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Infant Feeding for Mothers Living with HIV
I. Definition of the Prevention Area
HIV can be transmitted from a mother to her child during pregnancy or delivery. When a mother is HIV infected, her baby can also be infected through breastfeeding. Several interventions reduce the risk of transmission in the first two phases. Until recently, there was uncertainty regarding appropriate and healthy options for feeding infants of mothers living with HIV.
The 2010 World Health Organization (WHO) Guidelines on HIV and infant feeding have changed this landscape dramatically. The benefits of breastfeeding can now be achieved by mothers living with HIV, with a very low risk of transmitting HIV to the infant when breastfeeding is combined with maternal or infant antiretroviral (ARV) interventions. This avoids the risks associated with formula feeding and attains the ultimate goal of "HIV-free survival" for more infants.
II. Epidemiological Justification for the Prevention Area
Without interventions to prevent mother-to-child transmission, an estimated one-third of infants born to mothers living with HIV will become infected. Breastfeeding is responsible for 30 to 60 percent of the infections among children with HIV.
Mothers with high viral loads or low CD4 cell counts are most likely to transmit the virus during breastfeeding. Antiretroviral treatment before pregnancy or during early pregnancy and continuing postnatally can cut the risk of mother-to-child transmission by at least 75 percent. Other risk factors include mixed feeding (giving formula or other substances in addition to breast milk) in the first 6 months, various breast pathologies (such as mastitis, abscesses, or nipple lesions), and poor maternal nutrition.
III. Core Programmatic Components
The major programmatic options include promoting breastfeeding or formula feeding. Unfortunately, in regions with poor sanitation, unclean water used to mix formula has caused serious illness and deaths among formula-fed infants, who are more likely than breastfed infants to die from diarrhea, malnutrition, and serious infections. Alternatives such as heat treating expressed breast milk or providing breast milk from HIV-uninfected wet nurses are not practical in most resource-limited settings.
The 2010 WHO Guidelines advise national authorities to advocate a single infant feeding practice based on local conditions (socioeconomic and cultural contexts; availability and quality of health services; local epidemiology including HIV; the primary causes of infant and child mortality; and maternal and child undernutrition). Breastfeeding with antiretroviral (ARV) treatment/prophylaxis or avoidance of all breastfeeding are optimal choices. Most governments are expected to opt for breastfeeding with ARV treatment/prophylaxis. In resource-limited countries that have opted for breastfeeding as the primary option, exclusive breastfeeding for the first 6 months should be promoted even if ARV treatment or prophylaxis are not yet accessible; breastfeeding is not conditional on ARV treatment or prophylaxis.
Major messages in the 2010 WHO Guidelines for countries that opt for breastfeeding are:
- "Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status)should exclusively breastfeed their infants for the first six months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life."
- "If infants and young children are known to be HIV-infected, mothers are strongly encouraged to exclusively breastfeed for the first six months of life and continue breastfeeding as per the recommendations for the general population, that is, up to two years or beyond."
WHO also promotes counseling and support for infant feeding and informed choice on the part of the mother. Support should not be contingent on whether a mother's choice aligns with national recommendations.
The absence of comprehensive and widely accessible postnatal care (including infant feeding) has been a major gap in PMTCT programs overall. These new WHO recommendations urgently need to be implemented in order to achieve the ultimate goal of "HIV-free survival" of infants.
IV. Current Status of Implementation Experience
Cultural barriers, financial and manpower constraints, and other obstacles made it difficult to implement maternal, newborn, and child health and PMTCT programs recommended by WHO in 2006. In many cases, counseling and support for women were inadequate. The stigma associated with HIV compromised the ability of women to breastfeed, and the cost and complexity of using formula created further barriers to implementation.
Successful implementation of the 2010 WHO Guidelines will require several steps: national guidelines and policies related to HIV and infant feeding will need to be changed; training curricula altered; new training provided for health workers; and efforts to secure community support reinforced.
Finally, efforts to widely promote breastfeeding for all mothers--which have been compromised in recent years due to fears about HIV transmission--will need to be reinvigorated.
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This comprehensive review article summarizes key studies that examine infant feeding practices and antiretroviral treatment and prophylaxis to reduce mother-to-child transmission of HIV. The studies are grouped by category in three tables: 1) maternal treatment with highly active antiretroviral therapy (HAART) [Note: although the authors refer to HAART, the table includes women given highly active antiretroviral drugs solely as prophylaxis to prevent mother-to-child transmission]; 2) infant HIV prophylaxis; and 3) upcoming trials of maternal antiretroviral therapy or infant HIV prophylaxis. The authors conclude that well-designed studies show that infant prophylaxis with antiretroviral drugs during breastfeeding can reduce HIV transmission to as low as 1.2 percent at 6 weeks to 6 months. A combination of maternal HAART (or antiretroviral drugs for prophylaxis) and infant prophylaxis for the duration of breastfeeding, say the authors, could "effectively eliminate" mother-to-child transmission of HIV where formula is not acceptable.
Prevention of HIV transmission is not enough, according to the authors of this commentary, who say that measures to improve maternal health and child survival must also be addressed. The authors review key pitfalls of some prevention programs, from earlier attempts to encourage all women living with HIV to abstain from breastfeeding (which led to a sixfold increase in child mortality in Uganda), to the tendency to conduct prevention activities such as voluntary testing and counseling in urban areas. Because some prophylactic antiretroviral regimens are administered during, prior to, or just after a child's birth, many children of mothers with HIV are left unprotected during breastfeeding--a period when 40 percent of children with HIV will acquire the virus.
This clinical trial conducted in Malawi evaluated HIV-free survival rates of children whose mothers were categorized into one of three groups: group A, highly active antiretroviral therapy (HAART)-ineligible (defined as a CD4 count of 250 or greater); group B, HAART-eligible but untreated women; and group C, HAART-eligible and treated women. At 24 months, HIV-free survival of infants was 82 percent in group A; 68 percent in group B; and 81 percent in group C. When survival rates were adjusted for various infant prophylaxis regimens, the risk of death among the children of treated mothers and treatment-ineligible mothers were each approximately half that of the children of treatment-eligible but untreated women.
This study, conducted in Burkina Faso and Kenya, randomized 824 pregnant women living with HIV and with CD4 counts of 200 to 500 to receive either triple antiretroviral (ARV) prophylaxis or short-ARV prophylaxis. Over three-quarters of infants in both groups were breastfed. Infants in both groups were treated with single-dose nevirapine. At 12 months, the cumulative HIV infection rates among infants born to women receiving triple-ARV and short-ARV were 5.6 percent and 9.3 percent, respectively; however, there was no statistically significant difference in overall mortality.
This study randomized 2,637 mother-infant pairs, in which the mothers had CD4 counts higher than 250, to receive either maternal triple drug prophylaxis (referred to by the authors as highly active antiretroviral therapy), infant nevirapine, or no additional prophylaxis (all pairs were treated with single-dose nevirapine and one week of two-drug prophylaxis immediately after birth). Treatment extended up to 28 weeks of breastfeeding, and mothers breastfed exclusively for 24 weeks, followed by rapid weaning. Preliminary data show that at one week, 4.9 percent of infants in the two treatment groups were infected, reflecting transmission during pregnancy. At 28 weeks, 6.4 percent of infants in the control arm (those with no additional treatment) developed HIV; 3.0 percent of infants born to mothers treated with triple drug prophylaxis became HIV-positive; and 1.8 percent of infants treated with nevirapine became infected. Revised results will be published in an upcoming issue of the New England Journal of Medicine.
Five hundred and sixty women living with HIV with CD4 counts of 200 or higher were randomized to receive one of two triple drug regimens (referred to by the authors as highly active antiretroviral therapy): Arm A received abacavir/zidovudine/lamivudine and Arm B received lopinavir/ritonavir/Combivir, which were prescribed at 26 to 34 weeks of pregnancy through 6 months following birth. A control group of 170 women with CD4 counts less than 200 were treated with nevirapine/Combivir. Seven of 10 mothers breastfed for five months or longer. Neither infant mortality nor HIV transmission differed significantly among the groups. Infant mortality at six months did not differ by groups and was very low in all arms.
This systematic review of clinical trials of prevention of mother-to-child transmission of HIV during breastfeeding found that up to 42 percent of transmission occurs during breastfeeding. Mothers who had a high viral load; were young; did not breastfeed exclusively; or who had breast lesions were more likely to transmit HIV to their infants. In low-resource areas with poor sanitation, infants were more likely to die of diarrheal diseases and pneumonia when not exclusively breastfed--completely offsetting deaths from HIV at 2 years. The authors suggest that for mothers who initiate breastfeeding, a) breastfeeding should be exclusive, and b) extended prophylaxis should be given to the infant (nevirapine alone or nevirapine with zidovudine).
An outbreak of diarrhea led to an abrupt increase in acute malnutrition and deaths among children younger than 5 years old in Botswana. The outbreak occurred during a period of heavy rains when sewage may have flooded the water supply. The study authors examined risk factors for diarrhea, including the HIV status of mother and child; contamination of the water supply; presence of flush toilets; and breastfeeding. Approximately one-third of mothers were living with HIV and, as a result of local prevention counseling against breastfeeding, almost none of these mothers breastfed, whereas almost half of uninfected mothers did breastfeed. HIV status of the infant and failure to breastfeed were correlated with the risk of diarrhea.
In an attempt to balance the benefits of breastfeeding with reduced risk of HIV transmission by reducing exposure time, researchers randomized mother-infant pairs to early, abrupt cessation of breastfeeding at four months or to a control group that breastfed as long as desired. Children who were infected with HIV at four months were somewhat less likely to survive to 24 months if breastfeeding was stopped early. However, there was no statistically significant difference in overall child survival at 24 months in the two groups: approximately one-quarter of the children in the intervention arm and the control arm had died by 24 months. The authors conclude that the failure of early breastfeeding cessation and its associated costs did not justify such an approach.
Mothers living with HIV who chose to breastfeed were compared to those who chose to formula feed their infants. Eligible mothers received antiretroviral treatment and those who were not eligible received antiretroviral drugs to prevent mother-to-child transmission of HIV. Only one-quarter of mothers practiced exclusive breastfeeding at one month. Although formula-fed infants were less likely to become HIV-infected at one month, they were six times as likely to die by 12 months compared to breast-fed infants. Formula feeding was particularly risky for HIV-positive infants; all 3 formula-fed HIV-positive infants died by 12 months, compared to none of the 12 breast-fed HIV-positive infants.
Formula prepared by mothers in Durban, South Africa, had high levels of fecal contamination. The mothers, who participated in a program to prevent mother-to-child transmission of HIV, all said that they boiled the water before preparing formula. Some of the mothers stored the boiled water for later use, however, which significantly increased the risk of contamination. Other factors associated with contamination included storing leftover formula for later feeds and the use of unboiled water to rinse previously sterilized bottles. Although mothers correctly diluted powdered formula for younger infants, they tended to overdilute formula for older children. Some mothers put extra scoops of powder in the feed, mistakenly thinking the baby "needs it," a practice that puts the child at risk of potentially fatal problems from too much salt and sugar in the bloodstream.
This prospective, observational study examined the hypothesis that exclusive breastfeeding would reduce mother-to-child HIV transmission. Some study mothers received either single-dose nevirapine for prophylaxis or antiretroviral treatment. Infants who were exclusively breastfed were at least half as likely to acquire HIV at four months of age as infants of mothers who practiced non-exclusive breastfeeding. Eighty-four percent of the 958 mothers in the study practiced exclusive breastfeeding at four months. The researchers review factors hypothesized to increase HIV transmission during mixed feeding, and add a new hypothesis of their own.
