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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.
Sore throat is a symptom resulting from inflammation of the upper respiratory tract. Four regions are principally involved - the pharynx, the larynx, the tonsils and (rarely) the epiglottis.
Because sore throat is a symptom rather than a specific condition, estimates of incidence vary. The symptom is in any case likely to be under-reported, as it is often self-limiting and a clinician may not be consulted.
Sore throat is usually due to a viral infection. The most common bacterial agent is Group A beta-haemolytic streptococcus (GABS).[1] Asymptomatic nasal carriage of Group A streptococci is very common, especially in very young children.[2]
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The symptom of soreness on swallowing may be accompanied by fever and symptoms of upper respiratory tract infection such as headache, malaise, rhinitis and cough. Hoarseness may be present if there is laryngeal involvement.
Specific enquiry should be made about:
- Duration and severity of symptoms
- Any self-medication/over-the-counter treatment
- History of any comorbidities, previous risk factors, relevant past history
- Presence of trismus
- Feeling systemically unwell
- Dysphagia
- Rash
- Stridor
- Examination of the throat using a tongue depressor should not be attempted in patients with stridor, as epiglottitis may be present and examination may provoke laryngeal obstruction.
- Examination of the throat may reveal redness of the pharynx and tonsils, enlargement of the tonsils, presence of exudate and enlarged tender cervical lymph glands.
- Differentiating a viral sore throat from that caused by GABS on the basis of examination is difficult. The Centor Criteria may be helpful in this respect:[1]
- Tonsillar exudate
- Tender anterior cervical lymph nodes
- Absence of cough
- History of fever
- The presence of three or four of these signs suggests that the possibility of the patient having GABS is 40-60%. Conversely, patients without three or four of the signs imply an 80% chance of a viral infection.
- Centor Criteria may also be helpful in managing patients with tonsillitis. The presence of three out of four of the signs increases the possibility of quinsy to 1:60 compared with 1:400 for patients who do not.
- A scarlet fever-like rash (red punctate skin eruption, prominent in the skin creases), a flushed face, circumoral pallor and a 'strawberry tongue' suggest the possibility of a streptococcal infection.
Differential diagnosis[3]
- Coxsackievirus infection
- Infectious mononucleosis
- Malignancy (pharynx, tonsils, larynx)
- Diphtheria (very rare since immunisation)
- Investigation in primary care is not usually necessary. Some authorities recommend investigation, as this reduces the overdiagnosis of bacterial sore throat. However, in the context of UK general practice, the turnaround time for swab and serum results makes it unlikely that the results would make much difference to the immediate management of the patient. However, if symptoms and/or signs are prolonged, severe or atypical, investigation should be considered.
- Rapid antigen tests may be helpful but research shows no clear benefit over using a clinical score alone.[5]
- Throat swab - this may be helpful if Centor Criteria suggest bacterial infection or there is exudation or excessive erythema.
- FBC and glandular fever screening test - these may be helpful if glandular fever is suspected.
- Antistreptolysin O (ASO) titres - these may be useful in excluding recent streptococcal infection in patients who are systemically unwell or have prolonged symptoms.
It should be remembered that sore throat is a symptom of an underlying condition and efforts should be made to make an accurate diagnosis before considering treatment. The National Institute for Health and Care Excellence (NICE) recommends offering clinical assessment to all patients presenting with sore throat. For further details, see our separate articles on Laryngitis and Epiglottitis.
- Doctors and patients can use Decision Aids together to help choose the best course of action to take.
- Compare the options
- Sore throat is usually a self-limiting condition and patients should be told to expect natural resolution in one week.
- The patient should be advised to rest and avoid social contact to guard against transmitting the infection.
- Antipyretic analgesics like paracetamol and ibuprofen are of value.
- Gargles are anecdotally helpful but the evidence base is lacking.
- One study confirmed the effectiveness of over-the-counter lozenges containing amylmetacresol and 2,4-dichlorobenzyl alcohol (Strepsils®).[6]
- Studies looking at other remedies (for example, zinc lozenges, and Chinese and herbal medicines) found no clear evidence of benefit.[7]
- Antibiotics:
- NICE recommends three options: no antibiotics, delayed antibiotics and immediate prescription of antibiotics.[4]
- A discussion with patients/parents/carers should take place as to which strategy is best for individual patients. This decision should be based on a clinical assessment of severity and the presence or absence of three or more Centor Criteria (presence of tonsillar exudate, tender anterior cervical lymphadenopathy or lymphadenitis, history of fever and an absence of cough). Reassessment should be offered if the condition does not settle or if it worsens.
- If a delayed prescription is given, patients should be advised to use it if symptoms worsen or if the sore throat does not settle in a week. Reassessment should be offered if symptoms persist despite treatment.
- Immediate antibiotic should be offered to patients who are systemically very unwell, have peritonsillar abscess or cellulitis, or a significant comorbidity (eg, heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis).
- A Cochrane review found that there was a trend for protection against acute glomerulonephritis by antibiotics but insufficient cases were recorded to be sure of this effect.[8] Several studies found benefit from antibiotics for acute rheumatic fever, which reduced this complication; however, rheumatic fever is rare in Western societies in the 21st century. Antibiotics reduced the incidence of acute otitis media to about one quarter compared with placebo and reduced the incidence of acute sinusitis to about a half of that in the placebo group. The incidence of quinsy was also reduced. Symptoms of headache, sore throat and fever were reduced by antibiotics to about a half but the greatest time for this to be evident was around 3.5 days when the symptoms of about 50% of untreated patients had settled. The review concluded that antibiotics confer relative benefits in the treatment of sore throat but the absolute benefits are modest and at the cost of treating many with antibiotics who will derive no benefit. Antibiotics shorten the duration of symptoms but by a mean of only one day about half way through the illness and by about 16 hours overall.
- For adult patients requiring antibiotics, phenoxymethylpenicillin 500 mg two to four times daily for 10 days is the first choice. Erythromycin 500 mg twice daily or 250 mg four times daily for 10 days is an alternative for patients allergic to penicillin. Lower doses will be required for children.
- Erythromycin can also be used for treatment failures, which sometimes occur with penicillin. The course need only be five days. 5% to 35% of patients do not have bacteriological eradication with penicillin.[9] This may be due to to commensal infection with bacteria that produce beta-lactamase or poor penetration of penicillin into tonsillar tissues.
- Amoxicillin or ampicillin should be avoided, especially in adolescents and young adults because, if the diagnosis is really glandular fever, it will produce a rash, even in the absence of allergy to penicillin.
- Delayed prescriptions - a review of nine trials found that patient satisfaction was greater with immediate prescription, and that there was a small difference in the speed of relief of fever, pain and malaise in some of the studies, but not in others.[10]
- NICE recommends three options: no antibiotics, delayed antibiotics and immediate prescription of antibiotics.[4]
Referral criteriaNICE has produced guidance on the referral of children with recurrent episodes of acute sore throat, up to the age of 15 years.[11]
- Refer same day for suspected quinsy, or if swelling is causing any airway obstruction, marked swallowing difficulty with dehydration and/or systemic upset.
- Refer urgently (eg, within two weeks) if there is a history of sleep apnoea (daytime sleepiness, failure to thrive), or suspicion of an underlying disorder such as leukaemia.
- Routine referral is appropriate if patients have five or more episodes of sore throat in the previous year - significant to affect day-to day activities - or if they have guttate psoriasis exacerbated by acute tonsillitis.
Suppurative complications
- Otitis media
- Sinusitis
- Peritonsillar abscess (quinsy)
- Cervical adenitis
- Scarlet fever
- Streptococcal toxic shock syndrome (rare)
Nonsuppurative complications
- Rheumatic fever(rare in developed countries but still quite prevalent in developing countries)
- Post-streptococcal glomerulonephritis
- Guttate psoriasis - may flare up in the presence of a streptococcal infection[12]
One study found that symptoms settled in 40% of patients within three days and 80% of patients within one week, irrespective of whether the cause was viral or streptococcal.[8]
Further reading & references
- Aalbers J, O'Brien KK, Chan WS, et al; Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med. 2011 Jun 1;9:67. doi: 10.1186/1741-7015-9-67.
- Donkor ES; Understanding the pneumococcus: transmission and evolution. Front Cell Infect Microbiol. 2013;3:7. doi: 10.3389/fcimb.2013.00007.
- Sore throat - acute; NICE CKS, October 2012 (UK access only)
- Respiratory tract infections – antibiotic prescribing: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care; NICE Clinical Guideline (July 2008)
- Little P, Hobbs FD, Moore M, et al; Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ. 2013 Oct 10;347:f5806. doi: 10.1136/bmj.f5806.
- McNally D, Simpson M, Morris C, et al; Rapid relief of acute sore throat with AMC/DCBA throat lozenges: randomised Int J Clin Pract. 2009 Oct 22.
- Pelucchi C, Grigoryan L, Galeone C, et al; Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012 Apr;18 Suppl 1:1-28. doi: 10.1111/j.1469-0691.2012.03766.x.
- Spinks A, Glasziou PP, Del Mar CB; Antibiotics for sore throat. Cochrane Database Syst Rev. 2013 Nov 5;11:CD000023.
- Brook I; Overcoming penicillin failures in the treatment of Group A streptococcal pharyngo-tonsillitis. Int J Pediatr Otorhinolaryngol. 2007 Oct;71(10):1501-8. Epub 2007 Jul 17.
- Spurling GK, Del Mar CB, Dooley L, et al; Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004417.
- NICE 'referral advice' recommendations database; National Institute for Health and Care Excellence
- Nahary L, Tamarkin A, Kayam N, et al; An investigation of antistreptococcal antibody responses in guttate psoriasis. Arch Dermatol Res. 2008 Sep;300(8):441-9. Epub 2008 Jul 22.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
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SALT LAKE CITY -- It seems as if LeBron James is everywhere.
Turn on the TV or radio, there's LeBron. Open a newspaper, there's LeBron. Go to the Internet, more LeBron.
For Cavaliers fans who'd just as soon put him out of their minds, it has not been an easy week.
First he became the youngest player to score 20,000 points. Then he was voted in as an All-Star starter again. Through it all, there was talk about whether he'd come back to Cleveland if/when he opts out of his contract in the summer of 2014.
Much of that talk this time around was prompted by a story by Jason Lloyd in the Akron Beacon Journal last Sunday, although no one is more surprised at the reaction than Lloyd, who was writing about how the Cavs are unlikely to make a trade at the trading deadline this season now that Anderson Varejao is out after surgery. He did make a mention that the Cavs don't want to take on any bad contracts so they can keep their options open in the summer of 2014 when James could be a free agent, but that was not the focus of his story.
James, of course, opened this can of worms last season when he told reporters in Cleveland he'd be open to returning. Since then there have been other baby steps that could hint at a reconciliation. James changed agents to Benedictine graduate Rich Paul, who also represents Tristan Thompson. Cavs owner Dan Gilbert said he regretted saying the Cavs would win a championship before James, although he has yet to say James' name, calling him "the player who left."
Presumably, that would have to change when -- and if James -- actually decided to come back. Until then, it's going to be a long 18 months of speculation about The Decision II.

