text:
UPDATE: The Benton County Canine Shelter Office will be closed to in-person visits from the public starting Wednesday, March 18, 2020 until Tuesday, May 5, 2020 unless otherwise extended. Canine Shelter staff will continue to monitor calls and provide emergency services but will not be allowing visitors or facilitating adoptions during this time.
Questions regarding the Canine Shelter can be directed to:
Benton County Canine Shelter
(509) 460-4923
Contact Us
Benton County Canine Shelter
1116 N Grant Place
Kennewick, WA 99336
Phone: (509) 460-4923
Fax: (509) 222-3771
Want to see more of our photos and current updates? Follow us on Facebook!
Hours of Operation:
We are open the following hours, unless alternate arrangements are made with Canine Shelter staff:
Monday-Friday: 10 AM - 5 PM *
Saturday-Sunday: CLOSED
* To make sure you have enough time to visit our dogs, please arrive at the shelter between 10 AM - 4 PM.
Messages may be left before or after office hours and will be returned at our earliest convenience. In the event of an emergency, please call 9-1-1.
If you are interested in volunteering at our facility, please contact us or fill out a volunteer application today! Mail your completed application to us at the address listed above or drop it off during our office hours.
Mission Statement:
The mission of Benton County Canine Shelter is to give shelter to the displaced and abandoned, and safety to the abused and neglected dogs in the unincorporated areas of Benton County. We strive to educate the community on the importance of responsible pet ownership and care, and believe that all dogs deserve to have a safe and caring environment before going to their forever families.
Vision Statement:
Benton County Canine Shelter believes that all dogs should be treated with compassion and represented with honesty. We work with the community and rescue organizations on behalf of the dogs to give them a second chance in finding forever families.
We strive to promote public awareness and provide education to the community concerning the importance of spaying and neutering to prevent overpopulation. We utilize the newest available technology to reunite lost pets with owners, identify breeds and characteristics, and to advertise the availability of our adoptable dogs.
Benton County Canine Shelter only deals with stray and/or found dogs. We do not accept owner-surrenders. Vicious animal complaints and/or welfare checks on animals should be directed to the Benton County Sheriff's Office. They can be reached 24/7 at 509-628-0333 (non-emergency dispatch).

subset: commoncrawl


text:
Health Library
Text SUPPORT1 to 21825 to learn if you may be eligible for financial support with your medication(s).Msg & Data Rates May Apply. Msg freq varies. Terms apply. Text HELP for help. Text STOP to end.
NICOTINE (NIK oh teen) helps people stop smoking. This medicine replaces the nicotine found in cigarettes and helps to decrease withdrawal effects. It is most effective when used in combination with a stop-smoking program.
You should stop smoking completely before using the inhaler. Follow the directions carefully. Use exactly as directed. Do not use the inhaler more often than directed.
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
Side effects that you should report to your doctor or health care professional as soon as possible:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
breathing problems
changes in hearing
changes in vision
chest pain
cold sweats
fast, irregular heartbeat
feeling faint or lightheaded, falls
increased saliva
nausea, vomiting
stomach pain
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
dry mouth
nervousness or restlessness
trouble sleeping or vivid dreams
medicines for asthma
medicines for high blood pressure
medicines for mental depression
If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.
Keep out of the reach of children.
Store at room temperature below 25 degrees C (77 degrees F). Protect from heat and light. Throw away unused medicine after the expiration date.
They need to know if you have any of these conditions:
heart disease, angina, irregular heartbeat or previous heart attack
high blood pressure
lung disease, including asthma
overactive thyroid
seizures or history of seizures
stomach problems or ulcers
an unusual or allergic reaction to nicotine, other medicines, foods, dyes, or preservatives
pregnant or trying to get pregnant
Always carry the inhaler with you. Do not smoke, chew nicotine gum, or use snuff while you are using this medicine. This reduces the chance of a nicotine overdose.
If you are a diabetic and you quit smoking, the effects of insulin may be increased and you may need to reduce your insulin dose. Check with your doctor or health care professional about how you should adjust your insulin dose.
Copyright 2015 Holzer Health System. All rights reserved.
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text:
Amazing Print Tech has successfully facilitated millions of postcard, business card and stationery orders with its online printing technology since 1997. With a complete suite of Web to Print software applications, Amazing Print web2print software empowers printers with template based postcard, signage and business card printing software tools to effectively market, drive and close sales, rewarding its partners and customers with superior web-to-print technology and on-demand printing software support services. Behind more and more successful web storefronts, there is web-to-print software created by AmazingPrint development team. Thousands of printing companies ALREADY use amazing Print Tech's online ordering tools.
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text:
Print from the website of the AMF
Published on March 13, 2018
In order to systematise the publication of its policy and better organise the associated documents, the AMF conducted work in liaison with the industry that enabled it to clarify the scope and effect of its published policy, to structure the process for formulating it and determine the format suitable for disseminating it. The policy published by the AMF comprises instructions, positions, recommendations, accepted market practices and rulings, classified by themes.
Update of the AMF's policy in relation to MiFID IICertain policy documents related to the Books III, IV and V of the AMF General Regulation have not been updated in accordance with the texts which transpose MiFID II and which separate the legal framework of investment firms and asset management companies. This further update will be shortly. The documents are currently being updated and carry a disclaimer box on the first page.
In its New Strategy Proposals, the AMF undertook to publish its policy and reorganise the associated documents in order to make its activities more transparent and easier to predict. Prior to this, policy was disseminated in a variety of formats, including guides, Q&As, positions, guidelines, news releases and annual reports… - the effect of which was not always explicit – thereby making it difficult to access.
Working with the industry, the AMF organised a review aimed at clarifying the scope and effect of its policy and structuring the process for formulating and updating it.
The review resulted in a definition of the AMF's policy that differs from its statutory regulatory remit.
It also confirmed the AMF's aim of publishing its policy. However, this does not mean that the AMF will publish all its applicable policies, especially in new or specific situations. Publication is the final phase of a deliberative process that, by nature, can be applied only to recurring or generic topics.
Lastly, the review also underscored the importance of involving the industry in the process of formulating published policy.
When read in conjunction with past decisions handed down by the Enforcement Committee and the grounds for certain individual decisions, the AMF's published policy allows market participants to understand how the AMF applies – under the supervision of the courts – the laws and regulations governing matters within its jurisdiction.
It comprises instructions, positions, recommendations, accepted market practices and rulings, classified by themes.
Published policy is approved by the AMF Board. Barring exceptional or special circumstances that demand tight deadlines or confidentiality ahead of publication, the AMF's talking partners, namely professionals and representatives of retail investors, are consulted during the formulation process through the consultative commissions and/or through representative associations or persons chosen for their special expertise.
In order to help readers obtain and understand the AMF's published policy, all policy documents must contain a number of specific references and comply with general layout requirements that will allow market participants to easily identify the nature of each document.
In some cases, the AMF may decide to issue combined documents including positions and recommendations in cases where a single document containing all the AMF's interpretations and proposals would make it easier to understand a given topic. In such cases, the document title will refer to the presence of positions and recommendations, each of which will be clearly identified in order to avoid ambiguity (This may be done through the use of text boxes, although equivalent procedures are also possible).
Layout requirements do not mean that policy cannot be presented through other media such as Q&As, guides or reports The aim of publishing its policy in a clear manner may prompt the AMF to opt for other formats depending on the topic being dealt with. That said, every effort will be made to avoid a multiplicity of formats, which may undermine the clarity and understanding of the AMF's policy.
All the applicable policy documents which were not compliant with the new format at the time of initial publication have been brought into line with the new format. Reformatting these documents led to merely formal changes or to updating the regulatory references or contextual elements, or even to changing the scope of the initial policy document.
Legal information
Head of publications: The Executive Director of AMF Communication Directorate.
Contact: Communication Directorate – Autorité des marches financiers 17 place de la Bourse – 75082 Paris cedex 02


