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Ulcerative colitisInflammatory bowel disease - ulcerative colitis; Colitis - ulcerative
An in-depth report on the causes, diagnosis, treatment, and prevention of ulcerative colitis.
Ulcerative Colitis
Ulcerative colitis and Crohn's disease are inflammatory bowel diseases that cause chronic inflammation in the digestive system. Ulcerative colitis occurs only in the inner lining of the large intestine (colon) and rectum whereas Crohn's disease extends into deeper areas of the intestinal wall and can affect any part of the gastrointestinal tract (digestive system).
Causes and Risk Factors
The exact causes of ulcerative colitis are unknown.
- Genetics plays some role. Many people with ulcerative colitis have family members with the disease.
- Ulcerative colitis is diagnosed most often in people ages 15 - 35.
- Ulcerative colitis is more common among whites than people of other races. Jewish people of Eastern European (Ashkenazi) descent have a higher than average risk for developing this disease.
The symptoms of ulcerative colitis depend in part on how widespread the disease is and the severity of the inflammation. Common symptoms include:
- Diarrhea
- Rectal bleeding
- Difficulty or pain when passing stool
- Abdominal cramps
About half of patients with ulcerative have mild symptoms while another half go on to develop more severe forms of the disease. Some patients go into remission after a single attack, while others develop a chronic condition.
The onlycure for ulcerative colitis issurgical removal of the colon, but medications and dietary measures can help suppress the inflammatory response and control symptoms. Drugs used to treat ulcerative colitis include aminosalicylates (5-ASAs), corticosteroids, immunosuppressants, and biologic drugs. Some patients with ulcerative colitis are not helped by drugs and require surgical treatment.
Drug Approval
In 2013, the Food and Drug Administration (FDA) approved golimumab (Simponi) to treat moderate-to-severe ulcerative colitis that has not been helped by other drugs. Golimumab is the third biologic drug approved as maintenance therapy for ulcerative colitis. Like adalimumab (Humira) and infliximab (Remicade), golimumab blocks tumor necrosis factor (TNF), a protein involved in the inflammatory process. Golimumab is given by self-injection once a month. Like all TNF blockers, golimumab can increase the risk for serious infections.
Inflammatory bowel disease (IBD) is a general term that includes two main disorders:
- Ulcerative colitis
- Crohn's disease
These two diseases are related, but they are considered separate disorders with somewhat different treatment options. The basic distinctions between UC and CD are location and severity. However, some patients with early-stage IBD have features and symptoms of both disorders. (This is called indeterminate colitis.)
Ulcerative Colitis. Ulcerative colitis occurs only in the top layer of the large intestine (colon) and rectum. Ulcers form in the inner lining, or mucosa, of the colon or rectum, causing diarrhea, which may be accompanied by blood and pus.
Ulcerative colitis is classified into different categories depending on the location of the disease. Thefour main types of ulcerative colitis are:
- Proctitis. Disease confined to the rectum (the lower part of the colon that connects with the anus). In about a third of patients, ulcerative colitis begins with ulcerative proctitis.
- Proctosigmoiditis. Disease that affects the rectum and the sigmoid colon (the lower part of the colon located above the rectum).
- Left-Sided Colitis. Disease that causes continuous inflammation throughout the left side of the colon from the rectum to the area near the spleen.
- Pancolitis. Disease and inflammation throughout the entire colon.
Crohn's Disease. Crohn's disease can occur in any part of the gastrointestinal tract (digestive system) from the mouth to the anus. The inflammation associated with Crohn's disease affects all layers of the intestine and can extend into the deep layers of the intestinal wall.
The Gastrointestinal Tract
The gastrointestinal (GI) tract (the digestive system) is a tube that extends from the mouth to the anus. It is a complex organ system that first carries food from the mouth down the esophagus to the stomach and then through the small and large intestine to be excreted through the rectum and anus.
Esophagus. The esophagus, commonly called the food pipe, is a narrow muscular tube, about 9 1/2 inches long that begins below the tongue and ends at the stomach.
Stomach. In the stomach, acids and stomach motion break food down into particles small enough so that nutrients can be absorbed by the small intestine.
Small Intestine. The small intestine, despite its name, is the longest part of the gastrointestinal tract and is about 20 feet long. Food that passes from the stomach into the small intestine first passes through three parts:
- First it enters the duodenum
- Then the jejunum, and
- Finally the ileum
Most of the digestive process occurs in the small intestine.
Large Intestine. Undigested material, such as plant fiber, is passed next to the large intestine, or colon, mostly in liquid form. The colon is wider than the small intestine but only about 6 feet long. The colon absorbs excess water and salts into the blood. The remaining waste matter is converted to feces through bacterial action. The colon is a continuous structure but it is characterized as having several components
Cecum and Appendix. The cecum is the first part of the colon and it gives rise to the appendix. These structures are located in the lower-right quadrant of the abdomen. The colon continues onward in several sections:
- The first section, the ascending colon, extends upward from the cecum on the right side of the abdomen.
- The second section, the transverse colon, crosses the upper abdomen to the left side.
- The third section extends downward on the left side of the abdomen toward the pelvis and is called the descending colon.
- The final section is the sigmoid colon.
Rectum and Anus. Feces are stored in the descending and sigmoid colon until they pass through the rectum and anus. The rectum extends through the pelvis from the end of the sigmoid colon to the anus.
Doctors do not know exactly what causes inflammatory bowel disease. IBD appears to be due to an interaction of many complex factors including genetics, impaired immune system response, and environmental triggers. The result is an abnormal immune system reaction, which in turn causes an inflammatory response in the body's intestinal regions. Ulcerative colitis and Crohn's disease, like other IBDs, are considered autoimmune disorders.
The Inflammatory Response
An inflammatory response occurs when the body tries to protect itself from what it perceives as invasion by a foreign substance (antigen). Antigens may be viruses, bacteria, or other harmful substances.
In Crohn's disease and ulcerative colitis, the body mistakenly targets harmless substances (food, beneficial bacteria, or the intestinal tissue itself) as harmful. To fight infection, the body releases various chemicals and white blood cells, which in turn produce byproducts that cause chronic inflammation in the intestinal lining. Over time, the inflammation damages and permanently changes the intestinal lining.
Genetic Factors
Although the exact causes of inflammatory bowel disease are not yet known, genetic factors certainly play some role. Between 10 - 20% of people with ulcerative colitis have family members with the disease. Several identified genes and chromosome locations play a role in the development of ulcerative colitis, Crohn's disease, or both. Genetic factors appear to be more important in Crohn's disease, although there is evidence that both conditions have some genetic defects in common.
Inflammatory bowel disease is much more common in industrialized nations, urban areas, and northern geographical latitudes. It is not clear how or why these factors increase the risk for IBD.
It could be that "Western" lifestyle factors (smoking, exercise, diets high in fat and sugar, stress) play some role. However, there is no strong evidence that diet or stress cause Crohn's disease or ulcerative colitis, although they can aggravate the conditions.
Risk Factors
About 1 million Americans suffer from inflammatory bowel disease (IBD), and about half of these patients have ulcerative colitis. There are several risk factors for ulcerative colitis.
Ulcerative colitis can occur at any age, but it is most often diagnosed in people ages 15 - 35 and, less commonly, in people ages 50 - 75.
Men and women are equally at risk for developing ulcerative colitis.
Family History
Ulcerative colitis tends to run in families. People who have a first-degree relative (father, mother, brother, sister) with ulcerative colitis have a significantly greater risk for developing the disorder. .
Race and Ethnicity
Crohn's disease and ulcerative colitis are more common among whites. Jews of Eastern European (Ashkenazi) descent are at especially high risk. However, rates of inflammatory bowel disease have been increasing among other racial and ethnic groups.
Smoking appears to decrease the risk of developing ulcerative colitis. (Because of the hazards of smoking, however, it should never be used to protect against ulcerative colitis.) Conversely, smoking increases the risk of developing Crohn's disease, and can worsen the course of the disease.
Removal of the appendix (appendectomy) may possibly reduce the risk for developing ulcerative colitis, but increase the risk for Crohn's disease.
The two major inflammatory bowel diseases, ulcerative colitis and Crohn's disease, share certain characteristics:
- Symptoms usually appear in young adults.
- Symptoms can develop gradually or have a sudden onset.
- Ulcerative colitis and Crohn's disease are chronic conditions. In both diseases, patients experience sporadic episodes of symptom flare ups (relapse) in between symptom-free periods (remission)
- Symptoms can be mild or very severe. Severe symptoms can lead to complications.
Common Symptoms
The symptoms of ulcerative colitis depend in part on how widespread the disease is and the severity of the inflammation. Common symptoms include:
- Diarrhea
- Rectal bleeding and bloody stool
- Difficulty or pain when passing stool
- Abdominal cramps
Other symptoms may include:
- Fever
- Nausea
- Loss of appetite and weight loss
- Fatigue
The inflammation associated with inflammatory bowel disease (IBD) can cause symptoms outside of the gastrointestinal tract.
Joints. Arthritis is the most common non-intenstinal symptom of inflammatory bowel disease.
Skin Disorders. There are many types of skin problems associated with IBD. They often tend to appear during disease flare-ups and resolve when symptoms are controlled. Cankar sores (mouth ulcers) are very common. Skin disorders that tend to be seen more with ulcerative colitis than Crohn's disease include red knot-like swellings (erythema nodosum) and pus-filled skin ulcers on the shins and ankles (pyoderma gangrenosum).
Eyes. Inflammatory bowel disease is sometimes associated with various eye problems. A common complication is inflammation in the pigmented part of the eye, a condition called uveitis.
About half of patients with ulcerative colitis have mild symptoms while another half go on to develop more severe forms of the disease. Patients with more severe ulcerative colitis tend to respond less well to medications.
The course of ulcerative colitis is unpredictable. Some patients go into remission after a single attack, while others develop a chronic condition. There is no cure for ulcerative colitis (aside from surgical removal of the colon), but medications can help suppress the inflammatory response and control symptoms.
Complications in the Intestine
Malabsorption and Malnutrition. Malabsorption is the inability of the intestines to absorb nutrients. In IBD, this occurs as a result of bleeding and diarrhea, as a side effect from some of the medications, and as a result of surgery. Malnutrition may occur in ulcerative colitis, but it tends to be less severe than with Crohn's disease.
Toxic Megacolon. Toxic megacolon is a serious complication that can occur if inflammation spreads into the deeper layers of the colon. In such cases, the colon enlarges and becomes paralyzed. In severe cases, it may rupture, which is a life-threatening event requiring emergency surgery. Symptoms include weakness and abdominal pain and bloating.
Bleeding and Anemia. Rectal bleeding due to ulcers in the colon is a common complication of ulcerative colitis. It can increase the risk for anemia (reduced red blood cell count). In some cases, internal bleeding can be massive and dangerous, requiring surgery.
Intestinal Infections. Inflammatory bowel disease can increase patients' susceptibility to Clostridium difficile, a species of intestinal bacteria that causes severe diarrhea. It is usually acquired in a hospital. However, several recent studies indicate that C. difficile is increasing among patients with inflammatory bowel disease and that many patients acquire this infection outside of the hospital setting. Patients with ulcerative colitis are at particularly high risk.
Colorectal Cancers. Inflammatory bowel disease increases the risk for colorectal cancer. The risk is highest for patients who have had the disease for at least 8 years or who have extensive areas of colon involvement. The more severe the disease, and the more it has spread throughout the colon, the higher the risk. Having a family history of colorectal cancer also increases risk. If you have an IBD, discuss with your doctor how often you should have a colonoscopy (screening test for colorectal cancer).
Most experts or guidelines recommend that patients receive an initial colonoscopy earlier than people with no risk factors for colon cancer and then have follow-up colonoscopies based on risk factors. Some of these risk factors include severity of ulcerative colitis disease, family history of colorectal cancer, presence of primary sclerosing cholangitis, personal history of abnormal biopsies (dysplasia) in the colon, and presence of colonic strictures.
Complications Outside the Intestine
