called me by name. This time when Brian and I returned to school, we were treated like rock stars. We had proved that Santa personally visited us at our houses. The few moments of fame were almost worth the year of ridicule, but I don't think I would do it again.
Then, the following fall when I returned to school after summer vacation, a couple of the big kids started taunting us about meeting Santa Claus again. But this time, it was different. They said Santa wasn't real and that the Santa we met was just a friend of my father's who was dressed up as Santa. They made us angry, but Brian and I didn't say anything because we knew better. Besides, some of the big kids could get pretty mean.
They still teased us unmercifully and told the little kids that Santa was just a fairy tale. They made a few of them cry. Brian and I told them not to listen to the big kids, because Santa had come to our houses and brought us presents. We knew he was real because we met him face-to-face and he remembered our names.
I think we made most of them feel a little better, but I could tell that a few had doubts. They were not totally convinced that we were telling the truth.
Nonetheless, I had noticed one significant thing about those big kids. A few of them had tried to tell us that Santa wasn't real the year before. After their flagrant claims, I noticed that the presents they received on Christmas morning were different from ours. They didn't get any toys.
Instead, they got clothes, and new book bags for school, and other practical things from their parents. But none of them got any toys from Santa. I told Brian about this and he said he noticed it too. Anyone who stops believing in Santa doesn't get any more presents from the old elf. He stops bringing toys to those who don't believe.
We told the little kids about this, and they agreed. They said they would never stop believing because they didn't want to stop getting toys. They said they would always love Santa.
Well . . . after all these years, I still get toys at Christmas. If you can't believe in Santa Claus, there isn't much hope for anything good in this system we can't understand.


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We understand that Bill O'Reilly will be reporting on and playing highlights of the audio clips of Barack Obama's mainstream Chicago friend Bill Ayers on his O'Reilly Factor impact segment at ten after the top of the hour tonight. We posted the audio clips here (part 1) and here (part 2). It should be worth watching as this story breaks out of its cocoon following last week's debate. Thanks to Hugh Hewitt, Guy Benson and Chicago's Sandy Rios Show.
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tado° and HomeServe plc sign partnership agreement
Munich, August 29, 2014 - Smart thermostat company
"The British are clearly the innovation leaders in adopting smart thermostats. The UK is the country with the most installations in Europe," says Christian Deilmann, founder and CEO of
HomeServe plc supplies home emergency insurance coverage and domestic repair services to Britain's homes through its own network of directly employed and subcontracting engineers.
HomeServe Membership CEO Martin Bennett says: "We're incredibly excited to be offering HomeServe customers the opportunity to use
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TV picks for March 25-31: 'Game of Thrones,' 'Doctor Who,' 'Mr. Selfridge' & more!
Even if it doesn't seem like the first full week of Spring in some areas of the country, there's one surefire way of telling: Season finales are beginning to pop up on TV schedules. But that's not all: "Games of Thrones" is back! On Sunday. Winter is coming! Here's a look at what's worth watching, and what's worth skipping, on TV the week of March 25-31. Curt Wagner, RedEye's Show Patrol Want more? Discuss this article and others on Show Patrol's Facebook page.
Copyright © 2018, RedEye Chicago


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Jets edge Bruins in SO
Winnipeg, MB (SportsNetwork.com) - Evander Kane tied the game in the final minutes of regulation and the Winnipeg Jets beat the Boston Bruins 2-1 in a shootout on Thursday.
Bryan Little had the only goal of the shootout, beating Chad Johnson through his legs on Winnipeg's first try and in the team's last home game of the season.
Michael Hutchinson, who was drafted by the Bruins in 2008, made his second NHL start and stopped Brad Marchand with his blocker on Boston's final try to get his first win. He had 32 saves in regulation and overtime.
"I felt determined and relaxed out there," Hutchinson said. "I just wanted to give the team a chance to win and fortunately we came out flying in the third period and we definitely took the play to them and we got rewarded with a goal."
Kane tied the game with 1:57 remaining in the third period when he scored on a wrist shot from the left circle off a drop pass from Blake Wheeler, and Boston failed to capitalize on a 40-second 4-on-3 in overtime after Olli Jokinen went off for holding.
"They really turned it up in the third period," said Johnson. "I think they wanted to go out on a good note in their last home game."
Marchand scored Boston's goal midway through the first period when he collected a rebound to the right of Hutchinson after Reilly Smith flung the puck off the end boards from mid-ice and beat the netminder with a deke.
Johnson had 36 saves for the Bruins, who moved three points ahead of idle Anaheim for the NHL points lead.
The Bruins, who have already locked up the Eastern Conference's No. 1 seed, are trying to win the Presidents' Trophy for the first time since the 1988-89 season.
But they have just one win in their last five games (1-1-3) on the heels of a 15-0-1 stretch.
Game Notes
Hutchinson made 16 saves in his NHL debut for the Jets in a 1-0 loss to Minnesota on Monday ... The Bruins will play Buffalo at home on Saturday and end the season on the road Sunday against New Jersey ... The Jets will finish their season Friday at Calgary.


