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Better Health Decisions: Whose Responsibility?
Organizations are introducing consumer-driven health plans with the intention of migrating responsibility for health decisions away from the employer and onto the employee. However, many organizations have found that despite doing so, their costs remain high and employees still tend to make poor health care choices.
To illustrate this, companies with a high percentage of their employees in a consumer-driven health plan have still seen high single digit health-care cost increases consistent with those organizations that do not have such plans in place. With a significant amount of company dollars dependent on these employee's decisions—roughly $7,000 per employee per year—organizations are looking for ways to influence those decisions.
While employees often receive access to decision-support tools and resources, a growing number of organizations now actively train their employees to be smarter health consumers. Some organizations even go so far as to give employees cash incentive or medical premium discounts to encourage them to learn about their health and benefits. While this may seem surprising given that health information is freely available on the Web, the benefits to employers of driving informed decision making are real. The Benefits Roundtable, the Corporate Executive Board's network of benefits executives, has estimated that approximately $1,350 can be saved per employee per year as a result of improved employee health decision making. Since these cost savings drop straight to the bottom line, organizations must educate employees.
Organizations at the forefront of this effort train their employees to be better health consumers through these methods:
Targeting the right barriers—Employees face critical barriers during interactions with the medical and insurance system that prevent them from making cost-effective decisions. For example, employees need better access to lower-cost urgent care clinics instead of high-cost emergency rooms. A simple solution is to distribute geographically targeted information on local medical centers and their availability to employees. Keeping up the dialog—Leading organizations communicate continuously about informed health decision making by providing tips and suggestions to employees, rather than communicating only in advance of open enrollment as most organizations do. Bringing coworkers into the conversation—Internal social networks of employees have a significant influence on employee perceptions and actions. Use coworkers to communicate and promote health- and benefits-related messages. Leverage multiple channels to reinforce the message—A message needs to be repeated at least three times to have any influence on individual behavior. Develop communication plans that use technology to track the number of times a key health-related message is delivered to employees.


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Get an overview of this hotel3-star lodge with free breakfast and restaurant
Collect 200 points
Simply enter your Nectar card number when prompted. Your points will be credited 30 days after you return from your trip.*Offers may apply
Situated in Khorixas, this lodge is 0.4 mi (0.6 km) from Khorixas Field.
Property Features
This lodge features a restaurant, an outdoor pool, and a bar/lounge. Free buffet breakfast, free WiFi in public areas, and free self parking are also provided. Additionally, dry cleaning and a garden are onsite.
Room Amenities
All 55 rooms offer patios, coffee makers, and safes.Information missing or incorrect? Tell us!Opens in a new window
Damara Mopane LodgeFarm 68 Witklip Khorixas
Hotel Amenities
Hotel Amenities
The lodge offers a restaurant. A bar/lounge is on site where guests can unwind with a drink. Guests can enjoy a complimentary breakfast each morning. Public areas are equipped with complimentary high-speed wireless Internet access.
This Khorixas lodge also offers an outdoor pool, a garden, and dry cleaning/laundry services. Complimentary self parking is available on site.
Damara Mopane Lodge has designated areas for smoking.
- Total number of rooms - 55
- Number of floors - 1
- Bar/lounge
- Free breakfast
- Dry cleaning/laundry service
- Designated smoking areas
- Free WiFi
- Garden
- Restaurant
- Free self parking
- Outdoor pool
Available in some public areas: Free WiFi
Free self parking
Room Amenities
- Patio
- Air conditioning
- Coffee/tea maker
- Daily housekeeping
- Private bathroom
- Shower only
- Hair dryer (on request)
- In-room safe
- Cribs/infant beds available
Where to Eat
A complimentary buffet breakfast is served each morning between 6 AM and 9 AM.
Onsite venue - This restaurant serves breakfast, lunch, and dinner. Guests can enjoy alfresco dining (weather permitting).
Nearby Things to Do
Recreational amenities at the lodge include an outdoor pool.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Game viewing nearby
- Game drive nearby
To make special requests for accessibility needs, please note them at check-out when you book your room.
- In-room accessibility
Hotel Policies
Check-in time starts at 2 PM
Minimum check-in age is 18
Check-out time is 10 AM
Payment types
- No pets or service animals allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
No pets or service animals allowed
Hotel Name
- Damara Lodge
- Damara Mopane
- Damara Mopane Khorixas
- Damara Mopane Lodge
- Damara Mopane Lodge Khorixas
- Mopane Lodge
We should mention
No pets and no service animals are allowed at this property.

subset: commoncrawl


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Peninsula Mortgage's McComas passes test
Hayley McComas of Peninsula Mortgage, 720 E. Washington St., Sequim, successfully completed the National Mortgage Loan Originator Test as required by The Secure and Fair Enforcement Mortgage Licensing Act.
Call 683-2429 or visit www.penmortgage.com.
Walmart opening
The new Walmart in Port Angeles hosts a grand opening celebration, beginning at 7:30 a.m. on Wednesday, Oct. 27.
The store is located across road from the Walmart located at 3500 Highway 101.
Call 452-1244 for more information.
Chair massage offered
Local licensed massage practitioners offer free 15-minute chair massage sessions from 11 a.m.-
2 p.m. Wednesday, Oct. 27, at the Clallam County Courthouse, 223 E. Fourth St., Port Angeles.
Massage recipients remain fully dressed for treatment of the head, shoulders, neck, arms, hands and back.
The event celebrates American Massage Therapy Association's National Massage Therapy Awareness Week.
Licensed massage practitioners who want to participate in this event do not need to be members of the association but do need proof of liability insurance.
Call 417-5257 or e-mail email@example.com to sign up for a one-, two- or three-hour time slot.
For information, e-mail email@example.com.
West Coast Sea Glass wins top honors
Mary Beth Beuke, of Sequim, has been named a winner in StartupNation.com's 2010 Leading Moms in Business competition sponsored by Infusionsoft and in collaboration with Ladies Who Launch and the National Association for Moms in Business.
Her company West Coast Sea Glass can be found at www.West CoastSeaGlass.com
In addition, Beuke's work was featured this August in Parade Magazine.
Peninsula Awards & Trophies
Peninsula Awards & Trophies begins its winter schedule Monday, Nov. 1, at 241 E. Washington St., Sequim.
The store will be open 9 a.m.-
5 p.m. Tuesday-Friday and 9 a.m.-
2 p.m. Saturday, and closed Sundays and Mondays.
After-hour appointments also are available. Call 683-8842, e-mail firstname.lastname@example.com, or visit www.peninsulaawardsand
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But it seems to be working for him.
Since the Kalamazoo Air Zoo stopped charging $19.50 per head for admission to the museum in June 2009, attendance has been strong, said Ellis, president and chief executive officer of the museum.
Attendance nearly tripled in the first year of the free admission program, he said. The program, started in response to the sagging economy, is running through 2011.
Ellis said it's difficult to project how much revenue has been lost as a result of the program. The Air Zoo took in $1.2 million in 2008.
"Is some revenue lost? Probably yes," Ellis said.
Some money is made up through the purchase of food at the Air Zoo's food court, as well as the payment of fees for tickets to interactive rides, like full-motion flight simulators and a 4-D movie theater.
For $12.95, visitors who are 48 inches and taller can buy a one-day unlimited pass for every ride. There is also a $10.95 package for visitors 42 inches and taller and a $6.95 package for visitors 36 inches and taller. Children under 2 are free.
But the real costs are made up through corporate donations and funds from generous groups and individuals who have supported the Air Zoo, Ellis said.
"We're only able to sustain because we've gone out and raised funds like any other museum," he said. "These days, there is no magic formula, no golden egg."
The main objective, Ellis said, is to keep the Air Zoo – viewed by many aviation historians as one of the pre-eminent aviation museums in the country — open so that as many people as possible can learn about the wonder of flight.
"When we decided to have this program, we viewed it as the value that the Air Zoo has to the community," Ellis said. "We need to fulfill our mission."
Ellis said he's been contacted by officials from several for-profit and non-profit museums across the country who have inquired about the Air Zoo's no admission program to see how it's working.
"Would I recommend it? No," he said. "But it seems to be working for us."
It's worked well enough, in fact, to allow for expansion at the Air Zoo. The museum's east campus will be closed this month as a 50,000-square-foot expansion project at the main campus takes place.
The $2 million project, funded with grant money from a private foundation, will provide space for exhibits that are in the Air Zoo's possession but don't have a home, along with space for a library and archive. The new area is set to open in June.
"Heaven is here if you're an aviation nut," Ellis said. "And even though we can't predict the future anymore, we know that what were doing is here is important and will continue."


