How To Connect Gable Roof into Existing Gable Roof For Room Addition
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Alpharetta remodeling |room addition | new bathroom
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By Ian Bauer, Milpitas Post

A movement has materialized to thwart the potential move of the Bay 101 Casino from San Jose to Milpitas. The all-volunteer group of Milpitas citizens last week announced the launch of Milpitas Voters Against Measure E (Voters Against E).

Unlike supporters who say passage of Measure E on Nov. 4 will allow a card room to operate within city limits and adopt a 10.5-percent card room tax that will result in approximately $8.4 million in annual general fund revenue, the Voters Against E believe the action will degrade the city's quality of life.

"Milpitas has a well-earned reputation as a family-friendly town. In 1954, Milpitas won a major battle for independent status over the City of San Jose, celebrated by the 'Minute Man' statue in front of city hall today," Mike McInerney, a Voters Against E spokesman, wrote in a Sept. 18 statement. "Welcoming a card room to Milpitas, even if it locates on a corner of Milpitas next to the landfill, does not fit the character of the Milpitas where we want to raise our families."

McInerney added a card room will tarnish Milpitas' reputation as a family-friendly town.

In addition, opponents say Bay 101 -- in its quest to relocate from San Jose to Milpitas -- gained a "sweetheart deal" toward the relocation.

"The Bumb family, owners of the Bay 101 card room, want to relocate it to Milpitas," he wrote, noting Ed McGovern, the Bumb family's spokesperson, told this newspaper the family was tired of their treatment by the City of San Jose. "Measure E gives the Bumbs a sweetheart deal -- a substantial financial gain over their present arrangement with San Jose and a gambling-friendly environment where local control is severely handcuffed.

"In San Jose, only voters can decide whether to increase the number of tables per card room or allow new Vegas-style slot machines. Under Measure E, the city council may increase the number of tables and the state decides what games are allowed unless the voters pass a ballot measure to prohibit."

The group claims:

Milpitas City Manager Tom Williams countered that by saying the card room would be subject to annual reviews, and that employees would have to be re-licensed with a type of work permit every three years.

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Anti-card room group forms in Milpitas

T.S. No.u2020 011730-ID Parcel No. C0810004002A NOTICE OF TRUSTEE'S SALE On 1/7/2015 at 9:00 AM (recognized local time), AUCTION.COM ROOM, LA QUINTA INN & SUITES, 333 W. IRONWOOD DRIVE, COEUR D'ALENE, ID 83814, in the County of Kootenai,u2020 ELISA MAGNUSON, ESQ., a member of the State Bar of Idaho, of PITE DUNCAN, LLP, as trustee, will sell at public auction, to the highest bidder, for cash, in lawful money of the United States, all payable at the time of sale, the following described real property, situated in the County ofu2020 Kootenai, State of Idaho, and described as follows, to wit: LOT 2, AND THE NORTH HALF OF LOT 3, BLOCK 4, BOOTHE ADDITION TO THE TOWN OF COEUR D ALENE, ACCORDING TO THE PLAT RECORDED IN BOOK "B" OF PLATS AT PAGE 69, RECORDS OF KOOTENAI COUNTY, IDAHO. The Trustee has no knowledge of a more particular description of the above referenced real property, but for purposes of compliance with Idaho Code Section 60-113, the Trustee has been informed that the address of: 1945 NORTH 8TH STREET, COEUR D'ALENE, ID 83814, is commonly associated with said real property. Said sale will be made without covenant or warranty, express or implied, regarding title, possession or encumbrances to satisfy the obligation secured by and pursuant to the power of sale conferred in the Deed of Trust executed byu2020 DENNIS A HAYES SR., AND MARY L HAYES, HUSBAND AND WIFE as Grantor, to FIDELITY NATIONAL TITLE INSURANCE CO as Trustee, for the benefit and security ofu2020 MORTGAGE ELECTRONIC REGISTRATION SYSTEMS INC., SOLELY AS NOMINEE FOR COUNTRYWIDE BANK, FSB, ITS SUCCESSORS AND ASSIGNS as Beneficiary, dated 1/28/2008, recorded 2/5/2008, as Instrument No. 2143319000, official records ofu2020 Kootenai County, Idaho. Please note: The above named Grantors are named to comply with Idaho Code Section 45-1506(4)(a); no representation is made that they are, or are not, presently responsible for the obligation. The default for which this sale is to be made is the failure to make monthly payments when due from 4/1/2012 and all subsequent monthly payments thereafter, including installments of principal, interest, impounds, advances, plus any charges lawfully due under the note secured by the aforementioned Deed of Trust, Deed of Trust and as allowed under Idaho Law. The sum owing on the obligation secured by said Deed of Trust is $129,316.63, including interest, costs and expenses actually incurred in enforcing the obligation thereunder or in this sale, and trustee's fees and/or reasonable attorney's fees as authorized in the Note, Deed of Trust or as allowed under Idaho Law.u2020 All delinquent amounts are now due, together with accruing late charges, interest, unpaid and accruing taxes, assessments, trustee's fees, attorney fees and any amounts advanced to protect the security associated with the Deed of Trust described herein as provided under the Note, Deed of Trust and as allowed under Idaho Law. DATED: 8/20/14 LEGAL 1431 SEPTEMBER 12, 19, 26, 2014 OCTOBER 3, 2014

