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Vince Dooley is 80 now. The vagaries of age have barely touched the great coach's vault of knowledge. Conviction and class still mix with that sweet, smooth Southern drawl.
When Dooley speaks, it can argued that his words carry more weight these days. The man dominated the SEC and won a national championship borne on the massive legs of one of the greatest athletes of our time.
"Maybe," the great Georgia coach said this week, "there won't be any Herschels anymore."
|More on college football
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That's not heresy. It's Football 2012. Last week Dooley witnessed part of the game's latest offensive upheaval, watching his former employer (Georgia) beat his son Derek's current employer (Tennessee) in a combined 95-point shootout. Like a lot of us, he also relived the defensive carnage of West Virginia's 70-63 win over Baylor.
"Everybody is talking about it," Dooley said. "I guess there are a lot of reasons."
The shame -- in some folks' eyes -- is that those reasons are like receivers who outnumber the defensive backs covering them. There are too many. In one historic day last week, coaches both great and insignificant realized how futile their efforts have become. A game built through the decades on a philosophy of physical intimidation has evolved into a game of touch.
"Is this," Nick Saban asked this week, "what football wants to be?"
That's the central question as offenses and scoring have caused a football imbalance. The trend is at least 15 years old in college football. Since 2007, all-time records have been set in 12 of the 14 offensive statistical trends tracked by the NCAA since 1937. But something happened all at once Saturday that forced the game to examine itself.
In its first year in the Big 12, West Virginia's program and the league's unstated philosophy are perfectly matched. The Mountaineers could outscore everyone on their way to a championship.
Defensive coordinators have been forced to reevaluate what "good" is. The statistics are screaming that holding a team to 30 isn't so bad. That's the average number of points teams are scoring through Week 5. If that number holds, it would break a time-worn five-year-old record.
Much was made of Texas A&M's Johnny Manziel on Saturday becoming the first quarterback in history to throw for at least 450 yards and run for 100 in the same game. What wasn't so publicized was that his record lasted approximately three hours. Later in the day, Miami (Ohio)'s Zac Dysert became the first quarterback to throw for 500 and rush for 100 against Akron.
Take your pick: Tackling is a lost art. Too much emphasis on seven-on-seven. For purists, too many rules against defenders "targeting" offensive players. Defense, they say, wasn't made to be played selectively.
"Too many new hot-shot offensive gurus," one veteran FBS coach texted.
The great pounders of the past -- Walker, Earl Campbell, perhaps even Bo Jackson -- certainly wouldn't have played their traditional roles in modern spread offenses -- if they played in them at all. They would likely be fed a couple of extra pizzas and turned into linebackers or run-stuffing nose guards. If they were playing in the schemes of today, imagine their roles: Running the ball maybe 10 times a game, catching it a few times out of the slot and being asked to pass block. Well.
No more Herschels? It has taken two tailbacks and a clever rhyming nickname at Georgia just to get close to the subject.
Is this what football wants to be?
"Sure is," Missouri receiver T.J. Moe tweeted after hearing Saban's words.
So, there it is. A battle within a revolution within a conference. Alabama leads the country in scoring defense (seven points per game). Missouri was 12th last year in total offense playing the Big 12. Now they're in the same league.
If the SEC is holding the line on the conference's defense-first philosophy, six national championships is a hell of a statement. But where is the explanation for Georgia 51, Tennessee 44?
Like the statistics are shouting this week, giving up 30 could be the new normal.
"You have to put your ego aside, because it's more fun to win anyway," Texas defensive coordinator Manny Diaz said.
Diaz is the next man up this week trying to stop West Virginia's Geno Smith. That, a week after Texas gave up 36 points and 576 yards to Oklahoma State.
"I've been down there three times," Texas coach Mack Brown said on Monday. "He's got his door closed and he's under the desk."
In a sense, Diaz is the tip of the spear, part of a group of young defensive guns under 40 who could shape the game's future. Consider Diaz, 38, Washington's Justin Wilcox, 35, and Alabama's Kirby Smart, 36. At a tender age, Wilcox already has been at Boise State and Tennessee. His D shut down No. 8 Stanford last week by stacking the line against quarterback Josh Nunes. High-scoring Oregon is next. Smart might be the hottest assistant coach property in the country. He already has two national championship rings under Saban.
They work in three different worlds. All three have SEC backgrounds. Smart lives in a realm where he is judged by shutouts. His defenses have pitched zeroes in five of their past 16 games, including the BCS title-game smothering of LSU. Wilcox is trying to return Washington to the glorious defensive days of Don James. Diaz? He worked on Dan Mullen's staff in that defensive-minded SEC at Mississippi State. But this is the Big 12. Sometimes you have to put your ego aside.
Last season, the Horns finished 11th nationally in total defense in a five-loss season. This season the Horns have slipped to 63rd, but are undefeated.
"At some point, somebody has to stump for the defensive players," Diaz said. "The way the game has changed with the attacking of space and tempo with which it's done, has made defense harder than ever."
Texas won't give up 70 this week because it won't play football ping-pong with the Mountaineers. Baylor seemed content to drop eight on each play and keep the West Virginia receivers under an "umbrella." One problem: Those wideouts seemed to be behind the secondary on every play.
Playing from behind most of the day, Art Briles' offense ran 92 plays snapping the ball, on average, every 17 seconds. West Virginia won because it eventually broke serve and won 10 touchdowns to nine. Think of a world where the winning defensive coordinator -- Joe DeForest -- gave up 63 points.
"Welcome to the Big 12 …," DeForest said."You have to measure success differently in this league."
"Everybody can play [in the Big 12] and just about everybody can score," Diaz said. "Everybody's got a triggerman."
Yes, it's a quarterback game. If you've got one, you've got a chance. Duh, right? It's not that easy. Texas Tech's Tommy Tuberville coaches in the wild-and-wacky Big 12, too. Within its walls, he has been able to construct the nation's No. 1 total defense five weeks in.
"You're not going to win championships unless you play defense," Tuberville said from the school that Mike Leach made famous. "You can win some games, but unless you can stop people when you're having a bad [offensive] night ..."
Tubs has not wallowed in the glory of that No. 1 defense. He knows better. His next five games are against Oklahoma, West Virginia, TCU, Kansas State and Texas. As an assistant at Miami from 1986-93, he helped win three national championships, seeing some of the greatest defensive players of the era pass through Coral Gables. One of his favorites was Rohan Marley, a 5-foot-9, 175-pound linebacker who could tackle. Imagine that.
Today, Tuberville doesn't conduct live scrimmages during two-a-days. There's too much liability, he says -- legally and physically. Injuries, or even worse -- head injuries.
"You don't have as much contact in practice," he said. "Obviously what you're going to lack is your [tackling] fundamentals. You can teach technique but the best athletes tackle well. A lot of these high school coaches are putting their best athletes with their spread offenses. You don't have as many athletes on defense."
Saban went on the offensive (sorry, couldn't help it) during this week's SEC conference call, connecting no-huddle offenses to a different kind of player safety.
"You can't substitute defensive players," he said. "You go on a 14-, 16-, 18-play drive and they're snapping the ball as fast as they can ... all your players are walking around can't even get lined up.
"That's when guys have a much greater chance of getting hurt when they're not ready to play."
That's kind of the idea, Nick -- getting the other team tired out. It's up to you to get the matchups right. And for the moment, Alabama is one of the few places in the country where they have figured it out, making the game what it used to be -- one of physical intimidation.
It is -- in the mind of the Great Saban and his followers -- what football wants to be.
"Most of us are little amazed right now," Dooley said. "We may be ancient, but we can't be that ancient."

