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Qualify to sit for the RHIA® exam
Our online health information management degree will give you a tremendous advantage. The B.S. in Health Information Management combines concepts in health care, information technology, and leadership practice to provide you with the knowledge and skills you need to be a valuable designer, developer, and manager of health information systems. With a health information management degree from WGU, you'll become a unique asset in the high-demand field of healthcare information technology and management with the added credibility of the highly respected CompTIA Project+ certification—and eligibility to apply for the RHIA credentialing exam.
Eligibility for the Registered Health Information Administrator (RHIA) Credential:Graduates of WGU's B.S. in Health Information Management program are eligible to apply for the AHIMA Registered Health Information Administrator (RHIA) credentialing exam. More information about AHIMA can be found here.
WGU's Health Information Management program is accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).
According to the WGU 2014 CAHIIM Annual Performance Assessment Report:
In 2016, the pass rate for the Registered Health Information Administrator (RHIA) exam was 88% on first attempt and 100% on second attempt.
This program will be flexible and adaptable to your schedule. Click here to learn how this program works.
The B.S. in Health Information Management combines concepts in healthcare, information technology, and leadership. You'll become a unique asset in the high-demand field of health information management with the added credibility of your Project+ certification—and eligibility to earn AHIMA's RHIA credential.
The program requires a total of 121 competency units (CUs), our equivalent to the traditional credit hour. A course-by-course transcript evaluation will determine whether your previous college credit will transfer and waive any course requirements.
The WGU B.S. in Health Information Management program is grounded in real research on effective instruction, and adheres to national standards. We developed our online health information management program with significant input from experts and business leaders who serve on our Health Professions Program Council. This program provides the knowledge and skills that enable graduates to design, develop, and manage the information system of a healthcare facility.
These Courses Add to Your Credentials
Foundations of Success
Healthcare Management
Health Information Technology
Health Sciences
Leadership and Management
General Science Content
Healthcare Data
Business of IT
Professional Practice Experience
These General Education Assessments May Be Cleared through Transfer Credit
English Composition I and II
Introduction to Communication
Intermediate Algebra
Critical Thinking and Logic
Survey of United States Constitution and Government
Introduction to Humanities
Introduction to Psychology
Introduction to Probability and Statistics
The CompTIA Project+ certification is awarded with this degree program. You will complete this certification as part of your coursework—at no extra cost.
The first course you take in this program will be unlike any other you complete at WGU. Professional Leadership & Communication for Healthcare requires participation in online group meetings with faculty and fellow students. Multiple group options are available, so you will work with your enrollment counselor or mentor to determine the group whose schedule works best for you. Learn more about this unique course and how to prepare for it >>
The bachelor's degree program in Health Information Management also requires the successful completion of a capstone project. Your capstone project is something to be proud of – it's the culmination of all your hard work. The capstone project provides you the opportunity to demonstrate your competency and commitment to managing information technology in a healthcare setting. Go ahead, show everyone what you can do.
Opportunity Abounds at the Intersection of Healthcare and Technology
At the nexus of two rapidly-growing career fields – healthcare and information technology – is a chance for you to commit to a bright new future for yourself.
The online Bachelor of Science degree program in Health Information Management at WGU will give you the knowledge and skills you need to be a valuable designer, developer, and manager of health information systems.
WGU is designed to let you go to school on your time, not according to a class schedule. Our online degree program is flexible and puts you at the center of your education: you choose when and where to complete your coursework. Once you demonstrate your competency in a subject area, you can move on to your next course.
Online learning is not easy.
You should expect to work hard and spend 20 hours or more per week on your studies. Still, your program will be flexible enough to fit into your schedule, not the other way around.
The average time it takes to complete the B.S. in Health Information Management online for students with an associate's degree or its equivalent: 2 to 2.5 years. For students with little or no prior college: 4 to 5 years. That's significantly less than at other online schools.
Many students proceed faster than the normal pace designed into each program. But don't assume doing so is easy. WGU programs are quite rigorous. The pace at which you complete your WGU program depends upon how quickly you are able to take and pass the required assessments. Successful students who commit 15 hours or more per week to their studies are often able to complete their programs more quickly.
If you've taken courses or received a degree from another college or university, you may be able to clear some of these requirements through transfer credit.
Ultimately, the pace at which you complete your online B.S. in Health Information Management program depends on how rapidly you pass assessments.
It's your program. It's up to you. Create your own schedule, choose your pace and achieve your personal goals.
"Our partnership with WGU enables our employees to advance their education affordably without interrupting their careers." John Steele, Senior Vice President of Human Resources at Hospital Corporation of America
Western Governors University was the first university in the country to employ a cutting edge, competency-based learning model that lets you use skills and knowledge you already have to accelerate your degree program.
In WGU's online degree programs, students advance by demonstrating their competence in each subject area. You'll be able to move quickly through material you already know so you can spend your time focusing on what you still need to learn.
You'll work with your assigned Faculty Mentor on a personalized Degree Plan that establishes the pace at which you move through the program.
With few exceptions, you'll be able to choose when and where you study.
You'll complete as much work as YOU choose during each six-month term.
You'll collaborate with your Faculty Mentor to determine the learning resources that will help you develop and demonstrate your competency in each subject area.
You'll be required to complete at least 12 CUs per term for bachelor's degree programs and 8 CUs per term for graduate degree programs in order to make On Time Progress. If you choose to and are able, you can add courses and move more quickly through your program.
We're committed to keeping tuition low and making sure our online education degree programs remain the very best value for hardworking students. WGU doesn't spend money on classrooms, research facilities, or football stadiums. Instead, we focus on keeping costs low. In fact, we haven't increased tuition since 2008. And because we charge tuition at a flat-rate each term, if you complete coursework ahead of schedule, you can save yourself money as well as time.
No matter how many courses you complete each term, your tuition stays the same.
The more courses you complete each term, the fewer terms you have until graduation.
Our competency-based model gives you the opportunity to accelerate your progress.
If you complete your program ahead of schedule, you'll save both time and money.
You'll pay the same low, flat-rate tuition each 6-month term, regardless of how many courses you complete. If you accelerate your degree program, you'll pay less for your degree. The following hypothetical students illustrate two common scenarios for the Bachelor of Science, Information Management program:
For this program, a full-time course load is 12 competency units per term. Because we allow you to complete extra courses at no extra cost, you may be able to increase the value of your program by dedicating extra time to your studies.
The B.S. in Health Information Management online degree program at WGU is designed to be affordable for hard-working adults with bills to pay.
Learn more about tuition and fees.
(Note: Residents of California are required to pay a one-time immunization tracking fee of $50.)
WGU's B.S. in Health Information Management degree program is typically about half the cost of other equally reputable degree programs.
*$490/credit cost based on an average of $395 per credit for lower-division courses and $585 for upper-division courses.^$346/credit cost based on an average of $321 per credit for lower-division courses and $371 for upper-division courses.*Note: This chart is for illustration only and reflects the tuition information made public by other institutions and WGU standard tuition of $2,890 per term as of February 1, 2015. Tuition for the MBA and nursing programs is higher at $3,250 per term. Actual rates will vary depending on the number of terms needed to complete the program. Check the website for the most current tuition information.
WGU's financial aid experts are on hand to help you finance your education in the smartest way possible. 76% of WGU students receive some type of financial aid.
Federal Financial Aid is available to most students.
Western Governors University is regionally accredited by the Northwest Commission on Colleges and Universities. The Northwest Commission is also responsible for the accreditation of other major universities in the West, including the University of Washington, the University of Oregon, Gonzaga University, and the University of Utah, among many others. Learn more about accreditation here.
WGU's health information management program is accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). An independent accrediting organization, CAHIIM was created to evaluate the quality and integrity of health informatics and health information management programs. Program accreditation, which is granted after extensive reviews based on industry-developed standards, helps increase certification eligibility and job marketability for WGU graduates.
An online health professions degree from WGU tells employers that you're serious about success.
Take the next step into a prosperous future.
Our latest survey of leading employers speaks volumes about our ability to prepare grads to work in many industries:
of employers agreed that WGU graduates meet or exceed their expectations.
of employers said WGU grads exceed expectations.
of employers rated WGU graduates' job performance as very good or excellent.
of employers consider WGU graduates prepared for their jobs.
of employers said they would hire another WGU graduate.
Note: 2016 Survey of Employers by Harris Poll
You can learn more about how employers view WGU grads by exploring our National Student Success and Performance Data.
"The big draw was the fact that it was online. I could work at my own pace." James Dye,WGU Alumnus
You set your own pace by demonstrating your skills. In the online degree programs at WGU, you'll advance through each course by first mastering the course content, then completing and passing challenging assessments that measure your knowledge and skills in each subject area.
These rigorous assessments (tests, papers, assignments, and projects) let you demonstrate your competence in each subject area in order to pass the course and earn competency units (CUs), our equivalent to the traditional credit hour.
WGU sets a high standard, and we want our students to succeed. You'll be given ample opportunity to master the subject matter and re-take assessments as needed in order to graduate.
Enrollment is easy. View our Enrollment Checklist for the seven easy steps to getting started.
To be admitted into this online Health Information Management degree, you must:
You will also be required to take and pass the WGU Readiness Assessment — a short, multi-part online admissions test that helps determine the likelihood of success in a WGU program.
See More about College of Health Professions Admission Requirements
Speak to an Enrollment Counselor and Apply Today
You'll be on your way to a successful career. A world of opportunity awaits.
