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Plaid Flannel Sleep Pants
Item# 112004RT
Color :color
Size :size
Availability :
- 100% Polyester
- Porfolio Sleep Pants
- Micro Luxe Fabrication
- Drawstring and Elastic Waist Band
- Machine Washable
Rated 2.5 out of 5 by 2 reviewers.
Rated 4 out of 5 by BSHU Love sleeping in it! This are one of the best sweatpants, and great house wear, sleep wear. The material is very comfortable, and feels great wearing it. Cant go wrong if you order a size bigger. December 25, 2012
Rated 1 out of 5 BAD PRODUCT This product was not described correctly, it is microfiber/poly/polartech material (very static-y) and not flannel as advertised. December 22, 2012
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Entertainment Links
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Movie news, reviews, trailers, and more.
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Epworth Sleepiness Scale
Rate yourself in each situation using this scale:
0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
1. Sitting and reading
2. Watching TV
3. Sitting, inactive, in a public place, such as a theater
4. As a passenger in a car for an hour without a break
5. Lying down to rest in the afternoon when circumstances permit
6. Sitting and talking to someone
7. Sitting quietly after a lunch without alcohol
8. In a car, while stopped for a few minutes in traffic
Add up your score. If your total is 10 or more, you may have excessive daytime sleepiness, or EDS. This could indicate an underlying sleep disorder, so talk to your doctor.


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See what happens when Leonardo DiCaprio puts it all out there in Django Unchained — arguably one of his best roles to date — and you snub him, Oscar voters?! He decides to quit acting. At least temporarily.
While talking with a German publication, the daily paper Bild, the Martin Scorsese and Quentin Tarantino main dude explained his decision as a matter of being just generally exhausted — rather than our personal theory above — which, after his string of event-style films over the past several years, is no surprise. "I am a bit drained. I'm now going to take a long, long break. I've done three films in two years and I'm just worn out." But who wouldn't be exhausted after giving all those career-defining performances and constantly getting snubbed?
RELATED: Tom Hardy, Leonardo DiCaprio, Tobey Maguire to Produce Anti-Poaching Film
DiCaprio seems to be the Susan Lucci of movie actors. This year's shut out wasn't his first, by any means. He was similarly shut out on nominations for his work in Romeo + Juliet, The Basketball Diaries, Catch Me If You Can, Gangs Of New York, Shutter Island, Revolutionary Road and Inception. But that's not all, the three times he was nominated for anything Academy related (What's Eating Gilbert Grape, The Aviator, and Blood Diamond), he was left to smile and nod while someone else accepted the award. I mean, I've done a hell of a lot of losing in my life (as we all have), but damn, that's a lot of frustrating losses, eh?
But with all that down-time, what would DiCaprio do? Well his plans are simple, really. Just try and change the world. You know; no big deal! "I would like to improve the world a bit. I will fly around the world doing good for the environment." I mean, who doesn't use their million-dollar-making downtime to try and reverse global warming? I mean, when I'm not making ALL of the dollars here at Hollywood.com, my favorite hobby involves reengineering the make-up of pollution in order to transform it into clean air and water. But I mean, who doesn't tinker around with stuff like that, right?
At least we all have The Great Gatsby to look forward to in 2013. There's hope for your golden dreams yet, Leo!
RELATED: New 'The Great Gatsby' Trailer Reveals Not All that Glitters is Gold — TRAILER
What do you think of DiCaprio's decision to take time off? Let us know in the comments!
Follow Alicia on Twitter @alicialutes
[Photo Credit: WENN]
You Might Also Like:100 Hottest Women of the Century: Do You Agree?
9 Most Insane Celebrity Baby Bumps


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Home/Archive/Documents/JFK Assassination Documents/JFK Documents - Central Intelligence Agency/HSCA Segregated CIA Collection (microfilm)/HSCA Segregated CIA Collection (microfilm - reel 52: De Mohrenschildt - Hall)/
Reel 52 of a microfilmed set of CIA documents to which the House Select Committee on Assassinations had access.
Subjects: De Mohrenschildt, Devarona, Diosdado, Echevarria, Garanin, Gibson, Gonzales, Gutierrez, Hall.
© Mary Ferrell Foundation. All Rights Reserved. |Press Room |Our Policies||Site Map


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Home/Archive/Documents/JFK Assassination Documents/JFK Documents - Central Intelligence Agency/HSCA Segregated CIA Collection (microfilm)/HSCA Segregated CIA Collection (microfilm - reel 2: Artime - Barker)/
Reel 2 of a microfilmed set of CIA documents to which the House Select Committee on Assassinations had access.
Subjects: Manuel Artime Buesa, Eusebio Azcue Lopez, Bernard Barker.
© Mary Ferrell Foundation. All Rights Reserved. |Press Room |Our Policies||Site Map


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Even if you used to toke, you still need to confront your kid - especially if it's posing problems at school
Dear Dr. Wolf,
My teen smokes pot, plain and simple. He'll never admit it, but I've found rolling papers and empty Ziploc bags in his room, and sometimes he smells like it when he comes home. He just started Grade 11, which is a big year. My biggest issue is his moodiness and lack of ambition at school. I want to speak to him about the pros and cons, but I can't lecture him because I did the same at his age. I got an education and a good job and stopped after university, but I had a lot of high-school friends who veered down the wrong path. How do I start this conversation with my son?
-Pothead's Pop
Dear Pothead's Pop,
Many parents today feel conflicted about their children and marijuana use - especially if they themselves were marijuana users (and perhaps still are), and don't feel that marijuana was ever a significant problem in their lives.
They may even think of it fondly. "What can I say? Had a really good time. I liked that part of my life."
Even so, whether they smoked pot or not, most parents also know of at least one cautionary tale.


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Texas Rangers Fan Shannon Stone Dies After Falling From Stands
Very sad news coming out of Arlington as a Rangers fan died while trying to grab a ball that was tossed into the stands. Here are the details. The Texas Rangers say a fan died after falling out of the stands while More...


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Barren County Middle School
555 Trojan Trail
Glasgow, KY 42141
Map It!
