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Deprogram from Darwin legends - free and fun!
I now have a chance to say more about retired Australian political science prof Hiram Caton's new Web site on the pious Darwin legends that currently infest popular media. (I first mentioned it here but couldn't follow up until now.)
Caton, a friend and associate of the late David Stove, author of Darwinian Fairy Tales, has done extensive research on the real story behind Darwin and his Origin of Species - and no, it is not the pious legends you will be hearing on public television.
Both Caton and Stove are recognized as agnostic philosophers with limited use for pious legends in science or religion (must be something in the air Down Under?) Anyway, here is Caton's beginning stab at hauling away the trash (and his deceased colleague would be proud):
^Belief that the Origin was a 'revolutionary' scientific breakthrough conflicts with the fact that public opinion was at the time saturated with the evolution idea. It was so widespread that in 1860 the showman P T Barnum put on display a freak, styled Zip the Pinhead, alleged to be the 'missing link' between apes and humans.Dr. Caton tells me that his Web page, Whither Progress? on "Major Changes in Evolution Theory" is almost finished, and thanks me for reporting his views accurately, noting
^The natural selection principle was first stated in 1831 by Patrick Matthew, and was independently discovered in 1836 by Darwin's naturalist colleague, Edward Blyth. Herbert Spencer came close to a formulation in 1852, and Alfred Wallace discovered it in 1858.
^The Origin did not found modern biology. By 1850 it was a thriving science whose leading men were Louis Pasteur, Claude Bernard, Rudolph Vircow, and Robert Koch. Darwin, a naturalist, was not involved in this research mode. Conversely, evolution was not a parameter of experimental biology.
^The Origin did not instigate a 'revolutionary' disruption of science from religious belief. That antagonism became a cultural force thanks to the French Revolution. By the 1830s, French and British radicals invoked evolution as a rebuttal of religious beliefs about God's creation.
By 1860 this position was widespread throughout Europe and Latin America. Conversely, numerous scientists and clergymen believed in the compatibility of science and religious faith. That includes the discoverer of the first quantitative biological laws, Gregor Mendel.
^The only practical application of Darwinian theory with potential cultural impact was eugenics, devised by Darwin's cousin, Francis Galton. Three of his sons were dedicated to the eugenics cause, and one of them, Leonard, was the patron of a key figure in the creation of neo-darwinism, R A Fisher, as well as President of the Eugenics Society
I believe that you know that I don't believe that the extensive revisions and corrections of Neo-Darwinism imply rejection of evolution; rather the improvement of our understanding of it.Yes, I got that. He argues that " ... the Modern Synthesis is obsolete, and that a new grasp of evolution is in the making, has been argued by numerous authors. My purpose here is to highlight some major innovations that have transformed evolution science.", which he does. Darwintrolls, this is not for you. Serious thinkers, have a look.
Check out his deprogram from Darwin legends here.
Dr. Caton also writes me to record, for historical purposes, the response of one much-feted "religious" Darwinist,
Among the responses I've had from my mailouts is one from a prominent evolutionary biologist , who is giving a paper on Darwin and religion at the Duquesne University Darwin celebration in November 2009. He wrote:Caton then offers his response:
"Your synopsis says a number of truths, but they may amount to half-truths, since they seem to me to miss (but not only) what is the most important contribution of Darwin to the history of ideas: that he completed the Copernican Revolution by bringing the design of organisms into the realm of science. At a non-technical level, I elaborate this notion in my recent Darwin's Gift to Science and Religion (Joseph Henry Press, 2007)."
Dr. Caton also advises me that
Good morning Professor!
Thanks very much for responding to my email. I'm aware that you are among those to whom my evidence is in opposition. Specifically, I maintain that Darwin was but one in a long line of naturalists and experimental scientists whose study of living nature was based entirely on natural causes. In 1859, the British and American public had been exposed to the evolutionary naturalism of Herbert Spencer and the Vestiges of the Natural History of Creation.
Commentators such as Ernst Mayr dismiss Vestiges as romantic garble of no scientific significance. That view was also expessed by some scientists of the time, e.g., Herschel and Sidgwick.
Nevertheless, Vestiges presented what was for many (e.g. the young Alfred Wallace, Abe Lincoln) a convincing argument that living nature could and should be explained entirely on natural principles (documented in Secord's Victorian Sensation).
Furthermore, there was an extensive purely naturalistic evolution literature, mostly in French, from 1790--1840, documented by Corsi, The Age of Lamarck).
On p. 159 of your book you write: "Indeed, a major burden was removed from the shoulders of believers when convincing evidence was advanced that the design of organisms need not be attributed to the immediate agency of the Creator, but rather is an outcome of natural processes." Perhaps today (not all believers would agree), but not historically. In 1864 Pope Pius IX decreed the Syllabus of Errors. Eighty errors are enumerated under ten headings: Pantheism, Naturalism, and Absolute Rationalism; Moderate Rationalism; Indifferentism and Latitudinarianism; Socialism, Communism, Secret Societies, Biblical Societies, Clerico-Liberal Societies; Errors Concerning the Church and Her Rights; Errors about Civil Society, Considered Both in Itself and in its Relation to the Church; Errors Concerning Natural and Christian Ethics; Errors Concerning Christian Marriage; Errors Regarding the Civil Power of the Sovereign Pontiff; Errors Having Reference to Modern Liberalism. Under the last three headings, the encyclical deals extensively with varieties of the demand for separation of church and state. Under the first heading, the first six errors are:
1. There exists no Supreme, all-wise, all-provident Divine Being, distinct from the universe, and God is identical with the nature of things, and is, therefore, subject to changes. In effect, God is produced in man and in the world, and all things are God and have the very substance of God, and God is one and the same thing with the world, and, therefore, spirit with matter, necessity with liberty, good with evil, justice with injustice. - Allocution "Maxima quidem," June 9, 1862.
2. All action of God upon man and the world is to be denied. -- Ibid.
3. Human reason, without any reference whatsoever to God, is the sole arbiter of truth and falsehood, and of good and evil; it is law to itself, and suffices, by its natural force, to secure the welfare of men and of nations. -- Ibid.
4. All the truths of religion proceed from the innate strength of human reason; hence reason is the ultimate standard by which man can and ought to arrive at the knowledge of all truths of every kind. -- Ibid. and Encyclical "Qui pluribus," Nov. 9, 1846, etc.
5. Divine revelation is imperfect, and therefore subject to a continual and indefinite progress, corresponding with the advancement of human reason. -- Ibid.
6. The faith of Christ is in opposition to human reason and divine revelation not only is not useful, but is even hurtful to the perfection of man. -- Ibid.
Notice that Evolution is not one of the ten headings. Nowhere in this document is evolution or Darwin mentioned. Nowhere. So according to the Church, not Darwin, but pantheism, naturalism, and absolute rationalism should be credited for freeing believers from the burden you mention.
Several other mailout recipients have identified errors in my history, but on inspection they turn out to non-errors, and of course I've responded as I did to (the) Professor.Well, Dr. Caton, the BoBos need a god and I guess his name is Darwin.
His email persuaded me that my response to him should go up on the legend website in an expanded form. I'll also include the London Times obituary of Darwin. It's a long-very long-eulogy whose extravagance is matched only by praise of Stalin and Mao. Darwin is the greatest scientist and thinker of all times, &c &c. He's so great that the writer doesn't even compare him with anyone else--except Newton, who, of course, he excels.
Anyway, if you have read this far, check this out.
Labels: Hiram Caton


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Ecologically sensitive vineyards
There's a Latin saying that goes, "It is well to remember that there are five reasons for drinking: the arrival of a friend; one's present or future thirst; the excellence of the wine; or any other reason."
My "any other reason" to drink wine? If it's local, organic or made at an ecologically sensitive winery. There's nothing better than taking a sweet swig knowing that the vino was brewed with love by winemakers who care about the planet. Come circle the globe as we take a peek at five of the greenest wineries in the world. (Jess Root originally wrote this for TreeHugger. It now lives on MNN.com)

subset: commoncrawl


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NEW YORK (MarketWatch) -- Billionaire T. Boone Pickens said Thursday he's placing an order to buy 667 wind turbines from General Electric GE, -1.08% as part of an estimated $2 billion in start-up costs for his four-phase Pampa Wind Project. Pickens' Mesa Power LLP will buy the GE turbines, which will be capable of generating 1,000 megawatts of electricity, enough for 300,000 average U.S. homes. When complete, the Pampa Wind Project will cover some 400,000 acres in the Texas Panhandle. "You find an oilfield, it peaks and starts declining, and you've got to find another one to replace it," said Pickens, who once operated one of the largest independent oil and gas production companies. "It can drive you crazy. With wind, there's no decline curve."
T. Boone Pickens spending $2 bln to start up Texas wind farm
Quote References
-0.10 -1.08%


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Kitchen Remodeling in Ohio
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The 2010 Holiday Ale fest kicks off in just 2 days! By now, you have probably seen the beer list and its delicious descriptions on this blog or the HAF website. But what you've seen was probably just a long list. I thought it would be fun to see the information about the standard release beers in a different way.
I created a few graphs that give you more insight into the beer. I also sorted the information in a way that I hope is helpful as you ponder your holiday ale quaffing adventures. Let's begin...
By Style: Strong Ales represent 45% of beers at the fest! Belgian Ales and Porters are the second and third most common styles, respectively.
By Brewer Region: 72% of the beers (33) are from Oregon. 18% (8) are from California. Only 10% (5) of the beers are from Washington, Alaska, Nevada, and even one from Belgium.
By City within Oregon: Of the 33 beers from the Beaver state, 17 (52%) are from Portland. Bend is home to four beers and Eugene is sending us two. Ten other cities are each providing one beer.
Brews by Style: If you're interested in certain styles, here's your cheat sheet.
Belgian Ale
Belge d'Hiver
Black Pepper Belgian Pale Ale
Concentrated Evil
Franc'ly Brewdolph
Scaldis Noel
Streaking the Quad
Brown Ale
Parson Brown
Dark Lager
Very Noddy Lager
Old Grogham Winter IPA
Moore Holiday Ale
Ginger Beer
Lips of Faith Selections
Steins Christmas Ale
Aegir's Cauldron
Black Dynamite
La Niña Coffee Porter
Paddler's Porter
Smoked Porter w/ Vanilla Beans
Union Barrel Fermented Porter
Red Ale
Climax Noel (2009)
Rudolph's Imperial Red
Cranberry Saison
Sour Ale
Ebeweesner Scrooge
Femme Fatale
Sang Noir
Pavlov's Russian Imperial Stout
Toe Tingler Stout
Strong Ale
Alaskan Barley Wine (2008)
Brown Mashuggana
Figgy Pudding, Olde Stock
Ho Ho Ho Slapper
Jewbelation Blend
Kentucky Christmas
Lost Glove
Mrs. Claws
North the Fourth
Old Foghorn
Old Knucklehead Barley Wine
Papa Noel's Moonlight Reserve
Pray For Snow
Very Ill-Tempered Gnome
Let me know if you found this interesting or somewhat helpful. Be sure to check out my preview of 13 Holiday Ale Fest brews. Enjoy the Festival!!


