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From Brooke Army Medical Center, San Antonio, Texas; U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Maryland; Wilford Hall Air Force Medical Center, Lackland AFB, Texas; and Armed Forces Institute of Pathology, Washington, DC.
Disclaimer: The opinions and research contained herein are the private ones of the authors and are not to be considered as official or reflecting the views of the Department of the Army, Department of the Air Force, or Department of Defense.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Robert E. Eckart, MAJ MC, U.S. Army, Cardiac Arrhythmia Service (Cardiovascular Division), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, email@example.com.
Current Author Addresses: Dr. Eckart: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Dr. Scoville: U.S. Army Center for Health Promotion and Preventive Medicine, Directorate of Epidemiology and Disease Surveillance, 503 Robert Grant Avenue, Room 2A31, Silver Spring, MD 20910.
Dr. Campbell: Wilford Hall Air Force Medical Center, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236.
Drs. Shry and Stajduhar: Brooke Army Medical Center, 3851 Roger Brooke, Fort Sam Houston, TX 78234.
Dr. Potter: American Registry of Pathology, 1413 Research Boulevard, Rockville, MD 20850.
Dr. Pearse: Office of the Armed Forces Medical Examiner, 1413 Research Boulevard, No. 102, Rockville, MD 20850.
Dr. Virmani: Armed Forces Institute of Pathology, 6825 16th Street NW, Washington, DC 20306.
Author Contributions: Conception and design: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, K.C. Stajduhar.
Analysis and interpretation of the data: R.E. Eckart, S.L. Scoville, E.A. Shry, K.C. Stajduhar, R. Virmani.
Drafting of the article: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, R. Virmani.
Critical revision of the article for important intellectual content: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, K.C. Stajduhar, R.N. Potter, L.A. Pearse.
Final approval of the article: R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, K.C. Stajduhar, R.N. Potter, R. Virmani.
Provision of study materials or patients: S.L. Scoville, R.N. Potter, L.A. Pearse.
Statistical expertise: R.E. Eckart, S.L. Scoville.
Administrative, technical, or logistic support: R.E. Eckart, L.A. Pearse.
Collection and assembly of data: S.L. Scoville, R.E. Eckart, R.N. Potter, L.A. Pearse.
Sudden nontraumatic death in military recruits may offer insight into the causes and prevention of sudden death in young adults.
Among 6.3 million military recruits age 18 to 35 years, sudden nontraumatic death occurred at a rate of 13.0 per 100 000 recruit-years. Over half of the 126 autopsied decedents had an identifiable cardiac abnormality; one third had an anomalous coronary artery. More than one third of deaths had no explanation.
This study had no control recruits who did not die suddenly.
Sudden nontraumatic death among military recruits occurs rarely. Whether more intensive screening would effectively prevent sudden death is unknown.
–The Editors
Sudden death in healthy persons is uncommon and is usually due to previously undetected cardiovascular disease (1–2). Most sudden deaths among apparently healthy young athletes occur during exertion and are most often caused by cardiac abnormalities (3–5). Gardner and colleagues (6) reported that 60% to 78% of exercise-related deaths in U.S. military personnel during 1996–1999 were attributable to a cardiac cause. Among young adults (persons 17 to 34 years of age), 50% of exercise-related deaths were attributable to preexisting heart disease (6). Maron and colleagues (7–8) identified 158 sudden deaths in U.S. athletes younger than 35 years of age from 1985 through 1995 and found that 85% had a cardiovascular cause. In this and other studies of young athletes, hypertrophic cardiomyopathy, coronary artery anomalies, and cystic medial necrosis with a subsequent ruptured aorta were commonly associated with sudden death (3, 7, 9–10). Uncommon causes of cardiac death in persons who exercise include myocarditis, floppy mitral valve, aortic stenosis, aortic dissection, and sarcoidosis (3, 11). Phillips and colleagues (12) identified 19 sudden cardiac deaths from 1965 through 1985 during Air Force basic military training at Lackland Air Force Base, Texas, the only training site for Air Force basic military training. The most frequent underlying cause of these deaths was myocarditis (42%), followed by coronary anomalies (16%).
The frequency of sudden death in athletes younger than35 years of age is not clearly defined (13). Regardless of frequency, sudden death in young adults garners disproportionate attention from the media and raises important issues of legal liability (5). Deaths occurring during basic military training are of particular concern because they occur despite a preenlistment health screening program and have a substantial effect on the structure of basic training. The medical screening, conducted at a Military Entrance Processing Station, consists of a personal (but not family) medical history questionnaire and physical examination. The physical examination includes a clinical evaluation; blood and urine testing; and measurements of blood pressure, pulse, height, and weight. Cardiovascular screening is limited to heart auscultation. Electrocardiography is performed only if any abnormalities are identified.
Cardiovascular diagnoses that prompt rejection for enlistment include valvular heart diseases, coronary artery disease, symptomatic arrhythmia, persistent resting sinus tachycardia, documented ventricular arrhythmias, left bundle-branch block, Mobitz type II second-degree and third-degree atrioventricular block, the Wolff–Parkinson–White syndrome, hypertrophy or dilatation of the heart, cardiomyopathy (including myocarditis or pericarditis), history of heart failure, all congenital anomalies except for corrected patent ductus arteriosus, and hypertension. Disqualification for cardiac or vascular system abnormalities is very rare. In 2000, approximately 55 of almost 365 000 enlisted applicants (0.15%) to military service were found to be unfit for military service because of cardiac or vascular disqualification.
The duration of basic military training and the graduation requirements vary among the military services. In general, however, basic training may include basic rifle marksmanship; hand grenade, bayonet, and hand-to-hand combat training; unarmed combat training; physical fitness tests (that is, pushups, sit-ups, and a timed run); obstacle courses; live-fire exercises; foot marches (3, 5, 8, 10, and 15 kilometers); and field training exercises.
Efforts to understand and prevent the rare, but tragic, occurrence of sudden death among these young adults depend on active surveillance of the population and accurate determination of mortality rates. However, published information on cause-specific mortality in this population is limited to isolated case reports (14–18), and population-based studies focused on a single military service (19) or specific cause of death (12, 20). To provide surveillance data specifically for recruit deaths, the Armed Forces Institute of Pathology implemented the Department of Defense Recruit Mortality Registry (DoD-RMR) in the Medical Mortality Surveillance Division at the Office of the Armed Forces Medical Examiner. This registry contains reports of every recruit death and autopsy. Recruit deaths described in the publications mentioned previously were included in the DoD-RMR. Descriptive analyses of nontraumatic and traumatic causes of recruit mortality derived from the DoD-RMR have been published elsewhere (21–22). In the current study, we used data from the DoD-RMR to determine the cause of nontraumatic sudden death among military recruits over a 25-year period (1977 through 2001).
The Institutional Review Board of Brooke Army Medical Center approved this study. Nontraumatic recruit deaths were identified through the DoD-RMR. The registry reflects a review of military personnel records and investigative reports, death certificates and autopsies, and Armed Forces Institute of Pathology consultations and toxicology studies. The DoD-RMR considers a death to be a recruit death if the fatal incident occurred at a military training site before completion of initial training while the recruit was in an enlisted status in the Air Force, Army, Marine Corps, or Navy (22–23). Of the nontraumatic recruit deaths that occurred from 1977 through 2001, cases were eligible for this study if they were categorized in the DoD-RMR as idiopathic deaths or deaths due to the following causes: cardiac, exertional heat illness, vascular, asthma, and all exercise-related deaths not elsewhere classified. We obtained demographic data and details about the circumstances of the fatal incident from the DoD-RMR because clinical histories were not consistently available from pathology reports from the military treatment facilities or civilian hospitals where these deaths were initially evaluated. The inclusion criteria for this study were a nontraumatic death with an available autopsy report for pathologic confirmation of the cause of death.
We used the DoD-RMR to obtain and manually review records from each case that met the inclusion criteria. Cases were classified as sudden (cardiac, noncardiac, or idiopathic) and nonsudden. Sudden death was defined as an event resulting in death or terminal life support within 1 hour of the inciting event. Deaths were defined as cardiac in origin if the decedent had pathologically confirmed heart disease with clinical circumstances defined as potentially cardiac in origin. Idiopathic sudden death was defined as any sudden death unexplained by preexisting disease and without identifiable cause on postmortem examination.
