text:
WMU-NC wants to resource other Baptist entities in mission education and involvement, Fulbright said. That includes assistance to churches that affiliate with other denominations and with bodies such as the Cooperative Baptist Fellowship and the Baptist World Alliance. The SBC's conservative leaders have been highly critical of both groups.
Thursday, August 23, 2007
North Carolina Baptist Women Separate from Fundamentalist Men
Three cheers for the Women's Missionary Union in North Carolina. ABP is reporting that they have separated themselves from the Fundamentalist dominated state convention. Here's a quote:
Posted by Bruce Prescott at 8:19 AM
1 comment:
- bowtiebaptist said...
I wish that WMU could become self-sufficient in all states. The real shame is that we can never reclaim Lottie Moon because the Fundamentalists will never give up the offering to support the IMB. I suspect that if Lottie were alive today she would be a moderate. She was from Virginia and she did preach on occasion
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45 year old woman | Stoneham, MA, USA | Seeking men 38-50 within 50 miles
Active within 1 week
A little bit of sugar...and definitely little bit of spice!
I am looking for the real deal with someone who wants the same. What is the real deal to me? A relationship where we like and love each other and always look forward to the time we have to spend together. At the end of the day I'll come home with a little buzz from Zumba class, we can be together in the kitchen while I cook you my lasagna for dinner and we'll share the highlights of our day. Maybe we'll just snuggle together on the couch watching a download from Netflix, take a walk to explore the neighborhood, or just hang out while we each do our own thing. Easy, comfortable, with plenty of passion – the drama free kind. Though I'm a proud Jersey girl, I'm really more a child of the world. My South African mother and Italian dad raised me to be curious, open and tolerant. That curiosity led me to spend time in Piedmont and Madrid, where I honed my Italian and Spanish. I spent five fun, fabulous years in Spain which I loved for its crazy energy and beautiful people. Now I am happily settled in Boston, which I love for the ethnic restaurants and live music. And I never get tired of being near the water. I love my job as a teacher. Kids are just plain funny – and I've gotten good at being a professional fight-breaker-upper. Maybe I can moonlight as a nightclub bouncer?? Seriously, I inspire my students and I know that they may forget what I do for them, but they will (hopefully) remember things they learn from me. My friends call me good-natured, probably because we laugh a lot together and I'm good at listening – and really hearing – when people talk with me. I'm also good at providing a shoulder, a soothing meal and some fresh popcorn when needed. My friends would also say that it's time for me to find that special guy and break up with my IPad once and for all. I know that they're right and I look forward to dumping it when the time is right. I love to cook, plan meals and play with whatever is my latest new cooking gadget. This week it was my pressure cooker where I made braised short ribs. Next week, who knows? If I'm not trying out a new dish, then I love to explore new restaurants with friends. Boston is such a great live music city. I take full advantage on the weekends. I also love exercise, my favorite lately is nightclub Zumba, where they turn off the lights, turn on the disco ball and everyone, including me, dances their butt off for an hour. I walk out of there stress free and ready for whatever life has to hand me.
Cooking , Dining out , Exploring new areas , Shopping/Antiques
Dancing, Other types of exercise, Yoga
I exercise 3-4 times per week.
I like Cats, Dogs
When I was growing up my family had a Mastiff. I love big dogs like "Marmaduke"..I would have one if I had the time or space.
Davis square, Tu yYo, and la Hacienda and el Paisa in East Boston for their original ethnic food. Helmund's in Cambridge is a great place too.
University of Massachusetts Boston, Boston, MA
One of my favorite movies is "The Fugitive" and I admit that I like crime shows. I also like Key and Peele on Comedy Central. My favorite food is mediterranean. And a Nutella and pound cake sandwich is a definite fave once in a while.
I love to go to Zumba and dance my butt off...it's a great stress reliever. I think it's fun to hunker down with my iPad in bed and watch a good movie. Travel is something I love and I look forward to doing more. Recently I tried Krav Maga.
Rosie Perez, Handbook For An Unpredictable Life. I also just read a fascinating book on Trigger Point Therapy. The Make-Ahead Cook from America's Test Kitchen.
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What she is looking for
|5'8" (172cms)
|5'8" (172cms) to 8'11" (271cms)
|Body type:
|About average
|Slender, About average, Athletic and toned, A few extra pounds, Stocky
|Black, Blue, Brown, Grey, Green, Hazel
|Dark brown
|Auburn / Red, Black, Light brown, Dark brown, Blonde, Salt and pepper, Silver, Dark blonde, Grey, Platinum, Bald
|No Way
|No Way, Occasionally, Yes, but trying to quit
|Social Drinker
|Education / Teacher / Professor
|Administrative / Secretarial, Artistic / Creative / Performance, Executive / Management, Financial / Accounting / Real Estate, Labor / Construction, Legal, Medical / Dental / Veterinary / Fitness, Sales / Marketing, Self-Employed / Entrepreneur, Education / Teacher / Professor, Technical / Science / Computers / Engineering, Travel / Hospitality / Transportation, Other profession, Fashion / Model / Beauty, Architecture / Interior design
|$50,001 to $75,000
|$50,001 to $75,000, $75,001 to $100,000, $100,001 to $150,000, $150,001+
|Never Married
|Never Married, Widow / Widower, Currently Separated, Divorced
|Have kids:
|Yes, and they sometimes live at home, No, Yes, and they live away from home, Yes, and they live at home
|Wants kids:
|Definitely, Someday, Not sure, Probably not, No
|White / Caucasian
|Asian, Black / African descent, East Indian, Latino / Hispanic, Middle Eastern, Native American, Pacific Islander, White / Caucasian, Other
I am one of those women who you look at and say..wait Latina, Polynesian, mixed race..what is she? I embrace the fact that some people think I have an exotic look.
|Christian / Catholic
|Christian / Catholic, Christian / LDS, Christian / Protestant, Spiritual but not religious, Christian / Other
I was raised Catholic, but am not presently practicing. I would say that I am spiritual.
|English, Italian, Spanish
|Graduate degree
|High school, Some college, Associates degree, Bachelors degree, Graduate degree, PhD / Post Doctoral
I have a degree in Applied Linguistics/English as a Second Language.

subset: commoncrawl


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26 year old man | Brighton, MA, USA | Seeking women 22-29 within 30 miles
Active within 24 hours
I consider myself a very fun and outgoing...
I consider myself a very fun and outgoing person who can get along well with anyone. I'm from CT so I'm a Yankees and Giants but I'm a Celtics and Bruins fan too. I'm confused I know. For fun I love playing sports, going to games, bowling, golfing (real and mini), snowboarding, watching movies, traveling, and going out. I played baseball my entire life and through college so I have been active my whole life and Im looking for someone who is just as active and not someone who wants to sit around all the time. I see myself dating someone who is motivated, likes to go out often, goes to the gym, laughs at stupid things, and is easy going. I'm really attracted to someone who strives to better themselves and can have fun doing anything. I'm a pretty laid back but confident person always looking to improve myself and the people around me. I really dont know what else to say, so you'll just have to get to know me.
Camping , Coffee and conversation , Dining out , Fishing/Hunting , Movies/Videos , Music and concerts , Exploring new areas , Nightclubs/Dancing , Playing sports , Travel/Sightseeing , Watching sports
Baseball, Basketball, Billiards / Pool, Bowling, Football, Golf, Hockey, Running, Skiing, Swimming, Walking / Hiking, Weights / Machines
I exercise 3-4 times per week.
I have Dogs
Love dogs, hate cats
Boston, New York, Vermont (ski house there)...I am from Connecticut so I go back there every once in a while. Love to vacation anywhere.
Bryant University, Smithfield, RI
I try to have fun doing everything
Im more of a movie watcher, but if I hear good things about a book I'll pick it up
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|6'1" (185cms)
|5'1" (154cms) to 5'9" (175cms)
|Body type:
|Athletic and toned
|Slender, Athletic and toned
|Blue, Brown, Green, Hazel
|Auburn / Red, Black, Light brown, Dark brown, Blonde, Dark blonde
|No Way
|No Way
|Social Drinker
|Social Drinker, Regularly, Moderately
|Financial / Accounting / Real Estate
|Administrative / Secretarial, Executive / Management, Financial / Accounting / Real Estate, Legal, Medical / Dental / Veterinary / Fitness, Sales / Marketing, Student, Education / Teacher / Professor, Travel / Hospitality / Transportation, Nonprofit / Volunteer / Activist, Fashion / Model / Beauty, Architecture / Interior design
|$75,001 to $100,000
|$25,001 to $35,000, $35,001 to $50,000, $50,001 to $75,000, $75,001 to $100,000
|Never Married
|Never Married
|Have kids:
|Wants kids:
|White / Caucasian
|White / Caucasian
|Christian / Catholic
|Christian / Catholic, Christian / LDS, Christian / Protestant, Spiritual but not religious, Christian / Other
|Bachelors degree
|Bachelors degree


text: I was hoping that you guys would stop by my blog and comment or rate. The account that the blog is on is called EPE09sBlog. My blog is called On My Way and it is about my training for the upcoming season. This season is going to be very important because it will be the last year before high school and in high school I want to play varsity ball. (FYI) You can add me as a friend on my EPE09sBlog account. Anyway, here is the link to my blog: http://community.active.com/docs/DOC-6362.


