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Shaw-Battista, Jenna CNM, PhD; Fineberg, Annette MD; Boehler, Barbara CNM; Skubic, Blanche CNM; Woolley, Deborah CNM, PhD; Tilton, Zoe MD
From Sutter West Medical Group, Davis, California.
See related editorial on page 503 and related articles on pages 673, 678, and 683.
The authors appreciate the contributions of clinicians at the site of the quality assessment project who provided data, guidance, and editing of this manuscript, including Beth Johnson, MD (Sutter West Medical Group), and Leon Schimmel, MD (CommuniCare Health Centers, Inc.).
Presented at the 2011 annual meeting of the American College of Nurse–Midwives, May 24–28, 2011, San Antonio, Texas.
Corresponding author: Annette Fineberg, MD, Sutter West Medical Group, 2020 Sutter Place, Davis, CA 95616; e-mail: email@example.com.
Financial Disclosure The authors did not report any potential conflicts of interest.
OBJECTIVE: To evaluate maternal and neonatal outcomes of collaborative maternity care for a socioeconomically diverse patient population in a California community hospital.
METHODS: Collaborative practice structure and clinical guidelines were analyzed, as were de-identified electronic medical records for all primiparous women who delivered term singletons between 2000 and 2010 (N=4,426). Demographics, care processes, and perinatal outcomes were compared among women seen prenatally in a private collaborative practice compared with a Federally Qualified Health Center prenatal clinic run by nurse–midwives.
RESULTS: Evidence-based practices were used to achieve excellent perinatal outcomes. Three quarters of women received intrapartum nurse–midwifery care (74.4%). Few differences were seen in management or outcomes among women from different prenatal clinics despite significant variation in demographic and clinical characteristics. Private practice patients were older, less likely to be obese, and more likely to speak English compared with counterparts from public health clinics. They were also more likely to use hydrotherapy or epidural analgesia, or experience severe perineal laceration and repair. Overall, pharmacologic pain relief methods were limited: less than a quarter of primiparous women used narcotics (21.2%), epidural analgesia (23.7%), or warm water immersion (23.2%). Labor induction and augmentation, and cesarean delivery rates (12.5%), were similar among groups and low overall.
CONCLUSION: A collaborative practice of low-tech, high-touch care results in high-quality maternity services. The care model holds promise for replication to address health disparities by limiting obstetric interventions and warrants further investigation with regard to associated costs and resultant outcomes.
A collaborative practice of obstetricians and certified nurse–midwives in Yolo County, California, was founded in 1979 in response to women's requests for natural childbirth and increased participation in their health care. The practice was strengthened by a shared commitment to provide obstetric services to women without means and has evolved into a successful model that provides high-quality, family-centered maternity care. The collaborative practice serves diverse communities through a physician-owned suburban private practice, and a federally qualified health center with primary and prenatal clinics throughout the county. The patient population, collaborative practice, and selected perinatal outcomes have been described previously.1–4 Women seen prenatally by members of the collaborative practice give birth at Sutter Davis Hospital, a 45-bed community facility with a level I nursery located in a college town situated between two major metropolitan areas and expansive agricultural areas.
The collaborative practice philosophy includes extensive prenatal education, shared decision-making, and judicious use of obstetric interventions in accordance with evidence-based clinical guidelines that are developed collaboratively. Interprofessional clinicians believe that high-touch, low-tech care practices resulted in the limited use of pharmacologic pain relief methods and obstetric interventions, and optimal perinatal outcomes observed previously at the site.1–4 Further, postpartum patient satisfaction has ranked in the 91st through 95th percentiles over the past decade according to Press-Ganey national surveys. The objective of this quality assessment study was to re-evaluate the model of care and maternity services provided by the collaborative practice, and assess both adherence to stated philosophy and the quality of resultant maternal-neonatal outcomes in the socially and economically diverse child bearing population.
Members of the collaborative practice undertook a review of organizational structure, clinical policies, and quality improvement data in response to the joint call for manuscripts about collaborative maternity care issued by the American Congress of Obstetricians and Gynecologists and the American College of Nurse–Midwives in 2010. Practice members actively participated in efforts to identify key administrative factors and clinical guidelines that have contributed to the longevity and success of the collaboration.1–4 This quality assessment project had three additional goals: 1) articulate a shared philosophy of collaborative maternity care developed through an iterative process undertaken by interprofessional group members, 2) re-evaluate the evidence base for intrapartum management as part of ongoing clinical guidelines review, and 3) analyze de-identified electronic medical record data from 2000 to 2010 to assess whether maternity care practices or perinatal outcomes differed among first-time mothers who were seen prenatally by a nurse–midwife in a federally qualified health center compared with those seen by a nurse–midwife or obstetrician or both in the collaborative private practice.
Intrapartum care practices and outcomes data were analyzed for the 5,283 vertex singleton term births (more than 37 weeks of gestation) to primiparous women at the site during the study period. Deliveries by family practice physicians and other providers outside of the collaborative practice were excluded from analyses, leaving a sample of 4,426 primiparous women. Details about the collaborative practice structure, organization, and clinical guidelines are available in Table 1 and the Appendix. Clinical variables were selected for study a priori based on national quality measures and previous research demonstrating health disparities between patients in public and private maternity care settings.5,6
Medical record data were extracted from the First Pregnancy and Delivery database, a regional quality initiative of Sutter Health that uses a standardized primiparous patient population to facilitate comparisons between hospitals within and outside of the Sutter Health system.7–9 The use of de-identified First Pregnancy and Delivery data for this quality assessment project did not require approval from the Sutter Health Central Area Institutional Review Committee. Clinicians and administrative staff prospectively enter First Pregnancy and Delivery data during routine clinical charting, billing, and interface with county and state birth certificate and newborn screening programs. The validity of these data has been established in previous perinatal outcomes assessments, and related quality improvement measures have helped to minimize missing data and increase the number of parameters tracked at the site over time.7,8
After First Pregnancy and Delivery data were obtained, SPSS was used to generate crosstabs, perform hierarchical multiple logistic regression and χ2 testing, and compare means using independent samples t tests. Bivariate analyses were performed because regression analyses failed to reveal significant interactions between demographic factors, pre-existing clinical conditions, care processes, and perinatal outcomes. Analyses included the complete number of cases for each variable by list wise deletion; differences in sample sizes are primarily related to the timing of First Pregnancy and Delivery database modifications and inclusion of additional parameters. Given the large sample size, stringent criteria were selected to reduce type I error; findings were considered significant with a P<.01. Nonetheless, the study may have insufficient power to detect differences among groups for rare perinatal outcomes (eg, fetal demise) because of an insufficient number of cases (type II error).
Clinical and demographic characteristics and risk factors are summarized in Table 2 with reference to site of prenatal care. Most women who gave birth at the hospital spoke at least some English (71.5%), whereas 29.1% were Spanish-speaking and smaller proportions spoke languages from Asia (4%), Europe (1.7%), or elsewhere (0.9%). The sample was more diverse than these data indicate; 11.1% of women were Asian or Southeast Asian, and 2.5% were African American or African immigrants.
There were significant demographic differences among women attended prenatally in the private practice compared with federally qualified health center sites with regard to maternal age, obesity, educational attainment, race or ethnicity, and the ability to speak English. Hispanic, African, and African American women were significantly more likely to attend federally qualified health center prenatal clinics, whereas Asian women were more likely to receive care from the private practice (P<.001). There were no significant differences in adequacy of prenatal care among groups, although women initiated care at federally qualified health centers 1 month later than counterparts in the private practice; the mean gestational age at first prenatal visit was 3.95 months (±1.91 months) and 3.07 months (±1.45 months), respectively (P<.001).
Intrapartum care process and perinatal outcomes are summarized in Tables 3 and 4. Three quarters of women received nurse–midwifery care during labor (74.4%). Average dilation at admission was similar among groups (4.2±1.8 cm; P=.824), as was mean gestational age at delivery (40.14±1.28 weeks; P=.424), induction and augmentation of labor, and method of delivery. Overall, 14.7% of women experienced induction of labor, 21.6% received oxytocin augmentation, and 63.7% had spontaneous labors. Similarly, operative delivery rates were low and equivalent among groups; 12.5% of primiparous women delivered by cesarean, 4.1% of births were vacuum-assisted, and 0.3% required forceps extraction.
Less than one quarter of primigravid women used narcotics, epidural analgesia, and warm water immersion for labor pain relief, and a small percentage of neonates were born underwater (7.9%). Pain relief methods employed by women during labor varied by site of prenatal care; primiparous women from the private practice were significantly less likely to receive narcotics and more likely to utilize hydrotherapy, epidural analgesia, or both than women who were seen in a federally qualified health center prenatally (P<.001 for all comparisons).
Intrapartum and postpartum complications were rare in this primiparous sample. Outcomes selected a priori for analysis included intrapartum fever, defined as temperature 38.0°C and higher and used as a proxy for chorioamnionitis, and postpartum hemorrhage, defined as more than 500 mL blood loss after vaginal birth or more than 1,000 mL after cesarean delivery. Neither fever nor excessive blood loss differed by site of prenatal care (P=.698 and .971, respectively). Overall, 13.1% of women in the sample were febrile in labor and one tenth (9.9%) experienced hemorrhage. The blood transfusion rate was found to be 0.5% in a prior study of births at the site between 1997 and 2008, but was not examined in this quality assessment project.4
Obstetric laceration was one of few outcomes that significantly differed among women attended in the public compared with private prenatal clinics. Overall, 27.5% of primiparous delivery records lacked documentation of genital laceration (with or without suturing), with an intact perineum significantly more likely among women from federally qualified health center prenatal care sites (P<.001). The finding that women who received care in the private collaborative practice were significantly more likely to experience severe perineal laceration may be related to an apparent trends toward more episiotomies in this group.
Neonatal parameters examined included birth weight and nursery admission rates, neither of which differed among neonates born to women seen in the private practice compared with those born in federally qualified health centers. Mean birth weight was 3,471.7 g (±448.5 g), and 3.1% of neonates were admitted to the nursery rather than regular care (rooming in). Among neonates admitted to the nursery, 81.8% had Apgar scores of at least 7 at 5 minutes compared with 1.4% of neonates overall.