Crude mortality rates are presented as deaths per 100 000 recruit-years (calculated by multiplying numeric death rates [number of deaths/number of recruits] by average training period expressed in years). The average training period was 8 weeks for the Army and the Navy, 6 weeks for the Air Force, and 11 weeks for the Marine Corps. We obtained population data from the Defense Manpower Data Center. Of the cases that made up this series, 5 have been discussed in detail in previous case reports (14–18), and 26 have had their sickle-cell status reported (without detailed discussion of causes of death) (12, 20, 22). We calculated CIs for mortality rates by using the Rothman binomial method (24), and we calculated P values for comparisons by using the Mantel–Haenszel method (25). We considered P values less than 0.05 to be significant. Statistical analysis was performed by using JMP Professional 5.0.1 (SAS Institute, Inc., Cary, North Carolina).
The DoD-RMR contains 277 deaths identified from among 6.3 million recruits from 1977 through 2001. No recruit was noted to have preentry cardiovascular disease, and postmortem toxicology reports showed no evidence of illicit drug use. A family history of premature death or cardiovascular disease is not routinely gathered on initial-entry service members. Autopsy reports were available for 148 (97%) eligible nontraumatic deaths. The 126 sudden nontraumatic cases form the basis of the current study. The median age of the recruits was 19 years (range, 17 to 35 years), and 111 (88%) were male. The rate of nontraumatic sudden death was 13.0 per 100 000 recruit-years, a figure that did not vary significantly over the 25-year study period (Table 1). Approximately half (64 of 126 recruits) of the nontraumatic sudden deaths were due to an identifiable cardiac abnormality, and slightly more than one third (44 of 126 recruits) were idiopathic (Table 2). A temporal relationship to exertion was noted in 86% (108 of 126 recruits) of events. There were 18 noncardiac sudden deaths: 6 from coagulopathy and hemorheologic causes (3 sickle-cell crises, 2 episodes of pulmonary embolism, and 1 internal hemorrhage), 5 from intracranial hemorrhage, 4 from pulmonary causes (respiratory distress due to asthma [n = 2], sarcoidosis [n = 1], and alveolar hemorrhage [n = 1]), and 3 from exertional rhabdomyolysis or heat stroke.
The most common cardiac causes of sudden death were coronary artery pathology (39 of 64 recruits [61%]), myocarditis (13 of 64 recruits [20%]), and hypertrophic cardiomyopathy (8 of 64 recruits [13%]) (Table 3). There were 21 anomalous coronary arteries, all of which were the left coronary artery arising from the right (anterior) sinus of Valsalva, with a course between the pulmonary artery and aorta. Of those with this finding, 19 were men and 2 were women; the median age was 19 years (range, 17 to 31 years). Twelve recruits were white, 8 were African American, and 1 was Native American. Of these 21 deaths, premortem symptoms (chest pain, dyspnea, or syncope) were noted in the autopsy reports of 11 (52%) cases. Additional details regarding 1 of these deaths were published as a case report (18).
There were 44 cases of idiopathic sudden death despite a detailed investigation and a full autopsy. There were 38 cases related to exercise, and 12 were identified with sickle-cell trait. Among recruits with nontraumatic sudden death, sickle-cell trait was significantly associated with idiopathic sudden death compared with other causes of death (P < 0.001). Among recruits dying suddenly with hypertrophic cardiomyopathy, the mean (±SD) left ventricular mass was 481 ± 80 g and mean (±SD) left ventricular wall thickness was 2.0 ± 1.0 cm. On microscopic examination, 3 demonstrated myocyte hypertrophy, 1 demonstrated myocyte hypertrophy and disarray, and the remaining 4 had increased left ventricular mass alone without documented microscopic changes.
Premortem prodromal symptoms during training as a function of subclassification of cardiac death (P = 0.007) differed significantly. On review of the autopsy reports, almost one third (31%) of recruits with underlying coronary artery pathology who died suddenly and almost one quarter (22%) with underlying myocardial disease who died suddenly had documentation suggesting that the recruit had symptoms that may have been consistent with the underlying abnormality. This compares with less than 5% of patients with sudden idiopathic death (Table 4).
We found that over a 25-year period, 86% of sudden nontraumatic deaths among military recruits were related to exercise. Although cardiac causes were attributed to half (51%) of the sudden deaths, the proportion of coronary artery anomalies was significantly higher than those identified in previous cohorts of sudden deaths in athletes, as well as in previous studies of military recruits (3–4, 12).
Anomalous coronary anatomy is frequently described as the cause of sudden cardiac death; it accounts for 5% to 35% of causes of death in young persons although it is present in less than 0.3% to 0.8% of the population as a whole (26–30). We identified 21 cases with anomalous coronary arteries, all of which were the left coronary artery arising from the right (anterior) sinus of Valsalva, with a course between the pulmonary artery and aorta. Of these patients, 11 (52%) had a history of prodromal symptoms of chest pain, syncope, or dyspnea in the autopsy report. However, to avoid lost training days or disqualification from military service, the recruits may not have disclosed these symptoms before the fatal incident. This history is often not available to medical providers until the cause-of- death investigation has been completed. Basso and colleagues (31) reviewed registry data and found that in 27 sudden deaths in athletes due to anomalous coronary arteries, 12 of the athletes had undergone clinical evaluation before death, and 10 of these had had symptoms of either syncope or chest pain in the 2 years before death. Our finding that all anomalous coronary arteries were left main coronary arteries arising from the right coronary sinus is in concert with previous findings (32). Taylor and colleagues (32) reviewed records from 242 patients (0 to 87 years of age) with isolated coronary artery anomaly and reported that in the 140 cases in which the anomalous coronary artery originated in the aorta, the anomalous origin of the left main coronary artery from the right coronary sinus (49 of 140 [35%]) was most commonly associated with sudden death (32). Furthermore, most persons in whom the left main coronary artery arose from the right coronary sinus were younger than 30 years of age, and 50% were symptomatic before sudden death (32).
As previously published, screening with echocardiography identifies the anatomic but not the functional significance of anomalous coronary arteries (33–34). Previous reports have suggested that the use of echocardiography be limited only to athletes when screening for anomalous origin of coronary arteries (33). However, in our cohort, at least half of military recruits with coronary anomalies had prodromal symptoms before sudden death, and half died within 1 month of initiating strenuous exertion (range, 6 to 78 days). Therefore, we recommend that screening for anomalous coronary arteries with an imaging technique (echocardiography, computed tomography, or magnetic resonance imaging) be strongly considered in any young patient initiating an exercise program who presents with symptoms that may be referable to cardiovascular disease. This is of particular importance given the high false-negative rate of electrocardiography and maximal stress testing in those with anomalous coronary arteries (31). Attempting to enhance current cardiovascular screening of asymptomatic personnel by using an imaging technique, while feasible in small populations of athletes (35–38), would be of unclear utility in a large military population. Echocardiographic screening in particular deserves additional study before widespread application as a screening tool to establish its ability to reduce events without excess cost or over-diagnosis of the extremes of normal physiology (39).
In this study, the percentage of nontraumatic sudden deaths attributed to "hypertrophic cardiomyopathy" was 6% versus 6.3% (8 of 126), which is lower than published series (2–3, 7, 9). It is possible that we underdiagnosed hypertrophic cardiomyopathy. However, this seems unlikely because this is an autopsy series in which there was a notable lack of myofibrillary disarray on pathology reports and because direct measurements of maximal wall thickness were available. Although it may be suggested that these patients were too young to develop characteristic anatomic findings of ventricular hypertrophy, recent work by Maron and colleagues (40) found that ventricular thickness was highest in the youngest age group (18 to 39 years of age) and that thickness was reduced in persons older than 40 years of age (despite increasing flow gradient). In addition, it has been shown that the risk for sudden death is highest in those with the maximal wall thickness, also making underdiagnosis less likely in this series (41). It is also possible that in previous studies of athletes who died of sudden cardiac death, echocardiographic evidence of physiologic hypertrophy from athletic training was mistaken for hypertrophic cardiomyopathy. These deaths, then, may have been due to other, possibly arrhythmogenic, causes. Of similar concern in a series of this nature is the potential for previous exclusion of persons with hypertrophic cardiomyopathy by virtue of physical examination. However, this limitation would apply to all studies of this type, including those in athletes, unless it is presumed that athletes had never undergone a physical examination.
Examination of trends of sudden death due to myocarditis shows the value of these case series. Although histopathologic criteria for myocarditis change over time, it is more likely that alterations of previously close-living conditions of military recruits over the past few decades may have altered the natural course of echoviral, adenoviral, and coxsackieviral disease (12, 42). While there was no further definition of the causative agent of myocarditis, the decrease in cases since previous reports in this same population is encouraging.
