text:
Pre-SMACC mini RAGE
Currently the RAGE Podcast site is recovering from a cold, so here are the show notes for the pre-SMACC mini RAGE episode released June 2015.
And here are the references:
It's a knockout
GoodSAM App
AVOID: Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction.
HOT or NOT trial: HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial.
Helicopter Emergency Medical Services
Survival benefit of a physician-staffed HEMS assistance for severely injured patients
Willingness to pay for lives saved by HEMS
Intraosseous access
Intraosseous infusion rates under high pressure: a cadaveric comparison of anatomic sites.
Intraosseous hypertonic saline: myonecrosis in swine
Intraosseous hypertonic saline: safe in swine
Discussion post about intraosseous hypertonic saline at Sydney HEMS
Handstands: a treatment for supraventricular tachycardia?
Impact of a modified Valsalva manoeuvre in the termination of paroxysmal supraventricular tachycardia
The next RAGE Podcast will air late August / early September
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Post-arrest hypothermia in children did not improve outcome
Many clinicians extrapolate adult research findings to paediatric patients because there's no alternative, and until now we've had to do that with post-cardiac arrest therapeutic hypothermia after paediatric cardiac arrest.
However the THAPCA trial in the New England Journal of Medicine now provides child-specific data.
It was a multicentre trial in the US which included children between 2 days and 18 years of age, who had had an out-of-hospital cardiac arrest and remained comatose after return of circulation. They were randomised to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C) within 6 hours after the return of circulation.
Therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit with respect to survival with good functional outcome at 1 year, and survival at 12 months did not differ significantly between the treatment groups.
These findings are similar to the adult TTM trial, although there are some interesting differences. In the paediatric study, the duration of temperature control was longer (120 hrs vs 36 hrs in the adult study), respiratory conditions were the predominant cause of paediatric cardiac arrest (72%), and there were only 8% shockable rhythms in the paediatric patients, compared with 80% in the adult study.
The full text is available here.
Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children
N Engl J Med. 2015 Apr 25
Background: Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.
Methods: We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest.
Results: A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality.
Conclusions: In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year.
Don't just pre-oxygenate: have an Oxygenation Strategy
March 3, 2015 by Cliff
Filed under All Updates, EMS, ICU, Resus
A key component in the planning of intubation is pre-oxygenation. Recently apnoeic oxygenation during laryngoscopy has been adopted too. These are just two components of an overall oxygenation strategy to consider when intubating the critically ill. Some patients will require proactive preparation of the components of successful post-intubation oxygenation, especially those with severe lung pathology like ARDS.
Here's a handy list of things to consider when planning a peri-intubation oxygenation strategy. Some people like their airway stuff to begin with 'P', so I've obliged:
CPR in Pectus Excavatum
January 13, 2015 by Cliff
Filed under Acute Med, All Updates, EMS, Guidelines, ICU, Kids, Resus
Comments Off
Some pectus excavatum patients have a metal 'Nuss bar' inserted below the sternum which can make chest compressions more difficult. In those without one, standard compression depths compress the left ventricle more than in non-pectus subjects, and might lead to myocardial injury.
This has led to a recommendation in the journal Resuscitation:
"Until further studies are available, we recommend strong chest compressions, according to the current guidelines, in PE patients with a sternal Nuss bar and, to minimize the risk of myocardial injury, we suggest a reduced chest compression depth (approximately 3–4 cm) at the level of lower half of the sternum in PE patients who have not had corrective surgery."
Cardiopulmonary resuscitation in pectus excavatum patients: Is it time to say more?
Resuscitation. 2014 Dec 10.[Epub ahead of print]
Esmolol for refractory VF
Already well publicised on social media, the team at Hennepin County published a retrospective comparison between patients with refractory VF who received esmolol with those who did not(1). The results are impressive and I look forward to further studies on this.
I work in an ED in a hospital with no cath lab and no access to extracorporeal life support, limiting our options for patients who remain in shockable rhythms despite ACLS interventions. We now have esmolol available in our resus room. You might want to keep it in your list of options for ACLS-refractory VF, which might also include double sequential external defibrillation(2) and even stellate ganglion block.
The dose of esmolol used was: loading dose 500 mcg/kg, followed by infusions of 0, 50, or 100 mcg/kg/min
An important point to note in the esmolol study is that almost all patients received high-quality mechanical CPR with the combined use of an impedence threshold device to augment venous return and cardiac output. The authors "speculate that this additional hemodynamic support may be essential given the hypotensive effects of esmolol."
1. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation
Resuscitation. 2014 Oct;85(10):1337-41
INTRODUCTION: We compare the outcomes for patients who received esmolol to those who did not receive esmolol during refractory ventricular fibrillation (RVF) in the emergency department (ED).
METHODS: A retrospective investigation in an urban academic ED of patients between January 2011 and January 2014 of patients with out-of-hospital or ED cardiac arrest (CA) with an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT) who received at least three defibrillation attempts, 300mg of amiodarone, and 3mg of adrenaline, and who remained in CA upon ED arrival. Patients who received esmolol during CA were compared to those who did not.
RESULTS: 90 patients had CA with an initial rhythm of VF or VT; 65 patients were excluded, leaving 25 for analysis. Six patients received esmolol during cardiac arrest, and nineteen did not. All patients had ventricular dysrhythmias refractory to many defibrillation attempts, including defibrillation after administration of standard ACLS medications. Most received high doses of adrenaline, amiodarone, and sodium bicarbonate. Comparing the patients that received esmolol to those that did not: 67% and 42% had temporary return of spontaneous circulation (ROSC); 67% and 32% had sustained ROSC; 66% and 32% survived to intensive care unit admission; 50% and 16% survived to hospital discharge; and 50% and 11% survived to discharge with a favorable neurologic outcome, respectively.
CONCLUSION: Beta-blockade should be considered in patients with RVF in the ED prior to cessation of resuscitative efforts.
2. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases.
Prehosp Emerg Care. 2015 January-March;19(1):126-130
Background. Ventricular fibrillation (VF) is considered the out-of-hospital cardiac arrest (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when VF does not respond to standard defibrillatory shocks. Current American Heart Association (AHA) guidelines acknowledge that the data are insufficient in determining the optimal pad placement, waveform, or energy level that produce the best conversion rates from OOHCA with VF.
Objective. To describe a technique of double sequential external defibrillation (DSED) for cases of refractory VF (RVF) during OOHCA resuscitation.
Methods. A retrospective case series was performed in an urban/suburban emergency medical services (EMS) system with advanced life support care and a population of 900,000. Included were all adult OOHCAs having RVF during resuscitation efforts by EMS providers. RVF was defined as persistent VF following at least 5 unsuccessful single shocks, epinephrine administration, and a dose of antiarrhythmic medication. Once the patient was in RVF, EMS personnel applied a second set of pads and utilized a second defibrillator for single defibrillation with the new monitor/pad placement. If VF continued, EMS personnel then utilized the original and second monitor/defibrillator charged to maximum energy, and shocks were delivered from both machines simultaneously. Data were collected from electronic dispatch and patient care reports for descriptive analysis.
Results. From 01/07/2008 to 12/31/2010, a total of 10 patients were treated with DSED. The median age was 76.5 (IQR: 65-82), with median resuscitation time of 51minutes (IQR: 45-62). The median number of single shocks was 6.5 (IQR: 6-11), with a median of 2 (IQR: 1-3) DSED shocks delivered. VF broke after DSED in 7 cases (70%). Only 3 patients (30%) had ROSC in the field, and none survived to discharge.
Conclusion. This case series demonstrates that DSED may be a feasible technique as part of an aggressive treatment plan for RVF in the out-of-hospital setting. In this series, RVF was terminated 70% of the time, but no patient survived to discharge. Further research is needed to better understand the characteristics of and treatment strategies for RVF.
Open cardiac massage in asthmatic arrests?
January 12, 2015 by Cliff
Filed under Acute Med, All Updates, Resus
This idea was provoked by a colleague some years ago who could not achieve a palpable pulse during CPR of an arrested asthmatic child. He wondered whether the severe hyperinflation was rendering external cardiac compressions ineffective and whether he should have done a (prehospital) thoracotomy.
The literature is not strong. The 2010 AHA Guidelines rightly focus on reducing hyperinflation by disconnecting the tracheal tube from the ventilator circuit, and they mention ECMO for refractory cases, but there is no mention of open chest CPR.
I can only find two papers discussing it, both pretty old. A case series in the British Medical Journal from 1968 describes three patients with asthma who had asystolic arrests but did not achieve femoral pulses with external compressions(1). In two, open cardiac massage was performed resulting in restoration of sinus rhythm and cardiac output, and one appeared to make a neurological recovery.
A case report in 1987 describes a 32 year old man in asystolic cardiac arrest due to asthma(2):
"Ventilation required very high inflation pressures and little air movement was heard within the chest despite the administration of Adrenaline 1 mg and Aminophylline 250mg intravenously, and Adrenaline 1mg via the endotracheal tube. This was followed by an intravenous infusion of 100 ml of 8.4% Sodium Bicarbonate solution. External cardiac massage failed to produce a palpable pulse in the carotid area. The chest was, therefore, opened through a left anterolateral thoracotomy. The lungs appeared hyperinflated, bulky and tense and did not collapse when the pleural cavity was opened. The pericardium was opened and asystole confirmed, following eight to ten compressions of the heart some intrinsic activity commenced, ventilation also became much easier."
He achieved ROSC and became haemodynamically stable but failed to wake up and treatment was withdrawn some days later.
Neither reports include mention of disconnection strategies to reduce hyperinflation. The lack of neurological recovery is not surprising given the apparent prolonged state of arrest the patients were resuscitated from. However there does appear to be a survivor who may not have made it had standard resuscitation (at the time) been continued.
Does this mean I would open the chest in an arrested asthma patient?
Not straight away, no. I would treat dynamic hyperinflation with tube disconnection and external compressions. I would correct absolute and relative hypovolaemia with crystalloid. I would treat bronchospasm (and possible anaphylaxis) with intravenous adrenaline/epinephrine. And I would exclude pneumothorax, possibly with ultrasound or more likely with bilateral open thoracostomies. If however these measures resulted in no detectable carotid flow with external cardiac compressions, ECMO was not available, and the arrest was not prolonged, I would definitely consider doing internal cardiac massage via thoracotomy.
What about you?
1. Grant IW, Kennedy WP, Malone DN
Deaths from asthma
Br Med J. 1968 May 18;2(5602):429–30
2. Diament RH, Sloan JP
Failed resuscitation in acute severe asthma: a medical indication for emergency thoracotomy?
Arch Emerg Med. 1987 Dec;4(4):233–5
Difficult airways can't be reliably predicted
December 29, 2014 by Cliff
Filed under All Updates, EMS, ICU, Resus
This paper1 proves what Rich Levitan has been saying (and writing) for years – that there is no method of prediction of difficult intubation that is both highly sensitive (the test wouldn't miss many difficult airways) and highly specific (meaning those predicted to be difficult would indeed turn out to be difficult). Most importantly, this means one should always have a plan for failure to intubate and failure to mask-ventilate regardless of how 'easy' the airway may appear.
This study of a large prospectively collected database captured anaesthetists' clinical assessment of likelihood of difficult intubation and difficult mask-ventilation, and compared them with actual findings. These studies are always difficult, due in part to the lack of standard definitions of difficult airways, but the take home was clear – the large majority of difficulties were unanticipated and not suspected from pre-operative clinical assessment.
This issue was brilliantly summed up by Yentis in a 2002 Editorial2:
"I dare to suggest that attempting to predict difficult intubation is unlikely to be useful – does that mean one shouldn't do it at all? To this I say no, for there is another important benefit of this ritual: it forces the anaesthetist at least to think about the airway, and for this reason we should encourage our trainees (and ourselves) to continue doing it."
1. Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database
Anaesthesia. 2014 Dec 16. doi: 10.1111/anae.12955. [Epub ahead of print]
Both the American Society of Anesthesiologists and the UK NAP4 project recommend that an unspecified pre-operative airway assessment be made. However, the choice of assessment is ultimately at the discretion of the individual anaesthesiologist. We retrieved a cohort of 188 064 cases from the Danish Anaesthesia Database, and investigated the diagnostic accuracy of the anaesthesiologists' predictions of difficult tracheal intubation and difficult mask ventilation. Of 3391 difficult intubations, 3154 (93%) were unanticipated. When difficult intubation was anticipated, 229 of 929 (25%) had an actual difficult intubation. Likewise, difficult mask ventilation was unanticipated in 808 of 857 (94%) cases, and when anticipated (218 cases), difficult mask ventilation actually occurred in 49 (22%) cases. We present a previously unpublished estimate of the accuracy of anaesthesiologists' prediction of airway management difficulties in daily routine practice. Prediction of airway difficulties remains a challenging task, and our results underline the importance of being constantly prepared for unexpected difficulties.
2. Predicting difficult intubation–worthwhile exercise or pointless ritual?
Anaesthesia. 2002 Feb;57(2):105-9
High flow systems for apnoeic oxygenation
December 23, 2014 by Cliff
Filed under All Updates, EMS, ICU, Resus
Apnoeic oxygenation during laryngoscopy via nasal prongs has really taken off in the last couple of years in emergency department RSI, and is associated with decreased desaturation rates in out-of-hospital RSI.
More effective oxygenation and a small amount of PEEP can be provided by high flow nasal cannulae with humidified oxygen (HFNC)
A logical step in the progression of this topic is to consider HFNC for apnoeic oxygenation, and Reuben Strayer wrote about this nearly three years ago.
In a Twitter conversation today, Dr Pete Sherren highlighted a new article describing its use in anaesthesia for patients with difficult airways. This is labelled Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE). A reply from Dr Neil Brain points out that when used in kids, the bulkiness of the apparatus may get in the way of bag-mask ventilation (if that becomes necessary).
But does HFNC apnoeic oxygenation confer any advantages over standard nasal cannulae?
In an apnoeic patient, 15l/min via standard cannulae should fill the pharyngeal space with 100% oxygen, and you can't improve on 100%.
HFNC provide some continuous positive pressure, but this may be cancelled by the necessary mouth opening for laryngoscopy.
One issue with apnoea is of course a rise in carbon dioxide with consequent acidosis. The authors of the THRIVE paper (abstract below) point out that in previous apnoeic oxygenation studies, the rate of rise of carbon dioxide levels was between 0.35 and 0.45 kPa/min (2.7-3.4 mmHg/min), whereas with THRIVE the rise was 0.15 kPa/min (1.1 mmHg/min). They suggest that continuous insufflation with high flow oxygen facilitates oxygenation AND carbon dioxide clearance through gaseous mixing and flushing of the deadspace.
So should we switch from standard nasal cannula to high flow cannulae for apnoeic oxygenation? I think not routinely, but perhaps consider it in patients:
(1) with pressure-dependent oxygenation (eg. ARDS) although I'm not sure any CPAP effect would be sustained during laryngoscopy
(2) in patients with significant acidosis in whom a significant rise in carbon dioxide could be detrimental (eg. diabetic ketoacidosis).
I look forward to reading more studies on this, and to hearing from anyone with experience of this technique in the comments section.
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways.
Anaesthesia. 2014 Nov 10. doi: 10.1111/anae.12923. [Epub ahead of print]
Emergency and difficult tracheal intubations are hazardous undertakings where successive laryngoscopy-hypoxaemia-re-oxygenation cycles can escalate to airway loss and the 'can't intubate, can't ventilate' scenario.
Between 2013 and 2014, we extended the apnoea times of 25 patients with difficult airways who were undergoing general anaesthesia for hypopharyngeal or laryngotracheal surgery. This was achieved through continuous delivery of transnasal high-flow humidified oxygen, initially to provide pre-oxygenation, and continuing as post-oxygenation during intravenous induction of anaesthesia and neuromuscular blockade until a definitive airway was secured. Apnoea time commenced at administration of neuromuscular blockade and ended with commencement of jet ventilation, positive-pressure ventilation or recommencement of spontaneous ventilation. During this time, upper airway patency was maintained with jaw-thrust.
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) was used in 15 males and 10 females. Mean (SD [range]) age at treatment was 49 (15 [25-81]) years. The median (IQR [range]) Mallampati grade was 3 (2-3 [2-4]) and direct laryngoscopy grade was 3 (3-3 [2-4]). There were 12 obese patients and nine patients were stridulous. The median (IQR [range]) apnoea time was 14 (9-19 [5-65]) min. No patient experienced arterial desaturation < 90%. Mean (SD [range]) post-apnoea end-tidal (and in four patients, arterial) carbon dioxide level was 7.8 (2.4 [4.9-15.3]) kPa. The rate of increase in end-tidal carbon dioxide was 0.15 kPa.min(-1) .
We conclude that THRIVE combines the benefits of 'classical' apnoeic oxygenation with continuous positive airway pressure and gaseous exchange through flow-dependent deadspace flushing. It has the potential to transform the practice of anaesthesia by changing the nature of securing a definitive airway in emergency and difficult intubations from a pressured stop-start process to a smooth and unhurried undertaking.
London Cardiac Arrest Symposium 2014
December 13, 2014 by Louisa Chan
Filed under Acute Med, All Updates, EMS, Guidelines, ICU, Resus, Trauma
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The focus of the entire day is cardiac arrest and this is the second day of the London Cardiac Arrest Symposium.
Professor Niklas Nielsen kicked off with a presentation of his Targeted Temperature Management trial. It seems that even now there is uncertainty in the interpretation of this latest study. I take heart from the knowledge that Prof Nielsen has changed the practice of his institution to reflect the findings of his study – I have certainly changed my practice. But we need to remain aware that there is more work to be done to answer the multiple questions that remain and the need for further RCTs is recognised.
The management of Cardiac arrest after avalanche is not a clinical scenario that I imagine I'll ever find myself in. The management is well documented in the ICAR MEDCOM guidelines 2012. Dr Peter Paal reminded us that you're not dead until you're rewarmed and dead unless: with asystole, CPR may be terminated (or withheld) if a patient is lethally injured or completely frozen, the airway is blocked and duration of burial >35 min, serum potassium >12 mmol L(-1), risk to the rescuers is unacceptably high or a valid do-not-resuscitate order exists.
The age old question about prognostication after cardiac arrest was tackled by Prof Mauro Oddo. He covered the evidence for clinical examination, SSPE, EEG, and neurone specific enolase. Bottom line, all of these modalities are useful but none are specific enough to be used as a stand alone test so multiple modalities are required.
SAMU is leading the way with prehospital ECMO. They have mastered the art of cannulation (in the Louvre no less!) but there haven't enough cases to demonstrate a mortality benefit. The commencement of ECMO prehospital reduces low flow time and theoretically should improve outcomes. This is begging for a RCT.
The experience of the Italians with in hospital ECMO shoes a better survival rate for in-hospital rather than out of hospital cardiac arrests, explained Dr Tomasso Mauri. They treat patients with a no flow time of <6min and low flow rate of <45min and had a 31% ICU survival rate. If you want to learn more about ED ECMO go to http://edecmo.org.
The Douglas Chamberlain lecture this year was Selective aortic arch perfusion presented by Prof James Manning. He spoke about the use of this technique in cardiac arrest and also in trauma (where it is known to you as Zone 1 REBOA).
In cardiac arrest the aim is to improve coronary perfusion, to preserve perfusion to the heart and the brain, offer a route of rapid temperature control and offer a direct route of administration of adrenaline. Coronary perfusion is seen to be supra normal after SAAP. And the suggested place for SAAP is prior to ECMO.
It's more familiar ground talking about SAAP in trauma. This Zone 1 occlusion preserves cerebral and cardiac perfusion while blood loss is limited and rapid fluid resuscitation can occur.
You can hear Prof Manning on SAAP over at EMCrit (of course!).
It's been another great conference. Put the dates for next year's London Trauma & Cardiac Arrest Conferences in your diary: 8th-10th December 2015!
Happy Holidays & Keep Well
Louisa Chan
London Trauma Conference 2014 Part 2
December 12, 2014 by Louisa Chan
Filed under All Updates, Resus, Trauma
Day three is Air Ambulance and pre-hospital day and the great and the good are here en mass.
The heavy weights are coming out to make their points…..
Unarguably the best lecture of the day was delivered by our very own Cliff Reid on prehospital training. Using Sydney HEMS induction training he highlighted the challenges posed to prehospital services training doctors and paramedics rotating through the service.
Turning a good inhospital doctor into a great prehospital one in the space of an induction program requires focus. Knowledge is therefore not the focus of training, performance is. Often doctors already possess the clinical skills and knowledge and it is the application of these pre existing skills in challenging environments when cognitively overloaded that is the key.
The Sydney HEMS program provides the mindware and communication skills the practitioner needs to do this and drills these skills in simulated environments. He uses perturbation, so like the Bruce protocol exercise test the simulations just get harder until you are at the very limits of your bandwidth. Debriefing of course is important but the recommended protracted debrief is often impractical and unnecessary so simulations designed with cognitive traps are used to highlight learning points and are drilled until the message is received. In this way tress exposure enhances cognitive resilience. And importantly they use cross training, so the doctors and the paramedics undergo the same program so each member of the team understands the challenges faced by the other.
Does this sound like fun? For the shrinking violets out there it could be seen as threatening. But for the adrenaline junkies…….hell yeah!
It's truly a training ethos that I buy into and I'd love to be able to achieve that standard of training in my own service.
Microwaves seem to be the future if diagnostic testing. This modality is fast, is associated with a radiation dose lower than that of a mobile phone, non invasive, portable and has been shown to provide good information. It can be used on heads for intracranial haemorrhage and stroke or chests for pneumothorax detection. It's all in the early stages but seems like it will be a viable option in the future.
For further reading check out:
Diagnosis of subdural and intraparenchymal intracranial hemorrhage using a microwave-based detector
Clinical trial on subdural detection
Pneumothorax detection
How would you transfer a psychotic patient requiring specialist intervention that can only be received after aeromedical transfer? Stefan Mazur of MedSTAR, the retrieval service in South Australia shared their experience with ketamine to facilitate the safe transfer of these patients with no reports of adverse effects on the mental state of the patient, as first described by Minh Le Cong and colleagues. Is there no end to the usefulness of this drug? No wonder we're experiencing a supply issue in the UK!
And finally, the ultimate reflective practice should include the post mortem of our critically sick patients. The approach the forensic pathologist takes is similar to a clinician (with the time pressure removed). They read the scene and use this information to predict injuries (sound familiar?). Post mortem CT scanning with recon provides yet another layer of information. We are missing a trick if we don't seek this feedback to correlate with our clinical findings. Even better, rare practical skills are often routinely performed as part of the post mortem – we should be making use of this opportunity to train.


