Synovial fluid is defined as the collection of fluid confined within a joint space. Synovial fluid is physiologic, and acts as a joint space lubricant of articular cartilage, and nutrient source through diffusion for surrounding structures including cartilage, meniscus, labrum, etc. Synovial fluid is produced as an ultrafiltrate of blood plasma and is primarily composed of hyaluronan, lubricin, proteinase, collagenases, and prostaglandins. Synovial fluid production is from fibroblast like type B synovial cells. Physiologic changes in synovial fluid volume and content occur in response to trauma, inflammation, and bacterial, fungal, or viral penetrance. When patients present with acutely painful joints with suspicion of infection, inflammation or non-inflammatory causes of effusion, synovial fluid aspiration and analysis is imperative to aid in diagnosis and direct treatment modality.
In the presence of joint effusion, joint pain of unknown etiology, or suspected infection within a joint space, arthrocentesis can aid in diagnosis. In settings in which intra-articular injection is a consideration, aspiration should be performed before injection as the aspirated fluid should first undergo inspection for any gross abnormalities or signs of gross infection. Arthrocentesis can also be performed therapeutically for pain relief in a painful joint in which case an effusion or hemarthrosis is preventing a full range of motion of the involved joint. Aspiration should be performed by a trained physician under sterile procedural protocol to prevent the risk of infection and contamination of the aspirate.
Arthrocentesis is the process by which synovial fluid collection occurs by penetrating the joint space through aspiration. This procedure should be done under sterile procedural conditions and performed by a physician with intimate knowledge of the involved anatomy. Sterility is essential not only to prevent transmission of infection but also to ensure accurate fluid analysis. Ultrasound technology may be useful in ensuring correct needle placement but is often unnecessary. Fluoroscopy and CT guided arthrocentesis can also provide utility for deeper joints including shoulder and hip. Once indications are met for arthrocentesis, aspiration site is selected and marked. The literature documents the safe entry portals thoroughly for the shoulder, elbow, wrist, hip, knee, and ankle. The site is then prepped and draped in the usual sterile fashion using antiseptics that include one or a combination of alcohol, betadine, and/or chlorhexidine. Local anesthetic can be used to create a cutaneous/subcutaneous wheel for local pain control. Next, a large gauge, sharp needle, typically 18 gauge (or smaller if a smaller joint in being aspirated), is inserted into the joint attached to a minimum 10 cc syringe. A spinal needle may be an option for deeper joints or patients with anatomy complicated by obesity. On obtaining access to the joint, negative pressure should be maintained in the syringe until an adequate amount of synovial fluid is collected. The fluid should then be transferred to a sterile specimen collection cup and sealed for transport to the laboratory for analysis. The syringe may be emptied and reattached to the indwelling needle repeatedly, minimizing needle entry points. Once the procedure is complete, the antiseptic should be cleaned off the skin, site dried, and pressure and a soft dressing applied for local hemostasis. No activity modifications or changes in weight-bearing status are necessary following the procedure, in the absence of other pathology. Compressive ace bandage dressings often aid in the prevention of fluid reaccumulation.
Indications for synovial fluid aspiration and analysis include the presentation of acute painful joint with surrounding warmth/erythema, suspicion of septic arthritis, suspicion for subacute or chronic periprosthetic joint infection, acute exacerbation of chronic knee pain from osteoarthritis or non-inflammatory arthritis, or acute trauma with painful effusion. In the clinical presentation of acute injury, often arthrocentesis of hemarthrosis can be therapeutic and provide significant pain relief in the acutely traumatic knee. Effusions from chronic inflammatory arthritis can undergo therapeutic aspiration for pain relief. A definitive diagnosis of gout or pseudogout is also an indication for aspiration. It is important to note that infection and gout can co-exist within a joint space. Effusions of unknown etiology warrant aspiration and analysis.
Potential diagnosis from synovial fluid aspiration and analysis include:
- Inflammatory arthritis including gout, pseudogout, infection, or spondylarthritis, or non-inflammatory arthritis which can include effusion from osteoarthritis or meniscal tears
- Septic arthropathy: acute septic arthropathy, subacute or chronic septic arthropathy, or periprosthetic joint infection
- Hemorrhagic: traumatic, often seen with tendon, meniscal, or ligament injury
Normal and Critical Findings
Below we discuss normal and abnormal findings in native adult joints. It is important to note that cell count thresholds vary in joints with previous hardware such as post-traumatic fixation with hardware or in cases of previous joint replacement.
Native adult joint synovial fluid analysis :
According to the American Rheumatologic Association guidelines
- Non-inflammatory <200 to 2000 WBC/mm^3
- Inflammatory >2000 to 50,000 WBC/mm^3
- Infectious > 50,000 WBC/mm^3
Differential with polymorphic nuclear cells (PMNs)
- >75 percent PMNs indicative of bacterial joint infection
Crystal Analysis: Gout and Pseudogout
- Presence of monosodium urate crystals indicates a diagnosis of gout
- Presence of calcium pyrophosphate dihydrate crystals indicates a diagnosis of pseudogout
Gram stain and bacterial culture: synovial fluid aspirate is analyzed for gram stain and both aerobic and anaerobic culture to determine the presence of infection; the presence of any organism indicates abnormal findings.
Several factors can interfere with aspiration and therefore analysis of synovial fluid. Unsuccessful aspiration is common as synovium can clog the needle and interfere with sample collection. Non-sterile technique can contaminate the collected fluid. It is important to remember that multiple etiologies can co-exist, i.e., the presence of gout does not rule out the presence of concomitant infection.
Complications as a direct result of arthrocentesis are rare, and those that do occur are typically not severe. Potential complications include: seeding a cutaneous infection within the joint, cartilage damage from needle insertion (rare), pain at arthrocentesis site or local ecchymosis, bleeding and iatrogenic hemarthrosis, skin reaction to antiseptics or soft bandage adhesive. The most common complication reported is reaccumulation of the joint effusion.
Patient Safety and Education
While arthrocentesis is well tolerated with minimal complications, obtaining informed consent is a must before performing the procedure. Details of the procedure, risks and benefits, potential complications, and alternatives to therapy/diagnosis should be explained. Patients should understand and be able to verbalize the indications for their own procedure as well as be familiar with the previously discussed complications. Patients must have an opportunity to ask questions, and have those questions answered by the performing physician. Keeping patient safety in mind, previously discussed sterile procedural technique should be used every time to minimize potential risks of infection. The patient's chart should undergo a thorough review prior to undergoing arthrocentesis to ensure the patient has no significant allergies to any medication, material, or chemical that may be in use during the procedure.
Synovial fluid aspiration and analysis is a necessary therapeutic and diagnostic procedure useful in alleviating pain from a joint effusion and in the diagnosis of potentially serious joint pathologies. It is a low cost, highly effective means of pain reduction and diagnosis, and can be performed quickly, without general anesthesia, at the bedside. Arthrocentesis does not require a specialized surgeon which increases its utility in prompt therapy and diagnosis.


A fully feathered baby (called a fledgling) usually leaves the nest very early. Normally hide in bushes. They are not abandoned by their parents, they are always close by keeping an eye on their baby. Fledglings are often mistaken for birds that are injured or unable to fly when, on the contrary, they’re actually learning how to fly. A fledgling will hop out of the nest to perch on surrounding branches, or flutter to the ground, where it will be taught by the parents how to care for itself and find food.


