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Frank A. Chervenak, MD and Laurence B. McCullough, PhD
Dr. Chervenak is Acting Chairman and a Professor of Obstetrics and Gynecology at The New York Presbyterian Hospital Cornell Medical Center, New York, NY. Dr. McCullough is a Professor of Medicine and Medical Ethics at Baylor College of Medicine, Houston, TX.
Whether all pregnant women should have an ultrasound examination continues to be controversial. This question has been answered affirmatively in most of Europe and the rest of the world. We will argue that ultrasound should be offered to all pregnant women.
The RADIUS trial remains the largest and most expensive prospective study of the routine use of obstetric ultrasound. Screening ultrasound was found not to significantly improve perinatal or maternal outcome and the investigators concluded that routine obstetric ultrasound was not indicated. 1 The American College of Obstetricians and Gynecologists (ACOG) supported this conclusion in the November 1993 Newsletter 2 and in the December 1993 Technical Bulletin 3 on Ultrasonography in Pregnancy. The Bulletin states that "... in the United States the routine use of ultrasonography cannot be supported from a cost-benefit standpoint." The newsletter adds that ";... the College not recommend routine ultrasound screening." There is no uniform support for this stance. Critics have pointed out scientific shortcomings in both the methods and conclusions of the RADIUS trial. 4,5
There is another unstated concern that needs to be addressed. In the authors' view, ethics is an essential dimension of the routine obstetric ultrasound debate. 6 This is not so much a clinical issue to which there are ethical aspects, but rather it is a clear example in modern obstetrics in which widespread ignorance of basic ethical concepts can lead to inappropriate clinical judgment.
Ethics can be defined as the disciplined study of morality. Morality concerns both right and wrong behavior (i.e., what one ought and ought not to do), and good and bad character (i.e., virtues and vices). Since the goal of ethics is to improve human behavior and character, the fundamental question that ethics addresses is, "What ought morality be?" This question involves two further questions, "What ought our behavior be?" and "What virtues ought to be cultivated in our moral lives?" Medical ethics deals with these same questions, focusing on what morality ought to be for physicians.
The bedrock for what morality ought to be in clinical practice for centuries has been the obligation to protect and promote the interests of the patient. There are two perspectives in terms of which the patient's interests can be understood: that of the physician and that of the patient. 6
The first of these two perspectives on the interests of patients in the history of medical ethics is the perspective of medicine. On the basis of scientific knowledge, shared clinical experience, and a careful, unbiased evaluation of the patient, the physician should identify those clinical strategies that will likely serve the health-related interests of the patient and those that will not do so. The health-related interests of the patient include preventing premature death and preventing, curing, or at least managing disease, injury, handicap, or unnecessary pain and suffering. That these matters are constitutive of any patient's health-related interests is a function of the competencies of medicine as a social institution. 6 We cannot overemphasize the point that the identification of a patient's interests is not a function of the personal or subjective outlook of a particular physician, but rather of rigorous clinical judgment.
The ethical principle of beneficence obliges the physician to seek the greater balance of goods over harms for patient care. On the basis of rigorous clinical judgment, physicians should identify those clinical strategies that are reliably expected to result in the greater balance of goods (i.e., the protection and promotion of health-related interests), over harms (i.e., impairments of those interests). The principle of beneficence has an ancient pedigree in Western medical ethics, at least back to the time of Hippocrates. 6
The principle of beneficence in medical ethics should be distinguished from the principle of nonmaleficence, commonly known as "primum non nocere" or "first, do no harm." It is important to note that primum non nocere does not appear in the Hippocratic Oath or in the texts that accompany the Oath. Instead, the principle of beneficence was the primary consideration of the Hippocratic writers: "As to diseases, make a habit of two things-to help or to at least do no harm." 6 In fact, the historical origins of primum non nocere remain obscure. 6
There are more than historical reasons to reject primum non nocere as a principle of clinical ethics, because virtually all medical interventions involve unavoidable risks of harm. If primum non nocere were to be made the primary principle of clinical ethics then invasive radiological procedures would be unethical, an obviously absurd conclusion.
Primum non nocere is therefore super-seded in medical ethics of maternal-fetal medicine by the principle of beneficence. The latter is sufficient to alert the physician to those circumstances in which a clinical intervention has the potential to harm the patient. When a clinical intervention is on balance harmful to a patient, it should not be employed.
A well-formed clinical perspective on the interests of the patient is not the only authoritative perspective on those interests, because the perspective of the patient on the patient's interests is equally worthy of consideration by the physician. Each adult pregnant patient has developed a set of values and beliefs according to which she is capable of making judgments about what will and will not protect and promote her interests. It is commonplace that in other aspects of her life the patient regularly makes such judgments concerning matters of considerable complexity (e.g., choosing a professional calling, rearing children, entering into contracts, and writing a will of property). Despite the complexity of these decisions, she is rightly assumed to be competent to make them, with the burden of proof on anyone who would challenge her competence. 6
The same is true regarding health care decisions made by the pregnant patient. She must be assumed by her physician to be competent to determine which clinical strategies are consistent with her interests and which are not. In making such judgments, it is important to note that the patient utilizes values and beliefs that can range far beyond the scope of health-related interests (e.g., religious beliefs or beliefs about how many children she wants to have). Beneficence-based clinical judgment, because it is limited by the competencies of medicine, gives the physician no authority to assess the worth or meaning to the patient of the patient's non-health-related interests. Therefore, these are matters solely for the pregnant patient to determine.
The ethical significance of this perspective is captured by the ethical principle of respect for autonomy. This principle obligates the physician to respect the integrity of the patient's values and beliefs, to respect her perspective on her interests, and to implement only those clinical strategies authorized by her as the result of the informed consent process. This process is understood to have three elements: 1) disclosure by the physician to the patient of adequate information about the patient's condition and its management; 2) understanding of that information by the patient; and 3) a voluntary decision by the patient to authorize or refuse clinical management. 7
Providing patients with information about diagnostic and therapeutic alternatives is an essential component of respect for the patient's autonomy. Failure to provide the patient access to information deprives the patient of the opportunity to consider alternatives about the management of her pregnancy, some of which may be highly in accord with her values. Nondisclosure of diagnostic alternatives therefore seriously impairs the exercise of the patient's autonomy. Routinely offering obstetric ultrasound respects the autonomy of pregnant women and not routinely offering obstetric ultrasound systematically disrespects the autonomy of pregnant women, because the woman's access to the diagnosis of serious anomalies and, therefore, access to abortion for serious fetal anomalies is restricted. 8 These matters are not ethically or clinically trivial.
The implication of respect for autonomy in clinical practice means that every pregnant woman should be informed of the availability of this diagnostic modality at the physician's initiative. 8 A practice of discussing ultrasound only when women initiate inquiries makes a sham of respect for autonomy because many women are informed about this modality and its ability to detect at least three times the background detection rate of fetal anomalies. 1,8,9 Instead, the clinical strategy of prenatal informed consent for sonogram (PICS) should be employed with every pregnant woman. 8
PICS should be undertaken in several stages. Soon after the pregnancy has been diagnosed, the pregnant woman should be provided by her obstetrician with information about the actual and theoretical benefits and harms of obstetric ultrasound. The pregnant woman should then be given an opportunity to evaluate this information in terms of her own values, something every autonomous patient can do. It may be helpful to some women to consider, at this point in the process, the physician's scientific evaluation of the clinical data that have been reported in the literature. The pregnant woman should be asked to articulate her preference regarding the use of ultrasound in the management of her pregnancy. The physician should then provide the pregnant woman with the physician's own recommendation, and there should be discussion of any disagreement that may emerge. On the basis of the foregoing, the woman makes her final decision. This decision should then determine the use of obstetric ultrasound for that pregnant woman.
In other words, PICS establishes a patient-based indication for routine obstetric ultrasound. 8 The RADIUS investigators have explicitly opposed this indication 9 and ACOG, by its silence on this matter and its support of the conclusions of the RADIUS study, gives the appearance that it also opposes this indication. As a result, ACOG reduces the ability of physicians to be effective advocates for the autonomy of pregnant women regarding access to routine obstetric ultrasound. The authors propose that obstetricians act on their autonomy-based obligation to pregnant women and advocate for their autonomy by offering, and thereby providing, access to routine obstetric ultrasound.
There are two possible objections to our proposal: lack of benefit and excessive cost. We will show how each of these objections fails.
Lack of Benefits - Treating lack of benefit of routine obstetric ultrasound as decisive implies that beneficence-based considerations override autonomy-based considerations. The RADIUS trial, which applies to at most 40% of women who present for private obstetric care, found that routine ultrasound did not significantly improve outcome in terms of perinatal morbidity or mortality or maternal morbidity. 1 This is only one measure of the efficacy of this diagnostic maneuver. Screening ultrasound has accomplished significant improvement in detection of fetal anomalies, detection of twin pregnancies, diminished usage of tocolysis, and reduction of the occurrence of postdatism. 1,4,5 The RADIUS trial assumed that these possible benefits would be truly clinical benefits only if they had a documented improvement in perinatal morbidity and mortality. Although there are important measures, they do not represent the full array of clinical considerations.
Clinical judgment should not narrow itself only to the measurement of end points such as perinatal morbidity and mortality, but should also include the prevention of harm in small but important subsets of patients. The RADIUS study conclusions were slanted by an unjustifiably narrow concept of clinical judgment that is not acceptable in modern medical ethics. The study ignored other clinical realities (prevention of unnecessary tocolysis, early prenatal diagnosis of twin gestations not detected clinically, physician-patient ignorance of the presence of fetal anomalies prior to delivery, and inappropriate assignment of postdatism) that are also significant in and of themselves in clinical judgment. Ignorance of clinical realities is not bliss for either the patient or the physician. Lack of available information is not an acceptable standard of care.
In contrast to the narrow view adopted by the RADIUS study, the goal of modern medical ethics is comprehensive clinical ethical judgment. In such comprehensive clinical ethical judgment, the physician justifiably offers obstetric ultrasound as a matter of prudence to avoid rare adverse outcomes such as unnecessary tocolysis provided that such benefits outweigh the possibility of harm from erroneous ultrasound diagnoses. Prudential calculations in well-formed clinical judgment emphasize the seriousness of the outcome rather than the low incidence of the out-come. With respect to seriousness of outcome, the risks of not performing ultrasound are significant even though they are of very low incidence. For example, given the seriousness of the outcomes of undetected clinical complications, such as unexpected twins at the time of delivery, it is justifiably risk averse to attempt to prevent those out-comes when in clinical judgment the risks of not performing the ultrasound outweigh the risks of performing it. In the authors' view, high-quality ultrasound, 8 which is required as a matter of professional integrity, reduces the risk of harm from erroneous ultrasound and, therefore, tips the balance in favor of this prudential judgment.
This prudential judgment is not altered by concern for possible bioeffects. This is because there are no documented reproducible ill effects of obstetric ultrasound. Moreover, no credible study has documented a serious bioeffect. Therefore, in prudential clinical judgment, outcomes that remain theoretical have far less weight than serious outcomes that are documented.
An ethical analysis of routine ultrasound based on clinical judgment of the proper scope reaches two conclusions: 1) endpoints of overall perinatal morbidity and mortality are not the only relevant components of comprehensive clinical ethical judgment; and 2) prudential clinical ethical judgment supports offering highquality ultrasound. The first is neutral in the clinical judgment of PICS; the second supports PICS in clinical judgment. Thus, objection to PICS on the ground that it provides no benefit fails. Moreover, given the significance to the pregnant woman of the benefits of PICS, namely to make an informed choice about the management of her pregnancy, central matters of respect for autonomy are at stake. On balance, autonomy-based obligations should clearly be the physician's primary guide in response to objections based on lack of benefit.
Excessive Cost - Treating the excessive cost of routine obstetric ultrasound as decisive asserts that justice-based considerations or fairness override autonomy-based considerations. A central justice-based consideration is cost-effectiveness, which concerns identifying the least expensive means to achieve an agreed upon goal. An important goal of obstetric ultrasound is to detect fetal anomalies. Devore 10 has shown that the cost per detected case of an anomaly in the RADIUS trial was not greatly different from the cost per detected anomaly in the California MSAFP screening program. Given the improved detection rate in tertiary centers, Devore has shown that the cost per anomaly detected with quality ultrasound is much less. 10 The California MSAFP screening program is a reliable touchstone for cost-effectiveness. By this comparison alone, routine obstetric ultrasound is cost-effective.
A second justice-based consideration is cost-benefit which concerns whether the cost of an intervention in the present saves a greater cost in the future. We interpret Devore's analysis to suggest that routine ultrasound is cost beneficial because the cost per anomaly detected with quality ultrasound is far below the neonatal and lifetime costs of those anomalies, assuming that for many pregnancies in which serious anomalies are detected women will seek a termination.
Let us suppose for a moment that rou-tine obstetric ultrasounds were not cost beneficial. Should this consideration automatically override respect for auton-omy? Those who imply that the answer is "yes" confront a significant burden of proof. First, most theories of justice in Western philosophy give paramount consideration to personal autonomy and freedom, including theories of justice based on utilitarianism. It would mark a radical departure from this centuries-long history for the principle of justice to automatically override the principle of respect for autonomy. Justice-based con-siderations may override autonomy-based considerations when costs are enormous, even when some benefit results. This was not the case before, and is not the case after, the RADIUS study.
PICS, the routine offering of obstet-ric ultrasound, is the central issue in the routine obstetric ultrasound debate, because there is a decisive role for the exercise of the pregnant woman's autonomy to judge the benefits and harms of routine ultrasound and the worth to her of the information yielded by high-quality ultrasound. The authors of the RADIUS trial explicitly oppose PICS. 9 They have maintained a narrow focus upon morbidity or mor-tality. 1,8 We have shown that these are important, but not the only components of comprehensive ethical judgment.
In order to avoid errors in clinical judgment that is less than comprehen-sive, physicians should be strong advo-cates for offering obstetric ultrasound to pregnant women. Some may view this as an extreme and expensive proposal. However, it asks no more for patients than virtually all physicians expect for themselves or family members as an essential part of contemporary obstetric care. AR


