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Research & Innovation
Smithsonian scientists compare environmental impacts of biofuels
Panama City, Panama -- Biofuels reduce greenhouse-gas emissions in comparison to fossil fuels. However, biofuels ma...
January 8, 2008 By Pulp & Paper Canada
Panama City, Panama — Biofuels reduce greenhouse-gas emissions in comparison to fossil fuels. However, biofuels may not be superior if their production results in environmental destruction, pollution and damage to human health, argue postdoctoral fellow Jrn Scharlemann and William Laurance, staff scientist at the Smithsonian Tropical Research Institute.
In the Jan. 4 issue of the journal Science, Smithsonian researchers highlight a new study that factors in environmental costs of biofuel production. Corn, soy and sugarcane come up short. The authors urge governments to be far more selective about which biofuels they support, as not all are more environmentally friendly than fossil fuels.
A new study by Zah et al., commissioned by the Swiss government, calculates the relative merits of 26 biofuels based on relative reduction of greenhouse-gas emissions and an environmental-impact index, which includes damages to human health and ecosystems and natural resource depletion. It identifies striking differences in the environmental costs of different biofuels. Fuels made from U.S. corn, Brazilian soy and Malaysian palm oil may be worse overall than fossil fuels. The best alternatives include biofuels from residual products, such as recycled cooking oil and ethanol from grass or wood.
The Zah et al. study falls short in that it fails to consider secondary consequences of biofuels, such as rising food costs, but it is a big step forward in providing a way to compare the environmental benefits and costs of dozens of different biofuels.
"Different biofuels vary enormously in how eco-friendly they are," said Laurance. "We need to be smart and promote the right biofuels, or we wont be helping the environment much at all."
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Characteristics of the natural fire regime are poorly resolved in the Arctic, even though fire may play an important role cycling carbon stored in tundra vegetation and soils to the atmosphere. In the course of studying vegetation and permafrost-...
Alaska Reference Database
The Alaska Reference Database originated as the standalone Alaska Fire Effects Reference Database, a ProCite reference database maintained by former BLM-Alaska Fire Service Fire Ecologist Randi Jandt. It was expanded under a Joint Fire Science Program grant for the FIREHouse project (The Northwest and Alaska Fire Research Clearinghouse). It is now maintained by the Alaska Fire Science Consortium and FRAMES, and is hosted through the FRAMES Resource Catalog. The database provides a listing of fire research publications relevant to Alaska and a venue for sharing unpublished agency reports and works in progress that are not normally found in the published literature.
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Stress urinary incontinence, urge incontinence, mixed incontinence, overflow incontinence
1. What every clinician should know
Urinary incontinence, or the loss of bladder control, is a common condition and has been reported in up to 43% of women aged 37-54. The two phases of the bladder function include filling phase and emptying phase. When these functions are disrupted in women incontinence can occur. During the filling phase, the sympathetic system (via beta adrenergic receptors) inhibits the parasympathetic activity and helps in bladder filling without rise in detrusor pressure. The external urethral sphincter and levator ani muscle are under the influence of the pudendal nerve and sacral efferent nerves during the filling phase.
During the emptying phase, inhibition of pudendal and sacral efferents relaxes the external urethral sphincter and levator. Posterior slackening of the fascial hammock and rotational descent of the bladder neck occur. The cerebral cortex inhibits sympathetic relaxation of the bladder. The urethra shortens which lowers resistance to flow. Parasympathetic cholinergic receptors in detrusor stimulates bladder contraction.
Diagnostic definitions
Stress incontinence
This is the involuntary immediate loss of urine when the intravesical pressure is higher than urethral pressure. In other words, the loss of urine with activities such as coughing, laughing, exercising, etc. These patients generally have no associated irritating voiding symptoms. The prevalence of stress urinary incontinence in women aged 25-84 is 15%.
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Intrinsic sphincter deficiency (ISD) is a severe form of stress urinary incontinence confirmed on urodynamic testing. Many clinicians use a Valsalva or cough leak point pressure below 60 cm of H20 and/or maximum urethral closure pressure of <= 20 cm of H2O to confirm the diagnosis of ISD. The definitions and clinical consequences of this diagnosis are not well established.
Urge incontinence
Often referred to as overactive bladder-wet, this is the loss of urine due to an uninhibited detrusor contraction usually preceded by a strong urge to void. In other words, patients get the urge to void and have an accident before they can get to a commode. These patients also have many irritating voiding symptoms, such as frequency, urgency and nocturia. Urge incontinence can be associated with abnormalities of the nervous system but is generally idiopathic in its etiology and the prevalence of overactive bladder in women aged 25-84 years is 13%.
Mixed urinary incontinence
This is a combination of stress and urge urinary incontinence. It has been estimated that 29%-62% of women with urinary incontinence have mixed urinary incontinence.
Overflow incontinence
This occurs with urinary retention and overdistention of the bladder leading to intravesical pressure higher than maximal urethral closure pressure. These patients often have symptoms of spontaneous or continuous leaking but can have stress incontinence type symptoms. Chronic urinary retention can occur from injury to sacral portion of the spinal cord or nerves within the cauda equina. Diabetes is also a common cause of an overflow incontinence due to peripheral neuropathy and a paralytic bladder.
Risk factors that are common to both stress and urge incontinence are:
- Age
- Obesity
- Family history
- Diabetes
- Hormone replacement therapy (systemic)
Risk factors for stress urinary incontinence:
- History of childbirth
- Vaginal delivery
- History of hysterectomy
- Caucasian vs. Black women
Risk factors for urge incontinence:
- Older age
- Diabetes mellitus
- Two or more urinary tract infections in previous year
- High caffeine intake
- Smoking
- Black vs. Caucasian women
2. Diagnosis and differential diagnosis
History can aid with the diagnosis of incontinence type but will be incorrect in up to 25% of women. Clinical history of urinary frequency and urgency preceding an incontinence episode has 61% sensitivity for diagnosing urge incontinence.Clinical history of only leaking with associated activity (i.e., cough, sneeze, etc.) is 92% sensitive and 56% specific for diagnosing urodynamic stress incontinence in women.
A clinical history similar to stress incontinence but with an inability to empty the bladder without strain is a common symptom complex for diagnosing overflow incontinence. These subjects will generally have an associated disease state such as chronic illness that can result in an autonomic neuropathy, an obvious neuropathic condition, or a history of urinary obstruction following reconstructive surgery. A clinical history of continuous leaking is commonly associated with a fistula.
Diagnostic testing (urodynamics) should be performed in all subjects who fail a trial of conservative therapy or in anyone contemplating surgical correction. The "Gold Standard" for diagnosing stress urinary incontinence is objective evidence of leaking of urine with increase in intra abdominal pressure (coughing or valsalva maneuvers) during urodynamic testing. This can be a simple cough stress test where the patients bladder is retrograde filled through a red rubber catheter to at least 150 cc's and visually demonstrating gross urine leak per the urethra during a cough or Valsalva.
Complex multichannel urodynamic testing can also demonstrate stress incontinence but is not necessary in the routine (surgically naive) patient. Intrinsic sphincter deficiency requires complex multichannel urodynamics to diagnose. However, the clinical utility of making this diagnosis and its impact on clinical decision making has not been rigorously determined.
See Figure 1. Patient with indigo carmine-stained urine and positive urine stress test.
Urge incontinence is diagnosed based on patients symptoms, after eliminating other conditions. A cystometrogram demonstrating uninhibited detrusor contractions during the filling phase of the test is confirmatory, but will not be demonstrated in up to 50% of subjects eventually diagnosed with urge incontinence. A cystometrogram that can document bladder capacity which if very small (less than 250 cc's) should warrant referral to a specialist (either urologist or urogynecologist).
Overflow incontinence can be easily diagnosed with obtaining a Post Void Residual (a simple In and Out catheterization following a spontaneous void). A post void residual of greater then 300-800 cc's would make the diagnosis of overflow incontinence. A post void residual of less than 100 cc's is considered normal. Values in between present a diagnostic dilemma.
Differential diagnosis for urinary incontinence include urinary tract fistula, ectopic ureter and heavy vaginal secretions. Depending on the clinical scenario, the patient may need work up to exclude genitourinary fistula. This may include IVP or CT urogram and cystourethroscopy. A pyridium (or any agent that can stain urine) pad test can be used to rule out vaginal secretions that may mimic urinary incontinence.
Conditions that can be associated with urinary incontinence include:
- Dementia
- Urogenital atrophy
- Restricted mobility
