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This study examined documented treatment recommendations provided for sleep disorders and sleep problems in pediatric primary care, the persistence of sleep problems and sleep disorders in children and adolescents, and the relationship between sleep issues and health care utilization.
In-depth chart review of pediatric primary care patient visits (n = 750 patients) from 2007 through 2010.
Only 26 children (5.2% of those with a sleep disorder/ problem) received a treatment recommendation, with half of these recommendations behavioral in nature. Sleep disorders and sleep problems were highly persistent across time for up to a third of children. Children with sleep disorders had significantly more sick visits/calls (mean = 8.84, 95% CI 7.77-9.90) than children without a sleep disorder (mean = 6.34, 95% CI 5.56-7.12).
Very few children or adolescents were found to have documented treatment recommendations or referrals for diagnosed sleep disorders or sleep problems. In addition, given that sleep disorders and sleep problems are highly persistent, as well as result in more sick visits/calls, it is important that pediatric primary care providers screen for and identify these issues across development. Furthermore, it is essential to provide health care providers with more education and support on sleep disorders and sleep problems in pediatric primary care.
Meltzer LJ; Plaufcan MR; Thomas JH; Mindell JA. Sleep problems and sleep disorders in pediatric primary care: treatment recommendations, persistence, and health care utilization. J Clin Sleep Med 2014;10(4):421-426.
Disrupted or deficient sleep impacts every aspect of a child's functioning.1–9 There are a number of potential causes for poor sleep in youth, including sleep disorders and sleep problems. "Sleep disorders" typically include sleep issues that meet diagnostic criteria for a disorder, including obstructive sleep apnea, parasomnias, narcolepsy, and insomnia. "Sleep problems," on the other hand, encompass a number of sleep issues, including bedtime problems, night wakings, sleep related anxiety, deficient sleep, and poor sleep hygiene. It has been reported that up to 40% of children experience a sleep problem sometime between infancy and adolescence,10 yet sleep disorder diagnoses are less common. As disrupted or deficient sleep can be a result of both types of sleep issues (disorders and problems), it is important to have a better understanding of how sleep issues present in pediatric primary care.
Sleep disorders may be easier for pediatric health care providers to identify (e.g., if a child has prominent snoring or excessive daytime sleepiness), yet many sleep problems may go unrecognized in pediatric practice. One reason is that sleep concerns are not frequently raised by parents during children's well-visits.11,12 In addition, pediatric health care providers, who have limited training in pediatric sle ep13 and limited patient contact time, may not ask about or discuss children's sleep issues. One study of two general pediatric clinics found that a discussion of sleep issues is rare, diagnosis uncommon, and treatment recommendations lacking.14 Together these studies highlight the shortcomings in the evaluation and treatment of sleep issues in clinical practice.
Current Knowledge/Study Rationale: Sleep issues are common in children and adolescents, yet often are overlooked in pediatric primary care. Pediatric primary care providers receive little, if any, training on the diagnosis and treatment of sleep issues.
Study Impact: Sleep disorders and sleep problems persist across time for many children, and children with untreated sleep issues have more physician contacts and visits. Additional education and resources (e.g., toolkit) are needed to assist primary pediatric health care providers in recognizing and treating common pediatric sleep issues.
Based on the electronic medical records (EMR) of almost 155,000 pediatric patient visits, we previously reported that only 3.7% of children received an International Classification of Diseases, 9th Revision (ICD-9) diagnosis for a sleep disorder.15 However, because of the methodology used (capturing "smart fields" that clinicians select from), these data did not capture the "sleep problems" that children experience. Further, the use of smart fields did not allow for an examination of sleep-specific recommendations. Finally, while the study included a large, representative sample of youth, it was a report of only one well-child visit, preventing us from examining the persistence of sleep problems or the impact of sleep issues on child health. Thus, using a randomly selected sample from the original study, an in-depth chart review was undertaken with the following aims: (1) to examine treatment recommendations provided for sleep disorders and sleep problems; (2) to examine the persistence of sleep problems and sleep disorders; and (3) to examine the relationship between sleep issues and health care utilization (i.e., sick visits).
Our previous study examined EMR data from all well-child visits in 2007 for 154,957 children and adolescents from 32 different urban and suburban pediatric practices (including 175 physicians and 22 nurse practitioners) affiliated with a large, tertiary care children's hospital. From this sample, 750 patients (stratified by age) were selected. For each of 5 age groups (infants, 0-2.0 months; toddlers, 12.1-47 months; preschoolers, 4-5 years; older children, 6-12 years; and adolescents,13-18 years), 150 patients were randomly selected, stratified by the following 3 groups: (1) an ICD-9 sleep disorder diagnosis; (2) an identified "sleep problem" as indicated in free text fields (including such issues as cosleeping, bedtime resistance, sleep onset associations, deficient sleep, and sleep related anxiety); and (3) no diagnosed sleep disorder and no identified sleep problem ("no sleep issue"). All 32 practices were represented in the final sample, with no bias toward a single provider or clinical setting.
Information extracted from the medical charts included demographic data, medical and psychiatric diagnoses, treatment recommendations, medications prescribed, and identified sleep problems not captured in the smart fields of the original EMR search.
Treatment recommendations fell into 4 general categories: discussion of behavioral interventions or strategies (e.g., "put gate in the doorway and ignore tantrums" or "wake child 30-45 minutes before sleep terror"), referral for further evaluation of the sleep problem (e.g., urology, pulmonary, ENT), continue to monitor the problem (e.g., "monitor bedwetting issues" or "asked mom to observe patient while sleeping to ensure there is no apnea"), and general discussion of the issue ("discussed bedwetting" or "discussed good bedtime routine").
Medical record reviews were conducted for the initial 2007 appointment (baseline), as well as for well-child follow-up visits that occurred in 2008 (Year 1), 2009 (Year 2), and 2010 (Year 3). In addition, the number of and reason for sick visits and sick child related phone contacts between well-child visits were recorded. Sick visits were categorized into common presenting complaints (e.g., fever, earache/infection, cough/wheezing, rash). No sleep-related complaint was included as part of the sick visits/calls. This study was approved by the institutional review board at the Children's Hospital of Philadelphia.
The sample included 750 children, with a mean age of 6.21 years (SD: 5.40 years; range: 0.28-18 years). Of the 750 children and adolescents seen for baseline well-child visits in 2007, data were available for 520 youth (69%) in Year 1, 490 in Year 2 (65%), and 451 (60%) in Year 3. Two hundred ninety-seven youth (40%) attended the baseline and all 3 follow-up well-child visits. Preliminary analyses, including t-tests and χ2 tests, were conducted to determine if selective attrition occurred. The 297 youth with available sleep data at all time points were compared to those children who had missing well-child follow-up visits. Compared to children with available sleep data at all time points, those with missing data at a subsequent visit had a significantly lower household income (t737 = 4.48, p < 0.001), were older (t748 = -7.71, p < 0.001), and had fewer sick visits over an approximately 18-month period following the baseline visit (t593.85 = -5.05, p < 0.001). Children not seen in later years also differed from those with data at all 4 time points in terms of ethnicity (χ2(40) = 26.05; p < 0.001; ϕ = 0.19), with black children less likely to have additional visits after the baseline visit (standardized residual: 2.6). The 2 groups did not differ in gender (χ2(1) = 0.56; p = 0.45; ϕ = 0.03) or likelihood of having an identified sleep problem during the initial visit (χ2(1) = 0.49; p = 0.48; ϕ = 0.03). Baseline diagnosed sleep disorders and identified sleep problems are presented in Table 1.
Frequency and percent of patients with diagnosed sleep disorders and identified sleep problems by group
(more ...)
Next, we examined the frequency and type of recommendations made for sleep issues (including both sleep disorders and sleep problems). A χ2 test was conducted to determine if the likelihood of being given a sleep recommendation differed between children with a diagnosed sleep disorder, children with an identified sleep problem, and children without a documented sleep issue. The significant χ2 test revealed that the likelihood of having a documented sleep recommendation differed among the 3 groups (χ2(2) = 28.99; p < 0.001; ϕ = 0.20). Examination of standardized residuals revealed that children with a documented sleep disorder were the most likely to receive a sleep related recommendation (n = 21, 8.4%; standardized residual 4.2) and children without a sleep issue were the least likely to receive a recommendation related to sleep (n = 0; 0.0%; standardized residual: -3.0). Only 2.0% (n = 5) of the children in the sleep problem group received a sleep related recommendation.