subset: commoncrawl


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Library unveils community calendar
February 19, 2013
The James V. Brown Library recently unveiled a new online calendar that it hopes not only will connect the community but showcase the many activities the city has to offer....
The Library offers tons of great programs, classes, and other activities that encourage, not just community involvement, but family involvement. It's great to see they are making these things more available to the public.
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The Green Bay Packers weren't able to end their recent slide against the New York Giants on Sunday. While the game was close for most of the afternoon, the Packers ultimately fell by a score of 27-13 in New York.
It wasn't a great game from either the offense or defense this week. While the defense did finally get a turnover via an interception from Tramon Williams, quarterback Scott Tolzien threw three picks of his own to negate the good play from Williams. The defense also gave up a whopping 334 yards of total offense.
Overall, the Packers struggled to make enough plays on either side of the ball this week.
Here are some other takeaways from Green Bay's 27-13 loss to New York.
*All stats via NFL.com.


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AMCOMET to Link WMO, African Space Programmes
30 May 2014: At its Second Bureau Meeting, the African Ministerial Conference on Meteorology (AMCOMET) decided to link the African Space Programme with the World Meteorological Organization (WMO) Space Programme. AMCOMET also agreed on an updated Implementation and Resource Mobilization Plan and initiated the establishment of a Regional Climate Center in Central Africa.
The Bureau met from 29-30 May 2014, in Harare, Zimbabwe, and was preceded by the meetings of three Task Forces, which took place from 26-28 May 2014. These Task Forces made recommendations for the Bureau's consideration.
Following the recommendations of the Task Force on the Joint African Regional Space Programme, the Bureau requested the African Union Commission (AUC) and the African Ministerial Conference on Science and Technology (AMCOST) to link the African and WMO Space Programmes and integrate the Programmes with other regional programmes, such as the Monitoring of Environment for Security in Africa (MESA) and the African Satellite Meteorology Education and Training (ASMET) programme.
Based on the work of the Task Force on the Implementation and Resource Mobilization Plan of the Integrated African Strategy on Meteorology (Weather and Climate Services), the Bureau asked the Economic Community of Central African States (ECCAS) and the Economic and Monetary Community of Central Africa (CEMAC) to begin the process of establishing a Regional Climate Center in Central Africa.
As recommended by the Task Force on the Constitution and Rules of Procedure, the Bureau also took decisions on AMCOMET's structure, adopting "the same governance mechanism and structure [...] as a Joint Meeting of AU-WMO and with the same arrangement for the meeting of African Ministers of Finance, Planning and Economic Development."
AMCOMET was established in 2010 as a joint initiative of WMO and AUC. It promotes the development of meteorology, its applications in Africa and its contributions to socioeconomic development. WMO serves as AMCOMET's secretariat. [WMO Press Release] [IISD RS Sources]


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Senior Mapping Geologist
Location: Keyworth
Tel: 0115 936 3170
E-mail Mr Mark Barron
Barron, A J M, Lott, G K, and Riding, J B. 2012. Stratigraphical framework for the Middle Jurassic strata of Great Britain and the adjoining continental shelf. British Geological Survey Research Report RR/11/06.
Barron, A J M, Sumbler, M G, and Morigi, A N. 1997. A revised lithostratigraphy for the Inferior Oolite Group (Middle Jurassic) of the Cotswolds, England. Proceedings of the Geologists' Association, Vol. 108, 269-285.
Barron, A J M, and Riding, J B. 2014. A revision of the Jurassic (Bathonian to Oxfordian) lithostratigraphy of the onshore Moray Firth Basin, north-east Scotland. Proceedings of the Geologists' Association, Vol. 125, 74-82.
Farrant, A R, Noble, S R, Barron, A J M, Self, C A, and Grebby, S. 2015. Speleothem U-series constraints on scarp retreat rates and landscape evolution: an example from the Severn valley and Cotswold Hills gull-caves, UK. Journal of the Geological Society of London, Vol. 172, 63-76.
Woods, M, Barron, M, Hobbs, P, and Boon, D. 2007. Rock, Rail and Roade - uncovering a geological treasure. Geology Today, Vol. 23, 227-230.
Barron, A J M. 2000. Broadway Quarry, Worcestershire: an enlarged section in the Inferior Oolite Group. Proceedings of the Cotteswold Naturalists' Field Club, Vol. 41, 309-321.


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RESOLUTION 126, requesting that the American Medical Association (AMA) study the issue of product liability and personal injury as it relates to tobacco use, and Resolution 140, requesting the AMA to study tobacco product liability/personal injury law and the role of the medical community in such suits, were referred to the Board of Trustees for a report at the 1985 Interim Meeting. The results of the Board's study are set forth in this report.
In the past, tobacco companies have been held civilly liable when their product contained foreign objects such as human toes, mice, small snakes, nails, fishhooks, firecrackers, steel particles, and worms.1 However, no tobacco company has ever been held responsible for a death, disability, or disease caused by smoking.2 During the late 1950s and the 1960s, ten lawsuits against cigarette companies were filed on behalf of smokers with lung cancer.3 Four of
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Despite no rain falling over O.co Coliseum in Oakland, the game between the Athletics and Mariners was postponed due to poor field conditions. The Athletics tweeted the news:
Due to field conditions, tonight's game is postponed. Retain tickets & parking receipts as they will be honored at announced make-up game.— Oakland Athletics (@Athletics) April 5, 2014
According to DonBest.com, the game won't be made up during what supposed to be a four-game series:
Tonight's Seattle Mariners vs. Oakland A's game has been postponed due to field conditions. It will not be made up this weekend. #MLB— DonBest.com (@DonBestSports) April 5, 2014
The reason for the postponement was human error. MLB.com's Greg Johns explains:
O.co Coliseum infield wasn't covered with tarp overnight during heavy rain, leading to field issues. #Mariners and A's will play two on Sat.— Greg Johns (@GregJohnsMLB) April 5, 2014
So, we have one of the more unique postponements we'll ever see, but it is a postponement nonetheless.
In fact, the field was so bad, Mariners manager Lloyd McClendon wasn't even sure they'd be able to play tomorrow. Johns tweeted that information:
McClendon when asked if he was certain field would be ready by tomorrow: "I really am not sure. It's that bad out there."— Greg Johns (@GregJohnsMLB) April 5, 2014
The Mariners would appear to be bad luck for the O.co. It was last season following a game between Oakland and Seattle when the outdated stadium was backed up with raw sewage.
If the game is played tomorrow, Johns gives us the pitching matchup:
Dan Straily will get the start for the A's on Saturday vs. Felix Hernandez. Straily originally slated for tonight.— Greg Johns (@GregJohnsMLB) April 5, 2014
Chris Young was scheduled to get the start for the Mariners on Friday, but it appears the plan is to skip his turn in the rotation.
The series between the division rivals began on Thursday in thrilling fashion, as the A's handed the Mariners their first loss of the season with a 3-2 victory in the 12th on a Coco Crisp home run.
At the time of the postponement, the Mariners sat in first in the American League West at 3-1. The A's were a game behind at 2-1.


