text:
CHMP Backs Selexipag for Pulmonary Arterial Hypertension »
"The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has recommended the marketing of selexipag (Uptravi, Actelion Registration Ltd) for the treatment of adults with pulmonary arterial hypertension (PAH)./"...
Read the CHMP Backs Selexipag for Pulmonary Arterial Hypertension article »
Adverse reactions are usually reversible upon reduction of dosage or discontinuation of methyclothiazide (methyclothiazide (methyclothiazide (methyclothiazide tablet 5 mg) tablet 5 mg) tablet 5 mg) tablets. Whenever adverse reactions are moderate or severe, it may be necessary to discontinue the drug.
The following adverse reactions have been observed, but there has not been enough systematic collection of data to support an estimate of their frequency. Consequently the reactions are categorized by organ system and are listed in decreasing order of severity and not frequency.
Body as a Whole:Headache, cramping, weakness.
Cardiovascular System: Orthostatic hypotension (may be potentiated by alcohol, barbiturates, or narcotics).
Digestive System: Pancreatitis, jaundice (intrahepatic cholestatic), sialadenitis, vomiting, diarrhea, nausea, gastric irritation, constipation, anorexia.
Hemic and Lymphatic System: Aplastic anemia, hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia.
Hypersensitivity Reactions: Anaphylactic reactions, necrotizing angiitis (vasculitis, cutaneous vasculitis), Stevens-Johnson syndrome, respiratory distress including pneumonitis and pulmonary edema, fever, purpura, urticaria, rash, photosensitivity.
Metabolic and Nutritional Disorders: Hyperglycemia, hyperuricemia, electrolyte imbalance (see PRECAUTIONS section), hypercalcemia.
Nervous System: Vertigo, dizziness, paresthesias, muscle spasm, restlessness.
Special Senses: Transient blurred vision, xanthopsia.
Urogenital System: Glycosuria.
Read the Methyclothiazide (methyclothiazide tablet 5 mg) Side Effects Center for a complete guide to possible side effects
Hypokalemia can sensitize or exaggerate the response of the heart to the toxic effects of digitalis (e.g., increased ventricular irritability).
Hypokalemia may develop during concomitant use of steroids or ACTH.
Insulin requirements in diabetic patients may be increased, decreased, or unchanged.
Thiazides may decrease arterial responsiveness to norepinephrine. This diminution is not sufficient to preclude effectiveness of the pressor agent for therapeutic use.
Thiazide drugs may increase the responsiveness of tubocurarine.
Lithiumrenal clearance is reduced by thiazides, increasing the risk of lithium toxicity.
Thiazides may add to or potentiate the action of other antihypertensive drugs. Potentiation occurs with ganglionic or peripheral adrenergic blocking drugs.
Drug/Laboratory Test Interactions
Thiazides may decrease serum PBI levels without signs of thyroid disturbance.
Thiazides should be discontinued before carrying out tests for parathyroid function.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 6/4/2009
Methyclothiazide FDA Prescribing Information
Additional Methyclothiazide Information
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.
Get tips on handling your hypertension.


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Communications Officer at Ibis Ghana
Welcome to jobwebghana.com. This website helps you to achieve your career dream by linking you to vacancies from Top Companies in Ghana. Job Seekers are also exposed to best articles for career growth and development. Click Here to Subscribe for Job Alerts We strongly advise graduates not to pay money before getting a Job. Report fraudulent jobs to 0201533571
- Company: Ibis Ghana
- Location: Tamale, Northern, Ghana
- State: Tamale
- Job type: Full-Time
- Job category: Administrative/Secretarial Jobs in Ghana
Background : IBIS is a Danish International NGO that works for a world in which all people have equal access to education, influence and resources. Through the capacity strengthening of local civil society organisations, IBIS works to address the structural causes of poverty by promoting individual and collective rights of citizens to participation in local governance, empowering quality basic education as well as other human rights and democratisation. IBIS in Ghana places a premium on Communications for a variety of reasons. As stated in the country strategy this is important to raise awareness on the work of IBIS and its partners; raise the profile of IBIS and its partners and help the organisation and its partners to capture learning and be able to package and share it with a range of stakeholders. The position is based in the IBIS Programme Office in Tamale and will be responsible to the Country Director on overall issues. The Communications Officer will work closely with the Programme Directors, the National Policy Advisor and the Programme Development Advisor to effectively use communications to support IBIS in Ghana work. The Communications Officer will work closely with the Regional Communications Advisor for support as needed. Key areas of responsibility:
- Development and constant revision of a communications strategy in consultation with the Programme Directors and the Country Director
- Oversee the implementation of this strategy, providing regular progress reports and strategic analysis/recommendations to the Country Director.
- Develop healthy relationship with and maintain close collaboration with mass media, as well as with groups and organisations whose support is essential to the achievement of advocacy and communication objectives, including providing them with information on IBIS and partners work and events with a view to increasing their involvement with IBIS and partners
- Draft and edits articles, press releases, human interest stories and other advocacy/information materials for both web-based and traditional media, as appropriate.
- Work closely with the Regional Communications Advisor and IBIS in Ghana staff to ensure regular publication of the newsletter. Publicise work of IBIS and partners to raise profiles in support of advocacy work and fundraising
- Support IBIS participation in National advocacy and awareness raising activities/events by planning IBIS' participation, including preparation of information materials (e.g., press releases, programme summaries and country fact sheets), and necessary logistic arrangements.
- Work closely with Programme Directors and partners to identify advocacy issues and how communications can be used to support advocacy work
- Advise Country Director and Programme Directors on media issues and media engagements with persons and institutions outside IBIS
- Organise and generate public support for special events and activities to promote country programme goals.
- Monitor the public perception of IBIS in the country and recommend appropriate action to maintain a positive image for the organisation.
- Monitor and evaluate the appropriate and timely dissemination of advocacy and communication materials to target audiences, and participate in the evaluation of their impact.
- Build the capacity of IBIS and partner staff in communication and supporting them to publicise their activities and raise their profiles.
- Work closely with the Junior Programme Development Advisor and Programme Directors to link Communications to support Fundraising efforts
- To work with the Regional Communications Advisor to meet HO communication needs which Ghana can contribute to.
- At all times work in close collaboration with the Regional Communications Advisor to ensure IBIS in Ghana communications work is in accordance with IBIS global policy and plans on communications and contributing to the global objectives on communications WEB Management
- Work closely with the IT Manager and the Regional Communications Advisor to regularly update information on the IBIS website to ensure that information on the site is current
- Monitor the web for information requests and comments or feedback
- Work to improve the website and make it interesting for the surfing publics
- Other communication related tasks as may be directed by the Country Director.
Profile • Degree in communication and/or journalism • A sound background in communication/journalism, minimum of four years experiece • Knowledge and experience of current trends in communication research and the role of mass media • Knowledge of photography and use of video • Proven ability to effectively manage relationships with media representatives, government officials and IBIS partners • Ability to work in a team • Familiarity with development issues
How to Apply
Submit your CV and Application online : Click Here
Closing Date: 15th May, 2013
Dont Miss Latest Jobs In Ghana. Subscribe Today. CLICK HERE

subset: commoncrawl


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Heart attack is the leading cause of death for firefighters, according to the U.S. Fire Administration, which found heart attacks accounted for 44 percent of all on-duty fatalities among firefighters between 1990 to 2000.
As hundreds of New Jersey firefighters gather in Atlantic City this week for their annual convention, they too will be urged to protect themselves by going for a calcium scoring test, a CT scan used to gauge the amount of calcified plaque in his coronary arteries.
Research has found that the proportion of arteries affected by calcium -- not just the amount -- can be an important factor in identifying those at increased risk of heart attack.
"We believe this can give doctors an even better picture of disease risk," said Elizabeth Brown, a researcher in biostatistics at the University of Washington, the lead author of a calcium study published this spring in the journal, Radiology.
Firefighters noted that the high-stress nature of their jobs as to the risk.
"One minute you're still in the firehouse and then two minutes later you're going down a roadway with lights and sirens blaring. Your heart was at rest, but a minute later it's pumping 100 miles an hour," said Capt. Norman Tahan, 45, a veteran Clifton firefighter who underwent calcium scoring recently and was relieved to receive a score of zero.
Representatives from St. Joseph's Regional Medical Center distributed information about the test and scheduled appointments, according to William Lavin, president of the New Jersey State Firemen's Mutual Benevolent Association.
Lavin's father, who was also a firefighter, died from a heart attack at age 58. Lavin is now 50 and has decided to undergo calcium scoring sometime within the next month. He calls his family history of heart attack, combined with risk factors like high blood pressure, cholesterol and stress, "the perfect storm."
"The number of funerals and loss of life that we witness from heat disease is staggering," said Lavin, an Elizabeth firefighter who also has two brothers who are firefighters. "Anything our organization can do to warn guys or have them tested to help prevent untimely deaths is really our goal."
Frank Yuppa, chairman of radiology at St. Joseph's, said many heart attacks are due to plaque rupture, rather than the narrowing of blood vessels. He said calcium scoring is able to raise a red flag when stress test results appear normal or cardiac catheterizations show no significant disease.
Not everyone is enthusiastic about calcium scoring, including some cardiologists and primary care doctors who believe its predictive qualities are overblown. Because it is a screening examination, scans are also not covered by most insurers, including Horizon Blue Cross Blue Shield of New Jersey and Aetna.
But Lavin believes it is essential to reversing the number of firefighter deaths. Firefighters can receive the test at a discounted price of $150 -- compared to the usual $250 -- with the union and its foundations subsidizing the cost, he said.
"We already have health screenings like blood pressure and other vitals taken at the convention. This is what we feel is the next step."