text:
Summer Schedule for Fox's 'Loop,' 'Lot'
First out of the box will be FOX's highly anticipated filmmaking competition show "On the Lot," from Mark Burnett and
After that tease, "On the Lot" will take nearly two weeks off and, in the meantime, "So You Think You Can Dance" begins its third season with an hour-long audition episode on Thursday, May 24, followed by a second, two-hour, special on Wednesday, May 30. From there, performance shows will air on Wednesdays at 8 p.m. ET with result shows the next night.
"On the Lot" will return on Monday, May 28 with a two-hour "Film Premiere" episode, introducing the 16 finalists and their first films. The next night, in an hour-long "Box Office" results show, beginning at 8 p.m., four finalists will be eliminated. Monday, June 4 will make the first regularly scheduled 9 p.m. "Film Premiere" episode with the first half-hour results show the next evening.
The second season of "The Loop" (anybody remember the first season?) premieres on Sunday, June 10 at 9:30 p.m. The show's focus has been shifted to more workplace antics featuring co-stars
The summer's other major new premiere is the third season of
Since this is FOX, all premiere dates and times are preliminary and could change at any time.


text:
Petites histoires d'animaux Movie Reviews
Petites histoires d'animaux
Release Date: Nov 30, -0001
Rating: (NR)
Release Date: Nov 30, -0001
Rating: (NR)
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text:
The Blackwell Epiphany
Steam Achievements
Achievement Description Blowey Mallone Blow on everyone you can find Convergence Two becomes one Curtain Call Save your first ghost Deception Try to lie your way out of it Dumpster Jumper Make a leap without falling once Epiphany The hows and whys of Joey Ghostly silent Keep clam and keep cool Goldfarb Digger Find a secret room Joined the Music She has plenty of time... Laying it Bear Learn a long kept secret Legacy Reunite a family Move on and Listen Finish the game in commentary mode (from the first screen till the last) Online Troll Gain access to an online game Snow Plow Somebody's got to do it... Softly Softly Create no more then 300 footprints Teamwork Solve a puzzle together Time to Move On Complete the story Unbound Free yourself
Contributed By: Guard Master.
Know Something We Don't?
You can submit new cheat codes for this game using our Cheat Submission Form.
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If you see a non-working or fake code in the list above, let us know by using our Problem Submission Form.


text:
Saints release tight end Jeremy Shockey
NEW ORLEANS For flamboyant tight end Jeremy Shockey, the party is over - at least in New Orleans.
Shockey was released Tuesday by the Saints, who appear ready to move on with promising second-year pro and 2010 third-round draft choice Jimmy Graham.
Shockey was no stranger to the Big Easy social scene and also helped give the city a reason to celebrate like never before. He made a crucial touchdown catch in the fourth quarter of the Saints' lone Super Bowl victory over Indianapolis in Miami just more than a year ago.
But with one season and $4.2 million in base salary left on Shockey's contract, the Saints decided the best way to pursue a second championship would be without the 30-year-old, nine-year veteran.
"Jeremy played an important role in helping our team bring a Super Bowl championship to New Orleans," coach Sean Payton said. "He contributed to the success of our offense, both as a pass-catcher and run blocker, and we're appreciative of his efforts."
Acquired from the New York Giants in a trade at the onset of 2008 training camp, Shockey spent three up-and-down seasons in New Orleans and labored through injuries in all of them.
Last season, Shockey made 41 catches for 408 yards and three touchdowns in 13 games.
Shockey's agent, Drew Rosenhaus, did not answer his phone, but Shockey posted a note on his Twitter page: "Always will remember my time in New Orleans. What a city, you all welcomed me like one of your own, and we had a great run. Onto the next chapter, the Deep Unknown."
Shockey, a former Miami Hurricanes star who makes his offseason home in Miami's South Beach, is an adventure traveler and avid free diver. While he played for the Giants, who made him a first-round draft pick in 2002, he was popular and productive, but also seen as a malcontent and a distraction by the time his stay in New York had ended.
In New Orleans, he rejoined Payton, who had been his offensive coordinator in New York during his rookie season, which remains one of his best seasons statistically, with 74 catches for 894 yards and two TDs.
After Shockey arrived in New Orleans, he often sidestepped reporters and for the most part avoided generating negative headlines.
Not entirely, though. In 2008, he was critical of the team's handling of his sports hernia injury, which he contended was misdiagnosed. Off the field, he made news for being hospitalized after passing out because of dehydration at a pool-side party in Las Vegas in the summer of 2009.
As he looks for a new team, Shockey's resume includes 510 catches for 5,688 yards and 33 TDs in his nine-season career. The questions now are how many good seasons he has left and which teams want to take a chance on him.
In his three seasons in New Orleans, he caught 139 passes for 1,460 yards with six touchdowns in 38 regular season games, 34 of them starts.
Last season, Shockey made an effort to serve as a mentor for Graham, who also attended Miami, but entered college as a basketball player before a lone season of football with the 'Canes.


text:
NEW WORKSHOP FROM SEPTEMBER 2014: "Stone Age to Iron Age". This workshop follows the same pattern as the other workshops with the children taking part in 5 activities relating to the time period.
ALSO NEW FOR 2014, Build a Trojan Horse (and the Parthenon). This is more a DT day and is very similar to the Spitfire workshop. For details please see that page and change the wording!
Make history come to life with our 'Build an Iron Age Roundhouse', 'Build a Tudor House', 'Build a Viking Longship', 'Build Roman Siege Weapons', 'Build an Egyptian Pyramid' and 'Build a Spitfire' days. The days are specifically designed for the Key Stage 2 History curriculum.
However, the Roman Day is also excellent as a KS3 practical Science Day with problem solving.
"Charlie spent two days with us and delivered an outstanding workshop. We built the Tudor House and Viking Longship. The children were totally engaged from start to finish and spoke of the workshop for days. His subject knowledge, delivery and enthusiasm was infectious. We all learnt so much!" Julie Miles, Head of Primary Meadowbrook Montessori School, Berkshire.
"My best day of teaching ever." Sarah Potts, Y5/6 teacher, Meadowbrook Montessori School, Berkshire.
"It's too good an experience to miss out on. We've had many people in to work with the children but this has taken it to a new level."
Laim Doran, Headteacher Waltham Lees Primary School, Grimsby.
"About the best workshop day I have ever experienced."
Assistant Head, Michaelchurch Ecsley Primary, Herefordshire
"I have never seen anything quite so superb in our school before."
Mandy Lane. High Beeches Primary, Harpenden
Your children will have the hands-on experience of building a piece of 'living history'. They will use all the learning styles to solve problems as they work in teams, enjoy themselves AND learn history. The children will steep themselves in history for the day as they assemble scaled artifacts from different historical periods.
As well as constructing the large-scale artifacts, the children will enjoy a range of activities specifically related to the main project, giving them an insight into the processes involved in building a Tudor house, a Viking Longship, an Egyptian Pyramid or Roman siege weapons (which are very similar to Greek ones!). The House is large enough to sit 30 children in. The Longship is 6m long and the Onagars fire [soft] 'rocks' up to 20m. The Egyptian Pyramid is 3m square on the base and children can go in -but please don't tell them! We also help children to build spitfires (either 3m long or about 1m) as well as Lancaster Bombers, Blimps, V1and V2's. We also create "Trojan Horses" and even the Parthenon.
07521 439 301
We also run willow sculpture days: www.willowsculpture.co.uk


text:
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text:
Welcome to Dancin! Performing Arts Center
and our Spring Season 2015
From Ballet to Ballroom - Children to Adults
Beginning to Professional Dancin! has it All!
Enjoy classes with outstanding, professional instruction in:
Classical Ballet - Tap - Jazz - Lyrical - Contemporary
Hip Hop - Cheer/Pom - Irish Dance & Ceili
Vocal/Musical Theater - Litl' Kids Kombos
Line Dance/Country Couples
Ballroom & Social Dance
Yoga - Flex & Stretch


text:
Easy Country-Style Spareribs
|1 Cup (16 tbs)
|1 Cup (16 tbs)
|Dry sherry
|1 Cup (16 tbs)
|1⁄4 Cup (4 tbs)
|1 Medium, sliced
|1 Large, thinly sliced
|1 Clove (5 gm), minced or pressed
|2 Tablespoon
|Lean country style spareribs
|4 Pound
|To Taste
|To Taste
In a 4-quart kettle that can be used on a barbecue grill, combine catsup, water, sherry, worcestershire, onion, lemon, garlic, and butter.
Bring to a boil, reduce heat, and simmer for 30 minutes.
Arrange ribs, fat-side-up, on lightly greased grill 4 to 6 inches above a solid bed of low-glowing coals.
Baste lightly with sauce.
Cook, turning occasionally, for 1 hour to 1 hour and 20 minutes, or until meat near bone is no longer pink when slashed.
Every 1/2 hour add 5 or 6 briquets to fire, spacing them evenly, to maintain a constant temperature.
Reheat remaining barbecue sauce by placing kettle on grill.
As ribs cook, remove them from grill, cut into serving-size pieces, and place in kettle.
Cover and simmer for 20 to 30 minutes longer.
Spoon sauce over pieces to serve.
Season with salt and pepper.


