text: 1682 Empire Boulevard, Webster, NY 14580 3101 West Ridge Road, Bldg. D, Rochester, NY 14626 90 Office Park Way, Pittsford, NY 14534 Tel. (585) 671‐6790 Fax (585) 671‐1931 Tel. (585) 225‐1580 Fax (585) 225‐2040 Tel. (585) 225‐1580 Fax (585) 586‐2878 PRENATAL FOLDER TABLE OF CONTENTS Page Welcome 2 Prenatal Care – What to Expect 2 Nutrition 3 Weight Gain 4 Exercise 4 Sexual Intercourse 5 Toxoplasmosis 5 Travel 5 Smoking 5 Medications 5 Over‐the‐Counter Drugs 6 Changes During Pregnancy 6 Common Sensations in Early Pregnancy 6 Common Symptoms as Your Pregnancy Progresses 7 Labor and Delivery 8 Breastfeeding 10 When to Call 10 Administrative Issues 10 Patient Responsibility for Payment 10 Changes in Personal Information 11 Disability Claim Forms 11 Insurance Reminder 11 ADDITIONAL PACKET CONTENTS Educational Pamphlets (located in left pocket): Cystic Fibrosis Carrier Testing Car Safety for You and Your Baby 1st Trimester Screening: Is it right for you? Rochester General Hospital's TWIG Birthing Center Rochester General Hospital Childbirth Education Offerings Additional Information and Materials (located in right pocket): Why Choose a Group Practice for Your Obstetrical Care? Why Choose Rochester General Hospital for Your Delivery? West Ridge OB/GYN Recommended Reading List Pediatrician and Family Practitioner Listing Accepting New Patients West Ridge OB/GYN – 10/13 WELCOME!!!! We are pleased that you have chosen West Ridge Obstetrics and Gynecology to provide your care during pregnancy. Included in this packet are some general instructions and guidelines for normal pregnancies. If you have any special requirements, we will be happy to discuss them with you. Please feel free to call us during office hours from 8:30 AM to 4:30 PM, Monday through Friday, with any questions or concerns. We can be reached by calling one of our office numbers at: 5852251580 Greece office / Pittsford office 5856716790 Webster office We are available and would like you to call us if you are worried or have any questions. For emergencies, one of our physicians is always available and may be reached by calling one of our offices. If our offices are closed, our answering service can locate the on‐call doctor to assist you. If you do not receive an answer at either of the above numbers, you may reach our answering service directly at: 5857236516. For more information regarding our practice and additional educational information, please visit our website at ~ www.wrog.org. PRENATAL CARE – WHAT TO EXPECT Comprehensive prenatal care is critical to the birth of a healthy baby. Prenatal care should begin early in your pregnancy, usually in the first trimester, and continue until the baby's birth. During the course of your pregnancy, certain examinations and tests are performed to ensure your health and the health of your baby. Please read through this folder and review the enclosed information so that you can have an understanding of what to expect throughout your pregnancy. **After your initial visit, you should carefully review the information about cystic fibrosis and the 1st & 2nd Trimester Screening, so that we can better address your individual questions and concerns regarding these optional tests. Prenatal visit schedule: Every 4 weeks until the 28th week of pregnancy After 28 weeks, every 2 weeks until the 36th week of pregnancy Weekly visits after 36 weeks of pregnancy Postpartum visit approximately 4‐6 weeks following delivery The following are typically performed at the initial visit: Complete health history, including personal and family history Physical examination, including pelvic exam and Pap smear Prenatal blood testing is ordered which includes blood type and Rh factor, complete blood count, syphilis, HIV testing, lead level, rubella, hepatitis B, a urine culture, optional cystic fibrosis gene testing, and any other tests your doctor deems appropriate At each of the prenatal visits for the rest of the pregnancy, the following are checked: Your weight, blood pressure, and urine tests for sugar and protein Abdominal exam to measure the growth of the uterus and estimate the size and position of your baby Fetal heart rate ~ 2 ~ Additional routine testing that is done during the course of the pregnancy: At around 11‐13 weeks, optional 1st Trimester Screen for Down Syndrome and Trisomy 18 At around 15‐18 weeks, optional quadruple marker screening for Down Syndrome, Trisomy 18, spinal cord defects (such as spina bifida), and abdominal wall defects At 18‐20 weeks, anatomic ultrasound to rule out any fetal anomalies. At 26 weeks, one hour Glucola blood test to screen for gestational diabetes, blood test for anemia, and blood test for Rh antibodies in Rh negative women At 36 weeks, Group B streptococcus vaginal culture to test for carrier status prior to delivery. If your test is positive, you will be treated with antibiotics when you are in labor. Hospital Registration At approximately 24 to 28 weeks, you will be given a packet for Rochester General Hospital, which includes the Patient Bill of Rights and the Hospital registration packet to be completed as instructed. Choosing a Pediatrician It is important to find a pediatrician for your baby during the pregnancy. We have provided you with a list of pediatricians to help you in your search. It is important to find a doctor or group who will be most able to meet the needs of you and your child. Important things to consider as you choose a doctor for your baby include location, office hours, and having a physician or practice who can be supportive of your decisions about child care (breastfeeding, nutrition, discipline, daycare, etc). NUTRITION Healthy Diet Eating a well balanced diet is an important part of staying healthy throughout your life, but it is especially important during pregnancy for you and your baby. Your diet should include proteins, carbohydrates, fats, vitamins and minerals. Good sources of protein may be obtained from lean meats, poultry, fish, and milk products. The remainder of the diet should be well balanced with vegetables, fruits, breads, and cereal products. Pregnant women need approximately 300 extra calories per day, which is equivalent to an added one or two healthy snacks. Be cautious of fats and concentrated sugars (candy, soft drinks), which have many empty calories. Aspartame (NutraSweet, Equal) and Splenda have been shown to be safe in pregnancy. If you have some fluid retention, watch out for very salty foods (canned meats, canned soups, chips, pretzels, olives, tomato sauces, etc.). Read labels! There is hidden salt in so many prepared foods. Do not eliminate salt from your diet, however. Vitamins A daily prenatal vitamin supplement is recommended for every woman in pregnancy to meet the increased dietary needs for a variety of nutrients. Folic acid (at least 400 mcg) is a supplement included in the prenatal vitamins that is especially important during and before becoming pregnant to decrease certain types of birth defects. Prenatal vitamins also have a sufficient amount of iron needed for most women to prevent iron‐deficiency anemia during the pregnancy. You should also be getting approximately 1000 mg of calcium daily, which may not be included in your vitamin. Three servings each day of calcium‐rich foods such as milk, yogurt, cheese, or dark green leafy vegetables should be adequate. If you are unable to get calcium through your diet, a separate calcium supplement may be taken. Very large doses of vitamins may be harmful and should be avoided. If you are a vegetarian, please discuss this with your doctor. You will need to be sure you are getting adequate protein, iron, vitamins B12 and vitamin D. ~ 3 ~ Caffeine We advise patients to eliminate or minimize the use of caffeinated beverages in pregnancy. The American College of Obstetricians and Gynecologists recommends consumption of no more than two 8 ounce caffeinated beverages a day. Alcohol Drinking alcohol during pregnancy can put the baby at risk for growth restriction, heart defects, abnormal facial features, problems with joints and limbs, and mental and behavioral problems. There is no known safe level of alcohol in pregnancy, and therefore we recommend not drinking during pregnancy. (Many women have had alcoholic drinks prior to finding out they were pregnant. Most of these pregnancies will be uncomplicated if alcohol intake is stopped early in the pregnancy). Mercury Fish is a good source of protein and other nutrients, however, some types may contain high levels of mercury which may affect the baby's development. Fish such as shark, king mackerel, swordfish, tile fish, and albacore tuna should be avoided. Also, do not eat fish that came from Lake Ontario. You can eat up to 12 ounces or 2 meals per week, of other types of fish or shellfish