text:
cataract is a painless, cloudy area in the lens of the eye that blocks the
passage of light to the retina. The retina is the nerve layer at the back of
the eye. The nerve cells in the retina detect light entering the eye and send
nerve signals to the brain about what the eye sees. Because cataracts block
this light, they can cause vision problems.
Aging and exposure to
sunlight can cause cataracts. Changes in your eyes are often a normal part of
aging. But the changes do not always lead to cataracts.
Cataracts can
also happen after an eye injury, as a result of eye disease, after you use
certain medicines, or as a result of health problems such as
Sometimes children are born
with cataracts.
Cataracts can affect your
The vision loss from a cataract often happens slowly
and may never become severe. Sometimes cataracts do not cause any vision problems.
Your doctor can find
out if you have cataracts by doing a physical exam and by asking questions
about your symptoms and past health. You may need tests to make sure you
have a cataract or to rule out other conditions that may be causing vision
Surgery can remove cataracts. For most adults, surgery is only needed when vision
loss caused by a cataract affects their quality of life.
There are a number of things you can
do that may help you manage your vision problems. Many people get along very
well with the help of eyeglasses, contacts, or other vision aids. Keep your
eyeglasses or contact lens prescription up to date. Also make sure you have
plenty of lighting in your home. You may be able to avoid or delay
Whether you need cataract surgery depends on how much of
a problem the cataract causes for daily activities like driving and reading.
Surgery is almost always by your choice (elective) and can be scheduled when it
is convenient. For people who decide to have surgery, the surgery usually
works very well.
Some people have to have surgery. Children are
sometimes born with cataracts that need to be removed. Other people may get
cataracts after an eye injury or as a result of eye disease or other health
problems. Cataracts from these causes may also need to be removed.
There is no proven
way to prevent cataracts. But there are some things you can do that may help
slow cataract growth. Don't smoke. Wear a hat or sunglasses when you are in
the sun. And avoid sunlamps and tanning booths. Eat healthy foods. And keep diabetes under control.
Learning about cataracts:
Being diagnosed:
Getting treatment:
Ongoing concerns:
Living with cataracts:
Health Tools help you make wise health decisions or take action to improve your health.
cataract occurs when the lens inside your eye becomes
cloudy. Things linked to clouding include:
Not all
cataracts impair vision or affect daily living. For
those that do, common symptoms include:
Parents need to watch for
signs of cataracts in infants and children.
Cataracts may
stay small and you may not notice them. They often do not seriously affect
vision. And many cataracts do not need to be removed.
cataracts grow larger or denser over time, causing severe vision
As a cataract progresses, more of the lens becomes cloudy.
When the entire lens is white, the cataract is called a "ripe" or "mature"
cataract and causes severe vision problems. Delaying surgery until cataracts
are ripe or mature is neither recommended nor needed.
Cataracts in children are rare but serious. If a cataract prevents light from
entering a child's eye and stimulating the retina, the area of the brain used
for sight does not develop properly. Usually the child won't see well with
that eye (amblyopia), even if the cataract is later
Things that increase your risk for
cataracts include:
Some chronic diseases increase the risk for cataracts.
Keeping these diseases under control may help lower your risk for
Other things that may increase your risk include:
Call your doctor right away if you have:
Call your doctor to discuss your symptoms if you:
If you are an older adult, discuss with your doctor how often you need to have routine eye exams. For more
information, see the topic
Vision Tests.
If a doctor has
not determined that you have cataracts but you have symptoms that concern you,
see the topic
Eye Problems, Noninjury to find more information on what to do about your
Watchful waiting is a wait-and-see approach.
Watchful waiting is safe and appropriate in most cases of adult cataracts. If
you notice signs that your baby or child may not be seeing well, see your doctor. Cataracts in
children should be treated right away.
Speak with an
ophthalmologist about surgery to remove cataracts. In
most cases, you can decide if you want or need surgery based on whether vision
problems caused by the cataract are interfering with your daily
The following health professionals can evaluate
vision problems that may be caused by a cataract:
While other doctors may be able to detect
problems that may be caused by cataracts, only an ophthalmologist can treat
An ophthalmologist can help with the decision to have
surgery and can do the surgery, if needed.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Diagnosis of
cataracts is based on a
medical history and
physical exam.
Often tests are used
For more information, see:
When you are deciding whether to have
surgery, you may find it very helpful to evaluate the effect that vision loss from a
cataract has on your life. Your doctor may ask you to complete a questionnaire
regarding the effect of the cataract on your daily activities.
If you
already have some vision loss that cannot be corrected by cataract
surgery, your doctor may do a
low-vision evaluation to help find ways for you to
make the most of your remaining vision and to keep your quality of life.
During routine
eye exams, your eye doctor will look for early signs of vision
problems, including cataracts.
Testing your child for cataracts may be needed if
you think your child is having a vision problem.
Surgery is the only
effective method of treating vision loss caused by
Cataract surgery is a common
procedure that involves removing the clouded lens of the eye (the cataract).
The lens makes it possible for the eye to focus. The lens can be replaced with an artificial
lens called an
intraocular lens implant (IOL). Sometimes an IOL is not used, and eyeglasses or contact lenses can compensate for the lens that is removed.
Surgery is often not needed or can be delayed for months or years.
Many people with cataracts get along very well with the help of eyeglasses,
contacts, and other vision aids.
The choices for
treating cataracts in children depend on how likely
the cataracts are to interfere with the development of normal vision.
Whether surgery is needed for an adult with cataracts depends on the
degree of vision loss and whether it affects quality of life and ability to
Sometimes a cataract needs
to be removed because of another eye disease, such as
diabetic retinopathy or
macular degeneration. In some cases the cataract has
to be removed so that the eye specialist can treat the retina, the nerve layer
at the back of the eye.
Misconceptions about cataracts are common.
More and more medical centers have been built specifically
for cataract surgery. Marketing campaigns aimed at older adults may encourage
some people to have surgery when they do not really need it. Because of fear of
blindness or loss of independence, older adults may think they need to have
surgery even when their cataracts do not affect their quality of life. In many
cases, wearing eyeglasses or contacts and using other vision aids might be
appropriate and just as effective without any of the risks of surgery.
Only you can decide whether a cataract is affecting your vision and your
life enough to have surgery. If surgery is not going to improve your vision,
you may decide that surgery is not for you.
There is no proven way to prevent
cataracts. But certain lifestyle habits may help slow
cataract development. These include:
For more information, see the
If you have
cataracts, these tips and vision aids may help you
manage your vision problems and avoid or delay surgery:
Evidence shows that making certain lifestyle changes
such as not smoking and protecting your eyes from sunlight may help slow the
development of cataracts.
Your doctor will give you
instructions about what to do after cataract surgery.
Eye care for adults after cataract surgery includes using prescribed
eyedrops, protecting your eye, and watching for signs of infection.
Contact your doctor promptly if you notice any signs of complications,
such as:
It is normal to have blurred vision and some swelling
after surgery. It takes time for the swelling to go down. Your eyeglass
prescription may change after surgery.
A small number of adults and children with
cataracts may benefit for a short time from eyedrops
that widen (dilate) the pupil. These eyedrops increase the amount of light
getting into the eye. They are sometimes used to help prevent
vision loss in very young children who need to wait for surgery to be done.
There is currently no medicine
that will cure cataracts.
Surgery for cataracts involves removing the clouded lens of the eye
(the cataract). The lens can be replaced with an artificial lens called an
intraocular lens implant (IOL). Or, if an IOL cannot be used for any reason, it
will be left out and contact lenses or, in rare cases, eyeglasses can compensate for
its absence. Most people will get an IOL during surgery.
surgery, ask your doctor about what types of IOLs can go in your
eye. Or, if you will not be getting an IOL, ask
about the pros and cons of contact lenses or eyeglasses.
For most adults, surgery is only needed when vision
loss caused by a cataract affects your quality of life. The goals of surgery in
adults who have cataracts include:
The choices for
treating cataracts in children depend on how likely
the cataracts are to interfere with the development of normal vision. Surgery for
cataracts in children may be needed.
For adults who have cataracts in
both eyes, surgery is not normally done on both eyes at the same time. The
first eye needs to heal. Then your doctor will determine how much eyesight has
improved before surgery is done on the second eye.
If you have both
glaucoma and cataracts, you may have
surgery for both conditions at the same time.
Depending on which condition caused the vision loss, vision may improve after
There are two types of
cataract surgery. They are both done in an
outpatient center. The decision about which
one to use depends on what kind of cataract you have and how much experience
the surgeon has with each type of surgery.
In the past, cataracts were removed by
intracapsular surgery in which the entire lens and
lens capsule were removed. Intracapsular surgery is rarely, if ever, used
today. It is more difficult and has a higher rate of complications than
extracapsular procedures.
The most common problem after cataract surgery is clouding of the posterior lens capsule
(called aftercataract) within 5 years after surgery. This clouding is
usually not a serious problem. And it is easy to treat with a laser surgery
(Nd:YAG laser posterior capsulotomy) if it occurs.
For adults, cataract surgery is
almost always elective and can be done at your convenience. The surgeon, or
someone familiar with routine surgical practices, will usually be available for
any follow-up exams and treatment.
Surgery may be advisable if you want to continue to
drive a car. If you live in a retirement home or assisted-living facility, you
may decide to use vision aids and avoid surgery.
If you do not have another eye
condition, such as glaucoma or problems with your
retina, your chances of seeing better after cataract
surgery are very good. But you may still need reading glasses or glasses for
near vision.
Just because you have a cataract doesn't mean you
need to have it removed. Only you can decide whether cataracts are affecting
your vision and your life enough for you to have surgery. Learn
what to ask about cataract surgery before deciding whether to have the
The Eye Surgery Education Council website can help patients and families make decisions about eye surgery. The Council was started by the American Society of Cataract and Refractive Surgery.
EyeCare America is a public service program of the
Foundation of the American Academy of Ophthalmology. This site aims to raise awareness about
eye diseases and eye care. It has information about eye conditions, treatments, and general eye health. You can check to see if you qualify for a free eye exam.
As part of the U.S. National Institutes of Health, the National Eye
Institute provides information on eye diseases and vision research.
Publications are available to the public at no charge. The Web site includes
links to various information resources.
This website for older adults offers aging-related
health information. The website's senior-friendly features include large
print, simple navigation, and short, easy-to-read segments of information. A
visitor to this website can click special buttons to hear the text aloud, make
the text larger, or turn on higher contrast for easier viewing.
site was developed by the National Institute on Aging and the National
Library of Medicine, both part of the National Institutes of Health
(NIH). NIHSeniorHealth features up-to-date health information from NIH. Also,
the American Geriatrics Society provides independent review of some of the
material found on this website.
Prevent Blindness America assists the visually impaired
and provides consumer information on vision problems and vision aids.
Its website has information about eye health and safety for children
and adults. Many states have local affiliates.
Other Works ConsultedAwasthi N, et al. (2009). Posterior capsular opacification. Archives of Ophthalmology, 127(4): 555–562.Harper RA, Shock JP (2008). Lens. In P Riordan-Eva, JP Whitcher, eds., Vaughan and Asbury's General Ophthalmology, 17th ed., pp. 170–178. New York: McGraw-Hill.Long V, et al. (2007). Surgical interventions for bilateral congenital cataract. Cochrane Database of Systematic Reviews (1).Wright KW (2008). Pediatric cataracts section of Leukocoria: Cataracts, retinal tumors, and Coats disease. In Pediatric Ophthalmology for Primary Care, 3rd ed., pp. 286–300. Elk Grove Village, IL: American Academy of Pediatrics.
Next Section:
Previous Section:
Last Revised:
August 24, 2011
Healthwise Staff
Medical Review:
Adam Husney, MD - Family Medicine & Carol L. Karp, MD - Ophthalmology
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.