Photo: Daniel Schwen
King County in Washington State, US, is launching a two-year pilot project of the Smart Building Energy Tracking System, a new software that helps reduce energy consumption and carbon emissions.
Using software developed by Microsoft partner Iconics and MacDonald Miller Facility Solutions, the Smart Building Energy Tracking System is based on Microsoft’s cloud and business intelligence platforms.
The pilot project will provide King County with real-time energy analytics at five locations. This will help staff operate buildings in a more efficient manner, and identify heating, ventilation and air conditioning problems more quickly and accurately.
King County is home to around two million people, making it the most populous in Washington State. The city of Seattle lies in King County, and the county is the thirteenth most populous in the US.
“I spend a lot of time talking with government officials and our partners across the world about the mounting pressures of population growth and resource depletion,” said Rob Bernard, chief environmental and cities strategist for Microsoft. “It will be critical for all cities and governments to manage their natural resources more efficiently and bridge the disparate systems to optimise performance and value creation. Civic leaders want to grow the economy, but with urbanisation and less resources, they recognise the need to increase efficiency. King County’s pilot project is a great example of this.”
For some time, Microsoft has been using the Smart Building Energy Tracking System, and representatives from the company have co-hosted a tour for mayors, council members and energy and education representatives in the Puget Sound region of Washington State to demonstrate the benefits of the project more widely.
Bernard added: “We hope the results of this project inspire more governments to start thinking about how they can use technology to help tackle the serious environmental challenges that we face today and tomorrow.”
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When it comes to apportioning credit, science could learn from the movies. Since 1934, the Academy of Motion Picture Arts and Sciences, which awards the Oscars, has maintained an index to film credits, now called the Motion Picture Credits Database. For every film being considered for an award, the contribution of each person who worked on it, from hair stylists to the lead actress, is documented. Science, for all its focus on assessing and quantifying, has nothing like this.
The main currency in the world of science is authorship. Authorships enable scientists to accumulate citations, which seem to be established as the 'true' measure of successful and important science. Authorships are key to getting grants and winning promotions, and are also the foundation for a recently proposed algorithm for predicting scientists' success — their future h-index (Nature 489, 201–202; 2012). et al.
Yet authorship is a dubious indicator. Sophisticated readers know that decoding an author list in terms of actual contribution to the scientific paper is close to impossible, unless you are involved yourself. Students find that they have to contribute much more to be listed as an author than more senior researchers do. Initially, students can feel exploited, but they may get used to the system. Eventually, if they choose an academic career, they may (more or less willingly) adopt the behaviour themselves. Political and personal relations also determine whether a contributor appears in the list of authors or under 'Acknowledgements'.
Some disciplines follow conventions in which list order reflects the relative importance or type of contribution. However, only experienced readers understand the conventions, which differ between disciplines and can be difficult to apply to papers with many authors.
For example, a six-page paper on the discovery of the Higgs boson at the Large Hadron Collider at CERN, Europe's particle-physics laboratory near Geneva, Switzerland, was followed by seven pages of author names, but readers without a deep understanding of the experiment's organization have no way of deducing the roles of the authors. They could not all have written the manuscript, and skilled people not listed probably also contributed to the experiments. Simplifying each person's contribution to a co-authorship results in an incomplete picture of their role in the work.
“Decoding an author list in terms of actual contribution to the scientific paper is close to impossible.”
Scientific publishers are aware of the problems of authorship, and many journals (such as Nature) publish descriptions — often in broad terms — of the contributions of each author. However, these accounts are mainly intended to keep author lists free of people who have made no real contribution to the work. They provide little detail on what each author did. And they leave out people whose activities — fund-raising or data acquisition, for example — are not enough to qualify for authorship, but are still pivotal.
A better system could soon emerge. Already, databases of scientific authors such as ResearcherID.com, BioMedExperts.com and ResearchGate.net allow authors to interact, form interest groups and rate each others' publications. ResearchGate has even introduced a new metric based on a scientist's contributions and activity in the network.
As a natural next step, these online networks could give the authors of a paper an opportunity to publish detailed accounts of each person's contribution. With a mouse click, each contributor could verify what others contributed, resulting in merit lists validated by all participants. A similar, but paper-based, system has existed for decades in Denmark, where co-author declarations document what work PhD students contributed to the papers included in their theses. The rigorous rules for authorship, requiring substantial contributions to the design of the work, data gathering and writing, would no longer be relevant, because each contribution could be described and valued. Everyone who made the science possible would be properly acknowledged, and the word 'author' could regain its true meaning.
In the highly competitive film industry, credit lists are the basis for the CVs of the diverse professionals needed to produce a blockbuster. A full contribution database would offer similar benefits to scientists. Contributors could generate updated, verified and detailed accounts of their scientific merits using a few clicks. Journals, funding agencies and employers would all come to rely on the system. Journals might replace the authors and acknowledgments sections in papers with online credit lists, funding agencies could use the system to generate validated CVs for the review process and employers could find the person with just the right skills and experience for the job.
The technical platform for such a database could emerge from the world of music, software development, film, journalism or any other creative industry. With the right technology, writing and approving entries in these networks could become everyday routine, just as 'liking' something on Facebook is today. Validated web-based information networks will allow documented skills — not just numbers of papers or citation-based indices — to count towards advancement in academic life. The transparency and distributed nature of such networks would create a strong incentive for honesty, and fundamentally improve the morale and culture of science.
- Journal name:
- Date published:
- See Careers page 591


Increasing Access to Ready-to-use Therapeutic Foods (RUTF)
By Jan Komrska
Jan Komrska is a pharmacist working at UNICEF Supply Division leading Nutrition unit and responsible for procurement of products related to nutrition interventions of UNICEF.
The author acknowledges the work of UNICEF Supplies Division reflected in this article.
Since 2007, the use of ready to use therapeutic foods (RUTF) to treat severe acute malnutrition (SAM) in young children has been endorsed by the United Nations and non-governmental organisations (NGOs), and received wide notice by the media. With the proven success of RUTF, more countries have adopted their use as part of community-based management of SAM (CMSAM), and demand for the products has soared. Since 2006, UNICEF, the world’s major purchaser of RUTF1, has taken a series of steps to shape the market and diversify the supplier base. As a result of this effort, the market has grown from one qualified manufacturer in 2000 to 19 today. This number is expected to increase in the coming years, especially in countries where RUTF is used.
RUTF are high-energy foods fortified with vitamins and minerals, packed in individual portions providing energy intake of 500 kilocalories. They can be in the form of a soft paste or a crushable biscuit that is easy to swallow. Individual packaging allows easy handling and prevents contamination of the product between feedings. UNICEF requires RUTF to be manufactured by qualified suppliers in accordance with stricter quality standards than normal food products. The product most in demand and the subject of this article is RUTF in peanut paste form.
The first peanut paste RUTF was developed jointly by the French Institute of Research for Development and the manufacturer Nutriset in 1996 as a fortified peanut spread, now marketed under the name Plumpy’Nut®.
UNICEF Supply Division is responsible for procurement of specific products (including RUTF) for UNICEF country programmes and external partners, assuring transparency in using public funds and maintaining agreed product quality.
UNICEF procurement of RUTF in the period 2000-2010
UNICEF began to procure RUTF in 2000, when Nutriset was the sole qualified supplier and annual demand was below 100 metric tonnes (MT)2. The first long-term RUTF supply arrangement (LTA) was established with Nutriset on a sole-source basis in 2001.
