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I am new and I want to invite myself. My name is Wolfgang and I am using qcad for design of modell airplanes. the dxf files are used to mill it on a milling machine TRON+, which is currently build up. In the future i will give CAM-Expert a chance to do the job.
My Problems:
1) If we have an jpeg/raster Image and are willing to digitize it, then we will have to use splines. In normal use to design a fuselage of an airplane, you often only draw one side and simply mirror it to the other side. Because this digitizing is done by hand (clicking each point), we sometimes have to close the lines after mirroring it to get a closed curve. I did this by trim function. Obviously trimming of 2 splines does not work for me.
2) Modell airplane fuselage are often build with stringers, so I have to cut the above mentioned splines and insert a rectangle for the stringers. This also does not work, used function: insert in a spline.
Any proposals to do this?
THX in advance
Trim with Splines does not work
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In this Java tutorial, we will see why connection refused exception comes and how to solve java.net.ConnectException: Connection refused: connect Exception in Java. Normally, Java books like Head First Java won't teach you much about how to deal with such exception, it's simply too much to ask for a beginner's book.
java.net.ConnectException: Connection refused Error – Possible reasons
or Java Performance The Definitive Guide By Scott Oaks are some good read.

subset: commoncrawl


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Amanda Godin expected her children home from school around 4 p.m. Tuesday. An hour beforehand, she heard the crash -- outside her apartment at the River's Edge complex in Waterford Township.
"I looked out my window, and saw a bus. ... I was terrified," said Godin, watching police and fire officials clean up the remains of an accident that sent two to the hospital and totaled both vehicles involved.
The crash, between a Waterford School District bus and a Chevrolet S-10 pickup, happened after school hours at the corner of Elizabeth Lake and Airport roads. No children were inside the bus during the accident, officials report.
Initial investigations indicate that both vehicles appeared to have gone through the intersection during a yellow light. The pickup, traveling west on Elizabeth, hit the bus -- which was turning left onto northbound Airport Road -- nearly head-on.
Godin said she saw two people, possibly in their 20s, get transported to a nearby hospital as she watched from the open field at her apartment complex, which overlooks the intersection.
White Lake resident Lisa Rietzler, 50, who happens to be an employee of Pontiac-based Star EMS, was driving westbound on Elizabeth Lake Road with her husband when she saw the accident.
"I looked down the hill and said 'Oh (shoot),'" said Rietzler.
She got out of her car and checked the people inside of the pickup, which was for injuries. There were three teenagers.
"One of the guys hit the windshield," she said, smoking a cigarette on the shoulder of the road. "He lost consciousness for a bit, couldn't remember what happened."
The other two teens in the car had minor seat belt burns and abrasions, she said. When Waterford police and fire officials arrived, they sent two of the pickup's passengers to McLaren Oakland Hospital.
Dominic Rochowiac, 16, was driving by the accident Tuesday afternoon. He saw emergency personnel taking people out of the pickup on stretcher, he said.
Waterford Fire Captain John Lyman confirmed that the two taken to the hospital had minor body injuries and a "decreased level of consciousness."
The driver of the pickup, Zack Brown, 17, was standing on the shoulder at the intersection after the accident, pacing. The Waterford Mott High School student said he slammed on his truck's brakes when he saw the bus trying to turn, but skidded into the intersection, hitting the bus on the front passenger side.
The bus driver suffered minor injuries, and she was treated and released at the scene, said Wateford Fire Capt. John Lyman.
Waterford police officers came to the scene and directed traffic while Airport Road near the crash site was closed for nearly an hour. Crash reconstruction crews cleaned up the oil that spilled out onto the road from the collision, and both vehicles were towed away.
Authorities do not believe alcohol was a factor in this accident. The investigation remains open, said police.
Staff writer John Turk covers the Oakland County Board of Commissioners, police and general assignment. Contact him at 248-745-4613.


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Now that the election is over, I feel a void in my life.
The criticism of another's position, the constant heated debate between family members filled with a heavy dose of vituperation has since dwindled into anemic soliloquies where no one listens but the speaker.
Don't worry I 'm not going to rant about my political position nor demand any reader to understand what I think sound public policy should look like.
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Lincecum shines vs. D-backs, wins fourth straight
Righty hurls seven shutout innings; Sandoval contributes three RBIs
SAN FRANCISCO -- Seconds after Tim Lincecum tumbled to the ground while covering first base to end the fourth inning, the lone bit of uncertainty for the Giants on Friday night subsided, as he popped back to his feet. Totally healthy, he smiled.
Walking back to the dugout, Lincecum and Brandon Belt laughed while watching the replay on the scoreboard. So went Friday night for the Giants: not much concern and plenty of smiles, as they cruised to a 5-0 victory against the D-backs at AT&T Park.
Five runs were plenty of support for Lincecum, who's recently had plenty to smile about (and given his teammates reason to grin, too). He again looked like a pitcher who's completed the transition from power pitcher to finesse pitcher and perfected his altered craft in seven shutout innings en route to his fourth consecutive win.
In his last four starts, he's allowed just one earned run in 30 1/3 innings. He's thrown a career-high 27 consecutive scoreless innings at AT&T Park, which is the Giants' longest stretch since Ryan Jensen also tossed 27 unblemished innings in a row at home in 2002.
Lincecum's double-take-at-the-radar-gun velocity may be gone, but his confidence from his Cy Young seasons of yesteryear has returned, and that's not good news for opposing hitters.
"I'm not afraid to throw any of my pitches in any situation," Lincecum said, "and I feel like that confidence has carried me through these outings."
Added Pablo Sandoval: "I'm having fun watching him, every time out there. He's got his confidence back. I think that's one of the things we were looking for -- when he gets his confidence back, it's tough to beat us."
The D-backs were the last to do so in a Lincecum start, on June 20 in Arizona. Since then, Lincecum has been the brightest of the few bright spots through what's been a turbulent past month for the Giants.
"Timmy's really been a shot in the arm for us," manager Bruce Bochy said. "He's been the stopper here through these tough times. He's gotten us back on track, it seems like, in every start, and it's nice having a guy in the rotation doing that for you."
Having only allowed three hits, Bochy said Lincecum might have started the eighth inning, but a blister had begun to develop on his right middle finger. Bochy said the blister isn't cause for concern, but could've become exactly that had he pitched the eighth. And given the stellar play accompanying his latest tremendous outing, there was no need to press the issue.
Michael Morse impressed with a running catch in shallow left. Joe Panik made a diving stop at second. A flawless throw from Hector Sanchez thwarted Paul Goldschmidt's attempt to steal second base. And the bats did what the bats were supposed to do against a pitcher who entered the night with a 5.13 ERA through nine starts. They didn't waste much time, either.
Belt singled in the first and scored one batter later when Sandoval destroyed a baseball -- which landed atop Levi's Landing in a hurry -- for a two-run home run. Three batters, two runs.
They didn't maintain that torrid pace throughout the night, but the offense produced more than what'd become the norm lately. A Brandon Crawford single to right scored Tyler Colvin in the second, and one batter later, Lincecum and Panik (at third base) successfully executed a safety squeeze to push the lead to 4-0. A Sandoval double to left scored Hunter Pence to extend the lead to 5-0 in the fifth.
Arizona starter Mike Bolsinger was chased from the game after five innings. He allowed five earned runs on eight hits. The win improved the Giants to 37-15 this season when hitting at least one home run.
"It was nice to see, I'm not going to lie," Bochy said of the early runs via the long ball. "To get some early run support, it makes life a lot easier. We had some good at-bats early there; the guys did a nice job tonight."
None nicer than Lincecum, who's appreciative of his current streak after a couple of forgettable seasons.
"I know how hard it is to get to that point," Lincecum said. "You never take it for granted while you're in it; you just try and ride it as long as you can. I'm going to ride this wave as long as it goes."
Ryan Hood is an associate reporter for MLB.com. Follow him on Twitter @ryanhood19. This story was not subject to the approval of Major League Baseball or its clubs.


