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A multicenter study was conducted to assess the interlaboratory reproducibility of broth microdilution testing of the more common rapidly growing pathogenic mycobacteria. Ten isolates (fourMycobacterium fortuitum group, three Mycobacterium abscessus, and three Mycobacterium chelonae isolates) were tested against amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, sulfamethoxazole, and tobramycin (M. chelonae only) in four laboratories. At each site, isolates were tested three times on each of three separate days (nine testing events per isolate) with a common lot of microdilution trays. Agreement among MICs (i.e., mode ± 1 twofold dilution) varied considerably for the different drug-isolate combinations and overall was best for cefoxitin (91.7 and 97.2% for one isolate each and 100% for all others), followed by doxycycline, amikacin, and ciprofloxacin. Agreement based on the interpretive category, using currently suggested breakpoints, also varied and overall was best for doxycycline (97.2% for one isolate and 100% for the rest), followed by ciprofloxacin and clarithromycin. Reproducibility among MICs and agreement by interpretive category was most variable for imipenem. Based on results reported from the individual sites, it appears that inexperience contributed significantly to the wide range of MICs of several drugs, especially clarithromycin, ciprofloxacin, and sulfamethoxazole. New interpretive guidelines are presented for the testing of M. fortuitum against clarithromycin; M. abscessus andM. chelonae against the aminoglycosides; and all three species against cefoxitin, doxycycline, and imipenem.
The rapidly growing pathogenic mycobacteria Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum (and related species) cause several forms of clinical disease of varying severity, most commonly skin and soft tissue infections but also skeletal, pulmonary, and disseminated disease (1, 5-7, 15, 16, 19,20). Data from several studies have shown that these species vary in susceptibility to antimicrobial agents useful for therapy (1,2, 4, 5, 11-15, 17, 20). For this reason, antimicrobial susceptibility testing of isolates considered clinically significant is recommended. Various methods of testing susceptibility of the rapidly growing mycobacteria have been described, including agar disk elution, broth microdilution, and the E-test (2, 3, 11, 17). Currently, however, no standardized testing method for this group of organisms exists, nor has the interlaboratory reproducibility of any method been assessed. The primary goal of the present multicenter study was to evaluate the broth microdilution method for its ability to provide reproducible MIC endpoints and interpretive categories in several laboratories with different levels of experience with susceptibility testing of rapidly growing mycobacteria. A secondary goal was to identify a clinical isolate of one of these rapidly growing mycobacteria that would be an acceptable quality control organism for the microdilution test.
Organisms.Ten clinical isolates, previously studied at the University of Texas Health Center in Tyler, were selected for testing. Of the four M. fortuitum group isolates (three M. fortuitum and one Mycobacterium peregrinum), one (1353) was chosen because of its susceptibility to tetracyclines and the low clarithromycin MIC for it, a second (1359) was chosen because of the low clarithromycin MIC for it, a third (1351) was chosen because the clarithromycin endpoint was indeterminate (i.e., trailing), and a fourth (1352) was chosen because the clarithromycin MIC for it was high. Of the three M. chelonae isolates, one (1866) was chosen because it had mutational resistance to clarithromycin (18) and one (1814) was chosen because it was susceptible to tetracyclines but only moderately susceptible to tobramycin. Of the three M. abscessus isolates, one (1802) was chosen because it had mutational resistance to clarithromycin (18). The remaining isolates were selected because the MICs for them were typical of their species based on previous broth MIC results. Isolates on trypticase soy agar slants were mailed from the University of Texas Health Center at Tyler to the other three participating sites, where they were maintained at room temperature until tested.
Antimicrobial agents and microdilution trays.The antimicrobial agents evaluated were amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, sulfamethoxazole, and tobramycin (against M. chelonae only). A single lot of dried and sealed MIC trays containing twofold serial dilutions of each drug was provided by Trek Diagnostics (formerly AccuMed International, Inc., Westlake, Ohio). The final concentration ranges were 1 to 128 μg/ml for amikacin, 2 to 256 μg/ml for cefoxitin, 0.125 to 16 μg/ml for ciprofloxacin, 0.03 to 64 μg/ml for clarithromycin, 0.25 to 32 μg/ml for doxycycline, 1 to 64 μg/ml for imipenem and sulfamethoxazole, and 1 to 16 μg/ml for tobramycin. Each tray also contained a positive growth control well. The trays were stored at ambient temperature until they were used in the study.
Inoculum preparation.Each isolate was subcultured once onto a common lot of sheep blood agar plates provided by Remel (Lenexa, Kans.) and incubated in ambient air at 30°C for 72 h. Inocula were prepared by swabbing the confluent portion of growth on the blood agar plate with a sterile cotton swab. Growth on the swab was transferred to a tube containing 4.5 ml of sterile water and glass beads (Trek Diagnostic Systems), and the turbidity was adjusted until it matched that of a 0.5 McFarland standard by visual examination or by using a nephelometer. The growth suspensions were mixed vigorously on a vortex mixer for 15 to 20 s. The final inoculum (approximately 5 × 105 CFU/ml) was prepared by transferring 50 μl of the suspension to a tube containing 10 ml of cation-adjusted Mueller-Hinton broth (Trek Diagnostic Systems) and inverting the tube 8 to 10 times prior to use.
Susceptibility test method.Broth microdilution MIC testing was performed within 30 min after final inoculum preparation as described by Brown et al. (3). Final inoculum suspensions were poured into plastic troughs (Trek Diagnostic Systems), and 100-μl aliquots were transferred to each well of the MIC tray with a multichannel pipettor. The inoculated trays were covered with an adhesive seal and incubated at 30°C in ambient air. A blood agar plate was also inoculated with a loopful of the final inoculum to check for purity. The trays were first examined after 72 h. If growth (appearing as turbidity or a deposit of cells at the bottom of the well) in the growth control well was sufficient (i.e., at least 2+, based on the following scale: ± to 1+ growth, a few flecks in the bottom of the well; 2+, moderate growth for the particular species in the well; and 3+ to 4+, a readily visible button in the bottom of the well), the MICs were recorded. Otherwise, the trays were reincubated and read daily thereafter (for up to 5 days) until moderate growth was visible. For all but sulfamethoxazole, the MIC was recorded as the lowest concentration of a drug that inhibited visible growth. For sulfamethoxazole, the endpoint or MIC was defined as the concentration of the drug in the well with approximately 80% inhibition of growth compared to the growth in the control well with no drug. Susceptible and resistance breakpoints are listed in Table1 (3).
Quality control. Staphylococcus aureus ATCC 29213 andPseudomonas aeruginosa ATCC 27853 were tested at each site at the beginning of the study. Quality control was considered acceptable if the results were within ranges recommended by the National Committee for Clinical Laboratory Standards (NCCLS) (8a).
Study design and analysis.Four laboratories participated in the study; one had extensive experience with susceptibility testing of rapidly growing mycobacteria (site A), one had some experience (site B), and two (sites C and D) had no experience. The testing personnel at site D also had very limited experience with the microdilution method in general. Before testing was begun, personnel at site A reviewed the MIC procedure and interpretation of the results with the other sites via conference call to ensure standardization of the protocol. During the study, testing personnel at sites B, C, and D consulted personnel at site A if questions about the test procedure or interpretation arose.
All laboratories tested each isolate three times on each of three separate days. The MIC results and day of reading were recorded on data sheets and mailed to a coinvestigator (M.P.) for entry into a database. Each test at each site was considered a separate result. Agreement was determined by calculating the percentage of MICs within a three-dilution range (i.e., mode ± 1 twofold dilution) for each drug. For the one isolate-drug combination for which there was no clear modal MIC (i.e., M. fortuitum 1359 and sulfamethoxazole), agreement was the three-dilution range that encompassed the largest number of MICs reported. High off-scale MICs were converted to the next-highest concentration, whereas low off-scale MICs were left unchanged. The breakpoints for determining susceptibility and resistance (Table 1) are modified from those suggested by Brown et al. (3).
The day on which the MICs were considered interpretable differed among the sites. At site A, which had the most experience with testing the rapidly growing mycobacteria, all MICs were read on day 3, and at site B, all were read on day 4. At site C, most MICs were read on day 4 but a few were read on day 5, and at site D, about half were read on day 4, most of the other half on day 5, and a few on day 3.
In general, the MICs for the organisms tested in this study were similar to those previously reported by other investigators (Table2) (4, 9, 11-15). Tables3 through5 summarize the microdilution MIC results of the seven antimicrobial agents tested for M. abscessusand M. fortuitum and the eight drugs tested for M. chelonae and the percent agreement among the four participating laboratories. Agreement varied considerably for the different isolate-drug combinations. Overall, agreement was best for cefoxitin, ranging from 97.2 to 100% for all isolates except M. fortuitum 1359, for which there was 91.7% agreement. Agreement also was excellent for doxycycline (97.2 to 100%) for all isolates except M. chelonae 1814, for which agreement was 61.1%. For amikacin and ciprofloxacin, agreement was good to excellent for isolates of the M. fortuitum group (100% for amikacin and 97.2 to 100% for ciprofloxacin) and M. abscessus (amikacin, 97.2 to 100%; ciprofloxacin, 91.7 to 100%) but was much lower for the isolates of M. chelonae (66.7 to 97.2% for amikacin and 66.7 to 94.4% for ciprofloxacin). For tobramycin, agreement was excellent (94.4 to 100%) for all isolates of M. chelonaeexcept one (77.8% agreement). Agreement was excellent for sulfamethoxazole and M. abscessus (97.2 to 100%) and good for M. chelonae (91.7 to 97.2%) but was poor, ranging from 41.7 to 86.1%, for isolates of the M. fortuitum group. For clarithromycin, agreement was excellent (97.2 to 100%) for two isolates each of M. abscessus and M. chelonae, including the isolates (1802 and 1866) with known mutational resistance to the drug, but was much lower for all isolates of the M. fortuitum group (27.8 to 88.9% agreement). For all other isolate-drug combinations, agreement varied widely, and in over half of the cases, it was less than 80%.
To assess the potential impact of the variability in MIC results on patient management, we also evaluated percent agreement based on the interpretive category (Table 6). Again, agreement varied considerably, but the results were different from those based on MIC values. Agreement was excellent for doxycycline (97.2 to 100%); it was >94% for ciprofloxacin and 9 of the 10 isolates and was 100% for clarithromycin and 8 isolates. For the aminoglycosides, agreement was 100% for the M. fortuitumgroup but varied from 50 to 100% for M. abscessus andM. chelonae. Agreement was lowest with imipenem.
Further analysis of the data revealed some possible reasons for the broad MIC ranges, poor agreement by interpretive category, or both for certain isolate-drug combinations. For sulfamethoxazole, MICs that were lower (isolates 1801 and 1814) and higher (isolates 1353 and 1359) than the mode, causing wide MIC ranges and poor agreement by interpretive category, were reported by site D, where the testing personnel not only had no experience with the rapidly growing mycobacteria but also had limited experience with broth microdilution testing in general. Findings with clarithromycin were similar. The lack of reproducibility of MIC values for several isolates (i.e., 1801, 1831, 1353, and 1359) was due to very low MICs (i.e., 0.03 or 0.06 μg/ml compared to the modal MIC [Tables 3 to 5]) reported by site D. For isolates 1801 and 1353 the range was made even broader due to MICs higher than the modal MIC reported by site B (i.e., 4 μg/ml for isolate 1801 for all nine testing events). Another problem with clarithromycin occurred with two isolates of M. fortuitum that had trailing endpoints, similar to that observed when testing sulfonamides. This phenomenon caused difficulty in interpretation at all sites.
The problem of trailing endpoints was observed with ciprofloxacin only against isolates of M. chelonae. The lack of reproducibility (isolates 1814 and 1831) and the lower agreement by interpretive category (isolate 1831) were primarily due to reports from site D, suggesting lack of familiarity with the growth pattern as the cause of the problem. For both isolates, site D reported MICs lower than the mode (i.e., 2 and 4 μg/ml compared to >16 μg/ml for isolate 1814 and 2 μg/ml for six testing events compared to 8 μg/ml for isolate 1831).
For two isolates of the M. fortuitum group and one isolate of M. abscessus, cefoxitin MICs clustered at 32 and 64 μg/ml, and this twofold dilution variability caused a difference in interpretation: currently, 32 μg/ml is considered intermediate whereas 64 μg/ml is considered resistant (3). This same clustering at the breakpoint between intermediate and resistant was responsible for the poor agreement by interpretive category for tobramycin and one isolate of M. chelonae and for amikacin and one isolate of M. abscessus and two isolates of M. chelonae.
Suggestions for susceptibility testing of M. abscessus,M. chelonae, and the M. fortuitum group, based on the results of this study, are outlined in Table7.
Susceptibility testing of clinically significant isolates of the rapidly growing mycobacteria is recommended because these organisms differ in susceptibility to the antimicrobial agents commonly used for therapy (2, 4, 11-16). Based on data from the Centers for Disease Control and Prevention, many laboratories in the United States do such testing by a variety of methods (21). No standardized susceptibility test method currently exists for the rapidly growing mycobacteria, but investigators who have studiedM. abscessus, M. chelonae, and the M. fortuitum group extensively recommend broth microdilution testing (3, 11, 12). Data concerning other species of rapidly growing mycobacteria are very limited. Because of variability in the appearance of growth of M. abscessus, M. chelonae, and the M. fortuitum group in microdilution trays, unlike most bacterial isolates, interpretation of the MIC may be difficult. The primary focus of our study, therefore, was to evaluate the reproducibility of the broth microdilution method in several laboratories where persons performing the test have different levels of experience with this technique for testing the rapidly growing mycobacteria.
We found that reproducibility of MICs and agreement by interpretive category varied considerably among the different isolates and the different drugs. The wide range of MICs observed with several isolate-drug combinations was rarely seen with results reported by site A, where the rapidly growing mycobacteria have been studied for many years. This suggests that inexperience was in part responsible for the poor reproducibility and/or poor agreement by interpretive category.
