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Journal of Ophthalmology
Volume 2016, Article ID 6719529, 5 pages
Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation
1Department of Ophthalmology, Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, Turkey
2Department of Otorhinolaryngology, Diyarbakir Military Hospital, Diyarbakir, Turkey
3Department of Ophthalmology, Anittepe Military Dispensary, Ankara, Turkey
4Department of Ophthalmology, Kasimpasa Military Hospital, Istanbul, Turkey
5Department of Ophthalmology, Girne Military Hospital, Girne, Northern Cyprus, Mersin 10, Turkey
Received 31 December 2015; Accepted 16 February 2016
Academic Editor: Edit Tóth-Molnár
Copyright © 2016 Yildiray Yildirim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 () patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Group 2 () patients underwent transcanalicular diode laser dacryocystorhinostomy surgery without bicanalicular silicon tube intubation. The follow-up period was months for Group 1 and months for Group 2. Results. Success was defined by irrigation of the lacrimal system without regurgitation and by the absence of epiphora. Success rates were 84.4% for Group 1 and 63.6% for Group 2 (). Statistically a significant difference was found between the two groups. Conclusion. The results of the study showed that transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation was more successful than the other method of surgery. Consequently, the application of silicone tube intubation in transcanalicular diode laser dacryocystorhinostomy surgery is recommended.
1. Introduction
Nasolacrimal duct obstruction (NLDO) is the most common cause of chronic dacryocystitis and in this case the only treatment option is surgery [1, 2]. Although the external surgical approach still is the gold standard with the highest success rate, the most recent stage in the development of dacryocystorhinostomy (DCR) is the endocanalicular or transcanalicular approach. In this approach, a probe with a red light on the end is inserted outside punctum and is moved toward the nasal wall [3]. Subsequently, nasal osteotomy is performed by diode laser energy [4].
Laser-assisted DCR application began with Massaro et al. in 1990; and, in addition to argon laser diode, potassium titanyl phosphate (KTP), holmium YAG, CO2, Nd:YAG, and erbium lasers have also been used until today [5–7]. New ostium is created by these lasers from an intranasal or transcanalicular approach.
Flexible endoscopes (0.3–0.7 mm diameter) modified from gastroduodenal endoscopes were developed for transcanalicular surgery [8]. By extending the diameter of the endoscopes and increasing the pixels of imaging, better quality results have been obtained.
Some authors have suggested the use of silicon tube intubation in NLDO surgery [9, 10], while some prefer using silicon tubes only for definitive indications (canalicular damage, lacrimal sac inflammation, secondary surgery, small and contracted sacs, etc.) [11, 12].
The purpose of this retrospective study was to compare the surgical outcomes of transcanalicular diode laser dacryocystorhinostomy (TDL-DCR) surgery with and without bicanalicular silicon tube intubation in the treatment of a series of 113 patients with primary uncomplicated nasolacrimal duct obstruction.
2. Subjects and Methods
2.1. Subjects
A series of 113 patients who had not previously undergone this surgery were operated on for NLDO between 2010 and 2013. The study was carried out in accordance with the tenets of the Declaration of Helsinki. Approval for the study was granted by the Clinical Research Ethics Committee of GATA Haydarpasa Training Hospital (1491-59-14/1539) and informed consent was obtained from all the patients. A retrospective review was made of the 2 groups of patients. Group 1 is comprised of 58 patients who underwent TDL-DCR surgery with bicanalicular silicon tube intubation, and Group 2 is comprised of 55 patients who underwent TDL-DCR surgery without bicanalicular silicon tube intubation.
After complete ophthalmic examination, nasolacrimal duct obstruction was confirmed with lacrimal irrigation and dacryocystography with Lipiodol® preoperatively in each case. Blood tests were obtained from all patients to analyze systemic diseases.
The patients were selected according to the following criteria: (i) no history of nasolacrimal duct surgery; (ii) no canalicular obstruction; (iii) no history of traumatic injury to the ocular or nasal region; (iv) no concomitant nasal pathology, such as septum deviation, concha bullosa, nasal polyposis, and atrophic rhinitis; (v) absence of active infective dacryocystitis; (vi) absence of dry eye and lower lid laxity.
2.2. Methods
All operations were performed as in another previous study [13]. All operations were performed under local anesthesia. Before the surgery, topical anesthetic drops (oxybuprocaine hydrochloride 0.4%) were put on the conjunctiva and cornea. Then intranasal, infraorbital, and lateral nasal side anesthesia were applied with a solution mixture of epinephrine hydrochloride and lidocaine.
After dilating the lacrimal puncta, the fiber was inserted through the canaliculus to the wall of the sac. The feeling of a hard stop is essential during the insertion process. With the endoscopic visualization of the nasal cavity, the red light reflex of the fiber is clearly seen on the nasal wall of the middle turbinate plane (Figure 1). In this way, the target tissue was determined by the laser light guide.
Diode laser (INTERmedic™ diode S30 OFT 980 nm) parameters were settled at 10 W in 500 ms pulse mode potency, taking care not to prolong each impact to avoid overheating the structures. After reaching the nasal cavity, the osteotomy was expanded sufficiently with the fiber manipulation. A Crawford-type aspirator was used to displace the middle turbinate medially to protect the septum and middle turbinate and to maintain adequate exposure to the surgical site. Laser application was continued until the width of the new ostium becomes greater than 5 mm diameter (Figure 2). The size of osteotomy was controlled by the use of the nasal endoscope. The laser shots were between 28 and 45 shots at 10 watts. At the end of surgery, the laser probe was removed and lacrimal irrigation with saline solution was administered.
In addition to the surgery in Group 1 (), bicanalicular silicone intubation was performed. Silicone extensions of the tube were tied to each other and then were left free in the nasal cavity (Figure 3). Tamponade was applied to the nasal cavity to ensure control of the bleeding.
Postoperatively, antibiotic and steroid eye drops, nasal steroid spray, and also nasal saline were to be used four times a day for 2 weeks. Additionally, oral antibiotic was to be used for 7 days.
Follow-up postoperative examinations were carried out on the first day, in the first week, in the first month, in the 3rd month, and then at 3-month intervals. Silicone tube was removed 3 months after intubation. In follow-up visits, the patency of the lacrimal drainage system was checked. Resolution of symptomatic epiphora and lack of resistance in nasolacrimal saline irrigation were defined as success. The follow-up time was at least 12 months.
2.3. Statistical Analysis
Data analyses were performed using SPSS 14.0 (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL). The normal distribution of the considered variables was first evaluated using the Shapiro-Wilk test. The data was presented as the mean ± standard deviation for the continuous variables, and the number of cases was used for the categorical ones. Independent samples -test was used to compare the means between Group 1 and Group 2. The differences between the groups were analyzed by Chi-square tests. A value of was accepted as statistically significant.
3. Results
The study is comprised of 113 patients: Group 1 was composed of 58 patients (28 males, 30 females) with a mean age of (21–65) years and Group 2 was composed of 55 patients (21 males, 34 females) with a mean age of (21–65) years. Final success rates were (49/58) 84.4% for Group 1 and (35/55) 63.6% for Group 2 (). The mean surgical time for Groups 1 and 2 was and mins (range: 9–21 mins in both groups), respectively. The mean surgical time was longer due to silicon tube tying in Group 1 and there was a statistically significant difference among the groups (). The mean total laser energy of Groups 1 and 2 was and Joules (range: from 420 to 720 Joules in both groups), respectively. There was no statistically significant difference among the groups in terms of total laser energy ().
