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Perfectly Portioned Wellness, founded by Jessica Todd and Margot Witteveen understand that women’s health is in need of serious support. Women are frequently not heard and their health issues are often ignored. As functional medicine dietitians, we have the expertise and advanced training to guide women through their hormone imbalances. Your hormone balance is a journey and there are no quick fixes. We know that detoxes and fad-diets do NOT work and that you deserve to get the right support with a qualified nutrition professional.
We aim to educate and empower women. We help guide you through perimenopause/menopause. We work with women who struggle with PCOS and endometriosis.
We do not guess, we test. We use functional testing to understand your hormones and gut health. However, we don’t stop at testing. We use your story, and medical history to create an in-depth FPH (Four Pillars of Health) wellness plan.
Why work with us?
We are licensed and registered dietitians. We practice functional medicine nutrition and have advanced training in hormone health. We have the expertise and training to work with hormone imbalances and changes in your body.
Plus, we are women just like you.
Why functional medicine testing?
We recommend testing for hormones and gut issues. These data points help us uncover imbalances and detox pathways that we cannot assess just by talking with you or via your nutrition assessment. We use non-invasive testing that you can take in the privacy of your own home. We track your lab trends and make adjustments as needed.
Can you provide virtual consults if I do not live in you area?
Absolutely! We offer both in-person and virtual consults.
Does insurance pay for your services?
Unfortunately, insurance does not cover the type of care and services we provide. We focus on prevention and practice precision care. We hope the current healthcare model will change in the future and cover comprehensive services.
What platform do you use?
We use Practice Better to communicate, meet virtually, and store your medical information. It is a HIPPA compliant platform. Your FPH recommendations, supplements, and referrals will be located in one place. You can download the App and use it for quick messaging. Our clients love this feature!
Why meal planning isn’t the answer to your health problems?
We will provide you a sample of meals and snacks to get you started. While there are situations when we recommend temporary elimination diets to find your food triggers and we’ll provide meal plans (i.e. low FODMAP) for those. However, your progression in your journey goes beyond meal plans. Just simply giving you a meal plan to follow will not help you reach your goals.
Meal planning is an invaluable skill that will serve you for life. We’ll teach you how to nourish your body on a cellular level and you can practice this anywhere. You learn to apply the principles that are vital to help you thrive.
Who do you work with?
We work with women who are fully committed to doing the work on their health.
- Women who are willing to optimize their health through lifestyle changes
- Women who are willing to understand how hormones and gut health affect their overall well being
- Women who understand that healing takes time
- Women who are willing to invest in the lab testing and appropriate recommendations
We are not an ideal fit if….
- Someone is only interested in their weight and only wants to count calories
- Someone wants a quick fix or a 30 day detox
- Someone only wants a meal plan
- Someone expects immediate results
Yes, I am ready to work with you! Where do I start?
Great! We love working with motivated women. Book your complimentary health strategy call here.
Support for your HRT/BHRT
Genetic Testing + Interpretation
Specialized Hormone + Gut Health Testing


