text:
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Volume 14, Number 2, 2008, pp. 129–138
© Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2007.0623
Stress Management Versus Lifestyle Modification on Systolic
Hypertension and Medication Elimination: A Randomized Trial
JEFFERY A. DUSEK, Ph.D.,1–4* PATRICIA L. HIBBERD, M.D., Ph.D.,1,5
BEVERLY BUCZYNSKI, R.N.,6BEI-HUNG CHANG, Sc.D.,1,7KATHRYN C. DUSEK, B.A.,1,3
HERBERT BENSON, M.D.,1,3–5†and RANDALL M. ZUSMAN, M.D.6†
Isolated systolic hypertension is common in the elderly, but decreasing systolic blood pressure (SBP) with-
out lowering diastolic blood pressure (DBP) remains a therapeutic challenge. Although stress management train-
ing, in particular eliciting the relaxation response, reduces essential hypertension its efficacy in treating isolated
systolic hypertension has not been evaluated. We conducted a double-blind, randomized trial comparing 8 weeks
of stress management, specifically relaxation response training (61 patients), versus lifestyle modification (con-
trol, 61 patients). Inclusion criteria were ?55 years, SBP 140–159 mm Hg, DBP ?90 mm Hg, and at least two
antihypertensive medications. The primary outcome measure was change in SBP after 8 weeks. Patients who
achieved SBP ?140 mm Hg and ?5 mm Hg reduction in SBP were eligible for 8 additional weeks of train-
ing with supervised medication elimination. SBP decreased 9.4 (standard deviation [SD] 11.4) and 8.8 (SD
13.0) mm Hg in relaxation response and control groups, respectively (both ps ? 0.0001) without group differ-
ence (p ? 0.75). DBP decreased 1.5 (SD 6.2) and 2.4 (SD 6.9) mm Hg (p ? 0.05 and 0.01, respectively) with-
out group difference (p ? 0.48). Forty-four (44) in the relaxation response group and 36 in the control group
were eligible for supervised antihypertensive medication elimination. After controlling for differences in char-
acteristics at the start of medication elimination, patients in the relaxation response group were more likely to
successfully eliminate an antihypertensive medication (odds ratio 4.3, 95% confidence interval 1.2–15.9, p ?
0.03). Although both groups had similar reductions in SBP, significantly more participants in the relaxation re-
sponse group eliminated an antihypertensive medication while maintaining adequate blood pressure control.
2001–2003—an increase of 6 million elderly over this 11-
he prevalence of hypertension in the elderly (aged 65
and over) increased from 44% in 1993–1995 to 55% in
year period.1,2Total annual medical expenditures attributed
to hypertension (including co-morbidities) are estimated to
range from $108–110 billion dollars.3Because systolic
blood pressure (SBP) tends to increase while diastolic blood
pressure (DBP) tends to decrease after age 60,465%–75%
1Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA.
2Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
3Mind/Body Medical Institute, Chestnut Hill, MA.
4Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
5Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA.
6Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
7Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
*Dr. Jeffery A. Dusek is now at the Institute for Health and Healing, Abbott Northwestern Hospital, Allina Hospitals & Clinics, Min-
neapolis, MN.
†Co-senior authors.
Page 2
of elderly hypertensive patients have isolated systolic hy-
pertension (SH). SH is defined as SBP greater than 140 mm
Hg and DBP less than 90 mm Hg.5In this age group, the
economic impact of SH is projected to affect 10 million
Americans6and will continue to be a significant public
health problem in the 21st century.4
In the elderly, SH is a more important risk factor for car-
diovascular disease than elevated DBP or hyperlipidemia.7
While numerous therapies treat hypertension, effectively re-
ducing SBP in the elderly with SH remains a therapeutic
challenge.8,9Many antihypertensive treatments cause side-
effects such as dizziness, headache, fatigue, chest discom-
fort/cough, and sexual dysfunction, prompting some patients
to discontinue therapy.10,11Since 40% of the elderly in the
United States take five or more medications daily, they are
also at greater risk for side-effects and drug–drug interac-
Safe and effective nonpharmacologic approaches to treat
SH are of interest and public health importance.9Stress man-
agement techniques that elicit the relaxation response (RR)13
are safe and effective for treating essential hyperten-
sion,14–17but have not been studied in an SH patient popu-
lation. The RR is a coordinated physiologic response char-
acterized by decreases in volumetric oxygen consumption
(V˙O2),13,18,19heart and respiration rates,13,18responsivity to
norepinephrine,20and elimination of carbon dioxide18and
increases in exhaled nitric oxide.19It is considered the coun-
terpart of the fight-or-flight response. The RR is not a tech-
nique. Rather it is elicited by scores of techniques that re-
sult in everyday thinking being suspended. This is often
achieved by the repetition of a word, sound, prayer, phrase,
or muscular activity and the disregard of routine thoughts
when they occur through a return to the repetitions. Tech-
niques that bring forth the RR have been practiced for mil-
lennia and include, in part, meditation, prayer, yoga, t'ai chi,
qigong, the presuggestive stage of hypnosis, and autogenic
training.13,18,19Since these effects are likely to be benefi-
cial for the treatment of SH, we conducted a double-blind,
randomized controlled trial to determine whether 8 weeks
of training in eliciting the RR versus 8 weeks of lifestyle
modification (control group) would reduce SBP in elderly
patients with SH. The secondary objective of the trial was
to determine whether the dose of one or more antihyper-
tensive medications could safely be eliminated in patients
who reduced their SBP.
Study design
This 20-week randomized trial involved patients aged 55
and older with SH (Fig. 1).9The Committee for Clinical
Investigations, Beth Israel Deaconess Medical Center
(BIDMC), Boston, MA and the Institutional Review Board
at the Massachusetts General Hospital (MGH), Boston, MA
approved the study protocol and all amendments. The study
was registered at clinicaltrials.gov (NCT00179543).
Patients were recruited from hospital clinics (MGH and
BIDMC) and by brochures, newspaper advertisements, and
Internet postings. Potentially eligible individuals were
screened for the study if they were at least 55 years of age,
Flow chart depicting subject participation. The phases of the study are presented. RR, relaxation response; SBP, systolic blood
Page 3
had a SBP of 140–159 mm Hg, a DBP ?90 mm Hg, while
on two antihypertensive medications. They were ineligible
if the dose of any antihypertensive medication had been
changed within the 4 weeks prior to screening; if they had
a major medical illness in the previous 6 months (heart, kid-
ney or liver disease, stroke, cancer, endocrinopathy, or psy-
chiatric illness); if they had an abnormal laboratory test; if
they currently smoked; or if they previously practiced any
mind/body techniques. The potentially eligible individuals
started a "run-in" period of three consecutive weekly visits
to establish the presence of SH and verify whether antihy-
pertensive medications had been changed. Participants were
seated for 5 minutes and blood pressure was measured us-
ing a certified, manual, wall-mounted mercury sphygmo-
manometer (W.A. Baum and Co., Copiague, NY) with an
appropriately sized arm cuff; the first and fifth Korotkoff
sounds denoted SBP and DBP, respectively.21During each
of these run-in visits, the study nurse (BB) obtained at least
three blood pressure measurements while the patient re-
mained seated, waiting at least 2 minutes between mea-
surements. If the SBP or DBP varied by more than 8 mm
Hg, additional measurements were taken until the values
were within this range. The average of the closest three mea-
surements was used to determine final eligibility for the
study, and the average blood pressure obtained during the
final run-in visit was used as the baseline value. The same
study nurse (BB) made all of the blood pressure measure-
ments and used a questionnaire to assess the presence/ab-
sence of adverse events during all blood pressure assessment
A randomization list, without stratification, using an al-
location ratio of 1:1 and permuted blocks of 2 and 4 patients
per block, was generated by Dr. Patricia Hibberd prior to
study enrollment. Only therapists providing the RR or
lifestyle modification training accessed this list. Eligible pa-
tients were randomized to either group after successful com-
pletion of the run-in period.
After 8 weeks of training, patients returned for blood pres-
sure measurements using the same procedures as described
above. The study nurse (BB) measuring blood pressure was
blinded to the study treatment. The 8-week outcome for
blood pressure was the average of the closest three blood
pressure measurements. This blood pressure was used to de-
termine eligibility for the medication elimination protocol
(Fig. 1). Participants were eligible to participate in the su-
pervised medication elimination protocol if their SBP was
?140 mm Hg, DBP was ?90 mm Hg, there had been a re-
duction of ?5 mm Hg from baseline SBP, and there had
been no change in their antihypertensive regimen during the
8 weeks. Those who did not meet criteria at week 8 were
eligible to continue their assigned treatment and were re-
evaluated using the same criteria at week 12.
Patients who were eligible for medication elimination had
the dose of one antihypertensive medication reduced by half
(or a clinically appropriate amount) by the blinded study
physician (RMZ) and had their blood pressure checked af-
ter 4 weeks. If the SBP remained ?140 mm Hg and DBP
remained ?90 mm Hg, then the medication dose was again
reduced by a clinically appropriate amount or eliminated. If
the SBP increased above 140 mm Hg or DBP above 90 mm
Hg, the original dosage was resumed. The final three blood
pressure measurements were taken 8 weeks after each par-
