text: Catalog Auction info Parker County Impounded Livestock Auction - Online Only (#161078) 09/14/2021 10:00 AM CDT - 09/22/2021 10:10 AM CDT CLOSED! Lot #6Pot Belly Pig Click image to enlarge Previous Lot closed - Winning bid:$80 (16 bids) Ask a question Parker County Impounded Livestock Auction - Online Only (#161078) 09/14/2021 10:00 AM CDT - 09/22/2021 10:10 AM CDT CLOSED! Description Terms and conditions PLEASE SCROLL & READ BIDDER CONTRACT and ALL TERMS LISTED BELOW: * GENERAL TERMS: A 10% Buyer Fee Per Lot is added to High Bid and becomes the contract purchase price. All animals are being offered AS IS, WHERE IS, No Warranties, No Guarantees, No Refunds. RELEASE OF ANY ANIMAL TO A BIDDER, EVEN THOUGH A PAID INVOICE IS PRESENT, IS SUBJECT TO THE SOLE DISCRETION OF THE PARKER COUNTY ANIMAL CONTROL SUPERVISOR, Hereinafter "PCACS" WINNING BIDDERS MUST PROVE TO THE PCACS AS TO THEIR KNOWLEDGE IN TRANSPORTATION AND CARE OF THE ANIMAL BEING RELEASED. THE PCACS RETAINS THE RIGHT TO CANCEL THE TRANSACTION AT HISHER SOLE DISCRETION, FOR ANY REASON, AND MAY ORDER A FULL REFUND OF AN INVOICE. IT IS THE INTENT OF THE PCACS TO RELEASE THESE ANIMALS ONLY TO A SUITABLE OWNERENVIRONMENT WHERE THEY MAY BE TREATED HUMANELY AND KEPT IN GOOD CARE. Any animal may be redeemed by registered owner prior to close of auction. Buyers assume all responsibility and hold Seller and Auctioneer harmless for introducing any animal or animal part into the stream of commerce. All Invoices are Due and Payable upon receipt. A paid invoice receipt from Texas Auction & Realty is required for pickup and removal. Photographs and Descriptions are provided as a guide, and a guide only. Descriptions are provided by Weatherford-Parker County Animal Shelter. Bidders to verify correctness of ANY advertised information to their satisfaction as to use for any particular purpose. All bidding is based upon the Bidders Personal Inspection and Opinion. IT IS THE SUCCESSFUL BUYERS SOLE RESPONSIBILITY TO DEMAND A NEGATIVE COGGINS TEST RESULT FROM THE WEATHERFORDPARKER COUNTY ANIMAL SHELTER PRIOR TO REMOVING ANY EQUINE FROM THE PREMISES. * PREVIEW & INSPECTION: Animals are located at the Weatherford-Parker County Animal Shelter , 403 Hickory Lane, Weatherford TX. PREVIEW BY APPOINTMENT WITH THE ANIMAL SHELTER, DURING NORMAL BUSINESS HOURS. The Animal Shelter is Open to the Public Tuesday thru Saturday, 11am to 4pm. Phone 817-597-1030 for other arrangements. * INVOICES & PAYMENT TERMS: All Invoices are due and payable upon receipt. Buyer authorizes Ross Bandy Auctioneers, LLC dba Texas Auction & Realty to charge buyers credit card to pay invoices up to $2,500. A Cashiers Check will be required for invoices over $2,500. You may pay in Cash before you pickup your items. If you have a preference in how you wish to pay, please let the Auctioneer know before the auction ends! Otherwise, all cards will be charged after the conclusion of the online auction. In ALL instances, payment must be received within 48 hours after the close of the online auction, unless other arrangements have been made. No sale is final until payment has been made and accepted within these guidelines. The Weatherford Parker County Animal Shelter DOES NOT Accept Payments from winning bidders. PICK UP TIMES REMOVAL TERMS: By APPOINTMENT ONLY! Pickup and Removal are BY APPOINTMENT with the PCACS by phone 817-597-1030, after payment has been made, and during the normal business hours of the Animal Shelter. WINNING BIDDERS MUST HAVE A COPY OF THEIR INVOICE AND VALID IDENTIFICATION TO PICK UP ITEMS!! If someone other than the winning bidder will be picking up the merchandise, please send a copy of winning bidders ID and a letter or permission stating that they can pick up the merchandise. The person picking up the merchandise will be required to show identification. * EXTENDED BIDDING DYNAMIC CLOSING: If a bid is entered within the last five minutes of the closing of an item, the closing time will be extended by five minutes to ensure sufficient time for bidders to submit their bids. Extended Bidding will continue until bidding has ceased. All persons previewing, removing, or on the premises for any reason, assume all responsibility for their own safety. Auctioneer & Seller are not responsible for accidents. All items sold 'As-Is, Where Is', no warranty or guarantee of any kind. All sales are final. No returns or refunds. All descriptions are believed to be accurate, however, all bidding and buying is based solely on bidder's personal inspection andor opinion of the items. It is the BiddersPurchasers sole responsibility to: (a) perform all inspections of the items and to be satisfied as to its description, condition andor authenticity prior to bidding. (b) independently verify any information they deem important including information available. (c) all information contained in the item description and all promotional materials, including, but not limited to, photographs, dimensions, conditions, etc., was provided by or on behalf of the Seller and is believed to be correct, however, neither the Seller nor the Auction Company makes any promise, representation, guarantee, or warranty as to the accuracy or completeness of such information. Bidders must rely solely on their own inspection as to the accuracy of the photographs or other information provided. (d) failure to inspect the property does not relieve bidder of responsibility for payment and removal as stated in these terms. All Bids Are A Binding Contract. Bidder acknowledges that once a bid is offered, the Bidder shall be bound by the bid amount. Bids cannot be withdrawn or retracted. Verify your information entered (bid amount) before submitting your bids. Buyer is responsible for the items once bidding is complete. Seller, nor Auction Company are responsible for the items. Items subject to additions and or deletions prior to sale timeclosing. Texas Auction & Realty makes no warranty that: (a) your use of the site will be uninterrupted, timely, secure, or error-free. (b) the results that may be obtained from the use of the site will be accurate or reliable. (c) the quality of any information or other material obtained by you through the site will meet your expectations. (d) the use or the inability to use the site; unauthorized access to or alteration of your transmissions or data; statements or conduct of any third party on this site; or any other matter relating to the site. In case of any errors or malfunctions of hardware or software, Texas Auction & Realty reserves the right to cancel any transaction even if you have received confirmation of the transaction by email. We strive to make this system as stable as possible, however errors and equipment malfunctions are possible and may happen without notice. We cannot and will not guarantee uninterrupted access to the Site or its services. Buyer is responsible for the physical labor for dismantling, rigging, crating, loading and hauling at their own expense. Buyer is responsible for the items once bidding is complete. Sellers, Auction Company, and Staff are not available for load out.


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As predicted in this space a few weeks ago, there is compromise legislation pending in the General Assembly regarding the Common Core curriculum, the controversial program that seeks to establish consistent education standards across the country.
For this, you can thank Sen. Lindsey Tippins (R-Marietta), the chairman of the Senate Education and Youth Committee. Getting a compromise on the matter was like "negotiating peace in the Middle East," Tippins joked.
Tippins is a relative newcomer to the Senate, having arrived in 2010, but he is an old hand in matters of public education. For 12 years, he was an influential and respected member of the Cobb County Board of Education.
Unlike their Kool-Aid- drinking ideologues who never deign to get a teacher's input lest it deter them from their efforts to turn our public schools into an educational version of WalMart, Sen. Tippins and Rep. Brook Coleman (R-Duluth), chairman of the House Education committee, actually undertook a series of eight statewide "listening tours" to get local opinions — including those of school teachers — on a number of educational-related issues, including Common Core.
"The structure of our meetings," said Tippins, "was to talk with district superintendents and school board members and then hold a public forum. We know it is impossible for teachers to come to Atlanta during a school year, so Rep. Coleman and I thought we should go to them. We had no agenda. We were there to listen." Give them an "A" for effort, school teachers.
