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Reader! walk up at once (it will soon be too late) and buy at a perfectly ruinous rate A fable for critics - J Botume Jr
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J Botume Jr
Pork-Packing & Provision
Affiliated Organization
Hart, Baldwin, & Botume
Elizabeth Augusta Starr Lord (1832-1903)
John Franklin (1855-1917), Martha Sofia (1858-1925), and Bessie Everett (1863-1945)
J Botume Jr (1826-1892)
John Botume Jr was born 2 February 1826 to parents John Botume and Sophia Hough in Unadilla, Otsego, New York.
He was a merchant in the Boston area and would later become engaged in the pork-packing and provision business, under the firm of Hart, Baldwin, and Botume.
J Botume Jr would marry Elizabeth Augusta Starr Lord (1832-1903) on 4 October 1854 in Northfield, MA. They would have three children together: John Franklin (1855-1917), Martha Sofia (1858-1925), and Bessie Everett (1863-1945).
After his marriage, in 1859, J Botume Jr built a house in Stoneham MA, that is now known as the John Botume House. It is located at 4 Woodland Road along the shore of Spot Pond. The house was built as a summer home and it is now the last surviving property in this area. The Massachusetts Department of Conservation and Recreation now owns the property, which was acquired in 1895.
In 1865, J Botume Jr was the Sixth Sergeant of the Artillery Co. and became Eighth Sergeant in 1868. He moved to Melrose MA, in 1865, where he was a provisional dealer.
In 1867, he represented the 23rd Middlesex District in the State Legislature and was the President of the Massachusetts Brick Company. He was also on the Arbitration Committee Boston Board of Trade.
In 1877, he was invited to the Reunion of the Free Soldiers of 1848 and a copy of his handwritten confirmation of acceptance to the invitation.
John Botume Jr died on 9 June 1892, in Melson MA, from complications with diabetes. He was buried with Masonic Honours.
In UPEI's Provenance collection, J Botume Jr's signature can be found in the book Reader! walk up at once (it will soon be too late) and buy at a perfectly ruinous rate A fable for critics, by James Lowell along with the date "January 28/58".
Massachusetts Vital Records, 1840–1911. New England Historic Genealogical Society, Boston, Massachusetts.
1850 Seventh Census of the United States; (National Archives Microfilm Publication M432, 1009 rolls); Records of the Bureau of the Census, Record Group 29; National Archives, Washington, D.C.
Town and City Clerks of Massachusetts. Massachusetts Vital and Town Records. Provo, UT: Holbrook Research Institute (Jay and Delene Holbrook)
1860 U.S. census, population schedule. NARA microfilm publication M653, 1,438 rolls. Washington, D.C.: National Archives and Records Administration, n.d.
1870 U.S. census, population schedules. NARA microfilm publication M593, 1,761 rolls. Washington, D.C.: National Archives and Records Administration, n.d.
Minnesota census schedules for 1870. NARA microfilm publication T132, 13 rolls. Washington, D.C.: National Archives and Records Administration, n.d.
Roberts, Oliver Ayer. (1895-1901). History of the Military Company of the Massachusetts, now called the Ancient and Honorable Artillery Company of Massachusetts, 1637-1888. Boston : A. Mudge & Son.
Botume Jr., John, "Letter from John Botume, Jr. to Samuel Downer accepting his invitation to the reunion," Hingham Public Library Local History & Special Collections, accessed February 25, 2018.
John Bottume House. Wikipedia.org.
Subscribe to J Botume Jr RSS feed
Part of: Reader! walk up at once (it will soon be too late) and buy at a perfectly ruinous rate A fable for critics (2 objects)
Reader! walk up at once (it will soon be too late) and buy at a perfectly ruinous rate A fable for critics
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Амо́ль ( , ) — город на севере Ирана в провинции Мазендеран, административный центр шахрестана Амоль. Расположен в предгорьях Эльбурса, в 15 км от побережья Каспийского моря на реке Хераз. Амоль соединен скоростным шоссе с соседним Баболем и столицей Мазендерана, Сари. Население — более 200 тысяч человек (конец 2000-х).

Основу экономики Амоля составляет торговля цитрусовыми, а также железом, углём и другими полезными ископаемыми.

История
В 864 году стал столицей государства Алидов.

Около 1469 года город посетил Афанасий Никитин, упомянувший его в своих путевых записках "Хожение за три моря".

Достопримечательности
Мавзолей Насир-уль-Хакка - относится к XVI в. и расположена непосредственно в городской черте Амоля. Он имеет форму башни, и включён в Список культурного наследия Ирана. Купол мавзолея когда-то был украшен разноцветными изразцами, которые частично сохранились и в настоящее время. Если войти в здание, то можно заметить круглый потолок, в центре которого сделано отверстие. По словам Мауляны Аулии-Аллы данный мавзолей возник благодаря трудам Сейида Али.

В 18 км к югу от Амоля расположен весьма красивый лесопарк Мирзы Кучекь-Хана. В нем растут густые леса. Он, фактически, является одним из крупнейших лесопарков всего Ближнего Востока, а на территории провинции Мазендеран найдётся всего один парк, который будет больше него. Лесопарк оборудован всем необходимым для туризма: беседкой, питьевой водой, столами и скамейками, детской площадкой, ресторанами и кафе, площадкой для верховой езды и даже камином. В нём путники и туристы могут найти красивый родник, полюбоваться на водопад Махан, побродить в густых лесах и с удовольствием посмотреть на статные древние деревья, отдохнуть, остановившись на лесных лужайках, с которых открывается прекрасная панорама окрестных лесов .

Вообще, безусловно, Амоль привлекает посетителей не только своими туристическими памятниками, но также и воздухом весьма высокого качества, интересным побережьем Каспия, которое можно разглядывать долгое время, обильными лесами, где можно найти что-нибудь интересное, а также источников с минеральной водой. Что касается архитектурных и религиозных памятников, то надо выделить прежде всего мавзолей Мир Кавам-ад-дина Мараши, гробницу святого Ибрахима, мост под необычным названием "Двенадцать ключей".

Гробница святого Ибрахима представляет собою усыпальницу правнука основателя ислама Мухаммеда. Она была построена в XV в. Что касается облика этого строения, то оно имеет четыре угла, обладает также конусом, а её фундамент из кирпича имеет восемь углов, она облицована белыми изразцами и разукрашена росписью.

Мавзолей Мир Кавам-ад-дина Мараши, который положил начало династии Марашидов в Мазендеране, ещё называют мавзолей "Мир-э-Бозоргь". Он принадлежит ко времени Сефевидов, то есть, построен позднее, чем упоминавшаяся достопримечательность. Этот мавзолей простирается на большое пространство, обладает куполом и аркой, его облицовка из изразцов заставляет обращать на себя внимание, что впрочем справедливо и для великолепного сундука, сделанного из дерева. Короче, мавзолей является весьма популярным культурно-историческим памятником регионального значения .

Мечеть Мирзы Мохаммада-Али была основана в 1876 г. трудами Мирзы Мохаммада-Али Нияки. После этого она была несколько раз перестроена. Над михрабом внимательный посетитель обязательно заметит деревянную табличку, где написана дата строительства мечети

Среди новых гостиниц, основанных в Амоле, надо указать на основанную совсем недавно - в 2016 г. - гостиницу, носящую названию "Олямпикь" (букв.: Олимпийская). Она располагается в пяти километрах к северу от городской черты. Отель замышлялся как часть университетского комплекса "Северный Пардис", в связи с этим в нем имеются некоторые спортивные объекты, чтобы студенты были в форме. Отель этот трёхэтажный и обладает 29 комнатами. Посетители не могут не порадоваться обилию зелени вокруг гостиницы. Отель построен в том месте, из которого можно легко добраться и до остальных больших городов Мазендерана. В гостинице есть столовая, рассчитанная на 60 персон.

Примечания

Ссылки

Города Ирана

redpajama_set_name: RedPajamaWikipedia


Ingested foreign bodies are a common cause for emergency hospital admission. A precise interview of the patient often allows to establish the diagnosis. In 90% of cases, the foreign body is spontaneously eliminated without inducing any particular symptoms. In less than 10% of cases, it requires non-surgical extraction maneuvers (enemas, endoscopy). Only 1% of cases are treated surgically. Modern imaging frequently allows to establish a precise topographic diagnosis based on aspect, size and density. Coupled with laparoscopic surgery, it allows for an early, targeted and minimally invasive management. In this video, we show the case of a patient presenting with typical signs of peritonitis along with the incidental discovery of an intraluminal foreign body in the small bowel which brought about a micro-perforation.


