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|November 21, 2001
Volume 3, Issue 47
|Midwifery Today E-News
"Due Date"
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Quote of the Week:
"Obstetrics should be both art and science. The science lies in what we know to be true, the art lies in how that information is used for greatest benefit to mothers and babies."
- Don Creevy, OB
The Art of Midwifery
For heartburn during pregnancy: Chew a few pieces of diced papaya before meals. Papaya tablets are also safe--just follow the directions.
The best way to handle heartburn, however, is to prevent it. No super-spicy meals, eat small meals more frequently, bananas soothe the stomach, do not lie down after a meal but try walking or moving your body a bit. The sphincter muscle at the top of your stomach relaxes right along with all the rest of your body to soften up for birthing, and food/stomach acid can get pushed up. This is where the burning part comes in.
Another handy little remedy is slippery elm throat lozenges available from health food stores. Slippery elm bark is safe for pregnancy and it soothes the stomach, but take it only if/when the above suggestions do not work.
- Raven
- Midwifery Today Forums
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News Flashes
Reduced growth in utero is associated with noninsulin dependent diabetes and
impaired glucose tolerance in adult life. Researchers studied people born before,
during, and after a famine that occurred in the Netherlands from November 1944
to May 1945 and found that people exposed to famine in utero during the second
and third trimesters of pregnancy show impaired glucose tolerance and insulin
resistance, which predispose to both diabetes and heart disease. The most significantly
affected were exposed during the third trimester. Affected people were also more
likely to be obese as adults. Official rations during the famine varied from 400
to 800 calories per day. The study findings of glucose intolerance in adults exposed
to maternal malnutrition in fetal life adds credence to the hypotheses of fetal
origins of adult disease. Permanent changes in pancreatic function and other body
systems occurred in these subjects.
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Due Date
The concept of [a due date] is based on a gestational length established by fiat in the early 1800s. Franz Carl Naegele officially declared that pregnancy lasted 10 lunar months (10 x 28 days), counting from the first day of the last menstrual period). However, when Mittendorf et al. measured the median duration of pregnancy, they found that healthy, white, private-care, primiparous women with well-established due dates averaged 288 days and multiparas averaged 283 days, values significantly different from both Naegele's rule and each other. Others have found similar results. Mittendorf et al. also cited other studies showing racial differences in gestational length. For example, one showed that black women averaged 8.5 days fewer than white women of similar socioeconomic status.
Moreover, ultrasound-determined due dates are not accurate. One study used the date established by ultrasound at 16 to 18 weeks to test the validity of dating by the last normal menstrual period (LNMP). It found that as gestational age went past term, positive predictive values for the LNMP declined from 95% to 12%. The authors took this to mean the LNMP was inaccurate, but, of course, the ultrasound date is the problem. Even first trimester measurements have an error bar of +/- 5 days in the second trimester and +/- 22 days in the third.
Few practitioners appreciate the limitations of ultrasound or clinical data. Otto and Platt say the due date should not be changed unless the discrepancy is more than two weeks, yet they see doctors changing a due date by a few days, no trivial alteration if a woman will be induced when she exceeds a certain date.
Some risk does accrue in healthy postdate pregnancies (notably meconium passage and big babies) but it does not follow that we should induce all women. Studies have found that as gestational age goes from 37 to 44 weeks, perinatal mortality and morbidity distribute in a U-shaped pattern. If we try to eliminate postdate pregnancies on grounds of increased complications, should we not equally logically try to delay labor onset in the early-term group?
- Henci Goer, Obstetric Myths vs. Research Realities, Bergin & Garvey 1994
A prospective study was conducted at a West German US Army Hospital to compare
the accuracy of fetal weight estimation by a physician's clinical estimate as
compared to ultrasound. One hundred women had Leopold's and vaginal examinations,
an estimate was made. Then the same examiner performed an ultrasonic estimation
of weight. The exam was done within 48 hours of delivery. The mean error for the
clinical estimate was 7.9%. The error by ultrasound was 8.2%. There was no significant
statistical difference between the two types of estimates, including for the extremes
of birth weight.
Wood's method: Carol Wood, Yale nurse-midwifery professor, came up with a method to calculate the due date that takes into account individual variations in the menstrual cycle as well as the effect of a woman's having had previous pregnancies.
1. Add 1 year to the first day of the last menstrual period, then
*1st-time mothers with 28-day cycles: LMP + 12 months - 2 months, 14 days =
EDD: Estimated day of delivery
- Anne Frye, Holistic Midwifery Vol. 1, Labrys Press 1995
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Question of the Week Responses
Q: Would readers please share their experience with and information about endometriosis and pregnancy/labour? Our pregnant client has quite severe endometriosis with nonpregnant symptoms of frequent nausea, very painful cramping premenstrually and during menstruation, heavy bleeding, and bleeding from the rectum.
- Anon.
A: My first experience with a client with such severe endometriosis before and during pregnancy was more than 20 years ago. Beloved homebirth physician (wholistic MD and naturopath), Dr. Paul DuGre responded with nutritional advice: immediate daily supplementation of 1200 mcg. folic acid along with the rest of the B-complex vitamins in the more digestible and assimilable brown rice based form. He also suggested "Floradix Liquid Iron and Herbs" at one ounce per day for the first week, then 1/2 ounce daily. He recommended replacing starchy, sugary, processed foods with whole grains and natural foods high in vitamins and minerals, and vegetable proteins because they digest more easily and do not overstress the colon and rectum, and would help regenerate strong cells in the woman's body. The advice included eating lots of gentle fruits such as avocadoes and those rich in enzymes, as are papayas, bananas. Paul encouraged kegel exercises and general low-stress exercise such as swimming.
Paul also warned about what to avoid such as table salt (cheap sodium chloride), which should be replaced with mineral-rich salt such as sea salt and a sufficient amount of potassium-rich foods. He described the toxic side effects of additives like aspartame (Nutrasweet) and of sodium fluoride that has been infiltrated into city water and toothpaste and which proved to be harmful to women's systems and unborn babies (mentioning that the original idea of calcium fluoride might have been beneficial in some ways, but that the less-expensive sodium fluoride proved to be extremely harmful, especially to women's systems and unborn babies.)
- Julia Swart
A: Endometriosis is a condition in which the cells that create the lining of your uterus also grow inside your pelvis. Each month these cells thicken as if they were in the uterus, but they cover the outside of the ovaries, fallopian tubes, uterus, and the ligaments in the pelvis. Then like the lining of the uterus, they bleed each month--except there is nowhere for the blood to go and it sits in the pelvis, clots, and causes adhesions and pain. Some of these adhesions are called chocolate cysts and they grow on the ovaries.
There are many signs of symptoms and endometriosis and not everyone gets all of them, which makes it hard to diagnose. Signs & symptoms: heavy painful periods, pain during ovulation, pain during intercourse, constipation or diarrhea around period time, pain around the rectum, PMS, spotting of brown discharge two to three days before a period actually starts, and many more. Doctors used to think it was a condition that only older women got but now they know that one can have it from teen-age. When one becomes pregnant all these symptoms cease or decrease considerably until the baby is born. Usually the symptoms remain at bay as long as a woman breastfeeds but often return to some degree once menses commence again.
The Australian book "Explaining Endometriosis" by Ann Henderson can probably be found at your library or bookseller.
- Diana Stubbs, RM, IBCLE, BA Nurs
A: Seek a naturopathic physician in your area to get the best treatment advice.
- Leslie Peterson, ND
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Re: Midwife Melissa Jonas's statements about respecting all woman's choices [Issue 3:46]: I agree to a point, but the question is whether women who choose high-tech birth are doing so because they are truly informed and educated about their health and birth choices or because that is what they are told they need to do? Are they choosing high tech out of fear and ignorance? Most women today have no idea that they have choices, or that there are risks to high-tech/high-intervention births. We live in a society that assumes that more technology is better and that the medical care provider is the best person to make decisions regarding one's health. This is an extremely complicated issue. Korte and Scaer said in A Good Birth, A Safe Birth, "If you don't know your options, you don't have any."
On the other hand I remember a story that Penny Simkin told of an abused woman who chose a drugged birth because she wanted one day in her life without pain. Who could blame her?
We need to talk with the women we work with and find out why they are choosing the things they are and make sure they are truly informed before making those decisions. You never know which category she may fall into.
- Amy V. Haas, BCCE
I felt compelled to respond, in way of thanks, to a sensitive and insightful letter written by M. Jonas, LM. You have written as a homebirth midwife who has extended herself to the nonhomebirth women (for whatever their reasons), and by association I feel to those of us who care for women giving birth in hospitals. Many in the homebirth community do quickly write off, so to speak, those women and those midwives caring for them as somehow doing it the wrong way, which may simply be doing it a different way. You mentioned "the lack of compassion for women making choices other than those we recommend," which is caused by judgments and affects interactions with them as well as conveys a lack of respect.
As a CNM practicing in an urban hospital, with private patients, I too must keep constant vigil against not wanting women to make choices I would not make, when I have offered a noninterventionist approach. We have jacuzzis, showers, birth balls, etc., and yet I too have to remember that I must support women in an informed decision, this is their birth, these are their choices, and I have chosen to be "with woman" whether or not she is choosing to do what I think best or useful. For all midwives, in all locations, I appeal for unity and respect that we might best serve all the women in their diverse natures that live among us.
- Trish McPeak-LaRocca, CNM
Giving birth is about having a baby. Particularly in America the choices women often feel they have the right to make do not include the needs of her baby. I'm not talking about, e.g. someone who has unresolved sexual abuse issues and is terrified of labor and delivery and so opts for a cesarean, but about the average woman with average prenatal care and the "average" caregiver. The choices she is generally informed about typically leave out or minimize vital information about possible effects of her choices on her baby and possibly also on the relationship between mother and baby as a result. When a mother contemplating an epidural is asked "Why be a martyr?" she is not told that babies exposed to more than an hour's worth of obstetrical medications are, at worst, more predisposed to become substance abusers than those who are not, and at best, may experience feeling disconnected from their bodies, fuzzy thinking when under stress, feeling inadequate and incapable of completing things they start, and a whole list of other possible consequences, she is not truly making an informed choice. Nor is she being informed that motherhood begins before conception with the intention, or not, to conceive a child, nurture it in the womb for nine months, and encounter the profound spiritual, physical, family, rite of passage that birth was designed to be, so that when she has accomplished it she will, as the research has shown us, feel more confident in herself as a mother, more delighted in her baby, more likely to breastfeed and for longer, etc. than a woman who experienced less pain with her epidural, but missed the endorphins, the sense of accomplishment and wonder, and the ability to bond with an alert baby rather than a sleepy one with a poor suck who gets cranky about a week later when the drugs finally clear his/her system.
The very reason for giving birth, the baby, all too often in this culture gets left out of the equation except as a cute "product" of all this planning and devising and orchestrating and intervening. I'm reminded of Leboyer's photograph in his book "Birth without Violence" (published in the 70s!) showing everyone smiling at the success of the birth while the baby is held upside down by his feet, his hands on his ears and an expression of unadulterated anguish on his face. Have we really come very far since then as far as the baby is concerned?
Meanwhile, studies of prenatal communication between babies and parents point the way to a very different form of birth plan: one in which mother and baby are in communication with each other, in which mother trusts her intuitions about her baby and her body, in which baby trusts mother to move as she needs to in order to assist its passage through the birth canal, in which the motherbaby dyad work fluidly together to accomplish the birth as a profound celebration, and father stands guard as a protector of the birthing process in his family as well as loving support for his partner and child. This is a birth in which baby is informed of any procedure to be initiated that will impact him/her before it is begun: a birth in which the personhood of the baby is acknowledged, respected, and included in planning and decision-making. This type of birth has always been possible, but the machines that go "ping" are so enticing.
- Claire Winstone, M.A.,educator: pre- & perinatal psychology, doula
Regarding labor and cramping, make sure enough calcium/magnesium is in the diet. I've "cured" many of my menstrual cramps with cal/mag. I was also given a recipe for a "labor ade" from my midwife to drink during labor, which included--wouldn't you know it--crushed cal/mag tablets.
- Anon.
I had a baby three months ago. I was unable to see my very busy midwife again until nine weeks postpartum. Apparently one of my stitches popped open during initial healing and some underlying tissue snuck out. I was told to wait two more weeks to see if it would heal, and if it didn't, to come back. At my next visit an OB/GYN checked me out. I have to go to the hospital for a fistulagram to see if I have any fissures. Has anyone ever dealt with this situation? How would a homebirth midwife assess internal tearing? Is there any way to put that tissue back in place without being sliced open? (I opted to tear because of the research I had done on episiotomy. Is there anything I can do herbally or homeopathically to heal quickly, keep from getting infection, and avoid that whole "pain during sex" thing for the rest of my life?
- Abbie
Re: separation of abdominal muscles postbirth [Issue 3:46]:
It's called a divided rectus sheath; many women experience this. Simple exercises should close the gap. You may wish to discuss this with a physiotherapist. Exercises should not be painful and are usually started in the first week postpartum, gently at first, then increasing. My own gap closed after a month or two. It's better to have strong muscles than weak divided ones!
- Margaret Watson, UK midwife
When you do the sit-ups, focus on pulling the muscles together by hugging your arms across your body in an "X" pattern. Only lift slightly and pull at the same time. Also make sure you are using your abs and not your neck, shoulders, or back to pull up. Make sure your pelvis is tilted toward your sternum. (From Denise Austin's Pregnancy Plus Workout.)
- Jennifer Crowley
I had this same muscle separation following my third pregnancy. My midwife taught me to cross my arms over my belly, and with my hands grasping the outsides of the muscles and pulling them INWARD across the abdomen, doing my crunches. Just doing plain sit-ups won't help bring the muscles together again. You need to "train" them together by pulling them together with your hands (during the sit-up). Shape's "Fit Pregnancy" magazine publishes photos of this procedure every so often. They may have it at their online Web site.
- Cherwyn
In my previous practice I referred women with this problem to a physiotherapist. The condition is labeled "diastasis of the rectus abdominii." In other words, the muscles have separated! The immediate care for these women was to give them a very supportive tubular "corset" of "tubigrip" that supported the abdomen from just under the breasts to just below the pubic bone. The exercises recommended were very shallow curl-ups with knees bent and arms sliding up the legs to the knees only. She would have them start with two pillows under their heads for several days, then gradually remove the pillows. Great emphasis was placed on being very careful of getting out of bed--i.e., turn on side, then get up, and also not lifting anything heavier than the baby. The rectus muscles act as a corset and support your spine, so you have to be very careful to lift and bend properly. I am guessing, but you may find in future pregnancies that you "pop" out sooner and may need some support for your growing uterus.
- Mary Jo
I've read countless times about how you shouldn't rush the delivery of the placenta. I had my first baby 19 months ago, and my midwife had me pushing to deliver my placenta right after birth. She also tugged very gently to help it along. I believe it was because I had a tear from the birth that she wanted to stitch up before I lost too much blood. I had no ill effects from a "rushed" placental delivery that I know of. Is this an exception to the rule? If there is a tear to be closed, how does this affect delivery of the placenta?
- Jennifer
I am 37 and pregnant with my third child. I had a placenta abruption and emergency c-section at 34 weeks with my first child, and the same with my second child at 38 weeks. Am I risking too much to want to try to have a vaginal birth if I can make it that far without the placenta abrupting? Have any midwives ever had clients in this situation? I'm 45 minutes away from a competent hospital. I don't smoke, didn't have gestational diabetes, high blood pressure or any problems before it happened.
- LaDonna in N.C.
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"If I thought he was going to be this good," Northwestern coach Bill Carmody says, "I'd have offered him a scholarship as a freshman."
As a 6-4 senior guard, Hearn finally has that scholarship, and the numbers to justify it. He's a strong-shooting starter for a team clinging to a NCAA tourney dream, and if a bad ankle has slowed him down, it hasn't stopped him.
"He really picked it up in a big way last year," Carmody says, "and this is like a continuation, a progression, of that. He came here and has gotten better in a lot of things. Even before Drew (Crawford) was injured, he was our leading scorer, or close to it. He gets rebounds. He defends. He's just a good player."
Case in point — Northwestern's 68-54 upset victory at No. 22 Illinois Thursday night. Hearn's game-high 20 points earned him the BTN's "Amazing Performance of the Game" honor.
You'd better believe it.
Four years ago Hearn believed, but he had no proof other than solid numbers coming out of Snider High School — 14.9 points, 7.8 rebounds for the Panthers' state runner-up team of 2008 — that only earned him Division III interest. He was so lightly regarded Notre Dame and Butler told him thanks, but no thanks, as far as walking on.
Carmody might have told Hearn the same thing if it wasn't for former Northwestern assistant coach Mitch Henderson, now the Princeton head coach. Henderson saw potential, but no guarantee given Hearn was a high school power forward who would have to learn to be a college guard.
In other words, we like you enough to let you walk on. Beyond that, we'll see.
Welcome to the uncertain world of college recruiting. There are can't-miss guys (can you say Indiana forward Cody Zeller?) and no-chance guys, with most people somewhere in the middle.
Hearn played in the middle, but he didn't have to like it.
"I didn't know what to expect," he says. "I came in with a level of confidence to believe in myself that I could play at this level. In the world of basketball, with injuries, coaching changes, all the different factors contribute to what's going to happen.
"The trajectory I've had is a very interesting one, to say in the least."
That trajectory saw him average 0.4 points in 1.9 minutes of action in 13 freshman games. The next season wasn't much better — 1.0 points in 2.5 minutes and 19 games.
Last year, everything changed. Hearn started all 33 games, and averaged 7.4 points and 3.7 rebounds in 26.1 minutes.
That leads to this season. Hearn leads Northwestern in scoring, at 14.1 points, which ranks 10th in the Big Ten, which means he's ahead of Indiana's Victor Oladipo and Christian Watford, ahead of Minnesota's Rodney Williams, ahead of Wisconsin's Jared Berggren and Illinois' D.J. Richardson.
Hearn also leads the team in steals (21) and is second in rebounding, at 4.9. He shoots 50.4 percent from the field, 39.3 percent from three-point range.
He's been strong against strong competition. He had 19 points against Maryland, 10 rebounds against Baylor. He had 18 points and seven rebounds in 22 minutes against Stanford before hurting his ankle.
And then, of course, he had those 20 points at Illinois.
Why the big improvement?
"There are a couple of factors," he says. "First of all, I have a year of experience. Coming in last year I was essentially a freshman with the amount of minutes I'd played. Over the course of the year, I got used to the offense and my role. I just got more comfortable out there.
"Also, with the injuries we've had this year, it's really called for me and (guard Dave Sobolewski) and some of the other veterans to step up. Those were the factors that contributed to what I've produced this year."
Production had slowed recently because of that lingering ankle injury.
"The athletic training staff has taken care of me pretty well," Hearn says. "I'm approaching 100 percent. It hasn't been a hindrance to me these last couple of games. I expect to be fully healthy soon."
Adds Carmody: "He's still not 100 percent. He's not jumping as well right now. But he's giving it everything he's got. Now, as a senior, he takes over a little more responsibility and accountability in how the team plays."
In other words, Hearn has to lead by word as well as by deed.
"I think I've stepped it up (as far as being a vocal leader), although not necessarily to Coach's liking," he says with a laugh. "He wants me to be more vocal. I've always been more of a quiet player. I'm progressively trying to step into that role. Over the course of the year I'll get better at it. Hopefully I'll be successful with it."
Northwestern entered the school year with NCAA tourney aspirations, but those took a pair of big hits. Standout guard Drew Crawford had season ending shoulder surgery in December. He hurt the shoulder in September and tried to play through it. He was averaging 13.5 points and 4.6 rebounds when he shut it down. He's 10th in school history with 1,418 career points.
Another veteran guard, JerShon Cobb, is suspended for the season due to a violation of team policy. He averaged 7.3 points and 2.5 rebounds in his first two seasons.
Still, the Wildcats are within range of their first ever NCAA tourney bid. They are 11-7 overall and 2-3 in the Big Ten entering Sunday's game against No. 2 Indiana.
"The NCAA tourney remains our goal," Hearn says. "In every journey to a goal, there are going to be some obstacles along the way. We've obviously hit some with JerShon and Drew both being out this year, but we maintain our goals. We continue to work tirelessly at them."
Upsetting Indiana (15-2, 3-1) would boost Northwestern postseason prospects, but then, given the Big Ten's strength (sixth ranked teams, plus first-place Wisconsin), almost every conference game would.
"We enjoy the challenge of playing against the best teams in the country," Hearn says. "We take that challenge. Almost every night we have an opportunity to get a great quality win for our resume. All the guys look forward to that."


