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Marsha of HauteIceBeadwork, winner of the September Lions and Tigers and Bears, OH MY! challenge presents us with an interesting theme. TOTALLY TWISTED!
This challenge is an opportunity to design your own unique twist on any of the many beaded spiral techniques. You may use a skill you have, or learn a new technique to add to your repertoire. You can weave a basic spiral rope, or a double or maybe even a triple spiral. Bead a Cellini Spiral, Dutch Spiral, Russian Spiral Weave, or African Helix. You can use spiral fringe or twisted loop fringe, or maybe you know some corkscrew-y stitch not mentioned here. Show us you best beaded DNA! You may use other design components, and personalize your work in any way you choose, but let something totally twisted be the featured part of your entry.
You have from today September 20 until November 5th to create and list your entry. Only current members of Etsy Beadweavers may enter the challenge. If you are not a member, but have an Etsy shop and are into beadweaving please check out our membership requirements and complete the short survey at the button on the right. JOIN ETSY BEADWEAVERS.
Any EBW member may create one new beadweaving of your own design (not from a kit, book, magazine, or class) in response to the challenge theme. Your work should be entirely beadwoven, or have a substantially woven component, to feature and promote our art form. You may not renew an existing piece or list a tutorial as an entry.
Members are expected to participate in challenges when possible, and required to do so once each year. Start the weaving anytime after the theme is announced. Complete and list the work for sale on Etsy by the 5th of the month of the challenge, before midnight Etsy (Eastern Standard) time. Your listing date is proof you entered by the deadline, and also determines your placement in the mosaic, so DO NOT RENEW your work until after the voting poll opens on the 9th.
Your listing must be for sale for the duration of the challenge, unless it sells from your shop. If that happens, please alert the moderators to your sale, and you can still participate. If you must reserve your listing for purchase, please follow Etsy's recommendations and edit both your title and your description to begin with: "RESERVED FOR (buyer's Etsy username) ONLY." Etsy does not allow the listing of items not for sale, so reserving your entry to sell elsewhere or keep for yourself is not permitted.
Your listing must include the following four (4) things:
1. The theme of the challenge. For example, "This (describe your work) was created for the Etsy Beadweavers Team (insert the month) challenge on the theme (insert the title of the theme)."
2. An explanation of how your work relates to the theme.
3. The address of our team blog where the voting will take place and the voting dates. For example, "Please visit our team blog, http://www.etsy-beadweavers.blogspot.com between the 9th and 15th and vote for your favorite entry."
4.Tag your entry EBWC. This is how we find your entry. Please test this tag by seaarching "handmade" and "EBWC" on Etsy. If your entry does not appear in this search within an hour after listing and tagging it, please contact a moderator for assistance. Please do not apply this tag until after the previous challenge poll closes on the 15th, and remove the tag after the voting poll closes, so entries for the next month's challenge can be featured.
About Promoting the Public Voting Poll
The purpose of the public poll is to bring as many viewers to our team blog as possible, increasing awareness of Etsy Beadweavers and our art form. The winner of the public poll should be the work that the most viewers liked the best. Promote the challenge by inviting as many friends, acquaintances, co-workers and family members as you like to vote for their favorite entry. Please use your blog, Facebook, Twitter and any other resources you have to drive traffic to our blog during the challenge. Feel free to say which entry is yours. Many friends will choose to support you with a vote. But please DO NOT request that your friends vote for your work, or that of another member. Please let them make up their own minds about which entry they like the best. Let's play fair with each other, and keep our challenges fun for all.


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Obama Adviser Optimistic On Immigration Overhaul
A top White House adviser said Sunday the stars seem aligned for Congress to pass a comprehensive immigration overhaul this year, but he sounded less confident about prospects for toughening the nation's gun laws.
White House Senior Adviser David Plouffe made the rounds on Sunday talk shows, outlining the president's agenda for the months ahead. He said past presidents have been able to make significant progress during their second terms, noting that President Ronald Reagan pushed through more tax cuts and that President Bill Clinton helped transform budget deficits into budget surpluses.
He said Obama's focus will be on improving the economy, saying the president believes the best way to do that is to invest in education and manufacturing while also seeking what he called "balanced deficit reduction."
Republicans agreed to let tax cuts expire this year for those workers whose incomes exceed $400,000 a year, but Plouffe said that future negotiations on reducing the deficit will have to include more tax revenue as well as spending cuts and changes to entitlement programs.
"We've dealt with the tax rate issue. Now it's about loopholes," Plouffe said on ABC. "And I think the country would be well-served by tax and entitlement reform, because it'll help our economy."
Beyond the economy and the budget, Plouffe indicated that two social issues will be a focus at the outset of the president's second term: immigration and gun control.
On gun control, he mixed statements of optimism with an acknowledgement of political realities. Republicans control the House, and even some Democrats in the Senate have been extremely cautious in addressing the issue.
"It's going to be very, very hard," Plouffe said on CBS's "Face the Nation."
Republican Sen. John Barrasso of Wyoming underscored that point. He said he doubted supporters could get 60 votes in the Senate for legislation allowing universal background checks for gun purchasers and for limiting gun magazines to 10 rounds and under.
"The debt and spending. That's where people are focused. That's the big anxiety of this country," Barrasso said on CNN.
Sen. Roy Blunt, R-Mo., would not answer whether he could support background checks for every gun purchase. Without getting into specifics, he advocated for better information-sharing to prevent some people with mental health problems from buying guns.
"Let's do things that will make a difference here, rather than take one more opportunity to go at an old agenda," Blunt, a gun-rights advocate, said on Fox News Sunday.
When it comes to overhauling the nation's immigration laws, Plouffe said he believes there's broader support from Republicans nationally than there is from Republicans in Congress. Still, "the stars are aligned" for a bill to include beefing up border security as well as giving those already in the U.S. illegally a path to citizenship. He cited business organizations and religious leaders as key players backing a comprehensive immigration bill.
In leading up to Monday's inauguration, the White House has sought to leave the impression that the president will seek common ground with Republicans. It will also seek to undertake public campaigns to build pressure on Congress to act on the administration's legislative priorities.
The new mobilizing effort will be led by a tax-exempt group called Organizing for Action. The move represents the first time a sitting president has ever transformed his presidential campaign operation into an outside group with the express purpose of promoting his agenda. "We're also going to bring the American people more into the debate than we did in the first term," Plouffe said.
Blunt said the president should put forward proposals that a divided Congress can support rather than put in place an ongoing campaign effort designed to pressure Republicans into going along with his priorities.
"I don't think there's any reason to believe from looking at the last four years that that produces much of a result," he said. "It might produce a stalemate. It might get the president re-elected, but he's not running for a third term."
This program aired on January 20, 2013. The audio for this program is not available.


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Under The Stars
By Joanne Lazzaro
Label: Self-Released
Released 3/1/2015
Under The Stars tracks
1. Evening Star Song
2. Sky Chief
3. Medicine wheel
4. Moon Dances With New Star
5. Giant Cactus-Gathering Hook
6. Path of the Departed Souls
7. Bear Who Wanted a Mango
8. Rabbit Tracks
9. Spirits of the Long-Eyes
10. Amazing Grace - Trail of Tears
11. Zuni Sunrise (extended version)
12. Lark Who Sang His Song to the Sun Every Morning
I highly recommend listening to this album
The flute must be one of the hardest instruments to master. I have a deep respect for any musician however there are certain instruments that seem more difficult to produce an entire album with. I definitely think the flute is one of those that qualify.
Joanne Lazzaro took on the task of mastering this mystical instrument and created a fine album titled Under The Stars.
"Path of the Departed Souls" was my introduction to Joanne's music and it was featured on the Rate The Tracks site. There is something simplistic and beautiful about this music. The flute is the only instrument being played so you cannot help but focus on that. The difficulty for this type of recording is to pull in the listener and keep them interested. For my ears it worked as every track has a different tone and ambiance to keep it interesting. Although I enjoy rock music I am drawn to this kind of music more all of the time for its healing qualities. I find that I can get more focus on thoughts and feelings that are dismissed during the course of a busy and sometimes frenetic day.
There is a lot of great music to enjoy on this album and each track is an individual offering from the artist for you to use as you see fit. "Zuni Sunrise (extended version)" is as mesmerizing and relaxing as one track can possibly be. It has a mysterious element to it and reminded me of a time far away, perhaps ancient China. Like watching a movie as the scenes flicker by, you conjure all kinds of thoughts and images. This is what music of this sort is supposed to do and I think the artist accomplishes this consistently throughout the run of this recording.
I love the way Joanne closed out the album making her flute sing like a bird, literally. In the appropriately titled "Lark Who Sang His Song to the Sun Every Morning" she demonstrates the capabilities and power of her instrument by emulating a bird saying good morning to the sun. What a perfect way to close the curtain on a magical journey provided by a very talented flautist. If you want to feel like you are Under The Stars I highly recommend listening to this album.
Key Tracks: Path of the Departed Souls, Zuni Sunrise (extended version), Lark Who Sang His Song to the Sun Every Morning
Keith "MuzikMan" Hannaleck- New Age Music Reviews Founder
October 18, 2015
Review Provided By New Age Music Reviews
Rating: Excellent
- reviewed by Keith MuzikMan Hannaleck on 10/18/2015
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As you know, I am a proud member of the National Society Daughters of the American Revolution. For the next two years I am will serve as regent for the El Toyon Chapter here in Stockton.
Our chapter has a monthly newsletter and I am obligated to contribute something. A friend recently asked me "What kind of woman joins the DAR?" After 4 hours of intense research (intense = no distraction by shiny things) I can tell you that currently over 170,000 women are members of DAR. If you go back to the beginning in 1890 over 890,000 women have become members.
