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Thrombophilia - Wikipedia, the free encyclopedia. Thrombophilia (sometimes hypercoagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels). The leg is swollen and red due to venous outflow obstruction. The most common conditions associated with thrombophilia are deep vein thrombosis (DVT) and pulmonary embolism (PE), which are referred to collectively as venous thromboembolism (VTE). DVT usually occurs in the legs, and is characterized by pain, swelling and redness of the limb. It may lead to long- term swelling and heaviness due to damage to valves in the veins. Depending on the size and the location of the clot, this may lead to sudden- onset shortness of breath, chest pain, palpitations and may be complicated by collapse, shock and cardiac arrest. The condition has also been described in adults. Protein C and protein S deficiency have also been associated with an increased risk of skin necrosis on commencing anticoagulant treatment with warfarin or related drugs. Congenital thrombophilia refers to inborn conditions (and usually hereditary, in which case . They are relatively mild, and are therefore classified as . They are classified as . Those with blood groups other than type O are at a two- to fourfold relative risk. O blood group is associated with reduced levels of von Willebrand factor . A prominent example is antiphospholipid syndrome. In some cases antiphospholipid syndrome can cause arterial as well as venous thrombosis. It is also more strongly associated with miscarriage, and can cause a number of other symptoms (such as livedo reticularis of the skin and migraine). PNH increases the risk of venous thrombosis but is also associated with hemolytic anemia (anemia resulting from destruction of red blood cells). For example, sickle- cell disease (caused by mutations of hemoglobin) is regarded as a mild prothrombotic state induced by impaired flow. Patients with acquired hypercoagulable states or hereditary thrombophilia are more likely to develop clots, venous thrombosis, and arterial thrombosis. Inherited thrombophilia is a genetic. At this time the role of genetic testing for MTHFR has not. Management of Pregnant Women with Thrombophilia or a History. ASH Education Program. Again, these conditions usually warrant specific treatment when identified. Furthermore, particular cancer treatments (such as the use of central venous catheters for chemotherapy) may increase the risk of thrombosis further. Various mechanisms have been proposed. This probably results from a physiological hypercoagulability in pregnancy that protects against postpartum hemorrhage. The risk depends on the type of hormones used, the dose of estrogen, and the presence of other thrombophilic risk factors. It more than doubles the risk in numerous studies, particularly in combination with the use of oral contraceptives or in the period after surgery. Various coagulation abnormalities have been described in the obese. Gestational Diabetes Program: Health. The thrombophilias are a group of disorders that promote blood clotting. Individuals with a thrombophilia tend to form.Thrombophilia is defined as an acquired or familial disorder associated with thrombosis. The clinical presentation of an underlying thrombophilia may include venous. Management of thrombophilia often involves anticoagulant therapy. Preventing Thrombophilia-Related Complications of Pregnancy. Program 201, 173–180(2010). The mission of the Thrombosis Program is: To provide the best possible medical care to patients with thrombosis (blood clots) and individuals with thrombophilia. Plasminogen activator inhibitor- 1, an inhibitor of fibrinolysis, is present in higher levels in people with obesity. Obese people also have larger numbers of circulating microvesicles (fragments of damaged cells) that bear tissue factor. Platelet aggregation may be increased, and there are higher levels of coagulation proteins such as von Willebrand factor, fibrinogen, factor VII and factor VIII. Obesity also increases the risk of recurrence after an initial episode of thrombosis. Activated protein C resistance that is not attributable to factor V mutations is probably caused by other factors and remains a risk factor for thrombosis. These risk factors may include any combination of abnormalities in the blood vessel wall, abnormalities in the blood flow (as in immobilization), and abnormalities in the consistency of the blood. Thrombophilia is caused by abnormalities in blood consistency, which is determined by the levels of coagulation factors and other circulating blood proteins that participate in the . Tissue factor binds to circulating factor VIIa. The combination activates factor X to factor Xa and factor IX to factor IXa. Factor Xa (in the presence of factor V) activates prothrombin into thrombin. Thrombin is a central enzyme in the coagulation process: it generates fibrin from fibrinogen, and activates a number of other enzymes and cofactors (factor XIII, factor XI, factor V and factor VIII, TAFI) that enhance the fibrin clot. The severity of the imbalance determines the likelihood that someone develops thrombosis. Even small perturbances of proteins, such as the reduction of antithrombin to only 7. Even those with a form of thrombophilia may not necessarily be at risk of further thrombosis, while recurrent thrombosis is more likely in those who have had previous thrombosis even in