WASHINGTON D.C. (FOX 11 / AP) - The Education Department is getting social media criticism after misspelling the name of a prominent African-American sociologist - and then mistyping again when apologizing for the error.
In a tweet Sunday morning from its official account, the department attributed a quotation to W.E.B. DeBois (doo-BOYZ'), incorrectly spelling the last name with an "E."
It immediately drew hundreds of responses mocking the department's misspelling of the sociologist's last name, which is correctly spelled D-U B-O-I-S.
By midday, the department had posted a new tweet with the correct spelling and an apology. "Post updated - our deepest apologizes for the earlier typo," it tweeted, drawing a wave of fresh responses noting a second typo. Soon after, the department corrected the word to "apologies."
One commenter tweeted: "I love that your initial apology for a typo included a typo. We don't need any further proof that DeVos runs this account," referring to billionaire GOP donor Betsy DeVos, who was narrowly confirmed as education secretary last week with a tie-breaker vote by Vice President Mike Pence.
Others posted quizzical looks from African-American students.
Another tweeted: "Smooth move during #BlackHistoryMonth."
A spokesperson for the Education Department said Sunday the misspellings had been made by a long-time department employee. He said a new review process was being put in place with additional staff to prevent future tweet errors.
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Illusive Berlin based producer The Static Hand has come up trumps with his new single, ‘One Double One’ & video to boot.
Comprised of a series of synths, glitches and beats, ‘One Double One’ is a dark, eerie and decidedly unnerving creation, something the video certainly expands on. The video certainly brings to mind the creepy cut scene’s you get in BBC Three show Ideal. A perfect inclusion for the day that’s in it, being Halloween and all.
‘One Double One’ is taken from The Static Hand’s new album Short Bursts From a Starting Gun which is out now.
Last week State compiled a list of 50 musical ‘Hidden Treasures’ from it’s contributors, including myself (you can read it here). Afterwards I got to thinking about what other obscure or underrated material lurked in the dark corners of my music collection.
Now I don’t mean obscure for the sake of it. I mean the kind of record you were just lucky to pick up, get passed by a mate or something you just happened across online, which was overlooked or now all but forgotten. So, in no particular order, here’s a quick run through of 10 Hidden Treasures from the BarryGruff vaults, some of which may be familiar to you while others probably won’t.
Sluts of Trust – ‘That’s Right…That Cat’s Right’
This one from Glaswegian two-piece Sluts of Trust is taken their one and only album, We Are All Sluts of Trust, released back in 2004. ‘That’s Right…That Cat’s Right’ captures everything that’s great about them and the album, few, if any, match their raucous energy and sleazy somewhat perverse sound. It’s a great shame they more or less disappeared off the face of the planet after this, such a waste.
Duncan Lloyd – ‘Suzee’
Solo side-projects are one of the greatest sources of hidden gems, how many have slipped out with anyone barely noticing, as artists exorcise their creative demons? Step forward, Duncan Lloyd. Best known as the guitarist in Maximo Park, he released his solo LP Seeing Double back in 2008 which was as far cry from the high energy bowler hat hijinx of the day job. ‘Suzee’ is easily the catchiest and melodic cut from the album, capturing the rough, raw and no frills approach. And, yes, in case you’re wondering, no one really paid any attention to this.
Zero Boys – ‘Livin’ In The 80s’
Zero Boys are one of punk’s many underrated unsung heroes. Their 1982 LP, Vicious Circle is littered with loud, fast and raw punk rock anthems. ‘Livin’ In The 80s’ is just one of many snarling renditions but you’ll get the idea. 30 years later and Zero Boys still sound dangerous.
John Power – ‘Jumping Bean’
More noted for his time with The La’s and Cast, Power did however forge a credible, if overlooked solo career between the years of latter splitting and subsequently reforming. It was with Willow She Weeps, his second solo album, which saw him come into his own. Turning away from his pop/indie past in favour of powerful country blues. If one song shows this metamorphosis it’s ‘Jumping Bean’.
Ben Human – ‘Take Me To Las Vegas’
Ben Human is an illusive character, with mystery surrounding his real identity but rumour has it, he is in fact Ben Addison from the bands Corduroy & Boys Wonder. Regardless of who he is or isn’t, he has two albums of easy going and fun, sample filled electronica under his belt; Go Human Not Ape (2002) and Out Of Towner (2005). Taken from the latter, ‘Take Me To Las Vegas’ shows he’s quite exceptional when it comes to uplifting jazzy electronica.
Grantura – ‘Waves’
So far as can be reckoned Grantura released one album, In Dreams and Other Stories, in 2008 before disappearing into the sunset. Their album and brand of Americana is filled with cheerful melodies and intricate musicianship; it could easily soundtrack a sun soaked summer. ‘Waves’ is one of the high points from the LP with it’s vocal harmonies to melt even the iciest heart. Grantura are actually from London, although you’d never know on listening to them.
The Things – ‘Hold Me Down’
The Things will be a familiar name to anyone knocking about Dublin in the mid 00’s, others however, may not have been that lucky. A mix of rock ‘n’ roll and punk rock, they were fast, loud, and all with a dash of chaotic fury. ‘Hold Me Down’ is taken from their one and only LP, Some Kind of Kick, for shortly afterward the release they sadly parted company. Another great Irish rock ‘n’ roll band consigned to the annals of history.
Filthy Dukes – ‘Nonsense In The Dark’
Filthy Dukes might be a familiar name to some, due to their numerous remixes over the past few years but their debut album Nonsense In The Dark deserves some respect in it’s own right. The title track from the record saw them enlist vocal help from Orlando Weeks, of ‘The Maccabees’, to create a captivating piece of indie-influenced electronica that’s utterly chilled from start to finish, a real classic.
Lo-Fidelity Allstars – ‘Battle Flag (Feat. Pigeonhead)’
Released in 1998 through big beat specialists Skint Records, How To Operate With A Blown Mind from the late ’90s was one of those dance records ‘okay’ for scruffy young indiekids to listen to. While the album is still a decent listen after all those years, ‘Battle Flag (Feat. Pigeonhead)’ remains a fine cut.
Ian Pooley – ‘Bay of Plenty’
Pooley maybe a more recognizable name than others, a twenty year music career will do that. Anyway ‘Bay of Plenty’ is taken from the German producers excellent album Since Then (2000), which could be loosely defined as house music but it, like the album, has an unmistakable feel good samba vibe going on.
It’s difficult to know where to begin with Stealing Sheep but eclectic would be a good start. The Liverpool trio’s debut album Into The Diamond Sun is a heady cocktail of sounds, rather than been a scattered or confused, it is neatly sown together with layer upon layer of harmonies and a splendid array of psychedelic folk influences.
Into The Diamond Sun manages a perfect balance between the catchy and the interesting. Everything thing about their folk-tinged pop revolves around their vocal arrangements and the wonderfully dreamy three part harmonies, which are simply sublime. The album flows very nicely, peppered with electronic drones, hand claps and lavish guitar effects; it is these experimental eccentricities which embellish the record.
It feels both spooky yet somewhat uplifting, from the meandering ‘Circles’, ‘Gold’ and ‘Shark Song’, to the touch more lively ‘Genevieve’ and ‘Liven Up’. It is all crafted with a deft touch, like intricate brush strokes coming together to create a wonderful portrait. Lyrically too, Into The Diamond Sun is a just as colourful patchwork of vivid imagery.
Into The Diamond Sun is instantly lovable, in fact, it is utterly contagious. All in, a superb first effort.
Taken from said album, ‘Dark Is The Light’, is a calming, peaceful and tranquil piece of downtempo electronica, Imploded View’s MO after all. It differs from the album track with the addition of wonderful vocals from Livi, a composer and singer living in Saint Louis, which accentuates the sheer tranquil nature of the track.
‘Dark Is The Light ‘is out on November 12th through Psychonavigation.
This year’s #keepingitpeel marks the eighth anniversary of John Peel’s passing, and for the third year running the John Peel Day for bloggers is taking place.
Peel was probably the greatest radio DJ in history. Peel’s influence on music fans and bands alike can’t be quantified and his love of, and attitude toward music makes him a unique figure. It would probably be more fitting to introduce some new artist or other, but as that’s what happens here most days, here’s one introduced to me by the man himself; Cash 22 by The Flaming Stars.
‘Cash 22’ appeared in some John Peel list or another, a number of years ago and it just grabbed me. There’s no bullshit bravado, just a track of real and genuine emotion that will make the hairs on your neck stand on end. This is ‘indie music’ at its very best. Since their first EP in ’95, The Flaming Stars went on to release a slew of albums yet remain something of unknown quantity, in fact, I still know very little about them, bar this song obviously.
Also there’s a special KeepingItPeel Podcast, ‘Peel Acres’, which you can listen too and download right here.
Originally from South East London, now living in Dublin, GEM_DOS is a hard one to place in one genre or another.
Broadly speaking this is electronica but it is peppered with techno and drum and bass elements throughout. At times it is deeply atmospheric but always delivered with a real swagger and confidence, especially the clever and classy use of bass. There is a certain Orbital or 808 State character to some of it, especially ‘Get Found Out’. Meanwhile ‘Embrace The Fear’is a dank, clanker of a tune with tiny shreds of light threatening to break through, only to be quickly suppressed by the shroud of darkness.
GEM_DOS has managed to create hugely addictive jams suited to any time of the night or day, all in all, this is very impressive. Why not download GEM_DOS’s EP Trials for free? It’s here.
Glaswegian disco duo, Slow It Down and the London-based house veteran Elijah Collins, are gearing up to release their collaborative EP, Alright, released through Retrospective.
In the run up to the release Elijah Collins has also found time for a reworking of ‘Alright’. ‘Alright (Elijah’s Dub)’ is a super slick, smooth and irresistible slice of disco house, running along a bubbling bassline, it is bursting at the seams with positive energy. While not included on the 4-track EP, it more than deserve it’s own release, no doubt about it.
You can download ‘Alright (Elijah’s Dub)’ gratis below or you can stream the entire EP here.
There are two tickets up for grabs. No silly questions, just email your name to barrygruff [at] gmail [dot] com with ‘Riverbank’ as the subject title. Winners will be drawn at random and the competition closes at 12:00 on October 30th 2012.
The Unusual History of Ether is a songwriting partnership between Rebecca Collins and Danish guitarist Mikkel Ploug. The fruits of this union is fresh, slightly dark but profoundly beautiful indie pop songs, which are sung with passion, performed with grace and recorded quite beautifully. The Unusual History of Ether do, at times, recall the noir-ish, Gothic parts of Anna Calvi’s irresistible self titled debut from last year.
Tickets are €10/€12. Doors at 8pm & support comes from the ever brilliant Sive. Here’s a few choice cuts from the band.
Formed less than a year ago, Coves, are a two piece comprised of Rebekah Wood and John Ridgard. The duo already have a tour with Echo & The Bunnymen under their belt and are about to go out on the road with Eugene McGuinness.
Coves’ sound could lazily be classified as indie, but there is in fact, a bit of everything at play here as they explore a dazzling array of styles and colourful textures. Their songs are characterised by busy electronics and an imaginative foray through a whole host of electro-rock, psychedelia, shoegaze and post-punk sounds, with an overlaying of beautiful dreamy vocals from Wood. Coves even find scope to squeeze in some rather striking eastern influences on ‘Cast A Shadow’ and most notably, ‘No Ladder’.
An unmistakably joyous, imaginative and, above all, hugely enjoyable set of songs. Hopefully there is an album before too long.
Coves’ brand new EP Cast A Shadow is out now through and you can pick it up here.
Fuzz pop aficionados, We Are Losers are back with a new single ‘Salt Lips’, accompanied by an acoustic take of ‘Moany’.
We Are Losers have been sitting on ‘Salt Lips’ for ages apparently, recorded for a planned single, they have generously decided to put it out for free. ‘Salt Lips’ is a slice of melodic upbeat indie-pop, complete with infectious choruses and beautiful harmonies, just what we’ve come to expect from Elsted & company. ‘Salt Lips’ is a bit more suited to the summer months than a dreary Monday in October, that said, it is sure to brighten up your day.
Be sure now to grab both ‘Salt Lips’ & ‘Moany’ for free below.
Having already released his excellent debut album Romancing earlier this year, Devin has followed it up quickly with a brand new single, ‘Nineteen’.
‘Nineteen’ follows a similar trend to that of his album, continuing to embrace the rock ‘n roll days of yesteryear. While much of his debut album was pretty frantic stuff, ‘Nineteen’ displays a softer, more melodic side; it is a slower, ballad-like song. Artist’s who throwback to days of yore are always going to be with us in abundance but Devin sounds sounds passionate and genuine, maybe he was born but perhaps not, ‘Nineteen’ is another fine slice of pop music from the NYC man.
‘Nineteen’ is out October 23rd through Frenchkiss Records.
The Unusual History of Ether is a songwriting partnership between Irish singer-songwriter Rebecca Collins and Danish guitarist Mikkel Ploug. The two met when playing together at the Dublin Fringe Festival several years ago and forged a musical connection, resulting in ‘The Unusual History of Ether’ and Rebecca relocating to Copenhagen.
The fruits of coalition are fresh, slightly dark but profoundly beautiful indie pop songs, which are sung with passion, performed with grace and recorded quite beautifully. The Unusual History of Ether do, at times, recall the noir-ish, Gothic parts of Anna Calvi’s irresistible self titled debut from last year; particularly ‘Joshua’. Not a bad thing at all. There is a lot of potential here, especially as it has the potential to unite indie fans and lovers of pop in admiration.
The Unusual History of Ether released their debut EP Part One earlier in the year and have an album coming sometime in next year. Before all that, they will be touring Ireland in October/November, including Dublin’s The Workman’s Club (31/10) & The Riverbank, Newbridge (01/11). Full list of tour dates here.


