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Author Affiliations: Department of Family Practice and Community Medicine (Drs Gallo and Bogner) and Center for Clinical Epidemiology and Biostatistics (Dr Morales), School of Medicine, University of Pennsylvania, Philadelphia; and Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md (Dr Ford).
Black Americans are more likely to obtain mental health care from a primary care physician than from a mental health specialist. We investigated the association of ethnicity with the identification and active management of depression among older patients.
Cross-sectional survey of 355 older adults with and without significant depressive symptoms. At the index visit, the physician's ratings of depression and reports of active management were obtained on 341 of the 355 patients who completed in-home interviews.
Older black patients were less likely than older white patients to be identified as depressed (unadjusted odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63) and their depression was less likely to be actively managed in the 6 months before the interview (unadjusted OR, 0.63; 95% CI, 0.19-2.16). In multivariate models that controlled for potentially influential characteristics such as patient age, sex, marital status, level of education, functional status, physical health, severity of depressive symptoms, severity of anxiety symptoms, attitudes about depression, number of office visits in the last 6 months, and the physician's rating of how well they knew the patient, the associations of identification (OR, 0.25; 95% CI, 0.17-0.39) and management (OR, 0.57; 95% CI, 0.19-1.77) with patient ethnicity remained substantially unchanged.
Our study calls attention to the role ethnicity may play in the identification and active management of depression among older primary care patients.
The US Surgeon General renewed attention to the problem of unrecognized and untreated depression among older adults,1 stating that the primary care setting may provide the only opportunity in which serious depression and other mental conditions that affect elderly minority patients can be addressed.2 Primary health care is pivotal for the initial identification and management of depression among older patients.3 Black patients are more likely than white patients to obtain mental health care from a primary care provider. 4- 7 The increase in antidepressant use among older adults has occurred mostly among white patients.8 Despite the increase in antidepressant use among older adults, once in care, black patients appear to be less likely than white patients to receive appropriate diagnoses9 or to receive treatment thought to be effective for depression.5,10 Black patients have been reported to be less likely than white patients to adhere to a depression treatment regimen once it is initiated,11 even though no difference in treatment response according to ethnicity among patients who accept and sustain treatment has been identified.12 None of the cited studies focused on older primary care patients.
At the outset, we acknowledge that terms of race and ethnic origin are coarse markers of complex social and behavioral patterns. Ethnicity refers to a common heritage shared by a particular group.13 Culture is broadly defined as a common heritage or set of beliefs, norms, and values.2 We recognize that designations of ethnic status imply a homogeneity within groups that is a simplification. 14,15 Consistent with current publications of the National Institutes of Health,16 we use the terms black to include individuals of African, African American, and African Caribbean descent and white to include individuals of European descent. Any differences we observe across ethnic groups are likely to represent measured and unmeasured differences in social class, exposures, health beliefs and practices, and other characteristics.17
The goal of this investigation was to examine the characteristics of older patients identified by their primary care physicians as depressed, with a focus on the ethnicity of the patient. We hypothesized that black patients might have a different experience regarding depression identification and management than white patients in primary care practice. Our conceptual framework was a simplified version of the model suggested by Cooper and colleagues18 (Figure 1). In this model, attitudes about depression and familiarity with the practice mediate the relationship between patient ethnicity and the identification and active management of depression by primary care physicians. In the work of Cooper and coworkers,18 attitudes about depression and its treatment did not completely explain the relationship between patient ethnicity and acceptance of treatment for depression.
Conceptual framework of the Spectrum Study, adapted from Cooper et al.18
The overarching goal of the Spectrum Study was to characterize how depression presents in older primary care patients. The design of the Spectrum Study was a cross-sectional survey of patients and physicians. In all, 47 physicians (28 family physicians and 19 internists) from 13 practices contributed patients who participated in the Spectrum Study. 19,20 Practices were selected to achieve a substantial representation of black patients. Experienced agency interviewers worked with office staff at each practice to identify all patients 65 years and older. All such patients who came to a participating office were approached and asked to join in a study of health and aging. The study protocols were approved by the Institutional Review Board of the University of Pennsylvania School of Medicine, Philadelphia. A certificate of confidentiality was obtained from the Department of Health and Human Services as an additional safeguard.
At the index visit, the physician was asked to complete a brief assessment of the patient's condition at that visit. The physician rated the patient's level of depression at that visit on the following 4-point scale: none at all, mild, moderate, or severe. For this investigation, physician identification was defined as including ratings of mild, moderate, and severe depression. Next, the physician was asked to indicate whether any of the following were performed for the patient at the index visit or at any time in the past 6 months: "provided counseling/supportive listening for depression," "tried to refer to a mental health specialist," and "prescribed psychotropic medicine for depression, anxiety, or sleep." Physicians were asked to provide a reason for not prescribing medication or counseling if the patient was thought to be depressed by checking as many reasons as applied from a list or by writing in a reason of their own. Physicians were asked to rate how well they knew the patient.
We obtained information from the respondents on age, sex, ethnicity, marital status, living arrangements, level of educational attainment, and the number of visits made to the practice for medical care within 6 months of the index visit. Patients who denied being Hispanic or Latino/Latina were asked to select from the following choices read to them: American Indian or Alaska Native, Asian, black or African American, native Hawaiian or other Pacific Islander, white, or other. Patients who responded that they belonged to another ethnic group were excluded from this analysis. Persons who self-identified as African American were classified as black for the purposes of this investigation.
The Center for Epidemiological Studies Depression Scale (CES-D) was developed for use in studies of depression in community samples. 21- 23 The standard CES-D questionnaire contains 20 items and has been used in studies of older adults. 24,25 In this study, we used the CES-D finding as a continuous score, but we also identified patients whose CES-D score was 16 or higher as depressed. The CES-D appears to be a valid measure of depressive symptoms among persons from differing ethnic groups. 26- 28 The Beck Anxiety Inventory was used as a continuous score to measure anxiety symptoms. 29- 31
Questions from the 36-Item Short-Form Health Survey (SF-36) were used to assess functional status. 32,33 The SF-36 has been used in studies of outcomes of patient care, 32- 36 and appears to be reliable and valid even in frail elders.37 The SF-36 was scored using previously described techniques.38 Baseline medical comorbidity was measured by summing the lifetime presence of 12 chronic diseases or conditions, including myocardial infarction, angina, congestive heart failure, high blood pressure, diabetes mellitus, osteoarthritis, stroke, cancer, Parkinson disease, hip fracture, and vision and hearing problems. We asked patients whether they agreed or disagreed with 3 statements about depression and its treatment.39 The statements were "I believe depression is a medical problem," "If my doctor told me I had depression, I could accept that," and "I would take a medicine for depression if my doctor told me to."
We compared the characteristics of persons who self-identified as black with those of persons who self-identified as white, using 2-tailed t tests or χ2 tests for continuous or categorical data as appropriate. Our primary dependent variable was identification of the patient as depressed by the physician at the index visit. To adjust our estimates for potentially influential covariates and practice-clustering effects, we used generalized estimating equations for binary outcomes.40 We also examined identification in relation to whether or not the respondents scored 16 or higher on the CES-D,21 using the odds ratio (OR) as a measure of association. Consistent with our conceptual framework, we introduced terms in the multivariate models to represent age, sex, marital status, level of educational attainment, functional status, physical health, and depressive and anxiety symptoms. Subsequent models included terms for attitudes about depression and its treatment and familiarity with the practice (as represented by the patient's report of the number of visits made to that practice in the 6 months before the interview and the physician's rating of how well they know the patient) that were hypothesized to be mediators in our conceptual framework. In subsequent analyses, we restricted our attention to the persons whom the physician identified as depressed, with report of active management as the dependent variable. Finally, we tabulated physician reasons for not prescribing medication or counseling for patients identified as depressed.
Table 1 compares the characteristics of black and white patients in the sample. Proportionately more black patients were women and unmarried. Three persons self-identified as "other" for ethnicity and were excluded. Black patients were significantly more likely than white patients to report poorer physical and social functioning. Proportionately fewer black patients were identified as depressed by physicians or were reported to have depression actively managed within 6 months of the index visit.
Black patients who were identified as depressed, when compared with white patients identified as depressed, were more likely to report worse physical and social functioning and bodily pain (Table 2). Physicians indicated that they knew depressed black patients equally as well as white patients, but physicians were more likely to report that they knew black patients well who were identified as depressed than they did black patients who were not identified as depressed. Black patients who were not identified as depressed by the physician had poorer physical and role emotional functioning compared with white patients not identified as depressed. Figure 2 illustrates the detection rates according to CES-D strata and ethnicity. Black patients were less likely to be identified as depressed across the entire range of CES-D strata. Among persons who scored above the threshold on the CES-D, black patients were less likely than white patients to have been identified as depressed (OR, 0.48; 95% confidence interval [CI], 0.26-0.88).
Identification of depression by primary care physicians according to the level of depressive symptoms as measured by the Center for Epidemiological Studies Depression Scale (CES-D) and stratified by patient ethnicity. Data are from the Spectrum Study (2001-2003).19,20
Black patients whose depression was actively managed reported statistically significantly higher depression scores than white patients whose depression was actively managed, and poorer functioning on several measures (Table 3). Black patients whose depression was actively managed made more visits to the primary care office than white patients whose depression was actively managed.
After adjustment with generalized estimating equations to account for clustering and potentially influential covariates, including severity of depression symptoms, black patients were 0.25 times as likely (95% CI, 0.17-0.39) to have been identified as depressed (Table 4). Black patients were about half as likely as white patients to have received active management of depression (OR, 0.57), adjusting for potentially influential covariates, although confidence bounds of the point estimate included the null (95% CI, 0.19-1.77).
Physicians provided reasons for not actively managing the patient's depression in the 6 months before the index visit among the patients they identified as depressed. The most common reason was that the depression was too mild (6 of 12 black patients and 9 of 25 white patients). The next most commonly cited reasons were that the depression represented a temporary adjustment reaction (2 of 12 black patients and 4 of 25 white patients) and that the patient would be reluctant to accept the diagnosis of depression (3 of 12 black patients and 2 of 25 white patients).