DEAL was established at Wheaton College in Fall 2018. It is an umbrella entity that strives to create opportunities for innovative diversity work to flourish by fostering and coordinating leadership efforts across campus to ensure that Wheaton consistently provides a diverse, inclusive, equitable, and accessible learning community.
DEAL is charged by President's Council with overseeing diversity and inclusion campus work to ensure that Wheaton is making progress on the campus' Diversity and Inclusion Strategic Plan across the board.
To support the entire campus in having greater ownership and engagement in diversity, equity, and inclusion work.
To provide a committee structure for coordinated and synergistic leadership across campus.
To work collaboratively with top-level administrators to ensure that diversity, equity, and inclusion campus leaders have adequate resources to do their work effectively.
To engage and educate the campus community about diversity, equity, and inclusion work through initiatives and programming.
To increase communication and institutional responsiveness around persistent diversity, equity and inclusion challenges.
Visit the college's Historical Diversity Efforts page to learn more about Wheaton's previous diversity and inclusion efforts by the Council on Inclusion and Diversity (CID).
If you have any questions, please email deal@wheatoncollege.edu.


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Ampleon has released a 750 W LDMOS power transistor covering 902 to 928 MHz, achieving 72.5 percent efficiency at 915 MHz.
On March 15, the FCC adopted rules to encourage research and development in the spectrum between 95 GHz and 3 THz, creating a new category of license called the Spectrum Horizons License. In addition to offering experimental licenses, the FCC designated 21.2 GHz of spectrum as unlicensed, from 116 to 123, 174.8 to 182, 185 to 190 and 244 to 246 GHz.
Ancortek has launched a new software-defined, two-channel transmitter and four-channel receiver radar kit supporting digital phased-array beamforming and MIMO in the 24 GHz ISM band.
One regularly cited inhibitor to even faster adoption is the need for a public charging infrastructure that is universally available. The technical teams behind these infrastructures are working diligently to both increase the number of currently available plug-in stations as well as drive technological innovation and drive down costs to deliver wireless charging infrastructures available in both public and private spaces. This article examines several of the technical challenges that must be solved to bring this to fruition. First, let's review the current state of WPT in general, and in automotive applications specifically.
The Global Certification Forum (GCF) and 5G Automotive Association (5GAA) have agreed a collaborative framework under which they will combine their resources and expertise to accelerate the global introduction of Cellular Vehicle-to-Everything (C-V2X) products.


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El nombre de Robert Downey puede referirse a:

Robert Downey Jr. (1965), actor estadounidense.
Robert Downey Sr. (1936-2021), actor, productor y director estadounidense, padre del anterior.
Robert Downie, representante escocés de la Primera Guerra Mundial.