A total of only 41 recommendations were documented for 26 (3.5%) children across the 3 groups (5.2% of children with a documented sleep problem/disorder). The recommendations fell into 4 general categories: discussion of behavioral interventions or strategies (n = 21, 51.2% of all recommendations; 4.2% of children with a documented sleep problem/disorder), referral for further evaluation of the sleep problem (n = 14, 34.1% of recommendations; 2.8% problem/disorder groups), continue to monitor the problem (n = 3, 7.3% of recommendations; 0.6% problem/disorder groups), and general discussion of the issue (n = 3, 7.3% of recommendations; 0.6% problem/ disorder group).
To determine if age was related to the likelihood of receiving a sleep related recommendation, a χ2 test was conducted. The results of the χ2 test were not significant, χ2(4) = 7.67; p = 0.11; ϕ = 0.10, indicating that age was unrelated to the likelihood of receiving a sleep related recommendation.
In terms of medications as a potential treatment for sleep issues, a nonsignificant χ2 test revealed that the likelihood of being prescribed a sleep related medication did not vary by sleep group (χ2(2) = 4.39; p = 0.11; ϕ = 0.08). Across groups, antihistamines were the most frequently prescribed sleep related medication (9.7%), followed by α-agonists, antipsychotic agents, and SSRIs (0.4% for all), as well as benzodiazepines (0.1%).
A series of analyses were conducted to determine the persistence of sleep disorders and sleep problems. Phi coefficients were calculated to determine the stability of documented sleep disorders or sleep problems over time for each age group. In order to be included in the analyses, children must have had data through the well-child visit years being examined. As shown in Table 2, documented sleep disorders were highly persistent across age groups and across years. Sleep problems on the other hand were most consistently documented for school-age children, followed by infants. In general, preschoolers and adolescents had much weaker relationships between initial sleep problems and later sleep problems.
Phi correlation coefficient between documentation of a sleep problem in 2007, 2008, and 2009 with documentation of a sleep problem in later visits by age group
Next, we compared children with a sleep disorder, a sleep problem, or no sleep issue at the baseline visit to determine the likelihood of having a documented sleep disorder (Figure 1A) or sleep problem (Figure 1B) during the follow-up visits. Odds ratios (ORs) were used to determine if the 3 groups differed in the likelihood of documented sleep disorders or sleep problems at follow-up visits (Table 3). Children with an identified sleep disorder at baseline were significantly more likely to have a sleep disorder at Year 1 (OR = 121.1), Year 2 (OR = 25.81), and Year 3 (OR = 21.07). Interestingly the presence of a sleep disorder at baseline was not predictive of a future sleep problem across years. Furthermore, children with an identified sleep problem at baseline were significantly more likely to have a sleep problem at Year 1 (OR = 4.68), Year 2 (OR = 2.29), and Year 3 (OR = 2.65). In addition, children with an identified sleep problem at baseline were significantly more likely to have a sleep disorder at Year 1 (OR = 2.49), but not at Years 2 or 3.
(A) Percent of children with a sleep disorder documented at follow-up visits for children with sleep disorder, sleep problem, and no sleep issue at baseline visit. (B) Percent of children with a sleep problem documented at follow-up visits for children with sleep disorder, sleep problem, and no sleep issue at baseline visit.
(A) Percent of children with a sleep disorder documented at follow-up visits for children with sleep disorder, sleep problem, and no sleep issue at baseline visit. (B) Percent of children with a sleep problem documented at follow-up visits for children with sleep disorder, sleep problem, and no sleep issue at...
Results of binary logistic regression predicting sleep disorders and sleep problems in years 1 through 3 based on group at baseline
A one-way ANOVA was used to compare the frequency of illness-related physician contacts for children with a diagnosed sleep disorder, children with an identified sleep problem, and children without a sleep issue. The number of illness related contacts was determined by counting the number of physician visits and telephone contacts for the 6 months prior to and 12 months following each child's 2007 well-child visit. The number of illness related physician contacts differed significantly among the 3 groups (F2, 747 = 6.75, p < 0.01). Tukey post hoc comparisons of the 3 groups indicated that the children without sleep issues (mean = 6.34, 95% CI 5.56-7.12) had significantly fewer illness contacts than children with a diagnosed sleep disorder (mean = 8.84, 95% CI 7.77-9.90), p < 0.001. Children with an identified sleep problem (mean = 7.73, 95% CI 6.75-8.71) did not differ significantly from children with a diagnosed sleep disorder (p = 0.24), or with children without a sleep issue (p = 0.10) in illness contact frequency.
The results of this study highlight several important considerations in the treatment, persistence, and potential health care utilization associated with both sleep problems and sleep disorders in pediatric patients.
First, only 5% of patients with either a diagnosed sleep disorder or an identified sleep problem received a sleep related treatment recommendation. It was discouraging to find that only 8% of children with a diagnosed sleep disorder and only 2% with an identified sleep problem received any type of treatment recommendation. While it is possible that those children with a diagnosed sleep disorder were under the care of another provider, nearly half of these patients were diagnosed with Sleep Disorder NOS, which is a diagnosis less likely to be utilized in a sleep center than in primary care. Note that the sleep issues assessed in this study encompassed both medically based and behaviorally based sleep problems, and thus it would be expected that for at least the diagnosed sleep disorders, especially the medically based ones, that practitioners would be treating these concerns. Rather, further evaluation and treatment appeared to be rarely recommended. These results are consistent with other studies indicating that sleep issues often go untreated. For example, a recent study found that only 24% of children were screened for obstructive sleep apnea at well-child visits,16 counter to the American Academy of Pediatrics recommendation that screening occur every time. In addition, of those children who were identified as snoring—a hallmark of obstructive sleep apnea—62% received no further evaluation, and only 0.5% of all patients had a diagnosis of obstructive sleep apnea. Additionally, in our study, approximately half of the documented recommendations were behavioral in nature despite the fact that behaviorally based interventions have been found to be highly successful.17 Those behavioral recommendations made appeared to be appropriate, with no recommendations noted that were beyond usual practices. Note that it is highly possible that sleep-related recommendations were made by the practitioners but were simply not captured in the medical record. However, it is unlikely that recommendations were not charted for almost 95% of all patients with a sleep-related problem or disorder. Clearly, this is an area of great unmet treatment opportunity.
Because of the persistence of these sleep issues in pediatric patients, the need for treatment recommendations becomes even more critical. Between 28% and 36% of children had persistent sleep disorders, while 17% to 26% of children had a persistent sleep problem. Similar to a study of young children,18 our study demonstrates that sleep problems persist for a significant number of youth. Our results build upon previous research by including all ages, from infants through adolescents. Notably, sleep problems increased in school-aged and adolescent patients. While it is common to inquire about sleep for infants and young toddlers, it is less common for pediatric primary care providers to inquire about sleep in older youth and adolescents. However, it is essential to identify sleep issues that these patients may also be experiencing (e.g., difficulties falling asleep, multiple night awakenings). As children get older, parents become less involved with children's sleep routines, and are often not aware of sleep difficulties that older children and adolescents experience.12,19,20
In addition to addressing the persistence of sleep problems, addressing sleep disorders and sleep problems in primary care may reduce health care utilization for some youth. In this study, youth with sleep disorders and sleep problems had more sick visits and physician contacts than youth without sleep issues. This was especially notable for infants and adolescents, two groups known for significant sleep disturbances. Yet the two most common issues for these patients (night awakenings for infants and difficulty falling asleep for adolescents) can be addressed with behavioral interventions.
There are several limitations to this study. First, demographic differences were found between those with and without complete data across years. These differences (race, income, number of visits to the pediatrician) may have resulted in sampling error. Second, these data are drawn from one geographic area, although a highly diverse sample, and may not be representative across populations. Third, all 32 primary care practices were affiliated with one institution, which may resulted in similarities across providers in terms of training, practice, and documentation. However, many of these practices had been independent prior to being purchased by the institution within the past decade, reducing the likelihood of this bias. That said, our findings should be replicated in another hospital system or across multiple institutions.
Fourth, as mentioned above, it is possible that sleep recommendations were discussed during visits, and that these recommendations were not documented in the EMR. It is possible that if common sleep recommendations are added to EMRs as smart fields, an increase in documented recommendations may occur. Finally, the high persistence of sleep disorders may have been the result of practitioners simply not removing the diagnosis from the EMR at a subsequent well-child visit; however, since there was not 100% maintenance of sleep disorders across time, many practitioners clearly did update the current diagnoses.
