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Devote a day to the great NW salmon
"In the words of a popular T-shirt: Spawn 'Til You Die.Local salmon are anxious to do just that, biding their time until late-autumn rains show up to swell the flow of six Bainbridge Island streams, so they can spread a little coho mojo.We're just waiting for enough water for them to get upstream and do their thing, biologist Wayne Daley told us this week, with frisky fish now jumping in Fletcher Bay and other locations.It's hard to imagine an icon more central to the cultural fabric of the Puget Sound area than the salmon. Yet politics and self-interest continue to impede efforts to protect the already-endangered chinook, and their threatened coho cousins. This fall, the races for two Kitsap County Commission posts were largely defined by anger over the county's response to federal mandates for protection and restoration of habitat areas. Property rights advocates and commercial fishermen blame each other for the salmon's decline; both bear some blame, and the burden of recovery. Now Gov. Gary Locke has declared this coming Wednesday, Nov. 15, to be Salmon Day in the Pacific Northwest. Co-sponsoring are the conservation group People For Salmon and the Northwest Indian Fisheries Commission. The groups hope teachers, parents, businesses and community leaders will take a few moments during the day to discuss their role in the protection and recovery of these amazing - and to some, sacred - fish.Educational materials including the Salmon Day Pledge are available online at www.peopleforsalmon.org. Teachers not too locked into their lesson plans next week may find some useful items for their students, and there are plenty of ideas out there for the rest of us, including sound land-use practices.Wednesday's event will be marked by dedication of the new Kennedy Creek Salmon Trail near Shelton, completing a four-year restoration project. And thanks to the efforts of many Bainbridge volunteers, there are opportunities closer to home. If you want to see salmon moving upstream here, hike over to Fletcher Bay Road, just west of Island Center, and look over the edge of the roadway into Springridge Brook. Coho mojo!As Daley notes, the debate over salmon recovery must move beyond go away, leave me alone, and let me do whatever I want with my land. We agree. History has given us the chance to decide for ourselves whether the Puget Sound area will enjoy the magnificence of salmon runs even a decade or two from now.Or whether we'll keep pulling the thread, and watching the whole ecosystem unravel.Give it some thought next Wednesday and beyond. Those salmon have some spawning to do, and they're counting on us to turn down the sheets and fluff the pillows. "
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|N9YXA CQWW Score
|firstname.lastname@example.com (Cedrick Johnson- N9YXA)
|Sun Oct 27 18:22:01 1996
Well, after toiling over a mic pin config on my SB-400, I managed to pull off 13 Q's. Due to the infamiliarity of the rig(s) I borrowed, that slowed me down tremendously. I operated for 6 hrs the ENTIRE weekend and lost 48 hours of sleep!! Point Total= 450 pts 1. EA3FQV 2. OK1RI 3. VA6JO 4. IR9B 5. XO7A 6. VP5DX 7. VE2TVU 8. YW1A 9. VB9DBH 10. VE6FI 11. VA7A 12. VA6JY 13. XE3DV 73 es vy gud DX de N9YXA-Cedrick http://pages.prodigy.com/n9yxa
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Springfield, Massachusetts--Bright Nights at Forest Park is being showcased along side nine holiday attractions from across the country on www.people.com/holidayfun. The other attractions include Radio City Music Hall in New York City, Disney World in Orlando, Florida, the Fountains of the Bellagio in Las Vegas, and the Christmas Boat Parade in New Port Beach, California. There is also Colonial Williamsburg, Chicago's holiday tree, San Antonio, Texas' Paseo Del Rio Holiday Festival and Albuquerque, New Mexico's River of Lights. Under the Springfield icon, there is an image of Seuss Land arch and a short video plays.
"It is a great honor to be in the company of such holiday icons and it is exciting to be recognized by such a popular publication," said Spirit of Springfield President Judith A. Matt. "When I clicked on the link and saw Springfield in such good company, it sent shivers down my spine."
"Bright Nights at Forest Park is quite simply one of the most unique and enjoyable holiday experiences in the United States today. It combines iconic holiday imagery, a state-of-the-art lighting experience and the history and culture of the City of Springfield. And it is located in the historic and beautiful setting of Forest Park. It is an attraction that people of all ages can enjoy," said Congressman Richard E. Neal.
Bright Nights at Forest Park was selected by researchers at People magazine. They discovered the holiday lighting experience by way of the Internet. They thought the lighting was beautiful and would appeal to everyone. The link to "Holidays Across America" is at www.people.com under "Celebrate Like a Star! Holiday Fun, Food & More." Visitors to the site then click on the magazine cover which brings them to "Holiday Fun!" "Holidays Across America" is in the column on the left or they can go directly to www.people.com/holidayfun.
Bright Nights at Forest Park will operate Wednesday through Sunday through December 9, 2007. Beginning Wednesday, December 12, 2007, the lighting display will be lit nightly through Tuesday, January 1, 2008. Admission is $15 per vehicle Monday through Thursday, and $18 per vehicle Friday through Sunday and holidays. Bright Nights opens at 5PM for buses and welcomes cars from 6PM to 9PM Sunday through Thursday, and 6PM to 11PM Friday, Saturday and holidays.
The 2007 season of Bright Nights at Forest Park is supported by Baystate Health, Big Y World Class Markets, Clear Channel, Comcast, C & W Realty, Foxwoods Resort Casino, Friendly Restaurants, Hasbro Games, Health New England, Kentucky Fried Chicken and A&W All-American Foods, MassMutual Financial Group, Mercy Medical Center, Northeast Grounds Management, Northern Tree Service, Siemens, The Republican, Sheraton Springfield, United Bank, Urban League of Springfield, Verizon, Western Massachusetts Electric Company and WWLP-22News.
For more information about Bright Nights at Forest Park, visit www.brightnights.org or contact the Spirit of Springfield at (413) 733-3800.
Bright Nights at Forest Park is produced by the Spirit of Springfield and the Springfield Parks Division.


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Jewellery designing courses in Kolkata are the best course. There are lot of career option for Jewellery designing courses. There also many top Jewellery designing colleges in Kolkata that provides the best jewellery courses in Kolkata. Click on the Jewellery designing institutes in Kolkata to get the admission detail
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Jewellery designing courses in Kolkata is provided at various levels right short -term courses, diploma courses, graduate to Post graduate courses. The student has to give aptitude test and give interviews before getting admissions to the jewellery designing colleges in Kolkata. The basic qualification for seeking admissions to various jewellery designing colleges in Kolkata is class 1th or class 1+2. There are best jewellery design Institutes in Kolkata which offer best Jewellery design courses. One has today a bright career in jewellery designing in Kolkata. Creative Mind and Creative Work is required in Jewellery designing. There are institutes in Kolkata and top interior designing colleges in Kolkata which provide jewellery designing courses. There are ample of job offers for jewellery designers in the market. One can start their career in jewellery designing with a salary package of 6, to 1,. Jewellery designing in Kolkata is one of the fastest growing industry in the market. Jewellery designers can work in any of the sectors like Jewelery Designing House, Export House , Fashion House, Self-employment and Freelance Designing. Kolkata has many jewellery designing colleges which provide designing courses all over Kolkata. Mentioned here is list of Top 10 Jewellery design colleges in Kolkata 212-2016 and best Designing Institutes in Kolkata which provide Jewellery designing courses in Kolkata.


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By Beth Moncel
As the dog days of summer drag on, it can be tough to get dinner on the table without breaking a sweat. Slow cookers are my secret weapon against the sweltering August heat. Their compact design cooks everything from meat to potatoes or pasta without heating up your entire kitchen. Here are five great summer slow cooker dishes to keep you cool and satisfied through the end of summer.
When it's too hot to stand near the open flame of a grill, try using a slow cooker! You'll be blown away by how tender and succulent these Slow Cooker Ribs can be.
2. Slow Cooker Santa Fe Chicken Tacos
Quickly add the ingredients to your slow cooker before leaving for work in the morning and these deliciously fresh Santa Fe Chicken Tacos will be only minutes away once you arrive home in the evening.
3. Slow Cooker Chicken Philly Sandwiches
After a long day poolside, these Slow Cooker Chicken Philly Cheesesteaks are sure to be a crowd pleaser. Have them cooking while you're out having fun and they'll be ready to go when hungry bellies return home in the evening.
Whether it's a potluck or neighborhood barbecue, you've got to have baked beans. Instead of hours in the oven, use the slow, efficient heat of a slow cooker to make these Best Ever Slow Cooker Baked Beans.
5. Slow Cooker Balsamic Chicken
Slow cooker meals can be heavy, but this zesty Balsamic Chicken Caprese uses fresh basil and tomato to keep the flavors light and fresh for summer. This recipe is a must have for anyone with a summer garden!
View the original at Parade or follow us on Twitter, Facebook or Google+


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Now accepting applications for the Spring 2017 Program.
Approximate dates are early/mid January to mid May.
REEF's Marine Conservation Internship provides an in-depth look into REEF's Volunteer Fish Survey Project and Invasive Lionfish Program. The internship provides an array of diverse experiences including scientific diving, outreach and education, data collection and management, non-profit operations, and public speaking. During the four-month long internship, you will have many opportunities to dive and volunteer with partner organizations in the Florida Keys and South Florida. Explore the links below to learn more and apply.