that are low in mercury, including shrimp, canned light tuna, salmon, pollock, and catfish. No fish should be eaten raw. Listeriosis Listeriosis is a food borne illness caused by the Listeria bacteria that in pregnant women can result in preterm delivery, miscarriage, stillbirth, or severe newborn illness. To avoid Listeriosis, you should avoid hot dogs, luncheon, or deli meats unless they are heated to a steaming hot temperature. Avoid pate or meat spreads. Do not eat soft cheeses such as feta, blue cheese, Brie, or Mexican‐style soft cheeses. Cheeses such as cream cheeses, mozzarella, cottage cheese, and pasteurized cheese slices are examples of cheeses that can be safely eaten. Do not eat refrigerated smoked seafood (includes lox, kippered, jerky, smoked labels) unless it is in a cooked dish. Do not eat or drink products that contain unpasteurized milk. WEIGHT GAIN A healthy weight gain for most women is between 25‐35 pounds for the entire pregnancy. If you are overweight, you should gain between 15‐25 pounds. If you are underweight or pregnant with twins, you may need to gain more. Most of this comes in the last three months when the baby is growing very rapidly. Pregnancy is not the time to attempt weight loss. EXERCISE Daily exercise is highly recommended for all women during an uncomplicated pregnancy. Exercise can improve muscle tone and strength and lessen some of the aches and pains during the pregnancy, including back pain. It may improve your mood, help you sleep better, and provide you with more energy. You may also have less swelling, bloating, and constipation. Exercising in pregnancy has been shown to help you cope better with the pain of labor, and to be able to get back into shape more easily after the baby is born. Almost any exercise activity is allowable as long as there is no discomfort. It does not count as exercising to be at a tiring job, to run after a child all day, or to do lots of housework. These activities certainly can be exhausting, but exercise is a planned aerobic or strength‐conditioning activity. If you already exercise regularly, you can continue in moderation. If you would like to start, begin with exercising a few minutes most days of the week and work your way up to about 30 minutes of a day. Be sure to drink plenty of fluids while you exercise. ~ 4 ~ Very high levels of exercise for long periods of time may be problematic for blood flow through the uterus and are not recommended. Avoid situations that may elevate body temperature such as saunas, steam rooms, and very warm hot tubs. Women who enjoy aerobics usually should switch to low impact in mid‐ pregnancy. In late pregnancy when many exercises are awkward, lap swimming is especially good. Activities that should be avoided particularly during the second half of your pregnancy include downhill skiing, water skiing, scuba diving, gymnastics, horseback riding, and contact sports such as soccer, basketball, and hockey. In addition, women should avoid exercises that require them lying flat on their back during the second half of the pregnancy. SEXUAL INTERCOURSE In general, sexual intercourse may be continued to the end of pregnancy as long as there is no discomfort and the water has not broken. Please inform us if there is any bleeding following intercourse. TOXOPLASMOSIS Toxoplasmosis is a rare parasite infection transmitted in two ways: by cats and by handling or eating rare or raw meat. If you develop toxoplasmosis in pregnancy there is some risk to the baby. Cats may carry the infection in their feces, so a pregnant woman should avoid handling cat litter. You should wear a mask and gloves if no one else is able to change the litter. Also, when gardening, wear gloves as soil can be potentially contaminated. Some of the beef and pork that we consume may be affected, but the organism is killed by cooking. Avoid eating undercooked meat and wash your hands thoroughly after handling raw meat. TRAVEL Travel by any means is permissible throughout a normal pregnancy. If you plan a trip in the last month of pregnancy, please check with us. If seated during a long trip, take breaks to help your circulation, by walking or stretching your legs for 5‐10 minutes every hour or so. You may also want to consider wearing support hose, and be sure to drink plenty of fluids. According to the American College of Obstetricians and Gynecologists, "Although the baby is well protected inside of your body, for the best protection in a vehicle, wear a lap‐shoulder belt while you're pregnant every time you travel. The safety belt will not hurt your baby. You and your baby are far more likely to survive a car crash if you are buckled in. The upper part of the belt should cross your shoulder without chafing your neck. Never slip the upper part of the belt off your shoulder. Safety belts worn too loosely or too high on the belly can cause broken ribs or injuries to your belly. But more damage is caused when they aren't used at all." SMOKING There is powerful evidence that smoking can harm the developing baby. Smoking during pregnancy increases the risk of miscarriage, preterm delivery, growth restriction, stillbirth, and Sudden Infant Death Syndrome (SIDS). We strongly encourage women not to smoke at all, and especially not while pregnant. If you are a smoker, please ask us for information available on smoking during pregnancy and ask us for assistance to help you quit! MEDICATIONS All drugs have potential side effects and should be used only when the risk of taking the drug has been weighed against the benefit to be obtained. Although drugs account for only a very small percentage of problems in newborns, the most sensitive time in the infant's development is the first few weeks when a woman may not even know she is pregnant. Your doctor at West Ridge Obstetrics & Gynecology should be aware of any prescription medications you are taking, or of any herbal or homeopathic substances you are using during pregnancy. It is also important to notify all other health care providers, including dentists, if pregnancy is a possibility. We are available to consult with your other physicians or dentist if prescription drugs are indicated. Please encourage them to call us if they have any questions regarding the safety of medications. ~ 5 ~ OvertheCounter Medications (OTC): Pain Acetaminophen (Tylenol) appears to be safe for use throughout pregnancy. Please avoid aspirin and ibuprofen (Advil, Motrin, Aleve). Nausea and Vomiting Vitamin B6 in doses of 25 mg two or three times a day has no risk and may be effective. Higher doses are not recommended. Coughs, Colds, and Hay Fever ‐ Sudafed is a decongestant that appears to be safe after the 1st trimester. Saline nasal spray may also alleviate symptoms throughout pregnancy. Afrin nose spray is effective and safe (although your nose can easily become addicted to its use). Plain Robitussin is approved for coughs in pregnancy. Antihistamines such as Claritin and Benadryl are safe to use for seasonal allergy symptoms. Heartburn Almost all available antacids, in both tablet and liquid form, are safe. This includes Tums, Mylanta, Maalox, Zantac, and Pepcid AC. Avoid the bubbly ones containing aspirin (Alka‐Seltzer), and do not use baking soda as an antacid. Pepto‐Bismol should also not be used. Hemorrhoids All available medications appear to be safe. Diarrhea Imodium may be used, but if the diarrhea persists, you should contact your physician. Constipation Bulking agents (Metamucil, FiberCon) do not stimulate bowel function and are not addictive, and so are safe and effective throughout pregnancy. Softeners (Colace) also are safe and may be used daily. Avoid the use of stimulant laxatives such as Milk of Magnesia and Ex‐Lax unless directed to use by your doctor. Skin Preparations Calamine lotion and hydrocortisone creams appear to be safe. Vaginal Yeast Medications ‐ The over the counter preparations (such as Monistat) appear to be safe throughout pregnancy. CHANGES DURING PREGNANCY Common Sensations in Early Pregnancy Early pregnancy experiences vary greatly from one woman to another. Some feel wonderful, and others may feel awful. The majority of women do well, but have some unpleasant symptoms from time to time. The most common of these is extreme exhaustion despite adequate rest. Nothing but more rest is helpful for this distressing but non‐worrisome symptom. Breast tenderness and enlargement are common, and a well‐fitting bra will usually relieve discomfort. Nausea, with or without vomiting, is frequently called "morning sickness" but may occur at any time of the day. Most women feel better eating a little starchy food (such as crackers, and reads) at frequent intervals. Vitamin B6 (25 mg two or three times a day) is helpful for some women. Others may even try sea