those who have no detectable thrombophilic abnormalities. It is more likely to be cost- effective in people with a strong personal or family history of thrombosis. For example, if the thrombosis is due to immobilization after recent orthopedic surgery, it is regarded as . It is recommended that testing be done only after appropriate counseling, and hence the investigations are usually not performed at the time when thrombosis is diagnosed but at a later time. In other rare conditions generally linked with hypercoagulability, such as cerebral venous thrombosis and portal vein thrombosis, there is insufficient data to state for certain whether thrombophilia screening is helpful, and decisions on thrombophilia screening in these conditions are therefore not regarded as evidence- based. If either the woman or a first- degree relative has suffered from thrombosis, the risk of developing thrombosis is increased. Screening this selected group may be beneficial. In those with unprovoked and/or recurrent thrombosis, or those with a high- risk form of thrombophilia, the most important decision is whether to use anticoagulation medications, such as warfarin, on a long- term basis to reduce the risk of further episodes. The risk is determined by the subtype of antibody detected, by the antibody titer (amount of antibodies), whether multiple antibodies are detected, and whether it is detected repeatedly or only on a single occasion. Low molecular weight heparin (LMWH, such as enoxaparin) is generally used as an alternative. When the results of all studies are analysed together, no statistically signifiant benefit could be demonstrated. About 6. 0% of people who are deficient in antithrombin will have experienced thrombosis at least once by age 6. C deficiency and about a third of those with protein S deficiency. People with activated protein C resistance (usually resulting from factor V Leiden), in contrast, have a slightly raised absolute risk of thrombosis, with 1. Most people with the prothrombin mutation (G2. A) never develop thrombosis. Antithrombin deficiency is present in 0. Protein C deficiency, too, is present in 0. The exact prevalence of protein S deficiency in the population is unknown; it is found 1. Factor V Leiden is present in 5% of the population of Northern European descent, but much rarer in those of Asian or African extraction. In people with thrombosis, 1. V Leiden. In those who are referred for thrombophilia testing, 3. The prothrombin mutation occurs at rates of 1. Like factor V Leiden, this abnormality is uncommon in Africans and Asians. Antiphospholipid antibodies are detected in 2. The exact nature of these abnormalities remained elusive until the first form of thrombophilia, antithrombin deficiency, was recognized in 1. Norwegian hematologist Olav Egeberg. Centers of Disease Control. Hughes, and is often referred to as Hughes syndrome for that reason. Many studies had previously indicated that many people with thrombosis showed resistance activated protein C. In 1. 99. 4 a group in Leiden, The Netherlands, identified the most common underlying defect. The defect was called factor V Leiden, as genetic abnormalities are typically named after the place where they are discovered. Robbins Basic Pathology (Eighth ed.). Philadelphia: Saunders. Baglin, T.; Gray, E.; Greaves, M.; Hunt, B. J.; Keeling, D.; Machin, S.; Mac. Kie, I.; Makris, M.; Nokes, T.; Perry, D.; Tait, R. C.; Walker, I.; Watson, H.; British Committee for Standards in Haematology (2. British Journal of Haematology. Thrombophilia Testing, Recurrent Thrombosis, and Women’s Health. Case Presentation 1: A 3. He had noted right leg edema and calf discomfort a week earlier. He denied recent trauma, surgery, or immobility. His mother had a history of postpartum deep vein thrombosis (DVT). On physical examination, he was tachycardic with a heart rate of 1. Hg, and hypoxemic to 8. Contrast- enhanced chest computed tomogram demonstrated bilateral segmental pulmonary embolism. Right lower- extremity venous ultrasound documented femoral and popliteal DVT. Case Presentation 2: A 7. On physical examination, the patient had severe edema and tenderness of the left lower leg and thigh. Left lower- extremity venous ultrasound documented left common femoral, distal femoral, and popliteal DVT. Overview. Thrombophilias describe inherited and acquired hypercoagulable states that increase the risk of venous and, in some cases, arterial thrombosis. The prevalence of thrombophilias varies according to the population studied. In the general population, thrombophilias are less frequent than “traditional” venous thromboembolism (VTE) risk factors such as cancer, immobility, and obesity. However, in patients who have experienced an initial episode of VTE or have a family history of VTE, the prevalence of thrombophilia increases. In a European registry of 2. VTE, thrombophilia testing was performed in 2. Thrombophilia was detected in 3. The most frequently detected thrombophilias were factor V Leiden (2. The rate of thrombophilia detection was similar in patients with idiopathic (unprovoked) and provoked VTE. Thrombophilias may be classified according to their diagnostic yield. High- yield thrombophilia testing includes evaluation for factor V Leiden, prothrombin gene mutation, and antiphospholipid antibodies. Lower- yield thrombophilia testing focuses on deficiency of protein C, protein S, or antithrombin; homocysteine