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Optimizing and standardizing susceptibility testing for the polymyxins have become pressing issues, given the rise in multidrug-resistant Gram-negative bacilli. Recently, both the CLSI and EUCAST have recommended broth microdilution (BMD) (without polysorbate) as the reference method for polymyxin susceptibility testing. In this issue, K. L. Chew et al. (J Clin Microbiol 55:2609–2616, 2017, https://doi.org/10.1128/JCM.00268-17) compare the performances of three commercial BMD panels and the Etest to the reference, BMD, for polymyxin B and colistin, using 76 Enterobacteriaceae isolates (21 of which were mcr-1 positive). Although none of the commercial BMD panels strictly met FDA performance standards in this evaluation, possibly because of the small number isolates tested, the Sensititre panel achieved >90% categorical agreement for both polymyxin compounds. These results also reaffirm CLSI and EUCAST guidance that gradient diffusion testing, which had unacceptable error rates, should be abandoned. In a simulated analysis with lowered breakpoints (susceptible, ≤1 mg/liter; intermediate, 2 mg/liter; resistant, ≥4 mg/liter), error rates and agreement were improved across the various methods and the rate of detection of mcr-1-positive isolates improved. These observations, taken together with recent pharmacokinetic data on optimizing target attainment for the polymyxins, suggest that more-stringent (lower) breakpoints may be reasonable, although such an approach may be limited by the inherent reliability of current testing methodologies and a lack of robust clinical correlative data, which are sorely needed.
The views expressed in this Commentary do not necessarily reflect the views of the journal or of ASM.
Susceptibility testing for the polymyxins has been beleaguered over the years. The polymyxins were first isolated from Paenibacillus polymyxa in 1947 by two independent American groups (1, 2), and there has been a therapeutic renaissance in the use of both polymyxin B and colistin (polymyxin E) over the last decade, given the rise of multidrug-resistant (MDR) Gram-negative bacilli, such as MDR Acinetobacter and Pseudomonas and carbapenemase-producing Enterobacteriaceae.
Despite susceptibility testing being available for a long time, clarity has been lacking for appropriate methods of testing and optimal dosing for the polymyxins. Polymyxins are cationic polypeptides comprised of a heptapeptide ring, an exocyclic chain, and a fatty acid tail with positively charged residues which interact with and disrupt the Gram-negative lipopolysaccharide membrane; polymyxin B and colistin differ by only one amino acid in the heptapeptide ring (3, 4). Several reasons have accounted for difficulties with susceptibility testing for the polymyxins, including their cationic nature, their poor diffusion in agar due to their large molecular size, concerns over drug powder composition, and their heteroresistance. Further, the complex pharmacokinetics (PK) and pharmacodynamics (PD) of these compounds and the paucity of data correlating MIC data, drug concentration, and clinical outcomes have made setting clinical breakpoints challenging. The mechanisms underlying polymyxin resistance are complex, and correlation between these has been comprehensively reviewed recently (4). Complicating this has been the discovery of plasmid-mediated resistance due to mcr-1 and -2 (5, 6).
Polymyxin susceptibility testing guidance by various professional bodies has varied over the years (e.g., there have been different breakpoints and disk antimicrobial contents for diffusion testing) (7), although efforts have recently been made to harmonize these. In 2016, the joint CLSI-EUCAST polymyxin breakpoint working group agreed that the ISO-20776 standard broth microdilution method (BMD) (which is the same method outlined in CLSI document M07-A010 [8]) should be used for colistin MIC determination and be performed with sulfate salts of colistin in plain polystyrene trays without additives like polysorbate-80 (P-80) (9) and that diffusion methods should be abandoned. P-80 had at one point been recommended by the CLSI as a supplement for colistin BMD quality control testing (10, 11) to mitigate the cationic properties of the polymyxins, which cause them to adhere to the negatively charged polystyrene surface. However, P-80 in itself has some antibacterial activity and may act synergistically with polymyxins to spuriously lower MICs, especially for organisms for which MICs are in the low range, i.e., near the breakpoints and/or epidemiologic cutoff values of 1 to 2 μg/ml (13, 14). This led to the removal of P-80 from BMD for the polymyxins in CLSI document M100-S27 (15, 16). Manual BMD, however, is laborious and not performed in many routine clinical microbiology laboratories, which often rely on diffusion or automated systems for susceptibility testing. Moreover, and somewhat paradoxically in view of the drugs' poor diffusion in agar, diffusion methods (both disk and gradient strips) have been found to have unacceptably high levels of false susceptibility (or very major errors [VMEs]) in multiple studies (12, 17–28) (Table 1). Both the CLSI and EUCAST have now advised against diffusion methods for the polymyxins, removing disk diffusion interpretive criteria for them from their guidance documents (9, 15, 22).
Parsing the literature for the comparative performances of the various susceptibility testing methods for the polymyxins may be somewhat confusing, with studies seemingly giving contradictory results; Table 1 attempts to summarize data published from 2001 to date. Several important reasons accounting for these disparities should be borne in mind when evaluating studies. These include different susceptibility breakpoints used and various proportions of isolates studied for which the MICs are near the breakpoint. With regard to the number of isolates near susceptibility breakpoints, studies often lack a sizeable number of resistant isolates (especially resistant isolates for which the polymyxin MICs are low [4 to 8 mg/liter]), which may obscure an accurate estimation of VME rates. These MICs are also of clinical relevance given what we currently know about the pharmacokinetics of polymyxin B and colistin, dose optimization, and target attainment (29, 30). Indeed, VMEs or major errors (MEs) may be underreported if the MICs for the isolates studied fall into extremes, with either very high MICs (high-level resistance) or very low MICs (very susceptible isolates). VME rates should also be calculated with the number of resistant isolates as the denominator and ME rates with susceptible isolates as the denominator, rather than expressed as a percentage of the total number of isolates (12). Unfortunately, the literature has not been consistent, and VMEs and MEs have often been expressed as percentages of the number of isolates tested (resistant and susceptible) (Table 1, footnote c). Studies may also vary depending on the relative proportions of Enterobacteriaceae and/or nonfermenting Gram-negative bacilli, and heteroresistance has been described in some species, such as Enterobacter, Pseudomonas aeruginosa, and Acinetobacter spp. The most important reason for the variation of reported results in the literature for polymyxin antimicrobial susceptibility testing (AST), however, has been the lack of consensus in what constitutes a "gold standard" comparator. Until further data are available, per CLSI-EUCAST guidance, BMD with no supplementation should be the standard comparator.