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Via the TRT and the Flume, normally a pretty easy ride, took a little longer yesterday, but left me dreaming of laying down skintracks soon!
Tahoe Meadows to Spooner
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great pictures dude. seems to have snowed the most around Mt. Rose and east shore.
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Free shipping and $10 off contact lens orders from $99 | Code CLEAREYES | Ends Nov. 3rd | SEE TERMS
SofLens ® Multifocal ™ contact lenses provide clear vision at all distances. Manufactured by Bausch and Lomb, these contacts are visibility tinted for ease of handling.
Add power range:Hi: +1.75 to +2.50
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By ETC
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About Me Hectic lifestyle, Working mother of 2
LOVE THE CONTACTS, BUT THEY DO GET BLURY AT TIMES WHEN i HAVE HAD THEM IN TOO LONG.
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Welcome to Surf For All!
Surf For All is a charity based in Long Beach, NY, dedicated to assisting people in getting people into the ocean, on to surf boards to assist in maximizing their potential. We believe the ocean is a source of healing and spiritual strength that should be accessible to all.
Surf For All's roots go back to 2002 with the development of a surf program for developmentally disabled teenagers. Over the years we expanded our outings to cover a broader spectrum of disabilities–from autism, cerebral palsy, visual impairment and others. We work closely with the Long Beach School District and provide free weekly lessons for middle school students during the summer special education program. We have also expanded beyond teenagers and work closely with Wounded Warriors, providing lessons and support for our military heroes. We also provide programs for the economically disadvantaged. Our work has been featured on network television, major newspapers, radio, social media and elsewhere. Our message is always the same: We get more enjoyment out of the program than the students. Some of our students cannot walk, cannot speak, cannot see but they demonstrate shared humanity because when they get in the water they show that they know how to smile.
There are three board members of Surf For All. We have full 501(c)3 status from the IRS and are approved as a tax exempt charity.
[tab title="Joann"] Joann has been working with Surf For all since conception. . [/tab]
[tab title="Louis "] Louis has been working with Surf For all since conception. [/tab]
Our volunteers are all certified surf instructors and/or licensed New York State lifeguards. They range from students to teachers, from businessmen to politicians, moms and dads and at least one grandparent. We have been fortunate to have gotten some of the biggest names in international surfing involved. It's quite a rush for a kid to get a lesson then go home and Google the name of his instructor and see that the teacher is a star. It's like playing catch with Derek Jeter.


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MONTGOMERY TOWNSHIP — On a typical day last week, Skillman Park was empty save for flocks of birds whose pleasant chirping filled the air. It was a far cry from the recent era of bulldozers and wrecking crews that removed scores of derelict buildings from the site, formerly the state-run North Princeton Developmental Center.
More recently, another type of activity helped move the 247-acre parcel toward its future role as a public recreation area. An army of workers from the New Jersey Arborists Chapter of the International Society of Arboriculture (ISA) descended upon the park March 10 to prune branches, remove dead limbs and clear dead or diseased trees and other debris.
Raymond Brown, secretary-director of the Somerset County Park Commission, said the group's help was invaluable. "We had a lot of material for them to work with. It ended up being a great start for all of us."
Brown estimates that the NJAISA completed well over $100,000 worth of volunteer work during the cleanup.
Now a Somerset County-owned tract, the property will largely revert to nature. Walking and nature trails will loop around the site, enclosed by Route 601 and Burnt Hill Road, but development on the property, which has been preserved as open space, will be minimal.
Montgomery Township originally purchased the campus, which measures 256 acres, from the state in 2007, with the intention of preserving the land as open space.
The campus was at one time a sprawling institution for the care and treatment of epileptics, but later evolved for other uses, and then fell into disuse.
After purchasing the property, the township set about demolishing vacant and deteriorating buildings on the site, but the task of managing and rehabilitating such a large property was too great.
"The intention of Montgomery Township was well-founded, but the complexity of taking on something of that scale became an issue," said Brown. "We found ourselves in a position where the county was able to acquire the space."
Prior to the state taking over the property, more than 90 buildings on the site were demolished. Montgomery sold 247 acres of the plot to Somerset County last October, and the county assumed the role of preserving the area for recreation and conservation.
Somerset County Freeholder Patrick Scaglione, a member of the park advisory committee, envisions the site as being a place where people can "throw a Frisbee, have a picnic or take a walk."
However, he stresses that there are more immediate concerns.
"The near-term goal is going to be cleaning up the park and making it safe to the public," said Scaglione.
The advisory committee will soon begin meetings to consider ideas for the park and discuss hiring any necessary contractors. They also plan to incorporate input from both municipal residents and county residents.
Scaglione is quick to point out that while work has begun and plans are soon to be made, the park is most definitely a long-term project.
"We want to bring in the proper people for the job," he said. "Unfortunately that takes time, but we want to make sure we do it right."


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In the city of Coconut Grove, Florida, these things happen: A struggling adman named Eliot Arnold drives home from a meeting with the Client From Hell. His teenage son, Matt, fills his Squirtmaster 9000 for his turn at a high school game called Killer. Matt's intended victim, Jenny Herk, sits down in front of the TV with her mom for what she hopes will be a peaceful evening - for once. Jenny's alcoholic and secretly embezzling stepfather, Arthur, emerges from the maid's room, angry at being rebuffed - again. Henry and Leonard, two hit men from New Jersey, pull up to the Herks' house for a real game of Killer - Arthur's embezzlement apparently not having been quite so secret to his employers after all. And a homeless man named Puggy settles down for the night in a treehouse just inside the Herks' yard.
In a few minutes, a chain of events that will change the lives of each and every one of them will begin, and will leave some of them wiser, some of them deader, and some of them definitely looking for a new line of work.
With a wicked wit, razor-sharp observations, rich characters, and a plot with more twists than the Inland Waterway, Dave Barry makes his debut a complete and utter triumph.
©2008 Brilliance Audio, Inc.; ©2000 Dave Barry
Great story line, great characters and very funny! Would definitely recommend this book to anyone who wants a book that is easy to listen to.
"Classic Barry at his Best"
The jokes are hilarious and delivered with the perfect deadpan for the sarcasm, irony, absurdity all for which Barry is so famous. There is a joke every sentence or two making this book is VERY funny. The production is excellent including: perfect narration, changes in volume like talking over a phone, and a huge cast of wackos if you aren't laughing out loud a lot.. you'll, at the very least, be grinning to yourself or smirking a lot. Beware the "too high expectations" trap. This is just a very silly book but, but like Monty Python, it is *quality silliness.* If you aren't snooty you'll love it. Note: The forward warns you this is NOT a book to buy for your kids given the..uh.. adequate quantity of cuss words.
"Big Trouble"
Always fun to listen to; humorous yet so much of the analogies are true. Dick Hill is perfect as the narrator.
"Very Ammusing and Well Written"
Excellent book, very comical. It wasn't "oh my gawd my sides are splitting" funnybut it was clever, well-developed, kept my interest. Easily recommended.
This is a true Miami nut job, whacko story. The crazy part - some of it could be true. A fantastic fun ride
"A very funny Audible book!"
I've always loved Dave Barry's writing, and Dick Hill is one of the best narrators around. This combination was as great as I expected. The characters are all quirky and memorable, and Mr. Hill brought each one fully to life. Buy it, and spend a few hilariously entertaining hours listening to it. It reminds me of Carl Hiaasen's stories.
"a bit too "adult""
Dave Barry is funny as always, but this story gets a bit too suggestive in parts and uses much adult language.
"Love the movie, Love the book."
Not very often that I like the movie better than the book but this book is one of the few, if not only one, that this is true, but just barely.
I loved this book but I really like the changes they made to the movie keeping the movie really close to the book.
"Great book; over-the-top narration"
A nice novel to read. Hard to be funny for so many pages. The narration, however, distracted rather than contributed. Mr. Hill knows his business. So I suspect his editor forced him into this over-dramatization. Too bad. Read the book instead.
"Witty but overboard with the language"
Many funny parts, as you would expect with Dave Barry. The plot was fairly basic with all the characters interrelated in some way. I would have enjoyed the book more without such bad language. There were more F words in this novel than in a Bruce Willis movie. I understand he was trying to be true to what his characters would say, but it was way over the top with bad language for me. He warned us about the language in the forward to the book, but I didn't know it would be quite that bad.
"Just didn't get into it. Might try again later."
First of all I absolutely love Dave Barry's humor - he's my hero - and I am sure the writing and humor in this book is as skillful and professional as ever. But for some reason when I started listening to this, I just couldn't get into it. I think much of that could be to do with the fact that Dick Hill's voice just grates on my nerves. No offense to his narrating skills, but I just find him hard to listen to. I've had the same issue with other books he's done. (yes, I should have listened to the sample.) But I hope to go back and try this one again some day and perhaps once I get grabbed by some of the characters, I'll be back with a better review. Obviously I haven't really given it a fair chance but one you put up a star you're committed and I don't like it enough to give more than three.
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If you find this review inappropriate and think it should be removed from our site, let us know. This report will be reviewed by Audible and we will take appropriate action.


