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Montana Voices: ACA repeal goes too far; strips Medicaid benefits
Speaker of the House Paul Ryan (R-WI) speaks to the media on Capitol Hill in Washington, U.S., March 16, 2017. REUTERS/Joshua Roberts
By Jim Jenks
Congress is moving quickly to enact the American Health Care Act. This bill goes beyond its stated purpose to repeal and replace the Affordable Care Act by fundamentally restructuring Medicaid.
If this bill becomes law, Medicaid would no longer be a guaranteed benefit available to seniors, children, and people with disabilities who qualify; instead, it would be a fixed dollar amount (a per-capita cap) that would be used to pay for only some of the services for some of the program-eligible people.
This proposed change to the structure and function of Medicaid is solely a means to reduce federal spending, and it puts our country's most vulnerable people at risk. Two-thirds of the senior citizens who live in nursing homes, 39 percent of American children, and over 10 million people with disabilities are covered by Medicaid.
This bill, if it becomes law, will have even more dire consequences for Montana—the state whose population is aging faster than any other in the country—and for the Flathead Valley, which is aging faster than any other county in Montana.
Immanuel Lutheran Communities is dedicated to providing a comfortable home for
Flathead Valley seniors, and for 60 years the foundation of our mission has been to provide for those who can no longer afford to provide for themselves. Sixty percent of our residents are covered by Medicaid, which means over half of our residents will be put at risk of losing their home if this Medicaid restructuring becomes law as a part of the American Health Care Act.
I urge the members of the Montana congressional delegation to ensure full funding for the Medicaid program by rejecting the American Health Care Act in its current form. We can and must do better for our most vulnerable citizens.
Jim Jenks is a board member and past president of Immanuel Lutheran Communities.


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Christine Rotella Writes First Book, Understanding Spirituality | News
PLATTSBURG — Christine Rotella's identities include Executive Director, City Councilman, Businesswoman, Cancer Survivor, and is the author of the book Understanding Spirituality: For Older Children, Adolescents and Other Beginners for LifeRich Publishing. increase.
Based in Plattsburgh, he has studied spirituality for almost 30 years and is a Clairsentient/Claircognizant and Usui Reiki Master Teacher/Healer.
Rotella was diagnosed with breast cancer in 2011 and underwent a lumpectomy, chemotherapy, and radiation therapy.
"11 months later, I was in the ER, and it wasn't in the breast, it was in the lungs, ribs, spine, brain, and the liver had been shot through," she said.
"I remember exactly what they said about the liver. It had an 8cm tumor on the surface and it was inside and outside. It was a terminal diagnosis. There was Dr. Todd Whitman. He was a great oncologist. He's kind, caring, and open-minded.
spiritual self care
Rotella utilized essential oils, reiki, prayer, visualization and deep thought.
"I found that so many people were asking the same question," she said.
"Who is God? "Sometimes you can't even follow them. No, it was really just with novice kids in mind.I'll distill it down to the simplest explanation I can manage."
A divorced mother of two adult children and four grandchildren created a guide for her offspring.
"How do you explain it to children?" she said.
"I didn't think it was right to quote the Bible."
The nine chapters are:
• Why do I feel scared sometimes?
• Who am I?
• Who is God?
• How can I be good enough for God?
• Are angels, ghosts, and ETs real?
• Does evil exist?
• Why do bad and terrible things happen?
• What happens when a person dies?
• How should I pray?
The book features chapter illustrations by artist Joe Ferris and is available in softcover for $18.99, hardcover for $29.99, and e-book for $3.99.
"When we've achieved whatever our goal in this world is, we were thinking about the heavenly perspective of deciding it before we came and going home to rest," Rotella said.
"Then we come back to learn new lessons. That's how our souls grow. I used it to get the point across."
Rotella worked on the book for about a year, with breaks and waves of inspiration throughout the writing process. Her purpose in writing this book was to help people find peace of mind and inspire a desire to know more on a deeper level.
"Golden Man"
Lotella's text contains the following supernatural occurrences:
"I want to tell you a story. I know it's true because I know the woman where it happened. There was a steep driveway, and there was a deep ditch on the other side of the road at the end of the driveway, which had been filled with water from the thaw and recent storms.One day she was watching her three-year-old granddaughter, running errands. After they got in the car, she realized she had forgotten something and drove back home, when the car rolled backwards down the driveway and fell upside down into a ditch. When she returned she was horrified to see her granddaughter still strapped to the car seat and the car filled with water.Before she could act, the little girl saw her When asked to explain what happened, the child simply said, "It was the Golden Man, Grandma. He helped me."
"Just talking about it gives me goosebumps," she said.
"That was told to me by the woman it happened to. These are the kind of little things I'm throwing in here to make a point."
sighting of jesus
Rotella, who was raised Roman Catholic, says she has a relationship with Jesus, although she strayed from standardized religion.
"I don't really agree," she said.
"I refuse to take things at face value just because I've been told so. I want to know the truth about other things about myself, my heart, my soul.
"(Jesus) was called a rabbi, and rabbi means teacher. When they say the only way to heaven is through me, he didn't mean through the door. It was meant to teach us about how to live."
The first time Rotella actually saw Jesus Christ was when she was 12 years old.
"It was my first experience," she said.
"I was sitting on my grandmother's porch, swinging on a summer's day. She was floating in the sky. What was I like?"
Rotella shares similar experiences on her blog at www.dragonflyenergies.com.
"During therapy, I had so many spiritual experiences," she said.
"I was taking a nap and felt a hand grabbing the toe of one foot, which is exactly what my father used to do when I was a kid. It wasn't a doubt in my mind, so I just smiled and said, I don't go mad so easily."

redpajama_set_name: RedPajamaCommonCrawl


text:
Назва Тимохи, ймовірно, походить від чоловічого наймення Тимофій і його зменшеної форми Тимоха.

В Білорусі є село із назвою (), що відповідає назві Тимохи:
 Тимохи — село, Гродненська область, Ошмянський район;
 Тимохи — село, Гродненська область, Вовковиський район

В Росії є топонім із схожою назвою (), що відповідає назві Тимохи:
 Тимохи — село, Псковська область, Красногородський район

Див. також
 Тимофіївка

Примітки

redpajama_set_name: RedPajamaWikipedia


Restored 1979 Suzuki GT250X7 Motorcycle.
This great little Suzuki X7 was restored by its owner.
New pistons, rings and small end bearings were fitted.
The cylinder barrels and head were vapour blasted.
The fork tubes were re-chromed and rebuilt with new seals.
A new genuine front mudguard was fitted.
The front and rear wheel bearings were replaced.
A rare new genuine fuel tank was sourced and fitted.
New genuine down pipes were fitted.
The rear mudguard was replaced with a new item.
The rear footrests were replaced.
The paintwork was professionally finished.
The brake pedal and kick start were replaced.
A very nice restored Suzuki GT250X7 Motorcycle.
Suzuki GT250X7 – 1979 For Sale or Wanted?
If you're looking for the perfect Suzuki GT250X7 – 1979 for sale then take a look at the hundreds of restored classic motorcycles listed on our extensive Motorcycles For Sale pages. We regularly feature very nice restored Suzuki GT250X7 – 1979 bikes for sale.
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Hi, we're an enthusiast website displaying photos and stories of some wonderful bike restorations.


Intuitive Therapeutics paves the way for more accurate treatments.
CE marking of IntuitivePlan is targeted for Q2 2019!
Does your dose planning system fail to provide optimal treatment plans rapidly?
Are you devoting too much time to planning?
Failing to recruit enough experienced radiosurgeons or physicists?
Does the training of SRS planning take too long?
Do you need to reduce costs of radiosurgery treatments?
Watch how to start using IntuitivePlan.
Watch how to interact with dose isosurface using IntuitivePlan.
Watch how to handle complex multiple metastases cases using IntuitivePlan.
Watch Prof. Marc Levivier's presentation at the International Leksekll Gamma Knife Society meeting, Dubaï, March 4-8 2018, to learn more.
An intuitive inverse planning tool that calculates the optimal treatment plan and allows its use in real-time to enhance interactions, user-friendliness, productivity and patient safety.
Case courtesy of Dr. Ian Paddick.
Intuitive Plan can calculate the best treatment plans in real time. Users can modify the constraints interactively.
The treatment itself can then be delivered most rapidly.
It represents a significant technological breakthrough regarding existing systems and the current state of research in this field.
Intuitive Plan runs on standard PCs with graphics cards.
Download here the presentation brochure.
For clinicians: ultra-fast computation, shorter planning time, high quality of dosimetric profiles, interactivity with isosurfaces and multiple targets simultaneous computation.
For hospitals and clinics: Shorter treatment times, shortened planning times and homogeneous quality of treatment plans.
In collaboration with the Swiss Federal Institute of Technology Lausanne, the School of Engineering and Architecture of Fribourg, the CSEM of Neuchâtel and the University Hospital of Lausanne, Intuitive Therapeutics has developed since 2014 a novel algorithm capable of a revolutionary method of planning radiotherapy and radiosurgery treatments with extreme speed and unequalled ease of use.
Patent applications were filed in Switzerland, the USA, Europe, China, Japan, India, South Korea, Brazil and Hong-Kong. Two patents were delivered in the USA and in Switzerland in 2017.
In 2015, we produced the first real-time demonstrator for linear accelerators using IMRT (Intensity Modulated Radiation Therapy) and the first proof of concept for linear accelerators using VMAT (Volumetric-Modulated Arc Therapy). The use of the demonstrator allowed us to show the superior capacity of the solutions proposed by our algorithm.
In 2016, the first proof of concept for radiosurgery was achieved with the Leksell Gamma Knife® (Elekta AB, Sweden). As for IMRT and VMAT, our algorithm clearly brought more effective solutions in terms of quality and treatment time.
In 2016, we also achieved the proof of concept for the CyberKnife® (Accuray Incorporated, USA) demonstrating the capability to use our algorithm for this machine.
The Leksell Gamma Knife® is currently used as the reference platform for our developments.
Since May 2017, the company has based itself in St-Sulpice - Switzerland. It benefits from the support of the Service for economic promotion and innovation (SPEI - Service de la Promotion de l'Economie et de l'Innovation) of the Canton de Vaud.