As a nonprofit university, WGU doesn't need to benefit shareholders. Our students are our main concern. We also try to keep our operating costs low. And since we're an exclusively online university, we don't need to maintain expensive classroom buildings, a campus, and other non-academic programs.
Using financial aid is a personal decision. When making this decision, you should know that a degree is a great investment in yourself that will pay for itself many times over. Individuals with a bachelor's degree earn on average almost a million dollars more over the course their careers compared to those without one. A master's degree typically has a similar impact on your wallet. You should definitely consider federal financial aid if it means the difference between getting your degree or not. Speak to an Enrollment Counselor to learn more.
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Saturday, December 8
Kylie: Aphrodite - Les Folies Live, Max, 8.30pm
MAX'S 25-hour celebration of Kylie Minogue's 25 years in the music biz kicks off with this spectacular concert filmed on the last night of her Aphrodite - Les Folies tour at London's O2 Arena last year. It's quite the retrospective, ranging from Better the Devil You Know to All the Lovers via Confide in Me, Spinning Around and loads of other hits. A sultry, jazzy version of Slow works well but the arena-rock reworking of Can't Get You out of My Head is a huge disappointment - if there's one song in the Minogue oeuvre that demands faithful album-version treatment, it's that one. The set and costumes are over-the-top Greco-Roman by way of Robert Mapplethorpe. Classical pillars separate giant video screens full of rippling abs, and the male dancers' togas are cut short to show off their gold hot pants. It's kitschy, camp and a whole lot of fun. The Kylie marathon winds up tomorrow night with the tour doco My Year as Aphrodite at 8.30pm.
The Amazing World of Gumball, Cartoon Network, 9am
GUMBALL is a blue cat who lives with his mother (another blue cat) and his father (a useless pink rabbit). Today, Gumball's dad brings home an amnesiac homeless guy and Gumball and his sister decide the guy is Santa Claus. Memorable scenes include a reindeer lawn ornament being rectally impaled by a flying Christmas tree and bursting into flames as a child looks on horrified, his eyes filling with tears.
Metalocalypse, Comedy, 3.15pm
Terrific animated series that does for heavy metal what Archer does for spy movies.
Tony Robinson's Gods & Monsters, History, 11.40pm
Tony Robinson looks into what Britons down the ages believed about the origins of disease. Elves get a lot of the blame.
Extreme Tourist Afghanistan, Nat Geo Adventure, 8.30pm
Australian Sabour Bradley finds a wealth of fascinating stories in Kandahar.
Sunday, December 9
Allen Gregory, Sunday, Comedy, 8.30pm
PANNED by critics and unceremoniously cancelled after a single season of just seven episodes, Jonah Hill's first foray into animated television found little love in the US. And while it's true the show is populated almost entirely by selfish, manipulative, callous snobs and their willing doormats, that's certainly no bar to success, as evidenced by Gossip Girl, which is into its sixth season.
Perhaps part of the problem lies with our seven-year-old protagonist, Allen Gregory De Longpre (voiced by series creator Hill, who also co-wrote several of the episodes). He's a poor little rich kid who has been reduced to attending a regular public school, to which he lugs lunchboxes full of sushi and pinot grigio. He drips with contempt for others (especially the fellow dork he has pressed into service as his personal secretary and dogsbody), but he constantly fails in his attempts to ingratiate himself with the cool kids. Although he gets plenty of decent lines - mostly cruel put-downs - he doesn't have a fraction of the charm of, say, the far more monstrous Eric Cartman.
A bigger problem is that the show revolves around a particularly pernicious myth about gay people: that being gay is a choice and gay people can manipulate hetero ones into becoming gay. Allen Gregory's father, the formerly rich Richard (3rd Rock from the Sun's French Stewart), is a domineering gay narcissist who has apparently tricked the formerly ''straight as an arrow'' Jeremy into leaving his wife and kids and becoming his life partner. Their relationship is emotionally abusive and, it is implied, sexually abusive. It comes as little surprise tonight when Allen Gregory introduces Jeremy (Nat Faxon) to his classmates as ''my father's human sex doll''.
Anyway, Richard has got it into his head that the school is somehow homophobic, so he steamrolls the principal into making the school dance a same-sex affair - boys can invite only boys and girls can invite only girls. Again, this plays into the idiotic but persistent notion there's a ''gay agenda'' to recruit children by ''homosexualising'' public schools. Presumably, Hill, his fellow writers and fellow executive producers (who include former News Corporation boss Peter Chernin and former Family Guy executive producer David A. Goodman) would contend that they're mocking such ideas. If so, their intent is far from obvious.
What it mostly looks like is a bunch of hacks rehashing tired old gay jokes because they think it's edgy. And when you think it has now been nearly 16 years since the ''Homer's Phobia'' episode of The Simpsons so adroitly addressed the idea of gay contagion with humour and heart, well … But if you're just after a laugh, you might get a few.
The People Speak US, History, 7.30pm
Matt Damon, Marisa Tomei, Don Cheadle and others read from writings that changed or captured defining periods in American history.
Rove LA, Fox8, 7.30pm
Rove McManus chats to celebrity guests in front of a live audience in Los Angeles.
Dude, Where's Your Style? Style, 8.30pm
Scruffy boyfriends get makeovers.

subset: commoncrawl


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Big Data has dominated tech news of late. It has been touted as a possible solution for everything from intrusion detection to fraud prevention to curing cancer and setting optimal product prices.
But Big Data, which we're defining as data collected in large volumes, at high velocity and in a variety of formats, isn't a cure-all for every problem. In fact, if companies that believe in some of the myths surrounding Big Data, could head off in the wrong direction, waste a lot of time and money, cost a company its competitive position in the market, or damage a company's reputation.
Here are some of the biggest myths surrounding Big Data.
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Milanville Classifieds Free Ads Pennsylvania. Free classifieds online advertising in Milanville Browse or post new local Milanville classified ads for Biotechnology and Pharmaceuticals, Reception & Switchboard, Running Business Wanted-For Sale, Cameras & Accessories, Lighting And Fittings, Computer Accessories, Grooms, Home Based Business, Travel & Travel Partners, Indian Food Restaurants, Distributors Wanted, Jewellery, Tickets, General, Apparels For Sale, Materials, Vacation Rentals, Register Domain, Marketing, Advertising & PR, Games, Investment Opportunities, Drive In Restaurants, Retail Trade, Watches, Travel, Health & Beauty, Community Chest, Real Estate, Couches And Futons, Outdoor Settings And Furniture,
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Forums: Index > The Wizengamot archive > Where are they going to stop the first Deathly Hallows Movie?
Does anyone know where they are going to stop Deathly Hallows Part one? My brother and I think after Ron leaves or after he comes back and destroys the locket.
- Right now, the rumor is (according to Josh Herdman) right after HRH are captured by the Snatchers, but before they're taken to Malfoy Manor. [1]). I don't know if WB has confirmed it yet. --Cubs Fan (Talk to me) 00:25, 30 August 2009 (UTC)
thanks!Ash Po 01:24, 30 August 2009 (UTC)
Got this off the same website Please note that - while this may be the current plan - the director and producers have made it clear that they could very well change where they had been thinking of splitting it if they thought a different point worked better after filming was complete. So It might be split somewhere different --Profiteor 01:29, 30 August 2009 (UTC)


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Apartment for 4 in Paris - Eiffel
Спальные места4
Ванные комнаты1
Площадь43 м²
Этаж №2
- Кухня
- Интернет
- Полотенца
- Стиральная машина/сушилка
Краткое описание жилья
|saint dominique, 75007 paris, Франция
|Тип жилья
|ID жилья
|Процент подтвержденных запросов брони
|Время ответа
|Несколько часов
|Календарь обновлен
The apartment is located in the heart of the 7th arrondissement, between the Eiffel Tower and the Hotel des Invalides. This is a prestigious neighborhood where you will find the Hotel Matignon, Military School, the National Assembly. Guests have access to extensive public garden of the Champs de Mars dominated by the Eiffel Tower.
The building is typically Parisian, this is a secure building which dates from the late nineteenth century. It is very well maintained.
2nd floor without elevator, the apartment is very calm and clear
- Fully equipped kitchen: ceramic hob, oven, microwave, fridge and everything you need to cook and eat: dishes, pots, cups, glasses.
- Living room with sofa bed for 2 people.
- Bathroom with shower, heated towel rail and WC.
- Bedroom with real bed 2 people, very quiet.
For short term rentals (less than a month), towels and linens are provided, as well as cleaning. An efficient heating system ensures a steady and comfortable temperature in the apartment.
Within 10-15 minutes walk you will find the Musée d'Orsay, the Musée du quai Branly and the Musée Rodin.
You will find many restaurants and wine bars in the neighborhood. Breteuil market takes place two times a week, the busy shopping street Clerc is right next to the apartment so you can enjoy all the amenities.
The apartment is easily accessible by metro from the station Ecole Militaire (5 min. Walk). Easy access to stations. Access to the train to go to Château de Versailles is just 5 minutes from the apartment.
From the train station Gare du Nord or Chatelet you can take the train to the airport Charles de Gaulle and Orly.
Правила ПроживанияLATE ARRIVALS CHARGES
For late arrivals, please note that a late check-in charge will apply, which amounts to EUR 20 between 8PM and 10PM and EUR 40 after 10PM.