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Lil Wayne Pays $7 Million to Cover Tax Liens on His Miami House
Lil Wayne has no worries when it comes to his tax debts. The Young Money honcho finally paid the taxman a whopping $7.72 million he owed in back taxes. That's a lot of moolah, baby!
According to Gossip Extra, Weezy was on the IRS's radar after he was delinquent on three liens for unpaid income levy. The 'How to Love' rapper owed $3.3 million for 2008 and $2.2 million for 2009, according to Miami-Dade County records.
The taxman pounced on Wayne after he copped a $11.6 million mansion on La Corce Island in Miami. Hey, there's a reason why he's on the Cash Money record label.
But Wayne's financial struggles are far from over. Recently, a judge ordered him to pay $2.2 million to producer Quincy Jones III after he failed to appear in his own copyright-infringement case. And let's not go into his other legal battles with producers who are suing him for unpaid royalties.
Lil Wayne will clock more moolah next year, however, when he releases his new album 'I Am Not a Human Being II' on Feb. 19 and embark on a major tour. "I'm gonna tour right after the album drops and I'm gonna tour all year round worldwide," he says.
Watch the Lil Wayne 'No Worries' Video Feat. Detail
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Alexander Payne's Nebraska, which had its U.S. Premiere at the recent New York Film Festival.
San Francisco Film Society is tipping its hat to Awards Season with its first annual "Fall Celebration," which will "honor creativity, innovation, collaboration and inspiration in cinema." The organization will honor Ryan Coogler's Fruitvale Station, Spike Jonze's Her, Alexander Payne's Nebraska and Jehane Noujaim's The Square at the gala event slated for November 14.
The Fall Celebration will honor the "extraordinary creative participants and celebrate specific contributions made in film that represent the core values of the SFFS." Fruitvale Station as well as Destin Cretton's Short Term 12 and Benh Zeitlin's Oscar-nominated Beasts of the Southern Wild are among the films that have benefitted from SFFS' $1 million in support it provides annually.
"The San Francisco Bay Area has a unique perspective on film, with different values than any other city's," said outgoing San Francisco Film Society Executive Director Ted Hope. "The world knows our directors but we have more industry leaders than any other city other than New York or Los Angeles. This is such a vibrant and diverse community, where creativity and innovation are valued more than any other place in the world. What we chose to celebrate with this new event will soon be recognized as setting the standard worldwide."
Added SFFS board member Sid Ganis: "The Fall Celebration is a great way to further link like minds in the Bay Area and Hollywood. The focus of the Awards Season has now been broadened to the Bay Area where there are thousands of creative artists in all areas of filmmaking."
The World Premiere of Her closed out the recent 51st New York Film Festival, while the U.S. debuts of Nebraska and The Square screened at the fest which ran from September 27 – October 13. Fruitvale Station director Ryan Coogler spoke about his Sundance-winning film during the Summer Talks series at the Elinor Bunin Munroe Film Center in July.
SFFS' inaugural Fall Celebration will take place at The Battery, billed as a "contemporary private club" opening this fall. Coogler, Jonze, Noujaim and Payne as well as actors Michael B. Jordan (Fruitvale Station) and June Squibb (Nebraska) will be in attendance.
SFFS produces the annual San Francisco International Film Festival, which will take place April 24 – May 8 next year.