In Group 1, endoscopic examinations showed granulomas in 3 patients. These granulomas were removed by endoscopic procedures. In 6 cases, the result was evaluated as a failure, as there was mucosal scarring around the osteotomized area, and reobstruction occurred between 3 and 6 months postoperatively in 4 patients and between 6 and 12 months in 2 patients. In the 2nd month, 1 patient in Group 1 developed an episode of infection, which was immediately treated with medical therapy. Except for that patient, there were no other complications such as erosion of the punctum, fistulation to skin, and removal of the tubes. In Group 2, endoscopic examinations showed scarring of the internal ostium requiring secondary surgery in 20 of the patients. Reobstruction occurred between 1 and 3 months in 12 patients, between 3 and 6 months in 6 patients, and between 6 and 12 months in 2 patients postoperatively. The follow-up period was months for Group 1 and months for Group 2.
4. Discussion
Transcanalicular diode laser dacryocystorhinostomy (TDL-DCR) is a minimally invasive surgical procedure, which has the great advantage of accessing the operating field through anatomic pathways. It minimizes trauma to surrounding tissue, avoids unnecessary surgical skin scars, and provides precise cutting and removal of tissue by ablation. In addition, TDL-DCR causes minimum pain and minimum nasal bleeding. It is also easier and faster to perform compared to the classical dacryocystorhinostomy. Silicon tube intubation with DCR surgery is used to prevent the blocking of the lacrimal passage and to provide epithelization. Since silicon is an inert substance, it does not damage the conjunctiva and can be well-tolerated in the canaliculi.
As mentioned above, the use of silicon tube intubation has been suggested for patients with coexisting canalicular diseases, contracted or scarred lacrimal sacs, and persistent congenital nasolacrimal duct obstructions. Allen et al. [14] evaluated 242 cases retrospectively and showed no statistically significant difference between failure and age but a statistically significant difference between failure and silicon tube intubation. In their study, it was reported that formation of granulomatous tissue at the site of osteotomy is one of the most important failure factors in surgery with silicon tube intubation.
In literature, there are few studies about DCR surgery with and without silicon tubes. While some studies have reported no statistically significant advantage of using DCR with silicon stents over the DCR without stents [15–17], in the other studies, intubation is recommended in DCR surgery [9].
Feng et al. [16] concluded that no benefit was found in silicon tube intubation in primary DCR based on a meta-analysis of primary dacryocystorhinostomy with and without silicon intubation that included 9 trials involving 514 cases.
In the current study, the TDL-DCR surgery group with silicon tubes had a success rate of 84.4% (49/58), while the other group without tubes had a success rate of 63.6% (35/55), with a significant difference between these groups (). The success rates of both groups in the current study were similar to previous reports. Success rates have been reported to vary between 80% and 99% in external DCR surgery and between 58% and 97% in endoscopic nasal procedures [18–22]. The success of this combination with silicon tubes in TDL-DCR, possibly occurring ostium closure, is due to inhibition by the silicon tube during wound healing.
There were a total of 29 failures in this study: 9 in Group 1 and 20 in Group 2. Formation of granulomatous tissue occurred in 3 failed cases in Group 1. In this group, dacryocystitis was also observed in 1 patient. In addition, endoscopic examinations showed scarring of the internal ostium in 6 patients in Group 1 and in 20 patients in Group 2.
Rebeiz et al. [23] suggested 4 to 6 weeks for the duration of silicon tube intubation. To prevent the formation of granuloma, Kong et al. [24] suggested not removing the tubes before 8 weeks. Häusler and Caversaccio [25] reported that the tubes were well-tolerated by the patients and permit drainage of the nasolacrimal ducts for months and even years. In that study, the tubes remained in place for 9 months on average. In the current study, the silicon tubes were removed 3 months after surgery. The bicanalicular tubes in the lacrimal ducts were well-tolerated by all patients without notable problems except in 1 patient who developed an infection. The great number of female participants compared to the males was consistent with previous findings [18, 20].
This study concluded that the success rate was different in the two TDL-DCR surgery groups with and without silicon tubes. Silicon tube intubation was advantageous for patients who were undergoing their first dacryocystorhinostomy surgery for nasolacrimal duct obstruction. On the basis of these different outcomes, bicanalicular silicon tube intubation should be used in TDL-DCR surgery for patients with primary nasolacrimal duct obstruction.
Competing Interests
The authors declare that they have no competing interests.
Authors' Contributions
Taner Kar wrote the statistical analysis plan, cleaned and analyzed the data, and drafted and revised the paper. Enver Cesmeci and Tuncay Topal analyzed the data and drafted and revised the paper.
The authors thank Yildiray Yildirim for initiating the project, designing the data collection tools, and monitoring data collection for the whole trial. He is the guarantor of the study.
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Congrats! Be sure to grab my Featured On Button!
Sunday, April 14, 2013
Church Supper #82
Congrats! Be sure to grab my Featured On Button!
8 comments:
- Holly Waterfall said...
Gosh, thank you so much for the feature! I truly appreciate it! I brought something a little Brunch-y this week. Hope you enjoy it!
- April 14, 2013 at 12:34 AM
- Mrs. Sarah Coller said...
Thanks for the party. Hope you're having a nice week. I've posted the new Homemaking Party for the week and would love to have you link up, if you'd like!
Mrs. Sarah Coller
- April 14, 2013 at 8:42 AM
- Roxanne Munson said...
I am so glad I found your site. It remind me for the #sundaysupper movement.
- April 14, 2013 at 10:45 AM
- Christina Andersen said...
Hey sorry for uploading diy projects! I realized after I did it, but couldn't figure out how to delete them...if you know how to delete them feel free!! Thanks for your great link party:-) Christina at dearbeautifulyou.com
- April 14, 2013 at 1:24 PM
- Simple Words said...
Glad I found your blog. I love to recipes. Thanks!!
- April 14, 2013 at 2:01 PM
- Carolina HeartStrings said...
Happy Sunday! We linked up a great donut recipe.
- April 14, 2013 at 5:09 PM
- Faith Lohr said...
Thank you so much for hosting! I'm visiting from http://artistic31mama.com and am linking up for the first time. Glad to join in the fun!
- April 14, 2013 at 5:38 PM
Great party. Glad I found you.
I brought over my Lemon Poppyseed Bread with Blueberries from Saturday Dishes.
We're having a party tomorrow - What'd You Do This Weekend? I'd love it if you would join us.
It goes live at midnight.
Have a blessed week,
- April 14, 2013 at 8:21 PM

subset: commoncrawl


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Braylen Andreas David Louderback, age 6 of Mount Gilead gained his wings too soon as he passed on July 24, 2018. He was born on November 4, 2011 to Christopher Louderback and Amber Nelson who survive in Mount Gilead.
Braylen loved spending time outdoors, collecting rocks, loving flowers and plants, and fishing. He was a huge fan of the Ninja Turtles and Spiderman and enjoyed acting as Leonardo of the Turtles by throwing ninja stars at trees or dressing up as Spiderman and climbing trees. Braylen enjoyed playing with his Hot Wheels. He loved spending time with his family, especially his grandmothers and cousins. Braylen also loved going on family vacations, 4 wheelers and going on walks in the woods. Most importantly Braylen loved being close with God.