The wide MIC ranges for several drugs, especially those which have a trailing endpoint, such as sulfamethoxazole and ciprofloxacin with isolates of M. chelonae, were predominantly due to results from site D, which had no experience with the rapidly growing mycobacteria and very limited experience with microdilution testing in general. Excluding site D's data from analysis, however, has minimal impact on the overall results. The most noticeable change is 100% agreement by interpretive category for sulfamethoxazole and isolates of the M. fortuitum group. The only other positive effect was better reproducibility and agreement by category for ciprofloxacin andM. chelonae 1814 and 1831.
The recently revised Statement on Diagnosis and Treatment of the Nontuberculous Mycobacteria from the American Thoracic Society suggests that a minimum of seven drugs (amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, and a sulfonamide) should be tested against rapidly growing mycobacteria (16). Some modifications or additions to this recommendation are needed, however. For isolates of M. chelonae only, we recommend including tobramycin, because it has a much better therapeutic margin than amikacin (12) and most consider it the aminoglycoside of choice for this species (16).
We also believe that a sulfonamide need not always be tested. Data from previous studies have shown that virtually all isolates of M. chelonae and M. abscessus are resistant to sulfamethoxazole (MIC ≥ 64 μg/ml), whereas all isolates ofM. fortuitum are susceptible (MIC ≤ 32 μg/ml) (11, 12, 17). In addition, because of a major inoculum effect and use of an 80% inhibition-of-growth endpoint, testing can be problematic (3). Therefore, if the isolate has been identified (i.e., at least as belonging to the M. fortuitumgroup versus the M. chelonae-abscessus group), testing a sulfonamide may not be necessary. If the drug is tested and the MIC differs from the expected values, that result should be withheld until testing has been repeated. If the repeat result again differs from the expected values, we recommend reporting that result with a comment indicating that (i) the MIC is greater or less than that expected for the particular species and (ii) if the drug is being considered for therapy, the laboratory should be notified so the isolate can be sent to a reference laboratory for confirmation of the susceptibility test result and the identification.
Additional suggestions for modifications of susceptibility methods involve breakpoints for doxycycline and cefoxitin. The establishment of resistance breakpoints for doxycycline was relatively easy compared to those for most other drugs for the rapidly growing mycobacteria, as the distribution of MICs is primarily bimodal. In an early study (1979) comprised mostly of M. fortuitum isolates, Wallace et al. compared agar dilution MICs and disk diffusion (both done in Mueller-Hinton agar) and found that for doxycycline, 65 of 66 isolates (98%) had disk zones of inhibition of either ≥30 or ≤15 mm in diameter (17). The doxycycline MICs of all isolates ofM. fortuitum with zone diameters of ≤15 mm were ≥8 μg/ml in agar, and those for which the MICs were ≤1 μg/ml all had disk zone diameters of ≥30 mm. The doxycycline MICs of only 14 of 66 (21%) isolates were between 2 and 8 μg/ml (17). In a subsequent study with broth microdilution, the doxycycline MICs of only 6 of 96 (6%) isolates of M. fortuitum were in the 2- to 8-μg/ml range (12). This same study demonstrated a similar bimodal distribution of MICs for M. chelonae and M. abscessus (12).
In these early studies, MIC testing was done by agar dilution, while most studies conducted since 1985 have utilized broth. Data from some studies have suggested that MICs of doxycycline against the rapidly growing mycobacteria are lower in broth than in agar. In a study by Swenson et al. (11), a comparison of broth and agar MICs for 18 strains of M. fortuitum showed that isolates generally were more susceptible in broth (e.g., the concentration of drug that inhibited 50% of the strains was 8 μg/ml in broth and 32 μg/ml in agar). The one laboratory in the current study that has been performing susceptibility testing of the rapidly growing mycobacteria for many years has utilized disk diffusion to help with interpretation of doxycycline results for isolates for which the MICs in broth are 2 to 8 μg/ml. Such isolates with disk zone diameters of ≤15 mm have been reported as resistant, those with zone diameters of ≥30 mm have been reported as susceptible, and those with zone diameters of 16 to 29 mm have been reported as intermediate. This laboratory reviewed the disk diffusion results for 118 isolates of M. fortuitum for which the MICs in broth were 2 to 8 μg/ml; all but 3 (97%) had disk zone diameters of <30 mm, and all but 14 (88%) had zones of inhibition with diameters of ≤15 mm (20a). This suggests that MICs for the isolates for which the MICs in broth were 2 to 8 μg/ml would likely have been higher (≥8 μg/ml) if tested in agar. Several studies have demonstrated the success of doxycycline monotherapy in the treatment of disease caused by rapidly growing mycobacteria when the infecting organism is susceptible in vitro to concentrations of ≤1 μg/ml (1, 5, 20). We are aware of no clinical data regarding the efficacy of doxycycline therapy for isolates of theM. fortuitum group for which MICs are 2 to 8 μg/ml when tested by either agar or broth dilution.
Based on these findings, the proposed breakpoints for doxycycline are ≤1 μg/ml (susceptible), 2 to 8 μg/ml (intermediate), and ≥16 μg/ml (resistant). These recommended breakpoints apply only to doxycycline and not to minocycline or tetracycline and are the same as those suggested by two of the investigators in the latest edition of the Clinical Microbiology Procedures Handbook (3). They differ from the breakpoints listed in the current NCCLS document for aerobic bacteria, which has one set of values for all tetracyclines: ≤4 μg/ml for susceptible, 8 μg/ml for intermediate, and ≥16 μg/ml for resistant (8a).
The other drug for which breakpoint modifications are recommended is cefoxitin (Table 1). The problem with the existing cefoxitin breakpoints is that the resistance breakpoint (64 μg/ml) is in the middle of the normal MIC range for untreated isolates of several of the rapidly growing mycobacteria. Previous studies have demonstrated that the cefoxitin MICs for more than 90% of isolates of M. fortuitum and M. abscessus range from 16 to 64 μg/ml, with a mode of 32 μg/ml (2, 12, 14). In three studies from three different laboratories the MICs for 232 of 239 (97%) M. fortuitum isolates and 243 of 258 (94%) M. abscessusisolates were within this range (2, 12, 14). With the usual recommended dosing, peak serum cefoxitin levels above 100 μg/ml can be achieved (10). Additionally, the clinical response of isolates for which the MIC is 32 μg/ml to treatment with cefoxitin does not differ from the response of isolates for which the MIC is 64 μg/ml (20a). Based on this information, we recommend changing the cefoxitin interpretive breakpoints as follows: ≤16 μg/ml, susceptible; 32 to 64 μg/ml, intermediate; ≥128 μg/ml, resistant. This differs from the Clinical Microbiology Handbook (3), which has breakpoints of ≤16, 32, and ≥64 μg/ml, respectively. Using these new breakpoints, the percent agreement by interpretive category was 100% for all isolates in our study except 1802 and 1352, for which agreement was 97.2 and 86.1%, respectively.
Several problem areas for reproducibility of testing of clarithromycin, imipenem, tobramycin, and amikacin were identified in this study. The difficulty with clarithromycin occurred with some isolates of M. fortuitum for which the endpoint was trailing. In our study, these isolates were problematic for all sites. Currently, there are no clinical data with which to correlate the MIC interpretation in these cases. Given the lack of clinical information and the availability of other oral drugs with which to treat most isolates of M. fortuitum (i.e., quinolones and sulfonamides), we recommend a conservative interpretation. In our opinion, isolates of M. fortuitum that have a trailing endpoint with clarithromycin should be considered resistant to the drug until clinically relevant information that refutes this approach is available.
With regard to imipenem, reproducibility was poor at all sites. Although the reason(s) for the lack of reproducibility is not known, we believe that drug instability is at least partially responsible. Based on data from previous studies (2, 12, 14), all isolates ofM. fortuitum are susceptible or intermediate to imipenem in vitro (MIC ≤8 μg/ml). For the isolates of M. fortuitumincluded in our study, all MICs of >8 μg/ml, with the exception of two reports of 16 μg/ml from site A, were reported from the three laboratories with the least experience (primarily site B). In all three of these laboratories MICs were interpreted on day 4 or 5 (compared to consistent reading on day 3 at site A). Based on these findings, we hypothesize that for isolates of M. fortuitum the problem with imipenem can be avoided by strict adherence to a 3-day incubation period, which, in the experience of one of the authors (R.W.), is virtually always sufficient for M. fortuitum. If the imipenem MIC for an isolate of M. fortuitum is >8 μg/ml on day 3, we recommend repeating the test. If the repeat result is >8 μg/ml, it should be reported with a comment indicating that (i) the MIC is greater than that expected for M. fortuitum and (ii) if the drug is being considered for therapy, the laboratory should be notified so the isolate can be sent to a reference laboratory for confirmation. With isolates of M. abscessus and M. chelonae, on the other hand, growth often is not adequate until day 4. Given the instability of imipenem and the need for more prolonged incubation when testing the latter two species, we recommend either not testing isolates of M. abscessus and M. chelonae against imipenem or not reporting the result if the organism is resistant until the problem with reproducibility is resolved.
The last drugs with reproducibility problems were tobramycin and amikacin. For these drugs, lack of agreement occurred predominantly with isolates of M. abscessus and M. chelonaethat had modal MICs close to the breakpoints for resistance. The specific reasons for the problems are unknown. Until this issue is resolved, we suggest the following. Because therapeutically tobramycin is recommended only for M. chelonae infections, in our opinion, results should be reported only for isolates of this species, not for isolates of the M. fortuitum group or M. abscessus. In addition, isolates of M. chelonae for which the tobramycin MIC is >4 μg/ml should be retested before the result is reported. If the repeat result is >4 μg/ml, we recommend reporting that result with a comment indicating that (i) the MIC is greater than that expected for M. chelonae and (ii) if the drug is being considered for therapy, the laboratory should be notified so the isolate can be sent to a reference laboratory for confirmation of both resistance and identification. It is possible that the isolate belongs to a newly recognized species, Mycobacterium immunogen, for which the MICs of both cefoxitin and tobramycin (22) are high, in contrast to M. chelonae, which usually is susceptible to tobramycin.
With regard to amikacin, the most significant problem is lack of agreement based on the interpretive category. As with several other drugs, the amikacin MICs fall within a narrow range (2, 12). In our study, this was an issue for M. abscessus 1802 andM. chelonae 1831 and 1866. For 1802 and 1866, all MICs of 64 μg/ml, which is the currently recommended breakpoint for resistance, were reported by sites B and C, one of which tended to report higher than modal MICs for other drugs. For 1802, only three of the nine results at both sites were 64 μg/ml; most of the other six results were 32 μg/ml, and one result from site C was 16 μg/ml. For 1866, only one result from site B and two results from site C were 64 μg/ml; the other results ranged from 8 to 32 μg/ml. MICs for aminoglycoside-treated isolates of M. abscessus and M. chelonae which develop mutational resistance to amikacin will be >1,024 μg/ml (9). Based on these data, to avoid potential reporting errors and consequent failure to add an important supportive agent to the therapeutic regimen, we recommend that isolates ofM. abscessus for which the amikacin MIC is ≥64 μg/ml be retested. If the repeat result is ≥64 μg/ml, it should be reported with a comment indicating that (i) the MIC is greater than that expected for M. abscessus and (ii) if the drug is being considered for therapy, the laboratory should be notified so the isolate can be sent to a reference laboratory for confirmation of resistance. Because tobramycin is the aminoglycoside of choice for isolates of M. chelonae, amikacin results need to be reported only if the isolate is resistant to tobramycin. In such cases, the guidelines suggested above for M. abscessus should be followed.
A secondary goal of our study was to identify a candidate clinical isolate to serve as a quality control organism for susceptibility testing of the rapidly growing mycobacteria. Although none of the isolates evaluated was perfect for this role, M. peregrinum1353, ATCC 700686, was closest to optimal and is our choice for a quality control organism.
In summary, our data suggest that broth microdilution testing of the common rapidly growing pathogenic mycobacteria requires skill acquired through experience with the test method and knowledge of the expected susceptibility patterns of the different species. For laboratories that infrequently encounter isolates of rapidly growing mycobacteria for which susceptibility testing is clinically indicated, referring those isolates to an experienced laboratory may be most reasonable. If a laboratory chooses to perform testing in house, however, several issues must be addressed. The drugs recommended by the American Thoracic Society (16), plus, in our opinion, tobramycin for isolates of M. chelonae, should be tested at concentrations appropriate for these organisms. Because commercial panels do not provide adequate concentrations and/or drugs for testing these organisms, in-house-prepared or custom-made commercial panels must be used. Test performance must be validated. At present no proficiency testing service (such as the College of American Pathologists) regularly includes the rapidly growing mycobacteria, although during the past year the Centers for Disease Control and Prevention performance evaluation program for susceptibility testing ofMycobacterium tuberculosis included one isolate of M. fortuitum (21). The best alternative at present would be comparison of results with those of an experienced reference laboratory. This should be done with initial validation of the test system and again on a regular basis to demonstrate continued proficiency. This almost certainly requires identification of the isolate to the species level or, at a minimum, differentiation of theM. fortuitum group from the M. chelonae-M. abscessus group. Additional pathogenic species, such asMycobacterium mucogenicum and Mycobacterium smegmatis, were not evaluated in this study but may be encountered among clinical isolates. It is not anticipated that these other rapidly growing mycobacteria will perform differently than the three species or taxa evaluated in the present study, although the recommended drugs to be tested may differ.
This study was supported by educational grants provided by Merck & Co., Inc., and Miles, Inc., Pharmaceutical Division. MIC trays and associated disposable supplies were kindly provided by Trek Diagnostic Systems, and blood agar plates were kindly provided by Remel.
We thank Shirley Wright for her expert secretarial assistance.
- Received 17 December 1998.
- Returned for modification 6 February 1999.
- Accepted 27 February 1999.
- Copyright © 1999 American Society for Microbiology


