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SAMJ: South African Medical Journal
versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.99 no.6 Cape Town Jun. 2009
A simple clinical formula for predicting fetal weight in labour at term derivation and validation
Eckhart BuchmannI, *; Karabo TlaleII
IFCOG (SA), MSc (Med), PhD, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg
IIFCOG (SA), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg
OBJECTIVES: To derive and validate a simple formula for birth weight based on symphysis-fundal height (SFH) measurement during labour, and to determine a useful SFH cut-off value for prediction of birth weight >4 000 g.
METHODS: In a derivation study, SFH was measured in women at term in the active phase of labour. A simplified formula for birth weight was derived from a regression equation. The best cut-off SFH measurement was obtained for prediction of birth weight >4 000 g. After this, a similar study was done to validate these findings.
RESULTS: In the derivation study (N=504), birth weight was predicted by the equation: birth weight in g=301+78 (SFH in cm). This was transformed to the simplified formula: birth weight in g=100 ([SFH in cm]5). Using this formula for the data set, 68.1% of birth weight estimates were correct to within 10% of the birth weight. For prediction of birth weight >4 000 g, an SFH measurement of 40 cm had a sensitivity of 82% and a specificity of 80%. In the validation study (N=294), the derived simplified formula gave 65.0% of estimates correct to within 10% of the birth weight. The predictive values of the 40 cm SFH cut-off were similar to those in the derivation study.
CONCLUSION: The derived simplified formula was validated in the second study. The formula may be useful for intrapartum use in term pregnancies. A cut-off SFH measurement of 40 cm may identify labours at risk for cephalopelvic disproportion or shoulder dystocia.
Clinicians frequently estimate fetal weight when examining women in labour at term. This may help in predicting cephalopelvic disproportion when labour progress is poor,1 or give early warning of possible shoulder dystocia.2 In experienced hands, intrapartum clinical estimates of birth weight for term infants are at least as good as ultrasound-based predictions, being correct to within 10% of the birth weight in 55 - 72% of estimations.3-10 A more objective estimate of fetal weight may be offered by measurement of symphysis-fundal height (SFH) using a tape measure.11-13 This requires minimal experience, relying only on identifying the upper edge of the pubic symphysis and the highest point on the uterus. However, there is no simple formula that converts SFH measurement into fetal weight. The Johnson formula is frequently quoted, where birth weight in g=(SFH in cm13)×155, with further adjustments based on maternal obesity and engagement of the fetal head.12 A South African study found good correlation of intrapartum SFH measurement with birth weight (r=0.56), and derived a regression equation, but the authors stated that the derived formula was 'not sufficiently accurate to be clinically useful'.14 A problem with fetal weight estimation is that all methods are least accurate at extremes of birth weight.15-17 Macrosomia (birth weight of 4 000 g and above) is notoriously difficult to predict.2,18,19 Where a formula is inaccurate at the upper extreme of birth weight, the most useful tool may be a cut-off measure of SFH to assist prediction of macrosomia. This study was done to derive and validate a simple formula for birth weight based on SFH, and to determine a useful SFH cut-off value for prediction of fetal macrosomia (birth weight >4 000 g).
Derivation study
The derivation study was a prospective cross-sectional study undertaken from 2003 to 2005 at Chris Hani Baragwanath Maternity Hospital. The study was approved by the Human Research and Ethics Committee of the University of the Witwatersrand. This investigation of SFH measurement was part of a larger study, which was to evaluate clinical assessment in prediction of cephalopelvic disproportion. The methods have been described previously.20,21 The study population was women at 37 or more completed weeks of gestation in the active phase of labour (cervix fully effaced and at least 3 cm dilated) with singleton live fetuses and vertex presentations. Women with pre-existing or gestational diabetes mellitus were excluded. A consecutive sampling method was used on days that the researcher (EB) was available to collect data in the labour ward. All the researcher's measurements were done at the time of the routine labour ward rounds of the attending clinicians. Written informed consent was obtained from all participants.
The researcher palpated the woman's abdomen and estimated the level of head above the pelvic brim in fifths.22 The head was considered engaged if two-fifths or less was palpable above the brim. This was followed by marking the highest point on the uterine fundus, not necessarily in the midline, with a pen using a horizontal line.23 Between uterine contractions, he identified the highest point on the fundus by gentle downward vertical pressure with the left index finger. The SFH was measured with a soft tape-measure from the superior edge of the symphysis pubis in the midline to the line identifying the highest point on the fundus, and recorded to the nearest 1 cm. Women with palpably full bladders were asked to void or were catheterised before proceeding with measurement. The state of the membranes was recorded as intact or ruptured, and cervical dilatation (in cm) was noted. After completing these observations, the researcher recorded race, age, parity, maternal height, maternal weight and gestation in weeks. Maternal weights were recorded from the first antenatal visit. Birth weights were measured on scales frequently calibrated by the researcher, and provided readings to the nearest 10 g.
Statistical analysis was performed using Microsoft Excel and Epi-Info 6 statistical software. Categorical data were presented as frequencies and percentages, and continuous data as means ± standard deviations (SD). Univariate linear regression analysis was done to study the relationship between SFH and birth weight. A scatter plot with regression line and equation was derived, with SFH as the independent variable and birth weight as the dependent variable. This was modified into a simplified formula for easy recall by clinicians, to offer estimations correct to within 10% of the birth weight in at least 60% of estimations, if possible. The influence of body mass index (BMI), membrane rupture and engagement of the fetal head was studied by comparing mean SFH measurements and birth weight, using Student's t-test with statistical significance defined as p<0.05. To determine the most predictive cut-off measurement for macrosomia, a receiver-operating characteristic plot was made. A two-by-two contingency table was used to determine sensitivity, specificity, positive predictive value and negative predictive value of the SFH cut-off for macrosomia.
Validation study
The validation study was done using similar methods. Sample size calculation suggested that 340 participants would be needed to give a precision of 5% around an observed percentage of estimated fetal weights correct to within 10% of the birth weight. For example, such a sample size would give a 95% confidence interval (CI) of 55 - 65% if the observed percentage was 60%. The researcher who made measurements in the derivation study (EB) instructed a second researcher (KT) in recording SFH and collection of other data, as described above. Measurement was refined by measuring the SFH twice, 5 - 20 minutes apart, and recording the mean of the two measurements. This part of the study was done from July to September 2007 in the labour wards of Johannesburg Hospital and Chris Hani Baragwanath Maternity Hospital. Approval for the validation study was given by the Human Research and Ethics Committee of the University of the Witwatersrand. If it were found that the simple formula could provide fetal weight estimates with 10% of the birth weight in over 60% of estimations in this validation, the formula would be acceptable for use in clinical practice.
Derivation study
The researcher examined 504 women, 489 (97.0%) of black African ethnic origin. The mean age was 25.0±5.8 years, and the mean gestation was 39.3±1.6 weeks. Three hundred and twenty women (63.5%) were nulliparous. The mean maternal height was 157.4±6.4 cm and the mean weight 69.2±13.9 kg. The fetal head was engaged in 128 cases (25.4%), and the membranes were found to be ruptured in 263 (52.2%). The mean cervical dilatation at the time of examination was 5.9±1.9 cm. The mean SFH was 37.0±3.6 cm, with a range of 27 - 53 cm. The mean birth weight was 3 190±436 g, with a range of 1 880 - 4 890 g.
Univariate linear regression of SFH with birth weight gave a correlation coefficient of 0.64. The regression equation (y=301+78.0x) suggests that for each cm increase in SFH, birth weight increased by 78 g (solid line in Fig. 1). Since a 78 g/cm increase could be rounded up to 100 g, this was adjusted, with minimal change to the regression line, to the simplified formula: birth weight in g=100 ([SFH in cm]5), giving an increase of 100 g in fetal weight for each cm SFH (dotted line in Fig. 1). It is evident from the regression line in the figure that the simplified formula prediction follows the statistical regression line most closely in the SFH range of 32 - 40 cm, equivalent to birth weights of 2 700 - 3 500 g. Using this formula to translate SFH measurements to birth weights, 343 (68.1%; 95% CI 63.8 - 72.1%) of estimates were accurate to within 10% of the birth weight. Accuracy within 20% of the birth weight was achieved in 470 estimations (93.3%; 95% CI 90.6 - 95.2%).
A BMI of 30 kg/m2 or more was associated with higher mean SFH (38.9 cm v. 36.4 cm; p<0.0001) and greater mean birth weight (3 298 g v. 3 155 g; p=0.0009) than a BMI less than 30 kg/m2. The mean SFH was lower (36.5 cm v. 37.2 cm; p=0.03) with an engaged fetal head than with an unengaged fetal head, with no difference in birth weight. Status of the membranes (ruptured or intact) was not associated with any difference in SFH or birth weight (Table I).
A receiver-operating characteristic plot (not shown) indicated that the 40 cm SFH cut-off provided the best predictive value for macrosomia. A cut-off of 41 cm was less sensitive (59%) but more specific (87%) and a cut-off of 39 cm less specific (70%) but more sensitive (91%). A 40 cm cut-off gave a sensitivity of 82% and a specificity of 80% for predicting a birth weight of 4 000 g or more. The positive and negative predictive values for 40 cm were 16% and 99% respectively (Table II).
Validation study
There were 294 participants, of whom 289 (98.3%) were of black African ethnic origin. One hundred and ninety-five were investigated at Johannesburg Hospital and 99 at Chris Hani Baragwanath Maternity Hospital. Their mean age was 26.6±5.8 years, 111 (37.8%) were primiparous, the mean gestational age at delivery was 39.2±1.4 weeks, and the mean weight was 73.9±15.8 kg. Membranes were ruptured at the time of measurement in 152 cases (51.7%) and the mean cervical dilatation was 5.5±1.4 cm. The fetal head was engaged in 60 cases (20.4%) at the time of examination. The mean SFH, in each case using the average of two measurements, was 37.0±3.3 cm. The mean birth weight was 3 221±417 g.
Univariate linear regression of SFH and birth weight revealed a correlation coefficient (r) of 0.56. The regression equation (y=585+71.3x) suggested an increase in birth weight of 71.3 g for each cm SFH. Using the derived simplified formula: birth weight in g=100 ([SFH in cm]5), 191 estimations (65.0%; 95% CI 59.2 - 70.4%) were accurate within 10% of the birth weight. Accuracy within 20% of the birth weight was achieved in 275 estimations (93.5%; 95% CI 89.9 - 96.0%). A BMI of 30 kg/m2 or above (N=100) was associated with greater mean SFH (38.4 cm v. 36.3 cm; p<0.0001) and greater mean birth weight (3 363 g v. 3 148 g; p=0.0009) than a BMI less than 30 kg/m2 (N=178). The mean SFH was lower (35.8 cm v. 37.3 cm; p=0.001) with an engaged fetal head than with an unengaged fetal head. Rupture of membranes appeared to have no significant effect on SFH or birth weight (ruptured v. unruptured: 36.8 cm v. 37.1 cm respectively). The 40 cm SFH cut-off for macrosomia yielded a sensitivity of 83% (10/12), a specificity of 82% (232/282), a positive predictive value of 17% (10/60) and a negative predictive value of 99% (232/234).
The simplified formula derived in the first study was successfully validated in the second. The formula offers an easy conversion of SFH to birth weight for midwives or obstetricians looking after women in the active phase of labour at term. The formula is best memorised as a subtraction of 5. Examples are an SFH measurement of 33 cm giving an estimated fetal weight of 2.8 kg or one of 41 cm predicting a fetal weight of 3.6 kg. The method provided estimates (68% of estimations in the first study and 65% of estimations in the second study within 10% of the birth weight) that fell in the upper range of accuracies of clinical estimates reported in the literature.3-10 Membrane rupture had no influence on estimations, while an engaged head was associated with an under-estimation of birth weight by about 100 g. Users of the formula could add 100 g to the estimated fetal weight if the head is engaged. The data also suggested that a high BMI could lead to overestimation of fetal weight, possibly because of increased abdominal subcutaneous fat content. However, women with a high BMI tended to give birth to larger infants, thus compensating for such over-estimation.
An SFH cut-off value of 40 cm had good sensitivity and specificity for predicting a birth weight of 4 000 g or more. The greatest strength of this cut-off was its negative predictive value (99%). This means that an SFH of less than 40 cm in a woman in the active phase of labour at term gives a 99% likelihood that the newborn will weigh less than 4 000 g. However, this applies only in populations where macrosomia at birth (birth weight of 4 000 g or more) is relatively rare. Studies of women of black African ethnic origin in southern Africa suggest that the rate of macrosomia at birth is 2.3 - 3.4%,24,25 much less than in Europe or North America.26,27 Therefore, the predictive findings here related to an SFH of 40 cm should not be applied in communities or environments different from the one studied. The 40 cm cut-off can be recommended for general use in southern Africa for term parturients of black African ethnic origin, to identify women at high and low risk of complications such as shoulder dystocia and cephalopelvic disproportion. This adds to findings from a previous study from Pretoria,13 where a 30 cm cut-off was found useful in predicting birth weights of less than 2 000 g in women in preterm labour.
Interpretation of these results must take into account some limitations. While the validation study found the results of the derivation study to be repeatable and therefore probably reliable, it is important that the method of SFH measurement be followed exactly as recommended23 for the results to be reproduced elsewhere. The derived formula should only be used at term in women in the active phase of labour. Simple inspection of the derived regression line (dotted line in Fig. 1) shows that the formula becomes unreliable at the extremes of birth weights at term. Therefore, with SFH measurements of greater than 40 cm it is enough to consider that the infant will have a birth weight above the average, without aiming to predict the birth weight with any precision. For SFH measurements less than 33 cm there is similar inaccuracy, and a guess that the infant will be of below-average weight is sufficient. The results of this study are not able to give information about SFH in small babies, because the study specifically excluded all gestations of less than 37 weeks. Also, SFH measurement as described here may not be meaningful if the gestation is unknown. Careful clinical palpation or ultrasound scanning would need to be done first to determine whether the pregnancy is likely to be at term or not.
SFH measurement in labour, with or without the use of formulas or cut-offs, can assist in the prediction of birth weight. However, only randomised controlled trials will be able to demonstrate whether SFH measurements during labour will make a difference in terms of intrapartum interventions such as referral, oxytocin use and caesarean section, or fetal outcomes such as asphyxia, birth trauma and perinatal death.
This study was supported by a research grant from the South African Society of Obstetricians and Gynaecologists.
1. Handa VL, Laros RK. Active-phase arrest in labor: predictors of cesarean delivery in a nulliparous population. Obstet Gynecol 1993; 81: 758-763. [ Links ]
2. O'Reilly-Green C, Divon M. Sonographic and clinical methods in the diagnosis of macrosomia. Clin Obstet Gynecol 2000; 43: 309-320. [ Links ]
3. Chauhan SP, Lutton TC, Bailey KJ, Morrison JC. Intrapartum prediction of birth weight: clinical versus sonographic estimation based on femur length alone. Obstet Gynecol 1993; 81: 695-697. [ Links ]
4. Barnhard Y, Bar-Hava I, Divon MY. Accuracy of intrapartum estimates of fetal weight. Effect of oligohydramnios. J Reprod Med 1996; 41: 907-910. [ Links ]
5. Sherman DJ, Arieli S, Tovbin J, Siegel G, Caspi E, Bukovsky I. A comparison of clinical and ultrasonic estimation of fetal weight. Obstet Gynecol 1998; 91: 212-217. [ Links ]
6. Shamley KT, Landon MB. Accuracy and modifying factors for ultrasonographic determination of fetal weight at term. Obstet Gynecol 1994; 84: 926-930. [ Links ]
7. Baum JD, Gussman D, Wirth III JC. Clinical and patient estimation of fetal weight vs. ultrasound examination. J Reprod Med 2002; 47: 194-198. [ Links ]
8. Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Kenney SP, Devoe LD. Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients. Obstet Gynecol 1998; 91: 72-77. [ Links ]
9. Noumi G, Collado-Khoury F, Bombard A, Julliard K, Weiner Z. Clinical and sonographic estimation of fetal weight performed during labor by residents. Am J Obstet Gynecol 2005; 192: 1407-1409. [ Links ]
10. Hall MH. Guessing the weight of the baby. Br J Obstet Gynaecol 1996; 103: 734-736. [ Links ]
11. Johnson RW, Toshach CE. Estimation of fetal weight using longitudinal mensuration. Am J Obstet Gynecol 1954; 68: 891-896. [ Links ]
12. Johnson RW. Calculations in estimating fetal weight. Am J Obstet Gynecol 1957; 74: 929. [ Links ]
13. Jeffery BS, Pattinson RC, Makin J. Symphysis-fundal measurement as a predictor of low birthweight. Early Hum Dev 2001; 63: 97-102. [ Links ]
14. Bothner BK, Gulmezoglu AM, Hofmeyr GJ. Symphysis fundus height measurements during labour: a prospective, descriptive study. Afr J Reprod Health 2000; 4: 48-55. [ Links ]
15. Loeffler FE. Clinical fetal weight prediction. J Obstet Gynaecol Br Cwlth 1967; 74: 675-677. [ Links ]
16. Niswander KR, Capraro VJ, Van Coevering RJ. Estimation of birth weight by quantified external uterine measurements. Obstet Gynecol 1970; 36: 294-298. [ Links ]
17. Woo JS, Ngan HY, Au KK, Fung KP, Wong VC. Estimation of fetal weight in utero from symphysis-fundal height and abdominal girth measurements. Aust N Z J Obstet Gynaecol 1985; 25: 268-271. [ Links ]
18. Chauhan SP, Cowan BD, Magann EF, Bradford TH, Roberts WE, Morrison JC. Intrapartum detection of a macrosomic fetus: clinical versus 8 sonographic models. Aust N Z J Obstet Gynaecol 1995; 35: 266-270. [ Links ]
19. Sadah-Mestechkin D, Walfisch A, Shachar R, Shaham-Vardi I, Vardi H, Hallak M. Suspected macrosomia? Better not tell. Arch Gynecol Obstet 2008; 278: 225-230. [ Links ]
20. Buchmann EJ, Libhaber E. Accuracy of cervical assessment in the active phase of labour. BJOG 2007; 144: 833-837. [ Links ]
21. Buchmann EJ, Libhaber E. Sagittal suture overlap in cephalopelvic disproportion: blinded and non-participant assessment. Acta Obstet Gynecol Scand 2008; 87: 731-737. [ Links ]
22. Notelowitz M. The graphic monitoring of labour. S Afr J Obstet Gynaecol 1973; 11: 3-10. [ Links ]
23. Theron GB. Perinatal Education Programme. Manual I. Maternal Care. Cape Town: Perinatal Education Trust, 1993. [ Links ]
24. Essel JK, Opai-Tetteh ET. Macrosomia maternal and fetal risk factors. S Afr Med J 1995; 85: 43-46. [ Links ]
25. Buchmann EJ. Perinatal health in the Chiawelo district of Soweto. Maternal characteristics and clinical outcomes. CHASA J Compr Health 1996; 7: 118-123. [ Links ]
26. Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the United States, outcomes and proposed grades of risk. Am J Obstet Gynecol 2003; 188: 1372-1378. [ Links ]
27. Chauhan SP, Grobman WA, Gherman RA, et al. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol 2005; 193: 332-346. [ Links ]
Accepted 24 February 2009.
* Corresponding author: E Buchmann (firstname.lastname@example.com)


