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Lebanon Valley Camps Gretna Glen and Kenbrook Offer Fun for all AgesRecreation and Family-Fun Activities
Whether hosting wide-eyed children on a summer afternoon or corporate executives retreating from the hectic pace of the office, Lebanon's lush hills and valleys provide a welcomed respite.
No fewer than five camps call the Lebanon Valley home, including Kenbrook, Gretna Glen, YMCA Camp Shand, Camp Kirchenwald and Bashore Scout Reservation. Each serves the community, as well as visitors escaping more crowded municipalities. Gretna Glen and Kenbrook began as church-founded summer camps for children, but have grown to encompass much more.
Gretna Glen Camp and Retreat Center is a 200-acre facility located near Mount Gretna. Founded by the Eastern Pennsylvania Conference of United Methodist Church, the camp has been serving the outdoor needs of Pennsylvania children since 1892.
In the summers, those needs continue to be met through its various camping programs. Whether day campers or overnight visitors, children can take part in a myriad of indoor and outdoor activities, including swimming, archery, boating, crafts and challenge courses of various levels of difficulty. During the other three seasons of the year, Gretna Glen is turned over to adults – for retreats, meetings or simple leisure in the camp's scenic forest.
New to Gretna Glen is Team Builders Training, a program serving corporate, and school and community groups with a wide variety of staff development and life skills training options. Team Builders Training offers one-hour to multiple-day programs that are custom designed to work at the group's goals and in such a manner that the learning experiences are inclusive to all members of the group.
At Kenbrook, founded in 1949 by the Fairland Brethren in Christ Church, children and adults find much to do among the rolling hills and woodlands. The facility offers hiking trails, a canoeing lake, swimming pool, gymnasium/game room, ropes courses and full dining facilities. Adults who visit for corporate training, meetings or retreats find motel-style accommodations and a conference center. The sleeping areas for the children are more rustic.
Besides the summer camp opportunities, Kenbrook also allows its youth to "Venture Out," a program of high-adventure trips that include backpacking in the White Mountains or canoeing on the Potomac.


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Ka Mo'olelo Moana: Twenty four species of whales swim in Hawaii's waters
At this very moment, there could be nearly 10,000 humpback whales cruising around the coastal waters here in Hawaii, and if you spend any time gazing out toward the horizon there's a good chance you'll see one.
Members of this species, famous for their acrobatics and haunting vocalizations, unintentionally captivates us, and we forget that there are other whales here too. There are actually 77 other cetacean (that is, whale and dolphin) species in the world, of which 24, including the humpback, have been documented in Hawaiian waters.
The second most commonly seen cetacean in Hawaii could be the slender 4- to 7-foot, 100- to 150-pound, tri-colored Hawaiian spinner dolphin (Stenella longirostris). These creatures congregate in large pods of up to 1,000 individuals and are well-known for their playful behavior commonly seen by people. They have a unique ability to repeatedly spin on an axis like a ballerina, spinning up to seven rotations in a single leap. Just like humans with flushed skin after physical exertion, the spinner dolphin's white belly turns rosy pink the more they spin.
More elusive and peculiar looking is the 15- to 20-foot long Blainville's beaked whale (Mesoplodon densirostris). With a dorsal fin positioned closer to the tail than the head and a scarcity of surface behavior, this whale is difficult to find. The species name "densirostris" is Latin for "dense beak" and males have two large teeth that grow up from the lower jaw resembling tusks on a wild boar. The Blainville's beaked whale is so elusive and understudied, that we still don't know much about their biology or population and what is known about this whale is mainly from strandings.
Another mysterious whale here in Hawaii is the false killer whale (Pseudorca crassidens), named for its physical resemblance to the killer whale (Orcinus orca). These cetaceans attack smaller dolphins. At 15- to 20-feet long, they look like a black torpedo and typically travel in pods with 10 to 20 other individuals. Their common name can be deceiving because they are really part of the taxonomic family delphinidae, same as the killer whale and spinner dolphin. These dolphins hunt larger fish like tuna and jack and will launch into the air, captured fish in mouth, in a dramatic hunting maneuver. However, as long as you are not their prey, false killer whales are not considered aggressive animals and will share food, even offering their catch to people. Sadly, in 2012 the Hawaiian population was added to the endangered species list because their population size was estimated to be only a few hundred.
Found in much deeper Hawaiian waters are two real leviathans: the bulbous headed sperm whale (Physeter macrocephalus) and the largest animal ever to have existed, the blue whale (Balaenoptera musculus). The sperm whale is the largest toothed whale reaching lengths of about 50 feet and was named for the massive spermaceti organ in its head. Early biologists thought that this was part of the whale's reproductive anatomy but nowadays it is thought that the organ helps with hunting in the dark, thousands of feet down. In contrast, the blue whale, exceeding 100 feet in length, is a filter-feeding baleen whale and feeds mainly on the small nutrient dense krill.
This winter, as you scan the horizon you will most likely see the humpback whales, but keep in mind all the other species of whales that are also cruising around out there. Unlike the charismatic humpback whale, many of the 24 species of whales here in Hawaii are here all year long.
* Erin Iberg is the community education manager at the Maui Ocean Center. "Ka Mo'olelo Moana," or "The Ocean Story," is a monthly column submitted by the Maui Ocean Center, which is open from 9 a.m. to 5 p.m. daily in Maalaea. For more information, call 270-7000.

subset: commoncrawl


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Located in the Gonzaga beach one of the most import touristic Center of the town, you Will find all the structure and options leisure and service that you may need.
This neighborhood counts with two malls, many restaurants, pubs, night clubs, galleries, clothes and household-electric stores, tourism, agencies and others. All this options between the channels two and three.
The prices include:
Breakfast; Cable TV; Wi fi Internet; Frigobar; Conditional Air; Private Parking; Children with age of six or under don't pay; We don't charge taxes.


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Home safety
checks available
A Home Safety Evaluation Program is available to all Warren city residents.
When residents call for an appointment, personnel from the city fire and police departments inspect the home and evaluate its safety from a fire and personal security perspective.
For more information or to schedule an evaluation, call the city offices at 723-6300.
Closed for holiday
Experience, Inc. will be closed on Monday, Sept. 5, in observance of Labor Day. Persons with an emergency should call the state police at 723-3600.
The Allegheny Community Center will be closed on Monday, Sept. 5, for the Labor Day holiday. Activities will resume Tuesday.