WASHINGTON -- Worried about a possible war, Wall Street has been in a funk this year and the news on Main Street hasn't been any better. Business executives are freezing new spending and hiring, fearful of big commitments in the face of so much uncertainty.
Some analysts think the national anxiety, heightened by the loss of the space shuttle Columbia, could be enough to derail the feeble recovery and throw the country back into recession.
"The probability of a double-dip recession has certainly risen," said Sung Won Sohn, chief economist at Wells Fargo in Minneapolis. "The economy is still mired in a pretty soft patch and we have not made it to firmer ground."
"Soft patch" was the phrase Federal Reserve Chairman Alan Greenspan began using last fall to describe a significant slowdown in economic growth. The economy, which had been growing at a solid 4 percent rate in the summer, screeched to a near halt during the final three months of the year, managing to eke out a tiny 0.7 percent growth rate.
To buy some insurance against a possible double-dip recession, the Federal Reserve in November cut interest rates by a bigger-than-expected half point, pushing the overnight borrowing cost for banks down to a 41-year low of 1.25 percent.
But so far, the extra boost from lower interest rates has not been enough to jump-start the economy. Unemployment has been stuck at an eight-year high of 6 percent as businesses have laid off nearly 200,000 workers over the past two months.
Many analysts believe when the government reports the January unemployment figure on Friday it will show that businesses did add a small number of workers last month but not enough to show an improvement in the 6 percent jobless rate. In fact, they are forecasting that unemployment will hit 6.5 percent or even higher by this summer.
"The economy is very fragile right now," said Mark Zandi, chief economist at Economy.com. "Businesses are queasy. They are not investing or hiring and consumer confidence is still weakening. Any little thing that went wrong could push us back into recession."
The Conference Board reported consumer confidence fell again in January and now stands at a nine-year low, adding to worries that consumers, who have been the one bright spot in the economy for over a year, could put away their pocketbooks.
The report on the anemic 0.7 percent growth rate for the gross domestic product in the October-December quarter showed that consumer spending, which accounts for nearly two-thirds of the economy, slowed to a 1 percent growth rate, the weakest performance in nearly 10 years.
The concern is that more bad news -- such as a U.S. invasion of Iraq that took an unexpected turn for the worse or a new terrorist attack in the United States -- could be the final blow that would guarantee another recession.
"The real risk is the war," said David Wyss, chief economist at Standard & Poor's in New York. "It can go bad in all sorts of ways and that could push us into a double-dip."
Still, even economists who are worried that the weak economy could slip back into recession rate the possibility of that occurring at only a one-in-three chance -- although they say the odds have gone up in recent weeks, especially in light of the new tumble stock prices took in January.
But many economists say the most likely prospect is that the economy will gradually improve this year, helped along by continued low interest rates supplied by the Fed and further tax cuts from Washington.
Few analysts expect President Bush's entire $670 billion stimulus package to make it through Congress, but they said the final version could offer even more stimulus this year, given that many Democrats and Republicans have complained that too much of the Bush package won't take effect for years to come, when the economy won't need the help.
The housing industry is still enjoying strong sales as mortgage rates stay at levels not seen since the early 1960s. While the Fed is running low on ammunition with its key interest rate -- the federal funds rate, already down to 1.25 percent -- economists said the central bank would not hesitate to push the rate to zero if necessary to help protect the economy from further shocks.
Economists said that while there has been a stream of bad news recently, including the shuttle tragedy, consumers showed in the wake of the Sept. 11, 2001, terrorist attacks that low interest rates, including zero-rate offers from auto companies, were enough to get them back in the stores.
"As long as interest rates are this low, consumers are going to keep spending," predicted Michael K. Evans, head of Evans Carroll & Associates, a Boca Raton, Fla. economic consulting firm. "Consumers will continue to carry the day and that will keep us out of a double dip."


WATCH ABOVE: Storm chasers tracking a large storm cell south east of Killam capture the moment a tornado touches down.
Environment Canada has confirmed a tornado touched down near Killam Sunday afternoon, about 165 kilometres south east of Edmonton.
A massive storm cell blew through the region just after 4 p.m. packing a punch with toonie sized hail.
Environment Canada received reports of minor damage in the area, including to a farm yard.
Storm chasers following the ominous looking clouds spotted the tornado south east of Killam around 4:15 p.m.
He said the tornado lasted less than five minutes.
Environment Canada issued a tornado warning for Flagstaff County at 4:24 p.m. including Alliance, Bellshill Lake, Lougheed and Hardisty.
The warning was dropped at 4:46 p.m.
As of 8:30 p.m. Sunday night, a severe thunderstorm watch remains in effect for the region extending to Lloydminster, Wainwright, Provost and Vermilion.


Woodland Park, NJ — FSR is once again extending its range of innovative Pro AV solutions with the launch of its new, next-generation matrix switcher. Joining the company's switcher line of products that already address the needs of all types of users, FSR is now introducing its DV-HMSW4K-88 Matrix switcher, which routes eight HD sources to any eight HDTV displays.
The new FSR DV-HMSW4K-88 Matrix switcher supports 1080p full HD up to 4K plus all 3D formats, along with multichannel digital audio formats such as PCM, Dolby® True HD and DTS-HD® Master Audio™. Switching and other commands can easily be implemented using the front-panel push buttons, IR remote control, RS-232, or via TCP/IP.


In many industries and countries, the most in-demand occupations or specialties did not exist 10 or even five years ago, and the pace of change is set to accelerate.
Demand for workers with third-language skills grew by 15 per cent between 2014 and 2016, and companies stand ready to offer them better pay.
How can students prepare for the world of tomorrow?
By understanding the diversity and complexity of today's world and the increasing demand on thought and cross-cultural skills.
How can students prepare for the future of jobs?
By being multi-disciplinary, insatiably curious individuals who know how to model ideas.
How can students prepare for the coming age of intelligent machines?
By developing the essentially human qualities of critical thinking and complex interactivity that will be more important than ever.
To ensure that students have the foundational knowledge and essential skills to thrive in work environments that are evolving faster than ever, the Intercultural Studies and Languages major promotes the ideals of the liberal arts tradition and global citizenship.
This major aims to equip students with competencies for lifelong learning and with knowledge that is essential for any career and a meaningful human existence. In so doing, the program aims to foster the analytical and intuitive thinking skills, creativity, communicative facility and ethical awareness that prepare students to be future decision-makers and lifelong learners.


