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Atheistic Science Searches for Meaning in the Universe
We chat with cosmologist, and atheist, Sean Carroll about atheism in the cosmologist community.
Theme Week Dec 8, 2016 by Ubah Bulale
Now you can read us on the go! Check out the BTRtoday app for iOS and Android.
Theorizing about the origins of the universe doesn't sound like a bad job. Nor is appearing on Science Channel's Through the Wormhole with Morgan Freeman, the History Channel's The Universe, TedTalk, and Comedy Central's former The Colbert Report. Meet Dr. Sean Carroll, a theoretical physicist at Cal Tech and a cosmologist. Much like Neil Degrasse Tyson, with his uncanny ability to explain difficult physics, Dr. Carroll shares the same adaptability to engage people in the digital age. He has a silky radio voice, and ebullient passion for his work that is very captivating.
BTRtoday (BTR): Tell me about your work.
Dr. Sean Carroll (SC): I am theoretical physicist at CAL Tech. Mostly, I sit in front of my desk scribbling down equations and pictures trying to figure out the basic laws of physics and how they apply to our universe.Things like gravity, dark matter, the Big Bang, etc.
BTR: You make it sound simple, yet it's not a small mission. What inspired you to publish the paper "Why Almost All Cosmologist Are Atheists?"
SC: I was invited to give a talk at a meeting on science and religion and I wrote the paper then.
BTR: In the paper you argue for a materialist viewpoint. What would you say to critics who'd argue it not fair to do away with beliefs derived from other non-scientific methods?
SC: That paper is a bit old. I recently wrote a whole book, "The Big Picture," where I elaborate on these ideas, among many other things. In the book, I try to explain why things we associate with science–the techniques or living things–helps us in answering questions about the existence of God or the supernatural. Of course, it depends what you mean by supernatural; it could be so many things. But to the extent that we try to use God to help us understand parts of the universe we observe, that overlaps with what scientists try to do. And therefore in that regime the same techniques makes perfect sense to use.
BTR: Yourself and Jennifer Chen have published work that suggests the Big Bang did not originate in a singularity, but instead was one of many cosmic events.
SC: Our idea was that the Big Bang was not unique and instead a part of many such events. You could call it "many many bangs" so to speak. It's an attempt to understand why the conditions near our Big Bang are so special. Many cosmologists are trying to face up to the fact that the conditions near our universe are not at all random. We proposed a model that our universe nucleates (pops out of) a preexisting universe and goes on its on way. It is our attempt to explain why the universe started off small, dense, and rapidly expanding.
BTR: How can this model be tested?
SC: We have no strong way of knowing if this is true or not. It's very speculative.There are many models on the market that investigate this idea. We build models that seem plausible and then we try to make them more respectable.
In our model, we are the first to suggest that there are guesses, conjectures and things we think might be true, but that we don't know. The state of the theory itself is not nearly developed enough to put it through an experimental test. Making a prediction is a good first step.
BTR: Let's go back to the discussion on religion. Why are there many scientists, outside of cosmology, who are religious?
SC: There are many reasons people are religions and they differ vastly. I wouldn't want to speculate about the psychology behind it. It is true that religion is less common among cosmologists, mathematicians, and physicists than the average person in the country.
BTR: Stephen Hawking's wave function law obviously contradicts the idea of supernatural causation, and thus a God. Despite his popularity, why don't his ideas take hold in larger society?
SC: These ideas are actually taking hold, but very slowly. In general, atheists aren't very trusted. In the U.S., for example, it's very hard to get elected president if you're an atheist. I think it takes time and discussions for people to get used to an idea. Parts of Europe, for example, are becoming atheist. I was in Austria at a public school and there were crosses hanging on the wall. I asked the students about the crosses and they had no idea what it meant, it was simply a part of their culture and not their lifestyles.
BTR: The fine tuning of the universe, the idea that if anything were slightly out of order, there wouldn't be a possibility for life on earth, is a big argument for supernatural causation. What are your thoughts?
SC: I actually did a lecture on fine tuning and I have so many thoughts on the subject. First, we don't know that life can't exist in our universe if the conditions were different, because we only know the universe that we see. In theism, God wouldn't need a physical body for life to exists, only in naturalism would there be a need for certain physical restraints for life.
BTR: Tell me about your book, "The Big Picture."
SC: The subtitle is "On the Origins of Life, Meaning, and The Universe Itself." The idea behind the book is to connect our best understanding of the underlying laws of nature to the world we experience in our everyday lives. I discuss the laws of physics, but also the origin of life, biology, consciousness, etc. I conclude the book with what it all means and if science gives us any guidance in these areas. When it comes to how to be a good person, I concluded it doesn't.
BTR: Did you learn anything new while writing the book?
SC: I had the cosmology and physics part covered myself, but in areas like neuroscience and philosophy, I enlisted experts' inputs. And they were very generous with their time. It was quite fascinating to see the particles in my brain moving around and generating a magnetic field, or to trace how the energy and sunlight ultimately comes into our bodies in the form of sugar and helps us bend our muscles. This is all fascinating stuff that I had the pleasure of learning about.
BTR: But quantum mechanism deals in randomness? And you've claimed the universe isn't random?
SC: There's no doubt when you have a quant mechanical system, like an atom or electron, and you predict what you will see when you look at it, that the answer is often given to you in a probability. For example, the atom is over here and the electron is over there. But is that randomness real and fundamental or is it just apparent? We don't have the answer to it. I think it's just apparent. If we knew what the universe as a whole is doing–there wouldn't be randomness.
BTR: What are you most excited about in current cosmology?
SC: I am almost taking a step back from cosmology. The more I do in cosmology, the more convinced I am that we need to understand quantum mechanics. We've had it for a long time, but it's just kind of embarrassing, because we don't claim to understand it.
We simply don't understand our own theory, which is weird in the history of physics. And we've been OK with it, and I don't think we should be. However, we are making progress and before quantum mechanics gets to be 100 years old I'd like us to understand it.
DR. SEAN CARROLL'S BLOG AND BOOK Official Website Official Website
TAGS Atheism God quantum mechanics Stephen Hawking