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It happens now and then that one hears something praised for its childlikeness, perhaps a book or movie or some other supposedly enchanting object. Childhood is something through which all pass. Subsequent attitudes toward it persist, but with perhaps inadequate critical thought toward their meaning. What is the character of this childlike outlook, and how does it compare with what may be called an adult outlook upon human affairs?
What are generally valued in the constitution of the child are the following: innocence, honesty, wonder, naïveté, simplicity, joy, youthfulness, credibility, vulnerability, and curiosity. The child comes into the world without pre-existing notions, at least so far as the world of ideas are concerned. Of course there are established biological impulses, intuitions, and so forth. But the human child is at the mercy of the world, and must take the surface appearance of things as given, having no previous experiences from which to draw. Most of what is praised or otherwise valued in the child’s disposition comes down to this: ignorance. Considered in its negative aspect, an absence of knowledge for example constitutes a great disadvantage to the individual. But there is a positive aspect as well, for knowledge of the world in almost every instance brings with it unpleasant emotions such as distress, disappointment, and sorrow. The list of child attributes is characterized mostly by absence. Innocence is the absence of experience, honesty is the absence of an ability to dissemble, and credibility is the absence of an acquired mental power of skepticism.
There are however other child qualities which are less readily reducible to the absence of later, adult acquisitions. Among these are joy, youthfulness, wonder, and curiosity. It is easy both to explain and to grasp why these are positive things. Joy is not the mere absence of pain, but may indeed coexist with, and even be informed by, unpleasantness. Youthfulness is not identical with youth, and we have all observed the differing manners in which individual persons age. Note also that an adult may be joyful, and may confront the world with an attitude of both curiosity and wonder. While these states may be inherent in the conventional view of childhood — though not commonly found among actual children, especially outside the so-called rich countries — they may be found in adults as well, even if not widely. It appears to be the qualities determined by absence which characterize the essence of the child outlook, and once they have been filled in by experience, they are quite forever gone.
Thus far the consideration has been rather abstract. But we know that our attitudes toward the child are informed by our relationship to the material world of objects, and in this world one encounters on the one hand toys and on the other jobs, bills, mortgages, and problems with teeth and organs and so on. The life of the child looks to the adult like a life of freedom from responsibility, specifically the responsibility of responding to and altering material conditions. And the reason of course that children are generally in this era of human civilization free from such responsibility is that they are considered to lack as a class of person the required mental, emotional, and physical resources.
It interests me to note that what is praised or valued in the child is despised in the adult. Imagine an adult who believes all that he is told, who takes the appearance of things as the truth of the matter, and who is honest in all of his interactions. In art this is a comic state of affairs, and in life it is contemptible. The exception seems to be in the province of religion, where one encounters in society the general approbation of faith — that is, childlike credulousness. Outside of this, the irresponsible adult who behaves like a child by not “pulling his weight” is regarded with hostility. Nor is it possible to use the term childish as a compliment. The habits and dispositions of the child are not appropriate to the adult, and the reverse is the case also. But what may be said of these qualities in and of themselves?
Consider for example innocence, naïveté, and credibility. They are perhaps charming, but are they good? This question invites a subjective answer. To my tastes the skeptical disposition of mind offers something vastly preferable to innocence and credibility. Indeed, as I reflect upon the list of child qualities I discover that I prefer in almost every instance the adult alternative, even when this alternative is bound up with the unpleasant facts of human affairs.
Some years ago I engaged in an experiment with an evangelist who had come to my door. He was keen to convince me of the merits of salvation, as he understood them, and principally the merit of gaining one’s entry into heaven. I offered him the following challenge: to present me with a compelling description of this state called Paradise. He undertook his task by rehearsing a list of unpleasant facts one would not encounter in the Beyond: sickness, loneliness, misery, death. In other words, absences. Here one may think of the innocence we have considered in relation to the child outlook. On the surface of them, both the Christian Heaven and childhood seem marvellous places. But what I have found in both cases is that more deeply considered they are not so. I am rather fond of doubt, and while innocence may be a pleasant state I feel experience is far more rich and rewarding, as well as painful. I cannot ignore and will not resist the gut feeling that an eternity of pleasantness would be a terrible thing. Indeed, when I consider all that I cherish in this world, I am aware that these things are inextricably connected to others such as loss, pain, conflict, doubt, impermanence, and mortality. In other words, the full range of the adult human condition. There is no getting around it, either by recourse to an afterlife or to the one we have already had.
The consideration of the child and the adult is an indirect way of considering the messy world in which we live and the possibility of its improvement. While I believe in the idea of human progress and am committed to forging a future in which conflict is resolved by peaceful means, I would not wish for instance to abolish conflict, even if that were possible. I do not look with regret upon the lost innocence of childhood. Irony suits me well. I don’t care for pain and disappointment, but they seem to me the cost of going out of doors in pursuit of the good. I am against the certainty of faith and cling to the positive value of skepticism, which I consider essential to the survival of human civilization. Give me the hard lessons of experience, and keep me far from naïveté. Above all, save me from the sweet music of Heaven’s eternal choir, and give me the discordant strain of the human chorus. And if you please a decent single malt and a pen.

domain: literature


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A Novel Structure for Radial Basis Function Networks—WRBF
A novel structure for radial basis function networks is proposed. In this structure, unlike traditional RBF, we set some weights between input and hidden layer. These weights, which take values around unity, are multiplication factors for input vector and perform a linear mapping. Doing this, we increase free parameters of the network, but since these weights are trainable, the overall performance of the network is improved significantly. According to the new weight vector, we called this structure Weighted RBF or WRBF. Weight adjustment formula is provided by applying the gradient descent algorithm. Two classification problems used to evaluate performance of the new RBF network: letter classification using UCI dataset with 16 features, a difficult problem, and digit recognition using HODA dataset with 64 features, an easy problem. WRBF is compared with classic RBF and MLP network, and our experiments show that WRBF outperforms both significantly. For example, in the case of 200 hidden neurons, WRBF achieved recognition rate of 92.78% on UCI dataset while RBF and MLP achieved 83.13 and 89.25% respectively. On HODA dataset, WRBF reached 97.94% recognition rate whereas RBF achieved 97.14%, and MLP accomplished 97.63%.
KeywordsRadial basis Neural network RBF WRBF Classification Gradient descent
Unable to display preview. Download preview PDF.
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The Dutch electric-scooter company Etergo has developed a model with a range of 240 kilometers (about 150 miles), said Micah Toll in Electrek.com.
That’s five times the range of most current scooters. The vehicle, called the AppScooter, has three batteries that fit under the floorboard; it will also operate with just one, so you can commute on a single battery while leaving the others at home for more cargo space. The Dutch are accustomed to using two-wheeled vehicles as their main form of transportation, and for those long rides, Etergo’s scooters come with features more commonly associated with cars: a 7-inch touchscreen, internet connectivity, and Bluetooth phone controls. The machines could come across the Atlantic, but probably not before 2020.
SOURCE: This Week, 1/11/19


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Here’s an interesting wall that’s trying to be something else, but also proudly embracing its wallness at the same time. Quite postmodern, yet not postmodern, which really makes it incredibly postmodern. You don’t see walls lit this way. It pulls you in, but also jumps out at you, but it’s loyal to itself because the light strongly defines the dimensions of itself.
It was shown at the Museum of Contemporary Art San Diego in La Jolla, California.
photo by Doug Gates

domain: design


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Paddle and howl this summer on a canoe trip through Voyageurs National Park and the Boundary Waters Canoe Area Wilderness (BWCAW). Sharing a similar topography of cliffs, glacier carved lakes, and rocky shores dotted with tall pine trees, the best way to navigate both regions is following water trails. While Voyageurs National Park and BWCAW allow motorized boats, paddling canoes and kayaks is the best way to experience both regions. Watery adventures in both areas give you with classic North Country scenery and a chance to see wolves in the wild. To learn more about wolves, visit the International Wolf Center in Ely, MN, one of the BWCAW gateways. Voyageurs National Park, 11 miles east of International Falls (an entry point to Canada), stretches for 55 miles along the US border with Canada. One of the US’s premier water‑based parks, Voyageurs contains 84,000 acres of water, 655 miles of undeveloped shoreline, and some 500 islands. The park takes its name from the 18th and 19th century French Canadian fur traders who once paddled these routes transporting goods, soldiers, and explorers through the scenic waters. Along with canoers and kayakers, the park draws lots of motorboats. Quiet isn’t exactly the norm but the woodland and lake views are soothing.
Voyageurs is one of the best mainland parks for spotting bald eagles and active wolf packs. Some popular programs are the naturalist‑guided boat trips on Kabetogama Lake and Rainy Lake, some of which are in a 26‑foot replica of a North Canoe with a ranger (reserve ahead).
On these trips you may spot eagles’ nests, beaver dams, and possibly moose along the shore or in the lake.
To stretch your legs, go hiking. Landlubbers with little kids should try the 1.7‑mile, spruce-lined Oberholtzer Trail, the only trail accessible by car from the Rainy Lake visitor center. The heartier can tackle the four‑mile Locator Lake Trail reached by a six‑mile boat trip.
The BWCAW contains 1,200 miles of canoe routes and stretches for 150 miles along the border with Canada. On this back-to-basics trip you paddle along chains of lakes portaging when necessary and camping if staying overnight. If you want a guided trip or prefer to start your paddle trip in the BWCAW, then head to Ely, MN. Near the Superior National Forest, Ely’s nickname is “the Canoe Capital of the World.” Boundary Waters Outfitters, among several in town, rents canoes, provides complete and partial packages of gear, and offers canoe trips with a guide. The guide will wake you with coffee, teach you how to improve your strokes, and find you the best places to fish.
To learn more about wolves and see the resident pack, visit Ely’s International Wolf Center, an educational facility devoted to informing visitors about these misunderstood creatures. Kids love observing the resident pack and discovering how to track the critters. The latest additions to the center are two Arctic wolf pups. Check the Wolf Center’s events for seminars—learn why wolves howl—and at select times go out in the woods to distant pack and find out if they howl back at you.

