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DSHS Authors: 2019 Research Articles by DSHS Staff
The following list includes peer-reviewed research articles that have been written by staff of the Texas Department of State Health Services in the last five years. For more information about these articles or for a full-text copy, please contact the Medical and Research Library by e-mail at library@dshs.texas.gov by calling (512) 776-7559.
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2019 Articles (in date order with most recent first)
Hyde JR, Sears SC, Buendia JR, Odem SL, Vaaler ML, Mgbere OO. HIV omorbidities: pay attention to hypertension amid changing guidelines - an analysis of Texas Medical Monitoring Project Data. Am J Hypertens. 2019 May 9. pii: hpz078. doi: 10.1093/ajh/hpz078. [Epub ahead of print]
BACKGROUND: Hypertension is a significant risk factor for cardiovascular disease, a leading cause of death among people living with HIV (PLWH). Studies suggest that hypertension prevalence among PLWH is high, yet none assess how the 2017 redefinition of hypertension as ≥130/80 rather than the previous standard of ≥140/90 mmHg will impact prevalence among PLWH. The present study addresses this gap.
METHODS: We examined medical record abstractions of 957 PLWH in Texas from the 2013-2014 Medical Monitoring Project survey. Hypertensive participants were identified by charted diagnosis, antihypertensive medication use, or blood pressure readings ≥140/90 and ≥130/80 mmHg. Associations with sociodemographic and clinical variables were assessed using Rao-Scott chi-square tests, and odds of having hypertension were calculated using multivariable logistic regression models while adjusting for several demographic and HIV-related variables. Results: The 2017 redefinition of hypertension increased prevalence in the sample by 44.3%, from 47.6% to 68.7%. Age group, body mass index, sex, and race remained significantly associated with hypertension (all p<0.01).While prevalence was near equal between males and females at ≥140/90 mmHg (47.4 and 48.5%, respectively), males were 2.36 times more likely to have hypertension than females (95% CI: 1.55-3.60) at ≥130/80 mmHg. Prevalence remained comparable between white (73.3%) and black participants (72.9%).
CONCLUSIONS: This study shows that hypertension prevalence is remarkably high among PLWH and is further increased by updated guidelines. Barriers to hypertension control in the HIV care setting should be identified and addressed to facilitate continued improvement in quality and length of life for PLWH.
Pezzi C, Lee D, Kennedy L, et al. Blood lead levels among resettled refugee children in select US states, 2010-2014. Pediatrics. 2019 May;143(5). pii: e20182591. doi: 10.1542/peds.2018-2591.
BACKGROUND: Elevated blood lead levels (EBLLs; ≥5 µg/dL) are more prevalent among refugee children resettled in the United States than the general US population and contribute to permanent health and neurodevelopmental problems. The Centers for Disease Control and Prevention recommends screening of refugee children aged 6 months to 16 years on arrival in the United States and retesting those aged 6 months to 6 years between 3- and 6-months postarrival.
METHODS: We analyzed EBLL prevalence among refugee children aged 6 months to 16 years who received a domestic refugee medical examination between January 1, 2010 and September 30, 2014. We assessed EBLL prevalence by predeparture examination country and, among children rescreened 3 to 6 months after initial testing, we assessed EBLL changes during follow-up screening.
RESULTS: Twelve sites provided data on 27 284 children representing nearly 25% of refugee children resettling during the time period of this analysis. The EBLL prevalence during initial testing was 19.3%. EBLL was associated with younger age, male sex, and overseas examination country. Among 1121 children from 5 sites with available follow-up test results, EBLL prevalence was 22.7%; higher follow-up BLLs were associated with younger age and predeparture examination country.
CONCLUSIONS: EBLL decreased over the time period of our analysis in this population of refugee children. Refugee children may be exposed to lead before and after resettlement to the United States. Efforts to identify incoming refugee populations at high risk for EBLL can inform prevention efforts both domestically and overseas.
Yeh CY, Wheeler A, Bethea L, et al. Identifying barriers to implementation of emergency epinephrine bills: the Texas experience. J Allergy Clin Immunol Pract. 2019 May 3. pii: S2213-2198(19)30436-2. doi: 10.1016/j.jaip.2019.04.032. [Epub ahead of print]
Gray MS, Judd SE, Sloane R, Snyder DC, Miller PE, Demark-Wahnefried W. Rural-urban differences in health behaviors and outcomes among older, overweight, long-term cancer survivors in the RENEW randomized control trial. Cancer Causes Control. 2019 Apr;30(4):301-309. doi: 10.1007/s10552-019-01141-x.
PURPOSE: Rural cancer survivors (RCS) have poorer health outcomes and face multiple challenges-older age, and limited transportation, education, income, and healthcare access. Yet, RCS are understudied. The Reach-out to ENhancE Wellness(RENEW) trial, a home-based, diet and exercise intervention among 641 breast, prostate, and colorectal cancer survivors addressed many of these challenges.
METHODS: We examined whether rural and urban participants differed in their response to the RENEW intervention (e.g., physical functioning, quality-of-life, intakes of fruits and vegetables (F&V) and saturated fat, body mass index(BMI), physical activity, and adverse events).
RESULTS: Rural versus urban survivors report significantly more favorable mean (SE) changes in physical functioning [- 0.66 (1.47) v - 1.71 (1.00)], physical health [+ 0.14 (0.71) v - 0.74 (0.50)], and fewer adverse events [1.58 (0.08) v 1.64 (0.06)]. Rural versus urban survivors reported smaller increases in F&Vs [+ 1.47 (0.23) v + 1.56(0.16); p = 0.018], and lower percentages achieved goal behavior for endurance exercise and intakes of F&Vs and saturated fat.
CONCLUSIONS: The RENEW intervention reduced declines in physical health and functioning among RCS to a significantly greater extent than for urban cancer survivors. All survivors significantly improved intakes of F&V and saturated fat, and endurance exercise; however, lower percentages of rural versus urban survivors met goal suggesting that more intensive interventions may be needed for RCS.
Hoyt AT, Shumate CJ, Canfield MA, Le M, Ramadhani T, Scheuerle AE. Selected acculturation factors and birth defects in the National Birth Defects Prevention Study, 1997-2011. Birth Defects Res. 2019 Apr 25. doi: 10.1002/bdr2.1494. [Epub ahead of print]
BACKGROUND: Acculturation has been examined with respect to various pregnancy adverse outcomes, including birth defects. Given the mixed and limited findings on the association between nativity and birth defects, we sought to further explore parental nativity and years lived in the U.S. across a range of defects.
METHODS: Data from the National Birth Defects Prevention Study were used for this analysis. Infants with one of 46 major isolated birth defects (30 noncardiac/16 cardiac conditions) and infants without birth defects (controls) born during 1997-2011 were included. We examined parental nativity (foreign-born mothers, fathers, and both parents combined compared to a referent of both U.S.-born parents) and the number of years lived in the U.S. (≤5/6+ years). Descriptive statistics and logistic regression analyses were performed to estimate crude/adjusted odds ratios and 95% confidence intervals.
RESULTS: Compared to U.S.-born mothers, foreign-born mothers tended to be older (25+ years), of Hispanic or Other race/ethnicity and were less likely to have reported drinking, smoking, illicit drug use, or having taken folic acid. In the adjusted analysis, seven findings among both parents reporting a foreign-birth were significant, including an increased association with spina bifida, anotia/microtia, and diaphragmatic hernia (aORs range: 1.3-1.7), and a reduced association with craniosynostosis and gastroschisis (aORs = 0.7). A generally protective effect was observed among foreign-born subjects living in the U.S. ≤5 years.
CONCLUSIONS: We found that nativity was associated with some selected isolated defects, although the direction of effect varied by phenotype and by a number of years residing in the U.S.
Canfield MA, Langlois PH, Rutenberg GW, et al. The association between newborn screening analytes and childhood autism in a Texas Medicaid population, 2010-2012. Am J Med Genet B Neuropsychiatr Genet. 2019 Apr 24. doi: 10.1002/ajmg.b.32728. [Epub ahead of print]
Autism (or autism spectrum disorder [ASD]) is an often disabling childhood neurologic condition of mostly unknown cause. It is commonly diagnosed at 3 or 4 years of age. We explored whether there was an association of any analytes measured by newborn screening tests with a later diagnosis of ASD. A database was compiled of 3-5 year-old patients with any ASD diagnosis in the Texas Medicaid system in 2010-2012. Two controls (without any ASD diagnosis) were matched to each case by infant sex and birth year/month. All study subjects were linked to their 2007-2009 birth and newborn screening laboratory records, including values for 36 analytes or analyte ratios. We examined the association of analytes/ratios with a later diagnosis of ASD. Among 3,258 cases and 6,838 controls, seven analytes (e.g., 17-hydroxyprogesterone, acylcarnitines) were associated with a later ASD diagnosis. In this exploratory study, an ASD diagnosis was associated with 7 of 36 newborn screening analytes/ratios. These findings should be replicated in other population-based datasets.
Hoang TT, Lei Y, Mitchell LE, et al. Maternal genetic markers for risk of celiac disease and their potential association with neural tube defects in offspring. Mol Genet Genomic Med. 2019 Apr 9:e688. doi: 10.1002/mgg3.688. [Epub ahead of print]
BACKGROUND: We examined the association between the maternal genotype for celiac disease-associated variants and risk of neural tube defects (NTDs).
METHODS: We conducted a case-control study, using data from the National Birth Defects Prevention Study. We evaluated 667 cases (women with an offspring with NTD) and 743 controls (women with an offspring without a birth defect). We classified women as having low, intermediate, or high risk of celiac disease based on human leukocyte antigen (HLA) variants. We used logistic regression to assess the relationship between HLA celiac risk group (low, intermediate, high) and risk of NTDs. Fifteen non-HLA variants (identified from genome-wide association studies of celiac disease) were individually evaluated and modeled additively.
RESULTS: There was no association between HLA celiac risk group and NTDs (intermediate vs. low risk: aOR, 1.0; 95% CI, 0.8-1.3; high vs. low risk: aOR, 0.8; 95% CI, 0.5-1.3). Of the fifteen non-HLA variants, we observed five significant associations after accounting for multiple comparisons. Three negative associations were observed with rs10903122, rs13314993, rs13151961 (aOR range: 0.69-0.81), and two positive associations were observed with rs13003464 and rs11221332 (aOR range: 1.27-1.73).
CONCLUSION: If confirmed, our results suggest that the maternal variants related to celiac disease may be involved in the risk of NTDs.
Benjamin RH, Littlejohn S, Canfield MA, Ethen MK, Hua F, Mitchell LE. Interpregnancy change in body mass index and infant outcomes in Texas: a population-based study. BMC Pregnancy Childbirth. 2019 Apr 5;19(1):119. doi: 10.1186/s12884-019-2265-z.
BACKGROUND: Maternal prepregnancy body mass index (BMI) is associated with several infant outcomes, but it is unclear whether these associations reflect causal relationships. We conducted a study of interpregnancy change in BMI (IPC-BMI) to improve understanding of the associations between BMI and large for gestational age (LGA), small for gestational age (SGA), and preterm birth (PTB).
METHODS: Birth certificate data from 2481 linked sibling pairs (Texas, 2005-2012) were used to estimate IPC-BMI and evaluate its association with LGA, SGA, and PTB in the younger sibling of the pair. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) using data from the full sample and within strata defined by prepregnancy BMI for the older sibling.
RESULTS: On average, women gained 1.1 BMI units between pregnancies. In the full sample, interpregnancy BMI decreases were associated with reduced odds of LGA and increased odds of SGA and PTB (IPC-BMI < -1 versus 0 to < 1: LGA aOR 0.7, 95% CI 0.4, 1.1; SGA aOR 1.6, 95% CI 1.0, 2.7; PTB aOR 1.9, 95% CI 1.3, 2.8). In stratified analyses, similar associations were observed in some, but not all, strata. Findings for interpregnancy BMI increases were less consistent, with little evidence for associations between these outcomes and the most extreme IPC-BMI increases.
CONCLUSIONS: There is growing evidence that interpregnancy BMI decreases are associated with LGA, SGA, and PTB. However, taken as a whole, the literature provides insufficient evidence to establish causal links between maternal BMI and these outcomes.