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Conservatives revolt on immigration
John Boehner teased them last week for whining about the fact that they couldn't tackle a tough topic like immigration reform.
But conservative immigration foes have yet to let go of the speaker's remarks about them.
Story Continued Below
In the aftermath, they are stepping up their efforts to thwart any plan that might be afoot among House leadership to jam reform through the House by the end of this year. A group of conservatives plans to meet and strategize this week, and are scouring bills searching for offending language that might somehow slip through their gates.
( WATCH: Boehner mocks colleagues on immigration)
"We have to man the watchtowers 24/7," said Rep. Steve King (R-Iowa), referring to a feeling among hard-liners that House leaders will try to sneak through immigration measures.
Conservatives intend to huddle this week about immigration, according to Rep. Mo Brooks (R-Ala.), an outspoken critic of providing legal status to undocumented immigrants and encouraging more legal migration in the future. Brooks declined to disclose more details about the meeting, including how many lawmakers are involved.
"It is difficult to plan a specific course of action when the leadership keeps tossing out vague ways to give amnesty to illegal aliens," Brooks said. The sophomore lawmaker added: "When we see a specific plan from the House leadership, then those of us who favor American citizens first will have a better idea of where the leadership is specifically going and how we will specifically respond."
( CARTOONS: Matt Wuerker on immigration)
Since the Senate passed comprehensive immigration reform last year, House conservatives have fiercely guarded against passage of a large overhaul in their chamber — and even over approval of smaller bills — because they are concerned about a pathway to citizenship for the millions of undocumented immigrants in the United States. This small group of immigration reform opponents is threatening House GOP leadership with their jobs if they take up an overhaul.
These conservatives still believe their leaders would like to see reform succeed — despite its unlikely prospects — and Boehner's theatrical pantomiming last week in Ohio of conservatives behaving like babies when it comes to an immigration overhaul has not helped matters for them.
Conservatives also took notice of comments from Washington Rep. Cathy McMorris Rodgers, the chairwoman of the House Republican Conference, who last week told a local newspaper that she could see immigration legislation making its way to the House floor by August.
"That comment is unfair to the people who are very sincere about their concerns about people who came here illegally," Rep. Walter Jones (R-N.C.) said, referring to Boehner's remarks. "There are a number of members — we'll find out over the next few months — who feel like we need a change of leadership. We need a new direction."
( Also on POLITICO: Asian caucus recommends immigration changes)
Jones is one of 12 members who voted against Boehner for speaker in January 2013.
Brooks, who supported Boehner for speaker in that election, added that the GOP leadership's handling of immigration is a reason why House Republicans need to clean house in their top ranks. He noted that the four highest-ranking House GOP leaders — Boehner, Majority Leader Eric Cantor, Majority Whip Kevin McCarthy, and McMorris Rodgers — all hail from blue or purple states. A better balance, Brooks said, would be to have two Republicans in leadership who hail from red states and two from states that favor Obama and Democrats.
A handful of conservatives have not been pacified by assurances from leadership that it isn't quietly conspiring to carve out a legislative pathway to reform. Furthermore , they aren't mollified by their party's rhetoric blaming lack of progress on reform on distrust of President Barack Obama — who they think might not enforce immigration laws in the same way he hasn't enforced Obamacare.
( WATCH: Jeh Johnson defends Obama on immigration enforcement)
Boehner and McMorris Rodgers have since walked back their comments somewhat.
Boehner clarified his immigration jokes during a closed-door party meeting Tuesday, and told reporters that it wasn't mockery of House Republicans, but rather good-natured teasing that's characteristic of the Ohio Republican.
"There's no mocking. You all know me. You know, you tease the ones you love, all right?" Boehner said Tuesday. "But some people misunderstood what I had to say."
And a McMorris Rodgers aide said the lawmaker was simply expressing her personal views on wanting to see immigration reform done, rather than sketching out a legislative timeline.


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Dan Walters
Dan Walters: Bomber subsidy bill puts liberal legislators on the spot
If you are a liberal Democrat, two of your likely ideological tenets are ending tax breaks and subsidies for corporations and reducing spending on nuclear arms to free up money for health, social and educational services.
Assembly Bill 2389 violated both. The hastily written bill, sought by Gov. Jerry Brown, would grant one defense company, Lockheed Martin, a special tax break estimated at $420 million to help it and Boeing win a Pentagon contract for a new strategic bomber that would make it easier to rain thermonuclear destruction on a future military foe.
The loophole would be financed from the state treasury and thus divert funds otherwise available for the social and educational spending that liberals cherish. It's predicated on the assumption that several thousand high-paying manufacturing jobs would be created.
One of the legislation's unspoken aims is helping first-term Democratic Assemblyman Steve Fox, the bill's nominal author, win a tough re-election battle this year. His Antelope Valley district is a center of aircraft production, which has declined markedly with post-Cold War cutbacks in Pentagon weapons spending.
When the bill first surfaced in the Assembly, the angst among liberal legislators was palpable. They were being asked to embrace legislation that violates two of their oft-chanted political principles, and five Democratic Assembly members refused to vote for it.
The same dilemma – conflict between principle and practical politics – was even more obvious when the bill moved to the Senate.
Senate President Pro Tem Darrell Steinberg insisted that the bill be modified to reduce – in theory at least – its bite on the state treasury by taking some of the money out of a special fund given to Brown to make deals on job-generating business investments.
Even so, several liberal senators spoke against it on the Senate floor.
Sen. Bill Monning, D-Carmel, for instance, was highly critical of spending state funds on "the next generation of nuclear weapons systems" while not meeting health care and social services needs.
"That's where the money should be going," Monning told his colleagues. He and others also worried aloud that enacting the Lockheed Martin bill would open the door to demands from other companies for tax breaks with threats of high-wage jobs going to other states.
Once again, Steinberg straddled the line, agreeing with liberal critics about priorities, decrying the corporate practice of pitting states against one another but concluding, "I don't think we can turn our back on this."
When the final vote was taken, eight liberals either voted against it or refused to vote – the latter being tantamount to a "no."
It probably won't be the last time liberals face the dilemma, because the same subsidy may be sought for another bomber bidder, Northrop Grumman.


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DT Call
Through The Craft Room Door Magazine is always looking for enthusiastic, energetic, friendly and trust-worthy Design Team members. We are a drama-free team, we take pride in what we do and we work well together.
We are looking for card makers, scrap-bookers or versatile paper crafters that would like to be a part of our challenges and be published in TTCRD Magazine.
Minimum Requirements:
Your term will be for 6 months.
You must have an active blog and good photography skills to help us promote Through The Craft Room Door Magazine and our sponsors.
You will be required to submit a card or project with detailed supply list every two weeks for the challenge blog.
You will be required to comment weekly on entries to the challenges using an assigned number. (example: if you assigned number was 1 you would comment on 1, 11, 21, 31 etc)
Commenting on the cards and projects submitted by our followers for each challenge is extremely important. People take time to enter our challenges, we believe it is right and proper that we take time to comment on each and every entry.
You will receive access to the Subscribers Only Area of the magazine during your 6 month term and for 3 months after.
You will be required to supply, at minimum, one tutorial or craft related article for each magazine published during your 6 month term. It will be eligible for a random drawing for a $10 gift card to Amazon.
We have one blog yearly which is run during the month of November. Other Blog Hops may possibly be scheduled, so please be aware that you will be required to participate. Any necessary details will be provided when the event(s) are scheduled.
To be considered for the team, please send us your best project, DT commitments - past and present and blog address. Tell us something about yourself and why you want to be considered for the Design Team. This call is open to anyone, international applicants are encouraged to apply.
If selected, you will be sent more detailed information, including a statement of understanding regarding your obligations to both the challenge and the website.
If you are interested in being a Designer please send an email with "DT Interest" in the subject line and a link to your blog to
Sandra van Blaricum
Cara Malmrose
Cara Malmrose
Thank you and we look forward to hearing from you!


