text:
Number: 0035
Aetna considers standard or preservative-free injectable influenza vaccine a medically necessary preventive service for members when influenza immunization is recommended by the member's doctor.
Aetna considers high-dose injectable influenza vaccine (Fluzone High-Dose) a medically necessary preventive service for members age 65 years of age or older when influenza immunization is recommended by the member's doctor.
Aetna considers intradermal influenza vaccine a medically necessary preventive service for members 18 to 64 years of age when influenza immunization is recommended by the member's doctor.
Aetna considers intradermal influenza vaccine experimental and investigational for all other indications because its effectiveness for indications other than the one listed above has not been established.
Aetna considers intranasally administered influenza vaccine a medically necessary alternative to injectable influenza vaccine for immunocompetent healthy persons 2 to 49 years of age when influenza immunization is recommended by the member's doctor.
Aetna considers intranasally administered influenza vaccine experimental and investigational for persons younger than 2 years of age or older than 49 years of age and for other persons considered at increased risk for influenza or its complications. The safety and efficacy of intranasally administered influenza vaccine for persons at high risk for influenza and its complications have not been established. Intranasally administered influenza vaccine is contraindicated in autologous and allogeneic hematopoietic cell transplant recipients, and is considered experimental and investigational in these persons.
See also CPB 0476 - Influenza Rapid Diagnostic Tests.Background
Influenza viruses ("the flu") infect the respiratory tract. Symptoms include fever, cough, sore throat, runny or stuffy nose, headache, muscle aches, and extreme fatigue. Influenza viruses continually change over time, and each year the vaccine is updated to include the viruses that are most likely to circulate in the upcoming influenza season.
In the United States (U.S.), flu season usually peaks between late December and early March. The best time to be vaccinated against influenza is from October through mid-November. However, influenza vaccination can be taken at any time during the season. Pneumococcal and influenza vaccinations may be given simultaneously when both are required. Children may be given influenza vaccine at the same time as routine pediatric immunizations; however, vaccines should be given at different sites.
The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) recommends annual influenza immunization for persons aged 6 months and older beginning with the 2010 to 2011 influenza season. Prior to the expanded recommendations for the 2010 to 2011 influenza season, ACIP's recommendations for seasonal influenza vaccination had focused on vaccination of persons who have a higher risk for influenza complications. These higher risk persons should continue to be a primary focus for vaccination as providers transition to routinely vaccinating all persons 6 months of age and older. Higher risk individuals include:
Children younger than 6 months of age should not receive influenza vaccination.
It takes 1 to 2 weeks after receiving the vaccination for protective antibodies to form. Influenza vaccines are 70 to 90 % effective in preventing influenza among healthy adults. Among elderly persons or people with chronic conditions, the vaccine may be less effective in preventing disease than in preventing serious complications and death.
Children less than 9 years of age who have not been vaccinated previously should receive 2 doses of live attenuated (if age appropriate) or trivalent inactivated influenza vaccine (TIV). Children who received only 1 dose of a seasonal influenza vaccine in the first influenza season that they received the vaccine should receive 2 doses, rather than 1, in the following influenza season. In addition, for the 2010 to 2011 influenza season, children 6 months to 9 years of age who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine should receive 2 doses of a 2010 to 2011 seasonal influenza vaccine, regardless of previous influenza vaccination history. For all children, the second dose of a recommended 2-dose series should be administered 4 weeks or more after the initial dose (ACIP, 2010).
Only the subvirion or purified surface-antigen vaccines, i.e., those termed "split-virus" vaccines, should be administered to children younger than 13 years of age. The whole-virus vaccines are associated with higher rates of adverse effects in young children.
Split-virus vaccine is recommended for children younger than 12 years of age; the recommended vaccine dose is 0.25 ml for children aged 6 to 35 months and 0.5 ml for children aged greater than 3 years. Children less than 9 years of age who have not been vaccinated previously should receive 2 doses of vaccine at least 1 month apart. A 0.5-ml dose of whole or split-virus vaccine is recommended for adolescents and adults.
Influenza vaccine should not be administered to persons with anaphylactic hypersensitivity to eggs or egg products.
The FDA has approved a nasal-spray influenza vaccine (FluMist) jointly developed by MedImmune Vaccines Inc. and Wyeth Vaccines. The nasal-spray influenza vaccine is a made from a cold-adapted live attenuated virus that is sprayed as an aerosol from a syringe into both nostrils. The FDA originally approved the nasal-spray influenza vaccine only for healthy people ages 5 to 49 years of age, a group for whom influenza vaccination is considered elective. On September 19, 2007, the FDA approved expanding the population for use of the nasal influenza vaccine FluMist to include children between the ages of 2 and 5 years. The FDA currently recommends that individuals considered at high risk for severe cases of the illness -- including those older than age 50, infants ages 6 to 23 months, and patients with chronic conditions such as asthma or diabetes -- continue to receive the injectable version of the vaccine.
The Advisory Committee on Immunization Practices (ACIP) (CDC, 2003) has concluded that nasal-spray influenza vaccine is an acceptable option for persons at average risk for influenza. The ACIP has stated that persons at high risk of influenza should not be immunized with the nasal-spray influenza vaccine. Clinical studies are currently underway to assess the safety and effectiveness of this live attenuated virus vaccine in persons at increased risk of influenza.
Administration of vaccine via aerosol avoids local soreness from injection. Nasal-spray influenza vaccine, however, is derived from a live attenuated virus and is associated with an increased incidence of upper respiratory symptoms (sore throat, rhinitis, cough) following administration (MedImmune, 2003).
Preservative-free influenza vaccine (e.g., FluZone, Aventis Pasteur, Inc. Swiftwater, PA; Afluria, CSL Biotherapies, King of Prussia, PA) does not contain the thimerosal, a mercury-containing preservative. Standard thimerosal-preserved influenza vaccines contain trace amounts of mercury (AAP, 2003). The American Academy of Pediatrics, the American Academy of Family Physicians, the Advisory Committee on Immunization Practices and the U.S. Public Health Service has issued a joint statement advising the removal of thimerosal-containing vaccines from vaccines routinely recommended for infants (AAP, 2000). The joint statement explains that "[w]hile there was no evidence of any harm caused by low levels of thimerosal in vaccines and the risk was only theoretical, this goal was established as a precautionary measure. There is public concern about the health effects of mercury exposure of any sort, and the elimination of mercury from vaccines was judged a feasible means of reducing an infant's total exposure to mercury in a world where other environmental sources of exposure are more difficult or impossible to eliminate (e.g., certain foods)." Other persons who are sensitive to thimerosal should avoid vaccines containing this preservative. Furthermore, the U.S. Public Health Service recommended efforts be made to eliminate or reduce the thimerosal content in vaccines as part of an over-all strategy to reduce mercury exposures from all sources and ACIP and other federal agencies and professional medical organizations continue to support efforts to provide thimerosal preservative-free vaccine options (ACIP, 2008).
The American College of Obstetricians and Gynecologists and the American Academy of Family Physicians recommend routine vaccination of all pregnant women. No preference is indicated for use of TIV that does not contain thimerosal as a preservative for any group recommended for vaccination, including pregnant women. Live, attenuated influenza vaccine (LAIV) is not licensed for use in pregnant women (ACIP, 2008).
Nichol and colleagues (2007) examined the effectiveness of influenza vaccine in seniors over the long-term. Data were pooled from 18 cohorts of community-dwelling elderly members of 1 U.S. health maintenance organization (HMO) for 1990 to 1991 through 1999 to 2000 and of 2 other HMOs for 1996 to 1997 through 1999 to 2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important co-variates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27 % reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95 % confidence interval [CI]: 0.68 to 0.77) and a 48 % reduction in the risk of death (adjusted odds ratio, 0.52; 95 % CI: 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, these researchers modeled the effect of a hypothetical unmeasured confounder that would have caused over-estimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant -- though lower -- reductions in the risks of both hospitalization and death. The authors concluded that during 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. They noted that vaccine delivery to this high-priority group should be improved.
In an editorial that accompanied the afore-mentioned study, Treanor (2007) stated that these findings support the current policy of vaccinating the elderly but also demonstrate that the inactivated influenza vaccine is by itself a relatively mediocre means for controlling flu in this population. Until more immunogenic vaccines are developed, routine vaccination of children as well as health care workers could limit transmission and play an important role in controlling the development of influenza in the elderly.
A high dose seasonal influenza vaccine specifically intended for people aged 65 and older was approved by the FDA on December 23, 2009. Fluzone High-Dose (Sanofi Pasteur Inc.) was approved via the FDA's accelerated approval pathway. It contains 4 times the total amount of virus hemagglutinin (180 mcg) found in other seasonal vaccines. The higher-dose formulation is based on the theory that immune functions weaken with age and that the elderly are especially vulnerable to complications from seasonal influenza. In clinical studies, Fluzone High-Dose demonstrated an enhanced immune response compared with Fluzone in individuals aged 65 and older. Common side effects were more frequent with the high-dose than with regular-dose formulations, but the rate of serious adverse events was no higher. Since the product received accelerated approval, the manufacturer must conduct further studies to verify the higher efficacy of the vaccine among older people (FDA, 2009). The Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) have not expressed a preference for any flu vaccine indicated for people 65 and older (CDC, 2014).
There is evidence to suggest that influenza vaccination improves the clinical course of coronary artery disease (CAD) and reduces the frequency of coronary ischemic events. In a randomized, double-blind, placebo-controlled trial, Ciszewski et al (2008) assessed the effect of influenza vaccination on the coronary events in patients with confirmed CAD. This study included 658 optimally treated CAD patients (477 men, mean age of 59.9 +/- 10.3 years). A total of 325 patients received the influenza vaccine, and 333 patients received a placebo. Median follow-up was 298 days (inter-quartile range of 263 to 317). Primary end-point was cardiovascular death. Its estimated 12-month cumulative event rate was 0.63 % in the vaccine versus 0.76 % in controls (HR 1.06; 95 % CI: 0.15 to 7.56, p = 0.95). There were 2 secondary composite end-points: (i) the MACE (cardiovascular death, myocardial infarction, coronary re-vascularization) tended to occur less frequently in the vaccine group versus placebo with the event rate 3.00 % and 5.87 %, respectively (HR 0.54; 95 % CI: 0.24 to 1.21, p = 0.13), (ii) coronary ischemic event (MACE or hospitalization for myocardial ischemia) estimated 12-month event rate was significantly lower in the vaccine group 6.02 % versus 9.97 % in controls (HR 0.54; 95 % CI: 0.29 to 0.99, p = 0.047). The authors concluded that in optimally treated CAD patients, influenza vaccination improves the clinical course of CAD and reduces the frequency of coronary ischemic events. They stated that large-scale studies are needed to evaluate the effect of influenza vaccination on cardiovascular mortality.
A Cochrane review concluded that despite the significant effects noted in available randomized controlled clinical trials, that there are not enough data to evaluate the effect of influenza vaccination on coronary heart disease (Keller et al, 2008).
Maternal influenza immunization is a strategy with substantial benefits for both mothers and infants. Zaman et al (2008) evaluated the clinical effectiveness of inactivated influenza vaccine administered during pregnancy in Bangladesh. In this randomized study, a total of 340 mothers were assigned to receive either inactivated influenza vaccine (influenza-vaccine group) or the 23-valent pneumococcal polysaccharide vaccine (control group). Mothers were interviewed weekly to assess illnesses until 24 weeks after birth. Subjects with febrile respiratory illness were assessed clinically, and ill infants were tested for influenza antigens. These researchers estimated the incidence of illness, incidence rate ratios, and vaccine effectiveness. Mothers and infants were observed from August 2004 through December 2005. Among infants of mothers who received influenza vaccine, there were fewer cases of laboratory-confirmed influenza than among infants in the control group (6 cases and 16 cases, respectively), with a vaccine effectiveness of 63 % (95 % CI: 5 to 85). Respiratory illness with fever occurred in 110 infants in the influenza-vaccine group and 153 infants in the control group, with a vaccine effectiveness of 29 % (95 % CI: 7 to 46). Among the mothers, there was a reduction in the rate of respiratory illness with fever of 36 % (95 % CI: 4 to 57). The authors concluded that inactivated influenza vaccine reduced proven influenza illness by 63 % in infants up to 6 months of age and averted about one-third of all febrile respiratory illnesses in mothers and young infants.
According to the CDC, H1N1 (swine flu) is an influenza virus that was first detected in people in the U.S. in April 2009. It spreads from person-to-person in much the same way that regular seasonal influenza viruses spread (i.e., through coughing or sneezing by people with influenza). This virus was originally referred to as "swine flu" because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. However, studies have shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia as well as genes from bird (avian) flu and human influenza strains. It is referred to as a "quadruple reassortant" virus. Symptoms are similar to seasonal influenza (e.g., fever and chills, cough, sore throat, muscle aches, headache, and extreme fatigue). The CDC, however, reported that there is little 2009 H1N1 virus currently circulating in the U.S. and the Department of Health and Human Services has declared the end of the H1N1 influenza public health emergency as of June 23, 2010. With 2009 H1N1, aprroximately 90 % of estimated hospitalizations and 87 % of estimated deaths from April 2009 through January 16, 2010 occurred in people younger than age 65 years. In contrast, with seasonal influenza, about 60 % of seasonal flu-related hospitalizations and 90 % of flu-related deaths occur in people aged 65 years and older. These data confirm that the 2009 H1N1 impacted younger adults and children more than older adults compared to seasonal flu. However, people in all age groups can develop severe illness from either seasonal flu or from 2009 H1N1.
