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What do I need to know about Social Security?
Federal benefits expert James Marshall will answer your questions about Social Security benefits.
January 20, 2014
Self-plus-one coverage: What's in it for you?
Lots of people inside government are excited about the pending self-plus-one health plan option, Senior Correspondent Mike Causey says. It will cost more than self-only, but less than the standard family plan. So who are the winners and losers?
Retirement ride: Will you be going 1st, 2nd or 3rd class?
Thanks to some surgical budget-cutting by Congress and the White House, Uncle Sam now has a three-tiered retirement plan: First-, second- and third-class where the service is the same but the price tag is higher for some than others.
Retire or keep working? Keep this job or move on to another?
Retirement coach Mike Townshend will discuss what you should be thinking about when considering a career change or retirement.
January 13, 2013
GOP Senator: Budget cuts affect survivor benefits
Pentagon to GOP senator: Budget cuts for military retirees also affects survivor benefits
Despite what your significant other says, you're worth more than you think!
Thanks to a portion of the media and many politicians, a lot of federal and postal workers have a low opinion of themselves. But when you crunch the numbers, feds are significant players in the stock market and in the net worth department, Senior Correspondent Mike Causey says. Crunch your own numbers.
Investing in the Thrift Savings Plan
Financial planner Arthur Stein will answer your questions about the TSP, and Federal Times writers Andy Medici and Nicole Blake Johnson will discuss what's ahead for feds in 2014.
January 8, 2014
A look back at 2013 and some projections for 2014 with Mike Causey
Federal News Radio Senior Correspondent Mike Causey joins hosts Bob Leins and Tammy Flanagan to talk about the big issues affecting feds in 2013 and what's ahead in the new year.
January 6, 2014
Senator sues OPM over health care regulations
Sen. Ron Johnson (R-Wis.) has filed a lawsuit against Katherine Archuleta, the head of the Office of Personnel Management, seeking to overturn an OPM regulation that allows lawmakers and their staffs to continue receiving government contribution toward their health insurance premiums. Under the 2010 Affordable Care Act, lawmakers and their staffs were booted from the Federal Employees Health Benefits Program (FEHBP), under which the government typically kicks in about three-fourths of the cost of federal employees' premiums, and required to purchase health insurance on the federal exchange.
Issa bill would repeal military COLA cuts, allow USPS to move to 5-day delivery
A new bill would repeal reductions in military pensions approved by Congress late last month as part of the bipartisan budget deal and allow the U.S. Postal Service to reduce regular mail delivery to five days a week. Rep. Darrell Issa (R-Calif.), the chairman of the House Oversight and Government Reform Committee, introduced the legislation Dec. 19, shortly before Congress decamped for the holidays.
OPM seeks changes to feds' benefits, insurance opportunities
The Office of Personnel Management recently filed two proposals to change how feds enroll in the Federal Employee Dental and Vision Insurance Program and to expand the regulations of the Federal Employees' Group Life Insurance.
Mass-transit benefit declines thanks to congressional inaction
Are you a federal employee who uses public transportation to get to work? Be prepared to shell out more for your commute. Because of congressional inaction, a tax subsidy for mass-transit commuters is set to drop nearly in half from a maximum of $245 a month to $130.
Planning tips for the federal employees
Federal benefits expert Bob Braunsten will answer your retirement and benefit planning questions.
December 30, 2013
Will OPM allow flexible-spending rollovers?
Under federal "use it or lose it" rules, any unspent money employees set aside last year to pay for out-of-pocket health costs, such as prescriptions or co-pays, is forfeited at the end of the year. But a group of senators from states surrounding the Washington, D.C., area, wants to change that. Sen. Ben Cardin (D-Md.) along with Sens. Barbara Mikulski (D-Md.), Mark Warner (D-Va.) and Tim Kaine (D-Va.) wrote to Katherine Archuleta, the head of the Office of Personnel Management, requesting the agency implement new regulations that would allow federal employees to roll over as much as $500 in unused funds from year to year.
Fight over military pension cuts to continue
Cuts to military pensions in doubt, but future changes to troop pay, benefits likely
Why some feds are skeptical of new self-plus-one FEHBP option
Thanks to the bipartisan budget deal passed by Congress and on its way to the President's desk, though, federal employees will soon have a new health-insurance coverage option: "self plus one." Federal employees have long clamored for the couples-only option, but the Office of Personnel Management, which oversees the FEHBP, has always demurred, citing concerns it would disrupt the risk-sharing inherent in large group plans. Now, with the self-plus-one option enshrined in law, at least one federal-employee union finds OPM's recent change of heart "problematic."
Self plus one and more
AFGE's public policy director Jacqueline Simon explains why her organization is opposed to the self plus one plan, and Sean Reilly and Andy Medici from the Federal Times will discuss what's ahead for feds and retirees in 2014.
December 18, 2013 (Encore presentations December 25, 2013 and January 1, 2014)
Couples-only health plan? Good idea or bad idea?
What do you think about a couples-only federal health plan? Would that be fair to the group plan and its group rates? The addition of a self-plus-one health plan could have consequences not only for that couple's premiums but also yours, Senior Correspondent Mike Causey says.
Planning tips for the federal employees
Federal benefits expert Bob Braunsten will answer your retirement and benefit planning questions.
December 16, 2013
Analyzing the budget deal
On this week's Your Turn radio show, host Mike Causey examines what's in the most recent budget deal that will impact feds.

subset: commoncrawl


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Comments about 'Can Utah innovation lead the way on health care?'
- Oldest first
- Newest first
- Most recommended
In case anyone with private insurance is wondering how 25% of their health is provided by the public health system, it mostly means the immunizations you got as a kid. Immunizations, disease free water supply and decreased child mortality account for the vast majority of longevity increases seen over the last century.
- 9:12 p.m. Dec. 15, 2012
- Like (1)
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The most important word read in this article is collaborative. Individuals have
to take responsibility for their health, being a part of the team and solution.
Responsibility lies with both the providers and the recipients.
- 1:31 a.m. Dec. 16, 2012
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Confused about the comment about the importance of mental health treatment but there's no other reporting on the topic. There seems to be a disconnect here by the reporter or editor either has edited out an important discussion topic here or has an unfortunate bias and didn't follow-up this line of thinking which was the basis of this article about innovation in medical care.
- 9:50 a.m. Dec. 16, 2012
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Republicans have had decades to show us something better...
They did
nothing about it, until forced to.
OK, Let's see it.
prove Obama wrong --
I double-dog dare you.
[Competition is the
driving force of evolution and Capitalism -- only the strong survive.]
- 2:54 p.m. Dec. 16, 2012
- Like (1)
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LDS lib,
dems have had decades to show us something better....
they have not. They gave us something worse than doing nothing.
and I guess the Obamacare crowd and other BO apologists ignore the graphic
showing access to health care is only carries a 5% weight in determining a
person's health.
And Obamacare does not encourage
The BO misadministration will not allow Utah, or any
other state for that matter, to vary one iota from their one-size-fits-all
Obamacare, afetr all, BO knows best!
- 1:45 p.m. Dec. 17, 2012
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Book your room at Imperial Mae Hong Son Resort
Deluxe Room
Max Occupancy: 3 guests (up to 2 children)Junior Suite, 1 King Bed
Max Occupancy: 3 guests (up to 2 children)Hotel with an outdoor pool, in Mae Hong Son (Pang Mu)
Located near the airport, this hotel is in Mae Hong Son (Pang Mu), and area attractions include Wat Phra That Doi Kong Mu, Nong Chong Kham Public Park, and Srisangwal Hospital. Area attractions also include Wat Chong Kham and Wat Chong Klang.
Hotel Features
In addition to a restaurant, Imperial Mae Hong Son Resort features an outdoor pool. Other amenities include a poolside bar and a bar/lounge.
Room Amenities
Televisions come with satellite channels. Guestrooms also feature refrigerators, air conditioning, and minibars.
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text:
a tolerable christian rock band that's better at hiding the fact that they're Christian rock than Creed is.
af Anonymous
31. oktober 2003
(n): A bitch so basic she doesn't have a mom. Check for firmware updates regularly. May or may not need to plug in at night.
"Yo, is that chick a pod?"
"Check for a belly button."
"Check for a belly button."
af L Ashton
6. juni 2014
Word stands for "Police Obnoxiously Dressed" a POD is a police officer in his civilian clothes which usually looks like a thrift market exploded. The standard no name jeans or Lee jeans, along with a customary cheap heather gray sweatshirt. Often a POD will wear all white leather sneakers typically New Balance. A more sophisticated POD will wear tight cargo style pants with a tight polo shirt bearing some type of police logo. Often the POD will wear a sidearm in plain view or concealed in the all too often seen "fanny pack." PODS often have aggressively high and tight haircuts and will wear very awful ties when dressed up, not to mention the well established and worn mustache. Never discount the PODS tendency to wear denim shirts or sweatshirts mixed with denim.
"That guy is definitely a POD check his attire"
"look at that POD they have to be a police officer."
"look at that POD they have to be a police officer."
af BobbyA4
14. november 2013
Abbreviation for pussying out. When someone backs down from something, wether they said they would or not.
Hamish said he would go into town but he PO'd by saying he was tired.
af Tdogg222
2. november 2013
Pod is used to describe things/people that are absolutely flawless in every way, shape or form.