- Urinary tract infection
- Pharmacologic agent side effects (particularly alpha blockers)
- Endocrine causes (polyuria)
- Stool impaction
- Urinary retention
3. Management
Management of stress urinary incontinence
Conservative/behavioral measures
Weight loss of 5-10% may result in up to 60% reduction in weekly incontinence episodes. Fluid restriction to 0.75L/ day is associated with significantly lower number of incontinence episodes. Continence pessaries are safe, inexpensive, and may be appealing to some women, but in randomized controlled trials, they have been shown to be inferior to physical therapy.
Kegel's exercises or pelvic floor muscle rehabilitation involves contraction of the levator ani muscles in a set number of repetitions done on a daily basis. They are commonly recommended for stress or urge incontinence. The thought is that by strengthening the pelvic floor and urethral sphincter you can correct the defect causing stress incontinence and for urge incontinence the patient can hold the urethra closed by a levator /urethral sphincter contraction during the uninhibited detrusor contraction until it abates or the patient reaches a commode.
Kegel's exercises improve incontinence in about 50% of subjects treated but often relief is short lived. Clinicians have augmented Kegel's exercises by using weighted vaginal cones to increase resistance as well as using electrical stimulation to either augment contractions or help the patient with very weak levator ani muscles who is unable to contract her pelvic floor muscles.
In randomized controlled trials, comparing the effectiveness of conservative/behavioral measures to various combinations conservative/behavioral therapies, there were no clinically significant differences in single-modality or combination therapy at 12 months and beyond. Conservative/behavioral therapy is well tolerated, non-invasive and results in resolution of bothersome symptoms and treatment satisfaction in 49-75% of subjects.
This has an interesting relationship to incontinence. Incontinence incidence increases with use of systemic estrogens compared with placebo (risk ratio [RR] 1.32, 95% CI 1.17-1.48) in analysis of 6 trials.Conversely there is a significant improvement in incontinence symptoms with topical/vaginal estrogens compared with placebo (RR 0.74, 95% CI 0.64-0.86)
This is a tricyclic antidepressant that has anticholinergic, beta and alpha-2 agonistic properties.It has been proposed that imipramine induces norepinephrine reuptake inhibition, which might suppress detrusor activity, in addition it may increase the resting tone of smooth muscle cells in the bladder neck from alpha adrenergic stimulation. In the treatment of stress urinary incontinence with imipramine, although success rates of up to 70% have been reported, a review of literature suggests overall low efficacy. It has been recommended that imipramine be used for milder forms of stress incontinence and in patients who are not candidates for surgery.
This blocks reuptake of serotonin and norepinephrine. Duloxetinetreatment can significantly improve the quality of life of patients with stress urinary incontinence, but it is unclear whether or not benefits are sustainable. Approximately 33% of participants in clinical trials allocated duloxetine reported adverse effects (most commonly nausea) related to treatment. Approximately 10% allocated duloxetine stopped treatment as a consequence.
Periurethral bulking agents
These are injectable agents that bulk the bladder neck and bring about a modest mechanical obstruction much like early prostativc hypertrophy. Results of a recent Cochrane review (12 randomized or quasi-randomized trials) include two trials that found bulking agents similar to standard anti-incontinence surgery with respect to subjective improvement. Surgery out performed bulking agents for objective improvement.
Eight comparison trials found similar outcomes with all injectable agents, but results had wide confidence intervals. Another trial found transurethral injection associated with fewer early complications than periurethral injection. No studies compared injection therapy to conservative treatment. Overall, injectable therapy may be beneficial in subjects who are poor surgical candidates or in subjects with good urethrovessical junction who do not respond as well to mid-urethral sling surgery.
In evaluating surgical outcomes, both subjective outcomes (patient reported outcomes of via quality of life questionnaires) and objective outcomes are reported. The relative importance of either type of outcome is debatable.
Burch colposuspension
A Cochorane review of 46 randomized or quasi-randomized trials found that open retropubic colposuspension is an effective treatment modality for stress urinary incontinence, especially in the long term. Overall cure rates are 68.9% to 88.0%.After five years, approximately 70% of patients can expect to be dry. Laparoscopic colposuspension should allow speedier recovery but its relative safety and effectiveness are not known yet.
Minimally invasive synthetic midurethral sling procedures
A synthetic polypropelene sling is placed under the mid urethra using needles passed in one of two trajectories, either retropubic (referred to as TVT) or transobtruator (referred to as TOT).They are termed minimally invasive because they involve two small incisions in the skin and one small vaginal incision beneath the urethra. The retropubic approach can involve needles passed from the suprapubic area down through the vaginal incision (top down) or from the vaginal incision up through the skin (bottom up). The transobtruator approach can involve needles passed from the groin skin incision out through the vaginal incision (outside in) or from the vaginal incision out through. The sling is not attached to any structures and is left loose under the mid urethra.
A Cochrane review of 62 randomized and quasi-randomized trials evaluating minimally invasive synthetic midurethral slings found there was no significant difference in subjective cure rate at 12 months comparing midurethral slings with traditional slings open Burch colposuspension or laparoscopic Burch colposuspension. Suburethral slings are associated with fewer intra- or post-operative complications compared to other methods, except for more bladder perforations compared to open retropubic colposuspension. Retropubic bottom-to-top route significantly more effective than top-to-bottom route (RR 1.10, 95% CI 1.01 to 1.20) with less voiding dysfunction, bladder perforations and tape erosions (RR 1.06, 95% CI 1.01 to 1.11).
Significantly higher objective cure rates (RR 1.15, 95% CI 1.02 to 1.30) with fewer tape erosions (RR 0.25, 95% CI 0.06 to 1.00) with monofilament tapes compared with multifilament tapes. The retropubic route was associated with similar subjective cure rates but significantly higher objective cure rate and more perioperative complications compared with transobturator route (RR 0.96, 95% CI 0.93 to 0.99). The trans-obturator sling was associated with less voiding dysfunction, blood loss, bladder perforation (RR 0.14, 95% CI 0.07 to 0.26) and shorter operating time.
See Figure 2. Tension-free vaginal tape used for stress urinary incontinence.
Autologous fascial sling
This procedure involves using autologous fascia harvested from the rectus fascia or the fascia lata. The sling is passed through the retropubic space and placed under the bladder neck. Unlike the midurethral slings the fasccial sling is placed snug under the bladder neck and attached to the rectusfascia. Success rates are higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P<0.001). More women who underwent the sling procedure experienced difficulty voiding (6.1% vs. 0.0%).
There is insufficient data to comment on newer midurethral slings or mini slings.
Retropubic vs. transobturator synthetic slings
The rates of objective treatment success were 80.8% in the retropubic-sling group and 77.7% in the transobturator-sling group (3.0 percentage-point difference, 95% confidence interval [CI], -3.6 to 9.6).The rates of subjective treatment success were 62.2% in the retropubic-sling group and 55.8% in the trans-obtruator sling group (6.4percentage-point difference, 95% CI, -1.6 to 14.3). The rates of voiding dysfunction requiring surgery were 2.7% in those who received retropubic slings and 0.0% in those who received transobturator slings(P=0.004). There were no significant differences between groups in postoperative urge incontinence, patient satisfaction with the results of the procedure, or quality of life.
Postoperative recurrent urodynamic stress incontinence at six months was 21% (TVT Group) vs.45% (TOT Group)(p = 0.004).The requirement for repeat sling surgery in those with symptomatic urodynamic stress incontinence was 0.0% in the TVT Group vs. 12.7% in the TOT Group (p =0.003). There was no significant difference in hospital length of stay or postoperative complications among groups. Retropubic slings are preferred over transobturator slings in during intrinsic sphincter deficiency and recurrent stress urinary incontinence.
Intraoperative complications of retropubic mid urethral sling procedures include:
- Bladderperforation: 0.7-24%
- Hemorrhage:0.7-8%
- Bowelperforation <1%
- De novourgency and obstruction: 5.9-25%
- Erosion intourethra: 0.3%
- Groin and thigh pain is more common in patients who undergo a transobturator approach (OR 8.8, 95%CI: 2.6-29.5)
Bulking agents
Carbon coated zirconium oxide (Durasphere ®) (second-generation injectable bulking agent)
FDA approved for adult women with stress urinary incontinence due to intrinsic sphincter deficiency. At one year follow up, it is associated with up to 80% cure rate for treating stress urinary incontinence associated with intrinsic sphincter deficiency.
Calcium hydroxyaptite (CaHA) (Coaptite ®)
No systemic adverse events were observed with this product. At one year there was improvement of 60% with either agent. Subjects generally required fewer injections with CaHA then Collagen.
Silicone microimplants (Macroplastique ®)
Safe and effective at a median of 58 month follow up. It is associated with an overall subjective cure rate of 80%.