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The Burning
From the best selling author of The Coroner and
The Flight, another vintage Jenny Cooper thriller.
In the depths of a frozen winter, Coroner Jenny Cooper is called to the scene of a devastating house fire that has claimed the lives of Ed Morgan and his two step-daughters in the isolated hamlet of Blackstone Ley.
The police look no further when they discover the message Ed left for his wife, Kelly, telling her that he set the fire as revenge for her infidelity and that she will never find their infant son.
As Jenny digs into Blackstone Ley's murky past, she uncovers a history that begs more and questions. What provoked Ed's murderous rage? How might the other, guarded inhabitants of the village have been involved? And what connects the fire with the unsolved disappearance of a four-year-old girl nearly ten years ago?
Buy signed first edition from


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text: UV Pure systems, featuring Crossfire Technology, manufactures two systems that are engineered to be smart, virtually maintenance free and to protect against surges and brownouts. The Hallett series is NSF/ANSI 55 Class A certified with two systems for 15 and 30 gpm. The Upstream series of drinking water systems are engineered to meet NSF standards.


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Jordan Walden: Fastest fastball in baseball
R.J. Anderson writes for Fangraphs:
"Jordan Walden has thrown 40 pitches in the major leagues, 30 being fastballs, but one thing is evident: he throws really, really hard. How hard? Baseball Info Solutions has the average velocity at 98.9 miles per hour. If Walden qualified that would rank second only toJoel Zumaya's 99.3 MPH heater."
Getting to watch the second-fastest pitcher in baseball would be pretty cool, but even cooler would be watching the fastest pitcher in baseball. And I think there's reason to think Walden is, because the radar gun in Detroit is a lot hotter than the gun in Anaheim.
Six Angels starters have pitched in Detroit this year. Excluding Trevor Bell -- who hasn't started a game in Anaheim yet, so I ignored his start -- all of their average fastballs in Detroit were clocked higher than their average fastballs for the year, by approximately 1.4 mph. Here are their fastball speeds in the home start immediately before going to Detroit; in Detroit; and in the home start immediately following Detroit:
Kazmir lacks one "before" start because he had just returned from the disabled list.
And, to make sure it's not something specific to the Angels' pitchers, I looked at three of the four Detroit starters who pitched in Anaheim. (Leaving out Dontrelle Willis, because who knows what to expect from that guy.) They were slower in Anaheim than their season speeds, by an average of 1.1 mph:
It looks like there is about a 1.2 or 1.3 mph difference between the two parks' radar guns. Cut that difference in half (since each only pitches half his games as home) and it still looks like Walden has thrown harder than Zumaya this year, and harder than anyone. (Though Anderson is right that the sample sizes here make this completely inconclusive, and possibly misleading.)
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A health scare made his first week stressful but Chase Christopher Sturman's arrival was the brightest moment for his family in a year filled with despair and heartbreak.
Emma Cate, the elder sister of murdered Dawesville teenager Jessie Cate, and her partner, Reece Sturman, could finally take Chase home yesterday after the newborn spent a week in Princess Margaret Hospital's neonatal unit.
The 18-year-old first-time mother could hold her son only for a couple of minutes after giving birth because of his breathing difficulties.
A daunting week in three different hospitals with your baby on a breathing machine would frighten any parent, but Ms Cate said she was not overly worried and felt her sister's presence throughout.
She said Chase would grow up knowing Jessie, who was 15 when killed in December.
"I'll definitely tell him every- thing about her, what a great sister she was and what a great aunt she would have been," she said.
"I wouldn't say the chapter is closed because regardless, I'll never get over it and it will always be with me, but now I can focus on me, Reece and our family together."
Chase was born on September 14 at Peel Health Campus, weighing 3.4kg. After a stint in PMH, he was sent to Rockingham Hospital, where doctors yesterday gave him the all-clear to go home.
Now Chase is home, healthy and able to be cuddled, his adoring family - including Emma's mother Judy and three other siblings - finally have a reason to celebrate.
Chase's name is a tribute to Jessie because it was her favourite boy's name.
Ms Cate said the family was ecstatic at Chase's arrival and her youngest daughter, six-year-old Mia, had been longing to hold her baby nephew.


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For Immediate Release: Thursday, Sept. 26, 2013
Media Contact: Dawn Dovre, 605.773.3094
Scammers Take Advantage of Health Reform Confusion
PIERRE, S.D. -- The South Dakota Division of Insurance has issued a consumer alert warning people of scammers posing as insurance agents or federal government representatives.
State Insurance Director Merle Scheiber says scam artists may be trying to sell fraudulent policies or obtain sensitive information like Social Security and bank account numbers.
The consumer alert lists common red flags and provides tips on how to avoid being the victim of a scam.
Fake exchange websites are one common problem, along with claims the person's new "Obamacare" insurance card will be issued if he or she provides additional personal information.
"Don't be misled," said Director Scheiber. "Scammers may use pressure by saying their offer is only good for a limited time or you will go to jail if you don't have health insurance, but this is not true."
The Division can answer questions or concerns about insurance by calling 605.773.3563.
- 30 -


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Carlos Carrasco shut out AL East-leading Baltimore on three hits over seven innings, lifting the Cleveland Indians to a 6-0 win over the Orioles on Saturday night.
Carlos Santana hit a three-run homer in the first off Ubaldo Jimenez (4-9) and Michael Brantley added a two-run shot in the fifth as the hot-and-cold Indians won for the fifth time in six games. Jimenez, who pitched the Indians to the postseason in 2013, lost to his former teammates for the second time this season.
Carrasco (5-4) got two inning-ending double plays to avoid early trouble and then retired 15 straight after giving up a leadoff double in the third.
The Orioles have lost consecutive games for the first time since June 28-29.


