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Powder Diffraction (2)
Grain Orientation of Aluminum Titanate Ceramics during Formation Reaction
Yutaka Ohya, Zenbe-e Nakagawa, Kenya Hamano, Hiroshi Kawamoto, Satoshi Kitaoka
Journal: MRS Online Proceedings Library Archive / Volume 658 / 2000
Published online by Cambridge University Press: 18 March 2011, GG3.17
A microstructural change during the formation reaction of aluminum titanate from a mixture of rutile and corundum powders has been studied. The characterization was carried out using a polarization microscope, a scanning electron microscope and a micro-focus X-ray diffractometer. The formation of aluminum titanate was controlled by a nucleation step. The formation reaction proceeded to form spherically oriented regions of aluminum titanate grains among the matrix of rutile and corundum. At the end of the reaction, the specimen was entirely filled with the oriented region of consisting several hundred micrometers. The oriented region was composed of primary aluminum titanate grains of several micrometers and pores. Large cracks due to a thermal expansion anisotropy were formed at the boundaries of the orientated regions. The formation of the oriented region was caused by a small change in free energy, increasing elastic energy, and the endothermic nature of the reaction.
Agglomeration of silica spheres under ultrasonication
Naoya Enomoto, Shingo Maruyama, Zenbe-e Nakagawa
Journal: Journal of Materials Research / Volume 12 / Issue 5 / May 1997
Power ultrasound of 20 kHz was applied to the synthesis of silica spheres via the controlled hydrolysis of tetraethoxysilane (TEOS). Silica spheres of about 0.3 μm were agglomerated to form tolerably uniform, dense particles of about 2 μm through 90 min sonication. This agglomeration behavior was examined by laser diffraction particle size analysis and transmission electron microscopy. It was found that the agglomeration process involves (I) an incubation period in which no agglomeration occurs, (II) rapid formation of ramified particles, and (III) their densification. It was inferred that sonication enhances collision among silica spheres.
Microstructure of nitrate polycrystals solidified under ultrasonic vibration
Naoya Enomoto, Yasushi Iimura, Zenbe-e Nakagawa
Journal: Journal of Materials Research / Volume 12 / Issue 2 / February 1997
Molten nitrates in the system (1 − x)NaNO3−xBa(NO3)2 were solidified in the presence of a power ultrasound of 20 kHz. Their microstructures were compared with those of controlled samples which were solidified normally. Grain size in the controlled sample of monolithic NaNO3 (x = 0) was reduced by sonication. In the hypo- (x = 8 wt. %) and the hypereutectic (x = 28 wt. %) binary samples, the sonication completely eliminated the dendritic structure of the primary crystals and induced equiaxed particles of the primary phase. At eutectic (x = 18 wt. %), the sonication removed oriented structures of the eutectic lamellae. Several mechanisms of the microstructural modification were mentioned.
X-ray-diffraction data of Pb2(C2O4)(NO3)2·2H2O
Hee-Lack Choi, Nobuo Ishizawa, Naoya Enomoto, Zenbe-e Nakagawa
Journal: Powder Diffraction / Volume 11 / Issue 1 / March 1996
Published online by Cambridge University Press: 10 January 2013, pp. 7-8
X-ray powder-diffraction data for Pb2(C2O4)(NO3)2·2H2O were obtained. The crystal system was determined to be monoclinic. The unit-cell parameters were refined to a=10.613(2) Å, b=7.947(2) Å, c=6.189(1) Å, and β=104.48(2)°.
X-ray diffraction data of Ti2O2(C2O4)(OH)2·H2O
Hee-Lack Choi, Naoya Enomoto, Nobuo Ishizawa, Zenbe-e Nakagawa
Journal: Powder Diffraction / Volume 9 / Issue 3 / September 1994
X-ray powder diffraction data for Ti2O2(C2O4)(OH)2·H2O were obtained. The crystal system was determined to be orthorhombic with space group C2221. The unit cell parameters were refined to a = 1.0503(2) nm, b = 1.5509(3) nm, and c = 0.9700(1) nm.
Optimized High Strength Mortars: Effects of Chemistry, Particle Packing, and Interface Bonding
Della M. Roy, Zenbe-E Nakagawa, Barry E. Scheetz, Elizabeth L. White
Journal: MRS Online Proceedings Library Archive / Volume 42 / 1984
Published online by Cambridge University Press: 22 February 2011, 245
High strength mortars have been prepared utilizing optimized particle packing, reactive substituents to modify the chemistry- and addition of superplasticizers. Otherwise the processing techniques were conventional. The compressive strengths of one prototype material after curing at temperatures from 38 C to 250 C were above 70 MPa. The strengths were particularly high at 175 C (195 MPa) where excellent bonding had developed; one chemically modified material reached 245 MPa. The specimens cured at 175 and 250 C (after a lower temperature precure) developed their strengths rapidly, having reached essentially full strength by 7 days. At lower curing temperatures the strength increased with time, apparently still increasing at 56 days (106 MPa) for the materials cured at 38 C. Modified mixtures were prepared using different proportions of silica fume, MgO, different ratios of sand to fine components, and different sand mineralogy and other admixture proportions for rheological optimization. Microhardness, dynamic Young's modulus, density, and permeability were measured in addition to strength. Matrix chemistry and sand mineralogy and proportions affected the strength. Matrix-aggregate bond was very important. The above types of cementitious materials have potential importance for applications where they may be exposed to extreme conditions and to temperature cycling.
Rheological and Physical Properties of Magesium Oxide and Silica Fume-Modified Cement Mortars Cured at High Temperature
Zenbe-e Nakagawa, Elizabeth L. White, Della M. Roy
Published online by Cambridge University Press: 21 February 2011, 97
Physical properties and placement characteristics of cementitious mortars have been studied for their potential as repository sealing materials. They contained various expansive agents and industrial by-products, and were investigated at curing temperatures up to 250° C, the upper limit of an emplacement site or generally of relevance in accelerated reaction studies. An expansive agent, magnesium oxide, and two industrial by-products, silica fume and granulated blast furnace slag have been used at different percentages in the mixtures. Excellent general performance, including very high strengths up to 240 MPa combined with very low intrinsic permeability <10−8 Darcy (μm2) were generated at 175°C on material having a viscosity of 5000 cP (mPa·s) at 38° C. One 1700 cP(mPa·s) material treated at 250°C had compressive strength >180 MPa and also <10−8 Darcy (μm2) permeability. MgO was found to accelerate formation of tobermorite and generally cause expansion; at 250° C expansion was also related to xonotlite formation.


SOPHIA, N.C. – One of baseball legend Yogi Berra's famous quotes is, "It ain't over 'till it's over." Burt Myers just might start using that quote to describe the outcome of his last two NASCAR Whelen Southern Modified Tour races.
Myers was able to take the lead late in a race for the second straight week and it paid dividends once again.
The Walnut Cove, North Carolina, native took the lead from points leader Andy Seuss on the restart of a green-white-checkered finish attempt and held on to take the Southern Pride 150 at Caraway Speedway for his second consecutive win of the season and 13th career victory.
It was Myers' first victory at the .455-mile banked asphalt oval since the series' second event there in April 2005. One week ago Myers led only the final lap in scoring his first win of the season and he led only four laps in his most recent win at Caraway.
Seuss, who entered the event looking for his fifth consecutive win at Caraway dating back to last season and 11th of his career, was forced to settle for a runner-up finish. He was followed by Kyle Ebersole, David Calabrese and Danny Bohn.
Luke Fleming, J.R. Bertuccio, Bryan Dauzat, Daniel Speeney and Gary Putnam completed the top 10.
For Myers, who last won back-to-back races in 2010 (Tri-County Motor Speedway and Charlotte Motor Speedway), he couldn't believe how things turned out for him at a track where he hadn't had much success since the inaugural season of the tour.
While Myers had a fast car he was stuck in traffic numerous times behind Seuss and later Calabrese and could not get by the cars on the outside like he was able to do a week before at Langley.
George Brunnhoelzl III, the four-time defending champion, was quick in practice earlier in the day and won his 22nd career pole prior to the event and led for the majority of the first 140 laps.
For the second consecutive week, Brunnhoelzl III appeared to have a win in hand for most of the night, until he suffered a problem late in the race.
While leading with less than 10 laps remaining, Brunnhoelzl III suddenly slowed coming out of Turn 4 and eventually came to a stop on the backstretch to bring out the fourth and final caution of the race and set up the green-white-checkered finish.
A broken rear end eliminated Brunnhoelzl's chances of capturing his first win since April 22 at Langley Speedway in Hampton, Virginia, and his 11th career victory at Caraway. He finished 12th in the race for his first finish outside the top 10 at Caraway since April 11, 2009.
That opened the door for Seuss to pick up his fifth consecutive win at Caraway – but that outcome wasn't in the cards.
Ebersole was consistent throughout the race and happy to come home with a third-place finish – his best since he finished second at Southern National Speedway in March.
Seuss was able to build his lead to 23 points over Brunnhoelzl (386-363) in the season championship standings. Myers is now tied in third position with J.R. Bertuccio with 351 points with Bertuccio owning the tiebreaker. Danny Bohn completes the top five with 343 points.
The NASCAR Whelen Southern Modified Tour next heads to South Boston Speedway on Sept. 13th for the 10th of 14 events on the 2014 calendar.
At Caraway Speedway - Sophia, N.C.
1. (5) Burt Myers, Walnut Cove, N.C., Ford, 151 laps, 76.481 mph.
2. (2) Andy Seuss, Hampstead, N.H., Chevrolet, 151.
3. (6) Kyle Ebersole, Hummelstown, Pa., Ford, 151.
4. (14) David Calabrese, Toms River, N.J., Chevrolet, 151.
5. (3) Danny Bohn, Freehold, NJ, Chevrolet, 151.
6. (17) Luke Fleming, Mount Airy, N.C., Ford, 151.
7. (16) JR Bertuccio, Centereach, N.Y., Chevrolet, 150.
8. (7) Bryan Dauzat, Alexandria, La., Chevrolet, 149.
9. (12) Daniel Speeney, Newtown, PA, Chevrolet, 149.
10. (9) Gary Putnam, Vernon, Conn., Chevrolet, 149.
11. (13) Mike Norman, Lewisville, N.C., Chevrolet, 146.
12. (1) George Brunnhoelzl, III, West Babylon, N.Y., Chevrolet, 143, rear end.
13. (15) Dalton Baldwin, Dunedin, Fla., Chevrolet, 101, engine.
14. (8) Bobby Measmer, Jr., Concord, N.C., Chevrolet, 57, engine.
15. (4) Spencer Davis, Dawsonville, Ga., Pontiac, 37, rear end.
16. (10) Jason Myers, Walnut Cove, N.C., Ford, 17, engine.
17. (11) Joe Ryan Osborne, Holland, Pa., Chevrolet, 0, did not start.
Caution Flags: 4 for 25 laps.
Lap Leaders: G. Brunnhoelzl,III 1-52; B. Myers 53; G. Brunnhoelzl,III 54-142; A. Seuss 143-148; B. Myers 149-151.
Standings: 1. A. Seuss, 386; 2. G. Brunnhoelzl,III, 363; 3. J. Bertuccio, 351; 4. B. Myers, 351; 5. D. Bohn, 343; 6. L. Fleming, 338; 7. K. Ebersole, 318; 8. G. Putnam, 317; 9. J. Myers, 306; 10. S. Davis, 304.