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The same goes for networks. Unfortunately, once in production the big challenge is to stay in control of all operational processes, network changes and configurations.
What if.... all changes would be design driven, standardized and automated?
Impossible? With NetYCE you can.
Although network architects clearly define architecture & design principles, it is hard to comply to them in the daily operation. Networks keep on changing and expanding, often beyond control. As a result, 80% of the network's TCO is spent post deployment, requiring highly skilled engineers and a large team of network operators who manually keep the network running on a best effort basis.
Make architecture and design leading throughout all stages of the network lifecycle. Build, Operate and Maintain networks while enforcing standardization, processes and architecture & design principles.
Instead of having different teams work with their own tools, processes, information and interpretations, teams work together in a standard way with a single view of the network, using one application for change management.
NetYCE is the industry's first platform for Design Driven Networking. Finally, network architects, designers, engineers and operations can collaborate with one integrated approach to networking.
The result? Smarter, better and controllable networks with full automation and orchestration capabilities delivered on multi vendor and multi technology networks. Too good to be true? With netYCE you can!
The netYCE platform has been in production since 2001. Developed originally for the internal service provider of Rabobank group, one of world's largest triple A banks, managing multiple networks with thousands of devices. The solution is commercially available since 2011 and is currently deployed within large service providers, managed service providers and enterprise networks.
NetYCE has been awarded by analyst group EMA (Enterprise Management Associated) as Vendor to watch 2014. According to EMA: "NetYCE's solution represents a next generation approach to the challenge of automating and enforcing network configuration policy. EMA believes that network teams embracing the NetYCE approach could have real hope for eliminating the vast majority of risks that manual network configuration practices present to operational integrity, while also putting them in position to successfully make the transition to the programmable networks of the future."
Finally networks can be run as a business. Instead of depending on the availability of key resources or retaining specialised personnel, all knowledge gets translated in pre-designed processes, services, templates and scenarios, locking down all relevant details of the design and engineering processes, including its history.
All with the philosophy "Design once, Automate many."
Design Driven Networking has proven to save between 25% and 50% of the overall operational cost.
Design Driven Networking guarantees stable, flexible and agile networks with less incidents.
Due to standardization and process control, Design Driven Networking significantly reduces time to market for new services.
Deployed as designed guarantees networks to comply to standards and rules.
Switching and combining vendors and technology can be done without much effort.
New services, such as customer self service portals, release based services or smart outsourcing with full control is made easy.
Find out more...


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The History of Education Quarterly (HEQ) is planning a special issue on the
history of Asian American education. Although there is a growing literature
on the education of Asian Americans, most of the studies have been in the
social sciences; historical studies have been few. To help remedy this
situation, the HEQ will devote an entire issue to historical essays on
Asian American education.
The HEQ welcomes essays on any aspect of the diverse histories of Asian
American education, including but not limited to a focus on 1) a particular
Asian American ethnic group; 2) Asian Americans of mixed ethnicities; 3)
issues of class, gender, and/or inter-ethnic relations; 4) K-12 schooling,
higher education, or other educational institutions.
The HEQ is a publication of the History of Education Society, an
international scholarly association that encourages research in the history
of education, promotes and improves the teaching of history of education,
encourages cooperation among specialists in history of education, and
promotes an appreciation of the value of an historical perspective in the
making of educational policy.
The HEQ defines education in its broadest terms, that is, a cultural
experience encompassing a variety of institutions, actors, and informal and
formal settings.
Essays should be 25-35 double-spaced pages, including endnotes. Guidelines
for submission are given on a back page of the HEQ and at its website:
Submitted essays will be peer-reviewed. Your cover letter should include
the title of your essay, your name, postal address, email address, phone #,
and fax #. Your essay should begin with the title of your essay and not
include your name.


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Manchester veteran finally laid to rest
After 7 year battle, daughter has buried him in veteran cemetery
Published 7:49 AM EST Feb 15, 2013
A Manchester veteran has finally been granted a military burial.
Maurice Armand Soucy died in 2006, and this week he will be laid to rest in a veteran's cemetery in Arizona.
Soucy's daughter has been waiting seven years for the Army to approve her request to bury him there. The Army originally denied having records of his time in the service.
Soucy's files, along with decades of other data, were destroyed in a fire at a military records center in 1973.


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Along with this week's Malware Report, things are really humming with cybercrime. As we've been preaching for over ten years, people really need to be careful — and help squash online crime! If they don't, it will be bad for all of us. Just a few in this week's cache
* Sophos Pulls Partner Portal After Signs of Hacking
* How to avoid revocable living trust cons and scams
* Humor: Jon Stewart compares Obama to Nigerian spammer
* Inside Twitter's Spam Lawsuit: Cost More Than $700000
* WordPress Users : Hacked and mangled — yet again
* At Long Last, Twitter Files Anti-Spam Lawsuits
* New Crimes Added to Russian Criminal Code
* Minimize Your Exposure to Email Spoofing
* AVMA issues email fraud alert
* Tax Season Ushers In Scams
and more . . .
Sophos Pulls Partner Portal After Signs of Hacking
Security firm Sophos has taken its partner portal offline and will reset every user's password after it found signs of a potential security breach on the server hosting it.
"Two unauthorized programs were found on the server, and our preliminary investigations indicate that these were designed to allow unauthorized remote access to information," Sophos said in a security alert posted on its website.
Full story : PCWorld
AVMA issues email fraud alert
A suspicious email is spreading in the American Veterinary Medical Association's (AVMA) name, and officials want the group's 82,000-plus members to know that if they receive an email from the domain firstname.lastname@example.com, 'it's not from us.'
The suspected phishing email is from Veterinary Practice Resource Center, which invites veterinarians to sign up for an 'AVMA PURE CONTENT Free Webinar.'
Full story : VIN News Service
Tax Season Ushers In Scams
With taxes due April 17, most of us procrastinators will be spending the next week or so getting the necessary paperwork in order to file. But tax season also is scam season for scam artists looking to get at your personal information.
Clinton Raines, owner/agent of the State Farm insuance agency in East Atlanta, offers these tax-scamming tips for consumers to protect themselves
Full story : Patch.com
How to avoid revocable living trust cons and other tax scams
'Dirty Dozen Tax Scams' is an annual list published by the IRS, warning taxpayers that illegal schemes and scams will lead to significant penalties, and even criminal prosecution. Topping this year's list is identity theft, whereby scammers look for ways to use a legitimate taxpayer's identity and personal information to file a tax return and claim a fraudulent refund.
Other scams on the list include phishing ' fake Web sites or unsolicited e-mails asking gullible taxpayers to provide their Social Security number and their bank information because they have purportedly won such prizes as the Irish Sweepstakes.
Full story : Washington Post
New Crimes Added to Russian Criminal Code
The Supreme Court yesterday approved amendments to the criminal legislation to formalize some types of crime in separate articles, in particular loan, social benefit and insurance frauds, embezzlement of investors' funds and counterfeit credit card fraud, as well as phishing, an e-mail fraud scam designed to get unsuspecting users to reveal sensitive information such as passwords and pin codes.
The document, part of Dmitry Medvedev's policy of liberalizing the Criminal Code, is to be forwarded to the lower house of parliament in the near future. The Supreme Court paid particular attention to Article 159 on fraud.
Full story : RIA Novosti
At Long Last, Twitter Files Anti-Spam Lawsuits
Since the microblogging service exploded in popularity just a few short years ago, Twitter's most egregious problem has been spam. Type 'iPad' in a tweet, and expect a deluge of twitterbots @replying you with fake offers of $99 discount tablets.
Twitter took a new step in its fight against spammers on Thursday, filing a lawsuit in a San Francisco federal court against companies that create tools to automate posting to and following people on Twitter.
Full story : Wired News
Also see: Twitter fights spammers in new lawsuit, implements additional anti-spamming – www.theverge.com
Minimize Your Exposure to Email Spoofing
Did someone really hijack your email address to mass-mail spam messages? Not necessarily. Here's what might have happened.
Your mother calls you to ask why you keep emailing her about "enhancements," and your coworkers complain that you won't stop sending them ads. Does this sound like you?
Full story : PCWorld (blog)
Humor: Jon Stewart compares Obama to Nigerian spammer
The Daily Show's Jon Stewart lit into President Obama for his campaign's overuse of fundraising email solicitation's last night. "Seriously, there are exiled Nigerian princes getting Obama campaign emails going, 'Ease up on the money thing fella,'" Stewart joked.
Once expected to raise more than $1 billion for the 2012 campaign, Obama has repeatedly failed to match even his 2008 fundraising pace. Obama and Democrats reported raising $29 million combined in January, down from $36 million raised in the same month four years ago.
Full story : NewsOK.com
Inside Twitter's Spam Lawsuit: Fighting Five Defendants Cost More Than $700000
Twitter's costs in fighting the spam created by five defendants it's suing are more than $700,000 – and that may be a conservative underestimate.
The company is seeking full restitution of those costs and other damages, along with an injunction forcing each defendant to stop its activities, as it seeks a jury trial in a San Francisco federal court.
Full story : Marketing Land
WordPress Users : Hacked and mangled — yet again
Dan Tynan at IT World writes :
For the second time in two years my WordPress site was hacked, this time by Viagra spammers. Here are a few of the hard lessons I learned.
Full story : ITworld.com
What did you miss in the last Safenetting post
Send in your items for Safenetting readers
Facebook Safe Netting
Join / Like / contribute : UGNN FaceBook Group, (ug.netnews)
If you think you're a victim, file a complaint with the
FBI Internet Crime Complaint Center : IC3.
You can also keep up with the efforts to curb spam and cybercrime by reading the news at
Knujon and
HostExploit.com. And, you should
switch to SpamCop and take a stand against spam.