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(AURN/AP) -- Democratic Senator Dick Durbin on Monday removed a Facebook post that erroneously claimed a GOP leader had told the president, "I can't even stand to look at you," saying he's satisfied that people now know he's not to blame for the mistake.
The White House says the error stemmed from a "miscommunication."
On October 20th, Durbin, posted on his Facebook page that at a meeting with Obama during the government shutdown, a "GOP House Leader told the president: I can't even stand to look at you." Durbin was not at the meeting, but he says his source was a White House staffer who briefed him. That staffer has been identified as White House Deputy Chief of Staff Rob Nabors.
Dubin said Monday, "They gave me a bad quote and then they said it didn't occur." He added, "Now it's history, it's behind us."
The White House says the misunderstanding originated when White House officials gave Senate Democrats a summary of a meeting Obama had held with House Republicans. White House spokesman Jay Carney said, "There was a miscommunication when the White House read out that meeting to Senate Democrats, and we regret the misunderstanding, that quote was not accurate."
Durbin said Monday that there was never any misunderstanding, at least not on his part. He also said when a "staffer in the White House" told him and other senators about the meeting, he found the comments so "earth-shattering" that he wrote them down verbatim.
Durbin said Monday that he's now satisfied that it's clear he didn't make up the quote. Within a couple of hours, the only evidence of the dispute was a Facebook post in which Durbin expressed his appreciation for "this clarification from the White House."
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You might also be able to find out what their traffic is like and that will show you how well your own site is doing.
Interviews from people high up in your industry can hold a lot of value. Just be sure to get their permission before you publish anything online. After you have permission, write the articles from your interviews and submit to online directories. Never completely abandon an idea that has merit; simply move it to the back burner and be willing to explore it at a later date.
Incorporate Twitter, Facebook and other social media outlets into your online marketing efforts. Social media can help you remain in contact with customers while also letting you quickly send out promotions and updates. Just be wary of over-promoting. Rather, use these sites to promote interesting posts along with your marketing messages.
There is no secret formula to marketing on the Internet. It is a combination of science and art. You must research the online advertising methods that are effective within your industry and learn about newly designed techniques. Be analytical of relevant data while expressing your creative side through the aesthetics and theme of your site.
Allow your customers to control the content that they get from you. It will be a breath of fresh air in a world filled with spam and unsolicited advice. Let them know they have the option to participate and they will think more of you and your company.
Start a reward system. It is extremely valuable to hold on to the customers that you already have, and your outward generosity will speak volumes about your company. It is moves like this that generates positive word of mouth advertising.
If using images on your site, always include captions. Search engines will use these captions in relation to searches. With good captions on your images, your site can raise in search engine rankings.
When you do not regularly update or revamp your website, consider keeping things fresh with a company blog. Blogs yield fresh information, which will boost you up in the rankings. Adding a blog is an easy way to add fresh content consistently.
Check this web site you need to Beat The Competition With These Social Media Marketing Tips, Incredibly Easy Social Media Marketing Tips For Your Brands, New To Social Media Marketing? What You Need To Know position your site in search engines like google.With the way the Internet operates in this modern age, you better believe that you need to employ some marketing tactics if you want to compete.
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Clarinettist Luca Luciano is back to the Brunel University
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Harold Lopez-Nussa Trio - CUBA!
Karen Brundage-Johnson, PhD.
Luca Luciano's new CD on Soundset Recordings
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The hospitalized hospitalist
By James S. Newman, FACP
From the November ACP Hospitalist, copyright © 2008 by the American College of Physicians
After years of waddling down the hospital hallways making my appointed rounds, I decided it was time for a hip replacement. I had put it off as long as I could. Everyone said that I was too young for a THA but I was sure feeling old. My surgeon asked if I was ready. We discussed optionsresurfacing, total hip, alloy, ceramic. Did I have a preference? I could not believe it when I heard myself say, Whatever you think is best.
The morning of admission started early. 5:45 a.m. check-inungodly surgeons hours. I stood in the registration line with dozens of other people waiting to enter the medical machine. I felt my independence and identity dissolve as the two plastic armbands snapped on my wrist. My name is N-E-W-M-A-N, J-A-M-E-S. Birthday 4-21-59. No known drug allergies. I would repeat this over and over in the days to come. The last time I had an armband it was for a water park.
The next step was changing into the gown. Take off all your clothes, including your underpants, and put them in this plastic bag, ordered the nurse. Arm-banded and underpants-less, I knew I was no longer a physician; I was now a patient. In the preoperative area, the staff intermittently called me doctor but I knew it was just pretense. When a nurse came and gave me a hemi-torso shave there was no MD about it. I was a plucked chicken.
I would be having spinal anesthesia with a nerve block. As the fentanyl and Versed went in my IV I wondered why I didnt get the countdown from 100. I thought Id try I came to in the post anesthesia care unit. I pulled the covers over my head. They asked what I was doing, and I told them I was keeping the sand flies off me. It seemed reasonable at the time. I guess they thought I was delirious. For the next two hours I enjoyed the best hallucinations since The Grateful Dead at Red Rocks. Id be walking though a forest, then the blood pressure cuff would constrict, bringing me back to the PACU.
Another time I was riding a horse through Yosemite, then the cuff roused me again. It was a pleasant few hours. Being a guy, one of my greatest fears was urinary retention. I remembered my first I-and-O cath, but it was no big deal because my spinal was still working, the same for the second. As my sensation returned I swore it would be the last. I lay in my bed supine with a urinal in place, straining and fretting, envisioning all the patients Id sent out on routine I-and-O. I have never been so glad to urinate.
Finally up in my room, the stalwart nurse settled me into my bed. She wondered if I needed pain medication. I wanted my PCA. I was ready to start clicking that little button. But there was only oxycodone ordered! I said Id take it but not before I had some senna and Colace. I told her I did not want to have to be disimpacted. Dont worry, was the nurses response, I wont be on shift then anyway. I thought of all those times I had asked postoperative patients if they had passed gas. I always said the same corny line, We like patients to pass gas in the hospital, unless its in the elevator. The flatulent joke was on me this time.
Day 1 post-op, it was time for my shot of LMWH. The nurse asked who would be giving this at home. My wife, I told her. (That lasted about one day till my dear spouse pointed out that first, I was a doctor, and second, my hands had not been operated on. So much for the pity card.) It was nearing time for discharge. I could have left on day 2, but neither my wife nor my mother was ready to take a difficult patient like me home. I was just another placement problem. Would I need a social work consult?
I had been though delirium and retention, sluggish bowels and DVT prophylaxis. I did not think Id acquired MRSA, C. diff, or VRE. No atelectasis, bed sores, atrial fibrillation or fever. And best of all, the correct hip had been operated on. All in all, it was a successful run though a modern American hospital.
I wondered if I had learned anything about being a patient, or about myself. Had my horizons broadened and my world perspective altered? Would I be a better healer? Possibly.
I cut off my armbands, put on my underpants, and enjoyed that new hip smell.
Jamie Newman, FACP, is a hospitalist at the Mayo Clinic and editorial advisor to ACP Hospitalist.
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SAGINAW, MI — Keith K. Solomon Jr. shot Gerald Hudson about 15 feet away from Hudson's sister and her children, the sister testified.
The woman, whom MLive is not identifying because of safety concerns, was one of three witnesses to testify Wednesday, May 22, that Solomon and Hudson were speaking in the Birch Park housing community May 9 when Hudson was shot in the stomach.
The witnesses' testimony came during Solomon's preliminary hearing before Saginaw County Chief District Judge M. Randall Jurrens. Based on the testimony, Jurrens found that probable cause existed for Solomon, 21, to stand trial in Circuit Court on seven felonies, including assault with intent to murder.
Hudson, 25, was visiting the complex, off Hess on Saginaw's southeast side, with two others about 2:45 p.m. when Solomon, riding a bicycle, began circling the van in which Hudson was sitting, the van's driver testified.
Solomon stopped to go speak with two other men who had just arrived at the complex, the driver testified. Hudson recognized one of the men and walked over to them and shook the man's hand, the driver testified.
When Hudson began walking back to the van, Solomon followed, the woman testified. When Hudson realized Solomon was following him, he turned around and put his fists up to defend himself and told Solomon he didn't want to fight him, she said.
As the men stood close to the van, Solomon said, "You ain't going to knock me out like you did my cousin," the driver testified. Solomon pulled a black handgun from his waistband and then shot Hudson, said the driver, who transported Hudson to the hospital.
"He shot him and he ran," the driver said.
Hudson's sister, who lives in Birch Park, testified that she was watching her son and daughter play in the park inside the complex when she saw her brother and Solomon talking. She said that while she heard that Hudson and Solomon had fought on a previous date, she didn't know what he looked like. If she knew her brother was talking to Solomon, she testified, she would have encouraged her brother to walk away.
She testified that doctors told her and her family that Hudson was "an inch away from dying." Hudson remains hospitalized.
Solomon's attorney, Andrea Lebean, argued that Solomon should not be bound over for trial because Hudson did not testify and because the witnesses lacked credibility. Saginaw County Assistant Prosecutor Demond Tibbs argued that Hudson's presence was not required for the hearing because he only needed to show probable cause that Solomon shot Hudson.
Solomon, who last lived at 385 Canterbury off Gratiot west of Golfview in Saginaw Township, also is charged with possessing a firearm as a felon, carrying a dangerous weapon with unlawful intent, carrying a concealed weapon, and three counts of possessing a firearm during the commission of a felony-second offense.
The assault charge carries a maximum penalty of life in prison, while the second-offense felony firearm charge carries a mandatory, consecutive five-year prison sentence.
Solomon remains jailed on a $500,000 or 10 percent bond.