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subset: commoncrawl


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The very first thing that turned me off was that fact that I didn't have the ability to map to both buttons. I utilize both my buttons on the space navigator along with the two "thumb" buttons that I have on my mouse and they both both together well. I NEED THIS OPTION.
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So I have dropped a ShIIt load of weight and fat doing a Keto and LeanGains diet. Now its time to hit those stuburn deposits that are still clinging on. Thanks to the FORMUTECH gang it should be no sweat!
Going to cut out the Keto and keep the LeanGains going. Keto was really killing the weight and that's not where i wanted to go.
Will be Trying to mantaine or gain lean weight and drop BF%
Here's the Diet run down, going on an estimated LBM of 171lb:
Daily Totals
Protein : +171g :: 684Cals
Carbs : 342g ::1,368Cals
Fats : 51g :: 459Cals
Total Cals : 2,511
These numbers may adjust as i get a better idea of my BF%
Keeping up a reverse Pyramid 3 day split with 3 days of cardio worked in-between.
Dead Lifts , OverHeadPress, CableRows and abs if i have time
Cardio 45min
BenchPress , Weighted ChinUps , CloseGrip Bench ( and if time ) Flat DB Press + Ab Crunch Machine
OFF of Cardio
Smith Squats , Roman Dead Lifts , Donkey or Standing Calf Raises , Leg Lifts of Ab roller
Cardio and what ever else.


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I recently stayed at this condo rental suite with 3 other adults and two grandchildren. The accommodation was exactly as it was pictured, large, clean, and very modern. We had a wonderful view from every room, and the kids loved the indoor/outdoor pool. We all hope to rturn very soon.
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- Located in Canmore in the heart of the Rocky mountains surrounded by unfettered forest, riveting rivers and majestic mountains, our 1100 square feet luxury condominium suites have a state-of-the-art kitchen, 2 bedrooms, 2 bathrooms, living room with fireplace and in-suite washer & dryer. Suites hold up to 6 persons. Cable television and high speed internet is in each suite. After a summer hike or winter ski in the nearby Olympic Nordiq Centre, relax in our heated outdoor pool with sauna and hot tub surrounded by majestic snow capped mountains. ... more less
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Football Long Snapper Has Perfect Aim You Won't Believe [VIDEO]
Long snapping may not be the sexiest part of football, but one collegiate player is proving how cool it can be.
Long snapping may not be the sexiest part of football, but one collegiate player is proving how cool it can be.
You can call this teenager an accidental musical prodigy.
As our stomachs prepare for Thursday's massive caloric intake, let's take a look at how a few of our animal pals do it.
Colin Kaepernick threw for 235 yards and three touchdowns, and the San Francisco 49ers cruised past the Washington Redskins, 27-6, on Monday night in Landover, Md.
You can get dinner and a show at this McDonald's.
The holidays can bring out people's stranger sides, and Thanksgiving is no exception.
It's tough to swallow how much one person just paid for some wine.
While selfies took the world by storm in 2013, it turns out they've been around for a lot longer than you may think.
UPDATE 3:15 p.m. EST: The lockdown and shelter-in-place orders have been lifted, according to the Yale alert system. Police have been going door-to-door on campus searching for the gunman, though authorities will not confirm whether it may have been a hoax.
After a competitive 60 minutes of regulation and 15 minutes of overtime, the Green Bay Packers and Minnesota Vikings played to a stalemate, tying in their Week 12 game. Should there be ties in the NFL?
What's that expression about where sleeping dogs lie?
It's beginning to look a LOT like Christmas.


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Tag Archives: Edward Lowe Foundation
Celebrating Second-Stage Entrepreneurial Companies
Presented by the Arizona Small Business Association in conjunction with the Edward Lowe Foundation Gov. Jan Brewer The businesses of the 2009 class of Comerica Bank Arizona Companies to Watch represent the determined, innovative spirit necessary to advance our great state. I am especially pleased to extend my congratulations and … [Continue Reading]
- by AZ Business Magazine | on Nov/01/09


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"Internet Purchases Only" "Not a Retail Store Stock Item"
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Rossi MiniLoader muzzleloading rifles in either .45 or .50 caliber. These are full featured versions of the Rossi inline muzzleloading rifle, but scaled down for the smaller shooter. The Rossi MiniLoaders feature a Monte Carlo style stock and all Rossi muzzleloading rifle barrels are drilled and tapped to accept a scope mount base. These firearms incorporate the transfer bar mechanism and manual safety on a single shot, break-open design. The breech cannot be closed or opened if the hammer is cocked. Add that to the safety inherent in single shot long guns and you have the perfect shooting platform for training.