levels, methylenetetrahydrofolate reductase gene mutations; plasminogen activator inhibitor- 1 levels; plasminogen activator inhibitor- 1 gene mutation; and levels of factors VIII, IX, XI, and fibrinogen. Importantly, the yield of particular thrombophilia tests may vary according to patient demographics. Thrombophilias may also be categorized on the basis of whether the hypercoagulable condition is inherited or acquired and according to the risk of initial thrombosis (Table 1). High- risk thrombophilias include deficiency of protein C, protein S, or antithrombin; homozygosity for factor V Leiden or the prothrombin gene mutation; compound heterozygosity for factor V Leiden and the prothrombin gene mutation; and elevated antiphospholipid antibodies. Although quite rare (0. Factor V becomes resistant to cleavage by activated protein C because of this mutation. The prevalence of factor V Leiden is greatest among white patients (5%), especially those of Northern European descent. Factor V Leiden results in an almost 3- fold increase in the risk of a first episode of VTE. Although factor V Leiden increases the frequency of VTE at any age, the mutation results in the greatest increase in risk among patients . However, other polymorphisms of the prothrombin gene have been reported. Heterozygotes for the prothrombin gene mutation have 3. Heterozygosity for the prothrombin gene mutation confers a 4- fold increased risk of VTE. Testing for prothrombin gene mutation requires direct DNA- based genotyping. Antiphospholipid Antibodies. Antiphospholipid antibodies are a class of autoantibodies directed against epitopes on plasma proteins that are exposed when these proteins bind phospholipids on plasma membranes. Antiphospholipid antibodies may increase the risk of arterial and venous thrombosis through a variety of proposed mechanisms, resulting in endothelial injury and coagulation activation. DVT, pulmonary embolism, and stroke are the most common complications of antiphospholipid antibodies, although any segment of the arterial or venous circulation may be affected. A small subset of patients will develop catastrophic antiphospholipid antibody syndrome, characterized by thrombosis in multiple vascular beds culminating in multisystem organ failure. Testing for antiphospholipid antibodies includes lupus anticoagulant assays to detect autoantibodies that prolong in vitro clotting times and enzyme- linked immunosorbent assay for anti- cardiolipin antibodies, anti–. Because antiphospholipid antibodies may be transiently present in the setting of an acute thrombotic event or infection, testing should be repeated at least 1. Impact on Recurrent VTEThrombophilia testing is often performed to assess the risk of recurrent VTE in a patient with an initial event. However, only a subset of thrombophilias have been documented to significantly increase the risk of VTE recurrence. Although antiphospholipid antibodies and deficiency of protein C, protein S, or antithrombin consistently increase the risk of recurrent VTE, more commonly diagnosed thrombophilias such as factor V Leiden and the prothrombin gene mutation do not appear to increase the risk of recurrence. In the Leiden Thrombophilia Study, 4. VTE event underwent extensive thrombophilia testing, including evaluation for factor V Leiden and levels of homocysteine, fibrinogen, factor VIII, factor IX, factor XI, protein C, protein S, and antithrombin. The cumulative rate of recurrent VTE was similar in patients with and without thrombophilia (adjusted hazard ratio, 1. With the exception of patients with hyperfibrinogenemia, none of the tested thrombophilias were associated with an increased risk of recurrent VTE. A subsequent study evaluated the impact of factor V Leiden and the prothrombin gene mutation on VTE recurrence. Heterozygosity for either factor V Leiden or the prothrombin gene mutation was not associated with an increased risk of VTE recurrence. Furthermore, compound heterozygosity and homozygosity for either factor V Leiden or prothrombin gene mutation did not increase the risk of recurrent VTE. Determining whether a VTE event was provoked or unprovoked (idiopathic) appears to have greater implications for the prevention of VTE recurrence than the results of thrombophilia testing. In an analysis of 1. VTE, unprovoked VTE (adjusted hazard ratio, 2. VTE than thrombophilia status (adjusted hazard ratio, 1. Extending anticoagulation with either warfarin. VTE by 6. 0% to 9. VTE who have completed limited- duration anticoagulation. Low- dose aspirin in patients with unprovoked VTE who have completed limited- duration anticoagulation also reduces the risk of recurrent VTE. Persistently elevated D- dimer levels at 1 month after the completion of limited- duration anticoagulation in patients with an initial unprovoked VTE may identify some patients at increased risk for VTE recurrence. Impact on Women’s Health. Thrombophilia has important implications for women’s health, particularly contraceptive therapy, fertility, and pregnancy. Hormonal Contraceptive/Replacement Therapy. Use of combination oral contraceptive pills, especially those containing third- generation progestins, has been associated with at least a 3- fold increased risk of VTE. Use of combination oral contraceptive pills in patients with thrombophilia such as factor V Leiden heterozygosity is associated with at least a 3. VTE. 1. 