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Keokuk III YTB-771 - History

Keokuk III YTB-771 - History



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Keokuk

III

(YTB-771: dp. 270; 1. 109'; b. 31'; dr. 14; cpl. 12)

The third Keokuk (YTB-771) was launched 21 May 1964 by the Mobile Ship Repair Inc., Mobile, Ala.; and placed in service 4 September 1964, Chief Boatswain's Mate Jerry R. Richter in command. She serves in the Norfolk area as a tug.


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The First Official Memorial Day
Saturday, May 30, 1868
In 1868, Commander in Chief John A. Logan of the grand Army of the Republic issued what was called General Order Number 11, designating May 30 as a memorial day. He declared it to be "for the purpose of strewing with flowers or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village, and hamlet churchyard in the land."
General John A. Logan's Memorial Day Order

General Order
No. 11
Headquarters, Grand Army of the Republic
Washington, D.C., May 5, 1868

I. The 30th day of May, 1868, is designated for the purpose of strewing with flowers or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village, and hamlet churchyard in the land. In this observance no form or ceremony is prescribed, but posts and comrades will in their own way arrange such fitting services and testimonials of respect as circumstances may permit.

We are organized, comrades, as our regulations tell us, for the purpose, among other things, "of preserving and strengthening those kind and fraternal feelings which have bound together the soldiers, sailors, and marines who united to suppress the late rebellion." What can aid more to assure this result than by cherishing tenderly the memory of our heroic dead, who made their breasts a barricade between our country and its foes? Their soldier lives were the reveille of freedom to a race in chains, and their death a tattoo of rebellious tyranny in arms. We should guard their graves with sacred vigilance. All that the consecrated wealth and taste of the Nation can add to their adornment and security is but a fitting tribute to the memory of her slain defenders. Let no wanton foot tread rudely on such hallowed grounds. Let pleasant paths invite the coming and going of reverent visitors and fond mourners. Let no vandalism of avarice or neglect, no ravages of time, testify to the present or to the coming generations that we have forgotten, as a people, the cost of free and undivided republic.

If other eyes grow dull and other hands slack, and other hearts cold in the solemn trust, ours shall keep it well as long as the light and warmth of life remain in us.

Let us, then, at the time appointed, gather around their sacred remains and garland the passionless mounds above them with choicest flowers of springtime let us raise above them the dear old flag they saved from dishonor let us in this solemn presence renew our pledges to aid and assist those whom they have left among us as sacred charges upon the Nation's gratitude,--the soldier's and sailor's widow and orphan.

II. It is the purpose of the Commander-in-Chief to inaugurate this observance with the hope it will be kept up from year to year, while a survivor of the war remains to honor the memory of his departed comrades. He earnestly desires the public press to call attention to this Order, and lend its friendly aid in bringing it to the notice of comrades in all parts of the country in time for simultaneous compliance therewith.

III. Department commanders will use every effort to make this order effective.
By command of:
JOHN A. LOGAN,
Commander-in-Chief.
N. P. CHIPMAN,
Adjutant-General.


Keokuk III YTB-771 - History

JOHN RUBY, born 1795 in KY, died 1870 Keokuk Co., IA
Married Elizabeth B. MILLER d. 09/16/1858 age 52yr