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*From the Departments of Medicine (Dr. Ely), Vanderbilt University School of Medicine, Nashville, TN; the John Hopkins University School of Medicine (Dr. Haponik), Baltimore, MD; Barnes-Jewish Medical Center and Washington University School of Medicine (Dr. Kollef), St. Louis, MO; the Cleveland Clinic Foundation (Dr. Stoller), Cleveland, OH; and the Evidence-Based Practice Center (Drs. Meade, Cook, and Guyatt), McMaster University, Hamilton, Ontario, Canada. This research was supported by National Institutes of Health grant No. AG01023-01A1 (EWE) and a Beeson Scholarship from the American Federation for Aging Research (EWE).
Correspondence to: E. Wesley Ely, MD, MPH, FCCP, Division of Allergy/Pulmonary/Critical Care Medicine, Center For Health Services Research, Sixth Floor Medical Center East, Vanderbilt University Medical Center, Nashville, TN 37232-8300; e-mail: email@example.com
Health-care professionals (HCPs) can provide
protocol-based care that has a measurable impact on critically ill
patients beyond their liberation from mechanical ventilation (MV).
Randomized controlled trials have demonstrated that protocols for
liberating patients from MV driven by nonphysician HCPs can reduce the
duration of MV. The structure and features of protocols should be
adapted from published protocols to incorporate patient-specific needs,
clinician preferences, and institutional resources. As a general
approach, shortly after patients demonstrate that their condition has
been stabilized on the ventilator, a spontaneous breathing trial (SBT)
is safe to perform and is indicated. Ventilator management strategies
for patients who fail a trial of spontaneous breathing include the
following: (1) consideration of all remediable factors (such as
electrolyte derangements, bronchospasm, malnutrition, patient
positioning, and excess secretions) to enhance the prospects of
successful liberation from MV; (2) use of a comfortable,
safe, and well-monitored mode of MV (such as pressure support
ventilation); and (3) repeating a trial of spontaneous breathing on the
following day. For patients who pass the SBT, the decision to extubate
must be guided by clinical judgment and objective data to minimize the
risk of unnecessary reintubations and self-extubations. Protocols
should not represent rigid rules but, rather, guides to patient
care. Moreover, the protocols may evolve over time as clinical and
institutional experience with them increases. Useful protocols aim to
safely and efficiently liberate patients from MV, reducing unnecessary
or harmful variations in approach.
advances have been made regarding the optimal methods of weaning
ventilatory support and liberating patients from the ventilator. These
efforts are important because mechanical ventilation (MV) is associated
with considerable morbidity, mortality, and costs.1–3
However, the premature discontinuation of MV can contribute to the
incidence of failed extubation, nosocomial pneumonia, or increased
mortality.4–6 Traditionally, physicians have
approached the discontinuation of MV through a gradual reduction in
ventilatory support, which is reflected in universally applied but
varying forms of "weaning." However, this gradual approach may
unnecessarily delay the extubation of patients who have recovered from
respiratory failure. With better recognition of the complications of
MV, and with increasing awareness of the resources consumed during the
care of patients experiencing respiratory failure, a change in the
culture of weaning is well-supported by the literature. Evidence
supports the current concept of "liberation" from MV
7–9 (ie, that the timely recognition of
recovery from respiratory failure is more important than the
manipulation of MV in an attempt to facilitate weaning). Furthermore,
utilizing the skills and expertise of nonphysician health-care
professionals (HCPs) can improve patient outcomes.
The McMaster University Evidence-Based Practice Center has
conducted a comprehensive review of the literature regarding weaning to
address key questions posed by the Agency for Health Care Policy and
Research (AHCPR).1 To create this 380-page document, which
reviewed approximately 1,000 articles from 1971 to 2000, the authors
chose 154 articles for final review and evaluation. Among the many
aspects of weaning reviewed by the McMaster-AHCPR investigators, the
strongest conclusions were drawn in regard to the development and
implementation of ventilator weaning protocols and the use of
nonphysician HCPs (eg, respiratory-care practitioners
[RCPs] and nurses) in the ICUs to enhance patients' liberation from
We have described the methods of our reviews in the introduction
to this supplement and in the article concerning alternative
discontinuation assessment methods and weaning modes. Herein, we
summarize these methods briefly, focusing on aspects specific to this
We included all studies of adult patients who were receiving MV
that compared weaning conducted according to an explicit protocol
to the traditional, physician-directed approach. We included
randomized trials, or controlled nonrandomized studies. We excluded
studies that reported physiologic outcomes exclusively.
To identify relevant studies, we searched MEDLINE, EMBASE,
HEALTHStar, CINAHL, the Cochrane Controlled Trials Registry, and the
Cochrane Data Base of Systematic Reviews from 1971 to September 1999,
and we examined the reference lists of all included articles for other
potentially relevant citations.
Five respiratory therapists and five intensivists participated
in data abstraction and in rating the methodological quality of all
eligible randomized trials or nonrandomized controlled cohort studies
that addressed treatment issues. One of the investigators rechecked the
final data abstraction. The methodological features of randomized
trials that we abstracted included the following: the method of
randomization and whether randomization was concealed; the extent to
which groups were similar with respect to important prognostic factors;
whether investigators conducted an intention-to-treat analysis; whether
patients, clinicians, and those assessing outcome were blind to
allocation; the extent to which the groups received similar
cointerventions; and reporting of the reasons for study withdrawal. For
nonrandomized controlled clinical trials, we considered the extent to
which groups were similar with respect to important prognostic factors,
whether the investigators adjusted for differences in prognostic
factors, and the extent to which the groups received similar
We abstracted or, when necessary, calculated effect sizes in
terms of relative risks (RRs) and associated 95% confidence intervals
(CIs) for binary outcomes and mean differences and 95% CIs for
continuous variables.
We identified four randomized controlled trials (RCTs) that
compared protocol-based weaning to conventional weaning (Table 1
).9–12 One very small trial10 (15 patients)
compared computer-directed weaning to physician-directed weaning
and found trends in favor of the computer-directed weaning in both
nonextubation and reintubation rates (Table 2
Three RCTs9,11–12 compared weaning protocols that
were largely implemented by RCPs and nurses to conventional
physician-directed weaning. These trials were all methodologically
strong (Table 1) and, for this field, very large (300 to 357 patients).
All three studies enrolled virtually all patients who were receiving MV
in the participating units during the study periods.
Ely and colleagues9 reported a two-step protocol that was
driven by nurses and RCPs incorporating daily screening followed by a
spontaneous breathing trial (SBT). Although the 151 patients who were
managed in the medical and coronary ICUs and were in the intervention
group had a higher severity of illness than the 149 control patients,
they were removed from the ventilator 1.5 days earlier, had 2 fewer
days of weaning, had 50% fewer complications related to the
ventilator, and had mean ICU costs of care that were lower by more than
$5,000 lower per patient.9 These investigators studied
patients whose median durations of MV were 4.5 and 6 days,
respectively, in the protocol-directed and physician-directed groups.
The RR of successful extubation in the protocol-directed group was 2.13
(95% CI, 1.55 to 2.92; p < 0.001), indicating that MV was
successfully discontinued sooner in the protocol-directed group than in
the control group. The largest separation between groups was at
approximately 5 days, and differences disappeared by about 15 days.
Patients in the physician-directed group spent a day longer in the ICUs
and 1.5 days longer in the hospital. Neither of these
differences reached statistical significance.
Kollef and colleagues11 conducted their study in four ICUs
using three different weaning protocols that had been developed and
tested by the ICU staff prior to the start of the study. Despite the
large sample size, the power of their study to detect differences in
key end points was limited by the fact that most patients spent a
relatively short period of time on the ventilator. In the
protocol-directed and physician-directed groups, 25% of the patients
were extubated by 15 and 21 h, respectively, 50% were extubated
by 35 and 44 h, respectively, and 75% were extubated by 114 and
209 h, respectively. Only 12% and 17%, respectively, of the
patients spent > 7 days on the ventilator. Survival and regression
analyses suggested a difference that favored patients in the protocol
group. Simple analyses also favored the protocol-directed group, but
they failed to reach statistical significance (Table 2).
In a more recent investigation that included 335 patients
(approximately 50% surgical, and predominantly trauma), Marelich and
colleagues12 showed in an RCT that the use of a weaning
protocol incorporating multiple daily SBT assessments shortened the
median duration of MV from 124 to 68 h (p = 0.001).
Investigators censored patients in the protocol group for whom
attending physicians violated the protocol, potentially excluding from
the analysis patients who were destined to wean more slowly from
ventilation. This may overestimate the reported benefit of the weaning
protocol with respect to the duration of ventilation; thus, these
results are potentially misleading.
In addition to these RCTs, 11 non-RCTs have examined the impact of,
largely, respiratory therapist-directed or nursing-directed weaning
compared to physician-directed weaning on weaning outcomes in
critically ill patients (Tables 344A
).13–21 These studies, conducted in a variety of
populations, are generally much larger than the corresponding RCTs but
are more prone to bias, given their observational design (Table 3). The
results of these nonrandomized studies are generally consistent with
the results of the RCTs, demonstrating statistically significant
reductions or trends toward reductions in the duration of MV and ICU
length of stay. Protocol-based weaning was associated with other
favorable process-of-care outcomes such as fewer arterial blood gas
analyses. Mortality and reintubation rates did not appear to differ
between the experimental and control groups. Complications of
protocol-based weaning were not reported.
To provide clinicians with the most useful information set for the
design and implementation of weaning protocols, we have structured this
section into seven key recommendations (Table 5
). The results of the foregoing evidence-based review were incorporated
into the first three recommendations. The last four recommendations
were derived from emerging data about weaning from MV and extubation,
the optimal delivery of sedation and analgesia in the ICU, and the need
for an objective and graded plan of implementation.
Considerable evidence exists that allied HCPs can
implement respiratory-care protocols that enhance clinical outcomes for
critically ill patients with respect to appropriate blood gas analysis
or chest physiotherapy.21–26 Respiratory-care protocols
(ie, therapist-driven or patient-driven protocols) have been
investigated extensively during the past few years.31
From these studies, we have learned that the use of protocols can
improve clinical outcomes and enhance the appropriate allocation of
respiratory-care services.
Recommendation 1: Based on evidence from
randomized trials, we recommend that nonphysician HCPs be included in
the development and utilization of respiratory-care protocols (not
confined to liberation from MV).
The McMaster evidence-based AHCPR report on weaning1
concluded that there is strong evidence that weaning protocols can,
under some circumstances, decrease the length of time that a patient
spends on the ventilator. These protocols may be organized and led by
physician opinion leaders, then implemented on a daily basis by
nonphysician HCPs. A major transition in thought regarding weaning
began in 1994 and 1995, when it was demonstrated for the first time in
RCTs,8,32that one modality of weaning might be superior
to another if it was executed in a specified fashion. However, these
data did not establish that a weaning protocol was superior to the
standard of care, which was the individual physician's best
management.33 Now, the results of three randomized
trials,9,11–12 including 992 patients, suggest that
protocols can, at least under some circumstances, result in important
decreases in the duration of MV. The implementation of nurse-driven or
RCP-driven weaning protocols, regardless of the specific weaning mode
employed, can significantly expedite safe liberation from
That three RCTs using appreciably different protocols have all
demonstrated statistically significant reductions in the time spent
receiving MV (although the magnitude of the difference between groups
varied substantially) suggests that it is the protocols (and the
culture change that these protocols represent) that effect the
benefit, rather than any specific modality of weaning. The current data
do not support the use of any one protocol (although some guidelines
are offered below), and the selection of an appropriate protocol is
best left to multidisciplinary teams at individual institutions.
Importantly, each institution must endorse the fiscal commitment and
the staffing modifications that are necessary for developing and
implementing a multidisciplinary weaning protocol team of dedicated
HCPs.34While institutions should embrace collaborative
weaning efforts35 and should customize protocols to local
practices, several important general concepts may ease the process of
implementation and may enhance success, and these are reviewed in
multiple sections below.
Recommendation 2: Based on evidence from
RCTs, we recommend that ICU clinicians utilize protocols for liberating
patients from MV in order to safely reduce the duration of
Given the low negative predictive value of most weaning parameters
(ie, the available parameters predict weaning failure
poorly),3,36–37 it appears most prudent to conduct daily
assessments of the patient's ability to breathe
spontaneously.8–9,11,32 Clinicians should have a low
threshold to perform such a trial. Yet, in a recent international
utilization review38 of the actual weaning practices of
412 medical and surgical ICUs in 1,638 patients receiving MV, only 20%
of patients were weaned using some form of SBT, and in the United
States, SBTs were incorporated into weaning in < 10% of all patients
studied. Patients chosen for SBTs should be in hemodynamically stable
condition, and their condition should be improving with regard to the
underlying cause of respiratory failure. SBTs can be performed safely
by nonphysician HCPs using a T-piece, continuous positive airway
pressure without pressure support, or with pressure support up to 7 cm