Case No. CV14-6075 ORDER FOR PUBLICATION OF SERVICE IN THE DISTRICT COURT OFTHE FIRST JUDICIAL DISTRICT OF THE STATE OF IDAHO, IN AND FOR THE COUNTY OF KOOTENAI In the Matter of: The PETITION OF AMANDA HENDERSON for LILLY RENNAE KATHERINE PETERSON, a minor child. THIS MATTER having come on regularly before the Court. the Court being fully advised in the premises. and good cause appearing, NOW THEREFORE: IT IS HEREBY ORDERED that Petitioner is hereby authorized to publish the Summons in the above entitled matter in a newspaper of general circulation in the State of Idaho. Kootenai County, Coeur D' Alene, Idaho. at least once per week for four consecutive weeks. Service of the Summons shall be complete at the expiration of the period of publication. IT IS SO ORDERED. DATED: 25 day of August, 2014 /S/ JUDGE LEGAL 1541 SEPTEMBER 12, 19, 26, 2014 OCTOBER 3, 2014

Notice of Trustee's Sale Idaho Code 45-1506 Today's date: September 11, 2014 File No.: 7699.20903 Sale date and time (local time): January 15, 2015 at 10:00 AM Sale location: in the Veteran's Plaza outside the north entrance of the administrative building, 451 Government Way, Coeur d'Alene, ID 83814 Property address: 1503 E Park Ln Post Falls, ID 83854 Successor Trustee: Northwest Trustee Services, Inc., an Idaho Corporation P.O. Box 997 Bellevue, WA 98009 (425) 586-1900 Deed of Trust information Original grantor: Terry E Thomas, and Anna M Thomas, husband and wife Original trustee: Fidelity National Title Ins Co Original beneficiary: Mortgage Electronic Registration Systems, Inc. as nominee for Countrywide Home Loans, Inc. Recording date: 07/12/2006 Recorder's instrument number: 2042859000 County: Kootenai Sum owing on the obligation: as of September 11, 2014: $157,374.49 Because of interest, late charges, and other charges that may vary from day to day, the amount due on the day you pay may be greater. Hence, if you pay the amount shown above, an adjustment may be necessary after we receive your check. For further information write or call the Successor Trustee at the address or telephone number provided above. Basis of default: failure to make payments when due. Please take notice that the Successor Trustee will sell at public auction to the highest bidder for certified funds or equivalent the property described above. The property address is identified to comply with IC 60-113 but is not warranted to be correct. The property's legal description is: Lot 2 in Block 1 of Riverview Park Addition to Post Falls, according to the official plat thereof, filed in Book D of Plats at Page(s) 161 Official Records of Kootenai County, Idaho. The sale is subject to conditions, rules and procedures as described at the sale and which can be reviewed at http://www.northwesttrustee.com or USA-Foreclosure.com. The sale is made without representation, warranty or covenant of any kind. (TS# 7699.20903) 1002.272746-File No. LEGAL 1559 SEPTEMBER 26, 2014 OCTOBER 3, 10, 17, 2014