CHILDREN of John & Elizabeth Miller Ruby :
[1]Catherine RUBY b. 03/01/1825 - d.?
..+ Adam BALLARD
. [i] Milton BALLARD
. [ii] Elias BALLARD
. [iii] Jordan BALLARD
. [iv] Caroline BALLARD
. [v] Mary BALLARD
. [vi] John BALLARD
. [vii] Adam,Jr. BALLARD
[2]Sarah Ann RUBY b. 1830 - d. 12/22/1883 - m. 12/07/1854 Keokuk Co., IA.
..+ John Pierson SMITHART b. 1827 KY. - d. 08/20/1899
. [i] Milas Elvin SMITHART b. 10/24/1855 - d. 07/24/1923
. + Josehine GARDNER
. [ii] Harvey SMITHART b. 01/19/1858 - 05/1858
. [iii]
. (1) Russell SMITHART b. 03/1860 IA. - d. 06/08/1922
. [iv] Louis Russell SMITHART b. 1860 - d. 06/08/1922
. + Sarah J. REINIER
. [v]Perry Marshall SMITHART b. 11/04/1863 - d. 03/02/1929
. [vi]Norris Leonard SMITHART b. 1864 - d. 1940
. + Lora J. QUICKSAND
. [vii]Filando Wooden SMITHART b. 1868 - d. 1943
. + Lydia DOBBS
. [viii]Millie SMITHART b. 1870 - 06/16/1916
. + Sam BUTLER
[3]William R. RUBY b.? - d.?
..+ 1st. wife UNKNOWN
..+ 2nd. wife Emily J. SMITHART m. 09/26/1899
[4] Miles RUBY
[5] John RUBY, Jr. b. 1840 - d. 04/18/1914 - m. 11/24/1859
. + Jane WEBB
. [i] Susan Samantha RUBY
. + William Ellis PIERCE

Source: Contributed in 1999 by Dianne Underwood.


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SETHNESS ROQUETTE is Caramel Color

Since 1880, Sethness Products Company has been specializing in the production of the highest quality Caramel Color. Through five generations of family ownership, we have strived to provide our global customers with the best Caramel Color for their unique applications.

Over the years, Sethness has greatly expanded our global manufacturing capacity:

  • 1880 Charles O. Sethness acquires a Chicago building and establishes the Sethness Products Company
  • 1940 Sethness moves the U.S.A. manufacturing plant to Keokuk, Iowa
  • 1965 Sethness constructs the world’s largest Caramel Color facility in Clinton, Iowa
  • 1995 Sayaji Sethness plant is constructed in Ahmedabad, India
  • 2005 Sethness-Roquette opens plant in Merville, France
  • 2011 Sethness-Roquette China opens in Lianyungang, China
  • 2018-2019 Roquette acquires Sethness Products Company and rebrands us as SETHNESS ROQUETTE.

Roquette shares the values of product excellence and long-term vision, as for almost 140 years Sethness solely focused on the production of caramel color and offers the highest-quality products on the market today. SETHNESS ROQUETTE provides a large selection of caramel colors (in liquid and powdered forms) as well as a variety of clean-label caramel color options (non-GMO, certified organic, gluten-free, allergen-free, etc.).

Chuck Sethness, Representative of the Sethness family: “For about 140 years, our family-owned company has strived to offer the highest quality caramel color products to the most recognized players in the Food & Beverage industry. I am pleased that Roquette, a Group with which we share common values and a long-term vision, will now continue to leverage on the strong assets of both companies to reinforce its relationships with clients for the benefit of consumers globally.”

SETHNESS ROQUETTE, the world leader in caramel colors, was founded in 1880 to specialize in just that – the production of the highest quality caramel colors. Today, with expanded manufacturing capabilities producing a broader range of products in the United States, France, India and China, SETHNESS ROQUETTE is one of the very few caramels suppliers with a global industrial footprint.

Always empowered by strong family ownership, (first with the Sethness family and, since 2018, with the Roquette family) we strive to support the long-term growth of our customers around the world. To continue our strong focus on caramels and our customers’ specific requirements, SETHNESS ROQUETTE operates as a strong and independent unit within the Roquette Group, a global leader in plant-based ingredients and a pioneer of new vegetal proteins. We are dedicated to the art and science of making caramels and developing formulations to better fit our customers’ needs. Our teams use a wide range of natural raw materials and put years of experience and expertise to work to create the colors, flavors and textures that go into producing the highest quality caramels in the world. We are SETHNESS ROQUETTE.


USS Keokuk , a 677-ton ironclad, was built at New York City. Originally named Moodna (sometimes incorrectly spelled "Woodna"), she was renamed prior to her December 1862 launching, and was commissioned in early March 1863. Keokuk arrived at Port Royal, South Carolina, later in that month to take up her duties with the South Atlantic Blockading Squadron.

