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Intrapartum fetal hypoxia (shortage of oxygen) is a serious complication of labour which increases the risk of perinatal mortality and morbidity, including hypoxic ischaemic encephalopathy (acute or subacute brain injury due to asphyxia), cerebral palsy and developmental delay (Dilenge 2001; Fatemi 2009; McIntyre 2013). Whereas a healthy, term baby has a baseline heart rate between 110 and 160 beats per minute, moderate variations in heart rate amplitude and natural accelerations from its baseline heart rate, this may not be the case for the hypoxic baby (ACOG 2009; Liston 2007; NICE 2007; RANZCOG 2006). In contrast, a hypoxic baby may display minimal or a complete absence of heart rate variation and accelerations as well as have marked decelerations from its baseline heart rate values (ACOG 2009; Liston 2007; NICE 2007; RANZCOG 2006). Since abnormal fetal heart rate patterns may signify poor oxygenation and thus potential fetal compromise, maternal care professionals often perform fetal assessment during labour.
Cardiotocography (CTG, also known as electronic fetal heart rate monitoring) and intermittent auscultation of the fetal heart rate are the most common forms of fetal assessment during labour (ACOG 2009; Liston 2007; NICE 2007; RANZCOG 2006). In brief, CTG records the fetal heart rate and maternal uterine activity via two transducers usually placed on the mother abdomen; an ultrasound transducer measures fetal heart rate and a pressure transducer measures uterine contractions. Fetal heart rate and uterine contractions are printed on a strip known as a CTG trace or presented directly on a visual display unit to help identify abnormal readings. In contrast, intermittent auscultation is a method of listening to the baby's heart rate using a Pinard (fetal stethoscope) or a hand-held Doppler ultrasound device. The rationale underpinning both forms of fetal assessment is that babies who are at risk of becoming compromised can be identified early so that appropriate recourse can be made (i.e. more intensive monitoring or expedited birth of the baby) (ACOG 2009; Liston 2007; NICE 2007; RANZCOG 2006).
Description of the condition
In the early half of the twentieth century, intermittent auscultation served as the primary form of fetal assessment (Liston 2007). Technological advancements during this time period led to the development of CTG, and this method of fetal assessment was subsequently introduced into maternity care in the late 1960s (Chez 2011). Despite early beliefs that CTG could potentially supersede intermittent auscultation (Liston 2007), since its induction, there has been a growing professional debate on the efficacy of CTG monitoring (Alfirevic 2013; Chauhan 2008; Devane 2012; Hill 2012; Miller 2011a). Although CTG monitoring is typically reserved for high-risk pregnancies, in the many parts of the developed world, more than three-quarters of babies will be assessed using CTG (ACOG 2009; Devane 2007; Devane 2012). Yet, CTG has a relatively low specificity (a high false positive rate) for identifying fetal hypoxia and associated complications (Miller 2011a). For example, the false positive rate for the most abnormal of fetal heart rate patterns, the detection of cerebral palsy, has been reported as high as 99.8% (Nelson 1996). This lack of specificity can be attributed, in part, to the variability in interpretation of fetal heart rate traces. Despite guidelines for CTG interpretation, substantial inter- and intra-observer variation in interpretation has been reported among maternity care providers (Blix 2003; Chauhan 2008; Devane 2005; Figueras 2005). Misinterpretation of fetal heart rate traces can lead to poor decisions, which can result in unnecessary intervention or delay or withholding of necessary intervention. Together, this can impact on the risks of operative birth, perinatal asphyxia, hypoxic ischaemic encephalopathy and perinatal death.
Given these clinical implications, substantial research has investigated CTG monitoring in its current form versus alternative methods. In a recent systematic review, women with signs of labour who received a short, 20-minute CTG tracing on admission to the maternity ward were more likely to have a caesarean birth than women who were monitored using intermittent auscultation (risk ratio (RR) 1.20; 95% confidence interval (CI) 1.00 to 1.44) (Devane 2012). A related review found that in comparison to intermittent auscultation, continuous CTG during labour significantly decreased the risk of neonatal seizures (RR 0.50; 95% CI 0.31 to 0.80), though it did not decrease the risk of cerebral palsy (RR 1.75; 95% CI 0.84 to 3.63) (Alfirevic 2013). Further, continuous CTG was associated with significantly higher rates of caesarean (RR 1.63; 95% CI 1.29 to 2.07) and instrumental births (RR 1.15; 95% CI 1.01 to 1.33). Thus, while CTG can provide critical information to maternity care providers, it is not without limitations.
Description of the intervention
First developed in the 1960s, expert systems (ESs) represent a type of applied artificial intelligence designed to assist in complex decision-making (Liao 2005). In a healthcare context, ESs synthesise a computerised knowledge base derived from expert opinion with individual patient data to guide users towards possible diagnosis or treatment decisions (Liao 2005). To process data, an ES may apply rule-based algorithms or neural networks (i.e. a model of pattern recognition based on previously collected data) (McCartney 2000; McCartney 2011); notably, however, there are numerous other ES methodologies (Liao 2005). Requirements for ESs vary; systems may be web-based or supported on a stand alone personal computer. ESs are paperless and often represent real-time, which is critical in healthcare environments where changes in health status can occur rapidly. Advancements in ESs have led to their integration in a wide range of clinical settings, including cardiac care (Chi 2012; Seto 2012), cancer diagnosis (Issac Niwas 2012; Yang 2012) and diabetes diagnosis (Basciftci 2011; Picon 2012).
The potential for ESs in maternity care is also well recognised, and as a result, there has been an increasing interest in developing ESs for CTG monitoring (Ayres-de-Campos 2010; Greene 1996). Such an ES would combine information on maternal and fetal characteristics, which may include fetal heart rate, electrocardiogram (ECG) waveform, uterine contractions and/or gestational age, to provide a comprehensive overview of the labour and/or issue an alert if the baby's status becomes critical. ES-issued alerts may not only advise the user on potentially suitable intervention but also provide underlying reasons for this recommendation, simulating reasoning capacity that can be interpreted easily by the user (Liao 2005).
How the intervention might work
Despite controversy surrounding its ubiquitous use, CTG monitoring continues to be recommended by a number of professional organisations for the monitoring of at least specific subgroups of pregnant women (Miller 2011a). Yet, there is general consensus that measures must be taken to improve its interpretation (Chez 2011). For this reason, CTG clinical definitions and guidelines have undergone extensive review (ACOG 2009; Liston 2007; NICE 2007; RANZCOG 2006) and training programmes have been recommended and evaluated (Pehrson 2011). Arguably, however, guidelines and educational interventions alone may be insufficient in reducing inter-observer differences (Devoe 2000). Although complementary measurements to enhance CTG interpretation, such as fetal pulse oximetry, lactate level measurements and fetal ECG waveform analysis, have been investigated, to date, these techniques have conferred limited advantages over conventional CTG monitoring (East 2007; East 2010; Neilson 2012). In particular, issues in interpretability were reported for ECG waveform analysis, which may have impacted, in part, its utility as an additional indicator of fetal compromise (Steer 2008). Consequently, conventional CTG monitoring has remained the norm across many maternity units.
In this context, an ES for fetal assessment represents a potential alternative mechanism to counter issues with observer bias and improve interpretation of fetal heart rate tracings. Developing an ES to improve CTG monitoring has been a goal in maternity care for decades. Whereas earlier versions displayed only limited successes, substantial advances have been made in intelligence software (Devoe 2000; Greene 1996; Guijarro-Berdiñas 2002; Steer 2008). Moreover, several observational studies have reported significantly improved levels of agreement between practitioners interpreting fetal heart rate patterns and identifying adverse outcomes when assisted by an ES (Ayres-de-Campos 2010; Costa 2010; Costa 2010a). Thus, improving diagnostic interpretation may result in improved identification of truly compromised babies who warrant intervention.
Why it is important to do this review
Given that a high proportion of women will receive a CTG on their admission to the labour ward and/or will be monitored continuously throughout their labour (ACOG 2009; Devane 2012), it is critical to ensure that these CTGs are interpreted to the highest level of accuracy to minimise sub-optimal clinical decisions and outcomes. Improved CTG interpretation has clear short- and long-term health benefits for both mothers and babies through possible prevention of serious neonatal complications and unnecessary operative birth. There are also important economic implications for the healthcare system. Due to long-term care requirements, neonatal cases of hypoxia and cerebral palsy can lead to costly malpractice suits (Miller 2011b); thus, reducing morbidity incidence through enhanced fetal assessment could potentially have profound impact in this regard. Further, reducing unnecessary caesarean birth also benefits the healthcare system. Not only is caesarean birth typically twice the cost of a vaginal birth (Fawsitt 2013; Henderson 2001), but also, particularly in a nulliparous woman, may initiate a legacy of increased health costs (Grobman 2000) as a result of higher risk of subsequent caesarean birth and medical complications (Garmi 2012; Lydon-Rochelle 2010).
