text:
Health-care experts are placing a lot of faith in what is called the patient-centered medical home (PCMH). The term is off-putting to some because it sounds like "nursing home." However, it is simply a physician's office organized in a different way.
The PCMH recognizes that health care is rarely one doctor treating one patient. It requires a team of health-care providers, educating family members and using community resources. Physicians are more like team leaders, coordinating care with staff members as well as specialists and hospitals. The doctors are rewarded more for keeping their patients healthy and out of the hospital rather than for short face-to-face visits with lots of tests and procedures. Medical homes are usually paid a monthly fee for patients under their care.
The "patient-centered" aspect assumes patients will participate in their own care. They will ask for and receive the care they want and need, and act on the medical advice they are given. The medical home has a number of features that are missing in most doctors' offices: electronic medical records, email communication, remote monitoring of chronic conditions and frequent reminders about preventive care.
There are many strengths to this kind of approach. Physicians have fewer incentives to provide unnecessary care. Participants recognize that most patient transactions can be handled by email or telephone. A Mayo Clinic pilot study found that "e-visits," or care provided over the Internet, made office visits unnecessary in 40 percent of the cases.
A 2010 Health Affairs article described the future physician's office, using medical-home principles. The office might treat 100 patients a day. The doctor might be involved with 30 to 40, of whom perhaps 10 would have traditional face-to-face individual appointments. The other patients interacting with the doctor would do so by telephone, email or group appointments. The remaining 60 to 70 patients would be treated by nurse practitioners, physician assistants or medical assistants, who would handle less complex cases and counsel people with chronic conditions on disease self-management. These team members would spend more time – and likely be more effective – than a physician could in a 15-minute time slot.
The doctor's office currently is set up to deal with brief illnesses or disease that can be cured mostly by time and medication. It is ill-suited to treat chronic disease, which accounts for about 75 percent of health-care spending. Effective chronic-disease management requires close monitoring and tweaking of treatment to avoid complications that require hospitalization or emergency department (ED) visits, such as heart attacks, stroke or respiratory failure. Medical homes typically have after-hours arrangements for their patients to be able to see a physician or nurse without going to the ED. Less than one-third of doctors' offices have such an arrangement now.
An estimated 40,000 primary-care physicians work in practices set up as PCMHs. That is about 1 out of 8 physicians and pediatricians. Blue Cross Blue Shield of Michigan said it saved $65-$70 million in 2011 working with PCMHs. It paid an extra $7,500 per physician for the year. However, it saved money because better care yielded fewer hospital and emergency-department visits. The doctors also ordered more generic prescriptions because electronic prescribing allowed them to see lists of covered medicines.
Seattle-based Group Health (GH) is an integrated-care organization with its own health plan. It serves 600,000 members and employs about 1,000 physicians in Washington state and Idaho. Using medical-home care principles, GH has been able to improve quality and lower costs. It resulted in 29 percent fewer ED visits and 6 percent fewer hospitalizations, compared with its patient outcomes prior to becoming a medical home. In a survey at its clinic in Bellevue, patients expressed higher satisfaction with their care. More patients received recommended health screening tests, chronic-disease management and medication monitoring, compared with its prior traditional approach.
Paying doctors to keep people healthy seems so logical. However, it will not be widespread until health plans recognize this as customary care. In an Internet survey of 1,000 physicians, two-thirds said they believed the current health-care environment is detrimental to care. Less than 1 in 5 said they could make clinical decisions based on what is best for the patient rather than what health plans would reimburse.
While many physicians agree with medical-home principles, they already are stretched thin and are suspicious of what may be unrealistic expectations and extra effort. All of this is fine, they say, if they are properly paid. The government and health plans do not have a good track record in this regard. Many health-delivery innovations have been oversold, only to be swept away after impatient payers fail to see promised savings in short order. Health care has long been regarded as an expense rather than an investment. Unless that perspective changes, the medical home may never gain traction.
The health-care system envisioned by reformers calls for prompt patient access to care despite the next wave of additional demand from health reform and an aging population. They also want to create more attractive careers for primary-care physicians. That would mean a lightened workload and more income. The math simply does not work.
Two major barriers are money and workflow.
Seattle's GH invested $1.3 million at its Bellevue clinic to create its medical home. It had a 50 percent return on investment because its patients were also part of its insurance plan. Because GH treats and also insures its patients, it has an incentive to treat patient in ways that minimize hospitalizations and expensive procedures. Few clinics will be able to have that kind of payback. In most cases, the physicians will make the investment while the health plans and patients will reap the savings.
Typical physicians' offices are built around the doctors' hectic routines. They see patients at a frenetic pace and have little interaction with staff members. Medical homes, by contrast, require doctors to be managers of care teams, something they have not been trained to do and many are uncomfortable with. The current standard is doctor-centered, not patient-centered, care.
Medical homes will be created by highly motivated, well-funded physician groups willing to overcome the barriers to install an unproven business model. Medical homes appear likely to be islands of excellence rather than the standard of care.


text:
Chamber Issues Scam Warning
The Toccoa-Stephens County Chamber of Commerce is issuing a scam warning alert to its members.
In an e-mail sent out on Thursday, the Chamber said it has received reports of some of its members receiving calls from an unrecognizable number saying they represent the Chamber and are calling to update account records.
The Chamber said it has not authorized this activity and advises anyone who receives such a call not to give them any information.

subset: commoncrawl


text:
Facial Reconstructive Surgery
Facial Reconstructive Surgery WORTH IT RATING* DETAILS
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over all time
Facial reconstructive surgery is any surgery that restores facial features. These surgeries can repair disfigurement, burns, trauma, abnormal development, or any other facial deformity.
Average Price:
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My family will always be grateful to Dr.Houser and his entire office. I have had years of reconstructive surgery on my face and legs, Dr.Houser is by far the best plastic surgeon I have been to. Well, other than his dad who was my surgeon when I was little. As a child, I had extensive damage to... READ MORE
Skin Cancer, Eyelift, and the Best Doctor to Help! - Seattle, WA
I was diagnosed with Squamous Cell Carcinoma on my nose, close to my eyelid, and was referred to Doctor Meghan Nadeau by Dr Peter Odland who was performing my Moh's surgery. I did some research with fellow doctors and estheticians and her name came up from others. I met with Dr Nadeau and... READ MORE
39 Years Old, The Worst Car Accident of My Life. New Orleans, LA
It was September 4, 2015, and I was at the very start of my 86 mile commute to school. I'm a chemical engineering student, and I had an 8:30 class that Friday. It was the day before a holiday weekend, and I didn't expect traffic to be bad. I was in traffic, a complete standstill, when I sent a... READ MORE
47 Year Old Cyclist - Hit by a Car - Gulf Shores, AL
I'm an extremely healthy and active 47 year old mother of two. In August of 2015 I was hit by a car while cycling on a family vacation. My jaw was broken and my lips, mouth and chin were torn. Dr. Ruhani reconstructed my torn lips, tears inside my mouth and chin and under my nose and on my forehead. READ MORE
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text:
Disney Princesses!
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Join Date: Aug 2008
Posts: 54
Sunday, August 31, 2008 at 02:52PM
I've read the book The Princess Diaries, and in that one they simply cut her already straight hair and dye it blonde. I think in the movie, they wanted something that would be very dramatic. The huge curly hair at the beginning was likely a wig, since I believe Anne's hair is naturally straight.
That said, I remember being very annoyed with that, since I was roughly Mia's age when the film came out and had really come to terms with my curls at last.
Connected or not, later that year I got my hair chemically straightened (NEVER again).
What's ironic for the film, though, is that they make two very good points: the first is that they straighten her hair to make her more Princess-like, but Mia fights her "transformation" all the way through. It's made clear that they're kind of trying to make her seem less unique. The other is that the boy she ends up with loved her when her hair was curly, and I think liked her more when she was "just Mia" as opposed to Princess Mia.
So the curls aren't a deterrant for love, and the only person who really finds her "acceptable" afterwards is the jerk.