There were no intrapartum fetal deaths in the sample. Seven fetal demises occurred before hospital admission (0.16%). Diagnoses after stillbirths included tight nuchal cord (n=4), true knot in cord (n=1), chorioamnionitis (n=3), poorly controlled gestational diabetes (n=1), sexually transmitted infection other than HIV (n=3), or a combination. Gestational age at diagnosis of pre-labor fetal demise in this term nulliparous sample ranged from 37 0/7 to 40 4/7 weeks of gestation.
In addition to review of outcomes for primiparous women over the past decade, this study aimed to identify factors perceived to contribute to the longevity and success of the collaborative practice. Results of the interprofessional evaluation process include a mutually defined philosophy of collaborative maternity care, and list of organizational and administrative supports and hindrances to collaborative practice. Group members used consensus to identify five key factors they believe are involved in the collaborative model's sustainability and success: 1) a philosophy that optimal labor begins spontaneously and is permitted to progress without intervention; 2) extensive prenatal education to help women prepare for childbirth and understand what pain relief methods are available, including nonpharmacologic methods to increase coping with the challenges of labor; 3) ample hands-on support during labor from nurses, nurse–midwives, and volunteer or private doulas; 4) uniform adherence to mutually developed evidence-based clinical guidelines; and 5) obstetricians who firmly believe in the collaborative practice model and are experienced with facilitating normal birth that is independently attended by nurse–midwives.
Members of the collaborative also described challenges to the model of care both within the practice and occasionally with members of the larger medical community. Challenges were primarily related to cultural conflict with regard to the shared practice philosophy of childbirth as a physiologic process requiring supportive care rather than management unless illness or pathology is present. Although members reported intentionally cultivating a cohesive model of care that is presented to parturients in a consistent manner, they described inherent philosophical differences among individual clinicians and some notable differences between obstetrician and nurse–midwife care practices. The group attempts to lessen these differences through continual discussion, and members unequivocally feel that benefits of collaboration are worth the extra time and effort required for ongoing debate and review of research literature.
The iterative process used to identify practice members' fundamental beliefs about their collaboration and philosophy of care has already served as a springboard for additional quality assessment and improvement projects to enhance maternity services and test the hypotheses identified by practice members in this study. Detailed information about study findings related to collaborative practice structure, philosophy of care, ongoing quality improvement projects, and implications for model replication is provided in the Appendix and following discussion.
A survey of objectives for safe and effective perinatal health care identified by national agencies such as the Joint Commission, National Quality Forum, and U.S. Department of Health and Human Services (Healthy People 2010) reveals a consensus regarding the need to decrease the primary cesarean birth rate and prevalence of elective delivery before 39 weeks of gestation, among other perinatal benchmarks. Data suggest that women with the most access to care have the highest risk of cesarean delivery10 and a recent study found that nearly half (43.8%) of primigravid women in 19 U.S. hospitals were induced,11 which could double the risk for operative delivery.12 As demonstrated in this project and previous studies at the hospital, outcomes of the collaborative practice in Davis, California, meet or exceed measures of excellence, despite an economically and socially diverse population with significant risk factors for operative delivery, poor perinatal outcomes, and health disparities.1–6
The primary objective of this study was to assess whether maternity care practices and perinatal outcomes differed among women attended prenatally in federally qualified health centers compared with the collaborative private practice. Prenatal care site was examined as a proxy for socioeconomic and insurance status considering that the majority of women in the private practice have employee-sponsored or personal health insurance policies (more than 85%), whereas the federally qualified health center serves exclusively uninsured and low-income women enrolled in government health insurance programs. Despite statistically significant and clinically meaningful differences in demographic and clinical risk factors, few care processes or outcomes varied significantly by site of prenatal care. This was surprising given the body of literature that supports relationships between socioeconomic status and both maternity care processes and perinatal outcomes, including cesarean delivery.13
Overall, obstetric interventions were limited in this term primiparous sample; rates of labor induction and augmentation, analgesia and anesthesia, and operative delivery were low in comparison to comparable populations at the regional or national level.14,15 The descriptive study design does not establish causality and it is unclear whether the collaborative care model would result in fewer obstetric interventions or operative deliveries if applied to higher-risk populations. Nonetheless, the alarming health disparities experienced by minority women and underserved communities in California and nationally should compel further research on the collaborative care model as a potentially safe and cost-effective means to increase access to high-quality maternity services and improve perinatal health at the local and national levels.5,6,16
The collaborative model of care and restricted use of obstetric interventions were not associated with adverse maternal or neonatal outcomes. The observed rate of intrapartum fever (13.1%) does not suggest that the group's policy of expectant management of premature rupture of membranes (PROM) contributes to an excessive risk of uterine infection. Nationally, incidence of intrapartum maternal pyrexia ranges from 4% to 46%. This wide variation reflects the relationships between infection and premature labor, and epidural and intrapartum fever, which complicate comparisons among populations.4,17–19 Neonatal outcomes of the collaborative practice were similarly reassuring after analysis of birth weight, nursery admissions, and Apgar scores. The rate of 5-minute Apgar scores less than 7 (1.4%) is comparable to findings from national samples.20 Postnatal transfers to neonatal intensive care facilities were beyond the scope of this study, but a prior analysis of births at the site from 1997 to 2008 found a transfer rate of 2.1%.4
In addition to evidence-based clinical policies and reassuring perinatal outcomes, this quality assessment project revealed opportunities for further study and quality improvement, namely management of the third stage of labor. The observed postpartum hemorrhage rate (9.9%) is not the highest reported by facilities within the Sutter Health system, but ranks within the uppermost quartile. Further, recent National Hospital Discharge Survey data indicate a 2.6% incidence of hemorrhage and a range from 1.4% to 4.9% has been observed in California hospitals.21,22 Interpretations of study findings are complicated by a previous analysis of deliveries at the site during the same study period in which a 0.5% incidence of severe hemorrhage requiring blood transfusion was observed; this transfusion rate is equivalent to national data that report a range from 0.3% to 0.5%.4,21,23,24
Outstanding questions about postpartum hemorrhage and transfusion rates have generated ongoing collaborative practice discussion and hospital review. Because of the significant discrepancies in hemorrhage but not transfusion rates observed at the site compared with regional and national samples, quarterly drills have been instituted, postpartum blood transfusions are being tracked more closely, and related policies are under hospital review. Given the critical nature of this opportunity for quality improvement, active management of the third stage of labor is also being evaluated for increased utilization. Although compelling data suggest a significant reduction in blood loss is possible with routine implementation, there are outstanding questions about the generalizability of previous findings to women in spontaneous labor, as well as acceptance of active management by the local patient population.25 Other considerations include the possibility of increased blood loss after delivery in upright positions and decreased blood loss observed among women with epidural analgesia.26,27 Further, it is possible that blood loss was underestimated in comparative samples because measures of hemorrhage are frequently subjective. In contrast, members of the collaborative practice use objective measurements when excessive bleeding occurs; this may result in more accurate documentation of blood loss rather than reflecting an increased rate of hemorrhage among primiparous women at the site compared with other patient populations.
The collaborative approach to clinical decision-making regarding postpartum hemorrhage and active management of the third stage of labor are examples of the collective endeavors frequently undertaken by maternity care providers at the site. Within the model of interprofessional practice, all members are engaged stakeholders in quality improvement activities and evidence-based policy revisions. This likely fosters consensus and group adherence to clinical guidelines, improves patient education and outcomes, promotes normal birth, and reduces medical liability.28,29
Despite the longevity of the practice and favorable clinical outcomes, this study identified ongoing challenges to the model of care and barriers to its replication elsewhere. Communities may not be able to afford the time-intensive activities required to reach interprofessional consensus on differing philosophies of care and clinical guidelines, while still respecting and empowering all participants. Efficient use of time is critical for cost-effectiveness, which should be a future area of evaluation and improvement. With the ever-changing health care environment, determining the fiscal viability of the collaborative care model may prove challenging.
Other limitations on collaborative practice may arise from the belief systems and preferences of patients and members of the larger community. Members of the collaborative practice credit ongoing review of research literature with changes in the collaborative practice style, which is perceived to have become more conservative over the past decade to more closely adhere to community standards and policies about best practices in maternity care. Although clinical guidelines have evolved for specific conditions, the overarching practice model has remained patient-centered and respects women's choices to accept or decline interventions after informed consent discussions. This fundamental aspect of the model informs all management decisions and is intrinsically tied to the satisfaction with care experienced by our patients. When women choose to decline recommended care, they are asked to sign refusal forms that specify the risks, benefits, and alternatives discussed. These encounters need not be antagonistic if women are respected as partners in shared medical decision-making and clinicians are well versed in available data and able to effectively facilitate therapeutic relationships and informed consent.30 Despite the lament of one obstetrician in the practice, conflicts in treatment decisions are infrequent.31 Further, data from the practice suggest that optimal maternity care is fostered within the collaborative model and cannot be exclusively attributed to the demographics or clinical characteristics of the patient population.1–4,32,33 Therefore, patients' belief systems may not be a barrier to collaborative practice elsewhere, using the model of care described.
In summary, data from this quality assessment project and previous studies at the site demonstrate that collaborative maternity care contributes to excellent maternal and neonatal outcomes among diverse child bearing women in a California community hospital.1–4 The study identified a variety of organizational and cultural factors that practice members believe support or hinder collaborative maternity care. Collectively, the administrative processes and philosophical framework for collaborative practice result in a strong shared mission to provide safe, effective, satisfying, and cost-effective care to improve public health and benefit the community. Although the model of care is not typical, it holds great promise for replication because of the diversity of patients served and tremendous satisfaction for patients and providers alike. Practice members invite you to read more about their collaboration in the Appendix, and challenge you to identify a better method to achieve optimal perinatal results.
Although the model of collaborative maternity care has remained cohesive over 30 years, specific care practices have evolved in response to research, a significant growth in the demand for nurse–midwifery and family-centered maternity services, and successive changes in the staffing, practice ownership, and business affiliations. Details will be provided regarding the collaborative practice structure, philosophy of care, and clinical guidelines to facilitate evaluation of the model and inform replication elsewhere.
