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Most Cited Heart & Lung - The Journal of Acute and Critical Care Articles
The most cited articles published since 2011, extracted from Scopus.
Event-free survival in adults with heart failure who engage in self-care managementChristopher S. Lee | Debra K. Moser | Terry A. Lennie | Barbara Riegel
Volume 40, Issue 1, January 2011, Pages 12-20
Background: Self-care management in heart failure (HF) involves decision-making to evaluate, and actions to ameliorate symptoms when they occur. This study sought to compare the risks of all-cause mortality, hospitalization, or emergency-room admission among HF patients who practice above-average self-care management, those who practice below-average self-care management, and those who are symptom-free. Methods: A secondary analysis was conducted of data collected on 195 HF patients. A Cox proportional hazards model was used to examine the association between self-care management and event risk. Results: The sample consisted of older (mean ± standard deviation = 61.3 ± 11 years), predominantly male (64.6%) adults, with an ejection fraction of 34.7% ± 15.3%; 60.1% fell within New York Heart Association class III or IV HF. During an average follow-up of 364 ± 288 days, 4 deaths, 82 hospitalizations, and 5 emergency-room visits occurred as first events. Controlling for 15 common confounders, those who engaged in above-average self-care management (hazard ratio, .44; 95% confidence interval, .22 to .88; P < .05) and those who were symptom-free (hazard ratio, 0.48; 95% confidence interval, .24 to .97; P < .05) ran a lower risk of an event during follow-up than those engaged in below-average self-care management. Conclusion: Symptomatic HF patients who practice above-average self-care management have an event-free survival benefit similar to that of symptom-free HF patients. © 2011 Elsevier Inc.
Montreal Cognitive Assessment and Mini-Mental Status Examination compared as cognitive screening tools in heart failurePonrathi Athilingam | Kathleen B. King | Scott W. Burgin | Michael Ackerman | Laura A. Cushman | Leway Chen
Volume 40, Issue 6, November 2011, Pages 521-529
Background: Heart failure (HF) patients run four times the risk of developing cognitive impairment than does the general population, yet cognitive screening is not routinely performed. Methods: This cross-sectional study enrolled 90 community-dwelling adults with HF aged 50 years and above. Participants took the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA), to measure cognitive function in persons with HF. Participants were predominately men (66%) and Caucasian (78%), aged 50-89 years (62 SD, 9 years), and 77% had an ejection fraction <40%. Results: Fifty-four percent of participants scored ≤26 on the MoCA, suggesting mild cognitive impairment (MCI), and 17% scored ≤22, suggesting moderate cognitive impairment, compared with 2.2% on the MMSE. The MoCA scores were lowest for visuospatial/executive domain, short-term memory, and delayed recall. These findings were similar to those in published reports. Conclusion: These preliminary findings support the use of MoCA for cognitive screening in stable HF. © 2011 Elsevier Inc.
Cognitive impairment and medication adherence in outpatients with heart failureLee Ann Hawkins | Shirley Kilian | Anthony Firek | T. Michael Kashner | Christopher J. Firek | Helme Silvet
Volume 41, Issue 6, November 2012, Pages 572-582
Objectives: The study objectives were (a) to describe the prevalence and severity of cognitive impairment (CI) in an outpatient veteran population with heart failure (HF), (b) to describe the cognitive domains affected in those subjects found to have CI, (c) to examine clinical and demographic variables that may be associated with CI, and (d) to determine the relationship between CI and medication adherence (MA). We hypothesized that CI is a prevalent condition in veterans with HF and is associated with poorer MA. Adherence to therapy is essential for successful outcomes. CI may affect adherence; little is known about CI in veterans with HF or the effect of CI on MA. Methods: We enrolled 251 veteran outpatients with HF. Subjects were screened for CI; adherence was determined by pill counts. Subjects with CI underwent further neuropsychologic testing. Results: Unrecognized CI was found in 58% of subjects. Verbal learning, immediate memory, and delayed verbal memory were most impaired. CI was significantly associated with poorer MA. Variables associated with CI included age, African-American race, depression, use of alcohol, and nonparticipation in pill count. Conclusion: Unrecognized CI was prevalent and associated with poorer MA. We propose routine screening for CI in patients with HF. © 2012.
Linkages between anxiety and outcomes in heart failureMarla J. De Jong | Misook L. Chung | Jia Rong Wu | Barbara Riegel | Mary Kay Rayens | Debra K. Moser
Volume 40, Issue 5, September 2011, Pages 393-404
Objective: We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. Methods: In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. Results: In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. Conclusion: This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes. © 2011.
Depression and perceptions about heart failure predict quality of life in patients with advanced heart failureClaire N. Hallas | Jo Wray | Panayiota Andreou | Nicholas R. Banner
Volume 40, Issue 2, March 2011, Pages 111-121
Background: Mood is an independent predictor of mortality and quality of life (QoL) for people with heart failure. However, the underlying belief systems involved in mood are unknown. Objective: We sought to identify psychological and clinical variables predicting mood and QoL for people diagnosed with heart failure (HF). Methods: One hundred and forty-six HF patients were assessed with standardized measures, to determine their beliefs about HF, coping styles, mood, and QoL. Results: Patients with more negative beliefs about the consequences of HF and with less perceived control over symptoms showed maladaptive coping styles such as denial and behavioral disengagement, and more severe levels of depression and anxiety. Depression also independently predicted QoL outcomes. Conclusions: Anxious and depressed patients have more negative beliefs about HF, leading to negative coping behaviors and poor QoL. Our evidence suggests that changing negative beliefs may improve the psychological well-being and QoL of patients, irrespective of disease severity. © 2011 Elsevier Inc.
Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patientsMary Jo Grap | Cindy L. Munro | V. Anne Hamilton | R. K. Elswick | Curtis N. Sessler | Kevin R. Ward
Volume 40, Issue 5, September 2011, Page
Background: Ventilator-associated pneumonia (VAP) is an important complication of mechanical ventilation and is particularly common in trauma, burn, and surgical patients. Interventions that kill bacteria in the oropharynx reduce the pool of viable organisms available for translocation to the lung and thereby lessen the likelihood of developing VAP. Repeated administration of chlorhexidine (CHX) to the mouth and oropharynx has been shown to reduce the incidence of VAP, but use of a single dose has not been studied. This randomized, controlled clinical trial tested an early (within 12 hours of intubation) application of CHX by swab versus control (no swab) on oral microbial flora and VAP. Methods: A total of 145 trauma patients requiring endotracheal intubation were randomly assigned to the intervention (5 mL CHX) or control group. VAP (Clinical Pulmonary Infection Score [CPIS] ≥ 6) was evaluated on study admission and at 48 and 72 hours after intubation. Results: A total of 145 patients were enrolled; 71 and 74 patients were randomized to intervention and control groups, respectively. Seventy percent of the patients were male, and 60% were white; their mean age was 42.4 years (±18.2). A significant treatment effect was found on CPIS both from admission to 48 hours (P = .020) and to 72 hours (P = .027). In those subjects without pneumonia at baseline (CPIS < 6), 55.6% of the control patients (10/18) had developed VAP by 48 or 72 hours versus only 33.3% of the intervention patients (7/21). Conclusion: an early, single application of CHX to the oral cavity significantly reduces CPIS and thus VAP in trauma patients. © 2011 Elsevier Inc.
Effects of interventions on depression in heart failure: A systematic reviewPatricia C. Woltz | Deborah W. Chapa | Erika Friedmann | Heesook Son | Bimbola Akintade | Sue Ann Thomas
Volume 41, Issue 5, September 2012, Pages 469-483
Objective: We sought to conduct a systematic review to evaluate the effects of interventions on depression in adults with heart failure (HF). Methods: Published, peer-reviewed, English-language, prospective interventional studies were identified in a search of Medline, CINAHL, PsychINFO, and the Cochrane Libraries of Systematic Reviews and Clinical Trials from 1996 through August 2011 and relevant bibliographies. Eligible studies included patients with New York Heart Association functional class II and III HF with experimental or quasiexperimental designs and preintervention and postintervention measures of depression. Ineligible studies were nonpharmacologic with a sample size <50, and drug studies without a comparison group. Results: Twenty-three experimental and quasiexperimental studies that enrolled a total of 3564 persons with HF contributed evidence about 6 types of interventions: selective serotonin reuptake inhibitors (SSRIs), an erythropoiesis-stimulating agent, exercise, disease management programs, complementary and alternative medicine (CAM), and a multimodal intervention of cognitive behavioral therapy and exercise. Studies with SSRIs examined effects of sertraline, paroxetine, and citalopram. The CAM interventions included tai chi, progressive muscle relaxation therapy, and mindfulness-based stress reduction. Conclusions: Evidence is strong that pharmacology and CAM may improve depression. Moderate evidence supports the use of exercise. A strong body of evidence indicates that disease management programs do not improve depression. This review does not support the development of guidelines for treatment of depression in persons with HF because evidence is insufficient and, at times, contradictory. © 2012 Elsevier Inc.
Anxiety, depression, and stress as risk factors for atrial fibrillation after cardiac surgeryPhillip J. Tully | Jayme S. Bennetts | Robert A. Baker | Andrew D. McGavigan | Deborah A. Turnbull | Helen R. Winefield
Volume 40, Issue 1, January 2011, Pages 4-11
Objective: We sought to determine whether preoperative and postoperative anxiety, depression, and stress symptoms were associated with atrial fibrillation (AF) after cardiac surgery. Methods: Two hundred and twenty-six cardiac surgery patients completed measures of depression, anxiety, and general stress before surgery, and 222 patients completed these measures after surgery. The outcome variable was new-onset AF, confirmed before the median day of discharge (day 5) after cardiac surgery during the index hospitalization. Results: Fifty-six (24.8%) patients manifested incident AF, and they spent more days in hospital (mean [M], 7.3; standard deviation [SD], 4.6) than patients without AF (M, 5.5; SD, 1.4; P < .001). No baseline psychological predictors were associated with AF. When postoperative distress measures were considered, anxiety was associated with increased odds of AF (odds ratio, 1.09; 95% confidence interval, 1.00 to 1.18; P = .05). This analysis also showed that age was significantly associated with AF (odds ratio, 1.07; 95% confidence interval, 1.03 to 1.12; P < .001). Analyses specific to the symptomatic expression of anxiety indicated that somatic (ie, autonomic arousal) and cognitive-affective (ie, subjective experiences of anxious affect) symptoms were associated with incident AF. Conclusion: Anxiety symptoms in the postoperative period were associated with AF. Hospital staff in acute cardiac care and cardiac rehabilitation settings should observe anxiety as related to AF after cardiac surgery. It is not clear how anxious cognitions influence the experience of AF symptoms, and whether symptoms of anxiety commonly precede AF. © 2011.
Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010Laurie J. Conway | Elaine L. Larson
Volume 41, Issue 3, May 2012, Pages 271-283
Objectives: We set out to review and compare guidelines to prevent catheter-associated urinary tract infection (CAUTI), examine the association between recent federal initiatives and CAUTI guidelines, and recommend practices for preventing CAUTI that are associated with strong evidence and are consistent across guidelines. Background: Catheter-associated urinary tract infections are the most common healthcare-associated infection, and a cause of significant morbidity and mortality in critically ill patients. Methods: A search of the English-language literature for guidelines in the prevention of adult CAUTI, published between 1980 and 2010, was conducted in Medline and the National Guideline Clearinghouse. Results: Many recommendations were consistent across 8 guidelines, including limited use of urinary catheters, the insertion of catheters aseptically, and the maintenance of a closed drainage system. The weight of evidence for some endorsed practices was limited, and different grading systems made comparisons across recommendations difficult. Federal initiatives are closely aligned with the 4 most recent guidelines. Conclusion: Additional research into the prevention of CAUTI is needed, as is a harmonization of guideline grading systems for recommendations. © 2012 Elsevier Inc.
Lifestyle adjustments of adults with long-term implantable left ventricular assist devices: A phenomenologic inquiryJesus M. Casida | Linda Marcuccilli | Rosalind M. Peters | Susan Wright
Volume 40, Issue 6, November 2011, Pages 511-520
Objective: To explore and describe the lifestyle adjustments made by adult recipients of a long-term implantable left ventricular assist device (LVAD). Methods: A phenomenologic inquiry was used to uncover the lifestyle adjustments of 7 men and 2 women, ages 31 to 70 years, who had an LVAD for more than 3 months after hospital discharge. Results: An overarching theme, "adjustment takes time," represents the lifestyle adjustments of the study participants. Early adjustment was highlighted by participants' concerns with physical, psychologic, and environmental aspects, whereas late adjustment was highlighted by behaviors associated with acceptance of the LVAD as an integral component of their bodies and lives. Conclusion: This study provides insight into the patient's perspective regarding the challenges faced in living with an LVAD. The findings inform health care providers in the acute and critical care settings in assisting patients to positively adjust with the lifestyle imposed by an LVAD. © 2011 Elsevier Inc.
Sex differences in symptom presentation in acute myocardial infarction: A systematic review and meta-analysisLinda L. Coventry | Judith Finn | Alexandra P. Bremner
Volume 40, Issue 6, November 2011, Pages 477-491
Background: Recognition of sex differences in symptom presentation of acute myocardial infarction (AMI) is important for timely clinical diagnosis. This review examined whether women are equally as likely as men to present with chest pain. Methods: We conducted a systematic review and meta-analysis of English language research articles published between 1990 and 2009. Results: Meta-analysis showed women with AMI had lower odds and a lower rate of presenting with chest pain than men (odds ratio .63; 95% confidence interval, .59-68; risk ratio .93; 95% confidence interval, .91-.95). Women were significantly more likely than men to present with fatigue, neck pain, syncope, nausea, right arm pain, dizziness, and jaw pain. Conclusion: Health campaigns on symptom presentation of AMI should continue to promote chest pain as the cardinal symptom of AMI, but also reflect a wider spectrum of possible symptoms and highlight potential differences in symptom presentation between men and women. © 2011 Elsevier Inc.
Biomarkers for ventilator-associated pneumonia: Review of the literatureSteven J. Palazzo | Terri Simpson | Lynn Schnapp
Volume 40, Issue 4, July 2011, Pages 293-298
Objective: Ventilator-associated pneumonia (VAP) contributes significantly to morbidity and mortality in critically ill patients, but it can be difficult to diagnose. Clinical criteria, Clinical Pulmonary Infection Score, and quantitative culture of bronchoalveolar lavage have been used to distinguish between patients who are likely positive (sensitivity) and patients who are likely negative (specificity). Despite these test methods, patients continue to be misclassified. False-positive results may lead to inappropriate antibiotic use in patients. For those misclassified as test negative, appropriate treatment may be delayed. Biomarkers have been suggested as another method to enhance the ability to predict VAP. This article analyzes the evidence for the usefulness of 3 biomarkers that have been proposed as possible biomarkers of VAP: soluble triggering receptor expressed on myeloid type 1 cells, procalcitonin, and C-reactive protein. Methods: A Medline search was conducted for the years between 1990 and 2009 to locate articles on the subject of biomarkers for predicting VAP in critically ill adult patients. Results: Analysis of the literature does not currently support a clinical role for these biomarkers in predicting VAP. Variations in the diagnostic methods, antimicrobial use, cutoff values, and patient populations limit comparisons among the studies. Conclusion: Recommendations are offered to strengthen and standardize methods in future studies to clarify the utility of biomarkers for predicting VAP in specific patient populations. © 2011 Elsevier Inc.
Progress in sexual counseling by cardiac nurses, 1994 to 2009Elaine E. Steinke | Victoria Mosack | Susan Barnason | David W. Wright
Volume 40, Issue 3, May 2011, Page