domain: travel


Six Asus Transformer Pad TF103CE owners who bought the Asus Transformer Pad TF103CE considered that it was good looking. Five years ago Cnet.com wrote in their Asus Transformer Pad TF103CE review “Sexy Android tablet has been invading our tablet dreams for month”. Expert website Gadgetguy.com.au wrote “While the tablet itself has pretty standard specs for an Android 3.0 tablet – 1GHz Tegra processor, 10.1 inch screen – it’s a keyb” in their review and scored the product 5 stars. Expert website Tlbhd.com mentioned “Is well built, good looking and powerful” in their review.
A number of customers who bought it concluded that it was a good design. Expert review site Pcadvisor.co.uk said in their review of the Asus Transformer Pad TF103CE “In spite of my minor complaints about its design, this tablet is worthy of consideration” . Theverge.com said five years ago “Great design, build” .
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Before you learn about PSC, let’s learn a few basics about the liver…
The Liver and the Bile Ducts
PSC affects the bile ducts of the liver. The liver is one of the largest organs of the body, weighing roughly 1.5kg in an adult. It is located within the upper right side of the abdomen. The liver carries out many vital roles such as filtering toxins, synthesising blood clotting factors, assisting the immune system, and producing bile to help digest food.
The cells of the liver produce a substance called bile. Bile is a yellow-green solution that breaks down fats in food. Bile flows through the bile ducts of the liver, eventually flowing through the larger bile ducts as it leaves the liver, and heads towards the small intestine.
When discussing PSC and the bile ducts you will quite often hear the term intrahepatic bile ducts and extrahepatic bile ducts. Intrahepatic ducts describe the bile ducts that are inside the liver. Extra-Hepatic bile ducts describe the ducts that lie just outside the liver.
The extra-hepatic ducts are composed of a Right and Left hepatic duct, a common hepatic duct, cystic duct, and the common bile duct. The gallbladder is a small muscular sac that sits just underneath the liver, and its function is to store some of the bile leaving the liver that does not need to be used straight away.
PSC is strongly linked to IBD (Inflammatory Bowel Disease). Around two-thirds of patients diagnosed with PSC will also have an IBD diagnosis such as Ulcerative Colitis or Crohn’s disease.
Since the late 1900’s there has been increasing recognition, as well as exciting research carried out in the area of PSC. These studies include theories on possible causes and the development of potential new medications for PSC through lab research and clinical trials.
PSC Cases in Australia and Worldwide
PSC is considered a rare disease. Consequently, there is limited data collected on PSC in general and most of it is retrospective in nature. In a 2012 Australian publication on various conditions, it was estimated that there were only 872 reported cases of people with a PSC diagnosis in Australia. A conservative estimate in this publication suggested that by the year 2030 Australia will have just over 1,100 people with PSC. An incredibly small number of our population indeed.
It is possible, however, that these estimates are slightly below the actual true prevalence of PSC in Australia. A recent study of patients with PSC in NSW identified 208 patients living with PSC, and this study was by no means exhaustive in finding all cases within the state. Further studies are being conducted in other states. In any case, it is a rare disease and for this reason we partner with Rare Voices Australia in a bid to overcome the issues that are associated with rare diseases.
Worldwide, PSC is commonly found in Northern Europe and North America with a rate of between 0.4 and 2.0 cases per 100,000 per year. Although PSC can affect any age or gender, it is frequently found in younger males aged between 30-40 years old. PSC seems to be less common in Southern Europe and South-east Asia, although there have not been as many studies carried out in these countries. Studies of PSC in children are scarce, although studies show the overall number of children with PSC seems to be very low.
What causes PSC?
The exact cause of PSC remains unknown. However, recent studies have shown a combination of genetics, the environment, and the body’s own immune response may play a role in the development of PSC. PSC is not contagious, and so cannot be “caught” or transmitted to another person. Nor is it caused by alcohol, diet or other lifestyle factors.
The genetic component is slowly becoming better understood, though remains complex. There have been 22 genes identified which make an individual susceptible to PSC, however, just having some of the genes does not mean you will get the disease. It has been suggested by some that there may be an increased risk of first degree relatives also having PSC. The risk is poorly defined, bit does remain low. More commonly seen are other autoimmune diseases in both the patient and their family. has been suggested by some that there may be an increased risk of first degree relatives also having PSC.
Although some sort of autoimmune response is suggested, due to strong immune genetic associations and also the close relations with IBD, the term “autoimmune” means the body’s immune system is reacting against itself. There is some doubt, however, whether PSC is a true autoimmune disease , largely because of it’s lack of response to immune suppressant medications. Often it is referred to as an “immune-mediated” disease, meaning that the immune system is playing a role and is being overactive, but whether this is due to a reaction against itself or to some external source is not clear.
To date, there has been no definitive cause identified, but there is growing interest in the liver-gut axis and theories are being formed on the basis of the findings. The field of microbiome is one that is currently being heavily researched in IBD, and we are also seeing some research into the role it may play with PSC. The leaky gut theory suggests that pre-existing IBD causes the bowel wall to become more permeable, and therefore the bile ducts become exposed to gut bacteria, and toxins that ‘leak out’ of the gut. These toxins may damage the bile duct lining, and as a result, the ducts become susceptible to the toxic bile acid.
How do you find out you have PSC?
To diagnose PSC, an evaluation of your symptoms, medical history, blood tests, and imaging tests of your liver will be carried out. Once PSC is suspected, other causes for PSC type illnesses will need to be excluded by your Doctor. This includes illnesses such as autoimmune hepatitis, bacterial infection, cancers, and gallstone issues. Anyone with consistently elevated liver enzymes, particularly in a specific pattern called a cholestatic pattern”, should be considered as to whether they have PSC. In cases of early stage PSC most people have no symptoms. In fact, the first sign of PSC may be found through a blood test ordered by the doctor while being checked for something unrelated, particularly in a patient with coexisting IBD.
The Gold standard for diagnosis is MRCP (Magnetic Resonance Cholangiography). In most cases, this has replaced the need for ERCP ( Endoscopic Retrograde CholangioPancreatography) which is now reserved as a therapy mode instead of a diagnostic tool as it is more invasive and has additional risks.
In some cases, a liver biopsy will also be done. This tends to be where small duct PSC is suspected or to establish or eliminate other diagnoses such as Autoimmune Hepatitis or Primary Biliary Cirrhosis – two other immune-mediated liver diseases.
For more on tests take a look at our ‘tests and procedures’ section.
Understanding your diagnosis:
While PSC can have some typical symptoms and have similar markers, everyone’s PSC journey is unique. It’s important to talk with your doctors about your disease, how advanced your liver damage is, how it might impact with other illnesses you may have, and a range of other factors.
Some questions you might like to ask your doctors over the first months include:
- How well is my liver currently working?
- Do I have any fibrosis or cirrhosis?
- What further tests do I need and how often should I have them? Including surveillance tests.
- What should I do if I have issues or symptoms between appointments?
- Are there any dietary considerations I should follow? Is it ok to drink alcohol?
- Do I need to take any supplements?
- If you have known IBD – Do I need to see a gastroenterologist and Hepatologist or can you manage both at the moment?
- What follow up for my IBD do you recommend?
Remember that while your doctor should give you time and be attentive in your appointments, not all questions can be answered at one appointment and more pressing issues may take priority. If you feel you have more questions at the end of your appointment ask if you can be reviewed sooner to enable to spend time learning about PSC and how it is affecting you.
In the early stages of PSC, there are often no signs or symptoms. Other than higher than normal liver enzymes found in blood tests, many patients do not know they have the disease. For patients who do show symptoms, they are often non-specific, such as fatigue and tiredness. As the disease progresses other symptoms that present themselves include:
- Right Upper Quadrant Pain (Pain in the top right corner of the abdomen)
- Weight Loss
- Itchy skin (Pruritis)
- Chills and Fevers
- Spider Angiomas or Spider Neavi (swollen blood vessels beneath the skin – there are many causes for these and they are not an issue in themselves, however, treatments for cosmetic purposes are available).
- Jaundice (a yellow tinge to the skin and whites of the eyes)
In some cases, patients may develop frequent infections of the bile ducts. This normally causes fever, chills and upper right quadrant pain. Infection of the bile ducts, known as Acute Cholangitis, needs to be treated as early as possible with antibiotics as it can be serious.
Complications and symptoms of Later Stage PSC
In the late stages of PSC complications such as Cirrhosis of the liver may develop. A patient with late stage PSC may develop a range of symptoms such as:
- Fluid build-up in the abdomen (ascites),
- Varices – Enlarged blood vessels that can rupture and cause bleeding. Most commonly found in the oesophagus, but also common around stomas where these are present. (Bleeding varices are a medical emergency and an ambulance should be called if this occurs).
- Increasing weight loss, and loss of muscle mass.
- An enlarged liver and enlarged spleen.
- Hepatic Encephalopathy- forgetfulness, confusion, and ‘brain fog’. In serious cases can lead to coma. Usually seen in advanced stages of cirrhosis, however, can occur in earlier stages.
- Poor clotting due to reduction in Vit K production and reduced platelets in the bloodstream
Recent years have brought about promising theories and studies for the treatment of PSC. Clinical trials are occurring and it is always worth asking your doctor if there are any available to you that may be helpful. At this stage though, there are no proven medical treatments that halt or reverse liver damage caused by PSC, and we are still hoping for a cure. There are still medications and procedures that can be used to manage your symptoms and monitor any progression in an effort to be able to better predict it’s behaviour.