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Seneca County Department of Job and Family Services provided more than 50 local youths with jobs through its Youth Work Program this summer.
Director Kathy Oliver said the state Department of Job and Family Services provided funds to run the program this year, giving more youths the opportunity to participate.
The Temporary Aid for Needy Families Youth Summer Work Program started in February and is to run until Aug. 31. The TANF program was designed to help needy families become self-sufficient.
Article Photos
Justin Romig (left) and Kalob Vargas work on landscaping at the Department of Job and Family Services.
Above and below, Justin Romig (left) and Kalob Vargas work on landscaping at the Department of Job and Family Services.
Eligibility is based on ages and amount of need. Youth between ages 14-18 are eligible as long as the individual is in a needy family and still in school. Those ages 18-24 can apply for the program if they are in a needy family that also cares for a minor or if the individual cares for a minor and is considered needy.
Carol Owen, workforce development administrator, said the program gives eligible youth the opportunity to develop a work history and have references, along with a paycheck.
"It's a great benefit for the employers, too," Owen said. "We're reimbursing their wages up to $10 an hour. The only thing they're liable for is any worker's (compensation) claims."
Since February, 154 youths have applied for the program, and some applications are still pending. Only 20 have been denied due to having too much income or not meeting other requirements.
Sixty-six youths have been placed in jobs through the program.
"Some of them don't work out because we tell the employers, 'They are your employee.' We're reimbursing the wages, we can help do some of the mentoring, some of the job development, but they are their employees," Owen said. "If they're not working out, not showing up, they're going to handle them like they would any other employee."
The program works with EHOVE Career Center, which places the students in job opportunities. The vocational school has a contract with DJFS to provide the job development and placement. They find and offer opportunities in manufacturing, customer service, landscaping and yard work.
"There's enough (of) a variety that the youth can be exposed to a lot of different things," said Walter Stahl, grant coordinator at EHOVE.
Besides the summer program, EHOVE runs a year-long program through the Youth Workforce Investment Act. The longer program provides a more comprehensive opportunity.
"It'll take a look at developing workforce skills, so that may include finding a training provider, taking a look and identifying what the long-term goals are, taking a look at what the youth would actually like to do, so we have some different types of assessments that we can take a look at and try to identify what the person would like to do long-term," Stahl said.
Several establishments in the county have provided job opportunities through the summer program, including Seneca Lanes, Carmie's and Tiffin City Schools.
"One of the employers I'm excited about this year is American Fine Sinter," Owen said. "They're getting ready to expand, so they have a need. So, they're hiring some of the older youth, some of the 18-24 year group, and those are working out very well. ... but we're really hoping that, because they're going through an expansion, those placements will turn permanent."
This also is the first year the program has partnered with Sentinel Career Center. This gives the program the opportunity to find youths with skills and placing them in jobs where they get more experience in that particular field.
Owen said one of the youth who was placed in the factory was studying welding at Sentinel Vocational Center.
"He's been working at AFS this summer and getting some valuable experience," Owen said.
Kalob Vargas and Justin Romig have been doing landscaping and janitorial work at the DJFS office. After three weeks, they have detailed the agency's 14 vehicles and started clearing stones in front of the buildings, among other jobs.
Both said they would participate in the program again if they had the opportunity.
Vargas, a junior at Columbian High School, said he was in the program last year and got involved again when representatives came to the school.
"After I get out of high school and Sentinel, I was thinking about being an electrician," he said.
Romig, a senior at Bridges Community Academy, got involved because of his cousins.
"My cousins worked here," he said, "So they told me to get a job here."
When he graduates, he said he wants to be a construction manager.
"They're good kids; they're doing a nice job. They're really working," Oliver said.
The program is not accepting any more applications. Additional information and applications for next year are available at djfs.co.seneca.oh.us or by calling (419) 447-5011.


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Posts Tagged 'Seattle'
Wine, Chocolate, and Yoga
Three of the best things in life, in our opinion, are wine, chocolate, and yoga. That's why we're hosting a Wine, Chocolate and Yoga workshop at our Carson Ridge private luxury cabins. Join us May 27-29, 2011, and indulge your body and soul. Have you ever experienced chocolate with every part of your being? Have… Read more »
Reconnect with the Goddess in You
The first of our 2011 Goddess Within Workshop Series takes place this Saturday, March 19, at our Columbia River Gorge Lodge. These workshops coincide with the changing of the seasons: Spring Equinox: March 19, 2011 Summer Solstice: June 25, 2011 Autumn Equinox: September 24, 2011 Winter Solstice: December… Read more »
Senior Discounts at Columbia River Gorge Cabins
Wine becomes better with age, as does whisky and most cheese. Well-cared-for antiques are treasured, as are finely restored historic buildings. People flock to hear Placido Domingo and Paul McCartney, and are awed by the irrepressible talent of Morgan Freeman and Helen Mirren. In short, aged items and people are often held in high esteem,… Read more »
Calling All Gardeners
Do you love to sink your hands into fertile soil? Does growing organic food deeply satisfy you? Do you enjoy working with others? If so, consider spending a weekend in the gardens of our Hood River Cabins. Join us for How Our Community Garden Grows, April 15 – 17 (once the ground has thawed and… Read more »
Columbia Gorge Cabins Encourage Romance in February
Valentine's Day falls on a Monday this year, which means lovers may benefit from Weekday Discounts at our Romantic Columbia River Lodging. Stay at our Carson WA Cabins Sunday through Thursday and receive one of the following complimentary gifts: • Stay 2 nights and receive a $50 credit toward a spa treatment or gift shop… Read more »
February Valentine's Special
It's easy to brush Valentine's Day off as a Hallmark Holiday. After all, why must you declare your love through chocolates and flowers on February 14, just because the calendar says it's Valentine's Day. Just who was this Valentine, anyway? Valentine is thought to have been a Roman priest or bishop who lived in Rome… Read more »
Create a Peaceful Mind
Atisha, a Buddhist teacher from the first century, said that the greatest goodness is a peaceful mind. We agree. Without a peaceful mind, one cannot know oneself, and without knowing oneself, one cannot know others. We're offering a special Personal Retreat at our Hood River Cabins throughout the month of January. First and foremost, we… Read more »
Give the Gift of Travel
Still searching for that perfect gift for someone? Consider giving the gift of escape. Purchase a gift certificate for our Hood River Cabins prior to December 24, 2010 and receive a 10% discount; that's like two gifts in one! Consider the benefits of such a gift: Gift certificates to our Columbia River Gorge Romantic Lodging… Read more »
Columbia River Gorge Personal Retreat: New Year, New You
The holidays are a wonderful time filled with family, friends, and feasts. Yet the period between Thanksgiving and New Year's may also turn into a frenzied whirlwind of activity with nary a minute of rest. We travel, we cook, we clean, we host, we're guests, we make gifts, we buy gifts, we work, we spend… Read more »


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The Easter holidays bring changes to the routine business of living in the Texas Panhandle.
Easter proves to be a mixed bag for governmental offices. Randall County offices are closed today, but Amarillo government offices and Potter County offices are open today and Monday.
Amarillo branches of state and federal offices will be open today and Monday.
Residents don't necessarily have to shop ahead for Sunday dinner, as Albertson's and Homeland Stores will be open regular hours.
United Super Markets will be closed Sunday.
Banks will be open regular business hours, as will retail outlets at Western Plaza and Westgate malls. Convenience stores generally will be open.
The Postal Service will be open regular hours and will deliver mail as usual.
The Amarillo Public Library system will be open for regular business.
Utility company emergency numbers will be in effect during the weekend, and any emergency services that are functions of government agencies will also be in operation.
Amarillo Independent School District, Canyon ISD, Highland Park, Bushland and River Road students will be out of school today and Monday.
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Rhythm Band Set of 24 Rhythm Sticks
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Rhythm Band
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Comments about Rhythm Band Set of 24 Rhythm Sticks:
Three Kindergarten classes, 4 weeks of use. Can't see any degradation in paint finish. Smooth finish with the tiniest bit of texture; different than what I've purchased before for classroom rhythm sticks. Bought 24 more pairs after the first 24!