Management of urgent urinary incontinence
Conservative measures
Weight loss and diet changes are two ways to manage this incontinence. A 16% reduction in weight can result in 70% reduction in urge incontinence episodes. Fluid restriction to 0.75L/ day is associated with significantly decreased voiding frequency, urgency, and wetting episodes with improved quality of life.
Biofeedback, including timed voids, relaxation techniques, pelvic floor muscle rehabilitation, and avoidance of certain dietary irritants is another technique. Behavioral treatment yielded a mean of 80.7% reduction of incontinence episodes and was significantly more effective than drug treatment (mean 68.5% reduction, P=.04) and both were more effective than the placebo control condition (mean 39.4% reduction, P<.001 and P=.009, respectively). Patient-perceived improvement was greatest for behavioral treatment (74.1% "much better" vs. 50.9% and 26.9% for drug treatment and placebo, respectively). Only 14.0% of patients receiving behavioral treatment wanted to change to another treatment vs. 75.5% in each of the other groups.
In a randomized controlled trial that tested whether individualized drug therapy (extended release oxybutynin) enhanced with behavioral training would result in better outcomes than individualized drug therapy alone, there were no significant differences in frequency of incontinence, patient satisfaction or global perception of improvement at 6 and 12 months.
Anticholinergic drugs: Oxybutynin, Tolterodine, Fesoterodine, Trospium, Solafenacin, Darifenacin
Several head-to-head trials involving the various medications have shown only modest differences favoring one drug over another. Most differences were inside-effects, rather than any major outcome criteria (incontinent episodes, number of micturitions, nocturia). The clinical significance of these differences is debatable.
Tricyclic antidepressant, anticholinergenic, and alpha agonist properties. Success rate of up to 90% in treating urge incontinence reported. The fluctuating nature of urge incontinence together with poor study design and conflicting results obtained in trials makes drawing definitive conclusions difficult. Imipramine can be used inpatients with mixed incontinence.
Hormone replacement
Estrogen therapy may be effective in alleviating the symptoms suggestive of OAB. Local administration (Topical) may be the most beneficial route of administration.
Botulinum toxin A intravesical injections
There is superiority of botulinum toxin A to placebo in such outcomes as incontinence episodes, bladder capacity, maximum detrus or pressure, and quality of life. Botulinum toxin appeared to have beneficial effects in overactive bladder that quantitatively exceeded the effects of intravesical resiniferatoxin. Botulinum toxin intravesical injections are associated with increased risk of elevated post void residual.
Sacral neuromodulation (SNS)
InterStim® is an FDA approved implantable device that provides electrical stimulation to the sacral nerve. The exact mechanism of action SNS is unknown. It is indicated for patients with urge incontinence, urgency-frequency syndrome or urinary retention who have failed more conservative treatments. A review of SNS suggest that after five years, 63% urge incontinent patients have at least a 50% reduction in leaking episodes per day, after four years, 53% urgency-frequency patients have at least a 50% reduction in voids per day, and after one year, 53% of 19 non-obstructive urinary retention patients have at least a 50% reduction in catheterized urinary volumes.
Factors associated with poor response to SNS are:
- Poor mobility and requirement of a wheelchair
- Age greater than 55
- Presence of three or more chronic medical conditions
- Intra- vertebral disk disease
- Duration of complaints of greater than seven months
In patients with non-obstructive urinary retention (which can cause overflow incontinence), predictors of success with SNS include hypertonic pelvic floor dysfunction (Fowler syndrome).This condition is associated with elevated urethral pressure profile.
Limited evidence suggests that acupuncture may be helpful for irritating bladder symptoms. Percutaneous tibial nerve stimulation involves placing an acupuncture needle percutaneously in the ankle region near the tibial nerve and stimulating with an electrical generator for 30 minutes. A multicenter, double-blind, randomized, controlled trial comparing the efficacy of percutaneous tibial nerve stimulation to sham through 12 weeks of therapy demonstrated that percutaneous tibial nerve stimulation subjects achieved statistically significant improvement in bladder symptoms with 54.5% reporting moderately or markedly improved responses compared to 20.9% of sham subjects from baseline (p <0.001). Percutaneous tibial nerve stimulation may decrease symptoms of urge incontinence previously unresponsive to antimuscarinics based on a small randomized trial. There was more than 50% reduction in urge incontinence in 71% with tibial nerve stimulation vs. 0% with control (p < 0.001).
Overflow urinary incontinence
Treatment options for overflow incontinence include:
- Prolonged catheterization (either transurethral or supra pubic)
- Clean intermittent self catheterization
- Sacral neuromodulation (discussed above)
Subjects with overflow incontinence should be referred to an expert for management.
4. Complications
Psychosocial impact of untreated disease
Urinary urgency, frequency, and urge incontinence negatively impacts sleep, social interaction, and health-related quality of life. Depression is two to three times more common in women with urinary incontinence compared to those without. Severity of depression is directly proportional to the severity of incontinence. Urinary incontinence increases the risk for falls in elderly dementia patients. Other conditions associated with untreated urinary incontinence include increased risk for urinary tract infections and yeast vaginitis. It is also often perceived as a barrier to exercise.
5. Prognosis
Urinary incontinence is likely to worsen with time. In a nurses' health study that followed 23,792 women aged 54-79 yrs for two years, it was observed that 2.1% of those who reported leakage at least monthly at baseline progressed to at least weekly and 8.9% of those who reported leakage at least weekly at baseline improved to monthly or less, and 2% had complete remission.
A prospective study demonstrated that menopausal transition was not associated with worsening of urinary incontinence symptoms over six years in midlife women. The results were that 52.9% had no change, 32.4% had decreased incontinence, and 14.7% had worsening. In a prospective, observational study of three hundred twenty-four incident cases of stroke with incontinence 1 week post stroke, age 75 and older was independently associated with poor recovery from post stroke urinary incontinence.
6. What is the evidence for specific management and treatment
Abrams, P, Cordoza, L, Fall, M, Griffiths, D, Rosier, P, Ulmsten, U, van Kerrebroeke, P, Victor, A, Wein, A. "The standardization of terminology of lower urinary tract function: Report from the Standardization Sub-committee of the International Continence Society". Neurourol Urodynam. vol. 21. 2002. pp. 167-78. (Article on standard terms and their universally agreed upon definitions in lower urinary tract disorders.)
Cody, JD, Richardson, K, Moehrer, B, Hextall, A, Glazener, CMA. "Oestrogen therapy for urinary incontinence in post-menopausal women". Cochrane Database Syst Rev. 2009. pp. CD001405(Review article on the effects of estrogen on urinary incontinence suggesting minimal if any benefit.)
Duthie, JB, Herbison, GP, Wilson, DI, Wilson, D. "Botulinum toxin injections for adults with overactive bladder syndrome". Cochrane Database Syst Rev. 2007. pp. CD005493(Article on limited data regarding the use of Botox in women with recalcitrant OAB suggesting at least short term benefit.)
Keegan, PE, Atiemo, K, Cody, JD, McClinton, S, Pickard, R. "Periurethral injection therapy for urinary incontinence in women". Cochrane Database Syst Rev. 2007. pp. CD003881(Review article suggesting some short term benefit of injectible therapy but less effective then other surgical therapies.)
Lapitan, MCM, Cody, JD, Grant, A. "Open retropubic colposuspension for urinary incontinence in women". Cochrane Database Syst Rev. 2009. pp. CD002912(Article demonstrating long term efficacy of retropubic suspension in the treatment of stress urinary incontinence.)
Mariappan, P, Alhasso, AA, Grant, A, N'Dow, JOM. "Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults". Cochrane Database Syst Rev . 2005. pp. CD004742(Review article questioning any benefit of SNRIs in the treatment of stress urinary incontinence.)
Nabi, G, Cody, JD, Ellis, G, Hay-Smith, J, Herbison, GP. "Anticholinergic drugs versus placebo for overactive bladder syndrome in adults". Cochrane Database Syst Rev. 2006. pp. CD003781(Review article suggesting that anticholinergics demonstrate better efficacy then placebo in relieving symptoms of OAB.)
Ogah, J, Cody, JD, Rogerson, L. "Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women". Cochrane Database Syst Rev. 2009. pp. CD006375(Review article stating that minimally invasive slings (retropubic) have efficacy in treating stress urinary incontinence.)
Waetjen, LE, Feng, WY, Ye, J, Johnson, WO, Greendale, GA. "Study of Women's Health Across the Nation (SWAN). Factors associated with worsening and improving urinary incontinence across the menopausal transition". Obstet Gynecol. vol. 111. 2008. pp. 667-77. (Good epidemiologic study on urinary symptoms across various age groups.)
Ward, K, Hilton, P. "UK and Ireland TVT Trial Group. Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence". BMJ. vol. 325. 2002. pp. 67
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
- Stress urinary incontinence, urge incontinence, mixed incontinence, overflow incontinence
- 1. What every clinician should know
- 2. Diagnosis and differential diagnosis
- 3. Management
- 4. Complications
- 5. Prognosis
- 6. What is the evidence for specific management and treatment