Mothers in this study were encouraged to either exclusively breastfeed or to exclusively use replacement feeds if they chose not to breastfeed. Infants who received mixed feedings were, by three months, nearly 11 times as likely to become HIV infected as infants receiving exclusive breastfeeding. Infants who received replacement feeds for three months were more than twice as likely to die as infants who were exclusively breastfed. The authors state that 210,000 to 270,000 new HIV infections acquired by breastfeeding annually could be averted if mothers are encouraged to stop exclusive breastfeeding at six months (around 4 percent transmission) rather than the "more usual 18-24 months of mixed feeding" (16 percent transmission).
Mothers interviewed about their infant-feeding practices were selected from a cohort that had achieved some success in either exclusive breastfeeding or exclusive formula feeding. Despite the relative success of this cohort, 80 percent of breastfeeding mothers introduced other liquids to the infant's feeds within the first month. Factors that led to mixed feedings included conflicting health care messages (posters promoting breastfeeding and formula feeding were found in the same clinic); pressure from mothers, mothers-in-law, and grandmothers to add other liquids; and secrecy regarding the diagnosis of HIV, which led many women to reject recommended feeding practices out of fear that it would make their diagnosis obvious if they chose to exclusively formula feed or to stop breastfeeding early.
This small study examines transmission of HIV from mother to child during the postnatal (after birth and during breastfeeding) period. Breastfed infants who received zidovudine prophylaxis for six months were compared to formula-fed infants given one month of infant zidovudine. Three-quarters of mothers practiced mixed feeding. HIV infection at seven months was somewhat higher (9 percent) in the breastfed group than in the formula-fed group (5.6 percent); however, mortality at the same time was higher in the formula-fed group (9.3 percent) compared to the breastfed group (4.9 percent). HIV-free survival was similar between the two groups by 18 months.
This large study assessed the risk of mother-to-child transmission (MTCT) of HIV among mothers who practiced exclusive breastfeeding, predominant breastfeeding, or mixed feeding. Mixed breastfeeding was associated with the highest risk and exclusive breastfeeding with the lowest risk of MTCT. Mixed breastfeeding infants were 2.6 times as likely to become HIV positive at 18 months, and predominantly breastfed infants were 1.6 times as likely as exclusively breastfed infants to become HIV positive. Only 7.6 percent of infants were exclusively breastfed for at least three months. By six months, 93 percent of infants received early mixed feedings. More than two-thirds of the breastfeeding transmission occurred after six months. Maternal CD4 <200 was significantly associated with postnatal transmission.
The authors previously reported that the risk of mother-to-child transmission of HIV from breastfeeding is 16 percent. Among infants with HIV, up to 44 percent acquired the infection from breastfeeding. In this study, mothers living with HIV were randomized to either breastfeed or formula-feed their infants. Infant mortality at two years was similar in the two groups (approximately 1 of every 4 or 5 infants died by their second birthday). However, as HIV-free survival was higher in the formula-fed group, the authors concluded that "formula feeding can be a safe alternative to breastfeeding." The authors acknowledge that their study represents a "best-case scenario" as the mothers all had access to potable water, a reliable source of formula, and ready access to medical care.
This chapter describes the evidence on three strategies of infant feeding (exclusive breastfeeding, early weaning, and treatment of expressed breast milk) to reduce the likelihood of HIV transmission from an HIV-positive mother to her infant. The evidence for the reduced transmission of HIV to infants when mothers exclusively breastfeed is strong. The theories given on why mixed feeding may increase HIV transmission include: 1) mixed feeding damages an infant's intestinal mucosa which then facilitates HIV infection, and 2) mixed feeding may cause the mother's breasts to have subclinical mastitis that increase the breast milk's viral loads. However, further studies on these two theories have disproven them, and research is still necessary to further investigate them. Early weaning was thought to be a strategy in reducing HIV transmission to infants since it reduced their exposure to the virus; however, it was found that early weaning could cause increased morbidity and mortality to HIV-positive infants and had no effect among HIV-negative infants. The World Health Organization (WHO) no longer recommends this strategy. Treating breast milk with microbicides to inactivate HIV-1 was successfully reported in one study but subsequent research could not replicate the findings. Another study attempted to inactivate HIV by leaving breast milk at room temperature for six hours, but this was found to be ineffective as well. Direct and indirect heat treatment of breast milk are two prevention of mother-to-child transmission strategies. However, direct heat treatment often leads to loss of important nutrients in the milk. There are two types of indirect heat treatments--"Pretoria pasteurization" and "flash heat"--and both had positive results, but more research is needed to conclusively recommend these methods. WHO updated its guidelines on HIV-1 and infant feeding in 2010 based on the current evidence.
This article describes a follow-up study of the Breastfeeding, Antiretrovirals, and Nutrition (BAN) clinical trial, which assessed the effectiveness of 28 weeks of use of maternal or infant antiretroviral (ARV) prophylaxis on postnatal HIV infection at 48 weeks. The study also examined the effects on breastfeeding cessation and on maternal and infant deaths, as well as serious adverse events. The original BAN randomized clinical trial provided mothers and infants with antiretroviral therapy (maternal triple ARVs, infant nevirapine, or ARVs for both before and during labor but not after the birth) to prevent postnatal HIV-1 transmission. According to the authors, the 48-week follow-up study has demonstrated that both infant and maternal prophylaxis effectively reduces postnatal HIV-1 transmission, and that the protective benefits continue after breastfeeding ends. They report that once mothers wean their infants from breastfeeding, there is an increase in HIV transmission, infant morbidity, and mortality. They particularly point out that weaning at six months or less may increase infant morbidity. Due to these results, the authors recommend breastfeeding with prophylaxis for more than 28 weeks. They also remind readers that the World Health Organization now recommends that HIV-positive mothers or uninfected infants receive antiretroviral prophylaxis for 12 months of breastfeeding.
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These World Health Organization guidelines were updated in 2010 in response to significant new programmatic experience and evidence regarding HIV and infant feeding. The 2010 recommendations recognize the important impact of ARVs during the breastfeeding period, and recommend that national authorities in each country decide which infant feeding practice, i.e. breastfeeding with an ARV intervention to reduce transmission or avoidance of all breastfeeding, should be promoted and supported by their Maternal and Child Health services. The document includes the principles, recommendations, and summary of the evidence. Nine key principles focus on overall HIV-free survival; integrated versus vertical infant feeding interventions; setting national strategies for infant feeding; information and counseling for mothers; and promoting breastfeeding among the general population. Seven recommendations are provided on breastfeeding and young child feeding practices.
This report summarizes new findings, conclusions, and recommendations from the World Health Organization HIV and Infant Feeding Technical Consultation held in October 2006. Newer evidence has reversed many of these conclusions.
The authors performed a rapid assessment of HIV and infant feeding practices in Malawi, Kenya, and Zambia, and found serious problems, such as "lack of space and time for proper counseling"; lack of support for nutrition as a preventive measure; few linkages with community-based infant feeding programs; weak monitoring and evaluation; and lack of resources devoted to this activity. They found a "strong bias against breastfeeding" in all three countries, and they cite a United Nations assessment that found that despite training in PMTCT, Kenyan health care workers had "uniformly poor" knowledge of PMTCT. The authors emphasize the need to focus on overall child survival, not just reduction of the risk of HIV transmission.
HIV-negative and HIV-positive women in KwaZulu-Natal, South Africa, who received frequent counseling and support to practice exclusive breastfeeding (EBF) were twice as likely to practice EBF as those mothers who did not adhere to regular counseling visits. However, large numbers of mothers did not adhere to the full series of visits. Adherence to EBF at six months was 45 percent of HIV-negative women and 40 percent of women living with HIV. The authors conclude that EBF can be successfully promoted through the provision of a home support program with well-trained lay counselors.
HIV-exposed infants in Kenya experienced high rates of diarrhea during weaning, according to the Kisumu Breastfeeding Study. Researchers tried to reverse this situation by providing safe water storage vessels, hygiene education, and bleach for household water treatment. The interventions successfully reduced diarrhea before and after weaning, but not during the weaning period itself. Provision of safe water was not found to be protective against weaning-associated diarrhea among infants who were weaned early.
The study explored the feasibility of whether HIV-positive mothers who were breastfeeding could flash-heat (FH) their breast milk for their child to reduce the transmission of HIV. Mothers were visited weekly by a health worker and also had monthly clinic visits. Mothers who were eligible or currently taking antiretrovirals were excluded from the study to better determine the intervention's effectiveness on the infants. Baseline information on the mothers' demographics, and infant feeding, growth, and morbidity were collected. Mothers also kept daily journals on infant feeding habits, and health workers measured the peak milk temperatures and collected pre-heated and post-heated milk samples for bacterial cultures. Seventy-two mothers were eligible for the intervention since their infants were HIV-negative, and 51.4 percent (37 mothers) chose to FH their milk once their child turned 6 months. The median duration of FH was 9.6 weeks (range: 1 day-15.6 weeks). Women who expressed more often also expressed a larger amount of breast milk. It was found that mothers were successful in cleaning the utensils, heating the milk, and feeding their infants with the FH milk. About 42 percent of milk samples were found to be contaminated with bacterial growth. Mothers reported little stigma associated with expressing and FH but did report hiding their behaviors about 77 percent of the time, mostly from neighbors and infrequently from friends and family. The study was successful in demonstrating that HIV-positive mothers were both interested and able to express and FH their breast milk to decrease the likelihood that their infants would become infected with HIV.
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This generic training package for a five-day prevention of mother-to-child transmission (PMTCT) course was updated in 2008 and serves as a comprehensive, evidence-based tool that can be updated and implemented in country or regional resource-constrained settings. It consists of nine modules, each of which contains a participant manual, slides, and trainer manual. It is targeted to staff such as nurses, midwives, physicians, social workers, outreach workers, counselors, and program managers working in PMTCT programs or health care settings that provide PMTCT services. Guidance is given for closing the course, offering an optional field visit, and answering frequently asked questions. A glossary is also available. The document may be freely reproduced.
These tools were created to help health workers better support HIV-infected mothers. The tools include counseling cards, a reference guide, and an orientation guide for trainers. The counseling cards and reference guide are also available in French and Spanish. These tools do not reflect the November 2009 WHO guidelines.
Rapid Advice: Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants.
These recently-updated, evidence-based recommendations on PMTCT serve as a reference for countries to adopt and adapt according to conditions found at the national level (resource availability and limitations, etc.). They are intended as an aid to simplify and standardize previous recommendations by making guidelines for initiating antiretroviral treatment (ART) for pregnant women the same as for non-pregnant women and by taking into account programmatic considerations that affect implementation. They provide guidance for policy makers and program managers responsible for PMTCT programs and are a resource for health workers involved in prevention, care, and treatment of pregnant women and their infants. These recommendations focus on two key areas: a) when to start ART and which regimen to use for pregnant women who are treatment-eligible (and their infants); and b) when to start and which antiretroviral prophylaxis regimen to give non treatment-eligible women (and their infants). Recommendations are given for breastfeeding and non-breastfeeding infants. These recommendations form part of a larger guideline which is expected to be published and disseminated in March-April 2010.
View Report (PDF, 428 KB)
View Report Summary (PDF, 128 KB)
State of the World's Children
The tables found in the State of the World's Children report contain data for all countries as well as regional summaries on breastfeeding patterns.
View Report (PDF, 420 KB)