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the view of the valley below from one of the ledges on Vroman's Nose
Vroman's Nose
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North Scituate Vacation Packages
Providence, Cranston and Smithfield, are other places in the area which are also worth exploring.
North Scituate has plenty of cultural attractions within easy reach that allow visitors to really get a feel for the area. Step inside some of the museums here such as the Providence Children's Museum.
If you love nature and wildlife, plan a trip to the nearby green spaces. These are good spots to breathe deeply and relax. There are some great family parks, so why not take a break in Waterplace Park.
If you are spending a while in and around North Scituate, treat yourself with a visit to the Bank of America Tower and the Roger Williams National Memorial. Visitors who enjoy visiting sacred places shouldn't miss the First Baptist Church of America.
To browse through stores or enjoy a snack, set out to visit the Providence Place Mall and Westminster Arcade.
This area is the home ground of the legendary Providence Friars college basketball team in winter and Providence Bruins ice hockey team. Both teams compete in regular games at Dunkin Donuts Center. Music lovers can also check the stadium's website to see if there's a concert scheduled during their stay.
When you're ready to relax after enjoying the delights of North Scituate, check in to one of the area's many short and long stay accommodation options. If you're looking for a warm welcome and a good nights sleep check out the Providence Biltmore Hotel, the Omni Providence Hotel, and the popular Hilton Providence.


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Gov. Bobby Jindal is so intent on shutting down testing for the new Common Core academic standards that he won't let Superintendent John White or the state school board buy more than a few laptops at a time on their own. After the Board of Elementary and Secondary Education voted Tuesday to hire outside lawyers to sort out the fight with the Jindal administration over the Common Core test, the governor's office effectively cut off the money supply.
The administration has limited the board and Mr. White to $2,000 per contract without approval from the Division of Administration. The threshold had been $20,000.
Even the old limit might not buy a lot of legal advice, but Gov. Jindal is taking no chances.
BESE President Chas Roemer countered that the board has offers for free representation -- but the governor's staff says even that would have to be approved by the administration as well as Attorney General Buddy Caldwell.
This has gotten absurd.
Gov. Jindal, who came into office in 2008 touting high ethical standards for state government, should be embarrassed to be using the contracting process for his political whims.
The governor, who has presidential ambitions, has decided that being against Common Core is best for his future prospects.
His administration claims that its spending limits for Mr. White and BESE are merely protecting state tax dollars. The Partnership for the Assessment of Readiness for College and Careers test, which was developed by a multistate consortium, is provided by a single source. So, the purchase hasn't been competitively bid, which the administration says is improper. Mr. White and BESE argue the existing test contract could be used to supply the Common Core test.
The Jindal administration's complaints are a smokescreen. Gov. Jindal doesn't want a competitive bid process to seek a test that would be used by multiple states, as the PARCC exam would be. He wants a Louisiana-only test to be developed.
And he is determined to jettison the multistate test even though BESE, which has the constitutional authority to set education policy, has voted to continue with Common Core and PARCC.
The governor also failed to persuade the Legislature to stop Common Core during the spring session.
So, he is trying to do it himself -- and the only avenue he has is the purchasing process. "They are taking every punitive step they can to stop us," Mr. Roemer said. "This is not what the procurement process was intended to do."
He's right -- this is punitive.
Mr. Roemer has said he would prefer to solve the dispute with the governor without legal action. That would be best, although Gov. Jindal seems determined to impose his will on BESE and Mr. White.
At least one charter school organization is willing to join the fight to keep Common Core and the multistate test. The New Orleans' Choice Foundation board voted Thursday to join a pro-Common Core lawsuit against the governor, if BESE files one. Even if the state school board doesn't sue, Choice Foundation might go to court, chief executive Mickey Landry said. The charter board has pro bono legal representation lined up.
"We want to provide profoundly different opportunities for our children's future than they would have had otherwise. And we believe Common Core is one way to do that," Mr. Landry said.
Choice Foundation has made "significant investments" in the Common Core standards. The group has hired new staff skilled in Common Core methods and bought new teaching materials -- and has been training teachers for the new standards since 2011.
The benefit of the PARCC test is that it would allow his students' progress to be measured against their peers in other states, he said.
The ability to compare student achievement state-to-state is one of the main aims of Common Core. The effort originated in 2010 with the National Governors Association, which saw the need to set higher standards for students. Business leaders here see Common Core's higher standards as a key to economic prosperity for Louisiana and for individual families.
The governor signed on to Common Core four years ago, but he started backing away in recent months when it became controversial with some parents and conservative groups. He concluded his about face this summer after lawmakers refused to derail the new standards.
Gov. Jindal is doing a disservice to students by trying to limit their academic horizons.
He claims that Common Core and PARCC are an attempt by the federal government to nationalize education and intrude on local control. That isn't true -- but that argument plays well with some of the national voters the governor is trying to court.
And he is apparently willing to subvert the state procurement process to do it. BESE and Mr. White are right to fight back.


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Less than a year after playing for the Saginaw Spirit, defenseman Dalton Prout has been called up to the NHL by the Columbus Blue Jackets and will make his debut Saturday in Minneapolis, the Columbus Dispatch is reporting.
Prout played 29 regular-season games for the Spirit at the end of the 2010-11 season after being acquired at the trade deadline, recording 10 points. He moved on to the AHL's Springfield Falcons at the start of this season, where he has seven points in 41 games.
Prout will become the eighth former Spirit player to play in the NHL, and sixth currently on an NHL roster.


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Oceanport Mayor Mike Mahon has offered to have his borough serve as the "transition vehicle" to end the impasse between the state and the New Jersey Thoroughbred Horsemen's Association that is threatening to shut down Monmouth Park Racetrack next summer for the first time since it opened in 1946.
Mahon sent a letter today to Gov. Chris Christie requesting that the Monmouth racing license be transferred to Oceanport so the town can serve as the track's temporary landlord until a new private operator can be found. He said Oceanport has no interest in running the track on a long-term basis.
"There are other options available, and we're looking to help," he said.
Monday, Christie gave the New Jersey Sports and Exposition Authority and the horsemen's association seven days to reach a new lease agreement to privatize the thoroughbred track after a deal with real estate developer and horse owner Morris Bailey collapsed on Dec. 2 just as it was about to be finalized.
Christie blamed the horsemen's group, calling them "completely untrustworthy." John Forbes, president of the horsemen's association, said the state changed a key component in the deal at the last minute, opting not to transfer the license for thoroughbred racing at the Meadowlands.
Forbes called that license "a cornerstone" of the agreement.
Christie, who wants the state out of the money-losing racing business (it is also looking to privatize the Meadowlands Racetrack), threatened to shut down Monmouth Park next year if a deal isn't reached by the deadline he imposed.
He had no comment on Mahon's offer today — though no other solution to the stalemate has been forwarded by either side.
The board of directors of the Sports and Exposition Authority was updated on the Monmouth Park situation during today 's regularly scheduled meeting, though no action was taken on the matter, spokesman John Samerjan said.
Mahon said there is a legal avenue that will allow Oceanport to serve as the transition vehicle without the state having to go through a rebidding process that could take another year.
Monmouth Park, which runs live racing from mid-May until Labor Day, employs approximately 1,600 people at the height of the season and pays $1.84 million annually in property taxes to Oceanport.
Oceanport also provided the state with a $26 million loan over 20 years for the stormwater management project designed to clean up local waterways polluted by runoff from the track.
The unraveling of the deal to privatize Monmouth could also jeopardize the state's plans to lease the Meadowlands to Jeff Gural, since Christie said he wanted the deals done simultaneously.
Tom Luicci: firstname.lastname@example.com


