text:
"women should be entitled to have ultrasound and other prenatal tests, but...the process of informed consent must be taken far more seriously than it currently is. Women should be told in detail of the limitations of screening, and of the fact that clinical studies show no benefit to scanning during a normal pregnancy"
Thursday, May 13, 2010
"women should be entitled to have ultrasound and other prenatal tests, but...the process of informed consent must be taken far more seriously than it currently is. Women should be told in detail of the limitations of screening, and of the fact that clinical studies show no benefit to scanning during a normal pregnancy"
27 comments:
wow, I can't believe that was written in 1996! Some things never change! I just had an appointment w/ a genetic counselor (just for a specific test that was totally unrelated) who acted like we wanted to hurt our baby by forgoing our 20 week anatomy scan. It's amazing how many medical "professionals" are not practicing evidence based medicine. (oh, and obviously this was not at St. Vincents...it really was a night and day difference between the care there and at other NYC hospitals)
ReplyDeleteAs both a physician and a mother, I'm all for forgoing unnecessary testing. However, we had what would probably be deemed an unnecessary U/S primarily because I'm total worrier. They unexpectedly found a serious heart defect that will require surgery within the 1st 2 weeks of our daughter's life. If I had declined the U/S we would have never known until some time after birth, potentially decreasing the chances for the best outcome. Knowing early allows us to come to terms with this diagnosis & also to meet with & coordinate all the specialists that will help our daughter. I know that for many, declining the scan is an option that the family is comfortable with, and that for some who choose the scan, false positive results that will cause unnecessary follow-up tests & anxiety.
All that to say that I think it's a decision that should be made on an individual basis - that what's right for one is not what's right for all. For us, though, what seemed like an unneeded test at the time turned out to be the right thing to do.This topic is close to my heart. I'm a health professional, a health services researcher and a mom. When I got pregnant I looked through the medical literature to decide if we should get a 20wk ultrasound. I wrote about it briefly here: http://www.accidentalpharmacist.com/search/label/ultrasound
When we ended up getting an ultrasound in my 35th week to confirm a breech position (i.e., the ultrasound was indicated rather than optional), the ultrasound technician was angry that we missed the 20wk ultrasound. She told us that we had made her job much more difficult and she was going to have to screen a much larger baby (even though we intentionally declined screening). While she screened, she talked at us rather than with us - and eventually refused to talk to us at all. During the ultrasound, our baby's heart rate dropped several times because it turned out that she was compressing her cord (we think), leading to an emergency c-section. While the outcome of the second US had nothing to do with the first, it gave the technician the courage to call our midwife and accuse her of offering suboptimal care. It was a mess and the experience was shocking.
So, while an ultrasound is a woman's choice, it doesn't always feel like it. As with any medical test, we should ask the following questions: 1) What is the test looking for (and capable of looking for)? 2) Will knowing there's something wrong change the outcome? 4) What will I do if the test finds what it is looking for? 5) How common are false positives or false negatives with the test?
If the test found something but you would do nothing, perhaps the test is not worthwhile. As Kim pointed out - knowing didn't change the outcome as her daughter would have needed surgery anyways, but knowing ahead of time let them prepare - something parents often say about Down's Syndrome screening. There's a similar debate over early cancer screening - if you're going to die in 10 years and you can't do anything about it, should you find out now or find out when you actually get sick. The assumption is that 'knowing' means 'saving' but there's often no evidence of that.
And different people have different answers - it's very personal. Some people just want to know. And sometimes they wanted to know until they actually knew, and then they wish they could take it back.
So, my questions are still this: Why is ultrasound screening not presented as a personal decision of the parents? And, why is ultrasound considered a catch-all for the dangers of the womb when it the evidence shows it is not capable of that?I didn't like that article. I think she was whining in my opinion. Even though the results proved to be wrong, there is no need to rant on about her "horrible" experience. So she didn't have the "perfect" pregnancy experience....just thinking about pink dresses, wallpaper and baby showers. What if it was right? She would have been so grateful to have prepared herself to help her daughter with the clubfoot. These ultrasounds are only there to help and this article is a bit of a slap in the face for those who have actually found abnormalities. It annoys me when people complain like this when there are women who would do anything to make sure their baby is healthy. Bottom line, procreating is serious and should be approached with a realistic attitude. Nothing in life is perfect!
ReplyDeleteThank you for posting on this topic. My husband and I are TTC after a miscarriage in March. The way the miscarriage unfolded was closely tied to ultrasound.
When I found out I was pregnant (at 4 weeks) I had already started spotting. When the spotting didn't stop by week 5, the OB's office had me come in for an ultrasound. The ultrasound technician and the nurse said that everything looked normal, though they couldn't explain the bleeding. They SAID if it was a miscarriage, they would have been able to tell. Yet, they wanted me to come back in a week to repeat the procedure.
A week later I went back with my husband (he was away on business the first time) and we were fully expecting to hear once and for all that everything was fine and even to hear a heartbeat (we were at 6 weeks by that point). The first thing that the sonogram technician said to us was, "So, have you actually had the miscarriage yet? Or...?"
I was like WTF. We were told everything was fine and that we were just coming in to make sure of that. She was like, oh. Right. Anyways, the ultrasound showed no development and we were told we were having a miscarriage, which was devastating.
Anyways, this time around as we are trying to conceive, I am already thinking about how I want my pregnancy and birth to go. My goal is now to have a natural birth at home if we can afford it. But in thinking about prenatal care, I am instinctively distancing myself from the idea of sonograms. I didn't have the information on why they are not useful and potentially harmful (I am a natural worrier so I know that they would not be helpful for me) but I just know that I don't want to do them if we don't have to.Thank you for sharing this. With my 3rd pregnancy my husband and I decided to not find out the sex and to also not have the sonogram. There seems to be very little info/studies out there on the subject.