One of the things they discovered is that educators felt changes were needed in Common Core, but the curriculum should not be dropped in its entirety. If the state were to start over to develop a new curriculum, Tippins estimates it could cost $250 million.
Tippins said the pending legislation would not throw out current Common Core math and English standards, but it would remove us from the current national testing consortium and the specter of federal government influence.
"A major concern of a lot of people, including me, was that Washington would dictate the standards," Tippins says, "I don't want the federal government inserting their philosophies into the educational process. I think most Georgians feel the same way."
The legislation would create a 15-member council composed of three university professors, three representatives from the business community and parents to begin reviewing the Common Core math standards, followed by the English standards. Appointments would be made by Gov. Nathan Deal, Lt. Gov. Casey Cagle and House Speaker David Ralston.
"They'll bring in curriculum and subject matter experts and compare what the most rigorous national standards were prior to Common Core, look at where our standards are deficient and then make recommendations to improve them," Tippins said.
He has suggested the State Board of Education talk to states that have been successful in measuring student achievement "and see if we can get some ideas.''
A series of public meetings across the state will allow residents to comment on the changes. Then recommendations will be brought back to the Georgia Board of Education for approval. That is the way government ought to work.
Be assured that Georgia will have a rigorous set of standards in English and Language Arts, Mathematics, Science and Social Studies, but local school systems will have a strong say in the matter. Tippins says, "Once we have decided our standards in Georgia, the local school systems will have the ability to select and implement their curriculum to meet those standards. I doubt you will find the same curriculum being applied in Lumpkin County as you will in the City of Atlanta."
I asked Tippins what he would like to tell Georgia's public school teachers. "Thank them for doing a tough job," he says. "Teachers get criticized but those pointing the fingers fail to recognize the three biggest problem teachers deal with are disengaged students, uninvolved parents and chronic discipline (issues) — the decline of the family structure."
Not many of our legislators want to deal with that truth. There is too much special interest money available and too many self-interest agendas to try and get at the root cause of the problem.
Sen. Lindsey Tippins is a voice in the wilderness surrounded by zealots who can't wait for the elections to be over so they can get back to hosing public education. With four school teachers in my family, I am glad he is minding the store. School teachers should be, too.
You can reach Dick Yarbrough at email@example.com; P.O. Box 725373, Atlanta Ga. 31139; online at dickyarbrough.com or on Facebook at www.facebook.com/dickyarb.

subset: commoncrawl


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Watch the first teaser of Arizona Muse in Louis Vuitton's premiere fashion film, L'invitation Au Voyage. {Grazia Daily}
Sophie Dahl, former model and granddaughter of author Ronald Dahl, is expecting her second child with husband Jamie Cullum. {Telegraph}
More From ELLE
Marni is launching its first fragrance next February with a division of Estée Lauder. "It's for a woman who dresses for herself, who doesn't follow trends but is sophisticated and also maybe a little eccentric," says Consuelo Castiglioni, the brand's creative director. {Grazia Daily}
Chanel unveils its new Bijou sunglasses collection, inspired by the baroque opulence of costume jewelry. {Fashion Etc}
Spanx is getting its first freestanding store, a 1,200-square-foot boutique set to open at Tysons Corner Center in McLean, V.A. {WWD}
Yoox.com has tapped Naomi Campbell to model charitable T-shirts designed by five major designers, including 3.1 Phillip Lim, Dolce & Gabbana, and Moschino. {Fashionologie}
Paul Blum has stepped down as CEO of Kenneth Cole Productions, Inc. and plans to return to strategic development as an advisor for the company. Kenneth Cole, chairman and chief creative officer, will assume the role of CEO. {WWD}
Luxottica Group inked a deal on Friday to buy French luxury eyewear brand Alain Mikli. {WWD}


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The Consumer Product Safety Commission (CPSC) announced a recall on the Twist 'n Sparkle system after discovering an explosion hazard. The iSi Twist 'n Sparkle is designed to carbonate and flavor water, but the plastic bottles included in the system can explode under the pressure created by the device.
The explosion causes plastic parts of the bottle to break off and potentially injure bystanders. Nine incidents of exploding bottles have been reported, including three in which the plastic parts cut consumers' upper bodies. About 162,700 products are being recalled..
The carbonation system has been sold at national retailers and websites like William-Sonoma and QVC between June and March 2012. If you own the iSi Twist n' Sparkle Beverage Carbonation System, stop using it immediately. You can return the product to iSi (contact 800-645-3595) or to the place of purchase to receive a refund.
More From Good Housekeeping
More information can be found at the CPSC website.


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Story by
Emil Protalinski
Emil was a reporter for The Next Web between 2012 and 2014. Over the years, he has covered the tech industry for multiple publications, incl Emil was a reporter for The Next Web between 2012 and 2014. Over the years, he has covered the tech industry for multiple publications, including Ars Technica, Neowin, TechSpot, ZDNet, and CNET. Stay in touch via Facebook, Twitter, and Google+.
Verizon is sharing more details about the alleged leak of customer data that occurred over the weekend. The company still insists there was no breach, but the carrier has now revealed to TNW that an unnamed third-party marketing firm is to blame.
On Saturday, a self-proclaimed hacker leaked some 300,000 records (including serial numbers, names, addresses, date they became a customer, passwords, and phone numbers) which he claimed belonged to Verizon Wireless customers, and then later Verizon FiOS customers. TibitXimer, as he called himself on Twitter, was worried about being banned on the social network for revealing private information, but he has disappeared from the social network.
Although he said he might be suspended, the account is simply not present on Twitter, suggesting he either deleted it or changed his handle. The Pastebin link he used to detail the leak is also no longer working. We are trying to get in touch with him, but in the meantime Verizon has been very willing to share its side of the story.
TibitXimer claims he downloaded an estimated 3 million customer entries from Verizon's database on July 12, and leaked about 10 percent, or 300,000 of them, after the carrier allegedly failed to respond to his inquiries about its security issues. Again, here is Verizon's statement about the alleged hack:
This incident was reported to the authorities when we first learned of it months ago and an investigation was launched. Many of the details surrounding this incident are incorrect and exaggerated. No Verizon systems were breached, no root access was gained, and this incident impacted a fraction of the number of individuals being reported. We take any and all attempts to violate consumer and customer privacy and security very seriously, so we notified individuals who could potentially have been impacted and took immediate steps to safeguard their information and privacy. Verizon has also notified law enforcement of this recent report as a follow-up to the original case.
Yet this leaves us with the very big question of where the data came from. An anonymous comment by " Vzn Customer" suggested that at least some of the leaked customer records are legitimate:
I call BS – If this data isn't from Verizon servers, why did it match my account number exactly? I found my name and address, and the "phone number" that only exists on Verizon servers because I don't have a real home phone number.
Security researcher Adam Caudill weighed in on Twitter:
@tactical_intel It's part of a set of files that was posted in August; I strongly suspect it's a telemarketing file or similar.
— Adam Caudill (@adamcaudill) December 23, 2012
@mrkoot The file that's going around is one of the files that we discussed back in August. Nothing new.
— Adam Caudill (@adamcaudill) December 23, 2012
We asked Verizon for more information, and it turned out that Caudill's theory holds. The company reiterated that its systems were not breached and explained where the data came from:
There was no hack, and no access gained. A third party marketing firm made a mistake and information was copied. As for wireless v. wired customers, some of the individuals listed were Verizon customers who are not wireless customers but wired/wireline customers or prospective customers.
Based on this information, it would appear that TibitXimer may have found the file online and decided to make a bit story out of it. Yet this new tidbit leads to even more questions, the biggest one being: Why did a "third party marketing firm" have access to this data in the first place?
We have contacted Twitter about TibitXimer's account. We are also in touch with Verizon and will update this article as we learn more.
Update at 8:30PM EST: Twitter told us it does not comment on individual accounts for privacy reasons.
