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|April 23, 2008
Volume 10, Issue 9
|Midwifery Today E-News
"Twin Birth"
Print Page
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Now available: Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse
Read this book to discover how sexual abuse affects women during pregnancy and childbirth and what you can do to help. You'll learn from the experiences of 81 women and find suggestions for working together during maternity care and beyond. The book includes resources and information from current research. Suitable for both caregivers and pregnant survivors, Survivor Moms will help anyone whose life has been touched by sexual abuse. Published by Motherbaby Press, a division of Midwifery Today.
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If you're thinking about becoming a midwife…
…you need to attend the full-day Beginning Midwifery class at our conference in Ann Arbor, Michigan, this May. This is your day to learn about midwifery and decide if it is the profession for you. You'll learn both the challenges and the joys of this calling, so you'll be able to make an informed decision. Segments include The Art of Midwifery, Prenatal Care, Normal Labor Physiology, Emotional Issues in Labor and Anatomy of a Birth Bag.
The pre-registration deadline has passed, but walk-ins are welcome, so pack your bags and plan to be there! Learn more about the Ann Arbor, Michigan, conference and get a complete program.
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In This Week's Issue:
Quote of the Week
"I wish I had a twin, so I could know what I'd look like without plastic surgery."
— Joan Rivers
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The Art of Midwifery
The most prevalent danger in multiple gestations is prematurity and corresponding complications, such as respiratory distress syndrome and intestinal problems such as necrotizing enterocolitis. With insistence on excellent nutrition, encouragement and abundant social support, midwives help many women carry twins to term. Experienced, well-educated and fully-equipped midwives, with refined palpation and gentle version skills, can bring important elements to the pregnancy, if not also to the birth. Finally, enveloping the mother in optimism, love, patience and prayer is tremendously powerful "medicine" that results in outcomes the shiniest knives and fanciest machinery cannot hope to match.
— Judy Edmunds
ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to email@example.com.
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Research to Remember
A study by an obstetrician specializing in multiple-birth pregnancies showed that taller women are more likely to have twins. The cause is believed to be a protein called insulin-like growth factor, which increases the sensitivity of the ovaries to follicle-stimulating hormone and has previously been linked to greater stature. The study looked at 129 women who had twins or triplets and found that on average they were taller than the average woman in the US.
— Journal of Reproductive Medicine, September 2006
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Pregnancy Management for Twins
Fetal mortality is increased in twin pregnancy to four times that of singletons, and the major cause of death is prematurity. Birth weight is an important factor and twins born after 36 weeks gestation have a several times higher rate of survival. Ultrasound has not been proven to reduce perinatal mortality in multiple pregnancies. In her book Having Twins, Elizabeth Noble states that "making a decision about whether to have a test or about which test is appropriate may require a second and [even] a third opinion. Women expect a test to reassure them, but sometimes it provokes more anxiety if the outcome is not clear or further testing is necessary. It is much better to prevent complications by availing yourself of good health care and [healthful] nutrition."
Data from my practice of 300 births show that prematurity is rare with continuity of midwifery care at home. I support Dr. Tom Brewer's recommendations for a high protein diet with a balance of fresh whole unprocessed foods. Women with twins may need to eat small, frequent meals. I do not routinely advocate extra vitamins or supplements. We know that a drop in hemoglobin in the second trimester is evidence of normal healthy hemo-dilution, and this is more pronounced with multiple pregnancy.
Pregnancy discomforts are usually increased in women carrying more than one baby. If a woman goes into premature labor, having her rest and drink three to four glasses of water will dilute the level of oxytocin in her bloodstream. In one woman's experience, premature contractions at 33 weeks stopped and she carried her babies to term.
Women expecting twins will need to arrange for help at home before and after the birth. Contacting a diaper service…, and planning for home help are important components of preparing for the busy postpartum period. Wholistic care also includes dealing with emotional and relationship issues. Regular home visits are beneficial because the midwife can assess the home environment and determine how to best support the family during the perinatal period. It can also be very stressful for a woman carrying twins, who has other children, to travel to prenatal visits, especially late in the pregnancy.
— Susan Smith
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ICM Conference Update from Jan
One of the most exciting elements of the International Confederation of Midwives Triennial conference, besides the rich array of leading edge papers and classes, is the midwives themselves. There will be midwives from ALL over the world who will attend the conference in Glasgow, 1-5 June 2008. Be sure to take your notebook to collect names, addresses and phone numbers of all the new friends you will make from all over the world. If you have a business card take a lot of them with you. You will be able to learn about what is going on in midwifery and birth from Africa, Japan and a hundred other countries. Midwifery Today will be there as well gleaning exciting information. I will share this with you in both Midwifery Today Magazine and Midwifery Today E-News.
Toward Better Birth,
For more information: http://www.midwives2008.org/home.htm
Products for Birth Professionals
The number of live births in twin deliveries rose one percent between 2004 and 2005 to 133,122 births, for a rate of 32.2 twins per 1000 births. The actual number of live twin births has doubled since 1980 (from 68,339).
— http://multiples.about.com/od/funfacts/a/twinbirthrate.htm
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Question of the Week
Q: One of our clients recently discovered that she has twins. They each have their own placenta, and she has reached 21 weeks in very good health and is extremely determined about birthing at home! This is her second birth. We totally support her decisions and plan to attend her homebirth. However, with the increasing hospitalisation, it has been more than 20 years since there was a planned homebirth of twins here in Denmark. We only have hospital experience with twin births, and it is just so overly medicalised and regarded as high-risk with all the machinery and medicine close at hand and "the works"…. We are SO keen to learn more from midwives with twin-homebirth experience. Please share with me EVERYTHING that comes to mind!
— Marta
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Question of the Week Responses
Q: How long can a baby be on breast milk only, with the addition of no solid food or liquids? I don't want to feed my baby anything but breast milk until I have to, but am not clear whether there is a maximum after which it becomes less healthy to do so.
— Anonymous
A: My son refused to eat until age 2-1/2; he maybe would have a bite of something here and there, but preferred to breastfeed. Slowly he began to eat more as he decreased nursing until he stopped at age 3-1/2. I worried endlessly that I was doing something wrong.
Now, at age 17, he is a varsity athlete winning awards for all-district, all-conference and all-area.
— Anonymous
A: I breastfed my first son until he weaned himself at 38 months, and I am currently nursing my 31-month-old son. Both of them nursed exclusively until they were a year old with no ill effects. They are active and healthy. I also think this helps my cycles not to return until later than most of the women I know - 21 months with the first and 19 with my second. I hope this helps you.
— Laura Reiboldt
Q: I have a girl in class who has expressed a lot of fear and anxiety regarding her upcoming birth, from lots of surgeries (urogenital) as a baby/child. She remembers "things being done to her, no control, no choice, no voice, doctors talking at her, not to her, bloody surgeries, pain, etc., and "having to be strong and brave." She mentions already feeling some resentment toward baby for "having to endure labor/birth pain." She does not want her experience to prevent her from bonding and loving her baby.
This realization of fears is a huge step. It's much harder when they arise during labor and no one is prepared or knows what they stem from or what to do with them! I suggested she discuss with her midwives so they are aware and can help her during labor. We discussed the significance of having an unmedicated labor vs. having a labor where she feels safe, protected, unviolated, where she has some control of choices and that does not produce emotional trauma for her.
I welcome a discussion of whatever you can think of that may be helpful. I think they are considering hiring me as a doula, so also anything from that standpoint would be appreciated.
A: There is a wonderful book called When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin. I often recommend this book to my clients. I also like the book Mind over Labor: A Breakthrough Guide to Giving Birth, by Carl Jones, Marian Thompson and Emmett E. Miller. Both books are helpful when working through fears and anxieties in labor.
I encourage you to have her speak with her midwives and if their practice is not responsive to her needs then I would look for one that is. Also encourage her to seek out a professional therapist. If she is unwilling at this time, then have some names and numbers ready for her in case she needs them later. She needs to verbalize with you and her partner and anyone who will listen about her fears and concerns. The more she acknowledges them the more control of them she has.
Most importantly, I would remind her and you that she is normal. What she is feeling is normal for someone who has had similar experiences. The biggest difference this time is that she is in control. She has the option of choosing her provider and type of birth experience. She can pick her level of participation and awareness. By participating and being aware of the birth, she is participating in her child's birth and she should bond better and heal through the experience. Birth can be healing for the mother. It was for me and many of my clients.
— Ursula
A: I think it's important to emphasize to this woman that it is fine and normal for her to have these feelings AND that regardless of these feelings, she will still give birth to her baby. It's rarely possible to stop yourself from having an emotion, but you can refuse to allow it to get in the way of what you have to do. Birth doesn't require bravery, instead it requires letting go, being in the moment and letting your body do what it needs to do. While you'll probably have a nicer birth experience if you are able to resolve your fears and resentments, countless millions of scared, overwhelmed women have birthed before you, and you can too.
— Erika Peterson Bartlog
A: In this particular case, an epidural is probably the best for the woman. She has already been through enough pain and surgeries as a child, and the labor process does not have to be like that. If she has a doula for support, she should encourage this option, as many hospitals have patient-controlled epidurals and she can relax in the fact that she has control in this process. She can feel as little or as much as she wants and enjoy and appreciate her baby afterwards, instead of feeling angry at the child for putting her through an otherwise agonizing process.
— Anonymous
A: I have supported women in labour with similar issues and in my experience the best approach is for the midwives and caregivers to be fully aware of the woman's past medical and psychological encounters. That way they can work together and approach labour as "positive pain," which is something that I as a midwife target during antenatal classes. Having someone they trust during labour is vital and, as you already have a good rapport building with this woman, then acting as a doula would be most beneficial. It's good that she has voiced her fears and anxieties, as many women don't.
— MR, UK midwife
A: As a doula and previous HypnoBirthing Childbirth Educator, I found Emotional Freedom Techniques (EFT) to be immensely helpful to alleviate the energy around negative memories such as described in the question. You can find a trained practitioner at www.emofree.com or take the training by video yourself for little cost. There are wonderful articles on its use during pregnancy and birth on the site, as well. Anyone can use this surprisingly simple technique, even the mother herself.
— Jan Bennett-Collier
Editor's Note: Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse is now available from Motherbaby Press, a division of Midwifery Today.
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Time is running out on Duke's attempt to finish atop the ACC, but a visit from Boston College would seem to help its chances.
The sixth-ranked Blue Devils, though, got all they could handle from the Eagles earlier this month and will try to pull out another victory Sunday to remain unbeaten at home.
Duke has a chance to trim Miami's conference lead to two games with a win Sunday but the Blue Devils (23-3, 10-3) then only have four contests left. They'll visit Virginia on Thursday before facing the Hurricanes, who lost Saturday to Wake Forest, next weekend at Cameron Indoor Stadium, where they're 13-0.
A loss to Boston College (12-14, 4-9) or Virginia would damage their chances of earning a top seed for the conference tournament in Greensboro, N.C.
The Blue Devils would seem to have few problems with the first of those games as they've won 15 of 17 all-time matchups and 11 of 12 since Boston College joined the ACC. The Eagles have lost their six games in Durham by an average of 17.7 points.
Boston College, though, took Duke to the wire in a 62-61 home loss Feb. 10. The Blue Devils trailed by five with 1:59 remaining before scoring the game's final six points. Mason Plumlee converted three free throws in the final 46 seconds, and finished with 19 points and 11 rebounds.
"We were fortunate to win," Mike Krzyzewski said. "We played great over the last two minutes, had four stops and hit some big free throws."
The Eagles head into this game having lost five straight on the road but have won two of three overall. Freshman guard Olivier Hanlan had a career-best 26 points in Tuesday's 69-58 victory over Maryland, a team that beat Duke 83-81 last Saturday.
"Hanlan is playing great for them and (Boston College is) playing their best basketball of the year right now," Krzyzewski said.
Hanlan had a team-leading 20 points against the Blue Devils earlier this month and leading scorer Ryan Anderson (15.1 ppg) had 17.
Duke's Seth Curry, who had 18 points at Boston College, scored 25 against the Terrapins and 22 in Thursday's 88-56 rout at Virginia Tech. He made three of his five 3-pointers in the first seven minutes of that game and scored 19 in the first half.
"I'm always trying to be aggressive early on," Curry said. "Coach called the first few plays for me so I was able to get some good looks and they went down."
After letting Maryland to shoot 60.0 percent, Duke kept the Hokies to 43.1.
"When we're engaged defensively, that makes us a tough team to beat," Curry said.
The Duke guard will try to have a better performance than in his last home game. He scored 11 points on 3-of-10 shooting in a win over rival North Carolina on Feb. 13. Curry has averaged 18.7 points on 55.2 percent shooting in his three games against Boston College and scored 20 in the Eagles' most recent visit to Cameron Indoor, an 84-68 victory on Jan. 27, 2011.
With 877 wins at Duke, Krzyzewski is two shy of tying former North Carolina coach Dean Smith for the second-most at one school.