text:
Wow. That's a nice building!
Adellco plans condo tower at 28th Street and Sixth Avenue
Nobember 18, 2005
Adellco LLC is planning to build a residential condo tower of about 30 stories on the northwest corner of 28th Street and the Avenue of the Americas.
The site, which extends about half way to 29th Street, is now vacant.
According to Ann Eber, a vice president of Adellco, Costas Kondylis is the architect. She told CityRealty.com that plans were preliminary and that further details were not yet available.
The building will probably have the address of 815 Avenue of the Americas.
Adellco is run by Matthew Adell, who developed the 37-story Capitol at 55 West 26th Street in 2001 and the 36-story Ashton at 800 Sixth Avenue in 2004.
Copyright © 1994-2005 CITY REALTY
Last edited by krulltime; November 17th, 2006 at 03:42 AM.
Sure succeeds in looking unstable.
It reminds me a little of Calatrava's tower.
Yeah: similar proportions, broken up into "boxes," here more implied than real. Calatrava's tension members reassure you structurally; here there's no equivalent.Originally Posted by londonlawyer
True. But this will be a much cheaper building and won't have $30M+ apartments. Therefore, I expect more illusion than reality with respect to complicated engineering.
For Kondylis, this is a good building. I particularly like that it has a smallfootprint and therefore slender proportions. But I guess that's more a blessing of non-coercive zoning than the architect's contribution. Compare it to that fat glass pig proposed for 338-346 East 23rd Street.
I agree with you. I also like how the facade is curved in certain places which contrasts nicely with sharp edges elsewhere.
The Sixth Ave. foot print is tiny. It seems like two old (and very small)tenements were razed on 6th to make room for this, as were several more on the side street.
PS: There's an ad for this in the NY Times today.
I thought building "Sliver's" became illegal in the 90's...
slivers were "outlawed" in the 80's, but I think they applied to smaller sized plots ... it seems that the "law" in that regard might have been changed -- or simply forgotten.
...and a good thing too!Originally Posted by lofter1
Is anyone else familiar with this plot? The 6th Ave. portion is tiny!
I don't mind a sliver building on a corner. It's the mid-block sliver buildings with blank walls on either side...they are all ugly.
I like this one, but now that I mentioned it, I wonder what the other side will look like, it may be a blank wall.
If you look at the back left corners of the building, it appears to be transparent. I think this one's all glass. And it's pretty awesome. Finally a good building from Costas.
See, I've said before Costas was getting better with each project. This is exactly the type of design we've always complained we weren't getting but now we finally are and so I'm happy.
This is a great example of how--with a little creativity--even a boxy design can be made to look nice.
Is this thing "as of right" or will this be another one of those that will languish for a few years and never be heard of again?


text:
LA ROCHE-SUR-YON, France, Jan. 31 (UPI) -- Top 10 players Richard Gasquet and Jo-Wilfried Tsonga won in straight-sets Friday, putting France close to wrapping up a Davis Cup series against Australia.
Gasquet opened the best-of-five series with a 7-6 (7-3), 6-2, 6-2 victory over Nick Kyrgios and Tsonga defeated Lleyton Hewitt 6-3, 6-2, 7-6 (7-2).
Gasquet won an impressive 80 percent of the points when serving and faced just one break point. He also committed only 27 unforced errors, compared with 52 by Kyrgios.
Neither player had a break opportunity in the first set but Gasquet won 2-of-4 of his chances in the second set and 2-of-3 in the third.
Tsonga also went through his match without dropping serve, winning 75 percent of the points on serve. He moved ahead with one break in the first set and had a pair in the second.
He broke open the tight third set with a string of points in the tiebreaker for the win.
The French doubles team of Julien Benneteau and Gael Monfils will go against Hewitt and Chris Guccione on Saturday with a chance to lock up the series.
If Hewitt and Guccione win, Hewitt is scheduled to return to the court against Gasquet for the first singles match Sunday followed by a Tsonga-Kyrgios pairing to decide the series.


text:
The Crossover Talisman was shattered. Crossover Shards were scattered across the dimensions. Characters were pulled from their home dimensions and must band together to find the Crossover Shards to find their way back home. Posts are in character.
Use this control to limit the display of threads to those newer than the specified time frame.
Allows you to choose the data by which the thread list will be sorted.
Order threads in...
Note: when sorting by date, 'descending order' will show the newest results first.
Forum Rules


text:
Photo: Blond mummy in China
1)No one has been more enthralled and interested in the story about Ancient Caucasians (Romans) in China than Stormfront. (See Also: Blond Mummies in China)
Since humans are 99.9% genetically identical, as I've said before, one might as well be excited about his historical connection to ancients that also has male pattern baldness.
2)Now, here's a new story about ancient East Asians in Rome. Who's going to get excited about that, I wonder? DNA testing on 2,000-year-old bones in Italy reveal East Asian ancestry
Maybe they had some type of burial exchange program?
3) An Extraordinary Discovery. The Remains of an Icelandic Woman, Buried in 1051, with Trinkets, Roman Coins, etc., Exhumed Below the Great Falls of the Potamac_A Remarkable Runic Inscription—America Discovered by the Irish……..The Chicago Tribune, July 16, 1867
Clearly, everyone discovered America! The Africans (Olmecs) the East Asians, the Irish, the Chinese and of course the Vikings have all been said to have discovered America before Columbus in 1492. All those candidates ignore the fact that apparently when America was discovered–there were people here already!
Still, there appear to be enough proofs that this Christian woman lived on the continent 1,000 years ago to make one wonder why her story didn't appear in any history books?
"From the article;
Permit me through your columns to publish the details of the discovery near the city of Washington, of the remains of an Icelandic Christian woman , who died in the year 1051, and of the inscription in the Runic characters which mark her grave, the announcement of which has already sped by telegraph through the New World to the Old—to publish a fact which materially affects the history of the discovery of America by Europeans, by adding one more proof to the many now generally received by historians, of the extraordinary voyages of the adventurous Northmen, without compass or quadrant, to the eastern coast of this continent, five centuries before the landing of Columbus….."
The author recounts many other proofs of Icelandic/Northmen incursions into America and gives the location of the gravestone in extraordinary detail. He translates the inscription, which he has named 'the white shirt inscription" as follows;
"Here rests Syasy, (or Suasu) the fair-haired, a person from the east of Iceland, the widow of Kjoldr, and sister of Thorgy, children of the same father…..twenty-five years of age. May God make glad her soul. 1051"
The author Thomas Raffinnson, of the Royal Society of Northern Antiquities then goes into great detail concerning the inscriptions themselves and about the human remains, trinkets and Roman coins found at that site.
He indicates at the article's end that the reamins and trinkets along with detailed drawings of the inscription had been forwarded to the Smithsonian……
4)Giant Ancient Miners? Relics of Ancient Miners
Bruce Herald, May 16, 1902 Archaeologists were "much interested" in some old tools found at an abandoned, ancient coal mine near Edinburgh. During operations by the Weymess Coal Company and old unused pit was discovered that held among other items some ancient tools.
The discoverers were amazed at the size of some huge blocks of coal that had been cut out with a pick and wondered how the ancient miners had been able to cut blocks so large. Some of the tools found were made of wood.
The huge blocks had been cut out with picks—the handles of which were as large in thickness and in length as the props used at that time to prop up the roof as they went in current mining operations.
Who were these giant miners? One giant man might be a "freak of nature" but apparently due to the size of the cut blocks of coal and the incredible size of certain tools such as the pick axe, it was apparently a common size of the miner of that era and location..
*Historical Mysteries


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The Deepings Lions have been fund raising for 30 years in and around The Deepings and the surrounding villages and have raised over £250,000 for not only local good causes but international campaigns as well.
Who are the Lions and what do we do?
The Deepings Lions are part of an international organisation who number approx 1.3 million people operating in over 100 countries. We are ordinary people from all walks of life (sounds like an advert doesn't it) who give a little time and effort for the good of the community and have fun doing it .
During our year we either run or get involved in:
For 2020 we have introduced our Short Story Competition
The Deepings Carnival, The Duck Race, attend various markets (summer / Christmas).
Oh yes, and we look after Santa as he does his rounds around the streets of The Deepings and the surrounding villages.Follow Us on Social Media