Image credit: Stephen Davies
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One of my very first stories when I started working at Good Housekeeping was our toy reviews. Little did I know how large and impactful this project would become in just four short years. From that First Annual Toy Awards when we had 35 kids come in to help us pick the best of the bunch, to this year when we had over 115 boys and girls help us — the heart of the test has always been finding safe and well-constructed toys that inspire creativity, foster education, and encourage social play. Of course as a parent or caregiver these principles are paramount, but for a child the most important factor is how fun it is. So we try our best to find toys that meet our safety requirements, the parents' educational stipulations, and the kids' fun prerequisite.
Here are several steps you can take to ensure that you're picking out the safest toys for your children.
As a parent, you should always read all of the hazards and labels on a product. You can look for labels that indicate toys meet the latest ASTM toy safety standards. And beyond that, read toy labels carefully. The CPSC has stringent rules in place for the safety of children. The age ratings are meant as a guide, so it's important to ensure the toy is in fact appropriate for your child's skills, abilities, and interests.
- Look for a warning alerting that a toy is not suitable for a child under 3 years old due to small parts. Even without such an alert, still be wary as children can maneuver things in extraordinary ways to fit them in their mouths. If you are concerned that a toy may pose a choking hazard, you can do a simple at-home test: try to insert small toy parts into a toilet paper roll. And make sure that older children keep toys away from younger children, as they may not be appropriate or could be dangerous.
- Make sure household art materials have an ASTM D-4236 designation, which means that they have been reviewed by a toxicologist. And watch out for toys with a small magnet warning. If a child ingests more than one magnet, they can be attracted to each other making extraction more difficult.
- While they're definitely easier on the wallet, be mindful when obtaining second hand toys. Ensure that a toy is still safe and durable before giving it to your child. It's important to check for recalls as well (available at CPSC). Make sure the toy isn't broken or doesn't possess any potential hazards like sharp edges or pinch points.
Before you shop, be sure to see the winners of Good Housekeeping's Best Toy Awards 2011.
More From Good Housekeeping
Rachel Rothman (she/her) is the chief technologist and executive technical director at the Good Housekeeping Institute, where she oversees testing methodology, implementation and reporting for all GH Labs. She also manages GH's growing research division and the analysis of applicants for the GH Seal and all other testing emblems. During her 15 years at Good Housekeeping, Rachel has had the opportunity to evaluate thousands of products, including toys and cars for GH's annual awards programs and countless innovative breakthroughs in consumer tech and home improvement.


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Callimachus kəlĭm´əkəs [key], fl. 2d half of 5th cent. BC, Greek sculptor from Athens. He was famous as the maker of the gold lamp in the Erechtheum and a seated image of Hera for a temple at Plataea. There are several Roman copies of his works; one is Pan and the Three Graces (Capitoline Mus., Rome). He reputedly originated the Corinthian capital and invented the running drill used for simulating the folds of drapery in marble.
The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2023, Columbia University Press. All rights reserved.
See more Encyclopedia articles on: European Art to 1599: Biographies


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SVG - Christmas Deck the Halls "Fa La La La La" Hand Lettered
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As a CIO, you have either made – or heard – recommendations to create an IT project management office. Perhaps you have implemented one, and your department is reaping the benefits of project planning, monitoring, and controlling. IT delivers its projects on time, on budget, and to spec. Congratulations! You and your IT PMO have put the foundation of consistent innovation in place.
Nevertheless, it is no more than a foundation. A PMO must…
For more, see the full article at CIO Review.
Filed under: Agile, Innovation, IT Strategy, PMO, Portfolio Management, Project Management | Tagged: agile, Innovation, IT project management and portfolio management, IT Strategy, PMO, Portfolio Management | 1 Comment »


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Scrapes & Gravel
Regular price
By SCRAPES & GRAVEL, a Redefined jogging suit jacket in Scarlet coloured Sherpa featuring a classic crewneck, 2x4 ribbing, slim relax fit, tonal stitching, 6" zipper and signature leather label.
100% Cotton. Machine wash cold/ tumble dry low heat.
As seen on model in size L. Model measurements are Waist 28", Chest 35", Inseam 31"


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Building upon the Anabaptist principle of adult rather than infant baptism, the Amish have a tradition known as Rumspringa. The practice offers Amish teenagers a pivotal choice—put bluntly, either you're in or you're out—following a period of experimentation with secular culture, including wearing non-Amish clothes, watching Hollywood movies, driving a car and often smoking, drinking and using drugs. Inspired by the custom's intimation of anything goes (Rumspringa translated from Pennsylvania German means "running around"), New York-based artist Rob Pruitt adopted the custom as the premise for this recent, punningly titled exhibition, "Pattern and Degradation." Occupying two galleries and over 8,000 square feet, the show's diverse collection of images and objects demonstrated Pruitt's voracious appetite for multiple realms of visual culture, while simultaneously alluding to his own past art and art-world experiences. True to the spirit of Rumspringa, the show was a purposefully manic picaresque, as if created by someone burning through an unrestricted stylistic license about to expire.
Of the exhibition's approximately 10 different series (all works 2010), painting held sway, even in some of the sculptural pieces. On view at Gavin Brown were three large black-and-white "Panda Pattern" paintings rendered with enamel and glitter on canvas. The central canvas (approximately 8 by 12 feet) featured the artist's iconic giant panda image framed by zebra stripes, while an adjacent painting showed the bear in a field of tires, as if wandering through Allan Kaprow's 1961 installation Yard. The series' pulsating black/white binary produced a camouflage effect reiterated in several nearby "People Feeder" sculptures, each consisting of three to four truck tires stacked vertically and with the tire treads painted white. Set neatly inside the circular opening at the top of each stack is a stainless steel bowl filled with goodies for visitors to take, such as pretzels and various wrapped candies. Despite its visual appeal, the work implies a potential to degrade those who would consume treats from what amount to columns of industrial waste. The installation also seemed to be an acerbic response to the gift economies of Felix Gonzalez-Torres. In the "Rumspringa Quilt" works, the artist imitates Anabaptist embroidery and patchwork patterns using spray paint on linen. Although stenciled, the paintings' execution appeared relatively loose if not unpolished. "Exquisite Self-Portraits" invoke the Surrealist pictorial game—more by virtue of the title than in execution—as Pruitt digitally collaged onto large canvases three or four horizontal bands featuring photo fragments of his head and chest. Wearing a beret here, a Breton seaman shirt there, the artist puffs on a cigarette in one image and awkwardly accepts an erect cock (perhaps a dildo) in his mouth in another. Each section is colorized with a different bright hue. The style of this series is clearly indebted to Warhol's ironic identity play in his photo-booth self-portraits. Among other works at Gavin Brown were paintings of novelty T-shirts, "Rob Pruitt's T-Shirt Collection" and an entire wall covered with inkjet-on-adhesive-vinyl wallpaper that features a list of thousands of messages from Pruitt's Gmail inbox spanning four years.
Next door at Maccarone, the artist presented inkjet-on-canvas photographs of Cinnabons that he "iced" with ropy streams of iridescent paint, plus a collection of human-scale standing figures, baled cardboard "Monsters" possessing large, googly eyes made of working plastic wall clocks. While the artist's eclectic mix of images and materials throughout the exhibition relied on Warhol's visual language and Duchamp's approach in his assisted readymades, it should be noted that, for Pruitt, culling is an expression of delectation. In the pleasurable pursuit of self-representation (that is, in the demonstration of what he likes), Pruitt's art displays none of the spectrality attributed to Warhol nor the indifference of Duchamp.Ostensibly, the enjoyable activity of self-representation further provided Pruitt with a valuable coping mechanism during his self-proclaimed Rumspringa. As often mentioned in the press, he was virtually ostracized from the art world after mounting an exhibition in the early 1990s (with his then-partner, Jack Early) that some considered racially insensitive, if not racist. Beyond invoking a connection between expulsion and freedom, Pruitt now proposes an interesting question vis-à-vis his assistant-dependent, scaled-up, two-gallery show. Does the artist emerge from a state of contrition by assuming a grand, self-mythologizing position of Pop supremacy, or does he surreptitiously mock the community that shunned him by exhibiting his own taste-based brand, using any style he pleases? Whatever the answer, one senses that Pruitt is present, accounted for and affirmatively unbridled.