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If a student wishes to pursue an online class offering through other MoCAP options outside of Launch, he/she will need to contact Mrs. Tonya Woods, to discuss options ([email protected]).


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love? Why would the doctor tell you there is no
solution or cure to your problems? Why would
your lawyer say you stand no chance, that your
case is hopeless? Have you been cheated by
anyone or those owing you money refuse to pay
back? Do you need a rapid job promotion in
your place of work? You want to venture into
politics? Now I understand certain things are
hard to believe and comprehend, but all I ask
from you is only 3 days and if you will follow my
instructions and use the items you will receive, I
promise your life will never be the same
again.If you find no relevance in the help I offer
I solemnly appeals do not be vindictive and go
in peace. And if your intentions are to take
advantage of the powerful nature of our items
for the purpose of evil, I will not have any
business with you please be advised. May
angels guide you. All inquiries should be
directed to the Priest Abija email below Email:
firstname.lastname@example.com or
you can sent a text message to this number:(518) 303-6207!Dorispinto1001https://firstname.lastname@example.com


text:
October 27, 2010
Google Maps Tests New Navigation UI
Another change is that the list of recent searches and Google Maps views is displayed in the layer panel, so you can quickly switch between custom maps, driving directions, local search results and Google Maps layers.
{ Thanks, Dave. }
6 comments:
This has been spotted last month, in French.ReplyDelete
Isn't "Satellite" really an overlay, too? And "Earth" is just a 3D option. Voila, no more buttons and "Earth" vs "Satellite" confusion :-)ReplyDelete
Curious to know roll-out plans...This showed up today on my browser (FF only) but not on others within my company...ReplyDelete
Chrome OS = No more Google Earth? Everything done in Google Maps?ReplyDelete
On android maps, was dissapointed that the search bar never seems to go away. Why do I need the search, pin, layer, mylocation button open all the time? Put them back on the menu key. My droid screen isn't *that* big.ReplyDelete
Need to check it out, but we don't need more confusion, spend too much time with popups and menus. My problem, I guess, I can work with whatever is there.ReplyDelete