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Regular price
Bring your walls to life with the texture and depth of a stretched canvas print.
The artwork gets printed onto a canvas and then stretched on a stretcher bars.
All our canvases arrive ready to hang!
Add a gallery finish with a floating frame available in black, white and timber effect.
All of our prints are made to order so please choose carefully as refunds are not provided where you have simply changed your mind or made a wrong selection.
Printing time is about 10 business days
40 cm x 59 cm = 16" x 24"
50 cm x 75 cm = 20" x 30"
59 cm x 90 cm = 24" x 36"
75 cm x 100 cm = 30" x 40"
80 cm x 118 cm = 32" x 48"
Other sizes available by request


text:
I was dying for a bicycle. What I really wanted was a Spitfire, dark blue! That had to be the most beautiful bike in the world. However, I was a realist. I had heard my mother worrying over Christmas enough to know there would never be enough money for a new Spitfire. That would have cost more than she had to spend for the whole family. I would have been happy with anything of a reasonable size without training wheels. It didn't have to be new. It didn't have to have a horn. It didn't have to be blue. I just wanted a bike.
My mother did make a mysterious trip to Goodwill in Shreveport before Christmas. There is no way I could have missed knowing this. She was a timid driver. "Driving in town" was a frequent topic of discussion among her group of friends. The bolder ones proudly bragged, "I drive in Shreveport!" Most of them "drove in Springhill." Mother didn't mind "driving in Cotton Valley." It had businesses on two major streets, no parallel parking, and no parking meters. A kid could drive a tricycle down Main Street undisturbed.Needless to say, Mother must have felt pretty pressed by our pleas for bikes to plan a trip to Shreveport. She worried a lot that Goodwill might have parallel parking. Finally, the big day came. Though she was secretive about her purpose, I knew it had to be related to Christmas. She even recruited a friend to babysit Connie and Marilyn, the only time I'd ever known her to do such a thing!
She left as soon as we were on the bus, not getting home till long after dark, unheard of for her. There were no packages. The next day, we stopped by Bud Hooten's Hardware store where she bought a quart of sky blue enamel paint, some sandpaper, and a brush. We took these to my Uncle Albert's house. He had a boy, Bobby, staying with him. While Mother drank coffee with Aunt Jewel, possibly the dullest woman on earth, Bobby came in, wordlessly took the bag from the hardware store, and disappeared. Mother entertained no questions, so I knew it all had to be related to the trip to Goodwill and Christmas.
Christmas morning finally came. The mystery was revealed. Next to the tree stood two bikes of sky blue, a color never favored by Spitfire! Draped across the handlebars of my bike hung a string of lollipops! I was thrilled with my bike. "Oh, I love it! I love it! This must be what you got at Goodwill! I never thought I'd be able to get a bike for Christmas!"
At the mention of Goodwill, Mother's face fell. I never dreamed she'd think I'd believe this was a new bike! It was obviously repainted with wear marks that a simple paint job couldn't fix.
I tried to make her feel better. "I love it. I knew we couldn't ever get new bikes. I just wanted a bike.
She recovered, somewhat, though still disappointed. "Oh, well, I'm glad you like it. Now be careful. As soon as it was daylight, we were off on those Goodwill bikes, riding the first of a million miles!


text:
Print Circuit Board Live Wallpaper
PCB Live Wallpaper V2.0.0
The Print Circuit Board Live Wallpaper displays a print circuit board background with short circuits. You can choose from 6 different amazing print circuit board themes, including sound & vibration, the background brightness and the density of the short circuits. The vibration duration is linked to the sound volume. The higher the volume, the longer the vibration. And finally, shake your phone for additional Short Circuits.
- Android 4.0.3 and above.
- 6 different print circuit board themes.
- Set the brightness of background.
- Set the density of the short circuits.
- Set the shake sensitivity.
- Sound volume control.
- Multiple animation, sound & vibration effects.
- Short Circuits appear after touching the screen.
- Short Circuits appear after shaking the phone.
- Landscape and portrait screen orientation support.
Read 'How to create a Live Wallpaper' to learn everything you need to known to develop a Android Live Wallpaper yourself.
Get the Android PCB Live Wallpaper from Google Play.


text:
For Immediate Release
Patricia Kiernan Johnson;
Lisa Erdberg (San Francisco Opera), Patricia A. Richards (Utah Symphony | Utah Opera),
Cherie Shreck (Des Moines Metro Opera) and Timothy J. Wagg (Opera North) to be
Honored in New York in February
Bank of America
proudly sponsors the
National Opera Trustee Recognition Program
New York, NY—
OPERA America
, the national service organization for opera, is pleased to announce the recipients of the
2013 National Opera Trustee Recognition Award
. In its sixth year, this award honors outstanding trustees of U.S. opera companies for exemplary leadership, generosity and audience-building efforts on behalf of their respective opera companies.
The recipients of the 2013 National Opera Trustee Recognition Award are
Lisa Erdberg
San Francisco Opera
Patricia A. Richards
Utah Symphony | Utah Opera
Cherie Shreck
Des Moines Metro Opera
Timothy J. Wagg
Opera North
"We are delighted to be joined by
Bank of America
in celebrating the significant and enduring contributions of these devoted trustees," stated
Marc A. Scorca
, president/CEO of OPERA America. "The National Opera Trustee Recognition Award affords the entire opera community an opportunity to salute and learn from those who have been so generous in their passion for the art form, vision and support of their opera companies."
Each year, OPERA America professional member companies are invited to nominate one of their trustees for this award. Honorees from each of the four OPERA America budget levels are chosen by an adjudication committee through a competitive selection process.
The National Opera Trustee Recognition program is led by OPERA America Board Member
Carol F. Henry
(chairman of the board of directors' executive committee, Los Angeles Opera). Committee members include:
Elizabeth Eveillard
(past chair of the board of trustees, The Glimmerglass Festival),
Garry Fredericksen
(past president of the board of directors, Indianapolis Opera),
Ruth Orth
(past chair of the board of trustees, Pensacola Opera) and
Fillmore Wood
(former vice chairman of the board of directors, Opera Pacific).
"OPERA America's commitment to recognizing the multi-faceted contributions of opera company trustees is inspiring," stated Chairman of the Board of Directors
Dr. Frayda B. Lindemann
, who is also a trustee of the Metropolitan Opera. "As former chairman of the National Opera Trustee Recognition Program and a current opera company trustee, I deeply admire the dedication of all the nominees and am honored to commend their achievements on a national scale."
These honorees represent a significant range of accomplishments, generosity and a deep devotion to promoting opera in their communities. The following profiles illustrate just a few examples of their dedication.
Lisa Erdberg
Patricia A. Richards
Cherie Shreck
Timothy J. Wagg
Lisa Erdberg, San Francisco Opera (San Francisco, CA)
Lisa Erdberg, a subscriber to San Francisco Opera since 1993 and a donor since 1996, has held a number of crucial leadership roles on San Francisco Opera's Board of Directors, propelling the mission of the organization, including the positions of Executive Committee member, chair of the Directors and Officers Committee and vice president of the Board. Seeing engagement as essential to San Francisco Opera, Ms. Erdberg has been personally responsible for the Next Generation Task Force aimed at developing future audiences and donors. Ms. Erdberg has revolutionized the San Francisco Opera Board. Through her Engagement Initiative, she increased the financial contributions from the Board of Directors and encouraged them to introduce friends and colleagues to the opera, increasing San Francisco Opera's audience. Ms. Erdberg streamlined the election process and created a smoother transition process for new leaders, making the Board more effective and efficient. Ms. Erdberg is also deeply dedicated to the financial well-being of San Francisco Opera. In 2007, Ms. Erdberg made an early pledge to the Comprehensive Campaign and recently made a significant gift to the Camerata, San Francisco Opera's group of visionary donors who fund the projects that define the company's international reputation. Donna Baston, director of foundation and government relations, stated, "Her involvement and financial support is never about personal recognition. Rather, it is always about San Francisco Opera and how she can best help the company be as successful as possible."
Patricia A. Richards, Utah Symphony | Utah Opera (Salt Lake City, UT)
Upon being appointed vice chair of the newly merged Utah Symphony | Utah Opera (USUO) in 2004, a position she has called "the hardest assignment of her life," Patricia A. Richards now serves as the chair of the USUO Board of Trustees. A visionary from the inception of the 2002 USUO merger, Ms. Richards led a special task force early in the merger and again in 2012 to acquire a better understanding of what has worked, what hasn't worked, and how to improve on cooperative internal operations and relationships moving forward. Ms. Richards served as an instrumental force in locating a new CEO in 2007, as well as a new music director in 2009, demonstrating her deep commitment to the leadership and personnel of USUO. She is willing to lead as a fundraiser, government advocacy representative in the State Legislature, and personally recruits friends, neighbors and strangers to attend and support USUO. Additionally, Ms. Richards sought to focus the work of the Board of Trustees on real governance and strategic issues and aided the negotiation of the collective bargaining agreement with the Utah Symphony Musicians and Local 104 on five occasions. After retiring from her career as a banking professional for Wells Fargo in the Intermountain West, Ms. Richards and her husband, Bill Nichols, set the tone for USUO's comprehensive campaign by donating $1 million dollars, saying that she "cannot ask others to make such a sacrificial gift without leading first as board chair." Since that time, almost $25 million in additional support has been raised. "Pat Richards has been a pillar of strength for USUO. She has far exceeded any expectation of what a board chair should do for a nonprofit organization," stated USUO President & CEO Melia P. Tourangeau.
Cherie Shreck, Des Moines Metro Opera (Indianola, IA)
Cherie Shreck's lifetime contributions to Des Moines Metro Opera have been so significant that the organization recently named her an honorary member of its Board of Directors. She was a member the Board for a total of 14 years between 1989 and 2007, including serving as president of the Board of Directors, Executive Committee member and guild president. Ms. Shreck has demonstrated dedication to the financial well-being of Des Moines Metro Opera by organizing the first Salisbury Challenge to raise $1 million and establishing the Des Moines Metro Opera Foundation over 20 years ago. The Challenge ended up raising more than $4 million. Additionally, Ms. Shreck helped to lead the Apprentice Artist Endowment Campaign, the second Salisbury Challenge and the Robert L. Larsen Legacy Campaign. Her leadership has resulted in the Des Moines Metro Opera Foundation making an annual disbursement of nearly 25% of the annual company operating costs. Keenly aware of the importance of exposing individuals of all ages to the joys of live theater, Ms. Shreck brings new patrons to opera performances each year and has been a member of the Des Moines Metro Opera Guild since its inception. Stated Artistic Director Michael Egel, "Any compliment given, award lauded or applause rendered for the company is in part similarly accorded for Cherie…[she] is the epitome of an active and vibrant Board member who believes that the arts help define who we are not only as a community, but as a society as a whole."
Timothy J. Wagg, Opera North (Lebanon, NH)
Timothy Wagg has been an Opera North volunteer continuously since 1996 after retiring from a career with Consolidated-Bathurst in Canada. Since that time, Mr. Wagg has served on the Board of Trustees, the Advisory Committee and chaired the Finance Committee. He has created a new revenue source for Opera North by managing sponsors and underwriters for the season playbill, securing $25,000 for the company annually. Mr. Wagg works tirelessly to make opera more accessible to larger audiences. In addition to attending all Opera North performances and recruiting newcomers, he analyzed Opera North's demographic data, resulting in a 6% ticket sales increase. Mr. Wagg has obtained recognition and support for Opera North through his many corporate and nonprofit relationships. As Executive Director Pamela Pantos noted, "While the funds are vital to Opera North's bottom line, the bonds that have developed have solidified Opera North's reputation as a willing community partner." Mr. Wagg revolutionized the accounting and financial practices of Opera North by updating protocols, securing a payroll system and managing reporting networks. Mr. Wagg also prepares the Opera North annual audit. After 16 years of dedicated service, Mr. Wagg is "a permanent fixture" at Opera North and a board member who exemplifies the generosity and commitment of an award-winning trustee.
OPERA America's commitment to recognizing excellence in governance is shared by its sister organization, Opera.ca, the Canadian national association for opera. Opera.ca honors
Arthur R.A. Scace, Q.C.
, a long-time volunteer leader and past president and chairman of the Board of Directors of the
Canadian Opera Company
, as the 2013 recipient of its National Opera Directors Recognition Award.
OPERA America will pay tribute to these 2013 honorees and celebrate their remarkable achievements at a dinner and reception on Friday, February 22, in New York City.
The National Opera Trustee Recognition Program is made possible by the generous support of
Bank of America
Previous National Opera Trustee Recognition Program recipients are:
Elizabeth Eveillard, The Glimmerglass Festival
Joseph and Judy Liff-Barker, Nashville Opera
Susan F. Morris, The Santa Fe Opera
William C. Morris, The Metropolitan Opera
Dr. George R. White, Opera Theater of Pittsburgh
Eleanor "Ellie" Caulkins, Opera Colorado
Jackie Lockwood, Dayton Opera
John I. (Jack) Riddle, PORTopera
Lynn Wyatt, Houston Grand Opera
Jeffrey A. Evershed, Portland Opera
Benjamin Keaton, Long Leaf Opera Company
Fred and Eve Simon, Opera Omaha
Marc I. Stern, Los Angeles Opera
James T. Cody, Jr., The Dallas Opera
Richard Holland, Opera Omaha
Beth Ingram, Lyric Opera of Kansas City
C. Guy Rudisill, III, Piedmont Opera
Betty W. Healey, Opera Birmingham
Sally S. Levy, Opera Theatre of Saint Louis
Jane A. Robinson, Florida Grand Opera
G. Whitney Smith, Fort Worth Opera
For more information about OPERA America, its services, programs and events,
OPERA America leads and serves the entire opera community, supporting the creation, presentation and enjoyment of opera.
Artistic services help opera companies and creative and performing artists to improve the quality of productions and increase the creation and presentation of North American works.
Information, technical, and administrative services to opera companies reflect the need for strengthened leadership among staff, trustees and volunteers.
Education, audience development and community services are designed to enhance all forms of opera appreciation.
Founded in 1970, OPERA America's worldwide membership network includes nearly 200 Company Members, 300 Associate and Business Members, 2,000 Individual Members and more than 16,000 subscribers to the association's electronic news service. In 2005, OPERA America relocated from Washington, D.C. to New York as the first step in creating the first-ever National Opera Center. With a wide range of artistic and administrative services in a purpose-built facility, the Opera Center is dedicated to increasing the level of excellence, creativity and effectiveness across the field.
OPERA America's long tradition of supporting and nurturing the creation and development of new works led to the formation of
The Opera Fund
, a growing endowment which allows OPERA America to make a direct impact on the ongoing creation and presentation of new opera and music-theater works. Since its inception, OPERA America has made grants of nearly $11 million to assist companies with the expenses associated with the creation and development of new works.


