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Exotic pest plants can have many negative impacts on native ecosystems, by disturbing a community's natural equilibrium that has evolved over hundreds of thousands of years. They displace native flora and fauna by competition for and often monopolization of resources (water, light, nutrients, and space). Some plants, such as eucalyptus and iceplant, even use allelopathy, or chemical defenses, to inhibit growth of other plant species. Invasive plants can severely alter sensitive habitats like marshes or riparian areas, affecting critical watershed health. Some invasive plant species may cause harm to native fauna. For example, European beachgrass reduces and degrades western snowy plover habitat; iceplant outcompetes native dune plants that feed the Myrtle's silverspot butterfly; and cape-ivy can be toxic to native fish.
Population Action International and Conservation International have determined that the California Floristic Province (CFP) is a "global biodiversity hotspot"--one of only 25 terrestrial regions worldwide where biological diversity is most concentrated and the threat of loss most severe (Cincotta and Engleman 2000; Conservation International 2007). Forty percent of California's grass species are exotic; today it is rare to find a pristine native California coastal prairie community, and the dominance of exotic grasses over native bunch grass species could increase with global warming (Sandel and Dangremond 2012). This is only one example of how exotic pest plants can alter the structure, function, and composition of native communities, and degrade the overall health of natural ecosystems. Within the CFP, Population Action International found that original flora covers only 25% of the landscape, with only 9.7% of this land protected in parks, reserves, refuges, and other areas off-limits to development and resource exploitation. Point Reyes National Seashore supports 49 special status rare plant species (and manages others found on the northern lands of Golden Gate National Recreation Area), many of which are directly affected by invasive non-native species. While National Park status has protected the native flora at Point Reyes from development, only active restoration will protect the native flora from invasive species.
Diversity is the spice of life
Continue reading: Choosing our Battles
Last updated: February 28, 2015


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- By Jacquelyn White
- Posted Monday, June 23, 2014
The Great Outdoors with Zinio
This summer we want you to enjoy the great outdoors, but don't forget to take us with you! Check out these great eMagazines to start planning your next outdoor adventure.
Backpacker: Published nine times a year, Backpacker is a magazine of wilderness travel, offering practical, "you can do it, here's how" advice to help you enjoy every trip. Filled with the best places, gear, and information for all kinds of hiking and camping trips, each issue delivers foldout maps and stunning color photography.
Field & Stream: "The World's Leading Outdoor Magazine" devoted to the complete outdoor experience and lifestyle.
Outdoor Life: Our readers' hands-on spirit is reflected in the magazine's comprehensive gear tests and personal adventure stories. Whether shopping for a new rifle, searching for the hottest fishing holes this weekend or thirsting for exciting adventure tales, Outdoor Life is the ultimate resource.
Outside: Outside readers are passionately committed to leading an active lifestyle. Outside not only motivates readers to uncover and define their own personal day-to-day adventures, but also provides them with the tools, products and information to fulfill them.
Canoe & Kayak: Canoe & Kayak is the #1 Paddlesports resource for canoeing, kayaking, and whitewater rafting. Each issue is packed with destination reviews and features a different region of North America. In addition, you'll learn the latest paddling techniques, enjoy great photography from seasoned canoeists, and get our expert reviews of paddle and camping gear.
New to Zinio? All you need is your library card and a Zinio.com account. Download as many magazines as you like, new issues and back issues.

domain: library


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The last thing their customers need: Discount giant Costco starts selling budget coffins in Australia
- Australian Costco stores started selling caskets and coffins this week
- At $360 to $3800 they are about half the cost of coffins from funeral homes
- The coffins can be ordered in-store and shipped to customers in two days
- The retail giant has been selling coffins in their US stores for several years
Costco are known for having retail prices to die for – and now they have extended their offer to funerals.
Several Australian Costco stores started selling burial caskets and coffins this week, with the supermarket giant planning to roll them out over all of their national stores.
They are stocking 14 different coffins and caskets ranging in price from $360 to $3800 – which is on average 45 to 50 percent less than coffins from funeral homes, reports Sydney Morning Herald.
Australian Costco stores have started selling cut-price burial caskets and coffins this week
The supermarket giant has partnered with Australian company Scientia Coffins and Caskets to release the cut-price coffins (pictured)
Costco have partnered with Australian company Scientia Coffins and Caskets for the range of cut-price coffins.
'Dying is expensive and funeral costs are evidently going higher and higher,' said Scientia's chief executive Issac Leung.
'You're going to have people that are cost-conscious and are going to look for those savings.'
Costco have stocked coffins at their US stores for several years, but Australia is the first foreign market they are selling them in, said Costco's local general manager Patrick Noone.
At $360 to $3800 the range of coffins are about half the cost of coffins from Australian funeral homes
Costco have stocked coffins at their US stores for several years (pictured: their US products) , but Australia is the first foreign market they are selling them in
'This is an area where we think we can show value. And we're all going to need one, right?'
The coffins can be ordered in-store and shipped in two days to either the customer or their funeral director.
The coffins, manufactured in China and Italy, are reportedly made from eco-friendly medium-density fibreboard and timber.
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domain: economics


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Passport and civil registry offices across Sudan continue to witness large crowds of people seeking to obtain passports. The increased cost of minimum SDG150,000 for adults and SDG75,000 for children has been widely criticised.
Large crowds gathered in front of the passport offices in Dongola, Wad Madani, El Gedaref, Kassala and other Sudanese cities, seeking to renew their passports. The fees for issuing a passport for adults in Wad Madani, capital of El Gezira, rose to SDG700,000 and for children to SDG89,000.
In Kassala, the fees for obtaining a passport have risen to SDG175,350 for adults and more than SDG100,000 for children.
The El Gezira police stated that passports will be delivered within 72 hours of applicants completing the procedures, with 500 applications being received daily.
El Gezira Police Director Maj Gen Sufyan Abdelwahab explained that “the department will work in two shifts each day from morning until eight in the evening”.
Many see the cost increases as an attempt by authorities to cover military expenses.
As previously reported by Radio Dabanga, economic analyst Kamal Karar suggests the large increase in passport issuance fees was an attempt to “blackmail people and exploit their need for passports in order to escape the hell of war, in search of a better life”.
Karar stressed that the increase cannot be justified, arguing the government has “begun to act like parasitic brokers and merchants”.

domain: news


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Hi! I could not find any reference to this. Is there a cheap hardware ($300) for Wii / DC emulation available everyone is using with maximum compatability? I use Recalbox on a pi3 but I miss proper DC performance and Wii Emulation. What system should I get?
Might check out newegg's Build Your Own PC section. Sometimes you can even get Steam Machines cheap.

domain: hobby


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Conjuring 3 Is Moving Forward, Has A Script
After this past weekend and the box office performance of The Nun, The Conjuring Universe is at a point where it's stronger than it's ever been as a franchise. Big lines are forming for the new releases, and while the reaction to the latest installment has not been as positive as previous titles, there is no questioning the demand. Fortunately, the future is bright, as not only is the untitled Annabelle 3 gearing up to shoot this fall, but producer Peter Safran recently told me that The Conjuring 3 is aiming to start production in 2019:
Having produced all of the Conjuring Universe movies to date, Peter Safran is one of the key filmmakers navigating the future of the franchise, and I had the opportunity to speak with him about that vision earlier this year. When the subject of The Conjuring 3 came up, the producer not only confirmed its active development, but also established a timetable that suggests we could see the finished film in theaters in 2020.
David Lindsay Johnson, who co-wrote The Conjuring 2, was officially announced to be writing the script last year, though updates about the project have been few and far between. That being said, certainly one interesting news front has centered on whether or not James Wan will return to direct. Despite launching multiple franchises throughout his career, he has never completed a trilogy, and in August of last year he said that he would likely be too busy working on Aquaman to make The Conjuring 3. If the anticipated sequel starring Patrick Wilson and Vera Farmiga doesn't start filming until next year, however, one wonders if he might not be available after all.
There has been no official statement regarding what case from the files of Ed and Lorraine Warren will be plucked out to make The Conjuring 3 -- but Peter Safran himself had something interesting to say on that front a couple years ago during the making of Annabelle: Creation. Namely, he said that the project would have to move away from the haunted house setup that we've seen and do something different with the established characters. It's an exciting proposition, and we anticipate learning about what direction the film will take.
For now, fans of The Conjuring Universe can see The Nun in theaters -- and I'd also recommend staying tuned here on CinemaBlend for more from my interview with Peter Safran, including updates about The Crooked Man and discussions about a potential The Nun 2. And for what's immediately ahead on the big screen, be sure to check out our 2018 Movie Release Calendar.
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Smart Sports Snacking With Your Pet
It's a great time of year for sports fans and their pets! While you're watching the big game, there's no reason you can't include your pets in the fun, too. One of the ways you and your pet can enjoy sports together is through festive snacking. You can come up with all kinds of creative ideas, from healthy snacks to special, indulgent treats.
We asked Dr. Leslie, Big Heart Pet Brands' in-house veterinarian, for some fun tips on snacking with your pets during the big game.
Q: Is there ever a time when it's OK to give a pet "people food" as a snack, like during a big game?
Dr. Leslie: Ingredients used in human food are the basis for ingredients used in pet food. Most foods are OK for dogs, so long as they are fed in proportion to their dietary needs. Often fresh fruits and vegetables make great, low-calorie treats and snacks for dogs and cats.
Q: What kind of healthy snacks would you recommend for my dog or cat on a special sports occasion?
Dr. Leslie: Some great snacks are baby carrots, blueberries, blackberries, peaches or bananas. Avoid foods known to be toxic to dogs such as onions, garlic, grapes, raisins, etc.
Q: Sometimes I just want to let my pet indulge a little. How often can I give my dog or cat a snack that's not quite as healthy?
Dr. Leslie: Having an allowance for spare calories allows you to give your pet a little bit of an indulgent reward every day. Find out what 10 percent of your dog's or cat's daily calories is and make that their allowance. Then be creative and fill it with lots of light, healthy treats or one or two high-reward treats.
Q: Should I decrease my pet's dinner portion if we're having a big snack day?
Dr. Leslie: Yes — try to make sure that at least 90 percent of the calories come from a balanced diet, and then have fun with your remaining allowance.
Q: Can my pet get sick from eating too many treats on game day?
Dr. Leslie: Yes. Some dogs don't tolerate high sugar or high fat foods very well. In addition to having an extra full belly, which is uncomfortable, some dogs can develop inflammation of their pancreas if they have too much fat in a short period of time. The pancreas is responsible for producing fat digestion enzymes and can become overworked. Pancreatitis can be mild and result in tummy upset and diarrhea, but it can also be severe causing shock and even death.
Q: What's your favorite snack to give your pet during a game?
Dr. Leslie: A good sports party snack for dogs is a veggie bowl. Carrot sticks, raw broccoli and peppers can make your dogs feel like part of the family, won't ruin their diets, and won't make them sick. But save the guacamole for the humans! Avocados are on the "do not feed" list for dogs. (Plus, they're too yummy to share anyway!)
Of course, there's an easier way to treat your pet on game day. While you're planning your sports viewing party, consider surprising your dog with Pup-Peroni® Triple Meat Lovers with Bacon, Sausage & Pepperoni Flavors, and your cat with Meow Mix® Irresistibles® treats.
Explore more articles
7 Things That Can Stress Out Your Pet
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With a little planning, your home can remain clean(ish) even on rainy spring days.

