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SAMJ: South African Medical Journal
On-line version ISSN 2078-5135
Print version ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.100 n.11 Cape Town Nov. 2010
Maternal deaths associated with eclampsia in South Africa: lessons to learn from the Confidential Enquiries into Maternal Deaths, 2005 - 2007
J Moodley, for the National Committee on Confidential Enquiries into Maternal Deaths, National Department of Health, South Africa
Hypertensive disorders of pregnancy (HDP) are the commonest medical complication in pregnancy, and remain the commonest direct cause of maternal mortality in South Africa.1 The latest (2005 - 2007) Saving Mothers report (SMR) indicates that there were 622 maternal deaths from HDP during this period, virtually the same as in the 2002 - 2004 report.1,2 Numbers of deaths reported in the two previous SMRs were 507 for 1999 - 20013 and 628 for 2002 - 2004;2 these differences probably indicate under-reporting in the triennium 1999 - 2001. The most recent reports, 2002 - 20042 and 2005 - 2007,1 better reflect the numbers of maternal deaths from HDP.
Maternal deaths in South Africa are notifiable to the Department of Health (DoH) and are reported in a structured 'Maternal death notification form', which contains demographic data and clinical details surrounding the primary and secondary causes of death. This form, together with a copy of the hospital records, is sent to the provincial Maternal, Women and Child Cluster, which has trained assessors (an experienced maternal health specialist and a midwife) to formulate a confidential opinion on any sub-standard care based on patient-related, administrative and health personnel-related factors. Assessments are collated every 3 years and published as the SMR, which includes recommendations to reduce maternal deaths.
Causes of hypertensive maternal deaths in South Africa
Table I shows the primary causes of deaths in the sub-categories of hypertensive disorders that are similar to the 2002 -2004 report.2 Eclampsia accounted for 55.3% (N=344) of the deaths in the period 2005 - 2007 and cerebral complications for 283 (45.5%). Other causes of deaths included multi-organ failure, cardiac failure, metabolic complications and disseminated intravascular coagulation.
Demographic data
Of the 344 women who died from eclampsia, 171 were younger than 24 years, and of these 83 were below the age of 20 years; 50 were above the age of 35 years. Most women who died from eclampsia were also of low parity; 182 were primigravidas and 129 were of parity 1 - 3.
Timing of the emergency event
A large proportion of deaths occurred in the postpartum period. Most of these women had their convulsions in the antenatal period (N=322); 20 had their first convulsion in the postpartum period either in hospital, or at home after discharge from hospital.
Avoidable factors (N=344)
Patient avoidable factors were mainly related to delay in seeking help and infrequent attendance for antenatal care; 180 (60%) of the 344 women who died had attended an antenatal clinic.
The major administrative factors were delay in transport between institutions (11%) and communication problems between institutions and in institutions (11%). Others included delay in transport from home to institution, barrier to entry, lack of accessibility, lack of health personnel, and lack of appropriately trained staff.
Health care provider avoidable factors in 336 assessable deaths related mainly to delay in referring patients (N=63; 18%); management at an inappropriate level of health care facility (N=73; 21%); substandard care but correct diagnosis (N=106; 31%); failure to diagnose (N=68; 20%); and infrequent monitoring (N=27; 8%).
Clinical features of severe pre-eclampsia are often not taken into account by inexperienced health personnel. In our current understanding of the causation of pre-eclampsia, delivery of the fetus and placenta leads to cure. Since these women are still at risk of complications from the disease process in the period immediately after delivery, continued frequent observations of the pulse rate, blood pressure, urinary output, level of consciousness and potential signs of pulmonary oedema must be ensured. Antihypertensive therapy must be continued and should not be stopped abruptly. Magnesium sulphate (MgSO4) should be continued for at least 24 hours after delivery. All laboratory tests must be repeated within 4 - 6 hours after delivery and results reviewed. Patients should not be discharged until their blood pressure levels have been stable for a period of at least 24 hours. Furthermore, they should be asked to return to the postnatal clinic of the hospital within a week and only referred to a community clinic when all physical and laboratory tests have returned to normal (this should have taken place within 7 days of delivery). Advice on contraception, further pregnancies and the place (level of health care facility) of future antenatal care should be provided.
Eclampsia is the commonest direct cause of maternal death in South Africa, which is of concern since it is preventable if pre-eclampsia is detected early and managed by early delivery. In under-resourced countries, the availability of MgSO4 and the lack of protocols of management are significant issues associated with maternal deaths due to pre-eclampsia.4,5 In South Africa these factors should not be issues, as MgSO4 is widely available and on the essential drugs list for level 1 health facilities (district hospitals and clinics). Clinical guidelines for management of HDP, and in particular the management of obstetric emergencies,6,7 have been widely distributed to all hospitals and clinics, but are perhaps not reaching all health professionals. Regular face-to-face teaching and emergency drills on the labour ward floor may improve the situation.
Intracranial haemorrhage remains the commonest final cause of death in HDP. Although the exact mechanisms that cause hypertension and intracranial haemorrhage are not clearly understood, it appears that systolic and diastolic hypertension play a role. It is generally accepted that diastolic blood pressures of >110 mmHg are linked with intracranial pathology, but recently systolic hypertension has also been found to play a significant role. A systolic blood pressure value above which urgent antihypertensive treatment should be given has been identified as 155 -160 mmHg.8 The latest Why Women Die publication (2003 -2005) recommends that 'women with a systolic blood pressure of >160 mmHg need antihypertensive treatment. Consideration should also be given to initiating antihypertensive treatment at lower blood pressure values if the overall clinical picture suggests rapid deterioration with anticipation of severe hypertension.'9
In this audit, among the 207 women who had cerebral complications, the average blood pressures were systolic 177 mmHg (range 103 -244) and diastolic 115 (range 74 -162). These extremely high systolic and diastolic blood pressures imply that young women with severe preeclampsia and eclampsia require rapid but smooth lowering of high blood pressure. This is particularly important as most of the patients are young with an abrupt onset of hypertension. Eighty per cent of 207 women who had convulsions were primigravidas, and their mean age was 27 years (range 13 -45); 16 had systolic blood pressures of >160 mmHg with diastolic blood pressures of less than 110 mmHg. High blood pressure is of extreme importance and must be lowered rapidly, and blood pressure should be measured frequently during the acute phase.10 Although contentious, attention should also be given to the use of benzodiazepines to arrest seizures. It is likely that the blood pressures rise further during seizures and that most cerebrovascular accidents occur at this time, particularly in patients with low platelet counts. In South Africa, oral nifedipine, dihydralazine and labetalol are used for this purpose.7,8,11
In the 2005 -2007 SMR, cardiac failure (32.8%) and renal failure (10.3%) were assigned as the final and contributory causes of maternal deaths (Tables I and II).1 The number of deaths due to renal failure has declined in the 2005 -2007 report, but those from cardiac failure have increased since the 2002 -2004 report. In the hospital records of the patients it is difficult to distinguish between death from cardiac failure and fluid overload from renal failure because cardiac failure might lead to hypotension or pulmonary oedema or both; respiratory failure also carries the inference of tachypnoea, which may develop for many reasons, including pulmonary oedema. It is likely that all these terms may indicate deaths due to pulmonary oedema. It is of concern that the number of deaths from cardiac failure (probably pulmonary oedema) have increased in the 2005 -2007 SMR, particularly when guidelines on fluid balance are available.2 In the latest UK report (Why Women Die) there were no deaths from pulmonary causes alone, an improvement probably due to the availability of good fluid management clinical protocols.9
In a report on maternal deaths related to hypertension, one of 27 deaths between 2000 and 2004 was due to cardiac failure. The authors point out that obstetricians should be aware that postpartum mobilisation of extracellular water and subsequent shift into the intravascular compartment can aggravate hypertension.11
Fluid overload should be recognised early and treated adequately. Detecting patients at risk by history and examination, early referral and appropriate critical care is therefore essential for patients with severe pre-eclampsia.
Infrequent antenatal attendance remains a challenge. In South Africa's public hospitals most women 'book' for antenatal care, but often after the 22nd week of pregnancy, and attend infrequently. The last report emphasised community education on the benefits of antenatal care, but this appears not to have been implemented. Public health education and involvement of partners and families should again be a priority.
In the previous report2 the issue of 'hidden pregnancies' was highlighted. In this report many young women died from eclampsia; specifically, 3 teenagers aged 13, 14 and 15 years had 'hidden pregnancies', so there was considerable delay in seeking help. Education, provision of contraception and family support are key factors in preventing teenage pregnancies.
Maternity care is free of charge in South Africa and access to antenatal clinics widely available, so other social and cultural factors may be causing pregnant teenagers not to attend antenatal clinics. Improvement in education and dissemination of health information on radio, television and the print media may help to overcome this challenge. More specifically, education of antenatal attendees at time of booking and at every visit should be emphasised. Women with chronic hypertension or those with pre-eclampsia being treated as outpatients should be informed about the likely complications and steps to take if these symptoms occur.
The previous report2 also highlighted problems related to emergency management and recommendations were made regarding undergraduate, postgraduate and continuing professional education, including that all doctors should undergo a course on emergency resuscitation before registering as general practitioners; handson courses on mannequins done at frequent intervals are also recommended. The National Committee on Confidential Enquiries into Maternal Deaths is promoting essential steps in the management of obstetric emergencies (ESMOE). This involves trainers visiting all health districts and carrying out training on mannequins and other visual aids on the emergency management of common conditions causing maternal deaths.
Previous SMRs have not identified cases of acute fatty liver of pregnancy (AFLP), but there is an impression that this condition does occasionally occur.2,3 Whether these deaths should be grouped under HDP is debatable. AFLP is defined as a condition that occurs abruptly in the second half of pregnancy and presents with increasing jaundice and right upper quadrant pain. The liver enzymes (transaminases) are abnormal and patients go on to develop coagulopathy and encephalopathy. Treatment involves supportive measures and delivery of the fetus. On pathological examination the liver shows fatty changes in the hepatocytes.12
There were 3 cases of maternal death grouped under AFLP. All took place at the same tertiary hospital and its geographical drainage area, all the patients were relatively young (26 -30 years), parity 2 and in the second half of pregnancy, and all presented with jaundice and abdominal pain. One had mild hypertension, 2 had autopsies in keeping with fatty changes in the liver, and the third was said to have had all the clinical features of AFLP. As they were all from the same geographical area, the questions of viral infections, drug-related effects, or heavy alcohol intake are raised.
The majority of maternal deaths from hypertensive disorders in South Africa are associated with avoidable factors and substandard care. The challenge is to implement the recommendations arising from the SMRs. There is evidence from the 2005 - 2005 report that maternal deaths due to hypertension are decreasing, but more effort needs to be put into increasing the skills of health care professionals and improving the information on maternity care that we provide to women, fathers, families and communities.
1. National Committee on Confidential Enquiries into Maternal Deaths. Saving Mothers Fourth Report 2005-2007. Pretoria: Department of Health, 2009. [ Links ]
2. National Committee on Confidential Enquiries into Maternal Deaths. Saving Mothers: Third Report on Confidential Enquiries into Maternal Deaths in South Africa 2002-2004. Pretoria: Department of Health, 2005. [ Links ]
3. National Committee on Confidential Enquiries into Maternal Deaths. Saving Mothers: Third Report on Confidential Enquiries into Maternal Deaths in South Africa 1999-2001. Pretoria: Department of Health, 2006. [ Links ]
4. The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet 1995;345:1455-1463. [ Links ]
5. Langer A, Villar J, Tell K, et al. Reducing eclampsia related deaths - a call to action. Lancet 2008;371:705-706. [ Links ]
6. Department of Health. Guidelines for Maternity Care in South Africa. 3rd ed. Pretoria; Department of Health, 2007 [ Links ]
7. Department of Health. Essential Steps in the Management of Obstetric Emergencies. Pretoria: Department of Health, 2008. [ Links ]
8. Martin Jr NL, Thigpen MF, Moore RC, et al. Stroke and pre-eclampsia and eclampsia: a paradigm shift focussing on systolic blood pressure. Obstet Gynecol 2005;105:246-254. [ Links ]
9. Neilson J. Pre-eclampsia and eclampsia. In: Lewis G and CEMACH. Why Mothers Die 2003-2005. London: RCOG Press, 2007: 72. [ Links ]
10. Paruk F, Moodley J. Untoward effects of rapid-acting antihypertensive agents. In: Arukumaran S, Moodley J, eds. Best Practice and Research Clinical Obstetrics and Gynaecology. London: Harcourt Publishers, 2001: 491-506. [ Links ]
11. Schutte J. Schuitmaker NW, van Roosmalen J, Steeger EA. Dutch Maternal Mortality Committee. Br J Obstet Gynaecol 2008;115(6):732-736. [ Links ]
12. Barber MA, Equiluz I, Martin A, Placencia W, Valle L, Garcia JA. Acute fatty liver of pregnancy: analysis of five consecutive cases from a tertiary centre. J Obstet Gynecol 2010; 30(3):241-243. [ Links ]
Professor Moodley is Professor Emeritus in the Department of Obstetrics and Gynaecology, University of KwaZulu-Natal. His area of research focus is women's health.
Corresponding author: J Moodley (email@example.com)