Objective: To examine trends in the practice of sexual counseling by cardiac nurses. Methods: A non-experimental descriptive design was used to analyze survey data collected at 2 time points: 1994 (n = 171) and 2009 (n = 288). Results: Nurses in the 2009 sample reported more conservative values (P < .001) and greater sense of responsibility for providing sexual counseling (P < .0001) than those in the 1994 sample. Although sexual activities (cuddling, kissing, fondling, masturbation, oral sex) were discussed more frequently by nurses in the 1994 survey (P < .001), improvements in the specific discussion of myocardial infarction-related sexual activity and counseling were noted in the 2009 sample, including by patient age and gender (P < .0001). Conclusion: Comparison of the 2 data samples suggests an improving trend in provision of sexual counseling by cardiac nurses, which can be reinforced by including sexual counseling information and role-play opportunities in continuing education courses. © 2011 Elsevier Inc.
Caring for a spouse with end-stage heart failure through implantation of a left ventricular assist device as destination therapyLisa A. Kitko | Judith E. Hupcey | Juliann H. Gilchrist | John P. Boehmer
Volume 42, Issue 3, May 2013, Pages 195-201
Objectives: This qualitative study describes the experiences of spousal caregivers of a patient with end-stage heart failure (HF) from pre-LVAD to post-LVAD-DT implantation. Background: LVAD-DTs are implanted as permanent devices for end-stage HF patients with the goal of improving the length and quality of life. LVADs create new demands for both patients and caregivers. Methods: In-depth, semi-structured interviews of 10 spousal caregivers were thematically analyzed. Results: Throughout the process of caregiving, pre-implant through post-implant, all caregivers discussed their ability to adapt within the role as a caregiver. Adaptation as a caregiver occurred through three distinct time frames following the progression of the patient's HF and subsequent LVAD implantation: caring for a spouse with HF, decision for LVAD implantation made, and caring for a spouse with the LVAD-DT. Conclusions: Caregivers were able to adapt and develop effective strategies to incorporate the demands of caring for a spouse with an LVAD-DT, but the role remained challenging. The findings underscore the need for continued research that may be translated into effective interventions to support patient and caregivers as they live through this end-of-life trajectory. © 2013 Elsevier Inc.
What keeps nurses from the sexual counseling of patients with heart failure?Tialda Hoekstra | Ivonne Lesman-Leegte | Margriet F. Couperus | Robbert Sanderman | Tiny Jaarsma
Volume 41, Issue 5, September 2012, Pages 492-499
Objectives: We sought to examine the current practice of discussing sexual health by heart failure (HF) nurses, and to explore which barriers prevent nurses from discussing sexuality. Methods: The Nurses' Survey of Sexual Counseling of Myocardial Infarction Patients and a list of barriers were used to form a questionnaire, which was sent to all HF clinics (n = 122) in the Netherlands. Results: The majority (75%) of nurses (n = 146) felt a certain responsibility to discuss patients' sexual health. However, in practice, 61% of the nurses rarely or never addressed sexuality. Barriers that prevented nurses from addressing sexuality and that differed between nurses who do (n = 58) and do not (n = 88) discuss sexuality include a lack of organizational policy (49% vs. 79%, respectively; P < .001) and lack of training (43% vs. 80%, respectively; P < .001), and not knowing how to initiate the subject (24% vs. 72%, respectively; P < .001). Nurses preferred to address sexuality during a follow-up visit or when discussing medication. Conclusions: Although HF nurses feel responsible for discussing sexuality, this topic is rarely addressed in clinics. Several barriers were identified, relating to personal, patient, and organizational factors. © 2012 Elsevier Inc.
Pain and quality of life with chronic obstructive pulmonary diseaseChristine Råheim Borge | Astrid K. Wahl | Torbjørn Moum
Volume 40, Issue 3, May 2011, Page
Background: Pain as a symptom may be underrecognized in patients with chronic obstructive pulmonary disease (COPD). Objective: The aim of this study is to explore the prevalence and intensity of pain, its location, how demographic and clinical variables may be related to pain, and how pain is associated with quality of life (QOL). Methods: In this cross-sectional study, 154 patients with COPD answered the Brief Pain Inventory, Respiratory Quality of Life Questionnaire, and Quality of Life Scale, and performed spirometry. Results: Seventy-two percent of the patients indicated the location of pain on a body diagram. Lower lung function, higher score of pain intensity, and pain interference were associated with lower disease QOL. A higher score of pain interference was associated with lower global QOL. When controlling for disease QOL in the equation of global QOL, pain interference was no longer significant. Conclusion: The experience of pain is related to disease QOL in patients with COPD. © 2011 Elsevier Inc.
Feasibility and inter-rater reliability of the ICU Mobility ScaleCarol Hodgson | Dale Needham | Kimberley Haines | Michael Bailey | Alison Ward | Megan Harrold | Paul Young | Jennifer Zanni | Heidi Buhr | Alisa Higgins | Jeff Presneill | Sue Berney
Volume 43, Issue 1, January 2014, Pages 19-24
Objectives: The objectives of this study were to develop a scale for measuring the highest level of mobility in adult ICU patients and to assess its feasibility and inter-rater reliability. Background: Growing evidence supports the feasibility, safety and efficacy of early mobilization in the intensive care unit (ICU). However, there are no adequately validated tools to quickly, easily, and reliably describe the mobility milestones of adult patients in ICU. Identifying or developing such a tool is a priority for evaluating mobility and rehabilitation activities for research and clinical care purposes. Methods: This study was performed at two ICUs in Australia. Thirty ICU nursing, and physiotherapy staff assessed the feasibility of the 'ICU Mobility Scale' (IMS) using a 10-item questionnaire. The inter-rater reliability of the IMS was assessed by 2 junior physical therapists, 2 senior physical therapists, and 16 nursing staff in 100 consecutive medical, surgical or trauma ICU patients. Results: An 11 point IMS scale was developed based on multidisciplinary input. Participating clinicians reported that the scale was clear, with 95% of respondents reporting that it took <1min to complete. The junior and senior physical therapists showed the highest inter-rater reliability with a weighted Kappa (95% confidence interval) of 0.83 (0.76-0.90), while the senior physical therapists and nurses and the junior physical therapists and nurses had a weighted Kappa of 0.72 (0.61-0.83) and 0.69 (0.56-0.81) respectively. Conclusion: The IMS is a feasible tool with strong inter-rater reliability for measuring the maximum level of mobility of adult patients in the ICU. © 2014 Elsevier Inc.
Patient and family members' perceptions of palliative care in heart failureMaureen Metzger | Sally A. Norton | Jill R. Quinn | Robert Gramling
Volume 42, Issue 2, March 2013, Pages 112-119
Purpose: To describe patients with HF and their family members' (FMs) experiences with, and perceptions of, inpatient PC consultations. Methods: 40 semi-structured interviews were completed with 24 patients with late-stage HF and/or 16 designated FMs. Content analysis was used to derive themes from the data. Results: Four main themes resulted. Participants: 1) were generally ill-prepared for the PC consult; 2) pursued a plan that reflected their own understanding of patient prognosis, rather than that of the clinician; 3) described a primarily supportive role for PC; 4) often rejected or deferred PC services if they viewed hospice and PC as synonymous. Conclusion: Lack of awareness of PC and the conflation of PC and hospice were barriers to PC, and many participants felt that PC services are needed to fill the gaps in their care. A collaborative model of care may best meet the complex needs of this group. © 2013 Elsevier Inc.
Home care nurses' knowledge of evidence-based education topics for management of heart failureColleen Delaney | Beka Apostolidis | Leeanne Lachapelle | Richard Fortinsky
Volume 40, Issue 4, July 2011, Pages 285-292
Objective: We primarily sought to evaluate home care nurses' knowledge of evidence-based education topics in managing heart failure (HF). Moreover, we wanted to determine if differences were evident in nurses' knowledge based on education and work experience, and to identify home care nurses' specific educational needs. Methods: A cross-sectional survey design was used. Home care nurses (n = 94) were recruited from 4 home care agencies. A previously published 20-item HF knowledge questionnaire was administered to participants, and an open-ended question determined participants' need for further HF-related education. Results: Home care nurses' scores demonstrated a 78.9% knowledge level in overall HF education principles. The mean HF knowledge score was 15.78 (SD, ±1.69) out of a possible 20 points. Nurses scored lowest on knowledge related to asymptomatic hypotension (24.5% answered correctly), daily weight monitoring (26.6% answered correctly), and transient dizziness (30.9% answered correctly). Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers. Conclusion: Our findings suggest that home care nurses may not be sufficiently knowledgeable in evidence-based education topics for managing HF. The results help confirm the need to develop educational programs for home care nurses in managing HF, which may lead to improved quality of patient education. Further research is needed to address specific deficits in the knowledge of home care nurses, and to determine if HF educational programs for nurses would enhance and sustain nurses' knowledge of HF management education. © 2011 Elsevier Inc.
Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failureJia Rong Wu | Terry A. Lennie | Misook L. Chung | Susan K. Frazier | Rebecca L. Dekker | Martha J. Biddle | Debra K. Moser
Volume 41, Issue 2, March 2012, Pages 107-114
Objective: Prognosis is worse in unmarried patients compared with married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in medication adherence may play a role, because medication adherence is essential to achieving better outcomes. The study objective was to determine whether medication adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF. Methods: Demographic, clinical, and psychosocial data were collected by questionnaires and medical record review for 136 patients with HF (aged 61 ± 11 years, 70% were male, 60% were in New York Heart Association class III/IV). Medication adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital database, and death certificate review. A series of regression and Cox survival analyses were performed to determine whether medication adherence mediated the relationship between marital status and event-free survival. Results: Cardiac event-free survival was worse in unmarried patients than in married patients. Unmarried patients were more likely to be nonadherent and 2 times more likely to experience an event than married patients (P = .017). Marital status was not a significant predictor of event-free survival after entering medication adherence in the model, demonstrating a mediation effect of adherence on the relationship of marital status to survival. Conclusion: Medication adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase medication adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonadherence. © 2012 Elsevier Inc.
Cement pulmonary embolism after percutaneous vertebroplasty and kyphoplasty: An overviewNicholas Habib | Theodore Maniatis | Sara Ahmed | Thomas Kilkenny | Homam Alkaied | Dany Elsayegh | Michel Chalhoub | Kassem Harris
Volume 41, Issue 5, September 2012, Pages 509-511
Background: Because of the aging of the American population, osteoporotic vertebral fractures are becoming a common problem in the elderly. Minimally invasive percutaneous vertebral augmentation techniques have gained a great deal of importance in relieving the pain associated with these fractures, and are becoming the standard of care. Methods: These procedures involve the injection of polymethylmethacrylate (PMMA) into the vertebral body. However, these techniques have their complications, and among these, pulmonary embolism is one of the most feared. It is attributable to the passage of cement into the pulmonary vasculature. After encountering a case of PMMA embolism in our practice, we decided to highlight this topic and discuss the incidence, clinical presentation, diagnosis, and treatment of cement pulmonary embolisms. © 2012 Elsevier Inc.
Adherence to prophylactic asthma medication: Habit strength and cognitionsCatherine Bolman | Titia G. Arwert | Trijntje Völlink
Volume 40, Issue 1, January 2011, Pages 63-75
Objective: To explain adherence to prophylactic asthma medication (PAM, inhaled corticosteroids) by the attitude, social influence, and self-efficacy (ASE) model added with the concept of habit strength and to study whether habit moderates or mediates relationships between ASE factors and adherence. Methods: A mail-out survey was conducted among 139 asthmatic adults. Multiple regression analysis was conducted, with self-reported adherence as the outcome and ASE factors and habit as the independent variables. Simple slope analyses and bootstrapping mediation analyses were also conducted. Results: Having more severe asthma, taking PAM habitually, and perceiving few negative consequences of taking PAM were associated with better adherence. Self-efficacy influenced adherence indirectly through habit. The relationship between social norms and adherence was moderated by habit: In the case of weak habits, a supportive norm in a patient's environment toward taking PAM was positively related to PAM adherence; in the case of strong habits, a supportive norm led to less adherence. Conclusion: Interventions to increase adherence should enhance the formation of habits by stimulating patients to perform the behavior frequently in similar situations by increasing self-efficacy and providing environmental cues, such as reminder devices and pill organizers. In addition, the disadvantages of PAM use should be negated. © 2011 Elsevier Inc.
Descriptive study of partners' experiences of living with severe heart failureChristopher C. Imes | Cynthia M. Dougherty | Gail Pyper | Mark D. Sullivan
Volume 40, Issue 3, May 2011, Pages 208-216
Purpose: This qualitative study sought to describe the experiences of living with severe heart failure (HF) from the perspective of the partner. Methods: In-depth, semistructured interviews were conducted with 14 partners of individuals diagnosed with severe HF. Content analysis was performed to derive the main themes and subthemes of responses. Results: Three main themes were derived from the data: (1) My Experience of HF in My Loved One, (2) Experience With Healthcare Providers, and the (3) Patient's Experience of HF as Perceived by the Partner. Conclusion: The severity of the patient's disease limited the partner's lifestyle, resulting in social isolation and difficulties in planning for the future for both the patient and the partner. The partners were unprepared to manage the disease burden at home without consistent information and assistance by healthcare providers. Moreover, end-of-life planning was neither encouraged by healthcare providers nor embraced by patients or partners. © 2011 Elsevier Inc.
Physical activity in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003-2006)Soo Kyung Park | Caroline R. Richardson | Robert G. Holleman | Janet L. Larson
Volume 42, Issue 4, July 2013, Pages 235-240
Background: People with chronic obstructive pulmonary disease (COPD) are sedentary but the extent of the problem is not fully understood. Purposes: This study examines sedentary time and physical activity (PA) and the relative effects of demographic and clinical characteristics on sedentary time and PA in a population-based sample of people with COPD and a comparison group from the general population. Methods: Subjects were drawn from the National Health and Nutrition Examination Survey dataset (2003-2006). Physical activity was measured by accelerometry. Results: People with COPD were sedentary and spent less time in most levels of PA. Age, gender, race, level of education, working status, shortness of breath, self-reported health, and body mass index were significantly associated with sedentary time or level of PA. Conclusion: Findings emphasize the need to decrease sedentary time and increase PA in people with COPD. © 2013 Elsevier Inc.
Depressive symptoms and poor social support have a synergistic effect on event-free survival in patients with heart failureMisook L. Chung | Terry A. Lennie | Rebecca L. Dekker | Jia Rong Wu | Debra K. Moser
Volume 40, Issue 6, November 2011, Pages 492-501
Background: Depressive symptoms and poor social support are predictors of increased morbidity and mortality in patients with heart failure (HF). However, the combined contribution of depressive symptoms and social support event-free survival of patients with HF has not been examined. Objective: To compare event-free survival in 4 groups of patients with HF stratified by depressive symptoms and perceived social support (PSS). Method: A total of 220 patients completed the Beck Depression Inventory-II and the Multidimensional Perceived Social Support Scale and were followed for up to 4 years to collect data on death and hospitalizations. Results: Depressive symptoms (hazard ratio = 1.73, P = .008) and PSS (hazard ratio = 1.51, P = .048) were independent predictors of event-free survival. Depressed patients with low PSS had 2.1 times higher risk of events than non-depressed patients with high PSS (P = .003). Conclusion: Depressive symptoms and poor social support had a negative additive effect on event-free survival in patients with HF. © 2011 Elsevier Inc.