domain: pet


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A CLINICIAN-ADMINISTERED SEVERITY RATING SCALE FOR ILLNESS ANXIETY: DEVELOPMENT, RELIABILITY, AND VALIDITY OF THE H-YBOCS-M
Contract grant sponsor: National Institute of Mental Health research grants; Contract grant numbers: 5R01MH071688; 5R01MH071456.
Correspondence to: Natalia A. Skritskaya, Ph.D., School of Social Work, Columbia University, 1255 Amsterdam Ave., Room 835, New York, NY 10027.
Clinician-administered measures to assess severity of illness anxiety and response to treatment are few. The authors evaluated a modified version of the hypochondriasis-Y-BOCS (H-YBOCS-M), a 19-item, semistructured, clinician-administered instrument designed to rate severity of illness-related thoughts, behaviors, and avoidance.
The scale was administered to 195 treatment-seeking adults with DSM-IV hypochondriasis. Test–retest reliability was assessed in a subsample of 20 patients. Interrater reliability was assessed by 27 interviews independently rated by four raters. Sensitivity to change was evaluated in a subsample of 149 patients. Convergent and discriminant validity was examined by comparing H-YBOCS-M scores to other measures administered. Item clustering was examined with confirmatory and exploratory factor analyses.
The H-YBOCS-M demonstrated good internal consistency, interrater and test–retest reliability, and sensitivity to symptom change with treatment. Construct validity was supported by significant higher correlations with scores on other measures of hypochondriasis than with nonhypochondriacal measures. Improvement over time in response to treatment correlated with improvement both on measures of hypochondriasis and on measures of somatization, depression, anxiety, and functional status. Confirmatory factor analysis did not show adequate fit for a three-factor model. Exploratory factor analysis revealed a five-factor solution with the first two factors consistent with the separation of the H-YBOCS-M items into the subscales of illness-related avoidance and compulsions.
H-YBOCS-M appears to be valid, reliable, and appropriate as an outcome measure for treatment studies of illness anxiety. Study results highlight “avoidance” as a key feature of illness anxiety—with potentially important nosologic and treatment implications. Depression and Anxiety 00:1–13, 2012. © 2012 Wiley Periodicals, Inc.

domain: literature


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Jan. 16, 2018
Keita Bates-Diop earned his second Big Ten Player of the Week in as many weeks and his third of the season after leading the Buckeyes to wins over Maryland in Columbus and another at Rutgers Sunday. Last week Bates-Diop averaged 23 points and 8.5 rebounds after scoring 26 points vs. the Terrapins and 20 points in the road win at Rutgers. He also blocked five Scarlet Knights shots in a 68-46 win.
The No. 8/8 Ohio State University women’s ice hockey team used another offensive explosion, coupled with excellent goaltending, to wrap up a sweep of the No. 9/9 Robert Morris Colonials on Saturday afternoon at the OSU Ice Rink.
The No. 2 Ohio State University wrestling team (9-0, 4-0 Big Ten) raced out to a 20-0 edge by intermission before tacking on 11 more team points in the evening’s second half of matches to ultimately defeat No. 14 Minnesota (4-2, 1-1 Big Ten) by a final tally of 31-7.
Stephanie Mavunga scored 20 points and grabbed 16 boards to lead the Buckeyes to a 77-62 win over Indiana and improve to 5-0 in Big Ten play. Kelsey Mitchell became the 13th player in NCAA history to scores 13,000 points and moved to number 12 on the all-time scoring list.
On Saturday, the Buckeyes posted a team score of 4690, besting the Huskers (4667) and Rebels (4667). The score of 4690 is the second highest of the season and the 5th highest in program history.
Sixty-five competitors, including all 11 members of the Ohio State Pistol team, entered the 2018 Camp Perry Open pistol event. But only one emerged as the Pistol Overall Final champion, and that was Buckeye Anthony McCollum. After finishing second in qualification, he advanced to the Finals and fired a 235.7 to lead all shooters.
Stay up-to-date by adding the athletics calendar to your mobile device below:


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Alysha Clark (No. 32) took care of Game 1 and Breanna Stewart (far right) closed out the Seattle Storm’s semifinals sweep. | Photo by Julio Aguilar/Getty Images
Breanna Stewart dropped 31 points in the Seattle Storm’s Game 3 win over the Minnesota Lynx. Meanwhile, the Las Vegas Aces and Connecticut Sun continue their series after Angel McCoughtry helped the Aces force a Game 5.
The No. 2 Seattle Storm punched their ticket to the 2020 WNBA Finals with a 92-71 win over the No. 4 Minnesota Lynx on Sunday at IMG Academy in Bradenton, Florida.
The Storm won the championship in 2018. Later that year, superstar Breanna Stewart ruptured her Achilles in a EuroLeague Women championship game and missed all of the 2019 WNBA season. The team made it to the second round of the playoffs last year with Jewell Loyd and Natasha Howard leading the way, but Stewart’s return and the return of WNBA legend Sue Bird, who also missed last season following knee surgery, have returned the Storm to dominance and put them in position to win another championship.
In the other semifinals series, the No. 1 Las Vegas Aces finally found some breathing room against the No. 7 Connecticut Sun and came away with a comfortable 84-75 victory to force a Game 5.
Seattle Storm 92, Minnesota Lynx 71 | Storm win series 3-0 | Box Score
After making just a third of her shots through the first two games of the series, Stewart dominated Game 3 with a playoff career-high 31 points on 63.6 percent shooting from the field. She also had seven assists, six rebounds, three steals and two blocks. Bird added 16 points and dished out a game-high nine assists.
— Seattle Storm (@seattlestorm) September 27, 2020
Mercedes Russell scored 10 points and hauled in six rebounds for the winners in 18 minutes played. Loyd dealt with back stiffness and played just 23 minutes while Jordin Canada (19:29) and Howard (15:31) also got some rest due to the large margin of victory.
The Storm were comfortably ahead at the end of each quarter and led by 13 entering the fourth. Minnesota needed a big final quarter to steal the game and they did not get one. The Lynx scored 20 points in the final frame, but allowed 28 and never got closer than 12 on a Napheesa Collier 3-pointer with 5:38 remaining.
Collier finished with 22 points and recorded game highs in rebounding and blocking, with 15 and three, respectively. Crystal Dangerfield, the 2020 Rookie of the Year, had her best scoring performance of the semifinals with 16 points and Damiris Dantas chipped in the same. Still, it was not enough for the Lynx to avoid the three-game sweep.
Minnesota lost Game 1 by two points on a buzzer-beating layup by Seattle’s Alysha Clark and Game 2 by a 10-point margin.
The Storm opened Game 3 with a great first quarter that featured a 17-0 run. Stewart had eight points, three assists and two steals in the opening frame and Bird was good for eight points and four assists to help give Seattle a 24-12 lead entering the second.
Las Vegas Aces 84, Connecticut Sun 75 | Series tied 2-2 | Box Score
The Aces avoided elimination thanks to 29 points from Angel McCoughtry, 16 of which came in the third quarter.
The Sun had all the momentum coming into this one and the Aces were trying to avoid becoming the first No. 1 seed to not make the Finals under the new playoff format. McCoughtry rose to the occasion under that pressure after scoring 31 points combined in the first three games of the series.
— Las Vegas Aces (@LVAces) September 27, 2020
McCoughtry and Sixth Woman of the Year Dearica Hamby (24 points in the first three games) were the two players the Aces needed to step up the most. Hamby, however, was ruled out for the rest of the season with a knee injury, announced prior to tipoff, making McCoughtry’s role even more important.
A’ja Wilson, the 2020 WNBA MVP and 2018 Rookie of the Year, deserves a lot of credit for the win as well. She had carried the Aces through the first three games and notched 18 points and 13 rebounds in Game 4.
Danielle Robinson also scored 18 points for Las Vegas after combining for 26 in the first three games. Robinson rounded out her Game 4 stats with five rebounds, four assists and three steals.
The Aces absolutely dominated in the paint, scoring 46 points to the Sun’s 20, and they surrendered just seven turnovers, which prevented Sun star Alyssa Thomas from getting out in transition.
Thomas’ name was buzzing across the WNBA after she battled back from a shoulder dislocation in Game 2 to score 23 points in Game 3. On Sunday, she was held to 15 points and her teammate, Jasmine Thomas, led Connecticut in scoring with 25. Meanwhile, the Sun’s No. 1 scorer in the regular season, DeWanna Bonner, recorded 10 points and 15 rebounds in defeat.
The Aces led by 11 points entering the fourth and the Sun never got closer than nine in the final frame. Connecticut was up by two points after one quarter and by one point at the break before McCoughtry took over in the third. The Sun had yet to trail the Aces by double digits before the third quarter on Sunday.
The Storm await the winner of Game 5 between the Aces and Sun, which will take place on Tuesday, Sept. 29, at 7:00 p.m. on ESPN2.
Game 1 of the Finals is set for 7 p.m. on Friday, Oct. 2, and will be aired on ESPN2.

domain: sports


Fire at Citgo gas station in Westland
Viewer submitted photo.
WESTLAND, Mich. (WXYZ) - Firefighters battled a fire at at a CITGO gas station in Westland.
The gas station is located at Middlebelt and Ann Arbor Trail. The intersection is shut down at this time.
Flames and smoke could be seen through the top of the building.
Firefighters worked hard to keep the fire from spreading near the pumps.
No injuries were reported.