On 7 April, she joined USS New Ironsides and seven monitors in an attack on Fort Sumter, centerpiece of the formidible defenses of Charleston, South Carolina. Under the fire of heavy Confederate guns for more than half an hour, Keokuk was struck by about ninety projectiles, many of which hit at or below her waterline. Her experimental armor, featuring alternating rows of wood and iron, was completely inadequate to protect her from this onslaught and she was "completely riddled". Though Keokuk was able to withdraw and anchor out of range, she sank on the morning of 8 April 1863, after about one month of commissioned service.

This page features all our views of USS Keokuk and provides links to views related to her activities.

Watercolor by Oscar Parkes.

Courtesy of Dr. Oscar Parkes, London, England, 1936.

Engraved reproduction of an artwork by R.G. Skerrett, 1901.

Drawing by Fred S. Cozzens, published in "Our Navy -- Its Growth and Achievements", 1897, depicting the ship at sea during the Civil War.

Lithograph by T. Bonar, New York, depicting the ship while she was under construction at the Jeronemus S. Underhill Dry Dock & Iron Works, New York City, shortly before her 6 December 1862 launching.

Hand-tinted copy of a line engraving published in "Harper's Weekly", 1863, depicting the ship on the building ways at the J.S. Underhill shipyard, New York City, at about the time of her 6 December 1862 launching.

Courtesy of the U.S. Navy Art Collection, Washington, D.C.

Line engraving published in "Harper's Weekly", 1863, depicting the ship on the building ways at the J.S. Underhill shipyard, New York City, at about the time of her 6 December 1862 launching.

The following views are relatively inaccurate depictions of Keokuk 's appearance:

Line engraving published in "Harper's Weekly", 23 August 1862, roughly depicting the ship's intended appearance. Designed by Charles W. Whitney, she was then under construction at New York City.

Line engraving published in "Harper's Weekly", 1862, giving a very rough depiction of the ship's intended appearance. She was originally named Moodna , but was renamed Keokuk while under construction.

Line engraving published in "Harper's Weekly", 1862, depicting several contemporary U.S. Navy ironclad and conventional warships. They are (from left to right: Puritan (in the original twin-turret design) Catskill Montauk , Keokuk (citing her original name, "Woodna") Passaic Galena (behind Roanoke , with name not cited) Roanoke Winona New Ironsides Naugatuck Brooklyn and Monitor .

The following pictures feature a small image of Keokuk within a view of another subject:


  • acquire the knowledge, attitudes and interpersonal skills to help understand and respect self and others
  • make decisions, set goals and take actions to achieve goals
  • understand the consequences of and accept responsibility for personal behavior
  • complete high school with the academic preparation essential to choose from a wide range of substantial postsecondary options, including college
  • understand the relationship of academics to the world of work, and to life at home and in the community

Hypermobile Ehlers-Danlos Syndrome: Clinical Description and Natural History (for Non-experts)

Hypermobile type Ehlers-Danlos syndrome (hEDS) is the most common subtype of the Ehlers-Danlos syndromes (EDS) and possibly the most common of all hereditary disorders of connective tissue (HDCT). The new EDS classification system replaces the diagnosis of Ehlers&ndashDanlos syndrome Type III/ Ehlers&ndashDanlos syndrome Hypermobility Type (EDS-III / EDS-HT) and joint hypermobility syndrome (JHS).

Many people who were previously assigned a diagnosis of EDS-III, EDS-HT, or JHS will meet the criteria for hEDS some will instead be classed as having Hypermobility Spectrum Disorders (HSD). The new criteria for hEDS are stricter now, intended for a more consistent and targeted identification, in the hopes of aiding a greater understanding of the cause(s) and course (natural history) of the disorder. With stricter criteria there is a greater chance of finding the specific reasons why and how disease comes about. With greater understanding comes a better chance of positive changes for those with hEDS: fostering highly targeted research, achieving successful disease management, and ultimately maximizing quality of life for people with hEDS.

hEDS is mainly identified by generalized joint hypermobility (GJH), additional joint issues, and obvious skin signs, which are less severe than those seen in Classic EDS (cEDS) or Vascular EDS (vEDS). hEDS is more than &ldquojust GJH&rdquo plus a few items from a checklist of findings. In order to best understand the nature of hEDS, people with hEDS and those caring for them must become familiar with the disorder.