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Reading the forum on your cell phone? There's an easier way. We've enabled a Tapatalk app that makes browsing the forum a whole lot easier. Check it out in the iPhone or Android store if you don't own it already.
It's called a 'deadman' for a reason.
Ok, I know I'm a relative noob, but what the heck is the " large wedge-type anchor" in this eBay listing?
WOW ! a 24" picket..... cut it up and have 3 tent stakes
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WikipediaRead full entry
Purple grenadier
The purple grenadier (Uraeginthus ianthinogaster) is a common species of estrildid finch found in eastern Africa.
The length averages 13.3 cm (5.25 in). All ages and sexes have a black tail, and adults have a red bill. The male has a cinnamon-colored head and neck with a blue patch surrounding the eye. The rump is purplish blue and the underparts are violet-blue with variable rufous patches. The female is smaller and mostly cinnamon brown with white barring on the underparts and silver-blue eyepatches. Juveniles are like females, but mostly unbarred tawny-brown with a reddish-brown bill.[2]
The song (in Kenya) is described as "a high, thin chit-cheet tsereea-ee-ee tsit-tsit, or cheerer cheet tsee-tsee sur-chit."[2]
The phylogeny has been obtained by Antonio Arnaiz-Villena et al.The phylogeny has been obtained by Antonio Arnaiz-Villena et al.[3]
Range and habitat[edit]
It is found in subtropical and tropical (lowland) dry shrubland in Ethiopia, Kenya, Somalia, South Sudan, Tanzania and Uganda, an estimated global extent of occurrence of 1,500,000 km². The status of the species is evaluated as Least Concern.[4]
Origin and phylogeny has been obtained by Antonio Arnaiz-Villena et al.[5] Estrildinae may have originated in India and dispersed thereafter (towards Africa and Pacific Ocean habitats).
- ^ BirdLife International (2012). "Uraeginthus ianthinogaster". IUCN Red List of Threatened Species. Version 2013.2. International Union for Conservation of Nature. Retrieved 26 November 2013.
- ^ a b Zimmerman, Dale A.; Turner, Donald A.; Pearson, David J. (1999). Birds of Kenya and Northern Tanzania. Princeton University Press. pp. 254–255, 553. ISBN 978-0-691-01022-9.
- ^ Arnaiz-Villena, A; Ruiz V; González C (1999). "Los Azulitos Africanos". Revista Pájaros 35.
- ^ BirdLife International (2004). Uraeginthus ianthinogaster. 2006. IUCN Red List of Threatened Species. IUCN 2006. www.iucnredlist.org. Retrieved on 7 June 2007. .
- ^ Arnaiz-Villena, A; Ruiz-del-Valle V; Gomez-Prieto P; Reguera R; Parga-Lozano C; Serrano-Vela I (2009). "Estrildinae Finches (Aves, Passeriformes) from Africa, South Asia and Australia: a Molecular Phylogeographic Study". The Open Ornithology Journal 2: 29–36. doi:10.2174/1874453200902010029.
|Wikimedia Commons has media related to Purple grenadier.
|This Estrildidae-related article is a stub. You can help Wikipedia by expanding it.


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North Dallas Bank & Trust Co. Announces Fourth Quarter Earnings of $0.58 per Share
By: Marketwired .
Jan. 11, 2013 12:55 PM
DALLAS, TX -- (Marketwire) -- 01/11/13 -- North Dallas Bank & Trust Co. (OTCBB: NODB) announces net earnings of $1,481,209 or $0.58 per share for the three months ending December 31, 2012, compared to $1,469,501 or $0.57 per share for the same period in 2011. Net earnings for the year ending December 31, 2012 totaled $5,881,545 or $2.28 per share compared to $5,515,432 or $2.14 per share in 2011. The annual shareholders' meeting is scheduled for February 5, 2013 in Dallas, Texas.
The earnings were prepared internally without review by the company's independent accountants. Earnings are the result of past performance, events and market conditions and are not a guarantee of future results. Any forward-looking implications derived from this information may differ materially from actual results. Please direct any questions to Sam Renshaw, Vice Chairman and CFO.
North Dallas Bank & Trust Co., established in 1961, has more than $1 billion in assets and is a locally owned bank with five locations in the Dallas area.
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Your healthcare provider can use electronystagmography (ENG) to evaluate vertigo and certain other hearing and vision disorders. Vertigo is a false sense of spinning or motion that can cause dizziness.
For this test, your healthcare provider places electrodes above and below the eye to record electrical activity. By measuring the changes in the electrical field within the eye, ENG can detect involuntary rapid eye movement (nystagmus) in response to certain stimuli. If it does not occur when stimulated, you may have a problem within the ear, nerves that supply the ear, or certain parts of the brain.
The ENG is actually a series of tests that may include one or more of the following measurements:
Your healthcare provider uses ENG to find disorders of the peripheral vestibular system, the parts of the inner ear that interpret balance and spatial orientation, or the nerves that connect the vestibular system to the brain and the muscles of the eye.
You may have this test if you have unexplained dizziness, vertigo, or hearing loss. These are symptoms, not a diagnosis. The ENG may help find the exact cause of your symptoms. Possible causes include:
If a known lesion exists this test can identify the actual site. There may be other reasons for your healthcare provider to recommend an ENG.
There are very few risks with ENG. Some people may have dizziness or nausea during the test.
ENG should not be used if you have a pacemaker because the equipment may interfere with pacemaker function.
Rapid changes in position required for the test may aggravate back or neck problems.
The water caloric test may cause mild discomfort. If you have been previously diagnosed with a perforated tympanic membrane, you should not undergo the water caloric portion of the ENG test.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
Certain factors or conditions may interfere with ENG. These include:
You may have an ENG on an outpatient basis or as part of a hospital stay. Procedures may vary depending on your condition and your doctor's practices.
Generally, the ENG follows this process:
Once the test is done, your provider will remove the electrodes and wash off the electrode paste. Don't rub your eyes to avoid spreading the electrode paste.
Your provider will watch you for any signs of weakness, dizziness, and nausea. You may need to lie down or sit for a few minutes to recover.
Your healthcare provider will tell you when to resume any medicines you stopped taking before the test.
Your healthcare provider may give you other instructions after the procedure, depending on your particular situation.
Before you agree to the test or the procedure make sure you know:


