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The Effingham County Board of Education allows full-time employees to enroll their children in certain Effingham County Schools outside of the normal school attendance area under certain provisions.
A. FULL-TIME EMPLOYEE - an employee who is employed by the Effingham County Board of Education for more than half-time.
B. RESIDENT EMPLOYEE - an employee of the Effingham County Board of Education who resides within the geographical and political boundaries of Effingham County.
C. NONRESIDENT EMPLOYEE - an employee of the Effingham County Board of Education who resides outside of the geographical and political boundaries of Effingham County.
An employee who wishes to enroll his/her child in a school outside the school attendance area in which he/she resides must complete an "Employee's Student" form. This must be done at the end of each school year. New employees may complete the form upon board approval of employment. These forms are available from the school secretary. The form must be completed and submitted to the office of the Assistant Superintendent for Administrative Services by the designated deadline. Available space, appropriate grade level, reason for request, and other pertinent factors shall be considered prior to a school being assigned. The board office will notify employees of approval or denial of their requests.
the family's residency changes to comply with the student's school attendance choice
the employee is reassigned and moves a child's enrollment in conjunction with the employment transfer
the student attended the feeder middle school in that high school's district and customarily proceeds with classmates from middle to high school;
bona fide hardship cases, approved in advance through the GHSA and the Board of Education's standing Hardship Committee
A non-resident employee shall not be required to pay out-of-county tuition and shall follow the same application procedure as resident employees.
A non-resident employee's child must be enrolled in the school where the employee is assigned if the child's grade level is housed in that school.
If the nonresident employee's child is not at the grade level housed in the school where said employee is assigned, then the child may be enrolled in another Effingham County school which houses that child's grade level.
Nonresident employees who intend to enroll their child in an Effingham County School shall notify the school principal of such intentions.
All school principals shall maintain a list of all nonresident employee's children who are enrolled in their respective schools.
All non-resident employee's children, who are enrolled in the Effingham County School System shall be treated as a resident students except that the Effingham County Board of Education shall be under no obligation to provide transportation for said students. All non-resident employee's children shall otherwise be subject to all laws, policies, rules, regulations, and procedures of the Effingham County Board of Education, the Georgia State Board of Education, and the State of Georgia.
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Recently, I biked around my mostly pancake-flat Cedar Mill neighborhood, counting stop signs. It was a gorgeous day, but all I could think about was were those red signs everywhere, shouting: STOP.
There are 600 houses in my neighborhood, which is designed around a school, a church and a park. The whole point is to encourage walking and biking. But I counted at least 50 stop signs.
That is, not quite one stop sign for every 10 houses. No question that this squadron in red does make our neighborhood feel safer. Even drivers who do not come to a full stop do at least pay their respects to the law, with a gingerly salute of their brakes. But does it really make sense to require bikers to come to a full stop at our neighborhood stop signs, too?
Under Oregon law, bikes are supposed to stop. But, practically speaking, most bikers do not, shall we say, ride in tandem with that law. House Bill 2690, supported by the Bicycle Transportation Alliance, would bring biking practice and principle into sync, permitting Oregon bikers to follow Idaho's lead. In Idaho, for more than 25 years, bikers have been able to treat stop signs, functionally, as most Oregon bikers already treat them -- as yield signs.
The typical biker does not stop at stop signs for two simple reasons: First, the constant interruption of momentum required in physically stopping and starting a bike is more taxing and debilitating than you might imagine. (For statistics on this, read Jeff Mapes' great new book, "Pedaling Revolution.")
Second, there is no need to stop. Freed from the carapace of a car, bikers can see with their own eyes, and hear with their own ears, that no cars are coming.
Stop signs have mushroomed all over neighborhood streets to calm traffic, but they were never intended to calm bicycles. Bikes are calm to begin with. As the Bicycle Transportation Alliance's Karl Rohde puts it:
Around 60 percent of the public are interested in cycling, but have concerns for their safety and convenience. They would prefer to ride on low-volume, low-speed residential streets; however, in the interest of traffic calming, those streets are often loaded with stop signs to discourage automobiles from cutting through neighborhoods.
So the citizen choosing to bike to his or her destination is faced with a difficult choice: Do I take the neighborhood street with all its stops and starts or do I move over to the high volume street where I can travel at a faster pace amongst all that traffic? Or, worse, do I accept that in order to get to my destination safely and conveniently, I'm just going to have to be an outlaw.
Judging from the uniformly negative reaction I've gotten in testing the BTA idea on a few colleagues and friends in the past few days (including one husband), this legislation is probably not going anywhere. It just strikes too many people, at least at first hearing, as counterintuitive, vaguely worrisome and unnecessary. And, as one state transportation official said Monday, it also sends a mixed message.
At a time when bicycling proponents are mainly promoting the idea that they share the road, and ought to be treated as part of the transportation fabric, this legislation singles them out. (Of course, they may actually deserve to be singled out. That state official himself admitted that he himself treats stop signs as yield signs, when he is biking. "Please! I don't stop," he said. "You kind of slow down and look both ways.")
But, in any case, superficially, the legislation provides ammunition for the somewhat trumped-up "bikers vs. drivers" debate. It's telling that, six years ago, when similar legislation was proposed, conservative yakker Lars Larson was one of the people who led the opposition to it.
And yet the hard evidence is on the Bicycle Transportation Alliance's side. An analyis conducted by a University of California, Davis, researcher found no indication that Idaho-style stops increase traffic dangers. The researcher analyzed years of traffic data from two college towns with lots of bikers, Boise vs. Sacramento.
The Oregon bikers who do obey stop signs, exactly as cars do, tend to be those who are trying to make a political point. They're trying to be fastidious, to counteract the very real damage done by bikers who flamboyantly flout the rules of the road, and thereby alienate drivers and other riders.
Yet the reality is more complicated. The reality is that bikes and cars are very different creatures. The BTA-backed legislation would move the state toward honoring that difference.
It would also create a much more fluid fit between biking law and biking reality.

subset: commoncrawl


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LDPM: Livestock, Dairy, and Poultry Outlook /
Long-Term Growth in U.S. Cheese Consumption May Slow
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Outlook No. (LDPM-193-01) 19 pp, August 2010
Cheese production and markets have emerged as important elements of the dairy industry over the past three decades. Supply-and-use analysis shows an upward trend in total cheese consumption over the past three decades. Nielsen 2005 retail Homescan data were used to analyze cheese consumption by location as well as by income, age, and racial/ethnic groups. Own-price and expenditure demand elasticities were also calculated using the Nielsen data. To the extent that increases in consumers' food expenditure translate into more cheese purchases, it is expected that total cheese consumption will continue to rise. However, changes in the demographic profile of the U.S. population may somewhat slow future growth.
Keywords: Cheese, cheese consumption, Nielsen retail Homescan data, elasticities of demand, per capita use, socioeconomic characteristics
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Last updated: Sunday, May 27, 2012
For more information contact: Christopher G. Davis, Donald Blayney, Diansheng Dong, Stela Stefanova, and Ashley Johnson


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* Personal: Age 17; son of Johnny and Praxedes Victoria Casinas, of Kahului; enjoys reading, relaxing, drawing, anime, music, Pokemon games and learning new things.
* At School: National Honor Society secretary, Japanese Club, Math League, Inspiring New Knowledge tutoring, Honor Roll, Advance Placement classes, Counselor Center assistant, Advance Via Individual Determination Program.
* Off Campus: Assemblies of the First Born Maui Mission Youth vice president, National Society of High School Scholars.
Article Photos
Jethro Casinas
* Beyond High School: Plans to attend a four-year university and major in pre-physical therapy. After college, he plans to return to Maui and use what he's learned to benefit the community.
* Who is your personal hero and why?
"My heroes are none other than my supportive parents. They have taught me many valuable lessons and have always been my inspiration. Their humbleness, diligence and the sacrifices they have made have shaped who I am today. They have experienced the ups and downs of life and always found a way to overcome the hardships they faced. They have supported the decisions I have made in my life. I have learned the meaning of perseverance and persistence from them. I truly appreciate their love and support."
Fact Box
The students in this weekly feature are selected by officials at their respective high schools. "Student Spotlight" recognizes students of good character who are involved in school or community activities such as athletics, clubs, student government and volunteer work.


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Tickets are going fast for our special production of Shakespeare's Twelfth Night, taking place 2/20-3/2 at Intersection for the Arts. Michelle Hensley directs an all-female cast on a journey through love, laughter, and lunacy. Pictured here, clockwise from top left, are Rami Margron (Orsino/Maria), Cindy Im (Viola/Sebastian), Maria Candelaria (Olivia), and Nancy Carlin (Malvolio/Valentine). Learn about the rest of the cast and creative company and get tickets at http://www.calshakes.org.More
2014 Season Prep


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"The view from up here is great," Johnson said, as he looks out of dorm window.
"I feel like 'I'm moving on up' like The Jeffersons," he says jokingly.
Johnson, a senior accounting major from New Orleans, is just one of 500 students settling in to living spaces in ASU's two newest residence halls, which opened this week.
Tywanda Morgan, a sophomore from Lanett, Ala., was very impressed when she moved in.
"I really think the new dorms are nice," she said. "I lived in CJ Dunn Tower last year and this is much better."
Each dorm has suite-style rooms, key cards (similar to hotel keys), computer labs, group study rooms, common areas, laundry facilities and they are co-ed.
Johnson said that's what most students like about the new dorms.
"I think students look forward to having that freedom," he said. "We can invite our friends over to socialize and study."
The $15 million, 160,000-square-foot new development is providing more than aesthetic value; the structures' location was crucial in following ASU's 2020 Transformation Plan to make the university a pedestrian friendly campus. Each building provides students easy access to academic buildings, the student center, the Acadome and in the near future, the new football stadium, which is going in across the street.
"Yea now I can sit back on my couch and make sure we stay on schedule with the new stadium," Johnson says jokingly. "But this is great for the university. "I think the students will enjoy it, and it will attract more students."