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By now, 5-year-old Trinity Olivares' story is sadly familiar: On a Sunday in late September, the pig-tailed Rio Rancho kindergartner started vomiting. Her family took her to the hospital, the doctors put her on an IV and suddenly her heart stopped. She hadn't had a fever and she wasn't unhealthy, but Trinity had become New Mexico's latest victim of the H1N1 influenza virus, or swine flu. Through KOAT Action 7 News reporter Chris Ramirez, Trinity's mother urged other parents "to take every precaution."
Across the state, parents—and pretty much everyone else—began to do just that. They flooded into clinics and hospitals, calling and visiting emergency rooms in unprecedented numbers.
"When the first three kids died in the state, that definitely caused a surge of people seeking our services," Dr. Kevin Garrett, chief medical officer for Christus St. Vincent Regional Medical Center, says. According to Garrett, roughly one-third of the incoming patients to Christus' emergency room show flu-like symptoms—known in the medical community as influenza-like illness, or ILI—and between the hospital and its various clinics, especially those specializing in pediatric care, Christus is seeing more than 100 additional patients daily.
On Oct. 12, the hospital stiffened its visitation restrictions, prohibiting visits by healthy children, sick people or groups of more than two. While Garrett denies the new restrictions are a response to the surge in patients—"they're just good public health guidelines," he says—they nonetheless help contain the disease while New Mexico waits for the much-touted H1N1 vaccine recently approved by the US Food and Drug Administration. According to Chris Minnick, the New Mexico Department of Health's public information officer, the state has ordered more than 42,000 doses of the vaccine from manufacturers. Of those, though, Minnick doesn't know how many have actually arrived. Neither Urgent Care Santa Fe nor La Familia Medical Center had received a single dose as of press time, and Christus, which got its first 1,300 doses in two shipments—one from the Department of Health and another straight from the manufacturer—last week, has yet to immunize a single patient. Instead, the hospital is focusing on vaccinating health care workers.
Despite the flood of patients arriving at the ER, less than a quarter are actually hospitalized, Garrett says.
"Not everybody needs to be treated per se," he says. Unless your swine flu symptoms—fever, cough, shortness of breath, fatigue or muscle aches—are severe or prolonged, or you're in one of the Centers for Disease Control and Prevention's specified high-risk groups (pregnant women, health care workers, children, or people with chronic health conditions like asthma or diabetes), "you're better off to stay home and minimize your exposure," Garrett says. Swine flu isn't deadlier than regular influenza, he adds; it's just more infectious. That means more people will get it, and so more people—but no greater a percentage of those infected—stand to have a serious case.
Swine flu and "regular" seasonal flu are two strains of the same disease, Type A influenza, but a vaccine for one does nothing to the other. Because of the urgency of the H1N1 epidemic, and since seasonal flu generally doesn't kick in until December or January, Garrett says many flu-shot manufacturers have been ordered to switch production of seasonal flu vaccines to H1N1 shots. Still, manufacturers are struggling to meet demand: The Los Angeles Times on Oct. 17 reported that roughly 25 percent fewer vaccines than expected were produced. Minnick, however, is upbeat.
"We're expecting 1.2 million doses by the end of January 2010," he says, "and that's enough to cover a large percentage of New Mexico's population."
Garrett says that after vital health care personnel have been vaccinated, Christus will begin immunizing the at-risk populations.
Still, he notes, "We don't have a good enough sense of when supplies will be coming from the DOH, such that we can provide a free community clinic…but we will do that as soon as we are able to."