Guidelines for preventing infections in hematopoietic cell transplant (HCT) recipients by the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, European Group for Blood and Marrow Transplantation, American Society for Blood and Marrow Transplantation, Canadian Blood and Marrow Transplant Group, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Association of Medical Microbiology and Infectious Disease, and the CDC (Ljungman et al, 2009) indicated that intranasal influenza vaccine (live) should not be given to HCT recipients since an effective, inactivated alternative exist.
Available evidence shows that two doses of influenza vaccine does not improve antibody reponse in persons with hematologic malignancies. In a randomized controlled study (n = 70), Ljungman and associates (2005) examined if 2 doses of influenza vaccine were more effective than one to elicit an immune response in patients with hematological malignancies. These investigators found that responses were not improved by 2 doses compared with 1 (influenza A virus serotypes H1/N1 18 % versus 22 % and H3/N2 26 % versus 14 %; influenza B 25 % versus 22 %). The results were similar in patients with ongoing and discontinued therapy. Patients treated with monoclonal antibodies for lymphoma had very poor responses. These researchers concluded that 2 doses of influenza vaccine do not improve the antibody response in patients with hematological malignancies.
Frenck and colleagues (2011) examined if reduced doses of trivalent inactivated influenza vaccine (TIV) administered by the intradermal (ID) route generated similar immune responses to standard TIV given intramuscularly (IM) with comparable safety profiles. Recent changes in immunization recommendations have increased the number of people for whom influenza vaccination is recommended. Thus, given this increased need and intermittent vaccine shortages, means to rapidly expand the vaccine supply are needed. Previously healthy subjects 18 to 64 years of age were randomly assigned to 1 of 4 TIV vaccine groups: standard 15 μg HA/strain TIV IM, either 9 μg or 6 μg HA/strain of TIV ID given using a new microinjection system (BD Soluvia™ Microinjection System(1)), or 3 μg HA/strain of TIV ID given by Mantoux technique. All vaccines contained A/New Caledonia (H1N1), A/Wyoming (H3N2) and B/Jiangsu strains of influenza. Sera were obtained 21 days after vaccination and hemagglutination inhibition (HAI) assays were performed and geometric mean titers (GMT) were compared among the groups. Subjects were queried immediately following vaccination regarding injection pain and quality of the experience. Local and systemic reactions were collected for 7 days following vaccination and compared. A total of 10 study sites enrolled 1,592 subjects stratified by age; 18 to 49 years (n = 814) and 50 to 64 years (n = 778). Among all subjects, for each of the 3 vaccine strains, the GMTs at 21 days post-vaccination for both the 9 μg and the 6 μg doses of each strain given ID were non- inferior to GMTs generated after standard 15 μg doses/strain IM. However, for the 3 μg ID dose, only the A/Wyoming antigen produced a GMT that was non-inferior to the standard IM dose. Additionally, in the subgroup of subjects 50 to 64 years of age, the 6 μg dose given ID induced GMTs that were inferior to the standard IM TIV for the A/H1N1 and B strains. No ID dose produced a GMT superior to that seen after standard IM TIV. Local erythema and swelling were significantly more common in the ID groups but the reactions were mild-to-moderate and short-lived. No significant safety issues related to intradermal administration were identified. Participants given TIV ID provided favorable responses to questions about their experiences with ID administration. The authors concluded that for the aggregated cohorts of adults 18 to 64 years of age, reduced doses (6 μg and 9 μg) of TIV delivered ID using a novel microinjection system stimulated comparable HAI antibody responses to standard TIV given IM. The reduced 3 μg dose administered ID by needle and syringe, as well as the 6 μg ID for subjects aged 50 to 64 years of age generated poorer immune responses as compared to the 15 μg IM dose.
On May 11, 2011, the FDA approved Sanofi Pasteur's supplemental Biologics License Application for licensure of Fluzone Intradermal (Influenza Virus Vaccine). Fluzone intradermal vaccine is indicated for active immunization of adults 18 through 64 years of age against influenza disease caused by influenza virus subtypes A and type B contained in the vaccine.
In 2011, the ACIP provided the following recommendations regarding influenza vaccination of individuals with egg allergies:
Individuals who have experienced only hives may receive influenza vaccine with the following additional measures:
Other measures, such as dividing and administering the vaccine by a 2-step approach and skin testing with vaccine are not necessary.
In 2012, the US Food and Drug Administration approved quadrivalent formulations of both the live-attenuated influenza vaccine and the inactivated influenza vaccine; these vaccines contain two strains of influenza A virus and two strains of influenza B virus (Hibberd, 2012). Fluarix Quadrivalent is a vaccine indicated for active immunization for the prevention of disease caused by influenza A subtype viruses and type B viruses contained in the vaccine. It is approved for use in persons 3 years of age and older. Safety has not been established in pregnant women or nursing mothers. (FDA, 2013).
On January 16, 2013 the FDA approved Flublok in individuals aged 18 through 49 for active immunization against disease caused by influenza virus. Flublok is the first trivalent influenza vaccine made using an insect virus (baculovirus) expression system and recombinant DNA technology. Flublok's manufacturing technology allows for production of large quantities of the influenza virus protein, hemagglutinin (HA), the active ingredient in all inactivated influenza vaccines that is essential for entry of the virus into cells of the body. Flublok contains three, full-length, recombinant HA proteins to help protect against two influenza virus A strains, H1N1 and H3N2, and one influenza virus B strain (FDA, 2013). Fluzone Quadrivalent received FDA approval on June 7, 2013. Fluzone received approval for active immunization of persons 6 months of age and older for the prevention of influenza disease caused by influenza A subtype viruses and type B viruses contained in the vaccine (FDA, 2013c). Flumist Quadrivalent received FDA approval on February 29, 2013 for active immunization of individuals 2 through 49 years of age for the prevention of influenza disease caused by influenza A subtype viruses and type B viruses contained in the vaccine (FDA, 2013b).
In a June 19-20, 2013 meeting, ACIP voted and unanimously approved language changes to the vaccine safety update to state that "for individuals who have no known history of exposure to egg but who are suspected of being egg-allergic on the basis of previously performed allergy testing, use of RIV3 or consultation with a physician with expertise in the management of allergic conditions should be obtained prior to vaccination. If the patient only experiences hives after ingestion of egg, administer RIV3 (FluBlok) if the patient is aged 18to 49 years or administer a inactivated influenza vaccine (IIV) of choice and observe for at least 30 minutes following vaccination. If more severe reactions have been noted with eggs administer RIV3 (FluBlok) or refer to a clinician with expertise in allergic reaction" (Lardy et al, 2013).
The CDC's ACIP and the American College of Obstetricians and Gynecologists (2014) recommend that all adults receive an annual influenza vaccine. Influenza vaccination is an essential element of pre-conception, pre-natal, and post-partum care because pregnant women are at an increased risk of serious illness due to seasonal and pandemic influenza. Since 2010, influenza vaccination rates among pregnant women have increased but still need significant improvement. It is particularly important that women who are or will be pregnant during influenza season receive an inactivated influenza vaccine as soon as it is available. It is critically important that all obstetrician-gynecologists and all providers of obstetric care advocate for influenza vaccination, provide the influenza vaccine to their pregnant patients, and receive the influenza vaccine themselves every season. It is imperative that obstetrician-gynecologists, other health care providers, health care organizations, and public health officials continue efforts to improve the rate of influenza vaccination among pregnant women.
Madhi et al (2014) conducted 2 double-blind, randomized, placebo-controlled trials of trivalent IIV (IIV3) in South Africa during 2011 in pregnant women infected with HIV and during 2011 and 2012 in pregnant women who were not infected. The immunogenicity, safety, and efficacy of IIV3 in pregnant women and their infants were evaluated until 24 weeks after birth. Immune responses were measured with a HAI assay, and influenza was diagnosed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays of respiratory samples. The study cohorts included 2,116 pregnant women who were not infected with HIV and 194 pregnant women who were infected with HIV. At 1 month after vaccination, sero-conversion rates and the proportion of participants with HAI titers of 1:40 or more were higher among IIV3 recipients than among placebo recipients in both cohorts. Newborns of IIV3 recipients also had higher HAI titers than newborns of placebo recipients. The attack rate for RT-PCR-confirmed influenza among both HIV-uninfected placebo recipients and their infants was 3.6 %. The attack rates among HIV-uninfected IIV3 recipients and their infants were 1.8 % and 1.9 %, respectively, and the respective vaccine-efficacy rates were 50.4 % (95 % CI: 14.5 to 71.2) and 48.8 % (95 % CI: 11.6 to 70.4). Among HIV-infected women, the attack rate for placebo recipients was 17.0 % and the rate for IIV3 recipients was 7.0 %; the vaccine-efficacy rate for these IIV3 recipients was 57.7 % (95 % CI: 0.2 to 82.1). The authors concluded that influenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV.
In a systematic review, Prutsky and colleagues (2014) evaluated the evidence on LAIV in children younger than 2 years. These investigators searched Medline, EMBASE, the Cochrane Library, Web of Science, Scopus, PsycInfo and CINAHL through February 2013 for existing systematic reviews, randomized controlled trials (RCTs) and observational studies (for safety). They included studies enrolling healthy children less than 2 years of age who received LAIV, compared with placebo or IIV. Data were extracted independently by 2 investigators. The relative risk (RR) was pooled across studies using the random effects model. These researchers found 7 eligible RCTs and 2 observational studies. Randomized controlled trials included 6,281 children and were at low-to-moderate risk of bias. Live attenuated influenza vaccine reduced the incidence of influenza compared with placebo (RR = 0.36, 95 % CI: 0.23 to 0.58, p < 0.05) with a number needed to vaccinate of 17. Live attenuated influenza vaccine increased the incidence of minor side effects (fever and rhinorrhea); it had a similar effect in preventing influenza (RR = 0.76, 95 % CI: 0.45 to 1.30, p > 0.05) compared with IIV. There was an increase of hospitalization rate (post-hoc analysis) and medical attended wheezing with LAIV. The authors concluded that LAIV is highly effective in children less than 2 years of age compared with placebo and is as effective to IIV. The safety profile of LAIV is reasonable although evidence is sparse. They stated that LAIV may be considered as an option in this age group particularly during seasons with vaccine shortage.
In a Cochrane review, Dharmaraj and Smyth (2014) evaluated the effectiveness of influenza vaccination for people with cystic fibrosis (CF). These investigators searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and hand-searching of relevant journals and abstract books of conference proceedings. They also contacted the companies which market the influenza vaccines used in the trials to obtain further information about RCTs. Date of the most recent search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register: July 8, 2013. All randomized and quasi-randomized trials (published or unpublished) comparing any influenza vaccine with a placebo or with another type of influenza vaccine were selected for analysis. Two authors independently assessed study quality and extracted data. Additional information was obtained by contacting the investigators when it was indicated. A total of 4 studies enrolling a total of 179 participants with CF (143 (80 %) were children aged 1 to 16 years) were included in this review. There was no study comparing a vaccine to a placebo or a whole virus vaccine to a subunit or split virus vaccine. Two studies compared an intra-nasal applied live vaccine to an intra-muscular inactivated vaccine and the other 2 studies compared a split virus to a subunit vaccine and a virosome to a subunit vaccine (all intra-muscular). The incidence of all reported adverse events was high depending on the type of influenza vaccine. The total adverse event rate ranged from 48 out of 201 participants (24 %) for the intra-nasal live vaccine to 13 out of 30 participants (43 %) for the split virus vaccine. With the limitation of a statistical low power there was no significant difference between the study vaccinations. None of the events was severe. All study influenza vaccinations generated a satisfactory serological antibody response. No study reported other clinically important benefits. The authors concluded that there is currently no evidence from randomized studies that influenza vaccine given to people with CF is of benefit to them. They stated that there remains a need for a well-constructed clinical study, that assesses the effectiveness of influenza vaccination on important clinical outcome measures.
|CPT Codes / HCPCS Codes / ICD-10 Codes
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":
|ICD-10 codes will become effective as of October 1, 2015 :
|CPT codes covered if selection criteria are met:
|Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
|Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use
|Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use
|Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
|Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
|Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
|Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use
|Influenza virus vaccine, live, for intranasal use
|Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
|Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
|Influenza virus vaccine, quadrivalent, live, for intranasal use
|Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
|Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
|Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use
|Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
|Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
|Other CPT codes related to the CPB:
|Infectious agent antigen detection by immunoflourescent technique; influenza B virus
|influenza A virus
|Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semi quantitative, multiple step method; influenza A or B, each
|Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
|each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)
|Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular injections); one vaccine (single or combination vaccine/toxoid)
|+ 90472
|each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
|Immunization administration by intranasal or oral route: one vaccine (single or combination vaccine/toxoid)
|+ 90474
|each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
|Influenza virus vaccine. pandemic formulation, live, for intranasal use
|Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
|Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
|Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use
|HCPCS codes covered if selection criteria are met:
|Administration of influenza virus vaccine
|Nasal vaccine inhalation
|Influenza virus vaccine, split virus, for intramuscular use (agriflu)
|Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
|Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
|Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
|Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) [also covered for Fluzone High-Dose for member's age 65 years of age or older when influenza immunization is recommended]
|Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
|ICD-10 codes covered if selection criteria are met:
|Encounter for immunization