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Home > Business Management > Accounting and Finance > Time Recording & Expense Management case studies
Time recording and expense management is the process by which a business manages its records and pays its employees' pay and other work-related expenses. There is a range of new and innovative software currently available that can make your business's time recording and expense management much less time-consuming.
IThound.com has a list of white papers and case studies on best practice methods for improving your organization's time recording and expense management as well as a number of product specs on the latest pieces of software on the market.
Sort by: Date | Rating
Company: Quocirca
In a study of 400 individuals, 65% of claimants and 43.5% of processors found existing expenses systems too time-consuming. Expenses are complex, and this can have knock-on effects for employees, organisations and HMRC. Read this study for an insight into what issues claimants and processors face. VIEW SUMMARY
Category: Financial Consolidation and Performance Reporting | Published: July 2013 | Type: White Paper
Company: Keyedin solutions
Recording time and expenses can be a complex and time consuming activity. Manage your time much more efficiently by simplifying and integrating time and expenses with your project suite. You'll cut costs, drive up revenue and greatly increase your effectiveness. VIEW SUMMARY
Category: Time Recording & Expense Management | Published: August 2012 | Type: White Paper
Rating: + 1
Company: Quocirca
This paper looks at how you can create an open and clear means of dealing with expenses in higher education establishments VIEW SUMMARY
Category: Time Recording & Expense Management | Published: March 2012 | Type: White Paper
Company: Quocirca
Managing expenses in the legal sector is fraught with issues. One of the main headaches is the allocation of expenses to the right client while maximising the amount that can fairly be claimed from each client. Another is ensuring that the expenses can be reported in a granular and auditable manner. VIEW SUMMARY
Category: Time Recording & Expense Management | Published: February 2012 | Type: White Paper
Company: IBM United Kingdom Limited
Given the rapid growth in the number of virtual machines being deployed, it's no surprise that scalability, performance, and the overall volume of storage capacity have been identified as key challenges. VIEW SUMMARY
Category: Virtualisation | Published: November 2011 | Type: White Paper
Rating: + 6
Company: SDL Tridion
With the increasing number of channels by which a company can interact with its customers, employees may be tempted to bypass the IT department, with its associated delays and restrictions.All of this spells danger for the corporate IT and for the standing and morale of the IT department itself. VIEW SUMMARY
Category: Web Content Management | Published: May 2011 | Type: White Paper
Rating: + 4
Company: Access UK Ltd
This paper explores how today's integrated solutions can help you better manage key areas of your organisation. Includes checklists to help you identify the functions of your ideal system VIEW SUMMARY
Category: Human Resource Management | Published: December 2010 | Type: White Paper
Rating: + 6
Company: Access UK Ltd
As you might have discovered, the time inevitably comes when your existing business and accounting software lacks the functionality your organisation needs for business growth. Implementing a new system to manage your specific needs can be a daunting task but this paper provides a good overview VIEW SUMMARY
Category: Enterprise Accounting Software | Published: November 2010 | Type: White Paper
Rating: + 3
Company: Access UK Ltd
The Access FocalPoint application for iPhone provides a web-based free tool to maintain productivity and timely accurate client billing to include; expenses, timesheets and reports VIEW SUMMARY
Category: Project Accounting | Published: September 2009 | Type: Demo
Rating: + 1
Company: Access UK Ltd
This directors' guide highlights the traditional operational challenges associated with 7 key business areas, followed by a brief discussion of how web-enabled software addresses these issues VIEW SUMMARY
Category: Web Applications Software | Published: September 2009 | Type: White Paper
Rating: + 1
As a member you receive free access to our constantly updated library of white papers, analyst reports, case studies, web seminars and solution reports.
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© Incisive Business Media (IP) Limited 2016, Published by Incisive Business Media Limited, Haymarket House, 28-29 Haymarket, London SW1Y 4RX, are companies registered in England and Wales with company registration numbers 9177174 & 9178013.
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LIPA should not be privatized – how should its problems be corrected?
Posted on December 14, 2012 by lipaoversight
About lipaoversightLIPA Oversight Committee was created to analyze the rates and practices to determine if it is working in the best interests of the Suffolk County ratepayers
This entry was posted in long island power authority, municipal power, municipalization, municpal, national grid, privatization, servco and tagged lipa, long island power authority oversight committee, national grid. Bookmark the permalink.


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Pitcairn gas leak prompts some evacuationsUPDATED 12:35 PM EST Feb 13, 2014
Gas crews responded to the report on 2nd Street in Pitcairn.Video Transcript
I-70. A CAR COLLIDED WAY TRACTOR TRAILER. THE DRIVER OF THAT CAR WAS TRAPPED. FORCING EVACUATIONS IN PITCAIRN. VIDEO BACK FROM THE SCENE ON 2nd STREET. PEOPLE'S GAS CREWS WERE TRYING TO LOCATE THE SOURCE OF THE
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The title of the journal refers to the ears of corn that are plucked to rub in the hands before the grains can be eaten (Deut. 23:25).
Melilah was founded by Edward Robertson and Meir Wallenstein in 1944; the original series is now available online. The journal was relaunched as a New Series by Bernard Jackson and Ephraim Nissan in 2004 under the auspices of the Centre for Jewish Studies, University of Manchester. The current editors are Daniel Langton and Renate Smithuis, with assistant editor Simon Mayers.
If you wish to be informed when a new volume of Melilah appears, please subscribe (for free) for an email announcement.
There are known problems with Norton Safe Search and this website, as for many others; please follow the instructions here if you wish to disable it safely.


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You can enter the nursing profession by selecting from a variety of
accredited nursing education programs designed to meet the diverse needs
of both traditional and non-traditional students. All programs prepare
students for the licensing examination and are readily available at
schools throughout the Philadelphia region and nation. These programs
Well Ahead Newsletter
Main Line Health
Copyright 2016 Main Line Health
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The information provided in this Web site is for informational purposes only. It is not a substitute for medical advice. All medical information presented should be discussed with your healthcare professional. See additional Terms of Use at www.mainlinehealth.org/terms.
For more information, call 1.866.CALL.MLH.