bands for some relief. A short sharp pulling or stabbing pain in one or both sides of the lower abdomen is very common as the ligaments that support the uterus stretch, and although it can be quite uncomfortable for short times, it is almost never anything of concern. Mild menstrual‐like cramps are very common in early pregnancy, and are reassuring that the uterus is growing as it should. Frequent minor headaches are common and usually respond to acetaminophen (Tylenol). Please report to us if you have pain that does not resolve quickly. ~ 6 ~ Common Symptoms as Your Pregnancy Progresses Backache: Poor posture, the strain of carrying extra weight, and the relaxation of joints and ligaments from the hormones of pregnancy can cause backache. Exercises to stretch and strengthen your back may help, or you may try a maternity support belt, applying heat, sitting in chairs with good back support, and sleeping on your side with pillows between your knees, and below your abdomen for support. Avoid lifting heavy objects, and when doing any lifting, be sure to bend at the knees, not your back. Comfortable shoes are also a must. Constipation: Pregnancy can slow digestion and cause constipation. Prenatal vitamins also contain iron which may be constipating. To help, you should drink plenty of water, and eat high fiber foods such as whole grains, fruits, and fresh vegetables. Regular exercise also aids your digestion. You may consider using a stool softener such as Colace. Dizziness/Feeling Faint: It is not unusual to feel lightheaded in pregnancy. This may be caused by changing positions suddenly, being dehydrated, having low blood pressure or low blood sugar, being anemic, or being in a room that is too warm. If you feel dizzy, you should rest or lay down right away. To prevent feeling this way, be sure to drink fluids throughout the day, eat small frequent meals with higher protein, and change positions slowly. Do not hesitate to call your doctor if the dizziness persists, or if you have chest pain or shortness of breath that occur at the same time. Emotional Changes: Hormonal changes, the adjustment to pregnancy, and anticipation of caring for a new baby can cause normal emotional ups and downs. Communicate your feelings with supportive friends and family, and please be sure to discuss this with your care provider if you are concerned about how you are feeling. Frequent Urination: Your kidneys are working at a faster rate during pregnancy, so it is normal to go more frequently. As the baby grows, there will be increased pressure on your bladder also giving you an urge to go more often. It is important to continue drinking plenty of fluids. Avoiding caffeine may help you to urinate less often. Heartburn: Pregnancy hormones slow the emptying of the stomach and relax the muscle valves between the stomach and esophagus, increasing your chances of having heartburn. To lessen heartburn, you should eat small frequent meals that are not greasy or spicy. You should avoid lying down for 2 hours after eating. You may elevate the head of your bed or prop up with pillows. Antacids such as Tums are usually effective to treat your symptoms as well. Hemorrhoids: Hemorrhoids are uncomfortable, itchy bulging veins that occur in the rectal area from the increased blood volume and pressure of the uterus in the pelvis during pregnancy. Hard stools and straining with bowel movements may also cause them. You should try to avoid constipation/straining. If they occur, you may use over the counter preparations including Anusol, Tucks, or try sitz baths. Muscle Cramps: Leg cramps are common especially at night during pregnancy. To try and lessen the cramps, you may try gentle massage, stretching your legs, or taking a calcium supplement. Bananas and oranges may also help provide electrolytes such as potassium that can decrease the cramps. Nasal Congestion: Increased fluid volume that occurs during pregnancy may make you more congested. Sometimes a saline nasal spray may help you feel better. Sudafed is also safe to use to decrease the congestion when it is very uncomfortable. ~ 7 ~ Nosebleeds and Bleeding Gums: The mucus membranes can become more vascular and more fragile from the hormones in pregnancy. Saline nasal spray or Vaseline applied at bedtime to the nasal passages can keep the nasal passages moist and decrease nosebleeds. Good dental care should continue including flossing, but you may want to change to a softer toothbrush. Numbness or Tingling: As a result of tissue swelling and fluid retention, you may develop carpal tunnel syndrome in pregnancy with numbness or tingling of your fingers in one or both hands that usually resolves after delivery. Wrist splints may lessen the symptoms. Nerves may also be compressed by the uterus that can cause pain in the hips or lower legs (such as the sciatic nerve). Rest or a maternity support belt may be helpful, and again, symptoms usually resolve after delivery. Pain in the Pelvis or Abdomen: As the uterus grows, the muscles that support it are being stretched and pulled and you may feel this as a dull ache or sharp pain on one side of your belly. This is commonly referred to as "round ligament pain" and is often felt between 18‐24 weeks. Rest or changing positions may help. Pain may also be caused by gas or bowel cramping. Poor Sleep: Emotional changes, as well as discomfort or frequently having to urinate can limit your sleep. Try taking a warm bath or shower at bedtime, limiting naps, and going to bed at a regular time. Sleeping on your side with pillows for support may help you become more comfortable. Shortness of Breath: Changes in your metabolism as well as the enlarging uterus can normally make it harder to breath, especially in the third trimester or with low levels of exertion. Sleeping with your head elevated or on your side may help at night. If your shortness of breath is severe or not relieved with rest, please call your doctor. Skin Changes: Hormonal changes can increase pigmentation in the skin. Uneven patches called chloasma may occur on the face and they usually fade away after delivery. You may notice a line down the center of the abdomen called the linea nigra. Also, stretch marks often occur on the abdomen or breast as the skin stretches. They are not preventable, but they will fade after delivery. Swelling: Some swelling or edema is normal in the hands, face, legs, and feet during your pregnancy, especially towards the end. Continue to drink plenty of fluids, avoid high sodium foods, exercise, and elevate your legs when able. Notify your doctor if you have a sudden increase in the swelling. Vaginal Discharge: Hormones can increase normal secretions. Changes in hormones can also increase yeast or bacterial infections. Notify your doctor if you have any burning, itching, odor, or bloody discharge. Varicose Veins: The weight of the uterus and growing baby may compress and slow blood flow from the lower body. This may result in bulging veins in the legs or the vulva. Varicose veins are not preventable but to relieve the soreness and swelling you may try wearing support hose, elevating your legs when possible, exercising regularly, and avoiding crossing your legs. Notify your doctor if a vein becomes suddenly tender or more swollen. LABOR AND DELIVERY Preparing for delivery Educational classes are offered through Rochester General Hospital. A variety of classes are offered on topics such as childbirth, breastfeeding, and baby care. You may call the hospital information number 922‐ LINK for more information on what is available. An internet web link from our website has also been created to direct you to their class offerings. You may also schedule a tour to familiarize yourself with the birthing center and to help you understand what to expect during your hospital admission. ~ 8 ~ Going to the hospital You should call the doctor if you think it may be time to come to the hospital. This is when you are having strong contractions 5 minutes apart or less and lasting longer than an hour, if your "water breaks" even if you are not contracting, or if you are having bleeding, or severe abdominal pain. If you are preterm, you should call if you are having regular contractions even if they are mild. When you come to the hospital, you may park and enter at the Patient Discharge entrance on the south side of the hospital. If it is after hours, you may need to use an intercom to be allowed in. The Birthing Center is located by the Green elevators on the 3rd floor. Pain Management Some patients never require any medication for pain relief, while others do. It is good to understand some of the types of pain relief that are commonly used at the time of delivery. Narcotics: Drugs such as morphine or Nubain, may be used in labor when pain relief