text:
In October 2015, the President's Council of Advisors on Science and Technology (PCAST) delivered Aging America & Hearing Loss: Imperative of Improved Hearing Technologies, which targets America's worsening hearing loss epidemic. The report proposes a number of regulatory changes, at the level of the Federal Trade Commission (FTC) and Food and Drug Administration (FDA), which PCAST believes will "decrease the cost of hearing aids, spur technology innovation, and increase consumer choice options."
One of the most controversial proposals is the creation of a new category of "basic" category of hearing aids meant for over-the-counter sale. PCAST argues that this "would allow entrepreneurs and innovators to enter the market and open a space for creative solutions to improve mild-to-moderate, age-related hearing loss with devices that can be sold ( . . . ) at the local pharmacy, online, or at a retail store for significantly less."
So far, a number of key stakeholders have weighed-in, with professional societies (representing audiologists and hearing aid dispensers) and the Hearing Industries Association (HIA) voicing opposition to over-the-counter hearing aid sales, and the Consumer Electronics Association (CEA) and Hearing Loss Association of America (HLAA) supporting the recommendation.
UPDATE: The Academy of Doctors of Audiology have issued a position statement, which has clarified their stance. They are officially supporting the recommendation for over-the-counter hearing aids, with qualifications. The graphic above has been updated to reflect this.
What are the forces behind this polarization of opinion on over-the counter hearing aids, and are the positions taken by these organizations representative of the opinions of audiologists and consumers, respectively?
On the surface, the controversy would appear to be simple. Hearing professionals, and the organizations that represent them, have been clear in their messaging; if over-the-counter hearing aids become a reality, there will be a number of negative consequences for consumers. When consumers forego an expert hearing assessment they run the risk of missing the detection and treatment of underlying medical conditions. Consumers are also more likely, they argue, to achieve poor outcomes via self-treatment with over-the-counter devices. The HIA states that "Failure to adequately address hearing loss can have profound negative consequences including an increase in dementia risk…" If consumers are fitting their own hearing aids, how will they know if their hearing loss has been addressed adequately?
Consumers, on the other hand, need more affordable hearing solutions, and the current hearing care industry has not been able to deliver affordable solutions due to the high cost of traditional hearing aids and the unavoidable cost of professional care. To make matters worse, most consumers cannot rely on medical insurance or government subsidies to assist in the purchase of hearing aids.
The Hearing Loss Association of America (HLAA), the nation's leading organization representing people with hearing loss, supports over-the-counter hearing aids, but also advises consumers not to forego professional hearing care:
While HLAA supports this groundbreaking report from PCAST, access to technology or hearing aids by consumers is not a substitute for following good hearing health care practices. We encourage people to see their primary care physician and their hearing health care provider for regular checkups. [PCAST's] recommendations ( . . . ) serve to break down barriers and provide greater access to a variety of solutions for people with hearing loss.
Dig a little deeper, and complexities emerge.
Last week we surveyed 180 hearing professionals and over 130 hearing aid consumers to find out whether their positions were in-line with the positions taken by their representative organizations. We asked the question: Should the FDA Support Over-The-Counter Hearing Aids?
We expected to strong majority of consumer support for over-the-counter hearing aids. What we found was roughly 67% for, 28% against, and 4% undecided. The results were in the expected direction, but without a clear consensus. For hearing professionals, we expected to see the vast majority voting against the measure, but we found a small pocket (roughly 12%) of support for over-the-counter hearing aids. Below we will explore the numbers in visual detail, and also highlight some of the written comments submitted by consumers and hearing professionals.
Percentage Yes/No For All Groups Surveyed
We are including those who identified themselves as a friend or family of a hearing aid consumer, and those who identified themselves as a hearing aid industry professional, but please bare in mind that our sample size was relatively small for these two groups (as seen in the graph below).
Total Number Yes/No For All Groups Surveyed
Below, we've combined hearing aid consumers with friends and family of hearing aid consumers and hearing aid industry professionals with audiologist/hearing instrument specialist. The difference between the 2 groups is clear, but again, a clear consensus does not exist within either group.
Percentage Yes/No For Combined Consumer and Industry Groups
Data was gathered via Hearing Tracker's consumer and provider newsletter-subscribers, via consumer and professional members of the HLAA, and via hearing-industry groups on LinkedIn. Subscribe to our newsletter. Haven't had your say on OTC hearing aids? Have your say now. Don't feel like taking the survey? Leave a comment at the bottom of this page.
What are They Thinking?
Looking at the graph above, one begins to wonder 1) Why would an audiologist or hearing-industry professional support over-the-counter hearing aids? and 2) Why would hearing aid consumers, or their friends and family, be against more open-access to hearing devices? Thankfully, we gathered over 200 thoughtful written comments from survey participants, providing answers to these questions. Here are a few selections, categorized by type of individual, and whether they were for, against, or undecided about over-the-counter hearing aids:
Hearing Industry For Over-The-Counter Hearing Aids
OTC hearing aids are akin to reading glasses and should be available for do-it-yourselfers who are tech savvy. More affordable options will lower the price of currenlty overpriced hearing aids. Consumers want options.
FDA is a barrier to hearing healthcare; deregulate hearing aids.
We need to promote a model with the audiologist at the center of assessment and treatment, however the patient should have access to the full range of treatment options.
Makes logical sense for consumers who want to practice self care and who want affordability. Also in line with advancements such as apps.
Create competition, lower costs, address needs of a significant number of people who cannot afford or do not need professional appraisal and assistance.
There is little evidence to suggest a substantial risk to the health and welfare of consumers who adopt hearing aids for early stage, age related hearing impairments without medical intervention. There IS, however, extensive evidence to support the facts that major barriers to adoption of hearing technology exist in the form of high cost and inconvenience. Further evidence supports the early adoption of hearing assistance to improve patient outcome in terms of listening performance, depression, irritability, fatigue and cognitive state. With the current average time from self-identification to adoption of traditional hearing devices hovering around 9 years, it is clear that entry options which overcome the primary barriers to adoption (i.e., cost, inconvenience & performance) should be available to consumers if consumer outcomes are to be optimized in the long term.
Technology marches on… you cannot stop it.
We have OTC reading glasses so I do not see an issue for the same type of thing for people with mild to mod loss. But we have to educate the public or companies will take advantage of the fact that you cannot "see" hearing loss. Easy for purchasers of reading glasses to know if they help or not…not so easy with hearing. That being said, we need to open the door to innovation because we are not only talking OTC hearing aids but apps, etc. Even FitBits might someday provide hearing enhancement. (Hearables). Audiologists should embrace ALL technologies.
For most people, there isn't a medical condition that would be negatively impacted by self-treating with an OTC hearing aid. As long as people treated them like OTC reading glasses, I don't see a problem. There will still be a need for audiologists for people with more severe difficulties and people who need lots of support for their device. The OTC devices will have to be durable, though: water resistant, no flimsy cases, internal wiring that stands up to being dropped onto a lap or a carpeted floor, etc. None of these "mail-order" quality pieces of junk amplifiers that stop working in a month!
Cost is a major factor in the reduced access to hearing technology. Low-end, easy-to-use options may prove to be another available option for patients with milder levels of hearing loss.
To make hearing aids more main stream
With the caveat that they need some kind of standard specifications for selection by the consumer.
People deserve the choice
The FDA mission statement indicates that the organization " …is responsible for protecting the public health by assuring the safety, efficacy and security of …medical devices, …and products that emit radiation." There is no reason why hearing aids cannot be made both efficacious and safe in an over-the-counter format. Current device category restrictions are confusing to consumers, impair adoption and stifle innovation. The maintenance of a comfortable, high margin distribution cartel should not be a reason to limit access to new technologies and improved hearing performance. In fact, there is no reason why this category of devices could not also be available through professional channels in order to surmount some of the current barriers to adoption and create patient relationships at an earlier stage in the progression of hearing impairment. Creation of a new category of hearing aids that requires suitable standards of performance and quality will improve access to solutions, promote innovation and ultimately bring more patients into the hearing healthcare funnel, at an earlier stage, as hearing difficulties progress beyond the range where OTC solutions are effective.
Hearing help is too expensive
We need to promote a model with the audiologist at the center of assessment and treatment, however the patient should have access to the full range of treatment options.
Unmet consumer need
Technology and software have come so far.
Hearing Industry Undecided about Over-The-Counter Hearing Aids
Affordability is an issue and technology is evolving. Sure we in the industry can talk about patient safety but if a client does nothing that's not safe either. We should look at a way of screening for red-flag issues for people looking at a "premium PSAP" as their gateway solution.
Amplification for hearing loss without some supervision or instruction will lead to misleading claims of performance and could discourage consumers from seeking further help. That being said the current regulations are too restrictive and reduces access to hearing help to too many people due to costs.
Hearing Industry Against Over-The-Counter Hearing Aids
Poorly fit hearing aids won't work at best and can damage hearing at worst.
Consumers may become frustrated after trying several OTC hearing aids that are not appropriate for their hearing loss and give up on amplification. They may feel (at that point) that "hearing aids don't work". When, in fact, they have not been properly fitted for their hearing loss. An audiologist would be able to not only measure their hearing and ears, but also counsel them with regard to hearing speech in noise. Also, a professional could check to see if their hearing loss is simply the result of ear wax.
These devices seldom fit the hearing loss and give people the impression that all hearing aids are not going to work.
If affordable access to hearing care is the primary concern, then do away with the medical referral for medicare and allow direct access to audiologists.
In order for patients to get optimal use of their hearing aids they should be specifically programmed according to the patients hearing loss. The fitting of hearing aids should also be verified and validated which cannot be done over the counter.
If the government wants to reduce the cost to the end consumer, they should provide a medical benefit through Medicare (monetary contribution, ability to purchase through a 3rd party buying group, etc.). By the time an individual has noticed an age-related hearing loss, they do not have a mild or a moderate loss, rather they have a moderate-to-severe or greater degree of loss, which cannot be helped by such devices.
I have seen patients come into my clinic with hearing tests provided by retailers at "big box stores" who should have referred for ENT management and did not. These patients were misdiagnosed (hearing loss was exaggerated to make them hearing aid candidates) and red-flags for medical management were ignored. In one case, patient had a tumor on his auditory nerve. Had these patients not come into my clinic for a second opinion, this dangerous management of their care could have escalated into serious health problems. Patients should seek care from a qualified healthcare professional (audiologists) when discussing amplification to ensure they are treated ethically and appropriately.
Hearing aids are medical devices used to treat hearing loss, which is a medical condition. Hearing aids should be dispensed by professionals who are trained in the diseases of the ear and the intricacies of today's sophisticated hearing aids.
Hearing loss requires professional care. And high outputs put consumer safety at risk
Hearing aids are a medical device that need to be dispensed by appropriately trained individuals….and that is only the first step. Over the ensuing years of ownership…this same hearing care specialist needs to carefully monitor and adjust the hearing aids to maximize the user's experience and utility of the product.
It will kill the hearing healthcare industry and provide increased general dissatisfaction due to improper fit and poorly adjusted circuitry.
As an audiologist, I cannot support self care for hearing needs. OTC devices cannot be adequately programmed by someone who is a trained, licensed and certified professional and the user runs a tremendous risk of causing further hearing impairment or another physical injury.
People have enough difficulty with devices that are properly fitted by a hearing care professional. It is a recipe for failure.
People with hearing loss differ in so many ways, selling hearing aids over the counter takes away their right to be appropriately fit by a professional. As an Audiologist I feel that we are trained to deal with hearing loss and treatment options. OTC aids will diminish our standing as professionals.
Hearing Healthcare is not about a product, it is about total Healthcare and rehabilitation of restoring not only hearing sounds but the cognitive process.
Although this approach may provide an "adequate" solution for some hearing impaired people, much like getting eyeglasses at Sears or other low cost sources, it does not allow these people to learn about nor experience a complete and comprehensive evaluation that's explained to them, or prescriptively set hearing aids (REAL) which can only be performed in an office, or regularly scheduled follow up support/counseling/cleaning and maintenance to ensure long term satisfaction and value, or auditory rehabilitation ensuring the client's brain is learning to effectively adjust to and utilize the new world of sound the aids provide. It simply is a cheap rip off of quality care that may seem more expensive on the front end, but when delivered with integrity, is an exceptional value to people in the long run.