In this issue, Chew et al. (31) pragmatically evaluate four commercial polymyxin B and colistin AST methods commonly used and/or more easily implemented in routine clinical microbiology laboratories than BMD performed by the reference ISO-20776 standard (8, 9). These comprise a commercial BMD system (Sensititre), gradient diffusion (Etest), and two automated AST systems: Vitek 2 and MicroScan (colistin only). A total of 76 Enterobacteriaceae were studied, including 21 isolates harboring mcr-1. Using the EUCAST colistin resistance breakpoint of >2 mg/liter for Enterobacteriaceae and applying the same to polymyxin B, the authors found high levels of essential and categorical agreement (EA and CA, respectively) for polymyxin B with Sensititre and Vitek 2 (both >90%); for colistin, EA was 89.5% for Sensititre and 93.4% for Vitek 2. Due to limited dilutions, EA was not assessed for MicroScan. CA for colistin was 88.2% for MicroScan and Vitek 2 and 90.1% for Sensititre. VME rates for all commercial systems assessed, however, were in excess of the 1.5% recommended by the FDA (12), although in this comparison, Sensititre and MicroScan achieved the lowest VME rate for colistin (VME rate, 4%), and Sensititre and Vitek 2 achieved the lowest VME rate for polymyxin B (VME rate, 3.7%) (only 1 VME for both compounds with these systems). Using FDA requirements, the Etest did not meet acceptance criteria for EA, CA, VMEs, and MEs for polymyxin B and met CA criteria (92.1%) for colistin only. As the authors point out, the VME rates of >1.5% may be in part due to the relatively small (although comparable to those of previous studies) number of resistant isolates in their study. Larger studies with more resistant isolates may allow a more comprehensive assessment.
Overall, the study by Chew et al. (31) found Sensititre to be generally reliable for polymyxin B and colistin, although it tended to overcall resistance, and it found Vitek 2 to have an unacceptable false-susceptibility (VME) rate with colistin, although interestingly, it performed similarly to Sensititre with polymyxin B. MicroScan with colistin (despite having limited dilutions) performed similarly to Sensititre. The findings with the Sensititre panel are in keeping with previously published data (27) and a recent evaluation by EUCAST, which also examined other commercial BMD methods (e.g., Micronaut-S and Micronaut MIC Strip, SensiTest [Liofilchem], and UMIC [Biocentric]) (32, 33). It should be noted that not all commercial BMD systems perform alike and that few data are available for some systems, like the BD Phoenix; unpublished data from one evaluation with this system found an unacceptable VME rate of 15% (4).
The strengths of Chew et al.'s study include the utilization of the ISO-20776 reference BMD as the gold standard and the multiple commercial AST methods studied, which will be of interest to clinical laboratories seeking to evaluate a method for AST of the polymyxins. This is also the largest multimethod comparison, to date, on mcr-1-positive Enterobacteriaceae. Interestingly, the authors note that, if a colistin susceptibility breakpoint of ≤2 mg/liter is used, the Sensititre and MicroScan systems would detect 100% of the mcr-1-positive isolates included in their study (compared to only 71.4% by the reference method, BMD) and that the Sensititre and Vitek systems would detect 95.2% (compared to 81% by BMD) using the same breakpoint with polymyxin B. By reference BMD, six and four mcr-1-positive isolates, respectively, had colistin and polymyxin B MICs of ≤2 mg/liter. In an analysis with lower simulated breakpoints for polymyxin B and colistin (susceptible [S], ≤1 mg/liter; intermediate [I], 2 mg/liter; resistant [R], ≥4 mg/liter), the authors found reductions in MEs for all methods and VMEs for Vitek 2 (colistin) and Etest (colistin and polymyxin B), although again, FDA acceptance criteria were not fully met.
Currently, the CLSI and EUCAST share harmonized colistin breakpoints for Pseudomonas aeruginosa and Acinetobacter spp. (susceptible, ≤2 mg/liter). For the Enterobacteriaceae, EUCAST adopts the same colistin breakpoints, but the CLSI has yet to set these, although it adopts 2 mg/liter as the epidemiologic cutoff value (ECOFF) for Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Enterobacter cloacae, and Raoultella ornithinolytica. Clinical breakpoints are meaningful if they delineate an MIC for which there is a high probability of clinical response to properly dosed antibiotics. However, robust data correlating MICs, drug concentrations, and clinical outcomes of the polymyxins are very limited, and a clear correlation has not always been demonstrated (34). Retrospective correlative studies are also difficult to perform because polymyxin resistance may be lost upon subculture and storage (4). Less than 40% of patients with normal or augmented renal function, however, are able to achieve a steady-state plasma colistin concentration of 2 mg/liter, which has been proposed as a surrogate target for the optimization of the area under the curve of free or unbound drug at the MIC for the bacterial pathogen (fAUC/MIC), the PK/PD parameter that predicts treatment success (29). PK data lend support to lowering the current colistin breakpoints. The simulated lowered breakpoint analyses (with the introduction of an "intermediate" category) by Chew et al. was also found to improve CA and diminished VME and ME rates. Lowering breakpoints would bring about some technical challenges, however, as these would fall within the wild-type MIC distribution of isolates (≤2 mg/liter), and there remain concerns over the reliability of current testing systems to parse out S and R adequately. Perhaps, as the authors suggest, adding an intermediate category would help reflect these uncertainties in testing and also address the concerns over current dosing strategies and target attainment. More importantly, actual clinical correlative data are sorely needed.
With polymyxin B, there are even fewer comparative data for AST and PK, although the CLSI has breakpoints for Acinetobacter and P. aeruginosa. This lack of data is somewhat historic, as traditionally, colistin has been more widely used in North America and Europe, with correspondingly more studies performed, despite the fact it is administered as a prodrug, colistimethate, of which only about up to a quarter is converted to active colistin in vivo (4). In contrast, polymyxin B is administered in its active form, and target concentrations are more easily achieved, with less interpatient variability, and its PK is independent of renal function (30), making it a more attractive option for clinical use than colistin. Although polymyxin B MICs generally trend within ±1 dilution with colistin (10, 31, 35), they are different drugs, and AST should ideally be performed individually. Besides considering the format of the assay adopted, individual laboratories should carefully weigh, with clinician input, the preferred polymyxin at their institutions when introducing susceptibility testing for this class of antibiotics.
The study by Chew et al. included 21 mcr-1-positive isolates, for a number of which strains MICs were ≤2 mg/liter. Laboratories performing surveillance should note that surveillance criteria by current breakpoints may not always identify all isolates with mcr-1. The implications of polymyxin therapy for infections caused by the isolates for which MICs are low are uncertain, as there are currently no clinical outcome data. While the promoter sequences upstream of mcr-1 in the current study were examined and found to be intact, the actual level of mcr-1 expression was not determined in their study, and it is plausible that phenotypic resistance may become apparent only after polymyxin exposure. A recent study found that for transformants with mcr-1, the colistin MICs were usually 16-fold or higher (except for Pseudomonas aeruginosa, for which MICs were only modestly increased) (36). The possibility that mcr-1 isolates for which polymyxin MICs are low may remain undetected and silently spread is somewhat disconcerting given that mcr-1 and -2 are plasmid borne and may be shared by horizontal gene transfer. A lower breakpoint was found to increase the rate of detection of mcr-1-positive isolates in the authors' study across all methods, although the utility of such an approach would need to be examined with further in vitro and clinical data, which will hopefully also help shed light on the extent and clinical significance of this phenomenon.
The study performed by Chew et al. (31) indicates that commercial and automated BMD systems, which are in reach of most routine microbiology laboratories, may provide results fairly comparable to those of the reference, BMD. Future assessments will be strengthened by including larger numbers of isolates, especially those with polymyxin resistance and MICs straddling existing or putative breakpoints. It is also anticipated that impending regulatory changes will soon lead to FDA-cleared tests for the polymyxins (16). Future studies should focus on correlating microbiologic, PK, and clinical outcome data. For this to happen, quality assurance standards utilized in determining the potencies of clinically administered drugs also need to be reassessed and updated, given that these still rely on derivatives of diffusion-based methods (37). Nevertheless, the adoption of a standard reference methodology and continued harmonization of breakpoints by the CLSI and EUCAST, along with work such as that by Chew et al. (31) and other groups, are steps in the right direction toward further clarity in susceptibility testing for the polymyxins.