Sheth KR, Kovar E, White JT, et al. Hypospadias risk is increased with maternal residential exposure to hormonally active hazardous air pollutants. Birth Defects Res. 2019 Apr 15;111(7):345-352. doi: 10.1002/bdr2.1461.
BACKGROUND: With the increasing birth prevalence of hypospadias, there is growing concern for pollutant exposure interfering with normal penile development. We assess the association between hypospadias and hormonally active hazardous air pollutants (HAHAPs) through a nationwide database of hazardous air pollutants and the Texas Birth Defects Registry (TBDR).
METHODS: Using the TBDR, we identified 8,981 nonsyndromic isolated hypospadias cases from 1999 to 2008. Birth certificate controls were matched for birth year at a 10:1 ratio to cases. Estimated HAHAP concentrations from the 2005 U.S. EPA National-Scale Air Toxics Assessment were used to assign exposure based on maternal residence at birth. Exposure levels were categorized as quintiles based on the distribution in controls. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for each increasing exposure category of selected HAHAPs.
RESULTS: Of the 10 HAHAPs studied, seven were significantly associated with hypospadias risk. The HAHAP that was most strongly associated with hypospadias was phenol, which was associated with risk in all groups except the high exposure group. Cumulative HAHAP exposure demonstrated a modest increase in hypospadias risk (OR 1.15, 95% CI: 1.07-1.24, p < 0.001) in the medium and medium-high quintiles.
CONCLUSIONS: While maternal exposure to some HAHAPs was significantly associated with the risk of hypospadias in male offspring, the effects were modest, and no dose-response effects were observed. Future work should employ biomarkers of exposure to better delineate the relationship.
Spector LG, Brown MB, Wantman E, et al. Association of In Vitro Fertilization With Childhood Cancer in the United States. JAMA Pediatr. 2019 Apr 1:e190392. doi: 10.1001/jamapediatrics.2019.0392. [Epub ahead of print]
IMPORTANCE: In vitro fertilization (IVF) is associated with birth defects and imprinting disorders. Because these conditions are associated with an increased risk of childhood cancer, many of which originate in utero, descriptions of cancers among children conceived via IVF are imperative.
OBJECTIVE: To compare the incidence of childhood cancers among children conceived in vitro with those conceived naturally.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective, population-based cohort study linking cycles reported to the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System from January 1, 2004, to December 31, 2012, that resulted in live births from September 1, 2004, to December 31, 2013, to the birth and cancer registries of 14 states, comprising 66% of United States births and 75% of IVF-conceived births, with follow-up from September 1, 2004, to December 31, 2014. The study included 275 686 children conceived via IVF and a cohort of 2 266 847 children, in which 10 births were randomly selected for each IVF birth. Statistical analysis was performed from April 1, 2017, to October 1, 2018.
EXPOSURE: In vitro fertilization.
MAIN OUTCOMES AND MEASURES: Cancer diagnosed in the first decade of life.
RESULTS: A total of 321 cancers were detected among the children conceived via IVF (49.1% girls and 50.9% boys; mean [SD] age, 4.6 [2.5] years for singleton births and 5.9 [2.4] years for multiple births), and a total of 2042 cancers were detected among the children not conceived via IVF (49.2% girls and 50.8% boys; mean [SD] age, 6.1 [2.6] years for singleton births and 4.7 [2.6] years for multiple births). The overall cancer rate (per 1 000 000 person-years) was 251.9 for the IVF group and 192.7 for the non-IVF group (hazard ratio, 1.17; 95% CI, 1.00-1.36). The rate of hepatic tumors was higher among the IVF group than the non-IVF group (hepatic tumor rate: 18.1 vs 5.7; hazard ratio, 2.46; 95% CI, 1.29-4.70); the rates of other cancers did not differ between the 2 groups. There were no associations with specific IVF treatment modalities or indication for IVF.
CONCLUSIONS AND RELEVANCE: This study found a small association of IVF with overall cancers of early childhood, but it did observe an increased rate of embryonal cancers, particularly hepatic tumors, that could not be attributed to IVF rather than to underlying infertility. Continued follow-up for cancer occurrence among children conceived via IVF is warranted.
Sears S, Buendia JR, Odem S, et al. Metabolic syndrome among people living with HIV receiving medical care in southern United States: prevalence and risk factors. AIDS Behav. 2019 Mar 30. doi: 10.1007/s10461-019-02487-8. [Epub ahead of print]
Using representative data among 1861 in care people living with HIV (PLWH) in four southern states (Texas, Mississippi, Florida, and Georgia) from the 2013-2014 Medical Monitoring Project (MMP) survey, we estimated the prevalence and odds of metabolic syndrome (MetS) among various demographic and HIV related risk factors. Overall MetS prevalence was 34%, with our participants being mostly black (55%), male (72%), ≥ 50 years old (46%), and overweight or obese (60%) with undetectable viral loads (≤ 200 copies/ml, 69%), and were currently taking antiretroviral medication (98%). Compared to those who were ≥ 60 years, 18-39 year olds had a 79% (95% CI 0.13-0.33) lower odds of having MetS. Women were 2.24 times more likely to have MetS than men (95% CI 1.69-2.97). Age and sex were significant predictors of MetS. Since MetS is a combination of chronic disease risk factors, regular screening for MetS risk factors among aging PLWH is crucial.
Ryan MA, Olshan AF, Canfield MA, et al. Sociodemographic, health behavioral, and clinical risk factors for anotia/microtia in a population-based case-control study. Int J Pediatr Otorhinolaryngol. 2019 Mar 23;122:18-26. doi: 10.1016/j.ijporl.2019.03.026. [Epub ahead of print]
OBJECTIVE: Anotia and microtia are congenital malformations of the external ear with few known risk factors. We conducted a comprehensive assessment of a wide range of potential risk factors using data from the National Birth Defects Prevention Study (NBDPS), a population-based case-control study of non-chromosomal structural birth defects in the United States.
METHODS: Mothers of 699 infants with anotia or microtia (cases) and 11,797 non-malformed infants (controls) delivered between 1997 and 2011 were interviewed to obtain information about sociodemographic, health behavioral, and clinical characteristics. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated with logistic regression.
RESULTS: Infants with anotia/microtia were more likely to be male (aOR, 1.29; 95% CI, 1.10-1.50) and from a multifetal pregnancy (aOR, 1.68; 95% CI, 1.16-2.42). Cases were also more likely to have parents of Hispanic ethnicity (maternal aOR, 3.19; 95% CI, 2.61-3.91; paternal aOR, 2.11; 95% CI, 1.54-2.88), and parents born outside the United States (maternal aOR, 1.29; 95% CI, 1.06-1.57; paternal aOR, 1.92; 95% CI, 1.53-2.41). Maternal health conditions associated with increased odds of anotia/microtia included obesity (aOR, 1.31; 95% CI, 1.06-1.61) and pre-pregnancy diabetes (type I aOR, 9.89; 95% CI, 5.46-17.92; type II aOR, 4.70; 95% CI, 2.56-8.63). Reduced odds were observed for black mothers (aOR, 0.57; 95% CI, 0.38-0.85) and mothers reporting daily intake of folic acid-containing supplements (aOR, 0.59; 95% CI, 0.46-0.76).
CONCLUSION: We identified several risk factors for anotia/microtia, some which have been previously reported (e.g., diabetes) and others which we investigate for perhaps the first time (e.g., binge drinking) that warrant further investigation. Our findings point to some potentially modifiable risk factors and provide further leads toward understanding the etiology of anotia/microtia.
Kirby RS1, Mai CT2, Wingate MS3, et al. Prevalence of selected birth defects by maternal nativity status, United States, 1999-2007. Birth Defects Res. 2019 Mar 28. doi: 10.1002/bdr2.1489. [Epub ahead of print]
OBJECTIVES: We investigated differences in prevalence of major birth defects by maternal nativity within racial/ethnic groups for 27 major birth defects.
METHODS: Data from 11 population-based birth defects surveillance systems in the United States including almost 13 million live births (approximately a third of U.S. births) during 1999-2007 were pooled. We calculated prevalence estimates for each birth defect for five racial/ethnic groups. Using Poisson regression, crude and adjusted prevalence ratios (aPRs) were also calculated using births to US-born mothers as the referent group in each racial/ethnic group.
RESULTS: Approximately 20% of case mothers and 26% of all mothers were foreign-born. Elevated aPRs for infants with foreign-born mothers were found for spina bifida and trisomy 13, 18, and 21, while lower prevalence patterns were found for pyloric stenosis, gastroschisis, and hypospadias.
CONCLUSIONS: This study demonstrates that birth defects prevalence varies by nativity within race/ethnic groups, with elevated prevalence ratios for some specific conditions and lower prevalence for others. More detailed analyses focusing on a broader range of maternal behaviors and characteristics are required to fully understand the implications of our findings.
Abara WE, Trujillo L, Broz D, et al. Age-related differences in past or present HCV infection among people who inject drugs - national HIV behavioral surveillance, eight U.S Cities, 2015. J Infect Dis. 2019 Mar 27. pii: jiz142. doi: 10.1093/infdis/jiz142. [Epub ahead of print]
INTRODUCTION: Historically, older people who inject drugs (PWID) have had the highest hepatitis C burden, however, young PWID account for recent increases in HCV infection. We assessed factors associated with past or present HCV infection (HCV antibody-positive) among young (≤35 years) and older PWID (>35 years).
METHODS: Using Poisson regression, we calculated adjusted prevalence ratios (aPR) to examine socio-demographic and past 12-month injection risk behaviors associated with HCV infection.
RESULTS: Of 4,094 PWID, 55.2% were HCV antibody-positive (anti-HCV). Among young PWID, anti-HCV prevalence was 42.1% and associated with ≤high school diploma/GED (aPR=1.17, 95%CI=1.03-1.32), receptive syringe sharing (aPR=1.37, 95%CI=1.21-1.56), sharing injection equipment (aPR=1.16, 95%CI=1.01-1.35), arrest history (aPR=1.14, 95%CI=1.02-1.29), and injecting speedball (aPR=1.37, 95%CI=1.16-1.61). Among older PWID, anti-HCV prevalence was 62.2% and associated with ≤high school diploma/GED (aPR= 1.08, 95%CI=1.02-1.15), sharing injection equipment (aPR=1.08, 95% CI=1.02-1.15), high injection frequency (aPR=1.16, 95%CI=1.01-1.34), and injecting speedball (aPR=1.09, 95%CI=1.01-1.16).
CONCLUSION: Anti-HCV positivity prevalence is high and associated with risky injection practices. Almost half of young PWID were anti-HCV positive. Improving access to direct-acting antiviral treatment, syringe service programs, and medication-assisted therapy are critical to reducing HCV transmission risk and infection burden, particularly among young PWID who are more likely to be newly infected.
White JT, Kovar E, Chambers TM, et al. Hypospadias risk from maternal residential exposure to heavy metal hazardous air pollutants. Int J Environ Res Public Health. 2019 Mar 15;16(6). pii: E930. doi: 10.3390/ijerph16060930.
Objective: Investigate whether residential prenatal exposure to heavy metal hazardous air pollutants (HMHAPs) is associated with an increased risk of hypospadias. Methods: Data on non-syndromic hypospadias cases (n = 8981) and control patients delivered in Texas were obtained from the Texas Birth Defects Registry and matched 1:10 by birth year. Average exposure concentrations of HMHAPs were obtained from the 2005 U.S. Environmental Protection Agency National-Scale Air Toxics Assessment and categorized into quintiles. Odds ratios and 95% confidence intervals were estimated. STROBE reporting guidelines were followed. Results: We observed associations between hypospadias and prenatal HMHAP exposure. Manganese demonstrated significant increased risk of hypospadias at the medium, medium-high and high exposure quintiles; lead in the medium-high and high exposure quintiles. Cadmium, mercury and nickel demonstrated a significant inverted "U-shaped" association for exposures with significant associations in the medium and medium-high quintiles but not in the medium-low and high quintiles. Arsenic and chromium demonstrated a significant bivalent association for risk of hypospadias in a lower quintile as well as a higher quintile with non-significant intermediate quintiles. Conclusions: Using data from one of the world's largest active surveillance birth defects registries, we identified significant associations between hypospadias and HMHAP exposures. These results should be used in counseling for maternal demographic risk factors as well as avoidance of heavy metals and their sources.
Lindsey NP, Porse CC, Potts E, et al. Postnatally acquired Zika virus disease among children, United States, 2016-2017. Clin Infect Dis. 2019 Mar 11. pii: ciz195. doi: 10.1093/cid/ciz195. [Epub ahead of print]