In addition to his parents, Braylen is survived by three siblings; Noah, Mallori, and Jaxson Louderback of Mount Gilead; maternal grandparents Sheila and Jeff Minturn of Cardington; and paternal grandparents Terry and Debbie Louderback of Marion and Teresa Shears of Mount Gilead; numerous aunts, uncles and cousins.
Friends may call on Monday, July 30, 2018 from 10:00am to 12:00pm at Gompf Funeral Home, 440 Center Street in Cardington. The funeral service will be held immediately following. Burial will take place in the Glendale Cemetery following the service.
Those wishing to share a memory of Braylen or to express a condolence to the Louderback family may do so by visiting www.gompffh.com.


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Chicken a la Francois
This recipe comes from my husband who frequently makes this for us. He has a number of little things that elevate this from being basic roast chicken to showcasing the best of each ingredient.
Chicken a la Francois
2-3 chicken leg quarters (the drumstick and thigh attached)
3 medium Russet potatoes
2 cloves of garlic, sliced
2 tablespoons olive oil approx. 1 tablespoon herbs (I'm using freshly dried thyme & oregano)
salt & freshly ground pepper
Start by peeling & cutting potatoes. Because the potatoes will roast with the chicken the entire time, we're cutting large chunks so they don't overcook and dry out. See the video for Francois's recommendation for how to cut the chunks for the perfect size.
The remove some of the fat from chicken. It's just the obvious bits. Leave the skin on.
Slice the garlic into long, large chunks, maybe 2 pieces per clove. Pull up the chicken skin, cut a little slit in the meat, and nestle the slivers of garlic into the slit in the meat. Pull the skin back down. Hidden garlic treasures!
Add 1 tablespoon of the oil in a hot, oven-safe pan - we love to use our cast iron pan for this - and briefly saute the potatoes over medium heat to get a crispy skin, about 5 minutes, stirring often.
*I tried not sauteing the potatoes in a pan with a separate batch of potatoes and at the end of the roast, their skin was like leather, so this is an integral part of getting the potatoes to come out right.
Once there's some browning on the edges, turn off the heat and add the chicken. Scoot the potatoes over so the chicken can touch pan.
Pour the other tablespoon of olive oil over the chicken, season with salt and pepper and generously sprinkle dried oregano and thyme.
*I'm using herbs from our garden that we dried ourselves and they are absolutely divine. You can do this with any fresh herb. Just hang it in a drafty area, not directly in the sunlight for 2-3 weeks. When the leaves are dry and crumbly to the touch, pull them off stems and store in a jar. This chicken recipe is good with store-bought dried herbs but it is unbelievable with freshly dried herbs.
Now bake at 425 degrees Fahrenheit. After 20 minutes, remove the pan from the oven; remove the chicken and stir the potatoes. Return the chicken to the pan, skin side down. Bake for 25 more minutes, until the juices of the chicken run clear when you cut into it.
Flip the chicken skin side up and for an extra crisp, now broil on low for a few minutes, just until you see a pretty golden crisp. This is the place to sprinkle more herbs, too.
And you're ready to serve! The chicken skin is crunchy; the hidden garlic is soft; the potatoes are crisped but soft and buttery enough to only need a fork. As it cools, you'll need some fresh bread to soak up the juice at the bottom of the pan - it's another yummy secret of this dish.


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Everything SCUBA Diving - Accommodation
Self contained accommodation perfect for couples
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The Birth Of Clarke's Bread
Meet Brenan Clarke: the baker at the forefront of Toronto's artisan bread scene.
It's 1:00am on a Saturday night. Or is it early Sunday morning? Nick and I are waiting in a dark alley in North York. Cutting across the back parking lot of a weathered strip mall, we're startled by what seems to be a motion-sensored light above an open door, leading to an empty lit staircase. Weird. There's no one there. If you didn't know us any better, you'd think that we were first-time buyers of a crooked drug deal.
The last time I waited for bread at 1:00 am was in Mauritius. I was 13-years old and visiting family. We had just arrived and were still very much jetlagged. My uncle thought it would be the best time to go out and get some fresh, hot bread. He wasn't wrong.
Rolling through the dark and narrow streets, we stopped across a little white bungalow with bars on the windows. It was the only house on the block whose lights were still on. My uncle instructed that we stay in the car and hurried into the darkness. He reemerged by a lit door on the side of the house. He knocked and, within seconds, the baker opened the door and handed him some buns in exchange for coins. This, I learned, was a usual occurrence. Back home, the bread still steaming, we opened a tin of imported butter. I tore off a piece of warm bread, smeared it from edge to edge with the creamy gold, and tasted joy.
Now, half-way across the world, I'm doing it again.
As we looked for a seat among a pile of milk crates, there was Brenan Clarke, darting around the curb in his 2005 Dodge Caravan. Right on time. Bright-eyed and full of life, his day was only beginning.
"Do you want some drugs?" he yells out before bursting into laughter, a big smile on his face. When we met him a couple of weeks prior, he insisted that we come experience the witching hours of breadmaking; between 1:00am and 5:00am. This was our golden ticket to witness the magic that only comes to life as all the city sleeps.
"I don't know anything else. That was what I was thrust into from a very early age."
The kitchen is where Brenan always knew he belonged. Starting as a dishwasher in a fine dining restaurant at the age of 16, he fell in love with the hustle of a busy kitchen. At 18, Brenan moved to Vancouver and found work as a cook in various restaurants. The Vancouver Olympics came to town and there was money to be made. Desperate to retain their staff at a crucial time, the newly acquired restaurant where Brenan worked at the time paid handsomely. It was there that he filled his pockets with seed money for his next adventure.
"[I] went to France and I was at a little language school in a small town outside of Versailles," he recounted. "And, it was amazing. Where I was living was right next to a castle and right down the street was this amazing bakery. And I think a lot of my love of bread comes from that experience where the whole town in the morning (it was a very small town) would just go and get their bread for the day. The whole town smelled like fresh bread. It was nothing I had ever seen before. I mean, you have bakeries everywhere, but there's something about a whole community coming together to support one person. And that's what that was. Tons of people would go there every morning, get their coffee, get their baguettes. Nobody here really even does that. You don't see the same. It's not a thing. People don't go get bread at 7:00 in the morning, but that's what this was. And it was really cool."
Brenan travelled around France and England until his now-empty pockets beckoned him home. He enrolled in George Brown's culinary school and, towards the end of his program, got a job at Bymark through a fellow student. "I was working 45-50 hours a week, going to school full-time and it was at the end of my school year," he recalls. "I thought 'that's ok, there's only a month and a half left. I'll just do it, I'll just not sleep,' and did that. I barely passed".
After cooking at Bymark for a little over a year, it was time for a break. Brenan had been falling out of love with the excitement of the chef's life that he so idolized in his earlier years. The 12-hour days of being screamed at had lost its charm. He still wanted to be in the world of food, but no longer had appetite for fine dining kitchens.
With no prior experience baking bread, Brenan found a job as a baker's assistant at Mabel's. The bakery was in the midst of developing their own bread recipes. He quickly learned that it was no easier than working in a kitchen. If anything, the graveyard hours made it even harder. It was more 12-hour days of being yelled at, just in the middle of the night.
And Brenan loved it.
"Coming from what I was doing before; working in a kitchen and then going out and then being peer pressured into drinking all night...This was very different. You just go and you work and you'd be done work at like 10 in the morning and there's a whole world ahead of you and it's bright and sunny."