- Accepted manuscript posted online 19 July 2017.
For the article discussed, see https://doi.org/10.1128/JCM.00268-17
- Copyright © 2017 American Society for Microbiology.


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Congratulations to our 3 Grand Prize winners of the #SecretsOfButterContest! We challenged our community of chefs to unlock the secrets of European butter by creating a savory, bakery, or pastry dish using Butter of Europe for the chance to win 1 of 3 all-inclusive trips to The Anti-Convention. We received many amazing submissions but narrowed the competition down to 6 incredible finalists, two in each category.
After recreating each of the 6 finalist dishes in our Test Kitchen for one last round of judging, we are excited to finally announce our 3 winners! These 3 lucky chefs will be flown to San Diego for a VIP trip to The Anti-Convention in April 2020 and will also be receiving an epic paring knife from Meglio Knives!
Scroll below to see which 3 chefs were chosen as our winners and to see which 5 dishes received the most votes online and will be taking home the People's Choice Prize – a collection of Chef's Roll swag! Congrats to all our winners and to everyone who participated in this contest!
"From the Depths" Entremet
"Pumpkin Spice Brioche with Caramel Cinnamon Apples"
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"Maryland Softshell Crab with Four-Pepper Sauce"
Maryland Softshell Crab / Black, Pink, Green and Sichuan Peppercorns / Ginger / Garlic / Isigny Butter / Rice

subset: commoncrawl


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Chicken Stew with Green Olives
Category: Soups / Cuisine: Mediterranean / Tags: Crockpot, Heart-Healthy, Low-Cholesterol, Low-Fat, Slow Cooker
One of the absolute best stews I've ever made; great for company as well.
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The CC Bank Blog
Top 10 Financial Tips to Teach Your Kids
One of the most important things you can teach your kids is how to manage money. It may not seem like a priority, but it should be.
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Money Management Tips for New Parents
Starting a family is a major milestone in any person's life. It is an exciting time with filled with anticipation.
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Top 10 Ways to Save for Your Child's College Education
One of the most important investments you can make is in your child's education. This is an investment with very limited risk but huge rewards.
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Preparing for Retirement: Tips for Generation X
It may be something you have been trying to forget about but soon enough it may be time for you to retire.
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Ok, here's the experiment. We analyzed over 500,000 first contacts on our dating site, OkCupid. Our program looked at keywords and phrases, how they affected reply rates, and what trends were statistically significant. The result: a set of rules for what you should and shouldn't say when introducing yourself. Online dating advice at its best.
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Paul Talbot-Greaves ©2019
The week will comprise of making the most of watercolour painting, seeking out interesting designs and capturing the unique light of Provence. Paul uses a 3-step approach to watercolour that is suited to both plein-air and studio work and he captures scenes with energy and clarity. You will learn to look for the building blocks of painting in the villages and landscape around Les Bassacs, making sketches, taking photos or working with watercolour. There will also be chance to work from photos and sketches in the studio where Paul will conduct demonstrations and relevant tutorials to help you along with your work.
12 - 19 September 2020
9:30am - 5:00pm each day
Arts in Provence, 84490 St Saturnin les Apt, France
From €945
Watercolour Course


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A SIOUX BEADED HIDE POUCH. c. 1890. ...Click the image to load the highest resolution version.
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DescriptionA SIOUX BEADED HIDE POUCH
c. 1890
the three sides decorated with pipes, flags, horse tracks, crosses and floral elements, stitched with sinew in numerous shades of opaque and translucent beads against a hide ground
Length: 15 inches overall
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Dana* was referred to her Navigator by HR after missing a few days of work. She had been suffering from substance abuse issues and needed to get help.
Dana and the Navigator talked about her past history with addiction, and the Navigator told her about programs in the community. Together, they were able to call her insurance to find several in-network treatment options accepted under her health insurance plan. Dana was evaluated by a substance abuse professional and enrolled in an outpatient program that allowed her to continue working while receiving intensive outpatient treatment. The Navigator also connected with long-term support programs, such as AA, to help her maintain her new sobriety.


text:
Mondaiji-tachi ga isekai kara kuru soudesu yo:Volume WSS Part 2
Part 2[edit]
Part 1[edit]
—The Airborne Citadel. Garden in the courtyard.
The sound of the maidens' laughter could be heard coming from the courtyard where the red rosaceaes[1] were in full bloom.
Leticia was pulled along by Carla-Jijochō by the hand as they made their way to the tea party hosted by her sister. The second queen of the Vampires— Lamia Draculea's face lit up immediately upon seeing Leticia, her elder sister's arrival.
"Really now! The eldest daughter of the royal family who's always engrossed with the matters of the training grounds has appeared for tea? Pray tell me what sort of wind have blown you here?"
"There's no need to put it that way, Lamia. I also have plans to cultivate a hobby of attending female social events."
"Ara, ara, my, my. What a surprising statement, I wonder who's speaking. Hasn't my sister Highness appeared in all the social events in a tuxedo which is typically male? Isn't it the same for the dance steps? You do know that the number of ladies who have their hearts enamored by the beauty of the queen who leads them around the dance hall is quite a sizable number, right?"
Lamia gave a giggle as she teased her sister.
"That sure is harsh," Leticia muttered as she sat down.
Although the both of them were sisters of the royal family, their positions were different even if they were kin.
The eldest daughter, Leticia, has been brought up as a warrior to succeed the throne while the second daughter, Lamia, was brought up as a princess who was apt in handling foreign associates.
To put it bluntly, Lamia was only a strong political chess piece in the royal family.
She would either be married to a Community within the Alliance to stabilize their ties or be married into a wealthy vampire family to consolidate the power of their race. Those were the top two probabilities. The knight getup of Leticia in contrast to the gorgeous dress of Lamia revealed the mirror opposites of their situation.
It wasn't clear whether Lamia was being sour about this arrangement but she continued to make digs at Leticia while giving a sly smile.
"Why not take up some embroidery, my sister Highness? Merely training in swordplay will not help you capture the heart of a guy, you know?"
"Hm Hm, indeed. I can't even brew a pot of delicious black tea. Randomly asking a hundred people would surely return with a hundred replies of them wishing you to be their brides."
Using her heart felt words in response to the dig at herself, Leticia guessed that it would be for the best to honestly agree with her sister's words since her character wasn't really fated to be one to be in love anyway.
And with that, the bad person would be the one who gave the sarcastic remark.
Lamia immediately kept away her smile and pouted.
"……Mah, that's not confirmed. There might just exist a guy who would fall for an usual woman like you, my sister highness."
"Lamia-sama. Those words are too impolite to her Highness, Leticia." Carla who had been standing by the side quietly spoke up unhappily.
Seemingly in the defense of her master, Carla then gave a smile that made clear of her teasing attitude as she poured a cup of black tea that was specially brewed with the flowers of the rosaceas in the garden.
"Driving away the dragon kind, Her Highness Leticia with her long flowing blonde hair is just like a flower on the battlefield. Officers who aspire to be like our Highness are also numerous. Moreover, the mere mention of the Vampire Princess General would immediately bring up a vision of the most impressive female in the world of Little Garden. Hence the number of courageous suitors is definitely not in the small numbers, you know?"