Years Labeled (Rating):
2012 (79)
Facility Type:
K-12 School
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Barren County Public Schools
Property Manager:
Barren County Public Schools
For More Info:
Keith Harlow
Glasgow, KY 42141
Please note: The building information in this profile was verified and submitted to EPA at the time of application. Building energy performance, operating
characteristics, and ownership/management may be subject to change over time.


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- Apr 16, 2015
New York's Earth Day 1970, and the Birth of the Environmental Movement
Join Dr. Seidman in exploring how Earth Day created a new generation of activists, whose stories and approaches are instructive in considering the local and global environmental challenges of today.
- May 02, 2015
3rd Annual Teaching Social Activism in the Classroom Conference
Join us in this full-day conference, which will highlight the various tools and techniques used by teachers to engage their students in the history and practice of social change.
- May 14, 2015
Aids Activism as American History
Join Dr. Claire Potter in examining the role that New York City activists played in the national response to the AIDS epidemic.
- Jun 04, 2015
Activist New York: Engaging Students
Explore primary sources and pedagogical strategies with Facing History and Ourselves, a leader in the field of history, civics, and social-emotional education.


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Vegetable Fried Noodles
Even though I don't share many vegetable recipes on Rasa Malaysia (mostly because I find Asian-style vegetables very hard to shoot), it doesn't mean that I don't like them. Dine in or out, I always have a vegetable dish to balance off my meal. I love all kinds of vegetables, be it plain stir-fry, in soups, or in noodles.
Vegetable fried noodles is one recipe that I make use of the different vegetables I love. It reminds me of the 9th Emperor God festival in Malaysia when we observe a pure vegan diet during the festivity. My aunt is a very good cook and her vegetable fried noodles is one of my favorite dishes during the celebration—simple noodles fried with a variety of shredded vegetables.
This is my rendition of her vegetable fried noodles. Instead of using the regular vermicelli or rice noodles, I made the recipe with mung bean noodles (also known as cellophane noodles or glass noodles). I love the slightly starchy and springy texture of this noodle. For vegetables, I used cabbage, carrot, bean sprout, fresh shiitake mushroom, and scallion. It's simple and humble, the kind of dish that I enjoy especially when I eat too much meat for the week.
Have a great Memorial Day!
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10 comments... read them below or add one
Well, you definitely succeeded in shooting these noodles and vegetables well. That is a bowl of goodies that I could eat all day long.
That bowl looks so attractive and colorful. Healthy and delicious!
Excellent…Thanks 4 the recipe..
Love an easy and yummy bowl of vegetable fried noodles — and you did a great job with the styling and photography, Bee :)
Looking Superb..can't wait more to have this dish. !!
Thanks a lot for sharing such an interesting Asian Recipe like Vegetable Fried Noodles. This recipe surely looks simple but delicious to prepare at home.
I am a vegetarian, so will definitely try this..
Thanks for sharing.
Thanks for share this wonderful meal with us.
Wonderful (and delicious) recipe! My only critique is that your measurements could be a little clearer. It's hard to measure things in OZ when you don't have a scale in the kitchen. I tried my best to estimate how much veggies to use and ended up not putting enough in. Instead maybe you can say half of the cabbage, or 1 cup of beansprouts. Or even how many noodle clumps (how am I suppose to know how much 28 grams are?) It'd be a lot easier to measure with typical kitchen tools.


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Local legislators file bills
Thursday, January 3, 2013
ROCHESTER — Local state legislators have sponsored or cosponsored a number of bills that will be taken up by various House committees in the coming legislative session.
H-0075 is relative to the regulation of health clubs, and Jones is one of the cosponsors. Jones said the bill was trying to bring 1970s regulations into the 21st century, now that health clubs "have proved themselves."
H-0566 is relative to tuition payments for chartered public school pupils. Pitre maintains the Board of Eduction "has been interpreting the (existing) law incorrectly" and that the new bill will bring needed clarification.
H-0752 would raise the age of minority for juvenile delinquency proceedings from 17 to 18 years of age.
Perry said this would "1. — require special interest organizations to register with the secretary of state, and 2. — require them to disclose their expenditures."
He wants to greatly expand work industries within the New Hampshire prison system.


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The diagnosis of heart disease typically involves evaluating the signalment, history, and physical examination findings, as well as results of diagnostic tests such as radiography, electrocardiography, and echocardiography. Occasionally, more specialized tests such as cardiac catheterization or nuclear studies are necessary.
For patients with suspected heart disease, the signalment (age, breed, sex) helps provide a differential diagnosis list. The signalment influences the relative importance of possible heart diseases (eg, endocarditis is rare in cats and dogs but more common in cows and horses) as well as some specific abnormalities (eg, breed predispositions for certain congenital defects).
Animals presenting with heart disease may have no clinical signs or have a history of exercise intolerance, weakness, dyspnea, tachypnea, abdominal distention (ascites), syncope (fainting), cyanosis, or anorexia and weight loss. Other historical findings are more species specific, including peripheral or ventral edema (horses and cows). Cats rarely demonstrate cough with heart disease and more commonly present with a history of dyspnea (which may be subtle and go unnoticed by the owner) and anorexia. Dogs with congestive heart failure (CHF), in contrast, commonly demonstrate cough and dyspnea as a presenting complaint.
A complete physical examination should be performed on any animal being evaluated for heart disease or that presents with signs that could be attributable to heart disease. In addition to auscultation of the thorax, palpation should be performed to assess for the presence of thrills (low frequency vibrations that can be palpated with the fingertips) and alterations in intensity or location of the impulse beat. Concurrent auscultation and palpation of pulses should also be performed. Mucous membrane color and refill time, as well as assessment for jugular pulsation and excessive distention, is recommended. Limbs should be examined for the presence of edema, and the abdomen should be assessed for the presence of ascites. Because there are many causes of ascites, it is imperative to evaluate the jugular veins in every case in which ascites is present. If cardiac disease is the cause of the ascites, there is an obligatory distension of the jugular veins because cardiogenic abdominal effusion is caused by elevated right heart pressures. If ascites is present without jugular venous distension, then extracardiac causes of the ascites should be pursued.
