text: Structuring Recommendations for Clinical Decision Support (Text Version) Slide Presentation from the AHRQ 2010 Annual Conference On September 28, 2010, Jerry Osheroff made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (3.6 MB). Free PowerPoint® Viewer (Plugin Software Help).Slide 1 Structuring Care Recommendations for Clinical Decision SupportJerry Osheroff, MD, Thomson ReutersJon White, MD, Agency for Healthcare Research and QualityAHRQ Annual MeetingSeptember 28, 2010Slide 2 Backdrop and Drivers for the eRecommendations ProjectAHRQ HIT PortfolioFederal CDS portfolioFederal CDS CollaboratorySlide 3 Session OvervieweRec Project Context: Improving Care through HITeRec Project Overview: Engage stakeholders.Develop template, eRecs, and how-to guide.Vet deliverables for potential use.Next Steps: Engage more stakeholders.Vet and refine eRecs.Test drive eRecs.Slide 4 eREC Project ContextSlide 5 Pressing Health Care ChallengesCost and EfficiencyHealth spending =16% of GDP; > any other nation; $2.3 trillion; $7,600/person.Rising 6.9%/year (more than twice the inflation rate).14% of U.S. population is uninsured.$700 Billion in waste.Quality and Safety44,000-98,000 preventable inpatient deaths/year.Patients have only 55% chance of appropriate care.Anticipate 17 years before effective treatment routine.Sources: OECD Health Data, Thomson Reuters, Frost and Sullivan, IOM, Forbes, PwC Health Research Institute, Balas/IMIA, CITL, National Coalition on HealthcareSlide 6 National Framework for Performance ImprovementImage: A flowchart depicts the National Framework. The first column is headed "Drivers and Reporting" and contains three steps:Incentivize outcome improvement and CDS use.Determine local performance improvement priorities.Gather and report provider performance data.The second column contains three steps:Set National Improvement Priorities.Deploy Local Strategies to Drive Improvement (e.g. Decision Support).Realize Measurable Local/National Improvements and Repeat Cycle.Arrows point down from each step to the one beneath it.The third column is headed "CDS Infrastructure" and contains two items:Best Practices for developing and using CDS to address goals.CIS/CDS tools available that help drive improvements.Slide 7 Meaningful Use → Better Healthcare"By focusing on 'meaningful use,' we recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care."—David Blumenthal, 10/1/09Slide 8 Government Role: HITECH ActImage: Flowchart depicts the Government Role in the HITECH Act: Regional extension centers and Workforce training lead to Adoption of EHRs. Medicare and Medicaid incentives and penalties and Adoption of EHRs lead to Meaningful use of EHRs. State grants for health information exchange, Standards and certification framework, and Privacy and security framework all lead to Exchange of health information. Exchange of health information leads to Meaningful use of EHRs. Meaningful use of EHRs leads to Improved individual and population health outcomes, Increased transparency and efficiency, and Improved ability to study and improve care delivery. Research to enhance HIT is ongoing.Blumenthal D. N Engl J Med 2009;10.1056/NEJMp0912825Slide 9 HIT/EHR/CDS to the Rescue!But...Slide 10 Outpatient: It's Just Not That Easy!Conclusion: As implemented, EHRs were not associated with better quality ambulatory care.Image from an article in the Arch Intern Med: Electronic Health Record Use and the Quality of Ambulatory Care in the United States.Jeffrey A. Linder, MD, MHP; Jun Ma, MD, RD, PhD; David W. Bates, MD, MSc; Blackford Middleton, MD, MHP, MSc; Randall S. Stafford, MD, PhD.Arch Intern Med. 2007; 167 (13):1400-1405Slide 11 Inpatient: Not Easy Here Either!Image from an article in the Arch Intern Med: Arch Intern Med 2005;165:1111-1116.Original Investigation: High Rates of Adverse Drug Events in a High Computerized HospitalJonathan R. Nebeker, MS, MD; Jennifer M. Hoffman, PharmD; Charlene R. Weir, RN, PhD; Charles L. Bennett, MD, PhD, MPP; John F. Hurdle, MD, PhD√Advanced clinical systems with CDSBut...1/4 of admissions with at least 1 ADE; 9% serious harm.Problems with drug dosing, selection, monitoring.Slide 12 What Do We Mean By CDS?"...provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care"Includes and builds on current processes...Not just rules and alerts....Slide 13 CDS Stakeholders Work in Relative Isolation on Very Difficult ProblemsImage: A man underwater solving a Rubix cube is displayed.Slide 14 Collaborative Effort on National CDS StrategyJournal of the American Medical Informatics Association Volume 14 Number 2 Mar/Apr 2007JAMIA Perspectives on InformaticsWhite PaperA Roadmap for National Action on Clinical Decision Support.Jerome A. Osserhoff, MD; Jonathan M. Teich, MD, PhD; Blackford Middleton, MD, MPH, MSc; Elaine B. Steen, MA; Adam Wright; Don E. Detmer, MD, MA.http://www.jamia.org/cgi/content/abstract/14/2/141Slide 15 CDS Roadmap PillarsImage depicting Enhanced Health & Healthcare Through CDS as a building with 3 pillars consisting of: Best Knowledge Available When Needed; High Adoption and Effective Use; and Continuous Improvement of CDS Methods and Knowledge. Best Knowledge Available When Needed points to Strategic Objective A.Strategic Objective A: Represent clinical knowledge and CDS interventions in standardized formats (both human and machine-interpretable), so that a variety of knowledge developers can produce this information in a way that knowledge users can readily understand, assess, and apply it.Slide 16 Roadmaps for Successful CDSGuidebooks on CDS Implementation for Providers:Image of the front cover of "Improving Outcomes with Clinical Decision Support: An Implementer's Guide".2005 HIT book of the yearAll-time HIMSS bestsellerWidely used by CMIOs/others2011 Update in processImage of the front cover of "Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide".Co-published by leading societiesOver 100 contributors2009 HIT book of the yearCo-sponsors: AHRQ, 3 CIS vendors,."This is not just a book"—ongoing collaborationNotes: In parallel with the substantial national (and international) attention to the challenges associated with healthcare delivery, has been increasing attention to national efforts that can optimize the role of CDS in addressing these pressing challenges. One result from this attention is the Roadmap for National Action on CDS, presented to HHS Secretary Leavitt and AHIC in 2006. This Roadmap, developed by scores of stakeholders, has driven substantial public and private follow-up activities. Its key recommendations include developing better approaches to synthesizing and disseminating best practices for improving outcomes with CDS.Toward this end, HIMSS published a CDS implementer's guide in 2005 that has been well received and widely used to improve the efficiency and effectiveness of provider organizations' CDS efforts. In follow-up to this successful guide, nearly 100 contributors from dozens of organizations have come together over the last few years to build on the framework from this previous work to offer recommendations on improving outcomes in a specific, high priority area—i.e. improving medication use and outcomes. The result of this highly collaborative effort has been published in early 2009 by HIMSS and many other leading societies, and co-sponsored by AHRQ, leading CIS vendors and others. The book is offered by the collaborative group that produced it not as a 'finished product' but rather as a snapshot of an ongoing conversation among CDS implementers about how to best enhance the success and value of their efforts.This slides that follow present concepts, recommendations and figures used in this latest CDS implementer's guide.Slide 17 A Formula for Success: The CDS Five RightsTo improve care outcomes with CDS, you must provide:The Right Information: Evidence-based, useful for guiding action and answering questions.To the Right Stakeholder: Both clinicians and patients.In the Right Format: Alerts, order sets, answers, etc.Through the Right Channel: Internet, mobile devices, clinical information systems.At the Right Point in the Workflow: To influence key decisions/actions.Slide 18 Some Sources for "The Right Information"Image: A flowchart. The left side section reads, "Clinical and outcomes research (What works?)" which leads to a text box with: "What should be done? (CPGs)," which points to "What should be done now? (CDS)," which points to "How are we/am I doing? (Performance measurement/reporting)," which points back to the top text box: "What should be done? (CPGs)."Slide 19 Getting the 'Right Information' Into Clinical PracticeIn Theory, Straightforward:Evidence → GuidelinesGuidelines → Changes in clinical practiceChanges in practice → Improved quality of careSlide 20 Getting the 'Right Information' Into Clinical PracticeIn practice, barriers are widespread:Evidence basis has gaps and inconsistencies.Physicians disagree with guidelines or patients may not comply.Inertia exists; incentives to change are lacking; disincentives exist.Volume of guideline content is large and hard to track; accessible content at right time in care process is missing.Difficulty of implementing guidelines (in information systems): Guidelines have free-text format, ambiguous terminology, lack of data elements/data schema in published guidelines.Implementation is complex and site-specific (e.g., workflow).Slide 21 eREC Project OverviewSlide 22 eREC Project GoalTo accelerate widespread uptake of well-accepted, evidence-based patient care recommendations into clinical information systems: By developing a formal method for translating narrative into structured, coded logic statements.Useful for further local processing into CDS rules.Slide 23 AHRQ eREC Project TeamContractors Thomson Reuters Project Director: Jerry Osheroff, MDSusan Raetzman, Rosanna Coffey, Andriana Hohlbauch and othersTechnical Lead: Robert Greenes, Arizona State UniversityERec Developer: Margarita Sordo, Mass Gen Hosp, Harvard MedAdvisors: Peter Haug, Intermountain Health CareAziz Boxwala, University of California at San DiegoTed Shortliffe, American Medical Informatics AssociationKey Collaborators Jacob Reider, Electronic Health Records AssociationFloyd Eisenberg, National Quality ForumWilliam Bria and select AMDIS membersSlide 24 eREC Project ActivitiesNeeds and prior work: Synthesize stakeholder needs and related efforts.ERec Format: Develop format for converting guideline recommendations into structured logic statements.ERecs Applied: Convert 47 recommendations into the structured logic format: 45 "A and B" USPSTF recommendations.2 clinically relevant Meaningful Use criteria.Dissemination: Processes and lessons—so others can replicate and learn.Disseminate results—so CDS implementation accelerates.Slide 25 Focus of Needs and Prior WorkStakeholdersIssuesCDS vendors and implementersWhat will make eRec products most useful in process of translating guidelines into machine rules?Providers of careWhat works well or is problematic in CDS products and processes?Standards setting organizationsHow can existing standards be used in new format for translating care recommendations?Quality improvement organizationsCan performance measurement momentum be leveraged? Can eMeasures inform eRecs?Guideline developersCan the development of care guidelines be improved/informed by using eRec format?Slide 26 Needs and Prior Work: FindingsBuild on knowledge-sharing collaborativesTranslation is multi-step process.Other formalisms exist (HL7 RIM, GEM, etc.).Lessons:Create a semi-structured formalism.Leverage other formalisms as appropriate.Slide 27 eREC Project in CDS Context: Stage 2Image: A flow chart:Stages of Rule DevelopmentProduction Process1. Free-text logic statement[Arrow pointing left] Assemble Knowledge Assemble elements of narrative guideline needed to produce a logical statementInclude other CDS-related elements2. Structured logic statement[Arrow pointing left] Create Structured Logic Statement Express medical knowledge in structured format that codifies data and logical expressionsFlag and annotate items that require further disambiguationIdentify key implementation considerations3. Pre-executable logic statement[Arrow pointing left] Translate Statement to Pre-executable Format Evaluate logic statement in use scenariosIncorporate attributes that anticipate local implementation considerations, data types, and rule triggering scenarios4. Deployable logic statement[Arrow pointing left] Generate Deployable Rules Develop setting-specific representations for local systemsEnsure the rule can be engineered into HIS and care setting Slide 28 Needs and Prior Work: Findings (cont'd)Common needs vs. setting specific needsSubstantial effort and duplication for translation.Clinical assumptions are not always explicit.Implementers want disambiguated logic statements and clearly defined and coded data elements.Workflow considerations are highly local; tension over specificity in addressing these.Lessons:Provide data definitions and codes where possible.Include "Implementation Considerations": Less specificity of workflow considerations in logic increases portability and allows local tailoring.Slide 29 Importance of the Local Context for Applying CDSFlowchart showing the steps in applying CDS in a local context:Step 1: Establish CDS Management Charter, Governance; Engage Stakeholders which leads to: Step 2: Determine Opportunities, Goals, Baselines which leads to: Step 3: Examine Workflows, Infrastructure which leads to: Step 4: Configure Internventions to Test Goals which goes down to: Step 5: Test Interventions; Communicate, Train, Launch which leads to Step 6: Assess/Improve. An arrow then goes back toStep 2: Determine Opportunities, Goals, Baselines.There is also a text box in the middle which states: Manage CDS Assets, Decisions, ProcessesFigure ©2009 HIMSSSlide 30 Needs and Prior Work: Findings (cont'd)Quality improvement efforts:National push for Meaningful Use of HIT.Health Quality Measures Format (HQMF): standard for expressing quality measure in format for EHR integration, i.e., eMeasure .NQF Quality Data Set (QDS): Common language for information in quality measures, e.g., data elements, code lists, care setting attributes.Lessons:Desirable to leverage momentum and related tools.ERecs related in concept and content to HQMF and eMeasure.Some adjustments needed: Performance measures are population based; CDS based on patient-provider encounter.Slide 31 eREC Project Conceptual ApproachLeveraging Quality Measurement Standards and EHR Integration to Support Widely Useful Structured Recommendations for CDS RulesEvidence-Based Care Guidelines, e.g.:USPSTF A&B-graded recommendationsInterventions underlying meaningful use measuresCDS Interventions: eRecommendationseRecommendation operational exclusion criteriaOther CDS implementation considerationsClinical Information SystemseRecommendation eligibility criteria/eMeasure denominator criteriaExclusion criteriaAction recommended/action measuredQuality Measures: eMeasures (in HQMF Format)Value Sets, Code Sets, Code Lists, Quality Data Types:Unfolding work of NQF, HITSC, etc.Slide 32 eREC FormatThree main parts to eRecommendation format Header—information describing eRec and underlying clinical care recommendations.Data Definition and Logic Specification—identifies data elements, code sets, and values needed to express logic; provides logic statement for identifying patients who satisfy criteria for care recommendation.Implementation Considerations—lists other issues that care providers and vendors should consider when implementing for local settings.Slide 33 eREC Format: Header SectionImage: Screen shot of Header section from eRec format spreadsheet.Slide 34 eREC Format: Data and Logic SectionImage: Screen shots of Data and Logic Specification section of spreadsheet and Logic Statement section of spreadsheet.Slide 35 eREC Format: Implementation Considerations SectionImage: Screen shot of Implementation Considerations section of spreadsheet.Slide 36 eREC Dissemination Products Available from ProjectMethods Report: Background, existing approaches, approach for eRecommendations.eRec Template: Format for developers, vendors, implementers.eRecs of two types: 45 A- and B-graded recommendations from the USPSTF.2 Stage 1 Meaningful Use criteria.Available on AHRQ/NRC site when final. For Excel example of future eRec, E-mail firstname.lastname@example.com Operating Procedures (SOPs): How to apply eRec template to care recommendations.Slide 37 eREC Project Impact (To Date)Stimulating broad conversation among key CDS players (guideline suppliers, CDS implementers).Cultivating synergies between CDS and performance measurement (from goals to codes).Garnering attention of guideline developers.Illustrating the concept of formal logic structures to support measurable, CDS-enabled healthcare performance improvement.Slide 38 Next StepsSlide 39 Next Steps (proposed)Pilot eRecs in real world settings (EP/EH): Focus on MU clinical topics.Flesh out implementation considerations.Build 'value chain community' to follow and help drive to scale: Guideline suppliers, CIS suppliers, implementers, federal stakeholders, etc.Develop eRecs for additional MU measures, based on implementer need.Slide 40 Vision Beyond ProjecteRec as standard for expressing guidelines.Key guideline developers produce guidelines in eRec format for quick uptake into CDS.CIS vendors use eRecs as part of CDS capabilities deployment.Care delivery organizations implementing CDS adopt guidelines rapidly.Gain insights on and improve guidelines-to-alerts-to-better-outcomes chain of events.eRecs help drive measurable care improvements.Slide 41 Thank You For Your Interest!For more information:Jerry Osheroff, Project Director email@example.com information on AHRQ National Resource Center on Health IT site http://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/projectdetails?pubURL=http://wci-pubcontent/publish/communities/a_e/ahrq_funded_projects/projects/structuring_care_recommendations_for_clinical_decision_support.html Current as of December 2010 Internet Citation: Structuring Recommendations for Clinical Decision Support (Text Version). December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/osheroff/index.html