text:
Washington, District of Columbia. Gen. William Hoffman...
Washington, District of Columbia. Gen. William Hoffman (Commissary General of Prisoners) and staff
1 negative : glass, wet collodion.
- Title from Civil War caption books.
- Caption from negative sleeve: Gen. Wm Hoffman and staff. Washington D.C. April 1865 (Commissary geneal of Prisoners).
- Annotation from negative, glass side: Gen Hoffman & Lds. Spec 3/25/11, 4/1/4 marshall 4/4 a 6.
- Forms part of Civil War glass negative collection (Library of Congress).
- Civil War Glass Negatives and Related Prints
- Civil War
- United States--History--Civil War, 1861-1865.
- Glass negatives--1860-1870.
- Album: All photos
Added by AncientFaces

subset: commoncrawl


text:
The rumor that Robert Pattinson is at the top of the list to play Indiana Jones in a new Indy-led franchise may be crazy, but the idea that Harrison Ford was not the first choice to play the world's preeminent archeologist is even crazier. But it's true.
From Jack Nicholson to Chevy Chase, here are 10 actors who were either considered for or turned down the role of the intrepid Indiana Jones in "Raiders of the Lost Ark."
[via IMDB]
categories Movies


text:
NH Collection Barcelona Constanza
The NH Constanza Hotel is a 4-star property located in Barcelona's business district, close to Sagrada Familia, and Placa d'Espanya. The 308 air-conditioned guest rooms come in a choice of smoking or non-smoking, and include a private marble bathroom with hairdryer, telephone, and bath/shower combination. Each room is equipped with tea/coffee making facilities, satellite television, safe, desk, telephone, minibar, and radio. Specially adapted rooms are available for guests with disabilities, and all rooms are accessible by lift. The hotel provides a 24-hour front desk with multi-lingual staff, offering tour assistance, currency exchange, laundry services, babysitting and car/limo hire. The on site restaurants serve breakfast (surcharge), lunch and dinner, and room service is available around the clock. Drinks can be enjoyed in the bar/lounge. Six function spaces are offered for business travellers, which can be combined to suit individual needs. A range of business services and equipment is also offered. Leisure facilities include an outdoor swimming pool, gym, spa with sauna and massage treatments. The hotel provides on site parking and pets are accepted (charges apply).
Price range
NameNH Collection Barcelona Constanza
AddressDeu i Mata, 69-99, 08029, Barcelona Spain | 1.7 miles from city center | Show on map
Telephone: +34(93)2811500 | Fax:+34(93)4100335 | Official Homepage
Suitable for
- Food Lovers
- Business People
- Large Groups
Top 9 Features
Room features
- Bathroom with bathtub,
- Bathroom with shower,
- Windows that open,
- Television,
- Hairdryer,
- Central heating,
- Electric kettle,
- Air conditioning,
- Mini-bar,
- Pay-TV,
- Radio,
- Satellite TV,
- Desk,
- Telephone,
- Room safe,
- Cable TV,
- Internet,
- WiFi in the rooms,
- Cost of wireless internet in rooms,
- field_438
Hotel features
- Business center,
- Cafe,
- Entrance hall/ lobby,
- Express check-in / out,
- Elevator,
- TV lounge,
- Gym,
- Parking lot,
- Terrace,
- Hotel bar,
- Outdoor swimming pool,
- Hotel safe,
- Conference rooms,
- Non-smoking rooms,
- PC with internet,
- Restaurant,
- 24-hour reception,
- Snack bar,
- Deck chairs / Sun loungers,
- Towels at the pool / beach,
- Laundry service,
- Wellness Center / Spa,
- WiFi in Lobby,
- Room service,
- 24-hour room service,
- Car rental at the hotel,
- Reading room,
- field_437
Sports Facilities
- Bike Rental


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This summer, Kematen Cosmetics added new, state-of-the-art machinery to its Redding plant for filling tubes and jars. The site also now features a high-speed P.E. Labeler for labeling bottles, tottles, jars and cans. This machine is front, back, wraparound and multiple label capable, according to the company.
More info: www.kematen-cosmetics.com


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Mushroom Soup WallSmart Wallpaper
Note: This product is no longer available.
Design by Trine Andersen.
By ferm LIVING.
Designed with a 50's motif in mind, Mushroom Soup WallSmart Wallpaper is a blend of different mushrooms varying in types and sizes. Add a homey element to kitchens and dining rooms with this wallpaper. You don't need to be afraid of spills and stains, because Mushroom Soup WallSmart Wallpaper is easy to clean with a damp cloth. Enjoy mushroom soup year-round with this amusing wallpaper.
Printed on WallSmart wallpaper (non-woven fleece). WallSmart wallpaper is a new generation of non-woven wallpaper that is easier and faster to hang. When hanging the wallpaper, apply the paste to the wall and than hang the sections by butting the edges together.
Ferm Living's designs are a combination of graphic patterns and a unique modern touch. Each of their designs is inspired by Scandinavian nature, fashion, architecture, flea markets and trips around the world. All wallpapers, like the Branch WallSmart Wallpaper, are printed on the WallSmart quality (non-woven) — a quality that is very easy to work with, as the paste is applied directly onto the wall.
Be inspired! Choose your favorite design and start creating your own WonderWall.
Vendor does not offer glue. Wallpaper can be installed with glue available at major hardware stores.
Eco Friendly
Material(s): Non-woven fleece
Dimensions: 21" W X 32.8 Feet Long
Designer: Trine Andersen
Trine Andersen has been designing since she was a little girl growing up in the small Danish village of Jylland, where she made dresses for her dolls with spare fabric from her parents' clothing factory. She founded ferm LIVING in 2005, and today she designs from her studio in Århus, Denmark. Her wall art blends imaginative forms and offbeat subjects with a modern yet classic take. Trine draws inspiration from traveling, people watching, nature, fashion, and vintage books and magazines.View other products by Trine Andersen
Manufacturer: Ferm Living
"Ferm" is Danish for clever, and Ferm Living aims to design and manufacture interior products with a clever, graphic touch. The company originates from a graphic design agency in Aarhus, Denmark.
The company's eye-catching wall decor, pillows and accessories are a creative, easy, and affordable way to add inspiration and artistry to living spaces, bedrooms, kitchens and more.View other products from Ferm Living