"……I see. Then, is there a brave champion who has caught my sister Highness's fancy?" Lamia asked uneasily.
Leticia shook her head and gave a depressed wry smile.
"How's that possible? A vampire like me would be far from the fate of being a target for suitors and love itself. Moreover, I do not have any plans for starting up a family before the stabilizing of all the matters concerning the inheritance of the throne."
Hearing Leticia's answer, Lamia nodded her head happily.
"Ye, Yes, that's right! Although I said it that way earlier, my sister highness is a great person and a treasure of the Vampire race. There can't exist a man who befits your glory."
"It's just as Lamia-sama puts it. If anyone wants to propose to our Princess General, they would have to defeat the No.1 and No.2 fan club which is us!"
Carla threw her head back as she puffed her chest to make that declaration and Lamia's cheeks reddened in embarrassment.
Leticia did not seem to notice that as she laughed it off, "What's this? Wouldn't that make it impossible for the candidate to be someone who isn't unusually brave and courageous to take on this challenge? Carla's swordsmanship is astounding and even I would at least have to concede in a match out of three."
HmHm. Carla-Jijochō and the second princess nodded their heads in unison.
Leticia sipped at her black tea, suppressing her mirth. Relaxing in the fragrance of the rosacea garden while overlooking the courtyard below, she then clapped her hand as she seemed to have remembered something.
"But come to think about it, it isn't necessary for the other party to be a brave soul."
"What's that about?"
"Just think about it, didn't the Community of [Thousand Eyes] enlist the help of several Demon Lords? The people whom they hope to help out as their appointed [Floor Masters]."
"Aah. You mean those people? I remember that it's the "Laplace Demons" and "ShiroYoru Maou"…. Also known as the ShiroYoruOu?"[2]
"Right. And isn't ShiroYoruOu one of the most ancient powerhouses? If it were those people, even if they can't be my fiancé, they would be suitable to be Lamia's marriage candidate."
"Ara, did I just find trouble for myself?" Lamia gave a laugh as the arrow was returned to her.
—[Thousand Eyes], is a large scale trading Community that situated its Headquarters in the Outer Gate of the Two digits of sixty-nine, would probably be the only one who could directly interfere with the activities of the lower levels with their scale (level). The number of flags that rally under the flag of [Thousand Eyes] were sizable as they seek the protection of its scale. Therefore, [Thousand Eyes] is renowned as a special Community formed by many Community affiliates. It is said that the original name of the organization was something else but the person who carried that information seems to be gone by now.
It was the sort of Community that would promise to lend its powerful combat strength when its affiliates were in need and it would be the best strategy to use this opportunity to deepen their bilateral relations.
It was definitely an impeccable plan to have them as the marriage candidate of the second princess.
However, Carla shrugged her shoulders and shook her head in reply.
"It's a pity that it cannot turn out that way. ShiroYoruOu and Laplace are known to be female Demon Lords. Moreover, those Demon Lords…… Eh, they are not people who can be tied down by normal contracts."
"Hou? You have met them?"
Hearing Leticia's question, Carla shook her head.
She then put away her usual smile of merriment as she spoke again in a whisper, seemingly in the midst of telling a secret.
"ShiroYoruOu was only summoned after the repaying of her sins at the Buddhist faction, so there's no need to worry about that part…… but for the other Demon lord, there seems to be a few bad talk about the [Laplace Demon]. It is said to be working in the shadows with the Demon Lord who appeared in the West Side— [Dystopia]."
"I've not heard of that Demon Lord before. But if it is summoned in the West Side, it should be a Nordic Demon Lord right?"
Leticia and Lamia looked at each other, but since it was summoned within the Western regions, it shouldn't be a worry, they thought.
This is because the directions of the compass within the world of Little Garden is closely related to that of the Outer world.
Those that were summoned from Eastern Asia would appear in the East Side, while those summoned from the Western Nordic countries and the Middle East would typically appear in the West Side.
The West was ruled by the Slavic and Nordic god factions and it was also inhabited by many demons that were the symbols of bad omens.
The South was a region of abundance and harvest. Due to the various groups that were mixed in the region, it was not possible to trace the origins of them all. Although it's a rough description, but the division of Little Garden was something like that.
And among the regions, there were many who chose to migrate from the West Side, which is the biggest region of all.
The Greek gods, Roman Gods, Celtic Gods and the gods of the Ulster Cycle have relocated with their throngs of heroes. And it made no sense at all that they would do that sort of thing because of the appearance of a new Demon Lord.
However, Carla's expression became grave in her attempt to deny the speculations of the duo.
"It's a pity that we are still unable to obtain any information on the true identity of the Demon Lord. Whether it is a Demon Lord born from the West or another Demon Lord altogether, it was something that bothered me enough to send some spies. And the report that they brought back was really frightening ……Would you like to hear to report?"
Using her gaze, she directed the question to Leticia.
Fortunately for them, there were only royal family members present in the area.
"Lamia. Let's keep this between ourselves."
"Don't worry. It is my hobbit to pretend as a forgetful lady."
"HngHng. My highnesses are really very understanding. I'm feeling proud to be your chief maid."
Carla gave a slight smile but immediately kept it away as she pulled out the reports from her Gift Card. The three sheepskin scrolls were stamped with the insignia of a red branch.
"The insignia of a red branch……isn't that a secret report sent in by a knight of [Ulster]?"
"And it is a fairly huge Community within the Celtic God faction too."
"That's right. It's a report sent by a young lad named Sétanta[3], who returned the way he came at an astonishing speed after handing over the secret documents. HmHm, those strong legs would surely give the illusion of being a flash of lightning or wind itself when he ran. Well, he did say that he had another location that he had to rush off to and I did feel that spiritual power contained within him to be one of a demigod. He looked to be a promising youth too—- Aiya, let's get back to the topic. Regarding the contents of the secret report, it would really be an earth-shattering matter if it were not a lie. The truth is that the indigenous Celtic Gods have been wiped out."
Leticia frowned as she doubted her ears.
Among the indigenous gods, there were a range of power levels that had the inferior ones mixed within the jumble as well.
Including the Earth Gods and Sea Gods, there were also the Sky Gods that numbered significantly in their total. The gods for small streams were also counted as indigenous gods in a sense and it should be those that were affected greatly.
However, Carla seemed to have anticipated that sort of misunderstanding and she added to clarify the doubt.
"Your Highness, Leticia, this is no figure of speech. It is just as the phrase is meant to be. They were wiped out. Starting with the Sky god of Taranis, God of the fallen skies Albiorix, many other big named gods have been seeked out and wiped out."[4]
"You must be lying……!"
"Impossible!? Not deaths but the complete wipe out of their Divine spirits?!"
Leticia slapped the table as she exclaimed.
Lamia was taken aback by the reaction of her usually cool and calm elder sister who was clearly shaken to this extent and she asked apprehensively, "My sister highness, divine spirits are also a type of life aren't they? Being defeated by evil and dying is also possible isn't it……?"
"No, that's not the case. —Right, that's not possible. Divine spirits that exist would always have a resummoning system even after their deaths. But to actually say it as ….. a wipe out? Surely, a Demon Lord who possess such strength cannot exist?!"