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Since our last ICEHS newsletter, Centers for Disease Control and Prevention Director Thomas Frieden, MD, MPH, announced that Linda C. Degutis, DrPH, MSN, has been selected to serve as director of CDC's National Center for Injury Prevention and Control effective Nov. 7, 2010.
In his announcement, Frieden highlighted Degutis' distinguished career. Her expertise crosses a broad spectrum of public health and injury disciplines. Degutis is currently an associate professor in the Department of Emergency Medicine and School of Public Health, and associate clinical professor of nursing at Yale University. She is the research director for emergency medicine and directs the Yale Center for Public Health Preparedness, as well as the Connecticut Partnership for Public Health Workforce Development in the School of Public Health. From 1998-2002, she was the director of the New Haven Regional Injury Prevention and Control Program. She is a past president of APHA, as well as past chair of its Executive Board, and chair of the Injury Control and Emergency Health Services Section. At the state level, Degutis served as the chair of the Connecticut Coalition to Stop Underage Drinking, which focuses on environmental and policy change, and served on various committees and workgroups that focused on trauma system development in Connecticut. In addition, Degutis serves on the Institute of Medicine's Advisory Board for the Robert Wood Johnson Health Policy Fellowship Program and the Executive Boards of Advocates for Highway and Auto Safety and the American Trauma Society.
Degutis' research interests have centered on issues related to alcohol and injury, with a particular focus on interventions and policy issues. She is known internationally for her work in public health, injury, substance abuse and policy, and has served as the principal investigator or co-investigator for grants on a wide range of topics including: alcohol interventions; screening, brief intervention, and referral to treatment (SBIRT); public health preparedness; public health workforce training; public health systems research; and interventions for opioid addiction.
Please join Frieden and the ICEHS membership in welcoming Linda Degutis to her new position. We are all very excited about the experience, leadership, and vision she will bring to the Injury Center.
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I am honored and delighted to be selected as the next director of the National Center for Injury Prevention and Control. There are so many things to think about as I make this transition to my new position at CDC – taking on a new role, moving to a new city, learning the language of a federal agency, etc. But one of the best things about all of this is the opportunity to work with dedicated and smart people, both at CDC and in the injury field. This is an exciting time for our field, with the attention that is being paid to injury at so many levels – locally, statewide, nationally and globally. We are starting to see injury being recognized as a public health problem not only by those who focus their work in the field of injury prevention and control, but by organizations such as the Association of State and Territorial Health Directors (ASTHO), who have been working to decrease motor vehicle related mortality and morbidity. The Global Road Traffic Safety Initiative recognizes the growing problem of motor vehicle related injury and death in developing countries, and Dr. Frieden has identified motor vehicle injury prevention as one of the "winnable battles" that CDC will take on. Health reform provides other opportunities for prevention activities. It is clear that others are starting to see the importance of preventing injuries, both intentional and unintentional, across the lifespan.
The ICEHS Section has been instrumental in moving the injury field forward, and I am proud to be a member of such a great group. I am looking forward to continuing my membership in the Section, and to working with all of you in growing the field of injury prevention and control.
This year, the ICEHS Section-Wide Annual Business Meeting will be held Sunday, Nov. 7, 2010, at 3:00 p.m. Please schedule your flights so that you can arrive in time for our one Section-wide meeting, which will include ICEHS Committee Meetings as well as the ICEHS Section-Wide Business Meeting. For more information, please contact ICEHS Chair-Elect Bella Dinh-Zarr at (202) 701-5656 or email@example.com.
Iowa City, Iowa
As the theme of this year's meeting is "Progress through Partnerships." Of particular interest are abstracts that reflect the importance of partnerships between research and practice. Through these partnerships, the fields of practice and research can mutually inform one another to create injury and violence prevention and control programs that are evidence-informed and effective.
THE ABSTRACT SUBMISSION DEADLINE IS FRIDAY, OCT. 29, 2010 AT 5:00 p.. EDT. No late abstracts will be accepted.
A "Save the Date" card with more information about the 2011 Joint Annual Meeting is attached to this message.
ICEHS incoming Chair-elect Dr. Bella Dinh-Zarr forwarded this message on how transportation policy affects the nation's health and contributes to health inequalities.
Transportation systems and policies impact the public's health in myriad ways, partly via roadway fatalities and injuries, air pollution impacts and opportunities for physical activity. Two new fact sheets contain statistics that highlight how transportation affects health, as well as specifics on what initiatives and policies APHA supports.
Additional information may be found online in APHA's online toolkit at http://action.apha.org/site/R?i=SA-SbcbQN7puDhgmOhBp7Q .
Additional APHA reports are available online at: http://action.apha.org/site/R?i=42HNC4eAtZnz52u18Txf-g
* Shifting the Course of Our Nation's Health: Prevention and Wellness as National Policy:
* America Breathing Easier: Working Together, We Can Alleviate the Burden of Asthma and Keep America Breathing Easier:
* At the Intersection of Public Health and Transportation:
Promoting Healthy Transportation Policy:
Learn more at APHA's Annual Meeting, Nov. 6-10 in Denver. This year's theme is Social Justice: A Public Health Imperative.
ICEHS member Lee Annest provides us this update on Health Care Reform activities relevant to our work in injury surveillance and prevention.
DHHS and CMS have issued their final rulings regarding Electronic Health Records (EHRs) Meaningful Use Criteria for reimbursement for Medicare and Medicaid claims by hospitals and physicians offices. This is part of implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH). Below is a link to a brief NEJM article which summarizes the "meaningful use" regulation by Dr. Blumenthal. In order for hospitals and physicians to receive full reimbursement, they need to comply with these meaningful use criteria. There will be some financial incentives available to help hospitals get set up to comply. I think these regulations apply to what is expected in 2011 and 2012.
As some of you may know, there is a public health reporting component. We submitted a recommendation to include external-cause-of-injury coding as a required data element in the EHR system. It didn't get attention in this regulation, but I still think we will be okay because ICD-9-CM/ICD-10-CM coding is included in the EHR. There are a couple of more stages of implementation of the Act, so I will be following those activities to look for other opportunities to express our recommendations and needs.
I think coming up with some good quality of care assessment indicators for injuries that rely on external cause of injury (e.g., falls among older persons) would be the next avenue to explore — as mentioned in our action plan published last December. See http://www.cdc.gov/injury/data/ecode_report.html.
The EHR system will make allowance for implementation of ICD-10-CM so there will be lots of changes associated with the introduction of this new and more extensive morbidity coding system. There are many more codes and some different orientations of external-cause-of-injury coding. We will need to come up with new external-cause-of-injury and diagnosis code matrices for reporting injury data in federal and state-based emergency department and hospital discharge data systems.
Relevant New England Journal of Medicine articles include:
The "Meaningful Use" Regulation for Electronic Health Records (Blumenthal) http://content.nejm.org/cgi/content/full/NEJMp1006114/
Finding My Way to Electronic Health Records http://content.nejm.org/cgi/content/full/NEJMp1007785/
One in Four Patients Experienced Revolving-Door Hospitalizations
Roughly one-quarter of all hospital patients were readmitted for the same conditions that prompted their initial hospitalization over a two-year period, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).
According to the federal agency's analysis of data on 15 million patients in 12 States in 2006 and 2007, more than a third of those who had hardening of the arteries (called coronary atherosclerosis) were readmitted at least once to the hospital during the period. Multiple readmissions were also seen for 30 percent of patients with uncomplicated diabetes, 28 percent with high blood pressure, and 21 percent with asthma.
AHRQ also found that:
· Among Medicare patients, 42 percent experienced multiple hospital admissions and 38 percent multiple emergency department visits. For Medicaid patients, 23 percent experienced multiple hospital admissions, and 50 percent went to the emergency department more than once.
· About 22 percent of uninsured patients had multiple hospital readmissions, and 38 percent had multiple hospital emergency department visits but were not admitted.
· Privately insured patients were the least likely to require multiple hospital readmissions (19 percent) or make multiple visits to the emergency department (29 percent).
While some patients may be readmitted because of the severity and complexity of their underlying condition, research shows that many repeat admissions can be avoided if patients have better outpatient care. Readmissions can also drive up health care costs.
These findings are based on data described in Hospital Readmissions and Multiple Emergency Department Visits, in Selected States, 2006-2007. The report uses statistics from the HCUP State Inpatient Databases (SID) and HCUP State Emergency Department Databases (SEDD) for 12 States: Arizona, California, Florida, Hawaii, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee and Utah.
Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases
Nearly 12 million visits made to U.S. hospital emergency departments in 2007 involved people with a mental disorder, substance abuse problem, or both, according to another recent report from AHRQ. This accounts for one in eight of the 95 million visits to emergency departments by adults that year.
Of these visits, about two-thirds involved patients with a mental disorder, one-quarter was for patients with a substance abuse problem, and the remainder involved patients with both a mental disorder and substance abuse diagnosis.
The analysis also found that for the 12 million emergency department visits involving mental health and/or substance abuse:
· Depression and other mood disorders accounted for 43 percent of the visits, while 26 percent were for anxiety disorders and 23 percent involved alcohol-related problems.
· Mental health and/or substance abuse-related visits were 2.5 times more likely to result in hospital admission than visits not involving mental disorders and/or substance abuse. Nearly 41 percent of mental disorder and/or substance abuse-related visits resulted in hospitalization.
· Medicare was billed for 30 percent of all mental health and/or substance abuse emergency department visits; private insurance was billed for 26 percent; the uninsured for 21 percent; and Medicaid for 20 percent.