text:
Apple chief Tim Cook: iPad 'not an expensive product'
APPLE'S chief executive Tim Cook has insisted the iPad "isn't an expensive product", as the firm prepares to do battle with much cheaper tablets from Amazon and Google this Christmas.
In a magazine interview to mark his first year in charge of Apple, Mr Cook said the iPad, which starts at £269 (€333) for a Wifi-only iPad mini, was a "fair price", despite being undercut by Amazon's Kindle Fire HD and Google's Nexus 7, which both start at £159.
"A great product doesn't mean an expensive product. It means a fair price," Mr Cook told Bloomberg BusinessWeek.
"The iPad mini is all the way down to $329. This isn't an expensive product.
"What we wouldn't do is say, 'We've got to have something for this price, and then let's see what we can do for it.'"
The 52-year-old was spotted this week visiting Apple's flagship British retail store in Covent Garden amid the Christmas shopping rush.
Twitter: mattlarge - Just spotted Tim Cook being shown around Covent Garden Apple store http://t.co/QSp9VJko
His comments are a response to investor disappointment that the iPad mini was not more aggressively priced to address the threat from rivals. Apple shares dipped when the 7.9-inch tablet was unveiled last month.
Android tablets have made significant inroads into the tablet market in terms of sales, Mr Cook admitted, but he highlighted third party web traffic data that show iPads appear to be used much more.
"Certainly the data that I'm seeing suggests - and this is all third-party data - that over 90 percent of the Web-browsing traffic from tablets are from iPad," he said.
"Since these statistics do not correlate with unit sales, it suggests to me that the iPad user experience is so far above the competition.
"The iPad has become a part of their lives, instead of a product that they buy and place in a drawer."
He claimed that the experience of using Android tablets, usch as Samsung's Galaxy range, and Microsoft's new Surface, still does not match the iPad.
"[I have used] both of those - and some others," said Mr Cook. "What I see, for me, is that some of these are confusing, multiple OSs [operating systems] with multiple UIs [user interfaces]. They steer away from simplicity."
During Mr Cook's first year as Apple's permanent chief executive the firm has introduced an array of new products, including an updated iPhone, iMacs, iPods and MacBooks, as well as the iPad Mini. Its stock has risen by more than 40 per cent since he took over.
There have been missteps, however, including the embarrassment of Apple Maps, the replacement for Google Maps in iOS6, which was blighted by innacutrate and missing data. Mr Cook admitted Apple "screwed up", but denied it put its rivalry with Google ahead of customers' interests.
"We're putting all of our energy into making it right," he said.
"And we have already had several software updates. We've got a huge plan to make it even better. It will get better and better over time. But it wasn't a matter that we… decided strategy over customers. We screwed up. That's the fact."
This evening he will appear in a second interview, recorded for American television. According to details released by the broadcaster, NBC, Mr Cook will offer new hints about Apple's long-expected move into the living room.
"When I go into my living room and turn on the TV, I feel like I have gone backwards in time by 20 to 30 years," he said. "It's an area of intense interest. I can't say more than that."
He will also say that some new Mac computers will be manufactured in the United States, after Apple came under fire in the American media for creating more jobs in China than at home.
Christopher Williams Telegraph.co.uk

subset: commoncrawl


text:
Disulfiram changes the way your body breaks down (metabolizes) alcohol. If you drink alcohol while you
are taking disulfiram, you will experience uncomfortable symptoms, including
severe nausea, vomiting, and headache. These symptoms discourage you from
drinking alcohol by making it unpleasant.
Disulfiram is used to treat alcohol
dependence. It is most helpful if you are motivated to
stop drinking and are willing to take the medicine under supervision. Medicines
are not typically used alone to treat alcohol abuse or dependence. The best
treatment is a combination of medicine and
The effectiveness of disulfiram varies. When taken as directed, it
can help you completely stop drinking by increasing the number of days you go
without a drink.1 It works best if you are motivated
to stop drinking and you take the medicine as directed. Disulfiram is used less
often than some of the newer medicines (naltrexone, acamprosate), because it
might damage the liver.
The effects from disulfiram are intentionally unpleasant to help
encourage you to remain sober. Disulfiram causes the following effects when you
drink alcohol, with effects lasting from 30 minutes to 2 hours.
When you take disulfiram and do not drink, the main effect is
drowsiness. Use caution when you drive or operate machinery while taking this
In rare cases, disulfiram can cause abnormal liver function and
numbness or tingling in your hands or feet.
You should not take disulfiram if
See Drug Reference for a full list of side effects. (Drug Reference
is not available in all systems.)
You take this medicine every day for a period of weeks or longer,
until you overcome your craving for alcohol. Disulfiram should not be taken
within 24 hours of drinking alcohol. Disulfiram stays in the bloodstream for up
to 2 weeks after the last dose. Uncomfortable symptoms will develop during this
time if you drink alcohol.
While taking disulfiram, you cannot take medicines or use
substances that contain alcohol (such as cough syrups, liquid medicines
containing alcohol, mouthwashes, and wine vinegars). This will cause the same
effects that occur when you take alcohol.
Several medicines, including seizure medicines, interact poorly
with disulfiram. Be sure your doctor knows all the medicines you are taking
before you try disulfiram.
You might want to ask friends or family to help you take disulfiram
as directed until you feel confident about taking it on your own.
You might need liver function tests before and during the time you
take disulfiram.
You will need to carry an identification card or wear a medical
alert bracelet while taking disulfiram.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
CitationsDepartment of Health and Human Services (2009). Incorporating alcohol pharmacotherapies into medical practice. Treatment Improvement Protocol (TIP), Series 49 (HHS Publication No. SMA 09-4380). Available online: http://store.samhsa.gov/product/TIP-49-Incorporating-Alcohol-Pharmacotherapies-Into-Medical-Practice/SMA09-4380.
Last Revised:
January 18, 2012
Healthwise Staff
Medical Review:
E. Gregory Thompson, MD - Internal Medicine & Peter Monti, PhD - Alcohol and Addiction
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.