In this primary care sample, black patients were less likely than white patients to have been identified as depressed. This association persisted even after controlling for potentially influential variables, including severity of depressive symptoms and level of functioning. Black patients were also less likely than white patients to have depression that was being actively managed after controlling for potentially influential variables; however, the association approximated but did not reach standard levels of statistical significance. Black patients identified by their physician as depressed whose depression was being actively managed were more likely than white patients to be functionally impaired. These results are all the more remarkable because we have asked physicians to report on their care of persons whom they identify as depressed. Our study builds on previous work 9,18,41 and suggests that patient ethnicity may play a role in the identification and active management of depression among older adults who present in the primary care setting.
Before putting our results in clinical and research context, the limitations should be discussed. Our study was based on practices that participated in a research study and so may not be representative of all practices. The responses to the survey instruments do not necessarily reflect the actual discussion the patient had with the physician during the office visit when the patient was rated by the physician. In other words, we cannot be certain of the extent to which patients of different ethnic groups may express their symptoms differently during physician encounters. We did not have ratings of patient behavior or symptoms from clinical observers other than the patient's primary care clinician. Despite these limitations, our study design is associated with several strengths, and the findings deserve attention. Although limited to practices in a single geographic area (Baltimore, Md), we attempted to create a representative sample by random calling of physicians based on a sampling frame provided by a professional organization, we included multiple practices, and we sampled from urban and suburban areas. The data from physicians are nearly complete (97% of the participants were rated by their physician). We were able to adjust our measures of association for ratings of how well the physicians knew the patient and other potentially influential covariates. Because we linked patient data to whether the physician reported that they had actively managed the patient's depression within 6 months of the interview, we did not have to depend on medical chart reviews.
The Institute of Medicine report "Unequal Treatment"42 reviewed the medical literature on the extent and sources of disparities in health behaviors and outcomes across ethnic groups. Despite the observed variation in recognition and treatment of psychiatric disturbances according to ethnicity,9 empirical studies have not typically focused on the patient-physician encounter in studying observed differences in rates of antidepressant use, seeking specialty mental health treatment, or discussing a mental health problem with a general medical health care provider. 1,2,42
Few studies have focused on older adults to assess the relationship between physician ratings, patient characteristics, and identification and active management of depression. Miranda and Cooper43 found that Latino and African American patients were no less likely to be offered treatment for depression by primary care physicians, yet they were less likely to actually receive appropriate care for depression. Few older adults were included in that study (eg, only 2 African American patients were 65 years or older). Borowsky and colleagues44 reported that black patients were less likely to be identified by primary care physicians as having a mental health problem. That study was not focused on older adults or on the specific diagnosis of depression. Sirey and coworkers45 reported that white patients were much more likely than black patients to receive a recommendation for an antidepressant, but their study did not include adults older than 65 years and did not focus on the primary care setting. Studies of older adults in public housing46 and in long-term care47 showed that older African Americans were less likely to use available community mental health services, but no study of recognition has focused on older adults in primary care settings as we have done here.
For clinicians, it may be easier to determine whether a patient has a symptom of depression than to determine the severity of the symptom. When judgment about uncertain elements of the clinical examination is required, patient characteristics can have a greater effect on the final assessments. Physicians caring for black patients should be aware that there is a tendency for depressive symptoms to be judged as not severe. Physicians might introduce this fact into their interviews when appropriate and determine whether this leads to a different conversation with their black patients. Acknowledging that the possibility of a discrepancy occurs may be the first step toward improving the management of depression.
The recognition and management of depression in primary care settings is a negotiated process between the patient and the primary care physician. Given the competing demands of practice,48 the common uncertainty inherent in the diagnosis of depression in primary care settings, and differing perceptions of the physician-patient encounter across ethnic groups, 41,49 physicians may take their cue for identification and management decisions from their assessment of the likelihood that a patient will accept the diagnosis or treatment recommendations. In addition, physicians may interpret symptoms of persons as too mild to treat when the patient is black. Physicians and patients may collude not to treat depression, ascribing symptoms to other causes such as social conditions. We are performing analyses of open-ended interviews of the sample to understand what older adults think about the nature, treatment, and outcome of depression. Physicians and patients in primary care settings come to the encounter with attitudes, expectations, and values that may differ markedly from physician to physician and between physician and patient. Sorting out the multiple sources of disparity will require fine-grained studies of how characteristics of providers, patients, and health care systems influence the interplay of physician, patient, and environment.
Correspondence: Joseph J. Gallo, MD, MPH, Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce St, 2 Gates Pavilion, Philadelphia, PA 19104 (email@example.com).
Accepted for Publication: May 23, 2005.
Financial Disclosure: None.
Funding/Support: This study was supported by grants MH62210, MH62210, and MH67077 from the National Institute of Mental Health (NIMH), Rockville, Md (the Spectrum Study); Mentored Patient-Oriented Research Career Development Award MH67671-01 from the NIMH (Dr Bogner); and funding for a Robert Wood Johnson Foundation Generalist Physician Scholar (2004-2008) (Dr Bogner).
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Duke Energy Indiana Updates Power Restoration Estimates Sept. 19, 2008
Duke Energy has restored service to more than 380,000 statewide as of Friday morning. About 26,000 remain out of service in Clarksville, Connersville, Corydon and Madison.
The latest estimates for power restoration in the remaining areas are:
- Connersville the majority by Friday night; some outages could extend into Saturday
- Corydon the majority by Friday night; some outages could extend into Saturday
- Madison the majority by Saturday night; some outages could extend into Sunday
- Clarksville, Jeffersonville, New Albany the majority by Sunday night; some outages could extend into Monday
Power restoration is going to take longer than expected for some of our customers, said Duke Energy Indiana President Jim Stanley. Some of the North and South Carolina crews that we were fortunate to have assisting us are now moving to Ohio and Kentucky to help address the more than 130,000 outages we still have on our system there. On Thursday there also were significant new outages added to those we already had here, which has slowed restoration. Were finding that limbs and trees weakened from the storm are still falling on power lines and causing outages.
In the companys Clarksville and Madison districts there are more than 120 poles to replace and hundreds of spans of wire to put back up. These areas are taking longer to restore because there are so many individual problems to address.
In some cases, were rebuilding our electric infrastructure much like you build a house from the ground up, Stanley said. On Thursday we found 35 spans of wire down in Madison. I thank our customers for their understanding while we tackle each problem.
Duke Energy customers can report down lines or power outages at 1-800-343-3525.
Meter Boxes and Weather Heads
Individual outages are sometimes caused by a damaged meter box or weather head, which is part of the fixture that connects the service/supply line to the meter box. If the meter or weather head is damaged or pulled away from the building, customers need to contact a licensed electrician for repairs. In some areas, a local county inspection may also be necessary before power can be restored. Customers should turn off their main breaker until damage is repaired.
Standby Generator Safety
Duke Energy wants to remind its customers using standby generators to always follow the manufacturers instructions to ensure safe and proper operation. For safe operations:
- Contact a licensed electrician for installation. Generators can be dangerous. Contact a licensed electrician if you have any questions about the operation of the unit.
- If you are using a generator at your home to provide power until your service is restored, watch for crews and turn the generator off when they are in the area. The excess electricity created by a generator can feed back onto the electric lines, severely injuring a line technician who begins to work on a line, believing it to be de-energized.
- When using an emergency generator in a home, it is safer to plug appliances or devices directly into the generator. Do not connect a generator directly to a breaker panel or fuse box. If a generator has previously been connected to a breaker panel, turn off or disconnect the main breaker to ensure the safety of line technicians working on the line to restore service.
- Always make sure generator exhaust is located outside and properly vented. It can be dangerous to locate a generator in an enclosed space like a garage.
Duke Energys Indiana operations provide approximately 7,300 megawatts of safe, reliable and competitively priced electricity to more than 780,000 electric customers, making it the states largest electric supplier.
Duke Energy, one of the largest electric power companies in the United States, supplies and delivers electricity to approximately 4 million U.S. customers in its regulated jurisdictions. The company has approximately 35,000 megawatts of electric generating capacity in the Midwest and the Carolinas, and natural gas distribution services in Ohio and Kentucky. In addition, Duke Energy has more than 4,000 megawatts of electric generation in Latin America, and is a joint-venture partner in a U.S. real estate company.
Headquartered in Charlotte, N.C., Duke Energy is a Fortune 500 company traded on the New York Stock Exchange under the symbol DUK. More information about the company is available on the Internet at: www.duke-energy.com.
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The Adams Idea Pro Hybrid is a hybrid golf club offered by Adams Golf that is designed for serious golfers looking for a highly workable club. This sleek club has a perfect blend of aesthetics, feel and sound, and is one of the preferred hybrid clubs by professionals.
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The head has a tour preferred design with no offset, and the steel pull face construction creates lower spin and increased ball speed. The head has a low CG (center of gravity) and high MOI (moment of inertia), and the adjustable weight port allows adjustment to match the desired swing weight, or shaft adjustment. These hybrids give a mid launch angle with average forgiveness. The Idea Pro Hybrids come with Aldila VS "By You" hybrid shaft and a Golf Pride Tour Velvet grip. Lofts available are 16°, 18°, 20°, 23° and 26°, and all except the 26° are available in LH models.
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Correctional Officer Accused of Stealing Hundreds of Identities
Police do a routine stop because a man's car windows are too tinted, and inside his car they find a list of over 300 stolen social security numbers.
Police say they are unsure how Daniel Maldonado, a correctional officer in Miami Dade County, obtained the numbers.
Police say he was using the identities to file fradulent tax returns.
"A search of his car found several refund cards, as well as a ledger containing 323 names, social security numbers, names and dates of birth for all these people who are victims of identity theft."
Authorities do not know just how many people on the list have been victimized, but they did find cash as well as IRS returns Maldonado had obtained through the use of these identities.
The list of charges against Maldonado is long - he has hundreds of felony charges and six misdemeanors filed against him.
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Matrimony-dom Fail: Deion Sanders Says Maybe He Needs To Try Online Dating Since He's Been Divorced Twice! [Video]
- By Bossip Staff Categories: Ballers, Celebrity Interviews, Divorces
Deion Sanders Suggests The Online Dating Might Be A Viable Option For Him
According to TMZ reports:
Look, Prime Time knows his strengths and weaknesses, which is why he told us when it comes to being hitched, he could use some work.
Sanders was at LAX this weekend when we started talking about holy matrimony — and Sanders (who's been divorced twice) admitted, "I'm not good at marriage."
"I'm good with being a father," Deion said … "but I'm not good at marriage."
We've heard all about Deion's dot-com Don Juan tactics before so we're not really surprised to hear him say this.
Image via TMZ