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First Global launches phase two of Music - Perfect Pitch for A Sound Education
BICKERSTETH, St James - Principal of the Bickersteth Infant and Primary School in St James, Vivian Douglas has hailed the stakeholders for taking the bold step in continuing the Music - Perfect Pitch for A Sound Education project at his school.
"We have benefited tremendously from the programme and we have seen where it has really foster growth and development in the learning environment. Teachers and students are quite enthused. It has also impacted on the community, as the students are playing music at community functions," Douglas explained.
The programme is a joint initiative between the Grace Kennedy -owned First Global Bank and First Global Financial Services, who are providing funding to the tune of over $3 million for the 2013/2014 phase two segment, with the Ministry of Education providing the necessary expertise to see to the full potential of the project.
In October 2011, the programme was rolled out in six schools in St James, Manchester and Kingston, following researches, which showed that students who are exposed to music develop sound literacy and numeracy skills.
The initiative was geared towards grade three students, whose performance saw marked improvements in all the schools during the one-year trial run. Having witnessed the level of success among students, as well as their personal involvement in the programme, teachers had been calling for its resumption since last October.
And speaking at the launch of phase two of the programme, Education Minister Ronald Thwaites lauded GraceKennedy for the initiative.
"With this spectacular contribution that this programme has witnessed so far, it is to be congratulated," Thwaites emphasised. "The question in my mind is how are we going to take this successful model and extend it throughout the entire education system with 800 primary schools in Jamaica."
Against this background, Thwaites called on the private sector to emulate First Global's model, in an bid to enable more children to beat illiteracy.
Now you can read the Jamaica Observer ePaper anytime, anywhere. The Jamaica Observer ePaper is available to you at home or at work, and is the same edition as the printed copy available at http://bit.ly/epaperlive
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text:
2016 Toyota Tacoma Truck the popular one that will have the new design, All New Toyota Tacoma has undergone a change to confront the global automotive market competition is getting tougher. Toyota Tacoma will offer some of the latest generation engine-powered variant. Toyota is one of the producers of trucks that can not be underestimated. The same strategy seems to be also carried out by Toyota launched the latest edition of Tacoma who was prepared as one of Toyota's weapons to face intense competition from trucks. We will discuss the 2016 Toyota Tacoma specs for truck lovers.
2016 Toyota Tacoma Diesel Concept
2016 Toyota Tacoma will come up with a new design that is more modern and classy. 2016 Toyota Tacoma exterior design will be changed by adopting the platform of the Toyota Tundra. Toyota Tacoma change on the front has a sharp design and cool front grille makes the car is more masculine. As for the 2016 Toyota Tacoma interior design will also experience changes to the cabin look. All New Toyota Tacoma will provide features with advanced technology, some new technologies such as the entertainment system and a navigation system. New Toyota Tacoma will increase the sense of comfort and convenience to support this truck inside the cabin.
2016 Toyota Tacoma Diesel Engine
2016 Toyota Tacoma is the latest edition will provide some reliable machine to cope with heavy duty. According to rumors circulating, Toyota Tacoma 2.4 liter engine will use the inline-4 engine to trim the base. Toyota Tacoma engine will also be available in the 4.0-liter V6. We hope the New Toyota Tacoma will provide the engine that had an impressive performance.
2016 Toyota Tacoma Release Date and Price
2016 Toyota Tacoma Truck is one that will have a new look. Toyota Tacoma will offer advanced features to increase the value of leisure and entertainment in the cabin. Toyota has yet to provide confirmation of the release date of 2016 Toyota Tacoma. However, from some of the rumors, Toyota Tacoma the latest edition will be announced at the Detroit Auto Show 2015. As for the 2016 Toyota Tacoma price information will be sold starting at $ 20.765.