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|Carson Napier
|Biographical information
Carson Napier was a man who had grown exhausted with the planet Earth, he built himself a rocket ship intended for Mars. But instead ended up on the extraordinary planet of Venus.
Character HistoryEdit
Carson Napier is half British and American. He was born in India where he learned telepathy from guru Chand Kabi. He tells his story through telepathy to Burroughs, as there might not be a chance for him to return from his adventures.
Carson Napier wanted to go to Mars to have an adventure, and he spent a great deal of time and much of his own funds building a ship for the adventure. However, forgetting to calculate the moon's gravity as a factor, Carson Napier is driven of course and finds himself headed straight for the sun. Thankfully, Venus' gravity pulls him down upon the planet instead.
Landing upon the planet, Carson soon realizes past the thick two layers of atmosphere that there is life there. Landing on a large island of vegetation he soon realizes he hasn't even landed of the surface of Venus quite yet.
Soon enough he is found by the people of Kooaad and it is here that he falls in love with Duare, the daughter of the Jong (king). However, Duare doesn't love him back. Carson Napier has many adventures upon Venus as he tries to save his beloved Duare, and to get her back home to her father, the Jong of Kooaad.
Carson Napier is a telepath, a skill he learned from Chand Kabi, and this is how he is able to tell us his adventures over such a distance. It is also said that the slightly lower gravity of Venus gives him a very minor (practically unnoticeable) boost in strength.