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eHarmony is a growing, global technology company built on the belief that marrying computer science and relationship psychology can change the way people find their most significant relationships. Do you want to bring happiness to peopleâs lives while working with amazingly talented colleagues?
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eHarmony is pre-IPO, well-funded and profitable. We have more than 50 million registered users spanning across 150 countries and have launched country-specific services in the United Kingdom and Australia. Our competitive compensation package includes a base salary, discretionary bonus, stock options, free drinks and snacks, ping pong, video games and an on-site chair masseuse. Our 65,000 square foot headquarters is located in Santa Monica, CA, just blocks from the Pacific Ocean.
eHarmony is seeking a strong Senior Linux Systems Administrator. Primary responsibilities include maintaining server software. You will be responsible for directly interacting with software engineering as well as non-technical teams within the company. This position requires flexibility and willingness to be on call and available 24 hours a day, including weekends on a rotating schedule.
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⢠Managing web applications, web services and Java EE applications in a very high-volume environment
⢠Work closely with Software Engineering team to design, build and deploy new systems
⢠Having first-line responsibility for isolating application-level configuration, performance and database problems
⢠Provisioning and configuration of new systems and applications using one of the following: Chef, Puppet, CFEngine
⢠Analysis and tuning of system performance for application performance
⢠Setting up standard operating procedures including how software is deployed, change management practices are implemented, and performance tuning is performed, etc.
⢠Partnering closely with the Engineering team to assist them in isolating and debugging code-related problems
The successful candidate will have:
⢠5-7+ years of IT/Internet industry experience
⢠Extensive UNIX/Linux systems administration experience
⢠Strong Java EE application server experience (e.g. WebLogic, JBoss, Tomcat, Jetty)
⢠Experience managing web-based applications in a large-scale Linux environment
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SSJ3Gogeta wrote:Josef wrote:You can say that but it is clear that there are subtleties that are being ignored.
You don't understand the basis (gzhi) of Dzogchen upadesha. Its as simple as that.
That is an odd claim considering that you have done nothing to actually defend or explain your position other than claiming the ignorance of others.


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Suddenly, soccer is cool.
Television ratings for the World Cup are breaking records. Social media is abuzz. Sports bars and outdoor viewing parties have been jammed.
And as the U.S. men's national team readies to play Belgium on Tuesday in a win-or-go-home showdown, longtime soccer fan Enid Balavac is enjoying all the new company on America's soccer bandwagon.
"I have girlfriends who call me and say, 'Did you see the game?' " said Balavac, 67, a San Jose Unified School District substitute teacher. "I'm thinking, 'You're actually watching?' It's a great moment because even people my age who never played the game are investing in it."
We might never become a full-fledged soccer nation. But there's a sense that the sport might be on the cusp of a breakthrough into the consciousness of casual sports fans.
How else to explain why Americans are working up a healthy animosity toward Belgium -- a nonthreatening country that usually just brings to mind waffles and excellent beer?
Dave Kaval, the San Jose Earthquakes president, said everyone was talking soccer as he was getting his hair cut recently in Palo Alto.
"You know you're relevant when you're in a barbershop and that is the conversation," said Kaval, whose Major League Soccer club opens a new stadium in 2015. "We're part of the story and for a long time we weren't. This is a big, big success."
On Monday, Brandi Chastain was surrounded by the evidence of soccer's grass-roots popularity. She was at the AYSO National Games in Southern California, where boys and girls from 250 teams across the country are playing. Most of the youngsters weren't even born when Chastain won the 1999 women's World Cup with her famous penalty kick.
"These are kids who have grown up with soccer," said Chastain, of San Jose. "This is part of their culture. I asked them, 'Are you watching the World Cup?' And their answer was, 'Every minute. It's so crazy.' This is like the Super Bowl for them."
But David Carter, executive director of the USC Sports Business Institute, cautions that there's a difference between truly embracing a sport and paying attention for a few weeks every four years -- especially when it comes wrapped in red, white and blue.
"You have to remember that the World Cup is about so much more than soccer," Carter said. "It's a global event involving patriotism and national fervor. It also looks like those viewing parties are an awful lot of fun. So you have to be careful to not overstate the case. It's unfair to the sport to expect a seminal moment where we can say, 'It is here.' "
We've been hearing that soccer will arrive, any day now, since at least the 1970s. Aficionados were convinced that the country couldn't resist the charms of a game that the rest of the world calls football.
But Americans remained perfectly content with the kind of football that involves helmets and pads. Pro soccer leagues came and went. Millions of soccer-playing kids grew up to become ticket-buying fans of football, basketball, baseball and hockey.
There are signs, though, that is changing. On Saturday, for the third consecutive year, the Quakes drew 50,000 fans to their annual game at Stanford Stadium against the archrival Los Angeles Galaxy.
And on the world's biggest stage, the national team is shining. For the first time, the United States advanced into the knockout round in consecutive World Cups. To accomplish that feat, the squad had to survive the dreaded Group of Death.
"It feels different," added Balavac, who wore a Stars & Stripes head scarf at the Quakes game Saturday. "And these boys are heroes: Dempsey, Bradley and my favorite, Wondolowski."
Those would be U.S. players Clint Dempsey, Michael Bradley, and Danville native Chris Wondolowski, of the Earthquakes. But then you probably knew their first names -- another sign of soccer's trendiness.
The U.S.-Portugal game in group play drew a record 24.7 million viewers on ESPN and Univision. (Another 500,000 watched on mobile devices.) The next game, against Germany, had 14.2 million viewers in the middle of a work day.
Yes, Americans can be appalled by the theatrics players pull to draw fouls. ("And the Oscar for the best soccer dive goes to ... ") But the country is watching.
When conservative commentator Ann Coulter wrote last week that "any growing interest in soccer can only be a sign of the nation's moral decay," social media lit up with the consensus opinion that she must have taken a well-struck ball to her noggin.
Ed Foster-Simeon, the head of the U.S. Soccer Foundation, responded in a CNN op-ed that attendance to soccer matches in this country exceeded 10 million in 2013, the sport is the second-favorite of people ages 12 to 24, and soccer is the country's third-largest participation sport.
MLS also has been touting strong growth, drawing about 18,500 fans per game this season. The league also just signed a new $90-million-a-year TV package and has expansion plans.
Speaking from Salvador, Brazil, Wondolowski said the U.S. team has been stunned by the number of Americans at games.
"We've had amazing support," he said. "If you could hear the crowd, it gives me chills every time. They've been so loud, so together. It keeps us going during the hard times."
Just think if they could hear all the noise coming from back home.