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Captain Renault: What in heaven's name brought you to Casablanca?
Rick: My health. I came to Casablanca for the waters.
Captain Renault: The waters? What waters? We're in the desert.
Rick: I was misinformed.
This is an election year, and we're heading into two election seasons. Before you know it, the June primaries in California will be upon us. And in November, we'll have federal and state elections.
Over and over, you will hear from media, from politicians, from you mother that, whatever your politics, you need to get yourself informed. That seems like non-controversial advice that only makes sense.
U.S. & World
News from around the country and around the globe
The problem? You can be too informed.
Recent political science research on voter information is stunning because it doesn't conform to this conventional wisdom. Indeed, it is the most well-informed voters we should worry about the most, because the best-informed voters are also the most misinformed voters.
Why? It makes sense. The more information you take in, the more bad information you take in. (Which is why, ahem, California voters should read Prop Zero, and only Prop Zero).
At the same time, voters with little information often cast ballots in elections and make a hash of it.
The best thing to be is moderately informed. You don't want to know too little, because you won't know what you're doing. And you don't want to know too much, because you'll know too much that's nonsense.
There's a happy medium. So be informed. But don't overdo it.
Send us your thoughts via Twitter @PropZero or add your comment to our Facebook page.


text:
Craved for the steamed cake mum used to make, so I decided to make one myself yesterday. It tasted alright but the texture was too spongy. I prefer the soft and fluffy texture just like mum's one. Not sure what went wrong, maybe I over beat the eggs?
Comments :
- Home Cooking said... on
- 09 August, 2007 17:15
as long as it tasted good, never mind lah, can u give me some plz, hehehe...
- Lydia said... on
- 12 August, 2007 15:10
isha, do you like steamed cake too? same version or the one with brown sugar?
- Home Cooking said... on
- 13 August, 2007 16:51
i luv steamed cake, but never make it b4 hehehe...
have u ever tried steamed brownies. its so good ^_^
- Lydia said... on
- 13 August, 2007 18:41
yet to try steamed brownies... am not a big fan of brownies cos hate the sinful feeling after eating... will try the steamed version cos got a choc lover at home.
- Anonymous said... on
- 19 July, 2009 01:49
the most memorable steamed cake I have ever eaten was the one made by my grand aunt using an old fashioned
hand whisk. No baking soda, no baking powder .. Can never duplicate the taste with modern machines
- Lydia said... on
- 29 July, 2009 23:52
Simple one still the best! All my siblings love my mom's steam cake, gonna ask her for recipe. Perhaps, gonna steal her traditional whisk too!