Heart sounds are generated by the rapid acceleration and deceleration of blood and secondary vibrations in the cardiohemic system. Four heart sounds can potentially be ausculted. The first heart sound (S1) is associated with closure of the atrioventricular (AV) valves, and the second heart sound (S2) is associated with closure of the semilunar (aortic and pulmonic) valves. The third heart sound (S3) occurs in early diastole and is a result of rapid cessation of ventricular filling, while the fourth heart sound (S4) is associated with atrial systole (atrial contraction or atrial "kick"). In horses, all 4 sounds are normally audible. In cattle, typically only S1 and S2 are audible in normal individuals, although S3 or S4 can sometimes be heard. IV fluid administration in cattle can result in accentuation of S3 and/or S4. In dogs, cats, and ferrets, S1 and S2 are the only heart sounds normally audible. Less is known about goats, sheep, and pigs; however, only S1 and S2 are believed to be audible in these species.
A gallop heart sound is the presence of S1 and S2 accompanied by an interceding sound that is either an accentuated S3 or S4, or both. These are classified as protodiastolic (S3), presystolic (S4), or summation gallop heart sounds (fusion of S3 and S4). The most common gallop heart sound noted in dogs is a result of an accentuated S3 and typically occurs secondary to ventricular dilatation from cardiac diseases such as dilated cardiomyopathy, degenerative valve disease, or left-to-right shunts such as patent ductus arteriosis. An S4 gallop heart sound (presystolic) is caused by atrial contraction pushing blood into a relatively high pressure ventricle. This is most commonly audible in cats with cardiomyopathy, especially hypertrophic cardiomyopathy. Because the heart rate commonly exceeds 160–180 bpm in cats, it is difficult to determine if the gallop sound is due to an S3 or S4 gallop on physical examination. However, the presence of an S3 gallop in a cat is much less common than an S4 gallop due to the common cardiac diseases of cats. A systolic click is a short, sharp, often transient sound that can occur during mid- to late systole. These clicks are uncommon in dogs and probably in other domestic species. However, when present, systolic clicks are most commonly noted in dogs with early myxomatous degeneration of the mitral valve with prolapse of one of the mitral leaflets. They usually are single but may be multiple and can vary in intensity (even completely disappearing) depending on cardiac loading conditions.
Splitting of S1 is caused by discordant closure of the mitral and tricuspid valves, which can occur when there is asynchronous contraction of the ventricles as in left or right bundle-branch block, cardiac pacing, and certain ectopic ventricular beats. Splitting of S1 can also occur in normal healthy, large-breed dogs. Delayed closure of the pulmonic valve (in relation to the aortic valve) results in splitting of S2. This may be seen during inspiration in dogs (especially large-breed dogs) as the increase in negative intrathoracic pressure increases right ventricular filling. Splitting of S2 can be a normal finding in horses during either inspiration or expiration. Abnormal splitting of S2 has been associated with pulmonary hypertension, as in pulmonary emphysema of horses and heartworm infestation of dogs. Other possible causes include atrial septal defect, right bundle-branch block, or ventricular ectopic beats of left ventricular origin. Delayed closure of the aortic valve (paradoxical splitting of S2) could be seen with left bundle-branch block or ventricular ectopic beats of right ventricular origin.
The diaphragm may contract synchronously with the heart to produce loud thumping noises on auscultation and usually visible contraction in the flank area. The syndrome results from stimulation of the phrenic nerve by atrial depolarization and occurs primarily when there is a marked electrolyte or acid-base imbalance, particularly with hypocalcemia. It is most common in horses and dogs and occurs frequently in eclampsia. It is seen most commonly in dogs in association with electrolyte disturbances induced by GI disease.
Heart murmurs are audible vibrations emanating from the heart or major blood vessels and generally are the result of turbulent blood flow or vibrations of cardiac structures such as part of a valve leaflet or chordal structure. Murmurs are typically defined relative to timing, intensity, and location but can also be characterized by frequency (pitch), quality (eg, musical), and configuration (eg, crescendo-decrescendo).
A systolic murmur occurs during systole and is typically either ejection (crescendo-decrescendo) or regurgitant (holosystolic, plateau). Ejection systolic murmurs demonstrate the greatest intensity during mid-systole and appear diamond-shaped on phonocardiography. They can be produced by stenotic lesions at the semilunar valves (eg, pulmonic stenosis or subaortic stenosis). Regurgitant systolic murmurs demonstrate a constant intensity throughout systole and can be caused by mitral or tricuspid regurgitation (eg, myxomatous degeneration of the mitral valve) or a ventricular septal defect. Diastolic murmurs are typically decrescendo (decreasing in intensity through diastole) and a result of aortic or pulmonic insufficiency (such as that caused by aortic valve infective endocarditis in dogs or degenerative disease in horses). Continuous murmurs are most commonly a result of patent ductus arteriosus (a congenital cardiac defect) and occur throughout systole and diastole. Continuous murmurs vary in intensity over time, typically being most intense at the end of ventricular ejection and decreasing in intensity through diastole. A to-and-fro murmur occurs in animals that demonstrate both a systolic murmur and a diastolic murmur and can occur in animals with subaortic stenosis and aortic insufficiency.
In horses, early systolic and diastolic murmurs can be noted in the absence of heart disease or anemia. The point of maximal intensity is typically located over the left heart base. A short, high-pitched, squeaking, early diastolic cardiac murmur is sometimes seen in healthy, young horses. Occasionally, systolic murmurs are noted in some cats secondary to an increase in right midventricular flow velocity without significant structural heart disease. Innocent cardiac murmurs are also commonly noted in immature cats and dogs (<6 mo old) as a result of increased stroke volume.
Heart murmurs are classified as follows: Grade I—the lowest intensity murmur that can be heard, typically detected only while auscultation is performed in a quiet room; Grade II—a faint murmur, easily audible, and restricted to a localized area; Grade III—a murmur immediately audible when auscultation begins; Grade IV—a loud murmur immediately heard at the beginning of auscultation but not accompanied by a thrill; Grade V—a very loud murmur with a palpable thrill; or Grade VI—an extremely loud murmur that can be heard when the stethoscope is just removed from the chest wall.