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Essentials of Psychology: Concepts and Applications
Author:Jeffrey S. Nevid
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Publisher: Cengage Learning
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psychology accessible and engaging to beginning students in psychology, to provide a solid grounding in the knowledge base in psychology, and to help students succeed in the course. Nevid's comprehensive learning system--derived from research on memory, learning, and textbook pedagogy--is featured throughout. This learning model incorporates what the author calls the "Four Es of Effective Learning"--Engaging Student Interest, Encoding Information, Elaborating Meaning, and Evaluating Progressprovides a broad view of psychology as well as applications of the knowledge gained from contemporary research to the problems and challenges we face in today's world.
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What does SIG mean in Educational?
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shared interest group
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A posterior cruciate ligament injury is a partial or complete tearing or stretching of any part of the posterior cruciate ligament (PCL), which is located inside the knee joint.
Cruciate ligament injury - posterior; PCL injury; Knee injury - posterior cruciate ligament (PCL); Hyperextended knee
Your doctor will perform a physical examination to check for signs of PCL injury. This includes moving the knee joint in various ways.
Your doctor may also check if there is fluid in the knee joint. This test may show bleeding into the joint.
These tests may be ordered:
The posterior cruciate ligament (PCL) is the strongest ligament in the knee. It extends from the top-rear surface of the tibia (bone between the knee and ankle) to the bottom-front surface of the femur (bone that extends from the pelvis to the knee).
The ligament prevents the knee joint from posterior instability. This means it prevents the tibia from moving too much and going behind the femur.
The PCL is usually injured by overextending the knee (hyperextension). This can happen if you land awkwardly after jumping. The PCL can also become injured from a direct blow to the flexed knee, such as smashing your knee in a car accident (called "dashboard injury") or falling hard on a bent knee.
Most PCL injuries occur with other ligament injuries and severe knee trauma. Often the knee is dislocated and the nerves and blood vessels are injured. If you suspect PCL injury, it is important to be seen by a doctor right away.
At first, a PCL injury is treated by:
Limit physical activity until the swelling is down, motion is normal, and the pain is gone. Physical therapy can help you regain joint and leg strength. If the injury happens suddenly (acute ) or you have a high activity level, you may need surgery. This may be either knee arthroscopy or open surgical reconstruction.
Age has an effect on treatment. Younger patients are more likely to have problems without surgery, because chronic instability may lead to arthritis symptoms many years later. Many people do well without surgery. Injuries in which the bone is pulled off with the ligament, or multiple ligaments are injured need to be repaired with surgery.
Call your health care provider if:
PCL injuries often occur with other ligament injuries or severe knee trauma. You should be checked early for these other conditions.
Use proper techniques when playing sports or exercising. Many cases are accidents and are not preventable.
Honkamp NJ, Ranawat AS, Harner CD. Knee: Posterior cruciate ligament injuries in the adult. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2009:chap 23, section E.
Honkamp NJ, Ranawat AS, Harner CD. Knee: Posterior cruciate ligament injuries in the child. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2009:chap 23, section E.
C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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Angels signed C Yorvit Torrealba to a minor league deal.
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Reds manager Bryan Price said Tuesday that Joey Votto (quad) won't be out of the lineup for long.
The Phillies are not interested in acquiring Shane Victorino in any trade with the Red Sox, as they are intent on bringing back younger, cheaper talent, Scott Lauber of the Boston Herald reports.
The Twins are making progress on a contract extension with Brian Dozier, Mike Berardino of the St. Paul Pioneer Press reports.
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Giancarlo Stanton (face) is not in the Marlins' starting lineup for Tuesday's exhibition game against the Miami Hurricanes.
Matt Harvey (elbow) is likely to make his regular season debut on April 9 in Washington against the Nationals, the third game of the regular season, according to Kevin Kernan of the New York Daily News.
Red Sox manager John Farrell said Sunday that Rusney Castillo and Mookie Betts are "going to get equal playing time" during spring training.
Indians manager Terry Francona indicated on Monday that Nick Swisher (knees) is likely a couple weeks away from game action.
Jose Iglesias (shins) played one inning in the field Monday in the Tigers' exhibition game against Florida Southern.