Three quarters of births to women in the collaborative practice are attended by nurse–midwives, and obstetricians primarily manage care for women with significant disease or need for operative delivery. Nurse–midwives from the private practice and federally qualified health centers provide shared 24-hour coverage in the hospital's birthing center, which allows for a sustainable provider lifestyle. The on-call private practice obstetrician provides consultation, comanagement, and referral for all women regardless of prenatal care setting. This is possible because of a fiscal arrangement negotiated jointly with the federally qualified health center and physician-owned private practice, which has allowed both organizations to be financially viable. Obstetric revenue is shared by physician shareholders in the private multispecialty medical group. Practice members are not paid per delivery so there is no financial incentive to hasten its course. This is aligned with the philosophy shared by the obstetricians, nurse–midwives, and hospital nurses who are committed to promoting spontaneous physiologic birth with the judicious use of obstetric intervention and the practice of evidence-based maternity care.
The groups' values are reinforced with administrative, educational, and clinical processes. Interprofessional activities contribute to cultural cohesion and mutual respect, including continuing education activities, clinical training for student nurse–midwives, team-based emergency simulations, and shared administration of quality-improvement activities. Quarterly consensus meetings are designed to facilitate on-going discussion of values and foster consistency of care and guideline adherence among practice members, as well as permit timely review of emerging research to inform clinical management.
Nurse–midwifery care at the study site is primarily provided to healthy childbearing women, but significant psychosocial risk factors and moderate biophysical risk factors are not uncommon. This study did not attempt to examine the full range of risk factors present in the primiparous sample. However, an earlier examination at the hospital from 1997 to 2008 indicated that 17.7% of women attended by collaborative practice members had at least one significant medical condition before pregnancy, including chronic pulmonary disease or asthma (6.0%); psychiatric diagnoses requiring medication, inpatient treatment, or both (5.1%); endocrine disorders (3.0%); and hypertension (0.8%).4 Additional risk factors for poor perinatal outcomes present in the earlier sample included substance use (5.1%), sexually transmitted infection (4.5%), severe anemia (1.9%), multiple gestation (1.1%), intrauterine growth restriction (0.9%), and other antepartum fetal diagnoses (3.4%).4 Among women attended by nurse–midwives, 18.0% reported one or more of these pre-existing medical conditions or risk factors.4
During pregnancy, women who receive nurse–midwifery care at federally qualified health center prenatal sites and report or develop significant health conditions, illnesses, or other risk factors for poor perinatal outcomes are discussed in weekly collaborative practice meetings where interprofessional members jointly develop management plans and parameters for consultation and referral as indicated in Table 1. The private practice providers meet for the same purpose twice a month to discuss their at-risk patients. Further, the on-call obstetrician is always available to answer urgent nurse–midwifery management questions. Additionally, there are monthly hospital Performance Improvement Committee and Birth Center Issues meetings, which include all delivering providers as well as other stakeholders.
Advanced-practice nursing and nurse–midwifery care for women with significant medical or obstetric complications may require a standardized procedure approved by a supervising physician. At the study site, standardized procedures are reviewed by a quality-improvement committee and the hospital board of directors. Current standardized procedures include a nurse–midwife formulary, and guidelines for limited obstetric ultrasound scans and the nurse–midwife role as first assistant for cesarean deliveries. Standardized procedures and clinical guidelines are evidence-based and consistent with the Sutter Health System's First Pregnancy and Delivery initiative that outlines best practices for labor management in primigravid women.7
Obstetricians and nurse–midwives at Sutter Davis Hospital uniformly endorse the same basic labor management principles. First, low-risk women are encouraged to spend early labor at home, and inpatient admission generally occurs after cervical change has been observed and active labor has commenced. Therapeutic rest with morphine sulfate and sedatives is provided for prolonged latent labor on an inpatient or outpatient basis. Elective inductions before 42 weeks of gestation are avoided and elective primary cesarean deliveries are not performed.
The labor induction and cesarean delivery rates are also limited by a policy of expectant management for PROM at term. Afebrile women with clear amniotic fluid, reassuring nonstress testing, and negative group B streptococcus status are offered expectant management at home for up to 72 hours with informed consent. CNM-obstetrician consultation is required for abnormal findings, PROM more than 48 hours, and induction of labor. Speculum examinations are used for confirmation of rupture and to visually inspect cervical dilation. Digital cervical examinations are prohibited until active labor is evident. A daily nonstress test is performed and vertex lie is confirmed with ultrasonography on diagnosis of rupture. Women self-monitor temperature, color of the amniotic fluid, and fetal movements. Spontaneous labor ensues in 95% of women by 72 hours, thus induction is strongly recommended at this time.34 The practice of expectant management is based on data that indicate a strong correlation between chorioamnionitis and digital examinations, meconium staining, and group B streptococcus status, variables that have not been consistently well controlled in studies of PROM.20,35–38 Further, early induction of labor after PROM may be associated with higher operative delivery rates and prolonged labor lengths despite probable decreased intervals between PROM and delivery.39,40
Labor pain management is innovative at Sutter Davis Hospital. Nurses use a coping rather than pain scale, and analgesics are not routinely offered without maternal request and informed consent.41 Registered nurses organized and oversee a volunteer doula service to provide continuous labor support free of charge for women who request the service, whereas other women employ a private doula or decline support beyond that offered by their labor nurse and delivering provider. Comfort during labor is facilitated in a variety of additional ways. Laboring women may eat and drink unless they receive epidural analgesia, at which time clear fluids are recommended.42 Heat packs, sterile water papules, exercise balls, and hydrotherapy (showers and tubs for labor and birth) are encouraged. Water birth is permitted for healthy women with normal labors and reassuring intermittent or continuous fetal monitoring by means of waterproof Doppler or telemetry. The extensive use of nonpharmacologic pain relief methods is reflected in an epidural rate far below what was recently observed in California (65%) or nationally (76%); from 1999 to 2009 the annual rate of epidural analgesia at the hospital ranged from 13.3% to 23.9%.14,43
Additional unusual intrapartum care practices include intermittent fetal monitoring, which was used in 49% of deliveries in an earlier study at the site, in accordance with Association of Women's Health, Obstetric and Neonatal Nursing standards.4,44 Ambulation during labor is encouraged with either intermittent fetal monitoring or continuous use of a telemetry unit as indicated by clinical conditions. Movement is also facilitated by restricting intravenous fluid administration in the absence of indications for hydration by means other than oral intake.
Management practices in the second and third stages of labor at Sutter Davis Hospital facilitate optimal physiology and increase the spontaneous vaginal birth rate. Passive descent or "laboring down" is encouraged at the onset of second stage, especially for women with epidural anesthesia.45 Providers describe supporting rather than managing the second stage of labor by encouraging spontaneous pushing after an involuntary urge occurs with advanced fetal descent. Operative vaginal delivery and cesarean deliveries are not routinely recommended after prolonged pushing (more than 2–3 hours) if progressive descent is occurring in the absence of nonreassuring fetal status, maternal exhaustion, or both.46 Active management of the third stage of labor is not practiced routinely and is reserved for women with significant risk factors for postpartum hemorrhage at the discretion of individual providers. Delayed cord clamping (more than 1–3 minutes) is the norm, in the absence of indications for neonatal resuscitation.47
The collaborative practice described is an unusual provider of high-quality maternity services. As such, the model offers potential solutions to the challenges faced by maternity care providers who seek to offer evidence-based care practices in the context of dwindling private and public health resources and changes in maternal preferences and demographics. Practice members look forward to ongoing publication and discussion about optimal maternity care practices and additional examples of successful interprofessional collaboration. Practice guidelines, standardized procedures, and administrative policies are available from Sutter Davis Hospital upon request.
This article has been cited 1 time(s).
© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
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The State Ports Authority has extended a voluntary agreement with the state to reduce air pollution, it was announced today.
Since 2007, the partnership with the state Department of Health and Environmental Control has reduced emissions from cargo-handling equipment, trucks, tug boats and a dredge boat, officials said.
The agreement, which runs through 2018, is marked as the state's longest-running collaboration on air quality within the public sector, officials said.
As part of the agreement, DHEC will provide technical assistance and expertise in support of SPA's operational improvements and environmental efforts.
SPA has already phased in cleaner equipment at all facilities, switched to ultra-low sulfur diesel fuel in all port equipment and is designing the inland port in Greer to accommodate electronic gantry cranes for stacking containers.
"Our partnership with DHEC is an integral part of our overall environmental efforts, recognizing that a healthy, working port and a cleaner environment can be mutually compatible goals," said Jim Newsome, chief executive of SPA.
Check postandcourier.com for more updates.

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Belfast is a city which has been defined down the years by religious fervour and sectarianism. But amid the Troubles, another smaller community has existed quietly for more than a century.
However, the 80 remaining members of the Belfast Jewish community have an average age of over 70 and if numbers dwindle further, the community will die. So Aaron Black, a freelance filmmaker and son of the Belfast Hebrew Congregation chair, Michael Black, decided that now might be a good time to film his community's struggle for survival.
Mr Black spent six months shooting the documentary The Last Minyan — A Belfast Jewish Story, which will be shown on BBC Northern Ireland next week. He filmed both in his home city and when visiting expats in London, Manchester and Israel. Having drifted away from the community as an adult, Mr Black was touched by what he discovered. "The community was great. They come across as a very open, welcoming and proud group of people. Humour is also very important to them. I didn't want them to appear worthy or sad because they are neither of those things. I wanted to make a film less about faith but more about the culture and how they survive."
Michael Black said that keeping the congregation going had been a struggle. "With the arrival of a new rabbi and a couple of new faces we've had a boost. Usually a minyan is not a problem on Shabbat but we can struggle to get 10 on a Thursday. But on the upside, we're a very tight-knit community. One chap does a 90-mile round trip to collect an elderly man so that he can attend the shul. We grew up together so everyone knows everyone else, but we're not getting any younger. Unless we have a few more new faces we won't last much longer."
His son added that the community, which numbered 2,000 at its peak in the 1940s, had suffered during the Troubles. "Young people would leave to go to university and because of the political situation they would not return, so numbers dwindled."
Despite not being religious, making the film had got him more involved. "Despite the problems they have, I never felt any pressure to attend services. But at the end of the film I went to shul for the yahrzeit of my grandfather with my dad. These days I tend to go to the Thursday minyan. Making the film helped my understanding of the community and made me feel a bit more responsible as well."


