Discerning drivers will appreciate the 2019 Kia Forte. With less than 2,000 miles on the odometer, this 4 door sedan prioritizes comfort, safety and convenience. Smooth gearshifts are achieved thanks to the 2 liter 4 cylinder engine, and for added security, dynamic Stability Control supplements the drivetrain. A wealth of standard features means that you no longer have to sacrifice. Such as remote keyless entry, front bucket seats, automatic temperature control, tilt steering wheel, lane departure warning, power windows, cruise control, and a split folding rear seat. Audio features include an AM/FM radio, and 6 well positioned speakers. Kia ensures the safety and security of its passengers with equipment such as: dual front impact airbags with occupant sensing airbag, head curtain airbags, traction control, brake assist, a security system, and 4 wheel disc brakes with ABS. This car was designed with safety in mind, allowing you to drive with even greater assurance. We pride ourselves in the quality that we offer on all of our vehicles. Please don't hesitate to give us a call.


text:
using System;
using System.IO;

namespace Merlion.Server.Utils
{
	public class InvalidStream: Stream
	{
		public InvalidStream ()
		{
		}

		#region implemented abstract members of Stream

		public override void Flush ()
		{
		}

		public override int Read (byte[] buffer, int offset, int count)
		{
			throw new IOException ("Stream is invalid.");
		}

		public override long Seek (long offset, SeekOrigin origin)
		{
			throw new NotSupportedException ();
		}

		public override void SetLength (long value)
		{
			throw new NotSupportedException ();
		}

		public override void Write (byte[] buffer, int offset, int count)
		{
			throw new IOException ("Stream is invalid.");
		}

		public override bool CanRead {
			get {
				return true;
			}
		}

		public override bool CanSeek {
			get {
				return false;
			}
		}

		public override bool CanWrite {
			get {
				return true;
			}
		}

		public override long Length {
			get {
				throw new NotSupportedException ();
			}
		}

		public override long Position {
			get {
				throw new NotSupportedException ();
			}
			set {
				throw new NotSupportedException ();
			}
		}

		#endregion
	}
}

redpajama_set_name: RedPajamaGithub


We are currently looking for qualified plumbers within commuting distance of Brighton for a start on a busy project we have which is available in the middle of June. You will be working on a commercial building on an office and should be a good run of work for reliable hard working candidates. This will be various aspects of 1st and 2nd fix so you must be comfortable with both.
Previous experience is essential and references will be requested from you.
Candidates will need to have a skill card, full PPE and your own tools to get on site.


Are you a qualified assessor or looking to become one? Do you have nursing experience from a hospital, either NHS or Private?
We are looking for passionate assessors to join the team and cover the North Devon area. As an Assessor, you will be working across your allocated area, having a base in the Newton Abbott office alongside your colleagues and Area Manager. We expect that you will spend at least 4 days a week out and about visiting your learners and employers in their workplaces.
You must have a minimum of 3 years working within the NHS or private medical sector within a clinical environment. You must hold a Clinical Healthcare Support qualification, a Health and Social Care 'Health' pathway L2 /L3 or a relevant nursing qualification. We welcome applicants from a clinical nursing background or senior health care assistants in a hospital setting. A mandatory requirement would be for applicants to be competent in undertaking physiological measurements.
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text:
POST CARDS�PRINTED BY BHUTAN POST
The history of picture Postcards in Bhutan can be traced to the late 1960s. The first two issues of picture postcards of Bhutan initially printed by Posts & Telegraphs belong to postal stationary as they bear a postal stamp imprinted on them.
In 1966, a postcard was issued which showed:
an etched drawing of Rinpung Dzong (Paro Dzong) on the left back side
the preprinted postage stamp of 6 Chhetrum shows a drawing of Simtokha Dzong
was dark green color
on the left, the front side is free for writing of a message.
In 1967, Posts & Telegraphs released a set of 10 postcards with features as follows:
these picture postal cards were the first true picture post cards issued in Bhutan
the front side was completely used for the drawing
the left side of the divided back open for a message and the right side with the imprinted stamp and address lines, as we are used to in a typical modern standard picture card lay-out.
are in principle an overprint on the single �buff-colored� postal card issued in the same year which carries the same imprint of a purple, crossed Dorjis 10 Chhetrum
This was the last postcard with preprinted postage till 2008 when the �Color-Your-Own-Stamp� set of postcards with a 20 Ngultrum imprinted stamp was published
In 1968, Bhutan Post issued a set of first ever multi-color 9 picture cards as follows:
had a modern standard format (100 x 150mm).
printed on art board paper by the Reliable Calendar Company of Calcutta
the pictures show dzongs, lhakhangs, a folk dance, a yak, a mother etc.
The first Maxi cards were produced by Bhutan Posts and Telegraphs in 1968�(Paintings of Van Gogh and Millet). The next sets of maxi cards issued afterwards�starting with 1984 (Golden Langur) have been produced by WWF with limited direct�input by P&T or Bhutan Post.
Between 1972 and 1976, four such kind of sets of postcards are issued as follows:
postcards are packed in a thin, carton cover with the words �Dances of Bhutan� or��Views of Bhutan�.
the cover has at the front side a transparent window providing a partial view of the first postcard.
the size of these postcards went back to the smaller, old standard postcard format (90 x 140 mm), while also the glossy chrome print was rather old-fashioned.
In 1974, on the occasion of the coronation of the Fourth Druk Gyalpo, another set was issued, printed this time by Format International Security Printers Ltd. The brown colored cover carries the text �Views of Bhutan� and contained 6 postcards.
In 1976, two other covers, one orange and one blue colored also with the text �Views of Bhutan�, were issued with 8 postcards each, which were printed by the House of Questa. The pictures in these four sets as follows:
�Dances/Views of Bhutan� and show the usual dzongs and lhakhangs, valleys, mountains, dances, ceremonies, a monk, a mother and child.
Long titles on the �Dances of Bhutan� cards, for instance �Procession of the jury of the Court of Chheogyi Gyalpo leaded by Rasha, with Lamas blowing (jail) and burning incense standing in the foreground heralding their welcome.�,
cards under �Views of Bhutan� would simply state �A lama in deep prayer� or �Thangka painting�.
Late 1992 or early 1993, a set of some 63 color postcards showing among others dzongs, lhakhangs, valleys, landscape views, dances, people, and the newly opened GPO in Thimphu (in 1988).
In 1993, the Environmental Trust Fund set was released, 17 different postcards in� full color in a carton cover, showing landscapes, local flowers, animals and the� Rinpung Dzong in Paro. The printer was Secura Ltd in Singapore.
In 1996, the Posts &Telegraphs Department was transformed into the autonomous state owned Corporation with trading name Bhutan Post and has issued a steady�number of sets of postcards as follows:
a) A set of some three postcards showing the traditional dress of Laya and Merak & Sakten.
b) A set of 18 postcards showing mask dances, dzongs, lhakhangs and chortens, lakes, a mountain, and Buddhist symbols and figures (the East, South, West and North Guardian).
In the year 2000, �set of 6 postcards showing multi colored gouache ink style drawings of dzongs under the heading �Welcome to the 2000 New Millenium� as follows:
each card carries at the back side, the official �25 Years of Enthronement� logo with the raven crown.
left side of the back has been colored light grey.
�BHUTAN POST� is printed in large capitals at the back in the lower left corner but no logo
In 2001, a set of 10 postcards, with showing local animals, lhakhangs, some landscapes, rhododendrons and a girl at a festival. The new Bhutan Post logo (black and white) is used with the slogan �Bhutan Post Your Friendly Service Provider� .
Also in 2001, a set of 14 postcards, using pictures of dzongs, lhakhangs, Chorten Kora, the Chomolhari and Tshankha Village in Trongsa. Bhutan Post logo is used in color but without the slogan �Your Friendly Service Provider�.
In 2008, on the occasion of the participation of Bhutan to the Smithsonian Folklife Festival (25 June – 6 July 2008) in Washington DC, Bhutan Post issued a set of�4 postcards as follows:
imprinted "Color Your Own" postage stamps
four different postcards with each a different picture and imprinted post stamp, all under the theme �From gratitude springs happiness�.
Had one picture of a drawing showing the �Four Friends� and three cards with photos of prayer flags at a chorten, traditional dancers in the courtyard of a dzong, and of a red mask, the latter representing according to the title of the postcard "Gross National Happiness".
stamps designs use stylized drawings of four auspicious Buddhist symbols: the Endless Knot, the Conch Shell, the Parasol, and the Lotus.
In the 20th February 2008 issue, Kuensel (Bhutanese newspaper) published on the occasion of the 28th Birth Anniversary of His Majesty, a set of 7 thin carton pages with each 4 post cards on them, so 28 different postcards in all, which (in cooperation with Bhutan Post) could be posted for free the next three days (21, 22 and 23 February 2008) to destinations within Bhutan. The postcards had to be cut out of the pages by hand.
In 2010, a set of 17 different picture post cards, all of the 5th King Jigme Khesar�Namgyel Wangchuck in remarkable metallic-like colors was issued.