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|GIL .. BIOSCI/Bionet News .. Biosequences .. Software .. FTP
In article <3j0qqc$8rc at news.doit.wisc.edu>, mtkloth at students.wisc.edu says... > >gold at astro.ocis.temple.edu (Bert Gold) wrote: >> >> One of the universities where I work has decided to charge $ 100 per >> person per month for mainframe access. As everyone in these newsgroups >> knows, this kind of access is an absolute requirement for doing >> molecular biology in 1995! > >The University of Wisconsin in Madison not only does not charge, but it >has been encouraging all of the students and faculty to make use of email >and other internet tools. I think that it has been an enourmous help >to have these tools available. You are right. Internet access is a must. If the UW started to charge $100.00/month I'd tell them to screw themselves since there are many local net providers who will give you unlimited slip access for about a third to a quarter of this amount. I would encourage you to drop a note to NIH about this. I bet your university is already billing computer access to internet as an "overhead" expense for grants it administers. I am willing to bet that the govt. wouldn't take kindly to paying for something that isn't delivered. Don ps. A friend of mine who keeps track of such things estimates that the real cost of providing internet services to everyone on the net runs less than a $1.00/month (actually more like 50 cents/month). -- Donald A. Lehn, Ph.D. Phone: (608) 263-7668 Medical Sciences Center / 3415 Fax: (608) 262-9300 University of Wisconsin Medical School Email: dalehn at facstaff.wisc.edu 1300 University Avenue Home: (608) 277-1025 Madison, WI 53706-1532 Diabetes Knowledgebase: http://www.biostat.wisc.edu/diaknow/index.htm


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The evidence has never been clearer that women's political, economic, and social participation and leadership are vital to development. Countries where women are fairly represented in government enjoy greater security, higher levels of development, and more inclusive policy-making. The incoming administration should take advantage of this critical moment in history by developing the first-ever National Action Plan on Women's Equal Participation in Public Service and sign an executive order directing that the plan be implemented. This plan would chart a course to enhance women's equal role in public service and political participation around the world, and it would transform how the United States approaches its diplomatic and development-based support to women, thus ensuring equal participation in all levels of decision-making.
Resource type:
Wilson Center
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The greatest blow to Islamic terrorism in recent years came not from the killing of Osama bin Laden in his compound in Abbottabad, Pakistan, but rather from the Arab Spring. When millions of Arabs went out into the streets in protest against their dictators, the world saw that they were asking for freedom and justice, not an Islamic state. Indeed, perhaps the sharpest blow to the jihadi worldview was to see Egypt's Muslim Brotherhood--the largest Islamist organization in the Arab world--join the 2011 mass demonstrations in Tahrir Square to ask for elections, not Shari'a. The leader of al-Qaeda, Ayman al-Zawahiri, an Egyptian, certainly saw the danger and denounced the Brotherhood for participating in the democratic process.
There is jubilation in many quarters of Egypt and beyond over the downfall of the Muslim Brotherhood. And it is true that President Mohamed Morsi's government was a disaster in many dimensions. The Brotherhood ruled in a manner that excluded large segments of the society, used and abused the law and overreached. Perhaps as important, it was utterly incompetent, steering Egypt's already dysfunctional economy into the gutter. It had become wildly unpopular, with millions who had supported it now actively opposed. The Brotherhood was almost certain to be roundly defeated in the upcoming parliamentary elections. Had it failed politically, electorally and democratically, that would have been a huge boost for the forces of liberalism and reform in the Arab world. It would have sent the signal that political Islam may be a heartwarming, romantic idea but is utterly unsuited to governing--that mullahs can preach, but they cannot manage an economy.
Instead, the great danger of what has happened in Egypt is that followers of the Muslim Brotherhood will once again become victims, gaining in stature as they are jailed, persecuted and excluded. And some of them will decide that democracy is a dead end.
The most important debate in Egypt since the July 3 coup, taking place behind closed doors and on websites and in chat rooms, revolves around this question: How will followers of political Islam respond to the Brotherhood's ouster? For decades there has been a dispute among these groups on whether to embrace democracy or work through underground means and methods. The Brotherhood renounced violence some 40 years ago and chose to work though social and political organization, pressing for democratic change. This stance was actively criticized and opposed by the more extreme Islamist groups in Egypt and beyond--like al-Qaeda--which advocated violent struggle as the only way forward. Those groups now feel vindicated.
Somalia's al-Qaeda-affiliated al-Shabab movement weighed in with a series of tweets (yes, it has a Twitter account): "When will the Muslim Brotherhood wake up from their deep slumber and realise the futility of their efforts at instituting change?" "It's now time for the [Brotherhood] to revise its policies, adjust its priorities and turn to the one and the only solution for change: Jihad." An ultra-Islamist page on Facebook, Asalaffy, with more than 200,000 followers, posted a note thanking al-Zawahiri: "Thank you ... for you have warned us time and again to not enter the political game."


