Sidelined by Allergies and Asthma – Blindsided by Dust Mites

 

Mites are one of the major indoor triggers for people with allergies and asthma. Dust mite exposure can even cause asthma.

http://www.lung.org/our-initiatives/healthy-air/indoor/indoor-air-pollutants/dust-mites.html

 

Discussing the fact that autoimmune disorders often accelerate biological aging led to a discussion of other disorders with similar consequences. The consensus was that the focus should be on chronic disorders as well as any other disorder that causes irreversible damage to the organs and systems of the body. It was clear that this would be a long list. It was also clear that those with autoimmune disorders might also be coping with any condition on the list.

 

While every issue on the list was deemed worthy of consideration, the discussion quickly started to focus on allergies, the relationship between allergies and asthma, and the significance of dust mite allergy. The information on dust mite allergies blindsided many participants. Many of the online sites that discuss dust mites sensationalize them as microscopic “monsters” that are found in almost every home, especially in the bed.

 

In some cases this is because the website is designed to sell anti dust mite products. In other cases it is simply an approach to increasing readership. Unfortunately, this approach grosses out many readers and they do not want to read anything else about dust mites or to even think about them.

 

For the majority of the population, those who are not sensitive or allergic to dust mites, ignoring the topic of dust mites may be a feasible plan of action. However, this is not a rational response for anyone who has respiratory allergies or asthma. For this smaller proportion of the population that has asthma or respiratory allergeries it is important to be educated about dust mites and to develop a plan for reducing their impact on health.

House dust mites (Dermatophagoides pteronyssinus) aggregate.
Scale : mite length = 0.3 mm
Technical settings :
– focus stack of 57 images
– microscope objective (Nikon achromatic 10x 160/0.25) on bellow

 

I found the Dust Mite page on the website of the National Lung Association (http://www.lung.org/our-initiatives/healthy-air/indoor/indoor-air-pollutants/dust-mites.html) to be very helpful. In just a few straight forward paragraphs the page defines dust mites and explains from where they come. It also discusses who should be concerned about dust mites and the steps that can reduce their presence in beds and in other places in the home. I recommend this page to anyone with a household member who has asthma or is sensitive to other respiratory allergens. In the second category I include people who have recurring episodes of nasal, sinus, and ear inflammation or infections as well as those who experience seasonal allergies.

 

For those with an interest in research literature and reports, I suggest the following as good places to start.

 

Calderon, M. A., Kleine-Tebbe, J., Linneberg, A., De Blay, F., Fernandez de Rojas, D. H., Virchow, J. C., & Demoly, P. (2015). House dust mite respiratory allergy: An overview of current therapeutic strategies. Journal of Allergy and Clinical Immunology-in Practice, 3(6), 843-855. doi:10.1016/j.jaip.2015.06.019 – http://www.sciencedirect.com/science/article/pii/S2213219815003335

 

Kanchongkittiphon, W., Mendell, M. J., Gaffin, J. M., Wang, G., & Phipatanakul, W. (2015). Indoor environmental exposures and exacerbation of asthma: An update to the 2000 review by the institute of medicine. Environmental Health Perspectives, 123(1), 6-20. doi:10.1289/ehp.1307922 – https://ehp.niehs.nih.gov/1307922/

 

Pomes, A., Chapman, M. D., & Wunschmann, S. (2016). Indoor allergens and allergic respiratory disease. Current Allergy and Asthma Reports, 16(6), 43. doi:10.1007/s11882-016-0622-9 – https://link.springer.com/article/10.1007/s11882-016-0622-9

 

 

 

 

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What and How Many Autoimmune Disorders Do You Have?

When you are interested in how autoimmune disorders speed biological aging, it is necessary to know what and how many autoimmune disorders are involved. It is also necessary to know the severity of the disorder(s) and the chronological age at the onset as well as what other health problems are involved. In this brief post I offer a few references that address how many health conditions are considered to be autoimmune disorders and the tendency for patients to have more than one autoimmune diagnosis.

What Autoimmune Disorders Do You Have?

The National Institute of Allergy and Infectious Diseases recognizes 80 different autoimmune diseases (https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases). The American Autoimmune Related Disease Association lists approximately 20 additional conditions ( https://www.aarda.org/research-report/), for a total closer to 100.