ADVERTISEMENT FOR REQUEST FOR QUALIFICATIONS Submittals for Regional Electrical Engineering Services will be received by Division of Public Works, State of Idaho, at 502 N. 4th Street, P.O. Box 83720, Boise, Idaho 83720-0072 beginning immediately, until 3:00 PM local time October 8, 2014 for Electrical Engineering Services, Statewide. A written Request for Qualifications and other information are available at the Division of Public Works, 502 N 4th Street, Boise, ID 83720-0072; contact Elaine Hill, Project Manager at: (208) 332-1925. The RFQ is also available for viewing and printing at the following website: dpw.idaho.gov An Idaho Electrical Engineering License is required to submit a proposal on this project. Jan Frew, Deputy Administrator Division of Public Works LEGAL 1562 SEPTEMBER 19, 26, 2014

Notice of Trustee's Sale Idaho Code 45-1506 Today's date: September 12, 2014 File No.: 7021.18143 Sale date and time (local time): January 12, 2015 at 10:00 AM Sale location: in the Veteran's Plaza outside the north entrance of the administrative building, 451 Government Way, Coeur d'Alene, ID 83814 Property address: 9295 Quarter Mile Road AKA 9343 E Quarter Mile Rd Athol, ID 83801 Successor Trustee: Northwest Trustee Services, Inc., an Idaho Corporation P.O. Box 997 Bellevue, WA 98009 (425) 586-1900 Deed of Trust information Original grantor: Zara J. Malcolm, a single person Original trustee: North Idaho Title Original beneficiary: Countrywide Home Loans, Inc. Recording date: 11/30/1998 Recorder's instrument number: 1565357 and Modified by Agreement Recorded 12/30/1999 under Instrument No. 1618731 County: Kootenai Sum owing on the obligation: as of September 12, 2014: $118,101.71 Because of interest, late charges, and other charges that may vary from day to day, the amount due on the day you pay may be greater. Hence, if you pay the amount shown above, an adjustment may be necessary after we receive your check. For further information write or call the Successor Trustee at the address or telephone number provided above. Basis of default: failure to make payments when due. Please take notice that the Successor Trustee will sell at public auction to the highest bidder for certified funds or equivalent the property described above. The property address is identified to comply with IC 60-113 but is not warranted to be correct. The property's legal description is: The West Half of the West Half of the Northeast Quarter of the Northeast Quarter of the Northeast Quarter of Section 23, Township 50 North, Range 3 West of the Boise Meridian, Kootenai County, Idaho. More Correctly Described As: The West Half of the West Half of the Northeast Quarter of the Northeast Quarter of Section 23, Township 53 North, Range 3 W.B.M, Kootenai County, Idaho. The sale is subject to conditions, rules and procedures as described at the sale and which can be reviewed at http://www.northwesttrustee.com or USA-Foreclosure.com. The sale is made without representation, warranty or covenant of any kind. (TS# 7021.18143) 1002.270888-File No. LEGAL 1564 SEPTEMBER 26, 2014 OCTOBER 3, 10, 17, 2014