text:
2005 Pacific typhoon season
|Season summary map
|First system formed
|January 13, 2005
|Last system dissipated
|December 22, 2005
|Strongest storm1
|Haitang – 920 hPa (mbar), 195 km/h (120 mph)
|Total depressions
|Total storms
|Super typhoons
|Total fatalities
|Total damage
|> $7.2 billion (2005 USD)
|1Strongest storm is determined by lowest pressure
2003, 2004, 2005, 2006, 2007
|Related article
The 2005 Pacific typhoon season had no official bounds; it ran year-round in 2005, but most tropical cyclones tend to form in the northwestern Pacific Ocean between May and November.[1] These dates conventionally delimit the period of each year when most tropical cyclones form in the northwestern Pacific Ocean. This season ended up being less active than the 2005 Atlantic hurricane season, which had never happened before.
The scope of this article is limited to the Pacific Ocean, north of the equator and west of the international date line. Storms that form east of the date line and north of the equator are called hurricanes; see 2005 Pacific hurricane season. Tropical storms that form in the West Pacific basin are assigned a name by the Japan Meteorological Agency. Tropical depressions in this basin have the "W" suffix added to their number. Tropical depressions that enter or form in the Philippine area of responsibility are assigned a name by the Philippine Atmospheric, Geophysical and Astronomical Services Administration or PAGASA. This can often result in the same storm having two names.
This season, the circular list of 140 names, in use since January 1, 2000, was recycled for the first time following the formation of Typhoons Saola; the final name on the list, and Damrey; the first name on the list. Please note that on the following list, storms are listed by Tropical Depression number, and therefore Saola (18W), which is on the naming list before Damrey (17W), is listed after Damrey, having been the later storm to form, despite being the earlier to attain Tropical Storm status.
- 1 Timeline
- 2 Storms
- 2.1 Severe Tropical Storm Kulap
- 2.2 Severe Tropical Storm Roke (Auring)
- 2.3 Typhoon Sonca (Bising)
- 2.4 Tropical Depression Crising
- 2.5 Typhoon Nesat (Dante)
- 2.6 Tropical Depression Emong
- 2.7 Typhoon Haitang (Feria)
- 2.8 Tropical Storm Nalgae
- 2.9 Severe Tropical Storm Banyan
- 2.10 Tropical Storm Washi
- 2.11 Typhoon Matsa (Gorio)
- 2.12 Severe Tropical Storm Sanvu (Huaning)
- 2.13 Typhoon Mawar
- 2.14 Severe Tropical Storm Guchol
- 2.15 Typhoon Talim (Isang)
- 2.16 Typhoon Nabi (Jolina)
- 2.17 Typhoon Khanun (Kiko)
- 2.18 Tropical Storm Vicente
- 2.19 Typhoon Damrey (Labuyo)
- 2.20 Typhoon Saola
- 2.21 Typhoon Longwang (Maring)
- 2.22 Tropical Depression 20W
- 2.23 Typhoon Kirogi (Nando)
- 2.24 Typhoon Kai-tak
- 2.25 Tropical Storm Tembin (Ondoy)
- 2.26 Severe Tropical Storm Bolaven (Pepeng)
- 2.27 Tropical Depression 25W (Quedan)
- 3 Storm names
- 4 See also
- 5 References
- 6 External links
Also, windspeed advisories differ from the Joint Typhoon Warning Center to the Japan Meteorological Agency as the JTWC uses the U.S. criteria of 1 minute mean to designate maximum sustained winds, while the JMA uses the 10-minute mean wind criteria to designate tropical cyclone maximum sustained winds. This difference generally means that JTWC maximum winds will appear to be higher than the maximum winds described by the JMA for the same cyclone.
Severe Tropical Storm Kulap[edit]
|Severe tropical storm (JMA)
|Category 1 typhoon (SSHWS)
|January 13 – January 19
|Peak intensity
|95 km/h (60 mph) (10-min) 985 hPa (mbar)
On January 12, a tropical disturbance developed within an area of light vertical wind shear. This allowed deep convection to develop over a broad low-level circulation. The next day, the Joint Typhoon Warning Center (JTWC) issued a Tropical Cyclone Formation Alert (TCFA) as the system continued to develop. Later that day, they issued their first advisory on Tropical Depression 01W while the storm was located about 215 km (130 mi) southwest of Chuuk.[2][3] Several hours later, the Japan Meteorological Agency (JMA) also designated the system as a tropical depression.[4] Early on January 15, the JTWC upgraded 01W to a tropical storm[3] as the system turned towards the north. The northward movement was the result of the system traveling along the edge of a low to mid-level ridge located to the east.[2] About 12 hours later, the JMA upgraded the depression to a tropical storm and gave it the name Kulap;[4] which was contributed by Thailand and is the Thai word for rose.[2] Kulap gradually intensified over the next two days, reaching its peak intensity with winds of 95 km/h (60 mph 10-minute winds) around 1800 UTC on January 17, making it a severe tropical storm according to the JMA.[4] However, at the same time the JMA assessed Kulap to have reached its peak intensity, the JTWC classified it as a minimal typhoon with winds of 120 km/h (75 mph 1-minute winds).[3] Shortly after reaching its peak intensity, the storm began to undergo an extratropical transition and weaken.[2] Late on January 18, the JTWC issued their final advisory on Kulap despite the storm remaining tropical.[3] The JMA considered Kulap to have been a tropical storm until early the next day. The storm dissipated as a weak extratropical system around 1200 UTC on January 19.[4] Between January 13 and 14, the storm produced heavy rains over the island of Chuuk. Upwards of 300 mm (12 in) of rain fell during the two-day span, of which 166.6 mm (6.5 in) fell in 24 hours.[2]
Severe Tropical Storm Roke (Auring)[edit]
|Severe tropical storm (JMA)
|Category 1 typhoon (SSHWS)
|March 13 – March 18
|Peak intensity
|100 km/h (65 mph) (10-min) 980 hPa (mbar)
A tropical disturbance formed on March 11, near the equator. It rapidly developed into Tropical Depression 02W on March 13 as it steadily moved north, then west towards the Philippines. Later that day, it entered warm waters as it was upgraded into Tropical Storm Roke. Due to a strong ridge of high pressure north of it, it moved west-southwest, attaining peak intensity as a severe tropical storm. Roke then entered the PAR, giving the name Auring later that day. It made landfall in eastern Visayas on March 16. The next day, Roke rapidly weakened due to cool waters and dissipated on March 18. Roke is a male Chamorro name. Seven people were killed and damages amounted to $166,000 (2005 USD).[5]
- Typhoon 2000's tracking chart of Typhoon Roke (Auring).
Typhoon Sonca (Bising)[edit]
|Typhoon (JMA)
|Category 4 typhoon (SSHWS)
|April 16 – April 27
|Peak intensity
|165 km/h (105 mph) (10-min) 935 hPa (mbar)
A large area of convection formed on April 11. Late on April 14, a newly disorganized disturbance formed in that area and steadily intensified. The next two days, the disturbance interacted with another low-pressure area as it moved north towards warm waters. On April 17, the depression weakened due to strong vertical windshear. The JTWC designated as Tropical Depression 03W on April 18. It rapidly intensified into a tropical storm, with the JMA naming it Sonca late on April 20. Very early on April 21, the PAGASA classified it as a storm, naming it Bising. Convection built up the storm again on April 22 and entered an area with favorable conditions. The next day, Sonca rapidly intensified into a Category 4 typhoon until it reached peak intensity on mid-April 24. Sonca rapidly weakened due to cool waters and dissipated on April 27.
Sonca is a singing bird found in Vietnam.
- Typhoon 2000's tracking chart of Typhoon Sonca (Bising).
Tropical Depression Crising[edit]
|Tropical depression (PAGASA)
|May 16 – May 17
|Peak intensity
|55 km/h (35 mph) (10-min) 1006 hPa (mbar)
On May 8, a parade of tropical disturbances formed and affected southern Philippines from an ITCZ. As the ITCZ weakened on May 13, the last disturbance formed southeast of Mindanao, Philippines. It moved north until it became a tropical depression on May 16 at 0000 UTC (0800 PHT) 180 nautical miles (330 km) east of Surigao on Mindanao Island. It was assigned the name Crising by PAGASA. The storm never organized into a tropical storm and did not receive the more recognized International name for West Pacific storms. The storm drifted northwest then southwest and began losing convection. PAGASA stopped tracking the storm 24 hours later on the 17th at 0000 UTC (0800 PHT) 145 nautical miles (270 km) east of Surigao.
- Typhoon 2000's tracking chart of Tropical Depression 96W(Crising).
Typhoon Nesat (Dante)[edit]
|Typhoon (JMA)
|Category 4 typhoon (SSHWS)
|May 28 – June 10
|Peak intensity
|175 km/h (110 mph) (10-min) 930 hPa (mbar)
A tropical depression formed from a tropical wave late on May 28. It rapidly intensified into Tropical Storm Nesat on May 30, rapidly moving west. This was a powerful storm that formed on May 30 about 290 nautical miles (540 km) south-southeast of Guam as Tropical Depression 04W. It was quickly upgraded to Tropical Storm Nesat overnight at 1800 UTC (0200 PHT May 31). Nesat is a Cambodian word for fisherman. On the evening of June 1, it strengthened into Typhoon Nesat. On June 2, it entered the Philippine area of responsibility and was assigned the name Dante for Philippine warnings. Typhoon Nesat (Dante) quickly grew to a Category 4 storm as it approached the Philippines, but it curved away to the northeast and did not pose a threat to land. Waxing and waning in strength it eventually became extratropical southeast of Honshū, Japan at tropical storm strength on the morning of June 10 at 0000 UTC (0900 JST).
- Typhoon 2000's tracking chart of Typhoon Nesat (Dante).
Tropical Depression Emong[edit]
|Tropical depression (PAGASA)
|July 4 – July 6
|Peak intensity
|55 km/h (35 mph) (10-min) 1000 hPa (mbar)
A large tropical disturbance formed on July 2. The PAGASA issued a tropical depression strength near the Philippines on July 4 at 0600 UTC (1400 PHT) about 35 nautical miles (65 km) northeast of Catarman on Samar Island, giving the name Emong. It was assigned the name Emong by PAGASA. The storm never organized into a tropical storm and did not receive the more recognized International name for West Pacific storms. As a poorly organized depression it drifted over Luzon on July 5. Upper-level shear and the depression's landfall caused the storm to lose organization on July 6 while located about 40 nautical miles (75 km) south of Hong Kong.
- Typhoon 2000's tracking chart of Tropical Depression 93W(Emong).