To evaluate the effectiveness of continuous or intermittent CTG monitoring during labour with an ES compared with (1) continuous or intermittent CTG monitoring during labour without an ES or (2) intermittent auscultation with a Pinard stethoscope or hand-held Doppler ultrasound device.
Criteria for considering studies for this review
Types of studies
We will include all randomised, cluster-randomised and quasi-randomised trials comparing continuous or intermittent CTG monitoring during labour with an ES with continuous or intermittent CTG monitoring without an ES. We will also include trials that compare continuous or intermittent CTG monitoring during labour with an ES with intermittent auscultation with a Pinard or hand-held Doppler.
Given the rapidity at which the health status of the mother and baby can change during labour, cross-over trials are unsuitable for the intervention under review and therefore will be excluded.
Types of participants
Pregnant women in labour and their babies.
Types of interventions
We will make the following comparisons.
- Continuous CTG monitoring with an ES versus continuous CTG monitoring alone.
- Continuous CTG monitoring with an ES versus intermittent CTG monitoring alone.
- Continuous CTG monitoring with an ES versus intermittent auscultation with a Pinard stethoscope or hand-held Doppler ultrasound device.
- Intermittent CTG monitoring with an ES versus intermittent CTG monitoring alone.
- Intermittent CTG monitoring with an ES versus continuous CTG monitoring alone.
- Intermittent CTG monitoring with an ES versus intermittent auscultation with a Pinard stethoscope or hand-held Doppler ultrasound device.
For the purposes of this review, we define continuous CTG monitoring as monitoring of the fetal heart rate and uterine contractions, which commenced at some point during labour, and upon commencement, was only discontinued for short periods of time. We define intermittent monitoring as monitoring of the fetal heart rate and uterine contractions which were not continuous but rather at select intervals during labour.
We define an ES as any applied artificial intelligence tool designed to assist in complex decision-making by integrating a computerised knowledge base derived from expert opinion with individualised patient data (Liao 2005). Given that the underlying factors built into one ES may differ from others, where sufficient detail is provided by trial authors, we will describe which maternal and baby characteristics are included in the ES.
Types of outcome measures
Primary outcomes
- Incidence of caesarean birth.
- Incidence of perinatal mortality defined as fetal deaths (a baby delivered without signs of life at > 22 weeks' gestation and/or with a birthweight > 500 g) and neonatal deaths (death of a liveborn baby > 22 weeks' gestation and/or with a birthweight > 500 g occurring within 28 days after birth) excluding lethal congential anomalies.
- Incidence of neonatal seizures.
- Acidemia as evidenced by a pH less than 7.0 and/or a base deficit greater than 12 mmol/L in umbilical arterial cord blood or neonatal blood sample within the first hour of life, or both.
Secondary outcomes
- Incidence of operative vaginal birth (ventouse or forceps).
- Incidence of fetal blood sampling.
- Incidence of artificial rupture of amniotic membranes.
- Incidence of oxytocin augmentation of labour.
- Incidence of hypoxic ischaemic encephalopathy as defined by trial authors.
- Incidence of admission to neonatal special care and/or neonatal intensive care unit.
- Apgar score less than seven at five minutes.
Search methods for identification of studies
Electronic searches
We will contact the Trials Search Co-ordinator to search the Cochrane Pregnancy and Childbirth Group's Trials Register.
The Cochrane Pregnancy and Childbirth Group's Trials Register is maintained by the Trials Search Co-ordinator and contains trials identified from:
- monthly searches of the Cochrane Central Register of Controlled Trials (CENTRAL);
- weekly searches of MEDLINE;
- weekly searches of Embase;
- handsearches of 30 journals and the proceedings of major conferences;
- weekly current awareness alerts for a further 44 journals plus monthly BioMed Central email alerts.
Details of the search strategies for CENTRAL, MEDLINE and EMBASE, the list of handsearched journals and conference proceedings, and the list of journals reviewed via the current awareness service can be found in the 'Specialized Register' section within the editorial information about the Cochrane Pregnancy and Childbirth Group.
Trials identified through the searching activities described above are each assigned to a review topic (or topics). The Trials Search Co-ordinator searches the register for each review using the topic list rather than keywords.
For the purposes of this review, we will also include studies published as abstracts if we are able to extract sufficient information on the trial. In cases where insufficient data are published, we will first contact the trial authors to access required information. If after contacting the trial authors data remain insufficient, the abstract will be excluded from our review.
In addition, we plan to search grey literature through Open Grey and ProQuest Dissertation & Theses Database using the search terms given in Appendix 1
Searching other resources
We will review citations of reference lists of included papers identified through the above search strategy and assess their suitability for inclusion in the review.
We will not apply any language restrictions.
Data collection and analysis
The methods that will be carried out in this review were designed in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).
Selection of studies
Two review authors (Jennifer E Lutomski (JEL) and Declan Devane (DD)) will independently assess for inclusion all the potential studies we identify as a result of the search strategy. We will resolve any disagreement through discussion or, if required, we will consult a third review author (CA Ryan (CAR), Sarah Meaney (SM) or Richard A Greene (RAG)).
Data extraction and management
We will design a form to extract data. For eligible studies, two review authors (JEL and SM) will extract the data using the agreed form. We will resolve discrepancies through discussion or, if required, we will consult a third review author (DD). We will enter data into Review Manager software (RevMan 2011) and check for accuracy. When information regarding any of the above is unclear, we will attempt to contact authors of the original reports to provide further details.
Assessment of risk of bias in included studies
Two review authors (JEL and DD) will independently assess risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). We will resolve any disagreement by discussion or by involving a third review author.
(1) Random sequence generation (checking for possible selection bias)
We will describe for each included study the method used to generate the allocation sequence in sufficient detail to allow an assessment of whether it should produce comparable groups. We will assess the risk of bias for sequence generation as:
- low risk (any truly random process, e.g. random number table; computer random number generator);
- high risk (any non-random process, e.g. odd or even date of birth; hospital or clinic record number); or
- unclear risk.
(2) Allocation concealment (checking for possible selection bias)
We will describe for each included study the method used to conceal allocation to interventions prior to assignment and will assess whether intervention allocation could have been foreseen in advance of, or during recruitment, or changed after assignment. We will assess the risk of bias for allocation concealment as:
- low risk (e.g. telephone or central randomisation; consecutively numbered sealed opaque envelopes);
- high risk (e.g. open random allocation; unsealed or non-opaque envelopes, alternation; date of birth); or
- unclear risk.
(3.1) Blinding of participants and personnel (checking for possible performance bias)
Given the additional equipment required to support an ES, it is not possible for personnel to be blinded to the intervention in these trials. However, we will describe the methods used, if any, to blind women from knowledge of the intervention. We will consider that studies are at low risk of bias if women were blinded or if we judge that the lack of blinding would not likely impact results. We will assess the risk of bias for blinding of participants as:
- low risk;
- high risk; or
- unclear risk.
(3.2) Blinding of outcome assessment (checking for possible detection bias)
We will describe for each included study the methods used, if any, to blind outcome assessors from knowledge of which intervention a woman received. We will assess blinding separately for different outcomes or classes of outcomes. We will assess the risk of bias for blinding of outcome assessment as:
- low risk;
- high risk; or
- unclear risk.
(4) Incomplete outcome data (checking for possible attrition bias due to the amount, nature and handling of incomplete outcome data)
We will describe for each included study, and for each outcome or class of outcomes, the completeness of data including attrition and exclusions from the analysis. We will state whether attrition and exclusions were reported and the numbers included in the analysis at each stage (compared with the total randomised participants), reasons for attrition or exclusion where reported, and whether missing data were balanced across groups or were related to outcomes. Where sufficient information is reported, or can be supplied by the trial authors, we will re-include missing data in the analyses which we undertake. We will assess the risk of bias for incomplete outcome data as:
- low risk (e.g. no missing outcome data; missing outcome data balanced across groups; < 20% missing data);
- high risk (e.g. frequency or reasons of missing data imbalanced across groups; > 20% missing data); or
- unclear risk.