Une caution de EUR 200 est demandée pour couvrir d'éventuels dégâts ou réparations dans l'appartement du fait des locataires. Elle est réglée par CB avec notre terminal de paiement mobile (la somme en question n'est pas débitée mais " pré-autorisée" comme pour la location d'une voiture par exemple).
|Цена за неделю (вплоть до 4 гостей)
|65685 руб.
|Цена за месяц (вплоть до 4 гостей)
|246234 руб.
|Максимальная продложительность визита
|6 месяцев
|Заезд после
|Заселение до
|По договоренности
|Отъезд до
|Политика Отмены Брони
Обзор других предложений от этого хозяина
Fin lejlighed beliggende i stueplan. 2 gode soveværelser og fint badeværelse. Mindre stue/køkken i samme rum. Savnede et spisebord. Kun 50 meter til metrostation. En række cafeer, restauranter, bager, slagter, købmand inden for meget kort afstand.
Muy centrico, nuevo, aseado y limpio. Tiene practicamente de todo. Le falta conexion a internet, imprescindible en estos tiempos.
El apartamento se ajusta perfectamente a su descripción. Muy bien situado, con paradas de metro y bus cerca y en una buena calle. Excelente opción para una o dos personas.
Nice apartment with great location! The pictures describes the apartment well, fresh feeling as well. Great that it was close to the metro! However there were some unstable furniture and a bag of dirty laundry that decreased the experience. But overall I can definitely recommend this apartment!
Studio petit, mais bien organisé, propre, bien situé et hôte accueillant et ponctuel. Merci. Michel et Monique
Fantastisch. Perfekt gelegenes Appartement, sehr gut ausgestattet und gepflegt. Die Schlüsselübergabe hat perfekt geklappt. Nur für 1-2 Personen geeignet. Appartement liegt im ersten Stock, daher etwas laut.
We stayed in Paris for 9 days. The arrival was ok, fortunately we found the apartment fast and we were welcomed by Jeremy's assistant Lea. She was friendly but made a confused impression. Maybe this was the reason why she took our papers with a lot of Paris information (addresses etc.) with her. Later the electricity didn't work in the apartment, which was not a big deal, because just some switches in the fuse box were turned off, BUT we called Lea three times because of our papers and later because of the electricity, but she didn't answer the phone and also never called back.
About the apartment we can generally say that it was ok, but nothing more. It was rebuilt prior our arrival, so everything is new there - the furniture, the bathroom, the kitchen etc. But unfortunately nothing was clean. The shower was dirty, the shelves full of dust. The dishes were not clean (despite the dishwasher) but the flat ground was the worst – we have no idea how long the floor was not cleaned, but it seemed the dirt was still from the rebuilding. Otherwise – if the apartment would be clean – it is a very nice place to stay! Its perfect for two people and you can find more shops in that area as you can go in. You have a lot of metro (and also a RER) stations nearby, so nothing is far away. If you go about three minutes you can sit on the river of Seine. It's a beautiful place!
All in all we can say it was a nice city trip. And we would like to give a constructive feedback to the owner/assistants: Clean the apartment and call back if you see an unanswered call. The reason for could be important!
Best regards
Nice appartment with all you can wish for. Excellent place to discover the rest of Paris. Metro is nearby (app. 100 m.). Parking across the street for € 25,00 per day. Supermarket and some bars nearby. The market in the street is enjoyable. Jeremy was helpfull and would recommend this place to friends. Tanx!
We found this apartment very clean and comfortable. Very close to metro and in walking distance to Notre Dame.
Die Wohnung entsprach der Ankündigung, sie war sauber. Keine Beanstandungen
- Гарантировать качество жилья
- Проверить каждого принимающиего Вас хозяина по телефону
- Обеспечить безопасную оплату через шифрование на базе SSL


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Olmsted County Attorney Mark Ostrem asked lawmakers this afternoon to make synthetic marijuana illegal. He said all too often, his office sees people on parole for drug-related offenses who are using these substances that are marketed as bath salts and incense.
"We've had people come into probation offices and when they are asked to empty their pockets this spills onto the counter," he said.
Rochester GOP Sen. Carla Nelson is sponsoring a bill that would make it a grossmisdemeanor to sell fake pot and a misdemenator to possess it. So why all of the concern? Dr. Cody Wiberg, executive director of the Minnesota Board of Pharmacy, said the chemicals in these products can cause serious health problems.
"They are far more dangerous (than marijuana)," he said. "These drugs compared to the active ingredients in marijuana — THC — are much more potent."
He said use of these drugs can cause severe hallucinations, rapid heart rate, severe high blood pressure and seizures.
Members of the Senate Judiciary and Public Safety Committee agreed on a voice vote to consider including Nelson's bill as part of a larger drug bill.


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Midday Express of 2013-04-30
News from the European Commission's Midday Briefing
Nouvelles du rendez-vous de midi de la Commission européenne
€150 million for brain research launches EU 'Month of the Brain'
At the start of its 'European Month of the Brain' initiative, the European Commission has earmarked some €150 million of funding for 20 new international brain research projects. It will bring the total EU investment in brain research since 2007 to over €1.9 billion. The 'European Month of the Brain' (#brainmonth) will highlight European research and innovation in the area of neuroscience, cognition and related areas through over 50 events across Europe this May. The initiative aims to showcase the latest achievements in the field, but also to urge a more decisive effort to combat brain diseases. It also aims at highlighting how studying the brain can revolutionise computing. The initiative comes as the profile of brain research has been raised recently with ambitious new projects in the EU (FET Flagship Human Brain Project – IP/13/54 and MEMO/13/36) and the US (BRAIN project).
EU Solidarity Fund: Commission proposes €14.6 million to support Slovenia, Croatia and Austria after floods disaster
European Commissioner for Regional Policy, Johannes Hahn has today announced an aid package from the EU Solidarity Fund (EUSF) of over €14.6 million in response to serious flooding in Slovenia in October and November 2012. Neighbouring countries Austria and Croatia also suffered lesser damages as a direct result of the floods and will benefit from the grant in order to fund their emergency operations in the aftermath of the disaster.
State aid: Commission consults on new film support rules
The European Commission has launched the third and final public consultation in its review of the state aid criteria it uses to assess Member States' support schemes for films and other audiovisual works. The criteria are set out in a draft Communication, on which the Commission invites comments by 28 May 2013. The final Communication is due to be adopted by the Commission in the third quarter of 2013.
Mergers: Commission clears acquisition of joint control over ETCG by ETC Holdings, SCPE, Pemgrofund and CSSAF
The European Commission has granted clearance under the EU Merger Regulation to the proposed acquisition of joint control over Export Trading Company Group ("ETCG") by ETC Holdings (Mauritius) Limited ("ETC Holdings"), Standard Chartered Private Equity (Mauritius) III Limited ("SCPE"), PRIF AfriVest Limited ("PemgroFund") and CSSAF Consumer I ("CSSAF") all of which are based in Mauritius. Prior to the transaction ETC Holdings has had sole control over ETCG. ETC (i.e. ETC Holdings and ETCG) operates a vertically-integrated agriculture business across the African subcontinent including procurement, processing, warehousing, transport, distribution and merchandising of agricultural commodities. SCPE provides equity funding for expansions, acquisitions, leveraged buyouts and management buyouts across a range of industries. PemgroFund is a long term fund, with focus on investment in infrastructure and related opportunities across Africa. CSSAF is a global alternative asset manager. The operation was examined under the simplified merger review procedure. More information will be available on the Commission's competition website, in the public case register under the case number M.6890 .
Flash estimate - April 2013 - Euro area annual inflation down to 1.2%
Euro area annual inflation is expected to be 1.2% in April 2013, down from 1.7% in March, according to a flash estimate from Eurostat. Looking at the main components of euro area inflation, food, alcohol & tobacco is expected to have the highest annual rate in April (2.9% compared with 2.7% in March), followed by services (1.1% compared with 1.8% in March), non-energy industrial goods (0.8% compared with 1.0% in March) and energy (-0.4% compared with 1.7% in March).
March 2013 - Euro area unemployment rate at 12.1% EU27 at 10.9%
The euro area (EA17) seasonally-adjusted unemployment rate was 12.1% in March 2013, up from 12.0% in February. The EU27 unemployment rate was 10.9%, stable compared with February. In both zones, rates have risen markedly compared with March 2012, when they were 11.0% and 10.3% respectively. These figures are published by Eurostat. Eurostat estimates that 26.521 million men and women in the EU27, of whom 19.211 million were in the euro area, were unemployed in March 2013. Compared with February 2013, the number of persons unemployed increased by 69 000 in the EU27 and by 62 000 in the euro area. Compared with March 2012, unemployment rose by 1.814 million in the EU27 and by 1.723 million in the euro area.
Mergers: Commission clears the acquisition by Aegon Spain Holding B.V. and Santander Seguros y Reaseguros, Compania Aseguradora, S.A. of joint control over Santander Vida, Seguros Y Reaseguros, S.A and Santander Generales, Seguros Y Reaseguros, S.A.
The European Commission has cleared under the EU Merger Regulation the proposed acquisition by Aegon Spain Holding B.V. ("Aegon Spain") and Santander Seguros y Reaseguros, Compania Aseguradora, S.A. ("Santander Seguros") of joint control over Santander Vida, Seguros Y Reaseguros, S.A and Santander Generales, Seguros Y Reaseguros, S.A., currently solely controlled by Santander Seguros. Aegon Spain belongs to the Aegon Group of insurance companies, active worldwide, mainly in the United States, the Netherlands and the United Kingdom. Santander Seguros is ultimately controlled by Banco Santander S.A., active in the banking and the insurance sectors internationally. Santander Vida and Santander Generales will be active in the Spanish insurance market providing life and non-life insurance respectively. The Commission concluded that the proposed acquisition would not raise competition concerns given the very limited overlaps between the parties' activities and the presence of a number of strong competitors both in life and non-life insurance markets in Spain. The operation was examined under the normal merger review procedure More information is available on the Commission's competition website in the public case register under the case number M.6848 .