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Health SA Gesondheid (Online)
On-line version ISSN 2071-9736
Print version ISSN 1025-9848
Health SA Gesondheid (Online) vol.19 n.1 Cape Town Jan. 2014
The perception of midwives regarding psychosocial risk assessment during antenatal care
Johanna M. Mathibe-NekeI; Allan RothbergII; Gayle LangleyII
IDepartment of Health Studies, University of South Africa, South Africa
IIFaculty of Health Sciences, University of Witwatersrand, South Africa
BACKGROUND: The physiological and psychological changes caused by pregnancy may increase a woman's vulnerability to depression, which may in turn have adverse effects on both maternal and foetal wellbeing. Inadequate psychosocial risk assessment of women by midwives may lead to lack of psychosocial support during pregnancy and childbirth. Pregnant women who lack psychosocial support may experience stress, anxiety and depression that could possibly affect foetal wellbeing
OBJECTIVE: The objective of this study was to explore and describe the perception of psychosocial risk assessment and psychosocial care by midwives providing antenatal care to pregnant women
METHOD: An interpretive and descriptive qualitative approach was adopted. Three focus group interviews were conducted with midwives working in three Maternal Obstetric Units in Gauteng Province, using a semi-structured interview guide. The constant comparison data analysis approach was used
RESULTS: Findings revealed that midwives are aware of and have encountered a high prevalence of psychosocial problems in pregnant women. Furthermore, they acknowledged the importance of psychosocial care for pregnant women although they stated that they were not equipped adequately to offer psychosocial assessment and psychosocial care
CONCLUSION: The findings provided a basis for incorporation of psychosocial care into routine antenatal care
AGTERGROND: Die fisiologiese en psigologiese veranderings wat deur swangerskap veroorsaak word, kan 'n vrou se kwetsbaarheid vir depressie verhoog. Dit kan op sy beurt negatiewe gevolge vir sowel die moeder as die fetus se welstand hê. As vroedvroue nie voldoende psigososiale riskio-assesserings op swanger vrouens doen nie, kan dit tot 'n gebrek aan psigososiale ondersteuning tydens die swangerskap en geboorte lei. Swanger vrouens wat 'n gebrek aan psigososiale ondersteuning het, kan stres, angs en depressie ervaar wat weer die fetus se welstand kan beïnvloed
DOELWIT: Die doelwit van hierdie studie was om die persepsies van vroedvroue, wat voorgeboortesorg aan swanger vrouens bied, te ondersoek en te beskryf sover dit hulle persepsies oor psigososiale risiko-assessering en psigososiale aangaan
METODE: 'n Interpretatiewe en beskrywende kwalitatiewe benadering is gevolg. Drie fokusgroep-onderhoude is deur middel van 'n gestruktureerde onderhoudsgids gevoer met verloskundiges wat in drie voorgeboorteklinieke in die Gauteng Provinsie werksaam is. 'n Benadering tot data-analise wat van voortdurende vergelyking gebruik maak, is gevolg
RESULTATE: Die studie het aan die lig gebring dat verloskundiges bewus is van psigososiale probleme onder swanger vroue en dat die prevalensie van sulke probleme onder swanger vroue hoog is. Vroedvroue erken die belang van psigososiale sorg aan swanger vroue alhoewel hulle nie toereikend toegerus is om psigososiale assessering en -sorg te verleen nie
GEVOLGTREKKING: Die bevindinge stel 'n basis daar vir die insluiting van psigososiale sorg in roetine voorgeboortesorg
Introduction and background
The concept of psychosocial stressors experienced during pregnancy encompasses life experiences, including changes in personal life, job status, family makeup, housing and the possibility of domestic violence. All of these require adaptive coping mechanisms on the part of the pregnant woman, which can be facilitated through support by a midwife (Coussons-Readet al. 2005:625-626).
Pregnancy, birth and parenthood are phases in life that create demands on a woman's ability to adapt: physically, psychologically and socially. The physical discomfort of pregnancy, accompanied by the anticipation of childbirth and the responsibility of parenthood, often causes anxiety and emotional changes that might lead to complications, for example, preterm labour and delivery (Mamelle 2001:268).
Previous conflicts in childhood and adulthood are often reactivated during pregnancy and can make some women vulnerable as they become less prepared for the changes brought about by pregnancy and motherhood. It has been stated that these physiological and psychosocial adjustments in pregnancy may increase the women's vulnerability to depression, which may in turn have an adverse effect on both maternal and foetal wellbeing (Suppaseemanont 2006:11).
Reflecting on literature, a systematic review of 16 studies on antenatal screening for postnatal depression by Austin and Lumley (2003:13), which involved 23 000 women, revealed that 10% − 67% were at risk of postnatal depression. The preliminary evidence suggested that the introduction of a screening tool to aid early detection and diagnosis of depression helped to raise awareness of psychosocial maternal risks amongst healthcare providers who offer antenatal care services.
According to the World Health Organization (WHO 1998:13-14), maternal risk is defined as the probability of experiencing various levels of injuries or even dying as a result of pregnancy or childbirth. Risk assessment is not new to midwives as they have always been mindful of the possibility of risks during pregnancy and delivery. Midwives normally use their knowledge, skills and available evidence in order to assess any potential risks associated with pregnancy throughout the childbearing process. The WHO recommended that physiological and psychosocial assessment should commence during the first visit, as part of a comprehensive assessment, at which time the midwife elicits medical, surgical, social, psychological and obstetrical history, which may affect the outcome of the current pregnancy. The assessment should be reviewed during subsequent antenatal visits.
Risk screening, according to the WHO (1998:13-14), involves using a list of risk factors and some form of scoring system to classify pregnant women into specific risk categories, typically high risk or low risk, using cut-off points or thresholds. The focus of risk screening is to detect early symptoms and predict the likelihood of complications. The intention is to predict problems before they occur and, as such, take appropriate action by providing optimal maternal care. According to Feldman (2000), the overall aim of psychosocial risk assessment during pregnancy is to screen the pregnant population or family and provide care and appropriate intervention to women in need, which would reduce the risk for psychosocial stress and promote a positive attitude towards childbirth. In addition to minimising maternal distress, psychosocial support inspires healthier lifestyles and discourages behaviours such as smoking, substance abuse and poor nutritional intake, thus promoting a healthier pregnancy outcome.
Mercer (1986), as quoted by Hildingsson and Häggström (1999:83), described the purpose of social support as making women feel respected and valued. The quality of support is of more value than the quantity. Furthermore, research has revealed a growing body of knowledge regarding the negative influence of psychosocial factors on the outcome of pregnancy. A cross-sectional study to identify a relationship between life stress, perceived social support and symptoms of depression and anxiety was conducted by Glazier et al. (2004:252). Based on the results, the researchers recommended that psychosocial assessment of pregnant women and their partners should be conducted as routine care. Several authors, for example, Handwerker (1994). Lupton (1999) and Saxell (2000), as quoted by Stahl and Hundley (2003:299), indicated that risk assessment during childbirth is made more complex by the differences in the perceptions of risks between midwives and pregnant women. Risks, from a midwife's perspective, are based on specialised knowledge and training, epidemiology, personal values and experience, whereas a woman's understanding of risk is far more contextual, individualised and embedded in her social environment and everyday life experience.
The prenatal care guidelines by the Group Health Incorporated (2008) advocate for psychosocial risk assessment, namely, screening for economic, social and psychological status, emotional status, smoking, drug and alcohol abuse, domestic violence and history of sexual assault to be part of the overall risk assessment.
The methodological approach in this study is a mixed-method approach, combining quantitative and qualitative research techniques, methods and approaches to address psychosocial risk assessment and psychosocial support by midwives during antenatal care. The methodology was aimed at accommodating the diverse population involved in the study, the nature of data being sought and the number of investigations conducted, involving the collection, analysis and interpretation of quantitative and qualitative data.Data sources for the major study included midwives, midwifery experts, pregnant women and midwifery education regulations and curricula.
Problem statement
As a midwifery educator, the researcher observed that psychosocial risk assessment and psychosocial support were given insufficient attention in midwifery education and by midwives who provide antenatal care to pregnant women. Historically, the definition of maternal risk largely includes medical factors, with only a few psychosocial and socio-economic factors being considered, specifically psychosocial history-taking by midwives during antenatal care.
Menon, Musonda and Glazebrook (2010:361) indicated that it is important for health professionals to ask pregnant women about their feelings related to the pregnancy, childbirth and motherhood and to give women who express fear an opportunity to discuss this because psychosocial interventions have proved to be beneficial in providing comprehensive antenatal care. In the South African context, antenatal care is usually offered in the form of routine physical assessment and care, with limited or no psychosocial assessment and care.
Aim and significance of the study