These findings are based on data described in
~P. Hannah Davis
ICEHS member Dr. Catherine Stayton from the New York City Department of Health and Mental Hygiene states that on behalf of my colleagues who chair (Dr. Laura DiGrande) and coordinate (Princess Fortin) NYC's City Council-mandated Child Fatality Review Team, I am excited to share the team's recently released annual report. The 2010 NYC Child Fatality Review Team Report is available online through the NYC Department of Health and Mental Hygiene at http://www.nyc.gov/html/doh/downloads/pdf/episrv/episrv-childfatality-book10.pdf .
ICEHS member Dr. Muazzam Nasrullah, affiliated with NIOSH and the West Virginia Injury Control and Research Center, recently collaborated with Dr. Giuseppe La Torre, the editor-in-chief of Italian Journal of Public Health, as a "Guest Editor" for the special issue entitled "Injury and Violence Epidemiology." The special issue is now published and is available online at: http://ijph.it/#articles&id=31. The access of all articles is free, one has to register on the journal's website (for free). The journal publishes thematic papers and free papers together, thus a few articles at the end of the issue are free papers. Articles that are either thematic or free are mentioned at each page of the article.
A new paper in the American Journal of Preventive Medicine, "An Urgent Call to Action in Support of Injury Control Research Centers" reports that funding disparities for research are enormous across health problems, with funding for injury, the third leading cause of death in the United States, far out of proportion to the magnitude of the problem. For example, the federally-funded Injury Control Research Center (ICRC) program, created in 1987 with a $10 million Congressional appropriation to support five Centers, now supports 11 Centers who receive less than $1 million annually to support their work. Using funding to the National Cancer Institute as the standard and calibrating based on total deaths, the researchers determined the actual figure should exceed $1.4 billion. The report is co-authored by Center Director Andrea Gielen along with leaders from six other Injury Centers.
"Despite the meager support provided, Injury Centers have made substantial progress and discoveries over the past two decades, demonstrating their continuing potential to advance the science and practice of injury control," said Dr. Gielen. "As evidenced in this paper, what's urgently needed is increased investment to accelerate these discoveries and ensure our results impact communities."
The article includes select examples of research contributions by the ICRC program and presents four critical "Call to Actions" for Congress and the U.S. Department of Health and Human Services. These include: Cultivate investigator interest in injury control and further development of cutting-edge research through increased funding; Support training in the science of injury control; Launch a comprehensive national campaign to foster public support for eradication of injury as a health problem; and Support a comprehensive, multi-agency review to determine how best to fund basic, applied, and translational injury research.
The paper can be accessed at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHT-50937JG-8&_user=75682&_coverDate=07%2F31%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000006078&_version=1&_urlVersion=0&_userid=75682&md5=f9fbda7c99a29cf2dbbd3ad1fa51e2ed
With more than 800,000 injury deaths and 60 million medically treated injury events per year, injuries are one of the leading causes of mortality and morbidity in China. In 2004, an epidemiologic study of 200,000 farm families in rural areas of China yielded an annual estimate of more than 590,000 injury deaths and close to 3.5 million permanently disabled individuals. However, research efforts in injury and trauma in China are still at an early stage of development, with even fewer focusing on agriculture-related injuries. In response to this, the USA-China Agricultural Injury Research Training Project was created in 2007 with funding from the NIH/Fogarty International Center.
As a collaborative project between the Colorado Injury Control Research Center, the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital and the School of Public Health, Tongji Medical College at Huazhong University of Science and Technology (Tongji School of Public Health), the long-term goal of the project is to increase training and agriculture-related injury research in China in order to develop an infrastructure for future sustainable agricultural injury research.
Details about the USA-China Agricultural Injury Research Training Project and the impact of the training on its trainees' careers have been described in a special reported,
The Injury Research Center at the Medical College of Wisconsin is seeking a highly qualified candidate to manage the Violence Prevention Initiative Research and Evaluation activities of the Medical College of Wisconsin, along with other violence prevention-related activities and grants. The activities of the Violence and Evaluation Team include: identifying evidence-based violence prevention models; establishing national and international connections with violence prevention experts; providing evaluation expertise to the Initiative; and contributing a research perspective to the Initiative. The Program Manager will be responsible for identifying, preparing, and writing grants, including preparation of budgets for violence prevention-relevant research and programs. The Program Manager will also responsible for identifying, conducting, and contributing to the evaluation of violence prevention-relevant injury programs and research. The Program Manager will mentor and supervise medical and graduate students in conducting such programs and research. The successful candidate will prepare manuscripts for publication in peer review journals, as well as work with media, violence prevention community leaders, and the public to communicate research findings. Finally, the Program Manager will also be responsible for developing collaborative partnerships with violence prevention groups both internally and externally and at local, state, and national levels.
The successful candidate will have at least six years of progressively responsible experience in public health program management and/or public health research. Previous experience working in the field of injury or violence prevention and control strongly desired. Candidates must have an understanding of public health theories, principles, and practices and possess an understanding of skills such as: needs assessment; planning, implementing, and evaluating effective public health programs and policies. Candidates should also have experience developing, collecting, and analyzing qualitative and quantitative public health data, with computer expertise with a variety of software programs, including Access, Excel and statistical software such as SAS, SPSS, or STATA is required. A Master's Degree in Health Sciences or Public Health or equivalent is highly recommended.
Contact Information:
Ann Christiansen, MPHAssistant Director, IRC-MCW8701 Watertown Plank Rd.Milwaukee, WI 53226Phone - (414) 456-7670Fax – (414) 456-6470E-mail – firstname.lastname@example.com
Link to complete position description
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Archivist Attic: A Review of Alan Murray's "The End of Management", WSJ, Aug 21-22, 2010, W3.
Worthy of consideration for not only business but for public health injury control public service, Alan Murray's
What does a book on the history of modern management and its future demise offer our IC disciplines?
When I moved in the NYS Dept of Health in the early 1970 to a newly created position, Director of Burn Injury Prevention, Burns Care Institute; my new boss, a well liked doc closely linked to the department's leadership hierarchies oriented me to his work- organizational style: "Les, see this department policy and procedure (P&P) manual – that's for everyone else – not for you (or us)." He explained that much of new research funding took place, promptly and expediently, for new Department resource allocations in creative collaboration with Health Research, Inc, (HRI), a NYS approved non-profit research, independent arm of the state health department. (Over many years, I was able to persuade and leverage HRI's innovative administrative funding mechanism, as a principal investigator for federal and state injury prevention practice -research contracts and grants programs.)
Of course, my new boss did not mean to fully throw out the weighty P&P binders but he was offering me and the rest of his bureaus' staff the chance, then, to innovate beyond Peter Drucker's "the most important innovation of the 20th century", management- in a bureaucracy. And yet, per Murray, modern management's (for me, not to be confused with modern leadership) fundamental role is toward self-perpetuation and does not take on the 21st
That, as Murray mentions in the WSJ, is "heady stuff". However, in our work we too need to "devise a new form of (economics and polity) organization and a new science of management." And all that means more focus and action in the leadership quadrant of innovation (see signature below: APHA ICEHS community website, my
What will all that look like in the future public health injury control organization? That's not an easy question to answer as we have great comfort for now in the old organization. However, per Murray: 'we, fully vested in the status quo, will need quickly to adjust to the (for IC: public and private) marketplace developments...and become even more 'ruthless in reallocating resources to new ventures'.
For we in IC, that might range from assuring our IC organizational program resource allocations are not only evidenced based but translatable to the fluxes of the real world, that our research background section paper shows dynamical trends of past historical successes and failures- and any lesson learned- and that our work does not just conclude that more research is needed but it offers that obviously needed working plan for public health practice, that we are not paralyzed by our analysis due to an imperfect world with few always clear answers, that our practice whims for new venture capital (grants and other funds) are based on some review of weighed and ranked innovative collaborative options with NIH, Kellogg Foundation, et al., that we apply modern leadership texts and archetypes and systems leadership, etc. (See APHA ICEHS community web, below: My Millennium historiography and also the conclusions in my Kansas City speech to Bureau of federal Maternal and Child Health leadership, circa 1975, as an invited speaker.)
As Haddon synergized medicine and engineering, we must better overlay and act with new effective leadership archetypes and models of change agents. The past is prologue.
Thus, also read again Julian Waller's paper (Public health then and now: Reflections on half century of injury control.
Murray concludes in his WSJ article: 'Change, innovation, adaptability, all have to become orders of the day.' I recommend a through read of his WSJ article and his book for its transfer value to our present and future IC histories.
My opinions do not necessarily reflect other groups nor organizations.
LFisher Copyrighted 2010
Les Fisher M.P.H. , Safety/Leadership Consultant, Archivist, American Public Health Association, Injury Control and Emergency Health Services Section - See my monthly Archivist Attic commentaries at www.icehs.org and at extranet.icehs.org Newsletters and my Millennium... a historiography , with figures posted for Part 1-4 , all on injury prevention leadership history-at: http://www.apha.org/membergroups/sections/aphasections/icehs/ecommunity/Archivist's Bulletin Board
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subset: commoncrawl