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The beat 'em up Virtua Fighter 5 will soon be revived. Sega announceda remake now calledVirtua Fighter 5 Final Showdown , which may bepublished in summer 2012 via the PlayStation Network and Xbox Live.This is not a 1:1 port.Shall be revised to include the graphic, whatwill be noticeable for example in the form of smoother animations.
Add new elements come to the gamemechanics such as destructible walls in the battle arenas.Furthermore, saying that you must look forward to new game modes andtwo additional characters. As would be both strong sumo wrestler TakaArashi Jean Kujo, and the nimble.
Details of the purchase price of VirtuaFighter 5 Final Showdown are so far just as a concrete release date.First pictures of the two new fighters can be found in our onlinegallery.


text:
Resources to help economic development and site selection professionals connect with new places and locations. The archive for The Obvious Corporation articles.
Home Tags The Obvious Corporation
The Obvious Corporation
Vegan Manufacturing Facility To Open In Columbia, MO
The facility, which is scheduled to open this fall, will use technology licensed from the University of Missouri. The company expects to invest $2 million in the plant the first year and employ more than 60 people within five years. Posted on Aug 22, 2012 @ 11:15 AM


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Still waiting for pitter-patter of puppy paws
I'm ready for a puppy.
But my wife is not -- and she's not about to cave.
At least not yet.
For now, she likes the fact that ours is a one-dog household. Mia, our 7-year-old golden retriever, is low-maintenance and lovable.
The food goes in, the food goes out -- and I'm the one who deals with both.
A puppy, however, requires real work: Training, frequent trips outdoors, the occasional mess that must be cleaned.
My wife says she just doesn't have the time for that and isn't ready for another big change in our household since our children moved out last year, one to get married and one to go to college.
But she must know the puppy is inevitable (not next week inevitable, but maybe this year inevitable).
So far, I've kept my search mostly on the down-low.
I played with a Siberian husky at the mall pet store, I was tempted by a friend's white German shepherd pups, and I recently took an instant liking to some 6-week-old chocolate labs.
There was something to like about each of them.
I figure I will get another golden, though. There's just something about the breed that suits my family.
Mia and the dog we had before her came to us from family friends in Ohio who once bred goldens.
They've since gotten out of the business, which is probably why this search is taking longer than the last two.
I will not do to my wife what my son and now daughter-in-law did to us five years ago. My son arrived on our doorstep with a puppy, a cute border collie/golden mix named Lola. He had adopted the puppy and then moved home with her. Unfortunately for me, he took Lola with him when he moved out late last year.
I miss Lola. I miss having a second set of paws pattering around the house, a second cold nose greeting me each morning.
I'd like to have that again.
Besides, Mia could use the company.
For now, though, I will continue to sell my wife on the idea.
She will cave in time. I know it.
DOUG OATHOUT can be reached at 870-1698 or by e-mail at firstname.lastname@example.com.


text:
(Jan. 17, 2012) Northern Berkshire Healthcare will offer classes for Cardio Pulmonary Resuscitation (CPR), First Aid, and Basic Life Support (BLS) for Healthcare Providers on Saturday, February 18, 2012 at North Adams Regional Hospital. The class will focus on new American Heart Association guidelines on CPR which highlight hands-only CPR.
The day will begin for students who need First Aid from 8:30 a.m. to 10:30 a.m. That will be followed by a CPR class that covers both beginners and renewal from 10:30 a.m. to 12:30 p.m. From 1 to 3 p.m. is a class for anyone who needs a new or renewal of Basic Life Support certification. Prices for classes are CPR: New-$40, Renewal-$30; CPR & First Aid: $65; First Aid: $25; BLS: New-$65, Renewal-$30.
Businesses or organizations interested in offering any combination of classes may contact REACH for Community Health at (413) 664-5321.
Basic Life Support for Healthcare Providers is intended for healthcare professionals seeking a renewal and students entering nursing, medical assistant, surgical technology, and other medical fields. The course expands on the Heartsaver level and includes information on two-person rescuer CPR and rescue breathing.
Heartsaver First Aid with CPR and AED (Automatic External Defibrillator) was designed to prepare a wide variety of people who want or need to learn CPR. The course also covers the basics of first aid. Cardiac arrest can result from heart attack, drowning, electric shock, and other problems. Studies show that effective CPR, quickly administered, improves survival from cardiac arrest.
Employees from the REACH for Community Health Department at North Adams Regional Hospital have been certified by the American Heart Association to conduct the community classes. Classes are approximately three to four hours long.
Upon demonstration of the skills taught in the course, the student will receive a Healthcare Provider or Heartsaver First Aid with CPR and AED course completion card. For more information or to register for an upcoming CPR, First Aid or BLS class, please call REACH for Community Health at 413-664-5321.