and/or sedation are needed. They can occasionally cause respiratory depression in the newborn as well as in the mother. Effective antidote drugs exist which may be used if necessary. Phenergan: This is the trade name for promethazine, a drug that sedates and relaxes without the risk of respiratory depression. It does not directly provide pain relief, but is often used in combination with a narcotic to enhance the effect while keeping the dose of the narcotic low. Local Anesthetics: These are used to numb a local area or in spinal and epidural anesthetics. They rarely have adverse effects. Epidural: A commonly used form of pain relief for labor that involves injecting a local anesthetic into the area outside of, but surrounding the nerves of the spinal cord. It numbs and therefore eliminates pain from about the belly button down. Usually, pressure sensation and the urge to push will still be present when it's time for delivery. General Anesthesia: This is used for some operative deliveries, especially when there is limited time for performance of a spinal or epidural anesthetic. There is a small risk of respiratory depression for the newborn infant. Medications used to induce labor: Cytotec: A synthetic prostaglandin also called misoprostil, is a pill that can be given by mouth or vaginally to help "ripen" a cervix that is not significantly dilated or soft. It frequently requires more than one dose before the cervix begins to change or labor begins. Cervidil: Another type of prostaglandin used to ripen the cervix that is inserted vaginally and removed with a retrieval cord similar to a tampon string. Pitocin: This medication is the synthetic version of the natural hormone oxytocin which causes uterine contractions. It is given intravenously (through an IV pump) to induce or improve labor. **To use the above medications safely and to avoid fetal distress, the fetal heart rate and contractions must be monitored closely while using them. ~ 9 ~ BREASTFEEDING There are many benefits to breastfeeding. Human milk has just the right nutrients to nourish your baby. Newborns who are breastfed have fewer infections including upper respiratory infections, ear infections, and gastrointestinal infections. It is also likely that breast feeding will decrease your child's risk in the future of asthma, obesity, and diabetes. Nursing also helps you in several ways. In the early postpartum period, the breastfeeding stimulates hormones which help the uterus to contract down faster and decrease the blood loss. It also provides a bonding experience between you and your baby. In the long run, breastfeeding decreases your risk for breast and ovarian cancer. It is also cheaper than formula. Breastfeeding is natural, but is not always easy, and may or may not be the right choice for you. If you do decide to breastfeed your baby, there will be excellent support provided after delivery during your stay at Rochester General Hospital (RGH). In fact, RGH is the only area hospital designated as "Baby‐Friendly" by the World Health Organization for providing an optimal level of care for lactation. If you decide to bottle feed, you may wish to discuss with your pediatrician what the right formula is for your baby. WHEN TO CALL A physician from West Ridge Obstetrics and Gynecology is always available to help you around the clock. If the problem is not urgent, call any time from 8:30AM to 4:30 PM, Monday through Friday. We don't want you to sit at home worrying over something when a simple phone call to one of the doctors or one of our nurses would be helpful, so please call even if the concern seems trivial. Also, please call if any of the following occur: Vaginal bleeding Ruptured membranes or any other gush from the vagina Persistent dizziness, headache or blurred vision Extreme swelling Chills and fever Severe nausea and vomiting Severe abdominal pain Finally, call one of our offices if you suspect you are in labor. There should always be an answer at either office by calling 5852251580 for the Greece office or 5856716790 for the Webster office. If there is a problem with the phone, call our answering service directly at 5857236516 and ask for the on‐call doctor. ADMINISTRATIVE ISSUES Patient Responsibility for Payment Depending on your health insurance coverage, you may be personally responsible for a portion of your obstetric global fee. These payments may be made in a lump sum during your first trimester or divided into several payments collected at the time of your prenatal visits. Regardless of your payment decision, the complete balance should be paid by the time you reach 20 weeks of your pregnancy. Any medical visits unrelated to your pregnancy (such as sore throat, ear infection, bladder infection, bronchitis, upper respiratory infection, etc.) will require a co‐payment, which is expected to be paid at the time of service. Also, if your pregnancy becomes "high risk" there may be required co‐payments for the additional necessary visits. ~ 10 ~ Patients who have their baby circumcised will also be responsible for this charge, which is not included in the obstetrical fee. Circumcision is generally covered by insurance carriers; however, the baby must be added to your insurance policy shortly after birth for the claim to be paid by your insurance. We do not participate with Medicaid, so if the baby will be covered under Medicaid, you will be responsible to pay for the circumcision in full. Questions regarding your specific type of coverage may be addressed with any member of our Billing Office. You may also obtain additional information from your carrier's Member Services, whose phone number should be listed on your insurance card. Changes in Personal Information Please be sure to advise us of any changes in your personal information such as name, address, phone numbers, marital status or insurance coverage during the course of your pregnancy. Disability Claim Forms Routine disability benefits allow coverage for 2 weeks prior to your due date, 6 weeks postpartum for vaginal delivery and 8 weeks postoperatively for Cesarean section delivery, with the return to work date calculated from the actual date of the delivery. According to New York State guidelines, the maximum pregnancy disability coverage is 26 weeks in the case of a serious medical complication. You may want to check with your employer to see what the specific guidelines are for your employer's insurance carrier. Many workplaces have additional unpaid leave available under the Family and Medical Leave Act. It is your responsibility to acquire your disability forms from your employer or a copy can be found on our website. You should fully complete both the patient and the employer portions of the form and sign the form. A stamped envelope with the name and address of the organization (your employer or insurance company) or individual who will be receiving the completed forms should accompany this form. You will need to indicate your day of work or last planned day of work, expected due date, expected type of delivery (vaginal delivery, c‐section), and if you have any pregnancy complications for which your doctor is recommending early disability. Insurance Reminder Please let your health insurance carrier know BEFORE you deliver that there will be another member added to your contract. Your insurance company will also require notification AFTER the birth of the baby. You must notify your insurance carrier to list the name, sex and date of birth of your baby on your policy to prevent rejection of insurance claims submitted on behalf of your baby (including circumcision). Again, if you change insurance carriers or have any changes to your current policy any time during the course of your pregnancy, please notify us immediately to ensure that all services are covered appropriately. ~ 11 ~


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This Wednesday, August 13th BVUMC will host HamBingo. Bring your friends to this hilariously entertaining, adults-only event. There are over 30 fabulous Bingo Prizes and Door Prizes. The donation price for each bingo card is $10 and the card is good for the whole night. There will be a silent auction benefitting the community programs and ministries of Bay View United Methodist Church during the HamBingo event. Auction items range from Adirondack chairs to Wisconsin team game tickets to handmade quilts to restaurant gift certificates. A list of auction items is available at bayviewumc.org/wordpress/hambingo and on our facebook page. Auction items are updated as we receive them, so check often to see what's new. Anyone can bid on any item from now until the end of the day Sunday, August 17th. Auction bid can be made via email at officeadmin@ bayviewumc.org or by phone at (414) 744- 4036, as well.