Arrhythmias are abnormalities of the rate, regularity, or site of cardiac impulse formation and are noted during auscultation. Other terms such as dysrhythmia and ectopic rhythm are also used to describe arrhythmias. The presence of a cardiac arrhythmia does not necessarily indicate the presence of heart disease; many cardiac arrhythmias are clinically insignificant and require no specific therapy. Some arrhythmias, however, may cause severe clinical signs such as syncope, or lead to sudden death. Numerous systemic disorders may be associated with abnormal cardiac rhythms. (For discussion of specific arrhythmias, see Arrhythmias.)
A pulse is the rhythmic expansion of an artery that can be digitally palpated (or visualized) during physical examination. Physiologically, the pulse pressure is the difference between systolic and diastolic pressures. In dogs and cats, pulses are typically palpated at the femoral artery. Pulse deficits are absent pulses despite auscultation of a heart beat and are thus detected during simultaneous auscultation and pulse palpation. These occur as a result of ectopic contractions (arrhythmias) that occur so prematurely that the ventricles are unable to fill sufficiently, resulting in a reduced stroke volume that produces either a weak pulse or no pulse. Bounding pulses (an increase in pulse pressure) are usually caused by a reduced diastolic pressure and can be noted with aortic insufficiency or patent ductus arteriosus. Weak pulses (a reduction in pulse pressure) are usually caused by a decrease in systolic pressure and can be noted with systolic dysfunction, pericardial tamponade, or subaortic stenosis.
Dogs with severe subaortic stenosis may demonstrate a pulse pressure that slowly increases during ventricular systole and reaches a peak pressure late in systole called pulsus parvus et tardus. Pulsus paradoxus is a decrease in pulse pressure during inspiration and an increase in pulse pressure during expiration. This is a normal occurrence in animals, but it is usually too subtle to observe on physical examination. Animals with pericardial effusion and cardiac tamponade, however, demonstrate an exaggeration of this finding. Pulsus alternans is an alternating strong and weak pulse while the animal is in sinus rhythm; it can be noted (albeit rarely) in animals with myocardial failure or tachyarrhythmias. Pulsus bigeminus is an alternating strong and weak pulse caused by an arrhythmia such as ventricular bigeminy. The weaker pulse (during the ventricular premature contraction) typically follows a shorter time interval than the stronger pulse.
Jugular venous pulsation can be noted in normal animals. These pulses typically do not extend beyond a third of the distance up the neck of an animal in a standing position.
Pulmonary edema may develop as a result of CHF. On physical examination, this may manifest as respiratory crackles and wheezes. Dyspnea or tachypnea may also be noted. A decrease in air movement is commonly present during thoracic auscultation in animals that have developed pleural effusion as a result of heart disease. This results in decreased respiratory sounds, especially ventrally. However, respiratory diseases or pleural effusion secondary to other underlying disease can also result in these clinical signs.
Abdominal swelling may occur as a result of gas, soft tissue, or fluid accumulation. Animals with heart disease and right-sided heart failure (eg, those with heartworm disease, tricuspid valve dysplasia, pericardial tamponade) can develop ascites. In these circumstances, the ascites is associated with jugular venous distension.
Thoracic radiographs frequently provide valuable information in the assessment of animals suspected of having heart disease. However, thoracic radiography is rarely performed in horses or cows because of their large size and body conformation, which reduces the quality of the images. Finding generalized cardiomegaly or enlargement of specific cardiac chambers makes the presence of heart disease more likely and may also provide clues as to the specific disease present. Cardiogenic pulmonary edema is a common finding in animals with CHF and is associated with pulmonary venous congestion; pleural effusion may also be noted, but this typically indicates biventricular failure except in cats, in which it can be seen with left-sided CHF. Resolution of these abnormalities on subsequent thoracic radiographs can be used as one indication of efficacy of therapy. The presence of pulmonary edema does not definitively confirm a cardiogenic origin or rule out another origin such as pulmonary disease. Overall cardiac size can be assessed using the vertebral heart scale or score. This is most commonly done using the lateral projection. The maximal diameter of the cardiac silhouette from cranial to caudal is measured, as well as the distance from the carina to the apex of the cardiac silhouette (dorsal to ventral). These lengths are added together and measured in terms of thoracic vertebral bodies so they are normalized for the size of the animal. The vertebral bodies are measured from the fourth thoracic vertebra caudally. The normal range is 8.5–10.5 vertebral bodies in dogs, and 6.9–8.1 in cats.
Electrocardiography is the recording of cardiac electrical activity from the body surface. It can be used to identify not only cardiac arrhythmias and conduction disturbances but also chamber enlargement. However, small animals differ from large animals in that large animals have a category B type heart (small animals have category A), in which there is a richly penetrating Purkinje cell population. This results in reduced complexes on the surface ECG, impairing the ability of the ECG to accurately detect changes in cardiac size. Therefore, the most common form of ECG performed in large animals is a base-apex rhythm analysis, in which the recorded deflections are much larger and the diagnostic focus is rhythm determination.
Chamber enlargement can be indicated by waveform abnormalities. In lead II in dogs and cats, wide or notched P waves suggest left atrial enlargement, whereas tall P waves suggest right atrial enlargement. Evidence for left ventricular enlargement includes tall R waves in leads that have the positive electrode on the left side of the heart (leads I, II, aVF, CV6LL, and CV6LU). Right ventricular enlargement is suggested by deep S waves in the same leads in which the positive electrode is on the left side of the heart or the presence of a right-axis deviation. Wide QRS complexes can occur in patients with either right or left ventricular enlargement; however, they can also be due to conduction disturbances (see Conduction Disturbances). While the ECG may suggest chamber enlargement, thoracic radiographs and echocardiography are more sensitive.