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Buildings & Processes
Global Multi-Site Retailer
Las Vegas Resort Casino
Fetzer Vineyards
Group 42 Copy 2
< All Stories
Less is More: Global Multi-Site Retailer
By seeing how water is used throughout operations, this global retailer reduced use by 14% and avoided other hidden expenses.
Apana's client, a global multi-site retailer, has cut water use by 14%, and avoided other costs and protected assets with help from Water Efficiency as a Service™. Now deployed across North America and Japan, the solution is guiding efficient operations and protecting water infrastructure like cooling towers, water softeners and irrigation systems from multiple points of failure.
The journey to fleet-wide deployment began in Mexico. At the time, the retailer's warehouses were managing water primarily through bi-monthly water bills. Like most places in the built environment, waste events and anomalous use went undetected and undiagnosed for months.
Warehouses in Mexico faced a particular dilemma: excessive water flow increased costs at the wastewater treatment plants. An immediate and practical solution was to eliminate unnecessary water use by optimizing operations and addressing mechanical issues in real time.
The savings were substantial. With their focus on efficiency, the retailer wanted to replicate the gains to the broader fleet of facilities. An expanded pilot in the Southwest not only validated the savings but showed positive impacts for cooling towers, water softeners and other systems common in the United States.
It takes a lot of energy to pump, heat, treat and move water, so if you use less water, you'll use less energy, and that will lower your water footprint.
– WaterCalculator.org
Mexico warehouses were outfitted with the Apana solution. Cloud-based analytics delivered actionable alerts to key operations staff exactly when staff needed to know. Issues were resolved quickly.
In addition, the data provided significant operational insights that allowed unexpected cost reductions and performance benchmarking for future deployments of the Apana solution.
Example: Cost Avoidance
Operational practices could be seen through warehouse water use patterns. Unexpected water use usually indicated a waste event. Frontline staff began to suggest changes that not only saved water, they saved staff time, energy, chemical use and avoided other costs like drain line cleaning and unnecessary service provider visits. Hidden costs became controllable. The payback justified the next phases.
A representative sample of locations in the Southwest — including those with landscape irrigation, car washes and cooling towers — were selected for enrollment. The results in the initial U.S. test locations were slightly better than the 20% average savings documented in the Mexico locations.
By the end of 2014, some 30 installations had reduced water consumption 20% year over year, saving over 30 million gallons of water, and achieving a return on investment in under one year.
Example: Waste Elimination
Through real-time monitoring and alerts, the retailer saved 30 million gallons of water across the Southwest U.S. program expansion, equivalent to 40,000 kWh of energy, enough to provide drinking water to 60,000 families for an entire year.1
With a successful expansion in the Southwest, the retailer determined the Apana system was detecting waste, improving operational practices and garnering rapid ROI based on avoided costs. The system was paying for itself, so the decision was made to expand the program to additional warehouses.
Utilizing proven processes, Apana integrated the solution into all locations in the United States, Puerto Rico, Canada, Mexico and Japan. Deployment in Australia is underway. Other countries will be added as the retailer continues to expand.
In parallel, a region-by-region rollout of Apana's landscape irrigation module started. The irrigation module applies the intelligence of Apana's smart water management solution to landscape irrigation. Irrigation is often a large component of a property's water use profile.
Example: Asset Protection
The Apana system detected a 45 gallon per minute waste event on the irrigation system. Water soaked into the sandy soil and under the parking lot. Left unchecked, the 65,000 gallons per day would erode the soil and create costly repairs to the parking lot. Prompt notification to the locations. staff avoided a prolonged waste event and the parking lot was saved from destructive erosion and a possible sinkhole.
The Hidden Becomes Visible
Apana's system detected a 45 gallon per minute waste event on the irrigation system. It was immediately seen, diagnosed, and fixed, saving water and assets.
Based on the successful deployments in Mexico and the Southwestern U.S., the retailer expanded Apana's solution to all other locations in the U.S., Mexico, Canada, Japan and Australia. Waste elimination in the form of water, sewer, energy and other directly avoided costs created a less than one year payback for the entire system.
Waste elimination created a less than one year payback for the entire system.
This global multi-site retailer has realized significant value from global enterprise-wide deployment of Water Efficiency as a Service™. The direct savings from waste elimination, coupled with the added benefits of asset protection and cost avoidance, has delivered on the retailer's core value of sustainable, efficient operations and provided a compelling return on investment. The Apana system is now part of the construction plan of every new facility built in North America and Japan.
Investing in Values
Using their core values as a guide, return on investment was achieved through:
The Energy-Water Nexus
More Success Stories:
At a Las Vegas Resort Casino, Apana helped reduce water use in their fountain and pool operations.
From 2017-2018, Fetzer Vineyards reduced water intensity 25%, driving significant improvement to its water stewardship program.
See how real-time water management increased efficiency and profits at a new, meat processing complex.
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text: Bernice M. Frank, 96, of Princeton died Friday, October 4, 2013, at the University Medical Center of Princeton at Plainsboro. Born in Newark, NJ she had been a Princeton resident since 1951. Mrs. Frank was past chair of the Princeton Commission on Aging, a member of the Princeton Recreation Commission and for many years a member of the Community Connection of Princeton Health Care. Mrs. Frank was one of the founders of the Friends of Princeton Public Library from when it was in the Bainbridge House, and served as Secretary of the organization for more than 20 years. Starting as a Brownie troop leader and serving as a Girl Scout cookie drive co-ordinator, Mrs. Frank volunteered with the Girl Scouts for more than 55 years. Mrs. Frank was a Master Point bridge player, who co-ordinated a group of duplicate-bridge playing friends monthly for the past 40 years. Daughter of the late I. Edward and Celia (Rasnick) Kantor, she is survived by her husband of 70 years, Dr. Henry J. Frank, daughter and son-in-law, Ellyn and George "Mac" McMullin, son and daughter-in-law Elliott S. and Rondus "Roni" Frank, and daughter Dr. Carolyn Frank. Burial was private in the Princeton Cemetery. In lieu of flowers, memorial contributions may be made to Community Connection of Princeton Health Care, 1 Plainsboro Road, Plainsboro, NJ 08536, or the Girl Scouts of the USA 420 Fifth Avenue, New York, NY 10018-2798Arrangements were under the direction of the Mather-Hodge Funeral Home, Princeton.


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Shop Visit: See See Motor Coffee Co.
Thor Drake owns Portland's finest custom motorcycle store. He is also improbably tall, and his name is pronounced 'Tor' with no 'h'. You could say he's the living embodiment of the city's unofficial slogan: "Keep Portland Weird."
If the name sounds familiar, that's probably because Thor runs The One Motorcycle Show and organizes the 21 Helmets exhibition, both regular fixtures on the US custom calendar.
But most days you'll find Thor at his See See Motor Coffee Co. establishment, which is the kind of business we'd all like to run. It's essentially a motorcycle café that also sells cool gear, books and magazines—and has a couple of workshops tucked away at the back.
When did you start See See? We've been in action for seven years. I started it with Drake McElroy and a loose idea: that a dirt bike would be a good platform for a café-styled bike.
We grew up playing in the dirt, and wanted something fresh and new to work on. So Drake built a YZF450 and I built an XR400. We built bikes that looked good and performed well, with some classic design cues.
Where did that logo come from? I had a strange dream about the logo, and built a name and brand around it. The logo was a hat tip to the fact that motorcycles make me very happy. A lot of stuff at the time was all about skulls and being ultra tough: we just wanted to make something different.
We came up with the See See name to be less motorcycle-centric, but it also refers to the style of bikes we like: metric or "cc" bikes. The "See See" also comes from the eyes on the logo.
When did you open the store? On 10 June, 2010. It was a small shop on the industrial north side of Portland. We were one of the first Poler Stuff and Biltwell dealers.
How did you pick your location? Our location found us—we don't have deep pockets, and that was a huge factor. We've now moved to central Portland, on one of the main roads. But we're pretty isolated as far as businesses go, there's not much around us.
My partner George Kassapakis assured me it would be a good spot, but I didn't see it at first. But after we gutted the building I saw huge potential. It was four months of 12-hour days just getting the coffee side open.
What's it like inside? When you walk in the door you will notice 130-year-old barn wood. The front of the coffee bar is sheet metal I used in my last workshop as flooring. The whole back wall is stuff I pulled down during the renovation. The uprights on the bar are old frames, and I even used my old coin collection for covering ugly hardware.
George and I built the whole place, and I'm damn proud of that.
What do you sell? Premium Stumptown coffee, breakfast pastries by Roman Candle Bakery, sandwiches made in-house, and other tasty treats. We have hot dogs for lunch, and they are damn good. Some say the best. We have a couple of craft beers, wine and domestic lagers too (like Rainier Beer).
We also sell motorcycle parts, helmets, jackets, safety gear and lifestyle clothing. It's a curated mix of big and small brands—such as Icon, Bell, Biltwell, Brixton and Danner. Plus Chrome bags, Electric Sunglasses, and stuff from Loser Machine and Busch Bros. And even Deus ex Machina.
We have an expanding in-house line of See See gear too, and make a few parts of our own—like mini switches.
What are the workshops like? One side is a tiny machine bay, and the other is for tuning and assembly. We don't mess around with any maintenance, with the exception of our own bikes. We do about four customer bikes a year.
We always try to build motorcycles that are fun and different. We just did a custom Rokon for Danner Boots—I was real excited to do that one. Somehow we've got labelled as café-style builders, but we have only done a few. And even those are pretty different from the standard café style.
You sound busy. It's a careful balance. You need to make it worth your time, but you don't want it to be too much like work. You see a lot of builders get burnt out by trying to make motorcycle building their main business. It can turn from a hobby to a poorly paying job pretty quick. Someday I want to be old and still excited to build motorcycles.
I don't get to spend as much time as I would like in the shop itself. I think about it all day long, but business work (i.e., emailing) takes up most of my time.
Has See See lived up to your expectations? We are still open. I think that deserves a high five! But it's been mountains of work.
Running a small business in the USA can be tricky. It requires a ton of balance between work and pleasure, and most of the time the lines are blurry. I would say 70 percent of the time I'm doing work that's just like any industry, across the board. If you want to own something nice, you have to clean it and take care of it—and that's not glamorous work.
But I wanted to add to the motorcycle scene, something I enjoyed. Growing up as a skate rat in skateboard shops, you learn to foster your community. I've always wanted to be inclusive and open, showing people like myself a little knowledge and acceptance.
But, as you know, the motorcycle world is pretty quick to judge, classify and discriminate. I never understood this.
What kind of people visit See See? This is the best thing—we have no specific type of customer. If I had to categorize them at all, I would say they are all nice people.
We get a lot of young families, older enthusiasts, and lots travellers who stop in on their trips. On the motorcycle side we get it all as well. We love all types of motorcycles, so we cater to all types of bikes.
What's it like being based in the hipster capital of the world? Well, if you like motorcycles, good food and the wilderness, and you don't have millions of dollars, Portland is a pretty damn good place to live.
I lived here before the word "hipster" was the common name for young people. The word is too broad for my taste—I don't even know what it means. Maybe it's someone born between 1975 and 1987? Or is it a haircut? I have heard a lot of talk about skinny jeans, but punks wear the same style. So do cowboys for that matter.
What bikes do you ride yourself? Oh boy! Dirt: '14 KTM 500 XC-W, '75 Husky CR250 and a '86 Honda CR250. Flat track: '78 Trackmaster Yamaha TT500, and a '74 Framer Yamaha MX250. Street: '74 Cone shovel FLH Harley Davidson, '10 Triumph Scrambler 900, '79 SR500 (owned since I was 17 years old), and a '99 Ducati Monster 750.
We'll come and visit. When are you open? We're open seven days a week. Sometimes we have night events. I love having night events.
See See Motor Coffee Co., 1642 NE Sandy Blvd, Portland | Facebook | Instagram
Photos by Michael Antonovich.
Filed Under Custom Motorcycle Shop TAGGED See See Motorcycles |
Nov 8, 2014 Wesley Reyneke
Turn your CBR1000rr into a "cafe fighter"
Filo Rosso: A Magni racer for the road