La Commission clôture l'investigation approfondie sur la gestion des services d'eau potable et d'assainissement des eaux usées
Depuis janvier 2012, la Commission a enquêté de manière approfondie sur l'existence d'éventuelles pratiques anticoncurrentielles dans le marché de la gestion déléguée des services d'eau potable et d'assainissement des eaux usées en France. Cette investigation approfondie n'a pas permis d'établir l'existence d'une infraction aux règles européenne de concurrence. En conséquence, la procédure ouverte en janvier 2012 (voir IP/12/26) a été close. A l'avenir, la Commission continuera à surveiller de près l'évolution de la situation de la concurrence dans les marchés de l'eau et de l'assainissement en France et dans les autres Etats membres.
Task Force for Greece - Fourth Quarterly Report: Support for growth and jobs in Greece
Today, the Commission's Task Force for Greece (TFGR) presents its fourth quarterly report on technical assistance for Greece. The Task Force has made steady progress in assisting the Greek authorities, in a spirit of solidarity, to help implement a wide range of reforms agreed in the context of the economic adjustment programme for Greece and to maximise the use of EU Structural Funds. The assistance provided by the Taskforce builds on the commitment of the Greek authorities to implement these reforms, which are necessary to rebuild an economy that is conducive to growth and job creation, as set out in the Memorandum of Understanding with Greece.
Bees & Pesticides: Commission to proceed with plan to better protect bees
Today, EU Member States did not reach a qualified majority – either in favour or against - in the Appeal Committee which discussed a Commission proposal to restrict the use of 3 neonicotinoid insecticides.
Autre matériel diffusé :
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Jacksonville ASP.NET MVC Training
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These courses are designed for developers with prior C# or VB.NET experience and can be taught in either language. If your developers have object-oriented development experience but have not programmed in either language, please let us know – we would be delighted to tailor their training to help them make the transition to the .NET Framework and ASP.NET MVC.
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ADM Quarterly Conference Call Schedule
For more than a century, the people of Archer Daniels Midland Company (NYSE: ADM) have transformed crops into products that serve the vital needs of a growing world. Today, we're one of the world's largest agricultural processors and food ingredient providers, with more than 32,300 employees serving customers in more than 160 countries. With a global value chain that includes 428 crop procurement locations, 280 ingredient manufacturing facilities, 39 innovation centers and the world's premier crop transportation network, we connect the harvest to the home, making products for food, animal feed, industrial and energy uses.
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Welcome to the Clean Water Program
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Working with agencies from around Alameda County, the Clean Water program facilitates local compliance with the Federal Clean Water Act. We foster a culture of stewardship of our local creeks, wetlands and the Bay. Alameda County homes and businesses are connected to these important waters through the network of stormdrains found in every neighborhood. Whether you run a business, teach school or just live, work and play in our lovely County, there's something on this site for you. Please take a few moments to learn how your actions can affect our vital water resources, and what you can do to protect them.
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Pleural effusion occurs when fluid collects in the pleural cavity—the
area between the lungs and the chest. Fluid buildup may cause abnormal pressure
on the lungs.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineSpecialist Medical ReviewerRobert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology
Current as ofMay 23, 2016
Current as of:
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COLUMBUS, Ohio (AP) -- There have been some positive changes to Ohio's youth prison system, but there also are pervasive problems involving gang violence, education and medical care, according to an annual report.
The report, released this month, is written by court-appointed monitor Will Harrell, who oversees an agreement between the state and youth advocates who sued over conditions in the system.
The Columbus Dispatch reports (http://bit.ly/VgExkH) that Harrell found that administrators have been successful in reducing the number of offenders in secure confinement and spreading services for youthful offenders around Ohio.
But he also wrote that there are several "ongoing deficiencies" that must be addressed.
For example, he wrote that the Indian River Juvenile Correctional Facility near Canton still has too many incidents of violence.
"Youth gangs still exert a powerful negative influence at Indian River, and concerns remain about the high rate of fights and physical restraints," he wrote.
He also wrote that teacher absences contributed to a number of canceled classes at Indian River and the Scioto Juvenile Correctional Facility in Delaware north of Columbus, and that some teachers aren't getting the job done.
At Scioto, "some staff demonstrated an inability to effectively maintain order, and youth in several classrooms slept, walked around, or engaged in conversations unrelated to school," the report said.
The report found problems with medical files at all four state facilities, and it said records aren't always accessible to everyone trying to create treatment programs for youth.
The report also said that psychiatric services and hours at all the prisons are inadequate, and a disproportionate number of black inmates aren't placed in mental-health units.
Four years ago, the state settled a 2004 lawsuit alleging that a culture of violence permeated the youth prisons system. The settlement called for continuing review of the state's progress in making agreed-to changes.
The state says that the agreement should be concluded because the agency is a different organization today and should be concluded.
"We are carrying out our mission of improving Ohio's future by habilitating youth and empowering families and communities," youth-prisons spokeswoman Kim Parsell said in a statement.
Attorneys for youth inmates said that the recent report found possible violations of inmates' federal rights in 44 areas.
The attorneys also say that now is not the time to end the agreement when possible upcoming cuts to the youth-prisons budget could "put a severe strain on its ability to achieve constitutional compliance."
The system once had more than 2,000 juvenile inmates; it now houses about 600.
Information from: The Columbus Dispatch, http://www.dispatch.com


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IMET Corporation, a contract electronics manufacturer in Southampton, PA whose founder is an Electrical Engineering graduate of The College of New Jersey, has again been honored for its exceptional growth and business strategy. Outranking numerous businesses many times its size and age, the company was named "2014 Manufacturer of The Year" by Greater Philadelphia's Chamber of Commerce annual Excellence Awards. This distinction came within weeks after IMET's inclusion in this year's prestigious "Inc. 5000" list of America's fastest-growing private companies.
"Needless to say, receiving both of these coveted awards is quite a tribute to our executive, engineering and production staffs," reflects President Tom Krol, whose original career choice was being the lead guitarist in a moderately successful rock band. However, a college guidance counselor advised Tom to take a less arduous and "more secure" career path – in engineering. "Acting on that lady's suggestion was the best thing I've ever done," reflects the 38-year-old Philadelphia native. He founded IMET in 2000 from a rented garage while still a sophomore at TCNJ's School of Engineering. Today, the company now owns and operates a 15,000 sq. ft. building in Southampton, PA serving the medical, military, industrial and consumer marketplaces with product design and development, electronics engineering and circuit assembly.
The Excellence Awards dinner on November 20 was attended by The College of New Jersey's Steven Schreiner, Ph.D., Dean of the School of Engineering and Guy Caleerano, Major Gifts Officer.
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Warners, Paramount unite with Nolan
The studios announced on Friday [8] they will jointly handle production and worldwide distribution on Christopher Nolan's upcoming sci-fi Interstellar.
Warner Bros will release the film internationally and Paramount will distribute in North America in theatres and IMAX on Nov 7.
Nolan and Emma Thomas of Syncopy Films and Lynda Obst of Lynda Obst Productions are producin Interstellar while Kip Thorne will serve as executive producer.
Legendary Pictures, Nolan's collaborator on the Batman trilogy and Inception, is not involved in the project, described as a deep space voyage to the limits of human consciousness.
"As a film-maker and storyteller, Chris has continuously entertained the world with his extraordinary and unparalleled talents," said Paramount chairman and CEO Brad Grey.
"I am pleased beyond measure to welcome him to the Paramount Pictures family. Partnering with Chris, Emma, Lynda and Warner Bros to release this original idea next November is the perfect way to start the Thanksgiving and holiday movie season for audiences around the world."
"Christopher Nolan is truly one of the great auteurs working in film today, and we're extremely proud of our successful and ongoing collaboration with him and Emma Thomas," said Warner Bros Pictures Group president Jeff Robinov. "We are excited to be teaming with Paramount, and look forward to working with the Nolans, and producer Lynda Obst, on this extraordinary new project."
Readers' comments (2)
Can't wait for this!
Over three years ago Steven Spielberg was going to direct this for Dreamwork and Paramount.
Years later Steven Spielberg drops out Christopher Nolan takes over the directors chair and Warners take international rights.
Year on year Warners have incredible lineups this year with The Hangover III, Pacfic Rim, Man of Steel, The Great Gatsby, The Hobbit 2
and next year with this added to the lineup along with The Hobbit 3 and Wally Pfister's sci-fier Transcendence, Mad Max Fury Road, All You Need Is Kill, Jupiter Accending, Lego, Godzilla they are in for another incredible year.
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PHILADELPHIA – Saturday marked the first practice for the University of Pennsylvania cross country teams, and in just a few weeks the Quakers will officially start the 2013 campaign in Philadelphia. On Tuesday, Director of Cross Country/Track & Field Steve Dolan announced Penn's complete 2013-14 cross country and track & field schedules.
The Quakers start the cross country season with the Big 5 Meet at Belmont Plateau on Sept. 13 and will end the 2013-14 track and field season with a two-week trip to the United Kingdom in June.
Following the season opener, the cross country teams will compete in the Main Line Invitational on Sept. 26. October will bring the Paul Short Invitational (Oct. 5) and the Pre-Nationals (Oct. 19).