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WASHINGTON — Gov. Chris Christie is chairman of the Republican Governors Association, but it was the past chairman, Louisiana Gov. Bobby Jindal, who was the public face of the organization today in the nation's capital.
Jindal joined a dozen governors from both parties at a news conference outside the White House, and immediately walked across the street to lead an RGA news conference with Gov. Nikki Haley of South Carolina, Gov. Rick Perry of Texas and Gov. Bill Haslam of Tennessee.
"RGA is more important than just any one governor," Jindal told reporters at the Chamber of Commerce. "It's not about the chairman, it wasn't about the chairman when I was chairman last year. It's not about the chairman this year."
Christie was in D.C. Friday through early Sunday, when he took a train home to celebrate his eldest daughter Sarah's 18th birthday. Christie skipped the governors' annual dinner and meeting with President Obama, news conferences and the Sunday talk shows as he copes with the fallout of investigations from the U.S. attorney and a legislative committee over the controversial closure of lanes to the George Washington Bridge.
Like Christie, Jindal is a potential candidate for the 2016 Republican presidential nomination.
"Yes, I think he can be and has been an effective leader of RGA," Jindal said. "I think he should remain. The reality is Chris, he has taken responsibility, he said he will cooperate with all of the investigations. I don't know what more we can ask him to do beyond that so, yes, he can be effective."
Haslam said Christie has embraced his leadership role in behind-closed-doors meetings.
"If you'd have watched Chris lead our meetings for the past two days, you'd have no doubt that he's fully capable and committed to being the RGA leader," he said.
Aside from policy questions about what the governors discussed with Obama during the bipartisan National Governors Association meeting with him today, everyone wanted to know how Christie could represent RGA while staying out of sight. The RGA anticipated the criticism with an announcement last week that Christie raised a record $18 million since November.
Haley and Haslam, who are seeking re-election this year, said they would both campaign with Christie, though there are no concrete plans to do so yet.
"I would appear with any of my governor colleagues publicly," Haley said. "I'm incredibly proud of every single one of them… They've had great records, including Gov. Christie and I would be incredibly proud to let everybody know he supports me as well as say he's my friend."
"If Chris came down, we'd love to have him," Haslam said, adding later: "He's actually talked about coming to Tennessee this summer or fall, there's no definite plan yet."
Asked who paid for his trip to Washington, Christie's office and the RGA did not immediately respond.
Christie will travel to Boston for an RGA fundraiser Thursday and RGA has said he also plans to go to Georgia, Connecticut and Utah.
• Christie rebuffs reporters, counts on fellow Republicans' support at governors meeting


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It's not football season. Instead, it's golf season, even for football players and especially on Mondays, when there are celebrity golf outings galore.
That means plenty of free food, drinks, swag and lots of money raised for charities. And also some impressive or (mostly) horrid golfing. Trust me, I usually contribute to the awfulness.
On one beach Monday, at the 30th annual Ron Jaworski Celebrity Golf Classic at Atlantic City Country Club, Jets quarterback Michael Vick and Ravens quarterback Joe Flacco were hitting the links (in separate groups).
On another beach, some 900 miles south at the Tom Coughlin Jay Fund Celebrity Golf Classic at TPC Sawgrass in Ponte Vedra, Fla. Hosted by the Giants coach, wide receiver Victor Cruz was trying out his swing.
See for yourself who has the sweetest swing. Something (like that horrible backswing) tells me it's not going to be Cruz.
Trust me, I was there. Vick crushed his drive over the bunkers and into the fairway. Flacco smashed his into the fairway as well. I wasn't there but something tells me Cruz left his ball in the bushes to the right.


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Former Saginaw Spirit forward Cody Bass re-signed with the Ottawa Senators for one year.
In 57 games with Ottawa's American Hockey League team in Binghamton, Bass scored five goals with six assists and 109 penalty minutes.
oursportscentral.com: The Owen Sound, Ont., native made his NHL debut with Ottawa during the 2007-08 season, recording two goals, two assists and 19 penalty minutes in 21 games. He also played in all four of Ottawa's playoff games, scoring one goal and adding six penalty minutes.
Bass was Ottawa's first fourth-round pick, 95th overall, in the 2005 NHL Entry Draft.


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Good morning, readers.
I'm here with the midweek latest in Washington County courts news.
- The wait for a verdict in Joseph Walsh's child sex abuse case ended Tuesday afternoon, when jurors found him guilty on 19 out of 20 counts against him. The Tigard man was convicted of molesting four boys. Under Oregon's three-strikes law for sex offenders, he could be sentenced to life in prison.
- Nike, responding to an incarcerated pimp's $100 million lawsuit against the Beaverton company, says the case is baseless, The Oregonian's Aimee Green reports.
- Tom Robinson and Susan Dieter-Robinson, parents of two young stepsisters killed in a hit-and-run crash in Forest Grove last fall, spoke publicly about their decision to donate 11-year-old Abigail Robinson's organs. Follow The Oregonian's Edwin Rios for more.
- In federal court, Nike is suing five people -- including three former employees -- on allegations of stealing and reselling limited-edition company sneakers. The Oregonian's Everton Bailey Jr. has the story.
As usual, if you have questions or thoughts to share, let me know in the comments. Do you have a news tip? Find my contact information.
-- Emily E. Smith


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Biology class
endocrine system
regulation (maintain homeostasis)
-works by using chemicals formed by special cells to regulate processes throughout the body.
-responses are slower, but last longer.
the chemicals that are involved in regulation in the the endocrine system.
-released directly into the bloodstream
target cell
hormones travel in the blood until they reach this. which contains compatible receptors on its surface
receptor molecules
are chemically specific , they can only bind to hormones meant for that receptor (same shape, lock and key)
responses of the endocrine system regulate:
growth, blood pressure, immune responses, the rate of metabolism, muscle contraction, responses to stress, digestion, the development and function of the reproductive system
exocrine glands
release secretions through tubes or ducts.
-examples: sweat from glands, digestive enzymes from pancreas
what the endocrine system uses to maintain homeostasis
uses this for body temp. regulation, regulation of water & blood sugar regulation
- cause-effect mechanism
cause-effect mechanism
a change detected in the body causes an action in the appropriate area, which will return the body to its original condition
-example "A" causes a change in "B" which than causes a change back in "A"
the body doesn't produce enough insulin (type 1) or the body doesn't respond to the insulin (type 2) and blood glucose remains high
nervous system
it function is to maintain homeostasis by controlling and coordinating functions throughout the body and responding to the internal and external stimuli
cell body
contains the nucleus and most of the cytoplasm of the cell. the site of metabolic activity
branched extensions off of the cell body which carry impulses from other neurons to the cell body
long fiber that carries the impulses away from the cell body to other neurons
-covered in a myelin sheet for insulation
bundles of neurons branching from the central nervous system to all parts of the body
-long axons of neurons bundle together
a type of neuron, located in the central nervous system, carries impulses between sensory and motor neurons
the nervous system is divided into these to major divisions...
central nervous system, peripheral nervous system
brain and spinal cord
-protected by 3 layers of connective tissue called meninges.
-space between the protective layers contains cerebra spinal fluid (CSF):
fluid acts as an absorber. allows exchange of nutrients and waste products between the blood and nervous tissue.
separated into 3 parts: cerebrum, cerebellum, brain steam.
-each part contains a pacific function of the body
controls voluntary or conscious activities of the body including intelligence and learning.
brain divided into this.
-left controls the right side of the body, while right controls the left side of the body.
receives messages from the sensory organs and relays the info to the cerebrum which causes a response.
brain stem
connects the brain and spinal cord.
- controls involuntary body functions including blood pressure, heart rate, breathing and swallowing
-contains the pons and the medulla oblongata
spinal cord
main communication link between the brain and the rest of the body
-reflexes are produced directly here
peripheral nervous system
all nerves extending off of the brain and spinal cord
-sensory and motor function
motor function
transmits impulses from the central nervous system to the muscles or glands.
- two divisions: somatic and automatic
- controls activities that are under conscious control
-movement of skeletal muscles
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A woman suffered a serious head injury when her car rolled onto its roof in Berks County on Wednesday.
The crash happened just before 1 p.m. in the northbound lanes of Route 662 in Amity Township.
The driver, police said, may have been going too fast on the wet road when her vehicle went up an embankment as she was making a turn and landed upside down.