subset: commoncrawl


text:
UNEP Auctions "Paint for the Planet" Paintings, Releases Children's Survey Results
26 October 2008: The UN kicked off its "UNite to Combat
Climate Change" campaign on 23 October 2008, with the "Paint for the Planet"
art exhibition. The exhibition was followed on 25 October 2008 by an auction
that raised US$21,000, which will be donated to children affected by
climate-related disasters.
The "UNite to Combat Climate Change" campaign calls
for a definitive agreement at the Copenhagen Climate Change Conference in
December 2009. The paintings will travel to climate change meetings for the
next 14 months, and will finally be displayed in Copenhagen in December 2009.
In conjunction with the campaign, the UN Environment Programme (UNEP) has
released results of a survey that it says highlights the concern of young
people about climate change.
The results show that youth worldwide believe
climate change to be a top concern. Moreover, they show that in the US, South
Africa and Brazil, at least 70% of youth surveyed believe that leaders are not
doing enough. Commenting on the results of the survey, Achim Steiner, UNEP
Executive Director, underlined youth are "seriously worried about what climate
change will mean in terms of their future on this planet." [UNEP
Press Release on Paint for the Planet] [UNEP
Press Release on UNite to Combat Climate Change] [Paint for the Planet website] [UN
Press Release]


text:
§2B1.4. Insider Trading
(a) Base Offense Level: 8
(b) Specific Offense Characteristic
(1) If the gain resulting from the offense exceeded $5,000, increase by the number of levels from the table in §2B1.1 (Theft, Property Destruction, and Fraud) corresponding to that amount.
Statutory Provisions: 15 U.S.C. § 78j and 17 C.F.R. § 240.10b-5. For additional statutory provision(s), see Appendix A (Statutory Index).
Application Note:
1. Application of Subsection of §3B1.3.—Section 3B1.3 (Abuse of Position of Trust or Use of Special Skill) should be applied only if the defendant occupied and abused a position of special trust. Examples might include a corporate president or an attorney who misused information regarding a planned but unannounced takeover attempt. It typically would not apply to an ordinary "tippee".
Background: This guideline applies to certain violations of Rule 10b-5 that are commonly referred to as "insider trading". Insider trading is treated essentially as a sophisticated fraud. Because the victims and their losses are difficult if not impossible to identify, the gain, i.e., the total increase in value realized through trading in securities by the defendant and persons acting in concert with the defendant or to whom the defendant provided inside information, is employed instead of the victims' losses.
Certain other offenses, e.g., 7 U.S.C. § 13(e), that involve misuse of inside information for personal gain also appropriately may be covered by this guideline.
Historical Note: Effective November 1, 2001 (see Appendix C, amendment 617).


text:
FRUITPORT TOWNSHIP, MI – A dog inside a Fruitport Township home Wednesday, March 12, wasn't going to stick around and see what happened next when smoke began to fill the residence.
When a passerby who noticed the billowing smoke coming from the structure in the 6000 block of Maple Island Road had opened a backdoor, the dog took that opportunity to escape and ran to safety, according to a fire official.
The fire was reported at 1:40 p.m. No person was in the home at the time of the fire, said Fruitport Township Deputy Fire Chief Brian Michelli.
The cause of the fire remained under investigation Thursday, March 13, Michelli said.
It's believed the fire started in a mechanical room of the home where the boiler is located, he said. Foul play is not suspected.
Passersby driving in the area noticed the smoke coming from the home and stopped to check it out, Michelli said.
"They went up to the home and banged on the door," he said.
When the dog came running out, it was evident more smoke was inside the home and firefighters saw it billowing from the eaves and the roof when they arrived on scene, Michelli said.
A tanker truck was called to the scene. Crockery Township and Egelston Township fire departments and Canteen 450 out of Norton Shores assisted at the scene.
The fire caused about $60,000-$70,000 worth of damage to the home, which is insured, Michelli said.
Heather Lynn Peters covers police and fire, and writes a statewide food column, The Spunky Kitchen, for MLive/Muskegon Chronicle. Email her at firstname.lastname@example.com and follow her on Twitter @HLPNEWS.


text:
5 Ways To Play With Your Pet Conure
Have a great playtime with your pet conure with these tips.
Conure Chewing Clothes
If your conure chews and destroys things you don't want it to, deter it with these tips.
Encouraging Breeding In Sun Conures
Decrease human interaction and increase the cage size to encourage breeding.
Conure Interaction At Home
Some conures interact with other birds differently in multiple bird homes
Baby Parrot Development Stages
The developmental stages among birds are as diverse as the size, color and personality of each bird species.
Best Pet Birds To Get
Looking for a pet bird? Check out one of the top three pet birds: the budgie/parakeet, the cockatiel and the conure.
Meet The Conures
Looking for a great family pet bird? Check out the fun-loving conures!
The Different Conures
Learn about the different genera of conure species.
Male-Female Conure Behavior Differences
Find out the differences between male and female Aratinga and Pyrrhura conures.
Conures Love To Play
Find out what games and toys conures of all sizes love to play with.
*Content generated by our loyal visitors, which includes comments and club postings, is free of constraints from our editors' red pens, and therefore not governed by I-5 Publishing, LLC's Gold Standard Quality Content, but instead allowed to follow the free form expression necessary for quick, inspired and spontaneous communication.
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text:
Pollen count
Pollen count is the measurement of the number of grains of pollen in a cubic meter of air. The higher the number, the more people will suffer if they are allergic to a particular pollen (hay fever). Usually, the counts are announced for specific plants such as grass, ash, or olive. These are tailored to what is usually a common plant in the area being measured.
One method of taking the sample uses a silicone grease-covered rod that is rotated in the air to collect the pollen. The rod is rotated periodically during the collection period to gather samples through an entire 24-hour day. The rod is then removed and taken to a lab where the collected material is analyzed for the type of pollen and its concentration.
In the UK, the public announcement of the pollen count was popularised by Dr. William Frankland, an immunologist.
According to a study by Leonard Bielory, M.D. that was presented to the American College of Allergy, Asthma & Immunology, climate changes are expected to cause pollen counts to more than double by 2040.[1]
External links[edit]
|This ecology-related article is a stub. You can help Wikipedia by expanding it.
|This climatology/meteorology–related article is a stub. You can help Wikipedia by expanding it.