The only fall back to not getting one was not having that "peace of mind" I felt like I got with my 1st two pregnancies, I tried to remain positive but also had many moments where I felt I may have made the wrong decision, the big "What if..."
but I do not regret not having one. I got so much negative feedback from friends and family for not having one . But we are used to that as most of our lifestyle choices are not very...mainstream.Hi Leigh,
It's so funny how the world works, isn't it? It seems like, when you personally experience something, suddenly you are bombarded by so many other things that are related. Even with things so simple as buying a car or getting pregnant. You start seeing that same car everywhere, even though you are sure you rarely saw it ever before, and when you're pregnant, pregnant women are EVERYWHERE (Yeah... Like they simply weren't around before!).
So it is today with this whole ultrasound issue. I just went in this morning for one as I was nursing my daughter during the time of conception, had a varied cycle, and we were trying to figure out how far along exactly I was in the pregnancy. Turns out I was right on target with my "guess", but anyway, being that I've had all of my babies on their due dates, I was really wanting to have a better handle on the actual (more like most likely, as with anything in relation to an ultrasound) due date.
What I have learned during these experiences is simply to take the information you receive from the doctors with a grain of salt. Sometimes more than one grain. I go into these things with a very positive outlook. To me, no matter what problem may possibly be presenting itself, well, it doesn't bother me and I'm not going to change the fact that I will do my very best to carry this child to full term. I have no intention of aborting my baby for any reason.
(...continued in next comment)(continued from above)
A part of this is because of my belief that the chance that a life can be had and love can be shared far outweighs any possible difficulties. I know many families who have children with Down syndrome who love those children as they love each of their other children, and those children live wonderful, happy, love filled lives. Not to mention the benefits and character strengths that those families exude because of those children! I've had friends who've been told that their children would be born with spina bifida or kidney or heart problems, only to see those children born completely healthy and without even a sign of those supposed problems. My mother, when she found out that she was carrying conjoined/siamese twins, was told that she NEEDED to have an abortion because her daughters would most likely be vegetables and life would be terribly difficult, and most likely both of them would die. My sisters, who were the very first successfully separated conjoined twins (which I am so thankful is true!), just turned 23 years old last month and are both graduating from college this month - one with a degree in the arts, the other at the very top of her class as a bio major.
Every pregnancy is different. And, every ultrasound I've ever had has been different. I actually enjoy them, though I have wrestled with whether or not it is really "right" to see the baby before he or she arrives. I would argue that hearing the heartbeat is also a medical miracle in that regard. Without a stethoscope having been invented, it would have been very hard, or impossible to hear such a lovely thing as a baby's beautiful heartbeat.
But I do not rely on ultrasounds for on target info at all times. I think that whenever I am told that "this or that" may be an issue, spending the time to learn about those issues is not time wasted. I think that article was a great example of that, actually, even though the author puts it in more of a negative light. You can see that she was actually introduced to a whole other part of the world we live in. Now, according to her, she narrowly escaped such horrors, but honestly, I hope that it brought about for her a greater understanding of the problems some families face, and perhaps she can be an encouragement or of help to someone else who will truly have to deal with such a thing for their child.
As new/expecting parents, we prepare for all sorts of things. We prep baby clothes, we research the best car seats and slings, we eat this and that or avoid this or that - most of the time, just in case!
Regarding unnecessary worry... I think maybe I'm just totally not the understanding sort when it comes to worry. My faith in God has not "raised me" to be a worrier. I believe that whatever trials come my way, God is using them for his glory and for my (and all sorts of other people's) benefit. Many of your readers, and maybe you, may not agree with that on any level, but as I said, they are my beliefs and I am entitled to them as everyone else is entitled to theirs.
(again... continued... so sorry!)Today I was told that my "baby's brain ventricles were presenting with a cyst beside each one, which could - or could not - mean something serious. Every other body part that might give more of a hint as to what might be going on were absolutely beautiful and whatnot, so it was probably nothing to worry about, but that blood test I had turned down... Yeah. I should definitely get that taken before my 20th week expires five days from now..." Now, that was just paraphrasing, but, anyway. When I informed the doctor that I had no intention of taking the test, she looked back at me in shock. I explained that no one in my family had any history of that condition, that her showing me that the baby presented no other signs of the condition was pretty great news, that the baby was very mobile and had great blood flow and heartbeat was fabulous to me... the fact that I'd had three other pregnancies start and finish completely normally, that I'm healthy and live a healthy lifestyle, and so on, really steered me more toward leaning toward the positive and not getting myself all worked up over what was "probably nothing at all".
Her answer to me was a very scrunch faced, "Well, it's your decision, ultimately, I suppose." And she's right. And I've made it.
Anyway. Those are just my two cents. I'm very grateful for the tip to the article, though. I hope that it doesn't necessarily steer people away from getting ultrasounds if they are needed, but that it will encourage expecting parents (whether they are having an ultrasound or blood or fluid screening) to not allow themselves to fly into a fit of worry over what may or may not be an issue. Study up on the issue - does it ever hurt to learn something new? - but remain hopeful and positive for your baby. Would a deformity or other condition really cause you to love your baby less? The likely answer is that it absolutely wouldn't. And for those whom it would, I don't quite know how to respond to your reaction.
Hugs. I love that picture! You look beautiful! I can hardly wait to have a big beautiful belly like that again!!! (Four months to go over here!)Wow. Wow. Bravo to the woman who wrote it. This is something every family or family-to-be should know about. I honestly had never heard any compelling argument against ultrasounds other than that they can mis-determine the gender. I don't think that ultrasounds should be done away with completely. And I still think women ought to be able to have one if they want one. But it's so true: we need to know its limitations and flaws before going into it. Seems like a no-duh thing to me.