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With all the "1000w max" or whatever amps on here people probly pass this one up seeing 420w but this amp is bigger and heavier then alot of these off brand 2000w whatever amps on here. This amp probly actually puts out steady what it says maybe more, not some amp that made 3000 watts @ 20v for one second before it was destroyed in a testing facility.
Have it pushing one orion xtr 12 dual 2 ohm sub in my friends lancer and its obnoxious. Easily mistaken for two decent 12s.
Low pass filter settings dont make much sence compared to most amps so i have it 3 stars for ease of use. also im not a fan of these style terminals for power wire, but they do hold secure.
Expert Service 1-877-289-7664 [Hours]


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I was also able to get through the registration mess. Looking forward to the ride.
Type: Posts; User: 2thGrinder; Keyword(s):
I was also able to get through the registration mess. Looking forward to the ride.
I have them on both of my bikes and have been using them for about 4+ years. They are a great dependable tire :thumb:
I think 15-20 or so of our camping group got in. I look forward to seeing you Shifty. Went through Sisters today and it brought back fond memories of our McKenzie Pass ride. :thumb:
I really enjoy the trail around Hagg Lake on a mt bike as well. Also a good ride to ride the road around the lake on a road bike
It was an amazing week and great to see Shifty again. Hope all went well for you.
:thumb: i wish I would have been with you. i was dropping my daughter off at college at BYU-Idaho. 24 hours of driving in about 54 hours:notamused:
I am also in again this year. Can't wait
I think 55/Rad only has 2 frames currently in for paint, for now:thumb:
Brings back great memories from cycle Oregon last year. It was my favorite day!
I have cycle Oregon the 6-13 but maybe later in Sept.
That picture looks familiar.:) It would be fun to do again. I am doing the Mt Hood Hoo-Ha on the 16th. It is 75 miles with about 5500 ft of climbing so friday will be a rest day for me. If you...
The routes are limited. 26 over mount hood, 22 up past detroit lake or out of eugene over mckinzie pass if it is open. Mckinzie pass is the only one I have been on which takes you to sisters and...
fun clip.
I just realized I will be in Atlanta:(
I am also planning to do this ride again this year. It will be my fourth. I still prefer Summit to Surf, something about the route is amazing. I think we will be on a family vacation for...
I am also in. This will be my third.
I would highly recommend Cycle Oregon. It is week long ride between 4-500 miles and the climbing varies each year. This year it was over 28,400 ft. It is fully supported ride, 3 meals a day and...
Looks like there is quite a bit of info using the search feature. I have never tried this chain but have thought about it.
My favorite by far is the Hincapie wind vest. Great product.
If the weather is too bad my 100 may turn into 70. We'll have to see. I will watch for you.
just a form of "tooth grinder". Hazard of being a dentist.
I also like the prices of performance/nasbar/PBK but their service and staff knowledge is often lacking.
Jay Graves is the president of Bike Gallery. They are most often higher in price but a...
Shifty, how about a ride report?
I will be leaving for scout camp with my son on that saturday so I will be looking forward to next year as well.


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Snuggle up with Home accents.
Your coupon will be applied to the highest regular-price, eligible item in your cart.
Offer good for one item at regular price only. Limit one coupon per customer per day. Must present coupon at time of purchase. Offer is not valid with any other coupon, discount or previous purchase. One cut or one bolt of fabric or trim "by the yard" equals one item. Online fabric & trim discount is limited to 10 yards, single cut. Excludes Heidi Swapp™ Minc.™ Foil Applicator, CRICUT® products, Tim Holtz® Vagabond™ Machine, Silhouette CAMEO® Machine, candy & snack products, gum & mints, helium tanks, gift cards, custom orders, special orders, labor, rentals or class fees. Cash Value 1/10¢.
Snuggle up with Home accents.
Cheery craft projects for gifts (or for keeps).
Send heartfelt happies.
Fabrics and trims to make loved ones grin.
Needle-art supplies worth swooning over.
Beads and baubles to set hearts aflutter.
Stir up some love.
Fall in love with wedding and floral.
Say yes to days of dreamy artistic expression.
Stencil and stamp your way to DIY'd wearables.
Everything you need to make the season extra sweet.
Pine Car XLR8 Ultra Graphite for the serious competitor.
Laboratory tested for performance, special-blend formula XLR8 amps your racer's speed to the max. Included in the package is a stainless steel needle applicator for precision placement.
Each bottle contains 0.23-ounces.
I love it! Add to wish list


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44 year old woman | Weimar, CA, United States | Seeking men 38-48 within 50 miles
I love to experience all of the fun things the world has to offer!
my closest friends would describe me as a persoN who appreciatEs staying at home, but who really loves to get out and do fun, neW things. my son, 14, makes me smile. i am truly one proud mamma. i am most proud of my job. it was difficult For me to get throUgh the schooling but because of it I have the best job, with the best bosses on the plaNet. i am hoping to attract someone who is nice, caring, fun, loving and who wantS to be witH me. in A RelatiONship, i Am inTerested in someone who is Gentle and for coMpAnionship In the truest sense of the word; at this point i am not looking for marriage. oh--I pLay games, but only in jest; here is one for you. if you want to get in touch with me, look closely at what letters are capitalized above. ;)
Camping , Coffee and conversation , Cooking , Dining out , Movies/Videos , Exploring new areas , Nightclubs/Dancing , Shopping/Antiques , Travel/Sightseeing , Wine tasting
Billiards / Pool, Bowling, Dancing, Football, Skiing, Swimming, VolleyBall, Walking / Hiking
I don't exercise regularly.
I like Dogs, Fish, Horses
I like dogs and horses, but I am generally allergic to cats (I have met one cat that I wasn't allergic to).
Middle of the Road
the ocean
Sierra College, Rocklin, CA
Fav food: Spaghetti, Mexican Fav TV show: Sons of Anarchy Fav Music: old rock & roll, country
Paint, visit friends, watch TV, willing to do much more :)
Z{{Cta}} {{#if HasMoreInfo}} ?{{CtaSecondary}} {{/if}}
|What she is looking for
|5'2" (157cms)
|5'4" (162cms) to 6'2" (187cms)
|Body type:
|Slender, A few extra pounds
|No preference
|Light brown
|No preference
|No Way
|No Way
|Social Drinker
|Medical / Dental / Veterinary / Fitness
|No preference
I am a Medical Assistant for a private doctor's office.
|I'll tell you later
|No preference
|Currently Separated
|No preference
|Have kids:
|Yes, and they live away from home (1)
|No preference
|Wants kids:
|Not sure
|Someday, Not sure, Probably not, No, but it's OK if my partner has kids
|White / Caucasian
|White / Caucasian
|Christian / Catholic
|Christian / Catholic, Christian / Protestant, Spiritual but not religious
Non-practicing, but Catholic none-the-less :)
|Some college
|No preference


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updated 07/19/2011 AT 10:20 AM ET
•originally published 07/15/2011 AT 6:00 AM ET
Where's Blake? Leonardo DiCaprio added a new member to his posse – Bradley Cooper – during a night out at Beacher's Madhouse inside the Hollywood Roosevelt Hotel. The guys snuck into the club before 1 a.m. and took a seat in the front row for the vaudeville show. DiCaprio cheered for the burlesque performers and seemed more animated than usual. Grabbing Cooper's attention? The same troop of burlesque dancers.


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Feeling Immortal. by FlameOfInsperationWatch
©2006-2016 FlameOfInsperation
I'm in love with this one. <3
An image I feel holds a very powerful essance about it. I love the direct lighting that the sun gives off. And it just makes me feel like writing about how everyone should just sit back and breath in life to it's fullest and absorb the happiness that openly presents itself to you at every given moment of everyday, you just have to let it! The balance of this image is profound as well, I love how it is shadowed by the wall's frame yet the topping sky is left open. Again could be another of endless symbology. Its a VERY positive image, I feel and it is definetely worth my first favourite in your gallery. Also the title is very suiting!
Thank you dollface! It really means a lot to me coming from you since I do admire a great deal of your work! <3
This one came out so great. I wish Dan had the energy, that shot from the top of the wall would have been great.
Yeah it would of, but I don't think it was the energy, I think it was the fact that the tree was attacking his crotch that threw him off.
I gave him 20$ yesterday. Just so he'd have some money for himself for whatever his needs may be. I just don't know what else to do in a situation like this. Any advice?
I think it's time you talk to your parents about you dating him and see if maybe there's something they can do to help.
If I had my job already I would absolutly help you two out, you guys have been there for me through some stuff.
I love you, I hope things get better.
If I had my job already I would absolutly help you two out, you guys have been there for me through some stuff.
I love you, I hope things get better.
I can't tell them yet... I would if I could. They would put so many restrictions on me... more than your dad has on you. I would not be able to drive out and see him, nor would I be allowed to go to Hell. I spoke with him about this last night and he said..." then it would be pointless to be dating you if I couldn't see you..." I wanted to cry. I do kinda feel like he doesn't want to see me as much as I want to see him. Even if I'm just sitting there holding his hand or whatever... I just like to be around him. It makes me feel so comfortable inside. Ya know?


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We design web sites for local High Peak and national businesses. If you would like to make an enquiry, please contact us.
Patrick is a professional Alexander Technique Practitioner operating in Manchester and throughout the Peak District and needed a website to promote his business and give his clients more information.
This website was created for Campbell Design and Engineering Ltd. A company that specialises in architectural ironmongery and Urban Regeneration. The website build needed to be very visual to show off the company's artwork but along side this High Peak Web Solutions created an enterprise level email hosting and backup system for maximum security and reliability.
This site was commissioned by the SIGMA Maths Network to provide a central hub of resources for teachers and lecturers delivering maths support to university students. The site was built using a content management (CMS) system so that lecturers can update the site themselves without support. The project included full and customised support documentation and videos.
An information site for a multinational fuel distribution company. The project involved working with a corporate style guide to produce a design coherent with other marketing materials. The site is a full CMS and features several innovative elements including light boxes, feature sections and interactive infographics.
In addition to a professional business site, High Peak Web Solutions produced a logo and vector graphics that have been used on clothing, print media and vehicle decals.
A website for Learn and Lead, an organisation that connects school management teams across Merseyside.
This website includes a visually attractive landing page, Google Analytics, Blog & Mailing list system. John Mountford is a South African novelists whose first novel, Kill Mandela is released late 2013.
This is the website for Professor Timothy Insoll, an Archaeologist at the University of Manchester. The site was built to display the author's amazing picture galleries in a style similar to that of the social bookmarking site, Pinterest. The website combines a logical layout with a visually attractive style to provide a show case of work and updates about recent and current field projects.
This site design for a leading Derbyshire marketing agency required a simple, professional appearance with newsletter and social media integration. By working with the agency, High Peak Web Solutions has provided not only a brochure site, but also a blogging platform.
This is a complete site redesign for a major kidney disease charity. The site was given a bright and clear makeover for a simple user experience and a more modern style. As with all our sites, this can be updated by the user.
This is a website for the engineering company, Fabweld, based in New Mills. Fabweld.co.uk uses an innovative portfolio feature allowing the staff to show off their recent work in an accessible and aesthetically pleasing manner. This job also included vectorisation of a logo, graphic design, photo editing and working to a corporate style guide.
This is an example of a single page website, perfect for small businesses who wish to communicate the basics of their operations without investing in a full CMS. Like all our websites, this is a bespoke web design and features an interactive panoramic view of the beautiful surroundings of Higher Disley in Cheshire. Web Design was completed after a personal consultation and photo shoot with a professional DSLR camera.
This site was built for a performance billiard tip manufacturer. The site needed to give a powerful visual impact whilst presenting information in a way that was accessible for customers and other B2B clients. This site also combines a social media marketing package, search engine optimisation features and detailed visitor statistics to give the client the information they need to continue to dominate their market sector.