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erm...sign up for the Ajarn.com jobs board?
I was about to post the link to UN ESCAP:
The United Nations (ESCAP) seeks qualified applicants for building a roster of Language Teachers in Arabic, Chinese, English, French, Russian, and Spanish... but then I noticed the sticky on top of the staffroom stating that we're not to post any job ads... so what to do with this opportunity?
this be the link: http://www.unescap.org/jobs/pdf/VA_l...ers-ROSTER.pdf
The United Nations (ESCAP) seeks qualified applicants for building a roster of
Language Teachers
Arabic, Chinese, English, French, Russian, and Spanish
The Language Training Programme runs three terms per year. As and when necessary, part-time teachers are sought for 30-35 weeks per year, up to 10 hours per week, in Bangkok (Special Service Agreement, SSA).
Candidates will only be contacted when a vacancy arises. CVs of potential candidates will be stored in our roster. Successful candidates are to teach classes in the respective language at all levels to UN staff members, and will be involved in the design and evaluation of end-of-trimester examinations.
Minimum experience and qualifications:
native speaker of the language taught, fluent in English,
University degree and teaching certificate,
at least three years of experience in teaching the language as a foreign language,
excellent interpersonal and communication skills,
respect of the core values and competencies of the United Nations, including integrity, professionalism and respect for diversity.
Qualified candidates, who are presently residing in Thailand or planning to move to Thailand, are invited to submit their application, including their C.V. and reference details, by email to email@example.com. Alternatively, applications may be mailed to Staff Development and Training Unit, UNESCAP, United Nations Building, 14th floor, Block A, Rajadamnern Nok Avenue, Bangkok 10200
erm...sign up for the Ajarn.com jobs board?
LDMA - Ajarn Forum Admin
Don't get me wrong - I don't want a 'serious' board but I'd like posts to be either genuinely amusing, informative and/ or thought provoking.
Ian McNamara - July 2000
A clash with the management will not serve the purpose of your inner peace and therefore will deprive you from happiness. Thai Language School DOS, 2009
Only the bad person say the bad thing about the good thing.
Anon. Thai DOS
erm... me? You gotta be kidding...
I actually applied to this particular job 6 months ago and got not response.Originally Posted by discus2000
Maybe I should shoot them another resume??.......
hmm.... I wonder why?Originally Posted by traveler2
Now there's an ideaOriginally Posted by traveler2
You bastard!Originally Posted by bet
Still your cocky self!
What are you up to these days?
send it 5 times Trav!!!
We are buried beneath the weight of information, which is being confused with knowledge; quantity is being confused with abundance and wealth with happiness.
~ Tom Waits
Yet another couple of opportunities @ ESCAP... not teachers this time, though
Originally Posted by UN JobsEconomic Affairs Officer, P-4
DEADLINE FOR APPLICATIONS: 28 Oct 2007
DATE OF ISSUANCE: 29 Aug 2007
ORGANIZATIONAL UNIT: Economic and Social Commission for Asia and the Pacific
DUTY STATION: Bangkok
Depending on professional background, experience and family situation, a competitive compensation and benefits package is offered.
More Info
United Nations Core Values: Integrity, Professionalism, Respect for Diversity
Under the direct supervision of the Chief, Sustainable Development and Water Resources Section, and the overall supervision of the Chief, Environment and Sustainable Development Division (ESDD), the duties of the incumbent include: (1) analyze and identify policy options which could promote water resource management in the context of pursuing Green Growth of the Asia-Pacific region, (2) monitor economic developments in water resources sector and disaster management and identify recurrent and emerging issues of concern to the United Nations in Asia and the Pacific, (3) design and conduct research/studies and organize training activities on mitigation of loss of lives and damages to property due to typhoons, floods, droughts and other water-related disasters for the fulfillment of the Millennium Development Goals, (4) undertake studies including interpretation of related studies to analyze development prospects and policies on water-related disaster risk management and integrated water resources management, including water supply and sanitation, (5) develop draft policy recommendations pertaining to area of work, (6) design and monitor technical cooperation projects as well as formulate proposals for development strategies, policies and measures for presentation to intergovernmental bodies and others; (7) attend international, regional and national meetings to hold discussions with representatives of other institutions, (8) organize expert group meetings, seminars, etc on water-related disaster risk management and integrated water resources management, including provision of substantive support to the Typhoon Committee and the Panel on Tropical Cyclones, (9) prepare speeches and other inputs for presentations by senior staff, and (10) support less senior staff, reviewing their work and providing feedback.
Communications – good interpersonal skills, proven ability to write in a clear and concise manner and to communicate orally effectively; Professionalism – in-depth understanding of integrated water resources management principles and concept, especially those related to integration of water-related disaster risk management into socio-economic development process with proven ability to produce reports on these subjects, including some own-name publications; Leadership – creativity, vision and innovation with skill in overseeing work of less senior staff and external consultants undertaking report-writing or technical cooperation activities; Planning and organizing – proven ability to plan and organize own work and that of others; Technology awareness – proficiency in computer application including internet, word processing, spreadsheet packages and other software on lectures and presentations; Teamwork – ability to establish and maintain effective working relations with people of different national and cultural backgrounds with respect for diversity; Gender mainstreaming – ability to take responsibility for incorporating gender perspectives into the substantive work; Client orientation – ability to establish and maintain effective relationships with colleagues, other staff and outside collaborators. Leadership - Creativity, vision and innovation; skill in overseeing work of less senior staff and external consultants undertaking report-writing or technical cooperation activities.
more here
Chief, Energy Resources Section, P-5
DEADLINE FOR APPLICATIONS: 17 Dec 2007
DATE OF ISSUANCE: 18 Oct 2007
ORGANIZATIONAL UNIT: Economic and Social Commission for Asia and the Pacific
DUTY STATION: Bangkok
Staff members of the United Nations Secretariat must fulfill the lateral move requirements to be eligible to apply for this vacancy. Staff members are requested to indicate all qualifying lateral moves in their Personal History Profile (PHP) and cover note.
Depending on professional background, experience and family situation, a competitive compensation and benefits package is offered.
More Info
United Nations Core Values: Integrity, Professionalism, Respect for Diversity
The Chief of Energy Resources Section reports to the Chief of Environment and Sustainable Development Division. The incumbent will be responsible for the following. •Provides policy advice to the Chief of Division, on conceptual strategy development and management of the implementation of overall strategies, and policies and procedures. •Plans and oversees the management of the work programme and activities undertaken by the Section; ensures that substantive work programmes and programmed activities are carried out timely, coordinates diverse projects in the Section/Division, and, in liaison with other organizations of the United Nations System, donors and agencies. Provides programmatic and substantive reviews of drafts prepared by others, ensuring that the outputs maintain high-quality standards and comply with the relevant mandates. •Provides substantive input in the preparation of position papers and reports for presentation to intergovernmental bodies such as the Committee on Managing Globalization, the Commission session and other policy-making organs, as appropriate. •Carries out programmatic/administrative tasks necessary for the functioning of the Section, including preparation of budgets, assigning and monitoring of performance parameters and critical indicators, reporting on budget/programme performance, preparation of inputs for results-based budgeting, evaluation of staff performance (PAS), interviews of candidates for job openings and evaluation of candidates, taking due account of geographical and gender balance and institutional values. •Represents the Organization at inter-agency meetings, seminars, etc. on substantive-related issues, participates in international, regional or national meetings and provides programmatic/substantive expertise on an issue, or hold programmatic/substantive and organizational discussions with representatives of other institutions. •To carry out special assignments as requested on a ad hoc basis.
•Professionalism: Proven knowledge of the energy sector planning, development and management in general with a focus on integrating economic, environment and social dimensions in the energy sector through sustainable energy policy for enhancing energy security, access to energy services, promotion of renewable energy development, energy efficiency/conservation and energy/climate change policy integration. Takes responsibility for incorporating gender perspectives and ensuring the equal participation of women and men in all areas of work. •Communication: Speaks and writes clearly and effectively; exhibits interest in having two-way communication; demonstrates openness in sharing information and keeping people informed. •Teamwork: Works collaboratively with colleagues to achieve organizational goals; solicits inputs by genuinely valuing others' ideas and expertise. •Creativity: Actively seeks to improve programmes or services; offers new and different options to solve problems; promotes and persuades others to consider new ideas; takes calculated risks on new and unusual ideas; thinks "outside the box"; takes an interest in new ideas; is not bound by current thinking or traditional approaches. •Leadership: is proactive in developing strategies to accomplish objectives; establishes and maintains relationships with a broad range of people to understand needs and gain support; anticipates and resolves conflicts by pursuing mutually agreeable solutions; actively supports the development and career aspirations of staff; appraises performance fairly. •Judgement/Decision-making: Identifies the key issues in a complex situation; proposes a course of action or make recommendations based on available information, including proposals for future orientation of work programme and activities.
more here
and then one @ UNEP
Deputy Regional Director, P-5
DEADLINE FOR APPLICATIONS: 07 Dec 2007
DATE OF ISSUANCE: 08 Oct 2007
ORGANIZATIONAL UNIT: United Nations Environment Programme
DUTY STATION: Bangkok
Depending on professional background, experience and family situation, a competitive compensation and benefits package is offered.
More Info
United Nations Core Values: Integrity, Professionalism, Respect for Diversity
The United Nations Environment Programme (UNEP) is the United Nations system's designated entity for addressing environmental issues at the global and regional level. Its mandate is to coordinate the development of environmental policy consensus by keeping the global environment under review and bringing emerging issues to the attention of governments and the international community for action. UNEP's Division of Regional Cooperation (DRC) helps to implement UNEP's global programmes in the regions by initiating, coordinating and catalyzing regional and sub-regional cooperation and action in response to environmental problems and emergencies. The division coordinates the work of six regional offices, which bring regional perspectives to the development of UNEP policies and programmes and present and enlist support for UNEP's global policies in the regions. The Regional Office for Asia and the Pacific (ROAP)is located in Bangkok. Under the overall guidance and supervision of the Regional Director and in accordance with the priorities of UNEP Headquarters, the incumbent will be responsible for the following: 1. Policy Making: Assist the Regional Director in maintaining a close working relationship and coherent coordination with environment ministries and agencies in the region, regional and subregional environmental financial institutions, and intergovernmental bodies by: a) Undertaking consultative missions and meeting with partners to determine their needs, identify areas of cooperation and support, and inform them about UNEP's priorities and programmes; b) Providing technical advice and guidance that will enable UNEP focal points and partners define priority action programmes and projects which address critical environmental problems in the region; c) Following up strategic policies of UNEP regarding resource mobilization, in harmony with Headquarters priorities, so as to maintain a secure funding base for the organization. 2. Support to Subregional Organization Secretariats: a) Support Subregional Forums and their Secretariats for Central Asia, Southeast Asia, South Asia, Northeast Asia and the Pacific; b) Support technical Committees of the subregional forums; c) Follow up of the decisions of the Forum, particularly of the Subregional Environmental Policy Dialogue. 3. Intelligence Gathering: Undertake regional environmental intelligence gathering on behalf of UNEP Headquarters and service the information needs of the Executive Director, through the appropriate channels, by: a) Collecting and analyzing information on regional environmental matters (especially emerging issues) and politico-economic data on the region; b) Coordinating the development of up-to-date thematic and country files on the region; c) Broadening the base of and diversifying sources of information on matters of relevance to UNEP (Governments, NGOs, Internet, Universities, Media, etc): d) Supervising information packaging and communicating data clearly and concisely to UNEP Headquarters through the Regional Director; e) Ensuring a two-way communication flow with UNEP Headquarters. 4. Focal Responsibility for Substantive Activities: Assist the Regional Director in further evaluating the environmental needs in the region and promoting regional and subregional cooperation on substantive activities by: a) Analyzing progress in environmental protection as the basis of sustainable development in the region; b) Providing advice to the Regional Director and upper management at UNEP Headquarters regarding policy options and programme activities; c) Providing technical guidance and substantive input to partners in order to enhance the level of cooperation on regional and subregional environmental matters; d) Fostering, when necessary, the formation of new subregional environmental regimes and assisting in negotiations for their establishment. 5. Focal Responsibility for Inputs to UNEP's Programme in the One UN pilots under the Delivering as One Framework: Assist the Regional Director in the One UN pilots by: a) Representing UNEP within the UN Country Team (UNCT) to ensure that environment is incorporated in the work of the UNCT and in the initiatives under the One UN, especially during the common country programming process;b) Identifying opportunities for joint programmes in the country and channeling UNEP's inputs into the UN common country programming process; c) Drafting and keeping updated a UNEP-wide country programme document in collaboration with all UNEP units with national activities and use the process to promote synergies, avoid duplication, and ensure a coordinated delivery of UNEP's activities in the One UN pilots; d) Providing joint programming and planning support by: chairing e.g. forums such as UNDAF Thematic Groups on Environment; coordinating the establishment and execution of joint programmes; producing annual evaluations on UNDAF outcomes; and assisting in enhancing interagency cooperation and coordination; and e) Providing policy dialogue support by: producing policy briefs and updates; providing inputs for preparation of the RC Annual Report, MDC progress reports and other common analytical documents for the UN system; facilitating coordination activities at the technical level; representing the UNCT as necessary in policy dialogue with Government and development partners. 6. Management of Administrative Operations: Oversee the daily administrative functioning of operations in the Regional Office by: a) Assisting the Regional Director in the preparation and implementation of the Regional Office work programme; b) Ensuring the timely submission of project proposals and work plans, as well as of progress and evaluation reports to UNEP Headquarters; c) Managing the administrative functions of the Office and apportioning specific work and assignments to subordinates, including consultants; d) Serving as the designated security coordinator under the UN security plan in the duty station. 7. Coordination of Image Building/Public Information: Assist the Regional Director in enhancing UNEP's visibility and raising public awareness of environmental issues in the region. 8. Deputizing: a) Act as Officer-in-Charge in the absence of the Regional Director and represent him/her at meetings, when required. b) Undertake ad hoc assignments to support the functions of the Regional Office.
Creativity - ability to actively seek to enhance the programmes of UNEP in the region, offer new and different options to solve problems/meet client needs and promote and persuade others to consider new ideas. Communication - effective spoken and written communication, good presentation skills including ability to defend and explain difficult issues with respect to key decisions and positions to staff, senior officials and members of inter-governmental bodies. Planning and organising - proven ability to plan and organise work, requiring an in-depth understanding of its strategic direction and ability to integrate the work of the office into the Division's work programme. Leadership - strong managerial/leadership skills. Proven record of building and managing teams and creating an enabling environment.
more here
see, I have faith in you
just clicked in, an I thought I had joined jobcenter.com
The information contained in this message is likely to be confidential
and may be legally privileged. The dissemination, distribution, copying
or disclosure of this message, or its contents, is strictly prohibited.
Please consider the environment before printing this message
I've volunteered
Any idea on what they pay over there?
^why don't you click on the link provided... you know, the one just beneath "Remuneration" that says More Info
^ that'd be too easy.