Under an LTA, Supply Division places orders with suppliers, based on requisitions from UNICEF country offices. Suppliers are responsible for manufacturing the product and delivering it to the nearest seaport for shipment by sea freight or, in urgent cases, to an agreed airport for air shipment. Further transportation of RUTF to the beneficiary countries is assured by UNICEF-contracted freight forwarders. Therefore, RUTF prices referred in this article exclude shipping costs.
By 2004, demand began to rise as more countries began piloting the use of RUTF, and it became increasingly urgent for UNICEF to identify new sources of RUTF. During 2006, Supply Division began to work with manufacturers in countries where the product could be manufactured for local use, and approved suppliers in Niger and Ethiopia for local purchase in 2006 and 2007 respectively.
With the publication of the UN Joint Statement in 20073, demand increased dramatically, outpacing global production capacity. The situation became critical in 2008, when a hunger emergency in the Horn of Africa caused a spike in demand in the second half of the year. Even after a second global supplier (Vitaset, located in Dominican Republic) had been approved, the 11,000 MT ordered by UNICEF, still largely from Nutriset, did not meet peak in demand.
As a result of this experience, Supply Division made three key decisions in 2008:
- to initiate competitive bidding for RUTF in order to open the market for new suppliers
- to begin conducting annual forecasting for RUTF with individual country programmes, and
- to conduct a study on RUTF supply chain performance in order to identify weaknesses and propose solutions.
These efforts were part of a larger procurement strategy developed by Supply Division through which UNICEF could leverage its buying power to influence the market, promote increased competition and ensure a diverse and sustainable supply base.
Implementation of the Procurement Strategy
In 2008, in line with its procurement strategy, Supply Division launched the first competitive bidding exercise for the supply of forecasted 20,000 metric tonnes (MT) of RUTF, for the period 2009-2010. This exercise was preceded by a lengthy, multi-year process of advocacy for increasing production capacity with existing suppliers, identification of potential new global and local suppliers (usually existing food companies), and the development of manufacturing standards coupled with inspection of various manufacturing facilities.
For the majority of products, UNICEF typically would establish a LTA, based on the results of competitive bidding, for a period of two to three years with the supplier making the lowest acceptable offer, and eventually a backup LTA with the supplier making the second lowest acceptable offer. However this approach was not applicable in the case of RUTF, because it would not encourage any further market development and would leave UNICEF with one or two suppliers. Therefore, it was decided to distribute total forecasted quantity among all companies meeting UNICEF technical requirements for manufacturing facilities as well as product specifications.
Proposals were received from 13 companies and seven proved to be able to meet defined requirements for global supply of RUTF. LTAs were established subsequently with all seven suppliers, expanding significantly the supplier base (for more details see Table 1).
|Table 1: UNICEF-approved RUTF Suppliers, 2005-2011|
The second competitive bidding exercise for supply of forecasted 54,000 MT of RUTF for the period 2011-2012 was issued by the end of 2010. The forecasted quantity was based on the assumption of continued expansion of CMSAM to new countries and scaling up of existing programmes. Proposals were received from 27 companies out of which 12 met UNICEF requirements for global supply of RUTF. LTAs were established subsequently with all 12 suppliers listed in Table 2.
|Table 2: UNICEF-approved global RUTF suppliers|
|Global supplier||Product Name|
|1. Nutriset (France)||
|2. Vitaset (Dominican Republic)||Plumpy Nut®|
|3. Diva Nutritional Products (South Africa)||Generic name***|
|4. Insta EPZ (Kenya)||Generic name|
|5. Challenge Dairy (United States)*||Generic name|
|6. Tabatchnick Fine Foods (United States)||Nutty Butta|
|7. Compact (India)||EeZee PasteTM|
|8. Compact (Norway)||EeZee PasteTM|
|9. Edesia (United States)||Plumpy Nut®|
|10. Nutrivita (India)||Plumpy Nut®|
|11. JB/Tanjaka Foods (Madagascar)**||Plumpy Nut®|
|12. Mana Nutritive Aid Products (United States)||Generic name|
*Dairy-based, not peanut-based, RUTF.
**The first company located in programmatic country capable of exporting RUTF
***Supplier agreed to remove branded name Imunut from the labels
It is important to underline that RUTF products manufactured by UNICEF-approved manufacturers comply with the Joint statement specifications and they can be used by country programmes interchangeably.
A key part of the procurement strategy was to support the development of local production in countries where RUTF is used, particularly in Africa, in order to bring the supply closer to the beneficiaries and reduce delivery lead times.
After successful audits of the manufacturing sites by Supply Division’s Quality Assurance staff in Niger and Ethiopia, further audits were conducted at manufacturers in Malawi, the Democratic Republic of the Congo, Mozambique, Madagascar and Tanzania and resulted in their approval for local purchases to UNICEF. The suppliers listed in Table 3 are authorised to sell RUTF to UNICEF’s country programmes locally. As of 2010, about 23% of the RUTF purchased by UNICEF was sourced locally.
|Table 3: UNICEF-approved local RUTF suppliers|
|Global supplier||Product Name|
|1. STA (Niger)||
|2. Hilina (Ethiopia)||Plumpy Nut®|
|3. Project Peanut Butter ( Malawi)||Plumpy Nut®|
|4. Valid Nutrition (Malawi)||Plumpy Nut®|
|5. Amwili (DR Congo)||Plumpy Nut®|
|6. JAM (Mozambique)||Plumpy Nut®|
|7. Power Foods (Tanzania)||Plumpy Nut®|
As programme demand and production capacity increased, so did the volume of UNICEF procurement, in terms of the number of MT purchased and the number of countries placing orders. After a steady increase from 2000 to 2008, procurement of RUTF decreased not because of declining needs but as a result of resource mobilisation challenges caused by the global economic crisis and availability of stocks in countries from 2008. However, orders have rebounded in 2010 and by mid-year had surpassed 2009 levels, reaching 20,690 MT as of year-end (2010) (for more details see Table 4).
|Table 4: UNICEF Global Purchases of RUTF, 2000-10 (in MT)|
|Countries ordering RUTF||1||4||6||7||8||17||26||41||48||45||52|
The growing demand for RUTF, production capacity constraints and the volatility of prices of raw materials made forecasting of demand increasingly necessary. UNICEF first undertook global forecasting to collect information on needs for RUTF and other nutrition products in January 2009. This resulted not only in forecasting of global product needs (used for the bidding process) but also contributed to a better understanding of the scale of implementation of CMSAM.
The 2010 forecast indicated that UNICEF currently is implementing CMSAM in about 55 countries, where there are 6.1 million children with SAM. UNICEF country programmes intended to reach 1.8 million children (about 30 per cent), revealing a large gap in coverage, especially given the 20 million children estimated to be suffering from SAM worldwide.
Peanut-based RUTF consists of milk powder (30%), sugar (28%), peanut butter or paste (25%), vegetable oil (15%) and vitamin and mineral premix (1.6%).4 The product is packed in standard foil sachets. The milk and packaging material (aluminum foil) are the most expensive components, followed by the premix, peanut butter, sugar and oil.
Somewhat surprisingly, the entry of new suppliers into the market has not resulted in any dramatic drops in price, for a number of reasons. One possible reason might be that new suppliers do not have the large production volumes that usually result in lower prices, and are also faced with high-start-up costs.