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I have recently got my web server set up, It's running Debian 7.0 x64 with the latest ISPConfig and nginx. I managed to get it all working with one domain, but when I attempted to add the clients domain, my own domain will now only show the content of the newest domain. I am using digital ocean to manage the DNS settings, I understood what I read, I shouldn't have to set up DNS within ISPconfig if I manage it elsewhere (?) I also have attempted to set up Wordpress on said server, but it's just giving me a Error 500, and all I've done is upload a blank Wordpress installation. I have no real idea what I'm doing, so any suggestions would be helpful!
Have you added any IP-addresses in 'System -> IP adresses' and if so, have you choosen one of those IP-addresses or '*' in your Web Domain settings for your domains? When you're using an external DNS service for your domains, any DNS records for those domains in ISPConfig will not have any effect. What's the output of /var/www/YourWordpressDomain/log/error.log ?
Maybe the file have the wrong owner if you uploaded them as root user. see error.log of the website for details.
Currently, I have no IP addresses and am using *, I have also tried using the IP address to no avail. Does it matter about using the external DNS settings, or is that part of the reason the domains are not correctly pointing to their own directories? I uploaded them using an FTP user for the site in question. And this is from the error.log Code: 2013/05/30 08:36:02 [error] 5920#0: *168 FastCGI sent in stderr: "PHP message: PHP Warning: file_exists(): open_basedir restriction in effect. File(/var/www/clients/client1/web3/wp-config.php) is not within the allowed path(s): (/var/www/clients/client1/web3/web:/var/www/clients/client1/web3/private:/var/www/clients/client1/web3/tmp:/var/www/420headshop.co.uk/web:/srv/www/420headshop.co.uk/web:/usr/share/php5:/usr/share/php:/tmp:/usr/share/phpmyadmin:/etc/phpmyadmin:/var/lib/phpmyadmin:/usr/share/php) in /var/www/clients/client1/web3/web/wp-load.php on line 31" while reading response header from upstream, client: 220.127.116.11, server: 420headshop.co.uk, request: "GET / HTTP/1.1", upstream: "fastcgi://127.0.0.1:9012", host: "parahost.co.uk"
The fix for me, to get a website working with multiple domain names, was to add more entries in the config file /etc/nginx/sites-enabled/sitename, under server_name
I'm guessing you mean to have one website with multiple domains? That's the opposite of the issue I have. I need multiple sites, multiple domains, but no matter what domain I go to on my server, it displays the directory associated with whatever domain was set up most recently. for example: If I go to: www.domain1.com > It shows the files for www.domain2.com If I go to: www.domain2.com > It shows the files for www.domain2.com Even if I go to the IP Address of the server, I see the files for www.domain2.com I am baffled.
Really? That doesn't sound right, surely a client should be able to have two websites of their own on separate domains. And do I need to set up a client for the host site? As there is no client for that one.
Okay, I've got a bit closer to fixing it. I now have nginx vhosts correctly set up, it required me to change my nginx.conf to include: Code: server_names_hash_bucket_size: 64 I also had to change my vhosts file for the site from Code: root /var/www/420headshop.co.uk/web; index index.html index.htm index.php index.cgi index.pl index.xhtml; to Code: location / { root /var/www/420headshop.co.uk/web; index index.html index.htm index.php; } Is this an issue with ISPconfig3 and nginx?


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Andy Warhol and the Can that Sold the World
In the summer of 1962, Andy Warhol unveiled 32 Soup Cans in his first solo exhibition at the Ferus Gallery in Los Angeles-and sent the art world reeling. The responses ran from incredulity to outrage; the poet Taylor Mead described the exhibition as a brilliant slap in the face to America." The exhibition put Warhol on the map-and transformed American culture forever. Almost single-handedly,The National Urban League and Black Social Work, 1910-1940
A leading African American intellectual of the early twentieth century, Eugene Kinckle Jones (1885-1954) was instrumental in professionalizing black social work in America. In his role as executive secretary of the National Urban League, Jones worked closely with social reformers who advocated on behalf of African Americans and against racial discrimination in the United States. Coinciding withHow Black and White Southern Children Learned Race
In the segregated South of the early twentieth century, unwritten rules guided every aspect of individual behavior, from how blacks and whites stood, sat, ate, drank, walked, and talked to whether they made eye contact with one another. Jennifer Ritterhouse asks how children learned this racial "etiquette," which was sustained by coercion and the threat of violence. More broadly, she asks howGarvey and DuBois-A Race to Nowhere
Marcus Garvey came to the United States with a big dream that never came to fruition. With all of his good intentions of taking back the homeland of the Africans, he found that the world just wasn't ready for his radical ideas. One reason that they weren't ready was because of a man named W.E.B. DuBois.American Dramatists on Memory, Writing and the Politics of Culture
This new volume of interviews with contemporary playwrights attests to the fact the dramatic art is alive and well in America and celebrates the art and talent of fifteen of the theatre's most important artists. In extensive interviews, they discuss their work, influences and their craft and how the art form relates to our cultural heritage, as well as the state of theatre-its-meaning and purposes


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The Tennessee baseball program will host a preseason fan appreciation day from 9 a.m. until noon on Saturday, Feb. 9 at Lindsey Nelson Stadium. Admission is free as fans are invited to come tour Lindsey Nelson Stadium, meet the team and take a few swings in the new indoor batting cage facility.
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Win a Flyaway Trip to See Josh Abbott Band Live at Billy Bob's!
It'll be a two-night party to kick off the new year in Texas next month!
2014 Grammy Awards Nominees Announced
The 2014 Grammy nominees were announced Friday night (Dec. 6) during a concert broadcast live out of Los Angeles.
See Male Country Stars' Yearbook Photos [Watch]
Sure they act tough now, but the yearbook photos of country music's biggest male stars prove they were all little boys at one time. In this video you'll see a smiling Eric Church, Zac Brown without the beanie, Toby Keith in a suit and so much more.
Album Spotlight: Danielle Bradbery, 'Danielle Bradbery'
Danielle Bradbery's self-titled debut album is packed with innocent love songs aimed at a younger audience. The collection doesn't offer many surprises -- instead, the Texas teen does what she does best. Her most dedicated fans will be delighted by this debut.
Danielle Bradbery Named ToC's Hottest Country Star of 2013
Sixteen artists were eligible, a few hundred thousand fans weighed in and one young woman was chosen. Danielle Bradbery beat out superstars like Luke Bryan, Carrie Underwood and Miranda Lambert to be named the Taste of Country Hottest Country Star of 2013!
Album Spotlight: Will Hoge, 'Never Give In'
Brad Paisley, 'The Mona Lisa' [Listen]
Brad Paisley once again proves that the number of ways to say "you're beautiful" are infinite. On 'The Mona Lisa,' the singer again shows that his songwriting skills are only bested by his guitar playing.