H2O, and for durations of 30 min to 2
h.,6,8–9,11,32,34,39–40 The monitored assessment of
spontaneous breathing should be conducted at least once daily (with the
head of the bed elevated and after notifying the patient of
the start of the SBT) and should be integrated with other major events
in the patient's daily care, including the cessation or temporary
reduction in delivery of sedation and analgesia
medications.41There are emerging data about the utility
of noninvasive positive-pressure ventilation to facilitate weaning and
to avoid reintubation,42–45 as well as ongoing
multicenter trials that are studying protocols using this modality of
respiratory support for weaning patients from MV.
Recommendation 3: Based on evidence from
randomized trials, we recommend at least once daily SBTs to identify
patients who are ready for liberation from the ventilator.
When a patient does not demonstrate readiness for liberation
from the mechanical ventilator, but is improving as indicated by
lessening support requirements, the clinician is faced with a decision
about how to wean MV support. In randomized trials, both Esteban et
al8 and Brochard et al32 employed a screening
process whereby patients were enrolled into the trials only if they
failed to demonstrate readiness via an SBT. In these studies, either
once-daily SBTs or pressure support ventilation were both superior to
intermittent mandatory ventilation alone. Reported differences in the
superiority of SBTs vs pressure support ventilation have been
attributed to variations in the management protocols. The value of
differing modes depends on thresholds for initiating, progressing
through, and terminating weaning. Unfortunately, these thresholds
involve more than objective data and appear to be related to physician
judgment.1 Therefore, based on evidence from these
investigations, we can offer the following recommendations.
Recommendation 4: When patients fail an SBT,
we recommend the following assessments and interventions, based on
varying levels of evidence:
All remediable factors should be addressed to enhance
the prospects of successful liberation from MV (eg, electrolyte
derangements, bronchospasm, malnutrition, patient positioning, or
excess secretions).
The patient should be placed in an upright
position46 on a comfortable, safe, and
well-monitored mode of MV (such as pressure support ventilation).
An SBT should be performed at least once daily. Few data
support multiple manipulations of ventilator settings each day in an
effort to wean or "train" the patient. For clinicians who prefer
stepwise reductions in MV, both multiple daily SBTs and weaning
pressure support ventilation appear to be superior to intermittent
mandatory ventilation.8,32
In the face of repeated failures at daily SBTs,
clinicians should consider longer-term options, including both
tracheotomy and a long-term acute-care or stepdown ventilator
The clinical trials6,8–9,11,32 discussed above
each outlined a rigid extubation protocol or, alternatively, an
approach that incorporated the clinician's judgment and preferences
for the timing of extubation. Despite the care and rigor with which a
team of HCPs evaluates their patients' abilities to be liberated from
MV, some patients will require reintubation,5,48which
carries an estimated 8-fold higher odds ratio for nosocomial
pneumonia49 and a 6-fold to 12-fold increased mortality
risk.4,6,39,50 Reported reintubation rates range from 4 to
20% for different ICU populations4–6,8–9,32,34,51 and
may be as high as 33% in patients with mental status changes and
neurologic impairment.48 The optimal rate of reintubation
is not known but likely rests between 5% and 15% in
non-neurologically impaired patients.
One important cause of reintubation is self-extubation or accidental
extubation of patients who are inadequately sedated and/or restrained.
However, self-extubation also can occur in patients who are ready to be
liberated from the ventilator. For instance, approximately 50% of
patients who self-extubate do not require
reintubation.50,52–55 This fact should further motivate
physicians to adopt proactive protocols directed toward earlier
extubation. In fact, two investigations have shown an associated
reduction in reintubation rates by incorporating a protocol driven by
nonphysician HCPs.9,56
Recommendation 5:Based on the sum of
evidence from randomized trials and observational studies, we recommend
that when patients have passed an SBT, clinicians seriously consider
prompt extubation.
When other key features in the management of patients receiving
MV, such as sedation and analgesia, are protocolized and managed by
nonphysician HCPs, further reductions in the time spent receiving MV
can be realized. Standardizing the delivery of sedatives and analgesics
is the most recent development in the area of protocolization and
weaning from MV. One RCT, using a nursing-implemented protocol
to manage the delivery of sedation, showed a reduction in the duration
of MV by 2 days (p = 0.008), decreased length of stay in the ICU by 2
days (p < 0.0001), and a lower tracheostomy rate among the
treatment group (6% vs 13%; p = 0.04).41 In
another recently published RCT57among 128 patients
receiving MV in an ICU, those in whom sedation was maintained at a
lighter level (via daily interruption of their sedative infusion) spent
2 days less receiving MV (p = 0.004) and 3 days less in the ICU
(p = 0.02) than did patients in whom infusions were not interrupted.
In addition, the pharmacoeconomic impact of guidelines for analgesia,
sedation, and neuromuscular blockade appear to be favorable and have
received more attention in the medical literature
recently.58In summary, these studies have demonstrated
the important interactions between the delivery of psychoactive
medications and the expeditious weaning from MV. However,
considering the nearly universal use of these agents in patients
receiving MV and the relative paucity of controlled investigations in
this area,59further study is required before detailed and
specific methods of protocolization can be recommended. For example,
studies to date have monitored only the arousal component of
consciousness and have tracked relatively few adverse events, none of
which included patients' distress during awakening, recollections of
discomfort after their stay in the ICU, delirium, or persistent
neuropsychological outcomes. Emerging work in the area of the
content of consciousness (eg, delirium) is
revealing important interactions between the development of delirium
and outcomes including the duration of the hospital stay, as well as
long-term neuropsychological outcomes.62
Recommendation 6: Based on evidence from
randomized trials for the delivery of psychoactive medications, we
recommend the consideration of protocols that include daily cessation
and targeted sedation goals to reduce the duration of MV and of the
length of stay in the ICU.
Both the level of institutional commitment to improving clinical
outcomes and the health-care team's leadership, persistence, and
consistency in the implementation of protocols will determine the
ultimate success of any management protocol. Protocolized care has been
advocated in many facets of medicine, but relinquishing control of the
patient's management often creates resentment and frustration on the
part of physicians. Even when research clearly supports a change in
approach, it is very difficult to get physicians to alter their
practice and management styles.63Certain physicians may
have a low "readiness to change," and these professionals
may require either motivational interventions or consultation with
respected opinion leaders.64–65 Negative reactions to
protocols may be reasonable under some circumstances, since protocols
have the potential to do harm. Important considerations that may
facilitate behavioral changes include interactive education, timely and
specific feedback, participation by physicians in the effort to
change, administrative interventions, and even financial incentives and
penalties.63 Through a staged implementation process,
using periodic reinforcement of all participants in ventilator
management and the close monitoring of compliance with the protocol,
large-scale implementation within major medical centers is
possible.34 Protocol implementation (and acceptance) is
potentially less complicated in smaller, self-contained units with
fewer staff and more direct communication channels. Tips for the
implementation of weaning protocols and for avoiding barriers to
success, which were derived from the study of > 15,000 patient-days
of MV over nearly 2 years of implementation,65are
presented in Table 6
. The effective implementation of protocols requires adequate staffing,
and it has been shown that if staffing is reduced below certain
thresholds, clinical outcomes may be jeopardized.67
Indeed, in the specific context of liberation from MV, reductions in
nurse-to-patient ratios have been associated with a prolonged duration
of MV.68
It is imperative that protocols not be used to replace clinical
judgment, but rather to complement it. Protocols are meant to guide
patient care and may serve as the general default management, unless
they are based on patient response or if any of the HCPs
(ie, physicians, nurses, or RCPs) can justify a departure
from the protocol. Likewise, protocols should not be viewed as
rigid rules, but rather as dynamic tools in evolution that can be
improved on to address local problems and to accommodate new data. More
studies regarding the impact of protocol-based weaning are needed to
better delineate optimal approaches in specific patient populations
(eg, neurosurgical,69–70
trauma,12,71 or COPD patients42), in specific
organizational structures (eg, open vs closed units or
teaching vs community hospitals,72–), and using
computer-assisted decision making.73–74
Recommendation 7: We recommend the consideration of
the following strategies for weaning protocols: development using an
evidence-based approach by a multidisciplinary team; and implementation
using effective behavior-changing strategies such as interactive
education, opinion leaders, reminders, audit, and feedback.
In summary, this evidence-based review suggests that protocols
driven by nonphysician HCPs to manage the weaning and liberation of
patients from MV can reduce the time that patients spend receiving MV.
We have developed seven key recommendations to synthesize this
information for those attempting to design a weaning protocol. We also
have discussed key general issues to aid in protocol implementation.
Acknowledging the important nuances in protocols that should be
dictated by specific patient populations and institutional preferences,
the following two steps in any successful weaning attempt
derived from recent RCTs9,11–12,41,57 bear repeating:
step A should involve minimizing or temporarily
discontinuing sedation and analgesia enough to observe patient
awakening; and step B should involve an
assessment of the patient's ability to spontaneously
The data included in this systematic review and a more
comprehensive discussion of the original articles are included in an
Evidence Report of the Agency for Healthcare Research and
AHCPR = Agency for Health Care Policy and Research; CI = confidence
interval; HCP = health-care professional; MV = mechanical
ventilation; RCP = respiratory-care practitioner; RCT = randomized
controlled trial; RR = relative risk; SBT = spontaneous breathing
This article is based on work performed by the McMaster University
Evidence-based Practice Center, under contract to the Agency for
Healthcare Research and Quality (Contract No. 290-97-0017), Rockville,
MV = receiving mechanical ventilation.
Values given as mean ± SD, unless
otherwise indicated. LOS = length of stay; Combined end
point = nonextubation plus reintubation.
Int 1 = intervention 1 (computer-directed weaning);
Int 2 = intervention 2 (physician-directed weaning).
Values given as differences in means (95% CI).
Values given as RR (95% CI).
Int 1 = intervention 1 (daily screening plus SBT
protocol); Int 2 = intervention 2 (physician-directed weaning).
Int 1 = intervention 1 (protocol by nurse and
respiratory therapist); Int 2 = intervention 2 (physician-directed
Values given as median (interquartile range).
From survival analysis.
APACHE = acute physiology and chronic
health evaluation; MPM = mortality prediction model.
No. of patients not reported.
Values given as mean ± SD, unless
otherwise indicated. ABG = arterial blood gas analysis;
IMV = intermittent mandatory ventilation. NE = no estimate of
variance was available/calculable. See Table 2 for abbreviations not
used in the text.
Int 1 = intervention 1 (respiratory
therapist-directed protocol); Int 2 = intervention 2
(physician-directed weaning).
Int 1 = intervention 1 (nurse-directed oxygen
weaning); Int 2 = intervention 2 (physician-directed weaning).
Int 1 = intervention 1 (respiratory therapy-directed
IMV weaning protocol); Int 2 = intervention 2 (physician-directed
Int 1 = intervention 1 (protocol-directed
weaning); Int 2 = intervention 2 (physician-directed weaning).
Int 1 = intervention 1 (multidisciplinary
protocol-directed weaning); Int 2 = intervention 2
(physician-directed weaning).
Int 1 = intervention 1 (nurse and respiratory
therapist-directed weaning protocol); Int 2 = intervention 2
(physician-directed protocol).
PSV = pressure-support ventilation;
SIMV = synchronized intermittent mandatory ventilation. See Table 2
for abbreviations not used in the text.
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OK, now let's go back in NFL history and examine some stuff. To do this, we'll have to get in touch with Mr. Peabody and Sherman and use the WABAC (pronounced "wayback") Machine to go to 1985-86. For those of you in the younger crowd the WABAC Machine was used by a couple of characters on the old Rocky and Bullwinkle Show. A talking dog named Mr. Peabody and his young sidekick Sherman would use the time traveling machine called the WABAC Machine to travel through interesting historical periods and interact with characters from those periods.
In this case we're going to be traveling back to the 1985 and 1986 Chicago Bears, the last Bears team to win a Super Bowl and believe me this was an NFL football team to remember. Talk about defense. This was one bad bunch with probably the greatest set of linebackers ever assembled although possibly the Saints Dome Patrol was their equal. If you want to argue that the Saints didn't win a Super Bowl with that defense I'd be helpless to argue. Anyway, the Bears had a hell of a defense and a wacky Jim McMahon at quarterback,a guy that could draw reporters like flies.
Why argue NFL history now? Because Richard Bent, former Bears defensive player, is arguing that Mike Ditka killed the Chicago Bears chances of winning a second Super Bowl by playing Doug Flutie at quarterback rather than the more established Mike Tomczak. It seems that Richard Dent has been pissed off about this for years and he recently made the claim again on a radio show. Talk about holding a grudge.
My opinion? The Wayback Machine probably isn't necessary. While Ditka was the Head Coach, the defense was run by Buddy Ryan. Talk about a fiery guy. His son Rex Ryan is nothing compared to Dad. Ryan pretty much won that Super Bowl with his defense. Oddly enough, Ryan wasn't effective as a Head Coach, and Ditka sucked a the Saints Head Coach later on. Though they hated each other, Ditka and Ryan made for a very effective combination. What's the point of this whole article. There is none, I just thought that talking for a few minutes about NFL history, Rocky and Bullwinkle, Ditka, Ryan, Mr. Peabody, and Sherman would be fun.


