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A judge has ordered the New York Police Department to disclose documents and video revealing the surveillance of Black Lives Matter protesters at the city's Grand Central Terminal in 2014 and 2015.read more
How longtime D.C. music icon Toshi Reagon helped put together the musical program of the historic Women's March on Washington.read more
Director Rose Troche takes on the eerily familiar theme of a mass shooting for her latest virtual-reality project at the Sundance Film Festival.read more
Angela Peoples did not come to the Women's March on Washington to play. "White Women Voted for Trump."read more
Constance Wu, who is "mom" on ABC's delightful Fresh Off the Boat and in our hearts, had a lot to say about Casey Affleck's Oscar nomination ...read more
Showrunner Gloria Calderon Kellet breaks down the decision to tell a Latino LGBT story on the new Netflix seriesread more
Sister Wives' Kody and Meri Brown's daughter Mariah came out to her parents in the latest episode of the TLC show — read moreread more
Virginia bathroom bill is a cut-and-paste job of the most discriminatory elements of previous legislative effortsread more
Jane Wilson and Cassie Taylor spent Sunday afternoon on a couch in the library of a new community center run by Pride St. Louis.read more
If you thought 2016 was a nasty, brutish year for LGBT rights across the country, 2017 is already shaping up to be much, much worse.read more
NASA chief Charles Bolden recalls the historic trajectory of the "human computer" who played a key role in the Apollo 11 moon landing, and as a female African-American in the 1960s, shattered stereotypes in the process.read more
The light of my life Sarah Paulson is in the upcoming Ocean's 11 reboot Ocean's 8 along with Rihanna, Anne Hathaway, Cate Blanchett and more of your faves. And, to answer a very dumb question, she certainly isn't worried ...read more
Much writing has been dedicated to the problems with how rape is used to motivate characters in our favorite television shows, particularly Game of Sex and Violence. Generally, women get raped and men get motivated to grow as characters because of that rape.read more
With only two months until inauguration, social justice advocates have been processing how the incoming regime will affect their work and are looking ahead with vigilance.read more


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Leeya Flanagan is a music composer with a large range of musical versatility. She has a background of playing ragtime piano from a young age, and then branched out to learning to play jazz guitar in 2010. She graduated from Pyramind's school of Audio Engineering and Music Production in San Francisco in 2011, and currently makes music mostly for recreational purposes.
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subset: commoncrawl


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|Re:Something missing here
|attached to Verizon Tech Given 4-year Federal Prison Sentence For $4.5M Equipment Scam
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|attached to Electrical Power From Humans
|attached to Krugman On Bitcoin and the Gold Standard
|Actual link to the article
|attached to Amazon Folds In California Sales Tax Deal
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|attached to Journal Editor Resigns Over Flawed Global Warming Paper
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We are Microsoft. Unix is irrelevant. Openness is futile. Prepare to be assimilated.


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The work of the SPCA does not come with a small price tag. On top of daily care expenses, many animals come to the SPCA needing extensive medical treatments and rehabilitation. The annual operating budget of the SPCA is more than $6 million.The SPCA does not receive funding from the city, county, state, or federal governments. As a private nonprofit, we rely on the continued help of the community to present our programs.We look to partner with corporate sponsors who recognize the value of an association with the SPCA, and who are committed to an investment in the future of Western New York. Corporate sponsorship provides a unique marketing environment where stewardship and sound business practices intersect. Each year the SPCA offers a variety of signature events - Radiothon, Wine & Wags, and Paws in the Park.
Join us as a sponsor or a vendor by contacting Kara Lee, Assistant Director of Development, at 716-629-3510 or firstname.lastname@example.com.
SPCA Serving Erie County205 Ensminger RoadTonawanda, NY 14150Phone: 716-875-7360©2016 SPCA Serving Erie County


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Many pregnant women in Africa who access professional antenatal care do not receive all the WHO-recommended components of care. Using Demographic and Health Survey (DHS) data from Kenya, Malawi and Nigeria, this study assesses the relationship of education level with the quality of antenatal care received and highlights how the number of antenatal visits mediates this relationship. The results show that a large proportion of the effect of education level on quality of care is direct, while only a small portion is mediated through the number of antenatal visits. Efforts to improve pregnancy outcomes for under-privileged women should focus on removing structural barriers to access, strengthening the technical and interpersonal skills of providers, and addressing providers' biases and discriminatory practices towards these women. Such efforts should also seek to empower underprivileged women to insist on quality antenatal care by explaining what to expect during an antenatal visit.
Antenatal care, education, quality, mediation analysis, Africa
Recent estimates of maternal mortality indicate that, globally, about 358,000 women died from problems related to pregnancy and childbirth in 2008.1 Poor maternal health contributes significantly to poor clinical outcomes for the infant. About half of newborn deaths occur during the first 24 hours of life, due to infections, asphyxia and other complications occurring during childbirth and the post-partum period.2 Most of the women experiencing complications during pregnancy, childbirth, and the post-partum period reside in developing countries where access to quality maternal health care is limited. Sub-Saharan Africa presents a disproportionately high burden of maternal morbidity and mortality. About 60% of all maternal deaths in 2008 were estimated to have occurred in sub-Saharan Africa.1 Complications related to pregnancy and childbirth are major causes of death for women of reproductive age in this region. The major causes of maternal morbidity and mortality (prolonged bleeding, infection, high blood pressure, unsafe abortions, and obstructed labor) can safely be managed with early detection and access to the right type of care and intervention. Many women [End Page 161] do not access the care necessary to prevent and treat maternal health complications because of multiple individual, household, normative, health system and policy factors.
The Millennium Development Goal number 5 (MDG 5) focuses on improving maternal health.3 One component of this goal seeks to achieve a 75% reduction in maternal mortality ratio (MMR) between 1990 and 2015. There has been significant progress worldwide towards this target; the largest gains in this area have been in Southeast Asia and Northern Africa.3 Nonetheless, some African countries experienced increased MMR between 1990 and 2008, including Botswana, Zimbabwe, South Africa, Swaziland, and Lesotho. The second component of the MDG 5 goal was to achieve universal access to reproductive health care by 2015. One of the main indicators for this goal is antenatal care. Available data suggest that although most women are attending at least one health care visit during pregnancy, increasing from 64% in 1990 to 81% in 2008, not enough women are receiving the recommended quality of antenatal care. For example, about half of women in developing countries received the recommended four antenatal visits in 2009 although this number represents a significant increase from 35% in 1990.3 Antenatal care provides an opportunity to check health indicators and a forum to educate women on healthy pregnancy outcomes and complications that may arise. The World Health Organization recommends that, as part of routine antenatal care, all pregnant women should receive monitoring of pregnancy progress, appropriate tests to detect pregnancy-related complications, tetanus vaccination, anemia prevention and control, and information about home care, nutrition, family planning and healthy lifestyles.4 There is evidence that many women who received antenatal care services from a skilled provider do not receive the recommended components of care. Studies have shown that even in African settings where the majority of women attend antenatal clinics, most do not receive the information necessary for appropriate pregnancy care, including danger signs in pregnancy, and what to do in case of complications.5,6
Education delivers multiple market and non-market benefits. A woman's education has been shown to be associated with lower fertility and improvements in her earning potential, productivity, health, and longevity, as well as to offer benefits for her family and community.7–14 Education has been consistently linked with pregnancy and maternal outcomes for women. Evidence from many studies suggest that, compared with women having more education, women with less education may be at an increased risk for preterm birth, small-for-gestational-age birth, still-birth, neonatal and post-neonatal death, and maternal death.15–18 Many studies have found that better educated women are more likely than their peers with little or no education to use skilled antenatal care.19–22
Access to antenatal care, however, only paints part of the picture. What happens when women eventually access antenatal care? Does education play a role in the components of antenatal care received once a woman makes it to the health facility? A few studies in Africa and elsewhere have looked at the role of women's education in maternal care and found that women with lower levels of education are far less likely to receive the recommended care during pregnancy or attend a health care facility for delivery.23–27 However, these previous studies have generally looked at a single component of care. In this paper, we focus on women who reportedly received skilled care during their most recent pregnancy, that is, who reported that they saw a health professional (doctor, [End Page 162] nurse, or nurse-midwife) during an antenatal visit. We examined the relationship between education level and the quality of antenatal care, defined in this paper using a combination of key components performed during antenatal care visits. Education may also be associated with the total number of antenatal care visits a woman makes during a pregnancy. The number of antenatal visits defines the opportunity for receiving quality antenatal care. This study examines the mediating role of number of antenatal visits in the relationship between a woman's education level and the quality of antenatal care received. We used data from three African countries to examine commonalities and differences across settings. We hypothesize that education level is associated with quality of care directly and indirectly through its association with the number of antenatal care visits (see Figure 1). We acknowledge the oversimplification inherent in the analytic framework presented in Figure 1. Indeed, it is obvious that there are factors operating at the health system and wider societal levels that may prevent even the most educated women from accessing quality care. For example, a woman's education cannot reasonably be expected to compensate for health facility understaffing, the lack of provider skills, stock-out of necessary supplies or the absence of required equipment. Nonetheless, a mediation model, such as the one employed in this paper, allows us a better understanding of the complex relationship between education and quality of care.