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Kinect Sports News
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Playstation Move vs Microsoft Kinect: The Future of Motion Control
Wave your hands frantically in the air if you're excited for motion controls on HD consoles! In an effort to go toe-to-toe with Nintendo, Sony and Microsoft have decided to release their own version of immersive controls. For Sony, it's the PlayStation Move: a decidedly Wii-esque controller and camera that tracks your movements...
Microsoft Prices Kinect, New Bundle And 4GB 360 Announced
Microsoft today announced that its motion-controlled Kinect will retail for $149.99, and will include a copy of Kinect Adventures. Microsoft also revealed release and pricing details for a new 4GB Xbox 360 SKU, as well as a Kinect console bundle. Read More?
More Kinect Sports from E3 2010
See how you can stay active without leaving your spot in front of the television screen, thanks to Kinect Sports. We've got a screenshot gallery of all the different activities available, thanks to the body tracking technology behind Kinect, like javelin throwing, volleyball and tons more. Check it out!
Articles 1–3 of 3
Kinect Sports Party Pack DLC Trailer
2,058 Views | 01:23
Holiday Buyers Guide - Top Games on Xbox 360
30,659 Views | 02:50
How To Play Kinect Sports
5,967 Views | 06:28
Kinect Sports Review
12,488 Views | 01:47
Kinect Sports Tips - How To Always Win In Boxing
15,117 Views | 00:46
Classic Kinect Sports Cap Avatar Award
Kinect Sports Champ Trophy Avatar Award
I Heart Kinect Sports Tee Avatar Award
Classic Kinect Sports Tee Avatar Award
Golden Boots
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subset: commoncrawl