What if the patient has a reversible hearing loss or medical condition? Hearing aids are potentially damaging to hearing if not set appropriately.
Making over-the-counter hearing aids available to the general public without examinations of ears and understanding the many causes of hearing loss can create serious problems if untreated medical conditions are present. Even hearing difficulty caused by a simple obstruction of ear wax will not be seen and can result in the failure of the device to provide any help. Other conditions such as otosclerosis as well as more involved ear pathologies will be missed by the purchaser of an over-the-counter device.
Absolutely not! As an audiologist, this is an affront to my profession! Hearing aids are not a personal listening device, they are medical equipment, and therefore need to be treated as such. Instead, more needs to be done to stop internet sales of hearing aids and require all hearing aids to be sold by qualified audiologists and hearing instrument dispensers only.
This is a danger to consumers. iPods and iPhones with ear buds tell part of the story. Power junkies will not know when enough is enough and may end up damaging hearing even further.
Hearing Aids are not one size fits all. It takes a skilled audiologist to fit hearing aids appropriately. If anything is sold over the counter, it should be a general amplifier or hearing assistive technology, and not be deemed a hearing aid. Hearing aids should be fit to a prescription. This cannot be accomplished over the counter. It is an insult to the audiology community to believe that something sold over the counter could provide as much benefit as a hearing aid fit by a professional who has a doctorate degree in audiology. Hearing loss is a medical issue and should be treated as such. There is research that is beginning to show a correlation between untreated hearing loss and cognitive decline. It isn't just about volume, but devices fit to meet a patients hearing loss, listening needs, and lifestyle. There are already too many individuals with hearing loss who are being treated inappropriately by those without the proper education. As hearing loss is a medical issue that can have cognitive and social implications, there should be a movement away from OTC hearing aids and hearing aid dispensers, not towards them so that patients and their hearing loss can be treated appropriately from the start.
It is imperative to have the expertise of a trained hearing care professional in the diagnosing and fitting process with amplification. Due to the way in which our cognitive processing determines how we hear, each individual is so vastly different from one another that selling over-the-counter hearing devices will make them significantly less effective.
I believe it would hinder appropriate treatment for hearing loss. I've seen many patients who will wear hearing aids that are not giving them enough volume just because it's a cheaper option. With the research now showing links between hearing loss and dementia, I believe that our society can't afford for more individuals with hearing loss to wear inappropriate amplification.
Hearing loss can be the first sign of greater health concerns. It would be in the best interest of the individual to have their hearing evaluated by a professional to rule out other health issues before going directly to amplification.
Because I have not found a single patient happy with OTC hearing aids and they end up feeling all hearing aids do not work and give up seeking help. Also I have had patients with ear infections, earwax and other medical issues get them who needed to be treated medically and did not need a hearing device. The number one complaint of people with hearing loss is background noise and I have purchased many of the devices and they are extremely noisy and have no technology in them to handle background noise.
For so many years the government felt the need to 'protect' the public from ill-fit hearing aids. Why now the wild swing the other way? We as an industry and profession have worked so hard to uplift the professional fitting of hearing aids; we can't just let this agency or administration destroy that. Should there be less expensive hearing aids available, YES, but let us be the ones to continue to present and fit these to patients. OTC will degrade the whole industry, take away what we have worked so hard for the past 30 years.
Patients already have issues with hearing aids that are fit appropriately. Allowing patients to buy very basic devices OTC will exacerbate the problem of patients not hearing and understanding well with their aids. I feel that the primary reason for this is that consumers are not well educated on what their options are and the differences between hearing aids and amplification devices. They view hearing aids as still being very basic amplification devices, when they are not, in fact that. There is also a lot of follow up care that goes into a successful hearing aid fitting. Having aids OTC would eliminate that type of follow up care for those patients that choose to purchase aids that way. This is detrimental to the consumer, as well as to the industry.
Patients buy these "hearing aids" then come to audiologist to fix them because they don't work. When you try to explain why they don't understand. Then they tell people they bought these "hearing aids" and they have never worked. So this exacerbates the idea that hearing aids are not worth the cost because they don't work.
Consumers Against Over-The-Counter Hearing Aids
Not like buying a toaster. You need a professional! Over the counter dentures would not help anyone , this won't either. It will hurt the people who actually need them .
Hearing aids are not a one type/size fits all. There are different options and accommodations available and its important that the wearer is well versed on what to expect. You will have people that don't fully understand hearing loss or hearing aids selling them to people.
A simple increase in volume is not adequate for most with hearing loss. The loss is different across the different frequencies of sound. Some people may turn the OTC hearing aids up too loud in an attempt to improve what they hear. This usually just distorts the sound, and could lead to further hearing damage. I am all for more affordable hearing aids, but please keep a knowledgeable person involved in their fitting and adjustment.
All hearing aids need to be properly fitted by a professional.
Fitting and programming is crucial to successful hearing aid use.
Consumers Undecided about Over-The-Counter Hearing Aids
Well, I support the principle of the idea but hearing loss is unique to each individual and quite complex. Being able to find and adjust a hearing aid to address a person's situation is beyond the skill of the most individuals. My audiologist has spent many hours fine tuning my aids to give me the best hearing experience possible. Many audiologists have a Phd. What I would like to see is the price for hearing aids come down to be affordable to a wider range of people. The industry has something of a mystique built around the marketing, pricing and dispensing of hearing aids. As an example, 4 years ago when I was shopping for hearing aids, I found 1 brand and model that I liked. Then I went to a different supplier and found the same brand and same model for $1,000 LESS than the first supplier.
Patients need access to genuine audiologist assessment and care. Patients need properly fitted aids. Patients need protection from too-loud amplification. Enforcement/oversight of predatory hearing aid distributors is currently very insufficient, on the one hand. On the other hand, PSAPs are valid instruments that should be reasonably available. I, with an 80dB hearing loss, found a $300 Personal Sound Amplification Device/System that worked better than my old hearing aids and nearly as good as new Oticon hearing aids ($6,000). I wore it for a few months and it worked remarkably well. Then I bought it for my elderly family member who had arthritis and he liked its large size (big headset shape) and large dials and lack of earmold, which never worked for him. He wore it to our wedding and it really did work better than audiologist-fitted hearing aids ever did for him. I am concerned about a lack of national standards–no hearing loop installation standards as in Europe, no caption call standards (they miss entire sentences, no joke), no smartphone dB measurement data to compare across instruments, etc. We need rigorous and enforced standards, including over the counter hearing aids.
I agree that people may go this route when they would not go via the current system. I also understand how many people do not have hearing aids that should. My main concern is that anyone paying $500 for a PSAP, who ends up dissatisfied and unhappy with the results will bad mouth all hearing aids to others. I know several people who have purchased PSAPs, who think they have hearing aids. Most feel they are not worth the cost. I would say that if the device was in the $100 range, it might be OK.
There needs to be a warning included explaining that these are not intended for those with profound loss; otherwise folks like me may not get the best hearing aid(s) for their needs.
The great majority of hearing aid professionals do not follow any best practices they just want to make a huge profit by selling expensive hearing aids and then saying good bye. At least this has been my experience. Also I have recently seen 3 of my elderly friends buying expensive hearing aids that ended up on a shelf because the hearing professional who recommended and sold them could not (would not) do too much about the issues that these customers had with the hearing aids (proper fit, whistling, etc.). You don't have to go too far, just check how many professionals on Hearing Tracker say they follow best practices. So if this is the case, why should one go to a hearing professional and pay many thousands of $s to buy something that will not help them? Why does one need them if they do not provide added value? I do understand why they argue against OTC hearing aids, they will lose sales. If they do not want that to happen, then they should follow best practices and become professionals instead of just being salesman.
Consumers For Over-The-Counter Hearing Aids
Anything that makes hearing aids more accessible to more people is a good thing.
It can be the gateway for those who need hearing help to take the first step.
My hearing aids cost $6500. We need to make hearing aids affordable.
Some older people don't like going to the doctor and don't want an expensive high quality hearing aid. They just want something to get them by.
Hearing aids as they are dispensed now cost too much. I believe technology and software could be created that allows for user adjustment of settings without having to be adjusted only by highly-paid "specialists."
We live in a "I want it, and I need it now" society. The current methods take weeks to get hearing aids, is time consuming and doesn't work well if you are homebound or in a nursing facility. Doesn't matter if this is your first or tenth pair. Consumers should be able to get them if all they need is simple amplification. They are too costly, and insurance often won't pay, or will pay just a pittance of their cost.
Because who can afford $4,000 to $6,000 for hearing aids, they are not covered by most insurances yet I need them to work!
The hearing aid industry needs to be forced into being more competitive, innovative and responsive to consumer needs.
I am a hard hearing person, use hearing aids every day and had a lots of problems with the last pair I bought(very expensive) and now j have Kaiser as my insurance company but they do not cover hearing aids and it's totally unfair.
The cost of hearing aids at the dispenser is exorbitant, Perhaps I can afford them through this alternative although I question the service component that is so important when it comes to fine-tuning and fixing…
There are so many who can not afford hearing aids.
People with mild to moderate hearing loss are not inclined to spend the dollars necessary to purchase HAs (especially from an free standing audiology office as opposed to big box and other methods) but they could benefit from PSAPS as their loss progressed the would, hopefully explore upgrading to full featured HAs.
People with only a small vision loss have the option of buying cheap, over the counter eye glasses. I think people with a small hearing loss should have the same option.
Hearing aids sold by commercial audiologists are too expensive. On the other hand hearing aids sold over the counter will not have any expert available to show the customer how to use them (some people can't even insert ear plugs correctly) or to ascertain that they fit correctly or need any adjustment. So it's not altogether a simple answer.
Hearing aids are too expensive for most people. It's better to have something than nothing.
Getting started with "beginners" hearing aids will significantly reduce the typical time lag between patients knowing they need a hearing aid, and when they can finally get them. Statistics suggest that time is 7 to 10 years.
Because I suffer from severe to moderate hearing loss and can't afford hearing aids so I just remain nearly deaf.
Existing distribution structure of hearing devices has not served the American hard of hearing public. Over the past 4 decades, the percentage of HOH population using hearing aids has not changed in a significant way. New ways of distribution must be created as a matter of better public policy.
As long as the ability to further damage the ear is eliminated these should be treated like reading glasses which are widely available OTC.
Hearing aid dispensers charge too much and have abused their monopoly.
Because I think patient's needs are more important than the needs of traditional Physicians, Audiologists, Manufacturers and Dispensers. The current system is a racket. The costs prohibit access to hearing aids for a large group of people.
It would reduce the total cost to the motivated patient and would not prevent anyone from seeking a doctor's advice.
It will provide hearing assistance for those who cannot afford the exorbitant cost of hearing aids!
Innovation drives evolution and price reduction, hearing technology has no exception from this. If prices remain high, there is a large % that will never be able to benefit from hearing aids.
Prescription hearing aids are too expensive if electronic hearing assistance devices will do the job. On-line hearing test programs seem to follow the same procedures as do "professional" audiologists even if the results are not quite as precise.
So many people who need hearing aids never purchase them. It may be cost or vanity. For many with severe loss they need the assistance of an audiologist in choosing brands, models, and programming.
Today's hearing aids are out of the reach of the majority because the cost is too high. We must allow alternatives for these people with low cost and easy access. We cannot wait for insurance coverage. The gold standard will always be licensed fitters and audiologists but for those with fixed income access is most important. I personally know many paso users who love their cheap devices.
Competition would hopefully drive the price down for all hearing aids.
Because the cost of hearing aids is out of reach on millions of people that needs them. Hopefully this will bring the cost down and break the big six hearing makers monopoly.
Last modified: November 18, 2015


