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Semantic Technology In The Enterprise
Posted by Leslie Owens on April 18, 2012
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Remember The Jetsons? The flying cars and the automated kitchen and the food pills? Sometimes modern life can feel like that futuristic utopia. We've got robots in the home and a speech-recognition personal assistant named Siri built in the iPhone in our bag. IBM Watson, a supercomputer, beat its human competition in the TV game show Jeopardy! last year. How? By translating corny, nuanced questions into a format it could understand and compute.
But for most of us, our digital experiences at work feel like we're stuck in The Flintstones.
We wonder: "How can Amazon.com monitor my customer data so closely that it knows what book I want next, but after five years of daily use, my enterprise search engine doesn't get that I work in HR in the Chicago office?" We need to dig into our enterprise information so it is more rich and useful. Hal Varian, Google's Chief Economist, explained in the McKinsey Quarterly that "We have free and ubiquitous data, so the complementary scarce factor is the ability to understand that data and extract value from it." (He even goes so far as to say that statisticians will be the sexy job in the next 10 years!)
It's understandable to be cynical about semantic processing, especially if you've been told it relies on manually entered metadata.
For those sexy data scientists to get the whole picture on key business issues like customer satisfaction and product quality, they need to mine both data and content. And if you think the best way to integrate content with data is to manually tag it with metadata, then I hope I can convince you otherwise in my session on semantic technology at our upcoming Forrester event. The open and linked data in the public domain is filled with curated facts and topics that few organizations integrate in their enterprise solutions. The exciting potential in this data and the relationships they reveal was not lost on Google when they bought Freebase, an entity graph of 20 million people, places and things, in 2010.
Please join us at the EA Forum in Las Vegas in a few weeks, where I will talk about how to "Evolve Your Analytic Infrastructure To Include Semantic Technology."
We will cover how to integrate semantic components into your environment to help people and systems find and reuse information — and extract new insights from it.
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Soccer Programs To Participate In Cycle For Survival
Teams look to raise in upwards of $12,000 for cancer research
Soccer Programs To Participate In Cycle For Survival
Teams look to raise in upwards of $12,000 for cancer research
Men's Soccer Announces Summer Camp Dates
Camps begin on June 15 and vary between youth and high school ages
Women's Soccer Releases Summer Camp Dates
First skills clinic to be held April 21
Women's Soccer Hits the Road
The Ramblers travel to Iowa and Wisconsin this weekend
An accomplished goalkeepers coach, Paparounis also serves as a coach for United Soccer Academy Chicago and the Hawks Soccer Club. During the 2010 season, he was an assistant coach at Concordia University in River Forest, Ill., and he has also honed his craft as a goalkeeping coach for North Texas Olympic Development Program and at KeeperZone, Inc., in Dallas.
Paparounis graduated from Salisbury University in 2003 after a successful playing career where he was a First Team All-Capital Athletic Conference selection in 2001 and helped the Sea Gulls to three conference championships, a pair of NCAA Tournament appearances and a staggering 64-13-4 (.814) record during his four-year career.
Following his collegiate playing career, Paparounis played for the Carolina Dynamo in Division 2 of the USL in 2003, then spent three seasons with the Dallas-Fort Worth Tornados in USL-PDL.
He holds a United States Soccer Federation (USSF) National "D" Coaching License and a National Soccer Coaches Association of America (NSCAA) Goalkeeper Level 1 and 2 License.

subset: commoncrawl


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MrNcrdbl's Ncrdbl Cover of "Lady of the Island" by Crosby Stills & Nash Coming soon to iTunes, Spotify, Rhapsody, & Amazon!!!!! (This is mostly a promo video...
"Lady of the Island" song code: L21835; Written by Graham Nash; Published by: Sony/ATV Songs LLC OBO Nash Notes;
Licensed by The Harry Fox Agency, Inc.
License No.: 1165434076 on 1/27/2013
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Keller Williams reports record growth
Keller Williams Realty in Northeast Ohio celebrated its 10th anniversary with record growth in a variety of areas. While the company opened its first office in the area 10 years ago with one office and 23 sales associates, it now boasts 15 locations and close to 900 sales associates.
Keller Williams Realty marked record growth in a variety of areas as recorded by NorthEast Ohio Real Estate Exchange, a combination of multiple listing services from around the region. In 2012, the company marked more than $1.1 billion in closed volume, almost a 40 percent growth from the previous year. This was double the growth for the area recorded by NEOHREX which showed just under 22 percent growth for the year. Similarly, Keller Williams closed more than 30 percent more units in 2012 than in 2011. While NEOHREX showed more than a 3 percent loss in the number of agents in the area, the agent count at Keller Williams Realty has grown by 12 percent. For more information, visit www.kwworldwide.com.


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Human Resources and Security Specialists should use this tool to determine the correct investigation level for any covered position within the U.S. Federal Government.
Visit this federal site to search for our regulatory notices, proposed and final rules.
See the latest tweets on our Twitter feed, like our Facebook pages, watch our YouTube videos, and page through our Flickr photos.
OPM's Mike Orenstien (Left) presents the can sculpture to Mike Causey (Right) for judging.
USOPM Photo by Timothy Grant 08/25/2009