text:
At the Smithsonian | July 31, 2020
20th-Century Slavery Was Hiding in Plain Sight
The El Monte sweatshop case exposed a web of corruption—and the enslavement of more than 70 Los Angeles-area garment workers
A letter that tipped off authorities to the illegal conditions of the garment factory begs rescuers to work quickly and not arouse suspicion. "Don't forget to be careful," it concludes.
Erin Blakemore
Rotchana Cheunchujit was in bed when it happened. "We're here to help you," said someone in Thai.
Then she heard the axe. Federal agents broke down the front door, then stormed in. Soon, she was out on the sidewalk with her roommates, dazed.
"We were in shock," she says. "We didn't know what was going on." Hours later, Cheunchujit would be taken to jail. But in reality, she had just been set free.
Cheunchujit and 71 others were modern-day slaves in El Monte, California, held captive in a compound of apartment buildings that served as a garment factory. The workers there had been lured to the United States from Thailand by captors who tempted them with promises of money and prosperity, then forced them to toil around the clock to "earn" their freedom. On August 2, 1995, federal agents, aided by local police, state officials and the Thai Community Development Center, raided the Los Angeles-area complex. The conditions they discovered were horrifying—and the workers' ordeal went on to inspire local and federal anti-trafficking laws and garment industry reforms.
On August 2, 1995, a multi-agency task force led by the California Department of Industrial Relations raided a fenced seven-unit apartment complex in El Monte, California, a small community near Los Angeles.
"People have different versions of how this all came to the attention of the authorities," says Michael Gennaco, an assistant U.S. Attorney specializing in civil rights who prosecuted the case.
A document, now in the collections of the Smithsonian's National Museum of American History, played a part. The two-page letter is written in pencil. "Please be careful," it says. "Very Dangerous. Please bring much manpower." The letter, which was passed to authorities by the boyfriend of a woman who escaped the factory complex, includes a hand-drawn map of the complex. It begs authorities to work quickly and not arouse the suspicion of the factory's owners. "Don't forget to be careful," it concludes.
"It's not like no one knew about the existence of the shop. People had been talking about it," says Peter Liebhold, a curator in the museum's division of work and industry. One of them was California deputy labor commissioner T.K. Kim, who for years had heard rumors of a factory that was employing Thai garment workers who were not allowed to leave. In 1995, he finally got a tip that led to the location of the factory. Kim couldn't believe how many people were rumored to live and work there. But when he and an Immigration and Naturalization Service (INS) agent staked out the location, Kim saw bags filled with garments being loaded onto trucks.
The El Monte sewing room is crammed with tables and machines where 72 illegal Thai immigrants had been forced to work in virtual captivity.
It was obvious the complex was carefully guarded. It was surrounded by a high fence, and an additional razor-wire enclosure faced the apartment buildings that served as workplace, home and jail. Inside the courtyard, an armed guard always sat beneath a beach umbrella—tasked with making sure no worker escaped.
At the time, Liebhold and co-curator Harry Rubenstein were developing an exhibition that highlighted low-paid workers in the U.S. "It was an exhibition about what was wrong with America," Liebhold says. While other exhibitions celebrated American progress, he says, this one was designed to highlight what he calls a "failure of capitalism" and to bring to light social injustices like labor exploitation.
It included information on sweatshops and residential piece work—working conditions that had become largely illegal thanks to the tireless work of unions and consumer groups and the passage of New Deal laws in the 1930s.
Sweatshops had experienced a resurgence in the 1960s as new immigrants from Central and Latin America and Southeast Asia flooded into the U.S. Increased enforcement of immigration laws gave sweatshop managers added ammunition with which to threaten vulnerable workers.
The complex was carefully guarded and surrounded by a high fence. An additional razor-wire enclosure faced the apartment buildings that served as workplace, home and jail.
Liebhold didn't know about the El Monte sweatshop yet. But while the museum's exhibition was being developed, the factory owners—a Chinese-Thai family that recruited labor from rural areas in Thailand—were taking advantage of would-be workers' hopes for a better life in the U.S. They tricked them into signing agreements indenturing themselves to the business, then provided them with fraudulent passports and smuggled them into the country on tourist visas.
Once the workers arrived, their passports were confiscated. They were stuck, kept in line not only with violent threats and fear for their disadvantaged families back in Thailand, but the knowledge that they could be deported if they dared to escape.
Twenty-five years later, Rotchana Cheunchujit, now married with the surname Sussman, recalls the seemingly endless workload at the factory, where she sewed blouses and other garments. She received five to seven cents per garment—about $300 to $500 a month. The 24-year-old purportedly owed about $5,000 to her captors, but it slowly dawned on her she might never be able to pay it back. The owners took half of her wages up front and forced her and the other workers to purchase their own food and supplies from a makeshift commissary that sold necessities at high prices.
When she came to the U.S., Sussman had planned to work off the debt, then return to her children, ages 2 and 3, in Thailand and buy a business there. She worked 19-hour days in the factory and slept on the floor of a bedroom with eight other people. The sweatshop owners locked the door every night from the outside. "When I first came, I didn't realize I was a victim," she says. "After almost a year, I realized, well, I can't leave. I can't go anywhere. I can't say anything." Some of her fellow workers had been locked up for seven years.
The conditions were horrifying—and the workers' ordeal went on to inspire local and federal anti-trafficking laws and garment industry reforms.
Sussman missed her family, her freedom. But every morning, she got up and steeled herself for another day of endless labor in the dingy garage sewing room as armed guards, equipped with baseball bats, guns and knives, circled the premises. The garments she and her fellow prisoners made were sold at big-name stores all over the country—emblazoned with the coveted "Made in the USA" label.
Organizing the raid was anything but simple. At the time, no visas were provided for victims of crimes, and on the day of the raid, the workers were taken into custody by immigration officials. A group of Asian American activists demanded their release, then bailed them out. But once they were freed nine days later, the workers still lacked the paperwork that would allow them to legally live and work in the U.S.
"We thought all the workers should remain together and in this country, and should be able to have their story told," says Gennaco. "The other option, which we didn't find acceptable, would have been to keep them in detention. That didn't seem to make any sense."
Despite a lack of applicable laws protecting the workers, a coalition of activists and federal officials managed to secure permission to get the workers visas commonly used to keep informants in the U.S. The Thai Community Development Center and other groups helped them find lodging and jobs.
Courtroom sketches depicts the defendants listening to court proceedings in United States v. Manasurangkun, August 21, 1995.
Three former El Monte sweatshop workers testifying at subsequent penalty hearing.
As a shell-shocked Sussman and the other workers—who spoke no English and had almost no idea what was outside the sweatshop—tried to adjust to their new lives, the scope of their exploitation slowly became clear. Investigators found intercepted letters from the workers and their Thai families. Neither had reached their intended destination. Workers' letters that didn't keep up the façade of a happy life in America were simply kept, and letters from family in Thailand that revealed illnesses and deaths were not passed along for fear the workers would try to escape.
Investigators also learned more about S&K Fashion, a small Latino-staffed factory in downtown Los Angeles that had served as a front for the larger operation fueled by Thai labor. Slowly, they realized how widely the scam had spread. Vulnerable Thai people were lured by promises of weekend trips to Disneyland. Photos showing the excursions had been staged by the smugglers. On the other end of the racket, nationwide and regional retail chains like Miller's Outpost, Mervyn's, Montgomery Ward and others had sold clothing made in the compound.
When news broke of the raid, Liebhold knew he needed to help preserve the sweatshop's story. So he pushed for the museum to collect artifacts from the factory and the workers. "It's a very large collection," he says of the El Monte archive of more than 200 objects including photos, forged passports and an entire sewing machine workstation.
The exhibition itself provoked controversy—it prompted pushback from the California Fashion Association and other groups as well as a number of members of Congress who worried that its exploration of modern-day sweatshops could shed negative light on the garment industry.
After being freed from their captors, the Thai workers (Above: A celebration of freedom at Griffith Park, August 13, 1995) were not deported. Instead they remained in the United States and were issued visas with a path to citizenship.
"We had a lot of long days and difficult times," recalls Liebhold, adding that the discussion ultimately made the exhibition better.
"Between a Rock and a Hard Place: A History of American Sweatshops, 1820-Present" finally made its way to the floor of the National Museum of American History in April of 1998. The exhibition looked at the history of sweatshops in the United States through 100 objects like sewing machines and photographs of the 1911 Triangle Shirtwaist Factory Fire, which killed 146 garment workers. It included a recreation of the inside of the El Monte sweatshop. "As history, not political debate, the show smoothly tells what is a complex, open-ended social and business story," wrote the Washington Post's Jacqueline Trescott at the time.
As the six-month exhibition opened in Washington, D.C., the freed workers were fighting for the American dream their captors had stolen. Sussman found work as a seamstress and dishwasher and started taking night classes. She still worked seven days a week and walked to and from work and school. But life felt more expansive now that she was free. "I had so much time," she recalls.
Rotchana Cheunchujit Sussman (Above: with her husband Steven Sussman and children, Max, Evelyn and Evan) is now a naturalized U.S. citizen and recently opened a vegetarian Thai restaurant in Arcadia, California.
In February 1996, factory proprietor Suni Manasurangkun, three of her five sons and three others who had assisted them pled guilty to federal crimes. Two of Manasurangkun's sons fled the U.S. and were never apprehended. They are still considered fugitives and are being sought by Interpol for conspiracy, indentured servitude, kidnapping and other crimes. The federal case was not the last involving the El Monte workers. In 1997, a group of retailers that had sold the clothing made at the sweatshop settled multiple civil lawsuits for more than $4.5 million, which was used to compensate the workers for back pay.
Now known as the first modern human trafficking case, the El Monte case spawned a national anti-sweatshop and anti-trafficking movement. In 1998, the Thai CDC and other activists helped found the Coalition to Abolish Slavery and Trafficking (CAST), and, in 2000, President Bill Clinton signed the Victims of Trafficking and Violence Protection Act of 2000, a federal law that protects trafficking victims and that established the T-Visa, which allows some trafficking victims and their families to remain in the U.S.
Sussman and her fellow victims are now naturalized U.S. citizens. She has since reunited with her children, learned English and become an advocate for other workers. Her husband, Steven Sussman, adopted her children, and they had another child. All are now young adults. She recently opened her own vegetarian Thai restaurant in Arcadia, California.
Though she dreamed of the sweatshop for years after her release, she says she's moved on. "I was born and raised in the Buddhist tradition. You learn how to forgive and forget."
Gennaco and the workers he helped free still have a reunion every year. "It's just wonderful to behold," he says. For the now former prosecutor, the El Monte case is an opportunity for education and "understanding of the simple fact that if you come to America, even without papers, it is against federal law to exploit you. You're entitled to minimum wage, you're entitled to be free, and to have the labor laws apply to you no matter your status." He remains in awe of the victims' courage.
As for Liebhold, he sees the El Monte case as a landmark—and a reminder that issues of enslavement, labor exploitation and human rights violations aren't just the province of the past. "People work really hard and they are dying to work." he says. "It's about immigration and social justice. These are two topics that have not gone away."
The results of the El Monte raid were life changing for the workers and brought much-need reform to the retail industry, writes curator Peter Liebhold in "25 Years Later: The Legacy of the El Monte Sweatshop Raid" on the museum's blog "O Say Can You See?"
Erin Blakemore | | READ MORE
Erin Blakemore is a Boulder, Colorado-based journalist. Her work has appeared in publications like The Washington Post, TIME, mental_floss, Popular Science and JSTOR Daily. Learn more at erinblakemore.com.
American History American History Museum Labor History Manufacturing Slavery Thailand

redpajama_set_name: RedPajamaCommonCrawl


There has been a trend recently in MMOs away from the WoW-like hotbar interface, i.e. three on the bottom and at least one on the side, to a more ARPG-like one, that allows only one row of slots. The three MMOs I bounce around between right now–Guild Wars 2, Wildstar, and Marvel Heroes–all have limited hotbar space. At first I disliked this change and viewed it as a dumbing down of my favorite genre. Now I recognize it as a design choice which, while occasionally frustrating, is actually preferable in the long run.
As an altaholic, the best thing for me about this trend is that it makes it really easy to get back into a class, or game for that matter, after being away for a while. The reason why I've never gotten past Moria in LotRO is that every time I come back I'm faced with the daunting task of relearning what all of my skills do and how they fit together, so I usually end up rerolling so I can relearn how to play over time. In games like Guild Wars 2, or Marvel Heroes, I simply have to go down the line of 10 or so skills I had active when I parked this character and read their tooltips and I'm set. Later I may swap out some my skills if they don't fit the playstyle I'm looking for right now, but for the most part I can jump in and start playing with minimal thought.
Another recent trend that the changes in hotbars facilitates is the move away from rooted casting. Honestly, I'm trying to remember why anyone ever thought this was a good idea. Especially in dungeon settings, where players often have to run out of the way of things, putting casters at a big disadvantage. I guess it took away the disadvantages that melee classes have that I've been noticing in WildStar, i.e. squishy ranged classes can run and gun to avoid damage, but melee classes are kind of forced to just tank it out. Either way, one archetype or the other is going to suffer, and I'd rather not be forced to stand it one spot for several seconds at a time to heal or hit big numbers.
Finally, and perhaps most importantly, forcing a small number of hotbar skills means that the skills that are on the hotbar are more generalized and less situational. There are no spells in Guild Wars 2 that do extra damage to undead or only put fear on animals (there are potions that do extra damage to one type, but that's different). Wildstar doesn't have different breaks for different types of lockdowns. Everything is generalized. This is one of the places where it seemed like the genre was being dumbed down. But really, why should I have to remember which of my obscure hotkeys I only use once in a blue moon is the one I need in this situation? Is that really what the game is or should be about?
I am still a little frustrated with smaller hotbars. For one, as nice as it is that developers have done their best to reduce the number of situational skills, some still need to exist. Many times I've charged into combat in Guild Wars 2 with a portal or stability or run speed increase in my slot skills because I needed them once and forgot to flip them back to skills actually useful in combat by the time the cooldown ended. I also feel like Wildstar discourages me from experimenting with my build, partly because I have to buy my skills before I know if I want to use them or not, but mainly because I don't want to give up part of the rotation I have now to see if something else would fit in better. Overall, however, I think the trend is a good one. If I continue to gravitate toward games that force fewer hotbar slots, it would seem to be a good trend.