redpajama_set_name: RedPajamaCommonCrawl


NOT in a flood zone! This super cute home has two updated baths, beautiful hardwood floors, a spacious master suite and CENTRAL AIR! Windows are updated and the roof is approximately 5 years old. Washer and dryer stay! Don't miss out on this great home!


Patricia "Bonnie" Pointer (born on July 11, 1951 in Oakland, California) is an American R&B and disco singer most notable for being the next-to-youngest member of the popular 1970s and 1980s family music group, The Pointer Sisters.
She scored several solo hits after leaving the Pointers in 1977 including a disco cover of the Elgins' "Heaven Must Have Sent You" in 1978.Bonnie and youngest sister June began singing together as teenagers and in 1969 the duo had co-founded The Pointers (otherwise known as The Pair).
After Anita joined the duo that same year, they changed their name to The Pointer Sisters and recorded several singles for Atlantic between 1971 and 1972. In 1972, they recruited oldest sister Ruth and released their debut as The Pointer Sisters in 1973.
Their self-titled debut yielded the big hit, "Yes We Can Can", which put the Pointers on the musical map.Between 1973 and 1977, the Pointers' original look - displaying 1940s fashions and singing in a style reminiscent of the Andrew Sisters, the group also melded the sounds of R&B, funk, rock & roll, gospel, country and soul.
It was Anita and Bonnie who wrote the group's crossover country hit, "Fairytale," in 1974, which also became a top 20 pop hit and helped won the group their first Grammy for country. Anita and Bonnie also were nominated for Best Country Song at the same ceremony.
In 1977, the group was hit professionally after Bonnie suddenly left the group to begin a solo career leaving the quartet a trio. Fortunately for the Pointer Sisters, they continued scoring hits into the late-1980s finding super-stardom with their 1983 album, Break Out and issuing '80s hits such as "He's So Shy", "Slow Hand", "I'm so Excited," "Jump (for My Love)," "Automatic" and "Neutron Dance".
Signing with Motown in 1978, Pointer released the classic disco single, "Heaven Must Have Sent You." She would release three solo albums, including two self-titled albums for Motown, before retiring from the studio though she still continues to perform.
Bonnie reunited with her sisters on two separate occasions: reuniting with them as the group received a star on the Hollywood Walk of Fame in 1994 and another performing with them in 1996 singing "Jump (For My Love)" during a performance in Las Vegas.
In 2006, shortly after the death of sister June, she appeared on Entertainment Tonight, saying her sisters had not fulfilled June's burial wishes instead cremating her because it was cheaper. Also she claimed that Anita and Ruth refused to let her ride in the family car at the funeral.
The sisters responded that Bonnie demanded to be let back in the group or she would not come to the funeral. Bonnie and her sisters, who have had many conflicts since she left the group, are now estranged.
Bonnie Pointer performs dance, disco, soul music and can be booked for (private) corporate events, personal appearances, or other music performances. The estimated booking fee range to book Bonnie Pointer for your event is $20,000 - $50,000. Bonnie Pointer has more than 15.9K listeners worldwide and really knows how to entertain your audience. Similar artists are Carol Williams, Rick Dees, Madleen Kane . Contact AAE Music agency for ratings, reviews, videos and information on scheduling Bonnie Pointer for an upcoming event.


text:
Supa Dupa Fly est le premier album studio de Missy Elliott, sorti le .

L'album s'est classé  au Top R&B/Hip-Hop Albums et  au Billboard 200 et a été certifié disque de platine par la Recording Industry Association of America (RIAA) le .

Le magazine Rolling Stone l'a classé à la  des « 100 meilleurs albums des années 90 ».

Il est également cité dans l'ouvrage de référence de Robert Dimery Les 1001 albums qu'il faut avoir écoutés dans sa vie.

Liste des titres
Tous les titres sont produits par Timbaland, à l'exception de Release the Tension produit par Missy Elliott.

Notes et références

Album de Missy Elliott
Premier album musical sorti en 1997
Album produit par Timbaland
Album publié par Elektra Records
Album numéro un au Top R&B/Hip-Hop Albums
Album certifié disque de platine aux États-Unis

redpajama_set_name: RedPajamaWikipedia


With top team development your senior team is able to fully access its expertise and leverage its collective competencies. Success is sure to follow, leading to accomplishments great and small. As leaders and guardians of organizational culture, your top team leads by example and creates a resilient foundation for others and their ability to collaborate effectively.
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Cultivating self-awareness on an individual level helps your team works from a mind-set of openness and accountability, rather than from a position of protection, blame, fear or ignorance.
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Posted on August 03, 2013 at 5:00:22 am by Rob H.
No one told us this one. Everybody told us the hard parts of having children. Changing diapers. Random Puking. Endless Laundry. But nobody warned us about how gosh-darned difficult it would be to simply pick a place for dinner.
It was hard enough when we were just a couple of crazy kids trying to decide what sounded good. There were plenty of "I don't care"s and "Whatever you want"s and "Just pick something!"s until we would finally make a choice and jump in the car.
Most parents have learned these tricks and are prepared with toys, books, and easy snacks just in case their little ones get a case of the Squirmies, but any restaurant that can cover the food and entertainment for us saves a lot of packing and unpacking. For that, we thank you. If you're a parent, here are five Fort Wayne choices that might make the "What's for dinner?" conversation a bit easier.
Flanagan's knows how to cater to a wide variety of diners. For the adults, they have hearty meals and great drink choices, but they make my list because they also have a bunch of great meal choices for kids, and they've placed a boatload of random stuff on their walls. From the neon signs, to the toy trains, to the authentic carousel horses, my son is consistently entertained just by looking around. Granted, I sometimes wonder if the multitude of stuff blows his mind, but hey, he's having fun.
While the actual room may not be that exciting, the real reason to bring your young ones to the Window Garden is for the amazing view of Fort Wayne from the 13th floor of the One Summit Square building. They offer inexpensive cafeteria-style dining, but you should probably nab a spot near the window to make sure your kids will stay at the table long enough to eat. Chances are, they'll want to keep checking out the view. The Window Garden Cafe is only open for breakfast and lunch, so plan accordingly, but it's a fun way to start your day!
I really tried to stick with locally owned restaurants on this list, but after taking my son to Quaker Steak and Lube, I can't in good conscience leave this one out. Our kid is a car freak, and any restaurant that has a real NASCAR Sprint Cup car right outside its doors is an obvious favorite. But it doesn't stop outside. The interior of Quaker Steak is covered in pictures of cars and car parts, and if the #3 parked outside wasn't enough, there are more vehicles hanging from the ceiling. Just to send the excitement meter directly into the red, the kids meals are served in a snazzy cardboard car that they can take home (be sure to remove the mac and cheese cup to ensure minimal cheddar smearage, trust me). Be prepared, however. If your son or daughter is a fan of cars, your first Quaker Steak visit may be a little overwhelming...for everyone. Don't worry. It gets easier, and more fun, each time you go back.
The last entry on my list is a little more mellow. Friends is a cozy little place at the end of a small strip at the northwest corner of Lima Road and Dupont Road, tucked behind the Marathon Station. They are locally owned and they serve some of the best Greek food in town, which is something the wife and I really like, but they also have a wide variety of food, so we're always able to find something our son likes as well. Breakfast? Check. Burgers? Yep. French fries? Uh-huh, and good ones at that! Heck, our picky eater has even enjoyed some gyro meat from time to time (well played, Friends!). The service is great and quick so he never has to wait too long for something to munch on. Plus, the name is accurate because there's such a friendly atmosphere that he has a great time just watching the other diners and greeting people as they come in.
www.friendsrestaurants.com There are certainly more fantastic places out there that are great for a kid-friendly dinner, and all children have different interests, so your list may vary. However, this should give you some hope that just because you've decided to enter the land of Kids Meals and Sippy Cups, you aren't doomed to paper bags and drive-thru speakers. Go explore the restaurants in Fort Wayne and find your family-favorites too!