I've got a bunch of Intel X520-DA2 NICs we'd like to use with Cisco and other third party SFP+ modules. Under Linux, there is an unsupported flag we can pass to the kernel module to disable this enforcement however there doesn't seem to be anything similar for Windows users.
Is there a workaround to use these unsupported modules with the Intel X520 series NICs?
No, there is not a similar option available for Windows. You are limited to the supported modules listed at http://www.intel.com/support/network/adapter/pro100/sb/CS-030612.htm http://www.intel.com/support/network/adapter/pro100/sb/CS-030612.htm.


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The American Medical Association (AMA) is recommending that the biological sex of a baby should be removed as a legal designation from the baby’s birth certificate so as to avoid discrimination against individuals who identify as a member of the opposite sex or gender non-binary.
“Designating sex on birth certificates as male or female, and making that information available on the public portion, perpetuates a view that sex designation is permanent and fails to recognize the medical spectrum of gender identity,” AMA Board Chair-Elect Sandra Adamson Fryhofer, M.D., explained in a press release, further stating that removing a baby’s biological sex from the public document would prevent discrimination as individuals register for school and sports, apply for jobs, adopt, get married, or request their public records.
“This type of categorization system also risks stifling an individual’s self-expression and self-identification and contributes to marginalization and minoritization,” she said.
The medical organization believes that the U.S. certificate of live birth, which is submitted to the state vital records office, should still record a baby’s sex for the sake of collecting medical and public health data.
Jeremy Toler, M.D., a delegate from GLMA: Health Professionals Advancing LGBTQ Equality, argues that this change is necessary as an “equalizer” for transgender and gender nonbinary individuals as well as intersex individuals, that is, people who are born with physical characteristics of both genders as opposed to simply identify as one, another, or neither.
“We unfortunately still live in a world where it is unsafe in many cases for one’s gender to vary from the sex assigned at birth,” he stated.
There was some dissent from the medical community, however.
“We as physicians need to report things accurately,” stated Robert Jackson, M.D., an alternate delegate from the American Academy of Cosmetic Surgery. “All through medical school, residency, and specialty training we were supposed to delegate all of the physical findings of the patient we’re taking care of. I think when the child is born, they do have physical characteristics either male or female and I think that probably should be on the public record. That’s just my personal opinion.”
The American Medical Association is one of the most notable proponents of so-called “gender affirming” healthcare, having recently opposed legal measures to ban “transition-related care” for minors, which it deems “medically necessary.”
As the report and its supporters stated, the organization is taking the stance that gender is separate from physical sex, but that begs the question: Why are synthetic hormones and cosmetic surgery often used to distort a person’s natural image to adhere to that of a member of the opposite binary sex, a treatment protocol that is considered by the AMA to be “medically necessary…for children?”
Not only is it up for heated debate as to whether such treatments are even safe for children, much less necessary, but enabling individuals to be officially recognized according to their gender identity can have deadly results — in 2019, a woman who identified as a man gave birth to a stillborn baby because emergency room staff never considered that her symptoms were consistent with labor.
Medicine has without doubt advanced dramatically in recent years. But advancement must come with the healthy entertaining of opposing viewpoints. Unfortunately, when it comes to issues of gender identity and medicine, doctors are self-censoring and any dissenting voices are quickly being snuffed out by the virtue-signaling leftist establishment.
It is nothing short of chilling that the AMA is asserting this decidedly radical ideology about gender as though it is medically recognized or biologically factual.
This seems to be far removed from anything resembling “progress.”


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If you’re wondering how to repair a receding gum line, you’re not alone. This issue affects many people and may have many different causes. If you’re wondering if you should see a dentist or try one of the over-the-counter treatments, keep reading! In this article, you’ll learn the causes of receding gums, treating them, and ways to naturally repair a receding gum line. Get more info about repair receding gum line
What’s It Mean If You Have Receding Gums?
If you wonder what receding gum line means, it is a sign of deteriorating gum health. Healthy gums are pink and firm, and are not red or swollen. Gum recession can be caused by a variety of factors, including genetics, health conditions, and brushing habits. Understanding what’s causing your gums to recede can help you decide the most effective treatment.
Most people don’t realise it, but receding gums are a sign of more serious issues. They expose more of the teeth and may even cause bad breath. Recessive gums can lead to tooth decay, bleeding gums, and bad breath. Although it’s difficult to reverse, it can be treated and reversed.
You can reverse some of the effects of the gum recession. Medicinal aloe vera gel can treat gum inflammation. It also promotes oral health and helps repair the gum tissue. Green tea and peppermint essential oil are two great herbal remedies for gum recession. They contain compounds that help prevent the growth of bacteria in the mouth. And avoiding tobacco and alcohol, will help your gums to heal.
What Causes Receding Gums?
What causes receding gums? There are several reasons why your gums may be receding, including hormonal changes and poor oral hygiene. If you brush your teeth too hard, plaque will form on your teeth, eventually leading to receding gums. You should avoid over brushing and instead focus on massaging your gums while brushing. Brushing your teeth with a soft-bristled toothbrush will help prevent the formation of tartar.
You should brush your teeth twice a day, floss daily, and have professional cleanings at least twice a year. Brushing your gums is particularly important, as the bacteria living beneath them can cause gum recession. Remember to brush gently, but thoroughly and gently. Heavy-handed brushing can cause irreparable damage to your gums.
How to Treat Receding Gums?
While there are several ways to treat receding gums, the best option depends on the cause and severity of the problem.
You can try home treatments for your receding gum line. Saltwater rinses can help reduce inflammation of your gums and promote tissue growth. Turmeric is also a good treatment for receding gums. Its anti-inflammatory properties help prevent plaque and gingivitis. Additionally, omega-3 fatty acids can promote a more secure attachment of gums to teeth. Lastly, a hydrogen peroxide and water solution can help with your receding gums.
Ways To Repair Receding Gum Line Naturally
A few ways to treat receding gums include oil pulling and topical aloe vera. Both of these techniques are proven to reduce gum inflammation and plaque buildup. You should also consider consuming green tea as a natural way to reverse receding gums. Green tea has many benefits for oral health and has been shown to reduce the appearance of receding gums. Try to find the right combination of these two remedies to treat receding gums.
The recession of the gums is a common dental condition that exposes the tooth’s root, leaving it vulnerable to bacterial infection and decay. It can also lead to tooth loss due to the gap between the gums and the teeth. A recession of the gum line is often caused by poor oral hygiene, improper brushing, age, or genetics. Fortunately, there are several ways to repair receding gums naturally.
Oil Pulling A Natural Way To Treat Receding Gums
Often referred to as “oil pulling,” coconut oil is a popular ingredient in home remedies to treat a receding gum line. It has antimicrobial properties and can be used in combination with other oral care techniques. However, it has been controversial since it may cause damage to the pellicle proteins and biofilm found in the oral cavity. In addition, oil pulling will not “extract” blood from the mouth, which is necessary for proper dental health.
This practice involves swishing one tablespoon of oil around the mouth for ten to fifteen minutes. Afterward, rinse your mouth with warm water. Oil pulling has been around for 3,000 years and has gained a large following in recent years. It originated from Ayurvedic medicine. Oil pulling does not cure dental problems, but it can help repair receding gum lines. It is a natural alternative to modern oral care methods.
Tree Essential Oil
Using essential oils to treat gingivitis has numerous advantages, and tea tree oil is no exception. This oil offers a long range of home treatments and is anti-inflammatory and antiseptic. Tea tree oil can even kill MRSA in vitro, according to the National Institutes of Health, and it’s been studied as a cure for acne and athlete’s foot.
Gum recession can be treated using this oil, and it can also help prevent additional receding gums. Tea can help gum tissue regrow if you drink it twice or three times a day. It’s a terrific caffeine-free alternative to coffee and other caffeinated beverages. Drinking up to six glasses of tea each day is safe, and the benefits have been excellent.
Coconut oil is an effective therapy for receding gums when used correctly. It promotes tissue growth while also acting as a natural anti-inflammatory germicide, eliminating germs and other pathogens that cause gum recession. People with receding gums can also use saltwater mouthwash as a preventive step to arrest the progression of gum recession and avoid additional damage, in addition to using coconut oil as a mouthwash.
Adding eucalyptus oil to your dental paste, mouthwash, or even your daily brushing routine can help stop receding gums. You may be surprised to learn that this antibacterial, antimicrobial oil is effective against several oral ailments, including cancer-causing bacteria. This super-remedy has been used for centuries to treat various ailments and improve health. Below are some ways to incorporate this natural remedy into your oral health regimen.
Essential oils like lemon, yarrow, and eucalyptus are also good options for healing a receding gum line. Citrus oils, like eucalyptus oil, fight off bacteria and boost tissue production. Essential oils like yarrow are anti-inflammatory and can relieve swollen gums. Eucalyptus oil can also calm inflamed gums.
Researchers tested two types of toothpastes in one study and found that the oil in both products reduced plaque buildup. Another study showed that gum disease, or gingivitis, was reduced in people who chewed gum containing eucalyptus oil or leaf extract. Both methods reduced gingivitis symptoms, including bleeding and inflammation of the gums.
Turmeric gel has antiplaque and antigingivitis properties comparable to chlorhexidine. Despite the fact that both gels lowered gingival index and plaque levels, turmeric was more widely accepted. It was not disagreeable due to its sweet taste and non-staining qualities. Future research will be required to identify how frequently and for how long turmeric gel should be administered. However, preliminary findings suggest that turmeric gel may be useful in reducing the effects of plaque-induced gingivitis and improving overall dental health.
The Ayurvedic technique is an old medical practice that has its origins in the Vedas. Medicinal herbs have been used to treat and prevent numerous mouth diseases.
Peppermint Essential Oil
Peppermint essential oil can aid if you’re worried about receding gums. It’s safe to use on the gums and can even help with discoloured cavities. It will not, however, eliminate tartar or plaque. It won’t cure your receding gums, but it can help you prevent them. It’s also ideal for folks concerned about the effects of alcohol on their gums because it’s alcohol-free.
Peppermint essential oil comes in two varieties. Peppermint oil is a natural mint that helps to prevent gum recession by fighting bacteria in the mouth. Peppermint essential oil can help with this issue, but you should do some research to ensure it’s good for you. If peppermint essential oil isn’t your thing, you can try septilin, a multi-herbal gum recession cure. This product contains several natural, safe, and effective components. It’s available as a pill or a syrup. Adults should take two tablets twice a day, while children should take a teaspoon of syrup three times daily.
Vitamin C is another excellent treatment for gum recession. Vitamin C is a powerful antioxidant found in abundance in raw veggies. You can also use aloe vera instead of peppermint essential oil. Because of its anti-inflammatory, antibacterial, and narcotic properties, it’s a great treatment for receding gums. Another super-remedy for gums is eucalyptus.
Septilin’s efficacy in regrowing gum tissue was tested in a recent study. Researchers put 40 chronic periodontitis patients into two groups at random. After scaling and root planing, the medication was given to the test group for two weeks. The other group just received normal treatment. The researchers looked at changes in serum CRP and saliva TNF-a levels, as well as gingival bleeding index. The outcomes were favourable.
Septilin is available in syrup and tablet form for adults. Two tablets or two teaspoons three times a day is the recommended dosage. Additionally, mouth rinse made from a three percent hydrogen peroxide and water solution can be employed. The solution should not be consumed and repeated every two or three weeks. Hard-bristled toothbrushes can injure the gums, thus, brushing your teeth with a soft-bristled toothbrush is recommended.
Aloe vera is another natural periodontal disease treatment. Aloe vera aids in the strengthening of gum tissue by strengthening the collagen fibres that keep the tissues taut. After a scale and root planing procedure, which removes germs and irritation from the gums, it can also be used as a mouthwash. When used with Septilin, Aloe vera can help you recover a healthy smile while also reducing gum bleeding. In addition, the recipe aids in the improvement of gum pocket depth.
Gel of Aloe Vera
Aloe vera provides a number of benefits. It possesses antibacterial and anti-inflammatory properties in addition to soothing the gums. In addition to these advantages, aloe vera can be used as a mouthwash. If you use it as a mouthwash for a few minutes each day, it can help prevent and treat receding gums.
According to Davis, aloe vera helps wound healing by increasing blood supply and oxygenation. The activity of collagen and fibroblasts is thus stimulated. Aloe vera has several compounds that can aid in the reduction of inflammation and the formation of cells. These compounds include mannose phosphate and Gibberellins, which bind to the insulin-like growth factor receptor. Aloe vera is a plant that has anti-inflammatory and nourishing properties.
In addition to its anti-inflammatory and antibacterial properties, aloe vera can help with gastrointestinal issues. Aloe vera has been shown in studies to aid in healing oral illnesses, suggesting that it could be a useful treatment for gum disease and other oral ailments. If you’re worried about the negative consequences of aloe vera, try using it as a tooth care product. It’s important to keep in mind, too, that aloe vera isn’t for everyone. If you have diabetes or sensitive gums, talk to your doctor first. Some people may have diarrhoea or cramping after using aloe vera orally.
Salted water rinse has several benefits, including healing the gums. It contains omega-3 fatty acids, which have been shown to reduce inflammation and strengthen the attachment between the gums and teeth. It may also reduce the risk of developing periodontitis and other health problems. Saltwater rinse is a great at-home treatment for receding gums. Try using it twice a day to see positive results in a few weeks.
Using saltwater rinse on a regular basis can help you fight off gum disease, especially when combined with a good oral hygiene routine. It kills bacteria that can lead to gum recession. You should mix one or two teaspoons of salt with warm water. Rinse your mouth with the solution for a minute, swish it around, and repeat a day thrice.
Using Listerine to clean your teeth is not enough. While Listerine kills bacteria in your mouth, it struggles to remove plaque on the tooth surface. Therefore, it is ineffective in treating gum recession. You should try a professional treatment for your problem. Once you see visible results, you can use salt water rinse to repair the receding gum line in a few weeks.
Reversing receding gums can be done in a variety of ways. Oil pulling is one of the methods for reversing gum disease by reducing plaque and inflammation. Green tea helps prevent bacterial buildup, which is one of the most common reasons for gum discomfort. Topical aloe vera might also help to keep your gums healthy. Sore gums can also be treated with aloe vera. Finally, green tea provides various health benefits, including the capacity to reverse receding gums naturally.