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Tourist attractions of Kollam
Kollam was once an international emporium of trade and even today it is a prosperous commercial center. Kollam is located on the edge of the famous Astamudi. Kollam was one of the early centers of Christian activity in Kerala. The popularity of Kollam has been established by the time-honored proverb once you see Kollam; you will not need your home any more.
The Thangassery Light house, built in 1902, is a great center of attraction in Kollam. The Ananda Valleeswaram Temple of Kollam attracts people on almost all days. There are several Churches and Mosques around Kollam. The Pullichira Church was established in 1700 A.D. One of the oldest and most important Mosques in Kollam is the Chinnakkada Palli.
Mahatma Gandhi beach and park at Kochupilamoodu, Thirumullavaram beach and Ashramam picnic village, are some of the important spots of local sight seeing in kollam. Mahatma Gandhi beach lays just 2 km from Kollam. It is fascinating place for an evening walk. Thirumullavaram Beach is 5 km from Kollam. The sea here is ideal for swimming and bathing.
Kollam stands along Ashtamudi Lake and it is a major attraction. The children's Traffic and Entertainment Park, designed by NATPAC, is also worth visiting in Kollam. It is the largest traffic park in Kerala. The Adventure Park, located in Kollam village along the shores of the Astamudi backwaters, is also an exciting place to be at.