text:
Property is in very high demand and likely to sell quickly, even if it is overpriced or not in the best condition. Sellers receive multiple offers and the price is usually bid up above the seller's initial asking price.
Rental property is in high demand and availability is low. Rent prices have decreased by 16% over the past 3 months. This is 285% lower than the state average of $4,482 and 105% lower than the country average of $2,388.
Trend data coming soon.
|For Sale: 187
|New: 53
|Recently Sold: 190
|Reduced: 25
|Average Home Price
|Average Sold Price
|Property Records: 8,929
|Foreclosed: 7
The average home price in 95838 is $197,262, which is 23.1% higher than the average sold price in 95838 ($160,220) . The average home price per square foot in 95838 is $151 and about 2% of all homes in 95838 sold in the last 6 months. For 95838 home values, real estate prices, and city market trends, research the 8,929 property records or search our 190 recently sold or 187 homes for sale listings. The listings and properties in 95838 are only a part of the 9,092,661 properties and 153,663 homes for sale in California. Because of this, the average home price and average home value of 95838 also influence the average home price $360,877 and average sale price $580,566 of California. Listing counts, 95838 home prices and home values in 95838 are sourced daily from listing and property data on realtor.com®, which is the most up-to-date and accurate aggregation of real estate listings in the industry and includes approximately 800 regional MLSs and is the official website of the National Association of Realtors®.
|Median Age
|Median Household Income