text:
** Chats Lobby
Start: 20:15:54
vee: testing testing
Start: 21:00:44
vicky: hello you two!
Seventies Soulchild: Hi vicky & 3rd
vicky: you see I am on time lol
Seventies Soulchild: LOL Now we can stop talking about you being CPT...lol
vicky: lol that might not last very long
Seventies Soulchild: lol So what's new with you all? Ancestry got me... :{
vicky: I am feeling pretty good tonight. I found some missing relatives for a friend of mine
Seventies Soulchild: OK
vicky: why the mean face lol
Seventies Soulchild: Well it was an unexpected charge and I only keep but so much in the checking acc't.... And it was just the first of the month....
vicky: call them now and cancel, they are 24 7
3rdthawkins: hello Seventies and vicky
vicky: they did that to me once and I cancelled lol . Then started up the next month They should at least give you a warning
Seventies Soulchild: So I didn't know, if I hadn't gone to the bank for another reason today... but I just transferred from my savings...BUT I still was pissed and the charge has gone up AGAIN
vicky: hi 3rd! what!!! how much?
Seventies Soulchild: with tax for 1 yr $168
3rdthawkins: What Tha!
vicky: wonder if they announced that
Seventies Soulchild: Yeah that's what I said...
3rdthawkins: of course not vicky
Seventies Soulchild: When I first joined it was $99!
vicky: yeah me too
3rdthawkins: I didn't get a newsletter about that one
Seventies Soulchild: That's for U.S. Deluxe Its $12.95 a month
3rdthawkins: annual, right?
vicky: I didn't either.. I used to get a call before they went up as a courtesy
Seventies Soulchild: New management!
vicky: sheesh!! that should not make a difference
3rdthawkins: sure are trying to manage our wallets
Seventies Soulchild: oh but it does! I'm going to have to use family search more often!
vicky: I don't mind paying because its the best thing going but I would like to make up my own mind on whether I want to pay or not
AYWalton: Good evening all.
3rdthawkins: hello AY and alt
Seventies Soulchild: Right vicky Hi alt & AYWalton
AYWalton: Howy 3rd, alt, SoulChile, Ms. Vicky!
vicky: hello AYWalton and alt!
AYWalton: hope you are all well.
alt: Hello AYWalton 3rdthawkins Seventies Soulchild vicky
3rdthawkins: Familysearch is gaining ground on Ancestry, I think...........just have to do without images
vicky: heyyy missy are you in Samford
Seventies Soulchild: ooh what was that noise! lol
3rdthawkins: relie on index
AYWalton: lol, not yet. Traveling tomorrow. Orientation starts in the afternoon.
vicky: ok
Seventies Soulchild: Have a good time in B'ham...
AYWalton: I intend to, SoulChile. should be fun!
alt: yes, enjoy yourself and have a good week AYWalton
Seventies Soulchild: Yes...and make sure you hit the 'neighborhood'
vicky: lol lol
AYWalton: looking for the ribs joint in advance. Putting out the word that I want some. lol
Seventies Soulchild: lol
alt: Familysearch is putting up some good stuff 3rdthawkins, but a looong way to go to catch Ancestry
vicky: oh Seventies, I went in to look at Frenchy's obit and found one for my paternal great uncles wife. I was in total shock
Seventies Soulchild: What?! Oh wow! When did she pass?
AYWalton: who is Frenchy?'
vicky: I called one of my cousins and he told only one person and they did not send the msg out
AYWalton: You don't mean the singer. or do you?
vicky: nope not her AYWalton
AYWalton: oh!!
Seventies Soulchild: Frenchy's is a restaurant and a food line started by Percy Creuzot
3rdthawkins: yeah, I may subscribe to ancestry when I really need to then cancel, in the meantime, I'll go to the library if they have a record I need........for now on, it seems I need to start buying records
AYWalton: who is Frenchy that you are referring to?
vicky: her name is Odessa H Davis seventies and she taught for years at Booker T in H-town
Seventies Soulchild: Percy Creuzot the owner recently passed. A big deal in houston.
AYWalton: ahhhh ok.
Seventies Soulchild: Wow.
vicky: http://www.legacy.com/obituaries/houstonchronicle/obituary.aspx?n=odessa-h-davis&pid=143102719
AYWalton: is she the same French that SoulChile is talking about?
vicky: up at the top I saw his name and just happened to look down and saw her
Seventies Soulchild: Oh they're had her funeral at Wheeler Ave. Baptist... nice... No one in the family told you about her passing?
vicky: no AYWalton , Sharon mentioned that the owner of Frency's died so I went in to look for the obit
AYWalton: ahhh ok, now I follow you.
vicky: Frenchy, seventies claims has the best chicken so I tried one when I went to Houston
AYWalton: so how was the chicken?
vicky: lol
Seventies Soulchild: That's not a claim, its a bonified FACT, get it right ms vicky! lol
AYWalton: lol
vicky: well I guess it was awright
AYWalton: well there is one Church's franchise in Muskogee Oklahoma that folks drive from out of state to get. Don't be fooled by the Church's affiliation---two sistas own it and it will make you slap yourself!!!
Seventies Soulchild: Let me stop before I let my mouth get in trouble! lol
vicky: so based on the bragging she was doing her and Seraph I thought I would read his obit
AYWalton: anytime I am in Arkansas I get somebody to drive to Muskogee with me to get some of the sista's chicken! yes, stop while it's early SoulChile.
Seventies Soulchild: Oh so they use their own secret recipe huh?
AYWalton: oh yes!!!
3rdthawkins: Church's sho' is good AYWalton
vicky: lol seventies had me driving all over town with her "try this", and "go here' stuff lol lol
AYWalton: and folks run into folks they have not seen in ages---at Muskogee's Church's.
3rdthawkins: Guess they don't know nothing bout that
Seventies Soulchild: I'm tempted to post that skit by Ricky Smiley.... lol LOL That's the spot then AYWalton
AYWalton: oh yes---it is always a treat!!
Seventies Soulchild: Hey you had a good time didn't ya?!
3rdthawkins: I'm a witness AYWalton
AYWalton: If that place ever shuts down, they may as well close down the state!
vicky: oh yeah I did lol
3rdthawkins: lol AY
Seventies Soulchild: lol
3rdthawkins: haven't had Church's in a long time
Seventies Soulchild: Me either 3rd
3rdthawkins: hello Selma
Selma: Evening everyone...
Seventies Soulchild: Hi Selma
vicky: every town has their "best there is" food hi Selma!
Seventies Soulchild: Why I love the Food Network...
Selma: You packed AY?
Seventies Soulchild: You're going too right Selma?
Selma: Nope my reservation was messed up..haven't figured out if they did it or I did I..I thought I was going
vicky: alt, my daughters co-worker scratched a 20 dollar ticket and hit the mil dollar prize
Selma: Wow........big prize vicky
alt: WOW!!!!!!!
AYWalton: amazing!!
vicky: yep it sure is
AYWalton: howdy Ms Selma! I did not see you come in. I was doing other things---like packing!
Selma: LOL
vicky: sorry to hear Sel that you are not going mabe the next one
alt: Hello Selma
Selma: Me too...I had it on my calendar since January
Seventies Soulchild: oh just crash it! lol
Selma: I thought about that too seventies
Seventies Soulchild: Well they didn't take your money did they?
Selma: No they did not take my money...I sent my money, and they very nicely called me to say, they did not have my registration which I had completed on line
Seventies Soulchild: oh that's got to be annoying
Selma: So they put me on the waiting list, but folks were not dropping out, so I am not going..and I am pissed cause I wanted to go..but thats Life
Seventies Soulchild: Well now you have a few extra dollars to buy something for yourself
Selma: I got company coming to visit...I am sure I will spend the money.. LOL
Seventies Soulchild: Silver lining in every cloud! lol
Selma: Very good post on Genealogy Theft AY..although the folks who do that would read and say "Thats not me"..
3rdthawkins: It is common courtesy to show some kind of gratitude and thanks
vicky: lol @ Selma
Seventies Soulchild: I agree 3rd...
AYWalton: oh thanks, Selma. We know how that goes with some folks. And they will never recognize themselves. (still multi-tasking) so Vicky, any Mariah leads?
vicky: nawww Aywalton, non at all
3rdthawkins: you're better off asking me if I found anything on my great grandfather Robert Johnson
AYWalton: I am still trying to zoom in on a USCT, vicky.
Selma: There is another picture of enslaved children in the VHS collection trying to find.
Seventies Soulchild: Who are you particularly looking for AYWalton?
vicky: I have been going page by page now on that agri census to see if can get a hit
AYWalton: trying to find one in TX.
vicky: ok AYWalton, you know I am waiting :o
AYWalton: when I am in Samford at the hotel at night I shall be on the hunt.
vicky: I am waiting to be an adopted genie
AYWalton: will miss Selma not being there. She was going to be my conference buddy.
Seventies Soulchild: I should be getting my USCT pension file sometime soon. I hope that this Charles Rounds & mother Charity Rounds are my relations. That would add a new person to my family tree. Someone who had been missing.
AYWalton: Vicky what is the cemetery that Lawrence Taylor is buried in?
vicky: yeah AYWalton I hear ya St Johns Baptist Church Cemetery
alt: you and Deborah Abbott should 'fit' well together AYWalton .
Seventies Soulchild: retirees and lotto winners have so much fun! I'm jealous! lol
AYWalton: ok, thanks. I have never met her, alt. I know who she is, though.
alt: you will like her.
vicky: who are those two together seventies lol
Seventies Soulchild: lol
Selma: http://vhs3.vahistorical.org/starweb/vhs/servlet.starweb See if that works
Seventies Soulchild: hey ryan
AYWalton: Selma there is an error message with that link.
alt: error detected Selma
AYWalton: howy ryan.
vicky: error selma
ryan: hey 70s, Vicky, 3rd, Walton
alt: Hello ryan
vicky: hello ryan!
Selma: Umm..
Seventies Soulchild: tonight is movie night at the Soulchild house.. lol
Selma: I am trying to copy and past, but it won't let me