text:
I have made the mistake of peeking at the NY Times headline story before the caffeine has kicked in fully. Thier gist seems to be that the "less government" crowd is a bunch of hypocrites, but there is a glaring problem with their numbers. Or at least, I am glaring - here we go:
Even Critics of Safety Net Increasingly Depend on It
By BINYAMIN APPELBAUM and ROBERT GEBELOFF
LINDSTROM, Minn. — Ki Gulbranson owns a logo apparel shop, deals in jewelry on the side and referees youth soccer games. He makes about $39,000 a year and wants you to know that he does not need any help from the federal government.
He says that too many Americans lean on taxpayers rather than living within their means. He supports politicians who promise to cut government spending. In 2010, he printed T-shirts for the Tea Party campaign of a neighbor, Chip Cravaack, who ousted this region's long-serving Democratic congressman.
Yet this year, as in each of the past three years, Mr. Gulbranson, 57, is counting on a payment of several thousand dollars from the federal government, a subsidy for working families called the earned-income tax credit. He has signed up his three school-age children to eat free breakfast and lunch at federal expense. And Medicare paid for his mother, 88, to have hip surgery twice.
Wait - Medicare is now a "safety net" program? I thought that, like Social Security, it was an earned benefit - we all paid our taxes, and we are all eligible. Medicaid is means-tested; Medicare is not.
Pressing on, this problem re-emerges quickly:
There is little poverty here in Chisago County, northeast of Minneapolis, where cheap housing for commuters is gradually replacing farmland. But Mr. Gulbranson and many other residents who describe themselves as self-sufficient members of the American middle class and as opponents of government largess are drawing more deeply on that government with each passing year.
Dozens of benefits programs provided an average of $6,583 for each man, woman and child in the county in 2009, a 69 percent increase from 2000 after adjusting for inflation. In Chisago, and across the nation, the government now provides almost $1 in benefits for every $4 in other income.
The reporters addressed my question in the next paragraph, so my aneurysm subsided:
Older people get most of the benefits, primarily through Social Security and Medicare, but aid for the rest of the population has increased about as quickly through programs for the disabled, the unemployed, veterans and children.
So if most of the benefits are for a non-safety net program, why are we reading about it? The fog thickens here:
The government safety net was created to keep Americans from abject poverty, but the poorest households no longer receive a majority of government benefits. A secondary mission has gradually become primary: maintaining the middle class from childhood through retirement. The share of benefits flowing to the least affluent households, the bottom fifth, has declined from 54 percent in 1979 to 36 percent in 2007, according to a Congressional Budget Office analysis published last year.
Well I need to track down that CBO analysis, because if it is counting Social Security and Medicare then no kidding - the aging baby boom is undoubtedly hoovering up a larger share of benefits in 2007 than in 1979 [the obvious is true - see UPDATE]. That tells me nothing about, for example, the impact of the 1996 welfare reform, but it makes a great story for the Ministry of Truth.
Well, the day is yoing, and following Dan Rather I say "Keurig!".
IF I MAKE IT BACK... Eventually I hope to develop two points - first, the Democrats have long wanted to deliver middle-class entitlements paid for by "the rich", because that is where the votes are. Healthcare and college subsidies are two biggies for them.
Secondly, someone (IIRC, Ms. McArdle herself) had a cogent post noting that what looks like a safety net on the way down can look like absurdly high marginal tax rates on the way back up. If someone falls from $40,000 to $20,000 in income and picks up $15,000 in benefits on the way down they (presumably) lose those benefits as their situation improves. That creates a high effective rate and greatly reduces the incentive to get back to work.
One solution has been to move the cut-offs and break points up into middle class territory, which of course leads to the sort of headlines the Times delivers today.
UPDATE: From Sally Pipes of Forbes, last December:
The Congressional Budget Office just released a major new investigation into household income trends over the last three decades. Researchers found that while the total amount of benefits paid out by government social safety-net programs rose between 1979 and 2007, the share going to the poor actually shrank.
In other words, relatively affluent members of American society now consume a bigger share of government benefits. As the CBO put it, "government transfer payments are . . . moving away from households in the lower part of the income scale."
Why? The CBO continued: "That shift reflects the growth in spending for programs focused on the elderly population (such as Social Security and Medicare), in which benefits are not limited to low-income households."
And from the CBO report on income inequality:
Effects of Transfers on Different Income Groups. The shifts in the relative importance of different transfer programs since 1979 moved the distribution of transfer benefits away from households in the lower part of the income spectrum to some extent (see Figure 14 on page 24). Rapid growth in Medicare, which is not means tested (in other words, not provided to people based on a test of need determined by their income and assets), tended to shift more transfer income to middle- and upper-income households. At the same time, spending on Aid to Families with Dependent Children and its successor, Temporary Assistance for Needy Families, has declined relative to market income; benefits from those means-tested programs are heavily concentrated at the bottom of the income scale. As a result, households in the lowest-income quintile received 54 percent of federal transfer payments in 1979 and 36 percent in 2007.


text:
Mrs. Gillet's Classroom
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Scale of the Universe to Think Big
Branches of Govt
I will be a hummingbird.
Motivation of Michael Phelps
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Everyday Leadership
Science Daily
White House Chef
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Original Song
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Tech Team checklist 2021
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In Con Awards 2021
Accelerated Learning
Remote HW Announcements
Zooming with an astronaut who has been to space
Music 2022 Talent Show 2022
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3rd grade Writing Standards
April/May Class Newsletter 2020
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Stanford Struggle
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July 2020


text:
Weekend coming up!
All photographs are there to remind us of what we forget. In this – as in other ways – they are the opposite of paintings. Paintings record what the painter remembers. Because each one of us forgets different things, a photo more than a painting may change its meaning according to who is looking at it.
John Berger


text:
Experts agree: A federal government shutdown would be a dumb way to go.
Yet the risk of a shutdown on Oct. 1 is now a distinct possibility. And federal agencies have been instructed to make plans for one just in case.
The House on Friday will vote on a short-term government funding bill that will include a provision to defund Obamacare. That provision is a no-go for Senate Democrats and President Obama.
If they can't work out a compromise, many functions of the federal government will be shut down indefinitely on Oct. 1.
Besides causing inconvenience and delays, a shutdown could have larger consequences.
A long, broad shutdown could weaken an already modest economic recovery, Congressional Budget Office Director Douglas Elmendorf said Wednesday.
Federal Reserve Chairman Ben Bernanke, meanwhile, noted that "a government shutdown and, perhaps even more so, a failure to raise the debt limit could have very serious consequences for the financial markets and for the economy."
To say nothing of the fact that a shutdown wouldn't come cheap. Federal agencies have to use up time, energy and resources to plan for one. Shutting down, and then reopening the government, also costs money. Two shutdowns in the mid-1990s cost an estimated $1.4 billion, according to the Congressional Research Service.
There's no telling exactly what a shutdown this October would look like because the White House has some discretion in terms of what's hit and what's not. But based on the shutdowns in the mid-1990s, the following is a pretty good bet.
What will be closed for business: Many, if not most, federal government offices, programs, museums and parks would be shuttered.
So if the shutdown lasts awhile, the travel industry could take a hit as vacations and business trips are scuttled -- whether because people can't get a visa or passport or because they have to cancel their plans to visit Yosemite.
For federal contractors, projects may be delayed because the agencies they work for can't issue the paperwork needed to move forward.
And Americans who need something from a federal office affected by the shutdown may be out of luck.
What will be open for business: Parts of the government that provide what the White House budget office deems critical would still operate.
Critical services, broadly speaking, protect human life and property. Typically that has included air traffic control, national security, the handling of hazardous waste, food inspections, border protection, maintenance of the power grid and disaster assistance.
In addition, taxes likely would still be collected, and U.S. bonds issued. Anything else deemed essential to the preservation of the country's banking system would likely carry on as well.
Related: Pessimism deepens over budget standoff
Who will come to work and who won't: Hundreds of thousands of federal workers would be furloughed without pay. Historically that pay has been restored when the shutdown ends, but there's no guarantee of that in law.
Many federal employees, however, would be exempted from furloughs. President Obama and his presidential appointees, as well as members of Congress, fall into that category.
Also expected to work through a shutdown are federal employees needed to preserve key parts of the money and banking systems.
Anyone authorized to work during a shutdown would be paid, although in most instances they will not get their checks until after the shutdown ends.
How mail would be affected: The mail would still be delivered.
How justice will be served: The federal judiciary estimated that if a shutdown had occurred this year, the court system could have functioned for roughly 10 working days on the basis of fees and funds from prior appropriations, according to CRS.
Related: Budget follies: 3 crazy years and counting
When that funding runs out, the judiciary would allow "essential work" to be performed, including the resolution of cases.
Federal court staff and officers who work through the shutdown would not be paid during the shutdown. But Supreme Court justices and federal judges appointed under Article III of the Constitution would.
If you're called for federal jury duty, you won't get paid for it on time.
What happens to Social Security and other benefits: Funding for entitlement benefits is considered mandatory, meaning it's not subject to the annual appropriations process.
So the money will be there to pay the benefits. The only question is whether the federal workers who process them will be.
Social Security checks did go out during the last shutdown, and the White House should be able to ensure the same thing happens again if need be.
During the mid-1990s shutdowns, the Social Security Administration initially retained nearly 5,000 employees to send benefits to those already enrolled in the program. But during the second, longer shutdown, it realized it would need closer to 50,000 employees to process applications for new claims or Social Security cards, address changes and other benefit-related tasks.
How Obamacare will fare: Those who would threaten to shut the government down are those who most want to see Obamacare delayed and defunded.
But an analysis by the CRS concludes that the implementation of Obamacare is likely to continue in the event of a shutdown.