NOTICE OF PUBLIC AUCTION VIA SEALED BID CITY OF COEUR D'ALENE, KOOTENAI COUNTY, IDAHO NOTICE IS HEREBY GIVEN THAT the City of Coeur d'Alene will hold a public auction to sell the following described real property to the highest bidder: A 50 foot square parcel owned by the City and located at the intersection of 9th Street and Locust Avenue and further described by the County Alternate Identification Number (AIN) 199985. The public auction via sealed bid will be held in the Old Council Chambers of City Hall at 710 E. Mullan Ave., Coeur d'Alene, Idaho. Sealed bids will be received by the City Council of the City of Coeur d'Alene at the office of the City Clerk of said City on or before October 2, 2014 until the hour of 10:00 a.m. of said day. Bids will be opened in the Old Council Chambers located at City Hall 710 E. Mullan Avenue at 10:00 o'clock a.m. on said date. All interested individuals are welcome to attend. Payment in full will be due within seven (7) days of completion of the auction. Said property to be conveyed by quitclaim deed as is and where is. All bids shall be presented or otherwise delivered to the City Clerk under seal with a concise statement marked on the outside as, "bid for 9th and Locust property." All bids shall contain one of the following forms of bidder's security in an amount $100.00: (a) Cash, (b) Cashier's Check made payable to the City, (c) Certified Check made payable to the City, or (d) Bidder's Bond executed by a qualified surety company, made payable to the City. The right is reserved to reject any or all bids. Dated this 17th day of September, 2014. _________________________ Renata McLeod, City Clerk LEGAL 1570 SEPTEMBER 19, 26, 2014

NOTICE OF TRUSTEE'S SALE On Tuesday, the 13th day of January, 2015, at the hour of 10:00 o'clock a.m. of said day at Alliance Title & Escrow, 1270 Northwood Center Ct., Coeur d'Alene, in the County of Kootenai, State of Idaho, Ryan M. Fawcett, as Successor Trustee, will sell at public auction, to the highest bidder, for cash, in lawful money of the United States, all payable at the time of sale, the following described real property situated in the County of Kootenai, State of Idaho, and described as follows, to wit: LOT 3, BLOCK 3, OF MEADOWLAND ESTATES 1ST ADDITION, ACCORDING TO THE OFFICIAL PLAT THEREOF, FILED IN BOOK G OF PLATS AT PAGE 328, OFFICIAL RECORDS OF KOOTENAI COUNTY, IDAHO. The Successor Trustee has no knowledge of a more particular description of the above referenced real property, but for purposes of compliance with Section 60-113, Idaho Code, the Successor Trustee has been informed that the street address of 14504 N. Wright St., Rathdrum, Idaho, is sometimes associated with said real property. Said sale will be made without covenant or warranty regarding title, possession or encumbrances to satisfy the obligation secured by and pursuant to the power of sale conferred in the Deed of Trust executed by ROB R. DIETRICH, an Unmarried Person and APRIL L. ALLEN, an Unmarried Person, Grantor, to Ryan M. Fawcett, Successor Trustee, for the benefit and security of FIRSTBANK NORTHWEST, recorded September 20, 2004, as Instrument No. 1901941, Mortgage records of Kootenai County, Idaho; and assigned to the IDAHO HOUSING AND FINANCE ASSOCIATION by Assignment of Deed of Trust recorded on November 23, 2004, as Instrument No. 1914764, Mortgage records of Kootenai County, Idaho. THE ABOVE GRANTOR IS NAMED TO COMPLY WITH SECTION 45-1506 (4)(a), IDAHO CODE. NO REPRESENTATION IS MADE THAT THEY ARE, OR ARE NOT, PRESENTLY RESPONSIBLE FOR THIS OBLIGATION. The default for which this sale is to be made is the failure to pay when due, monthly installment payments under the Deed of Trust Note dated September 15, 2004, in the amount of $654.00 each, for the months of July, 2013 through August, 2014, inclusive; and for each and every month thereafter until date of sale or reimbursement. All delinquent payments are now due, plus accumulated late charges, plus any costs or expenses associated with this foreclosure. The accrued interest is at the rate of 5.57% per annum from June 1, 2013. The principal balance owing as of this date on the obligation secured by said Deed of Trust is $73,877.00, plus accrued interest at the rate of 5.57% per annum from June 1, 2013. DATED This 12th day of September, 2014. /s/______________ RYAN M. FAWCETT, a Member of the Idaho State Bar, SUCCESSOR TRUSTEE Legal 1582 September 19, 26, 2014 October 3, 10, 2014

NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN that the Kootenai County Board of Commissioners will hold a Public Hearing per Idaho Code u00DFu00DF31-1604 and 31-1605 to consider amendment of the Kootenai County Emergency Medical Services System (KCEMSS) FY2015 budget, as adopted, to reflect the Cash Carry Forward from FY2014 of $485,000.00 and Budget and Cash Reserves of $335,652.00 for a total increase requested of $820,652.00. The Public Hearing will be held on Tuesday, October 14, 2014 at 2:00 p.m. in the Board Chambers, County Administration Building, 451 N. Government Way, Coeur d' Alene, Idaho 83814. Dated this 23rd day of September, 2014. KOOTENAI COUNTY ATTEST: BOARD OF COMMISSIONERS ___________________ W. Todd Tondee, Chairman Deputy Clerk ATTEST: JIM BRANNON, CLERK By:____________________ Deputy Clerk LEGAL 1618 SEPTEMBER 26, 2014 OCTOBER 3, 2014

Case No. CV 14- 5827 NOTICE OF PETITION AND HEARING IN THE DISTRICT COURT OF THE FIRST JUDICIAL DISTRICT OF THE STATE OF IDAHO, IN AND FOR THE COUNTY OF KOOTENAI IN THE MATTER OF THE ESTATE OF Donna Mae Bergman An incapacitated/protected person 1. Notice is hereby given that Eugene Melvin Bergman, whose address is 16385 W. Hollister Hills Drive, Hauser Lake, ID 83854 has filed a petition for guardianship and conservatorship. 2. A copy of the petition is on file with the Clerk of the Court and may be reviewed upon request. 3. The petition has been set for hearing in the Court at the KOOTENAI County Court House on October 21,2014 at 10:00 o'clock, a.m. Dated this 22 day of September, 2014. /S/ Katherine Monroe Coyle Wytychak Elder Law, PLLC P.O. Box 1888 Coeur d'Alene, ID 83816-1888 Telephone (208) 765-3595 Facsimile : (208) 765-0515 ISB No. 7990 LEGAL 1621 SEPTEMBER 26, 2014 OCTOBER 3, 10, 2014

SUMMARY OF SPIRIT LAKE ORDINANCE NO. 558. AN ORDINANCE DE-ANNEXING FROM AND DECLARING THE SAME TO BE SEPARATE FROM THE CITY OF SPIRIT LAKE, KOOTENAI COUNTY, IDAHO, A SPECIFICALLY DESCRIBED AS A FIVE (5.0) ACRE PARCEL OF PROPERTY IN SECTION 8, TOWNSHIP 43 NORTH, RANGE 4 WEST, BOISE MERIDIAN; IDENTIFIED AS KOOTENAI COUNTY TAX PARCEL NO. 16256, BY DECLARING SUCH PROPERTY TO BE NO LONGER A PART OF THE CITY OF SPIRIT LAKE, REPEALING ALL ORDINANCES AND PARTS OF ORDINANCES IN CONFLICT HEREWITH AND PROVIDING A SEVERABILITY CLAUSE. THE ORDINANCE SHALL BE EFFECTIVE UPON PUBLICATION OF THIS SUMMARY THE FULL TEXT OF THE SUMMARIZED ORDINANCE NO. 558 IS AVAILABLE AT SPIRIT LAKE CITY HALL, 6042 W. MAINE STREET, SPIRIT LAKE, IDAHO IN THE OFFICE OF THE CITY CLERK. Ann Clapper, City Clerk LEGAL 1624 SEPTEMBER 26, 2014

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Legals September 26, 2014

Higher Open Tipped For Thai Stock Market

RTT News - Thursday 25th September, 2014

The Thai stock market has tracked higher now in six straight sessions, collecting nearly 30 points or 1.9 percent in that span. The Stock Exchange of Thailand settled just above the 1,590-point ...