text:
On Wed, 12 Jul 2006 11:14:44 -0700, yozhang wrote:
> Can semaphore be used with SMP? [...]
> I have learned that spin_lock is faster, and used in ISR, but thread
> that owns it can not sleep; semaphore is slow and can not used in ISR,
> but can sleep.
That description is roughly correct, but entirely orthogonal to
the issues of SMP. Both spinlocks and mutexes (which replace
semaphores) can be used for the purposes of SMP synchronization.
-- Pete


text:
Home > Browse by Tag case studies
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Company: Snow Software
Mobile is the new workplace: today's users regularly access data and consume software on multiple devices, from wherever they are. Organisations have had to respond to user expectations of being able to instantly consume data and make it available to them. Download to find out about an integrated VIEW SUMMARY
Category: Mobile | Published: November 2015 | Type: White Paper
Rating: + 1
Company: Sage
Mobile devices are used more nowadays by consumers than ever before, and they're relied more and more upon in business. Mobility in the workspace, therefore, becomes a vital factor in giving employees the tools they need to be as effective as possible. This paper draws upon the importance of VIEW SUMMARY
Category: Technology | Published: November 2015 | Type: White Paper
Company: Claranet
Demand for faster and more flexible IT is only getting higher; but IT teams struggle to commit time to important and strategic projects because of the overhead of low-level infrastructure management. Benefit from a proven hosting approach and deliver the business outcomes you need. Download to find VIEW SUMMARY
Category: Networks & Communications | Published: November 2015 | Type: White Paper
Company: Equinix
Interconnection integrates customers, employees and partners across geographies through direct, secure physical and virtual connections, to accelerate business performance and create new opportunities. This paper explores what you need to know in order to be successful in the emerging digital VIEW SUMMARY
Category: IT & Systems Management | Published: November 2015 | Type: White Paper
Rating: + 1
Company: Lookout Inc.
The way we protect our devices should be top-of-mind. Many big corporate breaches are coming from a number of angles; and mobile is just another one of these attack vectors. The way we approach protecting our enterprises is in for a major overhaul. Download to find out more. VIEW SUMMARY
Category: Security Solutions | Published: October 2015 | Type: White Paper
Company: DTP Group
This white paper examines the relevance, fairness and value of the cost per page service model. It also explores the advantages and disadvantages of Managed Print Service contracts and provides guidance that will help buyers negotiate and achieve best-value from their service provider. VIEW SUMMARY
Category: Print Servers | Published: June 2015 | Type: White Paper
Rating: + 2
Company: Good Technology
Implementing a BYOD program is a step towards a broader, more strategic mobility initiative, and a successful mobility deployment can have a truly transformative impact on the business. This paper brings you the top ten best practices for the successful implementation of your own BYOD program. VIEW SUMMARY
Category: Mobile Device Management | Published: June 2015 | Type: White Paper
Rating: + 2
Company: Cisco
With the "Internet of Things" (IoT) upon us, numerous industries are using IoT technology. Read to find out how IoT will introduce unprecedented growth in devices and data, and how to deal with this. More importantly, IoT introduces new cybersecurity concerns and therefore, CISOs need an IoT plan. VIEW SUMMARY
Category: Security Policies | Published: February 2015 | Type: White Paper
Company: Oracle
Mobile technology has matured as organisations look for transformative new ways to use mobility in their business strategies. Organisations need an enterprise mobility strategy to ensure that they can reap the business benefits of mobility and effectively address its many challenges. VIEW SUMMARY
Category: Mobile Working | Published: December 2014 | Type: White Paper
Rating: + 2
Company: Hewlett Packard Enterprise
The explosion of consumer devices in the last 5 years has created a paradigm shift in the way customers interact with their financial institution. Banks who adapt quickly to create a digitally integrated enterprise will reap customer loyalty and cost savings when serving digitally-savvy consumers. VIEW SUMMARY
Category: Mobile Device Management | Published: November 2014 | Type: White Paper
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text:
Got Dogecoin?
Very Much Wow | The Dogecoin Magazine covers Dogecoin technology, market presence, businesses & vendors, personalities, rants & raves, community activity, and adds a dash of humor to it all!
Shibe of the Day
Meet the members of the Dogecoin Community! We are featuring a Shibe a Day during the rest of 2014! Please answer our interview questions so that we may feature YOU!
Very Much Blog
Thoughts from the VMW Editorial team
20 November: Shibe of the Day – Vujcin77
Thanks to Shibe /u/vujcin77 for answering our interview questions and being our first Shibe of the Day! How did you first get involved with Dogecoin? 3 years ago I was mining Bitcoin. Twas' fun and all. But I needed something more. I wanted a better community. I browsed around, searching for cryptocurrency in every […]
Fall Edition Print Copies Available
Dear Readers, Print copies of our Fall edition are now available through Amazon and direct through our printer. See our VMW Issues page for ordering links and a special discount code for those buying direct! Our ePub and Kindle versions will go live this week for the Fall edition and all back issues. You may […]
The Big VMW Treasure Hunt!
Get ready to begin a world-wide search for One Million Dogecoins! We will be posting the rules and first clues this week!
The Latest WOW!
Read our latest articles
A Recipe for Crypto Success
by Crowley As the title suggests in this article, I'm going to be discussing the recipe for success in the cryptocurrency ecosystem. Follow these few easy steps and you're sure to scam people out of their money create a successful coin and get rich help humanity achieve a better future. Not all the steps are […]
Amaze So Listen: A Review of Watsky's "All You Can Do"
by Tom Boice While we are discussing the future of Dogecoin, I wanted to discuss one artist that seems to have an equally bright future, George Watsky. If you are active on /r/Dogecoin, you may recall that this Bay-area rapper tweeted that he was looking into accepting Dogecoin for payment – so that's already one […]
Watch Me Review: The Rise and Rise of Bitcoin
by Clay Michael Gillespie Let's face it: digital currency history is confusing. While big-daddy Bitcoin is calling the shots at the top, there's a plethora of events and information to explore and learn from that can help new altcoins, like Dogecoin, flourish and become successful. But how? How can we seriously trace such a complex […]
Crossword Contest!
Win a fabulous Dogecoin WOW cheese cutting board and knife set! Solve the crossword puzzle in our Fall 2014 issue and enter your answers today! All shibes who correctly solve the puzzle before December 8th will be entered into a drawing to win the prize.


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Product code: tyvek Tyvek Paint / PEST CONTROL/ Termite Control Suits
Practically anywhere in industry, Tyvek by DuPont has been hailed for years. It has served reliably as the unique material that imparts high strength, flexibility, durability, great barrier qualities and wearer comfort to protective clothing. Tyvek by DuPont improves the great protective features previous generations offered.
Superior barrier, durability and breathability leave competitive materials far behind. Superior barrier performance! Competitive materials possess poor levels of barrier durability or excessive porosity, so they offer much lower barrier protection. Tyvek delivers the best possible balance of performance you can get. Superior durability! Tyvek is built for the long run. The tough barrier qualities of Tyvek are found throughout the fabric. Superior breathability! Tyvek has been proven to bring twice the level of breathability as its ancestor. Thats the highest ever, and with no loss of barrier protection! COMES WITH ZIPPERED FRONT
|Average Customer Review: (1 Reviews)
Write an online review and share your thoughts with others.