6 The increased risk of VTE appears to be highest around the time of oral contraceptive pill initiation and within the first 6 months. Infertility. In a subset of women, thrombophilia results in infertility, which may manifest as difficulty with conception, recurrent pregnancy loss, or both. The mechanism by which thrombophilia causes infertility does not appear to be limited to a hypercoagulable state but may also include abnormalities of trophoblast differentiation and placentation. Thrombophilias are associated with both early and late pregnancy loss. Thrombophilia and Pregnancy. Thrombophilias also increase the risk of pregnancy- related complications, including VTE. For example, the relative risk increase for VTE ranges from 9- fold in women with heterozygosity for factor V Leiden to 3. However, the absolute risk increase in pregnant women with factor V Leiden is 0. Therefore, although the relative risk of VTE resulting from thrombophilia in pregnancy is high, the absolute risk is low. The risk of other pregnancy- related complications such as preeclampsia and placental abruption is also increased in the presence of thrombophilia. Thrombophilia Testing. Thrombophilia testing is often considered in patients with VTE at a young age, recurrent VTE, thrombosis in unusual sites, a strong family history of VTE, and recurrent pregnancy loss. Rationales for performing thrombophilia evaluations include selecting the optimal agent and duration of anticoagulation, predicting the risk of VTE recurrence, determining the optimal intensity of thromboprophylaxis, assessing VTE risk with pregnancy or hormonal contraceptive or replacement therapy, and identifying family members at risk for thrombosis. Patients seeking an explanation for an arterial or venous thrombosis, especially if unprovoked or expected, will frequently request thrombophilia testing. Strategies for Thrombophilia Testing and Cost Implications. Various strategies for thrombophilia testing have been proposed. The “kitchen sink” approach runs all available tests. A selective strategy performs the highest- yield tests first and focuses on those tests that will affect therapy or for which there is an intellectual curiosity, for example, if a patient has a compelling family history. Finally, a “no testing” approach is to defer all testing because the results are not expected to affect disease management. Selection of an approach to thrombophilia testing must take into account cost implications. A kitchen sink approach, if applied broadly, would result in a considerable cost to healthcare systems with limited yield, given the low prevalence of thrombophilia in the general population. Products & Services . Contact us today for for more information or to receive an estimate on installation. Cardinal Building Products. 1st Email: 'I had my Fort Knox mailbox hit three times (all hit and run). After the second time the box, along with the concrete, was knocked out the. Edgemoor Inc. 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Medical Services: Brandywine is a full service hospital with general medical as well as multiple specialty and sub- specialty divisions. Program staff works closely with participants, their families and insurers so that the extent of coverage is understood in advance of admission. Most insurance plans cover the major portion of costs. The Individuals We Treat: Program participants are ages 1. We treat both males and females with diagnosis of anorexia nervosa, bulimia nervosa or binge eating disorder. Many participants have a secondary diagnosis related to depression, anxiety, post- traumatic stress disorder or obsessive compulsive disorder. We address these related problems in the course of a comprehensive and individualized approach to care. Brandywine is not a dual- diagnosis facility, but care can be coordinated with drug and alcohol rehabilitation programs. The co- occurrence of an eating disorder and diabetes is often a challenge for individuals and families. To address the needs of these participants we offer a specialized treatment track. Program Highlights: Individualized approach in an attractive and supportive environment. One of the most experienced treatment teams in the nation. Round the clock nursing support. Individual therapy three times per week with masters or doctoral level clinician. Family therapy twice per week with doctoral level family specialist. Specialized treatment for diabetes (support from endocrinologist, registered dietitian and certified diabetes educator)Daily group programming including cognitive, interpersonal, and dialectical behavioral approaches. Psychiatric management daily. Experiential therapy in art, music, and movement modalities. Individual nutritional counseling, education, meal planning, and supervision (can accommodate Kosher and vegetarian diets)Off- unit meals and activities. Recreational programming including supervised exercise as appropriate. Educational support for middle, high school, and college students in our classroom with support from an accredited teacher. Consultations with medical specialists as needed. Spiritual support (Resources are available to support all denominations)Comprehensive discharge plans which include follow- up therapy, participant’s meal plan, plan for meal supervision at home and arrangements for constructive activities. Program is covered by most commercial insurance plans, Medicare, & some Medicaid. The Next Step: Recovery can begin with a phone call. Prospective participants, their families or treatment providers are invited to contact us. Eating Disorders Treatment Centers, Facilities & Clinics in Pennsylvania. Pennsylvania has always been a leader in the world of eating disorder recovery, offering some of the premier treatment centers in the nation. In 2. 