The exhibition was on view Sept. 11-Oct. 23.
Photos (left) View of Rob Pruitt's "People Feeders" (foreground), and "Panda Pattern Paintings" (on wall), both 2010. Right, Exquisite Self-Portrait: Father Martian, 2010, silkscreen on canvas, 84¼ by 63½ inches. Both at
Gavin Brown's enterprise.


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How Watching 'Unbundled' ESPN and AMC Could Cost More Than Your Whole Cable Bill
One last word (for now) on sports and the cable bundle
ESPN would cost as much as $30 a month if you yanked it out of the cable bundle and made it a standalone service, according to new analysis from Needham Insights.
I asked a friend from the cable industry to forward the entire 34-page report to me, and here's the money chart (click to enlarge).
Lots going on here, so I'll direct your attention to two places:
(1) First column on the right: Subscription fees skimmed off your cable bill account for between 71 percent and 91 percent of sports channels' revenue mix. The best business model in entertainment is one that most TV-watching families don't even know exists.
(2) First row, fourth column: ESPN makes as much as $7.2 billion each year before counting a cent of advertising. Before counting a cent of advertising. Needham's estimate is the highest I've ever seen, but not totally out of whack with others.
Starting to make up that $7.2 billion among a smaller cohort of pay-TV households would require each household to pay much more for today's ESPN. "We believe that only 20 million super-fan homes would pay $30/month for ESPN's group of channels," the authors write, which is "equivalent to 100 million households paying $6/month today."
A similar experiment with AMC would produce even more striking results. If AMC receives $0.27 from 90 million households each month, that's $24 million a month. Let's make a generous assumption that every person who watches "Mad Men" live (or a third of households that watch "The Walking Dead") agreed to subscribe to the standalone network and had to replace its full cost.
That's 2 to 3 million household paying about $10 a month.
Today, the typical household pays a little under $40 a month in total subscription fees to all of the networks. So, $30 for standalone-ESPN plus $10 for standalone-AMC is already equal to or more than the total programming costs in your cable bill right now. In simpler English: TV just got more expensive with just two a la carte channels.
You could respond to this by saying that, in an unbundled world, ESPN and AMC would probably downsize to meet the economic realities of their audience. And fine. But the big point is that a la carte seems to many people to be technologically inevitable, economically efficient, and unquestionably good for consumers. The best I can say is: I almost agree with the first part.


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Changes proposed by the U.S. Department of Justice and 33 U.S. states and territories are designed to stop Apple from committing further antitrust violations. Changes extend beyond e-books, potentially limiting Apple's ability to negotiate for such content as movies, music and TV shows, and increasing regulatory oversight of other business areas such as the company' App Store.
In a court filing, Apple called the proposed injunction a "draconian and punitive intrusion" into its business that would hurt consumers and competition and was "wildly out of proportion" to the harm it was meant to address. Perhaps it should of thought of that before it decided to cheat its customers by arranging a price cartel.


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Living Room Bookshelf Idea A back porch is a covered or open outdoor area that is attached to the back of a house. It is typically used for relaxing, entertaining guests, or enjoying the outdoor view. Back porches can vary in size and design, ranging from small intimate spaces to large, multi-level areas with multiple seating areas, cooking facilities, and even outdoor fireplaces or heaters. Some back porches are screened in to keep out insects and other pests, while others are open to the elements. Back porches can be a great addition to a home, providing a place to enjoy the outdoors while still being protected from the elements.
Living Room Bookshelf Idea is a part of Awesome And Cozy Back Porch Design For Summer pictures gallery.
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Diamond Fire, Inc. Information Technology Consulting Firm
Diamond Fire, Inc. is a full service information technology consulting firm. We are able to assist you in all of your needs including: Website Development, Custom software design, networking solutions. This is by no means a complete listing.
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Monday, 26 July 2010 04:38 PM EDT
The federal government is rapidly expanding a program to identify illegal immigrants using fingerprints from arrests, drawing opposition from local authorities and advocates who argue the initiative amounts to an excessive dragnet.
The program has gotten less attention than Arizona's new immigration law, but it may end up having a bigger impact because of its potential to round up and deport so many immigrants nationwide.
The San Francisco sheriff wanted nothing to do with the program, and the City Council in Washington, D.C., blocked use of the fingerprint plan in the nation's capital. Colorado is the latest to debate the program, called Secure Communities, and immigrant groups have begun to speak up, telling the governor in a letter last week that the initiative will make crime victims reluctant to cooperate with police "due to fear of being drawn into the immigration regime."
Under the program, the fingerprints of everyone who is booked into jail for any crime are run against FBI criminal history records and Department of Homeland Security immigration records to determine who is in the country illegally and whether they've been arrested previously. Most jurisdictions are not included in the program, but Immigration and Customs Enforcement has been expanding the initiative.
Since 2007, 467 jurisdictions in 26 states have joined. ICE has said it plans to have it in every jail in the country by 2013. Secure Communities is currently being phased into the places where the government sees as having the greatest need for it based on population estimates of illegal immigrants and crime statistics.
Since everyone arrested would be screened, the program could easily deport more people than Arizona's new law, said Sunita Patel, an attorney who filed a lawsuit in New York against the federal government on behalf of a group worried about the program. Patel said that because illegal immigrants could be referred to ICE at the point of arrest, even before a conviction, the program can create an incentive for profiling and create a pipeline to deport more people.
"It has the potential to revolutionize immigration enforcement," said Patel.
Patel filed the lawsuit on behalf of the National Day Laborer Organizing Network, which is concerned the program could soon come to New York. The lawsuit seeks, among other things, statistical information about who has been deported as a result of the program and what they were arrested for.
Supporters of the program argue it is helping identify dangerous criminals that would otherwise go undetected. Since Oct. 27, 2008 through the end of May, almost 2.6 million people have been screened with Secure Communities. Of those, almost 35,000 were identified as illegal immigrants previously arrested or convicted for the most serious crimes, including murder and rape, ICE said Thursday. More than 205,000 who were identified as illegal immigrants had arrest records for less serious crimes.
In Ohio, Butler County Sheriff Rick Jones praised program, which was implemented in his jurisdiction earlier this month.
"It's really a heaven-sent for us," Jones said. He said the program helps solve the problem police often have of not knowing whether someone they arrested has a criminal history and is in the country illegally.
"I don't want them in my community," Jones said. "I've got enough homegrown criminals here."
Carl Rusnok, an ICE spokesman, said Secure Communities is a way for law enforcement to identify illegal immigrants after their arrest at no additional cost to local jurisdictions. Jones agreed.
"We arrest these people anyway," he said. "All it does is help us deport people who shouldn't be here."
Rusnok said ICE created the program after Congress directed the agency to improve the way it identifies and deports illegal immigrants with criminal backgrounds. ICE has gotten $550 million for the program since 2008, Rusnok said.
Rusnok said the only place he knows of that has requested not to be a part of Secure Communities is San Francisco, which began the program June 8. Eileen Hirst, the chief of staff for San Francisco Sheriff Michael Hennessey, said it happened "without our input or approval."
Hirst said the sheriff thought Secure Communities cast too wide a net and worried that it would sweep up U.S. citizens and minor offenders, such as people who commit traffic infractions but miss their court hearings. Hirst also said the program goes against San Francisco's sanctuary city policy that calls for authorities to only report foreign-born suspects booked for felonies.
"Now, we're reporting every single individual who comes into our custody and gets fingerprinted," Hirst said.
California Attorney General Jerry Brown denied Hennessey's request to opt out. Brown said that prior to Secure Communities, illegal immigrants with criminal histories were often released before their status was discovered.
This month, Washington, D.C., police decided not to pursue the program because the City Council introduced a bill that would prohibit authorities from sharing arrest data with ICE out of concern for immigrants' civil rights. Matthew Bromeland, special assistant to the police chief, said police wanted the program and were talking with ICE about how address concerns from immigrant advocates before the bill forced them to halt negotiations.