November is the month of championships, starting with the Heptagonals at Princeton on Nov. 2. Soon after, the team will travel to Bethlehem, Pa. for the NCAA Regional on Nov. 15, where they will have the possibility to qualify for the IC4A/ECAC Championships in New York City or the NCAA Championships in Terre Haute, Ind.
While cross country is finishing the end of their season, indoor track is just warming up. The Villanova Invitational on Dec. 7 will mark the first of the season but the last for the year of 2013.
After the New Year, Jan. 18 brings the Lehigh Challenge and Jan. 25 is the Haverford College Invitational. The weekends of February are booked solid for the team as they travel to compete in the Columbia Invitational (Feb. 1), Sykes Sabock Cup (Feb. 8), Rider/Lafayette Invitational (Feb. 14), Millrose Games (Feb. 15), and Princeton Invitational (Feb. 22).
These weekend road trips will prepare the team for the Heps Championships hosted by Dartmouth at the beginning of the month in Hanover, N.H. The Quakers will then cap the indoor campaign at the NCAA Championships in Albuquerque, N.M., March 14-15.
A week after the NCAA Championships, Penn will open the outdoor season with the Philadelphia College Classic at historic Franklin Field. The next few meets to follow will be the Raleigh Relays in Raleigh, N.C. March 28-29. After Raleigh, they'll journey north to Princeton for the Sam Howell Invitational, April 4-5. The team will again travel South, but not as far, to Fairfax, Va., for the George Mason Invitational on April 12, only to take a trip once again back north to Princeton for the Larry Ellis Invitational April 18-19.
However, all roads eventually lead to track and field's most anticipated meet of the year: The Penn Relays.
2014 marks Penn's 120th consecutive year of hosting The Relays. Last year, there were 48,871 in attendance at historic Franklin Field on Saturday for a three-day total of 111,284 - eclipsing 110,000 fans for the sixth consecutive year. It is also the 10th straight year and the 13th time in the last 14 years with more than 100,000 spectators at the world's oldest and largest relay carnival.
The Penn Relays signify the conclusion of the regular season leading to the Heptagonal Championships hosted by Yale (May 10-11) and ECAC/IC4A Championships the following weekend at Princeton (May 16-18).
For those that qualify, the NCAA East Preliminaries are May 29-31 in Jacksonville, Fla., and the NCAA Finals in Eugene, Ore., June 11-14.
At the conclusion of the collegiate season, the Quakers will spend two weeks touring the United Kingdom for the biennial Transatlantic Series. Traditionally, every two years the Cornell and Penn track and field programs take on Oxford and Cambridge with the site alternating between the UK and USA.
|Fri, Sep 13
|Big 5 Meet
|at Philadelphia, Pa. (Belmont Plateau)
|9:00 a.m.
|Thu, Sep 26
|Main Line Invitational
|at Haverford, Pa.
|5:00 p.m.
|Sat, Oct 05
|Paul Short Invitational
|at Bethlehem, Pa.
|9:00 a.m.
|Sat, Oct 19
|Pre-Nationals/Princeton Invite
|at Terre Haute, Ind./Princeton, N.J.
|9:00 a.m.
|Sat, Nov 02
|Heptagonal Championships
|at Princeton, N.J.
|9:00 a.m.
|Fri, Nov 15
|NCAA Regional Championships
|at Bethlehem, Pa.
|9:00 a.m.
|Sat, Nov 23
|IC4A/ECAC Championships
|at Van Cortlandt Park (New York, N.Y.)
|9:00 a.m.
|Sat, Nov 23
|NCAA Championships
|at Terre Haute, Ind.
|9:00 a.m.
|Sat, Dec 07
|Villanova Invitational
|at Havertown, Pa.
|All Day
|Sat, Jan 18
|Lehigh Challenge
|at Bethlehem, Pa.
|All Day
|Sat, Jan 25
|Haverford College Invitational
|at Havertown, Pa.
|All Day
|Sat, Feb 01
|Columbia Invitational
|at 168th St. Armory, N.Y.
|All Day
|Sat, Feb 08
|Sykes Sabock Cup @ Penn State
|at State College, Pa.
|All Day
|Fri, Feb 14
|Rider/Lafayette Invitational
|at 168th St. Armory, N.Y.
|All Day
|Sat, Feb 15
|Millrose Games
|at 168th St. Armory, N.Y.
|All Day
|Sat, Feb 22
|Princeton Invitational
|at Princeton, N.J.
|All Day
| Sat, Mar 01 -
Sun, Mar 02
|Heptagonal Championships @ Dartmouth
|at Hanover, N.H.
|All Day
| Fri, Mar 14 -
Sat, Mar 15
|NCAA Championships @ New Mexico
|at Albuquerque, N.M.
|All Day
|Sat, Mar 22
|Philadelphia College Classic
|Franklin Field
|All Day
| Fri, Mar 28 -
Sat, Mar 29
|Raleigh Relays @ NC State
|at Raleigh, N.C.
|All Day
| Fri, Apr 04 -
Sat, Apr 05
|Sam Howell Invitational
|at Princeton, N.J.
|All Day
|Sat, Apr 12
|George Mason Invitational
|at Fairfax, Va.
| Fri, Apr 18 -
Sat, Apr 19
|Larry Ellis Invitational
|at Princeton, N.J.
|All Day
| Thu, Apr 24 -
Sat, Apr 26
|Penn Relays
|Franklin Field
|All Day
| Sat, May 10 -
Sun, May 11
|Heptagonal Championships @ Yale
|at New Haven, Conn.
|All Day
| Fri, May 16 -
Sun, May 18
|ECAC/IC4A Championships
|at Princeton, N.J.
|All Day
| Thu, May 29 -
Sat, May 31
|NCAA East Preliminaries
|at Jacksonville, Fla.
|All Day
| Wed, Jun 11 -
Sat, Jun 14
|NCAA Finals @ Oregon
|at Eugene, Ore.
|All Day
| Mon, Jun 16 -
Tue, Jul 01
|Oxford-Cambridge Transatlantic Series
|at United Kingdom
|All Day


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You exercise your body to stay physically in shape, so why shouldn't you exercise your brain to stay mentally fit? With these daily exercises you will learn how to flex your mind, improve your creativity and boost your memory. As with any exercise, repetition is necessary for you to see improvement, so pick your favorite exercises from our daily suggestions and repeat them as desired. Try to do some mentalrobics every single day!
noun :: One who forsakes his party or his principles; a renegade; an apostate.
"I might have expected naught better from a turncoat foreign knave such as thee, who once joined in the councils of De Montfort, and then betrayed his friends to curry favor with the King." --Burroughs, Edgar Rice
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ASCO Annual Meeting
June 4, 2011
In a recent study, researchers found that radiation therapy to the regional lymph nodes decreases recurrences (cancers that come back after treatment) for women with early-stage breast cancer that has spread or is likely to spread to the lymph nodes. Regional lymph nodes are the lymph nodes near where the tumor started. For breast cancer, these are the lymph nodes in the armpit on the same side of the body where the cancer began, called the axillary lymph nodes.
Breast cancer that has spread to the regional lymph nodes is called node-positive breast cancer. It is usually treated with surgery to remove the tumor (called breast-conserving surgery) and an axillary lymph node dissection, which is surgery to remove the axillary lymph nodes. Then, radiation therapy is given to the entire breast. If the tumor is larger than 5 cm or there are more than three positive axillary nodes, radiation therapy to the lymph nodes is given. This study was designed to look for a benefit to adding radiation therapy to treatment for women who would not normally have radiation therapy to the regional lymph nodes.
The study included 1,832 women with node-positive breast cancer or high-risk, node-negative breast cancer who had breast-conserving surgery and chemotherapy or hormone therapy and then received either radiation therapy to the breast only or radiation therapy to the breast and the regional lymph nodes.
After around 5 years, about 3% of the women who also received radiation therapy to the regional lymph nodes had a recurrence near where the tumor started and about 8% had the cancer return in other parts of the body, compared with almost 6% and 13% of women who received radiation therapy to the breast only. Women who received radiation therapy to the breast and the regional lymph nodes were also more likely to live longer; however, this result was not statistically significant, which means that it could be due to chance and not the treatment.
The side effects of radiation therapy to both the breast and the regional lymph nodes included pneumonitis (swelling of the lungs) and lymphedema (abnormal buildup of fluid in the arm, causing swelling).
What this means for patients
"These results will encourage doctors to offer all women with node-positive disease the option of receiving radiation therapy to the regional lymph nodes," said Timothy J. Whelan, BM, BCh, lead study investigator for the National Cancer Institute of Canada Clinical Trials Group and Professor of Oncology and Division Head of Radiation Oncology at McMaster University in Ontario, Canada. "This treatment improved disease-free survival, lowered the risk of recurrences, and there was a positive trend toward overall survival, while not greatly increasing side effects."
Questions to ask your doctor
- What type of breast cancer do I have?
- Has it spread to the lymph nodes?
- What is my risk of recurrence?
- What are my treatment options?
- Do you recommend radiation therapy?
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Obstructive sleep apnea (OSA) is increasingly recognized as a public health concern. Definitive diagnosis is by overnight polysomnographic (PSG) examination. Identification of clinical predictors would be beneficial in helping prioritize high-risk patients for assessment. Practical application of morphometric predictive variables would require a high level of reproducibility in a clinical setting. In this study, our objective was to evaluate reliability between observers in measurements of candidate morphometric parameters in women.
This was a prospective study of 71 women who had been referred for PSG with suspected OSA. Selected morphometric parameters were measured independently in the sleep laboratory by two trained sleep physicians.