subset: commoncrawl


text:
Originally written on Sliding Into Home | Last updated 11/28/12
NEW YORK - JANUARY 31: Houston Astro Andy Pettitte speaks to the press at the 26th Annual Thurman Munson Awards at the Marriott Marquis Hotel on January 31, 2006 in New York City. The dinner remembers the late Yankee catcher Thurman Munson who died tragically in a 1979 plane crash.( Photo by Brad Barket/ Getty Images)
From Bryan Hoch:Andy Pettitte has said that he feels like his left arm still has plenty of important innings to offer. The Yankees are counting on it. Pettitte and the Yankees officially agreed to a one-year contract on Wednesday, representing the second major move of New York's offseason following last week's re-signing of right-handed starter Hiroki Kuroda. The 40-year-old Pettitte will earn a base salary of $12 million for his services, plus potential awards bonuses. In order to make room on the 40-man roster, the Yankees designated catcher Eli Whiteside for assignment. It's also being reported that the Yankees are close to agreeing on a one-year deal with Mariano Rivera. With the signings of Kuroda, Pettitte and hopefully Rivera, the Yankees pitching staff is looking pretty strong.
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|ISSN 1088-6826(online) ISSN 0002-9939(print)
Simple going down in PI rings
Abstract | References | Similar Articles | Additional Information
Abstract: In this paper we prove two generalizations of a theorem which McAdam proved for commutative rings. Theorem 1 states that if is a central integral extension of PI rings, then going down for prime ideals holds between R and S if and only if going down holds in for each . Theorem 2 gives the analogous result for going down in where C is a central subring of the PI ring R. As a corollary we obtain a result of Schelter generalizing Krull's theorem on going down for integral extensions of integrally-closed subrings.
Retrieve articles in Proceedings of the American Mathematical Society with MSC: 13A15, 13B99, 13F10
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Report NEP-ACC-2008-06-13This is the archive for NEP-ACC, a report on new working papers in the area of Accounting & Auditing. Alexander Harin issued this report. It is usually issued weekly.
Subscribe to this report: email, RSS or Twitter.
Other reports in NEP-ACC
The following items were announced in this report:
- Md. Abid Hossain Khan & Ahmed Taneem Muzaffar & Abdul Kader Nazmul, 2008. "Corporate Financial Reporting on Internet: Global Developments and an Appraisal of Practices in Bangladesh," AIUB Bus Econ Working Paper Series AIUB-BUS-ECON-2008-25, American International University-Bangladesh, Office of Research and Publications (ORP), revised Jun 2008.
- Aidt, T. & Jensen, P.S., 2007. "The Taxman Tools Up: An Event History Study of the Introduction of the Personal Income Tax in Western Europe, 1815-1941," Cambridge Working Papers in Economics 0766, Faculty of Economics, University of Cambridge.
- Amaral, Hudson & Iquiapaza, Robert & Tomaz, Wesley & Bertucci, Luiz, 2008.
"Governança corporativa e divulgação de relatórios financeiros anuais
[Corporate governance and release of annual financial statements]," MPRA Paper 9068, University Library of Munich, Germany.
- Thor O. Thoresen & Jørgen Aasness & Zhiyang Jia, 2008. "More realistic estimates of revenue changes from tax cuts," Discussion Papers 545, Statistics Norway, Research Department.
- Johann K. Brunner & Susanne Pech, 2008. "Optimum taxation of inheritances," Economics working papers 2008-06, Department of Economics, Johannes Kepler University Linz, Austria.