(5) Selective reporting (checking for reporting bias)
We will investigate the possibility of selective outcome reporting bias by cross-checking outcomes of interest reported in the methods section to those reported in the results section of the trial publications. We will assess the risk of bias for selective reporting as:
- low risk (where it is clear that all of the study's pre-specified outcomes and all expected outcomes of interest to the review have been reported);
- high risk (where not all the study's pre-specified outcomes have been reported; one or more reported primary outcomes were not pre-specified; outcomes of interest are reported incompletely and so cannot be used; study fails to include results of a key outcome that would have been expected to have been reported); or
- unclear risk.
(6) Other bias (checking for bias due to problems not covered by (1) to (5) above)
We will describe for each included study any important concerns we have about other possible sources of bias. For instance, given that certain biases are inherent to cluster-randomised trials due to study design, in these types of trials we will investigate potential biases due to recruitment, baseline imbalance, loss of clusters, incorrect analysis and comparability with individually-randomised trials. We will assess the risk of other forms of bias as:
- low risk;
- high risk; or
- unclear risk.
(7) Overall risk of bias
We will make explicit judgements about whether studies are at high risk of bias, according to the criteria given in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). With reference to (1) to (6) above, we will assess the likely magnitude and direction of the bias and whether we consider it is likely to impact on the findings. We will explore the impact of the level of bias through undertaking sensitivity analyses (see Sensitivity analysis) and will assess the overall risk of bias for each included study as:
- low risk;
- high risk; or
- unclear risk.
Measures of treatment effect
Dichotomous data
For dichotomous data, we will present results as summary risk ratios with 95% confidence intervals (95% CI).
Continuous data
For continuous data, we will use the mean difference with 95% CI if outcomes are measured in the same way between trials. We will use the standardised mean difference with 95% CI to combine outcomes from trials that measure the same outcome but use different scales (Higgins 2011).
Unit of analysis issues
Cluster-randomised trials
We will include cluster-randomised trials in the analyses along with individually-randomised trials. We will adjust their sample sizes using the methods described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) using an estimate of the intra-cluster correlation co-efficient (ICC) derived from the trial (if possible), from a similar trial or from a study of a similar population. If we use ICCs from other sources, we will report this and conduct sensitivity analyses to investigate the effect of variation in the ICC. If we identify both cluster-randomised trials and individually-randomised trials, we plan to synthesise the relevant information. We will consider it reasonable to combine the results from both if there is little heterogeneity between the study designs and the interaction between the effect of intervention and the choice of randomisation unit is considered to be unlikely.
We will also acknowledge heterogeneity in the randomisation unit and perform a sensitivity analysis to investigate the effects of the randomisation unit, i.e. to determine the sensitivity of the effect estimates to inclusion and exclusion of cluster trials.
Multi-armed trials
We will include multi-armed trials in this review. To overcome potential issues due to multiple, correlated comparisons, we will analyse multi-armed trials using methods described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). If feasible in the context of the research question, we will first determine if we can combine the multiple comparison groups to create one relevant intervention group and one relevant comparison group. If an appropriate pair-wise comparison cannot be created, we will then derive an average (or weighted average) and variance for all relevant intervention/comparison groups while accounting for correlation between these comparisons.
Dealing with missing data
For included studies, we will note levels of attrition. We will explore the impact of including studies with high levels of missing data (we judge this a priori to be greater than 20% for primary outcome) in the overall assessment of treatment effect by using sensitivity analysis.
For all outcomes, we will carry out analyses, as far as possible, on an intention-to-treat basis, i.e. we will attempt to include all women randomised to each group in the analyses, and all women will be analysed in the group to which they were allocated, regardless of whether or not they received the allocated intervention. The denominator for each outcome in each trial will be the number of women randomised minus any women whose outcomes are known to be missing.
Assessment of heterogeneity
Where studies are considered similar enough (based on consideration of populations and interventions) to allow pooling of data using meta-analysis, we will assess the degree of heterogeneity by visual inspection of forest plots and by examining the Chi² test for heterogeneity. We will assess statistical heterogeneity in each meta-analysis using the T², I² and Chi² statistics. We will regard statistical heterogeneity as substantial if an I² is greater than 30% and either the T² is greater than zero, or there is a low P value (less than 0.10) in the Chi² test for heterogeneity.
Where we identify substantial clinical, methodological or statistical heterogeneity across included studies, we will not report pooled results from the meta-analysis but will instead use a narrative approach to data synthesis. In this event, we will attempt to explore possible reasons for the heterogeneity by grouping studies that have similar populations and interventions.
Assessment of reporting biases
If there are 10 or more studies in the meta-analysis, we will investigate reporting biases (such as publication bias) using funnel plots. We will assess funnel plot asymmetry visually. If asymmetry is suggested by a visual assessment, we will perform exploratory analyses to investigate it.
Data synthesis
We will carry out statistical analysis using the Review Manager software (RevMan 2011). We will use fixed-effect meta-analysis for combining data where it is reasonable to assume that studies are estimating the same underlying treatment effect: i.e. where trials are examining the same intervention, and the trials' populations and methods are judged sufficiently similar. If there is clinical heterogeneity sufficient to expect that the underlying treatment effects differ between trials, or if substantial statistical heterogeneity is detected, we will use random-effects meta-analysis to produce an overall summary if an average treatment effect across trials is considered clinically meaningful. The random-effects summary will be treated as the average range of possible treatment effects and we will discuss the clinical implications of treatment effects differing between trials. If the average treatment effect is not clinically meaningful, we will not combine trials.
If we use random-effects analyses, the results will be presented as the average treatment effect with 95% CIs and the estimates of T² and I².
Subgroup analysis and investigation of heterogeneity
If we identify substantial heterogeneity, we will investigate this heterogeneity using subgroup analyses and sensitivity analyses. We plan to carry out the following subgroup analysis.
- Low-risk pregnancies versus high-risk pregnancies as defined by the trial authors.
We will limit subgroup analyses to primary maternal and baby outcomes (see Types of outcome measures).
We will assess subgroup differences by interaction tests available within RevMan (RevMan 2011). We will report the results of subgroup analyses quoting the Chi
Sensitivity analysis
We will perform sensitivity analyses based on trial quality by repeating our analysis among only those trials judged of 'high quality'. For the purposes of this review, 'high quality' trials will be defined as trials with low risk of bias due to allocation concealment and low risk of bias due to incomplete outcome data.
We will limit sensitivity analyses to primary maternal and baby outcomes (see Types of outcome measures). Sensitivity analyses will also assist in investigating substantial statistical heterogeneity if present (see Assessment of heterogeneity).
We would like to acknowledge Lynn Hampson (Trials Search Co-ordinator), Frances Kellie (Managing Editor) and Jim Neilson (Contact Editor) of the Cochrane and Pregnancy Childbirth Group for their support throughout the drafting of this protocol.
JEL has been awarded a HRB Cochrane Review Training Fellowship from the Health Research Board (HRB), Ireland.
As part of the pre-publication editorial process, this protocol has been commented on by three peers (an editor and two referees who are external to the editorial team) and the Group's Statistical Adviser.
The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pregnancy and Childbirth Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
Appendix 1. Search terms for Open Grey and ProQuest
Open Grey
medical equipment AND (fetal OR foetal OR birth OR labour OR labor OR childbirth)
expert systems AND (fetal OR foetal OR birth OR childbirth OR labor OR labour)
cardiotocograph OR cardiotocography
fetal monitoring OR foetal monitoring
(We will search for each line separately and assess results of each).
ProQuest Dissertations and Theses
all(fetal OR foetal OR birth OR childbirth OR obstetrics) AND all((electronic NEAR/1 monitoring OR expert NEAR/2 systems OR intelligent NEAR/2 analysis OR computer NEAR/2 analysis OR cardiotocography OR cardiotocograph))
Contributions of authors
JEL drafted the initial protocol and is guarantor for the review. DD supervised the review process, critically assessed the methodology and drafted part of the protocol. RAG and CAR provided a clinical perspective; SM provided a consumer perspective. JEL, DD, CAR, SM and RAG revised the protocol for intellectual content and approved its submission for publication.
Declarations of interest
None known.
Sources of support
Internal sources
- No sources of support supplied
External sources
- The Health Research Board, Ireland.Cochrane Review Training Fellowship


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i'd only run one brake (rear). Does that make more sense?
you take one of these sparky
and you do this to it
and then you take a good long look at yourself, and wonder if that is why you are slower than your mates.