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The remote system can be accessed with a default password.
Description :
The account 'root' on the remote host has the password 'raspi'.
An attacker may leverage this issue to gain full access to the affected
Note that a version of Linux optimized for Raspberry Pi ARM computers is
known to use these credentials by default.
See also :
Solution :
Set a strong password for this account, or use ACLs to restrict access
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Marion County officers today charged a Salem man with the murder of a 77-year-old Salem woman during a burglary Nov. 28 at her home in the 400 block of 45th Avenue Southeast.
The suspect, Darius Pittman, 23, has been in the Marion County Jail on unrelated charges since Jan. 4, said Deputy Kevin Rau of the Marion County Sheriff's Office. An arraignment is set for 8:30 a.m. Friday
Florence Boatwright was found dead of violent trauma the day after her 60th wedding anniversary, Rau said. Her husband was home at the time of the incident.
In December, the Carole Sund/Carrington Foundation offered a $5,000 reward for information leading to a suspect's arrest. Rau said he was unsure whether the reward offer led to the suspect.


text:
Skip to comments.Beltway Sniper Shootings-FR Commentary-Tuesday, Oct. 15
Posted on 10/15/2002 2:17:07 AM PDT by Peach
To avoid multiple vanity threads regarding any news from press conferences, let's keep a live commentary thread going again today.
Note: This is the graphics-free thread. Graphics can be found under the thread titled "Beltway Sniper Shootings-Graphics Only"
Heck, all the 9-11 guys had plane simulator videos, GPS units..etc..
Hmmmm...to make everyone thing it was one person comes to mind.
Hey John! With the recent reports of two cars and four people involved, what would you say are the odds of this being random psychos? Is terrorism looking more likely? Is there any other explanation that is more likely than terrorism?
If you let me put my tin-foil hat on for a moment: The reason LE hasn't been attacked yet is that they want/need to establish a pattern. Once the pattern is established to the point that LE and the public knows what to expect....boom.
See, now you have the locals, who are small potatoes to these folks; plus the FBI & ATF in play. Once you get to that point, it's an easy matter to take them all out at once with some particularly nasty WMD.
Notice that everyone offshore is particularly quiet regarding the sniper attacks. I'm waiting for the other shoe to drop.
That patron was a black man. The state trooper was presumably white. The perps seem to be alternating black and white victims.
Young said as he backed his truck out of his parking spot, a white Astro van with two men inside tried to turn into his lane. He said the driver appeared very agitated to find his way blocked and instead drove by a neighboring Chinese restaurant and out of sight.
Young described the driver as a short man of slight build who appeared to be Mideastern. He said, ``I got a good look at the guy.''
The driver ``seemed to be excessively irritated because he couldn't pull into my lane,'' he said. ``I thought this fool was going to want to get out of the van and duke or something. But he didn't. He kept on going.''
Hmmm. Wasn't there concern a few months ago about Al Qaeda "chatter" related to getting trucking licenses? The concern then was that they might try to transport explosive fuels, or toxic waste, and use them in a terrorist incident. But what if part of the plan was just to provide some mobile "Bat Caves" for something like this? It would explain how the white Chevy Astrovan can just vanish the way that it does. It would mean they wouldn't have to drive far away - just to a secluded area. Heck, behind a strip mall is perfect. Just drive maybe a 1/4 mile or so, zoom into the back of the big rig trailer...and on to the next site.
Interesting speculation.
That Chinese restaurant that the Middle Easterner drove to would presumably be the Fortune Chinese Restaurant. Today's Washington Post has a plan of the shopping center.
Remember, they only buy one-way tickets, they return things to get their deposits back, they wire money back overseas if they don't need it, etc.
It is a curious fact, but this is how they seem to be operating...like they are on a really tight expense account.
That is, IF they are terrorists.
That would certainly fit with the notion of most of these events happening near shopping centers; it would be an easy matter to park a non-descript semi at or near a shopping center without arousing suspicion.
Christopher Hitchens has written about how, back then, friends of his in the government tipped him off that they thought there was a nuclear device in D.C., and advised him to get out of town a certain weekend.
That's a good point. The Jihad traiing manual mentions that they are very strict about accounting for weapons and ammunition -- right down to the number of bullets they are permitted to use.
First time I've seen anyone raise that, fascinating and salient point. Shooters? Any ideas? I don't know much about sniper spotting/shooting from a van, but there's gotta be someone around who does.
He wasn't in DC, was he? I wonder who else is out of town.
A white Chevy Astro and a white Ford Econoline look an awful lot alike; are we truly sure that we should be focusing on the Astro?
Darn it! Think he'll notice I only posted an excerpt and link?
Maybe the sniper would rather humiliate LE than kill them. I think he/she/it/they has succeeded at that thus far.
Speaking as 27-year-old who has to live through it -- thanks, and yeah, it's gonna be worse on the kids. :-(
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text:
Middleborough native Tyler Horan built his reputation as a winner during his time at Boston College High, helping the Eagles capture back-to-back state titles in baseball (2008-09) and leading them to a Division 1 Eastern Mass. Super Bowl title in 2008. After a redshirt season with Virginia Tech in 2010, he's been demonstrating more of that explosive power out of the batter's box he showed as a raw 16-year-old.
This past spring, Horan hit .282/.400/.585 totals in 54 games in left field for the Hokies, ranking fourth in the Atlantic Coast Conference in on-base percentage. He led the Hokies in RBI (41) and home runs (15) and ranked second in total bases (110).
After participating in the Home Run Derby at the last month's College World Series in Omaha, Horan has been tearing it up a mere 25 minutes down the road for the Cape Cod League's Wareham Gatemen. He's currently hitting .329/.391/.633 with an OPS of 1.024, leading the Gatemen in average and sitting tied for fourth in the league with six home runs.
Horan spoke with ESPNBoston.com before batting practice at Spillane Field on Thursday afternoon, before the Gatmen took an 8-1 loss to Hyannis.
Q: You took batting practice with the team at Fenway on Wednesday. How did that feel?
A: "It was definitely different. You grow up watching them and everything, you're watching all your favorite players out there, and you never expect to be out there hitting in the same place they are. On TV, the field looks big, but then when you're on the field and you crush a ball...for me, as a lefty, I crush a ball to right field, and I'm like 'Wow, these guys are hitting shots'. It's definitely a cool experience being able to play on the same field that they do."
Q: When you cracked one to right, did you envision Papi at all?
A: "A little bit. Definitely since he was my idol, especially coming out of BC High when I was a DH until my senior year. I'm a big, left-handed DH, and then obviously Papi is a huge left-handed DH. It just kinda fit to be watching him."
Q: You were in the College Home Run Derby last month, and you have six home runs right now. What's the adjustment typically like going from college to this level?
A: "For me, I don't think it was quite as bad, because our college is sponsored by Easton bats. We get Easton bats, and they have a black bat they call their 'speed bat', and a white bat their 'mass bat'. I use the white one, so it's already top-heavy, similar to the wood bats we use. So, the adjustment for me, I don't feel is quite so different. But then as far as pitching goes, maybe for the mid-weeks you're going to see a lot better pitching than you would in our mid-week games, but the ACC pitchers are also very good.
"You come here, and you're gonna see everybody's best pitcher. Whether that's a mid-week game or not, it's going to be their best starter, their best closer. You're always seeing the best of the best."
Q: Do you recall the first time you watched Cape League?
A: "I caught a couple games when I was real young, but a lot of times Little League would interfere, especially in our town. So I didn't catch too many games, but I've always been hearing about it. And then you see the movie 'Summer Catch' and you'll hear about it and go, 'Oh, that's right down the street from me, that'd be cool to play there some day'.
Q: Do you think about the Major Leaguers that have come through here, and the allure of the league?
A: "A lot of people say this is the last step before you make it to the minors for a lot of people. So thinking about it that way, it's really cool. It puts a lot of pressure on you, though, to try and...It's a scout's league, so you have to do your best, and just show off what you've basically. But at the same time, stay within yourself, and not let all the pressure get to you. Joe Carter at the Home Run Derby, he probably gave me the best advice -- to make it to the next level, everything's mental, because everybody has similar talents at this level, so it's all in your head."
Q: Building on that, talk about your experience in Omaha at the Home Run Derby.
A: "Oh, they treated us awesome, I couldn't have expected anything more. I had a king size bed, I had a jaccuzzi in my room and everything. It was an unbelievable experience, they were real nice to everybody. The fans loved it. Omaha just lives for baseball. I think there were 22,400 fans -- that's a rough number, but it was around that -- easily the biggest crowd that I've ever played in front of.
"It's also different because, instead of having the whole team out there, and thinking they're probably watching someone else -- no, all 22,400 are staring at you. And you don't have the safety of the turtle or anything, it's just completely different out there hitting. It's a rush. You get those butterflies, and for me once I got that first ball out, it's almost like, now I can loosen up and get it going."
Q: What was more rewarding for you at BC High -- winning two state championships in baseball, or winning a Super Bowl in football?
A: "That's a tough one. I don't know if I can separate the two. Honestly, I might have to say football because it was only the second or third time in school history that it's ever been done. In baseball, we were expected to go pretty far, and football it wasn't seen quite the same way. And then the hype for the football games, it builds up all to that one game. I can't really say, because either way all that dedication, all of your work goes into all three of those championships."
Q: Peter Hughes redshirted you for your first year at Virginia Tech. Was it just getting acclimated to year-round baseball?
A: "Yeah, it was that, and like you were talking about with the football question, I was very raw. My sophomore year of high school, I thought I was going to play football, so I didn't play summer baseball at all. I just worked on hitting the weight room, getting as big as I could as fast as I could, and it helped me in football but made me a raw but natural talent for baseball. When I got to college, after seeing pitching here -- Northern pitching isn't as good as Southern, because they can do everything all year round.
"Especially the year I came in, we had Jesse Hahn, Matt Price and Justin Wright -- all guys that can throw over 90. I remember the first time I got in the box, it was Jesse Hahn, and [whooshing noise] like that, it must have been 95 and I was like 'Oh man' [laughs]. It was definitely a good thing, I'm glad I redshirted. Once you get to this time, I have an extra year of eligibility, so I have negotiation in the draft. I definitely needed that year to adjust. I learned so much from baseball that year. Even when they traveled on the weekends, I'd go to the hitting building and work on all that stuff. I definitely worked really hard that year, but it paid off."
Q: What did you need to improve upon most?
A: "I had to adjust to the speed of the game at that point. It was just purely adjusting to the speed of the game -- the pitching, the speed, knowing different things on the basepaths, what to look for as an outfielder, what to look for in counts, where I should be playing. After I got that down, now I'm working on cutting down on my strikeouts, adjusting my swing a little bit, trying not to be so jumpy at the plate. My power numbers have always been good, I haven't been worried about those. I wanted to get my average up, because if my average goes up, my power numbers also go up because it's just running into more balls and eventually they go out."
Q: You're good friends with Eddie Campbell [a Bridgewater-Raynham alum and Horan's Virginia Tech teammate, currently playing for the Harwich Mariners]. How is the banter? Any smack talk?
A: "Eddie's dealing right now [laughs]. Me and Eddie, it's not too much, you always wish each other the best. My roommate who is also on Harwich, Clark Labitan, me and him got a little crap talk going back and forth. The thing with him is always, I live with three pitchers [at Virginia Tech] and I haven't gotten a hit off him or any or my other roommates yet. So, he'll go on Twitter and be like 'The hitless streak continues' and tag all of my other roommates in it. I can't wait until I get that hit, I'm going to be all over him. It's all friendly smack talk, but it's good."
Q: What lessons did you take from BC High that you still hold with you in college and the Cape League?
A: "I'd probably say their whole thing of men for others is their big thing, just helping with the community. My coach Peter Hughes, he went to BC High, so he played under Norm Walsh also. He follows those too. We have this program called '19 Ways', which every year we try to do 19 things to help the community. It all falls in line. Treat everyone the way you want to be treated.
"You see little kids come up to you for autographs, you make their day and just sign it. Live for the day, I guess."
Q: For a kid who aspires to play in the Cape League one day, what's the life like?
A: "Stressful at times, definitely. You could be playing every day, you get tweaks here and there. I'd say it's stressful, but at the same time you've got to keep your head up. You've got to be good to fail at baseball, because if you're average, you're .333. I'm batting .333 right now, but that means two out of every three times I'm failing. You've always got to keep your head up and have a short term memory to be a good baseball player."