Slightly more than one third (35%) of the sudden deaths in this series were classified as idiopathic, despite a full autopsy and detailed investigations at the time of each sudden death, as well as our own retrospective review. In several of the cases in our study, the autopsy report referred to a family history of premature sudden death; this suggests a congenital predisposition to malignant cardiac arrhythmia. The finding that 27% of idiopathic sudden death was associated with sickle-cell trait is concordant with a previous study of the recruit population from 1977 through 1981 (20). The military recruits studied by Kark and colleagues (20) are included in the DoD-RMR, and, as such, the similar reporting of an association between sickle-cell trait and sudden death does not necessarily further support an association.
The advantage of studying the recruit population is its diversity: It includes women, as well as ethnic and socioeconomic groups not ordinarily represented in athletic screening data. An equally important advantage is the control of the premortem environment (including factors such as the absence of recreational drug use), which may contribute to adverse cardiovascular outcomes (43–44). However, preenlistment screening may have altered the cause of sudden death compared with the general population by excluding those at significant risk for sudden death (including persons with significant cardiac disease). The relationship with exertion must be noted with caution in this patient population, as basic entry military training strongly emphasizes a high degree of physical fitness and, depending on the service, may make up most of the time the recruit spends in training. However, as previously stated by Maron (45), "medical clearance" is not a promise that the athlete, or future military recruit, is free of potentially fatal cardiovascular disease. Thus, we need to acknowledge that, albeit potentially reduced, small risks remain for potentially fatal disease, even after a normal "screening examination."
Nontraumatic sudden death (13 deaths/100 000 recruit-years from 1977–2001) is relatively rare during basic military training. The primary causes of nontraumatic sudden recruit deaths are cardiac and idiopathic. In contrast to findings in other civilian and military populations, coronary artery anomalies, and not myocardial disease, are the most common cardiac abnormalities associated with sudden cardiac death in young adults (17 to 35 years of age) during basic military training.
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After the initial history and physical which should on their form address the appropriate issues so they cannot be missed, the simplest screening test that comes readily to mind would be a timed 1 to 2 mile run, followed by a very basic assessment including a confidential self reporting form.
You mentioned the low sensitivity of ECG and stress ECG, and the more sensitive modalities of Ultrasound, CT, and MRI.
Another screening test would be stress Ultrasound, which in cost and availability should compare favorably with CT and MRI.
That would also apply to Thallium stress scintigraphy, planar or SPECT.
At the high tech end would be PET or PET / CT.
Your experience and thoughts would be appreciated. Thank you.
None declared
Eckart and colleagues (1) consider slightly more than one third (44 of 126) of nontraumatic deaths in military recruits as idiopathic or unexplained. The authors base their findings on the gross anatomy exposed at autopsy, but advancement in cardiac molecular pathology has revealed several molecular level defects that can lead to sudden cardiac death. For example, familial polymorphic ventricular tachycardia is characterized by exercise-induced arrhythmias and sudden cardiac death due to missense mutations in the cardiac ryanodine receptor (RyR2), an intracellular Ca2+ release channel required for excitation-contraction coupling in the heart (2). Other possible cardiac causes of sudden death in this setting are inherited ventricular arrhythmias such as the long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, and arrhythmogenic right ventricular cardiomyopathy. It is also interesting that a familial predisposition was noted in several cases of unexplained sudden cardiac death in the study.
1. Eckart RE, Scoville SL, Campbell CL, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med. 2004;141:829-34.
2. Lehnart SE, Wehrens XH, Laitinen PJ, et al. Sudden death in familial polymorphic ventricular tachycardia associated with calcium release channel (ryanodine receptor) leak. Circulation. 2004;109:3208-14.
We read with interest the work by Eckart et al (1) reporting the retrospective 25-year review of autopsies in military recruits. Authors state that study results may have been altered by preenlistment screening which, however, did not include electrocardiography (ECG) as a routinary tool. We (2) specifically addressed the effectiveness of pre-participation military evaluation in detecting hypertrophic cardiomyopaty (HCM) in a Italian population of 34,910 male conscripts, demonstrating that screening by 12-lead ECG (as well as history and physical examination) and subsequent referral to echocardiography when cardiovascular abnormalities were suspected, could effectively identify HCM. The power of ECG-based screening for HCM in that study was similar to that reported by Corrado et al. (3) in athletes. Similarly, our follow-up data were consistent with the hypothesis that withdrawal of such individuals from these activities might effectively blunt the occurrence of sudden cardiac death (3,4,5). Moreover, 12-lead ECG offers the potential to raise the clinical suspicion of clinically relevant (other than HCM) diseases, manifesting with ECG abnormalities, such as ARVC/D, dilated cardiomyopathy, long QT syndrome, Brugada syndrome, short QT syndrome, WPW syndrome, Lenègre syndrome (some of which are unidentifiable at autopsy) (6). The high number of unexplained sudden deaths (35%) could be otherwise properly interpreted if an ECG would have been performed. Sorbo et al. (7) reported the prevalence of WPW syndrome in 116,452 young male conscripts studied by the same ECG- based screening strategy. Both in the WPW and in the HCM study the vast majority of our conscripts were asymptomatic. Therefore, if pre- participation military screening had not been performed in these young men, it is probable that the diagnosis of HCM or WPW would have been delayed, or never accomplished. Recently, the employ of 12-lead ECG has been recommended in a consensus statement proposing a common European protocol to screen young athletes for prevention of sudden death (6). A study reporting the cardiological and genetic assessment of surviving relatives of sudden death victims, demonstrated the high diagnostic yield of ECG (at rest in 8, with exercise or flecainide in 5 subjects), with identification of the disease in 40% of families and 8.9 presymptomatic carriers for family (8).
Thus, we think that the study by Eckart et al. (1) prompts the need to implement 12-lead ECG in each screening policy (together with history and physical examination performed according to current recommendations (9,10)) of large populations (such as the military one). Such screening strategies of apparently healthy young people might be, however, encumbered by a high-frequency of false-positive test results: nonetheless, an early identification of clinically relevant pathological conditions in asymptomatic young people may permit both risk stratification and access to therapeutic interventions, potentially reducing the risk for sudden death.
Stefano Nistri, MD Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina - Italy
Domenico Corrado, MD, PhD; Cristina Basso " , MD, PhD, Gaetano Thiene " , MD FRCP Department of " Pathology and Cardiology, University of Padua "" Italy
1. Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med. 2004 Dec 7;141:829-34.
2. Nistri S, Thiene G, Basso C, Corrado D, Vitolo A, Maron BJ. Screening for hypertrophic cardiomyopathy in a young male military population. Am J Cardiol. 2003 Apr 15;91:1021-3
3. Corrado C, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998;339:364-9
4. Maron BJ, Mitchell JH. 26th Bethesda Conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. J Am Coll Cardiol 1994;24;845-899
5. Maron BJ. The paradox of exercise (editorial). N Engl J Med 2000;343:1409
6. Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, Biffi A, Borjesson M, Carre F, Corrado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann E, Mellwig KP, Panhuyzen-Goedkoop N, Pisani A, Solberg EE, van-Buuren F, Vanhees L, Blomstrom-Lundqvist C, Deligiannis A, Dugmore D, Glikson M, Hoff PI, Hoffmann A, Hoffmann E, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouck T, Senden J, Spataro A, Thiene G; Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology; Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology.Eur Heart J. 2005;26:1422-45
7. Sorbo MD, Buja GF, Miorelli M, Nistri S, Perrone C, Manca S, Grasso F, Giordano GM, Nava A. The prevalence of the Wolff-Parkinson-White syndrome in a population of 116,542 young males G Ital Cardiol 1995;25:681 -7.
8. Tan HL, Hofman N, van Langen IM, van der Wal AC, Wilde AA. Sudden unexplained death: heritability and diagnostic yield of cardiological and genetic examination in surviving relatives. Circulation. 2005;112:207-13
9. Maron BJ, Pfister GC, Puffer JC. Preparticipation cardiovascular screening for young athletes. JAMA. 2000 Aug 23;284:957-8.
10. Glover DW, Maron BJ. Profile of preparticipation cardiovascular screening for high school athletes. JAMA. 1998 Jun 10;279:1817-9.
Sudden Death in Military Recruits
The summary below is from the full report titled "Sudden Death in Young Adults: A 25-Year Review of Autopsies in Military Recruits." It is in the 7 December 2004 issue of Annals of Internal Medicine (volume 141, pages 829-834). The authors are R.E. Eckart, S.L. Scoville, C.L. Campbell, E.A. Shry, K.C. Stajduhar, R.N. Potter, L.A. Pearse, and R. Virmani.
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Something I've learned in my 8+ years of beauty blogging, is that many brands like to say they are something without any proof to back it. Brands say they are natural, but the ingredient label tells a different story. Brands say they are organic because they assume you won't know that sometimes natural doesn't necessarily also mean organic. Brands also say they are cruelty free knowing that there may not really be a way for you to know one way or another.
When I launched the A Girl's Gotta Spa! bath and body line, I wanted to make sure you knew who we were and not have to guess. Read more