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Here is the most trivial bit of math you may ever read:
We start with the premise that half the business trips out of Huntsville International Airport to Washington, D.C., Orlando and Houston are somehow NASA- and aerospace-related.
Using that supposition, NASA would have to launch four round-trip flights to the moon on every business day of the year to match the miles flown annually from Huntsville to those three destinations on space business, and back.
That's nearly 50 million miles of travel. Give or take a holding pattern over Reagan National.
It's more than obvious that most business travel in and out of Hunts-ville is related to the aerospace and missile-defense industries, with the presence of Redstone Arsenal and NASA's Marshall Space Flight Center and the presence of the countless companies related to them.
The six airlines serving Huntsville fly nonstop to 12 destinations - Atlanta, Baltimore-Washington, Charlotte, Chicago, Dallas-Fort Worth, Denver, Detroit, Houston (George Bush International), Memphis, Orlando, Ronald Reagan Washington National and Washington Dulles.
That doesn't include hubs such as Atlanta, Memphis and Charlotte.
Statistics from Huntsville International Airport don't differentiate between business and leisure travelers for specific destinations. However, according to Laura Gipson, public relations manager for the airport, 68 percent of the travel through the airport is for business.
That's why Huntsville had the dubious distinction of having the highest fares in the nation, because businesses and government entities don't balk as much at higher fares, are willing to pay for convenience, and often make spur-of-the-moment trips with high walk-up fares.
Because there are no official numbers, it's merely a well-educated guess to designate the following as the top five business destinations:
1. Washington, D.C.
It's served by Delta and USAirways on direct flights to Washington National, by United on direct flights to Dulles, and by AirTran on direct flights to Baltimore-Washington.
Washington National is overwhelmingly the top destination; Baltimore was actually the No. 6 destination and Dulles No. 7 in the first quarter of 2010. There were 147,003 arrivals and departures involving Huntsville and the three D.C. airports from January through March.
The countless layers of government and NASA business are two major reasons for flights to the District and nearby Fort Meade.
BWI handles much military travel and boasts the largest USO headquarters in a United States airport, and Baltimore's Johns Hopkins has one of the top medical centers in the nation and serves some Huntsville patients.
2. Orlando
It's served on direct flights by AirTran. It's served by 17 daily flights from Delta's Atlanta hub and three through Memphis.
The extra part of that trip is the flat, sandy 26-mile path on SR-528, heading east from the Orlando airport toward Kennedy Space Center, 40 or so miles away, depending on the specific destination at the Cape.
3. Dallas
It's served on direct flights by American.
Travelers are going there "because it's Texas, and for all the different companies out there," said Faye McWhorter of Elite Travel. "And not," she quipped, "just for Neiman-Marcus."
4. Houston
It's served on direct flights into Houston-George Bush International by Continental.
Johnson Space Center is NASA's lead space center. As a result, many companies related to the aerospace industry have operations there.
5. Los Angeles
There are no direct flights, though there are frequent one-stop connections through Atlanta, Dallas, Memphis and Chicago.
Lockheed Martin's operations in the L.A. suburb of Sunnyvale and Northrop Gruman's Los Angeles facility drive much of the traffic between Huntsville and the Left Coast.
There was a noticeable spike in travel figures to Los Angeles, moving up to No. 2 in the first quarter of 2010, from fifth in the final quarter of '09.
According to Gipson, "Parking was up 25 percent for the week of Jan. 6 over the same week in 2009."
That's a pretty easy mystery to solve. That week, Alabama was playing for the BCS National Football Championship in the L.A. neighbor city of Pasadena.
It just proves what we've already known, that in these parts, football is more serious business than anything.


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Pikeville Summer Blast ends summer on a fun note, but remembers 9/11
By Gary Popp
Published in News on September 14, 2011 1:46 PM
Full Size
News-Argus/MICHAEL K. DAKOTA
Cheyenne Saunders, 9, and sister Kaleigh, 9, enjoy a frozen treat during the Summer Blast in the Park in Pikeville Saturday evening.
PIKEVILLE -- During the third annual Summer Blast in the Park Saturday, residents took time for carefree recreation and heartfelt remembrance of those who lost their lives on 9/11. The festival began with a somber opening that included a...
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"Through Jeff's vision and leadership, Somerset Home has grown from a single youth shelter for a dozen children in 1982 to a $3.5 million agency with facilities and programs that annually help hundreds of abused, neglected and homeless youth," said Claire Calandra, chairman of the board of trustees. "Jeff has been a passionate advocate for vulnerable youth on the local, state and national levels, helping policymakers understand the issues and how alternative housing programs are cost-effective and produce better outcomes," she said.
"On behalf of the thousands of young people who have benefited from Somerset Home's many services, we extend our sincere gratitude to Jeff for leading the way for so many years," Calandra said.
Fetzko serves on the executive board of the N.J. Alliance for Children, Youth and Families (njacyf.org) and is treasurer of the National Network for Youth (nn4youth.org). He is also president of the N.J. Social Services Purchasing Alliance (sspanj.org), which allows social service agencies to purchase health and dental insurance at reduced rates.
Calandra said the Somerset Home board has established a search committee to identify a new executive director. In the meantime, she said, board member Raymond Fantuzzi is serving as interim executive officer.
"We anticipate no changes in our operations during this transitional period," Calandra said.