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Visit the Amarillo ISD Athletics Department (Opens in new window) to view sports schedules for seventh-grade, eighth-grade, and high school.
Other resources on the Athletics Department web page include:
The Amarillo Independent School District does not discriminate on the basis of race, color, religion, age, gender, disability, national origin, military status, genetic information, or any other basis prohibited by law.
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Public Comment
The Tea Party, Planning and Democracy, Part Two (News Analysis)
[Editor's Note: This is the second part of a two part series. Part One can be found here.]
Progressive observers treat the Tea Party's forays into land use planning as the work of paranoid reactionaries. The March-April 2011 issue of Mother Jones ran an article by Stephanie Mencimer that portrayed Tea Partiers as "nutters" whose opposition to increased density and mass transit is rooted in "a hostility to what it sees as elites" and a pro-sprawl, suburban lifestyle. Last December, the Lincoln Institute of Land Policy's Anthony Flint riffed off of Mencimer's piece in a post on the Atlantic magazine's "Urban Wonk" blog that decried Tea Party disruption of planning efforts from California to Maine to Florida.
The truth is more complicated. Pace Rosa Koire, to attack smart growth as part of an international plot guided by the U.N.'s Agenda 21 really is to espouse conspiracy theory. To denounce "human-caused global warming" as a myth, as does the East Bay Tea Party, is to indulge in perilous denial. But to claim that land use planning is often run by unresponsive elites is to tap reality. Flint himself intimated as much: "Some might wonder," he wrote, "whether there's some truth" to accusations that "planners have draped the public process with the trappings of citizen input, while in fact all the decisions to promote smart growth have been made."
Some do more than wonder, and they're not all members or even "fellow travelers" of the Tea Party—for example, longtime Berkeley community activist Doug Buckwald. Speaking at the Dublin open mike, Buckwald assailed Plan Bay Area for discriminating against dissenters from smart growth doctrine. He said that a friend had tried to register for a workshop online at 7:30 am the day that registration opened, only to be told that the meetings were filled, and that she would be placed on a waitlist. She never got a confirmation from MTC, but she did receive letters from Greenbelt Alliance urging her to sign up and hold the line against opponents to the process who were poised to flood into the meetings.
You may be thinking, what's wrong with that? Doesn't Greenbelt Alliance have a right to mobilize people who share its views? Of course it does. The catch is that the organization is hardly a disinterested party: it receives funding through its ties to the regional agencies. Like other non-governmental non-profits, Greenbelt Alliance has partnered with a city or county—in its case, Contra Costa County—for a share of the $5 million dollar Sustainable Communities Program grant that the Department of Housing and Urban Development awarded MTC and ABAG last November. Some of the other non-profit partners are the Bay Area Council, the Non Profit Housing Association of Northern California, TransForm, Urban Habitat and the Silicon Valley
Leadership Group Community Foundation. All of them have a direct financial stake in the SCS/RTP.
Besides conflicts of monetary interest, the advocacy non-profits have an accountability problem. As non-governmental entities, they're not answerable to the general public. To be sure, they see themselves as representing the greater good. Good intentions notwithstanding, citizens at large have no claim on these organizations.
These legitimacy issues haunt the Plan Bay Area process. Not only did non-profits help draft the SCS/RTP; their staffers have also participated in the public workshops, voting on investment options in transportation and housing. As Lisa Vorderbrueggen reported in the Contra Costa Times, ABAG and MTC used staff from some of their non-profit partners to facilitate Plan Bay Area's workshops last May. When a Greenbelt Alliance senior field representative "began delivering an overview of the One Bay Area Planning process" at the Contra Costa County event, someone yelled, "Is this a government meeting?"
"In the public agencies' defense," Vorderbrueggen wrote, "they were trying to save money": the Silicon Valley Leadership Group had gotten a Knight Foundation grant to pay for outreach, which is expensive. Nevertheless, she continued, "the public must have confidence that [the final SCS/RTP] is the result of broad input and not the work product of specific advocacy groups."
Accountability is an issue for the regional agencies themselves. As Buckwald observed, "the MTC is not a duly elected organization." In fact, some of the commission's members are not elected at all. The Metropolitan Transportation Commission comprises nine county supervisors, six city mayors or city councilmembers, and one representative apiece from the Bay Area Conservation and Development Commission, CalTrans, the Federal Department of Transportation and HUD. ABAG's Executive Board consists of fifteen supervisors and twenty mayors or city councilmembers. None of these officials were elected to serve on a regional body.
The way they conduct regional business distances them even further from the public. MTC and ABAG meetings take place during the day. The daytime schedule excludes working people, except those who are paid to be there, which is to say, the staff of public agencies and non-profit advocacy groups. In Fall 2010 I attended several morning meetings devoted to drafting the SCS/RTP goals; of the two or three dozen people in the room, a handful at most were citizens with no governmental or non-profit affiliation.
To be sure, the regional agencies don't always see eye to eye with the advocacy nonprofits on transportation, equity or other issues. And cities and counties push back against policies they consider onerous: check out the comments from many Bay Area jurisdictions on the first draft of the SCS/RTP . Criticisms notwithstanding, every letter avows the worthiness of SB 375's goals.
That's only to be expected. Though regional officials repeatedly state that local compliance with the requirements of SCS/RTP will be voluntary, when pressed, they concede that only those jurisdictions that meet those requirements will be eligible to receive some of the millions of public funds that will be disbursed through MTC.
What made the Dublin workshop unusual was that it was an official regional planning event attended by a large number of ordinary citizens, and that many if not most of those citizens challenged the premises of smart growth. The majority of the dissidents rested their case on a defense of property rights, "blind" justice, the private automobile and market fundamentalism or something close to it. As such, they could be readily written off as anti-government, anti-regulation and, most damning, anti-environment.
Not so Berkeley resident Steve Finacom, who raised the most radical objection of the evening, when he questioned planners' assumption that the more growth, the better. That assumption, he noted, conflicts with the view of the region's pioneering generation of environmental activists, such as the founders of Save the Bay: population and development need to be limited to what the area's natural resources (think water) can support without degrading the environment.
Finacom was indirectly alluding to the planning profession's close ties to the real estate industry. Unlike living organisms, property capital requires endless growth for its health. SB 375 "streamlines," i.e., reduces, environmental regulations for housing built near transit; not coincidentally, one of the bill's chief supporters was the California Building Industry Association.
Of all the public comments I heard at the Dublin workshop, the one that got the biggest hand was Buckwald's declaration that "this whole process should be shut down and started all over again with adequate public process from the start." Let's get real: MTC and ABAG are not going to re-boot Plan Bay Area. But they could—and should—do their best to make the rest of the process, as well as future planning for our region, more accountable to the public at large.
For starters, they could apply the lessons of the Plan Bay Area experience. When citizens ask tough questions, they should get straight answers. Exactly how did MTC and ABAG decide that our region would have two million new residents in the next twenty-five years? Are green policies really driving businesses out of California? Does the SCS/RTP consider how environmental regulations are affecting business in our region? New development raises property values and often forces poor people out of their homes and low-rent businesses out of their spaces; how does the plan deal with the displacement threat?
From the other side, when planners ask members of the public to evaluate "transportation trade-offs" or the qualities of "complete communities," they should provide well-presented factual material that enables ordinary citizens to make informed choices. Instead of asking people who are registering for an official meeting to identify themselves as advocates of one thing or another, give them the option of stating an affiliation. Require public officials and employees of non-profit advocacy groups to state their affiliations, and print those affiliations on their name tags. Have employees of public agencies and their non-profit partners vote separately from the rest of the public, and record and publicize their votes separately as well.
And how about holding meetings of ABAG's Executive Board and MTC at night?
These changes would make regional public process more open and more meaningful. But they'd have little or no effect on planners' core belief that development is environmentally benign as long as it's dense and close to transit. Challenging that belief and its formidable beneficiaries—I'm talking about real estate developers and the politicians whose campaigns they bankroll—will be much tougher than getting straight answers at planning workshops.


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Freshwater and Marine Aquarium, Volume 9, Issues 7-12
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Beijing Pollution Clears Way for Environmental Stock Surge
Beijing residents may be unable to see their hands in front of their faces thanks to the worst smog in recent memory. But some investors think they can see clearly – at least when it comes to profits ahead.
While Beijing struggled with pollution readings that were off the charts over the weekend, share prices of environmental protection stocks were surging to impressive levels as investors snapped up stocks that might benefit from the foul water and toxic air -- once government policymakers say "enough is enough."
On a day when the markets were up overall, Beijing SPC Environmental Protection, which produces equipment that removes sulfur from emissions of big thermal power plants, led the advance of the pollution-fighting brigade on the Shanghai and Shenzhen stock exchanges, climbing 5.8% on Monday. Anti-pollution comrade-in-arms Tianjin Capital Environmental Protection Group, a water treatment company, added 5.2%, while wastewater treatment firm Beijing Capital Co. advanced 3%.
The Shanghai Composite Index was up 3.1% on Monday.
"Environmental stocks are likely to be the targets of investor buying in the near term," said Amy Lin of Capital Securities, noting there are high expectations that Beijing will take action to address the environmental woes.
Pollution was so bad in Beijing that officials in the capital warned residents to stay home and avoid exercising outside. The city activated a new plan restricting construction and industrial activity. Masks and air purifiers suddenly were all the rage.
More In stocks
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Beijingers took the occasion to have a little fun, posting photos on weibo, China's Twitter-like microblogs, showing the city in its world-beating smog.
The pollution appeared to peak on Saturday when the air monitor at the U.S. embassy in Beijing showed an air-quality index reading of 755. The U.S. environmental Protection Agency says an index reading of more than 300 is "extremely rare" in the U.S. and generally occurs only during events such as forest fires.
The U.S. embassy's @BeijingAir Twitter feed previously referred to readings beyond 500 as "crazy bad."
The embassy's monitor showed the concentration of PM2.5 – tiny particulate matter considered especially harmful to human health – had reached 886 micrograms per cubic meter on Saturday -- almost 12 times the recommended standard in China and more than 25 times the standard in the U.S.
Policymakers have pledged to focus on cleaning up the nation's polluted environment and the embarrassing global attention could mean that more money and more attention is trained on the effort. If that really is the result, perhaps crazy bad air makes a crazy good investment.
-- William Kazer and Li Yue
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Sorry to spoil your day Jack, but there is actually a school that picked me up for the fall, as amazing as that is, and I fully admit it's kind of a shock. You see Jack, not everyone needs to be in some silly % of their class or on the LSAT to get a job as a lawyer, and nothing that happened in or before law school will matter to those of us with the ability to practice law, not just be super way cool neato law students... I have yet to see that pay anyone's rent. And some of us have lives outside of law school that require part time attendance, giving us credit hour per term issues. Law schools are pure evil and don't care, and I understand that, but I also understand that if I just get through the child advocacy job I have waiting for me will be worth it. Now, as I obviously don't need anymore advice from this site I'm going to leave you to your meaningless diatribe about %'s of this and %'s of that, and whatever other kicks you get out of having been on this site for 4 years-have a nice life Jack. The jack24 w/pick of Sutherland really screams little big man issues by the way, which of course will make you a perfect weasel lawyer at some firm somewhere. Do yourself a favor someday jack/24, have sex with a stripper, get in a bar fight, do something besides be such a damn weasel all your life. I feel sorry for men like you.
Oh, and the Jack 24 thing has been with me since I was first accepted to law school. It may be linked to some psychological problems I have, but it's more likely due to the fact that 24 was awesome back then.I could change it to Jack from lost... but then it might seem like I have daddy issues and I'm running from responsibility.Maybe someone current is better? Perhaps Michael from Burn Notice or Harvey from Suits?
You seems like a problem child that is why you are getting school transfer once again you can request for the stay.