Neck circumference and truncal measurements for lower costal, midabdominal, and hip circumferences had higher reliability coefficients (intraclass correlation coefficients [ICC] of 0.78, 0.95, 0.95, and 0.81) than the smaller dimension measurements, including cricomental distance or retrognathia (ICC of 0.04 and 0.17). Of the women participating in this study, 50 of 71 had apnea-hypopnea indexes (AHI) ≥ 5. Body mass index (BMI), neck circumference, lower costal girth, midabdominal girth, and hip girth were all significantly higher (p < 0.001-0.004) in women with AHI ≥ 5.
There was wide variation in inter-observer reliability for different physical dimensions. We propose that any clinical morphologic measurement employed in predictive modeling should be reliably reproducible in clinical setting conditions. Our findings support the use of several truncal measures, BMI, and neck circumference as predictive measures in women undergoing evaluation for OSA.
Gjevre JA; Taylor-Gjevre RM; Reid JK; Skomro R; Cotton D. Inter-observer reliability of candidate predictive morphometric measurements for women with suspected obstructive sleep apnea. J Clin Sleep Med 2013;9(7):695-699.
There is growing recognition of obstructive sleep apnea (OSA) as a public health concern, with up to 20% of adults estimated to have at least mild OSA.1 Untreated, OSA may pose substantial risks, contributing to development of systemic hypertension and mortality from cardio/cerebrovascular disease.2 If associated with hypersomnolence, OSA may contribute to an increase in motor vehicle or work-related accidents.3,4
The definitive diagnostic tool for OSA is the overnight polysomnogram (PSG). Increasing awareness of this disorder among both physicians and the general public is leading to greater numbers of referrals for sleep physician assessment and for PSG. Timely access to PSG varies by geographic region. Because of PSG access issues, alternative home-based sleep diagnostic testing has been validated for use.5 Clinical predictors for significant OSA are useful tools enabling the physician to prioritize referrals and diagnostic test scheduling by degree of urgency. In men, increased BMI (body mass index) and neck circumference are strong predictors of OSA.6 However, gender differences in body fat distribution and OSA associated symptoms have been reported, and it is unclear that recognized predictors of OSA in men would also carry the same significance in women.7–10
Current Knowledge/Study Rationale: Physical parameters may serve as clinical predictors of obstructive sleep apnea, assisting physicians in the diagnostic process and in prioritization of patient referrals for polysomnography. A high level of reproducibility of such physical measurements would be required for practical application; this study evaluates level of agreement between physicians in such measurements.
Study Impact: The results from this study demonstrate wide variation in inter-observer reliability for different physical measurements. Our findings support the utilization of body mass index, neck circumference and several truncal measures in predictive modeling for women undergoing evaluation for obstructive sleep apnea.
There have been efforts made to identify specific morpho-metric measurements, which could be employed as clinical predictors for OSA, either alone or in conjunction with other parameters.11,12
In order for such dimensions to be employed as practical screening tools, it is crucial to understand the reliability of measurements in a clinical environment. A physical dimension measurement that in a particular range is predictive for OSA may prove to be misleading should the measurement itself be subject to substantial variation between physicians. In this study, we address this concern by examination of inter-observer agreement in candidate predictive morphometric measures in women who are undergoing polysomnography for suspected OSA.
Consecutive women scheduled for routine PSG testing for evaluation of clinically suspected OSA were invited to participate in this study. Informed consent was obtained. This study was approved by the institutional research ethics board and is in accordance with the Helsinki Declaration.
Inclusion criteria included age ≥ 21 years and ability to provide informed consent. Exclusion criteria were: referring sleep physician's strong suspicion of another primary sleep disorder (primary insomnia, narcolepsy, restless legs syndrome, a parasomnia, or nocturnal seizures) as indicated on the patient's referral form.
Morphometric variables were assessed by standardized, focused upper airway examination and general examination. For each participant, this was performed by 2 independent sleep physician observers to assess inter-observer reliability. Measurements included: neck circumference, lower costal or chest circumference (lower margin of the antero-lateral ribs, while standing at functional residual capacity [FRC]), umbilical abdominal (mid-abdominal) circumference (peri-umbilical circumference of the abdomen with abdominal muscles relaxed at FRC while standing), hip circumference (widest circumference of the buttocks while standing), lateral pharyngeal space narrowing (grading by Tsai et al.11), vertical pharyngeal space narrowing (modified Mallampati score),12 cricomental space (in mm), maxillary over jet (in mm), and retrognathia (in mm). The presence or absence of tongue ridging, macroglossia, and tonsillar enlargement were also recorded.11,13
The pharyngeal grading system described by Tsai included a 4-class categorization, with class I designated when the palatopharyngeal arch intersects at the edge of the tongue, class II when the palatopharyngeal arch intersects at ≥ 25% of the tongue diameter, class III when the palatopharyngeal arch intersects at ≥ 50% of the tongue diameter, and class IV when the palatopharyngeal arch intersects at ≥ 75% of the tongue diameter.11
All 5 sleep physicians assessing patients for this study participated in a standardized training session on morphometric measurement techniques prior to study initiation.
Patients were studied overnight in the sleep lab using the standard 15-channel PSG (Sandman Elite version 8.0 sleep diagnostic software, Ottawa, Canada). Established protocols were used for all PSG studies.14 This included electroencephalogram (EEG, 3-channel), electrooculogram (2-channel), electromyo-gram (chin and leg), electrocardiogram, heart rate, snoring, thermistor airflow, nasal pressure airflow, oxygen saturation, chest wall motion, and abdominal motion.
SPSS v.17.0 was employed for data entry and analysis. Means and standard deviations were calculated for continuous data. Proportions were calculated for categorical data. Between group comparisons of continuous data were evaluated with independent 2-tailed t-tests. Between group comparisons of categorical data were evaluated with χ2 testing and Fisher exact test when the cell size was < 5. Measures of agreement between observers were calculated for morphometric measurements, κ coefficients for categorical data, and intraclass correlation coefficients for continuous data.15,16
For this reliability study using intraclass correlations, we used conventional values for α of 0.05 and β of 0.20. As each patient underwent separate measurements by 2 different observers, using a minimum acceptable level of agreement of ρ0 = 0.4, and an expected level of agreement of ρ1 = 0.9, then approximately 7 subjects would be the estimated sample required per reliability assessment.17
For 2 group comparisons based on an apnea hypopnea index (AHI) cutoff of 5, mean morphometric values derived from the 2 observers were utilized. Receiver operator characteristic (ROC) curves were plotted for the predictive relationships between abnormal range AHI (≥ 5) and morphometric parameters.
Of 95 consecutive female patients who attended the sleep lab during the study period, 71 consented to participate. The means and standard deviations of morphometric measurements by 2 physicians and the measures of agreement are detailed in Table 1. A greater degree of inter-observer agreement, as represented by the intra-class correlation coefficients and κ coefficients,15,16 was observed for some measurements compared to others. The greatest agreement was observed for the truncal measures of lower costal girth, midabdominal girth, and hip circumferences. The lowest degree of agreement was evident for the smaller dimension measurements for cricomental distance and retrognathia. Subjective dichotomous observations for the presence or absence of tongue enlargement, tongue ridging, or tonsillar enlargement also had lower measures of agreement between observers.
Comparison of morphometric measurements between observers
(more ...)
Of the 71 participants, 50 had AHI ≥ 5. Comparisons of morphometric continuous measurements between the 2 groups are detailed in Table 2. Mean measurement scores derived from the 2 observers were employed for this 2-group comparison. There were no significant differences in proportions of participants designated to have tongue ridging, macroglossia, or tonsillar abnormalities between those with elevated AHI and those with normal AHI values. Predictive relationships for abnormal AHI (≥ 5) with morphometric measures are described in Figures 1 and 2 and Table 3.
Comparison of morphometric measures between groups based on AHI
Area under the curve (AUC) for prediction of abnormal AHI
ROC curve for prediction of AHI ≥ 5 from truncal measures
ROC curve for prediction of AHI ≥ 5 from upper airway/mandibular measures
Although obesity has been linked to OSA and there are comparable frequencies of obesity between genders, the prevalence of OSA in women has been lower than in men.1 In men, increased BMI and increased neck circumference are predictive of OSA.6 It is less clear that these variables are predictive in women with OSA.8–10,18 Whittle et al. have demonstrated in magnetic resonance imaging (MRI) studies of men and women that there are differences in neck fat deposition distribution between the genders and greater overall soft tissue volume around the airway in men. They speculate that these or other anatomic factors may contribute to the gender disparity in OSA prevalence.7 Identification of clinical predictors for OSA in women would help prioritize PSG evaluation. Morphometric measures have been examined for identification of candidate variables to aid in the screening process. In this group of female patients who had been referred for polysomnography we found significantly different mean values for a number of measures (BMI, neck circumference, lower costal girth, midabdominal girth, hip girth, and the cricomental distance) between groups based on AHI category. However, of these potentially predictive measurements, the cricomental distance has a quite low measure of inter-observer agreement.
As illustrated by Figure 1 and 2 ROC curves, there is substantial overlap in the predictive relationship between truncal measures for an abnormal AHI, whereas the upper airway/ mandibular measures have a lesser area under the curve and are observed to be clustered about the reference line, which implies lack of predictive contribution. The truncal parameters each provide a statistically significant predictive measure, with BMI and neck circumferences having the highest area under the curve. It is possible that greater predictive capacity may be achieved by an additive combination of physical measures, or alternatively by ratio (through adjustment for height as an example). However, identification of such predictive models was outside the scope of this study.