text:
Aer Lingus has urged shareholders to reject budget airline Ryanair's latest €694 million (£545 million) takeover offer for the Irish budget airline on the grounds it "fundamentally undervalues" the business.
The Aer Lingus board also said it has received legal advice that the UK Competition Commission would again block Ryanair's offer to take control of the company.
Its rejection statement today followed Ryanair, which has a 29.82% stake in Aer Lingus, issuing a 182-page offer document yesterday that claimed a tie-up between the two Irish airlines would create jobs. Its offer of €1.30 a share, which aims to increase Ryanair's holding to at least 50%, is its third in six years.
Aer Lingus said it is a "robust and profitable airline with a proven business model, a strong balance sheet and an internationally recognised brand". It added that the board's "unanimous view" is that Ryanair's offer "fundamentally undervalues Aer Lingus and represents a significant discount to the intrinsic value of the business".
The first takeover offer by Ryanair, whose chief executive is the outspoken Michael O'Leary, in 2006 was blocked by the European Commission on competition grounds. Aer Lingus today said it believes the "reasons for prohibition are now even stronger than before: the number of routes that Ryanair would monopolise has sharply increased". Aer Lingus said it had "received legal advice that the EC is likely once more to prohibit the Ryanair offer, and that this is not therefore a credible offer which is capable of completion".
Aer Lingus also said the UK Competition Commission continues to investigate the "anti-competitive effects" of Ryanair's shareholding in its rival "despite Ryanair's repeated and ongoing attempts to stop both this investigation and the previous Office of Fair Trading investigation".
Ryanair launched its second takeover bid for Aer Lingus in December 2008, valuing the company at €748 million.
- More about:
- Aer Lingus
- Air Transport
- Mergers And Acquisitions
- Ryanair


text:
|Publication number
|Publication type
|Application number
|Publication date
|May 15, 2007
|Filing date
|May 19, 2004
|Priority date
|Mar 14, 2001
|Fee status
|Also published as
|Publication number
|Balu Balakrishnan
|Original Assignee
|Power Integrations, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (21), Non-Patent Citations (1), Referenced by (8), Classifications (19), Legal Events (2)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of and claims priority to U.S. application Ser. No. 10/435,152, filed May 8, 2003 now U.S. Pat. No. 6,788,514, which is a continuation of and claims priority to U.S. application Ser. No. 10/092,601, filed Mar. 8, 2002, now issued as U.S. 6,580,593 B2, which claims the benefit of and claims priority to U.S. provisional application Ser. No. 60/275,962, filed Mar. 14, 2001, entitled "Method And Apparatus For Fault Condition Protection Of A Switched Mode Power Supply."
1. Field of the Invention
The present invention relates generally to power supplies and, more specifically, the present invention relates to a switching regulator.
2. Background Information
In a switching power supply, a power supply controller is connected in series with a primary winding of a transformer to the high voltage direct current (DC) input derived from alternating current (AC) power line through rectification and filtering. Energy is transferred to the secondary winding in a manner controlled by the power supply controller so as to provide a constant output voltage. Another winding called a feedback or bias winding may be used to provide a feedback signal to the power supply controller. Alternatively, the feedback signal can come through an opto-coupler from a sense circuit at the secondary output. The feedback signal is used to modulate the duty cycle of the power supply controller or used to allow or disallow cycles in order to control the secondary output.
In the event of a short circuit condition, an overload condition (may be caused by either an overload at the output secondary winding or an under voltage condition at the power supply input) or an open in the feedback loop, the power supply controller detects the loss of feedback signal and goes into a mode called "auto-restart." In the auto-restart mode, the power supply controller tries to start the power supply periodically by delivering power for a period of time, also known as the on-time, (greater than needed for start up) and turns off the power supply for another period of time, also known as the off-time. As long as the fault condition is present, the power supply controller remains in this auto-restart mode limiting the average output power to a safe, low value. When the fault is removed, auto-restart enables the power supply to start automatically.
The operating principle of auto-restart is to reduce the average power delivered to the power supply output during fault condition to a safe level by running the power supply alternately between a first predetermined time period (also known as on-time) and a second predetermined time period (also known as off-time). During on-time power supply is on delivering energy to output while during off-time power supply is off delivering no energy to output. To make auto-restart protection effective, the off-time is set significantly longer than the on-time. When fault condition occurs for a duration shorter than the auto-restart off-time, the power supply will not attempt to restart until the off-time is over resulting in unnecessary long delay before recovery.
Methods and apparatuses for fault condition protection of a switched mode power supply are disclosed. In one aspect of the invention, a power supply circuit having an auto-restart function to turn the power supply on and off repeatedly under fault conditions is included. In one embodiment, one or more off-times following detection of a fault condition is smaller than subsequent off-times. Additional features and benefits of the present invention will become apparent from the detailed description and figures set forth below.
The present invention detailed is illustrated by way of example and not limitation in the accompanying figures.
Embodiments of methods and apparatuses for fault condition protection of a switched mode power supply are disclosed. In the following description, numerous specific details are set forth in order to provide a thorough understanding of the present invention. It will be apparent, however, to one having ordinary skill in the art that the specific detail need not be employed to practice the present invention. In other instances, well-known materials or methods have not been described in detail in order to avoid obscuring the present invention.
Reference throughout this specification to "one embodiment" or "an embodiment" means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, the appearances of the phrases "in one embodiment" or "in an embodiment" in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more embodiments.
As an overview, embodiments of the present invention provide improved fault condition protection for power supplies against faults that leads to open control loop conditions. In the various embodiments disclosed, a fault condition in the power supply may result from an open loop condition, which may be a result of a power supply output short circuit condition or a power supply overload condition. In one embodiment, the power supply overload condition may be a result of a power supply input under-voltage condition. In one embodiment, the off-time or the duration of a disable period of the initial auto-restart cycle or cycles is shortened significantly compared to the off-time or the duration of disable periods of subsequent auto-restart cycles. For faults with short duration, the recovery time of the power supply is reduced due to the shortened off-time of the initial auto-restart cycle or cycles. For faults persisting over longer durations, the protection provided by the auto-restart for a power supply in accordance with the teachings of the present invention is not compromised as, except for the auto-restart cycle or cycles, the off-time of subsequent cycles are not shortened.
As will be discussed, in one embodiment, a fixed number of auto-restart cycles are shortened after the detection of a fault condition and the subsequent auto-restart cycles have longer durations. In one embodiment, the fault condition is not detected until after the power supply has been in regulation. Only the first auto-restart cycle is shortened in one embodiment of the present invention. This modification allows a power supply to recover from momentary fault conditions with reduced delay. For example, in one embodiment, a power supply controller in accordance with the teachings of the present invention, the on-time is 50 ms and the off-time of the first auto-restart cycle is set to a much shorter value of, for example, 200 ms or four times of on-time while leaving the off-time of all subsequent auto-restart-cycles unchanged (one second or twenty times of on-time in this case).
Accordingly, when a fault occurs, a power supply in accordance with the teachings of the present invention makes its first restart attempt in 200 ms and then, if not successful, follows up with one subsequent attempt every 1.05 seconds. This allows the power supply to recover quickly from a momentary fault condition without compromising the auto-restart protection against faults persisting over longer time duration. Of course, the values of these time durations are provided only for explanation purposes and other time durations may be employed in accordance with the teachings of the present invention.
In one embodiment, an implementation in accordance with the teachings of the present invention includes a switching device for controlling, regulating or modulating power delivered to the output and a timer coupled to the switching device and to the feedback signal. When a fault condition occurs, the timer enables the switching device to deliver power to the output for a first predetermined period (on-time), which is then followed by the timer disabling the switching device to prevent power delivery to the output for a second predetermined period (off-time). The switching device may be alternately enabled for the on-time and disabled for the off-time when the fault condition persists. This function is known as auto-restart. In one embodiment, the switching device may be a power transistor. The timer may be a digital counter. An oscillator with a predetermined frequency may be coupled to the counter. The oscillator may have a control input for selecting between two predetermined frequencies: one fast, one slow.
In one embodiment of steady state auto-restart operation, the off-time is much longer than the on-time, which in one embodiment is accomplished by running the oscillator at the fast frequency during on-time and at the slow frequency during off-time. The off-time of the first auto-restart cycle may be shortened by running the oscillator at the fast frequency instead of the default slow frequency. In one embodiment, the on-times use the fast frequency while the off-times except for the off-time of the first auto-restart cycle use the slow frequency.
In one embodiment, the on-time and off-time are controlled by a signal decoded from the counter output according to desired on-time to off-time ratio. At power up, counter is reset to zero count. On-time starts from zero count and ends at n count. Off-time starts from n+1 count and ends at full count. In order to use the fast frequency for the off-time of the first auto-restart cycle and slow frequency for the off-time of all subsequent cycles, a latch is added in one embodiment. The output of the latch determines which frequency is to be used for the off-time. The latch being set selects the slow frequency and the latch being reset selects the fast frequency. The on-time uses the fast frequency regardless of the state of the latch output.
In one embodiment, at power up, the latch is automatically set to select the slow frequency for the off-time. After the power supply output reaches regulation, a feedback signal is generated from the power supply output, which in turn resets the latch and changes the selection to the fast frequency. Consequently, when a fault condition occurs, auto-restart begins with a short cycle providing an opportunity for the power supply to recover quickly if the fault is short in duration. At the completion of the first auto-restart cycle, off-time ends and the counter reaches full count. A full count signal is then generated to set the latch and selects the slow frequency. This ensures the use of slow frequency for the off-time of subsequent cycles if auto-restart continues as a result of a persisting fault. Upon the removal of the fault, the power supply restarts and the output reaches regulation. A feedback signal is then generated, which once again resets the latch and selects the fast frequency. Notice that, at this point, the power supply is back to the same status as it was first time after power up. For faults with a short duration, this fault removal process happens at the end of the first auto-restart cycle and the recovery time is short. For faults with longer duration, this happens at the end of a later cycle but the process is the same.
To illustrate,
In one embodiment, the counter 220 receives a clock signal 240 from an oscillator 202 and generates an OFF/ON_signal 242 to control the on-time and the off-time of the auto-restart operation. At power up, latch 222 is set before counting begins, and counter 220 is reset before counting begins. The OFF/ON_signal 242 stays low from zero count up to n count indicating auto-restart on-time. The OFF/ON_signal 242 goes high at n count and stays high till full count indicating auto-restart off-time. A full count signal 243 is generated at full count, which sets the latch 222 via OR gate 221.
As shown in the depicted embodiment, the latch output 245 is coupled to one input of AND gate 223. The other input of the NAND gate 223 receives the OFF/ON_signal 242 from counter 220. The output of NAND gate 223 connects to the FAST/SLOW_input of oscillator 202. A high signal at the FAST/SLOW_input selects the predetermined fast frequency for the oscillator 202 while a low signal selects the predetermined slow frequency. When latch 222 is reset, the signal at the FAST/SLOW_input (signal 246) is forced high by NAND gate 223. This forces the off-time to run the same frequency as the on-time (fast frequency). When latch 222 is set, the signal at the FAST/SLOW_input is equal to the OFF/ON_signal 242 which allows the off-time to run the opposite frequency as the on-time (slow frequency).
As shown in the depicted embodiment, the FB/UV circuit 203 receives a combined feedback and a line voltage signal from the FB/UV terminal 107. After separating the feedback signal from line voltage signal, FB/UV circuit 203 sends the FEEDBACK signal 241 to the RESET input of counter 220 and R input of latch 222. When power supply output reaches regulation, node 241 goes high resetting both counter 220 and latch 222. The OFF/ON_signal is also coupled to the input of the other AND gate 205 through inverter 204. The power MOSFET 206 or power switch coupled between DRAIN terminal 103 and SOURCE terminal 109 is disabled when OFF/ON_signal is high (auto-restart off-time) and enabled when OFF/ON_is low (auto-restart on-time).
In the foregoing detailed description, the method and apparatus of the present invention has been described with reference to specific exemplary embodiments thereof. It will, however, be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of the present invention. The present specification and figures are accordingly to be regarded as illustrative rather than restrictive.
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|Oct 29, 2009
|Power Integrations, Inc.
|Method and apparatus for a control circuit responsive to an impedance coupled to a control circuit terminal
|Sep 16, 2009
|Apr 15, 2010
|Bcd Semiconductor Manufacturing Limited
|Electronic Power Protection Circuit And Applications Thereof
|Mar 29, 2008
|Jun 3, 2010
|Jae Yoo Yoo
|Refrigerator and operating method thereof
|U.S. Classification
|361/93.4, 361/90, 361/91.1, 361/92
|International Classification
|Cooperative Classification
|European Classification
|Nov 15, 2010
|Fee payment
Year of fee payment: 4
|Nov 17, 2014
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Year of fee payment: 8


