text:
The Federal Government will Become America's Model Employer for the 21st Century.
Recruit, Retain and Honor a World-Class Workforce to Serve the American People.
Find out more about Federal compensation throughout your career and around the world.
Staffing to align with your agency's mission
Review the Federal Employees Group Life Insurance (FEGLI) Handbook
Answering your questions about Healthcare and Insurance
Manage your retirement online.
"...The Director of the Office of Personnel Management shall serve as the Suitability and Credentialing Agent..." ~Executive Order 13467, as amended
"...primary executive branch service provider for background investigations..." ~Executive Order 13467, as amended
OPM's Human Resources Solutions organization can help your agency answer this critically important question.
Developing senior leaders in the U.S. Government through Leadership for a Democratic Society, Custom Programs and Interagency Courses.
Visit this federal site to search for our regulatory notices, proposed and final rules.
See the latest tweets on our Twitter feed, like our Facebook pages, watch our YouTube videos, and page through our Flickr photos.
Degree: Doctor of Podiatric Medicine (D.P.M.) from a school of podiatric medicine accredited by the Council on Podiatric Medical Evaluation in the year in which the degree was granted.
Licensure: Applicants must be currently licensed to practice podiatric medicine in one of the States, the District of Columbia, or Puerto Rico.
Applicants who meet the basic requirements qualify for GS-11.
In addition to meeting the basic requirements, applicants must have 1 year of experience equivalent to at least the next lower grade level in the practice of podiatry in an office, clinic, or hospital.
For GS-12 positions, 1 year of post-graduate training in a school-affiliated podiatrist's office (preceptorship) or residency is qualifying.
For GS-13 positions, 2 years of post-graduate training in a school-affiliated podiatrist's office (preceptorship) or residency is qualifying.
There is no Group Coverage Qualification Standard for this series. Use the Individual Occupational Requirements described below.


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The previous season of Dexter ended with Deb finding out the title character's biggest secret.
Now, eight episodes into the seventh season, Dexter knows Deb's biggest secret.
As usual, Dexter didn't know what to say. "You never do," Deb lamented.
SPOILER ALERT: What follows is a discussion of the Dexter episode titled Argentina, which aired Sunday, Nov. 18 on Showtime in the United States and on The Movie Network and Movie Central in Canada. If you don't want to know what happened, now's the time to abandon ship before it gets to South America.
OK, in the final scene of Dexter's sixth season, Deb (Jennifer Carpenter) found out that her step-brother Dexter (Michael C. Hall) is a killer. Deb subsequently has been brought up to speed on the fact that Dexter not only is a killer, but a serial killer. That thing in the church was not a one-off.
But now Deb finally has come clean about why she headed to the church that fateful night. Acting on probably the worst advice a psychiatrist ever has given, Deb was going to confront Dexter with the news that she had romantic feelings for him.
Deb ultimately blurted that jaw-dropper when she was overcome by emotion upon hearing that Dexter has romantic feelings for fellow serial killer Hannah McKay (Yvonne Strahovski).
"You picked the one way that you could hurt me worse than you could ever f------ understand," Deb said.
"It's one thing to be in love with your brother, but it's a whole other level to be in love with your brother who's a goddam f------ serial killer. You're a serial killer and I'm more f----- up than you are."
Meanwhile, Astor, Cody and Harrison were in a nearby room, supposedly sleeping. Hope no one was up for a glass of water.
This will sound like a strange thing to say, given that Dexter always has been a show about a serial killer. But Dexter as an individual has become harder to like this season, more selfish, more self-centred.
He cares about his son and his two step-kids, but only peripherally, if they don't get in the way of his business. He cares about Deb, but he has no problem lying to her repeatedly. And now that he not only has the hots for Hannah but also is connecting with her emotionally and intellectually, he's willing to risk the well-being of just about everyone else in his life.
Bad friend. Bad father. Bad brother.
Not to mention bad employee. The guy's never at work!
Does the viewing audience still have a soft spot for Dexter Morgan? If so, it truly speaks to Hall's acting skill.
Other observations:
- The police tailing Isaak (Ray Stevenson) sure were easily shaken, weren't they? And what were the police doing letting Isaac sit there in his own apartment with his murdered would-be assassin lying in a pool of blood as the lab rats - including Dexter - did their work? Miami Metro really is the worst police force in history.
- By the way, did Dexter really need to slit the throat of that overwhelmed would-be assassin? Code, my ass.
- So finally it has been confirmed: Isaak and Viktor (Enver Gjokaj) were lovers.
- I haven't figured what LaGuerta (Lauren Velez) is up to with regard to Dexter's boat. Many of this show's past seasons are just a blurry memory to me now, which surely isn't helping my powers of deduction. Does anyone have any decent theories about what LaGuerta is pondering?

subset: commoncrawl


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Men's adidas Mutombo Basketball Shoes
Select a size above
Size Chart
Buy Online & Pick Up In-Store
Check Availability at stores near you.
Product Details
Originally release in 1993 for four-time NBA Defensive Player of the Year, eight-time NBA All-Star player, and legendary shot blocker, Dikembe Mutombo of the Denver Nuggets, the adidas Mutombos were designed to provide premium lock down for larger players while looking fresh at the same time.
The criss-cross African-inspired elements nod to Mutombo's homeland of Zaire (now known as the Democratic Republic of the Congo) and his logo is comprised of a shield, crossed spears, and Dikembe's #55 career-long jersey number. The mid top design ensures proper support while blocking and dominating all over the court.
The epitome of urban aesthetics of the '90s, it'll be hard to say "no, no, no" to these retro bangers.
- UPPER: Suede, leather, and synthetic
- MIDSOLE: Rubber
- OUTSOLE: Solid rubber with traction


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RANCHO CUCAMONGA -- A veteran's Texas hold'em tournament will be held Oct. 20 by Veterans of Foreign Wars Post 8680.
The event will benefit veterans programs.
It will begin at 1 p.m., with doors opening at noon. A lunch is included. The entry fee is $50.
The event, hosted by the VFW post and Carlson Casino Parties, at the post at 8751 Industrial Lane. Table sponsorships are available for $100.
Information: Jim Fettig, 909-746-7121.


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Brevard, N.C. - The Tornados celebrated Senior Day for Beth Brooker and Katie Thornburg on Saturday afternoon. The pair combined to go 3-10 on the afternoon, driving in four runs and scoring once apiece, but visiting Lenoir-Rhyne took home the wins, 9-4 and 10-2.
For the season, Brevard is 16-24, 2-14 in their inaugural season as full members of the SAC while Lenoir-Rhyne moves to 34-9, 11-5 in conference play.
Game 1: Lenoir-Rhyne 9, Brevard 4
Tornado starter Jennifer Gift (7-12) allowed eight runs in the top of the first inning before shutting the Bears down the remaining six innings, but the damage was done as Lauren Harris pitched five innings in relief to record the win in game one.
Lenoir-Rhyne sent 11 batters to the plate in the top of the first, which was highlighted by two runs coming in on a fielding miscue by the Tornados and a three-run home run by Noel Belk as the Bears took control of the game early.
Brevard came storming back in the second with three runs of their own, putting Thornburg and Katie Brown on base with a walk and a bunt single. A grounder by Sarah Carlos moved both runners into scoring position. A two-out walk issued to Becca Curlee loaded the bases for Brooker who dropped a single down the left field line scoring Thornburg and Brown on the play. A single up the middle by Kristina Clayton scored Curlee as Brevard cut the lead down to 8-3.
The Bears scored again in the top of the fourth as Sarah Atkins drove a line-drive home run over the centerfield fence with a full count to put the Bears back up by six.
Brevard answered in the bottom of the inning with a run of their own as Curlee drove a line-drive base hit to right center to score Carlos to make the score stand at 9-4.
The Tornados placed runners on base in the fifth, sixth and seventh, but were unable to cut into the lead any further in falling in game one.
Game 2: Lenoir-Rhyne 10, Brevard 2 (5)
A two-run single in the bottom of the first by Thornburg staked Tornados pitcher Liz Houser (9-11) to an early lead, but the Bears came back behind the pitching and hitting of Belk to take the nightcap of the doubleheader.
Lenoir-Rhyne got on the board in the top of the first as Atkins drove a double off the top of the wall in left center to score Belk to give the Bears an early lead.
Brevard took the lead in the bottom half of the inning. Brooker led off with a walk. On Clayton's bunt single, Brooker kept going, sliding safely into third ahead of the throw, allowing Clayton to move to second. After a pair of flyouts to right field, Thornburg came through for the hosts, dropping a base hit into shallow right center scoring Brooker and Clayton to put Brevard up 2-1.
The Bears came back in the second, scoring four runs as Carlee Carpenter cleared the bases with a double to left center, scoring Beth Slater, Brittany Davidson and Belk, before scoring herself on Kat Rivers single through the right side of the infield.
Lenoir-Rhyne added five more in the third as Belk drove home Erin Evans with a single to left field, before a bases-clearing double by Atkins down the left field line plated Slater, Belk and Carpenter. Rivers followed with a double of her own, scoring Atkins to give the Bears a 10-2 lead which would stand as Lenoir-Rhyne completed the sweep.
The Tornados have one final doubleheader remaining in the 2009 regular season, as they host the King College Tornado on Monday, April 20th. First pitch for the game is set for 2 p.m. The Bears wrap up their regular season at Brevard and will be getting ready for the first round of the 2009 Food Lion South Atlantic Conference Softball Tournament which will start on April 23rd.