ryan: Walton, liked your youtube presentation (a little basic for most of *us*) but I found some good points too, thx
vicky: whats a movie Soulchild?
alt: copy & use crtl v
Seventies Soulchild: And we're getting ready to watch Cadillac Records. . . y'all have a good weekend y'all
AYWalton: glad you enjoyed it, ryan, thank you.
Seventies Soulchild: LOL Vicky you know that thing that plays at the movie theatre... a moving picture.. lol
vicky: you and the younguns
ryan: Vicky, I've been on the Zephyer hunt too, nothing yet.
vicky: lol @ seventies
ryan: 3rd, found some stuff on Lum, in ms
Seventies Soulchild: Yea they are not youngins anymore but men in training.
vicky: peeped around a bit today ryan myself
Seventies Soulchild: Alright have a good night everyone...
AYWalton: I see the sound is different upon exiting, now. Ahh---------and the names are back on the right!!! Just noticed that!
vicky: yes
AYWalton: yay!!!
Selma: Yes......vkn did it on Friday..oh happy day
ryan: I'll tell you, I think there is a spelling "situation" on those Zephyers, because though they show from, MS they are hard to find
AYWalton: wonderful!!! It feels better, now.
vicky: tsc, tsc AYWalton I'am telling vkn you did not notice yesterday lol
AYWalton: I was not online yesterday, I was at the archives. so I have a good excuse. lol
vicky: oh ok you are excused lol
AYWalton: was getting in a good 2 hours at ArchivesII.
Selma: Oh did you find any goodies
AYWalton: Selma have you ever researched there?
Selma: Just that one time I visited..and found the Danish slave records
AYWalton: yes, was still getting letters from some boxes. Amazing stuff.
Selma: You didn't send me the email you said you would ..on the letters
vicky: what they just bring a box down. is there any indication what is in each box
ryan: Zephyr augustin 24 m b la la orleans 6-wd new orleans 1870
Selma: She must be packing vicky...LOL
vicky: lol must be
AYWalton: ok back----yes, I am, lol ok I am trying to remember I was going to send you.........
Selma: Don't forget your tooth brush
AYWalton: bought a new one! probably won't get much sleep tonight. Thinking about other things to take
vicky: I will look at that one ryan
ryan: vicky - i think you know this one zepher i 28 m b ms tx brazos millican 1880
AYWalton: Oh Selma did you see my blog? I put up some items that I got last week from the Freedman's Bureau. (I also mentioned your name!)
vicky: yes ryan isom I think
Selma: Yes, I saw it... LOL
AYWalton: Not sure if the letter was legible, though.
Selma: Are you going to put the names that are in the letter?
AYWalton: I plan to transcribe it, yes. And that Buck Bushyhead I think was a Cherokee Freedman, and his widow filed for a pension, so he did not live long enough to the Dawes era. but the notation said he was black Choctaw. howdy Ingrid_Doweary.
Ingrid_Doweary: Howdy AY, Vicky, Alt, Ryan and Selma
AYWalton: yes, but that is a Cherokee name, so it will be interesting. when I come back from Samford, I will get the pension file. ProfessorDru is in da house!!!
Ingrid_Doweary: Hey ProfDru.
ProfessorDru: hey gang
AYWalton: how's it going? how did your presentation go?
vicky: AYWalton how much are the copies at NARA if you get them yourself?
ProfessorDru: It went well, Angela
vicky: hello ProfDru
AYWalton: these days I am using my digital camera, so the copies are free.
vicky: ahhh Ok
alt: Hello Dru
AYWalton: sometimes I make paper copies, but I am getting away from that if I can. If you order it, the cost is about $65 or something. SoulChile has ordered some---but the wait is long.
vicky: after you download to computer do you put then on a disc
ProfessorDru: I've been on Twitter all day chatting with attendees of the Southern California Jamboree
3rdthawkins: hello ryan Ingrid and Pro Dru..................ryan, so you found something on Lum?
AYWalton: I have a portable hard drive. I put images on that. that link worked, Selma.
Selma: I don't know how I did that...I was sending to myself... LOL
AYWalton: they had a great time, for sure. Have you considered going next year, Dru?
ProfessorDru: Depends on how things are with my grandmother, Angela. That's why I decided not to go.
AYWalton: Ahhh I can understand.
ProfessorDru: Have you been before, Angela?
3rdthawkins: ryan, I'm trying to see if there's any connection to South Carolina, the name is pretty much none existent until 1900s, but most are from China, I did find that there was a name similar to the Chinese name Lum/Lin, but I am coming up short in S.C., starting to do what my gf's sister put
AYWalton: no I have not attended. I would love to. But being on the other side of the country I would have to weigh my options.
ProfessorDru: When is the AAHGS conference? The website is not updated.
AYWalton: and this year---going to Samford cut into my budget. AAHGS is first weekend in October.
ProfessorDru: I understand, Angela When does the call for papers end?
AYWalton: http://aahgsnews.wordpress.com/2010/05/07/aahgs-annual-conference-call-for-papers-2010/
3rdthawkins: do=doubt ryan
ProfessorDru: or rather due?
AYWalton: July 30th. are you going to submit?
ProfessorDru: Thanks Selma
AYWalton: perhaps you should submit also for the Jamboree, ProfessorDru.
vicky: Pro dru was Lisa Lee in on the tweet
ProfessorDru: Not sure I didn't see Lisa on the Tweet today.
AYWalton: I don't think she tweets that much. I see that Elys the young girl met Megan Smolenyak.
Selma: Who is Elys?
vicky: Mariah is that you lol
3rdthawkins: lol vicky
ProfessorDru: It was quite exciting to read tweets from different people about what was being said at sessions.
vicky: as I am putting on my tennis
AYWalton: She is a young girl about 18-19 years old who makes genealogy videos. She was a speaker, I think at Samford.
vicky: good seeing young people involved AYWalton
AYWalton: true. well, it's 10 pm and I gotta keep packing. I hope to briefly pop in during the brunch tomorrow, folks. from Alabama. so I had better run.
Selma: Make sure you give us daily updates..
ProfessorDru: Are you planning to attend AAHGS this year, Angela?
AYWalton: Yes, I plan to, Dru. I shall do that, Selma. I plan to submit a proposal as well. Better run, folks. Have a great evening everyone.
Selma: I gotta run too folks..have a great evening
ryan: Sorry 3rd.. Well, I did a google site search, on the msgenweb site and there were a few hits on Lum, some were first name
3rdthawkins: hmmm any S.C. connections
ryan: Google site search, is pretty neat, and powerful.. 1860 Census Results: 11 Expand by State 1870 Census Results: 11 Expand by State 1880 Census Results: 25 Expand by State 1900 Census Results: 18 Expand by State 1910 Census Results: 15 Expand by State 1920 Census Results: 11 Expand by State 1930 Census Results: NA
3rdthawkins: yeah, I've tried it, but not too much, it only led me to the Chinese name Lum/Lin
ryan: those are all ms
3rdthawkins: oh ok seem like it gets bigger than smaller numbers
ryan: yea, those are from heritagequest
alt: AA Lums on Ancestry by Census year .... Results 11 1850 United States Federal Census 8 1860 United States Federal Census 61 1870 United States Federal Census 20 1880 United States Federal Census 94 1900 United States Federal Census 554 1910 United States Federal Census 94 1920 United States Federal Census 26 1930 United States Federal Census 1 U.S. Federal Census Mortality Schedules, 1850-1885
3rdthawkins: hmm, ok, thx alt
vicky: gotta go nite nite
3rdthawkins: nite vcky vicky
ryan: There you go 3rd, lots of possibilities (smirk).. as they say, all roads through virginia, well tennessee, well really, mississippi
alt: SC LUMS Search Results 4 1900 United States Federal Census 14 1910 United States Federal Census 4 1920 United States Federal Census 3 1930 United States Federal Census
3rdthawkins: I'm looking for Moses Lum, married a Phills/Phyllis (Perkins) 1870-1890
ryan: Lum moses G. 22 w ms ms lincoln montgomery 1880
alt: no hits for Moses Lum on ancestry
ProfessorDru: gotta go
ryan: Yea, like I said, Mississippi
3rdthawkins: they had at least one child Jessie (my grgr gm)......Phillis had other children Sidney, Susan, and Henry Perkins
ryan: would moses g be yours?
3rdthawkins: but this was from my grandfather's sister's research, so don't know where she got the infor
ryan: would moses g be yours?
3rdthawkins: don't know, have to look at the census hold on for a min
ryan: this moses g I found in MS is white
3rdthawkins: wonder what happened to them
Ingrid_Doweary: I don't know 3rd. I was just listening and completing family tree information. Please continue your summary results.
3rdthawkins: well, I was going to tell ryan I didn't think that Moses was mine, for one he's white, another he's in MS, my grgr gm was born in S.C.
Ingrid_Doweary: You reviewed more than one census year?
3rdthawkins: my grgr gm was born in 1870 or 1880 in S.C., MS is too far away
Ingrid_Doweary: What other sources could you review?
3rdthawkins: well, I've been looking through S.C. death records, just a few lums, nothing mentioning moses lum, some with moses and phills as parents but nothing that's definitive........I can't even find Phillis's other children she had I did first name searches, nothing matches, even with the spouses and children
Ingrid_Doweary: What about statewide marriage records?
3rdthawkins: No statewide, they are only county, and most didn't start mandating it until 1900s, Charleston County have them from 1877 to present part of Charleston Co turned into Berkeley Co. in 1882, where I believe my grgr gm was born
Ingrid_Doweary: Are you able to identify the nearest historical society or genealogy society for the counties that you are researching?
3rdthawkins: I don't know if they county, I know there one for the state
Ingrid_Doweary: Well hopefully you have your research findings written down. Perhaps the other researchers may be able to offer additional sources to consult. Sorry, I was not of much help. Talk with you next time. Good nite.
3rdthawkins: good nite