Prices of globally purchased RUTF
The pricing structure in the LTAs is complex because of volume discounts, payment terms, currency used and other factors. The initial price paid by UNICEF for RUTF in 2001 was about €41.50 (56.80 USD) per carton. In 2006, as the average size of orders began to increase, Nutriset proposed scaled prices for larger orders, and the price decreased gradually to about €35.20 (48 USD) per carton in 2011. However, this drop in price was masked by fluctuations in the rate of exchange between the euro and the United States dollar, because the price is fixed in euros, as proposed by Nutriset. The RUTF prices offered to UNICEF by other suppliers range from 48.00 USD to 56.50 USD per carton in 2010.
Prices of locally procured RUTF
Local producers import almost all of the ingredients and the packaging material, most of which are subject to import duties. Often the price offered initially is too high to justify local purchase on a cost basis alone, even considering the added cost of freight.
Supply Division carefully scrutinises the prices proposed by local companies in order to assure best value for money. They are compared to the landed cost of globally procured RUTF (price at the factory plus freight cost to the final destination) and when found too high, UNICEF attempt to negotiate a lower price.
The prices of locally produced RUTF vary significantly among the different suppliers. In 2010, the local prices ranged between 57.00 USD (in Madagascar) and 69.00 USD per carton (in Mozambique).
RUTF is a heavy and bulky product, with a course of treatment for one child (one carton) weighing about 15kg. The 16,000 MT of RUTF purchased off shore in 2010, filled 830 40-foot containers. Shipping the product by sea is the most economical option, but air shipment might be required when RUTF is needed for emergency response to natural disasters, drought or political instability. Air freight of RUTF increases the landed cost by 100 per cent whereas sea freight only by 10 per cent.
In 2008, nearly 35% of RUTF purchased by UNICEF had to be transported by air, at a cost of $8.5 million, in order to reach the beneficiaries on time. By 2010, less than 1% of the RUTF had to be transported by air, costing less than $400,000. The decrease in shipment by air is a result of RUTF supply chain analysis that suggested a number of tools to reduce freight costs. These included introductions of forecasting of country programming needs, development of supplier base in locations close to where the product is used and prepositioning of stock in areas closer to emergency-prone countries (e.g. Dubai for the Horn of Africa and Ghana or Cameroon for the Sahel region).
Issues for future consideration
As more countries adopt and/or scale up CMSAM to treat SAM, the need for RUTF will continue to increase. Supply Division will continue to refine its procurement strategy and work with UNICEF’s Programme Division and external partners to address a number of issues that could affect RUTF availability and accessibility for the final beneficiaries.
UNICEF sees the continued diversification of the supplier base, with more qualified manufacturers in countries and regions closer to the end-users, as an important concern. This will facilitate the eventual transfer of CMSAM and use of RUTF from UNICEF and NGOs to national authorities.
Building a strong network of smaller suppliers in countries with the highest incidence of SAM therefore remains a priority. The work is ongoing with potential manufacturers in Sierra Leone, Uganda and Rwanda in order for them to become part of UNICEF-approved manufacturers. However in the process of expansion of UNICEF approved-manufacturers, the focus on product quality and safety shall remain central.
The Supply Division strategy to increase the availability of RUTF and assure a sustainable and diverse supplier base has accomplished its main goals. In 10 years, the supplier base has grown from one global supplier in Europe to 19 global and local manufacturers in Africa, Europe and Americas. The seven local suppliers are in countries where RUTF is used, and more local manufacturers are expected to be approved in the near future. Even with this substantial growth in production capacity, quality standards have been maintained. Forecasting of demand has been systematised and orders can be filled promptly when they are placed on time. Supply Division continues to work with UNICEF country offices to refine forecasting of demand and to work with suppliers to manage global production. Air freight costs have been reduced dramatically as a result of these improvements, and stocks are being prepositioned in key regions to allow for rapid response when necessary.
As outlined above, the major future challenge is the potential increased demand for RUTF as countries adopt and expand CMSAM. Supply Division will continue to work with suppliers, country offices, UNICEF’s Programme Division, and external partners on development of sustainable RUTF supply chain.
For more information, contact: Jan Komrska, email: firstname.lastname@example.org
1UNICEF is the largest, but not the only, purchaser of RUTF. Other major purchasers include MSF, the Clinton Foundation and different NGOs.
21 MT contains 72 cartons of RUTF. It takes approximately one carton to treat and save a child, so that each MT can save the lives of 72 children.
3WHO/WFP/UNSCN/UNICEF. Community-Based Management of Severe Acute Malnutrition. A Joint Statement by WHO, WFP, UNSCN and UNICEF, May 2007
4Mark J. Manary. Local production and provision of ready-touse therapeutic food (RUTF) spread for the treatment of severe childhood malnutrition. Food and Nutrition Bulletin, vol. 27, no. 3 (supplement) 2006, The United Nations University
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Learn About This Location
Zanesville was named in honor of Ebenezer Zane (1747-1811), who built Zane's Trace, a early road from Wheeling, Virginia to Maysville, Kentucky. In 1797, Zane gave land as payment to his son-in-law, at the point where Zane's Trace reached the Muskingum River. WIn 1801, the town was officially Zanesville.
The city grew quickly in the 1820s through the 1850's. Novelist Zane Grey, a descendant of the Zane family, was born in the town.


Ms. Mugdha Shetye talks about an offbeat career pet grooming. Pet groomers work with animals and helps in improving their hygiene and appearance. Becoming a pet groomer allows you to work with animals and provide valuable service to pet owners. There is no standard formal education for pet groomers but knowledge about animals is a must. New groomers need to work under experienced groomers. One also needs to learn about facets of animal behavior. New groomers are taught about how to safely handle pets; brush, trim, bathe, style animal coats and clip nails and also provide other maintenance services. To become a successful pet groomer besides getting trained one must have certain skill sets like love for animals, aware about pet psychology, Physical strength as one may have to lift the animals, patience and stamina and communication skills. Pet groomers can work in veterinary clinics, animal shelters, NGO’s, kennels or pet supply stores. One can also wok as a pet behavior counselor, have their open business by opening up a salon or parlor. One can also start boarding services for pets as pet owners often look for as safe and hygienic environment to leave their pets when they go out of town. Training of animal grooming is also one of the option. One can also join PETA.


Selections from John Donne’s Death’s Duel,
a Consolation Against the Dying Life and Living Death of the Body.
Converted to Modern English, Edited, and Introduced by theMB
In the year of Our Lord 1631, John Donne, Dean of St. Paul’s, left his sickbed and stood before the King’s Majesty in his chapel at the Palace of Whitehall, there to deliver a Lenten sermon. He spoke for an hour or so, taking as his text, Psalm 68, verse 20:
He is our God, the God of our salvation;
God is the Lord, by whom we escape death.
He said something like this on that occasion.