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Results 16 to 18 of 18
5th June 2012 11:23 AM #16
- Join Date
- Jun 2012
- Posts
- 4
Hi Kate,
My husband and I would also love to have a boy for our next child. I have a 3 yr. old daughter and having a boy the next time would be a wonderful gift for us. We are currently trying to conceive for almost a year now, but with no success I've also heard about this calendar that serves as a guide to determine the gender of the child. Like for example, if the baby is formed on a certain month it could determine the exact gender. Is this true? And one more thing, is age also a factor why I'm having a hard time to conceive now? I'm turning 39 this year.
14th January 2014 10:49 AM #17
- Join Date
- Jan 2014
- Posts
- 1
I have just joined the forum and would like to get some more ideas of what foods to eat in trying to conceive a girl.
16th January 2014 07:09 AM #18
Dear dianab,
Welcome to the forum! I hope you find it to be a supportive, caring and informative community.
There are no specific foods you can eat to make it more likely that you will conceive a girl. However, you do need to make sure you are eating a healthy, balanced diet (and drinking plenty of water) when you are trying to conceive. It is also very important to take your Folic Acid supplements. Here is an article which I hope you will find useful on Planning for Pregnancy: Preconception Care.
Warm wishes,


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|Yes, you can ask your contractor to install a similar ceiling,
but the insulation is crap, it's going to just KILL your heating bill.
|"It's a can of whup-ass. Let's open it."
|Yes, you can ask your contractor to install a similar ceiling,
but the insulation is crap, it's going to just KILL your heating bill.
|"Some people who took Red Pill reported side-effects, including
changes in appetite; changes in sexual desire; constipation;
dizziness; drowsiness; pursuit by kill-bots, increased saliva
production; deluisions of godhood; lightheadedness;
tiredness; kung fu; leather fetishes; unsteadiness; weight changes,
and the ability to control time and space. Consult with your
physician before taking Red Pill."
|"It's a can of whup-ass. Let's open it."
You're selling The Sixth Sense short. It's impossible to watch it again and have it affect you in the same way. That's the nature of a movie with such an ingenious twist. And it's not fair to hold movies like The Happening and The Lady in the Water against him.
It was a great movie. One of the best movies of the year.
@CJ - TSS is certainly not a bad movie. I'm just not entirely convinced it is a great one. It didn't strike me that way when I revisited it a few months ago.
I may well be selling it short. I think I'm clear in the post that I think it is well-acted and well-directed, and its use of color, composition and lighting are extremely effective even when you know where the scares are. Shymalan is a director whose strengths are obvious, and I keep waiting for him to put them to use in a better movie. I don't doubt it could still happen.
I should point out that it is totally fair to hold movies like The Happening against Shymalan. They're his movies after all. However, I presume your meaning was that it is not fair to let the lack of quality of those movies auger against The Sixth Sense, and I think that's certainly true.
I'm not certain that Shymalan's more recent output is coloring my views of TSS, but I do admit that it's possible. On the other hand, I absolutely think that it would hurt him and TSS's Oscar chances within the context of this hypothetical time-delayed Oscars, so I think that it's worth mentioning in this post.
On the other hand, if what you suggest is true, and the movie is designed to work in a unique way for full impact exclusively upon first view, then the flip side is true, too: it is also designed to be less effective on subsequent viewings. I'd suggest that a movie that is constructed in that way is probably not destined for long-term enjoyment. It may by its very design be fated for a quick peak of popularity that ebbs over time.
I guess for me, 1999 is such an embarrassment of riches when it comes to movies that don't lose enjoyment on the 10th or 20th viewing, that I'd have to disagree with you that TSS represents one of the year's best.
That's fair. And in my first comment, I should have said against it (the movie) and not him (the director). You can certainly hold those subpar movies against him.
Of course, I'm one of those people who liked The Sixth Sense, Unbreakable (his best, I think), Signs and The Village (which seems universally despised).
Perhaps my enjoyment of those flicks colors my opinions like your regard for all things QT.
Maybe. Though I'd point out that (1) I actually liked The Sixth Sense, too, albeit not as much as you. I also think Unbreakable is his best, and (2) Sure, I'll stack QT against Shymalan film-for film any day, but I don't love "all things" Tarantino. Thus far I think I've expressed my admiration for QT's first 3 movies, but I really doubt I'm alone in that. They're just extremely good films. If I ever get around to their respective years, I think you'll find me more circumspect about the uneven Kill Bill film (films?), and I think that it's possible that Death Proof won't even get an entry. If it does, it will not be particularly effusive.
Inglourious Basterds is fantastic, though.
Man, lot to cover this year.
-I disagree with you about American Beauty (Although you're not the first person I've heard make that comment). I feel even now it holds up very well, and while I'd agree that there are certain elements of the story I'd classify as contrived, I think the idea of dysfunction among families and in society still echoes pretty strongly, at least to me.
And I am annoyed that Sam Mendes has had a less-than-stellar career since. Oh, and Annette Benning doesn't get enough credit in that movie, I adore her in that, such a great job with her character.
-I'm surprised Jay & Silent Bob really turned you off of Dogma as a whole that much. For me, the fact that I keep reading about what a bitch Linda Fiorentino is is more of a distraction when I watch.
-Make sure when you watch Eyes Wide Shut you get to see the extended Orgy scene. Just sayin'.
-I probably said this when you covered 12 Monkeys, but that will always be my favorite Brad Pitt performance. I still think he doesn't get enough credit for being a really good actor because he's Brad Pitt.
-I'm not gonna lie, I look down at anyone that tells me they haven't seen Office Space. I have a Jump to Conclusions mat on the floor in my cubicle and I'm disgusted when people see it and then don't realize what it's from.
-I liked Signs. I don't care what anyone else thinks.
-Just like Brad Pitt is underappreciated because he's Brad Pitt, the South Park movie is underappreciated because it's South Park. Absolutely fantastic musical, which shouldn't be overly surprising considering their track record and ability to integrate song into the series as a whole (Take some notes, MacFarlane). Can't say enough good things about that movie, still hilarious even when I watch it now.
-God I hate George Lucas. I tried so hard to like those prequels, I really did. And they do NOT age well. Ugh. What an asshole. Jake Lloyd deserves to die.
-I've heard rumors about you and a whip cream bikini...care to comment?
I think Matrix walks away with this one -- if there was ever a movie made to win the retroactive Oscar for best picture, this is it. The Academy had not yet accepted this at the time, but the Matrix changed movies more than any other movie in that decade. Hands down.
I thought American Beauty was great, and I like your inclusion of Fight Club, which is surely worthy of nomination-but-not-winning in this year's crop.
I think Sixth Sense is quite overrated. I thought Signs was ok, but in general I don't think there's a single Shaylaman movie that ages well. His stuff is just a little to predictable for me, as I knew the "twist" to Sixth Sense within minutes of seeing it happen live. And any movie that relies totally on a surprise ending to win best picture, is never actually worthy of winning best picture.
Did not see Cider House Rules or Green Mile, but I am surprised you dismiss them as being horrible so quickly. I have heard from others that Cider House in particular is quite good.
Matrix with the easy time-delayed victory on this one, Goat. As surely as Inception bit a testicle.
@Maloney -- Actually, Jake Lloyd has suffered horribly from the Phantom Menace thing. He is sort of bitter and a little awesome about it. He also looks like Leonardo DiCaprio swallowed a man-sized sausage:
@Hoy -- I think The Matrix is certainly a credible choice, though it is not my choice. I think if we lived in the alternate universe of Matt Damon's hypothetical 10-year delay Oscar, it may well win. I just think it won't for the reasons I listed. The genre shouldn't really matter, nor should the fact that the sequels were disappointing (to be charitable), nor should the fact that the Wachowski brother/sister's output following has been underwhelming...nevertheless, I do think that these factors would play.
I can see why you'd want it to win, though.
*Isiah. Unless you're just the world's last remaining fan of Isaiah Rider.


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With the demand for more resilient and sustainable products, researchers have focused on self-repairing materials, which can withstand minor abuse and return to their original physical condition. Such materials would not only outlast their conventional counterparts, but also require less substance in their manufacturing, says Carolyn Dry, president of Natural Process Design (NPD). "The fact that structural damage can go undetected … means that some products are over-engineered. However, substances that can provide information about their internal stresses—as well as trigger reliable self-healing properties—allow manufacturers to be more confident in using lighter weight materials."
Airplane components made from NPD's ultralight graphite polymer composite, for example, weigh 30 percent less than standard components and also help reduce fuel consumption. The Beckman Institute for Advanced Science and Technology at the University of Illinois at Urbana-Champaign is also pioneering self-healing materials. Aerospace engineering professor Scott White has created polymers embedded with a chemical trigger and a microencapsulated healing agent. When the polymer is overstressed and cracks, it autonomically releases a healing agent into the rupture. Currently, it is limited to a onetime fix; White and his team are exploring a new generation of materials embedded with microvascular networks that can repeatedly self-heal. Potential building applications include elements in façades and high-traffic areas.
Stanford University chemical engineering professor Zhenan Bao and her team have invented a conductive, self-healing plastic capable of multiple repairs. The autonomic polymer, which incorporates nickel particles, can detect and communicate changes in pressure. As a result, the plastic behaves like human skin in terms of sensory capabilities. The team is working on developing a transparent version of the material, for potential use in touchscreens and robotics.
Though self-repairing materials' sustainability and resiliency are promising, these goals are also in conflict. To maximize resource savings, they must eliminate the redundant matter intended for safeguards, an earmark of resilient design. Indeed, Dry's idea of materials that relay their stresses would succeed only if facility managers had a more active relationship with their buildings than what now exists. While a built environment that acts like living tissue holds much promise, it brings with it many uncertainties.


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Bruce Springsteen topping 'Rolling Stone' list of Best Live Acts
Listen to Bruce Springsteen on iHeartRadio
Bruce Springsteen is getting the nod as the best currently active concert performer. The Boss has captured the top spot on Rolling Stone's" new list of the "50 Greatest Live Acts Right Now."
He earns praise both for the "nearly superhuman levels of energy" he brings to his shows, as well as for their duration. Bruce and the E Street Band gave their longest performance ever last July in Helsinki, Finland, playing a show that clocked in at four-hours, six-minutes.
Springsteen is also recognized for his spontaneity. While he prepares a set list for every show, he often deviates from the plan to take sign requests from the audience or some other song he feels is right for the moment.
Another veteran star is falling in at number two. "Rolling Stone" says Prince and his latest band 3rd Eye Girl are "fire hot," and he's currently treating crowds to hits spanning his extensive career. The Rolling Stones, who returned to the road late last year to celebrate their 50th anniversary, takes the number three spot. Neil Young rounds out the top five, following Canadian indie rockers Arcade Fire at number four.
U2 just misses the top ten to occupy eleventh place, while Tom Petty and the Heartbreakers are making the cut at number 13. Paul McCartney and Metallica both earned spots in the top 20.
Photo Credit Getty Images