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CyberKnife is a noninvasive alternative to surgery for many patients and offers new hope to those who have been diagnosed with a benign or malignant tumor.
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Because of its unsurpassed maneuverability and robotic design, CyberKnife can emit radiation from virtually any direction to conform to the unique shape of any tumor. This is significantly different from conventional radiation therapy that delivers more radiation to healthy tissue surrounding the tumor.
CyberKnife vs. Other Treatments
Boston Medical Center's CyberKnife treatment can be a more effective and less invasive alternative to both conventional radiation therapy and surgery.
Frequently Asked Questions
Answers to frequently asked questions about CyberKnife at Boston Medical Center.


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Halloween is a favorite holiday for many: a time for mischief and fantasy. A time to be whoever (or whatever) they want to be. And then, there's candy. Children and adults alike gravitate to this whimsical season, but when costumes, candy and decorations start accumulating, your budget might get a little spooked. In this week's money management roundup, we look at ways to stay on budget, from finding the least expensive candy on the market (per trick-or-treater) to creating a quick and cheap haunted house display. After all, vampires aren't all that cool if they're bleeding your wallet dry.
1. Tired of buying Halloween costumes for the kiddos (or yourself) only to throw them away the next day? The Kansas City Star looks at the growing trend of costume swapping to get renewed life out of old outfits.
2. The days of the penny candy are long over. Even those hard-as-rock "chew" candies that taste like honey taffy (why?) are close to $4 a bag. Check out MainStreet's line up of candy, broken down by the cost per visiting child (assuming they only take one).
3. Inspired by the YouTube posts of light displays and creepy homes and want to create your own haunted house? Well, Halloween's today, so you have to do it now. DVice has the tips and the know-how on decorating on the cheap, and on the fly.
4. From costumes to entertaining, Halloween doesn't have to be expensive if you're creative. Bible Money Matters has come up with some fun ways to make the most of the season–and your dollar.
5. Some people (ahem… Mom and Dad?) buy way to much candy for the 10 kids who come by the house. With all the leftover candy, Mint divulges great ways to re-purpose the sweet stuff. That is, unless you overbought just so you could eat Mounds bars until Thanksgiving.
6. You're dressing up as Charlie Sheen this year–scary! But what about your finances? Are they a princess or are they pirating your peace of mind? The Debt Princess identifies the most popular disguises finances take on and what that means for your wallet.
7. Another popular get-up this year (albeit a bit twisted) is the Gaddafi mask. Make Spend Save Invest asks whether or not your finances are as messed up as this costume.
8. Nothing's sweeter than the bags and bags of chocolates at Halloween, right? Get Rich Slowly points out that the world economy, in which chocolate plays a factor, is not made sweeter by this favorite treat.