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From Institute for Work & Health and University of Toronto, Toronto, Ontario, Canada; Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands; Finnish Office for Health Care Technology Assessment, National Research and Development Centre for Welfare and Health, Helsinki, Finland; and Erasmus University Medical Center, Rotterdam, the Netherlands.
Acknowledgments: The authors thank Drs. Jens Ivar Brox and Jan Lonn and Mr. Arne Naess for their assistance with the quality assessment and data extraction from non-English-language studies; the Physiotherapy "Educational Influentials" from the Institute for Work & Health for their guidance with syntheses; Emma Irvin, medical librarian at the Institute for Work & Health, for her assistance with the search strategy; Victoria Pennick for her assistance with editing; and Rosmin Esmail for her contribution to the original version of this review.
Grant Support: No external project funding was obtained for this study. Dr. Hayden is funded by a postdoctoral fellowship award from the Canadian Institutes of Health Research and Canadian Chiropractic Research Foundation.
Potential Financial Conflicts of Interest: None disclosed.
Corresponding Author: Jill A. Hayden, DC, Institute for Work & Health, 481 University Avenue, Suite 800, 8th Floor, Toronto, Ontario M5G 2E9, Canada; e-mail, email@example.com.
Current Author Addresses: Dr. Hayden: Institute for Work & Health, 481 University Avenue, Suite 800, 8th Floor, Toronto, Ontario M5G 2E9, Canada.
Dr. van Tulder: Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
Dr. Malmivaara: Finnish Office for Health Care Technology Assessment, PO Box 220, FIN-00531 Helsinki, Finland.
Dr. Koes: Department of General Practice, Erasmus University Medical Center, PO Box 1738, 3000 DR Rotterdam, the Netherlands.
Background: Exercise therapy is widely used as an intervention in low back pain.
Objective: To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments.
Data Sources: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews.
Study Selection: Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes.
Data Extraction: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up.
Data Synthesis: 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, −1.3 to 1.4 points]).
Limitations: Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias.
Conclusions: Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a graded-activity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments.
Results shown are mean change on a 100-point scale (lines are 95% CIs). Clinically important improvement is considered to be 20 of 100 points for pain intensity and 10 of 100 points for functional impairment.
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May 9, 2005
To the Editor Annals of Internal Medicine 190 N. Independence Mall West Philadelphia, PA 19106-1572
To the Editor,
The articles by Hayden et. al.1-2, review treating back pain of varying duration with exercise. The authors indicated in their discussion that there is more specific data available regarding the studies examined. As recommending exercise is a cornerstone for medical practice in general and is often cited as being recommended in back pain patients, I am curious if they could provide information on the duration of follow up in their studies evaluating the exercise intervention. A short term follow up may underestimate long term gain when a patient institutes a physically active lifestyle. The literature continues to identify exercise as increasing productivity and decreasing disability3.
Mark Hyman
1Hayden JA, van Tulder MW, Malmivaara AV, et. al. Meta- analysis:Exercise for nonspecific low back pain. Ann Intern Med.2005;142:765-775.
2Hayden JA, van Tulder MW and Tomlinson G. Systematic review:Strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med.2005;142:776-785.
3Burton WN, McCalister KT, Chen C, et. al. The association of health status, worksite fitness center participation, and two measures of productivity. J Occup Environ Med. 2005;47:343-351.
None declared
The application of meta-regression analyses to a meta-analysis of RCTs investigating exercise for chronic low back pain presents a practical and constructive approach to synthesis of the literature. We commend Hayden et al2 for the breadth of their study and attempts to deal with the complexities inherent in the topic. The depth of analysis is impressive and the blend of quantitative and qualitative methods provides a distinctive insight into the relevant issues.
There are however, some methodological issues of concern. The authors excluded studies on the basis of "˜low back pain caused by specific pathologies or conditions'. We assume that these "˜specific pathologies or conditions' include radiologic diagnoses of degenerative disc disease and spondylolisthesis because some studies that specifically investigated these diagnoses were not included, such as the studies by Ghoname1 and O'Sullivan4. As there is a poor correlation between such radiologic findings and LBP symptoms5, there is some question as to whether these exclusions are supportable. Moreover given the prevalence of these radiologic findings, it is probable that other included studies enrolled patients with these radiologic findings.
There also appears to be some inconsistency with which the criterion of LBP duration was applied during assessment of studies for inclusion in the analysis of chronic LBP. A significant number of studies that included patients with LBP of less than 3 months duration were not recognized by the authors as "˜mixed populations' (in Appendix Table 12 incl. refs: 26, 31, 32, 34, 40, 43, 48, 49) and therefore presumably were not included in the sensitivity analysis. This point is particularly pertinent in light of the contention that duration of LBP influences the efficacy of exercise.
A potential solution to this problem may be available within the meta -regression model employed in the companion paper3. By including a category describing "˜chronicity' as a variable within the model, quantitative data could be generated regarding the apparent correlation between exercise efficacy and duration of LBP while controlling for the effects of the other selected factors.
The methodological rigour and application of innovative statistical techniques demonstrated by the authors of this review are deserving of commendation. However some apparent flaws in the data collection process make interpretation of the results as presented somewhat difficult.
Steven Kamper, Christopher Maher, Kathryn Refshauge, James McAuley.
1. Ghoname EA, Craig, WF, White PF, Ahmed HE, Hamza MA, Henderson BN et al. Percutaneous electrical nerve stimulation for low back pain. JAMA. 1999;281:818-23
2. Hayden JA, van Tulder MW, Malmivaara AV, Koes, BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142:765-75
3. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142:775-85
4. O'Sullivan PB, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22:2959-67
5. van Tulder MW, Assendelft WJJ, Koes BW, Bouter LM. Spinal radiographic findings and non-specific low back pain: a systematic review of observational studies. Spine. 1997;22:427-34
Exercise for Low Back Pain
The summary below is from the full report titled "Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain." It is in the 3 May 2005 issue of Annals of Internal Medicine (volume 142, pages 765-775). The authors are J.A. Hayden, M.W. van Tulder, A.V. Malmivaara, and B.W. Koes.
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Oregon Scientific SE138 Strap-Free Heart Rate Monitor, Black, 1 ea
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Hate to wait? These tips will help you spend less time languishing in long lines at the store or thumbing through ancient magazines at the doctor's office. With a bit of planning, you can win the waiting game.
The most basic step is to avoid the trip altogether.
Buy your stamps by mail instead of driving to the post office on your lunch break. Be cautious about buying nonessentials. Do you really need that dry-clean only dress, or will it just bring more trips and expense?
Or pay someone else to do the job. Maybe there's a reliable teen-ager in your neighborhood who can do errands for you, said Janice Kemmer, who runs her own consulting company, American Business Organizers, from her home in Chino, Calif.
Shop smarter to avoid emergency trips for single items.
Example: Buy an extra bottle of shampoo. When you've used the first one, put shampoo on your list for your next trip. You'll always have a back-up. No extra trips, no waiting in line.
For meals, write down everything you use regularly. Stock up on long-lasting staples, like pasta and frozen vegetables. You should be able to limit your grocery shopping to once a week, Kemmer said.
Take advantage of the "golden hour," the first hour when business opens, said Peter Turla, author of "Time Management Made Easy" (Plume, $15.95).
An oil change at 8 a.m. may take half an hour. But in the afternoon, your wait could stretch to two hours.
Try to get the first appointment at the doctor and the dentist so you don't suffer the cumulative effects of delays.
The first appointment after lunch also can work.
You don't always have to be an early-bird. Marketing consultant Robbie Motter of Sun City, Ariz., finds herself driving home at odd hours. So she'll hit the grocery store at midnight.
"They're restocking, and they have everything fresh." And no lines.
Make the most of every trip.
Have a "to go" box or shelf near the door for items like library books that have to leave the house, Kemmer said. That way you won't forget anything.
Cluster your errands and do them in a logical order, said organization consultant Marla Benson, who runs her "DeClutter U" business from her home near the San Bernardino Mountains in California.
Example: you're driving into town for a 4 p.m. appointment with your tax accountant. Stop at Wal-Mart before the tax appointment to avoid the rush of people shopping after work.
Call ahead and speak up
Call the doctor's office before you leave for your appointment and ask if the doctor is running behind schedule, said Stephanie Culp, author of "You Can Find More Time For Yourself Every Day" (Better Way Books, $12.99).
You might want to reschedule if they're way behind.
Let them know, in a nice way, if you're made to wait too long at any business, Culp said. Go elsewhere if it keeps happening.
Appointments at the DMV or reservations for dinner are easy ways to avoid a wait. Supercuts even allows people to call ahead and get on the waiting list for a specific time.
If you must wait, make the most of your time.
Bring a file folder full of things from work you just need to read: memos, letters. Bensons suggests buying a file jacket (one of those folders closed on three sides) so stuff doesn't fall out.
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The 2012 Genie Awards are upon us once again with high hopes and low grumbling.
There are high hopes for a film industry perennially long on promise but short on delivery, and grumbling from critics who have watched the Academy of Canadian Cinema and Television, the organization responsible for the Genie and the Gemini Awards, struggle to live up to its claim that its awards are the "ultimate accolade" for Canadian films.
"To choose a good book, look in an inquisitor's prohibited list." – John Aiken
To Canadians, censorship may seem like a thing of the past, associated with book burnings and fascist regimes, but the truth is that freedom of expression is an ongoing battle. Books as recent as The Golden Compass, The Handmaid's Tale, The Catcher in the Rye, To Kill a Mocking Bird, and Of Mice and Men have appeared on Canada's list of challenged books and magazines. Considering that these titles have become celebrated classics in the modern canon, John Aiken's pithy epigram appears more true than ever.
Statistics Canada released its 2011 census information this Wednesday. The National Post has a nifty infographic that visually lays out changes in population growth. Lets take a look at the changing face of our nation, shall we?
Read More
Airs this Sunday, February 12th at 8 pm on CBC
Based on the life and writings of Stephen Leacock, Canada's first and foremost humorist, this two-hour signature television event celebrates the book's 100th anniversary. The reinterpretation of the popular work combines two key stories from Leacock's time-honoured Canadian classic of the same name, first published in 1912: the sinking of The Mariposa Belle steamer with its holiday crowd in the perilously shallow waters of Lake Wissanotti; together with the frantic campaign to save Mariposa's hotel and public bar from the Liquor Commission's shutdown. Leacock's sly, humorous portrait of small-town Canada—a portrait that mirrors the whole nation—remains intact in the adaptation.
The Queen begins a year of celebrations marking her diamond jubilee. On February 6, 1952, King George VI died in his sleep at Sandringham. His daughter Princess Elizabeth was declared Queen Elizabeth II. Since then, Queen Elizabeth has been England's oldest monarch and the second-longest reigning sovereign in British history. Celebrations marking the event will centre around the extended weekend of June 2 (the anniversary of the Queens' coronation) through to June 5.
"According to legend, the groundhog emerges from its burrow at noon on February 2 to look for its shadow. If it is a sunny day and the groundhog sees its shadow, according to folklore it becomes frightened and returns to its hole to sleep, and winter continues for 6 more weeks. If it does not see its shadow, it remains outside because the worst of winter is over and warmer weather is on its way."
-The Canadian Encyclopedia, "Groundhog Day"
Tragedy struck this week when one of Canada's top skiers Sarah Burke died from injuries while training. The four-time Winter X Games champion crashed at the bottom of a half pipe and went into cardiac arrest from her injuries. In a generous gesture of humanity, sympathizers have been donating funds to help Burke's family pay off her medical bills, which were not covered by the Canadian Freestyle Skiing Association. [Globe & Mail, CBC]
January is so often bad news, and the news of M&S's absorption into Random House dimmed the fugitive light that much more for many readers interested in Canadian literature. But one aficionado's "misguided" response to the news has captivated the Canadian googling public this week: Read More
This week, Canadian history buffs across the nation celebrated Sir John A. Macdonald's 197th birthday, remembering the contributions of our country's first prime minister and great uniter. We celebrated our early history even as one of our most storied publishing houses, McClelland and Stewart, was taken over by the German-owned Random House, leaving a big question mark as to the future of Canadian publishing and, in many ways, the question of Canadian identity.
A: Apparently to Germany. Today it was announced that the German-based publishing conglomerate Bertelsmann AG, which owns Random House, took full control of McClelland and Stewart, venerable independent Canadian publishing house and champion of Canadian literature through its flowering in the 20th century under the leadership of Jack McClelland, when it published such stars in our firmament as Margaret Atwood, Michael Ondaatje, and Farley Mowat (the triumvirate one can generally rely upon new CanLit students to name). Douglas Gibson, longtime Editor at McClelland and Stewart, became a household name himself as he steered the work of writers and the reading tastes of Canadians. The New Canadian Library, brainchild of Sinclair Ross and Jack McClelland and published by M&S starting in 1958, introduced countless Canadians to their literary history.