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There's so much going on in Talk week to week that we almost can't keep up. If you're in the same boat, here's a small selection of topics and responses that have piqued our interest this week.
The Serious Eats Budget Red Wine Hall of Fame
"As I attempt to develop my taste in wine, I have but two qualifications for purchase: 1) under $15 and 2) a funny name. This explains why I've drank so many bottles of Woop Woop and Fat Bastard. Even if it the taste isn't too great, it just feels good to say "gimme a little bit of that woop woop"." —Tanner
New Wheat Thins Flavors: Spicy Buffalo and Zesty Salsa
"Time to cease the bias against slender-challenged folks.
Demand that Wheat Fats be brought to market." —Obbop
5 Things To Do With Manhattan Special Espresso Coffee Soda
""Hi, my name is John, and I'm an addict."
"Hi John!"
"It started when I wrote this post for Serious Eats about Manhattan Espresso Coffee Soda. I thought it was harmless, you know, just another writing gig. I drank a bottle, and thought it was okay. But then, a few days later, I walked by the shop where I bought the first one, and I, well, I .... I..."
"It's okay, John"
"I... I needed another. And another. Pretty soon, I was taking trips by that store all the time, just to get a fix of Espresso Coffee Soda. I can't stop. I have a big bottle in my fridge, my girlfriend's fridge. It's just... so damned good."
Yea, I'm hooked. I don't know what it is: the thick foamy carbonation reminiscent of a thick, italian espresso; the light, sparkly bubbles that dance on my tongue; or how roaring twenties the logo looks. Since I wrote about it 2 months ago, I've become a loyal customer, a fanatic, a minion of Manhattan. " —John M. Edwards
Cakespy: Philadelphia Butter Cake
"I'm confused. I don't add crushed cadbury cream eggs to it? Or use it as stuffing for a roast chocolate chicken- carefully remove base of a hollow chocolate chicken, pipe in butter cake mixed with custard till gooey, and carefully rewrap with decorative foil?" —dashofginger
"@dashofginger: Have you been reading my diary? :-) No, stuff your face with it. " —cakespy
Pronouncing "macaron" (rant?)
"To make things even more pre-French-ious, the "n" is silent and you pronounce the "roh" through your nose. FUN!
In fact, I found the sweetest video of Adam and Robyn trying to say it...
CUUUTE!!!" [ed note: we agree!]—usernameTK
Food/restaurant workers! What's your story?
"When I was 16 I was working as a hostess for a diner type place in Ashland, Oregon. I'd have to go into the fridge and refill huge tubs of butter, ready made salad dressings, and condiments. To get to the freezer from the front, I had to pass through the kitchen, which was disgusting. I mean... BBQ sauce on the tile walls, the cuttingboards were stained beyond recognition, fry oil everywhere, greasy cooks (who also had a hard time keeping their eyes to themselves... I've never been a bad looking kid)... So one evening it was about 11:30 and we were a half an hour from closing. All of the tables had been bussed and reset, the floors handled, the coffee pots cleaned out, and so it was time for me to break down the salad bar by taking all of the trays back into the kitchen fridge, cover them all with plastic wrap, date them, and clean out the half melted ice from the salad bar and bleach out the whole thing. I put all of the salad dressings on the cart to take them back first. I went into the kitchen and stopped for a minute to bend over and pick up my pad and pen that had fallen out of my apron when BAM... The door swung open wide and knocked the cart, and all of its contents, onto me. I was COVERED in salad dressing. Ranch, Blue Cheese, Honey Mustard, Catalina, Thousand Islands, Italian... EVERYWHERE. In my hair. ALL over my back. Down the crack of my ass. In my shoes. EVERYWHERE. The only part of me without salad dressing all over it was my face. When I looked up to see the younger of the two line cooks standing over me with his jaw on the floor, I can't tell you how badly I wanted to punch him in the face. Too bad the manager came in and broke the silence with laughter that would make the Muppets roll their eyes in shame. I had to call my Mom out of bed to bring me another set of clothes. I smelled like Thousand Islands for three days.
I know you didn't want to hear a story, but thats pretty much how it goes when you work in a crappy restaurant. Some days are OK, and other days you go home smelling like test tube food." [ed note: Another strike against bottled salad dressing and thank God for moms]—BitchinFixins


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excellent, thanks to all you people who made this possible,
looking forward to trying it out, using unetbootin as we speak.
Thank you very much to all the people involved! Downloading right now at a very acceptable speed Can't wait to fool around with this next version!
excellent, thanks to all you people who made this possible,
looking forward to trying it out, using unetbootin as we speak.
tnx for the bt4, it looks great!!
I post a little quicke howto get the bt4 up and running "live with changes"
from windows.
download the iso from first page.
format a sd or usb-stick in fat32, (I suppose 1gb would do it but I prefer 2gb)
open the iso with winrar or other iso prog.
transfer the 2 directories "boot" and "BT4" to the card or usb.
when ready open the boot directory on the card and run "bootinst.bat"
now your card should be bootable, put the sd or usb in the computer and boot.
login with root, toor, startx.
when you see the desktop open konqueror and type /mnt in adress bar, and you will se your mounted drives, look for the boot BT4 directory and make a new folder named "changes".
remember what name your direcory have (in my case sdb1).
open boot/syslinux/syslinux.cfg in a text editor, and edit the last line in
MENU LABEL BT4 Beta - Console
KERNEL /boot/vmlinuz
APPEND vga=0x311 initrd=/boot/initrd.gz ramdisk_size=6666 rw root=/dev/ram0 changes=/dev/sdb1 quiet
where changes=/dev/sdb1 corsponds to your bt4 direcotory
reboot and start make whatever changes you want and it should be saved.
a tip is to edit the timeout figure in syslinux.cfg to: TIMEOUT 4
run this on my asus eee 701 (thats why I have vga=0x311) works great.
tnx again for the relese.
you could of course make the "changes" folder in windows and just edit the syslinux.cfg after boot
excellent work guys and thankyou muts and every one how made this!!
It's for BT3, works also for BT4.
Don't eat yellow snow :rolleyes:
Thanks Muts, Dev appreciate all the work really ....
its really fast in booting amazing speed i try both the vmware & HDD install in Fujitsu .. thanks for effort , nights u spend in wonderful dis
How you spend your time is more important than how you spend your money. Money mistakes can be corrected, but time is gone forever. David Norris
The BT4beta forum/sub-forums are now live.
Please use them for all comments/reports
Downloading now, great mirrors, getting my full 950 KB/s
Cheers devs
Superb work, team. I'll be a happy betatester now.
I have the card in me head, but you have the memory problems?
Cheers for all the good work devs.


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Chez Les Berberes
Riad Chez les Berberes is located in the Atlas Mountains, just a 15 minute walk from Imlil . It offers traditional Moroccan accommodation.
Each guest room is uniquely decorated in a Moroccan Berberes style and equipped with air conditioning and a balcony. Free Wi-Fi access is available.
The hotel restaurant serves traditional Moroccan specialties, such as tagine, couscous and mint tea... Relax on the terrace, with spectacular panoramic views.
Please note:
Cancellation Policy: 1 day before arrival
Check In: 7.00 am 11.00 pm
Check Out: 2.00 pm
Method of Payment upon arrival: Cash Only!
Breakfast is included.
Taxes are included.
Availability & RatesTo view availability and prices please select dates and click 'Update Dates'
B&B Facilities & Policies
- 24 Hour Reception
- 24 Hour Security
- Airport Transfers
- Bicycle hire
- Free Breakfast
- Cafeteria
- Child Friendly
- Currency Exchange
- Free Internet Access
- Free Parking
- Free WiFi
- Hot Showers
- Internet Access
- Self-Catering Facilities
- Outdoor Swimming Pool
- Outdoor Terrace
- Parking
- Restaurant
- Taxes included
- Tea & Coffee Making Facilities
- Tours/Travel Desk
Cancellation PolicyThis property has a 1 day cancellation policy. Failure to cancel within this time will result in a cancellation charge equal to the first night of your stay.
Must-Read Guesthouse InfoThis property has specific Terms & Conditions.
Please note:
Cancellation Policy: 1 day before arrival
Check In: 7.00 am - 11.00 pm
Check Out: 2.00 pm
Method of Payment upon arrival: Cash Only!
Breakfast is included.
Taxes are included.
DirectionsShow MapHide Map
Riad Chez Les Berberes:
60km from Marrakech in direction of High Atlas Mountains (Jbel Toubkal 4167 m). From Imlil you take left dirt road direction of Tizi Ntamatert (10mn see map) in face of Douar Ait Souka. Near the road you find our guesthouse Chez les Berbres.
Transportation: You can reach the house just 1h drive from Marrakech airport by a private transport arranged normally by Hassan Amzil or a public taxi with own arrangement from the airport or the Medina


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Discussion in 'Fan Zone' started by Zordon, Apr 28, 2013.
Shango is never happy. His whiner act was fun for a while, but now it's just the same old regurgitated bleh.
I don't even bother clicking on the play-button.
really pissed about no backup for Ware
Yeah, On the first night of the draft, he said he didn't like the Frederick pick and then said he didn't know anything about him and he wasn't part of his research, how could he not know him?, he's was the top rated Center, maybe he's not as smart as he thinks he is
who is shango?
I can understand that but geez louize you've only got 7 draft picks after the trade to shore up more than 7 weak spots on the team.
He obviously doesn't remember the mid/late 90's where draft pick after draft pick (most high draft picks) were wasted on "need" picks to shore up the DE position. I shake my head when I think of all of them.
The reserves behind Ware and Spencer are a big concern for me, but I understand the situation.
We could've had a perfect draft and he would find something to be pissed about. Really not sure why anyone cares what he thinks. Unless they enjoy listening to somebody yell and attempt to be funny.
thats what I was thinking...sounded like he wanted everything fixed over 3 day period at draft.
This is very laughable considering you love every wasted secondary pick this team makes.
Hey, we only had 7 picks. Can't do everything. But we damn sure can get our defensive backs every year.
The "everyfan," from what I gather.
has over 4 million video views. something to be said about that. He should be capitalizing with advertisers which i am sure he is.
I can't fault the organization for sticking to their board after round 1. Maybe they would have taken Short in the 2nd or Logan in the 3rd but they were off the board.
One should never be bitter on a Sunday morn... That just isn't right.
That's the cop out. They stuck to their board. The board what always seems to prioritize DBs over line play.
Did their board tell them Escobar was a better player than Warford? Or that Wilcox was better than Moore?
I like those players, but if so....you might want to cheat off someone else's board.
he's probably the most famous cowboys fan. his success angers some on here. that is the only explanation I can come up with for why some would not like a video of him discussing the lack of draft picks in the trenches.
We just need an infusion of O Line and D line.
It holds us back every year and unless we get lucky it will hold us back again this year.
I like what we did over all in this draft, but the guy has legitimate points.


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WTN: `04 Chateau Meric Graves.
Purchased for this months exercise, $25 Cdn. Little known house, owned by Francois Barron family (7th generation). Located in town of La Brede.
12.5% alc, good natural cork, opened one hour but not decanted.
Color. Very pale garnet, not much depth in centre. Already showing some maturity on the rim, light brick.
Nose. Appeals with black cherry, lead pencil, some dark fruits. Hint of some oak in background. Not much change on day 2.
Palate. Initial entry thought was dry, medium puckery tannins, cherry, blackcurrant. At first thought tad thin on mid-palate but it improved after 2 hrs. Tart finish but good length, the pork scallopini was a good match, bringing out some sweetness (?) in the wine finish.
It really improved after a couple of hours, tannins settled and drinks nicely.
Day 2, softer finish, blackcurrant, no downturn. Nice with Bresse Bleu cheese. Interesting wine, very good price.


