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Author Affiliations: Division of Cardiology, Department of Medicine, Brown University, and Providence Veterans Affairs Medical Center, Providence, Rhode Island (Dr Chatterjee); Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark (Dr Wetterslev); Division of Internal Medicine, Maimonides Medical Center, New York, New York (Drs Sharma and Lichstein); and Division of Cardiology, Texas Tech University, El Paso (Dr Mukherjee).
Background The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists.
Methods A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. English-language studies comparing blood transfusion with no blood transfusion or a liberal vs restricted blood transfusion strategy were identified. Two study authors independently reviewed 729 originally identified titles and abstracts and selected 10 for analysis. Study title, follow-up period, blood transfusion strategy, and mortality outcomes were extracted manually from all selected studies, and the quality of each study was assessed using the strengthening Meta-analysis of Observational Studies in Epidemiology checklist.
Results Studies of blood transfusion strategy in anemia associated with myocardial infarction were abstracted, as well as all-cause mortality rates at the longest available follow-up periods for the individual studies. Pooled effect estimates were calculated with random-effects models. Analyses of blood transfusion in myocardial infarction revealed increased all-cause mortality associated with a strategy of blood transfusion vs no blood transfusion during myocardial infarction (18.2% vs 10.2%) (risk ratio, 2.91; 95% CI, 2.46-3.44; P < .001), with a weighted absolute risk increase of 12% and a number needed to harm of 8 (95% CI, 6-17). Multivariate meta-regression revealed that blood transfusion was associated with a higher risk for mortality independent of baseline hemoglobin level, nadir hemoglobin level, and change in hemoglobin level during the hospital stay. Blood transfusion was also significantly associated with a higher risk for subsequent myocardial infarction (risk ratio, 2.04; 95% CI, 1.06-3.93; P = .03).
Conclusions Blood transfusion or a liberal blood transfusion strategy compared with no blood transfusion or a restricted blood transfusion strategy is associated with higher all-cause mortality rates. A practice of routine or liberal blood transfusion in myocardial infarction should not be encouraged but requires investigation in a large trial with low risk for bias.
Thrombolysis, anticoagulation, and antiplatelet drugs have revolutionized the therapeutic approach to acute coronary syndrome, with significant improvements in clinical outcomes.1- 7 However, such therapy may concomitantly increase the risk for bleeding, leading to the development of anemia during the hospital stay and to subsequent blood transfusion.8- 10Quiz Ref IDDespite advancement in reperfusion therapy, patients with low hemoglobin levels continue to have more postoperative complication and higher mortality rates,11- 14 and the presence of anemia in acute myocardial infarction has been associated with worse prognosis.15- 19
In patients with significant coronary occlusion, low oxygen-carrying capacity secondary to anemia may further compromise the myocardial oxygen supply, worsening the ischemia. By increasing the oxygen-carrying capacity, blood transfusion might be beneficial, especially in anemia secondary to acute blood loss. However, inappropriate blood transfusion may lead to circulatory overload and increased thrombogenicity, which can worsen the clinical outcomes. Furthermore, elevated hemoglobin levels have been shown to be associated with increased mortality.11,19 In post hoc analyses of a multicenter randomized controlled trial, Hébert et al20 reported no mortality benefits of liberal blood transfusion in maintaining hemoglobin levels of at least 10 mg/mL in critically ill patients with cardiovascular disease. However, because patients receiving blood transfusion tend to be older and have advanced disease and more associated comorbid conditions, these variables may act as confounding factors when determining mortality and morbidity rates.21- 23 Because of conflicting results reported in various investigations, the benefits and harm of blood transfusion in myocardial infarction remain controversial. In the present meta-analysis, we systematically evaluated the potential risk-benefit of blood transfusion in patients with myocardial infarction.
A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. Studies were identified that evaluated mortality outcomes and compared blood transfusion with no blood transfusion or a liberal vs restricted blood transfusion strategy. The search terms used were transfusion, myocardial infarction, and mortality. Pertinent trials were also searched for in clinicaltrials.gov and in proceedings from major international cardiology meetings (American College of Cardiology, American Heart Association, European Society of Cardiology, and Transcatheter Cardiovascular Therapeutics). References of original and review articles were cross-checked. Study selection was performed by 2 of us independently (S.C. and A.S.), with disagreement resolved by consensus among all the authors. Citations were first reviewed at the title and abstract level. Studies that were short-listed were then retrieved in full text.
Studies were considered suitable for inclusion if they met the following criteria: (1) they reported the effect of blood transfusion or a liberal blood transfusion strategy (blood transfusion levels at which there was no blood transfusion in the comparator arm) on mortality, (2) they had a comparator group with no blood transfusion or a restricted blood transfusion strategy and identified a mean hemoglobin level for both groups, and (3) they used statistical methods to minimize confounding between the groups (matching, covariate adjustment, or propensity-based adjustment). Our search was restricted to studies in the English language. Full texts of 16 potentially relevant articles were independently reviewed by at least 2 of us (S.C. and A.S.) to establish eligibility according to the inclusion criteria. To avoid confounding, we excluded studies assessing the effect of transfusion of components other than whole blood or red blood cells.
Data abstraction and study appraisal were performed by 2 of us (S.C. and A.S.) independently, with disagreement resolved by consensus among all authors. Key study and patient characteristics were extracted, including the outcomes of all-cause mortality and myocardial infarction reported at the longest available follow-up periods. Prespecified subgroup analyses were planned for patients with ST-segment elevation myocardial infarction (STEMI) and for patients with a hematocrit of less than 30% (to convert hematocrit to a proportion of 1.0, multiply by 0.01).
Data analyses were performed using commercially available software (RevMan 5.1 [Cochran IMS], TSA version 0.9 [Copenhagen Trial Unit], and STATA version 11 [StataCorp LP]). Outcomes were assessed using random-effects models to exclude the presence of significant heterogeneity (evaluated and quantified with the I2 statistic), and then pooled random-effects risk ratios (RRs [95% CIs]) were calculated following the method by DerSimonian and Laird.
The quality of the studies was assessed on the basis of elements from the strengthening Meta-analysis Of Observational Studies in Epidemiology checklist for cohort studies. We did not assign a threshold for study inclusion. All the studies included in the analyses met at least 15 variables in the checklist.
When available, odds ratios (ORs) reported in the articles were used to determine event rates, and unadjusted ORs (95% CIs) were used preferentially over adjusted ORs to avoid bias from different types of adjustments in the various studies.24 If ORs were not reported, we calculated them using the event and sample size frequencies. If frequencies were not given, ORs were estimated from percentages and were rounded to the nearest integer. If any cell had a 0 count, ORs were calculated by adding 0.5 to all cell counts from the study to avoid division by 0. The I2 statistic was used to examine the heterogeneity of effect sizes in the overall aggregations: I2 of less than 25% indicates low heterogeneity, and I2 exceeding 75% indicates high heterogeneity. Publication bias was evaluated using a combination of a funnel plot–based method, the regression test by Egger, and the trim-and-fill method to estimate the number of missing studies and to calculate a corrected OR as if these studies were present. The effect of potential outliers was examined by comparing the pooled estimate with estimates obtained after iterations using k minus 1 findings (each study is left out, and the effect is reestimated), where k is the number of studies. Studies were treated as statistical outliers if the k minus 1 estimate produced a 95% CI that did not overlap with the 95% CI of the aggregated estimate. P < .05 was considered statistically significant.
In a single study, interim analyses increase the risk for type I error. To avoid an increase of overall type I error, monitoring boundaries can be applied to decide whether a single study could be terminated early because the P value is sufficiently small. Because no reason exists why the standards for a meta-analysis should be less rigorous than those for a single study, analogous study sequential monitoring boundaries can be applied to meta-analysis as study sequential analysis.25,26 Cumulative meta-analyses of studies are at risk for producing random errors because of few data27 and repetitive testing of accumulating data and because the requirement for the amount of information analogous to the sample size of a single optimally powered clinical study might not be met.25,26
The underlying assumption for study sequential analysis is that significance testing and calculation of the 95% CIs are performed each time a new study is published. Study sequential analysis depends on the quantification of the required amount of information. In this context, the smaller the required amount is, the more lenient is the trial sequential analysis and the more lenient are the criteria for significance.25,26 A required diversity (D2)–adjusted information size was calculated, with D2 being the relative variance reduction when the meta-analysis model is changed from a random-effects model to a fixed-effects model.28D2 is the percentage of the variability between trials to the within-trial variance and constitutes the percentage of the variability between trials to the total variance in the meta-analysis. D2 is different from the intuitively obvious adjusting factor based on the common quantification of heterogeneity, the inconsistency (I2 statistic), which might underestimate the required information size.28
Study sequential analysis was performed with an intent to maintain an overall 5% risk for type I error, which is the standard in most meta-analyses and systematic reviews, and we calculated the required information size (ie, the meta-analysis information size needed to detect or reject an intervention effect of a 20% relative risk increase for harm, with a risk for type II error of 10%, at a power of 90%).25,26 Study monitoring boundaries were constructed with the conventional test boundary and using methods by O'Brien and Fleming.29
Our MEDLINE search returned 720 studies. After elimination of duplicate results, EMBASE, Cochrane Central Register of Controlled Trials, and the other registries returned 9 additional studies, leaving 729 studies for evaluation. Through a review of titles and abstracts, 705 studies were rejected for relevance. The remaining 24 articles were reviewed and assessed for satisfaction of the inclusion and exclusion criteria. Ten studies that met all criteria were included in this analysis (Figure 1).
Figure 1. Search strategy according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) checklist.40 CABG indicates coronary artery bypass graft.
Studies were fairly homogeneous for inclusion and exclusion criteria, with a few key differences. These results are summarized in Table 1.
We used the published strengthening Meta-analysis Of Observational Studies in Epidemiology40 checklist to select the studies for this review (Figure 1). The included studies reported statistically adjusted effect estimates for the outcome of mortality. Quiz Ref IDAmong 10 studies included, all except one (low-bias risk) were intermediate-bias risk studies as assessed by the Newcastle-Ottawa Scale41 for quality assessment risk evaluation of adequacy of selection, comparability, and outcomes assessment for individual studies (Table 2).
We identified 10 studies,30- 39 including 203 665 study participants, that met our inclusion and exclusion criteria. Only one study31 was a randomized trial; the others were observational studies.Quiz Ref IDAnalyses of blood transfusion in myocardial infarction revealed increased all-cause mortality associated with a strategy of blood transfusion vs no blood transfusion during myocardial infarction (18.2% vs 10.2%) (RR, 2.91; 95% CI, 2.46-3.44; P < .001), with a weighted absolute risk increase of 12% (P < .001) and a number needed to harm of 8 (95% CI, 6-17). The risk remained unchanged even on exclusion of the only randomized study.31 Pooled analysis using adjusted rates of mortality instead of the actual number of events yielded an effect largely similar to that of the primary analysis (eFigure 1). However, the mortality risk with blood transfusion was found to be mitigated when restricted to studies that included patients with STEMI (RR, 2.89; 95% CI, 0.54-15.58; P = .22) and patients with a baseline hematocrit of less than 30% (RR, 1.72; 95% CI, 0.39-7.63; P = .47) (eFigure 2 and eFigure 3). Multivariate meta-regression were performed using the log of the RR as the dependent variable and adjusting for the following variables as covariates: follow-up period, history of bleeding, baseline creatinine level, baseline hemoglobin level, nadir of hemoglobin level, and change in hemoglobin level during the hospital stay, as well as the use of glycoprotein IIb or IIIa, thrombolytics, or antiplatelets. The meta-regression showed that blood transfusion is associated with higher mortality after adjustment for all these variables. However, we could not adjust for demographic variables in the multivariate model because we did not have patient-level data. Significant heterogeneity was noted among the outcomes (I2 = 93%) (Figure 2). A sensitivity analysis performed by sequentially excluding one study at a time and performing a cumulative evaluation identified no single study as the source of heterogeneity. No significant publication bias was noted among the outcomes with visual inspection of the funnel plot, the regression test by Egger (P = .40), or with trim-and-fill adjustment (Figure 3).
Figure 2. Risk for all-cause mortality with liberal blood transfusion. M-H indicates Mantel-Haenszel. Diamond indicates the overall summary estimate for the analysis (width of the diamond represents the 95% CI); boxes, the weight of individual studies in the pooled analysis; whiskers, the 95% CIs: when they are to the left of the midline, representing a risk ratio of 1, it means that the risks of dying favor (ie, are less with) tranfusion; when they are to the right of the midline, representing a risk ratio of 1, it means that the risks of dying favor (ie, are less with) the comparator arm; if the lines touch the midline, representing a risk ratio of 1, it means that the risks of dying are comparable for transfusion and the comparators.
Figure 3. Trim-and-fill adjustment for assessment of publication bias. RD indicates risk difference.
The required diversity-adjusted information size (D2 = 97%) for the outcome of all-cause mortality was calculated based on analyzing a 10.2% proportion of events in the no blood transfusion or a restricted blood transfusion strategy group and evaluating for a 20% relative risk increase with blood transfusion or a liberal blood transfusion strategy at α = .05 and β = .10 (90% power). The cumulative z curves (calculated with both the conventional test boundary and the methods by O'Brien and Fleming)29 crossed the study sequential monitoring boundary of harm, suggesting firm evidence for a 20% relative risk increase with blood transfusion or a liberal blood transfusion strategy compared with no blood transfusion or a restricted blood transfusion strategy (Figure 4). We also constructed a L'Abbé plot42 and a small study regression graph to avoid a possible error with the effect of inclusion of small studies on the composite outcome.
Figure 4. Study sequential analysis of observational studies on all-cause mortality with a 20% relative risk increase (RRI), number needed to harm of 50, control event proportion of 10%, α = .05, β = .10, diversity (D2) of 97%, and required information size of 320 310. The analysis uses a random-effects model with a type I error risk of 5% and a power of 90%. The blue line is the cumulative z score from the cumulative random-effects meta-analyses, and each black box indicates the addition of data from a new study; the red lines are the study sequential monitoring boundaries calculated according to the O'Brien-Fleming α-spending function and stopping rule. The red vertical line indicates the diversity-adjusted information size of 320 310 patients based on an a priori 20% RRI corresponding to a number needed to harm of 50. There seems to be evidence for a 20% RRI even when the cumulative meta-analysis is adjusted for sparse data and multiple testing on accumulated data, disregarding possible bias.
Blood transfusion was also significantly associated with a higher risk for subsequent myocardial infarction (RR, 2.04; 95% CI, 1.06-3.93; P = .03). Significant heterogeneity was present for this outcome (I2 = 98%) as well. No significant publication bias was detected (Figure 5).
Figure 5. Risk for myocardial infarction with liberal blood transfusion (Tx). M-H indicates Mantel-Haenszel. Diamond indicates the overall summary estimate for the analysis (width of the diamond represents the 95% CI); boxes, the weight of individual studies in the pooled analysis; whiskers, the 95% CIs: when they are to the left of the midline, representing a risk ratio of 1, it means that the risks of myocardial infarction (ie, are less with) liberal Tx/Tx; when they are to the right of the midline, representing a risk ratio of 1, it means that the risks of dying favor (ie, are less with) the comparator arm; if the lines touch the midline, representing a risk ratio of 1, it means that the risks of a myocardial infarction are comparable for the 2 arms.
Several important clinical findings emerged from our systematic review and meta-analysis. First and foremost, a significant mortality risk is demonstrated with a policy of liberal blood transfusion in patients with myocardial infarction, especially in those patients without STEMI or with a hematocrit of less than 30%, bringing to light a real possibility of harm with the practice of routine blood transfusion in patients with myocardial infarction. The mortality outcome was associated with statistically significant heterogeneity, likely associated with concomitant therapies, heterogeneity in the patient population, and clinical settings (which could not be adjusted for in our analysis because of the unavailability of patient-level data) , but might also be due to the precision of the large observational studies, conferring an artificially high I2 statistic. Also notable was the fact that the results remained unchanged with meta-regression adjusting for certain variables, including the follow-up period, a history of bleeding, baseline hemoglobin level, nadir of hemoglobin level, and change in hemoglobin level during the hospital stay, indicating a significant risk for blood transfusion over and above that associated with bleeding (and anemia) in myocardial infarction.43 The single randomized trial included in our analysis, the Conservative Versus Liberal Red Cell Transfusion in Acute Myocardial Infarction Trial,31 had a small sample size and was underpowered to make any relevant conclusions regarding clinically important intervention effects. We attempted to overcome the risk for increased random error due to sparse data and repetitive testing in our analysis by constructing study sequential monitoring boundaries, and our results indicated that random error was not the greatest risk in our meta-analysis. However, confounding by indication may be an important problem because the patients liberally transfused may also be the patients with the most serious disease and at the greatest risk for mortality as estimated by prognostic factors at baseline independent of the interventions subsequently used. We also drew a regression plot to avoid overestimating the effects of small studies on the overall outcomes. Our 95% CIs were narrow, with a large sample size, indicating at least a possibility of real harm with liberal and indiscriminate blood transfusion practices.
Quiz Ref IDOf even greater concern was our finding of a significantly greater risk for myocardial reinfarction with blood transfusion. This finding seems to conform to recent findings of detrimental effects on platelet aggregation with blood transfusion.44 Overall, our findings are consistent with recent recommendations by the AABB (formerly the American Association of Blood Banks)45 and in a prior Cochrane review46 for a restrictive blood transfusion policy in critically ill patients. Our analysis attempts to address the lacuna in the knowledge about blood transfusion practices among patients with acute coronary syndromes as expressed in the aforementioned guidelines by providing an updated meta-analysis on the topic in the absence of an adequately powered randomized trial.
We also found that the risks for blood transfusion became mitigated during our subgroup analyses in patients with STEMI and in patients with a baseline hematocrit of less than 30%. This suggests a future direction of further research in identifying specific subgroups that may accrue a real benefit from blood transfusion, overcoming its detrimental influence.47,48
Our study had several methodological limitations. Quiz Ref IDAll the studies but one in our meta-analysis were observational, diverse study designs and patient characteristics made interpretation of aggregated estimates challenging, and causality could not be inferred. In addition, despite our efforts at adjusting for different variables, the relevance and reliability of the results were limited. For more definitive conclusions, randomized designs by blood transfusion at different hemoglobin levels and hematocrits and relevant outcomes are needed. For these analyses, we had only summary estimates and were unable to adjust for important patient-level covariates. Red blood cell transfusion may be a surrogate for other variables that could have favorable or adverse effects on outcomes (eg, baseline risk, infection, adenosine diphosphate, and soluble CD40 ligand).49,50 However, these variables were not reported in the studies used for this analysis and could not be considered. We also restricted our search to English-language sources.
Our study method also had several strengths. The magnitude and consistency of the observed effects for blood transfusion in myocardial infarction make the likelihood of random error affecting this observation unlikely. Moreover, we rigorously controlled for publication bias and used random-effects models, which are generally better suited when studies are gathered only from the published literature. We also evaluated for the validity of our mortality findings by constructing study sequential monitoring boundaries and inferred that our results indicated a firm evidence of harm with a practice of liberal blood transfusion in myocardial infarction.
In conclusion, this meta-analysis provides evidence that rates of all-cause mortality and subsequent myocardial infarction are significantly higher in patients with acute myocardial infarction receiving blood transfusion. Additional outcomes data are needed from randomized clinical trials that investigate important outcomes with adequate sample size and with low risk for bias.
Correspondence: Saurav Chatterjee, MD, Division of Cardiology, Department of Medicine, Brown University, and Providence Veterans Affairs Medical Center, 40 Roger Williams Green, Providence, RI 02904 (email@example.com).
Accepted for Publication: August 20, 2012.
Published Online: December 24, 2012. doi:10.1001/2013.jamainternmed.1001
Author Contributions: Dr Chatterjee had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Chatterjee, Wetterslev, and Lichstein. Acquisition of data: Chatterjee and Sharma. Analysis and interpretation of data: Chatterjee, Wetterslev, Lichstein, and Mukherjee. Drafting of the manuscript: Chatterjee, Wetterslev, and Sharma. Critical revision of the manuscript for important intellectual content: Chatterjee, Wetterslev, Lichstein, and Mukherjee. Statistical analysis: Chatterjee and Wetterslev. Administrative, technical, and material support: Chatterjee and Lichstein. Study supervision: Wetterslev, Lichstein, and Mukherjee.
Conflict of Interest Disclosures: None reported.
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Chatterjee S, Wetterslev J, Sharma A, Lichstein E, Mukherjee D. Association of blood transfusion with increased mortality in myocardial infarction: a meta-analysis and diversity-adjusted study sequential analysis. JAMA Intern Med. Published online December 24, 2012. doi:10.1001/2013.jamainternmed.1001.
eFigure 1. Pooled analysis using adjusted rates of mortality instead of the actual number of events yielded an effect largely similar to that of the primary analysis.
eFigure 2. The mortality risk with blood transfusion was found to be mitigated when restricted to studies that included patients with ST-segment elevation myocardial infarction.
eFigure 3. The mortality risk with blood transfusion was found to be mitigated when restricted to studies that included patients with a baseline hematocrit of less than 30%.
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September 22, 2004
Could you be raising a criminal? Acts of violence don't come out of nowhere, and every parent should be aware of the clues along the way. For the most violent of criminals, there are warning signs that often start in childhood. Below is a list of the 14 most common traits of serial killers.
1. Over 90 percent of serial killers are male.
2. They tend to be intelligent, with IQ's in the "bright normal" range.
3. They do poorly in school, have trouble holding down jobs, and often work as unskilled laborers.
4. They tend to come from markedly unstable families.
5. As children, they are abandoned by their fathers and raised by domineering mothers.
6. Their families often have criminal, psychiatric and alcoholic histories.
7. They hate their fathers and mothers.
8. They are commonly abused as children — psychologically, physically and sexually. Often the abuse is by a family member.
9. Many serial killers spend time in institutions as children and have records of early psychiatric problems.
10. They have high rates of suicide attempts.
11. From an early age, many are intensely interested in voyeurism, fetishism, and sado-masochistic pornography.
12. More than 60 percent of serial killers wet their beds beyond the age of 12.
13. Many serial killers are fascinated with fire starting.
14. They are involved with sadistic activity or tormenting small creatures.
Source: Internal Association of Forensic Science, an article written by FBI Special Agent Robert K. Ressler
"The Serial Killer," Harold Schechter