text:
Shopify original
Grow Your Business with Instagram
2 hours 3 mins • 32 lessons
How do you build an engaged following and increase your sales on Instagram?
Is it about using the right hashtags? Taking the perfect photo? Posting at the right time?
If you want to learn how to build an engaged audience of buyers for your product, you're in the right place to learn.
Your instructor, Gretta van Riel, is one of Australia's top young serial entrepreneurs. With five multi-million dollar startups under her belt, Gretta prides herself on turning audiences into brands and trends into markets. She loves Instagram and has amassed over 16 million followers (bot-free) on 25 accounts on Instagram.
In this course, you'll get the behind-the-scenes strategies and templates you can use to 10x your following and (ideally your customers) on Instagram.


text: The NcSTAR Vism 36" Double Carbine Case (Tan) is constructed of heavy duty PVC material and protects up to 2 carbine sized rifles. The primary compartment will accommodate 2 rifles 35 inches in overall length with a thick padded center divider and 4 hook and loop straps to properly secure each rifle. The secondary compartment is loaded with pockets to store extras such as handguns, optics, cleaning supplies, log books, etc. The three exterior pockets are perfect for keeping your magazines and ammo organized.


text:
Cheerful, joyful song, with happy vibe,positive and uplifting melody in retro style. The track consists of a female vocal, acoustic guitar, contrabass, saxophone, vibraphone and claps. Perfect music for corporate video, website, advertising, TV show and other media projects.
Also the track contains a short instrumental version (1:39 – 3:00 in preview)
Similar music:
It's A Perfect Day


text:
When Windows 8 launches later this year you'll be able to upgrade to the pro version of Microsoft's newest desktop OS for just $40 for a limited time. The deal will apply to a broad base of current Windows users including those running Windows XP, Vista and Windows 7. Microsoft had a similar offer during the launch of Windows 7 but this one is cheaper than its predecessor. (Windows 7 upgrades ranged from $50-$100 at launch.)
Another big difference between the Windows 7 and Windows 8 upgrade deals is that you get the pro version instead of the base version of Windows 8. And if you're a Windows Media Center fan, Microsoft's Windows 8 upgrade deal will let you download the entertainment center program for free (more on that later).
If you plan on upgrading to Windows 8, here's what you need to know about Microsoft's limited-time upgrade deal.
Is the Windows 8 Pro Upgrade Available for Pre-Order Right Now?
No. You won't be able to buy the Windows 8 Pro upgrade until Windows 8 launches. When it becomes available, you will find the upgrade deal on Microsoft's Windows site.
Any Idea When Windows 8 Will Launch?
Critics and analysts expect Windows 8 to launch in the fall. Most likely in October or possibly November.
When Does the $40 Windows 8 Pro Upgrade Expire?
After Windows 8 launches, you can purchase the upgrade for $40 until Jan. 31, 2013.
What Do I Get with Windows 8 Pro?
For the average user there's little noticeable difference between the home edition of Windows 8 and Windows 8 Pro. But if you are interested in features such as BitLocker encryption, booting from a virtual hard disk, and Hyper-V, then upgrading to Windows 8 Pro will make all the difference. For more information about Windows 8 versions, check out PCWorld's "Windows 8 Will Come in Four Versions."
What About Windows Media Center?
You will be able to download Windows Media Center for free when you upgrade to Windows 8 Pro during the limited-time offer. You'll find the free Media Center download as part of the "Add Features to Windows 8" control panel (formerly known as "Windows Anytime Upgrade").
Microsoft had previously announced that Windows Media Center would be available to Windows 8 users for a small fee. This caused some consternation among users since Windows Media Center contains built-in DVD playback functionality for Windows. Previous versions of Windows contained the program for free.
Microsoft said it was dropping the program by default to reduce media decoder licensing costs for computer makers. It's not clear what the Windows Media Center download will cost after Microsoft's introductory Windows 8 upgrade offer expires at the end of January.
What Do I Get to Keep from my Old OS?
Windows XP: Personal files only
Windows Vista: Windows settings and personal files
Windows 7 (all consumer versions): Windows settings, personal files, and apps.
Can I Start Fresh?
Yes. You can choose to take none of your personal information with you during the upgrade process, or you can create bootable media such as USB thumb drive or DVD to format your hard drive.
How Do I Create Bootable Media?
All you have to do is follow the instructions from the Windows 8 Upgrade Assistant, which guides you through the installation process after downloading Windows 8 Pro.
I hate Downloading Programs. Can I Buy a DVD at my Local Computer Store?
Yes, but it will cost you a bit more at $70.
Connect with Ian Paul (@ianpaul) on Twitter andGoogle+, and with Today@PCWorld on Twitter for the latest tech news and analysis.