It is not difficult for an interested person to gain basic information about these diseases. In addition to pages linked above,  a good place for anyone to start is on the Medlineplus web page that is devoted to autoimmune diseases ( https://medlineplus.gov/autoimmunediseases.html).

This basic information will not make anyone an expert. Some of the descriptions are really poorly written. Some of them are older and use outdated terminology  Even so they can help to raise awareness that these are  serious and usually chronic -as in lifelong and incurable – conditions. They can be deadly. The person who is living with them cannot ignore them or the impact they have on chronological aging.

How Many Autoimmune Disorders Do You Have?

There is a well-established body of evidence cataloguing the co-occurrence of autoimmune disorders.

http://www.healio.com/rheumatology/rheumatoid-arthritis/news/print/healio-rheumatology/%7Bed6a292b-402b-402b-82ca-c2c2e9c01e3b%7D/staying-ahead-of-multiple-autoimmune-disorders

Over the years I have discovered that most people will not drop all of their autoimmune diagnoses into casual conversation. For example, even though people with lupus, people with rheumatoid arthritis (RA), and people with multiple sclerosis (MS) are all quite likely to have Hashimoto’s thyroiditis, they seldom mention it first. If you want to know how many autoimmune disorders are playing a role in their biological aging, you must ask.

When people have three or more autoimmune diseases at the same time, they are said to have multiple autoimmune syndrome or MAS. Some researchers are promoting the use of the term “polyautoimmunity” for the coexistence of autoimmune diseases that follow a specific  grouping pattern.

Adriana Rojas-Villarraga, Jenny Amaya-Amaya, Alberto Rodriguez-Rodriguez, Rubén D. Mantilla, and Juan-Manuel Anaya, “Introducing Polyautoimmunity: Secondary Autoimmune Diseases No Longer Exist,” Autoimmune Diseases, vol. 2012, Article ID 254319, 9 pages, 2012. doi:10.1155/2012/254319

A friend once said, “Autoimmune Diseases like to hang out together.” That statement sticks in my head. In Living Well with Autoimmune Disease: What Your Doctor Doesn’t Tell You …That You Need to Know (2002), Mary Shomon introduces the concept of “underlying autoimmunity.” Since there is no single medical specialist trained diagnose and treat all autoimmune conditions, this can be a very important point for anyone  who is dealing with autoimmune issues as well as those who have questions about the relationship between their chronological and biological ages.

While I tend to think that autoimmunity always speeds biological aging, the relationship between them can become extremely complex when different glands, organs, and/or organ systems are involved. When a person’s glands and organs are aging at different rates, chronological age ain’t nothing but an often irrelevant number.

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Chronic Inflammation Accelerates Biological Aging

This is not an attempt to review the research literature on the role of chronic Inflammation in biological aging. It is merely an attempt to point those with whom I have been discussing the issue toward relevant research literature.

It is widely known that chronic inflammation can speed age related functional decline even when it is low grade and asymptomatic. Low grade chronic inflammation can reduce the number of years during which a person is relatively free of disability and serious illness (Finch, 2007: Youm, 2013).

Autoimmune diseases ARE serious illnesses characterized by chronic inflammation. The span of a person’s life that is healthy comes to an end with the onset of autoimmune symptoms – which can precede the diagnosis by years.  The chronic inflammation associated with autoimmune illnesses can destroy organs and bring disability and/or death even in those who are chronologically young.

Systemic Lupus Erythematosus is often considered to be the “prototypic” autoimmune disease.   In the 1950s only 50% of those diagnosed with lupus survived for ten years. In the 21st century, the 10 year survival rate is around 90%.

As a consequence, more patients with SLE are reaching advanced ages. However, their biological age often exceeds their chronological age as they suffer from significant organ dysfunction due to accumulated tissue damage in kidneys, brain, lungs and the cardiovascular system, which predicts morbidity and mortality in SLE. Various manifestations associated with old age, such as cardiovascular diseases or increased susceptibility to infections, are often found within the heterogeneous clinical spectrum in SLE patients, either as sequelae of disease course or medication (van den Hoogen, L. L, et al. 2015, 2).