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Hello All,
So, the debate over where 2005 ranks among the great Bordeaux vintages will go on for a very long time, and in fact, it's not one that even can be answered until 20 - 30 years out when we see how they perform on the long haul. Based on the current snapshot we have, it seems to me to break down like this: The high end Chateaux are comperable to 2000. The mid-range Chateaux do seem to be the real succes story, and the although the prices have gone up even there, the quality really does seems to have bested 2000. But, from my own tastings and from other batches of notes I've seen, it seems like the low-end wines are a bit dissappointing compared to the overall quality of the vintage, and to the same range of wines from 2000. Most of what I've had from both vintages is the under $20 stuff. And in that range, I haven't had a single 2000 that wasn't quite good. On the other hand, the comperable 2005's have been quality wines, but just don't seem to offer as much. I'm not the only one to have noted the suprisingly lack-luster performance of the lower 2005's. The surprising thing here is that both vintages are praised for extraordinary depth of quality. But it seems like the 2005 magic just doesn't go as deep as 2000. And for the low-end stuff, we already have a good sense of their 'track-record' as these are mostly wines destined for 5 years or so of life. If it were just me, my impressions would not be robust, as I have to date a relatively small sample of each vintage, and there are likely 'random selection' effects. But then, random samples also have the potential to tell you a lot. Anyway, these are just my thoughts on the matter, and I'm curious if the impression I've gathered so far does in fact reflect a general consensus, and I invite anybody and everybody to contribute their opinions.