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This statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) on Sep 2007.
This document provides specific recommendations and guidelines to assist physicians in the diagnostic work-up and treatment of surgical problems in pregnant patients, focusing on the use of laparoscopy. Surgical interventions during pregnancy should minimize fetal risk without comprising the safety of the mother.
Recent data show the safety and efficacy of laparoscopy during all trimesters for many surgical conditions with outcomes similar to conventional operations. Surgeons must be aware of data regarding differences in techniques used for pregnant patients to optimize outcomes
Guidelines for clinical practice are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion, when little or no data are available. Guidelines are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to indicate the preferable, but not necessarily the only, acceptable approaches due to the complexity of the healthcare environment. Guidelines are intended to be flexible. Given the wide range of specifics in any health care problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision.
Guidelines are developed under the auspices of the Society of American Gastrointestinal Endoscopic Surgeons and its various committees, and approved by the Board of Governors. Each clinical practice guideline has been systematically researched, reviewed and revised by the guidelines committee, and reviewed by an appropriate multidisciplinary team. The recommendations are therefore considered valid at the time of its production based on the data available. Each guideline is scheduled for periodic review to allow incorporation of pertinent new developments in medical research knowledge and practice.
I. Introduction
Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies [1, 2]. The most common non-obstetrical surgical emergencies complicating pregnancy are acute appendicitis, cholecystitis, and intestinal obstruction [1] . Other conditions that may require operations during pregnancy include ovarian cysts, masses or torsion, symptomatic cholelithiasis, adrenal tumors, splenic disorders, symptomatic hernias, complications of inflammatory bowel diseases, and abdominal pain of unknown etiology. During its infancy, some argued that laparoscopy was contraindicated during pregnancy due to concerns for uterine injury and fetal perfusion. As surgeons have gained more experience with laparoscopy it has become the preferred treatment for many surgical diseases in the gravid patient [3].
II. Definitions
Both the quality of the evidence and the strength of the recommendation for each of the below guidelines were assessed according to the GRADE system [4] (see Table 1). This is a 4-tiered system for assessing the quality of evidence (very low, low, moderate, or high) and a 2-tiered system for strength of the recommendation (weak or strong). Additional definitions are provided by SAGES in "The Definitions Document: A Reference for Use of SAGES Guidelines".
III. Diagnosis and Workup
Managing abdominal pain in the gravid patient presents a dilemma in which the clinician must consider the risks and benefits of diagnostic modalities and therapies to both the mother and the fetus. An underlying principle to the workup of abdominal pain was stated by Sir Zachary Cope in 1921, "Earlier diagnosis means better prognosis." [5]. In pregnant women with abdominal pain, fetal outcome depends on the outcome of the mother. Optimal maternal outcome may require radiologic imaging, sometimes with ionizing radiation. A risk-benefit discussion with the patient should occur prior to any diagnostic study.
A. Imaging Techniques
Guideline 1: Ultrasonographic imaging during pregnancy is safe and useful in identifying the etiology of acute abdominal pain in the pregnant patient (Moderate; Strong).
Abdominal pain in the pregnant patient can be separated into gynecologic and non-gynecologic causes. When radiographic studies are required ultrasound is considered safe, as no adverse effects to mother or fetus from ultrasound have been reported. It is the initial radiographic test of choice for most gynecologic causes of abdominal pain including adnexal mass, torsion, placental abruption, placenta previa, uterine rupture and fetal demise. Ultrasound is also a useful study for many non-gynecologic causes of abdominal pain, including symptomatic gallstones and appendicitis [6-12].
Risk of Ionizing Radiation
Guideline 2: Expeditious and accurate diagnosis should take precedence over concerns for ionizing radiation. Cumulative radiation dosage should be limited to 5-10 rads during pregnancy (Moderate; Strong).
Significant radiation exposure may lead to chromosomal mutations, neurologic abnormalities, mental retardation, and increased risk of childhood leukemia. Cumulating radiation dosage is the primary risk factor for adverse fetal effects, but fetal age at exposure is also important [8, 9, 13]. Fetal mortality is greatest when exposure occurs within the first week of conception. It has been recommended that the cumulative radiation dose to the conceptus during pregnancy be less than 5-10 rads [14]. As an example, the radiation dose to the conceptus for a plain abdominal radiograph averages 0.1-0.3 rads, while a CT of the pelvis yields up to 5 rads of fetal exposure[15] (see Table 3 for additional radiation doses).
The most sensitive time period for central nervous system teratogenesis is between 10 and 17 weeks gestation, and routine radiographs should be avoided during this time. In later pregnancy the concern shifts from teratogenesis to increasing the risk of childhood hematologic malignancy. The background incidence of childhood cancer and leukemia is approximately 0.2 -0.3%. Radiation may increase that incidence by 0.06% per 1 rad delivered to the fetus [14].
Exposure of the conceptus to 0.5 rad increases the risk of spontaneous abortion, major malformations, mental retardation, and childhood malignancy to one additional case in 6,000 above baseline risk [15]. It has been suggested that the risk of aberrant teratogenesis is negligible at 5 rads or less and that the risk of malformation is significantly increased at doses above 15 rads. No single diagnostic study should exceed 5 rads [9, 13, 14, 16-19].
Computed Tomography
Guideline 3: Contemporary multidetector CT protocols deliver a low radiation dose and may be used judiciously during pregnancy (Moderate; Weak).
Computed tomography (CT) may be used in the evaluation of abdominal pain in the gravid patient [20]. Radiation exposure to the fetus may be as low as 2 rads for pelvic CT scans but can reach 5 rads when a full scan of the abdomen and pelvis is performed [8, 21, 22]. This radiation dose is considered safe but may affect teratogenesis and increase the risk of developing childhood hematologic malignancies [21]. CT protocols and radiation doses vary by institution, and the individual practitioner should be aware of the radiation exposure at his or her institution and attempt to minimize fetal radiation exposure, if possible.
Magnetic Resonance Imaging
Guideline 4: MR Imaging without the use of intravenous Gadolinium can be performed at any stage of pregnancy (Low; Strong).
MRI provides excellent soft tissue imaging without ionizing radiation and is safe to use in pregnant patients. Some authors express concern about the detrimental effects of the acoustic noise to the fetus[23], but no specific adverse effects of MRI on fetal development have been reported [24-28]. Intravenous Gadolinium agents cross the placenta and may be detrimental; therefore their use during pregnancy should be confined to select cases where it is considered essential. [25, 29, 30].
Nuclear Medicine
Guideline 5: Administration of radionucleotides for diagnostic studies is generally safe for mother and fetus (Low; Weak).
Radiopharmaceuticals, including technetium-99m, can generally be administered at doses that provide whole fetal exposure of less than 0.5 rad [31, 32], well within the safe range of fetal exposure. Consultation with a nuclear medicine radiologist or technologist should be considered prior to performing the study.
Guideline 6: Intraoperative and endoscopic cholangiography exposes the mother and fetus to minimal radiation and may be used selectively during pregnancy. The lower abdomen should be shielded when performing cholangiography during pregnancy to decrease the radiation exposure to the fetus (Low; Weak).
Radiation exposure during cholangiography is estimated to be 0.2-0.5 rads[33]. Fluoroscopy generally delivers a radiation dose of up to 20 rads/minute, but varies depending on the x-ray equipment used, patient positioning, and patient size. During cholangiography, the fetus should be shielded by placing a protective device between the source of ionizing radiation and the patient. Efforts should be made to shield the fetus from radiation exposure without compromising the field of view necessary for proper imaging. No adverse effects to pregnant patients or their fetuses have been reported specifically from cholangiography.
The radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) averages 2-12 rads, but can be substantially higher for long procedures[34]. ERCP also carries risks beyond the radiation exposure such as bleeding and pancreatitis. In non-pregnant patients, the risk of bleeding is 1.3% and risk of pancreatitis is 3.5%-11%[35]. These additional risks warrant the same careful risk-benefit analysis and discussion with the patient as other operative and procedural interventions [8, 18, 36-38]. Alternatives to fluoroscopy include intra-operative ultrasound and choledochoscopy. These are both acceptable methods provided the surgeon has the appropriate equipment and skills to accurately perform the examinations.
Magnetic resonance cholangiopancreatography (MRCP) is an alternative approach that is gaining widespread acceptance. It is a useful diagnostic tool but offers no therapeutic capability. It has not been studied specifically in pregnant women.
B. Surgical Techniques
Guideline 7: Diagnostic laparoscopy is safe and effective when used selectively in the workup and treatment of acute abdominal processes in pregnancy (Moderate; Strong).
Diagnostic laparoscopy provides direct visualization of intra-abdominal organs. While not enough data are available to recommend this as a primary diagnostic approach in the pregnant patient, it is a reasonable alternative to radiologic imaging. The benefits of operative exploration are avoidance of ionizing radiation, diagnostic accuracy, and the capability to treat a surgical problem at the time of diagnosis. Furthermore, it has been shown that laparoscopy can be performed safely during any trimester of pregnancy with minimal morbidity to the fetus and mother [39-51].
IV. Patient Selection
Pre-operative Decision Making
Guideline 8: Laparoscopic treatment of acute abdominal disease has the same indications in pregnant and non-pregnant patients (Moderate; Strong).
Once the decision to operate has been made, the surgical approach (laparotomy versus laparoscopy) should be determined based on the skills of the surgeon and the availability of the appropriate staff and equipment. An appropriate discussion with the patient regarding the risks and benefits of surgical intervention should be undertaken. Benefits of laparoscopy during pregnancy appear similar to those benefits in non-pregnant patients including less postoperative pain, less postoperative ileus, decreased length of hospital stays and faster return to work [40, 45, 52-55].
Laparoscopy and Trimester of Pregnancy
Guideline 9: Laparoscopy can be safely performed during any trimester of pregnancy (Moderate; Strong).
Operative intervention may be performed in any trimester of pregnancy. Historical recommendations were to delay surgery until the second trimester in order to reduce the rates of spontaneous abortion and preterm labor[56]. Recent literature has shown that pregnant patients may undergo laparoscopic surgery safely during any trimester without any increased risk to the mother or fetus [39, 40, 55, 57-60]. Postponing necessary operations until after parturition may, in some cases, increase the rates of complications for both mother and fetus [57, 61-63].
It has been suggested that the gestational age limit for successful completion of laparoscopic surgery during pregnancy is 26 to 28 weeks [44]. This has been refuted by several studies in which laparoscopic cholecystectomy and appendectomy have been successfully performed late in the third trimester [58, 60, 64, 65].
Although laparoscopy can be performed safely in pregnancy with good fetal and maternal outcomes, the long-term effects to the children have not been well studied. One recent study evaluated eleven children from one to eight years and found no growth or developmental delay [51].
V. Treatment
There are many advantages of laparoscopy in the pregnant patient including: decreased fetal respiratory depression due to diminished postoperative narcotic requirements [45, 66-68], lower risk of wound complications [66, 69, 70], diminished postoperative maternal hypoventilation [66, 67], shorter hospital stays, and decreased risk of thromboembolic events. The improved visualization in laparoscopy may reduce the risk of uterine irritability by decreasing the need for uterine manipulation [71]. Decreased uterine irritability results in lower rates of spontaneous abortion and preterm delivery [72].
Patient Positioning
Guideline 10: Gravid patients should be placed in the left lateral decubitus position to minimize compression of the vena cava (Moderate; Strong).