Really enjoyed watching Colin real old school tough as they come .RIP.
He was a poor rider when he signed for 'The Cheetahs' and even with the help and assistance of Hans Nielsen never adapted to Cowley and didn't last very long.
Unlike Per Sorensen who was a revelation Hans helped put 1.5 on Per's average.
That and his 11 from 4 when we won away at hyde Road in 1987.
Otherwise it would be Sigalos or Bobby Schwartz at 7.
I think Ronnie Correy could have achieved much more had it not been for his broken back. He was one of the top few riders in the league prior to that.. he could easily have put 5 starts together in a World Final and taken a title.
When he returned he hadn't got the hunger on the world stage anymore.
Sigalos was a rider i took to right from the start i remember him scoring a 15 point max from reserve at Swindon.He got better and progressed to world level and when he went to Wolves you could argue he was reaching his peak.Wolves a few riders I enjoyed watching were Rob Phetzing and Schwartz ( a great rider and awesome team man,) .
My first ever favorite rider was Dennis Sigalos but he didn't race for Wolves long enough to get in this.
Great lot really Witcher spot on , Sigalos was good and the the world of speedway was robbed .I am but surprised with Munkedal but i liked him though just like Glanz, Eskildsen, Nicholajsen( etc) they were very valuable riders.
Quite excited about the new track, it has to be a massive improvement on the entertainment front that we have witnessed in recent years.
If you think of it along different lines compared to last season you may see it differently.
Yes Jacob is a big loss but it's only temporary and Nick Morris can be just as good around Monmore and should do well away.
It is really interesting Wolfie how people like to build there teams and you have put your team across from a different angle.Myself at Swindon i like familiarity and our core of the team know each other very well ok we might fall short but i like this way of assembling a side.Where as other Swindon supporters might? believe in freshning thing's up and maybe try to bring in a few improvers.Going back to Wolves Nick Morris will be a great signing and he will also score well away i would like to think Nick will return to Swindon someday i hope so.
Wolves are my Favourite top flight club and would like to see them win the league i go down watch them 3-4 times a season. I cant see alot of improvement in the side to be honest and now missing Thorsell i think they will struggle.
I really like Thorssell and he would of put half a point on his average he is quite a loss.But Scott should cover and do a good job be interesting if your way of thinking pans out it could well do.
Mega shock Wolves bottom Brummie ?? great that everybody has a different opinion personally i think Wolves will be very hard to crack at home.
Interesting Bagpuss i was not totally convinced with Peterborough before they will do well to replace Cook. .Wolves- Swindon- Aces- Pirates.
Swindon good price at 13/2.
Also with this side Doris there could be a option for a change if need be hopefully there will be no need for it happy with the side.
In all fairness it probably is. I also highly rate Ash Morris and Becker could turn out to be a real trump card but when compared to partnerships of Bjerre/Barker, Covatti/NBJ Allen/Heeps etc the Wolves pairing doesn't look so potent. I still think there is improvement in both riders but it will be hard for them both.
I think Wolves/ Swindon reserves could surprise this year Becker will have a prolonged run at reserve and if he can get dialled in at home he could do ok .Morris is very handy at reserve his strength is his gating and to be honest he was not disgraced in the top 5 last year.Swindon fingers crossed Zach who i rate and i think he is capable of adding a point on his average this year.James he will be great to watch and i believe he can hold his own.
Memories of Ron How and Brian Crutcher.
British- match- race- championship - Golden.Helmet- 1956. Brian Crutcher beat Moore,Briggs,Moore,Hunt, Briggs. 1958. Crutcher beat Fundin mixed it with the cream of the sport.
I have been compiling an alltime top 30 of British riders and by god it has been difficult.I have compiled a list of about 50 riders and need to eliminate 20.Ron How and Brian Crutcher were two riders i never got to see ride but know there career's and both were great riders.It would be great if any of you have any input on both riders which could help me in my research.My uncle who saw them both ride said Crutcher was very stylish indeed and How could always mix it with the best would they both be hovering around a top 30 British riders of alltime.??
...oh but what a character! Garry certainly left his mark on the sport with his 'misadvenetures' and people still talk about him after all this time.
I was always puzzled as a youngster about Garry Steve,because he seemed a happy go lucky chap when i see him ride.I have his prized autograph and always thought his reputation was false.In a way just like Jack Millen he had a fearsome reputation but people have commented on just how nice a guy Jack was he was great for helping young riders.Back to Middleton Steve how good was he ? you would know more than me on that score.He was really good for Oxford fast and aggressive it is such a shame how his life ended up.
To be fair Sidney, the five above him were better riders and Thommo will always be my number one.
Totally agree Terry , Thommo is a shoe in yes Middleton with all his ability has to go down as a underachiever.
Middleton would be higher than no 7 Terry wouldn't he????? he was very talented was very good at Hackney and Oxford .
Great point yes Doncaster was great value i liked him like Tatum moved up full time in a tough British league without NL experience.
I think that was during 1976 (when we lost again!) and if I remember Brian picked up a knee injury that night (clashed with Bob Kilby?) which caused him problems for the rest of his career. A real shame because he wa really developing into a very useful rider and may well have ended up a full-time 'Rebel' although he was a 'Panther' thru' and thru'.
We eventually broke our 'duck' and won at Blunsdon in 1978!
Spot on Steve sorted my progs out and in 1976 ( i remember spill now with Kilb, Brian got injured he was awarded a point in heat 4 .Swindon won 47-31 Ashby 12max. Gordon 14. 1978 Mastrup debut 0 knew there was guests Nigel Couzens 5 John Barker 4 for White City Swindon 36- White City 42 Kennett a 12 point max great days.
Yes, Sid, and with risk of going over old ground 'The Rebels' released Richard Greer to a struggling Birmingham before it was known that Dag wasn't available for the '77 season which left them two heat leaders short. Marek was inspirational (especially around Wood Lane) and it has to be remembered that Paul Gachet picked up an early season injury (broken ankle) which kept him out of the side for the entire season. Mike Sampson (who was a match winner on more than one occasion) and Dave Kennett filled in but it was the ovearll team spirit and ethic that got them thru' in the end (and a little help from Barry Thomas!) despite intense pressure from Exeter and Reading in particular. A great season and one that I cherish personally...great days!
I can remember Steen Mastrup making his debut against the White City i think ? and if i remember rightly Brian Clark rode for the City that night.?
Gordon Kennett, Dag Lovaas (await the usual comment), Marek Cieslak, Kai Niemi, Steve Weatherley, Trevor Geer, Mike Sampson. Richard Greer.
When you look at there Championship side Steve it does not look breathtaking there team ephic and spirit must of been good.
Some really good riders there Andy do you remember Jack Bibby.??
This week has been great because the fans have been kept up to speed about what is happening.The new track looks exciting, so roll on the pressday and i cant wait until the 11th.It has not been easy for the promoters/Rosco over the last few years because they are often in Limbo a lose/lose situation.Alot of the stuff they dont know themselves so i suppose the best ploy is to say nothing hope thing's turn out well speedway in the UK need Swindon just like every other Prem club.
Looks ok that. I think that will improve things. Looks like it might be one of those tracks where the bikes never go straight, always slightly sideways down the straight.
Not quite as much of a horse power track, which can't be a bad thing.
This changing of the track could be the best news the fans have had for along while it is quite exciting really.The track might take a while to develope but hopefully we will get better racing than we have been served up recently the widening of the straights should help anormously.
Not to the levels of yesteryear, correct King's Lynn have been great for that over the years.My main point was riders then were often kept on there popularity rather than there points potential.