An unsteady relationship with the head baker pushed Brenan to leave Mabel's. He tried working in a kitchen again, but yearned to be back in a bakery. Infatuated with the focaccias being sold out of Sanagan's in Kensington, Brenan wanted to learn how to bake them. He discovered that they were supplied by Blackbird Baking Co.'s Simon Blackwell, who at the time, was a one-man operation baking out of SOMA's King Street location.
"That's where Blackbird started. In that shop. And that's where I started. [...] It was just this cool startup bread company and I felt that no one else in the city at the time was doing anything worth doing." Brenan was the second employee at Blackbird Baking Co., and by the time he left his position as Head Baker in June 2016 - 2 ½ years later - the company had grown to a 24-hour, 23-employee operation.
"I left my job at Blackbird with no promise of it succeeding. I figured, if it didn't work out, I would...I didn't have a backup plan. This was it."
Brenan planned to launch his bread at a small farmer's market that summer. He had been doing some consulting work, helping North of Brooklyn perfect their pizza dough, and the owners offered their Church Street space for rent after-hours. Testing and experimenting throughout the night, in the too-small kitchen, with inconsistent ovens, and the nightly drunken ruckus beyond the walls, Brenan made it work. As he baked alone in a pizza kitchen, the scent of bread wafting through the air in the middle of the night invited an unlikely customer.
Brenan's first.
"Her name was Nathalie. And, she knocked on the window, maybe 6:00 in the morning. And she was an older French woman. I guess she was the cleaner at the bar. She asked if she could buy some bread. I was like, 'I don't make bread, I'm just testing'. She said, 'I want to buy your bread. I'm buying it. You're not letting me not buy your bread.' [...] She wouldn't let me not sell her bread and she would way overpay me. She paid me like $20 for 2 loaves of bread. I said 'that's too much money, I can't take this money'. She's like "you're taking the money" and took her bread and [said] 'you're here next week? I'm here next week'. And she came back week after week. [...] She was such a huge emotional step for me. She was the first customer. I hadn't sold a loaf of bread before on my own. She was like one of those things that made me seem confident in what I was doing. If this random person smells bread baking down the street and will give me $20 for 2 loaves of bread, I must be doing something right. Something's working here."
By the end of the summer, Clarke's Bread was born. Brenan got through the farmer's markets and moved into a new, larger kitchen.
"There's a point where it has to make sense for a business to make money and I understand that there's compromise, but there's just some things that I'm not willing to compromise on."
We followed Brenan down into the basement kitchen where we found Tristan MacLean, Brenan's first and only employee, mixing dough. He had been there since 11:00 pm. Also hailing from Blackbird, the duo bakes together 7 days a week.
Nick and I have sat at chef's tables and bars overlooking restaurant kitchens many times before. The organized chaos, the yelling, the cacophony of running appliances and clanking cookware; we always enjoy dinner and a show. But this wasn't it. This was...serene.
What we experienced was the closest thing to magic I've ever seen. Pumpkins turning into carriages magic. Mystic creatures in the air magic. And all in peaceful silence, in the dead of night. Swift, yet graceful movements in perfect concert with one another without a word, save for occasional good natured jokes and the intermittent beeping of multiple timers. With all of the timings kept in check and the precision of their scales, whether a loaf is ready to move onto the next stage is still very much done by nurturing feeling.
Clarke's breads are made with an incredible amount of care at every step of a process that can last 2 days. This shines through in the incomparable flavour and quality of their bread. It's all because care is the foundation in Brenan's breads; care in the utmost quality of his ingredients, care for the health of his customers, and care from the people that Brenan works with.
All of Brenan's breads are made with 100% organic flour and grains, exclusively from K2 Milling. Not long ago, before K2 started delivering, Brenan would make the weekly 2-hour drives to and from Beeton, Ontario to pick up his supplies. "I wanted to do more than anyone else was doing. I wanted to do healthy food and whole grains and K2 is, they're not necessarily whole grain, but they're what's called high extraction flour. So it's sifted whole wheat flour. All their flours are sifted whole grain flour and there's about 80% whole grain in all of their flour. I use that as a base and then I also use on top of that whole grains in all of my blends."
Brenan also believes that the same pair of hands should be involved in the process from start to finish. "What I really loved about Blackbird when I started was the small batches, the ability to do everything from start to finish yourself, and to watch your process. I think it really is very beneficial and it's really the only way I think it should be done".
"The best bread in Toronto is only made by a few select people."
Bread is undergoing an important period of awakening. As for many people, Brenan is unable to digest wheat that is not fermented, hence his penchant for sourdough breads. And as food documentaries continue to populate our Netflix list and people are gaining more general awareness of the foods they eat, we are starting to realize that for most of us, the root of the cause is not the bread itself, but how it is made.
Brenan went through the lineage of the most important bakers in the city and how one trained another, and how they move around within the same bakeries. Given the time-intensive nature of baking - especially sourdough - Brenan believes that it cannot be taught in a classroom setting. Baking is learned through apprenticeship, and new ways to perfect your craft comes from seeking those who are able and willing to teach. That night, Nick became his impromptu apprentice; Brenan patiently taught him how to shape various types of bread as we asked questions.
Toronto's bread baking lineages are few, and easy, to trace. He speaks highly of Blackbird Baking Co., Mabel's, and Forno Cultura. These are the bakeries that are dedicated to bringing bread back to its former, healthier glory; made in the traditional way, using natural ingredients. Brenan is humble, almost to a fault; I had to remind him that he is part of that group.
I told him how fortunate we felt to be in his presence. That some day, there will be a documentary made of the bakers who started it all. About those who triumphantly put bread back on the daily dinner table, eradicating our fear of being ill. And that he would be among them. He laughed; to him it was a ludicrous idea. Not to me.
We stumbled out of the bakery at 6:00 in the morning. Much later than we expected. It was still dark outside, but the birds were chirping, announcing the impending sunrise. We boarded a night bus home and as soon as we hit the pillow, we drifted to sleep.
When I woke up about noon that day, with images of flour clouds gently exploding through the air, I thought that I had perhaps dreamt it all. Did this really happen? And when I looked at the kitchen table and saw our doggybags of goodies, I knew it wasn't a dream. Brenan never lets us leave empty-handed.
Brenan has played a more integral role in this bread awakening than either of us can imagine. He's done more than he even knows, himself. And will likely never admit it. This is only the beginning for Clarke's Bread and as far as he's come, Brenan has a long way to go as he continues to obsessively perfect and experiment. Failure was never an option. But once we met Brenan and understood the fundamentals for his life's work, we knew immediately that failure was not even a possibility. Remember Brenan Clarke; he's big right now. But he'll be even bigger someday.
Words by Kimberley Kwo. Photos by Abhishek Dekate.


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MEET JENN, parties are my thing.
Above photo by Erica Ann Photography
MORE ABOUT OWNER, JENNIFER REYES (aka Jenn... and sometimes J-REY):
I started AWE Productions in 2014 to serve as an alternative to traditional norms in event planning. I have a diverse background in project management that to some's surprise translates *really* well into the world of weddings! I have been planning some kind of party or event since I was in high school (P.S. that was in the early 90's! But I'm a young AF 'over the hill'). I have planned weddings in the Portland area since 2007. I am your hype girl ("You look stunning"), gatherer ("Let me put that on the calendar") and intent on guests having a good time ("No worries, I'm picking up another keg").