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New Techniques to Evaluate Mitral Regurgitation
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- How to Read a Study Record
- Mitral regurgitation, or leaking of the mitral heart valve, is usually studied and assessed with an ultrasound test called a two-dimensional (2D) echocardiogram. While this test has proved very useful, technological improvements have helped researchers develop ways to study the heart valves using imaging with three-dimensional (3D) capabilities. In addition, recently developed magnetic resonance imaging (MRI) techniques may be able to provide better information about the causes and severity of the leak. Researchers are interested in testing these new techniques to determine their usefulness for patients with mitral regurgitation.
- To evaluate newer methods of studying mitral regurgitation severity using real-time 3D echocardiography (RT3DE) and cardiac magnetic resonance imaging (CMRI).
- Individuals at least 21 years of age who have been diagnosed with more than mild mitral regurgitation.
- Participants will have two procedures as part of this study: an echocardiogram and an MRI scan.
- For the echocardiogram, participants will have an ultrasound scan with a special kind of probe. Participants may also receive an injection of a contrast agent to provide a better image of the heart on the scan. The scan will take approximately 1 hour to complete.
- For the MRI scan, participants will have a standard MRI with special pads placed on the chest to provide better imaging of the heart. The scan will usually take between 45 and 90 minutes to complete.
|Mitral Valve Regurgitation
|Study Type:
|Study Design:
|Time Perspective: Prospective
|Official Title:
|New Techniques to Evaluate Mitral Regurgitation
|Study Start Date:
|January 29, 2010
Echocardiography is currently the technique of choice to assess the etiology and severity of mitral regurgitation (MR). Multiple 2D and Doppler parameters are assessed in an integrated fashion and the proximal flow convergent zone of the mitral regurgitation jet is used to calculate effective regurgitant orifice area and regurgitant volume. These measurements have been shown to have important prognostic information. In the last two years, the development of transesophageal imaging with 3D capability has allowed a better visualization of mitral leaflet pathology. Color Doppler 3D studies have shown that 2D methods generally underestimate mitral regurgitant volume. Magnetic resonance techniques have recently been developed to quantitate flow and calculate regurgitant volumes.
The purpose of this study is to evaluate newer methods of quantitating mitral regurgitation severity using real-time 3D echocardiography (RT3DE) and cardiac magnetic resonance imaging (CMR). Although RT3DE measurements have been shown to correlate well with CMR measures of LV volumes, using a 3D volumetric method to calculate mitral regurgitant volumes has not been well studied. In patients with more than mild mitral regurgitation, we will obtain transthoracic RT3DE measures of mitral regurgitant volume and compare them with traditional 2D measures of MR severity. We will also compare RT3DE and CMR measures of mitral regurgitant volume.
|Ages Eligible for Study:
|21 Years and older (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
- Adult patient, age greater than or equal to 21 years
- Able to give written informed consent
- Prior cardiac testing clinically read as having greater than mild MR
- Atrial fibrillation or other irregular rhythm that would preclude adequate 3D image acquisition
- History of valve surgery or significant valve disease other than mitral regurgitation
- Patients with pacemakers, defibrillators, cerebral aneurysm clips, neural stimulators, ear implants or other clinical contra-indications for magnetic resonance scanning will be excluded from the CMR portion of the study
- Any unstable condition that would make additional imaging time inadvisable (in the opinion of the investigator or managing physician)
- Pregnant or lactating women
Please refer to this study by its ClinicalTrials.gov identifier: NCT01063322
|United States, Maryland
|Suburban Hospital
|Bethesda, Maryland, United States, 20814
|National Institutes of Health Clinical Center, 9000 Rockville Pike
|Bethesda, Maryland, United States, 20892
|Principal Investigator:
|Vandana Sachdev, M.D.
|National Heart, Lung, and Blood Institute (NHLBI)
Additional Information:
|Responsible Party:
|National Heart, Lung, and Blood Institute (NHLBI)
|ClinicalTrials.gov Identifier:
|NCT01063322 History of Changes
|Other Study ID Numbers:
|Study First Received:
|February 4, 2010
|Last Updated:
|June 30, 2017
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Heart, Lung, and Blood Institute (NHLBI) ):
Mitral Regurgitation
Cardiac Magnetic Resonance
Regurgitant Volume
Mitral Valve Regurgitation
Additional relevant MeSH terms:
Mitral Valve Insufficiency
Heart Valve Diseases
Heart Diseases
Cardiovascular Diseases
ClinicalTrials.gov processed this record on September 25, 2017


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A Study of Dalcetrapib in Patients With Stable Coronary Heart Disease, With Coronary Heart Disease Risk Equivalents or at Elevated Risk for Cardiovascular Disease
This study has been completed.
Hoffmann-La Roche
Information provided by (Responsible Party):
Hoffmann-La Roche
ClinicalTrials.gov Identifier:
First received: January 13, 2012
Last updated: November 1, 2016
Last verified: November 2016
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- No Study Results Posted
- Disclaimer
- How to Read a Study Record
This multicenter, randomized, double-blind, placebo-controlled, parallel-group study will evaluate the potential of dalcetrapib to reduce cardiovascular morbidity and mortality in patients with stable coronary heart disease (CHD), with CHD risk equivalents or at elevated risk for cardiovascular disease. Eligible patients will be randomized to receive either dalcetrapib 600 mg orally daily or placebo orally daily, on a background of contemporary, guidelines-based medical care. Anticipated time on study treatment is 4 years.
|Cardiovascular Disease, Coronary Heart Disease, Dyslipidemia, Peripheral Arterial Disease (PAD)
|Other: Background care Drug: Placebo Drug: dalcetrapib
|Phase 3
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
|Official Title:
|A Phase 3b, Multi-Center, Double-Blind, Placebo-Controlled, Parallel Group, Study to Evaluate the Effect of Dalcetrapib 600 mg on Cardiovascular (CV) Events in Adult Patients With Stable Coronary Heart Disease (CHD), CHD Risk Equivalents or at Elevated Risk for Cardiovascular Disease (CVD).
Resource links provided by NLM:
MedlinePlus related topics: Coronary Artery Disease Heart DiseasesU.S. FDA Resources
Further study details as provided by Hoffmann-La Roche:
Primary Outcome Measures:
- Time to first occurrence of any component of the composite cardiovascular event (cardiovascular mortality and morbidity) [ Time Frame: approximately 4 years ]
Secondary Outcome Measures:
- All cause mortality [ Time Frame: approximately 4 years ]
- Safety: Incidence of adverse events [ Time Frame: approximately 4 years ]
- Change in blood lipid and lipoprotein levels [ Time Frame: from baseline to 12 months ]
|Study Start Date:
|January 2012
|Study Completion Date:
|July 2012
|Primary Completion Date:
|July 2012 (Final data collection date for primary outcome measure)
|Assigned Interventions
Experimental: Dalcetrapib
Dalcetrapib 600 mg orally daily on a background of contemporary, guidelines-based medical care.
Other: Background care
Guidelines-based medical careDrug: dalcetrapib
600 mg orally daily
Placebo Comparator: Placebo
Placebo orally daily, on a background of contemporary, guidelines-based medical care.
Other: Background care
Guidelines-based medical careDrug: Placebo
Matching dalcetrapib placebo orally daily
|Ages Eligible for Study:
|45 Years and older (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Adult patients, >/= 45 years of age
- Established cardiovascular disease A stable coronary disease B cerebrovascular disease C peripheral artery disease
- Without established coronary disease D pharmacologically treated type 2 diabetes mellitus and one or more risk factor(s) for cardiovascular disease E 3 or more risk factors for cardiovascular disease
- Receiving evidence-based medical and dietary management of dyslipidemia
Exclusion Criteria:
- Occurrence of myocardial infarction, hospitalization for unstable angina, stroke or revascularization (coronary, carotid or peripheral) within three months prior to randomization
- Uncontrolled hypertension
- Uncontrolled diabetes
- Concomitant treatment with any other drug raising HDL-C
- Previous treatment with compounds targeting cholesteryl ester transfer protein (CETP)
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: NCT01516541
Show 241 Study Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01516541
Show 241 Study Locations
Sponsors and Collaborators
Hoffmann-La Roche
|Study Director:
|Clinical Trials
|Hoffmann-La Roche
More Information
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on September 21, 2017
|Responsible Party:
|Hoffmann-La Roche
|ClinicalTrials.gov Identifier:
|NCT01516541 History of Changes
|Other Study ID Numbers:
2011-001891-21 ( EudraCT Number )
|Study First Received:
|January 13, 2012
|Last Updated:
|November 1, 2016
Additional relevant MeSH terms:
Cardiovascular Diseases
Heart Diseases
Coronary Disease
Coronary Artery Disease
Myocardial Ischemia
Peripheral Arterial Disease
Peripheral Vascular Diseases
Lipid Metabolism Disorders
Metabolic Diseases
Vascular Diseases
Arterial Occlusive Diseases
Anticholesteremic Agents
Hypolipidemic Agents
Molecular Mechanisms of Pharmacological Action
Lipid Regulating Agents
ClinicalTrials.gov processed this record on September 21, 2017