The maximum state pension (guaranteed by the Belgian government) is currently between (approximately) €2,180 for singles and €2,800 for families. Expats are unlikely to receive this amount form the Belgian Pension office, although state pension rights accrued elsewhere could offset the shortfall. Even those who spend their entire career in Belgium are unlikely to be comfortable getting by on an income that's limited to state entitlements. This is where pillar two – pensions provided by employers – comes in.
This pillar encompasses all the supplementary pension schemes linked to an occupational activity. An employee spending their entire career with the same employer can expect to retire on two-thirds of their final salary. There are different provisions for self-employed people (or supporting spouses) and employees. However, the idea of starting and ending a career with the same employer belongs to a bygone era, so for the vast majority it's important to keep track of all the pension bits and pieces built-up with the different employees possible in different countries. Even two-thirds of one's final salary may not suffice to continue one's standard of living. With this in mind, the Belgian government introduced the third pillar: tax-deductible savings that can only be accessed at retirement age.
As pillars one and two probably won't give you a comfortable pension, the government encourages you to take matters into your own hands, through tax-deductible pension savings and long-term savings. These combined payments are limited to about €3,000 person a year and the investments are mainly managed by your bank. By regularly depositing money in a pension savings fund or life insurance, you are entitled to tax relief on your professional income of most often 30%. Self-employed individuals can also use pension savings to reduce their social contributions.
This brings us to pillar four: unrestricted, non-tax-deductible savings.
Although there are no special tax breaks on this kind of "pension" savings, there are quite some other advantages attached to this scheme.
You can invest in such a way that savings grow tax-free and the entire fund can be taken out as a lump sum at any time. Investments are not restricted, so you are free to invest in the assets of your choice. In the current climate, where most EU governments are looking at ways to collect more taxes, it makes sense to accumulate at least part of your retirement funds in products that are not locked up until retirement.


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Privatdozent Photo Edition #14Although the so-called father of the atomic bomb J. Robert Oppenheimer (1904-67) didn't assume directorship of the Institute for Advanced Study until…
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redpajama_set_name: RedPajamaCommonCrawl


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The Art of the Actor
Carving Out Character: Two Actors in Process
September 11, 2014 | by Otis Ramsey-Zöe
Joy Jones and Maduka Steady in Studio Theatre's production of Belleville
Igor Dmitry
Gillian Williams in Studio Theatre's production of Belleville
Jacob H Knoll in Studio Theatre's production of Belleville
Jacob H Knoll and Gillian Williams in Studio Theatre's production of Belleville
Dramaturg and Howard University lecturer Otis Ramsey-Zöe launches his new series The Art of the Actor in conversation with Joy Jones and Maduka Steady as they delve into the rehearsal process for Belleville, running at Studio Theatre through October 12.
According to the Studio Theatre's website, Amy Herzog's Belleville "unmasks the seemingly perfect marriage and Parisian life of expats Abby and Zack... and the terrifying, profound unknowability of our closest relationships." Running parallel to that journey are neighbors Alioune and Amina, a French couple of Senegalese ancestry. I caught up with Maduka Steady (Alioune) and Joy Jones (Amina) during tech rehearsals to discuss their work.
OTIS: How did you prepare to take on your roles?
Joy: Prior to the start of rehearsal is definitely the part of the process that feels most like sculpture, where I'm beginning to carve out the rough shape of a person. As with most other roles, I began with a careful role-centered reading of the play: What does Amina say? What does she say about herself? What do other characters say about her? What are the larger given circumstances: time of year, time of day, location, etc.? I made myself a cheat-sheet with this info and any big, unanswered questions.
Next, I turned to the internet and found treasures like images of the Miss Black France beauty pageant, a graduate thesis on Senegalese immigrants and the concept of "Frenchness," and the meaning of my character's name. Amina, a shortened version of Aminata means "of good character, honest, and trustworthy." It's a popular name for Muslims; Aminata was the mother of the prophet Muhammad... Last but not least, I let it all simmer—so that I wouldn't become attached to any one piece of information, lest I jam up the rehearsal process.
Maduka: Most of the time, I have to prepare for non-American characters by studying people's voices from movies, TV, or the internet, but Studio Theatre connected me with Dr. Sow, a French teacher in D.C., who's originally from Senegal. He helped me with my Senegalese dialect and French dialogue. In addition, he shared many personal stories about his experiences growing up in West Africa and about moving away from home to start a new life overseas. Nothing is more effective than studying a real person from the same country as my character. I immediately felt closer to the reality of the story.
OTIS: Describe a major discovery or shift that occurred in the process.
Joy: Ask me in a week! Seriously, discoveries are ongoing. That said, one specific discovery was Amina's distinct emotional states in each of my three scenes. My part is small; so, I don't have many lines to express her thoughts and feelings, and it's been helpful to chart where she is in each of those scenes.
OTIS: Have you ever visited or lived in Paris?
Maduka: I studied French in middle and high school. My sister speaks fluent French and has lived and worked in Europe for many years. She told me about the different areas in and around Paris, so that I could get a sense of Alioune's neighborhood.
Joy: I spent a week in Paris a few years ago, after finishing a classical acting course in the UK. Until I got connected with friends-of-friends, I spent two incredibly solitary and lonely days there. After that the rest of my stay was wonderful. But the most valuable recollection was that Paris is a real place beyond the monuments, with real people living real lives.
OTIS: Alioune and Amina are rather young. So, on a scale of one to ten, how challenging is the situation with Zack and Abbey for them?
Maduka: For Alioune, at rise, I think the situation starts at an eight and escalates to an eleven by the end. Living under the same roof with Abby and Zack is perhaps their greatest professional challenge, because it's Alioune and Amina's first time as managers of their apartment building in Belleville. Alioune and Amina are anxious to prove to Alioune's uncle, who owns the building, that they are ready for this new responsibility.
OTIS: When creating Amina, did you invest anything personal of yourself?
Joy: Investing myself in a character seems inevitable, but I try to abide by something one of my UNC-Chapel Hill graduate professors, Craig Turner, said: "Love the character, and in doing so, bring yourself to the character, don't bring the character to you."
OTIS: How has the process of playing Alioune changed you as an actor, individual, or citizen?
Maduka: Working on Belleville reminds me of the old saying, "The harder you work, the luckier you get." It has taken a lot of effort to bring this play to life, and the dedication and excitement of the cast and crew at Studio Theatre supports and inspires me every day.
Belleville, by Amy Herzog, runs through October 12 at Studio Theatre.


More gushing praise for a Boulder Canyon bag design coming up. The silvery grey of this bag is not just a perfect match for the flavor within, but it stands out brilliantly on the shelves alongside its flavor colleagues. The red logo, although much smaller than their previous packaging, pops brilliantly against the muted colored background.
Not as thick as many Kettle Cooked Chips, but the bubbles and texture meant there were some extra large and particularly crunchy Chips. The snap was more brittle than with some, and the overall view was that of a crisp crunch rather than a hard, solid crunch.
There were clear salty and peppery flecks throughout the bag. The Chips were mostly whole, irregularly shaped and large. There were some small and relatively curly ones, but the oil was muted and the bubbles on the surface of the Chips did not overwhelm any that we tasted.
The aroma when opening the bag was of potato, nothing more nothing less. The taste altered as we munched our way through the bag consumption process. At first there didn't seem to be much flavor at all, but a few Chips in and the peppery flavor came through. Halfway through the bowl and the taste balanced. It was a good and well balanced combination of what would normally be considered relatively plain flavors.