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(UPDATED COVERAGE, May 10) McDonald's is offering fresh blueberries with oatmeal in a seasonal promotion that lasts through Aug. 3.
The blueberry banana nut oatmeal debuted May 7 and is available all day on the McDonald's menu. McDonald's fruit and maple oatmeal, which includes fresh apple pieces, is still available.
Naturipe Farms LLC is supplying snack-size blueberry packs to McDonald's for the oatmeal deal, said Robert Verloop, executive vice president of marketing for the Naples, Fla., company.
"We are providing them with our ready-to-eat fresh product," Verloop said May 7. "It is fantastic to see blueberries expand in distribution and reach into new channels."
Naturipe is packing the blueberries in Georgia and California. Verloop said Naturipe plans to eventually offer blueberries in the ready-to-eat packaging year-round to retailers, with different pack styles planned to meet customer needs.
Mark Villata, executive director of the U.S. Highbush Blueberry Council, said the seasonal use by McDonald's is great news for the blueberry industry. It will help keep the fruit on consumers' minds during the season, Villata said, which should translate into increased sales.
The chain of more than 14,000 quick-serve restaurants is considering doing even more with blueberries.
"A limited number of McDonald's restaurants are offering a la carte blueberries as part of a short-term menu test," company spokeswoman Molly McKenna said May 10.
McKenna said the company opted to buy 1.25-ounce packets of blueberries instead of bulk berries to ensure customers reeived the correct portion with their oatmeal and to speed preparation.
"Customers told us they want their oatmeal assembled and served quickly, and this process allows us to do that," McKenna said.
"If a customer chooses, they can request blueberries on the side, and they would receive an individual packet of blueberries with their order of oatmeal."
The new oatmeal includes about a quarter cup of fresh blueberries in each serving, along with walnuts and a dried crushed bananas, according to McDonald's website.
The senior director of nutrition for McDonald's USA said the oatmeal continues the chain's efforts to offer customers healthy options.
McDonald's officials said they are using mostly U.S. blueberries, with supplemental supplies coming from Mexico.


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Now that I've finished my album I am putting together the same album full of remixes. Instead of paying 20 people to do remixes for me I am trading a remix of my own for one of theirs. This serves three purposes. I don't have to shell out a bunch of cash. It forces me to work on material that's not my own which I find a challenge. Lastly, every remix I do for someone else gets promoted by that artist therefore extending my own name into the world. I know this is obvious but maybe this post will trigger you to go trade with your friends, fans and if your lucky music heros. This weekend I am finishing remixes for Haujobb and Steinkind. See how they just got some free press?
"A remixer uses audio mixing to compose an alternate master recording of a song, adding or subtracting elements, or simply changing the equalization, dynamics, pitch, tempo, playing time, or almost any other aspect of the various musical components. Some remixes involve substantial changes to the arrangement of a recorded work, but many are harmonic, such as creating a "vocal up" version of an album cut that emphasizes the lead singer's voice." – Wikipedia
For more info: facebook.com/thehorrorist


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Excuse the boring title to this thread, I could not come up with a good one.
My question is what is the most extreme thing you have done to watch a Pacer game either in person or on TV.
Have you called in sick to work in order to watch a game. Have you quit a job to watch a game. Have you choosen a career so you don't work nights so you can watch a game. Have you driven hours to watch a game
What is the most money you have ever spent to see a pacers game in person.
Hopefully you see what I am asking.
I certainly have taken a few vacation hours to watch a Pacers game, I did that last Monday.
The craziest thing I think I have done to watch a game was a few years back I forget the circumstances, but where I was living then I could not get the game on NBA League Pass, so I drove about an hour to get into WB4's viewing area, stopped at a hotel, asked if they could rent me a room for a few hours, they said they couldn't, (I guess it was not that type of hotel), so I paid a full nights rate, approx $60.00, watched the Pacers game, they lost, I drive back home.
When I choose a career, I did not want a job where I would be working evenings, nor did a want a job where I would be traveling in the evenings.
I once paid $100.00 for one ticket to watch the pacers play the Knicks game 6 of the 1994 eastern conference finals.
During the NBA season, if I go on vacation I either plan it around Pacers games, or I go during the allstar break.
I have a few other things I have done, but I'll leave it there for now


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I loved the first response I saw:
"I tracked down the person who hit your car and caused their kidneys to fail. If you want to sell them one of yours you can make a little new car money."
Also on hell,
"I will tell you it's not temporary in most cases, but occasionally I'll pardon someone. Satan says it sweetens the despair when everyone knows there's some tiny shred of the hope of relief from the suffering. We've had some spirited debates on that subject, but I defer to his expertise" God is such a joyful sadist!
Thanks for posting this! It's a lot of fun!
P.S. I thought god was "The Editor". Are there two?
"The Editor" maintains the site and sometimes makes minor corrections to what God says, but he's human. That's probably not very clear on the site (but makes more sense than the trinity).
May I ask a simple question. It might be theological. If the editor is editing god, does that mean the editor is more godlike, than god? I might start trembling.
Nah, it just means God is a busy dude.
How can someone who is exempt of space and time, omnipotent and omnipresent, EVER be busy? If this schmuck managed to create several quintillion cubic light-years of universe, why would one miniscule planet in all of that be so much fuss?
Maybe it's not so much he's too busy, and more that we are not worth his undivided attention.
Hannibal Burress has ruined prayer for me. I can no longer think about prayer without going back to his video. "Don't pray for me. Make me a sandwich!"
I know it's been posted before...
God, may I please have a peanut butter and jelly sandwich? Or maybe a Reuben?
Not to put too fine a point on it, but if you can't be bothered to DO something about my situation, FUCK THE HELL OFF!
Yeah, a sandwich would be nice, though ... know how to do a Reuben?
Here are some options.
I use 2 slices of dill rye bread, buttered.
On the bottom slice, I add 2 slices of Swiss cheese. I love the swiss with tiny holes, but they don't have that here. Must be midwestern.
Then some drained sauerkraut.
Then thin sliced cayenne peppers, then thin slices of onions
Then spread on a couple spoons of thousand island dressing.
Then depends on my mood. Since I'm vegetarian I leave out the corned beef. Sometimes I just add the other slice and grill as is, for a Naked Reuben. Sometimes I add a couple of slices of vegetarian bacon, then add the 2nd slice of rye, for a Virgin Reuben.
Then grill the sandwich. To pass time while grilling, you can say some prayers.
My favorite prayer is still the Alan Shepard Prayer (or astronaut's prayer). Sitting on top of the tube full of tons of fuel getting ready to take off he said, "Dear God please don't let me f&@! up"!
© 2017 Atheist Nexus. All rights reserved. Admin: Richard Haynes. Powered by


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lol dang I thought I was just going to leave it in my last message but this is actually an intriguing question. I think maybe Berkman is at the point in his career where he might sign for less if that means staying on a winning ballclub. Sure, he could sign for the big bucks but I get a feeling he really likes the chemistry on the Cardinals. Who knows. What ever happens he has been pleasure to watch and I wish more power to him where ever he goes.Now, lets discuss Berkman. I can't believe he's still hitting, but he keeps doing it, even against LH pitching. So, do you give him an extension? How much and how many years. How far would you go?
By the way, I think the injury Pujols had was kind of misunderstood a bit. Many people said it was a broken wrist but it was actually a non-displaced fracture on the forearm and it was almost like a hair-line fracture of sorts. The Cards kind of made it sound worse than it really was. Pujols is still playing with the "fracture" but normal baseball activities will not hurt it more or there isn't a greater chance that it will become worse. Pujols has played through pain all his career so it didn't really surprise me that he came back as soon as he did.