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text:
Log in via BSG
Clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy
Gastrointestinal infection
S S Johal1,
J Hammond1,
K Solomon2,
P D James3,
Y R Mahida2
1Division of Gastroenterology, University of Nottingham, Nottingham, UK
2Division of Gastroenterology, and Institute of Infection, Immunity, and Inflammation, University of Nottingham, Nottingham, UK
3Division of Pathology, University of Nottingham, Nottingham, UK
Professor Y R Mahida
Institute of Infection, Immunity, and Inflammation, C Floor, West Block, Queen's Medical Centre, Nottingham NG7 2UH, UK; Yash.MahidaNottingham.ac.uk
Objectives:Clostridium difficile associated diarrhoea (CDAD) is a hospital acquired infection in which optimal methods for diagnosis and the scale of the problem in the community remain to be determined. In hospitalised patients with CDAD, we aimed to (i) study patients in whom the onset of diarrhoea was in the community and (ii) investigate the role of bedside flexible sigmoidoscopy in diagnosis.
Methods: Patients with CDAD (onset in hospital or community) were studied prospectively. In those with diarrhoea of unknown aetiology, flexible sigmoidoscopy was compared with stool assay for C difficile cytotoxin.
Results: Of 136 patients with CDAD (which was associated with antibiotic exposure in 96%), diarrhoea started in the community in 38 (28%; majority in own home) and while an inpatient in 98 (72%). The majority with CDAD onset in the community had been hospitalised over the preceding 12 months (86.8% v 57.1% in the hospital onset group; p<0.001). In 56 patients with pseudomembranous colitis at sigmoidoscopy, the stool C difficile cytotoxin test was negative in 29 (52%) but toxigenic C difficile was isolated from all of nine stool samples cultured. Of patients with pseudomembranous colitis, 30.4% relapsed over the subsequent 57.7(4.2) days.
Conclusions: In a significant proportion of hospitalised patients with CDAD, diarrhoea started in the community. However, the majority of these had been hospital inpatients previously when they may have acquired C difficile, with the subsequent onset of diarrhoea in the community following exposure to antibiotics. Flexible sigmoidoscopy is superior to the stool C difficile cytotoxin test in a subgroup of patients with pseudomembranous colitis. Sigmoidoscopy should therefore be considered in all hospitalised patients with diarrhoea in whom the stool test for C difficile cytotoxin and enteric pathogens is negative.
CDAD, Clostridium difficile associated diarrhoea
ELISA, enzyme linked immunosorbent assay
http://dx.doi.org/10.1136/gut.2003.028803
Clostridium difficile is an anaerobic Gram positive bacillus that is an important cause of diarrhoea in hospitalised patients, which especially affects the elderly. Infection can lead to asymptomatic carriage or clinical disease, ranging from mild diarrhoea to life threatening pseudomembranous colitis.1–3C difficile associated disease is an important clinical problem that is believed to occur predominantly following hospitalisation and administration of antibiotics.4 Moreover, approximately 20% of patients with Clostridium difficile associated diarrhoea (CDAD) relapse despite initial adequate treatment.5–7
CDAD is usually diagnosed following a stool test for C difficile cytotoxin or for the presence of toxigenic C difficile in a cultured stool sample.8 As patients may be colonised by non-toxigenic strains of C difficile, any cultured isolates of the bacterium have to be tested in vitro for the production of cytotoxin. Although enzyme linked immunosorbent assays (ELISAs) are increasingly used, demonstration of the presence of C difficile cytotoxin by the characteristic cytopathic effect on cell culture monolayers is considered by many to be the "gold standard".9–11 However, the sensitivities of the cell cytotoxicity assays and ELISAs have been reported to be variable.12,13 In our retrospective audit of 110 patients with CDAD, the first stool sample after the onset of diarrhoea was negative for C difficile cytotoxin in 17%, resulting in a mean delay of 8.2 days before a diagnosis was made and appropriate treatment initiated.14 Endoscopic examination of the colon can reveal characteristic yellowish pseudomembranes, often with intervening normal looking mucosa. Although endoscopic examination is recognised to allow rapid diagnosis of C difficile associated pseudomembranous colitis,11 its role in the management of patients suspected of having CDAD remains to be determined. Such a role could include establishment of the diagnosis in patients with a false negative stool test for cytotoxin. Diarrhoea in some patients with CDAD resolves without any specific treatment (apart from withdrawal of offending antibiotics) and the role of endoscopic examination in the selection of such patients remains to be determined. It is also unknown whether pseudomembranous colitis predisposes to relapsing disease. We have therefore undertaken a prospective study in which the role of flexible sigmoidoscopy in the diagnosis and management of CDAD was investigated.
CDAD is generally considered to be a disease that is acquired by patients following admission to hospital and administration of antibiotics for another condition (for example, pneumonia). However, CDAD can also be acquired in the community.15–17 Of the hospital inpatients with CDAD, the proportion that developed the disease in the community has also been investigated in this prospective study.
Patients that developed diarrhoea (⩾3 watery bowel motions for more than 24 hours) as inpatients or those that were admitted to hospital with diarrhoea from the community were studied. CDAD was diagnosed if: (1) diarrhoea occurred in the presence of C difficile cytotoxin in a stool sample or (2) pseudomembranes were identified at sigmoidoscopy and the diarrhoea responded to oral vancomycin or metronidazole. Suitable patients for this study were identified from daily (during weekdays) visits to the medical (including Health Care of the Elderly) and surgical wards or following referral by medical or nursing colleagues. Those in whom the stool C difficile cytotoxin test was positive by the time the patient was seen by us, had their clinical progress prospectively monitored but did enter the sigmoidoscopy arm of the study. Patients with an unidentified cause for their diarrhoea (who during the same admission may or may not have had a negative stool test for C difficile cytotoxin) were recruited to the sigmoidoscopy arm of the study in which, following informed consent, a bedside flexible sigmoidoscopy was performed and a stool sample was taken at the same time for routine C difficile cytotoxin assay and culture for conventional enteric pathogens (see below).
In addition to demographic data, the following information was collected: onset and severity of diarrhoea, drug treatment, normal residence, and previous hospital admissions. If pseudomembranes were seen at sigmoidoscopy, treatment was started with oral metronidazole or vancomycin. All patients were seen daily until resolution of diarrhoea. This study was approved by the ethics committee of University Hospital NHS Trust.
This examination was undertaken by the bedside using a fibreoptic sigmoidoscope (Olympus OSF-3; KeyMed Ltd, Southend-on-Sea, UK). No bowel preparation was undertaken and if views of the mucosa were obscured by overlying stool, 10–20 ml of saline was applied down the sigmoidoscope. Unless contraindicated, biopsies were also taken for routine histological examination.
Stool samples
A stool sample was collected either prior to or at sigmoidoscopy and sent to the clinical enteric laboratory for C difficile cytotoxicity assay (using Vero cells) and culture for conventional enteric pathogens (Salmonella sp, Campylobacter sp, Shigella sp, and Escherichia coli O157) and examination by microscopy for Cryptosporidium. In some, an aliquot of the stool sample was frozen for anaerobic culture at a later date.
For culture studies, stool samples were partially defrosted and 200 μl of resultant liquid transferred to an Eppendorf. Samples were then incubated at room temperature for one hour in the presence of an equal volume of 70% ethanol to remove viable bacteria and select for the presence of spores.
Samples were then streak plated onto C difficile selective media (Oxoid, Basingstoke, Hants, UK) and incubated anaerobically at 37°C for two days. C difficile colonies were identified by distinct colony morphology and by fluorescence under UV light. Toxigenic C difficile were identified by their ability to produce toxin A. Single colonies from each sample were incubated anaerobically in brain heart infusion broth (Oxoid) at 37°C for two days. Following centrifugation (at 2000 g), the supernatant was tested for the presence of toxin A using C difficile toxin A test (Oxoid).
Analysis was performed using Fisher's exact test. Results are expressed as mean (SEM).
Comparison between community versus hospital onset of CDAD
Over a period of 30 months (starting March 2000), 136 patients with CDAD were studied. Of these, diarrhoea developed in the community in 38 (28%), and in the remaining 98 (72%) patients diarrhoea developed in hospital (onset 48 hours after admission for an unrelated condition). Details of the two groups of patients are given in table 1.
Clostridium difficile associated diarrhoea (CDAD) onset in the community compared with onset in hospital
Of patients admitted with diarrhoea, 33 (86.8%) had been hospitalised over the preceding 12 months compared with 56 (57.1%) that developed diarrhoea as inpatients (p<0.001). Patients who developed diarrhoea in the community also had a higher daily stool frequency (7.2 (0.8) v 4.6 (0.2); p<0.001) and shorter period of hospitalisation (22.6 (3.3) v 48.9 (4.0) days; p<0.001) but there was no difference in age, duration of diarrhoea, C reactive protein level, or total white blood count. Of the 38 patients who developed diarrhoea in the community, 21 (55.3%) were admitted from their own home, eight were from a warden aided complex, five from a residential home, and four from a nursing home. Of these 38 patients, 23 (60.5%) were discharged to their own homes following resolution of the diarrhoea. For patients that developed CDAD in hospital, 68 (69.4%) were admitted from their own homes but only 30 (30.6%) subsequently returned there (p<0.001 compared with those with community onset of CDAD).
The majority of the 136 (96%) patients had been exposed to antibiotics before developing CDAD, with 114 (84%) taking cephalosporins and/or broad spectrum penicillins (table 2). Metronidazole, which is often used for the treatment of CDAD, had been taken by 46 (33.8%) patients, in most cases in combination with other antibiotics (table 2).
Intake of antibiotics in Clostridium difficile associated diarrhoea (CDAD) patients
Investigation of the role of flexible sigmoidoscopy in diagnosis of CDAD
A subgroup of patients with CDAD (n = 63) took part in a study in which the role of flexible sigmoidoscopy in establishing the cause of diarrhoea was investigated (fig 1). For this arm of the study, 179 hospitalised patients in whom the cause of diarrhoea (onset in community or hospital) was unknown, consented to a study in which findings at flexible sigmoidoscopy were compared with assay for C difficile cytotoxin in a stool sample collected at the same time. Sixty three (35.2%) of 179 participating patients were considered to have CDAD based on either the presence of C difficile cytotoxin in the stool sample or the appearance of pseudomembranous colitis at flexible sigmoidoscopy and response to metronidazole and/or vancomycin. Duration of diarrhoea in the CDAD patients prior to sigmoidoscopy was 10.1 (1.2) days. The causes of diarrhoea in the 116 patients without CDAD are given in table 3.
Causes of diarrhoea, other than Clostridium difficile associated diarrhoea, in patients that underwent flexible sigmoidoscopy
Outcome in patients that underwent flexible sigmoidoscopy. CDAD, Clostridium difficile associated diarrhoea.
In 56 patients with CDAD (88.9%), flexible sigmoidoscopy showed pseudomembranous colitis (examinations limited to the rectum/distal sigmoid colon), with rectal sparing (pseudomembranes limited to the sigmoid colon) in six (10.7%). Mucosal biopsies from patients with a sigmoidoscopic appearance of pseudomembranous colitis showed histological changes characteristic of pseudomembranous colitis in 40 patients and colonic inflammation in 15 patients (one patient was on warfarin and therefore biopsies were not taken). However, C difficile cytotoxin assay in a stool sample collected at the same time as flexible sigmoidoscopy was negative in 29 patients (52% of patients with pseudomembranous colitis) (fig 1). Diarrhoea in all of these latter patients resolved on treatment with oral metronidazole and/or vancomycin over a period of 7.8 (1.5) days (compared with 7.0 (1.3) days in those with pseudomembranous colitis and a positive stool test for C difficile cytotoxin). Sixteen of 29 pseudomembranous colitis patients with a negative stool test for C difficile cytotoxin also had a negative stool test for cytotoxin prior to sigmoidoscopy (sample taken during the same episode of diarrhoea; mean 12.4 (3.9) days before sigmoidoscopy). None of the patients experienced any adverse effects as a result of flexible sigmoidoscopy.
Frozen aliquots of nine stool samples that were negative for C difficile cytotoxin (taken at the time of flexible sigmoidoscopy) were available for anaerobic culture and all revealed colonies of organisms with typical characteristics (morphology and fluorescence under UV light) of C difficile. These organisms were confirmed to be toxigenic C difficile by demonstration of the presence of toxin A in supernatant samples of subcultured colonies. In four patients with a negative stool C difficile cytotoxin test at the time of flexible sigmoidoscopy, subsequent stool samples (taken following initiation of treatment) were positive for C difficile cytotoxin (in two of these patients, anaerobic culture of an aliquot of stool sample collected at the time of flexible sigmoidoscopy grew toxigenic C difficile).
Fifty four of 56 (96.4%) patients with pseudomembranous colitis were treated with oral metronidazole or vancomycin, with resolution of diarrhoea over 8.4 (1.0) days. In two patients with mild diarrhoea and early pseudomembranes, the bowel habit returned to normal on discontinuation of the offending antibiotics. In seven of 63 CDAD patients without pseudomembranous colitis, diarrhoea resolved within 24 hours of discontinuation of the offending antibiotics in four (p<0.001 compared with patients with pseudomembranous colitis) and the remaining three patients responded to treatment with metronidazole and/or vancomycin.
Stool C difficile cytotoxicity test and treatment in patients not sigmoidoscoped
Of 73 patients with CDAD that did not take part in the sigmoidoscopy study, 26 (36%) had an initial negative stool test prior to the subsequent sample that established the diagnosis. Mean delay before sending the second stool sample was 13.1 (2.3) days. Fifty one (69.6%) patients in this group were treated with metronidazole and/or vancomycin with resolution of diarrhoea over 8.7 (1.0) days. In the remaining 22 (30.1%) patients, diarrhoea resolved (over 4.0 (0.7) days) after discontinuation of the offending antibiotics.
Relapse of CDAD