text:
New Haven Rising is launched
The cafeteria at Career High School was overflowing with neighbors of all ages from all parts of New Haven, Black, Latino, and White greeting each other with excitement.
NAACP fighting "battles we thought we had won"
As the theme for this year's convention, "NAACP: Your Power, Your Decision - VOTE," indicated, the attack on voting rights has become a critical issue.
Going to church to fight wage theft
Kordsmeier visited different congregations as part of an effort to build a coalition of "unions, churches, and community groups" to stand against wage theft.
Romney confronted in the air, on land, and at sea!
Nearly 100 demonstrators - with air support from a plane flying a banner - protested Mitt Romney's big fundraiser yesterday.


text:
|Doll/Doll Clothing
Designing is my passion, yarn is a big part my life. I've been crocheting and knitting for quite some time now and with my patterns I hope to inspire and stimulate anyone to start crafting!View all patterns by designer (63) »
This little mermaid is the beauty of the ocean! She loves to cuddle and be played with. She has a lot of features for children to play with and her look will melt the heart of all little girls (and mommies)!
Hair, head, body, rock and water are all worked in one piece, so there(tm)s very little sewing involved!
It(tm)s an easy and very fast pattern. It took me (and my testers) about one evening to make her!
For more security blankets, checkout my other patterns!


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By Staff Sgt. Peter Ford, MND-B PAOJune 30, 2009
BAGHDAD - Much like blood that flows through the human body, Soldiers of the 299th Brigade Support Battalion "Lifeline", 2nd Brigade, 1st Infantry Division move through streets of Iraq in the silence of night to support forward operating bases throughout the Baghdad area.
"Missions are done at night because there is less traffic," said 1st. Lt. Harris Malik, a native of Strongsville, Ohio, and convoy commander for A Company, 299th BSB. "Coalition forces are less visible at night and chances of having an accident are much smaller," he added.
Lifeline troops quietly transport vital equipment to FOBs every night; protected by Soldiers who provide security to ensure requested items arrive at their destinations. The U.S. troops weave through the streets of Baghdad with the satisfaction of knowing they are making a major contribution to each mission on the FOBs.
"I like to use the analogy of a football team when it comes to my Soldiers," said Command Sgt. Maj. Julia Kelly, a Pryor, Mont., native and ammunition specialist assigned to the 299th BSB. "We are like the line and the combat Soldiers are the quarterbacks, running backs and wide receiver, who get all the glory, but the line of the football team knows the star players can't score without the blocking in the trenches."
The lifeline quietly moves food, water and parts to supply FOBs with the necessary equipment that will enable Soldiers to be self-sufficient and to complete their missions.
"This week we had the task of supplying FOB Justice with water and ice because they had water issue with the Iraqi water supply," said Malik. "Thanks to the dedication of the lifeline, Justice never had to worry about drinking water, or water for personal hygiene."
The greatest reward the Soldiers of the 299th BSB say they can receive is the appreciation of their comrades in arms for the contribution they have made to support them over the years, continued Malik.
"I feel really good when the contributions to the mission are appreciated," he said.
Under the cover of darkness, dedicated Lifeline Soldiers of the 299th BSB continue to drive the streets of Baghdad to provide vital equipment and supplies to keep the organizations of the Coalition forces fully functional.


text:
Dynasty Warriors 8
consecutive battles
- Topic Archived
- Boards
- Dynasty Warriors 8
- consecutive battles
i also wanted to clarify, can i hit save, go leave and level up zhou tai in free mode and come back and resume where i left off in ambition without upsetting it, like i said, it's not that he is dying, i have good defense, but pounding away at an officer with the additional officer damage skill equipped adn his fourth weapon is tedious
rincewind1990 3 years ago#3
Yes you can save and quit and play the story/free mode as much as you want but you can not return to town. Doing so will break your streak so simply save between battles if you want to do something else.
As a side note if your objective is just to get Red Hare I have heard that you can do 30 battles, quit to town and repeat as every 30 battles will unlock a horse (Shadow Runner, Hex Mark and then Red Hare) but I can't say if this is true as I did it all in one run.
However if you want the Animal Collector achievement or if you just want to unlock the War Elephant you have to do 100 battles consecutively anyway so you might as well knock them out at the same time, just make sure you have space in your animal inventory.
tbh if you're JUST going after red hare do what I did...
step 1: Make sure you've unlocked all characters in Ambition mode, they duels every third stage are frakkin long.
step 2: ONLY do Material battles, they're by far the easiest, clear path to the boss, don't even need to get off your horse.
step 3: play on beginner :p, seriously I wapped the whole thing out in about an hour, my average battle time was something like 30 seconds and my fastest was 13 seconds, would have been 10 but I got there and the boss didn't spawn for a couple of seconds :p.
TalynRahl posted...
tbh if you're JUST going after red hare do what I did...
On easy mode, the enemies have shorter health bars :)
And don't forget to save every 10 battles or so.
Otherwise there's a glitch where your character gets stuck in the box and the screen goes white...
dreike posted...
On easy mode, the enemies have shorter health bars :)
health bars are shorter on easy than beginner? why :p?
and tbh put it on either and with a 1/2 leveled character you'll one shot everything.
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text: r chele21974 | Digital Scrapbooking at Scrapbook Flair Home Galleries Groups Challenges Blogs Forums Members Downloads MarketPlace Store Archive Join Login offline Joined: Jul 16, 2008 Last Logon: Nov 25, 2008 chele21974's Home Page www.scrapbookflair.com/chele21974 34, married, new to scrapping, just started the adoption process, need to learn how to scrap so that we can create our Lifebooks for the adoption agency...feeling alittle overwhelmed chele21974 is from Dayton, OH, USA chele21974's Scrapbooks There are no scrapbooks from chele21974 yet. chele21974's Favorite Scrapbooks There are no favorite scrapbooks chosen by chele21974 yet. chele21974's Friends chele21974 has 8 friends » view all chele21974's friends chele21974's Fans chele21974 has 5 fans » view all chele21974's fans Renew/Upgrade Membership Gallery Groups Blog Friends Favorites Tags Post and Share this page on Blogs and other Websites by copying and pasting this link: http://www.scrapbookflair.com/chele21974 chele21974's home page has been visited 398 times. About Us Bookmark Contact Us Designer Members FAQs Fan Mail Help Link to Us Membership News Privacy Search Site Rules Suggestion Box Tell a Friend © 2006-2016, Patent Pending, Aurora Digital Imaging, Ltd. Beta 5.0 The most fun digital scrapbooking site on the Internet. Free digital scrapbooking software, scrapbook templates, scrapbook embellishments and backgrounds. Beautiful scrapbook prints and photobooks.