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The World's Best Hotels, Resorts and Hideaways - Our 22nd Annual Survey of Sophisticated Travelers
As is our annual custom, we have again turned the tables and asked our readers to name their favorite hotels in the world. This is the oldes, most reliable poll of its kind conducted among sophisticated frequent travellers. More than 87% of this year's respondents hold the title of President/CEO/Owner/Partner and 90% have treaveled outside the US for business and leisure during the past 12 months.
In the US city hotel category, Chicago proved to be the hot new destination, capturing three of the top eight positions on the coveted Top 20 list. Four Seasons Chicago took No.1 honours, while The Peninsula continued to move smartly up the leaderboard to No. 7, followed by Ritz-Carlton. Also of note, Miami made the Top 20 for the first time, with the 3-year-old Mandarin Oriental jumping from No. 36 to No. 17.
Classic old resorts made a comeback in the Top 20 US resort list, led by the Greenbrier (No.1), The Cloister (No. 12) and The Broadmoor (No. 18). Other favourite grandly styled resorts were The Bellagio (No. 8), Ritz-Carlton Naples (No.14) and the Phoenician (No. 18). Hawaii also posted strong gains as the leading vacation destination by placing three properties in the top ten, including Four Seasons Hualalai (No.2), Mauna Kea (No.5) and Four Seasons Maui (No. 10).
Internationally, South Africa's 18-room Singita safari lodge became the smallest hotel in the 22-year history of our poll to be named the best international resort. That said, North American properties surged in popularity this year with 9 resorts in the Caribbean and Mexico making the Top 20, a feat last achieved by these two destinations in 1989.
The other in spot was New Zealand with four Top 20 hotels and resorts, including 22-room Kauri Cliffs that leaped from No.40 to No.10.
The lists:
Top 20 International Resort Hotels
Top 20 International Resort Hideaways