Additional research is needed examining the persistence of sleep problems and sleep disorders across development. Further, additional education and resources are needed for primary care pediatric health care providers, to assist with recognizing and treating common sleep issues in their practice. Such resources have been successfully developed for other behavioral disorders. For example, toolkits for the screening and management of attention deficit hyperactivity disorder (ADHD) and other mental health concerns in primary care have been developed and are available through the American Academy of Pediatrics. A Pediatric Sleep Toolkit may help providers to better identify sleep issues, assist pediatric primary care clinicians with basic sleep treatment recommendations, and provide information about when and where to refer patients for further evaluation. In addition, primary care friendly interventions need to be further developed and validated to assist with the treatment of sleep issues. For example, an internet-based intervention for infant and toddler sleep problems was shown to be effective in helping both children and mothers sleep.21 Further, treatment gains were maintained for one year.22 Similar interventions are needed for older children and adolescents.
This was not an industry supported study. Data were collected at the Children's Hospital of Philadelphia. Data analyses and writing were primarily completed at National Jewish Health, Denver, CO. The authors have indicated no financial conflicts of interest.
This study was funded in part by NIH K23 MH077662. We thank the network of primary care physicians for their contribution to clinical research through the Pediatric Research Consortium at the Children's Hospital of Philadelphia. We also thank Jonathan Crosette and Mark Ramos for their assistance with this project.
Beebe DW, author. Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr Clin North Am. 2011;58:649–65. [PubMed Central][PubMed]
Fallone G, Acebo C, Arnedt JT, et al., authors. Effects of acute sleep restriction on behavior, sustained attention, and response inhibition in children. Percept Mot Skills. 2001;93:213–29. [PubMed]
Sadeh A, Gruber R, Raviv A, authors. The effects of sleep restriction and extension on school-age children: What a difference an hour makes. Child Dev. 2003;74:444–55. [PubMed]
McKnight-Eily LR, Eaton DK, Lowry R, et al., authors. Relationships between hours of sleep and health-risk behaviors in US adolescent students. Prev Med. 2011;53:271–3. [PubMed]
O'Brien EM, Mindell JA, authors. Sleep and risk-taking behavior in adolescents. Behav Sleep Med. 2005;3:113–33. [PubMed]
Gangwisch JE, Malaspina D, Babiss LA, et al., authors. Short sleep duration as a risk factor for hypercholesterolemia: analyses of the National Longitudinal Study of Adolescent Health. Sleep. 2010;33:956–61. [PubMed Central][PubMed]
Flint J, Kothare SV, Zihlif M, et al., authors. Association between inadequate sleep and insulin resistance in obese children. J Pediatr. 2007;150:364–9. [PubMed]
Javaheri S, Storfer-Isser A, Rosen CL, et al., authors. Sleep quality and elevated blood pressure in adolescents. Circulation. 2008;118.
Javaheri S, Storfer-Isser A, Rosen CL, et al., authors. Association of short and long sleep durations with insulin sensitivity in adolescents. J Pediatr. 2011;158:617–23. [PubMed Central][PubMed]
Owens JA, author. Epidemiology of sleep disorders during childhood. In: Sheldon SH, Ferber R, Kryger MH, editors. Principles and Practices of Pediatric Sleep Medicine. Philadelphia, PA: Elsevier Saunders, 2005:27–33.
Blunden S, Lushington K, Lorenzen B, et al., authors. Are sleep problems under-recognised in general practice? Arch Dis Child. 2004;89:708–12. [PubMed Central][PubMed]
Owens JA, Spirito A, McGuinn M, et al., authors. Sleep habits and sleep disturbance in elementary school-aged children. J Dev Behav Pediatr. 2000;21:27–36. [PubMed]
Mindell JA, Moline ML, Zendell SM, et al., authors. Pediatricians and sleep disorders: Training and practice. Pediatrics. 1994;94:194–200. [PubMed]
Chervin RD, Archbold KH, Panahi P, et al., authors. Sleep problems seldom addressed at two general pediatric clinics. Pediatrics. 2001;107:1375–80. [PubMed]
Meltzer LJ, Johnson C, Crosette J, et al., authors. Prevalence of diagnosed sleep disorders in pediatric primary care practices. Pediatrics. 2010;125:e1410–8. [PubMed Central][PubMed]
Erichsen D, Godoy C, Granse F, et al., authors. Screening for sleep disorders in pediatric primary care: are we there yet? Clin Pediatr (Phila). 2012;51:1125–9.
Mindell JA, Kuhn BR, Lewin DS, et al., authors. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006;29:1263–76. [PubMed]
Byars KC, Yolton K, Rausch J, et al., authors. Prevalence, patterns, and persistence of sleep problems in the first 3 years of life. Pediatrics. 2012;129:e276–84. [PubMed Central][PubMed]
Meltzer LJ, Avis KT, Biggs S, et al., authors. The Children's Report of Sleep Patterns (CRSP): a self-report measure of sleep for school-aged children. J Clin Sleep Med. 2013;9:235–45. [PubMed Central][PubMed]
Paavonen EJ, Aronen ET, Moilanen I, et al., authors. Sleep problems of school-aged children: A complementary view. Acta Paediatr. 2000;89:223–8. [PubMed]
Mindell JA, Du Mond CE, Sadeh A, et al., authors. Efficacy of an internet-based intervention for infant and toddler sleep disturbances. Sleep. 2011;34:451–8. [PubMed Central][PubMed]
Mindell JA, Du Mond CE, Sadeh A, et al., authors. Long-term efficacy of an internet-based intervention for infant and toddler sleep disturbances: one year follow-up. J Clin Sleep Med. 2011;7:507–11. [PubMed Central][PubMed]


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Ruth C. Engs. "Should the drinking age be lowered to 18 or 19"." Adapted from, and in, "Drinking on Campus," CQ Researcher 8 (March 20,1998):257. Issue's author Karen Scrivo.
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INDIANA UNIVERSITY, BLOOMINGTONReal Card" Id January "star Available Idaho's In
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Why the drinking age should be lowered: An opinion based upon research
AN UPDATED VERSION OF THIS ARTICLE IS FOUND IN THE IU REPOSITORY AT: http://hdl.handle.net/2022/17594When in the repository page, schroll down to the botton and click on article
Id Photo Photo Cards Id Photo Cards Cards Id Photo Photo Cards Id Photo Cards Cards Ruth C. Engs, Professor, Applied Health Sciences,
Indiana University, Bloomington, IN 47405
The legal drinking age should be lowered to about 18 or 19 and young adults allowed to drink in controlled environments such as restaurants, taverns, pubs and official school and university functions. In these situations responsible drinking could be taught through role modeling and educational programs. Mature and sensible drinking behavior would be expected. This opinion is based upon reaserch that I have been involved in for over twenty years concerning college age youth and the history of drinking in the United States and other cultures.
Although the legal purchase age is 21 years of age, a majority of college students under this age consume alcohol but in an irresponsible manner. This is because drinking by these youth is seen as an enticing "forbidden fruit," a "badge of rebellion against authority" and a symbol of "adulthood." As a nation we have tried prohibition legislation twice in the past for controlling irresponsible drinking problems. This was during National Prohibition in the 1920s and state prohibition during the 1850s. These laws were finally repealed because they were unenforceable and because the backlash towards them caused other social problems. Today we are repeating history and making the same mistakes that occurred in the past. Prohibition did not work then and prohibition for young people under the age of 21 is not working now. Fake Maryland Fake Id Fake Maryland Maryland Maryland Id Id Fake Maryland Id Fake
The flaunting of the current laws is readily seen among university students. Those under the age of 21 are more likely to be heavy -- sometimes called "binge" -- drinkers (consuming over 5 drinks at least once a week). For example, 22% of all students under 21 compared to 18% over 21 years of age are heavy drinkers. Among drinkers only, 32% of under age compared to 24% of legal age are heavy drinkers. Fake Card Id Washington Maker
Research from the early 1980s until the present has shown a continuous decrease in drinking and driving related variables which has parallel the nation's, and also university students, decrease in per capita consumption. However, these declines started in 1980 before the national 1987 law which mandated states to have 21 year old alcohol purchase laws.
The decrease in drinking and driving problems are the result of many factors and not just the rise in purchase age or the decreased per capita consumption. These include: education concerning drunk driving, designated driver programs, increased seat belt and air bag usage, safer automobiles, lower speed limits, free taxi services from drinking establishments, etc.
While there has been a decrease in per capita consumption and motor vehicle crashes, unfortunately, during this same time period there has been an INCREASE in other problems related to heavy and irresponsible drinking among college age youth. Most of these reported behaviors showed little change until AFTER the 21 year old law in 1987. For example from 1982 until 1987 about 46% of students reported "vomiting after drinking." This jumped to over 50% after the law change. Significant increase were also found for other variables: "cutting class after drinking" jumped from 9% to almost 12%; "missing class because of hangover" went from 26% to 28%; "getting lower grade because of drinking" rose from 5% to 7%; and "been in a fight after drinking" increased from 12% to 17%. All of these behaviors are indices of irresponsible drinking. This increase in abusive drinking behavior is due to "underground drinking" outside of adult supervision in student rooms and apartments were same age individuals congregate and because of lack of knowledge of responsible drinking behaviors.