text:
NBC's hoping to use the headwinds of tonight's "America's Got Talent" finale to give a push to two of its new sitcoms, "Up All Night" and "Free Agents."
The pair debut at 9 and 9:30 p.m. today before moving to their regular time slots two hours earlier next week.
Of the two, "Up All Night" looks stronger, though I was pleasantly surprised by "Free Agents." Not in a "Hey, I've got to watch this every week," but more in a "This wasn't nearly as awful as I thought it would be" kind of way.
"Up All Night" stars Christina Applegate and Will Arnett as two harried new parents, and while some of the jokes are fairly expected, they're delivered by two great TV comedians. Arnett's playing a far more human character than he has in a while, which is refreshing.
Applegate's character works on a daytime talk show whose host is played by Maya Rudolph, in a sense reprising her "Saturday Night Live" impersonation of Oprah, but (like Arnett) scaled down to human proportions.
What I like most about "Up All Night" is the sense that Applegate and Arnett are very much playing a couple in love. They're wholly believable in their relationship, and they're wholly believable in their love for their child -- and still frustrated by the challenges of parenting. The characters mess up, but there's not a sense that one is smarter than the other, which is a sitcom trope I'm personally tired of.
"Free Agents" also has two characters that are relatable at its center -- well, mostly. Hank Azaria and Kathryn Hahn star as a pair of PR agents who fall into bed together, though neither one is ready for a relationship. Azaria is fresh off a painful divorce and is prone to weeping at inopportune moments. Hahn's finance died a year before the series opens, and she has found it impossible to put away the many, many photos of him scattered around her apartment.
The two actors work well together, giving performances that could work well in a comedy-drama hybrid. But that's not necessarily how the show itself is structured. Based on the first episode alone, it feels more like a traditional sitcom, replete with plenty of wacky characters. I hope they tone down some.
"Free Agents" is based on a British series that I haven't seen, though it will begin airing on BBC America on Oct. 8. Making the transition with it is Anthony Stewart Head (Giles from "Buffy the Vampire Slayer") as the head of the PR firm. I'm interested to see how his character plays in the original, because as of yet, he feels wasted here.
Also debuting tonight (7 p.m. on The CW, cable channel 11) is "H8R." I didn't get a screener of it from the network, for which I am counting my lucky stars.
In "H8R," Mario Lopez tries to tackle the scourge of cyberbullying not, as one might hope, seeking out real victims of it, but by taking the side of celebrities who have had mean things said about them on the Internet.
These aren't children who have been mercilessly mocked and harrassed to the point of suicide.
These are idiots like Snooki from "Jersey Shore" and Jake Pavelka from "The Bachelor" who have chosen to go on TV and make money from exhibiting the worst of human behavior. These are idiots like Kim Kardashian who used a sex tape as an audition for fame.
And they're the ones who need protecting from people saying mean things about them on the internet? Please.
The very idea of this show is enraging,but for me, it's just an idea, because I will never, ever watch this junk. TV critic Daniel Fienberg, though, actually had to watch it. His review is a far, far more eloquent takedown than a piece of garbage like this deserves, but it's definitely worth reading.


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"Any online business that cares about their customer service and reputation should be a member of Feefo. It has made a profound impact to our operational focus, our service delivery experience and the way in which we measure our own performance internally. We use Feefo every single day, it gives us an immediate and direct insight into how our products are performing and how our customers feel about customer service. It enables us to further understand and focus on the issues that truly matter to our customers. Feefo provides us with an excellent service. We love it!"
"The Feefo system is simple to use and hugely effective, with the return on our investment easy to see, even in such a short time period. Having offered verified hotel reviews for many years, we understand the importance of being able to guarantee 100% genuine feedback as Feefo does. Our 92% Quality Score is a true testament to our continued commitment to improving the customer experience and together with Feefo we will be able to build on this further and faster in the future."
Director of Customer Experience, Expedia
"The global paid and organic search conversion uplift from the star ratings as well as the increased on page conversion from using Feefo has been fantastic. Far higher than we initially anticipated."
Managing Director, Travelzoo
"After just one month we have already seen an increase in conversion rates on the Bamford Trading website from an average of 2.5% of visits to a current 4.98% (nearly 100% up) for January. Nothing else has changed on the site and so we have to put it down to the Feefo service and the additional confidence it has given our customers."
Owner, Bamford Trading
"Having a 97% Customer satisfaction rating, coupled with the stars appearing on Google organic and pay per click searches, means we have seen an improvement in the click through rate."
Operations Manager, Best Car Buyer
"Fresh content is now being added to our website via our customers, which is fantastic, continuing to add to our overall SEO and content marketing strategy. Our Google stars are a great recognition of trust and reliability for us, increasing our PPC CTR."
Digital Marketing Manager, The Business Octopus
"Referral traffic from Feefo comes with an extremely low bounce-rate, of 16% on average. People referred by Feefo.com spend far longer on our website than from other sources."
Managing Director, Serendipity Diamonds
"We see a higher conversion rate to sales when there is a Feefo recommendation next to a product. We can see product trends and listen to customer feedback instantly, which allows us to identify where issues are and resolve them equally fast."
eCommerce Manager, Moss Bross
"Integrating the Feefo review system has been a key aspect of our growth strategy, enabling us to increase website traffic, decrease online marketing spend and give visitors to our website the confidence in our products and our service to make an informed purchase decision by looking at genuine customer reviews."
Managing Director, Modern Rugs
"Partnering with Feefo has had a direct impact on customer confidence, and helped us to manage and improve the quality of our service by responding to, and acting on, the feedback we receive. Our Feefo ratings have also helped improve click-through from paid search, and improved our on-site conversion rate too."
Managing Director, HolidayGems.co.uk


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Alicia Silverstone Asks: Got Vegan Milk?Dresden Shumaker
Earlier last week, the not so Clueless actress launched a new service on her blog to help moms in need of supplemental breast milk. According to Alicia, the program, called Kind Mama Milk Share, was inspired by a friend who – due to a breast reduction – was not able to make as much milk for her newborn son as he needed. This new mother, like Alicia, is a vegan, and she wanted to be able to still feed her baby breast milk, but vet the lifestyle choices of her milk donors.
Alicia writes about her friend, "She tried reaching out in her community for donor milk, but it was almost impossible to figure out what kind of lifestyle choices the donors had made. And after all that hard work keeping herself vibrant and healthy, she felt she had a right to demand better for her baby."
Alicia has created a sort of virtual bulletin board on her blog instructing her readers, "If you have milk to share–post it! If you are in need of milk–post it! Think of all the babies we can help raise together!"
Alicia Silverstone is one of several celebrity vegan moms, like Emily Deschanel and Mayim Bialik, who have maintained their vegan lifestyle while they nursed.
When I was pregnant with my son I had anxiety about whether or not I would be able to nurse him once he was born. As I struggled with years of infertility before he was conceived, I was worried that my body would fail me when it came time time to breastfeed him. I told myself I would try to nurse my son and seek the help of lactation consultants if necessary, but if for whatever reason, my body was not able to produce milk I would be ready with alternative plans.
This included researching formula, and yes, looking into the world of breast milk donation and milk banks. I was vaguely familiar with milk banks because I had several friends who had great supply and made regular donations to their local banks. What I didn't know was what the process was like for the recipient. Did a new mom fill out a form simply asking for milk? Or would there be choices as to what kind of milk? Would you be able to indicate a preference for milk from a mom who didn't eat cilantro?
I know Alicia has been on the receiving end of some noisy criticism regarding some of her nontraditional parenting choices. When video of her pre-chewing food for her son Bear hit the Internet there was a frenzy of finger wagging.
I'm actually on team Alicia on this vegan milk bank idea. Her blog community is a passionate one about a healthy lifestyle, and they seem to seriously want to connect and help each other. To be honest, reading the comments on her Kind Mama Milk Share post, it kind of makes me love the Internet.
What do you think about celebrities creating online communities for programs like milk shares?
More Posts by Dresden:
17 Great Fireworks Moments in Film
15 Best Tom Cruise Movies
Melissa McCarthy Changes How People See Funny Women
Must See Summer Movies of 2013
20 Best Performances by Sunglasses in Film
Follow Dresden online: Blog | Twitter | Google+ | Facebook
Image Credit: Pacific Coast News


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The number of insurance claims paid by State Farm Insurance in Colorado last year fell nearly 41 percent from 2012, dropping Colorado from the list of the top 10 states with the most claims for the first time in years, State Farm spokeswoman Angela Thorpe said Tuesday.
"Colorado has experienced severe weather resulting in thousands of claims year, after year, after year," Thorpe said.
Windsor's August hailstorm pelted cars and roofs last year and the 2008 tornado racked up $193.5 million in damage, according to the Rocky Mountain Insurance Information Association.
In 2012, State Farm had about 16,000 wind and hail claims reported by Coloradans, but in 2013 saw a sharp decrease of only about 9,500 claims, Thorpe said.
Despite the drop in the number of claims, damage caused by wind and hail cost State Farm policyholders more than $3 billion in 2013, Thorpe said.
"Whether that's due to a less challenging year for our customers in terms of the severe weather events in 2013 or that the damage didn't exceed their deductible and they didn't make a claim — one thing is for sure — over the past several years we've seen positive uptake in the number of our customers opting for impact-resistant roofing," Thorpe said.
She said between 2012 and 2013, State Farm saw a 16 percent increase in the number of customers choosing impact-resistant roofing. After the tornado in 2008, she said the company began to see more customers opting for the bolstered roofing.
"Go back a few more years during particularly severe weather in 2009 and 2010, we replaced a lot of roofs and saw a significant increase in customers opting for (impact-resistant roofing)," Thorpe said.
She said homeowners that choose the impact-resistant roofing are able to get as much as a 28 percent discount on their homeowners insurance.
"We're hopeful our customers continue opting for IRR when building a home or replacing their roof," Thorpe said. "Ultimately fewer claims can influence rates favorably for our customers by taking loss mitigation steps."