Prevalence of hEDS: EDS occurs in at least 1 in 5000 of the population, 80&ndash90% of which could be cases of hEDS.

Accurate estimates for the occurrence of hEDS are lacking, but a minimum of 1 in 5,000 people are thought to have EDS, 80&ndash90% of which are cases of hEDS. High estimates under the previous classification system give figures suggesting up to 2 million people in the UK, 10 million in the USA, 17 million in Europe, and 255 million worldwide have hEDS. The new classification of hEDS is more selective, so figures will be lower than previously reported.

Genetics: We have a lot to learn about the underlying genetics of hEDS.

At present, no single gene mutation causing hEDS has been identified. hEDS is likely to be caused by many different genetic changes. With the stricter classification of hEDS and more in-depth genetic studies, additional hEDS-related genes should be identified. Identification of genetic causes for hEDS may lead to it being further broken down into specific named hEDS subtypes, or perhaps lead to hEDS being redefined or replaced by multiple new specific EDS types, in a manner similar to how classical-like EDS (clEDS) has been defined as a new EDS type due to the genetic cause being identified.

hEDS has a roughly 50% chance of being passed on to each child (autosomal dominance), but other patterns of inheritance may explain this disorder in certain families. hEDS inheritance is somewhat difficult to analyze, as hEDS may be mild during much of life, or compared to close relatives with the disorder, or may even appear to &ldquoskip&rdquo a generation. This may be in part because JH is heavily influenced by age, gender, and weight. The reason for a perceived excess of females remains poorly understood, but may come down to sex hormones having a greater influence upon JH. The best way to describe hEDS is as an autosomal dominant disorder influenced by age and gender, with symptoms more common in females.

Natural History: What happens to people with hEDS?

If a person has hEDS, it will likely affect them in different ways throughout their lifetime, and the person may be diagnosed with many other conditions known to occur in those with hEDS. For example, three disease phases were proposed in a 2010 study: a &ldquohypermobility&rdquo phase, a &ldquopain&rdquo phase, and a &ldquostiffness&rdquo phase. Alternatively, existing studies have led to speculation that there is a natural transition from EDS-HT to GJH with age.

Existing studies show that children with hEDS who experience pain will be more likely to have pain limited to lower limbs (e.g., &ldquogrowing pains&rdquo) and pain caused by repetitive tasks such as handwriting in the school setting. Children with hEDS may have poor coordination. The &ldquopain&rdquo phase is often accompanied by diagnosis with fibromyalgia or other long-term (chronic) pain conditions and perhaps chronic fatigue, typically starting in the second to fourth decade and accompanied by chronic pain, headaches, digestive system disorders, among others. The &ldquostiffness&rdquo phase is seen in only a few persons, and, unfortunately for them, the symptoms of the &ldquopain&rdquo phase may persist and escalate, functionality may overall be significantly reduced.

Conditions Often Occurring in Persons with hEDS

Pain: Yes, hEDS CAN cause significant pain!

Uneducated doctors all-too-often make emphatic statements such as, &ldquoEhlers-Danlos syndrome cannot cause pain!&rdquo In fact, while hEDS does not necessarily cause significant pain for every person meeting diagnostic criteria, many with hEDS will develop significant pain for some portion of their lives. Any doctor who invalidates the fact that hEDS can cause significant pain may have a profoundly negative impact, not only upon the success of the relationship between clinician and patient, but also upon the quality of life of those with hEDS.

Health practitioners need to understand that the occurrence of significant pain for many persons with hEDS is well-supported in the literature and has logically proposed or proven cause. In fact, joint/muscle pain in two or more limbs (recurring daily, &ge 3 months) and long-term widespread pain (&ge 3 months) are specifically considered as a part of the criteria for diagnosis of hEDS.

Skin and Connective Tissue: People with hEDS do NOT have to have profoundly stretchy skin!