text:
The Grand Rapids Downtown Development Authority tomorrow is expected to approve spending about $5,000 to study and develop preliminary designs for a portage that would allow paddlers of canoes, kayaks and other boats to more easily bypass the Fourth Street Dam.
It would be nice to see Grand Rapids literally live up to its name.
The plan study would be part of on-going efforts by Grand Rapids Whitewater, a group that hopes to restore the Grand River for recreational use throughout the downtown area. Significant stetches of the river downtown are not safely navigable due to the large dam near Fish Ladder Park and five smaller, but potentially dangerous low head dams.The study, which would be conducted by Fishbeck, Thompson, Carr Huber, would including meetings to seek input on preferred location and designs for the portage, assessing conditions and the work required to build river access sites and a preliminary plan for implementing the system.
The new study apparently would provide more technical detail than the the Grand Rapids Whitewater Park Preferred Alternative plan released in June. That report, by Fishbeck and others, included plans for a portage that included a take-out point in Sixth Street Park north of the Sixth Street Bridge and a put-in point at the existing boat ramp south of the Fourth Street dam. The plan favored a phased approach that included modifications to the smaller downstream dams at an estimated cost of up to $1 million with a potential second phase that included spending up to $2.8 million to modify the Fourth Street dam to make a whitewater run.
This new study would wrap up by late February.
While there may be more complications than imagined at first blush, the city would do well to activate the river so people who enjoy paddle sports can join the thousands of fishermen who already take advantage of the mighty downtown river. The end result would be an additional opportunities for recreation, tourism and downtown vitality.
We also need to be cognizant the course, like any water-based attraction, will result in accidents. With proper engineering and safety protocols, that risk could be minimized.