When the pregnant patient is placed in a supine position, the gravid uterus places pressure on the inferior vena cava resulting in decreased venous return to the heart. This decrease in venous return results in significant reduction in cardiac output with concomitant maternal hypotension, and decreased placental perfusion during surgery [73-75]. Placing the patient in a left lateral decubitus position will shift the uterus off the vena cava improving venous return and cardiac output [73, 74].
Initial Port Placement
Guideline 11: Initial abdominal access can be safely accomplished with an open (Hasson) technique, Veress needle or optical trocar, if the location is adjusted according to fundal height and previous incisions (Moderate; Strong).
There has been much debate regarding abdominal access in the pregnant patient with preferences toward either a Hasson technique or Veress needle. The concern for use of the Veress needle has largely been based on concerns for injury to the uterus or other intraabdominal organs [76, 77]. Because the intraabdominal domain is altered during the second and third trimester initially accessing the abdomen via a subcostal approach has been recommended [58, 60, 64, 71]. If the site of initial abdominal access is adjusted according to fundal height and the abdominal wall is elevated during insertion, both the Hassan technique and Veress needle can be safely and effectively used [58, 60, 78].
It has also been recommended that trocar placement be altered from the standard configuration to account for the increased size of the uterus [79, 80]. Ultrasound guided trocar placement has been described in the literature as an additional safeguard to avoid uterine injury [81].
Insufflation Pressure
Guideline 12: CO2 insufflation of 10-15 mmHg can be safely used for laparoscopy in the pregnant patient (Moderate; Strong).
The potential for adverse consequences from CO2 insufflation in the pregnant patient has led to apprehension over its use. As such, some authors advocate gasless laparoscopy in pregnant patients, but this technique not been widely adopted [82-89].
The pregnant patient's diaphragm is upwardly displaced by the growing fetus, which results in decreased residual lung volume and functional residual capacity [90]. Upward displacement of the diaphragm by pneumoperitoneum is more worrisome in a pregnant patient with existing restrictive pulmonary physiology. Some have recommended intraabdominal insufflation pressures be maintained at less than 12 mmHg to avoid worsening pulmonary physiology in gravid women [80, 91]. Others have argued that insufflation less than 12 mmHg may not provide adequate visualization of the intra-abdominal cavity [58, 60]. Pressures of 15 mmHg have been used during laparoscopy in pregnant patients without increasing adverse outcomes to the patient or her fetus [58, 60].
Because CO2 exchange occurs with intraperitoneal insufflation there has been concern for deleterious effects to the fetus from pneumoperitoneum. Some animal studies have confirmed fetal acidosis with associated tachycardia, hypertension and hypercapnia during CO2 pneumoperitoneum [92-94], while other animal studies contradict these findings[95]. There are no data showing detrimental effects to human fetuses from CO2 pneumoperitoneum [44].
Intra-operative CO2 Monitoring
Guideline 13: Intraoperative CO2 monitoring by capnography should be used during laparoscopy in the pregnant patient (Moderate; Strong).
Fetal acidosis and associated fetal instability in CO2 pneumoperitoneum have been documented in animal studies, though no long-term effects from these changes have been identified [92-94, 96]. Fetal acidosis with insufflation has not been documented in the human fetus, but concerns over potential detrimental effects of acidosis have led to the recommendation of maternal CO2 monitoring [97, 98]. Initially, there was debate over maternal blood gas monitoring of arterial carbon dioxide (PaCO2) versus end-tidal carbon dioxide (ETCO2) monitoring, but the less invasive capnography has been demonstrated to adequately reflect maternal acid-base status in humans [99]. Several large studies have documented the safety and efficacy of EtCO2 measurements in pregnant women [44, 58, 60] making routine blood gas monitoring unnecessary.
Venous Thromboembolic (VTE) Prophylaxis
Guideline 14: Intraoperative and postoperative pneumatic compression devices and early postoperative ambulation are recommended prophylaxis for deep venous thrombosis in the gravid patient (Moderate; Strong).
Pregnancy is a hypercoagulable state with a 0.1-0.2% incidence of deep venous thrombosis [100]. CO2 pneumoperitoneum may increase the risk of deep venous thrombosis by predisposing to venous stasis. Insufflation of 12 mmHg causes a significant decrease in blood flow that cannot be completely reversed with intermittent pneumatic compression devices or intermittent electric calf stimulators [101].
Although there is little research on prophylaxis for deep venous thrombosis in the pregnant patient, general principles for laparoscopic surgery apply. Because of the increased risk of thrombosis, prophylaxis with pneumatic compression devices both intraoperatively and postoperatively and early postoperative ambulation are recommended. There are no data regarding use of unfractionated or low molecular weight heparin for prophylaxis in pregnant patients undergoing laparoscopy, though its use has been suggested in patients undergoing extended major operations [102]. In patients who require anticoagulation during pregnancy, heparin has proven safe and is the agent of choice [103].
Gallbladder Disease
Guideline 15: Laparoscopic cholecystectomy is the treatment of choice in the pregnant patient with gallbladder disease, regardless of trimester (Moderate; Strong).
In the past non-operative management of symptomatic cholelithiasis in pregnancy has been recommended [61, 104-106]. At present early surgical management is the treatment of choice. Early surgical management of gravid patients with symptomatic gallstones is supported by data showing recurrent symptoms in 92% of patients managed non-operatively who present in the first trimester, 64% who present in the second trimester, and 44% who present in the third trimester [107, 108]. This delay in surgical management results in increased rates of hospitalizations, spontaneous abortions, preterm labor, and preterm delivery compared to those undergoing cholecystectomy [39, 40, 52, 88-91].
Altogether, nonoperative management of symptomatic gallstones in gravid patients results in recurrent symptoms in more than 50% of patients, and 23% of such patients develop acute cholecystitis or gallstone pancreatitis [57]. Gallstone pancreatitis results in fetal loss in 10% to 60% of pregnant patients [109, 110].
The significant morbidity and mortality associated with untreated gallbladder disease in the gravid patient favor surgical treatment. Laparoscopic cholecystectomy is preferred because of the salutary outcomes and favorable side-effect profile [59]. There have been no reports of fetal demise for laparoscopic cholecystectomy performed during the first and second trimesters [111]. Furthermore, decreased rates of spontaneous abortion and preterm labor have been reported in laparoscopic cholecystectomy when compared to laparotomy [112].
Guideline 16: Choledocholithiasis during pregnancy may be managed with preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy followed by laparoscopic cholecystectomy, laparoscopic common bile duct exploration, or postoperative ERCP (Moderate; Strong).
Complications associated with choledocholithiasis are relatively uncommon during pregnancy [113, 114]. However, these complications can result in significant morbidity and mortality making appropriate management of these patients important. There have been no trials comparing common bile duct exploration at the time of laparoscopic cholecystectomy to ERCP followed by cholecystectomy in pregnant patients. Good outcomes have been described with intraoperative common bile duct exploration, but few cases have been reported [115]. Multiple studies have demonstrated safe and effective management of common bile duct stones with preoperative ERCP followed by laparoscopic cholecystectomy [116-121].
Laparoscopic Appendectomy
Guideline 17: Laparoscopic appendectomy may be performed safely in pregnant patients with appendicitis (Moderate; Strong).
The laparoscopic approach is the preferred treatment for pregnant patients with presumed appendicitis[122], and the preponderance of studies have shown the technique to be safe and effective [58, 60, 123-129]. These retrospective series have shown very low rates of pre-term delivery and, in most series, no reports of fetal demise.
Accurate and timely diagnosis of appendicitis in the gravid patient may minimize the risk of fetal loss and optimize outcomes. In some circumstances clinical findings may be sufficient for diagnosis. When the diagnosis remains uncertain, prompt ultrasound, CT, or MRI are useful adjuncts to more accurate diagnosis of appendicitis and decrease the rate of negative laparoscopy. However the false negative rates of CT and MRI studies have yet to be fully evaluated in the gravid patient, and some hospitals may not have immediate access to these radiologic modalities.
The published data overwhelmingly attest to the safety of laparoscopic appendectomy in the gravid patient, but one recent study describes a higher risk for laparoscopy compared to laparotomy[130]. This population-based study showed an odds ratio of 2.3 for fetal loss in laparoscopy compared to conventional surgery for appendicitis. This single study does not contraindicate laparoscopic appendectomy in pregnant patients, but does illuminate a need for further research on the subject. Unless future studies bolster the above observational data, laparoscopic appendectomy remains the treatment of choice for pregnant patients.
Solid Organ Resection
Guideline 18: Laparoscopic adrenalectomy, nephrectomy and splenectomy are safe procedures in pregnant patients (Low; Weak).
Laparoscopic adrenalectomy during pregnancy has proven effective in the management of primary hyperaldosteronism [131], Cushing's syndrome [132-134], and pheochromocytoma [135-140]. Laparoscopic splenectomy has also become an increasingly accepted surgical approach in pregnancy [141]. Gravid patients with antiphospholipid syndrome [142], hereditary spherocytosis [143], and autoimmune thrombocytopenia purpura [141, 144, 145] have undergone laparoscopic splenectomy with good outcomes for mother and fetus. Two cases of laparoscopic nephrectomy have been reported in the first and second trimester without any associated complications and both infants were born healthy at term [146, 147].
Adnexal Masses
Guideline 19: Laparoscopy is safe and effective treatment in gravid patients with symptomatic ovarian cystic masses. Observation is acceptable for all other cystic lesions provided ultrasound is not concerning for malignancy and tumor markers are normal. Initial observation is warranted for most cystic lesions < 6 cm in size (Low; Strong).
The incidence of adnexal masses during pregnancy is 2% [148]. Most of these adnexal masses discovered during the first trimester are functional cysts that resolve spontaneously by the second trimester [79]. 80% to 95% of adnexal masses < 6cm in diameter in pregnant patients spontaneously resolve; therefore nonoperative management is warranted in such cases. [149, 150].
Persistent masses are most commonly functional cysts or mature cystic teratomas with the incidence of malignancy reported at 2% to 6% [151]. Historically, the concern over malignant potential and risks associated with emergency surgery have led to elective removal of masses that persist after 16 weeks and are > 6 cm in diameter [150-152]. Recent literature supports the safety of close observation in these patients when ultrasound findings are not concerning for malignancy, tumor markers (CA125, LDH) are normal, and the patient is asymptomatic[153-156]. In the event that surgery is indicated, various case reports support the use of laparoscopy in the management of adnexal masses in every trimester [157-169]. Perhaps more informative, a retrospective review of 88 pregnant women demonstrated equivalent maternal and fetal outcomes in adnexal masses managed laparoscopically and by laparotomy [71].
Adnexal Torsion
Guideline 20: Laparoscopy is recommended for both diagnosis and treatment of adnexal torsion unless clinical severity warrants laparotomy (Low; Strong).
Ten to 15% of adnexal masses undergo torsion [170]. Laparoscopy is the preferred method of both diagnosis and treatment in the gravid patient with adnexal torsion [171]. Multiple case reports have confirmed safety and efficacy of laparoscopy for adnexal torsion in pregnant patients [172-176]. If diagnosed before tissue necrosis, adnexal torsion may be managed by simple laparoscopic detorsion [177]. However, with late diagnosis of torsion adnexal infarction may ensue, which can result in peritonitis, spontaneous abortion, preterm delivery and death [152, 178]. The gangrenous adnexa should be completely resected [179] and progesterone therapy initiated after removal of the corpus luteum, if less than 12 weeks gestation [177]. Laparotomy may be necessary as dictated by the patient's clinical condition and operative findings [180].
VI. Perioperative Care
Fetal Heart Monitoring
Guideline 21: Fetal heart monitoring should occur preoperatively and postoperatively in the setting of urgent abdominal surgery during pregnancy (Moderate; Strong).
While intraoperative fetal heart rate monitoring was once thought to be the most accurate method to detect fetal distress during laparoscopy, no intraoperative fetal heart rate abnormalities have been reported in the literature [57, 112]. This has led some to recommend preoperative and postoperative monitoring of the fetal heart rate with no increased fetal morbidity having been reported [58, 60].