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Ontario County man charged with stalking, aggravated harassment
Posted at: 12/11/2012 12:05 PM
A 37-year-old Ontario County man has been arrested for stalking, aggravated harassment and obscenity.
State Police the charges against David Drake II of Stanley stem from an investigation that started in Ray Brook, N.Y.
Investigators say they were contacted by a 23-year-old woman who said Drake, a former Saranac Lake, N.Y. resident, sent her letters proclaiming his love for her. Troopers say those letters were accompanied by several hand-drawn cartoons of the woman's likeness that were of a graphic sexual nature.
According to investigators, the victim told police she doesn't know Drake and only saw him one time when he appeared at a restaurant she worked at.
Drake was arraigned and remanded to the Ontario County Jail in lieu of $1,000 bail.
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OOPS! You know Alicia and her husband Swizz Beats really need to learn how to tell one house from another! A report came out that while Alicia and her husband decided to rent a house in the Hamptons, now when they got to the house they decided to party it up a bit! And thats when the owner of the house came downstairs! Yes, Alicia and her friends were at the WRONG house!!
The owner of the house said her daughter and friends had been at the house earlier to pre-game before a football game and she thought they had returned, so when she heard noise coming from downstairs she decided to go down and say hi! She says she was shocked, however she recongized Alicia so she wasn't TOO scared!!
Funny thing is...if Alicia and her friends walked into the wrong house...how did they even get in? Did this woman leave her house unlocked! See people....this is why you LOCK your doors...celebrities will just start walking in whenever they want!


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William Bludworth
Comments127this wiki
Molly Harper-Visitor; Deceased
Peter Friedkin-Visitor; Deceased
Nathan Sears-Visitor; Deceased
Alex Browning-Visitor; Deceased
Clear Rivers-Visitor; Deceased
Kimberly Corman-Visitor; Deceased
Thomas Burke-Visitor; Deceased
A lucky few survive the disaster, and then one-by-one, Death comes for them all William Bludworth, to Sam and his friends. |
William Bludworth is a mortican from the Final Destination series. He is the owner of Bludworth Funeral Homes, and has the most knowledge of Death and its forces and capacities.
Bludworth was born on October 31, 1954 in New York. He is mysterious, agitated and imminent, to the survivors when they evaded Death. He works as a mortican in Bludworth Funeral Homes and has some currently unrevealed connection to Death.
Final Destination
After the death of Tod Waggner. Alex Browning and Clear Rivers went to see him at the morgue. There, they met William Bludworth, who told them that they had cheated Death by getting off the doomed Flight 180 aircraft, but now Death has a new design for all of them, and that by trying to cheat Death a second time will only infuriate it more. Before leaving, William says, "I'll see you soon." though it is unknown as to whom he is speaking to.Final Destination 2
One year later, Clear visited Bludworth again, along with Kimberly Corman and Thomas Burke, who survived the incident in Route 23. William, who cremates the body of the recently deceased Evan Lewis, then told them that the only sure-fire way to cheat Death is via new life. This lead them to believe that by Isabella Hudson having her baby, this could break the chain and give all of them a clean slate.
Final Destination 5
After a complete absence from The Final Destination, Sam, Molly and friends first encountered Bludworth at the North Bay Bridge Memorial where he told them that Death doesn't like to be "cheated". The second time they met was at Candice's death. They met him again at the scene of Isaac's demise, where he told them of Death's design, and that they could kill another person who would take their place, and in turn scratch their name off Death's list and taking the lifespan of the other person. Peter seemed to be the most willing to kill another person in order to save himself. When Bludworth meets up with the survivors of the Bridge Collapse, he says "I've seen this before", meaning that people surviving an accident are meant to die sooner or later. Later on, these events are revealed to have taken place before the first Final Destination. Soon after these events, he is promoted from "Undertaker" to "Mortician".
Death of the Senses
Due to a usual coroner being on vacation, Bludworth (going by just Bill) was transferred to a New York morgue, just in time for Death to begin targeting a new set of victims who were supposed to die at the hands of a would-be serial murderer killed in self-defense by latest visionary Jack Curtis. When Jack and his friend Officer Amy Tom stopped by the morgue to take a look at the corpses of first victim Chelsea Cox and the dead psychotic, Bludworth greeted them, and like he did for Alex, Clear, Kimberly, and Thomas, offered cryptic advice.
- Final Destination (portrayed by Tony Todd)
- Final Destination (novel)
- Final Destination 2 (portrayed by Tony Todd)
- Final Destination 2 (novel)
- Final Destination 3 (as Devil) (Voiced by Tony Todd)
- Final Destination 3 (novel) (as Devil)
- Final Destination 5 (portrayed by Tony Todd)
- Although Bludworth didn't appear in Final Destination 3, he portrayed Devil's voice in the movie. His voice was heard on the Devil's Flight roller coaster, as well as the operator of the subway at the end of the film.
- Some fans theorize that Bludworth is the personification of Death or a representative of it. However, this has been confirmed to be false by the producers.
- In the morgue in Final Destination 2, you can see William Bludworth wearing Evan's diamond studded Rolex. How he obtained the watch is unknown, unless no one took off hiswatch prior to the autopsy. This may suggest that he steals the belongings of those whose bodies he examines.
- This may be referenced in the opening of Final Destination 5 by Evan's Microwave exploding behind Tony Todd's Name.
- In the beginning of Final Destination 2 when Kimberly wakes up suddenly you can hear Tony Todd's voice saying "Kimberly". Considering the conductor of Train 081 was also voiced by Tony Todd it is unknown whether this is the voice of William Bludworth or a supernatural force.
- It is possible that Bludworth does not actually want the survivors to live, as the advice he gives e.g. "new life, kill or be killed" does not work. It is possible that, while not Death, he is something closely related to Death, possible Death's assistant as it is by acting on his advice that takes the lives of several of the survivors; Sam, Molly, Peter, Nathan and Agent Block die by the "Kill or be killed" advice, and the new life, when acted on, causes the eventual death of Kimberly and Officer Burke, as they think they've escaped Death by Kimberly dying and coming back to life, but they haven't and they both, after a five year interval, die.
- He is the only character that appears in more than two different Final Destination movies, and thus the only character able to survive the events of more than one film. He has made major appearances in Final Destination, Final Destination 2, and Final Destination 5. Tony Todd also voiced the Devil in front of the Devil's Flight from Final Destination 3, although this is not nessisarily William Bludworth. The only film not to feature Tony Todd is The Final Destination .
- Final Destination 5 ends with Bludworth saying "You all just be careful now." following the death montage. This makes him the last person to ever be seen in a Final Destination film up to this point.


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50 experts and 171 advocates oppose the HHS/IOM Contract to re-define ME/CFS.
Check out our IOM Contract Forum for the latest news and to join the campaign.
The fifth and final article in a series attempting to explain the science behind fairly common topics and exploring how they relate to ME/CFS. This time the topic is the nervous system – by Andrew Gladman.
Discuss the article on the Forums.
Dr. Marshall on XMRV
Discussion in 'Media, Interviews, Blogs, Talks, Events about XMRV' started by Cort, Nov 17, 2009.
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Fantastic! Share your favorites and earn zulily credit. see detailsconnect
Players will have their memories tested as they race through the curriculum. For each answer they get correct, they'll get a letter token and the first to spell SMART wins. Featuring over 1,300 questions covering topics from first through sixth grade, this game allows small scholars to review and retain information while learning new knowledge in a fun, interactive format.