The old expositors looked at the final part of the verse (God is the Lord, by whom we escape death) in three ways: First, it is in God’s power and it is often his will to give us frequent escapes and deliverances, even when we find ourselves almost in the jaws and teeth of death, and on the lips of that whirlpool, the grave. In this way of reading, the verse refers to those frequent, but temporary, evasions or deliverances from death which we all experience from time to time, and this is the most ordinary reading, and that which may be most obvious at first, the escape from death. But there is a second way of reading it common in the old expositors, that unto God the Lord belongs the escape in death, that is, in the manner of our death; regardless of the kind of departure we shall have out of this world, whether prepared or sudden, whether violent or natural, whether in possession of our right minds or shaken and disordered by sickness. Of course, all of us will die, but the manner of our passing matters little for, howsoever they die, precious in his sight is the death of his saints (Psalm 116:15). And so, in this sense of the words, the escape in death, God sees to us in the hour of death; the ways of our departing out of this life are in His hands. Yet a third way of reading our verse is the escape by death; that is, this God the Lord having united and knit both natures in one, and being God, having also come into this world in our flesh, he could have no other means to save us, and he could have no other way of departing out of this world, nor could he return to his former glory, but by death. And so in this sense, His escape by death is our deliverance by death, by the death of this God, our Lord Christ Jesus.
THE ESCAPE FROM DEATH
First, then, we consider that in all the deadly calamities of this life, we may justly hope of a good escape. Consider that all our periods and transitions in this life are just so many passages from one death to another; our very birth and entrance into this life is an escape from death, for in our mother’s womb we are dead, at least to the extent that we do not know we live. In the womb, we are dead to the extent that, as the psalmist says, idols are dead. In the womb we have eyes and see not, ears and hear not (Psalms 115:6; cf. Mark 8:18). . Of our making in the womb, the psalmist also says, I am wonderfully and fearfully made, and such knowledge is too excellent for me, (Psalm 139:6) for even that is the Lord’s doing, and it is wonderful in our eyes; (Psalm 118:23) it is he that made us, and not we ourselves, (Psalm 100:3) nor our parents neither. Thy hands have made and fashioned me round about, says Job (10:8). Though I be the masterpiece of the greatest master (man is so), yet if you, O Lord, do no more for me, if you leave me where you made me, destruction will follow. The womb, which should be the house of life, becomes death itself if God leaves us there. As soon as we are men, animated, quickened in the womb, though we cannot ourselves, our parents have to say in our behalf, Wretched man that he is, who shall deliver him from this body of death? (Romans 7:24) And that deliverer must be He that said to Jeremiah, Before I formed thee I knew thee, and before thou camest out of the womb I sanctified thee (Jeremiah 1:5). Eve had no midwife when she delivered Cain, therefore she might well say, I have gotten a man from the Lord, (Genesis 4:1) wholly, entirely from the Lord; she might well say it is the Lord that enabled me to conceive, the Lord that infused a quickening soul into that conception, the Lord that brought into the world that which he himself had quickened; without all this, Eve would have had to say, my body is but the house of death.
But then this first escape from death, the death of the womb, is but an introduction into death, the manifold deaths of this world. We have a shroud in our mother’s womb which grows with us from our conception, and we come into the world wound up in that shroud, for we come to seek a grave. We celebrate our own funerals with cries even at our birth; we beg our baptism with tears; and we come into a world that lasts many ages, but we last not. God has given us earth for our material, to be made of earth, and he has given us earth for our grave, to return and dissolve to earth, but earth is given to us in these ways only and not for our possession. Here we have no continuing city, (Hebrews 13:14), no house that continues, no persons, no bodies, that continue. This whole world is but a universal churchyard, but our common grave. That which we call life is but a week of death, seven days, seven periods of our life spent in dying, a dying seven times over; and there is an end. Our birth dies in infancy, and our infancy dies in youth, and youth and the rest die in age, and age also dies and determines all. Nor do all these, youth out of infancy, or age out of youth, arise in the clean way in which the phœnix arises out of the ashes of another phœnix, but as a wasp or a serpent out of a carrion, or as a snake out of dung. Our youth is worse than our infancy, and our age worse than our youth. Our youth is hungry and thirsty after those sins which our infancy knew not; and our age is sorry and angry, that it cannot pursue those sins which our youth did; and besides, so many deaths, so many deadly calamities accompany every condition and every period of this life, as that death itself would be an ease to them that suffer them. Upon this sense does Job wish that God had not given him an escape from the first death, from the womb, Wherefore hast thou brought me forth out of the womb? Oh that I had given up the ghost, and no eye seen me! (Job 10:18-19) And not only the impatient Israelites in their murmuring (would to God we had died by the hand of the Lord in the land of Egypt), but Elijah himself, when he fled from Jezebel, and went for his life, as that text says, under the juniper tree, requested that he might die, and said, It is enough now, O Lord, take away my life. (I Kings 19:4) How much worse than death is this life, when good men would so often exchange it for death! But if my case be as Saint Paul’s case, that I die daily; though that be true of me, I was shaped in iniquity, and in sin did my mother conceive me (there I died one death); though that be true of me, I was born not only the child of sin, but the child of wrath, of the wrath of God for sin, which is a heavier death: yet, God is the Lord by whom we escape death; and, if no other deliverance would give more to his glory and my good, yet he has the keys of death, (Revelation 1:18) and he can let me out at that door, that is, deliver me from the manifold deaths of this world, the every day’s death and every hour’s death, by that one death, the final dissolution of body and soul, the end of all.
But then is that the end of all? Is that dissolution of body and soul the last death that the body shall suffer? It is not. Though this be escape: it is an entrance into yet another death; though it be an escape from the manifold deaths of this world, yet it is an entrance into the death of corruption and putrefaction, and dispersion in and from the grave, in which every dead man dies over again. Except for that Holy One that HE would not allow to see corruption, all those who die now and sleep in the state of the dead, must pass this posthumous death, this death after death, this death after burial, this dissolution after dissolution, this death of corruption and putrefaction; when my mouth shall be filled with dust, and the worm shall feed, and feed sweetly (Job 23:20) upon me; when the ambitious man shall have no satisfaction, if the poorest alive tread upon him, nor the poorest receive any contentment in being made equal to princes, for they shall be equal but in dust. Even those bodies that were the temples of the Holy Ghost come to this dilapidation, to ruin, to rubbish, to dust. Truly the consideration of this posthumous death, this death after burial, that after God has delivered me from the death of the womb, by bringing me into the world, and from the manifold deaths of the world, by laying me in the grave, I must die again in the putrefaction of this flesh, and in a dispersion of that dust. This is the most inglorious and contemptible vilification, the most deadly and peremptory nullification of man, that we can consider. God would seem to have carried the declaration of his power to a great height, when he sets the prophet Ezekiel in the valley of dry bones, and says, Son of man, can these bones live? as though it had been impossible, and yet they did; the Lord laid sinews upon them, and flesh, and breathed into them, and they did live. But in that case there were bones to be seen, something visible, of which it might be said, Can this thing live? But in this death of putrefaction and dispersion of dust, we see nothing that we can call a particular man’s. Can this dust live? This death of incineration and dispersion is, to natural reason, the most irrecoverable death of all; and yet, God is the Lord by whom we escape death; and by recompacting this dust into the same body, and rejoining the same body with the same soul, he shall in a blessed and glorious resurrection give us such an escape even from this death as shall never pass into any other death, but establish us in a life that shall last as long as the Lord of Life himself.
And so that is the first way of reading these words (“God is the Lord, by whom we escape death”); though from the womb to the grave, and in the grave itself, we pass from death to death, yet, as Daniel speaks, the Lord our God is able to deliver us (Daniel 3:17), and he will deliver us.