subset: commoncrawl


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Mike Foltynewicz injury update: Braves place starter on DL with right triceps tightness
The Braves have placed starting pitcher Mike Foltynewicz on the disabled list with right triceps tightness, the team announced Saturday.
Atlanta activated starter Julio Teheran to take his place on the active roster.
The #Braves have placed RHP Mike Foltynewicz on the 10-day DL due to right triceps tightness, retroactive to 6/13. RHP Julio Teheran has been reinstated from the DL.— Atlanta Braves (@Braves) June 16, 2018
Foltynewicz originally suffered the injury in his start Tuesday against the Mets. He pitched five shutout innings and allowed just two hits in the game.
Foltynewicz wasn't bothered by the injury in his bullpen session Saturday. But Atlanta decided to place him on the DL for precautionary reasons, according to a report from MLB.com. He is expected to return and start against the Orioles this weekend, the report says.
Folty felt good during today's bullpen session. But given he's dealing with an ailment that could eventually affect his shoulder, it made sense for the Braves to give him extra rest, even if it amounts to just one more day. https://t.co/1noB7FdwSW— Mark Bowman (@mlbbowman) June 16, 2018
Foltynewicz has registered a 5-4 record with a 2.16 ERA in 79 innings pitched this season. He went 10-13 and tallied a 4.79 ERA in 2017.
The Braves currently lead the National League East with a 40-29 record. They've won four of their last six games.


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Date Added: Tuesday 18 December, 2007
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Peppermint is a stimulant. It restores the functions of the stomach, promotes digestion, stops vomiting, cures the hiccups, flatulent colic, hysterical depressions, and other like complaints." Peppermint leaf tea has been traditionally used for indigestion
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Wisława Szymborska (1923-2012)
To borrow from the lady herself, "they say the first sentence…is always the hardest. Well, that one's behind me, anyway." So Wisława Szymborska began the most important speech of her life when she accepted the Nobel Prize for Literature in 1996. It was light-hearted moments like these that perhaps endeared the humble Polish poet to noted fans like Woody Allen. Though often playful and imaginative, Szymborska's poetry is hardly light verse, however.
Travel Slow, travel smart.
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We cover Gdańsk (Sopot & Gdynia), Katowice, Kraków, Łódź, Poznań, Warsaw & Wrocław.


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Hello and thanks for dropping by.
This website was created to combine two of my passions - language and motorbiking. It currently contains details of the motorbike tours I have done over the past few years. I hope that fellow motorcyclists will find the information useful.
(Note: The images on this website are all my own. If you wish to use any of the photos, contact me ask for permission. The maps are licenced under Creative Commons licence CC-BY-SA from OpenStreetMap.


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The smaller chamber of the Swiss parliament voted on 20 September 2016 in favor of many Swiss tax payers which have been threatened with substantial payments for late interest due to late notification of dividends. Swiss Federation to release CHF 600 million.
The issue goes basically back to autumn 2011 when the Federal Supreme Court decided on a case in connection with the application of the notification procedure and its consequences in case of late filing. Based on this case the Federal Tax Authorities saw it as legitimate to apply a very rigid practice in connection with the notification procedure on dividends for withholding tax purposes – regardless whether the tax payer fulfilled all the substantive conditions for applying the notification procedure or not. Whereas prior to autumn 2011 the tax administration accepted late notifications without any reservations they all of a sudden requested an effective cash transaction of the tax with refund and an interest of 5% for late notification despite the fact that no taxes where in fact due in the first place. This lead to the Tax Authorities asking for a total of CHF 600 million in late interest for taxes the tax payers have actually never been liable for.
After heavy debating over the last three years the Swiss smaller Chamber voted in agreement with the larger Chamber for an amendment of the Withholding Tax Code with retrospective effect, i.e. that such failure of late notification should not trigger any interest but is only subject to a spot fine or a penalty. The upcoming final vote of the entire Swiss parliament is to be seen as mere formality. Theoretically, a referendum would be possible. However, this seems rather unlikely for the time being.
Therefore all pending cases should be solved as soon as the amendment of the Swiss Withholding Tax Code will come into force within the next months.
Further information:


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- Mac
- System Tools
- Backup & Restore
- JustCloud
The 220.127.116.11 version of JustCloud for Mac is available as a free download on our website. The software is categorized as System Tools. The unique identifier for this app's bundle is org.pythonmac.unspecified.JustCloud. The most popular versions of JustCloud for Mac are 2.3, 2.2 and 2.1. This Mac download was checked by our antivirus and was rated as clean. This Mac application is a product of JustCloud.
From the developer:
Professional Cloud Storage from JustCloud is Simple, Fast and Unlimited.
JustCloud provides your complete backup solution.
Automatically sync files across computers. With Just Cloud, you decide which files and folders you want to sync and where you want to sync them.
Just Cloud works in the background so your most important data is always backed up and available to you.
You may want to check out more software for Mac, such as Documents To Go Desktop, iBackup or Intego Backup Assistant, which might be related to JustCloud.
Please add a comment explaining the reasoning behind your vote.
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Today would have been my mother's 75th birthday. Lois Ann. An old fashioned kind of name not used much anymore.
She was born in Bedford, Indiana.
She was blonde and green eyed.
She was the 5th child of 9, born to a contractor and a housewife.
She remembered the attack of Pearl Harbor as a young girl.
She remembered ration books.
She lost a sister to leukemia at an early age.
She lost her mother at the age of 13.
Her father later re-married and relocated to Tulsa, OK and built many limestone buildings downtown.
She was awarded a scholarship to nursing school.
She didn't become a nurse as she discovered she couldn't handle blood.
She married at 19.
She moved to Ocean Springs, Mississippi at the age of 20.
She gave birth to two daughters in Biloxi.
She moved the family to New Orleans as my father's work changed three years later.
She moved the family to Shreveport as my father's work transferred him there two years later.
She gave birth to another daughter in Shreveport.
She moved the family to Atlanta some 11 years later as my father's work transferred him there.
She was a widow at the age of 44, 3 years later.
She moved herself and her youngest daughter to southern Indiana to be around family and begin anew.
She opened an antique shop and ran it.
She studied and received her realtor's license.
She enjoyed being a granny.
She lived a full life.
Tuesday, March 14, 2006
Lois Ann
Posted by Karen Townsend at 1:41 PM
4 comments:
- Blog Author said...
I know a Lois... you are right it's not used much anymore. The Lois I know is about 50. Wouldn't surprise me if the name makes a come back though... Adelle and Adeline and such are back!
- Jennifer said...
What a life she led. And what a lovely, strong example she must have been for you. Still, even.
Open Book
- AC said...
Resilient women inspire me. What a beautiful tribute to your mom.
- srp said...
Go Bedford, Indiana.
Technically my hometown, since I was born there.
My parents really lived in Oolitic.
I think Lois Ann is a beautiful name.
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I am formally an Environmental Chemist, who in 1999 joined the ranks of Software Quality Assurance, which would be QA and not Q&A (pet peeve of one of my early mentors). I had very little programming experience other than some classes taken at Austin Community College and dabbling with HTML. My first exposure to a scripting language was the 4-Test Language used by Silk Performer and Silk Test. In a reasonable amount of time and some outstanding mentoring I picked the language up quickly. We were able to write some rather robust performance tests for the various applications we were responsible for. I recall the language was very strict and sometimes difficult to troubleshoot. I then attended the Silk Test certification courses. At the time I liked the power that Silk Test provided for functional testing. I was anxious to use Silk Test to help test our internationalized products by using a series of if statements and localized string content. No sooner than I got started on this project I was part of a "reduction in force". The one thing I definitely remember is that the Segue suite of tools came with a healthy price tag.
Fortunately I landed a position with a start up company, who was test-driven and Agile. Here is where we implemented some extremely powerful methods using Webload. Webload was a terrific tool in that we could leverage performance tests as functional tests. We developed the testing methods almost as fast as the application was built. Sometime in 2002 Webload changed their application to be more GUI focused. The end result was this rendered many of our previously developed scripts almost useless. There were certain things we struggled with using 5.2 and these things were addressed in 6.0, but the trade off of redeveloping all of our scripts was huge. The bottom line was we never got back to the level of scripts we needed to be efficient at testing our product line application. In September of 2004, I decided to abandon Webload and continue our search for the Holy Grail of testing tools. I played with Open STA, Load Runner, and some emerging technology called WATIR, Web Application Testing in Ruby. Open STA was difficult to get off the ground. I do not recall the specifics, but it was quickly abandoned. I got a temporary license for using Load Runner. This was an awesome tool, but like other great tools came with a significant price tag. Well no sooner than I got my first WATIR script written I was again victim to a "reduction in force".
I was fortunate and landed my current Gig. There was not much time early on for me to dive into test automation. I had to put my head to the grind stone and learn the testing environments and a robust application. My new mentor threw me to the wolves. The QA team was responsible for maintaining and configuring their test environment. My first challenge was to install AIX and get our application up and running. Definitely I felt like ex-prize fighter, Terry, the main character of "On the Water Front". I took some serious blows, but after some hand holding I got it done. Now I just pray that the AIX machine does not crash! Once my domain knowledge was up to par, there was time for some automated test development. We were told to use an internal tool, Easy Test. This testing tool is content–driven using a table structure. It is really a powerful testing tool for both web and enterprise based applications. My two brain cells for the longest time just did not get it. I think the main reason was that I did not have the time to fully dive in and learn the tool. We were releasing a new product every 3-4 weeks, which left very little time for test automation. Once again there was a changing of the guard, but this time I was extremely fortunate to remain a member of a great Professional Services team. We developed a new application and right from the start we wanted to have test-driven development. WATIR was a logical choice.
The development team was excited about the potential of WATIR. We immediately hit a snag with WATIR's ability to handle modals and pop ups. I struggled for a couple of weeks to no avail. I quickly abandoned WATIR and dove into Easy Test. Easy Test handled modals, pop ups, and even desktop file exchanges like a champion. I do not intend to do a line by line comparison of these two tools here, but I can summarize by saying I now have two very good weapons in my bag of tricks. My brain kept leading me back to WATIR. WATIR seemed to come more naturally to me. I still had not conquered the modal issue, so I asked a seasoned developer to take a look at it. In a couple of days she pointed out the flaws in my approach and I was back to using WATIR. Today we are using WATIR. As time permits I will share some additional challenges and thoughts on using WATIR as our main tool for functional testing. Most likely I will find time about once a week to post a thought or two on the trials and tribulations of WATIR.