Bones. Ulcerative colitis, and the corticosteroid and other immune-suppressing drugs used to treat it, can cause osteopenia (low bone density) and osteoporosis (bone loss). Osteoporosis is more common with Crohn's disease than with ulcerative colitis.
Liver and Gallbladder Disorders. In severe cases, IBD can cause problems with the liver and pancreas and increase the risk for gallstones.
Thromboembolism (Blood Clots). People with inflammatory bowel disease are at higher risk for blood clots, especially deep venous thrombosis where blood clots form in the legs. They are also at risk for pulmonary embolism, when a blood clot travels from the legs to the lungs.
Urinary Tract and Kidney Disorders. IBD may increase the risk for urinary tract and bladder infections. Patients have an increased risk for kidney stones.
Delayed Growth and Development in Children. Children with ulcerative colitis are at slightly higher than average risk for delayed growth, but their risk is lower than with Crohn's disease.
Emotional Factors. Living with ulcerative colitis can pose many emotional challenges. Patients often deal with feelings of frustration, humiliation, and loss of control. Adolescents may have a particularly difficult time coping with this chronic condition. Although inflammatory bowel disease symptoms can be emotionally stressful, and symptom flare ups are sometimes associated with stressful life events, there is no evidence that stress or psychological factors cause IBD.
There is no definitive diagnostic test for ulcerative colitis. A doctor will diagnose ulcerative colitis based on medical history and physical examination, and the results of laboratory, imaging, and endoscopic tests, which usually include biopsies of colon tissue.
Laboratory Tests
Blood and stool tests may be used:
- Blood tests are used for various purposes, including to determine the presence of anemia (low red blood cell count). An increased number of white blood cells or elevated levels of inflammatory markers such as C-reactive protein may indicate the presence of inflammation.
- A stool sample may be taken and examined for blood, infectious organisms, or both.
Flexible Sigmoidoscopy and Colonoscopy. Flexible sigmoidoscopy and colonoscopy are standard endoscopic procedures for diagnosing ulcerative colitis. They are important in the diagnosis of both ulcerative colitis and Crohn's disease. Both procedures involve snaking a fiber-optic tube called an endoscope through the rectum to view the lining of the colon:
- Sigmoidoscopy, which is used to examine the rectum and left (sigmoid) colon, lasts about 10 minutes and is done without sedation. It may be mildly uncomfortable, but it is not painful. If sigmoidoscopy indicates ulcerative colitis, the doctor may order a colonoscopy to confirm the diagnosis and to identify how much of the colon is involved.
- Colonoscopy allows a view of the entire colon and requires a sedative, but it is still a painless procedure performed on an outpatient basis. A colonoscopy is also used to screen for colon cancer.
During these procedures the doctor can insert instruments through the endoscope to remove tiny tissue samples (biopsies). A pathologist will view the tissue sample under a microscope to look for signs of inflammation. These procedures can help a doctor to distinguish between ulcerative colitis and Crohn's disease, as well as other diseases. Patients diagnosed with ulcerative colitis may also need periodic endoscopies to evaluate their condition when symptoms flare up.
Barium Enema X-Ray
Sigmoidoscopy and colonoscopy are standard tests for diagnosing ulcerative colitis, but in some cases the doctor may order a double-contrast barium enema Swallowed barium passes into the small intestine and shows up on an x-ray image, which may reveal inflammation and other abnormalities.
Ruling out Diseases Resembling Ulcerative Colitis
Crohn's Disease. Diarrhea associated with ulcerative colitis tends to be more severe than diarrhea caused by Crohn's disease. Abdominal pain is more constant with Crohn's disease than with ulcerative colitis. Fistulas (tracts between areas of the intestine or between the intestine and other organs) and strictures (scarring) are common with Crohn's disease but very rare with ulcerative colitis. Endoscopy and imaging tests reveal more extensive involvement through the entire gastrointestinal tract with Crohn's disease than with ulcerative colitis. Ulcerative colitis only occurs in the colon and rectum.
Irritable Bowel Syndrome. Irritable bowel syndrome (IBS), also known as spastic colon, functional bowel disease, and spastic colitis, may cause some of the same symptoms as inflammatory bowel disease (IBD). Bloating, diarrhea, constipation, and abdominal cramps are all symptoms of IBS. However, IBS is not the same as IBD. Irritable bowel syndrome is not caused by inflammation.. Behavioral therapy may be helpful in treating IBS. (Psychological therapy does not improve inflammatory bowel disease.)
Infectious Colitis. Infectious colitis appears very rapidly and painfully. Organisms can be identified in stool samples.
Intestinal Ischemia (Ischemic Colitis). Symptoms similar to irritable bowel syndrome can be caused by blockage of blood flow in the intestine. This is more likely to occur in elderly people.
Celiac Sprue. Celiac sprue, or celiac disease, is an intolerance to gluten (found in wheat) that triggers inflammation in the small intestine and causes diarrhea, vitamin deficiencies, and stool abnormalities. It occurs in some people with inflammatory bowel disease (IBD) and is usually first noticed in children.
Acute Appendicitis. Crohn's disease may cause tenderness in the right lower part of the abdomen, where the appendix is located, that resembles appendicitis.
Cancer. Colon or rectal cancers must always be ruled out when symptoms of IBD occur.
Ulcerative colitis is a chronic condition marked by variable periods of no symptoms (remission) and active symptoms (flare-ups). Treatment can help suppress the inflammatory response and manage symptoms. A treatment plan for ulcerative colitis includes:
- Diet and nutrition
- Medications
- Surgery (when necessary)
Diet and Nutrition
Malnutrition may occur in ulcerative colitis, although it tends to be less severe than with Crohn's disease. Patients with ulcerative colitis may experience reduced appetite and weight loss.
Patients should strive to eat a well-balanced healthy diet and focus on getting enough calories, protein, and essential nutrients from a variety of food groups. These include protein sources such as meat, chicken, fish or soy; dairy products such as milk, yogurt, and cheese (if the patient is not lactose-intolerant); and fruits and vegetables. Depending on your nutritional status, your doctor may recommend that you take a multivitamin or iron supplement.
Drug therapy for ulcerative colitis aims to resolve symptoms (induce remission) and prevent flare-ups (maintain remission). The main types of drugs used for treating ulcerative colitis are:
- Aminosalicylates. Mild-to-moderate ulcerative colitis is usually treated with aspirin-like medications called aminosalicylates, or 5-ASAs. These drugs are also used to treat relapses. They may be administered rectally in patients who have mild-to-moderate disease that occurs only in the last portion of the intestine. They may also be taken by mouth.
- Corticosteroids. Corticosteroids (steroids) may be added or used alone to reduce acute inflammation. (Because of their significant side effects, they are not recommended for long-term use and maintenance therapy). Steroids may be administered rectally as an alternative to an aminosalicylate if the disease is limited to the last portion of the intestine. Pill forms taken by mouth may treat moderate-to-severe cases. People who do not respond to less aggressive treatments may need intravenous steroids.
- Immunosuppressants. Drugs that suppress the immune system (immunosuppressants) are useful, either alone or in combinations, for disease that does not respond to other treatments or for maintenance of remissions.
- Biologic Drugs. Biologic drugs used for ulcerative colitis target and block tumor necrosis factor (TNF), a specific protein involved with the inflammatory response.
Drug therapy is considered successful if it can push the disease into remission (and keep it there) without causing significant side effects. The patient's condition is generally considered in remission when the intestinal lining has healed and symptoms such as diarrhea, abdominal cramps, and tenesmus (straining painfully to defecate) are normal or close to normal.
Other types of drugs may also be used to treat specific conditions and symptoms associated with ulcerative colitis. Anti-diarrheal medications such as loperamide (Imodium, generic) may be given to help control diarrhea.
Drugs do not help about 25 - 40% of patients with ulcerative colitis. As a result, these people need surgical treatment. Surgery may also be necessary because of hemorrhage, perforation of the colon, or toxic megacolon.
Total proctocolectomy with ileal pouch anal anastomosis (IPAA), also known as restorative proctolectomy, and total proctocolectomy with ileostomy are the two definitive surgical approaches for widespread ulcerative colitis that cannot be controlled with medications. Other patients may have a colectomy (resection of a portion of the colon) for more limited disease.
Unlike Crohn's disease, which can recur after bowel resection, ulcerative colitis does not recur after total proctocolectomy. Total proctocolectomy is considered a cure for ulcerative colitis. (See Surgery section for more detailed information.)
Aminosalicylates contain the compound 5-aminosalicylic acid, or 5-ASA, which helps reduce inflammation. These drugs are used to prevent relapses and maintain remission in mild-to-moderate ulcerative colitis.
The standard aminosalicylate drug is sulfasalazine (Azulfidine, generic). This drug combines the 5-ASA drug mesalamine with sulfapyridine, a sulfa antibiotic. While sulfasalazine is inexpensive and effective, the sulfa component of the drug can cause unpleasant side effects, including headache, nausea, and rash.
Patients who cannot tolerate sulfasalazine or who are allergic to sulfa drugs have other options for aminosalicylate drugs, including mesalamine (Asacol, Pentasa, Lialda, Delzicol, generic), olsalazine (Dipentum), and balsalazide (Colazal, generic). These drugs, like sulfasalazine, are taken as pills several times a day. Lialda is a once-daily mesalamine pill for patients with ulcerative colitis. Mesalamine is also available in enema (Rowasa, generic) and suppository (Canasa, generic) forms.
Common side effects of aminosalicylate drugs include:
- Abdominal pain and cramps (mesalamine, balsalazide)
- Diarrhea (mesalamine, olsalazine)
- Gas (mesalamine)
- Nausea (mesalamine)
- Hair loss (mesalamine)
- Headache (mesalamine, balsalazide)
- Dizziness (mesalamine)
Mesalamine can cause kidney problems and should be used with caution by patients with kidney disease. All mesalamine preparations, including sulfasalazine, appear to be safe for children, and for women who are pregnant or nursing.
Corticosteroids (commonly called steroids) are powerful anti-inflammatory drugs. They are used only for active ulcerative colitis. Steroids are frequently combined with other drugs to produce more rapid symptom relief and to allow quicker withdrawal, although such combinations do not improve remission time. Because the oral form has serious long-term effects, they are not useful for maintenance therapy. Patients who have a poor response to steroids are also less likely to do well with repeat therapy.
Corticosteroid Types. Prednisone (Deltasone, generic), methylprednisolone (Medrol, generic), and hydrocortisone (Cortef, generic) are the most common oral corticosteroids. Newer steroids, such as budesonide (Entocort), are given via enema and affect only local areas in the intestine and do not circulate throughout the body. Such drugs may avoid the widespread side effects that are a serious problem with long-term treatment using older conventional steroids. They are only helpful for milder ulcerative colitis involving the rectum and sigmoid colon.
Administering Corticosteroids. Most corticosteroids can be taken as a pill. For patients who cannot take oral forms, methylprednisolone and hydrocortisone may also be given intravenously or rectally as a suppository, enema, or foam. The severity or location of the condition often determines the form.
Side Effects of Corticosteroids. Oral steroids can have distressing and sometimes serious long-term side effects, including:
- Susceptibility to infection
- Weight gain (particularly increased fatty tissue on the face and upper trunk and back)
- Acne
- Excess hair growth
- High blood pressure (hypertension)
- Weakened bones (osteoporosis)
- Cataracts and glaucoma
- Diabetes
- Muscle wasting
- Menstrual irregularities
- Upper gastrointestinal ulcers
- Personality change, including irritability, insomnia, depression, and psychosis
Withdrawing from Corticosteroids. Once the intestinal inflammation has subsided, steroids must be withdrawn very gradually. Withdrawal symptoms, including fever, malaise, and joint pain, may occur if the dosage is lowered too rapidly. If this happens, the dosage is increased slightly and maintained until symptoms are gone. More gradual withdrawal is then resumed.
Immunosuppressive Drugs
Immunosuppressant drugs are used for long-term therapy, especially for very active inflammatory bowel disease that does not respond to milder treatments. Such drugs suppress or limit actions of the immune system and therefore the inflammatory response that causes ulcerative colitis. Immunosuppressants can prevent relapse, even when used alone, and they can help maintain remissions of ulcerative colitis for several years.
Azathioprine (Imuran, Azasan, generic) and mercaptopurine ([6-MP], Purinethol, generic) are the standard oral immunosuppressant drugs. However, it can take 3 - 6 months for these drugs to have an effect. To speed up the response, they are sometimes prescribed along with a corticosteroid drug. Lower steroid doses are then needed, resulting in fewer side effects. Corticosteroids may also be withdrawn more quickly. For this reason, immunosuppressants are sometimes referred to as steroid-sparing drugs.