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Home > Health Library > Pacemaker: Living Well With It
A pacemaker keeps your heart from beating too slowly. It's important to know how this device works and how to keep it working right. Learning a few important facts about pacemakers can help you get the best results from your device.
You may have a device that combines a pacemaker and an implantable cardioverter-defibrillator (ICD), which can shock your heart back to a normal rhythm. To learn more about ICDs, see Heart Problems: Living With an ICD.
When you have a pacemaker, it's important to avoid strong magnetic and electrical fields. The lists below give some safety guidelines for pacemakers and ICDs. They show some electrical and magnetic sources and how they may affect your pacemaker. For best results, follow these guidelines. These safety tips also apply to devices that combine an ICD and a pacemaker. If you have questions, check with your doctor.
Your doctor or the manufacturer of your pacemaker can give you a full list of things that you need to avoid and things that are safe to use.
Some pacemakers have an alarm system that can tell you when to call your doctor. The alarm does not mean that your pacemaker is not working. It means that your doctor needs to check something on your pacemaker. For example, an alarm might mean that the battery needs to be checked.
Your doctor can tell you what your alarm will sound like or feel like. You might hear beeping. Or you might feel a vibration, like a cell phone vibration.
Call your doctor right away if you hear or feel an alarm.
Many medical tests and procedures won't affect your pacemaker. But some procedures include electromagnetic fields that could affect how your pacemaker works. To be safe:
You can travel safely with a cardiac device. But you'll want to be prepared before you go.
You can drive if you have a pacemaker and you don't have any symptoms such as fainting. But right after you get a pacemaker, your doctor may ask you to not drive for at least a week after the device is implanted. This gives you time to heal.
Pacemakers often are used to improve your ability to exercise. Most people with pacemakers have active lives and can exercise. Talk to your doctor about the type and amount of exercise and other activity you can do.
In general:
Most people who have a pacemaker can have an active sex life. After you get a pacemaker implanted, you'll let your chest heal for a short time. If your doctor says that you can exercise and be active, then it's probably safe for you to have sex.
Talk with your doctor if you have any concerns.
As you plan for your future and your end of life, you can include plans for your pacemaker. You can make the decision to turn off your pacemaker as part of the medical treatment that you want at the end of life. You can put this information in your advance directive.
Call your doctor right away if you have symptoms that could mean your device isn't working properly, such as:
Call your doctor right away if you think you have an infection near your device. Signs of an infection include:
Other Works Consulted
Indik JH, et al. (2017). 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm, 14(7): e97–e153. DOI: 10.1016/j.hrthm.2017.04.025. Accessed May 25, 2018.
Baddour LM, et al. (2010). Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation, 121(3): 458–477.
Lampert R, et al. (2010). HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm, 7(7): 1008–1026. Available online: http://www.hrsonline.org/Policy/ClinicalGuidelines/upload/ceids_mgmt_eol.pdf.
Lee S, et al. (2009). Clinically significant magnetic interference of implanted cardiac devices by portable headphones. Heart Rhythm, 6(10): 1432–1436.
Levine GN, et al. (2012). Sexual activity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 125(8): 1058–1072.
Swerdlow CD, et al. (2015) Pacemakers and implantable cardioverter-defibrillators. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 721–742. Philadelphia: Saunders.
Tjong FVY, Reddy VY (2017). Permanent leadless cardiac pacemaker therapy. Circulation, 135(15): 1458–1470. DOI: 10.1161/CIRCULATIONAHA.116.025037. Accessed March 21, 2018.
Wilkoff BL, et al. (2008). HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDS): Description of techniques, indications, personnel, frequency, and ethical considerations. Heart Rhythm, 5(6): 907–925. Available online: http://www.hrsonline.org/Practice-Guidance/Clinical-Guidelines-Documents/HRS-EHRA-Expert-Consensus-on-the-Monitoring-of-Cardiovascular-Implantable-Electronic-Devices/2008-Monitoring-of-CIEDs.
Zipes DP, et al. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 9: Arrhythmias and conduction defects: A scientific statement from the American Heart Association and American College of Cardiology. Circulation, 132(22): e315–e325. DOI: 10.1161/CIR.0000000000000245. Accessed April 7, 2017.
Current as ofJuly 22, 2018
Author: Healthwise StaffMedical Review: E. Gregory Thompson, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineKathleen Romito, MD - Family MedicineElizabeth T. Russo, MD - Internal MedicineAdam Husney, MD - Family MedicineJohn M. Miller, MD, FACC - Cardiology, Electrophysiology
Current as of:
July 22, 2018
Healthwise Staff
Medical Review:E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & Adam Husney, MD - Family Medicine & John M. Miller, MD, FACC - Cardiology, Electrophysiology
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content.
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Last month, the Bank of England issued a report that must have made Fed chairman Ben Bernanke squirm.
It said that the Bank of England's policies of quantitative easing - similar to the Fed's - had benefited mainly the wealthy.
Specifically, it said that its QE program had boosted the value of stocks and bonds by 26 percent, or about $970 billion. It said that about 40 percent of those gains went to the richest 5 percent of British households.
Many said the BOE's easing added to social anger and unrest. Dhaval Joshi, of BCA Research wrote that "QE cash ends up overwhelmingly in profits, thereby exacerbating already extreme income inequality and the consequent social tensions that arise from it."
The BOE countered that the benefits of easing may have trickled down, and that "without the Bank's asset purchases, most people in the U.K. would have been worse off."
Still, the paper is instructive for the United States. The latest round of QE announced by Bernanke yesterday has sparked growing controversy about how Fed policy has mainly helped the wealthiest Americans. (Read more: The One Percent Gives Up Ground ... to the Five Percent)
Economist Anthony Randazzo of the Reason Foundation wrote that QE "is fundamentally a regressive redistribution program that has been boosting wealth for those already engaged in the financial sector or those who already own homes, but passing little along to the rest of the economy. It is a primary driver of income inequality."
Donald Trump - not usually one for distributional analyses of monetary policy - said on CNBC yesterday that "People like me will benefit from this."
The reason is simple. QE drives up the prices of assets, especially financial assets. And most of the financial assets in America are owed by the wealthiest 5 percent of Americans.
According to Fed data, the top 5 percent own 60 percent of the nation's individually held financial assets. They own 82 percent of the individually held stocks and more than 90 percent of the individually held bonds.
By helping to reinflate the stock market in 2009 and 2010, the Fed created a two-speed recovery. The wealthy quickly recovered much of their wealth as stocks doubled in value. But the rest of the country, which depends on houses and jobs for their wealth, remained stuck in recession.
Put another way, most Americans have most of their wealth tied up in their houses (about 50 percent for most). For the top 5 percent, homes account for only 10 percent of wealth, while financial assets account for between one third and 40 percent.
By boosting the value of financial assets, Fed has helped the economy of Richistan but not the broader United States.
Bernanke is obviously aware of this criticism, which is why the latest round of easing is focused on mortgages. But here too, there is a divide between the rich and the rest. Despite lowered rates, banks remain strict on lending, restricting access to credit for most Americans. The wealthy and the asset-rich, however, will now enjoy even lower rates on their credit.
In other words, while Mark Zuckerberg can get a 1.05 percent mortgage, most American's can't.
Of course, low interest rates also penalize savers, and the wealthy as a group have the largest savings pool in America. If you ask the wealthy today what their biggest investment challenge is, it's finding low-risk yield when CD's and Treasurys pay next to nothing. (Read more: Ultra Rich Ready to Return to Stocks)
But that hardly undoes the advantages of easing. According to Spectrem Group, the wealthy have only about 13 percent of their investible assets in cash, and the rest (more than 85 percent) in stocks, bonds, alternative investments and mutual funds - all of which have benefited from easing.
I'm not taking a position on whether the Fed should ease or not. The benefits for the broader economy may indeed outweigh the costs. And no one else in Washington seems to be doing much in the way of policy to help the unemployed these days.
The question, though, is whether putting more profits into the hands of the top 5 percent will really generate jobs for the rest of America. So far, the evidence is not promising.
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Computer Science ColloquiumIm Rahmen des Informatik-Kolloquiums, das von den Instituten des Fachbereichs Informatik, der Österreichischen Gesellschaft für Informatik (ÖGI), der Arbeitsgemeinschaft für Datenverarbeitung (ADV) sowie der Österreichischen Computergesellschaft (OCG) abgehalten wird, spricht
Assoc. Prof. Dr. Jim Warren
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Director of Advanced Computing Research Centre (ACRC)über das Thema:
How Much Structure? - The Problem of Chronic Disease Management Decision SupportZeit: Fri 16.11.2001, 10:15, 60 Minuten
Ort: MZ412A
ZusammenfassungThere are distinct opportunities in providing expert advising agents to help General Practice physicians in devising care plans for the chronically ill. However, such agents are nontrivial to devise and require structured input on which to operate. Many other opportunities lie in using patient-centred secure Internet technology simply to facilitate
VortragenderAssoc. Prof. Warren is Director of the Advanced Computing Research Centre at the University of South Australia. He received his PhD in Information Systems in 1992 from the University of Maryland. For the past 10 years he has increasingly focused on the problems of health informatics, particularly the design of clinical workstations for General Practice physicians. His particular interest is the role of non-anthropomorphic agency and decision support that integrates with conventional information processing (i.e., a user shouldn't have to go to a separate decision support system or expert system to get help). He has led the development of a number of health information systems, his most recent being
Einladender: Prof. Dr. Michael Schrefl
Institut für Wirtschaftsinformatik
Data and Know
Liste aller Vorträge