The extent of inter-observer reproducibility would be expected to influence utilization of any predictive morphometric parameter. In this study evaluating measure of agreement between observers in a variety of morphometric assessments, we observe the greatest degree of agreement for truncal dimensions and neck circumference, and the lowest agreement for smaller upper airway/mandibular dimensions, such as cricomental distance. We propose that any clinical morphologic measurement employed in a predictive capacity would need to be one reliably reproduced in clinical settings in order to be of practical value. Our findings support the use of truncal measures, BMI, and neck circumference as predictive measures in women undergoing evaluation for OSA.
This was not an industry supported study. The authors have indicated no financial conflicts of interest.
The authors thank Dr. Brian McNab for his contribution to this study and also the Saskatchewan Health Research Foundation for their support of this work. This study was supported by a grant from the Saskatchewan Health Research Foundation.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S, authors. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;32:1230–5
Peker Y, Carlson J, Hedner J, authors. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006;28:596–602. [PubMed]
Ulfberg J, Carter N, Edling C, authors. Sleep-disordered breathing and occupational accidents. Scand J Work Environ Health. 2000;26:237–42. [PubMed]
Mulgrew AT, Nasvadi G, Butt A, et al., authors. Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax. 2008;63:536–41. [PubMed]
Gjevre JA, Taylor-Gjevre RM, Skomro R, Reid J, Fenton M, Cotton D, authors. Comparison of polysomnographic and home-based Embletta assessments of obstructive sleep apnea in Saskatchewan women. Can Respir J. 2011;18:271–4. [PubMed Central][PubMed]
Hoffstein V, Szalai JP, authors. Predictive value of clinical features in diagnosing obstructive sleep apnea. Sleep. 1993;16:118–22. [PubMed]
Whittle AT, Marshall I, Mortimore IL, Wraith PK, Sellar RJ, Douglas NJ, authors. Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax. 1999;54:323–8. [PubMed Central][PubMed]
Wahner-Roedler DL, Olson EJ, Narayanan S, et al., authors. Gender-specific differences in a patient population with obstructive sleep apnea-hypopnea syndrome. Gend Med. 2007;4:329–38. [PubMed]
Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P, authors. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep. 2007;30:312–9. [PubMed]
Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD, authors. Body fat distribution and sleep apnea severity in women. Chest. 1995;107:362–6. [PubMed]
Tsai WH, Remmers JE, Brant R, Flemons WW, Davies J, Macarthur C, authors. A decision rule for diagnostic testing in obstructive sleep apnea. Am J Respir Crit Care Med. 2003;167:1427–32. [PubMed]
Samsoon GLT, Young JRB, authors. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42:487–90. [PubMed]
Schellenberg JB, Maislin G, Schwab RJ, authors. Physical findings and the risk for obstructive sleep apnea-The importance of oropharyngeal structures. Am J Respir Crit Care Med. 2000;162:740–8. [PubMed]
Iber C, Ancoli-Israel S, Chesson A, Quan S, authors. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007. Westchester, IL: American Academy of Sleep Medicine;
Müller R, Büttner P, authors. A critical discussion of intraclass correlation coefficients. Stat Med. 1994;13:2465–76. [PubMed]
Rigby AS, author. Statistical methods in epidemiology. V. Towards an understanding of the kappa coefficient. Disabil Rehabil. 2000;22:339–44. [PubMed]
Walter SD, Eliasziw M, Donner A, authors. Sample size and optimal designs for reliability studies. Stat Med. 1998;17:101–10. [PubMed]
Dancey DR, Hanly PJ, Soong C, Lee B, Shepard J Jr.; Hoffstein V, authors. Gender differences in sleep apnea. The role of neck circumference. Chest. 2003;123:1544–50. [PubMed]


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TERRIER Toby has found a 'wheely' good home after a mis-diagnosis led to one of his legs being amputated.
The three-legged dog, who spends the majority of his time on his wheels, was wrongly thought to have spina bifida when he was a puppy.
His future looked bleak until he was rescued by Steve Maney and his wife Poppy, who own K9 Health and Hydrotherapy in Rimington.
The couple adopted the two-year-old dog when Steve came across Toby's story on Facebook and are now raising money for an MRI scan to see what the dog's condition may be.
After months of intensive swimming sessions at Steve's rehabilitation and fitness centre, based at Howgill Farm, Toby now lives a good life and is a strong swimmer.
Steve said: "I followed Toby's journey online and was disappointed to see that he had his leg taken off before any hydrotherapy treatment was given.
"I just thought 'Right, stop everything there and give him here.' "So when we got him home he had the correct treatment and we managed to get him walking on his remaining back leg. His other leg had been taken off because it was paralysed and he kept dragging it along. He grazed and cut it all of the time and it became sore."
A £300 donation has already come from Pendle Dog Rescue centre and Steve is now trying to raise £1,300 for the scan.
Toby is showing signs of improvement with the help of his rehabilitation programme, but without a scan his condition could worsen if he isn't given the right treatment.
Steve said: "If nobody can help then we will cover as much as we can and give him the therapy he needs.
"Even if we can just raise the money for his MRI that would be fantastic and we can take care of the treatment. We took him in as a rescue dog and feel that he deserves the help to live a normal life."
To make a donation towards Toby's treatment visit www.caninehealthandhydro.com


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CONROE, Texas - A former Conroe Independent School District police officer and a referee were both arrested on Monday amid allegations that each of the men had an improper relationship with the same student.
Former police Sgt. Christopher Sutton and referee Brian Ortiz have been charged with improper relationship between educator and student, officials said.
"The law clearly states that sexual relationships are prohibited between employees of educational facilities, like high schools, and their students," said Phil Grant, Montgomery County District Attorney.
According to Conroe ISD, the alleged victim is an adult student that attends Caney Creek High School. Officials said the district first learned about the possible charges when Sutton resigned from the Conroe ISD Police Department on Feb. 17.
"Christopher Sutton was a middle-aged man, law enforcement official engaged in a sexual relationship with a student there at the high school," said Grant.
According to documents, Sutton resigned because Ortiz threatened to talk to the media about the alleged relationship. Officials said Ortiz, a football and basketball referee at Caney Creek High School, is believed to be the victim's alleged boyfriend.
"We're going to take these cases very, very seriously. There is no excuse for a police officer that works at a school district, or a coach, or a referee, or a teacher engaging in sexual relationships with their students," said Grant.
Sutton worked as a police officer for the Conroe ISD Police Department for 14 years, serving as sergeant for the past nine years.
"These charges are serious and the safety and well-being of our students remains our highest priority," said Chief William Harness. "The District is working closely with the District Attorney's office and the city of Conroe Police Department in the investigation."
The district said Ortiz is a referee contracted through Houston TASO Basketball Officials Association, Houston TASO Football Officials Association and the Houston Basketball Officials Association.
Conroe ISD said it encourages anyone with information on the cases to contact Detective Ben Mitchell at 936-522-3215.
Copyright 2013 by Click2Houston.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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Hope that US politicians would find common ground to steer clear of the "fiscal cliff" boosted stocks on Friday, though the gains were not enough to offset the week's losses.
The Dow Jones Industrial Average added 45.93 points, or 0.4 per cent, to 12,588.31. The Standard & Poor's 500 Index rose 6.55 points, or 0.5 per cent, to 1359.88. The Nasdaq Composite Index gained 16.19 points, or 0.6 per cent, to 2853.13.
The late rise on Wall Street lifted SPI futures 12 points to 4360, pointing to small gains at the start of local sharemarket trade on Monday. The dollar inched up to $US1.0340 in overseas trade.
- European stocks slump on fiscal cliff fears
- Oil rises on Middle East tensions, Gulf fire
- Gold posts weekly loss on slowdown fears
For the week, the S&P was down 1.5 per cent, its second week in a row of losses. The Dow lost 1.8 per cent, down for the fourth straight week, while the Nasdaq was lower for the sixth week, also losing 1.8 per cent.
Stocks recovered from early declines after leaders of the Senate and House emerged from a meeting at the White House and indicated they would be flexible in efforts to settle fiscal policy differences.
Democrats said they recognized the need to curb spending and Republicans said they had agreed to put "revenue on the table" following a meeting with President Barack Obama.
"These are very small steps in the right direction," said Kate Warne, investment strategist at Edward Jones in St Louis. "The more evidence there is that Congress will make a decision sooner, the more likely we are to see stocks rebound."
About $US600 billion of automatic budget cuts and tax increases will start to take effect in the new year unless Washington reaches a deal. With memories of 2011's debt ceiling impasse fresh in investors' minds, many are worried this year's discussions could be drawn out or yield no agreement.
If all the changes go into effect, economists say it could tip the economy into recession. Investors have pulled out of stocks over the past two weeks, taking nearly 4 per cent off the S&P 500.
Shares of Penn National Gaming surged 28.2 per cent to $US48.23 on its busiest day of trading in more than four years, after the owner of gaming and pari-mutuel properties said late Thursday it will split its business into a gaming-focused real estate investment trust and a gaming operator.
More than 10 million shares changed hands, compared with average daily volume of 629,000 shares over the past 50 days.
Dell helped limit the Nasdaq's gains after lower PC sales hurt the company's profit. Dell slumped 7.3 per cent to $US8.86.
More violence in the Middle East also kept investors wary after Palestinian militants nearly hit Jerusalem with a rocket for the first time in decades and fired at Tel Aviv for a second day.
Sears late Thursday reported a quarterly loss that was narrower than expected, but same-store sales fell on weak demand for electronics, sending shares down 18.8 per cent to $US47.49.