text:
I'm sorry but I don't help cheaters of any kind.
I need some help with this thing. I've got the action replay max for the ds. I've got a code from a site I want to load onto the game. I have the game under codelists, but I can't add any codes, and I don't know why. ALso I can't add any subscriptions help?
wii number:1983-4115-1527-2746 name: FlAsH
Pokemon Diamond: 4295-9468-4634
I'm sorry but I don't help cheaters of any kind.
This forum requires that you wait 30 seconds between searches. Please try again in 1 seconds.
u gotta download some kinda cd thats all i know
was there any point of posting to this thenOriginally Posted by Fire Flower
have u tried adding the game again or manuly then add the cheats to that
Wii Username:MII123 Wii Online Code: 0430-9009-6263-5525
Mario Strikers Charged Football 395237 869217
Wii, 3XWiimotes, nunchuck, Classic Controller,1GB sd
Part of The WDSRT(Wiichat Ds Review Team)
Yeah you know the funny thing is, it's not even my action replay, this other guy wanted me to help him out. I've done the add and delete method, and that doesn't work. I'd add the code myself, but it's over 200 lines long and I don't have that sort of time, so I thought that if I copied over onto the PC thing then it would just go into the ar all at once. But I have no idea.
wii number:1983-4115-1527-2746 name: FlAsH
Pokemon Diamond: 4295-9468-4634


text:
Cliff Morgan
Nigel Perryman writes: Many have spoken of the sporting and broadcasting prowess of Cliff Morgan (obituary, Aug 30) but few, I think, of his charisma. I first met Cliff when he stayed with us when visiting his grandson at Christ College, Brecon. When we went to the Drovers Arms in Brecon for lunch, Cliff went unrecognised at first. Then he was spotted and people started asking questions. Within a short time he had the pub in the palm of his hand, rolling out a stream of anecdotes. The landlady, asked for an hour's warning before future visits, so


text:
Created in this Craftsy class
Embrace the art quilter within and learn to see the world through the eyes of an artist, doodle with free-motion quilting and add texture.
Other projects made as part of this class:
Offer some kudos...
Join the conversation...
Ask a question...
Add your comment...
|Here are some details about my project:
|Home Decor
|Whimsical, Funky, Casual
What materials did you use? fabric, batting, water soluble stabilizer (Superior dissolve 4X) deco bond, fabric scraps, ribbons,embroidery thread, fancy threads.
What are you most proud of? The originality of my project. I am a follow the line personality and it is fun to know that I do have a creative side to me.
Love what you have done. I am about to do an art quilt for the first time. Thanks for your inspiring words.
Thanks for taking time to look at my project and comment on it. Have fun with yours.
Wow so creative and many different techniques. I looked at this for a long time exploring everything. GREAT JOB Add your other works.
Thank you it was fun creating it.
Love your use of scraps for the flowers at the bottom.
Thank you it is a good way to use up scraps.
love it !!
Yes! Love your creativity! !
Thank you
Love this! The frog is so cute.
The frog started out as a rock and when I couldn't get it right I changed it to a frog thanks for your comment


