A seemingly legitimate $1,199 Motorola Xoom now sits on the Best Buy web site, ready for pre-order. What happened to the already steep $800? It would seem the hill has become a mountain for this initially well-received tablet. More »
... to Works dictionary installed on same computer?
Hello:
I recently installed MSOffice2007 on Vista Utimate system with latest Works edition. Works dictionary is pretty good and user friendly, but late edition Office has no lookup dictionary access except when connected ... via t
DEAR SIR,
I HAVE ONE SS PLATE MATERIAL IS SA240-304L I WANT TO MAKE HOLE IN THIS PLATE SO WHICH KIND OF DRILL BIT WE CAN USE.
Doctors should be not allowed to tell patients they are seriously impaired from lack of sleep before they operate
Here's another one of those stories about mainstream medical practices that sounds like it couldn't be true -- but it is. According to an editorial just published in the New England Journal of Medicine, there are currently regulations in place to restrict the work hours of doctors in training -- but no such rules for fully trained physicians. That means doctors who are severely sleep deprived are currently performing operations on unsuspecting patients who have no idea their surgeons are as impaired as if they were drunk out of their minds. "Studies have shown that sleep deprivation impairs psychomotor performance as severely as alcohol intoxication," the authors of the study pointed out in a media statement. Read more...
Juice detox , weight loss detox , drug detox
The following is an unsolicited testimony of a 43 year old male diagnosed with a rare form of arthritis.
Dear Dr. Young,
Thanks for your emails.i have a great success story to tell you. I am 43 and have always been very fit and healthy. About 3 years ago I started to get pains in my left knee. The knee swelled dramatically and under advice of a Doctor I received cortisone injections to reduce the swelling.
This was then followed by pains in my shoulder which was very quickly followed by the other shoulder. Eventually I couldn't raise my arms more than 3 inches.
The Doctor sent me for blood tests which showed my C Reactive Protein and Plasma Viscosity was off the charts.
I went through the conventional system who eventually after much head scratching diagnosed me as having a rare form of arthritis which was attacking my joints.
They prescribed a cancer drug and bi-weekly blood tests to ensure my liver wasn't going into failure.
By this time I was unable to play golf, run or do any sport. Read more...
Joint Mender for Joint Care
The following pieces of tissue (labeled “skin”) were received in the laboratory from an 80 year old man. No further history was available. On closer examination, they appeared to be friable ‘scabs’:
Examination with a dissecting scope (40x original magnification) revealed the following. Some of them were moving!
I would hope that nearly all physicians in the course medical school, residency, fellowship and junior staff time encounter a mentor or two along the way. I have been fortunate enough to have several good mentors and a few great ones. Among those is Dr. Joe Chaffin, recently appointed medical director and vice president of a large blood center in Denver, CO.
When I was a resident (not said in a gravely old voice…yet) Joe ran the blood bank at Walter Reed Army Medical Center teaching several years of residents throughout the national capital area everything you wanted to or needed to know about blood banking and not a lot of minutia to clog your brain in risk of losing the big picture and important need to know material. During that time Joe also taught at the Osler review course for pathology. My class and those before and after me benefited from Joe’s interests in computer programming, going through courses and quizzes written on a Macintosh! Of course, Joe at the time was the only one smart enough to have a Mac but I eventually caught on. Last but not least, around the same time Joe started the website Blood Bank Guy (no doubt with a Mac) and was responsible for our department website, still in the infancy of the Internet and later dismantled to a shell of its former shelf following increased DOD restrictions on public web content in 2001. Little remains of that today.
Fortunately, as Joe has moved on he has kept up Blood Bank Guy, lecturing, teaching and mentoring & has added podcasts and a Blood Bank Guy Blog.
Joe’s teaching style is to inform and educate through evidence-based medicine. Those of us who were fortunate to learn blood banking from Joe learned as much about the subject as we did about being effective communicators and being part of the treatment team and being able to defend your decisions that clinicians would respect. He was one of the few attendings I had who could do this and teach it.
Now if Joe could just stop being an ardent Detroit Red Wings fan, I might just have a little respect for the guy, but no one is perfect.
Look forward to your posts Joe as one of my continued references for those 3 AM blood bank calls for the right answer.