I can also tell you that the women of DAR come in all sizes, shapes and colors. They are doctors, lawyers, astronauts, teachers, housewives, single parents, suffragist leaders, pilots, artists and even an admiral of the US Navy.
Political Heavy Hitters: Janet Reno, Sandra Day O'Connor, Elizabeth Dole
Several actresses: Bo Derek, Lillian Gish, Ginger Rogers, Dina Merrill and Virginia Mayo
Eleven First Ladies : Barbara Pierce Bush, Laura Welch Bush, Roslyn Smith Carter, Hillary Rodham Clinton, Mamie Geneva Doud Eisenhower, Julia Dent Grant, Florence Kling Harding, Caroline Scott Harrison, Nancy Davis Reagan, Edith Carow Roosevelt and Eleanor Roosevelt.
And then there is
Mercy Lavinia Warren Bump Stratton Magri
Better known as Mrs. Tom Thumb.
Now tell me true people - is this a "Shiny Thing" or what!!! So for the better part of four hours I sat at the computer - clickty clack, clickty clack went my keyboard.
This woman had the most interesting and exciting life. She was born in 1841 to James Sullivan Bump and Huldah Pierce Warren at Middleborough, Plymouth County, Massachusetts. She came from a long-established and well-respected New England family that descends from five passengers of the Mayflower: John Billington, Francis Cooke, Edward Doty, Stephen Hopkins and Richard Warren. Lavinia's parents are of normal size as all her siblings with the exception of her younger sister Minnie. Minnie who also had a form of proportionate dwarfism.
At the age of 16 she became a school teacher. A few years later, she made a career change. She left Massachusetts and went to Mississippi to work as a a miniature dancing chanteuse on her cousin's showboat. P.T. Barnum, who was managing Tom Thumb at the time, learned of Lavinia and brought her into his show. Tom's real name was Charles Sherwood Stratton.
It must have been love at first sight, because just one week later, Tom Thumb and Livinia were married on 10 February 1863 in an elaborate ceremony at Grace Episcopal Church in New York City. Her sister Minnie was her maid of honor. P.T. Barnum, ever the show-man, didn't charge admission to the wedding. He did however charge $75 a person to the first 5000 people who wanted to attend the reception at the Metropolitan Hotel. It was a sold out event. They went to Europe for their honeymoon and one of the first stops was to England to call on Queen Victoria.
Twenty years later, on 15 July 1883, Tom suffered a stroke and died at the age of 45. In 1885, Lavinia remarried to Count Primo Magri, an Italian dwarf and they operated a famous roadside stand in Middleborough, Massachusetts. Lavinia died 25 November 1919 at the age of 78 and is buried next to her first husband Tom Thumb with a grave stone that reads simply, "His Wife."
I wasn't able to find the date that Lavinia joined the DAR nor which chapter she belonged to, but I was able to find her DAR membership number - 43670 - and her patriot ancestor. Through her maternal line, Lavinia descends from Sylvanus Warren who served as a Sergeant in the Massachusetts Militia.
Photos courtesy of University of Washington Library Special Collections and Wikimedia Commons


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Consider the doctor's office: the sanctum of care in American medicine, where a patient enters with a need — a question or an ailment or a concern — and leaves with an answer, a diagnosis or a treatment. That room, with its emblematic atmosphere of exam table and tiny sink and bottles of antiseptic, is in many ways the engine of our health care system, the locus of all our collective knowledge and all our collective resources. It's where health care happens.
But in a less sentimental light, the doctor's office doesn't seem so exalted. Yes, it remains the essential hub for clinical care. But what occurs in that room isn't exactly ideal, nor state-of-the-art. The doctor-patient encounter is fraught with tension, asymmetrical information, and flat-out incomprehension. It is a high-cost, high-resource encounter with surprisingly limited value and limited returns. It is too cursory to be exhaustive (the infamous fifteen-minute median office visit), too infrequent to create an honest relationship (one or two times a year visits at best), and too anonymous to be personal (the average primary care doc has more than 2,300 patients).
At best, it offers a rare personal connection between doctor and patient. At worst, it is theater. The doctor pretends she remembers the patient, and that she has actually had the time to read the patient's chart in full; the patient pretends that he hasn't spent hours on the Internet trying to diagnosis himsef, half-admitting what he's really doing day to day, and pretending he won't second- guess the doctor's orders the moment he gets back to a computer.
As woeful as that sounds, we know that there's real value here. This encounter can be meaningful; it should and must be meaningful. The doctor is a necessary interface to medicine, and his office is a source of care, expertise, and trust. The patient is eager and receptive to learning, primed for guidance and direction. Pragmatically, the doctor's visit is a powerful part of modern medicine. The problem is that we, collectively, are not optimizing this resource; we have not reconsidered and re-evaluated how we might exploit the visit to its full advantage.
So how can we improve this situation? How can we fix this thing?
This might be one more nebulous problem left unarticulated, except for the inspiration of Sal Khan, founder of Khan Academy. Earlier this year, Sal visited the Robert Wood Johnson Foundation, and explained the premise and power of Khan Academy. Sal explained how and what he's accomplished by putting simple, clear explanations of academic subjects in online videos. Khan Academy is often described as "flipping the classroom," insofar as it reverses the normal flow of instruction. In a "flipped" classroom, the lectures happen at home (in video form) and the homework gets done in the classroom, where the teacher can give individual attention to individual students. This flipped classroom, the idea goes, maximizes the teacher-student encounter and puts the teacher's expertise to its best effect.
But that's only one of two flips in what Sal has done. In the second flip, he explained, the fixed and variable conditions are reversed. Traditionally, the progress of instruction is fixed: The coursework moves ahead on the teacher's schedule, and at year's end, the entire class — or at least those who've fulfilled minimum requirements–graduates. What's variable is the proficiency of each student. Some have mastered the material, some glean parts but not all, and some are left behind. In Sal Khan's vision, these are reversed. Each student should reach a high level of proficiency with all the material, but should proceed at his or her own pace, not the teacher's.
Together, these two flips represent a significant reimagining of the student-teacher experience in the classroom. Suddenly, the classroom becomes a hub in a broader network of resources and information. Suddenly, the teacher's expertise is reasserted, treated less as a commodity and more as a precious resource.
Sal Khan inspired us, and the similarities between the classroom and the doctor's office were obvious: Why not "flip the clinic" the way Sal has flipped the classroom? Later that day, I was talking with Anne Weiss, team director of RWJF's Quality/Equality team. What exactly, we wondered, would a flipped doctor's office look like? What would a new sort of doctor-patient encounter involve? Is video content required? What are the resources, and the players, beyond the doctor (nurses, nurse practitioners, other staff) and on the patient's side (family, co-workers)? And how could you bring this new approach to both care providers and patients alike?
As with any good idea, it turns out many people are already working on these notions. In New Jersey, the Camden Coalition of Healthcare Providers has aligned to change the way they deliver primary care, leveraging data from across the coalition to coordinate resources and improve the efficiency of care. At the brand new The Betty Irene Moore School of Nursing at UC Davis in California, the faculty is rethinking the role of the nurse in care delivery, training a new generation in informatics, resource management, and interdisciplinary innovation. And HealthLoop, a San Francisco-based startup, is addressing the episodic nature of clinical medicine by turning follow-up — the essential but often overlooked post-visit status check — into a feedback loop, engaging the whole physician practice (doctors, nurses, support staff) in the end-to-end needs of patients.
These are all inspiring projects, and we're hoping that we can learn from each of them, and start fostering a community of change. For the next few months, part of my mission as the Foundation's Entrepreneur in Residence involves working with an amazing team of program officers and gather string on where innovation is happening. We want to capture it and consolidate it, with the goal of creating a robust resource for all physicians, their practices, and their patients, to improve the most potent resource in medicine. The end result, we hope, will be a toolkit for flipping the clinic, offering a specific source for new ideas, better tools and best practices. An important part of this project is to engage the broader community of stakeholders — patients of all kinds, providers at all levels, and experts of every niche — to share their ideas and feedback.
Right now, flipping the clinic is just an idea (for one thing: should we call it "flipping the doctor's office," which is more explicit, or "flipping the clinic," which is more catchy?). In a few months, we hope to propose a new framework for administering effective health care for all Americans, and others worldwide, with the goal of improving understanding, efficiency, and outcomes.
In the meantime, please offer your ideas and reactions below, or send them to me at TGoetz AT RWJF.org . We can't wait to get this started.
Thomas Goetz is an Entrepreneur-In-Residence at the Robert Wood Johnson Foundation, correspondent at The Atlantic, the former executive editor of Wired, and author of The Decision Tree. His latest upcoming work, The Remedy, will be released in early 2014.
Categories: Uncategorized


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Language of Continuity
"Assimilation" and "Jewish Continuity" are two pressing issues in our Jewish consciousness which are neither modern nor unique to our history as a people. It is fitting to read the story of Joseph's political ascendancy in Egypt during this Shabbat Hanukkah. In this week's Torah portion, and during the Festival of Lights, we reflect upon the persistent challenges of assimilation and Jewish continuity. Paradoxically, we learn that Jewish survival often necessitates a degree of acculturation.
Were it not for Joseph and his absorption into Egyptian society, the Israelite nation would not have survived the great famine of his day. Joseph becomes Pharaoh's vizier, changes his dress, assumes an Egyptian name, and intermarries with the daughter of a pagan priest (see Genesis 41:42—45). When Joseph's brothers come before him to beg for bread, they do not recognize him in his new Egyptian persona. He speaks through a translator. Yet, Joseph has remained an Israelite to his core — discerning his brothers' Hebrew conversation and weeping privately at their contrition (Genesis 42:23).