Id Photo Photo Cards Id Photo Cards Cards Based upon the fact that our current prohibition laws are not working, the need for alternative approaches from the experience of other, and more ancient cultures, who do not have these problems need to be tried. Groups such as Italians, Greeks, Chinese and Jews, who have few drinking related problems, tend to share some common characteristics. Alcohol is neither seen as a poison or a magic potent, there is little or no social pressure to drink, irresponsible behavior is never tolerated, young people learn at home from their parents and from other adults how to handle alcohol in a responsible manner, there is societal consensus on what constitutes responsible drinking. Because the the 21 year old drinking age law is not working, and is counterproductive, it behooves us as a nation to change our current prohibition law and to teach responsible drinking techniques for those who chose to consume alcoholic beverages.
(c)copyright, Ruth C. Engs, Bloomington, IN 1998, 2014Government Copy Demands Sermons Pastors – Of Shock Nathancherry
Citation for this opinion articles is now found on http://hdl.handle.net/2022/17594.
Id Photo Photo Cards Id Photo Cards Cards Id Photo Photo Cards Id Photo Cards Cards Note to students doing reports: Go to "Boozing and Brawling," "summary and tables," "reactance" and the other data based articles concerning college students 'binge' and other drinking behaviors on the Starbucks Blog Marissa's Adbuster – page to find the research that supports this opinion article / The Unstoppable Moves Latest Videos Highlights And Nba's Power Ranking Report Most Bleacher News
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Accessible Bathroom Design Ideas
Accessible Bathroom Design Ideas – {Are you planning to renovate your bathroom? The renovation itself can cost a hundred dollars, and therefore it is very important to make a plan before starting the process. Completing repair work, maintenance, and upgrades accessible bathroom design ideas on your home is not a matter to take lightly. Many important decisions go into completing accessible bathroom design ideas and such endeavors, and it is always in your best interest to step back, take some time to access the situation, consider options, and make a well-informed decision. The consequences of failing to do so are too great. When it comes to remodeling your bath, you need to make sure you have weighed all your options, so you have a great outcome and things turn out well. Here is a guide you need to read before starting a bathroom remodeling project.
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text: Toggle navigation The Harry Potter Lexicon Home Blog Lexicon Podcast Harry Potter Minute Essays Sources Support the Lexicon Feedback About the Lexicon Credits Privacy Policy Terms of Use Characters Harry Potter Albus Dumbledore Lord Voldemort Severus Snape Sirius Black Hermione Granger Ron Weasley Draco Malfoy more Places Hogwarts Diagon Alley Privet Drive Ministry of Magic HQ The Burrow more Magic Spells Potions Magical Objects Magical Plants more Events Harry is sorted into Gryffindor Battle of Hogwarts Death of James and Lily Triwizard Tournament more Things Quidditch Hogwarts Express Wands Daily Prophet Aurors Currency Converter more Creatures Dragons Hippogriffs House-elves Goblins Centaurs more Sources The Harry Potter Novels Other Potter Books Interviews Other Canon more Essays The Death Eaters: A Guide To Who Was Where Famous Wizard Cards Albus Potter and the lesson in Quantum Mechanics more Lists Magical People Government Wizarding Atlas more Unknown Harry has his final outburst in anguish over Sirius' death, and Dumbledore tells him everything Home Events Harry has his final outburst in anguish over Sirius' death, and Dumbledore tells him everything Harry has his final outburst in anguish over Sirius' death, and Dumbledore tells him everything Date Unknown Commentary Pensieve (Comments) View 0 thoughts swirling around the pensieve. Add your own. Editor: Steve VanderArk Timeline Dumbledore sends Harry and the Weasleys back to Grimmauld Place after Harry sees Mr. Weasley attacked Harry and Ginny begin dating Harry attends his first lesson with Dumbledore Harry breaks up with Ginny in order to protect her Harry has his final outburst in anguish over Sirius' death, and Dumbledore tells him everything Harry learns that Dumbledore has returned, races off to his office, and with him watches Slughorn's memory Harry learns that Snape was the one who told Voldemort about the prophecy Harry meets Andromeda and Ted Tonks Harry recieves Charlie's letter agreeing to take Norbert Harry spends the rest of the weekend in the Hospital Wing after his Nimbus 2000 is destroyed Interhouse competitions begin at Ilvermorny Ministry announces compulsory Hogwarts attendance for all British wizarding youth Original Order of the Phoenix is photographed Rita Skeeter first publishes an article about Harry in the Daily Prophet Sixth-years practice changing the color of their eyebrows, Ron and Hermione mock each other Snape is cleared of being a Death Eater Trevor is given to Neville by his Great Uncle Algie Sources


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The young actress came to the USA TODAY Los Angeles bureau to plug a new Disney Channel movie and join me for a #TalkingTech video interview. We got this shot in the conference room after the interview.
ZendayaJefferson Graham
Comedian JB Smoove
The comedian JB Smoove has a spontaneous laugh outside a tire shop in Los Angeles.
Bill Nye, the Science Guy
Bill Nye, best known for his 1990s science TV series, had us to his home in the San Fernando Valley, where he noticed that his home ceiling was adorned with stars. So we had him turn off the lights, so we could get a shot of him looking up to the artificial skies.
Bill Nyescience guyjefferson graham
Ariana Grande
The singer met us at her manager's office in Beverly Hills back when she was a co-star of a Nickelodeon TV show and was preparing to record a new album for Universal.
Lewis Black
The comedian Lewis Black met us at a West Hollywood bar, which agreed to let him do our TalkingTech video interview there. Afterwards, I asked him to show off one of his trademark screams to the iPhone. With each successive shot, Black turned redder and redder, until his eyes were literally bugging out of their sockets.
Lewis BlackJefferson Graham
Maria Menonous and Derek Hough
When they worked together on "Dancing with the Stars," they memorized their steps with the iPhone.
Ricky Gervais
The comedian Ricky Gervais was plugging a new app he was touting as the "Twitter of voice," at the Four Seasons Hotel in Beverly Hills. We photographed Gervais in a boardroom at the hotel.When we arrived, the room had a super long table and 12 chairs. We moved things around, put two chairs in the middle of the room, to isolate the background, and lit the room with the Lowell Rifa softbox and some Lowell Pro lights. I asked him to show me some emotion in showing off the app, thus the big smile and those fangy teeth!
Ricky GervaisJefferson Graham
Tori Kelly
Singer/songwriter Tori Kelly, photographed at the NAMM convention, atop the Anaheim Convention Center
The guitarist Slash, best known for his work in Guns N' Roses, was plugging a new series on the Fandango app, when we met up at a Hollywood screening room. We photographed this in the screening room, taking advantage of the dark background. He was lit by one softball, and we did the usual assortment of shots--wide, medium and closeup. I'm partial to this in-your-face shot, complete with stubble and yours truly in his glasses.
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Kelly Rowland
The former Destiny's Child singer met us at Sony Music offices in Beverly Hills for TalkingTech, where during the interview, I couldn't help but notice her sparkling eyes. Afterwards, I asked her to step in front of the window and look back at me.
Justin Williams
Magician Justin Williams hosts a monthly podcast at Meltdown Comics in Hollywood and does great things merging the old-fashioned art of magic with technology. So when it came time to do this portrait, we wanted to do something out of the ordinary. Thus: the notion of a big eye emanating from the iPhone. Shot in natural light from the Meltdown front window.
Kat McPhee
Scorpion star Kat McPhee on the set of her CBS show at the Manhattan Beach Raleigh studios.
Kat McPheeJefferson Graham
Bar Rescue's Jon Taffner
Jon Taffner m,et us at Barney's Beanery in West Hollywood, where he told me he couldn't catch any Zs without the "Sleep Machine," app. So I asked him to demonstrate, by opening his phone and closing his eyes. .
WWE's Zack Ryder
WWE performer Zack Ryder in the RAW ring
Norman Lear
The veteran producer Norman Lear has a new podcast. This portrait was taken in the PodcastOne studios in Beverly Hills.
NormanLearJefferson Graham
Brooklyn Decker
The actress/model Brooklyn Decker met us at the USA TODAY offices in Los Angeles, where I photographer her in a conference room.
Marc Maron
The podcaster had us to his "WTF" garage studio in Los Angeles, and posed from beyond the microphone.
Coco Rocha
The model Coca Rocha demonstrates her posing expertise at the Four Seasons Hotel in Beverly Hills
Larry King
From the set of his new Orca TV talk show, King was a guest on TalkingTech, despite him being very non tech savvy. He claimed to not use e-mail in the interview, assigning his wife the task of reading aloud e-mails addressed to him.