You are kindly invited to join the first of our Digital Pathology webinar series consisting of three presentations, where we will address the use of the Leica SCN400 and software suite for Research, Remote Slide Review and Education.
Complete Solutions for Digital Pathology Research –
From Slide to Result by Olga Colgan
Tuesday 25th January, 16:00 hrs CET (15:00 hrs UK)
Digital Pathology for Remote Slide Review –
Benefits and Considerations by Sean Costello
Wednesday 26th January, 16:00 hrs CET (15:00 hrs UK)
Integrating Digital Pathology in Education –
Benefits for Educators and Students by Colin Doolan
Thursday 27th January, 16:00 hrs CET (15:00 hrs UK)
Where is the digital pathology interest in dermatopathology buried?
With the increased adoption of both brightfield and whole slide fluorescence scanning, the accessibility of skin samples seems ripe for digital pathology applications. But there are good reasons for going slow in this clinic area:
1) Questions of dermatology diagnostic equivalency of glass versus image. While the whole slide imaging technology keeps improving, Jonhan Ho et al (University of Pittsburg, 2008) rightly mentions concerns with the whole slide image in clinical dermatology usage. A recent publication by Bjarne Nielsen et al (Aarhus University in Denmark, 2010), is positive on skin tumor virtual microscopy provided pathologists have completed a period of digital pathology training. The good news overall is scanning technology keeps getting better, especially in reducing poorly scanned areas that are unacceptable in a clinical practice.
2) Complexity of dermatopathology. The skin may be the only place where the surface really is the most complex. There are an estimated 1500 different rashes and skin tumors, including variants, making dermatology and dermatopathology among the most complex specialties of medicine. How exactly does one approach an equivalency study design with this much disease complexity? It would challenge even a Dr. Holger Lange to device an adequate regulatory digital pathology study design for dermatology. 🙂
3) Complexity of image analysis approaches. One needs to first be able to have the computer identify layers of the derm, prior to looking at feature-level analysis (e.g. cell and object counting, or geometry measurements in a given layer). Layer analysis requires a white-box or rules-based programming that combines geographic knowledge ("Which layer am I in?") with textual feature recognition ("Hey computer, this layer's texture looks like this..."). In this sense it is similar to layer-based ophthalmology image analysis. It takes substantial time to write these layer-based detection algorithms and one has to constantly verify that the assumptions made in the algorithm match the tissue being analyzed (e.g as a superficial example, an algorithm looking to identify five stratum layers may work in thick skin epidermis, but will fall apart when working in thin skin with a missing stratum lucidum and only three or four of the five layers).
4) Economics of clinical dermatopathology. Most dermatology practices do not send out many of their dermatapathology cases, and cannot afford the hundreds of thousands of dollars for digital pathology scanners and software, which would not change how they would practice their discipline (at least not yet).
Despite these limits in clinical dermatology digital pathology adoption, we are excited about the possibilities that whole slide imaging brings to dermatology research and pharmaceutical clinical trials. Quantitative data on both efficacy and toxicology is key to all stages of pharmaceutical product development, and skin is no exception. To be successful, the dermatology trained pathologist must work closely with an image analysis expert. Particularly in skin, the specific image analysis design must be discussed beforehand with a pathologist, and a pathologist needs to review and sign off on each result. This is true whether the study approach is simple, like increased collagen or dermal thickness measurements, or complex, like multiplexed IHC melanoma proliferation studies.
Interestingly enough, thanks to the efforts of some remarkable pathologist pioneers in dermatopathology, the dermatology field has historically been described in algorithmic terms. Dr. Ackerman's book in 1978 is the classic work, and written in a rules-based approach. There have been multiple new editions, but the original 1978 textbook, if you can find one, costs thousands of dollars, and is worth far more in the contribution he provided to this field.
As a digital pathology CRO, we do a lot of work in the area of skin samples, whether the sample is for implanted device material evaluation, cosmetics studies, or dermatopathology product development. This seems an opportunity for comparative pathology approaches, and the opportunity to participate in dialogs between veterinary and MD pathologists in developing dermatology image analysis applications is truly a privilege. However, finding MD dermatopathologists who have the interest, time, and training to be involved in dermatology product development is not easy.
Of all the various organs where digital pathology will have a major impact, the complexity of dermatopathology is perhaps the most humbling to image analysis experts. We are just scratching the surface.