Colorado officials became interested in the program after an illegal immigrant from Guatemala with a long criminal record was accused of causing a car crash at a suburban Denver ice-cream shop, killing two women in a truck and a 3-year-old inside the store. Authorities say the illegal immigrant, Francis M. Hernandez, stayed off ICE's radar because he conned police with 12 aliases and two different dates of birth.
A task-force assembled after the crash recommended Secure Communities as a solution.
Evan Dreyer, a spokesman for Colorado Gov. Bill Ritter, said Ritter recognizes that other states have had issues with the program and he wants to take time to consider the concerns raised by immigrant rights groups before deciding "how or if to move forward."
The Colorado Immigrant Rights Coalition said in its letter to the governor that the Secure Communities is "inherently flawed and should not be implemented." CIRC said one of its main concerns is that in cases of domestic violence, where both parties may be taken into custody while authorities investigate a case, victims may feel reluctant to report a crime out of fear that their illegal status will be discovered.
ICE maintains that only suspects arrested for crimes — and not the people reporting them — will be screened for their legal status.
Secure Communities: http://www.ice.gov/secure—communities/
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BMW's i3 is an interesting car for a lot of reasons. It's BMW's first rear-engine mass production vehicle since the 700, it's the smallest BMW-badged vehicle we've seen here in a while, and it's a great lesson on why batteries still kind of suck today.
MIT Technology Review plunges into this issue, and investigates the car is really a "plug-in hybrid." Those are their words, and I actually don't think they're accurate. The i3 isn't a hybrid as such, since the optional gas motor never drives the wheels. It's really more of a range-extended electric car.
Still, that's basically a semantic quibble, as the MIT article is totally valid otherwise. The article points out that if you look at the i3's design, it was initally designed with the gas motor as a range extender in mind from the start, and the pure-electric version came afterwards.
You can see that clearly here — at the rear of the car, the 660cc gas motor sits right next to the electric motor, and on the pure electric there's just an empty hole with a support brace. If the car was designed as a pure electric from the get-go, that space wouldn't have been wasted, it'd be used for batteries or cargo or whatever.
This means that going into the project, BMW knew battery power alone wasn't going to cut it. And, if you look at the numbers, it makes total sense:
A gas tank about the size of a brief case can nearly double the range of BMW's i3 from about 145 kilometers (90 miles) to 270 kilometers (168 miles). The gas engine also adds about $3,650 to the price of the car, boosting it, according to reports, from $41,350 to $45,000 in the U.S. Although the engine adds weight and cost, affecting performance, doubling the size of a battery pack would be more expensive and add more weight.
What would the tradeoffs have been of doubling the size of the battery pack to get a similar range? Automakers generally keep quiet about the cost of batteries, but current estimates suggest it would cost about $11,000 to double the size of the i3's battery pack, far more than the price increase for the gas generator. It would also add another 230 kilograms of weight, nearly twice the weight of the range extender system.
So, for power-to-weight/-cost ratios, batteries still can't match good dirty old gasoline. That's not really news, as such, just a slightly depressing reminder of what we already know.
There's other unanswered questions here as well. Converting energy from one form to another is inherently wasteful. That means if you're going to burn gasoline anyway, you may as well just put that energy right to the wheels instead of making electricity for a motor. That's how the plug-in Prius and most actual hybrids work, because, generally, it is more efficient.
There's schools of thought that an optimally sized ICE engine running at precisely the right speed would be more efficient making electricity, and that's the approach Fisker was trying, though not to too much success. BMW may hit closer with their tiny 33HP 660cc engine making the power, but there will still be some losses.
There's also some encouraging news here as well, though. The fundamental flexibility of an electric drivetrain is well demonstrated here, in that a module to make power is able to be simply plugged in or out, depending on the model you buy. That could mean that future advances in fuel cells or radioisotope thermoelectric generators or captive black holes or whatever could be (potentially) easily fitted to cars, and that's an engaging idea.
Plus, the i3 design I think is actually pretty great for a small city car. Stylish, great looking interior, suicide doors — I think I'd really like this car, overall.
Also, if I'm honest, what would really be exciting to me is the i3, stripped of its batteries and electric motor replaced with a small, say 1- 1.5L 3 or 4 cylinder motor at the rear. Something with around 80-100 HP could be plenty fun in a car like this. Hell, maybe one of BMW's motorcycle flat twins in there, and then we'd really have a modern 700.
Actually, let's do that while the battery nerds work on those captive black holes or whatever.


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OVERVIEW: What every practitioner needs to know
Are you sure your patient has bacterial gastroenteritis? What are the typical findings for this disease?
In clinical practice, diarrhea is typically defined as an increase in frequency and a decrease in consistency of the stool compared with the child's baseline. It is the caregiver who determines that the pattern is abnormal for the child. Most episodes of infectious diarrhea resolve within 7 days and are termed "acute" or "simple." The small percentage of episodes that last more than 14 days are considered "persistent diarrhea."
Diarrhea is a common complaint among children in the United States. Most cases (~90%) are due to viruses, and therefore antibiotics are not indicated. Even among the bacterial agents, there are few indications for antimicrobial therapy. For this reason, it is rare that the practitioner faced with a patient with diarrhea will be justified in prescribing antibiotics empirically.
Nonetheless, it is important for the practitioner to be able to distinguish the small subset of patients whose diarrhea has a bacterial cause. Knowledge of the offending agent and its antibiotic susceptibility informs the practitioner whom to treat, which antibiotics are appropriate, and what clinical course and possible sequelae to anticipate. Regardless of the cause of diarrhea, the primary goal is prevention and treatment of dehydration, which is seen most commonly in infants younger than 24 months of age.
Continue Reading
The bacterial pathogens that cause diarrhea are a heterogeneous group, but four species prevail in the United States (Shigella, nontyphoidal Salmonella, Campylobacter, and Yersinia), and will be designated as the "common bacterial pathogens" in this chapter. The clinical manifestations of the common bacterial pathogens are indistinguishable from each other. Each is capable of producing four syndromes: simple enterocolitis, dysentery, bacteremia without focal infection, and disseminated infection.
When evaluating a child with diarrhea, several features indicate that a patient is at higher than aggregate risk for having a bacterial pathogen:
Presence of diarrhea without or before onset of vomiting
A high number of diarrheal stools in a day (>3-4)
Blood in stools
Presence of fecal leukocytes
Severe crampy abdominal pain
Nonetheless, in an individual child it can be difficult to predict the cause on clinical grounds alone. Some children with bacterial diarrhea are afebrile and have watery stools without blood, and some children with viral diarrhea have fever and mucus in the stools. Clinical algorithms have been developed in an effort to identify which children are most likely to have bacterial diarrhea. In general, these algorithms have detected only a subset of children with bacterial diarrhea (range from 25%-70%, depending on the prevalence of bacterial diarrhea in the population and the algorithm used); however, when the above features are absent, it is highly unlikely that the child has bacterial diarrhea.
The dysentery syndrome requires special comment. Dysentery is a constellation of clinical signs and symptoms that are associated with severe distal colitis. Patients with dysentery characteristically present with a high frequency of small-volume stools containing blood, pus, and mucus, passed with urgency and straining during defecation, often in association with fever and abdominal cramps. Watery diarrhea may precede the onset of dysentery.
Shigella is the major cause of bacillary dysentery. The diarrheal illness associated with Shiga toxin-producing Escherichia coli (STEC), also known as enterohemorrhagic E. coli, also can begin with watery stools. The stools usually become bloody in 1-3 days; however, the bloody stools tend to be more voluminous in STEC infection compared with those seen in bacterial dysentery. Severe abdominal pain is common in STEC infection, but most children are afebrile.
The colitis associated with Clostridium difficile shares many of the features seen with the common bacterial enteropathogens. Occasionally, severe cases produce little or no diarrhea, especially in the presence of ileus or toxic megacolon.
In some patients, particularly infants younger than 3 months of age, and those with underlying conditions (immunodeficiency, malnutrition, hemolytic anemia, chronic colitis, prosthetic devices, or liver disease), the common bacterial enteropathogens produce invasive infections such as bacteremia with or without clinical enteritis. Nontyphoidal Salmonella is the most frequent offending agent. In approximately 10% of patients with bacteremia, extraintestinal sites are seeded, resulting in focal infections (osteomyelitis, pneumonia, meningitis, tissue abscesses). Rarely, contiguous spread from the intestine produces cholangitis, pancreatitis, appendicitis, or peritonitis after intestinal perforation. HIV-infected individuals are prone to the development of persistent or recurrent bacteremia.