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Chili to heat up Moose Lodge Oct. 13
The Local Heroes Chili Cook-off will take place from noon-3 p.m. Oct. 13 at the Oak Island Moose Lodge. Local fire, rescue and police departments, along with the US Coast Guard, will be competing for the title of "The Best Chili in Town."
Tickets on now sale for $10 each. Children 12 and younger are admitted free. Be sure to get $2 off coupons at the Southport-Oak Island Chamber of Commerce and First Citizens Bank, Oak Island branch.
Sept. 29 dinner benefits charity fund
The Knights of Columbus Our Lady of the Rosary Council 9039 in Shallotte will serve a comfort food dinner to benefit the council's charity fund from 6-7 p.m. Sept. 29 at Saint Brendan the Navigator Roman Catholic Church, 5101 Ocean Highway W. in Shallotte.
The menu will consist of Swiss steak, mashed potatoes, green peas, a green salad, fresh baked bread, carrot cake and iced tea, hot tea or coffee. Cost is $13 per person. Dine in or take-out available.
Shriners to have yard sale on Sept. 15
Members of the South Brunswick Shrine Club will host a community-wide yard sale from 9 a.m.-4 p.m. Sept. 15 at the South Brunswick Island Shrine Club, 4911 Old Shallotte Road in Shallotte. Families in the greater Brunswick County area are invited to participate in this opportunity to clean out that garage or attic and turn unwanted items into extra cash.
Come eat with local Shriners July 28
The South Brunswick Islands Shrine Club's Butterbean Festival will take place July 28.
Social hour is from 6-7 p.m. and dinner begins at 7 p.m. and consists of fried chicken, butterbeans, desserts and a cash bar. Cost is $10 per person or $15 a couple.
An auction will start at 8 p.m. and will include leather furniture, exercise equipment and many more items to benefit South Brunswick Islands Shrine Club.
Flotilla meeting set for July 24
The U. S. Coast Guard Auxiliary's July flotilla meeting has been rescheduled. This month only, the meeting will be at 7 p.m. on the fourth Tuesday, July 24, at the Coast Guard Station on Oak Island, Caswell Beach.
Two more safe boating courses (ABS) are being offered this year: Saturday, Aug. 4, and Saturday, Sept. 15. Call Fred Robertie at (910) 754-3629 for details.
Ladies Auxiliary to the Veterans of Foreign Wars (VFW) Post 7288 in Calabash members Janice Butterworth, Nancey Earney, Joan Elmeier, Barbara Hertline, Marlene Lidgard and Fran Redfield attended the North Carolina VFW Department Convention in Raleigh June 14-17.
The members attended council and business meetings and program awards sessions, served as pages for the department guard and floor members, voted on department resolutions and participated in the nomination and elections of new department officers for 2012-2013.
Don Eggert was awarded a Melvin Jones Fellowship (MJF) with Lions Clubs International Foundation (LCIF) at the June meeting of the Shallotte Lions Club.
As recognition of humanitarian work, an MJF is awarded to those who donate $1,000 to LCIF or to people for whom a donation was made by others, such as the local club.
Knights of Columbus elect 2012-13 officers
At the May 14 council meeting, members of Our Lady of the Rosary Council 9036 elected the following Knights officers for the fraternal year 2012- 2013:
Grand Knight: John Yencik
Deputy Grand Knight: Richard Rismiller
Chancellor: Richard Lombardo
Warden: Paul Murnane
Advocate: William Anstock
Treasurer: Paul Lombardi
Recorder: Robert Houser
Inside Guard: Thomas Smed
Outside Guard: Thomas Davin
The South Brunswick Islands (SBI) Rotary Club awarded several scholarships to seniors from West Brunswick High School. The scholarships were awarded to Corryn Diemer, Greg Hensley, Daniel Hernandez, Mary Amron Lee, Mary Britt Nelson, Nicole Turner and Darius Williams.
In past years, the club awarded three $1,000 scholarships to area seniors. The applicants for this year's scholarships were so outstanding the Rotarians who interviewed the applicants asked fellow club members to find a way to award more than three scholarships.
Landis installed as GFWC-NC secretary
Ann Landis was installed as the GFWC-NC recording secretary at the 110th annual convention of the General Federation of Women's Clubs-North Carolina (GFWC-NC) in Greensboro and will serve in the 2012-2014 administration. Landis was the organizing member and past two-term president of the GFWC of Holden Beach.
Copyright © 2017
The Brunswick Beacon is your source for local news, sports, events and information in Brunswick County, North Carolina and surrounding areas.


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And, of course, the fine print:
Get free shipping on your next order when you spend over $100. The discount will be automatically applied to your purchase; no promo code required. The subtotal of your purchase must be $100.01 or greater after any promotional discounts have been applied. Additional fees such as tax or shipping and handling do not apply toward your minimum subtotal requirement of $100.01. Offer applies to standard shipping only. Certain items that require additional shipping and handling are excluded from this promotion and do not apply towards your $100.01 subtotal minimum. Offer subject to change.
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Measures approximately 18" x 24". Machine wash cold; hang dry or tumble dry on low.
This product ships from the maker within 7 days, via USPS
If you're not happy with this item for any reason, you may return it for a full refund within 14 days.


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IF I CAN'T HAVE YOU THEN NOBODY CAN Plays Additional Show to Benefit St. Jude's Children's Research Hospital, 12/15
Tyrone Lowman bursts on the New York scene as a leading African-American playwright with his new play, If I Can't Have You Then Nobody Can. The overwhelming response already received has promoted an additional performance.
Ty Lowman has become a respected author by taking pages from the bible and writing them in a harsh, modern voice. The acclaim this latest play garnered out-of-town has prompted a New York limited run. But it doesn't stop there. The positive energy of this run opens the door for the rest of Ty Lowman's to premiere in NYC: What Kind Of Love Is This? about infidelity; Lord, Make Me Over, focusing on one man's drug-fueled inner turmoil; and He's Still a Man, about a pastor and his own sins of the flesh.
IF I CAN'T HAVE YOU... concerns Dorian Phillips (Victor Landol) – loved by his family and respected by his community. Until his secret of years before comes knocking at his door... and that secret wants him back at any cost!
The New York cast includes Ron Denson, Alyssa Baines, Casandra King, Eugene Daniels, and Taeshia Francis.
Special Benefit Showings on Saturday, December 15, 2012 at 3:00 p.m., 5:00 p.m. and 8:00 p.m. at The Sonnet Theater at The Producers Club, 358 West 44th Street in New York City. Tickets are $25 in advance / $30 at the door. A portion of the proceeds will be donated to St. Jude's Children's Research Hospital.