text: You are concentrating a solution containing a polypeptide of modest molecular weight by pressure filtration through a membrane. The solute concentration on the feed side of the membrane is 0.10 M and the temperature is 25�C. The applied pressure on the solute side of the membrane is 6 atm (absolute) and the pressure on the opposite (solvent) side of the membrane is atmospheric. If the polypeptide solute is completely rejected by the membrane (i.e., it does not cross the membrane) and the solution is ideal, what is the �effective� pressure difference across the membrane? If the hydraulic conductance of the membrane is 3 ml/hr/m2/mm Hg, what is the filtration rate of the solvent? Assume the membrane has a total surface area of 1 m2


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Kenya, Air/Safari/6 Nights, From $1,899 Scratch one off your bucket list with this weeklong tour of Kenya, from the big city to the Big Five. Book by July 27.
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Home > News, Stories & Videos > News
In her Kenyan village, Mama Emma uses her voice to help girls gain access to education.
Emmaculate Musheini, known as Mama Emma in her village, has five children and is a World Vision community volunteer.
Because World Vision's work in her village has improved her quality of life, she now advocates for education for women and girls in her community.
Mama Emma and her women's group were among the first to benefit from and support World Vision's presence in Mashuru, Kenya. "World Vision has taught me a lot," she says.
"Through our women's group, we have been able to support each other, as well as do so much together for our community. World Vision opened my eyes to greater opportunities around me."
When World Vision began its work in Mashuru in October 2000, some of the existing problems included lack of access to safe water, high incidence of preventable diseases among children, low school enrollment, and food insecurity due to lack of adequate rainfall. World Vision seeks to empower community members so that they play a key role in addressing these issues.
"World Vision helped us form groups and taught us about how to take care of our children. I was also taught about HIV and AIDS, and now I have become a voluntary counselor," Mama Emma says proudly.
When Mama Emma was young, she was not allowed to go to school because she was a girl.
"My father refused to let me go to school and sent my older brother to school instead of me," says Mama Emma. "And, even though I have been able to do a lot in serving my family and community, I see some limitation because I can't read and write. I have enrolled in adult education classes, but it's not easy."
Mama Emma and her friends have become well-known advocates in their village for girls' education and have even supported girls with school fees so that they can attend nearby schools. As a women's group, they have mobilized the community to raise money to build a classroom, where Mama Emma's youngest son, John, attends.
As Mama Emma explains, "It is not a cow or wealth that educates someone. It is knowledge, and that is what World Vision has given us. It is up to someone to apply what they have learned."
Thank God for Mama Emma and other female community leaders who advocate for girls in their community. Pray that education opportunities for girls around the world would continue to increase.
Make a one-time gift to help provide education for women and girls. Your gift will help provide resources such as school scholarships, art and music instruction, vocational training, and gender equality training.
Visit World Vision's Advocate Network for ways that you can advocate on behalf of girls and boys affected by poverty and injustice around the world.


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No one told me about yarn knots!
Okay so I've been browsing around for some time now. I guess I kinda figured this would be a normal problem butI hadn't read this anywhere. I'm working on my first sweater vest and as such had to buy more than one or two balls of yarn to complete it. Joanns was having a super clearance on some bulky yarn, called Life I think. It looked nice, felt nice and I figured .75 a ball was worth it for a first time "real" project so I stocked up, 10 balls, didn't care about dye lot though since the whole project was a bit experiemental. Anyhoo, I'm knitting knitting knitting and I come to a knot! Not like a tangle but the yarn is two stranded and one of the strands was knotted together and then twisted with the other non knotted strand. It's like they ran out of length and then just tied a knot to get more length. I dunno that seemed really peculiar. Later on I ran into a couple other bigger knots where the whole peice of yarn was tied together. I had no idea that would happen, I figured like quality control or something would prevent a single skein from not being a single continuous string of yarn, apparently not in this brand. Is this common? I've only knit 6 balls and found knots in three of them. Regardless except for one spot the knots all ended up on the wrong side of the work so I didn't really care, but what do you do, break the yarn and make a regular join as if you were starting a new ball? So peculiar.
Yeah, it happens. I have had it happen in cheap yarn, expensive yarn, whatever! I just cut and pick up again like I'm joining a new ball. It sucks, but it doesn happen! :shrug:
I've had that happen before too, with cheap and expensive yarns alike. Sometimes I cut and add, sometimes I just knit the knot in like it wasn't there. it depends on the project for me.
I've had it happen, and I just keep on going. With that said, most of my projects have been "practical" ones and very simple. For example, scarves and lapghans. I figure that even though I was giving them as gifts they were going to get a lot of use but not to the point where the knot was going to make them an embarrasment to use (how much do you care if there's one of those knots when you're cuddled under the blanket on the couch? :teehee: ) Also, sometimes it kinda ends up more on the wrong side of the work so it's not so noticeable on the front (if that makes sense).
Now, if I was making a sweater or something like that I'd do the cut and knit. I think it all depends on how much the knot is going to bother you. :shrug:
I've also run into places in the skein where it looks like there's a giant hairball (for lack of a better term)....that bugs me more than the knots do.
A tip I learned here: If you have a winder, rewind every ball, skein or hank. At least you know that you have then. :shrug:
for me, it depends on what i'm doing and how big the knot is. for instance, i was able to hide small knots in a garter stitch blanket and a sinful ribbed scarf, but would never attempt it in st stitch.
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Girls' Basketball: South Feature Athlete - South Park's Halie Torris
Name: Halie Torris
School: South Park
Grade: 11
Sport: Girls Basketball
Position: Forward
Background: Torris, a 6-foot forward, has teamed with senior guard Shelby Lindsay to give South Park an excellent inside-outside duo. The Eagles (17-2, 11-0), ranked No. 4 in Class AAA, are the Section 5 champions. Torris, a two-year starter, averages 15.3 points per game. As a sophomore, Torris averaged 14 points a game.
Coach Reggie Wells said: "Her work ethic is great. Halie Torris is not only a great shooter, but she can score inside. She's really starting to come around with the rest of her game. She's just coming under the belief of how much damage she can do down low."