Typhoon Haitang (Feria)[edit]
|Typhoon (JMA)
|Category 5 super typhoon (SSHWS)
|July 11 – July 20
|Peak intensity
|195 km/h (120 mph) (10-min) 920 hPa (mbar)
An upper-level low associated with an easterly wave occurred late on July 7. It became a tropical depression on the evening of July 11 as a poorly organized depression about 110 nautical miles (280 km) west of Marcus Island, Japan at 1200 UTC (2000 JST). By 1800 UTC (0300 JST July 13), it had reached tropical storm strength and was named Haitang, a Chinese name for flowering crabapple. It grew to typhoon strength at 1800 UTC (0300 JST July 14) the following day. As it moved westward it continued to gain in strength, reaching Category three status as it entered the Philippine area of responsibility. PAGASA named the storm Feria for Philippine warnings on July 15. By July 16, the storm continued tracking west and became a threat to Taiwan and Japan's Sakishima Islands. Haitang strengthened into a Category 5 super typhoon. On July 17 it weakened to a Category 3 as it continued west, sparing Sakishima a direct hit but aiming directly for Taiwan. Typhoon Haitang made landfall near Hualien, Taiwan at 0000 UTC (0800 HKT) on the morning of July 18. Taking a full day to cross the island and over the interior mountains, it caused flash floods and landslides killing four people. Weakening to a tropical storm as it entered the South China Sea, it reorganized into a minimal typhoon as it approached the southeast China coast. Haitang made landfall for the second time near Wenzhou China on July 19 at 1200 UTC (2000 HKT). Moving inland, it rapidly lost its strength and dissipated. PAGASA stopped issuing advisories for the storm near Jiangxi on July 20.
- University of Hawaii's tracking chart of Super Typhoon Haitang (Feria).
Tropical Storm Nalgae[edit]
|Tropical storm (JMA)
|Tropical storm (SSHWS)
|July 19 – July 24
|Peak intensity
|85 km/h (50 mph) (10-min) 990 hPa (mbar)
An upper-level low formed on July 17 near warm waters. It steadily intensified, moving north on July 20, with both JMA and JTWC upgrading it as Tropical Storm Nalgae. Later that day, it passed by an area of convection and cluster of thunderstorms, reaching peak intensity on July 21. It maintained its intensity until the afternoon hours of July 22, but the JMA classified it as a severe tropical storm. Nalgae rapidly weakened as it was downgraded into a depression on July 23 by both agencies. The JTWC made its final warnings on the morning of July 24 as it became extratropical. The remnants of Nalgae was beenabsorbed by a large extratropical system from Tropical Storm Banyan on July 28. In post-analysis, the JMA downgraded it to a Tropical Storm.
Tropical Storm Nalgae formed from a tropical disturbance 325 nautical miles (600 km) northwest of Wake Island on the morning of July 20. Nalgae is a Korean word for wing. Nalgae did not reach typhoon intensity or threaten land. It turned to the north and then east, avoiding Japan.
- University of Hawaii's tracking chart of Tropical Storm Nalgae.
Severe Tropical Storm Banyan[edit]
|Severe tropical storm (JMA)
|Tropical storm (SSHWS)
|July 20 – July 27
|Peak intensity
|100 km/h (65 mph) (10-min) 975 hPa (mbar)
A large tropical disturbance formed late on July 19, which formed in area of high convection and from the outflow of Typhoon Haitang. It rapidly intensified into a strong depression on July 21. While tracking northwards, it was named and upgraded as Tropical Storm Banyan later on July 22. Late on July 23, Banyan reached peak intensity of a severe tropical storm by the JMA until the sunset hours of July 24. Banyan rapidly weakened as it affected Japan by bringing heavy rainfall from July 25 to 28. It made landfall on July 26 and became a large extratropical system on July 27, which made the JTWC issued Banyan's final warning very early on that day. The system absorbed the extratropical remnants of Nalgae the next day and fully dissipated on July 31, affecting Alaska and Canada.
Severe Tropical Storm Banyan formed from a tropical disturbance about 300 nautical miles (550 km) north of Yap Island on the evening of July 21 at 1200 UTC (2100 JST). Banyan is a tree common in India and southern China. Banyan brushed the southern and eastern coasts of Honshū, Japan on July 26. It became extratropical off the northeastern coast of Honshū on July 27.
- University of Hawaii's tracking chart of Tropical Storm Banyan.
Tropical Storm Washi[edit]
|Tropical storm (JMA)
|Tropical storm (SSHWS)
|July 28 – July 31
|Peak intensity
|85 km/h (50 mph) (10-min) 985 hPa (mbar)
A cluster of thunderstorms was pulled from the very strong outflow from Tropical Storm Banyan east of Manila, Philippines on July 26. The next day, it was classified into a tropical disturbance which was moving northwest towards Hong Kong. On July 28, it became a tropical depression and then a tropical storm the next day, with the JMA naming it as Washi. Later that day, it reached peak intensity and rapidly weakened due to an exposed circulation on July 31. Washi finally dissipated later that day, with its remnants energy moving west dissipating on August 2.
Tropical Storm Washi formed as a tropical depression about 215 nautical miles (400 km) south of Hong Kong. Washi is a Japanese word for the constellation Aquila. The storm moved west towards Hainan. Tropical Storm Washi made its first landfall near Xinglong, Hainan. After re-entering the Gulf of Tonkin, the storm made its final landfall near Nam Dinh, Vietnam.
- University of Hawaii's tracking chart of Tropical Storm Washi.
Typhoon Matsa (Gorio)[edit]
|Typhoon (JMA)
|Category 2 typhoon (SSHWS)
|July 30 – August 7
|Peak intensity
|150 km/h (90 mph) (10-min) 950 hPa (mbar)
Typhoon Matsa (Gorio) formed as a depression 130 nautical miles (240 km) west northwest of Yap Island. Matsa is a Laotian name for a lady fish. Matsa formed east of and then moved into the Philippine area of responsibility. It has been assigned the name Gorio for Philippine advisories. Matsa passed between Taiwan and Okinawa with the center of the storm passing over the Yaeyama Islands of Japan on the evening of August 4. The storm made landfall near Zhejiang, Anhui, Jiangsu and Shanghai on mainland China on the morning of August 6 with maximum sustained winds of 145 km/h (90 mph). The storm rapidly dissipated inland over China but remnants brought heavy rain inland west of Shanghai.
- Typhoon 2000's tracking chart of Typhoon Matsa (Gorio).
Severe Tropical Storm Sanvu (Huaning)[edit]
|Severe tropical storm (JMA)
|Category 1 typhoon (SSHWS)
|August 10 – August 14
|Peak intensity
|95 km/h (60 mph) (10-min) 985 hPa (mbar)
Typhoon Sanvu (Huaning) formed as a tropical depression on the morning of August 10 at 0000 UTC (0800 PHT) 320 nautical miles east-northeast of Borongan on Samar Island inside the Philippine area of responsibility. PAGASA assigns names to Tropical Depressions because they often bring heavy rains and mudslides to the Philippines. Storm was named Tropical Depression Huaning for Philippine warnings but within 24 hours received the more recognized name Sanvu when it became a Tropical Storm. Sanvu is a Chinese name for coral. Tropical Storm Sanvu (Huaning) passed over a peninsula in Cagayan province on the island of Luzon early on the morning of August 12. It was upgraded to a typhoon before making landfall in China the next day on August 13. Sanvu (Huaning) rapidly dissipated after moving inland on August 14.
Sanvu was the first typhoon that necessitated a tropical cyclone signal for Hong Kong.
- Typhoon 2000's tracking chart of Typhoon Sanvu (Huaning).
Typhoon Mawar[edit]
|Typhoon (JMA)
|Category 4 typhoon (SSHWS)
|August 19 – August 27
|Peak intensity
|175 km/h (110 mph) (10-min) 930 hPa (mbar)
A cluster of thunderstorms began to circulate into a tropical disturbance early on August 18. Its circulation became exposed and intensified again later that day. It became Tropical Depression 11W on the evening of August 19 at 1200 UTC (2100 JST) 245 nautical miles (455 kilometers) southeast of Iwo Jima. The storm intensified rapidly in two days to a Category 4 Super Typhoon but weakened as it approached Japan. Mawar made landfall on Honshū as a Category 2 Typhoon on August 25 at 1800 UTC (August 26 0300 JST) with winds of 95 mph (152 km/h). After moving inland to the northwest it was downgraded to a Category 1 before entering the Pacific Ocean. It was downgraded to a Tropical Storm on August 26 and became extratropical on August 27. The extratropical remnants of Mawar dissipated on August 30.
Mawar is a Malay word for a rose. At least two people were killed by Mawar.
- University of Hawaii's tracking chart of Super Typhoon Mawar.
Severe Tropical Storm Guchol[edit]
|Severe tropical storm (JMA)
|Category 1 typhoon (SSHWS)
|August 20 – August 25
|Peak intensity
|100 km/h (65 mph) (10-min) 980 hPa (mbar)
Another disturbance formed east of Tropical Depression 11W on August 18. In the same time where 11W became Mawar, the disturbance rapidly intensified into Tropical Depression 12W on the morning of August 20 at 0000 UTC (0900 JST) 190 nautical miles (350 kilometers) southwest of Marcus Island, Japan. It reached Tropical Storm strength the next day and was named Guchol, a Yapese name for the spice turmeric. It reached peak intensity late on August 23. Guchol curved to the northwest and never threatened land. It became extratropical August 25 at 0000 UTC (0900 JST) 735 nautical miles (1,285 km) east-southeast of Nakashibetsu, Hokkaidō, Japan. The remnants of the storm dissipated and crossed the International Dateline on August 27.
- Weather Underground's tracking chart of Tropical Storm Guchol.
Typhoon Talim (Isang)[edit]
|Typhoon (JMA)
|Category 4 super typhoon (SSHWS)
|August 26 – September 1
|Peak intensity
|175 km/h (110 mph) (10-min) 925 hPa (mbar)
Tropical Depression 13W formed on the afternoon of August 26 at 0600 UTC northeast of the island of Yap. Within 24 hours it was upgraded to Tropical Storm Talim and the next day became a Typhoon. Talim is a Philippine name for a knife or sharp cutting edge. Typhoon Talim was assigned the name Typhoon Isang for Philippine warnings when it entered the Philippine area of responsibility on August 29. Typhoon Talim (Isang) made landfall at 1800 UTC August 31 (0200 PHT September 1) as a Category 3 storm. Talim dissipated over southeastern China on September 1. Typhoon Talim left at least 110 people dead and 23 missing in Fujian, Zhejiang, Jiangxi & Anhui provinces, with at least 40 people dead in the latter province due to landslides. It also left 7 dead in Taiwan. [1]
- Typhoon 2000's tracking chart of Typhoon Talim (Isang).