Finch, C.E. (2007). The Biology of Human Longevity – Inflammation, Nutrition, and Aging in the Evolution of Lifespans Burlington: Elsevier Science.

https://books.google.com/books/about/The_Biology_of_Human_Longevity.html?id=4rGOLEOC4mEC&printsec=frontcover&source=kp_read_button

van den Hoogen, L. L., Sims, G. P., van Roon, J. A., & Fritsch-Stork, R. D. (2015). Aging and systemic lupus erythematosus – immunosenescence and beyond. Current Aging Science, 8(2), 158-177. doi:CAS-EPUB-69078 [pii]

Pdf available from  

https://www.researchgate.net/publication/280537942_Aging_and_Systemic_Lupus_Erythematosus_-_Immunosenescence_and_Beyond

Youm, Y., Grant, R., McCabe, L., Albarado, D., Nguyen, K., Ravussin, A., . . . Dixit, V. (2013). Canonical Nlrp3 inflammasome links systemic low-grade inflammation to functional decline in aging. Cell Metabolism, 18(4), 519-532. doi:https://doi.org/10.1016/j.cmet.2013.09.010.

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Chronological, Biological, and Functional Age

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The Settling of Indian Ridge: Thinking

 

Last week I was asked an interesting question. “When was Indian Ridge founded?” I do not have a simple answer, at least partially because I don’t think that it was ever founded. Therefore, I set out to answer a different question. When did European and African descended people first settle on Indian Ridge? Once again, I have no simple straightforward answer.

In my attempt to arrive at an answer, I looked at several types of information. I looked at the original and updated federal surveys of the area. I looked at the dates that the first land patents were granted. I looked at the dates when nearby towns were founded. Finally, I looked at different versions of how Old Line Road came to be the boundary separating the land of the Choctaw from the land of the Creek. My references do not all agree and some of them are questionable. Therefore the purpose of this post is to start a conversation with those who have a better handle on the history of the area. Please offer corrections where my efforts go wrong.

Indian Ridge is located in Clarke County, Alabama. The current post office for Indian Ridge is Whatley, Alabama. Whatley appears to have been founded in 1897 (https://en.m.wikipedia.org/wiki/Whatley_Historic_District). This would be decades, if not entire centuries, after the first European and African descended people entered the area.

An earlier post office was located in Suggsville, Alabama which “is an unincorporated community in Clarke County, Alabama. It was laid out as a town in 1819 at the crossing of the Old Line Road and Federal Road (https://en.m.wikipedia.org/wiki/Suggsville,_Alabama).” Old Line Road is a central feature of Indian Ridge. 

This date is consistent with the 1820 date that the Bureau of Land Management gives for the sale of land that I would now consider to be part of Indian Ridge (https://glorecords.blm.gov/search/default.aspx). It is the St Stephens Meridian Township 8N Range 4E.

Search Results – BLM GLO Records

The original survey maps available from the Bureau of Land Management indicate that the survey of the area was completed in 1811. THESE FILES ARE VERY LARGE AND YOU WILL NEED TO BE PATIENT IN ORDER FOR THEM TO LOAD.

Plat_65065_1

Plat_65067_1

However, there were European squatters at Choctaw Corner by 1802-1803. It is quite likely – highly probable – that these squatters were accompanied by enslaved people of African descent.The presence of these squatters played a role in triggering the Creek War, also known as the Red Stick War. The dates of this War overlap those of with the War of 1812 at least partially because of the Red Stick Creek alliance with the British.

 

As a student living in other states, I was never required to learn much about the Creek or the Choctaw. I was definitely under the impression that African descended people did not reach that part of the Mississippi Territory that became my home until after the Indian Removal Act of 1830. In retrospect, I clearly did not give the issues the consideration they deserved.

I am now reading both early and contemporary histories of this area. My adult mind notices that African descended people are not mentioned in the early works and recognizes it to be an inaccurate presentation of history. My child mind was unsure. It sometimes thought that it was an inaccurate presentation and sometimes it concluded that the absence of African descended people from the discussion was a real historical absence. This is ironic because as a small child I was so fascinated by the Old Line Road historical marker that I learned to spell Andrew Jackson, Choctaw, and Creek before I learned to spell Creighton.

I found a marker provided by the DAR in 1938. It triggered a flood of questions that subsided once I moved out of the state.

Captain Andrew Jackson passed near the site of this marker on the Old Line Road north of U.S. 84. He and his troops rested here for the night in 1813. The marker was erected by Clarke Co. D.A.R.