text:
Greil Marcus
$22.95, 195 pages
On Sept. 23, 1998, Van Morrison played the Rose Garden, in between Lucinda Williams and Bob Dylan. Williams and Dylan were hot, Williams with "Car Wheels on a Gravel Road" and Dylan riding the post-Grammy bump from "Time Out of Mind."
Morrison had nothing new in particular to promote, and there were no expectations before his performance. He is notoriously moody and cranky, as capable of mumbling and mailing it in as he is of transcendence. His records in the 1980s and '90s were spotty and often seemed like less than his best effort.
In Portland that night, with much of the crowd still out in the concourse, Morrison came out and burned. He opened with "Baby Please Don't Go" and "Here Comes the Night," two songs from his early days with Them, and didn't let up, pausing so briefly between songs that his set ended up an 80-minute medley. He stalked around the stage in dark glasses and a black porkpie hat and growled through an extended "Raincheck" before ending with "Gloria." Dylan's subdued effort felt like an afterthought.
The concert (which has been bootlegged) was a reminder that when Morrison turns it on, there's no singer in modern music who can touch him. "As a physical fact, Morrison may have the richest and most expressive voice pop music has produced since Elvis Presley, and a sense of himself as an artist that Presley was always denied," Greil Marcus writes in "When That Rough God Goes Riding: Listening to Van Morrison." "But what is that voice for?"
It's a good question, one Marcus spends most of his short, maddening book trying to answer. Morrison always has been about being in the moment and trying to hold what Irish tenor John McCormack called "the yarragh in your voice." Marcus makes much of the yarragh, and as an abstract concept it's not a bad way to think about what Morrison does. His phrasing can appear random and instinctive and he thinks nothing of holding a note or repeating a line until he's good and ready to let it go. On "Madame George," the great track on "Astral Weeks," he repeats "dry your eye" 13 times and "the love that loves to love" until it collapses in the corner. On "Listen to the Lion" he roars and growls and purrs the beast into submission.
Marcus aptly describes Morrison as "small and gloomy, a burly man with more black energy than he knew what to do with, the wrong guy to meet in a dark alley, or backstage on the wrong night." Morrison's stubborn artistic independence and willingness to look foolish in pursuit of his genius makes him a good match for Marcus and makes "When That Rough God Goes Riding" a bookend to the author's "Like a Rolling Stone: Bob Dylan at the Crossroads."
As a critic, Marcus is high-toned, obtuse and snobbish. He's also literate, brainy and fearless in making cross-genre comparisons. He has a deep knowledge of Americana but can be sloppy with details. (Morrison's song is "Linden Arden Stole the Highlights," not "Arlen.") Marcus dismisses 15 years of Morrison's output with the wave of his hand and has essays on the use of Morrison's music in the movies "Breakfast on Pluto" and "Georgia." (And what about that surprising version of Pink Floyd's "Comfortably Numb" in "The Departed"?)
Reading: Marcus discusses "When That Rough God Goes Riding" at 7:30 p.m. Wednesday at Powell's City of Books, 1005 W. Burnside St.


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Meet the Cast of Red Mountain Theatre Company's Youth Series production of Big River (April 7-10, 2011):
Reid Watson
Where are you from originally?
I am originally from Birmingham, Alabama.
What's your favorite thing(s) to do when you're not performing?
I played baseball for eight years, basketball for five years, soccer and tennis for three years, and football for one year.. so, needless to say I love to be outside. My family and I have always been into exercising and walking through the trails and nature preserves near our home.
What's something interesting that most people wouldn't know about you?
Something interesting most people would know about me is that I love Patti LuPone. What they probably do not know is that I just got cast in Masterclass Starring Patti LuPone, and it will be filmed through HBO the week following Big River in NYC.
What's your favorite role you've ever played? What made it so special?
My favorite previous role would probably be "Mother's Younger Brother" in Ragtime. I had a strong connection to the role and the show in general. Getting to act the history of America as we know it today was such an incredible experience. However, now my favorite role is definitely Huck Finn in Big River. There's no way it couldn't be. Playing Huck is incredibly special because I get to be a little boy again. I feel like Huck embodies every emotion and game any young boy has ever had... be it playing Cowboys and Indians to learning about diversity and what it means to be loved.
What's your dream role and why?
My dream role is "Bobby" in Crazy for You. It would be such an exciting opportunity to be able to play "Bobby". I love to dance, and I always have.. and "Bobby" gets to dance a lot in the show. I also love his songs! And who wouldn't want to perform songs where your constantly surrounded by beautiful girls?
What has been the most enjoyable part of rehearsing this show?
There are so many enjoyable parts of rehearsing Big River. I love working with Tam DeBolt. She is willing to come in early to help us, stay late, answer emails...anything. I also LOVE getting to sing 3 duets with Montroville Williams! It truly is an honor. The whole experience has been incredible.
What's your favorite moment/song in the show?
My favorite moment in the show is probably listening to Sharon sing "The Crossing."
Why should Birmingham audiences see Big River?
Tam DeBolt's brilliant vision of the show.
Red Mountain Theatre Company presents
April 7-10, 2011
Thursday-Sunday, 7:30 PM & Saturday-Sunday, 2:00 PM


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ATHENS, Alabama - An escapee from the Indiana Department of Corrections was arrested Monday in an Athens motel, Chief Floyd Johnson said.
Athens police officers arrested Marvin Van Riggs, 27, of 675 E. Washington St., Indianapolis, Ind., after a caller reported Riggs was staying at Budget Inn on U.S. Highway 31, Johnson said. He is being held in Limestone County Jail as a fugitive from justice awaiting transfer to Indiana.
Riggs was wanted for escape by Indiana Department of Corrections, where he was being held on a burglary charge.
Call al.com reporter Kelly Kazek at 256-701-0576 or find her on Facebook.


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Dear visitor or member of Singles Home Exchange International,
This website has been taken over by HomeForExchange.com, a leading home exchange website with over 11,000+ members worldwide. The former owner of SHEI was forced to stop the website due to serious health problems. HomeForExchange.com has come to an agreement and taken over the whole website and it's members. The current website of SHEI will however be taken offline and all members will be moved to HomeForExchange.com. This will take a few days. We will inform all the members about the changes by email. New members should sign up with HomeForExchange.com.
If you have any questions, please contact me personally at email@example.com
Ans Lammers
Founder & owner of HomeForExchange.com


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KELSEY GAUBATZ AND CHRISTOPHER RAMIERZ, of Portage, a daughter.
REBECCA AND ALEXANDREW HOUSEHOLDER, of Scotts, a daughter.
REBEKA AND CASEY RICKLI, of Allegan, a daughter.
JENNA AND DEVIN ADAMS, of Otsego, a son.
SARAH PALMER AND WYATT THOMPSON JR., of Battle Creek, a daughter.
MEGHAN MOSHIER AND SAMUEL BANKS, of Kalamazoo, a son.
SARAH AND CHADRICK SELVIDGE, of Portage, a son.
CHELSIE AND JESSE OKELEY, of Kalamazoo, a daughter.
SARAH MCQUEEN, of Kalamazoo, a son.
JESSICA MINER, of Galesburg,
a daughter.
Bronson Methodist Hospital
AND LACIE BONIFACE, of Delton, a daughter.
TAYLOR HARRIS AND JEREL WASHPUN, of Kalamazoo, a daughter.
TIFFANY BLACKMAN, of Battle Creek, a daughter.
CHOEUNG AND MANUELITA CHAO, of Portage, a son.
DEREK AND MALLISA MINNEMA, of Oshtemo, a son.
RYAN AND JENNIFER WALTERS, of Kalamazoo, a son.


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But the Lakers have a powerful athlete who has been deemed one of the best in the country.
Joanna Kitlinski, a senior from Clinton Township, was named to the 24-player Collegiate All-America first team.
"It's definitely exciting, especially coming from a Division II school that many people don't know about," Kitlinski said. "There are girls on that list from Stanford, Penn State and schools like that. I was very surprised to be on the first team."
Kitlinski has blossomed into a talented rugby player in the past four years.
Her interest in the sport, however, didn't begin until she was a college freshman.
"A girl in my dorm played rugby and she told me there weren't any tryouts," Kitlinski said. "She said anyone could make the team, so I went to see what it was like. I loved it from the first day."
Rugby is a far cry from the sports Kitlinski played in high school. She ran cross country and track, but made the switch to a more aggressive sport.
It was a change Kitlinski relished.
"I always wanted to play a contact sport," she said. "I did powder puff (football) in high school, but that really wasn't a contact sport. I always knew I would be good at contact sports, and with rugby you can start anytime.
"The sport of rugby is easier to start later because there are not many high school teams."
Grand Valley women's rugby coach Bob Richthammer said a strong work ethic has elevated Kitlinski to All-American status.
"It's pretty special to say that one of the top 24 college players goes to a school that started a program eight years ago," he said. "And it's a tribute to all her hard work. All the kids work hard, but she's pretty special when it comes to working hard.
"She's one of the most humble players I've ever coached and she leads by example. She's just a workhorse."
Kitlinski takes pride in playing to her full potential. She rarely tires during games. She also has a mean streak.
"I think I am just relentless," she said. "When I'm playing a game, I don't give up. I look around and see other players tired, but I get pumped up as the game goes on. I play better when I'm angry at somebody."
Kitlinski has played for the USA Junior Team and was named a captain for the Midwest College All-Star Team that will compete next month. It will be her second stint on the all-star team.
"Last year was my first time playing on that team, so it was definitely surprising to be picked as a captain," said Kitlinski, a psychology major who has one more year of collegiate eligibility.
"It's pretty exciting and I'm looking forward to it."