text:
Arsenal vs Aston Villa Match Preview | Team News, Key Men & Predictions
EPL Index > Arsenal > Arsenal vs Aston Villa Match Preview | Team News, Key Men & Predictions
Arsenal need to rebound after an awful result against Watford last week. They blew a 2-0 lead and conceded a record number of shots to the team at the bottom of the table. They'll be back at the Emirates this week against newly promoted Aston Villa. If they can't bounce back in this fixture, the season could go south very quickly.
Aston Villa have struggled in their return to the Premier League with only four points in five matches. They were unable to beat 10-man West Ham on Monday after losing to Crystal Palace prior to the international break. They'll need to get some points against the top sides after dropping some winnable ones. There's no better time to start doing that than now.
Arsenal will continue to miss star striker Alexandre Lacazette through an ankle injury. Hector Bellerin and Kieran Tierney will both miss out after playing for the under-23s on Friday. Sead Kolasinac is a doubt after picking up a knock against Frankfurt.
Villa will be without striker Jonathan Kodjia and centerback James Chester. They could see the return of Matt Targett from his thigh injury.
Arsenal: Pierre-Emerick Aubameyang
Arsenal's only bright spot in the Watford match was Aubameyang. He scored twice to give them their two goal lead, his fourth and fifth goals of the season. He has scored five of Arsenal's eight league goals this season and 10 in his last 10 league matches. Hes one of the best strikers in the league and Arsenal need his goals. They've shown they cannot defend, so they'll need to just outscore teams. Aubameyang is the only way they do that with Lacazette out.
Aston Villa: John McGinn
Arsenal were torn apart in midfield last week. With that in mind, a busy midfielder such as McGinn could thrive against the Gunners. He leads Villa in shots taken and is their only player with both a goal and an assist. If Villa are going to win it will be because they won the midfield battle. McGinn will need to be at the top of his game for that to happen.
Arsenal are a much better team at home than on the road, so they should be able to win here. They haven't been convincing this season, but they should have enough to beat Villa.
Prediction: 3-1 Arsenal
by thejerseyfitz
Follow me on twitter @The_Jersey_Fitz.
Categories: Arsenal, Arsenal (NN), Aston Villa, Aston Villa (NN), EPL Index Featured Article, and EPL Index Match Previews.' 'Tags: AFC, Arsenal, Arsenal (NN), Arsenal Stats, Aston Villa, english Premier league, English Premier League Opta Stats, English Premier League Stats, EPL, EPL Index Match Previews, EPLIndex Match Preview, EPLIndex Match Previews, Premier League Match Preview, and Premier League Previews.
Published by EPL Index
Permalink: http://eplindex.com/83973/arsenal-vs-aston-villa-match-preview-team-news-key-men-predictions.html
Aston Villa vs Arsenal Match Preview | Team News, Stats & Key Men
Aston Villa is coming off of a disappointing loss to West Ham. Villa's games in hand are starting to disappear. They need to start racking up points to climb the table. This is a great chance to get on a roll. Arsenal is struggling with injuries in defense and in goal. That gives Villa's dynamic attack an opportunity to blitz the Gunners and secure three points. Arsenal's good run of results came to an end in a chaotic 2-1 loss …
Arsenal vs Aston Villa Preview | Predictions, Stats and Key Players
Arsenal welcome Aston Villa to the Emirates Stadium during the week, with the two sides having contrasting starts to the season. The Gunners have won all four matches to date and sit top of the table. Meanwhile, Villa have taken just three points from their four matches and Steven Gerrard is under pressure. They have Arsenal and Manchester City in their next two matches, which suggests that it could get worse before it gets better. Last season, Arsenal won both …
Aston Villa Vs Liverpool Preview | Team News, Stats & Key Men
Teams in the Premier League dread the fixture congestion of December, but it seems that the congestion has started already. Less than 72 hours after their respective League Cup victories on Wednesday night, Liverpool and Aston Villa will face up in the league on Saturday evening. The two teams will head into this Premier League fixture knowing that they will also meet again in December (subject to scheduling flexibility by the EFL) as per the League Cup Quarter Final draw …
Arsenal v Tottenham Preview | Team News, Key Men & Predictions
Arsenal come into this North London derby in need of a bounce back. They lost 3-1 to Liverpool last weekend and will need a good result to avoid going into the international break on a significant low. A loss to arch-rivals Tottenham would put a real sour note on the beginning of the season. They'll need to be at their best to avoid that result and keep themselves near the top of the table. Tottenham have struggled to begin the …
Aston Villa vs Chelsea Preview | Team News, Stats & Key Men
Chelsea need to win on the final day of the season, as they travel to face Aston Villa. The Blues have their fate in their own hands, following a win against top four rivals Leicester City during the week. However, they will be wary of a Villa side that have been a threat to the big teams this season. In their last game, they beat Tottenham away from home and they will want to take momentum into next season with …


Eyewash Station Market studies the global Eyewash Station market status and forecast, categorizes the global Eyewash Station market size (value & volume) by manufacturers, type, application, and region. Eyewash Station Market focuses on the top manufacturers in North America, Europe, Japan, China, and other regions (India, Southeast Asia).
Focuses on the key Eyewash Station manufacturers, to study the capacity, production, value, market share and development plans in future.
Regional and country-level analysis of the Eyewash Station market, by end-use.
Browse 153 market data Tables and Figures spread through 124 Pages and in-depth TOC on "Global Eyewash Station Market Research Report 2018"
The fundamental overview of Wall-mounted Emergency Eyewash Station market, revenue statistics, market definition, product scope, industry chain structure and market share are analyzed in this report. Furthermore, the industry policies, definitions, product classification, a variety of applications, production volume, demand and supply statistics of Wall-mounted Emergency Eyewash Station.
The fundamental overview of Vertical Emergency Eyewash Station market, revenue statistics, market definition, product scope, industry chain structure and market share are analyzed in this report. Furthermore, the industry policies, definitions, product classification, a variety of applications, production volume, demand and supply statistics of Vertical Emergency Eyewash Station.
The fundamental overview of Portable Emergency Eyewash Station market, revenue statistics, market definition, product scope, industry chain structure and market share are analyzed in this report. Furthermore, the industry policies, definitions, product classification, a variety of applications, production volume, demand and supply statistics of Portable Emergency Eyewash Station.
The fundamental overview of Portable Eyewash Station market, revenue statistics, market definition, product scope, industry chain structure and market share are analyzed in this report. Furthermore, the industry policies, definitions, product classification, a variety of applications, production volume, demand and supply statistics of Portable Eyewash Station.