There is a more recent marker (And Yes, I post both markers over and over again)

Old Line Road marker is located at the intersection of U.S. 84 and the Old Line Road, three miles east of Whatley. The road follows the watershed between the Alabama and Tombigbee Rivers and ends at Choctaw Corner; it was the dividing line between the Creek and Choctaw Indian lands as established about 1808. The marker was erected in 1978 by the Clarke County Historical Society.
http://clarkecountyal.com/historical-markers-and-sites/

There are some interesting stories about how Old Line Road became the boundary between the Choctaw and the Creek. The one repeated most often is that it was decided in 1808 by the outcome of two ballgames, one played by the men and one played by the women and both won by the Choctaw.

The initial Old Line was simply a trail. The Federal Road started out as a narrow one horse track for postal riders. By 1811, however, it was a road built from West to East, promoting travel in both directions, and migration largely from East to West. I am not claiming that all who came to Clarke County or to Indian Ridge were connected with the Federal Road. I am saying that its intersection with Old Line Road should probably not be ignored.

The chances are good that all who trace their ancestry to anywhere in Alabama south of the Tennessee Valley have a forebear who came over the Federal Road. During its period of maximum use, when “Alabama fever” was epidemic in the Carolinas and Georgia, the population of the territory (later, the state) increased by over half a million (Southerns and Brown, 1989, p.2)

I “suspect” that migrants might have started squatting on Indian Ridge in the early 1800s. The federal survey was completed in 1811. I have not been able to find any notes from the surveyors suggesting that they found settlers in the area. We know that the increasing size of the settler population coming over the Federal Road played a part in starting the Red Stick War which included battles close to Indian Ridge:between the Alabama and Tombigbee Rivers. By 1819 the nearby population was large enough for Suggsville to be laid out as a town. By 1820 settlers were definitely buying land on Indian Ridge from the federal government.

References

Ball, T. H.,. (1994). A glance into the great south-east = or, clarke county, alabama, and its surroundings, from 1540 to 1877. [Place of publication not identified]: Clarke County Historical Society.

Graham,John Simpson,,. (2012). History of clarke county. Westminster, Maryland: Heritage Books.

Hudson, A. P. (2010). Creek paths and federal roads: Indians, settlers, and slaves and the making of the American South. Chapel Hill: University of North Carolina Press.

Southerland, Henry deLeon., Brown,Jerry Elijah,,. (1989). The federal road through georgia, the creek nation, and alabama, 1806-1836.

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LUPANGEEZER falls and breaks brain again

My last bed included a box spring, an extra deep coil mattress with a pillow top, a 3 inch memory foam topper, and an extra inch or two from the topper cover. The bed was so high that I used a stool to climb up into it. There was a higher stoool for little giirls (at one point 5&6 thought of getting in and out of Grandma’s bed as a sport). Getting out of the bed was much easier and that was the point.

The arthritis on the right side of my body, including the sacroiliac and hip joints, is more advanced than on the left side. I have spent more than a decade trying to sleep on my back or my left side. However, once I fall asleep I end up on my right side. The pain of sleeping on my right side usually wakes me. I either adjust my position or get out of bed.

For years I have joked that older people get up so early in the morning because staying in bed is too painful. Heck that is why I am up so early today. I spent hours researching mattresses before I settled on latex. There will be no more motion transfer and no more feeling as though I am trapped in quicksand. I did make one big mistake. This firm is too firm. I am not sending it back. I am gonna order a softer latex topper.

But for now back to the night that my old bedding betrayed me. On the night in question my brain received a pain signal so strong that it responded with an order that I should turn over immediately and forcefully. It did not tell me to wake up, to think about my position in the bed, and to make my usual slow careful adjustments. The memory foam felt as though it were encasing my body and emphasized the need to move with power.

Because I was so close to the edge, I literally threw myself out of the bed. Because I was still asleep, the start of the fall felt as though​ it were taking place in a dream. There is no danger in a dream fall. I went with it. I did not wake up until the left side of my face and head made contact with the night stand. “Bam! This is not a dream.” Then the rest of my body twisted and hit the floor. The subfloor is concrete.