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If you're going to write a cursive sentence in Mary Beth Taylor's class at Parsley Elementary School, you have to prepare.
If you're going to write a cursive sentence in Mary Beth Taylor's class at Parsley Elementary School, you have to prepare.
Pencils rest on the desks in front of her fourth-grade students. Two fingers on one hand come down, pinching near the lead, while the other hand grabs the eraser. A quick spinning motion later, pencils hit paper, and the students are ready for the loops and swirls of cursive script.
A bill introduced in the N.C. General Assembly last month, called "Back to Basics," would require public elementary schools to teach cursive so students can "create readable documents through legible cursive handwriting by the end of fifth grade." But for elementary schools in Southeastern North Carolina, cursive is already part of the curriculum. Teachers like Taylor are having their students incorporate the handwriting into everyday learning.
Cursive handwriting was part of the elementary school curriculum for years under the N.C. Standard Course of Study, the state's old curriculum model. But this year, North Carolina, along with more than 40 other states, began implementing the Common Core standards for English and math.
The Common Core is designed to be a national curriculum that focuses on how students can apply what they learn. But it doesn't mandate that students learn cursive. The Back to Basics bill would also require elementary school students to memorize their multiplication tables, which is already a Common Core requirement.
In Southeastern North Carolina, all elementary schools teach cursive. Students in New Hanover and Brunswick counties learn cursive primarily in second and third grades, while Pender County students tackle it in third and fourth grades.
In Brunswick County, some teachers and schools emphasize it more than others, said spokeswoman Jessica Swencki, but all students are exposed to it. That difference in emphasis is common, said Brad Walker, associate professor at the University of North Carolina Wilmington's Watson College of Education.
"In a curriculum that's already over full, (cursive) has been one of the things that's kind of taken a second seat," Walker said.
Walker, a former fourth- and fifth-grade teacher, had his own students practice their penmanship every week, he said. But teachers today might not have that kind of time to spend on cursive because of all the other state mandates they're trying to fit in, he said.
"Personally, I want students to be able to read cursive," he said. "But I'm not sure we need a law to do that."
Rep. Pat Hurley, a Republican from Randolph County, said she introduced the bill because she wants every child to know cursive. If the bill passes, it could be implemented in the 2013-14 school year. Right now, it's in the committee on education.
Taylor has made time for cursive writing by using it to teach students other things. One morning's lesson has students copying down quotes from historical figures in their best cursive handwriting, making sure to get their punctuation marks in the right place. Then, they write – in cursive – a paragraph about the meaning of the quote. When they're done, they trade papers with a partner to practice reading the cursive letters. For fourth-grader Walker Hunt, this is a fun lesson. Walker prefers to write in cursive because it's "more fun, more of a challenge," he said.
Plus, he said, it's going to get him ready for the future.
"You need to (write in cursive) in fifth grade," he said. "And some in college."
Pressley Baird: 343-2328
On Twitter: @PressleyBaird


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In October of 2008, the Phillies and Milwaukee Brewers played what turned out to be a series-clinching game for the Phils at exactly the same time that the Eagles were playing the Washington Redskins. Televised against each other, the ratings were no surprise to people in Philadelphia. Even though the Phillies had a lot more at stake, the Eagles trounced them in the Philadelphia ratings, 22.7 to 13.2.
Two years later, a sea change.
Sunday night, the Phillies won the ratings war against the Eagles. It was the same situation -- a series-clinching game for the Phils, a regular-season game for the Eagles. It was the same television dynamic -- Phillies on cable, Eagles on a network. But according to Sports Business Daily, the Phils were the winners among Philadelphians watching television, 27.7 to 24.1.
The only difference between the two scenarios was the 2008 featured a pair of 1 pm games and 2010 featured two games that started after 8 pm. That wouldn't see to explain the flip in the numbers. Rather, my guess is that it has to do with expectations.
In 2008, the Phillies still hadn't won anything and the town hadn't won anything in a very long time. Back then, everybody was still waiting for the safe to fall on their heads. That was the old normal in Philadelphia, and in that mindset, an Eagles teams that was a perennial playoff contender took the lead, and by a large margin.
Now, fast-forward to today. In those 2 years, the expectations for both teams have been turned on their heads. Phillies fans have tasted success in ways that they haven't since 1980, and now they have a team with three starting pitchers/assasins named Halladay, Oswalt and Hamels. Phillies fans expect to win -- you know, the whole thing. It is a feeling that I can not remember being so pervasive in my professional lifetime, not in any sport or with any team.
As for the Eagles? Well, this was going to be a year when they caught their breath and tried to get Kevin Kolb ready to win championships. Expectations were dialed down all summer. Then, well, let's just say that the first month has been a little wacky. Short-term expectations might be higher now with Michael Vick, but he also happens to be hurt at the moment. You watch the Eagles, like much of the NFL, and it is hard to know what to think.
The Eagles do not appear to have lost any of their popularity, even with that. But the Phillies have grabbed a place that they likely have never held in this town, and it was reflected in those television numbers. Confident, swaggering, expecting to win; imagine.
PS: Nationally, it wasn't close. The Eagles' game routed the Phillies, 11.7 to 3.9.