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Bela Fleck
Banjo master Bela Fleck met us at the Sportsman Lodge in Studio City, in a ballroom. We asked him to play banjo for us.
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Rev. Al Sharpton
Rev. Sharpton on the set of his MSNBC TV show.
Joan Rivers shows us her Blackberry
The late comedian met us at her daughter Melissa's home in Pacific Palisades, and showed us her phone of choice, the Blackberry.
Dr. Phil McGraw
Dr. Phil McGraw on the set of his TV show, on the Paramount studios lot. Dr. Phil is a co-founder of the "Doctors on Demand," service.
Harry Shum, Jr. and his Google Glass
The former Glee star poses with his Google Glass on a city street in L.A.
Cheryl Hines
The actress Cheryl Hines at home in Los Angeles.
Jefferson GrahamCheryl Hines
Chris Hardwick
The Nerdist's Chris Hardwick at his studio in Los Angeles
Aisha Tyler
Comedian Aisha Tyler, on the set of the Talk TV show, on the CBS Studios lot.
aisha tylerjefferson graham
Stan Lee and a certain Spiderman
Stan Lee, then a spry 90, posed with his favorite creation at his offices in Los Angeles.
Michael Strahan
Back when he was co-host of "Live" with Kelly Ripa, Michael Strahan met us on the set of the ABC-TV produced series in New York, and posed with a Galaxy phone.
JeffersonGrahamMichel Strahan
Jason Mraz
Singer/songwriter Jason Mraz met us at the NAMM convention, and posed for us atop the Anaheim Convention Center roof.
Jefferson GrahamJason Mraz
The Black-Eyed Peas musician was plugging a new smartwatch that never went anywhere--but he was a lot of fun to talk to.
Jason Biggs
The "American Pie" co-star in his publicist's office.
Joel McHale
Joel McHale, on the set of the Community TV series, on the Paramount lot.
Fran Drescher
Actress Fran Drescher on the set of her TV Land series, "Happily Divorced." In our interview, Drescher said "Siri hates me," because the personal assistant didn't understand her voice. Notice I forgot to ask her to take off her mic after the interview--a big non-no!
Jefferson grahamfran drescher
Dave Stewart
Musician Dave Stewart, shot in his manager's office, holding his favorite toy camera
Fox's Bret Baier
Basketball great Manu Ginóbili
Photographed in Santa Monica at the Shutter's hotel.
Carson Daly
NBC's Carson Daly met us at a restaurant in Santa Monica for #TalkingTech.
Jefferson GrahamCarson Daly
Christina Hendricks
Ron Howard
Director/actor Ron Howard
Pete Wentz
Pete Wentz from the Fall Out Boy band met us at the Angels and Kings dive bar in Hollywood, where we asked him to lean over the bar for this pose.
Judge Judy
Judge Judy Sheindlin on the set of her TV show, on the Paramount studios lot, showing off her new Judge Judy app on the iPad.
Jefferson GrahamJudge Judy
JB Smoove and his Galaxy
On the CBS Studios lot in Studio City, comedian JB Smoove mugs with his Samsung Galaxy phone.
Phil Rosenthal - I'll have what Phil is having
The star and producer of the Netflix series "Somebody Feed Phil," poses for us in the USA TODAY studio, biting into an oatmeal cookie made by Ruth Stroud. Rosenthal was a guest on the TalkingTech podcast
Phil rosenthalsomebody feed philusa todaynetflix


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|By Jeremy Geelan
Article Rating:
|July 12, 2011 06:45 AM EDT
Strange just how much can happen in one-third of a year.
Four months ago to the day, I was wheeled into an operating theater in Denmark's top hospital. In the intense few hours that followed, a gifted surgeon and a deeply professional team obtained a dream result: they successfully resected a malignant tumor from my pancreas and then took an incredible number of biopsies from surrounding tissue, just to be on the safe side. Each and every one subsequently came up negative, so the cancer hadn't spread.
Day One - Righospitalet, Copenhagen, Denmark
I wrote briefly about the experience of being both diagnosed with the deadliest of all the cancers and spared/saved from it all within the space of three weeks. Many people have asked me: how have things been going since?
The answer is not simple, for one reason: chemotherapy.
As part of its world-beating approach to combating deadly cancers, Denmark's University Hospital recommends and requires that a "cured" patient nonetheless undergo follow-up chemotherapy...for six months.
Three of those months - nearly - have now elapsed, though I have to admit that no month when you are undergoing chemo "elapses" (if only). Having one's post-operative existence divided up into 21-day cycles, each one marked by rising levels of heavy metals in one's body, well it's no walk in the park, alas. And the side-effects of the chemicals used [PDF] - I can testify - are in some ways as insidious as the original cancer, in that they are gradual, but comprehensive.
In my case, and remember each and every cancer patient reacts difficulty, I managed the first three cycles, 63 days, with only a few setbacks. But the fourth cycle somehow knocked me sideways, which is why you have heard so very little from @jg21 on Twitter, and seen so very little of me on Facebook since June's wonderful 8th Cloud Expo in NYC.
The past three weeks, in fact, have brought me face-to-face with some very harsh realities. The final three months of chemo are going to be a challenge...and, in order to successfully meet that challenge, I am going to have to dramatically rearrange my professional priorities so as to maximize healing time, minimize stress, and optimize my working day.
For all indirectly affected by this epiphany, which would probably have been better had it come a tad sooner, I apologize. But never has "less is more" been truer. For me to be back to fighting fitness - and weight! - for the Fall, I need finally to accept that convalescence (from Latin convalescere, whose root is in valescere, to be strong...which I currently am not) isn't something that you just "fit in" around all your other commitments; it is something you have to prioritize ahead of those commitments.
My aim in July, August and September then is to write, but to do so largely offline. You will still see the results online, but only as and when they are uploaded. Look out soon, for example, for my updated and hugely expanded Top 350 Players in the Cloud Computing Ecosystem, for an entirely new feature, Around the Cloud in Eighty URLs, and assorted other features aimed at providing convenient one-stop destinations for Cloud insights and information.
I need a 3-month respite from Twitter. By the final three months of 2012 I shall be completely done with chemotherapy, will no longer be tasting heavy metal at the back of my throat 24x7, will no longer be falling asleep for 12 hours at a time, and will no longer see every muscle group in my entire body subject to the ravages that only chemo can exact...a fierceness that has no respect for former waist or neck sizes.
I repeat to myself twenty times a day that it is better than the alternative. And it is. But it would be wrong of me to pretend that this hasn't been the longest four months of my life, and that I am steeling myself for a rough final three months still ahead.
When all is said and done, it seems a ridiculously small price to pay for surviving pancreatic cancer. I am very, very grateful.
It brings to mind the words of the writer Melodie Beattie, who memorably noted:
Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity.... It turns problems into gifts, failures into success, [and] the unexpected into perfect timing."
Read the original blog entry...
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Lothman (right) recorded a season-high 51 assists helping the Crimson take down Princeton 3-0 to earn its first EIVA conference victory of the season.
CAMBRIDGE, Mass. –The Harvard men's volleyball team got 29 kills from its freshmen starters, DJ White and Caleb Zimmick, and defeated Princeton in three sets (28-26, 25-23, 25-20) at the Malkin Athletic Center, Saturday afternoon. White paced the Crimson with 18 kills, and Zimmick was a force in the middle with four blocks helping the Crimson to improve to 6-1 and 1-1 in EIVA play.
The Tigers and Crimson played a tight first set that saw 21 tied scores throughout. Harvard took its first lead of the set off a kill by Zimmick making it 5-4. Princeton evened it at 5-5 on the very next play with a Davis Waddell kill. The two teams continued to trade points throughout the set as Harvard received offense from senior Matt Jones, junior Nick Madden, and sophomore Will Chambers. With Harvard leading 17-15, the Tigers scored two straight points off kills by Cody Kessel and Michael Dye to square the set at 17-17. Harvard forced set-point at 24-23 as Jones slammed down a kill but the Tigers wouldn't go down without a fight. evening the score three times, before back-to-back kills from White and Madden closed out the set, 28-26 in favor of the Crimson.
The Tigers jumped out to a quick 4-1 lead in the second set off two kills by Will Siroky as well as several attack errors on the Crimson. Later in the set a Michael Owen service error gave Princeton the 13-8 lead. Harvard fought back, receiving inspiring play from Zimmick who tallied three kills and three blocks helping to put the Crimson up 19-15. The Tigers scored four-straight points to knot the score up at 19-19, but Harvard didn't wait long to pull back out in front scoring two-straight points off of kills from Chambers and Jones and scored four of the next eight points to close out its second set of the afternoon, 25-23.