ticipant started the medication elimination protocol. The av-
erage of these three measurements was considered the final
blood pressure value. Patients were classified as success-
fully eliminating one antihypertensive medication if their
SBP did not exceed 140 mm Hg after eliminating at least
one medication.
The trial was double blinded; patients were informed that
two different "stress management" training programs were
being compared. All personnel measuring blood pressure
and prescribing medication changes were also blinded to
group assignment. Therapists providing training in the RR
or lifestyle modification were not involved in assessment of
study outcomes.
Study intervention and compliance
To ensure equivalent time and attention, all patients at-
tended 60-minute individual training sessions for 8 consec-
utive weeks according to a standard research protocol 19and
listened to a 20-minute audiotape at home every day. As a
measure of compliance, patients recorded the amount of time
spent listening to audiotapes in a daily diary, and these di-
aries were reviewed with their therapist each week.
Relaxation response group
At each weekly RR session, trainers provided 15 minutes
of instruction in approaches that elicit the relaxation re-
sponse—diaphragmatic breathing, guided body scan, repe-
tition of a self-chosen word, and mindfulness meditation.
Participants were led through a scripted 20-minute guided
relaxation response elicitation, and in the remaining 25 min-
utes they received health information about cardiac risk fac-
tors, stress and hypertension, and mind/body approaches for
coping with stress. Patients in the RR group were asked to
listen to the same 20-minute relaxation response audiotape
Lifestyle modification control group
At each weekly control session, participants received 60
minutes of written and verbal information about the stress
response and its impact on health, identification of cardiac
risk factors, role of stress in hypertension, and specific
guidelines and recommendations for sodium restriction,
weight reduction, and improving diet and exercise habits.5
Throughout the course of the trial, patients in the control
group were asked to listen to a series of different 20-minute
lifestyle modification audiotapes daily.
Page 4
Statistical analysis
Based on other similar studies evaluating the effect of
mind–body interventions on SBP reduction and taking into
account the possible dropouts, we used a moderate effect
size of 0.55 for determining the study sample size. With a
sample of 61 patients per group, we had 85% power to de-
tect a moderate effect size of 0.55 using a two-sample t-test
with two-sided type I error of 0.05.
Baseline characteristics of the two groups were compared
using two-sided t-tests for continuous variables and ?2or
Fisher Exact tests for categorical variables. Metabolic syn-
drome, one of the baseline characteristics, was determined
using the International Diabetes Federation definition with
the exception that obesity was defined as body mass index
?30 kg/m2.22Similarly, we compared the characteristics of
the eligible patients in the two groups at their time of entry
into the supervised medication elimination protocol. The pri-
mary outcome was change in SBP from baseline to 8 weeks
in the two treatment groups, and this was compared using a
two-group t-test. This primary comparison was assessed us-
ing intent-to-treat (ITT) principles. As in a comparable
trial,23missing data were imputed using the last-observa-
tion-carried-forward (LOCF) method. Results were reported
180 Screening visit
122 Patients randomized
61 Assigned to
RR group
55 Completed
8 week visit
61 Included in
ITT analyses
44 Eligible for
medication elimination
protocol at either
8 or 12 week visit
44 Included in
61 Assigned to
control group
49 Completed
8 week visit
61 Included in
ITT analyses
36 Eligible for
medication elimination
protocol at either
8 or 12 week visit
36 Included in
• 34 SBP below 140 mm Hg
• 11 failed to complete run-in
• 8 eligible, but not randomized
• 2 previous RR training
• 2 SBP above 160 mm Hg
• 1 elevated depression
Flow of participants through the study.
Page 5
both with imputed data and without imputed data (com-
pleters only). We also estimated the statistical significance
of the change in SBP over the 8 weeks within each group
using a paired t-test.
We used a Pearson ?2test to compare the proportion of
patients in each group who successfully eliminated at least
one antihypertensive medication. We then estimated the
odds ratio (OR) of successful medication elimination for the
relaxation response versus control groups controlling for dif-
ferences in characteristics at the start of the medication elim-
ination protocol and SBP decrease using a logistic regres-
sion model. Missing data were imputed as failed to
successfully eliminate at least one antihypertensive medica-
tion for the ITT analysis. Data were also analyzed for com-
pleters only as a sensitivity analysis. The Statistical Analy-
sis System (SAS) version 9.1 (SAS, Cary, NC) was used for
The first patient was randomized in August 2001 and the
last participant completed the study in May 2005. Of 180
individuals screened, 58 were excluded—36 did not meet
the eligibility criteria for SBP, 11 failed to complete the run-
in, 8 declined to participate after completing the run-in pe-
riod, 2 had prior experience with mind/body approaches, and
1 person had moderate depression on the Beck Depression
Inventory (Fig. 2). The remaining 122, randomly assigned
to the RR or control group (61 per group), had similar base-
line SBP (146.2 versus 145.3 mm Hg) and DBP (77.3 ver-
sus 77.6 mm Hg). Other characteristics were well matched
in the two groups, except the RR patients were taking more
antihypertensive medications, were nearly 5.5 kg heavier
than the control group, had higher serum creatinine, and a
higher proportion met criteria for metabolic syndrome
(Table 1).
SBP and DBP after 8 weeks
Eighteen patients did not complete the 8-week visit (6 in
the RR group and 12 in the control group). Completers (n ?
104) and noncompleters (n ? 18) had similar baseline char-
acteristics including SBP (146.8 versus 145.6 mm Hg, p ?
0.34), DBP (79.7 versus 77.1 mm Hg, p ? 0.17). Based on
the ITT analysis with LOCF for these 18 patients, the de-
crease in SBP at 8 weeks was 9.4 (standard deviation [SD]
11.4) and 8.8 (SD 13.0) mm Hg for RR and control, re-
spectively (both p ? 0.0001) and no group difference (p ?
0.75; Fig. 3). Similarly, patients in both RR and control
groups had modest changes in DBP between baseline and 8
weeks (?1.5 [SD 6.2] and ?2.4 [SD 6.9] mm Hg, p ? 0.05
RR group
Control group
(N ? 61)Characteristics
Age, y
Female, n (%)
Race n (%)
Blood pressure at baseline, mm Hg
No. of blood pressure medications at baseline* n (%)
Blood pressure at baseline, n (%)
Angiotensin-converting-enzyme inhibitor
Calcium channel blockers
Angiotensin II receptor antagonist
Statins, n (%)
Metabolic syndrome**, n (%)
Weight, kg
Creatinine* mg/dL
66.6 ? 6.9
30 (49)
67.0 ? 7.6
37 (61)
55 (90)
4 (7)
2 (3)
51 (84)
6 (10)
4 (6)
146.3 ? 5.5
77.3 ? 7.1
145.3 ? 4.7
77.6 ? 7.8
29 (48)
32 (52)
43 (70)
18 (30)
36 (59)
31 (51)
41 (67)
27 (44)
17 (28)
7 (12)
18 (30)
33 (54)
82.4 ? 18.3
1.05 ? 0.31
31 (51)
26 (43)
33 (54)
22 (36)
23 (38)
10 (16)
12 (20)
17 (28)
77.1 ? 18.3
0.96 ? 0.20
Values are mean ? standard deviation or no. (%) of subjects, *p ? 0.05; **p ? 0.01.
RR, relaxation response.
Page 6
and 0.01, respectively) with no group difference (p ? 0.48).
The sensitivity analysis using patients who completed the
protocol achieved almost identical results: change in SBP
was ?10.2 (SD 11.6) and ?9.4 (SD 13.9) and change in
DBP was ?1.6 (SD 6.5) and ?2.6 (SD 7.3) in the RR and
control groups, respectively.
Both RR and control groups had minimal weight loss over
the 8-week intervention averaging 0.65 (SD 3.50) and 0.33
(SD 2.07) kg, respectively. Weight loss was not correlated
with 8-week reductions in SBP or DBP (both p ? 0.05).
Antihypertensive medication elimination
Sixty-six percent (66%) ((44?36)/122) of all study pa-
tients were eligible for medication elimination protocol
based on whether their 8-week or 12-week SBP was below
140 mm Hg and had decreased by at least 5 mm Hg from
baseline. Specifically, 44 participants in the RR group (34
after 8 weeks and 10 after 12 weeks) and 36 participants in
the control group (33 at 8-week visit and 3 at 12-week visit)
were eligible for supervised antihypertensive medication
elimination. Characteristics were well balanced between the
two groups except that a higher proportion of RR patients
had metabolic syndrome, higher serum creatinine, and were
taking more antihypertensive medications (Table 2).
Based on the ITT analysis, 14 (32%) in the RR group ver-
sus 5 (14%) in the control group were able to maintain their
SBP ?140 mm Hg while one or more antihypertensive med-
ications was eliminated. After controlling for the differences
in characteristics at the start of the medication elimination
RR group
Control group
(N ? 36) Characteristics
Age, y
Female, n (%)
No. of blood pressure medications at baseline* n (%)
2 medications
2? medications
Blood pressure at baseline, mm Hg
Statins, n (%)
Metabolic syndrome**, n (%)
Creatinine* mg/dL
Blood pressure change from baseline to start of
medication elimination protocol, mm Hg
65.9 ? 7.0
21 (48)
67.1 ? 7.7
22 (61)
22 (50)
22 (50)
29 (81)
7 (19)
145.6 ? 5.2
77.6 ? 7.1
15 (34)
27 (61)
1.03 ? 0.28
144.5 ? 3.6
77.7 ? 8.1
9 (25)
11 (31)
0.93 ? 0.17
?16.7 ? 7.9
?4.2 ? 6.2
?16.7 ? 7.4
?5.2 ? 6.0
Values are mean ? standard deviation or no. (%) of subjects, *p ? 0.05; **p ? 0.01.
RR, relaxation response.
pressures are shown for the RR and lifestyle modification control groups at baseline, 4-week, and 8-week visits.
The effect of relaxation response (RR) on systolic and diastolic blood pressure. The mean systolic (A) and diastolic (B) blood
Page 7
protocol (number of antihypertensive medications at the start
of the protocol, presence of metabolic syndrome, and serum
creatinine), and reduction in SBP from baseline, patients in
the RR group were more likely to successfully eliminate one