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on February 1, 2013 - 12:21 AM
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The ongoing revival of the 625-seat auditorium that once housed Studio Arena Theatre will get a major boost tonight when Road Less Traveled Theatre raises the curtain on Annie Baker's "Circle Mirror Transformation."
The critically lauded five-person play, directed by Road Less Traveled Artistic and Executive Director Scott Behrend, will be the first full local production to appear in the space since it reopened as the 710 Main Theatre last year. Behrend also directed the 2008 Studio Arena production of "To Kill a Mockingbird," the final full production of that storied and now defunct regional theater company.
"There's a strange sense of déjà vu working back in there," Behrend said, "but this feels like it's something new. It's been long enough where we're sort of coming into a space that's had a lot of history, but I feel like this is a new day dawning."
The play is part of a developing model in which the 710 Main Theatre will host a variety of productions, from local shows like "Circle Mirror Transformation" to touring pieces such as John Lithgow's "Stories By Heart," which was presented in September. The leaders of 710 Main, which was shepherded into existence by Shea's Performing Arts Center but retains its own separate board and organizational structure, have also expressed a desire to bring in full productions from other cities.
For Behrend, Baker's play – which features five students in an adult theater class, a kind of grown-up "Breakfast Club" situation with a tinge of "Waiting For Guffman"-esque humor – fits perfectly into his company's mission and the 710 Main space.
"It's not a piece that I think would translate to another medium. I think you've got to be in the room with these people," he said. "I am glad that this is the first show that we decided to do because it's an accessible show, but you still have to do a little bit of work to get the full effect."
The cast features familiar RLTP faces Lisa Vitrano, Dave Hayes and Robert Rutland, along with newcomers Morgan Chard and Kelsey Mogensen. It won the 2010 Obie Award for best new American play and has been produced at dozens of regional theaters across the United States.
The play's structure and dialogue, Behrend said, eschews the rapid-fire output of other popular playwrights like David Mamet or Aaron Sorkin for a more naturalistic approach.
"She really explores these awkward pauses that people have with each other, and sometimes it's deeply hilarious or deeply disturbing," he said. "We've been very successful in bringing a great organic feel to this play, which I think is required."
Since Shea's CEO Anthony Conte announced plans to reopen the former Studio Arena space as a presenting theater, some in the theater community have expressed fears that it would only program guaranteed crowd-pleasers on the order of "Nunsense" or "Dixie's Tupperware Party."
Behrend hopes "Circle Mirror Transformation" – though by no stretch a particularly difficult work – will put those fears to rest.
"I think there's been a real fear that [Conte] was just going to come in and program that space for extremely commercial product. That was the conversation that we'd heard from a lot of people in the community," Behrend said. "I think that this show makes a great statement that, this being the first [local] show, that that's not going to happen."
What: "Circle Mirror Transformation"
When: Opens 8 p.m. today through Feb. 17
Where: 710 Main Theatre, 710 Main St.
Tickets: $16 to $25
Info: (800) 745-3000
email: firstname.lastname@example.com