BACKGROUND: The clinical findings among children with postnatally acquired Zika virus disease are not well characterized. We describe and compare clinical signs and symptoms for children aged <18 years.
METHODS: Zika virus disease cases were included if they met the national surveillance case definition, had illness onset in 2016 or 2017, resided in a participating state, and were reported to CDC. Pediatric cases were aged <18 years; congenital and perinatal infections were excluded. Pediatric cases were matched to adult cases (18‒49 years). Clinical information was compared between younger and older pediatric cases and between children and adults.
RESULTS: A total of 141 pediatric Zika virus disease cases were identified; none experienced neurologic disease. Overall, 28 (20%) were treated in an emergency department, 1 (<1%) was hospitalized; none died. Of the four primary clinical signs and symptoms associated with Zika virus disease, 133 (94%) children had rash, 104 (74%) fever, 67 (48%) arthralgia, and 51 (36%) conjunctivitis. Fever, arthralgia, and myalgia were more common in older children (12‒17 years) than younger children (1‒11 years). Arthralgia, arthritis, edema, and myalgia were more common in adults compared to children.
CONCLUSIONS: This report supports previous findings that Zika virus disease is generally mild in children. The most common symptoms are similar to other childhood infections, and clinical findings and outcomes are similar to those in adults. Healthcare providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia, or conjunctivitis, who reside in or have traveled to an area where Zika virus transmission is occurring.
Kapoor R, Kancherla V, Cao Y, et al. Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: A multistate, population-based retrospective study, 1999-2010. Birth Defects Res. 2019 Feb 1; 111(3):159-169. doi: 10.1002/bdr2.1439.
BACKGROUND: Antecedents for infantile hypertrophic pyloric stenosis (IHPS) vary across studies; therefore, we conducted a multistate, population-based retrospective study of the prevalence and descriptive epidemiology of IHPS in the United States (US).
METHODS: Data for IHPS cases (n = 29,554) delivered from 1999-2010 and enumerated from 11 US population-based birth defect surveillance programs, along with data for live births (n = 14,707,418) delivered within the same birth period and jurisdictions, were analyzed using Poisson regression to estimate IHPS prevalence per 10,000 live births. Additional data on deliveries from 1999-2005 from seven of these programs were analyzed using multivariable logistic regression to estimate adjusted prevalence ratios (aPR)s and 95% confidence intervals (CI)s for selected infant and parental characteristics.
RESULTS: Overall, IHPS prevalence from 1999-2010 was 20.09 (95% CI = 19.87, 20.32) per 10,000 live births, with statistically significant increases from 2003-2006 and decreases from 2007-2010. Compared to their respective referents, aPRs were higher in magnitude for males, preterm births, and multiple births, but lower for birth weights <2,500 g. The aPRs for all cases increased with decreasing parental age, maternal education, and maternal parity, but decreased for parental race/ethnicity other than non-Hispanic White. Estimates restricted to isolated cases or stratified by infant sex were similar to those for all cases.
CONCLUSIONS: This study covers one of the largest samples and longest temporal period examined for IHPS in the US. Similar to findings reported in Europe, estimates suggest that IHPS prevalence has decreased recently in the US. Additional analyses supported associations with several infant and parental characteristics.
Benjamin RH, Mitchell LE, Canfield MA, et al. Fish consumption prior to pregnancy and pregnancy outcomes in the National Birth Defects Prevention Study, 1997-2011. Public Health Nutr. 2019 Feb;22(2):336-343. doi: 10.1017/S1368980018002641.
OBJECTIVE: To evaluate the relationships between maternal fish consumption and pregnancy outcomes in a large, population-based sample of women in the USA.
DESIGN: We collected average fish consumption prior to pregnancy using a modified version of the semi-quantitative Willett FFQ. We estimated adjusted OR (aOR) and 95 % CI for associations between different levels of fish consumption and preterm birth (<37 weeks), early preterm birth (<32 and <35 weeks) and small-for-gestational-age infants (SGA; <10th percentile).
SETTING: The National Birth Defects Prevention Study (NBDPS).
SUBJECTS: Control mother-infant pairs with estimated delivery dates between 1997 and 2011 (n 10 919).
RESULTS: No significant associations were observed between fish consumption and preterm birth or early preterm birth (aOR = 0·7-1·0 and 0·7-0·9, respectively). The odds of having an SGA infant were elevated (aOR = 2·1; 95 % CI 1·2, 3·4) among women with daily fish consumption compared with women consuming fish less than once per month. No associations were observed between other levels of fish consumption and SGA (aOR = 0·8-1·0).
CONCLUSIONS: High intake of fish was associated with twofold higher odds of having an SGA infant, while moderate fish consumption prior to pregnancy was not associated with preterm or SGA. Our study, like many other studies in this area, lacked information regarding preparation methods and the specific types of fish consumed. Future studies should incorporate information on nutrient and contaminant contents, preparation methods and biomarkers to assess these relationships.
Endres BT1, Begum K1, Sun H2, et al. Epidemic Clostridioides difficile ribotype 027 lineages: comparisons of Texas versus worldwide strains. Open Forum Infect Dis. 2019 Feb 9;6(2):ofz013. doi: 10.1093/ofid/ofz013.
BACKGROUND: The epidemic Clostridioides difficile ribotype 027 strain resulted from the dissemination of 2 separate fluoroquinolone-resistant lineages: FQR1 and FQR2. Both lineages were reported to originate in North America; however, confirmatory large-scale investigations of C difficile ribotype 027 epidemiology using whole genome sequencing has not been undertaken in the United States.
METHODS: Whole genome sequencing and single-nucleotide polymorphism (SNP) analysis was performed on 76 clinical ribotype 027 isolates obtained from hospitalized patients in Texas with C difficile infection and compared with 32 previously sequenced worldwide strains. Maximum-likelihood phylogeny based on a set of core genome SNPs was used to construct phylogenetic trees investigating strain macro- and microevolution. Bayesian phylogenetic and phylogeographic analyses were used to incorporate temporal and geographic variables with the SNP strain analysis.
RESULTS: Whole genome sequence analysis identified 2841 SNPs including 900 nonsynonymous mutations, 1404 synonymous substitutions, and 537 intergenic changes. Phylogenetic analysis separated the strains into 2 prominent groups, which grossly differed by 28 SNPs: the FQR1 and FQR2 lineages. Five isolates were identified as pre-epidemic strains. Phylogeny demonstrated unique clustering and resistance genes in Texas strains indicating that spatiotemporal bias has defined the microevolution of ribotype 027 genetics.
CONCLUSIONS: Clostridioides difficile ribotype 027 lineages emerged earlier than previously reported, coinciding with increased use of fluoroquinolones. Both FQR1 and FQR2 ribotype 027 epidemic lineages are present in Texas, but they have evolved geographically to represent region-specific public health threats.
Hoang TT, Lei Y, Mitchell LE, et al. Maternal lactase polymorphism (rs4988235) is associated with neural tube defects in offspring in the National Birth Defects Prevention Study. J Nutr. 2019 Jan 24. doi: 10.1093/jn/nxy246. [Epub ahead of print]
BACKGROUND: The risk of neural tube defect (NTD)-affected pregnancies is reduced with adequate folic acid intake during early pregnancy. However, NTDs have been observed among offspring of women with adequate folic acid intake. Some of these women are possibly not absorbing enough folic acid. Because lactase deficiency can lead to poor nutrient absorption, we hypothesized that lactase-deficient women will be at increased risk of having offspring with NTDs.
OBJECTIVE: We examined the association between maternal rs4988235 (a lactase deficiency genetic marker) and NTDs in offspring.
METHODS: We conducted a case-control study using data from the National Birth Defects Prevention Study, United States, 1997-2009, restricting to non-Hispanic white (NHW) and Hispanic women. Cases were women with an offspring with an NTD (n = 378 NHW, 207 Hispanic), and controls were women with an offspring without a birth defect (n = 461 NHW, 165 Hispanic). Analyses were conducted separately by race/ethnicity, using logistic regression. Women with the CC genotype were categorized as being lactase deficient. To assess potential effect modification, analyses were stratified by lactose intake, folic acid supplementation, dietary folate, and diet quality.
RESULTS: Among NHW women, the odds of being lactase deficient were greater among cases compared with controls (OR: 1.37; 95% CI: 1.02, 1.82). Among Hispanic women, the odds of being lactase deficient were significantly lower among cases compared with controls (OR: 0.50, 95% CI: 0.33, 0.77). The association differed when stratified by lactose intake in NHW women (higher odds among women who consumed ≥12 g lactose/1000 kcal) and by dietary folate in Hispanic women (opposite direction of associations). The association did not differ when stratified by folic acid supplementation or diet quality.
CONCLUSIONS: Our findings suggest that maternal lactase deficiency is associated with NTDs in offspring. However, we observed opposite directions of effect by race/ethnicity that could not be definitively explained.
Shewale JB, Ganduglia Cazaban CM, Waller DK, Mitchell LE, Langlois PH, Agopian AJ. Microcephaly inpatient hospitalization and potential Zika outbreak in Texas: A cost and predicted economic burden analysis. Travel Med Infect Dis. 2019 Jan 9. pii: S1477-8939(19)30001-8. doi: 10.1016/j.tmaid.2019.01.001. [Epub ahead of print]
OBJECTIVE: Estimate inpatient hospitalization costs for patients with microcephaly, and predict cost increases due to a potential Zika virus outbreak.
METHODS: We identified Texas-wide inpatient hospitalization discharge records (2008-2015), for newborns and non-newborns with microcephaly. We estimated the cost of each hospitalization by applying cost-to-charge ratios on the actual hospitalization charge. For comparison, newborn visits for patients without microcephaly were also identified, and hospital costs were compared between patients with and without microcephaly. We estimated costs for microcephaly during the first year of life following a Zika outbreak (possible 1-50% increase in birth prevalence) in Texas.
RESULTS: There were 8005 microcephaly hospitalizations ($203,899,042; total cost). The median admission cost for newborns with microcephaly (N = 1393) was higher compared to those without microcephaly ($6751 vs $725, p < 0.001). Microcephaly hospitalizations of newborns had a lower median cost compared to non-newborns ($6751 vs $9754, p < 0.001). Based on these observed hospitalization costs, we estimated that a potential Zika virus outbreak in Texas could result in an additional $1-6 million per year for hospitalizations.
CONCLUSION: Hospitalizations of patients with microcephaly are associated with high costs. An increase in microcephaly prevalence due to a Zika outbreak in Texas could have a considerable impact on health care costs.
Haidar A, Ranjit N, Saxton D, Hoelscher DM. Perceived parental and peer social support is associated with healthier diets in adolescents. J Nutr Educ Behav. 2019 Jan;51(1):23-31. doi: 10.1016/j.jneb.2018.10.003.
OBJECTIVE: Investigate associations between perceived parental/peer support for a healthy diet and adolescent dietary behaviors using data from the 2009-2011 School Physical Activity and Nutrition (SPAN) survey.
DESIGN: A secondary analysis of SPAN, a cross-sectional statewide study using a validated self-administered questionnaire, assessed obesity-related behaviors.
SETTING: Probability-based sample of Texas 8th- and 11th-grade students.
PARTICIPANTS: A total of 6,716 8th- and 11th-grade students.
MAIN OUTCOME MEASURES: Obtained by self-report and included sugary beverage consumption, fruit and vegetable intake, and SPAN healthy eating score.
ANALYSIS: Multiple logistic regression and linear regression were used to determine associations, controlling for demographic variables.
RESULTS: For every 1-point increase in parental support (range, 0-12), adolescents had 1.19 times higher odds of consuming ≥1 fruits or vegetables/d (P < .001) and 1.1 times lower odds of consuming ≥2 sugary beverages/d (P < .05), and had a SPAN healthy eating score (range, -100 to 100) that was 1.6 points higher (P < .001). For every 1-point increase in peer support, adolescents had 1.14 times higher odds of consuming ≥1 fruits and vegetables/d (P < .001) and a higher SPAN healthy eating score (P < .05).
CONCLUSIONS AND IMPLICATIONS: Parental/peer support was associated with healthier dietary behaviors. Future research could conduct pre-post intervention studies to determine whether an increase in parental/peer support is associated with positive changes in healthier eating.