text:
Перевод песни Debbie Gibson – Do You Have It In Your Heart?
Работает на технологии Яндекс.Переводчика
VERSE1: Baby all the songs On the radio Seems they're playin' too fast Or they're playin' too slow Nothin' seems right Since you walked out of my life Love's a lost feeling That cuts just like a knife in my heart Darlin' emptiness surrounds me now And chains are all around me tonight And I'm bound to your love But when push comes to shove It seems just like an endless fight So tell me... CHORUS: Do you have it in your heart? To give another try before we say goodbye to love So that we can try again baby Do you have it in your heart? Am I losin' my mind? Maybe I was too blind to see That our love could ever end But baby if you have it in your heart You will never part from me VERSE2: Just the other night At the movie show I saw you from a distance But you didn't know Though time has passed, I can still read your face I could tell that girl, she made you feel so out of place Boy I know... Though we said goodbye forever I know We could never let our dreams die 'Cause I'm looking around I don't like what I found Boy won't you look me in the eye And tell me... CHORUS BRIDGE: Let's put our pride aside And try to be strong So we can put the pieces back Where they belong Baby I'm losin' sleep And I'll be losin' much more If you don't walk back

subset: commoncrawl


text:
Atrium Health CentreTel: 01305 251545
Crossways SurgeryTel: 01305 854355
With patients' needs at the heart of everything we do, our website has been designed to make it easy for you to gain instant access to the information you need. As well as specific practice details such as opening hours and how to register, you'll find a wealth of useful pages covering a wide range of health issues along with links to other relevant medical organisations.
Information for Patients on the Infected Blood Inquiry
Please click here for the link to this document from Public Health England.
Are you taking Gabapentin or Pregabalin?
The law is changing - Gabapentin and Pregabalin are being re-classified as controlled drugs from 1st April 2019.
Click here for further information about these changes.
Our Practice has had training to provide staff with information about dementia.
For information about Dementia Friends please click here to view their website.
Copyright 2006 - 2019 My Surgery Website | Privacy & Usage | Edit | Staff Home | Site Map | Accessibility | Site T&C's | Service T&C's


text:
Elbridge Gerry and Ruth Bader Ginsburg on our federal system
This is the first of two posts about my forthcoming article, Legislative Delegations and the Elections Clause, Florida State University Law Review (forthcoming), available on SSRN. Comments, critiques, and feedback are welcome.
What were the Founding Fathers thinking about? They were thinking about who had a legislative function. There was no such thing in those days as the initiative or referendum, those developed later, but those are lawmaking functions, so I think it was entirely reasonable to read the Constitution to accommodate whatever means of lawmaking the state had adopted, rather than say, "No, the only way you could make law that counts for this purpose is by the legislature thereof." We can't know for sure because we have no way of convening with the Founding Fathers, but I think if they knew of the existence of the people's vote through the initiative or referenda, they would have said, "That's lawmaking." What we had in mind is who makes the law for the state.
Ruth Bader Ginsburg, conversation at Duke University School of Law, 2015
The evils we experience flow from the excess of democracy. The people do not want virtue, but are the dupes of pretended patriots.
Elbridge Gerry, comments at the federal constitutional convention, 1787
It is hard to overstate how inaccurate Justice Ginsburg's comments are. Men like Mr. Gerry aggressively fought any element of the Constitution that might veer too close to direct democracy. It's the reason so many elements of the Founder's Constitution, from the state legislature's power to elect Senators to the entire Electoral College (direct election, Mr. Gerry remarked, would have been "radically vicious"), often removed elections from the direct control of the people.
Constitutional amendments and state practice have made federal elections more directly democratic, from the direct election of Senators to the common practice of popular election of presidential electors pledged to support a particular candidate. But the Constitution continues to allocate responsible to actors other than "the people."
Justice Ginsburg, of course, was discussing Arizona State Legislature v. Arizona Independent Redistricting Commission, and the Court's opinion (PDF) handed down this summer. The Arizona state legislature challenged the existence of an independent redistricting commission, which had been created by ballot initiative and empowered to draw congressional districts, a task formerly reserved to the state legislature.
The Elections Clause (or the "Times, Places and Manner" Clause) provides, "The Times, Places and Manner of holding Elections for Senators and Representatives, shall be prescribed in each State by the Legislature thereof . . . ." The Arizona state legislature, understandably, thought that "legislature" meant "legislature," not "lawmaking apparatus."
Justice Ginsburg's off-the-cuff remarks were not the heart of the Court's judicial opinion, but some of the comments in the opinion draw quite close:
While attention focused on potential abuses by state-level politicians, and the consequent need for congressional oversight, the legislative processes by which the States could exercise their initiating role in regulating congressional elections occasioned no debate. That is hardly surprising. Recall that when the Constitution was composed in Philadelphia and later ratified, the people's legislative prerogatives—the initiative and the referendum—were not yet in our democracy's arsenal.
Apart from a rather dubious argument from silence, direct democracy did exist at the founding, even if the initiative and the referendum did not. Mr. Gerry's remarks certainly highlight that. And the people proposing or ratifying constitutions at conventions were an important and powerful device known at the time of the founding.
And within a generation of the founding, Justice Joseph Story challenged the notion that the people could alter federal election regulations. During Massachuetts's constitutional convention of 1820, Justice Story spoke out, as a citizen, to challenge the notion that the people could amend election provisions in the state constitution. That task, he emphasized, was reserved to the state legislature.
Justice Story's view did not prevail, for the people of Massachusetts did include provisions in their constitution about elections. But Congress has repeatedly been confronted with the question about whether an election was valid because it occurred pursuant to a regulation promulgated by some body other than the legislature of the state. It has a fairly extensive set of cases where it examines the word "legislature," discussions almost (but not wholly) absent from the Court's opinion.
Tomorrow, I'll summarize a few of the highlights from historical discussions, with a brief mention of direct democracy, and a more extensive analysis of delegating the legislature's power to another entity.