P.S. Speaking of humility and history, I need to remind Keith Kaplan that the last time the Chicago Bears won a Super Bowl was around when Dr. Ackerman's first edition was gaining fame. I don't mind the Bears, it is the Bears fans I can't stand. At least Jay Cutler doesn't like Bears fans either.
Humbly submitted by Steve Potts, of Flagship Biosciences, a digital pathology CRO.
FREE Special Edition White Paper
Published statistics indicate that, each year, there are more than 10 million visits to ob-gyn and primary care physicians because of vaginitis. Since this health condition could be caused by a number of different infectious agents, physicians—and their clinical laboratories—must often perform multiple diagnostic tests. That takes time, often doesn’t deliver a definitive diagnosis if the right infectious agent assays were not requested, and can frustrate both physician and patient.
Clinical laboratory testing plays a crucial diagnostic role in healthcare in the United States. That’s good news for pathologists, laboratory directors, and laboratory scientists. With the advancements in technology, laboratory test results are helping physicians make earlier and more accurate diagnoses. Numerous new diagnostic tests are available in the clinical marketplace. However, few of these assays possess the right combination of increased sensitivity, reasonable test cost, and the ability to significantly contribute to clinical care.
The Dark Report is happy to offer our readers a chance to download our recently published FREE White Paper “Vaginitis Diagnosis: An Opportunity to Improve Patient Care” at absolutely no charge. This free download will provide readers with a detailed overview of current legal challenges that your lab may encounter in the near future.
Pathologists and clinical laboratory scientists recognize how important it is that new diagnostic assays fit the following criteria:
Whenever all of these criteria are met, it presents clinical laboratories with the opportunity to hit a “diagnostic home run” with referring physicians. An example would the diagnosis of vaginitis. Currently there are several tests available for the detection of the causative agents for vaginitis, but few tests are available for the simultaneous detection of these causative agents from one collected specimen. Such a test would be of significant benefit to the clinician and patient, as multiple specimens would not have to be collected.
Every pathologist and laboratory scientist should evaluate this assay and review the clinical guidelines that call for its use in diagnostic and treatment decisions for vaginitis. This white paper is a good starting point. It has been organized to provide an accurate and broad overview of this subject.
Here is just some of what you will take away…
Table of Contents
Preface - Page 3
Chapter 1. Abstract — Page 5
Chapter 2. Background— Page 6
Chapter 3. The Three Common Underlying Causes of Vaginitis — Page 8
Chapter 4. Diagnosis of Vaginitis: Current Practice — Page 10
Chapter 5. DNA Probe Technology Opens the Door to Improved Vaginitis Care — Page 12
Chapter 6. Implications for Patient Care — Page 14
Chapter 7. Implications for the Laboratory — Page 15
Chapter 8. Assessing the Opportunity — Page 17
Chapter 9. Implementing DNA Probe Technology in the Lab — Page 21
Chapter 10. Marketing New Vaginitis Testing Capabilities — Page 22
Chapter 11. The BD Affirm VPIII Microbial Identification System at Work — Page 23
Chapter 12. Conclusion — Page 26
Appendices
A-1 About Andrea J. Linscott, PhD — Page 30
A-2 About BD — Page 31
A-3 About DARK DAILY — Page 32
A-4 About The Dark Intelligence Group, Inc., and The Dark Report— Page 33
A-5 About Executive War College on Laboratory and Pathology Management — Page 34
A-6 About Lena Chow — Page 36
Terms of Use — Page 40
This is the third (and last) in a series of posts on Laboratory Developed Tests (LDT). In this installment, I discuss where to find comparative analysis reviews of LDTs and add a few thoughts on LDT policies for pathology departments, cancer centers, and healthcare systems. The prior two posts covered the definition of LDTs, the current state of regulatory oversight, and the FDA’s decision to end enforcement discretion and regulate LDTs.
The number and complexity of esoteric molecular oncology tests is rapidly increasing, as are the other demands for patients’ tumor tissue for clinical trials and biorepositories. If a pathologist or laboratory medical director were fortunate enough to be asked for input on which tests are well validated, where should he/she begin looking for data and evidence-based guidelines? A PubMed search is always a good place to start, but there are other resources that specifically address some of these questions.
