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How will labor be different this time?
It's not a sure thing, but labor is likely to be shorter this time around. While first-time moms usually spend somewhere between ten and 20 hours in labor, it generally progresses much more quickly for women who've been through it before.
And the pushing stage is often easier, too. First-timers laboring without an epidural tend to push for about an hour. The average is closer to 20 minutes if you've had a previous vaginal delivery. You're also less likely to end up with stitches than a first-time mom.
Can I get my tubes tied while I'm in the hospital?
If you've decided you don't want to have any more children after this pregnancy and you opt for tubal ligation, you may have the surgery while you're in the hospital for your delivery. Be sure to discuss this ahead of time during one of your prenatal visits. Some states require that you sign a consent form at least a month before your due date. You can still change your mind later if you decide not to have the procedure.
How will my postpartum recovery be different?
You'll probably have more intense afterbirth pains. These cramps are caused by contractions of your uterus as it shrinks back to its pre-pregnancy size and location after you have your baby.
Afterpains are typically mild and short-lived for first-time moms (if they're felt at all), but they can be quite uncomfortable after a second delivery and usually get worse with each successive pregnancy. That's because first-time mothers have better uterine muscle tone so the uterus tends to contract and stay contracted, rather than intermittently relaxing and then contracting again.
Don't be surprised if it takes longer to regain your shape this time. As with your first pregnancy, postpartum weight loss alone won't do the trick. You'll need to exercise to regain good muscle tone.


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Sigiriya, located within the cultural triangle of Sri Lanka, is renowned for its rich history and heritage. Vil Uyana hotel has pride of place in this beautiful area, affording all who stay here breathtaking views of the magnificent Sigiriya Rock, one of Sri Lanka's most recognised world heritage sites.
Due to its highly original design, the hotel is the first in Sri Lanka to offer rooms built over water and paddy fields; each is spacious and tastefully designed offering great comfort and seclusion.
When dining, choose from casual, formal or 'under the stars', before retreating to the resort's island spa - where a range of signature treatments are sure to invigorate both your body and mind.
Things to enjoy - 2 restaurants, bar, swimming pool, Jetwing Island Spa, YogaShala, gym, research centre. Nearby: Elephant safaris, elephant gathering, bird watching. Attractions: Sigiriya Rock Fortress, Mineriya National Park, temples, Wasgumuwa National Park, Kauddulla National Park, village excursions, Pidurangala Temple, Ritigala, Kaludiya Pokuna.
Our menu of massages, wraps and body works offers everything from a pampering experience for couples to a soothing treatment for sun lovers to de-stress massages and even a Spa Dining Experience. Allow your senses to be drawn into a peaceful state by the welcoming smiles and soothing, skilled hands of our therapists as they employ traditional restoratives, herbs, oils, spices and flowers combined with time honoured rituals to balance body, mind and soul.
Fully equipped Gymnasium that includes threadmills, cross trainer, stepper, two multi stations, cycles and weights set.
Sulang (Winds) - Casual dining. Open 07:00 to 22:30.
Apsara (Celestial Maidens of Sigiriya) - Fine dining. Open 07:00 to 22:30.
Graffiti - Air-conditioned bar. Open 10:00 till midnight.
Mandhiya Library - Library lounge. Quiet water between an ebb and flow of tides). Open 07:00 till midnight.
Signature Dining - Special dining options. In-villa dining.
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Julie Sin
Julie Sin is public health commissioning support lead at Central and Eastern Cheshire Primary Care Trust.
Why public health practice must be integrated into commissioningSubscription
Whatever form the new NHS commissioning landscape takes, public health practice needs to be an integral part of it. A discussion is needed as to how it fits in to the structure, write Julie Sin, Su Sethi and Alison Rylands.


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Top Definition
this term, printed on an asher roth t-shirt on thedailykush.com; could be slang for somebody who grinds hard.
dayuum, son. you makin' cash. you like the new grindocologist in town.
by white boys love asher roth April 21, 2009
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Practice Areas
Welcome to Martin G. Schulz & Associates
Accident and Personal Injury Lawyers
serving Edmonton, Calgary and Vancouver
Respect, Representation, Recovery
If you or someone you love has been affected by tragedy,
we offer our condolences and are here to help!
Personal Injury Law is our focus
A personal injury lawyer is a lawyer who provides legal representation to those who claim to have been injured, physically or psychologically, as a result of the negligence or wrongdoing of another person, company, government agency, or other entity. Thus, personal injury lawyers tend to be especially knowledgeable and have more experience with regard to the area of law known as tort law, which includes civil wrongs and economic or non-economic damages to a person's body, well-being, property, reputation, or rights. As top personal injury lawyers we specialize in work injuries, automobile / car accidents, defective products, medical mistakes, disability, slip and fall accidents, and more. Call us or visit our offices in Edmonton, Vancouver and Edmonton.
WHO We Represent
Our compassionate and friendly staff represents REAL people with REAL problems, offering REAL solutions. Expertise and experience with car, bike or various other types of traffic accidents resulting in personal injury. We are plaintiff lawyers. This means that we do not represent defendants. We assist you in filing a personal injury claim – NOT defending a claim brought against you for damages. We have represented people from all walks of life, dealing with virtually every type of situation. Contact us today to speak to a top Vancouver, Calgary and Edmonton Personal Injury Lawyer.
Why Choose Us
You can rest assured, confident that you will be treated with dignity and respect from the moment you are greeted by our friendly and compassionate staff and throughout the legal process. It is of paramount importance to us that you and your family receive all the necessary care, support, and the maximum compensation you deserve.
Experience & Resources
Specializing in personal injury claims, our team has achieved great success on behalf of our clients. We have had the privilege of representing hundreds of injury victims just like you, and we have what is required to help you to regain your life and recover the compensation you deserve. We cover a wide range of personal injury and medical malpractice case types and have the skills and experience necessary to handle your unique situation.
Legal and insurance issues, healthcare expenses and endless forms, significantly add to your stress and confusion following an injury. Dealing with insurance companies can be intimidating, and they often offer the lowest possible amount to get rid of your claim. The truth is that you may not even know the full extent of your injury and what you'll need for your future. Our collective resources of professionals can assess the damages related to your situation and ascertain the compensation to which you are entitled.
Hiring the right personal injury lawyer is the most IMPORTANT decision you can make for yourself and your family. We know what your legal rights and obligations are, and we will apply our legal expertise and skills to the facts of your case in order to achieve the best possible result for you.
Passion and Dedication
We are a team of highly skilled lawyers and professionals committed to protecting your rights and obtaining fair compensation for your injuries. We understand that an injury can be life-altering and can have a serious impact on you and your family and in light if this understanding, we pledge to take you seriously regardless of the size or type of claim. We represent our clients aggressively to achieve the best result possible.
TIME Is Of The Essence
By law, you may have a limited amount of time to make a claim or file a lawsuit. When it comes to personal injury claims there are often time limits within which you can apply for damages. In some cases, you can have as little as 10 days to take legal action. If you've been injured, don't miss your opportunity to get the maximum settlement you deserve.
FREE, PRIVATE Consultation
We work on a contingency (percentage) fee basis. This means that we are paid ONLY when we are successful! We pay all legal expenses while your case is in progress. We DO NOT act for insurance companies or defendants.
Please don't sign anything until you've spoken with us.
Your Consultation Is Free ~ Your Peace Of Mind Is Priceless


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More New and Used
from Private Sellers
Note: Supplemental materials are not guaranteed with Rental or Used book purchases.
Love You Forever
ISBN13:by Munsch, Robert N.
Firefly Books Ltd
Questions About This Book?
Why should I rent this book?
Renting is easy, fast, and cheap! Renting from eCampus.com can save you hundreds of dollars compared to the cost of new or used books each semester. At the end of the semester, simply ship the book back to us with a free UPS shipping label! No need to worry about selling it back.
How do rental returns work?
Returning books is as easy as possible. As your rental due date approaches, we will email you several courtesy reminders. When you are ready to return, you can print a free UPS shipping label from our website at any time. Then, just return the book to your UPS driver or any staffed UPS location. You can even use the same box we shipped it in!
What version or edition is this?
This is the edition with a publication date of 10/1/1986.
What is included with this book?
- The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any CDs, lab manuals, study guides, etc.
- The Used copy of this book is not guaranteed to include any supplemental materials. Typically, only the book itself is included.
- The Rental copy of this book is not guaranteed to include any supplemental materials. You may receive a brand new copy, but typically, only the book itself.
- The eBook copy of this book is not guaranteed to include any supplemental materials. Typically only the book itself is included.
Customer Reviews
Love You Forever January 10, 2012
This book is the greatest. I bought my youngest daughter the book when she was was 3 years old.I cried then when I read the pages.That was 26 years ago and I still cry today.It is one of those stories that touch the heart.I have 3 daughters that all have lives of their own;but as long as they live my babies they'll be.Each one of them have a copy of this book and they too cry every time they read it.It is a great gift to pass on. It has a powerful meaning!
Love You Forever: stars based on 1 user reviews.
First published in 1986, this classic book by Munsch is a gentle affirmation of the love a parent feels for their child--forever. McGraw's soft and colorful pastels perfectly complement the sentiment of the book--one that will be read repeatedly for years.
Author Biography
Robert Munsch is the author of more than 25 books for children including The Paper Bag Princess and Stephanie's Ponytail. He lives in Guelph, Ontario.
Sheila McGraw has illustrated six children's books, including the best-selling I Promise I'll Find You and has written children's and adult craft books Papier M+óch+¬ for Kids and Painting and Decorating Furniture.