text:
'Once Upon A Time' Season 5 Episode 19 Review: 'Sisters' Bids Farewell To Longtime Villain
Recap and review of Once Upon A Time Season 5 Episode 19 – Sisters:
Once Upon A Time is entering the home stretch of Season 5, and that means some major changes, as "Sisters" bids farewell to a longtime series villain. And it's a satisfying moment, albeit not because of a sense of justice being served, but rather due to a feeling of redemption being attained. It brings the respective journeys of several characters full circle, and it does so in a way that is both engaging and poignant.
Yup, we're talking about Cora (Barbara Hershey), who finally moves on to the afterlife upon completing her "unfinished business" — making peace with her daughters, Regina (Lana Parrilla) and Zelena (Rebecca Mader). While Cora has never been a character for whom we've been asked to expect any kind of redemption, her plight at the start of this half-season at least put us into a position to sort of feel sorry for her, as she's condemned to being a miller's daughter for all eternity. It's with that mindset that she's placed back into the story to serve a more noble function, to unite her daughters in the hopes they'll prevent Hades (Greg Germann) from returning to life in the real world, since his plan involves restarting his dead heart with True Love's Kiss. It's a more than adequate story for a set of characters who haven't really been given all that much to do lately. For Zelena, she makes the argument that Hades can be saved, and I suppose it's as good an argument as any, since redeeming Hades would be as good as defeating him, no? Meanwhile, Regina has an opportunity to finally connect with a sister who's been her enemy for as long as they've known each other. And, lastly, this gives Cora one last shot to atone for what she's done to these two women, since they're at odds because of her. And that's what makes this interesting, as this is an episode that wants us to root for Cora, while also illustrating that she might not deserve our sympathy at all. In the flashbacks, we see how she drove a wedge between the two girls, first using Zelena's healing magic to save young Regina's life, and then separating the girls forever by obliterating their memories of one another. These were two girls who desperately wanted a sister in their lives. These two girls loved one another. But Cora ripped that away from them, because she felt Regina's love for Zelena was a weakness. It's a brief reminder to audiences of just how awful Cora could be. And yet, her redemption is all the more powerful for her recognition of how awful she'd been, noting she was a fool for thinking love could be a weakness. She praises both her daughters for their strength, and apologizes for all the suffering she's put them through, restoring their memories of one another in the process. This has the effect of creating a bond between Zelena and Regina, as Regina now trusts Zelena to be able to redeem Hades. Or, at the very least, Regina now trusts her sister enough to feel she deserves the chance to try. After all, Regina is someone who's come back from the brink of darkness herself, and who just needed someone to believe in her enough to give her that second chance. In a sense, this was Regina paying it forward.
This essentially brings us to the end of Cora's journey, barring any flashbacks or other magical whatnots. And if this is the end, it's been a great run for Hershey on the show. I think she's been one of the most consistently effective villains this show has ever had, due in large part because of the understandable nature of her turn towards evil. Her villainy came as much from a deep, pathological sense of self-loathing as it did her similarly pathological desire for power, and perfection from her daughter. While I do miss the black-and-white morality of the early seasons of Once Upon A Time, I appreciate that the show has evolved to a point where no one is all good or all bad. Granted, the show does tend to get carried away, in this regard, in that no true villains seem to really exist anymore. Everyone can be redeemed, and, more often than not, even the worst of the villains will be. But it can be rewarding to see that journey play out, even in relatively abrupt fashion. Cora's turn towards the light came virtually out of nowhere, but it still worked, because it was anchored in the journey of two characters struggling to come to grips with their lives now. Seeing Cora's beaming, peaceful face right before she enters into the light is surprisingly emotional. And it allows Regina and Zelena to see that the origin of their journey doesn't need to define them. They can be sisters again, and they can be good people, because their mother showed them it's possible to overcome even the worst stigma about who you are. Of course, you could argue that's a lesson Regina and Zelena gave her, but hey, it works both ways. Regardless, I found this to be really poignant storytelling, and gratifying beyond what I would have expected of a story centered on Cora.
Come to think of it, I liked more of this episode than I disliked, really. While David (Josh Dallas) having a fist-fight with his evil twin brother, James, should have been ridiculous, it actually turned out to be a thrilling climax. James had been allied with Cruella (Victoria Smurfit) to take Zelena's baby from Robin (Sean Maguire) in order to hold the child hostage in exchange for a way out of the Underworld. But David illustrated his growth as a hero by confronting his brother one-on-one. When Emma (Jennifer Morrison) tries to interfere with her magic, David waved her off, assuring her he had things under control. And, to her credit, Emma trusts in her father. She may be the Savior, but this experience in the Underworld seems to have taught her that not every issue necessarily has to fall upon her shoulders. Certain people are capable of settling their own debts, as we see with David, who really does give James a run for his money. Unfortunately, he doesn't really get the closure he would have liked to have gotten with his brother, as he accidentally knocks James into the River of Lost Souls. In a sense, his journey mirrors Zelena's, in that the chance at redeeming a loved one is stolen from both of them. David's chance at redeeming James is stolen from him by his own aggression, and Zelena's chance at redeeming Hades is stolen from her by Gold (Robert Carlyle), who introduces her to the returned Peter Pan (Robbie Kay) — who introduces himself by abducting her. So yeah…it's hard out here for a Witch. And it's going to be even harder out there for the rest of the group once Hades realizes the woman he loves has been taken. But Gold is doing this to try and awaken Belle and free their unborn child, so I guess everybody has deeply personal reasons.
Ultimately, I think Once Upon A Time has been doing a great job of telling character-driven stories this season, more so since the return from hiatus. "Sisters" is a surprisingly emotional episode that manages to bring character journeys full circle in poignant fashion. And I think these sorts of stories will make the final stretch of episodes towards the end of the season all the more resonant.
But what do you think of Once Upon A Time Season 5 Episode 19, "Sisters"? Sound off in the comments!
And for more on Once Upon A Time, read our recap and review of last week's controversial episode!TV 2016Once Upon A TimeRecapReview


text: Alec Casey is responsible for all consumer revenue at Trusted Media Brands. Prior to joining TMBI, he served as Head of Global Circulation and Production at Bloomberg LP. In this role he was responsible for global consumer marketing and production for all titles including Businessweek, which he helped re-launch in 2010, and was also responsible for launching the company's online learning platform. Previously, he held various leadership positions at Hearst and Time Inc., where he oversaw consumer marketing for various home, food and lifestyle magazines as well as helping launch Food Network Magazine, HGTV Magazine and Esquire's Big Black Book. Alec earned an MBA from The Wharton School and a BA in English from Dartmouth College.


text:
I'm getting a cylinder misfire and was assuming its my fuel pump since the guy I bought the truck from told me it would need to be replaced soon, but now testing to see if I hear the fuel pump I do hear it start up for a few seconds. Does that means its good and it could be my ignition coil?
My car has 120000 miles.
My car has an automatic transmission.
Hello. If the fuel pump is loud then that can mean that it is failing. I have also had many fuel pumps make noise for quite some time without having any issues. The only way to know for sure would be to test the fuel pressure. If the pressure is low then the pump would need to be replaced. Since the engine has a misfire I would usually check the spark plugs and ignition coils first. The vehicle may simply need a tune up. If there are no problems there then I do a compression test and check the fuel pressure to see if the fuel pump is fine and to see if there are any internal engine issues. If you want to have this misfire fixed, consider YourMechanic, as a certified mechanic can come to your to diagnose why there is a cylinder misfire and make repairs.
Our certified mechanics come to you ・Backed by 12-month, 12,000-mile guarantee・Fair and transparent pricing


text:
Although it still has to be approved by Italy's Ministry of Culture, there's a sizable offer currently on the table to restore Rome's legendary Colosseum by Diego Della Valle of the luxury brand Tod's.
The project, no doubt a colossal one, would cost upwards of 25 million euros (or approximately $32.8 million) according to WWD, which not only speaks volumes about the enormously charitable nature of the offer, but also the state of the brand itself. Clearly, Tod's had a good year in sales, otherwise Della Valle would have been insane to propose such an offer, which, if approved, would still have to be accounted for to the groups' shareholders.
Della Valle told WWD that the project would be a cultural, not a commercial one—no strings attached (there goes renaming it the "Tod's Arena.") Given the sheer number of historic monuments there are in Italy, this kind of underwritten support, if approved, might incite other companies to follow in the luxury brand's footsteps.


text:
Featured Recipe
20 minutes
15 minutes
Warm Chevre Crostini with Cranberry Basil Tapenade
Cranberry Pineapple Glazed Kielbasa Bites
Sweet Savoury Chicken Puffs
Beef Empanadas with Cranberries
Cocktail Meatballs in Fruity Chutney Sauce
Blushing Shrimp Ceviche
Brie and Cranberry Phyllo Triangle
Cranberry Bruschetta
Saucy Cranberry Teriyaki Drummies
Sizzling Bacon-Wrapped Apricots with Cranberry Glaze
Fruited Brie Bake
Shrimp Tempura with Cranberry-Wasabi Sauce
Jellied and Whole Berry Cranberry Sauce
Enjoy the tangy, sweet taste that adds something special to your meal
Craisins® Dried Cranberries
Toss in salads, yogurt or cereal.
Not a member?
Please enter the email address you used when you signed up.
Not a member? Register
Already a member? Sign In


text:
Blenders are well-equipped to puree and liquefy foods such as soup, salad dressing, smoothies and shakes and can often perform these tasks better than a food processor can. Most blenders cannot handle the same capacity as the average food processor, so pureeing usually must be split into several smaller batches.
Food processors are more useful for performing tasks that blenders do not excel at, such as executing clean dices of soft vegetables, chopping firm foods such as nuts, grating cheese and chopping large quantities of onions. These tasks are easier for a food processor because its blades move downward in a chopping motion, whereas the dual blades in a blender move around the food in a spinning motion.