01. 4, state lobbyists partnered with National Eating Disorders Association (NEDA) for a statewide Lobby Day to educate state representatives on eating disorders and the need for improved legislation. For information on the many treatment programs throughout Pennsylvania, see the directory below. Sponsoring Eating Disorder Centers. Name. Treatment. Patient Types Served. Therapies. Insurance. Timberline Knolls Residential Treatment Center. Timberline Drive. Lemont, IL 6. 04. Phone: 8. 77- 2. 17- 7. Email: info@timberlineknolls. Website: Timberline Knolls. Residential. Adults / Adolescents / Children. Female Only. Couples Therapy, Family Therapy, Group Therapy, DBT, CBT, Art therapy, Nutritional Counseling, Prescription Medication, Support Groups, Individual Therapy, Medical Care. Accepted, in- network with multiple providers. Medicare/Medicaid Accepted: No. Rebecca's House. 23. Rockfield Blvd Ste 1. Lake Forest, CA 9. Phone: 8. 00- 7. 11- 2. Website: Rebecca's House. Extended Care Treatment, Partial Day Treatment, PHP, IOP, Recovery Living. Adults / Adolescents. Male & Female. EMDR, DBT, CBT, Individual, Couples, Family, Group, Art, Equine Therapies, Prescription Medication, Support Groups, Spirituality, Nutrition and Expressive Therapies. Accepted, in- network with multiple providers. Rosewood Centers for Eating Disorders. S. Rincon Rd. Wickenburg, AZ 8. Phone: 8. 44- 8. 46- 3. Website: Rosewood Centers for Eating Disorders. Inpatient, RTC, PHP, IOP, Transitional Living, Detox, Acute Care. Adults / Adolescents Male & Female. Eye Movement Desensitization and Reprocessing Therapy, Dialectical Behavior Therapy, Nutrition Services: Meal / Nutrition Planning, Mindful Eating Group, Psychodrama. Aetna, Cigna, United Health Care, Blue Cross Blue Shield, Value Options, First Health Network and other providers. Rosewood Santa Monica. Cloverfield Boulevard, Suite 1. Santa Monica, CA 9. Phone: 8. 44- 7. 99- 4. Website: Rosewood Santa Monica. Adolescent Programs, Extended Day Treatment,Partial Day Treatment, IOP, Three Levels of Transitional Living Homes. Adults / Adolescents. Male & Female. DBT, CBT,Body Image Groups, Addiction & Psycho- Education, Meal Planning/Nutritional Education, Relapse Prevention, Gentle & Mindful Eating Groups,Multi- Family Therapy Groups, Collaborative Environment. Most major insurance policies accepted, Full and partial private pay options available. Mc. Callum Place. W. Ste 2. 01. St. Louis, MO 6. 31. 19. Phone: 8. 00- 8. 28- 8. Fax: 3. 14- 9. 68- 1. Website: Mc. Callum Place. Residential, Transional Living, PHP, IOP, Aftercare, Outpatient. Adults / Adolescents. Male & Female. CBT, DBT, Experiential, Expressive, Art, Pet assisted,etc. Blue Cross Blue Shield, Aetna, Mercy, Anthem Blue. Medicare/Medicaid Accepted: No. Sierra Tucson. 39. S Lago Del Oro Pkwy. Tucson, AZ 8. 57. Website: Sierra Tucson. Residential, Transional Living, PHP, IOP, Aftercare, Outpatient. Adults Male & Female. CBT, Medical Nutrition Therapy, DBT, etc.: Yes, Evidence Based Therapies as well as Integrative Therapies. Insurance accepted. No Medicare/Medicaid. Canopy Cove Eating Disorder Treatment Center. Mahan Drive, Tallahassee, Florida 3. Phone: 8. 00- 2. 36- 7. Email: support@Canopy. Cove. com. Website: Canopy Cove. Residential, Partial Hospitalization, Intensive Outpatient. Adults / Adolescents Male & Female. CBT, Individual, Group, Equine- Assisted Therapy, Art, Music, Expressive Therapies, Family Education, Family Therapy, Spirituality, Nutrition. Accepted, in- network with multiple providers. Remuda Ranch. 12. Jack Burden Road. Wickenburg, AZ 8. Phone: 8. 66- 3. 90- 5. Email: info@remudaranch. Website: Remuda Ranch. Acute, Residential, Transitional. Adults / Adolescents / Children Female Only. Family, Group, Individual, Nutrition, Experiential, Equine, Primary Care, Art, Body Movement, Culinary, DBT, CBT, ACT, ERPAccepted, in- network with multiple providers. Medicare/Medicaid Accepted: No. River Centre Clinic. Main Street. Sylvania, OH 4. Phone: 1- 8. 77- 2. Fax: 4. 19- 8. 85- 8. Email: info@river- centre. Website: River Center Clinic. RTC, PHPAdults / Adolescents / Children. Male and Female. Couples Therapy, Family Therapy, Group Therapy. Nutritional Counseling, Prescription Medication, Maudsley Therapy, DBT, CBT, Support Groups, Individual Therapy, Medical Care. Accepted, In- network with multiple providers. Medicare/Medicaid Accepted: No. Eating Disorder Clinics and Centers in PAName / Info. Treatment Level. Patient Types Served. Therapies Available. The Renfrew Center of Philadephia. Spring Lane. Philadelphia, PA 1. Phone: 2. 15- 4. 82- 5. Fax: 2. 15- 4. 82- 2. Email: info@renfrewcenter. Website: Renfrew Center of Philadelphia. RTC, Day Treatment, IOP Services. Adults & adolescents: women only. Couples Therapy, Family Therapy, Group Therapy, DBT, CBT, Art therapy, Nutritional Counseling, Prescription Medication, Support Groups, Experiential Therapy, Individual Therapy, Medical Care. The Renfrew Center of Radnor. King of Prussia Road, 2nd Floor. Radnor, PA 1. 90. Phone: 6. 10- 5. 27- 9. Fax: 6. 10- 5. 