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MMA News
Video | Poirier Cries During Post-Fight Interview | UFC News
Dustin Poirier couldn't hold his emotions back when he revealed the disappointment in himself after the UFC on FUEL TV 3 loss opposite the Korean Zombie, Chan Sung Jung via Darce choke making his 1st main event appearance the fight of the night.
"I had a really long training camp and I put 100% of myself into the training camp … I care so much man, I let myself down. I deserved to win, my wife deserved for us to win."
When asked about the pressure Dustin responded
"It wasn't even the pressure. I felt fine. I was excited to fight the main event. It was a huge opportunity for me. I wasn't worried about the 5 rounds my strength and conditioning program was incredible. I felt like I was in the best shape ever. I just took some bad shots made some mistakes but I'm going to go back in the gym and work on it and come back and get a W."


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The New Hampshire Health and Education Facilities Authority lowers the cost of health and education services in New Hampshire by providing eligible institutions with access to high quality, readily available, low cost financing alternatives.
It is with great sadness that we announce that long-time Board member Dick Cunningham recently passed away. DIck had been a Board member since 1988. He will be greatly missed.


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The dazzling new novel in the #1 New York Times -bestselling series from Clive Cussler, the grand master of adventure. When Kurt Austin is injured attempting to rescue the passengers and crew from a sinking yacht, he wakes with fragmented and conflicted memories. Did he see an old friend and her children drown, or was the yacht abandoned when... more...
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The outstanding new Fargo adventure from the #1 New York Times ?bestselling author. Baffin Island: Husband-and-wife team Sami and Remi Fargo are on a climate-control expedition in the Arctic, when to their astonishment they discover a Viking ship in the ice, perfectly preserved?and filled with pre?Columbian artifacts from Mexico. How can that... more...
The TombsPenguin Books Ltd 2013; Not Available
The Tombs is the thrilling fourth Fargo adventure by Clive Cussler. It's a prize beyond imagination. When an archaeologist excavating a top secret historical site realizes the magnitude of his discovery he requests help from treasure hunters Sam and Remi Fargo. And in rushing to join him, the husband and wife team are thrown into their... more...
Zero HourPenguin Books Ltd 2013; Not Available
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Ghost Ship is the latest action-packed novel in the No 1 New York Times -bestselling NUMA Files series from the grand master of adventure, Clive Cussler. When Kurt Austin is injured while rescuing the passengers and crew of a sinking yacht, he wakes up with conflicting memories of what he saw. Did he witness an old friend and her children... more...
Blue GoldPocket Books 2000; US$ 9.99
Clive Cussler?s New York Times bestselling Blue Gold, now available in ebook, is a heart-pounding thriller in the NUMA adventure series. Kurt Austin navigates the Amazon jungle in search of a legend that could change the path of science?but secretive powers will do anything to stop him. From deep within the Venezuelan rain forest emanates the... more...
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You Are the Heart of Your Family...Take Care of It. (Usted es el corazón de la familia...cuide su corazón.) Flip Chart
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This bilingual flip chart can help promotoras, community health workers, and other health educators teach Hispanic and Latino Americans about the link between diabetes and heart disease. The flip chart includes easy-to-understand illustrations, scripted presentations in Spanish and English, and questions to facilitate discussion. The flip chart also contains four copier-ready handouts, available in hard copy and on the accompanying CD.
Last reviewed: 06/01/2013


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October 01, 2014
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NBC recently announced that it will air a live television broadcast of Meredith Willson's The Music Man in 2015 following the Dec. 4, 2014, broadcast of Peter Pan. This news made us wonder: Who should star as Professor Harold Hill?
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Small Grant Fund Project successfully completed in Bhutan
Strengthening the wetland policy and guidelines for the Royal Government of Bhutan (Project code: SGF/11/BT/01)
With the generous contribution of the government of Japan, this project helped revise and strengthen the wetland policy and guidelines of Bhutan as well as raise public awareness about the importance of wetlands and the significance of being a member of the Ramsar Convention.
The Convention came into force for Bhutan on 7 September 2012, with the designation of two sites as Wetlands of International Importance, Bumdeling and Khotokha, representing a total surface area of 256 hectares.
The project was carried out by the Watershed Management Division (WMD) under the Department of Forests and Park Services, Ministry of Agriculture and Forests of the Royal Government of Bhutan, the Administrative Authority for the Ramsar Convention and the body responsible for wetlands management and conservation within the country. After the initial drafting of the 'Procedural Guidelines for Determination and Protection of Significant Wetlands' in preparation for Bhutan's accession to the Convention on Wetlands, the WMD identified the need to fine-tune, strengthen and incorporate these guidelines into the wider national biodiversity conservation policies. With the help of local specialists and researchers the 'Wetland Rules' were revised, resulting in the now finalized "Guideline on the Wise Use of wetlands in Bhutan". These guidelines were translated into Dzongkha, the national language, in order to make them accessible to the general public and raise awareness about wetland conservation.
The project also aimed to build capacity and raise awareness about the importance of wetlands as critical components of watershed ecosystems. Through a wetland documentary entitled "Conservation of Wetlands in Bhutan", people were made aware of the two Ramsar Sites in Bhutan and the possibility of declaring more Ramsar Sites. The 30 minute documentary helped provide a general overview of the initiatives taken by the government of Bhutan and provided information on the services and functions provided by wetlands and their values to local communities. The film was broadcast on national television and 100 DVD copies were distributed to government departments, NGOs and schools. The short 3 minute version of the film can be viewed above.
Lamentablemente, no hay versión en español de este documento


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Craybas Ousts Pironkova
Published July 14, 2010 12:00
PALERMO, Italy - Showing she still has what it takes to hang with the rising talents on tour, Jill Craybas - who turned 36 years young 10 days ago - upset No.4 seed Tsvetana Pironkova in the second round on Wednesday.
Things weren't looking great for Craybas in the first half of the year, her best result being a third round showing at Indian Wells; but last week she made her first quarterfinal of the season in Bastad, and now she has done it again.
Against Pironkova, who was fresh off of her breakthrough first Grand Slam semifinal at Wimbledon, Craybas lost the first set handily before getting down to business, setting the tone with a break in the first game of the second set and racing out to a 4-1 lead in the third. She won in three, 26 62 62.
Next for Craybas is No.8 seed Julia Goerges, who seemed out of sorts early in her match against qualifier Corinna Dentoni, falling behind 4-1 in the first set; but it didn't take long for her to snap back into it and she won, 64 63.
Click here to see photos from Palermo from last year!
No.1 seed Flavia Pennetta won her seventh match in a row in Palermo later in the day, crushing Renata Voracova, 60 63. It looked even more crushing as Pennetta raced out to a 60 50 lead, but the defending champion lost her serve at love at that point, the first of three games in a row that went to Voracova; Pennetta closed it out in the next game to move into the quarterfinals.
Next up for Pennetta is qualifier Nuria Llagostera Vives, who won a marathon 67-minute first set against No.9-seeded Alberta Brianti then won, 76(6) 62.
The other four second round matches take place Thursday. No.2 seed Aravane Rezai is among those gunning for the final eight.


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A Lawrenceville mother turned her son's stressful medical condition into a successful business. Using her own recipe, she cooked up a cure for her son's skin symptoms.
Anita Redd's middle son is now a teen, but she says she'll never forget the day he was born."He was born in my arms and his skin was flaying off of his lower body," said Redd.Doctors told her it was an incurable genetic condition, eczema. It's is a skin condition that causes symptoms like flaking, redness, itching, dryness and in some extreme cases - bleeding. Redd says doctors tried everything from steroids to cream. She worried about the effects it would have on her son and thought there had to be a better way to treat his condition.She did her research and looked into natural skin conditioners. She came up with olive oil and beeswax."My very first container that I made for him was in his dad's roll-on deodorant, Mennen stick. I melted beeswax and added olive oil until it got to be just the right consistency," said Redd.It worked and Anita's Balm was born. But Redd says she didn't consider it a business until she heard similar skin stories from others in her parents' group. She's now making it for others and delivering it.
A year later, tens of thousands of Anita's Balm products have been sold and they're in stores across the nation, including Return to Eden in Atlanta. Redd says she enjoys success, but helping families get through a stressful condition is her reward."This is the true heartbeat of my business. I would be happy to be in Kroger, in Walmart. But these are my customers," said Redd.Soon, you will see Redd's products even more places. She's currently working out a deal for Anita's Balm to be sold in CVS and Kroger's nationwide. For more information on Anita's Balm, click here.
WTXF-TV330 Market StreetPhiladelphia, PA 19106-2796Phone: (215) 925-2929Fax: (215) 982-5494


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TORONTO – The pair landed in Toronto a month or two apart at equally low points in their respective careers.
Mark Fraser was a homegrown product of the New Jersey Devils, but after five years and 98 NHL games he had been deemed expendable, shipped westward to the Ducks in December before landing with the Leafs in another trade two months later. Briefly a teammate of Fraser with the Ducks farm club in Syracuse, 2008 second round pick Nicolas Deschamps was toiling through a miserable second season with the Crunch when he was granted a fresh start with Toronto in early January.
The resuscitation of their careers would begin with the Toronto Marlies under the watch of Dallas Eakins.
Optimism had been high for Fraser in the summer of 2011. His former junior coach Pete DeBoer had just been hired to coach the Devils in a development that seemed to offer nothing but promise. The captain at one time for DeBoer's Kitchener Rangers, Fraser dialed up his old boss that summer wishing congratulations, also inquiring about his future. "I was just asking for a chance to perform and he said that he would give me the opportunity," said Fraser, who played in 61 games as a rookie with New Jersey in 2009-2010, bouncing in and out of the lineup the following season.
The promise of opportunity under DeBoer was quickly dashed.
Fraser laced up for just four games and was gone before Christmas.
"Unfortunately, between Pete and I, it wasn't a fit at the NHL level, but for many reasons besides our relationship," the 25-year-old explained. "The unfortunate thing is sometimes whether a coach likes it or not there's other deciding factors; there's general managers, there's scouts, there's other coaches, there's a lot of different opinions. And generally, it is the management who gets to decide."
While he holds no outward bitterness towards DeBoer, it's clear that his exit from Jersey was marked with disappointment. "My end in New Jersey wasn't due to the coaching staff or lack of connection, it was just the business side of things," said Fraser. "I'm really happy with where I landed now."
An imposing stay-at-home type on the blueline, the six-foot-four, 220-pound Fraser rapidly injected the Marlies with a dimension and leadership presence they had been lacking, forming a shutdown pair with Korbinian Holzer en route to an appearance in the Calder Cup final. Eakins realized the value the Ottawa native added and lauded his importance throughout the postseason run. "When he can turn around and say that to me about my game it just literally wanted me to elevate it that much more," said Fraser of Eakins' repeated support. "It was a phenomenal pat on the back, better than I've actually ever had before in my career."
Deschamps had amassed a lowly seven points and minus-7 rating in 31 games with Syracuse after a solid rookie season. He too rediscovered his game in Toronto, tallying 30 points and a plus-13 rating in 40 games, adding 12 more points in the postseason.
But he was not immune to inconsistency and frankly, he heard about it.
Scratched for the first time in his career in a game against Rochester, the Lasalle, Quebec native received a blunt assessment from Eakins. "He just told me 'You're not playing to your potential and if you're not playing like that you're not going to play'."
Deschamps didn't agree with the decision at first, but gradually took note of the lesson embedded in Eakins' tactic. "Every player wants to play," he said. "I just got fired up for the rest of the season. I just said in my mind 'I don't ever want to get scratched again'."
The Marlies head coach has a thorough strategy for every new player added to his roster.
"Number one, I've got to get to know them," Eakins explained. "I just start the conversation like you would when you're getting to know somebody, 'Where you from? Where were you were born? How was your childhood? Are your parents together? Do you have any brothers or sisters?' I try to get as much information that I can from the individual and that takes a lot of conversations. It's not just come in, sit down and we do an interview… It's an ongoing process.
Secondly, "I usually make about three or four calls," Eakins continued. "The great thing about my career being moved around as a player is I know almost everybody in the game. And so when we get a player in I'm usually able to quickly make three or four calls and get a few different opinions on the kid, get some other information and then now at least I've got some information on the motivation and his confidence and which way is this going to go."
Gauging the foundations of their careers to that point, Eakins is able to determine the tactics he'll need, be it a "firm kick in the butt" or a "hug". "Everybody thinks you coach a team, well you don't, you coach 23-25 individuals and you've got to find out which buttons are going to help you," he said. "I go into the weight room and I've been working out, but I've never known how much weight was on the bar. How do I know how much to lift? You've got to get to these kids' pasts and their present and how they want to go ahead in the future.
"When it comes to their work ethic and their discipline, every player in there, they know it, they are treated 100% the same. And when it comes to the way I'm going to motivate them and their goals – their personal goals, not goals on the ice – I treat every one of them exactly different."
It's a strategy that has yielded optimal results, particularly in the case of Fraser and Deschamps.
"When guys go out, we want to play for him not because we're afraid," concluded Fraser, "but because we respect him and we don't want to let him down."