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Ryback Promises To Send a Superstar Away In An Ambulance
Posted by Will Hengelbrok on Tuesday, May 21st, 2013
Recent Headlines
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Northern Hilltribes & Villages (ATHV)
From the luxury of Bangkok's malls and gleaming highrises, head north to Thailand's hills. Eating and sleeping with the hilltribes will bring you face to face with these colourful cultures. We'll leave plenty of time for fun in historic Chiang Mai with its night market and delicious cuisine. Our CEOs will help you get off the beaten path—but you'll stay flexible by being able to choose the activities you really want.
Highlights: Experience the bustle of Bangkok, explore the vibrancy of Chiang Mai, trek through northern hilltribes and meet the locals, ride on the back of an elephant and float on a bamboo raft.
Beaches & Backwaters (AHBB)
Watch the sunset through the fishing nets of Kochi, stretch out on white-sand beaches, drift through the tranquil backwaters and rise at dawn to see the sunrise. This 7-day tour offers a quick introduction to the diversity of South India. Inhale the exotic perfume of cardamom as you stroll through spice gardens and unwind with some yoga in your free time. Meet the locals and spend the night with a local family on a tour that's all about authentic cultural experience.
Highlights: Relax in the calm backwaters, experience a local homestay, chill out on quiet beaches, sample South Indian cuisine.
- Travel Style:
- Yolo
- Trip Type:
- Small Group
- Service Level:
- Basic
- Physical Grading:
- 2
Cambodia on a Shoestring (ATRC)
Marvel at the incredible Khmer ruins of Angkor Wat and the clear turquoise waters at Sihanoukville. This journey packages Cambodia's treasures into 10 well-paced days. Brave Ho Chi Minh City's jam-packed streets with other travellers your own age—you can be sure they'll keep pace with you—or check out the more laid back waterways of Vietnam's Mekong Delta. With your accommodation, transportation and general trip logistics arranged, you can concentrate on choosing the activities that interest you most.
Highlights: Explore bustling Bangkok, catch the sunrise over Angkor Wat, enjoy a delicious local Khmer meal in a small village, walk the bustling streets of Phnom Penh, chill out on golden beaches, connect with the locals on an overnight homestay, cruise the Mekong Delta, discover intriguing Ho Chi Minh City.
Southern Thailand Sojourn (ATSS)
From Bangkok nightclubs that never close to laid-back beachside drinks on Koh Tao, experience the energy of southern Thailand. Hike through the magnificent lowland rainforest of Khao Sok National Park, where tigers still roam, or laze in a riverside hammock. This is your trip—so tread your own path. With an expert CEO leading the way, you're free to snorkel beautiful coral reefs or work on your tan. Enjoy the best of the beachside sun and backpacker nightlife in nine amazing days.
Highlights: Explore bustling Bangkok, enjoy nature at Khao Sok National Park, relax on the white-sand beaches of Koh Samui and Koh Tao.
- Travel Style:
- Yolo
- Trip Type:
- Small Group
- Service Level:
- Basic
- Physical Grading:
- 2
Cuban Rhythms (CCCR)
For too many people, Cuba is nothing more than a beach resort. That's crazy; the island practically buzzes with energy and you should do likewise—get moving. Journey through the culture-soaked streets of Trinidad and Old Havana for your fill of drinking and dancing. The music here pours out of open windows. Hit the beach and explore the outdoors then connect with the locals in homestays and make friends for life as you hit the sites with other young people like yourself. Boring? Impossible!
Highlights: Dance the night away with other young travellers in Old Havana, mingle with the locals at overnight homestays, sample the local rum and cigars, connect to the salsa culture on the dance floor, move those hips to incredible live music, explore colonial Havana's alleyways, laze under the Caribbean sun.
Costa Rica on a Shoestring (CRBC)
Hit two of Costa Rica's famed features—volcanoes and beaches—on this exciting trip that isn't too hard on the wallet. Get the adrenaline pumping in La Fortuna, then soak up the hippie spirit of Montezuma and relax on the beach. While you're free to choose your own adventure and optional adrenaline-inducing activities like waterfall rappelling, your accommodation and transportation are included and our expert CEOs will help you make the most of your time. Take a trip that's packed with just the essentials—eight days of maximum Costa Rica at minimum cost.
Highlights: Try adrenaline sports like whitewater rafting and waterfall rappelling, take in the views of Arenal Volcano towering over La Fortuna, chill out on the Pacific, try to catch some waves.
Budget Egypt (DPGE)
This compact adventure offers maximum Egypt at minimum cost. Stare in amazement at the pyramids and float down the Nile on a felucca. Embrace the culture and meet remarkable people as you dine on traditional fare with a local family in a Nubian village. You'll enjoy basic accommodation and transport to the best sights. Walk through the Valley of the Kings or explore Karnak—it's your call. Don't just dream of Egypt, wake up in the 'Land of the Pharaohs' and open your eyes to adventure.
Highlights: Enjoy a traditional family meal, Explore ancient temples and monuments, Barter in bazaars, Sleep beneath the stars on a felucca, Visit a Nubian village, Explore the famous Khan el-Khalili souk.
Outback to the Red Centre—Adelaide to Alice Springs (OAAR)
Forego the typical coach tour and get off the beaten track from Adelaide to Alice Springs and explore some of the most remote areas on Earth. From Adelaide, hit the Flinders Ranges and cut through the Outback to the Red Centre. Here you'll meet some of the locals, experience the mysteries of Uluru and gain insight into regional Aboriginal and European history. Geared towards budget-conscious travellers looking to hit the Outback's highlights, this itinerary features lots of inclusions at a great price.
Highlights: Bed down at a traditional Outback station, live life underground in the historic mining town of Coober Pedy, learn about dreamtime stories from the Aborigines, enjoy the sunset over Uluru, sleep in a swag under the stars of the Outback sky
Brisbane to Cairns Experience (OABC)
You can get a sense of just how huge Australia is by looking at a map, but once you're there, the vastness really hits home. For travellers long on ambition but short on time, this extensive and compact journey up the East Coast of Queensland is nothing short of ideal. Employing a diverse range of transport—yachts, trains, 4x4s and buses—you'll visit Fraser Island and the Whitsundays, go snorkelling and camp out under the stars in an authentic Australian 'swag.' Your time here may not last long, but your memories will last forever.
Highlights: Sleep under the stars at a remote cattle station, zip over dunes in a 4x4 on a remote sand island, sail from island to island through the Whitsundays on a maxi yacht
The Red Centre to Adelaide (OARA)
Bored with the outskirts? Go right into the (Red) center of the action with our trek from Alice Springs to Adelaide. On the way, we'll hike Kings Canyon, camp out under the stars in Uluru, check out an opal mine in Coober Pedy and class it up with a wine tasting in the Clare Valley. Opt for a scenic flight over the great salt lake of Lake Eyre, and savour your time on the road with new friends and amazing Aussie CEOs. Now you can say you've really done Australia.
Highlights: Savour South Australian wine in the Clare Valley, bed down at a traditional Outback station, catch the magnificent colours of Uluru at sunset, explore the Red Centre.
The Red Centre to Melbourne (OARM)
It's a wide-open space between the aptly named Red Centre and Adelaide, and we intend to make the most of it on this 9-day trek full of good company and good times. From touring national parks to wine tastings in the Clare Valley to hitting up the iconic Great Ocean Road, you'll get a feel for the Outback that can only come from travelling in a close-knit group. Plus, our expert CEOs will make sure everything goes smoothly, leaving more time for you to enjoy yourself.
Highlights: Marvel at the 12 Apostles along the Great Ocean Road, bed down at a traditional Outback station, catch the magnificent colours of Uluru at sunset, explore the Red Centre
Sydney to Brisbane Experience (OASB)
Think Australia's out of your league since you're short on time and cash? Nope! This quick and economical Sydney-to-Brisbane jaunt squeezes tons of excitement into a short time frame at a price that fits any budget. Learn to surf and sip Australia's viticultural bounty on the coast, then move inland to the Outback to try your hand at gem mining and sheep shearing. It's Oz in a flash for a fraction of the cost.
Highlights: Taste wine in the Hunter Valley, stay overnight at a sheep station and learn techniques from the locals, fossick for gemstones, learn to surf in famous Byron Bay
New Zealand - North Island Encompassed (ONNE)
New Zealand's North Island thoroughly engages the body and the spirit, often at the same time. This 10-day trip promises loads of both. Up here, you'll learn Maori culture (and try your hand at bone-carving) straight from the source while bunking in villages in the bush and pick up some sustainable living tips on a conservation farm. Elsewhere, you'll sea kayak in a secluded harbour, get a surfing lesson from an expert and overnight on a houseboat. There's much more, but we've gotta leave some surprises, right?
Highlights: Snorkel in the beautiful Bay of Islands, surf world famous waves, learn about the Maori culture in a village homestay, conquer New Zealand's top-rated 1-day trek, dance the night away in Wellington.
New Zealand—Best of the North Island (ONNI)
Admittedly, we haven't checked the numbers too closely, but we're confident that New Zealand ranks among the world's leading producers of excitement. This quick trip across the North Island jams as many thrills as permissible by law into seven electrifying, activity-packed days. Sea kayak, learn to surf New Zealand's world-famous waves, experience Maori culture directly from the Maori themselves and more, all in a breezy week that always feels full and never feels hurried.
Highlights: Surf world-famous waves, experience a historic Maori village with a local guide, conquer New Zealand's top-rated 1-day trek, dance the night away in Wellington.
Galapagos on a Shoestring (SEGS)
This 9-day adventure is perfect for those who want to experience the incredible wildlife and scenery of the Galapagos Islands but prefer to sleep on shore—so your time on the water is limited to commuting between islands. Go ashore at the lesser-visited island of Isabela and spend your days with playful sea lions, giant manta rays and the Galapagos giant tortoise. With fewer inclusions but plenty of options, you can choose which activities are right for you and experience one of the natural wonders of the world on a budget.
Highlights: Witness whitetip sharks at 'Shark Alley', travel by public speedboats around the Galapagos Islands, camp in the highlands of Santa Cruz Island with views towards the ocean, visit Charles Darwin Research Station and the Giant Tortoise Breeding Centre, hike Sierra Negra Volcano.
Trip | Length | Style | Service Level | Starting Price |
Northern Hilltribes & Villages (ATHV) | 8 days | Yolo | Basic |
Beaches & Backwaters (AHBB) | 7 days | Yolo | Basic |
Cambodia on a Shoestring (ATRC) | 10 days | Yolo | Basic |
Southern Thailand Sojourn (ATSS) | 9 days | Yolo | Basic |
Cuban Rhythms (CCCR) | 8 days | Yolo | Basic |
Costa Rica on a Shoestring (CRBC) | 8 days | Yolo | Basic |
Budget Egypt (DPGE) | 8 days | Yolo | Basic |
Outback to the Red Centre—Adelaide to Alice Springs (OAAR) | 9 days | Yolo | Basic |
Brisbane to Cairns Experience (OABC) | 10 days | Yolo | Basic |
The Red Centre to Adelaide (OARA) | 7 days | Yolo | Basic |
The Red Centre to Melbourne (OARM) | 9 days | Yolo | Basic |
Sydney to Brisbane Experience (OASB) | 7 days | Yolo | Basic |
New Zealand - North Island Encompassed (ONNE) | 10 days | Yolo | Basic |
New Zealand—Best of the North Island (ONNI) | 7 days | Yolo | Basic |
Galapagos on a Shoestring (SEGS) | 9 days | Yolo | Basic |