domain: medical


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With the wind in my hair, that's how I spent my entire day today, digging and pulling, arranging and fluffing.
The bicycle got a new basket of flowers, if only I can keep the squirrels from planting their own goodies inside.
"It was the month of May, the month when the foliage of herbs and trees is most freshly green, when buds ripened and blossoms appear in their fragrance and loveliness.
And the month when lovers, subject to the same force which reawakens the plants, feel their hearts open again, recall past trysts and past vows, and moments of tenderness, and yearn for a renewal of the magical awareness which is love."
~ Sir Thomas Malory, La Morte d'Arthur


If you want to tow a caravan, trailer, horsebox or boat with your Toyota, your dealer will be able to help.
Toyota dealerships can offer high quality and competitively priced towbars and towing electrics at very competitive prices. Towing equipment is available for the Verso, Avensis, RAV4, Land Cruiser and Land Cruiser V8, with prices for a fully fitted towbar with 7-pin electrics starting from just £450. Upgrading to 13-pin wiring is an extra £50.
For many models a choice of towing solutions is available, including detachable and ball and pin types.
Toyota applies the same high standards to its towbars and electrics as any other component or accessory. These towbars are designed to fit your Toyota perfectly and function reliably for years to come. That’s why we offer a five year warranty on towbars and wiring for the Verso, Avensis, RAV4, Land Cruiser and Land Cruiser V8. Hilux towing gear comes with a three-year warranty.
So, if you are looking for towing gear designed specifically for your car at a very competitive price, get in touch with your local Toyota dealer.


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Thank you to GoodCook for sponsoring this Chickpea Frittata recipe post, and thank YOU for supporting the brands that help make Meal Prep On Fleek possible. All opinions are our own.
This vegan-friendly frittata uses chickpea flour instead of eggs for a protein-rich breakfast that satisfies hunger. Mushrooms and spinach can be swapped out for bell peppers, kale, or zucchini.
Looking to add more plant-based or vegan recipes into your meal prep routine? Look no further than this Chickpea Frittata! I know; you're probably wondering how a frittata could be vegan, given they are usually made with eggs. But, it's possible! This recipe is egg-free, gluten-free, and vegan!
In place of the eggs, I used chickpea flour which, believe it or not, mimics eggs with the taste and texture. You can also find chickpea flour in the store as Garbanzo bean flour. It works wonderfully to create many vegan recipes like tortillas, socca, frittatas, and even sweet recipes like banana bread and cookies.
Since I made this recipe vegan, I used nutritional yeast as the "cheese" in this dish. You wouldn't believe how much nutritional yeast tastes, just like cheese! It also adds a nice punch of vegan protein, plus provides you with 630% of your daily vitamin B12 needs, 90% of your daily folate, 420% of your B6, plus iron and potassium, all for only 40 calories!
For the seasonings, feel free to switch them up and use any you have on hand, and the same for the veggies! Let this chickpea frittata recipe be a vessel for using up whatever produce you have on hand. Remember our "no food waste" thing lately? Well, this is another great recipe to reduce food waste. I used mushrooms and spinach, but asparagus, peppers, tomatoes, onions, shredded or diced squash, etc., would all be nice in this! This rule also applies to the fruit. Again, use whatever you have on hand, or even canned fruit, to round out this dish.
Ready, set, prep!
Like many of my meal preps, I opted to serve this vegan frittata in my favorite teal meal prep containers. The small compartment for the fruit is 1 cup, and the large compartment, which the frittata lives in, is 2 cups. When using this container for vegan meal prep, I think about the larger compartment holding my carbohydrate, vegan protein, and fats and the small compartment holding my fruit and/or veggies. It creates a perfectly balanced vegan prep.
Although it is easy to tell which side is which, GoodCook® also embossed the compartment sizes on each as a reminder, which is one of my favorite features! It takes the need for extra measuring cups and spoons out of the equation. Hello, fewer dishes to wash!
Like all GoodCook containers, these also come in a set of 10, so you are ready for 2 meals per day for 5 days or 1 meal per day for you and a partner. They are also microwave, freezer, and dishwasher friendly, plus BPA free. And, let me tell you, they also last forever! I have been using mine for months with not a crack or issue in sight! Containers that are $1.00 a piece and last that long are right in my budget!
So, grab your containers, and jump right into this or one of the other delicious recipes for this week’s meal prep!
Chickpea Frittata Ingredients:
- 1 ¼ cups chickpea flour
- ¼ cup nutritional yeast
- 1 teaspoon baking powder
- 1 teaspoon sea salt
- 1 teaspoon Italian seasoning
- ¼ teaspoon garlic powder
- 2 ½ cups water
- 3 tablespoons olive oil + extra for greasing
- 1 cup sliced cremini mushrooms
- 2 cups fresh spinach
- 2 cups mandarin orange segments
- 2 cups sliced kiwi