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Q: Numpy with Blas and OpenBlas take the same time I install Numpy (in a virtualenv env) with OpenBlas (from the system).
$ sudo apt-get install libopenblas-dev
(env)$  mkdir evn/download
(env)$ pip install -d env/download numpy
(env)$ mkdir env/build
(env)$ cd env/build
(env)$ tar xzf ../download/numpy-1.9.2.tar.gz
(env)$ cd numpy-1.9.2

Edit the site.cfg:
[atlas]
atlas_libs = openblas
libraries = openblas

[openblas]
libraries = openblas
library_dirs = /usr/lib/openblas-base/

And then, install numpy using pip. Additionally, install numpy via system (with blas). I test the times with this scrpit. In both case, I have the same time. I check, and the system use Blas and the virtualenv use OpenBlas.  Why it takes the same time?
I use Debian testing, and python 2.7.9

A: If you use pip to install numpy, I believe that will build it without OpenBLAS support, no matter what you put in the site.cfg file.
You have to explicitly call  python setup.py build etc. You can follow for instance this answer for the installation guide.

redpajama_set_name: RedPajamaStackExchange


text:
Montana Free Press (https://montanafreepress.org/series/2020-election/)
Montana Democrats are optimistic about their electoral chances in 2020, but were warned by one former U.S. Senator to "modulate" their policy proposals in rural areas or risk defeat.
Former North Dakota senator warns Democrats that if they want to beat Trump and the Republicans in 2020, then they have to change how they speak to rural America.
Helena Mayor Wilmot Collins and Missoula Rep. Kimberly Dudik pitch party faithful a little less than a month before the 2020 primary election.
U.S. Rep. Greg Gianforte tops early fundraising totals as he seeks the GOP nomination for governor, but most donations from state GOP lawmakers have gone to his opponents


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Norway's Stortinget Passes Gambling Advertising Amendment
Entry into esports: Insurance group die Bayerische becomes new partner of Berlin International Gaming
Niji Narayan
The Norwegian Parliament (Stortinget) has approved a legislative amendment aimed at preventing offshore gambling operators from advertising their services to consumers in the country via the internet.
The amendment grants the Norwegian Media Authority (Medietilsynet) the power to order internet service providers and media companies to prevent access to illegal marketing.
"This [amendment] will reduce the scope of gambling advertising, and may in turn help reduce the number of problem gamblers," Abid Q. Raja, Minister of Culture and Gender Equality, said.
"[Previously] we have not had the necessary tools to enforce the advertising ban on foreign operators. But with this provision, the Media Authority is empowered to impose a duty on internet owners and distributors to prevent access to advertising for illegal gambling," Raja added.
Related Topics:Gambling Advertising AmendmentMedietilsynetNorwayNorwegian Media AuthorityNorwegian Parliamentoffshore gambling operatorsStortinget
Week 21/2020 slot games releases
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Hugely popular supplier secures one of Europe's most valuable accreditations
Premium slots and table games provider Habanero has secured a hugely important regulatory milestone through the acquisition of its Critical Gaming Supply Licence from the Malta Gaming Authority (MGA).
Capping an outstanding three years of growth and development across the continent for the provider, Habanero has already established itself as one of Europe's standout studios.
Known for its engaging gameplay, flawless graphics and pitch-perfect sounds – the developer's 100+ titles have already proven to be an established engagement and revenue driver for operators across 14 regulated European markets.
Habanero's latest licence enables the studio to provide its content to Malta-based operators, with a number of tier-one brands already billed for announcement in the near future.
The supplier's new certification also allows it to further progress its preliminary partnerships with Malta-based Scandinavian operators, as well as German-facing entities during the jurisdiction's grace period.
Commenting on the acquisition of its Critical Gaming Supply Licence from the MGA, Arcangelo Lonoce, Head of Business Development Europe at Habanero said:
"Our growth in the last few years across markets such as Italy has established Habanero as one of Europe's fastest-growing providers, so we're absolutely thrilled to be entering the next phase in our company's development with one of the industry's must-have accreditations.
"Thanks to the outstanding work of all our global teams, the wonderful world of Habanero is now set to reach more European players than ever before. We can't wait to see what our new partners and markets will make of our content, and we look forward to announcing more new partnerships soon enough!"
With a standout collection of titles, Habanero continued to cement its tier-one credentials throughout 2020 by teaming up with industry-leading operators such as Bet365, LeoVegas, and Playtech.
As well as being nominated for multiple SBC and EGR Awards in recognition of its creative approach, Habanero offers its partners a wealth of in-game promotional tools, with a hard-earned reputation for one of the industry's most customer-centric approaches.
Casino and sportsbook platform provider Soft2Bet has been certified by The Payment Card Industry Data Security Standard (PCI DSS).
The company was accredited with the certification after passing a rigorous audit, recognising its capability to securely protect the transfer of credit and debit card data between customers and payment service providers.
The news showcases Soft2Bet's strong compliance credentials, which are also demonstrated by the SGA, MGA and Curacao licences held by the market-leading casino and sportsbook platform provider.
The company's latest certification indicates its unwavering commitment to protecting the data of players using the 30+ operator brands in its portfolio, which is set to be enhanced with a new flagship sportsbook in early 2021 and currently includes the SBC-award winning Wazamba.
Ivan Piorischin, Product owner at Soft2Bet, said: "We take data protection very seriously here at Soft2Bet, and it's fantastic to have that commitment recognised with a coveted accreditation from the The Payment Card Industry Data Security Standard.
"As we look forward to entering new territories and launching further cutting-edge products in the year to come, regulatory compliance will continue to top our priority list."
The Latvian Parliament (Saeima) has approved at the first reading a bill to ban alimony debtors from gambling, and scheduled a second reading for January 20.
The bill would require operators to ensure that those who owe maintenance payments are not permitted to gamble either in person or online. In order to do so, they must check accounts against the national register of maintenance debtors, with the help of the Lotteries and Gambling Inspectorate, which will create an official data display for licensees.
"The restriction is intended to prevent debtors who do not provide maintenance they owe for a child from using funds unreasonably for entertainment and hobbies," the Saeima said.
The bill was submitted by the government and has already received approval from the Commission for Human Rights and Public Affairs with no objections. If it passes in the second and third reading and is signed into law, the restriction will come into effect on April 1.
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Dan, I have been here since 2006, and I don't know Cat or Misty. I am so sorry for all this pain you are going through. There are several people here on the board now that can relate to your loss. You are always welcome to chat here. I don't know of any other chat room. Please know in your heart that your loved ones are still with you. My prayers are with you.