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Center NewsI Have a Copyright: The Problem with MLK's Speech (EM)I Has a Dream Administrative Conference Appoints New Members Six Duke Law journals move to digital-only format Rai comments on "patent troll" lawsuits Court Ruling Takes a Stand on Essential High-Tech Patents Reselling media content: Seconds to go Rai elected to ALI Who owns Sherlock Holmes? Inventors still feel squeezed, despite patent reforms ABBA says 'Nej!' to Wake SPCA's viral adoption video Patentable subject matter at the Supreme Court: An exceptional case? Barely Any U.S. Culture will Enter the Public Domain this Year Why There Are Only 100 Copies of the New Bob Dylan Record Public Domain: Access Denied Public by Sufferance Alone: The Worst of 2012 The Politics of Internet Activism Let's Tame Software Patent Claims: Lessons From Bioinformatics U.S. Disavows Patent at Center of Apple-Samsung Dispute Suit Challenging Patent Law Faces Long Odds Patent Success or Failure? The America Invents Act and Beyond COMMUNIA Releases Final Report In Memoriam: Professor Keith Aoki Endowed by Their Creator?: The Future of Constitutional Personhood Faculty Co-Director James Boyle responds to recent NY Times op-ed on copyright Roundtable on Federal Government Engagement in Standards Indigenous/Traditional Knowledge and Intellectual Property The Public Domain: Enclosing the Commons of the Mind Multilingual Educational Resources about Intellectual Property and the Public Domain IP and Synthetic Biology 7 Ways To Ruin A Technological Revolution Faculty ScholarshipJames Boyle
David Lange
Arti Rai
Jerome H. Reichman
Duke University |


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Monsoon Adventure
Categories: Travel services > Package tours
Address: 36/91, Sukhumvit Rd., Khlong Tan Nuea, Watthana, Bangkok 10110 Thailand See map
0 reply, 3,576 viewed
Monsoon Adventure offers tours that respect nature and people and are original, not only through the itineraries but also by way of execution.
- Open days
Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday
Service hours
08:30 to 19:30
- Address
36/91, Sukhumvit Rd., Khlong Tan Nuea, Watthana, Bangkok 10110 Thailand
- Email
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LABERGE firstname.lastname@example.com_current.manitoulin_expositor 2002-02-20 published
Robert "
In loving memory of G. Robert "Bob"
LLOYD, 66 years, Wednesday morning, February
13, 2002 at the Sudbury Regional Hospital St. Joseph's Health Centre.
Beloved husband of Marilyn "Marnie"
LLOYD of Sudbury. Father
of Tim (partner Virginia) of Garson, Graham (wife
Line) of Sturgeon
Falls, Chris (wife
Sue) and Leanne
WELCH (husband Doug) both of
Sudbury. Cherished grandfather of Amie-Anne, April, Joleil, Ashley,
Kara, Andrew and Jenna. Dear son of Cecil and Eileen
predeceased. Dear brother of Clarke (wife Helen) of Kagawong, Gerald
(wife Leatha) of Sudbury, Don (wife Joan) of Guelph, Graham (wife
Ila) of Manitowaning, Ruthann (husband Victor
DUHAMEL) of Lively and
Sally (husband Victor
LABERGE) of Falconbridge. Sadly missed by many nieces and nephews.
Rested at the Lougheed Funeral Home. Funeral service was held in the
Church of the Ascension, Sudbury on Saturday, February 16, 2002.
Cremation at the Parklawn Crematorium.
Arrangements entrusted to Jackson and Barnard Funeral Chapel.
L... Names LA... Names LAB... Names Welcome Home
LABERGE - All Categories in OGSPI


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Bring a beautiful new look to your bedroom decor with the Nayla King Sheet Set by Lawrence Bedding. The Nayla bed set features floral satiny appliques and a soothing palette of shades of blue set against an indigo ombre ground, the background fabric transforms from a dark navy to light blue toward the top of the bed. The Lawrence Nayla King Sheet Set Sheet Set Includes: One Flat Sheet, One Fitted Sheet, Two Pillowcases (One With Twin), and 250 Thread Count.
Our mission is to provide an unparalleled online shopping experience for our customers, offering the widest selection of top-quality home products at affordable prices. Founded in 2000 in Franklin, CT. the Yankee Retail Company is an authorized retailer of many world-renowned brands; such as Croscill, Waterford Crystal, American Drew, Brownstone Furniture, Reed & Barton, Swarovski, Lenox, Laura Ashley, and Waverly.


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Come learn how our ice cream is made, sit in our milk truck, brainstorm your own ice cream flavor, milk a mechanical cow and learn about the people and culture of Turkey Hill. Discovery and delight abound for the whole family. And of course, there are free samples of Turkey Hill ice cream and iced tea!
© 2013, Turkey Hill Dairy


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Washington DC Pet Friendly Hotels + Cheap Hotels + HAMPTON INNS
Know When You're Going?
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Note: The nightly rates shown above do not yet include Tax Recovery Charge & Service Fees or (if applicable) Extra Person Fees, Child Fees, Additional Mandatory Hotel Charges or optional incidentals, such as parking, room service or movies.


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This is an Oasis next to GSMNP. My husband and I spent 2 nights in the upper east suite which was spacious, clean and comfortable. The first evening after taking a walk w/ the owners dogs around the beautiful grounds we enjoyed a glass of wine on the deck enjoying the beautiful views. Day 2 we spent hiking in Cade's... More
- Official Description (provided by the hotel):
- 50 acres to explore with hiking trails, wildlife, fishing pond with small boats, exceptional mountain views, party barn to rent for parties, weddings, reunions or receptions, lots of parking, privacy, romantic guest suites at the Manor House for two to six, plus the Hay Loft Sky Cabin for families up to 12. Horse facilities. ... more less


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KNOW THY CARNITINE! You have options when it comes to this important supplement. Know them both. Shares: 0
6 WAYS TO SAVE ON SUPPS Got no bucks for supps? There's hope yet. Use these six tips to stretch your budget and keep your gains on track Shares: 0
BUDGET SUPPS Learn how each of the ingredients in our "Supps on a Budget" article does its dirty work Shares: 0


text: Köppen's all-weather technology keeps you in your element. Our gear is designed to help you perform at your best, no matter what Mother Nature can throw at you. Inspired by Wladimir Köppen's climate classification system, Köppen is engineered to protect you in all weather conditions with superior comfort. It's the performance gear outdoor athletes need to stay in control. Make every element your element with Köppen.


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My best, and pretty much only, friend is moving to another state to be closer to her controlling ass boyfriend… Don't know what to say without her getting mad… Getting ready to freak out.
Ow… my heartstrings…
Somebody jumped up 27,000 points in about 10 minutes… that's not freaking possible! Cheating or glitch? >_<
So… I was #2 yesterday morning, slept longer than I wanted, woke up, and I wasn't even in the top five anymore. But after spending the entire night playing (with short breaks), I managed to rack up like seven-thousand-some points and take first. Hehe. ;)
An update to my rant about hating on Hufflepuffs—
So, Slytherins are always posting Wizard Duel results where they beat a couple Puffles… yeah, big deal, whatever… So, just this once I thought I'd sink to their level and retaliate. I've never had an easier task. ;)
Hufflepuff forever<3
Hate Hufflepuff? Guess what! We don't give a fuck. If you get sorted into Hufflepuff, delete your fucking account and start again! It's not hard to choose your own House on Pottermore. If you were a fan of Harry fucking Potter, you'd know exactly what answers to choose for the sorting quiz. Beat a few Puffles in Wizard Duels? Ooooh. Who gives a fuck. This member of Hufflepuff would own your ass. I beat Slytherins all the time. You don't see me posting screenshots of it like some lame assfuck. Hufflepuffs are just as awesome as any other House. The only reason we always get beat in shit is because of our fewer members… nobody ever wants to be a Puff because of the bad rep we get from all you haters. We're all members of the same fandom, so stop the hate. Peace.