For comprehensive summaries of the available evidence, two of the best sources I have found are the Technology Assessment Reports from the Technology Assessment Program (TAP) at the Agency for Healthcare Research and Quality (AHRQ) and the BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC).
The Coverage and Analysis Group at the Centers for Medicare & Medicaid Services (CMS) recently asked TAP at AHRQ to collect the available scientific evidence on the quality and validation of laboratory-developed molecular tests. The report, issued in May of 2010, summarizes the data and potential areas of concern involving analytical validation, proficiency testing, and lack of adequate control materials for the more sophisticated multi-gene assays. However, it does not include guidelines or recommendations on the tests themselves.
The BCBSA TEC is an evidence-based practice center (EPC) for the AHRQ dedicated to comprehensive comparative effectiveness reviews on cancer and infectious diseases. In TEC Assessments, five criteria are used to determine if a technology improves health outcomes: 1) The technology must have final approval from the appropriate governmental regulatory bodies, 2) The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, 3) The technology must improve the net health outcome, 4) The technology must be as beneficial as any established alternatives, and 5) The improvement must be attainable outside the investigational settings.
The TEC Assessments cover a variety of topics and are not limited to laboratory tests. However, using breast cancer as an example, one can find TEC Assessments on molecular testing and Laboratory Developed Tests (LDTs) that are timely and relevant. In 2007, the BCBSA TEC published an assessment of breast cancer gene expression profiling tests and concluded that Oncotype Dx (Genomic Health, Redwood City, CA) “provides significant recurrence risk information in addition to conventional criteria for individual patient risk classification” for patients with hormone receptor-positive, lymph node-negative tumors. In 2010, the BCBS TEC published an assessment of gene expression profiling tests for adjuvant therapy selection for women with lymph node-positive breast cancer, and concluded that Oncotype Dx did not meet TEC criteria for that patient population.
At our institution, the pathology department was recently asked by the cancer center to draft a policy for evaluating the molecular oncology send-out tests with an emphasis LDTs. By relying heavily on the BCBSA TEC criteria and including a few other issues of concern to us, we drafted the following policy:
1. The scientific and medical data must permit conclusions about the effect of the test results on clinical management.
2. The test must have final approval from the appropriate government regulating bodies.
3. A disease-specific working group in the cancer center (e.g. program directors and regular attendees of breast, lung, sarcoma tumor boards, and others) will review scientific and medical data and regulatory approval status.
4. The Department of Pathology (i.e. Medical Director of Surgical Pathology, Medical Director of Laboratories, Director of Molecular Diagnostics and appropriate sub-specialty pathologists) will review the scientific and medical data and regulatory approval status after review in #3.
5. Physicians ordering send-out molecular oncology tests must comply with he conflict of interest policies of the healthcare system and its hospitals.
6. Physicians ordering send-out molecular oncology tests will inform patients about cost and payment (or lack thereof) by third-party payers.
We presented this draft to the cancer committee for our cancer center, and now the real discussion begins.
What would a set of guidelines for your institution look like? Are there better sources of information than the ones I mentioned above? As a pathologist, how much do you want to be involved in advising your clinical colleagues about these tests? How would a hospital or healthcare system document the compliance of the ordering physicians with conflict of interest policies? Should patients be informed about cost, and, if so, by whom?
WHEN AND WHERE: April 15-17, 2011 at InterContinental Hotel, Rosemont, IL
Sponsored by CAP Foundation
http://www.cap.org/apps/docs/futurescape/index.html
They say “the best way to predict the future is to create it” and at Futurescape IV, academics, practicing pathologists, laboratory staff and medical technologists have the rare opportunity to do just that. Futurescape IV is a networking conference focused on immediate trends and technologies as the impact the pathology practice today and tomorrow.
Through interactive sessions and technology discussions you have a unique opportunity to
Register now through January 2011 to benefit from the early bird special rate of $325 for CAP members, $125 for residents and $525 for non-CAP members.
http://www.cap.org/apps/docs/futurescape/index.html
This is the second in a series of three posts on Laboratory Developed Tests (LDT). In this installment, I summarize developments in the past few years as the FDA eventually announced its intention to more actively regulate all LDTs. The first first post covered the definition of LDTs and the current state of regulatory oversight. In the next (and last) post, I discuss where to find comparative analysis reviews of LDTs and add a few thoughts on LDT policies for pathology departments, cancer centers, and healthcare systems.