text: Women's Basketball Rolls to 13th Straight Win February 21, 2014 Junior C.J. Coddington hit 8-of-11 shots and scored a career-high 21 points to help lead Stetson to its 13th straight win, 87-59 at the University of North Florida Thursday evening. Brianti Saunders netted 18 points and Jama Sharp added 17 points as the Hatters (21-5, 13-1 Atlantic Sun) won their seventh straight road game and remained tied for first place in the conference standings. It was just Stetson's second win in nine tries at the UNF Arena. "I thought it was great we could come here and get a win, because we have struggled here the last couple of years," Stetson head coach Lynn Bria said. "Overall our effort was very good. Defensively, we gave them too many second chances. We got (UNF) to miss, but we gave them too many offensive rebounds." After leading by just four with 5:30 to play in the first half, Stetson finished the period on a 19-7 run to break the game open. Coddington scored back-to-back lay-ups during the surge and Sharp banked in a three-pointer to beat the halftime buzzer. "C.J., Jama, and (Brianti) really carried us in the first half when the scoring wasn't there," Bria said. The Hatters added to the lead early in the second half, scoring 15 points in the just over four minutes. Coddington tallied 13 points after the intermission to top the 20-point mark for the first time in her career. "C.J. had a fabulous game," Bria said. "She finished very well around the basket. She has worked really hard on finishing her lay-ups. Her three-ball has come around, she is shooting very well, and she is giving us a lot on both ends of the floor." Coddington said it is her defensive play that helps get her energy going. "I try to be active, get steals, and do what I can," Coddington said. "I had a steal at the beginning of the game and I finished it, and that got my momentum going for the rest of the game. I have been focusing a lot on finishing my lay-ups, and it paid off tonight." Stetson was very aggressive on the offensive end, drawing 19 UNF fouls and getting to the free throw line 28 times. "(UNF) mixed up their defense - they went man, they went zone, but we did a good job of attacking both and getting to the free throw line," Bria said. Amber Porter recorded her eighth double-double of the season (11 points, 10 rebounds) and had five blocks to add to her school-record total (now 91). Cherisse Burris chipped in 11 points and eight rebounds for the Hatters, who shot an even 50% for the game (30-for-60), and topped 80 points for the 14th time this season. Ki Connor had 12 points to lead UNF (5-19, 1-12). Stetson will play its final regular season road game at 1 p.m. Saturday at Jacksonville.Print Friendly Version More Headlines