I woke up today excited at being in New York and also dying to stretch my limbs after that long flight. As our apartment was situated so close to the Hudson River, I decided the perfect way to start my birthday was with a run by the river. I've always loved running in other cities, it's such a great way to get to know the place, and I couldn't ask for a better place to run than by the river with the Statue of Liberty in the distance.
When I got back to the apartment, J was awake and it was time for a shower and a change of clothes before experiencing my first full day in NY!
It's an odd choice, but we decided to head to the 9/11 Memorial on my birthday. The twin fountains were incredibly beautiful and the names listed on the memorial brought home the incredibly tragedy of what had occurred and all those precious lives lost.
A fellow Chin had died at the site which gave me a strange feeling and caused my heart to go out again to all those who have lost loved ones here.
After visiting the Memorial, we walked across the Brooklyn Bridge (which was a lot longer a walk than we had reckoned on!) and found our way under the bridge to the famous Grimaldi's where we joined the queue outside for some well-earned pizza. We took a cue from the other diners seated close by and flavoured our pizzas with lots of yummy dried chilli flakes.
The rest of the afternoon was spent chilling out at the beautiful Central Park.
J had planned a couple of surprises for my birthday which, due to pesky reservations and the like, he was forced to postpone to the next two nights after the actual day so we spent the night drinking cocktails at The Little Branch, one of New York's secret bars before finding our way back to The Garage for some lobster ravioli and live jazz. Cocktails in New York are so incredibly cheap and dangerously strong – we couldn't stop ordering them wherever we went! In Perth, the cocktail is an art form in itself – it could take at least 20 minutes and a list of complicated ingredients resulting in a very yummy, usually sugar-heavy cocktail that's big on creativity and maybe a lot less so on alcohol. Perth cocktails have really raised the bar for me but New York cocktails prove that simple, strong and cheap have a lot to recommend for itself!


A Cornell professor expects fall foliage will be less vibrant in Tompkins County this year.
The Ithaca Journal interviewed Taryn Bauerle, an associate professor of plant science in Cornell University's College of Agriculture and Life Science, to hear her prediction of the fall foliage season.
Baurle has said she is not expecting a large quantity of deep purple and red leaves in the foliage in the Finger Lakes, and that the region should expect more oranges and yellows.
Question: How vibrant do you expect the the foliage to be this fall in Ithaca?
Answer: I think the fall foliage will not be so vibrant. We have had wet, overcast days, and few sunny days and cool nights. The overcast, wet days are not conducive for fall colors, so I'm expecting the colors to be dampened this year. But it's hard to predict. Mother nature can change on this. We will have to wait for what Mother Nature brings to us.
Q: Why is this important? Do the fall colors attract many tourists?
A: Fall foliage can be quite a driver for tourism, depending on the weather. Some regions can have quite a nice display. Fall foliage can be a big driver for the Adirondack region, unlike here in Ithaca, where we have had more moisture, humidity and overcast days. It doesn't look too great.
Q: Are the diverse colors of fall foliage in North America unique to the continent, in contrast with other continents such as Europe?
A: Many of our forests have more diversity of species, which can have more diversity of color. I can't speak for all of Europe, but their trees tend to be more planted and managed, so that's why there is not as much diversity. We also have maples, which can have red and purple leaves that can add to the colors of fall foliage.
Q: Has there been a trend in fall foliage over the past few years?
A: It does seem like over the past few years, the leaves have not been as vibrant as they normally are. That may be because of the wet weather we are receiving now, but some years have been quite dry, resulting in muted colors and leaves falling prematurely. There is a sweet spot for rain that helps bring out the best colors. Because of the shifting climate and extremes in weather, we had either had too much or not enough rain.
Q: What activities do you recommend for people who want to make the most of the fall foliage season?
A: That's a tough question. If the weather is nice, hiking would be a good idea. What would you do?