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|Trip Type:
|Half Day Whitewater
|June 1 - August 31
|Start Time:
|9:30 am & 2:00 pm check-in
|3.5 - 4 hours
|Matanuska Glacier off Glenn Hwy.
|River Grade:
|Class III & IV whitewater
|Age Limit:
|12 yrs min.
Save $20/person when combined with our "Matanuska Glacier Trips".
|Book Now!
This trip checks in at our Hicks Creek facility, 38100 W Glenn Highway, Glacier View, AK 99674. 96 miles from Anchorage on the Glenn Highway National Scenic Byway.
Our most popular Alaska whitewater trip for 40 years!
The perfect Alaska whitewater rafting trip for first-timers or experienced river runners! This exciting glacier fed class III & IV whitewater rafting trip is just 2 hours drive NE of Anchorage via the Glenn Highway National Scenic Byway and next to the 27 mile long Matanuska Glacier. The main rapids are several miles long and the result of a squeeze play between the glacier lateral moraine and "Lion Head", a massive basalt rock wall from an ancient volcanic plug. The remainder of the trip is swift water, exceptional scenic vistas and intermittent class II and III rapids. We provide all necessary river gear including dry-suits to wear over your clothing.
We have several options available for running this river trip to fit most desires.
Combine this river trip with any of our Matanuska Glacier adventures for a full day outing and get $20 off the river trip.
Ask about free RV and tent camping where the river trip ends at our Hicks Creek facility, for NOVA clients only.
"Our group of seven did the Six Mile Creek trip and we all had a great time, and we can't say enough about the people you had to work with us. Very professional and FUN; we had an experience we will remember forever! Thank You! "
Kevin Borer, Minnesota


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|Amount Per Serving
|% Daily Value
|Calories from Fat
|Total Fat
|0.5 g
|Phosphatidyl Choline (from soy lecithin)
|420 mg
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Source Naturals Phosphatidyl Choline In Lecithin -- 420 mg - 90 Softgels
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|Amount Per Serving
|% Daily Value
|Calories from Fat
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|Phosphatidyl Choline (from soy lecithin)
|420 mg
Source Naturals PHOSPHATIDYL CHOLINE provides premium quality and potency. This product has been concentrated to contain 3 times the phosphatidyl choline found in ordinary lecithin. This special soy lecithin also contains phosphatidyl inositol, phosphatidyl ethanolamine, and related phosphorus-containing lipids.
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Masanori Kanehara Related Articles
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Where do I find the new Carrara serial number?
Moved to the Carrara forum. The # is here
ARTCollaborations Store on DAZ3D ARTCollaborations on Facebook
*****Down On The Corner*****
New serial number can be found in the thread about the Carrara 8.5 beta, in the first post here http://www.daz3d.com/forums/viewthread/4700/
Chohole's Space NeilV's Freebies and stuff Summer 1 Bryce Rendering Challenge July Freebie Challenge
My DAZ 3D Gallery 11915


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Learn more about Silver Luxury Steel Chrome Deluxe Hard Cover Case For iPhone 5S 5 S 5_S:
|100% Brand new Product for iPhone 5S 5 S A1533 Perfect fit for Apple iPhone 5S 5 S A1533 Specially made for your iPhone 5S 5 S A1533 Stylish protection with full access to all ports, buttons and camera ***NOTE: Also Compatible with Apple iPhone 5 (A1429 / A1428):
Customer Reviews of Silver Luxury Steel Chrome Deluxe Hard Cover Case For iPhone 5S 5 S 5_S
Works as expected.
Antenna blocker!!11/7/2013
After I install case, I thought my phone was broken. With this case on my phone, I only had one bar of reception and when I took it off, it was five bars. Unfortunately it took me about four days to figure it out. I thought I was gonna have to get a new phone!!
Signal Killer!10/31/2013
Looks and feels great, but it kills all wifi and cellular signals to the phone. Couldn't even get my own wifi from the next room! Removed the case and all was back to normal. Stay away. It's an iPhone killer!
block wi-fi10/16/2013
generate problem with wifi conection
Very nice design but interfere with wifi reception10/16/2013
Very nice design but interfere with wifi reception, reduce wifi reception quite a bit with the case on. May need to locate location for wifi reception to avoid interference.
Not metal, Chrome Plastic10/16/2013
Description says chrome hard case, and luxury steel chrome case....however, it is chrome coated plastic not chrome colored steel...just FYI
Case cracking easily.10/15/2013
It looks great but the benefit is short lived by the the case poor quality. It cracked on all 4 corners after about 2 weeks of use. I feel sorry for recommending it to a friend (for the look) before knowing about its poor quality.
Order number: 7178944510/11/2013
Silver Luxury Steel Chrome Deluxe Hard Cover Case For iPhone 5S Wife loves this product, looks good and expensive yet price right.


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Connie Jackson Pryor
Connie Jackson Pryor, 62,, of Wichita Falls, died Sunday, November 23, 2008.
The memorial service will be conducted at 1 p.m. Friday, November 28, 2008, in the chapel of Owens & Brumley Funeral Home of Wichita Falls with the Rev. Danny Lively officiating. Arrangements are under the direction of Owens & Brumley Funeral Home of Wichita Falls.
A daughter of the late Henry and Bernice (Linker) Jackson, she was born September 22, 1946, in Brunswick, Georgia. Connie worked at Doctors Nursing Service in the 1980's and was the director of Hospice in the late 1990s. In 1999, she became the administrator of Arbor House Assisted Living, where she presently worked. Connie was a loving wife, mother, grandmother and friend and impacted the lives of many. She always thought of others before herself. She was also preceded in death by her brother, Robert Jackson.
Survivors include her husband, William 'Bill' Pryor; daughters, Dayna Green and husband, Steve, Emily Marable and husband, Tom, Rebecca Mataska and husband, Gary, and Nikki Pryor of Wichita Falls; grandchildren, Jayson, Levi, Billy, Cody and Alanna; nephew, Chief Robert "Bubba" Armbrusher and wife, Melody and their children of Valdosta, Georgia; and many friends far and near.
For those desiring, the family suggests that memorial contributions be made to Hospice of Wichita Falls.
Condolences may be sent to the family at www.owens andbrumley.com.
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US Military Goes All In On Climate Change Adaptation
October 15th, 2014 | by Tina Casey
Skeptics, schmeptics: Department of Defense steamrolls over climate change deniers with release of new Climate Change Adaptation Roadmap
October 15th, 2014 | by Tina Casey
Skeptics, schmeptics: Department of Defense steamrolls over climate change deniers with release of new Climate Change Adaptation Roadmap
June 26th, 2014 | by Jo Borrás
You won't believe how similar the numbers from this 1934 solar powered aircraft carrier blimp are to today's most efficient solar power power estimates
June 10th, 2014 | by Zachary Coffey
Sikorsky Aircraft Corp. has been breaking new ground in autonomous technology, and will soon roll out the Land Tamer UGV, a completely autonomous
May 8th, 2014 | by Christopher DeMorro
The Black Knight hybrid truck-helicopter made its first full-size trial flight, concluding years of research and development using off-the shelf parts.
March 30th, 2014 | by Jo Borrás
At just 3/5 the weight of an American Abrams tank and powered by an advanced, high-efficiency, 940 HP diesel engine,
March 17th, 2014 | by Jo Borrás
The ultra lightweight, fuel efficient car of the future may be closer than you think thanks, in part, to the US Navy and its advanced, high-tech weaponry
December 6th, 2013 | by Jo Borrás
Fighter jets + ethanol, it's a calculation that Lockheed Martin recently announced a significant investment in. Lockheed is hoping to
November 23rd, 2013 | by Jo Borrás
Back in November, the US military announced that it would be putting more than $30 million into Hawaii's Energy Excelerator,
November 3rd, 2013 | by Jo Borrás
America's armed forces have been moving towards EVs in recent years. Given the quiet running, low heat signature, and epic
September 23rd, 2013 | by Jo Borrás
To keep the US military mobile, Polaris has fitted non-pneumatic, airless tires to its MV850 ATV - standard issue to a number of soldiers in the US Special Forces
September 19th, 2013 | by Christopher DeMorro
The U.S. Army is considering a "lightweight" diesel-electric hybrid truck to replace the Humvee in combat operations
September 9th, 2013 | by Jo Borrás
The US Navy recently announced that it would be putting more than $30 million into Hawaii's Energy Excelerator green energy
September 1st, 2013 | by Jo Borrás
As I write this, warships are gathering in the Mediterranean sea and the Persian Gulf, ready to enter a civil
August 12th, 2013 | by Jo Borrás
America's military leaders have been strong advocates for converting America's war machine to renewable biofuels in general and ethanol in particular, and US Navy Secretary Ray Mabus just wrote a new article over at Foreign Policy that lays out all of his reasons to move away from oil, from dependence on foreign powers to oil's troublesome logistics and environmental impact
June 28th, 2013 | by Christopher DeMorro
America has the world's largest military by far, spending more than the next 20 countries combined. When we're not invading other countries, the military of developing world-changing technologies like GPS and the Internet, technologies that once seemed impossibly expensive for the average person to own. So one writer is asking; can the military make EVs mainstream
June 15th, 2013 | by Jo Borrás
Electricity-generating fuel cells that can be fueled by a cheap, abundant, and renewable fuel source seem to be the holy grail of a low-emission, energy-independent future. Up to now, making the hydrogen that's powered fuel cell cars has been expensive, but the US military may have come up with new way to generate electricity in a fuel cell with a fuel that we've been writing an awful lot about, lately: ethanol
November 26th, 2012 | by Christopher DeMorro
Ethanol has lost a lot of support in the past few years for a variety of reasons. One of the biggest knocks against corn-derived ethanol is the reduced horsepower and fuel economy, causing some to be wary of an alternative fuel promises. But a new study shows that algae-based biodiesel has nearly the same horsepower and torque output as petrol and soybean diesel
October 3rd, 2012 | by Andrew Meggison
The approval rating of the US Congress and the Senate is very poor right now – and for good reason. These elected officials are consistently taking out of both side of their mouth. Example, while the US military is pushing hard for green technology Republicans in the House of Representatives are trying to push through the so called "No More Solyndras Act"