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Business Centre
The latest business news, reviews, features and whitepapers
A reasonable choice for those who need DVI on a non gaming machine
The Extreme X600XT is based on the X600 XT chip and has 128MB of GDDR memory installed. Its default clock speeds of 500MHz for the GPU and 742MHz for the memory provided decent scores in Unreal Tournament 2003, but it did not produce adequate frame rates in Doom 3 above the 800x600 resolution setting. A large heat sink and relatively quiet fan cool the GPU, but the memory does not have any cooling devices, and Asus also ships the card with an overclocking utility that can run this card at a maximum GPU/memory clock speed of 550MHz/780MHz. We tested with these settings and experienced good stability and image quality, while noticing a three frame-per-second (fps) boost in Doom 3.
This card is one of the few we have seen which does not have a standard VGA port on its bracket, but instead has only a DVI port and a high definition (HDMI) port. It does ship with a DVI-VGA adapter so an analog monitor can be connected to it, and it also ships with component cables to make use of the high definition output. Because it does not have an analog VGA port, the card does not have the typical capability to be used in multiple monitor situations. Regular TV-out functions are supported via S-Video and composite cables and video-in functionality is also a feature of this card. Apart from high-end connectivity, a good software bundle is also supplied and includes such titles as Deus Ex: Invisible War, PowerDirector 3 and Medi@show.
If gaming is not your main focus, but you require high definition output, then this card is worth considering.
The latest business news, reviews, features and whitepapers
Visit our shop for the best deals on hot products
Watch our video news and reviews from around the world
Comprehensive buying guides, features, and step-by-step articles
First impression on unpacking the Q702 test unit was the solid feel and clean, minimalist styling.
For work use, Microsoft Word and Excel programs pre-installed on the device are adequate for preparing short documents.
The Fujitsu LifeBook UH574 allowed for great mobility without being obnoxiously heavy or clunky. Its twelve hours of battery life did not disappoint.
The screen was particularly good. It is bright and visible from most angles, however heat is an issue, particularly around the Windows button on the front, and on the back where the battery housing is located.
My first impression after unboxing the Q702 is that it is a nice looking unit. Styling is somewhat minimalist but very effective. The tablet part, once detached, has a nice weight, and no buttons or switches are located in awkward or intrusive positions.


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The good ...
Welcome to Nacogdoches: There are more than 500 miles of Texas between Amarillo and Nacogdoches, but there is a close kinship between the two towns. Last week was the five-year anniversary of the space shuttle Columbia tragedy. Amarillo was the home of Commander Rick Husband, who perished with the seven-member crew when the shuttle exploded upon re-entry - over Nacogdoches. In the wake of the disaster, Nacogdoches responded in heroic fashion, doing whatever it took to recover as much of Columbia as possible. The town responded with respect and resolve, and still honors Columbia's memory today. Thanks, Nacogdoches. Amarillo appreciates it.
the bad ...
Weather woes: For the second time in just over a month, the wicked weather turned Amarillo highways and roadways into dangerous thoroughfares. Thursday's 42-vehicle pileup on I-40 in east Amarillo was eerily similar to the massive wreck created Dec. 23 when at least 80 vehicles plowed into each other in the same area. The main similarity was blowing snow that struck quickly, left just as swiftly but had long-term damage. Both storms resulted in a motorist death. Motorists should be aware of the volatility of Amarillo weather, and that winter is not over yet.
and the ugly.
Tax relief: Whomever emerges as the next speaker of the Oklahoma House might want to consult a CPA. State Rep. Gus Blackwell, R-Goodwell, was mentioned last week as a replacement for former Speaker Lance Cargill, who resigned from the position after it was revealed he had problems paying state taxes. However, Blackwell later took the fall when he discovered - reportedly unknowingly - that he was late in paying taxes in Texas County for the past 13 years. The Panhandle lawmaker, who did not owe the state money, then removed himself from consideration as speaker. It isn't an unpardonable sin, but lawmakers have to be held to this standard that applies to all taxpayers.
© 2016. All Rights Reserved. | Contact Us


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We're thrilled to have a new sponsor for the only fully interactive Celtics halftime show around. Thanks to UBURGER Faneuil Hall for hopping on board.
There are 3 ways to join:
- Tweet us with the #RedsArmy tag. You don't even have to mention anyone, we'll see it with the tag.
- Submit a comment or question via the embedded chat.
- Turn on your web cam and talk to us directly.
It's totally your show. The stream below goes live right at the buzzer… and it doesn't stop until the ball is inbounded in the third quarter.


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As delegates begin arriving in earnest for the RNC, we've spotted Long Island Rep. Peter King, state GOP chair Joe Mondello, and former gubernatorial and comptroller candidate John Faso in the lobby here at the Marriott City Center.
At a convention that's so far devoid of the kind of star power that we saw among the Democrats in Denver, guys like King, Mondello and Faso are likely to get alot of attention from the New York media until folks like Rudy Giuliani appear.
Brooklyn GOP chairman Craig Eaton is also in town with a delegation from Kings County, including former party chair Hy Singer. Staten Island Young Republican Brandon Linker, 18, is a delegate at the convention and arrived today. Accompanying him was Islander Richard Hoffmann, vice president of the YRs.