Other pill forms of immunosuppressants include cyclosporine A (Sandimmune, Neoral) and tracrolimus (Prograf). Cyclosporine A is also given intravenously to patients with severe ulcerative colitis. These drugs are quicker-acting than azathiopine and 6-mercaptopurine. Cyclosporine A generally takes 1 - 2 weeks to take effect. Methotrexate (MTX, Rheumatrex) is another fast-acting type of injectable immunosuppressant that is effective for Crohn's disease but not for ulcerative colitis. Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
General side effects of immunosuppressants may include nausea, vomiting, and liver or pancreatic inflammation. Patients should receive frequent blood tests to monitor bone marrow, liver, and kidneys. Patients who take cyclosporine A or tacrolimus need to have their blood pressure and kidney function checked regularly. Children and young adults who take azathioprine or mercaptopurine should be monitored for signs of cancer as these drugs have been associated with increased risk of an aggressive form of T-cell lymphoma. Immunosuppressants are usually not recommended for women who are pregnant or breast-feeding.
Biologic Drugs
Biologic response modifiers are genetically engineered drugs that target specific proteins involved with the body's inflammatory response. Three biologic drugs are approved for treatment of moderate-to-severe ulcerative colitis in patients who have not responded to other drugs:
- Infliximab (Remicade), which is given by intravenous infusion in a doctor's office or hospital clinic (after the first three doses, the drug is administered every 8 weeks)
- Adalimumab (Humira), which you can give by injection at home (after the first two doses, you give yourself an injection every other week)
- Golimumab (Simponi)is given by self-injection at home once a month
Infliximab, adalimumab, and golimumab target and block an inflammatory immune factor known as tumor necrosis factor (TNF). These drugs are described as anti-TNF drugs, TNF blockers, or TNF inhibitors. Studies indicate that anti-TNF drugs may reduce ulcerative colitis symptoms and help patients achieve and maintain remission.
Common side effects of TNF inhibitors include respiratory infections (sinus infections and sore throat), headache, rash, cough, and stomach pain. All anti-TNF drugs can potentially cause serious severe side effects, including increased susceptibility to viral, fungal, and bacterial infections (including tuberculosis).
Your doctor should carefully monitor you for any signs of infection. Symptoms of fungal infections include fever, malaise, weight loss, sweating, cough, and shortness of breath. If you experience any of these symptoms, contact your doctor.
Anti-TNF drugs can increase the risk for cancer, particularly lymphomas, in children and adolescents. They can also increase the risk for leukemia in patients of all ages. Other severe side effects may include psoriasis, heart failure, liver failure, aplastic anemia, nervous system disorders, and allergic reactions.
Investigational Drugs. Vendolizumab (Entyvio) is a new biologic drug that is being investigated for treatment of moderate-to-severe ulcerative colitis and Crohn's disease. The FDA is considering this drug for approval in 2014. In clinical trials, the drug was particularly effective for ulcerative colitis.
Proctocolectomy and Ileoanal Anastomosis
Proctocolectomy is removal of the entire colon, including the lower part of the rectum and the sphincter muscles that control bowel movements. It can achieve a complete cure, but it is a last resort.
Ileostomy. In some proctocolectomies, the surgeon creates an opening in the abdominal wall (called a stoma) to allow passage of waste material. This part of the procedure is referred to as an ileostomy, and the stoma is created in the lower right corner of the abdomen. The surgeon then connects cut ends of the small intestine to this opening. An ostomy bag is placed over the opening and accumulates waste matter. It requires emptying several times a day.
Ileoanal Anastomosis. Ileal pouch anal anastomosis (IPAA), also simply called ileoanal anastomosis, has now largely replaced ileostomy because it preserves part of the anus and allows for more normal bowel movements. The procedure creates a natural pouch to collect waste, rather than using an ileostomy bag. The standard procedure involves:
- The colon is removed as in proctocolectomy, but the surgeon only strips the superficial diseased inner layer of the rectum, leaving the sphincter muscles intact.
- The anus is then attached to the ileum (the final portion of the small intestine leading to the colon).
- A pouch is constructed out of the small bowel above the anus. The pouch is able to collect waste material, and the patient can pass bowel movements normally through the anus, although they are watery and more frequent than normal (five or six times a day).
- A temporary abdominal opening (ileostomy) is usually required, but it is typically closed up in a second operation a few months later.
Managing Daily Life after Surgery
Flatulence is the most socially distressing problem following surgery. Unfortunately many of the fiber rich vegetables and whole grains that can benefit patients with ulcerative colitis can also cause gas. (Surgical patients should avoid or chew thoroughly insoluble fiber foods, such as popcorn, olives, and vegetable skins, which can obstruct the stoma.) Some pouching systems have filters that can help limit flatulence. Typically, flatulence occurs 2 - 4 hours after eating, which may help patients time their meals to ensure privacy afterward.
Patients must increase fluid intake, and include not only water but also broth, sports drinks, and vegetable juice to maintain appropriate levels of sodium and potassium.
Patients should avoid time-released, coated, or large pills, which often are not completely absorbed and may block the stoma.
Ileostomy and ileoanal anastomosis do not interfere with bathing or showering or most physical activity. (Patients should avoid contact sports.) As a rule, the surgeries do not impair sexual function.
Outcome and Complications from Ileoanal Anastomosis
Complications are common with any intestinal operation. In about 5 - 10% of IPAA procedures, complications occur that require conversion to an ileostomy. In general, patient satisfaction is very high with this procedure. Most patients report better or much better quality of life 5 years after the procedure. Most patients can postpone their bowel movements until they are convenient. Bowel movements still average about six a day.
Pouchitis. Inflammation of the pouch (pouchitis) is the most common complication of the pouch procedures. Symptoms include rectal bleeding, cramps, and fever. It can usually besuccessfully treated with antibiotics such as metronidazole (Flagyl, generic) or ciprofloxacin (Cipro, generic).
Bowel obstruction may occur although it is less common than pouchitis. With most patients, this condition can be treated by avoiding food for several days and administering intravenous fluids. In about a third of patients with bowel obstruction, surgery may need to be performed to remove the blockage.
Pouch failure occurs in a small percentage of patients. It requires permanent removal of the pouch and use of ileostomy.
Irritable Pouch Syndrome. Irritable pouch syndrome is a problem that includes frequent bowel movements, an urgent need to defecate, and abdominal pain. There are no signs of inflammation, however, as there are with pouchitis. Stress and diet play a role in this condition, and it is usually relieved after a bowel movement.
Infertility. IPAA triples the risk of infertility in women with ulcerative colitis. The surgery may cause scarring or blocking of fallopian tubes, which increases the risk of infertility. About half of women who undergo this procedure become infertile.
Lifestyle Changes
Diet and Nutrition
Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. While people vary in their individual sensitivity to foods, general guidelines for dietary management during symptom flare-ups include:
- Eat small amounts of food throughout the day.
- Stay hydrated by drinking lots of water (frequent consumption of small amounts throughout the day).
- Eat soft, bland foods and avoid spicy foods.
- Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
- Avoid fatty greasy or fried foods and sauces (butter, margarine, and heavy cream).
- Limit milk products if you are lactose intolerant (or consider taking a lactase supplement to improve tolerance). Otherwise, dairy products are a good source of protein and calcium.
- Avoid or limit alcohol and caffeine consumption.
Herbs and Supplements
Your doctor may recommend you take a multivitamin. Although other types of dietary supplements, such as probiotics ("healthy bacteria" like lactobacilli) and omega-3 fatty acids, have been investigated for ulcerative colitis, there is no conclusive evidence that they are effective in controlling symptoms or preventing disease relapses.
Various herbal remedies with anti-inflammatory properties have been investigated for treating Crohn's disease and ulcerative colitis. There is no definitive evidence that they work, but studies have suggested that some specific herbs may be helpful. They include wheat grass juice, psyllium husk, evening primrose oil, curcumin, aloe vera gel, Boswellia serrata, and Andrographic paniculata.
Remember that manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products and there is no regulation to ensure that the bottle contains what is advertised. Be sure to tell your doctor of any herbs or supplements you are taking or considering taking as some of these may interact with medications.
Stress Management
Stress does not cause Crohn's disease or ulcerative colitis, but it can trigger and worsen symptoms. Many patients find that stress management techniques help them cope better with living with and IBD. Stress management can include meditation, yoga, and relaxation response training as well as getting adequate sleep, exercising regularly, and building a healthy support network of family and friends. Some patients may also benefit from psychological counseling.
- www.ccfa.org -- Crohn's & Colitis Foundation of America
- www.gastro.org -- American Gastroenterological Association
- www.acg.gi.org -- American College of Gastroenterology
- www2.niddk.nih.gov -- National Digestive Diseases Information Clearinghouse
Abraham C, Cho JH. Inflammatory bowel disease. N Engl J Med. 2009 Nov 19;361(21):2066-78.
Adams SM, Bornemann PH. Ulcerative colitis. Am Fam Physician. 2013 May 15;87(10):699-705.
Bernstein CN, Fried M, Krabshuis JH, Cohen H, Eliakim R, Fedail S, et al. World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010. Inflamm Bowel Dis. 2010 Jan;16(1):112-24.
Burger D, Travis S. Conventional medical management of inflammatory bowel disease. Gastroenterology. 2011 May;140(6):1827-1837.e2.
Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, et al; British Society of Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010 May;59(5):666-89.
Clark M, Colombel JF, Feagan BC, Fedorak RN, Hanauer SB, Kamm MA, et al. American Gastroenterological Association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21-23, 2006. Gastroenterology. 2007 Jul;133(1):312-39.
Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011 Nov 3;365(18):1713-25.
Farraye FA, Odze RD, Eaden J, Itzkowitz SH, McCabe RP, Dassopoulos T, et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010 Feb;138(2):738-45.
Ford AC, Achkar JP, Khan KJ, Kane SV, Talley NJ, Marshall JK, et al. Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr;106(4):601-16. Epub 2011 Mar 15.
Ford AC, Bernstein CN, Khan KJ, Abreu MT, Marshall JK, Talley NJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr;106(4):590-9; quiz 600. Epub 2011 Mar 15.
Ford AC, Sandborn WJ, Khan KJ, Hanauer SB, Talley NJ, Moayyedi P. Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr;106(4):644-59, quiz 660. Epub 2011 Mar 15.
Holubar SD, Cima RR, Sandborn WJ, Pardi DS. Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis. Cochrane Database Syst Rev. 2010 Jun 16;6:CD001176.
Itzkowitz SH, Present DH; Crohn's and Colitis Foundation of America Colon Cancer in IBD Study Group. Consensus conference: Colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis. 2005 Mar;11(3):314-21.
Jess T, Horváth-Puhó E, Fallingborg J, Rasmussen HH, Jacobsen BA. Cancer risk in inflammatory bowel disease according to patient phenotype and treatment: a Danish population-based cohort study. Am J Gastroenterol. 2013 Aug 27. [Epub ahead of print]
Khalili H, Huang ES, Ananthakrishnan AN, Higuchi L, Richter JM, Fuchs CS, et al. Geographical variation and incidence of inflammatory bowel disease among US women. Gut. 2012 Dec;61(12):1686-92. Epub 2012 Jan 11.
Khan KJ, Dubinsky MC, Ford AC, Ullman TA, Talley NJ, Moayyedi P. Efficacy of immunosuppressive therapy for inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr;106(4):630-42. Epub 2011 Mar 15.
Kornbluth A, Sachar DB; Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010 Mar;105(3):501-23; quiz 524. Epub 2010 Jan 12.
Mallon P, McKay D, Kirk S and Gardiner K. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;(4):CD005573.
Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012 Jan;142(1):46-54.e42. Epub 2011 Oct 14.
Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011 May;60(5):571-607.
Ng SC, Lam YT, Tsoi KK, Chan FK, Sung JJ, Wu JC. Systematic review: the efficacy of herbal therapy in inflammatory bowel disease. Aliment Pharmacol Ther. 2013 Oct;38(8):854-63. Epub 2013 Aug 25.
Nguyen GC, Chong CA, Chong RY. National estimates of the burden of inflammatory bowel disease among racial and ethnic groups in the United States. J Crohns Colitis. 2013 Sep 24. pii: S1873-9946(13)00312-7. [Epub ahead of print]
Rutgeerts P, Vermeire S, Van Assche G. Biological therapies for inflammatory bowel diseases. Gastroenterology. 2009 Apr;136(4):1182-97. Epub 2009 Feb 26.
Thomas DW, Greer FR; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Probiotics and prebiotics in pediatrics. Pediatrics. 2010 Dec;126(6):1217-31. Epub 2010 Nov 29.
Timmer A, Preiss JC, Motschall E, Rücker G, Jantschek G, Moser G. Psychological interventions for treatment of inflammatory bowel disease. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD006913.
Advanced Studyec
Related Informationec
Review Date: 12/19/2013�
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