subset: commoncrawl


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Spurs trade Nando De Colo to Toronto Raptors for Austin Daye
The San Antonio Spurs have traded point guard Nando De Colo to the Toronto Raptors for Austin Daye, jumping out of nowhere at the very last second to pull the trigger as the trade deadline passed, Adrian Wojnarowski reported.
With Tony Parker, Patty Mills and Cory Joseph, San Antonio had a glut of point guards and too few minutes to find time for all of them, and they lacked a presence behind Kawhi Leonard at the small forward position. Well, they've done at least a little bit to rectify that situation.
Daye is a 6-foot-11, 200-pound, rail-thin combo forward with decent range — he's a 35 percent 3-point shooter for his career — and a ton of length. But don't be mistaken, he too is a fringe player. Still, he's the kind of body the Spurs definitely need, and he'll provide depth down the stretch for those moments San Antonio must go without Leonard, Danny Green, Marco Belinelli or Manu Ginobili.
He's on the hook for less than $1 million this season and has a non-guaranteed contract for next year. This move was made simply to tidy of the rotation situation and give the Spurs depth where they need it most. Daye, out of Gonzaga, is only 25 years old, so there's room to grow both physically and as a player.
This was absolutely out of the blue, as the deadline came and went without a peep. But the Spurs were able to pull it off as the clock struck 12, and overall it's a fine move for what San Antonio needs. Don't expect a ton of contribution at this point, but it's a decent transaction, nevertheless.
By the way: The Indiana Pacers have traded Danny Granger to the Philadelphia 76ers for Evan Turner; Philly is expected to buy-out Granger's contract, making him a free agent. Hello, San Antonio?


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On Tue, 17 Jul 2007 03:07:09 -0400, Matt Giwer wrote:
> My UPS died and I procrastinated on replacing it. I was doing
> yum -y upgrade
> when power dropped. It demoralized the entire OS losing track of installed
> software and corrupted the rpm database beyond my ability to recover it.
rpm --rebuilddb didn't fix it?


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Fibro's Fibromax NC heavy-duty rotary table features large roller bearings that enable high accuracy, even with large workpieces. The table offers a positioning accuracy of ±2 angle seconds for transport loads of more than 400 tons.
Unlike hydrostatic bearings, the top of the table is not lifted and heat is not lost, enabling workpieces to be processed in a precise and energy-efficient manner, without a cooling unit. The roller bearings take up both radial and axial forces, and, together with a play-free twin drive, make the rotary tables suited for circular milling and simultaneous machining.


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JERUSALEM, Israel - For the first time since Operation Cast Lead, the Israel Defense Forces' three-week incursion into the Gaza Strip in 2008-2009, Palestinian terrorists fired two long-range rockets into the southern city of Beer Sheva Wednesday night.
The Grad-type Katyusha rocket exploded in a residential neighborhood around 8:45 p.m., damaging homes and vehicles. Four people were treated for shock, including two children.
The IDF retaliated initially with a precision airstrike on an Islamic Jihad cell in eastern Gaza City.
Palestinian authorities said three members of the al-Quds Martyrs Brigades, the "armed" wing of the Islamic Jihad terror group, were lightly injured in the strike.
More IAF airstrikes followed overnight on the Hamas terror infrastructure, including weapons warehouses and smuggling tunnels, Army Radio reported.
Earlier on Wednesday, the IDF fired on an al-Quds Brigades' cell that had detonated a roadside bomb and launched a mortar shell at soldiers on a routine patrol along Israel's border with northern Gaza.
Palestinians medical sources said 11 people were injured, one succoming to his wounds Wednesday night.
Hamas and Islamic Jihad claimed responsibility for the attacks.
The IDF Spokesperson's Office said Palestinians have planted more than 12 roadside bombs along the border since the beginning of the year.
"The terrorist organizations are constantly operating against Israeli civilians and IDF soldiers," the Spokesperson's Office stated in its press release.
"The IDF holds the Hamas terrorist organization solely responsible for maintaining the calm in the Gaza Strip and for any terrorist activity emanating from it."
Palestinians Detonate Bomb, Fire Mortars
Fayyad Reaches Out to Hamas
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Are you seeking answers in life? Are you hurting? Are you facing a difficult situation?
Find peace with God, discover more about God or send us your prayer request.
Call The 700 Club Prayer Center at 1 (800) 823-6053, 24 hours a day.
A caring friend will be there to pray with you in your time of need.
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More Info
The Terrorists Funded by the WestBassam Tawil
The New Israel Fund and those who support it are helping terroristsRonn Torossian
Column one: Fighting fire with fireCaroline B. Glick
Op-Ed: There is no 'radical Islam' and there is no 'moderate Islam'Dr. Mordechai Kedar
'Narrow' escapesRuthie Blum
Why Palestinians Do Not Want Cameras on the Temple MountKhaled Abu Toameh
Social Media Killed My FatherYoni Kempinski and Ari Soffer
Iran's New Palestinian Terror Group: Al SabireenKhaled Abu Toameh


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The Bighorn River is arguably the finest trout stream for flyfishing in Montana if not the world. Big Sky Country, long summer days, cool, clear starry nights and plenty of big trout. There are many great fishing lodges throughout Montana, but the Fort Smith Fly Shop & Cabins has the finest accommodations and the most incredible view overlooking the fabulous Bighorn River. If you are looking to catch big, wild, powerful trout that will take you into your backing, the Bighorn is the place for you.
Fort Smith is a small, former cavalry outpost nestled in the foothills of the Bighorn Mountains.
We specialize in guided fishing floats on the Bighorn. We also have lodging, dining, boat rentals and a fly shop. We provide the most personalized service of any shop in Fort Smith. The comfortable and friendly atmosphere is only one reason people come back year after year.
After decades of guiding on the Bighorn, master angler and outfitter Michael Mastrangelo has developed a loyal following of clients, and has personally selected a group of the finest guides on the Bighorn. Michael offers many tips, tricks, and other helpful information on this website to help make your trip a success and entertain you when you are only dreaming of fishing here.
Class 101 Dates — September 18
Class 102 Dates — July 31; September 25