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Tissue Engineered Nasal Cartilage for Regeneration of Articular Cartilage (Nose2Knee)
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- How to Read a Study Record
|Cartilage Lesion Degenerative Lesion of Articular Cartilage of Knee
|Biological: Tissue engineered cartilage graft
|Phase 1
|Study Type:
|Study Design:
|Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:
|Tissue Engineered Nasal Cartilage for Regeneration of Articular Cartilage in the Knee After Traumatic Injury - a Phase I Clinical Trial-
- 1-Safety for the patient [ Time Frame: until 24 months ]Safety will be assessed by the incidence of adverse reactions and adverse events. Expected postoperative complications also occurring in the standard procedure are: pain, swelling and hematoma, casually post-anesthetic nausea, vomiting or fever.
- 2- Stability of the graft [ Time Frame: until 24 months ]It will be assessed by Magnetic Resonance Imaging (MRI) technique at 6, 12 and 24 months indicating if the graft is in place and if there are signs of complications. Parameters to be evaluated are: filling of the defect, integration of the border zone to the adjacent cartilage, intactness of the subchondral lamina, intactness of the subchondral bone, and relative signal intensities of the repair tissue compared to the adjacent native cartilage.
- Subjective pain relief [ Time Frame: until 24 months ]Subjective relief of pain for the patient will be assessed using the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package which includes the pre- and postsurgical evaluation of general medical conditions, pain, activity level as well as functional and morphological status.
|Study Start Date:
|May 2012
|Estimated Study Completion Date:
|November 2018
|Estimated Primary Completion Date:
|November 2017 (Final data collection date for primary outcome measure)
|Assigned Interventions
|Experimental: Implantation of cartilage graft
Biological: Tissue engineered cartilage graft
Autologous nasal chondrocytes expanded in vitro and cultured in a collagen type I//III scaffold
Detailed Description:
Articular cartilage injuries are a prime target for regenerative techniques, since spontaneous healing is poor and untreated defects predispose to osteoarthritis. Common current strategies such as arthroscopic debridement, microfracture, autologous osteochondral grafting, use of allografts and autologous chondrocytes implantation (ACI) still have drawbacks such as long and complex rehabilitation times, technically challenging operation techniques, defect-size limitations, donor-site morbidity, limited graft material and high costs. Furthermore many techniques show unsatisfactory long term results due to inferior quality of repair tissue as compared to native cartilage or have yet to prove the cost versus benefit. These drawbacks could be overcome by using a tissue engineered nasal cartilage graft, thereby reducing donor site morbidity without introducing additional risk of complication or technically challenging techniques.
This study is a phase I, prospective, uncontrolled, investigator initiated clinical trial involving 25 patients, with the objective of demonstrating safety and feasibility in the use of engineered nasal cartilage grafts for repair of articular cartilage. The specific surgical target of the trial is the repair of one or two full-thickness cartilage defects from 2 cm2 to 8 cm2 (per lesion, not exceeding a total of 8 cm2 for all lesions) due to traumatic injury on the femoral condyle and/or trochlea of the knee.
|Ages Eligible for Study:
|18 Years to 55 Years (Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Size of the defect on the femoral cartilage:one or two symptomatic lesion(s) grade III-IV from 2 cm2 to 8 cm2 at the femoral condyle and/or trochlea
- Other:
- Age: 18-55 years
- Written informed consent by the patient
Exclusion Criteria:
- Lesions smaller than 2cm2 or greater than 8cm2
- Total area of all lesions bigger than 8cm2
- Lesions other than on the femoral condyle and/or trochlea
- Any evidence of the following diseases in the target joint: septic arthritis; inflammatory joint disease; gout; recurrent episodes of pseudogout; Paget disease of bone; ochronosis; acromegaly; hemochromatosis;Wilson disease; primary osteochondromatosis; heritable disorders; collagen gene mutations
- Presence of a clinically relevant cartilage lesion on the patella (second lesion)
- Patellofemoral cartilage lesion
- Presence of relevant complex knee injuries affecting bone and/or ligaments
- Osteochondritis dissecans: recent (within 1 year before baseline); depth of lesion >0.5 cm; subchondral sclerosis
- Advanced osteoarthritis (as defined by Radiographic Atlas of Osteoarthritis, grade 2-3)
- Varus or valgus malalignment exceeding 5° (kissing lesions out)
Medical history:
- gravidity (Pregnancy)
- breast feeding
- presence of multiple severe allergies (including porcine collagen, streptomycin and penicillin)
- Osteoarthritis
- Current diagnosis of osteomyelitis
- Any clinically significant or symptomatic vascular or neurologic disorder of the lower extremities
- A blood result showing liver enzymes (serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, alkaline phosphatase) of more than 2 times the upper limit of normal or any other result that in the clinical investigator's mind is clinically important
- C-reactive protein level greater than 10 mg/L
- Uncontrolled diabetes
- Renal insufficiency
- Previous pacemaker implantation
- Any concomitant painful or disabling disease of the spine, hips, or lower limbs that would interfere with evaluation of the afflicted knee
- Mosaicplasty (osteochondral autograft transfer system)
- Microfracture performed less than 1 year before baseline
- Received hyaluronic acid intra-articular injections into the afflicted knee within the last 6 months of baseline Meniscal transplant (previous/present)
- Meniscal suture with meniscal arrows ipsilaterally (present or previous if not resorbed)
- Taking specific osteoarthritis drugs, such as chondroitin sulfate, diacerein, n-glucosamine, piascledine, and capsaicin, within 2 weeks of the baseline visit
- Corticosteroid therapy by systemic or intra-articular route within the last month of baseline or intramuscular or oral corticosteroids within the last 2 weeks of baseline
- Chronic use of anticoagulants
- Patients with human immunodeficiency virus, hepatitis, or syphilis
- Malignancy
- Alcohol and drug (medication) abuse
- Poor general health condition as judged by investigator
- Body mass index >35 kg/m2
- Medication:chronic treatment with steroids or growth factors (immunomodulatory drugs)
- Participation in concurrent clinical trials
- Participation in a previous clinical trial within 1 year
Please refer to this study by its ClinicalTrials.gov identifier: NCT01605201
|University Hospital Basel
|Basel, Switzerland, 4031
|Principal Investigator:
|Marcel Jakob, Prof. Dr.
|University Hospital, Basel, Switzerland
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
|Responsible Party:
|University Hospital, Basel, Switzerland
|ClinicalTrials.gov Identifier:
|NCT01605201 History of Changes
|Other Study ID Numbers:
TpP-I-2012-001 ( Other Identifier: Swissmedic )
|Study First Received:
|May 22, 2012
|Last Updated:
|September 1, 2017
Keywords provided by University Hospital, Basel, Switzerland:
Chondral lesions in the knee after traumatic injury
ClinicalTrials.gov processed this record on September 21, 2017


text:
Reading Ajahn Chah, he mentions that the Buddha "stopped thinking". How is this to be understood in the Theravada framework? I am still very new to Pali terms, abhidammma and commentary and so on, and often the original term (in this case) has not been provided. Any insights, suttas, abidhamma, commentary passages that would help me understand would be greatly appreciated. I want to deepen my understanding of the Theravada philosophical framework.
My initial thoughts would be that because he no longer clings to the Khandhas, no Sankharas arise, and yet he does not wink out of existance at the moment of Awakening, because we say that there is Nibbana "with remainder". Why is there no thinking then?


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text:
From our September 11th event at La Pena commemorating the 40th anniversary of the coup in Chile.
Isabel Allende 9 11 2013 - English from Freedom Archives on Vimeo.
Isabel Allende 9 11 2013 - Spanish from Freedom Archives on Vimeo.___________________________
Preserve the past – illuminate the present – shape the future
Publications: Audio, Video, and Books
Rest in Power
Hugo Pinell - Rest in Power
New George Jackson Video and audio!
For Love and Liberty
Mabel Williams,
Chokwe Lumumba, presente!
Other News
Read a web version of Out of Control here!


text:
The new Polyamory Weekly #141: You're Fat, redux is up! Direct download is at Poly Weekly #141
Subscribe now with iTunes one-click!
Please Digg this podcast at Digg's PW podcast page!
0:00 Introduction and host chat
Intro, under-18 warning and re-direction to www.scarleteen.com; friend me on Twitter and answer questions about what you want on the show, call 206-202-POLY with comments or discuss your own topics at the new FORUMS at http://forum.polyweekly.com.
2:00 Announcements & Promo stuff
- Don't forget to check out the new Poly Weekly forums to sound off!
- Many Loves Seminar on February 16 at the Center on Halsted, Chicago, IL, $15
- I'll be at Conflation, the Firefly-themed relax-a-con next weekend
- Review of the first meeting of the Poly Weekly book club! We decided to meet again next month to finish our discussion of Ravenscroft's Polyamory: Roadmaps for the Clueless and the Hopeful next month, Wednesday, February 27th, at the Center on Halsted in Chicago, 6:00-9:00 p.m., on the second floor by the white couches
8:50 Topic: You're Fat!, redux: How much honesty is too much honesty?
- First type of response: society is wrong (she shouldn't have to lose the weight; he should still find her attractive; as a culture, we're overweight)
- 17:30 Second type of response: try the indirect approach; use positive reinforcement (invite your partner on your walks
- 20:00 Third type of response: find out what's at the root of the weight gain (depression, poor self-esteem) and address that; there is usually a reason people stop taking care of themselves; consider that this is affecting the sexual desire of both partners, not just the man;
- 26:00 Fourth type of response: if you have built trust with your partner, you can bring up any issue, even weight gain (if you have a history of bringing up difficult issues for the good of the relationship, your partner will have faith in you in this, too)
34:50 Wrap-up
Questions? Comments? Feedback? Email firstname.lastname@example.com or call the listener comment line at 206-202-POLY. And hey, why not attach an audio comment to that email? 🙂 Check out PolyWeekly at polyweekly.libsyn.com. Thanks for listening!
Related Posts
Commenting area
This website should be required reading for any conversation surrounding this issue:
"But Don't You Realize Fat Is Unhealthy?"
I enjoyed the show and left a voice comment. But this one works better as a post. There is a great discussion of this exact topic here: http://laurietobyedison.com/discuss/?p=459 I'd recommend it highly.


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Tejada returns to bench after starting Saturday
Miguel Tejada was back on the bench Sunday after a two-RBI game Saturday in his first start with the Royals. Tejada will turn 39 in May and his return to the Majors was certainly a question mark, but manager Ned Yost said Sunday he's been "a great addition" so far. Yost said he's not worrying about mixing Tejada into certain spots; he's confident the veteran infielder can help wherever he's needed.
"He's a bona fide player coming off the bench," Yost said. "With all the left-handed hitters in our infield, the fact that he can mix in at every position and do so efficiently is a big thing for us. He's ready to do whatever we need him to do."
Kevin Roberts is a contributor to MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