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White Paper: Facts about Flash
The growth in the market for portable computing devices has led to high demand for small size storage. Flash memory is ideal for...
This Article Covers
Contrary to what its name may imply, Flash memory is here to stay. Since its inception almost 15 years ago, Flash memory has evolved into a versatile and practical storage solution. Recently, new applications and rapidly increasing demand for Flash have brought this adaptable, yet advanced technology to the front door of many business applications.Flash memory is a solid-state, non-volatile, rewritable memory that works like RAM and is hard-disk drive combined. Flash memory stores bits of electronic data in memory cells, just like DRAM and SRAM, but Flash also works like a hard-disk drive because when the power is turned off, the data stays in memory. Flash memory is becoming increasingly popular for portable computing and communications applications. Here are a few reasons why: Nonvolatile storage - retains data even with the power off (much like a disk drive) Low voltage - consumes very little power and saves battery life Durability - able to withstand severe shock or vibration without losing data Compact size - suitable for a broad range of portable electronics speed - extremely fast access time Flash memory and RAM look very much the same. Both can come in the form of discrete chips, modules, or memory cards. They store information in the same way, but Flash memory doesn't need to be constantly refreshed like DRAM, and it doesn't need constant power to retain data like SRAM. Flash memory is non-volatile, which means that it retains its data even when the power is turned off. The question is sometimes raised: "If Flash works like RAM but it doesn't need power to retain data, why not use Flash to replace main memory in computers?" There are several reasons why this can't be done. First of all, the memory cells in a Flash chip have a limited lifespan of 100,000 write cycles. Also, because of its design, Flash memory must be erased in blocks of data rather than single bytes like RAM. (That's like having to erase the entire word every time you press the "delete" key, instead of erasing a single letter.) Beyond that, Flash memory is too expensive to compete with RAM for main memory. Nevertheless, while it bears some similarity to RAM, Flash memory has been carving out its own independent markets, with little direct competition to RAM. Some examples include: Discrete Flash chips used in desktop PCs to store system configuration information Flash modules used in networking equipment to store microcode and instructions Flash memory cards used in portable computers and palmtops for mass storage Magnetic disk drives have moving parts and thus a lower tolerance for shock, vibration, extreme temperatures, or harsh environments. Electronic "Flash drives" have no moving parts to draw excess current, so they consume less energy yet are smaller and faster than hard-disk drives. Flash memory can also withstand shocks up to 2000G's without losing data. That's roughly equivalent to a 10ft drop onto concrete. Also, with no physical surface like on a standard hard drive platter to grab data from, data access time is significantly decreased. Again, the question is sometimes raised, "If Flash is faster and smaller than a hard-disk drive, why not use Flash memory to replace all hard drives?". The reason is that in practical applications, Flash memory and hard-disk drives serve different purposes. For example, typical desktop PCs need gigabytes of storage space (far beyond the present capacity of Flash memory - about 100Mb). Also, desktops don't have power constraints because they're plugged into A/C outlets, and durability isn't an issue because they're stationary. In this case, there's no need for the features that Flash has to offer. Plus, as with RAM, Flash cannot compete with hard disks in price. However, a Flash drive would be more suitable than a hard-disk drive in situations where size, power consumption, and ruggedness are important factors, and where capacity needs are smaller. Some examples would include handheld computer games, digital cameras, palmtop computers in manufacturing environments, or notebook computers in medical, insurance claims, and military/government field situations. Because of its ability to withstand tremendous shock without losing data, its ability to store information without constant power, and its low voltage requirements, Flash memory is a suitable replacement for portable hard drives in rugged situations, yet its range of applications is also broader. Some other applications for Flash memory include: digital cameras, cell phones, pagers and audio recorders, scanners - to store images and voice data networking devices; to store the microcode and instructions needed for transferring data printers and print servers; to hold fonts or frequently-used graphics desktops; and to replace ROM BIOS chips (the BIOS configures your computer every time you turn it on). One ideal application for Flash memory would be in a digital camera, like the KODAK Digital Science DC40 or DC50 Zoom camera. In this camera, Kingston's 20Mb Type II Flash (DP-ATA/20) card would function as an electronic "roll" of digital film. In fact, depending on data compression, an average of 6 to 15 pictures per Mb could be stored in this Flash card. After taking pictures in the field (e.g. police, insurance adjusters, architects), the digital images could be loaded directly into any notebook or desktop. Another instance might be in a truck that uses an on-board computer. Every time the truck hits a pothole in the road, the system could crash, but not with Flash memory. While Flash memory is in no position to compete with RAM or disk-drives in functionality, price, and capacity, it brings distinct advantages and opportunities for various business applications. With an increasing number of applications, Flash memory growth is expanding. At present, Flash memory is one of the fastest growing segments of the semiconductor industry. As prices drop and capacities increase, Flash memory will probably continue to grow in the PC Card market with the greatest growth in digital recording and wireless communications. Compiled by Ajith Ram (c) 1999, Kingston Technology Company
Enjoy the benefits of CW+ membership, learn more and join.


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Civil Unions signed in Ireland
Timothy Kincaid
July 19th, 2010
From the Irish Times:
The Civil Partnership Bill, which provides legal recognition for same-sex couples in Ireland for the first time, has today been signed into law.
The Bill was signed into law by President Mary McAleese at Ãras an Uachtaráin this morning
It extends marriage-like benefits to gay and lesbian couples in the areas of property, social welfare, succession, maintenance, pensions and tax.
Meanwhile, its neighbor is still talking about full marriage rights. (Pink News)
Simon Hughes, the deputy leader of the Liberal Democrats, has said that the government will give gay couples the right to civil marriage.
He predicted that the change would be made before the next general election.
Mr Hughes said a consultation would take place in the coalition government on taking civil partnership to the next level.
Speaking in a video interview, he said: "It would be appropriate in Britain in 2010, 2011, for there to be the ability for civil marriage for straight people and gay people equally.


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Today we are looking at the pixel art- and icon-gallery, with our Top 10 (or so) Tips provided by the wonderful assistance of Hardrockangel.
1. The outline of your pixel
Like a drawing, pixeling usually starts with a sketch that is later refined to a line art.
And this line art can make or break your pixel depending on how carefully it was made.
A couple of mistakes that are often made:
- bunched up pixels instead of a 1 pixel line
- a disproportionate outline (looks mashed)
- A sketched outline
So how can you make a good-looking line-art? Take your time!
Don't just sketch, but work with a hard brush-tool of 1 pixel and place each pixel by hand.
What to look for when critiquing:
- Is the pixel-outline neat?
- Are there bunched up pixels?
- Does the outline look sketched instead of pixeled?
2. Colour and use of textures
Another commonly made mistake is the use of bucket-fill and no shading.
Or, in most cases: the palette was picked badly and the outlines is too light or too dark to surround the inner colour.
For colour and palettes, it can be a great help to take a look at colour-theory tutorial. The colour rules that count for traditional and digital art also count for pixel art. Another great resource is the website ColourLovers, for palettes to build upon.
For shading, the most commonly used technique is dithering, where you alternate between to colours in a checkerboard-pattern. Depending on the texture you want to achieve, however, you can alter your style of shading.
Don't overdo your textures, though! A checkerboard all over (overdithering) is just as bad as shading by using the outlines (pillow-shading). Both look unnatural and amateuristic at best.
What to look for when critiquing:
- Do all the colours fit together?
- Is the pixel easy to read? Meaning: how easily can you make out what the pixel is supposed to represent?
- Is it shaded enough or over-dithered?
- Is it pillow-shaded?
3. Animation
The most common mistake made here is a sticky or a choppy animation, meaning an animation that is far from smooth. A sticky animation will in most cases look like it's running too slow and "dragged out", whilst a choppy animation will, in most cases, be too fast and badly looped.
The first one can be fixed by deleting some frames or by simply lowering the time it takes for each frame to follow the previous one. A choppy animation can be fixed by adding more frames and slowing down the frame-speed.
What to look for when critiquing:
- Is the animation smooth or choppy?
- Is it going too fast or do you feel like frames seem to be missing?
- Does it look like the animation is lagging?
- Does the animation loop properly?
A great resource for beginning pixel artists with all the do's and don'ts can be found on the PixelJoint-forum.
Want to test out your new found critique skills? Check out the Critiquable Art avalaible on deviantART!
Many Thanks to for helping to write this article!