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Walter Salles and Alice Braga talk about Kristen at the OTR PressCon in Brazil
iG Walter Salles praises again Kristen Stewart - "The director praised the "loyalty" of Stewart with the project even after the "boom" of "Twilight" and its guarantees of a fortune (which was not the case with "The Road"), and already gave a hint of her future works. "She told me what she wants to do and are upstream movies (against the grain; counterculture). Box Office success is not a concern for her."by Marco Tomazzoni
UOL Alice Braga on Kristen Stewart "Alice confirmed that Walter "discovered" Kristen Stewart before "Twilight" and hoped that people no longer associate her to the teen universe. "She's an complete actress since childhood and shows beyond the Girl from 'Twilight.'. I hope people stop to associate her to this teen idol and start to see her as a great actress of her generation." by Estefani Medeiros
Terra Alice Braga praises Kristen Stewart again - "The actress also praised the work of Kristen Stewart, who plays the young Marylou in the film and is considered a somewhat controversial choice of Walter, due to be better known since the Twilight movies. "Kristen is a great actress of this generation, goes far beyond Twilight. The lack of shame to make her sex scenes are brilliant," she said"
Source; naestradafilme via luacheia99 /KstewAngel /gossip_dance
Walter Salles and Alice Braga talk about Kristen
Posted by RobStenation at 1:44 AM
Labels: Brazil, Kristen mentions, OTR Promo, Walter Salles


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W: N. Pivetta (3-2) L: A. Cashner (1-5)
Phillies, Orioles to try to sneak one in before rain
MLB Headlines
The Baltimore Orioles and Philadelphia Phillies have to deal with Mother Nature before they meet for the first time since 2015.
The first contest of their brief, two-game set at Oriole Park at Camden Yards was rained out Tuesday night. The Orioles and Phillies will attempt to get a game in at 12:05 p.m. ET on Wednesday. The time of the first pitch was moved up 30 minutes as the teams try to beat more rain in the Baltimore forecast.
The Orioles' Andrew Cashner and the Phillies' Nick Pivetta, Tuesday's originally scheduled starters, will face each other Wednesday. Neither team has played since Sunday thanks to off days Monday and Tuesday's rainout.
Baltimore is coming off its most prolific offensive outing of the 2018 season. They scored 17 runs on 19 hits in a rout of the Tampa Bay Rays on Sunday. The Orioles (13-28) are still in a distant fifth place in the American League East, but have won five of their last six games.
"There's really no explanation for why April went the way it did," Orioles third baseman Danny Valencia told MLB.com after the 17-1 victory over the Rays. "There's a lot of great hitters in here and we've done a great job of relieving each other, and I can't imagine our offense doing what it did in April the rest of the season. It was only a matter of time before it turned."
Pivetta will have to deal with that offense Wednesday.
Pivetta (2-2, 4.15 ERA) threw five shutout innings during his last outing against the San Francisco Giants on Wednesday. Pivetta, a second-year major-leaguer who has never faced the Orioles, bounced back after allowing a combined 10 runs in six innings during his two starts before his last outing.
Cashner (1-4, 4.84), meanwhile, enters Wednesday with a 6.97 ERA and 1.79 WHIP over his last four starts. The 31-year-old righty surrendered three runs on six hits in six innings against the Kansas City Royals last Wednesday.
Cashner is 4-1 with a 2.55 ERA and 1.09 WHIP in 13 career games (seven starts) against the Phillies.
The Orioles took three of four from the Phillies during their last series in 2015, also at Camden Yards. It took the Phillies until June 18 to win their 23rd game that season (a victory that came against the Orioles). They enter Wednesday with a 23-16 record in 2018.
Phillies general manager Matt Klentak praised the Phillies strong start through the first quarter of the season Tuesday.
"This team's starting pitching has really been impressive through the first quarter of the season in their ability to throw strikes, in their ability to miss bats and in their ability to induce weak contact," Klentak told MLB.com. "On top of that, I think, in the bullpen there is a lot of depth on this team.
"The way this team is evolving, whether we are winning a close game or losing a close game or it's a blowout game, we're able to put a good arm on the mound that's delivered good results for us. And I think our offense is really starting to click now, too."
Tuesday's postponement will be made up July 12.
Updated May 15, 2018