The sinus node initiates each cardiac contraction in a normal animal, sets the normal rate and rhythm, and is called the pacemaker of the heart. Normal sinus rhythm is a rhythm that is regular and originates at the sinus node, indicated on the ECG by a P wave that precedes each normal QRS complex. Sinus bradycardia is a regular sinus rhythm that is slower than expected for that species. Sinus bradycardia may be noted in animals that are overdosed with anesthesia or agents that can result in elevated vagal tone or reduced sympathetic tone (eg, xylazine, digoxin), hypothermic animals, hypothyroid animals, animals with sick sinus syndrome, or in animals with elevated vagal tone secondary to systemic disease such as respiratory, neurologic, ocular, GI, or urinary tract disease. Treatment for sinus bradycardia is typically not needed unless clinical signs associated with the bradycardia, such as weakness or collapse, are noted. In dogs and cats, atropine (0.04 mg/kg, IV, IM, or SC) may be considered for treatment of bradycardia. The initiating cause should also be corrected.
Sinus tachycardia is the finding of a regular sinus rhythm at an excessive rate. Causes include stress (resulting in high sympathetic drive), hyperthyroidism, fever, pain, hypovolemia, cardiac tamponade, heart failure, or administration of agents that can increase the rate of sinus node discharge (eg, catecholamines). Treatment involves resolving the underlying cause.
Sinus arrhythmia occurs as a result of irregular discharge of the sinus node associated with respiratory cycling. The site of impulse formation remains the sinus node; however, the frequency of the discharge varies. Sinus arrhythmia is a normal finding in dogs and horses; it is abnormal in cats in the hospital setting, although it appears to be common in cats in their home environment. Sinus arrhythmia is characterized by increases in heart rate with inspiration and decreases with expiration. The variation in heart rhythm is associated with variation in the intensity of vagal tone. It is abolished by reduced vagal tone resulting from excitement, exercise, or administration of vagolytics such as atropine. It may be associated with a wandering pacemaker, which is characterized on the ECG by taller P waves during faster rates and shorter or flatter P waves during slower rates.
Sinoatrial block occurs when the impulse from the SA node fails to be conducted through the surrounding tissue to the atria and ventricles. Thus, no P waves or QRS complexes are noted on the ECG, and the P-P interval surrounding the break in sinus rhythm is an exact multiple of the normal P-P interval. This is often difficult to diagnose in dogs because sinus arrhythmia is common, resulting in a variable normal P-P interval.
Sinus pause is caused by a delayed discharge from the SA node. This results in a break in sinus rhythm in which the P-P interval surrounding the break is not an exact multiple of the normal P-P interval.
Sinus arrest is the absence of P waves on the ECG for a short period of time (typically accepted as a pause exceeding twice the normal P-P interval). Sinus arrest can be caused by prolonged SA nodal arrest or pause.
Atrial standstill is characterized as the complete absence of P waves on the ECG and occurs as a result of the atria being unable to be depolarized from the SA node discharge. Even though there are no P waves present, the QRS complexes are most often triggered by the wave of depolarization that comes from the SA node resulting in a sinoventricular rhythm. In some cases, the ventricular rhythm can be variable because of the concurrent presence of a sinus arrhythmia. The heart rate is typically slow (40–80 bpm) in affected dogs, depending on the precise etiology. Causes include hyperkalemia (transient atrial standstill), in which the elevated potassium precludes atrial myocardial depolarization; myocarditis; and specific forms of cardiomyopathy (atrioventricular cardiomyopathy), in which the atrial myocardium is replaced by fibrous tissue (persistent atrial standstill). Resolution of the hyperkalemia will convert the atrial standstill into a normal sinus rhythm.
Sick sinus syndrome is a constellation of clinical signs, including ECG changes (sinus pause or block, sinus arrest, junctional or ventricular escape complexes, and possibly supraventricular tachycardias) and weakness or syncope from the bradycardia (most common) or tachycardia (less common). With this clinical syndrome, the principal problem lies within the SA node or perinodal tissue; however, other portions of the specialized conduction tissue of the myocardium, including the AV node, can also be affected. Therefore, evidence for AV block may also be seen (see below). This disease is commonly noted in geriatric dogs, including Miniature Schnauzers and Cocker Spaniels. Medical therapy consisting of parasympatholytics (eg, propantheline bromide, 0.25–0.5 mg/kg, PO, bid-tid) or sympathomimetics (eg, extended-release theophylline, 10 mg/kg, PO, bid; terbutaline, 0.14 mg/kg, PO, bid-tid in dogs) to increase heart rate can be tried, but these are often ineffective or are effective for only a relatively short period of time or with unacceptable adverse effects. These drugs may also worsen supraventricular tachyarrhythmias that can occur with sick sinus syndrome. The most effective treatment for the bradycardia remains pacemaker implantation.
Atrioventricular (AV) block refers to alteration of impulse conduction from the atria to the ventricles. In first-degree AV block (prolonged conduction), the conduction time is increased and is recognized on an ECG as an increased PR interval. In second-degree AV block (intermittent conduction), occasional impulses fail to be conducted through the AV junction, characterized by occasional P waves not followed by QRS complexes. During the block, there is no S1 or S2 and no arterial pulse. In horses, the sound associated with atrial contraction (S4) is commonly heard, and the occurrence of S4 not followed by other heart sounds is diagnostic for second- or third-degree heart block. S4 may also be audible in dogs with second-degree AV block, but this is much less common. When the PR intervals preceding the dropped beat progressively lengthen, the condition is known as Mobitz type I second-degree AV block or Wenckebach phenomenon. If the PR intervals do not change, the condition is known as a Mobitz type II second-degree AV block.
In third-degree AV block or complete heart block, none of the impulses are conducted from the atria to the ventricles. The atrial rhythm (P waves) occurs more rapidly and independently from the ventricular rhythm (QRS complexes), which originates from subsidiary pacemakers within the ventricles. The heart and pulse rates are regular but slow and generally unresponsive to factors or agents that usually increase heart rate (eg, exercise, excitement, atropine). The difference in timing between atrial and ventricular contractions results in variation in ventricular filling and consequent variation in intensity of S1 (Bruit de Canon) and possibly arterial pulse pressure. Periodically, the atria contract when the ventricle is in systole, which results in large pulsations in the jugular vein (cannon A waves).