THE ESCAPE IN DEATH
And so we pass to our second way of reading God is the Lord, by whom we escape death: the escape in death; it belongs to God, and not to man, to pass a judgment upon us at our death. Those signs which physicians discern, and those predictions which they give for death or recovery in the patient, they discern and they give out of the grounds and the rules of their art; but we have no such rule or art to give a prediction of spiritual death and damnation upon any such sign as we may see in any dying man: we might comfort ourselves in the death of a friend, if it be testified that he went away like a lamb, that is, without any reluctance; but that may be accompanied with a dangerous insensibility of his soul’s actual condition. On the other hand, even Our blessed Saviour suffered in the Garden in preparation for Death, a sadness even in his soul to death, and an agony even to a bloody sweat in his body, and expostulations with God, and exclamations upon the cross. So, make no ill conclusions upon any man’s reluctance to die. The mercies of God may work momentarily in minutes, and many times invisibly to bystanders, or any other than the party departing. And then upon violent deaths inflicted as upon evil-doers, Christ himself has forbidden us by his own death to make any ill conclusion; for his own death had those impressions in it; he was reputed, he was executed as a malefactor, and no doubt many of them who agreed to his death did believe him to be so. Therefore make no ill conclusion upon sudden death nor upon an individual’s reluctance or fear in departing. The tree lies as it falls, it is true, but it is not the last stroke that fells the tree, nor the last word nor gasp that alone qualifies the soul. Still, pray for a peaceable death and against violent death, and for time of repentance against sudden death, and for sober and modest assurance against reluctant or fearful death, but never make ill conclusions upon persons overtaken with such deaths. God alone is the Lord, by whom we escape death. Our critical day is, perhaps, not the very day of our death, but the whole course of our life. I thank him that prays for me when the death-bells toll for me, but I thank him much more that catechises me, or preaches to me, or instructs me how to live. Our security is in the word of the Lord who said, do this and thou shalt live (Luke 10:28). But though I do it, yet I shall die too, that is, die a bodily, a natural death. God does not say, Live well, and you shall die an easy, a quiet death; but, Live well here, and thou shalt live well for ever. A good life here flows into an eternal life. But whether the gate of my prison be opened with an oiled key, a gentle and preparing sickness, or the gate be hewn down by a violent death, or the gate be burnt down by a raging and frantic fever, a gate into heaven I shall have, for from the Lord is the cause of my life, and with God the Lord is the escape in death. And this is the second sense of our text, as this escape in death is God’s care that the soul be safe, whatever the agonies the body suffers in the hour of death.
THE ESCAPE BY DEATH
And so, now we turn to the third and final way of reading the verse: God is the Lord, by whom we escape death. This final escape is a deliverance by the death of another. Now, at last. consider the end of the Lord, the end that the Lord himself came to, death, and a painful and a shameful death. But why did he die? and why die so? As Saint Augustine, interpreting our text, answers that question, (De Civitate Dei, lib. 17) because to this God our Lord belonged our escape by death. What can be more obvious, more manifest than this sense of these words? he says. In the earlier part of our text it is said, He that is our God is the God of salvation; or, as Augustine reads it, the God that must save us. Who can that be, says he, but Jesus? For therefore that name was given him because he was to save us. And so, to this Jesus, this Saviour, (Matthew 1:21) belongs the escape by death; having come into this life in our mortal nature, he could not go out of this life any other way but by death, to save us was to die. Though he were God the Lord, yet to him, to God the Lord belonged the escape by death; more cannot be said than Christ himself says of himself: These things Christ ought to suffer; (Luke 23:26) he had no other way but death.
That God, this Lord, the Lord of life, could die, is a strange contemplation; that the Red Sea could be dry, that the sun could stand still, that an oven could be seven times heat and not burn, that lions could be hungry and not bite, all these are strange, miraculously strange, but super-miraculous that God could die; but that God would die is an exaltation of that. But even of that also it is a super-exaltation, that God should die, must die, (said Saint Augustine), God the Lord had no escape but by death, and (says Christ himself), all this Christ ought to suffer, was bound to suffer (Luke 24:26); As the psalmist says, God is the God of revenges, he would not pass over the son of man unrevenged, unpunished (Psalm 93:1). But then (as it says in the same place), the God of revenges works freely, he punishes, he spares whom he will. And would he not spare himself? He would not. Says Christ, if it be possible, let this cup pass (Matthew 26:39), when his love, expressed in a former decree with his Father, had made it impossible. Many waters quench not love (Canticles 8:7). Christ tried many: he was baptised out of his love, and his love was not quenched; he mingled blood with water in his agony, and that quenched not his love; he wept pure blood, it seeped from his pores in his flagellation and thorns, and these expressed, but these did not quench his love. He would not spare, he could not spare himself. There was nothing more free, more voluntary, more spontaneous than the death of Christ. It is true, he died voluntarily for love of us; but yet when we consider the contract that had passed between his Father and him, there was a kind of necessity upon him: all this Christ ought to suffer. And when shall we date this obligation, this necessity? When shall we say that began? Certainly this decree by which Christ was to suffer all this was an eternal decree, and was there anything before that that was eternal?
Infinite love, eternal love; be pleased to follow this home, and to consider it seriously, that what liberty soever we can conceive in Christ to die or not to die; this necessity of dying, this decree is as eternal as that liberty; and yet how small a matter made he of this necessity and this dying? His Father calls it but a bruising of his heel (Genesis 3:15) (the serpent shall bruise his heel). He Himself calls it but a baptism, as though he were to be the better for it. I have a baptism to be baptised with, (Luke 12:50), and yet this baptism was his death. The Holy Ghost calls it joy (for the joy which was set before him he endured the cross) (Hebrews 12:2). And so, the Lord was God, yet could die, would die, must die for our salvation. And now, consider one last point: Our Lord refers to his passion and death as a cup, and no worse (Can ye drink of my cup) (Matthew 20:22). If such a thing as death on a cross may be compared to a cup, then the chalice of his passion and death was freely raised in a toast to our escape from death. In gratitude for so many and great escapes, but especially for this last escape, the escape by his death, what shall we render to the Lord (Psalm 116:12)? There is only one reply: we must take the chalice of his passion and death, accept the cup of salvation freely offered and drink deeply. This is the third and final way of reading our text: God is the Lord by whom we escape death.
And so, having demonstrated how the God of power, the Almighty Father rescues his servants from the jaws of death; how the God of mercy, the glorious Son took upon himself our escape by his death; and how the comforter, the Holy Ghost assures us that the escape in death is merely the entrance into everlasting life, the frail old Dean of St. Paul’s, retired again to his sickbed where, three days later, his own escape in death was made good.
31″To what then shall I compare the people of this generation, and what are they like? 32They are like children sitting in the marketplace and calling to one another, “‘We played the flute for you, and you did not dance; we sang a dirge, and you did not weep.’ 33For John the Baptist has come eating no bread and drinking no wine, and you say, ‘He has a demon.’ 34The Son of Man has come eating and drinking, and you say, ‘Look at him! A glutton and a drunkard, a friend of tax collectors and sinners!’ 35Yet wisdom is justified by all her children.” (ESV)
This passage from Luke’s Gospel contains a lovely and evocative comparison that on the surface seems quite simple:
“To what then shall I compare the people of this generation, and what are they like? They are like children sitting in the marketplace and calling to one another, ‘We played the pipe for you, and you did not dance; we sang a dirge, and you did not weep.’”
Our Lord goes on to tell us the comparison applies not only to “this generation,” but also to himself and to John the Baptist. On first hearing, the comparison seems obvious, but on reflection, we may realize that it has a sort of parabolic complexity that keeps us turning it over and over again in our minds. Indeed, this passage in Luke’s Gospel has been puzzled over for centuries.