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Life jackets have been in the forefront of life saving since 1852 when steamboats were required to carry a life
preserver for every passenger. The best life jacket in the world is worthless, however, if it isn't being worn when it's
needed. Pennsylvania boating accident statistics show that 80% of people involved in boating-related drownings each year
are not wearing life jackets.
Since predicting an accident is next to impossible, its best to wear a life jacket at all times when on the water.
Unfortunately, some boaters don't like to wear conventional life jackets. They consider conventional life jackets to be
bulky or uncomfortable. Recent innovations in materials and designs have gone a long way toward addressing comfort.
Perhaps the most promising are inflatable live
Actually, inflatable life jackets are nothing new. But they are gaining wider acceptance as more people recognize
that the devices comfort. The low profile and weight of inflatables makes that practice more practical. In fact,
Pennsylvania Fish and Boat Commission (PFBC) Waterways Conservation Officers are now issued and wear inflatable life
jackets while theyre on patrol.
So how do inflatable life jackets work? Depending on the model, one or more air bladders inflate automatically or
manually. An automatic system inflates the life jacket when it becomes immersed in water, without any action by the
wearer. It is the closest in performance to the classic buoyant life jacket since it requires no operator intervention
to activate. This is a critical factor when the wearer is, or may be, disabled prior to or upon entering the water.
The manual system inflates when a user pulls a lanyard to activate a carbon dioxide canister. Manual systems are the
simplest to maintain. They are less susceptible to unwanted or inadvertent inflation, but rely entirely on wearer
All models also have an oral backup. The oral system requires the user to blow air into the device through a tube.
Oral inflation is considered a backup system because the effort required to use the device may be greater than the user
can provide in some circumstances.
Inflatables are approved for all adults and for children 30 pounds and over. Childrens inflatables have built-in
foam so they will float before the unit is inflated. Boaters should choose the inflation system that best meets their
personal needs.
Life jacket users prefer the comfort of inflatables to conventional life jackets, however the units must be rearmed
properly after use. The newly designed inflatables are designed to minimize the chances of improper rearming. Many
inflatables now have an indicator to minimize the risk of incorrectly resetting the inflater. Unfortunately, indicators
that show the cartridge is actually loaded are further away. But every U.S. Coast Guard-approved inflatable does come
with directions and an owner's manual. Careful reading and adherence to the instructions makes proper use easy.
Because of their design, inflatable life jackets are slightly more expensive than traditional life jackets. Average
costs range from $70 for manually inflated types up to $190 for the high-end automatics.
Its a small price to pay to save a life. The most important bottom line is its important for boaters to take the
time to choose a device that they will wear and meets the need of the activity they are participating in and will work
for the environment to which they are exposed, says Dan Martin, Boating Safety Education Manager for the PFBC.
In Pennsylvania and most other states, inflatable life jackets are not approved for use on specialized boats known as
personal watercraft. They are also not approved for anyone being towed behind a boat.
PFD Information -- Boating Safety & Education -- PFBC Home


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3/31/10 Midafternoon Report: Market ignores job losses, prefers to think about the good old days 0 comments
The market is surprisingly flattish today considering that macro news was more lackluster than a republican fundraiser (umm, maybe that is a bad example) and earnings reports were few and far between. The big news was that ADP's employment data came out today and showed companies cut ~23k jobs last month which is much worse than the expectations that 40k jobs would be created. The drop in payrolls was a surprise to economists but then again they were also surprised by the sun continuing to come up every morning, Ricky Martin's sexuality, and the end of the movie the Blind Side. It's great that the market is up 70% from its bottom, but that has yet to do much for unemployed workers whose skills diminsh by the day. Until there is some uptick in employment, the market will have more downside risk than hand feeding a wild bear, playing russian roulette, or sleeping with Paris Hilton and refusing to use protection. In other macro news, the Chicago Purchasing Managers Index fell today below the guesses of economists and below the 5 year high from last month. The ISM said the index fell to 58.5 from 62.6, but remember anything above 50 is still expansion and anything hot and above 50 is on the MILF/GMILF borderline.
Internationally, Greece is planning a dollar bond sale in their attempt to ruin every currency. Greek bonds fell for a third consecutive day as the spread to the safer German bonds continues to rise. Also, Moody's downgraded their credit ratings of five Greek banks from "negative" to "look out below." If anyone gave a shit about what Moody's had to say, this may be relevant but after missing the downturn and being paid by the companies they are supposed to objectively rate, Moody's has less credibility than an Alan Greenspan economics lecture, a Jennifer Love Hewitt book on relationships (and no joke, she actually just wrote one), or a Donald Rumsfeld war plan.In stock news, Baker Hughes got closer to approval in their attempt to swallow up BJ Services. They'll have to spit out some assets to do so, but don't think the deal will be blown. Rite Aid, announced.. READ MORE INCLUDING ANALYSIS OF KITD's Q.
Disclosure: Long KITDBack To moneymcbags' Instablog HomePage »
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Bureau of Primary Health Care
The Bureau of Primary Health Care (BPHC) funds health centers in underserved communities, providing access to high quality, family oriented, comprehensive primary and preventive health care for people who are low-income, uninsured or face other obstacles to getting health care.
Health Center Program
For over 50 years, health centers have provided high quality preventive and primary health care to patients regardless of their ability to pay. Approximately 1 in 13 people in the U.S. relies on a HRSA-funded health center for medical care.
Over 1,400 health centers operate approximately 9,800 service delivery sites in every U.S. state, D.C., Puerto Rico, the Virgin Islands and the Pacific Basin; these health centers employ more than 180,000 staff who provide care for over 24 million patients. For millions of Americans, including some of the most vulnerable individuals and families, health centers are the essential medical home where they find services that promote health, diagnose and treat disease and disability, and help them cope with environmental challenges that put them at risk.
Learn more about the Health Center Program.
Last Reviewed: March 2016
About HRSA
BPHC at a Glance
FY2017 Budget Request (PDF - 320 KB)
Primary Health Care: The Health Center Program
Fact Sheet (PDF - 420 KB)
Did You Know?
- Health centers cared for nearly 23 million patients last year.
- Health centers care for 1 in 10 children in the U.S. and 1 in 7 people living in poverty.
- 98% of health centers use Electronic Health Records.
- Two-thirds of health centers have been designated as patient centered medical homes, which means they emphasize care coordination and communication to improve quality, lower costs, and enhance both the patient and provider experience.


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Lawyers for a Philadelphia priest and an ex-parochial-school teacher on Tuesday began a two-pronged defense to convince a Common Pleas Court jury that their clients' personalities were inconsistent with those of men who would rape a 10-year-old altar boy.
Lawyers for the Rev. Charles Engelhardt and Bernard Shero called a series of character witnesses who testified about the pair's reputation in the community for being peaceful and law-abiding.
Engelhardt's lawyer, Michael McGovern, also called seven current and former teachers from St. Jerome's parish school in the Northeast to tell the jury their memories of victim-accuser "Billy Doe."
It is not known whether either Engelhardt, 66, or Shero, 49, will testify in his own defense.


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Well I see that our former Congressman Charlie Wilson has written a letter to the Morning Journal supporting the coal industry. Then why if he has our interests at heart did he support the disastrous health care bill that stole $715 from our senior citizens' Medicare?
Well here's how it all went down. Nancy Pelosi came to him and said, "Charlie, we have way more than enough votes to pass the Cap and Trade Bill so you can be a hero and pretend to be a rebel and vote against it. However, we must insist that you vote for the Affordable Care Act because we need every vote we can muster."
Of course, Charlie caved in to her majesty and now we have a white elephant. But you can bet your dear old sweet grandmother that had the vote of Cap and Trade been razor thin that Pelosi would have grabbed him by the nose and he would have thrown the Ohio Valley under the bus.
The United Mine Workers supported Obama and he double crossed them. Charlie says they all support him. The UMW hasn't had an effective leader since John L. Lewis. They run through my mind like a procession of clowns. Let's see, there's Tony Boyle, Arnold Miller, Sam Church, Cecil Roberts and of course the biggest buffoon of all Richard Trumka.
These non-union miners here in Columbiana County aren't so gullible. Peddle your snake oil somewhere else Charlie. They aren't buying it.
Lloyd Berresford


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The A's have spent the last two offseasons attempting to address the third base position in Oakland.
The first attempt, trading for Kevin Kouzmanoff before the 2010 season, brought mixed results. Although he was not a disaster for the A's, he failed to live up to the expectations the front office and coaching staff had for him.
Last offseason was spent attempting to woo Adrian Beltre to Oakland for a consecutive offseason, only to be shot down, for a second straight offseason.
Edwin Encarnacion was briefly a member of the A's, being claimed off waivers from the Toronto Blue Jays before he was non-tendered and chose to re-sign with the Blue Jays.
The failed attempts to bring in an adequate replacement left Oakland little choice but to start the season with Kouzmanoff at the hot corner.
A complete ineptitude with both his bat and glove lead to his demotion to Sacramento. Andy LaRoche filled in temporarily before the A's went outside their organization and acquired Scott Sizemore from the Detroit Tigers.
Sizemore was a pleasant surprise, as he learned the position on the fly, but will the A's choose to stick with him as the primary third baseman in 2012?