Man, my girlfriend is so pod, I've no idea how I'm so lucky.
af Egrodo
2. oktober 2013


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Howdy, welcome to the Design House Digital | Digital Scrapbooking Day blog hop. Perhaps you're busy collecting all the 'ittle gifts and quickpages. Enjoy my own; you'll find the download link below.
If not, you've found the …
Here's my nifty contribution to the hop. A "notable-quotable" layered template for Photoshop and Photoshop Elements users.
Digital Scrapbooking Day 2011 DHD Bloghop FREEbie by Simply Tiffany | Notable Quotable Layered Template
download link does not expire — ever
My template matches the remaining kit pieces featured below. Visit all of the DHD designer blogs to complete your collection.
And releasing today are my Stuffy Collection Templates no. 4 – 7. These are the same that were featured in the Daily Digi's Digi Files for October 2011. They're on sale today for 30% off.
And Autumn Harvest Thankful Template. I'll use this to list 12 thankful thoughts I have for the month. It matches the Autumn Harvest Collection too.
FREE Template | My Scrappy Crafty Life said:
[…] a FREE template from Simply Tiffany. Download link NEVER EXPIRE – EVER!Just go to her website here and download the […]
PBS Challenge Template – 15/08 au 14/09 | FibiScrap said:
[…] J'ai techniquement déjà fait une page pour ce challenge sur le forum publiscrap. Mais comme il y avait trois templates proposés, j'ai remis ça avec le template de Simple Tiffany Studios. […]
Giveaway + Design House Digital Blog hop » Deena Rutter said:
December 2nd, 2013 at 12:32 am
[…] Audrey Neal Angie Hinksman Celeste Knight Dana Zarling Gennifer Bursett Jen Allyson Karen Funk Karla Dudley Robyn Meierotto Shannon Hegarty Tiffany Tillman […]


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... .
Many people with bronchiectasis also have a chronic infection of the nasal sinuses and a constant runny nose ... » Read on Complications
... tion in your sinuses. If sinusitis remains a long-term problem (chronic sinusitis) you may require surgery to improve the draina ... » Read on


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Passes for all Bulloch Academy athletic events during the 2011-12 school year are now available.
PORTAL - There are plenty of new faces at Portal this season, both on the diamond and in the dugout, but after several years of continued success, the Lady Panthers are set to continue the trend in the 2011 season.
CLAXTON - In just a few short years, Claxton has gone from perennial doormat to consistent contender.
"You've got to suck it up."
Football, food and fun were on the docket Thursday evening at Gator Alley as Bulloch Academy hosted its annual Peanut Boil.
Glenn Jones is preparing to bury his 16-year-old son.
As the new faces on the block in 2010, the Bulloch Academy softball team was mostly downplayed in its first year at Class-AAA – the highest in the Georgia Independent School Association. A state playoff appearance started to turn some heads, and now the 2011 version of the Lady Gators is primed to take things to the next level.
BROOKLET - Last season, Southeast Bulloch's opponents got everything they wanted from Jamal Johnson.
Steve Pennington is no stranger to the rarefied air at the top of Class AAAA, but despite getting the opponent's best shot with each passing week every season, the Blue Devils have stood the test of time and are unquestionably one of the elite football teams in the GHSA.
The hot, humid summer may be dragging on for most, but at Bulloch Academy, the countdown to a new football season is flying by and there is no time to lose.
BROOKLET - To compete for region titles in South Georgia year in and year out, teams must go through a never-ending process of dedication, preparation and execution.
BROOKLET - There's still over a month two go before opening night and almost three more weeks before players can practice in full pads, but the Statesboro football team is already in high gear as they joined Southeast Bulloch for 7-on-7 passing drills Tuesday in Brooklet.
The Bulloch Academy Boosters Club has kicked off its 2011-12 annual membership drive.
Bulloch Academy senior Zach Altany will take his love of basketball to the collegiate level when he shoots the three for Belmont Abbey College.
Aspiring baseball players in the area have a chance to get their big break Monday as the Kansas City Royals will be hosting an open tryout at Mill Creek Regional Park Monday.
While the Statesboro High basketball team travels to Glynn Academy tonight, future members will be on display at the Devil's Den as Langston Chapel Middle School and William James Middle School square off.
MILLEN - The Portal Panthers improved to 4-0 in Region 3A-A play with a 68-67 win Tuesday on the road.
Seniors led the way Tuesday night as Bulloch Academy pounded cross-county rival Robert Toombs in both girls' and boys' basketball action.
BROOKLET - After a quick start, it seemed as though Southeast Bulloch might let one get away against Beach High.
PORTAL - Woodville-Tompkins out of Savannah is the lone new addition to Region 3-A this season.
ALAMO - The Claxton Tigers earned a pair of wins on Saturday at Wheeler County.
Bulloch Academy erased a 24-point halftime deficit but it wasn't enough to overcome the multi-national force of Furtah Prep Friday night.
One of the best things about sports - at least for those who enjoy more than just one particular sport - is that the pages on the calendar can turn without the fun and games ever coming to an end.
After a pair of hard-fought games over the weekend, Statesboro ended its annual Gentlemen's Classic in style.
PORTAL - The Portal Panthers played a top-5 team from Class AA for the second game in a row, and got another win.
PORTAL - It took all night for the Portal Panthers to finally take a lead.
CHARLESTON, S.C. - Nobody in Georgia seems to be able to beat the Bulloch Academy Lady Gators, but on Saturday at the Carolina Invitational, they played a team from Maryland.
PORTAL - In the past three weeks, Southeast Bulloch has taken on elite teams from all around Georgia.


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clementine will sync and is very well capable of adding and removing tunes.
a few mentioned video, searching for the same solution.
clementine will sync and is very well capable of adding and removing tunes.
a few mentioned video, searching for the same solution.
hi, i seem to be having problems getting music on and off my ipod nano, it just says i cannot delete the file or folders. when trying to put music on it gives this-
Error opening '/media/STREET ROB/iPod_Control/Music/F24/libgpod655975.mp3' for writing (Read-only file system).
im using ubuntu 10.04 lucid
ive tried all the other programs, i imagine its the same problem, something in my ipod or permissions to read and write.
is there a way to change this so i can add and remove music?.thanks. rob.
I discovered this week that gtkpod in 10.10 now supports my 4GB Shuffle, which it didn't in 10.04. If you have the diddy Nano touch it looks like it doesn't yet work (neither does my iPhone 4). Check versions and see if an upgrade to 10.10 is likely to help:
thanks for that, im still having problems adding or removing music even using the gtkpod latest version, it appears as an error about reading and writing files, and i cannot figure out how to change this.
Hi, I have a 160GB Classic Ipod with firmware version 1.62 which accidently got upgraded when it was last connected to a windows machine with itunes on it, and ever since then it won't connect to ubuntu correctly. I tried to put music in via Gtkpod, clementine and 99% of the other Applications suggested here and none worked. Is there a patch that I can get that will fix this?
Did you try Rhythmbox? I accidentally did a firmware update to my 80GB classic a while back. Rhythmbox is the only player that will work properly with my pod.
I've tried that, None of it works. Is there a way to downgrade an IPODs Firmware so that linux recognises it?
Is the verdict out yet on if Ubuntu 10.10 works with the iPhone4?
yep short and long URL
when i connect my ipod, it says this:Code:Error mounting: mount: wrong fs type, bad option, bad superblock on /dev/sdb2, missing codepage or helper program, or other error In some cases useful info is found in syslog - try dmesg | tail or so


text:
A&E is "Real Life. Drama." A premium entertainment destination, A&E offers a diverse mix of high quality entertainment ranging from original scripted series to signature non-fiction franchises and the most successful justice shows on cable.
A&E is "Real Life. Drama." A premium entertainment destination, A&E offers a diverse mix of high quality entertainment ranging from original scripted series to signature non-fiction franchises and the most successful justice shows on cable.
Welcome to the official Audi StumbleUpon channel. Luxury has Progressed. Let us show you where we're taking it.
BIO is about real people who have extraordinary experiences in their real lives. We are up-close and personal, emotional, gritty and provocative, always unfiltered. BIO is about compelling, first person storytelling.
Follow Travel Channel on StumbleUpon for travel tips, articles, resources, inspiration, and clips from our shows.
Food Network is a unique lifestyle brand that strives to be way more than cooking. We are committed to exploring new and different ways to approach food, while also expanding our repertoire of technique-based information.
For the last 50 years our mission has been to stop the degradation of the planet's natural environment and to build a future in which humans live in harmony with nature.
Threadless is a community-based company that prints awesome designs created and chosen by you!
Chronicle Books is an independent publisher based in San Francisco. Inspired by the enduring magic of books, we create distinctive publishing that's instantly recognizable for its spirit, creativity, and value.
Astralwerks is a music label, founded in 1993 and based in New York. Astralwerks has always prided itself on aligning with musicians and groups with unique personalities + voices. Our kitchen drawer does not contain a cookie-cutter.
Adult Swim is all up in your Internet. Why busy yourself being productive when you could be watching videos and clips from shows like Aqua Unit Patrol Squad 1, Family Guy, and Childrens Hospital? And if our shows don't scratch your itch, maybe you'd prefer galloping across a rainbow dreamscape or harvesting some industrial hemp? Robot Unicorn Attack and Hemp Tycoon are just two of the countless games we have waiting for you in our online amusement park. In between watching videos and playing games, you can read interviews with celebrities like Robot Chicken's Seth Green and porn star Joanna Angel. And don't miss our funny lists, weird links, music videos, bizarre tangents and other distractions of questionable value. It's like a treasure trove of digital doubloons. Rest assured; Adult Swim is taking this Internet thing very seriously.