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Lisa Davis as Rose Dalton in The Dalton Girls
The Dalton Girls (1957) is a feminist western directed by Reginald LeBorg, which follows the adventures of Holly, Rose, Columbine and Marigold Dalton as they go on a crime rampage in the old west following the violent deaths of their brothers, members of the infamous Dalton Gang. When they visit Mr. Slidell (Glenn Davis), the mortician who is preparing the bodies of their brothers for burial, Slidell attempts to force himself on Holly, who kills him with a shovel in self-defense.
Just like Thelma and Louise (1991), the women are now on the run, and soon learn that no one will cut them an even break because of their past. They resolve to lead a life of crime, starting out with a stagecoach robbery, moving on to banks, poker games, and other potentially lucrative targets. Director LeBorg keeps things moving at a rapid clip, and the performances by Merry Anders, Lisa Davis, Penny Edwards and Sue George are all surprisingly convincing and sympathetic. Shot location near Kanab, Utah, the film is sparse, brutal and unforgiving.
What strikes one the most about The Dalton Girls is the speed and brutality of the narrative; it's over in 71 minutes, and instead of being centered on a group of outlaw men, the Dalton women make their plight seem like a calling — ridding themselves of the patriarchy. As Rose Dalton observes of one of their "gentlemen admirers," "Oh, honey, don't think about him. They tell me he plays women just like he plays poker. Riffle, shuffle, fast cut, big deal, the sky's the limit; and then all of a sudden you're lying there in the discard."
As Hal Erickson notes, "After all the members of the notorious Dalton outlaw gang have been killed or arrested, their sisters decide to pick up where the boys left off. Led by Holly Dalton (Merry Anders), who since killing a man in self-defense has been outside the law, the girls terrorize Colorado territory with their criminal raids. The other members of the gang are Rose, Columbine and Marigold Dalton, played by Lisa Davis, Penny Edwards, Sue George. In true Hollywood Chauvinist fashion, the Dalton girls are trailed by a bunch of matrimony-minded men; refreshingly, however, the ladies remain true to their heritage to the last."
The film is also, despite its somewhat compromised origins, absolutely serious. The best essay on the film is Gwendolyn Foster's "Crossdressing and Disruptions of Identity in The Dalton Girls," in Film Criticism 20.3 (Spring 1996): 24-33, which was reprinted in her book Captive Bodies: Postcolonial Subjectivity in the Cinema (SUNY UP, 1999). The Dalton Girls is scheduled to be released to DVD a part of the MGM Classics Collection in late September 2011; another interesting film that finally makes it to DVD.


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Canton, Mass. Casual Male Retail Group Inc. has entered a new partnership with GSI Commerce Inc. to operate online stores for both the Casual Male XL and Rochester Big & Tall brands in six European countries, according to the Boston Business Journal.
Under the agreement, GSI will provide Web store design, Web technology, order processing, fulfillment and call-center services for each Web store.
The Web stores are scheduled to launch during the fourth quarter of fiscal 2008 in the U.K., Germany, France, Italy, Spain and The Netherlands.
Each online store will be tailored to the specific European country in which it operates, and GSI will localize country-specific components of the solution, such as online payment processing, content translation and customer services.
The move will allow Casual Male to enter key new European markets and expand its presence beyond the U.K.


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Here's a fairly simple, but delicious recipe featuring our whole wheat pearl couscous from our test kitchen that can be used as a side dish or salad and would make a great addition to any potluck.
Whole Wheat Pearl Couscous with Peas and Mint
- 2 Tbsp Olive Oil (28g) + more as needed
- 1/2 large Onion, diced (70g)
- 1-1/4 – 1-1/2 cups Vegetable Stock (300mL)
- 1 cup Whole Wheat Pearl Couscous (171g)
- 2/3 cup Green Peas, fresh or frozen (89g)
- 1/4 cup grated Parmesan (28g) + more to garnish
- Salt & Pepper to taste
- 2 Tbsp fresh Mint, chopped (2g)
Step 1
Heat olive oil in saucepan over medium heat. Add onions and saute until translucent.
Step 2
Add vegetable stock to onions and bring to a boil. Add pearl couscous and return to a boil. Then, reduce heat to low, cover and simmer until all liquid has been absorbed. If couscous is not tender enough, add additional vegetable stock and simmer until absorbed.
Step 3
Remove from heat and add peas and Parmesan. Season to taste with salt and pepper. Add just enough oil to prevent the couscous from clumping. Let cool to room temperature.
Step 4
Stir salad to break up any clumps that may have formed then mix in chopped mint. Garnish with parmesan.
Makes 4 servings as a side dish.
Want to fancy this dish up? Take Jess in Inventory's hint and add prosciutto, fresh or crisped.


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NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.
Saturday, September 23, 2017
Urinary Disorders
Why So Long Before Good Unination Again?
I had superficial cancer (1 cancer at about 1.5 cm) scraped from my bladder. After the 7 day duration of the Foley in me, it still took about 3 full days till I could fully MT my bladder. My Dr said the scraping in my bladder wall traumatized my bladder tissue and it needed to "recover" from this trauma to function properly. OK, all well and understood. I know the bladder muscle contracts and expels the urine out of it. Exactly how does the scrapping interfere with the bladder muscle contractions? It seems like a small area of where the wall was scrapped would not impact bladder muscle contraction. OK, it does. But how? What is going on at the muscle cell level to interfere so hugely with normal bladder contraction? I am 81 years old and curious. My anesthesia was simply propofol. Thanks.
Placing a cystoscope and or a resectascope into the bladder can effect the bladder emptying. It is possible that the scope caused some inflammation of the prostate gland through which the urethra (water channel) passes or the water used in the procedure could have stretched the bladder mucscle itself. Either may have created more work for the bladder to empty post operatively. Anesthesia, pain medications and other medications can also effect bladder function. It is not uncommon for it to take a while for the bladder to completely empty after a bladder tumor resection in both men and women.
Donald R Bodner, MD
Professor of Urology
School of Medicine
Case Western Reserve University


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The Miami Marlins have contacted a number of teams, including the San Diego Padres, about the availability of slugger Giancarlo Stanton, according to U-T San Diego.
But the Miami Herald quotes a team source saying the Marlins "are not moving him" and still plan to start the season with Stanton as their cleanup hitter. The source also said the front office has not even had internal discussions about trading Stanton.
The Padres and Marlins haven't had detailed talks, according to the U-T San Diego report. But the price certainly would be high for the the All-Star right fielder. The Marlins have inquired about Padres infield prospect Jedd Gyorko, and he likely would be part of any deal for Stanton.
Gyorko, 24, batted .311/.373/.547 with 30 home runs and 100 RBIs between Double-A and Triple-A Tucson in 2012. Baseball America ranked him as the best third baseman in Triple-A and the 50th best overall prospect in baseball.
Miami management has soured on Stanton, who publicly expressed his displeasure about the deal that sent Jose Reyes, Josh Johnson and Mark Buehrle to the Toronto Blue Jays.
Stanton was one of the top hitters in the National League in 2012, finishing with 37 home runs, 30 doubles and a .290 batting average. He led the league in slugging percentage (.608) and was third in on-base plus slugging (.969).


text:
Posted 5 years ago
(1 item)
Can anyone provide me with any information on this perfume bottle? I bought it at a Thrift store. It says DeVilbiss on the bottom. How old is it? Is it valuable? I would love to know any info you can provide. This photo is not the actual one I purchased, but looks exactly the same. (I found the photo on the internet but have found little information on the bottle) Mine does not seem to have any damage that I can tell. The inner class tube in still intact.
Thank you for any information you can provide!