text:
With respect to both the article by Harrison et al1 and the Editorial by Liebowitz2 regarding outpatient strategies in the management of venous thromboembolism (VTE) using low-molecular-weight heparin (LMWH), the onus has shifted to the outpatient arena as the first consideration for treatment. Consideration was given to inpatient treatment only if conditions arose that increased bleeding risk, were associated with significant comorbidity, and incurred mental and physical restrictions to home treatment. Harrison et al found that more than 75% of all patients (89 of 113) with deep venous thrombosis (DVT) were treated at home. Other manifestations of VTE such as upper extremity DVT and pulmonary embolism (PE) were also included in the home treatment program. The rate of recurrent disease and major bleeding was 6% and 1%, respectively, and the home treatment program was associated with a high degree of patient satisfaction.
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Editor's Note BY LAURA DOERINGTimes have been tough. With the housing crisis, bank crisis, corporation crisis, we've certainly weathered a lot of crises lately. Read the article here.
Janet EvanovichNew York Times best-selling author dishes about her Alexandrine parakeet.BY MARY GORMAN
The Reality Of CheapThe wrong cage could end up costing you more.BY LAURA DOERING
When Birds & Budgets CollideLearn how to save without sacrificing your bird's well-being.BY DR. BARBARA NEFER
A Planted Bird RoomTurn your home into a jungle for your bird.BY DAVID A. SILVER
Feather MagicAn artistic view of feathers.BY BONNIE JAY
Eclectus' True Colors RevealedResearchers take to the treetops & discover that color means everything to Eclectus.BY ROBERT HEINSOHN
New 4 YouThe Latest Products
Avian FlairJewels Are ForeverBY ERIN O'BRIEN
Bird-Tested, Bird-ApprovedValentine's DayBY SUSAN CHAMBERLAIN
The Toy ChestPlay For HealthBY MATTIE SUE ATHAN
Causes & CuresLight RightBY MARGARET A. WISSMAN, DVM, DABVP- AVIAN PRACTICE
Heart to HeartHard Lessons LearnedBY CHRIS DAVIS
Small BirdsLoud 'TielsBY DIANE GRINDOL
Parrot PsychologyLove At First Sight?BY LIZ WILSON, CVT, CPBC
Dove & PigeonCrown PigeonsBY ROBERT ALISON, PHD
Lories & SoftbillsPet ToucansBY DICK SCHROEDER
MailbagFYIWeb ColumnAvian MarketplaceShow CalendarShow GalleryAvian Breeders' DirectorySmall Birds' DirectoryAvian Services' GuideAvian ClassifiedsFlock OnKids Talk BackJust HatchedAdvertising IndexWatch The Birdie
On The CoverRed-sided EclectusBY CAROLYN A. MCKEONE
*Content generated by our loyal visitors, which includes comments and club postings, is free of constraints from our editors' red pens, and therefore not governed by I-5 Publishing, LLC's Gold Standard Quality Content, but instead allowed to follow the free form expression necessary for quick, inspired and spontaneous communication.
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text:
Analysis: Assad still standing after six months of bloodshed
Sep 14, 2011, 6:47 a.m.
But exploiting that overwhelming military superiority over a mostly peaceful protest movement has come at a cost.
Assad's repression of the unrest has led to Western sanctions and calls for him to step down, as well as growing criticism from Arab and regional countries.
"The Syrian people do not believe in Assad. Nor do I," Turkish Prime Minister Tayyip Erdogan, a former ally of the Syrian leader, told Arab foreign ministers in Cairo on Tuesday.
At the same meeting, Arab ministers called for "immediate change...to halt the bloodshed" in Syria.
The United States and European Union have agreed a range of sanctions including an embargo on Syrian oil exports which, coming on top of a collapse in tourism revenues and sharp fall in trade, mean Syria faces gradual economic meltdown.
However Assad has weathered international crises and isolation before, particularly after the 2005 assassination of Lebanese statesman Rafik al-Hariri when an initial U.N. investigation pointed to Syrian involvement.
"The nature of Syria's isolation over the last decade is that they are well accustomed to being out on their own. They don't have these political and economic ties which make them dependent on outside players," Barnes-Dacey said.
By imposing sanctions and calling for Assad to go, Western powers have already pulled the few levers of influence they have over Syria, and have yet to convince China and Russia to back a tough United Nations resolution against Damascus.
Equally divided are Syria's opposition figures, who have failed to unite around an agreed platform, bridge gaps between those inside and outside the country, or coordinate fully with grassroots protesters who continue their defiant demonstrations.
Assad has promised reform including a multi-party election next year, but has not said whether he will allow a presidential challenger when his term expires in 2014. Opposition figures say the continued violence undermines any pledges of change.
Syria's Baath Party leadership needs only look next door to neighbouring Iraq to see another Baathist ruler, Saddam Hussein, who survived more than a decade of war and sanctions.
Assad's father, Hafez al-Assad, also survived popular unrest, killing many thousands of people when he crushed an armed Islamist uprising in the city of Hama in 1982.
One Damascus-based diplomat said Bashar still retains solid support among the bulk of his minority Alawite community, some Christians who fear post-Assad Sunni Muslim majority rule, and sections of business class of Aleppo and Damascus.
But if the protests and repression continue, his position and support would steadily weaken in the long term, eroded by economic woes and ever-growing resentment.
He could also face an increasingly armed uprising.
Rights groups say street protests have been overwhelmingly peaceful so far, but there have been reports of attacks on security forces. Syrian authorities say 700 soldiers and police have been killed.
In the absence of a strong, unified opposition, the diplomat said the biggest potential threats to Assad would come from an internal coup, a big wave of military defections, economic collapse or one of the two main cities -- Damascus or Aleppo -- siding with the protesters.
None of those appeared imminent, he said.
"Assad will never exert the control over Syria that he once did. The unrest is too widespread for a Hama-style crackdown" said Fraser. "However it is going to take a lot to topple him.."
(Additional reporting by Peter Apps in London; Editing by Jon Boyle)
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text:
Clases espontáneas respondiendo algunas preguntas por Twitcam.
—Twitter @andresrot
Clase 1 (8/Sep/12) — Link: http://twitcam.com/bz1cl (Duración: 94 minutos)
Contenido: Cómo practicar, ejercicios de mano derecha, escalas, cómo afrontar el business de la música, Cómo estudiar distintos estilos, influencias musicales, tocar out.
Clase 2 (14/Sep/12) — Link: http://twitcam.com/c1jt8 (Duración: 73 minutos)
Contenido: Armonía, creación de líneas de bajo, chord melody, funk.
Clase 3 (21/Sep/12) — Link: http://twitcam.com/c4lq1 (Duración: 72 minutos)
Contenido: Ejercicios rítmicos, time feel, tensiones y sus respectivos colores, dominantes secundarios, y más…
Clase 4 (28/Sep/12) — Link: http://twitcam.com/c7h6o (Duración: 79 minutos)
Contenido: Ejercicios rítmicos, métricas ¨irregulares¨ (7/4, 7/8), sustitición tritonal, mi historia en la música, intervalos, chord-melody.
To practice playing groove songs with 1, 2, 3 & 4 chords click on the links below!
After I got my Hofner Bass a few days ago, I rushed into recording the song "Yesterday" with it.
It is the first Solo Bass Arrangement that I upload using a 4 string bass, and since that song is apparently the 'most covered song ever' I figured I could teach you all how to play it, so we can raise that number even more!
It is a 26-minute-long video lesson and the reason for it is because I take some time talking and analyzing every section, and the reasons why I arranged those that way.
Sometimes I get requests on bass tabs and I feel that if you learn to play your bass that way, you will be very limited musically. My advice is always to learn music by ear.
Be the musician who plays bass and not the other way around!
Enjoy the video lesson!
This is a video lesson requested by a friend who asked me about how to think of improvising on a tune or song (in this case, the example is on the Jazz Standard "Black Orpheus") that has an active chord progression.
I basically talk about being aware (with your inner ear) of the key centers: Tonic, Sub-dominant and Dominant. And playing 'colors' (tensions) by choosing them by ear.
Video is in Spanish but it has captions in English.
Please comment if you have any questions or thoughts!