text:
Mike Pence on Families & Children
Republican Representative (IN-6)
Karen says people always tell her she's changing her kids' lives. She says, "They are changing mine." Please join me in welcoming Karen and her children tonight.
Adoption is a beautiful way for families to come together forever. We can better support families like Karen's by expanding and improving adoption in Indiana. We can improve the way we place children from state care into adoptive homes, and we can support every parent who is willing to lovingly adopt a child into their home. Let's make it our aim to make Indiana the most pro-adoption state in America.
Proponent's argument to vote Yes:
Rep. STEVE LYNCH (D, MA-9): This bill takes an important step toward improving the Federal Government's ability to recruit and retain a highly qualified workforce by providing paid parental leave to Federal and Congressional employees for the birth, adoption or placement of a child for foster care, which is a benefit that is extended to many in the private sector in other industrialized countries.
Opponent's argument to vote No:Rep. DARRELL ISSA (R, CA-49): This bill sends the wrong message at the wrong time to working American taxpayers and families that are struggling in difficult times. Our economy is in crisis, and deficits are already soaring. This bill does not have one provision to say if you make $170,000 a year, why do we have to give you this benefit, because you have to choose between feeding your children and being with your children? Certainly not. There are no protections against, in fact, those who do not need this special benefit getting it. There are no safeguards at all. As a matter of fact, this bill envisions the $1 billion over 5 years, swelling to $4 billion over 10 years or more because, in fact, they believe it should be 8 weeks of special leave. Federal employees enjoy one of the highest levels of job security, without a doubt, anywhere in the United States. I would venture to say many of them the highest. More importantly, in good times and bad, they keep their jobs.
The Christian Coalition was founded in 1989 by Dr. Pat Robertson to give Christians a voice in government. We represent millions of people of faith and enable them to have a strong, unified voice in the conversation we call democracy.
|Other governors on Families & Children:
|Mike Pence on other issues:
IN Senatorial:
Daniel Coats
Joe Donnelly
Gubernatorial Debates 2014:
AL: Bentley(R) vs.Griffith(D)
AR: Ross(D) vs.Hutchinson(R) vs.Griffin(R,Lt.Gov.)
AZ: Ducey(R) vs.DuVal(D) vs.Mealer(AE) vs.Gilbert(L) vs.
CA: Brown(D) vs.Kashkari(R)
CO: Hickenlooper(D) vs.Beauprez(R) vs.
CT: Malloy(D) vs.Foley(R) vs.Walker(R,Lt.Gov.)
FL: Scott(R) vs.Crist(D) vs.Snitker(L,Lt.Gov.)
GA: Deal(R) vs.Carter(D) vs.Hunt(L)
HI: Ige(D) vs.Aiona(R) vs.
IA: Branstad(R) vs.Hatch(D) vs.
MA: Coakley(D) vs.Baker(R) &Polito(R,Lt.Gov.) vs.
ME: LePage(R) vs.Michaud(D) vs.Cutler(I)
MI: Snyder(R) vs.Schauer(D)
NM: Martinez(R) vs.King(D)
NY: Cuomo(D) &Hochul(D,Lt.Gov.) vs.Astorino(R) vs.Hawkins(G) vs.
OK: Fallin(R) vs.Dorman(D)
PA: Corbett(R) vs.Wolf(D) vs.
Newly-elected 2014:
AK-I: Bill Walker
AR-R: Asa Hutchinson
AZ-R: Doug Ducey
IL-R: Bruce Rauner
MA-R: Charlie Baker
MD-R: Larry Hogan
NE-R: Pete Ricketts
PA-D: Tom Wolf
RI-D: Gina Raimondo
TX-R: Greg Abbott
Up for re-election 2014:
AK-R: Sean Parnell
AL-R: Robert Bentley
CA-D: Jerry Brown
CO-D: John Hickenlooper
CT-D: Dan Malloy
FL-R: Rick Scott
GA-R: Nathan Deal
HI-D: Neil Abercrombie
IA-R: Terry Branstad
ID-R: Butch Otter
IL-D: Pat Quinn
KS-R: Sam Brownback
ME-R: Paul LePage
MI-R: Rick Snyder
MN-D: Mark Dayton
NH-D: Maggie Hassan
NM-R: Susana Martinez
NV-R: Brian Sandoval
NY-D: Andrew Cuomo
OH-R: John Kasich
OK-R: Mary Fallin
OR-D: John Kitzhaber
PA-R: Tom Corbett
SC-R: Nikki Haley
SD-R: Dennis Daugaard
TN-R: Bill Haslam
VT-D: Peter Shumlin
WI-R: Scott Walker
WY-R: Matt Mead
Civil Rights
Foreign Policy
Free Trade
Govt. Reform
Gun Control
Health Care
Homeland Security
Local Issues
Social Security
Tax Reform
Term-Limited or Retiring 2014:
AR-D: Mike Beebe
AZ-R: Jan Brewer
MA-D: Deval Patrick
MD-D: Martin O'Malley
RI-I: Linc Chafee
TX-R: Rick Perry
Contact info:
Email Contact Form
Mailing Address:
Longworth HOB 1431, Washington, DC 20515
Official Website


text:
I kinda wish there was a different title for post shattering, only so I'd have reason to get it too, I had a load of fun finding all the quests, discovering all the little things I missed. I'd finished most of every zone while leveling during classic, but missed some good ones, like the first time you meet Tirion in EPL.
Currently playing:
Heroes of The Storm
/join mmo-champion in Heroes
Main support
Rank 5 in Hero League