text:
Mobile video is everywhere
Even a small video can make a big impact. Commercials aren't just for broadcast TV anymore. The opportunity for you to convert your audience is on the web. 10, 20 and even 30 second videos are played billions of times per day. And you only need to grab their attention once.
Homepage videos increase conversions by 20% or more.
According to HubSpot, 90% of users say that product videos are helpful in the decision making process. Also, 73% of B2B organizations who use video report a positive increase on ROI. Homepage videos can help you increase conversions faster.
Experiential marketing with video can take your campaign to the next level.
Experiential marketing is just like it sounds – focusing on the experience. Not all experiential marketing campaigns include a form of video, but when they do, we can help.


text:
'A haven of elegance in upmarket West London'
Behind the innocuous wooden doors of the Victorian terrace townhouses, adorned with elegant chandeliers and plush velvet sofas, treat yourself to the crème de la crème of London's infamous Bar, The Hyde. Sitting within the exclusive Roseate House, the Grade II listed building built in 1842 is the perfect example of timeless British charm. With original antique oil paintings and silk upholstery, Hyde Bar is an intimate venue that boasts the perfect spot for light lunch, our world-renowned afternoon tea or a relaxed evening drink in luxury surroundings.
Explore our menus (in PDF):
À la Carte | Afternoon Tea | Cocktail Menu | Whisky List
To make a Reservation contact us on 0207 479 6600 or click below to book onlineBook a Table


text:
'Good cameras with interesting features. '
'The display was quite good and it was a pleasure to watch videos on it.'
'Poor cameras.'
'Sluggish camera'
'Landscape shots without anything in the foreground were particularly poor, as even the centre of the frame was lacking in focus.'
'The front of the device is clean.'
'boring design'
'This one has a fake leather finish - complete with fake stitching. '
'Along with its low price, the device has some decent specs and features that make it a respectable mid-tier performer. '
'Being 'competitively' priced sometimes warrants inferior qualities, which unfortunately for this, is what's evident with its display.'
'Noise cancellation worked well, dispensing with moderately loud street noises. '
Lite in both the name and benefits
A Well Designed Phone With Dual LTE
Priced to Kill
'Huawei Honor 4C is a good phone but so are many others in this price range. '
'The sound quality in calls is alright at best and we also faced a few call drops. '
'However we feel quite let down by the poor camera performance. '
ReviewGist helps you find the best products to buy by making sense of online reviews.
We are currently aggregating 376,500 reviews
covering over 29,474 products.
© 2019 ReviewGist.com. All Rights Reserved.


text:
'Tis officially the season for pie.
And while there are plenty flaky, round delights to be found in the Bay Area, no purveyor of pie this year has received more buzz than Divisadero Street's Theorita, where chef Angela Pinkerton's homemade slices have been luring us into sugar comas since the place opened this past August.
With the holidays approaching, you're probably already wondering where you can pick up a perfect pie to finish out your Thanksgiving feast. You can easily place an online order for one of Theorita's seasonal favorites—including brown sugar pumpkin, sweet potato coffee cream, and that quintessential Dutch apple (all $34 each)—or you can get in the spirit and DIY it at home with Pinkerton's recipe for walnut bourbon chocolate pie.
Dig in!
Make the Butter Crust
1 ¼ cup all-purpose flour
2 tsp. granulated sugar
¾ tsp. kosher salt
1 ¼ sticks of high fat butter
3 tbsp. water, ice cold
A drop of white wine vinegar
Combine flour, sugar, and salt in a mixer. Add butter and pulse until it becomes a coarse meal. Add vinegar to ice cold water and drizzle in slowly until dough forms. Split in two, round into balls, and then flatten into discs. Chill overnight.
Roll on a lightly floured surface to about 12-inch circle, mold into 9-inch pie tin, and flute the edges. Freeze.
Place a coffee filter in frozen pie shell, fill with beans, and bake at 375F until lightly golden. Cool at room temp.
Make the Bourbon Ganache
3 oz. 70% Valrhona chocolate
1/2 cup cream
1/4 cup corn syrup
1 ½ tbsp. bourbon
1/2 tsp. butter, soft
Melt chocolate half way. Bring cream and corn syrup to a soft boil. Pour over chocolate. Stir, immersion blend, add all alcohol and butter, blend again to emulsify. Pour into the bottom of the par-baked shell. Set in refrigerator to chill for 20 to 30 minutes.
Make the Bourbon Honey Walnut Filling
2 eggs
3/4 cup orange flower honey
1/4 cup brown sugar
1 ½ tbsp. butter, melted
1 ¾ tbsp. all-purpose flour
½ tsp. kosher salt
1 tsp. vanilla
1 ½ tsp. orange zest
1 ½ tbsp. orange juice
1 tbsp. bourbon
1 cup lightly toasted walnuts, chopped
Melt together honey and butter, cool slightly. Blend eggs, brown sugar, salt, and zest together with hand blender, then emulsify in honey and butter. Blend in flour, then juice, extract, and bourbon. Strain.
Place walnuts atop the chilled ganache and pour filling into shell. Walnuts will float in custard. Place in a 350F oven and bake for 45-55 minutes, or until the pie is set, nuts are richly toasted, and filling puffs and begins to crack around the outer edges.
Cool at room temperature for a minimum of four hours before cutting. Store at room temperature, covering any cut surface lightly with plastic wrap or in a cardboard pie box.
// Theorita, 843 Divisadero St., theorita.com


text:
Jobs Around the World: December 2013
Reporting and Communications Manager for the International Rescue Committee in Bamako, Mali
- Edit and finalize high quality narrative reports for donors in compliance with donor requirements and IRC Mali internal calendar and process – 35%
- Design a country program communication strategy and produce information and communication materials such as brochures, newsletters, contribution to global IRC news bulletin, and annual and sector reviews – 35%
- Train/coach program staff on communication strategies and presentation of information in donor reports - 10%
Communications Specialist for the Asian Disaster Preparedness Center in Bangkok
Creative Services Manager for the International Maize and Wheat Improvement Center near Mexico City
We are seeking a dynamic, innovative, self-motivated and service-orientated professional for the position of Creative Services Manager in the International Communications Department to lead our talented in-house creative team. CIMMYT's creative team is tasked with creating all visual materials used to promote the organization – websites, graphics, print collateral, presentations, videos, photography and more. We're looking for a passionate leader with a deep understanding of design, marketing and branding.
Communications Coordinator for the Mennonite Central Committee East Coast in Philadelphia
Through providing leadership for the communications activities, this role works to deepen constituent awareness of MCC's programs and how constituents may get involved. In coordinating communications, this individual must be familiar with the range of resources available to tell the MCC story and the communication channels available to MCC at national/regional levels, ensuring branded communication that is timely, effective and appropriate. In partnership with the Donor Relations Coordinator, this role directs the work of the East Coast CDR network.
Behavior Change Communications Officer for Global Alliance for Improved Nutrition in Jakarta
- Oversee work done by a creative agency to ensure that formative research is translated into a BCC campaign including supervising pre-testing of campaign ideas and getting approval from government.
- Check communication materials prepared by creative and activation agencies to ensure consistency with the campaign theme(s).
- Liaison between GAIN and the research agencies in Indonesia and overseas for upcoming formative research projects in 2014.
Communications Coordinator for Child and Youth Finance International in Amsterdam
1) Communications & Marketing – assisting in the development and implementation of the Organization's communications strategies, marketing, and public relations activities, both external and internal. Coordinates the efforts of the communications team and works with the other departments of the Organization.
2) Public Relations & Advocacy- works with the Director of Communications to ensure that Child and Youth Finance is being represented in international arenas and that CYFI is being raised as a topic in the agenda of key global institutions and the media. This would involve writing of concept notes, building relationships with media, creation of press releases, media packs and other press material. (LOTS OF WRITING!)
Director of Communications and Market for the World Affairs Council of Northern California's Global Philanthropy Forum in San Francisco
S/He will be responsible for developing and implementing a dynamic global communications strategy which will proactively advance the GPF mission, its programmatic agenda and enhance its brand. The Director will be responsible for GPF's varied and integrated communications including: print media, web, videos and other online communications; media, public relations and marketing. S/He will work closely with external stakeholders and strategic partners to expand relationships and enhance the GPF's visibility as a unique learning community.
Development Manager for Spark MicroGrants in Musanze, Rwanda
Spark MicroGrants is seeking a full time Development Manager to spearhead our donor communications and outreach strategy. The Development Manager will be responsible for collecting field updates, donor reporting, grant writing as well as developing systems to institutionalize and automate external and internal communication. The ideal candidate must have very strong writing skills as well as prior experience creating grant proposals.
Technical Assistant in Logistics and Communications for Institute for War and Peace Reporting in Mexico City
We are seeking a Spanish speaker who is open-minded, organized and able to handle multiple logistics, administration and communications tasks simultaneously. The person will join a multidisciplinary team working on projects to train journalists and promote the right of expression and information in Latin America. This is a part-time post, 20 hours a week, by agreement Monday to Friday.
Human Rights Storyteller for EarthRights International in Chiang Mai, Thailand
The Storyteller's core purpose is to amplify the voices of our local staff, students, alumni, and partners working throughout Southeast Asia, on a variety of human rights and environmental issues. The Storyteller ensures that their stories reach and persuade our English-speaking audiences, thus allowing us to not only advocate and fundraise more effectively, but also to offer our local allies the dignity and justice of telling their own stories.
Graphic Designer for Access in New York
The new Access graphic designer will be our first in-house designer, and will have a tremendous opportunity to help shape our graphic identity as we go through a website overhaul and production of brand guidelines. In addition to these major projects, the designer will be engaged in creating layouts and images for campaigns and fundraisers, designing usable single-serving websites, visualizing data in interactive and compelling ways, branding tech initiatives and products, producing templates for our printed material, and helping us develop our own line of awesome schwag: stickers, t-shirts, and skunkworks projects like Accessbrau.