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- Doctors
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- Citrus Heights
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- Dr. Timothy N. Beamesderfer
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Ratings for Dr. Timothy N. Beamesderfer
I was referred to Dr. B by a friend of mine. We all attend the same church and I thought, why not see someone that can relate to me on multiple levels. While he was not taking additional patients, he made an exception for me and I couldn't be more pleased. He patiently listened and took his time evaluating my situation. He provided a solution that did not involve over the counter medication and set me up with a mychart account to track my medical records from home and contact his office with any non-urgent updates. Thank you, Dr. B! It was a pleasure to meet you today!
Not a big fan of going to the Doctors but this is my first doctor who actually listens and seems current on medicine and not just pumping prescriptions down my throat. Couldn't have asked for a better doctor and finally feel I am in good hands with my healthcare.
Dr Beamesderfer saved my life. I complained to doctors for years about symtoms in ear and head and was told it was nothing! I had one doctor after another role their eyes at me over the years! Dr Beamesderfer was the first to listen to me, he is a good listener! And investigated. He sent me for tests and to ENT doctor instead of writing on my chart nut case like other doctors! Found out I had a large tumor in the back of my ear and growing into brain for over 25 years they think! They got it out just in time and saved my life because it was pressing my brain stem by then. I struggle it's been hard and a slow recovery I could not do with any other doctor. He is the best doctor I've had in the 54 years of my life. He cares and listens to all my woes and other Heath issues and understands that after what happened I am a bit axiety and scared.
Dr Beamesderfer was an excellent Dr. I'm a new patient who just moved to California. He took the time to listen to my past medical history and even asked a few follow up questions so that he understood fully. He was a great listener and didn't rush the visit, like other Doctors do. Overall, I couldn't be happier with my new Dr.
Super nice guy. He is patient to listen to me, respectful, consciencious, generous with his time. When I was afraid he was even willing to pray with me. Great doctor.
Dr Beamesderfer is very attentive listener and not rushed. His honesty and integrity prompt him to seek other opinions so as to always be conveying accurate and useful medical and wellness advice. He is a very curious and interesting professional. His support staff was also very helpful in securing referral contacts. He is refreshingly alert and athletic and appreciates patients who pay attention to wellness.
Listens, very informative, lets me know what's happening during procedures, asks good questions.
Dr. Timothy N. Beamesderfer's Credentials
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- Loma Linda University School Of Medicine (Grad. 1991)
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Manage your account and access personalized content.
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Joshua Lawton-Belous enlisted in the army on October 11, 2001, and was deployed to Iraq not long after high school. After two tours as a medic, he was sent home with a traumatic brain injury that caused constant headaches and balance problems so severe that he had to learn to walk again.
"Imagine your brain as a mine. One of the tunnels collapses on you. The miners still have to get to the gold, but they have to dig around the mine tunnel," Lawton-Belous explains. "The way the neurons used to fire has collapsed, and now they're sort of digging through my brain to reconnect. That's where a lot of the headaches come from."
But Lawton-Belous found that his injuries were only one of the challenges he faced after his return home. Indeed, re-entering and navigating civilian life inspired him to start an advocacy group to help Virginia veterans further their education. But he soon discovered another effort helping veterans with this process: Oracle's Injured Veteran Job and Training Program.
A U.S. Department of Veterans Affairs study conducted in 2007 found 18 percent of recently returned veterans unemployed, more than three times the national rate at the time of the survey. The study also found that one in four veterans earned less than US$21,840 a year.
These challenges are even more acute for injured veterans. Oracle's Injured Veteran Job and Training Program is specifically designed to help women and men wounded in the Afghanistan and Iraq wars work in entry- to midlevel positions at any Oracle facility.
Participants can select on-the-job training in departments as diverse as IT, consulting, finance, human resources, and sales. Participants may also choose developmental training in database administration and managing Oracle Financials implementations.
So far, 10 injured veterans have been hired for internships through the program—including Lawton-Belous, who works in Oracle's Reston, Virginia, office as a business analyst. Other participants work full-time at Oracle, two have been placed in government jobs, and one is working for a small business.
Oracle's Injured Veteran Job and Training Program is small, says Oracle's Diversity Director Jane Robertson, but that's by design. "This program is not designed to serve a large number of participants," she says. "This population has had intense experiences, and we need to make sure we give them both the tools and support they need to succeed. Our hope is that the folks who do participate will be significantly helped."
To that end, each intern is matched with a mentor who is committed to customizing the job role and work accommodations to ensure success. "There are times when my head is completely killing me, and I can't even get out of bed," says Lawton-Belous. At Oracle, he has flexible hours, and people who understand his need for regular doctor visits. He also points out that a support network has formed among the veterans participating in the program.
Interns still have to complete rigorous program requirements—Lawton-Belous had to complete and pass more than 70 training modules. But he knows that his time at Oracle has given him a new vocabulary and an opportunity to see the inner workings of a multinational company up close.
Right now, Lawton-Belous is finishing up his bachelor's degree at George Mason University and trying to earn as many certifications as he can, including Six Sigma and Project Management Professional certifications. As far as the future goes, Lawton-Belous says, "It just depends on what opens up either at Oracle or wherever else opportunity presents itself."
Expanding opportunities is exactly what the program is about, says Robertson. "My definition for success for the program is that participants either go on to find a place within Oracle, or have the opportunity to increase their skills so that they thrive in their future endeavors wherever they choose to go."


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Kohelet Yeshiva High School has hired a new head of school just two months after the abrupt departure of the modern Orthodox institution's former leader.
Kohelet Yeshiva High School has hired a new head of school just two months after the abrupt departure of the modern Orthodox institution's former leader.
Rabbi Gil Perl will leave his position as head of school at Margolin Hebrew Academy and Feinstone Yeshiva, an Orthodox Jewish day school in Memphis, Tenn., to join the Merion Station school this summer. He replaces Rabbi Elchanan Jay Weinbach, who left for personal reasons in November, according to a school announcement.
Jerome Marcus, president of Kohelet, emphasized that Perl is a "very accomplished scholar in both the secular world and in the Jewish world."
Perl earned a doctorate in Near Eastern Languages and Civilizations from Harvard University, where he completed his dissertation on the Netziv, a 19th century rabbi who led a renowned yeshiva in Lithuania. Prior to working at the school in Memphis, Perl served as director of admissions and then associate head of school at Yeshiva University High School for Boys from 2005 to 2007. He received his rabbinic ordination in 2007 from Yeshiva University.
"He's done a lot of thinking about what modern Orthodoxy is and what it should be," said Marcus. "He thinks about how it can speak to Jews of many different intellectual and spiritual orientations."
Marcus said he did not expect there to be radical changes at the school between Perl and his predecessor.
"The religious orientation of the school and its commitment to modern Orthodoxy is not going to change," Marcus said. "I think every leader who is a substantial personality tries to leaves his own mark on the institution that he leads, and precisely how Rabbi Perl's approach will differ is not something that I would try to characterize at this point."
Rabbi Rafi Eis is serving as the interim head of school until Perl arrives.


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University of Minnesota Regents will get an update on the school's plan to deal with the H1N1 strain of flu as their two-day board meeting begins Thursday.
University of Minnesota officials know that H1N1 has arrived on campus. 50 to 60 probable cases have been reported, but U officials are certain there are many more unreported cases among students. Health workers on campus expect a "rapid spike" in cases in coming weeks.
The U's plan is fairly simple; students with flu-like symptoms should go home. If they can't leave campus, they should stay isolated.
Surgical masks are available for students with the flu who need to leave residence halls. The U is also considering relaxing class attendance requirements if a major flu breakout occurs.
The U's board of regents will get an update on the H1N1 plan today. There will also be a panel discussion on H1N1 at the Coffman Memorial Union Theater this morning.


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You are here: Kidspot Activity Corner Indoor activities for kids Aboriginal handprints
Aboriginal handprints
Make your own cave wall handprints with this easy art project you can do with your kids. You can buy powder paint at most craft stores and is called tempera.
What you need:
- Piece of black or brown paper
- White powder paint (tempera)
Dampen the paper with a squirt bottle or damp cloth.
Place your child's hand down firmly on the damp paper.
Flick the white powder paint over the hand and the paper.
Carefully lift your child's hand from the paper and look at the impression left behind.