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Preferably Exchange should get two separate RAID groups, one for transaction
logs, and the other for the Exchange Information Store. I would recommend
putting these two RAID groups on disks that are not 0-4 as these drives are
the OS and cache vault for the CX300 and should be low I/O disks. You can
then create a RAID group for the File/print server. If you can afford it, I
would purchase a few more disks and fully populate the CX300.
Eric Bursley
eric at bursley dot net
wrote in message
> We are getting a CX300 SAN. We are debating the best setup. The SAN will
> be
> used for file/print and Exchange. We have ten disks. One disk is a
> spare.
> Two disks will be mirrored for the Exchange logs. Here is the debate.
> Should we use the other 7 disks as one RAID array and two different LUNs
> or
> two RAID arrays? If we do two RAID arrays Exchange would get four disks
> and
> file/print would get three. The thought process is that you'll get better
> I/O performance using 7 disks. I more concerned about performance then
> wasted storage space. Exchange and file/print are on separate servers.


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An interreligious web site
"Here we have a multifaith, multi-approach, multi-ideological site flourishing—at a time when we're supposed to be getting more fragmented, more contentious, more divided." So wrote Steve Waldman, editor-in-chief and cofounder of Beliefnet (www.belief.net) at the beginning of the year on the first anniversary of the site.
Waldman went on to tot up the site's accomplishments, list its most popular offerings, and identify its most "inspiring" members. Beliefnet published over 4,000 articles, started 17,000 different discussions which garnered more than 200,000 messages, launched almost 1,000 "prayer circles" and created nearly 1,000 "memorials." Waldman predicted that in the first month of its second year roughly a million people would visit the site, almost 10 million pages would be "viewed" and approximately 45,000 messages posted on its message boards.
This article is available to subscribers only. Please subscribe for full access—subscriptions begin at $2.95. Already have an online account? Log in now. Already a print subscriber? Create an online account for no additional cost.


text: Ape 2,048pages on this wiki Edit Classic editor History Talk0 This article is a Stub and needs your help. Please improve it by adding more information. An Ape was an animal that was biologically engineered into the Brumak.[1] See AlsoEdit Monkey ReferencesEdit ↑ Gears of War: Destroyed Beauty Retrieved from "http://gearsofwar.wikia.com/wiki/Ape?oldid=122771" Categories: Stubs Surface Animals Add category Cancel Save


text:
Unless otherwise stated, all seminars are on Fridays at 4:00pm in Studio E at NYU (35 West 4th St., 8th Floor). If you or anyone you know would like to receive notification about these events, please subscribe to our mailing list by sending a blank email to: email@example.com
Additionally, if you or anyone you know would be interested in speaking on or presenting a relevant topic, please contact Areti Andreopoulou: email@example.com
Abstract: In the last century, musical composition has been largely inspired by processes that, at first, don't seem to be related with music. These processes, from Schoenberg' serialism to Xenakis' statistics or Cage's chance music, explore new strategies of sound (or note) organisation. In the recent past, the digitalization of sound combined with the power of computers has enabled the processing of sounds at the sample level, a level of granularity below milliseconds. Technologies have also made it possible to create new interrelationships between sound and the visual modality. This talk will explore the reverse process: visually-driven strategies of composition. I will describe a commission from the National Portrait Gallery in London in which I produced a sonified portrait. The image is treated as a map of constraints for a multi layer approach. The values extracted from the still image organise the overall form of the sound and also control sound effects such as granular synthesis and frequency filtering. I will go on to present a recent piece based on the sonification of animated images. The work, which draws on the idea of music processes, investigates the similarities between films articulations and musical articulations, and whether a visual art could be transposed into music.
BIO: Jean-Baptiste Thiebaut has a MS in Computer Science from University of Toulouse II and a MA in Composition from the University of Paris VIII. He is actually doing a PhD in Computer Science at Queen Mary University of London, on the topic of music visualisation and representation. He has been collaborating with the Groupe de Recherches Musicale (GRM) and the Centre de recherches Informatique et Creation Musicale in Paris. His past research focused on the representation of sound in space. He also composes electroacoustic and instrumental music and does live performance with a laptop within the band pplato. Recent artistic works have been exhibited at the National Portrait Gallery and the Institute for Contemporary Arts (ICA) in London.


text:
[Vietnam] .NET Software Engineer (SE & SSE) @KMS Technology
Location: Vietnam - Full-time
Opened on: August 22, 2013
Writes design and implementation web pages, modules or entire application follows Software Architecture Documents
Creates units test, performs test and fixes bugs
Participates in requirement, design and code reviews
Communicates with team members, clients subject matter experts across country borders to resolve project related issues
Technical Requirements:
At least 03 years of .NET programming experience, especially in web application development.
Has .NET architecture understanding and knows enhancements on the latest .NET Frameworks
Has working experience and good knowledge in C#, ASP.NET, ORM, DotNetNuke, JavaScript, JQuery, Ajax, CSS
Has working experience in CMS and has used at least one CMS framework such as DotNetNuke, N2, Joomla, Drupal
Has working experience in write SQL scripts and experience in workings with DBMSes
Has knowledge in others .NET technologies such as ASP.NET MVC, WCF, WPF, Entity Framework is a plus
Communication Requirements:
Good English communications skills
Education Requirements:
Bachelor's Degree in Computer Science/IT or higher
Advanced Degree and professional certifications are beneficial
If you are interested in this position,please send us your resume at firstname.lastname@example.com
|All times are GMT +5.5. The time now is 00:34.


text:
Despite scoring over 300 points as a sophomore last year, Brielle Kelly spent the past two seasons in the shadow of Shayna Erickson.
Erickson is gone now, playing forward at Manhattan College, and Kelly has taken control of the paint and West Morris' offense.
"Getting the ball to Brielle always helps," said point guard Sydney Sapir of West Morris' offense. "She's an animal. She's insane. We can always count on her."
Without Erickson, West Morris has had to rely on the junior forward to be the centerpiece of the team.
Kelly has answered the call.
"Brielle is a very strong physically and spirited basketball player," West Morris coach Fran Gavin said after a 53-41 triumph over Mendham. "She backs down from absolutely no one."
Kelly quickly established her dominance in the paint and after 14 games has posted nine double-doubles. Her prowess down low has caught the attention of some Division 1 programs. When the junior's club team, the North Stars, competed in a tournament in Georgia, a number of scouts from colleges including Michigan, Florida State and Notre Dame among others were in attendance.
Although scouts may have their eyes locked on West Morris' leading scorer, Kelly never looks any further than the basketball court.
"I don't think it's a burden at all," she said of the recruitment process. "I just keep playing my game. That's all I can do."
Even with the impending decision of where she will be attending school in a year and a half looming, Kelly's mind is focused only on the now and how she can help her team succeed in the Morris County when top seeded West Morris plays 16-Pequannock.
"I want to come in the counties strong and keep fighting," Kelly said. "We are looking to win and prove that we earned the number one seed."
Follow @RichardGrecoHS
Email Richard Greco at email@example.com
Follow @StarLedgerHS
Download the High School Sports app


text:
Medications and Drugs
Brand Names: Cladribine Novaplus, Leustatin
Generic Name: cladribine (Pronunciation: KLAD ri been)
What is cladribine (Cladribine Novaplus, Leustatin)?
Cladribine is a cancer medication that interferes with the growth and spread of cancer cells in the body.
Cladribine is used to treat hairy cell leukemia (a type of blood cancer).
Cladribine may also be used for purposes not listed in this medication guide.
What are the possible side effects of cladribine (Cladribine Novaplus, Leustatin)?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Tell your caregivers at once if you have a serious side effect such as:
Less serious side effects may include:
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is the most important information I should know about cladribine (Cladribine Novaplus, Leustatin)?
Do not use cladribine if you are pregnant. It could harm the unborn baby.
Before you receive cladribine, tell your doctor If you have liver or kidney disease or a bone marrow problem.
Cladribine can lower blood cells that help your body fight infections and help your blood to clot. Your blood may need to be tested often. Avoid being near people who are sick or have infections. Avoid activities that may increase your risk of bleeding injury. Tell your doctor at once if you develop signs of infection.
Do not receive a "live" vaccine while using cladribine, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.
Tell your caregivers at once if you have a serious side effect such as numbness or tingling, weakness or burning pain in your fingers or toes, lower back pain, blood in your urine, urinating less than usual, muscle weakness or tightness, pale or yellowed skin, easy bruising or bleeding, dark colored urine, or feeling like you might pass out.
Next Page:
(Page 1 of 3)
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Need help identifying pills and medications?