text:
We've mastered premium coverage, brilliant color and precise application with Krylon® ColorMaster™ Paint + Primer with durable Covermax® technology. The improved formula delivers the coverage of paint and primer in one can to achieve fast, superior results — even on plastic. The proprietary EZ Touch® conical spray tip is easy to operate and minimizes drips, runs, overspray and waste. ColorMaster dries in just 10 minutes to produce a smooth and flawless finish. It's the perfect solution for any project — indoors and out.Learn More
Krylon® Dual® Superbond® Paint + Primer features breakthrough technology, offering ultimate adhesion, maximum rust protection and easy application… all with less prep. It also has a proprietary formula that offers a high-adhesion, specialty primer to ensure top performance even on hard-to-adhere surfaces such as plastics, laminates and melamine. It also provides maximum rust protection without the need for a primer, while giving remarkable coverage, durability and corrosion protection. The two-in-one product preps the surface with no sanding or priming required. Dual Superbond provides top-tier performance on hard-to-paint surfaces in one simple step.Learn More
Krylon offers the perfect tool for outdoor painting needs with Rust Protector™ paint — hard-working, fast-drying, superior protection. Spray enamels dry to a smooth, durable, rust-fighting finish in just 8 minutes or less. That's up to 15x faster than the leading rust prevention competitor! The product adheres directly to metal surfaces and hardens to a tough finish that really lasts. Unbeatable dry time. Unbeatable performance. Available in today's most-wanted colors and finishes. A complete line of primers is available for added protection. Performance you don't have to wait for.™Learn More
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This 4-pin to 4-pin FireWire cable is used to transfer images and files between two FireWire compatible devices. Common uses are to connect a DV camcorder to a PC or DVR for downloading movies, or to connect an external hard drive to a PC. DV, FireWire, i.Link and IEEE 1394 are different names for the same cable type. Please see below for complete compatibility and specifications. FireWire FAQ
Price Each


text:
The Definitive Zombie Make Up and Costume Guide
Always wanted to know how to cast foamed gelatine moulds without scalding yourself? We've an online step-by-step howto on perfecting gelatine prosthetics for face and body.
Realistic gashes, cuts and wounds? Simply achieved with readily available ingredients - elmers glue, tissue paper, powder paint - or using store-bought makeup supplies - liquid latex, nose putty, fake blood, greasepaint. We give you the lowdown on how to get these effects.
Making your own blood? A range of recipes from the realistic (but inedible) to the tasty edible cranberry flavored gore.
How do you finish off the effect? We'll show you subtle or full-blown Romero Zombie makeup styles - just a hint of white zombie colors and a dark eyeshadow, to full green dripping gore with sunken eyes and depressed cheekbones.
What will you dress as? Nurse, Doctor, Lawyer, Sailor, Workman, School girl, soccer player, Rob Zombie's Dragula perhaps? Anyone is fair game who could have forgotten their zombie survival guide on the day the ghost train rolled into town and the Zombie Apocalypse took hold.
Finally, when you're out being a zombie, do you run or walk? Dawn of the dead Original, or Dawn of the Dead 2006. Are you quiet like in Night of the living dead or a noisy, brains-hungry monster like in "Return of the Living Dead", maybe even a wisecracking stiff, like Stubbs The Zombie? Here different Zombie regulars will share their favorite zombie acting styles.
So, what are you waiting for? Get started with either Zombie Makeup or refining your zombie character, or check out the list of materials


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Health Screening & Wellness Check-ups - Ho Chi Minh City
In our quest to achieve success, we often sacrifice our health. We may be so intent on work, school or personal matters that we fail to recognize the symptoms of serious illness or disease. Most people only visit the doctor when they feel that something is wrong. Unfortunately, the symptoms of some life-threatening conditions are all too easily missed. Many people have strokes or learn that they have cancer too late to receive treatment.
To fit into your busy life, Family Medical Practice offers a one-stop service—modern, comprehensive healthcare services and state-of the-art facilities—all in one place. These checkups are tailored to suit your age, sex, family history, personal risk factors and corporate requirements, including:
● Wellness checks with appropriate protocols for age and gender
● General health screening
● Pre-employment health screening
● Annual health checkups
● Immigration health screening for visa requirements
● School enrolment checkups
● Adoption screening
● Domestic staff screening
● Cardiology screening
● Occupational health consultancy and surveys
Should our doctors detect a threat to your health, they will advise you on treatments and ways to minimize your personal risks. Depending on the outcome of your check-up, you will be referred to a Family Medical Practice specialist physician who will do a complete evaluation of your medical issue and determine what the next actions for treatment are. This may include ordering additional tests, or prescribing medications if applicable.
Preventive medical checkups can identify potential diseases before they become life-threatening. The entire process takes around two hours—a short time for obtaining peace of mind.
● Thorough physical examinations
● Patient history assessments
● Laboratory testing, including tumor markers
● Comprehensive imaging services
● Radiology
● Ultrasonography
● Mammography
● 64-slice CT scanner
● Bone densitometry and body fat percentage
● Gastroenterology assessments
● Endoscopy & colonoscopy
● Cardiac assessments & consultations
● 64-slice CT scanner
● Echocardiography, Doppler
● Gynecology consultations
● Pap smear, ThinPrep Pap tests
● Mammography & breast exams
● Pulmonary function testing
Family Medical Practice is the designated medical center to conduct medical checkups for visa applications to the top counties of choice, these include:
● Canada
● United Kingdom
● Germany
● Belgium
Our accredited panel of doctors conduct medical check-ups required for student, tourist, and permanent resident/immigration visas. The service is available at all three of our medical centers in Ho Chi Minh City (Care1), Danang, and Hanoi. It takes about 90 minutes to complete your checkup, and Family Medical Practice will directly process your completed application to the relevant consulate of the country to which you are applying for a visa.
Family Medical Practice recommends pre-employment health screening and annual health checkups for all domestic employees—including maids, nannies, cooks, cleaners, tutors, guards and drivers. For more information about these customized packages, please contact your nearest medical center.
For health checkup appointments in HCMC, please contact Care1:
91 Nguyen Huu Canh, The Manor 1, Binh Thanh Dist. Tel: (84 28) 3514 0757
In Hanoi, call Care24 or click here.
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- [Saigon Times] Emergency Medical Response Center in the offing
- [Word] New Emergency Medical Response Center Passes First Test
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- [Hanoi - March 2018] FMP Hanoi takes care of your wellbeing on Women's day
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- [Hanoi] Departure announcement for Dr. Elisabeth Blanchi
- Holiday Notice: Christmas 2017 - New Year 2018
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- To your health: Food first: How to fine tune your body
- Head Lice
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- Autism - A lonely world
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- [Hanoi] New Doctors: welcome on board; Dr. Shushunov and Dr. Nalpas & Glad you are back: Dr. Elisabeth
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- [HCMC] Notice on Public Holiday - April 2016
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- Dr. Masato Okuda joined HCMC FMP Team
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- Dr. Jonathan Health Talk at ABC IS
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- Dr. Jonathan Halevy, MD: Pediatrician
- Thank you message to Dr. Jonathan Halevy
- Routine working hours change at FMP Hanoi
- ASEAN Quality Goods & Services - 2014
- School health check-ups service
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- Specialist Gynecology Services starting at HCMC Medical Center in November
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- Dr Rafi Kot - The growth of medical facilities in Vietnam
- Dr. Rafi Kot was interviewed by BusinessWoman Magazine
- Family Medical Practice - Da Nang
- Family Medical Practice HCMC is medical sponsorship for FOBISIA Primary Games.
- Treatment For Skin Conditions at FMP HCMC
- The 10th Asia Pacific Travel Health Conference (APTHC 2014)
- Family Medical Practice received the license for the Carmel Hospital in HCMC
- Dengue Fever in Vietnam
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- Meningococcal Meningitis
- Autism Awareness Month
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- [Hanoi] Changes in FMP Hanoi Pediatric Services
- Nothing to Sneeze at
- Dr. Shoji & Dr. Mori's BIO