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Hotel Tribuna
Carretería, 6, 29008 Malaga, Spain |Show on the map
from $36
- Terms and facilities
- Useful information
- Location
- Opinions
An exclusive hotel in the historical and commercial center of Malaga, placed opposite to the emblematic "Tribuna de los Pobres".
The hotel is a new establishment with 42 totally equipped rooms ( heating, air conditioned, full bathroom, telephone, minibar, satelite and cable Tv and free safe box).
In its restaurant" La Barbacana" it is possible to enjoy the archaelogical remains of the wall nazari while enjoying dishes of traditional gastronomy.
For its location, the hotel is the perfect place for the housing of the business clients, cultural client, vacational and certainly of the devout ones of the Holy Week .
Choose your room
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Score based on 23 reviews
Score based on 23 reviews
Tripadvisor Score Score based on 214 reviews
Average price per night for this hotel for the following weeks
|9/27/17 - 10/1/17
|10/2/17 - 10/8/17
|10/9/17 - 10/15/17
|10/16/17 - 10/22/17
Services and terms: Hotel Tribuna
Accommodation facilities
- Lift
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- Non-smoker Rooms
- Parking
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- 24 hr Room Service
Standard Room Services
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Useful information: Hotel Tribuna
Other names for Hotel Tribuna:
Tribuna Malagueña
Tribuna Málaga
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To lobbyist Grover Norquist, who thinks he owns the House Republicans: Hey, Grover, it's over.
Mr. (Lloyd) Blankfein, the millionaire CEO of Goldman Sachs, says the middle class needs to lower expectations for Social Security, … all the while he and his cronies made their millions on the backs of the middle class. … How about all of you greedy CEOs kicking some of that money back to us "little" people?
Halogen (blue) headlights are good to see the highway when driving a vehicle but seem to "blind" a person when a vehicle using the halogen lights comes toward them.
If the American people can give their love and support to those less fortunate during this holiday season, why can't the uber rich in Washington learn from this? When Washington says the "American people," they have to look farther than their gated communities. It's time to get your act together.
The Democratic Party is successful in presidential elections because they do not underestimate the intelligence of 51 percent of the people, especially the single women.
America is a center-right country. Look at all the governorships and state legislatures.
The roads in eastern Allen County are horrible. The Amish horses have trenched the roads to the point the roads are unsafe. When it rains, the trenches fill with water and cause the car to hydroplane severely. When will the county … repair the roads so they are safe?
To the ranter who feels it necessary to remind David Long, Marlin Stutzman and Bob Morris they work for everyone: Please remember to tell your liberal brothers, especially King Obama, the same thing. Many voters don't wish to be subjected to his "Robin Hood" economic agenda and "free to be me" social attitudes.
How can FWCS (Fort Wayne Community Schools) save money? First, get rid of the electronic signs. These should have never been bought. … We do not need a spokesperson. The school board members should field all questions. … Eliminate the superintendent position and all of the staff.
To the right-wing … (person) ranting about Katrina: King George (Bush) flew over and looked out the window at his minions below. President Obama hit the ground to see what happened first hand and to see what needed to be done.
Cheer up, Purdue fan. At least you have women's basketball — LOL.


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Available only from Hammacher Schlemmer, this is the combination recorder and stereo system that preserves classic vinyl records and cassette tapes by recording them to audio CDs or converting the songs to MP3s. It faithfully transfers an LP or cassette to a digital audio CD-R or CD-R/RW, and at any time during recording you can pause to select only certain songs, turn the album or cassette over, and change albums or cassettes to make compilation recordings. Using the free downloadable Audacity software that works on Windows 8, Windows 7, XP, Vista, or a Mac, it can convert LPs and cassettes to MP3s for use on a computer or MP3 player. The system also plays 33s, 45s, 78s, and cassettes through two 3 1/2-watt speakers, and has a built-in AM/FM stereo with digital tuner and single CD playback tray, all in a footprint less than 2' sq. Two RCA inputs in the rear enable you to connect the device to another stereo system or external speakers. Includes automatic/manual track, increment control, record-level indicator, record-level control, backlit LCD, and remote control that requires two AA batteries. Needle plays LPs for up to 50 hours before requiring replacement. Plugs into AC. 9" H x 19" W x 15" D. (23 lbs.)
Lifetime Guarantee
The LP And Cassette To CD/Digital Converter comes with The Hammacher Schlemmer Lifetime Guarantee. If this product ever disappoints you, for any reason, you may return your Hammacher Schlemmer purchase for exchange, credit, or refund.
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Evaluation of Circulating Osteogenic Factors in Trauma Patients (BMP-9)
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- How to Read a Study Record
Bone fractures in traumatic brain-injured and spinal cord-injured patients often heal faster than in other patients. However, such patients are also occasionally prone to bone formation in soft tissues such as muscle. This process is called heterotopic ossification and tends to occur around joints. Patients with heterotopic ossification often suffer from complications such nerve compression, ankylosis, chronic pain, osteoporosis, and infections. Loss of movement can also interfere with function and the quality of life of patients already experiencing difficulties associated with their trauma. Positioning, transfers, and hygiene become difficult and even impossible, which worsens the loss of autonomy.
Previous research has suggested that an osteoinductive factor (which has the capacity to induce the formation of bone) may be released into the bloodstream following a head or spinal cord injury. The investigators laboratory has shown that a growth factor called BMP-9, when injected into a damaged mouse muscle, has the ability to cause strong ossification in damaged muscle. The investigators would like to find out whether the levels of BMP-9 and/or its receptor (which is called ALK1) increase after traumatic brain and spinal cord injuries that occur at the same time as serious orthopaedic traumas.
The main goal of the investigators study is thus to determine whether BMP-9 levels increase in the serum of trauma patients.
|Healthy High Velocity Fracture Cranial Trauma Spinal Trauma
|Study Type:
|Study Design:
|Observational Model: Cohort
Time Perspective: Cross-Sectional
|Official Title:
|Evaluation of Circulating Osteogenic Factors in Trauma Patients (BMP-9)
|Estimated Enrollment:
|Study Start Date:
|December 2010
|Estimated Study Completion Date:
|December 2017
|Estimated Primary Completion Date:
|December 2016 (Final data collection date for primary outcome measure)
cranial trauma and fracture
Individuals presenting a cranial trauma that are classified at equal to or less than 8 on the Glasgow scale, combined with a fracture to the femur, tibia, or pelvis resulting from a high-velocity impact
cranial trauma
Individuals presenting a cranial trauma that are classified at equal to or less than 8 on the Glasgow scale
spinal trauma with fracture
Individuals presenting a spinal fracture that are classified with an ASIA score of A, B, or C, combined with a fracture to the femur, tibia, or pelvis resulting from a high-velocity impact
spinal trauma
Individuals presenting a spinal fracture that are classified with an ASIA score of A, B, or C
high velocity fracture, inferior limb
Individuals that present a fracture to the femur, tibia, or pelvis resulting from a high-velocity impact
Healthy individuals
|Ages Eligible for Study:
|18 Years to 65 Years (Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
|Sampling Method:
|Non-Probability Sample
Inclusion Criteria:
- cranial trauma with Glasgow =< 8
- spinal trauma with ASIA A, B, C
- high-velocity fracture of femur, tibia, pelvis
Exclusion Criteria:
- brain dead
- pathological fractures (cancer, osteoporosis)
- blood transfusion received
- pregnancy
Please refer to this study by its ClinicalTrials.gov identifier: NCT01433536
|Canada, Quebec
|Centre Hospitalier Universitaire de Sherbrooke
|Sherbrooke, Quebec, Canada, J1H 5N4
|Principal Investigator:
|Guillaume Grenier, Ph.D.
|Université de Sherbrooke
|Responsible Party:
|Guillaume Grenier, Associate Professor, Université de Sherbrooke
|ClinicalTrials.gov Identifier:
|NCT01433536 History of Changes
|Other Study ID Numbers:
MOP-115149 ( Other Grant/Funding Number: CIHR )
|Study First Received:
|September 12, 2011
|Last Updated:
|January 26, 2016
|Individual Participant Data (IPD) Sharing Statement:
|Plan to Share IPD:
Keywords provided by Guillaume Grenier, Université de Sherbrooke:
cranial trauma with or without high velocity fracture to inferior limb
spinal trauma with or without high velocity fracture to inferior limb
high velocity fracture to inferior limb
Additional relevant MeSH terms:
Wounds and Injuries
ClinicalTrials.gov processed this record on September 21, 2017


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James Spadavecchia contacted me about his product USBtribe. It's an interface you install into a Korg Monotribe. Once installed the Monotribe shows up as a controller. You have tempo and transport sync, synth MIDI in on Channel 1 and drum MIDI in Channel 10. The modified Monotribe also now has MIDI out so you can record the MIDI of what the Monotribe is doing. Installation was mostly easy. It took me a little fiddling to get the tiny plugs into the terminal block. To file a hole required for the wire's out I had to buy a round file. Check out the demo video I created above to see it's features.
"Introducing the USBtribe, a USB MIDI interface modification designed specifically for use with the Korg Monotribe analog ribbon station. This mod adds a USB socket to the Monotribe synthesizer, providing USB MIDI IO and DC power supply over a single USB cable." – usbtri.be
For more info: usbtri.be


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Most of the time BisonOffice.com can offer volume discounts. Simply fill up the request form below.
Volume price quote requests are usually processed within 24 business hours. Please note that due to our already competitive low prices, we are sometimes unable to offer a price lower than what is available on our website.
K & COMPANY Flora & Fauna Embellishments
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All you need to know about leasing
Check out our guide to understanding how leasing works for both business and personal useguide to leasing
Monday to Friday 9am to 5.30pm
27th May 2015
A significantly lighter, considerably more efficient, appreciably more technologically accomplished Audi Q7 hits the forecourts in the UK.
27th May 2015
Audi's fastest and most powerful series production car in history, the ten-cylinder FSI engined Audi R8 V10, is capable of 0-62mph in just 3.2 seconds, will be available to order in May with deliveries due at the end of the year.
27th May 2015
Audi CEO Rupert Stadler announced that Audi sold over 1.74 million cars in 2014, surpassing its sales targets with a 10.5% year-on-year increase.