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Welcome to LUNG FORCE Walk - San Diego
We are a force to be reckoned with. Only A Force of Many Can Stand Up To:
- the frightening rise of lung cancer in women
- the deadly disease that is COPD
- the daily challenges that asthma sufferers face
- pollution that threatens our lungs and our lives
With your participation and help, our LUNG FORCE Walk will make a difference in lives that desperately need it. Register today, because now is the time to raise our voices against lung cancer—and for lung health.
Check our EVENT INFO PAGE to learn more about our LUNG FORCE Walk.
Post updates on Facebook & Twitter pertaining to your commitment, fundraising progress and link to your personal fundraising page. Keep up with walk updates and news on our Facebook event page.
Share updates with your professional contacts on LinkedIn about your commitment to save lives.
PLUS...Pinterest, Instagram, You Tube, Google+ the list goes on. Make sure anyone you're connected to online knows about the important work you're supporting.


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Float like a fixed gear, sting like a ten-speed. The Knockout Tee places the Greatest Ever over a totaled two-wheeler, famously towering above his conquest and scowling with the glare of someone who's skinned his knee for the last time.
This product has no reviews yet. Be the first to review this product. Write a review
Enjoy 10% off your first order*


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Free Thanksgiving dinner available for those without funds or without a place to go on Thanksgiving day.
Karen McKnight offers free YogaBall classes through the month of December to help deal with holiday stress.
Tenth annual Festival of Contemporary Writing at Spalding
National slam poetry champion to share "soul-shaking stories"
'The New Jim Crow: Mass Incarceration in the Age of Colorblindness' at UofL
Opinion expert to speak at Bellarmine Thursday
Frequent 'Oprah' guest at UofL
Public relations pro Deirdre Breakenridge to speak at Bellarmine
'When Spirit Meets Action' to feature activist Monday
Kids' Hall-o-Treats night hosted by students and staff
'E.T. at the Rauch' at UofL
'Dump Sites' photos of murderers' disposal spots, lecture highlighted
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Bio: We are an indie label that is about the artist, for the artist ran by the artist. Our goal is to bring back artistry into music and get rid of all the cookie cutter music.For more information email us at firstname.lastname@example.com . We are alway looking at press kits and music video ideas. For ... See Full Bio


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Citigroup CFO John Gerspach to Present at the Goldman Sachs US Financial Services Conference Business Wire NEW YORK -- November 28, 2012 John Gerspach, Chief Financial Officer of Citigroup, will present at the Goldman Sachs US Financial Services Conference on Wednesday, December 5, 2012. The presentation is expected to begin at approximately 12:35 PM (ET). A live webcast and presentation materials will be available at www.citigroup.com/citi/investor. A replay and transcript of the webcast will be available shortly after the event. Citi, the leading global bank, has approximately 200 million customer accounts and does business in more than 160 countries and jurisdictions. Citi provides consumers, corporations, governments and institutions with a broad range of financial products and services, including consumer banking and credit, corporate and investment banking, securities brokerage, transaction services, and wealth management. Additional information may be found at www.citigroup.com | Twitter: @Citi | YouTube: www.youtube.com/citi | Blog: http://new.citi.com | Facebook: www.facebook.com/citi | LinkedIn: www.linkedin.com/company/citi Contact: Citigroup Inc. Media: Mark Costiglio, 212-559-4114 or Shannon Bell, 212-793-6206 or Investors: Susan Kendall, 212-559-2718
Citigroup CFO John Gerspach to Present at the Goldman Sachs US Financial Services Conference
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Build yourself flashing message on PIC16F877A with assemblerby arick
CPU Fan controller using PICby Jestin_Cubetech
AC Lamp Dimmer Using TRIAC and PIC16F877Aby Jestin_Cubetech
FM radio using TEA5767 and PIC16F877A micro-controllerby Jestin_Cubetech
Vehicle Accessory Computer Interfaceby bigbro_1985
High quality MMC digital voice recorder using PIC with limited RAM (PIC16F877A)by vinodstanur
Digital ic tester using pic microcontrollerby Jestin_Cubetech
7 segment clock with temperature display [ds18b20 and 5 digit display]by Jestin_Cubetech
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2 comments by Gilly6666 on Feb 15th, 2012
Well what can i say really, love computer games love being able to mod and make models for them even more. Heavily into modifying EAW, can do most things in terms of modfying the game, but love using 3d studio max and photoshop to bring ideas to life.
Been working on a few mods here and there helping people out, I am working on Eve at War, but at the moment am quite happy making the models for other people to use, as its quite satisfying knowing your works being put to use by someone who appriceates it.


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Cam Newton
Carolina Panthers Focused, Intimidating For First Playoff Game In Years
The Carolina Panthers have had an extra week off to prepare for their first playoff game in years, but they haven't taken the time off from preparing. They have been focusing on whichever team they may face and they are looking to be a team that is not only good, but one that is feared.
Panthers Need To Focus On Their Opponent, Not Themselves
The Carolina Panthers have a first-round bye in the upcoming playoffs and they have an extra week to prepare for whatever team may end up facing them in Bank of America Stadium. Cam Newton recently said that they don't care who their opponent is, but the key to winning is forgetting about egos and focusing on their opponent.
Newton Needs Panthers Players To Step Up
The Carolina Panthers had to win the last game of the season to get the NFC South title and a first-round bye so it's not like it was a time they could rest their players. Steve Smith had to sit out with an injury, and there were not a lot of other options for Cam Newton to rely on, but there need to be.
Presto Chango: Panthers Turn Awful 2013 Start Into First-Round Playoff Bye
The Carolina Panthers started off the season with a 1-3 start, and were tied with the Atlanta Falcons for second place. It wasn't a second place that was even close to the NFC South-leading New Orleans Saints, but the rest of the season proved to turn out completely different.
Panthers Pummel Bucs En Route To 8th Straight Victory
The Tampa Bay Buccaneers winning streak ended with a blowout loss Sunday to the Carolina Panthers. But how did they perform?
Panthers Top Bucs 27-6 For 8th Straight Win
CHARLOTTE, N.C. (AP) — Cam Newton and the Carolina Panthers are heading to New Orleans with a head of steam. Newton threw for 263 yards and two touchdowns and ran for another score, and the […]
Bucs Looking For Revenge Against Streaking Panthers
The Carolina Panthers have won seven games in a row. But can the Buccaneers defense slow them down?
Bucs Embarrass Themselves At Home Against Panthers
The Panthers looked sharp. The Bucs looked awful. What's next for a team that is now 0-7?
Bucs Lose Big Again To Carolina 31-13 And Move To 0-7 On The Season
TAMPA, Fla. (AP) — Cam Newton is playing some of the best football of his career, and the surging Carolina Panthers are back over .500 for the first time in five years. An efficient Newton […]
Panthers, Buccaneers: Two Teams Headed In Opposite Directions
The Panthers are slowly improving, while the Bucs are getting worse and worse. Who wins this divisional battle?