ReplyDeleteSorry for the second comment, but I wanted to add something else. I do remember wondering back when we were pregnant and going in for an ultrasound about what would happen if you receive really bad news. Because the waiting room is filled with people who just went in for an ultrasound and are awaiting their DVD; they're on their cell phones, giddy as all get-out, announcing their baby's gender to the grandparents to-be, etc. How awful for anyone coming out of that room with bad news. The idea of this scenario really disturbed me when we went in.
ReplyDeleteRe: Accidental Pharmacist's comment: there actually is some evidence showing that if you carry the brca1 or brca2 gene, that mastectomies can reduce your chances of getting cancer. (Listen to Dr. Susan Love interview) http://126.96.36.199/programs/patt-morrison/2010/03/18/can-removing-a-breast-prevent-breast-cancer/
In other words, I think some women are finding out in case more studies/information comes out that could help them. So I don't really know if these issues are comparable.I am still trying to get over my experience with my 1st son- we had 8 ultrasounds because at the 20 week they couldn't get a good look at his kidneys and WORRIED me unnecessarily almost sick! Saying he could have only 1 or no kidneys. We had ultrasound after ultrasound until he was born and he was perfectly FINE.
However, a couple years later we found out he has epilepsy and who KNOWS what role all thos stupid worrisome ultrasounds played in that. And don't get me started on the 3D for fun u/s. I wrote about that a while ago and grrr. People need to be educated about this stuff (and everything they are "assuming" is doctor protocol.)
StephRach, I found this link with a list of studies (the most recent dated 2006) that look at the effects of ultrasound on neurological development.
Also, NO studies exist that prove the safety of this procedure. Remember, even the American Medical Association recommends AGAINST unnecessary exposure.
"Unnecessary Exposure" includes the use of ultrasound to:
1. Confirm the sex of the baby.
2. Assess gestational age (how many weeks old the baby is).
3. Assess fetal size and growth.
4. Confirm multiple pregnancy.
5. Determine fetal presentation (the position of the baby in the womb).Ina May Gaskin writes briefly but convincingly in "Ina May's Guide to Childbirth" about this topic as well.
And here is the web site of the American Society of Radiologic Technologists, which itself warns against unnecessary use of ultrasounds, citing the 2006 study: https://www.asrt.org:/content/News/IndustryNewsBriefs/Sono/studyshows062408.aspxInteresting article, EXCELLENT feedback! It can be helpful and unhelpful at the same time. It's a great reminder that any and all prenatal care (I use the term loosely) is a choice. Of course, US is not perfect (what is?), nor is it even necessary. Plenty of babies have been born without.
I've been fortunate that my prenatal medical provider has reitereated over and over again that these tests and scans are a choice, and what exactly I could be getting from them.
I openly wonder how much insurance and medical liability come into play with the widespread use of the 20 week anatomy scan, and the routine 36 week position check for doctors. I have a feeling that there is something more behind the medical profession's treatment of US.
I love your thoughts, Leigh. Thanks for sharing this today.i have quite a bit of resistance to radiation in general, with no real evidence, just in my gut.
however, i am learning more and more the importance of balance and how destructive extremes can be.
in the case of this article and like so many others who have been misinformed--i'd rather them catch something early on so i can have time to prepare for it--if that means a misdiagnosis, then that means a misdiagnosis. thank god. i believe the benefits outweigh the risk here.
having come from a completely holistic, organic homebirthing approach on my first child and then after losing that child during my homebirth, i opted to another extreme with my second child. a planned c section and ultrasound technology as my assurance throughout my pregnancy.
the tricky thing is, that once you make a decision towards one camp, there is plenty of information--be it true or false--to support your decision --on the internet, in books, etc. as mothers, its important to avoid avoidable risks and measure things in benefits vs risks since there is no promise of an absolute. if it's a way to somehow protect my child, then i opt for u/s....even in my "extreme" case with my 2nd child, i was never exposed to it every visit or whenever i wanted to. it was still few and far between.Cara,
Thank you for your comments and question. I do not have url links for those original statements, however here is the source of the American College of Obstetricians and Gynecologists' advising against the routine use of ultrasound in low-risk pregnancy: "Routine Ultrasound in Low-Risk Pregnancy, ACOG Practice Patterns: Evidence-Based Guidelines for Clinical Issues," Obstetrics and Gynecology 5 (August 1997).
Here is a similar statement from the National Institutes of Health: "Diagnostic Ultrasound Imaging in Pregnancy," Consensus Development Conference Statement 5, no. 1 (1984, Washington, DC).
The World Health Organization (WHO) has also urged prudence: "Ultrasound screening during pregnancy is now in widespread use without sufficient evaluation. Research has demonstrated its efficacy for certain complications of pregnancy but the published material does not justify the routine use of ultrasound in pregnant women." -- World Health Organization, "Diagnostic Ultrasound in Pregnancy, WHO View on Routine Screening," Lancet 2 (1984): 361.
I will try to follow up with links/citations for the American Academy of Family Physicians statement.
Thanks!thanks much leigh! i ended up talking about this to my ob friend, wondering if my concerns were valid. he made an excellent few points i hadn't considered. one being that just as much as we lack evidence that u/s is safe, we lack evidence that it's unsafe too. and secondly (and more importantly) it is NOT radiation, like i thought. it's soundwaves. and the only harm that ultra sound is proven to cause is in oceans (specifically with dolphins & whales) I imagine at high megahertz, it could be problematic to one's hearing if too high but the ultrasound is at a 7 megahertz at it's highest (the loudest cell phone ranges to about 1900 megahertz) The sound frequency measures the distance from the "probe" to your fetus, scanning an image on a screen by sound. i thought this was pretty cool to learn and gave me some assuredness in having used u/s technology during my pregnancy. just an fyi! hope you find it just as helpful.