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Friday, January 31, 2014
Review of A Seal Wolf Christmas
A SEAL WOLF CHRISTMAS may be purchased here.
Terry Spear
Former Navy SEAL and gray wolf shifter, Bjornolf traveled to South America to shadow a team of shifters, that is trying to rescue a kidnapped family. With the team is Anna Johnson, to whom Bjornolf is greatly attracted. After Bjornolf and Anna return to the US, they are tasked with an undercover assignment as a married couple by the team leader. While investigating some murders, Anna and Bjornolf must, also, supervise a teenage wolf, which brings them closer together.
A SEAL WOLF CHRISTMAS is an entertaining paranormal romance with lots of action, suspense, and complex,likable characters. It is very entertaining trying to fit all the puzzle pieces together about the murder mystery. Bjornolf is a strong, alpha male, who is determined to protect Anna, but, also, trusts her to do the job that she is trained for. Anna has some issues,that she needs to work through, before she can truly be with Bjornolf. Luckily, Bjornolf is patient and supportive, until she is ready to reveal her issues.
All in all, A SEAL WOLF CHRISTMAS is an enjoyable read with great action and a lovely romance. I highly recommend it.
NOTE: I received this book in return for an impartial review.
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twinkle in (one's) eye(redirected from twinkle in my eye)
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twinkle in (one's) eye
1. A facial expression that denotes happiness, amusement, or knowledge of a secret. Just when Rita thought all hope was lost, Jared got a twinkle in his eye that told her he had a plan to get them both out of that sticky situation.
2. A hope or plan that is not yet in existence. You were not even a twinkle in your mother's eye when that photo was taken.
a twinkle in someone's eyeor
a gleam in someone's eye
If a plan or project is only a twinkle in or a gleam in someone's eye, it is only at the stage of being considered as a possibility. Projects that a few years back were just a twinkle in the planners' eyes are now bricks and cement. At this point, space-launched weapons were still only a gleam in his eye. Note: You can also talk about a glint in someone's eye. The European central bank was still no more than a glint in its creators' eyes. Note: Words such as gleam, glint and twinkle can be used to describe the way people's eyes shine or reflect the light. They often suggest hidden energy, emotion, or humour and refer to the excitement of having a particular idea before putting it into practice.


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Sample Containers & Preservation for Mercury Analysis in WatersJuly 30th, 2013
By Tim Crowther, Regional Client Services Manager, ALS Environmental – Canada
**NOTE: The content in this article does not apply to ALS Environmental's USA locations.**
On August 15, 2013, ALS Canada will begin supplying our clients with borosilicate glass containers with Teflon® lined caps for the collection of total and dissolved mercury in all water samples. Hydrochloric acid (HCl) preservative will also be supplied. Recent literature and ALS experimental test results indicate a glass container with HCl preservation is the most effective method for reducing mercury losses following sample collection. The sample bottle and preservative pictured overpage will be the recommended container for low-level total and dissolved mercury (≥10 ng/L), which were previously collected in a high-density polyethylene (HDPE) 'plastic' bottle with nitric acid preservation. HDPE containers are not suitable for ultra-trace level (0.2 – 10 ng/L) mercury analysis. Ultra-trace mercury sampling requires more sample volume, as well as the use of cleaner sample handling and analysis procedures.
The British Columbia Ministry of Environment (BC MoE) will require the use of Teflon® or borosilicate glass containers with HCl preservation for the collection of water samples for mercury analysis effective November 15, 2013. The United States Environmental Protection Agency (US EPA) and the Ontario Ministry of Environment have already prescribed the same. Various other agencies are considering similar changes, including the Canadian Council of Ministers of the Environment (CCME) and Alberta Environment.
Additionally, ALS recommends that filtration for dissolved mercury analysis be conducted within one hour of sample collection using a suitable in-line filter or 0.45 μm syringe filter supplied by ALS.
Read more about Sample Containers & Preservation for Mercury Analysis in Waters…


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Potty Time11/13/2008 04:44:00 PM Edit This 2 Comments »
Yes it's Potty Time in our house and it has been, well kinda, for months now. At the end of Lexie's first week of daycare in Jan when I picked her up, the teacher asked me to bring pullups to make potty time easier. What? What potty time? I was so surprised since she was only 20 months old and had never shown any real interest in the potty (other than to throw my phone in it.) The teacher said when the older kids in class lined up to go, Lexie got in line just like they did. So the teacher pulled down her pants and took off her diaper and away she went. Of course the teacher thought she did this at home as well. Surprise!! So I rushed out to get a little potty just like they had there and when I proudly showed it to Lexie she ran screaming from the bathroom. Okay...clearly she thinks going to the potty is a group activity and not to be done at home.
I tried moving it to different locations in the bathroom or to a different bathroom with the same results. So I just left it there with the hopes that she would show an interest in it at home. She does use it as a step stool to brush her teeth at night - whoo pee.
After we returned from Mexico she showed a little interest so I tried the reward of one "M" (known to the rest of the world as M&Ms) if she goes potty and I told her she'd get two if she went poop. For a while it was all very exciting and whenever I asked her to go potty we were successful more often than not. But rarely did she say I have to go potty on her own. I didn't want to push it though since I didn't have the time to not leave the house for a week while we focused on that - as I have been told by many moms as well as read that it takes that kind of time commitment to seal the deal. Plus she's only pooped twice and both of them were clearly surprises to her.
She is getting better. Most mornings she is dry and as soon as she wakes up now she say "poppy...poppy" and off we run to the potty. She will barely enter a public bathroom so I just am not ready to go with only big girl panties and have accidents while we are out during the holidays. So Jan 2009 will be diaper free for this household. Why I am mentioning it now? Well because how she dresses to go potty. Yes my Little Lexie Lou must wear a hat even to go potty. And these are just the hats I've managed to catch on film. I'm starting to leave the camera by the potty. She is a styling potty girl and I just had to share the fun.
So I think I'm going to keep adding to this post whenever I get another cute picture of her on the pot. You can't have too many, right?!?