text:
2013-12-12 / Around the County
Businessman Gives Back; Helps Clean Coats for Those in Need
Carmel businessman Steve Choi realizes that times are tough for many residents of Putnam County with the topsyturvy economy. The Brewster resident, who owns and operates Carmel Cleaners at the Putnam Plaza, has decided to do his part this holiday season by offering free cleaning and tailoring services to the Putnam Community Action Program's coat distribution program.
The full version of this story is available only to subscribers. Subscribe now to access to full versions of news stories in our archive of over 12,000 stories going back to 1999.


text:
Feb. 25, 2004
Recap?|? Box Score?|? Photo Gallery
Tennessee Head Coach Buzz Peterson
"A lot of things didn't go well for us. We kind of went back to the way we were early in the year. They moved the ball pretty quick in their half-court offense, so we went from zone to man-to-man, but we just weren't able to stop them. They shot well from the three point line. The adjustments we tried to make were in the post. I felt like (Erik) Daniels got some easy catches down in the post and he was kind of a point guard in the post for them. Overall, we went back to the way we were playing on the road early in the year - there just wasn't much toughness."
On Kentucky's 3-point shooting
"We were in a zone and they (Kentucky) were able to get some looks. And then out of a man-to-man they set some good screens to get looks. When (Ravi) Moss hit that one late on (Dane) Bradshaw, I kind of thought maybe it was just one of those nights for Kentucky where they were on."
On trying to slow UK's offense
"We tried some zone. We challenged our players to play better half-court defense and talked about some of our shell principles from practice. These last two days of practice have not been some of our better days of practice. I really believe the way you practice is the way you're going to play."
Kentucky Head Coach Tubby Smith
"It was a good all-around effort. I thought we had great balance and our guys had good focus tonight. Our concentration was there, especially on the defensive end. Obviously, from the rebounding standpoint, we did a good job. I thought Antwain (Barbour) got us going early and I was happy to see him get off to a great start. Erik (Daniels) and Chuck (Hayes) gave us their regular play along with Kelenna (Azubuike) and Cliff (Hawkins) once again orchestrated and ran the team the right way. The big key was trying to keep the ball off Scooter (McFadgon) as much as we could and I thought we did a fairly good job there. I don't like our free throw shooting. That is something we have to work on and do a better job."
On the complete game
"If you look at the numbers, it was probably one of our better games. We only had five turnovers in the second half and our young players are getting better. You can see that they are improving. I like what we are doing with them."
On Gerald Fitch
"He was on IV. He has had food poisoning so he was weakened and he got a little woozy in the second half. I knew he wasn't himself when he went in the game early on. He was nauseated and throwing up after pre-game meal."


text:
City of Pittsburgh Bureau of Police
Police Branches
The Operations Branch, under the command of Assistant Chief Anna Kudrav, includes six police zones and the Special Deployment Division (SDD) which includes Traffic, Special Emergency Response Team (SERT), Street Response Unit (SRU), Collision Investigation Unit, Explosives Ordinance Disposal team, and the staff at the Tow Pound.
The Investigations Branch, under the command of Assistant Chief Maurita Bryant, investigates and solves crimes against persons and property. This branch also includes the Office of Family Violence and Missing Persons, as well as Narcotics and Vice, which combats illegal drug manufacture, distribution, sale and use.
The Administration Branch includes the Training Academy, School Crossing Guards, Personnel & Finance, Support Services, and Research and Special Events Planning.