Seventeen (30.4%) of 56 patients with pseudomembranous colitis at sigmoidoscopy relapsed over the subsequent 57.7 (4.2) days. None of the seven patients without pseudomembranous colitis relapsed. In total, there were 20 CDAD relapse episodes, with 14 patients relapsing once and three patients relapsing twice. Broad spectrum antibiotics were taken during nine relapse episodes but there was no such history in the rest. Flexible sigmoidoscopy performed during 16 relapse episodes showed pseudomembranous colitis in 14 (87.5%). Of the stool samples sent during 19 relapse episodes, six (32%) were negative for C difficile cytotoxin. Frozen aliquots of five stool samples that were negative for C difficile cytotoxin were cultured anaerobically, and colonies of toxigenic C difficile (confirmed by the presence of toxin A in supernatant samples of subcultures) were identified in four.
Of 73 patients with CDAD that were not in the sigmoidoscopy study, 15 (21%) relapsed over the subsequent 42.1 (8.0) days.
CDAD is an infection of great clinical importance in hospitalised patients the incidence of which has increased markedly over the past 10 years4 (www.hpa.org.uk). In our hospital, the number of patients with C difficile infection increased from 29 in 1993 to 210 in 1995. A retrospective analysis of the case notes of 110 patients in 1995 showed that the first stool test for C difficile cytotoxin was negative in a significant minority of patients (17%), leading to a significant delay (8.2 (6.6) days) before the second diagnostic stool sample allowed appropriate treatment and infection control measures to be undertaken.14 It is well recognised that the sensitivity of neither the stool cytotoxicity test nor the ELISA tests is 100%.12,13,18 As endoscopic examination can reveal characteristic appearances of pseudomembranous colitis, our aim was to prospectively investigate the role of flexible sigmoidoscopy, at the bedside, in the diagnosis and management of CDAD. Flexible, rather than rigid, sigmoidoscopy was used because rectal sparing can occur in some patients with pseudomembranous colitis19 (which was confirmed in 10.7% of patients in our study). In order to determine the role of flexible sigmoidoscopy, it was felt that a "head to head" comparison with the stool cytotoxin test would be appropriate because, to our knowledge, such a prospective study has not been previously performed. Of a total of 136 patients with CDAD, in 73 (53.7%) the diagnosis had already been made (and treatment initiated) following a positive stool test for C difficile cytotoxin (prior to our seeing the patient). Review of the notes and results of these patients showed that in 36%, the first stool test for C difficile cytotoxin had been negative and the diagnosis of CDAD was not established until a second stool sample (sent by the team looking after the patient) was sent a mean 13.1 (2.3) days after the first. Following diagnosis of CDAD, these patients were subsequently followed up by us until resolution of diarrhoea.
A total of 179 patients with persistent diarrhoea of unknown cause entered that part of the study in which flexible sigmoidoscopy was compared with the stool C difficile cytotoxin test. Sixty three patients in this group were considered to have CDAD, with flexible sigmoidoscopy showing pseudomembranes in 56. In those with pseudomembranous colitis, the stool C difficile cytotoxin test (performed at the same time as sigmoidoscopy) was negative in 29 (52%). A previous stool C difficile cytotoxin test was also negative in a significant proportion of the latter group (16; 55.2% of those in whom the stool C difficile cytotoxin test was negative at the time of sigmoidoscopy). This raises the possibility that pseudomembranous colitis in these patients was due to another enteric pathogen and not toxigenic C difficile.20 We believe that pseudomembranous colitis in our patients was due to toxigenic C difficile for the following reasons. All of these patients responded to oral vancomycin and/or metronidazole over a period of time that was similar to those with pseudomembranous colitis and a positive C difficile cytotoxin test. Moreover, in nine patients (with a negative stool C difficile cytotoxin test) in whom a frozen aliquot of stool sample (taken at the same time as sigmoidoscopy) was available, toxigenic C difficile was isolated during anaerobic culture. Enterotoxigenic C perfringens can cause antibiotic associated diarrhoea (which can respond to metronidazole) but to our knowledge this infection has not been reported to cause pseudomembranous colitis.21,22
The reasons for negative stool C difficile cytotoxin tests in many of the CDAD patients in our study are unknown. For the sigmoidoscopy arm of the study, stool samples were collected and sent to the enteric laboratory on the same day as the endoscopic examination. Although there was no delay in sending these stool samples, it is conceivable that toxin degradation may occur rapidly in some samples because of the presence of proteases derived from other bacteria. Another possibility is that other components in stool samples (which may also be derived from bacteria) may interfere with the bioassay by binding to the toxins. Further studies are required to address these possibilities.
As stool C difficile cytotoxicity assays and ELISAs for toxins A and B are known to be negative in a proportion of patients with CDAD, it has been suggested that either stool culture for toxigenic C difficile and toxin detection should be performed at the same time on all stool specimens23 or toxigenic culture performed on those with a negative stool toxin assay.18 The former strategy would allow more cases of CDAD to be diagnosed but would impose a significant burden on the laboratory services, particularly as cultured C difficile would have to be confirmed to be toxigenic (by demonstration of toxin secretion or the presence of their genes), and a positive result would not be a significant addition in those patients with a positive stool toxin assay. Toxigenic culture in patients with a negative stool toxin assay would require either an aliquot of the original stool sample to be stored or another sample collected for anaerobic culture. Moreover, anaerobic culture and identification of toxigenic C difficile would take some time, during which the patient may deteriorate and continue to pose a risk of transmission of infection to neighbouring patients. Our study has shown that flexible sigmoidoscopy is superior to stool C difficile cytotoxin test in a subgroup of patients with C difficile associated pseudomembranous colitis. Because of the characteristic appearance of pseudomembranous colitis, flexible sigmoidoscopy would allow a rapid diagnosis in patients with a negative stool toxin assay, enabling treatment and infection control measures to be initiated, particularly as transmission of infection has been shown to occur in hospital.24–26 Endoscopy would also allow an assessment of the severity of the colitis in these patients, thereby facilitating subsequent management.
As shown in table 3, many of the hospitalised patients with persistent diarrhoea and a negative C difficile toxin assay will not have CDAD but other conditions such as ulcerative colitis, Crohn's disease, ischaemic colitis, or infectious enterocolitis. As the endoscopic appearances in many of these conditions are characteristic, together with the facility to take biopsies for histology and stool samples for further microbiological studies, flexible sigmoidoscopy could be of considerable benefit in the management of hospitalised patients with diarrhoea. However, because it is non-invasive and more cost effective, we agree with the recommendation that examination of a stool sample for C difficile toxins should be the initial investigation of choice in a hospitalised patient with diarrhoea.27 In the presence of continuing diarrhoea and a negative stool test for C difficile toxins (and other enteric pathogens), we recommend flexible sigmoidoscopy as it will enable a rapid diagnosis in those patients with pseudomembranous colitis who need treatment the most. Our study has shown that flexible sigmoidoscopy is well tolerated in these patients and can be undertaken by the bedside with the advantage of minimising the risk of transmission of the disease by transportation to the endoscopy unit.
Our study suggests that in the absence of pseudomembranes at sigmoidoscopy, specific treatment (apart from discontinuation of the offending antibiotics) may not be necessary but further studies are required to determine whether endoscopic findings are superior to clinical features in making such decisions about management. As none of the small number of CDAD patients without pseudomembranes at sigmoidoscopy relapsed during the study, it is possible that pseudomembranous colitis increases the risk of subsequent relapse. However, the difference in our study was not statistically significant and further work is required. If the presence of pseudomembranes is shown to be associated with the risk of relapse, such patients could be selected for studies to investigate therapeutic agents that may reduce this risk.
A significant proportion (28%) of our patients with CDAD developed their disease in the community (in their own homes in over half of these patients) following administration of antibiotics. The majority of these patients had been hospital inpatients over the preceding 12 months, raising the possibility that colonisation with toxigenic C difficile, without significant symptoms, occurred during such an admission. Asymptomatic acquisition of toxigenic C difficile following admission to hospital has been reported.24,28 If this were the case, growth of toxigenic C difficile could occur following antibiotic induced disruption of the normal bowel flora and would suggest the cautious use of antibiotics in community elderly patients who have had recent hospital admissions.
This study was supported by the Community Fund (formerly National Lottery Charities Board) via the Digestive Disorders Foundation. We thank Dr Vivienne Weston for helpful comments.
Larson HE, Price AB, Honour P, et al. Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet1978;1:1063–6.
Bartlett JG, Tedesco FJ, Shull S, et al. Symptomatic relapse after oral vancomycin therapy of antibiotic-associated pseudomembranous colitis. Gastroenterology1980;78:431–4.
Cleary RK. Clostridium difficile-associated diarrhea and colitis: Clinical manifestations, diagnosis, and treatment. Dis Colon Rectum1998;41:1435–49.
Wilcox MH. Cleaning up Clostridium difficile infection. Lancet1996;348:767–8.
Fekety R, McFarland LV, Surawicz CM, et al. Recurrent Clostridium difficile diarrhea: Characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis1997;24:324–33.
Walters BA, Roberts R, Stafford R, et al. Relapse of antibiotic associated colitis: endogenous persistence of Clostridium difficile during vancomycin therapy. Gut1983;24:206–12.
Bartlett JG, Chang TW, Gurwith M, et al. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med1978;298:531–4.
Brazier JS. The epidemiology and typing of Clostridium difficile. J Antimicrob Chemother1998;41(suppl C):47–57.
Barbut F, Kajzer C, Planas N, et al. Comparison of three enzyme immunoassays, a cytotoxicity assay, and toxigenic culture for diagnosis of Clostridium difficile-associated diarrhea. J Clin Microbiol1993;31:963–7.
Bond F, Payne G, Borriello SP, et al. Usefulness of culture in the diagnosis of Clostridium difficile infection. Eur J Clin Microbiol Infect Dis1995;14:223–6.
Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol1997;92:739–50.
Manabe YC, Vinetz JM, Moore RD, et al. Clostridium difficile colitis: an efficient clinical approach to diagnosis. Ann Intern Med1995;123:835–40.
Gerding DN. Diagnosis of Clostridium difficile-associated disease: patient selection and test perfection. Am J Med1996;100:485–6.
Wight N, Curtis H, Hyde J, et al. Clostridium difficile-associated diarrhoea. Postgrad Med J1998;74:677–8.
Hirschhorn LR, Trnka Y, Onderdonk A, et al. Epidemiology of community-acquired Clostridium difficile-associated diarrhea. J Infect Dis1994;169:127–33.
Kyne L, Merry C, O'Connell B, et al. Community-acquired Clostridium difficile infection. J Infect1998;36:287–8.
Levy DG, Stergachis A, McFarland LV, et al. Antibiotics and Clostridium difficile diarrhea in the ambulatory care setting. Clin Ther2000;22:91–102.
Lozniewski A, Rabaud C, Dotto E, et al. Laboratory diagnosis of Clostridium difficile-associated diarrhea and colitis: usefulness of Premier Cytoclone A+B enzyme immunoassay for combined detection of stool toxins and toxigenic C. difficile strains. J Clin Microbiol2001;39:1996–8.
Tedesco FJ, Corless JK, Brownstein RE. Rectal sparing in antibiotic-associated pseudomembranous colitis: a prospective study. Gastroenterology1982;83:1259–60.
Phillips RK, Glazer G, Borriello SP. Non-Clostridium difficile pseudomembranous colitis responding to both vancomycin and metronidazole. Br Med J Clin Res Ed1981;283:823.
Borriello SP, Welch AR, Larson HE, et al. Diarrhoea and simultaneous excretion of Clostridium difficile cytotoxin and C perfringens enterotoxin. Lancet1984;2:1218.
Asha NJ, Wilcox MH. Laboratory diagnosis of Clostridium perfringens antibiotic-associated diarrhoea. J Med Microbiol2002;51:891–4.
Delmee M. Laboratory diagnosis of Clostridium difficile disease. Clin Microbiol Infect2001;7:411–16.
McFarland LV, Mulligan ME, Kwok RY, et al. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med1989;320:204–10.
Clabots CR, Johnson S, Olson MM, et al. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis1992;166:561–7.
Samore MH, Venkataraman L, DeGirolami PC, et al. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med1996;100:32–40.
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Copyright 2004 by Gut
Robin Spiller
Gut 2004; 53 617-617 Published Online First: 13 Apr 2004.
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text:
Q: Problem with table formatting I would like to know what is wrong with this code above:
\begin{table}[htb]
\centering
\caption{My caption}
\label{my-label}
\begin{tabular}{lllll}
\textbf{ID} & \textbf{Título} & \textbf{Tipo} & \textbf{Story Points} & \textbf{Responsável} \\
1 & Elaborar a Introdução do Projeto & Atividade & 2 & Murilo \\
2 & Elaborar a Problematização, Solução Proposta e Justificativa & Atividade & 5 & Milton \\
5 & Estruturar Trabalho no Google Docs & Atividade & 2 & Murilo \\
7 & Ata da Reunião \#4 & Atividade & 1 & Murilo \\
8 & Publicações no Blog (Aula 21/08 e Reunião \#4) & Atividade & 1 & Caique \\
9 & Revisão da Proposta Inicial & Atividade & 2 & Murilo \\
12 & Elaboração do Burndown Chart & Atividade & 5 & Caique \\
15 & Setup do Ambiente & Atividade & 2 & Adriana \\
17 & Estudar Plug-ins de Análise Estática & Atividade & 2 & Adriana \\
20 & Pesquisar e Desenvolver Tutorial de JUnit & Atividade & 8 & Arion \\
21 & Desenvolver Esqueleto do Projeto no Spring Boot & Atividade & 2 & Adriana \\
24 & Integrar STS ao Code Convention do Google (GitHub) & Atividade & 3 & Milton \\
25 & Elaborar os RFs, RNFs e RNs & Atividade & 5 & Ivan \\
26 & Elaborar o DFD 0 & Atividade & 5 & Ivan \\
27 & Elaborar o DFD 1 & Atividade & 5 & Arion \\
28 & Elaborar o Caso de Uso Geral & Atividade & 3 & Milton \\
29 & Elaborar Modelagem de Dados & Atividade & 5 & Murilo \\
30 & Elaborar Identidade Visual da Aplicação & Atividade & 8 & Caique \\
32 & Recriar Vídeo de Apresentação & Atividade & 3 & Adriana \\
\multicolumn{2}{r}{\textbf{Total de Pontos}} & \multicolumn{3}{r}{\textbf{69}}
\end{tabular}
\end{table}