Harvard rode the momentum of its second set comeback victory into the third set getting on the Tigers early with a 4-1 lead, sparked by kills by Madden and White. Princeton made it closer off a kill by Siroky pushing the score to 10-8, Crimson. Harvard didn't relent however, scoring 10 of the next 15 points to extend its lead to 20-13. The Tigers mounted yet another comeback as Kessel, Siorky and an attack error by Madden made the score 20-16, however the Crimson stayed in control of the set scoring five of the next nine points winning the set, 25-20 and the match, 3-0.
White had the best day of his young career recording a season-high 18 kills and a hitting percentage of .739(18 kills on 23 attempts). Zimmick bested White's hitting percentage tallying a .786 percentage (11 kills on 14 attempts). Jones was second on the team in kills with 16 while junior Rob Lothman his best day this season recording 51 assists.
Harvard will now prepare itself for a tough test next weekend when it takes on No. 5 Penn State at the Malkin Athletic Center on Friday night, followed by Saint Francis (Pa.) on Saturday afternoon. Friday's match is slated for 7 p.m. while Saturday is a 4 p.m. start.


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More than 60,000 in attendance at Spring Game
Tommy Armstrong passed for 102 yards and a touchdown, and King Frazier ran for 64 yards and a touchdown in the Nebraska Red-White Game on Saturday.
Armstrong played six series in relief of starter Taylor Martinez and completed 5 of 7 passes.
-- RECAP: Chat with Big Red Zone Insider Sean Callahan
-- Send your fan photos to firstname.lastname@example.com
The redshirt freshman's touchdown pass was a well-placed 37-yarder that hit Alonzo Moore in stride along the sideline. Coach Bo Pelini said after the scrimmage that Armstrong would go into the fall as Martinez's top backup.
Ron Kellogg III, the No. 2 quarterback last season, was 11 for 12 for 148 yards and a score.
The afternoon had a touch of emotion when 7-year-old cancer patient Jack Hoffman of Atkinson, Neb., ran onto the field. He took a handoff 69 yards for a touchdown, with players mobbing him in the end zone.
The Red squad beat the White 30-21 in front of 60,174.


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Photo: McCann Digital Israel
Students from HaBezefer, the Israeli school of advertising and art, and ad agency McCann Digital Israel, came up with an unconventional response to cyberattacks: Re-design hacked takeover pages so they look more aesthetically pleasing.McCann Digital art director Nir Refuah told BI that "Israel is under constant cyber attacks each month, dozens of Israeli websites are being hacked by Arab hacker groups and replaced with anti-Israeli web pages."
(Israel and the U.S. were recently suspected of a cyber attack against Iran to delay nuclear development.)
While McCann and the students didn't have an immediate answer to end the wave of cyberattacks, they did come up with a way to solve their other hacking qualms, the "uninspired designs each time: black background, grotesque low-res images and unbearable amounts of text."
The solution? Students found 50 hacked pages, and while they kept the content, they redesigned the pages to look more cheerful. Refuah told BI that the students sent the redesign templates to various hacker group forums with the message, "We would like to end all cyber wars, but in the meantime — if you must hack our sites, at least leave something beautiful."
They made contact with five hackers thus far, although none of the work has appeared on a hacked site.
PREVIOUSLY: McCann Digital recently got attention for its early and creative use of Facebook's new timeline to create an anti-drug campaign that juxtaposed what a year in the life of a man would look like both clean and as an addict.
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Reduced cancer surgery puts lives at risk
The lives of cancer patients have been put at risk by a Sydney hospital's decision to slash operating hours it allows for a life-saving treatment.
Cancer patients and survivors say they fear people will die waiting for the peritonectomy surgery as waiting lists grow because of the cuts.
The surgery, which involves removing cancer from a large part of the abdominal area, is the only hope of a cure for some cases of the deadly asbestos cancer mesothelioma.
St George Hospital is the only place in NSW that performs it.
A world expert and pioneer of the procedure, David Morris, had been operating for three days a week at St George but has been forced to cut his operating days to two due to the growing surgery demands across the hospital.
"We were already struggling to get our patients treated," he said. "We already have 20 patients who have been waiting longer than the clinically recommended limit."
That time limit ranges between one and three months, depending on the patient.
Patients are flown from all over Australia and New Zealand to be treated by Professor Morris and the surgeon fears things are only going to get worse.
"I'm very worried people are going to progress and then be inoperable," he said.
People in need of cancer surgery should be prioritised over other patients if there was a shortage of money, he said.
Cancer patient Teressa Browne, 61, said the three months waiting for the surgery was extremely hard on patients and their families.
"It's a horrible feeling," she said.
I'm very worried people are going to progress and be inoperable.
The wife and grandmother of five said until she found out about Professor Morris she and her family worried nothing could be done for her.
This week she was told she is likely to finally get her surgery on Tuesday.
"Now I have got a bit of hope, but it's very hard to keep hope when you are waiting," she said.
St George Hospital said the cuts were necessary because without them the waiting list for other cancer surgeries would blow out.
"When reviewing surgical caseload for St George Hospital, the Clinical Council - which consists of clinicians, specialists and senior staff - is required to balance the needs of all surgical patients across all specialities to ensure patients are being treated within their clinically appropriate assessed time," Cath Whitehurst, the director of operations at St George, said.
But the opposition health spokesman, Andrew McDonald, said the decision had been taken because the hospital was underfunded.
"They are refusing to do it because of money, it's a simple as that," he said.
"They have got the surgeon who is ready, they have got the physical space and they have got the staff … they just don't want to pay them".
According to Mr McDonald it was wrong to say that continuing to perform the surgeries would put other patients at risk.
"They could easily increase their capacity within their built space to do the surgeries and not make people wait, they just haven't got the resources," he said.
A peritonectomy is used in peritoneal mesothelioma, which accounts for about a quarter of all mesothelioma cases, as well as in cancers of other areas such as the liver.
Ms Whitehurst said St George was already funded to do 72 peritonectomy surgeries every year, which was more than was needed given the population of NSW.
"At present peritonectomies are not offered in all states," she said.
The hospital did have some capacity to run some extra peritonectomy surgeries in emergencies, Ms Whitehurst added.
Amy is Health Editor for The Sydney Morning Herald. Before working at the Herald she worked as a freelance journalist and radio presenter, as well as writing for a number of publications for doctors. She also keeps a health blog at www.dailylife.com.au.


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To hire a veteran is to help a veteran
Robert Stokes' op-ed, "America's Walking Wounded," published April 19 in The Advocate, highlights the ongoing tragedy of post-traumatic stress syndrome and U.S. military veterans' suicide rates.
When it comes to figuring out why vets commit suicide, we know there are many reasons, but standing out among them are feelings of hopelessness and worthlessness. Fortunately, there's an extraordinary effort being made by the Veteran's Administration to address this, and it should be an important mission for American businesses as well.
One vital step to restoring veterans' well-being is giving them a job. I visited the Philadelphia Veterans Administration Medical Center on April 23 to learn more about what companies can do to hire vets, and in the process learned that having a job can have an extraordinary healing effect on vets who have been out of work.
"For a formerly homeless vet, the rise in self-esteem that comes from getting a job is exponential," Dr. Joan Ryan, a psychologist at the Philadelphia VA, told me.
She went on to describe that the structure of coming to work every day can itself be protective against many of the feelings that can make a person feel suicidal.
But the issue for many employers is the well-being of the workplace, as well as of their other workers. They worry that the veteran who has issues of depression or PTSD, or is recovering from an addiction problem, may not be up to the demands and stresses of employment.
Between 11 and 20 percent of veterans of the Iraq and Afghanistan wars reportedly suffer from PTSD, and research from the Center for New American Security shows that some employers see PTSD as a barrier to hiring any veteran. A company needs workers who are reliable and can get the job done, and employers feel they are taking a risk in hiring a potentially troubled vet.
This is where the VA is taking action. At the Philadelphia VA and other veterans hospitals around the country, they have a transitional program for helping veterans who've been unemployed to re-enter the work force. Currently, some 70 veterans have transitional jobs at the facility, such as food service or custodial work. While there, those in the transitional program have coaches and therapists who help them along the way. Only when they are ready do they go out into the community to seek regular employment.
The companies hiring these veterans get an immediate credit of up to $9,600 for hiring a disabled worker. But in addition, the newly hired vet will still have the support system and coaching available from the VA. They will be good workers and they have a support system to fall back on if needed. The VA does not want their veterans to fail.