NICOSIA, 29 May 2017 - Every year, the UN marks the International Day of UN Peacekeepers, when we pay tribute to all the men and women who have served either as military, police or civilians and continue to serve in UN Peacekeeping operations for their high level of professionalism, dedication and courage . We also honour the memory of those who have lost their lives in the cause of peace.
This year, the Special Representative of the Secretary-General in Cyprus and Head of Mission, Ms. Elizabeth Spehar, and UNFICYP Force Commander Major General Mohammad Humayun Kabir led the annual commemoration of the International Day of Peacekeepers at Mission HQ in the buffer zone.
"We pay tribute to those who have lost their lives to this noble cause, and commit to continuing to serve with diligence so that the people of Cyprus are able to enjoy a future free from conflict," he added.
"And we honour the memory of more than 3,500 peacekeepers who lost their lives while serving," he added.
Currently, more than 113,000 'Blue Helmets', UN Police and civilian personnel deployed to 16 missions around the world. Last year, 117 peacekeepers paid the ultimate price; they included military, police, international civil servants, UN Volunteers and national staff from 43 countries. So far in 2017, twelve peacekeepers have been killed.
Since the establishment of UNFICYP in 1964, 186 civilian, military and police personnel have died in service to peace in Cyprus.


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Ask Us: What problems would combined Knox-Overton K-8 solve?
Published 2:00 pm Monday, February 21, 2022
A conceptual drawing of the Knox-Overton K-8 school that's proposed to be built between the two facilities in Salisbury. and the firm LS3P.
Editor's note: Ask Us is a weekly feature published online Mondays and in print on Tuesdays. We'll seek to answer your questions about items or trends in Rowan County. Have a question? Email it to askus@salisburypost.com.
SALISBURY — A reader asked how a new K-8 school would improve educational outcomes for students in Salisbury.
Rowan-Salisbury Schools faces a K-8 project with a price tag that jumped about $14 million because of an increase in material costs. But district officials say the school would be valuable on a few fronts.
The plan is to build the new facility between the existing Knox and Overton Elementary schools, effectively combining the two. The plan has gone through a few iterations. The RSS Board of Education initially planned to heavily renovate Knox and demolish Overton, but the board approved a plan to build a new school after community backlash.
The original plan for the K-8 included demolishing Knox and Overton, but the board is expecting to decide on the fate of Overton later this month.
The original plan to renovate Knox carried a $26 million price tag. The K-8 school when approved in 2020 had a $55 million estimate, but that climbed to $69.6 million.
There are, however, some savings tied into the schools. In addition to the tens of millions in capital needs assessed at Knox, Overton is carrying about $2 million of its own needs. RSS Chief Operations Officer Anthony Vann said closing the facilities would cross millions off the district's running list of capital needs projects and discontinue their operational costs, too.
There are some design issues as well. If the district renovated Knox, it would not fix the fundamental issue of an open campus design.
School districts have moved away from open campus designs because they cause security problems.
"Open campuses are harder to contain as far as visitors and students going in and out," Vann said.
Knox has more entrances than a school of the same size built today. Older schools also have problems with visibility. The new design has designated places staff could observe large areas within the school, and the number of corners is kept to a minimum for that reason.
Vann said renovations could fix issues such as enclosed walkways between buildings, but it would not be the same as building a school designed to today's standards.
Vann said there is a tipping point where it is a better financial decision to build a new facility rather than refit an old building to what the district wants.
"It would be safe to say that by designing and moving into a new, modern facility that is designed for today's teaching and learning, I think it would certainly be a benefit to our students and staff," Vann said
Chief Academic Officer Jason Gardner said West Rowan Elementary School, the district's newest facility, is the model for what the district can do with classroom space to best accommodate learning
"They have the ability to flex the learning space in the class room and reconfigure it based on student needs," Gardner said. "And they have places in the school that are available for multi-classroom collaboration and things like that."
Senior Marketing and Communications Officer Tracey Lewis said the district also has received good feedback from families about their pride in West Rowan Elementary improving from their previous schools.
Gardner said aesthetics of new facilities are important. He said research supports better student outcomes when they are in a clean, modern environment.
At the end of 2018 researchers from the UCLA California Policy Lab and U.C. Berkley published a paper outlining metrics on millions of students and showing a move to new facilities from those in disrepair produced increased test scores and improved attendance.
All Hood Symposium set for April 21
RSS approves fence at Shive Elementary
Warming up to others: China Grove Middle club donates blankets to area youth