text:
Wearable Cardioverter-Defibrillators as a Bridge to Implantable Cardioverter-Defibrillator Placement
Revision Date(s) 03/10/15; 05/12/14; 03/10/14; 12/09/13
The use of a wearable cardioverter-defibrillator (WCD) as a bridge to permanent implantable cardioverter-defibrillator (ICD) placement, or replacement of an ICD that was removed, may be considered medically necessary for patients who meet ALL of the following:
Use of a wearable cardioverter-defibrillator for the prevention of sudden cardiac death is considered investigational for all other indications, including immediately (i.e., less than 40 days) following an acute myocardial infarction.
If the patient responds to maximal medical treatment after 90 days, coverage for the WCD will stop.
A short-lived contraindication to implantable cardioverter-defibrillator (ICD) placement occurs infrequently. One reason for use of the wearable cardioverter-defibrillator (WCD) is while a systemic infection is being treated before the ICD can be placed or replaced when an ICD is removed due to infection. Another reason is for a patient with a new onset of nonischemic cardiomyopathy. AHA/ACC Guidelines state that immediate ICD placement is contraindicated until the patient has had maximal medical treatment for 90 days. (6) In some cases the condition improves and the ICD is no longer necessary. The wearable cardioverter-defibrillator is intended for short-term use while the temporary contraindication (e.g., a systemic infection or new onset nonischemic cardiomyopathy) is being treated/managed. Once the intervention for the contraindication is completed, the permanent ICD should be implanted when appropriate.
Primary Prevention criteria for the use of the automatic implantable cardioverter defibrillator in adults:
*Code 93292 cannot be reported with code 93745.
A wearable cardioverter-defibrillator (WCD) is a temporary, external device that is an alternative to an implantable cardioverter-defibrillator (ICD). It is primarily intended for temporary conditions for which an implantable device is contraindicated, or for a period of time during which the need for a permanent implantable device is uncertain.
The available data establish that the WCD device can detect lethal arrhythmias and can successfully deliver a counter shock in most cases. There are a small number of patients who meet established criteria for an ICD but have a transient contraindication for an implantable device, most commonly an infectious process. In these patients who are scheduled for ICD placement, the WCD may be considered medically necessary as an interim treatment. The evidence shows that these patients benefit from a cardioverter-defibrillator in general; and the WCD can detect and treat lethal arrhythmias in these patients.
Sudden cardiac arrest (SCA) is the most common cause of death in patients with coronary artery disease. The ICD has proven effective in reducing mortality for survivors of SCA and for patients with documented malignant ventricular arrhythmias. More recently, the use of ICDs has been potentially broadened by studies reporting a reduction in mortality for patients at risk for ventricular arrhythmias, such as patients with prior myocardial infarction (MI) and reduced ejection fraction. ICDs consist of implantable leads in the heart which connects to a pulse generator implanted beneath the skin of the chest or abdomen. ICD placement is a minor surgical procedure, with the ICD device placed under the skin on the chest wall and the cardiac leads placed percutaneously. Potential adverse effects of ICD placement are bleeding, infection, pneumothorax, and delivery of unnecessary counter shocks. Further information on ICDs may be found in a separate medical policy. (See Related Policies).
The WCD is an external device that is intended to perform the same tasks as an ICD, without requiring any invasive procedures. It consists of a vest that is worn continuously underneath the patient's clothing. Part of this vest is the "electrode belt" that contains the cardiac monitoring electrodes, and the therapy electrodes that deliver a counter shock. The vest is connected to a monitor with a battery pack and alarm module that is worn on the patient's belt. The monitor contains the electronics that interpret the cardiac rhythm and determines when a counter shock is necessary. The alarm module alerts the patient to certain conditions by lights or voice messages. (See Appendix).
The U.S. Food and Drug Administration (FDA) approved the Lifecor WCD® 2000 system via premarket application approval in December 2001 for "adult patients who are at risk for cardiac arrest and are either not candidates for or refuse an implantable defibrillator". The vest was renamed and is now called the Zoll® LifeVest. FDA product code: MVK.
Medical policies are systematically developed guidelines that serve as a resource for Company staff when determining coverage for specific medical procedures, drugs or devices. Coverage for medical services is subject to the limits and conditions of the member benefit plan. Members and their providers should consult the member benefit booklet or contact a customer services representative to determine whether there are any benefit limitations applicable to this service or supply. This policy does not apply to Medicare Advantage.
The most recent literature search of the MEDLINE database was conducted through November 30, 2014.
The available evidence on the wearable cardioverter-defibrillator (WCD) consists of case series describing outcomes from patients using the device. There are no randomized controlled trials (RCTs) of WCD compared to standard care or alternative treatments. Randomized controlled trials of patients undergoing permanent implantable cardioverter-defibrillator (ICD) implantation can provide indirect evidence on the efficacy of the WCD if the indications for a permanent ICD are similar to the potential indications for WCD and if the performance of the WCD has been shown to approximate that of a permanent ICD.
FDA-labeled indications for the device are adult patients who are at risk for sudden cardiac arrest (SCA) and either are not candidates for or refuse an ICD. (1) Some experts have suggested that the indications for a WCD should be broadened to include other populations at high risk for SCD. (2) These potential indications include:
Is the WCD effective in detecting and terminating ventricular arrhythmias for high-risk patients, compared to an implantable device?
There are very few peer-reviewed published studies that report on clinical outcomes of WCDs, and no studies that evaluate the efficacy of WCD in reducing mortality compared to alternatives. Despite the small amount of evidence, a TEC Assessment completed in 2010 (3) concluded that the evidence is sufficient to conclude that the WCD can successfully terminate malignant ventricular arrhythmias. First, there is strong physiologic rationale for the device. It is known that sensor leads placed on the skin can successfully detect and characterize arrhythmias. It is also established that a successful counter shock can be delivered externally. The use of external defibrillators is extensive, ranging from in-hospital use to public placement and use at home. The novelty of this device is in the way that it is packaged and utilized.
Second, there is a small amount of evidence that supports that the device successfully terminates arrhythmias. Two uncontrolled studies were identified that directly tested the efficacy of the WCD. The first was a small case series of 15 patients who were survivors of SCA and scheduled to receive an ICD. (4) During the procedure to implant a permanent ICD, or to test a previously inserted ICD, patients wore the WCD while clinicians attempted to induce ventricular arrhythmias. Of the 15 patients, 10 developed ventricular tachycardia (VT) or ventricular fibrillation (VF). The WCD correctly detected the arrhythmia in 9 of 10 cases and successfully terminated the arrhythmia in all 9 cases. In 2010, Chung et al. published an evaluation of WCD effectiveness for preventing sudden death based on a postmarket release registry of 3569 patients who received a WCD. (5) Investigators found an overall successful shock rate of 99% for VT or VF (79/80 cases of VT or VF among 59 patients). Fifty-two percent of patients wore the device for more than 90% of the day. Eight patients died after successful conversion of VT/VF.
In 2013, Tanawuttiwat et al. reported the results of a retrospective, uncontrolled evaluation of 97 patients who received a WCD after their ICD was explanted due to device infection. (6) Subjects wore the device for a median of 21 days; during the study period, 2 patients had 4 episodes of arrhythmia that were appropriately terminated by the WCD, 1 patient experience 2 inappropriate treatments, and 3 patients experienced sudden death outside the hospital while not wearing their WCD device.
The WEARIT/BIROAD study (7) was a prospective cohort study that evaluated 289 patients at high risk for sudden cardiac death (SCD) but who did not meet criteria for an ICD or who could not receive an ICD for several months. A total of 289 patients were enrolled and followed for a mean of 3.1 months. During this time, there were 8 documented episodes of arrhythmia requiring shock in 6 separate patients. Six of the 8 episodes were successfully resuscitated by the WCD. By group sequential analysis, the estimate of percent successful resuscitations was 69%. There was 99% confidence that the true rate of success was greater than 25% and 90% confidence that the true rate was greater than 44%. In the 2 cases of unsuccessful defibrillation, the authors reported that the WCD was placed incorrectly, with the therapy electrodes reversed and not directed to the skin. Clinical outcomes for longer term follow up for 758 patients prescribed a WCD for a transient or undefined arrhythmia risk who were prospectively enrolled in a registry have been published in abstract form. (8) This abstract reports that during the follow-up period, there were 15 "appropriate" shocks delivered. Details about the registry population, the patient selection process, and the outcomes are not sufficient to allow more complete evaluation of the study findings.
The WEARIT/BIROAD results underscore the difficulty in proper use and compliance with the device. Six patients suffered SCA that was likely due to wearing the device improperly or not wearing the device at all. This implied that a relatively high rate of nonadherence may be the main factor limiting the effectiveness of the WCD. Also, there was a fairly high rate of dropout (22%) over the approximately 3 months of follow-up. In a study of 134 consecutive, uninsured patients with cardiomyopathy and a mean ejection fraction of 22.5% ± 7.3%, Mitrani et al., reported noncompliance with a WCD was even greater. The dropout rate was 35%. (9) The WCD was never used by 8 patients and only 27% wore the device for more than 90% of the day. Patients who were followed for 72 ± 55 days wore the WCD for a mean of 14.1 ± 8.1 hours per day. Additionally, during follow-up, no arrhythmias or shock were detected. In a prospective registry of 82 heart failure patients eligible for WCDs, Kao and colleagues reported 13 patients (15.9%) did not wear the WCD due to refusal, discomfort or other/unknown reasons. (10) These results suggest that the WCD is likely to be inferior to an ICD, due to suboptimal adherence and difficulty with correct placement of the device. Therefore, these data corroborate the assumption that the WCD should not be used as a replacement for an ICD but only considered in those situations in which the patient does not meet criteria for a permanent ICD.
Section Summary
There are no studies that directly compare the performance of a WCD with a permanent ICD. One small study in the electrophysiology lab demonstrated that the WCD can correctly identify and terminate most induced ventricular arrhythmias. A cohort study of WCD use estimated that the percent of successful resuscitations was approximately 70%. In that study, there was a high rate of non-adherence and dropouts, and failures to successfully resuscitate were largely attributed to incorrect use of the device and/or non-adherence. This evidence indicates that the WCD can successfully detect and terminate arrhythmias in at least some patients but that the overall performance in clinical care is likely to be inferior to a permanent ICD.
Does the WCD improve outcomes when used as a bridge to permanent ICD placement or clinical improvement in the following situations, compared to usual care?
Temporary Contraindications to Implantable Cardioverter-Defibrillator
Contraindications to an ICD are few. According to the American College of Cardiology/American Heart Association/ (ACC/AHA) guidelines on ICD use, the device is contraindicated in patients with terminal illness, with drug-refractory class IV congestive heart failure, who are not candidates for transplantation and in patients with a history of psychiatric disorders that interfere with the necessary care and follow-up post-implantation. (11) It is not known how many patients refuse an ICD after it has been recommended for them.
There is a small number of patients who meet established criteria for an ICD (see Related Policies) but have a transient (i.e., short-term) contraindication for an implantable device. The most common contraindication is , a systemic infectious process that precludes ICD insertion or when an ICD is removed due to infection and the reinsertion is delayed until the infection is resolved. The WCD may be beneficial, if the device is able to successfully detect and abort ventricular arrhythmias in this population. The study by Tanawuttiwat et al. referenced above provides some direct evidence that the WCD can be successful, but its successful use may be limited by nonadherence, given that 3 of the 97 patients included in the study died outside of the hospital while not wearing the WCD.
The WCD avoids potential complications associated with ICD implantation, but complication rates with current techniques for ICD placement are low. In 1 large trial of ICD versus antiarrhythmic drug therapy, (12) complications of ICD implantation in 507 patients included hematomas in 13 (2.6%), bleeding requiring transfusion or reoperation in 6 (1.2%), infection in 10 (2.0%), pneumothorax in 8 (1.6%), and cardiac perforation in 1 (0.2%). Early mortality (within 30 days of procedure) was not higher for the ICD group (2.4%), compared to the medication group (3.5%).
Immediate Post-MI Period
The evidence on the use of a WCD as a bridge to permanent ICD placement was reviewed in a 2010 TEC Assessment. (3) The most common of these indications is for patients who are in the immediate post-myocardial infarction (MI) period. For these patients, indications for a permanent ICD cannot be reliably assessed immediately post-MI, since it is not possible to determine the final ejection fraction until at least 30 days after the event. Since the first 30 days following an acute MI represent a high-risk period for lethal ventricular arrhythmias, there is a potential to improve mortality by using other treatments to prevent SCD.
Despite the rationale for this potential indication, the TEC Assessment concluded that the available evidence does not support the argument that any cardioverter-defibrillator improves mortality in patients in the immediate post-MI period. One post-hoc analysis of a randomized, controlled trial and two prospective randomized controlled trials were reviewed that led to this conclusion.
Secondary analysis of data from the MADIT-II trial evaluated whether an ICD improves mortality in the early post-MI period. (13) MADIT-II randomly assigned 1,159 patients with prior MI and an ejection fraction of less than 30% to an ICD or control and showed an overall mortality benefit for patients treated with an ICD. The secondary analysis examined the benefit of ICD according to length of time from the original MI and showed that the benefit of ICD was dependent on the length of time since the original MI. Within the first 18 months post-MI, there was no benefit found for ICD implantation (hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.51-1.81, p=0.92). In contrast, there was a significant mortality benefit when the length of time since MI was greater than 18 months (HR: 0.55; 95% CI: 0.39-0.78, p=0.001).
Two randomized controlled trials (RCTs) were specifically designed to address the question of early ICD use post-MI. The DINAMIT study (14) evaluated the utility of an automatic ICD (AICD) for this patient population. This trial randomly assigned 342 patients with an acute MI and an ejection fraction of 35% or less. The primary outcome was death from any cause, and a predefined secondary outcome was death from an arrhythmia. After a mean follow-up of 30 months, there was no difference in overall survival for the ICD group compared to control (HR: 1.08; 95% CI: 0.76-1.55, p=0.66). There was a significant difference for the ICD group in the secondary outcome of death from arrhythmia (HR: 0.42; 95% CI: 0.22-0.83, p=0.009). The decrease in deaths from arrhythmias for the ICD group was offset by a corresponding increase in deaths due to nonarrhythmic, cardiac causes. The authors suggest that the discrepancy in these outcomes may arise from the fact that patients in whom the ICD successfully aborted an arrhythmia may have eventually died from other cardiac causes, such as progressive heart failure.
The IRIS trial (15) was similar in design to the DINAMIT trial. This study included 998 patients who were 5 to 31 days post-MI and had at least 1 other high-risk factor, either nonsustained ventricular tachycardia or a resting pulse greater than 90. Patients were followed for a mean of 37 months. Results of the IRIS trial were similar to DINAMIT, with no difference in overall mortality between the ICD and control groups (26.1% vs. 25, respectively.8%, p=0.76). The ICD group had a decreased rate of SCD (6.1% vs. 13.2%, respectively, p=0.049), which was offset by a higher rate of nonsudden cardiac death (15.3% vs. 8.6%, respectively, p=0.001). This study also reported noncardiac death, which was similar for the ICD and control groups (4.7% vs. 4.0%, respectively, p=0.51).
In 2013, Epstein et al. reported on registry data from 8,453 post MI patients who received WCDs for risk of sudden cardiac arrest while awaiting placement of an ICD. (16) The WCD was worn a median length of 57 days (mean length of 69 ± 61 days) with a median daily use of 21.8 hours, Appropriate shocks were delivered 309 times in 133 patients (1.6%), 91% of which were successful in resuscitating patients from ventricular arrhythmias. For shocked patients, 62% were revascularized post-MI and the left-ventricular ejection fraction (LVEF) averaged 23.8 ± 8.8%. While 1.4% of this registry population was successfully treated with WCDs, interpretation of registry data is limited. It is not possible to determine whether outcomes were improved without a control group, and the registry contained limited patient and medical information further limiting interpretation of results.
In 2014, Uyei et al reported results of a systematic review conducted with the goal of evaluating the effectiveness of WCD use in several clinical situations, including for individuals early (≤40 days) post-MI with an LVEF less than or equal to 35%.17 The authors identified 36 articles and conference abstracts, most of which (N=28; 78%) were conference abstracts. Four studies (Chung et al [2010],5 Epstein et al. [2013]16, and 2 conference abstracts) assessed the effectiveness of WCD use in post-MI patients.