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Blockbuster bankruptcy weeks away?
Reports say the struggling movie-rental chain may enter a planned bankruptcy as soon as mid-September.
By Jeanine Poggi, TheStreet
It looks like the worst fear of many Blockbusterinvestors may come true: The movie-rental chain could be gearing up for a bankruptcy filing next month, according to reports.
Blockbuster and its senior debt holders met last week with six major movie studios to discuss their intention to enter a planned bankruptcy, the Los Angeles Times reported, citing sources familiar with the matter.
It would be essential for Blockbuster to retain the support of movie studios amid a bankruptcy filing, to ensure it continues receiving new releases so business isn't disrupted.
A planned bankruptcy, which the Los Angeles Times said would last about five months, would allow Blockbuster to escape leases at some of its underperforming stores. This could mean the closure of 500 to 800 more locations.
The flailing retailer is due to repay $42 million from its mounting $1 billion in debt on Sept. 30, but if this report proves true, the prepackaged bankruptcy would come as soon as mid-September. Blockbuster has already postponed the payment two times. Post continues after video:
Blockbuster's revenue tanked 20% to $788 million from $982 million, missing forecasts of $840.1 million.
The company attributed the decline to worse-than-expected results on the shuttering of stores over the past year, fewer store customers and a nearly 30% drop in average subscribers to its by-mail service.
Management continues to expect same-store sales to decline in the high single digits for the rest of the year.
Blockbusters' stock was delisted from the New York Stock Exchange last month and is now trading on the over-the-counter market.
For the most part, even amid this mess, Blockbuster has tried to carry on business as usual. It has announced plans to roll out more DVD kiosks, added video games to its Blockbuster by Mail service and teamed up with Comcast (CMCSA) to launch DVDsByMail.com, a site that allows Comcast subscribers to sign up for its mail service at a discounted rate. Blockbuster is also offering its Canadian members a $9.99-per-month plan that will allow them to rent unlimited movies (one at a time).
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The murder trial of Jodi Arias resumes Monday in downtown Phoenix.Arias will still be on the stand testifying for her 14th day.
After an intense grilling from the prosecution last week, that focused on her lies to family, friends and investigators, Arias will be facing more friendly questioning from her defense attorney.Jodi Arias' attorney is expected to be doing damage control Monday.Arias appeared to break down on the stand when the prosecutor showed a crime scene photo of her boyfriend Travis Alexander, dead in the shower with his throat sliced ear to ear."Ma'am, were you crying when you were shooting him?" said prosecutor Juan Martinez. "I don't remember," said Arias. "Were you crying when you were stabbing him?" said Martinez."I don't remember," said Arias. "How about when you cut his throat, were you crying then?" said Martinez. "I don't know," said Arias. Arias admits to killing Alexander at his Mesa house in 2008, only she says it was in self-defense.However, her story has changed over the years. First she denied the murder, then she blamed it on intruders, before saying it was self-defense."You're the one that did this right?" said Martinez. "Yes," said Arias. "Yes and you're the same individual that lied about all this right?" said Martinez "Yes," said Arias. Arias admits to getting rid of the murder weapons.But she claims she was in a fog and couldn't remember other key details. Still, the prosecution pressed on."And you would acknowledge that stabbing was with a knife?" said Martinez. "Yes," said Arias. "And according to your version of events, you would acknowledge that stabbing was after the shooting right?" said Martinez. "I do not remember, I do not remember that," said Arias. "I am not asking if you remember, I am asking if you acknowledge you did it," said Martinez. "Correct, yes," said Arias.
Once the defense is done questioning Arias, jurors will also get a chance to ask questions,which could give us a peek into what their take is on this trial.
If convicted Arias could face the death penalty.
KSAZ-TV & KUTP511 W. Adams St.Phoenix, AZ 85003Phone: (602) 257-1234Fax: (602) 262-0177


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Our Board of Directors effective April 25, 2014
Rt. Rev. William M (Rusty) Clyma III, President. Rusty is a Bishop in the Inclusive Celtic Church. Rusty is a Tulsa native who has served six years as a Benedictine Monk at St Gregory's Abbey in Shawnee, OK. He spent a few years in the San Francisco area, where he attended the Church Divinity School of the Pacific, served as a hospital chaplain, volunteered with the SF Night Ministry, and founded the Parish Church of St. Savior's. He was elected and consecrated Bishop of the Independent Sacramental Movement and formed what became known as The Inclusive Celtic Church. Rusty moved back to Tulsa in 2013 to open the parish of Emmaus Community in Tulsa, where he now serves. Rusty was elected to his first term on the Board in 2013.
Rev Jay Hoyt, most recent Past-President, is a minister with the Christian Church (Disciples of Christ) currently serving First Christian Church of Mannford, OK. He is a graduate of Dallas Christian College and received a Master of Divinity degree from Emmanuel Christian Seminary in Johnson City, TN. He has held ministries in Texas (Ft. Worth), Tennessee (Jonesborough), Louisiana (Slidell, Shreveport) and Oklahoma (Wagoner, Tulsa, Mannford). He served 2 terms on the board of Tulsa Metropolitan Ministry and a 5 month stint as acting executive director. He was recently re-elected to the board of TIA and has served as vice president and president. He also works in the transportation department of Union public schools of Tulsa.
Caroline Abbott, 1st Vice President
Sarah Morice-Brubaker, PhD, 2nd Vice President and Secretary, is an assistant professor of theology at Phillips Theological Seminary and an associate editor for Religion Dispatches. She holds a BA in religious studies from Yale University, an Master of Theological Studies from Duke Divinity School, and a PhD in theology from the University of Notre Dame. Her doctoral dissertation (forthcoming from Wipf and Stock) examines the relationship between Trinitarian theology, postmodern thought, and philosophy of place. She is currently working on her second book, tentatively titled Glory Days: The Power and Danger of Christian Nostalgia. Sarah participated in the first cohort of the Faith and Reproductive Justice Leadership Institute at the Center for American Progress in Washington, DC. She is married to Phil Morice-Brubaker, an antiracism consultant and trainer, and they have two sons. They are members of New Haven United Methodist Church in Tulsa.
Julie Skye, Treasurer, has been an investment advisor for 27 years, and a Registered Investment Advisor at Pinnacle Investment Advisors in Tulsa for 8 years. She received a B.S.B.A in Finance from the University of Tulsa in 1986 and an M.B.A. from the University of Tulsa in 1990. She is a committed social justice advocate and a shareholder activist, working with national organizations such as the Interfaith Center on Corporate Responsibility. Small group ministry is her chosen way to connect and effect change, but she serves on numerous boards, foundations and committees, including the National Unitarian Universalist Investment Committee; the UUA Liaison to the Committee on Socially Responsible Investing, and the UUA Allies for Racial Equity.
Rev. Mike Barron is the pastor of First Presbyterian Church, Broken Arrow. He is an ordained Teaching Elder since 1980, serving congregations in Texas and Oklahoma. He is a retired firefighter and formerly served on the Broken Arrow School Board (1993-1998). Currently he serves on the Broken Arrow Downtown Advisory Board charged with the revitalization of the newly-named Rose District. He also volunteers with Broken Arrow Neighbors in their Read to Feed book sales He was elected as the Moderator of Eastern Oklahoma Presbytery (PCUSA) for 2013.
Rev. Leslie Dotson is an Associate Regional Pastor for the Christian Church, Disciples of Christ. She is a graduate of Phillips Theological Seminary, and has served two local churches before moving into regional ministry. Leslie was elected to the Board in 2013.
Barbara Santee, PhD, has been a pro-choice feminist and community activist since the late 1960s. She is a native Tulsan who holds a Ph.D from Columbia University. Barbara was one of the founding members of TIA, and was on the board for 14 years. She has won numerous awards for her community activism on behalf of women and for her support of the separation of church and state. After a few years off the Board,Barbara was elected to serve again in 2013.
Rev. Guy Langston, is a retired United Methodist minister who has served a variety of churches in Oklahoma for over 45 years. Rev Guy is currently involved in the Confirmation Ministry at Boston Ave UMC, where his wife serves on the church's Interfaith Concerns Committee. Guy's passions include maintaining the separation between church and state.
Sandra Rana, PhD, has lived in Tulsa for over 30 years. Dr. Rana has been active in numerous interfaith and community organizations over the years including Tulsa Metropolitan Ministry (Past President), a founding member of Tulsa Interfaith Alliance, the City of Tulsa Human Rights Commission, Mayor's Jobs for Veterans Committee and as a member and Chair of the Governor's Ethnic American Advisory Council under Governor Brad Henry. Dr. Rana is a Senior Professional in Human Resources and is a member of TEOCCA and SHRM
Yusuf Dundar, was born in Turkey. He is an Electrical & Electronics Engineer, having graduated from the Firat University in Turkey with a Bachelor's degree in Engineering. After graduating from University, Yusuf moved to Canada . After a total of 5 years in Canada , Yusuf worked as a Project Manager in Turkey. Currently, he is working as an IT Manager for a company in Tulsa and is serving the Tulsa community as Executive Director at Dialogue Institute of Tulsa (formerly known Institute of Interfaith Dialog). He is also aboard member of OCCJ(Oklahoma Center for Community and Justice). Yusuf is married to Serpil Dundar and they have one daughter.