Asia News Network - Thursday 25th September, 2014

One thousand children turned up at Bangkok University recently, taking turns to dance their fingers over an iPad as they competed to be the smartest kindergarten child in Thailand. They had come ...

Straits Times - Thursday 25th September, 2014

THAILAND - A Singaporean navy officer cadet had to be evacuated by the Royal Thai Navy on Sunday after he exhibited stroke-like symptoms while sailing off the waters of Phuket, reported Thai news ...

The Nation - Thursday 25th September, 2014

Puttharaksa Negree and Rojjana Raklao claimed their second bronze medal together in the Incheon Asian Games after they finished third in the women's lightweight doubles ...

The Nation - Thursday 25th September, 2014

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Newest addition to Accors Phuket network opens in October

Published: Tuesday, September 23, 2014 at 10:04 p.m. Last Modified: Tuesday, September 23, 2014 at 10:04 p.m.

WINTER HAVEN | For people with questions about cancer, Winter Haven Hospital has more answers and resources than it did before.

The hospital and the American Cancer Society are jointly offering a cancer resource room at the hospital's Cassidy Cancer Center. It will be open to the public for free use.

A grand opening will be held from 10:30 a.m. to 1:30 p.m. Friday at the center, which is located in the main hospital at 200 Ave. F NE in Winter Haven. The ribbon cutting will be 11 a.m.

Registration for the ACS's Making Strides Against Breast Cancer Walk, being held Oct. 25 at Mosaic Park in Bartow, will be taken at the event.

Because of the size of Polk County, the American Cancer Society decided there was a need for a second ACS resource center in Polk in addition to the one in its office at 1920 S. Florida Ave. in Lakeland.

"They may come in for one thing, and we're able to help them with multiple others," said Stephanie McLean, the society's hospital accounts representative.

Volunteers from the hospital and cancer society staff the WHH cancer resource room. Its hours are 8 a.m. to 5 p.m. weekdays and after hours by appointment. Lakeland's is open 9 a.m. to 5 p.m. Monday through Friday.

Information and supplies for cancer patients, such as scarves, caps, wigs and bras, are available for free. Volunteers can help people start dealing with their diagnosis, treatment and need for information before or after treatment.

People can use the Winter Haven Hospital room without being patients at the hospital. For information, call Deborah Schulte at 863-291-6095.

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Cancer Resource Room at Winter Haven Hospital Opens Friday

Daily Big Cat 2014 09 22
Simba Leopard gets treats on a stick from Angie, Ginger Serval catches something in the ferns, Gale, Cody and Meredith remove a rotten limb and ants from Narla Cougar #39;s cage, check in on Mickey...

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Daily Big Cat 2014 09 22 - Video

Quitman, Miss. It's the first in the state of Mississippi and its home is Quitman Upper Elementary School. From fiber optics to now innovative reading, Quitman is leading the way when it comes to education. The school and members of the community welcomed the new addition of a Ben Carson Reading Room in a grand opening ceremony that was attended by countless individuals and thanks to the book "Gifted Hands", the room is a reality.

" I was actually reading Ben Carson's book Gifted Hands and I saw the idea that he had for the reading rooms," Quitman Schools Finance Coordinator Elisa Mayo said. "I knew right away that that was something that God wanted us to have for the children here. It was the best thing we could provide for them, so I immediately came back and went to the Phil Hardin Foundation and the QSD Imagination Library with the idea and both of them sponsored the Ben Carson Reading Room for us."

The room is described as a place designed to encourage young people to discover the joy of independent reading in a warm, inviting atmosphere and to THINK BIG.