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SAMJ: South African Medical Journal
versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.102 no.8 Cape Town Ago. 2012
South African guidelines for the management of Gaucher disease, 2011
Lysosomal Storage Disorder Medical Advisory Board (in alphabetical order); Louisa Bhengu; Alan Davidson; Paul du Toit; Trevor Gerntholtz; Kenny Govendrageloo; Rene Heitner; Bertram Henderson; Lawrence Mubaiwa; Sheeba Varughese
BACKGROUND: Gaucher disease is an autosomal recessive lysosomal glycosphingolipid storage disorder resulting from a deficiency of lysosomal enzyme acid â-glucosidase (glucocerebrosidase). This partial enzyme deficiency results in accumulation of glycosphingolipid-laden macrophages (Gaucher cells) throughout the liver, spleen, bone marrow, skeleton, lungs and brain (only in types 2 and 3).
OBJECTIVE: These guidelines aim to provide a standard of care for patients with Gaucher disease in keeping with international standards, but also realistic for South Africa, and to provide a shared-care model for treating physicians and funders regarding care for these patients.
RECOMMENDATIONS: All healthcare professionals involved in the diagnosis and management of Gaucher disease should take note of and implement these guidelines in clinical practice as far as possible.
VALIDATION: These guidelines were developed through consensus by the Lysosomal Storage Disorder Medical Advisory Board. They are largely based on the UK 2005 National Guidelines for Gaucher Disease, but include new treatment recommendations for enzyme replacement therapy based on subsequent publications. The Southern African Society for Human Genetics (SASHG) (who have endorsed the guidelines) and the National Osteoporosis Foundation of South Africa (NOFSA) provided valuable input.
GUIDELINES SPONSOR: Genzyme initiated the project and sponsored the meetings of the Advisory Board and all costs generated by these meetings.
CONCLUSION: It is intended that these guidelines will enable all patients suffering from Gaucher disease to be diagnosed and offered the best possible care available.
1. Background
The South African Lysosomal Storage Disorder (LSD) Medical Advisory Board (MAB) is a multidisciplinary/multispecialty team of physicians from academic and private healthcare institutions with an interest in treating LSDs. The multidisciplinary approach is essential because of the multisystem nature of the disorders. The LSD MAB members are independent and aim to provide a shared-care model for treating physicians and funders regarding various aspects of care for these patients.
The original UK 2005 National Guidelines for Gaucher Disease1,2 are based on limited natural history and literature available at that time. Since these guidelines were written, three important publications have emerged.3-5 They demonstrate a dose response to enzyme replacement therapy of up to 60 U/kg every other week (EOW) on haematological and visceral parameters, a similar dose response on bone mineral density, and a relationship between timing of initiation of therapy and reduced risk of avascular necrosis.1-3
The South African guidelines are based primarily on the UK guidelines. However, the LSD MAB included evidence from subsequent publications to provide an international standard of care, but also realistic for South Africa, given the constraints facing healthcare workers and patients. These guidelines are intended to enable all patients suffering from Gaucher disease to be diagnosed and offered the best possible care available.
Since Gaucher disease is rare, it is difficult to obtain large numbers of patients for studies. The availability of effective treatment makes randomised control studies ethically difficult to design and perform. Thus most of the data are derived from case reports and registries.
2. Disease overview
Gaucher disease is an autosomal recessive lysosomal glycosphingolipid storage disorder resulting from a deficiency of the lysosomal enzyme acid â-glucosidase (glucocerebrosidase).1 It is the most prevalent of the LSDs and is divided into 3 clinical types, of which type 1 is by far the most common.1 This partial enzyme deficiency results in accumulation of glycosphingolipid-laden macrophages (Gaucher cells) throughout the liver, spleen, bone marrow, skeleton and occasionally the lung.1 In types 2 and 3 pathology also occurs within the brain.1 The onset of clinical features may occur at any age in type 1 disease, while type 2 presents in infancy and type 3 typically in early childhood.1 Early onset in type 1 disease predicts a more aggressive course.1 Gaucher disease has been demonstrated to occur in all ethnic groups in South Africa. Some population groups such as the Ashkenazi Jews have a higher incidence.
3. Diagnosis
The diagnosis of Gaucher disease is based on history, clinical evaluation, laboratory investigations and diagnostic imaging.
3.1 Baseline assessments1
History, including family pedigree: medical history of painful hips, bone crises, fractures, orthopaedic interventions; surgical history, including splenectomy; history of respiratory tract infections or other frequent infections; history of eye movement abnormalities, squints; history of bleeding, bruising, blood transfusions, nose bleeds, onset of menarche and/or heavy menstruation; history of hepatosplenomegaly or abdominal distension.
3.2 Clinical assessments1
Height, weight, blood pressure and urine analysis; evidence of corneal opacification should be sought; oculomotor gaze palsies and pingueculae; presence of jaundice, pallor, ecchymoses, purpura and petechiae; spinal deformity, defects of joint movement particularly hip assessment; presence of visceromegaly (hepatosplenomegaly) and signs of chronic liver disease; neurological evaluation to include symptoms of parkinsonism for evaluation of type of Gaucher disease; and quality of life questionnaire.
3.3 Laboratory evaluations1
Baseline enzyme activity of glucocerebrosidase in leukocytes
DNA mutational analysis (at baseline only)
Bone marrow aspiration is not required for diagnosis. Recommended:1
Chitotriosidase activity is elevated in Gaucher disease (except in a small proportion of patients where it is absent due to a mutation that can be identified by DNA mutation analysis), and can be assessed at baseline and as required to monitor disease activity. Other biomarkers which decrease with effective enzyme replacement include serum angiotensin-converting enzyme (ACE) and tartrate-resistant acid phosphatase (TRAP).
Full blood count (FBC) with peripheral smear, vitamin B12, folate, iron and ferritin.
Endocrine profile: parathyroid hormone (PTH) & 25-OH vitamin D & thyroid-stimulating hormone (TSH) (free thyroxine (T4) & free triiodothyronine (T3) when indicated).
Biochemistry profile: renal, liver and lipid profiles, C-reactive protein (CRP), immunoglobulins, serum protein electrophoresis.
Clotting screen: international normalised ratio (INR), prothrombin time (PT), partial thromboplastin time (PTT) (factor XI levels and fibrinogen when necessary, particularly in pregnancy).
Serum storage for antibody screening (store for baseline) with protocol and informed consent.
HIV screening with informed consent; and hepatitis screen.
For timing of tests refer to section 7 (some blood tests are not available in South Africa and can be done in a European laboratory or specimens collected and frozen for later analysis as required).
3.4 Diagnostic and follow-up imaging1
3.4.1 Magnetic resonance imaging (MRI): abdomen and high-risk bones (femur, humerus, lumbar vertebrae, hip joints) at baseline, when clinically indicated and at dose adjustments: (i) initial assessment, staging and calculation of organ volumes; (ii) visceral infarction - only if necessary for clinical evaluation; (iii) new symptoms suggestive of bone or joint disease (bone marrow burden score6 is optional). MRI is valuable for assessment of structural bone abnormalities.
3.4.2 Dual energy X-ray absorptiometry (DEXA): at baseline and as needed. Identification of patients at risk of fractures, and prior to and at follow-up of patients requiring antiresorptive or anabolic bone therapy. For paediatric patients, DEXA scan must be performed at a centre that uses paediatric reference values. DEXA measurements should be done at bone sites that are free of osteonecrosis. DEXA is the method of choice for evaluating osteopenia/osteoporosis.
3.4.3 Plain radiology: skeletal survey when clinically indicated for acute bone crisis or diagnosis of fracture; chest X-ray (CXR) for suspected pulmonary involvement.
3.4.4 Ultrasound: organ measurement (liver and spleen size when volumetric MRI not available), gall stones, portal hypertension or chronic liver disease, renal involvement. Heel ultrasound if indicated to assess bone involvement if evaluation at other sites not possible by DEXA.
3.5 Cardiopulmonary evaluation1
CXR, pulmonary function tests and electrocardiogram (ECG) at baseline and as indicated. Echocardiography in selected patients to confirm or refute the suspicion of pulmonary hypertension or cardiomyopathy
4. Treatment
4.1 Criteria for treatment1
In general, presentation with clinical features of Gaucher disease;7 one aim of intervention in such patients is primary prevention of irreversible organ damage, including bone, spleen or liver damage,8 pulmonary9 and neurological complications.1
4.2 When to start - indications for specific treatment1'9
Immediate initiation of treatment:
Clinically significant thrombocytopenia or anaemia
History of progressive organomegaly (hepatosplenomegaly)
Bone involvement
Growth failure/retardation
Delayed puberty
Pulmonary involvement
History of splenectomy
Impairment of function (physical and quality of life)
Any child with disease manifestations should be treated.
4.3 Treatment options
4.3.1 Enzyme replacement therapy (ERT):1 imiglucerase, an analogue of human intracellular glucocerebrosidase, is the treatment of choice for types 1 and 3 Gaucher disease.
4.3.2 Supportive therapy:1 indicated for those patients who decline the above option (usually elderly patients) and require symptomatic supportive intervention with blood products, bisphosphonate therapy, and/or analgesia.
4.3.3 Mobility aids:1 e.g. crutches and wheelchairs to aid mobility for everyday living.
4.3.4 Experimental therapies:1 might become available and will need further evaluation at such time.
4.3.5 Monitoring:1 patients identified with Gaucher disease mutations, who may be asymptomatic, do not require treatment at present, but must be monitored regularly (6-monthly) for disease progression according to the goals of treatment (section 5) and indications to start therapy as above. Treatment options for all patients must be reviewed according to clinical and laboratory data.
4.3.6 Bone marrow transplantation:1 no longer advocated for type 1 patients now that effective ERT is available; may still be considered under certain circumstances for type 3 patients when a matched, unaffected sibling donor has been identified.
4.3.7 Other therapies: substrate reduction therapy is currently utilised in some patients with mild disease. It is currently not available in South Africa.
4.3.8 Genetic counselling:1 this is an important component of supportive care for any family and best provided by a healthcare professional well versed in these aspects of care. Parents of affected individuals, individuals themselves when they reach an age of understanding, siblings of carriers or affected individuals, and spouses/potential spouses should be included. Genetic counselling aims to enable the patients and their families to understand the medical facts, role of inheritance, strategies to prevent recurrence and to make the best possible adaptation to the disorder. Autosomal recessive inheritance implies that both parents of an affected person are carriers of a mutated acid â-glucosidase gene. The affected child has inherited a mutated copy from each parent. The parents have a 25% chance for another affected child in subsequent pregnancies. The affected person must also understand the risk of transmission of a mutated gene to their offspring.
Carrier testing is therefore important for these families. Whereas enzyme activity is a reliable method for the diagnosis of Gaucher disease, its use for identifying carriers is limited. The best method for carrier testing and prenatal diagnosis is mutation analysis.
4.4 Imiglucerase treatment - dosing regimen10
The only product currently registered for Gaucher disease in South Africa is imiglucerase that is administered by intravenous infusion over 1 - 2 hours. Dosage should be individualised to each patient and dosage adjustments made on an individual basis. This may increase or decrease, based on achievement of therapeutic goals as assessed by routine comprehensive evaluations of the patient's clinical manifestations. Dose is also partly determined by the requirement to use whole vials of imiglucerase, which is available in 400 U vials. Therapy may be continued throughout pregnancy at the discretion of the treating physician.11
4.4.1 Dose selection based on severity: demonstration of a dose response to imiglucerase for haematological and visceral parameters3 and bone mineral density1 implies a need and provides a rationale for initial dose selection based on clinical severity, followed by dose titration (up or down) according to achievement of therapeutic goals, and specific symptoms that are considered severe or higher risk. In specific cases, dose adjustments might be required according to clinical need.
Patients fulfilling one of the severe or high-risk criteria should start imiglucerase at a recommended dose of 30 - 60 U/kg every other week (EOW). All other patients, not fulfilling high-risk criteria, but fulfilling the 'indications for specific treatment', should commence imiglucerase at a recommended dose of 10 - 30 U/kg EOW (see 4.4.2).
4.4.2 Severe or high-risk disease (30 - 60 U/kg EOW): one of the following criteria:
Symptomatic paediatric patients identified with severe genotypes known to be associated with rapid disease progression
Paediatric patients prior to epiphyseal closure with evidence of growth failure and/or delayed puberty
The presence of bone disease comprising bone crises, bone pain, pathological fracture, radiological evidence of osteonecrosis, infarction or generalised osteopenia (previous joint replacement will be considered an indication of severe bone disease)
Significant splenomegaly as indicated by: spleen volume at least 6 times normal OR at risk of splenic rupture OR severe symptoms of abdominal distension or pain OR hypersplenism OR episodes of splenic infarction
Evidence of hepatic infarction or cirrhosis or complications
Transfusion dependency OR coagulopathy OR platelets under 20 000/ì! (20x107l)
Pulmonary involvement
Type 3 Gaucher disease. There are no known drug interactions with imiglucerase.10
Co-morbidities are not an indication to withhold therapy.10 Refer to the South African prescribing information for imiglucerase.
5. Goals of treatment
5.1 Treatment goals for anaemia1,9 (Table 1)
Achieve acceptable levels of haemoglobin (Hb); eliminate blood transfusion dependency; reduce fatigue, dyspnoea, angina; maintain improved Hb values achieved after the first 12 - 24 months of therapy.
Treatment response may vary. Mild anaemia may persist especially in patients with severe splenic enlargement.8
5.2 Treatment goals for thrombocytopenia1,9 (Table 2)