Not all patients will progress to end stage liver disease, and even for those who do, it tends to take 10 or more years from when you’re diagnosed. For those who do, a liver transplant is often a very successful treatment option.
For more information on transplants, see our ‘liver transplantation’ section on our Living with PSC page.
Ursodeoxycholic acid (UDCA or URSO)
The most widely used medication for PSC is called Ursodeoxycholic acid (UDCA or URSO). URSO is a type of bile acid that may have protective effects against the toxic bile salts within the liver. It has shown to greatly improve liver enzymes on blood tests, although studies have shown URSO does not prolong the amount of time between diagnosis and needing a liver transplant.
Medications such as Cholestyramine can be given to patients who suffer severe itching of the skin. It is wise to inform your doctor if this symptom appears as taking medication to help the itching will prevent scratching, and therefore open wounds and skin infections.
Medications such as Propranolol might be used to reduced portal hypertension if it is causing adverse effects such as varices, ascites, Hepatic encephalopathy, reduced platelets etc. These are not appropriate for everyone but can be helpful for some.
Hepatic Encephalopathy (HE) can become a life-threatening condition. Management of HE can often be achieved with the use of Lactulose and/or Rifaxamin.
Many patients with PSC are low on vitamins D, A, E, and K. These levels are monitored via blood tests, and vitamin supplements are prescribed by your Doctor as needed.
New and Trial Medication
There are promising studies underway into the effect of a new medication called NorURSO. NorURSO is a chemically chain-shortened version of URSO. It is currently undergoing trials, and so far has shown significant reductions in liver blood test results. Studies have shown that NorURSO also seems to demonstrate protective effects against damage within the bile ducts.
This strong antibiotic is also showing some promising results in some people, though is not currently PBS subsidised for use in PSC in Australia.
Please see our blog or Facebook page for up to date information on clinical trials.
Tests and Procedures
- Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; high levels indicate active inflammation.
- Alkaline phosphatase (ALP) – elevated levels may indicate blockages in the bile ducts. In children and adolescents elevated levels are also seen at times of rapid growth as this enzyme is also produced in bones.
- Aspartate aminotransferase (AST) – elevated levels may indicate liver injury, but this protein can also be manufactured in other organs so is not liver specific.
- Bilirubin – indicates bile duct blockage or liver damage, but not PSC specific. This level is rarely elevated in early PSC and is directly related to jaundice or “yellowing” of the skin and eyes in later stages or acute cholangitis episodes.
- Albumin and Total Protein – measures the proteins made by the liver and tells whether or not the liver is making an adequate amount. It is an indicator of the liver’s ability to perform its functions.
- Gamma-glutamyl transferase (GGT) – Increases in this level generally indicate a liver damage issue. This indicator is often particularly high in paediatric patients, but not always elevated in the adult population.
A variety of other blood tests may be done, including your body’s ability to clot, full blood count, other antibody markers and vitamin and mineral levels. These are non specific to PSC but can help build a profile towards diagnosis and state of your liver health.
Magnetic Resonance Cholangiopancreatography (MRCP)
MRCP (Magnetic Resonance Cholangiopancreatography) is a high tech, magnetic scan of the upper abdomen and is considered the ‘gold standard’ in PSC diagnosis. An MRCP can provide a detailed picture of the liver, and show strictures and dilations of the bile ducts. In PSC, these strictures and dilations may cause the bile ducts to take on a ‘beaded appearance’ on the MRCP scan commonly seen in PSC patients. The MRCP is non-invasive and has a higher sensitivity then other methods of imaging such as Ultrasounds and Computer Tomography (CT) scans and provides accuracy consistent with the higher risk ERCP procedure. These are often done as a monitoring tool at regular intervals on people with known PSC, and can also be used when a non-invasive look at the bile ducts is prompted by symptoms or changes in liver enzymes.
Endoscopic Retrograde Cholangio Pancreatography (ERCP)
ERCP stands for Endoscopic Retrograde CholangioPancreatography and is a procedure that uses a long, slender camera tube that passes through the mouth, stomach, duodenum, and eventually into the bile ducts so that they can be viewed. The ERCP is not frequently used to diagnose PSC these days, due to risks associated with it such as pancreatitis, bleeding, and introducing bacteria into the bile ducts. However it is still a widely used therapeutic tool where bile duct dilatation is required. It can also be used to provide scrapings of bile ducts to investigate potential cancer where this is suspected.
An abdominal ultrasound can show some non specific, but tell-tale signs of liver disease. This is an easy, relatively non-invasive test that can show the size and texture of the liver, as well as look at the blood flow of the liver and examine the size of the nearby spleen. It is not generally used diagnostically, however, it can still provide useful information to the doctor. As it is much more accessible than MRCP, some doctors will use this intermittently as a monitoring tool.
Fibroscan is a new technology that is beginning to be used in PSC. The more it is used the more we will be able to understand what helpful information it can give us. This is a tool to monitor progression on liver stiffness, that is, detect progression to fibrosis or cirrhosis.
Liver biopsy is a procedure where a fine needle is passed through the abdominal wall and a tiny piece of liver is taken for examination under the microscope. This procedure does carry a risk of bleeding and infection, however, your centre will take great care to avoid these things occurring. For children, this procedure is often done under a general anaesthetic, unlike in adults where it is better done while awake and using local anaesthetic.
Liver biopsy is generally not required for the diagnosis of PSC alone, especially where there is a clear indication from imaging along with pathology and clinical picture. It can be useful in diagnosing some of the variants of PSC (IgG4 Sclerosing Cholangitis and Small duct PSC), as well as overlap syndrome or differential diagnosis of Autoimmune Hepatitis.
The biopsy results cannot necessarily distinguish PSC from other biliary diseases where the bile ducts are damaged (eg. Primary Biliary Cirrhosis and Secondary Sclerosing Cholangitis).
Gastroscopy (with/without banding)
A gastroscopy is a procedure usually done under light sedation so the patient is not aware of what is happening. A flexible camera is passed down into the oesophagus, stomach and beginning of the small intestine. If varices are seen they can be treated by way of “banding”. This involves the vessel being pulled into the endoscope using suction and an elastic band is wrapped around it, essentially strangling the vein so it cannot bleed.
This is a procedure where a camera on a flexible long thin tube with a camera on the end is passed through the anus while the patient is usually sedated. Inflammation and/or ulceration of inflammatory bowel disease can be seen, and tissue biopsies can be taken to give more specific microscopic information.
It is generally accepted that a person with PSC should have a colonoscopy every 2 years even in the absence of known IBD or abdominal symptoms. In those with known IBD annual colonoscopies are recommended.
This is a low dose x-ray scan that scans the body and gives results about bone density. People with liver disease, as well as those with IBD, are at risk of osteoporosis and its effects. Those with both are at increased risks. Talk to your doctor about how often you should have these scans.
See “associated conditions and complications of PSC” for more on bone health.
Transjugular intrahepatic portosystemic shunt (TIPS)
TIPS is a procedure performed by a radiologist that can be effective in reducing portal hypertension and it’s complications such as varices. This is a complex procedure and can increase the risk of hepatic encephalopathy. It is therefore often reserved for cases that cannot be managed by more conservative means.
Associated Conditions and Complications of PSC
Inflammatory Bowel Disease
Inflammatory Bowel Disease is an umbrella term that takes in several immune-mediated conditions of the bowel, the most common being Ulcerative Colitis and Crohn’s disease. Because approximately 80% of people with PSC also have IBD we wanted to provide just a little information about it here. However, we do also encourage you to use other reputable sights and talk with your doctor to learn what you can about these conditions. Usually, the IBD presents before PSC, though it’s not unusual for people to receive a dual diagnosis of both conditions at one time. It can also appear years after the PSC diagnosis has been made, but this is much less common.
More typically, when present in PSC, the person will have Ulcerative Colitis (UC), though sometimes they will be diagnosed with Crohn’s disease (CD), Indeterminant Colitis, or PSC Colitis.
Ulcerative Colitis only affects the colon. The inflammatory process is superficial in that it always involves the first layer, called the mucosa, and in more severe cases, the next layer down, called the submucosa. It tends to be continuous rather than patchy. In PSC patients the symptoms are often mild but usually extend along the entire colon. They often have a superficial inflammatory reaction in the last part of the small bowel where this meets the colon (backwash ileitis) together with variable inflammatory changes to the ileoceacal valve that separates the small and large bowel segments . It is common to see rectal sparing (no inflammation in the rectum) in these patients. Given these differences, an alternative term, PSC Colitis, has gained popularity in the medical literature after first being described nearly 15 years ago.
Crohn’s disease affects any part of the digestive tract. However, in the Caucasian population it most commonly involved the last (terminal) part of the small bowel or ileum, with or without patchy inflammation of the colon. Crohn’s disease exclusively limited to the large bowel is less common and care needs to be taken to ensure that this is not confused with Ulcerative Colitis or PSC Colitis. This is especially the case for people with PSC colitis given the presence of backwash ileitis and and rectal sparing in this sub group. The inflammation in Crohn’s disease can affect all layers of the intestinal wall (called transmural inflammation), seen more commonly in the ileal bowel segment as compared to colonic segments. The distribution of the inflammation tends to be patchy and not continuous as compared to Ulcerative colitis.
Management of IBD