Symptoms include the following:
Blood in stool
What other disease/condition shares some of these symptoms?
Diarrhea can sometimes accompany nonintestinal infections (e.g., urinary tract infection, otitis media) and can be result from a multitude of noninfectious causes, including malabsorption and disorders affecting intestinal transit time. Inflammatory bowel disease and proctitis are inflammatory conditions that may mimic bacterial gastroenteritis. Entamoeba histolytica should be considered in a child with dysentery who has travelled to an endemic area.
What caused this disease to develop at this time?
Four "common" enteropathogens are responsible for most bacterial diarrhea acquired in the United States: Shigella, non-typhoidal Salmonella,
Campylobacter, and Yersinia. The diarrheagenic E. coli encountered most frequently (albeit uncommonly) in the United States are STEC, enteroaggregative E. coli (EAEC), and enterotoxigenic E. coli (ETEC). C. difficile colitis is unusual in children but should be considered in certain clinical settings. Although the data are conflicting, many experts believe that Aeromonas can cause diarrhea and dysentery. Vibrio species share an ecologic niche with Aeromonas and are occasionally identified in cases of diarrhea.
Simple epidemiologic sleuthing can provide clues to the diagnosis. The common bacterial diarrheas (plus Aeromonas) generally show distinct seasonality, with a peak in the late summer and autumn for all but Yersinia, which peaks in wintertime. Many agents have age predilections. The incidence of nontyphoidal Salmonella is highest in infancy, Shigella is most common in preschoolers (1-4 years), STEC is seen most often in school-aged children (5-9 years), whereas Campylobacter shows no clear age predisposition in childhood. Although asymptomatic carriage may be common, there is little evidence that children younger than 2 years are susceptible to C. difficile colitis.
The very low infectious dose of Shigella allows fecal-oral spread to occur readily, particularly in environments in which sanitation and hygiene are suboptimal, such as day care centers and custodial institutions.
Nontyphoidal Salmonella is the leading bacterial cause of foodborne outbreaks, with the most common vehicles being eggs and chicken. Transovarian passage of
Salmonella occurs in hens, so grade A eggs with intact shells can harbor the organism. Salmonella from these sources can be ingested in improperly cooked foods or can be inoculated onto grocery packaging, kitchen surfaces, utensils, and other foods, and cross-infect foods prepared for infants and children. Pet reptiles (turtles, lizards, or snakes) colonized asymptomatically with Salmonella serve as another vehicle for infection.
Campylobacter species infect a wide range of domestic and wild birds and animals. Infections among hikers who drink untreated surface water contaminated with the feces of infected birds and animals are well documented. However, most human infections are sporadic and related to ingestion of contaminated poultry. Unpasteurized milk and contaminated water are the most common vehicles identified in outbreaks. Unlike Salmonella, there is no transovarian passage of Campylobacter in hens, making eggs an uncommon source. Cats and dogs develop symptomatic Campylobacter infection that can be transmitted to humans.
Yersinia is classically associated with consumption or preparation of contaminated pork. Yersinia is cold tolerant, with winter seasonality and sustained infectivity in refrigerated blood products. Transmission from sick pets has also been reported.
ETEC contaminates food and water sources in developing countries and should be suspected in a child in who watery diarrhea develops in relation to travel to an endemic area. STEC, notably the most virulent serotype, known as O157:H7, is an occasional cause of diarrhea outbreaks as well as sporadic cases. STEC is excreted asymptomatically by cattle, particularly in the northern tier states. Exposure to cattle manure or food or water contaminated thereby, may lead to human infections. Undercooked beef is the most common vehicle, but vegetables and fruits are increasingly implicated, and contact with fresh water contaminated with manure, or exposure to infected animals, humans, or contaminated fomites also pose a risk.
The infectious dose for O157:H7 is similar to that of Shigella species, and person-to-person transmission is noted in nearly all large outbreaks of the infection. The presence of bloody diarrhea and hematologic complications (see below) should raise suspicion.
C. difficile usually occurs in patients with underlying medical conditions and recent antibiotic exposure and is frequently hospital acquired.
Infection with Aeromonas and Vibrio species should be suspected when there has been recent (usually within 3 days) exposure to natural marine environments or seafood or in cases of traveler's diarrhea.
In aggregate, the epidemiologic features that are most likely to help the practitioner arrive at the correct diagnosis include season; age; recent travel to a developing country; drinking surface water or swimming in natural aquatic environments; day care attendance; ill contacts; underlying medical conditions; a visit to a farm or petting zoo or contact with reptiles, birds, or pets with diarrhea; consumption of unsafe foods (e.g., raw meats, eggs, or shellfish or unpasteurized milk or juices); recent hospitalization; or antibiotic use.
What laboratory studies should you request to help confirm the diagnosis? How should you interpret the results?
The definitive test to detect the presence of bacterial gastroenteritis remains the culture of enteropathogens from the stool. In most clinical laboratories, the standard stool culture identifies Shigella, Salmonella, Campylobacter, and
Yersinia. Specialized testing is required if other agents are suspected, as discussed below.
Stool cultures are often viewed as having a high cost per relative yield, so efforts have been made to define the clinical scenarios where the yield is likely to be the highest. Although no approach is completely satisfactory, if any of the clinical features predictive of bacterial diarrhea are present (no preceding vomiting, frequent stools, hematochezia, fecal leukocytes, and abdominal cramps, as discussed above), it is justifiable to send stool for culture. An additional indication for a stool culture is to evaluate persistent diarrhea. Blood cultures should be obtained in ill-appearing or high-risk patients.
One approach to reducing performance of stool cultures in hospitalized children that have a very low yield is the "3-day rule." Unless overriding circumstances prevail (e.g., admission specimens were not sent, the patient has AIDS, or a nosocomial outbreak is suspected), routine stool cultures should not be requested from patients hospitalized for greater than 3 days. Conversely, this same set of patients should have specimens tested for C. difficile toxins especially if they are severely ill, or have fever, tenesmus, or bloody diarrhea.
There are effective ways to increase the yield of stool cultures in children with bacterial diarrhea. Yield from culture of a single stool is greater than 70%, but even the most experienced clinical laboratories may fail to isolate the offending pathogen. Whether this is due to intermittent or self-limiting excretion or the difficulty in finding a bacterium in the context of abundant commensal microbiota is unclear. In any case, a highly skilled clinical laboratory should be used, and in cases of high suspicion, multiple stools may increase yield.
The clinician also can improve the yield of stool cultures by attending to the conditions of collection and transport. Every effort should be made to obtain the specimen before the administration of antibiotics and to expeditiously transport the specimen to the laboratory, using transport media if possible. Shigella, for example, are fastidious organisms that do not survive well in stool allowed to remain at room temperature. If a whole stool is not available, obtain a rectal swab for culture, as the yield is very good.
The fecal leukocyte examination can be used to assess the likelihood that a patient's diarrhea is due to a bacterial pathogen. The presence of leukocytes indicates an inflammatory syndrome that is overall more likely due to a common bacterial infection. In contrast, fecal leukocytes are absent or sparse in patients with STEC infection.
There are studies suggesting that the yield for Campylobacter diagnostics is enhanced by use of an immunoassay in addition to or instead of conventional culture.
If STEC infection is suspected, the most common serotype (O157:H7) can be detected in most clinical laboratories using culture on MacConkey agar containing sorbitol. Sorbitol-negative (nonfermenting) E. coli should be serotyped to confirm the presence of
E. coli O157:H7. Commercial tests for the identification of Shiga toxin are also available, which have the advantage of leading to the identification of non-O157:H7 STEC, but should not be substituted for culture.