text:
Author Affiliations: Rollins School of Public Health (Drs Culler and Rask) and Emory Center on Health Outcomes and Quality (Dr Rask), Emory University, Atlanta, Georgia; Cardiac Data Solutions Inc, Atlanta (Ms Simon and Dr Brown); Henry Ford Hospital, Detroit, Michigan (Dr Kugelmass); and Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Reynolds).
The primary purpose of this study was to rank US hospitals performing coronary artery bypass graft (CABG) surgery on Medicare beneficiaries into 4 performance tiers and determine if there were overall and sex-specific differences in the risk-adjusted mortality rates across performance tiers.
A retrospective analysis was done using a Medicare Provider Analysis and Review (MEDPAR) file of all Medicare beneficiaries who underwent CABG surgery without valve repair or replacement during fiscal years 2003 and 2004. Logistic regression models controlling for demographic characteristics, comorbidities, and cardiac risk factors were used to predict the probability of in-hospital mortality. Hospitals performing at least 52 CABG surgeries during a fiscal year (at least 17 female patients) were ranked into 4 tiers. Rankings were based on the number of lives saved, calculated as the expected number of risk-adjusted deaths minus the actual number of deaths in the hospital during each fiscal year.
Average risk-adjusted mortality rate was stable and declining over the 2 years: 3.68% in 2003 and 3.61% in 2004. In 2004, the average risk-adjusted mortality rate ranged from 1.39% in tier 1 hospitals to 6.40% in tier 4 hospitals. The sex-specific mortality rate was consistently higher for women in all tiers, with the differential smallest (0.68%) in tier 1 hospitals and greatest (2.67%) in tier 4 hospitals.
The sex differential increases from top- to bottom-tier hospitals, suggesting female beneficiaries could benefit from having CABG performed at tier 1 hospitals.
Hospital performance on the basis of coronary artery bypass graft (CABG) surgery outcomes are being published by a growing number of public and private organizations.1- 3 While many of these reports rank hospitals according to a broad spectrum of factors including hospital structure, scope, processes, reputation, and postoperative clinical outcomes, inpatient mortality rate is the most commonly used measure of cardiovascular surgical care quality.4,5 New York, Pennsylvania, New Jersey, California, and Ontario, Canada, have all published risk-adjusted hospital rankings for cardiac surgery outcomes demonstrating differences in CABG mortality across hospitals.6- 10 With CABG surgery increasingly becoming an elective procedure performed by an increasing number of hospitals, there is a growing interest and debate over making hospital risk-adjusted mortality rates (RAMRs) publicly available.11- 13 In addition, the growing awareness of sex differences in cardiovascular outcomes has raised concerns about whether the sex differential in risk-adjusted mortality rate varies across hospital performance tiers.14- 16
The primary purpose of this study was to rank all US hospitals performing CABG surgery on Medicare beneficiaries into 4 performance tiers based on the total number of lives saved, calculated as the difference between the risk-adjusted expected number of deaths and the actual number of deaths. We chose this ranking method because it incorporates both a quality of care and volume component into the ranking. The hospital rankings are then used to answer 3 questions. First, are there statistically significant differences in the overall and sex-specific average RAMRs across performance tiers? Second, is the sex differential (average male RAMR minus average female RAMR) stable across hospital performance tiers, or does it change between tiers? Third, what would be the potential mortality impact (percentage of deaths avoided) among Medicare beneficiaries if bottom-tier hospitals would improve their RAMR to the average rate of hospitals performing in the top tier?
The Medicare Provider Analysis and Review (MEDPAR) files17 for fiscal year 2003 (FY2003) (October 1, 2002, through September 30, 2003) and fiscal year 2004 (FY2004) (October 1, 2003, through September 30, 2004) were the data sources for this retrospective analysis. The MEDPAR file is an administrative database maintained by the Centers for Medicare and Medicaid Services containing all claims submitted by hospitals for services provided to Medicare beneficiaries. For each hospitalization, the MEDPAR record includes patient information on age, sex, race, date of admission, date of discharge, the principal diagnosis code, 8 secondary diagnosis codes, 6 procedure codes, discharge status, total charges, and total reimbursement.
The population in this study consists of all US hospitals not in the Veterans Affairs Hospital System that performed at least 52 CABG procedures without concomitant valve surgery on Medicare beneficiaries during FY2003 or FY2004. The final study sample was derived as follows: First, the respective fiscal year MEDPAR file was searched for all hospital admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code of 36.10 through 36.19 or 36.2, indicating that the patient underwent a primary or secondary CABG procedure during that admission. A Medicare beneficiary's CABG hospitalization was excluded from the study if the beneficiary also underwent concomitant value surgery (ICD-9-CM procedure code of 35.00 through 35.04, 35.10 through 35.14, 35.20 through 35.28, or 35.31 through 35.39).
Table 1 summarizes the characteristics of the final study population. The initial search identified 143 462 Medicare beneficiaries (66.7% men) who were treated in 1069 hospitals during FY2003 and 134 707 Medicare beneficiaries (67.1% men) treated in 1108 hospitals during FY2004. Hospitals (and thus the Medicare beneficiaries they treated) were excluded from the study for either or both of the following reasons: (1) they performed fewer than 52 CABG procedures (on average <1/wk) on Medicare beneficiaries during the fiscal year, and/or (2) they performed fewer than 17 CABG procedures on female Medicare beneficiaries during the fiscal year. A minimum of 17 female patients was set because it represents approximately 33% of 52 CABG procedures.
Univariate differences in hospital outcomes were assessed using χ2 analysis or the Fisher exact test for discrete variables and 2-sample student t tests for continuous variables. For each fiscal year, a multivariate logistic regression model was estimated to predict the expected probability of in-hospital mortality for each patient. The identical statistical analysis was conducted in 2 consecutive fiscal years to provide insight into the stability of both the average RAMR and the size of the sex difference by hospital performance class. All analyses were performed with SAS version 9.1 statistical software (SAS Institute, Cary, North Carolina).
The primary purpose of the multivariate logistic regression model was to predict the probability of a Medicare beneficiary experiencing in-hospital mortality during a CABG hospitalization, controlling for demographic, comorbidity, and cardiac risk factors. The same multivariate logistic regression model was estimated in each fiscal year. The estimated logistic regression model controlled for demographic variables (age, sex, and race) and for the following comorbidities and cardiac risk factors coded from the administrative database: prior CABG procedure, prior percutaneous coronary intervention, prior myocardial infarction, unstable angina, type of primary acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure, renal failure unspecified, chronic liver disease, hypertension, conduction disorders, endocarditis, aortic aneurysm, history of cerebral vascular disease, diabetes mellitus, obesity, and current smoking status.
This study ranks hospitals on their CABG surgery performance based on the potential number of lives saved by each hospital. The number of lives saved by each hospital is defined as the difference between the hospital's expected number of deaths and its observed number of deaths. A hospital's expected number of deaths is calculated by summing the expected probability of in-hospital mortality (estimated from the logistic regression equation) for each patient treated at that hospital during the fiscal year. Hospitals were divided into quartile performance tiers based on the total number of lives saved, with the top quartile (tier 1) hospitals saving the most lives and tier 4 the fewest.
We chose to rank hospitals based on the number of lives saved instead of risk-adjusted mortality rates for several reasons. First, for a hospital to save lives, the hospital must have a below average (better) RAMR because a hospital can only save lives by definition if the number of observed deaths is smaller than its expected number of deaths adjusted for the demographic characteristics, comorbidities, and cardiac risk factors of its CABG patients. Second, the better a hospital's actual performance relative to the average hospital, the more lives it will save with any given set of patients. Likewise, between 2 hospitals with the same number of observed deaths, the hospital with the more difficult case mix will save more lives than the hospital with the less difficult case mix because increasing disease severity increases the hospital's expected number of deaths. Alternatively, between 2 hospitals with the same RAMR, the lives saved method will rank the hospital that treated the most patients higher than the hospital that treated fewer patients.
The primary outcome of interest in this study is the overall and sex-specific hospital RAMR among Medicare beneficiaries. We adopted the linear method of calculating a hospital's RAMR used in the Patient Safety Indicator software written by the Agency for Healthcare Research and Quality.18 A hospital's overall RAMR was calculated by subtracting that hospital's expected mortality rate from its observed rate and adding the difference to the national average mortality rate for all beneficiaries undergoing CABG surgery. We report the sex differential in RAMR as the male rate minus the female rate. As a result, a negative sex differential implies that the RAMR for women is higher than for men. We report RAMR by performance tier as the unweighted average of each hospital's overall or sex-specific RAMR in a given performance tier. Nearly identical results were obtained by calculating a patient-weighted average RAMR (data not shown).
The final study population consisted of 134 407 Medicare beneficiaries and 802 hospitals in FY2003 and 122 231 Medicare beneficiaries and 768 hospitals in FY2004 (Table 1). While excluded hospitals represent 25% and 31% of all hospitals performing CABG surgery on beneficiaries in the respective fiscal years, the excluded hospitals averaged fewer than 37 CABG patients per hospital. As a result, the final study population included approximately 93% and 91% of all Medicare beneficiaries undergoing CABG surgery in FY2003 and FY2004, respectively.
Table 2 lists the multivariate estimated odds ratios and 95% confidence intervals for each of the variables included in the logistic regression model. Overall, there were very few differences in the estimated odds ratios for individual variables between FY2003 and FY2004; the goodness of fit, as measured by the C statistic, was approximately 0.78 in both years.
The number of estimated lives saved in study hospitals ranged from a +15.91 to a −21.86 during FY2003 and from +15.06 to −15.82 during FY2004 (Table 3). As expected, the estimated number of lives saved decreased from tier 1 to tier 4; however, the average CABG volume per hospital per year was higher in tier 1 and tier 4 than in the middle 2 tiers.
Overall, there was a slight decline in the average hospital observed mortality rate (3.72% vs 3.63%) and RAMR (3.68% vs 3.61%) among Medicare beneficiaries undergoing CABG surgery from FY2003 to FY2004. In addition, compared with female beneficiaries, male beneficiaries had lower observed mortality rates (3.7% vs 4.8% in FY2003 and 3.1% vs 4.7% in FY2004) and RAMRs (3.2% vs 4.7% in FY2003 and 3.1% vs 4.7% in FY2004). As a result, the sex differential (risk-adjusted mortality advantage to male patients) for all hospitals changed little (from 1.5% to 1.6%).
Table 4 lists mean hospital RAMRs overall and by sex for each performance tier. The following observations can be made: First, the mean hospital RAMR increases consistently, both overall and for male and female beneficiaries, from the top performance tier to the bottom in both fiscal years. While not listed in Table 4, the mean overall and sex-specific RAMR achieved by tier 1 hospitals was significantly lower than the comparable RAMR achieved by hospitals in any of the other 3 tiers in both fiscal years (P < .001).