text:
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- No Study Results Posted
- Disclaimer
- How to Read a Study Record
|Study Type:
|Study Design:
|Observational Model: Cohort
Time Perspective: Prospective
|Official Title:
|Sex Differences in Vascular Markers of Stroke Risk
- Carotid intimal medial thickness (IMT) and 10-year cardiovascular risk assessment. The primary analysis will focus on gender differences. [ Time Frame: 3 years ]
- Brachial artery flow mediated dilation (BAFMD) and ankle-brachial index (ABI) [ Time Frame: 3 years ]
Biospecimen Retention: Samples With DNA
|Study Start Date:
|February 2008
|Study Completion Date:
|January 2013
|Primary Completion Date:
|January 2013 (Final data collection date for primary outcome measure)
Men and women with 1 or more cardiovascular risk factors
Detailed Description:
Men and women with stroke have different risk factor profiles. Women tend to develop stroke risk factors, subclinical disease, and have vascular events following menopause, presumably related to the depletion of estrogen. Men, however, tend to develop vascular disease at a younger age. Sex differences in subclinical disease are poorly understood. Identification of subclinical disease could lead to more aggressive interventions to prevent stroke and other vascular events.
The objectives of this study are to quantify and compare vascular function in men and women by measuring carotid atherosclerosis, endothelial dysfunction, and ankle-brachial index and then to determine the effect of age, race-ethnicity, cardiovascular risk factors, biological markers and hormonal markers on these vascular measures to determine gender-specific models. The aims of this project are to determine if middle-aged men and women at risk for stroke have differences in functional and structural vascular assessments, and to develop comprehensive vascular health profiles in men and women.
In this trial, researchers will use a cross-sectional design to study gender differences in vascular functions and other vascular risk factors in 150 women and 100 men with 1 or more cardiovascular risk factors but without evidence of stroke, heart disease, or peripheral vascular disease. Participants will be divided in two age groups: 45 to 54 and 55 to 64 and will be followed for two years for vascular outcomes, such as stroke, transient ischemic attack or TIA, or acute coronary syndromes.
Information from this study will help develop a comprehensive gender-specific model of subclinical disease, discover novel biological and vascular markers for stroke, and provide critical data to be used in future studies aimed at slowing progression of vascular dysfunction and preventing stroke.
|Ages Eligible for Study:
|45 Years to 65 Years (Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
|Sampling Method:
|Non-Probability Sample
Inclusion Criteria:
One or more cardiovascular risk factors
- non-insulin dependent diabetes
- hypertension
- hyperlipidemia
- metabolic syndrome, (NCEP ATPIII criteria)
- tobacco smoking
Exclusion Criteria:
- history of prior stroke (ischemic or hemorrhagic)
- known carotid stenosis
- peripheral vascular disease
- coronary heart disease
- venous thromboembolism
- polycystic ovarian syndrome,
- morbid obesity (BMI > 45 kg/m2)
- women using hormone therapy (hormone replacement, contraceptive pills or patches)
Please refer to this study by its ClinicalTrials.gov identifier: NCT00681681
|United States, North Carolina
|Wake Forest University Health Sciences
|Winston-Salem, North Carolina, United States, 27157-1043
|Principal Investigator:
|Cheryl Bushnell, MD
|Associate Professor, Department of Neurology, Wake Forest University Health Sciences
|Responsible Party:
|Cheryl Bushnell, Associate Professor of Neurology, Wake Forest School of Medicine
|ClinicalTrials.gov Identifier:
|NCT00681681 History of Changes
|Other Study ID Numbers:
K02NS058760 ( U.S. NIH Grant/Contract )
IRB00004014 ( Other Identifier: Wake Forest University Health Sciences )
K02NS058760-01A1 ( U.S. NIH Grant/Contract )
|Study First Received:
|May 19, 2008
|Last Updated:
|December 10, 2014
Keywords provided by Cheryl Bushnell, Wake Forest School of Medicine:
vascular marker
stroke risk
risk factors
sex differences
Additional relevant MeSH terms:
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
ClinicalTrials.gov processed this record on September 21, 2017


text: When he steps down as commissioner of baseball, how do you think Selig will be remembered? The most forward thinking and innovative commissioner ever? The destroyer of years of tradition? Reigning over the sport during it's most successful attendance years ever? Reigning over a sport during an era that is entirely tainted?


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I'm pretty new to discgolf and struggling quite a bit to throw RHBH. The problem is, that i'm not able to throw controlled and powerfull at the same time, hence i'm usually only using it for putting. Of course, i need to work on this but nevertheless i would like to have an understable disc for RHFH to be able to throw left curved long range. I'm not throwing very powerfull, hence i would also like to have a disc with decent gliding properties.
Currently considering a Innova Monarc/Mamba or a Discgolf Stratus/Glide and would be happy to get some advice.


text:
The Geneseo Migrant Center provides a variety of services to migrant farmworkers residing in the immediate geographic area as well as coordinating programs on a regional, statewide, and national level to benefit migrant farmworkers and their families.
The Geneseo Migrant Center, a division of the Genesee Valley Educational Partnership, also operates as a registered nonprofit 501(c)(3) entity known as the Geneseo Migrant Center, Inc. (GMC, Inc.). This dual identity has allowed the Center the flexibility to serve migrant farmworker families through financial support from federal and state governments, as well as corporate and private sources.
|"Let migrant farmworkers live and work
with the dignity befitting the importance of their task."
|Dr. Gloria Mattera, Founder
The Geneseo Migrant Center provides a variety of services and opportunities for migrant farmworkers and their families on a regional, statewide, and national basis to encourage and assist them in achieving their full potential.
The Center is committed to promoting equity for migrant farmworkers and their families by valuing diversity, understanding the importance of their work, advocating on their behalf, and identifying and addressing the ongoing and emerging needs of the migrant population.
El Centro Migrante de Geneseo provee una variedad de servicios y oportunidades a trabajadores del campo migrantes y a sus familias a nivel regional, estatal y nacional para animarlos y ayudarles a alcanzar su pleno potencial.
El Centro está determinado a promocionar la igualdad de los trabajadores del campo migrantes y de sus familias, entendiendo la importancia de su trabajo, abogando por su bien, e identificando y estudiando las necesidades actuales y emergentes de la población migrante.