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European Stocks Close Green With Credit 'Reality-Check' On Vacation
With London closed, the market's 'police' were away and so the mice played. Credit markets (sovereign and corporate) went absolutely nowhere as trading was minimal to negligible but equities just could not help themselves as the path of least resistance was to retraced back up from Friday's loss. The move in European equities is simply catch up to Friday's post-European-close levitation in the US (admittedly with a little higher beta) and volume was as dismal as one would expect. FX markets are also dead with EURUSD up only 5 pips at the EU close - having traded in a 40 pip range since it opened on Sunday night (most of which was around the Asian and European data releases). Quiet - in a word - with reality returning tomorrow as London's credit traders come back.
European stocks catch-up to US performance but massively outperform FX and credit markets (which were dead)...
Chart: Bloomberg
- advertisements -
Headline algos pop ES on QE-talk yet again. Simply amazing how that story never gets old.
"amazing?", more like 'criminal' how it never gets old.
They're algos. They don't sit at home waiting for a phone to ring, they don't think about what they're going to get for Christmas or where they're going for vacation.
They are iterative functions.
They are the perfect audience for those headlines.
Pathetic..many of these markets are within striking distance of their all time highs based on whether or not central banks will print.
Europe is going to collapse!
King Dollar!
"as London's credit traders come back."
Pardon, but don't you mean London's debt traitors???
and yet CNN has a story that claims economists and investors don't want QE3Investors and economists agree: No QE3
Thsoe wall street fuckers dont get it or what? Bullish on everything ...
id like to buy stocks on 30% or 40% discount, is that hard to comprehend for those fuckers...
Bullish & Buy is the only Mantra with those guys, and it's getting really boring.
QE3, QE4, QE5 -- fuck it, is that all we have to speculatie about? That, and how many oil rigs weak ol Isaac is going to put out of production? This is stupid. I m going on vacation. Fuck you Bernanke AND Draghi. Morons.
London traders were off enjoying the goat curries at the Notting Hill Carnival... The danger sign will be once credit markets begin diverging from equities as we saw in 2007. So, far all clear (after the jump).


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STARmeterSEE RANK
Up 16,712 this week
Paul Angelis
Actor | Writer | Soundtrack
Paul Angelis was born on January 18, 1943 in Liverpool, England. He is an actor and writer, known for Yellow Submarine (1968), For Your Eyes Only (1981) and Z Cars (1962). See full bio »
Born:in Liverpool, England, UK
More at IMDbPro » Represent Paul Angelis? Add or change photos


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Meeting on Economic Fluctuations and Growth Research
About 120 economists from all over the world - including Canada, Chile, France, Israel, Italy, Japan, Spain, and the United Kingdom - met in Cambridge on July 18 for the summer research meeting of the NBER's Program on Economic Fluctuations and Growth. In addition to academic economists, central bankers from many of the represented countries participated in the day's discussions. Organizers Olivier J. Blanchard of NBER and Harvard University and Thomas J. Sargent of NBER and Stanford University chose the following topics for discussion:
Patrick Kehoe, NBER and Federal Reserve Bank of Minneapolis and Fabrizio Perri, University of Pennsylvania, "International Business Cycles With Endogenous Incomplete Markets"
Discussant: Urban Jermann, NBER and University of Pennsylvania
David I. Laibson, NBER and Harvard University; Andrea Repetto, Universidad de Chile; and Jeremy Tobacman, Harvard University, "Self-Control and Retirement Savings"
Discussant: Lars P. Hansen, NBER and University of Chicago
Jason G. Cummins, New York University; Kevin A. Hassett, American Enterprise Institute; and Stephen D. Oliner, Federal Reserve Board, "Investment Behavior, Observable Expectations, and Internal Funds"
Discussant: Owen Lamont, NBER and University of Chicago
Susanto Basu, NBER and University of Michigan, and David N. Weil, NBER and Brown University, "Appropriate Technology and Growth" (NBER Working Paper No. 5865)
Discussant: Per Krussell, University of Rochester
Harold L. Cole and Narayana Kocherlakota, Federal Reserve Bank of Minneapolis, "Efficient Allocations with Hidden Income and Hidden Storage"
Discussant: Fernando Alvarez, University of Pennsylvania
Ricardo J. Caballero, NBER and MIT, and Mohamad L. Hammour, Capital Guidance, "Improper Churn: Social Costs and Macroeconomic Consequences"
Discussant: Robert B Hall, NBER and Stanford University
Earlier research has shown that standard models with complete markets generate cross-country correlations of consumption that are much higher than those in the data and cross-correlations of output and factor inputs that are much lower than those in the data. Kehoe and Perri introduce a particular type of friction in the international credit market - that international loans are not perfectly enforceable, in that any country can renege on its outstanding debts and suffer the associated penalties on future borrowing - and ask whether it can help to account quantitatively for these anomalies. They find that these types of frictions, in contrast to the exogenous restriction on the asset markets, can go a long way in helping to resolve some of the outstanding anomalies in the data.
Laibson, Repetto, and Tobacman calibrate a model that unifies the literature on hyperbolic discounting and on buffer stocks. They show that life-cycle consumption and asset accumulation patterns are consistent with the hyperbolic model. Hyperbolic consumers will react more favorably than exponential consumers to a stylized defined-contribution pension plan. Benchmark simulations (with a coefficient of relative risk aversion of 1 and a measured elasticity of intertemporal substitution between . …


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American Rivers and NOAA Community-Based Restoration Program River Grants
Restoring Rivers: Stream Barrier Removal Grants
Since 2001, American Rivers and the National Oceanic and Atmospheric Administration (NOAA) Community-based Restoration Program have provided financial and technical assistance for river restoration projects benefiting diadromous fish species in the Northeast (CT, MA, ME, NH, RI, VT), Mid-Atlantic (DC, DE, MD, NJ, NY, PA, VA), Northwest (ID, OR, WA) and California. We are also excited that projects located in the South-Atlantic (FL, GA, NC, SC) are eligible to receive partnership funds from American Rivers. [Diadromous fish migrate between freshwater and saltwater during their life cycle. Examples include alewife, American shad, American eel, salmon, steelhead and shortnose sturgeon.]
For the past ten years, our partnership with the NOAA Restoration Center has provided more than $5.3 million to support over 140 community-driven river restoration projects that have benefited diadromous fish populations and habitats throughout the country.
The American Rivers-NOAA River Grants program funds stream barrier removal projects in the Northeast, Mid-Atlantic, Northwest, South-Atlantic and California. Applications are being evaluated based upon the following priority criteria: (1) ecological merits of the project, (2) technical feasibility of the project, (3) timeliness in completion of funded phase; (4) benefits provided to the local community, and (5) financial clarity and strength of the application. Grants are provided for three distinct project phases: Construction, Engineering Design and Feasibility Analysis. The maximum award request is $150,000.
Our 2012 grant round has closed. Applicants can expect notification of funding decisions in March 2013, with disbursement of funds likely by May 2013.
Applicants can expect notification about funding decisions in March 2013, with disbursement of funds likely by May 2013.
- 2012 Grant Announcement (PDF)
- Application for Financial Assistance (PDF)
- Funding Guidelines (PDF)
Click here for more information on the NOAA Community-Based Restoration Program and its partners.
General Questions? Contact:
Serena McClain, American Rivers
1101 14th Street, NW, Suite 1400
Washington, DC 20005
202-347-7550 x3004