or more antihypertensive medications (OR 4.3, 95% confi-
dence interval [CI] 1.2–15.9, p ? 0.03). The results of the
sensitivity analysis in the 60 completers in the medication
elimination protocol achieved similar conclusions (OR 3.8,
95% CI 0.95–14.9; p ? 0.06). Figure 4 identifies the anti-
hypertensive medications eliminated by medication class
and group.
Compliance. The daily average that the RR group listened
to their assigned audiotapes was 924 seconds (15.4 minutes,
SD 7.6) and 852 seconds (14.2 minutes, SD 8.9) for the con-
trol group with no group difference (p ? 0.42).
Adverse events. Two (2) serious adverse events occurred
during the entire study (diagnosis of lung cancer and chest
tightness/dizziness), both in the control group and both con-
sidered unlikely to be related to participation in the study.
Eighteen (18) patients in the RR group and 14 in the con-
trol group had minor adverse events (mostly respiratory in-
fections and pain), all but an episode of back pain in a RR
group patient were considered unlikely related to the study.
In this randomized trial, we found that 8 weeks of stress
management training (via elicitation of the RR) and lifestyle
modification resulted in SBP reduction of more than 9 mm
Hg in elderly patients with SH. This result has clinical im-
pact since reduction in SBP of 5 mm Hg reduces mortality
by 7%5and risk of stroke by 30%.7Our observed SBP re-
duction was larger than exhibited in two previous studies of
stress management or RR on essential hypertension in mid-
dle-aged patients,14,17but equivalent to published study of
older essential hypertensives.16Our results are comparable
to the 11.8 mm Hg reduction in SBP reported in a substudy
of SH patients provided with the 8-week Dietary Approaches
to Stop Hypertension (DASH) diet.24To our knowledge, the
present study and the DASH trial24are the only nonphar-
macologic interventions that consistently and significantly
reduce SBP in "hard-to-treat" elderly adults with SH. We
recognize that our study patients had a mean age of 67 years
(versus 72 and 70 years in two recent studies of elderly pa-
tients with SH,25,26but since 36 subjects (30%) were aged
70–79 and 5 (4%) were aged over 80, our results are likely
generalizable to these "hard-to-treat" elderly with SH. Both
groups reduced their SBP by a similar and larger amount
than we had anticipated. We realize that we had insufficient
statistical power to detect a difference in the observed re-
ductions in SBP, between treatment groups, but we did not
calculate "post-hoc" power, because the observed differ-
ences between groups would not be clinically significant.
However, it is noteworthy that about two thirds of the study
subjects responded to nonpharmacologic therapy.
An important but secondary result occurred in the 80
(66%) participants who reduced their SBP to ?140 mm Hg
and by at least 5 mm Hg from baseline, which enabled them
to participate in the supervised medication elimination pro-
tocol. A higher proportion of patients were able to success-
fully eliminate at least one antihypertensive medication in
the RR group than in the control group; medication elimi-
nation was safe in both groups. Potential implications of this
trol group (B) able to eliminate specific classes of antihypertensive medications. Calcium, calcium-channel blocker Beta, ?-blocker;
Angio II, angiotensin II receptor antagonist; ACE, angiotensin-converting-enzyme inhibitor. Note: 1 subject in the control group was
able to eliminate both an ACE inhibitor and a diuretic.
Outcome of medication elimination protocol. The number of participants in the relaxation response (RR) group (A) and con-
Page 8
result include improved control of SH, decreased costs of
treatment of SH, fewer side-effects, and increased patient
adherence to antihypertensive therapy. There was imbalance
between treatment groups in the number of antihypertensive
medications that subjects were taking at baseline, raising the
concern that it might have been easier for patients on three
medications to eliminate one medication than those on two
medications. We attempted to control for this imbalance us-
ing logistic regression when we compared the likelihood of
medication elimination between the two study groups. Im-
portantly, there was no evidence that number of medications
independently predicted ability to eliminate antihypertensive
A major strength of our study is that it utilized a double-
blind design in which the assessment of outcomes and dose
modifications were made by a nurse and physician, respec-
tively, each blinded to group assignment. We were con-
cerned about the possibility that the study physician and
nurse measuring and evaluating the systolic blood pressure
might have been unblinded to treatment assignment, so in
addition to the above, we also counseled subjects to avoid
discussion of their treatment with these personnel. We also
conducted site visits to evaluate whether subjects were in-
forming the study nurse and physician about their treatment
assignment, and this did not occur. Furthermore, subjects
were blind to the study hypothesis and were not explicitly
aware of their treatment assignment in relation to the chance
that it might reduce SBP. To reduce bias in analysis, the
study blind was only broken after the final data set was
cleaned and frozen for analysis. This rigor adds credibility
to the result that patients in the RR significantly reduced
their SBP and were more likely to successfully eliminate an-
tihypertensive medications. The results in our control group
are also in line with other interventions, lending weight to
the validity of the conclusions.
We hypothesize that the larger than expected reduction
of SBP in both treatment groups might have been due to the
support provided to study subjects, possibly through im-
proved compliance with study regimens. The similar mag-
nitude in reduction in SBP in both groups may be the effect
of the intervention, the fact that participants spent identical
amounts of time with study staff, and the prescribed time
spent listening to study audiotapes. Since all patients were
informed that the study was comparing two different stress
management programs, the two groups likely had similar
expectations for improvement. At the end of the study, par-
ticipants were asked whether they thought that they had been
assigned to the active experimental or control group; 50%
in the RR group correctly identified that they were in the
experimental group, whereas 62% in the control group cor-
rectly identified that they were in the control group (p ?
0.43). The mechanisms by which the reduction in SBP oc-
curred are likely to be different in the two groups. Since the
lifestyle modification control group received considerable
information on blood pressure–reducing recommendations
of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC)
VII (e.g., sodium and weight reduction, increased exercise,
and enhanced nutrition), changes in SBP were presumably
due, at least in part, to modifications in diet and exercise.5
Hypertensive patients have endothelial dysfunction and low
plasma levels of nitric oxide (NO) metabolites.27Since RR
elicitation is associated with increased NO in healthy sub-
jects,19we hypothesize that in the current study RR elicita-
tion may have increased endothelial NO production result-
ing in vascular dilatation28and reduced SBP. Furthermore,
since four of the five classes of antihypertensive drugs (ex-
cept diuretics) increase NO availability,29this could explain
how RR group participants were more successful than con-
trols in eliminating antihypertensive medications. It is pos-
sible that NO increases resulting from relaxation response
elicitation might substitute for NO production stimulated by
antihypertensive medications. Despite much theoretical sup-
port for the role of NO in treatment of hypertension,28,29
there are no studies evaluating the therapeutic role of en-
dogenous NO in older adults with SH.
Despite promising results, our study has several limita-
tions. First, participants were on different combinations of
antihypertensive medications, with differential effects on the
ability to reduce or eliminate blood pressure medication. It
was not possible to standardize the particular antihyperten-
sive medication to be withdrawn as that depended on the
initial dosage and side-effects. Future investigations of this
approach to BP reduction and diminishing dependence on
drug therapy might address the question of whether the RR
takes the place of any particular class of antihypertensive
therapy. For example, are agents that have central nervous
system–dependent mechanisms of activity (i.e., ?-adrener-
gic-blocking drugs, or clonidine) more easily replaced by
RR-responsive patients, or are peripheral-acting drugs (an-
giotensin-converting enzyme inhibitors, angiotensin II re-
ceptor blockers, and calcium channel blockers) that may
have a vasodilator effect mediated by nitric oxide more
likely to be replaced by a technique working through a NO-
mediated mechanism? As expected, since decisions about
medication elimination were conducted in a blinded fash-
ion, there was no difference in the types of medications tar-
geted for medication reduction. Second, we recognize that
the dose–response effect on SBP is not the same for all med-
ications, even for those in the same class. However, there
was no evidence of systematic bias in those patients targeted
for elimination in this blinded trial. Third, our trial may not
have been long enough to establish the durability of the RR
training in lowering SBP and eliminating antihypertensive
drug therapy. Future studies should include monitoring for
a longer period of time. Fourth, there was no monitoring of
lifestyle modifications that may explain changes in SBP or
ability to eliminate antihypertensive medications in both
groups. However, weight loss was minimal across both
groups and was not correlated with 8-week blood pressure
Page 9
reductions. Fifth, the authors recognize that the sample size
was limited and had insufficient power to evaluate other po-