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Life insurance sucks. If you outlive your policy, you spent a lot of money for not much of anything. If you don't outlive your policy, well shucks you didn't waste your money on premiums… but you're dead.
So when my insurance company sent me a package detailing one of their newest offers, a "return of premium life insurance" policy, I was intrigued. The basics of the policy are simple – you pay premiums for term life insurance and if you outlive your policy, your premiums are returned to you. If you outlive your policy, you haven't wasted your premiums. If you don't, then the premiums were "worth" it.
What's the catch?
So where's the catch? Nothing in life is free, right?
In return for the return of premium piece, you pay higher premiums than you would on a life insurance policy without a return of premium option. The insurance company can take the difference and invest it, thus helping it generate a profit regardless of whether you outlive the policy.
There isn't a catch but does that mean it's worth it?
Are Return of Premium Life Insurance Plans Worth It?
I believe it comes down to your approach towards insurance. When you buy non-required insurance, you're buying peace of mind. For auto and homeowners, you are required to purchase it because of state law or because your lender requires it. For other insurances, like umbrella, accidental death & dismemberment, disability, or life insurance, it's about being able to sleep at night and not worrying what would happy should something bad happen.
Life insurance is tough because as I said at the onset of this post, if you outlive your policy you feel like you've wasted money. You bought insurance but you never needed it. You're happy about not needing it but you kind of wish you knew you didn't need it and could've saved that money. The return of premium plan gives you the ability to pay for not having to worry about outliving your policy.
No amount of financial comparisons or breakdowns will really help you come to grips with whether you want to do a return of premium life insurance plan or a regular term life insurance plan. If it doesn't bother you to outlive your policy, then you will probably want a regular vanilla term life plan and invest the difference in premiums. If you think outliving your plan will bother you, a return of premium plan may be for you if it gets you past that mental block and onto a policy you need (of course, if you need it, though I don't necessarily agree everyone needs it).
If you've looked at life insurance, have you considered this option? We haven't purchased life insurance yet and while this option is intriguing, I think I'd pass on it when the time comes. I'm curious to hear your thoughts on it.
(Photo: buttepubliclibrary [3])


text:
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Hi Kate: Ended up going to praise team tonight. Jen, the
Resolved Question:
Hi Kate:
Ended up going to praise team tonight. Jen, the usual drummer, texted me after practice started and asked if I wa going to be there on Sunday and if so could I come and practice because she toy forgot she wouldn't be there. P had jut told me we weren't going to the cabin this weekend, and I was still at work, which is really close to church, so I went. I should have thought it through first because (1) I was unprepared to be around everyone; and (2) I haven't even picked up drum sticks on months. I felt totally uncomfortable, but since I was behind the drums, I didn't have to chat with anyone. Jim was there he told me twice that they missed me, and he gave me a hug. I just said "thank you.". It was fine. But I felt weird. And now I have to go Sunday. I want to play drums, but I don't want to be around everyone. Oh well. It will be okay.
But I'm bumme we're not going to the cabin. Oh well. I'll get lots done here, maybe. Poor p has a colonoscopy tomorrow, so I took the afternoon off to take her. But I can do work in the waiting room. I don't envy her!
I think the adderall XR
well today, too. I was very focused and productive. Maybe when I take both together it will be even better!
It seems to me that in the last week, every might on the news there is another rape, and it's been in our area, which is really the safest (Albuquerque is split into 4 quadrants - NE, SE, SW, and NW). I don't know of it is just happening all the time now or it has always been this way and I didnt notice. Abq has really high crime, but there just seems to be a a tidal wave of this particular crime. Weird. And unnerving.
I new to think the I-could-have-died thing through. I've already talked to dr m an Linda about it. Linda has said a ton of times I coul have died, and dr m explained it pretty bluntly to me what could have happened. And she said even without anything further, that area is very vascular (which is why it heals well, but also why it can bleed a lot). It's weird, though. I have been in a lot of car accidents. I have totaled cars, tipped them over, hit buildings. And I never came even close to dying, but I have had friends who were on relatively minor accidents and died. It is weird and random and I have just been blessed to always be okay no matter what. I mean - even on 1st grade, when I fell was-first off the jungle gym onto the asphalt. I just had a concussion - a pretty bad one, but no skull fracture or anything. One of the kids down the street, the same year, fell of a swing on grass and hit his head and he had a skull fracture and almost died. I'm just fortunate. So that, in addition to other things, is why it is hard for me to imagine that I could have died. And it is so far-fetched to believe that someone might have killed me. Totally different than an accident. Also, in thinking about those shows, even though they're true stories, and I feel bad for the people and know it really happened, they don't seem real or possible, either. Like I can't believe that someone would actually do that to another human being.
Oh well. I need to get to bed. I'm all worked up - hope I can sleep!
4 years ago.
Mental Health
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Kate McCoy, M.Ed, NBCC, LPC
replied 4 years ago.
I'm sorry that you ended up having to go to church on Sunday. It sounds like everyone has a lot of expectations of you and are not focused on what you need (maybe that is just a therapist's perspective!). It would be alright for you to say no if you needed to. You are not responsible for the situations they have going on there at church. I know it's easier to say that than have to say no to people who need you, but sometimes you have to protect yourself and your needs even if they don't understand.
I was hoping that you would get a chance to go to the cabin. Working is not as much fun, that is for sure!
Poor P. I agree with you, that test does not sound fun. It's nice of you to support her during it. I bet it takes some of the
away for her, knowing that you will be there for her.
It does sound like there is a lot of crime where you live. How do you feel hearing about all the rapes going on?
You have been really blessed with all that has happened to you! God may have a purpose for you and you need to be here.
It is understandable that you have put some distance between what happened to you and the fact that you could have died. It is not easy for anyone to accept that they are that vulnerable. Most people keep the fact that they could die any day at any time at an emotional distance. You can't walk around every day with that knowledge or you would always be on edge. But in your case, the incident you went through did put you close. You coped with it at the time and you probably were in shock so you may have not absorbed what you felt. But the key here is to understand the full force of what you suffered. Being close to dying is part of that. It's not an easy concept, particularly if it has been a while since it happened. But even just talking about it like you are doing is good. Realizing it is part of the battle.
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The Lahainaluna softball team dropped its first-round game at the DataHouse Division I State Championship as Leilehua rallied in the seventh for a 6-5 victory on Tuesday at Rainbow Wahine Softball Stadium.
The Lunas (12-4) scored two runs in the top of the seventh to take a 5-3 lead, but the Mules (10-7) came back with three in the bottom half to pull out the victory.
Lahainaluna's Kuulani Haake homered and drove in three runs and Haley Ann Nakamura went 2-for-4 with two runs. Hope Morikawa pitched 6 1/3 innings, allowing seven hits and six runs, only two of which were earned.
Leilehua's Jazmyn Dangaran and Chenoa Au both scored twice, and Taezha Ann Cordero pitched a four-hitter with 10 strikeouts and hit a solo homer.
Both teams committed four errors.
The Lunas will play in a consolation game today at 11 a.m. against Kapolei, which lost 7-4 to Moanalua on Tuesday.
Fact Box
DataHouse Division I State Softball Championship
At Rainbow Wahine Softball Stadium
Tuesday's Results
First Round
Leilehua 6, Lahainaluna 5
Mililani 15, Keaau 0, 5 innings
Moanalua 7, Kapolei 4
Punahou 6, Waipahu 1
Today's Games
Lahainaluna vs. Kapolei, 11 a.m.
No. 4 Hilo vs. Moanalua 1 p.m.
No. Baldwin vs. Punahou, 3 p.m.
No. 1 Kamehameha Kapalama vs. Leilehua, 5 p.m.
No. 2 Campbell vs. Mililani, 7 p.m.
Thursday's Games
Keaau vs. Waipahu, 11 a.m.
Fifth-place semifinals, 1 and 3 p.m.
Quarterfinal winners, 5 and 7 p.m.
Friday's Games
Consolation final, 1 p.m.
Fifth-place game, 3 p.m.
Third-place game, 5 p.m.
Championship, 7 p.m.
Maui Interscholastic League champion Baldwin was seeded third and will open play in today's quarterfinals at 3 p.m. against Punahou, which beat Waipahu 6-1 on Tuesday.
No. 1 Kamehameha Kapalama, No. 2 Campbell and No. 4 Hilo also will open play today.
In the other first-round game Tuesday, Mililani beat Keaau 15-0 in five innings.


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All terms are divisible by 3. All terms satisfy the condition 2^n == 8 (mod n). The only number less than 693 which satisfies this condition and is not listed is 248, which is not divisible by 3. a(n)/3 is nearly identical to A106317(n-2) which does not contain the terms 399/3=133 and 195/3=65. - Gary Detlefs, May 28 2014
R. J. Mathar, Table of n, a(n) for n = 1..489
Eric Weisstein's World of Mathematics, D-Number.
Eric Weisstein's World of Mathematics, Knödel Numbers.
knodel:=proc(i, k)
local a, n, ok;
for n from k+1 to i do
for a from 1 to n do
if gcd(a, n)=1 then if (a^(n-k) mod n)<>1 then ok:=0; break; fi; fi;
if ok=1 then print(n); fi;
knodel(1000, 3) # Paolo P. Lava, Feb 24 2012
Cf. A002997, A050990, A050992, A050993, A208154-A208158.
Sequence in context: A175626 A096788 A050991 * A020192 A241809 A063174
Adjacent sequences: A033550 A033551 A033552 * A033554 A033555 A033556
David W. Wilson
Edited by N. J. A. Sloane, May 07 2007


text:
Compare & Save
Like most people with a small child we have come to realize that the prefilled fruit/veggie puree pouch is an invention that truly changed the way our children eat- fortunately for the better! Like many of you, we LOVE the convenience of prefilled pouches and LOVE the healthy food it is providing to our daughter, but when the grocery cart was filled with 15, 20, 30 pouches and it seemed that they were gone in the blink of an eye, the pouches started to hit us in the wallet.
This was a "lightbulb moment" that made us realize, we are not the only ones that must feel this way and there are hundreds of thousands of people in the US in the exact same boat. After some quick math at the grocery store, we realized that we would slash the cost of those prefilled pouches by simply substituting larger sized packaged products, instead of allowing these companies to take the same apple sauce they sell us in a 64oz jar for 8-cents an ounce and mark it up 5-TIMES the price just because it was in an easy to use pouch.
We understand that everyone may not be handy in the kitchen or more the case that people don't have time to prep homemade foods (Hence the astronomical popularity of the prefilled pouches). We compiled a list of the most commonly purchased pouches in our house and compared their prices versus simply filling an EZ Squeezee Pouch with store bought and often same brand product in a larger container.
If you are handy in the kitchen and have the time, be sure to click on our Recipes pages and create some great foods your self- And save even more money!