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American Diabetes Associationhttp://www.diabetes.org
Hypoglycemia Support Foundationhttp://www.hypoglycemia.org
Canadian Diabetes Associationhttp://www.diabetes.ca
Health Canadahttp://www.hc-sc.gc.ca
Hypoglycemia. EBSCO DynaMed website. Available at:
. Updated August 23, 2013. Accessed August 28, 2013.
National Institute of Diabetes & Digestive & Kidney Diseases website. Available at:
. Updated November 6, 2012. Accessed August 28, 2013.
Hypoglycemia (low blood glucose). American Diabetes Association website. Available at:
. Accessed August 28, 2013.
Kasper D, Harrison T.
Harrison's Principles of Internal Medicine.
New York: McGraw-Hill; 2005.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
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Red wines that are more fruit-forward and lighter in tannin and body.
Medium bodied reds that go down easy, with smooth tannins and supple fruit.
Wines where earthy and/or spicy dominate the flavors – typically medium to full body.
Full bodied wines that have concentrated fruit and are higher in alcohol and/or tannins. Some need age.
Medium red. Cherry, redcurrant and floral aromas are complicated by a whiff of soil. Offers good sweetness and breadth to its spicy, bright red fruit flavors. Finishes with a fine dusting of tannins and a hint of mocha. The fruit is mostly from Game Farm Vineyard in Oakville, which McMahon says features "rocky Tuscan soil." This will be bottled in July.
"A great wine in the making, the 2007 Cabernet Sauvignon Estate (just under 10,000 cases produced) possesses a fragrant bouquet of sweet black currants, crushed rocks, earth and background oak. Full-bodied and dense, with Montelena's typical power, tannin and reserved nature, this is a big, rich, formidably endowed red that requires 4-5 years of cellaring. That in itself is atypical of this exuberant, flamboyant vintage. Given this cuvee's past history, this 2007 should age for 30+ years.
Rating: 94+ points"
94 Points
The Wine Advocate
"Saturated, deep ruby-red. Deep aromas of blackberry, blueberry, violet and minerals; reminded me of a Pauillac. Silky on entry, then dense and sweet in the middle, conveying an impression of power. There's a youthfully medicinal quality to the dark berry and licorice flavors but unusual early sweetness and pliancy to this normally long-aging wine. Finishes with very suave tannins and impressive persistence. This is actually 14.3% alcohol, which is unusually high here. Barrett could only recall the 2004, 1994 and 1978 surpassing 14%.Rating:
93 Points
International Wine Cellar
"Not a wine for drinking now or anytime soon. It's so hard in tannins, it basically locks down the palate, and the astringency seems to accentuate the acidity and dryness. However, there is a deep core of blackberry essence and, after all, this is Montelena. All indications are that it will be a terrific wine in another 8 or 10 years."
92 Points
Wine Enthusiast
Chateau Montelena was founded in 1882 by Alfred Tubbs. The renaissance of the winery, under the leadership of James Barrett, began in 1972 with the replanting of the Estate vineyard and the establishment of the Chateau Montelena philosophy: make the best, period. Today the tradition continues. Jim Barrett's son, Bo, winemaker at Chateau Montelena beginning in 1982, is now its Master Winemaker. After more than three decades of experience with the same vineyards and varieties, the Montelena Estate Cabernet Sauvignon and Napa Valley Chardonnay are recognized as world-class.
It's hard not to think of Napa Valley when thinking of California wines. The region is, after all, the one that brought world recognition to California wine making. The area was settled by a few choice wine families in the 1960's who bet that the wines of the area would grow and flourish. They were right. The Napa wine industry really took off in the 1980's, when vineyard...Read More About Napa Valley
(cab-uhr-NAY sow-veeh-yawn) King of Red Many refer to Cabernet Sauvignon as the king of red grapes. Perhaps that title is due to its ability to grow worldwide in a number of climates, or to the fact that it produces wine with such character yet such diversity. Either way, this grape is responsible, as a whole or a partner, for some of the greatest wines in the world. In Bordeaux,...Read More About Cabernet Sauvignon
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Nneka and Chiney Ogwumike talk about what it means to play in their first WNBA All-Star Game together and do a little trash-talkingabout which team will win.
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10 U.S. Code § 3031 - The Army Staff: function; composition
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(a) There is in the executive part of the Department of the Army an Army Staff. The function of the Army Staff is to assist the Secretary of the Army in carrying out his responsibilities.
(b) The Army Staff is composed of the following:
Source(Aug. 10, 1956, ch. 1041, 70A Stat. 150; Pub. L. 93–547, Dec. 26, 1974, 88 Stat. 1742; Pub. L. 93–608, § 1(6),Jan. 2, 1975, 88 Stat. 1968; Pub. L. 98–525, title V, § 515,Oct. 19, 1984, 98 Stat. 2522; Pub. L. 99–433, title V, § 502(a),Oct. 1, 1986, 100 Stat. 1039.)
|Revised section
|Source (U.S. Code)
|Source (Statutes at Large)
|June 28, 1950, ch. 383, § 201, 64 Stat. 265.
In subsection (a), the words "an Army Staff consisting of—" are substituted for the words "a staff, which shall be known as the Army Staff, and which shall consist of—". The words "under regulations prescribed by the Secretary of the Army" are omitted, since the Secretary has inherent authority to issue regulations appropriate to exercising his statutory functions.
In subsection (c), the third sentence is substituted for 10:21a(c) (1st 13 words and 1st proviso). The words "officers and employees * * * or under the jurisdiction of" are omitted as surplusage.
In subsections (c) and (d), the word "hereafter" is omitted, since all wars and emergencies declared by Congress before June 24, 1950, have been terminated.
In subsection (d), the second sentence is substituted for 10:21a(d) (last 31 words of 1st sentence). The third sentence is substituted for 10:21a(d) (2d sentence). 10:21a(d) (1st 13 words of last sentence) is omitted as executed. The words "This subsection does not apply" are substituted for the words "and shall be in applicable".
1986—Pub. L. 99–433amended section generally, substituting "The Army Staff: function; composition" for "Composition: assignment and detail of members of Army and civilians" in section catchline and substituting in text provisions relating to establishment and composition of the Army Staff and authorizing the Secretary to prescribe the organization, duties, and titles of the Army Staff for provisions relating to establishment and composition of the Army Staff, authorizing the Secretary to prescribe the organization, duties, and titles of the Army Staff and authorizing part of the Army Staff to be designated as the Army General Staff, and limiting the number of officers who may be assigned or detailed to permanent duty in the executive part of the Department of the Army and on or with the Army General Staff.
1984—Subsec. (d). Pub. L. 98–525struck out subsec. (d) which provided that no commissioned officer who was assigned or detailed to duty in the executive part of the Department of the Army could serve for a tour of duty of more than four years, but that the Secretary could extend such a tour of duty if he made a special finding that the extension was necessary in the public interest, that no officer could be assigned or detailed to duty in the executive part of the Department of the Army within two years after relief from that duty, except upon a special finding by the Secretary that the assignment or detail was necessary in the public interest, and that the subsection did not apply in time of war, or of national emergency declared by Congress.
1975—Subsec. (c). Pub. L. 93–608struck out requirement of quarterly report to Congress on the number of officers in the executive part of the Department of the Army and the number of commissioned officers on or with the Army General Staff and the justification therefor.
1974—Subsec. (a)(3). Pub. L. 93–547increased the number of Deputy Chiefs of Staff from three to four.
Effective Date of 1984 Amendment
Pub. L. 98–525, title V, § 515,Oct. 19, 1984, 98 Stat. 2522, provided that the amendment made by that section is effective Oct. 1, 1984.
The table below lists the classification updates, since Jan. 3, 2012, for this section. Updates to a broader range of sections may be found at the update page for containing chapter, title, etc.
The most recent Classification Table update that we have noticed was Tuesday, August 13, 2013
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Winsome® Concord Antique Walnut Round Side Table
Item # WX2-151253
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This item is shipped directly from the factory. To see the expected shipping date, please add to your Shopping Cart. Sorry, no express shipping available. We are unable to ship factory direct items to Alaska, Hawaii, Puerto Rico or APO or FPO addresses.
This item cannot ship to Canada.
This item cannot ship internationally.
- Details & Specs
Winsome® Concord Antique Walnut Finished Round Side Table... big decorating impact in a small space!
A touch of elegance for any corner of your home! Stylish and very functional with one drawer and a shelf for extra storage space.
Hmmm... maybe I should start putting my keys in a little drawer like this to keep them in one place so I don't spend half an hour every morning looking for them!Features:
- Elegant antique Walnut finish
- Smooth round shape
- A drawer and a shelf for convenient storage
- Dimensions: 17 1/3" w. x 17 1/3" d. x 30" h.
- Some assembly required.
Understated elegance... order yours ONLINE today!
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Customer ReviewsNo reviews exist for this item....
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and found 6 items
996cc, 97bhp, 144mph, Insurance group 14
The Honda VTR1000F Firestorm is a brilliant all-rounder with few foibles: you'd be hard pushed not to have a ball on it. Regular refuelling's a drag but better on post-01 Honda VTR1000F Firestorms, when capacity went from 16 to 19 litres, but it's still thirsty. The Honda VTR1000F Firestorm has wonderful pull when you open it up in the midrange ...
937cc, 125bhp, 162mph, Insurance group 15
It's not often that you get quality and style along with 'budget'. But Suzuki delivered just that when it produced the RF900R in the late 90s. A sporty sports-tourer, the Suzuki RF900R delivered plenty of punch, decent handling, comfortable versatility and, er, odd styling. Old hat today, but the Suzuki RF900R is still excellent value.
599cc, 95bhp, 135mph, Insurance group 12
In many ways the older Yamaha FZS600 Fazer is better than the new model; much more midrange oomph, better weather protection, more upright riding position. But it does look kinda 80s disco from some angles and it's also a bit greedy on fuel. Otherwise, teh Yamaha FZS600 Fazer is a versatile all-rounder with great brakes and a reliable motor.
749cc, 100bhp, 152mph, Insurance group 14
For many, bike journalists included, the best road bike ever built. In 1994 Honda revised an already exceptional motorcycle, giving it super-model looks while still retaining those quintessential VFR qualities of legendary reliability, consistent performance and supreme comfort. The bodywork become less angular and gained Ferrari-esque louvres on its side panels.
955cc, 118bhp, 154mph, Insurance group 14
Never a big seller when new but the Triumph Sprint RS can be a real bargain on the used market. Sporty sports tourer with Triumph's powerful, mellifluous three cylinder engine. The Triumph Sprint RS is similar to the better selling Sprint ST but with a cheaper and lighter conventional swingarm, less plastic, firmer suspension, sharper geometry and a different exhaust. The ...
998cc, 113bhp, 150mph, Insurance group 15
The Aprilia RST1000 Futura is desperately underestimated, sadly short lived and now a potential bargain. Aprilia's ambitious rival for Honda's polished VFR sports-tourer is able, well-specced and potent. Quirky styling put off many, however, it sold poorly and depreciated massively. If you like the looks the Aprilia RST1000 Futura is a used bargain.
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Turning a Glass Vase into a Gorgeous Lamp
The Thrifty Abode
We've so been wanting to try this! I even bought a glass drill bit! It's sitting on top of my washing machine because I'm too scared to try it. But look how amazingly it worked out!
Aaron from The Thrifty Abode overcame the fear of cracked glass, and we're so happy she did. These lamps can cost an arm and a leg at big retailers, but she picked up a beautiful vase for $15 and, after drilling the hole and following the instructions on a $10 lamp kit, she ended up with a gorgeous lamp. Yay! It worked! You'd never know this was a DIY. Check out her blog post about the process to see great photos and get some great tips on drilling the hole through the glass.
(Images: The Thrifty Abode via Remodelaholic)
2 Comments
Great lamp.
The look of a plastic-covered lamp cord works here, but if you try this and you want a different look, consider rayon-covered lamp cord. You might find it in a local well-stocked hardware store or an electricians' supply store. Otherwise, search online for "rayon lamp cord" for a source. It comes in white, black, brown, and gold.
or you can always do what I've done. I went to an art store and bought an art pen in the color I wanted. I have also wrapped the cord in silver mylar.