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Coffee - it does a body good.
Health Benefits of Coffee - WebMD
No sarcasm, that was a good defense. And I appreciate your staunch stance, in the face of this most recent study, which - as we all know - is just another study and proves nothing per se.
I concede you have poked good holes in my arguments. BUT! What if coffee is good for some people and bad for others? As a person with all the obvious signs of asperger's syndrome, I find coffee necessary. Yes, I've quit. And it didn't take long to figure out how much coffee, primarily the caffeine as best I can tell, was helping me live my life well.
Yes, I was a video-game, kool-aid and ritalin kid, so the confounding variables are many. But I can tell you, without coffee, I'd be likely to quit my job and walk to Canada and live in the forest. I snap without it, like a bored teenager. It not only keeps me focused on the day to day details like doing my job (microbiology lab assistant and phlebotomist), but it keeps me away from dreaming about escape, it keeps me grounded in the work of the day, focused on life instead of dreams.
The remainder is an unjustifiable, egotistical power struggle
At the expense of the American dream, American dream
Of the American
We don`t give a damn about your world
With all your global profits
And all your jeweled pearls
We don`t give a damn about your world
Right now, right now!
And regardless, if using caffeine support the adrenals to prevent most of the long term adverse effects of caffeine usage.
heres goes the primal forums going crazy over a few cups of coffee, jesus christ (excuse me) but stop fussing over every little detail of your diet and enjoy life! when its your time to go your going to go, lol, the coffee aint gonna change it!!
2-4 cups a day here, and i can drink one right before bed with no issues.
Why do some people fall asleep after drinking coffee?
Good article thanks for posting, however i dont drink it for the caffeine, i just love the taste.


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Beyond: Two Souls Screenshots for PS3On: PS3, PS4
The game covers 15 years of Jodie's life and deals with living between our world and the other side.
Review Verdict Read Review
4Out of 10Back to game info
Latest Articles for Beyond: Two Souls
Beyond: Two Souls releases on PS4 next week, Heavy Rain in March 2016
Digital launch coming November 26, with a retail collection due in 2016.
Heavy Rain & Beyond: Two Souls PS4 release dates to be revealed 'soon'
Quantic Dream teases incoming announcement.
Heavy Rain and Beyond Two Souls announced for PS4
Quantic Dreams' two interactive story games are getting a re-release on PS4 - at least in Europe and PAL regions.