Most notably, in hEDS, the degree of softness, stretchiness, fragility, bruisability, and poor wound healing of skin differs from &ldquonormal&rdquo subjects but is mild in comparison to other types of EDS. Clinicians who are not up to date on the classification of EDS types often expect that all EDS types demonstrate severe skin changes, such as those observed in persons with cEDS and vEDS. Mild skin stretchiness (rather than severe) is clearly considered as a systemic manifestation in the criteria for clinical diagnosis of hEDS.

Stretch marks are not inevitable in hEDS, however, they often appear in persons with hEDS during adolescent growth spurts and are not necessarily due to rapid weight gain. The absence of stretch marks should not argue against a diagnosis of hEDS. Other tissues which may fail in hEDS include the protective coverings around organs. Weakness in this connective tissue in hEDS often results in hernia (tissues or organs pushing through). Hernias may also be more likely in persons with hEDS who undergo abdominal surgery, such as laparotomy or C-section.

Fatigue: Chronic fatigue is one of the most common complications among persons with hEDS.

Chronic, debilitating fatigue is common in hEDS, and such fatigue has significant impact on mental and physical function and ultimately on quality of life. Those with hEDS will often meet the criteria for chronic fatigue syndrome (CFS). Under no circumstances should a diagnosis of CFS to a person who also meets criteria for hEDS mean that hEDS should be disregarded. hEDS is considered to be a specific cause of chronic fatigue, while CFS is considered a syndrome with unknown cause in this case the diagnosis of CFS would more appropriately called into question.

Cardiovascular: While conditions of the heart and blood vessels can occur with hEDS, they are not usually life-threatening, but deserve individual consideration.

Heart and blood vessel conditions occurring in hEDS include heart valve and vessel dysfunction including mitral valve prolapse (MVP) and aortic root dilation. Problems with blood pressure and heart rate can also occur including postural orthostatic tachycardia syndrome (POTS), neurally-mediated hypotension (NMH), and orthostatic intolerance. Those having blood pressure changes may also experience near-fainting or fainting episodes.

Gastrointestinal (GI) Disorders: Digestive system problems occur with high frequency in hEDS.

As many as 75% of people with hEDS are likely to encounter problems with the function of their digestive system in their lifetime. Problems can occur anywhere along the digestive system, including the mouth and throat (e.g., chewing and swallowing) in addition to the functions of the rest of the GI tract. Disorders include poor movement of material along the tract, reflux, heartburn, abdominal pain, bloating, irritable bowel, diarrhea, constipation, or incontinence. Structural problems occur at a higher rate in those with hEDS than in the general population including hernias, internal organ displacement, and rectal prolapse. The relationship between all structural abnormalities and hEDS requires further study.

Dysautonomia: &ldquoFight or Flight&rdquo and &ldquoRest and Digest&rdquo function poorly for a majority with hEDS.

An extensive body of literature clearly indicates frequent problems with involuntary bodily functions (dysautonomia) in hEDS. Problems with involuntary body functions can lead to fatigue, dizziness, fainting, memory changes, poor concentration, reduced sweat production, changes in gut movement, bladder dysfunction, and/or certain psychological traits. Dysautonomia can be a devastating manifestation of hEDS, and, for some patients, it affects their quality of life more profoundly than joint instability, pain, or any other part of the disorder.

Bone Density: Existing evidence does not clearly indicate that hEDS is expected to cause low bone density or increased risk for fragility fractures. Carefully designed research is needed.

While existing studies have suggested a link between various EDS types and conditions such as osteoporosis (low bone density) and osteopenia (low bone mineralization), those with EDS often have a significantly reduced level of activity, and, rather than any alteration in bone density or mineralization being directly attributable to EDS, alteration in bone density or mineralization should be considered to be a direct result of reduced activity. Bone health should not be ignored in hEDS.

Osteoarthritis: Yes, hEDS increases the susceptibility of joints to osteoarthritis.

Osteoarthritis (a breakdown of joints) has been described in the literature as a possible long-term consequence of JH for decades. Since JH is a hallmark feature of hEDS, and JH is recognized to cause osteoarthritis, then hEDS would logically be expected to predispose many of those with the disorder to osteoarthritis. By the same token, osteoarthritis is by no means universal for all persons with JH, so it should NOT be expected to be inevitable for all people with hEDS.