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The mission of Scouting is to contribute to the education of young people, through a value system based on the Scout Promise and Law, to help build a better world where people are self-fulfilled as individuals and play a constructive role in society.
This is achieved by:
• involving them throughout their formative years in a non-formal educational process
• using a specific method that makes each individual the principal agent of his or her development as a self-reliant, supportive, responsible and committed person
• assisting them to establish a value system based upon spiritual, social and personal principles as expressed in the Promise and Law.
APR Vision 2020
By 2020, Scouting in the Asia-Pacific Region is recognized at the preferred and leading educational youth movement offering relevant programme in all segments of society. Strategic Priorities for 2012-2015.
• Young People
• Adults
• Management
• Finance
• Scouting Profile
Vision 2020: The Birth of a New Plan
Two and a half years was the time it took to develop the APR Plan for 2012–2015 using a systematic process involving a large number of key NSO leaders, regional volunteers and professional staff.
The Regional Scout Committee took direct responsibility in building up the regional plan, starting at the APR Scout Leaders Summit in Bangalore in June 2010. The Summit comprised of key leaders from National Scout Organizations including the top volunteer, top executive, and International Commissioner. All sub-committee members, in their collective capacity as technical advisers to the Regional Scout Committee in various areas, were invited to take part in the strategic planning exercise. With the APR Vision 2013 coming to a close, the Summit envisaged the future of Scouting in the Asia-Pacific Region with the new "Vision 2020".
The leaders finally agreed and adopted this statement "By 2020, Scouting in the Asia Pacific Region is recognized as the preferred and leading educational youth movement offering relevant programme in all segments of society."
To achieve the Vision, they decided five strategic priorities for 2012-2015: Young People, Adults, Management, Finance, Scouting Profile.
Building on the Vision 2020 statement, the Regional Scout Committee made a key decision on April 2011 that membership growth is the primary goal of the strategic plan for 2012-2015 and that sub-committees will have to be actively involved in identifying key strategies for the next triennium.
With the RSC decision to involve all sub-committees, what followed was a joint strategic planning forum on October 2011 with the enthusiastic participation of over 60 sub committee members they refined the statements and expanded the objectives and action steps. For maximum effectiveness, they checked for inconsistencies and duplications and to ensure that the work is coherent across all the subcommittees.
The draft from the October meeting was ready for the final stage at the 24th APR Scout Conference in Dhaka. Through a breakout group activity, the Conference had a direct hand in the planning process as well as the final say. Key leaders from almost all NSOs in the region, including World Scout Committee Members, reviewed and critiqued the plan, and presented their amendments and recommendations at the conference plenary. The conference unanimously adopted the plan with the inclusion of the proposed amendments. The underlying goal is for NSOs to give their full cooperation and ownership for the implementation of the plan at national or local level and ultimately, to collectively meet the Vision 2020.
With the new approach to strategic planning introduced for the first time in this triennium, it may not be perfect as this stage, but it surely is a good move in the right direction.


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Top Definition
To lose control of yourself by way of drinking an exorbitant amount of alcohol, shot after shot perhaps one may say. In such loss of control, one wakes up not remembering what just took place the last 6 hours of their life, startled in the back of a random empty Chrysler 300, with Canadian money in their pocket.
After a long wedding weekend, a man named Brett stumbled home walking to the other side of the dirty Black River. This was after pacing 100 yds back and forth 6 or 7 different times, and finally choosing the right direction to start walking in. All the while praising God his bum did not feel violated. Brett may have traveled to Canada, we or he will never know, but at least he got home in one piece. Ex: Brett was Canadian Money'd last night. Or; You're so Canadian Money right now you don't even know it. Or; I was so Canadian Money'd. Also; I was rich with Canadian Money last night.
di The Cottage Life 24 agosto 2009
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text: If your house feels a little cramped for your needs, there are a wide variety of solutions to the problem. You could move around some walls inside to use the space more efficiently, for example, or bump out in a remodel to add an extra room or even a whole new wing. See full article.


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Want Free Shipping Every Day? Learn How.
MayaBella is the work of Shannon Benavidez. I am a stay at home mom of 4. I love all things crafty and creative. If there are any designs that you need adjusted or have any questions please send me a message!
© 2008-2015 Spoonflower Inc


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Tuesday, July 29, 2014
A Ridgeville man who called law enforcement to report people disturbing his sleep in his home wound up spending the rest of the night in jail.
According to a Dorchester County Sheriffs Office incident report, deputies responded to a call on Church Street in Ridgeville at a little after midnight on July 17 in reference to people in pickup trucks drinking alcohol and shining lights near the railroad tracks. While they were enroute to respond to the call, dispatch informed them that another call had just come in, this time a complaint about someone being shot with a BB gun.
The deputies arrived at a gravel pull-off area near the railroad tracks where they spoke to several individuals, including a 19-year-old Ridgeville woman who said she was sitting on the hood of one of the trucks when something hit her in the chest. She then heard something rolling down the hood and found that it was a BB.
Another individual told deputies he turned on the light bar on his truck and saw a man standing in a yard about 60-70 yards away holding a gun, then the man went inside a house directly across from where the trucks were parked, according to the report.
According to the report, the officers saw a man, identified in the report as Scott Howard Wagner, sitting on the porch of the house the witness identified and spoke to him. Wagner told officers he had made the first call about the people across the street shining lights in his home. The officers asked about the BB gun and Wagner replied that he had no weapons of any type. The deputies asked if they could look around the mans property; Wagner told them they could not look around the property without a search warrant.
According to the report, the officers continued to speak with Wagner advising him of the evidence they had thus far and after a few minutes, he admitted that he shot a BB gun across the yard because he didnt know what else to do about the people shining lights.
One of the officers spoke to the woman who was hit by the BB; she advised that she did want to prosecute, according to the report.
The officers then arrested Wagner for second degree assault and battery and transported him to the Dorchester County Detention Center.
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Artists who have never won a Grammy
POSTED: 11:22 AM PST Feb 08, 2013 UPDATED: 11:18 PM PST Feb 15, 2016
Artists who walked away empty-handed from the Grammys on Monday night can take solace in the fact that more than a few legendary bands and singers also got shut out by the Grammys.
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MARTINSBURG - An armed home invasion took place this morning on Dogwood Court in Martinsburg.
Two suspects knocked on the door of the home until the resident answered, Trooper Cook, of the West Virginia State Police, said in a telephone interview this afternoon.
The suspects tried to gain entry; however, the resident was able to push them out of the home, Cook said. One of the suspects then struck the resident in the head with a firearm, according to Cook.
The two suspects, described as black males wearing jeans and hooded sweatshirts, fled the scene in a silver Ford Focus, according to a statement given by the resident.
Nothing was taken from the home, Cook said.
The incident is currently under investigation.
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Human Rights
LGBT Rights as Human Rights
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Top Definition
Describes the period in which a female menstruates.
I can't go in the bumper boats, I have a bad case of the maroon poon.
додав micah 24 Серпня 2006
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The result of placing ones penis into a bootyhole then remove said penis then inserting it into a vagina while it's menstruating. The results are a concoction of blood and feces that resembles the color maroon.
"Omg Neto totally maroon pooned Mrs. Big BootyHoe."
додав Bahhhginia 19 Травня 2015


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Systemwide Events Calendar
First Aid/CPR/AEDApril 10, 8:00am - 4:00pm
Manoa Campus, Campus Center Executive Dining Room
Campus Security and Emergency Management Department will be offering First Aid / CPR / AED Training classes through the American Heart Association to the UH community. All faculty, staff and students are encouraged to sign up for these classes.
Classes are limited to the first sixteen (16) participants. Classes normally run between six (6) to eight (8) hours with a one (1) hour lunch break.
To register or get additional information (class schedule), please email Officer R. Gomez with the UH Manoa Campus Security Department at email@example.com.
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$27.00 for material (Instructional Manual / Certification Card)
Event Sponsor
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More Information
Reymundo Gomez, (808) 956-8211, email@example.com
|Wednesday, April 10
|The Wellness Center - Fitness Class Schedule
Maui Campus, Pilina Bldg., Wellness Center
|First Aid/CPR/AED
Manoa Campus, Campus Center Executive Dining Room
|HYDRUS groundwater modeling workshop
Manoa Campus, Watershed Hydrology Laboratory at the College of Tropical Agriculture and Human Resources
|ASH - Acupressure for the Neck, Shoulders, and Back (3 of 4)
Windward Campus, Hale Kuhina 115
|Be the Change
Honolulu Campus, 874 Dillingham Blvd. Honolulu, Hi 96817
|HPU-Transfer Advising
Honolulu Campus, HCC Cafeteria-Bldg 4
|HPU Transfer Advising
Honolulu Campus, HCC-Cafeteria
|UH-Hilo Transfer Advising
Honolulu Campus, HCC Cafeteria
|Spring 2013 Faculty Speaker Series: Modern Living
Manoa Campus, Burns Hall 2118, East-West Center
|German Film Series - Spring 2013
Manoa Campus, Moore Hall 259
|College of LLL - Spring 2013 - Film Series
Manoa Campus, Center for Korean Studies - Auditorium
|Tunnel of Oppression
Manoa Campus, Frear Hall
|Manoa Pre-Law Association General Meeting
Manoa Campus, QLC 411
|Relay for Life Team Captain Meeting
Manoa Campus, Campus Center Executive Dining Room
|William Watson, composer
Manoa Campus, Orvis Auditorium
- Highlighted dates have scheduled events.
- Select the date to view all events for that day.