Animal Planet is at the electrifying intersection of humans and animals, a common, elemental life force is at work. You can feel it in the stories we tell and see it in the characters who bring them to life. The result is an entertainment bonanza of comedy, tragedy, fear, love and loathing. Plus cute cat photos!
Recipes, cooking tips, and articles from the Social Media team at Allrecipes.com, inspiring you to share your favorite dishes!


text:
Affordable Care Act (ACA or ObamaCare) Center - Blacksburg, VAWebMD Physician DirectoryBlacksburg, VirginiaAffordable Care Act (ACA or ObamaCare)What is the Affordable Care Act (ACA or ObamaCare)?The entire health-care industry is poised for the most profound changes in several generations. These changes can be categorized into Market Changes and the Affordable Care Act (ACA)... Other Related Affordable Care Act (ACA or ObamaCare) ArticlesEmergency Contact for Blacksburg
Nearby Blacksburg Hospitals *Lewisgale Hospital Montgomery Carilion New River Valley Ctr Carilion St Albans Behavioral Carilion Giles Community Hosp Mount Regis Center Catawba Hospital Lewis-Gale Medical Center Lewis-Gale Pavilion VA Medical Center Lewis Gale Hospital Pulaski Carilion Roanoke Memorial Hosp Carilion Franklin Mem Hosp *Provider Directory Terms of Use: The WebMD 'Provider Directory' is provided by WebMD for use by the general public as a quick reference of information about Providers. The Provider Directory is not intended as a tool for verifying the credentials, qualifications, or abilities of any Provider contained therein. Inclusion in the Provider Directory does not imply recommendation or endorsement nor does omission in the Provider Directory imply WebMD disapproval. |


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Save 25% on the Sony Xperia Z1 Case - Just add item number 4HLEX to your basket when buying Step 1 : Choose Your Handset All of our handsets are unlocked, giving you the freedom to select the network that suits you. Shoot incredible photos and video with the Sony Xperia Z1 smartphone's outstanding 20.7 megapixel camera.Featuring a high-end Exmor RS sensor and a 5 inch full HD Triluminos touch screen, you can frame, shoot and review all your footage in outstanding colour, contrast and detail. You can also take all your web browsing, movies gaming to the next level, so you're never short of spectacular entertainment. The Xperia Z1 is also dust and water-resistant, so you'll never fear dropping your phone in the sink again. The 2.2 GHz quad core processor does everything at the speed of light, so download and play games, browse the web and watch videos, instead of watching them load. There's 16Gb of internal storage that's expandable by another 32Gb using a microSD card, so you can carry around plenty of music, video and photos. Useful info:
Offer: SAVE 25% ON THE SONY XPERIA Z1 EXECUTIVE BOOK CASE


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My husband and I are planning a 10 -14 day trip to Maine mid-July.
Based on what I've read, we would like to visit: Kennebunkport, Portland, Rockport, Camden and Bar Harbor.
We know we would like to stay at least several days in Bar Harbor so we can explore Acadia National Park. We would also like to take a day ferry someplace so we can get out on the water to see some of the islands.
I hate switching hotels every night. Ideally, I would like to plan our itinerary so that we stay only one other place in addition to Bar Harbor and do day trips.
We can fly into either Boston or Portland.
Does any have any suggestions?
Thanks so much-
Help! Maine Trip Home Base
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With your goal cities it works better as a 3-stay vacation. A few nights Kennebunkport with a day trip to Portland/Cape Elizabeth, a day trip to Ogunquit/York Harbor and a day trip maybe to the Sebago Lakes region for a nice hike.
Then Camden/Rockport for 3 nights....or 4 if you want to take a ferry to Vinalhaven or Monhegan, or just a little jaunt to Isleboro for some biking around the island (ferry here is from Lincolnville just north of Camden).
Then Bar Harbor -
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Hoping to do this same trip, mid July as well, but with a toddler in tow.
Excited to see what you're told, Hillyhof. -
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That is really good advice from clarkgriswold.
In your planning, allow for driving time from place to place. Much of the highway will be two lane.
Depending on your interests, consider stopping in Freeport for LL bean and the outlets, Brunswick, Wiscasset and Boothbay Harbor.
When in the Rockport area, be sure to visit the Farnsworth Museum of Maine art. They also own the Olson house in Cushing, site of Andrew Wyeth's "Christina's World".
We enjoyed our stay at the Hartstone Inn in Camden and a ride on the windjammer Surprise. -
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We enjoyed our short stay at The Dunes in Oqunquit a couple of years ago. They have everything from motel units to cottages. Although right on Rt 1, the property is several acres in back so road noise is not noticeable. For anyone with a toddler, there are chairs and tables outside each unit (we had a one bedroom with LR, very small but adequate) so there's a good grassy area for children.
Near Camden, I have enjoyed Glenmoor-by-the Sea for the same reason. Larger units, lots of grass/
The mailboat cruise of Casco bay/Portland is a nice ride. The trip to Monhegan is longer open ocean time to an island with great hiking but take a picnic lunch. One of our best boat rides was a lighthouse cruise from the Maritime Museum in Bath. At the time, it was an all day trip and we took a picnic lunch to eat on an island. I think their trips are much shorter now.
Our favorite area is the mid-coast but since you would like to stay several days in Bar Harbor, maybe explore Camden on the way up and Rockport (are you sure you don't mean Rockland?) on the way back. I would agree with clarkgriswold for 3 different spots. Leave the Portland area for last so you'll be near the airport or plan a late flight out of Boston which recommends arriving 2 hours early to get thru security.
I think the distance is too far to just stay in 2 locations. You don't want to spend all your time on I95 which is a pretty boring hwy.
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Wills Money to Lady Gaga - "To my friends you gave me life and love, never think this was your fault… To Lady Gaga, you have been a fearless relentless proud LGBTQ advocate….." Excerpt Suicide note, EricJames Borges (Exclusive Copy below)
By Melanie Nathan, January 25, 2012
Raised in an extremist Christian household, assaulted in classroom with a teacher present, EricJames Borges, 19, was repeatedly bullied, tormented, terrorized, for the duration of his childhood and teen years. He came out with the video "it Gets better" , yet he could not live through the pain. EricJames committed suicide! "Disgusting, perverted, unnatural and going to hell" is what his parents told him as he was kicked out of his house. Exorcisms, beatings and extreme Christianity pervaded his young life and did not "cure" him – rather it killed him! Borges made a video just last month for the "It Gets Better" project, a campaign that features personal hope-filled videos to LGBT teens to get them through difficult times. Although he said "it gets better" he could not live through the extensive damage to his psyche and the pain that life had brought to him.
Melanie Nathan & Kristina Lapinski of Gay U.S.A. the Movie and Blog attended EricJames's funeral; Melanie writes this report and Kristina who took these photographs, filmed and conducted interviews for Gay U.S.A. the movie:-
Never before had the sound of 'Edge of Glory' been so inconceivable; EricJames Borges chose Lady Gaga, and not only for the echo that would pave his heavenly journey but as a benefactor, leaving the last of his life's dealings to his icon. Five hundred dollars would go to Lady Gaga's Born This Way Foundation, $500 to the Trevor Project, $521.56 to the Human Rights Campaign and almost $2,500 to his rescuer, Jennifer McGuire for her upcoming same-sex wedding. "I want it to go where it deserves; to life, love and equality."
Unlike during his life, nineteen year old EricJames Borges was in control at the end; he uploaded the music and chose the people; he designed his own funeral service and it was poignant. This past Saturday Borges was celebrated at one of three memorials held in Visalia and the one I attended was held by the town's grieving LGBT community, those describing themselves as his new family. His religious extremist parents had been invited but did not attend.
Mere months before EricJames came out, he recorded an "It Gets Better" video, made a short film and gave anti-bullying suicide prevention workshops to other teens; yet he could not sustain his own pain and committed suicide just two weeks ago. I obtained an exclusive and copyrighted copy of one of his suicide notes addressed to Jennifer McGuire and EricJames wanted all to know that he was grateful to the Trevor Project "I do not want my passing to reflect poorly on the Trevor Project," he clarified. "That organization was the best decision I ever made in my life."
A confused community packed the convention hall, trying to grasp the pain that could have caused this young suicide, further perplexed that even after the rescue which took him from a world of shame and torture to one of acknowledgment and safety, he would still want to die.
And so he did, in the home of a tender stranger, who took him in like her own, and whom he described in his last note as "mother-like" to him. She gave him love, safety, comfort and a Christmas like none other he had experienced in his life.
While officiate and friend, William Van VanLandingham, the director of the local chapter of Trevor Project noted "we are not here to point fingers," Jennifer McGuire, the kind stranger who had opened her home to EricJames, and had grown to love him, spoke to the mourners candidly:
"I am not going to avoid the elephant in the room. He tells his story better than any of us could in his short film and "It Gets Better" video, but I need it to be spoken out loud – and said for him… his parents tortured him – there is no other word to describe it. What he shared in his video was the tip of the iceberg, and that's only compared with what he shared with me, and I am sure there was more.