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Searching for rue Simon-Crubellier
By Bud Parr
"Play with all your mind, play"
I think, echoing here the epigraph to Life A Users Manual with my own substitution, that Georges Perec would have liked the "Searching for rue Simon-Crubellier" project where two artists search in Paris for the fictional street where the novel takes place. He was "a great pedestrian" who liked to walk around Paris writing about the "quotidienneté," and of course I think he would have loved the idea of looking for a mythical street, something familiar, yet nonexistent, and going so far as to consult mapmakers (see part 2 of the video) in their quest.
I think too that he would have liked that the artists don't tell most of the people that what they're searching for doesn't exist except in a certain collective consciousness. Perec's world, his "galaxy" as it's been called, is built upon games and deception. In this regard, Cervantes is a close literary ascendent. Perec says in a 1981 interview with Kaye Mortley ("The Doing of Fiction," Review of Contemporary Fiction, Spring 2009)
"...in almost everything I am producing there is, we could say, a story and the story of the story. A fiction and a fiction about the fiction and like, it's like mirrors, and it doesn't end with the fiction and the fiction about the fiction--there'll be speculation about the fiction of the fiction and so on. And there is, I could say there is several levels."
The same could be said of Don Quixote, whose journey is interwoven with stories within the story all told through the possibly deceptive narration of a translation of a text from a vaguely accurate original in a language different than that of its subjects, a story where puns become wrought with meaning and characters may be fictions even to their fictionally real counterparts. And, not to belabor the idea more than it deserves, I also see parallels between Bartlebooth's (Bartleby-like) anti-journey in Life A User's Manual and Don Quixote's quest, both not accepting society as it is given to them, both deceived by others, to die unsatisfied. The inner sense of frustration I felt with both of these men is something unique and unforgettable.
Of course, Cervantes brings his characters closer in than Perec, making him the more approachable writer, and perhaps the comparison should end at the layers and gamesmanship, but it is true that in each book the overriding structure is incomplete without the individually inconsequential stories running between the sheets. Perec said something like one way to read his books is laying on the couch. The truth in that statement is in the idea that to read Life A Users Manual one is best advised to put away the thoughts of the "Knight's Tour" that gives the book its structure, not wonder whether the book is the depiction of a painting or a moment in time, but to start with the stories, for to see the forest in this case is to look closely at the trees. Perec scholar Warren Motte says in an excellent introduction ("Reading Georges Perec," Context #22)
"And, finally, it must be noted that Life is animated by a closely-tuned narrative logic, each of the many tales it tells taking its place within a vaster story, each moment in the text carefully crafted with regard to the moment that precedes it and the moment that follows it—in short, it is a sheer joy to read."
If you loved Don Quixote. If you've ever enjoyed reading Jorge Luis Borges, or Italo Calvino, then I think you will enjoy Life A User's Manual. All of these writers bring something more to the table than what first appears, but with all of them, there is no user manual required.
And with that recommendation, from one reader to another, we conclude our "PerecFest" in our "Classics in Translation" series. Thanks to our contributors, Laird Hunt, Geoff Wisner, Martin Riker (and by extension, Warren Motte), Scott Esposito, Susan Harris, and of course Georges Perec by way of his terrific publisher David R. Godine. Our giveaway of copies of the new, definitive edition, of Life A User's Manual will go through the end of the month to anyone who has left a comment (please actually actually say something) here at Dispatches.
Click [here] to see all of our posts on Georges Perec.
Thanks, very much. This book has been on my to read list for a while, think I'll put it up top now! Thank you!
A little sorry to see that there aren't more comments on these posts, because they merit attention. I admire this search for the mythical setting of the book, probably because I've twice now been stymied in my own search for Perec locations. Seven years ago I visited Paris but didn't have enough free time. I returned just last month to Brussels but was kept away from Paris by freakish snow.
It only now occurs to me that Google's street view can give me a glimpse of 85 Avenue de Segur, which is an address that inexplicably appears in my notes. Where did I get that? Bellos's bio, maybe?
Perec pierces penetralia.
Surfaces and shallows satisfy standard souls.
Fewer comments.
Perec locations, perclocations, percolations.
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The warmest place in the country?
I woke up this morning itching to walk to Plymouth Hoe. I had been wanting to see the sea all week whilst in my office and so there was nothing that could have stopped me marching all the way up the hill on this cold icy morning - not even my death-trap of a road. After, once again, crawling on my hands and knees to get out of my road, I finally got to the seaside. It was so warm and beautiful. Lots of interesting bird life as well, probably because the poor little things can't find any food on Dartmoor. Anyway, I thought I'd share these pictures with you in case you need warming up... :)


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Hey guys.
I've been having a few issues with the rep system lately.
First off all, it isn't false reviews against me, and me complaining, it's far from that.
It's a general enquiry. Is the xbox rep-system actually broken/down/unresponsive at this point in time? (and the last month)
It's a serious question I would like to know, it's driving me crazy.
Please do not post saying 'you'll get rep over time etc, I do know this and trust me, somethings wrong
I'd like to also add, I've seen quite a few requests about this topic, as it seems i'm not the only one suffering.
I created this account around just under 2 months ago, I think. You know usually, when you're on a new account, you add your mates, get them to good review you and BAM! 5 stars there! sometimes it's there without even a day on the account. Well I've had my account for over a month now, with a counted total of 40+ good player reviews.
Yes I know the rep system is flawed, but it's never been like this before, and yes I know it's pointless.
But it's starting to drive me crazy. It looks incomplete without the 5 stars. FYI (and I know it's pointless) but I do have 85% preferred and 15% avoided.
We all know it used to take a minimum of 5 players to rep you and a solid night of multiplayer and it was there, but now, it actually feels legit broken.
So I decided to go to some investigating.
If you were ever in one of those moods to just randomly look in your recent players and give them good rep (i do it everynow and then) well I have been
So for the past week, before I go to bed each night, I've scouted my recent players list and seen any accounts with 3 stars, and I'd give them all good rep.
I did it for 60+ gamers. And not one of them starts budged a bit! Each of their accounts didn't increase at all in rep.
Now that is bizzare. It's never been like this.
And again, I know that the rep system is flawed, but this is definitely a glitch, or something.
One last thing, a few people I know, who have made new accounts recently, for MW3 and GoW3 clan matches, all of their accounts are within 2 months old too, and all have 3 starts rep. It seems like the rep system has frozen?
All I want to know is will it get fixed and will I get my 5 stars :/
Also, please don't reply with 'just keep playing online' I'm 3rd prestige on Mw3 and Lv90 on Gears 3, and Lv30 on Battlefield.
I've played heaps, and have 95 friends too. Thanks for your time!
You can try to recover the profile and see if this will correct the problem.
If this does not fix the problem, please start a new thread for others to help you better :)
Banana? + mEouse? = Squirrl!
Hello - I can understand your frustration with your rep score. The rep system is operating as intended right now, however. It is possible that of those gamers you gave a "5" score to, all of them had a large number of scores, so one score would not change things much. I'm sorry I can't help more.
Emily - Program Manager @ Xbox, Xbox One Preview Program
Thanks Portia, but that answer doesn't quite explain it to be honest.
Is there a way that you, or an xbox live dev/mod, or someone can look at the issue. It's been brought up in a number of threads and only this one, and this one forums.xbox.com/.../139978.aspx have been given any interest. The rep system has always been flawed but it's never been to a point this bad where people are actually asking 'why haven't i got my 5 stars after 2 months' that never happens, and has never happened.
Thought I would see if your thread was going any better than my own. It seems that xbox support seems to do a half [mod removed] job IMO and dont want to admit there is an issue or they will have to look into it and then fix it OR the select few helpful members (Very few) want to help but dont have the authorization or ability to do so. Paying for a service is intended it works at the end of the day in EVERY aspect of the service. If I payed HALF the attention to detail at work inspecting medical devices peoples lives would be at risk or even result in death so why at the end of the day should it be only me that does my job properly?
There IS a problem with the REP system . Your too busy ruining the dashboard and ruining our gaming experience with adverts on xbox to notice it. Please someone with actual experience in tech support and also the ability to fix the problem look into this matter its quite frustrating at the end of the day especially when I spend so much money on microsoft xbox each week. Thanks.
It's not worth your time to "investigate" the rep system. Your rep doesn't mean anything. Only YOU can see who has filed good and bad rep on you. You'll eventually hit 5 star rep on your profile also.
My Twitter
Xbox Ambassador (Since 2011)
Xbox One Preview Program (Since 2014)
Windows 10 Insider Program (Since 2014)
@Metapod and Deppers - I can certainly understand your frustration, and I do understand your concern. We appreciate the extra information you've provided, and with that, we can start to take a look. However, we do need more first hand reports of this issue specifically. Can you get the other GT's you mentioned in the other thread to post in this one (or the other one) detailing their exact issue with the Rep system? Unfortunately with only a handful of reports and with something we cannot repro, we need as much information from you and others affected as possible. Thanks! :)
I'll see what I can do Portia.
The only issue with us all is that the stars won't go up to 5 (@Xbox Dude) We (well I don't) don't care how many % avoided us etc. that's just dumb. It's the fact the 3 starts won't go up, or even budge at all, to 5 stars, after 2 months of online play and 30+ good feedbacks given on us
Been doing some reading and Hey lookie what I finds..
Don't know what to tell you now knowing this.
Thanks for that. But that was made in 2010. About 3-4 months ago, i made a 48 hour trials account, for some fun on Gears 3, by the end of the 2 days, I had 5 stars rep. I've had this account for over 2 months, it seems like, after a certain point, the rep system broke, probably around November 1, or something. Cos EVERYONE I know hasn't gotten any rep after that (stars)
@Miss Portia
Here are two recent threads over this issue. These are only two of the many that have been posted. Contact them, i have talked to them and they have the same issue as the OP here.
Can you look into it?
its almost certainly broken. had an old account that got to 5 stars literally on the first day of gaming. this one ive had for a couple months been fairly multiplayer heavy. 3 stars. didnt really think about it until i saw the thread
Alright, thank you all - we are investigating. I will update when I have more information. Hang tight! :)
Thankyou so much all! Hope we get some results! :)
I too am having this issue. I made a new account about a month ago to start fresh and I have had over 15 friends' prefer me and not the slightest budge in my stars.. It's really frustrating because my profile feels so incomplete.
mine has been stuck at almost 4 stars for 2 months