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Closed User Group
High-tech Ergonomics
Customer and market-driven products are the goal ― and the route taken to achieve that goal must be constantly shortened, making processes increasingly faster and more cost-efficient. To achieve this, you need technology which leads the market.
Comfort and safety in the green zone
With the ergonomics software RAMSIS, you guarantee optimal, standardized interior design ― seamlessly integrated into (global) product development.
Quicklink Mobility
First user of RAMSIS Bus & Truck tool in the 'Middle Kingdom'
07.08.2013 The module RAMSIS Bus & Truck, developed from the Human Solution Group in...
Read article -
RAMSIS User Conference 2013
EuroTest Prize 2013 for BOMAG and Human Solutions
23.04.2013 During bauma, the construction equipment show, the EuroTest Cooperation awarded the...
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Your service provider for safety norms at the bauma fair 2013
19.02.2013 bauma is the largest and most impressive trade fair for construction machinery...
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China remains a strong growth market
30.01.2013 Human Solutions GmbH has added another Chinese carmaker — Great Wall Automobile Co....
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© 2002-2013 HUMAN SOLUTIONS GmbH | All rights reserved | Home | General Terms and Conditions | Imprint


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PRPS Goods & Co.
Basic Polo
PRPS Goods & Co, another specialty collection of New York-based luxury denim label PRPS has an aesthetic reminiscent of authentic vintage finds. Offering a complete PRPS brand experience, PRPS Goods & Co is functional, purposeful and innovative. Encompassing an early American outdoor this collection has a strong denim foundation alongside meticulously made and finished shirts, jackets and knitwear.
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- Modeled in size L. See fit guide for model's dimensions.
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Dinefwr Ramblers (From South Wales Guardian)
Get involved: send your pictures, video, news and views by texting SWG NEWS to 80360, or email us
Dinefwr Ramblers
12:30pm Friday 29th June 2012 in Ammanford
On Sunday, July 1 a walk to Elan Valley to take place - Lead mines, woods and open moorland in the Elan Valley.Tea at the visitor centre afterwards.
Nine miles (moderate) explorer map 200. Please meet at Llandovery rail station, departing 9.30am and on by car. Leader: Judy Gore, 01591 610613.
Also on Wednesday, July 4 we will be Walking from Glanaman up on to the Betws mountain, passing King Arthur's Stone, past the WW2 bomb craters and return via Grenig Road.
Four miles (moderate) Explorer map 178. Please meet at Glanaman community centre car park, departing 1.30pm.
Leaders:HughandPam Simpson, 01558 822405.


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Anyone interested in doing a RP based on The Purge? If you don't know what The Purge is, it's a film " set in the year 2022 when the United States has become "a nation reborn", with crime and unemployment rates hitting an all-time low, due to the government having instituted an annual 12-hour period called "the Purge" during which all criminal activity (including murder, theft and rape) becomes legal. The only rules during the Purge are that government officials of "ranking 10 or higher" must remain unharmed and usage of weaponry above "Class 4" (such as WMDs) is forbidden. "
Any questions? Just ask them in this thread. ^^
EDIT: There will be a more broad range than in the movie