His parents tortured him by not protecting him from the extensive bullying. His parents tortured him through their relentless, extremist religious teachings. His parents tortured him with shame and intolerance and emotional and physical abuse that most of us can't even begin to imagine. And yes, I blame them, and not just a little, but for a majority percentage… His parents killed him."
Jennifer McGuire described how a college community including Professor Debra Hansen and Trevor Project volunteers had come to the rescue of the destitute young man. Yet all the love and support in the world would not be enough to save EricJames from the gushing wound of his childhood and the piercing gashes of his preceding teen years.
"By the time he got to us, his real family," wept McGuire, "he was so injured and so wounded that the triage we provided wasn't enough."
While grieving friends sat weeping the air was thick with an omnipresent craving to comprehend and as McGuire continued, through the poignancy of a triage metaphor, a small light was shed on that dark day, as if to entice understanding:
"He really was a warrior and many of us really were the MASH doctors trying to patch him up through our love and our friendship ….. we tried to stop the bleeding and in my heart I know we, all of us, did everything we could, but the wounds from the front-line, his front-line were just too severe."
The broken hearted McGuire continued:
"Our plan was to get him through his last year at COS and help set him up in a form or apartment at UCLA where he wanted to go to film school. He was so young, so alive, so strong in so many ways, yet utterly defenseless against the hell thrown at him.
And while many of us saw that and tried to protect him, basically, he had no defenses. He didn't know how to shrug off the torment from bullies. He didn't know how to reject the condemnations that are ever prevalent in our society.
We gave him slogans from t-shirts and videos instead of tools. He hadn't learned the art of removal or the snap and shoulder shrug or even anger, the defenses many of us have had, to learn to survive in this hostile world. Instead, he internalized it, all of it, and really he didn't understand it. It wasn't in his nature to understand the hate thrown at him."
Describing Borges as a smart and articulate young man who barely scraped the surface of his potential, McGuire related how she prepared for his move to her home:
"The day before he moved in, I emptied the bedroom for him; I emptied the drawers and the closet because I wanted him to move in, not just stay, but live there, and I made his bed, and I put a stuffed animal dog on the bed with the fluff pillows, thinking he'd stack them all in the closet when he went to sleep.
Instead he walked into the room, saw the stuffed animal, and hugged it, and teary-eyed said, "Is this for me?" And of course, I'm like, "Ya." And you know he slept with the dog every night."
And the eulogies effectively conveyed the message that EricJames had sought to impart, when he noted so succinctly in his final written words: "My pain is not caused because I am gay. My pain was caused by how I was treated because I am gay."
As McGuire concluded with an impassioned resolve to reclaim the "GAY" fight, the grieving community, and some well known activists all stood in unison, cheering, while the ultimate blast of "Edge of Glory" touched us with the sweet smell of ironic rebellion as the young man who could not be saved by anyone, controlled his own demise, leaving us with his choices and his money, defying those who stole his life, and revering those he had savored to his end.
Raised in an extremist Christian household, assaulted in classroom with a teacher present, EricJames Borges, 19, was repeatedly bullied, tormented, terrorized, for the duration of his childhood and teen years. He came out with the video "it Gets Better" (below,) yet he could not live through the pain. On January, 14, 2012, EricJames committed suicide! First reported by Melanie here oblogdeeoblogda.wordpress.com/2012/01/14/tragic-suicide-of-young-gay-anti-bully-activist-ericjames-borges/
How to find help if you feel suicidal
If you or a young person you care about needs support, call The Trevor Lifeline at (866) 488-7386. It's free, confidential and available 24/7. Learn more at TheTrevorProject.org.
– National Suicide Prevention Lifeline: (800) 273-8255
– Suicide Awareness Voices of Education: save.org.
– Suicide Prevention Resource Center: www.sprc.org
– Every county operates immediate mental health crisis response services. For information, contact your local county human services agency.
Article by Melanie Nathan
Photography by Kristina Lapinski
This Article, pictures and suicide note is exclusive to GAY USA the Movie and can only be reproduced with permission of Melanie Nathan, All Rights Reserved 2012© (Quotations require accreditation and a link to this site.)
Here exclusive to GAY USA the Movie and Blog and
Article was re-posted at:
Just a FYI, comments do not appear. It says there are 2 comments but the comments do not show up on your web page.
Note we moderate comments and are located on PST in CA , USA so takes time for comments to appear! Thanks for your support. Melanie Nathan
This is so incredibly sad, so sad. This followup is very important and very enlightening. I wonder though if your statement of "This Article, pictures and suicide note is exclusive to GAY USA the Movie and can only be reproduced with permission of Melanie Nathan, All Rights Reserved 2012© (Quotations require accreditation and a link to this site.)" will inhibit EricJames's full story from being shared with the potential of helping others. Maybe jsut some slight re-wording would be all that it takes. Maybe something like, "Reprints of this Copywrite article is encouraged permission is granted providing blah blah blah" You can think of your own what to say, but starting with a more willingness to share would be helpful I think. Rest in Peace young EricJames, rest in Peace. I didn't knwo you but you touched me.
Anyone can write to me for permission to repost which may be granted depending on how and where the article is used. If people want to spread the story, then one may use a quote from the article and link to the full article on this site. This precautionary measure has been taken because of how hate groups tend to misuse the information and the sensitivity due to the note. So with a quote and full accreditation there is really no hindrance to spreading this information around. I cannot grant crate blanche proviso's because I cannot cover every eventuality. Anyone interested in telling the story simply has to provide this link. The issue of suicide and suicide notes is sensitive – and so we tread as cautiously as possible drawing a fine balance .


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Kresge CEO shares lessons learned from green building
Constructing a green building was only the first step. Committed to reducing energy consumption and promoting renewable power, The Kresge Foundation had the Center for the Built Environment at the University of California at Berkeley evaluate the performance of its metropolitan Detroit office building, and continues to work on ways to improve energy efficiency.
Health organizations win innovation awards and chance to present case studies at upcoming summit
Four community health centers and one primary-care association will receive awards in recognition of their innovative approaches to primary care delivery and other initiatives that promote health and wellness in low-income communities. The $20,000 awards are part of a National Summit on Community Health Center Lending and Innovation, a two-day event taking place in Metropolitan Detroit next month.
Citizen volunteers' work monitoring air quality leads to recommendations for reducing harmful emissions
A new report makes the case that citizen volunteers can play a role in monitoring air quality and working to mitigate harmful air emissions. The report, by TriCounty Watchdogs and Global Community Monitor, focused on emissions from diesel-truck traffic. Titled "EXHAUST-ed! Community Exposure to Diesel Air Pollution in California's Transportation Corridor," the report details a year-long project in Lebec, Calif., and provides recommendations to reduce emissions.
Kresge Health Program adopts new term, 'community health partnerships,' and streamlines focus areas
This week we introduce a new term to talk about one of our Health Program focus areas: Community Health Partnerships. The phrase was coined after extensive discussions about what Health Program staff members hope to achieve and how they expect to reach those goals. "In using the term 'community health partnerships' we've put the emphasis on health, rather than on health care or sickness," says David Fukuzawa, who leads Kresge's Health Program.
Kresge-supported awards program names finalists for financing opportunities in hard-hit communities
PHILADELPHIA – The nation's largest awards program for responsible finance, the Wells Fargo NEXT Awards for Opportunity Finance, has announced three finalists for the $8.25 million NEXT Opportunity Award. The finalists plan to finance housing and community facilities in economically distressed Nevada, to create supportive housing for people with exceptional needs, or to expand access to affordable primary health care. The $8.25 million award will be divided between two or among all three finalists.
New office puts Kresge's Detroit Program team at the heart of the city's revitalization
The Kresge Foundation has joined the wave of organizations renovating and re-using office, retail and other space in Detroit. The national philanthropy recently completed the renovation of a 2,500-square-foot office in the city's Woodward Garden Block. The office space gives Kresge's Detroit Program a home base close to its work and a convenient space for meeting with grantees and other partners.
American Council on Education helps colleges support a new generation of GI Bill students
The Post-9/11 GI Bill provides more than 2 million eligible veterans with full tuition and fees at public universities, plus a housing stipend, money for books and supplies and a one-time relocation allowance. But many veterans have left that money on the table – not because they don't value education, but because help can be scarce when life gets in the way.
Kresge awards $1.2 million to Indiana and Wisconsin primary health care associations to strengthen community health centers
The recent U.S. Supreme Court decision to uphold the Affordable Care Act will mean huge changes, including increased demand, for health centers serving the nation's most vulnerable populations. To help federally funded community health centers adapt to a rapidly changing environment, The Kresge Foundation is investing more than $1.2 million in a comprehensive technical assistance program in Indiana and Wisconsin that could be replicated in other states. More than 20 million Americans receive primary care through community health centers.
Health centers and primary-care associations invited to apply for innovation awards
Community health centers and primary-care associations have until next week to apply for innovation awards for projects that highlight health center successes in: Advancing innovations in the delivery of primary care. Addressing the social determinants of health. And/or building healthy communities. Four awards of up to $25,000 each will be made as part of a National Summit on Community Health Center Lending and Innovation.
Power outage closes Kresge office
Our offices are closed today, Friday, July 6, due to a power failure. The utility company expects service to be restored Sunday. Some staff members are working from other locations, but the switchboard is not in operation and most inquiries will not be received until Monday. We're sorry about any inconvenience.