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The new study, however, isn't likely to prevent federal officials from upgrading the manatees' status from endangered to threatened in the coming year.
A family reunion of sorts occurs each winter when manatees gather at Blue Spring from throughout the St. Johns River. Older females reunite with former calves who have produced calves of their own.
Similar gatherings occur around the state as a growing population of manatees gathers in warm-water locations for refuge.
New research from the University of Florida concludes all that inbreeding among manatees is failing to boost their genetic diversity and may be increasing the risk of dramatic die-off from natural or human-related causes.
"Their genetic diversity is low," said Kimberly Tucker, principal author behind the new study from UF and the U.S. Geological Survey.
However, the new study isn't likely to prevent federal officials from upgrading the manatees' status from endangered to threatened in the coming year.
"From a scientific standpoint, I think they're pointing out some things we obviously need to consider," said Dave Hankla, administrator for the U.S. Fish and Wildlife Service's Northeast Florida region.
But at this point, "all of the indications we have are looking good for manatees," Hankla said. "We intend to move forward with a reclassification."
Even if the status is changed, Hankla said, it will not "reduce protections for manatees at all."
Concerns such as those raised by Tucker's research will be factored into the agency's planning and management regardless, he said.
"They're not out of the woods," he said. "We don't think they warrant coming off the (federal protected species) list."
The number of manatees counted during annual aerial surveys has grown over time, even while fluctuating widely from year to year. Surveyors with state and federal agencies and volunteer groups observe manatees in warm-water locations on the coldest winter days, when it's likely a higher number of manatees will be in those refuges. In 2002, observers counted 1,758 manatees. In 2011, they observed 4,834.
The manatees' status on the protected species list has been controversial for years. The Florida Fish and Wildlife Conservation Commission was prepared to change the manatee from endangered to threatened in 2007, but then-Gov. Charlie Crist stepped in and asked the agency not to change the animals' status given the high number of deaths the previous year. The wildlife service also discussed changing the endangered listing.
Tucker, conducting research for her Ph.D. at the UF, examined the genetics of 326 manatees, using samples collected by the survey. Her research, published last week in the Journal of Mammalogy, comes on the heels of a Dec. 14 request from a conservative legal foundation to the federal government to change the status of the manatees from endangered to threatened because the manatees have grown so much in numbers.
Manatees have been kind of a success story, Tucker said. "But the genetics are showing that although the population has grown, they don't really have a good set of diversity behind that population."
Their genetic diversity remains lower than average for other mammals, even other small populations of mammals in geographically limited locations, Tucker concluded. That could mean bad news for the manatee eventually, she said, increasing its susceptibility to dramatic die-offs from events such as red-tide blooms and severe cold events.
Just the week before Tucker's research was published, the Pacific Legal Foundation filed a petition on behalf of Save Crystal River asking federal officials to abide by its own status review and downlist the manatee to threatened. The foundation calls itself a nonprofit watchdog organization litigating for limited government, property rights and a balanced approach to environmental regulations.
Members of Save Crystal River are concerned about the potential impacts to fishing and tourism from new federal regulations enacted last summer in the 600-acre Kings Bay to protect critical habitat for the manatee in Crystal River on Florida's west coast.
The foundation's suit, filed Dec. 14, isn't likely to have any bearing on the wildlife service's action plan over the next several months, Hankla said. The agency has already contracted for its status review and is moving forward with a recommendation to change the manatees' status to threatened in the coming months, he said.
However, the foundation's action prompted an immediate response from the Maitland-based Save the Manatee Club. In a statement, the club called the petition "the latest attempt by the radical Save Crystal River group to undermine all protections for manatees."
The club opposes the downlisting.
"Considering that manatees have suffered two winters of catastrophic cold-related mortality in 2010 and 2011, dying in record numbers, this is clearly not an appropriate time to push a downlisting proposal," club officials stated in a news release.
In early 2010, severe cold resulted in the deaths of 503 manatees, according to records from the wildlife commission. In 2011, the agency recorded 453 manatee deaths, including 115 from cold stress. So far this year, the commission has reported 360 manatee fatalities.
Tucker's supervising professor at UF, Madan K. Oli, also said it would be "a bad idea at this time" to remove manatees from the endangered species list.
"My feeling would be not to downlist or remove the protections they have received so far," Oli said this week. "There are too many risks out there in addition to low genetic diversity."
The causes of manatee mortality, such as cold weather events and watercraft collisions, "are not going to go away," he said.
Some of the groups that would like to see manatees removed from the list have pushed back against the boat speed limits in place in many locations to protect the animals, Oli said. "Their numbers may be doing fine, but genetically they are not fine, and the causes of the original decline are still there."
Tucker didn't find any genetic defects as a result of the low diversity, such as the characteristics found in the Florida panther. But, she said, the underlying low diversity could be a signal of something that could really end up being a problem in the long run.
There's a greater chance of that when you have "brothers and sisters and cousins mating" in a small gene pool, she said. "You have greater chances of getting a bad recessive trait."
Other research has shown the four major manatee groups in Florida do mix genetically, she said. For example, manatees in the St. Johns River population encounter manatees from the Atlantic population that venture into the St. Johns River.
But the limited genetic mixing or underlying diversity may not be enough to help the animals resist disaster in the form of disease or natural or human-related catastrophes, the researchers said.
The Fish and Wildlife Service has been working with researchers to update the scientific information on manatees, Hankla said. Genetics are a part of that. He said the service was already familiar with Tucker's research before the journal article was published and plans to take all of the information into consideration.
Ultimately, the species classification is a public policy decision, Hankla said. "We use the scientific information and try to place the species in the right category," he said.
"An endangered species is one that's facing extinction today, on the brink of extinction," he said. "A threatened species is one that could become an endangered species in the future."


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In Engineering Sciences / STI
As part of the French STI reform and for teaching engineering sciences in preparatory classes for the grandes écoles, Scilab Enterprises provides teachers with free open source tools.
Scilab is free open source software for numerical computation which includes hundreds of mathematical functions. It has a high level programming language allowing access to advanced data structures, 2-D and 3-D graphical functions.
Freely available and distributed with Scilab, Xcos is a graphical editor to design hybrid dynamical systems models. Models can be designed, loaded, saved, compiled and simulated.
CPGE module allows to model control systems and perform time and frequency simulations (Bode, Black and Nyquist diagrams...).
Coselica module provides about 200 basic Xcos Modelica blocks for modeling and simulation of electrical (analog), mechanical (1D-translational, 1D-rotational, and 2D-planar) and thermodynamical (0/1D-heattransfer) systems.
The NIDAQ module allows to connect Scilab to NI Instrumentation Device
You can:
- Read data in Scilab for immediate analysis,
- Send data over analog and digital output channels provided by the instrumentation device,
- Control analog input and output, counter/timer and digital I/O DAQ device (National Instruments).