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Obstructive sleep apnea results from structural compromise of the upper airway and decreased muscle tone during sleep. Central sleep apnea is usually due to instability of the feedback mechanism of the body that controls respiration. While positional changes commonly affect the severity of obstructive sleep apnea, the effect of positional changes on the severity of central sleep apnea is less well known.
Zaharna M; Rama A; Chan R; Kushida C. A case of positional central sleep apnea. J Clin Sleep Med 2013;9(3):265-268.
Obstructive sleep apnea is characterized by repetitive partial (i.e., hypopnea) or total (i.e., apnea) obstruction of the upper airway with subsequent increased ventilatory effort (e.g., snoring, gasping, choking), resulting in cortical arousals and/or oxygen desaturations. Body position during sleep influences the frequency of apneas and hypopneas in 50% to 60% of individuals with obstructive sleep apnea (OSA).1–5 In such cases, the apnea-hypopnea index (AHI) is increased in the supine posture and reduced in the lateral posture. Positional sleep apnea is said to be present when there is a 50% reduction in the AHI during non-supine sleep.2,5,6
Central sleep apnea (CSA) is characterized by cessation of respiration due to repetitive lapses in ventilatory effort resulting in cortical arousals and/or oxygen desaturations. While positional changes commonly affect the severity of obstructive sleep apnea, the effect of positional changes on the severity of central sleep apnea has not been commonly described in the literature. Cheyne-Stokes Respiration (CSR), a specific form of central sleep apnea characterized by a cyclic crescendo and decrescendo breathing pattern, has been reported to be affected by body position during sleep.8–10 A recent study on patients with heart failure and CSR showed increasing severity of CSR in the supine position, with CSR becoming position-independent as cardiac dysfunction progressed.11
There are few reports in the literature of positional central sleep apnea in patients with no known cardiac history or congestive heart failure.12,13 We present a case of a healthy 29-year-old male with severe idiopathic central sleep apnea isolated to supine sleep that was successfully treated on continuous positive airway pressure (CPAP) therapy.
A 29-year-old male presented to his primary care doctor with a one-month history of fatigue. The patient is a shift worker and a truck driver, and he found himself tired and yawning while working. He also complained of occasional night time awakenings and snoring. The patient had not previously been seen by his primary care doctor, as he had always been healthy. A full physical examination and basic laboratory testing, including complete blood count, thyroid stimulating hormone, complete metabolic panel, lipid panel, and fasting blood sugar were normal. The patient had a slightly high blood pressure of 130/79 with pulse of 76. He was overweight with a BMI of 29. The patient was not on any medications and denied alcohol or illicit drug use. After a full medical and mental health history was obtained and appeared to be noncontributory, a sleep study was ordered.
The patient presented to our lab for a diagnostic polysomno-gram which showed the results reported in Table 1.
Results of diagnostic polysomnogram testing of patient present to the laboratory
(more ...)
Electrocardiography showed sinus rhythm with one premature ventricular contraction noted. There were no periodic limb movements or unusual behaviors noted, apart from occasional somniloqui. The patient was urged to return for an overnight CPAP and bilevel titration with servoventilation on standby in the event that central apneas were not effectively treated on CPAP or bilevel therapy. A positional pillow to avoid supine sleep was also recommended until positive airway pressure was initiated. (see Figures 1–3)
Central apneas in supine sleep on diagnostic polysomnogram.
Central apneas in supine sleep on diagnostic polysomnogram which resolved in lateral (left sided) sleep.
The patient returned for an overnight titration study. CPAP pressures of 5 to 18 cm water were tested. Bilevel pressures of 17/12 to 20/17 cm water were tested. Central sleep apnea dramatically improved on both CPAP and bilevel therapy in the supine and lateral position. A CPAP pressure of 14 cm water was recommended. A mean oxygen saturation of 96%, minimum oxygen saturation of 94%, RDI 2.7, and supine REM was observed at this pressure setting. A positional pillow was not used during the titration study (Figure 4).
Improvement of positional sleep apnea on CPAP and Bilevel therapy in both lateral and supine sleep.
The patient returned one month later for follow-up after using CPAP. Although he still experienced fatigue, download data showed effective treatment of his sleep apnea. Compliance data showed 100% of days with device usage, with an average of 7.5 h of usage per night. Therapy data showed an average residual AHI of 4.1 on CPAP of 14 cm water. Although download information was satisfactory, the presence of residual fatigue suggests that there may be residual respiratory events that were undetectable by the CPAP device. Although further testing was not pursued, a repeat titration study may have been considered at this point.
The patient was referred back to his primary care physician to evaluate further for possible underlying conditions; however, he denied any symptoms consistent with an underlying cardiac, renal, or neurologic condition. Further diagnostic testing had not been performed at the time of his sleep evaluation. An echo-cardiogram had not been performed, so further information on cardiac systolic and diastolic function, pulmonary artery pressure, and valvular problems was not available.
Positional sleep apnea is defined as greater than 50% reduction in the AHI between supine and non-supine positions. Sleeping position commonly affects the severity of obstructive sleep apnea. Specifically, sleeping in the supine position is associated with a worsening of obstructive sleep apnea and is more frequently seen in those patients with less severe OSA and smaller neck circumference. Worsening OSA in supine sleep is thought to be related to relaxation of muscles in the jaw and throat under the influence of gravity that cause narrowing of the airway.
Positional changes in central sleep apnea are less well understood and have mostly been documented in the literature in patients with Cheyne-Stokes respiration associated with congestive heart failure. There are only a few reports in the literature of positional central sleep apnea in patients with no known cardiac history or congestive heart failure. One study did show a change in sleep disordered breathing pattern from obstructive to almost all mixed and central apneas on both diagnostic and CPAP titration studies with change to supine sleeping position in 8 patients who had no cardiac history (one patients had a history of cerebral hemorrhage, and one had cerebral ischemia).12 Another study showed significant supine worsening of sleep apnea in patients with treatment-emergent central sleep apnea or complex sleep apnea both on CPAP therapy and adaptive servoventilation therapy (ASV).13 This case report showed idiopathic central sleep apnea in an otherwise healthy young man that was significantly worse in supine sleep. While CPAP therapy is not always helpful or even the first choice treatment in CSA, significant improvement in AHI was noted in our patient with CPAP pressures as low as 6 cm water during supine sleep. Treatment of central sleep apnea is generally based on the underlying cause. Central sleep apnea may be primary (idiopathic) or due to Cheyne-Stokes breathing (secondary to congestive heart failure, stroke, and possibly renal failure), positive airway pressure (i.e., complex sleep apnea), high altitude (i.e., > 4,000 meters), various medical conditions (e.g., brainstem lesion, cardiac or renal disorders), or drugs (e.g., opioids). In this patient, none of these potential causes were suspected or identified. Additionally, Cheyne-Stokes respiratory pattern and periodic breathing were absent on both the diagnostic and titration studies. Additional treatment options for central sleep apnea include other forms of positive airway pressure (i.e., servoventilation, bilevel PAP), supplemental gases (i.e., oxygen, carbon dioxide), medications (i.e., theophylline, acetazolamide), and correction of the causative etiology.
Sleeping in the supine position reduces cardiac output and increases venous return. Decreased cardiac output delays the transfer of blood gas information from the pulmonary capillary bed to the chemoreceptors and can lead to sustained fluctuations in respiratory output (i.e., central sleep apnea). Atrial pacing has been shown to reduce central sleep apnea in those with low cardiac output due to bradyarrhythmia.14 An increase in venous return could additionally exacerbate both diastolic and systolic dysfunction. This could result in an inability to reduce ventilation with carbon dioxide levels remaining near the central apnea threshold.
In addition to reducing cardiac output and increasing venous return, sleeping in the supine position can result in a reduction of both the functional residual capacity and the metabolic rate, which consequently enhances plant gain. Enhanced plant gain, which is defined as a large change in carbon dioxide levels relative to a small change in ventilation, is another proposed mechanism in the development of central sleep apnea.
The application of positive airway pressure in this patient could conceivably increase cardiac output and reduce venous return, improving arterial circulation time and reduces plant gain, which successfully normalizes ventilation.
The question must be considered whether this could be a mistaken case of obstructive sleep apnea. Given the worsening respiratory pattern in supine sleep, the lack of underlying causative etiology for CSA, absence of esophageal pressure manometry testing, normal wake baseline TcCO2 levels of 40-43 mm Hg, and the positive response to CPAP therapy, the possibility of obstructive sleep apnea cannot be ruled out. Although idiopathic central sleep apnea is usually associated with hypocapnia and this patient's TcCO2 levels were slightly elevated, it is not required. Eupneic patients with congestive heart failure may also have central sleep apnea. More important is the proximity of the central apnea threshold to the carbon dioxide level. Other features of central sleep apnea were evident on the patient's sleep studies, including improvement of respiratory events in REM sleep and clear flattening of the chest and abdominal belts even with an increase in sensitivity.
The present case suggests that positional changes in severity of central sleep apnea may be an important factor to consider. Many patients have difficulty tolerating current treatment options for CSA including CPAP, bilevel PAP, and servoventilation therapy. Positional pillows are often viewed by patients as a more tolerable alternative treatment of sleep apnea. Further research on the prevalence of positional CSA and exploration of positional therapy as a viable treatment option for CSA is needed. Although a positional pillow was recommended to this patient, he did not attempt positional therapy as a treatment option.
This was not an industry supported study. Dr. Kushida receives research support from Philips Respironics and ResMed through Stanford University. The other authors have indicated no financial conflicts of interest.
Oksenberg A, Silverberg DS, Arons E, et al., authors. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997;112:629–39. [PubMed]
Cartwright RD, author. Effect of sleep position on sleep apnea severity. Sleep. 1984;7:110–4. [PubMed]
Akita Y, Kawakatsu K, Hattori C, et al., authors. Posture of patients with sleep apnea during sleep. Acta Otolaryngol. 2003;550 suppl:41–5
Pevernagie DA, Shephard JW, authors. Relations between sleep stage, posture and effective nasal CPAP levels on OSA. Sleep. 1992;15:162–7. [PubMed]
Cartwright R, Ristanovic R, Diaz F, et al., authors. A comparative study of treatments for positional sleep apnea. Sleep. 1991;14:546–52. [PubMed]
Magalang UJ, Mador MJ, authors. Behavioral and pharmacologic therapy of obstructive sleep apnea. Clin Chest Med. 2003;24:343–53. [PubMed]
Oksenberg A, Silverberg DS, Arons E, et al., authors. Positional vs. nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997;112:629–39. [PubMed]
Oksenberg A, Arons E, Snir D, Radwan H, Soroker N, authors. Cheyne-Stokes respiration during sleep: a possible effect of body position. Med Sci Monit. 2002;8:CS61–5. [PubMed]
Sahlin C, Svanborg E, Stenlund H, et al., authors. Cheyne-Stokes respiration and supine dependency. Eur Respir J. 2005;25:829–33. [PubMed]
Szollosi I, Roebuck T, Thompson B, et al., authors. Lateral sleeping position reduces severity of central sleep apnea/Cheyne-Stokes respiration. Sleep. 2006;29:1045–51. [PubMed]
Joho S, Oda Y, Hirai T, et al., authors. Impact of sleeping position on central sleep apnea/Cheyne-Stokes respiration in patients with heart failure. Sleep. 2010;11:143–8
Issa FG, Sullivan CE, authors. Reversal of central sleep apnea using nasal CPAP. Chest. 1986;90:165–71. [PubMed]
Allam JS, Olson EJ, Gay PC, et al., authors. Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes. Chest. 2007;132:1839–46. [PubMed]
Garrigue S, Bordier P, Jais P, et al., authors. Benefit of atrial pacing in sleep apnea syndrome. N Engl J Med. 2002;346:404–12. [PubMed]
Nakao S, Come PC, Miller MJ, et al., authors. Effects of supine and lateral positions on cardiac output and intracardiac pressures: an experimental study. Circulation. 1986;73:579–85. [PubMed]