Language has long distinguished Jews in foreign settings. On the other hand, language has often served as the first sign of assimilation. The Joseph story is no exception. Joseph adopts the Egyptian language. In fact, one midrash suggests that Joseph learned all seventy languages of the world (Sotah 36b). However, this "assimilation" enables Joseph to bring Torah to the nations. The Sefat Emet argues that "Joseph the tzaddik, who came to rule over Egypt by the power of Torah, had to know all the languages and join them to the holy tongue." Sometimes assimilation is a powerful tool for the survival of Jewish values and ideals.
The Maccabean revolt, and the victory over Greek persecution, is another example of the subtle role of assimilation in ensuring the Jewish future. The Hanukkah story is certainly a tale of commitment to Jewish particularism in the face of powerful political and cultural influences. However, as Rabbi Irving Greenberg argues, the impact of Hellenism ironically contributed to the success of the Hasmonean campaign. For example, the decision to fight in self—defense on Shabbat was a conscious departure from the simple traditionalism of the pious Chasidim (see First Maccabees). Greenberg suggests that this decision arose from the internalization of some Hellenist influences:
"Exposure to Hellenist modes of thinking and philosophy evoked greater depth and sensitivity to such thinking in the Maccabean and later leadership — just as contact with more developed literary and philosophic models enriched traditional rabbis' capacity for halachic and narrative thinking in the past two centuries. Such thinking became a hallmark of the Maccabees and the later rabbis. They responded respectfully to Hellenism's ideas and methods, but only where they could enrich and be assimilated compatibly with the tradition. In short, without fundamentalism there would have been no Maccabean revolt; without moderate Hellenization the revolt would not have succeeded" (The Jewish Way, p. 265).
In conclusion, this Shabbat weds two powerful stories in the history of Judaism — Joseph and Hanukkah. Both of these central narratives in our tradition grapple with the experience of Jews under foreign control. Both of these tales reflect the delicate balance between assimilation and Jewish continuity. Modern Jews in the Conservative movement today face many of the same challenges described in these stories. What language will we speak? What food will we eat? Which philosophical influences will direct our actions? May the lessons of our history teach us to celebrate and perpetuate the ideals of Conservative Judaism. We must always grow and change as we learn from those around us. However, we must always be guided by the sacred goal of furthering the Jewish people and embracing the Torah.
The publication and distribution of the Taste of Torah commentary have been made possible by a generous gift from Sam and Marilee Susi.


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One year later and I am back on a bread baking spree. Two days ago, a standard sandwich loaf (flour/water/yeast/salt, tiny glug of olive oil). It got too late to bake, so I punched it down and left it in the fridge overnight, gave it a second rise the next day, and a final rise in the pan. It ended up with a nice texture but a sort of weird crust. Today I'm trying James Beard's pain de mie recipe, though I don't have the special lidded pan. I will weigh it down with cast iron, probably.
I have a bunch of eggs right now, so next will probably be some challah, though I also really want to try making brioche at some point.
― Jaq, Wednesday, 15 October 2008 20:45 (fourteen years ago) link
weird. I'm battering out the soda bread at a rate of knots at the mo, was just thinking of reviving this thread
I'm thinking also of getting a sourdough starter on the go, but I'm just not sure I have the time
― Matt, Wednesday, 15 October 2008 21:23 (fourteen years ago) link
I've been thinking about sourdough too, or maybe a whack at catching some wild free-floating local yeast. There is something very bready about fall....
― Jaq, Wednesday, 15 October 2008 21:43 (fourteen years ago) link
I decided to just bake the pain de mie dough as a regular loaf - good thing too, I think it would have blown the lid off if I tried to bake that much dough in my standard loaf pan. As it was, it bloomed so much the crust grew up into the broiler element:http://farm4.static.flickr.com/3166/2945138481_b44e2b15d5.jpghttp://farm4.static.flickr.com/3181/2946009358_9f17c67102.jpgThe dough has 1/4 lb of butter cut into the flour/salt before mixing with the yeast/water. Really tasty and a great texture - easy to slice really thinly too.
― Jaq, Thursday, 16 October 2008 14:29 (fourteen years ago) link
― Tracer Hand, Friday, 17 October 2008 01:53 (fourteen years ago) link
What a Gehry-esque crust. I like it. The crumb seems really tight, though -- is it dense?
― Casuistry, Friday, 17 October 2008 05:14 (fourteen years ago) link
Yes but staying moist and a really good keeper so far. It's a dry-ish, heavy dough, exhausting to work (unless you were really angry about something when you started kneading).
6 c. flour, 5 tsp kosher flake salt, 1/4 lb butter, 1 tbsp active dry yeast, 1 3/4 - 2 c warm water, 2 tsp sugar. Proof the yeast in 1/2 c water with sugar. Sift flour and salt together. Cut in the butter but don't overwork. Add 1/4 cup water to the yeast mixture, then mix in the flour mixture (with one hand only! The instructions are very specific. WHY???) Add the remaining water and mix to a dry sticky dough, turn out and knead HARD, let rise in well-buttered bowl, punch down, let rest a few minutes, knead hard again, let rise, punch down, let rest, knead hard for a few minutes and form into a loaf. Let rise in the pan and bake at 400 F for 40-50 min. If you actually have the proper pain de mie (or Pullman loaf) pan, there are additional gyrations of timing and temperature and pan flipping and finishing out of the pan on the oven rack.
― Jaq, Friday, 17 October 2008 20:12 (fourteen years ago) link
I need a reliable yeast roll recipe, plz. From folks who've actually made it. Thx!Too, I need a link to Is That Pie?
― Ai Lien, Sunday, 19 October 2008 22:46 (fourteen years ago) link
My family-handed-down-for-generations recipe is called Presbyterian Rolls. This makes about 70 rolls, and the recipe can be halved. I always make up the full amount and freeze after making out into rolls the ones I don't want immediately:
1 c. lard or Crisco3/4 c. sugar1 tsp. salt1 c. boiling water
Stir together until shortening is melted.
1 c. cold water, add after shortening is melted.2 eggs, well beaten2 cakes yeast (2 pkgs active dry yeast, or I use about a tablespoon) dissolved in 1/4 c. lukewarm water8 c. flour (or more as needed)
Note: you can also use rapid rise (bread machine) yeast - you don't have to mix it in water separately, and can use a scant tablespoon.
Mix the second set of wet ingredients together well with the melted shortening/water/sugar/salt mixture. Stir in flour, 1 cup at a time, until the dough is workable. Turn out onto a floured board and knead until smooth. Let rise in a buttered bowl until doubled in size. Punch down and make into rolls (roll out about 1/2" thick, cut into 2" circles and fold in half on cookie sheet is my family's preferred method). Bake in a 350 deg F oven for 20-30 minutes.
You can make the dough a day or two ahead of time and keep wrapped in the refrigerator. Take them out 2 hours before you want to bake them.
Is That....Pie? is here: http://isthatpie.wordpress.com/
― Jaq, Monday, 20 October 2008 03:23 (fourteen years ago) link
jaq dude, can i put that on "how to nom"? http://www.elishasessions.com/pumpkin
― Tracer Hand, Monday, 20 October 2008 03:24 (fourteen years ago) link
I don't mind Tracer, as long as it's attributed and you link it back to the post on Is That....Pie? once I have the photo essay up after Thanksgiving. I keep getting Page Not Founds when I go to Browse on HTN, or when I try the direct link http://www.elishasessions.com/pumpkin/recipe that I have in the blogroll on the ITP? site.
― Jaq, Monday, 20 October 2008 03:32 (fourteen years ago) link
i'll definitely source you!
― Tracer Hand, Monday, 20 October 2008 03:34 (fourteen years ago) link
which link gives you a page not found?
― Tracer Hand, Monday, 20 October 2008 03:35 (fourteen years ago) link
If I click on "Browse" from the main page of How to Nom, or if I use the link to the /recipe as in the post above.
― Jaq, Monday, 20 October 2008 03:36 (fourteen years ago) link
Can you only browse if you are a member? If so, I'll take the link off of the Is That....Pie? blogroll.
― Jaq, Monday, 20 October 2008 03:37 (fourteen years ago) link
no, you should be able to browse as a non-registered user, i'll try to fix that.
is that... pie looks pretty great!
― Tracer Hand, Monday, 20 October 2008 03:43 (fourteen years ago) link
I was able to browse a few days ago when I linked it up, but I don't know when it broke. Just now noticed I can't browse, so maybe something changed?
― Jaq, Monday, 20 October 2008 03:54 (fourteen years ago) link
yeah, lots has changed! mainly under the hood. i must have dropped a wrench in there somewhere, cause none of the recipes were showing up for unregistered users but now they are!
― Tracer Hand, Monday, 20 October 2008 04:18 (fourteen years ago) link
if i get a blogroll thingie goin i will link to PIE(?) for sure
― Tracer Hand, Monday, 20 October 2008 04:19 (fourteen years ago) link
I'm currrently experimenting with various things in terms of breadmaking. I got a breadmaker machine from LIDL a couple of weeks ago and have been making loaves since then, did a couple of bread mixes taht I bought from LIDl to progressive degrees of success as ingredients were more accurately measured. Have now progressed to trying to make loaves to a basic recipe adapted from one taht came with the breadmaker. So I successfully made one loaf substituting apple&mango juice not from concentrate for the water and molasses for sugar and using malthouse flour. Came out pretty well, didn't seem to have a great deal of flavour the night it was made but did the day after and is pretty tasty today. Not sure how long a loaf will last sans preseratives. Then yesterday i tried something else. I shredded several vegetables garlic, ginger, a bit of chili pepper, red pepper, carrots, aubergine, courgette, cabbage, a bit of butternut squash basically what I make a stir fry out of. Bunged into this veg shredder I bought last year, came out as about a bowlful when shredded. Then put that in with some mixed liquids which came to about 200 ml, a spoonful of molasses and 25 g of yeast. Worked just about but bread is a bit denser like a ginger cake or a fruit/nut loaf so wondering if that is the inevitable result.Bread is interesting, edible but I'm not 100% sure how recognisable the flavour is and there is an after-flavour presumably from the ginger/garlic/chilli.So it worked to some extent but may need some honing. Not sure if it might have been better if I remembered to add salt. Or if soy sauce would make a possible substitute which was another idea.