I pulled myself up and went into the bathroom. I did not see any blood and decided to spend the rest of the night in my recliner. The next day, I could see the swelling and bruising on the side of my face and head. I did not go to the emergency room immediately because I really dislike them. Feel free to think me stupid and to laugh. I am doing both. Just remember that an injured doesn’t work as well as it does when it is uninjured.

When you Bang your Brain you experience cognitive impairment. I did this in 2015. I remember part  a of the drill, including how much I hated concussion therapy. That is too much thinking for an injured brain. It is ready for a nap. But there is way too much sunlight in this bedroom. That may be contributing to the lupus flare. Gotta get some black out curtains up there.

To be continued ……

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Ancestry, Genealogy, and Identity: Bookmarking the Topic

Some days I believe that the most wonderful thing about retirement is that I can read on any subject that appeals to me. However, as a retired academic, I also appreciate the freedom that I have to stop reading on any subject without having to write a literature review or a grant proposal. I can explore a topic, decide that I have found what I need to know, and then move on. Sometimes I feel the need to leave a bookmark.

This blog represents a bookmark on the subject of my identity and ancestry. More specifically it is a bookmark on the fact that “Native American” is not a part of my identity and I have no problem with the ancestral origins estimates that I received from ancestry.com and Family Tree DNA. According to both reports 65% of my DNA is like that of people found in Africa and 35% is like that of people found in Europe. There is no mention of Native American in either report, not even a trace. (My daughter’s report on the other hand listed <1% Native American. I now refer to that as the “ubiquitous <1%.”)

I have thought about these test results and my reaction to them. Reading a blog post by TL Dixon helped me to organize my thoughts. Dixon writes, “Native American DNA is Just Not That into You” (http://www.rootsandrecombinantdna.com/2015/03/native-american-dna-is-just-not-that.html). After reading this post I understand that there are at least three possible explanations for why Native American DNA did not show up in my test results.

  1. It is possible that I have no Native American ancestor(s).
  2. It is possible that these two DNA tests have problems assigning Native American ancestry to my genome.
  3. My “full blooded” Native American ancestor lived so far back in time that their DNA has “washed out”.

I have looked at the options that Dixon offers for people who believe that their Native American DNA is hiding in the test. I am very new to genetic genealogy. I am just starting to use chromosome browsers. So many of these options need skills that I do not yet have. I am not motivated to put in the effort these options require. Hence the need for a bookmark.

I did not grow up with Native American ancestry as part of my family folklore. Not a single one of my kin keepers ever told me that I had Native American ancestry. I did not expect the test results to show Native American ancestry and I was neither surprised nor disappointed.

Influenced by articles like “The Great Migration and African-American Genomic Diversity”(http://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1006059), I have come to believe that

stopsign

 

…any Native American ancestor of mine lived so far back in time that they have washed out of my DNA and out of my identity. I JUST AIN’T THAT INTO NATIVE AMERICAN DNA.

Interacting with cousins about genealogy through social media, I have become keenly aware of the fact that many of them have socialization and life experiences that are different from mine. Some of them strongly identify with their Native American heritage. They put a lot of time and effort into finding their Native American DNA and they want the testing companies to do a better job. I think  Angelis Robinson-Smith presents this perspective poignantly in her blog post “Looking for me in the spit: DNA Testing” (https://angelissmith.com/2014/02/08/looking-for-me-in-the-spit-dna-testing/).

At this point I am more into the variations in our “identity” than I am into variations in our DNA. I don’t think like a genetic genealogist. I think like a sociologist. People who have paid attention to the recent rants in which I profess the importance of macro structural sociology will find this focus on identity amusing, if not hilariously funny. I just ask them to remember that I have always had a very strong interest in human development, including the development of self-concept and identity (I do tend to use the terms interchangeably).

My work as a Certified Family Life Educator and the strong emphasis that I have placed on training parent educators clearly reflect my interest in this area. To many people I am not a macro structural sociologist but rather the sociologist who promotes Effective Black Parenting and the Nurturing Parent Programs. There is no way for me to avoid considering the interplay between the increasing popularity of genealogy and identity development. In the end, I will probably write as much about group identity as personal identity.

Genealogy has become so popular that beginners like me can be overwhelmed not just by how much they need to learn but also by the massive amount of material in different media that offer to help them learn. I am going to take a break from reading about genetic genealogy by reading about identity and genealogy. I have reached a point where I would rather read Foucault than another attempt to explain the “autosomal X.”