Volume is expected to be light next week with some investors away for the Thanksgiving holiday, and the market closed on Thursday and open for only a half-day on Friday.
The decreased liquidity could spell more intra-day volatility for the market, though fewer market participants could also mute action.


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Hey there, time traveller!
This article was published 5/3/2013 (1631 days ago), so information in it may no longer be current.
Now that another snowstorm has left our city looking like Antarctica -- which is appropriate considering the zoo will soon be home to a "waddle" of penguins -- it seems like the perfect time for another instalment of our semi-recurring feature Naked People in the News.
Normally, this is a journalistic topic we only confront when the weather turns warm, but we are willing to make an exception today because we have become aware of a dangerous trend involving people making headlines via the technique of doing incredibly stupid things without the benefit of clothing.
As a crusading investigative journalist, we have also become aware of the fact that, if you repeatedly type the word NAKED in big block letters, you will get kajillions of Internet hits from bored office workers who are trapped in tiny cubicles and have way too much time on their hands.
Our new journalistic motto is: "If you are NAKED, we will cover you." NAKED! NAKED! NAKED! Please don't thank us. We are just doing our job.
Which, not surprisingly, brings us to our first nude newsmaker, a 24-year-old Iowa man named José Angel Perales Jr., who was arrested after being captured on surveillance video breaking into a lingerie store after hours and stealing goods.
According to news reports, the security footage reveals the burly suspect wandering around the boutique for several hours and trying on various lingerie items before leaving in (why not?) a red dress and a blond wig.
The stories state police did not have a lot of trouble tracking down their suspect. This was partly due to good old-fashioned policing, but we suspect it didn't hurt that, when they examined the security video of Perales wandering around NAKED, they noticed he had his last name tattooed on his back.
We know what you are thinking here. You are thinking: "Do not rush to judgment, Doug. This is the kind of unfortunate incident that could happen to anyone."
Well, you are correct, but if we have said it once, we have said it a million times: "If you are going to rob a lingerie store, at minimum you should take the standard precaution of wearing a camisole, a negligee and several brassieres, especially if you are a full-figured bandit."
But we don't have time to ponder the implications of this groundbreaking case, because we need to devote our mental energy to our next naked newsmaker, whose unclad antics have gone viral.
If you want to check this one out for yourself, just go to the video-sharing site and search for "naked man in hotel hallway." Here's a helpful research tip: Try to do this when your wife is not home if you want to avoid embarrassing conversations such as this:
My wife: "What the (bad word) are you doing?"
Me: "Just researching a column, honey."
My wife: "You're not the man I married."
Getting back to our story, according to several hard-hitting online news reports, what happened is a man at an unidentified hotel managed to lock himself out of his room when he stepped into the hallway to leave some dirty room-service dishes for hotel staff to pick up.
When the door to his room closed behind him, the man realized he was locked out because he didn't have his key with him. This is probably because he was wearing nothing but his birthday suit at the time.
Closed-circuit security footage uploaded to YouTube shows him wandering naked through the hallways, past other guests and into an elevator, using two plate covers to shield his modesty, as he casually makes his way to the front desk.
"I locked myself out of my hotel room," the naked man can be heard explaining on the video clip.
"Do you have any ID?" the front desk clerk responds. "I just need to see your driver's licence."
The naked man is indignant. "How can I have a driver's licence if I'm naked, man?" he snorts.
So far, thousands and thousands of people around the globe have watched this clip and more than a few viewers have suggested it might be a stunt, which is entirely possible. I mean, who among us has NOT strolled with no visible means of support through a major hotel simply for comic hijinks?
Regardless, the bottom line (if you catch our subtle drift) is this tragedy could happen to anyone, so if you plan to stay at a posh hotel in the near future, please remember this important safety tip -- Never EVER order room service!


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A BODY has been recovered from Helvellyn by police and mountain rescue teams searching for missing pensioner Richard Hayne.
Police and mountain rescue teams found the body on Saturday (May 31) at about 6.50pm at Brown Cove Craggs on the west side of Helvellyn.
Richard Hayne, 61, from Northamptonshire, went missing from Glenridding on Wednesday (May 28) after last being seen at breakfast time at the the Inn on the Lake.
The family and kin have been informed.
Anyone with further information should call Cumbria Police on 101 and ask for PC 1666 or Crimestoppers anonymously on 0800 555 111.


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You exercise your body to stay physically in shape, so why shouldn't you exercise your brain to stay mentally fit? With these daily exercises you will learn how to flex your mind, improve your creativity and boost your memory. As with any exercise, repetition is necessary for you to see improvement, so pick your favorite exercises from our daily suggestions and repeat them as desired. Try to do some mentalrobics every single day!
Alzheimer's disease is a degenerative disease of the nerve cells in the brain that causes impairment of memory and other brain functions -- such as language or perception of reality. Alzheimer's patients also experience personality changes and a decreased ability to take care of themselves. Many scientists believe that the disease is caused by the abnormal accumulation of a specific protein that eventually leads to nerve cell death. The disease appears to start in the hippocampus and spreads to other parts of the cortex as it progresses.
Alzheimer's disease is not part of the normal aging process. There are some genetic risk factors (gene mutations) that may influence the development of the disease. The main risk factor is age. Ten percent of people over the age of 65, and 50% over the age of 85, have the disease. Some studies have shown that a lifelong love of learning and physically staying in shape are negative risk factors for getting the disease. So, even if you are genetically prone to this disease, if you stay mentally and physically in shape, you can significantly delay or prevent the onset of Alzheimer's.
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Even with a steadily declining adolescent birth rate, two in five young women will become pregnant before age twenty, and four out of five of those pregnancies will be unintended, including about half of those among married teenage girls. Whatever their circumstances, though, the news that they are pregnant usually comes as a shock, and often not a welcome one.
The unforeseen development typically throws young lives into turmoil, at least for a time, forcing the girl to make perhaps the most agonizing decision of her life. Does she carry the baby to term, as 50 percent of pregnant teenagers elect to do? Or does she terminate the pregnancy?
It is hoped she knows she can count on her mother and father for guidance and support as she confronts these choices. Youngsters who fear meeting with rejection or abuse at home may try to keep the pregnancy a secret as long as possible. As a result, they often don't receive adequate prenatal care and counseling during the crucial early months of fetal development.
One-third of girls aged fifteen to nineteen, and one-half of girls under fifteen receive no prenatal care at all during their first trimester. The lack of medical attention can lead to problems later on. If they go forward with the pregnancy, the pregnancy could be complicated with an increased risk for mother and baby. And if they choose to abort, the earlier the procedure is performed the safer it will be.
However, anxiety over Mom and Dad's reaction isn't the only reason a girl may hide the fact that she is pregnant. "Young women can be in terrible denial," explains Dr. Claire Brindis, "simply refusing to accept the reality of their condition." Psychologists call this dissociation. Since today's baggy fashions make it easier for a girl to go for months, or perhaps through her entire pregnancy, without anyone noticing her expanding abdomen, don't go by appearances alone. If you suspect that your daughter might be pregnant but is trying to hide it, act on your intuition—but tactfully, perhaps with words like these: "Honey, you've been complaining of feeling tired and nauseous the last week or so, and you're going to the bathroom a lot. Are you all right? You remind me of what I felt like when I was pregnant."
A tearful "I'm pregnant!" isn't easy for any mother or father to hear. Worry, disappointment, anger—all are understandable responses. Most likely this isn't what you had in mind for your daughter. Meanwhile, a similar scene is probably being played out at the home of the boy involved (if the boy even tells his parents).
Give yourself and your spouse permission to be upset for a day or two. Talk things over together. If you blurt out an incredulous "What on earth were you thinking?!" or "How could you be so irresponsible?!" so be it; you're human. But then shut the door on anger and lock it away. Hurling blame at your teenager isn't going to change anything; it's time to sit down as a family and calmly discuss what to do next.
"A parent's most important role is to listen to the young woman or the young couple as they sort through their options," says Denver pediatrician Dr. Roberta Beach. "We know that in the long run teenagers usually feel satisfied with whatever choice they made, as long as they feel that the decision was theirs and that their family supported them."
A skipped period and a positive result on a home pregnancy test are usually what prompt a young woman to believe she's pregnant. The home test, while generally accurate, isn't as reliable as the laboratory test the doctors do to confirm a pregnancy. So the first step is to make an appointment with your daughter's pediatrician or gynecologist.
The doctor's office just called: The pregnancy test came back positive. Now where do we go from here? There are three options: abort, give birth and raise the baby or give birth and place the child up for adoption. Parents certainly have a right to voice their opinions; if circumstances allow, the young man and his family should be invited to take part in the decision-making process too. But legally, the ultimate verdict belongs to the expectant mother.
For some young women, the decision about what to do is never in doubt. Perhaps they are personally opposed to abortion. Or they know deep in their hearts that they are not ready to have a child this early in life and therefore wish to have an abortion.
Most girls, though, agonize over this difficult decision, which is further complicated by the fact that abortion is one of the most politically and emotionally charged issues of our times.
Depending on where she lives, she may face the harrowing prospect of having to travel dozens or even hundreds of miles just to find an abortion provider and once there she may need to wind her way through a gauntlet of taunts and threats by antiabortion demonstrators.
If you and your daughter feel that you might benefit from hearing an objective viewpoint, arrange a consultation with the pediatrician. In a nonjudgmental fashion, he or she can help you to evaluate the pros and cons of each option. Once the young woman has made up her mind, most pediatricians can refer her to health-care practitioners who provide abortion services, or to an obstetrician or adolescent clinic to begin prenatal care.