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Buying a new home with Roberts Brothers Inc. is not just a dollars-and-cents investment -- it's an investment in your life. Owning a home creates a sense of stability and identity for you and your family. Regardless of how times change, owning a home remains the cornerstone of the American dream.
To assist you in the process, Roberts Brothers, Inc. has everything you need, from a basic step-by-step overview to a property comparison list to home warranties and inspections. Whether you're a first-time buyer or need a brief buying refresher on the home buying process for Mobile and Baldwin County in Alabama, we can help you through it all. Here are a few of our resources:
Mobile and Baldwin County offer an excellent variety of architecture style homes. With more than 200 agents, Roberts Brothers Inc. boasts one of the highest numbers of listings and sales in the area. Our range of property styles, sizes, and prices guarantee that we can find the right home for all our customers. Check out our property gallery to get started in narrowing down your choices.


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Enhancing Daily Life
Find your local Chapter
Food, Eating and Alzheimer's
Regular, nutritious meals may become a challenge for people with dementia. As a person's cognitive function declines, he or she may become overwhelmed with too many food choices, forget to eat or have difficulty with eating utensils.
Nutrition tips
From our Blog
Cooking with Alzheimer's
Award-winning cookbook author Paula Wolfert talks about food, family, and cooking after an Alzheimer's diagnosis. Read more.
Proper nutrition is important to keep the body strong and healthy. For a person with Alzheimer's or dementia, poor nutrition may increase behavioral symptoms and cause weight loss.
The basic nutrition tips below can help boost the person with dementia's health and your health as a caregiver, too.
- Provide a balanced diet with a variety of foods.
Offer vegetables, fruits, whole grains, low-fat dairy products and lean protein foods.
- Limit foods with high saturated fat and cholesterol.
Some fat is essential for health — but not all fats are equal. Go light on fats that are bad for heart health, such as butter, solid shortening, lard and fatty cuts of meats.
- Cut down on refined sugars.
Often found in processed foods, refined sugars contain calories but lack vitamins, minerals and fiber. You can tame a sweet tooth with healthier options like fruit or juice-sweetened baked goods. But note that in the later-stages of Alzheimer's, if loss of appetite is a problem, adding sugar to foods may encourage eating.
- Limit foods with high sodium and use less salt.
Most people in the United States consume too much sodium, which affects blood pressure. Cut down by using spices or herbs to season food as an alternative.
People with Alzheimer's or dementia do not need a special diet. As with anyone, eating a well-balanced, nutritious diet is important for overall health.
As the disease progresses, loss of appetite and weight loss may become concerns. In such cases, the doctor may suggest supplements between meals to add calories.
Staying hydrated may be a problem as well. Encourage fluids by offering small cups of water or other liquids throughout the day or foods with high water content, such as fruit, soups, milkshakes and smoothies.
Possible Causes of Poor Appetite
- Not recognizing food. The person may no longer recognize the foods you put on his or her plate.
- Poor fitting dentures. Eating may be painful, but the person may not be able to tell you this. Make sure dentures fit and visit the dentist regularly.
- Medications. New medications or a dosage change may affect appetite. If you notice a change, call the doctor.
- Not enough exercise. Lack of physical activity will decrease appetite. Encourage simple exercise, such as going for a walk, gardening or washing dishes.
- Decreased sense of smell and taste. The person with dementia may not eat because food may not smell or taste as good as it once did.
Make mealtimes easier
Caregiver Stress Check
Alzheimer caregivers frequently report high levels of stress. Take our quiz and get resources to help.
During the middle and late stages of Alzheimer's, distractions, too many choices, and changes in perception, taste and smell can make eating more difficult. The following tips can help:
- Limit distractions.
Serve meals in quiet surroundings, away from the television and other distractions.
- Keep the table setting simple.
Avoid placing items on the table — such as table arrangements or plastic fruit — that might distract or confuse the person. Use only the utensils needed for the meal.
- Distinguish food from the plate.
Changes in visual and spatial abilities may make it tough for someone with dementia to distinguish food from the plate or the plate from the table. It can help to use white plates or bowls with a contrasting color placemat. Avoid patterned dishes, tablecloths and placemats.
- Check the food temperature.
A person with dementia might not be able to tell if something is too hot to eat or drink. Always test the temperature of foods and beverages before serving.
- Serve only one or two foods at a time.
Too many foods at once may be overwhelming. Simplify by serving one dish at a time. For example, mashed potatoes followed by meat.
- Be flexible to food preferences.
Keep long-standing personal preferences in mind when preparing food, and be aware that a person with dementia may suddenly develop new food preferences or reject foods that were liked in the past.
- Give the person plenty of time to eat.
Remind him or her to chew and swallow carefully. Keep in mind that it may take an hour or longer to finish eating.
- Eat together.
Make meals an enjoyable social event so everyone looks forward to the experience. Research suggests that people eat better when they are in the company of others.
- Keep in mind the person may not remember when or if he or she ate.
If the person continues to ask about eating breakfast, consider serving several breakfasts — juice, followed by toast, followed by cereal.
Encourage independence
Map out a plan to approach Alzheimer's
There are many questions you'll need to answer as you plan for the future. Use Alzheimer's Navigator - our free online tool - to guide you as you map out your plan.
Learn more:
Alzheimer's Navigator
During the middle and late stages of Alzheimer's, allow the person with dementia to be as independent as possible during meals. Be ready to help, when needed.
- Make the most of the person's abilities.
Adapt serving dishes and utensils to make eating easier. You might serve food in a bowl instead of a plate, or try using a plate with rims or protective edges. A spoon with a large handle may be less difficult to handle than a fork, or even let the person use his or her hands if it's easier.
- Serve finger foods.
Try bite-sized foods that are easy to pick up, such as chicken nuggets, fish sticks, tuna sandwiches, orange segments, steamed broccoli or cauliflower pieces.
- Use a "watch me" technique.
For example, hold a spoon and show the person how to eat a bowl of cereal.
- Don't worry about neatness.
Let the person feed himself of herself as much as possible. Consider getting plates with suction cups and no-spill glasses.
Minimize eating and nutrition problems
In the middle and late stages of Alzheimer's, swallowing problems can lead to choking and weight loss. Be aware of safety concerns and try these tips:
- Prepare foods so they aren't hard to chew or swallow.
Grind foods, cut them into bite-size pieces or serve soft foods (applesauce, cottage cheese scrambled eggs).
- Be alert for signs of choking.
Avoid foods that are difficult to chew thoroughly, like raw carrots. Encourage the person to sit up straight with his or her head slightly forward. If the person's head tilts backward, move it to a forward position. At the end of the meal, check the person's mouth to make sure food has been swallowed. Learn the Heimlich maneuver in case of an emergency.
- Address a decreased appetite.
If the person has a decreased appetite, try preparing favorite foods, increase physical activity, or plan for several small meals rather than three large ones. If the person's appetite does not increase and/or he or she is losing weight, consult with the doctor. Keep in mind, as the person's activity level decreases, he or she may not need as many calories.
- Only use vitamin supplements on the recommendation of a physician.
Help Is Available
Alzheimer's Association Message Boards. Exchange tips with other caregivers who are experiencing eating and mealtime challenges with a loved one with dementia.
My Plate for Older Adults. Read information from Tufts University about the unique nutritional and physical activity needs associated with age.
Eating. Get strategies from the Leonard Davis School of Gerontology for meeting the nutritional needs of people with Alzheimer's.
Swallowing Problems in Adults. Learn about swallowing problems from the American Speech-Language-Hearing Association.
Meals on Wheels. Find out about free, home-delivered meal services for seniors.
Top Resources