27- 9. Email: info@renfrewcenter. Website: Renfrew Center of Radnor. Outpatient Services, IOP, Day Treatment. Adults & adolescents: women only. Couples Therapy, Family Therapy, Group Therapy, DBT, CBT, Art therapy, Nutritional Counseling, Prescription Medication, Support Groups, Experiential Therapy, Individual Therapy, Medical Care. The Center for Eating Disorders at Sheppard Pratt. N Charles St, Ste 3. Townson, MD 2. 12. Phone: 4. 10- 9. 38- 5. Email: eatingdisorderinfo@sheppardpratt. Website: The Center for Eating Disorders at Sheppard Pratt. Inpatient, Outpatient, PHP, IOP, Support Groups. Adults, adolescents, children: Men and women. Couples Therapy, Family Therapy, Group Therapy. Nutritional Counseling, Prescription Medication, Maudsley Therapy, DBT, CBT, Support Groups, Individual Therapy, Medical Care. The Eating Disorders Program at Brandywine Hospital. Behavioral Health Pavilion. Reeceville Road. Coatesville, PA 1. Website: The Eating Disorders Program at Brandywine Hospital. Inpatient. Adults / Adolescents: Men & Women. Group Therapy, Individual Therapy, Family Therapy, Couple's Therapy, Experiential Therapy, Nutritional Counseling, DBT, CBT, Christian Counseling. The Emily Program. Cranberry Crossroads Business Center. Mac. Kenzie Way. Suite 1. Cranberry Township, PA 1. Phone: 8. 88- 3. 64- 5. Website: Emily Program. IOP, Outpatient. Adults / Adolescents: Men & Women. Eating Disorder Assessments,Individual Therapy,Group Therapy,Intensive Outpatient Program (IOP)Eating Disorder Recovery Specialists. Phone: 8. 00- 3. 15- 4. Fax: 9. 17- 5. 91- 7. E- Mail: info@eatingdisorderspecialists. Website: Eating Disorder Recovery Specialists. Outpatient: In- Home, On Campus, At Work. Adults / Adolescents. Male and Female. Recovery Coaching, CBT, DBT, Mindfulness, Therapeutic Exposures, Life Skills. Penn State Eating Disorder Program. Briarcrest Office Building. West Governor Rd, Suite 2. Hershey, PA 1. 70. Phone: 7. 17- 5. 31- 7. Email: pmagnuson@hmc. Website: Penn State Eating Disorders Program. PHP, IOP, Outpatient. Adults / Adolescents / Children: Men & Women. Couples Therapy, Family Therapy, Group Therapy, DBT, CBT, Art therapy, Nutritional Counseling, Prescription Medication, Support Groups, Individual Therapy, Medical Care. Life Counseling Services. Russell Rd. Paoli, PA 1. Phone: 8. 00- 2. 38- 4. Fax: 6. 10- 6. 44- 4. IOPAdults / Adolescents: Men & Women. Individual & Group Therapy, Evaluations & Assessments, Family Therapy, Christian Counseling, Medication Management. Premier Eating Disorder Treatment Centers. The Renfrew Center of Philedelphia. The Renfrew Center is the first and largest network of eating disorder treatment facilities in the country and has treated more than 6. The Renfrew treatment philosophy emphasizes a respect for the unique psychology of women, the importance of a collaborative therapeutic relationship, and the belief that every woman needs to actively participate in her own recovery. The Renfrew Center provides a comprehensive range of services at its facilities in California, Connecticut, Florida, Maryland, New Jersey, New York, North Carolina, Pennsylvania, Tennessee, Georgia and Texas. Programs and services vary by site and include: Residential; Day Treatment; Intensive Outpatient; Group Therapy; Individual, Family, and Couples Therapy; Nutrition Therapy; and Psychiatric Consultation. Renfrew’s training programs have reached more than 2. For more information, please visit www. RENFREW. 1- 8. 00- RENFREWwww. Renfrew Center is an Honorary Patron of Eating Disorder Hope – Helping to make our work possible! The Renfrew treatment philosophy emphasizes a respect for the unique psychology of women, the importance of a collaborative therapeutic relationship, and the belief that every woman needs to actively participate in her own recovery. The Renfrew Center provides a comprehensive range of services at its facilities in California, Connecticut, Florida, Illinois, Maryland, Massachusetts, New Jersey, New York, North Carolina, Pennsylvania, Tennessee, Georgia and Texas. For more information, please visit www. RENFREW. 1- 8. 00- RENFREWwww. Renfrew Center is an Honorary Patron of Eating Disorder Hope – Helping to make our work possible! While rooted in extensive experience, our programs continuously evolve to integrate the latest research and evidence- based practices including a strong cognitive- behavioral therapy (CBT) component and high levels of family involvement. Interdisciplinary treatment teams provide specialized care for children, adolescents and adults with eating disorders, both male and female. The Center’s full- continuum of care includes age- specific Inpatient Programs and 1. ADP History – Stable, Reliable and Profitable 'We formed an effective trio, with complementary strengths--me in accounting, Joe in organization, and Frank in marketing--and very compatible in personality and business style. Register with Park Street People. Candidate registration is a straightforward process which can be completed in 5 minutes. Once registered, you're details will be on our candidate database. Kerridge Commercial Systems (KCS) provides integrated business software solutions enterprise resource planning (ERP) for wholesale, distribution, retail, manufacturing and service management industries. In addition to software. CDK Global is transforming how cars, trucks and vehicles of all kinds are marketed, sold and serviced around the world. Our story begins in 1972, when ADP Dealer Services opened its doors to