Kip Moore, 'Young Love' [Listen]
Prices Lowered for Tropical Nights: Boots in the Sand Getaway Packages
Prices for the country music getaway of a lifetime have been slashed. Effective immediately, fans of Dierks Bentley, Jana Kramer, Billy Currington and Brantley Gilbert (plus sunshine, the beach and relaxation) can take in this Mexican vacay for under $1,000 per person -- a 33 percent discount!
Album Spotlight: Lady Antebellum, 'Golden (Deluxe Edition)'
The deluxe edition of 'Golden,' Lady Antebellum's fourth studio album, includes three previously unreleased songs plus three acoustic versions of well-known hits. All six fit within the context of the original 12 tracks. 'Golden' is still the most organic album the trio has released to date.


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Dragon Quest VIII celebrates its 10 year anniversary with iOS and Android release
It's Dragon Quest VIII's tenth anniversary today, and what better way to celebrate than making it available for everyone to play once more? Dragon Quest VIII: Journey of the Cursed King is now available on iOS and Android devices, making good on Square Enix's promise to bring the first eight Dragon Quest games to the mobile market. What's even better is that the game is more or less untouched, including the original score by Koichi Sugiyama.
Featuring intuitive touch-based controls, the mobile release of Dragon Quest VIII puts you in the shoes of the story's hero once more to defeat the evil Dhoulmagus, recover the forbidden scepter he stole from King Trode's castle, and save the kingdom. The new touch countrols are configurable for one or two handed play. Sliding across the screen will pan the camera a complete 360 degrees, allowing the player to see past the edges of an already limited screen. An auto run button has also been added.
The battle system has also been reworked to allow players to tap a button to automate battles based on their selected in-game battle strategy. People that prefer a more traditional approach can still control each character's actions individually. The automated mode can be cancelled mid-battle if needed, allowing players to play more defensively to avoid having to restart a lengthy dungeon.
Dragon Quest VIII is the youngest RPG to find its way to iOS and Android devices as a re-release, suddenly making mobile re-releases for other classics like Legend of Dragoon or Shadow of the Colossus seem not as far fetched as some may have thought previously. Dragon Quest VIII is now available for download from the App Store or Google Play store for $19.99.
The auto-battle addition isn't bad though at least, the Dragon Warrior/Dragon Quest Monsters games do the same thing.
A new hope crashed so quickly. D:
quote bluexyI hear ya.This is the last way I want to play Dragon Quest VIII. If there was an HD collection for console I would be all over that, but this? Argh. It's weird to see some publishers push for HD upgrades for core gamers, versus other publishers almost demaking their games for mobile. I guess that's just the western vs. Japanese market right now.
You would think they would make it(in HD) on PS3/4 or even the Vita before they would make it for *shudders* smartphones...
I too am disappointed to see this on mobile but I'll likely end up getting it anyway. Can't pass up the opportunity to replay one of my favorite games of all time!
quote AvalithWhoops, your right. Thats what I get for skimming, I get things confused with the last announcement.Zombie_Barioth, the DQ8 mobile release isn't restricted to Japan.
quote Fragment of ChaosUnfortunately no, according to the user reviews.Does it at least have controller support or support for Android devices such as Nvidia Shield?
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Nacchio says he's optimistic about Qwest's future
Qwest Communications International CEO Joe Nacchio said he is optimistic about the first quarter cash flow of his company.
In a telephone conference with analysts and reporters, Nacchio reassured the audience Qwest will post a negative free cash flow of $300 million to $400 million in the first quarter, better than the previous forecast of negative $500 million.
Nacchio also Qwest forged a marketing agreement with Japan Telecom Co. Ltd. to provide communications services to multinational corporations.
In related news, the law firm of Milberg, Weiss, Bershad, Hynes and Lerach, are in the process of amending an earlier complaint against the telecom company seeking damages on behalf of investors. The complaint accuses the company of defrauding investors with misleading financial statements and improper accounting.
Milberg Weiss is requesting the court expand the class period and add further defendants because additional claims and wrongdoing have been discovered in the media.
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Toronto MP Olivia Chow is calling on the federal government to strengthen the witness protection program after police last week announced murder charges against a man in the Danzig shooting case and appealed for more witnesses to come forward.
Chow, the NDP MP for the downtown riding of Trinity-Spadina, said police forces across Canada have been demanding an expanded federal witness program for several years.
"There's a provincial witness protection program but if it's a federal prosecution like drug-related murders...the RCMP runs a program but they charge full cost recovery. It's very expensive," Chow said.
"The local police have been saying since 2007 that it would be great if the federal government can come on side and have an agreement with the local police forces and make sure that it's not so expensive."
The RCMP witness protection program assessed 108 people but took in just 30 at a cost of $9.1 million in the 2011-2012 fiscal year. Only four of the protectees accepted came from other law enforcement agencies.
Toronto police spokesman Mark Pugash said the force is "exploring ways" to improve services offered to witnesses.
"We are very mindful of the concerns that some people have for not coming forward, and we're trying to do whatever we can to improve and increase the services that we can offer to witnesses to reassure them so that they can come forward with confidence."
Police use a variety of approaches when protecting witnesses.
"It might be going to a different school, living in a different area," Pugash said. "It doesn't always require what most people assume to be witness protection, but assessments are made on what is most appropriate under the circumstances."
Liberal MP John McKay (Scarborough-Guildwood) said changes to criminal procedures could also help protect witnesses.
"Within 35 days of the case, the crown has to disclose their entire witness list and then the trial doesn't necessarily happen for six months or a year or two, so for all of that period of time, the potential witness lives in the community, presumably beside or near or at least known to the accused," McKay said.
"Either the time period (should be) shortened or you could have an exemption from disclosure, disclose in a non-identifying fashion."
McKay, in whose riding Danzig Street is located, said the "chief problem" with the witness protection program is that "not everyone wants to go to Saskatchewan to live for the rest of their lives."
Conservative MP Corneliu Chisu (Pickering-Scarborough East) didn't address the issue specifically when asked about the witness protection program at an event in Scarborough earlier this week. "We introduced several pieces of legislation calling for tougher sentences for people involved in gang violence," he said.
Shyanne Charles, 14, and Joshua Yasay, 23, were killed and 24 others were hurt during a gang-related shootout at a barbecue at a townhouse complex on Danzig Street on July 16.
Shaquan Mesquito, 18, aka Bam Bam, has been charged with two counts of first-degree murder, one count of attempted murder, 23 counts of aggravated assault and one count of reckless discharge of a firearm.
Last week, police also released composite sketches of two persons of interest in the case.
Anyone with information on the Danzig shooting is asked to call Det. Sgt. Peter Trimble at 416-808-7394, Det. Sgt. Graham Gibson at 416-808-7405 or Crime Stoppers anonymously at 416-222-TIPS (8477).
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Bill Clinton and George W. Bush at the NCAA Finals 2014
So, Were Bush and Clinton Rooting For Different Teams?