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[jfirn* " The College News Volume II. No. 13 BRYN MAWR, PA., JANUARY 6, 1916 Price 5 Centa CALENDAR SATURDAY, JANUARY � 8.00 p. m.�Taylor Hall. Piano Recital by Ernest Schelling. SUNDAY, JANUARY t 6.00 p. u.�Vespers. Speaker, D. Cham- bers, '19. 8.00 p. h.�Chapel. Sermon by the Rev. Henry Lubeck of New York. TUESDAY, JANUARY 11 7.30 to 10.00�Rockefeller Basement. Red 'Cross Meeting. WEDNESDAY, JANUARY 12 4.30 to 6.00�Faculty Tea to the Graduates in Denbigh Hall. 9.30 p. m.�Mid-week Meeting of the C. A. Leader, F. Day, '19. FRIDAY, JANUARY 14 8.00 p. m.� Recital by Mr. 8amucl Arthur King for the Polish Relief Fund. SUNDAY, JANUARY 16 6.00 p. m.�Vespers. Speaker, N. McFaden, �17. 8.00 p. m.�Chapel. Sermon by the Rev. Robert Speer. MONDAY, JANUARY 17 8.00 p. m.�President Thomas at home to the Senior Class. WEDNESDAY, JANUARY It Collegiate examinations begin. SATURDAY, JANUARY 22 8.00 p. if.�Lecture on English Poetry by Mr. John Masefield. SATURDAY, JANUARY 29 Collegiate examinations end. ENDOWMENT MORE POPULAR WITH ALUMN/E THAN STUDENTS' BUILDING Suggest Possibility of Both At the meeting of the Undergraduate Association on Thursday, December 16th, President Werner gave the arguments of the Finance Committee of the Alumna? in favour of endowing a Professor's Chair as a memorial for Miss Oarrett. The alumnae feel that an increase in pro- fessors' salaries is a pressing need. An- other endowed chair would mean that the money formerly going to the professor who receives the chair will be released and added to the other salaries; hence it would be a benefit to all the professors, associate professors and readers. Every year class collections are taken among the alumnae to add to the Endowment Fund, which goes toward the establish- ment of a new chair. With these class collections and reunion gifts the alumna? have collected $29,149. With $75,000 a chair can be endowed; $50,000 is needed to start the Students' Building. The alumnae suggest as a possible plan that the undergraduates co-operate with them in raising $125,000, which sum will be sufficient for both the chair and the Students' Building. Miss Werner explained the point of view of the Alumnae Finance Committee. She said, "The alumnae asked to have brought before the Undergraduate Asso- ciation the importance of endowing an- other chair. It would be a very appropri- ate memorial, as Miss Oarrett showed her interest in the Intellectual side of College, more than in any other side, by giving scholarships and fellowships, and constantly contributing to the endow- ment fund. The alumnae feel that they can raise more money for this more im- portant cause, but as the Students' Build- ing is the memorial most desired by the undergraduates the Finance Committee suggests the possibility of co-operation to raise a sum large enough to cover the expenses of both the chair and the Stu- dents' Building". MANY ALUMN/C 8ENT TO WOMAN SUFFRAGE CONVENTION President Thomas Honored The annual convention of the National Woman Suffrage Association was held in Washington from Tuesday, December 14th to Saturday, December 18th. Thirty- five delegates of the College Equal Suf- frage League were present. Dean Reilly represented Bryn Mawr. Business sessions of the association were held every day, at which reports of this year's campaign and plans for future campaigns were discussed. Dr. Anna Howard Shaw, who has been President for the last twelve years, resigned in or- der to have more time for public speak- ing. Mrs. Carrie Chapman Catt, who has been head of the New York State Woman Suffrage Party, was elected In her place. Dr. Shaw was unanimously made Hono- rary President of the Association to be a member of the Executive Board. At a meeting of the delegates on Fri- day $50,000 for next year's budget were pledged in one afternoon. Twenty-five dollars were pledged "In honor of the women alumnaB of Cornell, and in honor of their most distinguished member, who has done so much for the cause. President M. Carey Thomas." Twenty-five dollars were also pledged In honor of the Bryn Mawr alumnae. On Saturday the College Equal Suffrage League held its business meeting, at WDict President Thomaj presided. Mrs. Howes, executive secretary of the College League, gave her report. She said that twenty chapters of the league now exist in the various colleges for women, and that special effort Is to be made to in- crease this number. The league, she said, wishes to furnish two speakers annually to each of its chapters. After the meeting a luncheon for about two hundred was given, at which Presi- dent Thomas was the toastmistress and Dean Reilly spoke. Dr. Shaw was the guest of honor. Among the Bryn Mawr alumnae who were present were: Mrs. Susan Walker Fitzgerald, '93, retiring recording secre- tary; Mrs. Mary Foulke Morrison, '99, elected In her place; Mrs. Cora Hardy Jarrett. '98; Mrs. Ella Sealy Newell, '99; Jean Crawford, '02; Alice Miller. '14; Isa- bel Miller, 11; Laura Delano. '14; Anna Stearns, '11; Helen Emerson, '11; Mrs. Katrina Ely Tiffany, '97; Mrs. Frances Fincke Hand, '98; Mrs. Helen Annan Scrlbner, '91; Mrs. Alice Field Newkirk, graduate student, '11*12; Violet Foster. �02; Marlon Reilly, '01. FABIAN SOCIETY DEBATES Dr. Oe Laguna, on Impromptu Speaking, at Bryn Mawr TRAVELING CHAPERONS The appointment of two traveling chap- erons, to take charge of special parties of girl students and young women traveling alone over the railroad, was announced on December 30th by the Baltimore and Ohio. The chaperons, It is stated, will be of valuable assistance in imparting Infor- mation as to points of Interest arrang- ing for tickets, hotel accommodations, baggage transfers, and other details of travel, all of which arrangements will be made with the cooperation and approval of the school authorities. The new ap- pointees are the wives of agents of the Baltimore and Ohio and are experienced travelers. It Is the plan of the B. A O. to retain the traveling chaperons permanently In the f tsaenger department organisation Speaking In Chapel on December 17th, Dr. de Laguna said: "I believe that the finest thing I saw in an EngllBh university was a meeting of the Fabian Society at Oxford. This so- ciety is socialistic In its origin; but that fact had no bearing upon the meeting to which I refer. There was a debate on the question: ! Resolved, That England is largely re- sponsible for the present war. An eminent Cambridge scholar, Mr. Bertrand Russell, who had come over for the occasion, opened for the affirmative, and a fellow of one of the Oxford colleges replied. After the opening speeches, members of the society, graduate and un- dergraduate, took part, not in any set order, and not on sides to which they had been assigned In advance, but freely and according to their convictions. As each speaker finished, there were always three or four ready and eager to begin. Finally, Mr. Russell was called upon to close the debate. It was by all odds the best Impromptu debating that I ever heard. The speaking was excellent, and the discussion showed hard and fearless thinking. I was particu- larly struck by the number of young men who spoke for the affirmative. It seemed to me that it showed an admirable inde- pendence of thought, to take that side at such a time and in such a place. I have been wondering whether It would not be possible to found a similar organization here�an organization for the free discussion of questions of great public or collegiate interest Such an or- ganization would, I suppose. Include un- dergraduate and graduate Btudents, and j possibly also women of the faculty and , administrative staff of the college�all. of l course, on terms of perfect equality. An executive committee would choose the � questions for discussion and secure the | principal speakers. These would be per- 1 sons who were known to take a deep <n- > terest in the questions. They might be business or professional men from Phila- ' delphla and other nearby cities, or poll- | tlclans or writers or teachers. In case of matters of local concern, they would , naturally be members of our own College �often enough undergraduate students. Meetings would be held three or four times a term. Those who joined the so- ciety would do so, not with the expecta- tion of being silent partners�for all mem- bers of the College would, as a general rule, be admitted to the debates�but to take active part In the discussions as often as they felt they had anything to 'say. It seems to me that such an organize tlon would do a good deal for Bryn Mawr College, or for any American college� vastly more than any of our ordinary de- bating societies". INNOVATION IN GYM CONTE8T Unprepared Drill New Feature The plans for the usual Gymnasium Contest between the Sophomore and Freshman classes have been somewhat changed this year. Instead of having a drill In free movements set beforehand and memorized by the class, one of the Judges, Dr. Carl Schrader, of the Harvard University Gymnasium, will put them through a free movement drill. The classes will be Judged for their physical ability, responsiveness to commands, at- tention and concentration. Each class will be drilled alone, that is, while the Sophomores are being drilled the Fresh- men will be sent from the room so that drill will be entirely new to them also. Apparatus work Is also on a slightly different basis this year. Each class has 1st, 2nd, and 3rd team Captains and Man- agers, who will manage the work for the day In the gym classes, each team work- ing as a division. The exercises for the contest will be arranged and selected by the class Captains. A club drill and folk dancing will, as usual, be a part of the contest. The Gymnasium leaders for this year are: 1918. Apparatus, M. McKensie; Clubs, L. T. Smith; Drill, K. Holllday; Dancing, D. Kuhn; General Supervisor, R. Cheney. 1919: Apparatus, A. 8tlles; Clubs, H. Johnson. The others have not yet been chosen. QUIET HOUR8 TO BE ENFORCED No Motion Made for Abolition As a quorum was not present at the Self-Government Meeting on Thursday, December 16th, and as no motion was made to change quiet hours, President Russell said that the Board regarded the attitude of the Association to be In fa- vour of the present regulations regarding quiet hours, and that hereafter these reg- ulations will be considered as Important as any other self-government regulations. If the regulations are not kept, the Board and Head Proctors will be expected to see that they are enforced. President Russell announced that two students going to or from Mrs. Miller's or Miss Martlen's after dark must take the main road past Shipley's, and that students shall not go to Miss Wesson's after dark In parties of less than three. C. Hall read the report of the convention In Cleveland. PRESIDENT THOMA8 GIVE8 BOOK8 TO FICTION LIBRARY Committee's Selections Received 18 EIGHTHOUR DAY TOO LONG? 1917 to Debate Resolved, That an eight-hour day of In- tellectual work Is too long for a college student, will be the subject of 1917's de- bate on Wednesday, January 12th, at 8.30 p. m.. In room F, Taylor Hall. The affirmative will be taken by D. Shipley and probably M. Wlllett, and the negative will be taken by V. Utchfleld and M. Scattergood. The % captain of 1917's team this year Is D. Shipley. The Denbigh Fiction Library has re- ceived several new books. President Thomas has given a volume of "The Harbor", by Ernest Poole, and "The High Priestess", by Robert Grant, which, she says, "Is being much discussed Just now because of Its presentation of 'the woman question*". The new books selected by the commit- tee which have already arrived are: "The Money Master�Parker. "The Wisdom of Father Brown"- terton. "These Twain"�Bennett. �The Would- Be-Goods"�Nesbtt. "Second Blooming"�George. -The Uttle Iliad"�Hewlltt. Chee- / 1
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Myocardial biopsy is the removal of a small piece of heart muscle for examination.
Heart biopsy; Biopsy - heart
Myocardial biopsy is done through a catheter that is threaded into your heart (cardiac catheterization ). The procedure will take place in a hospital radiology department, special procedures room, or cardiac diagnostics laboratory.
To have the procedure:
You will be told not to eat or drink anything for 6 - 8 hours before the test. The procedure takes place in the hospital. Most often, you will be admitted the morning of the procedure, but in some cases, you may need to be admitted the night before.
A health care provider will explain the procedure and its risks. You must sign a consent form.
You may feel some pressure at the biopsy site. You may have some discomfort due to lying still for a long period of time.
This procedure is routinely done after heart transplantation to watch for signs of rejection.
Your doctor may also order this procedure if you have signs of:
A normal result means there was no abnormal heart muscle tissue.
An abnormal result means abnormal tissue was found. This test may reveal the cause of cardiomyopathy. Abnormal tissue may also be due to:
Risks are moderate and include:
Liu P, Baughman KL. Myocarditis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 70.
Massie BM. Heart Failure: Pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 58.
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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Dungeon Fighter Online
Dungeon Fighter Online Overview
Dungeon Fighter Online is a side-scrolling action MMORPG that closely resembles old school beat' em ups like Streets of Rage & Double Dragon. Gameplay-wise, Dungeon Fighter resembles Pi Story. Both games are completely instanced, as every dungeon in the game is an individual instance were only those in the same party can adventure together. Each individual dungeon only takes a few minutes to complete which allows for much more of a casual experience than other MMORPGs. Plenty of quests are available in towns to help players level up quickly. There are currently nine characters to chose from, most of which have four classes, with the first job advancement available at level 20 and new awakened skills at level 50.
Dungeon Fighter Online Screenshots
Dungeon Fighter Online Featured Video
Dungeon Fighter Online Review
By Erhan Altay
Dungeon Fighter Online was developed by the Korean studio Neople in 2005 and originally went by the name 'Dungeon & Fighter.' More recently, Nexon has picked up the game and has decided to bring it to the North American audience. The game entered closed beta testing in July 2009 and has opened its doors to all players as of September 15. Dungeon Fighter is an interesting blend of old and new concepts; it has many of the traditional fantasy MMORPG features we've grown accustomed to, but mixes them with fast-paced, classic beat 'em up style gameplay found in oldschool console titles such as Double Dragons and Streets of Rage. The game is similar to the now defunct Pi Story, but has a more mature art style.
Select Your Fighter
Oddly, Dungeon Fighter Online must be launched from the official website. Clicking the desktop icon that's created during the install process only opens the browser and takes players to the site where they can log in and click 'Play Now' to launch the game. There is currently only a single server available titled 'Cain' with over a dozen channels. As with their other titles, Nexon can be counted on to add additional servers as the need arises. The character creation process in Dungeon Fighter is very simple; there are six classes to choose from with no appearance customization options available. Players can't even select their gender; Fighters, Gunners, and Priests are male while Slayers and Mages are female. The thief class, has not yet been added, but will be available after a scheduled update. Each class has a unique introductory story line presented in comic book form, which is worth reading through.
Saving Seria
After the intro story, players find themselves in a forest and must save a young woman from a group of sleeping goblins. This simple task serves as the game's tutorial by explaining the controls and introducing players to the gameplay style. The keyboard takes center stage in Dungeon Fighter, the arrow keys control movement while hotkeys activate attacks, abilities, and consumables. The graphics are two-dimensional, but players can move up and down as well as left and right. The best way to describe both the visuals and the gameplay in Dugeon Fighter Online is by imagining an old console side-scrolling beat 'em up like Golden Axe for the Sega Genesis. Those who have played Lunia will feel the familiarity between the two games despite radically different art styles and a different camera angle. Dungeon Fighter's resolution is stuck at a paltry 640×480 and with no option to play the game in windowed mode, players with large monitors are forced to endure severely stretched out graphics. The few options available in the settings menu allow players to disable the sound, music, and dialogue but little else. Players walk quite slowly but can double-tap the arrow keys to dash inside dungeons. A large town serves as the central hub from where players accept various quests from NPCs, train their skills, and form parties. This town is broken into several areas with the starting area called Elvenguard. The type of quests players are exposed to here serves as a good sample of what to expect throughout the game. It's always best to talk to all NPCs nearby and accept their quests before heading into a dungeon, since most quests can be completed simultaneously. One NPC may ask you to kill 10 of a certain monster and another may ask you to collect 10 items from the same dungeon. Efficient quest completion in this manner is the best way to level up, especially as a solo player.
Elvenguard & Beyond
The first few dungeons are repetitive both in appearance and with respect to their inhabitants. You wouldn't believe how many shades goblins come in. There are standard green goblins, red goblins, blue goblins, stone throwing goblins, mage goblins, dark green goblins with short scythes, and so on. Several other monster types make an appearance (including minotaurs!), but the forested environment stays the same for the first dozen levels or so. Before long players will graduate from Elvenguard and make their way left towards Hendon Myre, the next major area of town. Here there are a dozen NPCs with quests that revolve around the Grand Flores area, which has many dungeon stages available. Each dungeon can be thought of as a stage or maze depending on your perspective. Like in NosTale, a grid-like minimap is available on the top-right of the screen that helps players guide themselves towards the boss at the end of the level. Players receive large experience bonuses for completing stages and are also graded on their performance. Technique and Style are two important factors in determining a player's grade and are even requirements for certain quests. Many of the missions require players to complete dungeons within a certain time limit, achieve a minimum grade, or avoid getting hit more than a certain number of times. From my experience these sorts of quests are extremely difficult to complete alone since dungeons are designed like mazes with several dead ends. A party is much preferred in these situations and comes with several other advantages; including vastly improved experience bonuses.
Play Together or Die Alone
Dungeon Fighter Online is an MMORPG, but new players may forget that fact during the first few stages of the game. The game's quest system does a good job of keeping players moving along from one dungeon to the next, perhaps too good of a job, since players won't want to take the time to form a group. Obviously there are exceptions to this – if you're playing with a group of friends or if you're a serious completionist who doesn't want to skip the few quests that require multiple players. There's no problem with playing alone for the first dozen levels, at least with your first character, since it serves as good practice. Eventually, teaming up becomes much more attractive since the solo experience rate grinds to a halt. The bonus experience players receive at the end of a stage is multiplied depending on the number of players and larger groups can even access special 'super bosses' in certain dungeons. Most importantly, grouping with others allows players to complete dungeons much faster and keep the game from getting stale. For those looking for a different kind of player interactivity (namely PvP), Dungeon Fighter Online offers an arena feature. Players must be at least level 10 to participate in the arena, though there are several channels each with a different level range to keep matches competitive. Dungeon Fighter's main attraction, however, is the fact that it can be played in small bursts at a time with friends or alone. Gamers looking for a bit of nostalgia or a quick fix should definitely give the game a try. Dungeon Fighter Online may be another side-scrolling game by Nexon, but it plays very differently than MapleStory.
Final Verdict: Good
Dungeon Fighter is a fun, action-packed game with low system requirements. The retro gameplay is a treat for fans of classic beat 'em ups, but players craving more modern visuals may be disappointed. A robust quest system keeps the game well-paced, but repetitive stage designs can cause the game to get tedious.
Dungeon Fighter Online Videos
Dungeon Fighter Online Cinematic Trailer
Dungeon Fighter Online Beginner Video
Dungeon Fighter Online Mirkwood Run 1
Dungeon Fighter Online Mirkwood Run 2
Dungeon Fighter Online System Requirements
Minimum Requirements:
OS: Windows XP / Vista / 2000
CPU: 800 MhZ Pentium 3 or better.
HDD: 5 GB Free
Graphics Card: NVidia GeForce2 MX440 Or better.
Recommended Specifications:
OS: Windows XP / Vista / 2000
CPU: Pentium 4 1 GHz
HDD: 5 GB Free
Graphics Card: GeForce2 FX5200 (128 MB)
Dungeon Fighter Online Articles
- Dungeon Fighter Online Delays CBT - Posted on October 10, 2014
Neople is working hard to get Dungeon Fighter Online back for players - but unfortunately, they've hit a delay. - Weekly MMOHuts Stream (5/23): Dungeon Crawler Brawler Day - Posted on May 23, 2014
JamesBl0nde streams every Friday for MMOHuts on Twitch! - Dungeon Fighter Online makes a unexpected return by Neople - Posted on May 12, 2014
Suddenly, out of nowhere... It has returned! The ever-popular MMO Beat 'Em Up, Dungeon Fighter Online (DFO) has been revealed recently by Neople, the original developers of the game. - Dark Blood Announces Fishing For The Holidays - Posted on November 8, 2012
Outspark announced today that an exciting new fishing system will be making its debut in Dark Blood next Thursday, November 15, for players Level 20 and greater. Now fans of the hit, hardcore free-to-play arcade brawler can camp by the scenic rivers and lakes of Elwood Village and Water Veil with a roaring campfire by their side, and enjoy casting their lines into glistening piscine waters.
Similar games we recommend
- Elsword Online - Elsword Online is a 2D fantasy MMORPG side-scroller. Work with other players to clear stages in this anime inspired action oriented beat 'em up!
- Grand Chase - Grand Chase is a 2D side-scrolling action MMO with co-op and versus gameplay modes. Play instanced stages with up to four players or battle it out in PvP mode.