If you would like to live near a larger city with lots of amenities, you might want to retire in Harrisburg North Carolina. Located just 21 miles from Charlotte in the Piedmont Foothills, Harrisburg is ideally located near a big airport (21 miles away) and everything you'd want in the way of shopping, cultural events, history, and recreation close by, but not in your face.
The area was first settled by Scots-Irish in the mid 1700's and many of their descendants still live in the area. The town is actively restoring historical buildings to preserve their glory. The whole community is involved in rebuilding foundations, upgrading electrical and plumbing services and painting the store and post office and an old mill.
From the Queen City's NASCAR Hall of Fame to the nearby Charlotte Motor Speedway, Harrisburg lies within NASCAR country. For dozens of racing teams – even those in racing circuits other than NASCAR – this region is the place they call "home." If you are seeking to explore the world of racing, start your venture in Harrisburg at Wood Brothers Racing, U.S. Legends Cars International or Fast Track High Performance Driving School then check out other shops and businesses in the surrounding area, including the zMAX Dragway in Concord and the NASCAR Technical Institute in Mooresville. When the grandkids visit there is a Great Wolf Lodge, The Carolina Raptor Center, a Bank of America Stadium (home to the Carolina Panthers), the Time Warner Cable Arena (home to the Charlotte Bobcats and the AHL's Charlotte Checkers). There is also baseball and basketball nearby. There are a number of colleges in the neighborhood and hospitals galore. Harrisburg has a Children's Theatre, a Community Theatre, the Cabarrus Arts Council, art museums and a historic arts district.
Harrisburg is home to 11,500 people and 9.2% are over 65. The median price of an owner occupied home is $220,000, which is quite high for North Carolina, but modest compared to the rest of the country. Of those over 25 years, 38% have a bachelors degree or higher. The crime rate is just .61 per 1000 while the rest of NC is 3.53 – making Harrisburg one of the safest towns in the state. The average low temperature in January is 28 degrees and the high in June is 91. But…six months of the year, the temperature ranges between 64 and 80!
Click on the map below to show streets, highways and attractions!