Former US Presidents and political opposites Bill Clinton and George W. Bush had a game date on Monday, sitting together for the NCAA men's basketball championship game in Arlington, TX. The presidential pair took in the Final Four Championship excitement, watching the game from Dallas Cowboys owner Jerry Jones's luxury box. They were joined by not only Bush's wife, Laura, but also Dallas Cowboys quarterback Tony Romo, who sat in front of them with his wife, Candice — Chace Crawford's sister. During the game, the group laughed when they made their way on to the Jumbotron, and Clinton tweeted a picture following the Connecticut Huskies' victory over the Kentucky Wildcats, saying, "Great night watching #NCAAFinals with @JeffLongUA, Coach Richardson, Coach Sutton, Jerry Jones & 43" — a nod to the 43rd president, Bush.
Source: Getty / Tom Pennington
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The cool & comfy one is really cute!
by Toritoad on 1/25/2013 9:20:59 PM
So... I have to go shopping for something to go shopping in??? ...I now understand quantum physics...
by zwinky on 12/16/2012 10:34:36 PM
by zeus11 on 12/16/2012 7:01:37 PM
Hey Girls! Join Legit Boy Advice! This is a LEGIT club about boy advice. Any questions you have let me know because guess what?! I have 5 brothers and I have each age group of boys that you will have questions for (about ANYTHING)get REAL answers from REAL BOYS themselves! All you have to do is include your age and question and I'll get right too it!
by Chloe<3 on 12/15/2012 11:28:09 PM
I loved all these clothes and shoes. But, here in Brazil, Christmas in in the summer, so... it's too hot! We can't wear this kind of clothes :/
by Cindy Lima on 12/15/2012 11:15:10 PM
by sparklysharpie on 12/15/2012 10:02:48 PM
OMG, I have those exact same Target boots on the "Chic and Cute" page! I got them awhile ago but have only wore them like one time because I never know what to wear them with! I really want to wear them now, thanks GL!
by Alle93 on 12/15/2012 9:49:17 PM
On the first outfit Cool and Comfy, where is the cross body bag from?
by nerdy dancer12 on 12/15/2012 3:43:25 PM
Cool idea! I like the cool and comfy look the best
by YouCanCallMeCat on 12/15/2012 9:27:11 AM
Score some swoon-worthy reads!
Win a cute new collection in our
Books We're Crushing On giveaway!
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text:
hr benefits coordinator jobs
Vice President of Human Resources
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- Emeryville, CAemployee relations, compensation, benefits, and employee services. Develops ... relations, benefits, and training and development. Well-developed administrative human...
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- Springfield, MOprograms, employee relations, compensation, benefits administration, performance ... company policies and procedures, HR compliance/legal matters, and other important...
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Neurology Nurse Practitioner (1.5 hr outside of Savannah)
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Financial Coordinator
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- Marietta, GA~~Seeking a financial and benefits coordinator for a busy chiropractic clinic in ... Compensation $13-$15/hr, plus competitive bonus structure.
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Director of Human Resources-Healthcare
- Los Angeles, CAprocessing, compensation, health and welfare benefits, training and development, records management, safety and health, succession planning, employee relations and retention,...
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Speech Language Pathologist (SLP) School $55/hr.
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text:
Apathy, Auto-tune and Beans on Toast
While a number of British students take to London's streets in peaceful protest armed with banners, posters and organized chants many more will be running round conflict ravaged downtown Los Angeles armed with sniper rifles and shotguns. Of course, this second group are online and playing Call of Duty: Black Ops 2 and so won't be disrupting commuters or worrying the police.
The distraction of video games and the lure of Internet culture take up a lot of energy and can sap the average student of the will and determination to go out and protest. While the sentiment that these protests are in line with student opinion is demonstrable, the amount of students actively campaigning for improvements in education and more financial support is relatively small. It is far easier to spend your time as a student trying to avoid or escape the pressure of your workload than campaigning for change in higher education policy. The enveloping calm that day-time TV and video games can offer is for many, preferable to carrying a sign through the streets of London hampered by the cold, mud and nagging feeling that perhaps you could be having a nicer time somewhere else.
What the Internet now offers us is an incredibly easy way out of all that hardship. Getting your voice heard can be as simple as signing up to an online protest, pledging your support with an online signature. You could also use your twitter account to apologise for not making it to the demonstration and wish well those who are there.
A brief scan of the messages posted referencing the demonstration shows that for those who couldn't make it, a token comment expressing support was enough. The Internet's offer of making such a minor contribution and yet still feeling as though you are part of the movement is unlikely to result in progress. Replacing the masses that proudly followed Martin Luther King Jr. through the streets of Washington in 1963 with a collection of hastily typed tweets ('Srry cndt make it #too much standing', '#Ihaveadreamtoo') really won't have the same inspiring effect.
Gauging what the shifting and ever-altering student body values as important content does not inspire confidence in their ability to effectively get involved in changing policy. Typing 'Nick Clegg' into YouTube brings up a smoothly edited version of the Liberal Democrats leader's apology for breaking his pledge on tuition fees. His voice has been heavily auto-tuned achieving a similar sound to Cher's Believe and to the thousands of other auto-tuned videos on Youtube. This makes his speech even more awkward and even less effective in appealing to the students he has left to face the higher fees he promised he would never allow.
It is a fairly light-hearted and humorous spearing of a political figure and otherwise would not be that remarkable if it did not overshadow all other videos of Mr Clegg. It has just over two million views. If you add to that the numerous other edited videos with different songs in the background or the one with an animated cat speaking Clegg's words then the number grows much higher. Comparatively, an unedited video of a serious interview with the Lib Dem leader about benefits had a paltry view count clocking in under 500.
The popularity of the video was so great when uploaded that Mr Clegg was forced to watch it on television by Andrew Marr. Cue much squirming in seats. The efforts of the video's creator, cutting, editing, tuning and uploading, resulted in a one of the leaders of this country being forced to watch his own words parroted robotically back at him in front of a TV audience. The results of the student demonstration in London will have to be seen but are unlikely to have caused as much consternation to political heavyweights as the video did to poor Mr. Clegg. The video's message summed up in one word 'sorry', sung out in a warbling electronic whelp, has been featured on banners and placards in demonstrations. The assertion that 'sorry's not good enough' is being paraded around Kennington Park as I write.
Is this the way it should be? Understandably the banners need to be funny and biting to cheer up those marching in the rain and mud but should the time and effort of the UK's students be invested in comedic YouTube videos? The hours clocked watching it and the countless other political parodies loom giant-like over the hours spent on forming coherent and effective political groups, policy and action. The hours spent meandering around the Internet seems to be rising as the time spent engaging with politicians decreases. The group of informed student leaders and active protesters at my university were clearly outnumbered by video game and curry fanatics if the respective sizes of their societies are indicators of importance.
There are many opportunities available online to inform students of developments in governmental policy on higher education. University newspapers can, and indeed should, place great importance on these key issues. Focus however seems to more readily drift to other, more diverting areas. It could be football, reality TV, or the latest videos of gamers blowing up zombies while diving of buildings. Watching a video of some rain soaked 20-somethings yelling hoarsely about Education Maintenance Allowance is always going to be underwhelming, no matter how much auto-tune you use.
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Number of commits found: 5
As previously announced, remove these broken/insecure/obsolete ports.
Mark as deprecated. These ports have failed to fetch from their main mastersite since late 2002. PR: ports/62567 Approved by: maintainer silence (3 months)
Remove pkg-comment from remaining master/slave port sets. Approved by: portmgr (implicitly)
Style review in ports/korean.