text:
Welcome back to Singles Going Steady, a weekly playlist of songs we recommend you checking out this week (or more specifically, this very moment). Some were chosen because the artist is appearing in the Valley some time in the next week. Others were chosen because they're new. The only thing they have in common is that we enjoyed them and we thought you might enjoy them, too.
1. New Pornographers "Brill Bruisers"
This is the title track and first taste of the New Pornographers' first album since 2010's "Together," and the fact that it plays to the poppier side of A.C. Newman's sensibilities can only be a good thing. And frankly, if you must make reference to the pop-hook factory that was the Brill Building when titling an album, you had best deliver on the hook front. Newman says: "This is a record. After periods of difficulty, I am at a place where nothing in my life is dragging me down and the music reflects that. We wanted 'Xanadu' and we wanted Sigue Sigue Sputnik, which translated into sparklier and faster." Newman's take on "Xanadu" is clearly artier and more cerebral than even the most ambitious ELO songs on that soundtrack, but the chorus hook is every bit as undeniable. You'll be singing along by the end of your first listen.
2. Wilco, "I Am Trying to Break Your Heart"
Yes, this song is really old, but Wilco's "Yankee Hotel Foxtrot" is one of three classic albums about to be saluted at the Crescent Ballroom by assorted members of the local music scene. And this was the opening track, serving notice that Wilco had arrived at a different type of masterpiece than the equally masterful "Being There" and "Summerteeth." It's been 12 years now since that album hit the streets and "I Am Trying to Break Your Heart" remains a highlight of the Wilco live experience, its cacophonous crescendo and dynamic explorations having taken the template of "Misunderstood" into challenging new territory.
Details: Cover the Crescent. 8:30 p.m. Friday, June 13. Crescent Ballroom, 308 N. Second Ave., Phoenix. $5-$7. 602-716-2222, crescentphx.com.
3. Guided by Voices, "Planet Score"
It's good to see Guided by Voices still bringing power-chord bombast with the swagger of the "Who's Next"-era Who (without the synthesizers). You can barely make out Robert Pollard's vocals over the crushing guitars that drive this track, but it's more than worth your while to listen closely and try to decipher what he's saying, which I'm pretty sure includes the bittersweet opening line, "You could have gotten them all in the Planet score / They're like the ghosts of Motown / You just don't see them anymore."
Details: 8 p.m. Sunday, June 15. Crescent Ballroom, 308 N. Second Ave., Phoenix. $31; $28 in advance. 602-716-2222, crescentphx.com.
4. How to Dress Well, "Face Again"
After setting the tone with the claustrophobic wheezing of a synth, the spotlight shifts to the trembling vocals that define this record's melancholy soul. "Girl, the daylight, it don't have to hide truth," he sighs. "And you know this before I have told you." It's a sparse arrangement with ominous, pitched-down backing vocals adding to the tension as it builds to a soulful chorus of "I don't think you know what's best for me."
5. Blonde Redhead, "No More Honey"
Much like New Pornographers, Blonde Redhead haven't hit us with an album since 2010. And this first taste of "Barragan" is an atmospheric waltz with a seasick guitar riff and all the breathy pouting you'd expect from Kazu Makino, who delivers the lyric"Whatever you do, I won't be sorry" in a way that leaves you wondering if she means that in a good way or a bad way.
6. Operators, "True"
Dan Boekner and Sam Brown, who previously worked together on one of the greatest indie-rock releases of the decade with Divine Fits, are at it again, this time joining forces with Devojka. It's a total throwback to the synth-pop era, managing to work a cool robotic groove with some actual swagger (just like David Bowie would have wanted).
7. Polica, "Raw Exit"
More synth-pop, this time served with arcade sound effects, a chilly atmosphere and a sultry detachment on the mike that somehow puts the sexy in a chorus that demands to know, "Who's ready to die alone?"
8. The Mountain Goats, "Amy AKA the Spent Gladiator"
John Darnielle made a name for himself in the '90s with a string of lo-fi home recordings that put the singer's idiosyncratic voice and richly detailed lyrics front and center. He may have fleshed things out a bit since then. But that voice and those lyrics remain just as striking, starting "Transcendental Youth," the Mountain Goats' latest release, with this song. "Do every stupid thing that makes you feel alive / Do every stupid thing to try to drive the dark away," he advises before suggesting that you "jump in front of trains all day and stay alive."
Details: 8 p.m. Wednesday, June 18. Crescent Ballroom, 308 N. Second Ave., Phoenix. $25; $22.50 in advance. 602-716-2222, crescentphx.com.
9. Au Revoir Simone, "Fade Into You"
This is the second time this synth-pop trio have been featured in this column. This time, it's a haunting cover of a Mazzy Star with a guitar and bass from the Strokes' own Nikolai Fraiture.
10. Tom Petty, "American Dream Plan B"
This is the first track we've heard from the forthcoming Heartbreakers' album that's been hyped as a return to the sound of their earliest efforts, but in truth the sound is trashier and much closer to garage-punk than the hype suggests, with a sparseness that places it closer to Spoon. And Mike Campbell's guitar solo closes the deal with a speaker-shredding tribute to early Kinks.


text:
Foundation Pack XREF Migration Utility
By Lionel Dubreuil-Oracle on Feb 16, 2012
The Foundation Pack XREF Migration Utility is a tool to perform a one-time migration of cross reference (XREF) data from the existing single XREF_DATA table to new multi-tables, which may yield performance benefits for customers with large XREF tables.
If you work with large XREF tables, splitting up the single XREF_DATA table into one table per XREF artifact improves cross reference lookup performance. The XREF Migration Utility updates the metadata in the XREF artifacts for this multi-table use case, as well as generates a set of scripts that create a new table for each artifact and migrate the corresponding XREF data to them.
For more information, please look at the "Foundation Pack XREF Migration Utility" page on Oracle Technology Network (OTN).