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Jeff Storm from Waterford WI, won the 1st annual Marlin Walbeck
Classic Saturday night at Dells Raceway Park. Ben Pettis and Mike Lichtfeld brought the field to green with Lichtfeld taking the early lead followed by Landry Potter and John Deangelis Jr. in hot
pursuit. A early caution bunched the field again but Lichtfeld was up to the challenge and set sail while eventual winner Jeff Storm started working his way th...rough the field. At the half way
break it was Lichtfeld leading the pack and picking up the bonus cash of $300 for being the mid-race leader. After the pit stop Lichtfeld ran into a mechanical issue an could not restart the second
half which gave way to Storm as he had patiently worked his way up to second. It was current DRP and CWRA point leader Tim Schendal who kept Storm busy through out the second half of the event, but
Storm would not be denied and held on to win the prestigious event with Schendal coming in second, fast qualifier Alex Prunty finished third, Wisconsin Rapids Mark Eswein took fouth and Bobby Kendall
fifth. Trophy Dash winner was Kendall. Heat race winners were Ken Jacoby, Mark Eswein, and Travis Volm, and the B-main was won by Collin Reffner. DRP Would like to Thank the Walbeck Family and CWRA
for helping put on the first annual Marlin Walbeck Memorial along with all the fans, drivers and race teams who made the night a success.
Wisconsin Dells WI, 6/27/15
Marlin Walbeck Memorial
1 25 Jeff Storm
2 21 Tim Schendel
3 11P Alex Prunty
4 71E Mark Eswein
5 11 Bobby Kendall
6 22P Landry Potter
7 31J Cory Jankowski
8 97 Cole Anderson
9 22 Ben Pettis
10 7 John DeAngelis
11 23 Ryan Hinner
12 87 Collin Reffner
13 32L Steve Lichtfeld
14 54 Chad Devine
15 88J Ken Jacoby
16 44L Mike Lichtfeld
17 18N Frank Nitzke
18 45 Erin Schlough
19 711 Travis Volm
Heat#1 Ken Jacoby Even Heat:Travis Volm Odd Heat: Mark Eswein Dash: Bobby Kendall B-Main: Collin Reffner
Jacoby Waterproofing Super Late Model Qualifying
1 11P Alex Prunty 13.626
2 21 Tim Schendel 13.666
3 7 John DeAngelis 13.668
4 11 Bobby Kendall 13.676
5 25 Jeff Storm 13.684
6 22P Landry Potter 13.699
7 97 Cole Anderson 13.704
8 44L Mike Lichtfeld 13.765
9 22BP Ben Pettis 13.805
10 45 Erin Schlough 13.838
11 23 Ryan Hinner 13.861
12 31J Cory Jankowski 13.901
13 71E Mark Eswine 13.914
14 711 Travis Volm 13.962
15 3 Jeff Weinfurter 13.977
16 18N Frank Nitzke 14.010
17 87 Collin Reffner 14.055
18 13 Mike Breiner 14.159
19 32L Steve Lichtfeld 14.196
20 88J Ken Jacoby 14.258
21 54 Chad Devine 14.423
22 13 Cody Smiley 14.519
23 33 Bernie Fritz 15.054
24 85 Kirby Kirth DNS
In Late Model Action Saturday Night it was the recent High
School Grad Haley Kapp & 13yr old Grant Griesbach bringing the field to Green with Kapp taking over the top spot till 2-time & defending Track Champion Nick Nolden took the lead mid-race.
Nolden looked secure till Rio Wisconsin Pilot & current Point Leader at DRP Steve Dobbratz came knocking on the door late in the race to pull off his 2nd Feature event of the Year, Nolden
finished second with Dale Nottestad 3rd & fast qualifier Rich Schumann Jr. getting the 4th spot & Haley Kapp rounding out the top five.
Performance Parts Supply Late Model A-Main 40 Lap Feature
1 52 Steve Dobbratz
2 67 Nick Nolden
3 51 Dale Nottestad
4 54S Rich Schumann Jr
5 32 Haley Kapp
6 75 Dillion Hammond
7 28 Jesse Bernhagen
8 31KS Kelsey Schultz
9 18 Michael Ehde
10 44 Justin Mondeik
11 66 Chris Storey
12 17 Grant Griesbach
13 88 Ken Jacoby
14 7C Kurt Clapper
15 55 Chad Miller
16 52R Nick Roehl
17 31S Larry Schotten
18 93 Brad Muller 29
Dash: Steve Dobbratz, Heat#1 Ken Jacoby, Odd Fast Heat: Nick Nolden Even Fast Heat: Kelsey Schultz, Fast Qualifier: Rich Schumann Jr., B-Main: Brad Muller
Late Model Qualifying
1 54S Rich Schumann Jr. 13.999
2 52 Steve Dobbratz 14.037
3 75 Dillion Hammond 14.100
4 51 Dale Nottestad 14.101
5 67 Nick Nolden 14.175
6 44 Justin Mondeik 14.185
7 52R Nick Roehl 14.226
8 17 Grant Griesbach 14.247
9 32 Haley Kapp 14.254
10 31KS Kelsey Schultz 14.273
11 28 Jesse Bernhagen 14.286
12 66 Chris Storey 14.299
13 18 Michael Ehde 14.340
14 7C Kurt Clapper 14.422
15 31S Larry Schotten 14.450
16 55 Chad Miller 14.454
17 93 Brad Muller 14.652
18 88 Ken Jacoby 14.703
19 9 Hunter Drefahl 14.920
20 36S Steve Schlosser 14.970
Jesse Bernhagen Holds Off Haley Kapp To Get Late Model Win At DRP
The first Green flag of the evening was dropped for the CSR Super Cup, 20 lap feature! Before the first lap was completed, two cars from the back of the field spun around in turn two. The entire field was able to make it back onto the track for a full restart. Half way through the feature, Jamie Domski was able to make himself comfortable in the top spot and secure the win with Amanda Bohn following close in second.
The second feature show of the evening was provided by the DRP Bandits. The 24 of Marty Tackes and the six car of Dave Lembke made up the front row to take the green flag. From the sounds of it, Tackes may have missed the shift on the start, causing the his car to fall to the back of the field. as The 77 of Dan Rozek was in the top spot, something must have broke as he followed suit and fell to the the back of the field. The number 14 of Hannah Raley had something dragging, causing a shower of sparks over the cars following behind her. Josh Mazur and James Junget put on a great show as they raced side by side, lap after lap on the front row. With 5 laps to go, the 17 of Dave True, Jr and the 23 of John Preston spun coming out of turn 4. With only 5 to go, the flag man Arne Thompson got the cars going again with a single file restart. On the restart, Junget looked low making contact with Mazur. They where both able to save their cars from destruction. Mazur wasn't able to hold off Junget for long though, with 2 to go James Junget was able to pass for the lead and check out from the field. The show to watch was the race for second, Colton Morgan was able to pull one over on Mazur and Morgan made the pass with one to go.
As the Sportsman geared up for the start of their feature, the outside line looked strong, allowing the 29 of Davey Pennel to take the lead. The Sportsman race was filled with caution free action following behind the leader of Pennel who's car was on a rail right off the bat. With 6 to go in the 25 lap feature, Dave trute in the number 2 car was able to chase down Cody Hubred and finally conquer the second position with only 5 laps left in the feature. The show really started to get going with only a couple laps left, as the 4th place through 7th bunched up. Pennel was able to take the the Checkered by himself, he was checked out from the field early as he prepared for his victory. "Good thing I qualified bad so I was able to start in the front!" Pennel mentioned, also stating "Trute was coming quick, his car sure was dialed in!". Next week should be another great show, I know I cant wait to see if Trute's "Dean's Satellite" machine can be restrained again!
For the Late Model Feature, Kelsey Schultz and Grant Griesbach took the starting flag on the front row. Two laps in to the race, Schultz was able to take the lead. Just after Schultz completed her first lap in the top spot, the 55 of Chad Miller spun into the infield between turns one and two. With 48 laps to go the cone was brought out, allowing the drivers to choose which line would work best for their car. Behind Schultz, Griesbach, Jesse Bernhagen, Michael Clapper and Haley Kapp all took the outside lane. Only 5 laps into the race, the 67 of Nick Nolden's machine looked quick as he passed Schultz for the lead on the inside! Justin Mondike and Grant Griesbach raced side by side for the third spot. After putting up a fight, Griesbach couldn't hold Mondeik off any longer. Bernhagen took the opportunity to follow Mondeik past Griesbach to round out the top 3. It didn't take Justin Mondeik long to close in on the 31 of Kelsey Schultz for second. Once again, Bernhagen saw an opportunity and took it, He was able to swing around the outside and pass both Schultz and Mondeik for second! Mondike took a chance to make his move by sticking his nose to the outside, as the 31 of Schultz fell back, the 21 of Shane Morrissey was forced to make the track three wide out of turn 3 with 30 laps still left in the race. The 32 of Haley Kapp was steadily gaining ground and was able to find her way to 3rd as the race was reeled into the midway point. Kapp was able to close the gap on Bernhagen with 20 to go. Coming out of turn 3, Rich Schumann was able to drive right around the outside of Morrissey for third. Haley Kapp did an awesome job of making herself know among the boys. She was able to work her way further and further into the corner, gradually gaining inch after inch on Bernhagen. Kapp was finally able to pass Burnhagen with Schumann following close to her bumper. Before Kapp was able to complete a full lap in the top position, the 67 of Nolden parked his race car on the front stretch with what looked like engine trouble, causing a caution. Because the yellow was thrown before Kapp was able to complete a full lap, the line up was set back to the last completed lap. Bernhagen was put back into the leading position as Schumann, Mondiek and Dale Nottestad all choose the outside lane for the restart. As the field went back green, the 44 of Mondeik slapped the back stretch wall. He was able to re gain control of his car and safely pull it into the pits. As Schumann and Kapp raced side by side, it was Schumann who eventually slipped up, allowing Kapp to keep her position in 2nd. After taking back control of his machine, Schumann tried every trick in the book to work around the 32 of Kapp. Ultimately, Schumann was unsuccessful and even left the bottom lane open for Morrissey to squeeze by and take the 3rd spot. As the the race came to an end, the action erupted between Morrissey and Schumann! On the final lap, Schumann and Morrissey came out of 4 side by side and ended up finishing the race with a tie for 3rd place! Burnhagen was very proud of his win, and his competition, stating "Haley Kapp did a hell of a job tonight!".
Great job and congratulations to all of out drivers, you all put on a great show for our fans week after week!
Late Model
1- Jesse Bernhagen 28
2- Haley Kapp 32
3- Shane Morrissey 21
3- Rich Schumann 54
5- Steve Dobbratz 52
6- Dillon Hammond 75
7- Dale Nottestad 51
8- Larry Schotten 31S
9- Michael Clapper 15
10- Kelsey Schultz 31
11- Grant Griesbach 17
12- Michael Ehde 18
13- Chris Storey 66
14- Chad Miller 55
15- Hunter Drefahl 7
16- Justin Mondeik 44
17- Nick Nolden 67
18- Tyler Sauter 6
19- Nick Roehl 52
1-Davey Pennel 29
2- Dave Trute 2
3- Randy Breunig 23
4- Scott Luck 12
5- Cody Hubred 20
6- Daron Fish 360
7- Brandon Birdsill 23
8- Mahlon Borntreger 08
9- Bryce Miller 11
10- Mitch Lyden 21
1- James Junget 27
2- Colton Morgan 39
3- Josh Mazur 26
4- Dan Bagley 49
5- Jim Lapp 96
6- Dave Lembke 06
7- Jesse Johnson 38
8- John Preston 23
9- Chevy Schoff 6S
10- Marty Tackes 24
Outlaw Bandits
1- Kyle Stark 192
2- John Handeland 19
3- Tim Anderson 272
4- Georgae Sparkman 5
5- Ron Coppernoll 72
6- Brandon Tackes 24
7- Riley Zilmer 65
8- Josh Mazur 26
9- Tim Finstad 33
10- Dave Lembke 06
11- Ken Knapik 20
12- Dave Treu, Jr.
13- Cheri Kurth 07
CSR Super Cup
1- Jamie Domski
2- Amanda Bohn
3- Sydney Wonderling
4- Zayne Feller
5- Trevor Adams
6- Steve Naples
7- Zachary Tinkle
8- Cayla Domski
9- Jack Rouston
10- Preston Stoecker
11- Mike Naples
12- Noah Eisenhower
DRP Mother's Day Special Recap
The 2015 season at Dells Raceway Park sure is the year of broken
Garett Goodwin, Nick Roehl, Tyler Sauter and Chris Storey with transfer through the B-Main to race in the Late Model Feature.
The 67 of Todd Schmitz and number 6 car of Vince Bartolota where on the front line, followed by Shelby Berlin and Jacob Nottestad to start the Legend Feature. Bartolota immediately took the lead as the 67 of Schmitz fell into third place. Aaron Moyer was on the move right out of the gate, he quickly made his way from sixth to third place within the first 5 laps. Shelby Berlin tried her best to hold onto second as Moyer filled her rear view mirror. With twelve laps to go Moyer makes his move to pass the number 24 for the second place spot. Moyer took his Legend car to the outside of Bartolota. Just as Moyer tried to make a move for the first position, Albert Sachs Spun in the 4th corner. After a few side by side laps, Bartolota lost his leading position to the number 140 of Aaron Moyer. The number 16 of Matt Berlin made his way to the third position followed by his sister Shelby Berlin in 4th and Todd Schmitz rounded out the top 5.
The Outlaw Bandit race started off with a wreck in turn 4 before they where able to complete the first lap. The wreck collected the number 72 of Ron Coppernoll with a flat left front tire, the front row cars number 33 of Tim Finstad and the 11 car of Arch Preston. The number 88 car of Dennis Delaney held tough to his lead as John Handeland and George Sparkman teamed up on the outside. With 5 to go, the 5 Car of Sparkman was getting impatient. The 19 of Handeland and 5 of Sparkman split Delaney to take over the front row, moving him into third. Sparkman took the high side as Handeland claimed the low groove as they came out of turn number four going for the green, Sparkaman was able to take the checkered flag by a fender over Handeland. What an exciting clean sweep night for Sparkman, the driver out of Loves Park, IL. Not only did he Qualify as fast time, win his heat race and dominate the feature, but he also now holds the new Outlaw Bandit Track Record with a 16.046!
Thomas Fara went down low and Mahlon Borntrager went high after they took the Sportsman Feature Green flag. The top 12 cars managed to keep a packed field of side by side racing for the first 5 laps of the 25 lap feature. Borntreger hung outside as Kevin Gilding passed down low. The number 24 of Kyle Wolosek crowded the top two cars, as he followed close behind in third. Doug Paul made his move to take over the top spot. After starting in the back of the pack, Dave Trute made his way to the middle of the group before the half way mark. Mitch Lyden fell back to 5th as the number 7 of Rick Coppernoll made his way to 3rd. So far this season, Dave Trute has made himself very comfortable with the top groove. Once again Trute passed around the outside to move into the third spot with 6 laps to go. Kyle Wolosek didn't make it easy for Trute as they battled for the second position with only 4 laps left in the race. Doug Paul escorted the field with a straight away lead as they reached the three to go mark. With only 2 laps left, Trute quickly chased down the leader of Doug Paul. In the end Dave Trute came up short, losing by only a car length in the end.
Michael Clapper and Shane Morrissey took over the front row, shuffling the 44 of Justin Mondeik backwards. Just under 10 laps into the race Morrissey dove below Clapper working him for the lead. The number 52 car of Steve Dobbratz observed and opportunity and took a chance to follow Morrissey past Michael Clapper. The 17 car driven by Grant Griesbach made a move to the outside of Mondeik, battling him for 4th place. With just over 20 laps to go, Dobbratz made himself known as he dove low looking toward the inside of Morrissey for first. Rich Schumann, Jr. put on a great show as he entertained the crowd moving from almost last place to 6th with only half of the race completed. The reigning track Champion of Nick Nolden fought Schumann side by side for fifth with just 15 laps left to go. After Schumann made his pass, Nolden followed him through to overcome Clapper for 4th with the 51 of Dale Nottestad close behind in 5th place.