domain: health


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There are many factors that go into preventing hospital-acquired conditions, and with the federal government getting serious about reducing pressure ulcers, falls and health care-associated infections, bed and mattress manufacturers are taking note.
While “smart” certainly continues to be a buzzword for beds, with products that send patient data to nurses, some recent new releases focus on the basics to better target ulcers and infections as well as seepage; and make technological strides with improved patient monitoring and data collection in order to both improve care and boost the efficiency of caregivers.
Last November, for example, Sizewise introduced its NPT3 mattress, billed as the first pressure redistribution mattress with skin-sensing technology. Mary Nell Westbrook, chief marketing officer at Sizewise, says the mattress includes new gel-infused memory foam to help maintain an ideal skin temperature, along with a wrapped core to provide protection against seepage. The life of a mattress should be five to seven years, she says.
“Infection control is a huge topic,” Westbrook says. “I’ve seen some pretty horrendous pictures where a hospital has cut open a mattress and the seepage inside is pretty horrible. A mattress in and of itself shouldn’t be a disposable piece of equipment. Once an ingress has occurred, you can’t get that out of foam.”
ArjoHuntleigh markets its Skin IQ Microclimate Manager, a powered mattress cover for use with a pressure redistribution surface that moves moisture away from the patient’s skin. “It’s a different way of addressing the issue,” says Jason Tucker, ArjoHuntleigh’s senior director of marketing. “A fan is pulling air from within the surface, pulling air underneath the patient, and helps draw moisture away.”
The company also helps health care providers with programs around patient handling and pressure ulcer prevention. “We’re focused not just on products, but how we can, using our experience and our expertise, help customers reach goals related to clinical outcomes, financial targets and patient satisfaction,” Tucker says.
Repositioning the ‘smart’ way
Beyond the mattress, companies are introducing technology to help in pressure ulcer reduction, and this is where the “smart bed” comes in. As a start, the BAM Labs Smart Bed Technology gives caregivers the ability to provide individualized, patient-centered repositioning and then document that repositioning with the press of a button.
“We have optimized the scheduling for when these events need to happen,” says Mike Hanson, vice president of strategic partnerships at BAM Labs. Hanson says the scheduling can be tied to the individual patient’s needs and occur at the right time. A study of the product at three long-term care centers in Kentucky, published in the June 2014 issue of the Journal of Aging Science, found that over a 12 week period of using the Smart Bed Technology with 94 patients, the overall number of pressure ulcers decreased by 50 percent from baseline to the end of the study, and there was a dramatic 85 percent decrease in new pressure ulcer development during the study period.
Additionally, compliance with the two-hour turn schedule (the average time it takes for a nurse to complete a round) increased by 35 percent during the course of the study. Hanson says the study also adds to the body of knowledge, which is helping validate the standard two-hour turn schedule for patients who are at risk of developing pressure ulcers. In the past, an every two hour turn schedule wasn’t based on clinical evidence, but because it took two hours to do a round. Research is ongoing to identify optimal turn scheduling based on risk, surface, and other factors.
“The standard has been around in the medical community, but no one has been able to prove it because the technology wasn’t there,” Hanson says. Hanson says during the next study, they may look at whether two and a half or three hours is possible, “so patients can get enough rest and sleep.”
The Smart Bed Technology also detects presence in the bed, as well as trends in heart and respiration rate, using a touch-free sensor located under the mattress. This can identify if a patient is getting out of bed in the middle of the night, help assessments of length of time in bed, and provide data on heart rate or respiration rate trends. Changes in all these factors can provide objective data on depression, medication effects, stress, or even infection.
“What we do now is provide out-of-the box metrics reports and trends and support those quality initiatives that are coming from CMS and those other organizations,” Hanson says. “That has been an important topic for our customer base.”
The bariatric market expands
The bariatric segment remains one of the fastest growing segments of the hospital bed market. Jeff Ambrose, president of hospital bed distributer DiaMedical USA, says he’s been getting more and more inquiries even from smaller hospitals, which are seeing the need to offer bariatric options.
Ambrose says he often recommends the Burke Triflex II, a true bariatric bed with a 1,000-pound capacity, which he sells for $7,800 to $8,500. While some hospitals may make a choice between new or reconditioned standard beds, because of the demand, it’s nearly impossible to find reconditioned bariatric beds. “People need them,” Ambrose says. “It’s a new area of health care that hasn’t seen turnover yet.”
Patient mobility and fall reduction
Beds that turn into chairs, to help with patient mobility, are also seeing a high demand, as are low beds. In fact, in January, Stryker announced that it was acquiring Canadian company CHG Hospital Beds, which specializes in low-height hospital beds and related accessories, specially designed to reduce the risk of patient falls. The company also recently launched its Spirit One bed, an expandable low-height bariatric bed for the acute care market.
“The acquisition of CHG aligns with Stryker’s commitment to offering products that enhance the quality of care for both patients and health care professionals; in this case, aiding in the prevention of patient-related injuries resulting from a fall from a hospital bed,” Timothy Scannell, group president for medical surgery and neuro-technology at Stryker, said in a press release announcing the acquisition. “This acquisition will bolster Stryker Medical’s bed offerings and allow us to offer additional solutions to our customers.”
Keeping clean with copper
Infection control goes beyond the mattress. Copper BioHealth, a Chile-based startup that launched in 2013, has replaced the standard plastic-coated bed rails with rails made of copper, an anti-microbial element, on 150 beds in four Chilean hospitals, according to an NPR report late last year.
Andrea Cabello Cordero, business development coordinator for Copper BioHealth, says that while copper bedrails are more expensive than regular bed rails, the investment is worth it. The company’s bed rails cost between $890 and $1,370. Cordero compares that to a set of bed rails for electric Hill-Rom beds that cost $1,000 in Chile.
“It’s a fact that the bedrails are the most polluted surfaces in rooms of hospitals and clinics, which are cleaned between two to four times a day with various chemicals,” Cordero says. “That’s why we are focusing on this specific product. Antimicrobial copper bedrails reduce by 90 percent the microbial load on the surface, therefore the cost of investing in copper bedrails pays, not only decreasing infections … but also decreases the use of disinfectants and the impact of this on the environment.”
The company hasn’t yet assessed the impact of those copper railings in the Chilean hospitals. However, a 2013 study published in Infection Control and Hospital Epidemiology looked at three U.S. hospitals, including the Medical University of South Carolina, the Memorial Sloan-Kettering Cancer Center, and the Ralph H. Johnson Veterans Affairs Medical Center that used patient rooms where items such as bedrails, tables, IV poles, and nurse’s call buttons were made of copper-based materials. The study found that the proportion of patients that developed a health care-acquired infection was 3.4 percent in the copper-outfitted rooms, versus 8.1 percent in regular rooms.
Cordero says the company’s business strategy is to commercialize antimicrobial copper bedrails, designed and manufactured in Chile, through a leasing model and an associated maintenance service.
to check out the DOTmed Virtual Trade Show for hospital beds and related equipment.
DOTmed Registered Hospital Beds February 2015 Companies
Names in boldface are Premium Listings.
Tony Asbille, Global Star
Brett Freitas, Encore Medical Technologies Inc
roger meyer, hbr healthcare
Alison Fortin, Global Inventory Management
Scott Scholl, Medical Inventory Control
Juan Sandoval, Monterrey Medical Equipment
Ryan Walker, HatchMed