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Duro, Debora*; Mitchell, Paul D†; Kalish, Leslie A†; Martin, Cami‡; McCarthy, Maggie†; Jaksic, Tom§; Dunn, James||; Brandt, Mary L¶; Nobuhara, Kerilyn K#; Sylvester, Karl G**; Moss, R Lawrence††; Duggan, Christopher*
In the article that appeared on page 595 of the May 2011 issue, the article's subtitle was omitted. The full title is Risk Factors for Parenteral Nutrition–associated Liver Disease Following Surgical Therapy for Necrotizing Enterocolitis: A Glaser Pediatric Research Network Study.
Journal of Pediatric Gastroenterology and Nutrition.
November 2011.
*Division of GI/Nutrition, Children's Hospital, Boston, Harvard Medical School, USA
†Clinical Research Program, Children's Hospital Boston, USA
‡Beth Israel Deaconess Medical Center, Boston, USA
§Department of Surgery, Children's Hospital Boston, Harvard Medical School, MA, USA
||Department of Surgery, University of California, Los Angeles, USA
¶Department of Surgery, Baylor College of Medicine, Houston, TX, USA
#Department of Surgery, University of California, San Francisco, USA
**Department of Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, USA
††Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
Received 23 August, 2010
Accepted 15 December, 2010
Address correspondence and reprint requests to Debora Duro, MD, MS, University of Miami, Division of Gastroenterology and Nutrition, 1601 NW 12 Ave, MCCD Room 3005A, Miami, FL 33136 (e-mail: firstname.lastname@example.com).
This study was supported by the Glaser Pediatric Research Network and the Gerber Foundation. D.D. was supported by the following grants: institutional grant from NIH T32-HD43034-05A1; Pilot Feasibility from the Clinical Nutrition Research Center, NIH #P30 DK40561-13, and the Junior Faculty Career Development Award from Children's Hospital, Boston. C.D. was supported in part by K24 HD058795.
The authors report no conflicts of interest.
Objective: The aim of the study was to prospectively determine risk factors for the development of parenteral nutrition–associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC), the most common cause of intestinal failure in children.
Patients and Methods: From February 2004 to February 2007, we diagnosed 464 infants with NEC, of whom 180 had surgery. One hundred twenty-seven patients were available for full analysis. PNALD was defined as serum direct bilirubin ≥2 mg/dL or ALT ≥2 × the upper limit of normal in the absence of sepsis after ≥14 days of exposure to PN.
Results: Median gestational age was 26 weeks and 68% were boys. Seventy percent of the cohort developed PNALD and the incidence of PNALD varied significantly across the 6 study sites, ranging from 56% to 85% (P = 0.05). Multivariable logistic regression analysis identified small-bowel resection or creation of jejunostomy (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.97–12.51, P = 0.0007) and duration of PN in weeks (OR 2.37, 95% CI 1.56–3.60, P < 0.0001) as independent risk factors for PNALD. Preoperative exposure to PN was also associated with the development of PNALD; the risk of PNALD was 2.6 (95% CI 1.5–4.7; P = 0.001) times greater in patients with ≥4 weeks of preoperative PN compared with those with less preoperative PN use. Breast milk feedings, episodes of infection, and gestational age were not related to the development of PNALD.
Conclusions: The incidence of PNALD is high in infants with NEC undergoing surgical treatment. Risk factors for PNALD are related to signs of NEC severity, including the need for small-bowel resection or proximal jejunostomy, as well as longer exposure to PN. Identification of these and other risk factors can help in the design of clinical trials for the prevention and treatment of PNALD and for clinical assessment of patients with NEC and prolonged PN dependence.
Parenteral nutrition (PN) is a lifesaving therapy for patients with intestinal failure, and since its development, mortality due to dehydration and malnutrition essentially has been eliminated (1). This critical therapy, however, has been plagued by the recognition that patients with prolonged dependence on PN commonly develop hepatic dysfunction, also known as parenteral nutrition–associated liver disease (PNALD). PNALD is characterized by cholestasis, steatosis, and mixed inflammatory changes and can progress to fibrosis and cirrhosis (2,3). PNALD is especially common in infants and children with intestinal failure (IF), occurring in 40% to 60% of pediatric patients receiving prolonged courses of PN (4,5).
Recent data have confirmed that the presence of liver disease in patients receiving PN is strongly associated with a high mortality rate. In a cohort study of 78 children with IF, the mortality rate among those with cholestasis (direct bilirubin concentration ≥2 mg/dL) was close to 80% compared with 20% in those without cholestasis (6). These data confirmed a previously reported mortality rate of 90% among infants with IF and cholestatic liver disease who were unable to be weaned from PN (7). With advanced liver disease in the setting of prolonged dependence on PN, liver and intestinal transplantation is sometimes required (8).
Multiple risk factors for the development of PNALD have been identified and include premature birth, disruption of the enterohepatic circulation of bile acids, intestinal stasis with subsequent bacterial overgrowth, ischemia or decreased blood flow from reduced portal venous return causing inflammation and intestinal necrosis, early and/or recurrent central venous catheter–related sepsis, excessive glucose intake leading to hyperinsulinism and subsequent steatosis, and high parenteral protein, fat, and/or energy intake (7,9–12). No unifying theory, however, has been put forward to explain all of the features of PNALD, and previous studies to evaluate epidemiologic risk factors for its occurrence have been limited by retrospective, single-center designs (7,12,13).
We conducted a prospective, multicenter cohort study to identify clinical, demographic, and disease-specific risk factors for the progression of necrotizing enterocolitis (NEC) (14). The aim of the present analysis was to determine risk factors for the occurrence of PNALD in a subset of patients who underwent surgical treatment for NEC.
The subjects in this analysis were drawn from an observational, prospective cohort study of infants with NEC conducted at 6 academic medical centers in the United States. The design and primary results of the main cohort study have been reported (14). A total of 464 patients meeting the protocol definition for NEC were enrolled between February 2004 and February 2007. Entry criteria for this study were those commonly used to identify infants with suspected or confirmed NEC (15). Patients were enrolled on the day they met these criteria, which included having at least 1 finding from each of a prespecified set of historical factors, physical examination findings, and radiographic findings. Historical factors included feeding intolerance, apneic/bradycardic episodes, oxygen desaturation, or grossly blood stools. Physical examination findings included abdominal distension, capillary refill time >2 seconds, abdominal wall discoloration, or abdominal tenderness. Radiographic findings included pneumatosis intestinalis, dilated bowel, portal venous gas, ileus, pneumoperitoneum, air/fluid levels, thickened bowel walls, ascites, peritoneal fluid, free intraperitoneal air, or abnormal bowel gas pattern. Subjects were excluded if they had any major gastrointestinal anomalies or had undergone abdominal surgery before enrollment. The protocol was approved by the institutional review board at each site, and informed consent was obtained when required; consent waivers were granted at some sites.
For the purposes of this analysis and because liver biopsies were not routinely performed in these settings, PNALD was defined as abnormal liver biochemical testing (either serum direct bilirubin ≥2 mg/dL or alanine aminotransferase [ALT] ≥2 × the upper limit of normal [ULN]). In addition, subjects had to have at least 14 days of PN exposure at the time of liver disease diagnosis and no concurrent positive blood cultures to explain the abnormal biochemical tests. Full enteral feeding was defined as the provision of ≥100 kcal/kg/day from enteral nutrition (EN) and demonstrating a mean weight gain of ≥15 g/day for 7 days, or being discharged after discontinuing PN. Patients were ineligible for this analysis if they had no liver biochemical testing after 14 days of PN exposure, had evidence of abnormal liver biochemical testing before surgery, were being treated with intravenous omega-3 fatty acids or ursodeoxycholic acid, or had incomplete follow-up. Surgical therapy was defined as either exploratory laparotomy (with or without intestinal resection) or surgical placement of peritoneal drains.
Demographic, maternal, prenatal, and intrapartum data, and medication history (for both mother and child) and newborn history before study entry were abstracted from medical records. Data collected daily during the week before diagnosis of NEC included mode of feeding (PN or EN), method (bolus or continuous), type of EN (breast milk, formula, or a combination), volume of formula, and weight of the infant. After study entry, detailed clinical data were collected prospectively on a daily basis until subjects underwent surgery. Because bilirubin and ALT test results were collected routinely only for surgical patients and values before surgery were not recorded uniformly, we limited our analysis to surgical patients and considered only postoperative test results as outcomes. Surgical findings and data on postoperative course were collected weekly. Data collected included medications, laboratory and imaging evaluations, ventilation status, fluid/hemodynamic status, and blood culture results.
The use of PN was recorded up to 1 week before NEC diagnosis and then daily from the time of diagnosis until surgical intervention. If PN was not recorded for 5 or more consecutive days when it was known that enteral nutrition was withheld, then daily PN was assumed. After surgery, PN use was documented weekly. For the purposes of analysis, this day was considered representative of the week's PN exposure. Volumes of dextrose, protein, and fat were recorded over the same time intervals as for PN. Each nutrient was expressed in grams per kilogram per day and kilocalories per kilogram per day, and then summed over all of the days to obtain cumulative exposure.
Our study endpoint was the development of PNALD. Summary statistics for continuous variables were expressed as median (quartiles). Categorical variables were summarized with frequency distributions. Tests of group differences were made using the Wilcoxon rank sum test and the Pearson chi-square test or the Fisher exact test. Associations between pairs of predictors were investigated using the Spearman rank correlation coefficient.
The determination of predictors for PNALD was made using multiple logistic regression analysis. Except where noted otherwise, we used information that would be known at the time of surgery (or immediately after) as candidate predictors. Candidate postoperative correlates of PNALD were also considered, but only data from days 1 to 28 after surgery were used to define the predictors to minimize the use of exposure information to predict an event that may have occurred before the exposure. For surgical information, this included data from subjects who had second surgical procedures within 28 days of the first. All of the patients who underwent jejunostomy developed PNALD, preventing us from including a variable noting the creation of a jejunostomy in a predictive model. We therefore created a clinically relevant composite variable by combining jejunostomy with the presence of any small bowel resection because each variable was highly significant by itself, the 2 were correlated with each other, and both surgical interventions render part of the small bowel nonfunctional. The fit of the final model was assessed using the Hosmer-Lemeshow goodness-of-fit test (16).