I am starting with Paula Nicholson’s (2016) Genealogy, Psychology and Identity: Tales from a Family Tree (https://www.amazon.com/Genealogy-Psychology-Identity-Tales-family-ebook/dp/B01N6C3TAO). This work deals with the psychological impact of knowing about our ancestors.

In this book I explore why the growing, and apparently addictive, activity involved in tracing family histories informs our sense of who we are and our place in both contemporary culture, geographical and historical space.

This is a bookmark!

 

 

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01A NOVEMBER 02 IS VITAMIN D DAY

screenshot_2016-10-31-17-13-19-1

 

VISIT THE VITAMIN D DAY WEBSITE FOR INFORMATION AND RESOURCES.TAKE THE PLEDGE. JOIN THE EFFORT TO DEAL WITH THIS GLOBAL PROBLEM.

http://www.vitamindday.net

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I Definitely Got the History of Alabama “Wrong”

fb_img_1454934111987

In an earlier post, I stated that my family could not have settled on Old Line Road before the Indian Removal Act of 1830. I was definitely wrong about that. The Mississippi Territory became a part of the US in 1798. Some of my ancestors were probably there before the Great Migration 1798-1819 (http://mshistory.k12.ms.us/index.php?id=169). They were definitely there before Mississippi was granted statehood and Alabama became a separate territory in 1817.

This timeline reconfiguration requires that I rethink the importance of the interactions between the migrants and Native Americans. In retrospect the idea that Native American groups had gone on their “trail of tears” before my African ancestors started theirs is not just a flaw in my knowledge of the history but also a failure on my part to think like a sociologist. (If you are old enough to remember Ann Landers, then picture me beating myself with the “wet noodle” that she used.)

This article on the Slave Trail of Tears does an excellent job of connecting Richmond Virginia, where I have lived for the past 35 years,  to the Great Migration to the Mississippi Territory, including the location in Alabama where I was born.

http://www.smithsonianmag.com/history/slavery-trail-of-tears-180956968/
I have read more about the history of the Mississippi Territory in the past few months than in all of my first 69 years combined. My list of references has grown fairly lengthy and posting them here is definitely on my “to do list.” This post is my reminder and I will update to include reference list when that is practical.

What prompted this post was a chance encounter with one of the archaeologists who worked at VCU in 1994 when the human remains were found in the well on East Marshall Street on the health sciences campus. Yes, in 1994 VCU had  a program in historical archaeology. Historical archaeology and museum studies were important focal points in the first version of the degree in African American Studies.

It was these archaeologists who were initially called upon to determine if the skeletal remains were human. They also boxed and shipped some of the remains to the Smithsonian for additional authentication. Shortly after that the historic archaeology program ceased to exist.

Those of us who were working to design the new major, shifted gears and focused on first getting the major approved by the State Council for Higher Education for Virginia and then the establishment of the Department of African American Studies.   When Dr. Utsey became chair of the department these hard fought battles had been won and he was free to return to the subject of the remains found in the well.

http://emsw.vcu.edu/about/

The people around us looked on in astonishment as the archeologist and I jabbered loudly about the Defenders for Freedom, Justice & Equality and the Sacred Ground Historical Reclamation Project. We have great respect for how the community has worked on these projects.

http://www.sacredgroundproject.net

I have always wondered if any of my Mississippi and Alabama ancestors were sold to the West from Richmond’s Shockoe Bottom. I wonder if my kin were ever imprisoned in Lumpkin’s Jail. I wonder if VCU offers any courses on genetic genealogy? I ain’t volunteering and I ain’t instigating. I am just wondering.

I have been invited to come sit on the archaeologists’ front porch as I did when we were much younger. I know what I want to talk with about. As a working academic, especially while serving in an administrative position,  you learn not to bring up work you are not prepared to tackle. We retired folks just gonna rock, chat, and remember the good old days when even I could spend a hot summer day working in the field and then enjoy a Slurpee brain freeze while still dirt covered.

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02 How Much Vitamin D in Foods: Part 1 Fortified

 

THE NEW LABELS ARE COMING!!! They will cut down on your need to calculate percentages while increasing your need to understand the units of measurement.

http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm

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