The FDA recently decided to end its policy of enforcement discretion and more actively regulate LDTs. The agency has said it plans adopt a phased-in risk-based regulatory framework, but the details have yet to be established. A summary of key developments over the past few years is provided below:
The FDA expects to begin providing details of the new regulatory structure a few months after the July 2010 meeting. At the time this post was written (December 30, 2010), few, if any, new details were available.
Several key questions remain:
What type of premarket evaluation will be required? Will companies and laboratories go through existing premarket evaluation [i.e. 510(k) clearance or premarket approval (PMA)] or a modified (or new) version of these requirements designed for LDTs?
The language in the MOU between the FDA and CMS included the words “payment” and coverage.” But, will the agencies indeed work together to match reimbursement to the increased cost of premarket evaluation by the FDA?
What will the risk-based framework for evaluation of LDTs look like? The College of American Pathologists (CAP) proposed it own risk-based scheme for LDTs. It consists of three categories: low, moderate, and high risk. The risk stratification is based on the likelihood of an incorrect result leading to serious morbidity/mortality and whether the test methodology is well understood and/or independently verifiable. Premarket review by the FDA would only be required for high risk LDTs. Moderate risk LDTs would undergo prior review and approval by CMS-deemed accreditors.
If you would like to follow developments in the regulation of LDTs, I recommend the following sources:
GenomeWeb (take a look at Kirell Lakhman’s blog, The Sample, and Turna Ray’s articles in the Pharmacogenomics Reporter)
Myraqa (timely blog posts by Mya Thomae and others)
American Clinical Laboratory Association (the ACLA and its president, Alan Mertz, have followed the evolution of LDT regulation closely, click here for more from their web site)
College of American Pathologists (information on LDTs can be found under the Advocacy tab)
It has been awhile since I came across another pathologist blogger. My friend Dr. Brian Moore over at Neuropathology Blog mentioned a new pathology blog that focuses on academic and forensic neuropathology entitled "Path Wonk". Brian's post mentions:
"Jeremy Deisch, M.D., a neuropathology fellow at the UT Southwestern Medical Center in Dallas,recently has begun a pathology blog which focuses on neuropathology and forensic pathology."
Some really nice posts to date even for a non-neuropathologist. Look forward to more interesting stories and cases and welcome to the blogosphere!
This video is a brief introduction to Pixcelldata's Collibio product (video only). The video demonstrates some of the functionality within the "My Images" section of the product, registering an image server in Collibio and adding image links from an image server into Collibio.
Now up in Florence, Italy through February 12, 2011: a number of waxes and preparations from the amazing and elusive museum of the Institute of Pathological Anatomy; See images and video tour above to get a sense of what this collection has to offer.
More, from the Tuscan Traveler website:
For those visiting or living in Florence, only a short time is left to experience one of the most unique and wonderful exhibits for those interested in either the art of wax modeling or the science of medical-surgical pathology practiced in the 1800s.
The free exhibit, called Oltre il Corpo, L’uomo (Besides the Body, the Man), will end February 12, 2011.
...Whereas the anatomical wax models at [such museums as] Museo La Specola show the body in its perfect and healthy state, the creations at the Pathology Museum, from which curator Elisabetta Susani selected prime examples for Oltre il Corpo, L’uomo, are sometimes shocking representations of diseases that were treated in the 1800s. One of the most interesting is a the wax model side by side with the skeleton of a child with an incurable case of hydrocephalus...
The Pathology Museum was created in 1824 at the hospital of Santa Maria Nuova, built in 1288 by the father of Dante’s muse Beatrice. It wasn’t until 1742 when there was a move to create a medical academy to formalize the sharing of information among doctors and scientists.
It took another eighty years to establish the Florentine Medical-Physical Society. One of the first acts of the Society was to set up a Pathological Museum. It was not a museum for the public, but rather a repository for information about the pathology and medical-surgical treatment of diseases...
Due to the difficulty of ensuring correct conservation of the pathological materials, it was decided to have some duplicates fabricated in wax. The Museum’s model-makers studied the techniques practiced in the other wax-modeling laboratory in Florence, La Specola.