This code is generating a table like this one. The table doesn't fit correctly:

A: You can use tabularx to have columns with an automatic linebreak. Loading makecell allows to have a common formatting and line breaks for column heads. I also took the liberty to modify some alignments so the corresponding columns look better:
\documentclass{article}
\usepackage[utf8]{inputenc}
\usepackage[showframe]{geometry}
\usepackage{multirow,bigstrut, makecell,booktabs, tabularx}
\renewcommand{\theadfont}{\normalsize\bfseries}

\begin{document}

\begin{table}[!htb]
\centering
\caption{My caption}
\label{my-label}
\begin{tabularx}{\linewidth}{rXccl}
\thead{ID} & \thead{Título} & \thead{Tipo} & \thead{Story\\ Points} & \thead{Responsável} \\
1 & Elaborar a Introdução do Projeto & Atividade & 2 & Murilo \\
2 & Elaborar a Problematização, Solução Proposta e Justificativa & Atividade & 5 & Milton \\
5 & Estruturar Trabalho no Google Docs & Atividade & 2 & Murilo \\
7 & Ata da Reunião \#4 & Atividade & 1 & Murilo \\
8 & Publicações no Blog (Aula 21/08 e Reunião \#4) & Atividade & 1 & Caique \\
9 & Revisão da Proposta Inicial & Atividade & 2 & Murilo \\
12 & Elaboração do Burndown Chart & Atividade & 5 & Caique \\
15 & Setup do Ambiente & Atividade & 2 & Adriana \\
17 & Estudar Plug-ins de Análise Estática & Atividade & 2 & Adriana \\
20 & Pesquisar e Desenvolver Tutorial de JUnit & Atividade & 8 & Arion \\
21 & Desenvolver Esqueleto do Projeto no Spring Boot & Atividade & 2 & Adriana \\
24 & Integrar STS ao Code Convention do Google (GitHub) & Atividade & 3 & Milton \\
25 & Elaborar os RFs, RNFs e RNs & Atividade & 5 & Ivan \\
26 & Elaborar o DFD 0 & Atividade & 5 & Ivan \\
27 & Elaborar o DFD 1 & Atividade & 5 & Arion \\
28 & Elaborar o Caso de Uso Geral & Atividade & 3 & Milton \\
29 & Elaborar Modelagem de Dados & Atividade & 5 & Murilo \\
30 & Elaborar Identidade Visual da Aplicação & Atividade & 8 & Caique \\
32 & Recriar Vídeo de Apresentação & Atividade & 3 & Adriana \\[1ex]
\multicolumn{2}{r}{\textbf{Total de Pontos}} & \multicolumn{3}{r}{\textbf{69}}
\end{tabularx}
\end{table}

\end{document}

A: This approach use tabulary for automatic linebreaks and  array to center headers and allow some space between rows. The font is reduced to   the the standard \footnotesize. I do not recommend scaling the tables as first alternative because the lack of consistency with the font size of other parts of the document. A document where each table has a different font size is simply appalling.

However, nothing of this can make miracles with poor designs. Almost always some change in the content is acceptable and allow fit the table much better: Is the column "Type" really necessary if it never changed? And "Story Points" instead of simply "Points"? etc.  Only you can said that, but if not, it could look better:

\documentclass{article} % Atenção: compilá-lo com xelatex ou lualatex
\usepackage{tabulary,booktabs,array}
\begin{document}

\begin{table}
\centering
\caption{My caption}
\footnotesize
\renewcommand\arraystretch{1.3}
\begin{tabulary}{\linewidth}{lLlm{3em}l}\toprule
\textbf{ID} & \textbf{Título} & \textbf{Tipo} & \textbf{Story Points} & \textbf{Responsável} \\
\midrule
1 & Elaborar a Introdução do Projeto & Atividade & 2 & Murilo \\
2 & Elaborar a Problematização, Solução Proposta e Justificativa & Atividade & 5 & Milton \\
5 & Estruturar Trabalho no Google Docs & Atividade & 2 & Murilo \\
7 & Ata da Reunião \#4 & Atividade & 1 & Murilo \\
8 & Publicações no Blog (Aula 21/08 e Reunião \#4) & Atividade & 1 & Caique \\
9 & Revisão da Proposta Inicial & Atividade & 2 & Murilo \\
12 & Elaboração do Burndown Chart & Atividade & 5 & Caique \\
15 & Setup do Ambiente & Atividade & 2 & Adriana \\
17 & Estudar Plug-ins de Análise Estática & Atividade & 2 & Adriana \\
20 & Pesquisar e Desenvolver Tutorial de JUnit & Atividade & 8 & Arion \\
21 & Desenvolver Esqueleto do Projeto no Spring Boot & Atividade & 2 & Adriana \\
24 & Integrar STS ao Code Convention do Google (GitHub) & Atividade & 3 & Milton \\
25 & Elaborar os RFs, RNFs e RNs & Atividade & 5 & Ivan \\
26 & Elaborar o DFD 0 & Atividade & 5 & Ivan \\
27 & Elaborar o DFD 1 & Atividade & 5 & Arion \\
28 & Elaborar o Caso de Uso Geral & Atividade & 3 & Milton \\
29 & Elaborar Modelagem de Dados & Atividade & 5 & Murilo \\
30 & Elaborar Identidade Visual da Aplicação & Atividade & 8 & Caique \\
32 & Recriar Vídeo de Apresentação & Atividade & 3 & Adriana \\
\midrule
\multicolumn{3}{r}{\textbf{Total de Pontos}} & \textbf{69} \\\bottomrule
\end{tabulary}
\end{table}