In one possible reading, the children in the marketplace are “this generation” inviting wisdom’s children (St. John the Baptist and the Lord) to join them first in play-acting a wedding and then in play-acting a funeral. But when the children of “this generation” played the wedding pipe-song, St. John didn’t dance to their tune, but continued in his ascetic way by yelling back a call to repentance. And when the children of “this generation” later sang their funeral dirge, the Lord wouldn’t weep, but came to them feasting and drinking. So, St. John seems to them like a madman possessed of a demon who does not know how to behave at a wedding, and the Lord appears to them to be like a drunkard and a glutton behaving badly at a funeral by eating and drinking when he shouldn’t. In this way of reading the comparison, the people of “this generation” choose the tune, calling John the Baptist and Jesus each to a particular sort of game that has certain rules and expectations, but neither plays by the rules of the game being offered. Instead, they each propose an alternative.
In another possible reading, the flute player and the dirge singer, the “we” of the comparison are St. John the Baptist and the Lord: St. John is the singer of dirges when he calls upon the people to repent in preparation for the coming Messiah, and the Lord is the piper who calls the children of this generation to dance at the marriage feast that is the Kingdom of God. So, in this way of reading the comparison, the children who fail to respond appropriately are “this generation,” and they behave as children sometimes do when in a fussy mood; they refuse all the games that at other times they love to play. But more than a simple refusal, the children of “this generation” deride the ones offering the game by calling them names.
These are just two ways in which the comparison has been read; there are multiple variations. –At this point, I suspect, you may be waiting for me to tell you the right way to read and apply the comparison. That is, after all, the way sermons and homilies usually go. But, even if I were certain, in my own mind, that I had discovered the correct reading—maybe I should not reveal it. Like all the best puzzles, the best riddles, the most intriguing parables: the fascination, and the fruitfulness, of the comparison is found in its difficulty, the benefit of it only to be gained by turning it over and over in the mind or in discussion among friends, until at last you are almost certain that you have arrived at the best solution, but with a niggling doubt that you may not have it right after all. To reveal a “right” answer to the problem the passage presents would be to deny you the real joy of it.
So, instead, I’ll ask you to consider only what the readings have in common: the scornful treatment of the Baptist and of the Lord. And, of course, we know the murderous outcome of that scorn: the Baptist’s head brought in upon a platter, and Our Lord led to a Cross. But, lest we unfairly stigmatize the generation of that day, we must admit that our own generation is no less scornful: for instance, a hostile media is eager to misrepresent the Church and its claims, and to use its own misrepresentations of the Church’s message to destroy its effectiveness, to sideline, marginalize, and silence the Church and Christians in public life. But the tendency to scorn what is not understood—or to be unwilling to understand—appears to be a more pervasive tendency in fallen humanity. Consider, for example, the behavior of this generation in the online world of social media. In that arena, the tendency to scorn has attracted a special label: “haters” are those who diligently seek out some apparent misstatement or, if none is present, who manufacture one and generate from it an assassination of character. And “hater” is as good a label as any for the phenomena because scorn simply seems to be an objective, behavioral evidence of hate. Or, if that’s going too far, at least we could say that being scorned certainly feels like being hated, like having one’s own head presented on a platter. Many of you may have already felt the acid-burn of scorn: when you first heard your call to ministry, did any of you also hear—perhaps even from some close companion—an incredulous voice: “You, a priest!” It is not an uncommon experience: “The scorn of those who scorn you has fallen upon me,” says the Psalmist (69:10). As much as I wish that we might all evade a scornful reception, the Lord’s word is certainly true: “The disciple is not above his master, nor the servant above his lord” (Matthew 10:24). We are likely to get the same reception he got.
We might, however, hope not to encounter scorn within the Church, among those who have committed themselves to the Lord Jesus whose new commandment is to love one another as he has loved us (John 13:34). And yet, scorn slithers its way in here too. If we are not vigilant, we may find ourselves casting scorn upon an opponent in some controversy in the church. Even among seeming friends, scorn can come—in the jovial guise of humor.
But, scorn is particularly hateful when it occurs between brothers and sisters in a school of the Lord’s service like this House. We all come to this House unfinished, with much to learn, with many failings to correct, needing time and space to be transformed and fitted for ministry. And we have each of us committed ourselves to the spiritual program of this House. We must place our trust fully in that program. And if we find ourselves distracted by the errors and failings around us and if we are tempted to reform them or to scorn those who commit them, we should, instead, redirect our attention to our own hearts. (If you are anything like me, you will find more than enough there for reforming!) And if the temptation should reappear, consider this: we are all members of the body of Christ, and what is done to a part of the body is done to the whole (“as you did it to one of the least of these my brethren, you did it to me.”—Matthew 25:40).
It seems to me that—no matter how advanced in years—we can all be—in some areas of our lives—like the littlest of children who haven’t yet learned the tune or how to play. If we really want to help our neighbor, the best way might be to learn our own parts well, trusting that the Holy Spirit is also piping in the secret places of the hearts around us, so that all may, at last, join the song.
“In my Father’s house there are many dwelling places” (John 14:2) or “mansions” as the King James Version has it. The image is beautiful and has spawned many a lyric. There’s the song sung by Elvis Presley– “In my father’s house are many mansions/If it were not true he would have told me so/He has gone away to live in that bright city/He’s preparing me a mansion there I know.” There’s folk-singer Pete Seeger ‘s progressive version: “My Father’s mansion’s many rooms/Have room for all of His children/As long as we do share His love/And see that all are free.”
I don’t voluntarily listen to country and western music—unless I’m stuck in a car driving across Texas—but there’s also someone with the improbable name of Moe Bandy who has apparently written a song that goes like this: “In my father’s house [are] many mansions/Though tonight some make their bed along the streets.” There’s also the exuberance of the Mississippi Mass Choir singing: “I’m leaving my house/On my way to god’s house/My house is decaying ya see/but in my father’s house/ there are many mansions/And one of them belongs to me.” Or in Bob Dylan’s turn as a Christian singer, there’s a sly reference: “They say in your father’s house, there’s many mansions/Each one of them got a fireproof floor.”
However, none of these contemporary songs really do justice to the gospel text: “dwelling place” is a much better translation than “mansion.” For the King James Version translators, the word “mansion” did not mean a large and luxurious home; it simply meant “a dwelling place” or, more specifically, “a dwelling place within a larger house” (See Shorter OED). But popular culture didn’t catch onto the changed meaning of the English word “mansion.” And so, “preparing a place” in one of those “mansions” came to mean, in the popular imagination at least, restoring the balance between the have’s and the have-not’s—“dwelling place” became, in pop culture, a heavenly McMansion to be doled out in compensation for earthly deprivation. Now, I don’t doubt that such a putting-right of want and injustice will indeed take place. But I don’t think that is really what this morning’s gospel passage is actually getting at: rather, it is about union with the Lord in the bosom of the Father, which can occur as well—maybe better—in a cell as in a mansion.
Our text falls in John’s gospel after a section in which the Lord has described the death that he must undergo, and his words are comfort for the understandably anxious disciples. The disciples fear that the Lord’s death will be the end. Only in retrospect would it be possible for them to fully comprehend the words of Jesus. Experience will eventually make it clear: the Lord’s crucifixion and resurrection will bring the indwelling Spirit, and Jesus will be with them always (cf. Matt. 28:20), intimately united with them in his Church—a union dramatically realized in the Most Blessed Sacrament. Only in retrospect would they see the place prepared as an extension of the intimacy they have already enjoyed. So, yes, the place that Jesus goes to prepare certainly has its eschatological aspect, but isn’t there a foretaste to be experienced while still on the way?