All patients: increase platelet counts during the first year of treatment sufficiently to prevent surgical, obstetric and spontaneous bleeding.
Splenectomised patients: normalisation of platelet count by 1 year of treatment.
Patients with intact spleen:
Moderate baseline thrombocytopenia (60 000 - 120 000/ìÏ: the platelet count should increase by 1.5 to 2-fold by year 1 and approach low-normal levels by year 2
Severe baseline thrombocytopenia (<60 000/ì!): the platelet count should increase by 1.5-fold by year 1 and continue to increase slightly during years 2 - 5 (doubling by year 2), but normalisation is not expected
Avoid splenectomy (may be necessary for life-threatening haemorrhagic events)
Maintain stable platelet counts to eliminate risk of bleeding after a maximal response has been achieved.
Treatment response may vary.9
5.3 Treatment goals for splenomegaly1,9 (Fig. 1)
Reduce and maintain spleen volume to <2 - 8 times normal; reduce the spleen volume by 30 - 50% within year 1 and by 50 - 60% by years 2 - 5; alleviate symptoms due to splenomegaly: abdominal distension, early satiety and new splenic infarction; eliminate hypersplenism; avoid splenectomy.
Treatment response may vary. Patients with severe splenic enlargement may not experience decrease to normal size.8
5.4 Treatment goals for hepatomegaly1,9 (Fig. 2)
Reduce and maintain the liver volume to/at 1.0 - 1.5 times normal (according to body weight); reduce the liver volume by 20 - 30% within years 1 - 2 and by 30 - 40% by years 3 - 5.
Treatment response may vary. Patients with severe hepatic enlargement may not experience decrease to normal size.9
5.5 Treatment goals for skeletal pathology (Table 3)1'9 Lessen or eliminate bone pain within 1 - 2 years; prevent bone crises; prevent osteonecrosis and subchondral joint collapse; improve bone mineral density (BMD) - adult patients: increase BMD within 3 - 5 years.
Improve Bone Marrow Burden Score by 50% within 2 - 3 years (measured by MRI).6
5.6 Treatment goals for pulmonary involvement1'9
Reverse hepatopulmonary syndrome and dependency on oxygen; ameliorate pulmonary hypertension (ERT plus adjuvant therapies); improve functional status and quality of life; prevent rapid deterioration of pulmonary disease and sudden death; prevent pulmonary disease by timely initiation of ERT and avoidance of splenectomy.
5.7 Treatment goals for functional health and well-being1'9
Improve or restore physical function for carrying out normal daily activities and fulfilling functional roles
Improve scores from baseline of a validated quality of life instrument within 2 - 3 years or less depending on disease burden.
5.8 Treatment goals for other parameters9
Physical examination results should improve; stabilise or decrease serial measurements of the biomarkers such as chitotriosidase, TRAP, or ACE.
6. Safety information
6.1 Adverse effects of imiglucerase10
Approximately 15% of patients treated and tested have developed IgG antibodies to imiglucerase during the first year of therapy. Patients who developed IgG antibodies usually did so within 6 months of treatment and rarely developed antibodies to imiglucerase after 12 months of therapy. Approximately 46% of patients with detectable IgG antibodies experienced symptoms of hypersensitivity. Patients with antibodies to imiglucerase have a higher risk of hypersensitivity reaction. Conversely, not all patients with symptoms of hypersensitivity have detectable IgG antibody. It is suggested that patients be monitored periodically for IgG antibody formation during the first year of treatment.
Treatment with imiglucerase should be approached with caution in patients who have exhibited symptoms of hypersensitivity to the product. Anaphylactoid reactions have been reported in less than 1% of the patient population. Further treatment with imiglucerase should be conducted with caution in these patients. Most patients have successfully continued therapy after a reduction in the infusion rate and pretreatment with antihistamines and/or corticosteroids.
Adverse event forms should be submitted to the Medicines Control Council and/or the relevant pharmaceutical company.
7. Follow-up assessment (also refer to Section 3.3)
7.1 Timing1
Every 3 months until stable, then 6-monthly:
Clinical evaluation of haematological, visceral, skeletal and, where appropriate, neurological disease and application of a validated health-related quality of life instrument are recommended
Biomarkers including chitotriosidase, ACE and/or TRAP
Blood tests including FBC, liver enzymes and immunoglobulins, as well as other specific investigations depending on baseline results and ongoing co-morbidities.
IgG drug-specific antibody assessment as clinically indicated.
MRI volumetric evaluation of liver and spleen; 2-yearly for stable patients, sooner if indicated.
Imaging of bones as clinically indicated.
7.2 Asplenic patients
Asplenic Gaucher disease patients are at increased risk of osteonecrosis,12,13 pulmonary hypertension,14 cholelithiasis,15 and liver cirrhosis.16 Monitoring therapy by serial measurement of haemoglobin and platelet counts is usually unhelpful. Spleen size clearly cannot be used to monitor response to treatment, therefore particular attention should be paid to systemic and bony symptoms and to biomarkers of disease in order to prevent episodes of bone infarction.
Asplenic patients (especially females) are at increased risk of pulmonary hypertension. Clinicians should maintain a high index of suspicion for this complication. ECG, echocardiogram and Doppler studies should be performed yearly.
Overwhelming sepsis is a principal complication of the asplenic state, mainly as a result of infection with Gram-positive encapsulated organisms (i.e. Streptococcus pneumoniae).17
7.3 Management of asplenic patients1
Ensure that patients who have undergone splenectomy have received the following immunisations:
Haemophilus influenzae type b (Hib)
Pneumococcal polyvalent vaccine repeated every 5 years (for children under 10 years give two doses of pneumococcal conjugate vaccine 2 months apart followed by a dose of polyvalent vaccine 2 months later)
Influenza annually.
Long-term regular antibiotic prophylaxis with penicillin V 250 mg bd or erythromycin 250 mg bd, if allergic to penicillin, is mandatory.
If possible, patients should carry a standard medical information card stating: 'I have no functioning spleen.' Patients should be warned that they are at increased risk of sepsis.
8. Adjuvant therapy1
Adult patients may benefit from bisphosphonate therapy either orally (which can be prescribed by their general practitioner) or intravenously. Little evidence as to the efficacy of this treatment in Gaucher disease is available. Guidelines for the use of bisphosphonates should be similar to those of other causes of osteopenia/osteoporosis.
8.1 Other treatment considerations
Vitamin D, calcium may be considered; specific pain medication;1 seizure/neurological management; pulmonary hypertension management.1 There are no known drug interactions with imiglucerase; therefore co-morbidities are not an indication to withhold therapy.10
9. Surgical management1
Orthopaedic surgical intervention is commonly required to restore function and correct deformity. Subchondral bone collapse as a result of avascular necrosis leads to pain and loss of function and may require joint replacement, most commonly of the hip joint, but also of the knee and shoulder.18 Given that joint replacement is often carried out at a young age, there is frequent requirement for complex revision surgery.
Gallstone disease is also more prevalent in Gaucher disease.13 Peri-operative medical management of Gaucher disease patients must take account of: (i) the risk of infection in the asplenic patient; and (ii) the risk of bleeding associated with thrombocytopenia, platelet function defects and coagulopathies associated with the condition.
10. Indications for cessation of treatment1
Specific treatment may be withdrawn, following careful discussion with the patient and the multidisciplinary team, under the following circumstances:
Intolerable and unavoidable adverse effects; intercurrent illness.
Where long-term quality of life or expected survival is such that the patient will gain no significant benefit from specific treatment for Gaucher disease.
Lack of responsiveness to treatment, having made all appropriate dose adjustments and measures to improve effectiveness of treatment. This applies in the unlikely event of complete resistance to treatment and to irreversible progression of individual aspects of Gaucher disease (most likely neurological) whereby the patient's quality of life is very poor and where there is little or no prospect of response to treatment.
At the request of the patient, or properly allocated guardian acting in the patient's best interests, if the patient is properly deemed not competent.
If the circumstances of the patient's lifestyle are such that sufficient compliance with treatment is not possible. Such cases might include intravenous drug abuse associated with a peripatetic lifestyle.
If the health and well-being of medical and/or nursing staff are placed under significant threat as a result of the actions or lifestyle of the patient.
11. Role of the Lysosomal Storage Disorder Medical Advisory Board
11.1 Interaction between treating physicians and the LSD MAB
The MAB will act as consultants to assist treating physicians in the management of their patients.
11.2 Interaction between medical aid organisations and the LSD MAB
Medical aids/funders may consult the MAB regarding patients new to treatment or when dosage adjustments are requested.
Disclaimer. These guidelines were prepared for physicians and other healthcare professionals on behalf of the LSD MAB and reflect the best data available at the time. Caution should be exercised in interpreting the data; future studies may require alteration of the conclusions or recommendations in this report. It may be necessary or even desirable to depart from the guidelines in the interests of specific patients and special circumstances. These guidelines do not represent all the possible methods of management applicable to all patients, do not exclude any other reasonable methods, and will not ensure successful treatment in every situation. The unique circumstances of each patient must be taken into account by the responsible physician making decisions on any specific therapy. Just as adherence to these guidelines may not constitute defence against a claim of negligence, so deviation from them should not necessarily be deemed negligent.
Acknowledgements. The contributions of the MAB members are gratefully acknowledged: Dr Louisa Bhengu (medical geneticist, University of the Witwatersrand), Prof. Alan Davidson (paediatric haematologist-oncologist, University of Cape Town), Dr Paul du Toit (physician, private practice), Dr Trevor Gerntholtz (nephrologist, private practice), Dr Kenny Govendragaloo (paediatric cardiologist, private practice), Dr Rene Heitner (paediatrician, private practice), Dr Bertram Henderson (medical geneticist, University of the Free State), Dr Lawrence Mubaiwa (paediatric neurologist, University of KwaZulu-Natal), Dr Sheeba Varughese (paediatrician, University of the Witwatersrand).
Guideline sponsor. The meetings of the LSD MAB were sponsored by Genzyme.
Conflict of interest. The MAB was sponsored by Genzyme.
1. Deegan P, Hughes D, Mehta A, Cox TM. UK National Guideline for Adult Gaucher Disease, April 2005. Available from http://www.specialisedservicesnhs.uk./library/23/Guidelines_for_AdultGauchers_Disease.pdf (accessed 24 August 2011). [ Links ]
2. Vellodi A, Wraith JE, McHugh K, Cooper A. Guidelines for the management of Paediatric Gaucher Disease in the United Kingdom. Available from http://www.specialisedservices.nhs.uk/library/23/Guidelines_for_Paediatric_Gauchers_Disease.pdf (accessed 24 August 2011). [ Links ]
3. Grabowski GA, Kacena K, Cole JA, et al. Dose-response relationships for enzyme replacement therapy with imiglucerase/alglucerase in patients with Gaucher disease type 1. Genet Med 2009;11(2):92-100. [http://dx.doi.org/10.1097%2FGIM.0b013e31818e2c19] [ Links ]
4. Sims KB, Pastores GM, Weinreb NJ, et al. Improvement of bone disease by imiglucerase (Cerezyme) therapy in patients with skeletal manifestations of type 1 Gaucher disease: results of a 48-month longitudinal cohort study. Clin Genet 2008;73:430-440. [http://dx.doi.org/10.1111%2Fj.1399-0004.2008.00978.x] [ Links ]
5. Mistry PK, Deegan P, Vellodi A, et al. Timing of initiation of enzyme replacement therapy after diagnosis of type 1 Gaucher disease: effect on incidence of avascular necrosis. Br J Haematol 2009;147(4):561-570. [http://dx.doi.org/10.1111%2Fj.1365-2141.2009.07872.x] [PMID:19732054] [ Links ]
6. Maas M, van Kuijk C, Stoker J, Akkerman EM, Aerts JFMG, van Heeten GJ. Quantification of bone involvement in Gaucher disease: MR imaging bone marrow burden score as an alternative to Dixon quantitative chemical shift MR imaging - initial experience. Radiology 2003;229(2):554-561. [http:// dx.doi.org/10.1148%2Fradiol.2292020296] [ Links ]
7. Ida H, Rennert OM, Ito T, et al. Type 1 Gaucher disease: phenotypic expression and natural history in Japanese patients. Blood Cells Mol Dis 1998;24(1):73-81. [http://dx.doi.org/10.1006%2Fbcmd.1998.0172] [ Links ]
8. Beutler E, Demina A, Laubscher K, et al. The clinical course of treated and untreated Gaucher disease: a study of 45 patients. Blood Cells Mol Dis 1995;21(2):86-108. [http://dx.doi.org/10.1006%2Fbcmd.1995.0012] [ Links ]
9. Pastores GM, Weinreb NJ, Aerts H, et al. Therapeutic goals in the treatment of Gaucher disease. Semin Hematol 2004;41(suppl 5):4-14. [http://dx.doi.org/10.1053%2Fj.seminhematol.2004.07.009] [ Links ]
10. Cerezyme approved package insert. Genzyme, February 2010. [ Links ]
11. Granovsky-Grisaru S, Belmatoug N, vom Dahl S, et al. The management of pregnancy in Gaucher disease. Eur J Obstet Gynecol Reprod Biol 2011;156:3-8. [http://dx.doi.org/10.1016%2Fj.ejogrb.2010.12.024] [ Links ]
12. Rodrigue SW, Rosenthal DI, Barton NW et al. Risk factors for osteonecrosis in patients with type 1 Gaucher's disease. Clin Orthop 1999;362:201-207. [http://dx.doi.org/10.1097%2F00003086-199905000-00029] [ Links ]
13. Mankin HJ, Rosenthal DI, Xavier R. Gaucher disease. New approaches to an ancient disease. J Bone Joint Surg Am 2001;83-A(5):748-762. [ Links ]
14. Mistry PK, Sirrs S, Chan A, et al. Pulmonary hypertension in type 1 Gaucher's disease: genetic and epigenetic determinants of phenotype and response to therapy. Mol Genet Metab 2002;77:91-98. [http://dx.doi.org/10.1016%2FS1096-7192%2802%2900122-1] [ Links ]
15. Rosenbaum H, Sidransky E. Cholelithiasis in patients with Gaucher disease. Blood Cells Mol Dis 2002;28(1):21-27. [http://dx.doi.org/10.1006%2Fbcmd.2001.0480] [ Links ]
16. Lachmann RH, Wight DGD, Lomas DJ, et al. Massive hepatic fibrosis in Gaucher's disease: clinic- pathological and radiological features. QJM 2000;93:237-244. [http://dx.doi.org/10.1093%2Fqjmed%2F93.4.237] [ Links ]
17. Ein SH, Shandling B, Simpson JS, et al. The morbidity and mortality of splenectomy in childhood. Ann Surg 1977;185(3):307-310. [http://dx.doi.org/10.1097%2F00000658-197703000-00010] [ Links ]
18. Tauber C, Tauber T. Gaucher disease - the orthopaedic aspect. Report of seven cases. Arch Orthop Trauma Surg 1995;114(3):179-182. [http://dx.doi.org/10.1007%2FBF00443393] [ Links ]
Correspondence to:
A Davidson