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Ultrasound Guided Cannulation of Dialysis Fistulas
Recruitment status was: Not yet recruiting
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
|Other: Use of ultrasound guidance in cannulation
|Phase 4
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
|Official Title:
|A Randomised Controlled Trial of the Effectiveness of Ultrasound Guidance in Cannulation of Dialysis Arteriovenous Fistulas and Grafts in a University Hospital Dialysis Unit
- Time to establish dialysis [ Time Frame: Within an average of 5 minutes into each of the next 12 consecutive dialysis session ]Time to commence 2 needle dialysis from first palpation or imaging of fistula
- - Patient reported pain scores Patient reported anxiety and pain [ Time Frame: enrollment, two weeks and four weeks into trial ]Patient reported pain scores and anxiety scores recorded by questionnaire
- Number of cannulation attempts( skin punctures or passes of needle) [ Time Frame: Within an average of 5 minutes into each of the next 12 consecutive dialysis session ]number of cannulation attempts required
- complications of needling [ Time Frame: Within 2 hours of completing each of the next 12 consecutive dialysis sessions ]record presence of any complications due to needle insertion
- Referral for difficult needling during trial [ Time Frame: From enrollment to 24 hours following completion of the last of 12 consecutive dialysis sessions ]Referral for difficult needling to either senior nurse or to access clinic during trial
|Estimated Enrollment:
|Study Start Date:
|November 2011
|Estimated Study Completion Date:
|August 2012
|Estimated Primary Completion Date:
|May 2012 (Final data collection date for primary outcome measure)
|Assigned Interventions
No Intervention: Blind cannulation
Cannulation without guidance
Experimental: Ultrasound guided cannulation
Ultrasound guided cannulation
Other: Use of ultrasound guidance in cannulation
Use of guidance with duplex ultrasound to complete cannulation of dialysis access
Other Name: duplex ultrasound
Detailed Description:
Haemodialysis patients need to have two needles inserted into a large surgically altered vein (fistula) or surgical vascular graft/shunt for every dialysis session. Some fistulas or shunts may be more difficult to insert needles into than others. As such a system of colour coding or "traffic lighting" of patients is in place in most units. A "green light" patient is easy to "needle" with two needles and the majority of staff within the unit will be able to connect the patients to the dialysis machine. A "red light" patient is reserved for the more experienced staff within the unit who will often have to be timetabled to work specific times so that they are present to connect certain patients to the dialysis machines. "Amber light" fistulas lie between these two extremes.
Ultrasound (US) is routinely used in many hospitals and many dialysis units will have access to a machine to assess patients for problems. Indeed central venous line insertions for dialysis are now almost always performed under US guidance since two large studies in this area in 2002 provided strong evidence that US guided placement significantly reduces complications during catheter placement and a reduction in the number of attempts at insertion. In addition the National Institute of Clinical Excellence in the UK provided evidence that insertion time is quicker although this association was statistically less convincing.
Ultrasound offers the advantage of dynamic imaging without the risks of radiation exposure and can be done as an office based procedure using portable equipment.
Studies in emergency departments and particularly in paediatric care have suggested that US guidance can improve the speed and accuracy of cannulation in peripheral veins for intravenous access.
We suggest that US guided cannulation of fistulas might improve the cannulation rate of more difficult fistulas and potentially reduce the time required to commence dialysis and the number of local complications of cannulation (haematoma/aneurysm/infection).
To our knowledge US is not used in cannulation guidance in any dialysis units, although most units will have access to a machine as above. We therefore propose to perform a randomised controlled trial of US guided cannulation of fistulas versus current practice (blind cannulation) to assess the effectiveness of US controlled cannulation in a busy dialysis unit.
|Ages Eligible for Study:
|18 Years and older (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion criteria:
- Dialysis 3X per week
- Dialysing via 2 needles in fistula
- No deviation from routine dialysis protocol (additional or no heparin etc)
Exclusion criteria:
a. Active or recent fistula infection/thrombosis/intervention in 6/52 of study
Withdrawal criteria:
- Patient request
- Patient non compliance with study protocol
Please refer to this study by its ClinicalTrials.gov identifier: NCT01163981
|Contact: George E Smith, BSc MBBS MRCS
|01482 674128
|Contact: Ian C Chetter, MBChB MD FRCS
|01482 674178
|United Kingdom
|Hull Royal Infirmary
|Not yet recruiting
|Hull, East Yorkshire, United Kingdom, HU3 2JZ
|Contact: George E Smith, BSc MBBS MRCS 01482674178 firstname.lastname@example.com
|Principal Investigator: George E Smith, BSc MBBS MRCS
|Principal Investigator:
|George E Smith, BSc MBBS MRCS
|Hull and East Yorkshire NHS Trust
|Responsible Party:
|Ian Chetter, Hull and East Yorkshire NHS Trust
|ClinicalTrials.gov Identifier:
|NCT01163981 History of Changes
|Other Study ID Numbers:
Access 5
|Study First Received:
|July 12, 2010
|Last Updated:
|July 14, 2011
Keywords provided by University of Hull:
duplex Ultrasound
Vascular Access
Additional relevant MeSH terms:
Pathological Conditions, Anatomical
ClinicalTrials.gov processed this record on September 25, 2017


text:
Photography and Video
Still Photographs of Individual J.D. Recipients
Commencement Photo takes individual photos of each graduate during the Commencement ceremony. The company sends the order form directly to graduating students before Commencement.
DVD of the Commencement Video
This video covers the entire Commencement, including students robing in the Stuart Street building, the procession to the Boch Center (formerly Citi Performing Arts Center), the Commencement address, the valedictory addresses, the presentation of student awards and honorary degrees, and individual graduates receiving their diplomas. The Alumni Association underwrites the cost of the DVD, so it can be ordered for a shipping and handling charge of $5. Order information will be sent out following Commencement.
General Photos of Senior Class Reception and Commencement
The law school hires photographers to take photos at the Senior Class Reception and Commencement. These will be posted to New England Law's online "share site" on Shutterfly. The collection will include pictures from before, during, and after the ceremony at the Boch Center (formerly Citi Performing Arts Center), as well as from the party at the Four Seasons. You will receive an e-mail notice to your nesl.edu account when these pictures are available for viewing.


text: Politics 18 March 2012 Just one thing: a £50bn stimulus The Social Market Foundation tells George Osborne what it wants to hear in the 2012 Budget. Sign up for our weekly email * The Social Market Foundation tells George Osborne what it wants to hear in the 2012 Budget. If George Osborne does one thing, he should give the country a much-needed £50bn stimulus over the next four years, while sticking to the existing deficit reduction plan. The pre-budget wrangling continues. As politicians and commentators obsess over the varying impact of scrapping the 50p tax rate, raising the personal allowance, or managing the child benefit conundrum, the real context of this budget is the UK's persistent lack of growth. Last week's outlook downgrade by ratings agency Fitch didn't tell us anything we don't already know about the outlook for UK economy, as growth falters, unemployment grows and the Eurozone crisis rumbles on. But while the dangers of low growth are well rehearsed, the perils of looking weak by deviating from the deficit reduction plan are uppermost in the Chancellor's mind. So, to paraphrase the BBC's Paul Mason, the Budget is looking more and more like it will be an exercise in rearranging the deck chairs on the Titanic when it should be a real plan for growth. But a very large fiscal stimulus can be achieved within the existing deficit reduction plan. And what's more, the deteriorating outlook for the government's finances gives Mr Osborne the perfect opportunity to act. According to last November's OBR analysis, at least £15bn of additional annual cuts or tax rises will have to be made by 2017. Rather than wait until then, the Chancellor should make the necessary cuts and tax rises now by scrapping policies known to have a low or negative impact on economic output. The money saved from axing these measures should then be recycled into growth enhancing projects like infrastructure investment, which would boost economic output by around £10bn in each of the next three years, without wavering on the deficit reduction plan. And the catch? Well the low-growth measures Osborne should target will not be politically popular. From scrapping the winter fuel allowance to capping ISA holdings at £15,000, Mr Osborne would be slaying a few sacred cows. But these savings are unavoidable in the coming years, and waiting to set out those cuts on the eve of a general election is hardly going to make the government more popular. The benefits of acting now, by contrast, could be huge. With a £50bn stimulus under its belt, the economy might well be on the road to recovery by then. Ian Mulheirn is the director of the Social Market Foundation Back to list Ian Mulheirn is the director of the Social Market Foundation. Subscribe from just £1 per issue More