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Background:The association of celiac disease (CD) with refractory hypothyroidism is a known but less common condition.
Objectives:This study aimed to evaluate the prevalence of CD among patients with refractory hypothyroidism and compare the accuracy of different diagnostic procedures of CD in these patients.
Methods:During a six-month period, 25 patients with refractory hypothyroidism were included from the endocrinology outpatient clinics of Ahvaz Jundishapur University of Medical Sciences, Khuzestan, Iran. For all the participants, the serological profile of CD, including anti-tissue transglutaminase (anti-tTG), anti-endomysial antibody (anti-EMA), and total immunoglobulin A, was determined, and then they were referred to undergo upper endoscopy and random biopsies from the first and second parts of the duodenum.
Results:The average duration of hypothyroidism among the participants was 7 months. In addition, 75% of the patients (n = 19) were female. The mean age values of male and female subjects were 31.3 ± 17 and 34.3 ± 8.5 years, respectively (age range: 17 - 53 years). The average daily dosage of levothyroxine was 285.1 ± 89.9 mg. The most common comorbidities were anemia (72%) and diarrhea (24%). The most frequent serologic findings in these patients were positive anti-tTG (28%) and anti-EMA (16%). The most common results of upper endoscopy were normal mucosa (48%), gastritis (28%), duodenal fissuring (8%), duodenal atrophy (8%), and duodenal erythema (8%). Based on the results of the pathology report, 20% of the patients (n = 5) were diagnosed with CD (mostly marsh 1 and 0 stages). The sensitivity and specificity of tTG were 33 and 87.5%, respectively. The sensitivity and specificity of EMA were 11.1 and 87.5%, respectively.
Conclusions:Based on the results of this pilot study, the prevalence of CD among cases with refractory hypothyroidism is higher than that of global reports. Furthermore, routine screening of CD in these patients is highly recommended even with negative serology. The endoscopic view is not adequate for the diagnosis of CD among patients with refractory hypothyroidism. In addition, it is necessary to focus on pathology reports and antibody titer.
Celiac disease (CD) is one of the common autoimmune enteropathies with a high prevalence of undiagnosed subjects developing in intolerant individuals to a gluten-containing diet and related proteins (1). Untreated conditions can result in an intensive malabsorption syndrome and serious morbidity with autoantibodies against tissue transglutaminase and gliadin (2, 3). Clinically, a minority of CD patients present the classic manifestations, such as diarrhea, steatorrhea, and/or weight loss. Most cases presenting with atypical complications (e.g., osteoporosis, osteopenia, or bone fracture), and symptoms could remain undiagnosed and be missed (4-9).
Autoimmune endocrine diseases, such as autoimmune thyroid disorders, are closely associated with CD. Among these disorders, a higher prevalence of CD has been reported in subjects with autoimmune hypothyroidism. In addition, one of the most common concomitant non-gastrointestinal disorders among patients with CD is thyroid disease (9, 10). On the other hand, CD is one of the important causes of malabsorption that can lead to the suboptimal bioavailability of medications in CD patients, including those with hypothyroidism.
Atypical CD increases the need for levothyroxine. The effect was reversed by a gluten-free diet (GFD) or an increase in levothyroxine dose, and the malabsorption of levothyroxine may provide the opportunity to detect CD that was overlooked. Therefore, researchers believe that the diagnosis of CD should always be considered in patients requiring higher than usual doses of thyroid hormone replacement, even in patients with a normal bowel habit and no other apparent manifestations of the disease (1, 11-13). Among those with undiagnosed CD and autoimmune hypothyroidism, the consumption of gluten-containing foods can result in refractory hypothyroidism despite high doses of levothyroxine, probably due to drug malabsorption (1, 11).
Screening CD in cases with autoimmune hypothyroidism and early diagnosis and treatment could be helpful in the reduction of complications and improvement of drug absorption in such cases (14). This cross-sectional study assessed the prevalence of CD among patients with refractory hypothyroidism in Khuzestan province, Iran. It is hypothesized that the prevalence of CD among patients with refractory hypothyroidism is higher than that of global reports. Moreover, routine screening of CD among such cases could be highly recommended, even with negative serology.
This pilot study was carried out on 25 patients, including 6 male and 19 female patients, within the age range of 17 - 53 years. The mean age values of male and female subjects were 31.3 ± 17 and 34.3 ± 8.5 years, respectively. During a six-month period (within September 2014 to March 2015), the patients with refractory hypothyroidism were included from the endocrinology outpatient clinics of Ahvaz Jundishapur University of Medical Sciences, Khuzestan, Iran. For all the participants, serologic tests for CD, including anti-tissue transglutaminase immunoglobulin A (anti-tTG IgA) immunoglobulin G, anti-endomysial antibody (anti-EMA) IgA, and total IgA, were requested. The serum was diluted at 1: 100, and all the aforementioned indicators were measured by enzyme-linked immunosorbent assay (ELISA) (15). All the serologic measurements were performed in a standard referral laboratory.
All the participants underwent an upper endoscopy regardless of antibody titer for CD and random biopsies taken from the first and second parts of the duodenum with spike forceps for histology (at least four biopsies). A well-experienced pathologist assessed the biopsy samples and classified them based on Marsh criteria (16, 17).
Hypothyroidism was also demonstrated by the presence of anti-thyroid peroxidase antibodies and raising thyroid-stimulating hormone (TSH) (18). The participants were diagnosed with refractory hypothyroidism in case of the need for more than 250 μg levothyroxine daily. This pilot study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (ajums.REC.1392.175).
The data were statistically analyzed by SPSS software (version 20), chi-square test, and independence test. The continuous data with normal distribution and categorical data were reported as means±standard deviation, percentage, and frequency, respectively. A P-value of less than 0.05 was considered statistically significant.
The demographics and general characteristics of the participants are summarized in Table 1. In the beginning, 25 patients with refractory hypothyroidism within the age range of 17 - 53 years were enrolled in this study, 76 and 24% of whom were female and male, respectively. The mean age values of male and female participants were 31.3 ± 17 and 34.3 ± 8.5 years, respectively. The mean dosage of levothyroxine used for refractory hypothyroidism was 285.1 ± 89.9 mg, and the mean duration of the disease was 7.2 ± 6.9 months. According to Figure 1, in terms of geographic distribution, 12 cases (50%) resided in Ahvaz and the central part of the province. The rest of the patients were from the east (8.3%), north (33.3%), and other areas of Khuzestan province (8.3%).
Among the participants, the most common concomitant disease was anemia (72%). The most frequent gastrointestinal complaint was diarrhea (25%), and 33.3% of the subjects had other complaints (Table 2). A total of 7 patients (1 male and 6 females) had a nonspecific rise of liver enzymes (i.e., less than three times more than the upper limit of the normal range). The most common serologic findings in these patients were positive anti-tTG (28%) and anti-EMA (16%). The sensitivity and specificity of tTG were 33 and 87.5%, respectively. The sensitivity and specificity of EMA were 11.1 and 87.5%, respectively.
|Age (y)||33.58 ± 2.08|
|Weight ( kg)||76.36 ± 2.16|
|Duration (mo)||7.25 ± 6.91|
|Drug dosage (mg)||285.1 ± 89.9|
|Other digestive complaints||9 (36)|
In the upper endoscopy, the most common findings were normal mucosa (48%), gastritis (28%), duodenal fissuring (8%), duodenal atrophy (8%), and duodenal erythema (8%) (Table 3). The most common pathologic report was the presence of CD in 20% of the patients (mostly marsh 1 and 0 stages).
|Findings||Refractory Hypothyroidism||Titer of Antibodies U/mL||Normal Range|
|Anti-tTG||7 (28)||26.14 (16 - 42)||0 - 12|
|Anti-EMA||4 (16)||26.5 (17 - 37)||0 - 8|
|Duodenal atrophy||2 (8)|
|Duodenal erythema||2 (8)|
|Marsh 0||2 (8.0)|
|Marsh 1||2 (8.0)|
|Marsh 3||1 (4.0)|
The CD may lead to therapeutic failure in patients with refractory hypothyroidism due to the impaired absorption of levothyroxine. Recently, the greatest challenge for endocrinologists regarding the treatment of refractory hypothyroid patients has been the determination of drug dosage in these cases. Recent studies reported the close association of CD with autoimmune endocrine disorders, especially autoimmune hypothyroidism (19). According to these reports, the prevalence of occult autoimmune hypothyroidism in CD patients is higher; therefore, it seems logical to perform routine tests for checking the thyroid function among all CD patients (20-22).
On the other hand, some other studies evaluated the prevalence of occult CD in autoimmune thyroid diseases, namely autoimmune hypothyroidism (23). In occult CD, where the asymptomatic condition damages small intestinal mucosa and the serology tests for autoimmunity are positive, the genetics of these cases is compatible with their disease, and they may have a normal mucosa at an earlier step while having a regular diet; nevertheless, the disease may develop later (4, 24).
In clinical practice, the management and control of refractory hypothyroidism is a big challenge for endocrinologists, and one of the reasons could be various malabsorption disorders (25-27). Thyroxine malabsorption has been reported as the initial finding in patients with otherwise asymptomatic malabsorptive syndromes, especially CD (1). Consequently, a correct diagnosis of malabsorption could be helpful in the management and control of such cases. The treatment of malabsorption would normalize or at least improve thyroxine absorption in these patients (28).
Recently, studies have reported the high prevalence rate of undiagnosed CD patients with atypical presentations in the general population (9, 29). Individuals with atypical manifestations may masquerade as anemia, infertility (30), and/or osteoporosis (1). The most prominent concomitant disease of the present study was anemia, and the most frequently reported gastrointestinal complaint was diarrhea. Unfortunately, screening these subjects has not been currently advocated. Patients with occult CD also show immunologic abnormalities, such as a positive IgA antibody, against tissue transglutaminase and endomysium or may have raising intraepithelial lymphocytes in their small intestine (10).
The endoscopic small bowel biopsy is the gold standard test for CD diagnosis, and serologic screening tests are widely available. The detection of anti-EMA and anti-tTG antibodies by ELISA has a sensitivity range of 95 - 98% and specificity range of 94 - 95% (31). Up to 2.6% of the results may be false negative. However, EMA and tTG are widely used for CD screening in most laboratories worldwide (32). The most common serologic finding in the cases of the present study was raising anti-TTG and anti-EMA, respectively; nevertheless, their sensitivity and specificity were lower than those reported for usual cases (33 and 11.1% vs. 95 - 98% and 87.5% vs. 94 - 95%, respectively). Therefore, these serologic markers are less reliable for the diagnosis and screening of CD among subjects with refractory hypothyroidism.
As previously described, CD is characterized by villous atrophy and intestinal malabsorption, mainly affecting the duodenum, jejunum, and proximal ileum. As a result, these patients have a problem with the absorption of oral levothyroxine (25). Recent studies have demonstrated patients among whom CD diagnosis was delayed, and TSH levels were persistently elevated despite increasing doses of levothyroxine. Finally, CD diagnosis in the aforementioned subjects was made, and their daily requirement of levothyroxine decreased upon the commitment to a GFD (33).
In the upper endoscopy of the present cases, the most common findings were normal mucosa, gastritis, duodenal fissuring, duodenal atrophy, and duodenal erythema, respectively. Therefore, it is recommended to obtain duodenal biopsy specimens even from normal-looking mucosa. The most predominant pathologic report was also the presence of CD in 5 patients (mostly marsh 1 and 0 stages). The overall endoscopic view is not accurate for the diagnosis of CD among cases with refractory hypothyroidism, and it is necessary to focus on pathology reports and antibody titer (34, 35). In case of pathology report as marsh 0 or 1 stages, it is worth mentioning to refer patients for a genetic study to confirm the diagnosis and lifelong commitment to a GFD.
However, there have been a limited number of studies evaluating this issue, regarded as the strong point of the current study, this investigation was performed as a single-center study with a small sample size, which could be considered a limitation.
The prevalence of CD among cases with refractory hypothyroidism is higher than that of global reports, and routine screening of CD in these patients is highly recommended even with negative serology. The sensitivity and specificity of serologic tests in hypothyroidism patients are lower than those reported for patients with normal thyroid function; this finding can encourage physicians that even in case of negative serological results evaluate patients for the possibility of CD using upper endoscopy and random duodenal biopsy. The pathology reports of marsh 0 or 1 stages are potential candidates for a genetic study to confirm the diagnosis and lifelong commitment to a GFD.
Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009;137(1):88-93. doi: 10.1053/j.gastro.2009.03.059. [PubMed: 19362553]. [PubMed Central: PMC2704247].
Godfrey JD, Brantner TL, Brinjikji W, Christensen KN, Brogan DL, Van Dyke CT, et al. Morbidity and mortality among older individuals with undiagnosed celiac disease. Gastroenterology. 2010;139(3):763-9. doi: 10.1053/j.gastro.2010.05.041. [PubMed: 20685275]. [PubMed Central: PMC2930124].
Rubin CE, Brandborg LL, Phelps PC, Taylor HJ. Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. Gastroenterology. 1960;38:28-49. [PubMed: 14439871].
Maki M, Mustalahti K, Kokkonen J, Kulmala P, Haapalahti M, Karttunen T, et al. Prevalence of Celiac disease among children in Finland. N Engl J Med. 2003;348(25):2517-24. doi: 10.1056/NEJMoa021687. [PubMed: 12815137].
Telega G, Bennet TR, Werlin S. Emerging new clinical patterns in the presentation of celiac disease. Arch Pediatr Adolesc Med. 2008;162(2):164-8. doi: 10.1001/archpediatrics.2007.38. [PubMed: 18250242].
Rostami Nejad M, Rostami K, Pourhoseingholi MA, Nazemalhosseini Mojarad E, Habibi M, Dabiri H, et al. Atypical presentation is dominant and typical for coeliac disease. J Gastrointestin Liver Dis. 2009;18(3):285-91. [PubMed: 19795021].
Alavinejad P, Hajiani E, Masjedizadeh R, Hashemi SJ, Faramarzi M, Sebghatollahi V, et al. Epidemiologic and demographic survey of celiac disease in khuzestan province. Middle East J Dig Dis. 2014;6(2):98-103. [PubMed: 24872869]. [PubMed Central: PMC4034671].
Mehrdad M, Mansour-Ghanaei F, Mohammadi F, Joukar F, Dodangeh S, Mansour-Ghanaei R. Frequency of celiac disease in patients with hypothyroidism. J Thyroid Res. 2012;2012:201538. doi: 10.1155/2012/201538. [PubMed: 22545223]. [PubMed Central: PMC3321550].
d'Esteve-Bonetti L, Bennet AP, Malet D, Hoff M, Louvet JP, Caron P. Gluten-induced enteropathy (coeliac disease) revealed by resistance to treatment with levothyroxine and alfacalcidol in a sixty-eight-year-old patient: a case report. Thyroid. 2002;12(7):633-6. doi: 10.1089/105072502320288519. [PubMed: 12193310].
Ghoshal UC, Mehrotra M, Kumar S, Ghoshal U, Krishnani N, Misra A, et al. Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption. Indian J Med Res. 2012;136(3):451-9. [PubMed: 23041739]. [PubMed Central: PMC3510892].
Virili C, Bassotti G, Santaguida MG, Iuorio R, Del Duca SC, Mercuri V, et al. Atypical celiac disease as cause of increased need for thyroxine: A systematic study. J Clin Endocrinol Metab. 2012;97(3):E419-22. doi: 10.1210/jc.2011-1851. [PubMed: 22238404].
Hadithi M, de Boer H, Meijer JW, Willekens F, Kerckhaert JA, Heijmans R, et al. Coeliac disease in Dutch patients with Hashimoto's thyroiditis and vice versa. World J Gastroenterol. 2007;13(11):1715-22. doi: 10.3748/wjg.v13.i11.1715. [PubMed: 17461476]. [PubMed Central: PMC4146952].
Rostami K, Kerckhaert J, Tiemessen R, von Blomberg BM, Meijer JW, Mulder CJ. Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: Disappointing in clinical practice. Am J Gastroenterol. 1999;94(4):888-94. doi: 10.1111/j.1572-0241.1999.983_f.x. [PubMed: 10201452].
United European Gastroenterology. When is a coeliac a coeliac? Report of a working group of the United European Gastroenterology Week in Amsterdam, 2001. Eur J Gastroenterol Hepatol. 2001;13(9):1123-8. doi: 10.1097/00042737-200109000-00023. [PubMed: 11564968].
Surks MI, Chopra IJ, Mariash CN, Nicoloff JT, Solomon DH. American Thyroid Association guidelines for use of laboratory tests in thyroid disorders. JAMA. 1990;263(11):1529-32. [PubMed: 2308185].
Velluzzi F, Caradonna A, Boy MF, Pinna MA, Cabula R, Lai MA, et al. Thyroid and celiac disease: Clinical, serological, and echographic study. Am J Gastroenterol. 1998;93(6):976-9. doi: 10.1111/j.1572-0241.1998.291_u.x. [PubMed: 9647032].
Sategna-Guidetti C, Volta U, Ciacci C, Usai P, Carlino A, De Franceschi L, et al. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: An Italian multicenter study. Am J Gastroenterol. 2001;96(3):751-7. doi: 10.1111/j.1572-0241.2001.03617.x. [PubMed: 11280546].
Valentino R, Savastano S, Tommaselli AP, Dorato M, Scarpitta MT, Gigante M, et al. Prevalence of coeliac disease in patients with thyroid autoimmunity. Horm Res. 1999;51(3):124-7. doi: 10.1159/000023344. [PubMed: 10461017].
Centanni M, Benvenga S, Sachmechi I. Diagnosis and management of treatment-refractory hypothyroidism: An expert consensus report. J Endocrinol Invest. 2017;40(12):1289-301. doi: 10.1007/s40618-017-0706-y. [PubMed: 28695483]. [PubMed Central: PMC5680379].
Damle N, Bal C, Soundararajan R, Kumar P, Durgapal P. A curious case of refractory hypothyroidism due to selective malabsorption of oral thyroxine. Indian J Endocrinol Metab. 2012;16(3):466-8. doi: 10.4103/2230-8210.95716. [PubMed: 22629524]. [PubMed Central: PMC3354865].
Morris JC. How do you approach the problem of TSH elevation in a patient on high-dose thyroid hormone replacement? Clin Endocrinol (Oxf). 2009;70(5):671-3. doi: 10.1111/j.1365-2265.2009.03536.x. [PubMed: 19226259].
Humm KC, Wu LH, Merport Modest A, Hacker MR, Leffler D, Penzias AS. Prevalence of celiac disease is higher among women with infertility. Fertil Steril. 2013;100(3). S458. doi: 10.1016/j.fertnstert.2013.07.400.
Cataldo F, Marino V, Ventura A, Bottaro G, Corazza GR. Prevalence and clinical features of selective immunoglobulin A deficiency in coeliac disease: An Italian multicentre study. Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP) and "Club del Tenue" Working Groups on Coeliac Disease. Gut. 1998;42(3):362-5. doi: 10.1136/gut.42.3.362. [PubMed: 9577342]. [PubMed Central: PMC1727042].
Franzese A, Limauro R, Ecuba P, Campanile F, De Martino F, Tenore A. [L-T4 malabsorption determined by intolerance to cow's milk proteins and celiac disease in a patient with congenital hypothyroidism. A clinical case]. Minerva Pediatr. 1993;45(3):113-6. Italian. [PubMed: 8341224].
Ganji A, Esmaeilzadeh A, Bahari A, Ghafarzadegan K, Afzal Aghayee M, Mosanen Mozafari H, et al. Correlation between cut-off level of tissue transglutaminase antibody and marsh classification. Middle East J Dig Dis. 2016;8(4):318-22. doi: 10.15171/mejdd.2016.42. [PubMed: 27957296]. [PubMed Central: PMC5145300].
Shakeri MT, Ganji A, Mobarhan MG, Ghanbarabadi VG, Rahimi L. Pitfalls in estimation of celiac disease prevalence using serology: A cross-sectional study. Govaresh. 2017;21(4):266-71.