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Health and Wellness Resources for Students
Counseling and Psychological Services
Student Health 101
Support Groups
The Rutgers-Newark POWERHOUSE: Group of Alcoholics Anonymous
The Rutgers-Newark Al-Anon Family Groups
About NJ Connect's - Dual Approach
NJ Connect for Recovery is the only Call Line in New Jersey providing counseling specifically to individuals and families coping with addiction to heroin and prescription painkillers. People calling on behalf of themselves have access to a Certified Alcohol and Drug Counselor. Those calling on behalf of a family member or friend are connected to a Peer Specialist who can share a personal experience with recovery and who can understand the unique, complex effect of addiction on relationships.
Service Hours: 12 noon to 8 pm, Monday through Friday. At other times a voice mail may be left for call back the following business day.


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MINNEAPOLIS - It appears a safe bet that Thursday's 3 p.m. trading deadline will come and go pretty quietly for the 76ers. Perhaps that's not the news fans want to hear, but for the time being, at least, the Andrew Bynum fiasco kind of has the organization at a standstill.
"We are working the phones, but I don't think we'll be doing anything major," general manager Tony DiLeo said before Wednesday's game against the Minnesota Timberwolves that opened the unofficial second half of the NBA season. "If we do something, it will be minor. But it doesn't look like we'll take on any big salaries or anything like that."


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On Saturday morning, I was visited again by my (in my opinion as one who had barely woken up) way-too-perky Jehovah's Witness 'friend' from previous visits. (I'm sincerely sorry that I cannot remember her name.) After a fairly brief chat, I was given some new leaflets. The Witness had picked these out particularly for me, based on our last discussion during which I had professed my belief in science vs religion. The leaflet that I decided to start with is entitled "Was Life Created?" An excerpt from the introductory page, prefaced by the question "What do you believe?":
"Many religious fundamentalists believe that the earth and everything on it was created in six 24-hour days, just a few thousand years ago. Some atheists would have you believe that God does not exist, that the Bible is a book of myths, and that all life is the product of random undirected events."
Now, right there, I have issues with the statement about atheists: first, note the difference in the wording between the two sentences, i.e., "Many religious fundamentalists believe…" as opposed to "Some atheists would have you believe…" The implications that a) the beliefs of religious fundamentalists/literal Creationists are somehow more valid and earn more respect than the beliefs/non-beliefs of atheists, and b) that atheists want to force people to abandon their religion (whatever flavor it is) seem pretty obvious to me. This inference is made again a little further down the intro page, under the heading, "What is the purpose of this brochure?":
"It is not the purpose of this material to ridicule the views either of fundamentalists or of those who choose not to believe in God."
Again, carefully worded, "those who choose not to believe in God", as if we picked the wrong side, or refused to join their club. They won't "ridicule the views…of fundamentalists" (even though elsewhere in the introduction it states that religious fundamentalism and atheism are considered to be "opposing ideas") simply because the fundamentalists believe in a god and his bible. And obviously, by "God" they mean only the god of the Old or New Testament, not the Muslim's Prophet or any of the other major non-Christian religions of the world.
The intro wraps up with:
"Will you trust the claims of those who say that there is no intelligent Creator and that the Bible is unreliable? [YES!] Or will you examine what the Bible actually says? Which teachings are worthy of your trust, your faith: those of the Bible or those of evolutionists? Why not review the facts?"
The "facts" that are subsequently presented to advance the "intelligent Creator" argument are, oddly enough, all discovered through scientific research: how the planet Earth is in the ideal location to sustain life [sure, life as WE carbon-based oxygen-breathing life forms know it]; how the Earth's tilt is just right, along with the planet's speeds of rotation and orbit, to create the 'ideal' for human habitation: four seasons and 24-hour days. Also presented as "evidence" of an intelligent Creator are the size of our moon and its distance from the Earth [and here the JWs make Bill O'Reilly look like the idiot that he is, by mentioning that the planet's tides are affected by the moon); along with the laws of nature and science, i.e., the cycle of precipitation, photosynthesis, your basic Earth Science curriculum, and the multitude of species of animals. All of these scientific laws are indication to the JW's that a divine hand was involved.
If, as believers such as the JWs think, humans were made in god's image, I think that that god has a lot of explaining to do. Humans are the only species that is capable of completely ruining the beauty and wonder of our planet's unique ecosystems, as well as our own sources of food and water. What god would make a species such as ours?
Instead of (and possibly in answer to) the question being "What do you believe?", I believe that the question should be "What do you KNOW?"
This is our daily open thread–feel free to air your thoughts on, well, anything, including but not limited to Jehovah's Witnesses (or any other religious group), etc.