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Deborah W. Miller, M.D.
Dr. Miller treats a variety of ear, nose and throat problems. She has a particular interest in pediatrics and in disorders of the nose and sinuses, particularly minimally invasive, image guided endoscopic sinus surgery. She is certified by the American Board of Otolaryngology/Head and Neck Surgery.
Office Contact Information:
Bay Area ENT Specialists
333 North Texas Avenue, Suite 3100
Webster, Texas 77856
Phone: (281) 606-3100
Fax: (281) 606-3102
Website: www.bayareaentspecialists.com


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'Why don't young athletes in sport just quit?' Starting with this question and drawing on existential philosophy, phenomenology and hermeneutics, Talent Development, Existential Philosophy and Sport seeks a deeper understanding of the experience of being a talented young sportsperson striving to become an elite athlete.
As an alternative to conventional approaches to talent development governed by a worldview of instrumental rationality, the book introduces key ideas from educational philosophy to describe talent development through the concept of elite-Bildung. It pursues an existential understanding of developing in sport as a process of freedom, self-transcendence, striving for excellence and building up habits.
The book highlights a range of ambiguous and intriguing existential phenomena – most prominently wonder, question, expression, humour and repetition – and reveals an existential layer of meaning within talent development in sport, which can facilitate the process of becoming an elite athlete and give young athletes a number of reasons not to quit.
By deepening our understanding of performance and development in sport, and the process of becoming an elite player, this book is important reading for any serious student or researcher working in the philosophy of sport, sports coaching, sports development, sport psychology or applied sport science.


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The Heroes in a Half-Shell take on Shredder and Krang in their debut Game Boy adventure.
Teenage Mutant Ninja Turtles: Fall of the Foot Clan – or 'Hero' Turtles as it was called here in Europe – was the first Game Boy outing game for Leonardo, Michelangelo, Raphael, and Donatello. It's a pretty rudimentary platform adventure, but one many look back on with fondness. Great cover art, too.
Released: 1990
Platform: Nintendo Game Boy
Developer: Konami
Publisher: Konami/Ultra Games
Article Categories:Games · Nintendo Game Boy


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This month we're spotlighting a very inspiring author Nathan Squiers who popped by to chat about his works including his newest release 'Curtain Call' and his writing inspirations.
From his bio:
The bacon-loving force of paranormal calamity, Nathan Squiers (The Literary Dark Prince), is a resident of upstate New York where he lives with his loving fiancé and fellow author/unholy force of literary madness, Megan J. Parker, and two creatures that have chosen to disguise themselves as cats. Living day-by-day on a steady diet of body modification, excessively loud music, and high, potentially-lethal doses of caffeine, he often escapes reality by submerging himself in movie marathons, through stacks of novels and comics/manga, and (of course) losing himself in his own writing.
Learn more about The Literary Dark Prince and his writing adventures in the realms of novels/novellas, short stories, and comic books as well as formally joining The Legion and chatting with fellow readers at www.nathansquiers.com
On with the q's!
AWF: When did you decide you wanted to be a writer?
NS: It's hard to say exactly WHEN the decision was made. My entire life I've enjoyed depicting stories (before I could write I would enact detailed scenes with my action figures). In Elementary school, when everyone was asked to write about their summer vacation, I begged my teacher to write a piece of fiction instead, and the resulting short story was a classroom favorite. For a while I wanted to be a filmmaker--writing and directing movies--but a lot of the process was more mechanics and less magic than I felt a connection to. At that point I'd been dabbling in writing in some form or another for 8 years (I was about 15 at that time) and I'd decided that writing was the best outlet for my desire to tell stories. After the momentum picked up about 3 years later, I realized that the magic in writing (the ability to use ONLY words to depict an intimate sequence of events in a reader's mind) was exactly what I'd craved (so I suppose you'd say I was 18, but by that point it was more of an acceptance of a fact than a decision).
AWD: How would you describe the genre in which you do most of your writing?
NS: At face-value, I'd say my work is a supernatural/paranormal occult-thriller (but I've also been pegged with urban fantasy, horror, paranormal psycho-drama, and supernatural action/adventure). Truthfully, a lot of what I write takes in elements of a lot of genres--horror, mystery, paranormal thriller, fantasy, and a slew of others (even philosophy and psychology to work an element of "self-help" into the mix that allows for character growth & development)--to create something that I feel will entertain and enlighten readers. Other's take the metaphorical route and say that I write social parodies (albeit morbid and saturated in vampires). The best way to describe my style is "cinematic" and similar to movies like "Blade" and "Underworld" and "The Matrix".
AWD: What motivated you to start writing in this genre?
NS: To be honest, I've always been obsessed with vampires and other such monsters and using them in stories just made sense for me. I grew up reading comics and watching anime and horror movies and playing video games like Devil May Cry, so the supernatural and over-the-top, superhuman fight sequences (the types of fights that level city blocks) and elements of horror and gore just sort of added fuel to the literary fire.
AWD: Who would you say has influenced you the most?
NS: A lot of my style is fueled more by films and anime and comics, so I've been influenced by directors like Guillermo del Torro and his stunning use of visuals and creating mood through setting and Christopher Nolan for his technique in taking fantastic and otherwise unrealistic scenarios and making them into something so easily associated with reality. Key players in the comic book industry have also helped to inspire me; people like Alan Moore (writer of the Watchmen graphic novel) for his ability to stream random sequences that magically tie together in the end and Frank Miller (writer and illustrator of the Sin City series) for his use of dialogue and ability to tell MORE of a story with LESS details, as well as Steve Niles and Ben Templesmith (writer and illustrator of 30 Days of Night) for their brilliant approach to the raw potential chaos behind the vampire lore and how deep a community like that can go.
AWD: That's pretty cool. Those directors and writers have definitely made waves in their respective genres and have inspired many imaginations who've enjoyed their work (yours truly as well)! Do you have a particular favorite work from each director/artist?
NS: While I'm sure everyone and their grandmothers saw this one coming, I'd have to say that Blade II is a personal favorite from del Torro (if nothing else his approach towards lighting a scene was an inspiration for using similar techniques to put a chapter/scene in a certain tone/mood by using certain types of language). A lot of what makes him so inspiring is how he takes something inherently simple to look at, but has so many complex elements that build that visual into EXACTLY what he wanted the audience to see (using sparks and electric discharge as a means of conveying violence without any other violent elements). Movies like Hellboy and Pan's Labyrinth are good examples of del Torro's affinity for visuals and effects so that they highlight rather than make the films what they are, and from this I've honed my style to use vivid descriptions and details to scenes, while not defining the writing, help the reader to delve that much deeper into the piece.
What draws me to Nolan--aside from the movies in general--is the intimacy he shows towards mechanics and science behind what is ultimately make-believe. Because of this, movies like Inception, where he's applied concepts of mathematics and algorithms to define dreams-within-dreams and how time would play out when shifting about therein. Also, because of my love of comics, how he approached his Batman trilogy and brought Gotham and The Dark Knight into the real world rather than trying to convince the audience to follow into a city that, before that, had always been depicted in very unbelievable ways. Things like this allow an audience to say "Wow! I can actually SEE how Batman could exist in our world!" and, in doing so, gets them to invest THAT much more in the story. For me, I don't like having to convince an audience that the world I'm escorting them through is something they can relate to, because I've brought the vampires and therions and other creatures to THEIR city. By doing this, Xander Stryker standing on the side of a city skyscraper can become Xander Stryker standing on THE city skyscraper that the reader's uncle works at (or something of that nature).
AWD: What are your main concerns as a writer?
NS: The basic two: (1) have I properly and effectively utilized the English language and the organic flow of words to convey both the visual and emotional elements that I'm trying to deliver to the reader and (2) will this entertain and/or provide insight/perspective to one's own life?
AWD: How have your personal experiences influenced the direction of your writing?
AWD: Do you think you've achieved this with your current work?
NS: More-or-less. My #1 goal has always and will always be to entertain the reader (any life-lessons or morals that come from it are certainly nice, but that's just icing on the cake). For "Crimson Shadow: Noir", I think that so many people can read Xander's story and see themselves or their friends who have had similar situations (sadly, abuse is not as rare as it should be) and, though set in a world of monsters, the truth is that it's all very real and horrible and it DOES impact people in much the same way Xander was impacted by his own history.
With "Curtain Call: A Death Metal Novel", I wanted to convey a literal and metaphorical approach to music. In a band, each musician contributes an element that adds-up to the song that's heard by the audience, so I wanted to translate that sense of contribution to a greater degree. While this doesn't reflect in quite the same way as Crimson Shadow, I think the message still works as a social metaphor that everybody has a crucial role to play.
AWD: What will your next book be about?
AWD: What would you say has been your most significant achievement as a writer?
A: When "Noir" was in the early stages of editing (beta testing and revising and whatnot) a buddy of mine pointed out that, aside from the action/adventure element, the story of a suicidal teen finding strength and reason to persevere could serve to help others. At first I took it as a simple compliment--after all, it wasn't even an actual book, so harboring dreams of how it would be received by an audience seemed a tad farfetched when so much had to be done first--but, sure enough, a short time after the book's release through Crushing Hearts and Black Butterfly Publishing, I was contacted by a reader who thanked me. Apparently, for this person, the character of Xander struck a very powerful cord in their heart, and the story ultimately motivated them to stop their own self-destructive/suicidal activities and seek the help they needed to get better. For me, there's no greater honor than knowing my efforts to entertain and enlighten worked, but this message truly blew me away. While I'd hoped that the story and the charity work through To Write Love On Her Arms (an anti-suicide & self-harm movement) would be helpful, I'd never imagined that it would have THAT great of an impact on somebody. I do look forward to a long and fruitful writing career and hope that I can continue to entertain and inspire, but, knowing that somebody out there is alive and striving to achieve their own happiness because of something I wrote, there isn't really much more I can hope to achieve other than continuing to make readers happy.
AWD: Any last words for your readers and visitors?
NS: I feel that it's an incredible honor that people are willing to take a chance with me and my work to entertain them. For me, the readers have always been more than "fans" (to be honest, I HATE that word), and so I and a group of friends and some of my earlier readers decided to call any who considered themselves an enthusiast of my work as a part of "The Legion".
Having said this, I'd love any and all to join me, The Literary Dark Prince, and the others of The Legion in a brutal literary movement of gnarly proportions! Feel free to "Like" The Legion on Facebook at https://www.facebook.com/pages/The-Legion-of-Nathan-Squiers/329543403767153 and formally join The Legion on the forum page on my website at http://www.nathansquiers.com.
Check out Nathan's books and more information about him on the web!
http://www.nathansquiers.com - Personal Author Website
http://www.goodreads.com/Literary_Dark_Prince - Goodreads
https://www.facebook.com/Nathan.Squiers?ref=hl - FB author page
https://www.facebook.com/CrimsonShadow.Legacy?ref=hl - FB Crimson Shadow page
https://www.facebook.com/DeathMetal.NovelSeries?ref=hl - FB Death Metal page
https://twitter.com/Lit_Dark_Prince - Twitter
http://www.myspace.com/visceral_vices - MySpace