Outcomes reported were heterogeneous. For 2 studies that reported VF/VT-related mortality, on average 0.52 percent (2/384) of the study population died of VF or VT over 58.3 mean days of WCD use. For 2 studies that reported on VT/VF incidence, on average 2.8 percent (11/384) of WCD users experienced a VT and/or VF event over the course 58.3 (range, 3–146) mean days of WD use. Among those who experienced a VT/VF event, on average 82 percent (9/11) experienced successful termination of one or more arrhythmic events.
High-Risk Patients Post-CABG Surgery
One RCT (CABG PATCH) (18) evaluated early ICD placement in high-risk postcoronary artery bypass graft surgery (CABG) patients, selected by a low left ventricular ejection fraction (LVEF) and abnormalities on signal-averaged electrocardiogram (EKG). The trial followed patients for a mean of 32 months and reported on overall mortality. Results of this trial indicated no difference in overall mortality between the ICD and control groups (HR: 1.07; 95% CI: 0.81–1.42). There were no other mortality outcomes reported. There was a higher rate of infections in the ICD group, both deep sternal infections (2.7 vs. 0.4%, respectively, p< 0.05) and superficial wound infections (12.3 vs. 5.9%, respectively, p< 0.05). The cumulative incidence of inappropriate shocks was 50% at 1 year and 57% at 2 years.
Zishiri and colleagues performed a retrospective study that used registry data to compare outcomes with or without WCD use in patients with LVEF <35% after CABG surgery or percutaneous coronary intervention (PCI). (19) A national registry maintained by the manufacturer was used to identify 809 patients treated with a WCD post-discharge, and a separate registry from the Cleveland Clinic was used to identify 4,149 patients discharged without a defibrillator. At baseline, there were significant differences between groups on age, gender, LVEF and time period of treatment. Of the 809 patients treated with WCD, 1.3% had documented appropriate defibrillation treatment for an arrhythmia. Post-CABG, 90-day mortality was 3% in patients with WCDs versus 7% without WCDs (p=0.03). Post-PCI, 90-day mortality was 2% in patients with WCDs versus 10% without WCDs (p<0.0001). Adjusted long-term mortality risks, after a mean follow-up of 3.2 years, was also decreased in the WCD group (HR: 0.74, 95% CI: 0.57-0.97, p=0.027). These differences in mortality persisted after propensity matching. However, interpretation of this registry data is limited since patients treated with a WCD differed from patients who were not treated, and these differences may not have been completely eliminated through propensity matching. Therefore, this evidence is not sufficient to determine whether WCDs improve outcomes post coronary revascularization.
In the 2014 Uyei et al. systematic review described above, 3 studies (Chung et al [2010](5). Epstein et al. [2013] (16), and 1 conference abstract) were identified that reported outcomes for WCDs after coronary revascularization for patients with LVEF less than or equal to 35%.(17) Reported outcomes were heterogeneous across studies. In one study that reported on VT/VF-related mortality, 0.41% (1/243) of the study population died of VT or VF over the course of 59.8 days (mean or median not specified). Of those who experienced a VT/VF event, 7% of patients died over the course of "approximately 2 months" of WCD use. In another study, 50% of those with VT/VF events died over the course of 59.8 days.
High-Risk Patients Awaiting Heart Transplantation
There are no studies that are specifically address this population of patients, but some patients awaiting transplantation have been included in studies with mixed populations. The WEARIT/BIROAD study, discussed previously, was a prospective cohort study that included patients awaiting transplant, but it also included other high-risk patients and did not report separately on the population of patients awaiting transplant. (5) Rao et al. (19) published a case series of 162 patients with either congenital structural heart disease or inherited arrhythmias treated with WCD. Approximately one-third of these patients had a permanent ICD, which was explanted due to infection or malfunction. The remaining patients used the WCD either as a bridge to heart transplantation, during an ongoing cardiac evaluation, or in the setting of surgical or invasive procedures that increased the risk of arrhythmias. There were 4 patient deaths during a mean duration WCD treatment of approximately 1 month, but none of these were related to cardiac causes. Two patients received a total of 3 appropriate shocks for ventricular tachycardia (VT)/ventricular fibrillation (VF), and 4 patients received a total of 7 inappropriate shocks. The results of this study suggest that the WCD can be worn safely and can detect arrhythmias in this population, but the rate of inappropriate shocks is relatively high.
Newly Diagnosed Non-Ischemic Cardiomyopathy
Another potential indication for the WCD is in patients with newly diagnosed nonischemic cardiomyopathy. Similar to acute MI, in these patients the final ejection fraction is uncertain, since some patients who are newly diagnosed with nonischemic cardiomyopathy show an improvement in ejection fraction over the ensuing several months. A post-hoc analysis of the DEFINITE trial, (21) which evaluated the use of an ICD in nonischemic dilated cardiomyopathy, examined the benefit of ICD use by time since diagnosis. This trial excluded patients with a clinical picture consistent with a reversible cause of cardiomyopathy and thus may differ from the population considered for a WCD. For the overall DEFINITE trial, there was a 35% reduction in overall mortality, but this difference did not meet statistical significance. In the re-analysis, patients were divided into recent diagnosis of cardiomyopathy (less than 3 months) and remote diagnosis (greater than 9 months). The difference in survival was of borderline significance for the ICD group compared to controls, both for the recently diagnosed subgroup (HR 0.38; 95% CI: 0.14–1.00, p=0.05), and the remotely diagnosed subgroup (HR 0.43; 95% CI: 0.22–0.99, p=0.046).
The 2014 Uyei et al. systematic review described above identified 4 studies (Saltzberg et al. [2012], (22) Chung et al. [2010], (5) and 2 conference abstracts) that assessed WCD use in newly diagnosed nonischemic cardiomyopathy. (17) In the 3 studies that reported VT/VF incidence, an average 0.57% (5/871) subjects experienced VT and/or VF over a mean duration of 52.6 days. Among those who did experience a VT/VF event, an average 80% experienced successful event termination.
Peripartum Cardiomyopathy
One study of WCD use in peripartum cardiomyopathy was published in 2012. (22) This study included 107 women with peripartum cardiomyopathy treated with a WCD device during the period of 2003 through 2009. Patients were identified from a registry of WCD use maintained by the manufacturer of the device. The average length of time that the WCD was used was 124(123) days. During this time, there were no shocks delivered, either appropriate shocks or inappropriate shocks. There were also no patient deaths during the time of WCD treatment. Following discontinuation of the WCD, there were 3 deaths over a mean follow-up of 3.0(1.2) years. In a matched group of 159 women with non-ischemic cardiomyopathy who wore the WCD for 96(83) days, there were 2 appropriate shocks and 11 deaths.
In a smaller study reported in 2014, Duncker et al. reported outcomes for 12 prospectively-enrolled women with peripartum cardiomyopathy who were treated at a single center and followed over a median of 12 months. (23) A WCD was recommended for 9 patients with LVEF less than or equal to 35% and 7 of the 9 consented to wear the WCD. For these 7 patients, the median WCD wearing time was 81 days (mean 133 days). In 3 patients, 4 episodes of VF were detected that led to delivery of a shock, which successfully terminated the arrhythmia in all cases. No inappropriate shocks were delivered. Among the 5 patients without WCD, no episodes of syncope, ventricular arrhythmias, or deaths occurred.
For patients with indications for an ICD but temporary contraindications, the use of a WCD for a temporary period of time is likely to improve outcomes. These patients are expected to benefit from an ICD, and the use of a WCD is a reasonable alternative as there are no other options for automatic detection and termination of ventricular arrhythmias.
Two RCTs of implantable cardioverter-defibrillator use in the early post-acute MI period concluded that mortality was not improved compared to usual care. In both these trials, sudden cardiac death was reduced in the ICD group, but non-sudden cardiac death was increased, resulting in no difference in overall mortality. One trial of high-risk post-CABG patients also reported no benefit from implantation of a permanent ICD. Since a permanent ICD does not appear to be beneficial in these situations, a WCD would also not be beneficial for these patient populations.
For other indications, evidence is lacking concerning the impact of a WCD on outcomes. Case series for these conditions are not sufficient to determine whether a WCD improves outcomes compared to usual care.
External Automatic Cardiac Defibrillators
Home use of an automatic external cardiac defibrillator is another potential alternative to either an ICD or a wearable defibrillator. However, there are no clinical trials that establish the efficacy of automatic external defibrillators for high-risk patients. Bardy et al. (24) randomly assigned 7,001 patients with anterior wall MI, who were not candidates for ICD implantation, to home external defibrillator or usual care. After a median follow-up of 37.3 months, there was no difference in mortality between groups (HR 0.97, 95% CI: 0.81-1.17). Therefore, home external defibrillators may not be a good alternative to ICD or WCD in high-risk patients.
Ongoing Trials
A search of the online database ClinicalTrials.gov on December 10, 2014, identified 1 randomized controlled trials evaluating wearable cardioverter defibrillators that is ongoing:
Clinical Input Received From Physician Specialty Societies and Academic Medical Centers
While the various physician specialty societies and academic medical centers may collaborate with and make recommendations during this process through the provision of appropriate reviewers, input received does not represent an endorsement or position statement by the physician specialty societies or academic medical centers, unless otherwise noted.
2008 Input
In response to the request for input through physician specialty societies and academic medical centers, no input was received while this policy was under review for the April 2008 update.
2010 Input
In response to requests, input was received from no physician specialty societies and 4 academic medical centers while this policy was under review in 2010. Most, but not all, of those providing input suggested that the wearable defibrillator may have a role in selected high-risk patients following acute MI or in newly diagnosed cardiomyopathy.
2013 Input
In response to requests, input was received on the policy as a whole from 3 physician specialty societies and 8 academic medical centers while this policy was under review in 2013. Overall the input was mixed. Most, but not all, of those providing input suggested that the wearable defibrillator may have a role in selected high-risk patients following acute MI or in newly diagnosed cardiomyopathy. However, reviewers acknowledged the lack of evidence for benefit and that available evidence was not consistent in defining high-risk subgroups that may benefit.
2014 Input
In response to requests, further input was input was received from 2 physician specialty societies and 7 academic medical centers while this policy was under review in 2014, related to the role of WCDs in preventing sudden cardiac death among high-risk patients awaiting a heart transplant. Overall, the input regarding the use of wearable defibrillators in this patient population was mixed. Some reviewers indicated that it may have a role among certain patients awaiting heart transplant, but there was not consensus on the specific patient indications for use.
Summary of Evidence
The available data establish that the WCD device can detect lethal arrhythmias and can successfully deliver a counter shock in most cases. There are a small number of patients who meet established criteria for an ICD but have a transient contraindication for an implantable device, most commonly an infectious process. In these patients who are scheduled for ICD placement, the WCD is considered medically necessary as an interim treatment. The evidence shows that:
For other bridging indications, particularly for the immediate post-MI period, the evidence does not support the conclusion that the WCD improves outcomes. Clinical trial evidence from two randomized controlled trials report that overall survival is not improved. While these two trials both report a decrease in SCD, there is a corresponding increase in non-SCD, resulting in no net benefit in survival. Similarly, for high-risk post-CABG patients, one randomized controlled trial reports no difference in overall survival associated with early ICD placement. Thus, given the lack of trials that demonstrate the impact of the WCD on outcomes, these indications are considered investigational.
For other potential indications, there are only case series or no relevant published evidence. Therefore it is not possible to conclude from the available evidence that net health outcome will be improved. These other indications, including bridge to transplantation and peripartum cardiomyopathy, are also considered investigational.
Practice Guidelines and Position Statements
Guidelines from the major cardiology specialty societies do not make specific recommendations for the use of WCD. For example, the 2006 ACC/AHA guidelines on the treatment of patients with ventricular arrhythmias (25) include a statement on WCD but does not include a formal recommendation. "The wearable automatic defibrillator has been approved in the United States by the FDA for cardiac patients with a transient high risk for VF [ventricular fibrillation] such as those awaiting cardiac transplantation, those at very high risk after a recent MI [myocardial infarction] or an invasive cardiac procedure, or those requiring temporary removal of an infected implanted defibrillator for antibiotic therapy." In 2014, the Heart Rhythm Society, American College of Cardiology, and the American Heart Association issued a consensus statement on the use of ICD therapy in patients who are not included or not well-represented in clinical trials. (26) The statement does not contain formal recommendations regarding WCD use, but states, "The wearable cardioverter-defibrillator (WCD) may be an option as a 'bridge to ICD' for selected patients at high risk of sudden cardiac death due to ventricular arrhythmias, although the data are scant."
In 2014, the American College of Cardiology and the American Heart Association issued guidelines on the management of non-ST-elevation acute coronary syndrome (NSTE-ACS) (27) These guidelines do not make specific recommendations regarding the use of WCDs, but do state the following: "Life-threatening ventricular arrhythmias that occur >48 hours after NSTE-ACS are usually associated with LV [left ventricular] dysfunction and signify poor prognosis. RCTs [randomized controlled trials] in patients with ACS have shown consistent benefit of implantable cardioverter-defibrillator therapy for survivors of VT [ventricular tachycardia] or VF arrest. For other at-risk patients, especially those with significantly reduced LVEF [left ventricular ejection fraction], candidacy for primary prevention of sudden cardiac death with an implantable cardioverter-defibrillator should be readdressed ≥40 days after discharge. A life vest may be considered in the interim."
In 2006, The International Society for Heart and Lung Transplantation (ISHLT) issued guidelines for the care of cardiac transplant candidates that address the use of implantable or wearable cardioverter-defibrillators (28) Recommendations related to the use of WCDs include:
Medicare National Coverage
There is no national coverage determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of local Medicare carriers.
Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; wearable defibrillator system
Initial set-up and programming by a physician of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events
Automatic external defibrillator, with integrated electrocardiogram analysis, garment type
Replacement battery for automated external defibrillator, garment type only, each
Replacement garment for use with automated external defibrillator, each
Replacement electrodes for use with automated external defibrillator, garment type only, each
Type of Service
Place of Service
Selected components of the wearable cardioverter-defibrillator (from FDA website)
New Policy. Premera policy created to include in the policy statement, information about when coverage for the WCD will stop; and to maintain the allowance of newly diagnosed nonischemic cardiomyopathy (as explained in the Policy Guidelines) as an indication for the temporary use of the WCD. The Policy Guidelines statement on nonischemic cardiomyopathy was changed to investigational in the October 2012 version of BCBSA policy 2.02.15. Therefore, Policy 2.02.15 is deleted.
Replace policy. Policy updated with literature review. References 6, 7, 13, 15 added. No change to policy statement.
Replace policy. Policy statement unchanged. References 5, 6 added. ICD-9 and ICD-10 diagnosis codes removed; these are not utilized in adjudication.
Interim review. Added primary prevention criteria found in 7.01.44 to the Policy Guidelines section.
Update Related Policies. Remove 2.02.10 as it was archived.
Annual Review. Policy statements unchanged. References 8,17,23,26,27,28 added.
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When it comes to treating your guests, these Chicago bakeries go all out.
BRIDES Chicago: The Best Local Bakeries to Buy Wedding Sweets
When it comes to treating your guests, these Chicago bakeries go all out.
Which Celebrity Would You Want to Officiate Your Wedding? Real Brides Respond!
We asked a bunch of brides-to-be to answer the following question: If you could have any celeb officiate your wedding, who Read More »
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Do You Really Need to Give Guests Welcome Bags at Your Wedding?
Give guests a hearty welcome with a thoughtful gift bag to kick off your wedding festivities.Read More »
A Wedding Dress We Love by Melissa Sweet
Freshen up a classic with bold accessories.Read More »
5 Fresh Alternatives for Popular Pinterest Wedding Trends
What you need to know if you don't want your wedding to look like every other one on Pinterest.Read More »
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- Wedding Style
Mila Kunis and Ashton Kutcher Might Finally Get Married This Weekend!
The moment we've all been waiting for might finally be here!Read More »
BRIDES New York: How to Get a Marriage License in New York City
Let us help you navigate the big city's court system.Read More »
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BRIDES Northern California: The Best Wedding Venues in San Francisco
Check out our favorite spots in the Bay Area to tie the knot.Read More »
Tips to Keep Your Best Man from Embarrassing You During His Speech
If you love him but not his sense of humor, then these tips are for you.Read More »
Get Inspired: How to Add Rustic Touches to Your Wedding
Whether you want to play up your outdoor venue or add some contrast to an industrial space, get inspired for your Read More »
Fun and Creative Alternatives to a Sparkler Exit
Who says you need sparklers to illuminate your wedding?Read More »
WATCH: You Don't Want to Miss This Couple's Safari Wedding in South Africa
From the stunning landscape to the bride's bright red wedding dress, there's lots to see (and love!) at this summer destination Read More »