tential predictors of responsiveness to the RR intervention.
Sixth, since this trial did not include a "no-treatment" con-
trol group, it was not possible to determine whether the ap-
proximately 9 mm Hg SBP reduction would have occurred
regardless of treatment assignment. It was not intended to
evaluate nontherapy or neglect of the BP elevation in these
patients. The patients had systolic BP elevations above ac-
ceptable levels, they were older, and thus at risk for
atherothrombotic vascular events. Ethically, nontherapy was
not an acceptable treatment alternative. Finally, this study
was not specifically designed to address whether the treat-
ments enabled subjects to eliminate antihypertensive med-
ications, because that was not the primary outcome of the
study. The authors recognize that the subjects who partici-
pated in the medication elimination portion of the study
could be a biased subset.
Pharmacologic studies of stage 1 SH indicate that patients
treated with placebo have reductions ranging from 2.030to
3.431mm Hg in SBP over 8 weeks. Studies of aerobic ex-
ercise versus normal sedentary activity report a modest (?4
mm Hg) reduction in SBP,32and in the DASH trial24of con-
ventional versus fruit/vegetable diets, patients achieved an
average of 0.6 mm Hg and 3.8 mm Hg reduction in DBP
and SBP reduction, respectively. Thus, the reduction in SBP
achieved by both groups in this trial was greater than that
reported in studies of usual care (or placebo) and other ther-
apeutic approaches to SH. The final limitation of the study
was the observed difference between groups in three base-
line characteristics. Strict procedures were followed during
the randomization process and on review of the quality con-
trol procedures, no errors were found, nor were there any
errors in consecutive assignment of study subjects. The au-
thors conclude that baseline differences were due to chance.
In summary, 8 weeks of RR training and lifestyle modi-
fication reduced SBP by ?9 mm Hg in elderly patients with
SH, but patients receiving RR training were more likely to
eliminate at least one antihypertensive medication. Addi-
tional studies are needed to evaluate whether medication
elimination can be safely sustained through practice of the
RR and whether this approach results in decreases in mor-
bidity and mortality in the elderly with SH.
The prevalence of hypertension worldwide is substantial
and is increasing markedly, in concert with the aging pop-
ulation. Recent estimates suggest that 1 billion persons are
hypertensive and that this number will grow to 1.5 billion
by the year 2025.33Yet, only 30% of patients with hyper-
tension are controlled using current modest targets as a mea-
sure of success.34If blood pressure targets are reduced, as
they currently are for diabetic patients, for the entire popu-
lation, the number of patients classified as hypertensive will
soar beyond current estimates and the percentage of patients
whose blood pressure is adequately controlled will drop
significantly. The solution to this dilemma is not more wide-
spread prescription of antihypertensive pharmacologic
therapy. The treatment of prehypertension is feasible, but
expensive and likely to elicit side-effect/adverse events in
many patients.35A side-effect-free treatment strategy such
as the RR offers an as yet untapped opportunity to meet
these goals. If our findings in SH can be extended to other
patient populations, the benefits in preventing vascular
events as well as the cost savings in decreased drug depen-
dence are incalculable.
We thank all of the site personnel for their support and
the study participants for their cooperation during this trial.
The study sponsor did not play a role in the design and con-
duct of the study; the collection, management, analysis, and
interpretation of the data; or the preparation, review, or ap-
proval of the manuscript. The study was funded by grants
H75/CCH 19124, H75/CCH 123424, and R01 DP000339
from the Centers for Disease Control and Prevention (CDC)
and K24AT003683 from the National Institutes of Health
1. NHANES III Data Files. Online document at: www.cdc.gov/
nchs/about/major/nhanes/nh3data.htm Accessed August 10,
2. NHANES 2003-2004. Online document at: www.cdc.gov/
Accessed August 10, 2007.
3. Hodgson TA, Cai L. Medical care expenditures for hyperten-
sion, its complications, and its comorbidities. Med Care 2001;
4. Franklin SS, Gustin WT, Wong ND, et al. Hemodynamic pat-
terns of age-related changes in blood pressure: The Framing-
ham Heart Study. Circulation 1997;96:308–315.
5. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Re-
port of the Joint National Committee on Prevention, Detec-
tion, Evaluation, and Treatment of High Blood Pressure: The
JNC 7 report. JAMA 2003;289:2560–2572.
6. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hyper-
tension in the US adult population: Results from the Third Na-
tional Health and Nutrition Examination Survey, 1988–1991.
Hypertension 1995;25:305–313.
7. Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated
and treated isolated systolic hypertension in the elderly: Meta-
analysis of outcome trials. Lancet 2000;355:865–872.
8. Nuesch R, Schroeder K, Dieterle T, et al. Relation between
insufficient response to antihypertensive treatment and poor
Page 10
compliance with treatment: A prospective case-control study.
9. Franklin SS, Jacobs MJ, Wong ND, et al. Predominance of
isolated systolic hypertension among middle-aged and elderly
US hypertensives: Analysis based on National Health and
Nutrition Examination Survey (NHANES) III. Hypertension
10. Ross SD, Akhras KS, Zhang S, et al. Discontinuation of anti-
hypertensive drugs due to adverse events: A systematic review
and meta-analysis. Pharmacotherapy 2001;21:940–953.
11. Chen K, Chiou CF, Plauschinat CA, et al. Patient satisfaction
with antihypertensive therapy. J Hum Hypertens 2005;19:793–
12. Gurwitz JH. Polypharmacy: A new paradigm for quality drug
therapy in the elderly? Arch Intern Med 2004;164:1957–1959.
13. Beary JF, Benson H. A simple psychophysiologic technique
which elicits the hypometabolic changes of the relaxation re-
sponse. Psychosom Med 1974;36:115–120.
14. Benson H, Rosner BA, Marzetta BR, et al. Decreased blood-
pressure in pharmacologically treated hypertensive patients
who regularly elicited the relaxation response. Lancet 1974;1:
15. Leserman J, Stuart E, Mamish M, et al. Nonpharmacologic in-
tervention for hypertension: Long term follow up. J Car-
diopulmonary Rehabil 1989;9:316–324.
16. Schneider RH, Staggers F, Alexander CN, et al. A randomised
controlled trial of stress reduction for hypertension in older
African Americans. Hypertension 1995;26:820–827.
17. Schneider RH, Alexander CN, Staggers F, et al. A random-
ized controlled trial of stress reduction in African Americans
treated for hypertension for over one year. Am J Hypertens
18. Wallace RK, Benson H, Wilson AF. A wakeful hypometabolic
physiologic state. Am J Physiol 1971;221:795–799.
19. Dusek JA, Chang BH, Zaki J, et al. Association between oxy-
gen consumption and nitric oxide production during the re-
laxation response. Med Sci Monit 2006;12:CR1–CR10.
20. Hoffman JW, Benson H, Arns PA, et al. Reduced sympathetic
nervous system responsivity associated with the relaxation re-
sponse. Science 1982;215:190–192.
21. Kalish LA, Buczynski B, Connell P, et al. Stop Hypertension
with the Acupuncture Research Program (SHARP): Clinical
trial design and screening results. Control Clin Trials 2004;25:
22. Shaw LJ, Berman DS, Hendel RC, et al. Cardiovascular dis-
ease risk stratification with stress single-photon emission com-
puted tomography technetium-99m tetrofosmin imaging in pa-
tients with the metabolic syndrome and diabetes mellitus. Am
J Cardiol 2006;97:1538–1544.
23. Appel LJ, Champagne CM, Harsha DW, et al. Effects of com-
prehensive lifestyle modification on blood pressure control:
Main results of the PREMIER clinical trial. JAMA 2003;
24. Moore TJ, Conlin PR, Ard J, et al. DASH (Dietary Approaches
to Stop Hypertension) diet is effective treatment for stage 1
isolated systolic hypertension. Hypertension 2001;38:155–
25. SHEP Cooperative Research Group. Prevention of stroke by
antihypertensive drug treatment in older persons with isolated
systolic hypertension: Final results of the Systolic Hyperten-
sion in the Elderly Program (SHEP). JAMA 1991;265:3255–
26. Staessen JA, Fagard R, Thijs L, et al. Randomised double-
blind comparison of placebo and active treatment for older pa-
tients with isolated systolic hypertension: The Systolic Hy-
pertension in Europe (Syst-Eur) Trial Investigators. Lancet
27. Forte P, Copland M, Smith LM, et al. Basal nitric oxide syn-
thesis in essential hypertension. Lancet 1997;349:837–842.
28. Vita JA. Nitric oxide-dependent vasodilation in human sub-
jects. Methods Enzymol 2002;359:186–200.
29. Napoli C, Ignarro LJ. Nitric oxide-releasing drugs. Annu Rev
Pharmacol Toxicol 2003;43:97–123.
30. Black HR, Elliott WJ, Weber MA, et al. One-year study of
felodipine or placebo for stage 1 isolated systolic hyperten-
sion. Hypertension 2001;38:1118–1123.
31. Grimm RH Jr., Black H, Rowen R, et al. Amlodipine versus
chlorthalidone versus placebo in the treatment of stage I iso-
lated systolic hypertension. Am J Hypertens 2002;15:31–36.
32. Ferrier KE, Waddell TK, Gatzka CD, et al. Aerobic exercise
training does not modify large-artery compliance in isolated
systolic hypertension. Hypertension 2001;38:222–226.
33. Kearney PM, Whelton M, Reynolds K, et al. Global burden
of hypertension: Analysis of worldwide data. Lancet 2005;
34. Prevalence of actions to control high blood pressure—20
states, 2005. MMWR Morb Mortal Wkly Rep 2007;56:420–
35. Julius S, Nesbitt SD, Egan BM, et al. Feasibility of treating
prehypertension with an angiotensin-receptor blocker. N Engl
J Med 2006;354:1685–1697.
Address reprint requests to:
Randall M. Zusman, M.D.
Section on Hypertension and Vascular Medicine
Cardiology Division, Medical Services
Massachusetts General Hospital
55 Fruit Street
Yawkey Center #5B-5800
Boston, MA 02114
E-mail: firstname.lastname@example.com
Page 11