text:
Author Affiliations: Program on Ethics and the New Biosciences, Oxford Uehiro Centre for Practical Ethics, and The Ethox Centre, Department of Public Health and Primary Health Care, University of Oxford, Oxford, England.
Physicians sometimes refer to a "window of opportunity" for withdrawing life-sustaining treatment in patients with acute severe brain injury. There is a period of critical illness and physiological instability when treatment withdrawal is likely to be followed by death but prognosis is uncertain. If decisions are delayed, greater prognostic certainty can be achieved, but with the risk that the patient is no longer dependent on life support and survives with very severe disability. In this article I draw on the example of birth asphyxia and highlight the role that the window of opportunity sometimes plays in decisions about life-sustaining treatment in intensive care. I outline the potential arguments in favor of and against taking the window into account. I argue that it is, at least sometimes, ethical and appropriate for physicians and parents to be influenced by the window of opportunity in their decisions about life-sustaining treatment.
In intensive care, it is not uncommon for critically ill patients with poor prognosis to be allowed to die. Most deaths in pediatric and neonatal intensive care units follow decisions of this nature.1- 8 Life-sustaining treatment (LST) is sometimes withdrawn or withheld because it is thought highly unlikely that the patient will survive; treatment is futile. Alternatively, treatment is sometimes limited because of predictions of the patient's quality of life.2,4,5 The burdens of treatment, illness, and impairment are sufficiently great that it is not believed to be in the patient's best interests to continue active efforts to keep them alive, even though it is possible or even probable that, with treatment, they would survive.9,10
In the latter case, there is sometimes a sense of urgency about treatment decisions. This particularly applies to acute severe brain injury, for example, following stroke, acute hypoxia-ischemia, or trauma. Some physicians refer to a "window of opportunity" to decide whether to limit LST.11- 14 The concern is that, if decisions are deferred or delayed, the patient may no longer be physiologically dependent on intensive care treatments. At that stage, even if decisions are made by family members to limit further intensive care, there is a risk that the patient will survive with very severe impairment.
In this article I will assess some of the ethical questions raised by the window of opportunity in intensive care. I will draw on the example of hypoxic-ischemic encephalopathy in newborn infants and assess the potential arguments in favor of and against the window. I argue that it is, at least sometimes, appropriate for parents and physicians to take into account the window of opportunity in their decisions about LST.
One condition in which the window of opportunity question is sometimes raised is birth asphyxia, or newborn hypoxic-ischemic encephalopathy (HIE). Moderate or severe degrees of HIE affect 2 to 4 infants of every 1000 live births.15- 17 Despite the recent development of hypothermia as a form of neuroprotection for asphyxiated infants, almost half of those affected either die in the newborn period or survive with severe impairment, including cerebral palsy, global developmental delay, blindness, and deafness.18,19
Given the poor outcome for many infants with HIE, it is unsurprising that parents and physicians sometimes question whether LST should continue. Most deaths in infants with HIE in developed countries follow decisions to limit LST.2,16,20 Deaths usually occur in the first few days after birth, when infants are dependent on mechanical ventilation and/or inotropic support. Perinatal hypoxia-ischemia leads to early multiorgan failure in many infants with HIE,21 with improvement often occurring after 72 hours.22,23 Prior to this point, withdrawal of LST is likely (though not certain) to lead to the infant dying quickly.
However, prognostication in HIE is challenging.24 There are various tools used to help assess the prognosis of asphyxiated infants including clinical assessment, electrophysiological tests, and imaging of the brain. But most of these tools face the same problem, that early predictions are more fallible than later predictions.12 For example, magnetic resonance imaging of the brain is recommended for all infants with HIE25 and provides detailed, specific information relating to areas of brain injury and future impairment.23,26- 28 But early magnetic resonance imaging is significantly less accurate than later imaging.29,30 Furthermore, obtaining magnetic resonance imaging may lead to delays in decision making owing to difficulties organizing a scan, arranging transportation, and having it reported.31
What are the consequences of delayed prognostication (Table 1)? The main one is that infants may no longer be dependent on respiratory support.32 Spontaneous respiratory drive in infants with HIE is related to the severity of injury, degree of brain swelling, and use of sedatives or anticonvulsants.22 There is little available data on respiratory function in asphyxiated infants,33 and none on the timing of return of spontaneous respiration in such infants. However, in one recent study of infants with moderate or severe HIE treated with hypothermia, 40% of infants were extubated in the first 3 days after birth.34 If infants are not ventilator dependent, there is the possibility of withdrawal of other (less intensive) forms of treatment, for example, artificial nutrition. The most severely affected infants with HIE usually have impaired ability to coordinate sucking and swallowing and are dependent on artificial nutrition (usually by a nasogastric tube in the short term) to survive. But although some professional guidelines support withdrawal of nutrition,9,35 it is highly contentious,36- 39 is not offered in many places, and has been argued to be contrary to the interests of infants.40 If artificial nutrition is withdrawn, it can take 3 weeks or longer for infants to die.38
The window of opportunity for treatment limitation decisions in infants with HIE has been mentioned in passing by researchers32,41 but it does not feature at all in most descriptions of prognostication in HIE.22- 24,42 In a recent study of English neonatologists' views about prognostic tests and decision making in HIE, it was clear that this was an important consideration for at least some physicians caring for infants with asphyxia13: "There is a 'window of opportunity' to withdraw with dignity for the child and for the family and if you don't withdraw during that window of opportunity, the child then may start to respond, may then start to breathe, may come off the ventilator and may survive and is profoundly handicapped."13 Another clinician noted the potential effect of this on decisions: "There is some urgency . . . on the one hand you don't want to push parents, you specifically say you don't want them to rush to a decision about anything, on the other hand they need to be aware that there probably is a much greater chance of the child to survive without the ventilator the longer you delay."13 On the other hand, 2 neonatologists expressed a degree of ambivalence about the idea of a window of opportunity, stating, "I am not sure I quite buy into that personally. . . . The fact that the baby might survive doesn't mean to say that you have made the wrong decision" and "But whether it truly is used in decision making I'm uncertain. I'm not so sure that I use it."13
Are there reasons to avoid considering the window of opportunity? One general concern relates to quality-of-life judgments. Some clinicians, ethicists, and disability rights advocates contend that a diminished quality of life is not sufficient grounds for withdrawing LST.43,44 If it is only permissible to withdraw treatment when death is inevitable, then a window of opportunity cannot arise. However, both professional guidelines and legal cases have supported the relevance of quality-of-life considerations in treatment decisions.9,10,45,46
Specific objections to the window of opportunity include discomfort with the term itself, uncertainty, the burden of treatment, and the doctrine of double effect.
The term itself may partly explain clinicians' disquiet. The phrase potentially connotes that the death of the patient is opportune, whereas for families (and the infant), death represents a terrible misfortune. It might be thought insensitive to raise or even to contemplate the "opportunity" of death. However, in some instances it may be a greater misfortune if the infant survives.
A second reason relates to avoidance of prognostic uncertainty. Uncertainty is a particular problem for prognostication in newborn infants.24,47 Observing infants over time to see if they show neurological recovery can reduce this uncertainty.24 For this reason, some authors have recommended that prognostication should be deferred until after the first week of life.24
However, uncertainty is inevitable in decision making for newborns.9,32 The important question is not whether there is uncertainty but whether there is sufficient uncertainty that treatment must continue. Attempting to reduce uncertainty may have costs, and whether that is worthwhile depends on how those costs are weighed against the benefits of avoiding uncertainty. Cochrane has argued48 that there is no urgency to make decisions about treatment, for example, in adult patients following a stroke, because there is always the option of withdrawal of artificial nutrition. But given the contentious nature of withdrawal of feeding in newborn infants and the possibility of prolonged suffering, some parents and physicians may choose to withdraw treatment earlier, even at the cost of greater uncertainty.11
A related objection is that the window of opportunity is not a relevant consideration for treatment decisions because it is not permissible to withdraw treatment from infants who only need short periods of life support. It might be believed that recovery of respiratory drive portends a good prognosis, or a sufficiently good prognosis that treatment withdrawal should not be countenanced. To my knowledge, however, there is no published evidence on the return of spontaneous breathing and prognosis for infants with HIE. Anecdotally, some infants maintain or recover respiratory drive despite very severe patterns of brain injury.13,36,49 It would have been permissible to allow these infants to die if they had still been ventilator dependent.
A second version of this objection relates to the burden of treatment. If an infant will only require a short period of respiratory support, the burden of treatment is relatively minor. It is unpleasant for the infant to have a breathing tube in place, but sedation and analgesia can be provided to reduce any discomfort. In some views, it is only permissible to withdraw or withhold treatment when the burdens of treatment outweigh the benefits; this may not be the case for a short period of life support. But in the face of severe predicted impairment, there are other treatments that may permissibly be withheld that are even less burdensome than a short period of respiratory support. For example, in such infants it is sometimes felt to be acceptable (if the parents choose) to withhold treatment with antibiotics for a respiratory infection. Yet the discomfort and burden associated with a course of antibiotics is minimal. If it is permissible to withhold antibiotics it must be permissible to withdraw mechanical ventilation, even when it would only be required for a short period.
A more significant concern is that consideration of the window of opportunity potentially conflicts with the doctrine of double effect (DDE). The DDE is widely cited as providing a boundary for permissible actions in end-of-life decisions.32,50- 52 It governs actions that have 2 potential effects, 1 good and 1 bad. According to the DDE, it is impermissible to intend to hasten the death of the patient, but it is permissible to perform acts that unintentionally (or as an adverse effect) hasten death.50 The problem is that, if the timing of treatment withdrawal is influenced by whether the infant will die (when extubated), it may appear that death is either intended or is, at least in part, one of the direct goals of extubation. One of the neonatologists interviewed in a recent study suggested, "In some respects the outcome is the outcome . . . you can decide [that] continu[ing] intensive care is not the right thing to do but you are not necessarily doing that so that the baby dies."13
Can the window of opportunity be reframed so that it does not conflict with the DDE? The primary goal of the physician is to respect the interests of the infant. It may be in the best interests of an infant to have treatment withdrawn earlier rather than later, if later withdrawal will lead to survival in a state of severe impairment or to a slow death following withdrawal of artificial nutrition. However, if it is in the best interests of the infant to die, and it is those interests that are the goal of treatment withdrawal, the DDE would still potentially prohibit treatment withdrawal. One of the standard conditions of the DDE is that the good effect is not produced via the bad effect.53,54 A physician administering morphine to a patient may not do so to serve the best interests of the patient (when the death of the patient is believed to be in their best interests). The physician may, however, give morphine to provide pain relief (a different goal), even if this would also predictably lead to the death of the patient.
A more promising answer, perhaps, is that the physician's goal in withdrawing treatment is not to hasten the infant's death, but to respect parents' request that treatment be withdrawn. If parents are justified in a belief that continuing treatment would not be in the infant's best interests, their wishes should be respected. Parents may choose earlier withdrawal of treatment, partly to avoid the infant's survival with severe impairment. The question may then shift to whether the DDE applies to parental requests as well as to physicians' actions.
On the other hand, perhaps the doctrine itself should be rejected for treatment withdrawal decisions on the basis of predicted quality of life. A full discussion of the DDE is beyond the scope of this article.53- 57 However, one reason to support such a view is that it is permissible to withdraw treatment, though that will lead to the death of the infant. Indeed, if treatment is being withdrawn on the basis of predicted quality of life, the death of the infant must necessarily be judged to be better than continued life and treatment. It seems hypocritical to suggest that this cannot permissibly be one of the goals of action.
Table 2 below provides a summary of potential arguments in favor of and against the window of opportunity in treatment limitation decisions.
If it is appropriate to consider the window of opportunity in decisions about life-sustaining treatment, how should parents and physicians decide about the timing of treatment withdrawal? These decisions are particularly difficult because of the conflicting values at stake (Table 1). One possibility that I have explored in detail elsewhere would be to draw on decision theory.12 However, in practice, this would be extremely difficult to apply because of problems quantifying the probabilities and values of different outcomes.12
More generic guidelines could be generated. This discussion highlights 2 necessary conditions for withdrawal of treatment. The first is that the most likely outcome for the infant is sufficiently severe that it would justify treatment limitation if it were known with certainty58; it must be a "fate worse than death." Second, there must be a minimum level of certainty about that outcome. There is no way to express this quantitatively, but one potential way of capturing this is that treatment may be permissibly withdrawn if there is clear and convincing evidence that an infant will be very severely impaired if they survive.58
Families will differ in what they judge to be a sufficiently severe outcome and a sufficient level of certainty to warrant withdrawal of treatment. But the two factors are related. The worse the outcome if the infant survives (for example, the longer they are likely to survive and the more suffering they are likely to experience), the greater the amount of uncertainty that could be tolerated.
The generic features of the window of opportunity are early critical illness with uncertain prognosis and later physiological recovery coinciding with more certain outcome assessment. In this article I have focused on the example of newborn infants with HIE, but similar situations are seen in many forms of acute brain injury, from extremely premature infants with intraventricular hemorrhage to elderly patients with cerebrovascular accidents.
It is not clear how often or how much this factor influences treatment decisions, but it appears to be an important consideration for at least some clinicians. I have outlined above the potential arguments in favor of and against the window of opportunity playing a role in decisions. Some will oppose the window of opportunity because they reject withdrawal of treatment on the basis of predicted quality of life. Others may oppose it because of the uncertainty associated with early decision making. Nevertheless, it is generally accepted that it is appropriate to take into account the patient's quality of life in judgments about best interests. Complete certainty about prognosis is almost never achievable.
There is a need for better data on the timing and prognostic significance of the return of respiratory drive in infants with HIE. However, there is also sometimes a need to raise the possibility of a window of opportunity for treatment withdrawal with family members. This requires sensitive discussion about prognosis and uncertainty. Decision making should not be rushed, but families should be aware that infants may not die after treatment is withdrawn and that, in some cases, this is more likely if decisions are delayed.
Although dealing with uncertainty can make decisions difficult, when the outcome is sufficiently severe and there is enough certainty about prognosis, it is both ethical and appropriate for parents and physicians to take advantage of the window to withdraw LST.
Correspondence: Dominic Wilkinson, MBBS, BMedSci, MBioeth, DPhil, FRACP, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes, Oxford OX1 1PT, England (firstname.lastname@example.com).
Accepted for Publication: August 23, 2010.
Financial Disclosure: None reported.
Funding/Support: This study was supported by an Oxford Nuffield Medical Fellowship, Eric Burnard Fellowship, and Royal Australasian College of Physicians Astra-Zeneca Medical Fellowship.
Role of the Sponsor: The funders had no involvement in this work.
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John W. Campbell
From Wikiquote
John Wood Campbell, Jr. (8 June 1910 – 11 July 1971) was an influential American science fiction editor and writer, known for his challenges to writers.
|This article on an author is a stub. You can help Wikiquote by expanding it.
- History does not always repeat itself. Sometimes it just yells, 'Can't you remember anything I told you?' and lets fly with a club.
- Statement in Analog Science Fiction/Fact magazine (1965)
- Immunity corrupts; absolute immunity corrupts absolutely.
- Editorial in Analog Science Fiction/Fact magazine (1970)
- Of course, I never wrote the "important" story, the sequel about the first amplified human. Once I tried something similar. John Campbell's letter of rejection began: "Sorry — you can't write this story. Neither can anyone else."
- to Vernor Vinge, after Vinge proposed writing a story about the first human with hyper-amplified intelligence. (From Vinge's comments on "Bookworm, Run!" in The Collected Stories of Vernor Vinge.)