The aim of the study was to establish the perception and raise awareness of the importance of psychosocial care for pregnant women by conducting focus group discussions with midwives. The study aimed at closing the gap between the physical care and psychosocial care that is offered to women by midwives during antenatal care. The ultimate goal is for women to be provided with a routine holistic antenatal care service.
Research objectives
1. To explore and describe midwives' awareness, knowledge and understanding of psychosocial risk assessment and support.
2. To establish whether midwives conduct psychosocial assessment during antenatal care.
3. To develop recommendations for psychosocial care based on the study findings, with a focus on providing appropriate psychosocial support that would enhance maternal and foetal wellbeing.
Key concepts
Antenatal care is a part of reproductive health, a level of care in the maternity cycle that is given to a woman from conception until the onset of labour. A midwife or an obstetrician provides this care. The overall objective of antenatal care is to ensure the best possible pregnancy outcomes for pregnant women and their babies, through optimal physical, social and psychological preparation before delivery (Dragonas & Christodoulou 1998:127-130; Gauteng Department of Health 1997:3). The National Collaborating Centre for Women and Children's Health states that antenatal care is not an independent entity as each woman brings her physical, personal, emotional and cultural realities and her experiences of pregnancy, whereas a midwife brings her knowledge and expertise of the childbearing process to manage the pregnancy (National Institute for Health and Care Excellence 2003:26).
Psychosocial risk assessment is an evaluation of an individual's mental health, social status and functional capacity. The individual's physical status, appearance and behaviour are observed for factors that may indicate emotional distress or mental illness. Observations include posture, facial expressions, manner of dress, speech and thought patterns, degree of motor activity and level of consciousness. The individual is questioned concerning activities of daily living, including work schedule and social and leisure activities. Data should include the individual's response to and methods of coping with stress, relationships, cultural orientation, unemployment or change of employment, change of residence, marriage, divorce, or death of a loved one (Anderson & Anderson 1990:738; Anderson, Harris & Madl 1998:237-251)
Psychosocial support is the provision of assistance and support in the management of identified psychological or social problems or risks. Bryce, Stanley and Enkin (1988:20) define psychological or social comfort, assistance and the information one receives through formal and informal interaction with an individual or group, with the focus on providing information, support and referral for psychological, social issues and needs. For the purpose of this study, support refers to the functions that are rendered by midwives in order to reduce stress and social problems in a pregnant woman and to make her feel accepted through enhancing her self-esteem, health and emotional wellbeing, thus enabling her to make appropriate psychosocial adjustments.
Contribution to field
It is hoped that the findings of the study would indicate the extent of the midwives' understanding of the importance of and the implementation of psychosocial care to pregnant women. The midwives' responses would contribute to the formulation of guidelines.
Research method and design
An interpretive qualitative design was used, characterised by a search for meaning and understanding, the use of an inductive investigative strategy and a rich presentation and discussion of findings (Merriam 2002:1-10). This design was used in this study in order for the researcher to establish an understanding of how midwives make meaning of the phenomenon psychosocial care for a pregnant woman. The researcher was the primary instrument for data collection and analysis. Inductive reasoning was used to discover the system of psychosocial care as provided by midwives during antenatal care. Deductive reasoning was used to uncover the midwives' knowledge and understanding of psychosocial assessment and psychosocial care.
Population, sampling and data collection
The population consisted of all midwives working at three Maternal Obstetric Units in Gauteng Province that offer antenatal care services at primary healthcare level. All midwives who worked in the stated clinics were purposively selected to participate in focus group discussions (Merriam 2002:18-22). The clinic manager organised the venue and coordinated the group by ensuring that they all had information about the study and are aware that participation is voluntary and that they may withdraw at any stage of the discussion. Focus group discussions were conducted in a consultation room within each clinic. The midwives in each group were based at the same clinic. Three focus groups of two groups of five midwives and one group of six midwives discussions were conducted. These discussions were used to obtain insight into the understanding, attitudes, opinions and perceptions of midwives regarding psychosocial risk assessment and psychosocial support during antenatal care. The midwives were informed in full about the study and had three months in which to decide on participation. A consent form for participation was attached to the information letter and signed preparticipation.
An interview guide with open-ended questions was used. The interview guide was compiled from the preliminary results of self-administered questionnaires completed by pregnant women and the findings of focus group discussions which had been conducted with pregnant women. Five categories of open-ended questions, an opening, introductory, transition, key and ending question as described by Krueger (2002:6-8) were included. One of the inclusion criteria required midwives to have provided care to pregnant women for at least two years, in order to be able to share information about psychosocial risk assessment and psychosocial support. The researcher conducted each focus group and served as an observer, listener, moderator and analyser using an inductive process. Data were tape recorded and transcribed verbatim. Within-group and across-group data saturation was reached with the third focus group. The duration of the interviews was approximately 55 minutes.
Data analysis
The constant comparison analysis method (Onwuegbuzie et al. 2009:5) was applied as it provides a clear series of steps which can easily manage large amounts of complex data and allows the researcher to assess data saturation in general and across-group saturation. Three major stages that were applied are open coding, axial coding and selective coding, as data were initially grouped into small units, then codes were used to group data into categories and, lastly, the researcher developed themes that expressed the content of each of the groups under axial coding.
Philosophical perspective
A holistic ideology described by the American Holistic Nurses Association (AHNA) (Frisch 2001), which is ideal for all healthcare practitioners, was used as a theoretical framework to guide this study. With reference to the AHNA's description of holistic nursing, holistic antenatal care relates to the identification by a midwife of the interrelationship of the bio-psycho-socio-spiritual dimensions of a pregnant woman and understanding of the woman as a unitary whole in a mutual process with her environment. For the AHNA, practising holistic nursing requires midwives to integrate self-care, self-responsibility, spirituality and reflection on their lives, which will make the midwife interconnect with self, others, nature and God. This awareness may further enhance the midwife's understanding of each woman as an individual. A healthcare practitioner who believes in holism often considers and offers complementary and alternative forms of healthcare as options (Walter 1999).
All 16 participants were females. The discussions were generally relaxed, aided by the fact that the midwives were a working group and knew one another. This allowed them to relate to each other's comments. They were able to challenge one another and self-disclosure was also promoted. Focus group discussions produced data that provided insight into the understanding, attitudes and opinions of midwives regarding psychosocial risk assessment and psychosocial support. Typically, midwives defined a situation which presented a particular psychosocial problem, then described the action taken by a midwife and the outcome of the interaction. This approach provided the researcher with an overall view of the participants' perceptions of psychosocial care. The stories were analysed by viewing their relevance to a psychosocial problem and the resulting intervention. The following findings emerged in response to the research questions.
Overall views of psychosocial assessment
The concept psychosocial seemed to be familiar to the participants, although they did not describe their understanding of psychosocial assessment but rather indicated what should be assessed psychosocially during antenatal care, as reflected by their various responses. As three focus group discussions were held, the responses will be categorized as follows: Focus group number 1 (Fcg 1), focus group number 2 (Fcg 2) and focus group number 3 (Fcg 3). All participants were women:
'Psycho talks about mentality ... social is maybe the environment or socialisation or anything that is affecting her socially as a human being.' (P2, Fcg1)
'My understanding of psychosocial, it means how we as midwives, really, really, going deeper into the social background of the woman, do we really ask about the social background besides the physical background, do we really ask the questions, that is something usually that does not appear on our antenatal card but do we really try to go deeper into the background, the home situation, the financial support, and the ordinary support and how the mother is feeling [emphasizing] about the current pregnancy, all the previous pregnancies, were there conditions like puerperal psychosis or whatever that could be anticipated, psychosocial support, is [sic] there people or systems that can assist in whatever way to care for this patient for example the family.' (P1, Fcg 3)