text:
British Association of Dermatologists' guidelines for the management of bullous pemphigoid 2012
2002 Aug (revised 2012 Dec)
British Association of Dermatologists' guidelines for the management of bullous pemphigoid 2012.
Appropriate diagnosis and management of bullous pemphigoid
Immunosuppressive and metabolic adverse effects occur with use of systemic steroids and are dose-dependent.
Gastric protection, usually with a proton pump inhibitor, should be considered when treating with systemic steroids. Measures aimed at minimizing loss of bone density are appropriate in postmenopausal women and men over 50 years, and in any patient at increased risk of fragility fracture, who are expected to take prednisolone 7.5 mg or more daily for at least 3 months. Patients with bullous pemphigoid (BP) (and also patients with pemphigus vulgaris) were reported to have lower levels of vitamin D, and a higher incidence of severe hypovitaminosis D, than controls, suggesting additional risk of bone density loss.
Adverse effects of topical corticosteroids may include diabetes mellitus, cardiovascular and neurovascular disorders, severe infections, and cutaneous side effects, including purpura, severe skin atrophy, and striae.
Very potent topical steroids (clobetasol propionate) are an effective treatment for BP and they seem to have less serious adverse effects compared with 1 mg/kg of prednisone per day. However, they may be associated with systemic absorption and adverse events.
Adverse effects of azathioprine may include hepatotoxicity and myelotoxicity.
Azathioprine dose can be optimized with regard to myelosuppression risk by prior assay of thiopurine methyltransferase (TPMT) activity, a test that is now widely available in the United Kingdom and relatively inexpensive. However, a normal TPMT level does not totally preclude myelotoxicity and regular monitoring of blood counts and liver function are essential.
Adverse effects of anti-inflammatory antibiotics and nicotinamide may include gastrointestinal upset, pigmentation, and Candida infection.
The most important toxicities of methotrexate (MTX) are myelosuppression, hepatotoxicity, and pneumonitis. Many investigators recommend folic acid 5 mg on the non-MTX days to reduce some adverse effects, but this is not proven.
Glucose-6-phosphate dehydrogenase deficiency predisposes to haematological side-effects and all patients receiving dapsone need very frequent monitoring of blood count and liver function in the early months. The side-effect profile of dapsone and sulfonamides is potentially hazardous in the elderly.
Careful monitoring is required for possible haematological toxicity when treating with chlorambucil.
Cyclophosphamide is more toxic than other immunosuppressive drugs used for BP.
Ciclosporin may rarely have a place in refractory cases but its value is likely to be limited by renal toxicity, especially in the elderly.
The use of topical tacrolimus is limited by local irritation and its price compared with topical steroids.
Biological drugs are expensive and may be associated with potentially serious adverse effects.
At least one meta-analysis, systematic review, or randomized controlled trial (RCT) rated as 1++, and directly applicable to the target population, or
A systematic review of RCTs or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population and demonstrating overall consistency of results
Evidence drawn from a National Institute for Health and Clinical Excellence (NICE) technology appraisal
A body of evidence including studies rated as 2++, directly applicable to the target population and demonstrating overall consistency of results, or
Extrapolated evidence from studies rated as 1++ or 1+
A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results, or
Extrapolated evidence from studies rated as 2++
Evidence level 3 or 4, or
Extrapolated evidence from studies rated as 2+, or Formal consensus
(GPP)
A good practice point (GPP) is a recommendation for best practice based on the experience of the guideline development group.
This document has been prepared on behalf of the British Association of Dermatologists (BAD) and is based on the best data available when the document was prepared. It is recognized that under certain conditions it may be necessary to deviate from the guidelines and that the results of future studies may require some of the recommendations herein to be changed. Failure to adhere to these guidelines should not necessarily be considered negligent, nor should adherence to these recommendations constitute a defence against a claim of negligence.
PubMed, MEDLINE and EMBASE databases were searched up to June 2012 for meta-analyses, randomized and nonrandomized controlled clinical trials, case series, case reports, and open studies involving bullous pemphigoid, with no language exclusions; search terms and strategies are detailed in Appendix S1 (see the "Availability of Companion Documents" field).
Additional relevant references were also isolated from citations in the reviewed literature, as well as (independent) targeted searches carried out by coauthors. Working in pairs, the authors screened the identified titles, and those relevant for first-round inclusion were selected for further scrutiny. The abstracts for the shortlisted references were then reviewed and the full papers of relevant material were obtained; disagreements in the final selections were resolved by discussion with the entire development group. Additional selection criteria included relevant publications on the management of childhood bullous pemphigoid (BP).
Type of Evidence
High-quality meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs with a very low risk of bias
Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias*
High-quality systematic reviews of case–control or cohort studies
High-quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal
Well-conducted case–control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal
Case–control or cohort studies with a high risk of confounding, bias or chance and a significant risk that the relationship is not causal*
Nonanalytical studies (for example, case reports, case series)
Expert opinion, formal consensus
*Studies with a level of evidence '–' should not be used as a basis for making a recommendation.
The guideline development group consisted of consultant dermatologists.
This set of guidelines has been developed using the British Association of Dermatologists' recommended methodology (see the "Availability of Companion Documents" field) and with reference to the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument (see the "Availability of Companion Documents" field). Recommendations were developed for implementation in the National Health Service using a process of considered judgment based on the evidence.
Following completion of the literature search, the structure of the 2002 guidelines was discussed and re-evaluated, and different coauthors were allocated separate subsections. Each coauthor then performed a detailed appraisal of the selected literature with discussions with the entire development group to resolve any issues, e.g. with the quality of evidence and making the appropriate recommendations. All subsections were subsequently collated and edited to produce the final guideline.
Published cost analyses were reviewed:
Although the treatments were equally effective, the 5.5-fold higher cost of mycophenolate mofetil (MMF) (2 g daily) compared with azathioprine (2 mg/kg daily for a 75-kg patient) could be an important consideration in some health economies.
Intravenous immunoglobulin (IVIg) is well tolerated but expensive, costing £5320.00 per cycle of 2 g/kg in a 70-kg patient.
The guideline development group consisted of consultant dermatologists. The draft document was circulated to the British Association of Dermatologists (BAD) membership, the British Dermatological Nursing Group (BDNG), the Primary Care Dermatological Society (PCDS), and the Pemphigus Vulgaris Network for comments, and was peer reviewed by the Clinical Standards Unit of BAD (made up of the Therapy and Guidelines subcommittee) prior to publication.
Venning VA, Taghipour K, Mohd Mustapa MF, Highet AS, Kirtschig G. British Association of Dermatologists' guidelines for the management of bullous pemphigoid 2012. Br J Dermatol. 2012 Dec;167(6):1200-14. [116 references] PubMed
British Association of Dermatologists Therapy & Guidelines Subcommittee
Primary Authors: V.A. Venning, Department of Dermatology, Churchill Hospital, Oxford, UK; K. Taghipour, Department of Dermatology, Whittington Hospital, London, UK; M.F. Mohd Mustapa, British Association of Dermatologists, Willan House, London, UK; A.S. Highet, York Hospital, York, UK; G. Kirtschig, Vrije Universtiteit, Amsterdam, NL
British Association of Dermatologists Therapy Guidelines and Audit Committee Members: J.R. Hughes (Chair); J. McLelland; A.J. McDonagh; S. Punjabi; D.A. Buckley; I. Nasr; V.J. Swale; C.E. Duarte Williams; P.M. McHenry; S. Wagle, British National Formulary; S. Amin, British National Formulary; R. Davis, British Dermatological Nursing Group; S.E. Haveron, BAD Scientific Administrator; M.F. Mohd Mustapa, BAD Clinical Standards Manager
This guideline updates a previous version: Wojnarowska F, Kirtschig G, Highet AS, Venning VA, Khumalo NP. Guidelines for the management of bullous pemphigoid. Br J Dermatol 2002 Aug;147(2):214-21. [48 references]
Electronic copies: Available in Portable Document Format (PDF) from the British Association of Dermatologists Web site.
Bell HK, Ormerod AD. Writing a British Association of Dermatologists clinical guideline: an update on the process and guidance for authors. Br J Dermatol 2009; 160:725-8. Electronic copies: Available in Portable Document Format (PDF) from the British Association of Dermatologists Web site.
Literature search strategies are available from the British Journal of Dermatology Web site.
In addition, recommended audit points are provided in section 13 of the original guideline document.
Pemphigoid. Patient information leaflet. London (England): British Association of Dermatologists; 2012 Jan. 4 p. Available in Portable Document Format (PDF) from the British Association of Dermatologists Web site.
This NGC summary was completed by ECRI on April 22, 2005. The information was verified by the guideline developer on June 27, 2005. This summary was updated by ECRI Institute on November 6, 2007, following the U.S. Food and Drug Administration advisory on CellCept (mycophenolate mofetil). This NGC summary was updated by ECRI Institute on February 6, 2013. The updated information was verified by the guideline developer on March 6, 2013. This summary was updated by ECRI Institute on November 21, 2013 following the U.S. Food and Drug Administration advisory on Arzerra (ofatumumab) and Rituxan (rituximab).
Bullous pemphigoid (BP)
To provide up-to-date, evidence-based recommendations for the management of bullous pemphigoid (BP)
To update and expand on the previous guidelines by: (i) offering an appraisal of all relevant literature since January 2002, focusing on any key developments; (ii) addressing important, practical clinical questions relating to the primary guideline objective; (iii) providing guideline recommendations and, where appropriate, with some health economic implications discussing potential developments and future directions
Patients with known or suspected bullous pemphigoid (BP)
Histological examination of tissue
Immunopathological examination of tissue (direct) or serum (indirect) immunofluorescence
Anti-inflammatory antibiotics and nicotinamide (niacinamide)
Other treatments (not recommended routinely)
Topical tacrolimus
Plasmapheresis and immunoapheresis
Monitoring of drug therapy
Sensitivity and false positive rates for diagnostic tests
Effectiveness of treatments
Rate of treatment response
Rate of disease relapse/recurrence
Adverse effects of treatment, including morbidity and mortality
Definitions for the levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4) and strength of recommendations (A-D) are presented at the end of the "Major Recommendations" field.
Laboratory Diagnosis of Bullous Pemphigoid (BP)
A skin biopsy from a fresh blister stained with haematoxylin and eosin shows subepidermal clefting and an inflammatory infiltrate mainly consisting of eosinophils; however, the diagnosis is confirmed with immunofluorescence studies (IF). A biopsy for direct IF (DIF) is taken from uninvolved skin about 1 cm away from a fresh blister and is immediately snap-frozen in liquid nitrogen or transported in either Michel's transport medium or normal (0.9%) saline. If using saline, the biopsy must be processed within 24–48 h; with Michel's medium prompt handling is to be preferred, but a longer delay of up to 2 weeks may still yield results. Indirect IF (IIF) is performed on serum, and if this is not obtainable, on blister fluid. The characteristic DIF picture in BP is a linear deposition of immunoglobulin G (IgG) and⁄or complement component 3 (C3) along the basement membrane zone (BMZ). Other immunoglobulins, including immunoglobulin A (IgA), immunoglobulin M (IgM) and immunoglobulin E (IgE), may also be present. Substrates used for IIF include monkey oesophagus and normal human skin; the latter can be split using molar saline. Antibodies in BP serum usually detect antigens at the roof of the salt-split skin. In most cases this may help to differentiate BP from other immunobullous diseases such as epidermolysis bullosa acquisita (EBA) and some cases of mucous membrane pemphigoid (MMP), in both of which antibodies are deposited on the dermal aspect of the split skin.
Over recent years, enzyme-linked immunosorbent assay (ELISA) has emerged as an additional diagnostic technique for some autoimmune bullous diseases. Serum levels of antibodies to both BP180 and BP230 can be measured with commercially available ELISA kits, with the BP180 ELISA being more sensitive than the BP230 ELISA. The NC16A domain is an important pathogenic epitope of the BP180 antigen and is used in BP180 ELISA to detect antibody titres that reportedly correlate with disease activity. In one study, false-positive ELISA results using the same commercial kits were reported in 7.4% of sera with negative IIF. The ELISA is currently not widely available in the United Kingdom but is a useful additional diagnostic tool in selected cases and in research. IF studies remain the gold standard for diagnosis.
Autoimmune bullous diseases may overlap in morphology and immunopathology; however, factors such as age of onset, course of the disease, absence of scarring and extent of mucosal involvement are important in differentiating the diagnosis. DIF and salt-split IIF are useful in distinguishing BP from other subepidermal diseases, namely linear IgA disease, MMP and EBA.
Blisters occur in genetic bullous diseases, in particular the epidermolysis bullosa group and may also be caused by insect bites, burns, oedema, cellulitis, erythema multiforme, and contact dermatitis. Viral and bacterial skin infections should be recognized and treated before treatment with immunosuppressant therapy is initiated.
BP is usually a self-limiting disease with a clinical course that may last from months to years. During the active stage, the disease is associated with significant morbidity and a mortality twice that of the general elderly population. Older age at onset and frail general condition are poor prognostic factors. Many available treatments are associated with toxicity and may be poorly tolerated in patients with BP. Mortality during the first year is significantly higher in patients treated with high doses of systemic corticosteroids (prednisolone equivalent >40 mg daily). Treatment should aim to control symptoms with minimum adverse effects where possible. Options are broadly divided into anti-inflammatory drugs, immunosuppressive or immunomodulating drugs, and procedures aiming to remove circulating pathogenic antibodies and inflammatory mediators. The choice of treatment depends on the individual patient's circumstances especially the severity of the BP and the presence of comorbidities.
Systemic Steroids (Strength of Recommendation A; Level of Evidence 1+)
Systemic corticosteroid therapy was demonstrated to be effective in BP in uncontrolled clinical studies during the 1950s and has become established as the mainstay of treatment. The effect in most cases is rapid, with suppression of inflammation and blistering typically achieved within 1–4 weeks, after which the dose is gradually reduced. The most commonly used drugs are prednisone and prednisolone which are assumed to be bioequivalent.
General conclusions from the studies are:
Systemic steroids are the best established treatment for BP.
Immunosuppressive and metabolic adverse effects occur and are dose-dependent.
Doses of prednisolone of 0.75–1.0 mg/kg daily in widespread BP are effective within 1–4 weeks in about 60–90% of cases.
Clinical experience suggests that the more severe the disease, the larger the dose of steroid is required (up to 1 mg/kg daily), although this has not been rigorously proven. A minority of patients with BP respond poorly to such doses of systemic steroid; increasing the dose confers little additional benefit and is significantly more toxic.
It is not possible to identify a starting dose of prednisolone (or prednisone) that would be maximally effective and minimally toxic for all patients with BP. Doses which might meet these criteria for a majority of patients are:
0.75 mg/kg for patients with severe involvement
0.5 mg/kg for moderate disease
0.3 mg/kg for mild or localized disease
If new inflammatory or blistered lesions are few or absent within 4 weeks, the treatment can be regarded as successful and the dose of steroid should then be gradually reduced. A reduction of the daily dose of prednisolone at fortnightly intervals, initially by about one-third or one-quarter down to 15 mg daily, then by 2.5 mg decrements down to 10 mg daily, is suggested. The dose could then be reduced by 1 mg each month. In about 50% of cases relapse will occur at some point during the dose-reduction period, indicating that the previous dose is likely to be the minimal effective dose for that patient.
For patients with widespread BP who do not respond to these doses, or who relapse on unacceptably high doses, other agents, alone or in addition to the systemic steroid, may be preferable to higher doses of steroid.
The duration of systemic steroid treatment in BP is likely to be many months and is sometimes indefinite. Gastric protection, usually with a proton pump inhibitor, should be considered. Measures aimed at minimizing loss of bone density are appropriate in postmenopausal women and men over 50 years, and in any patient at increased risk of fragility fracture, who are expected to take prednisolone 7.5 mg or more daily for at least 3 months. Patients with BP (and also patients with pemphigus vulgaris) were reported to have lower levels of vitamin D, and a higher incidence of severe hypovitaminosis D, than controls, suggesting additional risk of bone density loss. Calcium and vitamin D supplementation and a bisphosphonate are usually recommended and have been shown to be effective in preserving bone density, if given from the start of systemic steroid therapy in patients with immunobullous diseases. Calcium may impair absorption of mycophenolate mofetil (MMF) and oral bisphosphonates and should be taken at a different time.
Topical Corticosteroids (Strength of Recommendation A; Level of Evidence 1+)
Very potent topical steroids (clobetasol propionate) are an effective treatment for BP and they seem to have less serious adverse effects compared with 1 mg/kg of prednisone per day. However, their use in extensive disease may be limited by practical factors (e.g. ability of patient or availability of carer to apply the treatment) and they may be associated with systemic absorption and adverse events. When feasible they should be considered for first-line treatment, especially in localized disease.
Azathioprine (Strength of Recommendation D; Level of Evidence 4)
After systemic steroids, azathioprine is still a commonly used drug in BP. It is mostly employed in doses of up to 2.5 mg/kg daily as an adjunct to systemic steroids for its presumptive steroid-sparing effect.
Azathioprine dose can be optimized with regard to myelosuppression risk by prior assay of thiopurine methyltransferase (TPMT) activity, a test that is now widely available in the United Kingdom (U.K.) and relatively inexpensive. However, a normal TPMT level does not totally preclude myelotoxicity and regular monitoring of blood counts and liver function are essential.
There is currently insufficient evidence of benefit to recommend routine addition of azathioprine to systemic steroids for the control of BP. In view of its side-effect profile, it is recommended that azathioprine only be considered as an adjunctive treatment to prednisolone where response has been inadequate and the disease is not suppressed, or where the side-effects of existing therapy are troublesome and unacceptable.
Anti-inflammatory Antibiotics and Nicotinamide (Strength of Recommendation D; Level of Evidence 4)
Erythromycin should be considered for treatment, particularly in children (adult dose 1000–3000 mg daily), and perhaps in combination with topical corticosteroids. A beneficial effect may be seen within 1–3 weeks of commencing treatment.
Tetracyclines and nicotinamide may be considered as treatment in adults, perhaps in combination with topical corticosteroids. However, apart from one case report of niacinamide (nicotinamide) as monotherapy in localized BP, there is no evidence for its effectiveness as a sole treatment of BP. The optimum doses, both for the antibiotics and nicotinamide, are not established. Nicotinamide is used between 500 and 2500 mg daily, usually started at 500 mg daily and then gradually increased to 1500–2500 mg daily to minimize gastric side effects. Tetracycline has been used at doses of 500–2000 mg daily, doxycycline at 200–300 mg daily and minocycline at 100–200 mg daily. Tetracycline should be avoided in renal impairment as should doxycycline and minocycline in patients with hepatic impairment. Minocycline has a worse side-effect profile and is therefore not the first choice of antibiotic. A few cases of minocycline-associated pneumonia and eosinophilia have been described, necessitating immediate withdrawal. Lymecycline has a beneficial side-effect profile and has been successfully used by some dermatologists (408 mg twice daily) in the U.K. without published evidence. When blister formation is suppressed sufficiently the antibiotics and nicotinamide must be reduced slowly, one at a time, over several months to avoid relapse.
Methotrexate (MTX) (Strength of Recommendation D; Level of Evidence 4)
The most important toxicities of MTX are myelosuppression, hepatotoxicity, and pneumonitis. MTX is excreted renally, which should be considered in the elderly and may explain the low doses required for disease control. Many investigators recommend folic acid 5 mg on the non-MTX days to reduce some adverse effects, but this is not proven.
Evidence from case series suggests that MTX can be effective at controlling BP, either as a monotherapy or in combination with topical or systemic steroids.
Dapsone and Sulfonamides (Strength of Recommendation D; Level of Evidence 3)
Glucose-6-phosphate dehydrogenase deficiency predisposes to haematological side-effects and should be excluded in predisposed races (e.g. those of African, Middle Eastern, and South Asian origin), and all patients receiving dapsone need very frequent monitoring of blood count and liver function in the early months. The side-effect profile of dapsone and sulfonamides is potentially hazardous in the elderly. In this age group, these treatments should be considered only if other treatments are ineffective or contraindicated, and treatment started at low doses (50 mg daily) to be increased by 50 mg daily in 2-weekly steps to a maximum of 150–200 mg daily.
Intravenous Immunoglobulins (Strength of Recommendation D; Level of Evidence 3)
Intravenous immunoglobulin (IVIg) is well tolerated but expensive, costing £5320.00 per cycle of 2 g/kg in a 70-kg patient. U.K. guidance on its use is available from the Department of Health (http://www.dh.gov.uk). IVIg should only be considered as an adjunctive treatment in patients with very severe disease where rapid control is needed, or when there is failure with or contraindication to other treatments.
Chlorambucil (Strength of Recommendation D; Level of Evidence 3)
Chlorambucil as an adjunct to systemic steroids should be considered as an alternative to other more established immunosuppressants if these have failed or are poorly tolerated or contraindicated. Careful monitoring is required for possible haematological toxicity.
Cyclophosphamide is more toxic than other immunosuppressive drugs used for BP. It may rarely be considered for exceptionally refractory disease.
Ciclosporin cannot be recommended in the routine treatment of BP. It may rarely have a place in refractory cases but its value is likely to be limited by renal toxicity, especially in the elderly.
Topical Tacrolimus (Strength of Recommendation D; Level of Evidence 3)
Individual case reports have described a response to topical treatment with the calcineurin inhibitor, tacrolimus. It has mainly been used for localized and limited generalized disease. The use of topical tacrolimus is limited by local irritation and its price compared with topical steroids. It may be useful as an alternative in localized and limited disease without the disadvantage of causing skin atrophy.
Biologic Agents
Rituximab (Strength of Recommendation D; Level of Evidence 3)
Antitumour necrosis factor-α agents (Strength of Recommendation D; Level of Evidence 3)
Other biologic agents (Strength of Recommendation D; Level of Evidence 3)
Biological drugs are expensive and may be associated with potentially serious adverse effects; until further supportive evidence is available, their role in BP remains limited.
Plasmapheresis and Immunoapheresis (Strength of Recommendation D; Level of Evidence 3)
Plasmapheresis and immunoapheresis have no role in the routine treatment of BP, although in cases of refractory BP or when reduction of immunosuppressive drugs is necessary due to intolerance and adverse effects, these modalities may be used as adjuvant treatment.
Childhood Bullous Pemphigoid (Strength of Recommendation D; Level of Evidence 3)
Although there is no evidence to support any particular treatment strategy in childhood and infantile BP, its generally short-lived and benign nature suggests that preference should be given to low-toxicity treatments such as erythromycin and topical steroids.
Skin Care in Bullous Pemphigoid (Strength of Recommendation D; Good Practice Point)
There are no studies on this topic and the following recommendations are based on the personal experience of the authors. Blisters should generally be left intact if possible as this may help prevent secondary bacterial infection. When they are particularly large or in sites where they are troublesome or interfere with function, such as the sole of the foot, blisters may be pierced with a sterile needle releasing the fluid, but leaving the blister roof in place. If there are extensive areas of erosion and open raw areas, antiseptics such as potassium permanganate as a bath or soaks, or antiseptic-containing bath oils (e.g. Dermol 600® [Dermal Laboratories, Hitchin, U.K.] or Oilatum Plus® [Steifel Laboratories, High Wycombe, U.K.]) may be used for a few days to dry the lesions and prevent infection. Painful eroded or raw areas may be covered with a low-adhesion dressing such as Mepitel® (Mölnlycke, Dunstable, U.K.) or Atrauman® (Hartmann, Heywood, U.K.) held in place with soft elasticated viscos stockinette (e.g. Comfifast® [Synergy, Swindon, U.K.], Tubifast® [Mölnlycke]). It is important to ensure that such areas of erosion are included in treatment with topical steroids (clobetasol propionate).
BP is frequently a chronic disease and ideally patients should be followed until they are in complete remission and off all treatment. Patients should be monitored for drug side-effects and to ensure that symptoms are controlled to their satisfaction without excessive doses of topical or systemic treatment. Occasional itching or lesions (if acceptable to the patient) indicates that they are not being overtreated. Once their disease is stable, an attempt should be made to wean treatment at roughly 2–4 weekly intervals; this should be done on clinical criteria rather than by IF testing.
Glucose-6-phosphate dehydrogenase deficiency predisposes to haematological side-effects and should be excluded in predisposed races (e.g., those of African, Middle Eastern, and South Asian origin).
Tetracycline should be avoided in renal impairment as should doxycycline and minocycline in patients with hepatic impairment.