text:
(Kuwait) – Labor ministers from Gulf and Asian countries meeting on November 26 and 27, 2014, should improve labor law protection, reform abusive immigration policies, and increase dialogue with trade unions and nongovernmental groups, 90 human rights organizations and unions said today.
Millions of contract workers from Asia and Africa, including an estimated 2.4 million domestic workers in the Gulf, are subject to a wide range of abuses, including unpaid wages, confiscation of passports, physical abuse, and forced labor.
"Whether it's the scale of abuse of domestic workers hidden from public view or the shocking death toll among construction workers, the plight of migrants in the Gulf demands urgent and profound reform," said Rothna Begum, Middle East women's rights researcher at Human Rights Watch. "This should include a thorough overhaul of the abusive kafala visa sponsorship system."
The ministers will meet in the third round of the Abu Dhabi Dialogue, an inter-regional forum on labor migration between Asian countries of origin and Gulf Cooperation Council (GCC) countries of destination. Nongovernmental groups participated in the first two rounds but were not invited to this year's gathering. Labor ministers from the GCC states are to meet separately on November 23 to discuss a draft domestic workers contract and the proposed formation of a cross-GCC body to oversee migrant domestic work.
The kafala system, used to varying extents across the Gulf, restricts most workers from moving to a new job before their contracts end unless they obtain their employer's consent, trapping many workers in abusive situations. Many migrant workers feel intense financial pressure not only to support their families at home but also to pay off huge debts incurred during recruitment. Poorly monitored labor recruitment agencies, in both the migrants' countries of origin and in the destination Gulf states, often overcharge migrant workers, deceive them about their working conditions, or fail to assist them if they encounter workplace abuse.
In Saudi Arabia and Qatar, migrant workers cannot leave the country without obtaining their employer's consent for an "exit permit" from the authorities. Some employers have refused to pay wages, return passports, or provide permission for "exit permits" in order to exact work from workers involuntarily.
A November analysis by the International Trade Union Confederation (ITUC), "Facilitating Exploitation," highlighted how gaps in national labor laws in GCC countries either partially or completely exclude domestic workers.
An October Human Rights Watch report, "I Already Bought You," and an April Amnesty International report, "My Sleep is My Break," found common patterns of abuse against domestic workers in the United Arab Emirates and Qatar respectively, including unpaid wages, no rest periods, excessive workloads, food deprivation, and confinement in the workplace. In several cases, domestic workers reported physical or sexual abuse and had been in situations of forced labor, including trafficking.
"The proposals made by GCC countries fall far short of the changes needed to protect domestic workers' rights, safety, and dignity," said Elizabeth Tang, general secretary of the International Domestic Workers Federation (IDWF). "GCC countries should join the growing number of countries worldwide that are extending full protection of their labor laws to domestic workers, including a minimum wage, a weekly rest day, the right to organize, and social benefits."
The GCC has discussed a potential region-wide standard employment contract for domestic workers. Recent media reports suggest that the GCC is also considering establishing a body to coordinate policies on hiring domestic workers that would consist of recruitment agency and government representatives. These developments have lacked transparency and have suffered from inadequate consultation with migrant domestic workers, trade unions, and migrants' rights organizations. Migrants' countries of origin are also discussing their own standard contract through a separate process.
"Standard contracts are not a substitute for labor law reform, and taken alone do not meet the standards in the ILO Domestic Workers Convention," said Sharan Burrow, general secretary of the ITUC. "The GCC should work in closer coordination with – not separately from – countries of origin to develop labor migration policies that fully respect the human and labor rights of migrants."
Migrants in the Gulf make an important contribution both to the economies of their own countries and those of the countries where they work. In 2011, migrant workers in GCC countries sent home more than US$60 billion in remittances. Competition for jobs among the workers' countries of origin, combined with their relative lack of bargaining power in relation to the labor-destination countries, means that the pressure they exert for better labor protections is weak.
"The meetings over the next few days provide a key opportunity to promote regional minimum standards that would avoid a counterproductive race to the bottom in labor conditions," said William Gois of Migrant Forum Asia. "The governments should develop a concrete action plan, in consultation with migrant workers themselves and the organizations that represent them, with benchmarks to monitor its progress."
Kuwait University Law School will host an event on November 23, 2014, at which panelists from Amnesty International, Human Rights Watch, IDWF, the ITUC, and Migrant Forum Asia will discuss the rights of migrant domestic workers.
The groups recommend that the governments:
- Establish and enforce comprehensive labor law protections for migrant workers, including domestic workers;
- Reform the kafala (sponsorship) visa system to ensure that workers can change employers without being required to first obtain their consent;
- Remove the "exit permit" requirement in Saudi Arabia and Qatar;
- Strengthen regulation and monitoring of labor recruitment agencies, including eliminating recruitment fees for workers;
- Ensure that migrants have access to justice and support services; and
- Expand the Abu Dhabi Dialogue to include labor-origin countries from Africa, such as Ethiopia, Uganda, and Kenya, and participation by nongovernmental groups.
Governments should ratify and implement international labor and human rights standards, the groups said. These include the International Labour Organization (ILO) Convention 189 on Decent Work for Domestic Workers, the ILO Forced Labor Protocol, and the International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families.
The first round of the Abu Dhabi Dialogue was hosted by the United Arab Emirates in 2008 and the second meeting was held in Manila in 2012.
The groups signing on to this statement include:
- Amnesty International
- Building and Woodworkers' International
- Human Rights Watch
- International Domestic Workers Federation
- International Trade Union Confederation
- Migrant Forum Asia
- Solidarity Center
- Action Aid
- Anti-Slavery International
- Asian Pacific Forum on Women, Law and Development (APWLD)
- Center for Women's Global Leadership (CWGL)
- International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers' Association
- Migrant Rights International
- Post 2015 Women's Coalition
- Public Services International
- General Federation of Bahrain Trade Unions, Bahrain
- Domestic Workers Rights Network (DWRN), Bangladesh
- Association for Community Development (ACD), Bangladesh
- National Domestic Women Workers Union (NDWWU), Bangladesh
- Refugee and Migratory Movements Research Unit, Bangladesh
- WARBE Dev, Bangladesh
- Cambodia Domestic Workers Network (CDWN), Cambodia
- Legal Support for Women and Children (LSCW), Cambodia
- Hong Kong Domestic Workers General Union (HKDWGU), Hong Kong
- Hong Kong Federation of Asian Domestic Workers Unions (FADWU), Hong Kong
- Overseas Domestic Workers Union (ODWU), Hong Kong
- Progressive Union of Domestic Workers in Hong Kong (PLUDW), Hong Kong
- Thai Migrant Workers Union (TMWU), Hong Kong
- Union of Nepalese Domestic Workers in Hong Kong (UNDW), Hong Kong
- Center for Indian Migrant Studies, India
- Migrant Domestic Workers Trust, India
- Migrant Forum India
- Migrants Rights Council, lndia
- National Domestic Workers Movement, India
- Tamil Nadu Domestic Workers Union, India
- Tamil Nadu Domestic Workers Welfare Trust, India
- Confederation of Indonesian Trade Unions (CITU) KSPI/CITU, Indonesia
- Congress of Domestic Workers in Yogyakarta (KOY), Indonesia
- JALA PRT, Indonesia
- KAPPRTBM (Domestic and Migrant Workers Protection Action Committee), Indonesia
- Konfederasi Serikat Buruh Sejahtera Indonesia (KSBSI), Indonesia
- Merdeka Domestic Workers Union, Semarang, Indonesia
- Migrant CARE, Indonesia
- Rural Women's Voices, Indonesia
- Sapulidi Domestic Workers Union, Jakarta, Indonesia
- Tunas Mulia Domestic Workers Union, Yogyakarta, Indonesia
- All Nepal Federation of Trade Unions (ANTUF), Nepal
- Home Workers Trade Union of Nepal (HUN), Nepal
- Migrants' Center AHRCDF, Nepal
- POURAKHI, Nepal
- Pakistan Rural Workers Social Welfare Organization (PRWSWO), Pakistan
- Center for Migrant Advocacy, Philippines
- Federation of Free Workers (FFW), Philippines
- Federation of Free Workers Women's Network (FWN), Philippines
- KAKAMMPI, Philippines
- Kanlungan Center, Philippines
- Scalabrini Migration Center, Philippines
- Sentro ng mga Nagkakaisa at Progresibong Manggagawa, SENTRO, Philippines
- Trade Union Congress of the Philippines (TUCP), Philippines
- Unlad Kabayan, Philippines
- Domestic Workers Union (DWU), Sri Lanka
- Good Shepherd Sisters, Sri Lanka
- Sri Lanka Nidahas Sevaka Sangamaya (SLNSS), Sri Lanka
- Hope Workers Centre, Taiwan
- Hsinchu Catholic Diocese Migrants & Immigrants Service Center (HMISC), Taiwan
- Homenet Thailand, Thailand
- Network of Domestic Workers in Thailand, Thailand
- Thai Domestic Workers Network, Thailand
- Mehru Vesuvalia (individual capacity)
- Domestic Services Workers Union, Ghana
- Jamaica Household Workers Union, Jamaica
- Solidarity with Migrants, Japan
- Joint Committee with Migrants in Korea (JCMK), South Korea
- National House Managers Co-operatives (NHMC), South Korea
- Cambodian Migrant Workers Solidarity Network (CMSN), Malaysia
- Centro de Apoyo y Capacitación para Empleadas del Hogar (CACEH), Mexico
- Nigeria Labour Congress (NLC), Nigeria
- Federación de Trabajadoras del Hogar del Perú (FENTRAHOP), Peru
- Humanitarian Organization for Migration Economics (HOME) Singapore
- Transient Workers Count Too (TWC2), Singapore
- Federation of Somali Trade Unions (FESTU), Somalia
- South African Domestic Service and Allied Workers Union (SADSAWU), South Africa
- Trade Unions' Congress of Tanzania (TUCTA), Tanzania
- National Union of Domestic Employees (NUDE) Trinidad and Tobago
- The Service Workers Centre Cooperative Society Limited (Trinidad)
- Centro de los Derechos del Migrante, USA
- National Domestic Workers Alliance (NDWA), USA
- United House and Domestic Workers Union in Zambia, Zambia