text:
namespace System
{
    using System.Collections.Specialized;
    using System.Runtime;
    using System.ServiceModel;
    using System.ServiceModel.Channels;
    using System.Text;

    // This represents a Query value, which can either be Empty, a Literal or a Variable
    abstract class UriTemplateQueryValue
    {

        readonly UriTemplatePartType nature;
        static UriTemplateQueryValue empty = new EmptyUriTemplateQueryValue();

        protected UriTemplateQueryValue(UriTemplatePartType nature)
        {
            this.nature = nature;
        }

        public static UriTemplateQueryValue Empty
        {
            get
            {
                return UriTemplateQueryValue.empty;
            }
        }

        public UriTemplatePartType Nature
        {
            get
            {
                return this.nature;
            }
        }
        public static UriTemplateQueryValue CreateFromUriTemplate(string value, UriTemplate template)
        {
            // Checking for empty value
            if (value == null)
            {
                return UriTemplateQueryValue.Empty;
            }
            // Identifying the type of value - Literal|Compound|Variable
            switch (UriTemplateHelpers.IdentifyPartType(value))
            {
                case UriTemplatePartType.Literal:
                    return UriTemplateLiteralQueryValue.CreateFromUriTemplate(value);

                case UriTemplatePartType.Compound:
                    throw DiagnosticUtility.ExceptionUtility.ThrowHelperError(new InvalidOperationException(SR.GetString(
                        SR.UTQueryCannotHaveCompoundValue, template.originalTemplate)));

                case UriTemplatePartType.Variable:
                    return new UriTemplateVariableQueryValue(template.AddQueryVariable(value.Substring(1, value.Length - 2)));

                default:
                    Fx.Assert("Invalid value from IdentifyStringNature");
                    return null;
            }
        }

        public static bool IsNullOrEmpty(UriTemplateQueryValue utqv)
        {
            if (utqv == null)
            {
                return true;
            }
            if (utqv == UriTemplateQueryValue.Empty)
            {
                return true;
            }
            return false;
        }
        public abstract void Bind(string keyName, string[] values, ref int valueIndex, StringBuilder query);

        public abstract bool IsEquivalentTo(UriTemplateQueryValue other);
        public abstract void Lookup(string value, NameValueCollection boundParameters);

        class EmptyUriTemplateQueryValue : UriTemplateQueryValue
        {
            public EmptyUriTemplateQueryValue()
                : base(UriTemplatePartType.Literal)
            {
            }
            public override void Bind(string keyName, string[] values, ref int valueIndex, StringBuilder query)
            {
                query.AppendFormat("&{0}", UrlUtility.UrlEncode(keyName, Encoding.UTF8));
            }

            public override bool IsEquivalentTo(UriTemplateQueryValue other)
            {
                return (other == UriTemplateQueryValue.Empty);
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            public override void Lookup(string value, NameValueCollection boundParameters)
            {
                Fx.Assert(string.IsNullOrEmpty(value), "shouldn't have a value");
            }
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    }