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G's 12g long planted with new (smaller) driftwood
regarding photos, I put all the old photos into a new album since I'm going to do a second tank journal soon and dont want any mixups/confusions with pictures. Please go to the photobucket site for all old pics. I'll try to edit in some FTS shots for progressions on post 131 on page 9
Marineland Double Bright LED
Eheim 2215 Filter with 2217 impeller
Koralia Nano 240
Hydor Inline Heater
5lb CO2
Black sand substrate
I have no idea what the rest are called lol
Otocinclus Vitatus
lookin good nice ideas how about white cloud mountain minnows aswell/either they have red on them and are a good shoaler will also contrast well with a black background
this has great potential!
Day 1:
Please ignore the rock, that's to prevent the driftwood from floating.
Thanks for reading!
p.s. big thank you to everyone on TPT who I got stuff from(driftwood, prefilters, co2 stuff, plants, fertilizers etc)
I'm more concerned with the boraras looking really nice in pictures because of the lighting that compliments their red color so when I put them in my tank, they'll look more washed out and bland.
good luck i will watch your progress :)
I am slightly worried that there isnt enough cover for the fish under that bright lighting from looking at my top down shot. I originally allotted more back space for plants but the tile under the driftwood skewed my location placement and i ordered too much hc. (dont often hear ppl complain about that, please be nice. its my first planted tank :red_mouth)
i would add vallisneria in the rear left corner i would keep the far right as an open swimming area and add a few crypts and stem plants in and around the driftwood with maybe a large crypt at the back
I found these crypts that I like. in parenthesis is how tall they get, but i want to know how wide do they get?
Cryptocoryne wendtii 'Green Gecko' (4-6in)
CRYPTOCORYNE X WILLISII 'LUCENS' (4-8in)
CRYPTOCORYNE UNDULATA (4-6in)
Keep in mind my tank is only like 9 inches tall lol with 1-2inches of sand = gigantic looking crypts. wont they overpower the driftwood?
Looks like you have a great start on this. I'm really starting to like that size tank.
Thanks! You should get one ;)
wow.. cant wait to see this
I thought the same thing about the lucens... Now I have some leaves that are close to a foot probably. My undulata stays about the listed height, not sure about green gecko because I havent had it but my wendtii red gets like a foot or taller sometimes.
darn, i liked the lucens the best. I'll go with the undulata in the back left corner then thanks! What color do you think it will be with around 40-50 par?
Day4: HC stems started perking up, can see some new smaller leaves (or is this wishful thinking? :p) Definitely saw alot of fuzzy mold on the driftwood though. Went into panic mode and wiped it down before I remembered to take pictures. Hopefully I caught it pretty early and it wont spread to the plants. Wiped down the wood with full strength excel and left the saran wrap off today to let the wood fully dry. Just covered it again now as the water level goes down reaaally fast when left open.
If I see mold on the hc, how much should i dilute the excel to spray onto the hc? I think i read 1:10 before?
Im not techy enough to know what par is for what lighting, but undulata stays green for the most part when it is shaded or low light. in medium light it gets a nice redish orange color. Havent grown in "high light" so I couldnt sat, but give it a shot its a nice plant. Why not try some luteait gets a dark reddish brown color with stripes if it gets enough light very cool. I can sell you some undulata and/or lutea if you need some.
The fungus on the wood is usually only temporary. Idk where you got it but it could be a softwood and not hold up too well under water. If it feels "waxy" or you can easily push your fingernewails into it its probably not a good idea to keep. I do a lot of drift wood collecting and you learn what kinds work and,which ones dont.
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text:
The Classic Cadillac Forum Discussion, Need Opinions-85 Eldorado in Past Cadillac Vehicle Discussion; Hi all, I've put about 13k into a 1985 Cadillac Eldorado and it seems lately I get the car fixed, ...
- 04-02-13 10:22 PM #1Cadillac Owners Member
- Automobile(s): 1985 Eldorado
- Join Date
- Apr 2012
- Posts
- 28
Need Opinions-85 Eldorado
Hi all,
I've put about 13k into a 1985 Cadillac Eldorado and it seems lately I get the car fixed, drive it three times and another problem creeps up. Ironically the 4.1 motor runs great (knock on wood). But now the service soon light has come on yet again. I figured all the money I have put into this (base coupe) it would be a brand new car. Literally everything mechanically has been replaced except the motor which has either 89k or 189k on it. Were cars from this decade made with low quality parts or are problems like this common with classic car enthusiasts? Also with all the money I have put into it, should I sell it while it's still running, or just bite the bullet and keep it considering all the money put into it? It is my first car and I worked on it with my father a few times so it does have some sentimental value. Lastly, are earlier generation Cadillac's with no computers more reliable cars? Opinions?
- 04-04-13 03:13 PM #2Originally Posted by TheChicagoan
I wouldn't say that they are made with low quality parts. It's just that they are getting to be 30 years old and parts (many of which should have been replaced years ago) are wearing out. The tires, brakes, and suspension/ steering on my caddy were all shot (original or close to it). Unfortunately, they all kinda wore out at the same time. It also needed a tune up on the engine. OTOH, my lesabre had replaced shocks and brakes (older but still working) when I bought it, so I only had to do front pads, and the engine has been worked on through the years as needed, so it still ran great.
As for selling your car, how much could you get out of it if you sold it? What could you buy for the money you would sell it for that is comprable to it? Is what you could buy for the money something you could live with and would be lower maintenance?


text:
First published in the EFSA Journal:
22. Mai 2012
14. Mai 2012
Question Number:
This external report is not produced by EFSA. It is published here to help keep the public informed of developments related to EFSA's scientific work. EFSA reserves its rights, view and position as regards the issues addressed and conclusions reached in the present document, without prejudice to the rights of the authors.


text: So, I have a 13" rMBP and every time I open iMovie, I get a popup that says, "iMovie can generate new thumbnails of your video at a higher resolution. This may take several minutes." I'm guessing this is just optimizing thumbnails for the Retina display, but it asks me EVERY TIME! Anyone know if this is normal and if I can stop this popup from happening?


text:
Gold Square Ring
☆ FREE shipping (BE & NL): from € 100
☆ Order before 3PM (BE): Delivered the next day
☆ 14 days to withdraw: Never regret it afterwards
☆ Not satisfied? Get a cashback within 7 work days! If you're happy, we're happy
About Me:
Perfect for layering!
Mix and Match this Gold Square Ring made of Stainless Steel
Available in Gold and Silver
Adjustable Size
Look After Me:
Wipe Clean
Size & Fit:
H: 5 mm
Adjustable size


text:
Introducing the At The Door Card Reader and Eventbrite's Mobile Box Office
As we mentioned back in December, we're completely committed to helping our event organizers manage all their event sales and data — both online and on-site at their events. At that time, we launched the free At The Door app so organizers with any type or size of event can capture credit card and cash sales via their iPad.
Today, we're expanding on our mobile box office solution by introducing the At The Door Card Reader and wireless printing capabilities for our event organizers.
With the At The Door Card Reader, it's never been easier to sell tickets and merchandise, such as your band's t-shirt or your famous BBQ sauce, and track those sales from your event.
At any time during or after your event, you can view the day's credit and cash transactions on your iPad. Your comprehensive Eventbrite event reports will include all of your online and At The Door sales, so you always have a complete view of your event sales at a glance. If you collect any information from your buyers, you'll not only be able to see this information in your attendee reports, but also have an opportunity to reach out to them for your next event.
We also configured the At The Door app to work wirelessly with Star printers, so you can print tickets or receipts on the spot. We're always trying to be eco-friendly and offer the ability to send online receipts through the app, but we understand that sometimes there's a need for paper receipts, such as for redeemable food and drink tickets at your event or a receipt to honor any future returns or exchanges.
To use the At The Door Card Reader, simply plug it into the 30-pin adapter (where you charge your iPad), open up your At The Door app, and you're off and running. Organizers are always given the option to collect cash or use a credit card in the app. When you select credit card, you simply swipe the card, and voila! Not only is it faster than manually entering credit card numbers, it's more fun!
To celebrate the launch of the At The Door mobile box office, we're waiving our standard Eventbrite service fee for every purchase made through At The Door (note: the standard 3% credit card processing fee will still be applied).
Other features of the At The Door mobile box office include:
- An optimized checkout flow that allows the At the Door app to process 400+ transactions per hour.
- A reliable swipe: Connection to the 30-pin adapter means the At The Door Card Reader gets a good read every time, eliminating the need for multiple swipes.
- Wireless integration with the Star TSP143 printer for tickets and customer receipts.
- Cash drawer reconciliation within the app.
- Encryption on the reader itself—all card data transmitted through the iPad is fully protected.
The At The Door Card Reader comes at no ultimate cost. It's $10 and sold through our brand new Brite Store; however, for a limited time, we're offering a $10 promotional credit to your Eventbrite account as a thank you for trying it out. An additional shipping and handling cost applies.
The printers are widely available, as well as through our retail partner's website, and can be easily set up to start printing right away, should you need hard-copy tickets.
So, give it a try for your next event and let us know what you think! Check out these Help Center articles if you need help setting up your At The Door Card Reader or wireless printer. You can also visit our At The Door page: https://www.eventbrite.com/atthedoor/.


text:
Oregon Historical County Records Guide
Clackamas County Scenic Images
Rock Outcropping
buy high resolution copy | next image
A rock outcropping near the Clackamas River along Highway 224. (Photo No. clacD0019)
About this image
Dimensions: 2892 x 1920 pixels (300 dpi version); Date created: October 2006; Camera: Nikon D70 Digital SLR; Lens: Nikon AF-S DX Zoom-Nikkor 18-70mm f/3.5-4.5G IF-ED; Photographer citation: Gary Halvorson, Oregon State Archives; Keywords/Tags: horizontal, Oregon, Clackamas County, rocks, formations, outcropping, Clackamas River, Highway 224, blue sky, trees.
buy high resolution copy | next image
County guide home | Scenic images home


text:
After reviewing the verse of Digital Cuttlefish (poet laureate of the Scientific Blogohedron) and remembering a comment they made, long ago - I began wondering as to what extent is it true that one MUST practice in order to write good poetry.Good poetry is a passion of mine; I've even sent two friends copies of Stephen Fry's guide to poetry - 'The Ode Less Travelled: Unlocking the Poet Within':I believe poetry is a primal impulse within us all. I believe we are all capable of it and furth … [Read more...]
Stephen Fry's The Ode Less Travelled – The Psychology Behind Blank Page Syndrome
Dystopia And Margaret Atwood's A Handmaid's Tale: 1986 – 2012
"OfFred was a normal everyday woman with a career, a name, a life like all women have come to expect and take for granted in this age. When the Religious Right came into power, they began to put into practice their insane beliefs which strip women of their identity, their rights, their body, their very name. Women are to be called Of (whatever asshat they belong to), instead of, say Beatrix. Reproduction is an issue because all the toxins in the environment have rendered many women infertile. … [Read more...]
The Young Atheist's Handbook – On Love
Expect the next Token Skeptic podcast episode very soon. Until then, a little spoiler: Lessons from The Young Atheist's Handbook: Love. … [Read more...]
A Skeptical Required Reading List – In Graphic Form
Here's my skeptical reading list! It's even available on a Token Skeptic shirt!This is with many thanks to Catherine, of Faster Pussycat Productions.The last time I caught up with Warren of Embiggen Books in Melbourne for a podcast, we ended up doing a tremendous discussion on Great Books In Skepticism – Podblack's Book Club With Embiggen Books, with the following recommendations:Demon Haunted World: Science as a Candle in the Dark by Carl Sagan Tribal Science: Brains, Beliefs and Bad I … [Read more...]
I COULD Just Scream, But Instead I'll Promote Science – XOJane Health Column On Birth Control
I don't want to do any kind of nasty, mean-spirited post about the news over on Gawker - Ranting Lady Blogger Hates Birth Control, Only Uses Plan B.Of course, it's caught the attention of a few sites you might read already (like XO Jane's Health Editor...are you playing with me? by Scicurious). The article in question is a column called "GET IT TOGETHER, GIRLS: EVERY GODDAMN PHARMACY IN NEW YORK IS OUT OF PLAN B! EVERY ONE!"What I will say is that apart from the casual attitude regarding Plan … [Read more...]