Headaches: hEDS may lead to severe or debilitating headaches for a multitude of reasons.

Headaches in general, as well as migraines in particular, are known to occur more frequently in persons with EDS than in the general population. Headaches in hEDS are considered to have many causes, with potential mechanisms including instability, strain, or muscle spasms in the neck, jaw joint dysfunction, and/or medication side effects. The headaches vary in type and severity among all persons with hEDS who have headaches. Some find headaches to be the most disabling manifestation of hEDS.

Temporomandibular Joint and Dental Issues: Dentists, Orthodontists, and Oral Surgeons may be the first to consider a diagnosis of hEDS.

A hypermobile jaw joint is more likely to show dysfunction than a non-hypermobile jaw. Those with hEDS and jaw joint dysfunction often have sounds, locking, dislocation, grinding teeth, and headaches in the temple.

Mouth manifestations of hEDS may include fragile gums which bleed easily, gum recession, gum disease, small or absent frenula (small connective flaps between the front gums and lips), pointed and deep teeth, shortened roots, abnormal enamel, tooth fractures, ineffective dental anesthesia, and rapid orthodontic correction (and rapid return without orthodontia).

Spine: It is difficult at times to determine whether a person with hEDS would benefit from surgery, and, even when surgery is necessary, it doesn&rsquot always solve everything.

People with hEDS may have neck pain, difficulty walking, numbness and tingling of the hands and feet, dizziness, swallowing difficulties, and changes in speech. These people are more likely to have signs of looseness or instability around the head and neck. In many cases, these symptoms are not entirely attributable to head and neck dysfunction: symptoms may still persist after successful surgery.

Abnormal spine curvature is common in people with hEDS, in a large part due to a combination of structural and functional abnormalities in the supporting tissues of the spine. Conservative management will ideally allow avoidance of surgery.

Gynecologic Issues: Women with hEDS may experience heavy periods or painful intercourse.

Pelvic Dysfunction: It is unclear whether hEDS alone predisposes women to pelvic dysfunction or how much of a role childbirth plays.

While the existing literature suggests that pelvic floor problems including urinary incontinence or uterine, rectal, or bladder prolapse are common to hEDS, many studies did not control for childbirth history, and included various EDS types.

Pregnancy and Childbirth: No studies to date recommend against pregnancy and childbirth based simply upon a diagnosis of hEDS.

While some studies of women with EDS-III/EDS-HT and JHS suggest increased rates of infertility, pregnancy losses, and premature births, other studies did not. In the case of studies regarding premature birth, the study group included women with Classic EDS. One of the most thorough studies prior to the current EDS classifications suggested similar measures of fertility.

When it comes to how pregnancy affects symptoms of hEDS, it goes like this: some get worse, some don&rsquot change, and some get better during the pregnancy. When it comes to labor, rapid labor is thought to occur in more than 1/3 of deliveries. The most considerable complications related to labor and delivery thought to occur at a significant rate in women with hEDS include bleeding during or after birth, as well as abnormal scarring from C-section or episiotomy. In general, no studies to date recommend against pregnancy and childbirth based simply upon a diagnosis of hEDS in the absence of any other factors.

Urinary System: hEDS may predispose children to urinary incontinence, urinary tract infections, vesicoureteral reflux, and voiding dysfunction.

Sleep Disturbance: Patients with hEDS may feel particularly tired.

People with hEDS often experience significant sleep deprivation. Going without healthy, restorative sleep can lead to any combination of significant health problems such as impaired immune response, poor muscle coordination, and higher perception of pain, as well as problems with memory and thought processes (e.g. &ldquobrain fog&rdquo), moodiness, depression, and anxiety. Some with hEDS carry formal diagnoses of additional conditions such as restless leg syndrome or sleep apnea.

Mast Cell Activation Disorder: Current understanding of mast cell activation syndrome (MCAS) in hEDS is limited.