Climate adaptation education offered through Kresge-supported 'Climate Solutions University'
Applications and scholarships are now available for educational programs that give communities the opportunity to assess and respond to climate-related risks that may be threatening their infrastructure, budgets and resident well-being.
2012 Kresge Artist Fellows highlight culturally 'rich environment' of metro Detroit
Two dozen Metropolitan Detroit literary and performing artists have been awarded Kresge Artist Fellowships for 2012. Each of the 24 fellowships includes an unrestricted prize of $25,000, rewarding creative vision and commitment to excellence within a wide range of artistic disciplines. The fellowships represent The Kresge Foundation's desire to advance the artistic careers of Detroit artists living and working in its hometown, as well as elevate the profile of the area's artistic community.
Study documents need to account for low-income communities in planning transit
The development of light-rail transit systems in U.S. cities represents a positive step toward reducing urban sprawl and traffic congestion and revitalizing inner-city neighborhoods. A recent research report by PolicyLink finds light rail also generates new jobs for residents and creates compact, walkable communities centered around transportation.
Goodwill of San Antonio helps bring businesses, community college together on job training that changes lives
Iliana Maldonado was eight months pregnant and working as a customer-service rep at a check printing company when the high-risk nature of her pregnancy forced her to quit her job. Within a few months she lost her apartment because she couldn't pay the rent. With her two-month-old son and two young daughters, Maldonado moved into a small room at Sam Ministries, a San Antonio homeless shelter.
ArtPlace to invest $15.4 million in 47 creative placemaking initiatives
CHICAGO – ArtPlace, a nationwide initiative to transform communities through strategic investments in the arts, announced today it will invest $15.4 million in 47 projects in 33 communities. Among projects receiving support are the restoration of a Memphis blues man's home into an interactive music center, an art installation of aerial "nets" across a Philadelphia pier, and the engagement of artists to combat urban vacancy and foreclosure in Cleveland.
Kresge and M-1 RAIL partners pledge to resolve last issues surrounding Detroit light rail project
Leaders of M-1 RAIL, a long-planned light rail project in Detroit, today released a statement following a meeting with local, state and federal officials. The M-1 group includes Roger Penske of Penske Corp., Dan Gilbert of Quicken Loans, M-1 RAIL CEO Matt Cullen and Kresge Foundation President and CEO Rip Rapson. Kresge is among the private funders committed to the project. The foundation has pledged $35 million.
Kresge supports KaBOOM! and Rails-to-Trails efforts to bring play, physical activity to nation's cities
Two organizations — KaBOOM! and Rails-to-Trails Conservancy — are working with communities across the nation to increase recreational opportunities so residents can be physically active. Each group also has developed informational materials to help cities, school districts and community organizations make the most of their resources, from underused playgrounds and vacant lots to bike and pedestrian paths.
Kresge's Arts and Culture team will integrate its grantmaking framework under the concept of 'creative placemaking'
The Kresge Foundation's Arts and Culture team plans to roll out a new program that unifies the elements of the three-part framework that has guided its grantmaking since 2010. The aim – helping communities use arts and culture to create healthy, vibrant places – is unchanged. But where recent grantmaking has used multiple approaches to support that goal, the new direction will put the focus squarely on the integration of arts and culture into comprehensive community revitalization efforts.
Pair of publications recognize members of Kresge investment staff
National investment publications have recognized two members of The Kresge Foundation's Investment Group for excellence in their field. Investment Director Donna L. Snider was included a story The Chief Investment Officer Forty (Mostly) Under Forty in Asset International's "aiCIO" magazine in April.
Kresge-funded program helps low-income families to eat better, local farmers to earn more
It's not hard to imagine abundant urban agriculture in Detroit, which has large swaths of under-utilized land and half a million people with limited access to fresh food. But it takes more than imagination to transform the food system.


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While road tripping the entire Blue Ridge Parkway, we stopped for the night in Roanoke on 10/27/13. It was a Monday night & we just wanted to watch football, eat up all of our leftovers & get a good night's sleep. Chose the Fairfield because they usually have what we want & this one was no exception. It was a big Fairfield, nice enough area with decent curb appeal. Check-in was a breeze. It's 4 stories with2 elevators that must have been updated recently as there was new carpeting in the hallways. Got up to our room (#220) & heard water running?? Was someone already in this room? The key holder said this was our room, so we tried the key & we got in. It was just the toilet running. My husband fixed it & we settled in. It was a spacious room with 2 queen beds, a microwave & fridge in a separate stand, a desk area, dresser with the HD flatscreen TV on, a full length mirror which is good because the bathroom is all in one room. Good internet hook up. Comfy beds & plenty of towels. The place was very quiet for good sleeping. The breakfast room is spacious enough with a good selection: scrambled eggs, sausage patties, waffle maker, the usual muffins/toast, cold cereals, yogurt, hard boiled eggs & fresh fruit mix of cantaloupe, honeydew, orange segments, grapes & pineapple. Didn't get to see much of what was in the area; but there was a BP gas station nearby to gas up & we were off on another great day of road tripping. The Fairfield provided just what we wanted & we were satisfied with our stay.
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text: Journal of Rehabilitation Research and Development Vol. 40, No. 5, September/October 2003 Pages 407–414 Comparison of breathing patterns during exercise in patients with obstructive and restrictive ventilatory abnormalities Margaret Nield, PhD; Ashim Arora, MD; Kathleen Dracup, DNS; Guy W. Soo Hoo, MD, MPH; Christopher B. Cooper, MD VA Greater Los Angeles Healthcare System, Los Angeles, CA; Departments of Medicine and Physiology, UCLA School of Medicine, University of California, Los Angeles, CA; University of California, San Francisco, CA Abstract—Patients with obstructive and restrictive ventilatory further insight into the pathophysiology of the two conditions abnormalities suffer from exercise intolerance and dyspnea. and the contribution of dynamic hyperinflation to dyspnea. Breathing pattern components (volume, flow, and timing) dur- ing incremental exercise may provide further insight in the role played by dynamic hyperinflation in the genesis of dyspnea. Key words: breathing pattern, dyspnea, exercise, obstructive This study analyzed the breathing patterns of patients with ventilatory abnormality, restrictive ventilatory abnormality. obstructive and restrictive ventilatory abnormalities during incremental exercise. It also explored breathing pattern compo- nents with dyspnea at maximum oxygen uptake (VO2 max). INTRODUCTION Twenty patients, thirteen obstructive patients (forced expiratory volume 38% ± 13% predicted, forced expiratory Patients with obstructive and restrictive ventilatory volume in 1 s/forced vital capacity ratio 39 ± 8%), and seven restrictive patients (forced vital capacity 55 ± 16% predicted, abnormalities suffer from dyspnea and exercise limita- forced expiratory volume in 1 s/forced vital capacity ratio tion. Dyspnea, a complex symptom with multilayered 84% ± 11%) performed symptom-limited incremental exercise pathophysiology [1], remains the most distressing symp- tests on a cycle ergometer with breath-by-breath determination tom for those with progressive obstructive and restrictive of ventilation and gas exchange parameters. Breathing patterns lung disease. Furthermore, dyspnea is debilitating with were analyzed at baseline, 20, 40, 60, 80, and 100 percent of VO2 max. Dyspnea was measured at end-exercise with a 100 mm visual analogue scale. The timing ratio of inspiratory Abbreviations: ANOVA = analysis of variance, CI = confi- to expiratory time (TI /TE) and the flow ratio of inspiratory flow · · dence interval, COPD = chronic obstructive pulmonary dis- to expiratory flow ratio ( V I / V E ) were different (p < 0.008) ease, VAS = visual analogue scale, VO2 max = maximum between obstructive and restrictive patients at all exercise oxygen uptake. intensity levels. The timing components of expiratory time This material was based on work supported in part by T32 (TE) and inspiratory time to total time (TITTOT) were signifi- NR 07072 and Rehabilitation Research Career Develop- cantly different (p < 0.008) at baseline and maximum exercise. ment Award D0926CD, Department of Veterans Affairs. Dyspnea scores were not significantly different. For obstruc- Address all correspondence and requests for reprints to Marga- · · tive patients, correlations were noted between TI /TE, V I / V E , ret Nield, VA West Los Angeles Healthcare Center, Pulmonary TITTOT and dyspnea (p < 0.05). Breathing pattern-timing com- Section 111Q, 11301 Wilshire Boulevard, Los Angeles, CA ponents, specifically TI /TE, in patients with obstructive and 90073; work: 310-268-4593; home: 310-393-4769; fax: 310- restrictive ventilatory abnormalities during exercise provided 246-4206; email: email@example.com. 407 408 Journal of Rehabilitation Research and Development Vol. 40, No. 5, 2003 significant impact on health-related quality of life [2]. 