"What I hope that our children get from that is that they need to think outside the box and they need to think that there is nothing they can't achieve and that reading is the way to get them where they would like to be and the dreams they might have for themselves," Quitman Schools Superintendent Suzanne Hawley said.

While the room provides an atmosphere that encourages reading, Principal James Kelley says it's meant to be a way to get kids to enjoy a book.

"There is no expectations," Kelley said. "Just come in and read, bring your parents in and let them read to you. It's a fun time, nothing required."

Kelley says each teacher is allotted two thirty minute blocks to bring their students into the reading room. He says the only rule is to read for enjoyment.

The first Ben Carson Reading Room was founded in 2000 in Aberdeen, Maryland. It opened at Hall's Cross Roads Elementary school. To date, there are over 110 locations spreading 14 states, with this being the first one in Mississippi.

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Quitman Upper Elementary Debuts Ben Carson Reading Room

The prevalence of preterm birth -- the birth of an infant prior to 37 weeks of pregnancy -- is a significant health problem that has increased over the past two decades. According to the Centers for Disease Control and Prevention (CDC), preterm birth affects nearly 500,000 babies each year, or one of every eight born in the U.S. While medical care has improved survival rates for preterm infants, questions remain about ways to positively impact the neurodevelopmental outcomes of preterm infants.

Research led by Barry M. Lester, PhD, director of the Brown Center for the Study of Children at Risk at Women & Infants Hospital of Rhode Island and professor of psychiatry and pediatrics at The Warren Alpert Medical School of Brown University, and James F. Padbury, MD, pediatrician-in-chief and chief of Neonatal/Perinatal Medicine at Women & Infants Hospital and the William and Mary Oh -- William and Elsa Zopfi Professor of Pediatrics for Perinatal Research at the Alpert Medical School, entitled "Single Family Room Care Improves Neurobehavioral and Medical Outcomes in Preterm Infants," is published in the October issue of Pediatrics, the official journal of the American Academy of Pediatrics.

The researchers found that a single-family room environment provides for appropriate levels of maternal involvement, developmental support, and staff involvement, which are essential to provide the kind of care that can optimize the medical and neurodevelopmental outcome of the preterm infant and lead to the development of preventive interventions to reduce later impairment.

As medical care has improved the survival rates for preterm infants, especially those born weighing less than 1,000 grams, nearly half of these infants still suffer long-term neurodevelopmental impairment and/or serious health consequences. Drs. Lester and Padbury led a research team that performed a prospective, longitudinal study to examine associations between the open bay vs. single family room NICU and medical and neurobehavioral outcomes at hospital discharge. They also examined, for the first time, factors that could help explain, or mediate, potential differences in NICUs.

"There are few studies that have compared the individual single family room neonatal intensive care unit (NICU) with the traditional 'open bay' model of care. In particular, two critical issues have not been systematically addressed," explained Dr. Padbury. "First is the effect of the single family room NICU on neurodevelopmental outcome. The second is how and why positive or negative effects of the single family room NICU occur."

In September 2009, Women & Infants Hospital, a U.S.News 2014-15 Best Children's Hospital in Neonatology, opened what was at the time the largest single family room NICU in the country. Prior to that, approximately 1,400 babies each year were cared for in the hospital's open bay NICU. The single family room model also offered an opportunity to more comprehensively implement a family centered model of care, where families are now more actively involved in their baby's care and care team.

Dr. Lester explained, "We hypothesized that infants cared for in the single family room NICU would have better medical and neurobehavioral outcomes than infants cared for in the open baby NICU, as well as that medical and neurobehavioral differences between NICUs could be explained, in part, by developmental support, parenting factors and the adoption of family centered care."