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Apr, 2014
I've not experienced this particular problem – with one exception – but I can well imagine that others have: a driver's rearward visibility is marred by cargo, tall passengers, inclement weather, or what have you. Not good. Nissan is offering a solution – a Smart Rearview Mirror that combines a newly developed narrow-angle camera and a specially shaped LCD monitor. The monitor has an aspect … Read More
Nissan Rogue, rearview mirror, New York Auto Show, Smart Rearview Mirror


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Wood Nature Plaques
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Above her bed or over her desk, these sweet flying friends and delightful daisies bring summertime smiles. Designed in a simple storybook style, each image is screen printed with hand-painted details on solid wood.
- 14" square
- Artwork is silk screened on solid wood.
- Sawtooth mount; mounting hardware not included.
- Sold individually.
- Dimensions & Care
- Overall: 14" square
- Weight: 1.25 pounds
- Dust with a soft, dry cloth.
- To protect the finish, do not apply abrasives or household cleaners.
- Shipping Info
- Please allow 5-7 business days for delivery. Delivery estimate includes monogrammed and gift-wrapped items.
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Reality Check on Cancer: Fast Progress But Too Many Preventable Deaths
The latest status report from the American Association for Cancer Research (AACR) shows that most cancer deaths are avoidable.
The latest status report from the American Association for Cancer Research (AACR) shows that most cancer deaths are avoidable.
For the first time, researchers show how a plant-based diet, stress management and other lifestyle changes may lead to longevity.
It's been 20 years since the Vaccines for Children (VFC) program provided free immunizations to all US youngsters. How well has the program done?
Anyone who has taken an alcohol-breathalyzer test knows what a snitch breath can be.
Real-life stories of former smokers' health problems provided the motivation smokers needed.
After failing to find ways of removing the brain plaques responsible for the disease, researchers now say they have another way of tackling Alzheimer's worst symptoms that leaves the plaques in place.
Decisions to decisions. How to choose from the wide variety available
Researchers discovered it before it became a pandemic, but there's no vaccine for it yet
Anthony Stokes now has a new heart, according to his family.
Told he should go home and prepare to die, Atlanta teen is now on the transplant list.
It's a day to celebrate the 10% who always feel they're being elbowed out by the other 90%
Shared medical appointments, or group visits, are becoming a popular — and possibly more satisfying — way to see the doctor.
Former President George W. Bush was hospitalized on Tuesday to treat a blocked artery in his heart.