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In the mid-1800's, a young missionary from Marseilles planted the first fruit trees in Kelowna - and the city's celebrated food and wine culture has blossomed ever since. Kelowna is abundant with orchards of apples, cherries, pears, peaches, and plums. It beckons you with vineyards, lavender and herb farms, and gardens of fresh food.
Kelowna is set on Okanagan Lake - dry, sunny summers invite exploration of pine forests, beach, and boardwalk. Discover delightful free concerts in the park, horseback riding up to amazing views, and great wineries - immerse in the beautiful vineyards and flavors of Mission Hill Winery. In winter, there is plenty to enjoy at the nearby Big White Ski Resort even if you're not a skier - like dog sledding and ice wall climbing.
Choose from 50 varieties of Dutch pancakes for breakfast at De Dutch Pannekoek House. Sample wild mushroom and gruyere tartlet at the Bouchon French Bistro. Enjoy the wild British Columbia salmon or twice baked goat cheese and rosemary souffle of the Old Vine restaurant at Quail's Gate winery - as you look out over the water and sip a glass of very good Canadian wine.


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More than 8,500 fans packed James Brown Arena in Augusta, Ga. to say goodbye to the Godfather of Soul in his last funeral on Saturday. The four-hour ceremony was both reflective and raucous, with a heartfelt speech by Michael Jackson and an energetic dance by MC Hammer.
Brown, wearing a black suit, red shirt and sequined shoes, was laid in a gold-plated coffin. About 20,000 mourners filed past the body throughout the day.
The ceremony began with a video retrospective of Brown's career, complete with singing of his signature hit, "I Feel Good." His band, the Soul Generals, performed many of Brown's classic songs. When they sang "Get Up (I Feel Like Being A) Sex Machine," MC Hammer danced onstage to a standing ovation from the audience."
Later, a tearful Jackson told the crowd that Brown had inspired him to become an entertainer. "James Brown is my greatest inspiration," he said softly, "When I saw him move, I was mesmerized...James Brown, I shall miss you, and I love you so much, and thank you for everything. God bless you."
Tommie Ray Hynie, Brown's estranged companion, sang "Hold On, I'm Coming" to the crowd, before kneeling beside the coffin to kiss a red rose and place it on Brown's chest. Despite making a scene after being evicted from Brown's home last Tuesday, Hynie has apparently been admitted back into the inner circle. Reverend Al Sharpton urged the audience to applaud Hynie, saying "I want everyone to come together."
Sharpton recalled one of his last conversations with Brown before he died. "He said to me, 'No matter what, I believe in God. And I know God believes in me.' And on Christmas night, he stepped from mortality into immortality. God needs to let James Brown sing tomorrow morning during Sunday worship in heaven."
As the funeral wound to a close, Brown was awarded an honorary doctorate from Paine College, a historically black school in his hometown of Augusta. After the benediction, Brown's family and friends got into black Lincoln town cars and headed off for another private remembrance for Brown.
Stars, Fans Mourn James Brown at Funeral
Tim Mosenfelder/ABACA


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With the Raiders first pre-season game in the books, TFDS looks at what good and bad came from the game:
The Good
-Brice Butler:
We'll start with the play of the game, a 30 yard finger-tip TD snag by rookie WR Brice Butler that gave the Raiders the go-ahead points. Butler had had a good drive even before the long TD. He had caught a deep pass on a crossing route and been able to shake his man to get down field for a 40 yard catch and run on the first play of the drive. The TD, however, was an entirely different level of concentration as it required him to lay out for the pass and grasp it with his fingertips. It was a very impressive play.
Butler has been coming on strong in training camp. He was the most surprising player I saw because he stood out with fluid routes, being able to create separation and for his solid hands which allowed him to come down with balls thrown in his vicinity.
-new offensive wrinkles:
As complicated as last year's offense was vanilla, the Raiders came out with shifting formations and a variety of different looks on offense. Last year's offense tried to be simple but effective. It achieved the first, fell short on the second.
Today's NFL requires a more complicated offensive philosophy. NFL players have become so good at what they do, that it's important to have misdirection in all phases of the game. If you signal what you're going to do to your opponent, it's likely that he'll be able to stop you. If you, however, provide confusion as to your plan, even a momentary hesitation can make the difference.
-Special Teams:
Another big improvement from last year, this year's special teams unit looks respectable. Last years' was one of the worst units in recent memory in almost all facets. We didn't get to see much of presumed starting PR/KR Josh Cribbs who only returned one kickoff for 23 yards. However, even that pedestrian return was higher than the Raiders averaged in 2012. The team only managed to average 22.3 yards per kick return in 2012.
Cribbs backups fared even better. Multi-purpose special –teamer Taiwan Jones took a ball 5 yards deep into the endzone and still crossed the 24 yard line, good for a 29 yard return. Rookie WR Greg Jenkins did even better, getting solid blocking with the third-team and taking the ball 51 yards down the field on his only attempt.
Other parts of the special teams unit fared well, too. The Raiders were able to block a field goal early in the game. Starting SS Tyvon Branch got a hand on the ball to bring it down and starting MLB Nick Roach was in the perfect position to catch it. He tried to return it for a TD but wasn't able to get up the field fast enough. Still, the play stopped the Cowboys from getting 3 points and it showcased Roach's ability to contribute to the team in a variety of ways.
After the game, Branch gave credit to Tracy Porter, saying that Porter had almost blocked the first field goal and he thinks that the kickoff unit shifted some attention Porter's way on the second kick which left a weakness up the middle that he could exploit.
Greg Jenkins also had a good heads up play as a punt returner. The ball was punted short of his position but it was bouncing down the field for a good Dallas bounce. It came right to him and he plucked it out of the air and ran up the field for a quick 11 yards.
Finally, the Raiders came up with a turnover on a punt in the mid fourth-quarter where the returner looked to have lost the ball slightly and muffed it when it came down.
Last year was a big improvement for the Raiders after having an historic, record-setting number of penalties in 2011. In their first game in 2013, the team was penalized only 4 times for 35 yards.
The Bad
The Raiders had two turnovers, which is two too many. The first, a strip sack of Matt Flynn, was due to either a very well-timed blitz or a missed blocking assignment.
The second was a poor decision by Terrelle Pryor, who was rolling to his right, to try to throw the ball back across his body which resulted in an interception in the end zone.
If the Raiders are going to be competitive this year they are going to have to do it by winning the turnover differential because they do not have the play-makers to succeed without being very careful with the football.
-Tyler Wilson
The rookie 4th round pick looked out of sorts and nervous when he finally got onto the field with slightly over 9 minutes left in the 4th quarter. He had a rocky start, too, throwing well behind receivers and going 3 and out on his first series. He was given an immediate second chance when the Dallas punt returner muffed a punt from Marquette King and he failed to impress in the second drive as well.
Wilson looked like he wasn't comfortable in the pocket. He locked onto his receivers instead of looking them off and throwing well timed passes. He too frequently threw to Travionte Session instead of spreading out the ball more. In all, it was an inauspicious beginning for the rookie who has dropped to 4th string on the roster.
The Ugly
-The offensive line:
The Raiders hope to be a run-oriented, play action offense with McFadden pounding through their power blocking scheme and allowing Flynn time to dissect the defense with his veteran knowledge of NFL coverage.
They looked far from ready on Friday night with the first team offensive line unable to open any holes for McFadden and also allowing a blitzer coming in to sack Flynn in the first series. They were okay on the second series in pass protection but still didn't do well creating lanes in the running game.
The offensive line is a big key for the 2013 Raiders and if they don't improve and soon, the Raiders 2013 season will be every bit as poor as 2012.