offer account and inventory. ADP History – Stable, Reliable and Profitable. Senator Frank Lautenberg. Since virtually all of the transactions we perform are repetitive in nature, they also generate reliable and predictable streams of revenue that has weathered virtually every economic cycle for the past six decades. Furthermore, through the decades, the story of ADP has illustrated a number of principles that still guide the company: Focusing on business markets that offer significant growth opportunities, recurring revenue, the chance to be the industry leader, and where clients have significant service needs. Embracing technological change to enhance product and service offerings. Attracting and retaining motivated, talented people who are committed to our aspirations and who help us win in the marketplace. Today ADP, with more than $1. Leveraging over 6. ADP offers a wide range of human resource, payroll, tax and benefits administration solutions from a single source. ADP's easy- to- use solutions for employers provide superior value to companies of all types and sizes. CDK Global provides integrated computing solutions to nearly 25,500 car, truck, motorcycle, marine and recreational vehicle dealers throughout Europe, the United States and Canada.ADP, LLC., is an American provider of human resources management software and services. ADP was formerly one of four American companies to get a AAA credit rating from Standard & Poor's (S&P) and Moody's, but S&P and Moody's. Information technology giant ADP is a few weeks away from finalizing the spinoff of its Dealer Services unit into a publicly traded standalone with a newly announced name. It will be known as CDK Global. View the latest Accel-KKR updates and learn more about industry best practices here. ADP is also a leading provider of integrated computing solutions to auto, truck, motorcycle, marine, recreational vehicle, and heavy equipment dealers throughout the world. Important dates in ADP History: 1. Henry Taub, a 2. 1- year- old New Jersey accountant, started a manual payroll processing business called Automatic Payrolls, Inc. ADP introduced an automated punch card, a forerunner of the mainframe computer, with the capability of increasing efficiency and capacity for payroll processing. The company, now called Automatic Data Processing, Inc., went public and leased its first computer, an IBM 1. ADP had 3. 00 clients, 1. ADP Dealer Services became ADP's third major business unit offering account and inventory service to auto dealers. Through the 1. 99. They no longer wanted ADP to provide services to their HR department.. ADP to be their HR department. That prompted ADP to become a professional employer organization (PEO). Another significant growth opportunity was overseas. In 1. 99. 0 Dealer Services acquired Autonom, a German company. ADP acquired the largest payroll and human resource services company in Europe: GSI, headquartered in Paris. The early twenty- first century saw continued growth and innovation at ADP. One example is the introduction of Global. View. SM – ADP’s comprehensive global service solution for payroll processing and human resources administration. Global. View. SM enables end- to- end, standardized payroll processing and HR across multiple countries on a single platform. Dealer Services extended its global position by acquiring Kerridge Computer Co. Ltd., the leading dealer management systems (DMS) provider to auto dealers in the UK, expanding its geographic coverage from 1. Gary Butler becomes ADP’s fifth CEO2. Carlos Rodriguez becomes ADP’s sixth CEO2. ADP open Chelsea Innovation Lab, in the heart of New York City's Silicon Alley. ADP spins off ADP Dealer Services to create new company, CDK Global. ADP celebrated 6. ADP Opens Global 'Center of Excellence' in Bucharest to Enhance Delivery of Human Capital Management Services to Global Clients. Blog berbagi dan belajar kali ini hadir untuk menyajikan kunci dan pembahasan buku Detik-detik Ujian Nasional 2015-2016. File PDF kunci jawaban diunggah setiap mata pelajaran serta dijadikan satu paket file RAR. Program yang kami bantu. Konsultasi Disertasi Hukum; Jasa Pembuatan Skripsi; Jasa Pembuatan Tesis; Jasa Pembuatan Tesis Hukum Notaris, Pidana, Perdata; Jasa Pembuatan Tesis Pemberdayaan Masyarakat; Jasa Pembuatan Tesis. Universitas Kristen Satya Wacana - Wikipedia bahasa Indonesia, ensiklopedia bebas. Universitas Kristen Satya Wacana (UKSW) adalah sebuah universitasswasta tertua dan salah satu yang terbaik di Indonesia, terletak di Salatiga, Jawa Tengah. Ide berdirinya perguruan tinggi yang beralaskan iman Kristen berasal dari DR. Abraham Kuyper (1. Perdana Menteri Belanda dan pendiri Vrije Universiteit te Amsterdam. Membongkar Gurita Cikeas adalah buku kontroversi karangan George Junus Aditjondro – Seorang Guru Besar Sosiologi dari Universitas NewCastle Australia – yang berisi tentang bisnis-bisnis Keluarga SBY dan Kasus Bank Century.Universitas Kristen Satya Wacana didukung oleh 1. Sinode Gereja di Indonesia, yaitu: Banua Niha Keriso Protestan (BNKP)Gereja Injili di Tanah Jawa (GITJ)Gereja Masehi Injili di Timor (GMIT)Gereja Isa Almasih (GIA)Sinode Gereja Kalimantan Evangelis (GKE)Sinode Gereja Kristen Jawa (GKJ)Gereja Kristen Jawi Wetan (GKJW)Gereja Kristen Muria Indonesia (GKMI)Gereja Kristen Pasundan (GKP)Gereja Kristen Protestan di Bali (GKPB)Gereja Kristen Indonesia - Jawa Tengah (GKI Jateng)Gereja Kristen Injili di Tanah Papua (GKI