I worked in high tech (and still dabble in the winter months) since 2004. I learned early on that I thrive being part of a team to reach a larger goal. I enjoy connecting people, teaching, mentoring and helping others - often leading me into functional operation roles as a: recruiter, hiring coordinator, welcome wagon, trainer and promoter of fun things. In 2011, I transitioned into business-to-business marketing developing content and planning product introductions. The fast paced environment and collaboration needed to internationally launch new products is still exciting --- whether its a new technology OR a newly wedded couple. :) And bonus, if you're on the nerdy side, I am semi-fluent in IT and engineer speak!
I enjoy the wedding industry so much, I've also started working for other fellow vendors when I am not helping my own clients. I am a DJ for NW Mobile DJ Service and also operated photo booths for venues and photographers. Occasionally, when other planners need an experienced, hit-the-ground-running helper, I work as a site coordinator or event assistant. This first hand experience in a variety of vendor roles only complements my expertise in overall planning and executing your wedding vision.
Do I only plan weddings? Heck no! I plan all kinds of parties. Life is full of events, many are life changing --- so why not celebrate with your nearest and dearest? One of my personal favorite ways to celebrate is with casual (but classy and thoughtful) cocktail party. Cocktail parties can range from an elaborate catered event at a venue to an intimate gathering at your favorite bar. In fact... you could even have a cocktail party AS your wedding reception! Past clients know I have a thing for customized giant ice cubes and welcome cocktails or punches!
Recap... I'm a party person but I also get things done in a variety of roles & settings. I have 20+ years of experience as an event planner & project manager for private, non-profit, & corporate events, all with drastically different budgets. I dig in and get things done on event day to make any event fun and fantastic. I have a wonderful network of local vendors that I recommend specific to your desires and needs for your event. I will be honest and direct but we will have plenty of laughs along the way, too.
In my free time, I enjoy trying the latest food & drink spots in Portland (Fernet!), discovering new music, crafty projects and regular meditation practice… I may have a slight obsession with teen soap operas (shhhh). When not planning client events, I volunteer with the Q Center, Portland's LGBTQ2SIA+ community center (#iDoAtTheQ, SHINE gala). I'm a former dog mom of three furkids so when the need arises, I help transport surrendered dogs for basset hound rescues in Oregon & Washington.
And all of that IS #AWEPDX - phew!
Contact me at (503) 899-8323 or email@example.com today to learn more about how AWE Productions can help you plan your Portland, Oregon area wedding, cocktail party or event.


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Charming fully remodeled home in Clarksville neighborhood. Vaulted ceilings and large windows in living area allow for light to radiate through main floor. Two spacious living spaces open to a finely finished gourmet kitchen and dining area with plenty of room to entertain. Main level master suite showcases a luxurious bath containing tub-shower combo with pebble stone floor and large walk in closet. Two additional bedrooms, office/bonus space and tasteful full bath upstairs. Crisp, sleek aesthetic.
Electricity on Property, Natural Gas on Property
Ceiling-High, Ceiling-Vaulted, Lighting Recessed, Smoke Detector, Skylight
Dishwasher, Disposal, Microwave Oven, Refrigerator, Single Oven, Stainless Steel, Water Heater Gas, Stove Commercial Grade, Water Heater Tankless
Deck, Gutters Partial, Patio-Covered, Private BackYard
Curbs, Interior, Public Maintained Road
Property Listed by: KW-Austin Portfolio RealEstate
The information being provided is for consumers' personal, non-commercial use and may not be used for any purpose other than to identify prospective properties consumers may be interested in purchasing.
Based on information from the Austin Board of REALTORS® (alternatively, from ACTRIS) from October 23rd, 2019 at 5:55pm CDT. Neither the Board nor ACTRIS guarantees or is in any way responsible for its accuracy. The Austin Board of REALTORS®, ACTRIS and their affiliates provide the MLS and all content therein "AS IS" and without any warranty, express or implied. Data maintained by the Board or ACTRIS may not reflect all real estate activity in the market.
All information provided is deemed reliable but is not guaranteed and should be independently verified.
Listing information last updated on October 23rd, 2019 at 5:55pm CDT.


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Netsol is the only company from Pakistan that is trading on the NASDAQ. OPEN Silicon Valley is excited to host the founders of Netsol, Salim Ghauri, Najeeb Ghauri and Naeem Ghauri.
In this session, we will learn about their entrepreneurial journey, and discuss startup opportunities in Pakistan. They will also talk about how they are fueling the startups through their incubator program and how you can get involved.
Moderated by Fahad Aziz (OPEN SV Board Member)


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Medical assistance is a rewarding career that gives individuals the opportunity to work in doctors' offices, hospitals, and healthcare facilities. Although there are no formal educational requirements to become a medical assistant, most employers prefer to hire individuals who have completed a postsecondary education program at a community college or university and earned a medical assistant certification. Completing a formal medical assistant program gives students the opportunity to gain laboratory experience and learn medical terminology.
While higher education is ideal for individuals interested in becoming medical assistants, many are concerned about how to pay for the program. Fortunately, there are plenty of financial aid options available to students who want to earn a certificate in medical assistance. Many schools offer merit-based and need-based financial aid packages, as well as loans, grants, medical assistant scholarships, flexible payment options, discounts for special student populations, and employer reimbursement and tuition deferment programs. When students consider costs, they should factor in tuition and other related expenses, such as books, special equipment, and materials. The following guide discusses the types of financial aid available to medical assistant students.
How Much Does it Cost to Get a Medical Assistant Certification?
The total cost of a medical assistant certification depends on several factors. Many schools charge a per-credit fee, which means the cost of tuition varies depending on how many courses the student takes each semester. Residency and location are also factors. Residents typically pay lower tuition rates than out-of-state students, and there may be different rates for on-campus students versus distance learners. There may be fees associated with technology, facilities, equipment, and other learning materials, as well as expenses for books, housing, health insurance, placement tests, and transportation. This is why it's important for students to research medical assistant scholarships and grants.
Paying for Your Medical Assistant Certification with Financial Aid
The FAFSA
The U.S. Department of Education's office of Federal Student Aid provides more than $120 billion each year in loans, grants, and work-study funds to help students pay for college and education-related expenses. To apply for financial aid, students must complete the Free Application for Federal Student Aid (FAFSA). The FAFSA not only allows students to apply for federal aid, but also state, school, and private aid, including medical assistant scholarships and grants.
To apply for student aid with the FAFSA, students must hold a high school diploma or GED certificate and cannot owe money or be in default on a current loan. They must have a clean record with no convictions for possession or sale of illegal drugs and have a valid Social Security number. Applicants must submit all records of income, such as state and federal income tax returns, W-2s, bank statements, and investment records. Students who are dependents must have their parent's financial information as well.
To apply for the 2018-2019 school year, students must submit the FAFSA by June 30, 2019. FAFSA corrections and updates must be made by September 14, 2019. Some states provide funding on a first-come, first-served basis, so it's prudent to apply for aid early in those states. The FAFSA4caster gives students an estimate of the amount of aid they are likely to receive.
Determining Your Financial Need
Students must know their expected family contribution (EFC) and the cost of attendance (COA) to figure out how much financial aid for which they are eligible. EFC is an index number that the school uses to determine how much financial aid students should receive. Factors such as household income, assets, and family size are considered to determine EFC. Keep in mind, the EFC is not the amount of money students have to pay for college, it's an estimate that helps schools decide on an appropriate financial aid package for their students.