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Anyone think we can put together a group of 15 that will be able to complete all 54 Dave Grohl songs? If you've already got some of them in your DLC library and want to give it a go, post your gamertag here!
Dave Grohl goal
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Oh boy, what a week this has already been. Economic meltdowns are accelerating at a rapid pace.
Our idiot government bails out Fannie Mae in a desperate and incredibly stupid attempt to salvage the home mortgage swindle, err bad loans shelled out, and we are all supposed to breath a sigh of relief…
Well, don't fall for any of it. This is the ice dam breaking, next comes the flood. Vaughn has a few things to say about all of this:
Fannie Mae Unsold $5 Billion Homes Bring Peril to ShareholdersThe problem here is; if they start flooding those foreclosed homes into the market it will drive down property values, which means more homeowners will be stuck in negative equity, which will trigger another round of foreclosures.
FDIC Faces Mortgage Mess After Running Failed Bank
So, you have faith in the FDIC, huh?
'Henry Paulson is about to be given an $800 BILLION dollar blank check in the form of an increased Federal Debt Ceiling which he can spend on Fannie Mae and Freddie Mac IN ANY WAY HE CHOOSES, INCLUDING BUYING THE CRAPPIEST LOANS THEY HAVE AND STICKING A ONE HUNDRED PERCENT LOSS, $800 BILLION WORTH, ON (the US taxpayers) TAX BILL.'
2nd Mortgage Holders (Banks) Now To Be Bailed Out Too
Bloomberg discovers the Real Estate Owned (REO) industry
Debt capitalism self-destructs
Consumers Set to Boost Savings Amid Economic Turmoil
'That could spell trouble for the economy if too many people start hoarding their money and stop spending it on goods.'
Canada's Inflation Rate Tops Analysts' Expectations at 3.1% in June
That percentage includes 'core'. I have a feeling that an overall average of 3.1% is not reflecting reality.
A brutal test in student borrowing
Note to Maria and Paul: don't bother trying to figure how to send your younger son, Michael, to college for another year for $48,000. Chances are great that there won't be much of job market in place for Michael, and your other son, to help pay that, and the accumulated school debt, back. Ever. Taking on more debt right now is NOT advisable in this economic climate.
'Some of the stress feels familiar. Maria and her husband, Paul, have been writing checks to Holy Cross for eight years. Their older son, Mark, graduated from the private Worcester college in 2005, and the Woburn family has always struggled to keep up with rising tuition and fees, which now total about $47,500 annually.'
Too late on that 'NOT advisable' thing, huh? Thoughts: First son, Mark; graduated in '05. Maria and Paul have been paying the college (and the bank) for 8 years, including the second son's attendance; an average of, say, $45,000. Being conservative in my estimate, that's in the neighbourhood of $360,000 (to date) for both kids to go to school. And Maria, their mother, can't work due to illness. Their dad has two jobs.
Chills. I'm feeling chills.
Meanwhile: Food stamp use soars in Mass. 'Fastest-growing program in nation'
Farm Bureau: Crop Damage Pushing $8 Billion
Which together with the shortage produced by the cultists' demand we all put ethanol in our cars, means higher food prices for the lucky people, and starvation for everyone else.
After the economies collapse and social unrest roils, the government hired mercenaries will come out the woodwork and from the air:
Blackwater expands it's fleet of airships
Blackwater to leave security business following problems in Iraq (and I've got a bridge to sell you — cheap)
New Killer Drones Invade Airshow
Still think remotely controlled 757s don't exist?
George Bush backs emergency deal for Fannie and Freddie
House votes to back Fannie Mae, Freddie Mac, stem foreclosures
Fannie and Freddie, Saved But Still Loathed (By Some)
Fannie Mae and Freddie Mac: A recipe for trouble
On top of this, we're supposed to believe that Gas Prices Dropping Like A Rock. Where do they dredge these idiots up from? Wish I got paid to write, I'm obviously in the wrong business. Gas is down, what 5 cents? 8 cents? And this is a "rock"?
It's all Obama's fault. Check it out. Type in "Obama Antichrist" in any search engine. What you'll find there will scare you one way or the other.
In other worthy news, we are told that the Marshall Islands are in a severe energy crisis (they should be able to afford more oil now that prices are actually going down, right?). Food is now a #1 issue for them.
In the banking sector, Bank of America profits plummet by 41%, Merrill Lynch loses 4.9 billion dollars, and Wachovia nearly doubles that loss with 9 billion.
Merrill Lynch makes the news again by warning that 'this winter will be brutal for utility bills'. Ya think?
General Motors and Ford now on the verge of bankruptcy, a 46% chance and rising. Also joining them will be Mervyn's.
How bad is it? How about as many as 8,500 banks failing?
I just got another order cancellation for an order that was going to ship this week, guess where I redirected it?
Some of my callers really don't believe me. I guess I can't help that now.
There's more, a lot more, but I don't want to make you cry.
10 Responses to "It's the End Of The World"
After reading this, I feel like a ship's mate in the engine room of the Titanic. The announcement was given to abandon ship, but the speaker wire was cut by the berg, and we never heard it!!
Heh. I can't see paying $48K a year for college even if I believed that things were all hunky dory.
My spawn is in college – even tho' he has heard my words on peak everything and financials and such. He hasn't looked at things deeply, and feels that Mother Dear tends to … catastrophize. He is of the view that we've got 40-60 years before the shit hits the fan. Now he's not quite half way thru', but neither he nor we have borrowed to pay yet. This fall he'll have to borrow some, but he'll probably get enough scholarships and work to pay for most of the rest of his college years. $48K? Snort. Living at home, even paying for gas to commute, paying for classes, car pool parking, books, etc will be about $14K a year. Existing scholarships drop that to $10K. Grandma drops that to $6K (he's the only grandchild). Carpooling to $5K.
Being an engineering major with an A average (that I'm trying to get into hydroelectric power) – priceless. Literally, if the shit hits the fan and he's not in an area with an appropriate landscape, priceless = worthless.
More privacy threats in the housing bailout legislation (Daily Reckoning):
Two egregious provisions of the bill haven't gotten a lot of coverage, especially since Fannie and Freddie got thrown into the mix, but I assume they'll end up in the final version of the bill: 1) Nearly all credit-card transactions will be tracked and reported to the IRS and 2) Many people in the mortgage and real estate industries must submit to a mandatory fingerprint registry.
Too late, already fucking crying!!!!!!!
Hmmm, what to make of this? (sorry if it was posted already) A half a million plastic coffins
Sounds like it could kill an already rocky credit card industry. Odd timing when everyone's credit purchasing will be in sharp decline… why now- when they could have pushed it through the bankruptcy bill awhile back?
… and how could we have fun with their search algorithms? Doing business as businesses with misleading names like Zebra Grooming? Labelling individual items erroneously as common things like gas or , clothing, or red herring things like bibles, scuba gear or artichokes? could we create local currency? use alternatives to the paypals of the world? randomly assigning descriptions to transactions?
I have seen a lot of signs recently that small storefronts are no longer taking credit cards- laws like this may just make customers happy to ditch them and buy local where people will accept checks from their small community bank with inadequate computers and staff to track things.
Regarding the 3.1% inflation rate in Canada, keep in mind that the Canadian dollar has appreciated about 4% against the US dollar during the last year, meaning that we have been shielded against inflation for goods imported from the US, especially food. In total, it has appreciated in value over the last 5 years by just under 40%!
I think the real world inflation rate for an adjusted Cdn vs US dollar this last year is more like 7%.


text:
Webuzo for Typo3 45 4.5.34
Webuzo for Typo3 45 4.5.34 Full Download Summary
File size: 282.12 MB
Platform: WinXP, WinVista, WinVista x64, Win7 x32, Win7 x64, Win2000, WinServer, Unix, Linux
License: Free To Try
Price: $25.00
Downloads: Total: 97 | This Month: 0
Released: 2011-07-01
Publisher: Softaculous Ltd
Publisher URL: http://www.softaculous.com/webuzo
Webuzo for Typo3 45 4.5.34 Full Description
TYPO3 is a free Open Source content management system for enterprise purposes on the web and in intranets. It offers full flexibility and extendability while featuring an accomplished set of ready-made interfaces, functions and modules.
Requirements:Any Virtualization software : VMWare, VirtualBox, Parallels, 3GB space, Min 512GB RAM, Min 1 Ghz CPU
Webuzo for Typo3 45 4.5.34 Screenshot
Webuzo for Typo3 45 4.5.34 Keywords
Webuzo for Typo3 45 4.5.34 Free Download Notice
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Subject: I have found a book that I think you would enjoy
Mrs Frisby and the Rats of NIMH
Mrs. Frisby, a widowed mouse with four small children, must move her family to their summer quarters immediately, or face almost certain death. But her youngest son, Timothy, lies ill with pneumonia and must not be moved. Fortunately, she encounters the rats of NIMH, an extraordinary breed of highly intelligent creatures, who come up with a bril... more »


text:
An easy way to edit photos, a Newfoundland expat's musings from Arkansas, and a digital archive of one of the best magazines ever made. We're going to hit every single one of those in the next few paragraphs, in our weekly tour of all things digital.
I use Photoshop at work for cropping and handling digital images, but I don't have a professional photo editor on my Macbook and some of the other devices around the house. My go-to solution is Pixlr, a web-based editor that is as easy as pie to use, and powerful enough to handle any rudimentary image-editing task. Consider this as a bookmark if you're, say, uploading to Facebook or needing an emergency crop. The downside? As mentioned, it's web-based, which means you'll need to have an active connection, which I've found limiting when a wi-fi link is nowhere to be found.
Planting Dandelions
Kyran Pittman has published a memoir of the same title, about how she had an arts-rich upbringing in Newfoundland (her father is the late poet Al Pittman) and wound up living in a tidy slice of suburban U.S. The companion blog features Pittman's look at daily life, and the subtle joys and amusing frustrations that play out. Pittman is a deft hand at blogging; indeed, the humour and insight she displayed in her first blog translated into magazine commissions and, in time, this book itself, which comes out in April. Look also for Pittman's Twitter feed: she's worth the follow.
Spy, on Google Books
Launched in 1986, Spy was unlike anything else on the magazine stand: it was smart, laugh-out-loud funny, sarcastic, insanely well designed, and stacked with clever featurettes that no one else was doing. Yet. Quickly enough, though, Spy's style and features were emulated elsewhere, and plenty of writers (me included) and designers were strongly influenced by its issues. Spy eventually sputtered out, but it's not been forgotten. Now, the whole lot — including the final weak issues put out by another team — have been digitized and available to read, for free, via Google Books.
Brain Pickings
The slogan for this page involves "eclectic interestingness from culture's collective brain." It's one of the sites I like to check from time to time, for a jolt of the unexpected, a spiked bit of pop-culture refreshment, and news of things I almost always have not yet heard of. Brain Pickings is for people who have one, and who also like to relax.
LOL, as in laugh out loud. Chances are quite good you will have laughed out loud at least once after you've scanned what this site has to offer. As with a lot of what passes for humour on the web, be prepared for things that seem designed to get a giggle from a frat brat.
Can't get enough movie news? Add InMovies to your buffet for news, reviews, trailers and more on upcoming films.
Evil Mad Scientist
Forget the stereotype of the myopic guy with frizzed-out hair and the white jacket; this is science with a far more up-to-date point of view. Case in point? The Eggbot, which does the most creative, eye-popping things to a regular old egg. That's just the start: come here for enthusiastic encouragement to make things on your own, from materials in the garage to Lego to geektastic hardware.
Daily Grape
Everyone has an opinion on wine, and Gary Vaynerchuk gets paid for his. His site, Daily Grape, makes it possible; you can find free content on syrahs here and cabs there, but you can pony up a little money for the advice in his regular newsletter. Not in the mood to spend? Look for the free app, which might be helpful as you explore the world's wines.
John Gushue is an online editor with CBC News in St. John's.
Blog: johngushue.typepad.com


text:
From Nikki's website: "Short scrambles requiring the use of hands" Um, Yikes?
The fact that I continued on after reading the sign made me feel accomplished. My first thought…Who hikes with food and water?
I'm from Los Angeles, where designated hiking trails dictate the time you spend working out. A 6-hour hike? Even my dog wanted to turn around and go home. Apparently the locals call this place…
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An 18-year-old Saginaw man suffered a gunshot wound to the leg in a drive-by shooting in Saginaw.
Police questioned Gary A. Russell Jr. about the shooting at Vestry near Bridgton about 7 p.m. Wednesday, Detective Sgt. Mark Lively said, but the victim was saying little.
The bullet struck the man's right leg near the knee and the suspects "might have been in a four-door white car," Lively said.