Bolt welding means the direct welding metal studs or similar metal fasteners (studs, anchor parts) to the work piece (the base material, generally the plate), featuring higher speed and strength, smaller heat-affected zone and less pollution, which is generally used in various aspects as the automotive, boiler, construction steel structure and ship building.
Threaded fasteners, common pins, open pins and studs can be used in this method with nonferrous metals as low carbon steel, low alloy steel stainless steel and copper.
Compared with ordinary stud welders, the features lighter weight, lower power consumption, more sensitive adjustment and lower fault rate and still good performance under the lowest voltage working conditions. Dual-core welding, and computer dual-core technology, the two main core machine without disturbing each other simultaneously, doubling the speed of construction, to save 30% lower price.
Related products for "RSN7-5000-2 Bolt Welding Machine"


Listening Tips and more Photos!
Hello and Happy Summer Everyone!
Just a quick note – we've added some new screenshots and testimonials from our students here – and tips for daily listening practice with podcasts and audiobooks here. Enjoy!!
And a HUGE welcome to our new students from Valladolid Spain, Los Angeles California, Poland, The Netherlands Antilles in the Caribbean, and Muhu in Estonia!! It's been a great start already!!
We've just added a lot of novels and movies to the reading list – mostly advanced level stuff but some on the intermediate level too. Enjoy here!


text:
Q: specify which jdk to use while having multiple installed I have two JDKs installed on my laptop and I want to run a java program using the command line, my environment variables are set and I want to know how the operating system will know which JDK to use because it is not indicated in the command?
C:\mywork> javac filenamehere.java

A: Generally Windows uses the PATH environment variable to find the first executable with a matching name.
If you want to specify which javac to use, try using the full path to javac.

redpajama_set_name: RedPajamaStackExchange


On November 18, 1994, individuals detained in jail after their court-ordered release filed this class-action lawsuit in the U.S. District Court for the Northern District of Illinois. The plaintiffs sued the sheriff of Cook County under 42 U.S.C. § 1983. The plaintiffs alleged that they were detained for ten hours or more while the corrections staff processed the paperwork after their court-ordered release.
The parties settled the case in 1996 and the court approved the settlement on June 27, 1997. The defendants agreed to pay each class claimant $90 to as many as 65,000 people whose release from the jail was delayed more than 10 hours. They had been inmates sometime between Dec. 2, 1992, and Oct. 1, 1996. The defendants also agreed to pay the plaintiffs' attorney's fees and costs, including costs of settlement. The plaintiffs and their attorney initially petitioned for $1,070,955 in attorney's fees and $80,463.76 in costs. They subsequently filed an additional fee petition seeking additional attorney's fees of $106,601.25 and costs of $15,130.54.
On September 29, 1998, the honorable Judge Elaine Bucklo awarded the plaintiffs $344,094.95 in attorney's fees and $92,196.91 in costs. 1998 WL 708803 (N.D. Ill. 1998).
We have no other information regarding this case.
Plaintiff Description All all persons who have suffered unlawful and prolonged detention in excess of ten hours rather than four hours.