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One who hoons.
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lentils. delicious, nutritious and oh, so colorful! lentils are extremely rich in fiber, folate, magnesium and lean protein. not only are they a great source for cholesterol-lowering fiber, but they also help in managing blood sugar disorders since their high fiber content prevents blood sugar levels from rising too quickly after a meal. they are also an excellent source of thiamine, vitamin b-6 and six important minerals. with 17 grams of lean protein in just one cup, 90% of our daily recommendation for folate and virtually no fat, lentils may just be the perfect addition to your meal!
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a few favorite lentil recipes:
- lentil cakes
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- lentil and bulgur soup


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Christopher Sardelli
An Indian Land woman and a Lancaster man both died after two separate car accidents last weekend.
Daphne Harrison, 28, of Indian Land, died March 18 after her car struck a tree. Harrison was driving south on Interstate 77, about three miles from Rock Hill, when the accident happened at about 8:45 p.m. Friday.
Harrison was driving a 1998 Ford along the highway when she ran off the right side of the road and hit a tree, said Lance Cpl. Judd Jones with the S.C. Highway Patrol.
Reece Murphy
The S.C. Department of Transportation is set to begin roadwork on one of Indian Land's busiest roads next week.
Lancaster County resident construction engineer Ken Wilson said S.C. DOT crews will begin repaving a half-mile stretch of Fort Mill Highway (S.C. 160) on Sunday, March 27.
The project is expected to take about a week to complete, Wilson said, with most work scheduled at night, between 7 p.m. and 6 a.m.
Christopher Sardelli
A loud car radio led to a Lancaster man being arrested on various drug and gun charges last weekend.
Derrick Antonio McIlwain, 25, 304 Robinson Road, was arrested March 19 on several charges after Lancaster police officers stopped his car at the intersection of Hampton Road and Louise Street.
Christopher Sardelli
A piece of bamboo left hundreds of Lancaster County homes and businesses without power for a few hours Monday afternoon.
At about 12:30 p.m., a power surge cut service to 366 customers in the Lancaster area, said Duke Energy telephone representative Amanda Burris.
Lancaster County Chamber of Commerce
It's a new year for the U.S. Congress and the S.C. Legislature and both have begun considering significant statewide and national issues that will impact the Lancaster County business community in both the short- and long-term future.
Lancaster County's unemployment rate dropped in January, a trend that mirrors job growth statewide.
According to the S.C. Department of Employment and Workforce, unemployment in Lancaster County fell to 14.6 percent in January, a 1 percent drop from December's rate of 15.6 percent.
Lancaster County had the state's 12th highest unemployment rate in January.
The newest reported rate is 3 percent less than January 2010's unemployment rate of 17.6 percent.
Lancaster County Water and Sewer District
Lancaster County Water and Sewer District (LCWSD) officials re-emphasize that dry climatic conditions are responsible for the Catawba-Wateree Basin remaining in Stage 1 drought level of the low-inflow protocol.
The protocol is an agreement between major water users in the basin that establishes a shared responsibility and priorities to conserve the limited water supply.
Local residents will soon be able to hear from the three men hoping to become the next District 16 state senator.
Democrat Keith Brann, Republican Greg Gregory and Libertarian Stan Smith will appear at the Before You Vote candidates forum March 29 at the Bradley Arts and Science Building at the University of South Carolina at Lancaster.
There will be a meet-and-greet session at 5:30 p.m. The forum is slated to run from 6 to 8 p.m.
Christopher Sardelli
It took months of preparation and hundreds of man hours, but the Lancaster County Sheriff's Office was recognized this week as it became one of only 44 state law enforcement agencies to earn its accreditation.
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oil on canvas (16.5 x 20 ins) 1974
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text: Pinch to zoom I'm in! Best Of Camden Screenprint by Lucy Loves This £32$58.70€36.33$39.73 3 customer reviews(3) Favourite Favourite Ask Seller View your favourites framingframing (required)noneblack frame with white mount as per main photo (+ £43)framing (required)noneblack frame with white mount as per main photo (+ $78.88)framing (required)noneblack frame with white mount as per main photo (+ €48.83)framing (required)noneblack frame with white mount as per main photo (+ $53.39) quantity personalise PRODUCT DETAILS made in britain A lovingly screenprinted artwork that shows off Camden in all its glory. The letter C is made up of beautiful illustrations of Camden's best bits. This is a limited edition – each print is signed and numbered. Please allow an extra 3 days for framing. Hanging this artwork on your wall would be a great way to celebrate the area you live in, or to remember a part of London you've just left. This print would also be the perfect present for any Camden-dwelling friend. It makes an ideal housewarming gift, but could also be given as a birthday or Christmas present. It is part of a series of monochrome prints called the London Letters, each dedicated to a different London area. Other areas currently available are: Angel, Balham, Battersea, Brixton, Camden, Chelsea, Clapham, Dulwich, Ealing, Earlsfield, Forest Hill, Greenwich, Hackney, Islington, Notting Hill, Peckham, Putney, Soho, Tooting, Vauxhall and Wimbledon. Also available is a print showing the Best of London, which incorporates important places and landmarks from across the city. This print is available in black. made from: Made in Britain. Screenprinted using high-quality water-based inks that contain no solvents at all. The paper stock is 280 gsm premium paper, made from 100% recycled fibres. Screenprinting is a craft and, as such, prints do vary, so each one is unique. This is part of the beauty of screenprinting. We offer a full professional framing service for our prints. They are made from solid wood, and handmade in the UK. We use high quality acrylic glazing that is indistinguishable from glass and is a safe option for artwork intended for children's rooms. They are also professionally framed by hand in our London studio. Please allow an extra 3 days for framing. dimensions: Unframed print: 30x21cm Framed print: 32.5x45cm product code: 199992 see more see less CUSTOMER REVIEWS 3 customer reviews read about our product rating system trusted independent customer feedback forum DELIVERY This product is dispatched to you by Lucy Loves This. Please note unfortunately we are unable to ship framed prints outside the UK. If you do order a framed print to be sent outside the UK, we will dispatch an unframed print and refund the cost of the frame. Unframed print: Your print is carefully packaged in a cello bag, before being mailed in a sturdy envelope. Framed print: Your print is carefully wrapped in bubblewrap, then packaged in a cardboard box. RETURNS You have 28 days, from receipt of cancellable goods, to notify the seller if you wish to cancel your order or exchange an item. Please note: goods that are personalised, bespoke or made-to-order to your specific requirements, perishable products and personal items sold with a hygiene seal (cosmetics, underwear) in instances where the seal is broken are non-refundable, unless faulty. Read more about our returns policy.Should you choose to return or exchange your order you will need to deliver the item(s) to the UK, where this seller is based.


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Hey everyone!!!! It has been a while since I last posted something. But now the while is over! Get ready for a new tut made by the one and only, Owllover! This tutorial is on the logo of a very popular video game, which is my personal favorite, Guitar Hero. Get out your pencils, erasers, and paper and draw!!
DragoArt members upload artwork and drawing tutorials! They are also allowed to leave comments on tutorials, profiles, etc. Many more features, as well; it's way better than just being a boring guest! Register Now!


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Animal Train Personalised Clocks
This educational clock has a train full of wild African animals! Each carriage has the same amount of animals as the number beside it so your child can count the animals in the carriages and learn to tell the time!
This gorgeous nursery clock is the perfect first Christmas or birthday present.
Can be personalised with up to 11 letters in the name
11" (28cm) in diameter
The design is printed and the print then laminated onto a wooden base to make a clock, after which they are personalised by me, by hand.
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Siemens has been named by Gartner, Inc. as a Leader in its 2017 Magic Quadrant for Manufacturing Execution Systems. Gartner is a leading worldwide IT research and advisory firm. Each year, Gartner evaluates vendors and displays evaluations in the Magic Quadrant. In this year's Gartner MES/MOM Magic Quadrant, which is the first ever for this area of applications, companies were assessed on "Ability to Execute", covering aspects such as products or service, overall viability, market responsiveness/record, marketing execution, operations and customer experience along with "Completeness of Vision", which scores aspects such as product strategy, innovation, understanding of market and industry verticals.
Gartner Magic Quadrant for MES 2017
Siemens holds a unique position in the manufacturing market. We provide a holistic solution that supports the entire value chain, from ideation to design, manufacturing execution, and software for plant automation, plant hardware, coupled with MindSphere, the open cloud-based operating system for the IoT.
Click here for more information on Siemens' Magic Quadrant placement, and to view the 2017 Magic Quadrant report for MES/MOM.
Congratulations to our team for a great acknowledgement of our solution.
Congrats and thanks for sharing!
This is great recongnition to both our segment teams progress and for client consumption that will bolster our momentum for FY17!
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Inspired by "Pick & Choose" from designer Carrie Nelson of Miss Rosie's Quilt Co.
Quiltmaker: Laura Boehnke
1 yard yellow tone-on-tone (blocks, outer border)
1/2 yard total assorted pink prints (blocks, outer border, binding)
1/8 yard turquoise print (blocks)
1/8 yard brown print (blocks)
1/2 yard total assorted turquoise, brown, and yellow prints (inner border)
2-1/2 yards backing fabric
43" square batting
Finished quilt: 36-1/2" square
Finished block: 12" square
Quantities are for 44/45"-wide, 100% cotton fabrics.
Measurements include 1/4" seam allowances. Sew with right sides together unless otherwise stated. {C}