text: On Wed, Jul 23, 2003 at 08:26:59AM -0400, ne... wrote: > Er, this is aktually a fix (-: The preemption patches made it > into the kernel so now your mouse will fly. We're not enabling preemption right now in 2.6 -- it's not quite ready yet, needs more time to harden (no offense intended, taking a while to "set" isn't unusual for a functionally invasive change...), FYI. michaelkjohnson "He that composes himself is wiser than he that composes a book." Linux Application Development -- Ben Franklin http://people.redhat.com/johnsonm/lad/


text: Critical Congenital Heart Defects Screening Bill Signed Into Law by Pamela M. on Monday, March 11, 2013 Governor Dennis Daugaard signed SB 168 to ensure newborn babies are screened for CCHD before leaving the hospital. The bill enjoyed strong, bi-partisan support throughout it's journey through the legislative process. The bill will go info effect on July 1st. The success of this initative was due in large part to the strong advocate involvement across South Dakota. CLICK HERE for the public news service story. We encourage all advocates to send a note of thank to Governor Daugaard and bill sponsors for supporting this life-saving bill. Visit our Action Center to send your message! « Now share your story Share This


text:
On a research trip to the National Archives some years ago, I was privileged to hold the framed French exchange copy of the Louisiana Purchase. Staring at the bold signature of Napoleon Bonaparte, I was awestruck. This document was not just a question on a history test (1803); it was a link to monumental events and a tangible survivor of time's oblivion.
Readers will glimpse some of that grandeur in David Howard's tale of a stolen original copy of the Bill of Rights and its wayward journey through the centuries. They will also get a down-and-dirty tour of the murky, sometimes ethically ambivalent universe of the high-dollar historic-document trade, in which uncomfortable questions like "Where'd you get this thing, anyway?" can be dodged for decades. Ultimately, this story is about "the madness that sometimes resulted when you mixed all that money and passion together."
The document in question originally belonged to North Carolina, one of the 13 states that received copies of the Bill of Rights from the federal government in 1789. Almost a century later, during the Civil War, North Carolina's copy vanished from the state capital of Raleigh when Gen. William Sherman's forces swept through like ravaging locusts. By 2007, the document had been regained by North Carolina and displayed for the public.
But that simple summary does not do justice to Howard's obsessively detailed history of this "numinous artifact." He takes us back to the document's origins, when James Madison formed the amendments to the Constitution to mollify critics who demanded guarantees of fundamental human rights. (North Carolina would not approve the Constitution until these guarantees were included, which boosts the historical importance and value of its copy.)
From there we meet the Union soldiers who probably looted the document, one of whom then sold it - for $5 - to a man named Charles Shotwell in 1866. This copy of the Bill of Rights remained in the Shotwell family for the next 124 years, often hanging unprotected on a wall like an old drugstore calendar.
By 1990, the document had passed down to Charles Shotwell's two aging granddaughters, who decided to sell it. And that's when Howard's tale really gains momentum: Enter Wayne Pratt, a dealer in antique American furniture who gained a national reputation as a flamboyant guest appraiser on the PBS show Antiques Roadshow.
Pratt, who had a jeweler's eye for the subtle differences between a Newport kneehole desk that might fetch $50,000 and one that could be turned for $1 million, knew nothing about historic documents. But he smelled a major payday, perhaps a big chunk of $20 million, if the broadsheet could be authenticated and if he could solve the question of provenance - i.e., who had legal right to the copy. Was it a legitimate spoil of war, a family heirloom or the property of North Carolina?
Lost Rights sometimes suffers from an overabundance of detail and a dense thicket of back stories, but Howard always manages to make us care about the fate of this sacred secular text.
"In such documents the life forces of the nation's founders live forever," writes Howard. And, as he convincingly illustrates, so do forces nowhere near as noble.
Chris Tucker (www.ctucker .wordpress.com) is a Dallas book collaborator and commentator for KERA-FM (90.1), National Public Radio.
Lost Rights
The Misadventures of a Stolen American Relic
David Howard
(Houghton Mifflin Harcourt, $26)