3 years (1995–1998). Each of these studies provided an Dyspnea management has focused on pharmacologic array of physiological variables with which to evaluate therapies, with limited benefit. Nonpharmacologic the subject in terms of aerobic capacity, cardiovascular approaches, such as breathing strategies and positioning, response, ventilatory response, and gas exchange are recognized for their capability to provide dyspnea response to symptom-limited maximal exercise. Each relief but are underused [3]. exercise study was preceded by spirometry and measure- The breathing patterns of patients with obstructive ment of maximal voluntary ventilation. Patients with and restrictive lung disease during exercise are likely to only obstructive or restrictive ventilatory abnormalities be important contributory factors in the genesis of dysp- were selected for breathing pattern analysis. Minimal nea. Both groups are ventilatory-limited during exercise duration of the exercise phase from the end of warm-up with high breathing frequency (fR) and high minute venti- to the start of recovery was set at 4 min to allow suffi- lation (VE). Obstructive patients are able to maintain or cient data points for analysis. increase their tidal volume (VT), while restrictive patients quickly become tachypneic with their VT encroaching on Methods their inspiratory capacity. Cardiac status does not usually The symptom-limited maximal incremental exercise limit exercise performance. This study analyzed the tests were all performed with the use of a standard proto- breathing patterns of patients with obstructive and col administered by the same staff on an electromagneti- restrictive ventilatory abnormalities during incremental exercise for a better understanding of the relationships cally braked cycle ergometer (Ergoline, 800S). This among ventilatory abnormalities, breathing pattern protocol consisted of a period of equilibration at rest, changes with dynamic hyperinflation, and dyspnea. We breathing through the mouthpiece, followed by unloaded reviewed our experience with these two groups of pedaling for 3 min, then a ramp increase in work rate to patients during exercise, with a focus on the timing and symptom-limited maximum. The rate of work rate incre- flow parameters of breathing patterns. We then explored ment was determined at the time of testing for each indi- relationships between these parameters and dyspnea. vidual based on clinical evaluation of his or her level of impairment or physical fitness with the goal of obtaining 10 min of incremental exercise data. Ventilation and gas MATERIALS AND METHODS exchange were continuously measured with the use of a metabolic cart (Sensormedics 2900). The physiological Study Subjects indexes were displayed graphically and printed in tabular format for subsequent analysis. Immediately after cessa- The inclusion criteria for patients with an obstructive tion of exercise, breathlessness was measured with a hor- ventilatory abnormality were a forced expiratory volume in 1 s of less than 70 percent of the predicted value and izontal 100 mm visual analogue scale (VAS). The line forced expiratory volume in 1 s/forced vital capacity ratio was anchored at one end (0 mm) with the words "not at less than 70 percent [4]. The inclusion criteria for patients all breathless" and at the other end (100 mm) with the with a restrictive ventilatory abnormality were a forced words "extremely breathless." All subjects were asked to vital capacity of less than 70 percent of the predicted mark the line at a point that best described their breath- value and forced expiratory volume in 1 s/forced vital lessness at maximum exercise. The psychometric proper- capacity ratio greater than 70 percent [4]. These values ties of the VAS for measuring breathlessness have been represent standard spirometric criteria for obstructive and established in similar clinical populations [5,6]. restrictive ventilatory defects. The institutional review board approved the study as an analysis of existing data. Analysis Breathing patterns were assessed in terms of VE, VT, Study Design fR, inspiratory time, expiratory time, inspiratory time to This study involved a consecutive retrospective expiratory time, total breath time, inspiratory time to total review of maximal exercise tests performed in the time, mean inspiratory flow, mean expiratory flow, and clinical exercise physiology laboratory at a large univer- mean inspiratory flow to expiratory flow. These variables sity-based hospital in southern California over a period of were determined during unloaded pedaling and at 20, 40, 409 NIELD et al. Breathing patterns during exercise 60, 80, and 100 percent of VO2 max by averaging three obstructive ventilatory abnormalities. The clinical diag- consecutive breaths at each level of exercise intensity. noses for the restrictive ventilatory abnormalities were Descriptive and inferential statistical analyses were pulmonary fibrosis, either idiopathic or related to sclero- performed with SPSS, (Statistical Package for the Social derma or radiotherapy for lung cancer. The average dura- Sciences) version 10.0 [7]. The timing, volume, and flow tion of the exercise phase from the end of warm-up to the components of the breathing pattern were compared start of recovery was 5.8 min for the obstructive patients between obstructive and restrictive patients at different and 5.6 min for the restrictive patients. Breathlessness exercise intensities with the use of analysis of variance was the first stated reason for exercise termination for 11 (ANOVA). Bonferroni corrections were used to account of 13 obstructive patients and 4 of 7 restrictive patients. for multiple comparisons at six exercise intensities. Pear- Other reasons for exercise termination were fatigue (gen- son product-moment correlation was used to explore the eralized and leg fatigue), anxiety, and bigeminy. relationships between indexes of breathing pattern and The volume, flow, and timing components of the dyspnea. Breathing pattern components at maximal exer- breathing pattern were compared during unloaded pedal- cise that might explain the variance in dyspnea were ing and at five levels of exercise intensity. The traditional explored with multiple linear regressions. · · parameters of breathing pattern, i.e., VE , V T , and fR did not distinguish between the two patient groups (Table 2). During incremental exercise, while VT tended to remain RESULTS smaller and fR higher in the restrictive group, the differ- ences were generally not statistically significant. Com- Data were obtained from 13 patients with obstructive parison of VE shows the similar ventilatory response ventilatory abnormalities and 7 patients with restrictive between the two groups (Figure 1). Table 3 shows the ventilatory abnormalities. The selected patients were flow components of breathing pattern along with inspira- considered "ventilatory limited" as defined by the con- · · tory flow/expiratory flow ratio ( VI / V E ). Neither the ventional criterion of their maximum minute ventilation inspiratory nor the expiratory flows differed between the being within 15 L·min–1 of their previously measured · · two groups, but VI / V E was distinctly different. The tim- maximal voluntary ventilation [8]. Table 1 shows demo- ing components of the breathing pattern are shown in graphic and clinical information for these subjects. Table 4. The clearest distinction between the obstructive Smoking-related chronic obstructive pulmonary disease · · and restrictive groups can be seen in terms of V I / VE and (COPD) was the clinical diagnosis for all patients with inspiratory to expiratory time (TI /TE). Both ratios were consistently different at unloaded pedaling and all levels of exercise intensity. In Figure 2, the differences in TI /TE Table 1. Demographic and physiological characteristics of subjects. Values were most pronounced at 80 percent (0.49, 95% CI [con- indicate mean ± standard deviation. fidence interval] 0.14 to 0.72, p = 0.002) and 100 percent Characteristics Obstructive Restrictive (0.53, 95% CI 0.30 to 0.83, p < 0.000) of VO2 max. The differences in TI /TE ratios between the two groups largely Number (male/female) 13 (6/7) 7 (2/5) are due to longer expiratory time in the obstructive group Age (yr) 68 ± 5 68 ± 19 as seen in Table 4. MVV (L·min–1) 41 ± 20 57 ± 15 Dyspnea scores at maximum exercise were not sig- FEV1 (L·min–1) 0.97 ± 41 1.46 ± 40 nificantly different (p = 0.39) between obstructive FEV1 % Predicted 38 ± 13 66 ± 23 patients (mean ± SEM [standard error of mean] 77 ± 5) FEV1/FVC % 39 ± 8 84 ± 11 and restrictive patients (68 ± 11). Table 5 shows correla- FVC % Predicted 69 ± 18 55 ± 16 tion coefficients for the various parameters of breathing VO2 max (L·min–1) 0.95 ± 0.40 0.80 ± 0.20 pattern and dyspnea at maximum exercise. The timing VO2 max % Predicted 55 ± 22 56 ± 22 components, TI /TE and TI /TTOT, showed a significant MVV = maximum voluntary ventilation negative correlation with dyspnea in the obstructive FEV1 % predicted = forced expiratory volume in 1 s percent predicted FEV1/FVC % = forced expiratory volume in 1 s/forced vital capacity ratio patients (r = 0.57, p = 0.04), and a positive correlation · · with V I / V E . By multiple linear regression analysis, TI /TE FVC % predicted = forced vital capacity percent predicted VO2 max = maximal