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Thread Rating:
Milk and Honey Spa Pedicure posted by Diana from Indiana
Post: #1(Print Post)
Milk and Honey Spa Pedicure posted by Diana from Indiana
Milk and Honey Spa Pedicure
Milk and Honey smooth and refresh. The enzymatic exfoliating properties of milk(contains lactic acid, a natural AHA), the hdrating qualities of honey(a natural humecatant that retains moisture). the exfoliation of sugar that stimulates cell circulation), and thescent of vanilla(scent of peace and relaxation) make the combination of a sure bet for making skin soft and smooth.
Sugar 1 T.
Honey squirt (1 t.)
Sweet almond oil (1/2 t.) or Solar oil may be substiuted
Dry Milk Flakes approx 1 cup
Base unscented lotion.
Take a small container ( I use souffle cups) and add sugar. Add 1 t. of honey and oil. Mix well....When you are ready to exfoliate, add a couple drops of water and stir. Do not add water too soon or water will dissolve sugar. Use on clients hands,arms, feet and hands.
Take a small container and add approximately 1 Tablespoon of base lotion, add vanilla (fo or from your grocery shelf), honey and oil. Mix together....and massage legs...........
When adding milk to your pedicures, turn jets off and add cup of dry milk to your tub...the clients foot can be soaking as you work on the other foot. Atleast a total of 10 minutes soaking..
Legs will be smooth as a babies butt!!!!
This recipe and brochure service discription was made by several of us on the nail tech list years ago. Sandy Jo from MN, Althena from Tx, Karen Hodges from Key West and myself got this all together......
Diana Bonn (diana from indiana) <dbonn AT iquest.net>
Muncie, IN USA
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BeautyTech.com Feed Your Nail Addiction
NailTech.com shop smart, brand name professional products for professional results
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Articles from RotoWire's fantasy archives that mention Jhonas Enroth's name.
April 12, 2016
Stanley Cup Playoffs: Player Rankings
Jan Levine ranks the skaters and goalies in the Stanley Cup Playoffs for fantasy playoff leagues. Can you guess where Alex Ovechkin ranks?
Stanley Cup Playoffs Preview: Ducks are Team to Beat
Jan Levine previews the Stanley Cup Playoffs as the Anaheim Ducks aim to bring the cup back to Southern California for the second time in three years.
April 5, 2016
Tuesday Daily Puck: Brouwery Tour
The Blues' Troy Brouwer has been red-hot lately, but is still available in a number of leagues for the season's last couple games.
April 3, 2016
The Waiver Wire: Crunch Time
Dan Waldner's best bet to light the lamp this week is Columbus' Boone Jenner, who faces a great schedule down the stretch.
March 22, 2016
The Daily Puck: Silfver Is Gold
Andrew Fiorentino offers a preview of Tuesday's games and recommends fantasy owners snatch up the Ducks' Jakub Silfverberg, who's seen his minutes and production tick up lately.
March 15, 2016
Tuesday Daily Puck: Back, Back, Back, Backlund!
Mikael Backlund has been enjoying increased minutes and rolling for the Flames, making for a nice down-the-stretch fantasy pickup.
February 28, 2016
Sunday Daily Puck: New Scenery, New Player
Joe Mahoney takes a look at the value of newly acquired depth players and recommends picking up Rickard Rakell.
February 16, 2016
Tuesday Daily Puck: Dumba and Dumba-er
Intriguing matchups abound for fantasy owners this Tuesday, while Andrew Fiorentino identifies the Wild's Mathew Dumba as a player who merits wider fantasy consideration.
February 14, 2016
Sunday Daily Puck: Return of Magic
Joe Mahoney looks for Pavel Datsyuk to have a big game Sunday and recommends picking up Jesper Fast
February 12, 2016
Yahoo DFS Hockey: Friday Picks
The Kid is back at it again, and Jason Chen is all over Pittsburgh's Sidney Crosby, who has a whopping 26 points in the new year.
Friday Daily Puck: Power Outage
Steven Stamkos is having a down year. Does that affect his value?
January 24, 2016
Sunday Daily Puck: Midway Crystal Ball
Joe Mahoney takes a shot at forecasting the NHL playoff picture, and recommends picking up Artem Anisimov.
January 17, 2016
Sunday Daily Puck: Another Year, Another Debacle
Joe Mahoney takes a look at the latest developments of the John Scott situation, and recommends picking up Carl Hagelin.
Yahoo DFS Hockey: Sunday Picks
Sasha Yodashkin breaks down a small Yahoo slate for Sunday, but Chicago's Jonathan Toews is an easy pick in a great matchup.
December 29, 2015
Tuesday Daily Puck: Toffolishness
Andrew Fiorentino offers a trio of young players you just can't get from him in keeper formats and takes a look at the Tuesday slate of NHL action.
Yahoo DFS Hockey: Tuesday Picks
Sasha Yodashkin breaks down the Tuesday Yahoo slate, including Boston's Ryan Spooner, who should thrive with his ascension to the second line.
December 12, 2015
DraftKings NHL: Another Week of Values
Rising young Blue Jackets star Ryan Johansen headlines this week in Neil Parker's DraftKings NHL value plays.
Saturday Daily Puck: Hall Pass
The top line in Edmonton continues to exceed expectations and put on a show.
December 4, 2015
DraftKings NHL: Next Week's Value Picks
Neil Parker offers his plays for the week ahead in DraftKings NHL action, including Blues pivot Jori Lehtera.
November 22, 2015
Monday Daily Puck: Blues' Blueliner Hitting High Note
Kevin Shattenkirk is picking up where he left off last year.
November 3, 2015
Tuesday Daily Puck: Rask And You Shall Receive
Andrew Fiorentino discusses the Patrick Kane criminal case and recommends impressive young center Victor Rask, who's been heating up in Carolina.
October 24, 2015
Frozen Fantasy: Windshield vs. Bug
Janet Eagelson explores how fantasy owners can dominate one league and sink to the bottom in another. Either way, waiver pickups, like the Islanders' Brock Nelson, are critical.
October 20, 2015
FanDuel NHL: Value Plays for the Week
In this week's FanDuel Value Plays, Michael Clifford provides his selections and makes a case for a newly promoted King.
October 13, 2015
Tuesday Daily Puck: Tuukka Fall
The Bruins' slipshod blue line is making Tuukka Rask look bad early on in the year, and things don't project to get a lot better.
September 3, 2015
From the Press Box: Pacific Division Preview
RotoWire's Paul Bruno previews the Pacific Division, where the Ducks have been the class team and may have gotten even better during the offseason.
September 1, 2015
Neutral Zone Wrap: Team-by-Team Offseason Review
It's report card time. Evan Berofsky grades each team's offseason moves, and the Red Wings get high marks for their signing of Mike Green from Washington.
April 11, 2015
Saturday Daily Puck: March Of The Penguins?
The Penguins face a must-win situation Saturday against Buffalo, while the red-hot Kyle Turris looks to help the Senators get into the postseason on the final day of the regular season.
April 5, 2015
Schedule Analysis: The Final Stretch
Brian Rutherford looks over the schedule for the final six days of the regular season, giving fantasy owners a few teams to focus on for last-gasp fantasy points.
March 9, 2015
NHL Barometer: Monahan's Flame Burns Bright
Jan Levine shines a deserving spotlight on Sean Monahan, who has been overshadowed in Calgary.
March 2, 2015
Tuesday Daily Puck: Don't Be Shy About Scheifele
Former top-10 draft pick Mark Scheifele has been coming on for the Jets lately, and he's Tuesday's recommended pickup.
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text:
Top Definition
a large baggie of marijuana
I am just sitting here chillin' with a fat sack looking for someone to party with
viết bởi Lucyyfur 08 Tháng sáu, 2005
Trending Now
Can you define these popular missing words?
fatsack: n. (pronunciation: fat-sak) One who is lazy, careless or irritable. The word also commonly refers to someone who eats food excessively, obsessively, or unnecessarily.
"You're such a fatsack," Denise told Leroy emphatically when she saw him eating a third serving of pie while sitting lazily on the couch.
viết bởi nitterpixi 06 Tháng tám, 2010
when a skinny person who doesnt normally have boobs gets fat and therefore has sacks of fat hanging off their chest
I never used to have boobs, then i got fat and now i have fat sacks
viết bởi Ryankensington 25 Tháng mười một, 2015
the sack on a fat person's body
That Man Has A Huge Fatsack.
viết bởi Caseyisforlosers32 15 Tháng tư, 2006
otherwise known as tuckshop arms
'i have fat sacks under my biceps'
viết bởi Georgiona 02 Tháng mười một, 2007
A lot of money in your pocket for spending.
I wish my parents had a fat sack like Jay-Z.
viết bởi Lade1020 02 Tháng ba, 2008


text:
Monkey Bites Nina Dobrev in Bali
Bulgarian-born Nina Dobrev was attacked by a monkey while she was on holiday on the Indonesian island of Bali, the actress revealed.
Dobrev, who rose to fame after starring in the Vampire Diaries, tried to pet the animal, but it her thumb, according to the website Dariknews.bg.
The incident left her thumb with a scar, and its nerve was severely damaged.
She was quoted by the LocalSyr as saying she had "no feeling" in that finger.
"Everybody made a joke like, 'Oh, you're the vampire girl (in the show), you're going to turn into a monkey now'," she admitted.
Nina Dobrev (born Nikolina Konstantinova Dobreva) and her family moved to Canada when she was just two years old.
- » Sofia Municipality To Renovate Zapaden Park
- » Samuel Jackson Takes Selfie with Bulgaria's Presidency
- » Nicole Scherzinger Dispels Rumors of Breakup with Bulgaria's Dimitrov
- » Grigor Dimitrov Tops List of 70 Most Popular Bulgarian Celebrities – Forbes Bulgaria
- » Bulgarian Women Among World's Top 10 Sexiest - Survey
- » Selfie of the Day: Kristalina Georgieva, Maxim Behar
With the design of high stability performanceand configured with 4 in 1 controller (included: gyro,ESC,receiver, mixing ), which will make the beginners manipulateit freely.
damn that's gotta hurt. Ummm where exactly is the Bali on a woman ???
"Because it confuses westerners, their brains can only handle simple things."
Yes Yane we know you easterners are so successful, wealthy and pools of progress. That's why Bulgaria has invented the ..........mmmmm.........what the FUCK has Bulgaria invented besides the Turkish toilet? LOL.


text:
Pitch-In for Baseball supports Twin Cities schools
Thanks to the nonprofit Pitch-In for Baseball and its president, former Twins All-Star shortstop Roy Smalley, with support from the Twins Community Fund, 19 Twin Cities schools' baseball and softball teams received new equipment for their approaching seasons. More »
Welcome to Play Ball! Minnesota
Play Ball! Minnesota is a unique collaboration among the youth baseball and softball leaders in Minnesota. As the first of its kind, Play Ball! Minnesota is aimed at improving and getting more kids in the game. More »
Youth clinics available free of charge
Created in 1961 by longtime Twins scout Angelo Giuliani, the youth clinics program serves as a way for the Twins to promote the games of baseball and softball to boys and girls throughout the region. More »
The summer of 2016 is the 56th summer the Minnesota Twins, Twins Community Fund and Play Ball! Minnesota, in partnership with Great River Energy, will offer free youth baseball/softball clinics.
While it is not possible for every coach or parent to know everything about the game, it is a responsibility to have general fundamental knowledge to be an effective teacher and mentor.
The Junior Twins program provides youth baseball and softball organizations in the Upper Midwest with monetary grants (up to $5,000) and resources.
Awards & Events
Minnesota Twins alumni, members of the Twins front office and Play Ball! Minnesota members lead general and breakout sessions on a variety of timely and pertinent youth baseball and softball topics.
Since 2010, Play Ball! Minnesota has hosted the Minnesota State High School League Prep Baseball Championships at Target Field.
Play Ball! Minnesota is proud to partner with the Minnesota High School Baseball Coaches Association to present this first-class experience for the top senior players in Minnesota.
Resources to help coaches become better teachers and mentors for youth and amateur players.
Resources to help administrators and officials create an atmosphere of safe and healthy competition.
Terry Ryan Award
The Play Ball! Minnesota Terry Ryan Award honors continuous passion, dedication and support for youth baseball and softball in Twins Territory. More »