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Top Definition
The German Log Ride is a sexual act envolving a group of three. Person #1 lays down on the floor face up. Person #2 sits like a dog on top of person #1s forehead. Person #3 then deficates on person #2s back, then urinates on the turd sending it flowing down person #2s back and into person #1s mouth.
The film was going well until Stacey found herself on the end og a German Log Ride.
dari Evil swiss Cheese Minggu, 22 Maret 2009
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Canon U.S.A. Introduces Color imageRUNNER C1030 Series of MFPs3 Nov, 2010
Canon U.S.A. Introduces Color imageRUNNER C1030 Series of MFPs
Lake Success, NY (November 1, 2010) – In response to the growing needs of both large and small office environments requiring compact, highly capable and easy-to-use color document imaging systems, Canon U.S.A., Inc., a leader in advanced digital imaging, today introduced the Color imageRUNNER C1030 Series of letter-size multifunction products (MFP). These new Color imageRUNNER models target users seeking a streamlined device to complete their office fleet with an easily managed MFP, excellent total cost of ownership, and superb image quality.
The new Canon Color imageRUNNER C1030 Series expands on the technologies of its popular predecessor – the Color imageRUNNER C1022 Series – with enhanced output speed and added features designed for the growing needs of corporate environments. The Color imageRUNNER C1030 Series MFPs can be seamlessly integrated into smaller corporate workgroup environments, satellite offices, and executive suites, while providing authentication and management tools consistent with other Canon systems. For businesses seeking a compact letter-size MFP that extends the benefits of a managed print service engagement, the Color imageRUNNER C1030 Series has been designed to save valuable time and resources by fully integrating with both the imageWARE Enterprise Management Console customer utility and imageWARE Remote, a management tool available to Canon Authorized Dealers to proactively and securely manage service and usage. End-users will also enjoy a simplified user experience as the new Series features print drivers, tools and menus similar to other Canon MFPs and printers.
"We are confident the expansion of our Color imageRUNNER platform will further distinguish Canon as the provider of choice for small businesses and corporate environments seeking a cost effective option with advanced technologies and solutions," said Sam Yoshida, vice president and general manager, Imaging Systems Group, Canon U.S.A. "Like the imageRUNNER 2500 Series introduced earlier this year, the Color imageRUNNER C1030 Series offers businesses a streamlined solution, combining excellent durability and simplicity of operation in a small package."
The new Color imageRUNNER C1030 Series has a compact design and bold capabilities that easily fit on a desktop or in a centralized area, saving valuable office space, while delivering document workflow productivity. These multifunction devices are based on the latest imageCHIP (Concurrent Hyper Intelligent Platform) LITE platform, providing proven performance for handling concurrent print, copy, scan, fax and send jobs.
Boasting professional-quality output and standard duplex-printing, the Canon Color imageRUNNER C1030 offers letter-sized print speeds of up to 22 pages-per-minute (ppm) in color and 30ppm (monochrome), at up to 600 x 600 dots-per-inch (dpi) resolution (2400 equivalent x 600 dpi), and scanning of documents at up to 20 ipm at 600 x 600 dpi, giving offices significant flexibility in delivering output. Image quality is excellent, delivering image output from a compact letter-size MFP typically seen only in larger systems. In addition, both models have fast warm-up, short wait times between jobs and are Energy Star-qualified with low 1W energy consumption in sleep mode.
Standard on all Canon Color imageRUNNER C1030 models is an intuitive and vibrant tilting 3.5" color LCD interface with a scroll dial for easy operation. Each model features a 350-sheet standard paper capacity for up to 8.5" x 14" media (expandable to 850 sheets), UFR II LT printing, 768MB of RAM, 10/100 Base TX Ethernet connectivity, a variety of Memory Media ports, and color send capability. Faxing, PCL and PostScript 3 (emulated) printing are available options.
The Color imageRUNNER C1030 Series raises the bar for security over predecessor models. The standard Department ID and User ID limits access to authorized users, while the new User Authentication for Send function secures business information by requiring users to positively authenticate against an LDAP server before using the standard Color Send capability. Document output can be also protected with the new Serverless Secure Print option, which holds print data at the PC until the user has been authenticated at the device. Centralized security and output tracking is available with standard firmware-embedded support for Canon's uniFLOW v5.0 optional solution, enabling server-based authentication, cost tracking, and secure print release. The Series also limits the potential for latent image data by performing all functions without a hard disk drive.
The new Color imageRUNNER C1030 Series is available in two versions – an "iF" model and "base" model. The iF model is bundled with standard features including PCL5c/6 support and faxing capabilities, while the base model is configurable with printing and fax options.
The Color imageRUNNER C1030 and C1030iF are available immediately through Canon authorized dealers and Canon Business Solutions at manufacturer's suggested price of $2,595 and $3,095, respectively.
About Canon U.S.A., Inc.
Canon U.S.A., Inc., is a leading provider of consumer, business-to-business, and industrial digital imaging solutions. Its parent company, Canon Inc. (NYSE:CAJ), a top patent holder of technology, ranked fourth overall in the U.S. in 2009†, with global revenues of US $35 billion, is listed as number six in the computer industry on Fortune Magazine's World's Most Admired Companies 2010 list, and is on the 2009 BusinessWeek list of "100 Best Global Brands." Canon U.S.A. is committed to the highest levels of customer satisfaction and loyalty, providing 100 percent U.S.-based consumer service and support for all of the products it distributes. At Canon, we care because caring is essential to living together in harmony. Founded upon a corporate philosophy of Kyosei – "all people, regardless of race, religion or culture, harmoniously living and working together into the future" – Canon U.S.A. supports a number of social, youth, educational and other programs, including environmental and recycling initiatives. Additional information about these programs can be found at www.usa.canon.com/kyosei.
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text:
Virtual Easter egg hunt
Easter egg hunts are a wonderful tradition that takes place around Easter. Try our virtual egg hunt game to see how many eggs you can find!
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The namesake of this most exciting ski slope in the Stoos ski area is Franz Heinzer, one of Switzerland's most successful ski racers. The piste, which runs in an almost straight line from the Klingenstock into the valley, is regularly used as a FIS racing route for downhill runs and super G. When races are not being held it is more or less open to everyone. However, this descent is only recommended for experienced skiers as there are some extremely steep sections.
Starting point: Klingenstock (1935 m a.s.l.)
Starting point: Klingenstock (1935 m a.s.l.)
Accessibility of starting point: chairlift
Destination: Klingenstock (1346 m a.s.l.)
Length: 4km
Altitude difference: 589 Meter
Gradient: 30% (average), 90% (maximum)
Level of difficulty: difficult (normal slope)
Food and beverages: at the end


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Endometriosis and Infertility
Endometriosis is a disease in which the endometrial tissue that makes up the lining of the uterus grows outside of the uterus. When this tissue implants and grows in the abdomen, it can cause cysts and scarring in the places where it is growing. It can bleed and cause pain, especially during a woman's period. Endometriosis can damage the ovaries, fallopian tubes, and even the bladder and bowel.
Endometriosis is associated with infertility. This may be because of the damage to the reproductive organs, but it also may be associated with problems inside the uterus that make it more difficult for an embryo to implant and grow there.
Although endometriosis is often seen in women between the ages of 25 and 44, it can also occur in teenagers. Teenagers that have severe pain with their periods should be evaluated for endometriosis. While doctors do not know exactly why this misplaced tissue growth occurs, they do know that a woman whose mother or sister suffers from endometriosis is more likely to have the disease.
Treatment options vary based on the severity of the disease, the age of the woman, and her reproductive plans. Medications can be given to suppress menses and reduce the long-term damage from endometriosis. Surgery is sometimes necessary to verify the diagnosis, remove the endometrial implants, repair damage to organs, and reduce the pain from endometriosis. Sometimes medical treatments or surgery are used to improve a patient's response to infertility therapies.
When the pain from endometriosis is severe, women who do not wish to have more children may opt for a hysterectomy. However, less invasive treatments such as ovarian suppression with continuous oral contraceptives or other hormone therapies are often successful in reducing the pain. Careful evaluation for other causes of pelvic pain is also important. Many women with endometriosis also suffer from irritable bowel syndrome, which also can cause pelvic pain similar to that of endometriosis.
Attend a free seminar to learn how Emory fertility specialists use IVF to treat endometriosis infertility.