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rehder wrote:How have you measured the distance you are throwing?
I have checked distances with GPS. It claims to be accurate to within 3 meters so lets just say 10 feet of error. I would hope its that accurate, since I am the one re-measuring the course for new tee signs and accurate distances would be pretty crucial (or nice) to have.
Alright, I played a second round yesterday without the ankle brace, and it was okay. Little sore after the round, but i rubbed and stretched real good afterwards and then put ice on it. Feeling fine today.
Guess i will start working on staying on my toes again and see how the tournament this weekend goes. (rhyme not intended.)
Im not going to try and add a run up, just so i dont kill off my timing, but i will try to stay light on my feet.


text: The new EZ-Fit Lid Dispenser from San Jamar is the simple, affordable way to protect beverage lids and keep counters clean and organized. The EZ-Fit Lid Dispenser dramatically improves the organization ofself-serve beverage counters by providing a simple, efficient solution. Two sizes are available to dispense most cold beverage cup lids. The design requires no


text: Girls' glitter shearling lodge moccasins Item F8563 Color: Size: All sizes are US sizes. K12 K5 Size Charts Quantity: 1 2 3 4 5 6 7 8 9 Prices do not include taxes. Add to Bag Wishlist Add to Bag Add To Wishlist share: size & fit Product Details The coziest (and shiniest) slippers, with faux-shearling lining and slip-proof rubber soles. Glitter-covered cotton upper. Faux-shearling lining. Rubber sole. Import. Item F8563.


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Note: This item is more than 13 years old. Please take the publication date into consideration for any date references.
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News Release
Media Contact: TPWD News, firstname.lastname@example.com, 512-389-8030
Aug. 9, 2004
Boating Safety Reminders for All
Extra! Read All Aboat It!
UNDATED — Since the Memorial Day week kick-off of boating season, Texas Parks and Wildlife game wardens have been out in full force attempting to make Texas waters safer.
There is good news this year though. The number of boating-related fatalities on Texas public waterways has sharply decreased between 2002 and 2003.
In 2002, 61 people died. And last year, 39 did.
The decrease can't be credited or attributed to any one factor and could be due to anything from weather to flooding to safer behaviors.
"Texas is different from many other states in that we have a year-round boating season. We also have more inland water than any of the 48 continental states. We have a coastline and all the activity there as well. We also have one of the highest number of registered boats in the nation. We just have a lot of activity. With all this in mind, we feel like overall, boating is a safe activity in Texas," said Willie Gonzalez, assistant chief of marine enforcement at TPWD.
A reminder: a law that went into effect in 2001 includes the suspension of a driver's license for failing to submit to alcohol testing when suspected of operating a vessel while intoxicated. This applies to watercrafts of 50 horse power or more.
Notable boating regulations include:
- Children younger than 13 years of age must wear approved life jackets while under way.
- All personal watercraft passengers, including those being towed, must wear life jackets.
- All boats must have at least one Type I, II, or III U.S. Coast Guard-approved life jacket wearable and of the proper size for each person on board.
- All life jackets must be in good and serviceable condition and readily accessible.
- Persons younger than age 16 must successfully complete a boater education class (unless exempt) in order to operate boats of 15 horsepower or more and windblown vessels more than 14 feet in length unless accompanied by someone 18 or older.
- Someone who either appears to be impaired and/or has a blood alcohol level of 0.08 percent or higher while operating a boat may be arrested for BWI.
- When operating at greater than headway speed, those on personal watercrafts must remain 50 feet apart from each other, and from other boats as well as shorelines, docks and any fixed objects.
Game wardens will be conducting media ride-alongs all summer. For more information, contact your local game warden office. Also, TPWD boater education courses are available in a traditional classroom setting, on line and through a home video course. Call (800) 792-1112 or visit (http://tpwd.texas.gov/edu/boated/boated.htm).
TPWD is now compiling data for 2004 and will release it in the coming weeks.
Publication — Permission is granted to publish, in whole or in part, any news releases on this page.
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(5.4.16 i)


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Babble Media Partners with Hyperion on Parenting E-Book Series
Hyperion and Disney Interactive's Babble.com, a leading parenting site dedicated to the "truth in parenting," announced today plans to publish an original ebook series that will feature crowd-sourced stories from real parents and that will address important issues for a new generation of connected and engaged parents. The first e-book in the series, PARENTING, UNCENSORED: STRAIGHT TALK FROM REAL MOMS AND DADS ON BREASTFEEDING, is set to debut on April 30, 2013, and a more all-encompassing guide to pregnancy and the early years of parenting will be released January 2014.
Each ebook in the series will include some of the best advice for parents from Babble editors and 10 personal, unfiltered stories from "real moms and dads." Rolling out topics sequentially, over the next several weeks Babble will provide readers with the opportunity to vote for their favorite posts from across the parent blogging Community within each subject category. Nomination pages are now live and located here http://www.babble.com/mom/best-of-blogs-campaign/ Babble will also cross promote on its Facebook page, driving users back to the site.
The announcement of the new partnership was made by Ellen Archer, President and Publisher of Hyperion. Of the deal, Archer said: "We're excited to be working with the top site for moms on a series of ebooks for today's plugged in generation. They are truly tapped into a Community of honest, unguarded parents with real, useful advice." Elisabeth Dyssegaard, Editor in Chief, negotiated the deal with Babble co-founder, Rufus Griscom.
Griscom said, "We are invested in building the individual brands of our bloggers, and see this ebook series as another opportunity for bloggers to expand their reach and brand."
Since its inception in 2006, Babble has become one of the most celebrated parenting sites on the web, named by Time Magazine as one of the 50 Best Websites of 2010 and by Forbes as one of the Top 100 Websites for Women. Its stable of bloggers contribute daily to parenting topics including pregnancy,?
childcare, health, food, family activities as well as lifestyle topics such as home, fashion and family products. As the premier blogging platform for a new generation of connected parents, Babble has created a vibrant Community of parents who support, encourage and celebrate the highs and lows of raising children.
About Disney Interactive
Disney Interactive, one of the world's largest creators of high-quality interactive entertainment across all platforms, is the part of The Walt Disney Company responsible for the global creation and delivery of interactive entertainment, multi-platform video games, and family-focused content across all current and emerging digital media platforms. Disney Interactive produces and distributes a broad portfolio of content from Disney Interactive Games and Disney Interactive Media. Products and content released and operated by Disney Interactive include blockbuster mobile, social and console games, online virtual worlds, #1 kid's entertainment destination Disney.com and the #1 Family/Parenting portfolio on the Web. Disney Interactive is the interactive entertainment part of The Walt Disney Company (NYSE: DIS).
About Hyperion
Founded in 1991, Hyperion publishes general-interest fiction and non-fiction hardcover, eBook, trade, and mass-market paperback titles. The company publishes about 80 combined hardcover, original eBooks, and paperbacks a year, and offers many of its titles as audio books. Hyperion is the adult trade book publishing unit of the Disney/ABC-Television Group, which is part of The Walt Disney Company.