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3 from NWAC earn medals at state championships
Three members of the North Whidbey Aquatic Club medaled at the Washington State Senior Championships, December 16 to 19 in Federal Way.
Finishing in the top eight for the Aquajets were Price Hu, third in 200 fly, 1:55.38; Ciara Hu, sixth in 200 fly, 2:07.05; and Jacob Jepsen, eighth in 200 back, 2:00.05.
Emily Huffer qualified for the Western Zone Championships in the 400 individual medley (4:45.99), and Jepsen qualified for the Senior Sectional in the 400 IM (4:17.42).
Ciara Hu set a NWAC record in the 400 IM (4:40.37) and joined Huffer, Akasha Trisler and Tori Nickerson to set a another in the 400 medley relay (4:09.74).
One hundred percent relay personal records were set by Jarik Bainco, Nickerson, Harrison Tack and Cole Weinstein; and Weinstein swam 100 percent individual PRs.
That performance helped Weinstein earn NWAC Swimmer of the Meet honors. He also swam a PR in the mile with a pulled stomach muscle and dropped an average of three seconds per 100 yards in the relays.
NWAC competes next at the Anacortes Challenge Jan. 15 and 16, where it will field a team of 60 athletes.
The North Whidbey Aquatic Club is a competitive swimming program of the North Whidbey Park and Recreation District. It includes swimmers of all abilities and ages from 6 through college.
Tryouts occur Mondays, Tuesdays and Thursdays at the city pool from 4:45 to 5:30 p.m. New swimmers should be able to swim a length of the pool in freestyle and backstroke.
The first two weeks are free.
For more information, please call the pool (765-7665) to speak with head coach Neil Romney or view the team's website at www.teamunify.com/pnswznwac.
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for upcoming sales and coupons
Open gates, overhead doors and parking barriers with your Bluetooth enabled cell phone.
Select Model VK or FE on checkout.
The Gatehouse offers wholesale pricing on all Liftmaster megacode 318 MHz remote control transmitters for garage doors and gates. This includes the Linear ACT, Linear MT and Linear MTD series. With one of the largest selections of Linear megacode products on the web, we are always in stock and ready to ship your products quickly. If you do not see the Linear megacode transmitter you are looking for, please email us at firstname.lastname@example.com. We respond very quickly and often in the evenings and on weekends, so email anytime!
The Gatehouse has been in business since 2003 selling remote controls, gate operators and replacement parts at wholesale prices. If you do not see what you are looking for please email us and we will be happy to get you information and pricing.


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— Who are you?'
—I--I hardly know, sir, just at present - at least I know who I was when I got up this morning, but I think I must have been changed several times since then.
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Charges filed in Kitsap County District Court
Court records show charges were filed against several Port Orchard and Gig Harbor residents in Kitsap County District Court.
The following charges were filed from May 15-27:
• May 27: Joseph Lee Lay, 32, transient, violation of court order (gross misdemeanor); Kimberly Dawn Howard, 44, Olalla, obstructing a law enforcement officer; Cody Lee Doucette, 21, Port Orchard, possession of heroin; Nicole Jaye Gardner, 26, Port Orchard, possession of a controlled substance.
• May 23: Mervin Marcos Hawkins, Jr., 52, Port Orchards, driving under the influence (DUI); Justin Edward Hopper, 25, Port Orchard, possession of methamphetamine; Christopher M.M Hutchins, 34, Gig Harbor, possession of meth.
• May 22: Sheree Lee Fox, 55, Port Orchard, two counts of forgery; Brock James Banks, 48, transient, failure to register as a sex offender (felony).
• May 21: Jared Michael Schmitz, 28, Port Orchard, possession of a stolen vehicle; Ronald C. Reschke, 51, Port Orchard, second-degree burglary.
• May 20: Thomas Morgan Cummings III, 33, Port Orchard, failure to register as a sex offender (felony).
• May 19: Candelaria O. Triplett, 47, Port Orchard, fourth-degree assault; Richard Douglas Petero, 38, Port Orchard, third-degree driving while license suspended; Jeremie Harvet Akins, 31, Port Orchard, second-degree assault; Gerrod Vincent McDonald, 21, Port Orchard, second-degree assault.
• May 16: Jacob M. Shurts, 20, Port Orchard, making a false or misleading statement to a public servant; Jonathan William Thiele, 37, DUI and third-degree driving while license suspended; Benton Matthew Green, 28, Port Orchard, felony harassment.
• May 15: Lloyd Allen Rider, 43, Port Orchard, felony violation of court order; Dustin Jeramiah Donovan, 20, Port Orchard; DUI and minor in possession of or consuming alcohol; Dustylinn Krystal Mears, 25, Gig Harbor, third-degree driving while license suspended.
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No, Lorde's 'Royals' is not racist. Can we dial back the lyric parsing?
It all started, as these things often do, with a blog post. A few days ago, Veronica Beyetti Flores on the Feministing website, alleged that Lorde's "Royals," the No. 1 song in the U.S. is racist.
It took a few days, but by last night, her accusations had blown up with news sites like CNN and Time weighing in on the made-up controversy.
Flores' interpretation of the song is that Lorde, by mentioning elements sometimes associated with rappers—and her rejection of them— is being deeply racist. She cites the lines "But every song's like gold teeth, Grey Goose, trippin' in the bathroom/Blood stains, ball gowns, trashing the hotel room/ We don't care, we're driving Cadillacs in our dreams/But everybody's like Cristal, Maybach, diamonds on your time piece/Jet planes, islands, tigers on a gold leash/We don't care, we aren't caught up in your love affair."
"While I love a good critique of wealth accumulation and inequity, this song is not one; in fact, it is deeply racist," writes Flores. "Because we all know who she's thinking when we're talking gold teeth, Cristal and Maybachs. So why shit on black folks? Why shit on rappers? Why aren't we critiquing wealth by taking hits at golf or polo or Central Park East? Why not take to task the bankers and old-money folks who actually have a hand in perpetuating and increasing wealth inequality? I'm gonna take a guess: racism."
What? I don't doubt that Flores truly somehow sees the song that way, but I don't really understand the giant leap she's making. The song is a rejection of material things, not of blacks or anyone who wants these things. It's written from the standpoint (or at least my interpretation of it) of a teenager who realizes she is being sold to at every moment and has decided not to buy into the conspicuous consumption. As she sings: "And we'll never be royals/It don't run in our blood/That kind of luxe just ain't for us."
And yes, while we may hear more rappers bringing up Maybachs or Cristal than a country artist, the fact is that rap songs are the pop music of the day. Kanye West had it absolutely right when he said that rap stars are the rock stars now so these symbols are touchstones of wealth for anyone who is listening to pop music, whether they are White, Black, Hispanic, Asian or any other ethnicity.
Lorde has not responded to Flores' colum, but, as the CNN piece points out, earlier told NPR, "I was just sort of reeling off some of the things which are commonly mentioned in hip-hop and the Top 40. I've always loved hip-hop, but as a fan of hip-hop, I've always had to kind of suspend disbelief because, obviously, I don't have a Bentley. There's a distance between that and the life I have with my friends." How does that make her racist? It just makes her like the 98% who can't afford a Maybach.
Have we gone so overboard that we are now parsing every lyric of every song and every movement of every artist? In just the past few months, the critique of Robin Thicke's "Blurred Lines" developed after a blogger wrote that she found the song "rapey." The song had been out for a few months before that and no one seemed to have much of a problem with it. And while that one probably had a little more validity than these others, next came a blogger accusing Miley Cyrus of being racist because when she twerked on the VMAs she was appropriating black culture and because all of her dancers were black.
We're getting into dangerous territory here. There is so much true racism that still exists in the world that we should be fighting against instead of looking for signs of it that aren't there. Has Cyrus shown any kind of pattern of racism? None that I can see. Is there anything else on Lorde's album that could be interpreted as racist? Not that I heard-- but then I didn't hear racism in "Royals." We can probably find something offensive in every song if we want to and if we are so desperate for page views, but sometimes, it's just not there. And every time we spend the energy trumping up a controversy, it takes our eyes off the real offenders.
Do you find Lorde's "Royals" racist?


text: Here's an interesting, balanced presentation of two universities that both call themselves "Catholic"--one in the "Jesuit tradition. This recent PBS show contrasts Georgetown's accomodation of LGBT pride events with Ave Maria's efforts to transmit Catholic teaching, in part, by preparing its students to respond to challenges posed by same-sex marriage. Check it out here.