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Bath School of Rock
Welcome to I'M A GUITARIST, the personal blog of Richard Perkins.
My Websites
Previous Blogs
- Acoustic Apprentice 2009
- Acoustic Blues France 2010
- Bath Guitar School Band 2009
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- Blues & Beyond 2012
- Complete Acoustic Guitarist 2011
- Complete Acoustic Guitarist 2012
- Complete Electric Guitarist 2011
- Modern Electric Blues 2010
- Modern Electric Blues 2011
- Monsters of Rock 2009
- Rock Apprentice 2010
- South West Rocks 2010
- Sussex Rocks 2012
- Sussex Rocks 2013
- Sussex Rocks 2014
@bath_gtr_school on Twitter
- A must watch if you want to get GOOD at guitar FAST with @officialsrslytv! youtu.be/0FRdgDleH8A 4 years ago
- .@bath_gtr_school's Matilda Zanelli performs the 1982 Rocky III theme song "Eye Of The Tiger" by Survivor. youtu.be/gpdokK1E24E 4 years ago
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- Go @GibsonGuitar! #PawnStars youtu.be/x2TWp_Bz5RU 4 years ago
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- RT @DaddarioandCo: Standard Tuning, Open Tuning or Alternative Tuning? What's your preference? #tuning #opentuning #droptuning #guitar http… 4 years ago
- A @gibsonguitar SG 1961 Les Paul Custom owned by Les Paul's wife Mary Ford sells for $90,000! youtu.be/HSX-wRBuHrY #PawnStars 4 years ago
- A @gibsonguitar SJ-200 owned by Stephen Stills sells for $85k & Vic Flick sells his beloved @Fender Strat for $55k! youtu.be/6pQ-A6YPTvw 4 years ago
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- RT @bath_gtr_school: .@bath_gtr_school's @imaguitarist has donned a Ned Flanders style mo this #Movember. Watch the Mo shave off: https://t… 4 years ago
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Tag Archives: The Heartbreakers
Tom Petty's Guitars Stolen From Tour Rehearsal
Five guitars belonging to Tom Petty and The Heartbreakers have been stolen from the Soundstage in Culver City where they have been rehearsing for their US tour which will start next week. The stolen guitars are: … Continue reading
Royal Wedding ~ Picnic in the Park at Royal Victoria Park, Bath
Tens of thousands of people gathered in Royal Victoria Park in Bath for the marriage of Prince William and Kate Middleton. Well-wishers arrived as early as 8am to claim prime spots in the famous park, and by the time the … Continue reading
Posted in Music, News, Photography, Review, Royal Wedding, Video, Website Tagged (I Just) Died In Your Arms Tonight, Andy Howard, B&NES, Bath, Bath & North East Somerset Council, Bath Music Plus, Bath Philharmonia, BBC Radio Bristol, Bite The Buffalo, Bootleg Beatles, City of Bath College, Cutting Crew, ICMP, Institute of Contemporary Music Performance, Kate Middleton, Mumford and Sons, Prince William, Rage Against The Machine, Rainy and the Dust, Richmond Events Management, Royal Wedding, Sam & Lily X, South West Group, Tallis Morris, The Heartbreakers, Tony Moore, Victoria Park, White Stripes, Will and the People, Womad Leave a comment


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As a side note, the T8 shoulders look pretty cool up-close (even have little pawprint shapes on them, and swirly twigs and moons and stuff!), but when zoomed out they look like you've just got pompoms on your shoulders.
Ignis the Furnace-Master: "Insolent whelps!"
Big guy with a molten codpiece. Usually, a fight like this would be rather frightening for a plant with all the fire and such, but it's probably a place where we shine the most: lots of aoe damage and snap-heals. The strat we used was to cluster the ranged/casters in the center of the room between the two water pools, and have the MT kite-tank the boss in circles around us, always keeping the boss facing away. The OT ran around picking up adds as best he could (a good resto druid is SUCH an aggro magnet) and running them through the fire and water, calling dps as needed to shatter them.
- Keep full stacks of LB on both tanks, if necessary (given strengths of cohealers, etc), once things really get rolling with the adds. It'll eat up your mana, but if your dps is good enough, you'll be able to manage it with an innervate and a mana pot and have the boss dead before you're completely OoM.
- Slag Pot: Ignis will periodically grab someone and hold them in the molten pot chained around his waist. People inside need to pop barkskin, etc to help shield from the damage, and as a healer you should help keep them alive. You cannot attack from within the slagpot, but you can still heal people, and yourself, while you are in the slag pot. If a healer is in the slag pot, they CAN HEAL THEMSELVES and should do so.
- Flame Jets: Do not be caught casting a spell when this ability goes off, or you'll be spell-locked for 8 seconds. It also causes a knock-up into the air, and deals raid-wide damage. Yay Wild-Growth and Rejuv.
- Scorch: this is the big burning spot he puts on the ground on the tank, and what the tank will be kiting him away from so they don't stand there and crisp themselves. You shouldn't stand in it, either. The OT will have to run through it to debuff the adds, and should call out when he's entering the "scorch" so that you can be alert of when he'll need extra healing, especially if your LB's dropped due to range.
Razorscale: "Rawr!"
A pretty proto-drake, though sadly, she is the twisted outcome of what "Loken" did to Veranus after he defeated Thorim in the Storm Peaks questline. Akin to Utgarde Pinnacle, you must bring her down using harpoons. As a healer, all you have to worry about is bouncing around avoiding fireballs and keeping those in range of you alive, until the group brings her down and then it's just a tank-and-spank to heal, with some minor kiting to get out of the patches of fire. My guild initially attempted the "v strat" as discussed on wow-wiki, but ultimately decided to just stay out of the circle and split up as two separate parties (closer to the 25-man strat), each party on either side of the circle with a tank, a healer, and mixed dps.
- As a general rule, don't stand in front of the boss when she's on the ground.
- Devouring Flames (P1): this is a large patch of blue fire she spits at whoever is closest to her while she's flying. With our organization of the groups, we assigned a hunter or warlock to act as the "tank" for this, where he was nearly constantly on the move to stay closest to her while trying to shoot the mobs to assist in dps, or sent his pet in to tank it when she went off to a far corner. It worked out really well, and he didn't take much damage, but I did make sure to always keep a rejuv on him and keep an eye on him and his pet when he went out of my range. The "flame tank" doesn't have to be attacking Razorscale while she's flying; he just has to be the closest person to her, or have his pet do so.
- Fireball (P1): she spits these at everyone, and they do hurt for a chunk of damage. I have read that you can dodge them, since while she casts them AT a specific person, they do not CHASE that person as they travel. Keeping on the move constantly is one of our strong points as druids, so make use of your strengths. Regardless, these fireballs are why you want to keep everyone topped off. If you'd prefer, you can keep Razorscale targeted so that you can see who she is casting them at.
- Adds: these spawn out of tunnelers in various locations, and are what your group is killing while Razorscale is in flight. Make sure you keep your party up, particularly when they grab the "big guy" who spawns in the center ring. Be especially mindful of healing your tanks when Razorscale lands (or rather, gets dragged out of the air with harpoons) and everyone moves to the center behind her, as they will likely be turning their backs on several mobs while doing so.
- Harpoons: there are 2 of these in the ten-man version, and they are used to bring Razorscale out of the sky. Designate a single dps to run over and fire these off when the harpoons are repaired by the NPCs, but have them hold off on firing the second harpoon until most of the current wave of adds are dead. Once Razorscale is down, the dps should all switch to attacking the proto-drake, and get as much damage on her as possible before she breaks the chains. Each time she escapes the chains, she'll do an aoe knockback effect around her. Above 50% life, she will leap back into the air after breaking the chains.
- Phase 2: at 50%, she'll stay grounded. DPS should mind their aggro as the 50% mark nears, because she will attack the highest threat first. Keep behind of the boss and sorta off to the side, out of the way, and watch where your tanks might turn her as she's kited. This is a simple phase compared to phase 1, provided she is kited to get the tanks and dps out of the fire patches. There should be two tanks for this phase, and they will need to taunt her back and forth whenever either tank gets a stack of two Fuse Armor debuffs.


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- Library Overview
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Did you know...
Charles Carroll of Carrollton Collection, 1757-1967, MS 1893
Charles Carroll of Carrollton Collection, 1757-1967
Maryland Historical Society
(Text converted and initial EAD tagging
provided by Apex Data Services, March 1999.)
Charles Carroll of Carrollton Collection, 1757-1967 Contact Information:
Maryland Historical Society
Manuscripts Department
Maryland Historical Society Library
201 West Monument Street
Baltimore MD 21201-4674
Fax: 410.385.2105
[email protected]
Contact Information:
Descriptive SummaryCharles Carroll of Carrollton Collection, 1737-1854; 1967.
Maryland Historical Society
Baltimore MD 21201-4674
microfilmed with the Microfilm Collection of the Carroll Papers
Scope and Contents
In addition to correspondence, the following items are included: copies of Charles Carroll of C. and Rachel Cooke marriage dispensation and marriage license; Char Carroll of Annapolis and Elizabeth Borook marriage certificate; Oct 4 1737 Ignatius Davis invoice; Jan 31, 1811 City of Annapolis Warrent; account sheet of money owed by Thomas Lee 1791-1818; notations on legal actions involving Joh Duncan in 1816 and Samuel Hughes in 1808 and 1819; 1825 George Elliott account sheet; June 1, 1831 Geroge Bassett et al; Jan 1, 1852 index to C. Carroll's books etc. and 1967 family traditions exerpts from Shauk-Free Families of Md.
This is an [UNK] collection of 30 items written to, by, or about Charles Carroll of Carrollton (1737-1832). Includes: letters of advice from his father Charles Carroll of Annapolis on his education (1758-1759); [UNK] of his parent marriage certificate (CC of A and Elizabeth Brooke) marriage certificate (1757) and his dispendation to marry his cousin Rachel Cooke (1766); letters on Bohemia Manor title, Carrollton boundaties (1787); and taxes (1793); a 1854 letter referring to CC of C's participation in 1784 on the commission to study improvements of the Potomac as far as fort Cumberland; a letter to his daughter Mary Carroll Caton, 1803 a citation by the City of Annapolis for riding in a carriage with his servant (1811); a letter to his son Charles Carroll Jr. about bilding a house at Folly, 1812; a letter presenting CC of with the pick, spade, hammer and trowell used to groundbreak the B and O RR; sn invitation to Col. Fox, 1829; a petiotion to build a monument to Mrs. Mary Washington, Geroge Washington's mother (1831), and some financial bonds and receipts.
Other items include a letter about Charles Carroll Harper's share of CC of C's estate (1831); a list of books owned by CC of C's estate (1852); CC of C (?) letter to his partners Charles Carroll Barrister, Benjamin Tasker and Walter Dulaney; and a letter (1845) for CC of C's granddaughter Lady Wellesley (Mary Caton, d. 1853) concerning the Jennings family.
Missing (as of 10/77) is one letter (1822 Sept. 6) on land dispute between CC of C and James Letts. The land was in Queen Anne's county. Letter mentions seeing Mr. James E. Barroll in Chestertown, who is in suit with Mr. Bordley. Agreement signed with Kerr has no personal interest in the matter or in [UNK] 's debts. (see Desk copy card).