text:
Thomas Wiederhold
Retired and loving it. I am at times an actor, a photographer, a living historian and I love the arts. Comments are cherished!
- +JPG+ since June 2009
- *3 hot photos
Frozen Pier Jan 7th 2015
8 Jan 2015 — 12 views, 2 favorites, 1 comment
In "Photo Challenge: Forms of Water"
JPG+ Required
Collections are a JPG+ feature. You must be a JPG+ member to create new collections and to add photos to collections.
Sign up for JPG+ to start using collections now!
Thomas's votable photos
Lights,Falls and action!
- Vote now!
- 5432 views
- 70 favorites
- 41 comments
Submitted to Fluid
Route 66 Model T
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- 10 favorites
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Submitted to Transportation
Enter "Nosh, Gobble, Scarf!"!
Q: Where can I find a free guide for pleasing Blur Technique.
A: Do you know?

subset: commoncrawl


text:
19 Feb 2014
On June 23rd, the WORLD will celebrate Olympic Day! Hundreds of thousands of people of all ages are encouraged to get out and participate in sports activities such as runs, exhibitions, music and educational programs. Olympic Day has helped spread the Olympic ideals all over the world.
This is the 65th anniversary of Olympic Day. It was introduced in 1948 and has been celebrated every year on June 23rd to honor the beginning of the modern Olympic Games on June 23 1894 at the Sorbonne in Paris. The goal of Olympic Day is to promote the Olympic values and participation in sport across the globe.
If you are interested in HOSTING an Olympic event, GREAT! The U.S. Olympic Committee has worked hard to make hosting an Olympic Day event as easy as possible. Essentially, if you can find a location and group of youth who have a morning or afternoon to dedicate to an Olympic Day activity, the USOC will provide the rest. The on-line tools and toolkit provided by the USOC will outline all the necessary steps to host a successful Olympic Day event. The USOC will also endeavor to secure an Olympian, Paralympian or hopeful to attend your Olympic Day event, if desired.
CLICK HERE for all of the details!
Need some ideas for Olympic Game events? We have YOU covered! Past Olympic events have included Olympic themed education and art projects, fun runs, day camps, discussion panels, youth clinics, etc.
You can find even MORE event ideas HERE.
For more information on Olympic Day, CLICK HERE.
Number of views (4219) Comments (0)
Long Time AAU Volunteer Passes
Spring Basketball is HERE and the Easter Classic is Kicking Off the Season!
2015 AAU Spring Fling I - Award Photos
2015 AAU Spring Fling I - Action Photos
Ezekiel Elliott Wins AAU Sullivan Award
Lakeshore Volleyfest AAU Super Regional
Region VI Karate Championships
District qUALIFIER
Cincinnati Royals Boys & Girls Super Regional
Middle Atlantic District Championships
All Iowa Attack Super Regional
Net Elite Super Regional
Golden Spike Super Regional