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65 e-Letters
Results/page 10255075100
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Tetanus-induced rhythmic seizures mimicking the clinical and electroencephalographic presentation of status epilepticus
I read this paper with great interest and congratulate the authors on consideration of tetanus in this case. I would point out that the EEG in Figure 1 was recorded with a low pass filter of 30 Hz, which could make EMG artifact look like the fast activity labeled as wicket spikes. If the raw EEG data are still available, examination at a low pass filter of 70 Hz would resolve the issue.
Tetanus does not in and of itself alter consciousness, so one might infer that she had suffered hypoxia during her spasms to cause her coma on presentation, which likely led to the idea that this was status epilepticus. Her eventual cognitive recovery attests to the skill and persistence of her medial team.
Culturing C. tetanii from a wound does not prove the diagnosis of tetanus, as the spores are ubiquitous, and only antitetanus antibodies from vaccination prevent the disease. However, I have no doubt about the diagnosis on clinical grounds. Did she receive tetanus toxoid in addition to human tetanus immune globulin? There are unfortunately cases of recurrent tetanus if active immunization is not pursued.
Ref: Birch TB, Bleck TP. Tetanus (Clostridium tetani). In Bennett JE, Dolin R, Blaser MJ (eds), Mandell, Douglas, and Bennett's Principles and practice of infectious diseases (ed 9). Philadelphia: Elsevier, 2020, pp. 2948 – 2953.
Ref: bcr-2021-242073.R2 - Very Late Onset Friedreich's Ataxia with rapid course mimicking as Possible Multiple System Atrophy Cerebellar Type. Rapid Response from Dr. Stefan M. Pulst, Professor & Chair, Neurology, University of Utah
Respected Editor and Dr. Pulst,
Thank you for your interest in our case. We agree with your comment that Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disease caused by bi-allelic expansion of an intronic GAA repeat in the frataxin (FXN) gene, but our patient had eight GAA repeats on allele-1 and 37 repeats (pre-mutated allele) on allele-2. The pre-mutated allele can be responsible for the disease, in
rare cases, by causing somatic expansion or pre-mutation in cell populations. But this occurs only when in the setting of the second allele in the clear pathogenic range of expansion. This intronic GAA expansion further silences the FXN gene, resulting in pathologically suppressed levels of the frataxin protein. As per the respected reader, even though the patient had the probability of compound
heterozygous mutation with a pathogenic point mutation in one allele, the second allele would not be pathogenic at 37 GAA repeats.
Usually, individuals with ataxia who are heterozygous for an expanded GAA repeat (> 66) may contain a separate loss-of-function mutation in the FXN gene copy over the allele with normal GAA repeat length. In the relevant clinical context, these patients should be considered to have Friedreich ataxia. [1] However, in populations where the prevalence of Friedreich ataxia carriers is high, such an
individual may have a different disorder responsible for ataxia apart from being a carrier for Fr...
individual may have a different disorder responsible for ataxia apart from being a carrier for Friedreich ataxia. [1] Nevertheless, investigators should look for an FXN loss-of-function mutation in heterozygosity with the GAA repeat expansion whenever possible, both by sequencing the FXN coding exons and the adjoining intronic sequences and by gene-dosage determination to rule out significant deletions. [1] These types of facilities are only available in the research faculties which are not available in our case, the same has been accepted as a limitation of our case. Sharma P et al. studied the carrier frequency estimation in a sample of 790 healthy study subjects across India. They reported the prevalence of "carrier state" to be 0.63% i.e. 5 in 790. They reported an approximately 19% prevalence of long-normal alleles (>12 alleles) with the longest repeats being 28. [2] The estimated prevalence of FRDA is 1/1,00,000 based on carrier frequency in the Indian population. [2]
We believe that due to the low prevalence of Friedreich ataxia carriers in India, we should investigate for mutations on other alleles even in heterozygous pre-mutated states, where FRDA has a high clinical likelihood. Even so, Sharma P et al. and the paper by Mukerji M et al. lack the data on the frequency of permutated alleles in the Indian population. [2,3] This underlines the lack of data on pre-mutated alleles in India. A study by Sharma R et al. shows that somatic instability of borderline alleles, which are not generally thought to cause disease, imparts a risk for clinical disease development. [4] Individual somatic cells in different organs may have dramatically varying allele sizes, implying that traditional DNA testing may be insufficient for phenotypic prediction in persons with borderline alleles. [4] In FRDA, the allele size at the lower end of the pathogenic allele range is not clearly entrenched. Although the actual frequency of borderline alleles has not been determined, they account for less than 1% of FXN alleles. As per Cook A et al. "In terms of genetics of FRDA, till date important clarifications still need to be made, particularly with regards to the specific chromatin modifiers responsible for silencing the FXN gene and the extent of this heterochromatization, and the epigenetic basis of FRDA". [5] As more and more literature is published, FRDA is being studied and reported as an gene silencing disorder with epigenetic basis. [5]
In our case, clinical presentation along with radiological investigations pointed us towards the possibility of the FRDA despite the borderline pre-mutated heterozygous state. We already accepted the limitation in our case was the inability to perform the full genome sequencing or exome sequencing which could have predicted the point mutation or deletion.
In our case, we barely aggravated any of our findings (radiological and clinical), and a most likely diagnosis of FRDA was considered. Nowhere, we tried to manipulate or exaggerate our findings. During the care of this patient, we took opinions from our neurology department, but we did not mention them in the acknowledgment as they were not involved in the writing of the case report. Furthermore, a patient hospitalized in an internal medicine department is routinely checked and advised by the neurology department at our tertiary care hospital.
As per the respected reader, interpretation of genetic tests needs subspecialty expertise provided by medical geneticists, genetic counselors, or neurogeneticists. However, these kinds of facilities are not available at our institute, and the case was managed in resource-limited settings.
According to the esteemed reader, errors of overinterpreting genetic test results and, even more so, erroneous interpretation can be harmful to patients and their relatives. In the present clinical setting, we tried to explain the intricacies of genetic tests to the patient and their relatives. We explained the disease's degenerative nature and the clinical likelihood of the FRDA. However, in the absence of a thorough genetic workup, we left this to the patient's next of kin, whether or not to further go for a workup. Clinically his next of kin (his son) was normal. We believe that, from an ethical point of view, as a physician, we managed the patient with the best of our abilities, clinical acumen, and available resources.
In our settings, it is not always possible to contact a neurogeneticist or other such professional due to the relative non - availability of such practitioners or the patient's inability to pay for such services (here in this case the annual income of the patient was below USD 1250 [no insurance]). Though we have a neurology department, it is not possible to do NCS testing (most of the time machines are in a non-working state), or many facilities are yet unavailable. With great efforts, we were able to convince the relatives for the costly triplet primed PCR assay. For even making an MRI or any radiological scan, the patient's affordability is an issue that we felt at every stage of treatment. In India (or any other Low-middle income country), such types of cases are handled by Internal medicine physicians (internists) primarily with neurological opinions from neurology consultants, which has happened in our case. These other factors must also be considered in the context of this case report.
We don't want to rule out completely the possibility that this might be a pre-mutated carrier state of FRDA; neither we want to mislead the scientific community. Irrespective of the genetics and diagnosis, the diagnostic dilemma we faced, and the clinical course of the patient are indeed was interesting and worth reporting. We already have accepted our limitations in the published version that we did not have access to advanced investigations required to certainly diagnose these kinds of borderline cases.
The reader is a renowned neurogeneticist and neurologist, as well as considering his vast experience in the said field, we will be more than happy to connect, discuss and collaborate with the esteemed professor on this topic.
1 Schulz JB, Boesch S, Bürk K, et al. Diagnosis and treatment of Friedreich ataxia: a European perspective. Nat Rev Neurol 2009;5:222–34. doi:10.1038/nrneurol.2009.26
2 Sharma P, Sonakar AK, Tyagi N, et al. Genetics of Ataxias in Indian Population: A Collative Insight from a Common Genetic Screening Tool. Genet Genomics Next 2022;3:n/a. doi:10.1002/ggn2.202100078
3 Mukerji M, Choudhry S, Saleem Q, et al. Molecular analysis of Friedreich's ataxia locus in the Indian population: Friedreich's ataxia in India. Acta Neurol Scand 2000;102:227–9. doi:10.1034/j.1600-0404.2000.102004227.x
4 Sharma R, De Biase I, Gómez M, et al. Friedreich ataxia in carriers of unstable borderline GAA triplet-repeat alleles. Ann Neurol 2004;56:898–901. doi:10.1002/ana.20333
5 Cook A, Giunti P. Friedreich's ataxia: clinical features, pathogenesis and management. Br Med Bull 2017;124:19–30. doi:10.1093/bmb/ldx034
Burden of organdonation after euthanasia: better exclude it than reduce it
Maes et al suggest that the burden of organdonation related issues in organdonation after euthanasia (ODE) patients is well tolerable or may even be neglegible. They present two cases with untreatable psychiatric disorders who requested for euthanasia and expressed their deathwish to combine with postmortal organdonation. The burden relates to the patient, his family and the professionals involved in euthanasia. They propose that all psychiatric patients whom euthanasia is granted should be informed about the possibility of postmortal organ donation(1).
First, we state that the burden can even be minimized further: it is not necessary for the patient to have his euthanasia performed in the hospital. These patients can be given the sense of dying at home and transported thereafter using an anesthesia bridge to the hospital, as we have shown to be feasible(2).
Second, it is not fair to use the experience of these two evident highly for ODE motivated psychiatric patients and their families as a reference for comparable euthanasia patients who are unaware of the option of post mortal organdonation.
But third, of perimount importance, we criticize the opinion that the amount of burden for ODE patients may reach a point to be neglegible. In our opinion this burden should not be minimized, but excluded. The suggestions of Maes et al are motivated by utilistic ethical considerations and the existence of waitinglists for transplantation. The act of organdonation h...
But third, of perimount importance, we criticize the opinion that the amount of burden for ODE patients may reach a point to be neglegible. In our opinion this burden should not be minimized, but excluded. The suggestions of Maes et al are motivated by utilistic ethical considerations and the existence of waitinglists for transplantation. The act of organdonation however is a pure altruistic one, and in the face of the ultimate choice to end one's life incompatible with any utilistic view.
Any suggestion of organdonation to an euthanasia patient, irrespective of the underlying disorder making him to choose his own death, compromises his freedom of an eventually irrevocable and irreversible choice to end his life.
Also the treating physician should be free of any coercion during the whole project of ODE and moral pressure beyond the relationship with the (euthanasia) patient; this excludes even the suggestion for a potential organdonation.
From the first international round table conference on ODE, we became aware of the moral conflicts of healthcare providers experienced in Canada in their practice to ask euthanasia patients to consider organdonation who were not aware of this possibility, which appeared far from a neglegible burden(3). We also know from the practice in the Netherlands that healthcare professionals at the ICU experience an increasing personal burden after multiple ODEs, especially in cases of psychiatric patients.
Using the donor registry as an opportunity to bring up the issue of organ donation in case of euthanasia does not resolve the intertwinement. It is of note that the donor registry has never been designed to be used in the context of ODE. 'Shared decision making' also does not mean that interests of transplant recipients need to be considered by euthanasia patients.
We conclude that the altruistic deed of an ODE patient should be safeguarded against any external driven interests and coercion, while at the same time healthcare providers shape the conditions that the wish to donate will be fulfilled.
The awareness of ODE will gradually grow via social media, internet and patient platforms. There is no alternative. Most important is the separation of interests to be hold. In the extremely vulnerability of ODE, society should have no doubts that healthcare professionals, as founded in constitutional legislation, first of all seek anyone's integrity of life, mind and person. This priority should never be compromised by any interests of others. Intertwinement of these interests may eventually further harm the challenges in ODE and post mortal organdonation in general, than it may help to reduce waitinglists for transplantation.
1. Maes G, Oude Voshaar R, Bollen J, Marijnissen R. Burden of organ donation after euthanasia in patients with psychiatric disorder. BMJ Case Rep. 2022 Jul 4;15(7):e246754. doi: 10.1136/bcr-2021-246754. PMID: 35787499.
2. Mulder J, Sonneveld JPC. Organ donation after medical assistance in dying at home. CMAJ. 2018 Nov 5;190(44):E1305-E1306. doi: 10.1503/cmaj.170517. PMID: 30397157; PMCID: PMC6217602.
3. Mulder J, Sonneveld H, Healey A, Van Raemdonck D. The first international roundtable on "organ donation after circulatory death by medical assistance in dying" demonstrates increasing incidence of successful patient-driven procedure. Am J Transplant. 2022 Mar;22(3):999-1000. doi: 10.1111/ajt.16879. Epub 2021 Nov 6. PMID: 34706144.
Answer by Marijnissen et al,
We thank Sonneveld and Mulder for their thoughtful comments and an opportunity to provide additional explanation to our paper 1. Sonneveld and Mulder argue that the burden of ODE should be fully excluded instead of being reduced as much as possible. In our opinion, however, excluding the patient burden completely in these delicate situations is impossible.
Nevertheless, somewhat paradoxically, the authors suggest that the burden of ODE can be reduced based on the possibility of letting people say goodbye to loved ones at home, after which they are transported to the hospital under anaesthesia. This assumption that saying goodbye at home will reduce burden however does not apply automatically for all patients and their loved ones. For example, the described opportunity has been openly discussed with the first patient some weeks prior to the ODE was performed and afterwards with the family of the second patient. However, they considered the burden of performing this procedure at home higher than saying goodbye in the hospital, as they preferred to accompany their loved ones to the ODE procedure in the hospital as well as when they actually die. This reflects, however, very personal views, which should always be considered and why in our opinion shared decision making is so important.
Sonneveld and Mulder also nuance our conclusion 'that the burden can be minimal after ODE' is based on two patients highly motivated for ODE'. Case-reports present by definition highly selective cases, but are important for the discovery of new ideas, for education in rare diagnoses or exceptional situations, and, as in our case, to challenge widespread believes.3 We wanted to inform other health care professionals about the possibility of organ donation after euthanasia in these patients, and its positive consequences – arguing that ODE is not necessarily or merely a burden to every patient.