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Week of the Young Child
by Donna Quirk, MBA RD LD
LMC Clinical Nutrition Manager
We are currently in the Week of the Young Child™, an annual celebration sponsored by the National Association for the Education of Young Children (NAEYC). The purpose of the Week of the Young Child™ is to focus public attention on the needs of young children and their families. This year's theme is Early Years are Learning Years®.
Nutrition plays such an important role in a child's normal growth and development. Guiding a child to develop healthy eating habits increases the chances that they will maintain a healthy weight throughout life. And finally, what fits so well with this year's theme is how essential nutrition is to support learning.
So, here are some tips to help your child –
- Toddlers need smaller portions than adults. What's a quick way to estimate? Serve a tablespoon of food per year of age. So a 2 year old should be served 2 tablespoons of the foods being served at a meal.
- Emphasize whole fruits instead of juice. Try melon balls, mandarin oranges, and frozen berries.
- Whole milk is recommended only up to the age of 2 years old. Choose low-fat milk or yogurt and reduced fat cheese after the age of 2 years.
- Have a picky eater? Relax and create a calm setting. Limit distractions – turn off the T.V. Provide regular meals and snacks. Serve a variety of colorful nutrient rich foods. Picky eaters may not eat perfectly every day, but over several days they do just fine!
- Do not skip breakfast! Eating breakfast helps school aged kids focus and concentrate better in the classroom and perform better on math, reading and standardized tests.
For more information, recipes, and meal ideas visit www.kidseatright.org


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The harder kids play, the harder they fall. The fact is, broken bones, or fractures, are common in childhood and often happen when kids are playing or participating in sports.
Most fractures affect the upper extremities: the wrist, the forearm, and above the elbow. Why? When kids fall, it's a natural reflex for them to throw their hands out in an attempt to stop the fall.
Many kids will have a broken bone at some point. Most aren't too big of a deal, but fractures can be scary for kids and parents alike. Here's what to expect.
Falls are a common part of childhood, but not every fall results in a broken bone. The classic signs of a fracture are pain, swelling, and deformity (which looks like a bump or change in shape of the bone). However, if a break is non-displaced (when the pieces on either side are straight in line with one another), it may be harder to tell.
Some telltale signs that a bone is broken are:
If you suspect that your child has a fracture, you should seek medical care immediately.
If your child has either of the following, do not move your child and call 911 for emergency care:
For less serious injuries, try to stabilize the injury as soon as it happens by taking these quick steps:
A doctor might be able to tell whether a bone is broken simply by looking at the injured area. But the doctor will order an X-ray to confirm the fracture and determine what type it is.
Reassure your child that, with a little patience and cooperation, getting an X-ray to look at the broken bone won't take long. Then, he or she will be well on the way to getting a cool — maybe even colorful — cast that friends can sign.
For little ones who may be scared about getting an X-ray, it can help to explain the process like this: "X-rays don't hurt. Doctors use a special machine to take a picture to look at the inside of your body. When the picture comes out, it won't look like the ones you take with your camera. Doctors know how to look at these pictures to see things like broken bones."
A fracture through the growing part of a child's bone (called the growth plate) may not show up on an X-ray. If this type of fracture is suspected, the doctor will treat it even if the X-ray doesn't show a break.
Because their bones are softer and more likely to bend than break in half, kids are more likely to have incomplete fractures (fractures that go partially through the bone). Common incomplete fracture types include:
Mature bones are more likely to break completely. A stronger force will also result in a complete fracture of younger bones. A complete fracture may be a:
Other common fracture terms include:
The doctor might decide that a splint is all that's needed to keep the bone from moving so it can heal. Whereas a cast encircles the entire broken area and will be removed by the doctor when the bone is healed, a splint usually supports the broken bone on one side.
When the doctor puts on a splint, a layer of cotton goes on first. Next, the splint is placed over the cotton. A splint may be made of stiff pieces of plastic or metal or can be molded out of plaster or fiberglass to fit the injured area comfortably. Then cloth or straps (which usually have Velcro) are used to keep the splint in place. The doctor might need to readjust the splint later.
Most broken bones will need a cast to keep the bone from moving so it can heal. A cast is essentially a big bandage with two layers — a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving.
Casts for broken bones usually are made of either:
Although kids might think a cast is cool when it's finally on, the process of getting one can be scary, especially for a child in pain. Knowing what happens in the cast room might help ease some worry — both yours and your child's.
For displaced fractures (in which the pieces on either side of the break are out of line), the bone will need to be set before putting on a cast. To set the bone, the doctor will put the pieces of the broken bone in the right position so they can grow back together into one bone (this is called a closed reduction).
A closed reduction is when the doctor realigns the broken bone so that it heals in a straighter position. Realigning the bones is a painful procedure, so sedation is given so the child won't feel it. This medicine usually is given through an intravenous (IV, into a vein) line. A cast is then put on to keep the bone in position. You can expect the doctor to take another X-ray immediately after the realignment procedure to make sure the bones are in good position.
If the fracture is complicated or more serious, an open reduction might be necessary. Open reduction is a surgical procedure in which an incision or cut is made in the skin and metal pins and plates are attached to the broken bone fragments to better stabilize the break while it heals. This is done under general anesthesia.
Although most broken bones simply need a cast to heal, other more serious fractures (such as compound fractures) might require surgery to be properly aligned and to make sure the bones stay together during the healing process.
Open fractures need to be cleaned thoroughly in the sterile space of an operating room before they're set because the bone's exposure to the outside environment poses a risk of infection.
With breaks in larger bones or when the bone breaks into more than two pieces, the doctor may put a metal pin in the bone to help set it before placing a cast. When the bone has healed, the doctor will remove the pin.
For the most severe breaks, a surgical repair may require a larger metal plate to be attached to the outside surfaces of the bone, or a rod may be put within the bone to hold bone fragments in place.
Fractures heal at different rates, depending upon the age of the child and the type of fracture. For example, young children may heal in as little as 3 weeks, while it may take 6 weeks for the same kind of fracture to heal in teens.
It's important for your child to wait to play games or sports that might use the injured part until your doctor says it's OK.
Although fractures are a common part of childhood, some kids are more likely to have one than others. For example, those with an inherited condition known as osteogenesis imperfecta have bones that are brittle and more susceptible to breaking.
Be sure your child is getting enough calcium and vitamin D to decrease the risk of developing osteoporosis (a condition that causes bones to be more fragile and likely to break) later in life.
Also, don't forget to motivate kids to get involved in regular physical activities and exercise, which are very important to good bone health. Weight-bearing exercises such as jumping rope, jogging, and walking also can help develop and maintain strong bones.
Although it's impossible to keep kids out of harm's way all the time, you can help to prevent injuries by taking simple safety precautions, like childproofing your home, making sure kids always wear proper safety gear such as helmets when participating in sports, and using car seats and seat belts for kids at every age and stage.
If your child does get a broken bone, remember that even though it can be frightening, a fracture is a common, treatable injury. With a little patience, your child will be back to playing and running around before you know it.