text:
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Dr. Sladic Discusses Irritable Bowel Syndrome (IBS) and Crohn's Disease
SCHEDULE CASE REVIEWFREE HEALTH UPDATES
About IBS:
The primary symptoms of IBS are abdominal pain or discomfort in association with frequent diarrhea or constipation, a change in bowel habits. There may also be urgency for bowel movements, a feeling of incomplete evacuation (tenesmus), bloating or abdominal distention. People with IBS, more commonly than others, have gastro-esophageal reflux, symptoms relating to the genitourinary system, chronic fatigue syndrome, fibromyalgia, headache, backache and psychiatric symptoms such as depression and anxiety. Some studies indicate that up to 60% of persons with IBS also have a psychological disorder, typically anxiety or depression and anxiety.
READ ABOUT CAUSES OF IBS
The cause of IBS is unknown, but several hypotheses have been proposed. The risk of developing IBS increases six-fold after acute gastrointestinal infection. Post-infection, further risk factors are young age, prolonged fever, anxiety, and depression. Publications suggesting the role of brain-gut "axis" appeared in the 1990s, such as a study entitled Brain-gut response to stress and cholinergic stimulation in IBS published in the Journal of Clinical Gastroenterology in 1993. A 1997 study published in Gut magazine suggested that IBS was associated with a "derailing of the brain-gut axis." Psychological factors may be important in the etiology of IBS.
Active infections: Prevalence of protozoal infections in industrialized countries (United States and Canada) in 21st century:
There is research to support IBS being caused by an as-yet undiscovered active infection. Other researchers have focused on an unrecognized protozoal infection as a cause of IBS as certain protozoal infections occur more frequently in IBS patients. Two of the protozoa investigated have a high prevalence in industrialized countries and infect the bowel, but little is known about them as they are recently emerged pathogens.
Blastocystis is a single-cell organism that has been reported to produce symptoms of abdominal pain, constipation and diarrhea in patients though these reports are contested by some physicians. Studies from research hospitals in various countries have identified high Blastocystis infection rates in IBS patients, with 38% being reported from London School of Hygiene & Tropical Medicine, 47% reported from the Department of Gastroenterology at Aga Khan University in Pakistan and 18.1% reported from the Institute of Diseases and Public Health at University of Ancona in Italy. Reports from all three groups indicate a Blastocystis prevalence of approximately 7% in non-IBS patients. Researchers have noted that clinical diagnostics fail to identify infection, and Blastocystis may not respond to treatment with common antiprotozoals.
Dientamoeba fragilis is a single-cell organism that produces abdominal pain and diarrhea. Studies have reported a high incidence of infection in developed countries, and symptoms of patients resolve following antibiotic treatment. One study reported on a large group of patients with IBS-like symptoms who were found to be infected with Dientamoeba fragilis, and experienced resolution of symptoms following treatment. Researchers have noted that methods used clinically may fail to detect some Dientamoeba fragilis infections. It is also found in people without IBS.
READ ABOUT DIAGNOSIS OF IBS
There is no specific laboratory or imaging test that can be performed to diagnose irritable bowel syndrome. Diagnosis of IBS involves excluding conditions that produce IBS-like symptoms, and then following a procedure to categorize the patient's symptoms. Ruling out parasitic infections, lactose intolerance, small intestinal bacterial overgrowth and celiac disease is recommended for all patients before a diagnosis of irritable bowel syndrome is made. In patients over 50 years old it is recommended that they undergo a screening colonoscopy.
Colon cancer, inflammatory bowel disease, thyroid disorders and giardiasis can all feature abnormal defecation and abdominal pain. Less common causes of this symptom profile are carcinoid syndrome, microscopic colitis, bacterial overgrowth, and eosinophilic gastroenteritis. IBS is, however, such a common presentation and testing for these conditions would yield such low numbers of positive results that it is considered difficult to justify the expense. Because there are many causes of diarrhea that give IBS-like symptoms, the American Gastroenterological Association published a set of guidelines for tests to be performed to rule out other causes for these symptoms. These include gastrointestinal infections, lactose intolerance, and coeliac disease. Research has suggested that these guidelines are not always followed. Physicians may choose to use one of these guidelines, or may simply choose to rely on their own anecdotal experience with past patients. The guidelines may include additional tests to guard against misdiagnosis of other diseases as IBS. Such "red flag" symptoms may include weight loss, gastrointestinal bleeding, anemia, or nocturnal symptoms. However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis — for instance, as many as 31% of IBS patients have blood in their stool many possibly from hemorrhoidal bleeding.
The diagnostic algorithm identifies a name that can be applied to the patient's condition based on the combination of the patient's symptoms of diarrhea, abdominal pain, and constipation. For example, the statement "50% of returning travelers had developed functional diarrhea while 25% had developed IBS" would mean that half the travelers had diarrhea while a quarter had diarrhea with abdominal pain. While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested that all IBS patients have the same underlying disease but with different symptoms. On this line is a recent study, which showed that constipation and/or diarrhea seems to be different manifestations of the same underlying condition, that is a build-up of fecal retention reservoirs in the colon. Abdominal X-rays were analyzed for colon transit time and fecal distribution, which correlated significantly with bloating and abdominal pain. Thus a group of patients were identified with an increased fecal loading compared to controls, but having a colon transit time equal or less to the controls. This suggests that defecation patterns do not reflect the amount of feces in the colon and is called hidden constipation. This phenomenon may be linked to bacterial overgrowth.
Published research has demonstrated that some poor patient outcomes are due to treatable causes of diarrhea being misdiagnosed as IBS. Common examples include infectious diseases, coeliac disease, Helicobacter pylori, and parasites.
Celiac disease in particular is often misdiagnosed as IBS. The American College of Gastroenterology recommends that all patients with symptoms of IBS be tested for celiac disease. Chronic use of certain sedative-hypnotic drugs especially the benzodiazepines may cause irritable bowel like symptoms that can lead to a misdiagnosis of irritable bowel syndrome.
Researchers have identified several medical conditions, or comorbidities, which appear with greater frequency in patients diagnosed with IBS.
Headache, Fibromyalgia, Chronic fatigue syndrome and Depression: A study of 97,593 individuals with IBS identified co-morbidities as headache, fibromyalgia, and depression. A systematic review found that IBS occurs in 51% of chronic fatigue syndrome patients and 49% of fibromyalgia patients, and psychiatric disorders were found to occur in 94% of IBS patients.
Inflammatory bowel disease (IBD): Some researchers have suggested that IBS is a type of low-grade inflammatory bowel disease. Researchers have suggested that IBS and IBD are interrelated diseases, noting that patients with IBD experience IBS-like symptoms when their IBD is in remission. A 3-year study found that patients diagnosed with IBS were 16.3 times more likely to be diagnosed with IBD during the study period. Serum markers associated with inflammation have also been found in patients with IBS (see Causes).
Abdominal surgery: A recent (2008) study found that IBS patients are at increased risk of having unnecessary cholecystectomy (gall bladder removal surgery) not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications. A 2005 study reported that IBS patients are 87% more likely to undergo abdominal and pelvic surgery, and three times more likely to undergo gallbladder surgery. A study published in Gastroenterology came to similar conclusions, and also noted IBS patients were twice as likely to undergo hysterectomy.
Endometriosis: One study reported a statistically significant link between migraine headaches, IBS, and endometriosis.
Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia.
READ ABOUT DIET AND IBS
Some people with IBS are likely to have food intolerances. In 2007 the evidence base was not strong enough to recommend restrictive diets.
Many different dietary modifications have been attempted to improve the symptoms of IBS. Some are effective in certain sub-populations. As lactose intolerance and IBS have such similar symptoms a trial of a lactose free diet is often recommended. A diet restricting fructose and fructan intake has been shown to successfully treat the symptoms in a dose-dependant manner in patients with fructose mal-absorption and IBS.
While many IBS patients believe they have some form of dietary intolerance, tests attempting to predict food sensitivity in IBS have been disappointing. One study reported that an IgG antibody test was effective in determining food sensitivity in IBS patients, with patients on the elimination diet experiencing 10% greater symptom reduction than those on a sham diet.
There is no evidence that digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS. However, the very act of eating or drinking can provoke an overreaction of the gastrocolic response in some patients with IBS due to their heightened visceral sensitivity, and this may lead to abdominal pain, diarrhea, and/or constipation.
Gibson and Shepherd state a diet restricted in fermentable oligo di and monosaccharides and polyols (FODMAPS) now has an evidence base sufficiently strong to recommend its widespread application in conditions such as IBS and IBD. They also state the restriction of FODMAPs globally, rather than individually, controls the symptoms of functional gut disorders (e.g., IBS), and the majority of IBD patients respond just as well. It is more successful than restricting only fructose and fructans, which are also FODMAPs, as is recommended for those with fructose malabsorption. Longer term compliance with the diet was high.
A randomized controlled trial on IBS patients found relaxing an IgG-mediated food intolerance diet led to a 24% greater deterioration in symptoms compared to those on the elimination diet and concluded food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.
Further information: NIH funding of IBS Research
READ ABOUT HISTORY OF IBS
One of the first references to the concept of an "irritable bowel" appeared in the Rocky Mountain Medical Journal in 1950.
The term was used to categorize patients who developed symptoms of diarrhea, abdominal pain, constipation, but where no well-recognized infective cause could be found. Early theories suggested that the irritable bowel was caused by a psychosomatic or mental disorder since no physical manifestation was found.
IBS can be classified as either diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) or IBS with alternating stool pattern (IBS-A or pain-predominant). In some individuals, IBS may have an acute onset and develop after an infectious illness characterized by two or more of the following: fever, vomiting, diarrhea, or positive stool culture. This post-infective syndrome has consequently been termed "post-infectious IBS" (IBS-PI).
More About Digestive Disorders
Managing IBS, Crohn's and Colitis Naturally
Intro to IBS, Crohn's and Colitis
IBS and Celiac Disease
Colitis and IBS
About Crohn's Disease:
Crohn's disease, also known as regional enteritis, is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is at its worst), vomiting, or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye, tiredness, and lack of concentration.
Crohn's disease is thought to be an autoimmune disease, in which the body's immune system attacks the gastrointestinal tract, causing inflammation; it is classified as a type of inflammatory bowel disease. There is evidence of a genetic link to Crohn's disease, putting individuals with siblings afflicted with the disease at higher risk. It is thought to have a large environmental component as evidenced by a higher incidence in western industrialized nations compared to other parts of the world. Males and females are equally affected. Smokers are two times more likely to develop Crohn's disease than nonsmokers. Crohn's disease effects between 400,000 and 600,000 people in North America. Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000. Crohn's disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age.
There is no known pharmaceutical or surgical cure for Crohn's disease. Treatment options are restricted to controlling symptoms, maintaining remission, and preventing relapse.
READ ABOUT SYMPTOMS OF CROHN'S DISEASE
Gastrointestinal symptoms:
Many people with Crohn's disease have symptoms for years prior to the diagnosis. The usual onset is between 15 and 30 years of age, but can occur at any age. Because of the 'patchy' nature of the gastrointestinal disease and the depth of tissue involvement, initial symptoms can be more subtle than those of ulcerative colitis. People with Crohn's disease experience chronic recurring periods of flare-ups and remission.