"Nope, your Highness, Leticia. Have you forgotten? A Demon lord that exist with the possession of that strength and is the exception to that rule? The cornerstone of the ancients and that which is undefeated till today…… they, who are given the title of "Godslayers"."
Reading between the lines, Leticia drew a breath in surprise.
In the world of Little Garden where the gods reside, heroes who possessed the accomplishments of having slain gods were not in the minorities. Just from that accomplishment alone, some have obtained Gifts and for some others, titles. Great strength, a wealth of knowledge and the aid of luck made such feats possible.
However, those were only hypocritical titles. False victories. The real [Godslayer] in every aspect of its title that is feared by the gods are the Demon Lords who possess such a title.
"…… A [Last Embryo]?Is the Demon Lord, [Dystopia] who appeared in the West one of those?"
"That's still uncertain. But there are many gods who would reckon it to be so. Apparently the [Paradigm Shift] that should occur in the Celts currently, no, it should be called Europe in this case, is in a temporary dissolution and it is going to greatly affect the future generations to come. The soon to be completed Akashic records would also be aborted as a result of that too."[5]
Leticia folded her arms before her chest as she digested Carla's speculations.
Initially with an interest to know a little about the happenings of the outside realms, the described situation had exceeded her imaginations.
The annihilation of a mythology group of Gods was bound to have an unimaginable effect on the world. It was a huge matter that could cause the current timeline to distort.
That is because— the spiritual levels of a mythology group is closely related to the histories of Humans in the Outer World.
Gods are the congregation of spiritual powers that are born from the belief of the Human race such as the anthromorphication of historic events, the attaining of Divinity by conquerors, the idolization of ancestors and various means.
Hence the annihilation of a mythological group would mean the changing of Mankind's history.
Therefore, a system of resummoning was made to prevent the changing of history.
However, if the system were unable to function in its resummoning of the gods from the world's timeline, it can only mean that the portion of the Celtic Gods were completely blotted out of the history of Mankind.
"The lucky portion who survived the attack managed to escape to the other mythological factions but it doesn't look like they will be reviving their mythological faction any time soon. The elder god Dagda[6] escaped with the <Lebor Gabála Éren>. Whereas the goddess Scáthach[7] who escaped to the Nordic mythologies have started to take in disciples to rebuild combat strength."
"What about God of the Sun, Lugh[8]? The position as the strongest combatant of the Celtic mythological faction is held by him, isn't it?"
Leticia's expression was anxious as she questioned.
Regarding Lugh, the Sun god, he's a very famous leader of the gods and possess many strong Gifts with the divine spear as his symbolic weapon of choice.
Could it be that he too, or so she had wanted to ask, but Carla shook her head to reject that speculation.
"It is still too early to determine from the unconfirmed reports…… it seems like the Sun god Lugh had escaped to head into the Celtic Mythologies to summon a new strongest species in order to bring down [Dystopia]."
"……That is really, quite a desperate move."
"Well, that is something that they have no choice as well. After all if things were to continue as they were, it would lead to the annihilation of the Celtic mythologies. Then, even the gods would not be able to escape from the fate of falling to the level of [No Name]."
[No Name] — A community that has its Flag and Name stolen and fallen as a result. Gods are built from the worship of believers. Therefore falling to the state of [No Name] was akin to being unable to rebuild or regain their former glory ever again.
And understanding the magnitude of the situation, Leticia hugged herself as she muttered in a broken whisper.
"[Dystopia]…… A Demon Lord possessing such a level of power actually appeared in the world of Little Garden. What's the faction of origin? Could it be some sort of Divinity holder from somewhere?"
"There's no way for us to be certain, Nor can we do away with the possibility that he is without any support from any other mythological factions. Mah, however, it must surely be the work of a Demon Lord who holds a special Gift or cosmology. And since I'm given the title of the [Knight of Little Garden], there will be no escaping the opportunity to cross swords with him. I will just have to be cautious then."
"Mhm. No matter the strength of the Demon Lord, as long as it is against my sister Highness, there will be no need for fear. With the Vampire Race led by our Princess General, we will definitely take the head of that Demon Lord."
The second queen in line clasped her hands before her bosom as she spoke with confidence in her words.
That sort of confidence would surely stir up pleasant feelings for the listener, but Leticia was still uneasy about the whole matter.
(If the Human history were to undergo a massive change, the futures of our Vampire race will also be affected. We are just a race summoned from the longest reaches of Human history. This matter would surely have affected our genetic inheritance by quite a bit.)
The Vampires were a race summoned from the distant future and they were the protectors of the phylogenetic tree.
The symbolic characteristic of their race that makes them "unsuitable for Sunlight" is probably due to the futuristic unusual activity emitted from the Sun that would engulf the entire planet called Earth. Starting with the unusual solar activity, the radiations emitted from the Sun would drive the Human race to the brink of extinction. However, it was those who seek to escape that impending end that became the ancestors of the Vampire race. In the attempt to escape the Sun that is harmful to the human body, the people who migrated to the satellite, which traces a trajectory around the Earth's equator, would become the Vampire Race or so it was recorded in the documents. To put it simply, in the history of Mankind, Vampires were once Humans.
Although that does not answer the question about the vampirism ability and it is still a puzzle until today.
— However, everything happens for a purpose and the Vampires knew that for a fact by their instincts.
And it was that instinct of their race that was pinging the alarms in Leticia's head.
This incident would cast a shadow on the Vampire Race.
"…… The ascension ceremony should be held as soon as possible."
"Ara. My Highness Leticia is getting pumped up?"
"Perhaps, just a little. Carla, continue to follow up on the investigations on [Laplace Demons]. And Lamia, please do forget the conversation we had today."
"I understand. After all, this matter is too dangerous for talk among flowers in social events."
The trio exchanged a solemn look and nodded.
It was then that they noticed the Sun already on its way down from the horizon, signaling that they had spent a considerable amount of time for their conversation.
Leticia then stood up, preparing to head to her father's office.
"I will have to report this matter to my father, his Highness. At the same time, we must start preparing to protect the survivors of the Celtic mythological faction. Carla, follow me.
"Yes mdm, my liege. …… On the other hand, Lamia-sama. My apologies for bringing such a heavy topic to the tea party. I promise to bring much more interesting topics the next time."
"Don't worry about that. I will request the payment from my sister Highness."
"As expected of Lamia, my Highness. Then, please place the tab on my Highness, Leticia."
"Aiya, what an incorrigible pair of my maid and my sister."
Indeed. Lamia giggled as she sent the duo off with her eyes.
"—Farewell, my sister Highness. I will look forward to tasting the tea brewed by the royal hands of my elder sister."
"Got it. I will spare a little time to practice that a little."
Leticia swung a coat over her shoulders as she left the atrium with a smile hanging on her lips. She was planning to surprise her sister in the next tea party.
The lands inhabited by the Celtic god faction was one that viewed black tea as the water of life. The harvest gods would surely have the best tea leaves. The image of her sister's surprised look floated to the surface of her thoughts.
In that case, there is a need to protect them well. Leticia wore a happy smile—
Part 2[edit]
—those blessed moments.
… and the important promise with her sister.
Thinking about the things which will never be realised ever again……, she sobbed quietly on the throne alone.
Part 3[edit]
Within the cold and deserted throne room, there came only the sound of fallen tears echoing in the silence.
There was not a sound of any wind.
Not a sound of people's voices.
Not a sight of any bureaucrat bustling around on his job.