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MacBook Pro 15" Unibody Early 2011 Battery Replacement Replace the battery in your Early 2011 MacBook Pro 15" Unibody. https://d3nevzfk7ii3be.cloudfront.net/igi/QVgRYpjTxnhjLGem Walter Galan No estimate Moderate MacBook Pro 15" Unibody Early 2011
Use this guide to replace a worn-out battery.
 2015-02-24T12:19:54-07:00 This guide has been found to be exceptionally cool by the iFixit staff. https://www.ifixit.com/Guide/MacBook+Pro+15-Inch+Unibody+Mid+2010+Lower+Case+Replacement/3025 MacBook Pro 15" Unibody Mid 2010 Lower Case Replacement https://d3nevzfk7ii3be.cloudfront.net/igi/ZFJQl6WHgwdCZx1n ../MacBook-Pro-15-Unibody-Mid-2010-Lower-Case-Replacement-3025/guide.xml https://www.ifixit.com/Guide/MacBook+Pro+15-Inch+Unibody+Early+2011+Battery+Connector+Replacement/5910 MacBook Pro 15" Unibody Early 2011 Battery Connector Replacement https://d3nevzfk7ii3be.cloudfront.net/igi/bYSpKoTKmjLUMOQk ../MacBook-Pro-15-Unibody-Early-2011-Battery-Connector-Replacement-5910/guide.xml Remove the following ten screws securing the lower case to the upper case: Three 13.5 mm (14.1 mm) Phillips screws. Seven 3 mm Phillips screws. https://d3nevzfk7ii3be.cloudfront.net/igi/cJVilSAppmEKRtFW Using both hands, lift the lower case near the vent to pop it off two clips securing it to the upper case. Remove the lower case and set it aside. https://d3nevzfk7ii3be.cloudfront.net/igi/S3X6juTLCvPG3qsj For certain repairs (e.g. hard drive), disconnecting the battery connector is not necessary but it prevents any accidental shorting of electronics on the motherboard. If you do not disconnect the battery connector, please be careful as parts of the motherboard might be electrified. Use the edge of a spudger to pry the battery connector upwards from its socket on the logic board. It is useful to pry upward on both short sides of the connector to "walk" it out of its socket. https://d3nevzfk7ii3be.cloudfront.net/igi/bYSpKoTKmjLUMOQk https://d3nevzfk7ii3be.cloudfront.net/igi/5mvrDVZ32FbB4C2A Bend the battery cable slightly away from its socket on the logic board so it does not accidentally connect itself while you work. https://d3nevzfk7ii3be.cloudfront.net/igi/eTItfxSqYQIKnTf1 Remove the two 7.4 mm Tri-wing screws securing the battery to the upper case. https://d3nevzfk7ii3be.cloudfront.net/igi/wcw4nPCRs5C636VY Carefully peel the battery warning label off the upper case between the battery and the optical drive to reveal an additional Tri-wing screw. Remove the last 7.4 mm Y1 Tri-wing screw securing the battery to the upper case. Do not remove the label from the battery. https://d3nevzfk7ii3be.cloudfront.net/igi/iP5gvOoUaEIIYDAM Use the attached plastic pull tab to remove the battery from the upper case. https://d3nevzfk7ii3be.cloudfront.net/igi/btDJQp5CYXdILTOO
To reassemble your device, follow these instructions in reverse order.
 2011-05-31T12:09:35-07:00


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May 4, 2016
Two men were shot in Rockford last night around 11pm. Police say it happened at the Blackhawk Housing Development at Seminary and 15th avenue. 23-year-old Bobby Washington and 23-year-old Phillip Johnson were both shot. Both have non-life-threatening injuries. Police are still searching for the suspect. No description or other information is being released at this time.
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Semi Precious Weapons strip down "Aviation High" for one intimate live performance.
Did somebody wake up on the precious side of the bed this morning? No? Not even the semi-precious side? Well, here, this acoustic performance of "Aviation High" that Semi Precious Weapons recorded for "Buzzworthy Live" should fix that for you — at least until you get a better bed.
Whereas the original track from the New York band's recently released third studio album, Aviation, kept pace with a pulsing, metronomic beat, this stripped rendition slows things down a bit, allowing Stevy Pyne's guitar strings, Dan Crean's drumming, and Cole Whittle's keys to build insane levels of tension as lead singer Justin Tranter's vocal honey drips out.
In other words, the chills — you're going to feel them.
"It's one of those magical songs that wrote itself in an hour," Tranter revealed to us during his visit to MTV HQ. "Everything fell into place with the music and the lyrics. At that point in my life, I was just so in love and so in lust that every time the person was around I felt high."
Hmmm, it's probably pretty similar to the high we get while listening to his transcendent vocal leaps, which seriously pull off some Rihanna-in-"Diamonds"-level feats of flawlessness. Shine bright, perfect BBs!
+ Watch Semi Precious Weapons perform "Aviation High" acoustic on "Buzzworthy Live."
Photo credit: MTV


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Oh Nokia.. windows 8 was truly the killer for ya.. if only Android.. you would be #1 phone!
Nokia announces its first phablets and tablet
Lauren Crabbe | Published: Oct 22, 2013 at 15:09 UTC12
Nokia has added two phablets and a tablet to its Lumia line up. Nokia's latest announcement happened at its Nokia World conference in Abu Dhabi this morning. As expected, the Lumia 1520 measures at 6 inches and comes with a 20-megapixel PureView camera with optical image stabilization.
The Lumia 1520 will have to compete against phablets from every major manufacturer of Android smartphones — Samsung's 5.7-inch, 13MP Galaxy Note 3, Sony's 6.4-inch, 8MP Xperia Z Ultra and HTC's just-announced 5.9-inch, 4MP One Max.
With its extra large 1080p full HD screen, the Lumia 1520 will come with some new photography apps standard. Nokia Camera is a combination of Nokia's manual photography app Pro Camera and its feature-packed Smart Camera app. Nokia Storyteller is a new photo management tool on the Lumia 1520 that sorts and presents photos either by time captured or location.
Another new tool on the Lumia 1520 is Refocus. This lens mimics the effect of a light field camera in that it allows the user to choose a focal point post-capture. Not to be confused with the old app of the same name and function, Nokia's Refocus Lens is accessible in the native camera app and lets user pick new focal points after the photo is taken or set everything in focus. Refocus is more like like iOS's Focus Twist than a Lytro camera in that it uses software instead of hardware to achieve post-capture focusing. Check out some examples of Refocus here.
If Nokia's Pro Camera release is any indication, we should be seeing Nokia Camera, Nokia Storyteller and Refocus released to non-Lumia 1520 devices shortly after the new phablet's launch.
See the new apps in action on the Lumia 1520:
The Lumia 2520 is Nokia's first tablet. With a 6.7MP camera, the tablet is also the first to feature Zeiss optics and Nokia promises that it takes great pictures even in low light.
Like Microsoft's Surface devices, Nokia's Lumia 2520 will exclusively run Windows Phone 8. The screen is designed for maximum readability in both outdoor and indoor lighting situations and its Power Keyboard accessory offers an easy way to charge your tablet while providing the full functionality of a desktop keyboard.
As reviewers continue to criticize Microsoft's latest tablets, Nokia's Lumia 2520 has a chance to emerge as a viable alternative to the Surface. We can only speculate how Microsoft's impending acquisition of Nokia's mobile division will affect the future of Lumia tablets, but as they currently appear to be competing products, we can't help but wonder if this will be Nokia's only tablet as well as its first.
An affordable answer to the new Lumia 1520, the Lumia 1320 has a 6-inch, 720p display. With a 5-megapixel camera, it is definitely not as powerful of an imaging device as the Lumia 1520, but Nokia hopes the Lumia 1320 will satisfy the need for a large screen smartphone in emerging markets.
The Lumia 1520 will be available first in US, UK, European and Chinese markets, and the Lumia 2520 will launch in the UK, U.S. and Finland. Meanwhile, the Lumia 1320 will initially be for sale only in China and Vietnam. Before taxes and subsidies, the Lumia 1520 will cost $749, with the Lumia 1320 coming it at a much lower $339. Nokia's tablet will run you $499 — $50 more than Microsoft's Surface 2.
For more news from today's Nokia event, check out its press release here.
Lumia 1520 Key Specifications
Lumia 2520 Key Specifications
Lumia 1320 Key Specifications