text:
An unusually historically informative short video, via Unreasonable Faith. On edit, back at Unreasonable Faith, PsiCop argues the video is factually challenged: This video has some factual flaws, and even in addition to that, it's anachronistic. The "pedophilia" referred to in early documents like the Didache and at the synod of Elvira very likely alluded to a [Read More…]
The Catholic Church's Struggles With Sex Abuse Scandals Down Through The Ages
April 24, 2010 by Leave a Comment
Like Camels With Hammers and Patheos Atheist on Facebook!

subset: commoncrawl


text:
"O ye who believe! Seek help with patient perseverance and prayer; for Allah is with those who patiently persevere" (2:153).I've been told many times in my life I am a patient person. I think I am. I thought I was. Now that I am a parent I feel I have stepped into a whole new dimension of patience, and I have a lot to learn.Everyone talks about the "terrible two's" of childhood, but the two's are a breeze compared to the three's—at least it seems that way with my son. His typical responses … [Read more...]
Being the Change
December 27, 2012 by Admin GrowMama Leave a Comment
Filed Under: Motherhood Reflections, Self-development Tagged With: Ambata Kazi-Nance, be the change you wish to see in the world, defiance, ghandi, guilty conscience, how to be a more patient parent, modeling positive behavior, positive encouragement, seeking help through patience and prayer, three year old tantrums, two year old tantrums Leave a Comment


description: Dams don't always hold water back; sometimes they have to let it through. A number of thrill seekers are requesting the release of water so they can enjoy a day of white-water rafting!

is_us_only: false

title: I Didn't Know That: Dam-Release Rafting

allowUserEmbed: True

credit: National Geographic

transcript:
JONNY PHILLIPS: Dams don't always hold water back, sometimes they have to let it through.  For example, if there's a threat to the dam's integrity, or they need to increase supply downriver, then they'll open the valves.
RICHARD AMBROSE: Go on Jonny, really let it rip!
JONNY PHILLIPS: Right.
RICHARD AMBROSE: Go on!  [Laughs] - look at that!  Jonny, you've broken it!
NARRATOR: This valve alone can release over 8000 litres of water a minute.
RICHARD AMBROSE: Now that is a lot of water!  Turn it off!  Turn it off!
RICHARD AMBROSE: Now there are a few dams in the country where a release of water can be requested by anyone.
JONNY PHILLIPS: You might be a farmer downriver who just needs a bit more water released to irrigate their land.
RICHARD AMBROSE: Or an environmental group concerned that lower water levels downriver are compounding the effects of pollution.
JONNY PHILLIPS: But you do have to pay.  For water to be released for a whole day it can cost 1500 pounds.
NARRATOR: But despite the cost, an increasing number of people are requesting the release of water so they can enjoy thrill seeking recreational pursuits!
JONNY PHILLIPS: And one of the most popular of those activities on this river is whitewater rafting.  But just how much difference can a release of water from a dam upriver make?
RICHARD AMBROSE: Well we're not moving at all at the moment and the river is just flowing gently, but we've been told they're gonna release a load of water from the dam up above and this river is gonna turn into a monster.
NARRATOR: With the dam open, the amount of water flowing down this river increases to a massive 900 million litres, that's 50 times the normal amount, which means the boys will be travelling down it 10 times faster than normal!
JONNY PHILLIPS: This is the biggest drop of the river.
RICHARD AMBROSE: That's a big one!  Oh my word!
JONNY PHILLIPS: Oh my word!
RICHARD AMBROSE: Here's the biggun!
RICHARD AMBROSE: Without that dam up there we couldn't do this today.  And more and more places across the UK are taking advantage of dams to have fun! Let's do it again, come on.
JONNY PHILLIPS: Sounds like a damn good idea to me!
RICHARD AMBROSE: For that you're carrying the raft, mate.