}

redpajama_set_name: RedPajamaGithub


text:
Railroad company invests in freight rail infrastructure to serve Charlotte Pipe
Published 3:30 pm Monday, June 1, 2020
The North Carolina Railroad Company (NCRR) is one of several partners named in the recent announcement that Charlotte Pipe and Foundry
will be relocating its production facility from Charlotte to Stanly County.
Charlotte Pipe and Foundry is a North Carolina-based manufacturer and distributor of cast iron and plastic pipe fittings with seven production facilities across the United States.
Charlotte Pipe and Foundry will construct a new manufacturing facility
at a site in Oakboro, an investment of $325 million. Charlotte Pipe and Foundry employs 1,050 in Mecklenburg, Union and Stanly counties, with 400 of those to be relocated to the Oakboro facility.
Through the North Carolina Railroad Company's economic development initiative, NCRR Invests, NCRR is investing approximately $1.5 million to
assist with the construction of a railroad industrial lead track and switches, and related infrastructure. The new manufacturing plant will be served by the Aberdeen, Carolina and Western Railroad with access to both Norfolk Southern and CSX.
"Rail infrastructure is extremely important in attracting high quality, capital intensive manufacturers and distributors to our state," says NCRR President Scott Saylor. "Occasionally those companies need room to expand their site footprint or operation. Through NCRR Invests, we are able to assist in addressing the freight rail infrastructure needs of companies like Charlotte Pipe and Foundry in order to retain jobs during this crucial moment for our economy, as well as enable future growth opportunities."
About the North Carolina Railroad Company
The North Carolina Railroad Company is a private corporation whose voting stock is owned by the State of North Carolina. The company manages the use of 317 miles of track and property stretching from Charlotte to the Port of Morehead City. The company's mission is to put the North Carolina Railroad Company to work for the good of the people of North Carolina and improve our state by expanding freight rail opportunities to grow business, enabling rail to move people and investing in North Carolina.
About NCRR Invests
NCRR Invests provides assistance to companies that take advantage of the state's freight rail opportunities and create jobs by locating or expanding their business in North Carolina. The goal of any NCRR investment is to drive job creation and economic growth.

redpajama_set_name: RedPajamaCommonCrawl


"Did you have a self-absorbed parent?
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Campaign Overview and Goals: In the fall of 2014, Green Light Go began a campaign with the Swedish duo Moonbabies to release their ninth album, Wizards on the Beach. The major goals for the artists were to gradually grow social media awareness and followers while garnering attention with key outlets for the album release.
Strategy: The strategy for Moonbabies was to focus on those who would most connect with the music and its theme. Targeting writers and thinkers that already had a preference for Swedish music, it was then possible to build momentum for those less exposed to the genre. Moonbabies also had a beautiful selection of bright, coloful photos to accent their image and sound.
Results: Through this approach we were able to secure coverage with key tastemakers including Culture Collide, The Big Takeover, Fresh on the Net, BBC6, BrooklynVegan, and Pure Volume with 86 placements in total. Moonbabies were also able to increase their social media presence dramatically, gaining close to 10,000 new Twitter followers, and 8,000 new likes on Facebook.


"It wasn't being funny. I thought it was Notre Dame the university was like, oh, man. It's horrible. Hopefully, they get it out. This is like Notre Dame. This is in France. What's going on from Fox News? The fame Notre Dame cathedral in Paris engulfed in flames on Monday leading the collapse of the structures main spire intense flames leaped out from two of its bell towers minutes before the fire collapsed later spread to one of the cathedral's iconic rectangle towers over the main structure of the cathedral remained in tax payers. Fire chief said adding that the blaze was stopped from spreading to the northern belfry church. Spokesman previously told French media that all of Notre Dame cathedral frame was burning after the spire collapsed. Everything is. Burning and nothing remained from the frame. Spokesman Andrei Fano said dramatic video show black smoke billowing from the top of the cathedral has firefighters furiously worked to contain the flames Notre Dame Peres in flames emotion, and the whole nation thoughts for all Catholics for all. French president Emmanuel Macron tweeted like all our countrymen. I'm sad to see this part of this burn their emergency services. They were trying to salvage the artworks stored in the cathedral, the French capital's police departments and no deaths have been reported, but did not say anything about injuries, Paris mayor and dog oh said that those living in this city of the cathedral evacuated from the area around eleven pm local time and case a possible collapse within the structure at the Vatican said they're praying for firefighters working on the blaze, those who are doing everything possible to confront this dramatic situation France's interior ministry said on Twitter that four hundred firefighters were mobilized it was not immediately clear what caused the fire Notre Dame was undergoing a six point eight million dollar renovation project with some sections under scaffolding. Bronze statues were removed last week for work at the fire. Started roughly five or six minutes after the cathedral close six forty five pm France twenty four reported as sources tell Fox News. And here's the fire which comes one day after Palm Sunday and during holy week was related the construction on the cathedral and President Donald Trump tweeting about the fire writing, it was horrible to watch the massive fire at Notre Dame cathedral in Paris."


The children used recycled bottles to make poppies for remembrance weekend. Elaine Penrose (from the community poppy project) worked with the children in class. These poppies will be displayed in Hoddesdon.


text:
Strava data reveals how brutal opening stages of Paris-Nice really were
A look at some of the power put out in the crosswinds by some of the top riders in the race
By Tim Bonville-Ginn
Paris-Nice has been a fantastic watch so far, both stages one and two have caused drama in the crosswinds and have put the overall leader, Max Schachmann (Bora-Hansgrohe), into a very nice position, but how do the stats look on Strava?
Stage one got cut to pieces by the wind and rain. Julian Alaphilippe (Deceuninck - Quick-Step) and Tiesj Benoot (Team Sunweb) went for a long distance break with around 30km to go, they were caught just over the top of the cobbled climb in the final 4km by Schachmann and Dylan Teuns (Bahrain-McLaren) with Schachmann taking the win.
It was the riders behind who went up the climb quickest on Strava, Stefan Küng (Groupama-FDJ) and Cees Bol (Team Sunweb) went up fastest on the Bosse pavée Neauphle segment.
Cees Bol's ride on stage 1 of the 2020 Paris-Nice on Strava
Bol later chucked out 1400 watts in his sprint, leading in the rest of the race to finish fifth, holding his sprint at around 1000w all the way to the line.
Stage two saw more pandemonium in the peloton with Bora-Hansgrohe taking full advantage of the wind. Riders like Alaphilippe and Nairo Quintana (Arkéa-Samsic) both lost time due to a puncture and a crash.
Some riders surprised yet again, Sergio Higuita (EF Pro Cycling) was right up there in the sprint where he came fifth behind eventual winner, Giacomo Nizzolo (NTT Pro Cycling). Higuita is now the highest placed pure climber in GC and wears the white jersey for best young rider.
As expected, some of the big riders have been putting out some very impressive power. In the final sprint, Nils Politt (Israel Start-Up Nation) held 1000w for 30 seconds which saw him take fourth on the stage.
Everyone's average power for the whole stage was in the high 200s, but the top riders on the stage got to around 1500w in the sprint.
Nils Politt's data from stage two of Paris-Nice 2020
Politt and his team had three riders up in the lead group, but the team that dominated the race on the second stage was Bora-Hansgrohe. Not only do they have the leaders jersey, they had four riders in the top 11 yesterday with Pascal Ackermann, Max Schachmann, Felix Großschartner and Peter Sagan all up there at the end.
It was Sagan who destroyed the peloton, which was already a depleted group, when he along with Schachmann and world champion, Mads Pedersen (Trek-Segafredo) decided to really up the pace on the last real exposed section before the finish, kicking riders like Viviani, Thibaut Pinot (Groupama-FDJ) and Romain Bardet (AG2R La Mondiale) out of the back.
>>> '90 per cent of the peloton think the race won't get to Nice,' says Jasper Stuyven
You can see the effort put in by the riders on Strava around the 140km mark, riders like Pascal Ackermann were hitting 800 to 1,000w regularly as Bora-Hansgrohe took control of the race.
Pascal Ackermann's Paris-Nice stage 2 2020 Strava ride
Ultimately it wasn't to be for Ackermann and co., but they have shown some very impressive form before the classics really kick in, with Sagan looking strong by the day.
Crosswind has wrecked the hopes for almost every big name sprinter in the race with Sam Bennett (Deceuninck - Quick-Step), Caleb Ewan (Lotto-Soudal) and Elia Viviani (Cofidis), among others, all not having a good go at victory.
With the mountains, time trial and punchier terrain being on the menu for the rest of the race, you have to wonder whether any will go all the way to Nice.
Tim Bonville-Ginn
Hi, I'm one of Cycling Weekly's content writers for the web team responsible for writing stories on racing, tech, updating evergreen pages as well as the weekly email newsletter. Proud Yorkshireman from the UK's answer to Flanders, Calderdale, go check out the cobbled climbs!
I started watching cycling back in 2010, before all the hype around London 2012 and Bradley Wiggins at the Tour de France. In fact, it was Alberto Contador and Andy Schleck's battle in the fog up the Tourmalet on stage 17 of the Tour de France.
It took me a few more years to get into the journalism side of things, but I had a good idea I wanted to get into cycling journalism by the end of year nine at school and started doing voluntary work soon after. This got me a chance to go to the London Six Days, Tour de Yorkshire and the Tour of Britain to name a few before eventually joining Eurosport's online team while I was at uni, where I studied journalism. Eurosport gave me the opportunity to work at the world championships in Harrogate back in the awful weather.
After various bar jobs, I managed to get my way into Cycling Weekly in late February of 2020 where I mostly write about racing and everything around that as it's what I specialise in but don't be surprised to see my name on other news stories.
When not writing stories for the site, I don't really switch off my cycling side as I watch every race that is televised as well as being a rider myself and a regular user of the game Pro Cycling Manager. Maybe too regular.
My bike is a well used Specialized Tarmac SL4 when out on my local roads back in West Yorkshire as well as in northern Hampshire with the hills and mountains being my preferred terrain.
Extinction Rebellion stages anti-Shell protest at British Track Champs
Two people carried a banner through the stands at Newport's Geraint Thomas National Velodrome
60% of motorists unaware of Highway Code changes, one year after introduction
Charity Cycling UK has called on the government to raise awareness of the updates
By Tom Davidson • Published 28 January 23
Strava data reveals rapid ascent of the Poggio in Milan-San Remo 2021
Strava data has revealed the power behind a rapid ascent of the Poggio in \ 2021.
By Alex Ballinger • Published 22 March 21
Five things we learned from Paris-Nice 2021
Talking points from a memorable edition of Paris-Nice
By Stephen Puddicombe • Published 15 March 21
Primož Roglič discolated his shoulder in first of two crashes on Paris-Nice stage eight
"It could have been worse," says the Slovenian, who is already looking ahead to the next race
By Jonny Long • Published 14 March 21
'Nobody waited for me when I punctured' says Max Schachmann, left with mixed emotions after Paris-Nice win
The German said it's not nice to win in the manner he did after successfully defending his title
Primož Roglič plummets out of yellow jersey as Max Schachmann defends Paris-Nice title
Magnus Cort won the final stage eight on a day filled with drama
Should Primož Roglič have gifted Paris-Nice stage to Gino Mäder? Both riders have their say
Roglič overtook the young Swiss rider in the final few metres to claim his third stage victory of the race
Primož Roglič breaks Bahrain hearts to take irrepressible third win on stage seven of Paris-Nice
Gino Mäder had his pocket picked on the line as Roglič took yet another stage win
'It's unbelievable how Primož Roglič continues his form at Paris-Nice,' says Steven Kruijswijk
The Slovenian is closing in on yet another stage race victory