Not a single knight shouting in their practice and drills.
And there wasn't the presence of her talkative maid nor her sister who admired herself.
There was only the sound of tears that sounded like beautiful gens falling upon the throne occupied by the Demon Lord.
It also meant that the throne was filled with emptiness.
"……A dream of the past, huh."
It has been a long time since those days.
Having been in a deep sleep for countless years, Leticia wasn't sure if she could keep track of the years anymore. But she would dimly make it out to be a hundred years or twice that amount. However, if she went by reason, it should be a thousand years.
Leticia who inherited the throne was merged with the dragon and hence obtained immortality. However, the lifespan of Vampires outside of the royal bloodline was roughly two hundred and fifty years. Even if there are survivors, those betrayers would most likely have died from old age by now. Even if there were remnants of their faction, they would still be far away and unrelated to Leticia.
But— the vengeance in her heart, was one that could not be explained with reason.
Leticia Draculea had set the rule.
They were not allowed to die by immolation.
And above all, they were not allowed to die.
If the group of rebellion adherents were not completely obliterated, the fire in her chest would never be able to abate.
The intense wrath filled flames that spewed from her thousand curses and regrets— were dispelled by the shrill chirp of a little bird.[9]
"Aiya. Although I empathize with your ordeal, obliterating an entire race is seriously overboard."
Pata!!! The huge doors that stood between the throne room and the clostiers were forcefully swung open. The fearless intruders had no intention to report their names. But that was right as well. After all, they have already introduced themselves once.
"Good evening. It's been a month since then. "Blonde My fair lady", are you faring well?"
"It's just as you can see. I'm fully rejuvenated. I was just planning to find you myself if you were to make me wait any longer."
"Ooh. Then I guess I must have arrived at the right time. Keeping you anxious and in suspense is just a spice for more fun in the game, isn't it?"
Canaria was not repentant in the slightest and was more boastful instead.
But Leticia did not rise to the bait. After all, she had no interest in this woman in the slightest and none of her words would carry across to the ears of Leticia.
Leticia's red eyes narrowed as she issued the final warning in a condescending tone.
"Here's your last chance. —Tell me the location of the Vampire village and I will spare your life."
"…… Hm? Did I mention about any survivors of the Vampire race?"
That's odd. Canaria folded her arms as she seemed to ponder her question.
This time, Leticia could not help but lift a brow at that reply.
"……Then, have they all been cleansed?"
"Who knows. Even that is a secret. Or else there would be no need for a Game would it? …… Ah, and it's best to refrain from saying out your desire to attempt "murder" on a poet. In this day and age, it will be a phrase that is going to invites scoffs and sniggers you know." Placing an index finger to her lips, Canaria happily informed Leticia.
Spreading out a sheepskin parchment, Canaria moved her quill fluently across its surface as she wrote the [Geass Roll].
"The reward for this game will be "all the information regarding the Vampires". It is up to you to challenge this Game as many times as you want and there's no need for you to place additional bets to participate in it. Challenging it repeatedly is OK."
"……? What is this? What do you stand to gain from this?"
"Ara, you are unsatisfied with this show of contempt towards possible gains? A heart that believes in servitude is a beautiful thing you know? Well, if you are unsatisfied with the lack of victory conditions, let's make do with the story of your past shall we?"
Smiling while poking at the sore spot of another. Leticia did not like this sort of roundabout approach but to start the search in the whole of Little Garden without any information on the Vampire whereabouts would be too much of a hassle.
More importantly, this body which was asleep for thousands of years was still dull in its movements and it was difficult to perform at her peak condition in a fight. Taking that into account, it might just be fine to take it easy in a warm up exercise.
After all, if it were to take some time in any case, taking the option of interrogating this woman might just be a good start as well.
"—Okay then, I will entertain your little Game for now."
"That's great. So let's —"
*Pak* Snapping her fingers. Although it was just a crisp sound similar to a popped bubble, the changes that followed that action was much more dramatic than the overturning of stars in the heavens.
By the time Leticia noticed her surroundings, she who should have been sitting on the throne was already transported to the space above the floating castle.
However, the transformations did not end there.
The airborne castle was engulfed in hungry flames and the streets were in a mess, seeming to be a scene of a war zone.
This wasn't a teleportation skill that transferred her into the skies. And it wasn't a technique to transport the skies to herself.
(Spatial transportation……!? No, it's not it! This is the reproduction of memories…… a Gift Game that is based on recalled memories?!)
The unexpected level of the Game left her wide eyed and stumped for words. This wasn't a Game that summoned a Gameboard.
Or rather, this was based off a certain person's real experience and memory to provide the framework. The player was to search for the error or contradiction in history within this Gift Game of Recollections. The evidence would be that huge dragon roaring in a frenzy below herself. Looking at the scene below from the eyes of a certain individual who experienced the last days of the Vampires, Leticia observed the huge dragon that was herself.
(This dragon……?!)
Each beat of the wings cleared a space around it within the sea of clouds. With an open jaw capable of swallowing whole rivers and mountains, this was the manifestation of the strongest force as described in myths.
But, who could this memory belong to. On that day, the only ones who resisted the huge dragon could only be from the Vampire race—
"— My sister Highness!!! The battles are over! Please calm down!"
(……!!? )
A nostalgic and familiar voice was borne to her ears.
No— to put it accurately, Leticia was hearing the voice of the person whom these recalled memories belong to.
The beautiful blond hair of the host, whom she was watching the scene from, was in a mess. Even her clothes were torn and exposed her thighs. Whilst on her right hand was a glove that was emblazoned with the symbol of the royal crest.[10]
Narrowly missing the charge of the huge dragon in its frenzy, the host shouted in grief as she rode a dragon.
"My sister Highness!!! Do you not recognize me?!!— My sister Highness!!!"
Those hands of a princess which were more suited to the light touching of flowers and butterflies while walking through the garden, were now gripping the reins tightly with apparent discomfort. Swaying as she rode the dragon, she continued to cry out to jolt the memories of herself in her intended target. However, Leticia who was already lost in rage was unable to listen to any of it.
The glittery golden comb and the dress robes that were sewn with the crest of the royal family.
There was no way that Leticia could have mistaken this person for another. She was the person who admired herself, the one whom she loved dearly and her only sister.
(Could this be….. How can this be……!!?)
Yes— this were the records of the day that the Vampire race were felled, the memories that were experienced by Lamia Draculea.
"『 Gift Game- "Blonde My fair lady"-
Requisites for Participation:
*Until the player admits defeat, they are allowed to challenge this game as many times as they want.
*The method to achieve victory is free for the player to choose (more details below).
*As part of the premise of this game, the game masters swear that "Everything will be in line with the factual historic events".
Conditions for Player's victory:
*Save Lamia Draculea.
*Save the Vampire Race.
*Come to face with the sins of becoming a Demon Lord
Oath: We hereby swear on our Name and Flag that the above described game is the real deal.
"Stamp of [Acadia] 』"
Translator's Notes[edit]
- ↑ [magrefnotes: rosaceas are part of the rose family. Not to be mistaken with Roselia the pokemon.] https://en.wikipedia.org/wiki/Rosaceae
- ↑ [magrefnotes: shiro-white, yoru- night, Maou-Demon Lord, Ou – Lord, maybe I should just change them all to English… leaving decision to editor and readers.]