text:
In order to receive help you need to provide us more details regarding what you are doing.
Also just my 2 cents before actually trying something out make sure you understand it not just copy/paste the commands.
So i've been following a few youtube guides along with forum guides on obtaining the wep key from a router. I use a Windows 7 Home Premium 32bit, and I just downloaded Windows Virtual PC to run with Backtrack 5. My laptop is a Compaq CQ40 and has an internal Broadcom 4322AG 802.11a/b/g/draft-n Wi-Fi Adapter. I read somewhere that USB adapters are needed (?) so i bought a Realtek RTL8188SU Wireless LAN 802.11n USB 2.0 which is a wireless usb network adapter. I have also modified the settings so Realtek and Broadcom are both detected using Settings in Windows Virtual PC.
I run startx in Backtrack 5, Launch Konsole, and as i type airmon-ng, i see 3 columns Interface Chipset and Driver. however, nothing appears under interface or chipset or driver, as is demonstrated in the videos. Would anyone please direct me to my mistakes?
In order to receive help you need to provide us more details regarding what you are doing.
Also just my 2 cents before actually trying something out make sure you understand it not just copy/paste the commands.
Back|track giving machine guns to monkeys since 2007 !
Do not read the Wiki, most your questions will not be answered there !
Do not take a look at the: Forum Rules !
I'm trying to obtain the WEP key of my router using BackTrack 5. I am stuck at the first command of airmon-ng whereupon this command is supposed to give me my wireless adapter name, because for now it just gives me
Interface Chipset Driver
with nothing beneath it. Am i doing something wrong
the Realtek RTL8188SU chipset doesn't work out of the box on backtract 5 and even if you install the drivers just to get wireless working aircrack-ng/airmon-ng still doesn't work with the same drivers.
you will have to get a supported wireless adapter that works with aircrack.
Please search, I have answered this question 3 times within a fairly short amount of time.
Look at the second post in this thread:
i a newbaby in backtrack and i just download bt5r1 and i used in two laptos and in both of them wcid show no device and in airmon too (one laptop hp dv6 using broadcom 4322 and the other using broadcom 4313)
how i can do it
can any one explained to me ??
an administrator just gave me a warning on my first post?! i cant PM anyone now, i dont know whats going on that was my first post!
here was the post, someone who is an admin please let me pm again and possibly explain why i was docked.
I am having real issues and none of my buddies are deep into linux knowlege. I am more than willing to let someone who is skilled use teamviewer to remotely help me with my issue. You see I cant get my usb adapters to get picked up on airmon-ng and i dont know how to modify the one i have internally on my laptop/ i have a hp pavillion dv7, and i am running backtrack 5 on vm workstation. I type aimon-ng and nothing comes up under chipset. i also tried to go into the network manager, and it wont show any wireless access pts or routers. i have a netgear wg111t and a a netgear wn121t. any takers?
Hey could the others create a new thread thanks - Reamer, I am following the instructions on the second post of the other thread which you gave me. In which directory should i place aircrack-ng-1.1.tar.gz?


text:
Samsung Electronics and Google have jointly announced Galaxy Nexus, a smartphone running the Android 4.0 Ice Cream Sandwich, the latest release of the Android platform.
The Galaxy Nexus features a 4.65-inch HD Super AMOLED display technology at 720p resolution and a 1.2GHz dual core processor.
Galaxy Nexus will be available in the US, Europe and Asia beginning in November and gradually rolled out to other global markets.
- Wireless broadband developments in Southeast Asia markets
As of 2013, the 10 ASEAN nations had a total of over 700 million mobile subscriptions, with the CAGR from 2003-2013 reaching 24%. This Digitimes Research Special Report analyzes the various mobile broadband markets in ASEAN and looks at the respective trends in 4G LTE development for those markets.
- 2015 global tablet demand forecast
This Digitimes Research Special Report provides a 2015 forecast for the global tablet market and analyzes the strategies of key market players such as Google, Apple, Intel, and Microsoft.
- 2015 China smartphone panel trend forecast
This Digitimes Research Special Report analyzes the strategies of key China-based major panel makers BOE, Tianma and IVO for attacking the different market segments through technology and pricing, and their relationship to local vendors Huawei, Lenovo, ZTE, Xiaomi and Coolpad.


text:
Let's get real: Santa Barbara was a terrorist act
The Federal Bureau of Investigation defines terrorism as "the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof in furtherance of political or social objectives." So why don't we consider the Santa Barbara shooter a terrorist?
Black guy shoot folks = thug. Brown guy shoots folks = terrorist. White guy guns down women = "nice guy who's mentally ill". #YesAllWomen
— Charles Clymer (@cmclymer) May 25, 2014
On Friday, a 22-year-old gunman went on a shooting rampage in and around the area of the University of California at Santa Barbara, ultimately killing six people before committing suicide. (Note: I will not name the shooter, for reasons about which I have previously written.) Prior to the carnage, the shooter posted a YouTube video and distributed a 137-page manifesto largely attributing his violent anger to his inability to date and have sex with women.
But the shooter's rant wasn't merely woe-is-me self-pity. He actively blamed and condemned women—not just individually, but as a categorical whole—for his shortcomings. "It's not fair. You girls have never been attracted to me. I don't know why you girls have never been attracted to me, but I will punish you all for it," the shooter said in the video.
In telegraphing his rampage, the shooter said he planned to "slaughter every single spoiled, stuck-up, blond slut I see."
"If I can't have you girls, I will destroy you," said the shooter. "You will finally see that I am in truth the superior one. The true Alpha Male."
As Elizabeth Plank and Jessica Valenti and several other writers have pointed out, the shooter's rants are the very definition of misogyny. And the hatred of women is not a random personal twitch but a deeply ingrained worldview—let's call it an ideology, even—with social and political implications. Misogyny is so real and dangerous that the Southern Poverty Law Center tracks extremist anti-women organizations among other threatening hate groups. Valenti writes:
According to his family, Rodger was seeking psychiatric treatment. But to dismiss this as a case of a lone "madman" would be a mistake.
Doing so not only stigmatizes the mentally ill—who are much more likely to be victims of violence than perpetrators of it—but glosses over the role that misogyny and gun culture play (and just how foreseeable violence like this is) in a sexist society. After all, while it is unclear what role Rodger's reportedly poor mental health played in the alleged crime, the role of misogyny is obvious.
Read The Full Article On The Daily Beast
More articles from The Daily Beast:
- How the Gun Nuts Try to Excuse Away the Santa Barbara Slaughter—and Why They're All Wrong
- Military Pushes Obama for 10,000 Troops in Afghanistan—and Says It May Not Be Enough
- Read Jon Favreau's Full Commencement Address to College of the Holy Cross
© 2013 Newsweek/Daily Beast Company LLC


text:
'Having operated on a shoestring budget for years, the Sabres are well-positioned to compete on the league's new, even playing field. They have a solid core of young players and money to spend on free agents when the richer franchises are forced to purge their rosters. So there will be no more excuses for the organization.'
New NHL rids Sabres of old problems
July 12, 2005 Submitted by
Via: Buffalo News


text:
This entry was posted on Monday, January 13th, 2014 at 3:38 am and is filed under . You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
About PRIDE | PRIDE Patient Fund | Support PRIDE | Donate | e-Store | Location Map | Register | Login | Contact
© 2017 PRIDE Foundation. All rights reserved.


text:
It's a trying time for pop superstar Brandy as she recently decided to call it quits on her relationship with longtime fiancé Ryan Press.
According to Us Weekly, the "Boy is Mine" songstress' rep confirmed the split- "They are no longer together. The engagement is off, but the friendship is still on."
The 45th Annual NAACP Image Awards went off without a hitch earlier this evening (February 22) with "12 Years a Slave" continuing to make waves snagging the biggest prize of the night.
Gathering together for another thrilling award show, Hollywood's biggest names flocked to the Pasadena Civic Auditorium for the 2014 NAACP Image Awards earlier this evening (February 22).
Watching a few trophies being handed out before Saturday's big night, Brandy attended the NAACP Non-Televised Awards Ceremony on Friday (February 21).
The "Boy is Mine" singer headed to the Pasadena Civic Auditorium where she hit the red carpet in a sleeveless black cutout gown.
Arriving back at her hotel after asking "How you doin?'" to Wendy Williams, Brandy was all smiles in New York City on Tuesday (March 26).
The "Sittin' Up in My Room" singer looked pretty in a short brightly colored patterned dress and high heels after making an appearance on "The Wendy Williams Show."
While some couples basically know they're getting engaged before the big question gets popped, Brandy Norwood had no clue about anything.
The singer/actress told press that she was completely taken by surprise; though she's not sure her fiancé Ryan Press premeditated any of it.
Ditching her winter duds for a bathing suit, Brandy is celebrating her engagement with fiancée Ryan Press in Hawaii (December 29).
The "Moesha" star posted a photo of the happy couple cuddling poolside with her new sparkler gleaming from her ring finger. On the photo she commented, "Hawaii sun all in my face :) Having a great time with my love @ryanpress215."
After having given up on a relationship in the past, Brandy has found love with music executive Ryan Press and will soon walk down the aisle with her knight in shining armor.
The "Moesha" star told Sister2Sister magazine in August, "I keep hearing about a ring. People keep calling me, hinting to me about it, but I don't know. I'm going to be patient and let it happen and just let it be. . . I guess it will happen when it's the right time."