ReplyDelete@ Susan - I'm not sure where you got your information, but your sisters where not the first pair of conjoined twins to be successfully separated, not if there are in their 20s. Sherrie and Sharise Jones were separated in 1967, and there were several other successful separations following theirs.
ReplyDeleteWith my first pregnancy (in 2002-03, when I was 32/33 yrs old), we opted to have only the 20 week ultrasound. We were working with midwives, so we had informed consent for each step and process. We chose to do the 20 week ultrasound (after I researched and tried to get clear about our reasons), but in retrospect I see that our choice was really based in fear, though my husband and I thought of it as "making sure everything is all right."
We were referred to the ultrasound doctor, and I told the doctor that I didn't want to receive any verbal information during the exam, and that at the end, I wanted to hear either "everything's fine" or "there is some issue that is serious enough to need follow-up and here is what it is."
The doctor agreed but he was definitely surprised, and a bit confused. He said that in all the years he has done ultrasounds, no one has made that request. He kept marveling over my request, which began to awaken my own feelings of self-consciousness. I think it just never occurred to him (or to anyone else) that patients could ask for the information on their own terms, or that individuals have different preferences.
During my second pregnancy (in 2006, at 36 yrs), we opted out of pretty much everything. :) I wanted to have a minimally invasive birth, and we had a very supportive and truly hands-off midwife who practiced informed consent all the way. We chose to do one test the whole pregnancy, and that was Group B Strep (I tested positive before). I had more information this time around and wanted to make an informed decision on taking the antibiotics if I tested positive (e.g., if certain other conditions presented themselves, such as broken waters for 24+ hours, etc.). BTW, the test was negative.
[I had also had gestational diabetes with my first, so I knew what it felt like/what the symptoms were, and sure enough, at about 24 weeks, my blood sugar completely changed, and I began testing my blood and eating on the gestational diabetes diet as I had before. I guess I'm trying to say that perhaps if I hadn't had it with my first pregnancy, I might have opted to have the test during my second.]
Anyway, sorry to stray from the topic of sonograms, but I think all tests bring up the same issues around informed consent. The same basic questions you ask around one test apply to them all, and I think it would be wonderful if professionals facilitated rather than hindered that inquiry process. It takes thought (actually I would say "presence"), time, and attention to come to clarity -- it can be difficult to do, even in private, and to be required to make decisions without the personal space needed is, in my opinion, a travesty.
I am, of course, not talking about immediately life-threatening situations which require a moment's decision. Though even those decisions will require a healing process afterward to come to terms with what happened.
One more thing, and then I'll stop -- I was a huge fan of Natalie Angier (back in the 90s! :) and I was so surprised to see her as the author of the article, then I realized the date. Wow! Could have been written today.


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@unversio Still the coolest guy in the peleton, despite serving up shoes for dinner to his mate Ivan »
BTW, I love Nibali, but am struggling with his Giro performance – just waiting for the 9 minute solo victory…. »
Danilo Di Luca – "Killer" = wanker Feel sorry for his DS – quote "It's true," Scinto said in a quiet, sad voice. "He's mad, he's a cretino, he needs treatment. There's nothing else to say. We gave him a second chance and the sponsors put their faith in … »
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@Chris indeed, maybe with MTB hooning, one should be encouraged to make as much noise as possible – certainly couldn't contemplate using one on a road bike By the way, about to build my THIRD set of wheels – indeed, I cannot stop visiting the hubs and r… »
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Is it the recession biting, or why are the jersey holders at this year's Giro wearing easy iron on transfers on the jerseys instead of proper individually logo'd up shirts – not so cool »
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Agreed that the racing is more exciting at the Giro, but unfortunately Le Tour said in a french accent is more sexy that Il Giro is in an italian accent Perhaps this is an unimportant point I do think the Giro still lacks the pomp and ceremony that the … »
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I just love tan sidewalls »
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Great table
By Cat lady
from RI
About Me Midrange Shopper
Comments about Klaussner Furniture Klaussner Winchester Rectangular Cocktail Table:
Its a real nice addition to the living room. Looks "old but cared for," and the drawers are big and hide lots of junk. Love it.
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Nice table, but...
By Couch Potato
from Towanda, PA
The table is great and looks really nice in the room. It assembled easily and fit together well. [...] Anyhow, I love the table and wasn't going to find anything like it at the local shops, so all's well that ends well, I guess.
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By Somebody
from San Francisco, CA
I ordered it after thinking for several days. I like the design, shape, size color. It fits perfectly in my living roon, I also got the matching end table, it goes well with my leather sofas. I am not very happy about the quality, there are very tiny bunch of holes on the table top and one other place. They are very tiny, not sure if the wood used has those holes. Also, doesn't look like 100% wood, could be some man made wood like material. I don't mind, because I don't think of a tree that is cut to make the table when I am using it. If you are looking for all 100% wooden table, this is not for you. But if you want a sturdy table for your living room, then you can get this. The size is perfect and the drawers are great to keep your remote controls. The color is much darker than in the picture, more dark cherry finish. [...]