Obstetrical Consultation
Guideline 22: Obstetric consultation can be obtained pre – and/or postoperatively based on the severity of the patient's disease, gestational age, and availability of the consultant (Moderate; Strong).
Maternal and fetal monitoring should be part of any pregnant patient's care and continue throughout her hospitalization, but the timing of a formal obstetric consultation will vary based on availability of the consultant and the severity of the patient's condition. Delaying the treatment of an acute abdominal process to obtain such a consultation should be avoided as treatment delay may increase the risk of morbidity and mortality to the mother and fetus [181].
Guideline 23: Tocolytics should not be used prophylactically in pregnant women undergoing surgery but should be considered perioperatively when signs of preterm labor are present (High; Strong).
Threatened preterm labor can be successfully managed with tocolytic therapy. The specific agent and indications for the use of tocolytics should be individualized and based on the recommendation of an obstetrician [182-185]. No literature supports the use of prophylactic tocolytics.
VII. Summary of Recommendations
More data have accumulated recently as laparoscopy has become common during pregnancy. Most of the data are found in case series and retrospective reviews which limit the ability to provide absolute guidelines. Further controlled clinical studies are needed to clarify these guidelines, and revision may be necessary as new data appear. The current recommendations for laparoscopy during surgery are:
Diagnosis and Workup
A. Imaging Techniques
- Ultrasound
Guideline 1: Ultrasonographic imaging during pregnancy is safe and useful in identifying the etiology of acute abdominal pain in the pregnant patient (Moderate; Strong).
- Risk of Ionizing Radiation
Guideline 2: Expeditious and accurate diagnosis should take precedence over concerns for ionizing radiation. Cumulative radiation dosage should be limited to 5-10 rads during pregnancy (Moderate; Strong).
- Computed Tomography
Guideline 3: Contemporary multidetector CT protocols deliver a low radiation dose to the fetus and may be used judiciously during pregnancy (Moderate; Weak).
- Magnetic Resonance Imaging
Guideline 4: MR Imaging without intravenous Gadolinium can be performed at any stage of pregnancy (Low; Strong).
- Nuclear Medicine
Guideline 5: Administration of radionucleotides for diagnostic studies is generally safe for mother and fetus (Low; Weak).
- Cholangiography
Guideline 6: Intraoperative and endoscopic cholangiography exposes the mother and fetus to minimal radiation and may be used selectively during pregnancy. The lower abdomen should be shielded when performing cholangiography during pregnancy to decrease the radiation exposure to the fetus (Low; Weak).
B.Surgical techniques
- Guideline 7: Diagnostic laparoscopy is safe and effective when used selectively in the workup and treatment of acute abdominal processes in pregnancy (Moderate; Strong).
Patient Selection
- Pre-operative Decision Making
Guideline 8: Laparoscopic treatment of acute abdominal disease has the same indications in pregnant and non-pregnant patients (Moderate; Strong).
- Laparoscopy and Trimester of Pregnancy
Guideline 9: Laparoscopy can be safely performed during any trimester of pregnancy (Moderate; Strong).
- Patient Positioning
Guideline 10: Gravid patients should be placed in the left lateral decubitus position to minimize compression of the vena cava (Moderate; Strong).
- Initial Port Placement
Guideline 11: Initial abdominal access can be safely performed with an open (Hasson) technique, Veress needle or optical trocar, if the location is adjusted according to fundal height and previous incisions (Moderate; Weak).
- Insufflation Pressure
Guideline 12: CO2 insufflation of 10-15 mmHg can be safely used for laparoscopy in the pregnant patient (Moderate; Strong).
- Intra-operative CO2 monitoring
Guideline 13: Intraoperative CO2 monitoring by capnography should be used during laparoscopy in the pregnant patient (Moderate; Strong).
- Venous Thromboembolic (VTE) Prophylaxis
Guideline 14: Intraoperative and postoperative pneumatic compression devices and early postoperative ambulation are recommended prophylaxis for deep venous thrombosis in the gravid patient (Moderate; Strong).
- Gallbladder Disease
Guideline 15: Laparoscopic cholecystectomy is the treatment of choice in the pregnant patient with gallbladder disease, regardless of trimester (Moderate; Strong).
- Choledocholithiasis
Guideline 16: Choledocholithiasis during pregnancy may be managed with preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy followed by laparoscopic cholecystectomy, laparoscopic common bile duct exploration, or postoperative ERCP (Moderate; Strong).
- Laparoscopic Appendectomy
Guideline 17: Laparoscopic appendectomy may be performed safely in pregnant patients with appendicitis (Moderate; Strong).
- Solid Organ Resection
Guideline 18: Laparoscopic adrenalectomy, nephrectomy, splenectomy and mesenteric cyst excision are safe procedures in pregnant patients (Low; Weak).
- Adnexal Mass
Guideline 19: Laparoscopy is a safe and effective treatment in gravid patients with symptomatic ovarian cystic masses. Observation is acceptable for all other cystic lesions provided ultrasound is not concerning for malignancy and tumor markers are normal. Initial observation is warranted for most cystic lesions < 6 cm in size (Low; Strong).
- Adnexal Torsion
Guideline 20: Laparoscopy is recommended for both diagnosis and treatment of adnexal torsion unless clinical severity warrants laparotomy (Low; Strong).
Perioperative care
- Fetal Heart Monitoring
Guideline 21: Fetal heart monitoring should occur pre and postoperatively in the setting of urgent abdominal surgery during pregnancy (Moderate; Strong).
- Obstetrical Consultation
Guideline 22: Obstetric consultation can be obtained pre- and/or postoperatively based on the severity of the patient's disease and availability (Moderate; Strong).
- Tocolytics
Guideline 23: Tocolytics should not be used prophylactically in pregnant women undergoing surgery but should be considered perioperatively when signs of preterm labor are present (High, Strong).
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- Condous G, Khalid A, Okaro E, Bourne T (2004) Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol 24:62-66
- (2007) ACOG Practice Bulletin. Management of adnexal masses. Obstetrics and gynecology 110:201-214
- Nezhat F, Nezhat C, Silfen SL, Fehnel SH (1991) Laparoscopic ovarian cystectomy during pregnancy. J Laparoendosc Surg 1:161-164
- Parker WH, Levine RL, Howard FM, Sansone B, Berek JS (1994) A multicenter study of laparoscopic management of selected cystic adnexal masses in postmenopausal women. J Am Coll Surg 179:733-737
- Tazuke SI, Nezhat FR, Nezhat CH, Seidman DS, Phillips DR, Nezhat CR (1997) Laparoscopic management of pelvic pathology during pregnancy. J Am Assoc Gynecol Laparosc 4:605-608
- Chung MK, Chung RP (2001) Laparoscopic extracorporeal oophorectomy and ovarian cystectomy in second trimester pregnant obese patients. JSLS 5:273-277
- Yuen PM, Chang AM (1997) Laparoscopic management of adnexal mass during pregnancy. Acta Obstet Gynecol Scand 76:173-176
- Loh FH, Chua SP, Khalil R, Ng SC (1998) Case report of ruptured endometriotic cyst in pregnancy treated by laparoscopic ovarian cystectomy. Singapore medical journal 39:368-369
- 163. Stepp KJ, Tulikangas PK, Goldberg JM, Attaran M, Falcone T (2003) Laparoscopy for adnexal masses in the second trimester of pregnancy. J Am Assoc Gynecol Laparosc 10:55-59
- Neiswender LL, Toub DB (1997) Laparoscopic excision of pelvic masses during pregnancy. J Am Assoc Gynecol Laparosc 4:269-272
- Yuen PM, Ng PS, Leung PL, Rogers MS (2004) Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy. Surg Endosc 18:1354-1357
- 166. Parker J, Watkins W, Robinson H, Byrne D (1995) Laparoscopic adnexal surgery during pregnancy: a case of heterotopic tubal pregnancy treated by laparoscopic salpingectomy. Aust N Z J Obstet Gynaecol 35:208-210
- Moore RD, Smith WG (1999) Laparoscopic management of adnexal masses in pregnant women. J Reprod Med 44:97-100
- Lin YH, Hwang JL, Huang LW, Seow KM (2003) Successful laparoscopic management of a huge ovarian tumor in the 27th week of pregnancy. A case report. J Reprod Med 48:834-836
- Mathevet P, Nessah K, Dargent D, Mellier G (2003) Laparoscopic management of adnexal masses in pregnancy: a case series. Eur J Obstet Gynecol Reprod Biol 108:217-222
- Struyk AP, Treffers PE (1984) Ovarian tumors in pregnancy. Acta Obstet Gynecol Scand 63:421-424
- Nichols DH, Julian PJ (1985) Torsion of the adnexa. Clin Obstet Gynecol 28:375-380
- Mage G, Canis M, Manhes H, Pouly JL, Bruhat MA (1989) Laparoscopic management of adnexal torsion. A review of 35 cases. J Reprod Med 34:520-524
- Garzarelli S, Mazzuca N (1994) One laparoscopic puncture for treatment of ovarian cysts with adnexal torsion in early pregnancy. A report of two cases. J Reprod Med 39:985-986
- Morice P, Louis-Sylvestre C, Chapron C, Dubuisson JB (1997) Laparoscopy for adnexal torsion in pregnant women. J Reprod Med 42:435-439
- Abu-Musa A, Nassar A, Usta I, Khalil A, Hussein M (2001) Laparoscopic unwinding and cystectomy of twisted dermoid cyst during second trimester of pregnancy. J Am Assoc Gynecol Laparosc 8:456-460
- Bassil S, Steinhart U, Donnez J (1999) Successful laparoscopic management of adnexal torsion during week 25 of a twin pregnancy. Hum Reprod 14:855-857
- Argenta PA, Yeagley TJ, Ott G, Sondheimer SJ (2000) Torsion of the uterine adnexa. Pathologic correlations and current management trends. J Reprod Med 45:831-836
- Tarraza HM, Moore RD (1997) Gynecologic causes of the acute abdomen and the acute abdomen in pregnancy. Surg Clin North Am 77:1371-1394
- Oelsner G, Bider D, Goldenberg M, Admon D, Mashiach S (1993) Long-term follow-up of the twisted ischemic adnexa managed by detorsion. Fertil Steril 60:976-979
- Cappell MS, Friedel D (2003) Abdominal pain during pregnancy. Gastroenterol Clin North Am 32:1-58
- Sharp HT (2002) The acute abdomen during pregnancy. Clin Obstet Gynecol 45:405-413
- Katz VL, Farmer RM (1999) Controversies in tocolytic therapy. Clinical obstetrics and gynecology 42:802-819
- Berkman ND, Thorp JM, Jr., Lohr KN, Carey TS, Hartmann KE, Gavin NI, Hasselblad V, Idicula AE (2003) Tocolytic treatment for the management of preterm labor: a review of the evidence. American journal of obstetrics and gynecology 188:1648-1659
- Tan TC, Devendra K, Tan LK, Tan HK (2006) Tocolytic treatment for the management of preterm labour: a systematic review. Singapore medical journal 47:361-366
- Romero R, Sibai BM, Sanchez-Ramos L, Valenzuela GJ, Veille JC, Tabor B, Perry KG, Varner M, Goodwin TM, Lane R, Smith J, Shangold G, Creasy GW (2000) An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a randomized, double-blind, placebo-controlled trial with tocolytic rescue. American journal of obstetrics and gynecology 182:1173-1183
Table 1 – GRADE system for rating the quality of evidence for SAGES guidelines
|Quality of Evidence
|Symbol Used
High quality
|Further research is very unlikely to alter confidence in the estimate of impact
Moderate quality
|Further research is likely to alter confidence in the estimate of impact and may change the estimate
Low quality
|Further research is very likely to alter confidence in the estimate of impact and is likely to change the estimate
Very low quality
|Any estimate of impact is uncertain
Adapted from Guyatt et al.
Table 2 – GRADE system for recommendations based on the quality of evidence for SAGES guidelines
|It is very certain that benefit exceeds risk for the option considered
|Risk and benefit well balanced, patients in differing clinical situations would make different choices, or benefits available but not certain
Adapted from Guyatt et al.
4. Guyatt GH, Oxman AD, Vist GE, et al; GRADE Working Group. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-6.
Table 3. Radiation Exposure to Conceptus in Common Radiologic Studies [15, 33, 34]
|Radiation Exposure (rads)
|Abdominal Radiograph
|Intraoperative Cholagiography
|Lumbar Spine Radiograph
|Intravenous Pyelogram
|Barium Enema
|CT of Pelvis
|ERCP(without pelvic shielding)
This statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) on Sep 2007.
This is a revision of SAGES publication #23 printed Jan 2011, revised Sep 2007.
For more information please contact:
11300 West Olympic Blvd., Suite 600
Los Angeles, CA 90064
- Tel:
- (310) 437-0544
- Fax:
- (310) 437-0585
- Email:
- firstname.lastname@example.com
Guidelines for clinical practice are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Guidelines are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to indicate the preferable, but not necessarily the only acceptable approaches due to the complexity of the healthcare environment. Guidelines are intended to be flexible. Given the wide range of specifics in any health care problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision.
Guidelines are developed under the auspices of the Society of American Gastrointestinal and Endoscopic Surgeons and its various committees, and approved by the Board of Governors. Each clinical practice guideline has been systematically researched, reviewed and revised by the guidelines committee, and reviewed by an appropriate multidisciplinary team. The recommendations are therefore considered valid at the time of its production based on the data available. Each guideline is scheduled for periodic review to allow incorporation of pertinent new developments in medical research knowledge, and practice.