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Tight Spot
Picture me, an 18 year old guy who is around 150 pounds (68 kg) and 6 foot (183 cm). I sail a hypersonic 111 from 04, and a home made board made by a local sailor (around 80 L he thinks). I sail mostly lighter winds (using 7.6 mostly) but it sometimes kicks in to be 5.8 or below. I like the custom board he made, but it is de-laminating and is the older school shape (narrow and really thick).
I need some help.
Money is pretty tight, I am graduation high school this year, so money is going towards college. I am not aloud to spend the money earned working on windsurfing... (parents do not understand :-S) I need to find a board that is a solid board for 5.8-4.1, will be used mostly for B&J sailing, with the occasional onshore or cross onshore wave sesh. Probably looking for a 2004-2006 board, as that is the only board I even have a chance of affording.
I just started 2 seasons ago, and am in love with this amazing sport and the lifestyle that comes with it. I am now starting to get into pushing myself beyond my high wind home made board. I have been trying forwards, and want to get into freestyle.
Thanks everyone for the help.
I gotta old Hypertech you can have for Fitty bucks.
Where U at?
Ottawa, Canada...
But I was more hoping for suggestions on what board would be good. It is a tough call between the flare, the evo, the acid and the kombat. Probably have to be around 80-90 liters ideally.
I was wondering what the evo is like for B&J. I like the idea that it would be sick for the onshore stuff I sail when the waves come. But for cruising having some fun in high wind trying forwards and maybe a vulcan or two, would it be good?
Evo 70 and AB+ Wave 78 for sale USD 100/Maui
Sounds like you're at the "dr. destructo" stage of your windsurfing career... Meaning that any board you buy, you will destroy on short order, if you sail with any frequency. Don't let it discourage you. Just make it a principle to first perfect your new maneuvers on an old beater board BEFORE you try them on a brand new one. The list of things that can go wrong when you learn new moves is endless: mast striking the nose, boom striking the tail, stress/breakage from flat-landing, and that's only the start...
I have a well-used but still very serviceable 2004 AB+ Wave 78 or a 2005 Evo 70 that I can send you for $100 each plus cost of shipping. Includes footstraps, no fin. Perfect practice boards.
Do you have an email?
Also, what is the Evo like in flat conditions?
Thomas- If merryfrankster's boards don't suit you, you should check out the iwindsurf.com classifieds. Lots of very cheap boards there suitable for highwind b&j / wave use.
Even a fairly old highwind bump & jump / wave board from 1996 or so will probably be a lot better than what you are riding now, and will be suitable for jumping and looping and some freestyle tricks. There are some seatrend ATV boards for sale in the "wave" and "freeride" sections of iwindsurf. Those use tuttle fins, which will let you experiment with swapping fins from the hypersonic.
If you want a 2004-2006 freestyle board you will probably have to pay significantly more. Also, keep in mind that if you're getting a board for less than $150, you may actually have to pay an equal or greater amount in shipping to get it to Canada. So if you can get something locally, or have a friend pick it up for you on a trip back from the Outer Banks or something that would save a lot of cash.
If you can hold out till spring there will probably be a swap meet with other boardheads cleaning out their garage for the umpteeth time trying to get rid of boards they havnt used in years- check out Toronto windsurfing club for possible dates.
People are more stoked to see their old gear being used by someone young and enthusiastic like you than sitting in their garage for another season.
Im sure you can pick up a decent board a few years old for $300 or less.
Dont think about it as money lost but invested.
You can always sell the gear later for at least 1/2 that.
+ you get better on a newer gear!
Good luck
Windsurferdaag- This is sort-of off-topic, but since you are one of the rare, independent young windsurfers, you could really help inspire other young guys and girls to try it. But whatever you do, DON'T try to teach your friends on your hypersonic, or they'll think windsurfing is way too hard. Tell them they need a big beginner board, or at least an old longboard, to learn on. :)
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By RICHARD H. SCHWARTZ,
Some considerations about the upcoming elections:
First, the Republican Party drove the country off track. They converted a major federal budget surplus into a major deficit; reduced regulation of banks and other industries, contributing to a major economic recession and increased likelihood of industrial accidents; created relatively few jobs and initiated two costly wars from which we are still having difficulty extracting ourselves.
Then, after being soundly trounced in the 2008 elections, the Republican Party is opposing Democratic efforts to get our country back on track.
They are opposing every Democratic proposal, often using wild exaggerations such as claiming that the new health bill involves "death panels" and that Democratic programs are socialistic, even when Republicans supported, and sometimes initiated or co-sponsored, similar programs in the past.
Now they want to be returned to power, so they can again provide major tax breaks to wealthy people and corporations, reduce necessary government regulations, appoint incompetent cronies, work to privatize social security, end Medicare and repeal the health care law, and do other things that initially got us off track and will make the situation even worse.
Fortunately, the American people are far too smart to let them get away with it.


text:
Joyce (Hawk) King
BURNHAM – Joyce (Hawk) King, 82, of Fourth Avenue, Burnham, died Wednesday, May 22, 2013, at her residence.
A memorial service will be held at 11 a.m. Saturday, May 25, 2013, at Pleasant Acres Assembly of God Church, 160 Summit Drive, Lewistown, with the Rev. Dennis Sproull officiating.
A viewing will be held from 6 to 9 p.m. Friday, May 24, at the church.
Barr Funeral Home, Inc. is in charge of arrangements. A complete obiturary will run in a later edition.