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I can certainly see that you are at a crossroads and will have to make some changes. I was not at all the perfect expectant mother, I should have exercised MORE. But, I always put you first, and made sure that you had an abundance of nutrition. - Sea Legs Mom
This made me feel terrible. What started out as what I perceived to be a healthy challenge (not gaining much weight), has turned into a source of concern for everyone around me, myself included.
So I ate quite a bit the last 5 days. And didn't weigh myself, thinking the weight would just come on naturally. But I was almost a whole pound lighter today when I finally stepped on the scale.
Never in my life did I dream I would have this problem. Usually weight is so easy for me to put on. But with my busy schedule and the terrible heart burn (and, yes, a crazy lingering fear of gaining weight), I guess I just can't do it.
Honestly, I have no fear that the weight will come, though. Things have just been a bit crazy lately with our work schedules. And SR and I have hardly seen each other. I actually had to skip dinner last night so we could go to bed together early before his 4:30 wake-up time.
He is over sleeping at the hospital right now. I miss him.
Thursday night and Friday we are going to a nearby state park. I can't wait.
I will leave you with a quote I heard yesterday on NPR (from a wise woman with a beautiful, androgynous voice):
There is nothing more than a human story. - Maya Angelou
Running song of the day: Gabriel by Najoua Belyzel


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Holy crap! Garindan rocks- I love the cartooney color scheme they used on him. Kind of bummed that they didn't give R5 a blown motivator or something. He looks identical to the TRU version.
Little boring as most of these are rereleases...although I love the vintage nods to Obi-Wan and Sandpeople
I still haven't and probably won't track down the Hoth chases...Hammerhead would be a must buy for me if they do him
Too bad they skimped on Luke's shirt deco- I wonder what his hair looks like under the hat?
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DA orders outside review of Jared Remy case
August 22, 2013
Boston Globe, by Travis Andersen
In an abrupt reversal, Middlesex District Attorney Marian T. Ryan named two veteran prosecutors Wednesday to conduct an outside review of her staff's handling of a domestic violence case last week against Jared Remy, who walked free after his arraignment, then allegedly killed his girlfriend the following evening.
Advocates for victims of domestic violence said they welcomed an independent review.
First Assistant Norfolk District Attorney Jeanmarie Carroll, a prosecutor for more than two decades, and Kevin Burke, a former Essex district attorney, will review factors that led to the recommendation that Remy be released without bail at his Aug. 14 arraignment, Ryan said.
Remy, who has a history of arrests for violence against women, is charged with fatally stabbing his girlfriend, Jennifer Martel, 27, last Thursday evening at the Waltham residence they shared. He is the son of Boston Red Sox broadcaster Jerry Remy.
"The death of Jennifer Martel is a horrific tragedy, and it would be irresponsible for our office not to reexamine what happened," Ryan said.
The announcement was an about-face from comments Ryan made Monday, when she rejected the idea of outside investigators in an interview with the Globe.
"The Middlesex district attorney's office is fully capable of conducting a review of our internal processes," she said at the time. Ryan was not available for comment Wednesday.
Asked about the reversal in light of Monday's comments, MaryBeth Long, a spokeswoman for Ryan, said, "What DA Ryan said was that we were going to do an internal review, and that's what we began in the immediate aftermath of this tragedy."
During the course of that review, Long said, the office determined that an independent probe was the best course of action.
"We want to be transparent, and . . . we want to make any changes necessary to better protect victims," she said.
Ryan has defended her office's decision not to seek to have Remy held after the alleged assault, saying that prosecutors recommended Remy's release with an order to not abuse Martel, based, in part, on a conversation prosecutors had with her and with Waltham police.
Remy had been released by a bail clerk Tuesday night after his arrest and was ordered to appear in court for an arraignment Wednesday morning.
A prosecutor also said in court last week they did not seek to have Remy held on bail after Martel "elected not to extend the restraining order and did not come to court on Wednesday morning."
Advocates for domestic violence victims generally applauded the independent review, although one questioned whether it would be truly independent.
"We applaud her decision to bring in two highly respected investigators to review the matter," said Martin W. Healy, chief legal counsel for the Massachusetts Bar Association, which had called for an independent probe.
Toni Troop, a spokeswoman for Jane Doe Inc., a statewide advocacy group for victims of domestic and sexual violence, also welcomed the announcement, but said the independent team would benefit from having a police representative and a domestic violence program advocate.
But Wendy Murphy, a former Middlesex prosecutor and prominent victims' rights advocate, questioned whether Burke and Carroll will be able to conduct a truly independent review.
"They're good people," Murphy said of the pair, adding "they really are what I would call establishment personalities."
"And when I hear the word independent," she said, "I think of a true outsider and someone who takes no prisoners."
Attempts to reach Burke and Carroll were not successful.
Murphy said that beyond the planned review, officials must enact systematic reforms to the justice system to protect victims.
Christopher Loh, a spokesman for Attorney General Martha Coakley, also hinted at the need for policy changes in a statement in which he described the outside review as an appropriate step.
"We also are continuing to look over the domestic violence laws and policies in the Commonwealth to determine what changes should be made to better protect victims," Loh said.
Sean Murphy and Todd Wallack of the Globe staff contributed to this report. Travis Andersen can be reached at email@example.com. Follow him on Twitter @TAGlobe.