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Anna G. Dawson
BERLIN – Anna G. Dawson (McCloskey), beloved wife of the late John J. Dawson, entered heaven on Monday, Jan. 26, 2009.
She was a member of St. John Neumann Roman Catholic Church and was active in the Ladies Ancient Order of Hibernians, the Ladies Auxiliary of the Knights of Columbus Council 9053 and her group of close friends in the "Lunch Bunch".
She is survived by her niece and first godchild, Jane A. Mooney and her loving nephew-in-law Patrick H. Mooney, of Ocean Pines; sister-in-law and loving friend, Helen McCloskey; brothers-in-law, Robert Dawson and his wife Linda, Joseph Dawson and his wife Carol all of Massachusetts; and several nieces and nephews who loved her like a grandmother.
A Mass of Christian Burial will be celebrated on Friday, Jan. 30 at noon at St. John Neumann Catholic Church in Ocean Pines. Friends may call from 10:30 a.m.-noon at the church. Rev. Thomas Protack and Rev. William Porter will officiate. In lieu of flowers donations may be made to Coastal Hospice, PO Box 1733, Salisbury, Md. 21802-1733. Arrangements by the Burbage Funeral Home in Berlin.
Charles E. Nock, Sr.
SALISBURY – Charles E. Nock, Sr., age 93, passed away Tuesday, Jan. 20, 2009 at Peninsula Regional Medical Center in Salisbury.
Born on January 29, 1915, at Cedartown near Snow Hill, he was the son of the late Gordon E. And Sarah Haddar Nock. He was preceded in death by his wife of 67 years Lucille in 1998.
He attended school in Snow Hill. For several years he was a supervisor at several local chicken processing plants including Birds Eye, Golden Pride in Stockton and Maryland Chicken in Snow Hill. He had been a poultry grower and farmer for many years. Nock had many hobbies including using his mechanical skills to repair grass cutters and farm equipment. Most recently his hobby had been woodworking, he had made many treasured items. Nock had written a book about his entire life to share with his friends and family. Most of all he enjoyed spending time with his family and loved them very much.
He is survived by four daughters, Belle Redden of Girdletree, Elizabeth (Sis) Ward of Pocomoke, Lottie Lankford of Delmar, DE and Linda Figgs and her husband George of Snow Hill; two sons, Charles E. Nock, Jr. of Pocomoke and his wife Gloria, and Sam Nock and his wife Barbara of Bloxom, Va.; adopted son, Keith Bullion and his wife Kristen of Pocomoke; 18 grandchildren; 29 great grandchildren; two adopted grandchildren; many nieces, nephews, a host of friends; and many beloved foster children.
Services were held. In lieu of flowers donations may be made to Klej Grange Fellowship Church, 3811 Stockton Rd., Pocomoke, Md. 21851 or to Springhill Cemetery, PO Box 28, Girdletree, Md. 21829. Arrangements by the Burbage Funeral Home in Snow Hill.
Paul Calvin Denis
SELBYVILLE, Del. – Paul Calvin Denis, 87, of Selbyville, Del., formerly of Silver Spring, died Monday, Jan. 19, 2009 at Atlantic General Hospital.
Born in Washington, DC, he was the son of the late Felix P. and Minna (Chapman) Denis.
He served in the U.S. Navy during World War II and had been a Senior Power Plant Operator with Pepco in Dickerson, Md.
Denis was a member and Past President of the Fenwick Island Lions Club and a member of the Ocean City American Legion, Salem United Methodist Church in Selbyville and he also attended St. Matthews By-The-Sea United Methodist Church.
He is survived by his wife, Thelma I. Denis of Selbyville; two daughters: Beverly D. van den Heuvel (Ron) of Frederick and Susan A. Denis of Fenwick Island, Del.; one sister, Dorothy Soucy of Millsboro, Del.; one brother, Arthur Denis of St. Matthews, S.C.; two grandchildren, Denise Black and Paula van den Heuvel; and a great granddaughter, Deziray Onley.
A memorial service will be held at 1 p.m. on Saturday, Jan. 31 at St. Matthews By-The-Sea United Methodist Church, Dagsboro Street and Coastal Highway, Fenwick Island, with Rev. Bruce Miller officiating.
In lieu of flowers, donations may be made to the Fenwick Island Lions Club, Scholarship Fund, c/o William Neimiller, 346 S. Ocean Drive, Ocean City, Md. 21842.
Arrangements By Hastings Funeral Home.
Ann Catherine Foster
BERLIN – On Monday, Jan. 12, 2009, Ann Catherine Foster, 88, passed away peacefully at the Atlantic General Hospital in Berlin.
Formerly of Rockville, Md., she has resided at the Tiburon Condominiums in Ocean City, Maryland for over 23 years. She is survived by her brothers, Charles and William Tangemann; her daughters, Judy Lucas and Karen Burka; her grandchildren, Jessie Lucas-Nowakowski, Dana Lucas, Sarah Burka, and Mark Burka; and her great-grandchildren, Lucas Nowakowski and Zane Nowakowski. She was loved and will be truly missed by her family and friends.
A memorial service in Ocean City, will be held at a future date.
Eugenia Messer
BERLIN – Eugenia Messer, age 96, passed away peacefully on Wednesday, Jan. 21, 2009 at Coastal Hospice at the Lake in Salisbury.
She was preceded in death by her husband Morris Messer. She is survived by her daughter, Ann Lutz (Bill) of Ocean Pines; two grandchildren, Megan Chesser (David) and Kirk Lutz (Shannon); and one great grandson, Sam Chesser.
Services and Interment will be private. In lieu of flowers donations may be made to Coastal Hospice at the Lake, PO Box 1733, Salisbury, Md. 21802-1733.
Arrangements by the Burbage Funeral Home in Berlin.


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Wildlife galore in North Otago
The unspoiled North Otago coast is a haven for wildlife, and is a photographer's dream.
North Otago may well be the wildlife enthusiast's "undiscovered country". Somewhat off the beaten path compared with its neighbours, yet right in the middle of everything, North Otago's vast territory remains an unspoiled landscape where nature reigns supreme and the influence of man is largely unfelt.
Nowhere is this more evident than in the region's main town of Oamaru. Though initially envisaged as the South Island's main port in the early days of British settlement, the harbour failed to keep up with the demand of shipping and was eventually overtaken by nearby Port Chalmers near Dunedin. But this was good news for the local fauna, which thrived in the pristine waters and unpolluted air of this natural wonderland.
Today, Oamaru is home to New Zealand's largest colony of Blue Penguins (also known as 'Fairy Penguins'), the world's smallest--and only blue-coloured--penguin species. Each evening at dusk, these penguins return in the hundreds from fishing out to sea to their land-based nests, where visitors can enjoy the spectacle of these extremely social birds tumbling onto the beach and making their way to their nests.
Less well known than the Blue Penguin Colony is our colony of Yellow-Eyed Penguins. These are among the very rarest of penguins, numbering only in the thousands, yet two nearby colonies--one just a five minute drive from central Oamaru--give visitors an opportunity to see these stunning birds up close.
North Otago is not just for flightless birds, though! Also present in huge numbers are shags, a variety of cormorant that can be viewed just about anywhere along our coast, though in especially large numbers on Oamaru's Sumter Wharf and in the aptly named Shag Point. Oyster catchers, tuis, and bell birds are also viewable in large numbers.
Aside from birds, our coastline also is home to pods of orcas, New Zealand fur seals and sea lions, and larger whales and dolphins are also common just offshore.
And best of all, it is often possible to view these incredible animals without throngs of people crowding around--though this is likely to change, as North Otago is one of New Zealand's fastest growing tourist destinations!
Article by
Pen-y-bryn Lodge
Come discover the true New Zealand in one of its most historic homes, situated on a hill overlooking the Pacific on one side, and the mountains on the other, all while enjoying world-class cuisine.


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|Jepson Flora Project: Jepson Interchange
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Jepson Interchange (more information)
©Copyright 1993 by the Regents of the University of California
Perennial, in soil or on or among rocks; rhizome creeping to erect, scaly
Leaves generally all ± alike (or of 2 kinds, fertile and sterile), generally < 50 cm, often < 25 cm; petiole generally thin, wiry, often dark, in transverse section with vascular strands generally 13, less often many in a circle; blade generally pinnate or ± palmate-pinnate (see Adiantum ), often 2 or more compound, lower surface often with glands, ± powdery exudate, hairs, or scales; segments round, oblong, fan-shaped, or otherwise, veins generally free
Sporangia in sori or not, marginal, submarginal, or along veins, sometimes covered by recurved, often modified segment margins (false indusia); true indusia 0; spores spheric, sides sometimes flat, scar with 3 radiating branches
Genera in family: ± 40 genera, 500 species: worldwide, especially dry areas. Definition of Cheilanthes and related genera problematic; traditional limits often untenable.
Plant in soil or rock crevices; rhizome short-creeping-decumbent, scales elongate-lanceolate, generally dark, sometimes with very narrow, lighter margin
Leaves ± alike or fertile and sterile slightly dissimilar; axes grooved, light to dark brown; blade 34-pinnate, ovate-triangular to 5-sided, glabrous, upper surface ± glossy; segments long, narrow, with a pointed, sterile tip
Sporangia in small clusters or continuous along margin; false indusia scarious, irregularly toothed
Species in genus: 4 species: generally w North America, also eastern Can, ± dry, mountainous areas
Etymology: (Greek: shield-bearer, from shield-like false indusia in A. californica )
Leaf 3(4)-pinnate, 1020 (40) cm, thin; leaflets pinnately dissected, segments lanceolate to triangular, teeth few
Sporangia: false indusia ± as wide as long, free, 12(5) per segment, with few coarse, irregular teeth or ± entire
Chromosomes: 2n=60,120
Ecology: Rock outcrops, crevices
Elevation: 201300 m.
Bioregional distribution: North Coast Ranges, Cascade Range, Sierra Nevada, Great Central Valley (Sutter Buttes), Central Western California, Southwestern California
Distribution outside California: Baja California
Horticultural information: SHD, DRN, DRY: 7, 9, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24; DFCLT.