text:
Bell satellite dish installation
With Bell, it's easy to have all of your services moved and installed in your new home.
Before you contact us, have the following information handy:
- Your Bell Satellite TV account number
- Your new street address, including postal code (No rural routes (RR) or post office (PO) boxes).
- Moving date
- An alternate phone number where we can reach you during the move (e.g. mobile phone)
Whether by chat or by phone, a specialist will walk you through the moving process and will schedule a technician visit for the day of your move.
Call 1 866 377-3166 or
What to do on moving day?
Pack up and bring all of your receivers, remote controls and internal switches.
Leave your satellite dish behind. Bell will provide a new dish if one isn't currently installed at your new address.
What to do on the day of your installation appointment?
Unpack your equipment. Place your televisions, receivers, remote controls and internal switches in the rooms where you want them connected.
Be home. The account holder must be on-site for the duration of the installation. If you can't be home at that time, please ensure a representative, 18 years of age or older, will be on-site to authorize the installation and sign the agreement on your behalf.
Related posts:
- Satellite dish installation cost
- DIY satellite dish installation
- Bell satellite dish pointing
- Satellite dish information


text:
ill battle u king
AKRE as the word ? or if u can think of somthing better
ill battle u king
AKRE as the word ? or if u can think of somthing better
wait so we doing handy throw and a sketch ?
and your post is like part jg's post now
and dont we have to pm our pics to who ever the mod is for the thread ??
erm wtf happened? i donno how the hell did your posts end up merged together :S i must've screwed up somewhere. but chill boy... post your entries again, i'll delete jacobs thing
thought i mite as well do a throw for the credits -.-
Last edited by MoF.; 09-24-2011 at 08:55 PM. Reason: zz
King u get my vote i guess yea sorey bout my throw i just quickly sketched it out jus for the extra freditsAnf wat markers u use for the oeange out line looks dope
Mof on the sketch, king on the throw. King that's the best sketch I've seen from you yet.
can we get more people to vote ???
New battles posted. Get on em kids.
looking to battle someone
exp. toy or intermediate
the opponent does the rules as its my frist time and pm me so we work it out
go peep the toy round robin thread in the toy battle forum, its a tournament
anyone fancy a friendly sketch battle...
you choose the word... at least 4 letters, 5 preferably, 6 maximum...
colours up to you, but black and white is fine with me
scary to say i've been here for a while.
noone fancy a quick sketch battle... throw a word at me
scary to say i've been here for a while.
yeh cool man.. colours?
scary to say i've been here for a while.


text:
Please select a to check availability, or to add this item to your Shopping Cart or Wish List.
For the riders and track day enthusiasts who are also dedicated race fans, LeoVince has created the GP Pro. This pipe mirrors the form and function of exhausts seen throughout the MotoGP paddock.
As mass centralization becomes the key philosophy in the design of race bikes, LeoVince meets the demands of a performance-based low-slung exhaust that offers both a serious performance boost and a sectionalized, hand welded GP look. This pipe features the first ever "dual curved baffle design". This gives it both a unique race sound as well as great performance characteristics. To finish it off it is media blasted to give it a "Titanium look" finish.
* Most applications
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Orders $39.99 and over qualify for our fast free shipping offer. Click Here for FREE Shipping Terms and Conditions.
Please see our International Orders page for orders shipping outside the US.
We show real-time availability on this product page when you select the size/color item you want. Most items will ship the same business day an order is placed,however if an item requires additional processing time a message will be shown indicating such.
See our full Shipping Policy for further details.
If your order arrives and it is not right, we will we'll fix it, NO NONSENSE, we promise.
Doesn't fit or just not happy with it? You can return any new, unused and unaltered item within 30 business days of delivery receipt of your item. We will issue a full refund to your original payment method.
See our full Return Policy for all of the pertinent details.
Have a functionality, fit, or otherwise product-specific question about the Leo Vince GP Pro EVO II Slip-On Exhaust Suzuki GSXR 600 / GSXR 750 2008-2010? Ask it here! If you have a customer service or shipping question, please direct it to our Customer Service department.


text:
Today I came across a rather strange scraping issue with the TMDB scraper.
All new additions to my movies seem to get the IMDB id wrong in the .nfo. Instead of "tt#######"* the <id> element is "tttt#######"* in the .nfo file after I made XBMC export my video library. I would think this is somewhat new as all my previously scraped movies write the correct syntax, that is also why I figured it would be a scraper issue. I have also tried "overwrite old files" in the export settings to confirm it is only newly scraped movies, and all other information seems to be filled in as it should be.
* Each # resembles a number.
I am using XBMC Eden Beta 2 and The MovieDB 3.0.5 scraper.
Though it seem to happen between ver. 3.0.0 (working) and ver. 3.0.4 (have the issue), as those are the only versions that I am seeing this with, using the Rollback feature.
In the end it seems like it is not a big deal but thought I would mention it
In case this is how the mechanics works I apologize sincerely for the inconvenience.
Best Regards,
The MovieDB scraping issue
Junior Member
Posts: 1
Joined: Jan 2012
Reputation: 0
2012-01-25 07:36 Post: #1
|find quote
Junior Member
Posts: 3
Joined: Jan 2012
Reputation: 0
2012-01-25 12:51 Post: #2
same Problem here, but the Quadruple t are already scraped into the Database when adding the new movies.
Using the TheMovieDB Add-On with Version 3.0.5 under Eden Beta 2.
|find quote
Team-Kodi Member
Posts: 2,716
Joined: May 2008
Reputation: 39
2012-01-26 21:30 Post: #3
Fixed in v3.0.7
|find quote
Team Kodi
Posts: 17,007
Joined: Jul 2011
Reputation: 311
Location: Dawn of time
2012-01-28 20:24 Post: #4
How are those bad scraped movies gonna be fixed containing the "tttt..."?
There's no simple way of knowing which one for regular users
Read/follow the forum rules.
For troubleshooting and bug reporting, read this first
Interested in seeing some YouTube videos about Kodi? Go here and subscribe
|find quote


text:
Straightening her back and elongating her neck, she centers herself at the top of the stairs.
The latter misfortune escalated into tragedy after a 21-year-old landed on a rock in precisely the right way to snap her neck.
His black hair sweeps back from the crest of his high forehead and laps at the nape of his neck; his lips are pursed.
"This past summer in a movie theater in Colorado I was shot in the face and neck," he says.
I received many bruises on my collarbones, neck, chest, and shoulders.
The blood had flown violently to his neck, which was burning him.
The man screamed and twisted his head, but the noose was about his neck and tightening.
Moore and I were now neck and neck on the lead, going at full speed.
Before it had gone a dozen paces Stafford had reached it, and his arm was about its neck.
Now to divide for the neck: K 34, and slip these st on to a safety-pin.
Old English hnecca "neck, nape, back of the neck" (a fairly rare word) from Proto-Germanic *khnekkon "the nape of the neck" (cf. Old Frisian hnekka, Middle Dutch necke, Dutch nek, Old Norse hnakkr, Old High German hnach, German Nacken "neck"), with no certain cognates outside Germanic, though Klein's sources suggest PIE *knok- "high point, ridge" (cf. Old Irish cnocc, Welsh cnwch, Old Breton cnoch "hill").
The more usual Old English words were hals (the general Germanic word, cf. Gothic, Old Norse, Danish, Swedish, Dutch, German hals), cognate with Latin collum (see collar (n.)); and swira, probably also from a PIE root meaning "column" (cf. Sanskrit svaru- "post").
Transferred senses attested from c.1400. Phrase neck of the woods (American English) is attested from 1780 in the sense of "narrow stretch of woods;" 1839 with meaning "settlement in a wooded region." To stick one's neck out "take a risk" is first recorded 1919, American English. Horses running neck and neck is attested from 1799.
"to kiss, embrace, caress," 1825 (implied in necking) in northern England dialect, from neck (n.). Cf. Middle English halsen "to embrace or caress affectionately, to fondle sexually," from hals (n.) "neck." Earlier, neck as a verb meant "to kill by a strike on the neck" (mid-15c.). Related: Necked.
"to kiss, embrace, caress," 1825 (implied in necking) in northern England dialect, from neck (n.). Cf. Middle English halsen "to embrace or caress affectionately, to fondle sexually," from hals (n.) "neck." Earlier, neck as a verb meant "to kill by a strike on the neck" (mid-15c.). Related: Necked.
neck (něk)
The part of the body joining the head to the shoulders or trunk.
A narrow or constricted part of a structure, as of a bone or an organ, that joins its parts; a cervix.
The part of a tooth between the crown and the root.
To kiss, embrace, and caress; dally amorously; make out, smooch: At least you'd want to neck me/ You ''spooned,'' then you ''petted,'' after that you ''necked'' (1825+)
Related Terms
dead from the neck up, dirty-neck, get off someone's back, give someone a pain, leatherneck, no-neck, a pain in the ass, redneck, roughneck, rubberneck, stick one's neck out, to save one's neck


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Disc & Digital
Spider-man 2
Now Available
About Spider-man 2
In SPIDER-MAN 2, the latest installment in the blockbuster Spider-Man series, based on the classic Marvel Comics hero, Tobey Maguire returns as the mild-mannered Peter Parker, who is juggling the delicate balance of his dual life as college student and a superhuman crime fighter. Peter's life becomes even more complicated when he confronts a new nemesis, the brilliant Otto Octavius (Alfred Molina) who has been reincarnated as the maniacal and multi-tentacled "Doc Ock." When Doc Ock kidnaps MJ (Kirsten Dunst), Spider-Man must swing back into action as the adventure reaches new heights of unprecedented excitement.
Grant Curtis
Alvin Sargent
Based on a Work by
Stan Lee, Steve Ditko
Executive Producer
Stan Lee, Kevin Feige, Joseph M. Carraciolo
Laura Ziskin, Avi Arad
Sam Raimi
Kirsten Dunst, James Franco, Tobey Maguire, Alfred Molina, Donna Murphy, Rosemary Harris