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Local anesthetics, General Anesthetics, Pain Meds, Opiods Meds, Migraine Drugs, and CNS stimulants (Amphetamines, Caffeine, Anorexiants, and Smoking Cessation)
How do local anesthetics work?
Suppress pain by blocking impulse conduction along axons near admin. site. Blocks sodium channels. Blocks sensory and motor neuron transmissions.
What is important to remember regarding large doses of local anesthetics?
Can provoke a systemic response.
How is epinephrine used with local anesthetics?
Cause vasoconstriction, confining the anesthetic response to a small area, decreasing blood loss, and prolonging drug response.
When do we use locals?
Apply to mucous membranes, skin, inject into CNS near nerves. Used to start IVs, minor surgery, dental work, diagnostic procedures, skin irritations that cause itching.
What are some adverse effects of local anesthesia?
Systemic if large dose. Skin irritation at application site, possible infection @ injection site, aspiration (if local used to suppress gag reflex).
If using cocaine as a local, what is important to remember?
Do not use epinephrine with it! It is a very powerful vasoconstrictor on its own.
What is balanced anesthesia?
The use of 2+ drugs to achieve optimal anesthesia: unconsciousness, analgesia, muscle relaxation, amnesia, rapid reversibility. Usually an inhaled anesthetic with one+ adjunctive meds.
What are the advantages of inhaled anesthetics?
Can cross the BBB, enhance transmission @ inhibitory synapses and depress activity at excitatory synapses. Distributes to areas of high blood flow first (brain, kidney, heart, liver). Very little metabolism.
What are the adverse effects of inhaled anesthetics?
Respiratory and cardiac depression (cardiac monitory and mechanical ventilation), arrythmias, malignant hyperthermia (genetic predisposition), aspiration.
What do benzos contribute to anesthesia? Adverse effects?
Reduce anxiety, promote muscle relaxation, amnesia. But may cause respiratory depression.
What do Alpha 2 agonists contribute to anesthesia? Adverse effects?
Reduce blood pressure, reduce sympathetic outflow, reduce pain, relieve anxiety. Promote drowsiness. May cause hypotension w/ reduced renal/hepatic blood flow.
What do anticholinergics contribute to anesthesia? Adverse effects?
Reduce secretions (oral, pulmonary). May cause tachycardia/arrythmias, urine retention.
What do opiods contribute to anesthesia? Adverse effects?
Relieve pain pre- & post-op. Can cause CNS and VS suppression.
What do neuromuscular blocking agents contribute to anesthesia? Adverse effects?
Block muscle contractions, permit intubation. May cause decreased respiratory effort.
What is the purpose of IV barbituates?
Induce anesthesia, loss of consciousness. Do not block pain or cause muscle relaxation.
What are the 2 types of Cyclooxygenase? What are their 'titles'?
Cox 1 (Good Cox), and Cox 2 (Bad Cox).
Why is Good Cox good?
Promotes bicarbonate, decreases gastric acid production, and maintains gastric perfusion (to protect GI). Supports renal function, and promotes platelet aggregation. Cox 1 works all the time.
Why is Bad Cox bad?
Responds to injury to cause inflammation, pain sensitization, fever, perception of pain. Promotes vasodilation. Supports renal function. Contributes to colon cancer.
How to Cox Inhibitors work?
Prohibit the cyclooxygenase enzyme, thereby stopping synthesis of prostaglandins. This reduces pain, fever, inflammation, and reduce stroke/heart attack risk.
What happens when we inhibit Cox 1?
Protection against MI and stroke (prevents platelets from clotting).
What happens when we inhibit Cox 2?
Reduces pain, inflammation, fever, colon cancer. But also promotes renal impairment, MI, and Stroke (prohibits blood vessel dilation).
What do Cox1/Cox2 inhibitors do? Side effects?
Reduce mild-moderate pain, reduce fever, reduce inflammation, reduce cardiovascular risks (only aspirin). Cause gastric upset/ulceration, impair kidneys (since both Cox 1 & 2 support renal fn).
Why is acetaminophen (tylenol) different from other Cox1/Cox2 inhibitors
It only has anti-inflammatory properties limited ot the CNS. It cannot prevent/reduce inflammation. But it does not cause peripheral upsets like GI, renal, or cardiovascular effects.
What are the two types of Cox1/Cox2 inhibitors?
Those w/anti-inflammatory effects, and those w/o anti-inflammatory effects in the periphery.
What dose of Tylenol can cause hepatotoxicity? What groups are at even higher risk of Tylenol overdose?
> 4 g/day. Alcoholics, ppl with hepatitis (liver damage), the elderly, and the young.
What are the benefits of Aspirin? Adverse effects?
Relieves pain/fever/inflammation. Prevents clots (low dose prevention of MI, stroke). Gastric ulceration, renal impairment, water retention (hypertension), tinnitus. Reye's Syndrome in children. Preg. Cat. D. Irreversible.
What are the benefits of Second generation NSAIDs (Cox1/Cox2 inhibitor) over First generation NSAIDs?
They are reversible, with less serious side effects. Pain relief, antipyretic, and anti-inflammatory. But can increase risk of cardiovascular events. Gastric ulcers, bleeding, renal impairment.
What are the benefits of Third Generation Cox-2 inhibitors?
Reduced pain, fever, and inflammation w/o the bad effects of Cox1 inhibition (GI ulcers).
Are there many third generation drugs out there?
No. Most were pulled due to high incidence of stroke, MI, and heart failure. Only Celebrex is available, and even then under careful supervision.
How do opioids work?
They resemble the body's natural analgesics, binding to receptors in the brain/spinal cord to relieve acute/chronic pain, somatic pain, visceral pain, superficial pain, referred pain, and neuropathic pain.
What are the three opioid receptors? Which is the most important?
Mu, Kappa, Delta. Mu is the most important as opioid analgesics act primarily on these receptors.
What are Mu receptors associated with?
Analgesia, respiratory depression, euphoria, sedation, physical dependence
What is important to know regarding opioids and dose?
There is no ceiling dose. It is possible to tolerate very high doses of opioid analgesics.
Why are opioid analgesics combined with other analgesics?
Allow for optimum pain control with a smaller dose of the opioid.
What are some general uses for opioid meds?
Pain relief, relieve labor pains (Demerol), suppress cough, slow GI motility, reduce O2 demand on the hrt, induce sedation, provide balance anesthesia.
What are contraindications for opioid use?
Allergy, RR <12, Elevated intracranial pressure ( depressed respiration causes CO2 buildup, which can lead to cerebral edema), Pregnancy (fetal dependence), liver impairment.
What are some adverse effects of opioid use?
Respiratory depression, sedation, tolerance, physical/psychological depedence, constipation/urine retention, hives, flushing, hypotension (histamine release). Most effects will disappear w/ time, except constipation.
What can be used to treat respiratory depression, constipation, urinary retention induced by opioids?
Opioid antagonists. But also reverse pain relief.
Why are Nonopioid Centrally Acting Analgesics better than opioids?
Since they do not work at opioid receptors, they do not cause respiratory depression, dependence, or abuse.
What causes migraine headaches? What are some triggers?
A neurovascular disorder involving dilation/inflammation of intracranial blood vessels. Stress, foods, sleep loss, loud noises, premenstrual drop in hormone levels. Drops in 5HT and rises CGRP may cause it.
What do migraine drugs seek to correct?
Correct low 5HT and rise CGRP by increasing 5HT, lowering CGRP.
What drugs can be used to treat migraines?
Nonspecific analgesics (to treat/stop migraine, not the cause). Serotonin Agonists.
How do Serotonin Agonists help treat migraines?
Increase serotonin levels, to cause constriction of intracranial blood vessels, suppress CGRP release.
What other types of drugs can be used to treat migraine prophylaxis?
Antidepressants, antiepileptics, beta antagonists, and estrogen patches.
How to CNS stimulants cause increased CNS activity?
Enhance neuronal excitation, suppress neural inhibition.
What are amphetamines? Where do they primarily work?
Powerful CNS stimulants. Work in the periphery (cardiac and vasoconstriction). Promote NE and DA release and inhibit reuptake in the CNS and peripheral nerves.
What are amphetamines used for?
Improve mood, arousal, wakefullness, and alertness. Reduces fatigue, augment self-confidence and initiative. Stimulate respirations. Supress appetite and perception of pain. Can increase heart rate, A/V conduction, force of contraction
What are some side effects of amphetamine use?
Can increase heart rate, A/V conduction, force of contraction to cause dysrhythmias and hypertension. Tolerance leads to loss of 'good mood', loss of appetite suppression, and heart/blood vessel stimulation. Physical dependence causes withdrawal symptoms and depression, excessive sleep, excessive eating/craving for drug. Abuse r/t euphoria. Suicide risk in children/adol.
What are some therapeutic applications of amphetamines?
ADHD, narcolapsy, obesity (not any more though).
What effects can caffeine cause?
Decreased drowsiness/fatigue, increased attention. Dilates peripheral blood vessels and constricts CNS vessels to relieve headaches. Promote bronchodilation (relief mild asthma symptoms). Diuretic effect on kidney.
What are some adverse effects of caffeine?
High doses cause nervousness, tremors. Increased heart rate could cause arrythmias.
How does the anorexiant Sibutramine/Meridia work?
Inhibits the reuptake of NE, 5HT, and DA to decrease appetite.
How do CNS stimulants (varenicline/Chantix) work to stop smoking?
They partially block nicotine receptors, allowing for mild activation by dopamine. They thereby get some of the pleasureable effects from the dopamine release, but it also provides a lower dose to help reduce craving and the intensity of withdrawal symptoms. By blocking the receptors, they block the reward nicotine gives.
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The Summit Area AARP meets at St. John's Lutheran Church, 587 Springfield Avenue, Summit on the fourth Monday of the month.
Coffee and social begin at 9:30 a.m.; meeting and program begin at 10 a.m. Visitors are welcome.
On Monday, March 26, the Director for Union County Division of Consumer Affairs, Department of Public Safety, Florence L. Peterson, will describe the process of how she and her staff enforce the consumer fraud laws in New Jersey. Seniors need to be especially alert and on guard. Instructive brochures will be available.
Trips planned include a presentation of JONAH at Sight & Sound Millennium Theatre, Lancaster County, Pa., on Sept. 14. Call Herman at 908-273-1962 for reservations.


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The ceremony begins at 11 a.m. and Medal of Honor recipient Gary Beikirch is the speaker. Flag raising by the U.S. Marine Corps with music provided by Heritage High School marching band. The VFW 1859 Honor Guard will give a 21-gun salute. The names of local fallen heroes will be read.
Lunch is served at noon with kids inflatables and games available as well as free child ID kits, face painting and clowns. See displays and models from the Saginaw Valley Air Museum.
Reservations are appreciated and can be made online at www.veteransappreciationday.com or by calling 989-327-5095.


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Jazz guitarist Walt Bibinger began playing guitar at age four, was playing professionally by age 12 and teaching by age 16. Four decades later Bibinger's experience as a musician has spanned performances with the masters like Bucky Pizzarelli and Howard Alden.
Mentored by Harry Leahey and taught at the Berklee College of Music of Boston, Bibinger has also been the featured performer at luthier showcases as well as countless festivals and concerts across the nation. Bibinger also partook in research and development for Martin guitars and hosted "The Jazz Listener" radio show for six years.
Completing the trio, Tony Marino will perform on Bass, and Grammy-Award winning drummer/producer, Bill Goodwin will keep guests on the dance floor grooving to the beat
Vocalist Nancy Coletti, whether singing Jazz or belting out contemporary ballads, has captured the attention of her audiences with unforgettable performances. Performing most genres including jazz, blues and pop, Coletti's versatility has enabled her to perform in renowned venues such as the legendary Deer Head Inn Jazz Club.
The Gala Benefit will take place at 6 p.m. on May 10 at the Red Mill Museum Village. Tickets and more information can be obtained at theredmill.org or by calling 908-735-4101.


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BIRMINGHAM, Alabama - The suspicious package that caused police to shut down streets around the main post office in downtown Birmingham this morning turned out to be a pair of tennis shoes in a shoe box, Birmingham police say.
Police used a small explosion to open the box at 8:48 a.m. so they could see what was inside, police Sgt. Johnny Williams said. The explosion caused a loud boom and caused the ground to vibrate but did not destroy the picnic table on which the shoe box was sitting, Williams said.
Police are reopening the roads around the post office, which were shut down not long after police arrived about 7 a.m. The picnic table was just outside the main entrance to the post office.