Diamond-coated clothing could keep wearers cooler
While there are already clothing materials that help keep wearers cool simply by allowing heat to escape, an experimental new fabric coating goes a step further. Utilizing a whole bunch of nanodiamonds, it actually draws heat away from the body.
First of all, unlike their non-nano counterparts, nanodiamonds are not expensive.
They're nanoscale diamond particles that can be cheaply and easily manufactured, and which have the same "carbon lattice" internal structure as regular diamonds. Among other things, that structure gives them excellent thermal conductivity – in other words, they're very good at conducting heat.
Led by doctors Shadi Houshyar and Aisha Rehman, a team of scientists at Australia's RMIT University recently mixed nanodiamond powder with polyurethane and solvent. The resulting solution was then applied to one side of a sheet of ordinary cotton via an electrospinning technique.
After being left to cure, the solution formed a coating which consisted of a web of nanofibers bonded to the larger cotton fibers. If the fabric were to be used in clothing, the coated side would face in towards the wearer's skin. The exterior surface was left uncoated, to keep it from drawing in ambient heat.
Samples of the material were placed with their uncoated sides facing towards a nearby 100 ºC (212 ºF) hotplate for 10 minutes, then removed from the area and left to cool for another 10 minutes. It was found that as compared to control samples of untreated cotton, the treated samples released 2 to 3 ºC (3.6 to 5.4 ºF) more heat through their coated side within the cooling period.
The treated cotton was also found to offer better protection from ultraviolet light. That said, its air permeability and moisture absorption weren't quite as good as those of untreated cotton, but still remained within an acceptable range.
"While two or three degrees may not seem like much of a change, it does make a difference in comfort and health impacts over extended periods and in practical terms, could be the difference between keeping your air conditioner off or turning it on," said Houshyar. "There’s also potential to explore how nanodiamonds can be used to protect buildings from overheating, which can lead to environmental benefits."
A paper on the research was recently published in the journal Polymers for Advanced Technologies.
Source: RMIT University