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Alps - Western Part > Graie Alps > Gran Paradiso > Climber's Log
Gran Paradiso Climber's Log
[ Sign the Climber's Log ]
|from Vittorio Emanuelle refuge, on the glacier
Date Climbed: Jul 24, 2006
|The icy bottom of Gran Paradiso glacier was 40-45° steep so we did an easy ice-climbing... :-) It was fun. There were two "bigger" crevasses on the glacier and some smaller.
The route is very long but in nice weather it's beautiful... in bad weather it sucks... We fortunatelly had sunshine and blue sky. :-)
|Posted Jul 29, 2006 1:43 am
|First on the summit this day
Date Climbed: Jun 24, 2006
|I climbed from Vittorio Emmanuele over the central moraine and ridge of the Gran Paradiso glacier.Great environment, but soft snow without catches along the ridge!I reached the summit in 4 hours from the hut. I used the normal route as way down.
|Posted Jul 16, 2006 6:32 am
|Normal Route
Date Climbed: Jul 3, 2006
|Good weather and snow.
|Posted Jul 3, 2006 9:49 pm
|Normal route via Rif. Vittorio Emmanuele
Date Climbed: Jun 17, 2006
|Started at the parking area in Pont and did it in one push right up to the summit. The weather was good when I started. But then... Lightning, rain, blizzard, whiteout - got it all on the way up. Reward - I was the first one to summit that day;)
|Posted Jun 19, 2006 7:16 am
|Normal on Ski from V. Emanuel II Hut
Date Climbed: Apr 19, 2006
|Bright sunny warm day, very little wind. Could you ask for better? Well crap snow conditions... refrozen slush transitioning into windbuffed satstrugi.
Took three hours and some change for the climb up and around an hour on the way down, mostly because I had to take off the skis and bushwack the last bit in the thick forest without snow cover.
Hey if you do this one, make sure climb the REAL summit. I made fun of a guide that was ferrying 11 clients to the fake summit wit the little Mother Mary on the top. It isn't the the summit and you miss out on the best climbing, which is in between there and the real summit, 20 minutes or so of scrambling away.
|Posted Apr 20, 2006 4:42 pm
|Jeroen Vels
|Normal route from Chabod
Date Climbed: Jul 24, 2001
|As part of a climbing course I scaled my first 4000 m peak. It's a nice tour, easy and very crowded.
See also my website here.
|Posted Mar 28, 2006 2:20 pm
|Route from Ref. Vittorio E. II.,nice ascent,but maybe a little boring...
Date Climbed: Jul 11, 2005
|Started from bivouac above Refuge V.E. II.My first mountain over 4000m...Good aspect,perfect weather...
|Posted Mar 14, 2006 3:44 pm
|Both Summits
Date Climbed: Sep 6, 2004
|Didier and I, sharing leadership, left Refugio Vittori Emanuele II and switched to the Ghiacciao del Laveciau route and reached both the traditional "Madonna" and the actual summit, farther north, in a perfect weather day.
|Posted Mar 11, 2006 4:11 pm
|Route Climbed: Normal Route, Rifugio Chabod Date Climbed: July 5, 2005
|Beautiful day but strong wind. Reached the summit in less than 5 hours from Refugio Chabod. First 4000 meter summit!!!!
|Posted Dec 7, 2005 3:47 pm
|Route Climbed: Normal route from Refuge Victora Emanuela II Date Climbed: 4.07.2004
|I'm glad this ascent which was my first 4000m-peak
|Posted Dec 4, 2005 9:50 am
|Greg Garrard
|Route Climbed: Normal Route Date Climbed: 25 August 1998
|I hiked this mountain in the summer of 1998 as a member of 'Alpine Ram', a 15 man British Army Expedition climbing in France and Italy. It was truly the highlight of our trip. After a very early start from Rifugio V Emanuele, we summited at approximately 11:OOam. There was only light low lying cloud in the valleys, so we had a fantastic panoramic view, with Mont Blanc off in the distance. I would highly recomend this to anyone who is going to be in the area, and are looking for a rewarding challenge.
|Posted Nov 14, 2005 1:58 pm
|Route Climbed: ordinary route Date Climbed: 4 of Jul 2004
|My son has did it with me as 11years old boy.
Nice Sunday
|Posted Nov 7, 2005 9:10 pm
|Route Climbed: normal route from Vittorio Emanuele II hut Date Climbed: July 2000
|My first 4000 in a beatiful sunny day!
|Posted Nov 6, 2005 12:52 pm
|Attila the Hun
|Route Climbed: From Vittorio Emanuel Hut Date Climbed: 20th September 2005
|My first 4000 m peak too. Excellent weather. Nice climb.
|Posted Sep 26, 2005 7:25 am
|Route Climbed: the north face Date Climbed: 28 august 2005
|My first "4000"! That was uncredible, really.
|Posted Sep 23, 2005 4:29 pm
|Route Climbed: Normal (Guiding) Date Climbed: Some day of July 2005
|Cold but clear day !!!
|Posted Sep 22, 2005 2:56 pm
|Route Climbed: Normal Date Climbed: 28 July 2004
|Good weather,easy walk up...great views.
|Posted Sep 21, 2005 11:58 am
|Route Climbed: Normal - alternative 2005 Date Climbed: 5 september 2005
|Very nice 4000m peak, our first one.
The normal route was very iced, so we climbed up the morene to the left of the normal route and had a very nice walk up to the Gran Paradisio glacier. Reached the summit in 4 hours and were the first on top that day. This ment no trafficjam on the summit!
The view is superb !!! Mont Blanc, Mont Viso, etc..
Jack and Filiep from Belgium.
|Posted Sep 7, 2005 1:48 pm
|Route Climbed: Normal Date Climbed: 8 Jjuly 2005
|Very nice mountain in a beautifull national park. The weather here in Italy was very good instead of the bad weather in Chamonix. Our original plan was to climb the Mont Blanc but this one was a very good alternative. Not so high but in a splendid environment with no big tourist attractions! It was only a pitty that the top was very crowded due to the bad weather in the Western Alps. We staid in as well Victor Emannuel and the Chabot hut but the latter is definitely the best one to stay!
|Posted Aug 15, 2005 3:28 am
|Route Climbed: Normal Date Climbed: 19th July 2005
Date Climbed: Jul 19, 2005
|A long hard day, cold and windy, but also my first alpine four-thousander. It was a pity not to have more time to enjoy the summit sights, but...
By the way: yes, I shared this climb and the rope with Rafa Bartolome (in case no-one had imagined so)
|Posted Aug 1, 2005 9:23 am


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For nine weeks during the high school football season, the Bears select one high school football head coach as the Bears "Coach of the Week" winner. This program was created to honor coaches who develop players' football skills and knowledge, character and leadership, discipline, teamwork abilities, and contributions to his program, players and community. Graduation rates, school and fan support and, most importantly, contributions to players' long-term success on and off the field are also included.
Since the "Coach of the Week" program's inception in 1996, the Chicago Bears have donated over $198,000 to various high school football programs in Chicagoland and throughout the state of Illinois.
The Chicago Bears "Coach of the Week" program is brought to you by Fox 32 Chicago and the Illinois Army National Guard.


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