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You guys have the cycling life.
- Posts: 524
- Joined: Fri Aug 22, 2008 3:35 pm
- Location: Penrith Australia
You guys have the cycling life.
Postby brendancg » Sun Feb 07, 2010 9:05 pm
As a Sydney sider I visited Canberra on the weekend with my family. All I saw were bike paths, bike lanes and thousands of bikes. I also saw people giving way and showing respect for bicycle riders. You guys have got the setup, had my wife and I seriously considering a move to your city (which may happen depending on work circumstances) It was so refreshing in comparison to Sydney. It was like everyone had taken a deep breath and decided to be human again. Good luck to you guys and enjoy, I may see you on the roads in the future.
Yesterday was an easy day.
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Re: You guys have the cycling life.
Postby HAKS » Sun Feb 07, 2010 10:29 pm
Glad to hear you enjoyed your visit and yes the cycling friendly city is what is on top of my reasons not to leave town
Current Ride: Trek Madone 6.5 (2013)
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Re: You guys have the cycling life.
Postby madrapper » Mon Feb 08, 2010 12:55 am
You think what you saw was good? Wait till you try out the mountain biking within spitting distance of Canberra! Our nation's capital is an awesome place to ride your bike - whatever your flavour.
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Re: You guys have the cycling life.
Postby bella26 » Mon Feb 08, 2010 9:26 am
This is definately the number 1 reason why my partner and I are planning a move there within the next couple of months. Oh the headaches...do I go road or MTB riding today...
2014 Bianchi Infinito CV 2012 Wilier Gran Turismo 2012 Specialized Epic FSR Comp 29er
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Re: You guys have the cycling life.
Postby Bantam Roosta » Wed Feb 10, 2010 6:45 pm
It wasn't just a once off either. Yes, there are issues, but generally mixing with traffic is a stress free event. Reading this forum on all the issues people have make me think I live in another country sometimes.
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Re: You guys have the cycling life.
Postby mikedufty » Wed Feb 10, 2010 7:10 pm
I get the same impression though, even when they are apparently talking about the same city I live in.
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Re: You guys have the cycling life.
Postby Fletcher » Sun Feb 28, 2010 5:22 pm
Thanks brendancg, and yes the cycle facilities are very good. Of course there is still tension between motorists and cyclists, in fact yesterday's Canberra Times published an article using AAMI survey data claiming Canberra drivers are less tolerant of cyclists than in other cities/states. In general though, I find most motorists here are pretty good (except for the attractive, respectable-looking woman in her 40s in the grey Lancer turning onto Eastern Way yesterday afternoon, she was a complete clucking lunatic ).
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Re: You guys have the cycling life.
Postby twizzle » Sun Feb 28, 2010 6:18 pm
Read that - "breaking the law or riding dangerously - whether by riding two, three and four abreast on single lane carriageways, brazenly crossing through red lights, or screaming at pedestrians on walkways and cycle paths to get out of the way"
So, are they trying to say that riding two across is breaking the law or riding dangerously? And where do we have cycle paths in Canberra?
Almost a good attempt at improving relations, foiled by shoddy fact finding. Not happy with the green pushing for off-road facilities either... I hate the crap pavement and blind/deaf/stupid peds and POBSO's - which is, unfortunately, more than 50% of the people I encounter.
So, are they trying to say that riding two across is breaking the law or riding dangerously? And where do we have cycle paths in Canberra?
Almost a good attempt at improving relations, foiled by shoddy fact finding. Not happy with the green pushing for off-road facilities either... I hate the crap pavement and blind/deaf/stupid peds and POBSO's - which is, unfortunately, more than 50% of the people I encounter.
I ride, therefore I am.
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...real cyclists don't have squeaky chains...
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4 rescued from disabled sailboat in Atlantic
PORTSMOUTH, Va. (AP) — A Coast Guard helicopter crew hoisted four people from a disabled sailboat about 300 miles off Virginia's coast.
The 42-foot Be Good Too was headed to the British Virgin Islands from New York when the crew contacted the Coast Guard on Monday. The Coast Guard says the crew reported that the sailboat was disabled and adrift.
Because of the distance, the Coast Guard says responding with a cutter wasn't feasible. The Navy sent the USS Ross to serve as a refueling platform for the helicopter.
The sailboat's crew was rescued around 9:15 a.m. Tuesday.
Matthew Brooks with the Coast Guard's 5th District Command Center says in a news release that the Coast Guard didn't want to transfer the crew from the sailboat at night because it would be risky.