There are a number of medications used in IBD that are very successful. Some people might be prescribed enemas or suppositories. Try not to be to put off by these. If they are effective in your case, it is a great way to manage your disease and minimise your systemic medication intake at the same time.
The initial class of oral medication used are known as 5ASA’s. Examples of these are Mesalazine and Sulfasalazine. These dampen down the inflammatory process in the bowel and allow the mucosa of the bowel to heal. They work by direction action on the colonoc mucosa (lining) and are usually delivered within a capsule that is resistant to break down as it passes through the stomach and the small bowel.
A second line of medications are the immunomodulators. These include things like Azathioprine, 6 Mercaptopurine and Methotrexate. These work through the patient’s bloodstream by reducing factors that drive inflammation.
In an acute episode, steroids are used, but these are not a good long term option because of the multiple side effects, particularly of long term use. They can be, however, a great way to get a severe flare under control.
The next level are the biologic agents. These target specific components of the immune system using a technology known as monoclonal antibodies. These agents are expensive and supported by the Federal Government’s Pharmaceutical Benefit’s Scheme (PBS). They are used when other medications fail. In fact, it’s a requirement of Medicare that you try the other medications before resorting to these. The biologics that have been used for many years now are Infliximab and Adalimumab. New biologics recently added to the PBS include Vedolizumab, Ustekinumab and Golimumab.
It’s important to talk with your specialist and find the best medication option for you. It’s not a one size fits all, and ongoing management is extremely important to monitor any condition changes and required changes to treatments.
It is generally recommended that if you have IBD and PSC, even if your IBD is controlled, that you have annual surveillance colonoscopies as there is a higher incidence of colon cancer in this setting.
Surgical management may also be recommended in some cases. In UC this would see the entire colon removed. This means you will require a temporary stoma followed by the additional surgery and the construction of an “artificial rectum” that is made from the last part of your small bowel (ileum). This is most commonly a “J” Pouch which relates to the technique of the surgery. The stoma is reversed so you can defecate through your anus. Alternatively, you and/or you surgeon may prefer the option of a permanent stoma. It is important to be aware that people with PSC who under J Pouch surgery are likely to have recurrence of gut inflammation in the new pouch , a condition called Pouchitis.
Surgery for a person with Crohn’s disease may look different due to the nature of the inflammation , and it is unlikely that a J Pouch or similar will be an option for you. Hence, it is important to be as clear as possible about the diagnosis of the co-existent IBD.
PSC causes inflammation to the liver. If this inflammation is ongoing it will lead to fibrosis and eventual cirrhosis. While PSC itself doesn’t have universally accepted staged classifications, liver disease that progresses into fibrosis can be staged as below.
- Stage 1 – A small amount of fibrosis limited primarily to regions in the liver called portal areas.
- Stage 2 – Fibrosis begins to appear outside the portal areas. The strands of fibrosis are not yet connected to each other.
- Stage 3 – Areas of fibrosis connecting to each other.
- Stage 4 – Widespread, honeycomb-like scarring known as cirrhosis.
Fibrosis is early scarring of the liver. The liver is a remarkable organ in that, if the underlying cause of fibrosis is removed, damaged cells can be restored unless cirrhosis has already occurred. Unfortunately in PSC we do not have any provem medications that allows this to occurr, however, there are some promising clinical trials currently occurring.
Cirrhosis is permanent and hard scarring. This cannot be reversed.
Cirrhosis can be classified as
- Compensated: where the liver is continuing to function relatively well and not causing significant issues with portal hypertension.
- Decompensated: where the liver is no longer performing its functions and any of the issues of portal hypertension are present.
Portal hypertension occurs in PSC where fibrosis or cirrhosis has developed. The scar tissue blocks the flow of the blood into the liver causing increased pressure in the blood vessel. The body tries to compensate much like we do when we’re in a traffic jam – when we can’t go the main route we try to find alternative routes – our body creates additional vessels for the blood to flow, but they are not as strong and flexible as our regular vessels, and they also direct the blood around the liver instead of through it, giving even less opportunity for the liver to perform its functions.
There are many possible issues with portal hypertension, but the two most common and dangerous are;
Hepatic Encephalopathy (HE): This can occur at any stage of liver disease, but is most commonly seen in the later stages. It is a complex disorder that affects the brain, causing symptoms from mild memory loss and personality changes through to loss of consciousness. This condition can develop gradually over time or have a sudden onset. It is important to tell your doctor if you or your family are concerned about HE symptoms as early treatment is ideal. We encourage you to listen to your family or trusted friends as part of this condition also produces a lack of insight into your capability, so if a friend is concerned, even if you feel fine, you should seek assistance. If someone you know with PSC is showing significant signs of reduced mental function you should call an ambulance. Medications such as Lactulose and/or Rifaxamin are commonly used to successfully manage HE.
Varices: Varices can occur in several areas. One common area where they present risk is in the oesophagus. Caused by the liver blocking the normal blood flow pathways, these vessels are not designed to carry the higher volume and pressures of blood and can rupture. If someone with PSC vomits blood or has black, tarry or bloody stools urgent care should be sought. In most instances, you should call an ambulance.
Another area where varices can cause bleeding issues is around a stoma if a person has one. These can be identified by the typical purple ring around the stoma. These too are also life threatening emergencies and immediate treatment should be sought if they bleed. In some of these cases, the varices bleed at superficial levels and manual pressure can also be applied to stop the bleeding. Even in these cases, if the amount of blood loss is high or unknown, the person should still be medically evaluated.
Liver disease, Inflammatory Bowel disease and use of steroids all increase the risk of Osteoporosis. In the longer term, it is thought that up to 90% of those with PSC will develop reduced bone mineral density.
Osteoporosis is a term used to define the significant loss of bone minerals, resulting in loss of bone thickness or density. This loss leads to weaker bones and increased risk of fracture. The first symptom of osteoporosis is usually a fracture, making it important to have regular Dexa scans to check for reducing bone mass. The best management for osteoporosis is ensuring adequate Vit D and calcium intake and undertaking regular exercise. Other medications are available if osteoporosis continues and specialist care from an endocrinologist will provide the best management plan.
The risk of developing a liver cancer of some sort when you have PSC and associated IBD is estimated to be over 400 times more likely than someone without these conditions. The most common of these is Cholangiocarcinoma (CCC).
CCA can be difficult to detect and there is currently no universally accepted surveillance model. However, many centres will perform annual MRI imaging correlated with the blood tumor marker carbohydrate antigen 19 – 9 (CA 19 – 9). These do have limitations and not all centres will perform these tests regularly. Early detection of CCA does bring about improved outcomes, and survival rates are improving with better surgical and medical treatments available.
PSC Phenotypes and Overlaps
International collaboration amongst researchers has helped us understand some different subgroups of PSC.
As we understand more about the variants below we may better be able to predict the course and find treatments that better target the different groups. Already patterns are beginning to emerge within the groups that provide some level of guidance and possible treatment options.
Large Duct Variants
This is the classic form of PSC, and as it is the most common, it is where we used to derive most of our statistics. The medium and large ducts are affected and the associated IBD is often mild. The natural history of this phenotype ranges from aggressive disease to indolent, that is, it is not presenting symptoms and is not progressing, or progressing extremely slowly. The typical beading pattern can be seen on MRCP.
In about 50% of these large duct cases, dominant strictures develop in either the common bile duct or the hepatic duct.
Non-IBD Large Duct PSC:
This phenotype tends to be diagnosed evenly among men and women and at an older average age. There is some evidence to support a better prognosis in this group.
High IgG4 PSC:
Still under the large duct banner is the IgG4 PSC, with only moderately elevated IgG4 levels (rarely greater than 2.8g/l, or twice the upper limit of normal). This is distinguished further from IgG4 sclerosing cholangitis discussed below.
PSC-Autoimmune Hepatitis Overlap (AIH)
The diagnostic criteria for this phenotype remain varied, leaving statistics on its frequency unreliable. These patients can at times present with typical AIH finding and progress to cholestatic disease. More often though, they present with extremely high elevations in their liver enzymes but have typical cholestatic histology findings. Even imaging can provide pictures that give mixed signals.
This rare phenotype tends to share many features of adult phenotypes, however, it does seem to be much more responsive to therapies and have a high frequency of AIH overlap. Sometimes termed Autoimmune Sclerosing cholangitis, this group reports a higher success rate with immunosuppressive medication as well as with Vancomycin.
Small Duct PSC
We still have a way to go in understanding this phenotype, and whether it is, in fact, a separate entity or actually just early stages of PSC. About 20% of these cases do progress to the classic large duct PSC and follow a similar pathway. Diagnosis for small duct PSC is made with liver biopsy, with raised Alkaline Phosphate levels for more than 6 months in the absence of radiological findings.
IgG4 Sclerosing Cholangitis
This is now recognised as a separate disorder to PSC, though diagnosis can take on challenges to differentiate it from the High IgG4 PSC phenotype. The differential diagnosis comes from a combination of histology, response to steroids, imaging, the involvement of other organs and serology (with a level of over 2.8g/l being suggestive of IgG4 sclerosing cholangitis).