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Home television becomes a theatrical experience when you add optional entertainment packages and technology extras from Cox Cable TV in Calaveras County. The Advanced cable plan offers the greatest assortment of home entertainment options out of all Cox Cable TV packages in Calaveras County. The number of stations can reach 270, and you can incorporate options like the Sports and Info Pak, the Music Pak, premium channels, and a host of other specialty entertainment packs. In the current era, so many of us deal with a loaded schedule. This can make it tough to catch programs as they air. Say hello to a new era of convenience with a DVR or on-demand cable. A DVR from Cox Cable in Calaveras County makes it easy to custom build a video library of your choosing and watch them at your leisure. On-demand cable comes pre-loaded with thousands of TV shows, movies, and other thrilling entertainment events.
With an arsenal of choices at the ready, Cox cable TV in Calaveras County puts you in complete command of your home entertainment. Call it the power of options. That's the Cox Cable TV home experience. And, no one offers more or does it better than Cox Communications. From A to Z, Cox cable TV in Calaveras County has you covered. Depending on the cable package you choose, Cox TV can deliver as many as 270 stations. Optional features and technology extras range wide. Premium channels, DVR technology, on-demand cable, and HD programming are available to you as Cox Cable TV subscriber in Calaveras County. Cox Communications also offers a stellar basic cable package in case your tastes run simpler. If your preferences lie somewhere in the middle, Cox TV in Calaveras County has you covered in Calaveras County. Diversity is the name of the game when you choose the Cox brand of home entertainment. This means something thrilling awaits every individual in your home. Sports, movies, music channels, and specialty networks are all part of the equation with Cox Cable TV in Calaveras County. See how much awaits you when you choose home entertainment from Calaveras County Cox Cable.
With so many options when it comes to home entertainment, Cox Communications in Hathaway Pines CA delivers ample excitement and then some. Moreover, Cox Communications offers the power of choice. This truly puts you in the driver seat when it comes to home entertainment. And, every member of your household will find something that fascinates them. You'll find this true whether you choose a comprehensive home entertainment package or one that simply covers the basics. In any direction, Cox Communications in 95233 has you covered. The bon a fide home entertainment enthusiast will find a goldmine of optional features and technology extras that you can incorporate around any cable TV package. This includes premium channels, entertainment packages, on-demand cable, DVR technology and more. Very truly, diversity and innovation are hallmarks of the Cox TV experience in 95233. Nowhere else will you find more sports, films, music and better TV series. Cox Communications has it all. See how much awaits you when you choose a home entertainment package from Cox in 95233.
The wide mix of entertainment and innovation offered by Cox Cable TV in Hathaway Pines CA will turn home television into an experience like you feel at the Cineplex or a live sporting event. Cox Communications puts you in the thick of the action like no other provider can. Of all Cox TV plans, the Advanced lineup offers the greatest mix of channels: as many as 270. Optional packages like the Music, Sports, and Info Paks round out the lineup nicely. Premium channels like HBO and Showtime are available for a low, monthly cost from Cox Cable in 95233. These days quite a few of us face a loaded day. Having a DVR or on-demand cable means a busy schedule will never keep you from watching home television. You'll watch it when it suits you. As an added bonus, Cox TV offers pay per view movies and events. This brings the best of Hollywood and other world class events direct to your living room. Go ahead, if you like, and put your experience over the top by adding channels in HD. Cox high-definition offers rich image detail, vivid color separation, and distinct audio. Things truly kick into high gear with channels in HD from Cox. Count on the number of HD listings to grow all the time.
Quite likely the most popular package from Cox Cable TV in Hathaway Pines CA, the Preferred plan offers a step up from regular TV. Like the Advanced cable package, the Preferred plan from Cox TV delivers a wide flux of channels, up to 236. It, too, provides access to additional entertainment packages, on-demand cable, Pay Per View TV and iTV as well. Enjoyed everywhere around Hathaway Pines CA and across the nation, premium channels from Cox are offered at a price that's easy to handle. At any time, you can add the likes of HBO, Showtime, Cinemax and Starz and tune into A-list feature films, plus hit original series and exclusive movie showings. Though any Cox cable package you choose in Hathaway Pines CA will feature digital picture and sound, nothing compares to HDTV viewing. And no one does it quite like Cox TV. The list of available channels in HD from Cox TV runs deep and continues to add more listings all the time. It creates a unique cinematic experience that's six times sharper than regular TV resolution. HDTV viewing really pays for itself when you consider the cost of taking your family to an evening at the movies or a live stadium event.
Some Hathaway Pines CA residents prefer home television that simply delivers the basics. If that's where your needs live, then you'll want to consider the Essential plan from Cox Cable. Even though it's an entry-level plan, you can still tune into a high number of channels, as many as 95. The Essential plan, along with all Cox TV plans in Hathaway Pines CA, features your local TV stations at no extra monthly cost. This is a break from satellite TV providers in Hathaway Pines CA who frequently charge extra for local programming. If you have multiple TVs around the house, Cox TV lets you connect as many as you like at no extra cost. There's also no need for extra equipment. Just in case you need it, Cox Cable TV in Hathaway Pines CA features full 24/7 tech support available over the Web or via phone.
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Updated 11/07/2012 05:09 PM
By: Barry Wygel
BRASHER FALLS, N.Y. -- A cook-off had the smell of peppers and onions wafting through school halls. St. Lawrence Central Middle School students competed in the preliminary rounds for North Country Junior Iron Chef. Seven teams tried to cook up a healthy quesadilla. The students could choose from a variety of ingredients.
The competition is not just to improve cooking skills. Teachers say the students will gain life skills as well. "They'll work at teamwork, organization and they will have a lot of fun," said Anne Norton, home and careers teacher.
The winning team from Wednesday's competition will compete against other North Country schools in March.


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Sanford police seek credit union robber
Friday, January 4, 2013
SANFORD, Maine (AP) — Police are looking for a suspect in New Hampshire who is wanted in connection with a credit union robbery in Sanford, Maine. |


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On Tuesday, Finance Director Gary Burkhalter will take over as interim county manager, until the Floyd County Commission settles on a permanent replacement. Click here to see the job posting.