text:
Browsing by Title
Leith, Rian; Pretorius, Joelien (Routledge, 2009)[more][less]
Abstract: In international relations states labelled as 'middle powers' are often responsible for crafting a middle way to bridge conflicting international interests. They typically favour multilateralism and cooperative international behaviour. Middle power diplomacy has played a crucial role in the establishment and maintenance of the nuclear non-proliferation regime. South Africa has played the role of a middle power in nuclear diplomacy since 1994, drawing on its moral position after giving up its nuclear weapons. This role has especially involved joining the efforts of middle powers in the North, such as Norway and Canada, to indefinitely extend the Nuclear Non-Proliferation Treaty (NPT). However, South Africa's foreign policy has shown a gradual shift away from a middle power orientation not least due to an increasing non-aligned position that calls for deep reforms to the perceived unfair world order tilted in the favour of the developed North. This shift is also visible in South African nuclear diplomacy and is eroding the middle ground that has so far sustained the nonproliferation regime. The paper argues that South Africa's middle power diplomacy has allowed it to punch above its weight in the nuclear realm, but its pursuit of international reforms has resulted in the drawing of a fault line between developed and developing countries. It is in the interest of nuclear non-proliferation to regain the middle ground by forming broad coalitions amongst all actors interested in nuclear disarmament. URI: http://hdl.handle.net/10566/481 Files in this item: 1
PretoriusNuclearPolicy2009.pdf (124.0Kb) -
Conradie, Ernst (University of Kwazulu-Natal School of Theology, 2000)[more][less]
Abstract: On the background of the current sense of despair concerning the environmental crisis, this article follows the basic intuition that a Christian environmental praxis can only be empowered on the basis of an adequate understanding of Christian hope. Christian eschatology has traditionally responded to three distinct aspects of the human predicament - human self-enclosure, and finitude in both time and space; instigated by an unacceptable present reality, it articulates the conviction of an upcoming transformation into what it ought to be. Investigating the theme of hope in some major ecclesial documents and literature that explicitly addresses the topic written during the struggle, it is argued that the strength of the eschatology developed during that period consists in its return to the prophetic roots of Christian hope. Its concentration on the anthropological aspect of the liberation from the predicament from human sin makes it necessary to rediscover the impact of eschatology on the salvation of creation and the theocentric aspect of hope. URI: http://hdl.handle.net/10566/409 Files in this item: 1
ConradieEschatology2000.pdf (1.633Mb) -
Joubert, Jane; Puoane, Thandi (South African Medical Association, 2007)[more][less]
Abstract: OBJECTIVE: To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. DESIGN: World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Population attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. SETTING: South Africa. SUBJECTS. Adults ≥ 30 years of age. OUTCOME MEASURES. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. RESULTS: Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI ≥ 21 kg/m2. Excess body weight is estimated to have caused 36 504 deaths (95% uncertainty interval 31 018 - 38 637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462 338 DALYs (95% uncertainty interval 396 512 - 478 847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. CONCLUSIONS: This study shows the importance of recognising excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight. URI: http://hdl.handle.net/10566/284 Files in this item: 1
PuoaneEstimating2007.pdf (412.1Kb) -
Xu, Yongxin; van Tonder, Gerrit J. (Water Research Commission, 2001)[more][less]
Abstract: The cumulative rainfall departure (CRD) method, based on the water-balance principle, is often used for mimicking of water level fluctuations. Because of its simplicity and minimal requirement of spatial data, the CRD method has been applied widely for estimating either effective recharge or aquifer storativity, and consequently gained a focus in South Africa. This paper critically reviews this method and proposes expanded algorithm. Validation of the method under typical South African conditions is discussed based on model-generated and known cases. The study is aided with a user-friendly Excel program called Recharge Estimation Model in Excel (REME). URI: http://hdl.handle.net/10566/822 Files in this item: 1
XuEstimationOfRecharge2001.pdf (64.79Kb) -
Koen, Chris (Oxford University Press, 2012)[more][less]
Abstract: 'Quasi-periodic' or 'solar-like' oscillations can be described by three parameters – a characteristic frequency, a coherence time (or 'quality factor') and the variance of the random driving process. This paper is concerned with the estimation of these quantities, particularly the coherence time, from modest sample sizes (observations covering of the order of a hundred or fewer oscillation periods). Under these circumstances, finite sample properties of the periodogram (bias and covariance) formally invalidate the commonly used maximum-likelihood procedure. It is shown that it none the less gives reasonable results, although an appropriate covariance matrix should be used for the standard errors of the estimates. Tailoring the frequency interval used, and oversampling the periodogram, can substantially improve parameter estimation. Maximum-likelihood estimation in the time-domain has simpler statistical properties, and generally performs better for the parameter values considered in this paper. The effects of added measurement errors are also studied. An example analysis of pulsating star data is given. URI: http://hdl.handle.net/10566/892 Files in this item: 1
KoenCoherenceTime2012.pdf (773.9Kb) -
Hersh, Marion A.; Tucker, William D. (Elsevier, 2005)[more][less]
Abstract: There are a number of pressures on researchers in academia and industry to behave unethically or compromise their ethical standards, for instance in order to obtain funding or publish frequently. In this paper a case study of Deaf telephony is used to discuss the pressures to unethical behaviour in terms of withholding information or misleading participants that can result from mono-disciplinary orthodoxies. The Deaf telephony system attempts to automate multiple aspects of relayed communication between Deaf and hearing users. The study is analysed in terms of consequentialist and deontological ethics, as well as multi-loop action learning. Discussion of a number of examples of bad practice is used to indicate both the compatibility of ethical behaviour and good scientific method and that ethical behaviour is a pre-requisite for obtaining meaningful results. URI: http://hdl.handle.net/10566/466 Files in this item: 1
HershTuckerUnethicalBehaviour2005.pdf (86.66Kb) -
Bozalek, Vivienne (Department of Social Work, University of Johannesburg, 2007)[more][less]
Abstract: This article describes the design and implementation of a module on Advanced Social Work Ethics using a blended learning approach and relying substantially on e-learning as a pedagogical tool. The design is contextualised by elaborating on the parameters in which the module was developed – viz. the minimum standards of the Bachelor of Social Work pertaining to ethics, as well as the e-learning and assessment policies at UWC. The module design and implementation was informed by constructivist pedagogical principles, and made use of the notion of 'critical friends' as a means of providing opportunities for students to interact as peers and provide input on each others' learning, thus decentralising the traditional role of the university lecturer. Examples of assessment tasks devised for the module to illustrate the pedagogical principles are also provided. Students' responses to their experiences of undertaking the module are drawn from their final journal entries and provide an indication of how the module was operationalised. URI: http://hdl.handle.net/10566/49 Files in this item: 1
Bozalek_Ethics(2007)[1].pdf (205.9Kb) -
Taliep, Naiema; Florence, Maria (Psychological Society of South Africa, 2012)[more][less]
Abstract: The absence of a suitable measure to assess the health-related quality of life (HRQoL) of children and adolescents in South Africa, led to the use of the KIDSCREEN-52 questionnaire which was developed and standardised in Europe. The current study is part of a broader study conducted in the Western Cape, which used the KIDSCREEN-52 to explore the influence of exposure to community violence on the subjective HRQoL of a sample of South African adolescents. This study aimed to investigate the reliability and construct validity of the KIDSCREEN-52 in a South African context. The broader study employed stratified interval criterion sampling to select 565 Grade 9 learners, aged 14-18. Participants were selected from six public schools in areas specified by the South African government as comprising key nodal areas in terms of crime in the Western Cape. The dataset for the current study comprised all participants (N=565) of the primary study. As the initial step in validation of the KIDSCREEN-52 in South Africa, the current study examined its factor structure by means of exploratory factor analysis, using principal component analysis with oblimin rotations. It also assessed the internal consistency reliability of each of the scales, using Cronbach's alpha. Exploratory factor analysis extracted 10 factors as identified by previous studies, with some deviation in the loadings of the last three factors. Items of two scales ("Feelings" and "About Yourself") divided into three scales, and "Bullying" items were not sufficiently presented in the factor solution. Internal consistency of the measure was shown to be acceptable to good, with Cronbach's alpha values ranging from 0.76 to 0.81 for the 10 scales. URI: http://hdl.handle.net/10566/402 Files in this item: 1
TaliepQualityofLife2012.pdf (262.4Kb) -
Maunder, Andrew; Marsden, Gary; Tucker, William D. (ACM, 2006)[more][less]
Abstract: Developing ICT software that is useful and usable in a rural context poses many problems. One of the major difficulties is understanding the real needs of the target users and the constraints imposed by the rural environment. Many techniques exist in the field of human computer interaction (HCI) that attempt to understand the needs of the target user but many are not useful in a rural context (or a least not when applied in a standard way). This paper presents some existing HCI research techniques that are applicable in a rural context and shows how they fit into the Bridges.org 'Real Access' framework. URI: http://hdl.handle.net/10566/663 Files in this item: 1
MaunderMarsdenTucker-CHISA 2006.pdf (99.84Kb) -
Goga, Ameena; Dinh, Thu-Ha; Jackson, Debra (South African Medical Research Council, National Department of Health South Africa and PEPFAR/US Centers for Disease Control & Prevention, 2012)[more][less]
Abstract: Aims and Objectives: The overall aim of this evaluation was to conduct a national facility-based survey to monitor the effectiveness of the South African National PMTCT programme. The primary objective was to measure rates of early MTCT of HIV at six weeks postpartum. The secondary objective was to periodically estimate coverage of key PMTCT interventions and services (e.g., HIV testing, CD4 cell count testing, infant antiretroviral (ARV) prophylaxis, infant feeding counselling). URI: http://hdl.handle.net/10566/462 Files in this item: 1
GogaPMTCT2012.pdf (5.124Mb) -
Koen, Chris (Oxford University Press, 2006)[more][less]
Abstract: The results of three short photometric monitoring runs on the L0 dwarf 2MASS J06050196−2342270, during three consecutive nights, are presented. The observations show the persistent presence of a 2.4-h period, with an IC band amplitude which decreased from 27 to 11 mmag over the three nights. The amplitude in the RC band appeared to be substantially smaller than in the IC band. URI: http://hdl.handle.net/10566/799 Files in this item: 1
KoenRapid_evolution2006.pdf (302.8Kb) -
Bittner, Lucie; Maneveldt, Gavin; Couloux, Arnaud; Cruaud, Corinne; de Reviers, Bruno; Le Gall, Line (Elsevier, 2011)[more][less]
Abstract: Systematics of the red algal order Corallinales has a long and convoluted history. In the present study, molecular approaches were used to assess the phylogenetic relationships based on the analyses of two datasets: a large dataset of SSU sequences including mainly sequences from GenBank; and a combined dataset including four molecular markers (two nuclear: SSU, LSU; one plastidial: psbA; and one mito- chondrial: COI). Phylogenetic analyses of both datasets re-affirmed the monophyly of the Corallinales as well as the two families (Corallinaceae and Hapalidiaceae) currently recognized within the order. Three of the four subfamilies of the Corallinaceae (Corallinoideae, Lithophylloideae, Metagoniolithoideae) were also resolved as a monophyletic lineage whereas members of the Mastophoroideae were resolved as four distinct lineages. We therefore propose to restrict the Mastophoroideae to the genera Mastophora, Metamastophora, and possibly Lithoporella in the aim of rendering this subfamily monophyletic. In addition, our phylogenies resolved the genus Hydrolithon in two unrelated lineages, one containing the gener- itype Hydrolithon reinboldii and the second containing Hydrolithon onkodes, which used to be the generitype of the now defunct genus Porolithon. We therefore propose to resurrect the genus Porolithon for the second lineage encompassing those species with primarily monomerous thalli, and trichocyte arrangements in large pustulate horizontal rows. Moreover, our phylogenetic analyses revealed the presence of cryptic diversity in several taxa, shedding light on the need for further studies to better circumscribe species frontiers within the diverse order Corallinales, especially in the genera Mesophyllum and Neogoniolithon. URI: http://hdl.handle.net/10566/904 Files in this item: 1