Was told last night that salt is there to feed yeast or at least to some extent and I know I need to look further into reactions like that. Salt and sugar both there at least partially to feed yeast. Sugar helps make the crust the way it works out. Not sure if any of that would be done by other ingredients if you're adding fruit or veg or whatever. Need to read further and not really sure where to look.
― Stevolende, Monday, 11 November 2013 14:36 (nine years ago) link
ooh - interesting. I thought salt retarded yeast, but maybe I misread that somewhere...
― Vic Arpeggio, Private Investigator (stevie), Monday, 11 November 2013 15:08 (nine years ago) link
I'm making Jim Lahey's duper famous no-knead recipe right now; it took about 5 minutes to stir and now it's sitting on the counter for 12 or 18 more hours. I'll resume it in the morning
― queen bey backers (Stevie D(eux)), Saturday, 28 December 2013 00:58 (nine years ago) link
I can't remember where in orbit was talking about yeast not working. Reading this book about fermentation - residual chlorine in treated water can kill it, so maybe that's what's going on? Leave tap water sitting out for a day or two, stirring occasionally or pouring from container to container to aerated.
― Jaq, Sunday, 11 January 2015 16:43 (eight years ago) link


text:
The Nigeria Labour Congress (NLC), has hit at at the Federal Government's Advisory Committee saying it has no relevance whatsoever to the implement of the new National Minimum Wage.
NLC President, Mr Ayuba Wabba, who spoke in an interview with the News Agency of Nigerian (NAN) on Thursday in Abuja, said the committee has no bearing with the agreement reached on the minimum wage.
NAN recalled that President Muhamamdu Buhari had on Wednesday inaugurated a Technical Advisory Committee on the implementation of the new National Minimum Wage and reiterated his commitment to its payment.
He said the committee would recommend "modalities for the implementation of the new minimum wage in such a manner as to minimise its inflationary impact, as well as ensure that its introduction does not lead to job losses.''
"The work of this technical committee will be the basis of a Finance Bill which will be submitted to the National Assembly, alongside the Minimum Wage Bill,'' he added.
According to Wabba, the Advisory Committee on minimum wage has no bearing with the agreement reached on the minimum wage.
"The Minister of Labour and Employment, Sen. Chris Ngige had told us that the committee is an internal process of the Federal Government.
"I think it is their own way of facilitating and mobilising their own resources for the implementation and also making sure that nothing is left undone and we do not have any problem with that.
"So, it is normal, I think, because initially we were thinking it is a committee that will renegotiate the new national minimum wage, but they said no, it is an internal process of government.
"So, it is not our problem, but essentially their own and it does not in any way affect our interest, the government has the right to set up any committee and we are not even members of that committee," he said.
He, however, said that he was informed that the committee was strictly on their own to guide government on how to implement the minimum wage, adding, "so clearly if it is how to implement, we do not have a problem with that.
Wabba also said that the advisory committee would not in any way affect the timeline of January 23 agreement reached between organised labour and the Federal Government on the transmission of Minimum Wage Bill to the National Assembly.
What are your thoughts on this story?


text:
The next stop on the hop is over to my friends, Kymona's blog. I can't wait to see what that crafty girl has up her sleeve!
I am so glad you stopped by today. Hope you have a fantastic day!
My place for all things crafty. Stamping, Scrapbooking or just about anything made of paper.
I love the cards you made for today. the gradient background is so lovely..ReplyDelete
Those watercolor dots! Beautiful.ReplyDelete
Lovely color choice.ReplyDelete
The watercolor dots card is my favorite! Love love love what you did with it!ReplyDelete
These cards make me happy! Hello 👋🏻 is a must have!!!ReplyDelete
I want to attempt all of these designs - soon! the colors and stamps make me happy!ReplyDelete
I love learning new ideas and then trying them out. This blog hop is going to keep me busy!!ReplyDelete
Simply beautiful projects, TFSReplyDelete
Loved your cards, so soft and elegant. Thanks for sharing.ReplyDelete
Your card are always some of my favorites!! I love the cover plate die!!ReplyDelete
Amazing cards so gorgeous!!ReplyDelete
Thanks for sharing your beautiful cardsReplyDelete
Such a beautiful line thank you.ReplyDelete
Pretty colors!ReplyDelete
Gorgeous cards! Love the pretty, soft colors.
Thanks for sharing.
I can't believe you can make these stamp sets look even MORE beautiful! Beautiful colors together!ReplyDelete
Enjoyed the cover plate die turned 2 different ways.ReplyDelete
HELLO!!! how could I live without those DOTS!!! you just rock, my friend!
thanks for the inspiration!ReplyDelete
Beautiful cards!!ReplyDelete
Lovely cards, and I adore the gradient one.ReplyDelete
So sweet. So simple. So pretty. You make it look effortless.ReplyDelete
OOh, these are so pretty! Loving those last two, so stunning!ReplyDelete
Three really gorgeous cards, Laurie! I LOVE how you used the negative lines on the Gradient Lines Cover Die...so crisp, clean and lovely with the blooms! Thanks so much for inspiring us, as always!ReplyDelete
Beautiful cards! I love your colors! Some of my faves!ReplyDelete
Fantastic cards Laurie. Especially love the first one with the heat embossed flowers and soft colors. What a great release!ReplyDelete
What beautiful spring colors Laurie! These are all marvelous!ReplyDelete
Adore your cards and your anything but plain and simple cards.ReplyDelete
Beautiful inspiration!ReplyDelete
Your use of white on white is really fresh and adds some texture. Love your last hello card....the watercolor dots are really fun and you put together everything perfectly. Fantastic cards!ReplyDelete
Gorgeous cards! Love the soft colours you used!ReplyDelete
Beautiful card. Thanks for the video. I love the hint using the Press and Seal. I get so frustrated trying to get items glued where I had them before adding the glue.ReplyDelete
very creative and colorful cards:)ReplyDelete
TFS your unique designs and creative use of the new products. Love your three fresh/refreshing cards.ReplyDelete
I love all your cards but the Hello's are my favorite. Thank you for the inspiration.ReplyDelete
Love your clean, fresh style!!ReplyDelete
Gorgeous cards!! Love the simple yet bright look of it. :-)ReplyDelete
Love the soft, spring colors....such pretty projects!ReplyDelete
your cards are gorgeous ! I love the colours you used so much ! And thanks a million for the video and all the precious tips :))ReplyDelete
Your cards are so beautiful!! I love the designs!! Thanks for the inspiration!!ReplyDelete
I love the white on white of the die-cut stripes for the background. I am falling more and more in love with the floral stamps, and love it heat embossed. You were so right about the additional bit of black and white--I don't know if I would have seen it if you didn't point it out, but it really made a difference. Thank you so much. (I am also loving the watercolor dots more and more each time I see them!)ReplyDelete
You are my favorite clean and simple card maker, Laurie! Just simply beautiful! Thanks!ReplyDelete
Ohhh...the big hello card is my fav. Super cute & love the colors & big die cute words. ;0)ReplyDelete
I love the clean, fresh look of all your cards today. Wonderful inspiration!ReplyDelete
Stunning cards, Laurie. Love the colours in the mega hello!ReplyDelete
The soft hues on your cards are spectacular and I love how you complimented each with the white. Especially the Big Hello Die! So much fun.ReplyDelete
Love all of your cards today! Especially the first one, I love that flower stamp set, it's so pretty! Thank you for the inspiration!ReplyDelete
I love the white on white with the gradient die! And the soft pinks and yellows you used on your flowers and lines. I have already ordered the big sentiment dies, which I will use often. Thanks for some beautiful ideas you have left here today!ReplyDelete
Love your beautiful card designs especially how you used white on white with the gradient die. Thanks for sharing!ReplyDelete
Beautiful cards especially the ones using the gradient die.ReplyDelete
Beautiful cards. Fabulous colors and love the softness of the first card ♥ReplyDelete
The cards are adorable, and the colors are amazing!ReplyDelete
Fantastic cards Laurie, and thank you for the video showing how to make the stunning floral one :-)ReplyDelete
Fantastic cards! Wonderfully CAS and beautifully graphicReplyDelete
These cards are lovely. I love the mega word dies and stamps. Thank you for sharing.ReplyDelete
Love the last two "hello" cards! Beautiful colors and lovely design!!ReplyDelete
I love everything you did with the cover plate die. Especially the tone-on-tone look. So beautiful!ReplyDelete
Love your CAS style!ReplyDelete
Lovely cards! I love so many of these new images and dies! WOW.. great releaseReplyDelete
All of you are so talented, thanks for all the inspiration.ReplyDelete
Beautiful, beautiful cards. Love the colors.ReplyDelete
Gorgeous cards. I love that big die and he flowers are lovely.ReplyDelete
Love your cards! The watercolor polka dot background is one of my favorites from this new release.ReplyDelete
Thanks so much for the EYE CANDY, Laurie! So glad that you are part of this blog hop!! You rock (as always!)!ReplyDelete
I love the gradient lines die!ReplyDelete
All your Cards are awesome!! Great white on white with the Gradient lines!! TFSReplyDelete
Love this release and the new products, thanks for sharing your beautiful to showcase them!ReplyDelete
Lovely cards!ReplyDelete
well I am in love with the gradient cover die. Beautiful. Cards. Thank youReplyDelete
Love your cards, especially the ones using the striped gradient die. The large Hello and Thanks are great also.ReplyDelete