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A Study to Compare Two Anti-HIV Drug Combinations in HIV-Infected Patients Who Have Previously Received Anti-HIV Treatment
This study has been completed.
Information provided by:
ClinicalTrials.gov Identifier:
First received: November 2, 1999
Last updated: February 19, 2009
Last verified: February 2009
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
The purpose of this study is to compare the safety and effectiveness of 2 anti-HIV drug combinations in HIV-infected patients. Both combinations will include nevirapine (NVP), 2 nucleoside reverse transcriptase inhibitors (NRTIs), and at least 1 protease inhibitor (PI). One combination will include a new protease inhibitor, ABT-378, combined in a capsule with ritonavir (RTV).
|HIV Infections
|Drug: Lopinavir/Ritonavir Drug: Nevirapine
|Phase 3
|Study Type:
|Study Design:
|Primary Purpose: Treatment
|Official Title:
|A Randomized, Open-Label, Phase III Study of ABT-378/Ritonavir in Combination With Nevirapine and Two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) vs. Investigator Selected Protease Inhibitor(s) in Combination With Nevirapine and Two NRTIs in Antiretroviral-Experienced HIV-Infected Subjects
Resource links provided by NLM:
MedlinePlus related topics: HIV/AIDS
Drug Information available for: Nevirapine Ritonavir LopinavirU.S. FDA Resources
Further study details as provided by Abbott:
|Ages Eligible for Study:
|12 Years and older (Child, Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria
Patients may be eligible for this study if they:
- Are at least 12 years old.
- Are HIV-positive and have a viral load (level of HIV in the blood) of 1,000 - 100,000 copies/ml.
- Are currently taking an anti-HIV drug combination that includes 1 PI and 2 NRTIs, and that has not been changed in at least 12 weeks.
- Are naive to (have never taken) at least 1 NRTI, other than zalcitabine or abacavir.
- Agree to abstinence or use of an effective barrier method (e.g., condom) of birth control.
Exclusion Criteria
Patients will not be eligible for this study if they:
- Have an active illness.
- Have received treatment for any active opportunistic (AIDS-related) infection within 30 days of study entry.
- Have ever received a nonnucleoside reverse transcriptase inhibitor (NNRTI).
- Have received investigational (not yet approved by the FDA) drugs within 30 days of study entry.
- Have received treatment with a PI other than their current PI.
- Are receiving chemotherapy for cancer.
- Are pregnant or breast-feeding.
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: NCT00004581
Show 88 Study Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00004581
Show 88 Study Locations
Sponsors and Collaborators
More Information
Keywords provided by Abbott:
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on September 21, 2017
|ClinicalTrials.gov Identifier:
|NCT00004581 History of Changes
|Other Study ID Numbers:
|Study First Received:
|November 2, 1999
|Last Updated:
|February 19, 2009
Keywords provided by Abbott:
Drug Therapy, Combination
HIV Protease Inhibitors
Reverse Transcriptase Inhibitors
Anti-HIV Agents
Additional relevant MeSH terms:
HIV Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
HIV Protease Inhibitors
Protease Inhibitors
Reverse Transcriptase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Nucleic Acid Synthesis Inhibitors
Cytochrome P-450 CYP3A Inducers
Cytochrome P-450 Enzyme Inducers
ClinicalTrials.gov processed this record on September 21, 2017


text:
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text:
She looked every bit the freshman Tuesday, sporting a Cal State Long Beach sweater, her big brown eyes bright as she sat on a bench and watched upperclassmen shuffle past Brotman Hall.
Paula Sanchez just wanted to know where to file some paperwork before the first day of fall semester next week. The 17-year-old was nervous, excited and ready. Except for the math classes.
"When I took the placement test here, I felt — not prepared," Sanchez said.
She is among a wave of students who may not feel completely prepared for college, if a survey released today of incoming freshman performance is any indication.
According to ACT, which administers one of the two major tests used by colleges to admit students, readiness for higher education remains a sore spot among a majority of graduating high school students.
Just 39 percent of ACT-tested 2013 graduates met three or more of the four benchmarks in English, reading, math and science, according to the yearly report, The Condition of College & Career Readiness 2013.
Perhaps of more concern, 31 percent of high school graduates did not meet any of the benchmarks, according to the report.
California students fared better, but not by much. According to the report, 33 percent met all four benchmarks, compared with just 26 percent nationwide.
For Sanchez, her worry over college math was a diffident admission from a girl who took trigonometry and carried a 3.8 grade-point average in high school.
Given the choice at her high school in Costa Mesa to move on to calculus or statistics, Sanchez said she opted for the latter. The coursework would be easier, she reasoned. Sanchez already was an advanced placement student in English and Spanish classes.
The statistics class was interesting because of its real-life applications, she said. But her math skills got rusty in the process. She forgot many of the formulas.
Sanchez had to take a math placement course at CSULB this summer. She said things may have been different if she had taken that calculus class in high school. And been pushed harder in math. Other high school classes were a snap, if they weren't for advanced placement students.
"The grades were weighted wrong, so it was easy to get an A," Sanchez said. "I like the challenge."
Unprepared freshmen
ACT officials said research shows that students who fail to meet benchmarks are more likely to struggle in first-year courses on college campuses. The benchmarks specify the minimum scores students need to indicate a 75 percent chance of earning a C grade or higher in college freshman classes.
The report showed that minority students aren't as prepared for college as others. According to the report, "no more than 48 percent of African American, Hispanic and American Indian students met any of the four ACT College Readiness Benchmarks."
In surveying the ACT scores of 1.8 million students, or 54 percent of the graduating class in the United States, researchers found that students are still least likely to be ready for college-level science classes, with only 36 percent of test-takers meeting the benchmark.
In 2013, 64 percent of ACT-tested high school graduates have met the English benchmark for college readiness, the highest percentage of the four categories.
Long Beach 'holds its own'
In the Long Beach Unified School District, which has had several high schools rank among tops nationally on lists by the likes of Newsweek and U.S. News & World Report, efforts have been made to open advanced placement college preparatory classes to a broader pool of students, said spokesman Chris Eftychiou.
He pointed to the Long Beach College Promise, a partnership between the district, CSULB and Long Beach City College that helps qualified high school students prepare for and complete college.
The program provides a free semester of tuition at LBCC, guaranteed admission to CSULB and support through a student's time at college.
"Three out of four graduating seniors go on to college, and the class of 2013 (earned) a record $76.6 million in scholarships," Eftychiou said.
He said seniors in the district "are holding their own on the ACT," but twice as many take the SAT. There were 1,246 seniors who took the ACT in the 2011-12 school year, the latest available results the district has, according to Eftychiou.
The average composite score was 20.95, according to the district. More than 50 percent scored 21 or higher. The national average was 20.9 in 2013, according to ACT. In California, the average composite score was 22.2, according to the ACT report.
'The bigger message'
Lynn Mahoney, interim vice provost and dean of undergraduate studies at CSULB, said the university uses ACT and SAT scores to find out if students need more placement tests in math and writing.
CSULB also participates in programs that ensure freshmen are "general education" ready on the first day of classes.
The Early Assessment Program helps high school seniors take the classes needed to be ready upon arrival at a CSU campus. The Early Start program allows incoming CSU freshmen to start or finish their developmental math or writing needs the summer before their freshman year.
Mahoney said about 45 percent of the recent crop of Early Start Math students moved up a level in math. The university expects next summer to expand the Early Start Writing program.
Mahoney suggested there could be an overemphasis on test scores, especially when it comes to high school students such as Sanchez, who are bright and earn high marks.
"I think the bigger message is that most of these students go on to graduate from the Cal State system, and they go on and have great lives, but they get caught in testing problems by their SAT and ACT scores," she said. "So if you're not a good test taker, even if you have good high school grades, you're going to get caught in this."
A different route would be to evaluate such test scores, and couple them with a student's high school transcripts, Mahoney said, adding that it would better help incoming freshmen who are smart, but may not be good test-takers.
"I think these students are college-ready," she said. "I think sometimes we use these one-off assessments a little too much."
Contact Josh Dulaney at 562-714-2150