The three major themes that were developed from the participants' responses in relation to the concept 'psychosocial risk assessment' were social factors, psychological factors and assessment (Table 1). Reflected within the social and psychological themes are subthemes in a form of factors that relate to psychosocial assessment, which also provide a holistic approach to assessment during pregnancy. Psychological subthemes included the emotional, mental status and sexual abuse.
According to the participants' responses, the social factors that influenced women's psychological behaviour were existing social problems, social stigma, environmental hazards, unplanned or unwanted pregnancy, life events and cultural and economic issues. The responses of women to these social factors, as also stated by Ul Moula (2009:20-21), could be manifested psychologically through emotions that included anger and mental instability and the fact that psychosocial factors in health are conditioned or modified by the social structures and contexts in which they exist. Participants in all three groups agreed that it is important for midwives to assess women psychosocially during antenatal care, for example, 'so that you can intervene immediately and refer to the right resource' (P3, Fcg 2). Participants indicated that psychosocial assessment did not occur routinely, unless there was an indication to go beyond the routine physical assessment. A psychosocial problem could be identified, for example, during health information sessions or when the midwife observes an unusual behaviour from a pregnant woman during a follow-up visit.
'Every time when we see the patient we just check the patient and let them go, we talk to the patient as usual … like we know our patients; and if you notice that she is not the person you know … is then [sic] that you find out what the problem is.' (P2, Fcg 3)
Dragonas et al. (1998:130-133) highlight that antenatal preparation provides an opportunity to confront psychosocial problems and offer psychosocial support.
Participants in all groups agreed that psychosocial assessment and psychosocial care should be included within routine antenatal care:
'Yes, I think it should be part of antenatal care … only if the ratio of staff and patients is corrected, because it will be easy for us to identify the risk on time and to manage or intervene.' (P4, Fcg 1).
'To add on that it is important for us to ask about the psychosocial problems it's for me to understand if the pregnancy was planned ... if it was unplanned, the woman might develop conditions like hypertension.' (P4, Fcg 3)
The implication was that psychosocial risk assessment is done to a limited extent:
'… I think we need to do more as part of the assessment … it does have to be more specific than what we are already doing … we are already identifying some problems … we can ask some more ... and then refer for further help.' (P5, Fcg 2)
Psychosocial assessment was considered time consuming by the participants:
'I think it is important but if a person has to be allocated for psychosocial care, you need somebody who can sit with them for hours because there are many problems now.' (P4, Fcg 2)
A reflection on staff shortage:
'It can be done, eh, there might be a challenge of the number of staff against patients because you have to give full attention to that person when she talks.' (P3, Fcg 1)
'Staff is really very, very low ... it's true if we can be more, we can attend to the women.' (P1, Fcg 1)
Common psychosocial problems that were encountered by participants
Participants provided a narrative account of their experiences of psychosocial care for pregnant women. The stories were then analysed in terms of common problems encountered, which were women suffering from HIV and not coping with the condition, unemployment, a lack of accommodation, a lack of family support, smoking, alcohol consumption, unplanned pregnancy, teenage pregnancy and poverty.
Interventions used to manage problems
Regarding the interventions that midwives took once a psychosocial risk was detected, participants described a situation which presented a particular psychosocial problem, explained the action taken and related the outcome of the interaction, as is reflected in Table 2. The stories were analysed by viewing their relevance to a psychosocial problem and the resulting intervention.
The actions that the midwives took once a psychosocial risk was identified were: listening to the woman attentively; giving women options such as termination of pregnancy and adoption; encouraging family involvement; and advising women on applying for social support grants.
The common resources and options available for further care once a psychosocial problem was identified were considered to be: social services, psychologists, termination of pregnancy services, adoption and referral for antiretroviral therapy (ARV) for those who were HIV positive with a low CD4 count.
Barriers to the provision of psychosocial assessment and care
Participants described the obstacles to the implementation of psychosocial assessment and care in the next segment.
Lack of experience and inadequate training on psychosocial care:
'… we have got a lot of patients with psychosocial problems, then for me personally I find that I am helpless and get frustrated because we cannot change that or we cannot sometimes assist.'(P1, Fcg 2)
Staff shortage and work overload resulting in an average midwife: woman ratio of 70:3; the increased number of pregnant women, specifically teenagers, who need special attention; overpopulation of antenatal clinics by foreigners; lack of consultation rooms and the view that social services were inactive; women often not opening up, probably fearing discrimination by midwives or victimisation by partners:
'... you find that you have a client, you want to help in every possible way, you have the resources, but the patient does not want to accept your help, that is a problem, you want to assist[emphasising], you want to refer [emphasising], you know you want to do all the possible things, but the patient is not just willing to accept your help … you would like to refer to a social worker, the only way is to refer, now she knows that the social workers will come to her home and she will be exposed, because she is staying with this man, so whatever she is to be helped with, the man should not be aware of …' (P1, Fcg 3)
Foreign language and women with speech and hearing disabilities; women who communicate through sign language to midwives who are not able to understand them, which often leads to poor antenatal history-taking, as is stated in the following:
'The checklist is fine but there would be those problems of language, not just ShiVenda or Siswazi, but even sign language [stressed]. Nurses were not schooled for sign language; you get a dumb-and-deaf patient, who cannot read or write, so now you have this checklist again, how would you communicate now.' (P1, Fcg 3)
'Clarity, some speak French, they can't speak English, we expect people from Malawi to speak English, we do sign language but it's a challenge, so history taking, psychosocial assessment is a challenge [laughing and giggling].' (P2, Fcg 1)
Regarding the shortage of midwives, a study on Zambian women's perception of antenatal care by Menon et al. (2010:361) concluded that overcrowding and pressure of work experienced by midwives cause stress, which may lead to them being less sensitive to the psychosocial needs of women, which could be a factor in this study.
Furthermore, participants cited a lack of formalised guidelines for psychosocial assessment and lack of a standard tool to record the information as the antenatal card is non-specific and, as such, the focus is mostly on medical conditions, as reflected by the following response:
'There must be a tool because on the green card is just a small line, it's not written clear, just says "social", therefore we ask the question "are you working?". If she says yes it's OK and if she says no, we ask her who is supporting her. If she says my mother, you write "mother supportive"… if there was a guideline regarding what to do. The green card says social, it does not say psychosocial, as such, each midwife records what she feel is appropriate.' (P1, Fcg 3)
Participants further reflected on the column that states 'social' on the Gauteng standardised antenatal card and the fact that it does not specify what of social and does not include psychological factors. 'With a checklist, I think we would be made aware of the things that we normally don't ask' (P1, Fcg 3). 'Even if it cannot be implemented now, is for the future, let it be incorporated into antenatal care, even if it can be how small it will make a difference ... to say what type of questions to ask' (P2, Fcg 3).
The social service resources were also reported as being dysfunctional:
'I have been listening to ourselves, we have been saying refer to the social worker, you know we have a problem with the social welfare, it's so bad ... unfortunately our provincial social worker is just not effective, not at all, therefore we rely on the non-government organisation to help us ... the structure is there, but the availability of the social worker, the person, it's aperson! [emphasised] [A] human resource, do you understand, the structure is there, this is social service…but when you go to that office you won't even get any help, it sometimes end on us to deal with those things, with the social issues of the patient.' (P1, Fcg 2)
Ethical considerations
Ethical approval was obtained from the University of Witwatersrand Human Research Ethics Committee (protocol number M081013). Permission was sought from the Provincial Health Department and from the clinics and the unit managers where interviews were conducted. Each participant was provided with sufficient and understandable information regarding the research in order for them to make a voluntary informed decision to participate. Participants signed the consent form before data were collected. Confidentiality and anonymity were ensured throughout by protecting the participant's identity and privacy when reporting the findings. The use of a skilled moderator and assistant moderator, welcoming of participants and an overview of the topic, ground rules which included that one person to speak at a time, listening respectfully to one other and emphasising that all participants need not agree with each other and the use of a moderator to keep the group focused, were adhered to throughout the discussion as the principles of focus group discussions (Franz 2011:1381-1383; Kruger 2002:1-7).