\begin{table}
\centering
\caption{My caption}
\footnotesize
\renewcommand\arraystretch{1.2}
\begin{tabulary}{\linewidth}{lLm{3em}l}\toprule
\textbf{ID} & \textbf{Título} &  \textbf{Story Points} & \textbf{Responsável} \\
\midrule
1 & Elaborar a Introdução do Projeto  & 2 & Murilo \\
2 & Elaborar a Problematização, Proposta e Solução  & 5 & Milton \\
5 & Estruturar Trabalho no Google Docs   & 2 & Murilo \\
7 & Ata da Reunião \#4   & 1 & Murilo \\
8 & Publicações no Blog (Aula 21/08 e Reunião \#4)   & 1 & Caique \\
9 & Revisão da Proposta Inicial   & 2 & Murilo \\
12 & Elaboração do Burndown Chart   & 5 & Caique \\
15 & Setup do Ambiente   & 2 & Adriana \\
17 & Estudar Plug-ins de Análise Estática   & 2 & Adriana \\
20 & Pesquisar e Desenvolver Tutorial de JUnit   & 8 & Arion \\
21 & Desenvolver Esqueleto do Projeto no Spring Boot   & 2 & Adriana \\
24 & Integrar STS ao Code Convention do Google (GitHub)   & 3 & Milton \\
25 & Elaborar os RFs, RNFs e RNs   & 5 & Ivan \\
26 & Elaborar o DFD 0   & 5 & Ivan \\
27 & Elaborar o DFD 1   & 5 & Arion \\
28 & Elaborar o Caso de Uso Geral   & 3 & Milton \\
29 & Elaborar Modelagem de Dados   & 5 & Murilo \\
30 & Elaborar Identidade Visual da Aplicação   & 8 & Caique \\
32 & Recriar Vídeo de Apresentação   & 3 & Adriana \\
\midrule
\multicolumn{2}{r}{\textbf{Total de Pontos}} & \textbf{69} \\\bottomrule
\end{tabulary}
\end{table}

\end{document}

A: In order to fit your table to the page width, one simple way is to use scalebox{}{} as follows:
\begin{table}[htb]
\centering
\caption{My caption}
\label{my-label}
\scalebox{0.8}{
\begin{tabular}{lllll}
\textbf{ID} & \textbf{Título} & \textbf{Tipo} & \textbf{Story Points} & \textbf{Responsável} \\
1 & Elaborar a Introdução do Projeto & Atividade & 2 & Murilo \\
2 & Elaborar a Problematização, Solução Proposta e Justificativa & Atividade & 5 & Milton \\
5 & Estruturar Trabalho no Google Docs & Atividade & 2 & Murilo \\
7 & Ata da Reunião \#4 & Atividade & 1 & Murilo \\
8 & Publicações no Blog (Aula 21/08 e Reunião \#4) & Atividade & 1 & Caique \\
9 & Revisão da Proposta Inicial & Atividade & 2 & Murilo \\
12 & Elaboração do Burndown Chart & Atividade & 5 & Caique \\
15 & Setup do Ambiente & Atividade & 2 & Adriana \\
17 & Estudar Plug-ins de Análise Estática & Atividade & 2 & Adriana \\
20 & Pesquisar e Desenvolver Tutorial de JUnit & Atividade & 8 & Arion \\
21 & Desenvolver Esqueleto do Projeto no Spring Boot & Atividade & 2 & Adriana \\
24 & Integrar STS ao Code Convention do Google (GitHub) & Atividade & 3 & Milton \\
25 & Elaborar os RFs, RNFs e RNs & Atividade & 5 & Ivan \\
26 & Elaborar o DFD 0 & Atividade & 5 & Ivan \\
27 & Elaborar o DFD 1 & Atividade & 5 & Arion \\
28 & Elaborar o Caso de Uso Geral & Atividade & 3 & Milton \\
29 & Elaborar Modelagem de Dados & Atividade & 5 & Murilo \\
30 & Elaborar Identidade Visual da Aplicação & Atividade & 8 & Caique \\
32 & Recriar Vídeo de Apresentação & Atividade & 3 & Adriana \\
\multicolumn{2}{r}{\textbf{Total de Pontos}} & \multicolumn{3}{r}{\textbf{69}}
\end{tabular}
}
\end{table}

The following images demonstrates0.8 and 0.5 scales of your original table:

However, using scalebox has severe drawbacks, such as running the risk of making the table undecipherable because the font is effectively too small.  Linear shrinking should be contemplated only as a last-resort, not as the first step.