domain: biology


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This week on X-Philes Talk X-Files, David is joined by Tiffany Devol and Ky Johnson from xfiles.news as we focus on the three-part story that takes us from season two into season three via ancient Navajo legends, a boxcar buried in the desert, and lots and lots of death. Cheerful stuff indeed.
Episodes discussed are:
- The Blessing Way
- Paper Clip
Hope you enjoy the episode and don’t get too freaked out by your smallpox vaccination scar!

domain: entertainment


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“I’m no longer comfortable being a survivor in silence.”
For many years Bret was haunted by nightmares, weighted by depressions, perplexed by huge gaps in his memory of his childhood. Bret had escaped his family and volunteered and served in Desert Storm, but he could not fathom the unseen “blueprint” that was shaping his life. Then, when Bret was 39, his older brother died suddenly of a stroke. Visiting the family farmhouse for the first time in years, Bret discovered in his brother’s room a “sex offender’s haven.” Suddenly, the past slipped into focus, and the years of sexual abuse emerged from the shrouded past.
For the first time, Bret sought help for his depressions, but received no help for the trauma that was feeding them. It was Bret who finally insisted that he needed help dealing with the sexual abuse, and with perseverance he found a therapist, and a group, who could help him. With their support, Bret confronted the traumas, and for the first time felt like “a survivor.” But more recently, he has found that he is “no longer comfortable being a survivor in silence.” Disclosing to his friends, and to an ever-widening network, and ultimately publicly, Bret realized that “the weight’s been lifted.” Working as a correctional seargent at a treatment center for sex offenders, Bret encounters men, daily, who remind him of his brother. But rather than hate them, he seeks to understand what drives them, and through that process, he has come to understand the brutalization that drove his brother, and to forgive him.


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Pokemon Go player shares simple trick to get Dusk Form Lycanroc
The most recent event from Pokemon Go allows players to evolve Rockruff into Dusk Form Lycanroc, but trainers are having a little trouble getting it. However, a player has shared some useful info on how to get a Dusk Form Lycanroc with ease.
But some trainers have managed to figure out an easy way to get a “guaranteed” Dusk Form Lycanroc, and are sharing it with other players in The Silph Road community on Reddit.
This was posted by Reddit user ‘TruckNo683,’ who stated they knew a “Guaranteed way to get Dusk Form Rockruff.”
According to the OP, the trick consists of participating in Gym Raids featuring Rockruff which are previously marked by other players as Dusk Form carriers.
The OP explained: “So apparently people have been noticing that if one person battles Rockruff in a certain gym raid and they get the dusk form Rockruff it is guaranteed that everyone who battles in that gym will have the dusk form Rockruff. Anyone else notice this?”
Pokemon Go players also confirmed that if you are missing a Rockruff with the Dusk Lycanroc evolution in your collection, the Raid icon will appear as a “shaded silhouette,” much like the ones that appear on the radar when a Pokemon you don’t have in the nearby.
Other trainers quickly confirmed this and stated: “The silhouette means it’s a new ‘form’ you haven’t caught. It’s like the wild Lati@s. Technically a different form but indistinguishable.”
This Pokemon Go tip is confirmed to help you get that prized Dusk Lycanroc Form, so, what are you waiting for? Go catch’em all!

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In the Premier League, no worse position exists than last place on the table. Even number 19 is happier than 20. And that particular circumstance is what supporters of both Everton and Wolverhampton have to look forward to this Saturday when the two play at what could be a very disgruntled Goodison Park.
Everton had all the chances in the world to win the first match of the season, and absolutely no hope of winning the second. Will the short season of extremes continue for this bunch of Toffees? Or will this upcoming affair against another struggling side end up being evenly matched or, perhaps, even an easy Blues victory?
Not if Gary O’Neil and Wolves have anything to say about it all. O’Neil was likely unfairly sacked by the Cherries after last season, and has a point to prove - as does a Wolves side that got left by former boss Julen Lopetegui just this past summer for its perceived inequities.
Who will win? Only time will tell.
RBM: First off, Wolves haven’t started this Premier League campaign much better than Everton so far; what is the vibe around the training ground, Molineux and the supporters??
I think supporters are fearful of the season ahead. The club sabotaged itself over the summer with the manager fiasco, and with zero investment in the team to date, it’s hardly a recipe for success. That said, we’ve played well at times during both matches so far and created plenty of good chances. There’s talent in the squad, so hope is not entirely lost.
RBM: What is the team struggling with?
Similar to Everton, we just can’t seem to put the ball in the net. Last season we didn’t create enough chances, but in the two games so far it’s been missing chances that have cost us points.
RBM: Why was Julen Lopetegui a good fit for the stretch run of last year, why did he depart, and what are Gary O’Neil’s strengths and weaknesses in comparison?
Lopetegui just had a lot of pedigree, and it gave everyone a lift, knowing we had an experienced, capable pair of hands. We also signed six players in January to help him keep us up. But he wanted even more players in the summer, and the club aren’t prepared to spend so they just went their separate ways.
The frustrating thing is that it took them so long to get to that point that we wasted the entire summer. Gary O’Neil doesn’t have anything like the same experience and hasn’t been given any time to implement his ideas. Again - not what you’d call a blueprint for success.
RBM: Who should observers be watching this season on Wolves? Names we might know and players we might not yet?
Matheus Cunha didn’t really do much last season after joining from Atletico Madrid in January, but he’s looked sharp and effective so far in our struggling attack. I’m also desperate to see giant striker Sasa Kalajdzic get some minutes as I think he could be a real difference-maker for us if he remains injury-free.
RBM: What type of business has the side done this summer? Are there any more summer moves waiting for the side before September?
We’ve done nothing (incoming anyway - lots went out) - apart from signing a third-choice keeper and bringing Matt Doherty back on a free. I’m hoping the club will do a bit of business to bolster us at both ends of the pitch before the month is out, but I’m not holding my breath given well-documented financial issues. Our best hope for improvement could be players like Fabio Silva and Kalajdzic, who were loaned out or injured last season but are capable of making an impact.
RBM: How do you expect Wolves to set up on Saturday, and which of the side’s players do you think could cause the Toffees the greatest issues?
Matheus Nunes getting sent off against Brighton was a blow because he’s been performing well and with our squad, he’s a tough player to replace. That might force Gary O’Neil into a change of shape, but if he sticks with the lop-sided 442 it could be something like: Sa; Semedo, Kilman, Dawson, Ait-Nouri; Lemina, Gomes, Sarabia, Neto; Cunha, Silva
RBM: Finally, what’s your prediction for Saturday’s match?
I’ve got to say, I’m not confident. If it was at Molineux, I’d be feeling more optimistic, but Goodison is a tough place to go, and I’m not sure we’ve got the backbone to resist the crowd and the style of play Dyche offers. I’ll sit on the fence and predict a draw - 1-1 - which I suppose at least gets both teams on the board. Would you take it?
We thank Tom for his time as always!