Lincoln and Guba's model, as described by De Vos et al. (2009:345-347), was utilised in order to ensure trustworthiness. Trustworthiness is based on how representative the description is and how justifiable the findings are. Neutrality was enhanced by direct involvement of participants in negotiating the truth through subjective accounts of personal experiences, and meanings of reality from each participant's perspective, until saturation was reached. Credibility was justified through member checking by conducting follow-up interviews with two members from each of the three groups interviewed and peer review was managed through the study being supervised by an expert in qualitative research methodology and midwifery. Data were analysed by an independent coder who is an expert in qualitative research methods and midwifery, using previously agreed-upon coding criteria in order to validate themes, which ensured consistency and dependability on audit. Transferability was enhanced by providing a thick description of the research process and respondent validation through the comparison of commonalities of responses from the different groups (Pope & Mays 2000:94-97).
The concept 'psychosocial; seemed to be a familiar concept for participants.The findings indicated that midwives understood and considered psychosocial care during pregnancy as an important part of antenatal care. A comprehensive assessment, which includes the physical, social and psychological aspects, is reflected within the participants' responses in Table 1.
Although participants reported a lack of formal guidelines or a tool for psychosocial care, psychosocial interaction amongst midwives and pregnant women usually occurred through empathetic perception and intuition, often in a subtle way. The assessment and support that midwives offered at the clinics, as reflected in Table 2, could, to a reasonable extent, have assisted in minimising the impact of psychosocial problems or risks on pregnant women. This is in keeping with the findings of Joseph et al. (2009:1058), who reported that a clinic-based psychosocial intervention significantly reduced psychosocial and behavioural risk factors amongst African American women during antenatal care. Listening to the woman attentively is regarded as being the appropriate first step in offering support as it allows the woman to express the problems that she is experiencing. Through attentive listening, women can be motivated to discuss the issue and, if indicated, seek further help. The results of a randomised study by Lavender and Walkinshaw (1998:217) revealed that the most effective psychosocial care includes listening, support, counselling, understanding and explanation, all of which seemed to have been applied by midwives in this study.
Most authors (Carroll et al. 2005:257; Fawole, Okunlola & Adekunle 2008:1052; Minnaar & Bodkin 2009:14; Namagembe 2007:1-2; Walker, McCully & Vest 2001:146; Willinck & Schubert 2000:10-11) recommend psychosocial care as part of routine antenatal care. The prenatal care guidelines in Group Health Incorporated Organisation (2008), also recommended that psychosocial assessment should be performed either by being included in the overall risk assessment or as a separate tool. Women should be screened for social, psychological and emotional risks, substance abuse, sexual abuse, economic status and domestic violence. The National Action Plan 2008-2010 of the beyondblue Perinatal Mental Health Consortium (St John of God Health Care n.d.) also recommends universal routine psychosocial assessment. Its strategic objective was to identify and develop a quality framework for universal implementation of routine psychosocial assessment in the perinatal period. However, little progress has been made in this regard at this stage.
Willinck et al. (2000:10-11), in a study regarding psychosocial risk assessment, concluded that psychosocial problems are prevalent during pregnancy. Furthermore, the study has also shown that the introduction of systematic psychosocial assessment during the antenatal booking visit was acceptable practice for women and midwives as it also improved the identification of psychosocial problems.
Namagembe (2007:1-2) highlighted that the experienced psychosocial problems may have an indirect influence on the woman's coping ability and may aggravate the physiological adjustment to pregnancy. Minnaar and Bodkin (2009:12-14), in a study on exploring bereavement and grief in HIV-positive pregnant women, led to a finding that women went through emotions such as denial, anger, bargaining, depression and acceptance. This response is supported by a randomised controlled trial amongst midwives and obstetricians that examined the effectiveness of the Antenatal Psychosocial Health (ALPHA) tool, revealing that 86% of respondents would use the tool as a standard practice to assess pregnant women psychosocially (Matthey 2005:268).
The conclusion and recommendation of the randomised controlled trial was that over and above the standard HIV programme, midwives should allow and encourage women to share their feelings, provide counselling, support women and offer care based on individual needs. As stated by the Royal College of Midwives (2000:224), legislation enables midwives to provide holistic care during pregnancy without recourse to other health professionals, which is also the situation within the South African context, as the South African Nursing Council Midwifery Regulations (South African Nursing Council 1984) allows midwives to assess women psychosocially. This is evidenced by the inclusion of the psychosocial aspect within Regulation 2598 of 1984 (Scope of Practice for Registered Midwives) as amended, as indicated by concepts such as optimum mental health, counselling of individuals, monitoring trauma, stress and anxiety, an environment that promotes the mental health of the mother, advocacy, coordination of care and referral of the women.
Limitations of the study
Some information might have been withheld by participants who were reluctant to share their perception of psychosocial care in the presence of colleagues. The fact that the researcher is also a midwife could have contributed to participants being uncomfortable in sharing information.
From the findings, it was evident that psychosocial problems exist during pregnancy, with HIV contributing significantly. Midwives displayed an awareness of psychosocial risks as they encounter them on daily basis. Midwives regard psychosocial assessment as an important aspect in caring for pregnant women and are willing to assess women psychosocially. However, they feel that they are not adequately equipped to do so for various reasons, for example a lack of guidelines or a tool to assess women psychosocially. The resources for referral for psychosocial care were also reported to be inadequate. The general finding of this study provides a basis for incorporation of psychosocial care into routine antenatal care.
Midwifery practice
The Gauteng antenatal card used for routine antenatal care focuses on the physiological aspects of pregnancy and provides only a small column titled 'social'. In addition to physical care, the antenatal booking history should also focus on psychosocial risks in order to identify women who need specialised supportive care. Psychosocial assessment can be done informally by asking the woman how she is feeling and whether she has any concerns, either currently or expected when the baby is born. Any response that indicates possible stress should be taken seriously, and appropriate support or intervention should be offered to the woman. The progress report column of the Gauteng Province antenatal card can be used for recording psychosocial factors, as the space assigned for social problems is inadequate.
Midwifery education
Psychosocial assessment and psychosocial care during pregnancy should be emphasised in the curriculum for midwives. In-service training on psychosocial care should be regularly offered to midwives.
In response to the findings of the focus group discussions, clinical guidelines for use in psychosocial risk assessment and psychosocial care need to be formulated.
The authors thank the midwives who willingly participated in the focus group discussions, the University of Witwatersrand for financial support and Jennefer Hesk for language editing.
Competing interests
The authors declare that they have no financial or personal relationship(s) which may have inappropriately influenced them in writing this article.
Authors' contributions
J.M.M. (University of South Africa) collected data, conducted data analysis and compiled the manuscript. A.R.R. and G.L. (University of the Witwatersrand) assisted with data analysis and made conceptual contributions.
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Johanna Mathibe-Neke
PO Box 87205, Houghton 2041
South Africa
Received: 16 Apr. 2013
Accepted: 29 Nov. 2013
Published: 22 May 2014


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Arrowmont workshop—a great learning experience!Posted: August 16th, 2012 | Filed under: Art excursions near and far, In the studio, Inspirations | No Comments »
This summer I spent two weeks attending a workshop at Arrowmont School of Arts and Crafts, taught by wonderfully talented potter Lana Wilson. It covered hand-building techniques, plus Lana's crazy cool slip decorating methods. We also had the treat of a guest artist for a couple of days, so we got some instruction from Sandi Pierantozzi, one of my absolute favorite potters ever!!
The best part of the whole workshop (where I learned to make several new pieces, including beautiful hand-built bowls!) was watching the contrast between Sandi's and Lana's work styles. Funny woman Lana calls herself "the queen of low standards," which you certainly can't tell if you've ever seen her work, but means she doesn't stress over each seam and rim, and also just kind of likes to see what happens when, say, you slam the clay on the table 10 times. Sandi is more of a perfectionist, paying careful attention to measurements, angles, and symmetry in each piece. But both artists love texture and surface decoration (as do I!), and both produce stunning work, just with different ways of getting there. They were also charming, funny, and seemed genuinely delighted to share with us their experience and techniques, making the workshop a wonderfully comfortable learning environment—and making me energized and excited to create new work with all my new skills!


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