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Asthma Health Center
Chronic Cough: Common and Often Vexing
Finding and Fixing the Problem
Chronic cough can be treated. But finding the right approach may take time.
Common causes for chronic cough include asthma, postnasal drip, and gastroesophageal reflux disease (GERD), write the researchers.
Doctors rule out the suspects one by one. That can be trying for patients, Lim notes.
"The thing is, people oftentimes go through evaluation not realizing that the diagnostic approach to cough is a diagnosis of exclusion," Lim says.
"So essentially, what you do is you go through a series of diagnostic tests that is useful at excluding possibilities. So at the end of a $64,000 work-up, people can tell you what you don't have. But they can't tell you what you have. Hence, the frustration," he continues.
"The second thing is that even if you find an abnormality, it doesn't mean that that abnormality is the 'a-ha' effect," says Lim. "You still have to treat that abnormality, and when that abnormality resolves and the cough resolves in parallel can you actually say that A causes B."
Setting Expectations
Lim advises patients to understand that finding a solution may take time. He suggests that patients find a nearby doctor since repeated appointments will likely be needed.
"It's just the nature of the diagnostic process. It's not that the doctor isn't doing his best," he says.
Lim adds that doctors should quickly be able to rule out the conditions patients fear most, like cancer.
Patients should "work with somebody they trust, who's accessible [and] willing to see them back," says Lim. "You need somebody who's interested in the subject, interested in people."
Doctors should give patients start-and-stop dates for each approach they try, says Lim.
Scanning the Sinuses
Lim and colleagues also checked CT sinus scans of 132 chronic cough patients.
Those patients had already failed treatment for rhinitis, reflux, and asthma. Nearly three-quarters of patients who were clinically suspected of having a sinus problem had abnormal CT sinus scans, and about a third had acute sinusitis, the researchers report.
The researchers aren't recommending CT scans for most people with chronic cough. The patients they scanned had already tried other approaches. Having a history of sinus problems or sinus surgery may also push sinus problems higher on the list of possibilities, says Lim.


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BEGIN:VCALENDAR VERSION:2.0 PRODID:-//http://oremlibrary.org//NONSGML kigkonsult.se iCalcreator 2.16.12 // METHOD:PUBLISH X-WR-CALNAME:JCal Pro Calendar X-WR-CALDESC:Your online events calendar X-WR-TIMEZONE:America/Denver BEGIN:VEVENT UID:20131116T220000UTC-3232ed@http://lib.orem.org/ DTSTAMP:20160825T061055Z DESCRIPTION:
November 16\, Saturday
3:00 PM – 5:00 PM Fireplace
Orem Stories Project
The first annual Orem Stories Project has invit ed local artists to
submit a portrait and share the story of an Orem resident. Entries
will be accepted at the library until November 11. For more information\,
please visit arts.orem.org. Art will be displa yed in the
library on November 16.


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A Philosophical Approach
Deanna Osmond carries on the Extension traditions of improving lives and using science to help people make informed decisions.
Deanna Osmond carries on the Extension traditions of improving lives and using science to help people make informed decisions.
In a milestone year, Bob Patterson reflects on the differences made by the land-grants through ag education — yesterday, today and tomorrow.
The Morrill Act helped make publicly funded research possible, and that research ushered in an era of American prosperity. For that reason, retiring CALS research director and associate dean Dr. David Smith calls the act "the single most impactful economic development legislation in the history of this country."
Vision and tenacity marked the efforts of those who laid the groundwork for the founding of N.C. State and its missions of teaching, research and extension.
CALS biologist Dr. Brian Langerhans explores predictability of evolution in Bahamian blue holes.
Six CALS students – beneficiaries of the land-grant university education — make their mark in academics, arts, research and more.
Dean Johnny Wynne seeds College's future success as he cedes the leadership reins.
At Oak Hill Elementary School in High Point, third graders have spent time this year learning how to plant a garden, harvest the plants and eat what they grow. The school is one of five FoodCorps sites in Guilford County where FoodCorps service member Leah Klaproth has worked with students and teachers since the beginning of the 2011-12 school year.
Faculty and staff at the Center for Environmental Farming Systems have been busy this year. Hardly a week goes by without news of how CEFS is expanding some already successful programs, starting new ones and collecting awards recognizing their work.
CALS scientists use an innovative the field lab site to demonstrate how new decentralized technologies can be used to produce non-potable waters -- those that aren't used for drinking, cooking, showering or bathing -- at the point where the water is initially used, whether it be in an individual home, a small business or small communities.
From evolution to the economy, the "Stewards of the Future: Research for Human Health and Global Sustainability" conference covered an array of topics and drew more than 400 participants representing science, industry and academia.
As Peggie Garner rushed in the pouring rain to the Onslow County Chamber of Commerce "Woman of the Year" luncheon, her biggest concerns were arriving on time and staying dry.
In Hertford County, public school students aren't lugging heavy book bags home. Though literacy is a problem there, the county schools don't have enough textbooks to go around, so students share books during the school day, rather than taking them home. But an anti-poverty effort of N.C. Cooperative Extension in Hertford County is improving young people's access to books.
Dr. Sam Pardue, head of the Department of Poultry Science at N.C. State University, has been appointed as Interim Associate Dean for Academic Programs in the College of Agriculture and Life Sciences, effective July 1. He replaces Dr. Ken Esbenshade who is returning to the Animal Science Department after 11 years as associate dean.
For nearly as long as Lizzie Johnson Harrell can remember, she has been, in some form or fashion, a teacher – whether she was leading a make-believe classroom at home with some of her 12 brothers and sisters, instructing first-year medical school students, or serving as a mentor to emerging microbiologists.
He's known fondly on campus as "Dr. Don." She lights up a room with seemingly boundless energy. Together, they're two of the top administrators at Coastal Carolina Community College (CCCC). Each is a force of nature driven by a single goal: student success.
After 30 years of service to the N.C. 4-H Horse Program, Dr. Bob Mowrey retired in January and established an endowment that will continue to provide support for the program and young people he nurtured for many years.
Dr. Johnny Wynne, who retired this summer as dean of the College of Agriculture and Life Sciences, was honored June 12 at a gala celebration at N.C. State University's McKimmon Center.