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Co-ed Cinema, 79 W. Main St., Brevard, 883-2200. Showing through Thursday: "Quartet," rated PG-13. Show- times: 1, 4, 7 p.m. Info: www.coedcinema.com.
Flat Rock Cinema, 2700 Greenville Highway, Flat Rock, 697-2463. All tickets $7.50. Showing through Thursday: "Quartet," rated PG-13. Showtimes: 1, 4, 7 p.m. Info: www.flatrockcinema.com.
Epic Theatres of Hendersonville, 200 Thompson St. Shows through Thursday: "21 and Over," rated R. "The Call," rated R. "Dead Man Down," rated R. "Escape From Planet Earth," rated PG. "Identity Thief," rated R. "Incredible Burt Wonderstone," rated PG-13. "Jack the Giant Slayer," rated PG-13. "Last Exorcism: Part II," rated PG-13. "Oz the Great and Powerful," rated PG. "Quartet," rated PG-13. "Safe Haven," rated PG-13. "Silver Linings Playbook," rated R. "Snitch," rated PG-13. Call theater for showtimes, 693-1146.
Green for Turtles awareness day, 1-4:30 p.m. Saturday at Team Ecco Center, 511 N. Main St. Free. Info: 692-8386.
Hendersonville Chamber music concert, 3 p.m. Sunday at First Congregational Church, 1735 5th Ave. W., Hendersonville. Tickets: $17.
Storytelling, 3-5 p.m. Sunday at the Feed and Seed, Fletcher. Free. Info: 216-3492.
185 King Street, Brevard. Today: Spirits of the Red City. Info: 877-1850 or firstname.lastname@example.com.
Saluda Inn & Wine Cellar, 229 Greenville St., Saluda. Thursday: 5-7 p.m. Happy hour. Music begins at 8 p.m. Fridays. Info: 749-9698.
Cypress Cellar, 321-C N. Main St. Entertainment, 8 p.m.-midnight in the bar on Fridays, and 6-9 p.m. in the dining room Saturdays.
French Broad Brewery, 101 Fairview Road #D, Asheville. Entertainment 6-8 p.m. Friday and Saturdays. Info: 277-0222 or www. frenchbroadbrewery.com.
Grey Eagle Tavern, 185 Clingman Ave., Asheville. 828-232-5800: Thao & the Get Down Stay Down/Sallie Ford & the Sound Outside. 9 p.m. $12, $15.
Jack of the Wood, 95 Patton Ave., Asheville. Ages 21 and older. Sundays: Irish Session 5-8 p.m. Mondays: Quizzo! 8-10 p.m. First Tuesdays: Singer/Songwriter in the Round, 8-10 p.m. Wednesdays: Old Time Jam, 6 p.m. Thursdays: Bluegrass Jam 8:30ish. Entertainment starts around 9 p.m. Info: 252-5445.
Just Vino, 2702 Greenville Highway, Singleton Centre. Thursday: Free wine tasting, 5-7 p.m. Friday: $3 drafts, Saturday: Live entertainment. Info: 693-5380.
Living Room Cafe & Coffeehouse, 356 N. Main St., Hendersonville. Dinner music 6:30-8:30 p.m. Friday and Saturdays. Today: Carrie Morrison and Steve Whitesides, Saturday: Elise Pratt and Mike Holstein, March 22: Linda Mitchell, March 23: Elise Pratt and Mike Holstein, March 29: Jeff Michels, March 30: Elise Pratt and Mike Holstein. No cover charge. Also serves breakfast and lunch. Info: 692-6335.
Midway Tavern, 2634 Hendersonville Road, Arden. Karaoke every Wednesday and Friday at 9 p.m. Performers Saturdays at 9:30 p.m. Info: 687-7530.
Mama Christina's Cafe, 2700 Greenville Highway, Flat Rock. Tuesday: Southern Blues, Thursday: Wine Tasting, 6-7 p.m., Wednesday, Friday and Saturday: Nello and Michelle, 6-10 p.m., Sunday: Jazz Jam, 6:30 p.m. Info: 866-593-7774; mamachristinas.com.
Mills River Music Barn, 1140 N. Mills River Road. All ages welcome. Country music, big dance floor. Every Friday and Saturday from 7-10:30 p.m. Bob Presley. Info: 891-7704.
Never Blue Restaurant, 119 S. Main St., Hendersonville. Today: Annie Sellick and Pat Bergeson, 5:30-7:30 p.m. Info: 693-4646.
Olive or Twist, 81 Broadway, Asheville. Wednesdays: Cadillac Rex, 8 p.m. Thursdays: The Heather Masterton Quartet, 8-11 p.m. Fridays: Rotating guest bands, 8-11 p.m. Saturdays: The 42nd Street Jazz Band, 8-11 p.m. Info: 254-0555.
The Orange Peel, 101 Biltmore Ave., Asheville. Ages 18 and older with valid ID. Today: The Breakfast Club, Saturday: The World of Trouble, Sunday: Nick Cave and the Bad Seeds, Monday: Awolnation, Tuesday: Local Natives; Thursday: Slice of Life Comedy. Info: 225-5851; www.theorangepeel.net.
Panther's Paw Pub & Club, 111 Joel Wright Drive. Opens at 4 p.m. Ages 21 and older; 18 to 21 years of age admitted as designated drivers with a valid driver's license. Karaoke on Tuesdays and Thursdays; DJ on Fridays. Info: 696-0810.
Party Place and Event Center, Friendship Church Road, Saluda. 8 p.m. Saturday: Tuxedo Junction, $9; Sunday: Blue Ridge Contra Dancers, $10. Info: 749-3676 or www.saludamountainjamboree.com.
Pisgah Brewing Co., 150 Eastside Drive, Black Mountain. Today: Phuncle Sam, Wednesday: Cornmeal, Thursday: The Heritage. Info: 669-0190 or www.pisgahbrewing.com.
Purple Onion Cafe and Coffeehouse, 16 E. Main St., Saluda. Saturday: JPQ Band; Thursday: One Leg Up. Info: 749-1179 or www. purple-onionsaluda.com.
Southern Appalachian Brewery, 822 Locust St., Hendersonville. Hours: 4 p.m to close Wednesday-Friday; 2 p.m-close Saturday and Sunday. Entertainment: 8-10 Friday and Saturday. Today: Carolina Rex, Saturday: St. Patty's Celebration/Mustache March contest featuring music by: The Stipe Brothers, Dan Ruiz, and Wayne Bodley, Sunday: Big Block Dodge, Thursday: Robin Tolleson & Steve Davidowski. Info: www.sabrewery.com.
The Ugly Mug Coffee and Tea, 2024 Asheville Highway, Hendersonville. Wednesdays: Open Mic with Zack Harding, 8-11 p.m. Info: 693-9999 or email@example.com.
White Horse Black Mountain, 105C Montreat Road, Black Mountain. Today: Amici Music chamber music concert, Saturday: St. Patrick's Day Celebration, Sunday: Transition Black Mountain, Tuesday: Irish music session, 6:30-8 p.m. Info: 669-0816.
Theater and dance
"The Little Prince," by the Flat Rock Playhouse YouTheatre, through Sunday at Playhouse Downtown, 125 S. Main St., Hendersonville. 7 p.m. Friday and Saturday and 2 p.m. Saturday and Sunday. Adults: $18; students and children: $10. Info: 828-693-0731; 866-732-8008.
"Music on the Rock: Tribute to the Neil Diamond," Wednesday through March 23, March 27-30 at Playhouse Downtown, 125 S. Main St., Hendersonville. 8 p.m. Wednesday through Saturdays. Tickets: $24. Info: 828-693-0731; 866-732-8008.
Henderson County Heritage Museum observing the 150th anniversary of the Civil War, 10 a.m.-5 p.m. Wednesday-Saturday, 1-5 p.m. Sundays, through Dec. 31, 1 Historic Courthouse Square, Hendersonville. Free. Info: 694-1619.
Southern Lights Square and Round Dance Club will hold a new series of lessons for new students (couples only) starting on March 27, 5:30-7 p.m. at the Stoney Mountain Activity Center, Stoney Mountain Road, Hendersonville. Info: 828-693-3825.
Southern Lights Square and Round Dance Club will hold "Pots of Gold" dance and the Experienced Clothing Sale on Saturday at the Whitmire Activity Building, Lily Pond Road, Hendersonville. Clothes will be on sale from 6:30 to 9 p.m. to active square dancers. Cash only. Advanced dance at 6 p.m. Early rounds at 7 p.m. Squares and rounds at 7:30 p.m. First two tips will be for new dancers. Caller: Stan Russell. Cuers: Lou and Al Krech. Info: 828-693-3825.
The Hendersonville Film Society, Smoky Mountain Theater at Lake Pointe Landing, 333 Thompson St., Hendersonville. Sunday: "The Mechanic"; March 24: "The Battle of the Sexes." Info: 697-7310; email hendersonvillefilm email@example.com.
Apple Valley Model Railroad Club open from 1-3 p.m. Wednesdays and from 10 a.m.-2 p.m. Saturdays. Free. Hendersonville Depot, Maple Street. Info: www.avmrc.com.
Hendersonville Ballroom Dance Club meets from 7:30-10 p.m. the first and third Friday of February-April in the lower room of the Elks Lodge, 546 N. Justice St., Hendersonville. Beginning in May, the club will return to the every Friday schedule. Annual membership is $14 with dance fees of $5 for members and $7 for non-members. Call 828-654-9708, email d.c.dance.studio@ morrisbb.net or visit www.hendersonvilleballroomclub for more information.
Line dancing classes every Wednesday at the Stony Mountain Activity Center, 800 Stoney Mountain Road in Hendersonville. Beginners meet at 9 a.m.; improvers at 10:30. $5 per class. Call in advance to register. Info: 890-5777 or firstname.lastname@example.com.
Going Out: March 15