Second, the sex differential in the average RAMR for all hospitals increases from the top to the bottom performance tier. For example, in FY2003, among top-tier hospitals, the average male RAMR was 1.24% compared with the average female RAMR of 1.96% (−0.72 percentage point differential), while among bottom-tier hospitals, the average male RAMR was 5.68% compared with the average female rate of 8.40% (−2.72 percentage point differential). The increase in the average hospital RAMR sex differential was statistically significant between tier 1 hospitals and hospitals in each of the other 3 performance tiers (P < .05).
Finally, while the risk-adjusted mortality rates for both sexes vary slightly in any performance tier between the 2 fiscal years, the average sex differential in RAMR in each of the performance tiers is very stable.
Table 5 details the potential mortality impact of improving outcomes in bottom-tier hospitals. The simulation estimates the number of deaths avoided if bottom-tier hospitals could improve their sex-specific RAMR to the average sex-specific rate achieved in top-tier hospitals. Overall, this simulation indicates that between 74% and 76% of all observed deaths in bottom-tier hospitals could potentially be avoided—a total of roughly 1500 deaths per year. Finally, while women have a higher RAMR in tier 4 hospitals than men, both sexes benefit nearly equally from the improvement in hospital outcomes with very similar rates of potentially avoidable mortality, in part because a sex differential remains, even in top-tier hospitals.
This study examined 3 questions concerning hospital performance rankings for CABG surgery. First, this study found that when hospitals were ranked according to the number of lives saved, Medicare beneficiaries of either sex undergoing CABG surgery in the typical top-tier hospital were significantly less likely to experience in-hospital mortality than beneficiaries being treated by the typical hospital in the other 3 tiers. The difference in RAMR between the average top- and bottom-tier hospital is quite striking. The relative risk of mortality for undergoing CABG surgery in a bottom-tier hospital was 4.4 times that of a top-tier hospital.
Second, this study found that women had a higher mortality rate than men by 1.5 percentage points. However, the sex differential increases from 0.7 percentage points in the average top-tier hospital to 2.7 percentage points in the average bottom-tier hospital.
Finally, potentially 75% of the observed deaths of either male or female Medicare beneficiaries treated in tier 4 hospitals could be avoided if tier 4 hospitals could improve their performance to the average performance of top-tier hospitals. Clearly, to achieve these simulated reductions in mortality, the causes of interhospital variation in mortality must be identified.
These findings raise a number of questions. First, is the statistically significant difference in average RAMR between hospital tiers clinically meaningful? We believe that a 4-fold difference in RAMR is a clinically meaningful difference between hospitals in the top and bottom tiers. Approximately 1500 deaths that occurred in tier 4 hospitals could potentially have been avoided in each fiscal year if hospitals in the bottom tier achieved outcomes similar to the average hospital in tier 1. While there will always be bottom-tier hospitals in any performance ranking, this study demonstrates the potential mortality impact of improving the quality of care. Better understanding of what the nearly 200 top-performing hospitals are doing to achieve their relatively low average RAMR may provide insight into how to improve the average performance in bottom-tier hospitals.
Second, this study also finds that even in the best performing hospitals there is a sex differential in mortality rates. This finding may support those who argue for clinical reasons (eg, artery size) why mortality equality between men and women may be difficult to achieve among patients undergoing CABG surgery.19- 23 However, after risk adjusting, there was a nearly 4-fold increase in the sex differential between the top- and bottom-tier hospitals. While we are aware of the limitations associated with RAMR models for predicting subsequent performance, the size of the increase in the sex differential between top- and bottom-tier hospitals clearly demonstrates the importance of examining hospital CABG outcomes, especially for various subpopulations.
Third, these analyses suggest that both male and female Medicare beneficiaries undergoing elective CABG surgery could improve their outcomes by carefully selecting their CABG hospital. The proportional consistency of the sex-based mortality differences across tiers implies that the quality problems of poor performers apply equally to male and female patients, especially since the difference in average RAMR between top performing and lower performing hospitals is greater than the sex difference in RAMR in the 2 bottom tiers. However, for beneficiaries to be able to exercise this choice, the following conditions must exist: (1) hospitals' rankings must be relatively stable over time and (2) beneficiaries must be able to access surgeons operating in top-tier hospitals and have financial and geographical access to top-tier hospitals. A brief examination of geographical access indicates that 37 states had at least 1 tier 1 hospital in FY2003 and that 40 states had at least 1 tier 1 hospital in FY2004. Furthermore, 20 states had at least 1 hospital ranked in the top tier and 1 in the bottom tier in both fiscal years.
Several limitations to this study must be acknowledged. First, the analyses and risk-adjustment models used to calculate RAMRs by sex are based on information contained in an administrative database.24,25 As a result, the risk-adjustment models we estimated might not adequately control for variations in patients' severity of illness because of a lack of clinical detail: the MEDPAR file is limited to 9 diagnosis codes per patient. Nevertheless, previous studies have shown that the predictive power of administrative databases, as measured by the C statistic, is nearly identical to that of clinical data sets for predicting the probability of death in a group of patients.26 Missing clinical data would not bias the results unless the missing factors were disproportionately distributed across Medicare beneficiaries and sex. The results of our risk-adjusted mortality models compare favorably to the results reported in the literature.6- 10
A second limitation is that this study uses in-hospital mortality rates as opposed to 30-day or 6-month mortality rates. For CABG surgery outcomes, we believe that in-hospital mortality is appropriate because studies examining long-term survival rates have shown that very few CABG patients who survive to discharge die in the first year after surgery.27- 29
A third limitation is that low-volume hospitals may not treat enough patients of each sex (especially women) to provide statistically meaningful and stable rankings. However, the lives saved method of ranking hospitals makes it difficult for low-volume hospitals to be ranked in either the top or bottom tier. And finally, this study population included only Medicare beneficiaries undergoing CABG without heart valve surgery and may not represent hospital performance for all CABG patients treated in US hospitals.
In conclusion, this study provides evidence that Medicare beneficiaries should pay attention to hospital performance rankings for CABG surgery based on lives saved. We also suggest that improving the quality of care in poorer-performing hospitals may be an important opportunity for improving CABG surgery outcomes. The difference in average RAMR across hospital tiers is substantially larger than the overall reduction in CABG mortality that has been achieved over the last decade with clinical advances in performing the procedure. The sex differential is smallest at high-performing hospitals meaning that both male and female beneficiaries benefit from having CABG performed at tier 1 hospitals. Future research is needed to focus on the processes and structures that differentiate the top performers and how these lessons can be translated to other hospitals.
Correspondence: Steven D. Culler, PhD, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 (firstname.lastname@example.com).
Accepted for Publication: May 19, 2008.
Author Contributions:Study concept and design: Culler, Simon, Brown, and Reynolds. Acquisition of data: Culler and Simon. Analysis and interpretation of data: Culler, Kugelmass, and Rask. Drafting of the manuscript: Culler, Simon, and Brown. Critical revision of the manuscript for important intellectual content: Culler, Kugelmass, Reynolds, and Rask. Statistical analysis: Culler and Reynolds. Obtained funding: Simon. Administrative, technical, and material support: Culler, Brown, Kugelmass, and Rask. Study supervision: Simon, Kugelmass, and Reynolds.
Financial Disclosure: None reported.
Funding/Support: Ms Simon, in her capacity as president of Cardiac Data Solutions Inc, Atlanta, Georgia, purchased the MEDPAR files analyzed in this study.
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Latest update September 26th, 2016 12:12 PM
May 09, 2012 alvinology foodie, Singapore heartland 1
If you have a craving for authentic thai food and do not want to spend a bomb at a fancy restaurant, Na Na Original Thai Food restaurant may just be the place for you.
The restaurant is located in Golden Mile Complex, Beach Road, which is like mini Thailand in Singapore where the Thai diaspora congregates. This adds a stamp of authenticity to the Thai food served as no taste bud can be more discerning than the Thai folks themselves.
I have dined there on two occasions, the first time with my parents and sister and the second time with Rachel. The bill came up to $60+ for 5 pax and $30+ for 2 pax respectively. Pretty reasonable considering how much we ordered, including beverages.
The service staff cannot really speak English, but the menu has images of all the dishes and is written in both Thai and English. Pointing will do the trick.
The restaurant sees a mix of both Thai and local customers. Business is pretty good on weekend, but the service is fast.
If you would like to visit the restaurant, it is located at Golden Mile Complex, 5001 Beach Road, #01-87.
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Alvin is a marketer by day and blogger by night. He is a 100% geek who spends too much time surfing the web.
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Interesting information can capture your attention today, inspiring you to devote at least some small portion of your time to learning. Though you may quickly find yourself engrossed in your chosen subject matter, everyday concerns can get in the way of your educational goals, halting your progress. This can be the perfect time to reaffirm your commitment to lifelong learning, as the fact that you are captivated by your curiosity today is likely a sign that you are hungry for knowledge. You may find that you are better able to retain the information you absorb when you make an effort to make use of what you have learned while tackling your responsibilities.
The ideas and concepts that awaken our interest quite are often those with the most potential to add value to our experiences on a day-to-day level. We often overlook opportunities to learn for learning's sake because we believe that we can find better uses of the free time available to us. While we may associate education and its trappings with study or reading, there are many ways we can integrate information into our existence. What fascinates us need not be placed in a category that is wholly separated from the mundane details of our everyday lives. Rather, we should always endeavor to apply the knowledge we gain toward the challenges we are called upon to face. The information that captivates you today will likely prove useful, provided you do not limit yourself by assuming it has no real purpose.
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Varsity Male Athlete of the Week: Felix Manus-Schell, Cathedral Prep football
Cathedral Prep's Felix Manus-Schell condensed a game's worth of highlight plays into one quarter of the team's District 10 Class AAA semifinal.
Manus-Schell achieved a rare feat by scoring on offense, defense and special teams for Prep, which routed Oil City 70-26 on Nov. 15 at Veterans Stadium.
As a wide receiver, Manus-Schell scored on an 11-yard pass from quarterback Billy Fessler. As a defensive back, the senior returned an interception 26 yards for his second touchdown.
Manus-Schell then capped the Ramblers' 42-0 first quarter by returning a punt 52 yards.
"It was crazy when we were talking about that on (the sideline)," he said.
Manus-Schell, an Old Dominion recruit, is aware his days as a Prep football player are dwindling. That's why he plans to do all he can to help the Ramblers extend their 2013 season beyond today's District 10 final against General McLane.
"I hope we can go to (the PIAA Class AAA championship game) and win it again," he said. "That way, I can go out big this year."