Abdominal pain may be the initial symptom of Crohn's disease. It is often accompanied by diarrhea, especially in those who have had surgery. The diarrhea may or may not be bloody. People who have had surgery or multiple surgeries often end up with short bowel syndrome of the gastrointestinal tract. The nature of the diarrhea in Crohn's disease depends on the part of the small intestine or colon involved. Ileitis typically results in large-volume, watery feces. Colitis may result in a smaller volume of feces of higher frequency. Fecal consistency may range from solid to watery. In severe cases, an individual may have more than 20 bowel movements per day and may need to awaken at night to defecate. Visible bleeding in the feces is less common in Crohn's disease than in ulcerative colitis, but may be seen in the setting of Crohn's colitis. Bloody bowel movements are typically intermittent, and may be bright or dark red in color. In the setting of severe Crohn's colitis, bleeding may be copious. Flatulence and bloating may also add to the intestinal discomfort.
Symptoms caused by intestinal stenosis are also common in Crohn's disease. Abdominal pain is often most severe in areas of the bowel with stenosis. In the setting of severe stenosis, vomiting and nausea may indicate the beginnings of small bowel obstruction. Although the association is greater in the context of ulcerative colitis, Crohn's disease may also be associated with primary sclerosing cholangitis, a type of inflammation of the bile ducts.
Perianal discomfort may also be prominent in Crohn's disease. Itchiness or pain around the anus may be suggestive of inflammation, fistulization or abscess around the anal area or anal fissure. Perianal skin tags are also common in Crohn's disease. Fecal incontinence may accompany perianal Crohn's disease. At the opposite end of the gastrointestinal tract, the mouth may be affected by non-healing sores (aphthous ulcers). Rarely, the esophagus, and stomach may be involved in Crohn's disease. These can cause symptoms including difficulty swallowing (dysphagia), upper abdominal pain, and vomiting.
Systemic symptoms:
Crohn's disease, like many other chronic, inflammatory diseases, can cause a variety of systemic symptoms. Among children, growth failure is common. Many children are first diagnosed with Crohn's disease based on inability to maintain growth. As it may manifest at the time of the growth spurt in puberty, up to 30% of children with Crohn's disease may have retardation of growth. Fever may also be present, though fevers greater than 101.3 ?F are uncommon unless there is a complication such as an abscess. Among older individuals, Crohn's disease may manifest as weight loss, usually related to decreased food intake, since individuals with intestinal symptoms from Crohn's disease often feel better when they do not eat and might lose their appetite. People with extensive small intestine disease may also have malabsorption of carbohydrates or lipids, which can further exacerbate weight loss.
Extraintestinal symptoms:
In addition to systemic and gastrointestinal involvement, Crohn's disease can effect many other organ systems. Inflammation of the interior portion of the eye, known as uveitis, can cause eye pain, especially when exposed to light (photophobia). Inflammation may also involve the white part of the eye (sclera), a condition called episcleritis. Both episcleritis and uveitis can lead to loss of vision if untreated.
Crohn's disease is associated with a type of rheumatologic disease known as seronegative spondyloarthropathy. This group of diseases is characterized by inflammation of one or more joints (arthritis) or muscle insertions (enthesitis). The arthritis can affect larger joints, such as the knee or shoulder, or may exclusively involve the small joints of the hands and feet. The arthritis may also involve the spine, leading to ankylosing spondylitis if the entire spine is involved or simply sacroiliitis if only the lower spine is involved. The symptoms of arthritis include painful, warm, swollen, stiff joints and loss of joint mobility or function.
Crohn's disease may also involve the skin, blood, and endocrine system. One type of skin manifestation, erythema nodosum, presents as red nodules usually appearing on the shins. Erythema nodosum is due to inflammation of the underlying subcutaneous tissue, and is characterized by septal panniculitis. Another skin lesion, pyoderma gangrenosum, is typically a painful ulcerating nodule. Crohn's disease also increases the risk of blood clots; painful swelling of the lower legs can be a sign of deep venous thrombosis, while difficulty breathing may be a result of pulmonary embolism. Autoimmune hemolytic anemia, a condition in which the immune system attacks the red blood cells, is also more common in Crohn's disease and may cause fatigue, pallor, and other symptoms common in anemia. Clubbing, a deformity of the ends of the fingers, may also be a result of Crohn's disease. Finally, Crohn's disease may cause osteoporosis, or thinning of the bones. Individuals with osteoporosis are at increased risk of bone fractures.
Crohn's disease can also cause neurological complications (reportedly in up to 15% of patients).[27] The most common of these are seizures, stroke, myopathy, peripheral neuropathy, headache and depression.[27]
Crohn's patients often also have issues with small bowel bacterial overgrowth syndrome, which has similar symptoms.
Crohn's disease can lead to several mechanical complications within the intestines, including obstruction, fistulae, and abscesses. Obstruction typically occurs from strictures or adhesions that narrow the lumen, blocking the passage of the intestinal contents. Fistulae can develop between two loops of bowel, between the bowel and bladder, between the bowel and vagina, and between the bowel and skin. Abscesses are walled off collections of infection, which can occur in the abdomen or in the perianal area in Crohn's disease sufferers. Crohn's is responsible for 10% of vesicoenteric fistulae, and is the most common cause of ileovesical fistulae.
Crohn's disease also increases the risk of cancer in the area of inflammation. For example, individuals with Crohn's disease involving the small bowel are at higher risk for small intestinal cancer. Similarly, people with Crohn's colitis have a relative risk of 5.6 for developing colon cancer. Screening for colon cancer with colonoscopy is recommended for anyone who has had Crohn's colitis for at least eight years. Some studies suggest there is a role for chemoprotection in the prevention of colorectal cancer in Crohn's involving the colon; two agents have been suggested, folate and mesalamine preparations.
Individuals with Crohn's disease are at risk of malnutrition for many reasons, including decreased food intake and malabsorption. The risk increases following resection of the small bowel. Such individuals may require oral supplements to increase their caloric intake, or in severe cases, total parenteral nutrition (TPN). Most people with moderate or severe Crohn's disease are referred to a dietitian for assistance in nutrition.
Crohn's disease can cause significant complications, including bowel obstruction, abscesses, free perforation and hemorrhage.
Crohn's disease can be problematic during pregnancy, and some medications can cause adverse outcomes for the fetus or mother. Consultation with an obstetrician and gastroenterologist about Crohn's disease and all medications allows preventative measures to be taken. In some cases, remission can occur during pregnancy. Certain medications can also impact sperm count or may otherwise adversely affect a man's ability to conceive.
READ ABOUT CAUSES OF CROHN'S DISEASE
Although the exact cause of Crohn's disease is still unknown, a combination of environmental factors and genetic predisposition seems to cause the disease. The genetic risk factors have now more or less been comprehensively elucidated, making Crohn's disease the first genetically complex disease of which the genetic background has been resolved. The relative risks of contracting the disease when one has a mutation in one of the risk genes, however, are actually very low (approximately 1:200). In broad terms, the genetic data indicate the innate immune systems in patients with Crohn's disease malfunction, and direct assessment of patient immunity confirms this notion. This had led to the notion Crohn's disease should be viewed as innate immune deficiency, chronic inflammation being caused by adaptive immunity trying to compensate for the reduced function of the innate immune system.
Some research has indicated Crohn's disease may have a genetic link. The disease runs in families and those with a sibling with the disease are 30 times more likely to develop it than the general population.
Mutations in the CARD15 gene (also known as the NOD2 gene) are associated with Crohn's disease and with susceptibility to certain phenotypes of disease location and activity. In earlier studies, only two genes were linked to Crohn's, but scientists now believe over thirty genes show genetics play a role in the disease, either directly through causation or indirectly, as with a mediator variable. Anomalies in the XBP1 gene have recently been identified as a factor, pointing towards a role for the unfolded protein response pathway of the endoplasmatic reticulum in inflammatory bowel diseases.
Diet is believed to be linked to its higher prevalence in industrialized parts of the world. A positive correlation has been found between the incidence of the disease and an increased intake of animal protein, milk protein and an increased ratio of omega-6 to omega-3 polyunsaturated fatty acids. Negative correlation of the disease incidence was found to the increased consumption of vegetable protein, and no correlation to fish protein. Smoking has been shown to increase the risk of the return of active disease, or "flares". The introduction of hormonal contraception in the United States in the 1960s is linked with a dramatic increase in the incidence rate of Crohn's disease. Although a causal linkage has not been effectively shown, there remain fears these drugs work on the digestive system in ways similar to smoking. Several scientific studies have posited isotretinoin is a possible cause of Crohn's disease in some individuals.
Abnormalities in the immune system have often been invoked as being causes of Crohn's disease. It is thought to be an autoimmune disease, with inflammation stimulated by an overactive Th1 cytokine response. However, more recent evidence has shown Th17 is of greater importance in the disease. The most recent gene to be implicated in Crohn's disease is ATG16L1, which may induce autophagy and hinder the body's ability to attack invasive bacteria.
Contrary to the prevailing view that Crohn's disease is a primary T cell autoimmune disorder, there is an increasing body of evidence in favor of the hypothesis that Crohn's disease results from an impaired innate immunity. The immunodeficiency, which has been shown to be due (at least in part) to impaired cytokine secretion by macrophages, is thought to lead to a sustained microbial-induced inflammatory response, in particular, in the colon where the bacterial load is especially high.
A variety of pathogenic bacteria were initially suspected of being causative agents of Crohn's disease. However, most healthcare professionals now believe a variety of microorganisms are taking advantage of their host's weakened mucosal layer and inability to clear bacteria from the intestinal walls, both symptoms of the disease. Some studies have suggested Mycobacterium avium subspecies paratuberculosis (MAP) plays a role in Crohn's disease, in part because it causes a very similar disease, Johne's disease, in cattle. The mannose-bearing antigens (mannins) from yeast may also elicit an antibody response. Other studies have linked specific strains of enteroadherent E. coli to the disease. Still, this relationship between specific types of bacteria and Crohn's disease remains unclear.
Some studies have suggested some symptoms of Crohn's disease, ulcerative colitis and irritable bowel syndrome have the same underlying cause. Biopsy samples taken from the colons of all three patient groups were found to produce elevated levels of a serine protease. Experimental introduction of the serine protease into mice has been found to produce widespread pain associated with irritable bowel syndrome, as well as colitis, which is associated with all three diseases. The authors of that study were unable to identify the source of the protease, but a separate review noted regional and temporal variations in those illnesses follow those associated with infection with a poorly understood protozoan, Blastocystis.
A study in 2003 put forth the "cold-chain" hypothesis that psychrotrophic bacteria such as Yersinia and Listeria species contribute to the disease. A statistical correlation was found between the advent of the use of refrigeration in the United States and various parts of Europe and the rise of the disease. Later studies have provided support for this hypothesis.
Studies done at the University of Liverpool have offered ideas to explain the apparent connection between Crohn's disease, Mycobacterium, other pathogenic bacteria, and genetic markers. In many individuals, genetic factors predispose individuals to Mycobacterium avium subsp. paratuberculosis infection. This bacterium then produces mannins, which protect both itself and various bacteria from phagocytosis, which causes a variety of secondary infections.