The data analyzed in this paper derived from Demographic and Health Surveys (DHS) conducted in three African countries: Kenya (2008–09), Malawi (2010), and Nigeria (2008) by ICF Macro and its country partners. These three countries were selected to represent three different regions of Africa: East, South, and West. The surveys followed a similar sampling design with eligible women selected through a multi-stage procedure. A detailed description of the sampling design for each survey is provided in the respective study report, accessible from the Measure DHS website (http://www.measuredhs.com/countries). The survey sampling design allowed representativeness at the national or sub-national levels. Survey teams used a structured questionnaire to interview eligible respondents who consented to participate in the survey. [End Page 163]
The analyses focused on the most recent birth among women of reproductive age who had a birth during the five years preceding the survey and who reportedly saw a skilled provider during the antenatal period.
The outcome variable that we analyzed in this paper is the quality of antenatal care received during the most recent pregnancy. We defined quality as a combination of the following components of antenatal care: whether the woman's blood pressure was measured during an antenatal visit (BPtaken), whether a sample of her urine was taken for analysis (urinanalyzed), whether a sample of her blood was taken for analysis (bloodanalyzed), whether the woman was told about possible complications during pregnancy (complication_info), and whether she bought or was given iron tablets during an antenatal visit (given_boughtiron). A description of how these variables were measured is provided on
The key independent variable assessed in this paper is the woman's education level, defined as a binary variable distinguishing between women with primary or no formal education (i.e., having completed between 0 and 6 years of schooling in Nigeria, between 0 and 7 years in Kenya, and between 0 and 8 years in Malawi), and post-primary education (i.e., having completed at least 7 years of schooling in Nigeria, at least 8 years in Kenya, and at least 9 years in Malawi). This classification may result in differently classifying women with the same number of years of education across the three study countries. Nonetheless, we prefer to use this approach rather than standardize across countries using an arbitrary number of years of schooling since it is plausible to assume that a person's perceived status depends on their level of education rather than on the number of years of schooling they have completed. In the estimated models, we examined the mediating role of the number of antenatal visits or the extent to which the effects of education on quality of care are channeled through this variable. The estimated models controlled for six covariates: age, age-squared, place of antenatal care (hospital versus lower-level facilities), number of children ever born, household wealth status and urban residence.
We started with bivariate analysis looking at the following relationships between: (1) the number of antenatal visits and education level; (2) the number of antenatal visits and quality of care; and, (3) education level and quality of antenatal care. Subsequently, we performed mediation analysis to assess the direct and indirect effects of education level on quality of care. In the estimated mediation models, the number of antenatal visits was modeled as a mediator variable while age, age-squared, place of antenatal care, number of children ever born, household wealth status and urban residence were covariates. In its most basic form, mediation analysis as originally proposed by Baron and Kenny involves four steps.28 In the first step, the relationship between the independent variable (X), and a dependent variable (Y) is estimated. In the second step, the association between the independent variable and mediating variable (M) is obtained. The third step involves estimating the relationship between M and Y. In the fourth step, the mediating effect is obtained as the product of the coefficient of [End Page 164]
. Description of Dependent and Independent Variables
|Description and measurement
|Quality of skilled care
|Derived from five components of care variables:
BPtaken: Takes on a value of 1 if the woman reported that her blood pressure was measured and 0 otherwise;
Urinanalyzed: Takes on a value of 1 if the woman reported that her urine sample was taken for analysis during an antenatal visit and 0 otherwise;
Bloodanalyzed: Takes on a value of 1 if the woman reported that her blood sample was taken for analysis during an antenatal visit and 0 otherwise;
Complication_info: Takes on a value of 1 if the woman reported that she received information about possible pregnancy-related complications during an antenatal visit and 0 otherwise; and,
Given_boughtiron: Takes on a value of 1 if the woman reported that she bought or was given iron tablets during an antenatal visit and 0 otherwise;
|The quality of care indicator is a binary variable, obtained by combining the five variables above, and splitting the resulting score into two categories: score below 5 (low quality) and a score of 5 (high quality).
|Measured as the highest level of education attained by the woman. The variable is defined as binary, distinguishing between women who had secondary or tertiary level (i.e., at least 7 years of schooling in Nigeria, at least 8 years in Kenya, and at least 9 years in Malawi; value = 1) and those with primary or no education (i.e., between 0 and 6 years of schooling in Nigeria, between 0 and 7 years in Kenya, and between 0 and 8 years in Malawi; value = 0).
|Mediator Variable (Number of antenatal visits)
|Measured as number of visits for antenatal care during the pregnancy of the most recent birth The variable was not normally distributed. Therefore, in the regression models, we used a version of this variable that was log-transformed using the lnskew0 command in Stata.
|Current age
|Age of the woman at the time of the survey; continuous variable measured in single years
|Current age squared
|The square of current age. This variable was introduced to test the hypothesis that the relationship between number of antenatal visits and age is not linear but curvilinear.
|Type of health facility used
|A binary variable that distinguishes between using a hospital for any antenatal visit and using a health center or a lower level facility.
|Number of children ever born
|Continuous variable measured as the number of sons and daughters to which the woman had ever given birth.
|Type of place of residence
|A binary variable measured as residence in an urban (value = 1) or a rural location (value = 0).
|The survey data included an asset-based measure of wealth that divides the respondents into five groups representing the poorest, poor, medium, rich and richest quintiles
[End Page 166]
the relationship of X to Y and that of M to Y. The limitations of such a causal steps-approach have been widely discussed.29 The models were estimated using the medeff command in Stata.30 Medeff is simulation-based and uses a parametric algorithm that builds on the seminal work by Baron and Kenny and extends the basic approach to binary dependent variables.28 We performed the analyses on all women who met the selection criteria in each country. In addition, to assess whether the effects of education level on quality of care depend on wealth status, we estimated separate models for rich (fourth and fifth wealth quintiles) and non-rich (lower three quintiles) women.
Ethical considerations
This study involves secondary analysis of publicly available DHS data and there was no need for the author to obtain IRB approval to conduct the study. Nonetheless, for the original data collection, ICF Macro and its partners obtained local IRB approval from the Scientific and Ethical Review Committee of Kenya Medical Research Institute (KEMRI) in Kenya, Malawi Health Sciences Research Committee in Malawi, and the National Health Research Ethics Committee in Nigeria.
Table 2 shows the number of women interviewed, the number that had given birth during the past five years, and the number that were eligible for the analysis in each country. The proportion of women with a recent birth who saw a skilled professional during pregnancy was particularly low in Nigeria compared with the two other study countries (Table 1).
Socio-demographic characteristics of the study participants differ across countries (Table 2). For example, on average, Kenyan and Nigerian women were better educated than their peers from Malawi. In addition, Nigerian women were older and more likely to reside in an urban area than women from Kenya or Malawi. There are also significant variations in the proportion of women that received all the essential components of antenatal care during pregnancy. Almost half of the women who saw a skilled provider in Nigeria received all the five essential components of care, compared with about one-fifth [End Page 167] in Malawi and one quarter in Kenya (Table 2). Most pregnant women in the three countries reportedly had their blood pressure measured (over 80%) or had a blood test (over 75%). In contrast, the proportion that reportedly had urine analysis was very low in Malawi (27.9%) and only moderate in Kenya (68.2%). Similarly, many pregnant women in Kenya (56.4%) and in Nigeria (35.0%) were reportedly not told about possible pregnancy-related complications. In each study country, post-primary education significantly increases the odds that a woman will receive each of the components of antenatal care (data not shown).