text:
To the Editor:
Most people carry $1 bills in their wallets or purses, but they never examine or know anything about the secret that the writings or the pictures on the bills reveal.
Over the portrait of George Washington it reads, "Federal Reserve Note." The Federal Reserve Act was passed in Congress while Woodrow Wilson was president. The stock of the Federal Reserve System is owned and run by private international bankers.
They have offices and banks throughout the whole world. The amount of money in circulation and in the U.S. treasury is controlled by the bankers through the Federal Reserve System.
On the back of the $1 bill, on the left side, within a circle, is a pyramid with an eye on top. This is the secret symbol of the "Illuminati."
The date on the bottom of the pyramid, in roman numerals, is 1776. This is the year the "Illuminati" was formed by Adam Weishaupt, a professor of Canon Law at Ingolstadt University at Bavaria, Germany.
You just found out the secrets on the $1 bill that the vast majority of people in this country and the world don't know about.
Someone said, "knowledge is power!"
What will you do with this knowledge?
God bless America.


text:
Corrected Date for "Sally Stroll"
Join Us for a Sally Stroll
We are having a Sally Stroll on Friday, May 3rd starting at 11:00 am in New York City. Please join us!
What is a... Read more
Sally NYC Stroll
Join Us for a Sally Stroll
We are having a Sally Stroll on Friday, May 5th starting at 11:00 am in New York City. Please join us!
What is a... Read more
First of all I want to express just how happy I am with our latest
e-Book, "Sally Discovers New York"!
Stephen inspires me everyday and channeling him to write this... Read more
Sally is Going to Bologna, Italy!
Sally is Going to Bologna, Italy!
Sally and friends are off to the Bologna Fair! How exciting! No one appreciates good food like Sally does. She thinks a whole fair... Read more
Kickstarter Update 2/28/13
Kickstarter Update 2/28/13
Does Sally ever get to see her classmates again?
The "Sally Discovers New York" e-book is all done, and if Sally says so herself, it came out... Read more
Kickstarter update 2/22/13
Last chance to have your dog featured in the Dog Mountain School Yearbook! Sally and friends have finished writing and illustrating "Sally Discovers New York!" We are pleased to announce... Read more
Sally's Bags are Packed!
Kickstarter Update for "Sally Discovers New York" 1/15/13
Thanks for all your great suggestions of places Sally should visit.
Some of places the Dog Mountain School will be visiting on... Read more
Seasons Greetings
Seasons greetings to all out Kickstarter friends
From Sally and everyone at Dog Mountain have a Happy New Year!
Happy Holidays
Happy Holidays to all our our friends at Kickstarter!!
From Sally and everyone at Dog Mountain have a Happy New Year!
YEA! We are funded! We are heading to New York City!
Yea! We are funded and Sally and friends are headed to New York City! Our "Sally Discovers New York" Kickstarter campaign is now officially over.
All in all, it was... Read more
Today is a SNOW DAY at Dog Mountain!
Even though it has been many years since I was a student, I still get a vicarious thrill when I wake up to a snow covered world and know today... Read more
15 Days to Go
We am happy to say, we are getting closer to our funding goal. We are over 2/3s of the way there! For Sally and her schoolmates to be able to... Read more
Sally Discovers New York
Kickstarter Update
It has been a rewarding week to see the wonderful support "Sally Discovers New York" is receiving. I think it speaks volumes to the loyal following Stephen and... Read more
Sally's Off and Running
Although this project has been in the works for months, we had to do some real soul searching about whether or not it was appropriate to launch "Sally Discovers New... Read more