text: Hello Kitty Kids Slippers, Girls and Little Girls Slippers With Sequin Bow Flag this deal What's the matter? Choose a reason Dead deal Duplicate Bad link Spam Inaccurate No value Alive again Edit deal s_m1978 Jan 16, 2013 True these are very cute...I wish to get in my size Reply ArtemisDeals Jan 16, 2013 Not that great of a price drop but I thought these were super cute! Reply 1 like Load More Comments


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5 Terrible Combinations Made From Great Things
#2. Randy Newman Plus Steven Bochco = Cop Rock and WTF?
Back in the '80s Steven Bochco was king of the prime time drama after executive producing Hill Street Blues and L.A. Law -- two of the biggest shows of the decade. But the '90s were a new and exciting time. There was a Democrat in the White House, and young Gladstone was finally sexually active. (Seems there was only a temporal association between a Republican presidency and me not getting any. Still, I just can't risk voting Romney in 2012.)
"This country can't afford four more years of Gladstone having sex."
And in this time of change, Steven Bochco had a novel idea. What if I take all the success of a show like Hill Street Blues and combine it with musical theater! After all, there was already precedent. The English show The Singing Detective (starring a psoriasis-afflicted replacement Dumbledore) had been wildly successful. So Steven got together with Randy Newman and Mike Post. Mike had written the classic show-opening music for Law & Order, NYPD Blue, The Rockford Files, L.A. Law, Quantum Leap, Magnum, P.I. and Hill Street Blues. Randy Newman is one of the greatest songwriters and movie composers of all time. I've previously discussed his satirical work, though he's probably best known for two fluffier pieces: Short People and I Love L.A. Oh, he's also written just about every song you've ever heard in a Pixar movie and scored movies like The Natural and Avalon.
Taking all these talents together produced the short-lived show Cop Rock. Yeah, even the title sucks. Take a whiff:
And some more?
The only good thing to come out of Cop Rock was that I used it to create the perfect drinking game for keeping people like my buddy John Cheese on their path of sobriety. Here's how you play. Run a clip of Cop Rock and take a drink each and every time you don't want to rip your ears off and choke yourself to death on them.
#1. Sex Plus Food = Dirty, Sticky Sex -- In a Bad Way
Most people like sex. Most people also enjoy both whipped cream and chocolate syrup. And somewhere along the line people thought it would be kinky to combine the two. No, not raping a tub of Cool Whip. More like being oh so naughty by putting some whipped cream on each other's sassy bits and then ... eating it off! I know! Like not even with a spoon.
Mixing food and sex is the saddest attempt to be edgy since Garth Brooks donned a wig and soul patch, pretending to be Chris Gaines.
I'm going to guess that, like whipped cream, Garth Brooks is also terrible in bed.
I know people keep doing this, but who is saying, "Hey, let's combine all the joy of oral sex with the thrill of dairy products stuck in my pubes!" And chocolate syrup? What possible reason could you have for that? You're just supposed to say you're gonna F the S out of someone; you're not supposed to make the bed look like you actually did. Also, you're not supposed to say you're gonna F the S out of someone, either. You're better than that, man.
In summary, if the only way you can get your partner's mouth anywhere near your junk is to cover it with candy, then get ready for some truly awful sex. You might as well mutually masturbate while eating ice cream.
Subscribe to the all-new HATE BY NUMBERS. Also follow Gladstone on Twitter and stay up to date on the latest regarding Notes from the Internet Apocalypse. And then there's his website and Tumblr too.
For more from Gladstone, check out My Break Up Letter To Regina Spektor and Don't Be Like Jessica Simpson: A Lesson For Young Girls Everywhere.


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Back to School is here and we got tips on all of the latest up to date Back to School Products to keep your kids in style. From Elementary to College kids , we've got something for everyone. If you would like to be included in our Back to School Shopping guide please email us at firstname.lastname@example.com
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Gavin W.
Private Detective, motorcycle man - Zappa Fan & Photographer..... living the dre - updated
4 Comments - More updates
- Interests:
- Photography
- Hobbies:
- Photography -
- Television:
- Nope
- Movies:
- meh
- Music:
- Zappa et al
- About me:
- Freelance Photographer and Private Investigator
Hi Gavin, thanks for the add. I'm really pleased you had the opportunity to get such great shots of the band.
I have a very good friend who lives in Mt. Eliza, is that in your neck of the woods?
Dude you can request extras, What world am i livin in. Trouble
every day would be my request but well you know! thay done that.
ttyl Peace Out Fruie.
Thanks for the offer of friendship. Very cool photos of the concert, by th way. I liked the black and white effects.
Gavin W. posted a comment on the photo Dzpz Gig Melb 21
Gavin W. replied to the forum post Photography at ZPZ Shows