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Family Birthplace
Memorial's Family Birthplace
South Florida's Family Birthing Center
Memorial's birthing center understands that the birth of your baby is one of life's most treasured moments. That is why we created the Family Birthplace, a special place for you, your baby and every member of your family. Through every step of your pregnancy, the Family Birthplace is dedicated to providing the support, education and high-quality birthing services to help you have a happy and healthy pregnancy, delivery and hospital experience. The Family Birthplace is a facility of Memorial Regional Hospital, Memorial Hospital West and Memorial Hospital Miramar.
A Birthing Center Focused on Family
At the heart of the Family Birthplace at Memorial is our family-centered care philosophy, which focuses on information-sharing and collaboration between families and medical professionals. With this level of involvement, your entire family can more fully participate in this exciting life event.
Childbirth Education Classes
The Family Birthplace at Memorial offers a childbirth education program called Expectations and Beyond to help prepare you for the birth of your baby. Expectations and Beyond features a variety of classes, including pregnancy planning, childbirth preparation, baby care, infant CPR and more. We also provide special birthing classes just for dads, siblings and grandparents.
Your Birthing Center Experience
When the time arrives to deliver your baby, you will find a warm, homelike environment with comfortable accommodations where you can share the birth experience with your entire family. Our beautiful maternity suites are furnished with medical equipment. Talk to your physician about the different birthing options available at Memorial's Family Birthplace.
Care Provided by an Experienced Staff
It is comforting to know that the Family Birthplace at Memorial can provide prompt, advanced medical care when difficult situations arise. Our birthing center's staff of board-certified neonatologists, anesthesiologists, neonatal nurse practitioners and specially trained neonatal nurses utilizes some of the latest techniques and procedures to monitor babies 24 hours a day, and every nurse is certified in neonatal resuscitation.
Lactation Services
Our board-certified lactation consultants have extensive experience in counseling breastfeeding mothers. New mothers can learn how to breastfeed successfully and how breastfeeding benefits their babies. Breastfeeding classes, educational materials and in-hospital support are available through Lactation Services.
A Birthing Center for You and Your Family
At the Family Birthplace, we have worked hard to create an attractive setting with the comforts of home for you and your family. From on-site shopping to highly advanced security measures, we offer a wide variety of amenities for your convenience and peace of mind. Extra touches, such as our sibling-friendly environment and online photo gallery, make it easy to share the joy of your baby's birth with all your family and friends.
The Family Birthplace at Memorial provides the compassion and attention you and your baby deserve during this very special time.
- Memorial Regional Hospital Family Birthplace
- Memorial Hospital West Family Birthplace
- Memorial Hospital Miramar Family Birthplace
Is Your Doctor a Memorial Doctor?
To find a physician who is committed to South Florida birthing services, call Memorial Physician Referral Service toll-free at (800) 944-DOCS. We're available 24 hours a day, 7 days a week.


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The 2013 Conservative Political Action Conference (CPAC) has chosen its key speakers for the March 14-16 event in Washington, and it says a lot about the Republican message for the future.
The top CPAC picks have demonstrated their ability to alienate millions of voters and lose elections by showing off just how crazy Tea Party candidates can be with their vision to take America back to the Stone Age and incoherent contradictory rhetoric that continues to confuse just about everyone.
Mitt Romney
Losing presidential candidate Mitt Romney will be coming out of hiding for the event.
After his embarrassing defeat to President Barack Obama in the 2012 election, Romney has been given a not-for-prime-time afternoon spot. But no matter what time Romney speaks it will still likely make headlines.
Millionaire Mitt gained fame and bad fortune on the 2012 campaign trail, when the grandson of former President Jimmy Carter managed to videotape Romney at Florida fundraising event, where he called "47 percent" of the American people lazy moochers who would never vote for him anyway because he wanted to take away their government handouts. Mother Jones published the video that some believe cost Romney the election.
If Romney holds true to form, he will probably take opposing views against himself, bringing pandering and bipolar politics to a new level.
Sarah Palin
Losing vice presidential candidate and recently unemployed Fox News commentator Sarah Palin will also take the 2013 CPAC stage.
Palin was the creator of the "Death Panel" myth intended to scare people about Obamacare. Since the completely false claim was soundly debunked, Palin ended up scaring more voters away from the Republican Party than people who supported health care reform.
Millions will be shocked if the former Alaskan beauty queen can make it through her speech without using the words "Obama" and "socialist" several times in the same sentence.
Rick Perry
Texas governor Rick Perry had the lead in the GOP primary races leading up to the 2012 election, but lost it after admitting during a debate that he wanted to eliminate parts of the US government but couldn't remember which ones.
Ted Cruz
No 2013 Republican event would be complete without a taste of the most frightening new star of the Tea Party. That brings us to freshman Texas Sen. Ted Cruz.
Cruz is the personification of everything scary about the Tea Party wing of the Republican Party. Upon arrival in Washington, Cruz quickly made a name for himself by conjuring of memories of McCarthyism during the confirmation hearings of Defense Secretary nominee Chuck Hagel.
While many Americans consider the 1950s witch hunt for hidden communists by Sen. Joe McCarty an embarrassment in US history, in 2013, CPAC views Cruz as their brightest unfounded conspiracy theory star.
To confirm their endorsement of communist hunters in the Republican Party, CPAC has given Cruz the coveted spot of final speaker at the convention.
What does all this say about the future of the GOP?
Despite the list of excuses for Romney's losing bid for the White House, which includes everything from bad weather to the failure of voter suppression efforts against likely Democratic voters, the Republican Party is sticking to its losing political message.
Fear not, America! No matter how badly the 2013 CPAC message is received by mainstream voters, the right-wing blogosphere will find a way to twist it into a glorious display of simply amazing conservative vision for 18th-century America.
If they have to sprinkle it with a few baseless conspiracy theories, fear-mongering, or insulting comments about rape -- so be it. Nothing makes a convention more fun than losing candidates making stuff up so they can fundraise off it later.
If you like to write about US politics, enter Allvoices' "The American Pundit" political writing contest. Allvoices is awarding four $250 prizes each month between now and Nov. 30. These monthly winners earn eligibility for the $5,000 grand prize, to be awarded in December. If you do not already have a free account, sign up here.
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Why do 'red states' have more poverty?


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Pronounced "chooooiieeech", this term refers to tall males with a dark complexion, generally Australians of European descent (predominately Greek or Italian). When referring to someone who is particularly identifiable as a cheech, this term may be used in conjunction with "full-blown" (ie. full-blown cheech). This kind of cheech is seen as a rarity and is often named 'Dion'.
Person 1: Oi Dion's full cheech ayy?
Person 2: Ye dude, he's full-blown cheech
Person 2: Ye dude, he's full-blown cheech
CoolDude420 tarafından 27 Ocak 2014, Pazartesi
an alcoholic drink, invented by mr tre cool himself.
wanna go drink some cheech homie?!
mollyCOOL tarafından 12 Nisan 2005, Salı
Failure at completing or learning to do something properly. Also, to believe you are doing the right thing when it is clear that you are not.
The hunter, Gorione, cheeched that up bad.
ZenGuild tarafından 2 Mayıs 2008, Cuma
A vagina belonging to a person of latino/hispanic descent. Commonly found to be quite hairy and smell like taco bell.
That mexican hotel maid stole my wallet while cleaning my hotel room, next time she comes to clean i'll hide in the bathroom and when she comes in i'll jump out and punch her in the cheech...
Chazz Michaels tarafından 9 Mayıs 2008, Cuma
is another word for dumbass or stupid ass.
is a banana a fruit?
wow! your a cheech!
wow! your a cheech!
Coolkidkay tarafından 6 Mayıs 2009, Çarşamba
To smoke every last little particle of marijuana plant matter out of a joint; sometimes going to extreme lengths to reap every last puff.
Johnny burnt his fingers trying to cheech that tiny roach, man. What a sad bastard.
Peter K tarafından 13 Ağustos 2005, Cumartesi
Cheese said with a lisp
I like cheech on toacht
LisaJane tarafından 3 Aralık 2005, Cumartesi