Mast cell activation syndrome is an immune condition that can create allergy-like symptoms, up to and including anaphylaxis. More research is needed to see whether MCAS is a condition that occurs with greater frequency in hEDS than in the general population and how it affects a person with hEDS and the management.

Psychiatric: hEDS is not in the psyche, it is in the connective tissue, but it can affect the psyche.

Many with hEDS are assigned psychiatric diagnoses or frankly ignored when clinicians fail to recognize that they meet diagnostic criteria for hEDS. Clearly, this leads to a failure in attempts to effectively care for the person with hEDS. It is important to realize that psychological conditions (e.g. anxiety or depression) are common in chronic conditions including hEDS. Ignoring significant coexisting psychological problems will lead to suboptimal treatment.

Quality of Life: Studies to date consistently suggest that hEDS adversely affects quality of life.

Carefully designed studies have clearly demonstrated that quality of life is often measured or reported as lower in people with EDS than in the general population&thinsp&mdash&thinspin particular, people with EDS and associated secondary issues such as digestive system disorders, anxiety, depression, physical pain.

Management

Recognizing hEDS is only half of the battle. Diagnosis alone is not enough. As with any disorder, effective management of hEDS includes recognizing its complexity. A body of evidence-based standards of care exists and includes the efforts of multiple healthcare practitioners. Management of hEDS must follow established standards of care and include treatment of both immediate and long-term issues as well as focusing on preventative care.

Clinicians, particularly surgeons and anesthesiologists, caring for a patient with hEDS should familiarize themselves with the management standards as they appear in the full publication (http://bit.ly/2017hEDS).

Key points for management of conditions in hEDS include:

  • The approach should be holistic focusing on the complications, the desire(s) of the patient, quality of life and functionality, as well as psychological aspects.
  • Results should not be expected overnight: It often takes months of routine toning exercise to stop deterioration, and it may take years before substantial reduction in pain is recognized. Fatigue, like pain, often responds to treatment such as exercise therapy but only very slowly.
  • Use of multiple medications together, physical therapy, and complementary medicine is often more effective than as-needed use of one or two medications at a time. Some patients who continue to struggle to cope with their pain may need a broad pain management program. The overall goal should be to maintain adequate control of pain to a tolerable level, not to completely eliminate it.
  • Management of psychiatric issues should include consideration of counseling and cognitive behavioral therapy, in addition to consideration of techniques such as distraction, hypnosis, and careful consideration of drug therapy.

Future Directions

While refinement of the diagnostic criteria of hEDS has been important, the search for genetic causes is crucial to identify, study, and ultimately treat patients with the disorder. hEDS is the only type of Ehlers&ndashDanlos syndrome without a known molecular defect. In order to solve the puzzle and identify how hEDS comes about, tools such as a database registry will be imperative. Many further studies are urgently needed to better guide therapy. Studies could investigate physical therapy, pain management, imaging and measurements, and MCAS in the hEDS population.

Summary

Every clinician should expect to encounter a number of patients with hEDS during the course of their practice. Further research is desperately needed, and hEDS must be on every clinician&rsquos radar. It is nothing short of negligent for clinicians to ignore these established standards of care for this disorder, as it has significant potential for negative impact on health-related quality of life.


Capabilities

Keokuk Steel Castings has been in business in one form or another for close to 100 years. The name may have changed over the years but one thing that hasn’t changed… We know steel castings.
From our melt and pouring experience, our alloy selections, to our highly advanced ability to upgrade castings to complex national, organizational, and customer specifications, no other foundry offers a broader range of services and support than Keokuk Steel Castings. Best of all – we offer the benefits of a custom foundry, the efficiency of a high-volume facility , the convenience of full in-house Nondestructive testing, finishing, and upgrade services. We’ve also partnered with a selected few highly capable machine shops to offer semi or fully machined castings as requested.

Keokuk Steel Castings is capable of serving your unique needs for commercial castings AND complex, highly engineered, steel castings. We serve a broad variety of industries and are always looking to expand our expertise into new areas of manufacturing or other non-traditional casting applications. Contact us today to find out how we can help you succeed in your casting needs.