Along with this noble work being done in Philadelphia and at our other VA hospitals, America's employers have some work to do, too. They need to change their perceptions about giving veterans a job.
Hiring managers, senior executives, department bosses and co-workers all need to understand that PTSD can, with care and understanding, be accommodated in the workplace. The Veterans Administration is proving that every day.
There's no one cure for the epidemic of suicides described by Robert Stokes in America's Walking Wounded. However, giving a vet a job is one really good approach.
I am proud to be part of a family company that is working to do more to hire veterans, and I hope other employers will try contacting their local VA office for information on hiring vets. You're likely to find that VA officials are more than eager to assist in your efforts, and the veterans you hire will be more than grateful.
Mitzi Perdue of Salisbury, Md., wife of the late Frank Perdue, is a past president of the 35,000-member American Agri-Women.


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"Math is beautiful on its own, and 'pure mathematics' is a fascinating field of study."
Whether she's teaching general education classes or Senior Seminar, Kimberly Jenkins wants her students to have a sense of wonder about their world, to always have questions that they are seeking to answer. Her favorite question is not "how" but "why."
"I don't care that you know how to calculate a confidence interval unless you also know where the interval came from and how to interpret it," says Jenkins.
Further, "I expect my students to be able to explain themselves to me and to their fellow students. You don't understand what you are studying unless you can explain it to someone else."
Jenkins relishes the personal attention she can give her students in their quest for answers to all questions. "I love getting to know the students and seeing how proud they are of themselves when they accomplish things they didn't feel they could. I love seeing how much the students mature and change in the four years we see them."
She also enjoys teaching math in a liberal arts setting and watching math students go on to become doctors, teachers, psychologists, actuarial scientists, ministers, and more.
"At the foundation of mathematics is logic. Math can be applied to so many fields and seen in so many different areas. A liberal arts education allows students to use their quantitative reasoning skills in many areas. It also gives students insight into other ways of knowing beyond the scientific/quantitative reasoning methods."


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Even when it was released in 2006, Nintendo's Wii games were already looking a little past it, stuck as they were in the muddy depths of standard-definition resolution and on relatively old hardware. In 2011, they're way past it.
Not to worry. If you'd rather play your Wii games in stunning HD - and trust us, they look stunning - then all you need to do is follow these simple steps.
While you can't play Wii games in HD on the actual console, no matter what kind of snake oil you're being promised, you can play them in HD on your PC.
How? Simple. Using a program called Dolphin, one of the most popular and accessible emulators around. What Dolphin does is simulate the workings of a Wii (or GameCube) on your PC, turning it into the prettiest and most powerful Nintendo console you've ever seen.
Note: We've prepared and tailored this guide to help those who already own a physical copy of a Wii game. Those who give Nintendo (and other publishers) the money they deserve for making these awesome games.
To get started, you're going to need a program called Rawdump, version 2.1.
Rawdump 2.1 [FileTrip]
What this does is let you drop your Wii (or GameCube) disc into your PC's disc drive and "rip" the content off it. This is important because you won't be playing the game off the disc, you'll be playing it off the "image" of the disc that you get using the program and save to your PC.
Drop the disc in, click "START DUMP", and when it's done you'll be left with a file ending in .Wii or .Wod. Select the file, click "CONVERT RAW TO .ISO", and you'll be left with an .iso file, which is what Dolphin needs to run.
Now we've got the game ready, we need to get Dolphin so we can actually run it.
Dolphin Emulator [Dolphin]
Make sure you get the right one for your operating system (it runs on Windows, Linux and Intel-based Macs). After it's downloaded, boot it up.
A lot of emulators out there are complex, arcane affairs, but one of the reasons Dolphin is so popular is that it's relatively simple to understand and easy to use. There are five big buttons that contain most of the settings you'll ever need to mess with, and those buttons, as you can see, are pretty self-explanatory.
It's not, however, perfect. It's not a plug-and-play affair. You'll need to mess around with a lot of the graphics and performance settings to get things running to a level that either suits you or to which your PC can handle. And yes, the better your PC, the better: because you're only emulating a Wii or GameCube, it can be quite a strain on your processor, so if you've got an older or weaker PC you may need to dial the settings down a bit.
Because these settings will vary from user to user, and even from game to game, I'm not going to list them here. Feel free to tinker with them yourself, or visit the super-friendly Dolphin forums for more specific guidelines.
Dolphin Forums [Dolphin]
Because you're playing on a PC, you can entirely customise the way the games are controlled. Dolphin lets users individually select each button press and axis of movement, so if you'd like to use a keyboard, control pad or combination of the two, you can.
For GameCube (and some Wii) games, all you'll really need to do is plug in a control pad, configure the settings (just click on the big GCPAD or WIIMOTE buttons) and you're off. For Wii games, though, you've got some choices.
While it's possible to play games using the keyboard, control pad and mouse to replicate the movements of a Wii controller, it's a shoddy workaround. The best way to play Wii games, especially those like Skyward Sword which require MotionPlus, is to use your actual Wii controller.
To get one running on your PC, you'll need two things: a Bluetooth adaptor (if your PC or Mac doesn't already have the capability) and a wireless sensor bar. Some people will say you don't need the latter, but it'll save you a lot of hassle. The Bluetooth adaptor lets you sync your Wii controller to your PC so it can read its movements, and using a wireless sensor bar means all you need to do is go turn your Wii on, take the bar away from your console and put it under your monitor instead. Get them running and bam, you've got the perfect Wii control system, right in front of your PC.
How to sync your Wii Remote with a PC [Instructables]
Nyko Wireless Sensor Bar [Nyko]
Now that you're all set up, it's time to play! Click on the yellow "OPEN" folder icon on Dolphin's main dashboard and browse to the .iso file you got from your Wii disc. Select it then, gods willing, your game should start up and look amazing.
If it doesn't, or if there are glitches, or the controller isn't working, or something else goes wrong, relax. Like I said, this isn't plug-and-play. Most games usually take a little fine-tuning to get working, and once again, the best place for advice on specific games (since some can be a little twitchy in Dolphin) is to head to that title's thread on the Dolphin forums.
Game Discussion [Dolphin]
And that does it! Hopefully those of you who have enjoyed their copies of Skyward Sword, or any other big Wii game recently (Okami and Mario Galaxy come highly recommended), can now go back and enjoy them all over again, only this time in shiny HD. Ditto for your GameCube collections as well, as Wind Waker looks amazing.


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Jimmy Fink is a radio aficionado, so much so that the Scarsdale DJ who currently works at 107.1 The Peak in North White Plains, remembers the days of vinyl.
At home, in fact, he has a wall of records --he was even mentioned in the short-lived HBO series, "Vinyl."
The longtime radio personality -- he worked 25 years spinning tunes and interviewing rockers at New York City-based WPLJ and K-Rock -- wanted to bring back a vibe that longtime rock fans seem to crave.
And so the Westchester resident -- he grew up in Eastchester -- has started a new section of his Peak show called "After 6."
"I used to do the 'After Midnight' portion of my late night show on K-Rock where 'we let it all hang out,' but since that's past my bedtime now, we made it 'After 6,'" he said.
Basically, the new format means there's no format ... no restrictions and no set playlist. He might play tunes with a cohesive theme or make great segues, feature some lost classics or tell tales of his escapades with rock stars past and present.
"What's great about it is that listeners get to hear what the original AOR radio was like when DJ's had ultimate freedom and creativity in what they played," he explained.
As for why Fink wanted to try this out? "It's because radio has become so homogenized and formatted over the years, I thought it might be fun to pull out some songs and artists that have gotten lost in the shuffle and present an hour that is less predictable and more personal to me.
"There are so many ways for people to listen to music today and I wanted to add something to my radio program that makes more sense and has an intelligent flow rather than just playing random songs one after the other."
Jimmy Fink is on the air on The Peak at 107.1 FM and streaming online at 1071ThePeak.com from 3 p.m. to 7 p.m. every weekday.
Follow Jeanne Muchnick's lifestyle stories on Instagram @DailyVoiceFeatures.
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Browsing Working papers by Author "Andersson, Ulf"
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subsidiary technology embeddedness and performanceAndersson, Ulf; Forsgren, Mats; Pedersen, Torben (København, 1999)[More information][Less information]
URI: http://hdl.handle.net/10398/6621
Files in this item: 1wp3.pdf (99.28Kb)
The importance of technology embeddednessAndersson, Ulf; Forsgren, Mats; Pedersen, Torben (København, 2000)[More information][Less information]
Abstract: Previous versions of this paper have been presented at the Nordic International Business conference in Oslo, May 1998, the conference in Organizational Studies at Stanford University in September 1998 and at the annual MESO conference at Duke University in May 1999. We thank the participants at these seminars for their valuable comments and suggestions. Two anonymous reviewers insightful comments and suggestions is also acknowledged. The Jan Wallander scholarship from Handelsbanken's research foundation is greatly appreciated by Ulf Andersson. URI: http://hdl.handle.net/10398/6865
Files in this item: 1linkwp24.pdf (181.9Kb)
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You're in the right place! Play best games for PC!