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Ask Dr. Isabelle Rapin, professor emerita in the Saul R. Korey Department of Neurology and of pediatrics, which of her accomplishments means the most to her and she will mention her work with basic scientists to seek greater clues to the underpinnings of the neurologic disorders she has diagnosed and studied in patients for more than 50 years. She also may mention her clinical work with those patients and their families, treating them, learning from them and offering guidance on managing issues that often span a patient's lifetime. But at the pinnacle, she will tell you, the achievement of which she is most proud, is her teaching.
Isabelle Rapin, M.D.A member of the Einstein faculty since 1958, Dr. Rapin – who retired during 2012 at the age of 84, but still comes into her office – has been a respected and admired mentor to countless colleagues, residents and students at the College of Medicine and beyond. As a leader in the field of child neurology, she is credited with a number of discoveries in the field of neurogenetic disorders in childhood, including shaping our understanding of autism - a disorder whose complexity is described as a spectrum of related disorders. In addition to her renown as a "mother of autism," she has been called "a luminary in her field" and "always the guiding light."
"Isabelle is responsible for carrying over Saul R. Korey's unique model for neurology that we have at Einstein, which, operationally, doesn't exist elsewhere," said Dr. Mark Mehler, who has known Dr. Rapin since his days as an Einstein student and is now professor and chair of neurology, as well as the Alpern Family Foundation Chair in Cerebral Palsy Research and director of Einstein's Institute for Brain Disorders and Neural Regeneration. "She's been a seminal influence in characterizing neurologic disorders as 'lifespan disorders,' which start at conception, extend throughout adult life and need to be addressed throughout a patient's life. She is a star clinician and teacher whose scholarly mentorship extended beyond students, postdoctoral fellows and faculty to include caregivers, families and the general public."
In recognition of her distinctive authority, on December 6, 2012, Einstein launched an annual conference in Dr. Rapin's honor, focused on communication disorders. The conference's inaugural session detailed recent advances in research of Williams Syndrome, a rare genetic disorder that results in developmental problems that can include delayed but remarkably fluent speech in the face of other cognitive deficits. Each year's conference will bring together scientists and clinicians at Einstein, to both raise their awareness of various communication disorders and to encourage collaboration toward identifying possible causes and treatments.
"Isabelle was doing translational research 50 years ago, before anyone had coined a term for it or knew what it meant," noted Dr. Mehler. "Influenced by Saul Korey, Dom Purpura and Bob Katzman, she taught all of us who followed the importance of bringing science into our understanding and treatment of disorders. She is the world's expert in the field of pediatric communication disorders, and during her career she defined as well as refined our understanding of an entire field."
Dr. Rapin receiving her Honorary Alumna award at commencement, in 2000, from Dr. Dominick P. PurpuraThe conference is just one of a multitude of honors bestowed upon Dr. Rapin throughout her career. Among others, she has received the American Academy of Neurology's President's Award, a prestigious award given annually to a leader in the field of neurology, and been given Honorary Alumna status at the College of Medicine, which also hosted an international symposium on autism in her honor in 2006.
A founding member of both the Child Neurology Society and the International Child Neurology Association, Dr. Rapin's many accomplishments in the scientific realm are a reflection of her lifelong passion for science. As a child growing up in Switzerland, she became fascinated by science and determined she would one day become a doctor. Her unique determination and ability to fully immerse herself in her field were clear by age 10, when she understood active versus passive immunization.
The nervous system fascinated her above all at the University of Lausanne Medical School, but it was rotation in a Paris hospital that introduced the perspective of child neurology, prompting her to come to the United States to fulfill this dream. She was lucky to be accepted as an intern in pediatrics at Bellevue Hospital, in New York City, followed by a neurology residency and year of fellowship at the Neurological Institute at Columbia-Presbyterian Hospital.
It was during her residency that Dr. Rapin first met her eventual Einstein colleague, Dr. Dominick P. Purpura, distinguished professor emeritus of the Dominick P. Purpura Department of Neuroscience and former Einstein dean. As Dr. Purpura recalled, "We were each busily reading charts in a room at the Neurological Institute when we struck up a conversation. That led to a fast friendship through which we could bounce ideas off one another and discuss our patients."
It was clear to Dr. Purpura from their first encounter that Dr. Rapin stood out. "I always felt that Isabelle knew so much more than the average resident, and I considered myself to be an average resident!" he said. "Even as a resident, she was already displaying strong leadership qualities."
Following her residency, Dr. Rapin was hired by Dr. Korey (Einstein's founding chair of neurology) for a faculty position at the nascent College of Medicine. Her interest in clinical research, begun during her residency, continued at Einstein. "I've always had a strong drive to recognize when patients can provide important clues to biology," she said. "When you find something in a patient that science helps to understand, it's dramatic and exhilarating. And Saul Korey created an environment where this was not only tolerated, but expected and supported."
In 1959, she obtained her first National Institutes of Health grant, spurring a long and prolific research career that has produced more than 250 papers, books and book chapters on topics that range from lysosomal diseases to hearing loss and language disorders.
"Isabelle's research contributions have changed our understanding of many different fields within neurology," said Dr. Solomon Moshé, director of clinical neurophysiology and of the division of pediatric neurology in Einstein's neurology department, as well as professor of neurology and of neuroscience. "And, she has conducted pioneering work in metabolic diseases of the brain."
Dr. Rapin's influence is also evidenced by her academic contributions at Einstein. She founded and initially led the Child Neurology Service and Fellowship Training Program, through which she has trained generations of successful adult and child neurologists. (This includes her own daughter, Dr. Anne Louise Oaklander, who earned an M.D.-Ph.D. degree at Einstein and is a leading pain neurologist at Massachusetts General Hospital.)
"I discovered as a teen that I loved teaching," recalled Dr. Rapin. "When I learn something new that excites me, I want to share it with others and get them excited, too."
"The program that Isabelle created was one of the first in the country, and has an international reputation for excellence," noted its current director, Dr. Moshé, who also holds the Charles Frost Chair in Neurosurgery and Neurology. "Many of our graduates originally trained at Einstein because of Isabelle, and have gone on to create their own successful programs. Almost everything happening in this field, worldwide, can be linked back to her in some way."
Consistently admired for her clinical and scientific accomplishments throughout her illustrious career, Dr. Rapin continues to impress her colleagues and friends with her enthusiasm for learning and her eagerness to share knowledge.
"I always go to Isabelle with any clinical questions, any questions about mechanisms of causation, and about the latest theories," said Dr. Purpura. "She is a tremendous source of good information and understanding. With her perseverance and synthetic mind, which is able to put her knowledge of clinical, behavioral and scientific research together, she can take in the little leaves, the trees and the forest. It's an unusual and powerful combination of skills."
Dr. Moshé, who considers Dr. Rapin to be one of his mentors, agreed. "Isabelle is a true mentor, who teaches you and then encourages you to develop your own perspectives while remaining available to help. She is always the one we go to with a difficult case, and somehow is always correct with the diagnosis."
Although she retired during 2012, Dr. Rapin continues to keep current with the research and clinical advances in her field. Ever the mentor, still available to colleagues and patients alike, she concluded, "Every patient can teach us something we don't know. Patients are our teachers."
Posted on: Wednesday, December 26, 2012