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SALT LAKE CITY – DeMarcus Cousins scored 27 points, including the winning free throw with 3.8 seconds left, and the Sacramento Kings ended a four-game losing streak with a 104-103 victory Friday night over the Utah Jazz.
The win snapped Utah's seven-game home winning streak, while the Kings (18-33) won on the road for only the fifth time all season.
Al Jefferson led Utah (27-25) with 27 points. Gordon Hayward added 19, but couldn't get his driving layup to fall, and Utah's tip-in attempt was too late.
Cousins left briefly to get stitches under his left eyebrow.
Marcus Thornton added 26 points for Sacramento.
Utah's rookie guard Alec Burks outplayed former Brigham Young star Jimmer Fredette, but Burks' late turnover gave the Kings a chance to win it. Cousins, who was fouled, made one of two free throws.
The Jazz shot 35 percent, including 0 for 13 for Derrick Favors.
The Jazz and Kings seemed headed in opposite directions, with Utah having won seven of its last nine coming into Friday's game. But each of the three previous meetings had been close.
In the first meeting, Fredette had a chance to win it late, but shot an air-ball 3-pointer.
Eight days ago, the Jazz won on Jefferson's last-second tip-in.
On Friday, Fredette's 17-foot jumper gave the Kings an 88-86 lead with 7:34 left to play, but the Jazz scored six straight, capped by Burks' baseline jumper.
Thornton's 3-pointer cut the gap to 1 but Burks followed with his own 3, then fed Hayward for a fast-break layup and a 97-91 Utah lead.
But the Kings scrapped behind Cousins, his three-point play off a nice move inside, tying it at 101 with 2:20 left,
It was tied at 103 when Burks lost the ball out of bounds with 15 seconds left.
Utah knew Cousins would get the ball but Earl Watson was called for the foul, and Cousins came through at the line.
The Jazz trailed by as many as nine points in the first quarter but fought back, outscoring Sacramento 30-24 in the second to take a 59-56 lead at the break.
Burks gave Utah its first lead with 6:15 left in the half when he stole the ball, and scored at the other end on a putback.
While Fredette was the marquee name and is seeing his minutes diminish under new head coach Keith Smart, Burks was quietly gaining the confidence of Jazz brass and teammates.
Burks, taken two spots behind Fredette and the No. 12 overall, is averaging 7 points and 2.1 rebounds a game. He had that by halftime Friday and finished with 15 points and was on the court instead of Devin Harris with the game on the line.
For the Kings, as the sign in the arena said Friday, it's still time to Simmer Jimmer.
Fredette, who has been surpassed by diminutive point guard Isaiah Thomas in the lineup, made his first shot Friday after entering with 2:46 left in the first quarter and hit a jumper in the fourth. But he looked like a man lacking confidence. He missed a pair of free throws, was called for a lane violation and traveling and was 0 of 2 from beyond the arc.
He finished with four points in 16 minutes in his second game back in Utah.
Thomas added 19 for Sacramento on 6-of-8 shooting.
The Jazz shot just 42.8 percent in the first half. The shooting woes continued in the second, especially for Favors, who set a Jazz futility mark. Utah shot 52 free throws but made just 38.
Notes: Jazz swingman Josh Howard was at Friday's game just eight days after arthroscopic surgery on his left knee. Howard already has been rehabbing the knee with hopes he will be able to play again should the Jazz make the playoffs, and possibly even sooner. ... Sacramento guard Tyreke Evans did not dress because of back spasms. ... Smart reflected on Friday being the 25th anniversary of his winning shot that gave Indiana a 74-73 win over Syracuse in the 1987 NCAA championship game. "It reminds me every time I look in the mirror that 25 years ago I had a full head of hair," he joked. "Today is always special." ... At halftime, the Jazz honored Hall of Fame golfer Billy Casper, a Utah resident.


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Anyone who wants the office is unfit to have it.
The Constitution sets some conditions before an individual can be elected as president of the United States. I want to modify those conditions. I want to add one proviso. I think any president ought to have to prove that he or she was born on Krypton.
Krypton, you may remember, is the birth planet of Superman. So why Krypton? My first response would be because it disqualifies everybody who is running -- and wouldn't that be lovely. But my real reason is that the voters seem to want someone with super human abilities.
The public seems to think that the president ought to do just above everything. If there is a disaster the president should be grief counselor in chief. He should assure us, comfort us, cajole us, uplift us, educate us, reform us, ad infinitum. Every flaw we have he is supposed to cure.
Apparently there is nothing the president isn't supposed to do. The Democrats are keen to get the president to centrally direct the economy. They think he can somehow magically cure all problems of poverty, joblessness, or just about any other economic problem you can imagine. Republicans seems anxious to have the president centrally plan the world. They want him to be able to reform nations, by force, that have been screwed up for generations.
One side sees the president as our therapist and nanny combined while the other side sees him as pastor and disciplinarian. Of course the more exaggerated the titles the happier the president is about them. Many people imagine him "the leader of the free world." Try finding that job description in the Constitution.
Hillbilly Huckabee was promising to revive "our national soul" in his campaign. Hillary wants to set the goals for the nation. King George said "that when somebody hurts, government has got to move." Unfortunately he didn't mean move out of the way.
When you consider the job descriptions that go with the presidency today it becomes apparent that no human being can fill the job. No one is smart enough or wise enough to wield all the power that the presidency now has. That is why the Founders never gave such powers to the presidency. If the presidency were limited to the functions outlined in the Constitution almost anyone could do it, provided he or she had a basic sense of decency. The presidency was a job that a relatively average man could perform.
That is no longer the case. Now the powers of the presidency are so far beyond anything imagined by the Constitution that it acts like a magnet attracting every power-hungry, second rate politician to the job. One reason it is so difficult to find decent candidates is that the office itself is now inherently indecent -- it is a major engine of destruction and suffering, both for the United States and the world as a whole.
The nature of the office today is such that it attracts people emotionally suited to the powers offered. That means individuals who are ego maniacs, thirsty for power, authoritarian and welling to stoop to the lowest levels possible in order to grab the things they want. When the presidency offers almost unlimited powers it attracts only the most immoral of candidates. The reason the candidates are so disgusting is that the office they are seeking can only attract the worst. Power attracts the lowest common denominator.
Any man or woman of basic decency wouldn't want to have the sort of powers that George Bush relishes. Bush is like a pig in a mud bath. He loves the powers. In fact, he loves them so much that he keeps inventing new powers for himself. Lord Acton said that "power corrupts" and he is certainly right. But power does more than that. Power also attracts the corrupt. It appeals to those individuals who lack the sort of moral restraints that allow societies to work. The accumulation of power appeals to the ruthless and the more power that is accumulated the more ruthless the politicians attracted to the job.
Numerous people have complained that King George seems oblivious to any feedback. Not only does he ignore what people has to say, he goes out of his wan to insulate himself from contrary opinions. Staff members who disagree don't remain staff members for long. This sort of self-centeredness, however, ought to be expected. After all, what other kind of person do you think would be attracted to the position?
In his masterful The Road To Serfdom, F.A. Hayek warned that in a totalitarian society "there is little that is likely to induce men who are good by our standards to aspire to leading positions " but "much to deter them, there will be special opportunities for the ruthless and unscrupulous...." This is a sound law of politics in my opinion.
That the United States is not entirely totalitarian does not mitigate this law. There is an inverse relationship between state power and the individual character of people operating the state. As state power increases the moral character of the individuals seeking the levers of power decreases. We have reached the stage where the unconstitutional powers acquired by the presidency are so vast that I seriously doubt any moral individual would seriously seek the office. The mere desire to be president today ought to be a warning that the candidate is not fit to hold the office. The more desperate they are for the position the lower their moral character.
Labels: 2008 election, big government, presidency


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Tiny Moments
I tend to lean towards a "big picture" view of the world...until there's a camera in my hands. So come with me to find all the details hidden like jewels in the corners of the world. Go ahead: get down low, scoot on your belly to get as close to the architecture of the world as you can.Read More