text:
- Table View
- List View
The Koranby N. J. Dawood
The Koran is universally accepted by Muslims to be the infallible Word of God as first revealed to the Prophet Muhammad by the Angel Gabriel nearly fourteen hundred years ago. Its 114 chapters, or surahs, recount the narratives central to Muslim belief, and together they form one of the world's most influential prophetic works and a literary masterpiece in its own right. But above all, the Koran provides the rules of conduct that remain fundamental to the Muslim faith today: prayer, fasting, pilgrimage to Mecca and absolute faith in God.
The Muqaddimah: An Introduction to Historyby N. J. Dawood Bruce Lawrence Ibn Khaldun Franz Rosenthal
The Muqaddimah, often translated as "Introduction" or "Prolegomenon," is the most important Islamic history of the premodern world. Written by the great fourteenth-century Arab scholar Ibn Khaldûn (d. 1406), this monumental work established the foundations of several fields of knowledge, including the philosophy of history, sociology, ethnography, and economics. The first complete English translation, by the eminent Islamicist and interpreter of Arabic literature Franz Rosenthal, was published in three volumes in 1958 as part of the Bollingen Series and received immediate acclaim in the United States and abroad. A one-volume abridged version of Rosenthal's masterful translation first appeared in 1969.<P><P> This Princeton Classics edition of the abridged version includes Rosenthal's original introduction as well as a contemporary introduction by Bruce B. Lawrence. This volume makes available a seminal work of Islam and medieval and ancient history to twenty-first century audiences.<P> Chosen for Mark Zuckerberg's "A Year of Books"
Tales from the Thousand and One Nightsby N. J. Dawood
"The folk-tales which have collectively survived in what is known as The Thousand and One Nights owe their origin to three distinct cultures: Indian, Persian, and Arab. They can be regarded as the expression of the lay and secular imagination of the East in revolt against the austere erudition and religious zeal of Oriental literature generally. Written in a simple, almost colloquial style, and depicting a unique world of all-powerful sorcerers and ubiquitous jinn, of fabulous wealth and candid bawdry, these tales have little in common with the refined didacticism of Classical Arabic literature and have therefore never been regarded by the Arabs as a legitimate part of it. Yet it is a remarkable paradox that to the non-Arab world, and particularly to the West, the Nights is today the best known and most widely read book of Arabic authorship, while the more serious works of Classical Arabic literature, for the most part untranslatable verse, remain quite unfamiliar. In fact, in the course of the past two centuries the Nights has attained, mainly through the medium of translation, the status of a universal classic and has come to be recognized as such. This is not surprising. The tales themselves are masterpieces of the art of story-telling." Introduction
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Single Universal Lysis Buffer for True Total RNA Purification from Plant Species and Tissues
we show the effectiveness of Norgen's universal lysis buffer to successfully isolate high quality RNA from various plant species, including challenging samples, and we compare it to a popular commercially available kit from Qiagen.
RNA extraction from plant tissues presents many more challenges than from animal cells or tissues. This is because plant tissues are quite variable and represent a large number of different species. Plant tissue cell walls are often made up of various compounds and arrangements (celluloses, hemicelluloses, pectin's), therefore finding one protocol that works well with all of these variations is challenging. Furthermore, plant tissues contain various substances that interfere with RNA extractions and/or cause interferences or inhibition in downstream application. Compounds such as phenolics, phytotoxins, polysaccharides, starches, tannins, and other secondary metabolites are present in various amounts and combinations, making it difficult for most RNA and even DNA extraction protocols to yield high quality nucleic acid for downstream applications. Therefore, many plant RNA purification companies have adapted a dual lysis buffer system, which contains two lysis buffers that both have a unique range of plant materials that they are able to work with. The issue with this system is that a process of trialand- error must be carried out to see which buffer works most effectively on a sample, at the customers cost.
Norgen's Plant/Fungi RNA Purification Kit contains a universal, robust lysis buffer that is very effective over a wide range of plant species. It allows Norgen's Plant/Fungi RNA Purification to target the isolation of RNA from various challenging plant samples, including grape and pine needle, with no need to test different lysis buffers. This saves the customer's time and effort to establish a rapid RNA purification system in the lab.
With Norgen's universal lysis buffer, plant total RNA can be purified from a wide range of fresh or frozen plant tissues, plant cells, or filamentous fungi samples using this kit. Furthermore, the total RNA profile of the sample is purified, from large mRNA and ribosomal RNA, down to microRNA (miRNA) and small interfering RNA (siRNA) using Norgen's proprietary resin as the separation matrix. The procedure is also free of environmentally hazardous compounds such as phenols and chloroform, and yet maintains the integrity of its total RNA profile isolation. The yield and quality of the isolated RNA is of the highest integrity, and is excellent for use in downstream applications such as RNA sequencing, Next Generation sequencing, RT-PCR, qRT-PCR, icroarrays, Northern blots for host RNA (miRNA) or for pathogen detection, among many other applications.
In this application note, we show the effectiveness of Norgen's universal lysis buffer to successfully isolate high quality RNA from various plant species, including challenging samples, and we compare it to a popular commercially available kit from Qiagen. Many publications showing the utility of Norgen's universal buffer and kit for various plant species and applications are listed on our website: (www.accuvisbio.com )
Plant RNA Isolation
Plant RNA was isolated from 50 mg of plant leaf tissue (equivalent to ~5 x 106 plant cells) using Norgen's Plant/Fungi RNA Purification Kit as per the provided protocol (Figure 1). Briefly, the plant leaf tissue (apple,peach, grape, pine needle, strawberry and pear) was ground in a mortar, containing enough liquid nitrogen to cover the sample, with a pestle until the tissue was ground into a fine powder. Next, the universal lysis buffer was added. The lysate was then transferred into a filter column, assembled with an RNAse-free microcentrifuge tube and centrifuged for 1 minute at 14,000 x g (~14,000 rpm) to filter out cellular debris. The flow-through was then transferred to a new RNAse-free microcentrifuge tube and an equal volume of 96-100% ethanol was added and mixed by vortexing. Next, 600 μL of the clarified lysate was then loaded onto an assembled column and centrifuged for 1 minute at 14,000 x g (~14,000 rpm). The flow-through was discarded and the column was reassembled. The remaining lysate was then loaded onto the column and re-centrifuged for 1 minute at 14,000 x g. The column was then washed a total of three times by applying 400 μL of Wash Solution to the column, centrifuging for 1 minute at 14,000 x g (~14,000 rpm) and then discarding the flow-through. Columns were centrifuged for 2 minutes at 14,000 x g (~14,000 rpm) to thoroughly dry the resin. For RNA elution the column was placed into a fresh 1.7 mL elution tube and 50 μL of the elution buffer was applied to the column. Columns were then centrifuged for 2 minutes at 200 x g (~2000 rpm), followed by a 2 minute spin at 14,000 x g. Purified RNA was then stored at -20°C for several days or at -70°C for long term storage.
At the same time, RNA was purified from plant leaf tissue using the leading market competitor's plant RNA purification kit according to the manufacturer's protocol and used in comparative experiments.
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Fashion Fair Oil free moisturiser 136ml
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Item No.1237599013
Fashion Fair's oil free moisturiser is a lightweight, oil free moisturiser that is uniquely formulated to replenish the skin's natural moisture balance without added shine.
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This oil free moisturiser from Fashion fair contains botanical extracts help to minimize oily areas and prevent pore-clogging bacteria from forming. Aloe Vera and vitamin E hydrate and smoothe the skin. Suitable for oily skin types.
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Horse Boots & Wraps
Easy Stretch Bell Boots with double thickness at the bottom for added protection are designed to stay put without rubbing. Tops allow boots to stretch on with ease.
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A leading transpersonal psychologist shares scientifically grounded insights and practices for healing the self and others through the power of intention.
About the Author
Dr.Jeanne Achterberg is a scientist and transpersonal psychologist whose in-depth research has brought her international recognition. A former faculty member at the University of Texas Southerwestern Medical School and past president of the Association for Transpersonal Psychology.
Total Running Time : 360 minutes
6 Disc Set
Audience: General
Format: Audio CD
Language: English
Number Of Pages: 6
Published: 1st March 2008
Country of Publication: US
Dimensions (cm): 17.196 x 17.424 x 2.845
Weight (kg): 0.299


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Nigel De Brulier
|Nigel De Brulier
8 July 1877
Bristol, Gloucestershire, England, UK
|30 January 1948
(aged 70)
Los Angeles, California, USA
|Years active
Nigel De Brulier (8 July 1877 – 30 January 1948), born Francis George Packer, was an English film actor, born in Bristol, Gloucestershire, who launched his career in the theatre stage in his native country and transferred to films after moving to the United States. His first film role was a poet in The Pursuit of the Phantom in 1914. In 1915 he acted in the film Ghosts based on a play by Henrik Ibsen.
Nigel De Brulier acted Cardinal Richelieu in the four films: The Three Musketeers (1921), The Iron Mask (1929), The Three Musketeers (1935) and The Man in the Iron Mask (1939). De Brulier appeared with Douglas Fairbanks in The Gaucho (1927) and was also one of the few actors of the silent era who reached reasonable success in talkies, although his roles in them were quite minor. He played the wizard Shazam in the 1941 Republic serial Adventures of Captain Marvel and also acted in Charlie Chan in Egypt in 1935.
He played Jokaanan, the Prophet in a silent film version of Oscar Wilde's Salome (1923). A clip of De Brulier in Salomé was used in Before Stonewall, a film documenting the gay rights movement[1]
De Brulier died in Los Angeles in 1948.
Partial filmography[edit]
- Hypocrites (1915)
- Intolerance (1916)
- Joan the Woman (1917)
- Triumph (1917)
- The Kaiser, the Beast of Berlin (1918)
- The Romance of Tarzan (1918)
- The Testing of Mildred Vane (1918)
- The Boomerang (1919)
- The Virgin of Stamboul (1920)
- The Four Horsemen of the Apocalypse (1921)
- The Three Musketeers (1921)
- Foolish Wives (1922)
- A Doll's House (1922)
- Salome (1923)
- The Hunchback of Notre Dame (1923)
- Wild Oranges (1924)
- Ben-Hur: A Tale of the Christ (1925)
- The Ancient Mariner (1925)
- Don Juan (1926)
- The Patent Leather Kid (1927)
- Noah's Ark (1928)
- The Iron Mask (1929)
- The Wheel of Life (1929)
- Moby Dick (1930)
- Miss Pinkerton (1932)
- The Hound of the Baskervilles (1939)
- ^ Salomé (1923/I) at the Internet Movie Database. Retrieved 28 February 2008
External links[edit]
|Wikimedia Commons has media related to Nigel De Brulier.