When caregivers do not want or cannot cope with a home death, then it may not be achievable.
Keeping a dying person comfortable at home requires both medical and nursing input. The GP's involvement in supporting families in this phase is crucial.
When a patient does not have access to a GP who will do home visits, assess, prescribe appropriate medications, and write a death certificate, then a home death may not be achievable.
What has the patient said about their wish to stay at home to die?
Has the plan been discussed within the family?
How much nursing support is available? Specifically, how many visits can the patient have?
Are the carers fully prepared for the fact that the dying person will be dependent and bed bound?
Home-based support for palliative care families: challenges and recommendations.
Ref: Hudson P. Home-based support for palliative care families: challenges and recommendations. Med J Aust. 2003 Sep 15;179(6 Suppl):S35-7.
This brochure outlines the common physical changes that occur when a person is dying, and gives advice for family caregivers on how to cope with them.
This excellent online Canadian resource 'walks' patients and/or families through the practicalities of caring for someone who is dying at home.


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The medication Qvar has the generic name of Beclomethasone inhalation. It is a steroid, which is aimed on the prevention of the release of substances that cause inflammation in the body.
Qvar is intended only for the prevention of asthma attacks, it is not able to stop an already begun asthma attack. If you have an already begun asthma attack, then it is necessary to take a quick-acting medication.
The drug Qvar is used within children older than 5 years and adults.
If you are allergic to Beclomethasone, then the medication Qvar is contraindicated to you.
To start using this drug, you need to be sure that it is safe for you. You should consult a doctor and tell your doctor if you have ever had the following symptoms: a herpes infection of the eyes, osteoporosis, a weak immune system, any infections, glaucoma and cataracts.
The effect of the medication Qvar on an unborn baby has not been studied. Before using the drug, you should tell the doctor if you are pregnant, plan a pregnancy, or breastfeed. When breastfeeding a child, you should not use this drug, as it gets into the breast milk and affects the child.
Is there an otc Qvar? Definetely, not. You cannot buy Qvar without prescription. But you can order it online. Online pharmacies sell Generic Qvar and you don't need to have valid prescription to order one.
When using the drug, follow the instructions for use and filling, as well as the recommendations of the doctor.
Make sure that the device is filled with the medication before use. Before inhalation, make several injections in the air, do this also if more than 10 days you have not used the inhaler.
After the inhalation, rinse your mouth with water and at least once a week wipe the mouthpiece with a dry cloth.
If the inhaler has a dose counter, then you know how many doses are left. The device must be filled when the dose counter is at zero.
Improving of your symptoms may occur after 1-2 weeks of taking the drug.
You should use all medicines in accordance with the doctor's recommendations, as asthma is usually treated with a combination of several medicines. If you do not observe the action of your medication, immediately consult the doctor.
The drug Qvar should be stored with the lid closed, away from the heat and moisture, at room temperature, in a place inaccessible to children.
In the case of a missed dose, take the drug as soon as you remember about it. But if it is already time for the next dose, then skip the missed one and take the dug on a schedule.
If the medication gets in your eyes, then rinse the eyes with water.
Try not to have contacts with sick people during treatment.
If you experience allergy symptoms, such as a rash, face swelling, breathing problems, after taking the drug, consult your doctor immediately.
If you experience any of the following side effects, immediately consult the doctor: severe fatigue, mild hunger, vomiting, nausea, weakness; fever, body pain, vomiting and other signs of infection; asthma symptoms worsening; problems with breathing, shortness of breath; white spots and ulcers in the mouth.
General side effects: sore throat, runny nose, irritation in the nose; severe headache, mouth infections.
These are not all the side effects that can occur when using the drug Qvar. To find out more information, you should ask your doctor.
Before using the drug Qvar, ask the doctor which medications and substances can negatively affect Qvar and do not use them during treatment. Constantly inform your doctor about your health and about all changes of your symptoms. Do not change the dosage of the drug yourself.
Follow all the doctor's instructions and never give your medications to other people.


text:
Ralf Dee: Engaging Folk Music Charisma
By Paul J Wolfle November 29, 2017 #Bavaria #singersongwriters Folk Music Guitars musicians
Bluesy, honest and often humorously clever, contemporary indie singer-songwriter and guitarist Ralf Dee's latest album, Glück gehabt, or "Have Been Lucky," was recorded entirely in German. But do fans need to speak the language of the song lyrics to really hear the music? Dee has created eleven new original acoustic tracks in a style that answers the question and more. Ironically, luck has nothing to do with it.
An Affable Style
The first thing that strikes you about Dee's collection of songs is the deftly picked guitar work on each cut. The chord changes and timing are smoothly executed, while the lingering fretwork has an inviting Reverend Gary Davis-meets-Leonard Cohen-by-way of Harry Chapin quality, perhaps best evidenced on "Das kann doch nicht alles sein," which loosely translated means "There Must Be More To It Than That." There is more.
Of course, being a songwriter, the Pfaffenhofen, Bavaria-based artist, who plays a Cajon with a pedal during the album, brings a personalized view of things to the music, including the 4:29 "Herr Jentsch," about an insurance agent selling various kinds of coverage that really is not needed. The background singing on the recording nicely accentuates the storytelling. According to Dee, the song's tongue-in-cheek message ironically reveals how lucky he is that the agent "Cares so much about his [Dee's] well-being."
But the favorite of the bunch is "Dufte Zettel," which has an acoustic Hot Tuna/Jorma Kaukonen feel. Love the close-up sound of the musician's fingers moving on and off the strings. Another winner, "Der Akrobat," evokes a Tim Hardin "Reason To Believe" appeal. "Verbranntes Land" (Burnt Land) is another folk-blues number. All in all, Ralf Dee's Glück gehabt has a distinct unplugged manner that holds a listener's attention. That alone, speaks for itself.
Posted in #Albums, #Germany, #music, #musicians, Ralf Dee


I went back and added a star to my rating because When Wallflowers Die is still in my head after 6 plus months. This story is haunting and tragic. I finished and just sat there thinking, "Damn, that was really messed up!" And I love messed up... You will, too.