If suspicion is high and point-of-care testing is negative or inconclusive, specimens can be sent to the state health laboratory for definitive diagnosis. Yield of stool culture for the pathogen drops dramatically after the seventh day of infection. Patients with STEC infection should be carefully monitored with a complete blood cell count with smear, platelet count, blood urea nitrogen level, and creatinine concentrations to detect changes suggestive of the hemolytic uremic syndrome (HUS). Diagnosis of ETEC and EAEC is possible only in research laboratories.
The laboratory diagnosis of C. difficile infection requires demonstration of
C. difficile toxin or toxigenic C. difficile. Because asymptomatic carriage with C. difficile can occur, a positive toxin assay does not prove pathogenicity. Endoscopy should be considered in children with evidence of inflammatory colitis to look for evidence of pseudomembranous colitis. A number of tests are commercially available to detect toxin-producing C. difficile in stool, including enzyme immunoassays for toxins A and B, cell culture cytotoxicity assay, and polymerase chain reaction (PCR). The sensitivity of cell culture and PCR are superior to that of immunoassay.
Would imaging studies be helpful? If so, which ones?
Imaging studies have limited utility in the evaluation of a child with suspected bacterial enteritis with one exception. If an extraintestinal infection is suspected, CT or magnetic resonance imaging may assist with diagnosis and management decisions.
If you are able to confirm that the patient has bacterial gastroenteritis, what treatment should be initiated?
General principles: Prevention of dehydration and correction of fluid and electrolyte losses, preferably by oral rehydration, is the mainstay of treatment for all bacterial diarrhea. Children who are not dehydrated should be offered ample quantities of appropriate fluids to prevent dehydration from occurring. An age-appropriate unrestricted diet is recommended as soon as dehydration is corrected. Continued feeding not only prevents nutritional deficiency but can also actually shorten the duration of the illness.
Antiemetic and antimotility agents: These should generally be avoided. Note that fluoroquinolones are effective in the treatment of many cases of bacterial diarrhea, as described below; however, these drugs are not approved for the treatment of diarrhea in children younger than 18 years and should be chosen only if the benefits outweigh the risks.
Shigella: Although most episodes of shigellosis are self-limited, antibiotics can shorten the duration of illness and fecal excretion. Treatment is recommended for patients with severe disease, dysentery, or immunodeficiency, or to prevent spread of infection. Agents of proven benefit include ampicillin (not amoxicillin) and trimethoprim-sulfamethoxazole (although antibiotic resistance to these agents is now common in the United States). Extended-spectrum cephalosporins (e.g., ceftriaxone), ciprofloxacin, and azithromycin are also effective. Except in severe cases, a 5-day course of oral antibiotics is sufficient.
Nontyphoidal Salmonella: Antibiotic therapy is not indicated for otherwise healthy children with simple gastroenteritis caused by nontyphoidal Salmonella because therapy does not shorten the course of the disease and may prolong fecal excretion. Although of unproven benefit, treatment of children with simple enterocolitis who are at increased risk of invasive disease (described above) is generally recommended. Ampicillin and trimethoprim-sulfamethoxazole are good choices for susceptible strains. Extended-spectrum cephalosporins, azithromycin, and fluoroquinolones are alternatives if resistance to first-line drugs is suspected or proved.
Bacteremia without focal infection: This condition is generally treated for 10-14 days, although the route of administration and duration of therapy can be adjusted according to the clinical presentation and underlying health status of the child. Children with localized invasive disease (osteomyelitis, pneumonia, abscess, meningitis, or bacteremia in HIV-infected patients) should receive empirical therapy with expanded-spectrum cephalosporins or fluoroquinolones until susceptibility results become available. Treatment should continue for at least 4 weeks (6 weeks for meningitis).
Aminoglycosides should not be used to treat nontyphoidal Salmonella infection even if in vitro testing indicates susceptibility. Occasionally, treatment failures have been reported with cephalosporins despite in vitro susceptibility.
Campylobacter: Oral macrolide agents have been shown to benefit some patients with Campylobacter infection when administered in the first days of illness. Aminoglycosides plus an intestinally active agent such as an extended-spectrum cephalosporin or carbapenem (e.g., meropenem) are often used to treat invasive infections until results of antibiotic susceptibility testing become available.
Yersinia: The efficacy of antibiotics in the treatment of simple enteritis and pseudoappendicitis syndrome caused by Yersinia species is unproved. Invasive infections should be treated with antibiotics; most strains are susceptible to trimethoprim-sulfamethoxazole, aminoglycosides, extended-spectrum β-lactams, and fluoroquinolones.
STEC and ETEC: Antibiotics should not be given to treat STEC infection because there is no known benefit, and some studies have suggested an increased risk of HUS. In addition, antimotility agents, narcotics, and nonsteroidal antiinflammatory drugs should not be given to patients with acute infection.
Volume expansion with normal saline may provide some benefit to infected patients, and dehydration should be carefully avoided. Patients with severe watery diarrhea after travel to a resource-poor country can be offered azithromycin or fluoroquinolones for empirical treatment of ETEC (although most ETEC infections are brief and self-limited and typically resolve before the traveler returns to the United States). EAEC infections do not require antibiotic treatment.
C. difficile: Treatment should be considered for moderate or severe diarrhea or colitis attributed to C. difficile. The precipitating antibiotic should be discontinued. Metronidazole (oral or intravenous) is usually first-line therapy. Oral vancomycin is indicated if disease is severe (requiring intensive care, pseudomembranous colitis diagnosed by endoscopy, or underlying intestinal disease) or for patients who do not respond to metronidazole.
What are the adverse effects associated with each treatment option?
Licensed antibiotics can be associated with a wide range of adverse effects. Although most are mild, severe, life-threatening reactions can occur, such as anaphylaxis. For this reason, we have tried to limit treatment recommendations to those instances in which evidence suggests a favorable risk to benefit ratio.
What are the possible outcomes of bacterial gastroenteritis?
The prognosis of bacterial diarrhea is generally excellent. Most episodes in otherwise healthy children resolve spontaneously in 7-10 days. In a small percentage (<10%), diarrhea can become persistent, requiring careful management of the child's fluid and dietary intake. In contrast, the prognosis can be guarded, even in the presence of appropriate antibiotics, when high-risk children become infected, particularly with nontyphoidal Salmonella. Examples include nontyphoidal Salmonella osteomyelitis in children with sickle cell anemia (which can result in chronic or recurrent disease and growth impairment) and meningitis in infants younger than 3 months of age (which has high morbidity and mortality). Pathogen-specific complications or sequelae are discussed below.
What causes this disease and how frequent is it?
Diarrhea is one of the most common illnesses affecting children. During each of the first 2 years of life, an infant living in the United States can be expected to experience 1-3 episodes of diarrhea. In the United States, acute diarrhea accounts for moret than 1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths/year. Bacterial agents are responsible for 5%-10% of these episodes. In 2010, the Centers for Disease Control and Prevention estimated the incidence of laboratory-diagnosed bacterial infections based on surveillance performed by the Foodborne Diseases Active Surveillance Network per 100,000 children younger than 5 years of age as follows: Salmonella, 69.5; Campylobacter, 24.4; Shigella, 16.4; STEC, 8.3; Yersinia, 1.9; and Vibrio 0.0.
How do these pathogens/genes/exposures cause the disease?
The invasive bacterial pathogens (Shigella, Salmonella, Yersinia, Campylobacter) cause disease by colonization and invasion of the intestinal mucosa, followed by the infiltration of leukocytes and the opening of intestinal tight junctions. The precise cause of the net secretory state manifested clinically as diarrhea remains obscure, although inflammation per se as well as altered intestinal permeability are established causes of the secretory state. The presence of specific enterotoxins has long been posited but never proved for these pathogens.
Several noninvasive bacterial pathogens share the pathogenic paradigm of attaching to the intestine and elaborating potent enterotoxins. STEC adhere intimately to the colonic mucosa and transduce a secretogenic signal mediated by the transepithelial injection of several protein toxins. Shiga toxin itself appears to be inflammatory and secretogenic and may exacerbate diarrhea in addition to targeting epithelial cells and producing vascular damage, which lead to hemorrhagic colitis, and in some children a prothrombotic state that proceeds to HUS.