Catherine of Siena, who we commemorate today, describes how we might begin in the here and now to move into that dwelling place prepared for us, how we might begin to move into a state of union with the way, the truth, and the life. In a dream, she heard the Lord saying to her:
“Do you know, daughter, who you are and who I AM? If you know these two things you have beatitude in your grasp. You are she who is not, and I AM HE WHO IS. Let your soul become penetrated with this truth, and the Enemy can never lead you astray” (in the Legenda ).
It’s such a simple thing to say (beatitude results from self-knowledge and from knowledge of God), but throughout the remainder of her brief life, Catherine returned over and over to this fundamental point, trying to plumb the profundity of her dream, developing its implications in her Dialogue and letters. In order to be “united with and transformed in God,” she says, we must “dwell within the cell of […]our soul[s].” And then, in one of her charmingly mixed-up metaphors, she tells us that within the cell of our souls is a well which at first appears dry, filled with earth. On descending into the well, we find earth and water: “in the earth we recognize our own poverty: we see that we are not. For we are not. We see that our being is from God. ” The earth in the well within the cell of the soul is self-knowledge. We see ourselves as we are—radically dependent on God for our very being. But the cell’s well’s earth reminds us not only that we are entirely dependent upon Him for our existence, but also that we are broken and sinful. But, as we excavate the well, we also discover the water: the “ineffable blazing charity” of God toward His unruly creatures: “I see next that as we discover the earth we get to the living water, the very core of the knowledge of God’s true and gentle will which desires nothing else but that we be made holy.” Catherine later calls the soul “a dwelling place [that] is spiritual and [that] you carry … with you constantly.”
So, in one sense, when Jesus says that he goes to prepare a place for his disciples in that House with many mansions, he is offering his disciples something far more than a consolation prize for having had no earthly place to lay their heads during this life. He is offering them a dwelling forever with Him in beatitude. And, in another sense, there’s no need to wait for the hereafter, because it’s here today. No need to call the movers, just enter the cell, climb down into the well, face the earthy self, and let the grace of God flood in.


Byzantium: The Surprising Life of a Medieval Empire
Princeton University Press, 2009
440 pp., $19.95
What About The East?
If Christianity is moving North to South, as we often hear these days, then what about the East? By emphasizing this "North to South" typology are we—yet again—ignoring the East? Sure, we understand Christianity in the southern hemisphere is booming, but what about Christianity in the Middle East, in Central Asia, and in that vast swath of territory we call "Eastern Europe"? The Middle East, Northeast Africa, and former Persia were real heartlands of Christianity during the first millennium, and Eastern Europe, particularly Russia, rivaled the West as the world's most Christianized civilization until the 20th century. Yet it is altogether common for Western scholars to take an entire degree in Christian history or theology, only to come to the stark realization that the history of the faith in the East was scarcely mentioned, particularly after the Great Schism of 1054. In recent years we have seen some very helpful correctives to this lacuna in our scholarship. One of the best is Judith Herrin's Byzantium: The Surprising Life of a Medieval Empire.
The inspiration for this volume came one day in 2002 with a knock on Herrin's office door at King's College, London. She was greeted by two "serious builders in hard hats and heavy boots." The men were doing repairs when caught by the intriguing title on her door, "Professor of Byzantine History." Herrin was asked to summarize 1,123 years of history—from the dedication of Constantinople in 330 to its fall in 1453—in ten minutes. Impossible. But it did force her to think about how to boil it all down, and in this book she has done a very fine job.
"Byzantine" is an intimidating word. What exactly do we mean by it? In the West, the word has evolved to mean something unnecessarily complicated or devious. This distortion is likely a relic of longstanding hostilities between East and West. Herrin writes: "The modern stereotype of Byzantium is tyrannical government by effeminate, cowardly men and corrupt eunuchs, obsessed with hollow rituals and endless, complex and incomprehensible bureaucracy."
Instead, she wants us to imagine a magnificently sophisticated civilization, studded with intelligence, order, and metropolitan vibrancy. And she justifies her preference by taking a "people's history" approach to the topic. Instead of the typical "Great Men" approach to empires—narrowing the foci to emperors, bishops, and prime movers—she bathes her narrative in the ordinary and earthy without sacrificing the aristocratic. The hoi polloi surface time and again in her social descriptions: builders, children, wives, and soldiers, all tending to their daily tasks.
Herrin's discussions of Byzantine education are particularly illuminating. She tells of children learning Aesop's Fables and progressing into their studies of rhetoric and persuasion in the teen years. More advanced students took on the quadrivium—arithmetic, geometry, harmonics, and astronomy. Only the most élite intellects were privileged to enter the discourses of Plato and Aristotle. Byzantines were a literate people; perhaps no other attribute is as evident in her story. Parents wrote to teachers with concerns about their kids' grades. Letters have been preserved on virtually every topic of the day, "diet, climate, friendship … expressions of sympathy … congratulations on marriage and the birth of children."
Transporting the reader back to a proud and golden time, Herrin's narrative vivifies a shadowy era, most poignantly when she leads us through the streets of the magnificent capital. If Constantinople was the heart of the empire, then the Hagia Sophia was the soul. Herrin's description of that breathtaking masterpiece, that wonder of the Byzantine world, is unforgettable: lamps solemnly burning round the clock, casting a copper glow on massive, larger than life icons that bring people to their knees in reverence. Marble flooring, gold-painted gallery ceilings, silver disks, precious stones, linens, and colors from the farthest reaches of the Roman Empire, all led Emperor Justinian I to proclaim his satisfaction "Solomon, I have surpassed thee." Visitors from other civilizations agreed: when Russian envoys entered this largest church in all of Christendom in 988, they later recounted, they "knew not whether we were in heaven or on earth … . We cannot describe it to you: only this we know, that God dwells there."
Constantinople was the jewel of the world for Byzantines, and they fought many battles over the course of centuries to protect their treasure. The walls of Constantinople were so impenetrably built that the city survived far longer than it should have. And the naturally protective location of the city was strategically brilliant. Any threat from the sea was met by Greek Fire—that mysterious substance shot out of tubes at invading boats—discouraging restless Muslim navies eager to make Constantinople their own capital.


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The most effective fortification form came via flour.
Dr Kraemer said the concern that folic acid fortification masked vitamin B12 deficiency was based on outdated and widely discredited data from the 1940s.
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Women of child-bearing age need sufficient body stores of folate before conception to prevent folate-sensitive neural tube defects (NTDs), which make up 20% to 60%of all NTDs.
Dr Kraemer said sightandlife and other NGOs continued to educate and lobby governments about the benefits of mandatory folic acid fortification.


Viridian Vitamin E
Vitamin E is an antioxidant that protects body tissue from damage caused by substances called free radicals. Free radicals can harm cells, tissues, and organs. They are believed to play a role in certain conditions related to aging.
The body also needs vitamin E to help keep the immune system strong against viruses and bacteria.
Vitamin E is also important in the formation of red blood cells and it helps the body use vitamin K. It also helps widen blood vessels and keep blood from clotting inside them.
Cells use vitamin E to interact with each other and carry out many important functions.


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