- ↑ [magrefnotes: aka Cúchulainn, son of Lugh. Known as Sétanta during his childhood and later receiving that heroic name after killing Cullan's fierce guard dog in self-defense. He defended Ulster, one of the Northern provinces of Ireland singlehandedly against the armies of queen Medb of Connacht in the famous Táin Bó Cúailnge battle. And was known to be a berserker in battle who knows not friend or foe. Taken and summarized from https://en.wikipedia.org/wiki/C%C3%BA_Chulainn.]
- ↑ [magrefnotes: Taranis is the God of Thunder in Celtic mythology while Albiorix Is the divine spirit who caused the Heavens to fall to earth.]
- ↑ [Magrefnotes: Akashic records whereby the Sanskrit word 'Akashic' means "everything under the sky", "space" or "ether". It is a type of amalgamated information in an unknown form that is coded and stored within ether. In other words, it is an existence that is not within the physical plane (something that cannot be perceived or experienced).
This concept is also quite popular in the West in recent years.
The Akashic records is understood as an entity that existed since the construction of all things and even before that. Even our knowledge base (eg. Medicine and Law) may have complex changes over time due to external influences; however, these have long been recorded in the Akashic records (eg. The people, animals, plants or ores and more); but are only encoded with a common tongue. (It can also be explained as the environment being the source of all observations and hence it is possible for all cultures and creations to have a common root.) Many works by authors have pointed to the Akashic records as something to be within the scope for a typical human to experience. However, it code is only something that is legible to those who have entered a transcendental state.
- ↑ [magrefnotes: Dagda, the eldest god of the Tuatha Dé Danaan, with the name interpreted in medieval texts as "the good god" with the titles of "Father of the gods" and "The knowledgeable and omnipotent god" among others. Wielder of knowledge, magic, Earth, fertility, destruction, death and rebirth. Legends tell of a strange magical staff in his hand that holds the ability to kill enemies with one end and revive the death with the other.
- ↑ [magrefnotes: Scáthach is a female god in the Celtic mythology who governs the underworld "Dún Scáith" as its queen. She possesses superpowers of strength and have the ability to offer trials to heroes while bestowing them with combat skills for battle. Scáthach, a female warrior who is well versed with many combat martial arts and trained Sétanta.]
- ↑ [magrefnote: Lugh mac Ethlenn(Lugh son of Ethlenn), God of the sun and light of the Celtic mythology is one of the representative gods of the Tuatha Dé Danann. His father is Cian while his grandfather (from his maternal side) is Balor of the cursed eye, from the Deep sea Giant race. On the other hand, Lugh's coupling with the Ulster's princess, Deichtire, bore him the Ulster's hero: Cú Chulainn.
- ↑ [magrefnotes: Canaria derived from Canary.]
- ↑ [magrefnotes: To make it less confusing, I've Italisized and bolded the words of her to refer to someone other than Leticia. eg. Lamia It was not as clear in the Chinese translation.]


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SNP 'failing to convince female vote'
Margaret Curran has attacked the SNP's "shallow approach" to women and claims that Nicola Sturgeon has "failed significantly" to engage with female voters.
Speaking at a Labour party summit for women's organisations yesterday, the shadow secretary for Scotland said the reason only 31 per cent of women support independence, compared with 43 per cent of men, "is because their policies are developed as a way to win women's votes rather than to change their lives".
Ms Curran criticised both the SNP and the Conservatives for failing to adequately represent women in public life. "The SNP think that if you just put a woman out to argue a policy, by definition makes it women-friendly.
"They have used Nicola Sturgeon an awful lot . . . they


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Axes Femme Shawl
Sold for:
Sold to: slytherinbunny (+40, -0) (Alberta, Canada)
$10Sold on: 06/23/19
Sold to: slytherinbunny (+40, -0) (Alberta, Canada)
Sold by:
Seller rating:
(+264, -0)
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Super comfortable free size shawl. I used this with classic for extra texture and could be a nice mori touch to coordinates. The matching shoes in the coordinate photo is also for sale
Shipping to United States: $7
This item does not ship outside United States
Condition: Good
Brand: Indie Japanese
Category: Boleros
I have animals: 2 cats, 1 dog. Though the rooms my lolita garments are stored are off limits to them. All items are stored in garment bags, storage containers, and hat boxes when not in use. I lint roll garments prior to shipment but if you have allergies please be mindful of this. I am willing to trade//partial trade what I'm selling for any of these items: - Current wishlist: https://goo.gl/aHJ3Y6 - Automatic Honey wishlist : https://goo.gl/zBfVCm Payment must be completed within 24 hours of winning auction and I do not accept echecks. If you send an echeck I will cancel the transaction and send another invoice. If the invoice is not paid within 24 hours the item will be relisted and negative feedback will be left. I only ship to the address listed on Paypal. Please make sure to select the correct address when paying, and if an address is wrong, I will gladly refund and re-invoice to make sure we can attach the correct address. I am open to payment plans with a nonrefundable deposit of between 35-40% depending on the item. Payment plan duration must agreed upon before buying or bidding on auction. Failure to make payments on agreed dates and on time will forfeit payment plan and there will be no refunds given. Shipping in usa will be 3 day priority. I do ship internationally ( and will mark down packages ) but you need to message me before bidding or BIN any of my items. I will give you a quote and once you have confirmed shipping options, I will amend the listing to you or automatically invoice that option after the auction is over. That is why the listing says does not ship out of USA. Failure to do have confirmed shipping before sale will forfeit the item and it will be relisted. If there is an issue with your purchase please contact me as I am more than willing to help remedy with an effort to have both parties satisfied. I do not accept returns for ill fitting items or items that do not match your measurements however. Please make sure to check the information given before purchasing or inquire. I reserve the right to refuse sales. If you are someone outside of the United States and do not contact me and confirm shipping before purchase, I will relist the item. I do not sell to users: Strawberry_lemon Oekakiaddict, Byoku, Rabbit_king, DarkRomantica, TsuTsu or user with emails: [email protected], [email protected], or [email protected]
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- Buy it Now placed by slytherinbunny for $10 on 2019-06-23 01:46:44 UTC
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It is with heartfelt sadness that we announce the passing of Dale Rintoul. A Celebration of Life will be held on Wednesday, January 16, 2019 from the Fort St. John Royal Canadian Legion at 2:00 pm.
In lieu of flowers, expressions of sympathy can be made in memory of Dale to the Fort St. John Royal Canadian Legion.
Donations may be made to:
Royal Canadian Legion Branch 102
10103 105 Ave, Fort St. John BC V1J 2M4
Tel: 1-250-785-3917
Nos plus sincères sympathies à la famille et aux amis de Dale Rintoul January 19 1945 January 10 2019 (age 73)..
Décès pour la Ville: Fort-St-John, Province: Colombie britanique


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For information about Coronavirus (COVID-19), including screening resources and facility updates, click here.
11109 Parkview Plaza Drive
Entrance 1
Fort Wayne, IN 46845
(260) 266-1000
11050 Parkview Circle
Entrance 12
11108 Parkview Circle
Entrance 10
(260) 266-2000
Parkview Regional Medical Center Campus
11130 Parkview Circle Drive, Entrance 7
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(260) 672-6100
2200 Randallia Drive
Fort Wayne, IN 46805
(260) 373-4000
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Blockages in your blood vessels can lead to life-changing or deadly outcomes, such as heart attack, stroke or amputation. Most blockages develop slowly over time. But, if detected early, they can be treated to prevent a more serious health condition. One way to catch these blockages early, is a vascular screening. This week, we expanded our offering of the Total Vascular Screening ($79), adding several additional locations.