Bivariate analysis
The results of the bivariate logistic regression models presented on Table 3 show that in each country, post-primary education is significantly positively associated with increased number of antenatal visits. Note that because the number of [End Page 168]
antenatal visits was log-transformed, interpretation of the coefficients is not very simple; the coefficients are interpreted in terms of percent change in the mean score.31 In Kenya for example, compared with no education or primary education, post-primary education significantly increases the mean number of antenatal visits by 18.2% (calculated as [e(0.167) – 1] multiplied by 100; p < .001). Similarly, in Malawi and Nigeria, post-primary education is associated with a 6.1% (p < .001) and 37.2% (p < .001) increase in the mean score for the number of antenatal visits, respectively. The bivariate results further indicate that the number of antenatal visits is associated with significant increases in the odds of receiving high quality care in the three countries. Substantively, the coefficient indicates that a 2.71-fold (Napier's constant, e) increase in the number of antenatal visits is associated with more than a three-fold increase in the odds of receiving quality care in Kenya, 1.6-fold increase in Malawi and 2.6-fold increase in Nigeria. Finally, in the three countries, post-primary education is associated with greater odds of receiving high quality care compared with primary or no education. In sum, the bivariate analyses indicate that the data meet the three basic conditions for mediation analysis in the three countries.28 The independent variable (education level) is related to both the mediator (number of antenatal visits) and the dependent variable (quality of antenatal [End Page 169] care). In addition, the mediator is related to the dependent variable. In the next section, we estimate the amount of the effect of education level on the quality of care that is mediated through the number of antenatal visits.
Mediation analysis
The results for the multivariate mediation analysis are presented on Table 4. We present the findings by country in the following paragraphs.
In Kenya, overall, the association of education level with the number of antenatal visits was positive and very significant. After controlling for the relevant correlates, post-primary education was associated with a 10% increase in the mean number of antenatal visits. In addition, education level was associated with about a 45% increase in the odds of receiving high quality antenatal care. The total effect of post-primary education on the quality of antenatal care received was 0.088, less than one fifth of which was mediated through the number of antenatal visits. Although the magnitude of mediated effect was small, it was nonetheless significant. The patterns of effects differ between the rich and the non-rich. Specifically, the relationship between education level and the number of antenatal visits was strongly significant for rich women but weak for their non-rich peers. In contrast, it appears that wealth does not moderate the association of education level with the quality of antenatal care. In other words, wealth tends to accentuate the positive effect of education level on the number of antenatal visits but does not change the relationship between education level and quality of care. The mediated effect was insignificant for non-rich women whereas it was highly significant for rich women.
The results for Malawi show that, overall, education level is predictive of both the number of antenatal visits and the quality of antenatal care received. For example, compared with lower level of education, post-primary education is associated with a 25% increase in the odds of receiving high quality antenatal care. The number of antenatal visits also significantly predicts the quality of care received such that a 2.7-fold increase in the number of antenatal visits is associated with a 56% increase in the odds of receiving quality antenatal care. Overall, only a very small, albeit significant, proportion of the total effect of education level on the quality of care received was mediated through the number of antenatal visits. There are noticeable differences between the rich and the non-rich regarding the role of education level. For the non-rich, education level did not significantly predict the number of antenatal visits or the quality of care received; the reverse is the case for rich women. In other words, for non-rich women, education level does not play any significant role, direct or indirect, in the quality of antenatal care received. For both rich and non-rich women, the number of antenatal visits significantly and positively predicts the quality of antenatal care received.
Overall, post-primary education was significantly and positively associated with the number of antenatal visits and with receiving better quality antenatal care. Compared with a lower level of education, post-primary education is associated with a 24.2% increase in the mean number of antenatal visits. Similarly, the odds of receiving high quality antenatal care were 34% higher among women with post-primary education than among their peers with primary education or less. In addition, the number of antenatal visits positively and significantly predicts the quality of antenatal care. The data show that a 2.7-fold increase in the number of antenatal visits is associated with about a two-fold increase in the odds of receiving high-quality antenatal care. A [End Page 170]
[End Page 172]
noticeable proportion of the total effects of education level on quality of antenatal care was due to the mediating role of the number of antenatal visits. As in the other two study countries, there were noticeable differences between rich and non-rich women, especially with respect to the mediating role of the number of antenatal visits. Wealth appears to attenuate the mediating role of the number of antenatal visits in the relationship between education level and the quality of antenatal care received. Indeed, whereas for rich women, only 12.6% of the total effect of education level on the quality of care was mediated through the number of antenatal visits, the comparative proportion was 25.2% for non-rich women.
This study focused on women who gave birth during the five years preceding the survey and who reportedly accessed skilled antenatal care during their most recent pregnancy in three African countries: Kenya, Malawi, and Nigeria. The study shows that many women attending antenatal care do not receive all the essential components of care. The findings further show considerable educational inequalities in the quality of antenatal care received. Using data from three countries is a key strength of this study, making it possible to see how the relationships vary across settings. In each of the three study countries, the total effect of education level on quality of care is significant. In Kenya and Malawi, only a fraction of the total effect of education level on the quality of care received is mediated through the number of antenatal visits. In Nigeria, the proportion of total effect mediated is more substantial. The data show that education level has an effect on the quality of care above and beyond its association with the number of antenatal visits after controlling for the place of care. In other words, even when the woman accesses the right type of care in a regular manner, her education level still makes a difference in the quality of care that she receives. This finding supports the inverse care law and is consistent with evidence from other studies.32–34 The less educated women are the ones most in need of quality preventive maternal health services. They are more likely to experience complications during pregnancy and childbirth; more likely to be malnourished, to live in areas with limited access to emergency obstetric care, and to be less knowledgeable about infection prevention; they are also more likely to have preexisting health conditions that may lead to complications during pregnancy. For example, a cross-sectional study conducted in Ghana found that signs and symptoms of preeclampsia were significantly higher among women with no formal education.35
The strong direct effect of education level on the quality of care does persist after controlling for household wealth, indicating that the relationship is not attributable to the association of wealth with education. A possible explanation of the observed inequality may be that educated women are more knowledgeable about the procedures to expect during an antenatal visit and more likely to request such procedures. Little education, in particular, can create a social distance between the patient and the provider, thereby making effective communication problematic. Another possible explanation of the observed educational inequalities may have to do with the way women with low levels of education are treated in health facilities. It is possible that service providers [End Page 173] tend to discriminate against women with little education by not providing them with comprehensive information about pregnancy care, not performing all the required tests, and not offering preventive medications (such as iron tablets). Low levels of utilization of maternal health services among underprivileged women have been linked to perceived stigma and discrimination in the health care setting.36,37 Evidence from other settings and for other health issues suggest that service providers tend to display active discrimination and prejudice against disadvantaged groups, including women with little education.38,39 Other studies have linked patient's education with satisfaction with the quality of client-provider's interactions in family planning clinics,40 doctor-patient encounters,41 quality of information received during consultations,42 active patient participation,41,43 and level of involvement in decisions regarding care and treatment.44 Future studies should include measures of discrimination and stigma in antenatal care settings to assess the extent of active discrimination against women with low levels of education and determine how this discrimination affects the quality of care received.
Wealth appears to moderate the indirect effect of education level on the quality of care. However, the pattern of moderation effect is not similar across countries. In Kenya, wealth appears to accentuate the positive effect of post-primary education on the number of antenatal visits such that the relationship of education level with the number of antenatal visits was very strong for rich women but weak for their non-rich peers. We can look at the way in which health care system is organized and financed in Kenya for a partial explanation of this pattern of effects. Irrespective of wealth status, the most important source of antenatal care is the public sector. Nonetheless, Kenya has one of the best-developed private health sectors in Africa, contributing over 40% of health services in the country.45 In 2010, of the 6,641 health facilities in the country, 3,541 are in the private sector (comprising 1,425 for-profit and 2,116 non-profit or faith-based facilities). Unlike most other African countries, the private sector in Kenya is very accessible to the poor even in the rural areas.46 Women in the poorest quintiles are as likely to use a private sector health facility for antenatal care as women in the richer quintiles. Nonetheless, the majority of the poor who use private sector facilities use a facility run by a faith-based organization (FBO) whereas the majority of the rich who use a private facilities use a for-profit facility.46 In general, the quality of antenatal care is highest in FBO-run facilities. For example in 2010, the proportion of facilities with all essential supplies for basic antenatal care was 12% in government facilities, 10% in NGO-run facilities, 38% in for-profit private facilities and 68% in FBO-run facilities.45 Taken together, these data indicate that proportionally more poor than non-poor women use facilities with potentially high-quality ANC services, thereby leaving less room for variableness by educational or other socio-demographic differences. Moreover, the mission of FBO facilities is to cater to the health care needs of the poor and underprivileged; it is reasonable to assume that discrimination against women with little education will be less in such facilities compared with facilities that target a broader segment of the population. It is therefore surprising that education level has a significant direct effect on quality of care among the poor in Kenya.