text:
|February 21, 2001
Volume 3, Issue 8
|Midwifery Today E-News
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Quote of the Week:
"There has never been any public outcry against the routine practice of separating newborn babies from their mothers, despite the fact that it has never been shown to be either safe or healthy for either mothers or babies."
- Suzanne Arms
The Art of Midwifery
One way midwives can facilitate strengthening the bond between the growing baby and the family: using a laundry marking pen, draw a picture of the baby on the mom's tummy, overlying the baby's actual position. Midwives can use this opportunity to teach about the usual positions of babies. Drawing the baby larger at serial visits is a concrete way for the family to track the growth of the baby. It helps partners and kids understand why mom looks the way she does, and gives them a visual way of identifying with the somewhat mysterious hidden little being inside.
- Sharon Glass Jonquil, Midwifery Today Issue 2
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News Flashes
A study funded by the Agency for Healthcare Research and Quality has determined that nearly one-quarter of women who undergo cesarean delivery may have had the procedure too early in their labor. Of the one million cesarean deliveries performed annually in the United States, about 294,000 are done because of lack of progress in labor. The up to 24 percent who had the surgery performed too early were dilated between 1 and 3 cm, which is contrary to the recommendation of the American College of Obstetrics and Gynecology that the cervix should be dilated to 4 cm or more before the diagnosis is made.
Each Issue of Midwifery Today Magazine is a new book for your library!
A review of 17 controlled studies conducted between 1975 and 1985 compared newborn infants in the hospital who had routine contact with their mothers with those receiving additional contact. In 13 studies the additional contact occurred only during the first hour of life; 9 of these noted significant positive differences in the later behaviour of the mothers toward their infants. In the four studies in which the extra contact extended through the first three days of life, the mother-child relationship was measurably better in quality for the extra-contact infants than for the control infants at one month, one year and two years of age. Increased contact at any time during the first three days after birth (when the mother and baby spend this time in the hospital) produces a long-term improvement in the quality of the relationship between mother and child. Increased contact may in part make up for the marked deprivation that is a part of current routines in modern hospitals. There is some evidence that this, with the additional deprivation of insufficient contact, can have serious consequences for the child--both child abuse and failure to thrive without organic cause are found more frequently in infants who have been separated from their parents immediately after birth. A more recent review of 29 random control trials between 1972 and 1985 of restrictive versus unrestrictive mother-infant contact in the immediate postpartum period found strong evidence that restricting contact significantly reduced both subsequent maternal affectionate behaviour and subsequent breastfeeding.
- Marsden Wagner, Pursuing the Birth Machine, Ace Graphics, 1994.
Do fragile babies need incubators at all? One doctor working in an African hospital, where there were none, found that the mother herself made a perfect incubator--warm, soft, food on tap, the ever present comfort of the familiar heartbeat. This doctor saved 90% of babies as small as 4 pounds. Contrast this with the well-established research findings that mothers of babies spending time in neonatal care units find it more difficult to bond with their babies, suffer more postnatal depression, are still talking to their babies less a year later, and are more likely to batter those children.
Medicalised childbirth itself fills the intensive care cots by creating damaged babies: for example, babies born with respiratory distress syndrome caused by premature induction; ceasarean babies denied the positive benefits of the stress of vaginal birth; babies starved of oxygen--induced contractions; babies born floppy and full of artificial drugs. Babies deprived of the stress of normal birth are also deprived of B-endorphin needed to fall in love with their mother and learn their new environment.
- Margaret Jowitt, Childbirth Unmasked, Hartnolls Ltd. 1993.
The newborn can serve as a caregiver to its mother in a most essential and critical way. The mother and infant share a common need for generalized peristalsis during the first days following delivery, but particularly during the first few hours. If the newborn is permitted to nurse shortly after delivery, the flow of oxytocin is released, which in turn stimulates the letdown process, a form of peristalsis. Oxytocin is well known to stimulate uterine contractions, which are necessary to minimize the danger of postpartum hemorrhage and facilitate involution of the uterus. Sucking also promotes prolactin. Thus the nursing activity of the newborn not only facilitates the establishment of lactation but also serves to promote a state of equilibrium and physiological heaing in the mother.
- Ruth D. Rice, Ph.D. in 21st Century Obstetrics Now! NAPSAC, 1977.
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Question of the Week
Does anyone know the story on short umbilical cords? And how short is too short to deliver vaginally? Is it genetic, does it run in families, is it likely to occur more than once, is it nutrition-related, is it avoidable? I've known two ladies to have very short cords and they are afraid to attempt a vaginal delivery again.
- Amy Jones
Send your responses (with "Question of the Week" in the subject line) to:
E-News Readers Speak Out on Bonding
Following are a question about bonding sent in by an E-News reader and answers offered by other readers.
A pregnant friend believes that if she cannot stay home all of the first 6 years of a child's life, she should work the first, and stay home the next 3 because the baby won't notice that she's gone in the first years of life. My response is emotional and moral, not scientific at all. I hesitated to tell her my opinion, deferring instead to what studies may have been done on the impact of leaving a child in early years. Have you heard anything, read any books or studies on this topic?
- Margaret Wallis
I once had a discussion with a friend who was the director of a private school. She said many parents put their children into private school for their high school years, hoping to get them into a good college. She felt this was going backward. If they were in private school for the lower grades, they would get a good base, good study skills and do well in the higher grades where ever they were. Well, I took that advice with my second daughter. She was in private school through 8th grade. She is now in public high school and tells me that in some classes, she is the only one who does homework. She has seen the difference.
Where am I going with this? If this mom stays home during the first three years when this baby is developing faster than she/he ever will again, her baby will have a stronger bond with its mom. The baby will develop a strong sense of trust, a solid base, so that when the mom does return to work, the baby will have grown to the stage where he/she wants to be more independent.
- Roni M. Chastain, RN, LCCE, FACCE
I would recommend reading psychological writing by John Bowlby and other
attachment theorists. These researchers have studied early bonding and
infant deprivation. Specifically, I suggest the book "A
Secure Base" by Bowlby. Research done by Mary Ainsworth, Ana
Freud, and Bowlby clearly indicates that the first years are the critical
years in bonding and maternal infant bonding. Also share with this mother
that three-year-old children are developmentally ready for socialization
and some early peer relationships much as they would get in a daycare
situation; infants are not. Most developmental psych research will get
you to this point.
Please see two articles: Mothering Magazine Issue No. 74 "The Needs of Children" by Paul Klein, and "The Infant Daycare Experiment" in Mothering Magazine (don't know the issue number). Find them at www.mothering.com
- Anon.
The study of how babies experience pregnancy and birth has been ongoing for many years now: Otto Rank published "The Trauma of Birth" in 1929, in which he explored the long-term impacts of the experiences of pregnancy and birth on the psyche, and many other psychologists, psychiatrists and researchers have continued to explore this realm. There is now quite a body of solid scientific research demonstrating, for example, that twins develop a relationship style in utero that continues through their childhood, that fetuses whose eyelids are fused shut can either evade or bat away the amniocentesis needle, that children act out their births in their play and develop lifestyles into adulthood that, to the trained eye and mind, clearly echo patterns laid down in birth.
Psychologist David Chamberlain has done a magnificent job of gathering the majority of the research from various areas of science into over 40 publications: I would refer you to his valuable book, "The Mind of Your Newborn Baby." Dr. William Emerson has spent a lifetime studying and treating infants, children and adults for prenatal and birth traumas that include abortion attempts, conception through forced sex, drug/alcohol-addicted mothers, family crises, prior pregnancy losses, etc., and those displaying signs or symptoms of having suffered from interventive, complicated and/or traumatic births.
If this woman believes her baby remembers none of its first year, she will presumably be treating the little person she is growing inside her as a non-person also, and such a welcome doesn't bode well for bonding postpartum. I wouldn't just recommend books such as Chamberlain's (and his articles "The Sentient Prenate," "The Outer Limits of Memory" and "The Cognitive Newborn: A Scientific Update"--all of which are extremely well-referenced) and Aletha Solter's "The Aware Baby," but John Kennell and Marshall Klaus's book on bonding and the video from Johnson & Johnson on "the amazing newborn."
It sounds as though she knows very little about what she's getting herself into, and maybe isn't interested, which is scary! Studies have demonstrated that babies can distinguish their mother's face from other women's faces virtually from birth; that they turn toward pads soaked in their mother's breastmilk and not toward those of other women; that adopted babies know very well that their adoptive mothers are not their biological mothers and struggle with their emotions when this is not acknowledged by the adoptive parents, especially those who assume that because they are ready to love their new baby, their baby will be equally ready to love them--rather than crying inconsolably and grieving the loss of the mother s/he has spent nine months bonding with, experiencing every emotion of the biological mother (transmitted via hormones through the blood supply).
I'm sure there are a gazillion studies out there demonstrating the suitability of breastmilk for the nourishment of infants and the inferiority of artificial substitutes. Is she planning to pump all day? And the reason human breastmilk is so low in protein and fat is to ensure that human infants are fed frequently, thereby keeping them physically close to mother and in skin-to-skin contact many times per day, thus regulating their respiratory, heart and brain rhythms by proximity to their mothers' rhythms. It is no accident that infants develop the ability to digest foods other than breastmilk at around the same time that they become more mobile and less completely dependent on their mothers--human infants need an "in-arms" period that is approximately as long again as pregnancy because they are born so early in the gestational cycle because of our erect posture and relatively small pelvises.
The primary developmental task of the newborn is to bond with its parents and siblings: to learn that it can count on its caregivers to meet its needs--not only the biological needs, but the emotional, developmental and spiritual needs of the first stage of life outside the womb. Joseph Chilton Pearce, in "Evolution's End," says: "The intelligence of the heart is not some sweet sentiment but a primary biological necessity and the foundation of all bonding.... The mother is the first teacher of the heart...." Newborn humans are not able to regulate these systems well when at a distance from their mothers, and thrive when carried or "worn" by their mothers during the first six-plus months of life. The more contact, love, and appropriate stimulation they receive, the more their neurological systems develop, the smarter, more coordinated and more "contactful" they become.
Any parent who thinks a child won't remember its experiences of pregnancy, birth and the first years of life is deluding herself and doing the child she brings into the world a horrendous disservice loaded with long-term consequences. This mom could even be setting herself up for a traumatic birth: what baby would be eager to be born to a mother who's planning to leave her/him to the care of others on a daily basis from day one? It sounds to me, as a pre- and perinatal psychotherapist, that this mom needs to take a hard look at her own prenatal and early history and resolve issues that are already affecting the life of her unborn child through her unconsciousness about the personhood of her baby.
She needs some basic education in child development, at the very least, in order to understand that breastfeeding, the production of oxytocin--the "cuddle" hormone--the introduction of solid foods and the increasing mobility and sociability of a young child are perfectly designed by nature to allow for an initial period of intense, one-on-one bonding with parents, and then increasingly long separations from mother and in the care of other familiar caregivers (day care, pre-school, kindergarten, first grade) as the child gets older. If she will read them, there is quite a list of books out there on attachment parenting that explain the rationale for this approach to new parents. If she is unwilling to be educated, she may yet surprise herself after giving birth--all that oxytocin may put a whole different spin on her willingness to leave her baby to the care of others, so it would be a shame if she prearranged her postpartum life around plans for an early return to work.
An extensive website details a lot of what I've written above and more, and provides links to authors such as David Chamberlain. The site has an extensive listing of books, journals and videotapes in the field of prenatal and birth psychology. It is at www.birthpsychology.com.
- Claire Winstone, M.A., R.C.C.
The book "Being There: The benefits of a stay-at-home parent" by Isabelle Fox, Ph.D. with Norman M. Lobsenz, ISBN 0-8120-9490-5, specifically addresses the subject of childcare based on a number of studies. The basic point of the book is that children who have substitute caregivers during the first three years of life tend to lack the ability to bond with other people for the rest of their life. The book goes into detail about many specific problems this can cause.
- Kathy, Renton, WA
Look into brain-based learning. It is fascinating and "scientific." It explains why all the things mothers do in the first few years are so important for a child's social, emotional, educational development. There are certain windows of time for children to sort of set up the connections in their brains to prepare them for future learning, relationships, etc. It is scary that most of these windows virtually close by age two to three. Encourage this friend to stay home!
- Amy D.
QUESTION OF THE QUARTER for Midwifery Today magazine
Mamatoto: Motherbaby
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?
Deadline: March 31, 2001
Send your response to:
More on apprenticeship:
There is a new organization formed to support apprenticeships. MATA's mission: Support Apprenticeship. Mission statement: To gather together and share the wisdom of those training midwives through apprenticeship; to champion apprenticeship on the institutional level; and to provide other services for apprenticeship preceptors and apprentices to help make the midwifery apprenticeship training route successful and accessible.
Interested folks can join the egroup by going to www.egroups.com and looking up Midwifery Apprenticeship Training Alliance.
- Jenny Dempsey
There should be a Midwives of North America (MANA) board position that represents the interests of apprentices, like an apprentice advocate, to be a liason for serious problems that can occur in the preceptor/apprentice relationship. MANA can't get involved in every little scrabble, but if the problem is serious enough, and especially if the apprentice has already invested a year or two into the apprenticeship, she should have some recourse if she is about to get dumped. I would also like to see the recent Midwifery Student Bill of Rights be re-worked for apprentices too.
As part of the CPM credential, the preceptor should be required to have something in writing with the apprentice after the potential apprentice has attended a few births and it looks like a relationship is developing. NARM can offer guidelines on what to include in the "contract." It should include concerns like:
Money: Is the preceptor paying the apprentice? At what point does that start and how much? Or does the apprentice have to pay the preceptor for her education, like going to school?
Responsibilities: Does the apprentice get to go to all births? Must she attend all prenatal and postpartum checks? Let the preceptor know when she won't be available. What if the preceptor has several apprentices competing for work--who gets to do what?
Education: When does the preceptor sign the CPM application? Does the apprentice have to get her own "primary" clients, or does she use the preceptor's clients? What didactic requirements are there? How and when will these be assessed and "graded"? Does the apprentice have to get outside training, such as college classes, EMT training, childbirth education or LLL training?
Time frame: When will the apprentice know she is done? Only when her preceptor says so, after her numbers are complete? What if there is a conflict here?
Are there ethical requirements for the preceptor/CPM? Can her CPM be pulled or put on probation for unethical behaviour? There needs to be some kind of consequence to both preceptor and apprentice for misconduct. Currently everything favors the preceptor. If she gets mad, the apprentice can be "dumped" from the apprenticeship for anything or nothing at all, even after several years of work. What is her recourse? There should be a grievance procedure in place for serious situations. And the apprentice should expect a fair hearing and equal playing field to air her complaints.
NARM wants to encourage future midwives to work toward and achieve their CPM credential. I think they need to be more mindful of where the future midwives and CPMs come from. Mostly, from apprenticeships. It would be helpful to these apprentices and the future of direct-entry midwifery if that special and sometimes volatile relationship could be handled more fairly.
- Vicki Johnson, former apprentice, now midwife
More on excessive bleed:
I have found that a postpartum tea brewed with shepherd's purse, false unicorn root, and a little licorice for flavor helps the mother bleed less in the weeks following delivery. However, we have to remember that often in our culture new moms do not get the support and help they need after giving birth. Most women who are bleeding for weeks and weeks after their birth are simply doing too much and need help in figuring out how to get more rest. Sometimes this means getting outside help; sometimes it is just a matter of helping them get organized and learn to let go of doing it all. Another thing I have learned is to check the mom's labwork prenatally for the platelet count. This is directly linked to her blood clotting ability. I worked with a vegan woman with a very low platelet count. She bled for a prolonged amount of time when she got a cut. We worked on her diet. She increased her protein intake and began eating eggs. Her platelet count went up and she had a beautiful homebirth with a minimum of blood loss. The best source of information on this subject was Anne Frye's book, Understanding Diagnostic Tests in the Childbearing Year. I have also used the Chinese herb yunan piao for postpartum bleeding with very good results.
- Lori Land
I was intrigued by the discussion of excessive post birth bleeding and was glad to see that someone mentioned the power of suggestion. Please do not scoff; when I first heard of this I thought "no way!" But I've used it and it has worked every time. You can tailor your approach to the personality of the woman. For those open to "alternative/complementary therapies" I look closely into the woman's eyes and say "stop your bleeding." For those more hesitant about such things I will walk her through a visualization of her uterus as a ball that can expand and contract, and I have her concentrate on having it contract, etc. Those more in tune with their bodies are often more successful in stopping the bleeding and keeping it stopped; with others it may start up again if they don't stay tuned in. You may need to resort to herbs or stronger meds. but I believe suggestion should always be the first line with excessive postpartum bleeding.
- Cathryn
I have used shepherd's purse for a particular woman and it has not been successful. I would appreciate hearing other suggestions, preferably for herbs.
- Anon.
What is meant by bleeding excessively? For some women 1/2 cup could lead to shock but for some losing even 3 cups can be well tolerated. Maybe she's really good at making extra blood supply in pregnancy. How does this woman tolerate the bleeding that occurs? Does she have problems with shock symptoms, recovery, or breastmilk supply postpartum? The standard "2 cups" is only a guide; look at the woman herself.
Bleeding "excessively" may be the result of an imbalance of the woman's physiology which seeks to eliminate excess heat (called Pitta in Ayurveda) from her body. Have you heard the old midwives' tale that redheaded women bleed more? They are also more likely to have excesses of pitta. The very blood building supplements which she took to prevent hemorrhage COULD actually increase the chance of bleeding if they increase that fire in her that wants to come out. In Ayurveda and in Chinese medicine, balancing an individual according to her particular constitution will reduce this kind of situation. Other more complex factors can also lead to excess bleeding, such as apana prana disorder. If there is a practitioner of Ayurveda or Chinese medicine available, this woman may greatly benefit from their help.
- Terra Richardson, Ayurvedic practitioner & midwife
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Midwifery Today: Each One Teach One!