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Arts & Culture Lewiston Auburn
To see the new website please click HERE
About Us
Arts & Culture Lewiston/Auburn was created to strengthen and support the arts & culture in the Lewiston/Auburn area as a central component of furthering economic and cultural development and to enhance the quality of life for our residents. We are made up of many different organizations whose independent goals are focused around Culture and The Arts.
About This Website
This website was designed to be a central location or "Portal" for you to easily navigate and stay informed about upcoming and ongoing events happening in our community. The calendar features events from all of our participating organizations and allows you to filter out specific genres or specific organizations.
Our Member Pages will give you a brief introduction of information about each participating organization with links to their calendars of events, some featured photos and contact information with links to their individual websites. These profiles are updated periodically throughout the year and we encourage you to take the time to learn about an organization you may have never considered.
The goal of Arts & Culture Lewiston/Auburn is to strengthen and support the arts and culture in the Lewiston/Auburn area and to further economic and cultural development in the region.


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BESSEMER, Alabama -- The Legacy YMCA in Bessemer is giving area businesses a chance to help support the Y's youth programs while also providing their employees with a fun, outdoor activity.
Legacy will host its Corporate Games Charity Event on Thurs., Oct. 24, from noon-6 p.m.
There will be a dozen events in the Corporate Games, including a one-mile fun run, an egg toss, an obstacle course, Frisbee Chaos and Hula Hoop it up.
Proceeds to register a team will help Legacy support its third-grade swim and water safety program and seventh-grade free membership initiative.
The Olympic-style, co-ed team competition is meant celebrate wellness in the workplace while increasing employee morale and emphasizing team building and communication, according to a Legacy news release.
Registration and payment is due by Oct. 10.
And you don't have to be a hard-core jock to participate, according to Legacy spokesperson Elaine Lyda.
"They don't have to be athletic or be in great shape," she said today. "We're not trying to scare people off. They can be a kid again and have fun with it. It's a chance to get out of the office and do something different and help a non-profit."
Each employee participating will receive one-week free membership to Legacy, lunch from Bob Sykes Bar B Q, free health screenings, a T-shirt and a goody bag.
The members of the 1st-place team will receive 6 months membership to Legacy, as well as rights to hold the Legacy Cup Trophy for one year.
The 2nd- and 3rd-place teams will also get awards, and there will be a team spirit award.
"The event is done at other YMCAs in the United States, and they are very successful," Lyda said. "The goal is to mix healthy living and a little healthy competition among area businesses."
The two sponsorship levels are set at $350 and $750 for a company to sign up a certain number of teams.
For all the details, contact Trisha Galvez, the Legacy membership and wellness director, at 205-426-1211 or firstname.lastname@example.com.
For more information regarding Legacy YMCA, go to www.legacyymca.org.
For more news from Bessemer, go to www.al.com/local/bessemer.


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At Little Village Academy, a public elementary school in Chicago, most students' lunch choices are limited to what's being offered in the cafeteria on any given day.
That's because unless they have a food allergy or serious dietary concern, students at the school are not allowed to bring in their lunches from home.
"Nutrition wise, it is better for the children to eat at the school," Principal Elsa Carmona told the Chicago Tribune. "It's about the nutrition and the excellent quality food that they are able to serve (in the lunchroom). It's milk versus a Coke. But with allergies and any medical issue, of course, we would make an exception."
Chicago Tribune reporters Monica Eng and Joel Hood said that during a recent visit to the school, they observed many students throw their lunches in the garbage, and heard many comments about the food tasting bad.
"This is the perfect illustration of how the government's one-size-fits-all mandate on nutrition fails time and time again. Some parents may want to pack a gluten-free meal for a child, and others may have no problem with a child enjoying soda," J. Justin Wilson, a senior researcher at the Washington-based Center for Consumer Freedom, told the Tribune.
» Full story: School's food is only option for some kids
What do you think? Should students be forced to eat cafeteria food? Leave your comments below.


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Flooding concerns eased in much of eastern Iowa as the Mississippi River crested at Davenport on Friday.
Officials are now turning their attention to points south along the river in Missouri and Illinois.
The National Weather Service reports that the Mississippi River at Davenport crested Friday at 20.89 feet - well above the 15-foot flood stage. That level is expected to drop starting Saturday to below 18 feet by Thursday.
Along the river in northern Missouri, the U.S. Army Corps of Engineers is preparing for flooding next week.
Corps civil engineer Davor Karic says most of the areas of concern are north of St. Louis.
Corps officials had expected to close Lock and Dam 24 north of St. Louis to navigation Friday, but later moved the projected closure to Sunday.


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Where does a plane's flight crew draw the line between a mere annoyance and someone so distracting they need to be removed from the plane. That's the question being asked after a family says they were taken off a JetBlue flight because their 2-year-old daughter threw a tantrum while boarding.
Family Booted From JetBlue Flight Over Toddler Tantrum
By March 9, 2012


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Graphic Designer, who feels that everyone should have their own identity and not rely on multi million pound fashion labels creating it for them.
Cool, clean, provoking t-shirt, will look fresh fitted or loose. Club Culture, summer
MySoti is a place where designers can upload original artwork and turn it into awesome, real-life products for sale that we print and ship out to customers worldwide!


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Free Webinar: Quote Werks
Wednesday, June 15, 2011 from 3:00 PM - 3:15 PM (ET)
A long established and respected application, Quote Werks performs advanced quoting capabilities and integrates with QuickBooks, GoldMine, Microsoft CRM, ACT and other popular business software applications. Join us for this 30 minute review of the capabilities of this powerful tool.
If you're receiving one of our popular newsletters you're getting them from Constant Contact, the #1 most popular email marketing tool used by hundreds of thousands of small businesses around the world. Join us for a 30 minute review of how you can use Constant Contact to keep in touch with your customers and market better to your prospects.
Don't want to pay those high monthly fees for a hosted system like Salesforce.com? Then ZohoCRM may be what you need — a full featured Customer Relationship Application that's fully web based ad hosted for only $25 per month! Join us for this free 30 minute demonstration of the key features of Zoho CRM.
This series enables clients and specially invited guests to see and hear, "on line", a live demonstration, by Gene Marks, of topics discussed in our monthly GoldMine newsletters.
This Month's Topics:
* Logging Field Changes In History
* Viewing Two Records At Once
* Using Comments In Picklists
* Using Conditional Colors
* Recently Viewed GoldMine Contacts
This series enables clients and prospective clients to see and hear, "on line", a live demonstration, by Gene Marks, of topics discussed in our monthly Microsoft CRM newsletters.
This Month's Topics:
* Cleaning Up Workflows In A Wait State
* Customizing Closing Dialog Boxes
* Enhanced Form Layout


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COLUMBUS, Ohio – When Urban Meyer first took over at Ohio State, he had to personally evaluate whether it was worth keeping Mike Vrabel on his coaching staff.
The evaluation period didn't last long.
Vrabel's experience as an impact player in the NFL for more than a decade spoke for itself, but what Meyer really admired about him was his natural ability to recruit, to connect with elite high school prospects for other reasons aside from being a former Pro Bowler.
Now Meyer is forced to replace Vrabel, who announced Thursday evening that he was heading back to the NFL and accepting a job as the Houston Texans' linebackers coach. And because Vrabel had such a profound impact on helping Meyer assemble Ohio State's 2014 recruiting class, that could have an effect on the Buckeyes.
Vrabel's ability to connect was clear to everyone who dealt with him, and he was named to Rivals.com's list of the top 25 best recruiting assistants in the country.
"Mike Vrabel, I have been doing this for 40 years, is one of the best recruiters I have ever been around, and I have been around the Glen Masons and the Nick Sabans," St. Vincent-St. Mary head football coach Dan Boarman told cleveland.com in November. "He has created a reason why these kids want to go to Ohio State.
"Just his personality. He knows the game, he knows the area and he knows the people. I would like to play for him, too. Throw all the accolades that he has out. It is just his personality and watching him deal with kids. He is great."
Cincinnati Moeller linebacker Sam Hubbard grew close to Vrabel during the recruiting process, but he reaffirmed to cleveland.com that his commitment to Ohio State is solid. He reached out to others in the recruiting class, and they all said the same thing.
"Everyone is upset," Hubbard said. "But I don't think anyone will decommit from what I have heard. It is tough to see him go, but I don't blame him for following his dreams. Good opportunity for he and his family."
Here is more reaction from Twitter.
I am thankful for everyone assoc with TOSU for 3 great years and my family and I are excited to join the Houston Texans as the LB coach.— Mike Vrabel (@CoachVrabel50) January 9, 2014
LB Kyle Berger:
Ohhhh myyyy, that's a buzzkill— Kyle Berger (@K_Bergs) January 9, 2014
I got a brotherhood with my fellow commits especially with @Kwon_daTRUTH @JDStandAlone &@DameWebb we got a mission together GO BUCKS !— QBKILLA!!! #â£1â£1⣠(@JayHolmes_) January 9, 2014
Probably the most sad ive evere been in ny life— Dylan Thompson (@BRONCODE59) January 9, 2014
Hearing that news just changed my whole mood— Jamarco Jones (@jjones_73) January 9, 2014
Part of the game we play. Best of luck!— Hubbs (@SamHubbard24) January 9, 2014