text:
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text:
Currency Displayed in
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Verizon A455 White Front Faceplate Assembly
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Here at CellularDR.com, we want to take the time to clarify our conditions and …
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text:
Gig Alert: Susmit Sen
Susmit Sen
"Rejuvination" - (Demo)
Playing Wednesday at Drom (85 Avenue A., East Village)
Get: Tickets | Directions
Like many self-taught musicians, guitarist Susmit Sen has a sound that's entirely his own blend of Indian music -- traditional sounds mixed with elements of jazz and rock. As a founding member of the seminal Indian fusion band Indian Ocean, Sen has honed his sound since the band began in the early 1990's.
On Wednesday, Sen takes the spotlight alone for the first time in the United States in advance of his first solo album. Sen stresses that this track, "Rejuvination," is still a work in progress, but the strength of the music is easy to hear. His agile guitar dashes and dances around soaring vocals, which are interspersed with lugubrious lulls. The result? The perfect jam session.


text: Bowe Bergdahl being released by the Taliban in trade for five terrorists we held captive. Obama administration doing the trade to get the VA out of the news for the six o'clock hour. Jefferson county school district controversy. Back to the Bowe Bergdahl and how the left is trying to make it okay for the seven o'clock hour. A woman in Michigan encountered a sign in the doctor's office that said they would have a five minute conversation with their adolescent children without the parents present in the eight


text:
A new book by local author helps moms through the highs and lows
Who knew it would be possible to feel completely elated and totally miserable at the same time? Most new parents learn the hard way that joy isn't the only thing babies bring, especially in the middle of a sleepless night.
"It's 3 a.m. and the baby's crying. You adore this child, but you also want to throw her out the window, and you worry: Is this normal?" says Debra Gilbert Rosenberg. "Yes, it's normal. New moms walk a tightrope. It's OK to admit that sometimes it's difficult, but you also don't want to forget that it's really wonderful, too."
A new mom's jumbled feelings are no surprise to clinical social worker Rosenberg, who's been leading new mom support groups at West Suburban Temple in Oak Park for 14 years. Her recently published book, The New Mom's Companion: Care for Yourself While You Care for your Newborn is designed to help ease the transition to motherhood.
The idea for a new mom's group occurred to Rosenberg after she had her first child, a daughter who's now in college. "My friend and I were both social workers with infants and we said, 'Geez, this is really different from what we expected. We could use some help going from being a person to a pregnant person to a mother.' But we were too caught up in being first-time moms to do anything about it."
Years later, just after she'd moved to Oak Park and had her third child, Rosenberg dusted off the idea when someone at her temple suggested starting a group for moms. First-time moms, along with their babies, attend a six-week session during which they discuss topics such as mom as an individual (what she was like before the baby, what she expected), how a new baby affects a marriage, extended families, and changes in a woman's social life and friendships after a baby comes.
Rosenberg says she wrote her book for people, like herself, who may feel too private to join a mother's group. She felt there was a dearth of books addressing the needs of new mothers. "If you look for books about motherhood, you find ones about breastfeeding and taking care of the baby, or books by journalists who became moms and write about their own stories. What I wanted-and what I wrote-is a book like Dr. Spock about being a new mom. It's in a Q-and-A format, so you can look up a topic, flip to that page, and be done. That's all the time you have as a new mom," explains Rosenberg.
If you'd like more information about Rosenberg's new mom's groups, call West Suburban Temple at (708) 366-9000. Her book is available at local bookstores and online.
-- Laura Stuart
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text:
Vision Statement: Be a district respected by others as a model of excellence in student achievement.
Mission Statement: To prepare our students with exceptional character, knowledge and skills to thrive in their changing world.
Beliefs and Guiding Principles
The St. Croix Central School District welcomes you to the SCC 4Kids Web Page! We are excited to start our fifth year providing an enriched learning experience for our four-year-old learners.
Our program is offered at two community sites: Discovery Preschool in Roberts and Trinity Lutheran Church (operated by Discovery Preschool) in Roberts. We also have one site at St. Croix Central Elementary. Community sites will each have one morning session from 8:00-11:00 and one afternoon session from 12:00-3:00. The Elementary site will have only an afternoon class from 12:00-3:00.
For more information regarding our program, I highly encourage you to review our SCC 4Kids Parent Handbook. It explains our vision, values and beliefs, curriculum and much more. If you are new to our school district and your child was four-years-old prior to September 1 of this year, please contact Jessica Stanton.
The St. Croix Central School District 2017-2018 4K Registration will be held at our Trinity Lutheran Church basement site at 1250 Broadway Street in Hammond, WI on Thursday, March 30th at 5:30 pm and Friday, March 31st at 8:30 am and 2:00 pm.
Parents with children who will turn 4 years old on or before September 1, 2017 can sign up for a time slot online HERE or contact Jessica Stanton at the St. Croix Central Elementary School at 715-749-3119 or email@example.com.
During the presentation, parents will learn about the program and the sites, be able to ask questions and fill out enrollment forms. This registration meeting is for parents only; therefore, we ask you to not bring your child with you.
We are beginning to plan for next year's SCC 4Kids program and need parents of children under four-years-old to make sure their child is enrolled in our district census. The district is required to gather information for all residents under the age of 21; regardless of whether or not they attend St. Croix Central Schools. If you are new to the district or have had changes in your family's status in the past year, please complete the census form and return it to SCC Elementary School. It is especially important to have information for children ages 0-5 in order to send out mailings regarding pre-school events and planning for our district needs, including the SCC 4Kids program. If you have a child who is not currently enrolled in our district census please complete the census form and return it to St. Croix Central Schools, Attention Heather Wester, P.O. Box 129, Roberts, WI 54023. The form can be found on the SCC webpage by following this link: http:// www.scc.k12.wi.us/district/ds_registration_information.cfm.
SCC families can find information about summer school 2017 by visiting the Summer School page, available under any "For Parents" page. Questions can be directed to Mr. Langeness.
Elementary: 715-749-3119
Discovery: 715-749-3060
Trinity: 715-796-2916


text:
First the name - Hop Jacks (or Hop Backs as they are also called) are pieces of traditional brewing equipment that are used to add fresh hop flavors and aromas to the hot wort as it is transferred from the brew kettle to the heat exchanger. Fresh hop flowers would be placed in the Hop Jack for the very freshest hop character. Though hop jacks are still in use, they are not in use here. However, the results achieved with this beer are similar and represent the kind of hop character that is achieved using a Hop Jack.
This beer is one of a series that will showcase the diversity of hop varieties available to us. Each batch of Hop Jack Ale will have the same malt recipe but will differ in the hops used. The ibu's will remain the same also, allowing the drinker to appreciate the differences between hop varieties. The malt profile for this beer is very simple, using only pale ale malt and a very light caramel malt. We will make this beer in 1/2 size batches so expect it to move quickly. Served unfiltered. Stop in and see what hop we used this time!
Brewer: Free State Brewing Company
Style: American Pale Ale
Alcohol Content: N/A
Seasonal: No
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text:
President's Listening Tour: Atlanta
Audio: [41 min 26 sec]
The Carter Center in Atlanta provided the perfect setting for a lively and intimate conversation with alumni, parents, and friends of the College who are bound together by a shared commitment and love for Swarthmore. The importance of the faculty in shaping the culture of the College was a theme during this Listening Tour event. President Rebecca Chopp celebrated the dedication of the faculty, who embody the values, discipline, and rigor we most want our students to embrace and cultivate — not only as students — but throughout their lives.