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Uterine fibroids and hysterectomyHysterectomy and uterine fibroids; Leiomyoma; Myoma
An in-depth report on the causes, diagnosis, treatment, and prevention of uterine fibroids.
Uterine Fibroids
Uterine fibroids, also called leimyomas or myomas, are non-cancerous growths that originate in the muscular wall of the uterus. Fibroids are the most common type of tumor found in female reproductive organs. Uterine fibroids are very common, especially among African-American women.
Symptoms of Uterine Fibroids
Symptoms of uterine fibroids may include:
- Heavy and prolonged menstrual bleeding
- Pressure and pain in the abdomen and lower back
- Frequent urination
- Constipation
- Pain during intercourse
- Some women with fibroids do not have any symptoms
Complications of Uterine Fibroids
- Fibroids can increase pregnancy complications and delivery risks.
- Anemia due to iron deficiency may result from heavy menstrual bleeding.
- Large fibroids may reduce fertility, although this is rare.
Many women with fibroids choose not to have treatment, especially if they are approaching the age of menopause. Fibroids grow slowly and usually shrink after menopause. Treatment includes various drug and surgical options.
Medications for Fibroids
- Continuous-dosing oral contraceptives can reduce or eliminate menstrual periods.
- Progestin-releasing intrauterine devices can help control excessive menstrual bleeding (menorrhagia). The levonorgestrel-releasing intrauterine system (Mirena) is approved by the Food and Drug Administration (FDA)for treatment of menorrhagia.
- Gonadotropin-releasing hormone (GnRH) agonists reduce estrogen and progesterone levels, which diminishes the size of fibroids.
Surgical Options
Invasive and less-invasive surgical methods include:
- Myomectomy
- Uterine artery embolization
- Endometrial ablation
- Magnetic resonance-guided focused ultrasound (still not commonly available)
- Hysterectomy
Robotic-Assisted Hysterectomy
In 2013, the American College of Obstetricians and Gynecologists (ACOG) released a statement warning patients and doctors about unfounded claims used in advertisements of robotic surgery for hysterectomy. According to ACOG's president, "…there is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives." ACOG recommends vaginal or laparoscopic hysterectomy as the preferred surgical procedures.
A uterine fibroid (known medically as a leiomyoma or myoma) is a noncancerous (benign) growth of smooth muscle and connective tissue. Fibroids can range in size from as small as a pinhead to larger than a melon. Fibroids have been reported weighing more than 20 pounds.
Fibroids originate from the thick wall of the uterus and are categorized by where they grow:
- Intramural fibroids grow within the middle and thickest layer of the uterus (called the myometrium).
- Subserosal fibroids grow out from the thin outer fibrous layer of the uterus (called the serosa). Subserosal can be either stalk-like (pedunculated) or broad-based (sessile).
- Submucosal fibroids grow from the uterine wall toward and into the inner lining of the uterus (the endometrium). Submucosal fibroids can also be stalk-like or broad-based.
The Female Reproductive System
The primary structures in the reproductive system include:
- The uterus is a pear-shaped organ located between the bladder and lower intestine. It consists of two parts, the body and the cervix.
- When a woman is not pregnant the body of the uterus is about the size of a fist, with its walls pressed against each other. During pregnancy the walls of the uterus are pushed apart as the fetus grows.
- The cervix is the lower portion of the uterus. It has a canal opening into the vagina with an opening called the os, which allows menstrual blood to flow out of the uterus into the vagina.
- Leading off each side of the body of the uterus are two tubes known as the fallopian tubes. Near the end of each tube is an ovary.
- Ovaries are egg-producing organs that hold 200,000 - 400,000 follicles (from folliculus, meaning "sack" in Latin). These cellular sacks contain the materials needed to produce ripened eggs, or ova.
The inner lining of the uterus is called the endometrium. During pregnancy this inner lining thickens and becomes enriched with blood vessels to house and support the growing fetus. If pregnancy does not occur, the endometrium is shed as part of the menstrual flow. Menstrual flow also consists of blood and mucus from the cervix and vagina.
Reproductive Hormones. The hypothalamus (an area in the brain) and the pituitary gland regulate the reproductive hormones. The pituitary gland is often referred to as the master gland because of its important role in many vital functions, many of which require hormones.
In women, six key hormones serve as chemical messengers that regulate the reproductive system:
- The hypothalamus first releases the gonadotropin-releasing hormone (GnRH).
- This chemical, in turn, stimulates the pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
- Estrogen, progesterone, and the male hormone testosterone are secreted by the ovaries at the command of FSH and LH and complete the hormonal group necessary for reproductive health.
It is not clear what causes fibroids, but estrogen and progesterone appear to play a role in their growth. Fibroids tend to shrink after menopause, when estrogen levels decline.
Risk Factors
Uterine fibroids are the most common tumor found in female reproductive organs.
Fibroids are most common in womenfrom their 30s through early 50s. (After menopause, fibroids tend to shrink.) About 20 - 40% of women age 35 and older have fibroids of significant enough size to cause symptoms.
Race and Ethnicity
Uterine fibroids are particularly common in African-American women, and these women tend to develop them at a younger age than white women.
Family History
Family history (having a mother or sister who had fibroids) may increase risk.
Other Possible Risk Factors
Obesity and high blood pressure may possibly be associated with increased fibroid risk.
Effect on Fertility
Most fibroids appear to have only a small effect on a woman's fertility. Female infertility is usually due to other factors than fibroids.
Effect on Pregnancy
Fibroids may increase pregnancy complications and delivery risks. These may include:
- Cesarean section delivery
- Breech presentation (baby enters the birth canal upside down with feet or buttocks emerging first)
- Preterm birth
- Placenta previa (placenta covers the cervix)
- Excessive bleeding after giving birth (postpartum hemorrhage)
Anemia due to iron deficiency can develop if fibroids cause excessive bleeding. Oddly enough, smaller fibroids, usually submucosal, are more likely to cause abnormally heavy bleeding than larger ones.
Most cases of anemia are mild and can be treated with dietary changes and iron supplements. However, prolonged and severe anemia that is not treated can cause heart problems.
Urinary Tract Infection
Large fibroids that press against the bladder occasionally result in urinary tract infections. Pressure on the ureters may cause urinary obstruction and kidney damage.
Uterine (Endometrial) Cancer
Fibroids are nearly always noncancerous, even if they contain cells with abnormal shapes. Cancer of the uterus usually develops in the lining of the uterus (endometrial cancer). Only in rare cases (less than 0.1%) does cancer develop from a malignant change in a fibroid (called leiomyosarcoma). Nevertheless, rapidly enlarging fibroids in a premenopausal woman or even slowly enlarging fibroids in a postmenopausal woman need evaluation to rule out cancer.
Many patients with fibroids do not have symptoms. When they do, symptoms may include:
- Heavy Menstrual Bleeding. The most common symptom is prolonged and heavy bleeding during menstruation. This is caused by fibroid growth bordering the uterine cavity. Menstrual periods may also last longer than normal.
- Menstrual Pain. Heavy bleeding and clots can cause severe cramping and pain during menstrual periods.
- Abdominal Pressure and Pain. Large fibroids can cause pressure and pain in the abdomen or lower back that sometimes feels like menstrual cramps
- Abdominal and Uterine Enlargement. As the fibroids grow larger, some women feel them as hard lumps in the lower abdomen. Very large fibroids may give the abdomen the appearance of pregnancy and cause a feeling of heaviness and pressure. In fact, large fibroids are defined by comparing the size of the uterus to the size it would be at specific months during gestation.
- Pain During Intercourse. Fibroids can cause pain during sexual intercourse (dyspareunia).
- Urinary Problems. Large fibroids may press against the bladder and urinary tract and cause frequent urination or the urge to urinate, particularly when a woman is lying down at night. Fibroids pressing on the ureters (the tubes going from the kidneys to the bladder) may obstruct or block the flow of urine.
- Constipation. Fibroid pressure against the rectum can cause constipation.
Pelvic Exam and Medical History
Doctors can detect some fibroids as masses (lumps) during a pelvic exam. During a pelvic exam, the doctor will check for pregnancy-related conditions and other conditions, such as ovarian cysts. The doctor will ask you about your medical history, particularly as it relates to menstrual bleeding patterns. Other causes of abnormal uterine bleeding must also be considered.
Ultrasound is the standard imaging technique for detecting uterine fibroids. The doctor will order transabdominal and transvaginal ultrasounds. Ultrasound is a painless technique that uses sound waves to image the uterus and ovaries. In transabdominal ultrasound, the ultrasound probe is moved over the abdominal area. In transvaginal ultrasound, the probe is inserted into the vagina.
A variation of ultrasound, called hysterosonography, uses ultrasound along with saline (salt water) infused into the uterus to enhance the visualization of the uterus.
Hysteroscopy is a procedure that may be used to detect the presence of fibroids, polyps, or other causes of bleeding. (It may also be used during surgical procedures to remove fibroids.)
Hysteroscopy can be performed in a doctor's office or in a hospital setting. The procedure uses a long flexible tube called a hysteroscope, which is inserted into the vagina and through the cervix to reach the uterus. A fiber-optic light source and a tiny camera in the tube allow the doctor to view the cavity. The uterus is filled with saline or carbon dioxide to inflate the cavity and provide better viewing. This can cause cramping.
Hysteroscopy is non-invasive and does not require incisions; however,some women report severe pain with the procedure. Local, regional, or general anesthesia may be given.
In some cases, laparoscopic surgery may be performed as a diagnostic procedure. Laparoscopy involves inserting a fiber-optic scope into a small incision made near the navel. Whereas hysteroscopy allows the doctor to view inside the uterus, laparoscopy provides a view of the outside of the uterus, including the ovaries, fallopian tubes, and general pelvic area.
Other Tests
In certain cases, the doctor may perform an endometrial biopsy to determine if there are abnormal cells in the lining of the uterus that suggest cancer. Endometrial biopsy can be performed in a doctor's office, with or without anesthesia. Dilation & curettage (D&C) is a more invasive procedure that involves scraping the inside lining of the uterus. It can be used to take tissue samples and also as a procedure to help temporarily reduce heavy menstrual bleeding.
The doctor may also order a complete blood count (CBC) to check for signs of anemia.
Ruling out Other Conditions that Cause Heavy Bleeding
Almost all women, at some time in their reproductive life, experience heavy bleeding during menstrual periods.
A number of conditions can cause or contribute to the risk:
- Menstrual disorders
- Miscarriage
- Having late periods or approaching menopause
- Uterine polyps (small benign growths in the uterus)
- Intrauterine device (IUD)
- Bleeding disorders that impair blood clotting, Von Willebrand disease
- Uterine cancer
- Pelvic infections
- Adenomyosis. This condition occurs when glands from the uterine lining become embedded in the uterine muscle. Its symptoms are nearly identical to fibroids (heavy bleeding and pain).
- Medical conditions, including thyroid problems and systemic lupus erythematosus
- Certain drugs, including anticoagulants and anti-inflammatory medications.
- Often, the cause of heavy bleeding is unknown.
Many women with uterine fibroids do not require treatment. A woman's age and the severity of her symptoms are important factors in considering treatment options.
The three treatment options are:
- Watchful Waiting. A woman may choose to delay having any treatment, particularly if she is close to reaching menopause. Periodic pelvic exams and ultrasounds can help track the progression of her fibroid condition.
- Drug Therapy. Hormonal treatments such as oral contraceptives or a progestin-releasing IUD can help reduce heavy bleeding and pain. Gonadotropin releasing hormone (GnRH) agonists stop ovulation and the production of estrogen, and can reduce fibroid size.
- Surgery. There are many surgical options ranging from less invasive to very invasive. They include removal of the fibroid (myomectomy), removal of the endometrial lining (endometrial ablation), shrinking the blood supply to the fibroid (uterine artery embolization), and removal of the uterus (hysterectomy).
Women should discuss each option with their doctor. Deciding on a particular surgical procedure depends on the location, size, and number of fibroids. Certain procedures affect a woman's fertility and are recommended only for women who are past childbearing age or who do not want to become pregnant. In terms of surgical options, myomectomy is generally the only commonly performed procedure that preserves fertility.
For fibroid pain relief, women can use acetaminophen (Tylenol, generic) or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil, generic) or naproxen (Aleve, generic).
Prescription drug treatment of fibroids uses medicines that block or suppress estrogen, progesterone, or both hormones.
Hormonal Contraceptives
Oral contraceptives (OCs) are sometimes used to control the heavy menstrual bleeding associated with fibroids, but they do notreduce fibroid growth. Newer types of continuous-dosing OCs reduce or eliminate the number of periods a woman has per year.
Intrauterine devices (IUDs) that release progestin can help reduce heavy bleeding. Specifically, the levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena), has shown excellent results. It is approved by the FDA to treat heavy menstrual bleeding. However, the presence of fibroids may cause the IUD to be expelled from the uterus.
GnRH Agonists
Gonadotropin-releasing hormone (GnRH) agonists include the implant goserelin (Zoladex), a monthly injection of leuprolide (Lupron Depot, generic), and the nasal spray nafarelin (Synarel). GnRH agonists block the release of the reproductive hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone). As a result, the ovaries stop ovulating and producing estrogen. Basically, GnRH agonists induce a temporary menopause.
GnRH agonists may be used as drug treatment to shrink fibroids in women who are approaching the age of menopause. They may also be used as a preoperative treatment 3- 4 months before fibroid surgery to reduce fibroid size so that a more minimally invasive surgical procedure can be performed.
Before using these drugs, the doctor should be certain that no other complicating conditions are present, particularly leiomyosarcoma (cancer). The use of these drugs can delay treatment of the malignancy and cause severe complications.
Commonly reported side effects, which can be severe in some women, include menopausal-like symptoms. These symptoms include hot flashes, night sweats, vaginal dryness, weight gain, and depression. The side effects vary in intensity, depending on the GnRH agonist. They may be more intense with leuprolide and persist after the drug has been stopped.
The most important concern is possible osteoporosis from estrogen loss. Women should not take these drugs for more than 6 months.
GnRH treatments used alone do not prevent pregnancy. Furthermore, if a woman becomes pregnant during their use, there is some risk for birth defects.
Surgical Alternatives to Hysterectomy
A myomectomy surgically removes only the fibroids and leaves the uterus intact, which helps preserve fertility. Myomectomy may also help regulate abnormal uterine bleeding caused by fibroids. Not all women are candidates for myomectomy. If the fibroids are numerous or large, myomectomy can become complicated, resulting in increased blood loss. If cancer is found, conversion to a full hysterectomy may be necessary.
To perform a myomectomy, the surgeon may use a standard "open" surgical approach (laparotomy) or less invasive ones (hysteroscopy or laparoscopy).
- Laparotomy. Laparotomy uses a normal abdominal incision and conventional "open" surgery. It is used for subserosal or intramural fibroids that are very large (usually more than 4 inches), that are numerous, or when cancer is suspected. While complete recovery takes less than a week with laparoscopy and hysteroscopy, recovery from a standard abdominal myomectomy takes aslong as 6 - 8 weeks. Open laparotomy poses a higher risk for scarring and blood loss than with the less invasive procedures, a concern for women who want to retain fertility.
- Hysteroscopy. A hysteroscopic myomectomy may be used for submucosal fibroids found in the uterine cavity. With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal. The doctor then uses an electrosurgical wire loop to surgically remove (resect) the fibroid.
- Laparoscopy. Women whose uterus is no larger than it would be at a 6-week pregnancy and who have a small number of subserosal fibroids may be eligible for treatment with laparoscopy. As with hysteroscopy, thin scopes are used that contain surgical and viewing instruments. Laparoscopy requires only tiny incisions, and has a much faster recovery time than laparotomy.
Complications. The risks for myomectomy are generally the same of those for other surgical procedures, including bleeding and infection.
Recurrence of Fibroids. Myomectomy is not necessarily a permanent solution for fibroids. They can recur after these procedures.
Uterine Artery Embolization
Uterine artery embolization (UAE), also called uterine fibroid embolization (UFE), is a relatively new way of treating fibroids. UAE deprives fibroids of their blood supply, causing them to shrink. UAE is a minimally invasive radiology treatment and is technically a nonsurgical therapy. It is much less invasive than hysterectomy and myomectomy, and involves a shorter recovery time than the other procedures. The patient remains conscious, although sedated, during the procedure, which takes around 60 - 90 minutes.
The procedure is typically performed in the following manner:
- The patient receives a sedative to cause drowsiness, and a local anesthetic is applied to the skin around the groin.