redpajama_set_name: RedPajamaStackExchange


text:
Paterson residents dealing with surge in shootings in their neighborhood
Paterson law enforcement officials said some of the 1st Ward shootings may be connected to an ongoing dispute among street gangs in the ward.
Paterson residents dealing with surge in shootings in their neighborhood Paterson law enforcement officials said some of the 1st Ward shootings may be connected to an ongoing dispute among street gangs in the ward. Check out this story on northjersey.com: https://www.northjersey.com/story/news/paterson-press/2019/02/22/paterson-residents-deal-surge-shootings-their-neighborhood/2949998002/
Ed Rumley, Paterson Press Published 11:37 a.m. ET Feb. 22, 2019 | Updated 5:37 p.m. ET Feb. 23, 2019
PATERSON — Catalina Gomez said Paterson police officers have been stopping inside her 1st Ward liquor store several times a day ever since the business was the target of 17 gunshots recently.
Authorities also set up two large mobile streetlights at the intersection where the liquor store is located, North 6th and Clinton streets.
"We all dived to the floor," Gomez said, recounting the Feb. 17 shooting at Angel's Liquor and Grocery, an incident in which no one was wounded. "It was terrifying."
Since the shootings, Gomez closes the liquor store two hours earlier, at 7 p.m.
"We are losing money, but we'd rather save our lives," she said.
The shooting at Angel's was part of a surge in gun violence in Paterson's 1st Ward in 2019. Law enforcement officials said some of the shootings may be connected to an ongoing dispute among street gangs in the ward.
A portable police light fixture stands outside the scene of a recent shooting in Paterson's 1st Ward, Angel's Liqour & Grocery. (Photo: Ed Rumley/Paterson Press)
Through the first seven weeks of this year, there have been seven shootings that left eight people wounded in the 1st Ward, according to statistics compiled by Paterson Press. That's more than Paterson's other five wards combined.
During all of 2018, the 1st Ward had 10 shootings with 12 people wounded and one killed. The 1st Ward has also been the scene of at least five "shots fired" incidents – cases like the one at Angel's Liquor in which bullets hit businesses, homes or vehicles, but not people.
Paterson Police Chief Troy Oswald said city detectives are working on finding the shooters, and patrol officers have been ordered to pay special attention to areas where the shootings took place.
"We are making these shootings our number one priority," said Oswald. "We're addressing this with several different prongs."
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Councilman Michael Jackson, who represents the 1st Ward, said he and other area residents have noticed the increased police presence as well as the use of mobile lights and cameras.
"I just got a call from one woman who said she was grateful for the lights," Jackson said. "She said it's keeping people off the corners and making it a lot safer."
A couple of Paterson police vehicles were parked outside the Consuelo Mini Market on the corner of Belmont and North 9th streets on Thursday afternoon. Someone had fired five gunshots at that corner on Feb. 5 and then drove off in a car, authorities said. Some of the bullets hit a home.
Jose Alba, the mini market's manager, said he is afraid, "that someone will come in here with a gun and shoot me." The store used to stay open until 10 p.m., Alba said. But after the shooting, he closes by 7 p.m.
About a year ago, Alba said, a masked gunman had entered his store, pointed the weapon in his face and robbed him.
Jose Alba, manager of the Consuela Mini Market in Paterson's 1st Ward, with his son, Jose Alba Jr. (Photo: Ed Rumley/Paterson Press)
A 19-year-old woman inside another 1st Ward convenience store, the Temple Deli & Grocery, was wounded on Feb. 18 when shots were fired outside the business.
Outside the Temple Street bodega on Thursday, two sisters were pushing a metal cart home from a nearby grocery store.
"Since the shootings, I don't allow my children to walk to the store anymore," said one of the siblings, 33-year old Melissa Navarro. "I tell them that when they come home from school to go straight into the house. I hope they catch whoever did this."
Story continues below gallery
Shooting at Paterson Bodega
Paterson Police respond to a shooting at a deli on Temple St in Paterson on Monday February 18, 2019. Tariq Zehawi, Tariq Zehawi/NorthJersey.com
Navarro said she was wounded in the leg during a drive-by shooting in the neighborhood about three years ago.
Nearby, Carlos Merced was on the porch of his home on Temple Street, enjoying an unusually warm February afternoon. Merced, 55, said he has seen the neighborhood get more and more dangerous.
"Now, when I go outside, I am always looking behind my back," Merced said."You never know when a bullet is coming. This area is a hot spot."
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Corey Lynn
http://www.coreysdigs.com
Biden Scandals Are Rolling Out Like An Avalanche
Corey Lynn October 27, 2020
Bombshells are rolling out so fast on the Biden family corruption, that it's difficult to keep up with all of the scandals. While Giuliani, Bannon, and Lude Media have been exposing evidence from Hunter Biden's laptop, Matthew Trymand, Peter Schweizer, and Seamus Bruner have been unveiling additional corruption schemes that they have extracted from Bevan […]Read More
Down The Tube: Take A Stand With Fallen Patriot Accounts
Corey's Digs reported on the censorship taking place by big tech back in August, 2019: Controlling Minds, Narratives & Elections: Google, YouTube, Facebook & Twitter, and interviewed Google whistleblower Zach Vorhies on the Dig It! Podcast. Since then, the censorship has escalated dramatically, election interference being predominant, and a large amount of reporters and journalists […]Read More
SAS Legend Gives Preppers Food For Thought
By James Fitzgerald We live in a world where people wait in line for what is already theirs — food, water, and shelter. When the European immigrants landed on the shores of the American continent in the first wave of settlement in the 1600s, they quickly cast off the burdens of feudalism and adopted the […]Read More
Birds Falling from The Sky by The Hundreds of Thousands?
Over the past month there has been a lot of buzz about birds, but perhaps the most shocking news, was the story about "hundreds of thousands of birds, possibly millions" having fallen from the sky to their death. This story was picked up by local and major news sources, but with all of the distractions, […]Read More
Secrets and Scandals of the Vatican
> Speaker and Edge discuss the Pope, the Vatican, and the Catholic church. From the New World Order agenda, to the countless money scandals, the rampant pedophilia, and accusations of satanic practices within elements of the church, Speaker and Edge pack a lot into this one hour episode. When we take a step back to […]Read More
FACT CHECK: "It's a rosary that Biden wears that belonged
Corey Lynn October 8, 2020
The night of the first Presidential debate between President Donald Trump and former Vice President Joe Biden on September 29th created viral controversy over whether Joe Biden was wearing some sort of device on his left wrist, or the rosary from his deceased son Beau who passed away on May 30, 2015. The mainstream media […]Read More
The Curious Case of Trump's Illness Baffles Pundits Left and
By James Fitzgerald The world views US President Franklin D. Roosevelt as a renowned leader who steered America through the Great Depression and second world war, but during his tenure the public was scarcely aware that he was unable to walk unaided — after being struck by polio in 1921— and was wheelchair bound behind […]Read More
Voter Fraud Claims Add To Election Fever
Corey Lynn September 30, 2020
By James Fitzgerald There have been a flurry of articles about ballot fraud in the run up to the November elections, including several tweets by President Donald Trump on the matter. But what is the evidence for the tampering with or binning of voting slips and how widespread might it be? An explosive video featured […]Read More
Theories, Evidence, and Bombshells
Corey wraps up some vital evidence, incredible bombshells, and her theories on the battle for a vaccine, Trump vs Gates' strategies, mandates and restrictions, their long game, upcoming elections, and potential increase in riots, in this video. She connects and points to a lot of information that paints a bigger picture and indicates potential actions […]Read More
Why a COVID-19 Vaccine Likely Won't Happen Anytime Soon
Leave it to me to go against the grain again, but I have to call it like I see it, just as I have said for months that Hillary Clinton would never run for President again, despite nearly everyone declaring "she's running!" So once again, I'm going to call this like I see it, and […]Read More
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NPER (CURRENCY:NPER) traded 0.4% lower against the US dollar during the 1 day period ending at 20:00 PM ET on March 21st. One NPER token can now be purchased for about $0.0043 or 0.00000107 BTC on popular exchanges including DEx.top, Coinrail, Bibox and DDEX. NPER has a market cap of $297,407.00 and $30,301.00 worth of NPER was traded on exchanges in the last 24 hours. Over the last week, NPER has traded 21% lower against the US dollar.
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NPER uses the hashing algorithm. Its genesis date was January 11th, 2018. NPER's total supply is 218,999,990 tokens and its circulating supply is 68,927,451 tokens. The official website for NPER is nper.io/En. NPER's official Twitter account is @NPERproject and its Facebook page is accessible here. The official message board for NPER is medium.com/@NPERproject.
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Nation Current Affairs 27 May 2018 Amid risk of US sanc ...
Amid risk of US sanction, India, Russia conclude advanced missile deal
Published May 27, 2018, 4:43 pm IST
Updated May 27, 2018, 4:45 pm IST
Russia and India are likely to announce the deal before an annual summit in October this year.
The official said both Russia and India are likely to announce the deal before an annual summit between Prime Minister Narendra Modi and Russian President Vladimir Putin in October. (Photo: File)
New Delhi: India has concluded price negotiations with Russia for a nearly Rs 40,000 crore deal to procure S-400 Triumf air defence missile systems for the Indian Air Force, officials said.
They said the two countries are now trying to find a way out to evade the provisions of a US law that seeks to punish countries and entities engaged in transactions with the defence or intelligence establishment of Russia.
"The negotiations for the missile deal have been concluded. The financial component has been finalised," a top official involved in the negotiations for the deal with Russia told PTI.
The official said both Russia and India are likely to announce the deal before an annual summit between Prime Minister Narendra Modi and Russian President Vladimir Putin in October.
Two other officials said both sides are now looking at ways to insulate the deal from the sanctions announced by the US against Russia under its Countering America's Adversaries Through Sanctions Act (CAATSA).
The issue is understood to have figured during PM Modi's informal talks with Vladimir Putin in Sochi last week.
There has been mounting concerns in India over the US sanctions against Russian defence majors including Rosoboron export as billions of dollars of military purchases may be impacted because of the punitive measure.
The US had announced sanctions against Russia under the stringent law for its alleged meddling in the American presidential election in 2016.
CAATSA, which came into effect in January, mandates the Donald Trump administration to punish entities engaging in significant transaction with the defence or intelligence establishment of Russia.
US Defence Secretary Jim Mattis last month appealed to the Congress to urgently provide India the national security waiver, saying imposing sanctions under CAATSA for the S-400 air defence missile deal would only hit the US.
India wants to procure the long-range missile systems to tighten its air defence mechanism, particularly along the nearly 4,000-km-long India-China border.
In 2016, India and Russia had signed an agreement on the 'Triumf' interceptor-based missile system which can destroy incoming hostile aircraft, missiles and even drones at ranges of up to 400 km. S-400 is known as Russia's most advanced long-range surface-to-air missile defence system.
China was the first foreign buyer to seal a government-to-government deal with Russia in 2014 to procure the lethal missile system and Moscow has already started delivery of unknown number of the S-400 missile systems to Beijing.
The S-400 is an upgraded version of the S-300 systems. The missile system, manufactured by Almaz-Antey, has been in service in Russia since 2007.
Tags: air defence missile systems, narendra modi, vladimir putin, donald trump
Location: India, Delhi, New Delhi
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Matter of Opinion
Editorial Comics
Read a digital copy of the latest edition of The Spencer Magnet online.
Taylorsville Elementary School Students of the Month
Pictured are the Taylorsville Elementary School December Students of the Month. Pictured are Mackenzie Sego, Anthony Shelburne, Dustin Monroe, Dawson Moore, Kaitlyn Humphrey and Dylan Stone.
Top of the class: Achievement abounds in local education
Richards named to Bethlehem High honor roll
The following Spencer County students have been named to the honor roll for the first semester of the 2010-11 academic year at Bethlehem High School in Bardstown, Kentucky.
"A-B" Honor Roll: Grade 9 – Katherine J. Richards of Spencer County.
Locals named to Center College dean's list
The Far Middle: Salt truck budget cuts
CARTOON: The Far Middle
School Board considers drug testing
The Spencer County Board of Education is looking for ways to address drug usage in the schools and a random drug testing program at the high school could be a component used in those efforts.
Thieves target local schools
Six people, including three juveniles, have been arrested on charges related to break-ins at Spencer County High School and Taylorsville Elementary School.
Matthew Shake, 19, of Taylorsville, and three juveniles were charged with two counts of burglary and theft by unlawful taking of less than $500 for break-ins at both the high school and elementary school on Jan. 2-3.
School district's head lice policy could change
The Spencer County School District could have a new policy soon on how to deal with head lice, citing the old policy as being unjust and outdated.
School buses may have fenced home soon
Spencer County School District officials are considering fencing in a bus storage lot at the intersection of Main Cross and Back Alley that has been a point of concern for bus drivers and Spencer County Board of Education members.
At the November board meeting, member Sandy Clevenger discussed that several drivers approached her with issues relating to bus vandalism and safety, noting parked buses could not be locked and were subject to any pedestrians or vandals passing by the lot.
The Spencer Magnet is your source for local news, sports, events, and information in Spencer County, KY and the surrounding area.