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text:
International observers will have an opportunity to make sure that the election process will be held strictly according to the legislation and with respect to European standards.
Foreign minister: European integration main direction of Ukraine's development
Lytvyn: Party of Regions to increase its presence in parliament
PR Newswire: International observers activate their missions in Ukraine
Teixeira: Possible date for Ukraine-EU Summit not discussed yet
Lytvyn: Date for mayoral election in Kyiv to be determined after parliamentary elections
Central Election Commission registers 64 more international observers
Martyniuk: Frequent elections saving Ukrainians from increase in tariffs for utility services
Yanukovych: Parliamentary elections should be held in line with democratic standards
Yanukovych asking utility workers to stop dreaming of tariff increase after elections
International observers at the upcoming parliamentary elections in Ukraine will have an opportunity to make sure that the election process will be held strictly according to the legislation and with respect to European standards, a member of the Regions Party, Ivan Popesku, has said.
"The president, the government, the Foreign Ministry, the ruling coalition and the Regions Party invited observers from various international organizations and countries in order that they come to Ukraine and confirm that the election process in the country is held in line with European standards, we adhere to the election law and we are ready to prove that Ukraine is a European state," Popesku said.
"Representatives of nongovernmental organizations and international official organizations have already been registered by the Central Election Commission (CEC). For example, the Parliamentary Assembly of the Black Sea Economic Cooperation, as well as other countries, has already registered its observers. There are applications from Hungary, the Czech Republic and other European countries that will be represented by their own missions or in the membership of the OSCE mission, or with the PACE mission. This shows their interest to the election process in Ukraine. Since further European integration of countries depends on elections, we hope the elections will get the highest evaluation. And after that we will sign the Association Agreement, including terms on a free trade area, as well as on the liberalization of visa travel," he said.
"Therefore, we are happy that international observers will come, as they will make sure that the election process is fair in Ukraine and that Ukraine is ready to adhere to European and international standards," Popesku noted.
EU to provide 70 million euro to restore safe environment at Chornobyl
Ukraine to create special operations forces under Ukraine-NATO program for 2015
Prompt signing of Open Skies Agreement between Ukraine, EU is important - Poroshenko
Tusk says Russian sanctions linked to absolute implementation of Minsk agreements
Tusk says EU may take decision on Russia in June if Donbas conflict escalates


text:
Moderators: Three Stars, dagny, pfim, netwolf
offsides wrote:Good news. Betcha Geno is liking this. Hopefully get to watch him in a couple three weeks.
Users browsing this forum: Abe Frohman, Antonio, Chirpin' Grinder, djlm, Fast B, FLPensFan, jeffshly, lemieuxReturns, maopens, mikey287, no name, Steve, The U, topshelf66 and 52 guests


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View Diary: (Updatedx2) Goldman Sachs CEO Blankfein Lawyers UP - Hires Top White Collar Crime Defense Attorney (117 comments)
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text:
Buzzfeed I hate these sliding things! They don't work.
Buzzfeed I hate these sliding things! They don't work.
Ketchup tastes like your mouth after throwing up.
It's Bippity boppity boo. You boop a kitty on the nose.
My grandma always said Chelsea Kramer instead of Kelsey Grammer.
The glue holding down that rug I leeching into his brain.
Pretty sure 19 is a cover up for the beach lol. Very unattractive options.
Poor thing.
You tell them you're proud of your body. That'll show em!
Rude & unprofessional.
#8-So true.
This is my new favorite thing.
I'd never noticed #10 before!
Robert Stack from Unsolved Mysteries is still the narrator of my nightmares.
I made that paper bag tree in Kindergarten and it's still on my mother's dresser.
I think the Pocahontas ring is way off the mark. Too ornate.
I'm sad he regrets Gideon.
I can't wait for more of these. 💙
I almost completely disagree with your choices.
That's just embarrassing.
*Salma Hayek
Helena Bonham Carter & Sacha Baron Cohen were just in character. It's called acting.
Ugh! I have to shower after listening to that nonsense so the stupid doesn't stick.
The alternate title: The V.A. Put Shit In Hero's Eye.
I thought she was going to burn her face but that was sooo much better! Bahahaha.
I always disliked Gwyneth in that pale pink abomination. Terrible fit in the bust, hair is too severe, and the color & styling were just wrong for her.
Cuteness overload
These parents are drama queens. Put your damn phone down and comfort your child instead of acting foolish and upsetting her. If they thought they were discriminated against why didn't they file a complaint? Idiots.
It looks like a coyote with mange.
It's messed up that she will probably lose more in endorsements for going back to her abuser than he did for BEING the abuser.
That was magical!
Happy tears!
HA! My friends and I would try to pause it at just the right moment to see Devon Sawa's "hose". Didn't work.
It is beautiful & classic Disney :)
David Wilson's death was announced as a suicide by a publicist not the County Sheriff. They are not releasing a cause of death until all official autopsy & toxicology reports are back. It's irresponsible of you to imply otherwise.
The thought of eight kids makes ME want to grow a beard.
I was expecting much worse. Not bad at all really.
9/10. Joel Coen Y U LOOK SO CREEPY?
The main goal of foster care is reunification, not adoption. And I've never heard someone say about a pregnant woman "Look at her BREEDING when there are so many children in foster care she should be tending to." Don't judge someone else's journey to parenthood.


text:
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I just finished my room a couple of months ago so here are some pics of the first indoor grow Ive ever tried. I found a hermi yesterday and Im not sure if it pollinated the room or not. There were two or three sacs busted on it but needless to say, it's no longer in there. Do you think its worth finishing? I have heard thats where you get feminized seeds from. The pick of close up is the hermi. Dates are wrong on pics too lazy to set camera!
Sorry for the long absence but have been really busy with other probs. One is supposed to be a skunk cross with orange crush and the other is sup. to be tutti frutti cross with bubblegum. Both were gifted by a friend who passed away several years ago. I have been growing outdoors for along time and have been able to sustain the strain luckily.
where ever you heard that hermis drop feminized seeds is a load of shit if you take seeds from a hermi when u pop those seeds you have even greater chances of getting more hermis its not worth its i tried its it was a horrible failure just smoke the weed and pick out the seeds i wouldnt use them but hey i ma not a professional if hermis dropped fem seeds every one would have light leaks and would stress there plants to get the to hermi who ever said that needs to be slapped but your grow looks great keep up the work
you posted that hermi comment a month ago and no one caught it, this site has gone to shit. back when i first signed up a thread like this one would be 6 pages deep in a month, your grow is fucking great not enough people on this site any more that give a fuck it seems i am not saying there aren't people that care, it is just a ghost town.... *steps off soap box and quietly leaves the forum*
From what I have read you are wrong about the hermi thing twitch. If you stress a non genetic herm into a male flower or three they will be full of female pollen. So maybe the good ol days were really the wrong ol days.


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I added a new piece commissioned by the awesome Stringduo over on Tumblr; it was a really fun piece to work on and Stringduo was a real pleasure to work with! I've got another commission presently in the works, so keep your eyes peeled for the next update. :)
Green-bordered artwork depicts properties that I claim no rights to; ie, fanart. Prints of these works are not available for sale.
Purple-bordered artworks are commissioned, and belong to their respective owners. Prints of these works are not available for sale.
Red-bordered artwork was made by referencing 'Bewildered' with TwiggXstock's permission. Prints of this artwork are not available for sale.
Blue-bordered artwork was made in conjunction with Drew Tucker.