COA is the total amount of money it costs to go to school for the duration of a program. To determine the amount of need-based aid a student is eligible for, students must subtract their EFC from COA. Need-based federal student aid programs include the Pell Grant, Federal Supplemental Educational Opportunity Grant (FSEOG), direct subsidized loans, Perkins Loan, and work-study programs.
Non-need-based aid is calculated without using the EFC. To determine the amount of merit-based money, including money awarded for scholarships for medical assistant programs, students must subtract the total financial aid awards from the total COA. Non-need-based federal student aid programs include direct unsubsidized loans, PLUS Loans, and the Teacher Education Access for College and Higher Education grant.
Sources of Financial Aid
- School aid: School-based financial aid is awarded to students from an educational institution's funds and may be based on academic excellence or financial need. Schools often offer financial aid to specific student populations, such as scholarships for medical assistant students. Other financial aid opportunities include flexible payment plans and loans. Students should contact their school's financial aid office to get more specific information about their options.
- Federal aid: Federal aid is awarded by the federal government. Authorized under Title IV of the Higher Education Act of 1965, federal aid options include loans, grants, and work-study programs, and they must be used to pay for education-related expenses. Students apply for federal aid using the FAFSA, and the federal government shares FAFSA information with applicable schools. A school's financial aid office determines the amount of money awarded to each student.
- State financial aid: State financial aid is state-sponsored money awarded to students to help pay for college. State aid includes loans, grants, and scholarships and may be based on academic excellence or financial need. State aid is sometimes aimed at specific student populations, such as low-income students or veterans. Students apply for state aid using the FAFSA, though some states require additional documentation.
- Privately-funded scholarships: A privately-funded scholarship does not need to be repaid. Scholarships are typically based on merit, considering factors such as essay submissions, official SAT or ACT scores, class rank, and GPA. Sometimes preference is given to students who demonstrate the most financial need. Some awards are limited to specific student populations, such as scholarships for medical assistant students. When students complete the FAFSA, they automatically apply for scholarships.
Types of Financial Aid
- Scholarships: A scholarship is a financial gift to a student based on academic merit. Scholarship money does not require repayment. Scholarships are awarded by many institutions, including government agencies, colleges and universities, nonprofit organizations, and private foundations. Some scholarships are renewable. There are no limits to how many medical assistant scholarships for which students can apply, so some students may choose to apply for many scholarships to increase their chances of receiving an award. Requirements and deadlines vary.
- Grants: A grant is a gift based on financial need. Grant money does not require repayment, with some exceptions, such as withdrawing from classes. Grant money is often awarded on a first-come, first-served basis. Grants are awarded by federal and state government agencies, colleges and universities, private organizations and foundations, and corporations. When students submit the FAFSA, they automatically apply for grants. Private grants may have additional requirements and deadlines.
- Federal Loans: A federal loan is awarded by the U.S. government and must be repaid with interest. The U.S. Department of Education offers federal student loans through the William D. Ford Federal Direct Loan Program. There are four loans offered through this program: subsidized loans, unsubsidized loans, parent PLUS loans, and loan consolidation options. Each type of loan has its own benefits and features.
- Private Loans: A private loan is awarded to a student from a private lending institution that must be repaid with interest. Private student loans typically require an established credit history or a good credit score. There is often a cosign option to help students with low or no credit receive private loans. Private loans may have adjustable or variable interest rates. Repayment options vary based on the lending institution, which may include fees for late or defaulted payments.
- Work-Study: Federal work-study is a program that allows students to earn money by working part-time jobs on or off campus. Eligibility for work-study is based on financial need. The total work-study award depends on when students submit their application and the availability of funds at the school. Work-study is available for part-time and full-time students but is often not a practical option for nontraditional students.
Federal Grants
The U.S. Department of Education offers grants to students to help pay for higher education at four-year universities, community colleges, and career schools. Grants are similar to scholarships in that they don't require repayment. When students submit the FAFSA, they automatically apply for federal grants. Grants are typically awarded based on financial need, though there are a few exceptions. Students must consult the financial aid office at their school to determine how much grant money they are eligible to receive.
- Federal Pell Grants: The Pell Grant is the largest federally-funded grant available from the U.S. Department of Education. Students can receive up to 150% of a scheduled award per year. The maximum award for the 2018–2019 school year is $6,095.
- Federal Supplemental Educational Opportunity Grants (FSEOG): FSEOG is a grant for students who demonstrate exceptional financial need. With this grant, students are awarded between $100 and $4,000 each year. Participating schools receive limited FSEOG funds each year.
- TEACH Grants: The Teacher Education Assistance for College and Higher Education Grant is designed for students who are pursuing a career in teaching. To be eligible for a TEACH grant, students must score above the 75th percentile on the college admissions test. Students are awarded up to $4,000 each year.
- Iraq and Afghanistan Service Grants: The Iraq and Afghanistan Service Grant is available for students who are not eligible for a Pell Grant whose parent or guardian was a member of the military and died on the line of duty after 9/11. The maximum award for the 2018–2019 school year is $6,095.
State Grants
State governments award college grants to help students pay for their education. Students that qualify for federal aid are not likely eligible for state financial aid; however, students who are not eligible for federal aid may still be qualified for state aid. Most state agencies offer grants and other financial aid opportunities. Students who are interested in exploring grants in their state should visit the National Association of Student Financial Aid Administrators website.
Finding Scholarships
A scholarship is a gift for students to cover a large portion of their college tuition and does not require repayment. Scholarships are typically awarded based on merit, considering factors such as academic standing, official SAT or ACT scores, class rank, and GPA. Other awards are aimed at special groups or student populations, such as medical assistant scholarships. Students can apply for scholarships by submitting the FAFSA. Some scholarships require an essay and letters of recommendation. Students should apply to as many scholarships as possible to increase their award chances.
Taking Out Loans to Pay for Your Medical Assistant Certification
Medical assistant scholarships and grants are ideal payment options for students because they do not require repayment. However, these awards do not necessarily cover all education-related expenses. Students also have the option of taking out loans to help pay for their medical assistant certification programs. More than 70% of students at four-year colleges take out loans to help pay for school. There are many types of loans available, including federal and state loans and private loans from banks and other lending institutions. Students should do their research to determine the best options for their needs.
What Kind of Loan Should You Take Out?
Several loans, including federal and private loans, are available to students to help cover education costs. Private loans are offered through schools, banks, and other private lending institutions, while federal loans are available through the U.S. Department of Education's William D. Ford Federal Direct Loan Program. There are several factors to consider when deciding what kind of loan to take out, including interest rates, annual percentage rates, interest capitalizations, prepayment penalties, and application fees, as well as forgiveness, forbearance, and repayment options.
The U.S. government offers students subsidized and unsubsidized loans. Subsidized loans are based on financial need, and the government pays interest while the student is in school. Unsubsidized loans are not based on financial need and students are responsible for paying interest at all times. The government also offers PLUS loans to parents of dependent undergraduate students as well as loan consolidation programs, in which students can consolidate debt into monthly payments. Federal loans often feature fixed interest rates, while private loans may have variable or adjustable interest rates. Generally, private loans are more expensive and less flexible than government-funded loans. Additionally, private loans typically have a more stringent approval process and may require a cosigner.
Loan Repayment
With federal loans, students have many options for repayment. The default repayment option is a standard 10-year repayment plan, but students can switch to a different plan at any time. Students can also opt for the extended repayment plan, which gives them 25 years to pay back their loans. Another option is the graduated repayment plan, in which payments start off at a lower rate and then increase every two years. Several repayment options are based on income, including the pay-as-you-earn plan and the income-contingent, income-based, and income-driven plans. Each plan has different eligibility requirements and schedules. The repayment estimator calculator is a great resource for students to figure out the best option for repayment.