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Citi Field to host soccer match
JUPITER, Fla. -- European soccer clubs Olympiacos and A.C. Milan will play at Citi Field on July 24, the Mets announced on Tuesday.
The winner of 40 league titles and 26 Greek Cup titles in its history, Olympiacos will be making its first New York-area appearance in 27 years as it squares off against A.C. Milan, winner of a record 18 Serie A titles in Italy.
Tickets go on sale on Thursday at 10 a.m. ET at mets.com/soccer. The game will be televised internationally on FOX Sports 1.
The match is part of the Guinness International Champions Cup, featuring eight of the world's most recognizable soccer clubs: Real Madrid CF, Manchester United, Manchester City, Liverpool FC, AS Roma, Inter Milan, A.C. Milan and Olympiacos. Twelve round-robin contests will take place from July 24 to Aug. 2 in New York (at Citi Field and Yankee Stadium), Chicago, Philadelphia, Washington, Charlotte, Denver, Phoenix, Pittsburgh, Minneapolis, Dallas and one additional city. The finals are scheduled for Monday, Aug. 4, in Miami.
Citi Field has hosted several soccer games in recent years, catering to the diverse ethnic groups that live in the area. Nearby Astoria, Queens, is home to the largest population of Greeks outside Greece; New York proper boasts the largest Italian-American population in the country.
"It is with great pleasure that the administration, technical leadership and we, the players of Olympiacos, await the match against A.C. Milan," said Olympiacos' captain, central defender Aavram Papadopolous. "We are delighted to be playing against a historic rival in front of thousands of fans, most of which will be Greek expatriates. We promise to honor their turnout and offer a beautiful spectacle to all of those who really love football!"
Anthony DiComo is a reporter for MLB.com. Follow him on Twitter @AnthonyDicomo. This story was not subject to the approval of Major League Baseball or its clubs.