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The neurobiological manifestations of sustained arrhythmias in children prenatally exposed to cocaine1 are suggested by reports linking brainstem cardiovascular control to dopamine lateralized to the right hemisphere.2 This hypothesis is supported by a study demonstrating that prenatal stress reduces dopamine turnover in the right nucleus accumbens, leading to depression in adult offspring.3 The fact that delay-dependent speeding of reaction time, indicating motor readiness, is abolished by depletion of dopamine subserving cardiovascular reactivity in challenging tasks2 prompts identification of a subset of children who are at increased risk for significant arrhythmias under conditions of stress1 by monitoring vocal hesitation and switching pauses.2 This noninvasive method is supported by immobility in behavioral despair,3 lengthy pause times, and shortened reaction times following cocaine administration.4 It is also supported by the construct validity of response latencies, easily obtainable through microcomputer testing of spontaneous speech in emotionally
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Looking beyond the dead trees
Frank Carroll
Published: Thursday, October 4th, 2012
This year marked my 41st fire season as an active participant in firefighting, fire policy development, fighting mountain pine beetles and other pests and working in forest management in general. I have worked for the National Park Service, the U.S. Forest Service and private industry. Much of my life has been spent trying to answer the question how do I keep my forest alive and well in an environment filled with fires and mountain pine beetles and all of the other challenges that foresters face?
I have not been alone in this quest. The answer to the question affects everything from the value of our property to the safety of our homes, especially for people who live in the forest, under the eaves of the trees in what we call the Red Zone. In fact, answering that question can mean the difference between whether I want to live in the forest or not.
I spent an afternoon near the Sugar Shack in the Black Hills Experimental Forest. Foresters and other scientists are working to understand how various forest treatments like thinning and burning work over time. What is the effect of thinning trees on mountain pine beetles?
Available only in the print version of the Custer County Chronicle. To subscribe, call 605-673-2217.
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This item is no longer available but there's always a sunny side.
Check out some of our favorites we think you'll love too.
Adelaide V-Neck Sweater
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Adelaide V-Neck Sweater Description
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Not in any supported fashion. And any unsupported hack that might conceivably allow you to do it will inevitably hose your system in some way, since IE is a rather important component of the OS.
Why do you want to do this? If it's for testing purposes, I recommend using a VM.


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Contact Us
Email us at email@example.com
Check us out on our SACstagram
Friend us on Snapchat (@MarywoodSAC)
The Student Activities Crew (SAC) coordinates extra-curricular events for Marywood's undergraduate students. SAC hosts activities during the day, at night, and on weekends to accommodate both residents and commuter students.
SAC hosts a variety of programs:
- Comedians
- Hypnotists
- Trivia Nights
- Bonfires
- Open Mic Nights
- The Annual Homecoming Formal
- Off-Campus Trips inlcuding whitewater rafting, NYC, the beach, and Dorney Park!
- And so much MORE!
Because SAC programs funded by student activities fees, most events are free for all Marywood undergraduate students.
For more information on SAC and the events we sponsor, check out our social media pages (MarywoodSAC) on Facebook, Twitter, Instagram, and Snapchat! Always feel free to email us at firstname.lastname@example.com as well.


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The FOX star, 27, took to Instagram on Monday to show off her bikini ensemble, writing, "Look back at it."
Her carefree snapshot follows a flurry of less light-hearted rumors that included everything from a nasty feud with star Lea Michele to a meltdown that got her written off the remaining shows.
"Rumors that Naya was let go or fired are false," her rep told PEOPLE last month, also shutting down reports Rivera was dropped by Columbia Records.
To the best fans in the world, thank you for all the [love]! Don't ever let the he say she say get you down.— Naya Rivera (@NayaRivera) May 2, 2014
Either way, it was a well-deserved bikini romp (and not the first this month) for Rivera, whose engagement to Big Sean also ended in April.


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Top Definition
An article of clothing worn around the neck, usually considered tacky unless you happen to be a Time Lord.
I wear a bowtie now. Bowties are cool.
di Charmify 04 giugno 2011
Trending Now
Can you define these popular missing words?
Photos & Videos
A formal piece of clothing worn by men, and has no perverted sexual meaning, whatsoever. It has nothing to do with sex positions, manuvers, or anything related. Just a piece of clothing usually worn with a suit or tuxedo.
1. Hey, that Bow Tie looks great on your tuxedo.
2. Hey, this word doesn't have anything to do with sex.
3. 95% of things on this site are sex-related. wtf, u pervs.
2. Hey, this word doesn't have anything to do with sex.
3. 95% of things on this site are sex-related. wtf, u pervs.
di mynameiswilly 21 maggio 2009
(Verb) When one tittyfucks a girl upside down, letting there balls rest on the girls neck comfortably. Therefore, resembling in the look of a bowtie.
"Yo, I gave Hayley a bowtie last night. It was awesome!"
di Tu madre! 12 dicembre 2006
another word for a chevy, and/or its the logos name for chevrolet
just a nice guy in a bowtie...oh and fords suck
di FoSho 04 maggio 2005
Synonymous with cool. See fez.
"Bow ties are cool."
di Doctor whom? 29 ottobre 2012
a incredibly fashionable and sexy clothing item worn around the neck. often worn at formal occasions but also as a growing fashion statement with the alternate youth
i love to wear a red bow tie in school
di john griffon 15 settembre 2006
The coolest clothing item.
Only accessory cooler than a fez.
Only accessory cooler than a fez.
"I wear a bow tie now. Bow ties are cool!"
di 1026cm 06 settembre 2013