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MeritBadgeDotOrg talk:Usage standards policy
From MeritBadgeDotOrg
| Please familiarize yourself with Help:Talk pages before posting on discussion (a.k.a. talk) pages.
— Use headings, indentations; and please, always sign (~~~~) your posts. (See Help:Talk pages for details.)
— Ask your Scouting/advancement-related questions on our forums... several Scouters will be happy to help you.
Gramatical error
I found a gramatical error on this page, but the page is locked so I can't fix it. In the section "What is the primary source of advancement requirements?", the last sentence of the first paragraph reads "The are two exceptions to this rule:". I think you meant "There are two exceptions to this rule:". Scoutaholic
- Got it; thanks, --RWSmith 16:58, April 24, 2007 (EDT)
I don't meet these criteria. 441Us 07:24, October 11, 2010 (EDT)
- I suggest that you register on MeritBadge.Net, which is our sister site. (Please use the same username and email address on both sites.) If you can successfully register there, then I will be able to determine whether or not to allow (and exception for) you to remain registered here. Fair enough? —RWSmith (Bureaucrat), 21:03, October 11, 2010 (EDT)
- Update: User account blocked. —RWSmith (Bureaucrat), 17:43, September 14, 2011 (EDT)


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debbiemidson on Family Tree Circles
view: full | list
Journals and Posts
Looking for McDowell Family from Ballymena, County Antrim, Northern Ireland and New Zealand
Searching for family of Alfred Michael McDowell born 24 January 1906 in Ballymena, County Antrim, Northern Ireland.
Mother: Ellen McDowell
Father: John Patrick McDowell
1st Wife: Sophie Esther Anderson (daughter: Patricia Mary Chadwick)
2nd Wife: Jean Mildred Tanner (two sons(?))
Died 24 January 1973 in Auckland New Zealand.
Looking for Dumbleton Family of England, New Zealand, India, Nairobi
Looking for family of Arthur Roderick Dumbleton (born 1864 in India) who married Mary Phoebe Stewart of Katikati in 1885. They had children:
Lawrence Philip Dumbleton born 1893
Gordon Mervyn Charles Dumbleton born 1887
Frances Mary Pauline (Anderson) born 1888
Violet Louisa Grace (Brown) born 1891
Arthur's father was Major General Charles Dumbleton who married
Mother Elizabeth Francis Reed in April 1856. Elizabeth was the daughter of General Sir Thomas Reed, G.C.B. General Reed was a Waterloo veteran who was destined to become the provisional
Commander-in-Chief upon the death of Generals Anson and Barnard at the siege of Delhi during the Indian Mutiny.
Arthur Roderick died in Nairobi in 1927.
Looking for Anderson of New Zealand (formerly Norway & Sweden)
Looking for descendants of Olava Anderson (nee Olsen) born in Christiania in Norway in 1861. Married William Anderson (born in Sweden 1856) in 1884 at Wellington, New Zealand. Children:
Charles Gustav Anderson born 1895 (died 1963 age 68)
Oscar Theodore Anderson born 1899 (married Dorothy May Keat 1924)
Berta Olivia Anderson born 1891
Francis Henry born 1887
Emil Percy born 1889 (married Ellen Myers 1912)
William born 1885 (died 1918 age 33)
- Displaying 1-3 of 3 Journals
- 1
- of1


text: « Return to Search Mayor Menino joins The Beal Companies and Massachusetts Eye and Ear to Celebrate the Construction of New Facility October 27, 2011 Contact: Mary Leach Ph.: 617-573-4170 Boston, MA (Oct. 27, 2011) – Mayor Thomas M. Menino, John Fernandez, President and Chief Executive Officer of Massachusetts Eye and Ear Infirmary (Mass. Eye and Ear), Bruce A. Beal, Chairman of The Beal Companies, and Robert Beal, President of The Beal Companies, today celebrated the commencement of construction of Mass. Eye and Ear's new facility in the Longwood area in Boston's Mission Hill neighborhood. In addition to outpatient clinics and surgical facilities operated by Mass. Eye and Ear, the new building will include a café, retail stores and garaged parking. "Building this state-of-the-art facility will create another 125 construction jobs, and 70 permanent jobs in this key industry. Boston's hospitals and medical institutions are the backbone of our economy, and I excited they are thriving and expanding in our city," said Mayor Thomas M. Menino. The property is owned and being developed by The Beal Companies and involves the renovation and expansion of an existing building located at 800 Huntington Avenue. The final building will be approximately 90,000 square feet and contain approximately 150 parking spaces. "This new facility will allow us to meet the growing demand for the specialized services we provide," said John Fernandez, President and CEO of Mass. Eye and Ear. "The proximity to so many hospitals in the Longwood area and to our teaching and research partner Harvard Medical School will allow more opportunities for collaboration in patient care and clinical research initiatives." "We are proud of our continuing role of working with Boston's important medical institutions to expand access to their life changing services and programs into Boston's neighborhoods" said Robert L. Beal, President of The Beal Companies, the owner and developer of the project. "This new facility will not only allow patients to receive care where they live but will bring jobs and economic activity to the area." See a video about the groundbreaking. The project development team includes Tsoi/Kobus & Associates as the project architect and Suffolk Construction as the construction manager. About Massachusetts Eye and Ear Founded in 1824, Massachusetts Eye and Ear Infirmary is an independent specialty hospital providing patient care for disorders of the eye, ear, nose, throat, head and neck. Mass. Eye and Ear is an international leader in Ophthalmology and Otolaryngology research and a teaching partner of Harvard Medical School. Under the direction of Mass. Eye and Ear's board of directors, the Massachusetts Eye and Ear Infirmary and Schepens Eye Research Institute recently formed the world's largest and most robust private basic and clinical ophthalmology research enterprise. The hospital is also home to the Eaton-Peabody Laboratories, a multi-disciplinary group of 24 investigators within 11 research units dedicated to the study of hearing and deafness. For more information, call 617-523-7900 or visit http://www.masseyeandear.org/. About The Beal Companies The Beal Companies, LLP is a full service real estate firm which owns and manages over 3.5 million square feet of real estate in the Greater Boston area. Since 1888, The Beal Companies has established an enviable reputation as a leader in owning, developing, managing and leasing commercial properties, including particular expertise in medical office, surgical, and life science facilities for both institutional and non-institutional uses. Beal acts as a principal and invests in real estate on its own behalf, and on behalf of institutional and individual partners. Additional information on The Beal Companies can be found at www.bealco.com.


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Welcome to our website for all Zen Block Level 67 Solutions. Hello everyone, thank you for visiting our website, here you will be able to find all the solutions for Zen Block. A game created by MagicAnt.Inc a developer of many popular games like Jumpr and Poly jump! Our staff is playing daily this amazing game and is sharing with pleasure with you all the solutions that you need to continue to the next level. Please find below all the solutions.
Zen Block Level 67 Solutions


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ggh wrote:Gee, looking at the list of online folks, you're the only heavy hitter here Hal.
Edit: and fortunately that was untrue again by the time I hit submit
I'd like to consider myself a heavy hitter, despite my post rate. I'm just always stuck in the past and I like to post responsibly. Now I'm getting hassled by the phone company for how I use the internet I pay for, so we'll see if that also effects my posting rate. I hope not. *hoping*
P.S. Congrats tman2nd.


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Essential Piano Loops Vol.1 brings you 156 Essential Piano Loops which can be used in Pop, Rock, Classic Rock, Ambient, Chill out, Fusion, Experimental ,Gospel, Cinematic music production played by prolific modern age pianist Anuj Matthews. These Loops are in WAV and MIDI format and can be played in various scale, tempo, and also the notes can be changed to suite any particular composition and these MIDI loops can be played with other instruments like Harp, Acoustic Guitar or any choice of plucked instruments.
Essential Piano Loops Vol.1 is packed with 156 Piano Loops MIDI and WAV format.
All the loops are 100% royalty-free, so once purchased, you can use them in your commercial release without having any hidden cost.
Specifications Detail:
- 156 Piano loops
- 156 Midi Files
- WAV files
- Loops sync to BPM
- 44.1 kHz/24-Bit
- Instant downloadable
- 100% royalty-free
Each Piano Loop is provided with BPM information and can be mixed, matched with other sounds and loops and edited according to the requirements of any particular production.
- 520 Mb Complete Pack Content.
- 24 bits / 44.1khz
- PC/MAC Compatible (Logic, Cubase, Live, Reason, SonyAcid, Fruity loops, GarageBand, etc...)
- Wav
- Midi
All of the content is 100% royalty-free. Once purchased, you can use these audio loops in your music releases, both commercial and underground, with no restrictions.
How to Order:
Simply click "Add to Cart" BUY COMPLETE. When you finish your order, click "checkout". If you are a new costumer you need create an account, if you are a returning costumer only fill up the form. Your Download Link will be sent in you account in Loophunter immediately after your payment has been received.
For any problem send a email firstname.lastname@example.com
*Note: The previews are low resolution MP3s. The quality of the files you will receive will of course be much higher, uncompressed WAV-AIFF, stereo, 44k, 16-24 bit.
Producer: Zion Music


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Alanis Nadine Morissette (born June 1, 1974) is a Canadian singer-songwriter, guitarist, record producer, and actress. She has won 16 Juno Awards and seven Grammy Awards, was nominated for two Golden Globe Awards and also shortlisted for an Academy Award nomination. Morissette began her career in Canada, and as a teenager recorded two dance-pop albums, Alanis and Now Is the Time, under MCA Records Canada.
Her first international album was the rock-influenced Jagged Little Pill, released in 1995. Jagged has sold more than 33 million units globally and became the best-selling debut album in music history. Her following album, Supposed Former Infatuation Junkie, was released in 1998 and was a success as well. Morissette took up producing duties for her subsequent albums, which include Under Rug Swept, So-Called Chaos and Flavors of Entanglement. Morissette has sold more than 60 million albums worldwide.
Morissette was born in Ottawa, Ontario, Canada, the daughter of Georgia Mary Ann (née Feuerstein), a Hungarian-born teacher, and Alan Richard Morissette, a French-Canadian high school principal. She has a twin brother Wade Morissette (also a musician) who was born 12 minutes after her. Morissette's parents were devout Catholics. She attended Glebe Collegiate Institute (Ottawa, Canada) for high school.