In the last feature of the night, the 51 Bandit car of Dan Snyder claimed his position in first on the first lap followed by Andrew Portzen in second. The 77 car of Dan Rozek fought off Josh Mazur as Rozek pinched up close to the bumper of Portzen, making sure to not allow too much space between them. With 15 to go, Snyder claimed a 6 car length lead over Portzen. The 26 of Mazur looked to the outside of Rozek with 10 laps to go as the 27 car of James Junget became antsy in 8th place. Dan Snyder was able to create an even larger lead as Portzen and Rozek became caught behind a rookie lap car with 5 laps to go. For the second consecutive week, Colton Morgan was a great contender. This week, Morgan was able to make his way from 12th place to fifth during the 20 lap feature!
Late Model Feature
#52 Steve Dobbratz
#21 Shane Morrissey
#54 Rich Schumann, Jr.
#67 Nick Nolden
#51 Dale Nottestad
#15 Michael Clapper
#17 Grant Griesbach
#32 Haley Kapp
#75 Dillon Hammond
#28 Jesse Bernhagen
#31S Larry Schotten
#52 Nick Roehl
#44 Justin Mondeik
#18 Michael Ehde
#31 Kelsey Schultz
#29 Garett Goodwin
#66 Chris Storey
#6 Tyler Sauter
#26 Doug Paul
#2 Dave Trute
#24 Kyle Wolosek
#7 Rick Coppernoll
#21 Mitch Lyden
#97 Chris Weber
#12 Scott Luck
#29 Davey Pennel
#23BB Brandon Birdsill
#5 Kevin Gilding
#08 Mahlon Borntreger
#11 Bryce Miller
#65 Riley Zillmer
#18 Thomas Fara
#5 George Sparkman
#19 John Handeland
#24 Brandon Tackes
#26 Josh Mazur
#88X Dennis Delaney
#33 Tim Finstad
#72 Ron Coppernoll
#11 Arch Preston
#51 Dan Snyder
#43 Andrew Portzen
#77 Dan Rozek
#23 John Preston
#39 Colton Morgan
#0 Ren Revels
#26 Josh Mazur
#24 Marty Tackes
#27 James Junget
#49 Dan Bagley
#96 Jim Lapp
#6 Jake Hassler
#8D Logan Delaney
#14 Hanna Raley
#6S Chevy Schoff
Tim Schendel Wins Cabin Fever 60 At DRP
Wisconsin Dells, WI (May 1st, 2015)- The Dells Raceway Park, 53rd Annual Season opener was an exciting evening of racing! Including, a broken track record or two!
Usually Super Late Model Dash races are more of a "Parade of Cars" than a peddle to the metal all out competition, not tonight! If you weren't at Dells Raceway Park on May 2nd, you missed out! The first few laps of the SLM dash started out as the perfect show of cars, but that didn't last! Only 4 laps after the green flag was thrown, the action erupted! By the 6th lap the 22 machine of Landry Potter started to get a little squirrely, Potter was able to re gain just enough control of his race car to save it from kissing the wall going into turn 3 and was able to pull off the track to safety! Going into the 7th lap Brian Johnson, Jr. #17 out of Machesney Park, IL. sure began to give the 17 car of Greg Pawelski a run for his money! After a lap of door to door action Pawelski was able to beat Johnson out of turn four to take the checkered. Some may look at a simple dash race as a not so rewarding victory, but for Greg Pawelski its a huge triumph since this was his first ever race behind the wheel of a Super Late Model race car!
What an exciting show those Outlaw Bandits provided! Only 3 laps into the Outlaw Bandit feature, the top four drivers where able to pull away from the field. Five laps after the green flag, a tough fight was going on for 2nd place. Dennis Delaney is able to hold on to the top spot for a short 8 laps before Ron Coppernoll made a pass and took the first position. John Handeland sure held his own against Coppernoll. Handland's car looked to handle well as he was able to get a better entrance into turn one and a great run coming out of turn 2 allowing him to take the first place as Coppernoll fought to keep his number 72 car off the back stretch wall. Mark English looked to have mechanical issues and fell off the pace with only three to go. Luckily, he was able to pull his race car safely into the pits. Round of applause to James Junget and Dennis Delaney for putting on a great show while battling for the 3rd place finish. Handland took the checkered with a straightaway between his back bumper and the nose of the number 72 car of Coppernoll in 2nd position.
While the Dells Raceway Park Sportsman took the green flag, Jeff Nehrkorn's car looked strong as he took the lead on lap 2 over the 18 of Thomas Farra. Mitch Lydon made a quick move 4 laps in to make the pass on Scott Luck for fourth place. Nehrkorn and Farra fell off as Chris Weber and Rick Copperoll made their way to the top two spots. Weber in the 97 car dove down low to the inside of Coppernoll for a side by side battle, Weber took the lead with 19 to go. Scott Luck sure did a great job of utilizing the outside groove to gain positions throughout the field. Dave Trute quickly gained speed as he made his way through the field. Trute was the man to watch while he made his way from 11th to 3rd place in only quick 15 laps. The number 2 of Trute quickly closed in on the leader, Chris Weber! With 6 laps to go, Weber lost his battle but he defiantly didn't give it up easy. Ultimately, the "Team Dean's" driver Dave Trute, was able to make his move coming out of turn two to claim his Win and park his Dean's Satellite sponsored Machine in the Weaver Auto Parts Victory Lane.
The Super Late Model race quickly turned to chaos as they came out of corner number two on the second lap. The front row of Ken Reiser and the number 44 of Mike Lichtfeld got together, causing Lichtfeld to spin directly in front of the field. The 25 of Jeff Storm, 87 car driven by Collin Reftner and the number 11 Bobby Kendall where all victems of the wreckage. Storm and Kendall where able to drive their cars into the pits. Unfortunately, the 87 car diven by Reftner had to be pulled off the track with a wrecker, ending his night early. Neither Reiser nor Lichtfeld honored the Gentleman's Agreement by claiming fault of the wreck, resulting in both drivers losing their positions on the front row and they where both sent to the back of the pack. Before our Flag man Arne Thompson was able to bring the field back to green flag racing, Ken Reiser pulled into the pits for an unknown reason and Kendall was able to make it back onto the track to take the restart. As the cone was put out on the back stretch, Frank Nitzke and Tim Schendel chose the outside groove behind the leader of Alex Prunty. As the green flag was dropped, an immediate combat broke out between Schendel and Ben Pettis for the third position. For a short while, Pettis was able to hold off Schendel but not for long! It only took 6 laps of green flag racing for Tim Schendel to work around Pettis and slide past Nitzke into second place. After being sent to the back on the first lap, the 44 machine of Lichtfeld was able to gain 7 positions in only 10 short laps! Schendel was able to obtain the lead from Prunty, but Prunty was holding on strong to the back bumper of Schendel. Pettis and Nitzke fought a long hard war against each other for the fourth position, Brian Johnson, Jr. took the opportunity to follow Pettis past Nitzke. With thirty laps to go, Greg Pawelski was still holding onto a strong 5th place position. As Prunty gave it his all on the outside lane to hold off Pettis, he just couldn't hold on long enough. With Pettis in second and 24 laps to go, Cory Jankowski spins on his own while exiting turn 4. After a short caution, Schendel immediately pulled away from the field, Pettis took second and Johnson fell into third. Just before 10 laps to go, Lichtfield passed the 17 of Johnson. During the last ten laps, a lot of space accumulated between the top three drivers. As they approached the 5 laps to go mark, Storm was able to close in on Prunty, which detonated an exciting side by side battle for 5th place. Ultimately Storm came up short, finishing in 6th place. "We all need a little luck now and then." Tim Schendel said gratefully referring to his victory, especially after a difficult off-season. Second place driver, Mike Lichtfeld was a class act and presented the crowd with a great interview and even apologizing for accidentally getting into fellow driver (Johnson) during the race. I believe I speak for all spectators who where in attendance as I issue a huge thank you to all of our Super Late Model drivers for always providing a compelling display of power, sportsmanship and simply good, enjoyable racing!
The Bandits sure do put meaning to the saying "Rubbing is Racing"! Not even a quarter of the way through the twenty lap feature, the entire field was side by side and The number 77 of Dan Rozek became antsy while sitting on the second row inside. Rozek ended up pushing into the number 13 of Josh Bisbee while driving down the back stretch causing Bisbee to spin in the middle of the turn 3 and 4 corner. As the cone was put out to pick a racing line, only John Preston and James Junget choose the the outside groove. Colton Morgan quickly made his appearance known as he worked his way to the front of the pack. With less than 10 to go, he stole the second position and made his way around Portzen for the lead in just 3 short laps. The 24 of Tackes and the 8 of Delaney spun in turn two, causing the field to take the green as a single file restart. After starting the race in almost the last position, Colton Morgan was able to secure his win with a straightaway lead over the rest of the field.
53rd ANNUAL SEASON OPENER - FEATURE RESULTS:
1. Morgan
2. Junget
3. Portzen
4. Preston
5. Snyder
6. Mazur
7. Bagley
8. Rozek
9. Delaney
10. Tackes
11. Schoff
12. Bisbee
13. Lapp
14. Lembke
Outlaw Bandits-
1. Handeland
2. Coppernoll
3. Delaney
4. Junget
5. Tackes
6. English
7. Finstad
8. Knapik
1. Trute
2. Weber
3. Luck
4. Coppernoll
5. Lyden
6. Pennel
7. Paul
8. Birdsill
9. Farra
10. Borntreger
11. Miller
12. Nehrkorn
13. Zillmer
Super Late Models-
1. Schendel
2. Pettis
3. Lichtfeld
4. Johnson, Jr.
5. Prunty
6. Storm
7. Tolf
8. Nitzke
9. Pawelski
10. Breiner
11. Jacoby
12. Jankowski
13. Kendall
14. Reiser
15. Reftner
May, 9th- 2015!
MOTHER'S DAY SPECIAL!- All Escorted Ladies receive free general admission!
Late Model, Sportsman, Bandits, Outlaw Bandits and Legend cars!
NEW for the 2015 season, Dells Raceway Park is introducing a spin on the typical season pass, featuring huge savings! The new pass will be in the form of a punch card. For only $200 you will receive a card which will be good for 20 racing events of your choice including special events, excluding only the ARCA Midwest Tour race on June,13th. That breaks down to only $10 per event, resulting in savings from $2-$7 per race! You are in control of how you would like to use your punches. You can use them one at a time for yourself, or bring all of your friends for a night of fun and redeem multiple punches at once! Season Passes are available for purchase now on our Website and will be conveniently ready for pickup at Grandstand ticket window #1. On race day, Season Passes will be on hand for purchase at all Grandstand ticket windows.
Make sure to join us Saturday, May, 9th for our Mother's Day Special!
By, K.Lensing
For more information, please visit us online at www.dellsracewaypark.com or on social media www.facebook.com/dellsracewaypark
2015 Season Schedule
|Seniors 65+
Students 10-15
|ICEBREAKER Practice- Super
Late Models & Great Northern Sportsman
Free Admission in Grandstands / Pit Pass $15 2pm-5pm
|Ice Breaker
Super Late Models 100 Lap A-Main Event $3000 To Win
(Based on 24 cars)
Great Northern Sportsman Series 40 Lap A-Main $500 To Win
TT @ 12:30 Racing @ 2pm (Non-DRP Points Event for SLM Special Event Rules)
|Practice Open To All
Tech-Safety Inspection (11am-4pm) / Open Practice (12pm-5pm) / Pit Pass $15
|Cabin Fever 60 - 53rd
Annual Season Opener
TT @ 5:30 Racing 7pm Super Late Model 60, Sportsman, Bandits, Outlaw Bandits
|Night Practice Starts
Every Weds May 6th-Aug 26th Pit Pass $15
|Mother's Day Special
Escorted Ladies Free Admission
Late Model 40, Sportsman, Bandits, Outlaw Bandits, Legend Cars
|American Ethanol Super
Truck Series 37/Armed Forces Appreciation Night
Super Late 60,Sportsman,Bandits, Outlaw Bandits, Super Trucks, Am Super Cup
|2nd Annual Rich Siedschlag
Memorial 50 / Dewalt Tool Night
Late Model 50, Sportsman, Bandits, Outlaw Bandits, CSR Super Cup Cars
|Sunday-Memorial Day
Mechanical Mayhem
Starts at 6pm / Gates Open at 4pm
Monster Truck Thrill Show Plus: Spectator Eliminator Races, School Bus Races, Gauntlet Race, Roll Over Contest, Flag Pole Race, Auto Soccer, Car Tag & More….
Plus: Thunder Cats World Class FIREWORKS EXTRAVAGANZA!
|Lyle Nabbefeldt Memorial 55
/Scout Night/ CWRA Challenge Series
Super Late Model 55, Sportsman, Bandits, Outlaw Bandits
LM-OFF (CWRA Super Late Model Co-Sanctioned Event w/DRP ) rain date 6/27
|VORES Compact Traveling
Tour Series
Late Models 40, Sportsman, Legends, Bandoleros, CTS Compact Tour Series
SLM-OFF, Bandits & Outlaws OFF (All Bandits Welcome to race with CTS Tour)
|ARCA Midwest Tour Bill
Meiller Memorial 101 Presented by Assembly Products
ARCA Midwest Tour Super Late Models, Mid AmericanStock Car Series 50 & Bandits
LM-OFF Sportsman & Outlaws-OFF
|4th Annual Josh Blum
Memorial 50 - Burnout Contest
Late Model 50, Sportsman, Bandits, Outlaw Bandits, Midwest Truck Series
|Marlin Walbeck Classic 60 /
CWRA Challenge Series
Super Late Model 60, Bandits, Outlaw Bandits, Legends, Bandoleros
LM-OFF & Sportsman-OFF (CWRA Co-Sanctioned Event w/DRP ) rain date 8/29
|Independence Night of
Starts at 6pm / Gates Open at 4pm
Monster Truck Thrill Show / Green Mamba Jet Car / The Demolition Devil
All on One Night Performing Car Crushing Stunts, Iron Melting Mayhem & Death Defying Acts, School Bus Races & Spectator Eliminator Races, Ring of Fire Bus Jump, Domino Triple Car Jump, Barrel Rolls, Moving Ramp Jump & More…
Plus: Thunder Cats World Class FIREWORKS EXTRAVAGANZA!!
|Mid-Season Championship 50
/ Outlaw 600 Modifieds
Late Model 50, Sportsman, Bandits, Outlaw Bandits, Legends, Outlaw 600 Modifieds
|TUNDRA Super Late Model
Series- 60 Lap Feature / Dewalt Tool Night
Super Late Model 60, Sportsman, Bandits, Outlaw Bandits, CSR Super Cup
LM-OFF (Not a DRP Points Event for SLM, TUNDRA Points Only for SLM)
|Kids Night On Track Penny
Late Model 40, Bandits, Outlaw Bandits, Am Super Cup, Midwest Trucks
OFF & Sportsman-OFF
|Historic Auto Attractions
Night / Midwest Vintage Series/ INEX Legends
Late Model 50, Sportsman, Bandits, Legends, Vintage Race Cars
SLM-OFF & Outlaws-OFF
|Summer Sizzler
Super Late Model 60, Sportsman, Bandits, Outlaw Bandits, Legends, Bandoleros,
|3rd Annual Habelman
Cranberry 100 - Continuous 100 Laps!
Super Late Model 100, Sportsman, Bandits, Outlaw Bandits
LM-OFF (*DRP Points Event for all SLM )
|Kids Bike Night / On Track
Bike Presentations By Drivers
Late Model 40, Sportsman, Bandits, Outlaw Bandits, Am Super Cup, WI Sport Trucks
|Performance Parts Supply
Super Late Model 60, Sportsman, Bandits, Outlaw Bandits, Legends, Bandoleros
|Labor Day 50 Plus:
Spectator Eliminator Races
Late Model 50 ,Sportsman, Bandits, Outlaw Bandits, Legends
|Labor Day of Doom
Destruction Starts at 6pm / Gates Open at 4pm
The Demolition Devil, Performing Death Defying Acts, Bus Jump, Domino Triple Car Jump, Barrel Rolls, School Bus Races, Gauntlet Race, Auto Soccer, Car Tag, Flag Pole Race, Spectator Eliminator Races & "The Great American Trailer Race".
Plus: Thunder Cats World Class FIREWORKS EXTRAVAGANZA!!
|Season Championship Night
Extended Features All Classes
Super Late Model 75 , Late Model 50, Sportsman, Bandits, Outlaw Bandits, Legends
|Open Practice Showdown
Open practice for all divisions - Noon to Dark
|4th Annual September
Showdown Weekend
Late Models, Sportsman, Bandits, Outlaw Bandits, Legends
(Non-A-Main Winners of 2015 Features) Plus Showdown Features All Divisions
|4th Annual September
Showdown Finale (CWRA Reunion Night)
Super Late Models (Co-Sanctioned-CWRA Challenge Series Championship Night)
Late Models, Sportsman, Bandits, Outlaws, Outlaw Modified 600's, Midwest Trucks
|Showdown Rain Date
|1st Annual FALLOWEEN 100 /
Super Late Model 100 A-Main Event / Bandit Nationals
TT @ 11:30 Racing @ 1pm