text:
Would you like a North Sails Expert to call you? Just leave us your number and a short message we will direct the inquiry to the right person to help. We promise to call as quickly as possible, but at some times we may be out sailing. Looking for a quote? Please use the request a quote tab above.
Find My Expert
Please search by name or location to find your local North Sails Expert.
Find My Loft
Find your local loft below.
Are you looking for something you can't find on our web site? Do you need product information or help with a sail? Just send us a message and we will respond promptly.
Are you ready to buy? Would like to learn more about products and prices? Please fill in the forms below and we will have your local North Sails Expert create a custom sail proposal for you.
North Sails for Grand Prix Racing
Grand Prix sailboat racing is about pure performance and winning championships. This quest aligns perfectly with the North Sails philosophy, which is why we have become the chosen partner for the world's most successful programs.
Quite simply, Grand Prix is all about results—but running a successful Grand Prix program is quite complicated. Knowing your sails are the fastest they can be means one less thing to worry about, and one less thing to manage. As a program partner, we help simplify the design, production, and use of your sail inventory. North makes upgrading your sails easy, making it the fastest path to better boat speed. With sixty years of empirical data backing up our expertise, we are always learning new methods—and we are always looking towards other industries and aerospace advancements for inspiration. Constant innovation is what led us to 3Di, and it's why we will come up with the next industry-changing development, too.
Our design team works on the cutting edge of sailing technology; aero, hydro and material science. We are constantly searching for ways to build faster and more versatile sails— because even the perfect sail that isn't trimmed well won't be achieving its full potential. We've proven that innovation can take place within box rules, and we work closely with each program to design the fastest possible sails for their boat and sailing team. Nothing is as smart as superior boat speed. Let North Sails help you win on the world stage.


text:
With Spring in full bloom, I want to share my three favorite Spring perfumes. I'm a girl who loves scents. It's not an exaggeration to say that I have been known to drop in Saks Fifth Ave just to wander around the perfume and cosmetics floor. If I happen to have a totally fruitless day of shopping at one of the big NYC department stores, getting a perfume sample can make it all seem totally worthwhile. My ideal Spring scent is one that mirrors all the wonderful changes that are going on in nature; the fresh air, the light perfume of flowers, lengthening hours of daylight, the promise of warmer weather.Read More
This past Christmas, my husband and I decided to do "small" gifts. My husband is very generous by nature when it comes to gift giving so the decision presented a bit of a challenge for him. I'd definitely give his efforts an A plus, because I couldn't have been happier with his gift of Sabon Patchouli Lavender Vanilla Body Scrub.Read More


text:
There are many aspects of blindness a person losing their vision must adjust to. I just found an article describing twenty losses of blindness. These include:
- Losses in the basic sense of psychological security.
- Losses in basic skills, such as mobility or techniques of daily living.
- Losses to communication, such as loss of social adequacy, ease of written and spoken communication.
- Losses of appreciation, such as loss of physical integrity, visual perception of the pleasurable or beautiful, or loss of confidence in the remaining senses.
- Losses concerning occupation and financial security.
- Losses affecting the whole personality, such as loss of independence.
For me, losses in my basic sense of psychological security are common and not just blindness-related. I am not dealing with losses in basic skills at this point, and have never felt a loss in communication. Oh well, I have, but it was easy to adjust to.
Where I really struggle is with loss of appreciation. To be honest, I'd hoped to gain color perception back after surgery. This didn't happen, and there is no way of compensating for the meaning of colors. After all, they can't be touched, heard or otherwise non-visually perceived. Having always been quite a visual person, I still have a vivid but decreasing imagination of color, but this actually further reinforces the knowledge that I've lost the actual perception of it. I remember in 2004 going to blindness rehab and discussing with my fellow students what we would do if we gained sihgt. Most people said they'd read, travel or otherwise gain independence. I said I'd appreciate the beuaty of the sights around me.
As for losses to occupational or financial security, these have not really been related to blindness in my case. My parents say I would've gone into engineering or math if I'd been sighted, but this not at all interests me and never did after the age of around twelve. Whether vision loss contriubted to my loss of interest in math, I do not remember. I did consider career paths, such as in speech and language pathology, that are not suitable for a blind person, but I do not know whether I genuinely wanted to become a speech/language pathologist or just wanted to read up on it in university. What I did lose that somewhat relates to this, is recreation. I still miss not being able to draw, for example. Whether this is a loss of appreciation or a loss of occupation, I do not know.
Lastly, there is the loss of personal independence. I did lose independence skills when I lost vision up until my most recent vision loss ten years ago, but now my dependence is mostly related to my mental health conditions and autism. I have to think further on how this personal independence thing affects the whole personality, as is postulated. I think more is meant than just loss of practical independence, but I'm not sure.


text:
Volunteering in Paraguay offers a truly unique insider's glimpse into this little visited country in the heart of South America. Get off the beaten track in Graham Greene country (author of The Honorary Consulate and Travels with my Aunt) in the capital Asuncion, and you will be submersed into another world.
With strong Indian culture and language, set against the quirky faded colonial architecture of this hot and steamy riverside city, you will forget any other world existed before Paraguay.
When you volunteer you will be involved in a variety of projects involving children – working in day care nurseries, with street kids projects or in community centres offering free and low cost education and fun activities to both disadvantaged city and rural communities. You may find yourself helping between activities with meal times, keeping the place tidy and generally supervising children. No experience is required.
Volunteers stay in shared volunteer accommodation and travel together each weekday with a volunteer coordinator. You will never be on your own whilst in Paraguay and weekends are free to relax and explore this hidden untouched gem of South America with newly made friends. A trip to the impressive Iguassu Falls on the Brazilian border is also a must when you have finished your volunteer work.
Paraguay is a country of fascinating contrasts and boasts exotic natural reserves and massive man-made dams. The capital and largest city is Asuncion, where much of the historical section, with its charming colonial buildings and plazas, are near the river and easily walkable.
Paraguay is one of South America's least densely populated countries and in 2009 the population was estimated at 6.3 million with around 60% living in poverty, it's economy revolves around agriculture and the official language is Spanish.
Come and volunteer in Paraguay and have the experience of a lifetime!


text: November 7, 2014 Mississippi College Random Fun Our Favorite Movies for the Fall November 7, 2014 Mississippi College Random Fun The fall is a great time to curl up on a comfy couch, make some yummy apple cider, and watch a few classic films. Need some movie ideas? Great, well we've taken care of that for you. Here are our Choctawkers favorite movies to watch in the fall. Take note. We are excellent movie critics.


text:
The agency that typically provides Southern California with about half its water supply tightened the spigot Tuesday when its board voted to cut regional deliveries by 15%.
The move by the Metropolitan Water District of Southern California increases pressure on Southland residents to further curb water use in the fourth year of one of the worst droughts on record. It follows Gov. Jerry Brown's unprecedented order directing Californians to slash urban water use by 25% compared with 2013 levels.
Intended to reduce Metropolitan's overall deliveries by 15%, the cuts will take the form of allocations to the 26 cities and water districts that MWD supplies with water from Northern California and the Colorado River. Agencies that exceed their allocations will have to pay punitive surcharges on the extra water, a cost they will try to avoid by strengthening local conservation measures.
The delivery cut, which will take effect July 1, marks only the fourth time Metropolitan has trimmed wholesale supplies for its member agencies, which in turn sell water to the hundreds of local water districts that supply residential and commercial customers throughout the urban Southland.
A 15% drop in deliveries would conserve about 300,000 acre-feet of water, slowing the drawdown of Metropolitan's dwindling reserves. One acre-foot of water is nearly 326,000 gallons, or enough to supply two households for one year.
MWD began the drought in 2012 with record amounts of water stored in groundwater banks and regional reservoirs. But to meet demand as the drought forced the state to slash Northern California water shipments, Metropolitan has steadily drawn on its savings account. This summer, staff projects reserves will have fallen from 2.7 million acre-feet to slightly more than 1 million acre-feet.
The staff recommended a 15% reduction, which a board committee approved Monday despite arguments by some members that a 20% cut was necessary to avoid depleting reserves to dangerous levels.
Metropolitan has trimmed deliveries several times in previous droughts -- 10% in 1977, 17% in 1991 and 10% in 2009-10. In each instance, MWD's member agencies have reined in use enough to avoid financial penalties.
But officials predict it will be tougher this time to attain the necessary water savings to avoid surcharges, given that many Southland cities have significantly reduced their use in recent years.
"It's going to be a real challenge," board member Don Calkins of Anaheim said Monday.
In addition to reserves, Metropolitan is expecting full deliveries from the Colorado River this year and will get 20% of its requested amounts from the State Water Project, compared with 5% last year. The agency also is ramping up a long-term program under which growers in the Palo Verde Irrigation District in southeast California idle land and sell the conserved water to Metropolitan.
But Metropolitan's plans to buy as much as 100,000 acre-feet of water from Northern California farmers have been frustrated by a lack of sellers, forcing MWD to shop for supplies in the Colorado River basin.
Jeffrey Kightlinger, MWD's general manager, said the staff will review water demand and supply every month. As part of Tuesday's vote, the board also said it would review water supply conditions in December to see if adjustment to the allocation was necessary.
Twitter: @boxall


text:
Altar servers are involved in some of the holiest and most sacred events in our tradition of Catholic worship. The participation of altar servers is special. When they serve at the altar, they serve Christ.
The Altar Server's ministry is a unique one in the Catholic Church; it is a great privilege. Other than priests and deacons, no one else is allowed to so closely play a part in the preparation of the Eucharist.
Servers carry the cross, hold the book for the priest when he is not at the altar, carry the incense and censer, present the bread, wine, and water to the priest during the preparation of the gifts and assist him when he receives the gifts from the people.