text: Insight Global Expands Baltimore Branch April 27th, 2018 ATLANTA, GA – April 2018 – Insight Global, a staffing and services company, has expanded its Baltimore office. The space was expanded by 5,560 sq. ft., making it 13,408 sq. ft. in total. The address remains the same (as the project expanded... Read more


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Jan 27, 2016
Curious Cats
My cats, Alfred and Stella, were curious about my chocolate cupcake (stuffed with a cherry and cheesecake filling) and shot of brandy. Of course, it was not a snack suitable for cats, but I did let them have a little bit of milk from the creamer. Oil on 11"h x 14"w stretched linen. SOLD.
Posted by Jonelle Summerfield at 1/27/2016 01:00:00 PM
Labels: jonelle summerfield, paintings of alcohol, paintings of black cats, paintings of calico cats, paintings of cats, paintings of coffee, paintings of cupcakes, paintings of desserts
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B.ZERO1 necklace in 18 kt pink gold with white ceramic and pavé diamonds. 39-44cm long.


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The 32nd annual LAFCA achievement awards ceremony will be held in Los Angeles on Jan 14.
Other winners included Paul Greengrass, named best director for United 93, Helen Mirren named best actress for The Queen and Sacha Baron Cohen and Forest Whitaker who tied for best actor for Borat and The Last King Of Scotland respectively.
Peter Morgan won best screenplay for The Queen, Luminita Gheorghiu was named best supporting actress for Romanian drama The Death Of Mr Lazerascu, Michael Sheen was named best supporting actor for The Queen and Florian Henckel Von Donnersmarck's The Lives Of Others was voted best foreign language film.
An Inconvenient Truth won the best documentary citation and Happy Feet was voted best animated film.FULL LIST OF LAFCA WINNERS 2006
Best picture of the year: Letters From Iwo Jima
Runner-up: The Queen
Best director: Paul Greengrass, United 93
Runner-up: Stephen Frears, The Queen
Best actress: Helen Mirren, The Queen
Runner-up: Penelope Cruz, Volver
Best actor: (tied) Sacha Baron Cohen, Borat & Forest Whitaker, The Last King Of Scotland
Best screenplay: Peter Morgan, The Queen
Runner-up: Michael Arndt, Little Miss Sunshine
Best supporting actress: Luminita Gheorghiu, The Death Of Mr Lazarescu
Runner-up: Jennifer Hudson, Dreamgirls
Best supporting actor: Michael Sheen, The Queen
Runner-up: Sergi Lopez, Pan's Labyrinth
Best foreign language film: The Lives Of Others, Florian Henckel Von Donnersmarck
Runner-up: Volver, Pedro Almodovar
Best documentary/non-fiction film: An Inconvenient Truth, Davis Guggenheim
Runner-up: Darwin's Nightmare, Hubert Sauper
Best production design: Eugenio Caballero, Pan's Labyrinth
Runner-up: Jim Clay, Veronica Falzon, Geoffrey Kirkland, Children Of Men
Best animation: Happy Feet, George Miller
Runner-up: Cars, John Lasseter & Joe Ranft
Best music: Alexandre Desplat, The Painted Veil & The Queen
Runner-up: Thomas Newman, The Good German & Little Children
Best cinematography: Emmanuel Lubezki, Children Of Men
Runner-up: Tom Stern, Flags Of Our Fathers
New generation: Michael Arndt, Jonathan Dayton & Valerie Faris, Little Miss Sunshine
Career achievement: Robert Mulligan
Independent/experimental: (tied) Old Joy directed by Kelly Reichardt and In Between Days directed by So Yong Jim
Special citations: to Jean-Pierre Melville's 1969 film Army of Shadows which had its US premiere this year, and to Jonas Mekas for his career as a critic and filmmaker.


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Mind over meds : know when drugs are necessary, when alternatives are better-- and when to let your body heal on its own
Large Print Book
Large print edition.
"In Mind over Meds, bestselling author Dr. Andrew Weil alerts readers to the problem of overmedication, and outlines when medicine is necessary, and when it is not. Dr. Weil examines how we came to be so drastically overmedicated, presents science that proves drugs aren't always the best option, and provides reliable integrative medicine approaches to treating common ailments like high blood pressure, allergies, depression, and even the common cold. With case histories, healthy alternative treatments, and input from other leading physicians, Mind over Meds is the go-to resource for anyone who is sick and tired of being sick and tired." --
Available copies
- 1 of 1 copy available at OWWL.
Current holds0 current holds with 1 total copy.
View other formats and editions
|Call Number /
Shelving Location
|Status /
Due Date
|Mount Morris Library
|613 Wei (Text)
Adult Nonfiction