Typhoon Nabi (Jolina)[edit]
|Typhoon (JMA)
|Category 5 super typhoon (SSHWS)
|August 29 – September 7
|Peak intensity
|175 km/h (110 mph) (10-min) 925 hPa (mbar)
Typhoon Nabi (Jolina) formed from a tropical depression on the afternoon of August 29 at 0600 UTC (1600 AEST) east of Saipan. 18 hours later it was upgraded to Tropical Storm Nabi. Nabi is a Korean word for a butterfly. It strengthened into a Typhoon on August 30 and passed near the islands of Saipan and Guam on August 31.After passing near the Marianas Islands, the storm continued to strengthen until reaching Category 5 intensity on September 1. Typhoon Nabi was assigned the name Jolina for Philippine warnings when it entered the Philippine area of responsibility on September 3. Typhoon Nabi (Jolina) passed to the east of the island of Okinawa, Japan, and made landfall in the Kagoshima Prefecture of Japan on September 6 as a Category 2 storm. It dissipated shortly after that.
Twenty-one deaths have been reported in Japan. On September 8, five people were missing in South Korea and fifty in Japan as a result of the storm. Japan also reported 143 injured. The storm damaged 10,000 homes in Japan, where 31 of 47 prefectures reported some damage. Eighty-eight roads in Japan were damaged, and 168 landslides were reported there. The heaviest damage was in Miyazaki prefecture on the island of Kyūshū. There were no deaths in the Marianas Islands. Saipan did experience heavy wind gusts of 120 km/h (75 mph). Guam experienced gale-force wind gusts in addition to approximately 75 mm (3 in) of rain.
Due to the effects of the storm in Japan, the name "Nabi" was later retired, and was replaced by "Doksuri".
Typhoon Khanun (Kiko)[edit]
|Typhoon (JMA)
|Category 4 typhoon (SSHWS)
|September 6 – September 12
|Peak intensity
|155 km/h (100 mph) (10-min) 945 hPa (mbar)
Tropical Depression 15W formed from a well-defined low pressure system located about 50 nautical miles (95 km) east of Yap on September 6. It strengthened into a tropical storm later that day. The system was classified as a tropical storm by the Joint Typhoon Warning Center on September 6, while the Japan Meteorological Agency, the agency responsible for naming typhoons, did not upgrade the system until a day later. Tropical Storm 15W entered the Philippine area of responsibility on September 7. It was named Kiko by PAGASA first before being named Khanun by the JMA. Khanun is the Thai name for jackfruit. Typhoon Khanun (Kiko) made landfall in eastern China on September 11 at 0600 UTC (1400 HKT). Khanun dissipated the next day, September 12.
More than 800,000 people were evacuated from their homes as the storm neared. Many people, evacuated by the army, were taken to schools, railway stations, hotels and other solid buildings to take shelter from the approaching storm.
The city of Taizhou, Zhejiang bore the initial brunt of the storm as it was close to where the storm made landfall, 220 km south of Shanghai. Other coastal cities braced for the typhoon as it headed north. At least 14 people were killed and 1 went missing in Zhejiang province. Damages totaled to $849 million (2005 USD).[6]
Japan's southern Sakishima Islands suffered strong winds, high waves and heavy rains as the storm passed. Opening hours at some polling stations were altered to make sure citizens could still vote in the Japanese general election despite the weather.
- JTWC's Tracking Chart of Typhoon Khanun (Kiko).
Tropical Storm Vicente[edit]
|Tropical storm (JMA)
|Tropical storm (SSHWS)
|September 16 – September 18
|Peak intensity
|85 km/h (50 mph) (10-min) 985 hPa (mbar)
Tropical Depression 16W formed 205 nautical miles (375 km) east-southeast of Dong Tac Airport, Vietnam on the morning of September 16. It reached Tropical Storm strength overnight local time and was named Vicente, a Chamorro male name. Shortly after forming, Vicente interacted with a tropical disturbance west of Luzon and made a cyclonic loop. Vicente then absorbed the disturbance before passing just south of Hainan Island. Eventually, Vicente tracked into the Vietnam coast northwest of Huế on September 18 and gradually dissipated.
As the pressure gradient between Vicente and a ridge of high pressure over southeastern China brought a strong easterly airstream to the coastal areas of Guangdong and caused rough seas with swells, a swimmer was drowned on September 17. Another one drowned the following day in rough seas at Sai Kung, Hong Kong. Also, a ship from China struck a reef between Shangchuan and Xiachuan Islands. All seventeen crew members were rescued.
In Vietnam, about 5 people were killed or reported missing.
- Weather Underground's tracking chart of Tropical Storm Vicente
Typhoon Damrey (Labuyo)[edit]
|Typhoon (JMA)
|Category 2 typhoon (SSHWS)
|September 19 – September 27
|Peak intensity
|150 km/h (90 mph) (10-min) 955 hPa (mbar)
Due to its proximity to the Philippines, PAGASA assigned it the name Labuyo and began issuing advisories on a disturbed area of tropical weather to the east of the islands on September 19. The JMA started to warn on the system in the same day. On September 20 it was classified as Tropical Depression 17W by the Joint Typhoon Warning Center. On September 21, it was upgraded to Tropical Storm Damrey. It strengthened into a typhoon on September 24. Damrey is a Cambodian word for elephant.
Typhoon Damrey (Labuyo) made landfall at Wanning, in China's Hainan province at 2000 UTC, September 25 (0400 September 26 local time) with maximum sustained winds up to 180 km/h. This made Damrey the strongest typhoon to strike Hainan since Typhoon Marge in September 1973.
At least 16 people are believed to have died in China, and the entire province of Hainan suffered power outages. Damrey then went on to impact Vietnam before losing tropical characteristics while a Tropical Storm. The Joint Typhoon Warning Center ceased advisories with the final one at 0900 UTC September 27 with the system 90 nautical miles (170 km) south-southwest of Hanoi, Vietnam.
- Weather Underground's tracking chart of Typhoon Damrey (Labuyo).
Typhoon Saola[edit]
|Typhoon (JMA)
|Category 3 typhoon (SSHWS)
|September 20 – September 26
|Peak intensity
|150 km/h (90 mph) (10-min) 950 hPa (mbar)
A tropical disturbance formed from the monsoon and moved northwest on September 15. The next day, it became more organized and the Japan Meteorological Agency initiated a warning for Tropical Depression 18W southwest of Marcus Island, Japan at 0000 UTC (0900 JST), September 20. The depression was upgraded to Tropical Storm Saola 18 hours later as it continued to strengthen moving westward. Due to a normal speed of a typhoon and warm waters, Saola became a typhoon and reached peak intensity early on September 22. The strorm didn't made landfall but it affect Japan from September 23 to 25 by bringing heavy rainfall. Saola weakened to a tropical storm and became extratropical on September 26.
The name Saola comes from saola, a newly discovered endangered species in Vietnam.
- Weather Underground's tracking chart of Typhoon Saola.
Typhoon Longwang (Maring)[edit]
|Typhoon (JMA)
|Category 4 typhoon (SSHWS)
|September 26 – October 3
|Peak intensity
|175 km/h (110 mph) (10-min) 930 hPa (mbar)
Tropical Depression 19W formed about 335 nautical miles (620 km) south-southeast of Iwo Jima, Japan on September 26. The Joint Typhoon Warning Center initiated a warning for it at 0000 UTC the same day, and was upgraded to Tropical Storm Longwang six hours later. Longwang is Chinese for Dragon King. At 0300 UTC September 27, the Joint Typhoon Warning Center upgraded it to a typhoon. It continued to increase in strength as it tracked west to west-northwest towards Taiwan, and was upgraded to a super typhoon on September 29. PAGASA named the storm Maring for Philippine warnings on September 29. Longwang made landfall at 0515 local time on October 2 south of Hualien City, Taiwan as a Category 4 storm. Half a day later, at 2135 local time (1335 UTC), it made second landfall in Fujian Province, China as a minimal typhoon. Longwang dissipated on the next day.
Despite its intensity, Longwang caused mostly property damage, and claimed only one life in Taiwan.
- Weather Underground's tracking chart of Typhoon Longwang (Maring).
Tropical Depression 20W[edit]
|Tropical depression (JMA)
|Tropical depression (SSHWS)
|October 6 – October 8
|Peak intensity
|55 km/h (35 mph) (10-min) 1006 hPa (mbar)
The meteorological agencies is now operated of Guangdong and Hainan upgraded a low-pressure center over South China Sea to a tropical depression at 0800 local time, October 6. The Hong Kong Observatory followed suit 30 hours later. The JTWC finally issued a warning for this system at 1500 UTC October 7 (2300 local time), and tropical depression number 20W was issued to the system. The JTWC issued its final advisory on the system just six hours later, 55 nautical miles (102 km) west-northwest of Huế, Vietnam. As the system never reached Tropical Storm strength, it was not given a name from the list. The only damage it did, if any, however, was that massive rainfall amounts were recorded - over 230 mm (9 inches) were recorded in some parts of Hainan.
Typhoon Kirogi (Nando)[edit]
|Typhoon (JMA)
|Category 4 typhoon (SSHWS)
|October 8 – October 19
|Peak intensity
|185 km/h (115 mph) (10-min) 930 hPa (mbar)
A large cluster of thunderstorms formed with convection developed and separated into three low-pressure areas on October 6. But dew to warm waters in the western side, two failed to become storms and the Japan Meteorological Agency began issuing warnings for the other disturbance and became Tropical Depression 21W, which was located southeast of Okinawa at 1200 UTC, October 9 and assigned the name Kirogi to it at 0600 UTC next day. Prior to becoming a Tropical Storm it entered the Philippine area of responsibility and was assigned the name Nando by PAGASA for Philippine warnings. JTWC finally issued a warning for Kirogi at 0900 UTC, October 10, despite listing it as a Tropical Depression. It was upgraded to a typhoon at 0000 UTC October 12, and reached Category 4 strength about nine hours later. On October 16, Kirogi weakened was it pushes northeast. Kirogi was declared extratropical at 0300 UTC October 19. Kirogi is a Korean word for a type of migrating bird that lives in North Korea from autumn to spring.