- An interventional radiologist makes a small quarter-inch incision in the skin and inserts a catheter (a thin tube) into the femoral artery. The femoral artery is a large artery that begins in the lower abdomen and extends down to the thigh. The radiologist then threads the catheter into the uterine artery.
- Small plastic particles are injected into the artery. These particles block the blood supply to the tiny arteries that feed fibroid cells, and the tissue eventually dies.
- Patients usually stay in the hospital overnight after UAE and are given pain medication. Pelvic cramps are common for the first 24 hours after the procedure.
- It takes 1 - 2 weeks for the patient to recover from the procedure and return to work. It may take several months to several years for the fibroids to completely shrink.
- Most patients have a light, brownish color vaginal discharge for several days following UAE, which may last until the next menstrual cycle. Most women resume regular menstrual cycles within 2 - 3 months of the procedure. Heavy menstrual bleeding reduced by the second or third cycle.
Effect on Fertility. In general, UAE is considered an option for only those who have completed childbearing. The American College of Obstetricians and Gynecologists advises women who wish to have children that it is not yet known how this procedure affects their potential for becoming pregnant. Some evidence indicates UAE may increase the risk for miscarriage in women who do become pregnant.
Complications. UAE has a lower rate of complication than hysterectomy and laparotic myomectomy and a shorter hospital stay. Compared to other procedures, women who have UAE miss fewer days of work. Serious complications occur in fewer than 0.5% of cases. In addition to potential impact on fertility, other postoperative effects may include.
- Pain. Abdominal cramps and pelvic pain after the procedure are nearly universal and may be intense. Pain usually begins soon after the procedure and typically plateaus by 6 hours. The pain usually improves each day over the next several days. A low-grade fever and general malaise are also common in the first week after the procedure.
- Early menopause. Most women who have UAE will continue to have normal menstrual periods. Some women, however, go through menopause after the procedure. Menopause is more likely to occur in women over age 45 who have UAE.
Success Rates. Studies on uterine artery embolization show high patient satisfaction (over 90%) and low complication rates. Menorrhagia symptoms, as well as pelvic pain and urinary symptoms, improve in 85- 95% of patients within 3 months after treatment. Uterine artery embolization is effective formost patients. However, some women may have fibroid recurrence and may need future procedures (repeat embolization or hysterectomy).
Some studies suggest that women with larger single fibroids or larger uteruses are not good candidates for UAE.
Endometrial Ablation
Endometrial ablation destroys the lining of the uterus (the endometrium) and is usually performed to stop heavy menstrual bleeding. It may also be used to treat women with small fibroids. It is not helpful for large fibroids or for fibroids that have grown outside of the interior uterine lining. For most women, this procedure stops the monthly menstrual flow. In some women, menstrual flow is not stopped but is significantly reduced.
Endometrial ablation procedures use some form of heat (radiofrequency, heated fluid, microwave) to destroy the uterine lining. The procedure is typically done on an outpatient basis and can take as few as 10 minutes to perform. Recovery generally takes a few days, although watery or bloody discharge can last for several weeks.
Endometrial ablation significantly decreases the likelihood a woman will become pregnant. However, pregnancy can still occur and this procedure increases the risks of complications, including miscarriage. Women who have this procedure must be committed to not becoming pregnant and to using birth control.
A main concern of endometrial ablation is that it may delay or make it more difficult to diagnose uterine cancer in the future. (Postmenopausal bleeding or irregular vaginal bleeding can be warning signs of uterine cancer.) Women who have endometrial ablation still have a uterus and cervix, and should continue to have recommended Pap smears and pelvic exams.
Magnetic Resonance Guided Focused Ultrasound (MRgFUS)
MRgFUS is a non-invasive procedure that uses high-intensity ultrasound waves to heat and destroy (ablate) uterine fibroids. This "thermal ablation" procedure is performed with a device, the ExAblate, which combines magnetic resonance imaging (MRI) with ultrasound.
During the 3-hour procedure, the patient lies inside an MRI machine. The patient receives a mild sedative to help relax but remains conscious throughout the procedure. The radiologist uses the MRI to target the fibroid tissue and direct the ultrasound beam. The MRI also helps the radiologist monitor the temperature generated by the ultrasound.
MRgFUS is appropriate only for women who have completed childbearing or who do not intend to become pregnant. The procedure cannot treat all types of fibroids. Fibroids that are located near the bowel and bladder, or outside of the imaging area, cannot be treated.
This procedure was approved in 2004, and long-term results are not yet available. Likewise, it requires an extensive period of time involving MRI equipment. Many insurance companies do not pay for this treatment.
Hysterectomy is the surgical removal of the uterus. The ovaries may also be removed, although this is not necessary for fibroid treatment. Hysterectomy is a permanent solution for fibroids, and is an option if other treatments have not worked or are not appropriate.
A woman cannot become pregnant after having a hysterectomy. If the ovaries are removed along with the uterus, hysterectomy causes immediate menopause.
Types of Hysterectomies
Once a decision for a hysterectomy has been made, the patient should discuss with her doctor what will be removed. The common choices are:
- Total hysterectomy (removal of uterus and cervix).
- Subototal, also called supracervical hysterectomy (removal of uterus and preservation of the cervix).
- Oophorectomy (removal of an ovary). Bilateral oopherectomy is the removal of both ovaries. Bilateral salpingo-oophorectomy is the removal of the fallopian tubes and ovaries). These procedures can be performed with either total or supracervical hysterectomy.
Types of Hysterectomy Procedures
Hysterectomy procedures include:
- Total abdominal hysterectomy
- Vaginal hysterectomy
- Laparoscopically assisted vaginal hysterectomy (LAVH)
- Total laparoscopic hysterectomy
- Robotic-assisted hysterectomy
Total Abdominal Hysterectomy. Total abdominal hysterectomy (TAH) has been the traditional procedure. It is an invasive procedure that is is best suited for women with large fibroids, when the ovaries also need to be removed, or when cancer or pelvic disease is present. The surgeon makes a 5-inch to 7-inch incision in the lower part of the belly. The cut may either be vertical, or it may go horizontally across the abdomen, just above the pubic hair (a bikini cut). The bikini cut incision heals faster and is less noticeable than a vertical incision, which is used in more complicated cases. The patient may need to remain in the hospital for 3 - 4 days, and recuperation at home takes about 4 - 6 weeks.
Vaginal Hysterectomy, LAVH, and Total Laparoscopic Hysterectomy. Newer minimally invasive procedures have become the preferred methods for hysterectomy. The American College of Obstetricians and Gynecologists (ACOG) recommends vaginal hysterectomy as the first choice, when possible. Vaginal hysterectomy requires only a vaginal incision through which the uterus is removed. The vaginal incision is closed with stitches.
ACOG recommends laparoscopic hysterectomy as the second choice for minimally invasive procedures. Laparoscopic hysterectomies use a laparoscope to help guide and perform the surgery. The laparoscope is a thin flexible tube through which a tiny video camera and surgical instruments are inserted.
A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy (LAVH). It uses several small abdominal incisions through which the surgeon severs the attachments to the uterus and, if needed, ovaries. In LAVH, the uterus (and ovaries) are then removed through the vaginal incision, as in the standard vaginal approach. In total laparoscopic hysterectomy, they are removed in small pieces through the abdomen.
Vaginal hysterectomy, LAVH, and total laparoscopic hysterectomy have fewer complications, shorter hospital stays, and faster recovery times than abdominal hysterectomy.
Robotic Hysterectomy. Robotic-assisted hysterectomy is a type of laparoscopic hysterectomy, but the surgical instruments are attached to a robot. The surgeon uses a computer console in the operating room to guide the robot's movements. Robotic hysterectomy is much more expensive and complicated than vaginal or traditional laparoscopic hysterectomies, and there is debate on whether it provides equally good outcomes. (There are also safety concerns; the FDA is currently investigating complaints associated with some robotic systems.) ACOG advises that robotic hysterectomy is best suited for complex hysterectomies, such as those required for cancer conditions. Before choosing robotic hysterectomy, it is important to find a surgeon who has extensive training and experience with this technique.
Minor complications after hysterectomy are very common. About half of women develop minor and treatable urinary tract infections. There is usually mild pain and light vaginal bleeding post operation. More serious complications are uncommon but can include infection and blood clots.
Postoperative Care
The patient should ask a family member or friend to help out for the first few days at home. The following are some of the precautions and tips for postoperative care:
- For 1 - 2 days after surgery, the patient is given medications to prevent nausea and painkillers to relieve pain at the incision site.
- As soon as the doctor recommends it, usually within a day of the operation, the patient should get up and walk in order to help prevent pneumonia, reduce the risk of blood-clot formation, and speed recovery.
- Walking and slow, deep breathing exercises may help to relieve gas pains, which can cause major distress for the first few days.
- Coughing can cause pain, which may be reduced by holding a pillow over a surgical abdominal wound or by crossing the legs after vaginal surgery.
- Patients are advised not to lift heavy objects, not to douche or take baths, and not to climb stairs or drive for several weeks.
Patients who have had abdominal hysterectomies should discuss with their doctors when exercise programs more intense than walking can be started. The abdominal muscles are important for supporting the upper body, and recovering strength may take a long time. Even after the wound has healed, the patient may have an on-going feeling of overall weakness, for some time. Some women do not feel completely well for as long as a year while others may recover in only a few weeks.
If a woman has had her cervix removed, she no longer needs annual Pap smears. However, women who have had any type of hysterectomy should continue to receive routine pelvic and breast exams, and mammograms.
Premature Menopause after Hysterectomy
Surgical removal of the ovaries causes immediate menopause. If the ovaries are not removed, they will usually continue to secrete hormones until the natural age of menopause (average age 51 years), even after the uterus is removed. However, sometimes the ovaries stop producing hormones within a few years after hysterectomy. This is referred to as early (or premature) ovarian failure. Doctors are not exactly sure why thiscan occur. Because hysterectomy removes the uterus, a woman will no longer experience menstrual periods, even if she has not become menopausal.
Your doctor may recommend you take hormone replacement therapy (HRT) after your hysterectomy. Women who have had a hysterectomy are given estrogen-only therapy (ET), which may be administered as pills or as a skin patch that releases the hormone into the bloodstream. It can also be given "locally" to treat specific symptoms such as vaginal dryness (see below). Hot flashes and vaginal dryness are the most common menopausal symptoms. Hot flashes are often more severe after surgical menopausethan in menopause that occursnaturally.
Sexuality after Hysterectomy
Sexual intercourse may resume 4 - 6 weeks following surgery. The effect of hysterectomy on sexuality varies among women. Some women notice a change in their orgasmic response because they no longer experience uterine contractions. Other women report increased sexual drive and pleasure because they are free from the problems that prompted hysterectomy.
A vaginal gel or lubricant can help reduce vaginal dryness. Your doctor can also prescribe a low-dose vaginal estrogen treatment, which is applied directly the vagina. Topical vaginal estrogen is available in a cream, tablet, or ring that is inserted into the vagina. .
- www.acog.org -- American College of Obstetricians and Gynecologists
- www.asrm.org -- American Society for Reproductive Medicine
- www.sirweb.org -- Society of Interventional Radiology
- www.radiologyinfo.org -- Radiology info from the American College of Radiology and the Radiological Society of North America
- www.womenshealth.gov -- National Women's Health Information Center
American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008 Aug;112(2 Pt 1):387-400.
American College of Obstetricians and Gynecologists.Statement on Robotic Surgery by ACOG President James T. Breeden, MD. Published March 14, 2013. Accessed August 20, 2013.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Centers for Disease Control and Prevention (CDC), Farr S, Folger SG, Paulen M, et al. U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. MMWR Recomm Rep. 2010 Jun 18;59(RR-4):1-86.
Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007 Jan 25;356(4):360-70.
Evans P, Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician. 2007 May 15;75(10):1503-8.
Goodwin SC, Spies JB. Uterine fibroid embolization. N Engl J Med. 2009 Aug 13;361(7):690-7.
Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2012 May 16;5:CD005073.
Hickey M and Kaunitz AM. Hormonal contraception. In: Melmed S, Polonsky, KS, Larsen PR, and Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. St. Louis, MO: WB Saunders; 2011; chap 18.
Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril. 2010 Jun;94(1):324-30. Epub 2009 Apr 9.
Kaunitz AM. Progestin-releasing intrauterine systems and leiomyoma. Contraception. 2007 Jun;75(6 Suppl):S130-3. Epub 2007 Mar 9.
Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009 May;113(5):1104-16.
Lethaby A, Hickey M, Garry R, Penninx J. Endometrial resection / ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001501.
Moorman PG, Myers ER, Schildkraut JM, Iversen ES, Wang F, Warren N. Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol. 2011 Dec;118(6):1271-9.
Moss J, Cooper K, Khaund A, Murray L, Murray G, Wu O, et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 2011 Jul;118(8):936-944. doi: 10.1111/j.1471-0528.2011.02952.x. Epub 2011 Apr 12.
Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD003677.
[No authors listed] ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18.
Parker WH, Broder MS, Chang E, Feskanich D, Farquhar C, Liu Z, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study. Obstet Gynecol. 2009 May;113(5):1027-37.
Perera HK, Ananth CV, Richards CA, Neugut AI, Lewin SN, Lu YS, et al. Variation in ovarian conservation in women undergoing hysterectomy for benign indications. Obstet Gynecol. 2013 Apr;121(4):717-26.
Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF;Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomas. J Vasc Interv Radiol. 2010 Aug;21(8):1153-63. Epub 2010 Jun 16.
Stout MJ, Odibo AO, Graseck AS, Macones GA, Crane JP, Cahill AG. Leiomyomas at routine second-trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol. 2010 Nov;116(5):1056-63.
Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009 Jan 7;301(1):82-93. Epub 2008 Dec 2.
van der Kooij SM, Bipat S, Hehenkamp WJ, Ankum WM, Reekers JA. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011 Oct;205(4):317.e1-18. Epub 2011 Mar 16.
Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI, et al. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA. 2013 Feb 20;309(7):689-98.
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Reviewed By: Reviewed by Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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text:
Washington : Government Printing Office
|Public Law 89-689
|Public Works Appropriation Act, 1967.
|Public Law 89-689
|Public Law 89-689
|Public Law 89-689
|16 U. S. C. 661 note.
Page 1074
Be it enacted by the Senate and House of Representatives of the
Page 1075
United States of America in Congress assembled, That the following sums are appropriated, out of any money in the Treasury not otherwise appropriated, for the fiscal year ending June 30, 1967, for certain civil functions administered by the Department of Defense, the Panama Canal, certain agencies of the Department of the Interior, the Atomic Energy Commission, the Atlantic-Pacific Interoceanic Canal Study Commission, the Delaware River Basin Commission, the Saint Lawrence Seaway Development Corporation, the Tennessee Valley Authority, and the Water Resources Council, and for other purposes, namely:
For engineering and economic investigations of proposed Federal reclamation projects and studies of water conservation and development plans and activities preliminary to the reconstruction, rehabilitation, and betterment, financial adjustment, or extension of existing projects, including not to exceed $450,000 for investigations of projects in Alaska, to remain available until expended, $15,075,000, of which $13,473,000 shall be derived from the reclamation fund and $500,000 shall be derived from the Colorado River development fund: Provided, That none of this appropriation shall be used for more than one-half of the cost of an investigation requested by a State, municipality, or other interest: Provided further, That not to exceed $35,000 of this appropriation shall be available for payment to the Salt River Pima-Maricopa and Ft. McDowell Indian tribes for economic studies in connection with the potential construction of Orme Dam on the Salt River in Arizona: Provided further, That $425,000 of this appropriation shall be transferred to the Bureau of Sport Fisheries and Wildlife for studies, investigations, and reports thereon as required by the Fish and Wildlife Coordination Act of 1958 (72 Stat. 563-565) to provide that wildlife conservation shall receive equal consideration and be coordinated with other features of water-resource development programs of the Bureau of Reclamation.
Approved, October 15, 1966.