text:
By Marsden Wagner
Issue 118, May/June 2003
Recently, a woman in Iowa was referred to a university hospital during childbirth because of possible complications. At the university hospital it was decided that a cesarean section should be done. After the cesarean section was completed and the woman was resting in her hospital room, she went into shock and died. An autopsy showed that, during the cesarean section, the surgeon had accidentally nicked the woman's aorta, the biggest artery in the body, which led to internal hemorrhage, shock, and death.1
A cesarean section can save the life of the mother or her baby, or both. A cesarean section can kill a mother or her baby, or both. Every procedure or technology used during pregnancy and birth carries risks for the mother and baby. Whether or not to use any procedure or technology will be a judgment based on balancing the chances that it will make things better against the chances that it will make things worse.
We live in the age of technology. Since long before human beings landed on the moon, we have believed that technology can solve all of our problems. It should come as no surprise that doctors and hospitals are using more and more technology and invasive interventions on pregnant and birthing women. Has all this technology solved the problems surrounding birth? Let's look at the record. Is the increasing use of technology saving the lives of more pregnant and birthing women? In fact, the risk of a woman in this country dying from maternal mortality (i.e., causes related to pregnancy) has not decreased in more than 25 years. Each year, nearly 1,000 women die during pregnancy, during birth, or in the first week after giving birth. Nearly half of these deaths could have been prevented with better access to higher-quality maternity care. Hundreds of thousands of other women experience medical complications from pregnancy.2
The data also suggest an increase in recent years in the number of women dying during pregnancy and birth in the US.3 We have known for some time that maternal mortality in the US is underreported–in one state in one year, a third of the maternal deaths had not been reported.4 But the latest evidence suggests that "The actual pregnancy-related death rate could be more than twice as high as that reported for 1990."5
Why Are More American Women Dying?
It is difficult to pinpoint why more American women are dying before, during, and after giving birth–the data give only the leading or immediate cause of death, not the underlying causes. But if we look at the six leading causes of pregnancy-related deaths in the US, three–hemorrhage, anesthesia, infection–are often the result of invasive obstetric interventions.6 For example: Although the immediate cause of death is frequently given as "hemorrhage," in many cases the hemorrhage is associated with cesarean section (as in the case cited in the first paragraph). There is good research, both in the US and the United Kingdom, showing that the maternal mortality rate for cesarean section is four times higher than for vaginal birth.7-9 The rate of maternal mortality is still twice as high as for vaginal birth even when the cesarean section is routine, or "elective"; i.e., it is not an emergency procedure. With nearly twice as many cesarean sections as are necessary being done today in the US, the procedure could be a significant part of the reason for the country's rising rate of maternal mortality.10
Another possible cause of rising pregnancy-related deaths in the US is the markedly increasing use of epidural blocks for normal labor pain. Administering an epidural block doubles the risk that the woman will die; "anesthesia complications" are documented as one of the leading causes of maternal mortality in the US.11
There is good reason to believe that other obstetric technologies also contribute to the rising number of women who die during childbirth in this country. Data from the Centers for Disease Control (CDC) show that in the past ten years the number of women given powerful and dangerous drugs to induce labor has gone from 10 percent of all births to 20 percent.12 In the same ten years, the drug Cytotec, not approved by the FDA for labor induction because of insufficient scientific evaluation of risk–a warning often ignored by doctors–has become the single most popular labor-inducing drug. New scientific data show that inducing labor with Cytotec causes a marked increase in uterine rupture, an obstetric catastrophe in which a quarter of all babies die, many women die as well, and, of the women who survive, almost none can ever have another baby.
Why has the rate of Cytotec-induced labor doubled when the ability of women's bodies to begin labor has not decreased? Further CDC data show that the answer is doctor convenience. In those same ten years, the number of births taking place Monday through Friday greatly increased.13 Like taking prenatal X-rays in the 1930s, prescribing the drug di-ethyl-stillbesterol (DES) to pregnant women in the 1950s, and thalidomide in the 1960s, inducing labor with Cytotec in the 1990s is another obstetric intervention that has gone into widespread use without adequate scientific evaluation, with tragic consequences for thousands of women and babies.
The scientific evidence strongly suggests that the increasing use of obstetric interventions and technologies–cesarean section, epidural anesthesia, and drugs to induce labor–is not saving more women's lives, but ending them. Medical care was responsible for some of the earlier decreasing mortality of pregnant and birthing women, not because of high-tech interventions but because of basic medical advances, such as the discovery of antibiotics and the ability to give safe blood transfusions. There has never been any scientific evidence that such high-tech interventions as the routine use of electronic fetal monitoring during labor decrease the mortality rate of women.14 There is also no scientific evidence to prove that the fall in maternal mortality was because birth was moved into the hospital.15 The evidence does show that, as long as a system is in place that can transport women in labor within 30 minutes to a facility where antibiotics, blood transfusions, and necessary cesarean sections are available, there should be very little maternal mortality. For example, in the Netherlands, a third of all births are planned homebirths attended by midwives that refer women to doctors when necessary. The rate of maternal mortality in the Netherlands is far lower than in the US.
The Importance of Quality Care
The US spends twice as much as any other country on maternity care, and yet 15 other countries have lower rates of maternal mortality. There are at least two reasons for this, both having to do with access to quality care. More than 40 million Americans have no health insurance; many of these are women needing maternity care. If a woman applies for Medicare support for her maternity care, she must have means testing, which necessitates that she jump through many bureaucratic hoops before she can receive care. This can be a disaster. Furthermore, women receiving publicly funded care go to overcrowded hospitals staffed by interns and residents who are overworked and insufficiently trained.16 In addition, when poor women qualify for their maternity care to be funded by Medicare, they may be referred to a private practitioner, and receive this care in the doctor's private offices and private hospitals. There they often receive less attention than the women whose care is being funded by private insurance instead of public funds, in part because of the cultural and socioeconomic gaps between the poor women and their doctors. The delays and crowding, and lack of understanding and skill of some doctors, can all lead to pregnancy-related deaths.
The second reason the US has a higher rate of maternal mortality than 15 other countries is the way birthing women are cared for here. American doctors insist that women need to be in the hospital when giving birth, yet these same doctors who need to provide maternity care for them are not in the hospital when the women actually give birth, but in their offices doing prenatal checkups on healthy women, or in another hospital doing gynecological surgery, or at home eating dinner.17 So when the birthing woman who is in the hospital (or transported to the hospital) needs urgent attention for developing complications, the obstetrician is often not there, must be called, and may come too late. Research shows that, in more than 70 percent of cases, the main factor in the death of babies at birth is the doctor's absence.18
The US and Canada are the only countries in the world in which obstetricians provide primary birth care for the majority of normal births. The American obstetrician tries to be all things to women: a primary provider of maternity care for healthy pregnant and birthing women; a provider of preventive care for women; a specialist in women's diseases; and a highly skilled surgeon. No other doctor anywhere in healthcare tries to maintain competence at all of these levels and in so many areas because it is unreasonable to expect this from one human being. It's unlikely that an obstetrician can perform a six-hour gynecological surgical procedure on a woman with extensive cancer, then rush to his or her office and do the best job of quietly, patiently counseling a pregnant woman about her sex life. If you are considering a hospital birth with an obstetrician as your primary birth attendant, ask the doctor how much time he or she will spend with you during your labor. One of the reasons a midwife, rather than an obstetrician, is generally a better choice to attend your hospital birth is that, assuming a normal pregnancy, midwives have been shown statistically to be safer birth attendants than doctors.19 This is, in part, because the midwife is there in the hospital with you throughout your labor, while the obstetrician is not.
For more than 50 years now the US has had a system of maternity care that often boils down to this: A woman goes into labor, goes to the hospital, and is admitted by the labor and delivery (L&D) nurse, who examines her. The L&D nurse then calls the obstetrician, who gives orders over the telephone to the nurse. The obstetrician may or may not come by the hospital during the labor to check the woman. It is the job of the L&D nurse to monitor the labor and call the obstetrician when the birth is imminent so that the doctor does not have to hang around the hospital waiting for the birth.
During my 15 years as Director of Women's and Children's Health for the World Health Organization, I frequently visited the industrialized countries of Europe. I observed that in the 15 countries that lose fewer pregnant and birthing women than the US does–including those countries with the world's lowest rates of maternal mortality–obstetricians remain in the hospitals, ready to jump in and treat serious complications. In those countries, it is the midwives who are out in the community, giving prenatal and postnatal checkups, and who are also in the hospitals as the only health professionals at the births of 80 to 90 percent of women who give birth without serious complications.
It cannot be overemphasized that American women's lack of access to quality, immediate obstetrical attention in the hospital is a major reason so many of them die unnecessarily during pregnancy and childbirth. Put differently, every one of the 15 countries that have lower rates of maternal mortality has universal healthcare coverage for all pregnant and birthing women (with no bureaucratic hoops to jump through), and all obstetricians are hospital-based, ready to care for these women should they develop complications. Furthermore, maternal mortality is not higher in those countries where there are large numbers of planned homebirths with midwives, because there is a system in place for transporting birthing mothers to the hospital, and for managing complications with mutual respect and collaboration between out-of-hospital midwives and hospital staff.
Data from many states in the US show maternal mortality to be four times higher for African-American women than for Caucasian women, and nearly twice as high for Hispanic women.20 The markedly greater risk that African-American and Hispanic women will die during pregnancy and childbirth is because this group includes a higher proportion of uninsured women, poor women, and women who go to hospitals with insufficient and/or poorly trained staff. In short, African-American and Hispanic women have less access to quality maternity care.
Where's The Data?
Occasionally, a group of obstetricians tries to get a handle on maternal deaths in their locale. In a study of ten hospitals in the greater Chicago area, reported in 2000, the maternal mortality rate there was twice as high as reported by the CDC.21 Furthermore, on investigation of each case, these Chicago obstetricians found that 37 percent of the deaths were preventable. In the preventable cases, mistakes by doctors and nurses were determined to be the cause of death more than 80 percent of the time. Unfortunately, as is nearly always the case, the study made no attempt to determine how many of the deaths were related to obstetric interventions such as induction of labor, epidural block, and cesarean section. Lamenting that state maternal mortality committees, which carefully review all maternal deaths, are now largely defunct in the US, the study urged that these committees be revived to investigate causes and develop programs of intervention and education.
There is an urgent need for careful auditing of every single maternal death in the US, with a thorough analysis of causes–including underlying causes–and presentation of the results to the public. The Federal Aviation Authority could not set policies for safe flying if they were unaware of half of the planes falling from the skies, and couldn't retrieve the "black boxes" of most of those planes they knew had fallen. But this is analogous to the CDC trying to set policy for safe motherhood when they have limited data on maternal mortality. Federal policy prohibits the CDC from making surveys of what is happening in all states with maternal deaths.22 At the state level, there are enormous pressures from state and local medical societies to prevent adequate investigation of all maternal deaths.23 It's not easy to get information about the nearly 1,000 women who die each year in the US around the time of birth. To begin with, it's difficult to track maternal deaths, as death certificates in only 16 states include a question concerning whether the deceased had been pregnant within a year of her death. Although some states have regulations requiring that such deaths be reported, in no state can anyone, including scientists who want to study why these women die, gain access to information about individual cases of maternal death. If there is an investigation of a maternal death by a hospital, it is a longstanding policy that this happen behind closed doors, which protects the doctor and hospital involved. There is no public accountability. Public knowledge of pregnancy-related deaths does not fit well into any HMO or healthcare facility's marketing efforts. Employees of most hospitals know that their job security often depends on their willingness to keep silent, and the tribal loyalty of doctors is a powerful deterrent to accessing information. The CDC is doing everything it can to push states to improve their maternal death audits. It has had some successes, but today only a few states conduct thorough audits of all maternal deaths, and only one state, Massachusetts, has a law, passed after intense lobbying by consumer groups, mandating that newspapers report maternal deaths.
We know that at least half of these maternal deaths are not reported anywhere, that nearly all of these women die in the hospital, not at home, and that, with adequate medical attention, close to half of these women need not have died. The possibility of liability due to inadequate medical attention has doctors terrified of litigation, and reluctant to release information concerning maternal mortality. American women need to know that their chance of dying around the time of birth is increasing. They have a right to know why.
1. Personal communication with midwife and author Ina May Gaskin.
2. Centers for Disease Control and Prevention, "Safe Motherhood: Preventing Pregnancy-Related Illness and Death," CDC, Atlanta, 2001.
3.M. McCarthy, "US Maternal Death Rates Are on the Rise," Lancet 348 (1996): 394.
4. A. Rubin, et al., "Maternal Death After Cesarean Section in Georgia," Amer J Obst Gyn 139 (1981): 681-5.
5. See Note 3.
6. See Note 2.
7. D. Petiti, et al., "In Hospital Maternal Mortality in the US," Obstet Gyn 59 (1982): 6-11.
8. D. Petiti, et al., "Maternal Mortality and Morbidity in Cesarean Section," Clin Obst Gyn 28 (1985): 763-8.
9. M. Hall and S. Bewley, "Maternal Mortality and Mode of Delivery," Lancet 354 (1999): 776.
10. M. Wagner, "Choosing Caesarean Section," Lancet 356 (2000): 1677-80.
11. See Note 2.
12. www.cdc.gov/nchs/birth { 13. Ibid.
14. M. Wagner, Pursuing the Birth Machine: The Search for Appropriate Birth Technology (London & Sydney: ACE Graphics, 1996): 184.
15. Ibid., 38.
16. The federal government gives funds to hospitals to recruit obstetricians-in-training to provide care to women on Medicare. These obstetricians-in-training are very frequently on call nights and weekends in addition to their normal workload.
17. The serious consequences of the absence of the woman's obstetrician during her labor in the hospital is documented in the Institute of Medicine study Medical Professional Liability and the Delivery of Obstetric Care 2 (Washington, DC: National Academy Press, 1989): 161-191.
18. Ibid.
19. M. MacDorman and G. Singh, "Midwifery Care, Social and Medical Risk Factors, and Birth Outcomes in the USA," J Epidemiol Community Health 52 (1998): 310-7.
20. See Note 1.
21. A. Panting-Kemp, et al., "Maternal Deaths in an Urban Perinatal Network: 1992-1998," Amer J Obst Gyn 183 (2000): 1207-12.
22. Personal communication with CDC, 2001.
23. Ibid.
Marsden Wagner's education includes an MD with clinical specialty training in perinatology (neonatology and obstetrics), and two years' post-graduate study with an advanced scientific degree in perinatal science. He was the Director of Maternal and Child Health for the California State Health Department, spent six years as Director of the University of Copenhagen-UCLA Research Center, and 15 years as Director of Women's and Children's Health for the World Health Organization. He has consulted and lectured in more than 50 countries and has given testimony before the US Congress, Israel's Knesset, the French National Assembly, and the British, Italian, Russian, and Danish Parliaments. His publications include 121 scientific papers and nine books, and has won the Living Treasure Award from Mothering. He raised four children alone as a single father, and is now an independent consultant.