When students are facing financial difficulty, they may have trouble repaying their loans. When they can't make a payment, the government typically allows students to change their monthly payment due dates or consolidate their loans. A direct consolidation loan is a federal loan that consolidates debt into monthly payments. Consolidating loans allows students to extend the amount of time they have to repay their debt. If those options don't work, students can postpone their payments through deferment or forbearance. Students should keep in mind that private loans are typically not as flexible.
Loan Forgiveness
Students are required to repay their loans even if they do not graduate or find a job in their desired field. However, certain circumstances can lead to the cancellation of a student's payment obligation, which is called loan forgiveness. Loan forgiveness is often used for direct loans. Forgiveness is an option for students with special circumstances, such as those who follow certain career pathways, like teaching, or individuals who work in public service. Loan forgiveness is sometimes called loan cancellation, which means that the the borrower's obligation to repay is canceled. Loan cancellation is often used for Perkins Loan program benefits. Loans that are forgiven or canceled based on qualifying employment do not require income tax payments. Loan discharge is a type of loan forgiveness in which the borrower's obligation to repay the balance is canceled due to circumstances such as when a school closes or a student goes bankrupt or becomes permanently disabled. In rare cases, loan discharges entitle borrowers to receive refunds, such as if a school misleads students or engages in misconduct or violates a state or federal law.
Financial Aid for Graduate Students
Graduate school can be expensive, but there are many financial aid options available, including federal work-study programs, loans, grants, and medical assistant scholarships. Student loans are available through the William D. Ford Federal Direct Loan Program, which includes subsidized and unsubsidized loan options, loan consolidation programs, PLUS loans for parents and guardians, and several loan forgiveness and repayment options. Students can potentially take out loans from their state government, school, bank, or other private lending institutions. Private loans are often more expensive than government-funded loans. All loans accrue interest over time and require repayment over a certain number of years.
Grants and scholarships are ideal for students because they don't require repayment. These gifts are offered through federal or state governments, schools, nonprofit organizations, and private foundations. Scholarships are typically awarded to students based on academic merit, while grants are based on financial need. Some awards are aimed at specific student populations, such as scholarships for medical assistant students.
Scholarships for Medical Assistant Certification Students
Medical Assisting Scholarship Award
Who Can Apply: Aspiring medical assistant students can earn money to help pay for their education through this scholarship contest. Students must submit a 500-word essay or a two-to-three-minute video explaining why they want to become medical assistants.
Amount: $2,000
NCMSA Scholarship
Who Can Apply: Eligible medical, nursing, and physician assistant students can apply for scholarships through the Northampton County Medical Society Alliance, an organization of physicians and their spouses. Awards are based on academic, financial, and community service criteria.
Amount: $1,000
Maxine Williams Scholarship
Who Can Apply: Medical assistant students can receive educational assistance through the American Association of Medical Assistant's Maxine Williams Scholarship Fund. Awards are based on academic ability and financial need. Students must have a minimum GPA of 3.0.
Amount: $1,000 and a one-year membership in the AAMA
Alice Newell Joslyn Medical Scholarship
Who Can Apply: The Alice Newell Joslyn Medical Scholarship is for students entering the medical and healthcare profession. This scholarship is designed for Latinx high school graduates in San Diego County. Applicants must submit a personal statement and an estimated family contribution based on their student aid report.
Amount: $500–$2,000
ASCP Foundation Laboratory Student Scholarship
Who Can Apply: The American Society for Clinical Pathology offers 10 high-achieving laboratory student scholarships each year. Students must be enrolled in an accredited laboratory science program or phlebotomy training program. Learners must also have a minimum GPA of 3.0.
Amount: $1,000
ASCP Foundation STEM Student Scholarship
Who Can Apply: High school students interested in pursuing a medical science degree can earn scholarship money through the American Society for Clinical Pathology STEM student scholarships.
Amount: $2,000 and an invitation to attend the NEXTPO event
ASCP Foundation Leadership Institute Scholarship
Who Can Apply: Medical assistants with five to eight years of work experience in laboratory science are eligible for the American Society for Clinical Pathology Leadership Scholarship. This scholarship program gives laboratory professionals and pathologists five hours of one-on-one coaching and a certificate.
Amount: 10 courses; 25 credits
Zelda Walling Vicha Memorial Trust Fund
Who Can Apply: Through the Zelda Walling Vicha Memorial Trust Fund, the American Society of Podiatric Medical Assistants awards two scholarships to fourth-year podiatry students throughout the United States. Awards are based on high scholastic achievement and financial need.
Amount: $2,000
The Medical Professionals of Tomorrow Scholarship
Who Can Apply: U.S. Medical Supplies, an online provider of lift chairs and mobility products, hosts a merit-based scholarship contest for full-time students at two-year or four-year colleges pursuing a medical-related program. Students must submit a 500-word essay about their decision to enter the medical field.
Amount: $1,000
Laboratory Control Ltd Health Care Career Scholarship
Who Can Apply: Medical assistants and healthcare students can earn scholarship money through the Ottumwa Regional Health Legacy Foundation. Applicants must be enrolled in a nationally accredited program and have a minimum GPA of 3.0.
Amount: $1,000 minimum
Gilberto and Lennetta Pesquera Medical School Scholarships
Who Can Apply: The Glens Falls Foundation Gilberto and Lennetta Pesquera Fund offers merit-based scholarship money for medical school education. Applicants must submit a paragraph about their area of medical interest and career goals.
Amount: $4,000
HIMSS Foundation Scholarships
Who Can Apply: Medical assistant and healthcare students can earn scholarship money through the Healthcare Information and Management Systems Society (HIMSS). Applicants must be enrolled at an accredited undergraduate or graduate school.
Amount: $5,000 and a trip to the HIMSS Annual Conference and Exhibition
The Robert & Virginia Hoffmeier Oncology Scholarship Fund
Who Can Apply: The Robert & Virginia Hoffmeier Oncology Scholarship is an annual scholarship for a member of the support staff at the Oncology Unit at CentraState Medical Center in Freehold, New Jersey. Applicants must plan on attending a nationally recognized conference or lecture.
Amount: $1,000
AMES Scholarship
Who Can Apply: The Alliance Medical Education Scholarship is for second-year and third-year medical students enrolled in a Pennsylvania medical school. Applicants must be Pennsylvania residents.
Amount: $2,500
Foster G. McGaw Graduate Student Scholarship
Who Can Apply: Students in healthcare management graduate programs can apply for the Foundation of the American College of Healthcare Executives scholarship. Applicants must submit an application essay about their reasons for pursuing a career in healthcare.
Amount: $5,000


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I founded Mother Wit Writing and Design in 1983, but have worked as a graphic designer since 1975. Among other accomplishments, my creative studio has won the West Virginia Communicators Best of Show award and several First Place awards from the National Federation of Press Women. Please contact me for information about fees or to request a cost estimate for your next design project. Here are images from a few recent design projects:
Laotong Yoga
Sue Julian and Barbara Steinke, the founders of Laotong Yoga, have brought the healing power of yoga to incarcerated women and men in several West Virginia prisons. Their work is universally praised by inmates, staff, and administrators.
For more than ten years, I have designed logos, posters, postcards, and programs for this women's chorale.