Papua)Sinode Gereja Kristen Sulawesi Tengah (GKST)Sinode Gereja Kristen Sumba (GKS)Gereja Protestan Maluku (GPM)Gereja Protestan Indonesia Barat (GPIB)Gereja Protestan Sulawesi Tenggara (GEPSULTRA)Sinode Gereja Toraja (GT)Program - program pendidikan yang diselenggarakan oleh UKSW serta jenjangnya adalah sebagai berikut: Sekolah Laboratorium. A.program studi yang ditawarkan serta kelompok ujian. Daya tampung penerimaan mahasiswa baru universitas pendidikan indonesia tahun 2015. Untuk soal-soal Ujian Nasional SMA Tahun 2013 lengkap 20 paket soal (bahkan sampai 71 paket soal) sudah diunggah. Untuk mendownload soal UN SMA 2013 komplit anda klik link di bawah ini!!! Children Center. Kelompok Bermain. TK Satya Wacana. Sekolah Dasar Satya Wacana. Sekolah Menengah Pertama Satya Wacana. Sekolah Menengah Atas Satya Wacana. Fakultas Bahasa dan Sastra. Pendidikan Bahasa Inggris. Www.unri.ac.id - Tahun 2016, sebanyak 12 Program Studi (Prodi) Universitas Riau (UR) memperoleh akreditasi. Analisa & Perancangan SI. Analisa & Perancangan SI.ppt; er1.gif; er2.gif; er3.gif; er4.gif; er5.gif; Flowchart.pdf; struktur.jpg; Untitled-1.gif; Untitled-2.gif; Untitled-3.gif; Untitled-4.gif; Untitled-5. Sastra Inggris. Fakultas Keguruan dan Ilmu Pendidikan. Bimbingan Konseling. Pendidikan Sejarah. Pendidikan Ekonomi. Pendidikan Pancasila & Kewarganegaraan. Pendidikan Matematika. Pendidikan Guru Sekolah Dasar (PGSD)Pendidikan Anak Usia Dini (PAUD)Magister Manajemen Pendidikan. Fakultas Ekonomika dan Bisnis. D- 3 Sekretaris. Manajemen. Ilmu Ekonomi Studi Pembangunan. Akuntansi. Magister Manajemen. Magister Akuntansi. Doktor Ilmu Manajemen. Fakultas Hukum. Ilmu Hukum. Magister Ilmu Hukum. Fakultas Ilmu Sosial & Ilmu Komunikasi. Sosiologi. Ilmu Komunikasi. Hubungan Internasional. Fakultas Biologi. Pendidikan Biologi. Biologi. Magister Biologi. Fakultas Ilmu Kesehatan. Ilmu Keperawatan. Ilmu Gizi. Pendidikan Jasmani Kesehatan Rekreasi. Teknologi Pangan. Fakultas Pertanian & Bisnis. Agroekoteknologi. Agribisnis. Magister Agroekoteknologi. Fakultas Teknik Elektronika & Komputer. Teknik Elektro. Sistem Komputer. Fakultas Sains dan Matematika. D- 3 Analisis Kimia Industri. Pendidikan Fisika. Fisika. Kimia. Matematika. Fakultas Teknologi Informasi. D- 3 Usaha Perjalanan Wisata. D- 3 Komputerisasi Akuntansi. D- 3 Teknik Informatika. D- 3 Public Relations. Teknik Informatika. Sistem Informasi. Desain Komunikasi Visual. Pendidikan Teknik Informatika dan Komputer. Public Relations. Ilmu Perpustakaan. Destinasi Pariwisata. Magister Sistem Informasi. Fakultas Teologi. Teologi. Magister Sosiologi Agama. Doktor Sosiologi Agama. Fakultas Psikologi. Psikologi. Magister Sains Psikologi. Fakultas Seni Pertunjukan. Program Pasca Sarjana Studi Pembangunan. Magister Studi Pembangunan. Doktor Studi Pembangunan. Selain kerja sama dengan institusi pendidikan dan nonpendidikan dalam negeri, UKSW juga memiliki kerja sama dengan institusi luar negeri, yaitu: A. Lembaga Kristen. United Board of Christian Education in Asia (UBCHEA)Evangelical Lutheran Church in America (ELCA)International Christian Scholarship Program (ICSF)Ecumenical Scholarship Program (ESP)Mennonite Central Committee (MCC)Presbyterian Church America (PC- USA)Presbyterian Church in Ireland. United Church of Christ (UCC)Uniting Churches in the Netherlands (UCN)Association of Christian Universities and Colleges in Asia (ACUCA)B. Institusi Pendidikan. Charles Darwin University, Australia. Griffith University, Australia. Queensland University of Technology, Australia. Sydney University, Australia. Australian National University, Australia (ANU)University of Western Sydney, Australia. Seagate Technology, Australia. University of the Sunshine Coast, Australia. Vrije Universiteit of Amsterdam, Belanda (VUA)The Amsterdam Faculty of Education, Amsterdam (EFA)Christelijke Hogeschool in Netherland (CHN)Passau University, Germany. Protestant University of Applied Science Ludwigsburg, Germany. Arizona State University, USA (ASU)St Olaf College, USABeloit College, USAValparaiso University, USAUniversity of Glasgow, UKCzech University of Life Sciences Prague, Czech Republic. Kwansei Gakuin University, Jepang (KGU)Kansai Gaidai University, Jepang. Chung Yuan Christian University, Republic of China. Hyogo University Mobility in Asia and the Pacific. Ateneo de Manila University, Philippines. Chang Jung Christian University, Taiwan. Christian University of Thailand. National University of Singapore, Singapore (NUS)Universidade da Paz, Timor Leste. Universidade Nacional Timor Leste, (UNTL)Dili Institute of Technology, (DIT)Universidade Oriental Timor Lorosae. Lembaga Pers Mahasiswa Scientiarum (www. Lembaga Pers Fiskom Lentera (portalentera. Radio XT FMBuletin Senin UKSWRadio Flofiskom FM 1. MHz. Radio Labschool FM 1. MHz. Satya Wacana TV ch. UHF/youtube. Kampus Induk, jl. Sidorejo, Salatiga. Kampus Stiba, jl. Kartini No. 1. 7- 2. Sidorejo, Salatiga. Kampus 2 FTI, jl. Raya Osamaliki Sidomukti, Salatiga. Kampus 3 (proses pembangunan), jl. Fatmawati- Gunung Payung, Bukit Soka Sidorejo, Salatiga. Kampus Lab Agro UKSW, Kopeng, Salatiga. U pitanju je parametarski 3. D alat koji je otvorenog koda, pro. Prvenstveno namenjen iskusnim dizajnerima, programerima, profesorima, a potom i svim ostalim korisnicima koji su zainteresovani za parametarsko trodimenzionalno modeliranje. Naime, ovaj program omogu. Make. Human predstavlja odli. 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