Williams, who starts work Jan. 7 as an assistant county manager for Athens-Clarke County, said the teamwork is what he'll remember the most from his time here.
"There are so many dedicated and unselfish community leaders who volunteer their time and talents to make Rome and Floyd County a better place to live," he said. "And I've been privileged to be at the helm with so many hardworking and dedicated employees."
Asked for a list of his proudest accomplishments, he includes as his partners department heads, community leaders, city of Rome officials and Greater Rome Chamber of Commerce members.
The Lowe's distribution center at Ga. 53 and 140 came to fruition on Williams' watch. He also oversaw the successful completion of a number of SPLOST projects — including the Armuchee Connector and the 10-tower countywide communications network.
Williams' tenure was marked by financial woes stemming from the national Great Recession, and he expressed some disappointment that the sole response has been more budget cuts.
A plan to raise money through a special purpose, local option sales tax was rejected by voters, and the County Commission has, so far, ignored his recommendations on revamping county operations to make them sustainable.
"The widespread distrust of big government should not be unfairly leveled at the local governments. They are made up of your neighbors, friends and family, providing necessary and essential services at a value," he said. "If the community fails to reinvest in itself on an ongoing basis, then stagnation will inevitably occur."
Burkhalter and Assistant County Manager Noah Simon — whom Williams hired in March — will be working with the Commission in January to wrap up the 2013 budget.
Meanwhile, the board is advertising in state and national publications for Williams' replacement.
"Applicants must have a Bachelor's Degree (Master's Degree preferred) in Management Administration or related field and at least five years experience as a county manager or assistant city manager or any combination of education and experience," reads the posting on the Georgia Local Government Access Marketplace website.


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The Junior Class has purchased 1000 Sheetz Coupon Booklets to sell as a fund raiser for this year's prom. For more information, please click the headline.
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Administration Bill Oblas, Principal Rick Brown, Assistant Principal Muriel Heanue, Assistant Principal Mark Patterson, Assistant Principal Ken Wright, Athletic Director Dan Croyle, Guidance Director School Board Members Thomas E. Reed, At-Large Member Jill Turgeon, Blue Ridge District Jennifer Bergel, Catoctin District Bill Fox, Leesburg District For technical issues please contact our Webmaster |


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SportsApril 23 2012
Forest Service to Conduct Prescribed Burn
Forest Service to Conduct Prescribed Burn
On Monday April 23, weather permitting, the Fort Pierre National Grassland plans to conduct a prescribed burn on the south end of the National Grassland.
The two burn units to be included are located in the Dry Hole Chester unit: T106N, R79W, Sec. 8 (approximately 320 acres) and the Chester Middle unit: T106N, R79W, Sec 5 (approximately 480 acres. These units are located along the west side of SD Hwy 83; 23 miles south of Fort Pierre or 5 miles north of Vivian, South Dakota. The goal of burning these units is to reduce flammability and to create a vegetative disturbance in areas that have not been burned or grazed in several years due to a lack of reliable water.
"We've seen an improvement in grassland health from our previous prescribed burns, such as better native grass vigor and diversity; so we want to continue to use that tool in our tool box" added Ruben Leal, Fort Pierre District Ranger. In order to ensure that the objectives of the project are met and that the burn stays inside designated control lines, specific conditions have been established for this project. The burn will not be implemented unless weather conditions including wind speed, wind direction, humidity, and smoke dispersal fall within specific ranges. Control lines have been mowed around the boundary of the unit and fire retardant foam will be utilized on the day of the burn to keep the fire from spreading beyond the control line.
The burn will be managed by personnel from the Nebraska National Forest and Grasslands, as well as partners from other state and federal agencies and local Volunteer Fire Departments. Personnel from the Fort Pierre National Grassland will notify adjacent landowners, law enforcement entities and local fire departments on the actual day of the prescribed burn. Smoke may be visible from Interstate 90 and from the communities of Vivian, Draper, Presho, Murdo, Kennebec, Pierre and Fort Pierre. Other residents and communities may see or smell smoke from the prescribed burn.
- Friends, classmates graduate
- Memorial Day Services
- Lyman track teams win Conference Meet
- Western Great Plains Confernce Track meet to be held in Presho
- Youth selected to attend Boys and Girls State
- Nominating petitions due
- Love of horses inspires essay
- City-wide clean up days scheduled
- Pierre publisher elected president of South Dakota Newspaper Association
- Prom on the Bayou
- Get ready for Scavenger's Journey


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LITCHFIELD >> It's been over 12 years since 27-year-old Tanya McKay's death was ruled a homicide by the Connecticut Chief Medical Examiner's Office — a ruling which came nearly five months after the New Hartford woman was found unconscious at her home and brought to Charlotte Hungerford Hospital, where she never regained consciousness.
The Medical Examiner's Office said McKay's death was the result of a blunt traumatic head injury for an incident that occurred New Year's Day in 2000. McKay was brought to the hospital by "a male friend" at 5:30 a.m. that day.
McKay's estranged boyfriend at the time, Peter J. Sebbin, now 53, initially declined commenting to police about the investigation, and wasn't arrested until Dec. 29, 2004 — close to five years after McKay's death.
Upon arrest, Sebben was charged with first-degree manslaughter and tampering with physical evidence, for which he has been at liberty on a $125,000 bond. The two felonies Sebben is facing will now go before Judge James P. Ginocchio and a jury Wednesday, with the trial slated to begin 12 years after the woman's death.