oxygen uptake and VT at maximal exercise accounted for 43 percent of 410 Journal of Rehabilitation Research and Development Vol. 40, No. 5, 2003 Table 2. Breathing pattern analysis at baseline, 20, 40, 60, 80, and 100 percent VO2 for patients with obstructive (O) or restrictive (R) ventilatory abnormalities. Traditional breathing pattern parameters are minute ventilation (VE ) , breathing frequency (fR), and tidal volume (VT). Values are mean ± standard error of the mean. VE (L·min–1) fR (min–1) VT (L) % VO2 max O R O R O R Base 19.8 ± 2.2 15.4 ± 2.2 22 ± 1 24 ± 2 0.92 ± 0.08 0.64 ± 0.07 20 23.6 ± 1.8 20.8 ± 3.2 24 ± 1 30 ± 3 1.01 ± 0.10 0.70 ± 0.07 40 27.0 ± 2.2 24.1 ± 3.0 25 ± 1 32 ± 3 1.09 ± 0.10 0.77 ± 0.07 60 27.8 ± 3.1 27.4 ± 3.6 27 ± 1 32 ± 3 1.19 ± 0.12 0.86 ± 0.09 80 30.4 ± 3.8 33.0 ± 4.7 29 ± 2 37 ± 3 1.23 ± 0.12 0.90 ± 0.10 100 39.8 ± 4.2 37.4 ± 4.9 32 ± 2* 41 ± 2 1.23 ± 0.11 0.91 ± 0.10 Base = unloaded pedaling *p < 0.05 with Bonferroni corrections for six comparisons (critical value of p = 0.008) VO2 max = maximal oxygen uptake the variance in dyspnea for obstructive patients (R2 = differences were most noticeable in examination of the 0.43, p = 0.06). The same model was not significant for timing components of breathing patterns. The inspiratory the restrictive patients (R2 = 0.30, p = 0.48). to expiratory ratio and flow ratio differences were signifi- cantly different at all levels of exercise, with the magni- tude of difference most pronounced at maximal exercise. DISCUSSION For patients with obstructive ventilatory abnormalities, · · TI/TE was consistently lower and VI / VE was consistently This study highlights the differences in breathing pat- higher than for those with restrictive ventilatory abnor- terns during incremental exercise between patients with · · malities. The VI / VE is similar to TI /TE ; it incorporates obstructive and restrictive ventilatory abnormalities. The both inspiratory and expiratory timing parameters. It highlights the contribution of volume as well and thus is a helpful indicant of the overall changes that occur with increasing exercise intensity. The TI /TTOT data show con- sistently lower proportion of inspiratory time in relation to total breath cycle time (below 0.5) for obstructive patients as compared to the restrictive patients who spend a greater proportion of the breath cycle in inspiration. The breathing patterns that we observed for the obstructive group generally confirm findings previously noted at rest and with increased workloads for those with COPD [9–12]. The changes in breathing pattern with incremental exercise include increased fR, modest changes in VT, shorter expiratory times, and doubling of flow rates. Interestingly, the conventionally studied breathing pattern components of VE, fR, and VT during Figure 1. incremental exercise did not demonstrate differences Relationship between minute ventilation (VE) and exercise intensity between conditions as well as the timing components. As relative to maximum oxygen (% VO2 max) subjects with obstructive seen in Figure 1, VE was comparable at each exercise (∆) and restrictive (!) ventilatory abnormalities. Reference values of normal ( ) subjects (based on unpublished laboratory data) are intensity. Only fR at maximal exercise was significantly ° shown with their regression (--). different (Table 2). 411 NIELD et al. Breathing patterns during exercise Table 3. Ventilatory flow analysis at baseline, 20, 40, 60, 80, and 100 percent VO2 for patients with obstructive (O) or restrictive (R) ventilatory abnormalities. Values are mean ± standard error of the mean. VT /TI (L·s–1) VT /TE (L·s–1) · · VI / VE % VO2 max O R O R O R Base 0.80 ± 0.10 0.47 ± 0.09 0.58 ± 0.05 0.65 ± 0.09 1.36 ± 0.13* 0.76 ± 0.15 20 0.90 ± 0.10 0.65 ± 0.15 0.67 ± 0.05 0.81 ± 0.08 1.39 ± 0.12* 0.79 ± 0.16 40 1.05 ± 0.11 0.82 ± 0.14 0.77 ± 0.07 0.82 ± 0.06 1.47 ± 0.11* 0.97 ± 0.11 60 1.27 ± 0.13 0.93 ± 0.14 0.86 ± 0.10 0.92 ± 0.10 1.66 ± 0.15* 1.00 ± 0.08 80 1.37 ± 0.16 1.10 ± 0.19 0.96 ± 0.12 1.15 ± 0.15 1.55 ± 0.12* 0.95 ± 0.10 100 1.69 ± 0.19 1.16 ± 0.16 1.12 ± 0.13 1.36 ± 0.18 1.55 ± 0.09† 0.87 ± 0.06 Base = unloaded pedaling VT/VE = expiratory flow *p < 0.05 with Bonferroni corrections for six comparisons (critical value of p = 0.008) · · V I / V E = inspiratory flow/expiratory flow †p < 0.01 with Bonferroni corrections for six comparisons (critical value of p = 0.002) VO2 max = maximal oxygen uptake VT /TI = inspiratory flow Table 4. Ventilatory timing analysis at baseline, 20, 40, 60, 80, and 100 percent VO2 for patients with obstructive (O) or restrictive (R) ventilatory abnormalities. Values are mean ± standard error of the mean. % VO2 TI (s) TE (s) TI /TE TTOT (s) T / TTOT I max O R O R O R O R O R Base 1.29 ± 0.12 1.55 ± 0.18 1.62 ± 0.11* 1.06 ± 0.15 0.82 ± 0.08* 1.65 ± 0.28 2.91 ± 0.18 2.61 ± 0.20 0.44 ± 0.02* 0.59 ± 0.04 20 1.21 ± 0.13 1.32 ± 0.22 1.49 ± 0.11 0.90 ± 0.10 0.77 ± 0.06* 1.54 ± 0.26 2.58 ± 0.17 2.21 ± 0.27 0.47 ± 0.04 0.58 ± 0.04 40 1.14 ± 0.15 1.04 ± 0.13 1.44 ± 0.11 0.96 ± 0.10 0.72 ± 0.06* 1.14 ± 0.15 2.47 ± 0.14 2.00 ± 0.21 0.46 ± 0.04 0.52 ± 0.03 60 1.01 ± 0.12 0.99 ± 0.10 1.44 ± 0.12 0.96 ± 0.09 0.67 ± 0.07* 1.05 ± 0.10 2.34 ± 0.13 1.95 ± 0.18 0.44 ± 0.05 0.51 ± 0.02 80 0.98 ± 0.11 0.88 ± 0.09 1.38 ± 0.16 0.81 ± 0.07 0.69 ± 0.05† 1.13 ± 0.12 2.25 ± 0.22 1.69 ± 0.15 0.45 ± 0.04 0.52 ± 0.02 100 0.75 ± 0.03 0.80 ± 0.03 1.17 ± 0.09* 0.69 ± 0.06 0.68 ± 0.05† 1.21 ± 0.12 1.92 ± 0.12 1.49 ± 0.08 0.40 ± 0.01† 0.54 ± 0.02 Base = unloaded pedaling T /TE = inspiratory time/expiratory time I *p < 0.05 with Bonferroni corrections for six comparisons (critical value of p = 0.008) TTOT = total breath time (s) †p < 0.01 with Bonferroni corrections for six comparisons (critical value of p = 0.002) T /TTOT = duty cycle I TI = inspiratory time VO2 max = maximal oxygen uptake TE = expiratory time A preferential increase in fR rather than VT in patients pared to inspiratory times in the restrictive group have been with restrictive ventilatory abnormalities has been previ- previously noted [14]. This difference may not be appreci- ously noted [13,14]. Our restrictive patients with restrictive ated if only the duty cycle, TI /TTOT, is considered. ventilatory abnormalities had smaller VT at baseline and When normal subjects exercise, VT increases both as a tended to have higher fR during exercise as compared to result of increased end-inspiratory lung volume and those with obstructive ventilatory abnormalities. Presum- decreased end-expiratory lung volume. The fall in end- ably, adopting a more rapid, shallower breathing pattern expiratory lung volume, which is a minor but important contribution to the increased VT, is thought to be facili- optimizes work of breathing and helps avoid diaphragmatic tated by expiratory muscle recruitment. O'Donnell and muscle fatigue. As a consequence of the higher fR, the total Webb demonstrated normal breathing patterns and breath time tended to be shorter compared to the patients showed important differences in patients with COPD [15]. with obstructive ventilatory abnormalities. Both inspiratory Increased airway resistance slows expiratory flow, pro- and expiratory times from 40 percent to maximal exercise longing lung emptying. Furthermore, airway collapse, were shorter in the restrictive group compared with the especially in patients with emphysema, causes air trapping obstructive group. The timing difference was more pro- and prevents complete lung emptying. During exercise, as nounced for expiratory time. Shorter expiratory times com- breath time shortens, insufficient time for expiration 412 Journal of Rehabilitation Research and Development Vol. 40, No. 5, 2003 By contrast, in subjects with restrictive ventilatory abnormalities either because of reduced lung or chest wall compliance or because of respiratory muscle weakness, there may be insufficient time for adequate inspiration as fR increases and TTOT decreases. The decreased inspira- tory flow (VT /TI) as compared to obstructive patients' VT / TI reflects restricted lung expansion (Table 3). Marciniuk and colleagues found that end-expiratory lung volume did not fall significantly during exercise in interstitial lung disease [16]. Markovitz and Cooper drew attention to the changes in end-inspiratory and end-expiratory lung vol- umes with respect to the level of VE in patients with inter- stitial lung disease [17]. They identified a fall in end- inspiratory lung volume and end-expiratory lung volume toward maximal exercise and referred to this phenome- non as "dynamic hypoinflation." Dynamic hypoinflation, Figure 2. Relationships between the ratio of inspiratory to expiratory time (TI / caused by inadequate time for lung inflation at a time of TE) and exercise intensity relative to maximum oxygen uptake (% increased ventilatory demand, may limit exercise capacity VO2 max) in subjects with obstructive (∆) and restrictive (!) and contribute to the sensation of dyspnea in those with ventilatory abnormalities. Reference values of normal ( ) subjects restrictive ventilatory abnormalities. (based on unpublished laboratory data) are shown with their ° · · The timing components, TI /TE, VI / VE , and TI /TTOT, regression line (--). further underscore our current understanding of these exer- cise-associated changes in respiratory mechanics. Increases in dynamic hyperinflation for the obstructive compounds these problems, resulting in dynamic hyperin- patient are associated with proportionately slower expira- flation as manifested by an increase in end-expiratory tory flow rates as compared to inspiratory flow rates and lung volume with increased end-inspiratory lung volume. · · would be manifested as increasing VI / V E . In restrictive