Materials Produced

  • Armor
  • Carbon Steel
  • Austenitic Stainless Steel
  • Martensitic Stainless Steel
  • Duplex Stainless Steel
  • Ferritic Stainless Steel
  • Hastaloys
  • Monel
  • Inconel
  • Gray and Ductile Iron
  • Low Allow Steel

Weight Range

Quality Systems

  • ISO 9001:2008 Compliant-transitioning to ISO 9001:2015
  • Pressure Equipment Directive – PED 2014/68/EU compliant
  • ASME B&PVC Section III NCA 3800 compliant
  • US NRC 10CFR50 Appendix B compliant
  • AAR M-1003 compliant
  • MIL-I- 48208A and MIL-I- 45662 compliant
  • HAF604 Certified (China Nuclear)
  • American Bureau of Shipping (ABS) compliant
  • Indian Boiler Regulation Compliant (IBR, 1950)

Core Room

  • 4 “Blow” type core machines
    • Isocure binder system
    • 100lb/min Pacemaster Mixer
    • Pepset binder system
    • 250lb/min Pacemaster Mixer
    • U-180 and Dependable 400
    • Pre-coated Silica sand

    Molding

    • “Loop” molding
      • Pepset binder system
      • Continuous control “Smart Pumps”
      • 1000lb/min Kloster mixer
      • 200 molds/shift
      • Maximum flask size approximately 34”x44”x14”
      • Pepset binder system
      • Continuous control “Smart Pumps”
      • 1000lb/min Strongscot mixer
      • 40 molds/shift
      • Maximum flask size approximately 64”x84”x28”
      • Thermal
      • Mechanical

      Arc Melting

      Induction Melting

      • 2-ton Inductotherm induction furnace
        • Alumina lined
        • Alumina lined
        • Alumina lined

        Pouring

        • “Teapot” configured tap and pouring ladles
          • 700lb Monolithic Foseco “Kaltek” pre-cast liner
          • 3,500lb Foseco “Kaltek” liner boards
          • 6,000lb Foseco “Kaltek” liner boards

          Heat Treat

          • 4-”Box” type gas-fired ovens
            • 12’x12’x6’
            • 10,000lb capacity
            • Up to 2,150 deg. F
            • 18’x12’x6’
            • 15,000lb capacity
            • Up to 1,800 deg. F
            • 12’x6’x6’
            • 10,000lb capacity
            • Up to 1,350 deg. F
            • 8’x16’x8’
            • 2 Cooling tower s
            • 4-50hp agitation pumps

            Keokuk Steel Castings has been in business in one form or another for close to 100 years. The name may have changed over the years but one thing that hasn’t changed…We know steel castings.


            Keokuk Junction Railway

            The present company was incorporated in 1980 as the Keokuk Northern Real Estate Co., [4] formed in May 1980 to purchase 4.5 miles (7.2 km) of the Chicago, Rock Island & Pacific Railroad yard track in Keokuk, Iowa. [5] The KJRY obtained that trackage in 1981. [1] In December 1986, the KJRY bought, from the Santa Fe Railway, 33.5 miles (53.9 km) of trackage consisting of the LaHarpe line and Warsaw line from Keokuk/Warsaw, Illinois to LaHarpe, Illinois, [1] [5] formerly owned by the Toledo, Peoria and Western. [4]

            Pioneer Railcorp filed with the Surface Transportation Board to acquire 66.62% of KNRECO, Inc. (the KJRY) from majority shareholder John Warfield, [6] and purchased KNRECO in March 1996. [5]

            The KJRY bought 12.1 miles (19.5 km) from LaHarpe to Lomax, Illinois plus assigned trackage rights from Lomax to Fort Madison, Iowa in December 2011 and 76 miles (122 km) from the Toledo, Peoria and Western from LaHarpe to Peoria, Illinois in February 2005. [1] [5]

            Brookhaven Rail Partners acquired Pioneer Rail corporation on July 31, 2019. [7]


            Watch the video: Verka Serduchka - Dancing Lasha Tumbai Ukraine 2007 Eurovision Song Contest (August 2022).