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See also: Best iPad Air 2 and iPad mini 3 deals
Apple Smart Cover - £29
Apple sells the official Smart Cover for the iPad mini, which is a miniature version of the full-size iPad's Smart Cover that protects the front of the iPad and acts as a handy stand. It's available in the same colours: black, white, pink, yellow, blue, green and red. The price is also the same at £29, and it attaches with powerful magnets, and can wake and sleep the iPad mini automatically.
Apple Smart Case - £55
The iPad mini Smart Case has the same front as the Smart Cover but also protects the back of the iPad. It costs £55 because it's made with leather rather than the polyurethane Smart Cover, and is available in black, red, blue, brown or beige.
Read next: iPad mini 3 vs iPad mini 2 comparison
We'll add to the selection below as we come across more iPad mini covers, cases and sleeves
Belkin Slim Style cover for iPad mini - £35
As the name suggests, this iPad mini case from Belkin has protective corners to keep the tablet in place, magnets to secure the case shut when not in use, and a soft inner lining to protect the screen from scratches. The cover can be used as an adjustable stand, positioned in various angles thanks to rubberised feet on the frame and a grippy inner lining.
Belkin's Slim Style Cover comes in Azalea/Fiesta, Blacktop/Gravel and Stone/Cyan colour options.
Everything Tablet Luxury Leather Flip case - £49.99
Everything Tablet still sells its original 360-degree rotating case for the iPad mini for £24.99, but now the company has launched a luxury range.
The Luxury Leather Flip case is made from real leather and Alcantara lining. The iPad clips into the plastic shell and a hinge offers multiple angles for viewing and typing.
It's available in grey, navy, pink, white and yellow, and currently costs £49.99 (down from £59.99). You can also use the voucher code cases15 to get 15 percent of your entire order.
Griffin TurnFolio for iPad mini - £35
This particularly practical TurnFolio iPad mini case has a folio design, so it opens like a notebook and the iPad slots into a protective frame that holds it in place. Flip the cover over and it is capable of holding your iPad mini into landscape or portrait mode for a four-position workstand. The entire frame surrounding the iPad mini is removable too. There are cutouts for all ports, buttons and cameras, and it's available in a range of colours and designs.
Griffin IntelliCase for iPad mini - £35
A combination of a polycarbonate rear shell and a TPU cover, the IntelliCase provides protection in a slim package for your iPad mini. Magnets in the cover wake and sleep the tablet when it's opened and closed, and also provides two stand positions: for typing and FaceTime calls, or watching videos. It's available in red ordigital camo (blue/grey) .
Griffin Survivor for iPad mini - £50
If you need to keep your iPad mini safe from harm in harsh conditions, the Survivor All-Terrain should be a good option. As with other cases in the Survivor range, the iPad mini version has a shatter-resistant polycarbonate frame over which is a shock-absorbing silicone bumper. There's also a built-in screen protector and ports are covered, keeping out dirt and rain. A huge variety of colours will be available to suit your taste, and Griffin has made many of the models compatible with Touch ID so make sure you check that when you're choosing which colour option to go for if you own an iPad mini 3.
Proporta iPad mini Back Shell - £15
We're not too surprised to see smartphone-style shell cases available for the iPad mini, and Proporta's are some of those. These slim plastic cases cover the rear and sides, adding protection without too much bulk or weight.
Currently, there's a choice of pink, blue, purple or white.
Barbour iPad mini Quilted case - £55
Proporta has teamed up with Barbour to bring the famous brand to the iPad mini with its Barbour Quilted case. It protects the front and back of the tablet with a folio design, and it offers two stand angles. Barbour-lovers will be pleased to see the quilted exterior of this iPad mini case, which comes in a terracotta colour.
Cygnett Armour case for iPad mini - £30
Cygnett's Armour case for the iPad mini grips the tablet with six 'hooks' but has a foldable rear panel which allows the edge to rest on the inside of the front cover in an upright position for watching videos or making video calls as well as other angles. It's also available in purple.
Cygnett Enigma Slim Folding case - £24.95
Cygnett's Enigma Slim Folding case has a clever origami-style front cover that allows you to stand the iPad mini in various different positions. It has a soft, rubberised exterior and microfiber interior, and there's access to all ports and functions. This case comes in blue or pink colour options, too.
Case-mate Tuxedo for iPad mini - £25
We've seen the full-size iPad version of the Tuxedo, and it's much like Apple's own Smart Cover. However, it extends around the rear of the iPad mini, and is attached with a super-strong adhesive tape (which leaves no residue when removed).
Inateck TBP-IM Protection for iPad mini - £10.99
Inateck's TBP-IM is a soft but durable felt slip case for the iPad mini. It's cheaper than much of the competition, at £10.99 from Amazon, and will do a great job protecting your tablet from wear and tear. The tablet is held in place via a leather clasp and magnetic buckle, or you can turn the case on its side and fold it over to create a stand.


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Authorities have arrested two brothers in connection to a woman found strangled to death in her car parked at the San Jose airport nearly 25 years ago.
David Zimmer, the victim's husband, was arrested Friday by investigators. His brother, Robert Zimmer, was also arrested last week. The brothers each face a murder charge in the death of Cathy Zimmer.
Last month, investigators released new evidence in hopes of solving the San Jose State student's death. The evidence was a large, colorful quilt that was covering Cathy's body when she was found on March 10, 1989.
The quilt catapulted the cold case back into the headlines.
David Zimmer, 66, of Half Moon Bay, is expected to be arraigned next week, according to the Santa Clara County District Attorney's Office.
Robert Zimmer, 69, of Santa Clara, has been arraigned and is being held without bail. His next court date is April 18.
"When I reinstated the Cold Case Unit to assist county law enforcement with the investigation of
unsolved homicides and sexual assaults, it was these kinds of arrests that I had in mind," District Attorney Jeff Rosen said in a press release. "We do not forget victims, nor do we ever give up on justice."
The investigation revealed David and Cathy were going through a separation when she was killed, officials said. Evidence then led investigators to her husband and his brother.
Court documents show that in July 2012, the district attorney's crime lab analyzed a DNA swab that was taken from a piece of Cathy's clothing worn at the time of her death.
Investigators ran the DNA profile through the crime lab database and found Robert Zimmer to be a possible match.
Officials said David Zimmer profited from his wife Cathy's death. He sold their home for more than $225,000 and collected proceeds from two life insurance policies totaling $183,000.
Cathy was a 38-year-old mother of two teens. She was working part-time at a real estate office and taking classes at San Jose State, where she was last seen a day before her body was found.
Debi Lawrence, who was 14 when her mother died, on Friday said she couldn't believe her step-father and step-uncle were involved.
"It's senseless because I don't believe that murder has to happen," she said. "On the other hand, I guess there's a reason why it wasn't just some random person that didn't know her and robbed her."
In a previous interview with NBC Bay Area, Lawrence said that she had a thousand questions since the day she received the news of her mother's death.
"Everyday. Everyday I think about it," she said. "The loss. Not having her everyday to ask question about things I'm going through, everything from high school to all those things with boys, and schoolwork, and how to prepare for college."
NBC Bay Area's Stephanie Chuang and George Kiriyama contributed to this report.


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Livex Lighting is a manufacturer and distributor of decorative residential lighting. Our company was founded in 1993 and is now headquartered in a 150,000 square foot facility in Morristown, New Jersey.
Livex Lighting currently offers over 2,500 products ranging from lighting fixtures for indoor and outdoor applications to lampshades, chandelier shades, ceiling medallions and accent furniture.
The goal of Livex Lighting is to provide the highest quality product at the most affordable price.We are constantly responding to the ever-changing needs, styles and fashions of the lighting industry while at the same time always maintaining the highest standards of quality.
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New Ford Ranger to appear at Geneva
* String of world and European debuts * All-new Ranger and all-new small car * Electric cars and plug-ins, too...
Ford will reveal a string of new cars at the Geneva motor show in March, including an all-new Ranger pick-up.
The Ranger will go on sale in the UK towards the end of the year, and Ford says it has concentrated on making it more fun to drive as well as safer.
An all-new small car will also make its first appearance at the show. Likely to be a replacement for the Fusion supermini, Ford say the newcomer is 'groundbreaking'.
The Vertrek concept car seen at the Detroit motor show hops over the pond to make its European debut and shows us what the next-generation Kuga is going to look like.
Also on display for the first time in Europe will be the all-electric Focus which goes on sale in 2012 along with the plug-in hybrid version of the C-Max MPV that's due in 2013.


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Saturday night we headed down to a shopping center in Provo called The Riverwoods. They had tons of Christmas lights up, so we just went to walk around for a little bit. Evan had so much fun running around checking out all of the lights!
Checking out Santa-the line was way too long and it was way too cold out to sit on his lap
Riding the motorcycle
We later saw a shorter line and came to find out it was for free carriage rides! Since I have super pregnancy heat, I volunteered to wait in line while the boys ran around. There was definitely a reason it was free, but it was fun!
This isn't the best picture, but I love Evan's face!
We're excited to get to take Grandmas and Grandpas back with us in the next few weeks!


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Theatre Facilities
Hosch Theatre, Burd Center for the Performing Arts
Opened in 2002, the Hosch Theatre is the largest performance space in the John S. Burd Center for the Performing Arts. Named after its donor, Mary Helen Roop Hosch, the theater offers seating for an audience of approximately 350. The Burd Center is located at 429 Academy Street, close to the main campus area.
Hosch Theatre
Pearce Auditorium was dedicated on May 21, 1897, as "the largest of its kind in the South." In 1978, the building was named to the National Register of Historic Places. Three years later it was closed for renovations, then reopened in the spring of 1984.
In addition to its wide usage by such local groups as The Arts Council, the Gainesville Theatre Alliance, the Gainesville Ballet, the Gainesville Symphony Orchestra and many Brenau University events, Pearce Auditorium had been the site of many famous speakers. Helen Keller, Will Durant, Ted Shawn, Ruth St. Dennis, Martin Luther King Sr., Letitia Baldridge, Robert Peters, Williams Warwick, Dan Rather, Jane Fonda, and Maria Von Trapp spoke or performed in Pearce. The Arts Council has welcomed additional guests in recent years as part of its Pearce Series, including the Atlanta Symphony Orchestra, the New York City Opera, the Joffery II Ballet, the Vienna Boys Choir, Ramsey Lewis, Dave Brubeck, Herbie Mann, Chuck Mangione, Steve and Loretta Switt.
Choral Room, Music Wing at the Burd Center for the Performing Arts
Banks Recital Hall, Burd Center for the Performing Arts