text:
|Derner, Justin
|Polley, Wayne
|Johnson, Hyrum
|Tischler, Charles
Submitted to: Plant and Soil
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/5/2001
Publication Date: N/A
Citation: N/A Interpretive Summary: Shoots and leaves of warm-season plants grow better with increased concentrations of atmospheric carbon dioxide (CO2) when soils are dry. However, it is unclear if root growth exhibits the same pattern. Soil water had greater effects than did CO2 on root growth of the two dominant warm-season grasses from tallgrass prairie, little bluestem and big bluestem. However, root growth responses to CO2 was similar whether soil water was limiting or abundant. Greatest increases in root growth occurred in very fine roots. This pattern of root growth may influence nutrient cycling in soil, because fine roots die and decompose quickly and take up more nutrients and water from soil than large roots.
Technical Abstract: Aboveground growth of C4 plants responds more strongly to atmospheric CO2 concentration when soil water is limiting than abundant. Whether the same is true of root growth and morphology, however, has received little attention. We investigated interactive effects of CO2 and soil water availability on root growth and morphology of C4 grasses. Seedlings of the two dominant C4 grasses from tallgrass prairie were grown for 8 weeks in an environmental chamber with CO2 concentrations of 368 (ambient) and 203 (subambient) umol mol-1. Seedlings were maintained at either high (ca. 90%) or low (ca. 50%) soil relative water content (RWC). Interactions between CO2 and RWC affected leaf length and shoot and total mass with proportionally greater responses to increases in CO2 at the high than low RWC treatment. In contrast, RWC had substantially greater effects than CO2 on root variables (45-101% vs. 29-36%). The responsiveness of these C4 grass root systems to CO2 was similar whether soil water was limiting or abundant. The relative distribution of root surface area, number of root tips and length and volume of roots were significantly affected by CO2 with greatest proportional increases (39-58%) occurring in very fine (0-0.3 mm) roots. Increased fine root growth with increases in CO2 concentrations may significantly influence 1) nutrient cycling, as these roots may have greater turnover rates, and 2) nutrient and water uptake from soil. Therefore, the human-induced increases in CO2 may have increased soil exploitation by C4 grasses irrespective of soil water availability and potentially increased competitiveness for soil resources.