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I'll take a potato chip - and eat it!
Yes they sure can be, more than other kinds of shows. Although, I think its more of a Japanese thing than a anime thing.
A lot of exaggerated melodramas are usually (although not exclusive to) from Shounen and Shoujo titles, which may need a suspension of disbelief at times due to its highly situational nature.
On the other hand, a number of good Seinen and Josei titles are more restrained in with melodramatic moments and emphasize more on realism in terms of both storyline and characters, which is one its major advantage and assets over its counterparts imo.
Wouldn't be as interesting if it wasn't.
>_> yes watch evangelion or read the 8th chapter in the uminkeo visual novel. SO much rage but you know what life can't always have a happy ending.
Living life one day at a time
Erm, yes.
"If we are to die one day, wouldn't it be better to have no regrets?" ♥
This is anime we're talking about
expect it.
I do, but that is what makes it 1000+ times better than American cartoon, they actually have a plot, and the people who work on it care about it enough to make it good quality and interesting. That is one of the reasons I watch anime.
This is a little long but here me out. Here is were I am stuck. As a kid who grew up in the 70's and 80's (yah i'm 37 and still watch cartoons) I watched The Transformers, Gobots, GI Joe Thunder Cats, Silverhawks, Inhumanoids, Visionaries etc... Even when I was 10 I knew that some of the animation and story lines were really bad even though the concepts were pretty cool. Pirates of Darkwater (ok 90's), , Beetlejuice, Tinytoons and there spinoffs, Rescue Rangers, Gummi Bears, Eak the Cat, Ducktales etc. were all pretty cool too with better story lines and witty dialogue.
In the 90's cartoons got way better with titles like Batman the animated series, Superman, Freakazoid, Reboot, Beast Wars, Beast Machines (all of which I absolutely love). The story lines were very, very well written, especially with the latter and with animation that was very inventive.
In the 2000's the trend of great story lines continued with titles like Avatar and now Transformers Prime, The Legend of Korah, and the new Thundercats (story line is almost there but artistically is very nice).
I guess what I am trying to say and what I am figuring out is that I really appreciate a good story. Take for example Avatar - Puppet Master. Having my own ups and downs in life , after watching this episode I was left in tears at the end when Katara morally crossed a line and blood bended. It's all about good story for me.
Even though Anime has beautiful backgrounds, the dialogue is often over dramatic, going from super sad to hysterically happy and other extreme and over the top emotional characters. Take for example durarara. Part of the plot was about that blade that when stabbed people, those who were infected stabbed others claiming that they were stabbing out of love ............ what the heck is that supposed to mean! The same with Casshern sins episode ...... 4 or 5? Same thing. A female character said she would have to destroy Casshern because she ..... loved him....? What? I don't get it.
But don't get me wrong (I travel to Japan often and love the country and have decent fluency) School Rumble was hilarious (in Japanese was way better), Last Exile was awesome (even with it's over dramatic-ness with some characters) and 12 Kingdoms ( gooooood story line). In 12 Kingdoms there was a cliffhanger plot that was developing. I estimated it would take 2-3 episodes to be revealed but took about 5-6 episodes. A little over dramatic here but that was o.k. for me. I really liked Mushishi and the slower pace that was presented. Very un anime-ish.
One more thing about anime is that the character models ( I hope this is the correct term) all look the same in just about any anime title. Just swap out the hair, give them some different clothes and you've got a new character. Male or female, it doesn't matter :)
Yes, in the end Anime is definitely over dramatic. Blend the 2, good story and beautiful animation and we'll be set.
Nigga you best be jokin
Tom-san spanks Shizu-chan as punishment for having a perfectly round derriere
Yes especially the "I take a potato chip and eat it" scene from Death Note. That's too dramatic but funny at the same time.
In the end...we are all satisfied...and you are set free.
That's often the point. It's basically the same reason why people listen to their music loudly.
I've never watched a series that didn't become very over-dramatic at some point. I like it, generally. People who watch a drama and complain it's too dramatic remind me of people who play survival horror games and complain they aren't afraid.
You're supposed to get swept up in the moment. That's the .. whole .. point? ..
...You know the question about bears in the woods?
Still, it means I watch Code Geass and the like as a form of comedy. Good times.
lol ikr? XD
all my old friends left :(
Well, yeah. It'd be boring if it was realistic.


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Lester to Red Sox: Let's make a deal
FORT MYERS, Fla. — Jon Lester said Monday the Red Sox have not yet opened negotiations on a contract extension with his agents. But he hopes that day is coming.
"We haven't sat down. I think there's going to be a time and a place for that," Lester said. "But that's not really something I'm concerned about right now. I need to worry about getting for the season physically."
Lester doesn't have a timetable. He's open to most anything.
"If it's something we do get done in spring training, great If it's not, I think you have to take everything as it comes," he said. "If that involves going through the season still talking or getting it done early, you have to play it by ear."
Lester said in January that he wanted to stay with the Red Sox and was willing to sign for less than he could get on the free-agent market. That hasn't changed.
"I'm not going to go back on what I said," Lester said. "I said what I said from the heart and I mean it. We'll see where it goes from there. We've still got a long way to go. It's going to be a tough process."
Agents Sam and Seth Levinson were instructed by Lester not to call him unless there was something to report.