Typhoon Kai-tak[edit]
|Typhoon (JMA)
|Category 2 typhoon (SSHWS)
|October 28 – November 2
|Peak intensity
|150 km/h (90 mph) (10-min) 950 hPa (mbar)
A tropical disturbance developed north of Papua New Guinea on October 20. It entered in an area of favorable environments on October 23, as it slowly intensified. On October 25, it affected the Philippines and rapidly moved to the South China Sea on October 27. The next day, the Japan Meteorological Agency initiated marine warnings for a Tropical Depression. Fifteen hours later, the Joint Typhoon Warning Center issued the number 22W to the system. The next day it was upgraded to Tropical Storm Kai-tak. Kai-tak was a name submitted by Hong Kong in honor of their former airport. On October 30 it was upgraded to a Typhoon. Kai-tak made landfall north of Huế, Vietnam, early on the morning of November 2. At least 19 people were killed and 10 others were left missing in Vietnam. Damages from the storm were estimated to be at least $11 million (2005 USD).[7]
- UNISYS track chart of Typhoon Kai-tak
Tropical Storm Tembin (Ondoy)[edit]
|Tropical storm (JMA)
|Tropical storm (SSHWS)
|November 7 – November 11
|Peak intensity
|65 km/h (40 mph) (10-min) 1002 hPa (mbar)
The Joint Typhoon Warning Center initiated warning for Tropical Depression 23W at 0900 UTC November 7, north-northwest of the Micronesian island of Yap. The storm gained enough power to warrant upgrading to a Tropical Storm 12 hours later. The system entered the Philippine area of responsibility on the morning of November 8 and was named Ondoy by PAGASA. The storm encountered shear as it moved west, and lost organisation on November 8, being downgraded to a tropical depression. On November 9 it regained tropical storm strength and had a better LLCC (low-level circulation centre). On November 10 it was named Tembin by the JMA. Tembin is a Japanese constellation for the group of stars known in the west as Libra. Tembin then made landfall near midnight November 11 local time in the northern Philippines and lost much of its circulation and convection. Tembin dissipated rapidly the next day.
- Weather Underground's tracking chart of Tropical Storm Tembin
Severe Tropical Storm Bolaven (Pepeng)[edit]
|Severe tropical storm (JMA)
|Category 1 typhoon (SSHWS)
|November 14 – November 21
|Peak intensity
|100 km/h (65 mph) (10-min) 985 hPa (mbar)
A low-pressure area formed along from the outflow of Tropical Storm Tembin on November 10. The Joint Typhoon Warning Center initiated a TCFA warning for a low-pressure system about 150 nautical miles (280 km) west-southwest of Palau late on November 12. This was upgraded to a tropical depression the next afternoon, 290 nautical miles (550 km) west of Palau. Forming inside the Philippine area of responsibility it has been named Pepeng by PAGASA. It was named Bolaven on November 16 by the JMA. Bolaven is a Laotian word meaning plateau or mesa. Although it strengthened into a Category 1 typhoon on November 17, it weakened to a tropical storm before making landfall on November 20 at about 800 local time in Cagayan Valley in the northern Philippines. Bolaven rapidly dissipated that same day north of the Philippines on November 21.
- Weather Underground's tracking chart of Typhoon Bolaven
Tropical Depression 25W (Quedan)[edit]
|Tropical depression (JMA)
|Tropical storm (SSHWS)
|December 16 – December 22
|Peak intensity
|55 km/h (35 mph) (10-min) 1000 hPa (mbar)
On December 16, a tropical disturbance developed and was given the name Quedan by PAGASA. Quedan organized into Tropical Depression 25W on December 18 off the northern coast of Borneo. On December 19, the JTWC classified it as a Tropical Storm. The JMA upgraded it to a tropical depression, but they warned it for a brief time. The storm dissipated early on December 20, as wind shear increased on the system.
Storm names[edit]
Within the North-western Pacific Ocean, both the Japan Meteorological Agency (JMA) and the Philippine Atmospheric, Geophysical and Astronomical Services Administration assign names to tropical cyclones that develop in the Western Pacific, which can result in a tropical cyclone having two names.[8] The Japan Meteorological Agency's RSMC Tokyo — Typhoon Center assigns international names to tropical cyclones on behalf of the World Meteorological Organization's Typhoon Committee, should they be judged to have 10-minute sustained windspeeds of 65 km/h, (40 mph).[9] While the Philippine Atmospheric, Geophysical and Astronomical Services Administration assigns names to tropical cyclones which move into or form as a tropical depression in their area of responsibility located between 135°E and 115°E and between 5°N-25°N even if the cyclone has had an international name assigned to it.[8] The names of significant tropical cyclones are retired, by both PAGASA and the Typhoon Committee.[9] Should the list of names for the Philippine region be exhausted then names will be taken from an auxiliary list of which the first ten are published each season. Unused names are marked in gray.
International names[edit]
During the season 23 named tropical cyclones developed in the Western Pacific and were named by the Japan Meteorological Agency, when it was determined that they had become tropical storms. These names were contributed to a list of a 140 names submitted by the fourteen members nations and territories of the ESCAP/WMO Typhoon Committee.
|Ramil (unused)
|Santi (unused)
|Tino (unused)
|Undang (unused)
|Vinta (unused)
|Wilma (unused)
|Yolanda (unused)
|Zoraida (unused)
|Auxiliary list
|Alamid (unused)
|Bruno (unused)
|Conching (unused)
|Dolor (unused)
|Ernie (unused)
|Florante (unused)
|Gerardo (unused)
|Hernan (unused)
|Isko (unused)
|Jerome (unused)
The Philippine Atmospheric, Geophysical and Astronomical Services Administration uses its own naming scheme for tropical cyclones in their area of responsibility. PAGASA assigns names to tropical depressions that form within their area of responsibility and any tropical cyclone that might move into their area of responsibility. Should the list of names for a given year prove to be insufficient, names are taken from an auxiliary list, the first 10 of which are published each year before the season starts. No names were retired from this list, so the names were used again during the 2009 season. This is the same list used in the 2001 season, except for Bising, Dante, Nando, Pepeng, Ramil, Santi, Tino, Undang, Yolanda and Zoraida which replaced Barok, Darna, Nanang, Pabling, Roleta, Sibak, Talahib, Ubbeng, Yaning and Zuma respectively. The names Bising, Dante, Nando and Pepeng are the first time to be used this year. Unused names are marked in gray.
The names Matsa, Nabi and Longwang were retired by the ESCAP/WMO Typhoon Committee. The names Pakhar, Doksuri and Haikui were chosen to replace Matsa, Nabi and Longwang respectively. According to the PAGASA, the name Undang was later removed from the list because it was already retired during the 1984 season. The name chosen to replace this name is Urduja for the 2009 season.
See also[edit]
- List of Pacific typhoon seasons
- 2005 Pacific hurricane season
- 2005 Atlantic hurricane season
- 2005 North Indian Ocean cyclone season
- South-West Indian Ocean cyclone seasons: 2004-05, 2005-06
- Australian region cyclone seasons: 2004-05, 2005-06
- South Pacific cyclone seasons: 2004-05, 2005-06
- ^ "Archived copy". Archived from the original on 2010-12-20. Retrieved 2006-08-26.
- ^ a b c d e Gary Padgett (April 7, 2005). "Monthly Tropical Weather Summary for January 2005". Typhoon 2000. Retrieved February 23, 2009.
- ^ a b c d "Best Track for Typhoon 01W (Kulap)". Joint Typhoon Warning Center. 2006. Retrieved February 23, 2009.
- ^ a b c d "JMA Best Tracks for 2005". Japan Meteorological Agency. 2006. Archived from the original on December 10, 2006. Retrieved February 23, 2009.
- ^ http://www.spa.gov.sa/details.php?id=247685
- ^ http://www.chinadaily.com.cn/english/doc/2005-09/13/content_477308_2.htm
- ^ http://www.mg.co.za/article/2005-11-03-typhoon-kai-tak-batters-vietnam
- ^ a b Padgett, Gary. "Monthly Tropical Cyclone summary December 1999". Australian Severe Weather. Archived from the original on August 28, 2012. Retrieved August 28, 2012.
- ^ a b the Typhoon Committee (February 21, 2012). "Typhoon Committee Operational Manual 2012" (PDF). World Meteorological Organization. pp. 37–38. Archived (PDF) from the original on August 28, 2012.
External links[edit]
- Satellite movie of 2005 Pacific typhoon season
- Japan Meteorological Agency
- China Meteorological Agency
- National Weather Service Guam
- Hong Kong Observatory
- Macau Meteorological Geophysical Services
- Korea Meteorological Agency
- Philippine Atmospheric, Geophysical and Astronomical Services Administration
- Taiwan Central Weather Bureau
- Joint Typhoon Warning Center


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31 January 2010
Whether you love him or hate him, Nick Punto can draw both the best and worst out of people.
A lot of Twins fans think Punto shouldn't be in the major leagues; some say he is extremely under-valued. The opinions on this utility infielder fall not into just these two buckets, however, but dozens.
How do you view Punto? Where should he be playing? Why does manager Ron Gardenhire insist on inserting him into the lineup day after day?
Answer these questions and more on Feb. 12, Nick Punto Day! On this date, feel free to let loose your varying opinions on Punto, whether via your own blog, through either an email to me, or as a comment on any one of the dozens of Twins blogs on the interwebs.
So, on Feb. 12, share your thoughts on one of the most controversial subjects in the Minnesota clubhouse: Nick Punto!
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text:
Dept. 4298, 1000 E. University Ave.
Laramie, WY 82071
Phone: (307) 766-2761
Toll Free: 1-888-989-9463
TeleType: 1-800-908-7011
Fax: (307) 766-2763
Email: firstname.lastname@example.com
Skip to Main Navigation. Each navigation link will open a list of sub navigation links.
The mission of the Wyoming Institute for Disabilities (WIND) is to assist individuals with developmental and other disabilities and their families by promoting and supporting full community inclusion, community membership, independence, productivity and social participation. WIND provides early intervention activities, training and technical assistance to professionals, research on disability issues and is home to the state assistive technology program and accessible instructional material coordinating center.