We are a bit surprised that these authors feel it is better that patients are informed about ODE through social media than by their physician, who knows them best and who can provide correct and nuanced information. The report of the limited round table conference only advertises ODE with anesthesia initiated at home (ODEH) and talks about a 'patient ‐driven process', but how can this be patient-driven if the patient is not aware of the possibility of this procedure? Furthermore, by only focusing on avoiding an act in the interest of the transplant waiting list (which is not the way we see ODE), the authors forget to act in the interest of the dying patient by ignoring potential altruistic motives. Physicians are responsible to provide information about all possibilities a patient has, making shared decision possible – only then we can speak of an "irrevocable and irreversible choice to end his life" and "integrity of life, mind and person". We however do not challenge that informing a patient about ODE is a very sensitive matter, because of which the registration as an organ donor might be a good starting point for this patient-physician discussion. Recently, a Dutch medical disciplinary committee judged that informed consent is also necessary when physicians decide not to perform a surgery, which demonstrates that withholding a medical act causes a burden for both patients and relatives. In other words, irrespective of whether patients chose for ODE or not, the burden of ODE can never be fully excluded. Nonetheless, more research is needed on the best way to introduce and implement ODE, probably especially in a patient with a psychiatric disorder, to minimize the burden.
Our case report on the burden of organ donation after euthanasia in patients with a psychiatric disorder was not aimed to state that the burden of ODE is low in general. Instead, it was meant to give the perspective that a doctor may do the patients short when he or she avoids discussing ODE based on the assumption that it may be too burdensome for them. Nonetheless, we fully agree that the burden for professionals working at the ICU can be substantial and this burden also involves professionals informing patients about the possibility of organ donation during a trajectory for euthanasia 4. We fully agree with the authors that patients should always be prevented from feeling pressure to donate their organs. To this end, our protocols (and laws) state that both procedures should independently be performed by different teams. The best way and timing of discussing all possibilities with patients is probably highly personal and require further study how to optimize the procedures of ODE from both a patient and doctors' perspective beyond expert opinion.
1. Maes G, Oude Voshaar R, Bollen J, Marijnissen R. Burden of organ donation after euthanasia in patients with psychiatric disorder. BMJ Case Rep. 2022 Jul 4;15(7):e246754. doi: 10.1136/bcr-2021-246754. PMID: 35787499; PMCID: PMC9255367.
2. https://www.ama-assn.org/delivering-care/ethics/withholding-information-...
3. Vandenbroucke JP. Observational research, randomised trials, and two views of medical science. PLoS Med. 2008 Mar 11;5(3):e67. doi: 10.1371/journal.pmed.0050067.
Response from Tushar Vidhale, MD (Dated: July 8th, 2022)
Usually, individuals with ataxia who are heterozygous for an expanded GAA repeat (> 66) may contain a separate loss-of-function mutation in the FXN gene copy over the allele with normal GAA repeat length. In the relevant clinical context, these patients should be considered to have Friedreich ataxia. [1] However, in populations where the prevalence of Friedreich ataxia carriers is high, such an individual may have a different disorder respon...
Usually, individuals with ataxia who are heterozygous for an expanded GAA repeat (> 66) may contain a separate loss-of-function mutation in the FXN gene copy over the allele with normal GAA repeat length. In the relevant clinical context, these patients should be considered to have Friedreich ataxia. [1] However, in populations where the prevalence of Friedreich ataxia carriers is high, such an individual may have a different disorder responsible for ataxia apart from being a carrier for Friedreich ataxia. [1] Nevertheless, investigators should look for an FXN loss-of-function mutation in heterozygosity with the GAA repeat expansion whenever possible, both by sequencing the FXN coding exons and the adjoining intronic sequences and by gene-dosage determination to rule out significant deletions. [1] These types of facilities are only available in the research faculties which are not available in our case, the same has been accepted as a limitation of our case. Sharma P et al. studied the carrier frequency estimation in a sample of 790 healthy study subjects across India. They reported the prevalence of "carrier state" to be 0.63% i.e. 5 in 790. They reported an approximately 19% prevalence of long-normal alleles (>12 alleles) with the longest repeats being 28. [2] The estimated prevalence of FRDA is 1/1,00,000 based on carrier frequency in the Indian population. [2] We believe that due to the low prevalence of Friedreich ataxia carriers in India, we should investigate for mutations on other alleles even in heterozygous pre-mutated states, where FRDA has a high clinical likelihood. Even so, Sharma P et al. and the paper by Mukerji M et al. lack the data on the frequency of permutated alleles in the Indian population. [2,3] This underlines the lack of data on pre-mutated alleles in India. A study by Sharma R et al. shows that somatic instability of borderline alleles, which are not generally thought to cause disease, imparts a risk for clinical disease development. [4] Individual somatic cells in different organs may have dramatically varying allele sizes, implying that traditional DNA testing may be insufficient for phenotypic prediction in persons with borderline alleles. [4] In FRDA, the allele size at the lower end of the pathogenic allele range is not clearly entrenched. Although the actual frequency of borderline alleles has not been determined, they account for less than 1% of FXN alleles. As per Cook A et al. "In terms of genetics of FRDA, till date important clarifications still need to be made, particularly with regards to the specific
chromatin modifiers responsible for silencing the FXN gene and the extent of this heterochromatization, and the epigenetic basis of FRDA". [5] As more and more literature is published, FRDA is being studied and reported as an gene silencing disorder with epigenetic basis. [5]
2 Sharma P, Sonakar AK, Tyagi N, et al. Genetics of Ataxias in Indian Population: A Collative Insight from a Common Genetic Screening Tool. Genet Genomics Next 2022;3:n/a.doi:10.1002/ggn2.202100078
3 Mukerji M, Choudhry S, Saleem Q, et al. Molecular analysis of Friedreich's ataxia locus in the Indian population: Friedreich's ataxia in India. Acta Neurol Scand 2000;102:227–9.doi:10.1034/j.1600-0404.2000.102004227.x
Not Visceral, but Localized Leishmanial Lymphadenopathy
We have read with interest this case, but we do not agree with the authors about considering this case as a visceral leishmaniasis (VL). This is a typical case of localized leishmanial Lymphadenopathy (LLL), as we and others described in several series of cases (1,2). This not-well known form of presentation of leishmaniasis is more common in Middle-East region, caused by dermatotropic strains like L. tropica or L. major, but isolated cases are described in Mediterranean region caused by L. infantum, as probably this case.
In last decade, we suffered in Southern urban cities of Madrid, mainly Fuenlabrada, an important outbreak of leishmaniasis. More than 1000 cases of leishmaniasis were reported, and we could describe several cases of LLL (2).
LLL is a form of presentation of leishmaniasis in patients without cellular immunosuppression, which presented with lymphadenopathy as the only form of presentation, and without systemic manifestations (no fever, no splenomegaly, no kytopenias, and normal acute phase reactants). Some LLL patients can refer lesions of cutaneous leishmaniasis (CL) near the adenopathy that had been previously spontaneously resolved or not, showing adenopathies as a local inflammatory rather than a systemic disease. Median duration of the adenopathy was 3 months in our patients. None of these patients, some of them without treatment, progressed to VL.
We think it is important to distinguish LLL from VL because of crit...
We think it is important to distinguish LLL from VL because of critical outcome differences. VL is an incurable and potential mortal disease without treatment. LLL is a benign localized disease, similar to CL, which can be treated with systemic treatment for a faster resolution of the adenopathy, but that it is possible to resolve with lower doses of Liposomal Amphotericin B, avoiding toxicity, or even monitoring without treatment (2).
1.Ignatius R, Loddenkemper C, Woitzik J, Schneider T, Harms G. Localized leishmanial lymphadenopathy: an unusual manifestation of leishmaniasis in a traveler in southern Europe. Vector Borne Zoonotic Dis. 2011 Aug;11(8):1213-5. doi: 10.1089/vbz.2011.0642. Epub 2011 May 25. PMID: 21612538.
2.Horrillo L, San Martín JV, Molina L, Madroñal E, Matía B, Castro A, García-Martínez J, Barrios A, Cabello N, Arata IG, Casas JM, Ruiz Giardin JM. Atypical presentation in adults in the largest community outbreak of leishmaniasis in Europe (Fuenlabrada, Spain). Clin Microbiol Infect. 2015 Mar;21(3):269-73. doi: 10.1016/j.cmi.2014.10.017. Epub 2014 Oct 29. PMID: 25658537.
A supporting case for this profound presentation
Jiang presents a very interesting and unique case of bilateral corneal decompensation in a patient with COVID pneumonitis. We would like to offer a similar case to support their hypothesis of viral endotheliitis. These cases demonstrate an ocular manifestation of COVID-19 infection which was previously unknown. This manifestation is important to be aware of as the subsequent visual impairment may be profound, though likely amenable to treatment.
Jiang pointed out the unclear onset for their case and possible delayed presentation from 34 days of ventilation. While we cannot assume the onset time of Jiang's patient, our patient provides an interesting comparison. Our case describes a male patient who developed significant and painless overnight vision loss. He had gone to bed with only cough as a symptom of COVID infection and awoke to find himself only able to perceive light and gross motion. This patient presented to our local accident and emergency department with this sudden and profound bilateral loss of vision. He required admission due to his inability to self-care.
On examination the patient was found to have significant bilateral corneal oedema. Both eyes were white with no evidence of local infection, inflammation, or ocular surface trauma. There was no epithelial uptake with fluorescein in either eye. Intraocular pressure was within normal limits and symmetrical. No corneal dystrophy could be seen with biomicroscopy. The patient was started on topi...
On examination the patient was found to have significant bilateral corneal oedema. Both eyes were white with no evidence of local infection, inflammation, or ocular surface trauma. There was no epithelial uptake with fluorescein in either eye. Intraocular pressure was within normal limits and symmetrical. No corneal dystrophy could be seen with biomicroscopy. The patient was started on topical Predforte drops which were administered 2 hourly to both eye. He was also given topical lubrication in the form of celluvisc 0.5% four times a day to both eyes. Notably, viral eye swabs taken from the conjunctival sac were positive for COVID and negative for HSV and VZV. Viral eye swabs as a diagnostic tool for aetiology of ocular pathology is of unknown specificity, though has been widely suggested in the literature (1).
This gentleman was rather comorbid with, notably, diabetes, hypertension, obesity and stable sarcoidosis. He had no ophthalmic history or family history of note. Though he suffered from polypharmacy, he was not on any medication known to cause corneal decompensation and no significant medication changes had been made within 12 months of his admission. His chest x-ray on admission showed only air space shadowing consistent with COVID pneumonitis. Therefore, there were no other obvious causes of corneal decompensation (2).
Systemically our gentleman was also found at admission to have an acute kidney injury and hypoglycaemia. This was thought to be secondary to his inability to feed himself with his acutely deteriorated eyesight. Hypoglycaemia was treated by the paramedics, but his kidney injury worsened and ultimately, sadly, resulted in death at 72 hours after admission. The patient was reviewed daily and interestingly, as his kidney function continued to deteriorate his corneal oedema began to improve. His vision improved to counting fingers in each eye. As noted by Jiang, this systemic upset is unlikely to be the cause of corneal decompensation which is usually due to a more local insult. Hence the most likely cause and perhaps supported by the positive swab is viral endotheliitis secondary to COVID-19 infection.
Supporting Jiang's case, we, similarly have a case of profound bilateral corneal decompensation for which all differentials for cause had been ruled out and leaving viral endotheliitis secondary to COVID infection the most likely cause. In comparison to Jiang's case, our gentleman shows that acute deterioration is possible, and importantly, this manifestation of disease may occur throughout the range of the severity of COVID pneumonitis. Reassuringly, both patients have shown good initial responses to topical treatment with steroids. The literature continues to grow with profound manifestations of COVID pneumonitis, it remains of utmost importance to be aware of these presentations especially when they may present across the range of COVID severity.
(A note to the editor: we have submitted this letter with the purpose outlined above. If consent from this patient's relatives is required, please let us know. Many thanks for reading this letter.)
1. Kaur P, Sehgal G, Shailpreet, Singh K, Singh B. Evaluation and comparison of conjunctival swab polymerase chain reaction results in SARS-CoV-2 patients with and without ocular manifestations. 2021.
2. Moshirfar M, Murri M, Shah T, Skanchy D, Tuckfield J, Ronquillo Y et al. A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment. 2021.
A supporting case from Dr Evelyn Qian, Lothian describes similar ocular manifestation and positive conjunctival swab PCR relating to severe COVID pneumonitis, in support of our hypothesis of SARS-CoV-2 viral endotheliitis which was previously unknown.
Qian describes a case of acute bilateral corneal oedema in the presence of severe COVID-19. Conjunctival swabs were positive for SARS-CoV-2 by rRT-PCR assay, and negative for HSV and VZV. His ocular condition was treated with topical steroid drops which demonstrated clinical improvement before he passed away from acute kidney injury at 72 hours after admission.
Dear Sir/Madam.
Thanks for your interest in our case report and the literature review on CeAD and spinal manipulation, which is the most important element of patient care.
All clinicians would like to have a positive outcome for their patients using evidence-based practice.
Unfortunately, the patient in this case had a near fatal outcome by a chiropractor practising in a major metropolitan region of China. The chiropractor is a graduate of a traditional Chinese medical university. The patient could only recall heavy massage and possibly using an equipment (activator? we did not put in the paper because of the uncertainty).
The side effect with this mode of chiropractor treatment is extremely rare as what we have reviewed. This mode of treatment can certainly be the risk factors for the outcome (we ruled out most of the other risk factors presented in our case). We are sharing this case purely for education purpose without the intention of criticising any individual and the chiropractor profession. We did not want to see any more similar cases with an almost fatal outcome. We do appreciate that the whole profession of chiropractors constantly reviews their practice to ensure the delivery of evidence-based practice for treatment effectiveness of various aches and pain (shoulder girdle and neck pain in our case), which all health professionals should practice routinely.
Hope the response helps to clarify the queries.
Dr Daniel Xu
MBBS, PhD, FRACGP
Academic Coordinators, General Practice Research & International Health
Curtin Medical School
The First Affiliated Hospital, Sun Yat-Sen University
CCRE, School of Public Health
Location Building 408, Level 3, Room 3516
Postal Address |GPO Box U1987, Perth, Western Australia, 6845 | AUSTRALIA
Tel | +61 (0)8 9266 1740
Mobile | +61 (0)415288896
Email |daniel.xu@curtin.edu.au
Paradoxical reactions in neurotuberculosis – what is the optimal management?