ETEC adhere to the small intestinal mucosa by colonizing fimbriae and elaborate secretory toxins: heat-labile toxin or heat-stable toxin, or both. Cholera toxin produced by
Vibrio cholerae is very similar to heat-labile toxin. The pathogenesis of C. difficile–associated diarrhea includes alteration of the colonic microflora (usually, but not always, after antibiotic therapy), overgrowth of C. difficile and toxin production (necessary but not sufficient), plus mucosal injury, inflammation, and diarrhea.
Other clinical manifestationsthat might help with diagnosis and management
Yersinia is notorious for causing pseudoappendicitis in older children and adults that has been attributed to mesenteric adenitis. A syndrome of exudative pharyngitis and cervical adenitis also has been linked to Yersinia.
What complications might you expect from the disease or treatment of the disease?
The major complication of diarrheal disease from any cause is dehydration. Signs of dehydration include dry mouth, decreased urination, increased thirst, sunken eyes, and decreased skin turgor. When severe, lethargy and cardiovascular instability ensue.
Salmonella, Shigella, Campylobacter, and Yersinia are all capable of producing reactive arthritis, either alone or in association with conjunctivitis and uveitis. This postinfectious sequela is primarily a disease of adults and is exceedingly rare in children. Arthritis begins acutely usually 2-4 weeks after the intestinal illness. Joint symptoms range from mild arthralgia to severe polyarthritis and become chronic in about 10% of cases. Individuals with the HLA-B27 histocompatibility antigen are predisposed, accounting for approximately one half of the cases. The risk to the remaining 92%-99% of the population that is HLA B27 negative is thus very low.
HUS occurs in about 2%-8% of children younger than 10 years of age infected with STEC. Predictors for the development of this syndrome are incompletely understood, although those with more severely inflammatory enteritis (evidenced by a high peripheral white blood cell count) are thought to be at increased risk. Patients infected with STEC are also at risk for cerebrovascular accident and toxic megacolon. Case fatality is approximately 2%-3%. Insufficient data are available to determine the long-term renal function in those who survive. Patients with proven STEC infection should be observed carefully (as outpatients in most cases); the HUS risk period is past when the platelet count rises, or if the platelet count is stable and diarrhea is resolved or resolving.
Intestinal complications of shigellosis include toxic megacolon, rectal prolapse, and protein-losing enteropathy. These are rare complications in developed countries, where patients are generally well nourished and present to medical attention before these serious sequelae arise. A variety of extraintestinal manifestations may occur. The most common is seizures, usually in febrile children without associated encephalopathy.
Because Shigella dysenteriae serotype 1 harbors the phage encoding Shiga toxin, patients with this infection are prone to the development of HUS, although antibiotic therapy does not appear to increase its risk. Shigella sepsis is uncommon and is usually seen in hosts with malnutrition or immunodeficiency. Persistent diarrhea and malnutrition are the most common chronic sequelae seen in children from developing countries.
Guillain-Barré syndrome is a known complication of Campylobacter gastroenteritis. One study estimated that about 30% of episodes of Guillain-Barré syndrome have a preceding Campylobacter infection. The neurologic manifestations begin 10-21 days after the onset of diarrhea. Molecular mimicry has been incriminated as the cause, resulting from cross-reactivity between bacterial lipooligosaccharide epitopes and GM1 gangliosides on the surface of host neural tissues. No management approach has been shown to mitigate the risk. Advice to the patient with proven Campylobacter infection as to the signs and symptoms of this syndrome is prudent.
How can bacterial gastroenteritis be prevented?
Consumption of contaminated food poses the greatest risk for bacterial gastroenteritis. Parents should be counseled routinely about safe food handling and preparation, as well as hygienic practices when handling pet chicks, reptiles, cats, and dogs (see http://www.cdc.gov/salmonella/general/prevention.html). Small children should not be permitted to handle raw meats in the grocery cart or assist with the preparation of meat or poultry before cooking, and eggs, chicken, beef, pork, and seafood should be thoroughly cooked before consumption.
Beef poses a particular hazard. Hamburger and beef steaks should be served well done (internal temperature at least 155°F). Hikers should bring ample supplies of clean water to obviate the need to drink untreated surface water. Fecal oral hygiene should always be practiced on exposure to any other person with diarrhea. When traveling to developing countries, children should only consume food that is cooked and served steaming hot, and drink only hot, bottled, or canned beverages.
What is the evidence?
Steiner, MJ, DeWalt, DA, Byerley, JS. "Is this child dehydrated?". JAMA. vol. 291. 2004. pp. 2746-54. (Excellent review of clinical evaluation methods to assess dehydration.)
Lukacik, M, Thomas, RL, Aranda, JV. "A meta-analysis of the effects of oral zinc in the treatment of acute and persistent diarrhea". Pediatrics. vol. 121. 2008. pp. 326-36. (Meta-analysis demonstrating the many benefits of zinc in children with diarrhea, mostly in developing settings.)
Christopher, PR, David, KV, John, SM. "Antibiotic therapy for Shigella dysentery". Cochrane Database Syst Rev. vol. 8. 2009 Oct 7. (Authoritative review of effectiveness of different antimicrobial agents in therapy of shigellosis in children.)
Canani, RB, Cirillo, P, Terrin, G. "Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations". BMJ. 2007. pp. 335-340. (Comparative trial of probiotic regimens in acute gastroenteritis.)
King, CK, Glass, R, Bresee, JS. "Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep. vol. 52. 2003. pp. 1-16. (Authoritative overview of the approach to children with diarrhea in the United States.)
Li, ST, Grossman, DC, Cummings, P. "Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis". PLoS Med. vol. 4. 2007. pp. e98(Systematic review of the benefits and risks of loperamide for diarrhea in children.)
"The Treatment of diarrhoea. A manual for physicians and other senior health workers". 2005. (Definitive guide for management of diarrhea in children worldwide.)
Ake, JA, Jelacic, S, Ciol, MA. "Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion". Pediatrics. vol. 115. 2005. pp. e673-80. (Seminal study describing the benefits of isonatremic volume expansion in children with O157:H7 infection.)
Holtz, LR, Neill, MA, Tarr, PI. "Acute bloody diarrhea: a medical emergency for patients of all ages". Gastroenterology. vol. 136. 2009. pp. 1887-98. (Authoritative review of management of bloody diarrhea.)
Ongoing controversies regarding etiology, diagnosis, treatment
The optimal management of simple Salmonella enterocolitis in infants and those with underlying conditions is not known. It is difficult to reconcile the lack of benefit associated with treating simple enterocolitis in otherwise healthy individuals with the known risks of treatment in that population (prolonged excretion and increased risk of relapse), and the increased risk of invasive disease in high-risk individuals. Most experts will obtain blood cultures in these high-risk individuals and begin empirical treatment. The route and duration of treatment can be adjusted according to the results of the cultures, the organism's susceptibility, and the child's response to therapy.
Another area of controversy is whether antibiotics should be used to treat STEC. A 2002 meta-analysis implied that antibiotic therapy of E. coli O157:H7 infections might not be harmful. However, this conclusion has been questioned on methodologic grounds and the consensus of experts is that antibiotics may increase the risk of HUS and should not be used.
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- OVERVIEW: What every practitioner needs to know
- Are you sure your patient has bacterial gastroenteritis? What are the typical findings for this disease?
- What other disease/condition shares some of these symptoms?
- What caused this disease to develop at this time?
- What laboratory studies should you request to help confirm the diagnosis? How should you interpret the results?
- Would imaging studies be helpful? If so, which ones?
- If you are able to confirm that the patient has bacterial gastroenteritis, what treatment should be initiated?
- What are the adverse effects associated with each treatment option?
- What are the possible outcomes of bacterial gastroenteritis?
- What causes this disease and how frequent is it?
- How do these pathogens/genes/exposures cause the disease?
- Other clinical manifestationsthat might help with diagnosis and management
- What complications might you expect from the disease or treatment of the disease?
- How can bacterial gastroenteritis be prevented?
- What is the evidence?
- Ongoing controversies regarding etiology, diagnosis, treatment


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