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The Cleveland Browns' chaotic offseason got even crazier on Tuesday when they announced that CEO Joe Banner and general manager Mike Lombardi are leaving the team.
Wow. Browns announced CEO Joe Banner and GM Michael Lombardi are leaving team. Ray Farmer promoted to GM.
— NFL: AroundTheLeague (@NFL_ATL) February 11, 2014
The Browns fired coach Rod Chudzinski after the season, a move that surprised the NFL world and enraged the players.
After multiple candidates passed on the job in January, they finally hired former Bills defensive coordinator Mike Pettine.
Here's the full press release from the team:
BEREA, Ohio – The Cleveland Browns on Tuesday promoted Ray Farmer to General Manager and announced that Joe Banner will be stepping down in the next two months as he transitions out of his role as CEO.
Farmer will immediately take the over the team's football operations and lead the Browns during free agency and the draft.
Additionally, the team announced that General Manager Michael Lombardi is departing the organization. President Alec Scheiner will continue in charge of the organization's business operations. Owner Jimmy Haslam made the announcement.
Haslam released the following statement:
"First of all, we wanted to capitalize on the knowledge, experience and character we're fortunate to have in Ray Farmer. Ray has a tremendous football IQ, he's compelling, and he understands the types of players we need to acquire and develop in order to win in Cleveland. He embraces his partnership with Mike Pettine, which is critical in helping build the right team. Ray will provide excellent leadership in our front office.
"We appreciate Joe's contributions to the Cleveland Browns, especially in helping us as new owners. He was committed to creating a successful organization and bringing in talented individuals. We thank him for his work and dedication. We wish him and his family the best.
"Alec will continue in his role as President of this team. I think he's one of the most intelligent and innovative young executives in the NFL.
"We're also grateful for Mike Lombardi's efforts and commitment since rejoining our organization. He is an experienced and creative NFL executive with a unique ability to see the big picture. He has tremendous instincts and I know he'll be a valuable addition to any NFL organization. We simply wanted to give Ray this opportunity that he's earned. We wanted to move forward under his leadership and capabilities.
"The purpose of these moves is to unify our team with one, unequivocal goal: Provide our fans with the winning organization they have long deserved."
Statement from Joe Banner:
"It is bittersweet leaving the Browns organization. I have thoroughly enjoyed working with Jimmy Haslam and helping him set the infrastructure for this franchise. I am proud of the talented individuals we brought in to help lead this team and feel that the Cleveland Browns are in good hands moving forward."


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klausesser wrote:Hi!
A device like the Merlin should be very good to shoot a time-lapse-sequence with a panning camera.
I tried to do that yesterday - but didn´t succeed to find the correct settings.
Let´s say a 180deg-turn shooting 1 picture per second - the pan should last 5 minutes. That would mean 300 pictures which is 12 seconds of video.
In the software that´s coupled to a certain focal-length. Is there a way to avoid that?
Ok - one could use the very slow motion-option of the Merlin´s hand-controller and using an interval-release. But i guess the Merlin/Papywizard basically should already be able to do by using the normal speed and stopping 300 times for a shot - am i wrong? But it has to be independant from the focal-length.
the function:"amount of shots" doesn´t do - it increases the angle and is limited to "100". What is it anyway for?
klausesser wrote:the function:"amount of shots" doesn´t do - it increases the angle and is limited to "100". What is it anyway for?
best, Klaus
mediavets wrote:You can also experiment and see what effect decreasing the no. of rows or columns will have on the Total FOV. With a hi-res pano involving a lot of images you may find that you can significantly reduce the no. of shots and the elapsed time of the shoot by dropping a row without a huge effect on the Total FOV.
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Expressive Build Language and Deep API
The key to unlocking Gradle's power features within your build script lies in discovering and applying its domain model, as shown in Figure 4.
Figure 4: Build scripts apply the Gradle DSL and have access to its deep API.
As you can see in the figure, a build script directly maps to an instance of type
Project in Gradle's API. In turn, the dependencies configuration block in the build script invokes the method
dependencies() of the project instance. Like most APIs in the Java world, it's available as HTML Javadoc documentation on Gradle's website. Who would have known? You're actually dealing with code. Without knowing it, you generate an object representation of your
build logic in memory.
Each element in a Gradle script has a one-to-one representation with a Java class; however, some of the elements have been sugar-coated with a sprinkle of Groovy syntax. Having a "Groovy-fied" version of a class in many cases makes the code more compact than its Java counterpart and allows for using new language features such as closures.
Gradle can't know all the requirements specific to your enterprise build. By exposing hooks into lifecycle phases, Gradle allows for monitoring and configuring the build script's execution behavior. Let's assume you have the very unique requirement of sending out an email to the development team whenever a unit test failure occurs. The way you want to send an email (for example, via SMTP or a third-party email service provider) and the list of recipients are very specific to your build. Other builds using Gradle may not be interested in this feature at all. By writing a custom test listener that's notified after the test execution lifecycle event, you can easily incorporate this feature for your build.
Gradle establishes a vocabulary for its model by exposing a DSL implemented in Groovy. When dealing with a complex problem domain, in this case the task of building software, being able to use a common language to express your logic can be a powerful tool. Let's look at some examples. Most common to builds is the notation of a unit of work that you want to get executed. Gradle describes this unit of work as a task. Part of Gradle's standard DSL is the ability to define tasks very specific to compiling and packaging Java source code. It's a language for building Java projects with its own vocabulary that doesn't need to be relevant to other contexts.
Another example is the way you can express dependencies to external libraries, a very common problem solved by build tools. Out-of-the-box Gradle provides you with two configuration blocks for your build script that allow you to define the dependencies and repositories that you want to retrieve them from. If the standard DSL elements don't fit your needs, you can even introduce your own vocabulary through Gradle's extension mechanism.
This may sound a little nebulous at first, but once you're past the initial hurdle of learning the build language, creating maintainable and declarative builds comes easy. A good place to start is the Gradle Build Language Reference Guide. Gradle's DSL can be extended. You may want to change the behavior of an existing task or add your own idioms for describing your business domain. Gradle offers you plenty of options to do so.
Gradle is Groovy
Prominent build tools like Ant and Maven define their build logic through XML. As we all know, XML is easy to read and write, but can become a maintenance nightmare if used in large quantities. XML isn't very expressive. It makes it hard to define complex custom logic. Gradle takes a different approach. Under the hood, Gradle's DSL is written with Groovy providing syntactic sugar on top of Java. The result is a readable and expressive build language. All your scripts are written in Groovy as well. Being able to use a programming language to express your build needs is a major plus. You don't need to be a Groovy expert to get started. Because Groovy is written on top of Java, you can migrate gradually by trying out its language features. You could even write your custom logic in plain Java Gradle couldn't care less. Groovy veterans will assure you that using Groovy instead of Java will boost your productivity significantly. A great reference guide is the book Groovy in Action, Second Edition by Dirk Koenig et al. (Manning, 2009).
Flexible Conventions
One of Gradle's big ideas is to give you guidelines and sensible defaults for your projects. Every Java project in Gradle knows exactly where source and test class file are supposed to live, and how to compile your code, run unit tests, generate Javadoc reports, and create a distribution of your code. All of these tasks are fully integrated into the build lifecycle. If you stick to the convention, there's only minimal configuration effort on your part. In fact, your build script is a one-liner. Seriously! Figure 5 illustrates how Gradle introduces conventions and lifecycle tasks for Java projects.
Figure 5: In Gradle, Java projects are build by convention with sensible defaults. Changing the defaults is easy and achieved through convention properties.
Default tasks are provided that make sense in the context of a Java project. For example, you can compile your Java production source code, run tests, and assemble a JAR file. Every Java project starts with a standard directory layout. It defines where to find production source code, resource files, and test code. Convention properties are used to change the defaults.
The same concept applies to other project archetypes like Scala, Groovy, web projects, and many more. Gradle calls this concept build by convention. The build script developer doesn't need to know how this works under the hood. Instead, you can concentrate on what needs to be configured. Gradle's conventions are similar those in Maven, but they don't leave you feeling boxed in. Maven is very opinionated; it proposes that a project only contains one Java source directory and only produces one single JAR file. This is not necessarily reality for many enterprise projects. Gradle allows you easily to break out of the conventions. On the opposite end of the spectrum, Ant does not give you a lot of guidance on how to structure your build script, allowing for a maximum level of flexibility. Gradle takes the middle ground by offering conventions combined with the ability to change them easily. Szczepan Faber, one of Gradle's core engineers, put it this way on his blog: "Gradle is an opinionated framework on top of an unopinionated toolkit."
Robust and Powerful Dependency Management
Software projects are usually not self-contained. All too often, your application code uses a third-party library providing existing functionality to solve a specific problem. Why would you want to reinvent the wheel by implementing a persistence framework if Hibernate already exists? Within an organization, you may be the consumer of a component or module implemented by a different team. External dependencies are accessible through repositories, and the type of repository is highly dependent on what your company prefers. Options range from a plain file system to a full-fledged enterprise repository. External dependencies may have a reference to other libraries or resources. We call these transitive dependencies.
Gradle provides an infrastructure to manage the complexity of resolving, retrieving, and storing dependencies. Once they're
downloaded and put in your local cache, they're made available to your project. A key requirement of enterprise builds is
reproducibility. Do you remember the last time a coworker said, "But it works on my box"? Builds have to produce the same result on different
machines, independent of the contents of your local cache. Dependency managers like Ivy and Maven in their current implementation
cannot fully guarantee reproducibility. Why is that? Whenever a dependency is downloaded and stored in the local cache, it doesn't take into account the artifact's origin. In situations where the repository is changed
for a project, the cached dependency is considered resolved, even though the artifact's content may be slightly different.
At worst, this will cause a failing build that's extremely hard to debug. Another common complaint specific to Ivy is the
fact that dependency snapshot versions, artifacts currently under development with the naming convention
–SNAPSHOT, aren't updated correctly
in the local cache, even though it changed on the repository and is marked as changing. There are
many more scenarios where current solutions fall short. Gradle provides its own configurable, reliable, and efficient dependency-management solution.
Large enterprise projects usually consist of multiple modules to separate functionality. In the Gradle world, each of the submodules is considered a project that can define dependencies to external libraries or other modules. Additionally, each subproject can be run individually. Gradle figures out for you which of the subproject dependencies need to be rebuilt, without having to store a subproject's artifact in the local cache.
Scalable Builds
For some companies, a large project with hundreds of modules is reality. Building and testing minor code changes can consume
a lot of time. You may know from personal experience that deleting old classes and resources by running a cleanup task is
a natural reflex. All too often, you get burned by your build tool not picking up the changes and their dependencies. What
you need is a tool that's smart enough to only rebuild the parts of your software that actually changed. Gradle supports incremental
builds by specifying task inputs and outputs. It reliably figures out for you which tasks need to be skipped, built, or partially
rebuilt. The same concept translates to multimodule projects, called partial builds. Because your build clearly defines the
dependencies between submodules, Gradle takes care of rebuilding only the necessary parts. No more running
clean by default!
Automated unit, integration, and functional tests are part of the build process. It makes sense to separate short-running types of tests from the ones that require setting up resources or external dependencies to be run. Gradle supports parallel test execution. This feature is fully configurable and ensures that you're actually taking advantage of your processor's cores. The buck doesn't stop here. Gradle is going to support distributing test execution to multiple machines in a future version. The days of reading your Twitter feed between long builds are gone.
Developers run builds many times during development. That means starting a new Gradle process each time, loading all its internal dependencies, and running the build logic. You'll notice that it usually takes a couple of seconds before your script actually starts to execute. To improve the startup performance, Gradle can be run in daemon mode. In practice, the Gradle command forks a daemon process, which not only executes your build, but also keeps running in the background. Subsequent build invocations will piggyback on the existing daemon process to avoid the startup costs. As a result, you'll notice a far snappier initial build execution.