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Number: 0757
Aetna considers non-invasive fetal membranes rupture tests (e.g., Actim PROM, AmniSure ROM and the ROM Plus Fetal Membranes Rupture Test) experimental and investigational for detecting preterm rupture of membranes (ROM) and all other indications because of insufficient evidence of its clinical effectiveness over standard diagnostic methods for detecting ROM.Background
Premature rupture of membranes (PROM) is defined as rupture of membranes before the onset of labor. Membrane rupture that occurs before 37 weeks of gestation is referred to as preterm PROM (PPROM). Premature rupture of membranes complicates approximately 8 % of pregnancies and is generally followed by the prompt onset of spontaneous labor and delivery. The most significant maternal risk of term PROM is intra-uterine infection, a risk that increases with the duration of membrane rupture. Fetal risks associated with term PROM include umbilical cord compression and ascending infection. Preterm PROM complicates only 2 % of pregnancies but is associated with 40 % of preterm deliveries and can result in significant neonatal morbidity and mortality. The 3 causes of neonatal death associated with PPROM are prematurity, sepsis and pulmonary hypoplasia (RCOG, 2006; ACOG, 2007).
Several risk factors for PPROM have been identified, including intra-amniotic infection, low socioeconomic status, low body mass index, second and third-trimester bleeding, nutritional deficiencies of copper and ascorbic acid, connective tissue disorders (e.g., Ehlers-Danlos syndrome), cigarette smoking, cervical conization or cerclage, pulmonary disease during the pregnancy, uterine over-distention, as well as amniocentesis. The risk of recurrence for PPROM is between 16 % and 32 %. Risk factors for PROM include previous preterm birth (especially if the cause was PROM), short cervical length (less than 25 mm) during the second trimester, and preterm labor or symptomatic contractions in the current pregnancy. In addition, PROM can occur without any identifiable risk factor.
According to the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin Premature Rupture of Membranes (2007), and the Royal College of Obstetricians and Gynaecologists (RCOG) Guideline Preterm Prelabour Rupture of Membranes (2006), the diagnosis of PROM is based primarily on the patient's history and physical examination. Patients often report a sudden gush of fluid or continued leakage of fluid. Sterile speculum examination provides a visual inspection of fluid and an opportunity to inspect for cervicitis and umbilical cord or fetal prolapse, cervical dilation and effacement, and to obtain cultures as appropriate. Digital cervical examinations are avoided due to the increase risk of infection and they add little additional information to the speculum examination (unless the patient is in active labor or imminent delivery is planned). Diagnostic methods using nitrazine paper and determination of ferning (arborization) have sensitivities approaching 90 %. The pH of vaginal secretions is generally 4.5 to 6.0, whereas amniotic fluid usually has a pH of 7.1 to 7.3; however, false-positive results may occur as the result of contamination with blood or semen, alkaline antiseptics, or bacterial vaginosis and false-negative results can occur with prolonged leakage and minimal residual fluid. In unusual cases in which the diagnosis remains unclear after physical examination, ultrasonography may be helpful. When ultrasonography is inconclusive, transabdominal instillation of indigo carmine dye followed by observation for passage of blue fluid from the vagina will confirm ROM unequivocally. Management of ROM hinges on knowledge of gestational age and evaluation of the relative risks of preterm birth versus intrauterine infection, abruptio placentae, and cord accident that could occur with expectant management (RCOG 2006; Medina and Hill, 2006; ACOG, 2007).
The AmniSure ROM (Rupture of Membranes) test received Food and Drug Administration 510(k) marketing clearance in 2003 and is a rapid, non-instrumented qualitative immunochromatographic test for in-vitro detection of amniotic fluid in vaginal secretion of pregnant women. AmniSure detects PAMG-1 (placental alpha-1 microglobulin) protein marker of the amniotic fluid in vaginal secretions and is intended to aid in the detection of ROM in pregnant women greater than 34 weeks gestation with signs, symptoms or complaints suggestive of ROM.
A comparison study of AmniSure versus standard diagnostic methods for detection of ROM in 203 pregnant women suspected of ROM reported that the AmniSure test was highly accurate (sensitivity = 98.9 %, specificity = 100 %, and negative predictive value [NPV] = 99.1 %) in diagnosing ROM (Cousins et al, 2005). Test performance was calculated by comparing AmniSure results against clinical history, nitrazine and fern results, presence of pooling, ultrasound (US) evidence of oligohydramnios, and findings from repeated examinations.
A study of 184 pregnant women suspected of ROM reported the sensitivity, specificity, positive predictive value (PPV) and NPV of the AmniSure device were 98.7 %, 87.5 %, 98.1 %, and 91.3 %, respectively (Lee et al, 2007). Rupture of membranes was diagnosed if fluid was seen leaking from the cervical os or if 2 of the following 3 conditions were present: (i) pooling of fluid, (ii) positive nitrazine test, or (iii) ferning. Rupture of membranes was diagnosed definitively on review of the medical records after delivery. The investigators stated that the cause of fals- positive results in 3 patients was unknown, and that the possibility of small leak that sealed over could not be excluded.
Chen and Dudenhausen (2008) compared 2 rapid strip tests for the detection of amniotic fluid, based on the detection of insulin-like growth factor-binding protein-1 (IGFBP-1) and of PAMG-1. Samples of amniotic fluid were taken in 20 pregnant women between 31 3/7 and 41 2/7 gestational weeks at elective cesarean section before delivery of the newborn. These samples were diluted with 0.9 % saline solution in a dilution series down to concentrations of 1:320. Immunoassay strip tests were then compared in their ability to detect remaining concentrations of amniotic fluid. In 5 cases, both test methods showed the same results. In all remaining 15 cases, the test based on PAMG-1 proved to be superior by detecting amniotic fluid at least at one descending concentration below the test based on IGFBP-1. Thus, the rapid strip test based on PAMG-1 seems to be a more sensitive bedside test compared with the test based on IGFBP-1 for the detection of amniotic fluid.
These studies indicated that the AmniSure is a promising method of detection of PPROM. However, controlled clinical studies are needed to determine the clinical effectiveness of the AmniSure ROM test over standard diagnostic methods for ROM.
Commenting on the studies on AmniSure by Cousins et al (2005) as well as Lee et al (2007), Duff (2009) stated "[t]hese results are promising, but require further confirmation before a recommendation for routine use of this device can be made". Caughey et al (2008) stated that "[i]n time, such noninvasive tests [as the AmniSure] may replace the need for traditional clinical assessment and amnio-dye testing for the diagnosis of PROM".
Lee and colleagues (2009) stated that the AmniSure test is approved for the diagnosis of PROM. Yet, a fraction of patients with a positive test have intact membranes by sterile speculum examination. The objective of this study was to determine the clinical significance of this finding. The study population consisted of 4 groups of nulliparous women at term: (i) not in labor without clinical evidence of ROM (n = 125); (ii) in labor without clinical ROM with a negative AmniSure test (n = 56); (iii) in labor without clinical ROM with a positive AmniSure test (n = 25); and (iv) in labor with clinical ROM (n = 30). The AmniSure test was performed in cases without clinical ROM (groups i, ii and iii). The AmniSure test was positive more frequently in women in labor with intact membranes than in patients not in labor at term without ROM (30.9 % (25/81 women) versus 4.8 % (6/125 women); p < 0.001). In addition, patients in labor without clinical ROM with a positive Amnisure test had a significantly shorter admission-to-delivery interval than those in labor without clinical ROM with a negative Amnisure test (p < 0.05). The authors concluded that a positive AmniSure test is present in about 1/3 nulliparous women at term presenting in labor with intact membranes; and patients with a positive AmniSure test had a shorter admission-to-delivery interval than those with a negative test.
A review of Amnisure by the Canadian Agency for Drugs and Technologies in Health (CADTH) identified 6 controlled clinical trials and 1 evidence-based guideline regarding the diagnostic accuracy and use of the AmniSure and other similar tests for determining whether premature rupture of fetal membranes has occurred in a pregnancy (HTIS, 2010). No economic evaluations were identified regarding the cost-effectiveness of the AmniSure and other similar tests. CADTH identified no relevant health technology assessments, systematic reviews, meta-analyses, or randomized controlled trials.
In a prospective cohort study, Neil and Wallace (2010) evaluated the clinical utility of Amnisure. A total of 184 women presenting with a history of PROM to a tertiary maternity hospital were included in this study. Before and after Amnisure, the attending clinician assessed and recorded membrane status (PROM or intact), his/her level of confidence in this diagnosis, and the intended management plan. There was clinician uncertainty regarding the diagnosis of PROM in 83 (47 %) women. Amnisure significantly increased clinician confidence and led to a change of intended management in 23 (13 %) women. In 33 women presenting with possible preterm PROM, 7 thought to have PROM before Amnisure had a negative test, leading to a change of management in these women. The authors concluded that Amnisure is clinically useful when the clinician is uncertain about the diagnosis; but not useful when the clinician is confident about the diagnosis.
Pollet-Villard et al (2011) compared 2 biochemical tests of PROM in-vitro: (i) Actim PROM (Medix Biochemica, Kauniainen, Finland), which detects IGFBP-1, and (ii) AmniSure (AmniSure International LLC, Cambridge, MA), which detects PAMG-1. Samples of amniotic fluid were collected during caesarean section in 41 patients. A dilution series was prepared and both tests were performed twice at each dilution. Sensitivity, detection limit, response time, and reproducibility of both tests were compared. Both tests' sensitivity was 100 % at dilution 1:10 and 1:20. AmniSure sensitivity was higher at dilution 1:40 and 1:80 (p < 0.05). In 29 of 40 cases, AmniSure had a lower detection limit than Actim PROM. AmniSure response times were shorter and reproducibility was higher than Actim PROM (p < 0.05). The authors concluded that AmniSure had a lower detection limit of amniotic fluid than Actim PROM, with a shorter response time, a higher sensitivity, and a better reproducibility.
In a case-control prospective study, Marcellin et al (2011) compared the performance of 2 rapid tests for the diagnosis of PROM based on the detection of IGFBP-1 and PAMG-1 in cervico-vaginal secretions. Pregnant women between 24 and 41(6/7) weeks' of gestation, consulting for profuse amniotic fluid loss (group 1) or for other reasons without any rupture of membrane (group 2) were included in the study. Successively, AmniSure test (PAMG-1) without speculum, and then Actim Prom test (IGFBP-1) during speculum examination were performed during the same visit. A total of 80 subjects (40 in each group) were included between 25(1/7) to 41(1/7) weeks of gestation. AmniSure diagnostic test demonstrated a sensitivity and specificity of 95 % (82.4 to 99.4) and 94.8 % (79.3 to 98), respectively and a PPV and NPV of 95 % (84.7 to 100) and 94.8 % (87.9 to 100), respectively. Actim Prom test demonstrated a sensitivity and specificity of 97.5 % (85.7 to 100) and 97.4 % (82.4 to 99.4), respectively and a PPV and NPV of 97.5 % (88.5 to 100) and 97.4 % (92.5 to 100), respectively. The authors concluded that both tests have similar performance to diagnose PROM.
Birkenmaier et al (2012) evaluated the performance of the PAMG-1 immunoassay (AmniSure) in cervico-vaginal secretions in patients with uncertain ROM and investigated the influence of the examiners experience. This prospective cohort study was performed in pregnant women (17 to 42 weeks of gestation) with signs of possible ROM. Evaluation included clinical assessment, examination for cervical leakage, nitrazine test as well as measurement of the amniotic fluid index by US and Amnisure. Occurrence of ROM was based on review of the medical records after delivery. A total of 199 women were included in this study. Amnisure had a sensitivity of 94.4 %; specificity of 98.6 %; PPV of 96.2 %; NPV of 98.0 %. Clinical assessment showed a sensitivity of 72.2 %; specificity of 97.8 %; PPV of 92.9 %; NPV of 90.6 %. Amnisure was more sensitive for diagnosing ROM (p = 0.00596) compared to clinical assessment, independent of the examiners experience. Furthermore, the sole use of Amnisure reduced costs by 58.4 % compared to clinical assessment. The authors concluded that Amnisure was more sensitive compared to clinical assessment, independent of the examiners experience and gestational age.