The significance of the AV block varies by species. Both first- and second-degree AV block may be present without outward evidence of cardiac disease. First-degree AV block may result from excessive vagal tone and generally is not considered significant in dogs or horses unless other evidence of heart disease or pathologic cause of increased vagal tone (eg, CNS or pulmonary disease) is present. In all species, second-degree AV block may be indicative of heart disease. However, in horses, Mobitz type I is common and is a normal physiologic response resulting from increased vagal tone. Mobitz type II second- and third-degree (complete) AV block is always abnormal in all species.
Second- and third-degree AV block may be caused by fibrosis, neoplasia, other injuries to the AV node, hypoxia, agents that increase vagal tone, or electrolyte abnormalities. The ideal treatment would be to correct the underlying cause, although this is not usually possible. High-grade second-degree AV block (many nonconducted P waves) and third-degree AV block are frequently associated with exercise intolerance or syncope. Oral therapy with extended-release theophylline (10 mg/kg, PO, bid), terbutaline (0.14 mg/kg, PO, bid-tid in dogs), or propantheline bromide (0.25–0.5 mg/kg, PO, bid-tid) may occasionally be useful in animals with second-degree AV block, but more aggressive therapy (pacemaker implantation) is usually indicated in symptomatic animals. Third-degree heart block is usually associated with irreversible lesions; the only effective treatment is pacemaker implantation.
Arrhythmias can be divided into bradyarrhythmias, in which the heart rate is excessively slow, and tachyarrhythmias, in which the heart rate is excessively rapid. The former includes sinus bradycardia, sinus arrest, SA block, AV block, and atrial standstill (see above). Tachyarrhythmias can be divided into supraventricular and ventricular based on their site of origin. Supraventricular premature depolarizations are premature depolarizations that originate from above the ventricles. They may also be called atrial premature complexes/depolarizations. Possible sites for ectopic depolarizations include the SA node, atrial myocardium, and supraventricular AV nodal junction. Electrocardiographically, supraventricular premature depolarizations include a QRS complex that appears relatively normal but occurs earlier than the next expected normal QRS complex. Variable P wave morphologies may be noted before or after the supraventricular premature depolarization or may be hidden in the preceding sinus complex or within the premature depolarization. Supraventricular premature depolarizations are most commonly a result of atrial enlargement, stress, or other causes of increased sympathetic tone. Supraventricular tachycardia is a series of supraventricular premature depolarizations occurring consecutively for a relatively prolonged period of time. Accessory pathways are congenital abnormalities that allow an electrical connection between the atria and ventricles outside the normal connection (AV node/bundle of His). These pathways or bypass tracts have been recognized in dogs and cats and may result in supraventricular tachyarrhythmias. Treatment may involve radiofrequency catheter ablation of the bypass tract or oral medications such as procainamide, sotalol, or diltiazem.
Atrial flutter is a rare, usually transient arrhythmia that either reverts to sinus rhythm or progresses to atrial fibrillation. It is caused by a large circular reentrant loop within the atria and is characterized on the ECG by a "saw-toothed" baseline with relatively normal QRS complexes that can appear in a regular or irregular rhythm. The atrial rate of discharge is very rapid (often >400 bpm) so that only intermittent atrial impulses are conducted across the AV node because of prolonged AV nodal refractoriness.
Atrial fibrillation is a rapid and very irregular atrial rhythm caused by disorganized depolarization of the atria. As in atrial flutter, the AV node is bombarded by frequent atrial depolarizations that result in prolonged AV nodal refractoriness and nonconduction of most of these atrial depolarizations. Atrial fibrillation is characterized on the ECG by the absence of P waves, an undulating baseline that can appear almost flat (fine) or very rough (coarse), and relatively normal appearing QRS complexes that occur with no identifiable pattern (irregularly irregular). The irregularity results in variation in the diastolic filling period of the ventricles. Along with a loss of the atrial contribution to filling, this causes variation of the intensity of the heart sounds and amplitude of the arterial pulses. In dogs and cats, atrial fibrillation is almost always associated with underlying cardiac disease. Notable exceptions occur in some giant dog breeds such as Irish Wolfhounds, Scottish Deerhounds, Great Danes, and others in which the rhythm can develop with otherwise normal hearts (lone or primary atrial fibrillation).
The goal of treatment of atrial fibrillation in dogs and cats is control of the ventricular response rate (ie, the frequency with which QRS complexes are generated from the fibrillatory depolarization waves) and not conversion to sinus rhythm, because this rhythm is usually associated with underlying cardiac disease. This is usually accomplished with digoxin combined with either diltiazem or a β-blocker such as atenolol. These drugs slow AV nodal conduction, resulting in fewer atrial depolarizations crossing the AV node to the ventricle. Amiodarone has also been used to control the ventricular response rate, but its adverse effects (hepatic and thyroid toxicities) limit its use to second-line therapy in animals refractory to the digoxin and diltiazem/atenolol protocol. Conversion to sinus rhythm in dogs with primary atrial fibrillation or recent onset atrial fibrillation secondary to cardiac disease can be attempted. Current pharmacologic choices include quinidine and amiodarone, while direct-current cardioversion has gained some popularity in teaching institutions.
In ruminants, atrial fibrillation is usually paroxysmal and associated with GI tract disorders (eg, vagal indigestion), but it also may be persistent and occur as a sequela of cor pulmonale or with other cardiac diseases.
In horses, atrial fibrillation most often occurs in the absence of underlying cardiac disease (primary or lone atrial fibrillation) and is associated with the normally high vagal tone found in horses that most likely have some predisposition for the arrhythmia. However, it may also occur secondary to cardiac disease such as mitral insufficiency, aortic insufficiency, myocarditis, pericarditis, or untreated congenital cardiac defects. The resting heart rate is usually within the normal range when there is no underlying cardiac disease, while it is typically elevated with underlying disease; this may help identify the cause of the arrhythmia on physical examination. Most horses with primary atrial fibrillation exhibit no clinical signs at rest or with moderate exercise/work; however, more strenuous exercise or work may result in evidence of reduced cardiac output. This can be seen in racehorses who are evaluated for a sudden reduction in race performance. In this setting, the clinical signs could also be due to paroxysmal atrial fibrillation, which would be identified only during the exercise period. In horses with primary atrial fibrillation, conversion to sinus rhythm with quinidine at a dosage of 22 mg/kg, PO, every 2 hr is currently the treatment of choice. The success rate for conversion is greatest in horses with atrial fibrillation of shorter duration. The chance for success is considered excellent if the duration is <4 mo and relatively good if >4 mo, although conversion may take longer and quinidine toxicity is more likely to develop. Most horses can return to successful racing performance after conversion. Conversion to sinus rhythm is not indicated in horses with underlying cardiac disease because the likelihood of conversion or maintenance of sinus rhythm if converted is very low.