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Roberto Di Matteo went from Champions League hero to zero as Chelsea crashed to a 3-0 defeat at Juventus and to the brink of an embarrassing exit from the competition.
Di Matteo's biggest selection gamble since he took charge backfired as goals from Fabio Quagliarella, Arturo Vidal and Sebastian Giovinco left the Blues facing the prospect of becoming the first holders to depart the competition before Christmas.
Chelsea slumped to third place in Group E with one match remaining and are now hoping Shakhtar Donetsk can beat Juve next week to help them progress.
The Ukrainian side have already qualified for the last 16 themselves.
That would be the equal of any let-off the European champions enjoyed en route to last season's astonishing Champions League triumph, which ultimately prevented owner Roman Abramovich dispensing with Di Matteo.
With Pep Guardiola supposedly waiting in the wings, Di Matteo could find himself on borrowed time barring another dramatic turnaround.
The same could be said of the Chelsea career of Fernando Torres, who was axed tonight, although David Luiz produced enough hapless moments for the both of them.
Di Matteo's other changes prompted memories of Andre Villas-Boas's so-called 'suicide-note' selection at Napoli last season, the Blues boss playing without a recognised striker and fielding Cesar Azpilicueta in front of Branislav Ivanovic.
If the line-up was meant to ease the defensive jitters that had seen Chelsea fail to keep a clean sheet for nine matches, it took less than four minutes for them to re-emerge when they twice nearly gifted Juventus the lead, Stephan Lichtsteiner going close before Petr Cech somehow turned his volley onto the post.
The Blues were being penned in but almost scored a sensational breakaway goal in the ninth minute when Oscar ran 70 yards, beating three men before feeding Hazard, whose shot ricocheted behind off Gianluigi Buffon's legs.
Normal service resumed and, when Chelsea fell asleep at a corner, Claudio Marchisio forced another smart Cech stop.
Juve were getting in behind far too easily and Quagliarella twice sent weak shots at Cech, as did Mirko Vucinic on the turn and Andrea Pirlo with a free-kick.
The pressure continued with Hazard mostly isolated, although he was certainly holding the ball up better than Torres had managed of late.
But Oscar almost produced a goal out of nothing again when he raced onto Ramires' pass, Leonardo Bonucci getting back to block.
And that proved crucial as Juventus took the lead in unconventional fashion seven minutes from half-time, Quagliarella reacting to redirect Pirlo's low drive past Cech, who could not keep the ball out having already moved to cover the original shot.
It would have been 2-0 seconds later but for the latest incredible goal-line clearance in Ashley Cole's career, the full-back getting back to prevent Kwadwo Asamoah's cross being bundled home by Lichtsteiner.
Chelsea immediately surged upfield but Juan Mata could not prod Hazard's cross past Buffon.
Forced onto the front foot, the visitors ended the first half on top but they were back to leaving far too much space in behind after the restart.
They survived a penalty scare inside five minutes when Vucinic threw himself down under pressure from Gary Cahill and wasted a free-kick of their own when Mata hit the wall.
Pirlo was seeing more and more of the ball and his long-range shot was deflected wide in between Quagliarella sending another tame shot at Cech and failing to round the goalkeeper after Luiz played him onside.
Di Matteo took action by sending on Victor Moses for Azpilicueta on the hour but Chelsea were 2-0 behind a minute later in shambolic circumstances.
Their defence was nowhere to be seen as Asamoah picked out Vidal, whose shot deflected off Ramires and through the admittedly luckless Cech's legs.
Lichtsteiner departed for Martin Caceres but there was no sign of a comeback as Juve threatened a third goal before Di Matteo finally turned to Torres, with John Obi Mikel making way.
Vucinic produced a Torres-like miss six yards out and Ramires was booked for sending Giorgio Chiellini sprawling.
Chelsea tried to respond but Torres made no impression and Giovinco came off the bench to seal the game on the break, poking the ball beyond the onrushing Cech from 20 yards.


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The long-term budget outlook for the federal government is bleak. What is surprising is that this is considered news.
The forces driving the U.S.'s long-term budget problem have been known for decades. We've also known for years that sometime in this decade, the outlook would begin to worsen considerably. And now it has. And no, the deteriorating fiscal situation has little to do with stimulus spending, bank or auto bailouts, or the wars in Iraq and Afghanistan.
Instead it has to do with the aging of the baby boom generation.
As boomers enter retirement, budget outlays will soar for Medicare, Social Security, and the part of Medicaid that helps pay for old-age nursing home care. The other factor is that health spending is growing faster than the economy, leading to spiraling costs in all health programs—whether for retirees, the working population, or children.
For full details, you can read the Congressional Budget Office's long-term budget outlook. Here are two nuggets from page 10:
- All future growth in spending (other than interest on the debt) is due to growth in benefit programs. On the health side, that means Medicare, Medicaid, and (to a lesser extent) the new insurance exchanges. On the retirement income side, it means Social Security.
- Eighty percent of the increase in non-interest spending over the next 25 years is due to health programs. (Social Security is the other 20%.) Again, driving this is partly the aging of the population, and partly rapid growth in health costs.
Right now, the country is spending 10% of GDP on health programs and Social Security. By 2035, this figure will grow to 16% of GDP.
To pay for that increase solely through tax revenues, we would need to reverse the Bush-era tax cuts (which run about 2% of GDP) and then increase taxes by twice that amount. In other words, we'd need to "triple reverse" the tax cuts. Alternatively, we'd have to nearly double today's 15% payroll tax for Social Security and Medicare (my estimates, using CBO data).
To pay for the increase solely with spending cuts, benefits under Medicare and Social Security would have to be substantially scaled back. For example, putting Social Security on a sound fiscal footing through spending cuts only would require a 20–25% benefit reduction.
This is why Congress is having such difficulty with the budget. Who wants to tell constituents that the great surge in benefits spending (particularly health spending) of the past 50 years has to slow? The choices are unappealing politically: benefit reductions, higher taxes, or a combination of the two.
Rapidly rising health costs threaten the fiscal stability of state and local governments, private employers, workers, and retirees. If we don't "bend the cost curve," health costs will threaten the federal government itself.
Under the CBO's worst-case scenario, federal debt will exceed 200% of economic output by 2035. That's definitely "Greek crisis" territory for the U.S.
Note: The link to CBO.gov will open a new browser window. Except where noted, Vanguard accepts no responsibility for content on third-party websites.


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Hi all, it's time for my yearly update! While I haven't had a scan since last April, my doctor gave me clearance at that time to "do what I want". I can still get a scan every year if I want. Or every other year. Whatever makes me comfortable. And I am not sure just yet what I will do, but I do have to celebrate for a minute. January 29, 2007 was the date of my surgery and it is a date I will never forget. Here i am, 6 years later, celebrating my life. I am happy, healthy and still working at my favorite job (almost 21 years here!). 6 years ago I was thinking about the letters I would write to each of my children for when I was gone.
Keep fighting the fight. There IS good news out there and hopefully there will be MORE good news in the years to come. I think of all of you daily and love to hear about all the good scans that have been happening lately.
Hugs sent out to all,


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LAKE COUNTY -- The recreational boating season has begun, and residents should get their 2013 mussel prevention registration sticker before using their vessel in any Lake County water body.
Residents should also remember to check in with a participating screener when after returning from an out-of-county trip with a boat.
Inspections and any necessary decontamination are free-of-cost.
The highly invasive quagga and zebra mussels can spread unknowingly from one body of water to another on boats and equipment with devastating effects to lakes, boats, docks, water intake equipment and beaches, Scott De Leon stated in a press release. They are the most serious biofouling pest ever to be introduced to North American freshwater systems.
A few facts:
Quagga mussels can colonize hard and soft surfaces, mud, plants, docks, boat engine cooling systems and water pipes.
Mussels can potentially produce millions of offspring in a season.
Densities of zebra and quagga mussels in Lake Mead since their first introduction in 2005 have grown exponentially and now account for 40 percent of all animal population in the lake.
Beaches become littered with piles of glass-sharp shells.
Mussels can seriously alter the chemistry and biology of the local water ecosystem.
Obtaining and displaying a 2013 mussel prevention registration sticker is vital to getting other recreational users of Clear Lake to participate in the County Mussel Prevention
Program and keeping Lake County mussel free, De Leon said.
For the latest list of screeners, visit www.nomussels.com or call 263-2344.


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Melissa Weimer
Dental Receptionist
Age: 31
Height: 5'3" Weight: 115 lbs
Medford, OR
I am 31 years old and have found a passion for living a healthy lifestyle through diet and exercise. I have been working out regularly for the past five years and even competed a couple of times in figure contests. I have been a loyal customer for several years. I could not have reached my goals without supplements from Nutrition Express. My favorite products are Fitness Multi 1, L-Carnitine and L-Glutamine by Fitness Labs, Ultramet meal replacement by Champion Nutrition, and of course, Nitro-Tech protein bars by MuscleTech. I also use ThermoRip by Fitness Labs to help me through early morning cardio sessions!
I am currently studying to be a personal trainer. My ultimate goal is to use years of training to teach people what I have learned. I would love to help other people reach their goals they thought were unattainable.


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Vehicles registered in Lake and Porter counties are required to undergo emissions tests and tampering inspections every two years if they were manufactured after 1976 and have a gross vehicle weight rating (GVWR) of 9,000 pounds or less. Vehicle manufacturers typically print the GVWR on the driver-side door jamb.
Vehicles manufactured in odd-numbered years are tested during odd-numbered years and vehicles manufactured in even-numbered years tested during even-numbered years. Exemptions include vehicles manufactured during the four latest model years and antique vehicles (as defined by 326 IAC 13-1.1-1 - see Section 1 on page 2). For instance, a vehicle with a manufacturer's model year of 2009 should be tested in 2013, and tested again in 2015 and 2017.
Bring your Indiana Application for Vehicle Registration Renewal or your current registration with you to the testing station. Because you may be asked to exit your vehicle, please leave pets, other than service animals, at home.
If your vehicle is driven by a college student who is away at school or if the vehicle is kept in another state for part of the year, early testing is recommended. Vehicles can be tested as early as October of the year before they are due. To save yourself some time, take your vehicle in for testing on off-peak days.
For more information about the Clean Air Car Check vehicle emissions testing program call 888-240-1684 or visit the Clean Air Car Check website