In Malawi, wealth seems to accentuate the effects of education level on both the number of antenatal visits and the quality of care received. Indeed, the data did not reveal any significant effects of education level among the poor on either of these two [End Page 174] outcomes. This finding suggests that inability to pay for services is a strong factor overriding the privileges derived from post-primary education and further hindering access to quality services among the poor. Although antenatal services are generally free in Malawi as in other African countries, shadow fees (sometimes charged to cover supplies) and transportation costs may prevent many non-rich women from making the required number of antenatal visits and receiving quality care, irrespective of their education level.
In Nigeria, wealth appears to depress the positive effect of post-primary education on the number of antenatal visits. The combination of poverty and little education is particularly detrimental for the number of antenatal visits. This finding makes intuitive sense. Indeed, it is possible that rich women, irrespective of their educational level, have better access to the media and other sources of health information and are thereby more knowledgeable about ideal care seeking behaviors. It is also possible that household chores and other domestic responsibilities constitute less of a barrier to accessing care for rich women than for non-rich women.
The findings from this study have significant programmatic and policy implications, especially in connection with the achievement of the MDG 5. Although the study shows that education level has strong direct effects on the quality of antenatal care, the findings should not be interpreted as suggesting that achieving MDG 5 is contingent upon increasing educational opportunities for women. The findings highlight the need to intensify efforts to reach less educated women with quality antenatal care. Obviously, improving the overall quality of antenatal services is essential. Increasing the availability of quality of antenatal care in all types of health facilities, especially in those that are most likely to be visited by women with low level of education is essential. Efforts to remove structural barriers to quality antenatal care for poor and lowly educated women should be intensified. Service providers should understand the rights of women of all backgrounds to quality antenatal care and do their best to provide the best possible quality care to women irrespective of their background. The findings from this study may suggest the presence of active discrimination against women with low level of education; therefore, service providers also must understand the effects that their personal biases may have on disadvantaged groups who are in greatest need of quality antenatal service. In particular, attention should be paid to making underprivileged women feel welcome and comfortable in the health facility. Relevant efforts should not just be supply-focused. Women with low level of education should be empowered to make a demand on health services for quality. Programs that target women with low level of education with relevant information about what they should expect during antenatal visits and that coach them to demand such quality services are relevant.
This study uses data from the most recent DHS in the study country; however, it is important to note that there are some on-going efforts to promote access to quality antenatal care in the study countries. For example, in Nigeria, the federal government and some state governments are working with local and international partners to implement programs that provide monetary and other incentives to women who obtain at least four antenatal visits. In addition, the government is intensifying efforts to recruit and retain qualified midwives and relevant health workers.47,48 The Emergency Human Resources Program (EHRP), focusing on improved staffing of maternal and other [End Page 175] health services, construction of maternity waiting houses, and increased use of Health Surveillance Assistants for home visits are some of the strategies that the government of Malawi is implementing to improve maternal health outcomes.49 In Kenya, the rights-based, community health approach that the Ministry of Public Health and Sanitation adopted in 2007 as part of its National Heath Sector Strategic Plan II (NHSSP II) has been shown to be effective in increasing antenatal attendance and other reproductive health outcomes.50
This study has some limitations that we highlight below. First, the use of cross-sectional data makes claims about causality impossible since both the dependent and the independent variables were measured during the same time period. However, the strong association found between education level and quality of services suggests that the policy and programmatic implications of the results should be taken seriously. Second, the survey data were self-reported and thereby subject to memory lapse, social desirability, and other biases. Focusing on the most recent birth may have helped to minimize the bias due to memory lapse. A related limitation is that it is plausible that women with low education were less likely to understand and thereby recall some of the specific procedures connected with the components of antenatal care that we examined in this paper. Nonetheless, because the relevant questions focused on descriptions of the procedures rather than using specific nomenclatures, it is reasonable to assume that this bias is minimized. Additionally, the way quality of care was operationalized in this study might have introduced some biases into the results. Due to limitations inherent in the survey data analyzed, some essential WHO-recommended interventions during antenatal visits were not included in our indicator of quality of antenatal care. For example, although the indicator included whether or not blood sample was taken, the WHO recommendations were specific about the tests should be conducted with the blood sample, including tests for haemoglobin, HIV, syphilis, and rhesus group. Similarly, although we included whether or not urine sample was taken in the indicator of quality, the WHO recommends testing the urine for bacteriuria and proteinuria. Regrettably, the survey data did not include such details. Finally, the use of education level rather than years of schooling to compare outcomes in countries with different educational systems may have introduced a bias into the results and affected the comparability of the role of education across countries. Nonetheless, the fact that the association of education with the outcome variables is similar across countries makes this problem less of an issue.
Stella Babalola is Associate Professor and teaches Health Communication in the Department of Health, Behavior and Society Johns Hopkins University. She is also Senior Research Advisor at the Center for Communications Programs of the same university. Dr. Babalola has a wealth of experience in international health, teaching, communication and research. During the last five years, her research has been largely in the areas of HIV risk reduction and women's reproductive health.
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24. Edmonds JK, Hruschka D, Bernard HR, et al. Women's social networks and birth attendant decisions: application of the Network-Episode Model. Soc Sci Med. 2012 Feb; 74(3):452–9. Epub 2011 Dec 7. http://dx.doi.org/10.1016/j.socscimed.2011.10.032; PMid:22196965 PMCid:PMC3265634
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32. Hart TJ. The inverse care law. Lancet. 1971 Feb 27;297(7696):40512.
33. Watt G. The inverse care law today. Lancet. 2002 Jul 20;360(9328):252–4. http://dx.doi.org/10.1016/S0140-6736(02)09466-7
34. Mercer SW, Watt GC. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007 Nov–Dec;5(6):503–10. http://dx.doi.org/10.1370/afm.778; PMid:18025487 PMCid:PMC2094031
35. Dinglas C, Lardner D, Homchaudhari A, et al. Relationship of reported clinical features of pre-eclampsia and postpartum haemorrhage to demographic and other variables. West Afr J Med. 2011 Mar–Apr;30(2):84–8. PMid:21984453 [End Page 178]
36. Adamson PC, Krupp K, Niranjankumar B, et al. Are marginalized women being left behind? a population-based study of institutional deliveries in Karnataka, India. BMC Public Health. 2012 Jan 12;12:30. http://dx.doi.org/10.1186/1471-2458-12-30; PMid:22240002 PMCid:PMC3269389
37. Napravnik S, Royce R, Walter E, et al. HIV-1 infected women and prenatal care utilization: barriers and facilitators. AIDS Patient Care STDS. 2000 Aug;14(8):411–20. http://dx.doi.org/10.1089/108729100416623; PMid:10977970
38. Barber SL, Bertozzi SM, Gertler PJ. Variations in prenatal care quality for the rural poor in Mexico. Health Affair (Millwood). 2007 May–Jun;26(3):w310–23. Epub 2007 Mar 27. http://dx.doi.org/10.1377/hlthaff.26.3.w310; PMid:17389636
39. Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004 Nov;19(11):1154–9. http://dx.doi.org/10.1111/j.1525-1497.2004.30227.x; PMid:15566446 PMCid:PMC1494785
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41. Peck BM. Age-related differences in doctor-patient interaction and patient satisfaction. Curr Gerontol Geriatr Res. 2011;2011:137492. Epub 2011 Oct 5.
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As we watch the rise of the Islamic State in Iraq and Syria, with all of it's brutality and beheadings, we are seeing an influx of foreign radicalized jihadist fighters to the region, with many of them coming from Europe and North America.
This has led to closer scrutiny of some Islamic Mosques here in America, which has revealed that some of them may be working as recruitment centers for ISIS.
Now that there has been a beheading in Oklahoma, the heartland of America, there is an extra sense of urgency to the need to check out the Mosques that radicalized jihadists are attending.
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Fox News' Megyn Kelly has been looking closely at the Mosque attended by the Oklahoma beheader, and what she found is disturbing.
Alton Nolen, the beheading suspect, converted to Islam while serving time in prison for assaulting a police officer.
Upon his release from prison, Nolen began attending the Islamic Center of Oklahoma City, the same Mosque that was attended by the so-called "20th hijacker" of the 9/11 terror attacks, Zacharias Moussaoui.
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Obviously, there is no direct connection between Nolen and Moussaoui, but in attending the same Mosque, they may have been in contact with some of the same people.
Furthermore, the fact that at least two attendees of the Mosque went on to plot and/or commit violent terrorist acts, means that said Mosque must be closely monitored for active involvement in the radicalization and recruitment of jihadists.