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Youth share their testimonies of the temple and the lessons they have learned by going to the house of the Lord (see D&C 110:7).
In the April 2011 general conference, President Thomas S. Monson counseled, "My young friends who are in your teenage years, always have the temple in your sights" ("The Holy Temple—a Beacon to the World," Ensign, May 2011, 93). We asked several youth to share the blessings they have received by going to the temple. Here are a few of their responses. What are some blessings you have received from temple attendance? Share your experience below.
You Know You Are Doing a Great Thing
Chloé D., Nevada, USA
Last year while visiting family in Wisconsin, my cousin and I went on a youth temple trip to the Nauvoo Illinois Temple and performed baptisms for the dead. We had a bunch of family names that we took to the temple. My grandma told us about one of our deceased ancestors. Grandma had a close relationship with her. I got to be baptized for this family member and other ancestors, and it was a really cool experience, because I could feel their presence and know they will have a chance to accept the work done for them. When I go to the temple, I know I'm doing a great thing.
Seeing pictures of the temple makes me think that even though temples are all over the world, you do the same ordinances in each one and receive the same Spirit. I don't think of any bad things there; only uplifting thoughts fill my mind in the temple. It is an amazing feeling to think of things you can do to help others.
I Can Help People Who Didn't Have the Chance
James N., Mississippi, USA
Every time I go to the Memphis Tennessee Temple, I like to get into a spiritual mood. I like to imagine the people whom the ordinances are performed for. Sometimes there will be people who have been waiting for hundreds of years. Sometimes I think I take my own baptism for granted; some people never had that chance to learn about the gospel and be baptized while they were on earth. I think it's great to be a part of that work for them. I can help people who didn't have a chance to be baptized on earth, and it is awesome that I'm able to help them.
Our Classmates Ask about Our Temple Trips
Annalise K., Arizona, USA
The temple closest to me is the Mesa Arizona Temple. Every month, my school has early-release days. Last year, my friends and I started a new tradition on early-release days where we would wear our Sunday clothes to school, go out for lunch, and then attend the temple to do baptisms for the dead. It's definitely helped me gain a deeper understanding of the temple, of what it means, and of how important it is. Regularly visiting the temple has helped me feel the Spirit more often. It's definitely brought my friends closer to one another. Also, a lot of our classmates ask about our temple trips because they notice that at least 10 of us always dress up for early-release days. This attention encourages other youth to go to the temple too.
Another blessing has been attending the temple with a friend whose family is very against the Church. She was able to get her first limited-use recommend, and it has been neat to see the positive effect this has had on her life.
All My Troubles Disappear
Kole E., California, USA
My favorite temple experience was when I was first able to go to the temple. I went to the San Diego California Temple. Just being able to walk in, I felt that all of the troubles I was having at school and elsewhere were just gone. I felt at peace being in the temple. I was overcome with feelings of happiness. Being in the temple helped me focus on what I needed to do at church and in other duties. It was just so incredible to be able to go and get away from all the troubles I had.
Setting Temple Goals
Elder Richard G. Scott of the Quorum of the Twelve Apostles has said: "I encourage you to establish your own goal of how frequently you will avail yourself of the ordinances offered in our operating temples. What is there that is more important than attending and participating in the ordinances of the temple? What activity could have a greater impact and provide more joy and profound happiness than worshipping in the temple?" ("How Can We Make the Most of Temple Attendance?" New Era, March 2012, 2).
You can set temple attendance goals for yourself. For example:
- How often will you go?
- How will you prepare yourself beforehand to get the most out of your temple experience?
- Are there others you could invite?


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Foxy Brown's 1st Freestyle Right After Her Release From Rikers Island (ill Na Na Is Back. Welcome Home)
Foxy Brown's Fresh Off The island Freestyle. Welcome home Foxy. Courtesy Of ALLHIPHOP&IP=18.104.22.168
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LAS VEGAS — Danny Garcia stopped heavy favorite Amir Khan in the fourth round to stay undefeated and add another super lightweight belt to his collection on Saturday night.
"I always knew I would win this fight," Garcia said. "I needed a great fighter in front of me to show how great a fighter I am. Now everyone knows."
Khan bruised Garcia early, even opening a small cut above his eye. But Garcia sent Khan to the canvas in the third round with a left hook, but the 2004 Olympic silver medalist for Britain was able to beat the count.
At the start of the fourth, though, Garcia swarmed him with power punches, knocking him down twice quickly. Khan got back to his feet each time, but the referee ended the bout at 2:28 of the round.
"It wasn't my night," Khan said. "I was coming in with my hands down and Danny took advantage of that. He countered very well against me."
The American now has the WBA title to go along with his WBC one. He improved his record to 24-0 with 15 knockouts while Khan fell to 26-3 with 18 KO's.
Khan was originally scheduled to face Lamont Peterson on May 19th in a rematch of their Dec. 10th bout in which Peterson took a 12-round split decision to win Khan's WBA and IBF titles.
Just days before the bout, Peterson tested positive for synthetic testosterone.
The fight was canceled and he was stripped of his WBA title which was later restored to Khan.
Garcia, who beat Erik Morales for the WBC title on March 24 agreed to fight Khan and took full advantage of the opportunity, defeating the popular fighter in spectacular fashion.
On the undercard, Fernando Guerrero beat Jose Medina by unanimous decision and Phil Lo Greco, J Leon Love, Daquan Arnett, Jamie Kavanagh and Abner Cotto won their bouts.


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Learn how MacUpdate Desktop can install apps on MacUpdate with the simple click of the icon. Plus, keep all your apps updated.
MoviePod saves you the trouble of having to manually convert your movies in order to play them on your iPod. With MoviePod, converting a movie takes a single Drag & Drop!
MoviePod can automatically add converted movies to a playlist of your choice and update your iPod.
You can queue up as many movies for conversion as you like and when you return, MoviePod will have them all ready to go on your iPod.
What's New in MoviePod
- Completely universal build (improved performance for Intel-based Macs)
Requirements for MoviePod
- Mac OS X 10.3.9 or later
- A video-enabled iPod


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When you think of Minnesota food, you might think of a few classic staples: nutty wild rice, flaky walleye, and stick-to-your-guts hot dish. Change, of course, has arrived with a vengeance as a food revolution has swept the state, and tradition is increasingly seen as a platform for invention. Chefs around the state revel in adapting and sometimes completely transforming hidebound dishes, creating menus that riff playfully on familiar flavors and foods.
MPLS Dog at Uncle Franky's, Twin Cities
Diners know the Chicago Dog and the Coney Island Dog but how about the MPLS Dog? Stop into Uncle Franky's to enjoy this new creation. The MPLS Dog is an all beef hot dog topped with hot dish, a drizzle of ketchup, Cheese-Whiz and crispy tater tots. You can find the MPLS Dog at Uncle Franky's in Minneapolis, Fridley and Plymouth.
Grand View Lodge Dining Room, Nisswa
Plunge into a venison wild rice meatloaf at the Grand View Lodge Dining Room if you'd like to experience an elevated take on a Midwestern classic. The venison and wild rice take you to the arboreal wilds, and the presentation and technique bring you back into the comfort of civilization.
Piggy Blue's Bar-B-Que, Austin
SPAM takes center stage in Austin, Minnesota, home of the famous canned ham that fueled American troops through multiple wars (and became an intrinsic part of Hawaiian and Korean cultures in the process.) Stop by Piggy Blue's Bar-B-Que for a Spam Town Po' Boy or Spam Burger.
Fitger's Brewhouse, Duluth
Fitger's is a food, drink and music hub of Duluth's social scene, so it's no surprise that they've got some inventive takes on local flavor. The brewpub's smoked fish salad uses smoked trout from local smokehouse Northern Waters, wild rice and smoked dressing, and it brings a hearty does of flavor to the table.
If you're up for something a bit more edgy, try the Northern Waters Smokehaus Whitefish Burger, where the locally caught fish is seasoned with breadcrumbs, eggs, mustard and spice, served on a ciabatta roll and finished with wasabi mayonnaise.
|Photo courtesy of The Blue Door Pub
The Blue Door Pub, St. Paul & Minneapolis
The humble cheese-stuffed hamburger known as the Jucy Lucy got its start in South Minneapolis taverns like Matt's, Adrian's and the 5-8 Club. But it has been taken to inventive heights by the team behind The Blue Door Pub in St. Paul, with a new location in Minneapolis' Longfellow neighborhood.
The Blue Door's menu swims with creative versions of the stuffed favorite, but the one that caught our eye was the Bangkok Blucy, stuffed with coconut milk-soaked mozzarella and topped with pickled carrots, cucumbers, red onion, and ginger with a side of curry for dunking.
The Boathouse, Ely
Craft beer has come to Minnesota's vacation country in force, as evidenced by frontier brewpubs like the newly founded Boathouse in Ely. The Boathouse's beer-battered walleye uses house-made craft beer and thereby managed to capture a good percentage of a successful fishing trip in each bite taken.
Alternately, take your walleye to Mexico via India with the brewpub's fish taco, which features breaded strips of fish on naan bread with shredded cheddar and a side of broccoli slaw.


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Jim Maddux has announced he is leaving his position as men's soccer coach at Lipscomb University to accept a position as a financial analyst with Merrill Lynch.
"We are disappointed that Jim will be leaving Lipscomb," said Dr. Steve Potts, Lipscomb Athletics Director. "Jim embodies all the qualities we seek in a coach in terms of character, integrity and Christian commitment. We thank him for his service to the Lipscomb Soccer program and wish him great success in his new career."
Maddux was a standout soccer player at Lipscomb, and served as an assistant coach for three years. He was elevated to head coach for the 2004 season.
Maddux graduated from Lipscomb in 2000 with a double major in Finance and Management. In 2002 he received his MBA degree with an emphasis in Financial Services from Lipscomb.
"I would like to thank Lipscomb University, and especially Dr. Steve Potts, for providing me the opportunity as head coach of the Lipscomb men's soccer program," Maddux said. "I have been very fortunate to spend nine years with this program and watch it grow from its infancy to its current NCAA Division I status.
"I will certainly miss the players and friends at Lipscomb that I have grown close with over the years. I look forward to watching and supporting this program's success for not only next season, but into the future."