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Home Articles Instruction for Authors Journal Information Policy Submit a Paper
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Gut and Liver 2019; 13(3): 300-307 https://doi.org/10.5009/gnl18085	IgG4-Related Sclerosing Cholangitis and Primary Sclerosing Cholangitis
Atsushi Tanaka
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
Atsushi Tanaka (https://orcid.org/0000-0002-6358-5283), Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan, Tel: +81-3-3964-1211, Fax: +81-3-3964-6627, E-mail: a-tanaka@med.teikyo-u.ac.jp
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract	Full text	Tables & Figures	PDF
Sclerosing cholangitis (SC) is defined as a condition with progressive stenosis and destruction of the bile ducts due to diffuse inflammation and fibrosis and currently includes three categories: primary sclerosing cholangitis (PSC), secondary cholangitis, and IgG4-related sclerosing cholangitis (IgG4-SC). SC categories share similar clinical features, such as cholestasis. Patients with SC present with cholestatic symptoms, including jaundice and pruritus, and blood tests reveal elevation of cholestatic enzymes. Cholangiography, endoscopic or magnetic, is inevitably required for making a diagnosis. Although the presentation of IgG4-SC and PSC are similar, the comorbidities, treatment response, and outcomes differ significantly, and therefore, it is strongly advisable to be familiar with these two diseases to make a correct diagnosis. Differentiation of cholangiocarcinoma from IgG4-SC and PSC is also extremely important. In this review, the clinical characteristics, comorbidities, treatment and outcomes of IgG4-SC and PSC will be outlined based on experience mainly from Japan.
Keywords: IgG4, Cholangiography, Cholangitis, Corticosteroid
Other SectionsAbstractINTRODUCTIONIgG4-SCLEROSING CHOLANGITISPRIMARY SCLEROSING CHOLANGITISCONCLUSIONSCONFLICTS OF INTERESTFiguresTablesReferences Abstract
Other SectionsAbstractINTRODUCTIONIgG4-SCLEROSING CHOLANGITISPRIMARY SCLEROSING CHOLANGITISCONCLUSIONSCONFLICTS OF INTERESTFiguresTablesReferences INTRODUCTION
Sclerosing cholangitis (SC) is defined as a condition with progressive stenosis and destruction of the bile ducts due to diffuse inflammation and fibrosis.1,2 SC was formally classified into two categories: primary sclerosing cholangitis (PSC) with unknown etiology, and secondary SC caused by a variety of pathological conditions, including postoperative biliary stenosis, bacterial cholangitis, and choledocholithiasis.3 Recently another etiology of SC, IgG4-related sclerosing cholangitis (IgG4-SC), was established as a clinical phenotype in the biliary tree of a systemic IgG4-related disease (IgG4-RD). Thus, SC is now categorized as PSC, IgG4-SC, and secondary SC.
In 2015, we performed a nationwide, multicenter survey by sending questionnaires to physicians in order to elucidate the present status of PSC and IgG4-SC in Japan. Comprehensive information on 435 and 527 patients with PSC and IgG4-SC, respectively, were recorded, and we have already published these results.4,5 This review, with citing data from these works, will outline the epidemiology and demographics, clinical characteristics, management, and outcomes of PSC and IgG4-SC, mainly based on recent literature and our experience in Japan.
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IgG4-SC is also known as IgG4-associated cholangitis (IAC)6 mainly in the European literature. IgG4-SC is a biliary tract manifestation of IgG4-RD, characterized by systemic, inflammatory, sclerosing lesions with massive infiltrations of IgG4-positive lymphocytes involving many organs including the eye; salivary, and lacrimal glands; lungs; pancreas; retroperitoneum, kidneys; and vascular systems.7–11 In particular, IgG4-SC is frequently found associated with pancreatic involvement in IgG4-RD, a condition termed autoimmune pancreatitis (AIP).12 AIP and IgG4-SC are relatively new clinical entities, established by the landmark studies of Hamano et al.13 in 2001 and Kamisawa et al.14 in 2003. The clinical diagnostic criteria of IgG4-SC were established by the Japanese Biliary Association in 2012 (Table 1)15 to facilitate its correct diagnosis and differentiation from PSC or cholangiocarcinoma. Conversely, the HISORt criteria, consisting of histology, imaging, serology, other organ involvement (OOI) and response to therapy, have frequently been used for the diagnosis of IgG4-SC (or IAC) in the United States and Europe.16–18 The HISORt also consist of histology, imaging, serology, OOI of IgG4-RD, and response to steroid therapy19 but were originally designed for the diagnosis of AIP.
1. Epidemiology and demographics
Despite epidemiological data of IgG4-SC in Japan are lacking, these can be extrapolated from those obtained for AIP. In 2011, Kanno et al.20 carried out a clinico-epidemiological survey of AIP in Japan, yielding an overall prevalence of 4.6 per 100,000 population, and an annual incidence of 1.4 per 100,000 population. In this study, the prevalence of IgG4-SC in patients with AIP was reported to be 39%, and thus an overall prevalence and an annual incidence of patients who have both AIP and IgG4-SC are estimated as 1.8 and 0.5 per 100,000 population, respectively. Furthermore, our nationwide survey of IgG4-SC in 2015 demonstrated that the proportion of patients diagnosed as having both IgG4-SC and AIP was 87% of all IgG4-SC cases.5 Collectively, the overall incidence and annual prevalence of IgG4-SC in Japan were calculated to be 2.1 and 0.63 per 100,000 population, respectively, which are less than half of those of AIP.
The demographics of patients with IgG4-SC are summarized in Table 2. IgG4-RD is generally a male-dominant disease, and indeed male patients were also dominant in other cases series of IgG4-SC from the United States18 and United Kingdom.21 The age at presentation was also similar among the three reports, indicating that patients in their 60s were at the highest risk of developing IgG4-SC. In Fig. 1A, the age distributions at presentation are shown for 527 cases of IgG4-SC in Japan. Ages ranged from 23.0 to 88.5 years and unlike PSC, which can be difficult to differentiate from IgG4-SC in terms of biliary imaging, no patient developed IgG4-SC in childhood or adolescence. The median age at diagnosis was 66.2 years.
Although case-controls studies to clarify the etiology of this enigmatic disease have not been carried out, preliminary data have suggested a role for environmental triggers in the development of IgG4-SC and AIP.22 A questionnaire-based study revealed that a history of "blue-collar" work was noted in 88% of patients with IgG4-SC and/or AIP in the Amsterdam cohort, and in 61% of patients with IgG4-SC and/or AIP in the Oxford cohort, both of which were much higher than the rate observed in patients with PSC.22 Occupational antigens such as solvents, industrial and metal dusts, and pigments and oils, to which these patients could have been exposed, could be the triggers for developing IgG4-SC.
2. Clinical characteristics
In our 527 patients, the most frequent symptom at presentation was jaundice, followed by pruritus and abdominal pain. Of note, it was extremely rare for patients with IgG4-SC to present with symptoms of decompensated cirrhosis, as variceal rupture was noted in only one patient, and there were no patients with ascites or encephalopathy. Since no treatment had been given to these patients, the natural course of IgG4-SC may be benign with very exceptional cases progressing to cirrhosis. Regarding laboratory data at presentation, the levels of serum alkaline phosphatase (ALP) were elevated in the majority of patients. Serum IgG4 levels were recorded for 485 of 535 patients with IgG4-SC and were above normal range (<135 mg/dL) in 409 patients (84.3%); thus, serum IgG4 levels were within normal limits in 15.7% of patients with IgG4-SC (Fig. 2A). As discussed below, serum IgG4 levels were elevated in 12.5% of patients with PSC, and thus the serum IgG4 level was unable to uniquely differentiate PSC from IgG4-SC. Serum CA19-9 levels (normal range; <37 IU/mL) were elevated in 192 of 468 patients tested (41%) and anti-nuclear antibodies were found in 137 of 354 patients tested (39%).
Cholangiograms were available for 518 of 527 patients. According to the classification proposed by Nakazawa et al.,23 intrapancreatic biliary strictures resembling pancreatic cancer (type 1) without any other strictures in the bile ducts represented the most common finding (64%), followed by strictures in the hilar hepatic lesion (type 4, 10%), and in both intrapancreatic and hilar lesions (type 3, 11%). Intrahepatic segmental (type 2a) and diffuse (type 2b) strictures, in addition to intrapancreatic biliary strictures, were detected in 24 and 41 patients (5% and 8%), respectively. Unclassified cholangiographic findings were reported in 21 patients (4%). Histological examination of the liver and bile duct were performed in 57 and 238 patients, respectively. No histological specimens were obtained from either the liver or the bile duct for a total of 179 patients.
3. Comorbidities
Presence of OOI of IgG4-RD greatly facilitates the diagnosis of IgG4-SC, and AIP was the most prevalent OOI being present in 88% of patients. Other OOIs included dacryoadenitis and sialadenitis in 73 patients (15%), as well as involvement of the retroperitoneum (37 patients, 7%), kidneys (six patients), aorta (six patients), and lungs (four patients).
Gallstones and gallbladder polyps were detected in 47 (10%) and in 17 (3%) of patients, respectively. Regarding malignant diseases in the biliary tract, the development of cholangiocarcinoma was only reported in four cases (0.8%), indicating the occurrence of cholangiocarcinoma is a rare event in patients with IgG4-SC.
4. Management and outcomes
It is well known that prednisolone (PSL) is a very effective treatment for IgG4-SC, as for other IgG4-RD. In our case series from Japan, PSL was initiated in 462 patients (88%) following diagnosis. At the final follow-up, PSL treatment was terminated or continued in 312 (63%) and 181 (37%) patients, respectively. Overall, the treatment responses to these protocols were excellent. Reduction in ALP levels to <50% of pretreatment levels or to within normal range was achieved in 395 patients (88% of documented cases), and alleviation of biliary strictures was noted on the imaging results of 376 patients (90% of documented cases). Endoscopic dilatation or stenting were performed in 48 (9%) and 253 (50%) patients, respectively. Surgical procedures were performed in 45 patients (9%) and malignant disease was suspected preoperatively in most cases referred for surgery.
During 4.1±3.1 years of follow-up, 27 patients (5%) were reported to be deceased, but only four patients died due to liver or bile duct-related conditions. No liver transplantation (LT) was performed in this cohort. Cirrhosis progression accounted for two deaths. The overall 5- and 10-year survival rates were 94.4% and 81.0%, respectively, and the 5- and 10-year survival-free from death due to liver or bile duct-related diseases were 98.9% and 97.7%, respectively. Therefore, poor outcomes including mortality due to liver or bile duct disease and LT can be avoided with treatment with corticosteroids in most cases of IgG4-SC with excellent outcomes.
The outcome of patients with IgG4-SC has also been investigated in retrospective cohorts in the United States18 and the United Kingdom.21 Sample size, follow-up period, corticosteroid treatment, and outcomes are summarized in Table 3. Progression to cirrhosis was noted in 5.2% in the UK cohort and 7.5% in the US cohort, respectively. Mortality due to liver or bile duct complications was found in only one case in the US cohort, and in two cases (liver failure and cholangiocarcinoma) and one case that underwent LT in the United Kingdom.