Ventricular premature depolarizations arise from a site within the ventricular myocardium or specialized conduction system. On the ECG, the QRS complex usually appears wide and bizarre compared with normally sinus-driven QRS complexes, occurs earlier than the next expected sinus driven QRS complex, and does not have a consistently associated preceding P wave. Most commonly, these complexes occur from noncardiac causes such as electrolyte abnormalities, acute toxicities, neoplasia (eg, splenic hemangiosarcoma in dogs), gastric distention (eg, gastric dilation and volvulus syndrome in dogs), or trauma. They may also be associated with ventricular myocardial diseases such as dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (Boxer cardiomyopathy), and myocarditis.
Ventricular tachycardia is the occurrence of sequential ventricular premature depolarizations over a prolonged period of time. These could be paroxysmal, nonsustained (4–10), or sustained. Ventricular fibrillation is a result of microreentrant circuits within the ventricular myocardium resulting in the absence of effective ventricular contractions; thus, it is a terminal rhythm. An accelerated idioventricular rhythm is commonly seen in dogs in the intensive care unit secondary to illness or trauma. It is characterized on the ECG by the presence of a ventricular rhythm that is relatively slow (usually <120 bpm) and associated with atrioventricular dissociation, whereas sinus rhythm is seen when the sinus rate is faster than the ventricular rhythm. This is considered a relatively benign arrhythmia in most animals. While the underlying cause should be sought and treated as necessary, the arrhythmia itself typically results in no clinical signs, requires no specific therapy, and resolves once the underlying illness/trauma is corrected.
Echocardiography, the use of ultrasound to evaluate the heart and proximal great vessels, complements other diagnostic procedures by quantifying the dynamic events of the cardiac cycle. Cardiac chamber and wall dimensions can be determined; the anatomy and motion of valves can be visualized; and pressure gradients, blood flow volumes, and several indices of cardiac function can be calculated. Echocardiography can also identify changes in myocardial tissue texture indicative of ischemia and fibrosis and delineate masses, valvular vegetations, pericardial effusion, and many other features previously verifiable only with cardiac catheterization or at necropsy.
There are 3 main types of echocardiography: two-dimensional, M-mode, and Doppler. Two-dimensional echocardiography provides a wedge-shaped, two-dimensional image of the heart in real-time motion. Several standard long-axis and short-axis views obtained from standard imaging windows on the thorax have been developed for dogs, cats, horses, and cows. M-mode echocardiography is produced by a one-dimensional beam of ultrasound that penetrates the heart, providing an "ice-pick view." The tissue interfaces that are encountered by the beam are then plotted on a screen. This mode of evaluation is typically used to measure chamber dimensions, wall thickness, valve motion, and great vessel dimensions. Doppler echocardiography uses the principle of changing frequency of the ultrasonic beam after it contacts a moving RBC to measure flow velocity and thus identify turbulent or high-velocity flow. This can locate cardiac murmurs.
Cardiac catheterization involves the placement of specialized catheters into the heart and surrounding great vessels. Indications include diagnostic evaluation, eg, when other diagnostic tests are insufficient to identify specific cardiac abnormalities or are unable to identify the severity of a lesion, presurgical evaluation, therapeutic intervention, and in clinical research. Diagnostic and presurgical cardiac catheterization, however, have largely been replaced by echocardiography.
Last full review/revision July 2011 by Daniel F. Hogan, DVM, DACVIM (Cardiology)
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17. Gone (Interlude)
It's always dim in the bedchamber, at least when he's there, because the drapes are never open. The window hangings are made of cloth so heavy and dark that they nearly defeat themselves, because simply to look at them would be to assume that they were made for the sole purpose of concealing indiscretion.
Or at least the younger man thinks so, staring at the fabric from the inside. It's quiet enough that he can hear his own slow breathing, hear his companion shifting on the blankets beside him.
"What are you thinking?" the older man asks.
Valacar takes his gaze away from the window, looks over at him.
"I met your wife. Yesterday, by the fountain."
A pause. "Pretty, isn't she?"
"What did she say?"
"She misses the coast."
"Ah. She's one of your people. I'd almost forgotten."
Valacar lies back on the bed, stretches and folds his wrists on top of his head, thinks about how she looked like so many people do upon coming inland from Amroth: still dark from the coastal sun, a vaguely shocked look in her eyes. Expectant. "No, you didn't," he says. "You don't forget anything."
"I said, almost."
"I wanted to be a sailor like my cousins, you know, because I lived so near the shore. I wanted to be buried at sea."
"You'd be devoured by fish, I'd imagine."
Valacar closes his eyes and shrugs. He is thin and listless and guilty. "What would I care? I'd be dead."
"If you didn't care, then why would you want to be buried at sea in the first place?" And before Valacar can answer, Aradîr leans in and kisses his eyelids, the bridge of his nose. Tender but careless. Valacar is nearing twenty-one and already picking up regrets with every step he takes. He is listless and guilty and happy, and he cannot see any other way to do things.
"I don't know," he murmurs. "Never mind."
Sixteen years later, Mordor smokes and fumes before them, and Beren marches with the others. The hours slide together and he watches the back of the man in front of him and for the first time he truly begins to doubt: to doubt his captain, to doubt himself, even to doubt this man who calls himself their king, and above all this fool's errand they've been set upon. Doubt that he fights, that he chokes down every morning with his rations, but that's there all the same. They keep moving and the world folds into night.
"Are you all right?" Laeron asks, walking beside him.
"Fine," says Beren. "Fine. You?"
"I'm all right," he replies, and in spite of everything, Beren doesn't doubt him. Laeron is staring ahead, not at the man in front of him, but up and into the distance, as if he's seen something perched on the horizon. Staring up and ahead, waiting for whatever it is that comes next.