text:
Written by Katie Byrne, published 31st jan 2017
They announced their engagement last year - and now the countdown to the wedding of Pippa Middleton and James Matthews is firmly on!
Tipped to be the society wedding of 2017, the celebration will see Pippa - little sister of the Duchess of Cambridge - tie the knot with her banker beau in a family-filled celebration, taking place in the bride's Berkshire family home.
So what, exactly, have the pair got planned for their special day? Here's what we know so far...
Watch: Kate and Pippa Middleton as bridesmaids at their uncle's wedding
#1 The couple have opted for a late-spring wedding: they'll be marrying at St Mark's Church in Englefield, Berkshire, on 20 May.
#2 Pippa and James sent out their save-the-dates inside their Christmas cards, with the wedding invites reportedly due to be created by iconic London stationers, Mount Street Printers.
#3 Designer Giles Deacon is hottly tipped to be the creator of Pippa's wedding gowns, after he was spotted entering her London home with armfuls of dress bags. However, Jenny Packham and Alice Temperley are also in the running. (And let's not rule out McQueen, who created the iconic Maid of Honour gown (left) Pippa wore at the wedding of her older sister, the Duchess of Cambridge, in 2011...)
#4 The reception, which will reportedly take place at the family home of Pippa's parents, Carol and Michael, will accommodate between 350 and 400 guests. However, this will be no ordinary home-held affair, according to the Daily Mail: rather, Pippa and James are said to be hiring a luxurious marquee for the occasion.
Five predictions for Pippa Middleton's wedding flowers
#5 Pippa has been spotted visiting Chelsea florist Lavender Green Flowers (who adorned the third addition of our Wedding Blog Awards with the most beautiful blooms) to fill the celebration with blooms; insiders suggest that the day will be brimming over with beautiful hydrangeas.
#6 Prince George and Princess Charlotte will reportedly be their aunt's page boy and flower girl, with speculation hot as to whether their mother, the Duchess of Cambridge, will be her sister's Maid of Honour.
#7 Equally, reports suggest James' little brother, Made In Chelsea star Spencer, will most likely stand as Best Man at the nuptials.
#8 Finally - the rings! Pippa's £250k engagement ring was selected from up-market jewellers Robinson Pelham, so it seems likely the wedding rings will also be chosen from its glittering array of bands. Interestingly, the Chelsea jewellers also made the earrings that Kate wore for her 2011 wedding to Prince William, too.


text:
We just received a small shipment of gorgeous lingerie from our Canadian friends at Fortnight, and we think you'll love the gloriously bright Jade color of the Mira styles. The Longline Bralette, Bikini and especially the body-conscious Slip sell out quickly every season, and this is sure to be no exception! Act fast to get your size while it's still in stock…
New Fortnight Summer Color
1 Comment
The green is agreat colour, I'm a big fan of long line bras
Gret Blog BTW Sue x


text:
The West method is a philosophy of pointing dog training, developed by Bill West and refined and individualized by many well known trainers such as Bill Gibbons, Maurice Lindley and others.
Silence defines this method. Dog psychology and the idea that the bird is the dog's teacher are also key concepts.
In addition to West's influence in revolutionizing pointing dog training, he was also a dedicated teacher and mentor to other trainers. Those trainers in turn continued to keep the pay it forward training philosophy alive.
In an effort to continue this tradition, this site hopes to help the newbie, amateur and experienced alike, with a training method that is simple to understand and implement and that will bring years of joy and camaraderie in the field with your dog.
Learn more by downloading the FREE Field Manual, by John Rodgers and Maurice Lindley by entering your email below:
This is a 18 page start-to-finish training guide.
Sample pages are shown below:


text:
Photography Classes in Williams CA
Looking for photography classes in Williams CA? Whether you are a hobbyist, professional, or beginner, the best way to improve your photography technique is through hands-on training with knowledgeable instructors.
There are numerous recognized and accredited photography schools in California. Photography classes teach topics like lighting, exposure and composition, posing and unposing, portrait capture, and other photography fundamentals. Growing into a skilled photographer can lead to a prosperous professional career or lifelong hobby.
There are many Photography Classes in Williams CA:
- Williams Photography 101
- Williams Digital Photography Classes
- Williams Nature Photography Classes
- Williams Editorial Photography Classes
- Williams Studio Photography Classes
Williams CA Photography Classes
Pacific Union College
One Angwin Ave
Angwin, California 94508-9707
Phone: (707) 965-6313
40.97 miles away
Butte College
3536 Butte Campus Drive
Oroville, California 95965-8399
Phone: (530) 895-2511
47.15 miles away


text: By Finley In Mathematical Biology 11/12/2017 0 Mathematical And Computational Biology By modeling the biological world, we formalize verbal theories, generate testable hypotheses, and develop strategies of knowledge evaluation. This module aimed at Level four students, covers the idea and software of graphs, including both theoretical work and the use of algorithms. Dynamical methods theory permits us to study these techniques of equations and inver information about the behaviour of the corresponding biological, chemical or physical techniques. To assist the group lab project, college students will obtain steerage on lab- ebook/report maintaining, experimental design and challenge planning, along with interpretation of data and presentation of mission outcomes. The Journal of Mathematical Biology focuses on mathematical biology – work that makes use of mathematical approaches to achieve biological understanding or clarify biological phenomena. Students taking this module must have taken the module MA11001, or equal. There are definite benefits to considering this route as the time needed to check is reduced by one year which enables you to begin working and incomes earlier. A combination of IB Certificates plus other skills, reminiscent of A-Levels, Advanced Placement Assessments or the Worldwide Baccalaureate Career-related Programme (IBCP), may even be thought of. Consideration might be given to the physiological issues of life on land (reproductive freedom from water, breathing air particularly in the course of the mid- Devonian drop in global oxygen levels, water conservation and the emergence of the mammal -like reptiles). Ecology and evolutionary biology have traditionally been the dominant fields of mathematical biology. Computing power is used extensively in modern arithmetic. The power to work effectively as a part of a group and the appliance of peer help and peer-assessment will type a big a part of this module. #mathematical, Share


text:
Mars sample rover
A mission to mars will mean doing a lot of EVA:s (Extra Vehicluar activity) in order to understand the planet better. During explorations of the planetary surface observations and collecting of different samples will be done, followed by analysis of them. The focus of this project has been how to store and document samples in an efficient manner.
This project was carried out in collaboration with NASA, Johnson space center, Houston.


text:
Form-Focused Instruction and Second Language Learning: Language Learning Monograph, Volume 4
Form-Focused Instruction and Second Language Learning: Language Learning Monograph, Volume 4
ISBN: 978-0-631-22858-5 June 2001 Wiley-Blackwell 400 Pages
Download Product Flyer
The early chapters of this book trace the attempts to explain classroom language learning in terms of general theory of learning (behaviorism) and the study of naturalistic language learning. The middle chapters document the attempts of researchers to enter the "black box" of the classroom in order to describe the teaching-learning behaviors that take place there and to investigate to what extent and in what ways instruction results in acquisition.
The book concludes with a theory of classroom language learning. This theory advances an explanation of the relationship between explicit and implicit linguistic knowledge and in so doing accounts for how both form-focused and meaning-focused instruction contribute to second language acquisition in the classroom.
Table of contents
1. Investigating the Form-Focused Instruction: Rod Ellis.
Part II - Experimental Studies.
2. Integrating Formal and Functional Approaches to Language Teaching in French Immersion: An Experimental Study: Elaine M. Day and Stan M. Shapson.
3. The Differential Role of Comprehension and Production Practice: Robert M. DeKeyser and Karl J. Sokalski.
4. Attention, Awareness and Foreign Language Behavior: Ronald P. Leow.
5. Does Type of Instruction Make A Difference? Substantive Findings From a Meta-analytic Review: John M. Norris and Lourdes Ortega.
Part III - Interpretative Classroom Studies.
6. Another Piece of the Puzzle: The Emergence of the Present Perfect: Kathleen Bardovi-Harlig.
7. Negotiation of Form, Recasts, and Explicit Correction in Relation to Error Types and Learner Repair in Immersion Classrooms: Roy Lyster.
8. Learner-Generated Attention to Form: Jessica Williams.
9. The Case of the Missing "No": The Relationship Between Pedagogy and Interaction: Paul Seedhouse.