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I found a frog at the local church. I am not really sure what type it is, so i don't know what to feed it, I'm feeding it flightless fruit flies but it doesn't eat them.
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Do frogs have teeth? Come on Froggie, show me them teeth! How many have you got and what do they look like? Are those teeth sharp? Would you bit me?
Mar 28, 20 04:41 AM
axolotl are able to grow back fingers, toes and even whole limbs within a short space of time
Mar 28, 20 04:39 AM
lucky charm frogs and toads promise exciting prosperity and happiness in all that you do
Do frogs have teeth? Find out here...
Is it possible that frogs can predict earthquakes?
Have you heard of the frog that breaks its own bones? The Horror Frog...
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They say that you can never go home again but Danny Williams's parting gift to the people of Newfoundland and Labrador seems to be more than a massive guarantee they'll bear an ever greater public debt than the crushing one they carry now.
The guy who made his fortune delivering Detroit television stations to townies just couldn't resist adding some cable to the deal.
Seems that Nalcor, the government-owned energy monopoly Williams created is now promising the people of Labrador that if they go along with his plan to bring Labrador power to townies, they will get cable.
Now to truly understand just exactly what this little bait and switch deal is really all about, recall that Danny Williams once promised, in writing, that
[c]onsistent with our energy policy objectives, a Progressive Conservative government will make use of the hydroelectric potential of the Lower Churchill and any electricity that can be recalled or reclaimed from the Upper Churchill to accomplish the following priorities:
• Promote industrial development and meet domestic energy demand in Labrador and then on the Island of Newfoundland. [Emphasis added]
But that promise went out the window right as soon as Williams got into the business of trying to build his debt-laden legacy. They've been offering cash for the past couple of years for people to study small hydro projects as an alternative to powering these coastal towns with diesel.
If the Old Man and his hand-picked successor get their way, power lines from Muskrat Falls will run right by communities now served by diesel generators. Power lines will run by the towns and take that Labrador power off to St. John's and down into Nova Scotia, but none of it will go to the people closest to the dam, if it is built.
So, as it turns out that promise about using Labrador power for Labradorians is headed for the same dustbin that holds the one about only developing the Lower Churchill with Hydro-Quebec if there was redress for the 1969 deal. As it turned out, Williams spent five years of his seven in office trying to get HQ to take an ownership stake without redress. Set redress to one side is the way Premier Kathy Dunderdale described it last year.
What was that some famous politician said once about greatest frauds and unkept promises?
Anyway, …
The people in different parts of Labrador are none too pleased about this idea, apparently. You can tell because there are suddenly Internet and telephone cable lines in the mix for the Lower Churchill. The existing lines in Goose Bay are apparently at capacity and can't handle any more subscribers.
Only a handful of years ago, back when the Old Man's party was cutting a deal to subsidize some private sector cable companies, the cost of adding the lines to Labrador was something they needed to study. And at a cost of $80 million or so back in 2006, it seemed to be a bit much, apparently because the provincial government couldn't manage to step up. Billions in public infrastructure but no cash for a Labrador cable line.
And then in 2009, Danny Williams was mongering any scare he could find just to sling a power lines through a World Heritage site. The cost of going around the park was about $100 million according to Williams, and that was too much since it might jeopardize granny's heart surgery or some such foolishness.
But now – suddenly – they can find the cash.
If…that is.
Even though fibre optic lines would be a completely separate thing from the Nalcor project, government is now talking it up. Maybe they are counting on the gullibility of the people of the Big Land.
Maybe they should think again.
- srbp -


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Yuppie – just added one more feather in my cap of Oracle Certifications.
Oracle Identity Manager 11g Certified Implementation Specialist
This exam checks your knowledge of OIM 11gR2(11.1.2), OPAM and OIA 11gR1 PS1(188.8.131.52).
The details of this exam can be found here.
Throughout my preparation, I have tried to share the key topics via this blog. You can check all the relevant posts by clicking here. I will continue to add more and I plan to index them as well in future for ease. In the mean time if you are looking for some help or guidance wrt topics to cover or if you need to understand any concept or if you want to get trained, please feel free to contact me @ sumit (at) oraworld.co.uk. Please mention 1Z0-459 as Subject Line.
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If you want to know when I have shared new learnings here, you can also Subscribe to Blog.
All the Best 🙂


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This is
Felix (1951)
Lives in
Centre (Nieuwmarkt)
Country of Origin
In the Netherlands since
Palm wine, which is made from the core of the palm tree.
Favourite place
When I first lived here it was Artis (the zoo), because I missed the tropical animals. Now it is the Begijnhof
"I was the first ever Beninese to come to Amsterdam in 1970. Since that time forty five Beninese have come here to live. I came to Europe to study, living first in Switzerland where I was not allowed to stay. Through an organisation of Dutch volunteers who I had met in Benin I arrived in the Netherlands. I fell in lovely with a wonderful woman in Amsterdam. We both lived in Jordaan; I at the top of the Lijnbaansgracht and Westerstraat, and she on the corner at the Anjelierstraat. We hadn't seen each other as neighbours. It was only at a mutual friend's party that we met. We are still together and have three daughters, all in their thirties now.
12 people in Amsterdam have the Beninese nationality


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Caldera is a catalyst for the transformation of under served youth through innovative year-round art and environmental programs. Funds raised at the prestigious annual gala, Interlude to the Season Arts Awards Gala on January 25, 2017 (previously known as Prelude for the Season), will support Arts & Business Council Sacramento Region programs including artists workshops and the Arts & Business Council Sacramento Region ART Fellowship.
For English language learners (ELLs), the school offers bilingual (Spanish-English) instruction sections for all math, science and social studies classes required for graduation. The Two Percent : The Two Percent Gallery Tours take small groups to visit New York City galleries and architecture for intimate, mind-opening and fun discussions, and some New York history along the way.
The annual Arts & Business Awards showcase partnerships and sponsorships between businesses and arts organisations in the UK. Categories include cultural branding, people development, community and young people, sustained partnerships and business innovation as well as awards for individuals who sit on arts boards or act as arts fundraisers.
New Arts Venture Challenge, directed by Jutt and managed by the Arts Institute, now runs in parallel with the School of Business' Business Plan Competition, providing students with multiple avenues for pitching entrepreneurial ideas with a creative edge or for a creative business start-up.
ALSO: Arts & Business and Fine Arts allows for the Digital Arts Communication specialization, something NOT offered without Arts & Business (much to my disappointment). Our program is highly regarded by local and national business leaders, with graduates working for many successful companies and ventures.


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What you will do
3 hour workshop
If you love getting out and about in nature, and want to learn how to capture beautiful wildlife and landscape photographs then this is the workshop for you!
During this photography workshop, you will learn how to capture exciting, creative wildlife images through 'in the field' tutorials in front of the majestic Red and Fallow deer that call Richmond Park home. I will also take you to some of my favourite spots in the park for landscape photography (exactly where on the day will depend on the weather and if it is a sunrise or sunset shoot). With Silver Birch Tree copses, lone Oak Trees, fern gardens and lakes, there are plentiful subjects to ensure you will come away with beautiful images.
At the same time as learning the technical side of photography, we will talk a lot about the thought process of creating (not just taking) photos. I will offer tips on composition, guide your photographic eye and help you develop a proactive photography mindset, ensuring you can apply your new found skills to any given situation when photographing in the future.
Subjects covered: • Tips and tricks for creative compositions • The importance of backgrounds in wildlife photography • Making the most of the available light • Focusing modes for pin sharp wildlife images • Histogram and the importance of exposing to the right • How to photograph wildlife respectfully • Story-telling and the art of photographing a single scene in many different ways
Select a class time
None of the dates work for you? Let the host know and you will be notified when new dates are added.
You will only receive an email from us if new dates are added for this class, you will not receive any marketing emails, and that's a promise!
Did you know?
Obby Guarantee
We ensure quality. If your class doesn't reach your expectations, we'll give your money back.
Flexitime Class
This is a Flexitime class, which means the teacher can run this class around your schedule.
Time & Location
Select a date and location you want and your teacher will get back to you to confirm their availability.
Class location
Gallery (10)
About your host, Matthew Williams-Ellis
Matthew's photography workshops are about learning your camera inside out, immersing yourself in photography, trying new techniques, and having fun with your camera alongside like-minded people! Tutorials are 'in the field', where you are encouraged to experiment with your new skills to create eye-catching photos of some of London's most iconic sites!
You will always receive plenty of 1 to 1 time ensuring you master your camera, develop a proactive photography mindset and further your photographic eye. You will leave feeling confident about both the technical and creative aspects of photography, allowing you to capture unique and interesting images when photographing in the future.
All workshops are taught by Matthew, a London-based professional travel and landscape photographer, who has been a finalist in Travel Photographer of the Year on more than one occasion. "Nothing beats getting out there and exploring the world with camera in hand". Whether learning long exposures in Regent's Park in Autumn, photographing Richmond Park at sunrise or Tower Bridge at sunset, he can't wait to help you capture it!
Camera Equipment: Camera - Essential(!). Ideally a digital SLR or other camera that can be controlled manually. Please contact before booking if you only have smart phone. Lenses - Wide angle through to telephoto. Tripod - Not essential, but without it you will be limited during the sunrise/sunset shoot. Loan can be arranged. Filters - Optional Clothing: Wear sturdy trainers as we will walk a lot around the park, and wrap up warm if it is a cold day! Transport: The closest tube stop is Richmond. Please bear in mind that for the sunrise workshop the meet time is before the first tube starts so you will need to arrange your own transport to Richmond Park gates (TW10 6JJ).
Age Requirement
Flexible cancellation policy
Any class can be cancelled and fully refunded within 24 hours of purchase. See cancellation policy.


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The Hyundai Santro is the most hotly anticipated of launches of 2018. The hatchback with the Santro badge makes its return to India and will replace the Eon in the company's line-up. We've already told you that there will be a whole bunch of colours that the Santro will be available in and now we've got some fresh pictures of the car draped in the Marina Blue colour. The blue certainly suits the body shape of the Santro and it looks pretty good in it. This is a colour similar to what we've seen on the Elantra. The company already announced that there will be a total of 7 colours on offer namely - Typhoon Silver, Polar White, Stardust (dark grey), Imperial Beige (as seen in the pictures), Marina Blue, Fiery Red, and that Diana Green, which comes with matching green interior styling.
Also Read: New Hyundai Santro Launched In India
Hyundai Santro
Also Read: New Hyundai Santro 2018 Asta Trim Fully Revealed In New Spy Photos
Hyundai has built the Santro on an all-new platform and has invested a sum of $100 million in 3 years. The all new Santro is equipped with a 4-cylinder 1.1-litre Petrol engine with low vibrations, superior performance and high fuel efficiency. The petrol version puts out 68 bhp and there's 99 Nm of torque on offer. The car will be the first Hyundai model to offer in-house developed Smart Auto AMT Technology and will have a factory fitted CNG option. The mileage with the CNG option on the car is 20.3 kmpl. Power with the CNG stands at 59 bhp.
Also Read: 2018 Hyundai Santro: Price Expectation
Also Read: 2018 Hyundai Santro First Drive
Also Read: 2018 Hyundai Santro Sportz AMT: Interior Pictures Leaked
Hyundai India has also packed in the Santro with new age technology features including segment-first 7 inch Touch Screen Audio Video System. The Multi-media system is equipped with smart phone connectivity - Android auto, Apple Carplay and Mirror Link along with supporting voice recognition function & rear parking camera display on screen. The Santro also sees the introduction of rear AC vents which is a segment first.
Image Source: TeamBHP
Also Read: New Hyundai Santro: 5 Key Features Explained In Detail
Also Read: New Hyundai Santro Bookings Officially Begin In India At ₹ 11,100
Also Read: Hyundai Santro Bags Over 14,000 Bookings
Also Read: Hyundai Santro vs Rivals - Spec Comparison
For the latest auto news and reviews, follow CarandBike on Twitter, Facebook, and subscribe to our YouTube channel.