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Dining In: Easter Sunday dishes
Gardening: Last frost dates
Dustings of snow recently in south Pierce County, Olympia, and Snohomish County lead many gradeners to wondering if spring is ever going to arrive. The soil is still cold and wet. Spring bulbs are emerging slowly, but they are cheering us by coming up.
Counseling centers receive accreditation
The Presbyterian Counseling Service, North Puget Sound Presbytery (NPSP), a Samaritan Center, recently was awarded full accreditation by the Samaritan Institute, located in Denver, Colorado.
Egg hunts have a long history
Egg hunts are part of spring rituals that go back long before there was an Easter. Primitive people were intrigued as they watched an inanimate egg hatch into a living creature, and searched for visible signs that winter's bleakness was giving way to spring's rebirth.
Evergreen project to help older adults
The Evergreen Care Network is taking part in a pilot project that provides support services for functionally impaired older adults. The project's goal is to provide needed services to older adults to enable them to remain safely in their own homes.
Flower arranging at library
All persons interested in gardening and flower arranging are invited to attend a program of Japaneses flower arrangement at the Woodinville Library on April 3rd at 11 a.m. Master Ikebanist Mitsuko Hakomori, of the Sogetsu Ikebana school, will demonstrate.
Help with heating bills available
The Multi-Service Centers of North and East King County can help with heating bills. Low-income residents of the Snoqualmie Valley can get financial help to pay their heating bills through the Multi-Service Centers by calling 869-6027.
More home & garden


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Air Jordan 1 AJKO "Bred" & "Black Toe" OFFICIAL PICTURES + VIDEOThe recent OG AJKO releases from Jordan Brand did well and have become quite popular over time. They're definitely not doing our bank accounts any favor with this quickstrike release.
COMPLETE pics + BRED colorway after the cut!
The popular Black Red/Banned colorway of the Jordan 1 releases again along with an AJKO Black Toe basically to please the fans. These two fan favorites will surely fly off shelves on its June 2nd release so be sure to prepare if you've been waiting for this drop. The red,white and black AJKO release back in 2010 initially weren't received well but now has a value of around $220 to $280. Everyone now knows what's up with the AJKOs so don't sleep! What do you guys think of this upcoming release?
Official pictures from Jordan Brand


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St. Peter's Hospital Pharmacy is critical to improving and protecting the health of our patients. At St. Peter's, the pharmacy incorporates its primary focus of medicine safety with advanced technology and processes into its 24 hour/day operations. With its main location at the Hospital, opposite the Emergency Department, the pharmacy uses highly-trained Pharmacy staff to meet its demanding workload at its multiple locations.
The pharmacy's inpatient services comprise the majority of its work and include servicing patients admitted to the Hospital and its various residential care and treatment centers (i.e., hospice, SPARC).
The St. Peter's Outpatient Pharmacy provides services to the St. Peter's Health Care Services employees and clinic patients, patients being discharged from the Hospital, as well as patients from the Community Hospice and SPARC.
St. Peter's Hospital - 315 S. Manning Blvd. - Albany, NY 12208 - 518-525-1550Notice of Privacy Practices Disclaimer


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Lady Dogs top Acadiana; Pios slip past Iota
LAFAYETTE – The Iota Lady Bulldogs exploded for 29 points in the third quarter and rallied from an early deficit to upend Acadiana, 65-61, Saturday in the Lady Rams' own tournament.
The Lady Dogs improved to 5-3 on the season with the victory.
The Lady Rams jumped out to a 29-17 lead at the break before the Lady Dogs caught fire in the third quarter.
Jillian Boone poured in 14 of her game-high 29 points in the frame and Brittany Johnson pitched in eight to help the Lady Dogs take a 46-45 advantage.
Johnson then went 9-for-10 from the free throw line down the stretch in the final frame as Iota outscored the Lady Rams 19-16 to seal the victory.
Johnson finished the night with 20 points while Mallory Faul had eight and Whitney Landry had four. Cameron Crochet and Madison Smith each added two points in the victory.
Notre Dames slips past Iota
HACKBERRY – The Notre Dame Pioneers grabbed an early lead and then held off a late rally to upend Iota, 44-35, in the consolation finals of the Hackberry Tournament Saturday.
The Pios led 22-15 cushion at the break and outscored the Dogs 9-0 in the third quarter to take a 31-15 lead into the final frame.
Iota cut the lead to three in the final eight minutes, but the Dogs were never able to get over the hump despite outscoring the Pios 20-13 in the final eight minutes.
Sophomore Hunter Meche and Claiton Johnson paced the Pios with 12 and 11 points, respectively. Tre Milstead followed with 10 points and also pulled down 14 rebounds. Brice Brandon added eight points and Alex Thomas had three.
Luke Reed led the charge for Iota with 14 points. Garrett Reppond pitched in seven points, Steven Cooper scored five, Zack Hebert had four, Curtis Antonie and Bray Latiolais each had two and Deandre Curtis finished with one.


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Tulsa police arrested a man who they said is behind a string of recent sexual assaults.
Brandon James, 24, was charged with three counts of sexual battery and one count of lewd molestation of a minor.
Investigators said several women described James as the person who sexually assaulted them.
The views expressed are not those of this site, this station or its affiliated companies. By posting your comments you agree to accept our terms of use.blog comments powered by Disqus


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September 30, 2011
Washington Stuck Between Rock & a Hard Place
Glen Asher, Oye! Times
ith oil prices being volatile on the downside in recent weeks, the mainstream media coverage of high United States gasoline prices has faded noticeably. This is most certain to pick up again should the world shake off a global economic meltdown and once again face the prospect of oil prices in excess of the hundred dollar a barrel mark. As my regular readers well know, as a geoscientist, I am a firm believer in the concept of peak oil (or at the very least peak cheap oil) and it is my belief that consumers in Canada and the United States will eventually be forced to deal with gasoline prices that are far higher than what we are seeing today, excluding the impact of increases in excise taxes. . .
TAGGED: gas taxes, gas prices, Oye! Times


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Great plastic plates for any occasion!
The Ivory 9 inch Plastic Plates are a great addition to any party table. Each of the ivory plastic dinner plates comes in a package of 20 and is perfect for both buffets and main courses.
Please allow ample time for delivery. Our ship date for this product is noted in your shopping cart. Many items are shipped separately, so please allow extra time for these items to arrive. Shipping charges are based on the value of the merchandise and not the number of shipments. For additional shipping information, please contact our Customer Service Department at (email@example.com or 1-800-314-8794).
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WASHINGTON - A Senate vote on equal pay for equal work for women was blocked by a Republican minority today. Just days before the Paycheck Fairness Act went down to GOP-fillibuster defeat, the steelworkers union and the Teamsters had challenged GOP presidential nominee Mitt Romney to back the legislation.
Steelworkers President Leo Gerard and Teamsters President James Hoffa spoke out for the legislation, pushed by a coalition of Democratic senators led by Barbara Mikulski, D-Md. The Paycheck Fairness Act would make it illegal for firms to discipline or fire workers who ask about pay. Other unions, their allies, and the Coalition of Labor Union Women are waging a national call-your-senators drive in advance of the vote.
The bill also would impose triple damages in pay discrimination cases and would narrow the "business necessity" reasons firms use to discriminate in pay by gender.
"In this environment, when more hard-working women are the sole wage-earners for their families, it is particularly vital we provide them with every tool to fight discrimination by their employers," said Gerard.
"Throughout this primary season, we have seen Republican candidates take aim at women's rights. It is time for Mitt Romney to end his party's despicable war on women and support this bill," Gerard added. Romney has ducked reporters' questions about women's rights, including the legislation.
"It is outrageous that Romney refuses to support fundamental fairness for women by ending pay discrimination," stated Hoffa. "Coincidentally, the U.S. Chamber of Commerce is doing its best to defeat this legislation. Romney is once again beholden to the only thing he understands -- the almighty dollar. He would rather allow women's wages to continue to be depressed than bite the hand of his corporate backers."
"Romney's refusal to take a stand for basic fairness shows why unions are so important," Hoffa said. "If Romney won't denounce something as despicable as job discrimination, it's crystal clear he won't stand up for the middle class."
The Paycheck Fairness Act would put teeth into a 1962 equal pay law. It also would build on the Lilly Ledbetter law, which Democratic President Barack Obama signed, restoring the right to sue for pay discrimination. Ledbetter, a supervisor at an USW-represented tire plant in Alabama, suffered pay discrimination for 19 years before finding out. She told Press Associates at a congressional hearing on her law had the contract covered her, the pay discrimination would not have occurred.
Photo: Obama signs the Lilly Ledbetter Bill. Ron Edmonds/AP