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Upton Videographers -
Wedding and Event Videography in Upton KY
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Starting treatment for HIV immediately after diagnosis is the most effective method yet discovered for preventing an infected partner from passing the virus that causes AIDS to a healthy partner, according to many experts.
Don't miss these Health stories
More women opting for preventive mastectomy - but should they be?
Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.
- Larry Page's damaged vocal cords: Treatment comes with trade-offs
- Report questioning salt guidelines riles heart experts
- CDC: 2012 was deadliest year for West Nile in US
- What stresses moms most? Themselves, survey says
- More women opting for preventive mastectomy - but should they be?
A U.S. National Institutes of Health sponsored international study of 1,763 mostly heterosexual couples released Thursday finds that the drugs used to treat AIDS can almost totally eliminate the transmission of the virus.
The study began in 2005 and was supposed to last 10 years. But the results were so dramatically positive that a committee that monitors the results halted the study five years early.
In all the couples, one partner was infected and the other was not. In half of the couples in the study, the infected partner got the drugs used to treat HIV infection immediately at the start of the study. In the other half, the infected partner got the drug at the normal medically indicated time — when his or her immune system began to deteriorate. At the time the study began, the HIV-infected partners had CD4 T-cell levels — a key measure of the immune system — of between 350 and 550 cells per cubic millimeter. A normal count is between 500 and 1,500.
In the 882 couples where the drugs were used in the normal way, 27 partners became infected with HIV. But in the 881 couples where treatment began early, only one was infected.
Previously, anecdotal reports have indicated that people who are being treated with the drugs are less likely to infect others. Scientists say it makes sense because the drugs reduce the amounts of virus in the body. But this is the first study to rigorously prove the concept.
During the study, both group were counseled on safe sex and given free condoms.
The study was carried out a several sites, mostly in African and Asian countries.
There were very few couples in the United States. Only a few gay male couples were in the study so officials say they can not draw any rigorous conclusions for that population. But many infected gay men in the U.S. and other countries, according to doctors, already, take the drugs to reduce the risk of infection. However, officials emphasize that this medical approach should never be used as an approach for safe sex practices.
The study also raises the issue of access to the drugs in poor countries. Already — for financial reasons — only a small percentage of people who need the drugs to save their lives get them. Expanding the use for the prevention of transmission raises the same issues of access to the drugs.
© 2013 NBCNews.com Reprints