ArtWorks West Virginia
For a number of years, I have designed this quarterly magazine for the West Virginia Division of Arts, Culture and History. It contains news about the state agency's arts programming and information for individual artists.
Water Gap Retreat
Water Gap Retreat is a small, friendly campground for tents and RV camping near Elkins, West Virginia.
Flying Pig Improv
This logo was designed for the immensely creative and talented improv artist and teacher, Jessie Gray. She thinks the pig in flight is a good metaphor for her work (and play). In her own words: "I'm crazy about them. Flying Pigs. They represent the impossible becoming possible."
Fortissimo Piano Studio
This logo embodies the grace and fluidity of the music made by a professional pianist and teacher with many years of experience.
Monongahela Forest Hiking Guide
The 9th edition of this popular guide, edited by Hugh Rogers, has been redesigned and updated with new, full-color maps and plenty of gorgeous color images by photographer Kent Mason.


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The Human Capital Project (HCP) is predicated on the conviction that cognitive capital is critical in a world where entrepreneurial and socioemotional skills are required for productive employment…
Strengthening the cash flow forecasting capacity could help countries to determine the right amount of cash reserves and carry with possible minimum cost – because cash is king.
At the G20 Leaders Summit in Japan, World Bank Group President David Malpass stressed reducing inequality and realizing inclusive growth globally.
Financing UHC efficiently and equitably is important to ensure inclusive growth—especially since the health sector accounts for 11 percent of global GDP.
A host of analyses over the last few years have examined the correlation between the size of an economy and its impact on climate. In addition, the costs and socio-economic consequences of climate…
City leaders will gather again at the Urban 20 Mayors Summit in Tokyo, Japan, to continue their conversations and further unlock cities' tremendous potential in driving inclusive, resilient, and…
Mental health is a critical health issue, whether you are young or old, and just as important as physical health. All too often, however, it seems that society tends to emphasize the latter,…


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Gardai in County Limerick investigate late night assault on woman
Gardai in County Limerick are investigating a late night attack on a woman
GARDAI in County Limerick are investigating a late night attack on a woman.
The assault occurred last Saturday night at 11.30pm on Main Street, Abbeyfeale.
Gardai said a young lady in her early 20s was on her way home from work when a man "jumped out in front of her and began to verbally abuse her".
"He then grabbed her glasses off her face and continued to shout at her," said a garda spokesperson.
"The lady does not know the male that attacked her but she provided a very good description to Gardai in Abbeyfeale who are investigating and looking for any witnesses to this assault to please contact them on 068-30010."


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Nick Brandreth uses historical photographic processes to document New York State
I was lucky enough to ask Nick Brandreth a few questions about his current photography project.
What is your photography project and what do you hope to achieve with it?
My project is to use historical photographic processes to explore and create a body of work documenting parts of New York State that have the potential to be affected by "fracking". With this project my plan is create a beautiful body of work by first creating a series of negatives on glass with a hand made silver bromide emulsions. Then I will take soil from the different landscapes which will be milled down and added to other earth pigments to create Carbon prints. By using the carbon printing process and added my own pigment made from the landscape, the body of work will in fact be made from the same land in which I'm trying to help protect. In the end i hoping that the work will stand as a historical document of our modern landscape as well as help raise awareness of what we have and what we stand to lose.
I'm interested in why you choose to use the dry plate method for your documentary project. Can you tell me a little bit about why it is special and how does it relates to your subject matter?
For the past year I've been apprenticing under Mark Osterman the process historian at the George Eastman House. My intentions were to come and learn about as many processes as i possibly could. I was looking to find the perfect process that would pair with my style of shooting & working. I really fell in love with the dry plate process, It takes me about a day to make a emulsion and then i can coat as many plates as i want in almost any size to go out and work with. The emulsion technology that I'm working with is of the same vintage that George Eastman started the Eastman dry plate company which eventually became Kodak. I typically work with 4x5 and whole plate (6.5x8.5) and I'm coating this emulsion on glass plates, on a normal day I'll go out into the field with about 6 plates. Making images on glass has become an obsession, I think glass plate negatives by themselves are some of the most beautiful objects one could create photographically. So when it all boils down to it the process really paired with my workflow extremely well and its a bit of an homage to the rich history of photography in western, NY.
Upstate New York has a long history of being a place where people flock to see beauty but also a place of industry. Will you be focusing solely on the area's natural beauty or will you also be including elements of the regions industrial past?
This is actually a question i find myself coming back to repeatedly. New York State along with most of the north eastern US has a rich history of industry that is nestled away amongst the area's rich natural beauty. It's hard to say exactly at this point what images i will end up making as I'm still exploring my idea. However, this project is about how one industry will potentially effect and alter a landscape forever. Most of the small towns and cities sprinkled across the NY are there because of industry that once was or is still in place. Therefore, I will try to touch on the subject of the state industrial past and how the landscape has been affected up until this point. A large portion of my focus is on bodies of water across the state and a good potion of the industry is positioned on or in close proximity to major water ways. If we look to some of these places as an example of what happens after the industry leaves an area, I think we can take a cue as to what will happen after the energy companies and the fracking boom leave. Western, NY isn't exactly know for being a financial hub for our country, It's argued that drilling will bring some financial stimulus to area's that are struggling. However, in my eyes the short term monetary gains are over shadowed by the fact that the land and the people who depend on it will be far worse of then before they started. Most of the jobs won't go to local people and most of the gas will be exported to other countries. I'm not trying to think 10 or 20 years into the future I'm trying to think hundreds of years ahead. I think that at this point our systems of obtaining energy be it oil or natural gas is archaic and new means need to be implemented. There are more than enough smart and talented people who could rise to such occasion, and i hope these work could lead to some type of change.
For More Information
Support Nick Brandreith's kickstarter.
Visit Nick Brandreith's website.


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We know our Michigan Members have plans that sometimes require a loan to make them happen. Whether you want to make home improvements, consolidate debt from a higher-interest loan or finance a higher education expense, we provide various options so you can get what you need.
*APR=Annual Percentage Rate. Variable rate subject to change monthly based on the prime rate as published in the Wall Street Journal plus a margin. Actual rate offered is based on overall creditworthiness factors. Interest begins to accrue when you access the funds. Floor APR is 6% and the maximum APR is 18%. Other conditions may apply.
**APR=Annual Percentage Rate. Actual rate offered is based on credit worthiness factors. Approximate monthly payment would be $32.03 per $1000 borrowed at 8.99% for 36 months. Other conditions may apply. Rates subject to change.
†Available to employees of or those employed at hospitals, facilities, and affiliates of the Detroit Medical Center, Beaumont Health, St. Joseph Mercy Health System, Spectrum Health and Munson Healthcare. Subject to eligibility verification.
‡Credit limit offered will be $1,000 on all approved loans. After $1,000 initial draw, subsequent draws must be made for the full amount of the available credit limit. Outstanding balance must be $100 or less for subsequent draws. Member must have a minimum automatic monthly payroll direct deposit of $500. Subject to approval based on overall creditworthiness factors. Other conditions may apply. Rate subject to change.
Contact Credit Union ONE at 800-451-4292 or visit any Credit Union ONE branch for assistance.
The Member Contact Center Loan Servicing Agents can assist members with changing the due date on their loan that may better for their budget. Credit Union ONE does not refinance our own loans however we can look into lowering the interest rate on the loan if the member qualifies. If members are facing financial difficulties, we can assist with starting the Loan Modification process.