The reliable, fuel efficient and exceptionally manoeuvrable machine will be used at one of the largest expanses of wet grassland in the UK. The RSPB has over 200 nature reserves around the country covering 151,200 hectares of land.
The T6.140 which has been fitted with a New Holland front loader will be used for the general management of the nature reserve. The reserve is home to the tens of thousands of wintering ducks, geese and swans that visit the estuary and surrounding grazing marshes.
Mark Smart, Site Manager said "The tractor is already allowing me to do work that I would not have been able to do with the old one. The creep gearbox is allowing me to work on a very hard, heavy clay site for the Norfolk Wildlife Trust, installing new wet features for breeding waders like lapwing and redshank.
The four cylinder T6.140 produces up to 143hp and a maximum of 590Nm of torque with Engine Power Management (EPM). The four cylinder design ensures outstanding manoeuvrability, ultimate flexibility and exceptionally efficient productivity in compliance with T4A emissions.
Operators also enjoy best-in-class visibility thanks to the practical yet eye-catching design, backed up by simple controls and plenty of space to reduce fatigue.
Ernest Doe & Son's Ltd dealership in Wymondham supplied the tractor. Branch Manager, Ross Johnson said: "We're delighted to have met the RSPB's needs with the British-made T6.140. The tractor is the perfect match for their requirements which include the versatility to undertake a variety of activities on multiple terrains. The land is very fragile and the technologically advanced, Michelin Xeobib tyres fitted to the tractor facilitate greater protection of the soil.
RSPB's Norfolk Broads Area Manager, Ian Robinson, explained that Berney Marshes is just one of three nature reserves in the Norfolk Broads managed by RSPB to benefit all wildlife.
"Spring sees the marshes filled with the atmospheric calls of birds such as lapwing and redshank. Using New Holland's tractor is allowing us to give a home for these and other species across the Norfolk and Suffolk Broads.


As President Obama begins the final days of his presidency, Amnesty International USA (AIUSA) launched an aggressive effort urging him to use all the powers of his office to close Guantánamo before his term ends. With an open letter to the president, a hard-hitting bus shelter ad campaign targeting key locations in Washington, D.C., online advertising and a coalition White House rally planned for Guantánamo's 15th anniversary on Jan. 11, Amnesty is seeking to move Obama to action before President-elect Donald Trump takes office on Jan. 20.
Amnesty's bus shelter and online ads feature an image of the Statue of Liberty in a crowd of people, all clad in Guantánamo's notorious orange jumpsuits, with the message "Don't Leave Guantánamo to Trump." The ad points to Amnesty's online action telling President Obama to finish the job and shut down Guantánamo for good. The ads will run in D.C. for several weeks, through the end of Obama's administration.
Details on the Jan. 11 rally, a coalition effort with the Center for Constitutional Rights, Reprieve, Veterans for Peace, Witness Against Torture, National Religious Campaign Against Torture, and others are forthcoming.
"Despite your positive actions to date, your legacy will include failing to cure this corruption of our country's ideals of justice and fairness. You will leave behind Guantánamo as a system of injustice that—having survived for 15 years, two political parties and four presidential terms of office—may remain open for the foreseeable future.
Our concern is heightened by the sharp rise in anti-Muslim and anti-immigrant rhetoric during the election. Proposals for large-scale detention without charge, which once seemed inconceivable, are now on the table as options your successor may pursue. Guantánamo, with its shameful tradition of secrecy and insularity from legal process, would be all too convenient a location for mass imprisonment, returning the United States to one of its grimmest chapters.


In 1963, Marvel Comics debuted their response to the massive success of DC's Justice League with a super group of their own - The Avengers. Originally comprised of characters only recently introduced in the Marvel Universe, The Avengers quickly became a staple of comic book stores for decades to follow and the team as well as each individual character has spawned thousands of comic book issues, dozens of movies and television shows and a handful of trading card sets.
Despite the long history of The Avengers, the super group is a relative newcomer to the trading card market. Individual characters have had their own sets and many "all-purpose" Marvel sets have devoted cards to the group, as well as its members, which makes collecting a complete set of Avengers cards a fun challenge. This guide compiles only those sets that are 100% devoted to the group, whether it be the comic iteration or the popular films, as future guides will be devoted to each individual member.
With Avengers movies scheduled for release in 2018 and 2019 along with those dedicated to Captain America (2016), Thor (2017), and Ant-Man and Wasp (2018), there will be no shortage of Avengers-related card sets in the coming years. In 2009, Disney acquired Marvel and one of Disney's greatest strengths is marketing both high-end and entry-level collectibles for their franchises, so expect a great deal more on the trading card front in the near future.
While there are no official announcements for future Avengers cards, with two movies forthcoming it is a safe bet that more are on their way. Becoming a collector of superhero teams like the Avengers, Fantastic Four or Justice League can be a very fun hobby as you track down every variant, relic, autograph, or chase set on the market.
Collectors who decide to venture down the rabbit hole of each individual member's card sets as well as their appearances in Marvel Universe sets will find themselves on a seemingly never-ending quest to complete their collection as new cards are released every year and date back three or four decades. Although it is clearly no small task, the thrill of the hunt is why we all got into this hobby in the first place, right?
Click on the images or headings to shop for cards on eBay. Links in the body go directly to product profiles on the site.
The earliest card set devoted solely to The Avengers wasn't released until 2006 and is a comprehensive retrospective of the first 43 years of the comic franchise. With an 81-card base set and a healthy amount of extras, the Complete Avengers by Rittenhouse is a gorgeous set of cards that chronologically details the major events from the comic books and, ultimately, ties in with the 2006-2007 Marvel crossover event, Civil War.
Every hobby box of The Complete Avengers includes a hand-drawn sketch card which, as Rittenhouse claims, is a first for any trading card series. Another first for a comic-based series are a set of relic cards that include panels cut from the original ten Avengers comics. Rittenhouse calls these relics Cut Archive Cards and included them as dealer incentives.
There are also three chase sets ranging in scarcity: The nine-card Greatest Enemies (1:10) chase set has original villain art work by John Czop, the 18-card Earth's Mightiest Heroes (1:20) present foil treatments of popular comic covers, and the 9-card Legendary Heroes (1:40) set honor the founders of The Avengers and are harder to acquire than sketch cards.
The most rare cards from this set are the Stan Lee sketch cards which are limited to only 100. It isn't terribly difficult to track down Stan Lee sketch cards on the trade market, but they do, understandably, command a high asking price.
Upper Deck's first foray into Avengers cards should have been a revolutionary advancement to the medium. Released in 2011, the Kree -Skrull War set was actually a full-fledged comic book story with every nine cards combining to make a full page of the story. The story is based on, and in continuity to, a popular arc from 1971 and 1972, written by Roy Thomas.
There are five complete stories featured in this set, with the main 20-page story (90 cards) acting as a base set and the remaining cards serving as four chase sets. In total, there are 189 cards in the complete set which equates to 42 pages of comic storylines. There are also cover cards, one to a pack, which combine to create full page cover art and very rare (1:432) sketch cards.
Although this set is a conceptual high point for comic card collecting, the execution fell flat with a story that "wasn't that good" as our reviewer put it and a numbering system that was difficult to read.
To coincide with the release of the first Avengers film, Upper Deck released Avengers Assemble in 2012. This 176-card set came with three hits per box: one sketch card, one single or duo memorabilia card, and one trio or quad memorabilia or printing plate. Because of the unique collation of hits, the popularity of the film, and a respectable but limited autograph list, hobby boxes for this set are harder to find and certain cards have slightly inflated asking prices but it shouldn't be hard for collectors to piece together the base set and a handful of cool hits.
More rare with this set is the two-per-case Ultimate Panel Cards which, like the Cut Archive Cards from Rittenhouse, include embedded panels from Avengers comic books.
Hand Drawn sketch Card - Marvel's The Avengers 2011 - The Vision!
To commemorate the sequel to 2012's Avengers, Upper Deck released their 90-card Age of Ultron set. Much like their Avengers Assemble set, this collection includes a number of different relic and autograph combinations, including double and triple autograph cards. While the base set is much smaller than 2012's offering, there are a number of chase cards and variants to collect as well as the requisite sketch cards.
Assembling a complete base set and all the chase sets for this collection should be fairly easy and inexpensive for completists, but tracking down autograph cards is going to be much tougher as there is no guarantee per hobby box (the only guarantee is two memorabilia cards) and it is believed that they are all hobby exclusive.
Collectors would be well advised to grab any hobby boxes they can find on eBay if they're truly interested in grabbing a more impressive hit.
On the comic book side of things, Rittenhouse released their second set of Avengers cards in 2015, this time focusing solely on the Silver Age comic era (1956-1970). The Avengers Silver Age is a 100-card base set with 70 chase cards and Gold (#/10) and Silver (#/100) parallels. Each box includes two Archive Cut Cards with the possibility of pulling a dual panel book card.
Rittenhouse has made the focus of this set be the Archive Cuts instead of sketch cards, which fall about three per case. The quality of Rittenhouse cards is truly geared towards collectors as the card stock and designs are typically higher quality than Upper Deck and sets are a more limited quantity. This set is perfect for comic book collectors who would like a little piece of history from books they may remember from their youth.
The Hero Attax cards released by Topps are not traditional trading cards but are game pieces to their popular game. The European exclusive set contains 207 cards and mixes comic imagery with stills from the Age of Ultron film, a first for an Avengers base set.
Despite its continental exclusivity, this set is very easy to track down in the states via online retailers and auction sites. Because it is a card game, it is safe to assume that a good percentage, if not the majority, of the cards will be damaged or in poor condition so a die-hard Avengers collector may find great value in a complete, mint condition set when inventory has become limited over time.
This oddball set is a six-card Canadian exclusive. Customers of Canadian Subway sandwich stores who ordered a meal deal would receive one of these cards free with their purchase. Once you had the card and downloaded an app on your phone, simply pointing your phone at the card would unlock custom 3D content on the surface of the card.
It's a very cool promotional item and should be of interest to collectors simply for its conversational appeal if for nothing else.