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Back on February 15th, 2008 (yes, theFrontSteps has been around that long) we were asked by a reader if we knew of any good maps showing areas in San Francisco that are either bedrock or landfill. You'd be amazed how many people, to this day, read that post, and how many more emails we get asking if we have an even better map that will drill down and show the exact streets and topographic undulations as they pertain to a specific home/condo or listing.
Until now, we've come up empty, but we're pleased to say, we have been informed of two new (to us) maps. One is a State of California Geologic map showing San Francisco areas prone to liquefaction (green) and "earthquake induced landslides" (blue), and you can really drill it down to the street you live on. (Click on the image to download the pdf and get your SF liquefaction/landslide knowledge on…quiz next week):
That's a cool map. The other map is hidden in our MLS, and it allows us to layer the Liquefaction map over the listing location map. Do they give that access to you? Of course not, but we welcome you to contact us if you'd like us to research a listing for you (expect to work with us on the transaction, or tell your Realtor to do it for you).
Have a look at this property at 260 Green, a gorgeous 4 bed, 4.5 bath trophy San Francisco home in Telegraph Hill, with a recent price reduction from $12,900,000 to $11,000,000. By way of magic mouse clicking we're able to tell you immediately if that home is in a prone area, and apparently price is not the only thing subject to sliding at 260 Green. (Obviously our one second look at a map does not compare to consulting with an expert soils or seismic engineer, so make sure you do if you have your eye on this property, or any others for that matter…okay.)
So that's all great and what we can do for you, but what if you don't want to contact a Realtor? San Franciscans, if you don't know roughly where your home/neighborhood is on that map…you got issues. For the out of town readers considering a move to San Francisco, you can compare the liquefaction/landslide map to this San Francisco Neighborhood map. That will give you a good starting point. (For details go here.)
And in case you missed our original post and would like to know whether the chances of your house crumbling during "The Big One" are Very High, or Low (not just whether you're in the zone), here you go: (the below map requires Shockwave)
Needless to say, if you live/plan on living in an area of green (first map) orange or red (bottom map), you better know how to duck for cover, and know that earthquakes don't discriminate based on property values…if you're in the zone, you're in the zone. We hope "The Big One" never hits, but we all know it's a matter of when, and not if, so choose your property location wisely, inspect, inspect, inspect, and remember to do those seismic upgrades you've been putting off for so long.
[Update: As is often the case, our readers are more bad ass than we are, and so provided a link to a soil stability (types) site: Click here to see it.]
IF YOU'RE LOOKING AT THIS POST CONSIDERING WHERE YOU WANT TO PURCHASE OR NEED TO SELL PROPERTY IN SAN FRANCISCO, IT'S BEST YOU CONTACT ME! I can get into details with you.
–Map of San Francisco locations prone to Liquefaction and Earthquake Induced Landslide [State of California Geologist]
–SF Districts Map (Not the totally new one with new zones, but close enough)[SFAR]
–Map of Bedrock Versus Landfill San Francisco [theFrontSteps]
–Contact Us to Check Your Property Liquefaction/Landslide Location[email firstname.lastname@example.com]
–Map: Bay Area's Biggest Earthquakes [theFrontSteps]
–Liquefaction Zones of San Francisco's Marina District [theFrontSteps]
–Bay Area Liquefaction, Landslide, and Seismic Zones – Mapped [theFrontSteps 8/1/2016]
Or use this form.


text:
Nicholas Platt, the fifth president of the Asia Society, has spent most of his life working on relations between the US and Asia. He assumed the presidency of Asia Society in 1992 after a 34-year career as an American diplomat in Asia which culminated in service as US Ambassador to the Philippines (1987-1991) and Pakistan (1991-1992).
Ambassador Platt will be retiring this summer after twelve years as President of the Asia Society and will be succeeded by Vishakha N. Desai. In this interview, Ambassador Platt discusses his time in the diplomatic corps, American foreign policy in Asia, the mission of the Asia Society following the events of September 11, 2001, and the future of the institution.
You came to the Asia Society after a 34-year career at the US Department of State. How did you make the transition from government service to a non-profit organization? To what extent was there some continuity between the work you did as an American diplomat and the work you have done as president of the Asia Society?
The transition was very rapid. The Asia Society had approached me to take this job in March 1992 and I had only been in Pakistan for about six months. I had told the Search Committee that I would like to take the job but it would have to wait for me till November. I could not just abandon my post; I had to tell the President that I was his at least until the elections that year. So I left Pakistan on election day, before the polls opened. I retired from the Foreign Service on November 16 in the morning and became President of the Asia Society in the afternoon; between careers I had lunch!
There was a lot of transference; some of the muscles that you use in doing this job are similar. The contacts that I had in the Foreign Service and among the Asian leadership and in the foreign policy field were all usable. But I had to learn a whole new set of skills. I never realized the extent to which running an NGO is similar to running a business: the importance of setting up a budget, of raising the funds to balance it, of making sure that the programs you do are the most efficient and effective and at the same time affordable. All of this involved considerations that I never had to make before. As Ambassador in three different places, the budgeting was done. I had a mission, I had to report and represent and negotiate and do all the things that ambassadors do, but the last thing it was was a business!
The State Department career infected me with a passion for Asian cultures and societies, as for the political and economic problems in the region. What attracted me to the Society was the ability to continue to work on those and to do so in a holistic way. I found as a Foreign Service officer that it was impossible to work in a foreign environment without knowing something about the culture. You could not understand politics or economics or society unless you had some feel for the culture. And here was an institution that presented it all.
In your experience, has the Asia Society been entirely independent of US government interests or has it in some broad sense pursued American foreign and economic policy objectives in the region?
We are independent in terms of funding and in terms of the details of policy. We can do programs that people in the government would not do or would not approve. That said, the interests of the United States and the interests of the Asia Society are broadly congruent. Our mission is to teach Americans more about Asia and to connect Asians and Americans, to provide a full range of information so that America and Asia can come closer together. I regard that as very much in the interest of the US government as well as American society, economy, etc. We cannot do a good job of those things unless we know more about each other.
The cultural programs at the Asia Society, while they have no political content for the most part, are designed to raise people's levels of awareness and understanding of countries in Asia: their histories, their polities, their interests. The focus on contemporary art is quite political and we can and do present programs in the contemporary art field that are not necessarily to the liking of the governments of the originating countries. We feel that they add to the knowledge and understanding of these places and therefore we should do them.
There are programs that we can do and things that we can say that people in the government wish they could but cannot. We do that. Having worked in the government, I have good contacts and I try to keep track of what policy is, not so that I can necessarily follow it, but so that I can be aware of when we might be deviating and when we might be filling in some blanks that the US government cannot.


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In BB's translation of the Majjhima Nikaya, at MN 124.41, his note to the sentence, "Then, seated in the midst of the Sangha of bhikkhus, the venerable Bakkula attained final NIbbana" (p. 988), says, "[The] Majjhima Nikaya Attakatha [commentary says]: Ven. Bakkula entered into meditation on the heat element and attained final Nibbana by causing his entire body to be consumed by that blaze. Only the relics remained" (p. 1338).
1. Does this relate to what we moderns call "spontaneous combustion"?
2. Did Reverend Bakkula commit suicide?