During a colonoscopy, biopsies of the colon are often taken to confirm the diagnosis. Certain characteristic features of the pathology seen point toward Crohn's disease; it shows a transmural pattern of inflammation, meaning the inflammation may span the entire depth of the intestinal wall. Ulceration is an outcome seen in highly active disease. There is usually an abrupt transition between unaffected tissue and the ulcer. Under a microscope, biopsies of the affected colon may show mucosal inflammation, characterized by focal infiltration of neutrophils, a type of inflammatory cell, into the epithelium. This typically occurs in the area overlying lymphoid aggregates. These neutrophils, along with mononuclear cells, may infiltrate the crypts, leading to inflammation (crypititis) or abscess (crypt abscess). Granulomas, aggregates of macrophage derivatives known as giant cells, are found in 50% of cases and are most specific for Crohn's disease. The granulomas of Crohn's disease do not show "caseation", a cheese-like appearance on microscopic examination characteristic of granulomas associated with infections, such as tuberculosis. Biopsies may also show chronic mucosal damage, as evidenced by blunting of the intestinal villi, atypical branching of the crypts, and a change in the tissue type (metaplasia). One example of such metaplasia, Paneth cell metaplasia, involves development of Paneth cells (typically found in the small intestine) in other parts of the gastrointestinal system.
READ ABOUT DIAGNOSIS OF CROHN'S DISEASE
The diagnosis of Crohn's disease can sometimes be challenging, and a number of tests are often required to assist the physician in making the diagnosis. Even with a full battery of tests, it may not be possible to diagnose Crohn's with complete certainty; a colonoscopy is approximately 70% effective in diagnosing the disease, with further tests being less effective. Disease in the small bowel is particularly difficult to diagnose, as a traditional colonoscopy allows access to only the colon and lower portions of the small intestines; introduction of the capsule endoscopy aids in endoscopic diagnosis. Multinucleated giant cells, a common finding in the lesions of Crohn's disease, are less common in the lesions of lichen nitidus.
A colonoscopy is the best test for making the diagnosis of Crohn's disease, as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of disease involvement. On occasion, the colonoscope can travel past the terminal ileum, but it varies from patient to patient. During the procedure, the gastroenterologist can also perform a biopsy, taking small samples of tissue for laboratory analysis, which may help confirm a diagnosis. As 30% of Crohn's disease involves only the ileum, cannulation of the terminal ileum is required in making the diagnosis. Finding a patchy distribution of disease, with involvement of the colon or ileum, but not the rectum, is suggestive of Crohn's disease, as are other endoscopic stigmata. The utility of capsule endoscopy for this, however, is still uncertain.
Radiologic tests
A small bowel follow-through may suggest the diagnosis of Crohn's disease and is useful when the disease involves only the small intestine. Because colonoscopy and gastroscopy allow direct visualization of only the terminal ileum and beginning of the duodenum, they cannot be used to evaluate the remainder of the small intestine. As a result, a barium follow-through X-ray, wherein barium sulfate suspension is ingested and fluoroscopic images of the bowel are taken over time, is useful for looking for inflammation and narrowing of the small bowel. Barium enemas, in which barium is inserted into the rectum and fluoroscopy is used to image the bowel, are rarely used in the work-up of Crohn's disease due to the advent of colonoscopy. They remain useful for identifying anatomical abnormalities when strictures of the colon are too small for a colonoscope to pass through, or in the detection of colonic fistulae.
CT and MRI scans are useful for evaluating the small bowel with enteroclysis protocols.They are also useful for looking for intra-abdominal complications of Crohn's disease, such as abscesses, small bowel obstructions, or fistulae. Magnetic resonance imaging (MRI) is another option for imaging the small bowel as well as looking for complications, though it is more expensive and less readily available
Multiphase white blood cell scans have been shown to be effective in detecting the locations of active Crohn's disease, particularly in hard to diagnose patients suffering with the early stages or a mild form of the disease with negative endoscopic and radiologic findings. The procedure, a type of nuclear medicine, uses white blood cells removed from the patient; they are tagged with a radioisotope, and then injected intravenously into the patient, and later scanned at several intervals to detect any abnormal white blood cell accumulation, such as pooling in the intestinal tract. Studies have also suggested such scans are useful to monitor the disease and evaluate the effectiveness of therapy.
Comparison with ulcerative colitis
The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.
READ MORE FOR TREATMENT OF CROHN'S DISEASE
At the present time, there is no cure for Crohn's disease and remission may not be possible or prolonged if achieved. In cases where remission is possible, relapse can be prevented and symptoms controlled with medication, lifestyle changes, and, in some cases, surgery. Adequately controlled, Crohn's disease may not significantly restrict daily living. Treatment for Crohn's disease is only when symptoms are active and involve first treating the acute problem, then maintaining remission.
Certain lifestyle changes can reduce symptoms, including dietary adjustments [Elemental diet], proper hydration, and smoking cessation. Smoking may increase Crohn's disease; stopping is recommended. Eating small meals frequently instead of big meals may also help with a low appetite. To manage symptoms have a balanced diet with proper portion control. Fatigue can be helped with regular exercise, a healthy diet, and enough sleep. A food diary may help with identifying foods that trigger symptoms. Some patients should follow a low dietary fiber diet to control symptoms especially if fibrous foods cause symptoms.
Crohn's cannot be cured by surgery, though it is used when partial or a full blockage of the intestine occurs. Surgery may also be required for complications such as obstructions, fistulas and/or abscesses, or if the disease does not respond to drugs. After the first surgery, Crohn's usually shows up at the site of the resection, however it can appear in other locations. After a resection, scar tissue builds up, which can cause strictures, which form when the intestines become too small to allow excrement to pass through easily, which can lead to a blockage. After the first resection, another resection may be necessary within five years. For patients with an obstruction due to a stricture, two options for treatment are strictureplasty and resection of that portion of bowel. There is no statistical significance between strictureplasty alone versus strictureplasty and resection in cases of duodenal involvement. In these cases, re-operation rates were 31% and 27%, respectively, indicating that strictureplasty is a safe and effective treatment for selected patients with duodenal involvement.
Short bowel syndrome (SBS, also short gut syndrome or simply short gut) can be caused by the surgical removal of the small intestines. It usually develops in those having had half or more of their small intestines removed. Diarrhea is the main symptom of short bowel syndrome, however other symptoms may include cramping, bloating, and heartburn. Short bowel syndrome is treated with changes in diet, intravenous feeding, vitamin and mineral supplements, and treatment with medications. Another complication following surgery for Crohn's disease in which the terminal ileum has been removed is the development of excessive watery diarrhea. This is due to an inability of the ileum to reabsorb bile acids after resection of the terminal ileum.[citation needed]
In some cases of SBS, intestinal transplant surgery may be considered; though the number of transplant centers offering this procedure is quite small and it comes with a high risk due to the chance of infection and rejection of the transplanted intestine.
Crohn's disease is a chronic condition for which there is currently no cure. It is characterized by periods of improvement followed by episodes when symptoms flare up. With treatment, most people achieve a healthy height and weight, and the mortality rate for the disease is relatively low. However, Crohn's disease is associated with an increased risk of small bowel and colorectal carcinoma, including bowel cancer.
Researchers at University College London have questioned the wisdom of suppressing the immune system in Crohn's, as the problem may be an underactive rather than an overactive immune system: Their study found that Crohn's patients showed an abnormally low response to an introduced infection, marked by a poor flow of blood to the wound.
Since Crohn's is an auto-immune disease it is thought that the body is attacking itself and thusly cannot fight off infection or wounds because it is busy mistakenly fighting itself.
READ ABOUT THE HISTORY OF CROHN'S DISEASE
The disease was named for American gastroenterologist Burrill Bernard Crohn, who, in 1932, together with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness. For this reason, the disease has also been called regional ileitis or regional enteritis. The condition, however, has been independently identified by others in the literature prior, the most notable one being in 1904 by Polish surgeon Antoni Leśniowski for whom the condition is additionally named (Leśniowski-Crohn's disease) in the Polish literature.
Ileitis terminalis was first described by Polish surgeon Antoni Leśniowski in 1904, however, due to the precedence of Crohn's name in the alphabet, it became later to be known in the worldwide literature as Crohn's disease.[citation needed] Only in Poland it continues to be named Leśniowski-Crohn's disease. Burrill Bernard Crohn, an American gasteroenterologist at New York City's Mount Sinai Hospital, described fourteen cases in 1932, and submitted them to the American Medical Association under the rubric of "Terminal ileitis: A new clinical entity". Later that year, he, along with colleagues Leon Ginzburg and Gordon Oppenheimer published the case series as "Regional ileitis: a pathologic and clinical entity".
Distribution of gastrointestinal Crohn's disease, based on data from American Gastroenterological Association:
Crohn's disease is one type of inflammatory bowel disease (IBD). It typically manifests in the gastrointestinal tract and can be categorized by the specific tract region affected. A disease of both the ileum (the last part of the small intestine, which connects to the large intestine), and the large intestine, Ileocolic Crohn's accounts for fifty percent of cases. Crohn's ileitis, manifest in the ileum only, accounts for thirty percent of cases, and Crohn's colitis, of the large intestine, accounts for the remaining twenty percent of cases and may be particularly difficult to distinguish from ulcerative colitis. Gastroduodenal Crohn's disease causes inflammation in the stomach and first part of the small intestine, called the duodenum. Jejunoileitis causes spotty patches of inflammation in the top half of the small intestine, called the jejunum (MedlinePlus 2010). The disease can attack any part of the digestive tract, from mouth to anus. However individuals affected by the disease rarely fall outside these three classifications with presentations in other areas.
Crohn's disease may also be categorized by the behavior of disease as it progresses. These categorizations formalized in the Vienna classification of the disease. There are three categories of disease presentation in Crohn's disease: stricturing, penetrating, and inflammatory. Stricturing disease causes narrowing of the bowel that may lead to bowel obstruction or changes in the caliber of the feces. Penetrating disease creates abnormal passageways (fistulae) between the bowel and other structures, such as the skin. Inflammatory disease (or nonstricturing, nonpenetrating disease) causes inflammation without causing strictures or fistulae.
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The president did not promise that everything he will say will be perfect.
His infamous "sexist remarks on women" dubbed by many arose spite from feminist groups and activists. Their spite is justified because those remarks indirectly hit women's softest parts.
According to Justice Assistant Secretary Aimee Neri in a report, she has witnessed the works of Duterte in eradicating abuse against women in Davao. Duterte ordered a special council in handling violence against women. Through this, we could justify that he does not tolerate abuse.
There might be a lot of reasons why the president have had uttered those words. Those remarks maybe rooted out from his dark humor that he shamelessly displays to lighten up issues. Another maybe rooted out from his personal experiences and come lashing out in the form of frustrating remarks, and we should not take it personally sometimes.
In the end, we should not trust the words that come out from any other person's mouth. Yes, many promote good will and try to keep up images to live up to society's expectations, but they themselves only know if they are genuine in wanting to help others. Though the president may have humoured his alleged attacks on women, we should not also overlook his actions in protecting women in this country.
The world has more women in commerce and government now compared to those years when women are kept at home. We have a voice now. And only us could defend it. Instead of lashing out to others, not only to the president, when they threaten our empowerment, we should work on proving our worth by being better every day and respect other's opinions because it will reflect back at them and not at us in the end.