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Former USC women's volleyball player Kelli Tennant, whose rise up the ranks in the sports broadcasting world has now landed her as a host on Time Warner Cable SportsNet and SportsNet LA, has authored a book, "The Transition: Every Athlete's Guide To Life After Sports." Inspired by the challenges she faced when her playing career was cut short by injury, Tennant began working on the book in 2009. She openly writes about her struggles and also includes real-life anecdotes from numerous professional, Olympic and collegiate athletes, including ex-Laker Luke Walton, who wrote the book's foreword. The book concludes with a game plan to help athletes adjust.
Tennant's goal is to get the book into the hands of as many transitioning athletes as possible, from the high school to the pro levels."The cheering will stop," Tennant writes. "This book is to help prepare you before that day comes so you have the tools to make the transition, successfully." "The Transition" is available on Amazon or Kindle. A portion of the proceeds from the book will go to charities that benefit disadvantaged athletes, including USC's Swim With Mike.


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After 19 years at university, training first as a lawyer and then as a neurosurgeon, Dr. Robert "Bob" Elgie turned his formidable intellect to politics as a Conservative MPP and cabinet minister.
Whatever he did, he was always adept at getting his point across with a few well-chosen words.
When Liberal leader Stuart Smith, a psychiatrist, interrupted him during question period, Dr. Elgie turned to the Speaker of the House, saying, "Mr. Speaker, would you please advise the member from Hamilton West that I am not on his couch today. He is on my operating table, so tell him to listen."
In the seventies, as chief of medical staff at Scarborough General Hospital, he lobbied heavily for a CAT scanner. The board turned him down.
During a retirement dinner, Dr. Elgie presented the head of the hospital with his self-proclaimed "chicken" award.
As Dr. Elgie explained to stunned guests, the chicken was in fact a capon from his freezer and entirely appropriate because it was, "a rooster that lost its balls." A CAT scanner duly arrived.
This victory was a source of pride for Dr. Elgie, a man with a wry sense of humour who devoted himself to public service until his death on April 3 at 84. The cause was suspected congestive heart failure.
Despite an illustrious career in medicine, politics had always been at the back of Dr. Elgie's mind. Growing up in a political family, he strongly believed that, by influencing public policy, he could continue to improve people's lives.
He entered the political arena in 1977, and was handily elected as the Conservative member for Toronto's York East. He went on to hold portfolios in Labour, Consumer and Commercial Relations, and Community and Social Services in various Conservative cabinets.
In 1978, thanks to Dr. Elgie's efforts as minister of labour, amendments to Ontario's Human Rights Code passed into law: People with disabilities could no longer be discriminated against.
David Lepofsky, a blind lawyer who worked with Dr. Elgie battling line by line over the bill, writes, "More than three decades later, this huge advance in disability rights continues to massively benefit over 1.7 million Ontarians with disabilities. Dr. Elgie didn't do it because it would win seats for his party or bump them up in the polls. He didn't do it for a legacy because many won't remember. He did it simply because it was the right thing to do. He was a man of great conscience."
Dr. Elgie, a red Tory who supported unions, was beloved by labour. During an MPP swearing-in ceremony for one of Frank Miller's governments, too far to the right for Dr. Elgie's liking, he eschewed the traditional dark blue suit, opting instead for a brown one over a pink shirt. The Clerk of the Assembly remarked, "I think you're trying to send a message, Dr. Elgie."
When the Liberals returned to power in 1985, Dr. Elgie had no interest in being a backbencher. He formally resigned and accepted an appointment as chairman of the Workers Compensation Board, where he served until 1991.
While there, he created a tribunal to adjudicate the concerns of disaffected workers.
Later that same year, Dr. Elgie moved to Halifax, where he founded Dalhousie University's Health Law Institute, for which he received an honorary degree. He also served half time as chairman of the province's Workers' Compensation Board, and spent eight days a month in Ottawa heading the Patented Medicine Prices Review Board, the body that sets prices for medications.
On his blog, Steve Paikin, host of TVO's nightly public-affairs program The Agenda, refers to Dr. Elgie as "One of the most brilliant and compassionate MPPs Queen's Park has ever known."
Bob Rae, who was interim leader of the federal Liberal Party and former NDP premier of Ontario, wrote via e-mail, "He was smart, courteous, with a great sense of humour and great warmth. No one reflected the traditions of progressive conservatism more than Bob Elgie. I loved the guy."
While law or medicine could individually provide a lucrative income, Dr. Robert Elgie was motivated less by money than the desire to leave the world a better place.Report Typo/Error
Follow us on Twitter: @GlobePolitics