Don't know what PC game is worthy of your time? Here are the best PC games you can play. There's a wealth of PC games you can play right now. We've finally decided on a proper list, so here are the best PC games you have to play.


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This series of 1-hour demonstration sessions are scheduled online during a typical lunch hour. They deal with a variety of advanced topics in Canvas such as large enrollment classes, rubrics, and integrations. To view the upcoming session topics and course descriptions, visit the Learning Resource Network and search for "Canvas Brown Bag."
Are you looking for a basic overview of Canvas (Penn State's Learning Management System)? This 1-hour demonstration session will introduce you to the fundamentals of Canvas at Penn State. You will walk away with best practices and resources for using Canvas to facilitate teaching and learning.
This course can be delivered online via Zoom or in-person as a 1 hour demonstration session.
Do you want to use multiple methods to measure students' mastery of your course content? This 2.5-hour hands-on session will prepare you to design and deliver a variety of assessments in Canvas. You will walk through the steps for creating assignments and quizzes and explore quiz settings that determine how students interact with questions and review and receive feedback.
Every Canvas course should be built on a solid foundation of well-organized content. During this 2.5-hour hands-on session, you will begin constructing that foundation for one of your Canvas courses. Specifically, you will build a course structure with Modules, add Pages, upload files, and explore options for building a Course Home Page and Syllabus.
This hands-on session prepares Canvas users to optimize content for accessibility. Participants learn to identify accessibility issues within content, use the Rich Content Editor, create extended deadlines for quiz and assignment submissions, and use recommended guidelines for accessible quizzes.
Are you looking for ways to speed up your grading processes? Would you like to quickly provide feedback or message students about a specific assignment? During this 2.5-hour hands-on session, you will learn to use the Canvas Gradebook for grade management and reporting. Explore how to organize and view grades, utilize SpeedGrader for grading and feedback, and pull grades from Canvas into LionPATH.
In this hands-on workshop, participants will become familiar with the basic tools for data management in Microsoft Excel 2016. Participants learn how to import, extract, and manipulate spreadsheet data. Participants will also use some of Excel's tools to help manage multiple worksheets, visually compare workbooks, and work more efficiently in Excel.
• Create tables and pivot tables
• Explore workbook and worksheet protection
• Import, sort, filter and validate data
• Create built-in and custom lists
Snow day? Are you or your students sick? Students missing prerequisite skills? With Kaltura and Zoom, you can breathe easy knowing you can recover lost class time. In this session, participants will learn strategies to keep students engaged and accountable for missed material. Create reusable lectures with automatic chapters and slides allowing students to find exactly what they need, when they need it. Learn to use Kaltura Capture to create picture-in-picture videos giving students the flexibility to personalize the viewing experience. Create Video Quizzes to ensure that students are engaged and interacting with your lecture recordings.
Do you have videos, images, or audio files to share with students? Learn how to share your media using Kaltura, Penn State's new media management and streaming service in this one-hour demonstration session. Explore Kaltura's key features and capabilities within Canvas, discuss ways video is being used in higher education, and discover which Kaltura tools are best suited for your needs.
During this session, participants will learn about their options for uploading and sharing media, and collaborating on media or media collections within Penn State's Media management and streaming service, Kaltura MediaSpace. Participants will learn about how to share individual items to be worked on collaboratively with others and how to create channels for a variety of audiences.


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How to Invoice Your Customers in Quicken 2012
In Quicken 2012, you can invoice customers, record their payments, and monitor unpaid amounts after you've described your business, finalized your invoice form(s), and created an item list. To invoice a customer, follow these steps:
Choose Create Invoice command.
Display the Business tab, click the Business Actions button, and choose the Invoices And Estimates→Create Invoice command. Quicken displays the Invoice window. The Invoice window shows a bit of information in its boxes, but don't get confused about that.
Identify the customer and provide the address, if necessary.
If you're invoicing a customer for the first time, type his or her name into the Customer box in the upper-left corner of the Invoice window. Quicken will copy the company name to the Bill To box. You can then complete the address by adding the street information, city, state, and ZIP code.
If you're invoicing a customer for the second or subsequent time, open the Customer box and select the customer from the list that Quicken displays.
You can add customers on the fly, which means you only briefly describe your customers with sketchy vagueness. Alternatively, you can also go hog wild and describe each and every customer in painstaking detail. To go the painstaking detail route, choose the Business→Customers→Add Customer command.
When Quicken displays the Edit Address Book Record dialog box, use its boxes to describe your customer. Note that you can use the Add Customer command at any time. You don't need to wait until you're ready to record an invoice.
Tag the transaction.
If you're using Quicken to track more than one business and you've (very rightly) created a tag for each business, enter the appropriate tag into the Business Tag box.
Provide the Date, Invoice Number, and Purchase Order Number information.
Use the Date box to indicate the invoicing date (typically the invoice date is the actual date you create the invoice). Use the Due Date box to specify when you expect payment. Use the Invoice # box to give the invoice a unique number. Finally, if you're billing on purchase order numbers, use the P.O. Number box to provide the customer his or her purchase order number.
Describe the individual items you're invoicing the customer for.
To enter an invoice item, click the Item column for the line you want to add and then select an item from the list Quicken displays. Quicken adds the category and description information you provided for the item — but you can edit these if you want. Next, specify the item quantity and verify the rate.
You can initially fit ten items onto an invoice, but if you need more room, click the Add Lines button.
Add sales tax if applicable.
If items on the invoice are subject to sales tax, enter the sales tax rate into the Tax box. Quicken then calculates the sales tax for you by multiplying the sales tax percentage against each of the taxable items on the invoice.
Note: Quicken tracks the sales tax you've collected using a liability account. Quicken shows the liability account in the Tax Account drop-down list box at the bottom of the window.
(Optional) Add customer messages or memo descriptions to the invoice.
If you want to add a message to the invoice, enter the message in the Customer Message box.
If you want to record a bit of extra information about the invoice — information that won't appear on the invoice — enter that into the Memo box.
Save the invoice.
You can save the invoice and close the Invoice window by clicking Save And Done. Or, you can save the invoice and redisplay an empty Invoice window so you can create another invoice by clicking Save And New.


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There is nothing better then sinking your teeth into a big juicy burger especially when you are starvin' like Marvin. For the second food tut I will show you "how to draw a burger", step by step. When we go out for fast food we don't sit there and say "hey, lets get some hamburgers". Instead we say "yo, let's go out for some burgers". Unless you are a very punctual person, I don't think people say the complete word when describing something especially food. Burgers are one of America's signature BBQ foods along with hot dogs, BBQ chicken, and even BBQ ribs. All four products described is what you will see most of this weekend when people party in their backyards with family and friends for Labor Day weekend. I guess you guys will have fun drawing a burger because you can add whatever you want on the inside. I simply added lettuce, tomato and cheese. I will be back soon with more tuts for you all to enjoy.
DragoArt members upload artwork and drawing tutorials! They are also allowed to leave comments on tutorials, profiles, etc. Many more features, as well; it's way better than just being a boring guest! Register Now!


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Vice President Global Labor Relations
Deere & Company
Bradley D. Morris is Vice President, Global Labor Relations, Deere & Company, a position he has held since May 2011.
Morris is responsible for developing the strategy and tactics for both the negotiation and administration of collective bargaining agreements. He leads the various labor relations initiatives and the Global Labor Relations Strategy.
Morris joined John Deere in 1975 as a co-op student and spent his career in manufacturing prior to joining labor relations in 2001. Prior to his current position, Morris was Director, Global Labor Relations & Continuous Improvement.
Morris graduated from Purdue University in 1980 with a B.S. degree in mechanical engineering. He completed the Purdue University Executive MBA Program in 2002.
Morris is a member of the Quad-City Area Labor-Management Council, the U.S. Labor and Employee Relations Network, and the Council on Labor Law Equality.
Deere & Company (NYSE: DE) is a world leader in providing advanced products and services and is committed to the success of customers whose work is linked to the land—those who cultivate, harvest, transform, enrich, and build upon the land to meet the world's dramatically increasing need for food, fuel, shelter, and infrastructure. Since 1837, John Deere has delivered innovative products of superior quality built on a tradition of integrity. For more information, visit John Deere at its worldwide website at www.JohnDeere.com.