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Member Since: November 17, 2010
March 27, 2013 at 1:08am
I have a daughter with Autism and this story touched me, and brought a tear to my eye. My daughter loves Cheeseburgers and they have to be just so. I want to be able to experience normal everyday things with her, and yet sometimes I know it isn't possible. It can be really frustrating when things need to conform to certain guidelines in order for there to be peace. Not only did the waitress and manager show a tremendous amount of compassion and grace, but this little girl's sister handled this situation admirably!
To "Lost Sam", I think it can be difficult to tell the difference sometimes between a child with a disciplinary problem and a child who has a neurological condition such as Autism. That being said, nowhere in this story did I read that this little girl threw any kind of tantrum, or acted out inappropriately at all. She simply didn't eat the burger, which prompted her sister to ask her why. There was no disruption, her sister handled the situation and didn't make a big deal out of it. She took responsibility, ordered another burger, and intended to pay for it. The staff went out of their way to do what they could to help the situation, and that is what this story is really about. Two people who could have just done their job and simply brought her another burger, went a step further, and treated her with love and respect. Nobody likes to be around a screaming or disruptive child, but I can't find anything in this story that would even make you
March 16, 2013 at 12:06am
Might as well just strap flags to their waists.
In reply to the story What Major Rule Changes Is the NFL Proposing Now That Has Some Fuming?
December 14, 2012 at 9:41pm
I think we can all be hurt, saddened and compassionate towards these children and their families, and at the same time realize that our Creator is sovereign, and He does have control over everything. Why He allows things to happen, is beyond our understanding most of the time. That being said, our society as turned away from Him, and we do need to turn back to His truth and ask His forgiveness. Its much bigger than prayer in school. I believe that regardless of whether this man's statement has a shred of truth, or is just crap, his timing was horrible, and insensitive at best.
July 2, 2012 at 11:36pm
I do believe it is possible for Mitt Romney to repeal Obamacare…..
I do not believe he will….
Mitt Romney, No…..
Ron Paul, Yes!
June 28, 2012 at 5:23pm
We all need to take a lesson from the Harbinger and repent! We cannot turn this around in our own power. We need direction, wisdom and strength from our Creator! That will only happen through repentance.
June 18, 2012 at 1:21pm
In Randy's defense, I watched the local news and couldn't believe some of the flat out tacky attire. It seemed most of the women I saw, thought spandex two sizes too small was chic, and classy wedding attire. You don't have to have a perfect body to choose clothing that is flattering and fits. And you don't have to be wealthy either, but I'm assuming most of these guests are.
In reply to randy's comment on the story Guess Who Got Frisked at the High-Profile Wedding of Valerie Jarrett's Daughter
June 17, 2012 at 4:35pm
AND…by the way…I'm not endorsing the bill! ( I don't know enough about it to argue either way) I simply believe that regardless of what our opinion is, it can be argued without purposely offending the other side.
June 17, 2012 at 4:28pm
Um, I don't think it was the word…I think it was the context …She was being crass and sarcastic in her attempt to make her point. Not to mention the fact, that if she was truly trying to be scientifically correct, she should have used Uterus and Ovaries. They are just as, if not more involved in a woman's reproductive system.
June 12, 2012 at 2:49pm
Yes! I was thinking the same thing! AND…She didn't call police immediately!? She waited until "she saw the man later going by on a bicycle." & " A neighbor recognized him and alerted police, " ..Was she going to report it at all?
May 14, 2012 at 3:49pm
I'm sure I will get raked over the coals for this, but I have to say it anyway. I don't agree with Ron Paul on everything. I don't think that's possible with any candidate. However, one thing sticks out to me about this man, his humility. I don't think he really wants to be President. He wants to do what he believes is right. You can disagree with him on everything, but I don't see how anyone can question his motives. I can't say this about any of the other candidates. He was willing to stand up for what he saw to be very very wrong in our country, knowing most people wouldn't get it. I believe his goal has been to expose truth and show people that gov't doesn't know best. I think he's done a great job.He has reached a lot of people who may have never realized how bad things are getting on both sides of the isle. I am one of them. I used to be a straight GOP ticket voter. Whoever got the nomination, that's who got my vote. I thought Ron Paul was a wack job last time around, and I thought people who supported him were a bunch a dope smokin hippies, or crazy pacifists. I was wrong. You don't have to spend your day getting high in order to see that his message of liberty may be exactly what our country needs. He has gained my respect, but then again I'm probably just acting like a democrat with no sense.
In reply to the story Ron Paul Just Released a Big Statement -- and Some are Saying It Means He's 'Out of the Race'
May 14, 2012 at 4:04pm
ImMormon responded:
May 14, 2012 at 4:43pm
West Coast Patriot responded:
May 14, 2012 at 4:55pm
ImMormon responded:
May 14, 2012 at 6:00pm
soybomb315 responded:
May 9, 2012 at 10:58pm
Shalom Aleichem, Vidal!
March 8, 2012 at 7:05pm
I don't care if they are wearing sweatpants and turtlenecks! If you tell a child to, act as if a man "can't afford" them….and announce that they must act "like showgirls" and dance as if they were "completely topless"…Your are sexualizing and exploiting them! I have 5 daughters, and I would have never allowed anything like this. Why would I ever want to train my little girl to be a showgirl? Why would a little girl even really know what a "show girl" is? Ballet is one thing…Strip Tease is quite another. I'm sure there's a "lap dance" episode in the future.
In reply to the story Lifetime's 'Dance Moms' Reaches New Depths: Girls as Young as 8 Dance Burlesque in Nude Bikinis
March 8, 2012 at 9:18pm
dmforman responded:
March 8, 2012 at 10:10pm
AmericanPatriot01 responded:
March 9, 2012 at 9:44am
Tom K responded:
February 29, 2012 at 8:07pm
@Jaycen….You took the words right out of my mouth!
In reply to Darla_K's comment on the story Bestiality Advocate in Canada Charged With...Well, You Guessed It
February 14, 2012 at 2:57pm
Huh? Why the sarcasm?
In reply to KellyR's comment on the story N.C. Food 'Inspector' Sends Girl's Lunch Home After Determining It's Not Healthy Enough
February 14, 2012 at 2:57pm
Huh? Why the sarcasm?
In reply to KellyR's comment on the story N.C. Food 'Inspector' Sends Girl's Lunch Home After Determining It's Not Healthy Enough
February 14, 2012 at 2:43pm
This is scary…very very scary! I'm afraid it may get much worse before it gets better…..
In reply to the story N.C. Food 'Inspector' Sends Girl's Lunch Home After Determining It's Not Healthy Enough
February 14, 2012 at 2:45pm
Itsjusttim responded:
February 14, 2012 at 2:57pm
KellyR responded:
February 14, 2012 at 2:57pm
KellyR responded:
December 5, 2011 at 9:24pm
Israel Hates? When was the last time a Jewish person blew themselves up in order to kill as many innocent people as possible, including children, because the Torah claims they have no right to exist? I have never been taught, nor read anywhere in Torah that all non-Jews are pigs or dogs.
In reply to MMSands's comment on the story '#IsraelHates': Activists Launch New Twitter Hashtag to Bash Jewish State
November 29, 2011 at 10:45pm
@Jefferson: I'm not defending Cain. I don't know if these allegations are true or not….BUT, I do know a little bit about defamation/slander, because my husband and I were recently the on the defending end of just such a lawsuit. Federal Anti-SLAPP legislation has become strict with regards to these suits, and those who bring them. Several states have added to the Federal Statute and placed even more restrictions on plaintiffs. In our state, I recently read an article by an attorney that gave a serious warning to plaintiffs attorney's looking to file these types of suits. The burden of proof seems to be largely on the plaintiffs in these cases and the consequences can be very costly. Even attorney's are feeling the heat from courts, from my understanding. I know the bar is set very high now, and because of this I don't necessarily think the lack of suits filed against these women speaks to their credibility…..and, on a side note…..after almost 3 yrs, the suit against us was dismissed…..but it cost us dearly.
In reply to B-Neil's comment on the story Cain Tells Staff: I'm 'Reassessing' If I Should Stay in Race
October 17, 2011 at 9:55pm
Sorry for the typos….Trying to type and watch football at the same time!
October 17, 2011 at 9:45pm
Lesbian, Gay, Transgender month? I can tell you that's one month my children would be "out with the flu"…..AND…Anything I due to justify being deemed worthy as an example of success, has nothing to do with with the fact that I I am heterosexual, and I don't see why it's different for Lesbian's , Gays, Transgenders or anyone else. Oh wait!….. It's different because, their Lesbian's, Gays, and Trangenders….
In reply to the story Gay Advocates Petition to Have Teacher Fired After She Posted Anti-Gay Messages on Facebook
October 17, 2011 at 9:55pm
KellyR responded:
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text:
Facebook and WordPress have announced the first official plugin by the social media network allowing for some interesting new features to be offered to users of the WordPress content management platform. This will allow for cross-publication of posts to WordPress powered websites, Facebook Timelines and Facebook Pages with a single click.
Social Publishing
Posts can now be posted directly to Facebook from an author's WordPress Dashboard, this is not an entirely new feature by any means as publishing apps directly to Facebook have been available in the past but never offered this level of post customization including the status that accompanies the post as well as the post coming from an official Facebook app. This official tie-in has us envisioning that WordPress posts shared to Facebook via this plugin will receive a greater weight in the Open Graph model they are now using for applications.
"The plugin was built by Facebook engineers in collaboration with open source partners, and makes it simple for anyone to make their WordPress site more social – no coding required," a blog post posted by Facebook engineer Matt Kelly stated.
Upon publication via the site itself, a central location, the content of the WordPress post will show up on all of the tagged Facebook Timelines and Facebook Pages resulting in undoubtedly more distribution for your site in an easier and likely more effective fashion.
Advanced Social Plugins on Posts and Pages
The plugin offers the following additional options within it's settings.
- Like, Send, and Subscribe buttons - (Ingrained Note – It is assumed that these will become the most effective Facebook sharing tools used on WordPress sites.)
- Comments, including SEO support (Ingrained Note – This will allow search engines to index the comments, a potential SEO benefit.)
- Recommendations Bar, which allows users to click to start getting recommendations, Like content, and add what they're reading to Timeline as they go (Ingrained Note – It will be interesting to see how this 'Recommendations' concept takes off with Facebook in the near future.)
WordPress Widgets
The plugin also has Widget support, allowing for Recommendations, Recent Activity and Like, Send and Subscribe buttons to be easily added via the drag-and-drop functionality known by so many WordPress users.
- Recommendations
- Recent Activity
- Like, Send, and Subscribe buttons.