text: NEW YORK, Jan. 22, 2013 /PRNewswire/ -- Newtek Business Services, NASDAQ: NEWT, The Small Business Authority , is proud to announce that it has attracted and retained the talents of a legendary executive in the electronic payment processing and technology space – Randy Sagar. Randy has joined as Executive Vice President of Business Development and will be opening an office in Louisville, Kentucky. Randy is a former partner in Financial Alliance and was the EVP of sales and marketing for National Processing Company of Kentucky (NPC) and its successor Bank of America Merchant Services, where he was responsible for building a team of professionals who added over 8,000 new merchant accounts per month through its Wholesale, ISO, Agent Banks and Direct programs. Randy has been active in the Electronic Transaction Association for 15 years where he has authored or coauthored numerous whitepapers. Additionally, Randy has 20 years experience in the acquiring side of the business and is a National City Bank Excel award winner for revenue company wide. Randy has retained the services of two well-established executives, Mike Valerio and William Berry, who will focus on developing the Independent Sales Agent ("ISA") and Independent Sales Organization ("ISO") electronic payment channels. Both Mike and William have spent most of their careers establishing and creating distributional channels. William's primary focus has been on developing relationships with agent banks and credit unions and William will extensively utilize the patented Newtracker system to further grow and develop Newtek's strategic alliance partner channel. Mike brings more than 12 years of experience in helping ISOs and ISAs build their business and boost their bottom line. Randy, Mike and William are highly focused on growing customer count and distributing Newtek's full suite of products, including but not limited to the Newtek Advantage™ operating platform and its business applications that focus on payroll, insurance, web traffic statistics and merchant processing in the cloud. Barry Sloane, Chairman, President and Chief Executive Officer of Newtek Business Services said, "We are overjoyed at the prospect of hiring multiple professionals at this talent level to help catapult the company to greater levels in areas of sales, marketing and senior operating management. In these areas, we could have done no better than by acquiring the team of Randy Sagar, William Berry and Mike Valerio. In their past experiences at NPC and Bank of America, their ability to open up thousands of electronic payment processing accounts through direct channels of individual agents, agent banks and credit unions clearly puts them at the top of their class. They are equally excited at the opportunity to cross-sell and cross-market the Newtek Advantage™ operating platform and distribute payroll, insurance, small business loans and other eCommerce solutions to small and medium sized businesses in the United States." Randy Sagar said, "Introducing our clients to Newtek will be like finding a diamond in the rough for many merchant service providers as well as the end user, the actual merchant. The Newtek Advantage™ is a great platform for business and ISOs alike, in that it allows a user to plug in multiple products, many of which are cloud based. End result, for ISOs - more revenue opportunities, and for their merchants - a one-stop shop for all their business needs serviced by one sales entity. I am excited to be associated with the talent level assembled at Newtek and feel there is a game changer in the Newtek Advantage™ platform." Also joining Newtek will be Sundeep (Sunny) Dronawat as Executive Vice President and Advisor to the Chairman. Sunny will be focused on working with Newtek's technological products such as future offerings in the areas of cyber-security and POS in the cloud for eCommerce clients. Sunny is the former CTO, LISG and VP of e-Commerce at Integrity Life, Western Southern Financial. He is Co-Founder of Rural America Onshore Outsourcing and POS on Cloud. Sunny has a MBA in Marketing and a Ph.D. in Chemical Engineering from University of Louisville. Sunny is certified in Six Sigma, and is a Fellow of Financial Services Institute (FFSI) and Life Office Management Institute (FLMI). Sunny is also a "Kentucky Colonel." He was awarded the MOSIAC outstanding immigrant award by Jewish Community and Family Services of Louisville. Sunny is also involved in community activities and is President of Indian Community of Kentucky, Board Member of Kentucky State Parks Foundation, Co-founder and Board member of Indian Professionals Council of Kentucky. Barry Sloane, Chairman, President and Chief Executive Officer of Newtek Business Services said, "Sunny Dronawat is one of the brighter technological minds in the finance and business services market today. Sunny brings with him the keen sense of state of the art technologies and solutions that small and independent business owners will require to operate their businesses in years to come." Sunny Dronawat said, " Newtek represents a tremendous opportunity to provide small businesses the state of the art technologies and applications that currently exist within its four walls. Newtek attracted me with its superior product sets offered to small businesses to help them succeed. The Newtek management team and organization made it an easy decision to join them. I look forward to working with this world class team." Randy and Sunny will report directly to Barry Sloane, Chairman, President and Chief Executive Officer of Newtek Business Services. About Newtek Business Services, Inc.