Donna Fletcher Crow is the author of 43 books. She writes two contemporary mystery series, and an historical series. Glastonbury – A Novel of Christian England is her most well-known work, an epic historical novel centered around the Holy Grail.
CD: Donna, thank you for stopping by my blog for a chat. I believe we share one of life's great challenges – gardening in the semi-arid American West. Has your English garden survived the winter?
DFC: It's lovely to be here, Catherine! Oh, yes—not just gardening, but trying to grow an English cottage garden. My David Austin English roses are my favorites and I think they made it through the winter. Another challenge I have is that my garden is really too shady to be prime for roses, but I soldier on.
CD: The question I most want to ask is how you manage to write three mystery series: The Monastery Murders, The Lord Danvers Series, and the Elizabeth and Richard Mysteries? How do you find time to enjoy that fabulous garden?
DFC: Oh, time. Isn't that always the question! I love having three series to work on because that way I can have one with my editor, one in the incubating stage and one actively growing (hopefully) on my computer. And I enjoy the fact that, while they are all mysteries that include my love of history in some way and usually a good dash of romance, each one has a separate focus that indulges a different interest of mine: Celtic saints for the Monastery Murders, the Victorians for Lord Danvers which is Victorian true-crime, and English literature for Elizabeth & Richard which is literary suspense. And then when it all starts driving me crazy I go out and smell my roses.
CD: I am amazed at the variety of your work. Mystery, Historical, Romance, Children's Fiction, and Non-Fiction. If you only had room for three novels in your suitcase for a long trip (let's exclude The Bible, non-fiction, and assume you can't take an e-reader), which would you pack?
DFC: No contest—they would all be English mysteries.
CD: Can you tell us about the journey to your first published novel?
DFC: Brandley's Search (reissued as Where Love Begins) was my first novel. I had been overdosing on Georgette Heyer novels and one of her minor characters got hold of me and demanded that I continue his story. It was like being pregnant—I would wake up in the middle of the night and write; be driving down the road and have to pull over and make notes. I do wish all my novels would come like that.
Then I somehow managed to get it accepted by a small publisher who rather promptly went out of business (not my fault, honest). I was at a writers' conference when the word went around. I was sitting next to an editor. "They had my novel!" I wailed.
"Send it to us," she replied.
That first novel became a six-book series The Cambridge Chronicles and that editor even accompanied me on a research trip to England. All that was 30-some years ago and we still keep touch.
CD: With so many successful novels, most in series, has the excitement faded when a new book becomes published?
DFC: Never! It's always like a having a baby.
CD: Do you have any insights or opinions about the opportunities for beginning writers in the rapidly changing world of publishing?
DFC: What a Brave New World publishing is today! I love the opportunities available through electronic publishing and social media. Most of my older books are coming back as ebooks and that's just so exciting! The challenge is not to let it become too easy. We all need to keep rewriting, working with good editors and working to up our standard whether it's our first book or our 45th.
CD: How has your faith influenced your fiction writing? Is it a strain of soft music in the background of the story, or is it front and center?
DFC: The main influence has been in my choice of subject. My passion is the history of British Christianity so there will be an old monastery, a Celtic saint or a magnificent cathedral somewhere in any story I tell because that's what I love. I firmly believe that no matter what we write who we are will speak louder than our actual words. I hope my faith is that for my stories.
CD: Do you have a favorite character? Favorite setting? Favorite time period?
DFC: Felicity, the amateur sleuth heroine of my Monastery Murders is one of my favorite characters to work with because she has so much growing to do. Book 4 in the series is with my editor now and it's fun to see the progress she has made and the rough edges I still need to work on. Also, the fact that she's so hard-headed and impetuous is a great way to keep the plot going because her scrapes are always interesting—no matter how much they drive her loving, sensible Antony absolutely wild.
Anywhere in the British Isles is my favorite. Even The Daughters of Courage, my family saga set in the Idaho desert, works in a bit of English background.
Favorite time period is whichever one I'm working on at the moment, although I've always had a special drawing to the Regency, fed by my love of Jane Austen. I got to indulge this in A Jane Austen Encounter, the latest in my literary suspense series.
CD: Do all of your historical novels involve research? How do you keep track of research pertinent to a novel or series?
DFC: Absolutely. Research is the core of everything I write. I read everything I can find on my subject here, then head off across the pond to find the missing bits on-site in England. I try very hard never to write about a place I haven't visited. When in the field I make notes in spiral notebooks and take pictures. In the "old days" I then put things on 3x5 cards and kept them in index boxes. Now everything goes in folders on my computer.
CD: Thank you for visiting today, Donna.
Playful mystery featuring an engaging pair of amateur sleuths.
A letter, apparently from Jane Austen's great-niece, is at the heart of this entertaining literary mystery— the third volume in Donna Fletcher Crow's Elizabeth and Richard series. American academics Elizabeth and Richard Spenser are celebrating their 20th wedding anniversary with a trip to England to visit Jane Austen's various homes. Their first port of call is Bath, where Richard— thanks to his distinction as an Austen scholar— is invited to help sort through a box of documents donated anonymously to the city's Jane Austen Centre.
It's great fun— but just as entertaining as the mystery itself are the settings. Fletcher Crow brings Bath, Winchester and Chawton to vivid life in her pages, with a good helping of literary history and numerous references to Austen's writings that illuminate the narrative.
Catherine, it's lovely to be here with you in the Rocky Mountains. I love this opportunity to meet your readers. I also appreciated the personally crafted interview questions.
Certainly enjoyed one Donna's interview here & learning more about her writing journey. I admire her books!
Thanks for dropping by, Carole. I enjoy hearing about the journey of an author's first novel. Donna certainly had an interesting first! I have one of her books on my Kindle, and can't wait to start reading.
Hi Carole, how lovely to hear from you. Thank you for stopping by. Happy reading, Catherine. Hope you enjoy!


Rather than go thru the week 17 games, I thought it would be more appropriate to take a look back at the entire 2007 season. Where did we come from, how did it go, and where do we go from here? Whether you won your league, or finished somewhere in the doldrums, now is the time to reflect on the season and make some notes of what you should change for next year. That's right, take notes. Write it down somewhere so that you can refer back to it before draft day next summer.
By and large, the winning formula continues to involve grabbing 2-3 stud running backs in the first 4 rounds of your draft. Then grab a handful of backup RBs in the middle to late rounds and hope they become the starters. Yes, it is possible to win in other ways, but in nearly all of the leagues that I am involved in, the Champion ended up with three stud RBs in their starting lineup, a serviceable WR, and a QB that emerged from the lower part of the rankings on draft day. When the weather gets cold, the RBs rule the day. I know "a guy" that had a lineup that involved Chad Johnson, Andre Johnson, and Anquan Boldin. Some pretty good WRs to say the least (all three finished the year in the top 15 at their position). Alas, down the stretch this team faded away and missed the playoffs.
Speaking of those backup RBs, My Friends, this is where the gold mine is on draft day. While the other owners are bulking up on WRs that will never amount to anything, you should have been picking up backup RBs to stash on your bench. The laughter was deafening on draft day when I selected Travis Henry, but I think he ended up being a pretty good RB3. How about the performance of Ladell Betts and Maurice Jones-Drew down the stretch? Not bad.
Aside of the player appearing on the cover of Madden Football, there's no way to predict who will get hurt over the course of a season. We can do our best to guestimate which guys are prone to injury, but that's about it. Many publications, including ours had players like Lamont Jordan, Ronnie Brown, Willis McGahee, and Clinton Portis highly ranked, but their seasons ended prematurely (though we will discuss the entire Raiders offense a bit later).
Owners that had LaDainian Tomlinson were certainly riding high most of the season. What a year he had, almost singlehandedly carrying fantasy teams into the playoffs. Then came a major bump in the road in Week 16, "costing" Tomlinson owners the Championship. If they'd only been building some depth on their team while he was carrying them to win after regular season win. Yes, even fantasy sports is a team game.
This simply goes without saying. He started the year by telling us all that undrafted rookie Mike Bell was going to be "The Guy". Then after an exciting week one, Mike disappeared for the next 6 weeks with Tatum trying to carry the load. I say trying, because he never put up great fantasy numbers either. Then around week 10 it got real ugly, Shanahan not only wouldn't say who was starting, but he'd have guys not even dressed for no reason. If you banked on one of these guys on draft day, you know what I'm talking about. Normally Shanahan produced one stud RB, even if from RB5 on the draft day depth chart, this year that was not the case.
How else can you describe what went on in Oakland this season? Just a horrible disease that infected every player on the team. Sure, Lamont Jordan got hurt, but there's no rational explanation as to why Aaron Brooks and Randy Moss fell off the face of the fantasy earth. We can only hope that Art Shell's tenure at the helm is short lived.
Unless your name was Reggie Bush, then if you were a rookie running back in 2006, you didn't do that well. Yes, I know that Laurence Maroney had a couple of nice games, but he did not perform well enough to be worth a regular spot in your starting lineup. Many were touting guys like LenDale White, DeAngelo Williams, and Joseph Addai on draft day, but in the end these players were useless. You could even lump Cedric Benson into this category again this year. Until I see something from this guy, I'll be avoiding him as well. The young/rookie RBs rarely do well, it's the steady veterans like Thomas Jones that hold onto the starting jobs.
Sure, Peyton Manning had a pretty good season, though I'm sure his fantasy owners were expecting a bit more when they took a chance and drafted him in the first round of their draft. But if you look at the regular season numbers, it is guys like Drew Brees, Jon Kitna, Philip Rivers, and Vince Young that end up in the top 15 at their position. And say what you want about Michael Vick and Brett Favre, these guys ended up with some decent fantasy numbers as well. None of these guys were highly touted on draft day, in fact, many of them were probably not even selected on draft day. This is something I have been shouting to the hilltops for many years, waiting on QBs is a good fantasy strategy. Wait, then grab 3 around the 7th – 11th rounds of your draft.
Of course, the above discussion blows away the preconceived notion that a rookie/young QB cannot succeed. Even a QB going to a new team is often frowned upon, but Drew Brees ended up being the #2 QB right being Peyton Manning. Philip Rivers was very consistent, Vince Young not only threw the ball well, but ran effectively, keeping his fantasy numbers high. Even Tony Romo was a viable fantasy starter. I have no idea where I'm going with this discussion, just pointing out the facts. Maybe it's ok to have a young/rookie QB on your fantasy team, especially if the NFL team they are on are going to let him learn on the job and accumulate fantasy numbers.
Just to finally tie up the discussion on QBs, the waiver wire was a great place to pick up a starting fantasy QB once the season had begun. While I do recommend drafting backup RBs, I don't think it's a good idea to draft backup QBs. However, this is something to keep a very close eye on during the season. As mentioned above, Vince Young and Tony Romo ended up being viable fantasy starters, no doubt someone plucked them off your league's waiver wire and enjoyed the benefits.
2006 was an awful year for the Tight End. 2005 saw a renaissance at the position, where there were 15 or so players that were viable fantasy starters. This year, that was not the case. Guys like Randy McMichael and Chris Cooley were supposed to close the gap between the haves and have nots in the TE rankings. But the only thing that closed the rankings was that the guys in the top did not have dominating years. Sure, Antonio Gates, Tony Gonzalez, Kellen Winslow, Todd Heap, et.al. ended up at the top, but overall it was a down year for all TEs. Many, myself included thought there would be value at TE in the later rounds, this did not materialize either.
Many WRs performed up to expectations (ie. Marvin Harrison, Terrell Owens, Torry Holt). Many came out of no where to surpass expectations (ie. Marquis Colston, Mike Furrey, Lee Evans, Jerricho Cotchery). But when the winds of winter began to swirl around the NFL, the numbers overall at the WR position went way down. Even the guys that ended up near the top like Chad Johnson, Steve Smith, and Anquan Boldin, they mailed in some pretty crappy weeks. Consistency at the position was a rarity this season. Again, not sure where I'm going with this, just pointing out facts.
As is usually the case, pre-season kicker and defense rankings were not worth that much. There were plenty of lower ranked kickers that did well over the course of the season. And yes, Baltimore and Chicago had dominating defenses all season, but after them, there were some teams that did well on a week to week basis. One thing that I am coming around to, is that having two defenses on your roster, especially after the waivers have been closed, is a good thing. Many of the defenses that did well one week, did not do so the next week. Often the best fantasy defenses ended up being teams that were going up against bad offenses. Being able to play the matchups with defenses is a good thing, something to keep in mind for the upcoming season.
So what to take away from all of this? Many of the usual adages still hold true: stud RBs are gold, backup RBs that emerge are diamonds in the rough, QBs emerge during the season and can help your team, consistency at WR is hard to find do don't base your team around WRs. So in the end, coming out of draft day with a good base, paying close attention during the season by making key free agent acquisitions, and a little luck along the way in having your guys stay healthy is what brings home the trophy.