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Basic Genetics Łódź November 2008 www.felesgrata.dk Who am I? Ole Amstrup Cattery name: DK Feles Grata Breeding: Oriental shorthair preferably blotched tabby, with silver, in all colours. How long: Since 1983 Home page: www.felesgrata.dk Who am I? What have I been doing. – Board member of Danish cat clubs – Board member of Felis Danica – Chairman of Felis Danica – Member of the Danish breeding commission – Member of the FIFe B&R (LO) commission – Lecturing genetics in Denmark and Norway Who am I? Why colour genetics? – Because I once breed budgerigars! – Because I love mathematics! What will happen? I will try to give a short explanation of what we think we know right now! Give you a basic knowledge about genetics (colours and patterns). To see a cat Some see a cat! I see: a female cat genetic black colour not diluted with white it's a tortie mackerel tabby shorthair To see a cat I see: A- agouti BB black D- not diluted Mc – mackerel tabby LL shorthair Ss bi-colour xox tortie To see a cat A cat is "built" of many different elements – a puzzle which can be joint together in many ways. – colour – sex – pattern – hair lenght – etc. "Colour - genes" B / b / bl black / chocolate / cinnamon D/d dense / dilute W/ w dominant white / coloured X/Y female / male Xo sex linked red placed on X "Pattern - genes" A/a agouti / non agouti Old teori: T a / T / tb Ticked/spotted/mackerel/blotched New teori: Mc / mc mackerel / blotched T a / ta Ticked tabby / not ticked tabby Sp / sp Spotted / mackerel S/s piebald spotted no white Wb wb wideband (tipping) normal ticking "Other genes" C / cb / cs / ca / c self/burmese pointed/himalayan pointed/recessiv white/albino I/i silver / non silver L/l short hair/ long hair "Other genes II" Dm/dm dilute modifier? Bm/bm black modifier Wb/wb wide band Genes Colour genes (pattern/hair length etc.) – Each gene controls one feature – Can be dominant, recessive or partly dominant Genes Polygenes – A lot of "small" genes work together – They work in different ways Chromosomes Genes are placed on the chromosomes There are several thousands genes on every chromosome The colour genes we know control one exact feature. There are three different types of genes controlling one feature: dominant recessive partly dominant Chromosomes 18 pairs with two identical 1 pair is not always identical X Y X X X carries genes. Y carries no genes. You can only deduct that this individual will be a male Chromosomes Division in sperm cells - male chromosomes two different at a male [XY] types of sperm cells. Chromosomes Division in egg cells - female chromosomes two identical at a female [XX] germ cells / eggs. Distribution of X and Y chromosomes When performing a mating, we can look at each gene / feature at the time. In this example we only look at the X & Y genes. In this table we fill in the possible egg and sperm cells. X Y X X Distribution of X and Y chromosomes X Y X XX XY X XX XY Distribution: male offspring [XY] - 50% female offspring [XX] - 50% Colour genetics We will look at one feature at a time. They can be combined later on. B genes - colour B B - black black i.e. MCO – NFO – SIB – TUV – RUS – KOR - SOK . B genes - colours B >b B - black b - chocolate black black chocolate i.e. BRI – PER/EXO – SBI - BUR B – genes - colour B > b > bl B - black b - chocolate bl - cinnamon black black black choc. choc. cinnamon Category IV – RAG – SNO – ACL – ACS – BRI? B – genes - colours B > bl B - black bl - cinnamon Ruddy Ruddy Sorrel ABY - SOM B genes – colour distribution Distribution of B genes / B black – b chocolate B B B b B BB BB B BB Bb B BB BB b Bb bb black X black black (choc.) X black (choc.) 100% black 75% black ( 25/50), 25% choc. B genes – colour distribution Distribution of B genes / B black – b chocolate B b b b b Bb bb b bb bb b Bb bb b bb bb black (choc.( X choc. choc. X choc. 50% black / 50% choc. 100% choc. D - genes - dilution cross section of a normal coloured hair (dense). colour pighment evenly distributed in the hair colour is black, choc., cinnamon D - genes - dilution Diluted hair Colour pigment is mixed with air bubbles The hair looks paler black blue choc. lilac cinnamon fawn D - genes - dilution / BB – Bb - Bb l black black blue full colour intensity/dense diluted [DD] and [Dd] do not change the colour of the hair. [dd] spread out the pigment and the hair will look paler. D - genes - dilution / bb – bb l choc. choc. lilac full colour intensity/dense diluted [DD] and [Dd] do not change the colour of the hair. [dd] spread out the pigment and the hair will look paler. D - genes - dilution / b b l l cinnamon cinnamon fawn full colour intensity/dense diluted [DD] and [Dd] do not change the colour of the hair. [dd] spread out the pigment and the hair will look paler. "Mating" black [Bb Dd ] X lilac [bb dd] Distribution of B genes and D genes B b D d b Bb bb d Dd dd b Bb bb d Dd dd 50% black / 50% choc. 50% dense/ 50 diluted "Mating" black [Bb Dd ] X lilac [bb dd] distribution Dd Bb Dd n black Bb dd Bb dd a blue Dd bb Db b choc. bb dd bb dd c lilac Tabby patterns All cats have a tabby pattern!! But you cannot always see it!! There are various theories about the genes, which decide the tabby patterns. When it can be seen it is a a coloured pattern on an agouti background Tabby patterns Old theory: Three different genes decide the tabby patterns Ta - ticked tabby T - mackerel/spotted tb - blotched This theory is more or less outdated, but it works on a daily base. Problem – sometimes ticked, blotched and spotted kittens are born in the same litter - after a mating between a ticked tabby and a blotched ! Tabby patterns New theory: Mc/mc A gene controls if it is mackerel or blotched Sp/sp A gene controls if the patterns should break up in spots (this is questionable – it might just be polygenetic) Ta/ta A gene which causes the ticked tabby pattern – this is partly dominant. I doubt that there is a spotted gene – so I will not talk about this. I do believe that the breaking up in spots is polygenetic and has to be managed via selection. Mc genes Mc / mc controls the basic tabby pattern mackerel/spotted blotched polygenes polygenes polygenes Mc genes Mc / mc control the basic tabby pattern The difference in appearance is polygenetic (in my opinion) Mc genes mc mc A genes – agouti / non agouti AA (Aa) is the original pattern for cats and the tabby pattern can be seen. A causes bands of different colours in the single hairs The hairs will be ticked – provide an agouti base The coloured pattern sits on this agouti base. A genes – agouti / non agouti aa is a mutation. there are only single coloured hairs – no ticked hair / on an agouti base. A genes – agouti / non agouti Ticked hair. Bands of various colours on every hair. The true colour is to be found in the tip of every hair. A genes – agouti / non agouti Non-agouti hair One colour (the tabby pattern should have the same type of hair) A genes – agouti / non agouti AA The tabby pattern can be seen (agouti) Aa The tabby pattern can be seen (agouti) aa The tabby pattern can not be seen. The cat is self (non-agouti) Two agouti cats can have self kittens, but two self cat cannot have tabby/agouti kittens!! The red colour The red colour. The red colour is sex linked. The gene is placed on the X chromosome. The result is that only phaeomelanin (the yellow/red colour) is produced No eumelanin is prodcued, which gives the black, chocolate and cinnamon colours. The red colour I have chosen to place the gene as a variation of the normal X gene, as the placement of the red gene is at the X chromosome. X the normal coloured cat Xo red Y carry no genes This way I think it is more clear that the colour is sex linked and the explanation about the outcome as a result of mating red/tortie cat is more clear. This is my way of seeing it – and not all share my opinion on this matter. The red colour Xo blocks the normal colours. Only red will be produced. In order to work fully there must be two Xo in a female . In the male, who only has one X chromosome, one Xo gives a red male The red colour - females Possible combination of the female sex chromosomes. Normal Tortie red The red colour - males Possible combination of the male sex chromosomes. Normal red The red colour The red gene blocks the result of [aa] There is no difference between a red with a genetic black, chocolate or cinnamon background The tabby pattern is always visible in red cats!!! A red self is genetically impossible Red mating Male: red Females: normal - tortie - red females: tortie red or tortie red males: normal normal or red red xo y xo y xo y x xo x xy xo xo xo xo y xo xo xo xo y x xo x xy x xo x xy xo xo xo xo y ½ Red mating Male: Normal Female: normal - tortie - red females: normal normal and tortie tortie male: normal normal and red red x y x y x y x xx xy xo xo x xo y xo xo x xo y x xx xy x xx xy xo xo x xo y ½ C genes – albino serie C genes have 5 levels. C normal colour cb burmese point cs himalayan point (siamese, colour point, sc. birma, ragdoll) ca recessive white (blue-eyed albino) c red-eyed albino C genes – albino series Strength between the 5 different genes are: C > cb > c s > c a > c C dominates all others cb onyl partly dominates cs (tonkanese) I will only deal with C or cs. C genes – albino series [cscs] causes the pigmentation to be linked to the temperature. The coldest areas will have colour. Colour on legs, tail, ears and face. The warmer areas will be lighter. Eyes will be deep blue. A pointed cat is genetically a cat in whatever colour, which is lighter in the warmest parts of the cat. At birth all kittens are white (no pigmentation) I genes – Silver (inhibitor) [II] & [Ii] cause suppression of the yellow pigment in the individual hairs. and that leaves the lowest part of the hair without pigmentation (but can vary a lot!!) [ii] is the normal coloured cat. (non-silver) I genes – Silver (inhibitor) The I gene "pushes" the colour up in non agouti hairs. The lower part of the hair is completly white Non agouti and silver = smoke. non-agouti hair smoke hair. I genes – Silver (inhibitor) In agouti cats, the I gene surpresses the phaomelanin (the yellow/red colour) and the ticked hairs wil be black and white without coloured bands. agouti hair silver agouti hair I genes – Silver (inhibitor) In agouti cats the I gene inhibits the phaomelanin (the yellow/red colour) and the ticked hair will be black and white without coloured bands. non silver OSH n 22 silver OSH ns 22 I genes – Silver (inhibitor) Rufism/tanning? – Unwanted colouring - mostly on legs, neck and sides…. – Selection will reduce the problem – Is it connected to the warmth in colour?? – I think I have observed that a deep, warm, intense colour at a non- silver cat leads to a cold, clear, non-rufistic silver ofspring! S - genes Piebald spotted S genes are only partly dominant towards s That means that there is a difference between [SS] or [Ss] S gene causes a small or large distribution of white in the normal colour. S - genes Piebald spotted The variation is very big and it is impossible to predict any outcome of the white pattern!!! S - genes Piebald spotted The amount of white is controlled on the basis of the cell / polygenetic, and it is possible to find cats with the genetic [SS] or [Ss] which have the same amount of white. S - genes Piebald spotted Grades of white ss Ss SS L - genes The L - genes affect the hair length. [LL] and [Ll] is short hair. [ll] is long hair. A short haired cat can carry gene for longhair L - genes Long hair cats L - genes The difference between long hair and semi long hair is not genetic – it is not a result of the L genes. The difference is a result of selection and is polygenetic. Ta genes The Ta gene cover the "normal" tabby patern. Is only partly dominant. Ta genes Ta Ta Ta ta ta ta Abyssinian ticked – no stripes Ticked tabby – stripes on legs tail and head Normal tabby ticked tabby patern Ta genes Homozygot ticked tabby A - McMc TaTa Ta genes Heterozygot ticked tabby A - McMc Tata W – genes – dominant white Dominant white. Removes all pigment from the coat. Cover up ALL other colours/paterns! Eyecolour can be blue, orange/green or one of each (odd eyed). W – genes – dominant white Can cause deafness in white cats. The deafness gene is placed on the same chromosome and will "follow" the W gene. W – genes Gen-code: -- -- -- -- -- -- -- -- -- -- -- W- Dilute modifier Not recognized in FIFe! Does it actually exist?? Modifies diluted colours (can only be seen when the cat is homozygot [ d d ]) The EMS code is for registration purposes only in imported cats from other organisations. Dilute modifier 2 x "caramel" or 1 x lilac? Dilute modifier 2 x "caramel" or 1 x lilac? lilac silver ticked Dilute modifier B - dd Dm - blue-based caramel b - dd Dm - lilac-based caramel blbl dd Dm - fawn-based caramel - - dd Dm - xoy/xo xo apricot (+ all torties) Black modifier Amber / light amber A recessive gene – Dm for normal colour – dm for amber Do not work with red (epistatic) Cancels the blocks the work of [ a a ] Black modifier BB Dd Mc- bmbm Pedigrees What do you need to decide the genetic code? – Colour of the cat – Parents colour – Colour of offspring All the rest can only give you an idea! – no precise knowledge. Pedigrees What can we see? – non-agouti – black – tortie – non silver Pedigrees What can we see? – non-agouti – black – tortie – non silver What can we know? – Carry dilution – Is probably Mc – – is [ss] [ww] / [ii] Pedigrees What can we see? – non-agouti – black – tortie – Non silver, mo white/white spots What do we know? – Carry dilution – Is probably Mc – – is [ss]/ [ww] / [ii] Genetic code? [ aa BB Dd ii Mc- ss ww xox] Pedigrees What can we see? Pedigrees What can we see? – A- – bb – Cc – Dd – Ii – mcmc
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Robin vs. batgirl
ok. I know there are tons of you who hate both Stephanie and Damian. Well.... you shouldn't read this issue.
Its a mirror image of Barbara and Dick all those years ago, duke'n it out to prove who's the better bat kid. We also get some Actual Barb on Dick (er...Batman) Action, as the two reminisce on the good old days when they where the brats in the capes.
The story runs smoothly enough. A couple of cool characters climb their way out of the underused box and take it to Dick while the bat-minors learn to work together.
honestly, the only thing anyone can hate about this issue are the characters.If you like the current core of the Bta-family (minus Tim), you'll love this issue.


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The Green Bay Packers Hall of Fame Inc. Golf Classic is set for Monday, July 13, 2015, at The Bull in Sheboygan Falls, WI. Those interested in participating in the event can contact Holly Borga (920-965-6986; email@example.com) for more information.
The Green Bay Packers Hall of Fame Inc. will induct former Packers quarterback Brett Favre at the 45th Annual Hall of Fame Induction Banquet. The event will also feature the retirement of Favre's No. 4. This dual recognition is an honor that is unprecedented in Green Bay Packers history. The banquet will be held on Saturday, July 18, 2015, in the Lambeau Field Atrium.
1919 Kitchen & Tap is scheduled to open on July 24, 2015 on the first floor of the Atrium (below where Curly's Pub was located). We hope you'll join us at our new restaurant as we continue to make history with respect to our past!
The Green Bay Packers 2015 Annual Meeting of Shareholders will be held Tuesday, July 28, at 11 a.m., at Lambeau Field. The meeting will take place rain or shine.
posted 6/3/98, modified 6/6/07
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Banana Almond Tart Recipe Cooking Show
Banana Almond Tart is a very sweet and yummy dish to try this out in a splendid way so check this out and enjoy.
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Almond Cream Recipe Cooking Show
Almond Cream is a delicious and yummy dessert to try this out in your kitchen and enjoy.
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In this episode you will learn how to make cream cheese and almond tart try this out.
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Kristina Jackson, a pastry chef for Real Food Daily and a nutrition consultant with a degree from The Institute for Integrative Nutrition, shows you how to make almond milk.
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Chocolate Almond Milk Recipe Cooking Show
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Our family visited Virginia Hot Springs for Christmas of 2012 and stayed with Natural Retreats. The conceirge service was wonderful and the staff on site absolutely took care of our every need! We had a great time exploring and dining in the historic area and our family found many interesting things to see and do. We highly recommend the Jefferson Pools experience, which is a historic and natural hot springs pool. We thought we might spend 20 minutes or so soaking and ended up enjoying the relaxing float for over an hour!! Thank-you so much Natural Retreats!!
- Official Description (provided by the hotel):
- Take a break in a remarkably beautiful wilderness location with the new residences at Virginia Hot Springs, set amongst the 11,500 acre Homestead Preserve. This stunning and iconic region is richly historic and provides the perfect setting for our luxurious and comfortable cabins and cottages.You'll find a wealth of activities within your reach, including many hiking trails, horseriding paths, a skiing, snowboarding and tubing area, fly fishing rivers, golf courses and plenty of local entertainment to help make your holiday unique.The retreat is surrounded by the Allegheny Mountains at the southwest edge of the Old Dominion. The Nature Conservancy's Warm Springs Mountain Preserve and the George Washington National Forest also borderthe area, providing stunning views and landscapes to explore in every direction. ... more less


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I am commenting on a thoughtful letter by Jerry Turner published Feb. 26 in the Journal Review concerning the request by the Crawfordsville District Public Library board that the county commissioners expand the library district to include three additional townships: Coal Creek, Wayne and Ripley. A little background may be helpful.