text:
celebrity life
Ellen's fact-finding mission Down Under
- From: news.com.au
- January 22, 2013
- Ellen's producers scouting locations for her tour
- TV host will fly two fans over the US and back
- 'You may wanna pack a bag and get your passport ready'
ELLEN fever kicked up a few notches today with a surprise announcement, as her production crew found some lucky Aussies to take to her show in LA.
Ellen Degeneres will fly two Australian fans over to the US for a taping of her show, before she comes over here for an Oprah-esque tour in March.
Today she gave tickets to two lucky fans at the Sydney Opera House.
The hugely popular presenter whipped fans into a frenzy last night, encouraging them to get down to the Sydney Opera House in time for this morning's announcement.
"(Tuesday's) a big day, Australia. If you're near the Sydney Opera House you may wanna pack a bag and get your passport ready. Seriously," she teased her Twitter followers.
"Before I go Down Under, someone in Sydney's gonna have a chance to come up over. I hope you're free tomorrow at 9:30am."
She urged local fans to bring their passports and luggage to a live cross with her producers from the Opera House.
About a dozen Ellen show crew flew into Melbourne on Saturday night, then on to Sydney on Sunday, after a day in Melbourne, to begin scouting for locations for the host's Oz odyssey.
Her producers yesterday toured Circular Quay, took a Sydney BridgeClimb and enjoyed lunch at Cafe Sydney before settling on the upper level of the Opera House for today's live cross.
Ellen and her wife Portia de Rossi are due in Australia around March 17, to "do tape pieces and meet the fans and hang out".
- with The Daily Telegraph
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Comments on this story
not again of NSW Posted at 12:26 PM January 22, 2013
Another junket that we won't get anything from except the bill.
Peter of Perth Posted at 12:08 PM January 22, 2013
As usual, the east coast is all there is to Australia.
MELISSA WILL of Australia Posted at 10:41 AM January 22, 2013
Bring Lee DeWyze with you PLEASE. !!!!!!


text:
BMS truck race now Thursday morning
BRISTOL, Tenn. - Rain washed out NASCAR's Truck Series race at Bristol Motor Speedway on Wednesday night.
The race has been rescheduled for Thursday morning at 10 a.m.
Defending race champion Kyle Busch is set to start up front after winning his fourth pole of the season earlier in the day at 124.662 mph. Cole Custer, a 16-year-old rookie driver, qualified second 15.414 (124.484).
Earlier Wednesday evening, NASCAR Whelen Modified Series rookie Tommy Barrett Jr. captured the Bush's Beans 150 race.


text:
Name: Aubrea Phipps
School: Everett
Age: 17
Article Photos
Grade: 11
Sport: Basketball
Athlete of the week achievement: Phipps scored 20 points in a victory over Windber in the District 5 Class AA quarterfinals.
Season update: Phipps is averaging 18.2 points, 11.6 rebounds and 1.6 blocks.
Coach Keith Moyer's quote: "She's had an up-and-down season. She's playing her best basketball this month after the pain she had in her ankle earlier in the year. She's one of those quiet leaders. She lets her game speak for herself.''
Favorite teacher: Mrs. Dodson
Favorite subject: Anatomy
Favorite movie: "P.S. I Love You"
Favorite food: Hot wings
Favorite song: "The Motto" by Drake
Outside interests: Golfing, shopping, hunting, hanging out with friends
Favorite professional team: Pittsburgh Steelers
Favorite college team: Duke
Pro athlete most admired: Tim Tebow
Best athlete I ever played with: Homer-Center's Katelyn Skinner
Best athlete I ever competed against: Delone Catholic's Sierra Moore
Most influential person on my athletic career: My parents and coaches Moyer and Pierce.
Proudest athletic achievement: "Scoring my 1,000th point in my junior year.''
How I got my start in basketball: "My dad."
Future goal: "To go to college and become a nuclear medicine technician."


text:
Maria Blevins is a scholar of organizational and environmental communication, with research focusing on sustainability and environmental conflicts, especially those concerning water.
Teaching a range of classes, Maria enjoys helping people explore theories and skills that interests them.
She received her undergraduate degree from the University of Maine at Machias, her M.A. from the University of Montana, and completed her PhD at the University of Utah. In her spare time, she loves to whitewater raft and play guitar.


text:
Enhanced Oil Recovery (EOR): Optimized Surfactant-Polymer Flooding Technologies
May 1 @ 12:30 PM - 1:30 PM - Neil Armstrong Hall of Engineering, Room B071
In recent years, chemical flooding has regained its popularity worldwide because of diminishing oil reserves, high oil prices, and advances in new chemicals and technologies for enhanced oil recovery (EOR). Among the broad spectrum of chemical EOR technologies, surfactant-polymer (SP) flooding appears particularly promising. It is, at basis, a variation of micellar-polymer (MP) flooding that prevailed during the 1970s and 80s. After the 1990s, fewer MP projects were conducted in oilfields due to the unreasonably high cost of chemicals. Only a handful of field MP projects have been reported in the open literature. The major technical challenges to MP flooding, aside from the cost of chemicals, were poor understanding of interactions between surfactant and polymer, lack of high-quality surfactant and polymers, and loss of surfactant and polymer in reservoir.
In the SP process, a low concentration of surfactant is used to achieve ultra-low interfacial tension between the trapped oil and the injection fluid/formation water, while the high-viscosity injection fluid provides a favorable mobility ratio. SP performs comparably to alkaline-surfactant-polymer (ASP) flooding, but eliminates issues such as scale buildup and polymer degradation associated with ASP. With careful design and optimization, SP flooding could be a technically viable and cost-effective chemical EOR process for various types of heavy/medium/light oil reservoirs with different rock and fluid properties. Comprehensive and systematic laboratory studies should be conducted to provide guidance for field implementations.
The presentation discusses the key recovery mechanisms of SP flooding that capitalize on the synergistically beneficial interactions among the surfactant, polymer, formation brine, and reservoir rocks for efficient oil mobilization and displacement. Several representative SP field flooding projects are discussed in detail from laboratory evaluation to field implementation. It concludes by proposing a number of research topics in two categories for studying the fundamentals of SP flooding: interactions of i) surfactant-polymer systems and of ii) liquids-solid surfaces. Understanding of these fundamental concerns will help better formulate effective SP systems and design field injection schemes for specific reservoir conditions.


text:
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Boxshot & Details
- Developer: Cauldron Ltd.
- Publisher: Activision
- Genre: Action Shooter First-Person
- Release: Nov 14, 2006
- ESRB: Teen
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text:
On Fri, 31 Oct 2003 18:12:47 +0000, Xoono.net wrote:
> Hello,
> I wanted to upgrade my Mozilla version to 1.5 but I did not find any
> binary distribution so compiled it and I am making the tar available for
> download in my website, I hope some of you will find it useful.
> http://www.xoono.net/mozillatars.html
> Thank you.
For all of your PPC Mozilla/Firebird needs....
I wonder if these guys are going to port Thunderbird as well...
My mailbox is NOT an advertisement medium. Tehrasha Darkon
My address is NOT for sale, lease or rent. firstname.lastname@example.com
Send me spam, lose your account. Get it? TINLC-1372
http://tehrasha.mamehost.com/bastard B.A.S.T.A.R.D