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PSC is a chronic cholestatic disease of unknown etiology, which is characterized by progressive stenosis and destruction of the bile ducts due to diffuse inflammation and fibrosis, and which eventually results in cirrhosis and liver failure.24,25 Unfortunately, despite the severity of this disease, no standardized medical treatment is currently available, and although autoimmune reactions are believed to play a role in PSC pathogenesis, immunosuppressive therapy has not been effective.26–29 As a result, the long-term outcome for patients with PSC is unfavorable and is characterized by a high mortality rate, with LT being the only option for patients with advanced PSC.
The prevalence and incidence of PSC are high in North Europe and North America, and low in Japan (Table 4).5,30–38 The prevalence is reported to be 4.15 to 16.2 per 100,000 population in Northern Europe and North America,39 respectively, while the prevalence of PSC was 0.95 per 100,000 in Japan. The prevalence of PSC is increasing somewhat in European countries,39 although it is unclear whether the apparent increase is due to a "real" increase of prevalence or to a better identification of the disease.
The nationwide surveys undertaken in 2015 in Japan enrolled 435 cases, which consisted of 263 males (60.5%); the median age was 44.6 years old, ranging from 3 to 84 years (Fig. 1B). Male dominance is also consistently observed in Western countries (Table 4). It is of note that there were two peaks in the age distribution, 20 to 40 and 60 to 70 years (Fig. 1B), while individuals between 20 and 30 years old have been reported to be at high risk in Western countries. Nevertheless, two peaks in the age distribution were recently found in Canada and the United States (California).34,37
In Japan, 62% of patients were diagnosed as having PSC with no evidence of any symptoms, but with an elevation in liver enzymes detected on chance blood examinations. Among patients with symptoms, the most prevalent symptom was jaundice, followed by pruritus. While both serum ALP and gamma-glutamyl transpeptidase (GGT) levels were elevated in typical cases, ALP levels were less than 2× upper normal limits in 45% of patients, indicating the possibility that PSC cannot be ruled out even in patients with relatively lower ALP levels. As described, serum IgG4 level was elevated in 12.5% of patients with PSC (Fig. 2B). Histopathologically, an obliterative, non-suppurative cholangitis with substantial periductular fibrosis, referred as "onion-skin fibrosis," is a typical finding, although this finding is found only in 20% to 40% of patients.
The most useful diagnostic tool for PSC is cholangiography. Typical findings of PSC include a beaded appearance (Fig. 3A), pruned tree appearance (Fig. 3B), and band-like stricture (Fig. 3C). In addition, a shaggy appearance and diverticulum-like outpouching can be observed. While endoscopic retrograde cholangiography (ERC) is chosen as a diagnostic procedure in most cases in Japan, clinical guidelines of PSC from the European Society of Gastrointestinal Endoscopy and the European Association for the Study of the Liver (EASL) recommend magnetic resonance cholangiography to avoid complications due to ERC.40
Inflammatory bowel diseases (IBD) are frequently present as a comorbidity in patients with PSC. In previous reports, 50% to 80% of patients with PSC in Western countries and 40% of all patients (and 61% in younger patients) in Japan had coexistent IBD. Ulcerative colitis is more common than Crohn's disease and atypical ulcerative colitis with right-sided colitis and rectum sparing is a characteristic feature of IBD in patients with PSC. The risk of colorectal carcinoma is higher in patients with IBD compared to those without IBD.41 Colonoscopy is mandatory in all patients diagnosed as PSC, despite the presence or absence of gastrointestinal symptoms, such as diarrhea or bloody stool.
PSC is associated with an increased risk of cholangiocarcinoma and gallbladder carcinoma, and is 400-fold higher than healthy individuals. In Japan, 27 and four cases with PSC developed cholangiocarcinoma and gallbladder carcinoma, respectively, during follow-up, with an annual incidence of 1.43%.4 Cholangiocarcinoma can occur as an intrahepatic mass or a hilar tumor. Since one-third or half of cholangiocarcinomas are diagnosed at the same time, or within the first year after, diagnosis of PSC, it is therefore strongly advisable to carefully exclude the possibility of cholangiocarcinoma when a new diagnosis of PSC is made. Nevertheless, it could be extremely difficult to differentiate cholangiocarcinoma from PSC. Although novel modalities have been developed, including fluorescence in situ hybridization or probe-based confocal laser endomicroscopy, meta-analysis has demonstrated that single-operator cholangioscopy with targeted biopsies appears to be the most accurate endoscopic retrograde cholangiopancreatography (ERCP)-based modality for diagnosing cholangiocarcinoma in PSC.42
To date, no medical treatment has been approved that improves transplant-free outcomes of patients with PSC in an evidence-based manner. Although ursodeoxycholic acid (UDCA) is currently used for a number of patients with PSC, clinical trials of UDCA failed to demonstrate a positive result from UDCA treatment and even a worse prognosis with a high-dose (>28 mg/kg/day) UDCA.43 Thus, the clinical practice guidelines (CPG) for PSC from the American Association for the Study of the Liver did not recommend the use of UDCA in adult patients with PSC as medical therapy.44 The use of UDCA was not recommended in other CPGs for PSC from the EASL and from the American College of Gastroenterology.44,45 Meanwhile, several cohort studies, although retrospective, indicated that a reduction of ALP levels at 6 months or 1 year after commencement of UDCA treatment is associated with an improvement of long-term outcome of patients with PSC.46–49 The presence of dominant strictures, defined as a stenosis of the common duct with a diameter of 1.5 mm or less and/or 1.0 mm or less of a hepatic duct (within 2 cm of the bifurcation), requires endoscopic interventions which significantly improve long-term outcomes.50,51 LT is the only curative procedure for PSC but recurrence is not uncommon, especially with a living-donor.52
In a nationwide survey in Japan, the 5- and 10-year overall survival rates were 81.3% and 69.9%, respectively, and the 5- and 10-year LT-free survival rates were 77.4% and 54.9%, respectively.4 Prognostic factors associated with worse outcomes included older age, lower albumin levels, and higher bilirubin levels.
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Although the clinical presentation of both IgG4-SC and PSC includes similar cholestatic features, comorbidities, treatment response, and outcomes differ. Patients with IgG4-SC respond well to PSL treatment and long-term outcomes are excellent with very low rates for occurrence of cholangiocarcinoma. In contrast, there has been no standardized medical treatment approved for PSC to improve long-term outcomes and indeed almost half of patients with PSC faced death or LT in a Japanese cohort. In addition, the impact of comorbidities including IBD and cholangiocarcinoma is significant in PSC. Therefore, when patients with cholestatic features present in daily practices, it is strongly advisable to make an accurate diagnosis employing all available diagnostic modalities, and also to differentiate cholangiocarcinoma from IgG4-SC and PSC. The development of novel diagnostic procedures for IgG4-SC, PSC, and cholangiocarcinoma, as well as the development of new drugs for PSC are definitely unmet and urgent needs in this field.
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Fig. 1. Age distribution at presentation. (A) IgG4-related sclerosing cholangitis and (B) primary sclerosing cholangitis.
Fig. 2. Distribution of serum IgG4 levels at presentation. (A) IgG4-related sclerosing cholangitis and (B) primary sclerosing cholangitis.
Fig. 3. Typical cholangiographic features of primary sclerosing cholangitis. (A) Beaded appearance (arrows), (B) pruned tree appearance, and (C) band-like stricture (arrows).
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Clinical Diagnostic Criteria of IgG4-Related Sclerosing Cholangitis, as Established by the Japanese Biliary Association in 2012
Diagnostic items
(1)Biliary tract imaging reveals diffuse or segmental narrowing of the intrahepatic and/or extrahepatic bile duct, associated with thickening of the bile duct wall
(2)Hematological examination shows elevated serum IgG4 concentration (≥135 mg/dL)
(3)Coexistence of autoimmune pancreatitis, IgG4-related dacryoadenitis/sialadenitis, or IgG4-related retroperitoneal fibrosis
(4)Histopathological examination shows:
Marked lymphocytic and plasmacytic infiltration and fibrosis
Infiltration of IgG4-positive plasma cells (>10 cells per high power field)
Storiform fibrosis
Obliterative phlebitis
Optional: effectiveness of steroid therapy
Definite diagnosis: (1)+(3), or (1)+(2)+(4) (a+b, or a+b+c, or a+b+d)
Probable diagnosis: (1)+(2)+optional item
Possible diagnosis: (1)+(2)
Adapted from Ohara H et al. J Hepatobiliary Pancreat Sci 2012;19:536–542, with permission from John Wiley and Son.15
Demographic Features of IgG4-SC
Male sex, %
Age at presentation, yr
USA18 2008 53 85 62*
UK21 2014 68 74 61†
Japan5 2017 527 83 66†
IgG4-SC, IgG4-related sclerosing cholangitis.
*Mean;
†Median.
Treatment and Outcomes of Patients with IgG4-SC
Number of enrolled patients
Follow-up period, mo
Corticosteroid treatment
All-cause mortality
Mortality due to liver and bile duct diseases
USA18 2008 53 29.5* 30 (57) 4 (7.5) 7 (13) 0 1 (1.9)
UK21 2014 68 32.5 98 (85)† 6 (5.2)* 11 (9.6)* 1 3 (2.6)*
Japan5 2017 527 49.2 458 (88) NA 26 (5) 0 4 (0.8)
Data are presented as mean or number (%).
IgG4-SC, IgG4-related sclerosing cholangitis; LT, liver transplantation; NA, not applicable.
*The mean follow-up period of patients treated with corticosteroids;
†The proportion of 115 patients with autoimmune pancreatitis, including those without IgG4-SC.
Epidemiology of Primary Sclerosing Cholangitis
Incidence*
Prevalence*
Presence of IBD, %
Norway30 17 1.3 8.5 71 71 1998
Singapore31 10 - 1.3 90 20 2002
USA (Minnesota)32 22 0.9 13.6 68 73 2003
UK33 46 0.91 12.7 62 62 2004
Canada34 49 0.92 - 55 67 2007
UK35 223 0.41 3.85 63.5 48 2008
Sweden36 199 1.22 16.2 71 76 2010
USA (California)37 169 - 4.15 59.8 64.5 2011
UK38 837 0.68 5.58 63.2 54.0 2017
Japan5 415 - 0.95 60.5 40 2008/2015
IBD, inflammatory bowel diseases.
*Per 100,000 population.
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Gluck M, Cantone NR, Brandabur JJ, Patterson DJ, Bredfeldt JE, Kozarek RA. A twenty-year experience with endoscopic therapy for symptomatic primary sclerosing cholangitis. J Clin Gastroenterol 2008;42:1032-1039.
Gotthardt DN, Rudolph G, Klöters-Plachky P, Kulaksiz H, Stiehl A. Endoscopic dilation of dominant stenoses in primary sclerosing cholangitis: outcome after long-term treatment. Gastrointest Endosc 2010;71:527-534.
Egawa H, Ueda Y, Ichida T, et al. Risk factors for recurrence of primary sclerosing cholangitis after living donor liver transplantation in Japanese registry. Am J Transplant 2011;11:518-527.
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Rugrats, also sometimes called Puggats, are a hybrid mix of a Pug and a Rat Terrier. The Rugrat is loving, loyal and almost always strives to please its owner. Being highly intelligent, this breed is easy and willing to be trained. The Rugrat bonds closely to its owners and will always be within sight.