text:
Cameron Hayley made a turn four pass for the lead when Gray Gaulding overdrove turn four and Haley got by on the inside for the win in the NASCAR K&N Pro Series Battle at the Beach race. The 16-year old Canadian Hayley was excited to win at Daytona.
"I don't even know what to say this is the most incredible feeling ever. I don't even know what to say," Hayley said in victory lane. "Gene Price Motorsports gave me a heck of a car to do this."
Hayley will take over the #24 car for Gene Price Motorsports after Dylan Kwasniewski moved on to the K&N East Series and Turner Scott Motorsports. Hayley passed Gray Gaulding in the final corner after Gaulding spun out leader Michael Self a lap earlier. Self was leading after Greg Pursley got turned by Cale Conley on lap 128. Pursley led all 127 laps prior to the incident and would finish ninth.
The race was slowed 10 times for caution including an accident that took out Dylan Kwasniewski. He finished 27th. John Hunter Nemechek finished 28th after a scary accident took him out of the race on lap 57.
The final caution of the night flew with two laps to go when Cale Conley was spun out after contact with D.J. Kennington. Conley would finish 11th.
That set the race up for an epic green white checkered finish in which the contact between Gaulding and Self was made. Gaulding thinks he slipped on oil in the final corner that made the car slide to the high side in turn four, opening the door for Hayley to slide on by for victory.
It was a great two days of racing on the short track at Daytona. Wednesday practice for the Budweiser Duels will begin for the NASCAR Sprint Cup Series.Tags: Cale Conley, Cameron Hayley, D.J. Kennington, Dylan Kwasniewski, Gene Price Motorsports, Gray Gaulding, Greg Pursley, Michael Self, Motorsports, NASCAR