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It might be remembered most as the year Childish Gambino won hearts and minds, but there were plenty of other memorable music videos in 2018. We saw Star Wars director Rian Johnson tell a love story for LCD Soundsystem, SOPHIE explore questions around identity and appearance, and Janelle Monae perform in a pair of vagina trousers.
There was also some serious debate around how music videos directors make their money – which CR delved into earlier in the year – raising the seemingly eternal question of why videos often receive so little investment by labels and artists. Especially as Hiro Murai’s This Is America video is proof, all on its own, that the music video can still make an enormous cultural impact.
Here are our ten picks of the year:
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Davidson’s Chase Continues
The NCAA tournament in March 2008 was so thrilling for us Davidson people, so consuming, so galvanizing, that it was next to impossible to not think grandiose thoughts. So now this is how it’s going to be.
Davidson hasn’t been back since.
The team the next year lost in the semifinals of the Southern Conference tournament, because that’s what sometimes happens, even with someone like Stephen Curry on the roster. The team the year after that won 16 games. Last year’s team won 18.
The other day in the Charlotte Observer, longtime Davidson coach Bob McKillop quoted English poet Robert Browning.
“You only have a few times in your life to grab the golden ring. In the aftermath of Stephen’s experience here, grabbing it again was going to be difficult,” the coach said. “Browning said a man’s reach should exceed his grasp or what’s heaven for? I’m always reaching and grabbing, looking, because it’s the only way to get where you want go.”
This year, the Wildcats had won 20 already by Saturday when they faced a very good Wichita State team in one of the weekend’s bracketbuster games. It was broadcast on ESPN2. It made me miss my school.
I don’t really know the kids on this team, but I feel like I do, because I know where they go to class, and I know their professors and their coaches. They played hard Saturday, but in the end, it was pretty clear the better team won.
The story of Davidson basketball, I once wrote, is “the chase of the chance,” and that shot by Jason Richards against Kansas on March 30, 2008, which would have put Davidson in the Final Four (!), was that chance in concentrated form. The moment was so full of possibility it was almost hard to watch.
March 2008? It was awesome. But 16 wins then 18 wins then 20? That’s somehow more authentic. More instructive. Davidson’s run in retrospect is a reminder: It’s not about the ring. It’s about the reach. Chances come and go. The chase doesn’t stop.
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The Kansas Sports Hall of Fame has announced the members of the Class of 2013, who will be enshrined in ceremonies on Oct. 6 at the Wichita Boathouse.
The new inductees total eight, including Wichita Carroll High School star and Colorado State All-American Mike Bell, joined by Pittsburg State’s three-time national football coach of the year Chuck Broyles, along with two-time Kansas State All-American women’s basketball player Nicole Ohlde and Martín Gramática, a two-time All-America football selection as a placekicker at Kansas State.
Three members of the 1952 Kansas national championship basketball team and Olympic gold medalists — Al Kelley of McCune, Bob Kenney of Winfield and Bill Lienhard of Newton. Former Boston Celtics players Bob Brannum of Winfield will be enshrined posthumously.
The new class raises the total number of inductees to 227 in the Kansas hall, which is celebrating its 52nd anniversary this year.
• MIKE BELL, WICHITA
Mike Bell, a native of Wichita and an all-state football player at Wichita’s Bishop Carroll High School, played collegiately at Colorado State University, where he was an All-American in 1977 and a consensus All-American defensive tackle selection in 1978. A sack specialist, Bell recorded 25 sacks during his collegiate career and left Colorado State as the career leader in that category. Bell parlayed his stellar collegiate career into a first round, second overall selection by the Kansas City Chiefs in the 1979 NFL Draft.
He played 12 years with the Chiefs, totaling nearly 500 tackles, recovering 10 fumbles and recording 40 sacks. Bell led the Chiefs in sacks in 1983 and 1987 and was selected as a Pro Bowl alternate in 1983 and 1984. Bell was inducted into the Colorado State University Athletics Hall of Fame in 2001.
• BOB BRANNUM, WINFIELD
Bob Brannum had a career in basketball that spanned over four decades. A star high school player standing 6-foot-5, the Winfield native led his high school squad to the state tournament in both his junior and senior seasons before enrolling to play for fellow Kansan Adolph Rupp at the University of Kentucky in 1943.
Brannum had an immediate impact for the “Baron” and Kentucky, leading the Wildcats in scoring as a freshman and being named a consensus first-team All-America selection. Following a transfer to Michigan State University after his discharge from military service during World War II, Brannum was drafted by the Sheboygan Redskins of the National Basketball League. Brannum played professionally for five seasons, first with Sheboygan and later the Boston Celtics.
Following his playing career, Brannum became one of the most successful collegiate coaches in the New England area, coaching at Norwich University, Kenyon College and Brandeis University from 1961 to 1986. When he retired, Brannum held the record for all-time coaching wins at Brandeis University and was inducted into that school’s Athletic Hall of Fame in 2001.
• CHUCK BROYLES,
Broyles, from Mulberry, was responsible for one of the greatest eras in college football history. After a stellar career as a player in which he was an honorable mention NAIA All-American in 1968 at Pittsburg State University, Broyles entered the coaching ranks. Broyles was an assistant and head coach at various stops in Kansas and Missouri before going back to Pittsburg State as an assistant to Dennis Franchione in 1988.
Broyles served as an assistant for just two seasons and was hired as the head coach of his alma mater in 1990. It was as a head coach that Broyles really made his mark and becoming one of the most successful coaches in college football history, posting a record of 198-47-2. Under Broyles, the Gorillas made four appearances in the Division-II national championship game, including winning the national championship in 1991.
Broyles’ career win percentage of .806 placed him third on the all-time Division-II coaching list when he retired in 2009. He was named a three-time national Coach of the Year and was inducted into the Pittsburg State athletics Hall of Fame in 2011.
• NICOLE OHLDE,
Clay Center’s Nicole Ohlde is another in a long line of decorated women’s basketball players from the state, who will join her K-State All-American teammate, Kendra Wecker, in the Hall of Fame this fall. Ohlde was a first team all-state basketball selection and state-champion high jumper her senior year at Clay Center and chose to play at K-State, where she rewrote the school’s record books and graduated as “the most decorated player in school history.”
She was named the Big 12 Freshman of the Year and garnered third-team all-conference honors in her first season in Manhattan. That was only the tip of the iceberg. She was named the Big 12 Player of the Year in both 2003 and 2004, and was a consensus first team All-American both seasons as well. She was a finalist for the Wade Trophy and the Naismith National Player of the Year twice and was a John R. Wooden Award finalist in 2004.
Ohlde was named the Big 12 Female Athlete of the Year in 2004. When she graduated from K-State, she held spots in the school’s top five all-time in scoring, rebounds, field goals made, blocks, career double-doubles, free throws made, free throws attempted and minutes played. She was selected as the sixth overall pick in the 2004 WNBA Draft by the Minnesota Lynx and played seven years, winning a championship with the Phoenix Mercury in 2009. Ohlde was the first women’s basketball player to have her number retired at Kansas State in 2004.
• MARTÍN GRAMÁTICA, KSU
Although not a native Kansan, former Kansas State University placekicker Martín Gramática will always hold a special place in the hearts of Wildcat fans across the state. A four-year letterman at K-State, Gramática rewrote the record books on his way to being named a two-time All-American in 1997 and 1998. He holds K-State career records for scoring, extra-points made, extra-point attempts, field goals made and field goal attempts.
During the 1998 season, when Kansas State secured its first No. 1 football ranking before falling to Texas A&M in double-overtime in the Big 12 championship game in St. Louis, Gramática set an NCAA record for longest made field goal without the use of a tee when he kicked a 65 yard field goal.
Gramática won the 1997 Lou Groza Award, given to the nation’s top collegiate kicker, and was the runner-up for the award in 1998. He went on to play nine NFL seasons, where he won a Super Bowl with the Tampa Bay Buccaneers in 2002 and was named to the 2001 NFC Pro Bowl team. In 2008, Gramática was honored in the K-State Ring of Honor at Bill Snyder Family Stadium.
• AL KELLEY, McCUNE
A native of McCune in Crawford County, Earl Allen “Al” Kelley was a standout on the Kansas basketball teams from 1952 to 1954 and went on to become an Olympic gold medalist in 1960. Kelley saw limited playing time on the 1952 KU national championship team as a sophomore, but came into his own during his junior season in 1953 when the Jayhawks finished as the national runners-up.
Kelley averaged 12.9 points per game as a junior and 12.4 points per game as a senior co-captain of the team in 1954. He was named to the All-Big Seven team in both 1953 and 1954. Kelley still ranks in the top ten all-time at KU for season free-throw percentage when he dropped in 86.2 percent in 1954. Following his collegiate career, Kelley was drafted in the seventh round of the 1954 NBA draft, although he instead chose to play for the AAU powerhouse Peoria (Ill.) Caterpillars.
In his first season with the Caterpillars in 1954, Kelley helped lead the team to the AAU national title and the 1954 World Basketball Championship in Brazil. He was selected to play on the Olympic team for the 1960 Rome Games where the United States claimed gold, beating every opponent by an average score of over 40 points per game. As a result of their historic run, the entire 1960 USA Olympic team, including Kelley, was the first Olympic team to be enshrined in the Naismith Basketball Hall of Fame in 2010.
• BOB KENNEY, WINFIELD
Robert “Bob” Kenney was also a member of the 1952 KU national championship team and was a member of the 1952 Olympic gold medal team. A three sport star for Winfield High School in the late 1940s, Kenney played both football and basketball at KU in 1950 and 1951 before deciding to just play basketball during his senior year of 1952. He was second on the team in scoring in both 1951 and 1952 and was a captain of the 1952 championship squad. Kenney was also an All-Big Seven selection in 1952. One of seven Jayhawks selected to play on the 1952 U.S. Olympic team, Kenney was second on the U.S. team in scoring and averaged 10.9 points per contest. He scored in double digits four times in the eight games and was a major contributor for the gold medal team. He was also a member of the U.S. team that won the gold medal in the 1955 Pan American Games.
• BILL LIENHARD, NEWTON
William B. “Bill” Lienhard was another standout on the star-studded 1952 KU national championship team and a member of the 1952 Olympic gold medal squad. After earning All-State honors and leading the state in scoring his senior year for Coach John Ravenscroft at Newton High School in 1948, Lienhard attended the University of Kansas, where he was a three year starter for Coach Phog Allen. Lienhard was named a captain of the 1952 team and averaged 5.8 points per game during that championship season.
Linehard’s calling card was an outstanding one-handed set shot which the KU game program described as “deadly against zone defenses” and described Lienhard as the “finest one-hand set shooter in Kansas basketball history.” He was selected to play on the 1952 Olympic team, where he averaged 4.0 points per game on the way to winning a gold medal.
— Mack McClure

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