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How Much Of the Body Is Replaceable?
By LINDA VILLAROSA
Published: November 11, 2003
Legend has it that in the fifth century A.D., a beautiful woman kissed the hand of Pope Leo I during Mass. The pope, mortified at feeling desire for the woman, ordered a servant to cut off the offending hand. The Virgin Mary later restored the limb by performing the Miracle of the Severed Hand, an act immortalized in stained glass at the Church of Orsanmichele in Florence.
Many centuries later, replacing a body part is no longer miraculous, but simply commonplace. From the top of the head to the tips of the toes, nearly every part of the body can be replaced by transplanting organs and tissues from one person to the next or substituting artificial parts for weakened or damaged tissue. And research in several areas -- from building better medical devices to creating artificial organs to growing new ones with the help of stem cells -- is progressing at a pace only Steve Austin, the Six Million Dollar Man, could match.
''How much of the body is replaceable? I have not come across a part of the body that someone somewhere isn't working on,'' said Dr. Robert Langer, professor of chemical and biomedical engineering at M.I.T. and a pioneer of tissue engineering. ''Someday every part will be replaceable, even if that day is centuries away.''
Chart HAIR -- can be moved, follicles and all, from the back and sides to the top of the head. EARS AND NOSE -- Cochlear implants can restore hearing. Prosthetic noses and external ears can replace lost ones. LUNGS -- can be transplanted, and scientists are studying temporary artificial lungs. NERVES -- In a transplant, a donor nerve forms a scaffold to bridge a missing segment of nerves. Eventually, the nerves regenerate. LIVER, KIDNEY -- Beyond transplants, dialysis machines are in use for kidneys and being tested for livers. Experiments are under way for an artificial liver and a kidney that combines human tissue with a pumping mechanism. BLOOD VESSELS -- of synthetic material, sometimes combined with human tissue, can replace arteries and veins. GENITALS -- Implants can replace testicles that have been removed. Vaginas are rebuilt, generally for cancer patients. BONES -- Metal rods or natural grafts can replace broken or shattered ones. Now, artificial bones are being made of plastic; after about two months, what's left of natural bone tissue bonds with the artificial material, which is eventually absorbed into the body. Researchers are experimenting with polymer scaffolding that fuses with bone cells. LEGS -- Last summer, a 13-year-old British girl with cancer became the first recipient of a ''bionic leg,'' a bone implant that mimics natural growth with the help of an electromagnetic device. JOINTS -- Knee, finger, hip, elbow and shoulder joints can be replaced with metals, plastics or ceramics. Toes are sometimes transplanted from the feet to replace lost fingers. CARTILAGE, TENDONS, MUSCLES, LIGAMENTS -- These tissues can be transplanted from person to person. Cartilage can be grown in a lab, using the patient's own tissue, then injected back into the body. PANCREAS -- An artificial pancreas, newly approved by the F.D.A., checks diabetic patients' blood sugar, calculates how much insulin they need, and signals an implanted pump to send out the right dose. In mice, killing the cells responsible for diabetes leads the pancreas to regenerate cells that produce insulin. Researchers hope to try the same experiments in humans. HEART -- Along with transplants and artificial hearts, artificial valves replace original ones, and battery-operated pacemakers regulate the heartbeat. Ventricular assist devices help the heart pump while a patient awaits a donor heart. VOICE BOX -- Researchers at M.I.T. are working with the singer Julie Andrews, whose vocal cords were scarred by surgery. They hope to create artificial material to replace portions of vocal cord or use tissue engineering to grow new ones. SKIN -- can be transplanted from one part of the body to another. Experts have developed artificial skin that meshes with a burn victim's own skin, allowing it to regenerate. HAND -- Mechanical hands are used as prostheses, and hands have been transplanted from one person to another. BRAIN -- A pacemaker-like device can be implanted to calm tremors, and a shunt can be inserted to drain fluid in hydrocephalus. Researchers now know the brain can grow new cells, particularly in the learning and memory centers. In mice, neural stem cells have been used to replace brain cells lost to strokes or cerebral palsy. EYES -- The cornea can be transplanted, and researchers hope to make an implantable microchip to restore vision. TEETH -- Unlike sharks, we cannot regrow teeth, but implants replace lost teeth and roots. And last year, researchers implanted pigs' tooth cells near the intestines of rats. In five months, tooth crowns had formed. (Sources by Dr. Robert Langer, M.I.T.; Dr. Denise Faustman, Harvard Medical School; Dr. Alan J. Russell, University of Pittsburgh School of Engineering; Dr. James Herndon, Harvard Medical School; Dr. Todd Kuiken, Rehabilitation Institute of Chicago)


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In what has become the season of bad-behavior-followed-by-Internet-explosion-followed-by-apology/explanation, "So You Think You Can Dance" executive producer and judge Nigel Lythgoe said he had no idea a female dancer had apparently exposed her private parts on Tuesday's show.
"None of us knew she did this," Lythgoe told TMZ. "The show was always designed to expose talent, but not in this way."
It was during the Atlanta auditions for season six.
A woman who seems to only be identified right now by her audition number, 22036, was told she had danced a strong enough audition to be sent to the next rounds in Las Vegas. She jumped in the air and rolled on the ground, briefly showing what looked like a lack of underwear.
Although it's in question whether she was totally naked under there or wearing flesh-colored underwear. As FOX told Zap2it on Wednesday:"The footage in last night's 'So You Think You Can Dance' was reviewed thoroughly by the network's Broadcast Standards & Practices prior to air and it was separately confirmed with the dancer that she was wearing flesh-toned dance gear."
Either way, it looked like the real thing and it happened fast enough that the judges at the time of filming and many viewers at home missed it completely.
Lucky for all of us, the Internet was there to play leering/chiding watchdog.
This is just the latest "what were they thinking?" moment in the late summer/early fall of 2009. There was the Kanye West/Taylor Swift/Beyonce incident at the MTV Video Music Awards; the "keep f---ing that chicken" mistake by TV anchor Ernie Anastos; and the f-bomb dropped on live television during the season premiere of "Saturday Night Live," just last week.
Can't wait to see what happens next. Or at least to read about it later.
What other crazy things have happened in pop culture recently? Send me an e-mail to firstname.lastname@example.com.
Location, ST | website.com