text:
you ladies never warned me....
Hope all goes well & it's just a UTI!
Married my best friend in May 2008
Step Mom to Kayla (September 2001),Mommy to Griffin (July 2009) AND Charlotte (November 2012)
terbutaline and magnesium are both nasty stuff. I hated getting them.
Mom to Luke (w/cf DF508) 8-17-07, Analeigh 6-30-09, Jude 11-27-12, MC 10-01-13 Rainbow Baby EDD 9-17-14
Turbutaline is a shot they give you in the hospital that may stop your contractions. The nurse warns you that you'll feel your heart race for a little while after and and you'll feel jittery. It was awful when I got it. I had like a full-blown 15 minute panic attack. I was freaking out...
Pp's turbutaline is the drug they use to stop active contractions so you don't go into labor, or they use it to help stop progression of labor. It's not fun!
Ugh that sucks that you had to get 2!!! So sorry momma!! Hope they stop soon!
I had turbutaline with my first pregnancy and it burned at the shot site and then gave me bad heart palpitations. I actually stopped getting the shots because of the side effects. I was already 37 weeks, so I wasn't worried.
Catherine & Efrain : 8/15/03
Arwen Leia: 3/12/04, Selene Elizabeth: 7/7/06
Willow Maya: 12/13/12


text:
Presidential Advisory Council on HIV/AIDS
The Presidential Advisory Council on HIV/AIDS (PACHA) was a commission formed by President Bill Clinton in 1995 to provide recommendations on the US government's response to the AIDS epidemic. President George W. Bush and Secretary Tommy G. Thompson renewed the Council's charter on July 19, 2001.
The Council was not the first Presidential inquiry into HIV. In 1987, Ronald Reagan appointed the President's Commission on the HIV Epidemic (1987–88) to investigate the AIDS epidemic. This was followed by the National Commission on AIDS (1989-1993).
The council is now[when?] cochaired by:
- Thomas A. Coburn, M.D. – an obstetrician and former Republican congressman from Oklahoma who gained a national reputation for his opposition to safer sex as a way to prevent HIV infections. Dr. Coburn is currently serving as the Junior Senator from Oklahoma.
- Louis W. Sullivan, M.D. – President's Office, Morehouse School of Medicine, Sullivan was the Secretary of Health and Human Services during the George H. W. Bush administration
The other members are:
- Rosa M. Biaggi, M.P.H., M.P.A – Connecticut Department of Public Health
- Jacqueline S. Clements – Lincoln Community Health Center. Clements is an HIV testing counselor in rural North Carolina who is living with HIV and lost her husband and child to AIDS.
- Mildred Freeman – Director, Health Education Division, National Association for Equal Opportunity in Higher Education
- John F. Galbraith – President and CEO, Catholic Medical Mission Board
- Edward C. Green, Ph.D. – Senior Research Scientist, Harvard Center for Population and Development Studies
- David Greer – A marketing and communications consultant in Philadelphia. He is living with HIV.
- Cheryl-Anne Hall
- Jane Hu, Ph.D. – CEO & Founder, China Foundation, a philanthropic think tank
- Karen Ivantic-Doucette, M.S.N, FNP, ACRN – Marquette University College of Nursing
- Rashida Jolley
- Franklyn N. Judson, M.D. – Professor and Director, Denver Public Health Department
- Abner Mason – Executive Director, AIDS Responsibility Project
- Sandra S. McDonald – President/Founder, OUTREACH, Inc
- Joe S. McIlhaney, M.D.
- Henry McKinnell, Jr., Ph.D. – Chairman & CEO Pfizer Inc
- Brent Tucker Minor – Co-chair of the Ryan White Planning Council. He is living with HIV.
- Jose A. Montero, M.D. – Associate Professor of Medicine, University of South Florida
- Dandrick Moton – Director, Community and Youth Relations, Choosing to Excel
- David Reznik, D.D.S. – Chief, Dental Service, Grady Health System. Reznik is an expert in oral health care for people living with HIV, and serves on the Ryan White Planning Council of Metropolitan Atlanta.
- Debbie Rock – Executive Director, Baltimore Pediatric HIV Program, Inc
- Reverend Edwin Sanders II – Senior Servant, Metropolitan Interdenominational Church
- Prem Sharma, D.D.S., M.S. – Associate Dean Emeritus, Marquette School of Dentistry
- Lisa Mai Shoemaker – HIV/AIDS Activist/Motivational Speaker
- Anita Smith – Children´s AIDS Fund
- Don Sneed – Executive Director, Renaissance III, a non-profit organization providing AIDS-related services in south Texas. Sneed is a former addict, and is living with HIV.
- M. Monica Sweeney, M.D., M.P.H. – Assistant Clinical Professor of Preventive Medicine, SUNY Health Science Center of Brooklyn
- Ram Yogev, MD – Professor of Pediatrics, Northwestern University Medical School
Former members[edit]
- Charles W. Blackwell – Served as the Council's only Native American member from 1997 to 2001.[1]
- Beny Primm, MD – The Addiction Research and Treatment Corp.
Critics have said they lack confidence in PACHA and note that the Council as reorganized under President Bush held only two meetings in 2002 and issued only five recommendations to the White House. By comparison, the President's Commission on the HIV Epidemic (Watkins Commission) submitted 597 recommendations to the Reagan Administration.
The Union of Concerned Scientists released a report in February 2004 entitled Scientific Integrity in Policymaking that said that President Bush intentionally appointed under-qualified individuals to PACHA as part of a broader effort to manipulate the government's scientific advisory system by providing the appearance of expert advice while controlling the advice given.
Critics pointed to the appointment of Dr. Joseph McIlhaney, a Texas-based doctor known for rejecting the use of condoms to prevent the spread of HIV and other sexually transmitted diseases and for his advocacy of abstinence-only programs despite negligible evidence that they reduce pregnancy rates among young people.
See also[edit]
- National Commission on AIDS
- Office of National AIDS Policy
- President's Commission on the HIV Epidemic
- President's Emergency Plan for AIDS Relief
- ^ "Chickasaw Nation Ambassador Charles W. Blackwell – a Man of Vision". KXII. 2013-01-04. Retrieved 2013-01-20.


text:
After a lovely blind date, crossword-puzzle creator Mary Horowitz falls head over heels in love with Steve, a news cameraman. Mary is convinced that she and Steve are soul mates, and with the encouragement of a reporter, follows Steve around the country in a bid to win his love. Along the way, she befriends an assortment of misfits who accept her for who she is, leading her to reassess her reasons for this strange journey.
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