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Funny Commercials
Intermediate4 videos
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Fedex: Going Golfing
About this Video
An assistant is on the phone with her boss who calls in sick while the rest of the staff get ready for golf.
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Key Learning Points
- making a phone call
- apologizing
The Man Your Man Could Smell Like
About this Video
A funny deodorant commercial shows what it's like to be a man.
Source: Old Spice
Key Learning Points
- asking someone to do something
- expressing possibilities
Nike: Back for the Future
About this Video
A salesman and a customer encounter a man who claims to be from another time.
Source: NikeB4TF
Key Learning Points
- attracting attention
- introducing something to someone
FedEx: Castaway
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A man finds out that everything he needed to survive on an island was with him the entire time.
Source: FedEx
Key Learning Points
- expressing gratitude
- enumerating
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quote:Cutting programs that prevent visits??? Just stupid.
quote:Do you get so upset when someone has a dream team of lawyers to fight their murder case (OJ) versus those that only have a public defender?
quote:I applaud Jindal for living within our means. The country should take note.
quote:Be responsible for self and pay for your own health care.
quote:.let's live within our means. Screw poor people..
quote: If a person makes 20 k a year...and has a family of four...
quote:How about, not have a family of 4 if you only make 20k/year?
quote:What I do know is that you hold up medicaid as a good system.
quote:The problem with health care today is at its basic element - Cost. Nothing is being done to stream line the process, cut out waste
quote:No one knows it more than me so don't even go there bud.
quote:BTW I grew up one of these poor people and busted my azz to get where I am today. No one knows it more than me so don't even go there bud.
quote:The biggest (pardon the pun) in the American healthcare crisis is OBESITY. We need to be investing in obesity prevention.
quote:I guess Louisiana should follow Michigan's economic model...


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Congratulations to the Ann Arbor Mini Maker team for a successful Faire! Over 1100 attendees blew smoke rings, rode the worlds largest (claimed) bristlebot, piloted robots, made music, silk-screened t-shirts and had a great time! Missed it? Be sure to check out the Flickr pool, or read the excellent writeup at the Ann Arbor Chronicle!
Photo credits: Matt Mets, Dug Song


text:
Search Swinburne Research Bank
Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.3/35259
- Title
- Team and equipment mental models
- Author(s)
- Langan-Fox, Janice; Edlund, Geoffrey; Code, Sharon L.
- Abstract
- In cognitive psychology, researchers have suggested that mental models are important to the general understanding of how humans interact and cope with the world. Mental models are believed to guide comprehension of and responses to information in the environment. Two branches of mental model literature are discussed, and some preliminary findings presented regarding team and equipment mental models. Team mental models were explored and measured in a large government business enterprises, and concerned management and shop floor employee experiences of industrial participation. Equipment mental models were explored in relation to cases using a large mobile telephone network.
- Publication type
- Conference abstract
- Source
- Productivity, ergonomics and safety : the total package : Proceedings of the International Workplace Health and Safety Forum and the 33rd Ergonomics Society of Australia Conference, Gold Coast, Queensland, Australia, 24-27 November 1997, p. 101
- Publication year
- 1997
- Keyword(s)
- Cognitive psychology; Ergonomics; Industrial psychology; Mental models; Mobile phones; Networks; Occupational psychology; Team mental models; TMMs; Working environment
- Publisher
- Ergonomics Society of Australia, and Workplace Health and Safety Program, Department of Training and Industrial Relations
- Copyright
- Copyright © held jointly by the Ergonomics Society of Australia and the Department of Training and Industrial Relations, 1997.