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For the North American region, the new 2019 Ford Ranger Raptor is set to meet the needs of that segment of the population. Needs are seen in the design and technical character. The new model will be based on the existing T6 platform. Ford has been preparing a return to the market for some time, this time the Ranger will see the brightness of the market in 2019. By some, that name will be named Bronco, but it remains to wait for us and see for ourselves this truth.
Although still photos are not available to confirm our story, spyware camcorders are always targeted by certain photographers. That's how Ranger Raptor got into the target, and certain images were made that can serve to describe the design. CarAdvice from Australia has made an effort to get us a day on the photo issue. Information of a picturesque character is important to that extent, because the photograph says more than a thousand words. One of the models, such as the The Ranger FX4, is in production and gives way to the new 2019 Ford Ranger Raptor. Ford plans to launch the Ranger model for 2019, but not the Raptor model, which it will have to wait.
Unfortunately, the Americans will have to wait for the completion of another model and its debut. Maybe it's not so bad, what is a long wait is sweet. For a long time, the F-150 Raptor was the design Ford relied on. The model under the 2015 F-150 has experienced the final changes and has shown that it can go forward with changes, but that old spirit of the vehicle remains. Ford Ranger Raptor 2019 expects and gives hope for something new.
Generally speaking, Ford takes care of the design, in a way that improves design as well as preserving the old design. The F-150 Raptor is a good example of Ford's success. The Ranger Raptor will, after all, judge to follow his great cousin and try to walk his tracks on the outside design. The features and style of the F-150 will in all likelihood follow the model that is expected. If you take a closer look at the photographs that CarsAdvice has prepared, we can see what's happening. The best assumption of the future looks is the combination of spy pictures and the 2017 F-150 Raptor.
The 2019 Ford Ranger Raptor, its front, the right bumper, the thick plate, and the hook for a tow, represent a part that relates to what was downloaded from the F-150 Raptor. These parts, which we have listed, are primarily functional and in this way they sing Raptor. If you plan to move out of the field, you will not have a problem because the bumper is designed to fit outside the field hinges and is additionally made of steel that gives it resistance. The front panel that has a plate and which is mounted on the bumper enables the protection of technical parts. The hooks owned by the new 2019 Ford Ranger Raptor are available as with the F-150 Raptor.
The front side also has grids that are also copied from the F-150 model. Raptor denounced Ford's name in terms of signature. This is also present in other vehicle brands.
The design that the 2019 Ford Ranger Raptor should have, will have esthetic and functional purpose. If we look at the side, it is easy to see cellular items that have a multiple purposes. The first purpose refers to the protection of switches and is intended as a slider, as well as only reducing the input of the vehicle. If we compare it with the predecessor, the new model should be a cheer dimension. The width of the tire is also higher and therefore the mudguards and tire protection must be significantly higher. BFGoodrich's new (ish) All-Terrain T / A KO2 is a label for tires that have been used earlier, saying good tires on F-150 tires.
Of course, the difference between a truck in the size of a tire will exist. The Ford F-150 will have a 35-inch size, while the 2019 Ford Ranger Raptor will have some 33 inches. It will cost some 17 inches in the dial. The wheels will come standard with aluminum material. Beadlock will be used to use outdoors. The luggage compartment will be comfortable and carry the Raptor tag. Spy photos point to mounting hooks, which confirms that they will find and up-production.
As always, so is the case now that there is no relevant information regarding the new Ford raptor model. We can only guess and suppose. Based on certain assumptions, we can see what are possible updates to the F-150. The F-150 Raptor should receive seats that are unique, with leather material. Thick supporters are another feature of new seats. And here the seats will have a special fabric that will give esthetic appearance. Regardless of the start of the wheels, the F1-style will be built here. These are some of the possible modifications. Of course, as the day of realization is closer, we will get more precise information about the vehicle and its design, from the outside and from the inside.
We also reached the driving force. In all likelihood, the F-150 Raptor will get a 3.5-liter EcoBoost V-6 second generation, and one such engine right 450 horsepower with 510 pound-feet of torque. If we compare it to 3.5-liter EcoBoost we will see that it is for even 75 horsepower and more than 40 torques. But if we take into account that the 2019 Ford Ranger Raptor is smaller and lighter, then why should this version be enough? During 2016, the F-150 will have its 375 horsepower available with 470 pound-feet of torque. Ranger Raptor will definitely have one engine that will be at a satisfactory level and customers will be more than satisfied.
In this case, the Ranger would have the driving power at an enviable level with 3.5-liter EcoBoost. There are certain doubts that the 2.7-liter EcoBoost V-6 will be ideal i8 that everything will be according to plan. On the other hand, we have a 3.2-liter five-cylinder turbodiesel that will be a much more expensive option for the reason. The Global Ranger is known for the use of oil burners that Ford uses, which are relevant to US regulations as well as specifications. EPA is a standard with which Ford will not have problems.
Power transfer could be done thanks to an automatic gearbox with ten speeds. Yes, you've read well, ten speeds. The F-150 Raptor already has something in use like the F-150s with the standard 3.5-liter EcoBoost output. The offer will also find an automatic gearbox with six speeds. The choice will be more than sufficient. If we look at the 4WD system, there could be changes to the high-tech components. This means that the Ranger Raptor will have an electronic locking of the differential, as well as a limited slip differential. Controlling the F-150 Raptor when it comes to the T system, it can be done in two ways, manually thanks to a particular keypad placed on the instrument panel, and automatically having six modes of operation. Rock Crawl can activate 4WD Low, including a 4WD additional traction.
It is important to point out that there are certain deviations from the established way that Ranger Raptor has. This involves linking the last relay with Watt's and springs that are more elastic and replacing the previous leaf springs. If we make a comparison with a RAM car, it is similar to the configuration with its cousins 1500 and 2500HD.
Ford Ranger Raptor Estimated Specs
Engine 3.5-liter turbocharged V-6 engine
Torque 470 LB-FT @ 3,500 RPM
Transmission Electronic 10-Speed Automatic
Horsepower 375 HP @ 5,000 RPM
2017 Ford F-150 Raptor Specs
Engine High-Output 3.5-liter turbocharged V-6 engine
Torque 510 LB-FT @ 3,500 RPM
Transmission Electronic 10-Speed Automatic
Horsepower 450 HP @ 5,000 RPM
If you were expecting a price list, we do not currently have it. However, we can compare it with the 2018 Chevrolet Colorado ZR2 whose price spins around $ 40,995. You have Extended Cab Colorado with 3.6-liter V-6 and still some accessories. You can also count on the 2.8-liter Duramax turbodiesel from other options. If we want to make a comparison, Toyota Tacoma TRD Pro, which is an MSRP of $ 40,960, is among the more expensive.
If you want an automatic option, the exchange price is $ 42,960. 2017 F-150 Raptor and SuperCab price is $ 49,265. And it's not possible to make a small difference between the Ford Raptor and the Ford F-150, because it would make no sense.
Our estimate is that the 2019 Ford Ranger Raptor could start with $ 42,000.
Look some video below.
Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!


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Activate Series: #1 - What Is the Belmont Report and Why Does It Matter? September 6, 2017 11:59
Our weekly Activate vlog series uses clips from Educe® online courses to illuminate the truth behind the cultural battles of today (and tomorrow) and move Christians from education to action in their communities, churches, and circles of influence.
In the mid-1970s, driven by the horror of the Tuskegee Syphilis Experiment and other injustices at the behest of science, the U.S. government tasked an 11-member panel to define the ethical principles at the foundation of human subject research. The three principles established by these 11 people, written in what's known as The Belmont Report, have had an enormous impact on medical research and practice. Exposing these principles, and the eugenic philosophies that inspired them, helps us shine light on common arguments for abortion, reproductive technologies, embryonic stem cell research, genetic engineering, and even assisted suicide. This excerpt from our Foundations online curriculum provides critical context for much of what we see and hear today. As you watch the clip, consider:
- How might this context help you connect the dots in conversations about life and death issues, given that many of these issues are masked as health care or the advancement of it?
- In what ways does this information help strip away rhetoric and make the crux of current events more clear, such as Sofia Vergera's court battle for the right to destroy her embryonic children or Iceland's pursuit to eliminate all pre-born children with Down Syndrome?
We welcome your comments below.


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Blues on the Chippewa 2017
photos by Marcie Pannell, Dan Tolin
Blues on the Chippewa took place at Memorial Park in downtown Durand August 4–6. The event featured numerous musicians and music lovers from all over the country. Also featured was a craft show and classic car/motorcycle show. Proceeds will help provide funding for Pepin County Food Pantry & Titus Music for Children Program.