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Stacey Solomon Releases First Pictures Of Wedding
Ali Condon
Published 19:19, 28 July 2022 BST
| Last updated 20:05, 28 July 2022 BST
Featured Image Credit: Instagram/@staceysolomon
Stacey Solomon has shared the first photos of her fairytale wedding to Joe Swash with fans, after taking a brief hiatus from social media to enjoy the festivities.
The couple exchanged their vows on Sunday 26 July, in the garden of their Essex home - known by the family as Pickle Cottage - in front of their loved ones.
Fans had been dying to see Stacey's final look, after the Loose Women presenter took them along on her journey to find the perfect bridal gown – and they were not disappointed.
A post shared by Stacey Solomon (@staceysolomon)
Posting a collection of professional photos of she and Joe from the magical day, Stacey wrote: "Forever. Me and My Husband. I don't think I will ever get used to saying that. It all feels like a dream."
She went on to add a quote from Dr Seuss, which read: "You know you're in love when you don't want to fall asleep because reality is finally better than your dreams."
The TV personality continued: "The most special day that we didn't ever want to end. We love you all & the special community we've built on here so so much and couldn't wait to share these moments with you.
"Joe lost his father at the age of 11 and so did my dad. A huge part of our wedding day was reflecting on how this had a huge effect on them and how hard it is, even to this day to deal with."
Stacey had taken her Instagram followers wedding dress shopping with her. Credit: @staceysolomon/Instagram.
Stacey wore a stunning gown had a corset top and a princess skirt with a slit up the left-hand side.
The blushing bride styled her long blonde locks with a gentle curl, and adorned them with a breath-taking flower crown attached to a floor-length veil.
Earlier this week, Stacey showed patiently waiting fans a glimpse at the wedding decorations to tide them over until the highly-anticipated dress reveal.
The newly married couple's home was decorated with stunning fairy lights, foliage with white flowers and chairs.
Stacey also shared the footage she filmed at night time when the lights were in full effect.
Fans have been eagerly awaiting Stacey and Joe's wedding ceremony since the couple announced their engagement on Christmas Eve in 2020.
The couple welcomed their daughter Rose on Stacey's birthday, 4 October 2021 and following her birth, they turned their attention to wedding planning.
Stacey started dating Joe in January 2016 and they became Instagram official later that month.
As per Stacey's request, Tyla will make a donation to charity Grief Encounter, which supports bereaved children.
Topics: Stacey Solomon, Wedding, Celebrity
Stacey Solomon confirms she's having a baby girl in gender reveal
Stacey Solomon shares Rex's adorable new haircut after chopping off 'Thor' style
Stacey Solomon hits back at critics as she dresses daughter in matching outfit