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|The mystical, war-torn realm of the Witcher saga is alive once more — vibrant, ever-changing and ever-thirsty for blood. The battlefield calls to you. Don't deny your warrior's duty — return to the fight as the saga continues in The Witcher 2: Assassins of Kings. The bleeding-edge visuals, thrilling real-time combat and deep character development made famous by The Witcher return to your screen with resounding force in this gripping second installment. The intriguing storyline will thrust you into the role of Geralt of Rivia once more as you live the dark tale of a mythic warrior on a noble quest. And in this loaded Premium Edition, a plethora of Witcher extras, including a "Making Of" DVD, audio CD, game guides and more, give you an exclusive edge. But fighters take caution: once you return to the world of The Witcher, you'll never truly leave the battlefield behind.
Defining new standards for realistic, non-linear gameplay and engrossing character development, this second chapter of the epic Witcher saga brings role-playing realism to new heights. The unique and expansive world envisioned by author Andrzej Sapkowskii comes to life with the new force of a state-of-the-art engine developed by CD Projekt RED. Enhancing the best features of the RPG and eliminating all of its limitations, this advanced system puts cutting-edge crafting mechanics, weapons and armor, a redesigned, more user-friendly interface and balanced opponent strength at your fingertips for true gaming excellence. Summon might and magic to fight in the intuitive combat system, and enjoy a unique blend of tactical elements and dynamic action. Your decisions have drastic consequences in this war-torn world, so tread carefully as you embark for glory in a realistic and dangerous new journey.
"...everything that a good sequel should be. RPG Fan
"...one of the most memorable and best written fantasy video games you'll ever play. Tom Chick, 1UP
Customer Reviews of Witcher 2: Assassins Of Kings Enhanced Edition
Best Game Ever!4/19/2012
This is my favorite game of all time. I didn't even like the first Witcher, but The Witcher 2 was OUT OF THIS WORLD. The graphics quality was the best I have ever seen so far, and my top notch computer with an MSI GTX560Ti couldn't even fully max out the games graphics. It was very fun to play, and it had a lot of choices to make that had consequences.
View all buying options for Witcher 2: Assassins Of Kings Enhanced Edition
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Condition: Brand New


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News Section: Politics
The Bradenton Times 2014 Local Primary Guide
Want to get informed before casting your vote? Check out all of TBT's coverage of local races appearing on the August 26 primary ballot consolidated in one easy location. Bookmark the page as new content will be added as it is published in TBT. Once completed, the Primary Guide will also be emailed to all TBT subscribers. Click here to sign up for a free email subscription to The Bradenton Times.
Click here to visit The Bradenton Times' 2014 Primary Election Page.
Join the conversation post Facebook comments here or on our site at the bottom of article.
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esports, FPS, Shooter, Killerspiel, TDM, CTF, Multiplayer, Clan, Liga, Match, Funwar, Gamer, Gaming, Progamer, Clanbase, Call of Duty, , Modern Warfare, Soldier of Fortune, Counterstrike, Clanliga, Maus, WASD, Aim
This great product in white from our department Men and T-Shirt category can be printed just for you in the size and style you like. The design esports_8 was created by finestshirtz.uk and uploaded to Spreadshirt for you to have printed on a T-Shirt. Next to a host of other great designs, you can find this esports_8 design in Spreadshirt's Gaming category. If you are interested in topics like Battlefield or Clanbase, then you'll love esports_8 designs by finestshirtz.uk. Spreadshirt also offers a huge selection of personalised T-shirts, hoodies and accessories for the category Gaming as well as top Clanliga clothing. finestshirtz.uk's designs have already impressed many of our customers, so we are sure that we've got right stuff for you! Spreadshirt is your shop for great designs of all kinds – whether it's Battlefield, Clanbase or Clanliga. We are sure that you will find something nice in our shop, there are many amazing personalised Gaming T-shirts, jumpers or accessories for you to find! Tags: Design ID: 11232432
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Printable View
Originally Posted by Wade Barrett 1979
The one thing I think he'll have to adjust is the pick up. He needs to swap to an AA or F5 pick up, I don't think he'd manage the fisherman pick up on Show.
That think he's adjusted it before on a second(or rather, third) attempt with Tensei.
Originally Posted by B-MCINTYRE
Antonia Cesaro Wrestlemania moment for the win.
Cole: He's not going to try and OMG Neutralizer!!!
YES!!! Come on Claudio BDK forever (Most people won't get this!)
As LayCool used to say - REAL TALK.
Antonio Cesaro will lose the US Championship before or at WrestleMania...to either Jack Swagger or The Miz.
Show is better as a heel i dont want to see him as a goofy giant


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CRIMINAL MINDS "Painless" Season 7 Episode 4 – School shootings are a particularly sensitive topic to tackle, yet they've become a staple of all crime shows. It's perhaps ironic that the best televi More »
On this week's episode of Criminal Minds , survivors of a high school massacre gather for a memorial, only for some of them to wind up dead. Top 5 Moments 10 Years Later: A decade after the massacre More »
Ask and ye shall receive. After lamenting that there wasn't enough Hotch last week - boom! A thoughtful storyline with not only Hotch, but Jack too. And for those pining away wanting more Reid anti More »
CRIMINAL MINDS "Painless" Season 7 Episode 4 airs Wednesday October 12th (9:00-10:00 PM, ET/PT) on the CBS Television Network. Episode Synopsis: Survivors of a Boise high school massacre return to More »
Following an episode that left our critic gasping in suspense , Criminal Minds will return to a scene of a heinous crime next Wednesday night. On "Painless," the BAU will be after a killer with the More »
Someone is referencing to an old crime to unleash a new terror in next " Criminal Minds ". In the upcoming episode, survivors of a Boise high school massacre return to remember the event that took pla More »


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This section contains 1,475 words
(approx. 5 pages at 300 words per page)
Critical Essay by Tom Mathews
SOURCE: "Book 'Em," in Newsweek, Vol. CXXI, No. 11, March 15, 1993, pp. 79-81.
In the following excerpt from an essay that includes commentary by Grisham, Mathews surveys Grisham's career through The Client and discusses critical response to the author's works.
Grisham is a straight arrow making his way along a very crooked path—a world of sleazy lawyers, fathead politicians and hot-dog G-men where something always stinks just below the surface of wealth and respectability. Grisham's law is as simple as Aesop and as old as Scheherazade: bore 'em and you die. In The Client his hero is Mark Sway, an 11-year-old who tries to stop a suicide only to learn a mob secret that could cost him his life. To save himself from the bad guys—and the good guys—Sway pays $1, all he has, to hire Reggie Love, 52, a street lawyer with a divorcée's past and a grandmother's soul. Dodging Mafia hoods, crazy neighbors and the police, vowing to join a health club and get in better shape if she ever gets out alive, Reggie wonders whether she is "too old for this nonsense. The things lawyers do."
It was those things that drove Grisham right into fiction. "I'm pretty cynical about the legal profession," he says. "Thrilled to be out of it." A Time to Kill, his first and best novel, is also his most autobiographical. In Jake Brigance, you find the distillation of Grisham's own experience as a small-town ham-and-egger around the De Soto County courthouse. Before an all-white jury, Brigance defends a black Viet vet who took an M-16 and blew away two crackers who raped his 10-year-old daughter. Grisham took three years to write it, getting up at 5 a.m. and scribbling in a Sparco notebook, the kind court reporters use. "My motives were pure when I wrote A Time to Kill," he says. "It's better because you can almost smell the biscuits and the eggs and the grits and hear the chatter in the Coffee Shop; the people are better, the setting is better; you can feel the sweat sticking to their shirts in the July heat around the courthouse."
But the book didn't sell, so Grisham wrote his second novel, The Firm, as "a naked stab at commercial fiction." He tells the story of Mitchell Y. McDeere, Harvard Law, seduced by an $80,000 starting salary and a black BMW into joining a top-drawer law firm that turns out to be a money laundry for the mob. Into this tale Grisham poured his own contempt for corporate lawyers in $1,200 suits who pay for their $245 Cole Haan loafers and solid-cherry desks by billing $300 an hour for 30-hour days. He wrote The Pelican Brief, partly to convince [his wife,] Renée, his most important critic, that he could invent a strong woman. When the world's deadliest terrorist bumps off two Supreme Court justices, it is left to Darby Shaw, a Tulane law student, to figure out a plot the FBI can't—and the White House won't—unravel. It's the quintessential Grisham formula: "You take some horrible, mean, vicious, nasty conspiracy over here," he says. "You put a very sympathetic hero or heroine in the middle of it, you reach a point where their lives are at stake—and you get them out of it."
Not exactly Crime and Punishment? Grisham pleads nolo contendere. He puts on no literary airs. And yet … something seems to be eating him….
"These legal thrillers are driving me nuts," he says, a confession that should give his publishers heartburn. And Oxford bookseller Richard Howorth, whose grandfather once gave Faulkner a D in English, warns literary sourpusses not to do the same with Grisham. "Anyone who dismisses Grisham as 'commercial'," he says, "is making a big mistake."…
For a writer committed to thrills, Grisham practices only safe sex in his prose. "I cannot write about sex," he confesses. At one meeting with his editor in New York, the subject came up, and Renée said, "Johnny can't write about sex. He knows very little about it." Stifling a guffaw, David Gernert, his editor, said, "Don't even try."
So readers love his books, but are they art?
"Oh, there are a few literary snots in town who take shots at me," Grisham says mildly. Vernon Chadwick, professor of English at Ole Miss, argues that the market people in Hollywood and New York have seized on Grisham to water down American culture with the Southern-novel lite. But it isn't that easy. "Marketing can do many things, but it can't just buy a mass readership," says Gary Fisketjon, an editor at Knopf. "Readers detect crassness, the wrong touch." Like trout scrutinizing a badly tied fly, they may rise, but they won't take the offering.
Given the abundance of ego and the shortage of cash among so many "real" writers, the astonishing thing is how many around Oxford, where literary matters count, are willing to speak up in Grisham's defense. "I suppose I would have been more sullen if a bad book were taken as serious literary work," says Barry Hannah, whose own Bats Out of Hell, just out from Houghton Mifflin, is superb. "I liked the way John cleared the air." Donna Tartt, the author of The Secret History, who comes from nearby Grenada, observes that Dr. Johnson believed anyone who wrote for any reason but to make money was mad.
Let's not duck the literary issue: artists do something Grisham doesn't. The artist clearly enlightens where the commercial writer entertains. Consider the case of Larry Brown, another Oxford novelist, who tried to go commercial only to wind up an artist in spite of himself. Brown was a captain in the fire department. He once hoped to make a little money moonlighting in literature. Over eight years, he wrote five novels—the first, he says, was about "sex-starved women and man-eating bears in Yellow-stone," an idea that should have turned the trick, but didn't. He also wrote 100 short stories, only to throw them all out before publishing Facing the Music, the collection that established him as one of the South's authentic new voices. In the best writing, Brown discovered, character counts more than plot. That may not have helped his bank account much; but he doesn't hold it against Grisham. "Everybody's glad for what happened to John," he says. "He paid his dues. He works harder than I do."
An astute justification of Grisham comes from Sydney Pollack, who directed the movie of The Firm. "This is a very suspicious, cynical decade," says Pollack. "All bureaucratic authorities are suspect. Part of the reason the book is so successful is you have an Everyman taken advantage of by the authorities and by the experts who are supposed to defend you against the authorities. And he beats them both." [In February 1993] Grisham told a chamber of commerce group that A Time to Kill was his best novel and that he had been going downhill ever since. "Was this wise?" wondered Hannah, for whom Grisham had inscribed a book: "To one of my heroes." The truth is that in the cluttered office Grisham calls "mission control," the only room on his spread that he won't let Renée redecorate, the place where he pins the deadline on the wall once a year, shooing out his son, Ty, 9, and his daughter, Shea, 7, for the duration, Grisham is restless.
Someone once asked him to explain the significance of the fact that where Faulkner, a complicater, invented Yoknapatawpha, Grisham, a simplifier, dreamed up Ford County in A Time to Kill. ("Give me a break," he replied.) Once upon a time, his plan was to alternate one Ford County novel with every thriller. His Ford County ideas brought hems and haws from his agent and editor. The result was a three-book contract with Doubleday that holds him to legal thrillers. Now, he says, "what I'd really like to do is just go back to Ford County and never leave."
Of course, you can't go home again and bat out a Ford County novel in six months (The Pelican Brief took 100 days, The Client six months, and both show some damage). But Grisham says he's now so rich he could write a book every five years or maybe every 10 years. He doesn't intend to get into the ring with Count Tolstoy, as Hemingway would put it, or Faulkner. His idea is just to take more time, and in the tradition of Larry Brown, pay more attention to character. Whatever the case, he has what it takes to make the change. A while ago Bill Ballard sat in his law office near The Bookworm in Hernando, writing a review of The Client for the local library. Grisham, he wrote, now enjoys what Mark Twain called "the calm confidence of a Christian holding four aces." And it's never been a good idea to bet against him.
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Posted July 1, 2003 and updated on February 13, 2012
Why is The Real Cancun rated R?
Official MPAA Rating: The Real Cancun is rated R for for strong sexuality/nudity, language and partying.
Please Note: We have not viewed this movie. The information below is a summary based on data gathered from government and industry sponsored film classification agencies in various global regions.