text:
Orange Crush is a Leeds-based team of web designers, developers and digital specialists, helping businesses grow their brands, audiences and communities.
We specialise in producing high quality, stop-and-look websites and develop digital strategies to support and deliver our customers' objectives.
We're not a high-volume digital agency. We focus on quality and take great pride in our work. We believe 'good enough' simply isn't good enough.
If you are of a similar mind, please get in touch. We're likely to be a good fit.


text:
The EuroHeart Failure Survey programme—a survey on the quality of care among patients with heart failure in Europe
Background National surveys suggest that treatment of heart failure in daily practice differs from guidelines and is characterized by underuse of recommended medications. Accordingly, the Euro Heart Failure Survey was conducted to ascertain how patients hospitalized for heart failure are managed in Europe and if national variations occur in the treatment of this condition.
Methods The survey screened discharge summaries of 11 304 patients over a 6-week period in 115 hospitals from 24 countries belonging to the ESC to study their medical treatment.
Results Diuretics (mainly loop diuretics) were prescribed in 86.9% followed by ACE inhibitors (61.8%), beta-blockers (36.9%), cardiac glycosides (35.7%), nitrates (32.1%), calcium channel blockers (21.2%) and spironolactone (20.5%). 44.6% of the population used four or more different drugs. Only 17.2% were under the combination of diuretic, ACE inhibitors and beta-blockers. Important local variations were found in the rate of prescription of ACE inhibitors and particularly beta-blockers. Daily dosage of ACE inhibitors and particularly of beta-blockers was on average below the recommended target dose. Modelling-analysis of the prescription of treatments indicated that the aetiology of heart failure, age, co-morbid factors and type of hospital ward influenced the rate of prescription. Age <70 years, male gender and ischaemic aetiology were associated with an increased odds ratio for receiving an ACE inhibitor. Prescription of ACE inhibitors was also greater in diabetic patients and in patients with low ejection fraction (<40%) and lower in patients with renal dysfunction. The odds ratio for receiving a beta-blocker was reduced in patients >70 years, in patients with respiratory disease and increased in cardiology wards, in ischaemic heart failure and in male subjects. Prescription of cardiac glycosides was significantly increased in patients with supraventricular tachycardia/atrial fibrillation. Finally, the rate of prescription of antithrombotic agents was increased in the presence of supraventricular arrhythmia, ischaemic heart disease, male subjects but was decreased in patients over 70.
Conclusion Our results suggest that the prescription of recommended medications including ACE inhibitors and beta-blockers remains limited and that the daily dosage remains low, particularly for beta-blockers. The survey also identifies several important factors including age, gender, type of hospital ward, co morbid factors which influence the prescription of heart failure medication at discharge.
- Heart failure
- Medical treatment
- Survey
1 Introduction
Chronic haert failure (CHF) is a major health problem and is associated with a high morbidity and mortality.1–3 Various national surveys have shown that medical management of CHF is characterized by polypharmacy and by the underuse of recommended medications.4–6 Since 1997, the Guidelines of the European Society of Cardiology (ESC) have recommended routine use of ACE inhibitors and beta-blockers for the management of heart failure due to left ventricular systolic dysfunction, a recommendation that has recently been reinforced by further data from randomized trials and revised guidelines.7 There is also a rapid change in the perception of heart failure management, based on recent trial evidence. The Euro Heart Failure programme is the first pan-European survey to describe the clinical profile and treatment of patients hospitalized for or with heart failure, a key event that provides an opportunity for improved diagnosis and treatment. The survey provides detailed information on how current recommendations are implemented in patients who have been hospitalized.
2 Patients and methods
A detailed description of the patient population and of the methodology used in this survey are provided in the diagnosis paper. In brief, 11 304 patients from 24 countries belonging to the ESC, including countries from Western, Eastern and Northern Europe and the Mediterranean, were enrolled with suspected or confirmed heart failure in 60 hospital clusters that included 116 hospitals. The average age was 71.3 years and 53% were males. Heart failure was recorded for the first time and the index admission in 27% of patients, whilst 56% of patients had a diagnosis of heart failure prior to the index admission. Seventy percent of patients had experienced at least one previous hospital admission in the 2 years preceding enrolment.
3 Methods
3.1 Modelling results for prediction of treatment on Euro heart data
In order to assess the relationship between variables and an outcome or 'event' and to consider associations in a multivariate context, we performed non-linear mixed models. Specifically, we used a logit link function and binomial error to identify any characteristics of patients which were predictive of different drug treatments. We exploited a hierarchical approach to data modelling in which clusters were defined as random effects.8 Conditioning for country made no material difference to the results. All analyses were conducted using SAS 8.1.
4 Results
Table 1gives the proportion of patients prescribed various major heart failure medications during hospitalization overall: diuretics were the most commonly prescribed treatment for heart failure (86.9%) followed by ACE inhibitors (61.8%), beta-blockers (36.9%), cardiac glycosides (35.7%), nitrates (32.1%), calcium channel blockers (21.2%) and spironolactone (20.5%). Angiotensin receptor antagonists were not prescribed frequently for patients with heart failure. Only 17.2% of the population received the combination of a diuretic, an ACE inhibitor and a beta-blocker.
|ACE inhibitors
|61.8 (40–85.1)
|Angiotensin II receptor antagonists
|4.5 (1.9–14)
|Antithrombotic therapy (any)
|77.6 (57.7–92.7)
|29.1 (27.1–73)
|36.9 (10–65.8)
|Calcium channel blockers
|21.2 (9.8–33.4)
|Cardiac glycosides
|35.7 (17.3–53.5)
|86.9 (64.2–96.4)
|IV inotropic agents
|7.2 (0.5–19.5)
|32.1 (6.3–70.6)
|20.5 (5.7–58.5)
Table 2gives the rate of prescription of major cardiovascular classes according to left ventricular ejection fraction (LVEF) when available (62% of patients). ACE inhibitors were more often prescribed when LVEF was reduced (79.0% when LVEF <40 vs 63.2% when LVEF >40%) as were cardiac glycosides (42.7 vs 31.3%). Calcium channel blockers were used more commonly in patients with preserved ejection fraction. The rate of prescription of diuretics and beta-blockers was similar in the two subgroups.
|EF ≥40%(%) (n=3969)
|EF <40%(%) (n=2248)
|ACE inhibitors
|14.3 to 19.1
|Angiotensin II antagonists
|0 to 2.3
|1.7 to 7.1
|Calcium channel blockers
|−15.6 to −11.5
|8.7 to 14.0
|Diuretic agents (any)
|2.8 to 6.6
|Inotropic agents
|2.4 to 5.6
|Loop diuretics
|4.3 to 8.7
|−1.5 to 4.0
Note that patients who did not have left ventricular ejection fraction (LVEF) reported are not shown on this table. Patients who did not have LVEF measured were much less likely to receive an ACE inhibitor or beta-blocker.
4.1 Agents and dosages
Table 3gives the type of diuretic agent, ACE inhibitors and beta-blockers used and Table 4provides the average daily doses prescribed at hospital discharge for these three classes.
|ACE inhibitors
|Diuretics (mgday−1)
|ACE inhibitors (mgday−1)
|Beta-blockers (mgday−1)
Loop diuretics were by far the most commonly prescribed diuretics (94.7% of patients) followed by spironolactone (23.6% of patients), whereas the use of thiazide diuretics in this hospital population was low (11.5% of patients). Furosemide accounted for 87.7% of all diuretics prescribed and the daily dosage varied considerably. Fig. 1gives the distribution of the daily dose of furosemide in the population. Over 40 of patients received 80mgday−1or more of furosemide. One-third of the patients received two or more diuretic agents. However, only 6.6% received the combination of a loop and a thiazide diuretic, whereas 18.8% received a loop diuretic and spironolactone.
The rate of prescription of these three first line CHF medications was studied across the participating countries. It was homogenous for diuretics (data not shown) (77.8 to 96.4% of patients) but important variations were found for ACE inhibitors and beta-blockers (Figs 2 and 3). The rate of prescription of cardiac glycosides (17.3 to 53.5% of patients), spironolactone (5.7 to 58.5%), nitrates (6.3 to 70.6%) varied also widely. Intravenous inotropic therapy was used in 7.2% of our patients, mostly dopamine (69.4%) and dobutamine (49.1%), with rates varying widely between centres (0.5 to 19.5%). Calcium channel blockers were used fairly often (9.8 to 33.4%). Amlodipine (37.9%), verapamil (22.5%) and diltiazem (20.3%) were the most common agents.
Table 5gives the number of different heart failure medications used 70.6% of the patients were taking three or more and 44.6% four or more heart failure medications.
|Number of drugs
4.2 Influence of hospital wards, aetiology and age
The rate of prescription of ACE inhibitors and beta-blockers was influenced greatly by the type of hospital ward to which the patients was admitted. ACE inhibitors (71.5 vs 56.4% of patients) and beta-blockers (50.7 vs 26.3% of patients, odds ratio 2.69, 95% confidence interval 2.37 to 3.31) were more often used in patients receiving care in cardiology wards compared to general internal medicine wards .
However, patients admitted to general internal medicine wards were older (71.7% of patients were aged ≥70 years compared to 46.8% on cardiology wards, 25.1% difference, 95% CI 23 to 27%) and had more co-morbidity (83.8 vs 73.8% of patients, 10% difference, 95% CI 8 to 12%).
ACE inhibitors and beta-blockers were prescribed more commonly in younger patients (67.7% of those aged <70 years vs 57.9% of those aged ≥70 years for ACE inhibitors, odds ratio 1.3, 95% CI 1.18 to 1.43); 47.4 of those aged <70 years vs 30% of those aged ≥70 years for beta-blockers, odds ratio 1.82, 95% CI 1.63 to 2.04.
The presence of ischaemic heart disease defined by current/previous myocardial infarction or angina was associated with a higher rate of prescription of beta-blockers (42.1% with vs 22.9% without IHD, odds ratio 2.63, 95% CI 2.32 to 2.99) and calcium channel blockers (25% with vs 11% without IHD, odds ratio 2.56, 95% CI 2.22 to 2.95). Similarly, the presence of a history of hypertension was associated with a higher rate of prescription of ACE inhibitors (69.2% with vs 53.4% without, ) and beta-blockers (40.5% with vs 32.7% without, ).
4.3 Role of co-morbidity
The presence of co-morbidity had a powerful influence on the rate of prescription of heart failure medications. Beta-blockers were prescribed only to 19.1% of patients with a history of asthma or pulmonary disease as compared to 43.2% to patients without pulmonary disease, odds ratio 0.35, 95% CI 0.30 to 0.40. Renal dysfunction defined by a serum creatinine of 176μmoll−1(2mgdl−1) influenced the rate of prescription of ACE inhibitors (57% in patients with vs 66.3% in patients without renal dysfunction) 9.2% difference, 95% CI 4 to 14% (Table 6). There was no obvious difference in the average daily dosage of the most commonly prescribed ACE inhibitors according to renal function (Table 7). Renal dysfunction also influenced the rate of prescription of spironolactone (15.6% with vs 22% without, difference, −6.4, 95% CI −10 to −2%). However, the effect of renal dysfunction on the use of ACE inhibitors and spironolactone disappeared in a multivariate analysis (see below) suggesting that other factors associated with renal dysfunction may have had an important effect on prescribing patterns.
|P value
|Age >70 years
|Age ≤70 years
|Ischaemic heart disease
|Renal dysfunction
|Any of previous
|ACE inhibitor
|Renal dysfunction
|No renal dysfunction
ACE inhibitors were more commonly prescribed in diabetic patients (67.6 vs 59.7%, 7.9% difference, 95% CI 6 to 10%) whereas beta-blockers were not (36.6 vs 36.9%). Both beta-blockers (24.8 vs 37.2%) and ACE inhibitors (49.6 vs 62%) were less likely to be prescribed in patients with a recent history of stroke.
Antithrombotic therapy, either an antiplatelet or anticoagulant agent, was used in 77.6% of the patients (ranging from 57.7 to 92.7% in different countries). The rate of prescription was influenced by the presence of atrial fibrillation/supraventricular tachycardia (82.7 with vs 74% without, odds ratio 2.86, 95% CI 2.41 to 3.39) and the presence of ischaemic heart disease (82.3 with vs 65.2% without, odds ratio 2.96, 95% CI 2.51 to 3.50). The average daily dosage of aspirin was 114±57mg.
Anticoagulant therapy was more likely to be prescribed in the presence of AF/SVT (59.4%) than in the absence of arrhythmia (33.4%, 22% difference, 95% CI 20 to 24%).
Digitalis glycosides were more likely to be used in the presence of atrial fibrillation or supraventricular tachycardia (56.2 with vs 20.9% without, odds ratio 5.50, 95% CI 5.02 to 6.03).
4.4 Multivariate analysis (Table 8)
|Odds ratio (95% CI)
|Respiratory/pulmonary disease
|0.35 (0.30 to 0.40)
|Speciality at admission (Cardiology vs GIM, for being Cardiology)
|2.69 (2.37 to 3.31)
|2.63 (2.32 to 2.99)
|Age group (>70)
|0.55 (0.49 to 0.61)
|Gender (being male)
|1.16 (1.05 to 1.29)
|Cardiac glycosides
|5.50 (5.02 to 6.03)
|Calcium channel blockers
|2.56 (2.22 to 2.95)
|Gender (being male)
|0.79 (0.71 to 0.88)
|Speciality at admission (cardiology vs GIM, for being Cardiology)
|0.88 (0.78 to 0.99)
|Antithrombotic agents
|Age (>70)
|0.80 (0.72 to 0.89)
|Gender (being male)
|1.19 (1.00 to 1.40)
|2.86 (2.41 to 3.39)
|2.96 (2.51 to 3.50)
|1.37 (1.12 to 1.69)
|0.52 (0.42 to 0.64)
|Age (>70)
|0.77 (0.70 to 0.85)
|Gender (being male)
|1.34 (1.22 to 1.48)
|2.45 (2.21 to 2.71)
|Age group (>70)
|0.76 (0.67 to 0.85)
|Speciality at admission (Cardiology vs GIM, for being Cardiology)
|1.61 (1.31 to 1.99)
|0.78 (0.66 to 0.92)
|1.39 (1.25 to 1.56)
|Gender (being male)
|1.28 (1.15 to 1.43)
|0.10 (0.02 to 0.45)
|Speciality at admission *IHD
|0.68 (0.54 to 0.87)
|Stroke *IHD
|5.31 (1.13 to 25.05)
|Age (>70)
|1.92 (1.57 to 2.34)
|Gender (being male)
|1.34 (1.23 to 1.46)
|0.44 (0.38 to 0.51)
|5.67 (4.78 to 6.72)
|1.66 (1.39 to 1.99)
|0.44 (0.36 to 0.54)
SVT=supraventricular tachycardia; AF=atrial fibrillation; IHD=ischaemic heart disease.
4.4.1 Beta-blockers