Sindgikar et al. report a severe paradoxical reaction in a 15-year-old HIV-uninfected patient with stage III tuberculous meningitis, during her fifth month of treatment. After improving with re-initiation of corticosteroids, the paradoxical reaction worsened after the prednisolone was weaned over 8 weeks. The patient continued 4 months of corticosteroids in addition to 13 months anti-TB treatment (ATT) with significant morbidity at one year follow up, including permanent disability.
Whilst corticosteroids are the mainstay of treatment for paradoxical reactions, their effectiveness for this difficult-to-treat complication has not been assessed in randomised controlled trials (RCT)(1). TNF-alpha is a key cytokine implicated in the exaggerated inflammatory response underlying paradoxical reactions (2,3). We have used infliximab, a monoclonal antibody targeting TNF-alpha, in the management of severe paradoxical reactions in paediatric central nervous system TB with positive outcomes (4,5). Anti-TNFα monoclonal antibodies, including infliximab, have also been used with encouraging results in adults for this indication (6,7). Thalidomide, another anti-TNF-alpha therapy was evaluated in an RCT of children with stage II and III tuberculous meningitis (8), however, this trial was ceased early due to increased deaths and adverse outcomes with a thalidomide dose of 24 mg/kg/day. A subsequent case series of 38 children treated with low-dose thalidomide (3-5 mg/kg) with life-th...
Whilst corticosteroids are the mainstay of treatment for paradoxical reactions, their effectiveness for this difficult-to-treat complication has not been assessed in randomised controlled trials (RCT)(1). TNF-alpha is a key cytokine implicated in the exaggerated inflammatory response underlying paradoxical reactions (2,3). We have used infliximab, a monoclonal antibody targeting TNF-alpha, in the management of severe paradoxical reactions in paediatric central nervous system TB with positive outcomes (4,5). Anti-TNFα monoclonal antibodies, including infliximab, have also been used with encouraging results in adults for this indication (6,7). Thalidomide, another anti-TNF-alpha therapy was evaluated in an RCT of children with stage II and III tuberculous meningitis (8), however, this trial was ceased early due to increased deaths and adverse outcomes with a thalidomide dose of 24 mg/kg/day. A subsequent case series of 38 children treated with low-dose thalidomide (3-5 mg/kg) with life-threatening TB mass lesions despite drug-susceptible anti-TB treatment and corticosteroids reported encouraging results (9), further supporting the role of anti-TNF-alpha agents in the treatment of paradoxical tuberculous reactions.
Future carefully designed trials are needed to evaluate the effectiveness of anti-TNF agents for paradoxical reactions. They could also establish risk factors and biomarkers to help determine which patients are likely to develop paradoxical reactions, and which would potentially benefit from anti-TNF-alpha therapy shortly after ATT initiation to prevent the long-term morbidity associated with this potentially devastating complication.
1. Marais S, Van Toorn R, Chow FC, et al. Management of intracranial tuberculous mass lesions: how long should we treat for? Wellcome Open Res. 2019;4:158.
2. Tsenova L, Sokol K, Freedman VH, Kaplan G. A combination of thalidomide plus antibiotics protects rabbits from mycobacterial meningitis-associated death. J Infect Dis. 1998;177(6):1563-1572.
3. Donald PR, Schoeman JF, Beyers N, et al. Concentrations of interferon gamma, tumor necrosis factor alpha, and interleukin-1 beta in the cerebrospinal fluid of children treated for tuberculous meningitis. Clin Infect Dis. 1995;21(4):924-929.
4. Abo YN, Curtis N, Butters C, Rozen TH, Marais BJ, Gwee A. Successful Treatment of a Severe Vision-Threatening Paradoxical Tuberculous Reaction with Infliximab: First Pediatric Use. Pediatr Infect Dis J. 2020;39(4):e42-e45.
5. Abo YN, Curtis N, Osowicki J, et al. Iin press). Infliximab for paradoxical reactions in pediatric central nervous system tuberculosis. Journal of the Pediatric Infectious Diseases Societ. 2021.
6. Santin M, Escrich C, Majòs C, Llaberia M, Grijota MD, Grau I. Tumor necrosis factor antagonists for paradoxical inflammatory reactions in the central nervous system tuberculosis: Case report and review. Medicine. 2020;99(43):e22626-e22626.
7. Marais BJ, Cheong E, Fernando S, et al. Use of Infliximab to Treat Paradoxical Tuberculous Meningitis Reactions. Open Forum Infect Dis. 2021;8(1):ofaa604.
8. Schoeman JF, Springer P, van Rensburg AJ, et al. Adjunctive thalidomide therapy for childhood tuberculous meningitis: results of a randomized study. J Child Neurol. 2004;19(4):250-257.
9. van Toorn R, Solomons RS, Seddon JA, Schoeman JF. Thalidomide Use for Complicated Central Nervous System Tuberculosis in Children: Insights From an Observational Cohort. Clin Infect Dis. 2021;72(5):e136-e145.
Letter to the Editor regarding "Obstetric rectal laceration in the absence of an anal sphincter injury"
We read, with interest, "Obstetric rectal laceration in the absence of an anal sphincter injury" by Awomolo et al in your journal [1]. We commend the authors on reviewing this rare injury.
We appreciate your detailed case report and were pleased to read that your patient recovered well from her injury. We agree that these rare injuries require careful repair with experience, good surgical technique and detailed knowledge of perineal anatomy. Your extensive literature review found other similar cases, many of which we included in our most comprehensive case series [2], but we were surprised to see that our case series was not included in your paper. Although rectal buttonhole tears are rare they are now defined in many National guidelines in the world [3]. What our paper also adds is a standardised approach for repair of isolated rectal tears and follow up, with a video demonstration on a porcine specimen. In addition, we have highlighted that rectal button hole tears can occur concomitantly with a third or 4th degree tear when there is intact bridge of anorectal mucosa between the two injuries.
We appreciated the insufficiencies in training regarding classification, diagnosis and repair of obstetric anal sphincter injuries (OASIS) over 20 years ago and began the first hands-on course in 2000 (www.perineum.net). We have also introduced the Prevention and Repair Of perineal Trauma Episiotomy through Co...
We appreciated the insufficiencies in training regarding classification, diagnosis and repair of obstetric anal sphincter injuries (OASIS) over 20 years ago and began the first hands-on course in 2000 (www.perineum.net). We have also introduced the Prevention and Repair Of perineal Trauma Episiotomy through Coordinated Training (PROTECT) course certified by the International Urogynecological Association (www.IUGA.org). We are currently appraising OASIS diagnosis and repair training for doctors and midwives in the UK, through online surveys and evaluation of training courses. We hope to publish our data in the coming year, making recommendations about content and frequency of training.
Joanna C. Roper MRCOG
Ranee Thakar MD FRCOG
Abdul H. Sultan MD FRCOG
1. Awomolo A, Hardman D, Louis-Jacques A (2021) Obstetric rectal laceration in the absence of an anal sphincter injury. BMJ Case Rep 14:e243296. https://doi.org/10.1136/bcr-2021-243296
2. Roper JC, Thakar R, Sultan AH (2020) Isolated rectal buttonhole tears in obstetrics: case series and review of the literature. Int Urogynecol J. https://doi.org/10.1007/s00192-020-04502-2
3. Roper JC, Amber N, Wan OYK, et al (2020) Review of available national guidelines for obstetric anal sphincter injury. Int Urogynecol J 31:2247–2259. https://doi.org/10.1007/s00192-020-04464-5
Misrepresentation of chiropractic in a case of carotid artery dissection
We read with interest the case report by Yap et al regarding "A near-fatal consequence of chiropractor massage: massive stroke from carotid arterial dissection and vertebral arterial oedema,"(1) which describes a 35-year-old man with a massive stroke purportedly caused by massage. Cerebrovascular disease is an invested topic for manual therapists, considering such providers are responsible for recognizing emergent signs/symptoms of a cervical artery dissection (CeAD) and referring accordingly,(2) however, we are concerned about appropriate and accurate reporting of details of the case including several inconsistencies and evident biases.
We believe this case report likely misclassifies the treating provider as a chiropractor. The report does not specify the credentials of the person providing massage during the business trip. As pointed out by the authors, there is limited regulation and licensing of chiropractic in China.(3) Furthermore, spinal manipulation is by far the most common treatment intervention provided by chiropractors(4) but the authors did not mention its use in the case presentation.
We request the authors clarify the credentials of the massage provider, and elaborate on treatment interventions, specifically if cervical spinal manipulation was performed. Previous case reports have misrepresented the treating provider as a chiropractor when describing potential adverse events.(5) This practice is spurious and adds to over-reporting of adverse...
We request the authors clarify the credentials of the massage provider, and elaborate on treatment interventions, specifically if cervical spinal manipulation was performed. Previous case reports have misrepresented the treating provider as a chiropractor when describing potential adverse events.(5) This practice is spurious and adds to over-reporting of adverse events incorrectly linked to the chiropractic profession.(5)
The authors also conflate "massage" with "chiropractic manipulation" which are two distinct forms of treatment. Spinal manipulation performed by a chiropractor typically involves a thrust or impulse directed to the spine, while massage does not.(6) While the case presentation states massage was the treatment rendered, the title, the discussion, and learning points all highlight chiropractic cervical spine manipulation—which by definition, is not massage. The authors' literature review included the search term "chiropractic manipulation" which is inappropriate to introduce, as their case pertains to massage.
The authors' discussion references case reports only, missing seminal studies relevant to manipulation and CeAD, and their conclusions regarding "chiropractic massage" being a "fatal practice" is not supported by the literature. A systematic review of several large observational studies including more than 100 million person-years of data did not identify evidence of a causal association between chiropractic spinal manipulation and CeAD.(7) This is supported by a systematic review of 47 prospective trials that did not identify any incidents of CeAD in recipients of spinal manipulation.(8) Further, to our knowledge there is no epidemiologic evidence linking massage and stroke, and only one case report describing a potential relationship.(9)
Protopathic bias, or confounding by indication, have been proposed as explanations for rare instances in which a stroke is preceded by chiropractic spinal manipulation. In both models, neck pain or headache, common prodromal symptoms of CeAD, prompt a patient to seek care from a chiropractor when the dissection is already in progress.(7, 10-14) This hypothesis is supported by case reports describing such patients presenting to chiropractors with evolving CeAD and referring appropriately.(15-18)
The current case is potentially another example of a dissection-in-progress considering the patient sought massage for neck, shoulder girdle, and upper back pain. The details of initial presentation and physical examination (if performed) for this "chiropractor massage" are not reported, which may have led to a different outcome if the case was managed by a qualified/licensed chiropractor.
The authors' report of symptom onset coinciding solely with this "chiropractor massage" is not supported in the literature. We propose alternative explanations to the authors regarding the mechanism and resulting conclusions for the case report. Cervical artery dissections are often spontaneous without a known cause.(19) However, there are hypothesized triggers of CeAD which the authors did not mention and could have played a role in the current case such as airplane travel20 and/or viral infection such as mild case of COVID-19 given the timing of this report.(21,22)
In summary, the authors' conclusions regarding a correlation between chiropractic spinal manipulation and carotid artery dissection and are superseded by higher levels of epidemiologic evidence that has not identified such a causal link. Additionally, the postulated causal relationship between carotid artery dissection and massage exceeds the available data. The patient's stroke could have been precipitated by a spontaneous CeAD and was treated with massage therapy rather than emergency care. This case should not deter health care providers from referring to, or patients from seeking care from, qualified chiropractors.
1. Yap T, Feng L, Xu D, Zhang J. A near-fatal consequence of chiropractor massage: massive stroke from carotid arterial dissection and bilateral vertebral arterial oedema. BMJ Case Rep. 2021 Aug 6;14(8):e243976. doi: 10.1136/bcr-2021-243976. PMID: 34362754; PMCID: PMC8351484.
2. Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med. 2019 Mar;51(2):118-127. doi: 10.1080/07853890.2019.1590627. Epub 2019 Apr 6. PMID: 30889367; PMCID: PMC7857472.
3. World Federation of Chiropractic: Legal Status of Chiropractic by Country. (Accessed August 23, 2021) https://www.wfc.org/website/index.php?option=com_content&view=article&id...
4. Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, French SD. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap. 2017 Nov 22;25:35. doi: 10.1186/s12998-017-0165-8. PMID: 29201346; PMCID: PMC5698931.
5. Wenban AB. Inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' in the peer-reviewed biomedical literature. Chiropr Osteopat. 2006 Aug 22;14:16. doi: 10.1186/1746-1340-14-16. PMID: 16925822; PMCID: PMC1570468.
6. Hurwitz EL. Epidemiology: Spinal manipulation utilization. J Electromyogr Kinesiol. 2012;22(5):648-654. doi:10.1016/j.jelekin.2012.01.006
7. Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. (2016). Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016;8(2):e498.
8. Coulter ID, Crawford C, Vernon H, Hurtwitz L, Khorsan R, et al. Manipulation and mobilization for treating chronic nonspecific neck pain: a systematic review and meta-analysis for an appropriateness panel. Pain Physician 2019;22(2):E55-E70.
9. Birkett W, Pouryahya P, Meyer ADM. Bilateral vertebral artery dissection and cerebellar stroke: a rare complication of massage. N Z Med J. 2020 Apr 3;133(1512):88-92. PMID: 32242183.
10. Cassidy JD, Bronfort G, Hartvigsen J. Should we abandon cervical spine manipulation for mechanical neck pain? No. BMJ. 2012;344:e3680. doi:10.1136/bmj.e3680
11. Hutting N, Kerry R, Coppieters MW, Scholten-Peeters GG. Considerations to improve the safety of cervical spine manual therapy. Musculoskelet Sci Pract. 2018;33:41-45.
12. Perle SM, Jung H, Ham J, Choi H. Letter to the Editor: A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation (Korean J Neurotrauma 2018; 14: 159–163). Korean J Neurotrauma. 2019;15(1):72-73.
13. Murphy DR, Schneider MJ, Perle SM, Bise CG, Timko M, Haas M. Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? No. Chiropr Man Ther. 2016;24(1):43. doi:10.1186/s12998-016-0124-9
14. Bronson MA, Perle SM, Tuchin P. Issues with vertebral artery dissections. Interv Neuroradiol. 2017;23(2):154-155. doi:10.1177/1591019916680111
15. Michaud TC. Uneventful upper cervical manipulation in the presence of a damaged vertebral artery. Journal of Manipulative and Physiological Therapeutics. 2002;25(7):472-483.
16. Tarola G, Phillips RB. Chiropractic response to a spontaneous vertebral artery dissection. Journal of Chiropractic Medicine 2015;14(3):183-190.
17. Futch D, et al. Vertebral artery dissection in evolution found during chiropractic examination. BMJ Case Reports. 2015: bcr2015212568.
18. Mosby JS, Duray SM. Vertebral artery dissection in a patient practicing self-manipulation of the neck. Journal of Chiropractic Medicine. 2011;10(4):283-287.
19. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001 Mar 22;344(12):898-906. doi: 10.1056/NEJM200103223441206. PMID: 11259724.
20. Humaidan H, et al. Airplane stroke syndrome. Journal of Clinical Neuroscience. 2016;29:77-80.
21. Morassi M, et al. Bilateral carotid artery dissection in a SARS-CoV-2 infected patient: causality or coincidence? Journal of Neurology. 2020.;267(10):2812-2814.
22. Gencler OS, Meltem RE, Aydın A. Unilateral common carotid artery dissection in a patient with recent COVID-19: An association or a coincidence? Journal of Clinical Neuroscience. 2021;87: 26-28.
2019 - 2022 (Publication date)