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Rugby World Cup 2011
Fijian flanker cited
ESPNscrum Staff
September 18, 2011
Fiji flanker Dominiko Waqaniburotukula could be facing a ban © Getty Images
Fiji flanker Dominiko Waqaniburotu could see his participation in the Rugby World Cup brought to a premature end by suspension after he was cited for a dangerous tackle during Saturday's Pool clash with South Africa.
Waqaniburotu stands accused of making a tip tackle on Springbok fullback Patrick Lambie and has been summoned to appear before the Independent Judicial Officer Christopher Quinlan at a hearing in Auckland. The exact time and date of the hearing have yet to be confirmed.
Should the back-row be found guilty he would most likely miss his country's two remaining fixtures in New Zealand, against Wales and Samoa, as the minimum recommended ban for such an offence is three weeks.
© ESPN Sports Media Ltd.
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IT Services
Information Technology Services strives to provide a high level of customer service by providing quality technical deliverables with a high level of professionalism and responsiveness. We adhere to principles of technical and fiscal stewardship with an end goal of a high quality of life for employees and citizens.
IT Services Core Values
Professionalism: The department will interact courteously, ethically, and with
Stewardship: The department will earn trust by practicing fiscally responsible management that ensures system integrity and availability.
Expertise: We will be advocates for our customers by developing and maintaining competence and knowledge.
Quality of Life: We will recognize the importance of balancing the relationship between quality of work and quality of life.
About the Department
While the IT Services Department is an internal service department of the city, its efforts also help to provide the level of quality customer service that citizens, businesses, prospective citizens, and visitors deserve from the City of Asheville. Please contact the department for services and additional information.
Chief Information Officer: Jonathan Feldman
Location: 3rd floor, City Hall
Mailing: 70 Court Plaza Asheville, NC 28801
Office Hours: 8:30 a.m. - 5 p.m.
Office Phone: (828) 259-5510
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Wednesday, February 8, 2012
blood orange pistachio polenta cake // the liebster!
32 comments:
You're right, blood oranges are beautiful - and so is this cake! I love the combination of pistachios and blood oranges.ReplyDelete
Oh, and Cara's a doll, huh? I think she wins everyone over with that charm of hers :) She's even better in person!Replies
Ohmygoodness, it's as if I paid you all to say such sweet things! You are taking my breath away, really. And I *am* better in person, you are right :) haha! So is Ashlae, by the way! Such kissable lips...hahaha, kidding, I'm kidding! <-I'm still laughingDelete
she is quite the charmer isn't she :-)Delete
I may need to make a special trip to Cali for a Cara and Ashlae visit - baking and stretchy pants included :-)
what an absolutely delicious looking cake! i'm in love with the polenta-pistachio-orange combo! and, it's weird, i don't think i've ever had a blood orange before. i'm thinking i need to try one!ReplyDeleteReplies
Yes! I am thinking you need to absolutely go to the store this very minute and get yourself a blood orange - they are SO Beautiful!Delete
I've never tried them either, but I agree that they're beautiful on top of that cake! I've been wanting to try making a cornmeal cake for a while too but I haven't gotten around to it yet!Delete
I hope you do try a Polenta Cake Genevieve, I would love to see what you would come up with!Delete
Heather, seriously. WOW. Your words just blew me away. Thank you does not cover it, but THANK YOU for saying that! I wish you lived in Cali (notice how I didn't vice versa the living situation) so we could hang out and you could feed me with all of your beautiful creations! :) <-selfish. So grateful to have met you through blogging!!! When I finally make it out to Maine with Greg, I am definitely calling you up. xo P.S. That cake is INCREDIBLE! Again. Well, you know how I'm a big fan of you...ReplyDeleteReplies
You are so welcome and it is SO deserved- you are an incredible person and do amazing things with your blog; I wish I lived in sunny Cali at least 6 months out of the year - can you guess which 6 months!Delete
Um yeah, no brainer :-) if you are ever in Maine you need to absolutely let me know - you rock Cara!
this is such a lovely, dainty cake!ReplyDeleteReplies
I love that you called this cake dainty - thank you for stopping by!Delete
Awe, thank you so much! You are an incredible sweetie! xoxoReplyDelete
I am honoured to be mentioned on your blog! :) You made my week.
Love love love the look & sound of this cake. The pictures are fantastic. The addition of pistachios makes it perfect. Great pops of colour.Replies
You totally deserve this Award-I love your blog and getting to know you too; I hope others love it as much as I do!Delete
I had so much fun making this cake- LOVE winter citrus!!
i looveeee that pretty blood orange color! and perfect with the pistachios! and all the tips.. can be taken as evidence that at some point you did the deed, else how would you know!:DReplyDelete
cara is definitely one hyper, uber creative and loveable person!Replies
My lips are sealed - i may just be able to foresee into other peoples foreseable kitchen disasters :-)Delete
How many times can Heather use a version of foresee in her reply :-)
Cara is a great girl- she is going to love you described her as hyper!
And congratulations for your liebster.. and i love the interruption and return to the scheduled program:) love all the blogs you passed on the award to!Delete
i foresee you foreseeing other peoples foreseeable disasters.......
I think Cara is currently busy with the difficult task of choosing the bake off winners:)
Thanks Richa! It is so fun getting to spread the word about some of the Blogs that I love :)Delete
Lol- if I could only foresee my foreseable disasters - then I would be onto something!
Hopefully Cara's Jeans fit after tasting 42 Dessert Recipes - Yikes! Loved your entries for the Bake-Off, you are so talented!
Congratulations on your Liebster.ReplyDelete
And more importantly...you should totally sell that cake on the street corner. I'd buy it. You'd have a line!Replies
Thanks Jen!Delete
Its a bit cold to be out on the street corner this time of year in New England! but i would definitely consider becoming a street corner girl during the summer- wait that came out wrong, you know what I mean :)
Lovely flavor blend here! Like you I am loving all the orange citrus variety out there, hard to keep any of those oranges for baking. I have never made a cake with polenta, but this is inspiring. The texture must be amazing! Awesome array of photos here. Great post!ReplyDeleteReplies
Thank you Tina - between juicing and baking I am lucky to enjoy a bllod orange as just that an Orange! I loved your Blood Orange cupcakes,love seeing what people come up with using seasonal fruits & veggies!Delete
Congratulations my friend - much deserved and what a fabulous cake to celebrate with ;)ReplyDelete
Choc Chip UruReplies
Thanks Uru - I hope school is going well and I am also hoping you have some time to whip up more sweet treats to share with us all!Delete
Gorgeous cake! I completely agree with you that this time of year would be totally awful without the cheeriness of winter citrus. We just launched the all new seasonalpotluck.com and February is oranges month (thank god!) If you'd like to link up your recipe, we'd love to have you http://bit.ly/zDoNfxReplyDeleteReplies
Thank you Betsy- what a great site Seasonal Potluck is, I am so happy that you stopped by! I have linked up, there are so many beautiful citrus recips that are super inspiring!Delete
Beautiful post! I love the popping color of blood oranges, and seriously need to find more ways to use them. This cake looks amazing - perhaps just the inspiration I need!ReplyDeleteReplies
I LOVE the color too - it amazing that color just comes natuaral to the blood orange, it has got to be one of the prettiest fruits around :)Delete
What a gorgeous, delicious cake! Congrats on the Liebster, too!ReplyDelete
This looks beautiful! Love the addition of pistachios to it too. Your photos always have great lighting by the way. Can't seem to get mine right! :pReplyDeleteReplies
I LOVE Pistachios and the colors together sealed the deal for me :)....your photos are always beautiful - don't be so hard on yourself!Delete
I am lucky to have great light in my mudroom which is adjacent to the kitchen; best light this time of year for me is between 10am - 3pm :)
- AnonymousApril 19, 2013 at 4:03 AM
I cannot think of anything more unappealing than the thought of rust particles floating around in your tuna fish or tomato soup.ReplyDelete
I figured I should provide warranty information for your own knowledge.
Luckily we saved room for pie - well worth the stop.
Also visit my site :: hang gia dung


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Micetro is Bad Dog's weekly competitive shortform show, where 9 improvisors work together to score points per scene. After each round the people with the most points continue to the next round. The person with the most points at the end of the hour wins the $5 grand prize, and is guaranteed a spot in next weeks show.
WHEN: Every Saturday at 7pm
TICKETS: $5, or free with the purchase of an 8pm Theatresports ticket. Purchase Theatresports tickets online or at our Box Office.


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CLAREMONT, Calif. – The Claremont-Mudd-Scripps swimming and diving teams are all set to compete at the SCIAC Swimming & Diving Championships which begin on Sunday, Feb. 17 and run through Tuesday, Feb. 19 at Splash! La Mirada Aquatics Center. The Athenas are in search of their 11th-straight SCIAC team championship while the Stags are going for their sixth in a row.
For more information on the 2013 SCIAC Championships hosted by the University of Redlands at Splash! La Mirada Aquatics Center, including directions, ticket prices and preview information, please visit the tournament home page which can be found here.
On the women's side, the Athenas had an 8-0 dual meet record this season in SCIAC, as they narrowly defeated Pomona-Pitzer 152-146 at Axelrood Pool to finish with an unblemished mark in conference meets. Right behind CMS with SCIAC dual-meet records of 7-1 were Pomona-Pitzer and Occidental in what proved to be a strong, balanced conference from top to bottom this season.
"Each team has several impact athletes so there is a lot of depth in the conference," said head coach Charlie Griffiths. "It is not going to be a meet [the SCIAC Championships] where any one team is viewed as dominant."
The Athenas have two swimmers in junior Michele Kee (200-yard individual medley) and sophomore Louisa Dunwiddie (1650-yard freestyle) who are top seeds heading into the Championships. Kee is a two-time SCIAC Swimmer of the Year. On both the 1-meter and 3-meter boards, senior diver Carmen Lundell enters the Championships as the No. 2 seed.
For the men, the Stags had a perfect 8-0 dual-meet record this season in SCIAC while Redlands and Pomona-Pitzer finished toward the top of the conference as well. Last season, Redlands finished in fifth at Nationals and they have multiple All-Americans back on their squad.
Sophomore Patrick Shultz (500-yard freestyle, 100-yard butterfly and 100-yard freestyle) and sophomore Alex Mendoza (500 free and 1650 free) are both top seeds heading into the Championships for the Stags. Sophomore diver James Stevick is the top seed on both boards.
Preliminary races will begin at 9 a.m. on each day of competition with the finals taking place at 4 p.m. on all three days.
SCIAC Championships website
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Follows CMS Athletics on Twitter: @AthleticsCMS


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Type 1 Diabetes: Diagnosis
During a physical exam, your doctor likely will take your medical and family history, and have you take one or more blood tests to measure your blood sugar levels. This would include a fasting plasma glucose (FPG) test, which requires that you not eat for at least 6 hours prior to the test. Additionally, your doctor will probably order glycated hemoglobin (HbA1c or A1c) blood tests. A1c tests measure your average blood sugar levels for the past two to three months.
It is also common for your doctor to check your urine for ketones, which are fatty acids that appear when you have high blood sugar levels.
Sometimes, type 1 diabetes is diagnosed in the emergency room after a person develops diabetic ketoacidosis (DKA). This condition develops when you don't get enough insulin, your blood sugar level rises sharply and ketones build up in your blood. Symptoms of DKA may include severe and sudden nausea, vomiting and stomach pain.
Whether you are diagnosed in an emergency department or at your doctor's office, be sure to tell your doctor about any and all symptoms you've experienced, such as frequent urination, excessive thirst or even trouble concentrating.
Because you may have health conditions related to type 1 diabetes, expect your doctor to run other tests, such as a fasting lipid profile—a test that measures the fats in your blood after a 12-hour fast (no food or drink, except water). Your doctor will also check other areas of your body such as your feet, eyes, heart and kidneys.