In a multivariate model, the odds of the patient receiving a beta-blocker were increased if the admission was to a cardiology ward rather than a general ward (odds ratio 2.69, 95% CI 1.05 to 1.29) and were also independently increased for patients suffering from ischaemic heart disease (odds ratio 2.63, 95% CI 2.32 to 2.99). Odds were decreased in the presence of respiratory/pulmonary disease (odds ratio 0.35, 95% CI 0.30 to 0.40) and for patients aged ≥70 (odds ratio 0.55, 95% CI 0.49 to 0.61).
4.4.2 ACE inhibitors
A multivariate model for ACE inhibitor treatment showed that the odds of receiving an ACE inhibitor were increased for male patients (odds ratio 1.34, 95% CI 1.22 to 1.48) and for patients with ischaemic heart disease (odds ratio 2.35, 95% CI 2.21 to 2.71). Older patients (over 70 years of age) had reduced odds of ACE inhibitor treatment (odds ratio 0.77, 95% CI 0.70 to 0.85) (Table 8). Univariate factors including renal dysfunction, diabetes, respiratory disease influenced the outcome of whether the patient received an ACE inhibitor. However, when variables were considered together the effects of these particular factors did not account for any additional variation in the results and so were not included in the final model.
4.4.3 Spironolactone
In a multivariate model, the odds of the patient receiving spironolactone were increased if the admission was to a cardiology ward rather than a general ward (odds ratio 1.61, 95% CI 1.31 to 1.99), for male patients compared with female patients (odds ratio 1.28, 95% CI 1.15 to 1.43) and were also independently increased for patients suffering from supraventricular tachycardia or arrhythmia (odds ratio 1.39, 95% CI 1.25 to 1.56). Odds were decreased in the presence of ischaemic heart disease (odds ratio 0.78, 95% CI 0.66 to 0.92), for patients aged 70 and over (odds ratio 0.76, 95% CI 0.67 to 0.85) and for those who had suffered a stroke.
Patients with ischaemic heart disease who had been admitted to cardiology wards were less likely to receive spironolactone (odds ratio 0.68, 95% CI 0.54 to 0.87) but more likely to receive spironolactone if they had also had a stroke (odds ratio 5.31, 95% CI 1.13 to 25.05).
4.4.4 Calcium channel blockers
Men were less likely than women to receive calcium channel blockers (odds ratio 0.79, 95% CI 0.71 to 0.88) and the odds were also reduced for patients admitted to cardiology wards rather than general internal medicine wards (odds ratio 0.88, 95% CI 0.78 to 0.99). The odds of receiving calcium channel blockers were independently increased for patients with ischaemic heart disease (odds ratio 2.56, 95% CI 2.22 to 2.95).
4.4.5 Antithrombotics and aspirin
The odds of a patient receiving an antithrombotic agent (including aspirin) were increased by the presence of SVT/AF (odds ratio 2.86, 95% CI 2.41 to 3.39) and by the presence of ischaemic heart disease (odds ratio 2.96, 95% CI 2.51 to 3.50). The odds for male patients were independently higher than for female patients (odds ratio 1.19, 95% CI 1.00 to 1.40) but were decreased for patients over the age of 70 (odds ratio 0.80, 95% CI 0.72 to 0.89). Men with ischaemic heart disease were more likely to receive an antithrombotic agent (odds ratio 1.37, 95% CI 1.12 to 1.69). Patients with ischaemic heart disease were less likely to receive antithrombotic therapy if they also had SVT/AF (odds ratio 0.52, 95% CI 0.42 to 0.64) (Table 8).
An analysis of factors predicting treatment with aspirin showed that odds were increased for patients aged over 70 years (odds ratio 1.92, 95% CI 1.57 to 2.34) and for male patients (odds ratio 1.34, 95% CI 1.23 to 1.46). Patients with ischaemic heart disease had higher odds of receiving aspirin (odds ratio 5.67, 95% CI 4.78 to 6.72) especially if they were men (odds ratio 1.66, 95% CI 1.39 to 1.99). The presence of SVT/AF reduced the odds of treatment with aspirin both in isolation (odds ratio 0.44, 95% CI 0.38 to 0.51) and further in combination with ischaemic heart disease (odds ratio 0.44, 95% CI 0.36 to 0.54.
5 Discussion
5.1 Categories of medication
Previous surveys suggest that guidelines for the pharmacological treatment of chronic heart failure are not closely adhered to.4–6 This survey suggests that although prescription of ACE inhibitors and beta-blockers may be increasing, they still remain underused, both in terms of the proportion of patients receiving them and the doses employed. This applies particularly to beta-blockers. Only 17% of our population received the recommended triple association: diuretic, ACE inhibitor, beta-blocker. The experience described in this survey reflects recommendations from Guidelines published in 1997,9 as well as new knowledge obtained during 1997–2001 expressed in the more recent version from 2001.
In the EPICAL study, which gathered information on hospitalization in patients with severe heart failure due to left ventricular systolic dysfunction during 1995 in Eastern France, 75% of patients were receiving ACE inhibitors but only 5% beta-blockers at discharge.10 The patient population was younger than patients enrolled in our survey and consisted mainly of males. The IMPROVEMENT of Heart Failure survey enrolled >10 000 patients in primary care in 14 European countries during 1999. The composition of this population, in terms of age, gender, and left ventricular systolic dysfunction, was remarkably similar to the current survey, reflecting the high rates of hospitalization amongst patients with heart failure. In the IMPROVEMENT survey, 60% of patients were prescribed an ACE inhibitor, 30% a beta-blocker and 12% spironolactone.11 In a large survey of patients hospitalized for chronic heart failure in cardiology, general medicine and geriatric departments in France, only 49 and 11% of patients received an ACE inhibitor and a beta-blocker respectively on admission.4 Similar trends were found in two recent surveys in Australia and France.5,12 In the Australian study, 58.1% of patients only were receiving ACE inhibitors and 12% beta-blockers. In the French survey performed among ambulatory patients in private practice, the respective numbers were 54 and 11%. However, most of these surveys included relatively small numbers of patients (500–1000) and were performed on a national basis. The Euro Heart Survey on heart failure is the first pan-European Survey in hospitalized patients.
Diuretics and particularly loop diuretics were by far the most commonly used heart failure medications in this survey. Although entry criteria may have influenced the results, our findings are in agreement with previous surveys.4–6,12 There was little variation from one centre to the other in the rate of prescription of diuretics. This finding contrasts with the important variations found in the rate of prescription of both ACE inhibitors and beta-blockers. However, it should be emphasized that these variations are individual centre variations and therefore only partly reflect the current situation in ordinary practice in a given country. It is likely that variation between centres within each country are also large.
The rate of prescription of ACE inhibitors reached 80% in patients with documented reduction in ejection fraction, which indicates that the situation is improving as compared to previous surveys. In contrast, beta-blockers were clearly under-prescribed even in patients with a documented low ejection fraction.
Various factors can explain the under use of ACE inhibitors and beta-blockers:
Underestimation of the morbidity and mortality of the syndrome.
Underestimation of the magnitude of the benefit brought about by these classes.13
Concern on the potential adverse reactions. For instance, in a survey among UK general practitioners, nearly half of the participants expressed concern about adverse effects related to initiation of ACE inhibitors.14 However, our survey was not designed to study the reasons for non-prescription of recommended drugs.
The clinical profile of the patient: in our survey, the likelihood of receiving an ACE inhibitor or a beta-blocker was dependent on the age of the patients. Patients aged ≥70 years were less likely to receive either class of agent. Co-morbidities, such as asthma or pulmonary disease reduced the prescription of beta-blockers. Other co-morbidities, such as diabetes led to increased usage of ACE inhibitors. Both classes of drugs were less commonly used in the setting of a recent stroke but this survey was prior to the publication of the PROGRESS study, which suggested a beneficial effect of tight blood pressure control in patients with stroke.15 Similarly, the rate of utilization of antithrombotic agents and cardiac glycosides was significantly increased in the presence of atrial fibrillation or supraventricular tachycardia.
The aetiology of chronic heart failure: the presence of ischaemic heart disease increased the rate of prescription of aspirin and beta-blockers. Both ACE inhibitors and beta-blockers were used more frequently in hypertensive patients.
Speciality at admission: the medical specialty responsible for patient care influenced the rate of prescription of recommended drugs. In our survey, both drugs were significantly more prescribed in cardiology wards than it internal medicine wards, although this may have more to do with the greater age and co-morbidity of patients cared for in medical wards. In a Germany study, it was shown that both ACE inhibitors and beta-blockers were less prescribed in a rural than in a metropolitan hospitals potentially reflecting the benefits of specialization.6
The pathophysiology of heart failure: many patients in the Euro Heart Failure survey had preserved left ventricular systolic function, a condition for which there is little evidence that treatment alters outcome. ESC guidelines indicate that recommendations are largely speculative. The results of several large randomized trials are awaited.16 The high proportion of patients with 'diastolic dysfunction'—often due to hypertension—not only help explain the underuse of beta-blockers and ACE inhibitors but also the high rate of use of calcium channel blockers which are not recommended or contra-indicated for the treatment of heart failure with systolic dysfunction.
Treatment directed at ischaemic heart disease, rather than at heart failure, probably explains why the prescription of beta-blockers was not even lower and also explains the high rate of use of calcium channel blockers and nitrates, agents for which there is little evidence of benefit in patients with left ventricular systolic dysfunction. Spironolactone was prescribed in more than 20% of our overall population and even more commonly in the absence of renal dysfunction, suggesting that the conclusions of the RALES study have been accepted in Europe.17 Angiotensin II receptor antagonists were used only in a minority of patients, reflecting uncertainty over the role of these agents as an alternative or in addition to ACE inhibitors.18,19 ESC guidelines do not advise the use of this class of drugs as first line therapy.
Cardiac glycosides, an 'old fashioned' heart failure medication which has only been demonstrated to reduce the rate of hospitalizations for patients in sinus rhythm20 but which may continue to have a role for patients with atrial fibrillation was still used in about a third of our population, including 21% of those without supraventricular arrhythmia. In most ESC countries, more patients with heart failure now receive beta-blockers than receive digoxin.
5.2 Dosage and preparations
Daily dosage of diuretics varied considerably but many patients received high doses suggesting that many had advanced heart failure.
The most commonly prescribed ACE inhibitors were used at doses equal to or greater than 50% of the doses used in randomized trials except for captopril, which was used in doses substantially lower than target. This suggests that guideline recommendations are being followed in great part. Since we did not record the reason for using a given dosage of a drug, we are unable to assess whether dosing was limited for reasons of safety or tolerance or because of lack of attention by the physician. Our patients were, on average, considerably older than the patients in the clinical trials. Most ACE inhibitors are eliminated mainly be the kidneys and lower doses may be justified in elderly patients as they have reduced renal clearance. Although the ATLAS trial showed that higher doses of an ACE inhibitor, lisinopril, were associated with some improvement in morbidity21 there is no robust evidence that high doses of ACE inhibitor are of benefit to very elderly patients (aged >75 years) with heart failure.
On average, daily dosage of beta-blockers were far below the target doses used in randomized trials. It is possible that many patients were still in the process of having the dose of beta-blocker uptitrated but it is also probably reflects caution on the part of clinicians and the absence of a substantial dose-ranging study to show the relative benefits and problems of titrating to higher doses. Atenolol, for which no substantial trial in heart failure exists22 and which does not have a license for this indication, constituted nearly 25% of all beta-blockers prescribed, the choice of this agent probably reflecting its use to treat underlying problems, such as ischaemic heart disease or hypertension.
Overall, our results suggest that the application of modern therapeutic guidelines has improved compared to that previously reported in smaller national surveys.
5.3 Limitations
We acknowledge that Euro Heart Survey on Heart Failure was concentrated on University hospitals clustered with one or more community hospitals. This design might have resulted in an over representation of metropolitan hospitals vs rural healthcare units. Therefore, the Euro Heart Survey on Heart Failure is not a true epidemiological survey representative of the overall population but rather a large hospital-based European data base.
5.4 In summary
We report here the detailed analysis of treatments used in the Euro Heart Survey on Heart Failure. Diuretics were the most commonly prescribed class of agent. Overall, ACE inhibitors were used in 61% of patients and almost 80% of those with reduced left ventricular ejection fraction. The respective figures for beta-blockers were less widely used overall (37%) and in patients with reduced left ventricular ejection fraction (49%). Daily dosages of ACE inhibitors reached 50–60% of the target recommended dose except for captopril, which was prescribed at much lower doses, whereas the daily dosage of beta-blockers were far below the target dose used in randomized trials.
Many factors including age, aetiology of heart failure, co-morbidity, specialty at discharge and pathophysiology of heart failure influenced the rate of prescription of the recommended drugs. Overall, our results suggest that the situation is improving for ACE-inhibitor prescription but remains suboptimal for beta-blockers. Continued medical education and improved organisation of services are required to improve the dissemination and uptake of guidelines on treatment of chronic heart failure in daily practice.