At these ages the main focus is on developing and training a broad repertoire of motor skills (not just soccer: Climbing, jumping, throwing, simple games with a variety of balls, etc.) This way they develop movement skills applicable to any sport. We as a soccer club have a special responsibility, because many children start to participate in soccer and then might go on to other organized sports.
By age seven we shift our main focus on developing coordination. This is the foundation for the development of soccer-specific technical/tactical elements (ability to play). At the same time, players learn the rudiments of basic techniques like shooting, dribbling and passing. This is achieved through lots of small group games and competitions to make sure the kids have fun playing soccer.


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William Shatner Blasts '2018 Prudes' Who Want to Ban 'Baby, It's Cold Outside'
AP Photo/Michael Dwyer
Veteran actor William Shatner tore into "myopic censorship club members" on social media this week, who've been calling for the Christmas classic song "Baby, It's Cold Outside" to be taken off the air.
Captain Kirk scoffed at CBC radio's decision to ban the Christmas song, "Baby, It's Cold Outside," a song that many radical leftists now claim is a "rape song," TheWrap reported. The famed Star Trek star is no right-winger, mind you, but he is a proponent of freedom, and he does not suffer liberal Twitter ninnies well.
William Shatner, who never misses an opportunity to remind fans he is Canadian, not an American, was quite unhappy that the Canadian radio system was going to ban the song. His tweet was unequivocal in support of the song penned in 1944.
"Call in to CBC radio all day and get them to play 'Baby, It's Cold Outside' over and over until midnight!" Shatner said.
Call in to CBC radio all day and get them to play "Baby It's Cold Outside" over and over until midnight! 😝😈 pic.twitter.com/qrRwAHOwYX
— William Shatner (@WilliamShatner) December 11, 2018
Unsurprisingly, the T.J. Hooker star immediately began tangling with fans over the song, slamming the "myopic glasses" through which people have been viewing the holiday ditty.
Not every fan lined up against Shatner because of the song. For instance, one wondered if Bill couldn't find something "more important to rally for."
Shatner begged to differ.
"I would think that censorship of classics because certain 'types' need to judge things through their own 2018 myopic glasses and demand they be stricken from history is important," Shatner responded. "Or is this 1984 only 34 years too late?"
I would think that censorship of classics because certain "types" need to judge things through their own 2018 myopic glasses and demand they be stricken from history is important. Or is this 1984 only 34 years too late? https://t.co/sU4JgIA80i
Some fans thought Bill was joking to get a rise out of people. The "Rocketman" singer was quick to disabuse them of that notion.
I'm not, actually. 🙄 https://t.co/CzdP0cKIcB
Shatner also slammed the "Myopia Censorship Club" lined up against the song:
🙌🏻 I'd still call and request the song be played just to stick it to the Myopia Censorship Club members! 😏 https://t.co/5s8pRZaw92
Shatner continued to criticize fans upset over the classic Christmas tune needling them for loving rap music but agitating against "Baby, It's Cold Outside."
"Have you watched the original choreography, myopic Peter or are you one of those who needs to take the lyrics & extrapolate worst case? You must clutch your pearls over rap music," Shatner tweeted.
Have you watched the original choreography, myopic Peter or are you one of those who needs to take the lyrics & extrapolate worst case? You must clutch your pearls over rap music. 😂 Here's the original choreography from 1949: https://t.co/bYvhvJg8Zt https://t.co/Jr4FNJccUs
Shatner added that the choreography to the song is "the interpretation of the lyrics from the timeframe when it was written (1940's)."
The choreography is the interpretation of the lyrics from the timeframe when it was written(1940's.) If 2018 prudes want to interpret the lyrics as something else; the problem obviously lies in their own minds not in the original lyrics. https://t.co/vXWJiw9M4X
Eventually, CBC Radio rescinded its ban on the 1940s song after reacting to a backlash against the decision to stop playing it.
Follow Warner Todd Huston on Twitter @warnerthuston.
EntertainmentSocial JusticeTechBaby It's Cold OutsideCBC RadioWilliam Shatner