Korean pk fonts collection of hLaTeXp(300dpi)
Servers and bandwidth provided byNew York Internet, SuperNews, and RootBSD
12 vulnerabilities affecting 37 ports have been reported in the past 14 days
* - modified, not new
All vulnerabilities


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Thursday, 17 Jul 2014 06:47 PM
Health officials are reporting that for the first time, U.S. mosquitoes are spreading a virus that has been tearing through the Caribbean.
Two people in Florida have domestically-acquired chikungunya (chik-en-GUN-ye) infections, officials said Thursday. In both cases, they said, a person infected with the virus after visiting the Caribbean was then bitten again by an uninfected mosquito in Florida, which then transmitted the illness further.
Health officials urged residents to prevent mosquito bites, but said there was no cause for alarm.
"There is no broad risk to the health of the general public," said Dr. Celeste Philip, a public health official with the Department of Health.
Federal officials noted it's an unfortunate milestone in the spread of a painful infectious disease that has raced across the Caribbean this year and is apparently now taking root in the United States.
"The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens," said Roger Nasci of the Centers for Disease Control and Prevention, in a prepared statement.
Chikungunya virus is rarely fatal. Infected people typically suffer fever, severe joint pain and swelling, muscle aches, headaches, or rash. Patients usually recover in about a week, although some people suffer long-term joint pain. There is no vaccine and no specific treatment for it.
This virus is not spread person to person, but rather by the bite of certain mosquitoes. That's why health officials believe the virus is spreading here — the two cases had not recently left the country.
The infected Floridians were described as a 41-year-old woman in Miami-Dade County who began experiencing symptoms on June 10, and a 50-year-old man in Palm Beach County, who first noticed symptoms July 1.
Philip said both are doing well.
State epidemiologist Anna Likos said in order for the virus to be transmitted from an infected person to an uninfected mosquito, they must be bitten within the first week of illness.
More than 230 chikungunya cases have been reported in Americans this year, but all the others were travelers believed to have been infected elsewhere.
Now that chikungunya is in the United States, CDC officials think it will behave like dengue virus, with imported cases causing occasional local transmissions but not widespread outbreaks.
Chikungunya was first identified in 1952 in Tanzania. It first appeared in the Americas late last year, on a Caribbean island. By July 11, more than 355,000 suspected and confirmed cases were being reported in the Americas.
Officials have been expecting it to land in the United States, noting that two types of mosquitoes that can carry the virus live here.
Earlier this week, the New England Journal of Medicine published an editorial on the looming chikungunya threat by two National institutes of Health infectious diseases experts — Dr. David Morens and Dr. Anthony Fauci.
They noted several chikungunya vaccines are being developed. But even if they prove effective, they would be years away from becoming available.
Mosquito control and avoidance are the best current options, they said.
© Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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I must have left my trunk open and my battery drained because all the lights and power options didnt work. I tried juicing up the battery with my house charger hook up and when i do, the fans turn on without me putting the key in the ignition. The car still wont have enough juice to get it cranking. What would cause that problem?
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Ask Your Question1996 Buick Riviera Question: Fan turns on without key being in the ignition. What does that mean/how to fix?
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Results 1 to 3 of 3
Thread: Like to have triplets
24th February 2015 04:48 PM #1
- Join Date
- Feb 2015
- Posts
- 10
Like to have triplets
I'm currently single but I love kids so I want to start a family in the future. I'm currently into watching variety shows. There is this Korean variety show about dads taking care of their kids while mums take a rest. One father has adorable triplets. I love watching them so much that I wish to have triplets in the future. Are there ways to get pregnant with triplets or twins?
Last edited by chamareah; 24th February 2015 at 05:03 PM.
25th February 2015 07:49 AM #2
Aw you are going to make a lovely mummy!
There's not much you can do to sway the odds of twins or (even more unlikely) triplets I'm afraid. Triplets by natural conception are very rare.
Twins are more likely if there is a maternal family history of twins. They are also more common in couples undergoing certain types of fertility treatment. Twins are also more common in mothers over 35 years of age (although a woman's fertility does start to significantly drop from age 35).
With warm wishes,
25th February 2015 01:04 PM #3
- Join Date
- Feb 2015
- Posts
- 10
Thank you . It's too bad there are no established ways. I guess I just have to pray lots and wait for a miracle for it to happen. Every child is a blessing so whatever happens, I'll still be thankful if I'll be blessed with one.


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Manfred: No Suspensions For Pace Violations Weekend Plans With NBC's Jim Bell Wolff: No Interest In "Coliseum City" Concept Training Home Of Mariners, Padres Gets Upgrades Bumgarner Tops All MLB Merch Sales Cubs' Ownership Sales Support Wrigley Renovations Mike Sundet Leaving A-B For Momentum Big Papi Slams New Batter's Box Rule Padres Ownership Excited Fans Are Re-Energized Liberty Media Has No Plans Of Selling Braves
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SBD/3/Law Politics
Published October 3, 1994
Any hope for Congress to intervene in the baseball strike "wilted on the Senate floor" when Howard Metzenbaum (D-OH) withdrew his legislation that would have temporarily lifted the exemption. Metzenbaum's "surrender" came during a "spirited debate" as he attempted to attach his amendment to an appropriations bill. But with bipartisan opposition forming and the likelihood of a "second amendment that would cripple his rider," the retiring Metzenbaum passed "the baton" to his colleagues, Orrin Hatch in particular (Larry Whiteside, BOSTON GLOBE, 10/1). Acting MLB Commissioner Bud Selig said the clubs were "grateful for the overwhelming support," but claimed the "No" votes in the Senate would have been about 2/3 (THE DAILY). MLBPA Exec Dir Don Fehr said the union would lobby Congress again on the matter when it reconvenes in January (Claire Smith, N.Y. TIMES, 10/1). WHAT'S NEXT? Peter Gammons writes the MLBPA will file a complaint with the NLRB to try to block a possible owners' impasse declaration, but with the "November 1 Total Chaos date on the horizon, no one moves." Two problems the owners may not have considered if they plan to use replacement players: 1) The Blue Jays cannot open the season without an agreement because it is against Ontario law to use replacement labor; 2) It may be impossible to get work visas for foreign players to work as replacements, as some owners hoped to do with Hispanic players (BOSTON GLOBE, 10/2). BASEBALL NOTES: The owners informed ABC and NBC they will decide in a month whether they intend to renew The Baseball Network for '96. The original deal allows for any of the partners to opt out if the combined revenues for '94-'95 didn't reach $330M, which is virtually impossible because of the strike (Mark Maske, WASHINGTON POST, 10/1).


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A versatile tank that slims and shapes the midsection and back without pinching, rolling or riding up is cut from innovative paper-thin fabric that sculpts beautiful curves so comfortably it feels like wearing nothing at all.


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The Role of Nonlinear Dynamics in Affective Valence and Arousal Recognition
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IEEE Transactions on Affective Computing
By G. Valenza,A. Lanata,E. P. Scilingo
Issue Date:April 2012
pp. 237-249
This paper reports on a new methodology for the automatic assessment of emotional responses. More specifically, emotions are elicited in agreement with a bidimensional spatial localization of affective states, that is, arousal and valence dimensions. A ded...
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