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The Mosquito Coast
Release Date: November 26th, 1986
PG|1 hr. 58 min.
Plot Summary
A brilliant but unstable inventor and his family create what they hope will be their Utopia in Central America.
Cast: Harrison Ford, Helen Mirren, River Phoenix, Jadrien Steele, Hilary Gordon, Rebecca Gordon, Jason Alexander, Dick O'Neill
Director: Peter Weir
Distributor: Warner Bros. Pictures


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The author has collected a large amount of useful data on this subject and arranged them so that the reader can obtain a clear insight into the present status of hypotension. He has systematically outlined the conditions and diseases in which hypotension occurs. The temporary hypotension observed in surgical shock is duly considered, and the relation of this hypotension to decreased blood volume is discussed. Dehydration in cholera is considered the cause of the decreased blood volume and hypotension. Postural hypotension, on the other hand, is attributed to a disturbance of the vasomotor system.
The author presents in detail the different views regarding the relation of the suprarenals to blood pressure. He accepts the evidence that the suprarenal cortex is the necessary portion of the gland for maintaining normal blood pressure. Addison's disease is considered the most clearly defined clinical example of chronic hypotension. He discusses the lack of uniform
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Cooley Dickinson Board of Trustees*
Sanford Belden - Chair
Charles Staelin - Vice Chair
Kevin Lake - Secretary
John Nunnelly - Treasurer
Joanne Marqusee - Assistant Secretary
Board of Trustees
Michael L. Blute, Sr., MD†
Kenneth Bordewieck
R.F. Conway, MD
David Brown, MD†
James Donnelly, MD
Laurie Fenlason
Sally Griggs
Khama Ennis-Holcombe, MD
Tony James†
Eliza Lake
Pauline Marney
Elizabeth Mort, MD, MPH†
James Kirchhoffer, MD
Nancy Reeves
Henry Rosenberg, MD
A. Kim Saal, MD
Peter L. Slavin, MD†
Kumble Subbaswamy†
Geoffrey Zucker, MD
(* For the fiscal year ending Sept. 30, 2016)
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Cooley Dickinson Hospital • 30 Locust St. (Route 9), Northampton, Mass. • (413) 582-2000


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State Agencies |
Online Services
Find more...
The following are forms, fact sheets, and links to federal regulations and policy memorandums from the Ohio Department of Education (ODE) that pertain to administration of the Child and Adult Care Food Program (CACFP).
All sponsoring organizations (multi-site sponsors) must conduct and document monitoring reviews for food service operations to assess compliance with meal pattern, recordkeeping and other CACFP requirements.
Policy memorandums, resources and links to legislation relating to all CACFPs conducted at child care facilities, adult care facilities and in family child care settings.
System used by schools and community agencies enrolled in USDA Child Nutrition Programs through ODE to submit required data and apply for meal reimbursements.
Last Modified: 9/16/2016 3:20:41 PM


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Mozilla has taken a hatchet to Microsoft's browser ballot proposal, claiming it would do little to alter the status quo. The browser ballot is Microsoft's answer to EU charges that bundling Internet Explorer with Windows harms competition. The scheme will present customers with a screen offering a selection of browsers and download links when they first install or start Windows.
However, the move's not buying Microsoft any brownie points with Mozilla. Both Mitchell Baker, chairwoman of the Foundation, and Harvey Anderson, Mozilla's chief counsel have posted lengthy blogs citing a list of changes they'd like to see made.
"Even if everything in the currently proposed settlement is implemented in the most positive way — IE will still have a unique and uniquely privileged position on Windows installations," claims Baker.
"It is always there, often with prominent placement in the user interface. Choosing another browser as a default doesn't change this. Contrast this with all other browsers who aren't available without separate installation," she adds.


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KENT - Nov. 17, 2012.
It's a date Luke Wollet won't forget anytime soon.
The Poland Seminary High School graduate and Kent State University senior safety's interception late in last year's game in Bowling Green sealed the victory and the Mid-American Conference, East Division title - the first one for KSU in almost four decades.
It was one of many highlights the Golden Flashes had as they advanced to their first bowl game to cap an 11-3 season.
Saturday, Kent State hosts the Falcons at Dix Stadium - starting at noon.
"It was a pretty special moment for me just because of all the events that happened leading up to that week. It's a moment I'll cherish forever," said the 6-foot, 198-pound senior safety. "As far as last season, I really don't even think about it anymore. I got new goals. Last season is in the past. I focus on this year."
He started off the 2013 campaign with five tackles in the Golden Flashes 17-10 victory Thursday against Liberty - the university, not the area high school.
Wollet hopes those tackles add up to the team lead - just like last year's linebacker Luke Batton did, pacing KSU with 143 tackles. Wollet was second on the team with 119.
"My biggest focus is stepping up and making more plays this year, really taking on that role Batton had last year," Wollet said. "We have a lot of great players on our defense, a lot guys like Roosevelt Nix, Darius Polk, a lot of guys that are stepping up and doing a great job. If we can come together, that's the most important goal right now."
One player in particular Wollet knows quite well is Canfield High School graduate Jordan Italiano, who also plays safety.
"Jordan is an extremely hard worker," Wollet said of the 5-10, 207-pound sophomore. "He pushes me because I see how hard he works. If he's not watching film, he's lifting, he's doing something. When he first got here, I tried to take him under my wing, but he's really grown into his own player and own person. He doesn't need my help anymore. He's about to breakout this year. I'm excited to see him grow."
Italiano earned a more significant role on defense this season, making the starting roster before the season started.
"It's a good feeling," he said. "It's a nice opportunity for me. I truly appreciate that just because he kind of sees the hard work coming off. You work so hard and you finally see, 'Ok, now it's your shot. Now, make the most of it.'"
Italiano added Wollet is a hard worker.
"He has great instincts, great intelligence," Italiano said. "He's always out here working, pushing himself to his full potential so he can be the best he can be."
Kent State coach Paul Haynes said Wollet has great instincts for the game.
"I think he's a passionate guy who is one those guys that you say wear it on your sleeve," Haynes said. "He always does. He has a chip on his shoulder. He will tell you from Day 1 no one recruited him. He's out to prove it every single day that he belongs as a Division I athlete. I think that's first and foremost, where his passion lies.
"He has a knack for the ball. You don't get honors for tackles at DB. You get honors for making plays and getting your hands on the ball. That's the thing he has done well. He's a good leader. He brings a lot of energy to the game. He brings a lot of passion. That's what you want out of that position."
Wollet was trying to make an impression on Haynes, who is in his first season at KSU.
"Anytime you have a new coaching staff, it's always a personal challenge to try to show them you're a leader and want to be a contributor to this team," Wollet said. "It's just like a new boss. They're looking for jobs and you try to fill one of those jobs. It's exciting and remotivates you at the same time. You have to bring your best everyday. No complacency."
Maybe that hard work will land Wollet in the NFL?
"You always hear a bunch of talk on the outside," Wollet said. "I know my weakness and strengths. Every day I come out here and try to get better. I know all the way from coach (Jon) Heacock to coach (Brian) George. I give 100 percent each day. I know I have a ton of weakness and a lot of things I know people in the NFL are going to say, 'He's not tall enough. He's not big enough.' I will always be outworking whoever I'm going against. I'm always trying to get a step up on them. Maybe one team will see that and give me an opportunity."


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Wednesday, April 3, 2013
Three South Carolina high schools were awarded top honors at the 37th annual Model United Nations at Winthrop University. Held March 20-22 in Tillman Hall and the DiGiorgio Campus Center, the program involved hundreds of students representing nearly 30 high schools from North and South Carolina. An awards ceremony Friday afternoon capped two days of deliberations over world events centered around this year's theme of "Globalization: Peace, Security and Development."
The Russian team from Pinewood Preparatory School, which included Ben Gamble, Bobby Thomas, Logan Dwyer and Mattie Piness, took the Winthrop Cup for best all around high school.
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