It was another boiling August day and Iowa City's pedestrian mall was filling up for the lunch hour when, within 30 seconds of each other, two people hurried up to a patrolman on duty, concerned about a man down the block.
"It looks like he's about ready to die," the second man told Officer David Schwindt, who was making his way to the scene.
Near the Englert Theatre, Schwindt found a shirtless and groggy young guy hunched over on a bench. It was clear that more than just the heat was taking a toll on him. The man, whom Schwindt addressed by name, told the officer he was just sleeping.
After a couple more questions, Schwindt let him be. He had seen him in this conditionbefore. "When he's sober, he's a super nice guy," Schwindt said, walking away.
For the past eight months, Schwindt has been getting to know many of the people who spend their days on the streets in downtown Iowa City. Some are battling drug and alcohol addictions, some are fighting mental illness, some are homeless and some are prone to erratic behavior. Loud arguments, aggressive panhandling and open drug use are among the problems.
Schwindt is the Iowa City Police Department's downtown foot patrolman, a new beat created in January through the city's partnership with the Iowa City Downtown District aimed at addressing what some call an escalation in troubling behavior in the ped mall area.
Business people fear the behavior is chasing away customers, and city leaders worry that it's harming efforts to transform downtown into a more attractive shopping and entertainment hub. Others, though, have denounced a set of new downtown restrictions going before the city council this summer as a war on the homeless.
Schwindt patrols Tuesdays through Saturdays during daytime business hours, spending much of his shift at the corner of Washington and Dubuque streets. It's at this entrance to the ped mall where he and others say the problems have been largely concentrated this past year.
Before the creation of the new beat, officers patrolled downtown in squad cars as part of a larger coverage area. Schwindt works on foot or bike in the ped mall and surrounding downtown area, including the Northside Marketplace.
After checking on the man on the park bench, Schwindt asked a group hanging out at the corner of Washington and Dubuque to turn down a laptop that was blasting music — a violation of an ordinance prohibiting amplified sound. Schwindt also informed the laptop's owner, Gabriel Mathers, that it was against city code to be seated on this sidewalk.
After he complied, Mathers, who said he was hitchhiking his way back to Oregon and had been sleeping downtown for about a week, said most of the people in the ped mall were, like him, not wanting to cause trouble.
"Most people that I've met down here are pretty good people," Mathers said.
Schwindt opened a pack attached to his police bike and pulled out pair of socks, which he gave to a woman in Mathers' group. Schwindt buys packs of socks, or has them given to him, that he hands out when he notices people need them.
"You can do a lot of bridge building with a pair of fresh, clean socks," Schwindt said.
Around the corner, Schwindt warns a couple of bicyclists that they can't ride through the ped mall. And along Dubuque Street, near Prairie Lights, he asks a man seated on a light pole if he had water and was staying cool.
Schwindt said he rarely gives out tickets and has not had a single incident that's required him to file a use-of-force report this year. Instead, he said he would rather work with people — whether it's connecting them with local resources or simply explaining the sometimes arcane laws specific to downtown — rather than involving them in the criminal justice system. For every ticket he writes, he guesses he gives 99 warnings.
Schwindt also has gotten to know downtown's business owners, making it one of his first tasks this past winter to sit down with each shopkeeper to ask what their concerns are and what the the police department could be doing better.
Police Chief Sam Hargadine said Schwindt has done a good job of building relationships in an area where police often are caught in the middle.
Hargadine said the police department received a $250,000 federal grant that allowed it to fund the downtown beat and one other community officer position for the next three years. The Downtown District, is providing a $10,000 annual contribution, as well.
Karen Kubby, who co-owns Beadology on Washington Street, said the Downtown District's financial support has been a good investment.
Kubby said while some officers who have worked downtown in the past have taken a heavy-handed enforcement approach, Schwindt has been a community builder.
Astrid Bennett, co-owner of the Iowa Artisans Gallery at Washington and Dubuque streets, has been frustrated the past few years about the behavior outside her store, which she said has affected both her customers and staff. She said the addition of a downtown patrolman gives shopkeepers an immediate outlet for assistance.
"I think it's made a big difference having someone right there we can call if there's an incident or any concerns, that we have a pathway we can go if there's something that's worrisome or annoying," Bennett said.
Schwindt sees his role as helping people on both side of the fence. Twice, for instance, people he has gotten to know in the ped mall have asked him for help kicking their synthetic drug addictions.
"I've walked them down to the police department, grabbed a squad car, took them to the hospital and sat with them through the whole intake process," he said.
Schwindt would rather extend a hand, he said, than a ticket.
Reach Josh O'Leary at 887-5415 or joleary@press-citizen.com.