This phenomenon is thought to contribute to exercise lim- patients, exercise is associated with increases in inspiratory itation by constraining the increase in VT and forcing · · flow, resulting in VI / VE ratios that approach unity and a operational lung volumes toward an unfavorable portion TI /TTOT closer to 0.5. The assessment of the changes in of the compliance curve for the respiratory system. The end-inspiratory and end-expiratory lung volume observed resulting increase in elastic work contributes to a vicious in dynamic hyperinflation requires additional equipment cycle of worsening breathing efficiency. and measurement, which is not usually performed in most Table 5. Relationship of breathing pattern components with dyspnea at maximal exercise. Ventilatory · · VE VT fR TI TE TI /TE TTOT TI /TTOT VT /TI VT /TE V I / VE Abnormality Obstructive r –0.33 –0.13 –0.46 –0.02 0.42 –0.57* 0.33 –0.58* –0.11 –0.48 0.59* * * p 0.26 0.67 0.12 0.96 0.15 0.04 0.27 0.04 0.73 0.10 0.03* Restrictive r 0.21 0.04 0.22 –0.26 –0.56 0.48 –0.54 0.49 0.12 0.31 –0.50 p 0.65 0.94 0.65 0.57 0.19 0.27 0.21 0.27 0.49 0.50 0.25 VE = minute ventilation TE = expiratory time · · V I / V E = inspiratory flow/expiratory flow VT = tidal volume TI /TE = inspiratory/expiratory time r = correlation coefficient fR = breathing frequency TTOT = total breath time p values = significance TI = inspiratory time · · V I / V E = inspiratory flow/expiratory flow * p < 0.05 413 NIELD et al. Breathing patterns during exercise exercise laboratories. These timing components could pro- ria, the groups were not matched based on gender or vide another avenue to assess these changes and is attrac- body mass index. Dyspnea was measured at maximum tive given its derivation from current measures or derived exercise only. The small number of subjects in each parameters. group may be responsible for Type II errors where there We also compared breathing pattern parameters with is insufficient power to detect a difference between dyspnea as quantified by VAS at maximum exercise. Sig- groups, when such a difference might be present. For nificant correlations were found between dyspnea and the example, the expected differences in fR at baseline were timing components of TI /TE and TI /TTOT as well as VI / · not detected. However, despite the small number of sub- · VE for subjects with obstructive ventilatory abnormali- jects, differences were clearly present for TI /TE at all lev- ties (p = 0.04). We did not find a significant relationship els of exercise intensity studied. between mean expiratory flow and dyspnea as reported by Eltayara and colleagues in those with COPD [18]. These contradictory findings could be explained by the CONCLUSIONS use of different methods for measuring expiratory flow and dyspnea. Eltayara and colleagues used an application Patients with obstructive and restrictive ventilatory of negative expiratory pressure to study expiratory flow abnormalities have similar changes in VE , fR, and VT with at rest and measured dyspnea using a modified Medical incremental exercise. By contrast, analyses of the timing Research Council dyspnea scale [18,19]. Our study components of breathing pattern were consistently differ- derived mean expiratory and inspiratory flows from mea- ent between subjects with obstructive and restrictive ven- sured tidal volumes and the time components of the tilatory abnormalities. Diametrically opposite changes in · · TI /TE and VI / V E provide insight into their different breath. We also found that while inspiratory flow rates · · were not associated with dyspnea, VI / VE was associated pathophysiological mechanisms and highlight the contri- with dyspnea. To our knowledge, other investigators have bution of dynamic hyperinflation in the genesis of dysp- · · not explored the relationship between TI /TE, V I / V E , and nea. Finally, we demonstrated a relationship between dyspnea. timing components and dyspnea at maximum exercise in Studies of breathing pattern and dyspnea have impli- subjects with obstructive ventilatory abnormalities. cations for the teaching of breathing strategies. Since TI / TE and VT at maximal exercise explained 43 percent of the dyspnea variation for obstructive and not restrictive REFERENCES patients, the ventilatory disorder should direct the choice 1. American Thoracic Society. Dyspnea: mechanisms, assess- of breathing strategy. Prolonged expiratory times in rela- ment, and management: a consensus statement—1998. Am tion to inspiratory times would likely decrease air trap- J Respir Crit Care Med 1999;159:321–40. ping and reduce dynamic hyperinflation for those with 2. Ferrer M, Alonso J, Morera J, Marrades RM, Khalaf A, obstructive ventilatory disorders and provide dyspnea Aguar MC, et al. Chronic obstructive pulmonary disease relief. The focus on expiratory time may be more effec- stage and health-related quality of life. Ann Int Med 1997; tive compared with the usual teaching instructions to 127:1072–79. increase VT or slow fR, since there would be direct 3. Nield MA. Dyspnea self-management in African-Ameri- emphasis on the breathing parameter more likely to bring cans with chronic lung disease. Heart Lung 2000;29:50–55. dyspnea relief. Our findings suggest the need for further 4. Morris JF. Spirometry in the evaluation of pulmonary func- investigation of manipulation of the timing components tion. West J Med 1976;125(2):110–18. of the breathing pattern during low-level exercise. Since 5. Gift AG. Visual analogue scales: measurement of subjec- dynamic hyperinflation is difficult to measure directly, tive phenomena. Nsg Res 1989;38(5):286–88. 6. Adams L, Chronos N, Lane R, Guz A. The measurement of use of noninvasive measures, such as the timing compo- breathlessness induced in normal subjects: validity of two nents of TI /TE and TI /TTOT, would be useful. scaling techniques. Clin Sci 1985;69(1):7–16. The retrospective study design and the small number 7. SPSS Inc. SPSS Advanced Statistics 10.0. Chicago: SPSS of subjects in each group limit the conclusions that can be Inc., 1999. drawn from this study. While the patients with ventilatory 8. Sue DY, Hansen JE. Normal values in adults during exer- abnormalities were selected by pulmonary function crite- cise testing. Clin Chest Med 1984;5:89–97. 414 Journal of Rehabilitation Research and Development Vol. 40, No. 5, 2003 9. Tobin MJ, Chadha TS, Jenouri G, Birch SJ, Gazeroglu HB, 15. O'Donnell DE, Webb KA. Exertional breathlessness in Sackner MA. Breathing patterns. 2. Diseased subjects. patients with chronic airflow limitation. Am Rev Resp Dis Chest 1983;84:286–94. 1993;148:1351–57. 10. Dodd DS, Brancatisano T, Engel LA. Chest wall mechanics 16. Marciniuk DD, Stridhar G, Clemens RE, Zintel TA, Gal- during exercise in patients with severe chronic airflow lagher CG. Lung volumes and expiratory flow limitation obstruction. Am Rev Resp Dis 1984;129:33–38. during exercise in interstitial lung disease. J Appl Physiol 11. Gallagher CG, Younes M. Breathing pattern during and after 1994;77:963–73. maximal exercise in patients with chronic obstructive lung 17. Markovitz GH, Cooper CB. Exercise and interstitial lung disease, interstitial lung disease, and cardiac disease, and in disease. Curr Opin Pulm Med 1998;4:272–80. normal subjects. Am Rev Res Dis 1986;133(4):581–86. 18. Eltayara L, Becklake MR, Volta CA, Milic-Emili J. Rela- 12. Vitacca M, Clini E, Bianchi L, Ambrosino N. Acute effects of tionship between chronic dyspnea and expiratory flow lim- deep diaphragmatic breathing in COPD patients with chronic itation in patients with chronic obstructive pulmonary respiratory insufficiency. Eur Resp J 1998;11:408–15. disease. Am J Respir Crit Care Med 1996;154:1726–34. 13. Burdon JG, Killian KJ, Jones NL. Pattern of breathing dur- 19. Fletcher CM, Ellmes PC, Wood CH. The significance of ing exercise in patients with interstitial lung disease. Tho- respiratory symptoms and the diagnosis of chronic bronchi- rax 1983;38:778–84. tis in a working population. Br Med J 1959;1:257–66. 14. Dimarco AF, Kelsen SG, Cherniack NS, Gothe B. Occlu- sion Pressure and breathing pattern in patients with intersti- Submitted for publication July 9, 2002. Accepted in tial lung disease. Am Rev Resp Dis 1983;127:425–30. revised form February 3, 2003.


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Cartoon Characters For Halloween Costume Ideas
25 Cool Cartoons to Inspire Your Halloween
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25 Cool Cartoons to Inspire Your Halloween
For the honor of Grayskull, who hasn't secretly wished for She-Ra's sweet winged headdress? Cartoon characters carry a lot of power no matter how old you get, and they almost always have the most awesome hair and makeup. Here are 25 of the coolest cartoon ladies to inspire you, along with ideas for getting their looks without breaking the bank. Ready for a radically fun All Hallows'?
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4 years
What about doing a "do it yourself" catwoman costume? There are ways to do the mask with makeup but where can you find a latex/spandex body suit that's feline friendly to this beloved comic book character?
4 years
OMG I've been trying to think of She-Ra's name forever but whenever I described her no one knew what I was talking about. Thank you so much!!
4 years
Thanks, Bellakaoru! ;) I knew all those years of hanging out in the comic book store would pay off one day. Now if I could only get a competitive Magic league going...
4 years
Thanks, Bellakaoru! ;) I knew all those years of hanging out in the comic book store would pay off one day. Now if I could only get a competitive Magic league going...
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