In a prospective observational study, Phupong and Sonthirathi (2012) compared the efficacy of PAMG-1 rapid immunoassay with conventional standard methods for the diagnosis of ROM. Patients with symptoms or signs of PROM were included in this study. Conventional standard methods were performed to establish the diagnosis and were compared with PAMG-1 immunoassay results. Rupture of membrane was diagnosed if visualization of fluid leaking from the cervical os or 2 of the following 3 conditions were present: positive nitrazine test, ferning test, and nile blue test. The diagnosis of ROM was confirmed by reviewing the medical records after delivery. A total of 100 patients (gestational age 36.5 +/- 3.5 weeks, range of 22 to 41weeks of gestation) were recruited into the study. Seventy-six percent were preterm and 24 % were at term. PAMG-1 immunoassay had a sensitivity of 97.2 %, specificity of 69 %, PPV of 90.8 %, NPV of 90.9 % and an accuracy of 89 %. In contrast, conventional combined standard methods had a sensitivity of 88.7 %, specificity of 96.6 %, PPV of 98.4 %, NPV of 77.8 %, and accuracy of 91 % for the diagnosis of ROM. The authors concluded that PAMG-1 immunoassay is a rapid method for the diagnosis of ROM and it has a higher sensitivity than conventional standard methods for the diagnosis of ROM.
In a comparative prospective study, Abdelazim and colleagues (2012) examined the accuracy of the PAMG-1 test (AmniSure) for the diagnose PROM. A total of 150 pregnant women after 37 weeks gestation were included in this study for induction of labor and divided into 2 groups according to the presence or absence of PROM; 75 patients with PROM were included in group I and 75 patients without PROM were included in group II as controls. Patients with multiple pregnancies or fetal distress or vaginal bleeding or preterm labor or chorioamnionitis were excluded from this study. Trans-abdominal US was done to detect the gestational age and the amniotic fluid index (AFI less than or equal to 5 cm in PROM) followed by sterile speculum examination to detect amniotic fluid pooling from the cervical canal and for the collection of samples. The sensitivity and the specificity of PAMG-1 to diagnose PROM were 97.33 % and 98.67 %, respectively, compared with 84 % sensitivity and 78.67 % specificity for Ferning test and 86.67 % sensitivity and 81.33 % specificity for nitrazine test. The PPV and NPV of PAMG-1 were 98.64 % and 97.37 %, respectively, compared with 79.74 % PPV and 83.1 % NPV for Ferning test and 82.28 % PPV and 85.91 % NPV for nitrazine test. PAMG-1 was more accurate (98 %) for detection of PROM than Ferning (81.33 %) or nitrazine (84.0 %) tests.
In a retrospective cohort study, Mi Lee and associates (2012) examined the frequency and clinical significance of a positive Amnisure test in patients with preterm labor and intact membranes by sterile speculum examination. A total of 90 patients with preterm labor and intact membranes underwent Amnisure tests prior to amniocentesis (less than 72 hrs); most patients (n = 64) also underwent fetal fibronectin (fFN) tests. Amniotic fluid (AF) was cultured for aerobic/anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8. The prevalence of a positive Amnisure test was 19 % (17/90). Patients with a positive Amnisure test had significantly higher rates of adverse pregnancy and neonatal outcomes (e.g., impending preterm delivery, intra-amniotic infection/inflammation, and neonatal morbidity) than those with a negative Amnisure test. A positive test was associated with significantly increased risk of intra-amniotic infection and/or inflammation, delivery within 7, 14, or 28 days and spontaneous preterm birth (less than 35 weeks) among patients with a negative fFN test. The authors concluded that a positive Amnisure test in patients with preterm labor and intact membranes is a risk factor for adverse pregnancy outcome, particularly in patients with a negative fFN test. Moreover, a positive Amnisure test in patients without symptoms or signs of ROM should not be taken as an indicator that membranes have ruptured.
An evidence review of methods to diagnose rupture of membranes by Caramore and Dresang (2011) concluded that, where diagnosis is essential and conventional testing proves equivocal, amniocentesis with injection of indigo carmine dye is the most definitive test. The authors stated that the most widely available of the newer biochemical assays, the PAMG-1 assay, appears to offer improved accuracy compared with conventional methods, but the clinical significance of a positive test, particularly in the setting of labor, is unclear.
Van der Ham et al (2012) evaluated the diagnostic accuracy of PAMG-1 and IGFBP-1 for rupture of the fetal membranes (ROM). The authors noted that sample sizes of recent studies are small and studies used different "silver standard" definitions for ROM. Therefore, reported results should be interpreted with caution. The authors found that, compared to nitrazine or ferning test alone, IGFBP-1 and PAMG-1 are more accurate. However, compared to the conventional testing (combination of history, ferning, nitrazine, speculum and ultrasound) no statistical difference in accuracy was found. The authors concluded that IGFBP-1 and PAMG-1 seem to be sensitive and specific; however, evidence is lacking especially in equivocal cases and comparative studies against the real gold standard (amnio-dye) have still not been published. The authors stated that further effectiveness research is needed before tests can be applied in practice.
An assessment by the Canadian Agency for Drugs and Technologies in Health (CADTH, 2012) found that AmniSure had high sensitivity and predictive accuracy for rupture of fetal membranes; however the lack of direct comparison to individual tests and limited statistical reporting prevent drawing conclusions about comparative effectiveness. Performance results suggest that AmniSure may be a useful tool for detecting membrane rupture, but no evidence related to cost-effectiveness was identified. The assessment stated that evidence-based guidelines for the use of AmniSure in clinical practice are lacking. The assessment stated that there is a limited quantity of evidence directly comparing AmniSure to conventional clinical methods, which include fern testing as one of the diagnostic criteria, for detecting rupture of fetal membranes. The assessment identified one study comparing AmniSure to the fern test alone. This study exclusively included term pregnancies and may not be generalizable to preterm membrane rupture. Other identified studies made a comparison to a suite of clinical criteria which varied between studies. These criteria included fern tests, but a positive fern test was not necessarily required to make a diagnosis, limiting the ability to draw a direct comparison. The assessment noted that all studies excluded patients with vaginal bleeding or other complications which may limit generalizability of their findings. CADTH identified no evidence-based guidelines or cost-effectiveness analyses of Amnisure.
van der Ham et al (2011) stated that PROM is a common obstetrical problem, but its diagnosis is frequently problematic. Lacking a gold standard, the diagnosis is equivocal in some 10 % of cases. These researchers performed a systematic review to assess the accuracy of several tests for the diagnosis of PROM in these equivocal cases. They performed an electronic search in PubMed, Embase, DARE and the Cochrane Library and reference lists for potentially missed articles. No language restrictions were used. Only accuracy studies for diagnostic methods for PROM in women with equivocal PROM were selected. The studies were scored according to STARD and QUADAS guidelines. Based on the full description of reference and index tests, an expert panel finally decided whether the selected articles were of sufficient quality to be included. These investigators identified 3,864 studies of which 146 full manuscripts were obtained. They excluded 133 due to multiple reasons. The remaining 13 studies were scored by an expert panel. Only 3 articles with a total of 155 patients fulfilled all criteria. These articles tested 3 different methods: (i) pH measurement (64 patients), (ii) insulin-like growth factor binding protein-1 (ILGBP-1, 83 patients) and (iii) alpha fetoprotein (AFP, 8 patients). Sensitivity varied from 88 % (pH) to 100 % (AFP), specificity varied from 56 % (ILGPP-1) to 100 % (AFP). Based on the limited evidence on the accuracy of tests to diagnose ruptured membranes, the authors concluded that the use of a particular test cannot be recommended.
The ROM Plus Fetal Membranes Rupture Test is a rapid, qualitative test for the in-vitro detection of amniotic fluid in vaginal secretions of pregnant women. It detects both placenta protein 12 (PP12) and alpha-fetoprotein (AFP). However, there is insufficient evidence regarding the effectiveness of this test.
Fichera et al (2014) evaluated the accuracy of a second-trimester rapid cervical phosphorylated IGFBP-1 (phIGFBP-1) test to predict spontaneous preterm delivery in asymptomatic twin pregnancies. During the second trimester, a rapid test to detect phIGFBP-1 in cervical secretions was performed on consecutive twin pregnancies between 2009 and 2011 to evaluate its predictive value for spontaneous preterm delivery at less than 28, less than 30, less than 32 and less than 34 weeks' gestation. Excluded were patients with cerclage, pessary or undergoing indicated preterm delivery. A total of 197 pregnancies fulfilled the study criteria and were tested at a median gestational age of 20.3 weeks (interquartile range: 20 to 20.6). Median gestational age at delivery was 36.4 weeks. Spontaneous preterm deliveries at (i) less than 34 weeks occurred in 21 (10.7 %) cases, (ii) less than 32 weeks in 9 (4.5 %), (iii) less than 30 weeks in 6 (3 %) and (iv) less than 28 weeks in 4 (2 %). Seventeen patients (8.7 %) were test positive: In this group, 3 patients delivered before 34 weeks' gestation, whereas none delivered at less than 32 weeks. The sensitivity, specificity, PPV and NPV of the test for spontaneous preterm delivery less than 34 weeks were 14 % (95 % confidence interval [CI]: 3 to 37 %), 92 % (86 to 95 %), 17 % (4 to 44 %) and 90 % (84 to 93 %), respectively, with a positive and negative likelihood ratio of 1.79 (0.56 to 5.74) and 0.93 (0.78 to 1.10). The authors concluded that in the second trimester, rapid cervical phIGFBP-1 testing in asymptomatic twin pregnancies has a poor performance in predicting spontaneous preterm delivery.
In an UpToDate review on "Midtrimester preterm premature rupture of membranes" (McElrath, 2015) states that "The diagnosis of midtrimester PPROM is based upon a characteristic history (leaking fluid from the vagina) and physical examination (visualization of fluid flowing from the endocervical canal), supplemented by standard laboratory tests (nitrazine, fern) in cases of diagnostic uncertainty". It does not mention measurements of PAMG-1 (AmniSure) and IGFBP-1 (Actim PROM).
In a meta-analysis, Palacio and colleagues (2014) evaluated the published data for the accuracy of 2 amniotic fluid-specific biomarker tests for PROM: (i) IGFBP-1 (Actim PROM) and (ii) PAMG-1 (AmniSure). This analysis included all PubMed referenced studies related to Actim PROM and AmniSure with available data to extract performance rates. To compare accuracy, a comparison of pooled indexes of both rapid tests was performed. Studies in which both tests were used in the same clinical population were also analyzed. Membrane status, whether it was known or a suspected rupture, and inclusion or not of women with bleeding, were considered. All the available studies published in PubMed up to April 2013 were reviewed. Data were retrieved from 17 studies; 10 for Actim PROM (n = 1,066), 4 for AmniSure (n = 1,081) and 3 studies in which both biomarker tests were compared directly. The pooled analysis found that the specificity and PPV were significantly higher for AmniSure compared with Actim PROM. However, when 762 and 1,385 women with known or suspected ROM, respectively, were evaluated, AmniSure only remained significantly superior in the latter group. Furthermore, when the 2 tests were compared directly in the same study no statistically significant differences were observed. Remarkably, women with a history or evidence of bleeding were excluded in all 4 studies for AmniSure, in 2 Actim PROM studies and in 2 of the 3 studies reporting on both tests. The authors concluded that no differences were observed in the performance of the 2 tests in studies where they were used under the same clinical conditions or in women with known membrane status. They stated that although AmniSure performed better in suspected cases of PROM, this may need further analysis as exclusion of bleeding may not be representative of the real clinical presentation of women with suspected PROM.
Mariona and Roura (2015) stated that the diagnosis of the status of the fetal membranes has traditionally been reduced to either intact or ruptured. In the last decades, evidence has accumulated demonstrating that this clinical approach may well be an over-simplification. Practically, all maternal organs experienced physiologic or eventually pathologic changes during the length of the gestational period. These investigators proposed that the fetal membranes are also significantly impacted by those changes. The accurate, specific, simplified and low-cost diagnosis of the status of the fetal membranes is of critical importance for the assessment of risk to the pregnancy followed by efficient and prompt treatment. The presence of PAMG-1 in the vagina specifically indicates a disruption in the integrity of the fetal membranes and may indirectly mean increased risk for preterm birth. The authors concluded that further research to properly characterize this marker and its importance in the care of pregnant woman at risk for preterm birth is strongly recommended.
|CPT Codes / HCPCS Codes / ICD-10 Codes
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":
|ICD-10 codes will become effective as of October 1, 2015:
|CPT codes not covered for indications listed in the CPB:
|Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin-1 [PAMG-1], placental protein 12 [PP12], alpha-fetoprotein), qualitative, each specimen
|ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):
O29.011 - O30.019, O30.031 - O35.6xx+
O36.011+ - O9a.53
|Complications of pregnancy, childbirth, and the puerperium
|Supervision of pregnancy
|Encounter for antenatal screening of mother