text:
Graciosa (Azoren), een eiland in de Portugese eilandengroep Azoren
 Graciosa (Canarische Eilanden), een eiland in de Spaanse eilandengroep de Canarische Eilanden
 Fort Graciosa, een kort bestaand Portugees fort in Morokko (1489)

redpajama_set_name: RedPajamaWikipedia


THE Oldham Rugby League Heritage Trust will make the tenth presentation of the Heritage Trust Trophy following the Law Cup clash of Oldham and Rochdale Hornets at the Crown Oil Arena on Sunday (kick-off 3pm).
First presented in 2004, the Heritage Trust Trophy is awarded to Oldham's man of the match in the annual pre-season game between the neighbours and fierce derby rivals from opposite sides of the M62.
Previous winners were Ian Watson (2004), Andy Isherwood (2005), James Kirkland (2006), James Coyle (2008), Gary Sykes (2010), Ben Wood (2011), Jamie Dallimore (2013), Josh Crowley (2016) and Scott Leatherbarrow (2017).
Hornets currently hold the Law Cup following a 24-12 win at Bower Fold, Stalybridge in January last year.


One year out, it is a little unclear exactly what local leaders are enforcing, whether the original text added to the Handbook (and presumably still there, unchanged) or the narrower and softer form of the Policy spelled out in the November 13, 2015 First Presidency Letter posted at LDS.org. Or maybe local leaders are just following their own conscience or their own inspiration to deal with particular cases, regardless of what they are told in the Handbook or in a First Presidency letter or in counsel given at this or that regional leadership meeting. It's not an easy time to be a bishop.
Reaction to the redesigned site by the usual online commentators has been quite positive. One might get the impression that the new site is an attempt to walk back the Policy, which has certainly had the opposite effect from creating a "welcoming community" for married gays, unmarried gays, sympathetic relatives of unmarried gays, or just Mormons who think it is wrong to label an entire class of people as apostates and bar their children from membership and ordinances. But the claim that the new site is an attempt to walk back the Policy is never actually made on the new site, and as far as I can tell the Policy is never even mentioned or referenced! How can a comprehensive LDS site about being Mormon and gay not explain, not even reference, the Policy? So again, it is a little unclear what local leaders are actually doing and it is a little unclear what senior LDS leaders are actually thinking. It's still a big mess.
an LDS historian's response: "As a believer, I could not conceive of leadership implementing such an odious policy so clearly antithetical to our core principles."


This mens group digs deep into who God calls men to be. It is challenging yet exciting to learn the things God wants us to do as men. You will find community, accountability, friendship, and the humbling love of God in this group. Join us Tuesday nights in room 204. Dinner will be served at 5:30pm and group starts at 6:00pm.


Security staff at Southampton General Hospital, who are being attacked in the A&E department, will strike for eight days in their dispute over pay rates, sick pay, and safety concerns.
The plight of the 21 security staff, who are being attacked on a regular basis by members of the public either under the influence of drink or drugs, or with mental health problems, has attracted national media attention.
The Unite members are to strike for eight days in April, May, and June, as well as starting an overtime ban on April 5.
Unite said that neither the employer Mitie Security Ltd nor the bosses at the University Hospital Southampton NHS Foundation Trust had made any effort to resolve the dispute since the lack of adequate personal protective equipment (PPE), such as stab vests and safety restraints, was revealed earlier this month.
The security staff voted unanimously for strike action and industrial action short of a strike and will now strike for 24 hours on 5 April, 19 April and 24 May. There will also be a 48 hour stoppage starting on 3 May and a further 72 hour strike on 7 June. All the strikes will start at 00.01.
Unite lead officer for health in the south east Scott Kemp said: "Since the attacks on our members received national media coverage, it has been very disappointing, to say the least, that there has been no approach from either the trust management or Mitie to try and resolve the issue.
"Talks are scheduled for 26 March, under the auspices of the conciliation service Acas, however the security guards are still being left open to attack and injury in the meantime.
"The lack of urgency on Mitie's part to resolve these personal protection issues at the Tremona Road site is a disgrace – that's why our members voted unanimously for eight days of strike action.
"Our members are at the forefront of providing security and a safe environment for staff, patients and visitors – that's why Mitie's management needs to get around the table and negotiate constructively.
"At present, if the security staff are injured at work, and if the resulting investigation finds in their favour, they get two weeks' full pay and then two weeks' half-pay. After that, it is the statutory minimum.
Unite said that the demand for an increase in pay from the current £8.64 an hour reflected the continuing stress of the job. The security staff are seeking £10.50 for security officers and £12.16 for supervisors, with additional payments of 50p per hour on night rates; £1 an hour on Saturday and double time on Sunday.
The link to the petition supporting the security staff can be found via: tinyurl.com/uhs-security.


text:
Alois Franz "Luis" Trenker, född 4 oktober 1892 i Sankt Ulrich in Gröden, Sydtyrolen, Österrike-Ungern (nuvarande Italien), död 12 april 1990 i Bolzano, Sydtyrolen, var en italiensk arkitekt, bergsklättrare, skådespelare, regissör och författare.

Han deltog vid olympiska vinterspelen 1924 i Chamonix i det italienska laget i fyrmansbob, som slutade på sjätte plats.

Referenser

Noter

Externa länkar

Italienska filmregissörer
Italienska bobåkare
Italienska arkitekter under 1900-talet
Italienska skådespelare under 1900-talet
Italienska författare under 1900-talet
Italienska idrottare under 1900-talet
Tävlande vid olympiska vinterspelen 1924 från Italien
Tävlande i bob vid olympiska vinterspelen 1924
Riddare av Förbundsrepubliken Tysklands förtjänstorden
Personer från provinsen Sydtyrolen
Födda 1892
Avlidna 1990
Män