We are all about freedom of religion and freedom of speech in this country, and Muslims certainly enjoy the same Constitutional protections of their rights as everyone else.
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However, if a certain Mosque is taking advantage of those freedoms and liberties to recruit and train people who would do harm to this country, then perhaps it is best that said Mosque be shut down.
Please share this on Facebook and Twitter if you agree that Mosques should be shut down, if it is proven that they are involved with the recruitment and radicalization of Islamic terrorists.


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A 75-year-old man with end-stage renal disease presented with a 6-month history of nonhealing, markedly painful, necrotic ulcerations of the lower extremities (Figure 1A). The ulceration progressed in spite of multiple treatments elsewhere that included intensive wound care with wet-to-dry dressings, topical becaplermin, surgical debridement, and Unna boot dressings. A skin biopsy specimen demonstrated intravascular and extravascular calcification with pannicular necrosis and fibrin thrombi in dermal blood vessels consistent with calciphylaxis (Figure 2).
A, Ulcers before treatment (note inflamed, necrotic ulceration on lower extremity). B, Appearance of ulcers immediately after treatment. C, Appearance of ulcers 6 months after treatment with tissue plasminogen activator.
Histopathologic features of affected skin. A, Multifocal vascular and extravascular calcification with pannicular and epidermal necrosis (hematoxylin-eosin, original magnification ×25). B, Affected arteriole exhibiting mural calcification and intimal hyperplasia (hematoxylin-eosin, original magnification ×400). C, Fibrin thrombi within superficial dermal vessels (hematoxylin-eosin, original magnification ×400).
The patient had been receiving peritoneal dialysis for approximately 1 year for end-stage renal disease. His medical history included recurrent deep venous thrombosis, chronic active hepatitis C, obstructive sleep apnea, and hypertension. His serum albumin level was decreased at 1.9 g/dL (normal, 3.4-4.8 g/dL) and the serum calcium level was 9.1 mg/dL (2.3 mmol/L) (corrected, 10.8 mg/dL [2.7 mmol/L]; normal, 8.9-10.1 mg/dL [2.2-2.5 mmol/L]). The serum phosphorus and parathyroid hormone levels were increased at 5.2 mg/dL (1.7 mmol/L) (normal, 2.5-4.5 mg/dL [0.8-1.5 mmol/L]) and 8.5 pmol/L (normal, 1.0-5.2 pmol/L), respectively. The calcium-phosphate product was 47.2 mg2/dL2 (corrected, 56.0 mg2/dL2).
Coagulation screening tests demonstrated the following: low factor II activity at 35% (normal, 70%-130%), low factor VII activity at 48% (normal, 65%-140%), low antithrombin III antigen and activity level at 72% and 59%, respectively (normal, 84%-120% and 80%-120%, respectively), low protein C antigen and activity level at 42% and 30%, respectively (normal, 60%-125% and 70%-130%, respectively), a normal protein S antigen and activity level, and an increased level of fibrinogen at 671 mg/dL (19.7 µmol/L) (normal, 160-340 mg/dL [4.7-10.0 µmol/L). These coagulation abnormalities were interpreted as being consistent with vitamin K deficiency or warfarin effect. However, the patient was not taking warfarin, and the vitamin K level was not determined. Prothrombin and factor V Leiden mutations were not detected. Findings were negative for antineutrophilic cytoplasmic antibodies (cANCA and pANCA), cryoglobulins, and cryofibrinogens.
The patient presented with signs and symptoms consistent with calciphylaxis. The mortality rate varies with the distribution of involvement, with reported mortality rates ranging from 23% (distal) to 63% (proximal).1 Treatments reported beneficial for calciphylaxis include parathyroidectomy,1- 3 low-molecular-weight heparin,4 wound debridement,2 hyperbaric oxygen,5,6 intensive wound care, and increased frequency of hemodialysis.7
In our patient, wound debridement and intensive local wound care had not led to improvement. Parathyroidectomy was not performed in view of its uncertain benefit because of the patient's minimally increased level of parathyroid hormone. Hyperbaric oxygen treatment was not available.
Because vascular occlusion may be a primary mechanism leading to the cutaneous necrosis associated with calciphylaxis,8,9 we elected to institute thrombolytic therapy in our patient. Low-dose tissue plasminogen activator (tPA; alteplase) was administered according to the protocol used for other cutaneous vaso-occlusive disorders (Table 1).10,11 The patient was hospitalized and given a daily 10-mg dose of alteplase intravenously for 14 days, followed by warfarin anticoagulation maintenance therapy. Also, the dialysis was intensified; the patient received hemodialysis daily for 1 week until the serum level of phosphorus normalized; then, he was maintained on hemodialysis 3 times weekly. Bedside debridement of the ulcers was performed daily as tolerated.
After completion of the tPA protocol (2 weeks after hospitalization), the ulcerated areas were markedly improved and less painful (Figure 1B). After discharge, the patient continued to receive wound care with daily whirlpool and periodic debridement. In addition, beginning at 6 weeks after discharge, skin grafts with the skin substitute Apligraf (Novartis, Basel, Switzerland) were placed on the larger areas of ulceration, with 4 total dressings applied over a 2-month period. Six months after tPA treatment, the patient had superficial erosions on the right and left anterior tibias, but otherwise the ulcers had healed completely (Figure 1C).
Thrombolytic therapy was considered a reasonable treatment choice for our patient for the following reasons: (1) there was clinical and laboratory evidence of a hypercoagulable state (history of multiple deep venous thromboses, low protein C level, and low antithrombin III level), and a hypercoagulable state has been reported in several patients with calciphylaxis12- 16; (2) fibrin thrombi were observed on histopathologic examination; (3) anticoagulation therapy has been reported effective in patients with calciphylaxis4; (4) we postulated that calciphylaxis may be considered an occlusive vasculopathy (with clinical resemblance to warfarin-induced skin necrosis or type I cryoglobulinemia); and (5) we have found that low-dose tPA is effective in the treatment of other coagulopathic disorders of the cutaneous microvasculature (eg, livedoid vasculopathy10,11 and antiphospholipid antibody syndrome). To our knowledge, therapies directed at clot lysis have not been used for calciphylaxis.
Tissue plasminogen activator has found wide use in reducing morbidity and mortality in thrombosis-associated myocardial infarction, pulmonary embolism, and stroke.17 We postulated that a mechanism similar to that occurring in atherosclerotic disease may mediate the pathogenesis of calciphylaxis, wherein progressive, calcific narrowing of the cutaneous microvasculature ultimately leads to thrombotic vascular occlusion and downstream tissue necrosis.
The explanation for the coagulopathy in our patient is unclear, but it may be secondary to poor nutrition, end-stage renal disease, or long-term hemodialysis or it may be multifactorial. Vitamin K deficiency has been observed in patients with chronic renal failure,18 in patients receiving long-term hemodialysis,19 and in patients with calciphylaxis.20,21
Thrombolytic therapy appeared to be effective in our patient. Paradoxically, oral anticoagulation with warfarin has been reported to be a risk factor for the development of calciphylaxis.4,22 This risk may be secondary to low vitamin K–dependent anticoagulation factors (eg, protein C and protein S). However, vitamin K replacement was associated with progression of calciphylaxis and mortality in a patient with calciphylaxis and a documented low serum level of vitamin K.20
Most treatments of calciphylaxis have centered on restoring calcium and phosphate homeostasis. Theoretically, this may prevent further calcification of the cutaneous microvasculature, which is thought to precede thrombus formation.23 These therapies have included parathyroidectomy (surgical and ethanol ablation), alteration of ionic concentrations in the dialysate, and oral phosphate binders.
Good wound care was likely a vital therapeutic component leading to healing in our patient. Regardless of the cause of cutaneous ulceration, debridement of necrotic tissue by surgery, whirlpool, or wet dressings is often necessary to allow for wound reepithelialization. Moreover, restoration of a normal phosphorus level after intensive dialysis may have contributed to our patient's improvement.
Because tPA therapy carries the risk of potential hemorrhage-associated morbidity and mortality, patients must be evaluated carefully for hemorrhagic tendencies before therapy is instituted. Furthermore, the tPA protocol is performed on an inpatient basis to monitor for hemorrhagic complications. Contraindications to tPA therapy may include a history of stroke, intracranial neoplasm, aneurysm, arteriovenous malformation, recent extracranial or spinal surgical procedure or trauma, active internal bleeding, bleeding diathesis, malignancy, or uncontrolled severe hypertension.