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In Minecraft Vanilla SMP, having access to the server, can I somehow retrieve the position of an offline player?
Take the 2-minute tour ×
Arqade is a question and answer site for passionate videogamers on all platforms. It's 100% free, no registration required.
Yes. Use NBTedit:
Editor by copyboy from minecraftforum.net:
Download it, and run, click File -> Open then go to your Minecraft server directory and find players directory and select the name of player you want, for example Player.dat
You should see something like this:
You need to go to "Pos", and there you have it, coords of player you wanted.
Just double click any to edit it :D


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» Views
Populism or prudence
Publication Date : 20-08-2014
India's national and regional parties are engaged in competitive populism, which is gradually driving the country towards a financial and political abyss. Mindless populism has led to mass madness of greed and entitlement. Subsidies are always tempting; they guarantee instant pay-offs for political parties, and this has been especially true since the 1980s when Indian politics became more turbulent.
Elections are virtually defined by promises of subsidy. A significant percentage of federal and state revenues are allocated as subsidies whose objectives have not been met on account of poor governance and rampant corruption. The handling of subsidies has come to be marked by theft and leakages.
Given the alarming fiscal deficit, rising inflation and the dire fiscal condition of several states, questions are being raised as to whether India is fast approaching a tipping point and whether subsidies, if unchecked, will irreversibly damage the country's rise as a rapidly emerging economic power. As the Finance Minister has pointed out: "India has to make a choice between mindless populism and fiscal prudence."
While certain subsidies are explicit in the budget, others are hidden. The second category includes subsidies on interest rates, in the provisions made for social and
economic services, notably health care and education. Subsidies on food, fertiliser and fuel (kerosene and LPG) are prominent and constitute the largest chunk -
totalling around 2.5 lakh crore rupees (US$40.97 billion) or around 2.5 per cent of the GDP.
The amount of food subsidy has increased significantly in the post-reforms period and has reached a record level of Rs 1,30,000 crore in 2013-14 to cover expenditure on food security. India has one of the largest food subsidy programmes in the world; it has created a relatively effective social safety net but has also been criticised for the budget deficits, economic inefficiency, poor targeting and huge leakages.
The increase in the food subsidy bill has been attributed to the rise in procurement prices and other incidental charges that have to be borne to build up a buffer stock of foodgrain for the sake of food security. As it turns out, the government is the biggest hoarder of foodgrain because of the sharp annual ratcheting up of the Minimum Support Price (MSP) since the mid-Nineties.
The waste in government runs parallel to widespread hunger. One estimate suggests that a one per cent increase in MSP leads to a 0.3 per cent rise in the consumer price index. The MSP was originally meant to be a safety mechanism to insulate farmers from the vagaries of the open market. The support price is one way to placate the vote-banks.
The Targeted Public Distribution System (TPDS) has been far from effective. A large quantity of subsidised foodgrain gets diverted and resold to procuring agencies of the government. In 2013, the Planning Commission reported that almost 40 per cent of the foodgrain, allocated under the TPDS, did not reach the intended beneficiaries.
Agriculture is the main prop of the Indian economy; it provides sustenance and livelihood to more than 70 per cent of the rural populace.
Free electricity has been used by medium and large landowners to extract groundwater (GW) throughout the year to such an extent that aquifer levels have dropped sharply in several states. In certain regions, the depletion is alarmingly close to 90 per cent. The presence of arsenic in GW has been reported in West Bengal, Bihar, Jharkhand, Chhattisgarh, UP and Assam.
The subsidy on chemical and synthetic fertilisers has increased exponentially from a mere 60 crore during 1976-77 to an astronomical amount - 67,971 crore in 2013-14. According to the Economic Survey of 2013-14, indiscriminate use of chemical fertilisers has led to the imbalanced use of soil nutrients in Punjab and Haryana - the granary of India. As a result, the quality of the soil has declined.
The biggest challenge is the burden of subsidies on petroleum products. Kerosene for the PDS, domestic LPG and diesel are sold at rates that are far less than international market prices. The argument for providing subsidies on LPG is totally irrational as cooking gas is used by the rich and the middle class.
Studies show that 40 - 50 per cent of kerosene, supposedly meant for the poor, is diverted for other purposes, mostly for adulterating diesel. Two bright young officers of a public sector oil company were killed for spilling the beans. Adulterated diesel can damage vehicles and aggravate pollution. Use of kerosene can lead to respiratory diseases. It is almost as if the government is subsidising pollution, fuel adulteration, congestion and chest ailments.
Another expression of populism is the 'loan mela' or the practice of writing off of debts of the poor. Subsidies are directed at various sections of society to assist
the poor economically. But the benefits are hijacked by those who are powerful. The poor have to make do with the minimum share of both visible and hidden subsidies.
"We are basically a subsidy-driven economy and that has to change," Amartya Sen had once remarked. This is not to suggest that subsidies are wholly undesirable. To subsidise the vulnerable segments of the population is the core of any economic policy, not only in India but all over the world.
The transfer of subsidies to the poor and without leakage can lessen their constraints and induce them to improve their capabilities and attain their own potentialities. The objectives of subsidies can be achieved if they are judiciously devised, properly targeted, transparent and accompanied by official data that can enable the intended beneficiaries to claim the welfare handouts as a matter of right.
($1= 61.02 rupees)
(The writer is a retired IAS officer)
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● TOKYO: Intransigent N. Korea must be pressed to advance its probe of abductions