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Conference Recap
A look back at another exciting Quality Manufacturing Conference.
"The program was wonderfully designed."
"Thank you for providing comprehensive educational sessions"
"The keynotes were great, it was nice to see industry and FDA saying the same thing."
"We found the conference sessions as well as the side-bar conversations with members extremely valuable!"
Celebrating its fourth year, ISPE/FDA/PQRI Quality Manufacturing Conference hosted officials from FDA and top industry leaders, who led discussions and workshops on pharmaceutical quality that helped advance industry thinking on hot topics like: Continuous Manufacturing, Modernization and Production Efficiency, Drug Shortage Prevention, Risk Management, Robust Change Management and Using Operational Excellence as a Foundation for Quality.
If you weren't able to join us in Washington, DC this year, make sure to join us on 6 – 8 June 2016 in Bethesda, MD at the Marriott North for the 5th Annual ISPE/FDA/PQRI Quality Manufacturing Conference.
Here's a look at what you missed.
Keynote Speakers
Monday's keynotes set the tone of the whole conference with key quality manufacturing messages.
Juan Andres, Head Pharma TechOps, Novartis Pharma AG
"The pharmaceutical industry must create a culture of quality beyond compliance by making supply, quality, and efficiency work together."
Janet Woodcock, MD, Director, FDA/CDER
"We must resolve the problems of the past and turn to the opportunities of the future—and there are many. Quality metrics will be a big part of the answer."
Tuesday morning, Christine Moore and Andy Skibo encouraged the audience to question the risk within their own supply chain.
Christine Moore, Acting Director, Office of Process and Facilities,
Andrew Skibo, Head of Global Biologics Operations & Global Engineering,
Wednesday, Thomas Cosgrove led a full day of programming dedicated to Regulatory issues.
|Thomas Cosgrove, JD, Director, Office of Manufacturing Quality, Office of Compliance, FDA/CDER/OC/OMQ
Breakout Sessions
The breakout sessions focused on 3 key areas: Manufacturing Innovations, Quality Systems Advances and Regulatory Insights. Sessions included presentations such as these:
- ISPE Quality Metrics Initiative Update - Diane Hagerty, Vice President, Genentech Inc, USA
- Continuous Pharmaceutical Manufacturing: Quality-by-Design, Systems Integration, and Control - Richard Braatz, PhD, Edwin R. Gilliland Prof of Chemical Engineering, Novartis-MIT Center for Continuous Manufacturing, USA
- Continual Improvement - Cpks in Action - Georgina McLeod, PhD, Principle Process Development Engineer, AbbVie, USA
- Delivering Breakthrough Therapies to the Market with Continuous Manufacturing and Real Time Release - Hayden Thomas, Vice President, Formulation Development, Vertex Pharmaceuticals, Inc., USA
- Driving Process Performance through Awareness and Proactive Response - Jenn Walsh, Associate Director Technical Services, Bristol-Myers Squibb, USA
- Robust Change Management - Across the Lifecycle - Nigel Hamilton, Head of Global Quality External Affairs, Global Quality Strategy & Systems, Sanofi, United Kingdom
- Product Tracing and Identification under the Drug Supply Chain Security Act - Connie Jung, Senior Advisor for Policy, FDA/CDER/OC, USA
And many more.
Diane Hagarty Speaking on the Quality Metrics Initiative
Panel Discussions and Special Events
Quality Metrics Q & A – Wave 2
Mairead Goetz, Head of Compliance, Group Compliance & Audit, Group Quality Assurance, Novartis Pharmaceuticals Corporation discussed The ISPE Quality Metric Pilot Wave 1 Report and presented the next steps for Wave 2.
Breakfast with the Investigators
In one of the more popular sessions, attendees listened attentively as Milind Ganjawala, Branch Chief, Office of Manufacturing Quality, Office of Compliance and Jonathan Chapman, Investigator/BLT-DO Drug Monitor, Brooke Higgins, Senior Policy Analyst, gave their impressions of the inspection process and recommendations for ensuring a smooth inspection. After their presentation, the group spent the majority of the time fielding audience questions.
FOYA Banquet
A full room congratulated the 2015 Facility of the Year Award winners:
- Astellas Pharma, Inc, Tube Labeling Project-Category Winner for Equipment Innovation
- AstraZeneca China, Farmers' Fields to Pharmaceuticals-Category Winner for Project Execution
- IDT Biologika, Multipurpose Biologics and Vaccines Production Facility (Isolator Vaccine Filling Unit) - Category Winner for Facility Integration
- Pharmalucence, a Sun Pharma Company, Aseptic Fill-Finish Facility - Honorable Mention
During the event, guest speaker, Mary Fitch, AICP, HON. AIA, Executive Director, Washington Chapter of the American Institute of Architecture related a personal story of how pharmaceutical architecture and good building design can be both functional and beautiful.
Mary Fitch, AICP, HON. AIA, Executive Director Washington Chapter of the American Institute of Architecture
FOYA Display
Exhibit Hall
Just for Attendees
Thank You
Thank you to the Program Committee, speakers, attendees, exhibitors and sponsors who helped to make this year's event such a big success!
Indicates content available to ISPE members only.
Thank You to Our Top Tier Sponsors


text: Got my new Roamio basic hooked up yesterday, and all of my channels are coming in great OTA. Tonight, however, a V52 error situation has cropped up. As soon as our recordings started, the 4th Tuner (Tuner 0) threw up the V52 error. Stopped the recordings, reset the box, and started digging through some things. I paused the show I was watching, then switched tuners to pull in another station. Everything was fine. Hit "Live TV" again and picked a 3rd channel, still fine. Sure enough, though, as soon as I went to the 4th tuner...BOOM a V52 error. Diagnostics consistently shows that no matter what order I go in, it always ends up being "Tuner 0" showing no signal at all. Is this a case of the internal splitter degrading my OTA signal to the point that the 4th tuner cannot pull in the picture, or will I be returning this unit?


text:
In case you missed it, make sure to try Vogtinator's Ndless-based 3D engine 'nGL', and crafti, a Minecraft powered by nGL!
My TI-Nspire, one of the earliest production model of the blue Clickpad TI-Nspire is getting old… Mid-2007 I started to work with Romain Liévin on the reverse engineering of the USB protocol that made the TI-calc linking program TiLP able to talk to the TI-Nspire.
Today I'm proud to see Ndless and Luna power Lua, ARM, C and C++ programs each one more exciting than the last. This free software was possible thanks to community collaboration but also donations.
As Jim Bauwens sends me a TI-Nspire CX CAS that will make testing on real hardware easier for me, I want to thank you, from Switzerland to Mexico for your contributions, including Benoît Garrone, Mark Mäkinen, Rodrigo Carrillo, Sebastian Wolf and Marcel Maeder.
In case you missed it, tangrs has been working hard for the past few months to get Linux ported to the TI-Nspire calculator.
The port is not yet fully stabilized nor quite ready for broad consumption and requires some user-level knowledge of Linux systems, but is definitely worth a try. It basically looks like a Ndless-based TI-Nspire specific loader configured to run a Linux kernel image with a RAM disk .
Experimental support for root filesystem installed on USB mass storage is being worked on, so that Datalight's proprietary Flash FX/Reliance filesystem used by TI's OS isn't a limit anymore. This also means that the native TI-Nspire OS image is not replaced by the Linux system, and Linux can been booted on demand.
Support for USB keyboard, X server, directFB, Wi-Fi (with the help of a powered USB hub) and text-based Internet browsing is progressively being added and tested (thanks to Vogtinator for the build and demo).
Linux for the TI-Nspire also means instant compatibility with hundreds programs (although cross-compilation to ARM is necessary), including command line tools, script engines, mathematical and scientific utilities and games, as long as the constrained RAM size and CPU speed are not an issue for them.
The project is under active development, tangrs is looking for contributors to make Linux become a strong alternative to the stock OS.
- Threads on Omnimaga.org: development, support
- nspire-linux FAQ
- Projects on GitHub: kernel loader, Linux fork
The 100 Ndless-based project milestone have finally been reached according to compu's TI-Nspire Native Programming Statistics.
Long live the growing community!
Long was the time when Ndless introduced rudimentary graphics functions such as setPixel() in its Particles demo… The lack of a fully-fledged GUI API has for a long time discouraged many developers from trying their hands on native development on the TI-Nspire.
Two major contributions are about to make significant changes on our development experience with Ndless:
- totorigolo has released v0.3 of his nRGBlib library, which adds double-buffering, arbitrary image drawing and a desktop map editor [download]
- hoffa has worked hard on nSDL [topic on Omnimaga], a port of the popular multimedia SDL library. The latest version even includes smooth mouse support. Credits to atiatini for the plasma effect.
No more excuse not to try out native development on the TI-Nspire!
Thanks to all of you who gave their votes to oclua and/or Luna for ticalc.org's 2011 edition of the "Program of the Year" series. There were good competitors this year, congrats to the winners!
totorigolo is preparing an interesting graphics library for Ndless programs. Compatible with the CX and its color screen, it will hopefully be ported to classic (grayscale) TI-Nspire.
-> TI-Planet (French, Google translation)
critor has worked on the original port of nDOOM by Mraklopaz to adapt it for TI-Nspire CX and its nice color screen (credits to Adriweb for the demo).
Ndless 3 will of course be required to run it. There are still some issues to be fixed before the (unplanned) release of Ndless.
As Lionel Debroux points out, native programs are currently mainly games and emulators, because being quite independent of the underlying OS. I hope to see soon a broader choice of programs, such as utilities and science programs, thanks to the possible bridge with the Lua features of OS 3.x. It would hopefully allow to write native Lua extensions, and embed Lua scripts in Ndless programs.
Credits to calc84maniac for gbc4nspire.