Surprisingly realistic models were fabricated, providing a fascinating glimpse of the major pathologies in the 19th century. The collection of anatomical wax figures includes numerous wax reproductions, mainly the work of Giuseppe Ricci, Luigi Calamai and Egisto Tortori.
A remarkable example of symbiosis between science and art, the wax models were important, above all, for their value in teaching, allowing professors to illustrate the most important diseases to future physicians without having to depend the dissection of cadavers or the preservation of diseased organs....
Osservatorio dei Saperi e delle Arti (OSA)
Open: Monday – Friday 10am – 5pm, Saturday 10am – 1pm (Free)
Ends: February 12, 2011
Address: Largo Brambilla 3, New Entrance of Careggi Hospital
Click here to read the full story and see more images. Images and video above drawn from the Tuscan Traveler website.
Louis Mantin was an aesthete and gentleman of leisure who bequeathed his opulent home to the town of Moulins on condition that a century later it be a museum.
After he died in 1905, the mansion was closed up and fell into dilapidation. Now...it has been returned to its original pristine state.
The result is a remarkable time-capsule, combining rich fin-de-siecle furnishings, archaeological curios, skulls and other Masonic paraphernalia, a collection of stuffed birds, as well as the latest domestic gadgets such as electricity and a flushing loo.
19th Century aesthete and gentleman of leisure Louis Mantin willed his mansion--complete with a private museum of art, archaeological and natural historical specimens--to the people of Moulins, to be opened as a museum 100 years after his death. Now, 106 years after his death in 1905--and after a 3.5m euro refit funded by local authorities--the home of this real life Des Esseintes been returned to its original pristine state and is, per Monsieur Mantin's wishes, open to the public.
"In the will," explains Maud Leyoudec, assistant curator of the collection, Mantin "says that he wants the people of Moulins in 100 years time to be able to see what was the life of a cultured gentleman of his day. A bachelor with no children, he was obsessed with death and the passage of time. It was his way of becoming eternal."
Text, video and story from yesterday's BBC. Click here to read the full story and take a video tour. You can find out more (if you read French!) here.
Via Eleanor Crook and Chantal Pollier.
Some of you might remember Morbid Anatomy's coverage of last year's wonderful and amazing Congress for Curious People. I am now in the process of co-organizing this year's Congress, which will also serve as the launch event for my new exhibition at the Coney Island Museum entitled The Great Coney Island Spectacularium.
For this year's 10-day Congress--which begins on April 8 and ends on April 17th, 2011--Coney Island USA is keen to add a kind of arts, crafts, and curiosities fair featuring all things uncanny, unusual, or sideshow related.
Below is the official call for vendors. Please feel free to pass this along to interested parties:
The Congress of Curious Peoples is seeking unusual vendors for it’s Colonnade of Curiosities. April 8-17. High end, low brow and things in between. But your products must be interesting. Art, Jewelery, sideshow related items, the strange, the bizarre and the macabre...
Please email: congressvendors@gmail.com with a full description of your work and a link to a website and or photos. Due to the many submissions and limited space, we will contact only those we are considering.
To find out more, or if you would like to submit work, please email: congressvendors@gmail.com. To find out more about last year's Congress, click here; to find out about The Great Coney Island Spectacularium, click here.
Image: From Obscura Antiques and Oddities
If you are free tomorrow night, why not come down to Observatory to take in a talk with James Walsh, artist behind the current exhibition The Arctic Plants of New York City, for a discussion about collecting, botanicals, and the artistic process?
Full details follow; very much hope to see you there.
An artist’s talk with writer and artist James Walsh
Date: Tuesday, January 18
Time: 8:00
Admission: $5Artist and writer James Walsh will talk about the making of his current installation, The Arctic Plants of New York City, and its place in his larger project of discovering the surprising number of plants that are common to both New York City and the arctic. As an introduction to the project and a demonstration of how it evolved, Walsh will read selections from a series of letters he wrote to friend while his plans for the project were just beginning to form. After that, he will speak a little about how the plants, texts, and images he collected were distilled down into the present installation.
You can find out more about this event on the Observatory website by clicking here and can can access the event on Facebook here. You can get directions to Observatory--which is next door to the Morbid Anatomy Library (more on that here)--by clicking here. You can find out more about Observatory here, join our mailing list by clicking here, and join us on Facebook by clicking here.
Image: Pressed Trifolium repens, or White Clover, by James Walsh