Montgomery County has five public libraries serving citizens in: Crawfordsville-Union, Darlington-Franklin, Ladoga-Clark, Linden-Madison and Waveland-Brown. These citizens pay for the services through a library tax levy imposed by the library board. In 2011, the rates for each $1,000 of assessed valuation were:
• 0.1395 Crawfordsville and Union Township
• 0.1279 Linden and Madison Townships
• 0.0899 Waveland and Brown Township
• 0.0768 Darlington and Franklin Township
• 0.0664 Ladoga and Clark Township
For example, the taxpayer with $100,000 in assessed valuation in Crawfordsville-Union will pay $139.50 while the taxpayer in Ladoga-Clark will pay $66.40. Taxpayers with more property (assessed valuation) will pay more; citizens pay nothing if they have no property.
The township boards in three other townships pay a fee to an adjoining library to obtain library service for its citizens. In 2012, Sugar Creek Township (population 448) paid the Darlington Public Library $2,000; Walnut Township (population 1,394) paid the Ladoga-Clark Public Library $4,000 while Scott Township (population 837) did not pay.
The three remaining townships that do not provide library service are the ones being considered for the expanded district. The residents of Ripley Township who purchase a library card from any county public library may present a receipt and receive reimbursement from the township. In 2012, Ripley Township (population 977) paid residents $1,243 for 22 library cards at $56.50 each; in 2013 the township paid residents $960.50 for 17 cards.
Residents of Wayne and Coal Creek townships receive no taxpayer-funded library services since the townships do not pay for them.
In 2007, the bi-partisan Indiana Commission on Local Government Reform recommended county-wide library systems and service for all citizens. The report states that 395,000 citizens in 38 Indiana counties do not have access to library services in the communities in which they live. "By reducing the number of districts, we can address current unserved and underserved areas and achieve additional economies of scale within administrative and purchasing expenditures." "Remove the taxing authority of any office or entity that historically has little or no oversight or transparency."
By state law, if the county commissioners expand the district of a library, the library board of the district determines the tax levy.
I applaud the commissioners for seeking comments from citizens and from Coal Creek Township trustee Roger Kunkle, Wayne Township trustee Jack Edwards and Ripley Township trustee Jim Spence before they decide.
As the three county commissioners weigh the advantages and disadvantages of an expanded Crawfordsville District Public Library, citizens should listen carefully to the reasoning of each of them. The commissioner might reason that township boards, not the commissioners or library boards, should continue to decide whether constituents have library service. The commissioner might reason that there is more transparency and better representation when decisions about library coverage are made by commissioners rather than by township boards. The commissioner might reason that although Coal Creek, Ripley and Wayne citizens will pay a tax they did not pay before, the new tax levy rate for the larger district will be smaller than the current Union Township rate. (More assessed valuation lowers the tax rate.) The commissioner might reason that equal access to the educational opportunities of a library improves the quality of life of the county, a potential factor in the decision making of a prospective industry or business.
Which of these factors or others would influence your decision if you were the commissioner?


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Excellent beach access home on Lake Winnipesaukee (SOR7B)
From $1,705 / week
Description from the manager
Description from the manager
Bedrooms: 3/
Bathrooms: 2/
Sleeps: 6/
Type: House
Overlooking the beautiful association beach at Patrician Shores. This one level 3 bedroom home features an open concept living room, dining room and kitchen that steps out onto a large deck extending the entire length of the home. This newly renovated deck overlooks beautiful Lake Winnipesaukee from an elevated lot providing a one of kind view. There is an easy footpath leading down to the beach where a dedicated swim area is roped off for your protection. This large sandy beach and community also provides a swim raft, a 24 foot boat slip, community tennis and basketball courts. This home provides the unique feel of being in a waterfront...Read more
About the manager
About the manager
Bayside Rentals
Bayside Rentals
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Overall rating:
4.0 / 5.0
Excellent beach access home on Lake Winnipesaukee (SOR7B) Meredith, New Hampshire
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If you like comics, then I'll encourage you to read the author's own comic-inspired book "Soon I Will be Invincible." It it good fun.
Villain: "Once you get past a certain threshold, everyone's problems are the same: fortifying your island and hiding the heat signature from your fusion reactor."
I second Ringo's comment. "Soon I Will Be Invincible" is very enjoyable indeed.
Speakeasy is a blog covering media, entertainment, celebrity and the arts. The publication is produced by Barbara Chai and Jonathan Welsh with contributions from the Wall Street Journal staff and others. Write to us at email@example.com or follow us on Twitter at @WSJSpeakeasy or individually @barbarachai.
Content engaging our readers now, with additional prominence accorded if the story is rapidly gaining attention. Our WSJ algorithm comprises 30% page views, 20% Facebook, 20% Twitter, 20% email shares and 10% comments.


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Nutritionists have taken back their warnings against dietary cholesterol. Now some are challenging the warnings against salt. [Read more...]
Christianity, Culture, Vocation
Nutritionists have taken back their warnings against dietary cholesterol. Now some are challenging the warnings against salt. [Read more...]
Have you been told to "watch your cholesterol," so you've gone on a diet that cut out eggs, meats, and some of your favorite foods, making yourself miserable? Well, it was all for NOTHING.
The official Dietary Guidelines Advisory Committee, recognizing that cholesterol comes from the liver and not the food we eat and that cholesterol in the blood isn't the main factor in heart disease anyway, has decreed that people need not longer worry about cholesterol in their diets. So go eat an egg. [Read more...]
"Orthodoxy" means "right belief." Now there is a new word, "orthorexia," meaning "right eating." The National Eating Disorders Association defines it as "fixation on righteous eating." [Read more...]
Japan, where people enjoy a good cut of whale, is pushing back against international anti-whaling rules, which are allegedly nothing more than "eco-imperialism." According to the Japanese, it would be as if people in India who believe cattle are sacred would impose punishments on nations that eat beef.
Notice how the various sensitivities we are supposed to have–honoring cultural relativism, respecting the environment, not oppressing anyone, being tolerant of eveyone's practices and beliefs–can be set against each other. Can you think of other examples? [Read more...]
The food industry is the biggest sector of the economy. Food is a major factor in health. Food production has a major impact on the environment. Food is a factor in policies about poverty, foreign aid, and entitlements. Shouldn't we have a coherent national food policy, other than an agriculture bill that rewards farmers for producing food that isn't necessarily good for us? A group of food activists is making the case that we should. See what they are proposing after the jump.
Would this just be big government infringement on liberty, or is there something to this? What would be some free market solutions to these concerns? [Read more...]
The children's crusade against big government that we've blogged about earlier is intensifying, as kids are rebelling against the healthier lunch room fare–ignoring fruits & vegetables, protesting whole wheat facsimiles of culturally significant foods like biscuits and tortillas, and filling the garbage bins with other nutritious food that they just don't like–required by federal guidelines against childhood obesity.
School officials, deploring the waste, are asking for more flexibility in what they can offer in their lunchrooms, and Republicans are pushing for some changes. Democrats, as is their wont, are blaming corporations, rather than the consumers, for trying to change the guidelines, with one target being that great patron of Lutheran causes Schwan Foods, which supplies 75% of the nation's lunchrooms with the pizza school children crave. [Read more...]
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AsiaSpa Magazine
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May 22, 2012; Davie, FL, USA; Miami Dolphins offensive tackle Jake Long (77) during practice at the Dolphins training facility. Mandatory Credit: Steve Mitchell-US PRESSWIRE
On The Forum
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- SEA coaching staff high on RB Thomas Rawls - Thomas Rawls | SEA
- Report: Pierre-Paul has nerve damage, burns - Jason Pierre-Paul | NYG
- Montee Ball expected to see 7-8 carries/game - Montee Ball | DEN
- Tice: Trent Richardson has 'lost some weight' - Trent Richardson | OAK
- Packers | Andrew Quarless safe for now
- Lions | Detroit's slot WR job up for grabs
- Bills | MarQueis Gray likes new offense
- Bills | Bacarri Rambo could start
- Giants | Jason Pierre-Paul could miss Week 1
- Ravens | Elvis Dumervil eyeing SB with sacks
- Cowboys | Dez Bryant deal done soon?
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- Lions | Ameer Abdullah to be featured?
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35 posts tagged with dog and adoption.
Displaying 1 through 35 of 35. Subscribe:
MeFi, help me name my new dog?
We are adopting this puppy right here, and I'd love some help with name ideas! [more inside]
The problem is, I want to hug all the world's dogs.
How can I figure out what dog I want to adopt, when it's so hard for me to meet with them? [more inside]
Help me legally and ethically adopt my dog from a crazy LA rescue org.