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A rather unpleasant purpose: klling people, cyanide is highly toxic and therefore used for single fast and efficient execution, the gas chambers of the nazis were filled with a cyanide gas.
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Another purpose of potassium cyanide is the recycling of gold and silver from scrap metal, a thing highly debated due to the toxicity of cyanides as stated before.Its main uses are in organic synthesis, and in the preparation of many useful chemicals, plastics and pharmaceuticals. It is also used in electroplating, photographic developing, fumigation, and as an insecticide.
Potassium cyanide is a highly poisonous compound that is an inhibitor of many metabolic processes, but has been shown to be an especially potent inhibitor of heme enzymes and hemeproteins. It is used in many industrial processes
Physical properties: Potassium cyanide is a white or colorless crystalline solid, which has a faint odor of almonds (due to the cyanide ion). It has a density of 1.52 g/mL and a melting point of 634.5 °C. It is a highly water soluble and deliquescent solid (which absorbs water from air and dissolves).
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Cyanide is known as a highly toxic chemical, and can certainly cause death at the right concentrations. However, purchasing it is nigh on impossible, although on the Peaceful Pill Handbook forum (for PPH members only) there was one report of it being sold from China. It is possible to manufacture it, although not easily. In The Peaceful Pill Handbook1 there is detailed information on how to manufacture sodium cyanide. There are also a few articles that can be found searching on the web, although less detailed.
It is also possible to combine sodium cyanide with concentrated hydrochloric acid to create hydrogen cyanide gas that can be lethal in an enclosed space, and this method has been used in gas chambers over the years.
It should be noted though, that in the US, carrying out the death penalty by use of lethal gas resulted in many reports of suffering during executions. Some executions saw the prisoner take up to 11 minutes to die, and be in agonising pain during that time. This method was therefore abandoned as the primary method of execution in the US, and in California was labelled as being "unconstitutionally cruel".
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Potassium chloride (injected) is also said to be potentially lethal, and more accessible as a method. the minimum lethal dose can be ingested in (50mg/kg) or (100mg/kg) for guarantee effect. you could Combinate kcn with sedatives and muscle relaxants to help .
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The effect of potassium cyanide is similar to that of sodium salt. After consumption of 100 to 200 mg of potassium cyanide, there is loss of consciousness in one minute and sometimes in 10 seconds depending on the resistance of the body and the amount of food in the stomach. After 45 minutes, the person goes into a coma and can die within two hours if there is no medical intervention. During this period, there may be convulsions. In general, death intervenes by stopping the heart. Potassium cyanide price, Potassium cyanide for sale, Potassium cyanide buy online, where to buy Potassium cyanide, order Potassium cyanide for suicide, buy suicide pills, ,how to take Potassium cyanide to die
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Diamondbacks: Market Dynamics V: Performance-Based Incentives Paying Players Like Salesmen
ST. LOUIS, MO - SEPTEMBER 10: Adam Wainwright #50 of the St. Louis Cardinals tips his cap after recording his 1,600th career strikeout while playing against the Pittsburgh Pirates in the second inning at Busch Stadium on September 10, 2018 in St. Louis, Missouri. (Photo by Dilip Vishwanat/Getty Images) /
Get ready Diamondbacks fans, it's Market Dynamics Week here at Venom Strikes, where we explore financial elements shaping the current baseball conversation. Frontloading, opt-out clauses, performance-based incentives, swellopts – understanding the function of these contract elements is essential to tracking the ever-changing financial relationship between players and owners – a bedrock talking point in the contemporary baseball world. Time to see what the hubbub is about with today's topic: performance-based incentives.
Rather than look only at the deals the Diamondbacks are or are not signing, we are defining some of the terms being thrown around in free agency this winter in an effort to better understand how baseball's free market behaves. Today, we look at performance-based incentives, what are they, and are they turning baseball into a commission economy?
Performance-based Incentives
As teams resist giving out large guarantees, players are countering with "incentive-laden" deals. Adam Wainwright's current deal is a perfect example of this.
The Cardinals have laid out essentially every possible circumstance for his 2019 season and paid him accordingly. Whether he starts or ends up in the bullpen, Wainwright will be rewarded for staying on the field. These incentives ensure Wainwright fair compensation and protects the team against injury.
Performance-based incentive-laden contracts are an attempt to grant fair compensation for services rendered. In a vacuum, this makes a ton of sense. Put together with these other contact elements – frontloading, swellopts, incentive deals – and it begins to feel like the Cardinals are paying Wainwright on commission.
This, indeed, would be a bizarre development. Paying players like salesmen. That is, after all, one of the many hats that a professional baseball players wears. What's bizarre is that this doesn't feel like a CBA-orchestrated development. Players are, generally speaking, disoriented by the direction the market has turned. Owners, meanwhile, are so wary of long-term spending that the only certainty worth paying for is the current season's performance.
Gotta give ownership and their front offices credit: they're doing a stellar job of protecting themselves against an unexpected downturn in performance (or severe injury). And still, if a player making the league minimum breaks out, say, the way Max Muncy did last season – there's not a reciprocal reward system.
It's true that there are reward bonuses for certain achievements, milestones, or awards, but they tend to be paltry in the grand scheme of things – $25K for an All-Star appearance, $500K for a Cy Young, etc – and they tend to be contractually negotiated at a time of free agency or extension. Most players with "outburst" seasons like Muncy are, for obvious reasons, making the league minimum, pre-arb, and therefore lacking in any kind of compelling negotiating position.
Next. Market Dynamics IV: Swellopts. dark
The Diamondbacks personnel decisions have taken a backseat to new market forces this winter. One of those forces is performance-based incentives, which are becoming more common as owners hedge against potential dead money and players search for ways to up their value.


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Love Story...
A beautiful story from Cincinnati...
Couple's love spans 75 years
By John Johnston
jjohnston@enquirer.com
It was a small ceremony attended by only a few family members and friends. They gathered on a Tuesday in the priest's parlor at St. Boniface in Northside and listened to a young couple recite their wedding vows.
To have and to hold, from this day forward...
"They wouldn't let us in church," recalls the former Thelma Wiesman, who was the bride that day. Walter Shroyer, the groom, wasn't Catholic, although he later converted.
"That's a long time ago," Thelma says.
Seventy-five years.
She was 18 and Walter was 19 when they married on Aug. 11, 1934. Now 93 and 94, they will mark a milestone Tuesday that few others attain.
They're sitting on the patio of their buff brick home in Colerain Township, enjoying a summer breeze and eyeing Walter's large garden in the distance. Its dozens of tomato plants are beginning to produce plump, juicy fruit.
Walter thinks back to the fall of 1933. He was working part-time as a waiter at the Graystone Ballroom in Music Hall when he spotted an auburn-haired hat-check girl. Thelma.
"I think I fell in love with her the minute I saw her," he says. "I asked to take her home one night. She agreed. I think she thought I had a car. But I didn't, so I had to take her home (to Northside) on a street car."
They had few luxuries. The nation was mired in the depths of the Depression.
Unemployment in Cincinnati was at 30 percent. By 1934, the year the Shroyers married, unemployment was 25 percent and only 62 percent of local workers had full-time jobs.
For richer, for poorer...
"My mother and father didn't have anything," Thelma says. "His mother and father didn't have anything. In other words, we were poor."
Relatives treated the newlyweds to dinner on their wedding night. The family then gathered and quaffed a keg of beer.
The next morning, "I went to the grocery store a half square up," Walter says, "and bought two eggs, 5 cents apiece, and brought 'em home for our breakfast."
Their first home was a third-floor, two-room apartment in Northside. Rent was $10 a month. "But we didn't have any heat. When cold weather started coming, we had to move out," Walter says. They found a place for $13 a month, heat included.
Walter eventually got a job at Formica. He was a senior account representative when he retired in 1978. For years, he also supplemented the family income by working Saturdays at a nursery.
For better, for worse...
Thelma says the happiest days of her married life were when she welcomed their children into the world. The couple had four: Walter Jr., Mary Lou, Margie and Jane. Perhaps the saddest day was when they lost one. Margie was 48 years old when one of her sons came home and found her in a chair, dead of an aneurysm.
It happened 20 years ago, but Thelma's eyes water and her voice cracks when she thinks about it.
"You're not supposed to outlive your children," she says quietly.
In sickness or in health...
Three years ago in October, Thelma suffered a heart attack.
"The doctors told us to say our goodbyes because she wasn't going to make it through the night," daughter Jane Frey says.
The three adult children gathered outside Thelma's intensive care room with their father.
"That's just about the worst feeling a person can have," Walter says. "All I could do was just visually, mentally, pray that it wasn't going to happen."
Morning arrived, and Thelma's heart was still beating. She received a pacemaker, and was home for Christmas.
"They didn't want me up there," Thelma says, referring to heaven.
To love and to cherish, till death do us part...
Walter says their "policy" since Day 1 of their marriage has been: "If we had a problem between us, everything was solved and forgotten by the time we went to bed." "And," Thelma says, "he never goes to bed without kissing me."
And hereto I pledge you my faithfulness.
Walter won't deny that, on occasion, he has "looked at a pretty girl when she walked by."
But, "Neither of us ever cheated," he says. "That just has to happen once and that could spoil the whole rest of your life. But I know it never happened."
"Oh my goodness, no," Thelma adds.
Then Walter blurts out: "I could never figure out how she could put up with me for 75 years."
Says Thelma: "I guess I just loved him."
Walter thinks about that, as if searching for another way to express how they've lived out their wedding vows the past three-quarters-of-a-century, before finally agreeing with his wife. "It's nothing but just love," he says.
Domus Dei...
Not like other men...
This week's Collect...
"Where Do You Stand?"
Congratulations to our Deacons...
St. Augustine, Bishop and Doctor
Welcome home, Sisters!
Respect and gratitude...
School stuff...
St. Louis IX of France
A really good idea...
A great blog returns...
Upon her head a crown of twelve stars...
A gentle Shepherd...
Part of the answer...
"All right, students. Listen carefully..."
Ave Sanctissima, Ave Purissima...
Everything's in gear...
And so it begins...
I don't recall that particular Mystery...
St. Vincent de Paul clarification...
Wise thoughts...
Avail yourself of the Indulgence...
Collect for Sunday, 2nd August