In summary, a hypercoagulable state may be the principal factor for the development of vascular occlusion and cutaneous necrosis in calciphylaxis. We suggest that a detailed coagulation screen be performed for patients with calciphylaxis. Low-dose tPA or other thrombolytic agents may prove effective in treating calciphylaxis. However, our findings are limited to this report and need to be confirmed with further studies.
Clinicians, local and regional societies, residents, and fellows are invited to submit cases of challenges in management and therapeutics to this section. Cases should follow the established pattern. Submit 4 double-spaced copies of the manuscript with right margins nonjustified and 4 sets of the illustrations. Photomicrographs and illustrations must be clear and submitted as positive color transparencies (35-mm slides) or black-and-white prints. Do not submit color prints unless accompanied by original transparencies. Material should be accompanied by the required copyright transfer statement, as noted in "Instructions for Authors." Material for this section should be submitted to George J. Hruza, MD, Laser and Dermatologic Surgery Center Inc, 14377 Woodlake Dr, Suite 111, St Louis, MO 63017.
Corresponence: Roger H. Weenig, MD, Department of Dermatology, Mayo Clinic, Rochester, MN 55905 (email@example.com).
Accepted for publication October 14, 2003.
The authors have no relevant financial interest in this article.
Sewell LD, Weenig RH, Davis MDP, McEvoy MT, Pittelkow MR. Low-Dose Tissue Plasminogen Activator for Calciphylaxis. Arch Dermatol. 2004;140(9):1045-1048. doi:10.1001/archderm.140.9.1045
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While commonly thought of in terms of their effect on children, it is now believed that ADD and ADHD may not be outgrown. Some studies suggest that as many as three-percent (3%) of adults may suffer from attention deficit disorders.
Behaviors in adults and children are similar: distractibility, lack of impulse control, problems with organizing or sequencing tasks, restlessness, and forgetfulness.
Clinical articles and research, treatment information, personal pages, or support groups should be suggested to the appropriate subcategory. Submitting them here will only delay possible listing.
Information about this disorder in children for parents, teachers, and caregivers should be suggested to /Child_and_Adolescent/ADD_and_ADHD.
As always, information contained in these articles is not intended to provide medical advice or replace personal consultation with a physician.
All sites or pages submitted to this category may be more technical in nature, but must contain information of use to adult sufferers, their families, spouses, and partners.
Websites designed for the education and training of medical professionals and providers should be submitted to the appropriate category in Health/Medicine/.
Information must be mainly focused on alternative treatments for these disorders. It must not advocate orthodox prescription pharmaceutical drugs, such as Ritalin.
Websites providing treatment information for parents only, should be submitted to the appropriate subcategory in /Child_and_Adolescent/ADD_and_ADHD.
For quicker placement in the directory please follow these Submission Tips:
Title: Name of Site or Author
Description: This describes the website and should note distinguishing features found on the site.
These groups, communities, or meeting places provide an opportunity for people with a common experience (such as a condition or disease, or a care-giving role) to share their concerns, and to seek and offer information and advice.
Read each site's PRIVACY POLICY carefully, before providing personal information.
These sites are for educational and support purposes only. Please consult your doctor or other health care provider before making any lifestyle changes that may adversely affect your condition.
Support groups for parents only should be suggested to the appropriate subcategory in /Child_and_Adolescent/ADD_and_ADHD.
English language sites only. Please submit other language sites to the appropriate category in World.


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Newegg.com - A great place to buy computers, computer parts, electronics, software, accessories, and DVDs online. With great prices, fast shipping, and top-rated customer service - once you know, you Newegg.
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Showing Results: Most Recent
This review is from: ASUS M5A99FX PRO R2.0 AM3+ AMD 990FX + SB950 SATA 6Gb/s USB 3.0 ATX AMD Motherboard with UEFI BIOS
Pros: Plenty of Pros, no need to list them all, Northbridge runs very cool in comparison to some other brands. I don't personally overclock, but if it's your thing, lots of timing/voltage features. With the rebate, I couldn't resist buying a second board.
Cons: AMD Turbo (Overclocking) Is enabled by default, using this setting will void your warranty as it is an "overclock" setting. Be sure to disable this feature, and manually set your clock multiplier / bus speeds for your cpu's max frequency.
Other Thoughts: This is a very nice board, and it's why I ordered a second one.READ FULL REVIEW
This review is from: G.SKILL Sniper Series 8GB (2 x 4GB) 240-Pin DDR3 SDRAM DDR3 2133 (PC3 17000) Desktop Memory Model F3-17000CL9D-8GBSR
Pros: Used this brand on over 15 builds, and have no issues with reliability. Running at 2133 with no problems. Used the "tested" settings from the mfg. website for guaranteed results.
Cons: None yet.
Other Thoughts: No reason not to get G.Skill for all your memory. I always use a search engine to get real data from benchmarks of the memory I am about to buy vs. other brands. G.Skill is always in the top of it's class.READ FULL REVIEW
This review is from: Arctic Silver 5 High-Density Polysynthetic Silver Thermal Compound AS5-3.5G
Pros: Provides a good seal between the cpu / heatsink. After the break-in period this helps to provide great cooling.
Cons: (Not really a con, more of an inconvenience) Break-in period is longer than other products, but it's worth the wait.
Other Thoughts: Been using this stuff for years, and after the break-in period it provides excellent thermal conductivity. I wouldn't use anything else (for now).READ FULL REVIEW


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I have a https connection from Client to Server and a malware in client. The malware modifies the message and compromises its integrity. I am using a proxy to check the Integrity of the message after the malware has changed the message and before sending it over the internet to the server.
Now, How can I check the Integrity of the message (Sure that it has not been modified by any Man in the Middle) for the second half of my communication channel(Which is from Client to the Server over the internet).
I see few conventional approaches of CRC or Checksum will help. But I am looking for some non traditional or upcoming approaches. I am new to this area and want to take expert advise about the direction I need to search for answer to my question.
Ideally SSL Data shouldn't be able to be decrypted by any MIM. But my assumption is that any Protocol is subjected to attack and compromised in real world and few recent studies are proving that https is breakable. Thus, I am trying to perform a What if analysis? On the client side, lets say malware is not more powerful than just modifies the transaction amount and destination account number in a typical online Baking transaction.
Any pointers would be of great help.


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5 Parks near San Angelo, Texas
Goodfellow AFB, Texas 6.08 miles S
Grape Creek, Texas 8.48 miles NW
Water Valley, Texas 19.12 miles NW
Robert Lee, Texas 29.69 miles N
2680 Camper Rd San Angelo, Texas 76904 (map) | (325) 944-3850
Sites: 83 | Latest Rate: $50.00 | 36 Reviews
|Clean Restrooms:
|Clean Showers:
Sep 2016 - $50.00
Daily rates have jumped from $38.00 to $50.00 per day! Pricey? Compare the area's other RV Parks.... not a RESORT!
Has a very good store of RV goods and Ice, some food and cold beverages.
Many shade trees.
A little out of town, but right on a lake for fishing, swimming, water sports. - Blackie13
Apr 2016 - $44.00
The park was really clean and new owners were nice. Only complaint is we stayed in site 55 and was way too close. We had about 8 feet between the each. The pullout was in our small camping area when neighbor setup. I would not recommend any of the 50 thru 58 numbered sites. - LuluBoyd
Oct 2015 - $32.00
This park is very well maintained, the staff are friendly and helpful. Park is located on shores of a small lake and at this time of the year it is very peaceful, we've never stayed in the summer so can't say what it's like then This is one of the nicest parks we've ever stayed in. We stayed for a week. Park has two sections the spaces in the older section aren't quite as large as the new section but appear to be adequate if you don't have a hugh RV. We stayed on the newer side our trailer is 45 ft and there was plenty of room for it and our vehicle with lots of room between us and the rv's on either side and there were several sites larger than ours. - Myrtle the Turtle
3900-2 Mercedes Road San Angelo, Texas 76901 (map) | (325) 949-4757
Sites: 126 | Latest Rate: $17.00 | 44 Reviews
|Clean Restrooms:
|Clean Showers:
Dec 2016 - $17.00
Very nice state park. We were going to spend 2 nights, but extended for a third night. The price reflects the 50% discount for the 2nd night when using the Texas State Park annual pass.
The sites are large and spaced far apart. They have both pull-throughs and back-ins with covered picnic tables at each site.
The sites are water & electric only, no sewer.
It's just a few miles into San Angelo for shopping.