BittnerEvolutionaryHistory2011.pdf (3.272Mb) -
Bittner, Lucie; Payri, Claude E.; Maneveldt, Gavin; Couloux, Arnaud; Cruaud, Corinne; de Reviers, Bruno; Le Gall, Line (Elsevier, 2011)[more][less]
Abstract: Systematics of the red algal order Corallinales has a long and convoluted history. In the present study, molecular approaches were used to assess the phylogenetic relationships based on the analyses of two datasets: a large dataset of SSU sequences including mainly sequences from GenBank; and a combined dataset including four molecular markers (two nuclear: SSU, LSU; one plastidial: psbA; and one mitochondrial: COI). Phylogenetic analyses of both datasets re-affirmed the monophyly of the Corallinales as well as the two families (Corallinaceae and Hapalidiaceae) currently recognized within the order. Three of the four subfamilies of the Corallinaceae (Corallinoideae, Lithophylloideae, Metagoniolithoideae) were also resolved as a monophyletic lineage whereas members of the Mastophoroideae were resolved as four distinct lineages. We therefore propose to restrict the Mastophoroideae to the genera Mastophora, Metamastophora, and possibly Lithoporella in the aim of rendering this subfamily monophyletic. In addition, our phylogenies resolved the genus Hydrolithon in two unrelated lineages, one containing the generitype Hydrolithon reinboldii and the second containing Hydrolithon onkodes, which used to be the generitype of the now defunct genus Porolithon. We therefore propose to resurrect the genus Porolithon for the second lineage encompassing those species with primarily monomerous thalli, and trichocyte arrangements in large pustulate horizontal rows. Moreover, our phylogenetic analyses revealed the presence of cryptic diversity in several taxa, shedding light on the need for further studies to better circumscribe species frontiers within the diverse order Corallinales, especially in the genera Mesophyllum and Neogoniolithon. URI: http://hdl.handle.net/10566/780 Files in this item: 0
Du Toit, Darcy (Juta Law, 2006)[more][less]
Abstract: Introduction:This article examines the meaning and scope of the prohibition of unfair discrimination against employees contained in s 6 of the Employment Equity Act in the light of the development of the concept of 'unfair discrimination' from the early 1980s onwards. In so doing, it ipso facto delineates the content and scope of the defences available to an employer faced with a claim of this nature. Though focusing on direct discrimination, it will suggest that the same fundamental principles are applicable to indirect discrimination. Some conceptual points of departure should be noted. The prohibition of unfair discrimination by the EEA derives from the basic right to 'equal protection and benefit of the law' contained in s 9 of the Constitution and, more specifically, from the constitutional injunction that '[n]ational legislation must be enacted to prevent or prohibit unfair discrimination'. URI: http://hdl.handle.net/10566/683 Files in this item: 1
DuToitUnfairDiscrimination2006.pdf (232.6Kb) -
Tylleskar, Thorkild; Jackson, Debra; Meda, Nicolas; Ingrebetsen, Ingunn Marie S; Chopra, Mickey; Diallo, Abdoulaye Hama; Doherty, Tanya M.; Ekström, Eva-Charlotte; Fadnes, Lars T; Goga, Ameena; Kankasa, Chipepo; Klungsøyr, Jørn I; Lombard, Carl; Nankabirwa, Victoria; Nankunda, Jolly K; Van de Perre, Philippe; Sanders, David; Shanmugam, Rebecca; Sommerfelt, Halvor; Wamani, Henry; Tumwine, James K; PROMISE-EBF Study Group (Elsevier, 2011)[more][less]
Abstract: Background: Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. The effect of breastfeeding counselling by peer counsellors was assessed in Africa. Methods:24 communities in Burkina Faso, 24 in Uganda, and 34 in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering team were masked to the intervention allocation. The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00397150. Findings 2579 mother–infant pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n=402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 (79%) of 392 and 139 (35%) of 402, respectively, in Burkina Faso (prevalence ratio 2·29, 95% CI 1·33–3·92); 323 (82%) of 396 and 161 (44%) of 369, respectively, in Uganda (1·89, 1·70–2·11); and 56 (10%) of 535 and 30 (6%) of 485, respectively, in South Africa (1·72, 1·12–2·63). The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 (77%) and 94 (23%), respectively, in Burkina Faso (3·27, 2·13–5·03); 305 (77%) and 125 (34%), respectively, in Uganda (2·30, 2·00–2·65); and 41 (8%) and 19 (4%), respectively, in South Africa (1·98, 1·30–3·02). At 24 weeks, the prevalences based on 24-h recall were 286 (73%) in the intervention cluster and 88 (22%) in the control cluster in Burkina Faso (3·33, 1·74–6·38); 232 (59%) and 57 (15%), respectively, in Uganda (3·83, 2·97–4·95); and 12 (2%) and two (<1%), respectively, in South Africa (5·70, 1·33–24·26). The prevalences based on 7-day recall were 279 (71%) in the intervention cluster and 38 (9%) in the control cluster in Burkina Faso (7·53, 4·42–12·82); 203 (51%) and 41 (11%), respectively, in Uganda (4·66, 3·35–6·49); and ten (2%) and one (<1%), respectively, in South Africa (9·83, 1·40–69·14). Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 (5%) and 36 (9%), respectively, in Burkina Faso (0·57, 0·27–1·22); 39 (10%) and 32 (9%), respectively, in Uganda (1·13, 0·81–1·59); and 45 (8%) and 33 (7%), respectively, in South Africa (1·16, 0·78–1·75). The prevalence at age 24 weeks in the intervention and control clusters was 26 (7%) and 32 (8%), respectively, in Burkina Faso (0·83, 0·45–1·54); 52 (13%) and 59 (16%), respectively, in Uganda (0·82, 0·58–1·15); and 54 (10%) and 33 (7%), respectively, in South Africa (1·31, 0·89–1·93). Interpretation: Low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings. URI: http://hdl.handle.net/10566/516 Files in this item: 2
TylleskarExclusiveBreastfeeding2011.pdf (1.030Mb) -
September, Rose (University of Johannesburg, 2007)[more][less]
Abstract: The author reflects on the findings of a study commissioned by the Human Science Research Council (HSRC). A qualitative research methodology was used to explore the perceptions of service providers in the early childhood development (ECD) sector on job creation through government's Expanded Public Works Programme (EPWP). The EPWP is aimed at drawing significant numbers of unemployed people into productive work by increasing their capacity to earn a sustainable income through training. In response, the national departments of Social Development, Health, and Education developed a Social Sector Plan (SSP) for EPWP in which the ECD sector was identified as one of the key areas for expansion. From a developmental social work perspective, both Early Childhood Development and productive employment are important strategies to alleviate persistent poverty. This article is intended to create dialogue, further research and action towards realizing the potential of the ECD sector to create more sustainable jobs in order to improve the quality of people's lives. URI: http://hdl.handle.net/10566/210 Files in this item: 1
SeptemberExpandedWorks2007.pdf (220.1Kb) -
Rey-Moreno, Carlos; Tucker, William D.; Bidwell, Nicola J.; Roro, Zukile; Siya, Masbulele Jay; Simo-Reigadas, Javier (ACM, 2013)[more][less]
Abstract: The DEV community knows that technology interventions involve consideration of social and environmental factors as much as technical ones. This is particularly true for the introduction of communications infrastructure in rural im- poverished areas. Research into WiFi solutions has fallen o as ubiquitous mobile solutions penetrate even the deepest rural communities worldwide. This paper argues that mo- bile penetration su ers from two signi cant problems such that the latest wave of WiFi mesh networks o ers bene- ts that traditional top-down WiFi, and mobile, networks do not. In addition, we propose ethnographic and partici- patory methods to aid the e ective rollout of mesh inverse infrastructure with and for a given community. This paper describes and then analyzes a mesh for voice rollout within a situated context. We explain how to conduct informed com- munity co-design and how to factor in local socio-political concerns that can strongly impact on the design, rollout and subsequent maintenance of community-based wireless mesh networks. While we have not yet analyzed baseline and ini- tial usage data, as the mesh rollout is still very fresh, we do have new lessons to o er the DEV community that we have learned while establishing this baseline study. URI: http://hdl.handle.net/10566/676 Files in this item: 1
Rey-Moreno et al DEV2013.pdf (261.4Kb) -
Piper, Laurence; von Lieres, Bettina (Institute of Development Studies, 2011)[more][less]
Abstract: Summary: The paper argues that the practice of democratic mediation is an increasingly common, yet under-researched, component of engagements between citizens and public authorities across the globe. While the actors who mediate (and their tactics) are diverse and are not necessarily of the marginalised group, they share a commitment to overcoming representational, knowledge or ideological deficits in decision-making for the marginalised group. While the 'speaking for' nature of democratic mediation clearly opens up critical legitimacy problems, the practice of democratic mediation appears to be remarkably common, and even effective. The paper demonstrates this by surveying at least three kinds of democratic mediation observed across a large number of cases. First is 'mediation as professional advocacy'. The mediator in these cases is more an 'interested intermediary' in contentious policy politics. In a context of skewed powerrelations where certain groups remain systematically marginalised, not least through knowledge and representational deficits, a degree of advocacy is required to get more egalitarian policy dialogue. Second is 'mediation as representational entrepreneurship'. This refers to engagements between citizens and forms of public authority that stretch from the local to the global level. In more 'global-local' mobilisations, mediators are often experts, professionals, and international NGOs. In more 'local – global' movements, the mediators are 'hybrid activists' deeply rooted in the local identities and associations. However, in either case the actor is distinguished by the taking of initiative to include the voices of the marginalised in a domain of power-relations which is multi-level. Lastly, 'mediation as citizenship development' refers to forms of activism typically associated with community and capacity development, and usually involves limited advocacy by civil society organisations (CSOs). Hence there 04 IDS WORKING PAPER 364 may be little by way of explicit mediation in local governance decision-making in these cases, although the empowerment of communities has a demonstrable and mostly positive impact on local governance. URI: http://hdl.handle.net/10566/480 Files in this item: 1
PiperDemocraticMediation2011.pdf (1.662Mb) -
Blaauw, Phillip (Derick); Pretorius, Anmar; Schoeman, Christie; Schenck, Catherina (Rinie) (The Clute Institute, 2012)[more][less]
Abstract: There has been an increasing inflow of migrants and refugees into South Africa during the last two decades. The origin of these migrants is mainly from South Africa's long-established sources of migrant workers, including countries from the Southern African Development Community. Over the last decade, African immigrants have encountered brutal manifestations of resentment at their presence in South Africa. The reasons for this are multifaceted, but one of the pertinent perceptions is that immigrants from the country's northern borders are taking South Africans' jobs. It is often claimed that casual immigrant workers are willing to work for very low daily wages. In doing so, they get temporary employment in the informal and formal economy at the expense of South African workers, who have much higher reservation wages in the same informal labour market. This is the first study to focus on the wages of migrant day labourers in South Africa by investigating the determinants of day labour wages for migrant day labourers from Zimbabwe. The respondents for this study were interviewed during the first countrywide survey of day labourers in South Africa during 2007. The paper concludes that the income from migrant day labourers from Zimbabwe often exceeds that of the average day labourer in South Africa. The Zimbabweans are, in many cases, better qualified than the average day labourer in South Africa. The main determinants of these migrant wages are their formal level of schooling, language proficiency and the completion of vocational training courses URI: http://hdl.handle.net/10566/649 Files in this item: 1
BlaauwZimbabweanLabourers2012.pdf (265.3Kb) -
Stern, Ruth; Puoane, Thandi; Tsolekile, Lungiswa (Centers for Disease Control and Prevention, 2010)[more][less]
Abstract: Introduction Noncommunicable diseases are increasing in developing countries, exacerbated by growing urbanization. We examined the experiences and perceptions about noncommunicable diseases of people who migrated from rural areas to urban Cape Town, South Africa. Methods We conducted a qualitative study in an impoverished periurban township that has a noncommunicable disease prevention program, including health clubs. We used in-depth interviews, participatory reflection and action groups, and focus group discussions. Results Participants described changes in eating patterns and levels of physical activity. These changes were a result of socioeconomic and environmental constraints. However, respondents were not concerned about these changes. Despite hardships, they were pleased with their urban lifestyle. Furthermore, they approved of their weight gain because it signified dignity and respect. Participants who attended health clubs found them informative and socially and emotionally supportive. Conclusion The study highlighted the complexity of the risk factors for noncommunicable diseases and the need to develop prevention strategies that extend beyond the traditional focus on diet and exercise. URI: http://hdl.handle.net/10566/292 Files in this item: 1
PuoaneExplorationNCD2010.pdf (381.1Kb)