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This 104-piece easel box contains everything a young artist needs to explore a wide variety of painting and drawing techniques. The set's premium-quality media includes 12 oil paints, 12 acrylic paints, 12 watercolor paints, 12 watercolor pencils, 12 charcoal pastels, and 12 oil pastels. A selection of nine nylon brushes includes popular #1 and #2 round tip and #4 and #12 square tip. All pieces fit into a beech storage box that organizes media and accessories in slide-out trays and doubles as a convenient easel. Includes 12 sheets of watercolor paper, two canvas boards, a wooden palette, and more. 15" L x 10" W x 6" D. (7 lbs.)
Lifetime Guarantee
The 104-Piece Multi Media Art Set comes with The Hammacher Schlemmer Lifetime Guarantee. If this product ever disappoints you, for any reason, you may return your Hammacher Schlemmer purchase for exchange, credit, or refund.
Should you have any questions, we are available seven days a week (8:00 am – midnight EST). Please call 1-800-321-1484 to speak with a specialist or email us at email@example.com to receive a response within three business hours or less.
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(based on 19 reviews)
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(9 of 9 customers found this review helpful)
By Steve
from Joshua Tree,CA
I saw this in your catalogue and knew immediately the value of it for my wife. She has always painted since she was young and now, being confined to a wheelchair, this offered the perfect solution for placing the easel in front of her on top of her desk. This has opened every avenue possible for her and for this I am thankful.
Bottom Line Yes, I would recommend this to a friend
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(3 of 3 customers found this review helpful)
outstanding product !
By none
from Bend,Or.
My granddauhter just loves it.
Fast service and shipping.
By bigdog00
from Durango, Co.
I ordered this for my granddaughter for Christmas, so I do not know how she will like it, but from looking at it myself, she will love it.I appreciate your fast shipping and service.
(2 of 2 customers found this review helpful)
Painting Kit is Handy and Cute
By Dealseeker
from Nebraska
I haven't spent a lot of time with this little gadget yet but I'm totally charmed by the winter time possibilities. So far all that worries me are the plastic paint trays, which seem unnecessarily tippy. I'd have preferred metal but that's just me.
(1 of 1 customers found this review helpful)
creative gift for children
By jo
from ponte vedra beach, florida
Creative gift for children
Very impressive
By Upstatepano
from Upstate SC
Was very pleased with the quality of the product.
Good artists starter kit.
By Hugh
from Ft. Lauderdale, FL
I looked everywhere for a complete artist's starter kit. This is the only one I could find. Not only does this kit have everything, it's also built into a very well designed, well made case that is usefull.
This is a great set
By Kat
from Evanston WY
The chalk was broken, but a customer service representative is sending a replacement set
By Hope
from NY NY
About Me Grandparent
My granddaughter feels "like a professional" using the paints and recognizes the quality of the supplies. She says they "are cool!"
Excellent product
By Judy the painter
from Wilmington, nc
COPYRIGHT © 2017 HAMMACHER SCHLEMMER & COMPANY, INC. ALL RIGHTS RESERVED. W108147 E. 57th ST • NEW YORK, NY • 10022 • 1-800-_321-1484


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Message Board
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Talk about the novels, new and used books that Robson has written!
Author Robson's Book Reviews
Ghost Warrior: Lozen of the Apaches
An epic story of Lozen and her role as a spiritual leader with her gift of far sight and her role as a warrior with her brother Victorio and later Geronimo. ...
Mary's Land
The story of two women who make the dangerous journey from England the the new land in America. One had invested on a plantation and is going in order to secure her independence and one is a petty criminal who is going over as an indentured servant. When they meet, they help each other create a life filled with unexpected love and and adventure....
Ride the Wind
At the age of 9 Cynthia Ann Parker was captured in an indian raid. Forced to give up everything and everyone, Cynthia comes to love the Comanches and adopts their ways. Ride the Wind is the story of Cynthia, her son Quanah Parker and a way of life that is gone forever. This is one of the best books I have ever read, this is a must read book for anyone who loves 19th century history....
Shadow Patriots: A Novel of the Revolution
Shadow Patriots tells of the Culper Ring, a group of George Washington's spies operating out of Manhattan and Long Island. The city of New York itself can hold its own among the American Revolution's cast of pungent characters. The story includes familiar names -- Washington, Hamilton, Benedict Arnold -- and one unfamiliar number, the mysterious 355. 355 was the Culpers' code for "lady," and after 225 years she remains a nameless heroine who, many his...


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KV Pharmaceuticals has fought, and failed, on multiple fronts to capitalize on a drug used to prevent preterm births known as Makena.
Now the bankrupt drug maker is turning to Utah Attorney General John Swallow in a bid to strike a Medicaid policy favoring KV's competitors compounding pharmacies that make the drug for pennies on the dollar.
"In violation of Utah law, compounding pharmacies continue to make and distribute large volumes of … copies, or essential copies of Makena," alleged KV vice president Patrick Christmas in a letter preceding a private meeting on Tuesday with Swallow.
Pointing to the deadly meningitis outbreak caused late last year by products compounded by a pharmacy in New England, Christmas suggests Utah should more tightly regulate compounders.
"FDA-approved drugs such as Makena provide a greater assurance of safety and effectiveness than do compounded products," he said, citing a June 2012 FDA statement.
Rex Olsen, an attorney in Swallow's office, characterized the meeting as informational. "It's not a new issue, but they brought up some concerns worth investigating," he said.
But removing Medicaid restrictions on Makena could cost the state more than half-a-million a year, according to data from the Utah Department of Health.
"Your taxes will go up, my taxes will go up and there will be less money for other Medicaid drugs," said Richard Rasmuson, owner of University Pharmacy, one of six specialty pharmacies in Utah that have mixed the drug for years.
Makena, an injectible synthetic version of the hormone progesterone, was first marketed as a generic decades ago by Bristol-Myers Squibb. When Squibb stopped manufacturing it, pharmacies such as Rasmuson's started mixing it for as little as $10 to $15 per injection.
In 2010 KV won exclusive approval from the U.S. Food and Drug Administration to market the injection under the Orphan Drug Act, and the price shot up to $1,500 a dose.
Two years ago KV dropped the price to $690 per injection. With discounts Utah Medicaid could pay under $300, according to a KV spokesman.
But that's still well above the rate charged by compounders, which is why many states, including Utah, require doctors to seek special approval to prescribe Makena to Medicaid patients. They must provide proof that the compounded version caused an allergic or adverse reaction.
Such policies have hurt sales, plunging KV into bankruptcy.
Medicaid filled 390 prescriptions last year, all of them compounded, for an estimated savings of $640,158 over what KV would have charged, not including drug maker discounts.
The FDA, after coming under fire for the price hike, announced in 2011 it would not enforce KV's exclusive rights, especially since most of the cost for development and research was shouldered by others in the past.
KV has been tussling with the FDA ever since, claiming in a lawsuit that the agency abdicated its responsibility to crack down on rogue compounders, which was tossed out by a federal judge.
The company has also sued several states' Medicaid programs, sometimes successfully.
Utah law prohibits compounders from making any prescription drug in doses regularly and commonly available commercially.
Still, Olsen doesn't believe compounding pharmacies are breaking the law.
"We don't want clients getting anything inferior. But in this case, the product has been on the market for years," he said.
Tim Morley, director of Utah's Medicaid pharmacy program, said there have been no safety problems with compounded versions of the drug.
Ray Ward, a family physician who served for years on an advisory committee to Medicaid, said the dispute highlights the undue influence that pharmaceutical companies exert over America's patent system.
"There are several medicines that have been around for years that companies come back and patent and sell at 100 times the original cost," he said. "These are not breakthroughs and they should not be patentable."
Twitter: @kirstendstewart
What is Makena, and who uses it?
Makena is a synthetic form of the hormone progesterone that first came on the market more than 50 years ago to treat other problems.
It has been shown to calm the muscles of the uterus, preventing preterm labor in women. These very early births produce children who if they survive need months of intensive care and often suffer disabilities.


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Gallery: Dead dolphin washes up on Torrance beach
An adult Risso's dolphin that probably was floating in the ocean for some time washed up dead on Torrance beach Wednesday morning.
Dan Mullin saw the white-bellied animal tossing in the surf from his beach-facing home Wednesday morning and thought it was a shark. On closer inspection, he realized it was a dolphin - still an unusual find on the beach.
"We see sea lions come on the beach and die but I've never seen a big animal like that floating toward shore," Mullin said. "It was kinda intriguing. There were bites taken out of it so you wonder what was chomping away at it. "
Diane Alps, programs director at Cabrillo Marine Aquarium and president of the Los Angeles chapter of the American Cetacean Society, said it's unusual to see dead dolphins.
"It's a deep-diving, squid-eating dolphin," Alps said. "It's missing a layer of skin so it's definitely been adrift for some time. "
The sun-bleached cetacean also had bite marks in its face and tail - likely from curious blue sharks, Alps said. "It's really common for dead floating animals to get munched on," she said.
Marine mammal researchers from the Los Angeles County Natural History Museum will do an autopsy to determine the dophin's cause of death.
Although sightings of dead dolphin are rare, Alps said whale watchers spotted a dead long-beaked common dolphin floating off the coast of Redondo Beach on Tuesday.
"We hardly ever see one adrift, so to see two is very odd," Alps said.