We'd definitely stay here again if in the area. - wntrtxn
Jun 2016 - $15.00
Stayed the weekend before July 4 weekend. Not many people. Stayed in Bald Eagle Campgrounds. Only three other campers in area. Site was somewhat level. Had a grill, fire ring, and covered table. Roof over table was too close to parking, so had to park at odd angle to open slides. Lots of trees. Rest rooms were clean, but could use more effort. Next time will stay in Red Arroyo or Lake View only because they are closer to lake. - Widecreek
Apr 2016 - $28.00
This lovely state park just outside of San Angelo was a great 3-day stop. The daily fee for camping is $20 but each of us paid $4 park entrance fee daily, thus $28 per day. The park entrance fee can be avoided by purchasing a $70 yearly Texas state park pass. We chose site #14 with a view of the (distant) lake. The wild flowers were blooming, the sun was shining, and each site is so spacious we felt we were in the park alone. Each site has a concrete pad plus a concrete covered patio with a picnic table. Lots of biking and hiking available. This park is home to the official Texas State longhorn herd as well as a herd of bison. We had a great stay! - JanW
6699 Knickerbocker Rd San Angelo, Texas 76904 (map) | (325) 949-3242
Sites: 60 | Latest Rate: $32.00 | 45 Reviews
|Clean Restrooms:
|Clean Showers:
Dec 2016 - $32.00
This was only the second time we've stayed at a KOA in over 20 years of RVing. We spent the week between Christmas and New Year's here (buy 6 nights, the 7th is free). Boy, did this place "sell" us on them! Not only was the park very nice, the owners (2 couples) were outstandingly friendly and helpful. In addition to the regular services, we had trash pickup at our site and a daily newspaper delivered to our site. The Wifi was excellent! (a rarity at RV parks). We will definitely return and even try another KOA soon. - retired rover
May 2016 - $28.00
Used this park as an overnight stop. Large, level pull-thru site allowed me to keep tow car hooked up. Also had a nice, clear sky for the rooftop satellite and hookups were well-placed. Would definitely stay here again. - Phaeton40AH
Feb 2016 - $27.00
We stayed for the 4th time for 19 days. We are vendors and attend the Stockshow and Rodeo every year. One call, they remember who we are and try their best to fill our request to be close to the front and bathrooms. Cleanest and nicest park! Managers and owners are all working hard daily to make improvements but those are above board in my opinion. They deliver daily paper and pick up trash on site. We stayed in our truck camper after setting it off the truck...used it to go back and forth to rodeo grounds. They have access to wonderful walking "trail" (it's a road) but locals love it! The sites are all they should be...level, clean, have tables, some grass, ok spacing and ease of all connections. The store is great; foods, ice, ice cream! and again, the nicest staff ever!!! I saw the nice dog park but don't have pets. The restrooms (a very big deal to me) are always clean with the exception of the busloads of stockshow kids who stay in a cabin for 1-2 nights....kids have no respect for the property or anyone else who may use it. The staff gets to the cleaning as quickly as the kids leave. I have no negatives...wifi is good and even the noise from planes-in the flight path on some days, does not bother me. I would recommend to anyone! - snj
5193 S Hwy 208 San Angelo, Texas 76903 (map) | (325) 942-5683
Sites: 50 | Latest Rate: $38.00 | 1 Reviews
|Clean Restrooms:
|Clean Showers:
Oct 2016 - $38.00
No showers.
Laundry has new washers and dryers.
Only year and half old.
Wide open. Quiet.
All sites are extra long and drive thru
Not much shade for summer heat. - Blackie13
1950 South Concho Drive Goodfellow AFB, Texas 76904 (map) | (325) 944-1012
Sites: 33 | Latest Rate: $15.00 | 14 Reviews
|Clean Restrooms:
|Clean Showers:
Nov 2015 - $15.00
The older area of the park is ok, with some shade, but the new area is just a parking lot. Not a very interesting or pretty park, but it is near a lake. It looks like a nice place for a big picnic, but not really great for a destination stay. The host was super friendly and helpful. The park is a few miles from the base, so no base services, but there is a gas/convenience store within walking distance. There was some traffic noise during the day, but it was very quiet at night. The wifi was inoperative and apparently, no one knows how to fix it. The cell service was good. I wouldn't go out of my way to visit this park, but it was a handy enough place to stay for a night. - KAP99
Aug 2015 - $20.00
Great campground. I've stayed there many times. Very convenient to San Angelo. Walking distance to gas station. Staff is very friendly. Showers are satisfactory (body hair - tight space). There is actually wasted space that could be used with towel hooks - benches which would make it more accommodating. Almost zero shade. Would be nice if the overflow got sewage drains and trees. Would definitely stay there again. - r Smith
Apr 2014 - $20.00
Two sections to campground. An older loop right next to entrance, and a new area. Older area has trees, concrete pads, table. New area is a basic parking lot with utility pedestals. Arrived near sunset and got the last site in older section. Campground host very helpful. Some long term residents, but park was clean and quiet. Nice area to walk around. Do be aware that campground is near road, and water front area is a day use recreation area for a training AFB with lots of very young airmen, soldiers, sailors and marines out to party on the weekends. Will stay here again every time we are in the area is space is available. Much better rate for facilities than city owned or commercial CG nearby. - PawPaw


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Skip the food at the grocery store that's traveled hundreds of miles across country and buy your goods from your local grower at Springfield Marketplace in Michigan. Our 9,000-square-foot facility sits on 20 acres of land and offers residents a place to find locally grown food every Thursdays from 2p-7p. Food vendors open every Thursday 11am-2pm and Friday 11am-2pm.
Besides offering Michigan locals a place to peruse beautifully grown fruits and veggies, Springfield Marketplace also has local shops like Turkey Heaven and Umami Ramen, and enough room to host numerous events—including weddings. Make Springfield Marketplace your go-to shop for quality produce and a gorgeous space to hold any event!
Whether you need an amazing space for your wedding or you want enough room to hold your next corporate party, you'll find all the square footage you need at Springfield Marketplace. We take pride in offering Calhoun County a spectacular venue with enough room for banquets, weddings, corporate events, annual happenings and any other ceremony or celebration you have.
Give your guests room to move by renting out Springfield Marketplace in Michigan today, accommodates up to 300 people!
Don't miss out on holding your event in our 9,000-square-foot facility by waiting to reserve your spot. Stake your claim by calling 269-441-9273 and rest easy knowing you'll have a unique venue you'll be hard pressed to find anywhere else. We work hard to make sure our space is immaculate and a gorgeous backdrop to your event. Stop by today to start planning out your next celebration at Springfield Marketplace.
We want you to have everything you need right at your fingertips. That's why we have a fully equipped commercial kitchen you can rent for your next event. Our commercial kitchen is the perfect place to whip up something spectacular and impress your guests with scrumptious cuisine. Call Springfield Marketplace at 269-441-9273 to find out everything our commercial kitchen has to offer.


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we have 14 dbs in our application set, and linking them all up when we create a new TFS branch is a bit painful.
the SSC command line does lots of things but it is missing the ability to link a db to src control.
Return to SQL Source Control Previous Versions
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Removing barriers to help current & former foster youth reach their potential without being blocked by their past
Lawyers Fostering Independence (LFI) is a one-of-a-kind program based in King County. LFI connects volunteer attorneys with current and former foster youth to provide life-changing civil legal assistance, keeping them moving forward to independent and productive lives.
What happens to the over 500 youth who age out of foster care in Washington state every year?
45% will not graduate with a high school diploma
Only 50% will be employed by age 24
25% will experience PTSD
28% will become homeless within a year
Former foster youth face significant emotional, educational, financial, and legal challenges that threaten their independence and future as adults. From identity theft to juvenile records to housing problems, a myriad of issues keep former foster youth from rebuilding their lives.
Together, LFI attorneys remove legal barriers that stand in the way of former foster youth securing housing, employment, and furthering or completing education. Our volunteer attorneys donated nearly $150,000 in billable hours in 2015, hosting 4 legal clinics every month, closing 72% of assigned cases, and serving 57% more youth than in the previous year.
Over the years we have helped our young clients move past legal obstacles, freeing them to move toward safe, independent, and productive lives. For example, our volunteer attorneys:
Resolved an identity theft case, which cleared up the client's credit and resulted in the client passing a housing credit check and becoming stably housed for the first time in several years.
Sealed a juvenile record for a young man, leading to him getting a great job two weeks later after having not been able to get a job due to the record for the prior two years.
Obtained a name change to clear up confusion with the state in order that the client could receive the public benefits she was entitled to and needed to be stably housed and provide for her child.