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Chirag Saraiya
Forbes Blogs
My Stats
|Contributor Since:
|May 2010
About Me
Before moving to Banc of America Securities' M&A Group, where he focused on sell-side advisory work in the Consumer & Retail sector, Chirag was with Merrill Lynch's Private Placement Group in New York. He then spent a number of years in Banc of America Securities' London and Paris offices helping to expand their European presence. He joined TTS in 2003. Chirag graduated Phi Beta Kappa from Emory University and holds a MBA with concentrations in Strategy & International Business from The Kellogg School of Management, Northwestern University. His research focus at Kellogg included Private Equity & Venture Capital investing in emerging markets. Chirag has led training seminars in the United States, Europe, Asia, Australia & the Middle East. He lives in Chicago and heads TTS's Midwest & International operations. Currently he is an Adjunct Professor of Finance at the Kellogg School of Management, Northwestern University, where he teaches a course on Leveraged Buyouts.


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Supplement Facts
Serving Size: 2 Capsules
Servings per Container: 30
|Amount Per Serving
|% Daily Value
|Butcher's Broom (Ruscus aculeatus) (root extract) (Guaranteed 10 mg [10%] saponins)
|100 mg
*Daily value not established.
Other Ingredients: Cellulose and gelatin (capsule).
Keep your licensed health care practitioner informed when using this product.


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Wee Travels: Exploring the Plains
View Single Post
Studly Adventurer
Joined: Apr 2011
Location: Wasatch county
Oddometer: 734
I hit pavement near Ft. Wallace and decided to just slab it home from there. It had been blowing 40 mph all day, more from the west so at least I was riding more into it instead of across it. And it was hot. This was in Kit Carson, CO.
I think I drank a gallon of Gatorade plus a couple quarts of water, and poured another couple quarts down my jacket. It actually wasn't that bad as long as I kept my shirt soaked. The wind annoyed me more. I rode into Pueblo and could see this to the west...
This was the Royal Gorge fire that had just started earlier in the day. It had closed hwy 50 so I had to go around thru Westcliffe. I could also see the Black Forest fire off to the north.
I checked into a motel in Salida at 8pm. I had hit the road that morning around 6am. Long day. I get carried away sometimes when by myself. The next day I made it the rest of the way home. I rode hwy 92 which was really nice.
Hwy 139 north out of Grand Junction is always a nice ride. It doesn't look like much heading out of the GJ area...
But once you get north a ways it looks like this...
Well that's all I got. Hopefully I've convinced a few of you to give the plains a closer look.
ALinUTAH screwed with this post 06-16-2013 at
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How's your basic cooking knowledge?
Well, if you're reading this at all, I know you at least have an interest in cooking (or perhaps just eating – that means you, Dad!). Cooking is something that so many people do, but often out of necessity, rather than because they are passionate about the art. It's also something for which the vast majority of people do not receive any training, other than watching their parents cook. But what if your parents were not big cooks? What if you just had to learn as you go? Sometimes you miss the critical points, the basic techniques that can make a big difference to your overall effectiveness as a cook.
That's where the Basics comes into play. Starting today and every Wednesday you'll be able to see a new Basic episode (or two!), showing you how to do one cooking technique properly. Today we're launching two segments – how to cook pasta and how to make a marinara sauce. Already a pro? Well, watch it anyway – you never know when you might learn something new! Remember: the more you know, the more you know you don't know!
I hope you enjoy the segments. They were a lot of fun to make and they let me do what I love doing best – teaching people! If you like the segment, be sure to click "Like" and subscribe to the series. So, without further ado… let's get BASIC!


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Saban statue to debut April 16
Published: Saturday, April 2, 2011 at 3:30 a.m.
Last Modified: Saturday, April 2, 2011 at 12:39 a.m.
TUSCALOOSA | The statue of University of Alabama head football coach Nick Saban commemorating the Crimson Tide's 2009 national championship will be unveiled on April 16, before the kickoff of A-Day, the spring football game.
On stands now
The story of the creation of the statue is featured in the latest issue of Tuscaloosa magazine, available Monday at Barnes & Noble,Books-a-Million, The Tuscaloosa News and area Kangaroo stores.
Saban is Alabama's fifth national championship coach. Statues of each of the previous four already stand along the Walk of Champions plaza in front of Bryant-Denny Stadium's University Boulevard entrance.
Alabama's 1992 national championship coach, Gene Stallings, will attend the unveiling, along with representatives of the families of the other three coaches whose likenesses already stand there: Frank Thomas, Wallace Wade and Paul W. "Bear" Bryant.
"In keeping with our custom of honoring our national championship head football coaches, we are pleased and proud to unveil the statue of Coach Saban to add to our Walk of Champions at Bryant-Denny Stadium," UA Director of Athletics Mal Moore said in a statement. "By leading our team to Alabama's 13th football championship in 2009, coach Saban earned his place among the legends we recognize. This is an outstanding testament to his work at Alabama, and a fitting tribute to the accomplishments of our entire football program under his leadership."
Alabama's permanent team captains from the 2010 season will be honored at Denny Chimes at about 12:15 p.m. on A-Day.
The unveiling will take place at the Walk of Champions at about 12:40 p.m.
Players from UA's 2009 national championship team, as well as players on the current roster, will be on hand for the ceremony.
Reach Chase Goodbread at firstname.lastname@example.com or at 205-722-0196.
Reader comments posted to this article may be published in our print edition. All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.