The Total Vascular Screening is now available at Parkview Whitley Hospital, Parkview Warsaw, Parkview Huntington, Parkview LaGrange, Parkview Wabash and Parkview Noble, in addition to the Parkview Heart Institute. The expansion of this program signifies our continued dedication to making our high quality services more accessible to communities outside of Allen County.
The screening can detect abnormal conditions in your neck, abdomen and legs. These conditions can be the beginning stages of build-up that indicate the risk for future heart attack, stroke, restricted blood flow to the legs or an aneurysm (weakening of the blood vessel walls). Early detection, with proper follow-up, can slow or stop the progression of the disease and prevent a future health crisis.
No. Because this is an early detection screening, a doctor referral is not required. Your results will be sent to your primary care physician for evaluation and further testing, if needed. If you do not have a primary care physician, we will direct you to the Parkview Welcome Clinic for assistance with follow-up.
No. Because this is an early detection screening, insurance does not cover this service. Collection of payment will occur at the time of service.
In the exam area, you will lie on your back. A specially trained vascular sonographer will apply a cool gel to an ultrasound wand. This will be guided painlessly over your neck, and then on your abdomen, in order to identify any early signs of blockage or aneurysm. In addition, blood pressure cuffs will be placed on your arms and ankles. These will detect any unusual changes in pressure, which would point to blockages forming in the legs. The screening can be completed in 30 minutes. Those who have already experienced the screening often express their surprise at just how quick and simple the process is.
The Total Vascular Screening is now available at Parkview Whitley Hospital, Parkview Warsaw, Parkview Huntington, Parkview LaGrange, Parkview Wabash and Parkview Noble, in addition to the Parkview Heart Institute.
"Our goals are convenience and ease of access," Michael GeRue, SVP/COO and service line leader, Parkview Heart Institute, said. "We want to make it incredibly simple to receive care in your community hospital, close to home, with high quality providers from the Parkview Heart Institute."
To schedule your Parkview Total Vascular Screening, call (260) 266-5740.
One man's weight loss journey with the help of his cardiologist and clinical nutritionist.
Understanding the way the heart functions when you carry extra weight and how to set smart goals for achieving a healthy weight.
Dr. Mark O'Shaughnessy addresses family history of heart disease, overcoming bypass surgery and more.


text:
Move forward. Stay weird.
A former student has his own clothing design company: Howard & Lloyd. I was scrolling Instagram today and saw one of his past t-shirt slogans: "Move forward. Stay Weird."
I love that.
It's like it should be the two mantras of my life.
Whether we like it or not, life is always moving forward. I'm sitting in an empty house right now. Trust me, I'm pretty aware that life is marching its steady pace, and even if I've thrown myself in front to slow it down, it feels like I'm presently getting trampled by the entire tuba section.
I didn't get a chance to see my kids much over Thanksgiving. They had their reading break and were actually here for the whole week. I only had one night where there wasn't a meeting, or practice, or travelling for sports. We hosted a tournament on their last day here, and then they were gone. They won't be back until Christmas.
It was typical of how this fall has gone, as I've had one-day weekends for the past five weeks. I get that math isn't my strong point, but it works out to two things for sure:
One. I'm tired. Literally, not just in the post-election sense.
And two. One day isn't enough for catching up. Right now I'm failing on about every imaginable metric there is. As much as I convince myself that it doesn't matter - because most of it really doesn't - it doesn't mean that I have to like it!
But we keep moving forward. This past week I had two opportunities to rejuvenate my thinking. The first was PD on Reconciliation. There are many, many times that I feel absolutely discouraged and disheartened. It's Saskatchewan. The list would be long and depressing. But the opportunity to come together with other educators to learn, and support each other in our learning, gives me hope to continue this important work in any way I can.
The second PD was listening to Dr. Jody Carrington and her "ReConnection Revolution" message on relationship building in our communities. She is a truly amazing speaker, and her message that 'kids are only as okay as the people holding them' hit pretty close to the mark. When I know I'm overextended, the housework can definitely wait. The piles of clean laundry on my floor are a testament to that. It's only two weeks until I will head out to Calgary and see the kids. And if this is another week where this isn't my finest writing, well, I guess I can live with that too.
Staying weird isn't a problem.
For the right price, I could dig out all my middle and high school pictures. There'd be no doubt about it.
At every opportunity, I try to model that and to encourage kids to be themselves. I haven't written about author Matt Haig for a while, but he's a touchstone when I need a shot of authenticity. This week he wrote: If you aim to be something you're not, you'll always fail. Aim to be you. Aim to look and act and think like you. So long as it doesn't hurt anyone, embrace that you-ness. Be you to the power of you. You2.
So in the spirit of taking care of myself so I can be there for our kids and colleagues, I'm cutting this short. Again. And then calling it a night.
Have a great week everyone, and wish us luck as volleyball season wraps up this week with playoffs!
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February 2020


text:
Yes, tis the season.
There was this book, I remember it well and I still own my copy. It originally belonged to my dad and was called Flatland. I apologize that my little phone cannot italicize the title to this book, which is, I suppose, what we ought to do to book titles if we are to be respectful of them, or maybe many people have heard of this book already so it is so well known that this slanting of letters is unnecessary anyway. The author I guess was immediately criticized for his antifeminist portrayal of women.
Yes. We women of no shape. See, one`s status in this society Flatland was dependent on the number of sides you had. So a square had higher status than a triangle. An octogon had very high status.
Guess how many sides women had? If I recall correctly, and I may not, we had two. Yes, we women were only lines.
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Skies were clearer Sunday over the Tanana Zone as scattered showers tapered off and the sun came out. Showers and mainly wet thunderstorms are forecast today for the zone, but precipitation is expected to be spotty. These storms could linger over the next few days ahead of a change in the weather that is predicted […]Continue reading
Tag Archives: Twin Ponds Fire (#486)
Tanana Zone receives large dose of dry lightning
Alaska was hit with more than 10,000 lightning strikes in the last 24 hours, and the Tanana Zone received its share as dry lightning. Two new fires were reported in the Tanana Zone on Wednesday, with 19 new fires statewide. Additionally, the dry wind from the northeast and downdrafts from thunderstorms have fanned flames from […]Continue reading


text:
Longwood U-Haul hit again by thieves
Locks cut off units
A U-Haul storage location in Longwood was hit for the second time in as many months Wednesday night when thieves broke in through a side fence, and made entry into a number of units.
"Eleven lockers were broken into," said officer Kevin Tuck, with the Longwood Police Department. "The locks were cut off. The units appear to have been chosen at random."
The U-Haul lot that sits at 650 North Ronald Reagan, in Longwood, is just one of many lots that have been targeted in a recent spree of burglaries.
"This appears to be a growing trend," Tuck confirmed. Earlier in April, a different lot was hit in Altimonte Springs as well. Tuck confirmed that surveillance cameras were rolling at the time, but would not confirm police had seen the tape yet.
Longwood police are asking anyone with any information to reach out to them.
Copyright 2015 by ClickOrlando.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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