When we brought home a new pup from a local rescue organization three months ago, we had no idea we were getting involved with a Crazy Lady. The adoption STILL isn't finalized and we really want to make it official and never deal with them again. Help me understand if their requests are reasonable and officially adopt my dog! [more inside]
Introducing a new foster dog
Due to an emergency rescue, my plans for introducing a new foster dog have been pushed up significantly to tonight. There is one problem, I'm the only one around tonight and by the time, I pick her up - it will be super dark so introducing dogs in a neutral location is out. Help me make this as smooth as possible. [more inside]
Preparing my house for a new adopted shelter dog
What can I do to make my home "dog-proof" for the new 18-month-old dog I'm getting from a shelter? And what can I do to ease the trauma for him of moving to a completely new home? [more inside]
playing the field, doggy edition
My husband and I are in the process of adopting a dog. Based on online profiles and email conversations with foster families, we've got it narrowed down to two pups that have been fostered through two local rescue groups. Now we are scheduling in-person meetings with the dogs and "home visits" where they send a volunteer to make sure our house is ok for a dog. Should we be telling each group that we are deciding between two dogs, which we're meeting on Thursday and Friday? [more inside]
We are getting a dog! Advise needed.
I have some questions about how to best bring a new dog into a new home. [more inside]
Questions on adopting a dog, with consideration for desert and a baby
My wife and I have talked of adopting a dog for a while. Following the untimely passing of one of our cats, this is more feasible, and could help console us. But we have questions for adopting a dog in our desert climate, and on dogs coming into a family with a baby, and a cat. And we're concerned about being good owners, as our time at home is limited during the week. Also, we're discussing what a good age range for an adoptable dog would be. Details inside. [more inside]
What's wrong with this dog?
I adopted a dog on Saturday, a Silky Terrier mix. He had just gotten to the pound the day I adopted him, having been dropped off by a family who said they couldn't afford him. He's a very sweet dog and hasn't made a peep since I got him (seriously, not even a whine). Thing is, he won't eat. He's eaten maybe five tiny pieces of Kibbles and Bits and hasn't relieved himself in solid form, despite many walks. I finally gave in and gave him canned food and he took a bite, then ran off with the remainder, dropping it in the middle of the hallway and not touching it after that. [more inside]
Dog Ownership 101
What's it like to be a first-time dog owner? [more inside]
Mail order wedding?
Is adopting a dog sight-unseen foolish? [more inside]
Another exciting round of NAME. THAT. DOG!
NAME. THIS. DOG! [more inside]
A dog without politics in Seattle?
I am looking to adopt a dog, but first I want more information. I live in Seattle. I'd love to find a dog group/dog place where I can go, ask questions, maybe even get to know some different dogs, but I've lived in Seattle for more than 20 years and I've seen how ridiculous, make-PETA-look-sane, over the top animal people here can be. Is there a dog place/group in Seattle that is kind to people? [more inside]
How to adopt a Boston Terrier, without waiting months?
What's the best way to adopt a Boston Terrier (without waiting months and months)? [more inside]
Can a rescue organization claim a dog as their own for its entire life?
How much legal weight does a shelter dog adoption agreement carry if the original adopter (who signed the agreement) has died? [more inside]
At this rate, there will be sixteen by next week.
Cool or uncool: your spouse gets a second dog from a local shelter without asking or consulting you? [more inside]
Should we find our dog a new home?
Help me think through whether we ought to find a new home for our dog. Long, special-snowflake details inside. [more inside]
Second dog or not?
Should I get a second dog? [more inside]
We got a puppy. Was this a bad idea?
Should we keep our puppy? What do we do? [more inside]
Please help me place my mother's senior dog
Does anyone have experience with giving up a senior dog for adoption? How does the process work? [more inside]
Should we foster a dog?
Should we foster a dog? [more inside]
A great life for my elderly Pekingese
How to give my new 9-year-old Pekingese the healthiest, happiest life possible. [more inside]
New shelter dog is making me bonkers. Help!
My new shelter dog is making me bonkers. What do I do? [more inside]
Which to adopt from: No-kill or "kill" shelters?
No-kill vs. kill shelter: is one more "right" to adopt from? [more inside]
Tough decisions regarding my dog
I adopted a dog a few years ago and now I'm considering the possibility of giving her up. I feel awful about it and I'm not sure what to do. Good reason for doing it: starting med school. Not sure if it's a good or bad reason: Boyfriend hates her. Really long, but if you can handle it, I'd love some insight. [more inside]
How to deal with giving up a beloved pet?
Help me deal with having to give up one of my dogs... [more inside]
We adopted a Rott!
We just adopted a rescue Rottweiler and we couldn't be happier. When we bring her home on Monday, I want to be completely prepared. Please help! Details inside. [more inside]
Is there a good way to "shop around" animal shelters for pet adoption?
I'm a potential dog adopter. Is there a responsible way to "shelter-shop", and if so how do I do it? [more inside]
Blind Leading the Blind?
Just returned from a trip to the animal shelter looking for a second dog to adopt. Found a very sweet blind Aussie Shephard and fell in love. Need help to see if this is a good match: Can anyone share experiences/special challenges with caring for a blind dog? [more inside]
Daisy attacked & damaged 3 dogs, has heartworm, severe separation anxiety: is it time to put her down?
My dog has damaged (bitten through the skin) 3 other dogs and was just diagnosed with heartworm. I know it's a bit impersonal to ask online, but can help me figure out when it is time to consider putting down my pet? [more inside]
Thinking about returning an adopted dog--guilt! shame! I suck!
Returning an adopted rescue dog when the adoption just doesn't "take." Happened to anyone? How to handle? (Lengthy angsting and soul-searching within...) [more inside]
DogFilter: Should I adopt a male or female Boston Terrier pup?
DogFilter: Should I adopt a male or female Boston Terrier pup? [more inside]
Housebreaking an Adopted Dog
Does house training a young dog work the same as house training a puppy? [more inside]
Can a 19-year-old adopt a dog?
Would rescue organizations or shelters allow a 19-year-old college student to adopt a dog? [more inside]
How to ask someone if they will give their dog to me, as they don't seem to care for it
What's the best way to approach someone, who doesn't seem to care in the least for their pet, and ask them if they would like to give the dog a better home by letting me take him? (MI) [more inside]
What's the best way to approach someone, who doesn't seem to care in the least for their pet, and ask them if they would like to give the dog a better home by letting me take him? (MI) [more inside]
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Nicely Maintained 2004 Volkswagen R32 Hatchback - naturally aspirated 3.2: V-6 engine under the hood with a six-speed manual transmission... More
1963 VW beetle bug, one owner, well restored, 32.791 miles, 4 cyl. This is an estate vehicle, and will sell to the highest bid on... More
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Some Ferry Routes Switch To Winter Schedule
Posted: 11/01/2010 - With the cooler weather moving in several ferry routes are switching to their winter schedule.
Posted: 11/01/2010 - With the cooler weather moving in several ferry routes are switching to their winter schedule.
Updated: 10/29/2010 - There have been problems with the electronic voting machines in Craven and New Hanover counties.
Updated: 10/26/2010 - New signs going up on the major highways entering eastern North Carolina are welcoming drivers to the region's rich military heritage.
Updated: 10/25/2010 - The State Board of Elections says only 2 counties have reported early voting problems with the touch-screen Ivotronic machines.
Updated: 10/24/2010 - Prices for the Bald Head Island ferry will increase about 40 percent next year.
Updated: 10/19/2010 - Jimmy Bass, Senior Associate Athletics Director for External Operations at East Carolina University, will be the next Athletics Director at the UNC-Wilmington.
Updated: 10/19/2010 - Hollywood is coming back to North Carolina, and state leaders say that could mean millions of dollars for the local economy.
Updated: 10/04/2010 - U.S. 264 is now open between Greenville and Washington. U.S. 17 at the Jones/Onslow County line is again open as well.
Updated: 06/01/2011 - A double whammy of rainmakers is causing some to remember Hurricane Floyd and the flooding that followed, as well as wonder what will happen to area rivers this week. Click full story to read the stats and see what all this rain is expected to do to Eastern Carolina's waterways.
Posted: 09/27/2010 - A record 8.10 inches of rain so far in Brunswick County has led authorities to declare a state of emergency.
Updated: 09/23/2010 - Candidates in a North Carolina congressional race have been using selective editing and selective facts to air ads that are leading voters astray.
Updated: 09/20/2010 - A young man who was surfing off the coast of an Eastern Carolina beach has died.
Updated: 09/16/2010 - Authorities have identified the person killed after a county inmate van and a pickup truck collided, catching fire.