text: James Cromwell partnered up with PETA and their spokesperson Jeremy Beckham and busted into a board meeting at UW-Madison. The two entered the meeting shouting and holding up signs to protest the torture of cats at the University Of Wisconsin. Apparently the university kills up to 30 cats a year in an effort to improve hearing for those who are deaf. The people meeting in the board room didn't even seem to care and the police were there a minute later. Cromwell, who was nominated for an Academy Award for Babe will be charged with disorderly conduct.


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Coffee Makers
Commercial Coffee Makers
If you measure your coffee consumption in gallons rather than one ounce shots, then you are in the right place! We stock high quality products from BUNN and also Curtis, industry leading manufacturers that provide a full range of commercial coffee makers and grinders for every application. Whether your rush is in the morning, noon or night, these coffee makers continually churn coffee into the urn. From 60 to a whopping 302 cups of coffee per hour, you can have quantity and quality to please your patrons.
BUNN BrewWISE Dual TF DBC Commercial Coffee BrewerInstead of brewing pot after pot of coffee to satisfy peak demand, sometimes don't you wish you could just tap a keg of fresh brewed coffee? The BUNN BrewWise Dual TF DBC Commercial Coffee Maker is one Big Mama Jama. Capable of filling a bathtub with coffee in less than four hours. Just in case you need to fill a bathtub with coffee. Not that we do that around here, no sir, not recommended (it goes cold too fast!) Brew what you need when you need it with 1/2 gallon, 1 gallon, or 1.5 gallon batches. Learn More$2,099.00
BUNN 1.5 Gallon ThermoFresh ServerEven here at our place on Monday morning there can be a line queuing for coffee. Someone usually daydreams aloud about brewing directly into their mouth. Skip the line, and the scalded mouth, by having plenty of coffee on-hand with the BUNN 1.5 gallon ThermoFersh server. It has a visible gauge so you know when you are running low. Purchase more than one as insurance to never have to wait for a batch to brew. Learn More$299.00
Curtis D500GT Single Airpot BrewerNo more burnt coffee! The Curtis D500GT DV Single Airpot Commercial Coffee Brewer brews prevents scorch and waste. Brewing into the thermal airpot keeps the coffee at an ideal temperature without having to use an additional heat source that can change the coffee flavor profile for the worse. This highly programmable unit also provides flexibility for whole and half batches. Learn More$625.00
Curtis D1000GT Twin Airpot BrewerThe Curtis D1000GT Twin Airpot Brewer allows for double capacity with the added benefit of two separate brew heads for added flexibility. Decaf and Regular! Light Roasts and Dark Roasts! Columbian and Ethiopian! All residing side-by-side in harmony. Please your customers with ease. Have time left over to play coffee trivia? Milk as an additive to coffee became popular in the 1680's, when a French physician recommended that cafe au lait be used for medicinal purposes. Now you know! Learn More$1,225.00
Curtis G3 TP15S Single Airpot BrewerCoffee is the most popular beverage worldwide with over 400 billion cups consumed each year. Add to the tally with this dependable, programmable Curtis TP15S G3 Airpot Brewer. A steady medium flow will produce up to 1.5 gallons per hour, about 99-182 cups. Also available in a Twin configuration for double the capacity and brewing selection. Learn More$1,625.00
Curtis G3 TP15T Twin ThermoPro BrewerWhen Gulliver landed on the shores of Brobdingnag they shouted, 'Go Big! Or Go Home!' and so his travels continued. Travel no further in search of a colossal coffee maker, the Curtis TP15T Twin ThermoPro Brewer can make up to 302 cups of coffee per hour. Twin servers keep brewed coffee ready to serve plenty of venti-coffee loving average or giant-sized customers. Each ThermoPro holds up to 1.5 gallons each, three ginormous gallons total. Learn More$2,425.00
Curtis G4 CGC Single Cup BrewerIf the Curtis G4 CGC Single Cup had expressive eyes and was on a wheelbase it would look a lot like a coffee making co-worker of Wall-E. Smart technology goes from fresh whole bean to cup in no time flat. Skip paper pods and plastic coffee capsules and still get one cup convenience with "real" coffee from the Curtis G4 CGC. Learn More$1,212.99
Curtis G4 TP15T Twin ThermoPro BrewerA G6 is a Gulfstream business jet with a top speed of Mach 0.925. The Curtis G4 is the equivalent in the coffee making world, capable of a top speed of up to 302 cups of coffee per hour. A 4.3" touch screen controls the hot brewing action. Twin servers keep brewed coffee ready to serve jet-setters and homebodies alike. Learn More$2,500.00
Curtis ThermoPro 2.2 liter Lever Airpot with Glass LinerWhat's the difference between Curtis ThermoPro lever Airpots you ask? Well! Glass is a better insulator than stainless steel so to keep fresh brewed coffee hot longer, a glass lined carafe is recommended. Also there is a possibility that stainless steel liners can alter the flavor profile of your gourmet coffee. The flip side is a glass lined carafe could potentially break if dropped. High volume lever fills most single cups in one stroke. Learn More$40.00
Curtis ThermoPro 2.2 liter Lever Airpot with Stainless Steel LinerWhat's the story morning glory? Stock up on ThermoPro airpots to satisfy the morning masses and the nighthawk demand. Unbreakable stainless steel lined 2.2 liter capacity thermal servers have compatible brew through lids for Curtis coffee makers. High volume lever fills most single cups in one stroke. Learn More$50.00