If you are a former foster youth needing non-criminal legal help, an attorney looking to volunteer, or someone just wanting more information, please contact the LFI program at 206.696.7503 x17 or email@example.com.
A Youth Dependency Guide: Know Your Rights! In collaboration with partners from Perkins Coie, Washington Defender Association, and Columbia Legal Services, CCYJ has produced a handbook for the ABA on the legal rights of youth in dependency.


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This application, in response to PAR-07-159 (National Cooperative Drug Discovery Groups for the Treatment of Mental Disorders, Drug or Alcohol Addiction), represents the resubmission of the competitive renewal application of "The Emory-MSSM-GSK-NIMH Collaborative Mood and Anxiety Disorders Initiative", MH-069056. This unique opportunity to accelerate antidepressant and anxiolytic drug development brings together expertise of four complementary research groups: the Emory University School of Medicine Department of Psychiatry and Behavioral Sciences, the NIMH Intramural Mood and Anxiety Disorders Program, the Mt. Sinai School of Medicine Department of Psychiatry (MSSM) and the Center for Excellence in Drug Discovery (CEDD) in Psychiatry of GlaxoSmithKline (GSK), one of the largest multinational pharmaceutical companies. The two major goals of the current application are the development of innovative new models for basic and clinical research in mood and anxiety disorders and the intensive scrutiny of 3 novel GSK antidepressant/anxiolytic candidates [two structurally distinct CRP! receptor antagonists (GSK008 and CRF-002), and a 5-HTiA/IB/ID receptor antagonist (GSK-1), in preclinical and clinical paradigms. In addition to an Administrative and Genomics/Endocrine/Statistics Core, 5 research projects are proposed. The preclinical projects are based at Emory University and are led by established investigators including, Michael Davis, PhD (Rat Models of Anxiety), Donald Rainnie, PhD (Physiologic Actions of Novel Antidepressants/Anxiolytics in the Basolateral Amygdala), and Clinton D. Kilts, PhD and Mark Goodman, PhD, (CRFi receptor PET Ligand Development). One clinical project is based in the intramural NIMH program: Effects of novel antidepressants/anxiolytics on human startle in normal volunteers (Christian Grillon, PhD, PI). A placebo-controlled, double-blind trial (based at Emory: Barbara Rothbaum, PhD, PI and MSSM: Dennis Charney, MD, PI) will assess the efficacy of the CRFi receptor antagonist GSK008 in patients with post-traumatic stress disorder (PTSD). This proposal encompasses virtually all of the major goals outlined in the PAR, namely, development of new neurochemical tools including PET ligands, exploration of new models for drug development and facilitation of a partnership between academia, NIMH and industry.
Mood and anxiety disorders are the most common of all psychiatric disorders and are associated with very significant morbidity and mortality. The primary goal of this NCDDG Center is to accelerate the development of novel drugs for the treatment of depression and anxiety.
|Kilts, Clint D; Kennedy, Ashley; Elton, Amanda L et al. (2014) Individual differences in attentional bias associated with cocaine dependence are related to varying engagement of neural processing networks. Neuropsychopharmacology 39:1135-47
|Kaye, Joanna L; Dunlop, Boadie W; Iosifescu, Dan V et al. (2014) Cognition, functional capacity, and self-reported disability in women with posttraumatic stress disorder: examining the convergence of performance-based measures and self-reports. J Psychiatr Res 57:51-7
|Dunlop, Boadie W; Rothbaum, Barbara O; Binder, Elisabeth B et al. (2014) Evaluation of a corticotropin releasing hormone type 1 receptor antagonist in women with posttraumatic stress disorder: study protocol for a randomized controlled trial. Trials 15:240
|Sink, K S; Chung, A; Ressler, K J et al. (2013) Anxiogenic effects of CGRP within the BNST may be mediated by CRF acting at BNST CRFR1 receptors. Behav Brain Res 243:286-93
|Zoellner, Lori A; Rothbaum, Barbara O; Feeny, Norah C (2011) PTSD not an anxiety disorder? DSM committee proposal turns back the hands of time. Depress Anxiety 28:853-6
|Sink, Kelly S; Walker, David L; Yang, Yong et al. (2011) Calcitonin gene-related peptide in the bed nucleus of the stria terminalis produces an anxiety-like pattern of behavior and increases neural activation in anxiety-related structures. J Neurosci 31:1802-10
|Mathew, Sanjay J; Vythilingam, Meena; Murrough, James W et al. (2011) A selective neurokinin-1 receptor antagonist in chronic PTSD: a randomized, double-blind, placebo-controlled, proof-of-concept trial. Eur Neuropsychopharmacol 21:221-9
|Martin, Elizabeth I; Ressler, Kerry J; Binder, Elisabeth et al. (2010) The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. Clin Lab Med 30:865-91
|Binder, E B; Nemeroff, C B (2010) The CRF system, stress, depression and anxiety-insights from human genetic studies. Mol Psychiatry 15:574-88
|Martin, Elizabeth I; Ressler, Kerry J; Jasnow, Aaron M et al. (2010) A novel transgenic mouse for gene-targeting within cells that express corticotropin-releasing factor. Biol Psychiatry 67:1212-6
Showing the most recent 10 out of 35 publications


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Does anyone know why all of the sudden,my iPad would tell me when I am trying to read my mail on my aol account,that it cannot get my mail because the user name or password is incorrect?? I haven't changed anything,and when I go on my computer,I can access my aol mail just fine. I tried rebooting,it did nothing. I tried deleting the account and putting it in again,but nothing. What does this mean? I am very un technically savvy!
YWN Coffee Room » Decaffeinated Coffee
Please help me with my iPad and aol mail!(5 posts)
that can happen. first make sure you have a decent amount of battery. what you can do is you can not only turn off the ipad but hold down the power button to totally shut it off and then slide your finger across the screen as told to do and power it off, wait a minute or two and then power it on. if this doesn't help then sometimes waiting a day or two can help.
i've had the same with my ipod touch and my gmail. did u try going into your settings to mail,contact,calendar settings. try re-entering your passcode for the account . usually works for me
Call 1800-my-apple and tell them wat happened
Big Brother Apple is watching you at all times.
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This project received 22 bids from talented freelancers with an average bid price of $ USD.Get free quotes for a project like this
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I need a coder who has experience in API. It would be a bonus if you have banking api but not necessary. Please place your placeholder bid now and once I get to you the full project spec then you can make a firm price quote. Thank you.
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The Waldersmith Space Commander is the peak of innovation and creativity on retro arcade tables, manufactured by the Games Room Company. Over 350 of the most popular arcade games are packed into this futuristic design. Precision cut, toughened glass protects the 19" LCD screen, which renders your games in faultless quality. The machine also houses a powerful personal computer, complete with USB slots, for all your favourite music and photos. A keyboard and mouse also comes as standard with the Commander.
The Space Commander Cocktail Table is a powerhouse of contemporary innovation, combining retro 80s nostalgia with the modern technology required to deliver it to an absolutely perfect standard.
We at the Games Room Company have always had a great appreciation for video games, ever since the first commercial video game (Computer Space) was released back in 1971. We were one of the first companies to bring over TATO's Space Invaders to the UK, quickly going on to supply pubs all over the country. Our founder, Reginald Waldersmith, was a particularly avid fan of Atari's Pong, describing it as being "quite as fun as real tennis, and not nearly as exhausting". We have proudly continued his fondness for retro video games, and much of our inventory includes games we've manufactured ourselves.
Unit 2
RHS Gate House
Hamm Moor Lane
Tel: +44 (0) 1932 568414
The Games Room Company is a family run business, established in 1962.
Enthusiastically dedicated to supplying vintage and contemporary games. Specialists in the rare & whimsical with a keen eye on quality & excellent service.
We are constantly scouring the globe for new and innovative products for our showroom and website, as well as sourcing and restoring our famous vintage products.
© 2014 The Games Room Company Ltd


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Under the proposed Program, South Asia will undertake necessary reforms to address key development challenges in order to attain equitable broad-based growth. Expected outcomes are innovative approaches in addressing the key development challenges in South asia, which will be implemented and disseminated within the region and to other Asian countries. Furthermore, in line with the ongoing Innovation and Efficiency Initiative, the proposed umbrella approach is expected to improve operational efficiency in providing development assistance services to the DMCs in South Asia by focusing more on the quality of ADB services to address the above-mentioned development challenges in South Asia, rather than on associated paper preparation. It may also contribute to some reduction in the number of TAs during the next 5 years.
Latest Project Documents
Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.
The Public Communications Policy (PCP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.
The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.
In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.