text:
Search America's historic newspaper pages from 1789-1963 or use the U.S. Newspaper Directory to find information about American newspapers published between 1690-present. Chronicling America is sponsored jointly by the National Endowment for the Humanities external link and the Library of Congress. Learn more
Libraries that Have It: Daily bumble bee. [microfilm reel] (Omaha, Neb.) 1890-189?
Omaha, Neb. (1890-189?)
HOLDING: Nebraska State Hist Soc Libr, Lincoln, NE
View more titles from this institution
Available as: Microfilm Service Copy
- <1890:10:30, 11:1-3>
Last updated: 02/1996
Available as: Microfilm Master
- <1890:10:30, 11:1-3>
Last updated: 02/1996


text:
272 pages
The challenges that space poses for political theory are profound. Yet until now, the exploration and utilization of space has generally reflected – but not challenged – the political patterns and impulses which characterized twentieth-century politics and International Relations. This edited volume analyses a number of controversial policies, and contentious strategies which have promoted space activities under the rubric of exploration and innovation, militarization and weaponization, colonization and commercialization. It places these policies and strategies in broader theoretical perspective in two key ways. Firstly, it engages in a reading of the discourses of space activities: exposing their meaning-producing practices; uncovering the narratives which convey certain space strategies as desirable, inevitable and seamless. Secondly, the essays suggest ways of understanding, and critically engaging with, the effects of particular space policies.
The essays here seek to 'bring back space' into the realm of International Relations discourse, from which it has been largely removed, marginalized and silenced. The various chapters do this by highlighting how activities in outer space are always connected to earth-bound practices and performances of the every day. Securing Outer Space will be of great interest to students of space power, critical security studies and IR theory.
Introduction - Natalie Bormann and Michael Sheehan
1. Unbundling sovereignty, territory and the state in outer space: Two approaches - Jill Stuart
2. Space weapons – Dream, nightmare or reality? - Dave Webb
3. Critical astropolitics: The geopolitics of space control and the transformation of state sovereignty - Raymond Duvall and Jonathan Havercroft
4. The spaces between us: The gendered politics of outer space Penny Griffin
5. The lost dimension: A spatial reading of US weaponisation of space - Natalie Bormann.
6. Haunted dreams: Critical theory, technology and the militarization of space - Columba Peoples
7. The (power) politics of space: the US astropolitical discourse on global dominance in the War on Terror - David Grondin
8. Between blind faith and deep scepticism: The 'weaponisation of space' and the Canadian debate on ballistic missile defence - Miguel de Larrinaga
9. The mice that soar: Smaller states perspectives on space weaponisation - Wade Huntley
10. Profaning the path to the sacred: The militarisation of the European space programme - Michael Sheehan
11. Neo-Realism and the Galileo and GPS Negotiations - Iain Ross Ballantyne Bolton
12. Pol Sci-Fi 101: Lessons from science fiction television for global and outer space politics - Mark D Hamilton


text:
- Home
- About
- North America
- Asia
- Europe
- Activities
- Maps
- For Sale
- Disclaimer
January 16, 2012
The only sign of instability occurred when Maggi took a tumble and I skied up to check on her when we were just entering treeline. She was OK, and when she made about 3 turns away from me, the slope I was standing on made an ominous "whoompf" as the snow settled. Maggi called back to tell me she just saw it crack, but I was already straight-lining to safer terrain. The slope did not slide, but instead just gave us a verbal reminder that it was January 2nd in the San Juans.
January 6, 2011
Special thanks to Cross Clothing, Phar North, SickStickz, and Bent Gate Mountaineering.
March 2, 2010
Music: Metric – Sick Muse Helmet Cam footy from a day at Silverton on February 27th, 2010, with the DU Alpine Club. It was the best snow, best guide, and best crew I have had in 4 years of going down there. Too bad my helmet cam takes terrible footage. I will work on that […]
January 4, 2010
During the two days we spent in Silverton, I brought out my cheap Oregon Scientific Action Cam for some shots of what we were skiing. Here is the result, all nicely put together with Cut Copy's Time Stands Still. The point at 1:47 when the snow flies in your face is a butter 360 in […]
January 1, 2010
I spent the month of December staying with my parents and Darcy in Glenwood Springs, Colorado. They do not have internet, and I did not have camera or did I do anything that interesting, so I didn't post for the entire month. I find myself back in Denver today though, with a brand-spanking new Canon […]
March 5, 2009
So every year I take at least one trip to Silverton, Colorado. Usually it's just one trip with the DU Alpine Club, but sometimes I'll get lucky and go down there twice with friend and family during the unguided season. It is easily the gnarliest lift-accessed terrain in Colorado, and probably amongst the top three […]


text:
Yugioh Treeborn Frog Shadow of Infinity Rare Aqua Effect Monster SOI-EN025 M/NM
Type: Effect Monster
Sub Type: Aqua
Attribute: Water
Level / ATK / DEF: 1 / 100 / 100
Text: If this card is in your Graveyard during your Standby Phase and there are no Spell or Trap Cards on your side of the field, you can Special Summon this card to your side of the field. This effect cannot be activated if there is a face-up "Treeborn Frog" on your side of the field.
You can find items like this and many more in our store at http://comycgyrl.ecrater.com


text:
When I was a new mom to a very fussy, colicky baby, I did what most new moms do nowadays: I turned to the Internet for advice. Soon enough, I found the work of Dr. Harvey Karp, whose baby soothing techniques outlined in his bestselling book, The Happiest Baby on the Block, have been lifesavers for exhausted, desperate parents for years.
I'm not sure if it was the soothing techniques themselves that saved us (otherwise known as "The Five S's": swaddle, stomach position, shushing, swing, and sucking). To be honest, I never really mastered swaddling, no matter how hard I tried. But the book itself was definitely comforting. Just knowing I wasn't alone in having a howling, finicky baby was totally reassuring. And I really jived with central idea of that book — that babies aren't really ready for the world when they're first born, and that the first three months of life is like a "fourth trimester" for infants.
At the time, there wasn't much else out there about how to soothe colicky babies, and I know I wasn't the only one who was saved by Dr. Karp's groundbreaking and super-helpful work. But now, Dr. Karp is on a mission to help with another aspect of new parenthood that affects new moms (and even dads) everywhere: postpartum depression.
In a recent editorial on Thrive Global, Dr. Karp discussed that while postpartum depression remains a huge problem among new mothers, it's still rarely talked about openly, and very often misunderstood. And yesterday, Dr. Karp chatted with me about his mission to bring awareness to this important and pressing topic.
For starters, Dr. Karp touched upon the many lingering myths that surround PPD — the first being that it only happens to women. On the contrary, Dr. Karp says that men can absolutely suffer from PPD as well. But here's what's even more fascinating about it: Despite popular belief, postpartum depression isn't only a hormone driven phenomenon; because it's actually prevalent among adoptive mothers, too.
But perhaps the biggest myth he hopes to debunk is that PPD is characterized most by depression, when in fact, the most common symptoms of PPD are anxiety-related. When people think of PPD, says Dr. Karp, they often think of a mother who is "sad and tearful," but, he notes that "oftentimes it's not a sad depression, but an anxiety-ridden depression." In reality, "people [with PPD] aren't so much sad, but they can't turn off their mind, and they can't sleep." Women with PPD may also suffer from obsessive compulsive disorder, and a feeling of "impending doom," Dr. Karp adds.
Hearing all of this was totally eye-opening for me personally, because while I didn't have depression after either of my two boys were born, I absolutely did experience anxiety symptoms. Had I known that they were symptoms of PPD, I might have looked for help before things got worse (which they did, unfortunately, with my first child).
When I asked Dr. Karp why he thinks so many mothers experience anxiety surrounding new motherhood, he had a very interesting take. He explained that new motherhood takes many women by surprise, and it's a huge responsibility that many mothers simply aren't prepared for. When you have a baby, and you're getting ready to leave the hospital, says Dr. Karp, "you can't believe they are letting you take the baby home." (I think we can all attest that this statement is basically 100% true!)
And then, when you finally do get home, you have almost zero help, Dr. Karp says, adding that this isn't the way parenting is supposed to work — in fact, it's not even the way things worked just 50 years ago.
"This is first time in human history that we don't have the village," Dr. Karp shares. And as a result, he says it's taking a toll on mothers the most. Parents these days are expected to parent all alone, without extended family nearby.
This sort of thing is unprecedented, says Karp, and is why often so many women end up with symptoms of PPD. "They are doing something no mother has done before," he shares.
But this isn't the only reason why Dr. Karp feels more women are experiencing PPD these days. He tells me that there are three other main causes, too, as he sees it: sleep deprivation, a crying baby you can't calm, and a general feeling incompetence at caring for your baby.
According to Dr. Karp, sleep deprivation (which pretty much affects all parents, amiright?) changes your brain physiology and leads to a more hyper-vigilant amygdala, which is part of the fear center of your brain. You feel more and more anxious, more on edge, and more like something bad is going to happen.
Dr. Karp also says that these days, parents aren't as prepared for the practical aspects of caring for a baby (diapers changing, feeding, soothing, etc.) as they could be. In our culture, he says "many parents have never held a baby before." All of this can leave new parents feeling totally inadequate and unable to soothe their babies in those overwhelming first weeks of parenthood.
So a sleep deprived parent who is holding a screaming baby and has no idea what to do to fix it? Yeah, that parent may very well spiral into PPD, says Dr. Karp. (And I think we can all see how that might very well be the case: just typing out that scenario makes me anxious!)
Dr. Karp also reports that 1 in 8 moms suffer from PPD, and that the disease can lead to marital stress, low self-esteem, poor bonding, obesity, breastfeeding problems, lifelong problems with depression, and in extreme cases, suicide or even infanticide.
So what's the solution to all of this? Dr. Karp believes that screening for PPD is extremely important, and tells me that while legislation for PPD screening was passed last year, it unfortunately didn't get funded (at least not yet). But even if all doctors eventually screen women for PPD, Dr. Karp believes we need to practice prevention here — that it's a "terrible failure" to wait until a woman gets depressed to treat her.
Dr. Karp has devoted much of his life to writing helpful guidebooks and developing products specifically designed to help parents deal with the stress of new parenthood. (Interestingly, he now recommends the Happiest Baby DVD over the book, because he says that pictures are worth a thousand words when it comes to learning practical, hands-on techniques like these.) Among his latest parenting lifesavers? The Snoo — a "smart sleeper" bassinet that comes with a built-in swaddle, rocks and shushes your baby, and automatically adjusts the settings according to your baby's needs. (Dr. Karp calls it "your own personal grandma or night nurse for the first six months.")
Regardless of what you use to get some relief, though, Dr. Karp wants new parents everywhere to know that caring for yourself is just as important as caring for your baby, and that we all deserve help, wherever it comes from. He believes that addressing a new parent's need for sleep, support, and baby care education are really what will solve the terrible problem of postpartum mood disorders — and I think that's something we can all get behind.More On