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Daily Fantasy Baseball Advice and DFS Strategy
OCT 1, 1:22p ET
| Adam Meyer & D.J. Foster
Stick Hand | Left |
Age | 23 (8/2/1991) |
From | Vancouver, BC |
Drafted | 2009 - Rd 1, 4th by ATL |
Salary | $6,000,000 |
2014-15 Season Career | |||
Rotowire: Apr 12 / 2:35p ET
News: Kane, who underwent surgery on the labrum in his shoulder in February, is out of his sling, but still isn't close to taking the ice, The Buffalo News reports. "Probably not for a couple more months," Kane said. "I want to take as much time and be cautious of the shoulder and make sure it's 100 percent so I don't have any setbacks going forward."
Impact: Kane is expected to be full-go for training camp. The Sabres traded for him knowing his medical situation and gave up a lot to do so, and the plan is for him to have a prominent role as the team works through a rebuild -- one that may include a key future linemate for Kane, with as Buffalo's guaranteed to get either Connor McDavid or Jack Eichel in the draft.
StatsLLC: Feb 21 / 12:00a ET
News: On Friday, Kane attended his first game in Buffalo since being acquired in a trade with Winnipeg last week.
Impact: Kane is recovering from season-ending shoulder surgery he had shortly before the trade.
Rotowire: Feb 12 / 1:35p ET
News: Kane, who had been nagged by a shoulder injury all season before undergoing surgery last week, is looking forward to a fresh start with Buffalo, ESPN.com reports.
Impact: The winger's shoulder woes date back to last year, and he admitted that it's been especially bothersome over the past two months. Kane has also battled injuries to his ankle and hand this season, but was able to compile 22 points in 37 games at sub-optimal health. Though he'll be sidelined for the remainder of the season, Kane should be fully recovered by August and will be motivated to put up career numbers in 2015-16. He's in line to serve as the Sabres' top left wing next year.
Rotowire: Feb 11 / 8:51a ET
News: Kane (shoulder) was traded to the Sabres on Wednesday in a multi-player deal, TSN's Darren Dreger reports.
Impact: Kane is out for the season after undergoing shoulder surgery over the past weekend, but with the Sabres not expected to contend in the Eastern Conference for another year or more, the winger will provide the team with a foundational piece for their rebuild. The 23-year-old's departure from Winnipeg was a matter of when -- not if -- after it was reported that he and the team didn't see eye-to-eye, and a recent locker-room incident with Dustin Byfuglien only exacerbated matters. Kane is slated to be the Sabres' top left wing when he returns in the fall, and perhaps the change of scenery will help vault the former fourth overall pick to superstardom. His adjustment to the new organization could be further aided by the arrival of one of the two star centers, Connor McDavid and Jack Eichel, in the 2015 NHL Entry Draft, as the league-worst Sabres find themselves in prime position to claim a top-two draft pick.
StatsLLC: Feb 11 / 12:00a ET
News: The Buffalo Sabres acquired Kane from the Winnipeg Jets in a seven-player trade on Wednesday.
Impact: Kane is out four to six months after undergoing elective shoulder surgery. The fourth-overall pick in the 2009 NHL Draft, Kane was a healthy scratch for the Jets last week and was Winnipeg's biggest trade chip. The 6-2, 195-pound winger had 10 goals and 12 points in 37 games this season.


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we are thinking of renting a car in madrid for 10 days to travel southward. economy car rentals seems to have the best rates but i have read mixed reviews about it in this forum. has anyone tried using them in spain? any success or lack thereof? thanks!
economy car rentals
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I've rented from http://www.economycarrentals.com/ in Turkey, Sicily and Poland with no problems. On the other hand, I've had no damage to the various cars I rented.
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We used Ecomony car rentals May 2011, picked up in Tarragona and dropped off in Girona, without any problem. Our contract was with National/Atesa. We are using Economy for two rentals in Italy next month. We have always been pleased with our rentals through them but like Michael have never had any damage to our rental cars. "Knock on wood"!! Deborah
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Try www.doyouspain.com
We've had some excellent prices from them, but they do operate a full to empty fuel policy, so be sure you'll use a full tank. -
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We often use them and are satisfied with them. I always recommend going for no excess coverage though, even if you have a credit card that supposedly covers everything. It saves on hassles if you do get a tiny dent and you don't have to worry about refunds etc.
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It saves on hassles if you do get a tiny dent and you don't have to worry about refunds etc
I've heard it differently. http://www.economycarrentals.com/ offers cars only with no excess, aka no deductible, but it is the broker who offers it not the rental agency, so that in case of damage, the rental agency will still bill the renter's credit card who then must ask for reimbursement from http://www.economycarrentals.com/ (I use the web site because there are several brokers who have the word "economy" in their name). -
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has one branch in Sweden.
That's probably more than in many other countries since it does not provide the cars themselves. I rented through it in Turkey and Poland, and I am not aware that it has offices in either country. -
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Do not a rent a car until you leave Madrid. Additionally, we always try and rent a car on the outskirts of a city, so we do not have negotiate the traffic and streets of that city.
We have rented cars in Spain many times and they are a burden in cities, even smaller cities, because the streets were not originally built for cars.
You should also find which rental car company you will actually go to. -
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Re which company supplies the car when booked through EconomyCarRentals... they supply you with that info and the paperwork required as soon as you do the booking. In my case they charged just a dollar on my credit card... the balance was paid direct to Avis when I picked up the car in Athens.
I did a whois search on the domsin and sure enough their address is in Crete. Who knew? Not me anyway! LOL -
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I always go with www.speedyrentalcars.com
I have been using them for a while and I'm happy. Comments have been removed by Fodor's moderators
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If you are American (or Canadian, close enough for this), then rent from either Europcar or a US-based agency. If something goes wrong during the trip or you're overcharged later, you can fight the company from home.
If you're from EUville, the above does not apply. -
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Total disaster! We have booked two Vans in Sicily together with my friends. Both reservations confirmed and with given vouchers. At the provider it appeared that they do not have reservation for one of them in the system. Finally they found spare car but w/o air condition. AC was to be repaired within two days. On sheduled day we were said it will be on following day. On following day the date was moved in next three days. An so on and so on untill the day of car return. The car was never repaired. We had to travel with small children in 40 Celcius degrees conditions through whole period of rental! The other car was broken technically for two days. No spare car provided, no compensation! The help from Economy Car Rental was useless. Dozens of phone calls to Economy Car Rental help desk finished with statement that they are sorry but you cannot contact or do anything! Mails send to them without any answer! Once answered 3 days before rental finish that we should do it ourservels as you are helpless. The worst client service ever! I demand once again full compensation otherwise the case will find final in court!
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Hi Michael
I don't know if this post will catch your eye about a recent car rental in Italy.
Economy car rentals did not provide the rental with zero deductible. This is a change from the last time I rented from them in Italy (2011).
But the excess was pretty reasonable as an add on before completing the rental. I think it is about $7 a day. And it brings the excess to zero.
The same rules apply. Damage charged to credit card and Economy will reimburse. -
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I had a really bad experience with Economy Car Rentals who booked me with a company that did not let me travel from Italy to Croatia even though I indicated I needed a cross border card. They charged 1.5 times the legal deposit in Italy and refused to refund my deposit. I think any positive reviews are by the company themselves. They are crooks. -
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We've been renting cars in Europe thru AutoEurope.com w/o any issues. They're nice to deal with, they work with only reputable companies (I think mostly Europcar), and they're very good at solving problems if they arise, including upgrading to a larger car when the one offered was way too small (not too many options when one insists on automatic transmission...)....
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text: SEALED KNOT ARMY COUNCIL 19th March 2011 The General Council of the Armies will be hosted by His Majestie's Army. Venue: Ramsey Abbey College, Abbey Road, Ramsey, Cambridgeshire, PE26 1DG OS ref: TL 293 848. Lat/Long. 52° 26′ 50.5″ N, 0° 5′ 51.18″ W Sat Nav. Longitude and latitude reference - 52.44736, -0.09755 Representation at the Army Council: Both Lord Generals Both Army Chiefs of Staff All General Officers Master Gunners of both armies From the Regiments and Brigades/Tertios: Commanding Officer or delegated officer 2i/c or delegated officer Living History representative Others: Chairman of the Board of Safety Mayor of Living History One representative of SKMS Commentary Team Co-ordinator Editor "Orders of the Daye" Senior Powder Master Master of Horse Members of the Board of Directors It is the responsibility of Regimental Commanders to make sure that their regiment is represented. Please arrive at 10 am for a prompt start at 10.30 a.m. The meeting will finish and the building cleared by 5 p.m. Agenda 10.00-10.30 Coffee/tea 10.30-12.45 Individual Army meetings Living History meeting 1.00-2 p.m. Lunch 2.15-4.30 General Meeting hosted by the Lord Generals 1-3 p.m. Emergency Temporary Membership cards collection - in foyer from Membership Secretary Refreshments Canteen for coffee/tea, bacon rolls, cake etc - open from 9.30a.m.-2.30p.m. Please pre-book lunch to avoid delays, on arrival or before 11.30 a.m. in canteen for jacket potatoes, pies, pasties, chips etc. Directions From A1 North and South - A14 from West A1 junction with A14 (roundabout/underpass) from north slip road to roundabout 1 st exit – Thrapston Road (A14) east towards Huntingdon. Stay in left lane. From West continue on A14 under A1. From South slip road to roundabout 3rd exit Thrapston Road (A14) towards Huntingdon. From A14 travelling north A14 junction with A141 Spittals Corner roundabout. Slip road from A14, follow signs for A141 (3 rd exit). Follow A141 for approx 4 miles from Spittals Roundabout to Hartford Roundabout - 1st exit, continue on A141 towards March for 3.4 miles (caution- speed camera!). Continue on A141 to roundabout junction B1040 (further .8 mile) 1st exit. Continue on B1040 for 5 miles through Warboys and Bury to Ramsey. (See attached map of Ramsey) Drive towards church in High Street. Turn right into Hollow Lane in front of church, by Abbey Green. Turn first left into Abbey Road. Follow round to right for parking.