And many miles away, in the city they've left behind, a soldier lies dying, far from home. Nothing special about that. Women in blue move around him and at times there's only this strange half-light and the rustle of their skirts as he drifts in and out of this place. His arm still hurts, or at least the part of it that's gone.
And for a moment he remembers the weight of a woman's fingers in his, so many years ago when his hands were still fit to hold anyone. Before he grew unreachable, before he began to waste and wear away, piece by piece. He almost remembers the light on her hair, like something from a dream. But then it's gone, like everything else.
The wheels turn, and history groans into place: three figures stand high above the flames in the deep-shadowed mountain, and then one of them tumbles. The Ring goes into the fire, and that is the end of that story.
You may close the book if you are so inclined.
And years after that, a woman sits in a garden, delivered to peacetime. The sky is clear and the breeze stirs her skirts and for the moment she is not thinking about anything extraordinary. A small worn book lies closed in her lap. A little dark-haired girl, bored with playing, runs to her, clambers up to sit beside her on the bench.
"Tell me a story, Mama."
The woman sets aside her book and cannot help but think, as she does from time to time, that she has both too many stories and too few. At times she suspects that the weight that pins down her words is an absence and not a presence, the sharp edges of loss and disappointment.
"Which story, my dear one?"
But now the weight in her lap is that of her daughter, warm and bird-light, and she realizes that the sound she is now hearing is her own voice, no different from the last time she spoke, and no different from the time before that. Just another part of the sound the world makes, the way it creaks on when no one is really listening to it.
This is a work of fan fiction, written because the author has an abiding love for the works of J R R Tolkien. The characters, settings, places, and languages used in this work are the property of the Tolkien Estate, Tolkien Enterprises, and possibly New Line Cinema, except for certain original characters who belong to the author of the said work. The author will not receive any money or other remuneration for presenting the work on this archive site. The work is the intellectual property of the author, is available solely for the enjoyment of Henneth Annûn Story Archive readers, and may not be copied or redistributed by any means without the explicit written consent of the author.


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(CNN) — Sen. Ted Cruz, who has crafted a plan to put the government's finances on the line if President Barack Obama's health care plan isn't stripped of its funding, said in an interview this week there aren't enough Republicans on board currently to make his idea a reality.
"We do not have the votes right now," Cruz said, noting that to succeed, he'd need 41 senators or 218 representatives to get behind his legislation -- which would provide a year of funding for the federal government, minus Obamacare.
But the Texas Republican, speaking with CNN chief political correspondent Candy Crowley on "State of the Union," argued a coming "grass-roots tsunami" would bring over fellow conservatives to his side in the next month.
"I'm convinced there's a new paradigm in politics, that actually has Washington very uncomfortable. And it has politicians in both parties very uncomfortable," he said. "And that new paradigm is the rise of the grass roots, the ability of grass-roots activists to demand of their elected officials they do the right thing."
Opponents of Cruz's effort say he's risking a government shutdown in order to repeal Obama's health law, and argue the president would never sign a measure defunding the signature legislation of his five years in office.
But Cruz casts the effort differently: Democrats, he said, would be the ones shutting the government down if they refuse to support a measure that funds all federal programs except Obamacare.
"President Obama, Harry Reid, will scream and holler that the mean, nasty Republicans are threatening to shut down the government. And at that point, Republicans have to do something we haven't done in a long time -- stand up and win the argument," he said.
"We have voted to keep the government open, to fund the government," Cruz continued. "Why is President Obama threatening to shut the government down to force Obamacare down the the throats of the American people?"
Cruz has support for his plan from a handful of Republicans in Congress, including Sens. Marco Rubio of Florida and Mike Lee of Utah, but many others in his party have said the plan risks alienating Americans who are tired of seeing the federal government's finances put in the middle of partisan bickering.
Establishment figures like Sen. John McCain and last year's GOP presidential nominee, Mitt Romney, have voiced opposition to the plan, as has Sen. Rand Paul, a tea party-backed Kentucky senator who has aligned with Cruz in the past.
Democrats also fiercly oppose the tactic, including former Vermont Gov. Howard Dean, who appeared on "State of the Union" Sunday.
"These are crazy ideas from the far right," Dean said, calling Cruz "a slick spokesman."
"God help us if he gets to be ything more than the senator from Texas," he added.
Cruz was speaking with CNN in Houston, where he appeared at a town hall meeting that was part of a tour sponsored by the conservative Heritage Foundation meant to build support for the effort to defund Obamacare.
"Obamacare was passed under false pretenses," Heritage Foundation President Jim DeMint, a former senator, said on "State of the Union" Sunday. "The American people were lied to and they have every right to demand that their representatives stop this unfair and un-American law."


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HD View Utilities (32 bit)
The HD View Utilities are a set of tools that help you create stunning HD View images. This package includes a Photoshop plug-in that enables you to export an HD View Web page or a cross-platform Silverlight Deep Zoom page from within Photoshop. Also included is hdmake, which a simple command-line utility that provides the same function for users who don't own Photoshop.
Note By installing, copying, or otherwise using this software, you agree to be bound by the terms of its license. Read the license.
System Requirements
- Operating system: Windows XP, Windows Vista, or Windows 7 (32-bit version)
Installation Instructions
- Click the Download button at the top of this page.
- Follow the onscreen instructions to complete the download.


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It is the present day and Matsuko's nephew, Sho, is cleaning out his dead aunt's filthy apartment. Through a series of encounters, he gradually learns of his aunt's checkered life. Matsuko, in fact, seems at time to be speaking to Sho from the grave as he becomes the audience's guide to her life. We first see Matsuko in the early 1970s as a popular junior high school teacher in her hometown until a fateful day when she imprudently assumes the blame for a theft by one of her favorite pupils, Ryu. She loses her job, her reputation and subsequently, the welcome of even her own family. We then travel back to her childhood to see her desperately seeking the affections of a father who appears to care more for Matsuko's chronically ill sister.


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Tomosynthesis reduces digital mammography screening recall while increasing tumour detection...
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