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23rd March 18:12
External User
Posts: 1
Another "crackdown" *Sigh*
People who read here a lot know what I think of "crackdowns" in the NHL.
How many here still think last years "crackdown" will have positive effects
for years to come? Not too many, I don't think, especially now that the
league have moved on to yet another "crackdown"!
Well, I don't have to much to say about the goalie pad "crackdown" except
this one tidbit. The new regulation on goal pads affects less than 1/3rd of
goalies. The vast majority were wearing what are still considered leagal
pads. So, a rule that affects only 30% of goalie even a little bit will
solve a decade long scoring dought in the game that has gotten worse over
I'm already wondering what next season's crackdown might be? Perhaps it
will be time for another obstruction crackdown! (I'd put a smiley here, it
the situation wasn't so sad.)
23rd March 18:12
External User
Posts: 1
Another "crackdown" *Sigh*
I've been saying that all along . I think even the 1/3 or 30%
estimates are on the high side for the number of goalies this is going
to effect. 38"-plus pads stick out on goalies pretty bad. Off the
top of my head, I think Garth Snow (how long until he finds the next
equipment-size-loophole to exploit? Any bets?), Roberto Luongo, and
John Grahame are perhaps the only 3 who'll be affected.
The rule is a joke. If the league were serious about it, they'd have
said the limit is 2" above the knee. But they just want to make more
PR waves while demonstrating they truly don't believe there's a
Ian Merrithew - ADM Systems Engineering
28th March 22:13
External User
Posts: 1
Another "crackdown" *Sigh*
Or maybe they would limit the width of the pads. If you look at goalies
throughout the years, their pads have widened so much, it's incredible.
They raise the issue of protection, but I do not think they would be less
protected if they would be wearing narrower pads. Heck, they stop shots
with the front of the pad...they could still be as thick as they currently
are, just not as wide.
P.S.: BTW, I'm sure Hackett won't be affected at all by the new rule
news:<firstname.lastname@example.com> ...
30th March 21:53
External User
Posts: 1
Another "crackdown" *Sigh*
Actually, there's already a rule on the books for the width of the pads: 12
inches. It seems to be well-enforced, too. But then, widening your pads
will kill your mobility really fast, so it's too much of a tradeoff for any
sane goaltender.
Ian Merrithew - ADM Systems Engineering
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MEDINA, Ohio – If you were a kid in the 1970s or earlier, chances are you remember riding your bike to and from school. If you close your eyes, you can probably conjur up the feeling of the cool morning air rushing past your face, the thrill of coasting down a hill or the rhythmic thumps as your tires bumped over the cracks in the sidewalk.
In 1969, half of all American children either walked or rode their bikes to school. By 2012, that number had dropped to 15 percent.
Teachers at Claggett and and A.I. Root middle schools, with the help of Medina Century Cycles, are hoping to change that, at least for a few weeks in May.
The third annual middle school Bike to School program runs May 5-16. Students, parents and teachers are invited to join in the fun and win a few prizes along the way.
Oh, and maybe get a little more fit.
"Our goals are really to get more kids on bikes and off the sedentary lifestyles that have become more prevalent," said Mike Petcher, manager at Medina Century Cycles.
Petcher noted that fewer kids seem to be riding bikes these days.
"Fifteen years ago, BMX bikes were a big seller for us. We'd sell 60 or 70 at Christmastime. Now, it's more like five or six. Kids are doing something else; they're not riding bikes to the same degree," Petcher said.
The program will kick off April 29 with a bike fair at Century Cycles, 1059 N. Court St. Students can bring their bikes and helmets in for a free safety check from 6:30 to 8 p.m. and register their bikes with the police department.
"The bike fair helps them get fired up about Bike to School," Petcher said. "We make sure their bikes are safe and ready to go." That may mean pumping air into tires, lubing a chain or explaining the basics of bike maintenance.
Century Cycles also sponsors Bike to School programs in Bay Village and Rocky River. The Bay Village program started eight years ago. They expanded to Rocky River a few years later and to Medina three years ago.
A.I. Root physical education teacher Melanie Condosta, who lives in Lakewood, thought it would be fun and educational to bring the program to Medina.
She said the program had a pretty good turnout the first two years, despite the fact that Medina is a spread-out suburban and partially rural area. While some kids live close to their school in neighborhoods with sidewalks, others live several miles away on country roads or along highways.
Condosta said she and fellow educators Connie Daum, who teaches health at Claggett, and Sherrie Schneider, a Claggett intervention specialist, encourage students who live farther away to ride with their parents or in groups, or to leave a bike at a friend's house and meet there for the ride in to school.
Students – and teachers – who ride their bikes during the two-week program are eligible to win prizes. Century Cycles gives away two Raleigh bikes at each school, as well as Cedar Point passes.
Condosta said daily prizes are being donated by Dairy Queen, the Subway restaurant on North Court Street, Arby's and Domino's. There's also a Raleigh water bottle giveaway day.
Students get bonus entries into the prize sweepstakes for wearing helmets. "Ohio law doesn't require helmets, but we encourage kids to wear them for safety," Condosta said.
Last year, Condosta said the goal was 200 riders per day.
"We were close. When they see more kids riding, they want to ride," she said.
Last year's program (which ran for three weeks) saw 3,222 riders total. Students pedaled 14,752 miles (the distance from Medina to Sydney, Australia), burned 250,784 calories (the equivalent of 1,791 cans of Coca-Cola) and saved their parents $2,590.64 in gas money, Condosta said.
This year, the program is down to two weeks, because the school year is ending earlier than it has in the past and planners have to work around the weather.
"Last week, it snowed. We don't want that! It's a warm-weather event. We want it to be fun," Petcher said.
Condosta said weather can be a challenge – the first year, it poured on the second day and everyone got soaked.
Students also often have to figure out how to juggle backpacks and instruments. Sometimes a parent will drive several students' instruments to and from school.
Petcher said seeing a kid riding to school with a smile on his face is what the program is all about.
"It sets them up for a good day, a good week, a good month," he said.


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A quick look at the MoDaCo Alpha 10 Desire ROM
MoDaCo gives us N1 users Sense with this Desire ROM. Click here for instructions on how to get here from a stock Nexus One. Carlos already did a video review of Alpha 6, but I wanted to take the newer version for a spin and continue to dust off of my movie makin' gear. Despite the warnings from MoDaCo that most probably will not want to use this as their production ROM, it is my ROM of choice right now. Fantastic! I point out a few features that are not exclusive to the ROM, but maybe some of you are curious about standard 2.1 as well. Video after the break.


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- You are here:
- GT Home
In addition to its annual lectures, ChBE hosts a weekly seminar throughout the year with invited lecturers who are prominent in their fields. Unless otherwise noted, all seminars are held on Wednesdays in the Molecular Science and Engineering Building ("M" Building) in G011 (Cherry Logan Emerson Lecture Theater) at 4:00 p.m. Refreshments are served at 3:30 p.m. in the Emerson-Lewis Reception Salon.
Osmotically Driven Membrane Processes for Sustainable Production of Water and Power
Increasing global water scarcity and the environmental impacts of the consumption of fossil fuels present grave challenges to the present and future health, welfare, and prosperity of the people of both the developed and developing world. This presentation will introduce the emerging field of osmotically driven membrane processes (ODMPs), which shows great promise to assist in addressing these challenges. These processes, based on the use of osmotic pressure gradients in membrane separation systems, have been significantly advanced by the identification of a solution of osmotic agents that create high osmotic pressures for separations and power generation, but have the particular benefit of being thermally removable, and completely recyclable, using low quality heat. Two of these processes will be described in detail. The first of these is a method of desalination, intended to sustainably augment fresh water supply, known as forward osmosis (FO). Data from a pilot scale study of such a system, used to desalinate frac-flowback and co-produced water from the Marcellus Shale, will be discussed. The second process is a method of power generation using a closed cycle pressure retarded osmosis (PRO) system to convert low temperature heat to electrical power. Methods of modeling, designing, and operating both processes will be described. Experimental data will relate the efficiency of both processes to limitations of mass transport in the support structure of the membranes used, and illuminate the limitations and possible areas of improvement in solute separation and recycling methods. Future research in these and related areas will be discussed.


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To Senator Casey
When I answered the phone on the eve of the 2010 election for governor, the caller quickly said, "Hi David, this is Tom Corbett. I won't raise your taxes." Click. However, that's not what happened.
In 2011, real estate property taxes were increased by most school districts because $1 billion was cut in the State budget for public education, $860 million for public schools alone. Educational programs and extracurricular activities were cute and/or eliminated, and tuition rates for students in public colleges and universities were increased.
Thousands of public school teachers and staff were laid off and drew unemployment instead of working, and over 200 neighborhood schools were closed. Class sizes for students were increased and school bus travel times were lengthened, too.
At the same time, the capital stock and franchise tax for businesses was lowered and will be eliminated in 2014, along with reductions in the corporate income tax rate. Millions of dollars of taxpayer money was given to private universities, private developers and non-profit organizations that already had surplus funds. While others were getting the gold mint, Pennsylvania taxpayers got the shaft in the form of higher property taxes, added fees for motorists and higher gas taxes. Revenue from casino gambling and the lotteries are restricted and only go so far. The state's personal income tax and the sales tax are both regressive and hurt the poor. Pennsylvania needs to join neighboring states by passing a constitutional amendment that permits a graduated person income tax at all levels of Pennsylvania government.
Senator Casey, Pennsylvania has a lot of problems, and we need a governor who will lead us into the 21st century, not take us back into The Dark Ages or The Great Depression of the 20th century. Please give very serious consideration to seeking the Democratic nomination for governor in 2014. Pennsylvania needs another Governor Robert Casey
David L. Faust