Attorney Hubert J. Santos, Sebben's appointed lawyer, previously argued for the trial to be moved out of the Litchfield Judicial District, but Ginocchio denied the motion. Santos' grounds included the comment section of the Register Citizen's website, which he called "inflammatory" and would sway potential jurors.
Ginocchio said the comments weren't in the news outlet's print edition and were limited to a minimum group of people. Since 2009, Ginocchio said, there's been "very little coverage of the case."
Sebben and McKay had a domestic violence history, with both being arrested once in a four-month span in 1999. Sebben was charged with disorderly conduct and third-degree assault for an incident with McKay in February 1999. McKay was arrested on July 6, 1999 for third-degree assault for an alleged incident on Sebben.
Both incidents were dismissed by state prosecutors.
Now, more than a decade later, state prosecutors have targeted Sebben as the prime reason behind McKay's death.
Reach Ricky Campbell at 860-489-3121 x343.
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Unity in the Foothills
102 Prospect Street, Torrington, Ct 06790
A Course in Miracles Tuesday evenings 7 p.m.
Transformational Prayer Group Thursday 1:15 p.m. and Sunday 9 a.m.
First United Methodist Church
21 Fern Drive, Torrington, CT 06790
Rev. Barbara B. Shaffer, Pastor
860-489-8084 www.fumctorr.org
Email email@example.com
Sunday Service at 9:30 a.m.
Sunday School from 10:45 a.m. to 11:45 a.m.
Pre-K thru Adult
Northfield Bible Church
10 Camp Hill Road, Northfield, CT 06778
860-283-9598 www.nccindependent.org
Bible Doctrines Class: Sunday at 9:00 a.m.
Sunday Service at 10:00 a.m.
Bible Study: Wednesday at 7:00 p.m.
Pot Luck Supper every 4th Friday of the Month at 6:15 p.m.
First Assembly of God
387 New Harwinton Road, Torrington, CT 06790
860-482-7464 www.firstagtorr.org
Sunday School for all ages 9:30 a.m.
Sunday Worship Service at 10:45 a.m.
Family Night Thursday at 7:00 p.m.
Adult Bible Study Prayer Service: Saturday at 9:15 a.m.
Cable 5 Sundays, Wednesdays, and Fridays at 3 p.m.
Founders Congregational Church
41 Birge Park Road, Harwinton, CT 06791
Sunday School and Services 10:00 a.m.
Bible Study: Tuesday at 7:00 p.m. and Thursday at 10:00 a.m.
Center Congregational Church
155 Main Street, Torrington, CT 06790
Email firstname.lastname@example.com
Sunday Services and Church School at 10:00 a.m.
Second Congregational Church of Winsted
Biblical, Traditional, Protestant Worship
800 Main Street, Winsted, CT 06098
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Worship 10:00 a.m.
Sunday School 9:00 a.m.
July - August Worship 9:30 a.m.
Hours: 8:30 a.m. to 4:00 p.m. Monday - Thursday
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PC-BSD 9.1 DVD are shipping now. You may order your copy here: DVD.
FreeBSD 9.1 CD and DVD are shipping now. You may order your copy here: CD, DVD.
Coming Soon: FreeBSD 9.1 and PC-BSD 9.1.
Upcoming Events: iXsystems will be at the following tradeshows and conferences: Sept.13 Software Freedom Day | Sept.29 KyivBSD | Oct.20-21 EuroBSDcon | Oct.28-30 Ohio Linuxfest | Oct.31-Nov.1 Open Storage Summit | Nov.3-4 MeetBSD | Dec.9-14 LISA (More Details)
At BSDCan 2012 in Ottawa
Old 1BSD software used today
BSD Certification Group awards first certified BSD Associates
BSDA "Associate" sysadmin course to be taught in DFW Texas
The Best of FreeBSD Basics book published
The FreeBSD Handbook is a comprehensive FreeBSD tutorial and reference. This revised third edition has been expanded into a two volume set filled with updated information on the latest FreeBSD technologies.
The first volume provides step by step instructions for installing FreeBSD on a PC, setting up a graphical desktop environment, and installing additional third party software.
The second volume provides detailed information for system administrators seeking to setup or maintain network servers running FreeBSD.
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FULL RESOLUTION - 869x1222
News » Published 15 hours ago
Is this Christian Bale the Actor?
Share your thoughts on this image?
Related Celebrity: Actor - Christian Bale
25th May 2013 @ 08:52am
Will Christian Bale win another Oscar for David O. Russell's 'American Hustle'?
14th March 2013 @ 05:11am
The synopsis, release date, and filming locations regarding David O. Russell's Abscam film have been revealed
10th March 2013 @ 10:30pm
Christian Bale has been pegged as the frontrunner to star as the male lead in David O. Russell's epic Ends of the Earth


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My Cart is a persistent shopping cart that stays with you while you navigate around Patagonia.com.
To minimize this window, click again on My Cart.
M's Merino 1 Silkweight T-Shirt $60.00 #36350
M's Merino 2 Lightweight T-Shirt $70.00 #36710
M's Merino 2 Lightweight Zip-Neck $85.00 #36730
M's Merino 3 Midweight Crew $90.00 #37110
Script section containing code for Chat Solution


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Zipper Back Tee
Item# 5056928
Take An Extra 25% Off Markdowns - Price reflects discount
Excludes Sweaters & Cardis
- Soft stretch jersey with scoopneck
- 3/4 sleeves
- Exposed back zipper
- Curved hem
- Cotton Spandex Blend
- Machine wash.
- Imported
Very versatile
I normally wear a small, but got a medium in this top after reading other reviews. It's a great top, a little thin but a Cami underneath takes care of that.