A product-limit estimate of the survivor function was used to examine the time from surgery to PNALD, defined as the time from surgery until either serum direct bilirubin ≥2 mg/dL or ALT ≥2 × ULN, with a minimum of 14 days' PN exposure and no concurrent positive blood cultures to explain the abnormal biochemical tests. This duration was censored at the time of the last laboratory report for those who did not develop PNALD, including those who later died. Patients not requiring surgical intervention were excluded from this analysis because markers of liver dysfunction were not routinely obtained in patients who did not undergo surgery. Group comparisons were made using proportional hazards regression. Because not all of the patients had accumulated 14 days of PN exposure before surgery, an adjustment was made in all of the time-to-PNALD analyses to allow these patients to be considered at risk for PNALD at the appropriate time (17).
All tests of significance were 2-sided with a type I error rate of 0.05. All of the data analysis was performed using SAS/STAT software, version 9.1 of the SAS System for Windows (SAS Institute, Cary, NC).
Of 464 subjects, 180 (39%) underwent surgical intervention for NEC (Fig. 1). In all, 127 surgical patients had ≥14 days of PN exposure and were available for analysis, of whom 70% developed PNALD. The rate of PNALD varied significantly across the 6 study sites, ranging from 56% to 85% (P = 0.05). Among the 89 subjects with PNALD, 56 subjects met the criteria for liver disease due to both direct bilirubin >2 mg/dL and ALT >2 × ULN, 31 due to direct bilirubin >2 mg/dL alone, and only 2 subjects due to ALT >2 × ULN alone.
Two-thirds of all of the patients were boys (Table 1) and 63% were white, with a median gestational age of 26 weeks. Age at diagnosis of NEC ranged from 1 to 74 days (median 11 days), with 32% diagnosed within 1 week of birth and 65% within 2 weeks. Fifty-seven percent of the infants weighed <1000 g at birth. Sixty-three percent of all of the patients had surgery for NEC within 48 hours of diagnosis, and 84% of the patients had surgery within 1 week. Twenty-two (17%) patients required a second surgery within 28 days of the first, usually within the first week. Among the 127 enrolled patients, 23 (18%) patients died at a median age of 10 weeks (interquartile range 6–25). Additional patient characteristics are shown in Table 1.
One hundred (79%) patients received EN before or on the day of diagnosis of NEC, whereas 14 (11%) received enteral feeds after diagnosis and before surgery for NEC. Days of PN use before surgery ranged from 1 to 70 days (median 10 days), with daily dependence on PN from birth until surgery in 38 (30%) patients.
Initial surgical intervention for NEC included peritoneal drainage (n = 29, 23%) or exploratory laparotomy (n = 98, 77%). Among the 29 patients who underwent peritoneal drainage, 6 required surgical resection. Sixteen (55%) of the 29 patients developed PNALD, as compared with 100% among 17 patients requiring jejunostomy and 76% among 80 patients requiring some type of surgical resection. Findings during laparotomy prompted small-bowel resection (n = 65, 66%), creation of diverting ileostomy (n = 57, 58%), large-bowel resection (n = 30, 31%), and ileocecal valve resection (n = 23, 23%). Multiple surgical interventions were common, with 50 (39%) patients undergoing ≥2 of these operative procedures. Resection of the small bowel ranged from 0.8 to 80.0 cm (median 12.0 cm) among those 45 patients whose resected bowel length was recorded. Unadjusted comparison of patients with PNALD versus those without is shown in Table 2. Abdominal wall discoloration and pneumoperitoneum were less frequently reported in patients progressing to PNALD, whereas any EN by the time of diagnosis, ileocecal valve resection, jejunostomy, and small-bowel resection were more frequent in patients who developed PNALD (P < 0.05 for each). Abdominal distension, pneumatosis intestinalis, portal venous gas, ventilation on the day of diagnosis, and any PN use by the day of NEC diagnosis were marginally statistically significant (P < 0.10), with each more prevalent among patients with PNALD. Statistically significant effects were not found for any other demographic characteristics, maternal and birth information, medical and feeding histories, or surgical interventions (Table 2).
Independent predictors of PNALD are shown in Table 3. PN exposure measured in days proved more predictive than when measured as kilocalories per kilogram per day and summed over days. The 2 were highly correlated (Spearman correlation 0.81, P < 0.0001) and either by itself was highly significant. Furthermore, once total PN exposure was included in the model, the addition of any of the 3 specific parenteral macronutrients (carbohydrates, fat, or protein) was not significant. In preliminary models, we accumulated PN exposure days separately before and after surgery; each variable was significant when adjusted for the other (P ≤ 0.001 for each) and had similar coefficients (test of equality, P = 0.38). We therefore combined the 2 into a single variable. Overall, the odds of PNALD increased 2.4-fold for each additional week of PN exposure. Patients with small-bowel resection or jejunostomy had odds of PNALD nearly 5 times that of patients without these interventions (P = 0.001), even when taking into consideration length of PN exposure. The independent effects of abdominal discoloration, prediagnosis EN, and other surgical interventions were not statistically significant after adjustment for the aforementioned independent predictors.
Figure 2 displays time from surgery for NEC until PNALD for patients with ≥4 weeks of PN before surgery (n = 16) compared with those with <4 weeks of preoperative PN (n = 105). The probability of PNALD was consistently greater in the PN ≥4 weeks group. The median time to develop PNALD was 9 days for patients with ≥4 weeks of preoperative PN use compared with 21 days in the PN <4 weeks group. Overall, the risk of PNALD was 2.6 (95% CI 1.5 to 4.7; P = 0.001) times greater in the ≥4 weeks of PN group.
PNALD encompasses a variety of injuries in the liver (18) and is associated with a high mortality rate among children with intestinal failure (7). Our prospective multicenter study identified 2 independent and strong predictors of PNALD: pre- and postoperative exposure to PN, and the creation of a proximal jejunostomy or small-bowel resection for NEC. Overall, 70% of the cohort developed PNALD, making it a common morbidity of infants undergoing surgical therapy for NEC. To our knowledge, our study is unique because it prospectively determined risk factors for PNALD in a large cohort of patients with NEC and quantified the risk of its occurrence, a 2.4-fold increase for each additional week of PN exposure and a nearly 5-fold higher risk for patients who undergo small-bowel resection or the creation of a jejunostomy.
Our data do not support the hypothesis that a particular parenteral macronutrient (protein, fat, and/or carbohydrate) (7,9–12) is responsible for the development of PNALD (12,19). We evaluated whether exposure to higher amounts of these macronutrients was related to the occurrence of PNALD and found that once the total PN exposure days was included in the model, the total energy from PN or from any of the 3 specific macronutrients did not significantly improve the fit of this model. Similarly, the percentages of energy from each macronutrient were not statistically related to the occurrence of PNALD. Instead, our data suggest that total PN exposure days is the primary nutrition-related risk factor for PNALD. Prospective trials of newer forms of parenteral macronutrients in the prevention of PNALD, including omega-3-fatty acids (20), are under way and will help evaluate these findings.
Exposure to enteral feeds, either breast milk or formula, was also not predictive of PNALD. A previous retrospective study (7) found that the use of protein-hydrolysate formula was associated with a lower incidence of PNALD in a group of intestinal-failure patients, but our prospective data did not support this relation in patients with NEC. Univariate analysis suggested that any EN on or before the day of diagnosis of NEC was associated with PNALD (P = 0.01, Table 2). Similarly, in our recent analysis (21) from this cohort we found that exposure to enteral feeds before the diagnosis of NEC was associated with subsequent need for PN for ≥90 days. Continued feeding during this period of disrupted intestinal integrity may potentiate the local inflammatory response and in turn increase the severity of NEC, the need for prolonged PN, and the risk for cholestatic liver disease.
We also found several factors to be associated with the development of PNALD in the univariate analysis (Table 2) that did not remain significant predictors in the final multivariate model. Nevertheless, these results may provide clues about the etiology of this condition. Collectively, these risk factors (abdominal distension, pneumatosis intestinalis, portal venous gas, mechanical ventilation on the day of diagnosis) are associated with increased severity of NEC and consequently require prolonged duration of PN. Among the surgical factors analyzed, ileocecal valve resection was a significant univariate risk factor for the development of PNALD. This finding has not been previously reported in the literature, although 1 retrospective case series (22) found that absence of an ileocecal valve leads to prolonged PN exposure. It is possible that resection of the ileocecal valve predisposes patients to less efficient enterohepatc bile salt recirculation and subsequently more cholestasis. Similar physiologic mechanisms may underlie our observed association between PNALD and small-bowel resection or the creation of a jejunostomy.
The variation in PNALD incidence across the 6 university referral centers (56%–85%, P = 0.05) is interesting and may reflect differences in patient characteristics and in surgical, medical, or nutrition-management practices. In addition, variation in referral patterns could lead to overrepresentation of the most severe NEC cases at some centers and underrepresentation at others.
Although our study is one of the few prospective, multicenter reports on the incidence of PNALD in infants with NEC, it still has important limitations. Because of the design of the parent study, our analysis was limited to patients who underwent surgery for NEC. The incidence of PNALD among medical patients with NEC, however, is likely to be lower, owing to their much shorter duration of PN use (21). In our analysis of predictors of prolonged PN dependence, for instance, we found that 42% of surgical patients with NEC had PN exposure ≥90 days versus only 2% in medical patients with NEC (P < 0.001) (21).
In summary, PNALD is a common morbidity among patients undergoing surgery for NEC. To our knowledge, this is the first prospective multicenter effort to report data concerning the incidence and risk factors for this severe condition and to provide a quantifiable estimate of disease risk. In patients with PNALD, both the high likelihood of developing end-stage liver disease requiring liver transplantation and the high mortality rate (6,8) highlight the importance of identifying, in advance, patients who are likely to develop this condition. Identification of risk factors may allow the development of strategies for the prevention of PNALD and/or to offer treatment options early in the course of disease that can ultimately minimize the high rate of morbidity and mortality.
The following people and institutions participated in the study: Joyce Simpson, RN, MPH, Yale-New Haven Hospital; Geneva Shores, RN, and Pam Gordon, RN, Texas Children's Hospital; Janet Mooney, RN, Department of Pediatrics, University of California, Los Angeles; Keniki McNeil, RN, Stanford University and Lucile Packard Children's Hospital; Carol Sweeney, BSN, and Laura Boger, BA, Children's Hospital, Boston; and Marcia Wertz, RN, University of California Children's Hospital, San Francisco.
intestinal failure; jejunostomy; necrotizing enterocolitis; parenteral nutrition–associated liver disease; short-bowel syndrome
Copyright 2011 by ESPGHAN and NASPGHAN
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