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Results 1 to 8 of 8
December 21st, 2007 #1
painter x stopped working on my mac...
yeah, like if i want to use it. i click on the shortcut to run the program.
it doesn't load the program and gets stuck at the splash image and then just quits and tells me if i want to report or relaunch.
i'm using a macbook pro with leopard osx.
anyone know if there might be a fix for it?
any help would be appreaciated.
Hide this ad by registering as a memberDecember 21st, 2007 #2
Basic troubleshooting:
1. Restart your computer. I assume you've already done this, but it never hurts to ask.
if that doesn't work
2. Run Disk Utility and repair any problems it finds (You'll have to boot from a CD or external drive to repair your startup disk).
if that doesn't work
3. Trash your Painter prefs file.
if that doesn't work
4. Reinstall Painter.
Tristan Elwell
**Finished Work Thread **Process Thread **Edges Tutorial
Crash Course for Artists, Illustrators, and Cartoonists, NYC, the 2013 Edition!
"Work is more fun than fun."
-John Cale
"Art is supposed to punch you in the brain, and it's supposed to stay punched."
-Marc Maron
December 21st, 2007 #3Registered User
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December 21st, 2007 #4
ok, i've tried everything there is.
reinstalled it, still wouldn't work. could it be something within my computer settings or something?
December 21st, 2007 #5Registered User
- Join Date
- Aug 2007
- Posts
- 73
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- Thanked 4 Times in 4 Posts
There was a similar problem with a PC and Internet explorer and the splashscreen. If you have a rif file, double click on that and see if painter will open. It will bypass the splash screen. I know absolutely nothing about macs, but this may be worth a try. If that does work, you can trash the splash screen. I don't remember how, but I'm sure someone else will remember. Also, check that you have the latest patch to Painter. You should have PainterX.1
December 22nd, 2007 #6
hmm tried opening one of my Rif files, didn't work.
even if i got the latest patch, which i did.
even tried re-installing it.
do you think it's the new leopard version of osx being the problem?
my scanner won't work because it's not supported by leopard and i've heard alot of other compatability problems by other people with many other things.
but painter was working just fine before and it just started doing this. i don't remember anything i could have done that could cause this.
i'm totally losing it , an exspensive program that i really need to use and it just fails all of a sudden.
December 22nd, 2007 #7
I don't have a solution for you, but I do "feel your pain," as they say. When I upgraded from a Mac PPC G4 to an Intel Mac Pro, I lost Painter 7 and I'm still sick over that. I love Painter 7's interface and would stay with it forever if I could.
I've decided to stay with OS 10.4.10 (Tiger) for now until the kinks are worked out in 10.5 Leopard. I'm just reading too many horror stories about Leopard - and Microsoft Vista, too.
More speed and advances in computer technology are great, but I sometimes wish they would just say, "We've gone as far as we can and there will be no more upgrades to anything." We'd lose a lot I'm sure, but it would make life a lot less complicated.
Call me an ""old fogey"" or a pessimist if you like, but when you spend a ton of money on new stuff and it breaks something that was fixed, it upsets me.
December 23rd, 2007 #8
well i got it working again, i missed one of th options elwell suggested about the prefs file. apparently that's what made it screw up. after that i reinstalled it and ran the latest update it runs much better now.


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"Thom Grey was created to exemplify a more youthful and university inspired sensibility," the designer told WWD.
He was not Hugh Hefner, who used his house to exemplify his sexual values.
Few Americans appear to exemplify that proposition better than Joseph P. Kennedy.
early 15c., "to illustrate by examples, to instruct by (good) example," from Medieval Latin exemplificare "to illustrate," from Latin exemplum (see example). Meaning "to serve as an example" is recorded from 1793. Related: Exemplified; exemplifies; exemplifying.


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Georgia congressman gives new meaning to chutzpah
Jack Kingston is proud of his ability to add to the nation's sea of red ink.
Rep. Jack Kingston, a Republican member of Congress from Georgia, is no slouch at bringing home the bacon. In spending bills working their way through Congress, Kingston has earmarks -- local spending items inserted into appropriations measures -- worth $83 million. Is he hanging his head and digging his toe into the carpet in shame? Not at all; he's proud of it.
"Why do you think we have 13 military bases in the state of Georgia?" Kingston told a reporter for Cox Newspapers. "That doesn't happen by accident." He credited legendary Georgia lawmakers such as Richard Russell and Carl Vincent for "being entrepreneurial about bringing something home."
Bringing something home. There you have it -- three words at the heart of our fiscal mess. Members of Congress -- and the people they represent -- are hypocrites when it comes to federal spending. They hate it in general but love it in particular, especially when the "particular" is their own district. You can be sure that every member of Congress opposes deficit-spending. But given the option of reducing the deficit or bringing home, say, $83 million in pork, well, you know the answer.
Lard and largesse
Rep. Kingston is not alone; there are many big spenders in Congress and Texas has its share, though few are probably as brazen about it as Kingston. What members of Congress seem unconcerned about is how the government (read: taxpayers) will pay for this lard and largesse. They should be required to figure out that for every dollar they propose in spending, they would have to raise taxes, or cut spending somewhere else, by that amount. Of course, it's easier to defer having to make tough calls to sometime in the misty future when the present occupants won't be around.
But we shouldn't just point fingers at Congress. Former Federal Reserve Chairman Alan Greenspan, in his new book, released Monday, criticizes President George W. Bush for his failure to use his veto power to curb out-of-control spending. When Bush took office in 2001, he inherited a $200-billion budget surplus. But every year thereafter, government spending has been in the red. In 2004, the deficit swelled to a record $413 billion.
A study last year by the Cato Institute compared the spending habits of each president for the past 40 years. It turned out that Bush has been one of the biggest spenders of all time, outpacing even Lyndon B. Johnson's during his Great Society excesses.
Greenspan, in his book, laments the loss of fiscal discipline by the Congress and the president. "Congress and the president viewed budgetary restraint as inhibiting the legislation they wanted," he wrote. " 'Deficits don't matter,' to my chagrin, became part of Republican rhetoric." Greenspan is right, but he should have had the courage to voice his opinions more openly when he might have been able to influence events.
Now, the president and Congress must know that we cannot sustain the prospect of federal deficits as far as the experts can project. We can't continue to avoid making tough spending decisions as the nation prepares to try to cope with the baby boom retirement. We can't blithely pile up mountainous debts while we postpone any serious discussion of the country's ever-worsening fiscal condition. We're all to blame -- for the voters keep rewarding their own members of Congress who are skillful at bringing home the bacon.
The deficit is bigger than any elephant in the room -- and it is getting bigger. The time is coming when Congress will have to do what members love talking about -- actually reducing the federal deficit and begin, ever so painfully, to put the nation's fiscal house in order. It will take some doing, thanks to big spenders like Jack Kingston.
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42 year old man | Plainfield, IN, USA | Seeking women 27-41 within 50 miles
Fun, adventurous, active guy looking for great gal
I like to stay active and think it's important to take care of my health. I'm looking for someone who also feels that being healthy is important. But, I also like to enjoy life at the same time. Part of that enjoyment, for me , is a nice craft brewed beer or a glass of wine. And, though most of the time, I will order or cook a healthy meal... a good pizza loaded up with toppings is definitely a necessity! Being adventurous and trying new things (i.e. restaurants, cities, etc) is how I like to live life. I'm looking for someone equally active and adventurous to do these things with. I have a great group of friends from college that are scattered all over the country. I love to visit them and their families. They are good people.
Camping , Cooking , Dining out , Gardening/Landscaping , Museums and art , Music and concerts , Exploring new areas , Nightclubs/Dancing , Playing sports , Travel/Sightseeing , Watching sports , Wine tasting
Baseball, Basketball, Cycling, Football, Golf, Running, Weights / Machines
I exercise 5 or more times per week.
I like Dogs
Middle of the Road
I'm a food and beverage guy at heart. I spent a portion of my life working in restaurants and still have a love for it. Places such as Bluebeard, Black Market and R Bistro top my list of eateries.
Purdue University, West Lafayette, IN
Live music, checking out new restaurants, brewpubs, the baseball park (StL Cardinals), and the Colts!
I spend the majority of my free time running or working out. I try to run a marathon or two per year, which forces me stay in decent shape. I like to check out intimate live music shows, attend beer fests/wine tastings, or take in a museum.
Born to Run - Christopher McDougall. If you are a runner, this is a must read!
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|5'10" (177cms)
|5'4" (162cms) to 5'9" (175cms)
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Studied Electrical Engineering & Business at Purdue. I'm analytical by nature.


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Local Sports
Russell's Hoch Runs in McPherson Regional
Russell High School cross country runner Hannah Hoch competed in the McPherson 4A Regional on Saturday, Oct. 26.
Russell Stopped by Hoisington
The Russell High School football team will miss the playoffs for the seventh-straight year after falling to Hoisington 53-14 on Friday, Oct. 25 at Shaffer Field in Russell.
KVA Rankings - Week 7
The Kansas Volleyball Association is pleased to announce the 2013 Week 7 Volleyball Rankings sponsored by PrepVolleyball.com.
RHS Golfers Compete at State
Russell High School's Megan Boxberger and Alex Ptacek both competed in the Class 4A State Golf Tournament in Pittsburg on Monday, where Boxberger finished 11th overall.
Russell Drops District Opener to TMP
The Russell High School football team fell behind 21-0 less than five minutes into their Class 3A, District 15 opener and ended up losing 49-0 to rival Thomas More Prep at Shaffer Field in Russell on Friday, Oct. 18.
More Articles...
- Broncos Compete in NCAA League Meet
- KVA Rankings - Week 6
- Lady Broncos Split Senior Night Triangular
- RHS Sending Two to State
- Sacred Heart Too Much for Broncos
- Area Football Scores - Week 6
- RHS Runs in Sterling
- Russell Announces 2014-15 Football Schedules
- KSHSAA Releases District Football Assignments for 2014-15
- KVA Volleyball Rankings - Week 5
- Lady Broncos Swept by Minneapolis
- KSHSAA Sets 2014 State Basketball Sites
- Russell Goes 1-1 in Home Triangular