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Burberry London
Rabbit-Collar Wool-Blend Coat
Unfortunately, this item will not be back in stock.
Burberry London's patriotic history as a military supplier comes to the forefront in this smartly detailed wool-blend coat. It features epaulettes and a belted back, along with a detachable rabbit collar and double-breasted fastening. Slip it over tailoring to strike a dynamic silhouette in the city. Shown here with a Raf Simons shirt, Jil Sander trousers and Paul Smith shoes.
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text: Google's Chrome OS netbook coming Dec. 7th December 3, 2010 9:13 PM Devindra Hardawar 0 If you're not reaching, engaging, and monetizing customers on mobile, you're likely losing them to someone else. Register now for the 8th annual MobileBeat, July 13-14, where the best and brightest will be exploring the latest strategies and tactics in the mobile space. It's been a long stretch, but Google is nearing the finish line with its Chrome OS netbook operating system. The company sent out invitations today to a Chrome event on Tuesday, December 7th, where it will launch the netbook, sources tell Engadget. But don't expect to get your hands on one anytime soon. Apparently, there will only be around 65,000 units produced, and those will go to Google's closest "friends and family." It's a testing method the company has already used for its Nexus S Android phone, and which it seems to be using for its upcoming Nexus S phone. The version of Chrome OS on the devices will also be an early beta release that's not quite ready for prime time, so Google wouldn't want to sell the netbooks to general consumers. The news follows our report from early November that speculated Google was set to launch Chrome OS smartbooks during that month. Many of the details from that report seem to be validated with this latest news — namely the low production amounts, and that the devices will be manufactured by Taiwanese firm Inventec. That earlier report was wrong about the first Chrome OS device being a smartbook though — it's apparently running an Intel Atom Pine Trail processor, like a typical netbook, and not a cellphone processor as smartbooks generally do. All Things Digital is also reporting that Google is gearing up to launch its Chrome App Store on December 7th, which would house web apps that would work on Chrome OS, as well as Chrome browsers on any platform. What better way to launch your app store than with a shiny new device? Chrome OS and other devices running it won't be available to consumers until 2011. Hopefully by then, Google can get a better sense of what it actually wants to do with Chrome OS. We reported last week that Google executives still don't have a clear way to define the OS. VB's research team is studying mobile user acquisition... Chime in here, and we'll share the results.


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Medford Real Estate Listings & Rental Properties in Oregon
Looking to buy a home or rent an apartment? Whether you are looking for homes for sale, new homes, apartments finder, guides and rentals, foreclosures or apartment communities for rent; Find all Medford real estate for sale or rent in Oregon on OregonLive.com.
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Homes For SaleView More Listings »
Medford, OR 97501
Single Family
3 Beds, 2 Baths
Offered by Windermere Real Estate/Lane County
754 N Riverside
Medford, OR 97501
48 Beds, 24 Baths
Offered by JOSEPH BERNARD, LLC
2508 Argonne Avenue
Medford, OR 97504
Single Family
7 Beds, 4 Baths
Offered by Cynthia J Sleppy Real Estate
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800 Danville Lane
Medford, OR 97501
Single Family
3 Beds, 3 Baths
1331 Swayze Lane
Medford, OR 97501
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3 Beds, 2 Baths
4352 Tamarack Drive
Medford, OR 97504
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4 Beds, 4 Baths
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Apartments & RentalsView More Listings »
4609 Cherry Lane
Medford, OR 97504
Single Family
3 Beds, 2.5 Baths
Offered by Bob Seldon & Associates, LLC
901 W 8th St - 901 W 8th St.
Medford, OR 97540
Single Family
Offered by Ashland Property Management, LLC
1215 W. 11th St
Medford, OR 97501
Single Family
2 Beds, 1 Bath
Offered by J&L Moore Property Management, LLC
Apartments & Rentals in Medford Area: Apartments & Rentals Listings »
When searching for in Medford, OregonLive.com wants you to have all of the right information to help you make the best decision possible. We know that the search can be difficult and we strive to make it easier for you. Since we have thousands of for you to browse through, there's no need to go anywhere else. Our rental listings feature photos, amenities, maps, detailed descriptions, and denote if the apartment is pet friendly to help you make the best choice.
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You can also browse all real estate types and MLS listings by Medford above, or you can also view results by neighborhoods or regions.


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Matt Slauson
Position: G
Height: 6-5 Weight: 320 lbs.
Born: February 18, 1986 in Sweet Home, OR
High School: Sweet Home, Air Force Academy Prep
College: Nebraska (school history)
Drafted by the New York Jets in the 6th round (193rd overall) of the 2009 NFL Draft.
Weighted Career AV (100-95-...): 25 (3955th overall since 1950)
Promote your website or business by sponsoring this page for $5 on Pro-Football-Reference.com. Your message will replace this ad.
Output includes all games from 1920 to 2014.