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McKenna, Inslee spar over tax plan for schools
SEATTLE (AP) - Washington's gubernatorial candidates agreed Tuesday night that increasing taxes isn't something they would do as governor, and said during their final debate that more money needs to go to public schools and universities but sparred over a proposed tax plan to equalize the way Washington homeowners pay for public schools.
Both candidates expect the state to have growing revenues in the coming years. In order to free up extra cash for education, Republican Rob McKenna would like to cap non-education spending growth at 6 percent per biennium.
"I'm not willing to consider tax increases," McKenna said. "Voters don't want to see higher taxes."
Democrat Jay Inslee said he believes his economic plan can trigger strong job growth to increase revenues, as well as efforts to contain health costs.
But Inslee called McKenna's support of the so-called levy swap a tax "gimmick" that would raise taxes on people in many school districts.
The plan would replace some local property taxes with a statewide education property tax and essentially take tax money from property-rich taxpayers and distribute it to areas with schools in greater need.
Instead of the school districts with the highest property values being able to collect the most school levy dollars, taxpayers across the state would be contributing more to the overall state education system, and that money would be redistributed according to student population and needs, not by property values.
"It may help Olympia politicians on paper, it does not help students in school," the former congressman said.
McKenna, the state's attorney general, said that was not true and pointed out that the proposal was being advanced by Democrats in the Legislature.
"Hope is not a strategy, and hoping that a jobs plan will create more jobs to address this is not a strategy," he said. "Congressman Inslee has no plan."
When asked whether there were specific tax exemptions that he would close, Inslee cited a tax break for bull insemination that he said costs a million dollars a year.
"That's not going to solve our educational problems, but it is an attitude that we need to start being rigorous to solve these education funding problems. I'm calling for these to have a sunset provision in which they come for a vote on a regular basis."
McKenna agreed that while so-called tax loopholes should be regularly reviewed, he said he was more concerned about sales taxes that go uncollected by out-of-state online merchants every year. However, McKenna said closing exemptions alone wouldn't solve the overall problem.
"You're not going to close the budget gap for education by closing loopholes and preferences," he said. "There's just not enough money there."
McKenna also criticized Inslee's plan to create an Economic Competitiveness and Development office.
"The answer is clearly not to expand state government," he said.
Inslee responded that the office would make government more efficient by moving aspects of economic development and trade policy work from the Department of Commerce to the new agency.
"We're not increasing the size of government, we're making it work," he said.
The race between McKenna and Inslee is considered to be one of the most competitive races for governor in the country. Both sides have raised about $10 million each, and outside groups have also are flooded the state with cash. Recent polling has showed the candidates running about even.
Counties will start sending ballots to voters on Wednesday.
Copyright 2012 The Associated Press.


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Note: This item is more than 13 years old. Please take the publication date into consideration for any date references.
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Media Contact: TPWD News, email@example.com, 512-389-8030
Feb. 2, 2004
Civil Restitution Program Going Well
AUSTIN, Texas Assistant Chief of Fisheries Enforcement, Kris Bishop, briefed the Texas Parks and Wildlife Commission Jan. 29 about the progress of the department's civil restitution program, since the legislature in 1999 implemented a law saying licenses can be denied until fines are taken care of.
On average, $365,000 of Civil Restitution is assessed annually. Collection has averaged $297,000 a year since passage of the enhanced penalty in 1999. It is TPWD's belief that this program has a two-fold benefit, Bishop said. "Not only are we able to recover funds that benefit the department's efforts to manage and conserve the natural resources of Texas but we have also raised the awareness of the general public as is evident in the gradual decrease of civil restitution cases filed each year."
To date, more than $7 million in civil restitution has been assessed, of which more than $3 million has been collected and deposited in Fund 9. The Resource Protection Division also conducts some Civil Restitution assessment, usually involving fish kills, due to pollution or seismic activity. They report that they have collected and deposited more than $700,000 into Fund 9.
Quite often citations issued by game wardens involve the illegal taking of a resource. In 1985, the 69th legislature granted the statutory authority that allows TPWD to assess civil liability to those who unlawfully take, kill, possess or injure the wildlife or aquatic resources of our state. They also granted the Parks & Wildlife Commission the authority to set rules that establish guidelines for determining the monetary value of those resources. The monetary value of each wildlife species is obtained by considering eight scoring criteria: Recreation, Aesthetic, Educational value, Scarcity, Environmental tolerance, Economics, Recruitment, Ecological role. Value is added for Endangered/Threatened species and trophy game animals.
Some examples of Texas wildlife values include:
- White-tailed deer: $163 female, $525.50 male, $3,025.50 for a 150 B&C score Trophy White-tailed deer
- Mourning Dove: $15.50
- Whooping Crane: $7,100.50 + $1,000 Endangered list
Restitution is a civil process and is separate from and in addition to any criminal penalty assessed by the criminal court. Historically, civil restitution was treated more as a gentleman's debt: letters were sent requesting payment. If not paid, collection could only be sought through a civil lawsuit brought by the Attorney General's office, which in most cases was not cost-effective.
A review of the program's effectiveness revealed a low collection rate and prompted the legislature to pass a statute in 1999 that allows the department to refuse to issue a license/permit/tag if the applicant has been convicted of illegally taking a resource, is liable to the state for the value of the resource, and has failed to fully pay the amount due after the department has issued notice.
A series of five letters are sent to the violator notifying them of their liability.
They are sent at monthly intervals and even include a 20 percent discount for timely payment.
The final letter advises them they have been placed on license suspension and contains a warning that if found participating in an activity requiring that license, they will be charged with a Class A misdemeanor- punishable by a fine of $500-$4,000/confinement in jail not to exceed one year/or both.
For more information about the civil restitution program, call (512) 389-4846.
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(5.4.16 i)


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Kyrie Irving fractured his right hand on Saturday morning after slapping the padding on the gym wall at practice.
Irving will be out six to eight weeks and is expected to be ready for training camp.
Via Marc J. Spears/Yahoo! Sports (via Twitter)
Read more: http://basketball.realgm.com/wiretap...#ixzz20frzT4LF
This is a little immature.


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Molina exits game with hamstring injury
BALTIMORE -- Jose Molina left Saturday's game vs. the Orioles due to a tight left hamstring.
The Rays catcher said he was fine after the game, and he does not expect to miss any time.
When Molina hit his second double of the game, he pulled into second base without sliding and still managed to avoid the tag. Moments later, Jose Lobaton was sent in to pinch run for Molina.
Bill Chastain is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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HIV/STI Prevention for Drug-Involved Couples (Connect II)
This study has been completed.
Columbia University
Information provided by:
Columbia University
ClinicalTrials.gov Identifier:
First received: January 21, 2011
Last updated: January 26, 2011
Last verified: January 2011
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
This randomized controlled trial is designed to address gaps in couple-based HIV prevention research by focusing exclusively on HIV negative concordant couples where one or both partners are drug-involved. Building on prior couple-based HIV research that resulted in an evidence-based HIV prevention model for couples (Connect), intervention components were modified to address dyadic drug risk reduction and drug-related unsafe sex and a couple-based HIV risk reduction intervention (Connect II) was designed specifically for drug-involved, HIV negative concordant heterosexual couples at risk for HIV/STIs. For this RCT, couples are recruited primarily through street outreach in drug using locations and randomized into one of three arms: (1) couple-based HIV Risk Reduction condition; (2) individual-based HIV Risk Reduction, which delivered the same content as the couple-based condition but was provided to either the male or female drug-using partner alone; or (3) couple-based Wellness Promotion, which served as an attentional control arm. This RCT tests two major hypotheses: (1) whether the HIV risk reduction intervention provided to the couple or an individual partner would be more efficacious in decreasing number of unprotected acts of intercourse and having a lower cumulative incidence of biologically confirmed STIs over the 12-month follow-up period compared to the Wellness promotion control arm and (2) whether the couple-based HIV risk reduction intervention would be more likely to decrease the number of unprotected acts and have a lower cumulative STI incidence compared to the Individual HIV Risk reduction Arm.
|Sexually Transmitted Diseases
|Behavioral: Couple HIV/STI prevention intervention Behavioral: Couple-based HIV prevention Behavioral: Individual HIV/STI prevention Behavioral: Couple Wellness Promotion
|Phase 2
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:
|HIV/STI Prevention for Drug-Involved Couples
Resource links provided by NLM:
MedlinePlus related topics: HIV/AIDS Sexually Transmitted DiseasesU.S. FDA Resources
Further study details as provided by Columbia University:
Primary Outcome Measures:
- number of unprotected acts of intercourse [ Time Frame: 90 days ]
Secondary Outcome Measures:
- cumulative incidence of biologically confirmed STIs (i.e., Chlamydia, gonorrhea, and Trichomoniasis [ Time Frame: past 12 months ]
|Study Start Date:
|November 2005
|Study Completion Date:
|October 2009
|Primary Completion Date:
|October 2009 (Final data collection date for primary outcome measure)
|Assigned Interventions
|Experimental: Couple-based HIV prevention
|Behavioral: Couple HIV/STI prevention intervention Behavioral: Couple-based HIV prevention
|Active Comparator: Individual HIV/STI Prevention
|Behavioral: Individual HIV/STI prevention
|Active Comparator: Couple Wellness Promotion
|Behavioral: Couple Wellness Promotion
|Ages Eligible for Study:
|18 Years to 40 Years (Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
Couples were eligible to participate if:
- Both were 18 and older and at least one partner was 18-40
- Both tested HIV negative using Oratest procedures
- Both identified each other as main, regular partner, boy/girlfriend, spouse, lover
- Both reported that they have been together for at least 6 months
- Both intended to remain together for at least one year
- At least one partner reported using illicit drugs in the prior 90 days and was seeking or in drug treatment
- At least one partner reported having had unprotected intercourse with the other in the prior 90 days.
Additionally, at least one partner had to report one or more of the following HIV risk criteria:
- Having had sex with other partners in the prior 90 days
- Injecting drugs in the prior 90 days; or
- Self-report being diagnosed with an STI in the prior 90 days.
Exclusion Criteria:
Couples were excluded from the study:
- If either partner reported experiencing severe intimate partner violence in the past year by the other partner as assessed by subscales of the Revised Conflict Tactics Scale
- If either partner exhibited a severe cognitive or psychiatric impairment assessed during informed consent
- If either partner did not have sufficient understanding of English
- If either partner reported intentions to have a baby in the next year and to relocate beyond a reasonable distance from the study site in the coming year.
Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01285349
Please refer to this study by its ClinicalTrials.gov identifier: NCT01285349
|United States, New York
|Social Intervention Group/Columbia University School of Social Work
|New York, New York, United States, 10027
Sponsors and Collaborators
Columbia University
|Principal Investigator:
|Louisa Gilbert, PhD
|Columbia University
More Information
Keywords provided by Columbia University:
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on September 21, 2017
|Responsible Party:
|Louisa Gilbert, Social Intervention Group at Columbia University
|ClinicalTrials.gov Identifier:
|NCT01285349 History of Changes
|Other Study ID Numbers:
|Study First Received:
|January 21, 2011
|Last Updated:
|January 26, 2011
Keywords provided by Columbia University:
HIV, STI, condom use, drug use,
Additional relevant MeSH terms:
Sexually Transmitted Diseases
Virus Diseases
Genital Diseases, Male
Genital Diseases, Female
ClinicalTrials.gov processed this record on September 21, 2017