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The South African Broadcast Corporation (SABC) will broadcast the post budget breakfast with Minister of Finance Pravin Gordhan.
The broadcast is set to take place on Thursday on SABC 2 from 06h30 to 07h15.
"The SABC remains committed to ensuring that it delivers on its mandate and brings news of national importance to the millions of South African audiences," reads the SABC statement in part.
The statement further says, "This announcement follows an article in the Sunday Times newspaper published last weekend where it was reported that the budget breakfast will only be broadcast by a private broadcaster. The Acting Group Chief Executive Officer, Mr. Jimi Matthews and Chief Operations Officer, Mr. Hlaudi Motsoeneng interacted with the Office of the Minister and the Director-General to resolve this matter."
One of the biggest challenges Finance Minister will face when he delivers his Budget Speech on Wednesday is dealing with the possibility of a downgrade. He will have to convince investors and rating agencies that confidence in the economy can be achieved.
Gordhan will have to explain what government will do differently to avoid a downgrade to junk status. He will have to deliver what he promised when he was re-appointed in 2015.
"We will seek to increase investment by the 2017 budget. We are going to double our efforts to ensure that efficiency of expenditure across the public service. We have been clear that one of the risks to our fiscal framework is the financial state of state owned companies."


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Jay D. Ducote Creates Louisiana Barbecue Sauce
Sometimes it can be hard not to think Louisiana cuisine was forged by earth's hottest fires. Every table of deliciously spicy jambalaya or blackened redfish is replete with a variety of hot sauces: Crystal, Tabasco, Louisiana, Mindy's, etc. For all that spice, though, there isn't much in the way of barbecue sauce. One food blogger decided this was unacceptable.
Meet Jay D. Ducote. He's many things: Louisiana food blogger, radio personality, and founder of Bite and Booze, owner of a fantastic beard, (presumably) reamed out by Gordon Ramsey at least once en route to being named a top 100 amateur chef by MasterChef. He also has created one of the first iterations of something that should have existed long ago: a Louisiana barbecue sauce.
And why not? All those other states have their versions. It was time for the Boot to step it up, and who better to lead the charge than a man who's been eating food for a living since 2009? Sure, he's got a master's in political science, but he's also got a trained palate (and is a trained cast-iron tailgating chef). And he's chock full of opinions re bottled barbecue sauces.
"The strong, strong majority of what's on the market is really nothing but glorified ketchup," he tells me.
It's certainly not Louisiana.
"Louisiana is not known for its distinctive barbecue style, not like the rest of the South," he says. "We have hot sauces, but not barbecue. I just wanted to create a different style of sauce that could be defined as Louisiana style."
So he took what was best about Louisiana sauces–that delicious, vinegary spice of our hot sauces–and put it through a barbecue filter.
"One way to look at it is it's a hybrid of a lot of different styles from around the American South with some of those flavors that are indigenous to Louisiana," he says.
The result? A lighter sauce that won't burn in the pan. Each bite starts off sweet before a firestorm rages down your esophagus (in a good way!). Tomato, apple cider vinegar, Louisiana cane syrup and brown sugar, creole mustard, hot sauce, and more blend together into a "medley of a lot of different flavors you'd see in Louisiana cooking and barbecue sauces across the country."
Louisiana might not famous for its barbecue, but this sure isn't a bad start.


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Nurses and UMDNJ Hospital Reach Deal on Abortions
A federal judge says a major New Jersey hospital and 12 nurses who claimed they were forced to assist in abortions over their religious and moral objections have reached a deal.
Attorneys for the nurses and the University of Medicine and Dentistry of New Jersey met with U.S. District Judge Jose Linares in Newark on Thursday and hammered out an agreement on the nurses' lawsuit.
Linares says the deal allows the nurses to remain in their current positions and doesn't compel them to assist in any part of an abortion procedure. They must only help in a life-threatening emergency if no other staff members are available.
The hospital has denied the nurses' claims that UMDNJ changed its policies to require them to assist with abortions or risk losing their jobs.


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Will Ferrell & Zach Galifianakis Premiere "The Campaign"
Teaming up for a fun-filled evening, Will Ferrell and Zach Galifianakis were in the house for the premiere of their new movie "The Campaign" in Hollywood last night (August 2).
The "Anchorman" legend wore a dark suit and gave a coy smile as he posed for the paparazzi outside Grauman's Chinese Theater.
Meanwhile, Galifianakis opted for a grey coat and trousers with a salmon shirt and red tie while peering out at the world from behind his bushy beard.
And Brooke Shields added some feminine flair to the fete, hobnobbing with fellow guests before the screening began.
Due to hit theaters on August 10th, "The Campaign" is about long term congressman Cam Brady's bid to defeat newcomer Marty Huggins in a North Carolina district race.


text:
Help:Job queue
From semantic-mediawiki.org
|Table of Contents
This page advises on doing maintenance by using a shell script to work on the jobs piped into a job queue by Semantic MediaWiki, but also by MediaWiki itself and other extensions relying on jobs.
Cron job
$wgJobRunRate = 0; in your "LocalSettings.php" file and create the script in a file called "runJobs.sh":1
- runJobs.sh
#!/usr/bin/env bash
# will be executed by a cron-job
RUNNING=$(ps aux | grep /mediawiki/maintenance/runJobs.php | grep maxjobs)
if [ -z $RUNNING ];
then su XXX -c "php $MEDIAWIKI/maintenance/runJobs.php --maxjobs=999";
Email 1 further explains that "... XXX to a user that should execute runJobs.php ... have CRON execute the shell-script every minute or so.".
- JobQueueRedis and SMW is reported to fail with "JobQueueRedis.php: Redis server error: Could not insert 1 htmlCacheUpdate job(s)" issue
- mws:JobQueue
Mail discussions
- MediaWiki Job queue problem about "stuck" Jobs
- SMW UpdateJob error
- Job queue affecting semantic queries in MW 1.22
- many runjobs about 7000 jobs (refreshLinksDynamic) after a day


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[Re: Goodbye To All That: Nature and the Future Body in Sri Aurobindo by RY Deshpande on Mon 28 Apr 2008 04:44 AM PDT Profile Permanent Link
Your quotes from the Letters belong to the early 1930s. Much happened in the spiritual tapasya later, and happened very rapidly, witness for instance the autobiographical sonnet The Golden Light dated 8 August 1938... Quotes from the Supramental Manifestation trace the various possibilities which Sri Aurobindo the Yogi was examining from the point of view of the Divine Body...]
[I speak as a historian: one who uses documentary and other evidence to reconstruct the past in order to understand the present better. A historian generally begins with a problem: an event or line of development that has not been sufficiently studied or is commonly misunderstood. Sri Aurobindo's relationship to Hinduism is such a problem.... Since I speak to you as a historian, I will present my findings chronologically. -- Sri Aurobindo and Hinduism (a speech by Peter Heehs: Hyderabad 2006) by Rich on Sat 22 Mar 2008 11:40 AM PDT Permanent Link Sri Aurobindo and Hinduism] [PDF - Sri Aurobindo and Hinduism - Apr 29 - View as HTML ... www.anti-matters.org/ojs/index.php/antimatters/article/view/73/]Let's not nurture this double edged weapon of chronology. [TNM] 7:46 AM


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Hermes Eau des Merveilles Twilly Set
Marvelous, dahling! A 3.3 oz Eau des Merveilles spray, Shower Gel, Body Cream, Purse Spray...and an adorable silk twilly to tie on your purse, wrist, neck, or in your hair.
a little lime, a little coconut... white bergamot... aahhh!!!! the scent of summer!
One of my favorite scents. Light and fresh with floral and fruity notes. Perfect for spring.Tags: beauty, perfume, fragrance, scents, Juicy Couture, fashionista, Delish, floral, juicyAdded 9 Years Ago from Juicy Couture
Liking Bond No.9 fragrances makes me feel a little too trendy for my own good - but I just can't help myself. The fragrances are fantastic and the bottle design is amazing.


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The second release from his upcoming album Indicud, King WIzard is a killer track with a very spacey, heady feel to it. This Cudi-produced jam comes complete with intricate lyrics and a mid-tempo beat. Continue Reading
First released in October, Afrojack finally came out with a music video for Can't Stop Me. I've been bumping this great party song for awhile now, and this accompanying music video is killer. The video Continue Reading
Boom. Styles & Complete are at it again with their latest single Hold on LIl Girl. The dynamic duo from my stomping grounds of North Carolina have been absolutely electric lately. Hold on Lil Continue Reading
Here is the brand-new music video for Flux Pavillion's Day Dreamer. Known for their awesome beats, Flux Pavillion teamed up with singer Example to add a whole new dimension to their music. With the Continue Reading
Can 5 & A Dime do any wrong when it comes to making music? It seems that everything that they put out is just monstrous. Their newest single, Breaking Single is just another example of what we have come Continue Reading
Here we go again with another hit from 3LAU. Pronounced Blau, the 21 year-old from Vegas has been absolutely killing it lately. His remix of Tristen Garner's Action is awesome. The original song samples Continue Reading
The latest remix from Madeon is simply awesome. He uses his unique style while remixing Martin Solveig's, The Night Out. This monster jam is just what we've come to expect from Madeon. By adding a very Continue Reading
White Panda's latest album is simply killer. Bambooyah! is about 50 minutes in length, but listening to the whole thing is definitely worth it. With so many different samples featured, you are getting a Continue Reading
Straight off their album Big G, Cherub's recently released video for Hold Me is an awesome example of why they will become a household name, shortly. If you aren't already listening to Cherub, you Continue Reading
The newest single from 5 & A Dime, Can't Stop Won't Stop, puts a ton of different samples on a track that is simply killer. By combining all of these different samples, there is never a dull moment while Continue Reading