The police and prosecution take domestic violence very serious. They egregiously pursue convictions in these cases because they are considered to be a crime against a victim.
Domestic violence refers to a familial relationship. The victim may be a spouse, partner, brother, sister, grandparent, child, or other persons residing together.
Police have the burden on the scene to distinguish the aggressor from the victim. Often the victim is cited or arrested when the police are unable to identify which party was the aggressor at the scene. It can also occur when false accusations are made against a victim by the aggressor.
Police Departments keep logs of incidents where the police have been called to a residence before. In many of these cases, an arrest will be made, or both parties will be cited, or arrested and forced to defend their charge in court.
Domestic Violence (DV) crimes are described under Arizona Law ARS § 13-3601. This law applies to specified domestic persons who become victims of assault, homicide, threat, intimidation, neglect, abuse or other act of violence.
Offenses may be classified as felonies or misdemeanors, and penalties vary depend on circumstances involved. They include: aggravated or mitigated factors; age of the victim; nature and severity of injuries; if a weapon was used; and whether or not the crime was dangerous or non-dangerous; and if the crime was a first time or repeat offense.
Non-dangerous Misdemeanor DV charges call for minimums of 30 days to 6 months in jail; and fines from $500.00 to $2500.00.
Non-dangerous Felony DV charges call for 6 months to 18 months in prison, minimums; and 4 to 10 years maximum ranges.
Persons convicted of non-dangerous domestic violence offenses may be ordered to participate in domestic violence offender or anger management counseling programs.
Dangerous Felony first time offenses expose a person to a minimum of 18 months to 3 years in prison; and maximum penalties of 7 years to 21 years on prison.
Felony domestic violence offenders will be exposed to court ordered fines that can reach a maximum of $150,000, plus restitution.
Persons convicted of domestic violence offenses will be ordered to participate in domestic violence offender or anger management counseling programs. Additional Court ordered penalties may apply such as community service, or probation.
If you have been charged with any domestic violence offenses you should consult a criminal defense attorney before pleading guilty. There may be defenses that can be used to challenge the charges, lead to suppression of evidence, or even a dismissal of charges. It is never a good idea to go to court without qualified legal representation for any criminal offense. If retained, an attorney will protect your rights, defend your charges. If the case can't be dismissed, they will work to mitigate sentencing to help you avoid or reduce harsh jail or prison sentencing.
• Arizona Coalition Against Domestic Violence .