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1836 P2C Two Cents, Judd-52, Pollock-55, Low R.6, PR65 NGC....
2009 January Orlando, FL FUN Auction #1121
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Orange County Convention Center
Innovative 1836 Two Cent Pattern in Billon1836 P2C Two Cents, Judd-52, Pollock-55, Low R.6, PR65 NGC.
Judd-52, PR65
Judd-52, PR65
Design. Obverse: A small eagle with outstretched wings standing on a cloud, with the peripheral legend UNITED STATES OF AMERICA and 1836 below. Reverse: The denomination TWO CENTS surrounded by a laurel wreath. Struck in billon (90% copper, 10% silver) with a plain edge.
Commentary. The two cent denomination was proposed as part of the Act of January 13, 1837. Unfortunately, the portion of the bill dealing with the two cent coin was deleted before the bill was passed. The two cent coin became a reality only in 1864.
Physical Description. A well-preserved specimen, with a sharp strike and wisps of gray toning. An attractive example of this early pattern. NGC Census: 2 in PR65, none finer. PCGS Population: 1 in PR65, none finer (12/08).
Provenance. Stack's private treaty transaction (10/1991).
From The Lemus Collection, Queller Family Collection Part Two. (PCGS# 11194)
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Limin' with the Locals
There are no hot sauce factories in Barbados that offer an official tour like the Mt. Gay operation, but Anne Marie was able to arrange visits to two facilities. "Factory" is an extravagant term for what is essentially hands-on manufacturing of the typical Bajan hot sauce that's bright yellow with dangerous red flecks of bonney pepper. At the Lottie's facility, about fourteen workers sat around tables performing various necessary functions: cleaning bonney peppers, chopping onions, mixing herbs and spices, and applying labels to bottles of the finished products.
Ready for Processing
Jackie Heath, owner of Lottie's, was in the middle of shipping a 55-gallon drum of hot sauce to the U.S., where it would be bottled as Spitfire Sauce. She revealed to us that she had switched careers in mid-stream, giving up selling insurance to become the producer of one of the island's best-known brands of hot sauces, seasonings, and fruit juices. Her mustard-based hot sauce is so popular that Jackie has part of each batch packed in 32-ounce bottles! She estimates that there are between six and eight firms manufacturing hot sauces in Barbados right now, and that probably a maximum of 100 acres of bonney peppers are under cultivation in many small plots to supply the hot sauce industry.
Bajan Chile Products
One of Jackie's competitors is Pat McClean, who runs L.G. Miller Import and Export, which manufactures and sells hot sauces and other products under the Windmill Products brand. Her father started the business in 1965 with a homemade hot sauce recipe and soon they were producing thirty gallons of sauce a week. Nowadays, their capacity is about 2,000 gallons per week, and part of each batch is packed for competing brands. They also run special manufacturing for other Bajan food companies; for example, Pat bottles Anne Marie's Native Treasures brand.
Pat McClean
When we visited, the plant was down except for workers cleaning tamarind, but Pat showed us the modern, stainless steel equipment and the stacked products produced from the last batches run: three versions of hot pepper sauce, two ketchups, a number of syrups, jams, and jellies, and the ever-present Bajan herb seasonings. Pat loaded us up with samples, and we staggered out to the car.
Ever the organizer, Anne Marie had scheduled two sessions of "limin'." Now, to lime is essentially to relax and hang out with friends, which is easily done in friendly Barbados. One night, she and her husband Charlie took us to the fishing village of Oistins for a seafood feast. Numerous vendors prepared the day's catch, spiced up with the ubiquitous hot sauces. I opted for dolphin at Bellamy's stand and received a succulent cut from near the backbone that tasted great with Anne Marie's tamarind sauce, not to mention her nutmeg-dusted rum punch. We were joined by Mark and Kim and Noel and Andrea and soon a spirited discussion resulted, during which we covered all the important subjects: could Dole beat Clinton, Princess Di's affairs, the Chicago Bulls, and Mighty Gabby's calypso song about Lorena Bobbitt.
The limin' continued in full force on Sunday, when a caravan of cars converged on Farley Hill and most of the crew from Oistins was joined by Jasmine and Frank, Norman the jokester and Dennis for a rain-soaked picnic. Farley Hill is a landscaped national park and the ruins of a nineteenth-century plantation great house that was featured in the 1956 Harry Belafonte film, Island in the Sun. That would be before it burned down. Some 900 feet above the ocean, it is constantly cooled by the trade winds, which brought squalls that kept us jumping back into the cars. Under the direction of Anne Marie, we feasted on Cabbage and Bacon Salad, Roasted Pork with Bajan Seasoning, Ackee and Salt Fish, Caribbean Rice, Coconut Bread, Black Cake, and Sweet Potato-Pineapple Pie.
The only question we had was, could restaurant fare top this?
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text: Bollywood Indian actress Urmila Matondkar gestures during a press conference in Lahore, 10 December 2003. Matondkar used the third day of her Pakistani tour to urge visa restrictions to be eased in order to allow more artists to travel between India and Pakistan. Urmila has been approached by The United Nations Development Programme (UNDP) to shoot a music video depicting the easing of relations between India and Pakistan. AFP


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July 8th, 2014 #1Registered User
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Need help with choosing a monitor
Hello everyone, Im currently looking for a new monitor with focus on Digital Art but Im kinda in the blue here Ive bought my current monitor(lg flatron w2252tq pf 22) like 4-6 years ago, before I even started thinking about working in Photoshop so its not really up to task, unfortunately my budget is low so Im looking for the best cheapest solution (max 500$) from what Ive read the best one in this price range is EIZO FS2333 but most people rate it by how well it does in games(doesnt matter to me) and its hard to tell how usefull it is for this kind of purpose. So I will be gratefull for all opinions, tips or mayby other propositions for that price.
PS.I dont see any hardware specific tread so Im posting it here I hope its ok.http://getsugadante.deviantart.com/gallery/ - DeviantArt Gallery
Hide this ad by registering as a memberJuly 20th, 2014 #2
Hi there,well for a low budget you can always look for dell u2414h . Its around 300$ very good colors, no flicker and also provides you a usb 3 hub.


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Budget Battle Concludes
[Sorry, the video for this story has expired, but you can still read the transcript below. ]
KWAME HOLMAN: The Senate spent most of today disposing of some 40 amendments in order to bring the budget outline for the next fiscal year to a vote this afternoon.
SEN. PETE DOMENICI: First I want to say to the Senate, we're getting very close. We only have about four amendments on each side, and I think we can work them out.
KWAME HOLMAN: But the real focus was on the floor where final negotiations toward a ten-year tax cut and spending plan were underway. Leaders were trying to fashion a deal that would satisfy main- line Republicans and Democrats, as well as a small number of centrists from both parties. That was necessary because on Wednesday it became apparent President Bush's $1.6 trillion, ten-year tax plan could not survive in the evenly divided Senate. Democrats, with the help of three Republicans, voted to divert nearly $500 billion of the tax cut to education programs and federal debt reduction. Today, as the appointed time for the final vote arrived, it became clear some compromise had been reached, only because Budget Committee Chairman Pete Domenici called for the yeas and nays.
SPOKESMAN: The clerk will call the roll in final passage.
KWAME HOLMAN: And as the vote proceeded, it also was clear that compromise was one more than a few Democrats could support.
SPOKESMAN: Mrs. Carnahan, aye. Mr. Johnson; Mr. Johnson, aye.
KWAME HOLMAN: Though he wasn't needed to break a tie vote, Vice President Dick Cheney announced the final tally.
DICK CHENEY: The ayes are 65. The nays are 35.
KWAME HOLMAN: The action then shifted to the media gallery, and reporters learned the compromise was just under $1.3 trillion in tax cuts over ten years, about $300 billion below the President's mark. The Vice President said the administration was satisfied with that outcome for now, but more negotiations lie ahead when Senate and House members meet in a Conference Committee.
DICK CHENEY: I think in the final analysis we made a decision that the best way to proceed was to take the number that was there as of this morning with respect to the overall tax level, I think Pete said, what, 1.3, 1.28, and go with that, rather than try to have another vote this afternoon and take that to conference. And we're confident that coming out of conference we will get a good number, fairly close to what the President originally recommended.
KWAME HOLMAN: A majority of Democrats voted against the package, but Democratic leaders too declared satisfaction. The package directs tax writing committees to decide how to send $85 billion in tax rebates to Americans during this calendar year.
SEN. KENT CONRAD: It was a Democratic amendment on the floor that put the fiscal stimulus for this year at $85 billion of tax cut to put money in people's pockets as quickly as possible. And we have said we think it should be a combination of rate cut and direct payments to taxpayers to give a lift to this economy.
KWAME HOLMAN: Democratic Leader Tom Daschle said there was even more.
SEN. TOM DASCHLE: More importantly than just the tax cut, what we feel good about, of course, is the commitment now to education and the commitment to debt reduction that we felt were so important. Not only that, we have the full commitment to prescription drug benefits. So I think we've made good progress this week, and I'm very encouraged by it. I understand some of our Republican friends have called this a victory. If this is a victory, there ought to be more like them.
KWAME HOLMAN: But the spotlight may have been brightest on the handful of Senate centrists, whose commitment to a smaller tax cut than the President's help force the compromise . The tax cut figure in the resolution is almost exactly what centrist leader John Breaux of Louisiana proposed early in the debate.
SEN. JOHN BREAUX: I that think what we have shown today that it is, in fact, possible to change the political culture of Washington. A vote of 65-35 for a budget is a significant change from the way business was done in the past, and I think it does represent a new day of cooperation between both parties to reach a common goal and a common good.
KWAME HOLMAN: For his, the President says this latest step toward final action on taxes and spending bodes well.
PRESIDENT GEORGE W. BUSH: When the House and Senate complete their work, they will have paved the way so the American people can receive an across-the-board income tax reduction, a doubling of the child credit, relief from the marriage penalty, and the elimination of the death tax. This budget also wisely increases spending on education, funds priorities like Medicare and Social Security, and pays down a record amount of debt.
KWAME HOLMAN: The process begins when Congress returns from its two-week recess.


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Sweetwater High School's football and volleyball teams are heading to Snyder today for what could be consider-ed their last "doubleheader" of the 2011 season, and the rivalry between the schools won't be the only thing on both teams' minds.
The SHS football team, which is 1-1 in district play after a 28-6 win last week over Big Spring, must win one of its last two games to have a playoff shot. Snyder (1-0) is tied with Wylie for first place and leads both Sweetwater and Brownwood by a half-game.