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Each month, the Cub Scout program focuses on a core value. The Cub Scout April theme is Faith. BSA has started releasing theme based pack meeting plans for each of these core values. I hear that the new April theme will be Cub Scouts Give Thanks. So this month, I'll be highlighting some ways that thankfulness can be incorporated into the Cub Scout program on my site ScouterMom.com.
This April theme for Cub Scouts brings to mind both thankfulness to the Creator and remembering to show appreciation to each other. This thankfulness theme also presents a good opportunity for your Cub Scouts to thank everyone who helps them with the program – their parents, their leaders, and the chartering organization. Have your Cub Scouts spend some time writing thank you notes to them, or come up with a creative way for the Cubs to show their appreciation.
Related Cub Scout Achievements and Recognitions
Bear Achievement 18 – Jot It Down
- Requirement e: Write a thank you note.
Good Manners Belt Loop
- Requirement 3: Write a thank-you note to someone who has given you something or done something nice for you.
Computers Pin
- Requirement 6: Use a computer to prepare a thank-you letter to someone.


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May 18th, 2012
With tonight's season finale of Degrassi promising us at least one EClare moment (check out these sneak peek pics here) we decided to take some time to reflect on our favourite EClare moments. Somehow we managed to whittle the list down to just 10, but let's face it – we could go on all day about our love for EClare.
Check out the Top 10 EClare Moments below and don't miss the season finale of Degrassi tonight at 9 pm ET on MuchMusic! Catch up on Season 11 online here!
Tune in to MuchMusic starting at 8 pm ET this Friday for your chance to win one of the three amazing prize packs from Lauren Toyota and the cast of Degrassi while they do live hits on MuchMusic leading up to the Season 11 Degrassi finale at 9 pm ET.
Tags: degrassi
Posted on Friday, May 18th, 2012 at 1:40 pm by Allison and is filed under Degrassi on Much.


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High school roundup: STA girls rally to upset No. 5 Hollis-Brookline
Wednesday, February 27, 2013
HOLLIS — The St. Thomas Aquinas High School girls basketball team overcame a 19-point halftime deficit to upset Hollis-Brookline on the road in the Division II tournament's first round Tuesday, 56-53.
Abby Ahern led the Bears (12-7) with 15 points, while Sarah Curtin and Liz Peabody added 12 each.
Anthony Lupi led the way with 14 points, Kam Towle added 11 and Colin Shaughnessy tossed in 10.
The winner will play at No. 2 Spaulding (15-2-1) Saturday, 7 p.m., at the Rochester Arena. |


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Easy Mother's Day Foods the Kids Can Help Make
Treat Mom to breakfast in bed this Mother's Day. The kids can help cook these delicious brunch recipes that will make Mom smile.
Need a few more ideas to impress Mom this Mother's Day? Take a peek at our collection of Mother's Day brunch beverages.


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Juliana Floral/Cecelia Paisley Cosmetic Bags, Set of 2
No longer available
Designed with two coordinating prints, our quilted cosmetic bags are perfectly sized to tuck inside a purse or tote.
Small: 8.5" wide x 4.5" deep x 5" high
Large: 13" wide x 5" deep x 7" high
Woven of pure cotton.
Interior is a solid bisque color lined with leakproof vinyl.
Interior elastic pocket on one side.
Zipper closure.
Set of 2, one of each size.
Spot clean.


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quote:Yeah bull shite that you expect a whole race to just get over it because you say so.
quote:Seems if black folks were really interested in doing something for their community, they would look to Gary Johnson who supports the decriminalization of many drug laws which could radically change the "community"
quote:and your argument is weak. No black person alive today was ever a slave. Few are even around long enough to remember the civil rights movement.
quote:My grandparents were from south louisiana and taught us never to trust white folks ever
quote:Let's face it, any black today that "hates" white people does so as a conscious choice based solely on their own prejudice and has absolutely nothing to do with white people's attitude towards blacks as a whole.
quote:Shouldn't excuse it though
quote: My grandparents were from south louisiana and taught us never to trust white folks ever.
quote: My grandparents were from south louisiana and taught us never to trust white folks ever. Sounds like a smart way to go through life.
quote:It can be difficult to overcome prejudices that are passed down over many generations
quote:The problem is that a lot of young black people are more racist than their parents
quote:Not racist just realist. I would imagine that race doesn't mean a lot to whites because it never affects them on the same level. I've seen white people change directions to avoid me on the sidewalk, follow me around in a store, etc. It stings (but I've been prepared) to see that another person is suspicious of me just because my skin is brown.
quote:So you don't think you have equal (or more in most cases) opportunities than a white person?
quote:why not just graduate from high school, take out a loan for college, graduate and get a job to fit your degree like others do?
quote:Is a pigs arse pork?


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Narrow By Clear All
31 waist Boys' School Uniforms
Get ready for class with boys' school uniforms
Every year, your son outgrows his old school uniform, and needs a new wardrobe to get through the school days. When you're regularly replacing too-small pants and jackets, you don't want to spend a fortune. At Kmart, you can find the boys' school uniforms that he needs every year at a price you can afford. Replacing shirts, sweaters and ties will also give him the opportunity to change things up with the latest in school uniforms for boys.
A school uniform makes it easy for your kids to get ready in the morning. His school uniform options are few, but they offer the perfect mix of choice and simplicity, making his mornings just a little easier. Instead of spending hours deciding on the perfect pair of boys' jeans, your little man can wake up, get dressed quickly and enjoy a leisurely breakfast with the family before school.
At Kmart, you can stock up on boys' school uniform pieces and boys' everyday essentials for the entire school year so he's ready for every season. Look for the newest uniform styles in the school-approved colors and patterns that your kids need. From sweater colors and tie patterns to dress shirt styles and jacket designs, your littlest man is going to love getting ready in the morning.


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Faithful Catholics
In being confronted with the reality of sexual scandal in our Church, at all levels really, I am wondering if there is something we might do here on CM that could result in the building up of our Catholic Faith. Every now and then I see a post by one person or another that comments rather incredulously that people who are not in agreement with 7 listed Faith Questions still are allowed to participate on a "Catholic" dating site.
Would CM truly be more helpful to the Catholic Church on a whole if people who are not willing to accept the 7 Church Teachings listed, especially, in the light of the current sexual scandals rocking the Church, the teaching on no sex outside of marriage, the teaching on contraception, and the understanding that a Catholic, once married and divorced, is not free to even date until, or if, an annulment has been obtained? What do you think?
I'm interested to hear what Catholics faithful to the teachings of the Church think about this as well as those who do not accept the teachings of the Church.
May God bless and guide us all.


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Exciting News - We will have a brand new web site very soon. Stay tuned & see you in 2015! |
On behalf of the Brandywine Health Foundation, our Board of Directors and the 2014 Festival Committee, we extend a very special thank you to First Niagara Bank and PECO for returning as the presenting sponsors and for continuing your generous support of the 2014 Strawberry Festival. We also want to thank Brandywine Hospital for once again hosting this very special community event. Your continued contributions to this event are overwhelming! |
Explore | Plan | Live
Performances | Family Fun | Schedule |
Food | Crafts,
Artisans & Vendors | Directions | Become A Volunteer | Mission | Sponsors | Become A Vendor | Home |
Contact the Brandywine Health Foundation | ||||||||||
Site Designed & Donated by Neptune Moon LLC. |