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CLAREMONT - Occupy Claremont continues to live on.
The group appeared at a City Council meeting this month in support of a request for banking proposals to evaluate the city's banking services and determine what bank is best-suited for Claremont government.
The local organization was especially active last year, when it attempted to make changes in city government.
"Our hope is this will move from the big banks to a community or regional bank," said Occupy Claremont member Terry Donnelly, who supported the measure at the council meeting.
The proposals are intended to gather information from banks about social responsibility, said Adam Pirrie, the city's finance director, at the meeting.
The city wants to find out about:
"Pricing, while important, will not be the primary factor in staff's recommendation," Pirrie said, adding that "reinvestment" and other criteria will be used to evaluate the proposals.
Banks that are interested must return their proposals to the city by Jan. 28, and the bid will be awarded to the successful bank on March 12, Pirrie said.
Mayor Larry Schroeder thanked Pirrie and city staff at the meeting for "being sensitive to the community's desire to see this brought before the public."
On Friday, Donnelly added that the item "gives smaller banks a real shot" at serving the city instead of Bank of America because the smaller institutions "should do much better" in meeting the proposal's social criteria.
But Donnelly admitted he did not know if regional and community banks will submit a proposal to serve Claremont.
"We're (just) trying to find ways for those banks to apply," Donnelly said.
The next Occupy Claremont meeting will take place from 2 to 3 p.m. Jan. 13 in front of City Hall, 207 N. Harvard Ave.
Occupy Claremont's Charles Bayer said the request for banking proposals is not the only item the group has been working on.
He is a coordinator of a program at the Services Center for Independent Living that helps homeless people get services. The center is on South Spring Street.
He added that the Occupy movement has not stopped.
"What Occupy did is plant the seeds," Bayer said. "Now there's plants that have grown up under that soil that are the direct descent of Occupy, but it doesn't look like Occupy because we don't have tents on someone's porch.
"We're much more aligned with dealing with problems. Some of the criticism of Occupy is that it had no agenda other than itself. In Claremont, it has to do with banking, foreclosure and the homeless. That's what's going on this community."
Reach Wes at via email, call him at 909-483-8549, or find him on Twitter @ClaremontNow.


text: Polyethylene is a thermoplastic polymer consisting of long chains produced by combining the ingredient monomer ethylene (IUPAC name ethene), the name comes from the ingredient and not the actual chemical resulting. The ethylene actually converts to ethane as it takes its place in a polymer and straight sections of the polymer are the same structure as the simple chain hydrocarbons, e.g., propane, decane and other straight single-bonded carbon chains. As with any polymer, the structure of the resulting substance defies molecular description due to cross branching of the chains.


text: 'The Sharks have been seeking to ease Suter's workload because the 37-year-old has had arthroscopic knee surgery during the past two seasons. "I certainly don't want to take any games off as long as the knees are doing good," Suter said. "When we discussed it earlier, it's more about getting rest between games."'


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Engineers study bridges in effort to save them
Thousands of bridges are approaching the end of their structural life, but University of South Carolina engineers are teaming up with other national researchers to help save them.
Their research, which is the focus of a major national study, includes designing a bridge monitoring system.
Posted: 07/20/09 @ 4:00 PM | Updated: 10/26/09 @ 3:17 PM | Permalink


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Workforce Legislation Hastily Advances in House and Threatens Access to Youth Jobs
Apr 05, 2013
By Kisha Bird
Over the past six weeks, the House Education and Workforce Committee saw a flurry of activity related to the reauthorization of the Workforce Investment Act (WIA) and efforts to reform the nation's job training and education system. The Workforce Investment Act of 1998 has been up for reauthorization for the past ten years. There have been several attempts since 2003 to advance legislation, but efforts have been repeatedly stalled. And unfortunately, while it is good that Congress has expressed renewed interest in reauthorization, the current bill passed by the House would actually reduce access to job training and education for the nation's most vulnerable youth.
Here are the events that transpired.
In late February, Virginia Foxx, majority chairwoman of the Subcommittee on Higher Education and Workforce, held a hearing,"Putting America Back to Work: Reforming the Nation's Workforce Investment System," which discussed key features of H.R. 803-theSupporting Knowledge and Investing in Lifelong Skills Act (SKILLS Act).
A week later, the committee held its mark-up of the Skills Act. Tensions ran high, as Democrats requested more time to develop bipartisan proposals and to resolve disagreements. On March 6, dissatisfied with the mark-up process, every democratic committee member walked out in protest.. As expected, the bill passed out of committee following a party-line vote and advanced to the floor of the House. And on March 15, the SKILLS Act passed out of the full House of Representatives-again along party lines (215-202).
The Skills Act would consolidate nearly three dozen federal programs into a block grant called the Workforce Investment Fund. Like H.R. 4297, which cleared the committee in 2012, it would eliminate a separate youth funding stream, strike WIA youth provisions (including the 10 youth program elements), and establish a new set of common performance metrics without any youth-specific indicators. It would also create an option for states to consolidate additional education and training programs, such as adult education, into the block grant.
Conversely, the House Minority introduced its own reauthorization bill,H.R. 798, which would require states to streamline and coordinate the use of workforce and education programs through unified planning. It would expand the range of training options available for participants, expand priority of service for out-of-school youth and individuals with barriers to employment, take steps to improve cumbersome eligibility requirements that hinder service to youth, and modernize the adult education system to meet the postsecondary and employment needs of students. The bill would also authorize Innovation Funds to support the development and expansion of promising workforce strategies, such as career pathways, industry partnerships, and dropout recovery and re-engagement.
What does this mean for youth?
The SKILLS Act would eliminate $1 billion dedicated to youth employment and training services. This follows $1 billion in cuts already made to youth deployment and training over the last decade. This bill would be a big step backward for an already struggling economy. The unemployment rate for young people 16-24 is at an all-time high, with 6.7 million youth not in school or not working andjust 12 percent of all black male teens employed. Current WIA youth programs reach approximately 235,000 low-income young people across the nation and link them to a wide array services-including summer and year-round employment, job training, and apprenticeship programs that help them earn secondary and postsecondary credentials and advance in the labor market.
The next step in the reauthorization process is for a bill to emerge from Senate Committee on Health, Education, Labor, and Pensions (HELP). While it is not certain where this stands, we are hopeful Senate leaders will craft a bi-partisan WIA reauthorization bill that preserves dedicated youth funding and advances best practices to serve disadvantaged and disconnected youth.


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