May 16, 2013
Strange Cut
Wish this shirt was cut differently. The sides are cut too high, which makes it impossible to wear on its own without a cami underneath - would like to wear this to work without bothering with a cami all the time. Quality is great. Will be returning this one...
May 8, 2013
A perfect everyday shirt!
I honestly bought this shirt BECAUSE the reviews were so good! I'm pretty lazy and hate driving out to the mall, so I do a LOT of online shopping. I saw this tee, loved the zipper detail, but didn't make any move to add it to my shopping cart until I read the reviews!
The shirt is a fantastic quality (I'm wearing it now!), very soft. And all of the reviewers are correct: Definitely order a size up. I normally wear an XS, but I took their advice and ordered a SM and it is perfection! The fit is very flattering (I have a long torso and sometimes have trouble with shirts being too short). I have the green/teal color and it is so bright and vibrant! It looks fantastic with dress pants or jeans and my only regret is that I didn't order more colors! I have my eye on that blue shade!
May 6, 2013
Love this tee
I bought this zipper back tee in 2 colors (didn't have my size in the other colors I liked) and love it. It's such a nicer look for a tee and i'm able to wear to work with dress slacks. The fit is good and the fabric is not at all thin. Would buy more if they had my size available.
May 3, 2013
Love this tee!!!
Just got this tee on sale and I love the fit. Going back to get it in more colors. I usually wear a S in Limited tops but got this in a M and it fits great!!!
May 3, 2013
I really like this shirt! Like some previous reviewers have said, it does run a bit small, but not so small that it turned me off from buying it. The zipper detail in the back take this simple shirt to a whole new level! I got the navy, and I plan to get more!!
April 21, 2013
I'm glad I bought this
but the rest of the reviews are correct on sizing. You must size up. I would normally not buy a large in TL, because a medium usually fits perfect. But decided to go with the reviews and glad I did. The blue cobalt is a vibrant color and I love the zipper detail. It's something that can be worn with jeans and nice shorts or to the office if it's casual with a nice pair of slacks. I would buy another one if it stays on sale.
April 14, 2013
zipper back tee
If you're not a tee person....well this one is it. casual enough, but you don't look like you're cleaning the house or going to the gym. And very comfortable!
April 4, 2013


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I promptly received my brown & teal Rose Deco chair. No pieces were missing; nothing was damaged. As excited as I was, I built it right away! There was only some minor assembly that was all accomplished with the provided Allen wrench. The directions were a bit shoddy.. our package came with more washers than described in the written portion, which with we did nothing. You need to use the larger washers for attaching both the legs and the chair back (the smaller washers were absolutely useless as they slid right through the holes and were literally unexplained in the directions). After struggling with our options, however, the assembled chair is sturdy and extremely comfortable! It is a perfect accent piece to our living room and we fully appreciate the functionality of it. I would not be hesitant to offer this seat to a house guest, or fear they would be aching to move elsewhere. I am also happy with the way the chair was engineered to hide all the connecting points via Velcro flaps; these hidden areas really keep the chair looking chic and high-end!
I'm an artist selling my work online, so I know that all computer screens are all calibrated differently. I know that when you see a photo, there could be some slight differences in real life. So I expected there to be some differences. But I ordered the Purple Rose on light grey version of this product, and the roses in reality are not purple. They are grey. No way around it. It's like whoever named the product was doing so based on the picture, not by looking at the actual product. This wasn't a show stopping set back, since I have a lot of grey elements in my home, and it matches those nicely. I still would have liked to have the touches of purple the picture leads you to believe are there. The product looks good once assemblied. You'll have to assemble it yourself, and when you do so, you'll pretty quickly realize that it's not a particularly high end structure. Once put together, the velcro flaps and such aren't very visible if you don't know they're there. If it was my only chair, I might be worried about it's ability to last holding actual people regularly over time. But it's an accent chair so it just has to look pretty most of the time, and it does that well. When guests sit on it, they indicate that it's pretty comfortable. It's still new, so the cushion and springs are still in good shape.
Nice chair for the price. Instructions could be clearer. Comfortable chair. Soft cushion. Use as a chair in bedroom.
I am a 150 lb., 5' 5" female and this chair makes me feel like a giant when I sit in it. It is so small! The top of the seat is only 16" from the floor (very low) and the back of the chair stops 6" inches from my shoulders! It looks like a child's chair and is sized accordingly! Plus, after only a few sittings, I can feel the springs already. Except for the color, I am totally disappointed and would not recommend this item. I've ordered from Overstock multiple times in the past and have been pleased, however, this was a *** loss!
Color and overall construction of chair seemed to be adquate for the price, however, the dimensions of the seat of the chair and height of the back of the chair were not listed and were very unproportionate. Besides not feeling comfortable or high enough for support on your back the seat of the chair was very deep. It almost seemed like the seat and the back of the chair should have been swapped.
I ordered a purple rose chair and this is actually gray. Not purple in any light. Natural light (took it outside), amber light... The seat cushion is nice. The back seems short.
we purchased six of these chairs. we had to return one because after some time (less than 1 month) the back starting to come loose and even tightening the screws would not solve the problem.
This is a cute little side chair that makes the room have some interest...love the design and feel of the fabric....it is short and my grand kids love to sit on it....for the money, it is a very nice chair...it compares to others of the same type to be $50.00 or so less!!!! love it!
I like this chair for the price and it matches my bedroom decor perfectly. It was easy to assemble and sturdy. I use it in my bedroom to get dressed in the morning so the fact that the back is quite low doesn't matter to me. If I was sitting in it reading for hours, it would be a problem.
The chair is perfect for an accent chair. It's pretty sturdy - I wouldn't recommend a 220lb man (as my husband is...) to sit in this chair... but it's great for a chair for guests to sit in.
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