Posted: 09/15/2010 - Bald Head Island could receive FEMA assistance for beach erosion caused by Hurricane Earl.
Updated: 09/08/2010 - The owner of a coastal North Carolina restaurant is fed up with screaming children who bother other diners.
Updated: 09/08/2010 - LCpl. Ross Carver was from Rocky Point and based at Camp Lejeune.
Posted: 09/06/2010 - North Carolina investigators say three people have died in a shooting in a coastal community.
Posted: 09/01/2010 - The mental health and substance abuse problems affecting returning troops and active law officers are getting attention in North Carolina.
Updated: 08/27/2010 - The Frying Pan Shoals Light Tower sits some 25 miles off the North Carolina Coast.
Updated: 08/26/2010 - The 89-year-old Wilmington man was adjusting his parking job when he backed over his wife in their driveway.
Updated: 08/13/2010 - Looks like more people are vacationing along our coast this year.
Posted: 08/12/2010 - UNC system President Erskine Bowles on Thursday directed a student insurance company to contact students who have bought a policy this fall and give them the chance to opt out of that coverage.
Posted: 08/06/2010 - The North Carolina State Ports Authority lost $6 million in the budget year that ended in June.
Posted: 08/04/2010 - The Charlotte Bobcats are going back to owner Michael Jordan's hometown for training camp.
Posted: 07/26/2010 - A North Carolina family is thankful for their 17-month-old son's life after a gruesome household injury. He fell off a chair onto a pressure washer, and a metal rod went into his skull.


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Breakfast, lunch, tea and cake in Brighton
Mostly Matt and Cat write about the Isle of Wight. But not always. In 2014 they took an autumn city break in Brighton where they got some great dining out tips from the locals, and this is one of several reviews they wrote there. It's one of an occasional series of mainland reviews.
They say that Ventnor is where all of the refugees from the early Isle of Wight Pop Festivals laid their roots. The Islands most southerly town was known for its preponderance of beardies and yoghurt-weavers, partly drawn to the locations climate and lack of police presence - perfect conditions for growing exotic weeds. Although today you may still find a cadre of whiskery hippies - identifiable by their Peruvian cardigans and green wrists from copper bangles - their children and grandchildren are now owning the town. These energetic progeny have injected an artistic vibe into Ventnor, which has drawn businesses,visitors and other creatives to this revitalised corner of the Isle of Wight.
That model is not unique though. If you can imagine Ventnor magnified several hundred times, you wouldn't be too far from envisioning Brighton. Once rather dismissively labelled London by the Sea, like Ventnor this city has evolved and grown into something really interesting. Yes, the seeds were sown by hippy forebears who themselves must have been influenced by the citys ultimate patron of leisure and style, the dissolute Prince Regent. And now they have born fruit.
2094 views
Categories: Mainland
Ronnie and the Taco Bandits
After years in the doldrums, the Isle of Wight has become quite the destination for festivals and events. Yachts, books, hedges and even potatoes have their own celebrations.
And, as much fun as it is bimbling around a field welly-wanging, examining artificial insemination charts and enjoying a good old fashioned sing-song, everyone needs to refuel. However, festi-nosh can be extremely varied; from the delights of a of a Secret Supper Club pop-up restaurant all the way down to some rip-off burger you'll hate yourself (and its purveyor) for eating.
Matt and Cat have chuntered on about the rise of street food on this blog before. In the days prior to the ubiquity of the hipster food wagon, for decades we on the Island spearheaded the trend with Minghellas ice cream van and the Jolly Fryer mobile chippy. And now the Isle of Wight's peripatetic catering facility club has a new member in the playful form of Ronnie and the Taco Bandits.
2677 views
Categories: We like, Take aways, Street food
Sloop Inn, Wootton
One of the top questions Matt and Cat get asked is 'Can you recommend a decent Sunday roast?' You'd think that meatophile Matt would have a list as long as your arm of places where you can get a spectacular platter piled high with roast beef of Old England. However, you'd be wrong. Matt and Cat are so indolent that they usually miss Sunday lunch altogether, preferring instead to sleep in as late as possible - sometimes after a Saturday night to remember. After all, if a Day of Rest is good enough for God...
But as the nights finally draw in and the days of picnic lunches fade into the distant memory of yet another hot summer (thanks, David Thornton), M&C decided to get up early and head to Wootton Bridge to find a roast for, what for them was, breakfast.
You need to plan your strategy for a visit to the Sloop. Matt and Cat turned up one Sunday just after midday. This was a good game plan. There was room in the small car park and, more importantly, room in the pub. If you want the premium seats you need to arrive even earlier - the really early birds had staked their claim on all of the window seats at the back of the pub. Clearly these tables, with their view up the pretty river, were the most popular. Matt and Cat were resigned to grabbing a table a bit further inside, which had a disappointing lack of daylight but was within sight of some ancient and gnarly beams - presumably a remnant of the original inn.
Having staked their seating claim with judicious use of jackets flung over the seats, they trotted down to the business end of the pub - the bar and carvery. In a 2008 review of the Sloop, M&C said that the carvery concept is like 'school dinners for pensioners'. In this regard, little has changed. The system is simple: you buy your drink plus dinner ticket at the bar, which you swap for the roast of your choosing.
6695 views
Categories: We like, Family friendly, Ryde, Carveries
Eastern Eye, Sandown
There are a some local Indian restaurants that M&C would say are definitely worth a visit. Monsoon in Ryde is a lively, modern curry house that Matt and Cat are always happy to recommend. The veteran Saffron in Cowes also has many fans, and M&C have enjoyed several meals there. It remains true that Indian cuisine on the Isle of Wight has not universally enjoyed the huge improvements in standards and choice that other sectors of the Island's food and drink offering have seen over the last decade or so and, to be perfectly frank, Cat has all but given up going out for a curry. It may be that she always chooses poorly. Not being one for the hot stuff, her rota of chicken tikka masala, chicken passanda and chicken korma (the mildest red one, the mildest yellow one and the mildest orange one) is never going to set anyone's arse on fire.
It has been quite a while since the old Taj Tandoori in Sandown High Street emerged from its chrysalis as the shiny new Eastern Eye in early 2013. With Cat taking a curry hiatus it fell to Matt and companion Bill to give the place the once over.
3728 views
Categories: We like, Restaurants, Take aways, Sandown & Shanklin, Indian
Fogg's, Ventnor
Fogg's has undergone something of a mild transformation. An earlier incarnation saw a wildly ambitious multi-page menu with an eclectic range of dishes from around the world. Probably a menu that was more fun to conceive than deliver. A change of ownership saw the menu's international offerings contract a little and in autumn 2014 another step-change occurred as the venue changed its name to Fogg's and launched another new menu.
Fogg's has a pretty lively voice on social media and Matt and Cat have regularly read about the restaurant's popular fish dishes - often created with locally-caught seafood brought ashore at Ventnor Haven. M&C have wondered why Fogg's doesn't just knock the world food stuff on the head and embrace its obvious strengths. Maybe bring to the fore their locally-provenanced menu with a seafood emphasis. Certainly these days, punters seem to crave local distinctiveness in their food, and visitors to the Island regularly ask M&C where the Island's fish restaurants are - the Rick Stein effect is clearly not confined to Cornwall.
And so it came to pass that Cat was left with a booking for a table for two at Fogg's, Ventnor (previously Phileas Fogg's) on a Saturday night.
9323 views
Categories: We like, Restaurants, Family friendly, Ventnor area, Local produce


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Release Date
Sep 2015
What the movie has in store for you, wait and watch this space for more updates.
Go to: Mareyalaare Cast & Crew
Chetan i am die hard fan of you,your film birugali has influenced me a lot..... Great keep going.......
I am a tamilian staying in Bangalore. I love old kannada movies. Specially DAD's Rajkumar. I am really proud of the kannada film industry which has produced great artistes like Vajiramani, mushri, Balkrishna, lokesh. There are no matches to these great people. I strongly feel that right now Chethan and Puneet are the best. I am proud to be in bangalore and i wish was a complete kannadiga. Kannadigas have very big heart. Love you people and every one who are born in this land called karnataka are blessed and needs to be proud
Chetan I Waiting For Your Film Pls Come
i hope this flm is rocks (kannada) flm industry
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text: The hotel is located in sector 17 nearer to Madhya Marg, quite near to the star hotel Taj. The food was good . The service by staff and in house excellent. However, the rooms size was a sore point, and so is the general upkeep and maintenance. There are no great scenic views from the hotel. I didn't ask for... More