Approximately 400 infants born weighing less than 1,500 grams were enrolled at Women & Infants Hospital -- 151 were cared for in an open bay NICU and 252 were cared for in the single family room NICU. The open bay data were collected consecutively over 18 months in 2008 and 2009 prior to the opening of the hospital's new NICU. After a three-month hiatus (no new patients were enrolled during the first three months in the new single family room NICU, and no patients were enrolled who were cared for in both settings), data were again collected consecutively over 31 months from 2010 to 2012 in the single family room NICU.

The results showed that the infants cared for in the single family room weighed more at discharge, had a greater rate of weight gain, required fewer medical procedures, and had a lower gestational age at full enteral feed and less sepsis. In addition, these infants showed better attention, less physiological stress, less hypertonicity, less lethargy, and less pain.

"What we found was that the single family room provides more opportunities to do things that improve outcomes, such as increased maternal involvement and increased developmental support," said Dr. Lester. "If you build a single-family room unit and do not change how you care for the babies, it would be unrealistic to expect to see any significant improvement."

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Research evaluates neurodevelomental, medical outcomes in single family room NICU

PUBLIC RELEASE DATE:

22-Sep-2014

Contact: Amy Blustein ablustein@wihri.org 401-681-2820 Women & Infants Hospital

The prevalence of preterm birth the birth of an infant prior to 37 weeks of pregnancy is a significant health problem that has increased over the past two decades. According to the Centers for Disease Control and Prevention (CDC), preterm birth affects nearly 500,000 babies each year, or one of every eight born in the U.S. While medical care has improved survival rates for preterm infants, questions remain about ways to positively impact the neurodevelopmental outcomes of preterm infants.

Research led by Barry M. Lester, PhD, director of the Brown Center for the Study of Children at Risk at Women & Infants Hospital of Rhode Island and professor of psychiatry and pediatrics at The Warren Alpert Medical School of Brown University, and James F. Padbury, MD, pediatrician-in-chief and chief of Neonatal/Perinatal Medicine at Women & Infants Hospital and the William and Mary Oh - William and Elsa Zopfi Professor of Pediatrics for Perinatal Research at the Alpert Medical School, entitled "Single Family Room Care Improves Neurobehavioral and Medical Outcomes in Preterm Infants," is published in the October issue of Pediatrics, the official journal of the American Academy of Pediatrics.

The researchers found that a single-family room environment provides for appropriate levels of maternal involvement, developmental support, and staff involvement, which are essential to provide the kind of care that can optimize the medical and neurodevelopmental outcome of the preterm infant and lead to the development of preventive interventions to reduce later impairment.

As medical care has improved the survival rates for preterm infants, especially those born weighing less than 1,000 grams, nearly half of these infants still suffer long-term neurodevelopmental impairment and/or serious health consequences. Drs. Lester and Padbury led a research team that performed a prospective, longitudinal study to examine associations between the open bay vs. single family room NICU and medical and neurobehavioral outcomes at hospital discharge. They also examined, for the first time, factors that could help explain, or mediate, potential differences in NICUs.

"There are few studies that have compared the individual single family room neonatal intensive care unit (NICU) with the traditional 'open bay' model of care. In particular, two critical issues have not been systematically addressed," explained Dr. Padbury. "First is the effect of the single family room NICU on neurodevelopmental outcome. The second is how and why positive or negative effects of the single family room NICU occur."

In September 2009, Women & Infants Hospital, a U.S.News 2014-15 Best Children's Hospital in Neonatology, opened what was at the time the largest single family room NICU in the country. Prior to that, approximately 1,400 babies each year were cared for in the hospital's open bay NICU. The single family room model also offered an opportunity to more comprehensively implement a family centered model of care, where families are now more actively involved in their baby's care and care team.

Dr. Lester explained, "We hypothesized that infants cared for in the single family room NICU would have better medical and neurobehavioral outcomes than infants cared for in the open baby NICU, as well as that medical and neurobehavioral differences between NICUs could be explained, in part, by developmental support, parenting factors and the adoption of family centered care."

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Research evaluates neurodevelomental and medical outcomes in single family room NICU