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Her own crushes and romances have been much scrutinized, but Taylor Swift still has a soft spot for young love.
The fashion-loving music star, 24, reached out to a teen fan named Hannah who sent the singer a note via Instagram about falling for the boy next door – a nice guy with a girlfriend who didn't know she cared. And who might never love her back.
As Hannah wrote about the object of her affection: "There's a guy Taylor, a guy who's sweet and charming and makes me laugh. A guy who said sorry for eating in front of me after finding out I had to skip breakfast. A guy who grew up across the street from me. A guy who plays guitar like me. A guy who was my first best friend. A guy who I met when I was seven and he was nine. A guy who this one time, when we were younger, said that I was 'like' his girlfriend because I was a girl and his friend. I wish," her note said.
"A guy who I have the biggest crush in the whole wide world on, and he'll never like me back. (And he has a girlfriend who he adores and she's pretty and has an amazing figure and is actually nice to me). A guy who will never like me back. @taylorswift can you give me some advice maybe. I love you. Hannah."
Touched by the message, the Grammy-winning singer and songwriter responded – first by complimenting Hannah's big blue eyes – then with her take on unrequited love.
"Hannah. Eyes, eyes, eyes. Woah. You have the prettiest, widest, most child like eyes. (Composes herself) Okay. About this guy. I think we grow up thinking the only love that counts as true love is the kind that lasts forever or is fully realized. When you have a broken heart, the first thing a stranger will ask is 'how long were you two together?' As if your pain can be determined by how long you were with someone. Or if you were with them at all. I don't think that's how it works," Swift, who stars in a new movie The Giver, told Hannah.
"I think unrequited love is just as valid as any other kind. It's just as crushing and just as thrilling," Swift wrote. "No matter what happens in this situation, I want you to remember that what you are doing is selfless and beautiful and kind. You are loving someone purely because you love them, not because you think you'll ever have your affections reciprocated. You are admiring something for its beauty, without needing to own it. Feel good about being the kind of person who loves selflessly. I think someday you'll find someone who loves you in that exact same way.
Hannah expressed her gratitude to Swift for weighing in.
"You have no idea how much this means to me, thank you. You understand and that means so much. I feel like you're the big sister I don't have. Thank you, I really did need to hear that from you."
Taylor Swift Helps a Young Fan with a Broken Heart over the Boy Next Door
Mark Humphrey/AP


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Listen to Star 96 – The Prairie Star
- If you want to keep this as simple as possible and you normally use Windows Media Player to listen to Internet radio, choose the link to our MP3 stream
- You may also listen using Windows Media Player to our lower quality Windows Media stream
- Real Player users can tune in directly to our MP3 stream but we do not offer our programming in Real Media format at this time
- Live on campus? Tune in to UIS Cable Channel 96
- You don't use any of the above? Our MP3 stream is compatible with just about all media players, including WinAmp, iTunes and QuickTime.


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Thanks for Getting in Touch About TradeNet
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Company Biographies
Diana Byer (Founder & Artistic Director)
Diana Byer has performed as a soloist with Les Grandes Ballets Canadians, Manhattan Festival Ballet, New York City Opera, and the Juilliard Ensemble. She received her principal dance training from Margaret Craske and Antony Tudor. Details >
ChoreographersNYTB combines classic masterpieces with the modern sensibilities of established and up and coming choeographers of today. Works by the following choreographers are featured in current Legends & Visionaries programs.
Artistic Staff
Michael Scales (Music Director)
Michael is active as a collaborative pianist and chamber musician, as well as promoting and performing works by new composers. Details >
Sylvia Taalsohn Nolan (Costume Designer)
Sylvia is the Resident Costume Designer of The Metropolitan Opera. In addition to opera, she has a special interest in dance design. Details >
Gillian Bradshaw-Smith (Set & Property Designer, Scenic Painter)
As a fine artist, Gillian showed her work in art galleries and museums, including the prestigious Cordier & Ekstrom Gallery. Her work in scenic design, principally for the ballet, started in 1990. Details >
Joshua Andino-Nieto
Joshua Andino-Nieto, of Spanish decent, was born and raised in Stuttgart, Germany. Details >
Alexis Branagan
Alexis grew up in New Jersey and began her intensive ballet training with New Jersey Ballet.
Details >
Steven Melendez
Steven Melendez joined New York Theatre Ballet as an apprentice dancer in 2001. In 2006 he joined Ballet Concierto in Buenos Aires, Argentina and in 2007 joined the Vanemuine Theater Ballet Company in Tartu, Estonia. Steven returned to New York Theatre Ballet in 2010. Steven is a Van-Lier Fellowship recipient and was a 2012 Clive Barnes Foundation Award Nominee. Details >
Carmella Lauer
Before joining NYTB, she danced with Nashville Ballet, Ballet Tucson, and Saeko Ichinohe Dance Company. Details >
Mayu Oguri
She has worked with the Jeune Ballet de CNSMD de Lyon, The Francesca Harper Project, The Albano Ballet Company and Kazuko Hirabayashi Dance Theatre. Details >
Amanda Treiber
She was a member of The Tallahassee Ballet and danced in Balanchine's In the Inn, staged by Suzanne Farrell at FSU. Details >
Michael Wells
Michael Wells trained at the Atlanta Ballet and at the University of North Carolina School of the Arts.
Details >
Stephen Campanella
Stephen Campanella received his training at Princeton Ballet School and the graduate program at Pittsburgh Ballet Theatre. Details >
Mitchell Kilby
He began his training at the Marie Walton Mahon Dance Academy at age 16. After two years, he was accepted and received a full scholarship to The Joffrey Ballet School in New York. Details >
Elena Zahlmann (Associate Artistic Director)
Elena Zahlmann trained with Elisabeth Carroll at Princeton Ballet, and on scholarship at the New Jersey Governor's School of the Arts. Details >


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RiverView Health
Doing Business As:
RiverView Hospital - Crookston, MN
RiverView Care Center - Crookston, MN
Glenmore Recovery Center - Crookston, Baudette, East Grand Forks, Roseau, Thief
River Falls, MN
RiverView Home Care - Crookston, MN
RiverView Clinic - Crookston, East Grand Forks, Fertile, Red Lake Falls, MN, Grand Forks, ND
Application for Employment
RiverView Health is "An Equal Opportunity Employer"
We welcome you as an applicant for employment. As an Equal Opportunity Employer
it is our policy not to discriminate against or harass any employee or
applicant for employment because of race, color, creed, gender, disability,
age, religion, national origin, sexual orientation, marital status, status with
regard to public assistance, or physical and mental disability in regard to any
potisiton for which the employee or applicant for employment is qualified. Age
is not a factor except for those under 16 years of age. Employment of relatives
where a direct employee/direct supervisory relationship would exist is
RiverView Health employs only United States citizens or aliens lawfully authorized to work in the United States.


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Author(s): S. Kumar, J. Crowley, S. K. Klein, J. J. Lahuerta, J. Lee, P. Moreau, G. Morgan, P. G. Richardson, D. S. Siegel, B. G. Durie, on behalf of the International Myeloma Working Group (IMWG)
Background: Outcome of patients (pts) with multiple myeloma (MM) has improved with the introduction of the immunomodulatory drugs (IMiD; thalidomide, lenalidomide) and the proteasome inhibitor bortezomib (Bz). However, MM remains incurable and new therapies are needed. Improvement with upcoming therapies needs to be measured in the context of outcome with the current therapies. Moreover, the natural history of MM with the newer therapies used currently remains unclear.
Methods: We designed a multicenter, retrospective study that enrolled 270 pts with relapsed MM, from 8 sites in US, 5 in Europe and 1 in Asia. Pts were refractory to Bz, defined as no response to prior Bz-containing regimen or disease progression within 60 days of a Bz-containing regimen. Pts also had to be relapsed, refractory, intolerant, and/or ineligible, to an IMiD. Clinical and lab data from diagnosis and individual relapses were collected. The date pts satisfied the above entry criteria was defined as time zero (T0).
Results: The median age at diagnosis was 58 years (range, 31-86) and median time from diagnosis to T0 was 32 months (mos) and 32% had > 3 prior regimens, including a transplant (SCT) in 60%. Following T0, 192 (71%) pts had a treatment recorded, including an SCT in 34 (13%). Various regimens were utilized after T0 (median=1; range 0-8). The first regimen following T0 contained Bz in 52 (27%) pts and an IMiD in 63 (33%) pts. An MR or better was seen to at least one therapy after T0 in 87 (45%) including > PR in 65 (34%) and > VGPR in 18 (9%). The probability of achieving a PR or better was higher for younger patients, those with a VGPR or better before T0 and those who received an SCT after T0. The median overall survival (OS) and event free survival (EFS) were 8 mos (95% CI; 6,10) and 5 mos (95% CI; 4,5 mos) respectively.
Conclusions: This study confirms the poor outcome of pts once they relapse and become refractory to novel agents. This observational dataset will provide context for interpreting ongoing clinical trials of new drugs for MM. SCT results in higher response rates, especially in those receiving it for the first time, and should be taken into account when defining populations for studies of new drugs.


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Doug Allen
Doug Allen delivers the weather forecast each weekday during "News 8 at 5," "News 8 at 5:30," "News 8 at 6" and "News 8 at 11."
Doug assumed his duties with WGAL's news department in April 1989, after having co-hosted the station's edition of "PM MAGAZINE" for more than four and a half years.
Winner of an Emmy Award for Best Weathercaster, Doug works closely and consults with News 8's chief meteorologist, Joe Calhoun. Together they operate this area's most complete and state-of-the-art weather center.
Doug grew up in Bethel, Conn. Upon graduation from high school, he was awarded an American Legion Scholarship. Doug attended Jones College in Jacksonville, Fla., graduating with a degree in broadcast management.
Beginning his career as a radio program director in Cape Cod, Mass., Doug later worked as an afternoon announcer on CBS radio station WHTT in Boston. While in Boston, he also hosted a music video show on WNEV-TV.
Particularly enthusiastic about his association with the 21-hour on-air Children's Miracle Network Telethon, Doug co-hosts the major event each spring on WGAL. Proceeds from the telethon stay in the Susquehanna Valley area and benefit the Penn State University Hospital at the Milton S. Hershey Medical Center.
You can e-mail Doug at firstname.lastname@example.com.
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First responders in Berks County will get the chance to protect themselves from the flu free of charge.
St. Joseph Medical Center in Reading is offering drive-up flu shots for members of the police, fire and EMS departments in the county.
The clinic goes from 2 - 7 p.m. Monday and from 2 - 6 p.m. Tuesday.
Two more clinics are planned for next week.
Anyone who is on-duty or shows a police, fire or EMS identification can get the shot for free.