text:
VIEWS: 23 PAGES: 3 CATEGORY: Current Events POSTED ON: 1/22/2011
How can Islam reconcile itself with the 21st century? This No-Nonsense Guide explains the Islamic worldview, examining the Qur'an and Islamic law (sharia), Islam in history, and Islam's relationship with the West. The authors analyze the struggle within the faith for a more humane and holistic interpretation of their religion, examine issues surrounding women's rights, economic development and the absence of democracy in some Muslim countries. This is a balanced portrayal of 'real Islam', looking beyond the common perceptions and polemical debates. It shows what Islam has achieved and shows why a better understanding of Muslims is needed throughout the world. But it also explains why Islam needs to make itself more relevant by showing it can create just, tolerant and peaceful society, and explores the steps for reform.


text:
As a hand surgeon in San Antonio, Dr. Nancy Otto offers surgical and non-surgical care for conditions affecting the hand, wrist, fingers, forearm, elbow and shoulder.
Learn More
We invite you to write a review about your experience with Dr. Otto.
Find potential causes and treatment options with the MD.com Symptom Checker.


text:
There has always been something primeval and spiritual about a drum and the sound in which it produces. I can feel my heart beat with it in unison, my body flowing with new energy! The drum provides a way for a community to play and to experience not only the tremendous healing benefits that it provides but also a sense of belonging and fun! I encourage you to join me on my healing journey and to share the rewards it brings! Let us enter the Beat Street Community Drum Circle!
When: Please arrive no later than 2:45pm. The drum circle begins at 3pm and ends approximately at 5pm.
Where: Jericho Hill Centre is located at 4196 West 4th Avenue in the Vancouver West Point Grey area.
Website: http://drummingandhealth.com/events/beat-street-community-drum-circle/
How to find us: We will be inside the building.
Equipment: All drumming and other instrumental equipment will be provided onsite. You are more than welcome to bring your own drum, if you choose.
Cost & Duration: This will be a FREE trial for drum circle newcomers. The duration is approximately 2-hours.
Waiver: The host, group, Drumming and Health, Lyle Povah and Jericho Hill Centre are not responsible in any way for attending members. Members who RSVP YES for this event are solely and totally responsible for their own personal safety and well being before, during and at any time after the conclusion of this event. The host, group, Drumming and Health, Lyle Povah and Jericho Hill Centre shall be held harmless and shall be unconditionally free forever of any and all liabilities, obligations and responsibilities to any of the attendees, guests and all third party individuals, relatives and representatives.
It was sooooooooo fun~! I really liked it. Maybe I'll want to go again in the future if it's free~! HAHA.
September 17, 2013
I had a great fun! It was amazing how many different rhythms we could have at the same time. Lyle was a great singer, too!
September 15, 2013
Didn't really get a chance to mingle with many people in the group as I had to leave early...this was my first meet-up with the group and you all seemed very friendly and inviting..and a special thanks to Akemi for organizing the event and making me feel welcome.
September 15, 2013
can that accommodate that many people?
will they have enough drums for everyone?
maybe we should put a cap on the # of RSVPs to avoid disappointments.
September 7, 2013
Oh.. i didn't check the day :( i need to work on sundays.. Sounds so much fun tho :) i wish i could get my day off that day! We will see :)
August 5, 2013
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GCN Power Praise Season 1 (www.manmintv.org) - Today's Christian Videos
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Younger Christians gather once a month for a special time of praising God from the depths of their heart as they truly fathomed His love. With Rev. Soojin Lee, a spiritual praise leader who over the years has touched the hearts of countless people overseas, this program not only promotes and presents a taste of Christian culture in the finest from but also provides precious opportunities to those who do not yet know God to meet with Him comfortably.
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Fed pays 50% of Food Stamps...State Pays 50%, whats your point?<quoted text>
Take a look at the difference between federal spending on any given state and the federal taxes received from that state. We measure the difference as a dollar amount: Federal Spending per Dollar of Federal Taxes. A figure of $1.00 means that particular state received as much as it paid in to the federal government. Anything over a dollar means the state received more than it paid; anything less than $1.00 means the state paid more in taxes than it received in services. The higher the figure, the more a given state is a welfare queen.
That Red states are "Fed-up with moochers"? We know that!
CA and Liberal progressive states are biggest drain on FEDERAL MONIES!
free HEALTH care, free foodstamps, free housing, for illegals and anyone with an aversion to success!


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Transocean Buyer Interview Questions
Interview Experience
Interview Experience
Getting an Interview
Getting an Interview
Interview Difficulty
Interviews for Top Jobs at Transocean
- Senior Recruiter (2)
- Third Engineer (1)
- ART Program (1)
- ART Subsea (1)
- Rig Trainee (1)
- Wells Engineer (1)
- Intern (1)
- Buyer (1)
- Administrative Assistant (1)
Helpful (2)
Buyer Interview
I applied through a recruiter. The process took 4+ weeks – interviewed at Transocean (Singapore (Singapore)) in December 2011.
I was head-hunted by a Senior Supply Chain Manager through Linkedin. The first interview was conducted via telephone with the Senior Supply Chain Manager and Project Director. The tele-conference lasted an hour, with me giving an introduction of myself and past experiences. A second interview ensued shortly with the same interviewers in person. I was quizzed on some technical aspects of the job.
Interview Questions
- The Project Director assumed I had a master degree. 1 Answer
They were very keen to hire me after the interviews and met my expected pay package. They did not even bother to ask how much I was paid in my previous employments.


text:
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I'm told both sides have been meeting all day and it's still going on even at this late hour. That has to mean actual negotiations are taking place. I'm told this is a good sign. I'll let you know what's happened in today's session as soon as I hear. Could sanity prevail? Or did they find something else nonsensical to argue about? See my previous: Tricks & Treats At WGA Strike Talks (… All About The Chairs).
WGA/AMPTP Talks Update: Still Going On
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