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Star Tracks: Monday, May 16, 2016 42 years, 2,191 covers and 55,436 stories from PEOPLE magazine's history for you to enjoy
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People Top 5
LAST UPDATE: Tuesday February 10, 2015 01:10PM EST
PEOPLE Top 5 are the most-viewed stories on the site over the past three days, updated every 60 minutes
- September 27, 2004
- Vol. 62
- No. 13
Picks and Pans: Books
Dueling Apprentices
by Gish Jen
In her vibrant, multilayered third novel, Jen once again explores the dilemmas of maintaining cultural identity in the American melting pot. Does a family require shared blood and ethnic heritage? Or can it be constructed of disparate elements and held together by good intentions and force of will?
Tech-company exec Carnegie Wong, the son of Chinese immigrants, and his Anglo investment-whiz wife, Blondie, are sure if s the latter and take great pride in their blended family, including Asian adoptees Lizzy, 15, and Wendy, 9, along with surprise biological baby son Bailey. But when Lan, a distant cousin from China, arrives to act as nanny to the children (an arrangement that Carnegie's mother, who wants to be sure her grandchildren speak Chinese, has stipulated in her will), life gets more complicated. Blondie and Lan are soon competing for the children's—and Carnegie's—affections, and it's easy to see that trouble is on the way. Yet it's impossible to predict the deft plot twists and surprise revelations that ensue. Like a radio play, Love Wife is all dialogue, with the characters providing the narration and exchanging comments in vivid prose. (Recalling his mother's failing faculties shortly before her death, Carnegie observes that she "looked puzzled, like someone trying to remember what was delicious about chocolate.") Wise and compassionate, Love Wife unflinchingly probes the ties that bind—and separate—people, races and nations.
by Stephen King
After six gunslinging, blood-spilling and time-tripping books, The Dark Tower, the seventh and final installment of King's fantastical series of the same name, finally reveals what's lurking at the top of that tower. And the answer is...a year's supply of Turtle Wax! Not really, but many series fans are going to be miffed when they find out what metacowboy Roland of Gilead encounters at the end of his odyssey to save both real and surreal worlds. It's a long way to go for an ending that doesn't—ahem—necessarily end.
As in previous Tower books, King resorts to such ego-boosting horse-play as making himself a character and dotting the Tolkienesque good-vs.-ghoulish plot with references to his own bestsellers. But give him credit for keeping the adventure entertaining. For every mention of rat-headed nurses and mystical vampires, there are pop-culture gags about Robert Goulet and Darth Vader. And as for that finish, Roland's fate might be frustrating, but hey, it's the journey that counts.
by Heather Cochran
When bad-boy actor Joshua Reed is nabbed for drunk driving, his punishment is 90 days of house arrest—in the West Virginia home of the 25-year-old president of his fan club, Leanne Gitlin. Starting with this whimsical premise, Mean Season deftly swings between the comedic living situation and some serious undercurrents: "the strange run-ins that can alter everything in the blink of an eye, or the shift of a single season." Joshua and Leanne fight and flirt, but she is also forced to deal with the death of her father, the disappearance of one brother and the disabling football accident of another. Meanwhile she reheats her schoolgirl crush on Max, a handsome Winn-Dixie employee Joshua's pals threaten to steal away from her by sending him to L.A. for a screen test.
Unlike most plucky-heroine stories, this first novel has considerable emotional heft that works seamlessly with the comic relief. The pathos never gets too unwieldy or the humor too frivolous. Whether describing a passionate first kiss or a fatal tragedy, Cochran makes this story sing.
by Marc Acito
Ah, 1983, when a year's tuition at a primo college was only 10 grand. But high schooler Edward Zanni doesn't have that kind of cash, and his CFO dad—who works for a company called Wastecom—is willing to pay only for business school, not the acting schools Ed wants to go to. What's a budding thespian to do? When he tries to work, he is instantly fired from every job, which he concludes is a sure sign that he's "best suited for a life in the arts." When he's admitted to his top choice, Juilliard, he decides that crime is the only way to pay. So Ed and his friends use their acting skills to bilk some sleazy figures.
Acito has fantastic narrative chops, writing funny, fast and satisfying chapters, even when the plot isn't always as sharp as it should be. The casual raunchiness can be surprising at times and completely unbelievable at others, as is the constant coupling and un-coupling that goes on with Ed and his friends, at least a couple of whom are bisexual. This is a book for mature readers that reminds us what a blast immaturity can be.
by Kim Wozencraft
Plumbing the secrets of cop shop and cellblock alike. Wozencraft writes with equal authority and pathos about their opposing worlds. Diane, an unjustly imprisoned Texas cop who compares her job to being in a gang—"you hang out wearing your colors and drive around looking for trouble"—plots escape with her cellmate Gail, a one-time nonviolent revolutionary. Many inmates are misguided young women busted as drug mules working for their men; others are just unlucky. "When the enormity of prison, of doing time, hit them," Wozencraft writes, "they did the crash-and-burn thing. Some got suicidal. Some got hysterical. Most, like Diane, wept. Some for hours, some for days."
Wozencraft, who chronicled her own descent from cop to con in the book and film Rush, is chilling in her descriptions of life on the inside as well as on the lam. Though it ends abruptly and leaves the fate of a pivotal character hanging, Wanted is a deftly told jailbreak caper that provokes thought—and goose bumps.
by Steve Turner
Like Elvis, Johnny Cash was a God-fearing boy from the Bible Belt who felt torn by the marriage between sacred and secular music that gave birth to rock and roll. As one friend puts it in this warm biography of Cash, who died last Sept. 12, "God was always tugging at his soul."
Though presented as an authorized biography—Cash's five children all spoke with Turner—this portrait is hardly sanitized. There are bright shards of detail: Cash's father scarred him for life by blaming him for his brother's death in a circular-saw accident; Cash had a long but apparently chaste love affair with Hank Williams's widow, Billie Jean; his relationship with Presley was so contentious that Cash left when the King came to visit. Throughout, Turner returns to that tug of God. Said Cash, who recorded two albums at prisons: "I found it part of my religion...to perform for people in bondage, especially those behind bars."
The Apprentice's winner Bill Rancic's You're Hired: How to Succeed in Business and Life and third-place finisher Amy Henry's What it Takes: Speak Up, Step Up, Move Up are the first of a slew of Apprentice-related books. Here's how The Donald's protégés stack up:
AMY ON BILL "[Nick, Katrina and I] tried to rein in his tendency to micro-manage, so we could do our jobs."
BILL ON AMY Her dispatching a casino hostess to poach VIP high rollers from his turf during an Apprentice task "was amateurish, a clownish tug-of-war for business, and it made all of us look bad."
BILL AND AMY ON OMAROSA "She was deceitful, disorganized and completely unprofessional," says Bill. Amy's take: "I may not have liked Omarosa personally, but I recognized her professional strengths."
THEIR DIGS AT THE OTHERS Amy: "On The Apprentice, one of the other women, who didn't care for me personally, criticized me by saying that I used relationships to try to win the game. Of course I used relationships!" Bill: "If I spoke out against a member of my own team, I was perceived as disloyal. If I spoke out in favor...I was perceived as lying... If I chose to stay out of the fray, I was perceived as being indecisive."
AMY'S BIGGEST BLUNDER Posing in her undies for the laddie mag FHM. "I regret it. I took a lot of heat from professional women."
BILL'S BIGGEST REGRET Disparaging what he calls those "scantily dressed" casino hostesses as "hookers" on camera. "I realize now that this didn't exactly endear me to millions of viewers."
AMY SETS THE RECORD STRAIGHT She wants us to know that (a) she has been bleaching her hair blonde since sixth grade, (b) she and Nick "went out a couple of times but decided to remain friends," and (c) she and Bill were not "canoodling," as reported in a Manhattan gossip column.
SUCK-UP AWARD To Bill for describing his new boss as "an innovative, risk-taking, media-sawy businessman...a living, breathing embodiment of the Dream." (Okay, okay, you're still hired.)
- Contributors:
- Bella Stander,
- Sean Daly,
- Andrea L. Sachs,
- Jeremy Jackson,
- Steve Dougherty,
- Mike Lipton.
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Budget points from PwC CI
Thankfully a pretty quiet budget, once again many of the measures have been previously announced in the Autumn Statement or the 2013 Budget.
You can catch up on reactions and analysis here www.pwc.co.uk/budget.
Some of the key highlights are:
15% Stamp Duty on Property Purchases The government has announced the extension of its "Mansion Tax". This tax is aimed at owners of residential property which are held through a corporate envelope and are not held for commercial purposes.
Stamp duty on residential property purchased by non-natural persons has been extended to include properties valued in excess of £500,000. Stamp duty will be levied at 15% on the purchase of the property, with the annual tax on enveloped dwellings ("ATED") levied each year. Capital gains tax at 28% will be payable on any gain on disposal. This will not impact any properties purchased for commercial purposes, such as renting. The stamp duty change is effective as of midnight tonight, with the ATED coming into force from 1 April 2016 for properties valued between £500,000 – £1million and from 1 Aril 2015 for properties valued between £1 – £2million. Capital gains tax comes in from 6 April 2015 for properties in excess of £1million and 6 April 2016 for properties valued between £1 – £2million.
As announced in the Autumn Statement the intention is to introduce CGT on gains made by non-residents disposing of UK residential property from April 2015. A consultation is expected shortly.
Anti Avoidance The government has re-emphasised its commitment to the G20 / OECD work on tackling tax avoidance through aggressive tax planning by multinational companies. Nothing new of any note was announced today, but a position paper "Tackling aggressive tax planning in the global economy: UK priorities for the G20 / OECD project for countering Base Erosion and Profit Shifting" was released alongside the Budget.
The paper sets out the UK's priorities with regard to the BEPS project. Outputs this year include a template for country-by-country reporting, aimed at enabling tax authorities to better assess risks to the tax base arising from aggressive planning. There are also further outputs scheduled for 2014 on the digital economy, hybrid instruments and entities, and countering tax treaty abuse (OECD paper released last week).
Category: Finance & Business
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Scott Hutchins discusses the writing process for his book "A Working Theory of Love".
Are you interested in the stories behind your favorite reads? So are we. That's why we are presenting Books & Beyond, a show that gives you a fascinating window into the most compelling books and authors on the market today.
Books & Beyond is shot at some of the U.S.' most storied independent bookstores — like the Strand in New York, and Powell's Books in Portland, OR — lending an evocative sense of place. Watching the show is like stepping into your favorite bookstore and setting off on an exciting bibliographic journey.
The show immerses viewers in stimulating conversations and the exchange of ideas with recently published authors. Highlights include a talk with cartoonist and author Aline Crumb (who's married to the famous comic underground artist, R. Crumb), as well as a discussion with New Yorker author D. T. Max about the late author David Foster Wallace. Whether the topic is lighthearted or weighty, the common denominator is this: Books & Beyond plays to the sophisticated, knowledgeable 50+ viewer who's a lover of all things literary.