text:
Since it was only yesterday, you probably remember reading here that Alabama linebacker Ezekial Knight had requested to transfer from UA and was calling around to smaller schools to find a place to play.
To that point, he was still officially a member of the Alabama football team. No more.
Here is a statement just emailed out by the UA media relations department:
Tuscaloosa -- Alabama head coach Nick Saban announced Wednesday that senior linebacker Zeke Knight has been medically disqualified.
"Zeke Knight has been medically disqualified based on a medical condition that we cannot disclose due to student privacy laws," said head coach Nick Saban. "He has had extensive medical evaluations by numerous physicians, all of which concluded that it was in his best interest to no longer play football."
Knight played in all 13 games last season, starting 11 at outside linebacker. He was sixth on the 2007 team with 64 tackles and also recorded two interceptions, 11 tackles for loss and three sacks. Knight's absence in the lineup, combined with the graduation of Darren Mustin and Keith Saunders, leaves sophomore Rolando McClain as the lone returning starter at linebacker in 2008.
"Zeke is a fine young man and we appreciate all that he has done for this program," said Saban. "Zeke did a great job for us as a starter last year and, more importantly, is on track to graduate in August.
"I would like nothing more than to have him with us for one more season on the football field, but unfortunately that won't be the case after consulting with the doctors and medical staff on numerous occasions. I wish him and his family nothing but the best. Zeke Knight will always be a part of the Crimson Tide family."


text:
A man was taken to UAB Hospital after being shot this morning on the 300 block of 23rd Street Southwest in Birmingham, police said.
The man was shot in the hip and his injuries are not life-threatening, an officer reported to a dispatcher.
"He just said some fool ran up to him and shot him," the officer reported.
A dispatcher said the shooting happened within the last two hours.