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FLMNH Vertebrate Fossil Collections
The Florida Museum maintains five separate fossil vertebrate collections. Their specimens derive mainly from the Cenozoic Era (last 65 million years), with more than 80% coming from about 1000 localities in Florida. Other major contributing regions are islands in the Caribbean Basin, Central and South America, and intermontaine basins of Wyoming and Montana. Combined, the collections total about 775,000 specimens, of which more than 475,000 are catalogued and on a searchable computer database. Holotypes number about 225 specimens.
The primary and largest of our collections consists of specimens recovered by Florida Museum of Natural History staff, graduate students, and volunteers and those donated to the museum. This collection is referred to as the UF collection. Three other vertebrate fossil collections are the former collection of the Florida Geological Survey, portions of the Timberlane Research Organization collection, and the UF Department of Zoology Fossil Bird Collection (assembled by the late Professor Pierce Brodkorb). Each of these collections is maintained in a separate catalog, under the acronyms UF/FGS, UF/TRO, and UF/PB, respectively. The fifth collection (UF/IGM) is maintained for specimens collected in Colombia by joint expeditions of personnel from the Florida Museum of Natural History, the Instituto Nacional de Investigaciones Geologico-Mineras (Bogota, Colombia), and the Smithsonian Tropical Research Institute. Following their preparation, casting, study, and publication, the original fossils will be housed in Bogota and casts will be stored in Gainesville.
The FLMNH collections provide the most complete basis available for study of Cenozoic vertebrate life and evolution in the eastern United States and the circum-Caribbean Basin area.
We will excavate fossils at the Thomas Farm Site in Gilchrist County on March 24-31 and April 3-6. Click here for more details and link to an application form.
Three Florida Museum paleontology collections (invertebrate paleontology, vertebrate paleontology, and paleobotany) are hosting the 2014 North American Paleontological Conference on February 15-18, with pre- and post-conference field trips. Over 300 applications were received from paleontologists from around the world to deliver presentations at the conference. Detailed information can be found at this web site.
In March 2013, vertebrate paleontologists from the Florida Museum of Natural History and co-authors from other institutions have named two new genera and species of caimans and a new species of anthracothere from the early Miocene of Panama and a new genus and species of sabertoothed cat from the early Pliocene of Florida in three separately published scientific papers.
The tiger-sized sabertoothed cat Smilodon fatalis from the late Pleistocene is one of the iconic fossils of its time and well known to the general public. Most use the term ?sabertoothed cat? to just refer to this single species. But sabertooth cats are instead a group of about 20 to 25 valid species known from all continents except Australia and Antarctica. They first appear in the middle Miocene of Eurasia. The ancestry of Smilodon fatalis can be traced back to a jaguar-sized species known as Smilodon gracilis in the early Pleistocene, between 2.5 and 1 million years ago. A second, similar-sized species Megantereon hesperus first appears in the late Pliocene, about 3.5 million years ago. Together Smilodon and Megantereon are classified in the tribe Smilodontini, and they differ from other sabertooth cats by having short, powerful limbs and extremely elongated upper canine teeth. Until now there was no clear evolutionary link between the Smilodontini and other sabertoothed cats. Writing in the online journal PLOS One, Steven Wallace of East Tennessee State University and Richard Hulbert Jr. of the Florida Museum of Natural History name and describe a new genus and species of sabertooth cat from the very early Pliocene (about 4.5 million years ago) from Central Florida. Its name is Rhizosmilodon fiteae, and the anatomy of its lower jaw and teeth are intermediate between Eurasian Miocene sabertooths such as Paramachaerodus and the older members of the Smilodontini, Smilodon gracilis and Megantereon hesperus. Wallace and Hulbert used the widths of several limb bones to estimate the body mass of Rhizosmilodon fiteae to be between 55 and 85 kilograms (about 120-190 pounds), similar to modern jaguars and leopards. Their analysis of its evolutionary relationships place it within the Smilodontini, as its oldest and most primitive member. This means that the tribe lived in North America for at least 4.5 million years, and that Smilodon evolved in North America. All the known fossils of Rhizosmilodon fiteae were found in the commercial phosphate mines of central Florida, mostly in southwestern Polk and northwestern Hardee counties. The species is named for Barbara Fite of Lutz, Florida, who donated one of the better specimens to the Florida Museum of Natural History. Wallace S. C., and R. C. Hulbert Jr. 2013. A new machairodont from the Palmetto Fauna (early Pliocene) of Florida, with comments on the origin of the Smilodontini (Mammalia, Carnivora, Felidae). PLoS ONE 8(3):e56173. University of Florida press release on the sabertoothed cat paper. The report describing the two new caimans was authored by former UF graduate student Alex Hastings (currently at Georgia Southern University) along with current UF graduate student Aldo Rincon, Florida Museum curators Jonathan Bloch and Bruce MacFadden, and Carlos Jaramillo of the Smithsonian Tropical Research Institute. It is one of a number of recent papers documenting fossils discovered as a result of construction to widen the Panama Canal that has exposed fossil-bearing sediments that were otherwise covered by jungle. Collection funding is provided by a major grant from the National Science Foundation. Caimans are members of the alligator family, and today live in South America. Fossil caimans are more widespread, being also known from North America. The species were named Culebrasuchus mesoamericanus and Centenariosuchus gilmorei. The single known specimen of Culebrasuchus mesoamericanus came from the Culebra Formation, while specimens of Centenariosuchus gilmorei were found in the overlying, slightly younger Cucaracha Formation. Despite being of similar geologic age, the evolutionary analysis presented in the paper by Hastings et al. suggests that the two likely had very different histories. Culebrasuchus is regarded as the most primitive caiman in terms of its anatomy, despite being tens of millions younger than the oldest known fossil caimans. Centenariosuchus falls within a group of extinct caimans that are all otherwise known from South America that includes the giant form Purussaurus and the ?duck-billed? caiman Mourasuchus. If this relationship is correct, then this represents one of the oldest known dispersal events between North and South America in the Neogene for a non-flying vertebrate. Several other types of crocodilians were reported from Panama in the paper, but from fossils too incomplete to identify with certainty. Several fragments of jaws represent a form with a long, slender rostrum, like a gharial or the extinct crocodile Gavialosuchus, while two very large teeth are similar to those of the large caiman Purussaurus. Hastings, A., J. I. Bloch, C.A. Jaramillo, A. Rincon, and B. J. MacFadden. 2013. Systematics and biogeography of crocodylians from the Miocene of Panama. Journal of Vertebrate Paleontology, 33(2):239-263. (if you cannot freely access the website, contact the lead author for a pdf of this paper) Anthracotheres are an extinct family of artiodactyls, the mammalian order that includes pigs, hippos, giraffes, deer, sheep, and antelope. Anthracothere fossils have been found in Europe, Asia, Africa, and North America, with an age range of Eocene to Miocene. Some paleontologists believe anthracotheres are either ancestral to or closely related to hippos. In the new paper, UF graduate student Aldo Rincon and co-authors Jonathan Bloch, Bruce MacFadden, and Carlos Jaramillo, describe the first known specimens of an anthracothere from Central America. They form the basis of a new species called Arretotherium meridionale. The genus is also known from fossils in Saskatchewan, South Dakota, Montana, Nebraska, and coastal Texas. Rincon, A. F., J. I. Bloch, B. J. MacFadden, and C. A. Jaramillo. 2013. First Central American record of Anthracotheriidae (Mammalia, Bothriodontinae) from the early Miocene of Panama. Journal of Vertebrate Paleontology, 33(2):421?433. (if you cannot freely access the website, contact the lead author for a pdf of this paper) University of Florida press release on the two Panama papers.


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After struggles on and off the track during his first season at Furniture Row Racing, Martin Truex Jr. says he's settling in and optimistic about the future. And as he prepares to race in this week's NASCAR Sprint Cup Series race at Atlanta Motor Speedway, it's showing.
Posted on 28 February 2015 | 9:42 am
Stanley Furniture Company, Inc. today reported sales and operating results for the fourth quarter and total year ending December 31, 2014.
Posted on 25 February 2015 | 3:44 pm
Puritan Furniture, 1061 New Britain Ave., West Hartford, 860-236-4271, and the Puritan Distribution Outlet, 1210 Silas Deane Highway, Wethersfield, 860-529-8231, are each holding a 12-hour clearance sale from 11 a.m. to 11 p.m. Saturday, Feb. 28. Furniture and bedding will be discounted...
Posted on 26 February 2015 | 1:34 pm
Over the Past 10 Years, Morris Furniture Company has Invested Over $1 Million into Area Nonprofits, Especially Those in the Arts FAIRBORN, OH / ACCESSWIRE / February 27, 2015 / Morris Furniture Company, ...
Posted on 27 February 2015 | 6:00 am
DFS Furniture Holdings [DFSFH.UL] has set the price range for its initial public offering at 245-310 pence per share, which would value the company at 585 million pounds ($899.55 million) at the middle of the price range. The company said in a statement it expected to raise 98 million pounds through the listing on the London Stock Exchange.
Posted on 23 February 2015 | 1:39 am
The plastic elements look like ropes made out of Play-doh. The post A Novel Furniture Idea: Squeeze It From a Tube appeared first on WIRED .
Posted on 25 February 2015 | 8:57 am
The Dock 86 store in Little Canada will soon be joined by HOM Furniture and Gabberts in the space that used to serve as the warehouse for Dock 86. All three stores will be attached, and they will open at 9:30 a.m. Saturday.
Posted on 27 February 2015 | 6:40 pm
Leon's Furniture Limited - 2014 Fourth Quarter
Posted on 26 February 2015 | 4:26 pm
Ballistic Furniture Systems, Inc., the premier manufacturer of ballistic protection for workplaces and public areas, is launching Amulet™ Retrofit 'E' Kits to transform current off
Posted on 26 February 2015 | 7:00 am
You'll be able to drop a compatible smartphone on your IKEA nightstand for a quick charge.
Posted on 1 March 2015 | 1:37 am