fantastic cards, Laurie - can't wait to start creating with my gradient stripes die and stamps!!ReplyDelete
Love the spring colors!ReplyDelete
I just love the new background stamps and dies! Your cards are, as always, crisp and wonderful!ReplyDelete
Absolutely beautiful cards Laurie. I love the CAS look of them all. Very beautiful cards!ReplyDelete
These are simple, but oh so beautiful!ReplyDelete
I love all of the new ideas!ReplyDelete
Such sweet cards using the new products!ReplyDelete
Oh so pretty cards! Love the colors you used. Thank you for the chance to win.ReplyDelete
all your cards are simple yet beautiful! It just goes to show that you can make a stunning card without putting hours into creating it! TFS!ReplyDelete
Love the colors you chose.ReplyDelete
Loved the soft pastel feel in ur cards!!ReplyDelete
Beautiful cards! Love the large hello die and the colors you used. So pretty!ReplyDelete
Your cards are gorgeous.ReplyDelete
Just lovely cards! LOVE the soft colors. Beautiful.ReplyDelete
Love the soft colors on your cards - they are all beautiful! TFS!ReplyDelete
Love the simple designs - so pretty!ReplyDelete
Love the colors on all three of these beautiful cards. That first one, though, is absolutely stunning, Laurie!!ReplyDelete
I LOVE that CAS look on all your cards.. gorgeous!!ReplyDelete
Your cards are so beautiful! I really love those flowers :)ReplyDelete
Splendid, lovely cards! Love the pretty flowers against the white background.ReplyDelete
All your cards are beautiful. I really like the 2 cards you used the Gradient cover die on. Simple but beautiful.ReplyDelete
Beautiful cards. I love the big, scripty Hello.ReplyDelete
Laurie, your cards are so beautiful! I love the white on white with the Gradient die...those gorgeous flowers really pop off that background. That second card with the big hello and the beautiful striped background is also a stunner! Thanks for the great video!!ReplyDelete
Your cards are always beautiful!! Really loving the watercolor dots in this release.ReplyDelete
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Fun cards with beautiful colors! Loving the Mega Greeting set the best!ReplyDelete
I love all of your cards, thanks for sharing.ReplyDelete
Your card is so beautiful ! I love the various styles and ideas.ReplyDelete
Your cards are all so pretty but the watercolor dots card is my favoriteReplyDelete
Gorgeous cards! Love your big, bold sentiments and fresh look of spring!ReplyDelete
Love your color palette. So happy. Thanks for the inspiration!ReplyDelete
I love the soft pretty colours you've chosen for your lovely cards. I particularly like the 'white on white' background of your first card, and love the simple way you've chosen to use the wonderful new 'Water-color Dots' stamp set in your third card.ReplyDelete
Love how you arrange the flower using press and seal. Nice card.ReplyDelete
Love the clean, simple styling of your cards! Beautiful color choices and ink blending. The embossed flowers look gorgeous on the white background!ReplyDelete
Love the mega hello die card! all the cards are amazing!ReplyDelete
Wow! Gorgeous cards. Love the new release!ReplyDelete
This release ROCKS! I love the GIANT sentiments and that gradient die!ReplyDelete
I love everyone of those cards and be recreating them soon. Those enourmous dies are amazing!!ReplyDelete
So beautiful! Your color combinations are stunning!ReplyDelete
Great cards, Laurie. Love your watercolor dots BG with the Oxide pink.ReplyDelete
I love the CAS and pastels on allot your creationsReplyDelete
Lovely cards! No matter which way you place the gradient stripe die, it is a terrific look. I need to use my press and seal more! Thanks for sharing.ReplyDelete
Hi Laurie! I just love what you did with the watercolor dots stamps - the subtle background and simple sentiment you added just make the perfect little saying hello card. Plus you could make a bunch of these and send them to a ton of friends since it would be easier to create! I love the colors you chose to use as well. Beautiful projects thank you so much for sharing!ReplyDelete
Fabulous cards!!! This is such an amazing release!!!!ReplyDelete
Your cards are beautiful and thanks for the press and seal tip, will definitely be using it!ReplyDelete
Such pretty cards - love the soft colors.ReplyDelete
Soft and super beautiful! :)ReplyDelete
Your Creations are Simply Stunning!!😍🤩 Thank You for the beautiful inspiration!!ReplyDelete
Beautiful cards. So colorful and fun!!ReplyDelete
Love how your style really showcases these amazing stamps!!!ReplyDelete
I love your clean and simple cards, especially the Watercolor dots. I think it is my favorite set from this release.ReplyDelete
Beautiful cards! Thank you for the inspiration!ReplyDelete
Fabulous projects. Love them all. Thanks for sharingReplyDelete
Beautiful cards, I love the gradient die cut and the watercolor dots. Such fun!ReplyDelete
Very pretty cards!ReplyDelete
I love them all--so beautiful--the new products from Altenew are fabulous!ReplyDelete
Beautiful inspiration! This is another wonderful release with some lovely sentiment dies and more beautiful layering flowers. Love it!ReplyDelete
Amazing cards! Lovely choice of colours.!ReplyDelete
Lovely cards. I like how you used the Gradient lines cover plate.
slrdowney at hotmail dot com
Love your stamp and die combos. So many options with this new release. Thanks for sharing!!ReplyDelete
Wonderful cards that make these products shine.ReplyDelete
You are so right....clean and crisp and delightful. The distress oxides you chose are my favorites. They fit together so well on the cards. The video was a bonus! Thank you.ReplyDelete
I love the soft colors of these cards--great job! This new release from Altenew is gorgeous.ReplyDelete
Very pretty! Thank you for sharing!ReplyDelete
These cards are beautiful in their simplicity. Thanks for sharing your ideas.ReplyDelete
Wow!! Absolutely Gorgeous cards! love all this fabulous soft colors. Thanks for the inspiration.
Gorgeous cards! Love the color combos you used! Lovely flowers and gradient lines die!ReplyDelete
Love the gradient dies and how you created a gradient background as well.ReplyDelete
BEAUTIFUL cards!
LOVE your designs, especially your use of the gradient lines and the negative bits ... definitely a MUST-HAVE with the MEGA words and MORE :)
I absolutely love what you did with the Gradient Lines die on the first two cards, especially turning it on the side for the second one.. Thank you for the inspiration!ReplyDelete
All your fabulous Altenew cards are making me want to shop something fierce. Lol. But really, though...these are amazing!ReplyDelete
I appreciate all of your comments! Comments are moderated so they may not show up right away. Thank you for taking the time to stop in!


text:
|Firebird Docset → Firebird Docwriters' Docs → Firebird Docwriting Guide
Table of Contents
This guide discusses the various aspects of writing documentation for Firebird. It is intended for people who want to help write documentation for the Firebird project, or who at least strongly consider to do so. After reading this guide, you'll have all the necessary knowledge to start writing Firebird docs in our chosen format DocBook XML.
Before reading this guide, check with yourself if you know:
What the Firebird manual module is.
What CVS is, and how to use a CVS client to download the current manual module.
How to build the current Firebird documentation from your downloaded manual module.
This knowledge is essential if you are going to contribute to our documentation project. If you feel unsure about one or more of these points, you should first read the Firebird Docbuilding Howto, and then come back here.
We start off with some short chapters about:
The firebird-docs mailing list.
Picking a subject.
Making an outline for your document-to-be.
After that we'll take some time to explain the basics of DocBook XML, because that's the format we'd like you to deliver your docs in. Topics discussed include:
DocBook XML – what is it?
Reasons why we prefer DocBook so strongly to other formats.
Tools you can use to produce DocBook texts.
Don't worry if DocBook doesn't mean anything to you yet: the required knowledge can be learned in less than an hour, and chances are that you will benefit from this knowledge in other projects too, whenever you have to write technical documentation.
The next part is about the actual docwriting:
Setting up the document itself.
Using DocBook elements.
A word or two on language and writing style.
Copyrights and the Public Documentation License.
Finally, we will show you how to add your finished doc to the Firebird project. Main topics in this section are:
Commiting your finished document to the manual module.
Where to ask for commit rights if you don't have them.
Dos and don'ts once you have received commit rights.
|Firebird Docset → Firebird Docwriters' Docs → Firebird Docwriting Guide


text:
You would like to try cloth period pads, but there's still something holding you back? Might that Read more
Grass/Rounds (grey,green)
Wet/dry bag
Wet/dry bag
This little handy wetbag has two separate pockets. You can use it for storing cloth pads, wipes or make-up.Go to full description
This bag is made from waterproof PUL fabric. There are two separate compartments -- the zippered, larger one for your used pads and a smaller one with a snap for the clean pads. The clean pad compartment will hold 4 day pads, the used pad compartment will hold approx. 6 day pads.
There is a handy button-up strap so you can hand it anywhere.
You can also use the wetbag for storing cloth wipes for your baby, its size and two separate pockets are ideal for this purpose.
Air+ is a unique fabric with a membrane with high breathability and water resistancy (breathability RET 10 Pa.m2/W, water resistency >10 000 mm). It is made in Europe (mostly in CZ) in a wide range of colours and prints exclusively for Anavy.
Due to hight breathability of the fabric, you can experience some wetness on the outside of the product. It is caused by the water vapour condensation and it is not a defect.