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About Us>Our team > Joy Jenrette
Joy Jenrette
Joy Jenrette was diagnosed with early-stage breast cancer in 2008 at age 25, then had an early-stage recurrence in 2012. She was diagnosed with metastatic breast cancer in 2018 and is living and working in Atlanta. Joy is a Living Beyond Breast Cancer Hear My Voice advocate. Since her metastatic diagnosis, she's learned a great deal about the importance of self-advocacy, especially when it comes to receiving quality treatment, and she is passionate about sharing what she's learned to help other women feel empowered to improve their quality of life until there is a cure for this disease.
Like many women living with this disease, Joy has had a roller coaster of a journey, but is focused on loving and living life with as much joy (pun intended) as she can. She's blessed to have the loving support of her husband, friends, and family.
As part of her advocacy journey, she has participated in LBBC's first virtual Hear My Voice Metastatic Advocacy Program class, LBBC conference panels, and an Anthropologie-LBBC breast cancer campaign, and represents LBBC at Tigerlily's Young Women's MBC Disparities Alliance. She has also participated in the Susan G. Komen's In My Own Voice program, Komen's RealPink Podcast, Komen's national TV and radio metastatic breast cancer awareness campaign, and various other panels, forums, and campaigns about living with metastatic breast cancer, self-advocating, and disparities for Black women with breast cancer.
She is very excited to be a member of LBBCs board of directors to give back to an organization that helped guide her and continues to guide her through her metastatic breast cancer journey and has also helped her find her voice as an advocate.
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Kelly Bernd knew something wasn't right. One runner after the next was passing her by on the same 3.1-mile course at Guajome Park where a year earlier she won the Avocado League finals.
This was the same Kelly Bernd who'd already qualified for the state championship meets in cross country and track and field every year since she was a freshman. She'd already accepted a track scholarship from UCLA.
It wasn't until she visited doctors shortly afterward that Bernd learned that she was suffering from a severe iron deficiency.
The normal serum ferritin range for a female is 15 to 150 nanograms per millilter, and should be higher for a competitive female runner. Her ferritin level was 6 ng/mL.
With the help of doctors and nutritionists, Bernd has figured out a solution. She now takes liquid iron supplements daily and has reached healthy ferritin levels. She is readying for her freshman year at UCLA.
Ravens track and cross country coach Andy Corman believes that Bernd may have just scratched the surface of her potential during a distinguished prep career. It wasn't until her senior year that she became aware of the condition.
Bernd said she is now healthy. She joined her UCLA teammates recently for a training camp in Mammoth.
But she admits there were moments when doubts crept into her mind. She wasn't sure she'd ever be able to continue running competitively, let alone at the elite collegiate level at UCLA.
"I just didn't know what was going on but I thought it would work out," she said.
Bernd credits a supportive team atmosphere at CCA with helping her get through some tough times. Her teammates included her younger sister Claire, an incoming junior who emerged as a standout last season, qualifying for the state meet in track and cross country.
"Honestly, even with all this happening I had this great team to run with every day," Kelly said.
Kelly served was the team's captain her junior and senior years.
Claire said her older sister led the team by example.
Kelly competed as a senior despite the iron deficiency, helping the cross country team qualify for the state meet.
"We realistically should have been having the conversation 'You shouldn't run, you shouldn't even get out of bed,'" Corman said.
That Kelly found a way to summon the energy to compete when her teammates depended on her is a big part of her legacy.
But Kelly's iron deficiency exacted a toll on her during her senior year, when for the first time in her career she didn't qualify for the state meet in track.
That coincided with Claire qualifying for the state meet for the first time. Kelly had mentored her sister's running career since she started high school, steering her away from field hockey, which Claire intended to pursue.
"It was absolutely remarkable just to see how proud Kelly was that Claire had qualified and that Claire had made it," Corman said.
Claire acknowledged that concerns about her sister's health were difficult for everyone.
After races, runners from other teams congratulate each other on their efforts.
"The first thing they'd say is 'Great job girls, Kelly great job' … they'd say how hard it is and how it must be so hard," Claire said. "It was hard to watch that because she'd be so disappointed every time but she took it so well.
"Every time after a race it would be hard for me to hear people talk to her because they wouldn't say 'Good job' as much, they'd go straight to the 'iron talk' and how it must be so hard. I could tell that she just really wanted to have some good races and have people just recognize her for who she really is, and get back to where she was.
Kelly's iron deficiency never stopped her from giving her all.
"We were inspired by her because even with her iron (deficiency) she'd blow us all away anyway," Claire said.


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Defender Shaughnessy hopes Irish eyes turn across water
by Paul Third
Aberdeen defender Joe Shaughnessy has urged the next Republic of Ireland manager not to disregard the talent playing in Scotland.
Former Republic manager Giovanni Trapattoni largely ignored Scottish football. But, with the Irish FA's search for his successor under way, Shaughnessy hopes the Italian's replacement will take a look at the talent plying its trade in the Scottish Premiership.
Celtic attacker Anthony Stokes was recalled for the recent World Cup qualifiers against Germany and Kazakhstan by interim coach Noel King and under-21 international Shaughnessy insists there is more talent capable of making the grade.
The Dons defender is among those hoping to push their case and said: "I didn't get involved with the under-21s until I got into the first-team at Aberdeen and my aim is to try to get into the full team. But it does seem harder for players in Scotland to get into the Ireland team.
"There are a lot of Irish players across here but they haven't really had a chance. Look at Aaron Doran at Inverness. He played for the under-21s, but he has not got near the full squad.
"If I can keep playing well in the first-team then I am sure I will get some recognition, hopefully, that will be the case because it would be brilliant."
Shaughnessy's consistent displays for Aberdeen have led to him becoming the established right back at Pittodrie despite playing consistently at central defence at youth level.
Shaughnessy would like to return to a central role in the future but is more than happy to continue his education in a wide role.
He said: "I am still learning at right back because I didn't play there until I came into the first team.
"I am quite comfortable and I enjoy it. I just try to learn from every game."
Revellers party through the night as Up Helly Aa celebrations disperse around Lerwick long after ceremonial burning