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Hieromartyr Sadoc (Sadoth) the Bishop of Persia
Hieromartyr Sadoc was the hierarch of a Persian district. When the Persian emperor Sapor learned that Sadoc was preaching faith in Christ, he gave orders to arrest and imprison him together with 128 Christian believers. For several months they attempted to persuade the righteous martyrs to repudiate the holy Faith, but unable to accomplish this, they executed them.


text: June 20, 2003 - New Jersey Voters Oppose Newark Arena Plan 3 - 1, Quinnipiac University Poll Finds By a 56 - 19 percent margin, New Jersey voters would prefer to see the New Jersey Devils and the Nets play in the Meadowlands rather than in a new arena in Newark, according to a Quinnipiac University poll released today. Urban voters prefer the Meadowlands 51 - 29 percent, with support growing to 67 - 14 percent among suburban voters. Philadelphia area voters support the Meadowlands 44 - 13 percent with 43 percent undecided. The Devils win the hearts of 43 percent of New Jersey voters who say they are fans, including 20 percent from the Philadelphia 76ers area. The Nets can claim the loyalty of 40 percent of Garden State voters, including 20 percent from Philadelphia Flyers country. "Most New Jersey voters don't root for the Garden State's hockey and basketball teams, even after the Devils won hockey's Stanley Cup. And not many fans - even urban fans - want to see hockey or basketball in Newark," said Clay F. Richards, assistant director of the Quinnipiac University Polling Institute. From June 11 - 16, Quinnipiac University surveyed 815 New Jersey registered voters, with a margin of error of +/- 3.4 percent. The Quinnipiac University Poll, directed by Douglas Schwartz, Ph.D., conducts public opinion surveys in New York, New Jersey, Pennsylvania, Connecticut and nationally as a public service and for research. For additional data -- www.quinnipiac.edu and quicklinks or call (203) 582-5201. 24. Do you think of yourself as a New Jersey Nets fan or not? Tot Men Wom Yes 40% 48% 32% No 55 49 60 DK/NA 5 3 7 25. Do you think of yourself as a New Jersey Devils fan or not? Tot Men Wom Yes 43% 52% 35% No 53 47 59 DK/NA 4 2 6 26. Would you like to see the Nets and Devils continue to play in the Meadowlands or move to a new arena that would be built in Newark? Tot Men Wom Fans(Nets or devils) Meadowlands 56% 55% 56% 64% Newark 19 24 14 26 DK/NA 25 20 30 11


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The Federal OSC directs Federal response efforts and coordinates all other Federal efforts at the scene of a discharge or release. The OSC may monitor local, Tribal, State, or private actions to remove a discharge, and may provide technical assistance to local, Tribal, State, or RP response personnel.
If a response action is being conducted through local, Tribal, State, or responsible party efforts, the OSC will ensure adequate oversight. If local, Tribal, or State agencies or the responsible party cannot or will not initiate action to eliminate the threat, or if the removal is not being conducted properly, the OSC should advise the government agency or responsible party and take appropriate actions to mitigate or remove the threat or discharge.
When the OSC has determined that a discharge poses or may present a substantial threat to public health or welfare, he/she is authorized by the NCP to direct all private, State, or Federal actions to remove the discharge or to mitigate or prevent the threat of such a discharge. In addition, the OSC may remove or arrange for the removal of the discharge to mitigate or prevent the substantial threat of the discharge; the OSC may remove and, if necessary, destroy a vessel that is discharging or threatening to discharge, without regard for any other provision of law governing contracting procedures or employment of personnel by the Federal Government (40 CFR 300.322).
Upon receipt of notification of a discharge or release, the OSC is responsible for conducting a preliminary assessment to determine the following items:
OSC responsibilities in the event of a discharge or release include the following items:
As requested by the NRT or RRT5, the OSC shall submit to the RRT5 a complete report on the removal operation and the actions taken. The report shall record:
Regional Response Teams are responsible for regional planning and preparedness activities, as well as for coordination of assistance and advice to the OSC during site-specific incidents. The Co-Chairs of RRT5 are the Chief of the Emergency Response Branch, US EPA Region 5 and the Incident Management and Preparedness Advisor (IMPA), Ninth Coast Guard District. The RRT5 membership includes representatives from each State appointed by the Governor, and the designated regional representatives of the following Federal Agencies:
Federal RRT5 member agencies have duties established by Statute or Executive Order that may apply to Federal response actions following or in prevention of a discharge of oil or a release or threat of release of a hazardous substance, pollutant, or contaminant. The RRT5 also functions as the Area Committee for Inland Region 5.
The principal components of the RRT5 are a standing RRT and incident-specific RRTs. The standing RRT consists of designated representatives from each participating Federal Agency listed above and each State. Each incident-specific RRT is formed from the standing team when the RRT is activated for a response, and consists of representatives of appropriate local governments, State agencies, and Federal Agencies.
Each member agency should designate one member and at least one alternate member to the standing RRT. Agencies whose regional subdivisions do not correspond to the standard Federal Regions may designate additional representatives to the standing RRT to ensure appropriate coverage of the standard Federal Region. Federally recognized Native American Tribal governments may arrange for representation on the RRT. Other interested parties may attend and observe RRT meetings. The usual process by which the RRT reaches its decisions is by consensus. However, in instances where a decision is reached by means of a vote, the voting capacity of each Federal member agency and other RRT member organizations is limited to one vote per member agency or organization.
The first Federal official affiliated with an RRT agency to arrive at the scene of a discharge or release, provided they have the proper training, should coordinate activities under the NCP, this RCP/ACP , and agency guidance until the predesignated OSC is available. That Federal official should consult directly with the predesignated OSC regarding any necessary initial actions. Fund-financed operations must be authorized by the OSC prior to implementation.
The Federal Agencies listed in this section have duties established by statute, executive order, or Presidential directive which may apply to Federal response actions following, or in prevention of, the discharge of oil or release of a hazardous substance, pollutant, or contaminant. Some of these agencies also have duties relating to the rehabilitation, restoration, or replacement of natural resources injured or lost as a result of such discharge or release. It is recognized that Native American authorities, responders, and communities are entitled to the same cooperation and protection arrangements as the States.
The U.S. Forest Service is the designated USDA representative to RRT. USDA maintains a Regional Emergency Team in each of the 10 Standard Federal Regions to provide liaison and coordination with Federal Agencies operating on a Regional basis. Regional Emergency Teams are composed of representatives of USDA agencies having essential emergency functions at the Regional level. These are:
DOC, through the National Oceanic and Atmospheric Administration (NOAA), has three roles within Region 5:
Scientific Support Coordinator (SSC): In accordance with the NCP, the SSC provides scientific advice to support the Federal OSC in operational decisions that will protect the environment effectively, mitigate collateral harm, and facilitate environmental recovery. The SSC advises on other technical issues (as requested by the OSC) after consulting with the appropriate NOAA Emergency Response Division (ERD) resources or other Federal, State, or academic networks. This includes considering advice from the trustee agencies (including the NOAA ERD RRT member), and any divergent opinions.
National Resource Trustee: The Secretary of Commerce acts as trustee for natural resources managed or controlled by DOC, including their supporting ecosystems. 40 CFR 300.600(b), (b)(1). Pursuant to the Great Lakes Critical Programs Act of 1990, 33 USC 1268 (Great Lakes Act), and the Great Lakes Water Quality Agreement of 1978, as amended by the Water Quality Agreement of 1987 (Great Lakes Water Quality Agreement), the United States, in part through DOC, manages and/or controls the water and sediments of the Great Lakes System.
The Secretary of Commerce also acts as trustee for natural resources managed or controlled by other federal agencies that are found in, under, or using waters navigable by deep draft vessels, tidally influenced waters, or waters of the contiguous zone, the exclusive economic zone, and the outer continental shelf. All federally managed or controlled resources that are found in these waters, such as water and sediments that form navigation channels and that are managed, controlled, and maintained by the Army Corps of Engineers, and the fisheries that are controlled by the Food and Drug Administration through derivation of action levels, fall within DOC trusteeship. Similarly, the water and sediment of the Great Lakes System are within the administrative jurisdiction of the United States, and are federally managed or controlled pursuant to the Great Lakes Act and the Great Lakes Water Quality Agreement.
The Secretary has delegated his authority to act as trustee to the Administrator of NOAA. Pursuant to these delegations, NOAA has trusteeship for the water, sediment, and biological resources of the Great Lakes and their supporting ecosystems. The NCP also cites as examples of DOC trusteeship the following natural resources and their supporting ecosystems: migratory birds, anadromous fish, and endangered species and marine mammals. 40 CFR 300.600(b)(1), (b)(2).
Under OPA and the NCP, NOAA has specific responsibilities as a natural resource trustee that include
All of these activities are intended to minimize impacts and to restore the environment.
Carries out this goal by
This member can provide:
These roles are the responsibility of all DOC representatives, whether from NOAA HAZMAT, NOAA National Marine Fisheries Service (NMFS), or NOAA National Weather Service (NWS).
DOD, consistent with its operational requirements, may provide assistance in critical oil and hazardous materials incidents, the maintenance of navigation channels, and removal and salvage of navigation obstructions. DOD will provide the OSC and RRT5 Chair for releases occurring on DOD property or facilities and for all incidents involving DOD hazardous substances.
DOE provides the designated OSC/RPM for responses to releases on or from any facility or vessel under its jurisdiction. DOE administers, implements, and coordinates the Federal Radiological Monitoring and Assessment Center (FRMAC). Under the Federal Radiological Emergency Response Plan (FRERP), DOE provides advice and assistance to the RRT regarding the identification of the source and extent of radioactive contamination, and removal and disposal of radioactive releases.
FEMA requires the development, evaluation, and exercise of all-hazard contingency plans for all FEMA-funded jurisdictions at the State and local levels. SARA Title III plans are often annexes of the all-hazard plan. FEMA monitors and provides technical assistance regarding public sector emergency response training and planning for incidents involving hazardous materials. In a response, FEMA provides advice and assistance to the lead agency on coordinating relocation assistance and mitigation efforts with other Federal Agencies, State and local governments, and the private sector.
If the President declares a disaster or emergency, FEMA coordinates all Federal assistance, including temporary housing. The OSC coordinates with the Federal Coordinating Officer in situations where both authorities are active.
FEMA's National Emergency Support Team and Regional Emergency Response Teams provide coordination of Federal response in situations of unique national significance, such as commercial nuclear power plant or nuclear weapons accidents and catastrophic natural disasters.
The U.S. General Services Administration (GSA) leverages the buying power of the federal government to acquire best value for taxpayers and its federal customers. GSA exercises responsible asset management. GSA delivers superior workplaces, quality acquisition services, and expert business solutions. GSA develops innovative and effective management policies.
In emergencies—as in everyday operations—GSA provides other federal agencies with what they need to do their jobs. GSA can go to the site of an incident and find suitable space for the response team to set up operations, furnish and equip the space, and set up telecommunications.
GSA is capable of providing:
The GSA Regional Emergency Coordinator (REC) provides a team that may consist of one or more of the following: a REC and/or team leader, contracting officer, telecommunications specialist, and real estate/leasing specialist, if needed, to coordinate the provision of support at the incident site or operating location. Support may be furnished through GSA employees and contractor personnel who are located at the scene of the oil or hazardous material release, or at their regular duty stations, depending on the specific requirements of the emergency situation.
All acquisition and procurement activities by GSA are supported by written justification in accordance with current Federal laws and regulations (e.g., Federal Acquisition Regulations), which, when necessary, authorize other than "full and open competition." All procurement actions, including those for multimodal transportation services, are made in accordance with GSA's statutory and administrative requirements, and use the appropriate fund citation/reimbursement procedures. Expenses incurred by GSA in providing requested assistance to other agencies must be reimbursed.
HHS assists with the assessment, preservation, and protection of human health and helps ensure the availability of essential human services. HHS provides technical and nontechnical assistance in the form of advice, guidance, and resources to other Federal Agencies, as well as to State and local governments.
The principal HHS response comes from the U.S. Public Health Service (PHS). Within PHS, the primary response to hazardous materials emergencies comes from ATSDR and the Centers for Disease Control (CDC). Both ATSDR and CDC have 24-hour emergency response capability whereby scientific and technical personnel are available to provide technical assistance to the lead Federal Agency and State and local response agencies on human health threat assessment and analysis, and exposure prevention and mitigation. Such assistance is used in situations requiring evacuation of affected areas, dealing with human exposure to hazardous materials, or advice on mitigation and prevention.
Agency for Toxic Substances and Disease Registry: ATSDR is the lead Federal public health agency for hazardous material incidents under CERCLA. Two ATSDR representatives are assigned to each US EPA Region to assist in US EPA/ATSDR communications. Regional representatives can also assist in emergency response events that involve RRT5 issues by coordinating with ATSDR headquarters Emergency Response and Consultation Branch and with the CDC RRT5 representative. Under CERCLA Section 104(i), ATSDR is required to
Additionally, ATSDR operates a 24-hour phone line to address public health issues.
Other PHS agencies involved in support during hazardous materials incidents, either directly or through ATSDR/CDC, include the Food and Drug Administration (FDA), the Health Resources and Services Administration, the Indian Health Service, and the National Institutes of Health (NIH).
DHS, through USCG, provides the Co-Chair of RRT5 and predesignated OSCs for the Great Lakes Coastal Zone and specified ports and harbors in Region 5, based on an MOU signed in 1992. Through USCG, the DHS
maintains continuously manned facilities that are capable of command, control, and surveillance for oil or hazardous substances releases occurring on the waters of the United States, and may provide these services to the OSC
DOI can provide information concerning the lands and resources specifically under DOI jurisdiction, as well as offer technical expertise related to geology, hydrology, minerals, fish and wildlife, cultural resources, and recreation resources. Under Executive Order 12580, DOI is designated by the NCP as a Federal Trustee for Natural Resources.
DOI has direct jurisdiction for protection of resources on its own lands, as well as trustee responsibilities for certain natural resources, regardless of location. The DOI natural resource trusteeship that extends beyond DOI site boundaries includes migratory birds, anadromous fish, and endangered/threatened species and their critical habitat.
Bureaus may provide assistance in investigations to evaluate the magnitude and severity of discharges on or affecting facilities or resources under their jurisdiction, and may conduct activities as natural resource trustees as set forth in Subpart G of the NCP.
Bureaus may also provide:
Within the Department, individual bureaus and offices have specific responsibilities and capabilities as follows:
The Biological Resources Division performs research in support of biological resource management; inventories, monitors, and reports on the status and trends in the nation's biologic resources; and transfers the information gained to resource managers and others concerned with the care, use, and conservation of the nation's natural resources.
All bureaus of the Department of the Interior may be contacted through the Regional Environmental Officer, the designated member of the RRT5.
DOJ members of the RRT5 serve as representatives of the Department of Justice and not as legal counsel to the RRT5 or its member agencies. Although the DOJ representative to the RRT5 is not a substitute for member agencies' in-house counsel, the DOJ representative will be able to offer the advice, views, and expertise of the Department with respect to RRT5's long-term planning and incident-specific functions.
As a consequence of DOJ's primary role as litigation counsel for the Federal Government and as legal counsel on enforcement and interagency matters, its participation in RRT5 activities will ordinarily focus on litigation concerns regarding response activities and interagency coordination. The DOJ representative might provide
DOL, through the Occupational Safety and Health Administration (OSHA)
The Nuclear Regulatory Commission (NRC) will
DOS will
DOT, through the Pipeline and Hazardous Materials Safety Administration (PHMSA), establishes oil discharge contingency planning requirements for pipelines, transport by rail and containers, or bulk transport of oil.
US EPA provides the Co-Chair of RRT5 and provides OSCs for all inland areas for which an ACP is required. US EPA also generally provides the Support Center for responses in the inland zone.
US EPA is responsible for providing expertise regarding environmental effects of pollution and environmental pollution control techniques. US EPA will also
Subarea Contingency Plans help coordinate timely and effective responses by private industry, local and state officials and various federal agencies to minimize damage resulting from releases of oil or hazardous materials in the Subareas.
They include:


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The PC demo for Konami's Pro Evolution Soccer 2011 is live right now from the PES web site, and it'll be available tomorrow for Xbox 360 and PS3.
Jon Murphy, the project leader for PES 2011, tweeted earlier today that the Xbox Live demo was confirmed for tomorrow. He later said the PS3 version should be available by afternoon.


text:
Saturday, August 31 through Monday, September 2 for the Labor Day holiday.
World War I Military Portraits is comprised of more than 32,000 photographs, typewritten volumes, and service records. The items were compiled from collections of the American War Mothers Milwaukee County…
19th Century U.S. Newspapers, from Gale, provides access to historic primary source newspapers, featuring full content and images from numerous urban and rural publications throughout the U.S. Wisconsin newspapers are well represented.
Sorry, this event has already happened. Please explore our event calendar for events in the future.


text:
(SACRAMENTO, Calif.) — Wide geographic variation in Medicare costs is largely explained by health differences across communities rather than inefficient care delivery, according to a study published online today in the SAGE journal Medical Care Research and Review.
Previous research found that Medicare could reduce spending by as much as 30 percent without harming health if all providers adopted treatment patterns found in low-cost areas, but today's study calls into question how well these analyses accounted for differences in Medicare beneficiaries' health status.
James Reschovsky of the Center for Studying Health System Change, together with Jack Hadley of George Mason University and Patrick Romano of the UC Davis Center for Healthcare Policy and Research, examined multiple ways of adjusting for patient health. They found that a broader accounting of health status explained at least 75 percent to 85 percent of Medicare geographic cost differences between high- and low-cost areas.
"Geographic variation research has been used to argue that there is considerable waste and inefficiency in the delivery of health care. We do not question this conclusion, but caution that inefficiencies in American health care may not be nearly as strongly related to geography as the Dartmouth Atlas of Healthcare and others have suggested. Although data limitations may preclude ever developing the perfect casemix adjustment approach, our results suggest that the portion of the geographic variation that can be explained by patient health is much greater than previously estimated, leaving less of the geographic variation potentially attributable to inefficiency," the article states.
Previous geographic variation research also often used average spending on beneficiaries in their final months of life to adjust for area differences in health and to define high- and low-cost areas — an approach that assumes people near death have roughly equal health status. The new study by Reschovsky and colleagues, however, found that the health status of beneficiaries near death varied considerably by number and types of conditions, and that these differences accounted for 84 percent of the health-care costs in the final year of life. This differed little — only two percentage points less — when the same casemix indicators were applied to the entire elderly Medicare population. Because the end-of-life spending approach fails to effectively account for differences in population health, it misclassifies many areas in terms of the costs for treating Medicare patients, the study found.
The study, "Geographic Variation in Fee-for-Service Medicare Beneficiaries' Medical Costs Is Largely Explained by Disease Burden," was based on an analysis of claims from 1.6 million Medicare beneficiaries in 60 representative communities and was funded by the Robert Wood Johnson Foundation through a grant from its Health Care Financing and Organization program. Reporters may obtain a copy by e-mailing Alwyn Cassil at firstname.lastname@example.com.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to inform policymakers and contribute to better health-care policy. Based in Washington, D.C., the center is affiliated with Mathematica Policy Research. For information, visit http://www.hschange.com/
The UC Davis Center for Healthcare Policy and Research includes more than 100 researchers in disciplines ranging from economics to pediatrics who conduct research on health-care policy, delivery, quality and costs to improve public health. For information, visit http://www.ucdmc.ucdavis.edu/chpr/
Medical Care Research and Review is a peer-reviewed, bi-monthly journal containing critical reviews of literature on organizational structure, economics, and the financing of health- and medical-care systems. The journal also includes original empirical and theoretical research to enable policymakers to make informed decisions and identify health-care trends. More information is available at http://mcr.sagepub.com/