You would like to try cloth period pads, but there's still something holding you back? Might that Read more
Zajímá vás, odkud pochází materiály, které používáme ve výrobě?Read more


text:
OVERVIEW: What every practitioner needs to know
Are you sure your patient has pseudotumor cerebri? What are the typical findings for this disease?
The Pseudotumor Cerebri syndrome may be idiopathic or arise from a secondary cause. Prompt diagnosis and treatment are needed to prevent permanent visual loss.
Most common: Headaches (often with nausea and vomiting), transient visual obscurations, diplopia
Continue Reading
Next most common: shimmering lights, visual loss, pulsatile tinnitus, neck pain, back pain, torticollis, ataxia
Some children are asymptomatic with papilledema discovered on a routine eye examination
Most common: Papilledema (Figure 1,
Figure 2, Figure 3, Figure 4), visual acuity loss, visual field loss, esotropia, abducens palsy
Next most common: Stiff neck, cranial nerve palsies (III, IV, VII, XII), torticollis, ataxia, enlarged and poorly reactive pupils
What other disease/condition shares some of these symptoms?
Medication-induced pseudotumor cerebri (see medications below)
Impaired cerebral venous outflow: cerebral venous sinus thrombosis, jugular vein thrombosis
Meningitis (infectious, inflammatory, malignant)
Brain tumor
Chronic migraine
Chronic tension-type headache
Post traumatic increased intracranial pressure
What caused this disease to develop at this time?
Incidence 1/100,000 in the general population
More common in children over age 10
Prior to puberty, boys and girls are equally affected
Girls are more frequently affected after puberty
Predisposing factors:
Obesity, particularly in adolescents
Polycystic ovarian syndrome
Medications: Vitamin A, tetracycline/minocycline/doxycycline, human growth hormone, corticosteroid withdrawal, thyroxine replacement, levonorgestrel implants, desmopressin nasal spray
No known genetic abnormality although familial cases have been reported
What laboratory studies should you request to help confirm the diagnosis? How should you interpret the results?
Lumbar puncture with opening pressure measurement following neuroimaging: There is a wide variation of normal opening pressure in children. Pressures greater than 280 mm CSF are considered abnormally elevated and suspicious for pseudotumor cerebri. Unless the child develops a post-spinal headache, the headache and other symptoms often improve (at least transiently) after the lumbar puncture. The cerebrospinal fluid contents (glucose, protein, cell count) should be normal. CSF cytology and other testing may be warranted on the diagnostic lumbar puncture.
Ophthalmological exam, including perimetry if the child is able to perform it. The important aspects of the examination are best corrected visual acuity, pupillary reactions, ocular motility, visual field testing and examination of the optic fundus. Visual acuity is generally preserved initially; loss of central acuity at presentation warrants aggressive management. A relative afferent pupillary defect indicates asymmetrical optic neuropathy; large and sluggishly dilated pupils are often present in the setting of severe visual loss. An enlarged physiologic blind spot is the most common visual field defect and is sometimes symptomatic. Other visual field abnormalities include inferonasal field loss, generalized constriction, and inferior or superior arcuate defects. A central scotoma generally accompanies loss of central visual acuity.
Automated perimetry has been successfully performed in children as young as age 4 but is often unsuccessful in children under age 12. Goldmann perimetry is often successfully performed when automated perimetry is not possible.
The lumbar puncture should be performed with the child in the lateral decubitus position with legs extended. Sedation, although often required in younger children, should be avoided when possible to avoid false elevation of the cerebrospinal fluid pressure reading. The subarachnoid space may need to be entered with the patient in the sitting position in very obese children; however, the patient must be moved to the lateral decubitus position to measure the opening pressure.
If the pressure is elevated, remove enough cerebrospinal fluid to bring the pressure into the normal range (approximately 150-170 mm CSF). It is possible to develop a post-spinal headache after the lumbar puncture, so over-drainage is not generally recommended.
Would imaging studies be helpful? If so, which ones?
Neuroimaging: magnetic resonance imaging (MRI) of the brain with and without gadolinium, magnetic resonance (MR)-venogram. MRI may be normal or show cerebellar tonsillar descent, empty sella, distention of perioptic subarachnoid space, protrusion of optic nerve papilla into the vitreous, flattening of posterior sclerae. MR venogram may reveal transverse sinus stenosis.
Computed tomography (CT) of the brain with contrast may be performed, but sagittal views are less satisfactory than MRI, and radiation exposure occurs with CT.
Confirming the diagnosis
See attached algorithm (Figure 5). There are no randomized, clinical trials upon which to base treatment guidelines.
If you are able to confirm that the patient has pseudotumor cerebri, what treatment should be initiated?
Note: No randomized, controlled clinical trials have been performed. Recommendations are based on experience, case series, and generally accepted standards of care. Medical and surgical treatment options are summarized in Table I.
Discontinue causative agent if applicable, then treat as follows:
Mild visual loss
Acetazolamide 15 mg/kg/day in 2-3 divided doses or methazolamide
Weight loss if child is overweight
Moderate visual loss
Acetazolamide 15 mg/kg/day in 2-3 divided doses or methazolamide
Repeat lumbar puncture(s)
Topiramate (1.5-3 mg/kg/day in 2 divided doses) may be helpful if there is prominent headache
Weight loss if the child is overweight
Severe visual loss
Optic nerve sheath fenestration and/or
Lumboperitoneal or ventriculoperitoneal shunt
Acetazolamide 15 mg/kg/day in 2-3 divided doses IV or PO
Adjunctive or temporizing treatments: repeated lumbar punctures, lumbar drain, corticosteroids
Long-term treatments
Weight loss of at least 6% total body weight if child is overweight. Excessive weight gain is associated with disease recurrence
Continue acetazolamide or methazolamide
Headache management if acetazolamide not effective
Amitriptyline or nortriptyline (monitor for weight gain)
Allergy or intolerance of acetazolamide
Methazolamide (50-100 mg BID – TID)*
Furosemide (2 mg/kg/day, may gradually increase to 6 mg/kg/day as needed)
(* There is little experience with these agents in treating children)
Table I.
|15 mg/kg/day in 2-3 divided doses.Starting dose in adolescents 1 gm daily in 2-4 divided doses (maximum 4 gm daily)
|Likely mechanism of action is decreased CSF secretion by choroid plexus mediated by carbonic anhydrase inhibition. May improve headaches.May be given IV.
|Common side effects: paresthesias, altered taste sensation, fatigue, gastric upsetRare side effects: Elevated liver function tests, renal stones, allergyNOTE: Allergy to sulfa antibiotics is not a contraindication to acetazolamide use
|25 BID up to 100 mg TID (Dosage not established in children)
|Proposed mechanism similar to acetazolamide.May be better tolerated than acetazolamide although generally not used first-line
|Same as acetazolamide
|1.5 – 3 mg/kg/day in 2 divided doses
|Mild carbonic anhydrase inhibition. Efficacy for visual loss not established.Most beneficial for patients with headache as major manifestation. May be used concurrently with acetazolamide in low doses.
|Common side effects: Paresthesias, fatigue, gastric upset, weight lossUncommon side effects: cognitive dysfunction, alopecia.Rare side effects: Renal stones, hypohidrosis, allergy.May interfere with oral contraceptive efficacy in doses over 200 mg/day
|2 mg/kg/day starting dose, increase gradually to 6 mg/kg/day if needed
|Inhibits CSF secretion at choroid plexus. More potent systemic diuretic than acetazolamide.
|Requires electrolyte monitoring for hypokalemia
|Well tolerated, potassium-sparing diuretic.
|No known action at choroid plexus
|Well tolerated, potassium-sparing diuretic
|No known action at choroid plexus
|Lumbar drain
|May be used to monitor pressure when diagnosis uncertain.May be used to urgently or temporarily lower CSF pressure if definitive surgery not possible
|Incorrect placement, catheter migration or occlusion may preclude functioning system.Rare complications: infection, radiculopathy
|Optic nerve sheath fenestration
|Preferred treatment for patients with visual loss as major morbidity.May be performed unilaterally or bilaterally.Generally halts or reverses visual loss.Unilateral surgery may improve vision in both eyes.Well tolerated and no hardware required.Should not be performed primarily for treatment of headache, although headaches often improve after surgery.
|Requires experienced oculoplastic surgeon.Common side effects: ocular discomfort, diplopia (usually transient), eyelid edemaRare side effects: worsened vision or blindness
|Ventriculoperitoneal shunt
|Immediately lowers CSF pressure.Treats headaches and visual loss, assuming patent and contiguous perioptic subarachnoid space.
|Stereotactic placement may be needed as the procedure is technically difficult in the presence of normal-sized ventricles.Common complications: Shunt failure is common and may occur at any time.Shunt revision may be required as the child grows.Rare complications: intracranial hemorrhage, shunt migration, infection, abdominal complications from distal catheter
|Lumboperitoneal shunt
|Same as ventriculoperitoneal shunt
|Technically easier to perform in non-obese patient.Common complications: shunt failure is common and may occur at any time.Rare complications: Radicular pain, acquired Chiari malformation from over-shunting, infection, abdominal complications from distal catheter
What are the adverse effects associated with each treatment option?
Please refer to Table I.
What are the possible outcomes of pseudotumor cerebri?
Most children with mild-to-moderate optic nerve swelling and visual field defects have resolution of their condition with prompt diagnosis and treatment. Papilledema resolves in 4.7 months, on average, in the pediatric population. Permanent visual acuity loss occurs in up to 10% of cases, with permanent visual field loss in 17%. Profound visual loss, including blindness may occur; most cases of fulminant IIH are associated with high-grade papilledema, early loss of visual acuity, and rapid progression despite medical intervention. Recurrence rate is 6%-22% and is associated with weight gain.