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In light of recent events, I felt compelled to personally and publically thank Mr. Tim Marcum for his continuing service to Owen County schools, Owen County athletics and Owen County students.
This coming Sept. 11 will mark a day of remembrance across the country.
But a special event in Owen County will mark and honor a treasured part of Owen County's agricultural history.
A special tractor parade will wind its way across Owen County starting at 10 am. Sept. 11.
Johnny Stewart, who is organizing the parade, said he hosted a tractor show in May as a fund-raiser for Relay for Life and the success of that event sparked the idea for the parade.
She is the only female basketball player in Owen County history to accomplish such an impressive feat.
Kaylan Richardson scored 1,122 points as a Lady Rebel. That is good for fifth on the all-time scoring list. She then when to Alice Lloyd College where she scored 1,097 points making her the first, and to this point only, player in Lady Rebels' history to score over 1,000 points in her college career.
The other day, I was throwing together a hash-brown potato casserole at the last minute for a potluck family reunion when I realized the recipe called for a can of Campbell's Cream of Mushroom soup, an item I'd forgotten to pick up on my run to the grocery store. But not to worry, I thought.
He is one of the best players to ever play football at Owen County High School, and he did it while playing for his father.
Curt Cochran graduated from OCHS in 1981. During his time as a Rebel, he lettered four years in football, three years in basketball and baseball and one year in track.
While a member of the football team, the Rebels compiled a record of 33-11 including a regional championship in 1980. That season, the team lost just one game during the regular season before falling to Russellville in the state semifinals.
On Aug. 30, students will say goodbye to Owen County High School Principal Shannon Treece and hello to their new leader, Danny Osborne.
Osborne, a 33-year-old principal at Virgie Middle School in Pike County, signed his contract with the Owen County School District Monday.
Owen County Schools Interim Superintendent Don Martin announced the new hire during Monday evening's Owen County Board of Education meeting.
Despite talk of the national economy being on the rise, the Owen County Fiscal Court met Aug. 10 and decided to keep last year's tax rates.
Owen County Judge-Executive Carolyn Keith said the court could have taken the 4-percent increase.
"With the way the economy has been, I just didn't feel that people could take that increase," Keith said. "A 4-percent increase would have amounted to about a $2,000 difference in revenue."
The Owen County 10U baseball All-Stars recently competed in the District 6 Cal Ripken Tournament.
The team fell short of reaching the state tournament, losing to Grant County in a best of three series. The Rebels lost by a score of 7 to 4 in the first match-up. Owen County was led on the mound by Austin Towles and Jason Gray. At the plate the Rebels were led by Grant Cobb with two hits. Kirby Young, Logan Harrod, Austin Brown and Towles also had hits.
For about week, Owen County's Greg Estes has been all over the place.
His picture has been prominently featured on Yahoo News. He's fielded calls from local, regional and international media organizations.
All this over a $5 bike.
Last week, the News-Herald broke the story first of Estes, the custom-made racing bike, and former Tour de France champion Floyd Landis.
In 2006, we were told by doctors in another hospital that our mother would die in the next few days.
The reason I am sharing these thoughts with you is I was approached by someone who wanted more information on the home dialysis and I feel there are more people out there who one day may need to think about going this way instead of going to a clinic and going through a more aggressive treatment.
Instead of doing it daily, you do it every two to three days and it is more aggressive.
Copyright © 2016
The Owenton News-Herald is your source for local news, sports, events and information in Owen County and Owenton, KY, and the surrounding area.