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10 Ways to Display Air Plants
We've accidentally killed many plants with neglect or over-watering, but our air plants have been alive and kicking for three years. They're almost impossible to mess up: just give them a quick soak in a bowl of water once a week and leave them alone the rest of the time. They're also weirdly beautifully and, since they don't require soil, there are countless ways to display them.
• 1 Air Plant Vase from LBrandt
• 2 Reclaimed Glass Bottle Terrariums from FernSeed
• 3 Felt Wool Pocket with Air Plants
• 4 Driftwood with Air Plants from KnottyNatureArt
• 5 Light Bulb Terrarium from Tiny Terra
• 6 Air Plants in Lab Glass from Tortoise Loves Donkey
• 7 Air Plant in a Bowl from Tortoise Loves Donkey
• 8 Desktop Frog with Air Plant from Peacocktaco
• 9 Air Plants in Bottles from TortoiseLovesDonkey
• 10 Stone and Air Plant Garden from Viva Terra
• 6 Ways to Decorate with Tillandsias
• Bromeliads: Low Maintentance Houseplants
• Etsy Finds: Tillandsia Art


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Fantastic apartment located in a XIX Century historical building on Las Ramblas. It's in one of the most exciting areas of Barcelona and you won´t find anywhere more central. It's just 2 minutes´ walk from Plaza Reial, Gaudi´s Palau Guell, la Boqueria Market, Opera Liceu the beach and the Cathedral.
The apartment is located on the 4th floor with a small elevator, and has 2 rooms with air conditioning. Each room has recently been refurbished, with 3 bathrooms, and has free 24-hour internet WI-FI connection. There's also a lounge area were we can allocate a large double sofabed and a fully equipped kitchen.
The public car park is 1 minute´s walk from the apartment and is available at the standard city rate of 25 EUR per night. Our accommodation is family-orientated and non-smoking. No stag or hen parties allowed.
Included: internet WIFI, TV, quiet room, Staff available all year, kitchen, kettle, heating element, hair dryer and iron machine, extra bed, daily cleaning, central heating, bed linen and towels, heat/cool air conditioner, 10% VAT, 1 minute walk to metro
Upon request: washing machine, traveller cot, terrace, parking nearby, mobile phone, Fan in room, dryer, city views, breakfast, balcony with views, alarm clock


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Jacob & Co Capri 17.85 ct Diamond Mens Watch JW0012
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Polished Stainless Steel Case, approx. 32x55mm, Full Diamond Case with 8.95 carat total diamond weight, Multi-colored chrono Blue Mother-of-Pearl dial with and date indicator above 6:00, Full Diamond 8.90 ct Linky Stainless Steel Bracelet Included, Total diamond weight is 17.85 ct. Japan Quartz. Chronograph Movement.
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Posted 7 years ago
(2 items)
The once red "Coca Cola" script on the clock face is faded to white and is barely visible, but it's still there! The bottom glass either is original or at least period correct with waves and bubbles, but is missing the gold painted "In Bottles 5 c" lettering. Keeps excellent time and the sound of the clock tick-tocking when the house is quiet is so relaxing and comforting. It's like it is the heartbeat of the home.
My parents have a virtually identical Gilbert Coca Cola clock that's been in the family since my grandfather purchased it from a downtown hardware store that was closing in the early 1930s. The only differences between theirs and mine are that their red "Coca Cola" script is still mostly red and is clearly visible. Their bottom glass, while cracked diagonally from one corner to the other, still retains most of its gold "In Bottles 5 c" lettering and their clock face has a gold ring about 3 inches in diameter in the exact center of the dial around where the hour and minute hands attach to the post.


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The Boulders, a gated mountain community officially opening Saturday, is Henderson County's first major new residential development since the recession, and officials say it is one of several indications of a local development comeback.
The Boulders, a gated mountain community officially opening Saturday, is Henderson County's first major new residential development since the recession, and officials say it is one of several indications of a local development comeback.
Located on nearly 42 acres just off Asheville Highway in Hendersonville, The Boulders will soon release the first 20 of its planned 59 home sites — where buyers can either have a house built from The Boulders Cottage Collection or use their own approved builder to create their home, following The Boulders' architectural guidelines.
Lot prices start at $69,000 and land/home packages begin in the upper $300,000 range.
"We've got two lots sold already, and one is pending," said Taryn Schneider, spokesperson for The Boulders. "We're getting (a) great response now. So it's pretty encouraging."
Perhaps encouraging to the rest of the county is the fact that the building permits for the completion of The Boulders' first stage haven't been the only ones issued recently.
"We have seen several new construction permits," said Autumn Radcliff, Henderson County's senior planner. "In the last probably six months, we've spoke to various developers with tracts all over the county, some of them very large."
She said the last time Henderson County saw a "boom" in construction was around 2006 and 2007, before the economic slump that forced many developers to put their plans on hold.
The Boulders is one such development. The concept for the development has morphed since 2006 when the project was first pitched to the county, Radcliff said.
"The land was purchased about seven years ago," said Schneider. "We went (through) different variations of layout to get it where it is now. We geared up again about a year and a half ago."
The first batch of home sites offers views, convenient access to downtown Hendersonville and Asheville, city water, electric, natural gas, and "true" fiber-optic cable.
Schneider explained that some communities boast of having fiber-optic cable, but actually have some segments of copper, slowing down the faster fiber optic speed. She said The Boulders homes have fiber-optic cable running from start to finish, and thus faster Internet speeds.
"We're finding a lot of people are wanting new construction," said Schneider. "There's a lot of older product out there."
There are also plenty of undeveloped lots in the county just waiting to be developed, Radcliff said.
During the 2006-07 boom, she said, "We had so many new subdivisions we were approving."
Now, with the uptick in construction permits requested from Henderson County, it appears developers are moving on their postponed plans.
"We have a lot of our established subdivisions ... that still have additional phases to complete," including Carriage Park, River Stone and Champion Hills, said Radcliff. "And they've been coming back in (for permits). Things are moving."
Reach McGowan at email@example.com or 828-694-7871.