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Bed & Breakfast Complimentary Concierge
At Alma de Sedona Bed & Breakfast Inn, we pride ourselves on providing our Complimentary Concierge Service to all our guests. We suggest that if you are coming in the high season (March though May) that you call us ahead of time to make reservations for tours and activities. It is also good to make dinner reservations at that time too.
Even parking lots at the large attractions like Slide Rock can be full before the morning is over. We will make sure that you know the best way to enjoy all the attractions of Sedona. Hiking is very popular and some of the trails are just a 10 minute walk from the Inn.
We offer links to our favorite tours, restaurants and activities here on our website. That way you can take your time and browse through the suggestions and make decisions on which of these you would like to do. We never recommend a tour if we have not personally been on that tour and enjoyed it thoroughly.
If you want to participate in outdoor activities or just relax, be sure to check out our 'Adventures' page, we list the best and closest 'Parks and Monuments', the ghost town of 'Jerome', the 'South Rim of Grand Canyon', 'Wineries', 'Golfing' and 'Horse Back Riding' too.
Some of the tour companies offer tubing on the Verde River and then go wine tasting, or the famous 'Saddle and Paddle' where you take a horseback ride and go kayaking. How about a helicopter ride, bi-plane ride or balloon ride to see Grand Canyon? We know the best tour operators, restaurants, shopping and relaxing activities in Sedona. Don't hesitate to take advantage of our Complimentary Concierge Service at Alma de Sedona.
Call us at 928-282-2737 or toll free 1-800-923-2282 and we will be happy to help you plan your activities while stay with us. We are here to pamper you.


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This deal has ended.
Buy any Keurig K-Cup or Vue Brewer and get two 24-count boxes of K-Cup packs with code MAKEITEASY at Green Mountain Coffee Plus, you'll get free shipping and the first 700 customers get a free Mother's Day mug automatically during checkout. Add any Keurig Brewer and any 2 24-count boxes of K-Cups to your cart to get the discount. The 2 boxes of K-Cups and free shipping would regularly add around $50. Sales tax is not charged in most states.No longer available


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Thu 24 Jan 2008
Snoop knows whats up
Posted by theamericangreen under Uncategorized
No Comments
Talking Points Memo has an interesting Must Read segment today. Check it out. This is a picture of the guy that we have been following recently, the man who gave Arnold the green cape and let him run with it.
So, we at the American Green have been watching some the Wire again, getting excited for season 5 of the best show on TV. And there's this scene, during season three, where Tommy the plucky young councilman (who has his eyes set on the mayors chair) goes to the mayor to talk about the rash of state witnesses that are being offed while under police protection. They mayor says that he's on it! That hes going to make some changes 'round here. And that he is glad that Tommy didn't do anything him self, bringing it to his attention first. And Tommy goes away believing good things have happened.
Well, it turns out that the Mayor isn't actually going to change a single thing. He doesn't have the money. Blah Blah. But the point that we are trying to make here is that the EPA really seems to be mirroring this thing straight up. They are saying that California should chill out, cause the EPA knows there is a problem. They are saying that, don't worry, we are all over this, and soon your going to be seeing big movement on this issue. But at the end of the day, they just keep giving these vague smoke-screen statements on the environment being important. We know that politics is a big game of media manipulation, so we call for a young Tommy in the administration to get fed up and go to the press. Call them out for their complete lack of action. It really feels like the Bush administration is going to keep on pretending that if they don't look, then there wont be anything there. Out of sight and out of mind might actually work on this one, because they are out of here in less then a year. But at some point, why in gods name does California have to wait a year?? As Snoop would say: Shit, or get the fuck out da way.
This is a Picture of Snoop, from the Wire. So bad ass, we don't even need to have a reason to add her in here. But maybe we could send her after Mr. Johnson… hmmm…


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The NET5402T-OSP is a 2 channel H.264 video encoder from Pelco that can integrate a positioning system and analog cameras to make an IP surveillance video system. The NET5402T-OSP video encoder comes with PoE, open standard based architecture, SNMP support, G.711 audio encoding, an OSD on/off option, as well as NTSC/PAL video standards, and dual stream video to 4CIF @ 30/25 images per second. The NET5402T-OSP video encoder also features a gray metallic finish, 1/2/4 channel modes, a 64kbps audio bit rate, integrated Pelco D PTZ and Coaxitron protocol support, plus analytic alarm triggers, a sheet metal construction, and Linux operating system. This encoder is able to provide easy use in many areas, and can be installed without any complications.
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View the original article at: http://www.countryweekly.com/news/rachel-farleys-early-start
Singer/songwriter Rachel Farley is off to an early start on her musical career, landing her debut single, "Ain't Easy," on the country charts at the tender age of 17. If you do the math, she started getting ready for this moment when she was incredibly young—just 11, to be precise.
"I picked up a guitar when i was 11," recalls Rachel. "My brother had actually picked it up before me and I wasn't allowed to touch it because I was musically inclined. My parents were like, 'If you pick it up before him he's gonna get frustrated. Just lay low.' I was like, 'Alright, alright. I won't touch it.' So I didn't."
But it didn't take long for her turn to arrive, and she made the most of it. "It took him maybe three weeks of just getting frustrated because he didn't want to tune it," says Rachel with a laugh. "It was too much work. So he was like, 'I don't want to play this thing!' So I took over his lessons."
Seems like that arrangement worked out pretty well, considering Rachel has already shared stages with Brantley Gilbert and Jason Aldean. Her debut album, which she is recording with Jason's producer Michael Knox, is due this summer.
Read more about Rachel in the April 8 issue of Country Weekly, on stands now.
[1] http://www.countryweekly.com/news/miranda-lamberts-boo-boo
[2] http://www.countryweekly.com/news/its-no-typo-eric-church-play-lollapalooza