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eS127 Multi-Function Display, MFG# E70284-NAG, with 12" LCD, Navionics+ U.S. Charts, 50/200KHz sonar, WiFi, internal GPS, and HybridTouch operation. Optional radar, night vision, AIS, video in, autopilot, remote, Sat WX, and audio control.
The eS Series has a sleek glass bridge design with three mounting options. Choose from bracket, surface or fully recessed flush mounting. Super bright displays (1250 nits) with optical bonding technology for sharper colors and contrast. Enjoy HybridTouch™ - Responsive touch screen control with pinch to zoom or simple keypad interaction using the multifunction rotary control and keypad
You have the freedom to choose the very best charts from C-MAP by Jeppesen, Navionics, and Raymarine's expanding LightHouse chart catalog. Sync charts, waypoint and routes between your mobile device and MFD with Navionics Boating App. Includes a fast 10 Hz GPS/GLONASS internal receiver for rapid chart position updates and faster satellite acquisition.
Comes standard with a 600 Watt, 50/200KHz ClearPulse sonar. Hi-Power CHIRP and CHIRP DownVision sounder modules can also be used.
Choose from a wide variety of Raymarine radars, from a 4KW 18" radome to a 12KW 6' open array.
Monitor onboard video with support for up to 10 video of IP cameras and one analog camera. View up to 4 cameras simultaneously. Record and take snap shots of digital video streams
Optional thermal night vision allows you to stay safe with superior FLIR thermal night vision technology. Avoid obstacles, such as rocks, floating logs, and other debris, and quickly identify overboard people and pets.
With the optional Evolution Autopilot you can control your course directly from the eS Series chartplotter display, Follow waypoints and routes with unmatched precision using Evolution's aerospace derived 9-axis sensor technology, and add a p70 or p70R pilot control head for remote control and advanced features.
The eS Series is NMEA 2000 compatible, so you can enjoy complete monitoring of engines, generators, batteries and more; and control lighting, climate, navigation components, wipers, entertainment, security and much more.
Stay ahead of the front with graphical weather overlays and weather reports from SIRIUSXM (USA only). Enjoy Sirius XM audio and control your Fusion Stereo with FusionLink.
The eS Series is compatible with any Raymarine display using Lighthous II software, has NMEA 0183 capability, HDMI Video output (eS9x & eS12x), WiFi for mobile apps, and Bluetooth for remote and MP3 control.
Compatible with RMK-9 and RCU-3 remote controls


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A Short-lived Victory
After the battle at Lexington/Concord, New England militia gathered
at Boston's Breeds Hill and gunned down 40 percent of British forces
before running out of ammunition. Their subsequent flight from Bunker
Hill, however, allowed Britain to claim victory. Congress quickly
authorized a volunteer Continental Army, appointing George
Washington as Commander-in-Chief. The General formed an
eight-mile blockade around Boston that languished for months before
the British evacuated to New York City. There they were joined by
40,000 fresh troops, while only 10-15,000 untrained men remained
in the new American army.
The Fourteenth Colony?
Ethan Allen and his Green Mountain Boys along with Captain Benedict
Arnold and his company of Connecticut militia were sent to northern
New York. There they gained hero status after successfully capturing
Fort Ticonderoga! Hoping to enlist the French majority in British
Canada to join sides with America, the regiments were then sent
on to Quebec.
Canada proved most difficult, however. Allen and 30 of his men
were captured, and remained prisoners for two and a half years.
Benedict Arnold was shot in the leg as the Continentals tried to
capture Quebec in December 1775. He turned command over to Daniel
Morgan who was soon surrounded after being abandoned by the rest
of the army. Morgan and 371 frontier sharpshooters languished in
Canadian jails for almost two years. (However, this was not the
last time that Morgan and his riflemen would prove to be heroes.)
Arnold, meanwhile, retreated with his men to a small island in Lake


text:
Zebrafish anatomy and developmentA structured controlled vocabulary of the anatomy and development of the Zebrafish (Danio rerio).
Yeast phenotypesA structured controlled vocabulary for the phenotypes of budding yeast.
Experimental Conditions OntologyThe Experimental Conditions Ontology is designed to represent the conditions under which physiological and morphological measurements are made both in the clinic and in studies...
Xenopus anatomy and developmentA structured controlled vocabulary of the anatomy and development of the African clawed frog (Xenopus laevis).
C. elegans phenotypeA structured controlled vocabulary of Caenorhabditis elegans phenotypes
C. elegans developmentA structured controlled vocabulary of the development of Caenorhabditis elegans.
C. elegans gross anatomyA structured controlled vocabulary of the anatomy of Caenorhabditis elegans.
Vertebrate Trait OntologyThe Vertebrate Trait Ontology is a controlled vocabulary for the description of traits (measurable or observable characteristics) pertaining to the morphology, physiology, or...
vertebrate Homologous Organ GroupsvHOG is a multi-species anatomical ontology for the vertebrate lineage, developed as part of the Bgee project. The mapping to species-specific anatomical ontologies is provided...
Vertebrate Anatomy OntologyVertebrate anatomy ontology. Currently covers the skeletal system
Units of measurementMetrical units for use in conjunction with PATO
Uber anatomy ontologyUberon is a multi-species anatomy ontology created to facilitate comparison of phenotypes across multiple species, and for GO cross-products. Each uberon class is the superclass...
Teleost taxonomyThe Teleost taxonomy ontology is being used to facilitate annotation of phenotypes, particularly for taxa that are not covered by NCBI because no submissions of molecular data...
Plant Trait OntologyA controlled vocabulary to describe phenotypic traits in plants. Each trait is a distinguishable feature, characteristic, quality or phenotypic feature of a developing or mature...
Mosquito gross anatomyA structured controlled vocabulary of the anatomy of mosquitoes.
Taxonomic rank vocabularyA vocabulary of taxonomic ranks intended to replace the sets of rank terms found in the Teleost Taxonomy Ontology, the OBO translation of the NCBI taxonomy and similar OBO...
Teleost Anatomy OntologyMultispecies fish anatomy ontology. Originally seeded from ZFA, but intended to cover terms relevant to other taxa
Tick gross anatomyThe anatomy of the Tick, Families: Ixodidae, Argassidae
Solanaceae Phenotype OntologySolanaceae crop phenotypes and traits, developed in collaboration with the research community, especially for breeder traits of agronomic importance.
Spider OntologyAn ontology for spider comparative biology including anatomical parts (e.g. leg, claw), behavior (e.g. courtship, combing) and products (i.g. silk, web, borrow).
Vous pouvez également accéder à ce catalogue en utilisant API (cf Documentation de l'API).


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Don Hoover, PT, PhD, CSCS
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Phone: 270-745-4378
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Dr. Hoover's ongoing clinical practice includes specific emphasis in the areas of sports medicine, occupational health and rehabilitation, geriatrics, and human performance enhancement. He has more than 15 years of university teaching experience in exercise science and physical therapy, and currently teaches Movement Science I and II in the DPT curriculum. Dr. Hoover's research interests focus on the interactions between bioenergetics, motor control and biomechanics in gross motor activities such as cycling, running, and jumping. He has published over 30 peer-reviewed manuscripts and abstracts on these and related topics, and well over 90% of these have included undergraduate and graduate student co-authors. He is also increasingly interested in the scholarship of teaching and learning and have done a number of national presentations on this topic as well. Dr. Hoover is involved in a number of professional organizations, including the American Physical Therapy Association, National Strength and Conditioning Association, American College of Sports Medicine, and International Society for Biomechanics in Sport. In particular he has enjoyed contributing to the APTA's annual Education Leadership Conference and the formation of the American Council of Academic Physical Therapy (ACAPT).
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Study Session
SS1. Review of Tentative Agendas and Annotated Version of the City Council 2013 Goals & Priorities
MAYORS ANNOUNCEMENTS: 4th of July Announcement
PUBLIC COMMENTS: (This section of the agenda is for audience comments for items NOT on the agenda.)
CITY MANAGER REPORT: Lomita Sheriffs Station recognition of citizens and Sheriff staff
C. Award Contract for the FY2012-2013 Annual Sidewalk Repair Program (Supports 2013 City Council Goal #4, Public Infrastructure Citywide Street Maintenance) (Murphy)
1. Citywide Landscaping and Lighting Maintenance District (Supports 2013 City Council Goal of Government, Efficiency, Fiscal Control and Transparency) (Ramezani)
2. Abalone Cove Sewer Service Charge (Dragoo)
3. Appropriation of City Budget for FY13-14 (Downs)
4. Award Professional Services Contract for the Hawthorne Blvd. Traffic Signal Synchronization Project (Jules)
5. 2013 Five-Year Capital Improvement Plan (Supports 2013 City Council Goals of Public Infrastructure & Government Efficiency, Fiscal Control and Transparency) (Mills)
6. 2013 Five-Year Financial Model (Downs)
7. FY 13-14 Los Angeles County Sheriffs Service Agreement and Regional Cities Deployment Survey (Supports 2013 City Council Goal for Public Safety and Traffic Issues and the Goal for Western Avenue Corridor Issues) (Petru)
9. Response to Sharon Yarbers Allegations Regarding the Citys Administration of the San Ramon Project (Dragoo)
10. Metro Recommended Funding Plan for Crenshaw/LAX Transit Project (Brooks/Knight)
Continued: 9. Response to Sharon Yarbers Allegations Regarding the Citys Administration of the San Ramon Project (Dragoo)


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Probate is the legal process used to carry out a person's will after their death; a probate attorney advises you on how to perform the steps in the process. In general, once you have identified and collected the dead person's belongings, including their money, property, and other assets, you pay the person's debts and taxes. Once all debts have been paid, you distribute their money and property according to the language of the will. If there is no will, the laws of the state where the dead person lived control how the property is distributed. A probate attorney helps you plan what happens to your property when you die, as they can probate wills and act as your probate court estate representative. A probate attorney also represents family members and beneficiaries wishing to challenge wills.


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You have arrived at this page because you were looking for Papain, and you have come to the right place to purchase Papain. Welcome to ALPHACHEM Limited, 1-888-338-2995 a Canadian supplier of chemicals for use in laboratory and industrial applications.
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Alphachem also manufactures custom solutions, made to customer specifications. Alphachem currently distributes over 4,000 chemicals for the laboratory, pharmaceutical, food, coatings, cosmetic, and plating industries. Chemical grades include ACS, HPLC, USP/NF/BP, FCC, TECHNICAL and SEMI grade for the electronic industry. Alphachem is a Canadian distributor for J.T. Baker. Their products are stocked in our Mississauga warehouse. Alphachem is pleased to accept any size order. If you are looking for Papain CALL ALPHACHEM - 1-888-338-2995
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