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Midwifery Today, Issue 95, Autumn 2010
Theme: First Stage
Cover photo by Lyndsay Stradtner
Life in Motion Photography
The theme of Midwifery Today Issue 95 is First Stage. Packed with informative, clinical articles related to the first stage of labor, this issue will help midwives understand the dangers of epidurals; the pros and cons of rupturing membranes; and the wonders of using homeopathic remedies for labor and birth. Also included in this issue: Author Leah Hazard discusses the unique cycle of fear, tension and panic that fathers experience during their partners' labor and birth; midwife Carol Gautschi discusses her views on first stage; and a midwife working in Haiti gives an eloquent update on one Haitian birth clinic's role in helping earthquake survivors.
Poetry: Immortality
From the Editor: From Russia With Love
In her editorial for our Autumn 2010 issue, Midwifery Today's editor in chief, Jan Tritten, recalls the 2010 Birthing in Love Conference, held in Russia this spring; "adopts" a new daughter; is amazed by Russia's sites and people; and ponders the best way to train midwives worldwide.
Tricks of the Trade
Marion's Message: Study Shows Mothers' Lives Saved
Recent news that pregnancy- and childbirth-related deaths have substantially decreased worldwide proves that efforts by maternal and child health care workers are finally paying off.
Media Reviews
Optimal Pelvic Positioning produced by BirthWorks International, Jean Sutton and Cathy Daub, and Orgasmic Birth by Elizabeth Davis and Debra Pascali-Bonaro
Classified Advertising
Photo Album
The Amniotomy Question: Examining the Pros and Cons of Rupturing Membranes
In this thoroughly researched article, author Verna Oberg explores amniotomy's role as a ritual for birth attendants and discusses its possible psychological effects on the baby.
Ordinary Miracle: The Homebirth of Ava Christine
Looking forward to her planned homebirth, a mother finds that her fourth birth experience brings all the joy, love and happiness she expected, as well as something she didn't anticipate—her longest first stage of labor yet!
Like Cures Like: Homeopathy for Labor and Birth
In the first part of this two-part series on homeopathy, midwife Diane Gregg advises other birth practitioners on using homeopathic remedies during labor and birth, citing case studies from her own practice. Included in this article are handy, homeopathic remedy charts perfect for clipping out, laminating and sticking in your birth kit.
Deceleration Phase
A midwife draws on her art history knowledge, visualizing and contemplating "the truest blue ever painted on canvas," as she births her second child, Azure, at home.
Birthing to Redeem
Scarred by a negative birth experiences, a mother finds redemption in a natural, midwife-assisted birth.
Gift of Intuition
A group of Hawaiian certified nurse-midwives share their thoughts on midwives' intuition and spirituality in childbirth.
The Epidural Trip: Why Are So Many Women Taking Dangerous Drugs during Labor?
Using up-to-date statistics and research, this article gives a nitty-gritty look at one of the most common obstetric interventions in use today—epidural analgesia—and exposes the serious risks epidurals pose to mothers and babies.
Who Counts Where I Come From?
As a Cherokee daughter facing another nationwide census, author Sister MorningStar discusses how people are counted in this world, and ponders the statistics on cesarean births, which only count the mother, not the baby—or babies—born to her.
Santa Fe Homebirth
A father details the birth of his daughter, who entered the world surrounded by loved ones, in her mother's childhood home near Santa Fe, New Mexico.
Paying attention to the "emotional roller coaster fathers experience throughout pregnancy and birth," author Leah Hazard explores the cycle of "fear, tension and panic" many fathers experience during their partner's labor and offers tips for midwives and doulas to help fathers better enjoy the birthing process.
A Story of Homebirth after Cesarean
After undergoing a c-section with her firstborn, a mother finds hope and comfort planning her vaginal birth after cesarean, then birthing her daughter at home.
Gestational Diabetes: An Update for Midwives
This article examines the evidence behind the new diagnostic criteria for gestational diabetes, which will double the number of pregnant women diagnosed with gestational diabetes, and discusses how the new criteria may affect midwifery care.
Before the First Wave: Midwife Carol Gautschi Shares Her Views on First Stage
Veteran midwife Carol Gautschi shares her insights on the first stage of labor and offers practical advise to midwives.
First Stage: Preparing the Fetus Ejection Reflex
Author Michel Odent reminds midwives that "when there is an authentic fetus ejection reflex, the midwife can forget her usual worries about, for example, shoulder dystocia, difficulties for the delivery of the head in the case of a breech presentation, difficult process of rotation, dangerous perineal laceration, etc." and gives succinct pointers for helping women experience a natural fetus ejection reflex.
Russia 2010 Conference Photos
A Family-centered Cesarean Birth
Faced with a necessary cesarean, a mother must give up her hopes of having a homebirth, but still manages to craft an inspiring birth plan that gives her daughter "the gentlest birth possible given the circumstances."
Turn Baby Turn: New Maneuvers for Turning a Malpositioned Baby
An obstetric nurse shares her maneuvers for helping to get a baby's head out of the mother's bladder compartment and into the pelvic compartment, then facilitating rotation from an occiput posterior position to an occiput anterior or occiput transverse position, saving the mother many hours of hard, ineffective labor and avoiding the need for a c-section.
The Choices We Make: Building Trust between Midwife and Client
Veteran midwife Ireena Keeslar offers tips to midwives who want to build a midwifery practice that honors and respects their clients, while still making time and space for themselves and their own families.
International Midwife
We'll Grow Back When the Rain Comes: An Update from Haiti
A midwife working with laboring mothers in a still-devastated Haiti, is empowered and amazed by the tireless midwives she meets who are "single-handedly making such a big difference in women's lives and the region at large."
Take a trip through Borneo with author Linda Jenkins and discover the birthing rituals and customs of this delightful island nation.
Fight for Your Right: Successful VBAC in an Australian Hospital
In this "it would be funny if it weren't so true" story, an Australian midwife recounts the behind-the-scenes things doctors and nurses do and say when a laboring mother transfers from home to hospital with her private midwife, doula and husband.
One Midwife's Journey: Stories from Papua New Guinea and Beyond
Gigliola, a veteran midwife now in her 80s shares stories with author Lindy Joy Cummings about her long midwifery career in Papua New Guinea and other remote parts of the world.
Cards & Letters