What will you tell the family about prognosis?
The most worrisome complication of idiopathic intracranial hypertension (IIH) is visual loss; the efforts to treat IIH are primarily directed at preserving vision. Although most children do well, a small percentage will lose vision despite our best efforts. It important for the child to take medications as prescribed and return for follow-up visits. Management is directed by the visual status; the treatment team incorporates a neurologist, an ophthalmologist (or neuro-ophthalmologist), pediatrician and possibly other specialists (e.g., endocrinologist, neurosurgeon). Any perceived worsening of vision should be investigated immediately.
There is some evidence that pubertal children are at higher risk for a poor visual outcome than younger children. The child should avoid eating foods with a high salt content. He/she should avoid taking vitamin A and related medications, many of which are used to treat acne. If the child is overweight, weight loss must be achieved and maintained. The child will probably not require life-long treatment. In most cases, the medications can be tapered and discontinued once it is certain that the optic disc swelling has resolved and there is no evidence of recurrence. Some children will continue having headaches even though the disease is controlled; they are generally managed medically.
What will you tell the family about the risks-benefits of treatment?
The medications used to treat IIH all have side effects, which are usually tolerable. Acetazolamide (off-label use) commonly produces tingling in the extremities and makes carbonated beverages taste bad. It may also cause stomach upset and fatigue. Some children are allergic to it (watch for skin rash).
If acetazolamide cannot be used, other diurectics may be effective. Topiramate may be helpful for headache prevention (off-label use). Surgical procedures are employed when vision is threatened. Shunts often fail in the long term; one should have a shunt placed with the expectation that it will need to be replaced at least once in the future. Therefore, shunts are not generally recommended for the treatment of headache. Optic nerve sheath decompression carries a low risk of visual loss, but is generally effective for reversing visual loss or stabilizing vision.
What causes this disease and how frequent is it?
The disorder may occur at any age. It most frequently occurs in obese females of childbearing age. Obesity is less frequently encountered In prepubertal children with pseudotumor cerebri.
No infectious agents are known. Symptoms may occasionally follow a viral illness or mild head trauma.
Pseudotumor cerebri has been associated with the following medications: Vitamin A, isotretinoin, tetracycline, minocycline, doxycycline, human growth hormone, corticosteroid withdrawal. Less frequent associations include lithium, thyroxine supplementation, anabolic steroids (body building), chlordecone, levonorgestrel implants, desmopressin nasal spray.
Polycystic ovarian syndrome is associated with pseudotumor cerebri. It is rarely reported with Addison disease. No definite association exists with oral contraceptives or pregnancy.
There is no known genetic component. Familial cases have been reported but it is uncertain whether there is truly a genetic factor versus other factors common among family members (e.g., obesity).
How do these pathogens/genes/exposures cause the disease?
It is unknown how these pathogens/genes/exposures cause increased intracranial pressure.
Other clinical manifestations that might help with diagnosis and management
What complications might you expect from the disease or treatment of the disease?
Complications from the disease:
Permanent visual loss, visual field loss, rarely legal or complete blindness
Double vision (usually correctable by strabismus surgery)
Depression and anxiety
Missed school days from disease-related disability and appointments
Complications from the treatment:
Shunt failure requiring revision
Side effects of medication (See Table I)
Small risk of worsening vision following optic nerve sheath fenestration
Are additional laboratory studies available; even some that are not widely available?
How can pseudotumor cerebri be prevented?
It is uncertain why some children develop increased intracranial pressure in response to various medications or weight gain when most children do not. There are no known effective preventive measures.
What is the evidence?
Avery, RA, Shah, SS, Licht, DJ. "Reference range for cerebrospinal fluid opening pressure in children". NEJM. vol. 363. 2010. pp. 891-3. (Perhaps the most important study related to IIH. One hundred nintey-seven children without infection, inflammation or ischemia having a lumbar puncture for their clinical care were studied prospectively to determine a threshold for abnormally elevated opening pressure [90th percentile or higher]. The threshold for abnormal opening pressure was 28 cm of water. Subjects having the procedure done using moderate to deep sedation had a slighter higher opening pressure than those performed without sedation. There was a small relationship between BMI and opening pressure.)
Avery, RA, Licht, DJ, Shah, SS. "CSF opening pressure in children with optic nerve head edema". Neurology. vol. 76. 2011. pp. 1658-61. (In a follow-up study to the above study by the same group, 41 opening pressure measurements were obtained on 33 subjects with optic nerve head edema and no evidence of infection, inflammation or ischemia. The mean pressure was 41.4 cm CSF (range 22-56) compared to control subjects (mean 18.9, range 9-29). Forty of the 41 patients with optic nerve head edema had opening pressures > 28 cm CSF, supporting the conclusions of the previous study.)
Balcer, LJ, Liu, GT, Forman, S. "Idiopathic intracranial hypertension: relation of age and obesity in children". Neurology. vol. 52. 1999. pp. 870-2. (This retrospective study of 45 consecutive children with newly diagnosed IIH showed that younger children were less likely to be obese than older children [43% of ages 3-11 years, 81% of 12-14 year-olds, 91% of 15-17 year olds].)
Weig, SG. "Asymptomatic idiopathic intracranial hypertension in young children". J Child Neurol. vol. 17. 2002. pp. 239-41. (Case series of children diagnosed with IIH after finding asymptomatic papilledema on a routine eye exam.)
Ko, MW, Liu, GT. "Pediatric idiopathic intracranial hypertension (pseudotumor cerebri)". Horm Res Paediatr. vol. 74. 2010. pp. 381-9. (Review of IIH diagnosis and treatment in children [Note that normal values for opening pressure on lumbar puncture were established after this paper was published].)
Tibussek, D, Schneider, DT, Vandemeulebroecke, N. "Clinical spectrum of the pseudotumor cerebri complex in children". Childs Nerv System. vol. 26. 2010. pp. 313-21. (Retrospective series of 53 patients, including symptoms, characterization of headaches, CSF pressure, treatment, comorbidities and medications at presentation. This article emphasizes the heterogeneous nature of the disorder.)
Stiebel-Kalish, H, Kalish, Y, Lusky, M. "Puberty as a risk factor for less favorable visual outcome in idiopathic intracranial hypertension". Am J Ophthalmol. vol. 142. 2006. pp. 279-83. (The authors analyzed outcome data for 96 patients [prepubertal, pubertal, teenage, adult], incorporating medical risk factors commonly associated with a poor prognosis [hypertension, renal failure, anemia]. Puberty was significantly associated with a moderate to poor visual outcome, compared with the other age groups.)
Thuente, DD, Buckley, EG. "Pediatric optic nerve sheath decompression". Ophthalmology. vol. 112. 2005. pp. 724-7. (Visual outcomes from 17 eyes in 12 children under age 16 years were retrospectively evaluated following optic nerve sheath fenestration. All patients had improvement in disc edema with improvement or stabilization of acuity in all surgical eyes. No patient had visual loss, infection or strabismus. One patient required a lumboperitoneal shunt and 2 required acetazolamide therapy postoperatively. Five patients subsequently had the procedure performed in the other eye.)
Soiberman, U, Stolovitch, C, Balcer, LJ. "Idiopathic intracranial hypertension in children: visual oucome and risk of recurrence". Childs Nerv Syst. vol. 27. 2011. pp. 1913-8. (A retrospective study of 90 children under age 18 with a mean follow-up of 30.65 months showed an improvement in visual acuity overall. The highest risk of recurrence was within the first 18 months after diagnosis.)
Ongoing controversies regarding etiology, diagnosis, treatment
There are no randomized clinical treatment trial results to guide therapy in children or adults. Therefore, many controversies exist:
Which surgical treatment is best: shunting or optic nerve sheath fenestration?
What is the correct dose of acetazolamide?
What is the role for venous sinus stenting in the treatment of IIH?
There are many obese children and adults in the world – why is IIH a rare disease?
If IIH is associated with weight gain and venous hypertension, why isn't it more common during pregnancy?
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
- OVERVIEW: What every practitioner needs to know
- Are you sure your patient has pseudotumor cerebri? What are the typical findings for this disease?
- What other disease/condition shares some of these symptoms?
- What caused this disease to develop at this time?
- What laboratory studies should you request to help confirm the diagnosis? How should you interpret the results?
- Would imaging studies be helpful? If so, which ones?
- Confirming the diagnosis
- If you are able to confirm that the patient has pseudotumor cerebri, what treatment should be initiated?
- What are the adverse effects associated with each treatment option?
- What are the possible outcomes of pseudotumor cerebri?
- What causes this disease and how frequent is it?
- How do these pathogens/genes/exposures cause the disease?
- Other clinical manifestations that might help with diagnosis and management
- What complications might you expect from the disease or treatment of the disease?
- Are additional laboratory studies available; even some that are not widely available?
- How can pseudotumor cerebri be prevented?
- What is the evidence?
- Ongoing controversies regarding etiology, diagnosis, treatment


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NEW YORK, NY – 50 Cent announced today that he is going on tour with Keenan Cahill.
For those of you who have being living under a rock for the past few months, Keenan Cahill is one of the few, the proud, the Youtube superstars. 16 year old Keenan's rise to fame came as a result of his desire to video himself lip-synching various pop songs and posting them on Youtube under the handle, BeenerKeeKee19952.
Keenan has now built up an enormous roster of songs, lip-synching hits such as Michael Jackson's Thriller, Lady Gaga's Telephone, Jersey Shore's very own DJ Pauly D's Beat Dat Beat, and just recently Landry Fields and Andy Rautins of the New York Knicks teamed up with Keenan to perform a "GO NY GO" remix. Like most Youtube postings, it started off as a hobby.