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Except where noted, MP3's are available at 320 kbps -- plays on iPod® and all MP3 players
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The premier release from two sets of enormously talented siblings, the Cunninghams of Scotland and the Ó Domhnaills of Ireland. This album brings it all together: the incomparable songs and keyboard work of Triona, the wonderful ballads from Mícheál, sublime fiddle from Johnny, and stellar accordion and keyboard wizardry from Phil. Silly Wizard meets The Bothy Band -- and an historic album is born.
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Work for Hargreaves Lansdown Plc.?Claim Your Profile
Hargreaves Lansdown Plc provides a range of investment products, investment services, and financial planning and advice to private investors in the United Kingdom. Its flagship service, Vantage, is a direct-to-private investor fund and wrap platform. Vantage offers clients the administrative convenience of being able to hold and manage their investments, including unit trusts, OEICs, equities, bonds, investment trusts, and cash.


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|2013 ALS User Meeting Highlights
This year's ALS User Meeting launched with a welcome from Users' Executive Committee Chair Corie Ralston and LBNL Director Paul Alivisatos. ALS Director Roger Falcone followed with a "state of the ALS" presentation that began with a reminder of the ALS mission, which he noted remains true even in the midst of a government shutdown: "Supporting users in doing outstanding science in a safe environment." Falcone gave the 414 meeting attendees an update on the ALS beamlines, which included good news about increased user numbers thanks to the new RAPIDD access system, enhanced robotics, and remote capabilities. Falcone reflected that ALS metrics continue to represent our highly productive users—the number of journal articles and papers per user that come from ALS research have continued to grow in the past year. Looking forward, Falcone touched on how a proposed ALS upgrade to a diffraction-limited light source would increase scientific capabilities.
With DOE travel cancelled due to shutdown, the meeting's scheduled DOE update was filled with a presentation by the Lab's own government relations representative, Don Medley, on how to talk about science with elected representatives. Medley spoke about framing discussions with politicians in terms of the "value of our country's science ecosystem."
The keynote speaker series began with the director of Argonne National Lab's Joint Center for Energy Storage Research (JCESR) George Crabtree—via video conference—speaking about the challenges and opportunities in energy storage science. Crabtree encouraged his audience of scientists to look beyond lithium ion batteries to the next generation of battery capabilities and presented numerous ways that synchrotron science can move that process forward. Next up was UC Berkeley's Michael Eisen, who gave an engaging presentation on the transformation of scientific research communication. Eisen, a biologist and an associate professor of genetics, genomics, and development, is also the founder of the Public Library of Science (PLOS), which is a nonprofit publisher that seeks to make research publication more open and immediately available. Jim Krupnick, recently retired Berkleley Lab COO, then took the stage to reflect on the early days of the ALS and its construction history, especially appropriate in this 20th anniversary year. Krupnick regaled the audience with entertaining vignettes and rarely seen historical photos. UC Berkeley's Jamie Cate gave the final keynote, which was focused on high-resolution structures of the ribosome, many of which were determined at the ALS.
ALS staff updates included User Services group lead Sue Bailey, who introduced the new ALS user portal and RAPIDD access system. Christoph Steier, deputy group leader of the ALS Accelerator Physics Group, gave an ALS accelerator update. Recent upgrades have improved brightness at the ALS by a factor of three, while storage ring RF upgrades and low-conductivity water upgrades have also been implemented this year. Looking to the future, Steier spoke about the dramatic improvements in brightness and coherence that would be possible with a diffraction-limited upgrade. The proposed ALS upgrade, termed ALS-II, would follow the trend of international user facility activity toward brighter storage rings. Steve Kevan, deputy division director for science at the ALS, went on to elaborate on how the ALS-II would benefit user science in general and various beamlines in particular.
Next up was the ever-popular student poster competition, followed by a reception that gave the 23 students a chance to field questions about their work and 34 exhibitors an opportunity to introduce their wares to users. First prize went to Royce Lam of UC Berkeley's Saykally Group, for his research using x-ray absorption spectroscopy to probe ions in solution.
Tuesday morning featured this year's David Shirley Award winner, North Carolina University's Harold Ade, speaking about his achievements in polymer science. This year's student poster award winner also had a chance to present and field questions about his research. The morning progressed with science highlight presentations by ALS users working in a variety of research areas.
Tuesday's awards dinner was a celebratory gathering of ALS users recognizing exceptional synchrotron science. The Klaus Halbach Award for Innovative Instrumentation went to Chris Jozwiak of the Lab's Materials Science Division and the Tim Renner User Services Award for Outstanding Support to the ALS User Community went to John Pepper of the ALS Mechanical Technology Division. Descriptions of the awards and more photos of the recipients will be posted soon.


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What to do with a day off?
I know, bottle the wheat ale and move the stout to a secondary where its going to chill out with some coconut.
That's a good day off indeed, and that's what I plan to do this week on one of my days off.
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"LEANING" under 52 as of right now...
Originally Posted by MSUBeau7: I like the under and the Saints... Saints are an animal in the dome
Took und 53 for 2 units and saints for 3 units
Dome will be rocking...30-20 F saints
Originally Posted by califresh23: i guess i was the only one who really liked the over on this game.. im having a really good week.
No, I got NO and OVER, I was telling ppl to grab NO at -6.5 since last night.
Copyright © 1995-


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The Jimmy Dore Show: Premium Audio now available!
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RCMP defends officer behaviour at G8/G20 summits Add to ...
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A report into the conduct of the RCMP during the 2010 G8 and G20 summits has found officers acted in a "reasonable and appropriate" fashion.
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Regent University Behavioral Intervention Team (RUBIT)
The Regent University administrative, faculty, staff and student community espouse a foundation of academic excellence based on Christian worldview principles. The objective of producing top Christian leaders who operate in pivotal professions is of primary importance to the university's mission. However, in the event issues arise that warrant concern for the safety of our faculty, staff or students, policies are in place for addressing disruptive, suspicious, or unusual behavior. In particular, these policies function to provide direction in handling homicidal, suicidal, assault or self-injurious threats and behavior.
The Regent University Behavioral Intervention Team (RUBIT) was established to provide guidance, uphold policies and address faculty, staff and student safety needs. The members of this team consist of the Executive Director of Student Services, Director of Student Activities and Leadership, Vice President/General Counsel, Chief of Police, Staff Counselor, Director of Residence Life and Student Conduct, Director of Campus Ministries, and Vice President of Human Resources (if an employee is involved). The RUBIT may involve other university representatives depending on the nature of the concern addressed.


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Jonathan Joseph, Wyatt Sikora, and Grant Lozoya are set to join the Stetson men's basketball team for the 2014-15 season, as announced by Hatter Head Coach Corey Williams on Tuesday.
Part of Williams' first full recruiting class at the helm of the Stetson program, the trio will bring a wealth of talent to the Hatters next season.
"All three of these guys play at a very high level, and those are the kinds of kids that we want to recruit," Williams said. "They bring a level of skill to the recruiting class that Stetson hasn't really had before. They will immediately make us better. I know they're freshmen, but more often than not they are going to play like they're upperclassmen, and I'm looking forward to that."
Joseph is a local product, hailing from Orlando where he attended Orlando Christian Preparatory School. The 6-5 wingman led OCP to the Florida 2A State Championship as a junior in 2012-13, and the team is the favorite for the upcoming 2013-14 season.
"He's an unbelievable athlete who can guard multiple positions," Williams said of Joseph. "He has a quick first step and he understands the game. He can shoot it from the perimeter and get it to the basket. He adds a dimension to our team that we don't currently have."
Sikora, brother of current Hatter junior Kyle Sikora, comes to Stetson from Key Largo, Fla. The 6-10 big man played high school ball at Florida Christian School in Miami. An All-Dade County selection by the Miami Herald, Sikora averaged 14 points, nine rebounds, and three blocks as a junior in 2012-13.
"Wyatt is long, very skilled, and really versatile," Williams said. "We wanted to get kids who are skilled and understand the game, and he is most definitely one of those. He's a great passer, he can shoot, he can post up, he can block shots, and he's a great team player."
Lozoya calls Westlake, Calif. home and attended Westlake High School before spending a post-graduate season at The Lawrenceville School in New Jersey. The 6-2 shooting guard led Westlake to a 28-6 record as a senior in 2012-13 while earning All-State, All-League, and All-County honors.
"He can shoot it long range, he's very smart, he can play the point if we need him to, and he's an excellent scorer," Williams said of Lozoya. "The other thing that he really does a good job of is that he finds people. He's going to be able to create good situations for himself and his teammates."
Joseph, Sikora, and Lozoya are the first three members of Williams' first full recruiting class as a head coach. The Head Hatter brought in five players quickly after becoming the coach at Stetson this past June.