We all know Assassin's Creed Unity has its problems. It's buggy, broken, and unfinished. It crashes, it can't maintain a solid frame rate or even the integrity of its characters' faces. French people caught up in the French Revolution speak in thick English accents. But now that some patches have dropped and the game is (more or less) playable, we can finally see its good side: it's shockingly ambitious, even bold, and all sorts of fun. It also makes tons of smart changes to the series, fixing or at least addressing many long-standing problems.
The answer is simple. When trying to figure out what accent would be best-suited to the time period and the location, the development team took a tip from Hollywood. British accents, they determined, just have more of a period feel than an American accent would. It gives the distinct feeling of being set in the past in a foreign place.
That's a pretty audacious line of logic, but here's the beautiful thing about Unity: it's multilingual. I played the entire game from start to finish in French with English subtitles, and it made the whole experience feel authentic. Even if Ubisoft's decision to record the main dialogue in British-English makes no sense, it's truly commendable that they've given the player their choice of languages, even when it's not strictly necessary outside PAL territories.
A common complaint in the Assassin's Creed franchise is that the controls are too simple and thus imprecise, leading to leaps in the wrong direction and overly difficult descents. That's fixed in Unity. You hold the same trigger you've always held to start free-running, but now there are two modifier buttons instead of one. One directs Arno to climb up a building like assassins have always done, while the other initiates a swift and efficient climb down toward the street. I've wanted this exact change for the series for a long time now, and I finally feel like I have perfect control of my Assassin. Sure, when other parts of the game break they can interrupt that fluid motion, but technical issues aside it's much improved.
The swordplay in Assassin's Creed has always been a contentious subject. It feels too stilted in the first game, encouraging players to wait for enemies to attack so they can be parried. A good balance is struck in Brotherhood with the execution chain system, but that ends up making subsequent games feel way too easy, to the point that even groups of 15 enemies or more are no problem. In Unity, I find myself actively strategizing to take down even two guards, because a single mistake can lead the entire city watch to bear down on me. Each enemy has a colored bar above his head; with each attack it will flash red, then gold, and you need to parry at that moment. The interplay between blocking and parrying makes combat dangerous again and it feels great. The mechanic makes dealing with groups a nightmare, and there are a lot of them in Unity's massive crowds, but on the whole the tougher swordplay makes fighting with Arno more fun than any previous assassin.
Speaking of Arno, I have to agree with our reviewer Matt Whittaker in his assessment of Unity's star. Arno is indeed "a stunningly complex character who feels far more human than any assassin the series has seen since Ezio Auditore da Firenze took the world by storm in Assassin's Creed II." He's everything I could have hoped for from an Assassin during the French Revolution: funny, charming and a hopeless romantic, ready to burn the world for his one true love. Like Connor and Edward Kenway before him, Arno wasn't raised as an Assassin and doesn't seem to care much for their creed. That always annoyed me about those two characters, but Arno's motivations and lack of commitment to the creed are addressed in a thoroughly satisfying way during the story.
Unity doesn't just correct the flaws of the past though; it feels like the game Ubisoft has always wanted to make. Massive crowds numbering in the thousands line the streets, which I've never seen in a game before, particularly one this detailed. That the game functions at all with these crowds on-screen is an impressive feat. I can finally blend into a crowd to lose pursuers like in that first trailer for Assassin's Creed. Beyond that, the sheer level of detail in Unity's Paris is seriously unbelievable. The world is gorgeous, but it also makes a tangible difference in the gameplay. Ducking through buildings isn't just a matter of scripted scenes anymore – whole missions are now set indoors. Of course, not every building has an interior, but those that do make the world feel more natural.
I went into Unity expecting to hate it as much as everyone else seems to, but I ended up enjoying it more than any game in the series since Brotherhood. Our review paints a picture of a game where every success is undercut by crippling technical failings, and that's more than a fair assessment. We should demand better from developers. It's just tragic that those issues have marred what could have been the series' strongest entry in years. Unity is deeply, at times unacceptably, flawed, but it's also massively ambitious, and that's worth recognizing.