Then Keenan's world turned upside down when Katy Perry became aware of his rendition of her smash hit Teenage Dream, tweeting "I heart you @KeenanCahill" and further tweeting "THIS… is my Teenage Dream." Perry linked Keenan's video to the tweet and well, the rest is history.
Since Katy took notice, Keenan has appeared on Chelsea Lately and at the end of last year Keenan made a game changing video, lip-synching 50 Cent's Down On Me with a special guest appearance form none other than the superstar himself, 50 Cent. The video to date has garnered over 24 million views in its short life online.
Word on the street is that 50 was so impressed with Keenan's moves and charm that he has requested that the young internet sensation accompany him on an upcoming tour, that is, as long as Keenan's mom gives her approval.
The tour will be in support of 50's long awaited 5th studio album, Black Magic, which is slated to be released this summer. It should come as little surprise that 50 would consider including Keenan on the tour.
Recently, when asked about the new album, 50 stated, "I'm not sure if I'll make a full mixtape [beforehand]. That's what I was doing when I was making collaborations with new artists: I was working with artists that wouldn't exactly be my equal because they don't have a successful track record. But at some point you have to make the decision to just be an artist and work because you enjoy the music and you think it's a good idea, as opposed to it being someone of your caliber."
Who knows, maybe Keenan will even be a featured artist in one of his new songs. One thing's for sure, he is bound to be in a video.
NEW YORK, NY – 50 Cent announced today that he is going on tour with Keenan Cahill.


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NEW YORK (AP) ? Even if Congress approves a deal to raise the federal government's debt ceiling, the U.S. could still lose its coveted AAA debt rating sometime in the next six months, largely because the proposed agreement does not cut enough spending.
The three main ratings agencies declined to comment Monday on the prospect of future downgrades. But the agencies, along with economists and analysts, have signaled that doubts about the nation's debt will persist.
Moody's Investors Services has said it will probably rate the U.S. debt as AAA for now but with a negative outlook ? a rating that indicates a possible downgrade yet to come.
Fitch Ratings has indicated the deficit must be reduced to a "more sustainable level" for the U.S. to maintain its AAA rating. And Standard & Poor's has said any deal to raise the debt ceiling must cut at least $4 trillion from future budget deficits or the rating will probably be lowered to AA.
The proposal crafted by Obama and congressional leaders cuts only about half that amount, which led at least one expert to suggest that S&P could still downgrade the rating as early as next month.
"The details (of the deal) don't look as pretty as the headlines," said Guy LeBas, chief fixed income strategist at Janney Montgomery Scott.
Ratings agencies probably won't look favorably on the fact that most of the spending cuts in the current plan won't be made until after 2013, LeBas said.
"That means you're waiting longer to do the saving, and you would have accumulated more debt," LeBas said. And if the deal is passed, but only by a slim margin, it might indicate to the rating agencies that lawmakers "will reverse or water down the measures" in the future. Both could be the catalyst for a downgrade, he said.
Avalon Partners chief economist Peter Cardillo believes there is a 70 percent chance of the U.S. being downgraded to a AA credit rating within the next six months, as more details of the spending cuts emerge.
But both Cardillo and LeBas said a downgrade ? once considered highly unlikely and catastrophic ? might not be that bad for the U.S.
A credit rating downgrade usually leads to higher interest rates, said Kim Caughey-Forrest, senior stock research analyst at Fort Pitt Capital Group. That would make it more expensive for governments, companies and consumers to borrow money. The 10-year Treasury note is considered the floor for all other interest rates, so higher rates could raise borrowing costs on everything from mortgage loans to credit cards.
But the conventional wisdom that rates will rise sharply on a downgrade might not hold up. A study released last week by JPMorgan Chase bond strategists points to a more gradual increase.
The study showed just a slight increase in lending rates when countries lose their AAA rating. In May 1998, S&P knocked Belgium, Italy and Spain from AAA to AA. A week later, 10-year rates had barely budged. In some cases, rates actually fell. A week after S&P took Ireland's AAA rating away in March 2009, 10-year rates in that country fell 0.18 percentage points.
Analysts and bond traders are not convinced rates will rise much if the U.S. loses its AAA rating. Caughey-Forrest and others note the recent high demand ? and the resulting falling yield ? for Treasurys.
Global investors still consider U.S. debt one of the safest investments. Many mutual funds, money market funds and banks find U.S. debt so safe they hold Treasurys as a proxy for cash. And they've continued to do so, despite the threat of a debt default and a downgrade.
The yield on the 10-year Treasury note was at or below 3 percent in July and dropped to 2.75 percent on Monday, an eight-month low.
A downgrade could spur a "quick jolt of nervous, knee-jerk selling" of bonds, LeBas said. Some money-market funds could be forced to sell U.S. government debt if they require client money to be invested in only AAA-rated debt. The combination would likely cause yields on Treasurys to rise in the short term, said Brad Hintz of Bernstein Research.
LeBas expects yields on 10-year Treasurys to jump above 3.5 percent this year ? not a level traders consider to be a significant increase. When the recession began in December 2007, yields were as high as 4.20 percent.
But Hintz, LeBas and others said demand for Treasurys will return quickly, sending yields back down.
"A downgrade won't frighten foreign buyers away because this is the largest market and there's no other place to go," Cardillo said.
Treasurys have a solid appeal for the world's central banks. China's central bank holds an estimated $1.16 trillion. Japan, the second largest foreign owner, holds $912 billion.
And at $9.3 trillion, the U.S. government bond market is massive compared to other countries. Treasurys are also considered the easiest security to buy and sell quickly. Daily trading of Treasurys runs at $580 billion, far higher than British gilts ($34 billion) or German bunds ($28 billion), according to a recent study by Fitch.
"I think no matter what happens, Treasurys are the safe haven," said Dan Greenhaus, chief global strategist at the brokerage BTIG in New York. "No other market is as large or as liquid."


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Olympic gymnasts Ross and Kocian: we were abused by Nassar
BOSTON (AP) — Madison Kocian and Kyla Ross watched the women they won Olympic gold with step forward one by one over the last 18 months to detail their abuse at the hands of disgraced former USA Gymnastics national team doctor Larry Nassar.
The more their Olympic teammates talked, the more Kocian and Ross began to examine their own interactions with Nassar. Over time they realized their experience mirrored those of hundreds of other women who were abused by Nassar under the guise of treatment. They realized they hadn't been spared but instead were victims, too.
It took months for them to process and even longer to go public. Yet they're doing it now — months after Nassar was sentenced to an effective life sentence after being convicted of federal child pornography and state sexual abuse charges — to both help themselves heal and to send a message to victims of sexual abuse everywhere that there is no timetable on coming to grips with the trauma and it's never too late to speak up and say "hey, me too."
"Everyone copes in their own way," said Ross, a member of the "Fierce Five" that stormed to gold at the 2012 Olympics.
"It doesn't matter how old you are and what happens to you. I've come to the point in my life this is something I want to share my story and move on," Ross told The Associated Press.
Ross and Kocian, a member of the "Final Five" that won team gold at the 2016 Olympics, have retired from elite gymnastics and now compete collegiately as teammates at UCLA. They both say they were in denial about their abuse. The turning point came in January as they watched nearly 200 women come forward to read victim impact statements to Nassar.
The group included Jordyn Wieber, who competed alongside Ross at the 2012 London games and now serves as an assistant coach with the Bruins. Until she stood in front of Nassar, Wieber had never spoken publicly about her abuse. Ross and Kocian both leaned on her before deciding to join the army of survivors.
"Just seeing the process through her view had helped me find my voice and be confident in myself and realize I was a victim," Ross said. "But we don't want to be viewed as victims. This is something we have to grow through. Now we're just trying to find our voice and help."
All five members of the 2012 Olympic team — Ross, Wieber, Aly Raisman, Gabby Douglas and McKayla Maroney — have revealed they were abused by Nassar. Kocian is the fourth member of the 2016 Olympic team to come forward, joining Raisman, Douglas and Simone Biles. Ross and Kocian have both filed civil lawsuits against Michigan State — where Nassar worked for decades — and plan to do the same against the United States Olympic Committee and USA Gymnastics.
They place part of the blame for their abuse on what they described as a toxic culture around the USA Gymnastics elite program that allowed Nassar's treatment to run unchecked.
Ross described getting a "pit" in her stomach every time she visited the Karolyi Ranch near Houston that served as the longtime training home for the senior national team. Kocian felt she and her teammates were "voiceless" thanks in part to the tone set by former national team coordinator Martha Karolyi. Karolyi retired in 2016.
"You live under a fear of not being able to speak up because this was our only avenue to accomplish our dreams and make the Olympic team," Kocian told the AP.
Both women, now 21, stepped away from elite competition following the 2016 Olympics. While there has been significant change within USA Gymnastics over the last two years, including a new president and board of directors, they'd like to see more.
"There are still people at the top that I feel have overseen this issue for a long time and I think that needs to be changed as well as the whole culture around everything," Kocian said. "I don't think enough has been changed from the coaching standpoint. There are still coaches under that abusive style of coaching whether it's verbal abuse, that's what enables all of this."
USA Gymnastics said in a statement it is "heartbroken" that Ross and Kocian are among Nassar's victims, adding "their powerful voices and stories will continue to be a basis for our future decisions."
Kocian or Ross, who helped UCLA to an NCAA title last spring, have no plans to return to elite competition. Kocian described a lack of empathy from USA Gymnastics throughout her career as part of the problem.
"Possibly if maybe more people had reached out to my parents to see if I was OK when so many people knew about this and they went through whole Olympic Games knowing and not doing anything," Kocian said. "Even to this day have heard nothing support wise from them. I think my decision might have been different (otherwise)."
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