WIND is one of 67 University Centers for Excellence in Developmental Disabilities (UCEDD)in the United States. Each state now has at least one UCEDD; all UCEDDs are affiliated with universities and receive funding from the Administration on Developmental Disabilities, U.S. Department of Health and Human Services. UCEDDs share the common university goals of teaching, research, and service, but have a specific interest in persons with disabilities, particularly developmental disabilities and broaden teaching, research and service goals beyond the campus to the community at large. For more information see this UCEDD brochure.
Wyoming Institute for Disabilities
1000 E. University Ave
Laramie, WY 82071
WIND is located in the Health Sciences Building on the University of Wyoming Campus. The building is located on the intersection of 9th and Clark Street.
If you are stopping in for a short visit, consultation, or to pick up a device, you may park in the small lot in front of the building. The receptionist can give you a temporary parking permit. If you are arriving for the day, please contact us for a day pass. If you are visiting campus for an extended stay, more parking information is available through TransPark.


text:
Our View: Say no to payday loans
Despite the staunch opposition of the United Way of Erie County and a dozen other nonprofit organizations in Erie, payday loans could become legal in Pennsylvania. On Tuesday, the Pennsylvania Senate Banking and Insurance Committee voted to advance the proposed legislation, Senate Bill 975, to the Senate Appropriations Committee. A similar bill failed in 2012.
These types of loans are called "predatory" lending for good reason. Del Birch, vice president of community building for the United Way, says SB 975 "is nothing more than a wolf in sheep's clothing that would legalize 300 percent APR (annual percentage rate) loans."
The proposed bill is the Micro Credit Modernization Act. By pairing "micro" with "modernization," the legislation is positioned to look as though it's meeting a pressing need in Pennsylvania to update credit laws and expand credit options for people who have a hard time obtaining loans. But opponents point out that payday loans keep poor people in perpetual debt because of the excessive interest, the quick repayment terms and the lender's ability to gain direct access to the debtor's bank account if the loan is delinquent.
The United Way of Erie County and nearly 100 other organizations across the state are part of Stop Predatory Payday Loans in Pennsylvania. This coalition includes AARP Pennsylvania, the Pennsylvania War Veterans Council, Habitat for Humanity and the Society of St. Vincent DePaul in Pittsburgh and Philadelphia.
St. Martin Center in Erie, which is a coalition member, works hard to educate its clients about how to manage their money, stay out of debt and make wise decisions about housing.
In April, Dave Pesch, the agency's director of housing counseling, said that a new study by the Housing Alliance of Pennsylvania and the National Low Income Housing Coalition shows that more than half of the renters in Erie can't afford to pay the average monthly rent of $681 for a two-bedroom apartment. Erie County renters earn an average of $9.63 an hour; they'd need to earn $13.10 to afford the average rent. For poor people squeezed to pay for basic needs like this, a payday loan might sound attractive.
But as Pesch wrote in an Aug. 19 Guest Voice column, payday loans are structured "to keep people borrowing over and over again. Repayment-in-full is taken first on payday, before the borrower is able to pay rent, utilities or child-care costs. As a result, borrowers are immediately short on funds and likely to borrow against their next paycheck just to make ends meet."
In a letter to the Pennsylvania Senate, the coalition said that payday loans are a "barrier to self-sufficiency and financial stability." The United Way of Erie County's goal is help 10,000 Erie residents become self-sufficient by 2025, so they don't need help from government or nonprofit agencies to meet their basic needs. Contact SB 975 sponsor Sen. Pat Browne, R-Lehigh County, at (717) 787-1349 to tell him we need Pennsylvania residents to become self-sufficient, not long-term debtors.


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Guyot Designs The Standard
38 oz (1124 ml)
12.9 oz (365 g)
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Our single wall, stainless steel bottles are great with a Gription, splash-free with a Splashguard. They also work with all standard wide mouth water purifiers and accessories.
Retailers' Descriptions
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- GearX.com
Beyond carbon-neutral, this Guyot Designs stainless steel Standard drinking bottle is verified carbon-negative - each and every bottle manufactured carries with it 100 pounds of emissions reductions. Carry your water or favorite drink with you around campus, to work, or up the mountain in the 38-ounce widemouth plastic-free design - the classic straight-sided configuration will never let you down.
- Mountain Gear
Each stainless steel Guyot water bottle we sell through our website is part of Guyot's C-Minus program. Every bottle we produce carries 100lbs of verified green house gas emissions reductions - making Guyot's bottles not just carbon neutral, but carbon negative! Each bottle comes with it's own specific batch number. Guyot's single wall bottles are great with a Gription, splash-free with a Splashguard. They also work with all standard wide mouth water purifiers and accessories.
- Altrec Outdoors
Built for the outdoors but useable anywhere, the Standard stainless steel wide-mouth water bottle from Guyot Designs is the healthy alternative to plastics or polycarbonate. Made of 18/10 surgical grade stainless steel. Stainless steel is 100% recyclable and lead-free. Screw-on plastic lid with nylon lanyard. 38 fluid ounce capacity. 63mm wide mouth.
Guyot Designs The Standard
The Guyot Designs The Standard is not available from the stores we monitor. It was last seen January 15, 2013 at Mountain Gear.
If you're looking for a new water bottle, check out the best reviewed current models.


text:
Penney CEO's challenge: Can it be fixed?
NEW YORK -- There won't be an easy fix for J.C. Penney -- if it can be fixed at all.
As Mike Ullman takes the reins again less than two years after his departure, he faces a herculean task to undo the mess left by Chief Executive Ron Johnson, who was ousted last week. With the department store retailer in the middle of a disastrous overhaul that has driven away shoppers, the 66-year-old Ullman has to quickly figure out what parts of Johnson's legacy to keep and what to trash.
The overarching question is whether the century-old company, one of the anchor tenants at the Millcreek Mall, can be saved at all. Very few retailers have recovered from a 25 percent sales drop in a single year, like that suffered by Penney under Johnson's watch.
"Ullman can't go back to the old ways, but he can't do what Ron Johnson did," said Ron Friedman, head of the retail and consumer products group at Marcum LLP, a national accounting and consulting firm. "I think there will be a combination of the two. But he has to make some quick moves."
Apparently, the company's board of directors felt Ullman, who served as Penney's CEO for seven years and is known for strong relationships with suppliers and calm, steady execution, would be the best choice right now to secure the company's future. But it could take Ullman 18 months to stabilize the business, says Burt Flickinger III, president of retail consultancy Strategic Resource Group. He gives the chain a 50-50 chance to survive.
Johnson's goal was to reinvent the stodgy retailer into a mini-mall of hip specialty shops.
Instead, Penney's loyal shoppers went in search of deals elsewhere, and the chain didn't attract the younger and more affluent shoppers that Johnson coveted. Now the 1,100-store chain is burning through cash. In the past year, the company lost nearly a billion dollars and saw its revenue tumble by nearly $4.3 billion to $12.98 billion. Customer traffic dropped 13 percent. Steep sales declines have continued, say analysts, even though Johnson added back some sales events and coupons early this year.
Some speculate that Ullman may ditch the everyday price strategy and instead ramp up the return to discounting and coupons to get shoppers back in the stores. But that will still be an expensive move. Michael Binetti, an analyst at UBS Investment Research, and others believe that Ullman also will temporarily suspend the rollout of the mini-shops, which started late in 2012 and feature such brands as Joe Fresh and Levi's.
When the overhaul of its home area is completed in May, the company will have carved up 30 percent of its store space into mini-boutiques. Whatever Ullman ends up doing, analysts expect him to be thoughtful and deliberate in his moves. That's a big difference from Johnson, who was criticized for not testing his strategies in a few stores, particularly the pricing plan.
In a statement released by Penney on Monday, Ullman said he plans to immediately "engage with the company's customers, team members, vendors and shareholders, to understand their needs, view and insights" and then work with the management team and the board to develop a game plan.
Still, there are concerns. Penney struggled under Ullman's first regime, though the company was still profitable. Ullman brought in Penney's first mini-shops, including beauty company Sephora and exclusive names like MNG by Mango, a European clothing brand. But he didn't do much to transform the store's shopping experience or to attract new customers.
That showed up in the sales figures. During Ullman's previous tenure, from December 2004 to October 2011, sales declined from $18.18 billion in 2004 to $17.6 billion in 2010, his last full year at the company. Sales per square foot dropped to $155 from $177, according to Deborah Weinswig, an analyst at Citi Research.
When Ullman left Penney in November 2011, the situation wasn't great. But it also wasn't the crisis it is now. The company's credit ratings are deep into junk status. Its stock has lost 67 percent of its value since February 2012 when investors bullish on Johnson's grand plans drove the price up around $43. That makes it that much harder for Ullman to turn business around.
Ultimately, Penney's fate lies in once-loyal shoppers like Beth Williams, 39, who deserted the chain early in 2012.
Williams, a writer and mother of a 3-year-old from Plum, said she used to shop at Penney once a month for her family. But that changed when her local store got rid of coupons and sales events. She also doesn't like the new styles that she believes only target customers in their teens and 20s.
Williams says she would go back if Penney had more sales and brought back more traditional clothing like khaki shorts with forgiving fits.
"I would go back," she said. "I miss it. That was my go-to store for a long time, and then it changed."


text:
what is the date of exam of the recruitment of jr. clerks
what is the date of exam of the recruitment of jr. clerks
Related Questions:
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dear friend here is the details -
1) notice date - 15 nov. 2013
2) qualification - 12th with 60% / graduation
3) age - 18 to 35 years
4) written - 200 marks
5) books - arihant
6) exam date - 23 december , 2013
7) cut off - 125 marks
8) online website for preparation - gr8ambitionz.com
9) process - written + interview
10) result - 12 march 2014
Dear friend,
candidates who have cleared their intermediate can apply for the junior clerk posts.The notification for these posts will be released in the month of november.
And the exam is conducted for 200 marks. The exam pattern is shown below
Reasoning-50 marks
Aptitude-50 marks
General awareness-40 marks
English language-40 marks
Computer knowledge-20 marks
And the exam will be held on 23rd december, 2013.
candidates is based on written test and interview.candidates who have passed the written test are only eligible for the interview.
Age limit:-
35 for SC and ST
30 for OC and BC
33 for OBC
All The Best


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11/13/2012 • WHO: Winter Circle Productions presents Big Gigantic plus Crizzly WHERE: House of Blues WHEN: Friday, November 16th – Show at 8:00 TICKETS: $17.50... more
LMB NOLA: a blog about concerts and music in the Big Easy. Prepare to get funky... more...
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