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Drunker and Dirtier and Even Grittier
He may wear his patch over the opposite eye, but when Jeff Bridges takes on John Wayne's iconic role as Rooster Cogburn in the Coen brothers' new version of "True Grit," it is impossible not to compare the two. Wayne won his one and only Academy Award for the role. Bridges has already been nominated for Best Actor for his performance by the Screen Actors Guild and the Broadcast Film Critics, whose picks generally mirror the Oscars (which announce on January 25), which makes it likely that he'll snag his sixth Academy Award nomination for his work.
The Coens' new iteration is, however, dirtier, grittier and filled with cuss words — in fact, very likely much closer to the reality of the old west than its predecessor. And the new "True Grit" also features an astonishing performance by newcomer Hailee Steinfeld, as the determined 14-year-old Mattie Ross. Her face is completely mesmerizing, and from the moment we meet her, we understand that it isn't actually Cogburn who is the one with "True Grit" in this story, it is Mattie. Steinfeld plays her with a naturalness that is rarely seen in actors of any age, let alone one who was only 13 when she made this, her first film. Now 14, she'd already been acting for a few years in television before snagging this role; and this movie makes her a star.
Matt Damon rounds out the main trio in this tale of retribution set against a gorgeous western landscape; his slightly preening take on LaBoeuf, the Texas Ranger, is a terrific counterpoint to Cogburn's drunken slovenliness. The rest of the supporting cast of bad guys, including Josh Brolin and Barry Pepper, give appropriately chilling performances as well.
All in all, this remake of "True Grit" is darker, dirtier and edgier than the original; but that doesn't necessarily mean better. Our advice is to see both for yourself and compare. Both are definitely worth the price of admission.
Reviewed by Jenny Peters
The kinds of movies made for foodies, including classics such as Like Water for Chocolate and newer releases like Chef and Ratatouille.
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Electronic Equipment, Instruments and Components
Company Overview of Codan Limited
Executive Profile
Charlie P. Stuff
Executive General Manager of Radio Communications, Codan Limited
|Total Calculated Compensation
|This person is connected to 1 Board Members in 1 different organizations across 3 different industries.
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As of Fiscal Year 2016
Mr. Charles P. Stuff, also known as Charlie, M.B.A, B.Sc, has been an Executive General Manager of Radio Communications at Codan Limited since September 3, 2015. Mr. Stuff served as the President of Cobham Avionics and Surveillance at Cobham PLC since September 2005. Mr. Stuff served as the President of Chelton Avionics Inc., a subsidiary of Cobham plc. He was a US Army Officer and held senior management positions with Rockwell Collins and Cobham PLC. He led the turnaround ...
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Team Lomachenko, Top Rank VP Got Nervous With Draw
By Rick Reeno
On Saturday night at the StubHub Center in Carson, California - Vasyl Lomachenko (2-1, 1KO) captured the vacant WBO featherweight crown with twelve round majority decision over previously undefeated Gary Russell Jr. (24-1, 14KOs).
After the fight was over, the post-fight celebrations by Team Lomachenko were hit with a black cloud when ring announcer Jimmy Lennon Jr. announced that all three judges had rendered a majority decision. When the score of 114-114 was announced first, there was some nervous energy in the ring for Lomachenko and his camp members.
"After the fight of [Ruslan] Provodnikov [against Chris Algieri], I got a little nervous of course when I heard it was even, 114-114," said Lomachenko's manager Egis Klimas.
But when Lennon announced that the other two judges had it 116-112 for Lomachenko, the correct fighter was awarded the vacant title.
"The fact that it was 114-114 is absolutley absurd and it just shows that yes we got it the way it should have been, but that you know what - it was still f***ed up that it was that score," said Carl Morretti, VP of Boxing Operations for Top Rank, when speaking with BoxingScene.com.
[QUOTE=Hook-Right;14689334]Oh hey, it's Junior Dong the Troll! Has your Floyd voodoo doll arrived yet? I know you already have a full size poster in your room.[/QUOTE] Pacquiao'd?Comment by PunchyPotorff on 06-23-2014
Some of these judges need one of two things: -new glasses -not be paid off anymore And the first one doesn't count.Comment by Deevel916 on 06-23-2014
[QUOTE=Hook-Right;14689028]You mean like when 1 judge robbed Floyd against Canelo and scored it a draw? If anyone knows about paying off judges, it is TR and Arum. Dude had his offices raided by the FBI for a reason.[/QUOTE] What does…Comment by Hook-Right on 06-23-2014
[QUOTE=isidius;14689163]Oh really? What about Pac - Bradley 1?[/QUOTE] Arum bribed the judges to generate interest in a rematch. It's obvious, and was noted by boxing media at the time. Arum had very few guys to match Pac with. Remember, the…Comment by Hook-Right on 06-23-2014
[QUOTE=junior gong;14689047]Who's crappy, floydgimp alt are you?[/QUOTE] Oh hey, it's Junior Dong the Troll! Has your Floyd voodoo doll arrived yet? I know you already have a full size poster in your room.Post a Comment - View More User Comments (24)


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2005 Dodge Dakota 4dr Club Cab ST Rwd SB (3.7L 6cyl 6M)
I wish I would have opted for the V8 but this truck serves my purpose of light hauling and travel very well. There is a little drag in take off, but the truck rides as smoothly as it can and I have thoroughly enjoyed owning it.
Cab space is open and comfortable but not too excessive.
More space in back in extended cabs. I need about another inch or two to fit a carseat in when the wife's car is busy.
A loyal Ford truck person, I thought I would try something different.Price and research brought me to Dodge. So far, so good. A basic truck w/AC. My commute in L.A. takes me 86 miles round trip. Handle's well in traffic, although brakes are a little "spongy". I am impressed with what Dodge has done with the Dakota.
Audio system is great! Confidence while driving is better than Ford Ranger. A solid vehicle.
Gas mileage for V6 is less than expected.Interior is becoming a disappointment,it stains with water.
I really like the truck with the exception for the rear end vibration when you use the brakes. I asked the dealer before i bought the truck if there were any items of concern and was told no. I returnrd 3 days later to the service department to check out the vibration I felt. The service look at my truck and said oh yea you have the model that has a SRB out about vibration. We have 6 or 7 trucks waiting to get fixed.
I like the way it handles and the power for a v6. its a fun truck to drive. They just have to fix the vibration. I am still waiting
Dodge fix the problems before you sell the truck
This truck is amazing. I have the 3.7 l V6 and it has great power and sound. The interior Is my favorite, very comfortable, quiet, smooth. The only thing I dont like about the truck is the front bumper sticks out 6-inches too much, but other than that I rate it altogether a 9/10. I wouldnt buy anything else but a Dodge
Interior, all the guages, comfort, room.
The front bumper sticks out to much
Just bought the new model Dakota for 2005. I like the new look but wish the mileage was a bit better. This is not a commuter vehicle. I have detected a vibration at 60 MPH, and I hope the dealer can track that down for me. Beyond that, it is a fun truck to drive.
New, bold look, as roomy as a full size truck. The dealer incentives really lowered the cost!
Great platform for a hybrid to improve milage.
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Fight against dog lab taken outside
Two groups want Medical College to stop operating on and killing the animals
In an effort to keep the Medical College of Wisconsin from using and then killing dogs in a human physiology laboratory designed for first-year medical students, two animal advocacy groups have erected a billboard along Highway 45 that decries the practice: "Don't put man's best friend under the knife. Stop the Medical College of Wisconsin's dog lab."
Yet, just as the 48-foot-by-14-foot poster went up near Hampton Ave. this week, a Medical College spokesman said the college would evaluate the possibility of replacing dogs with pigs for its 2008 laboratory.
The college's animal research and review board has approved a protocol allowing physiology course instructors to determine the educational value of pigs in a live animal laboratory, said Richard Katschke, the associate vice president of public affairs at the Medical College. This means that later this spring, the instructors will use pigs for the human physiology laboratory to see whether they are suitable models.
If they are, the instructors will rewrite the class protocol and apply for approval from the U.S. Department of Agriculture to use pigs. If they don't work out, said Katschke, "then it's back to the drawing board."
The college would then have to determine whether it will continue with dogs, look for another animal model or consider alternatives.
Katschke said the decision to re-evaluate the use of dogs was not the result of pressure from the billboard's sponsors - the Wisconsin Humane Society and the Physicians Committee for Responsible Medicine. Instead, the decision was the result of a thoughtful re-examination of using companion animals for classroom purposes, and the public's general distaste for it, he said.
"If we were caving in to the animal rights groups, we wouldn't be using animals at all," Katschke said. Instead, "so much focus has been placed on the dogs that the importance of the class has been lost."
The college's change of course did not, however, appease officials from the Physicians Committee or the Humane Society.
Spokesmen for the groups said the college's announcement appears to be a deflection of the real issue, which is that 60 dogs are still slated to be killed after the next lab in February. And that animals are not ideal models for studying human physiology.
"Our primary concern is to encourage the Medical College to immediately discontinue the practice of killing dogs in their physiology lab," said Jeff Rusinow, a board member of the Wisconsin Humane Society.
"There is no reason why MCW can't change their practice now for this semester's upcoming lab," he said, considering that the college owns four state-of-the-art human simulators.
While many medical schools once used live dogs to teach human physiology, pharmacology or surgery, only two U.S. medical schools still do, according to the Physicians Committee. Those schools are the Medical College of Wisconsin and the New York Medical College in Valhalla, N.Y. And only one of the top 20 rated medical schools - Washington University Medical School in St. Louis - still uses any live animals, according to the committee.
The dog lab at the Medical College of Wisconsin is designed for students to explore the circulation system as part of a physiology course. Last year, 52 dogs were operated on while under anesthesia. The dogs were euthanized at the end of the laboratory exercise. It is expected that about 60 dogs will be used for the class during this year's spring semester.
The college's physiology department is ranked No. 1 in the United States in terms of the federal money it receives from the National Institutes of Health.
"It's a shame that an outside group with a philosophical position is resulting in a change in the way that medical education is done," said Gale Davy, executive director of the Wisconsin Association for Biomedical Research and Education.
"What does this change for anybody? For humans or for animals?" she said. "If the pig was as good a model as a dog, they'd have been using pigs years ago."