text:
“If my people, who are called by my name, will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven, and I will forgive their sin and will heal their land. ” 2 Chronicles 7:14
History is always more than just a list of events. The events which are chosen, how they are described, the conclusions that are drawn, show us history is about meaning as well as facts. Living in Ireland, we know how much history matters, how much the way that history is understood matters.
The Constitution of Ireland begins with these words:
‘In the Name of the Most Holy Trinity, from Whom is all authority and to Whom, as our final end, all actions both of men and States must be referred, We, the people of Éire, Humbly acknowledging all our obligations to our Divine Lord, Jesus Christ, Who sustained our fathers through centuries of trial, Gratefully remembering their heroic and unremitting struggle to regain the rightful independence of our Nation . . .’
Talking about ‘centuries of trial’ and ‘heroic and unremitting struggle’ in a constitutional document demonstrates a view of history that is about much more than setting down facts; it’s about seeing history as something with meaning. The Constitution is a statement of explicit belief that God himself has brought Ireland to the point it has reached in 1937, it acknowledges ’all our obligations to our Divine Lord, Jesus Christ, Who sustained our fathers through centuries of trial’.
Understanding how history has been seen in Ireland, as God working his purpose out down through the centuries, enables us to understand how history was seen in the Bible. Events were seen as having meaning, as showing that God had a purpose in what happened.
The books we see as ‘history’, Joshua through to Esther, are not the only history told. We know from looking at the first five books, Genesis through to Deuteronomy, the books of the Law, that the stories of the patriarchs—Abraham, Isaac and Jacob—and the stories of Moses are vital parts of the history of the people. The Exodus, the escape from Israel, is the single most important point in the history told in those first five books, a moment that is still recalled each year.
The history books tell the history of the nation of Israel, from the occupation of the land, down to the loss of both the kingdoms and the return from exile. Eight centuries of history are covered. The history books begin with the time of Joshua and the occupying of the land of Canaan in the 13th Century BC. Joshua is followed by the reigns of the Judges up until c. 1050 BC, a time which covers the days of the book of Ruth. Then the books of Samuel, Kings and Chronicles tell of the establishment of kings: Saul who died c. 1007 BC, David who ruled Judah from 1010-1003 and the united kingdom of Judah and Israel from 1003-970 BC, Solomon, who ruled 970-931 BC.
Solomon is the last ruler of a united Kingdom; it divides into the northern kingdom of Israel, which falls to the Assyrians, the first deportations happening in 740 BC and the kingdom finally falling in 722 BC. Judah, the southern kingdom, is invaded in 597 BC when there is the first deportation of Jewish people to Babylon, again in 587 BC when the Temple in Jerusalem is destroyed and further captives are taken, and finally in 582 when the final deportation takes place. The book of Esther is set during the time of the Jewish exile.
Ezra and Nehemiah were one book until the Christians divided them in the Third Century AD. They cover the period from around 539 BC, as the exile in Babylon is drawing to a close, until about a century later, and tell of the rebuilding of Jerusalem and of the Temple.
Read the history books in the Bible and there is a pattern of history in the book of Judges that is repeated through the following centuries. The people repeatedly turn their backs on God and on his Law, which leads to them suffering his judgment, which then prompts them to repent of their wrongdoing, which brings forgiveness from God. This pattern continues through the time of the kings — a cycle of sin, downfall, repentance, and restoration.
In the days of David, David’s murder of Uriah in order that he may have Uriah’s wife, Bathsheba, leads to the death of her baby and David’s repentance for his wrongdoing. In the time of Solomon, at the moment of the dedication of the Temple c. 957 BC, God declares that if the people would only repent of their wrongs, God would forgive them. In 2 Chronicles 7:14, he declares. “If my people, who are called by my name, will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven, and I will forgive their sin and will heal their land. ”
The cycle goes around and around. Ahab, the king in the days of Elijah, is described as worse than all of those who preceded him. Three hundred and fifty years on from the dedication of the Temple, the people are still turning their backs on God. During the reign of Josiah, after the reading of the Book of the Law, in 2 Kings 22:16, God warns, ‘This is what the Lord says: I am going to bring disaster on this place and its people, according to everything written in the book the king of Judah has read. Because they have forsaken me’.
Josiah is a good king. 2 Kings 23:25 says, ’Neither before nor after Josiah was there a king like him who turned to the Lord as he did—with all his heart and with all his soul and with all his strength, in accordance with all the Law of Moses’, but Josiah’s efforts are in vain. He is succeeded by his son Jehoahaz and then by his son Jehioakim, 2 Kings 23:32 and 37 are identical comments on the two sons, ‘He did evil in the eyes of the Lord, just as his predecessors had done’.
Read the books of history as we would read other history books and they can make rather dismal reading; from the times of great expectation at the opening of Joshua, everything seems to have fallen apart by the end of Kings. Read them as we would read other history books, and we would have to admit that the writers were not always accurate, that the stories do not always accord with historical facts.
But do the opening words of the Irish Constitution accord with historical facts? There was not much sign of the people being sustained during the years of the Famine; nor much sign of unremitting struggle in the times that followed the arrival of Strongbow. History is about belief as well as about events.
Gerhard von Rad, the German theologian wrote, “in principle Israel’s faith is grounded in a theology of history. It regards itself as based upon historical acts, and as shaped and re-shaped by factors in which it saw the hand of Jahweh at work.” What matters is not the historical acts themselves, but the belief that God is present and active in the history of his people.
Von Rad believes the Old Testament, “tells of God’s history with Israel, with the nations, and with the world, from the creation of the world down to the last things, that is to say, down to the time when dominion over the world is given to the Son of Man”. He goes on, “This history can be described as saving history because, as it is presented, creation itself is understood as a saving act of God and because, according to what the prophets foretold, God’s will to save is, in spite of many acts of judgment, to achieve its goal.”
Read the books of history and there are many, many times when the people fail and many, many times when God forgives. God’s will is to save us; through the history of his people, his will is to save. May we have the gift to discern his hand all through the ages.

domain: history


text: MESSAGE FROM THE EDITOR Neurological Disease on the Global Agenda Neurological disease impacts people living all over the globe. This is obvious but easy to forget when you review the literature. Most manuscripts published in wide-distribution journals come from high-income countries in Europe and North America. The Annals of Neurology is no exception: we published 685 manuscripts in the last three years, and 91% had a corresponding author in either North America or Europe (Figure 1A). Broken out by national income according to World Bank classification,1 the problem appears even worse, with 97% of manuscripts produced in high-income countries (Figure 1B), where only 15% of the population resides. Furthermore, the vast majority of clinical studies of neurological disease describe people in high-income countries. In the Annals, for example, we could find only four manuscripts describing populations in Africa during the last three years. This focus on neurological disease in high-income countries may be responsible for neglect in recognizing that these diseases are important elsewhere. Taking a step back and looking at estimates of the global impact of neurological disease, the numbers are startling and underline the extent of current neglect. The best estimates of disease burden come from the World Health Organization's (WHO) Global Burden of Disease program, which systematically combines evidence from the literature and from governmental programs, such as death registries.2,3 The disability-adjusted life-years (DALY) is a well established metric of disease burden, tracked by the WHO, that is equivalent to one year of life without disability or a greater number of years with lesser disability (e.g., one DALY also equals two years of life with 50% of normal function). It is a nice metric that better reflects the impact of disease on both early mortality and on disability, which is very important for neurological diseases. Applying the DALY metric to diseases worldwide, it is apparent that the global burden of neurological disease is extremely high and that it is actually greater in lower income countries than in the developed world (Figure 2). Neurological disease accounts for a loss of over 20 disability-free years of life per 1,000 person-years in a low-income country compared to 14 DALYs lost per 1,000 person-years in high-income countries. It is not surprising, of course, that certain neurological diseases that tend to impact the elderly, such as Parkinson's disease and dementia, are less common in countries where the life expectancy is substantially lower. However, other diseases more than make up for the difference, in particular stroke and birth asphyxia/trauma. Thus, the burden of neurological disease is actually skewed towards lower income countries while our attention is diverted elsewhere. Although the broader issues of lower income countries are often ignored, or at least under-appreciated in the global stage, it is curious and disconcerting that, unlike neurological diseases, other diseases that differentially impact the developing world have gained wide attention and broad support. For example, HIV/AIDS, tuberculosis, and malaria are diseases that disproportionately affect lower income countries, and several very large organizations have rec- Figure 1. Source of manuscripts published in the Annals of Neurology April 2005 – June 2008 by continent (A) and by World Bank national income level (B). © 2008 American Neurological Association A11 Published by Wiley-Liss, Inc., through Wiley Subscription Services . likely to be distinctly different in lower income countries where frequent visits with physicians, not to mention neurologists, may be impossible.5 We need to train a cadre of bright young investigators who can make the case for the importance of global issues in neurology, who can propose and carry out useful research in this area, and who will be at the table when decisions about allocation of dollars for global projects are made. We must remember that neurological diseases are diseases of the developing world. We at the Annals of Neurology have been trying to work more closely with authors from these countries to increase our acceptance rates, primarily by assisting with editing and watching closely for signs of biased reviewing. Perhaps the word will get out that we want these manuscripts and the number of submissions from lower income countries will increase, the real source of under-representation. Of course, the number of these submissions will never increase if studies from these countries are not funded. Is it time to create a Global Fund for Neurological Diseases? Figure 2. Burden of neurological diseases in loss disability-adjusted life-years (DALYs) per 1,000 person-years by World Bank national income level. The burden of neurological diseases is greater in lower income countries. ognized the pressing needs created by these disorders and brought substantial resources to bear. The WHO, the US Agency for International Development, the UK Department of International Development, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Gates Foundation each spend hundreds of millions of dollars each year to improve health in the developing world, and the vast majority of this supports infectious disease research and treatment. Where are the large funders for neurological disease in lower income countries? One could argue that the NIH and the pharmaceutical and device industries are major sponsors of neurological disease research, and the numbers demonstrate a strong commitment.4 But this seems to only further emphasize the need for focus on neurological disease in resource-poor countries, where the distribution of neurological disease is different and where many treatments developed elsewhere cannot be used, such as many patented drugs and even some generics that require monitoring, such as warfarin and anticonvulsants. Strategies for implementation of proven interventions are also A12 Annals of Neurology Vol 64 No 1 July 2008 S. Claiborne Johnston, MD, PhD and Stephen L. Hauser, MD Editors References 1. World Bank. Data and Statistics: Quick Reference Tables. http://go.worldbank.org/B5PYF93QF0. Accessed May 24, 2008. 2. World Health Organization. Burden of Disease Statistics. http://www.who.int/healthinfo/bod/en/index.html. Accessed May 2, 2008. 3. Mathers CD, Bernard C, Iburg K, et al. The Global Burden of Disease in 2002: data sources, methods and results (GPE Discussion paper 54). In: Lopez AD, Mathers CD, Ezzati M et al., eds. Global Burden of Disease and Risk Factors. Oxford: Oxford University Press; 2006:45-240. 4. Dorsey ER, Vitticore P, de Roulet J, et al. Financial anatomy of neuroscience research. Ann Neurol 2006;60:652-659. 5. Patoine B. Nervecenter: How to stem a global health crisis. Ann Neurol 2007;62:A8-11. .

domain: biology


text:
Three FHS brass players headed to All-State
Three Frenship High School brass players will go to the Texas Music Educators Association conference in San Antonio this month as All-State musicians.
Joseph Lynch, Austin Harville and Hilary Kamau, all seniors, were named to the All-State bands last month.
Hilary is headed to his second All-State convention; he was also named to the All-State band as a trumpet player last year.
This year, it was harder preparing for the auditions, Hilary said.
"You're going against the same people as you did last year, and they all know you, they're coming after you," he said.
Hilary, who came to the United States seven years ago from Kenya, said he hopes that as a second-year All-Stater, he can absorb more of the TMEA conference.
"I know I'm going to meet some great people," he said.
Next year, he hopes to attend the University of North Texas, where he is contemplating majoring in neuroscience, but also hopes to study jazz.
Hilary said he likes to play both classical and jazz trumpet, but he particularly loves jazz because, as he says, "Jazz is more free."
Austin made the All-State band for the first time, but he said he has tried out for four years.
"I think that the potential was always there," Austin said. "I feel like I just never worked hard enough.
"This year, I put my best foot forward to practice and practice and practice more and more, and it really worked out."
Austin said he is excited about the convention because it is one of the largest in the world.
"There's going to be a lot of people and a lot of excitement and I'm just happy to be a part of it," Austin said.
He said he is thinking about majoring in music at Texas Tech.
Lynch also tried out all four of his years in high school, but this is his first year to make the top bands in the state.
He said he originally wanted to play trombone or trumpet, but his fate was sealed when he picked up a tuba.
"The first time I picked up a tuba, people said I was good at it," he said. "It's fun; we're dark."
Lynch is hoping to major in music performance at Tech.
"I think I only got serious (about playing) probably last year when I knew I was going to be a major," he said.
He is excited about playing at All-State.
"Because the music I've seen is pretty good," Lynch said.
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domain: artistic