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Virtual Reality Racing: Project Cars Confirmed for Morpheus
Project Cars, the racing game from Slightly Mad Studios (World of Speed), will be among the first to utilize Sony's PlayStation 4 virtual reality headset, codename Morpheus.
Sony unveiled Morpheus at GDC last week and the only game confirmed for development at the time was spaceship dogfighter Eve: Valkyrie. Now Slightly Mad says it will get in on the PS4 VR action, too.
"Virtual reality is a perfect fit for racing games since the game world literally comes rushing towards you from the distance and the increased sense of depth and speed that stereoscopic vision affords you makes this incredibly real and tangible," the studio said in a statement. "So when you're racing you get a much better perception of distances and position and you feel far more enveloped by that world rather than just looking through a window at it."
"Project Morpheus also allows you to see detail you might have otherwise missed… Via our interior cameras not only can you look around the cockpit and see everything from a first-person perspective, but using head-tracking via the PlayStation Camera you can also now move around the cockpit too – peer closer at some intricate detail or turn around and look out of the back window."
Sony said its VR headset is still very much a work in progress and declined to offer a release window or pricing. However, Project Cars is set for a November launch on the PlayStation 4, so we will likely see Morpheus sometime this fall.


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LOS ANGELES — IMAX Corporation (www.imax.com) has signed an agreement with Paramount Pictures to release four of the studio's tent-pole films in 2011. The four films include Super 8 (June 10), Transformers: Dark of the Moon (July 1), Mission: Impossible – Ghost Protocol (December 16) and The Adventures of Tintin: The Secret of the Unicorn (December 28).
Sony Pictures Entertainment is co-production partner on The Adventures of Tintin: The Secret of the Unicorn, and Sony Pictures Releasing International (SPRI) will handle distribution and marketing in most key territories overseas.
Transformers: Dark of the Moon and The Adventures of Tintin: The Secret of the Unicorn were both originally shot in 3D and will be digitally re-mastered into IMAX's format for presentation in IMAX 3D.
Mission: Impossible -- Ghost Protocol is the fourth chapter in the franchise and will feature scenes shot with IMAX cameras. These sequences, exclusively in IMAX, will expand on the screen to further immerse the audience.


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Elizabeth Hunter
I'm an associate editor for The Lutheran. I also serve as editor of The Little Lutheran and its sister publication, The Little Christian. Both are intended to nurture the faith of people aged 6 and younger. Check it out, subscribe and let us know what you think. Amber Leberman (who art directs the children's magazines) and I are open to making changes based on your suggestions.
My favorite part of this calling is leaving my desk to visit other ELCA members who serve in congregations and church-related ministries. I enjoy hearing about their vocations, joys, challenges, and how Christ keeps them going.
I attend Holy Family Lutheran Church in Chicago, with my two sons, ages 6 and 3, who love stories, music and the church—just like their mom.
Articles by Elizabeth Hunter:
- Seminary, synod make 'mission possible'
Renovation effort warms homes and hearts
- Ten years after the tsunami
- Repair, rebuild, restore
Six generations gather for ninth Women of the ELCA triennial
- Is 'Allah' exclusively for Muslims?
Malaysian Christians face religious freedom issue
- The first 100 days
Bishop Eaton shares her vision for the church
- ELCA campaign underway
- 'Love shouldn't hurt'
Empowering domestic violence survivors
- Why not child sponsorship?
Here's why ELCA World Hunger practices accompaniment
- Hopes high for year-end World Hunger push
- Making seminary debt manageable
ELCA Stewards of Abundance tries targeted scholarships
- Go, sow! Sow! Go!
Eaton installed as presiding bishop in joyful, emotional service
- Luther's enduring legacy
ELCA colleges, universities help the church cultivate a sense of vocation
- Helping students find jobs
With a sense of vocation, ELCA schools go beyond basic career services
- Fundraising campaign approved
The first of its kind in the ELCA
- Hearing the cries
'Yes' to criminal justice, other actions
- Faith leaders extend best wishes to ELCA
- Hanson urges ELCA to add to book of Acts
- A farewell
- A new presiding bishop
Eaton first woman to hold post, looks to sharpen message, open doors
- Cookie hospitality
- Memorials address immigration, communion, violence & more
- Boerger elected on fifth ballot
Serves up 'yummy' parts of ELCA Constitution
- ELCA 'made new'
Dramatic elections, campaign highlight Pittsburgh gathering
- Malaria Campaign passes halfway mark
- Paperless in Pittsburgh
2013 Churchwide Assembly will elect presiding bishop, secretary and more
- Seminaries provide free financial coaching
- Pet of the Year
- In a new key
Ecumenical effort supports music and worship leaders
- 'Mighty Fortress' not a tavern song
Separating fact from fiction
- Favorite hymns
Readers say sacred songs made the difference
- Meet a hymnwriter
Susan Cherwien shares 'old truths in new words'
- A tale of two seminarians
The economy of theological education, then and now
- Care without walls
Lutheran agency helps Ohio seniors recuperate
- On each shelf, many stories
ELCA Archives show the life of the church, then and now
- ELCA response to Sandy will continue ...'Until the work is done'
- Faith & criminal justice
Task force members share their hopes
- LSTC welcomes Valparaiso campus
Follows the trend of ELCA seminary and college partnerships
- Vacation Bible or Sunday school, Tanganyika-style
In 1962, Tanzania was still named Tanganyika
- Two rabbits for two neighbors
Children of Lutheran pastors enjoyed playing together
- Lutheran hospital's gift horse
Norwegian deaconess drove a clever bargain
- It's smart to 'Be Well'
This S.C. Lutheran retirement community strengthens seniors
- The Little Lutheran, then and now
Two different issues, 60 years apart
- ELCA senior living sparks imaginations
Art and drama programs help those with Alzheimer's and dementia share their memories
- What do you know about criminal justice?
Read the ELCA's draft social statement, ready March 15
- Now the zampoña, charango, flauta and bombo!
Peruvian Lutherans strike a chord in their neighborhood
- Community connections
ELCA colleges make life better for their neighbors
- Convention business
New leaders elected, budget approved
- Women of the ELCA respond
... by making room for newcomers, healing, prophecy and action
- Gettysburg, Luther & Odyssey join forces
- Papua New Guinea: Leadership & mission
Blogs by Elizabeth Hunter: (Read All)
- Summer family
- Father's Day immigration debate
- What does our brand of Lutheranism say?
- Lawrence Clark to direct Lutheran Theological Center in Atlanta
- Immigrants built Augustana Lutheran Church (Andover, Ill.) to last
- Where moms have it best
- ELCA congregation's chimes disturb, delight Duluth neighbors
- Where pastors and imams 'bend it like Beckham'
- 'Something different' about this congregation's furniture, worship
- What you have first given us
- ELCA Montana Synod: Nguyen embodies spirit of hope
- May Day
- Texas Lutheran University receives $1.4 million from AT&T
- A cousin, a comment, some bishoply calls....and now we have a Nobel Peace Prize Forum
- What I learned in first communion class
- Praying with our eyes open
- Immigration: Should we care?
- ELCA endowment gives $75,000 to a Chicago community center
- Waldorf College students volunteer in Gulf Coast
- County mistake taxes Atlanta congregation
- paddy-what?
- St. Olaf College president to lead Moravian college & seminary
- Midwest tornadoes
- Thick skin
- Update: Tsunami relief continues
- Where the cafeteria ladies only serve porridge
- Hello, nanotech
- Group begins work on ELCA social statement on human sexuality
- Lutheran bishop Munib Younan condemns cartoons, violence
- Words like permalink
- After Hamas' victory, Lutheran bishop tells Christians not to panic
- Danish rye bread
- Read those annual report forms carefully
- Grand Canyon Synod bishop resigns over sexual misconduct
- LSS of Austin receives $1 million grant
- Jesus spammed me today
- Huh? Christmas worship not life-style friendly?
- World AIDS Day
- Five hours is a long time when you're 1
- Poster children
- Need a little upside-down?
- Big city care
- Please, no more cheese
- A new list
- Who have you met?
- Poor bird
- Stuck on something sticky
- Katrina hits us, too, right in the heart
- Hair-raising, taming tales of my Iraqi hairdresser
- What do some prisoners, science educators and VBS students have in common?


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W e've been talking at our congregation about Christmas programs and the Advent season of preparation for such a glorious event. The usual themes emerge--prepare, anticipate, getting ready.
As I spent more time thinking about the Advent message, I thought of the spring flooding, which is nothing new to this area. We knew a flood was coming. We thought we were prepared. Scores of people sandbagged around Ada, Minn., many working around the clock. But when the dikes couldn't hold back the water and our streets and homes filled with the anger of the elements, many of us left defeated, helpless and fearful for the future. Did we not prepare? Grown men cried. Parents comforted children. T he elderly stared in disbelief.
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