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Healthy snacks for LONG FLIGHT?
Jan 20 2010 15:15
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I am going to be having to take a lot of flights in an out of Europe and America. And I am trying to lose weight, what are some snacks I can bring that can get through security without problems?
Here's what I thought of:
- Cereal baggies (best type of cereal to bring?)
- Home made trail mix (best low cal/fat trail mix to make?)
- Box of raisins
- Other dried fruit, which kind? (not sugar-coated!)
- Whole Wheat Crackers, Rice Cakes, Bread
- Low or Fat Free Cheese sticks
- Nuts like almonds or cashews?
- 100 cal snacks? (are these healthy?!)
- Baby carrots + celery sticks
- Tea bags (in-flight hot water)
- Sugar free gum (which kind?)
- Granola bars (which is the healthiest?)
- Small apple? a couple?
Jan 20 2010 16:18
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If I am leaving from home, I take 2 turkey sandwiches with me and eat them when they serve the meals. I also normally pack some sliced apples (I buy the ones at the store that are in individual bags). Be sure you only take what you will eat (or your travel companions will eat) as you normally can't take the fresh fruit in with you oversees. I also usually pack some oatmeal in its own tub and some soup or canned chicken (tuna is too smelly for the plane) for the trip home. Maybe not the healthiest, but better than airplane food for sure. I also usually have small bags of pretzels, goldfish, granola bars, etc that are always in my travel bag. My friends tease me, but they always eat my food
Jan 20 2010 16:52
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Hahah! I've had that happen to me as well; friends that would constantly tease me for not eating fried stuff fatty pizza slices, pasta bowls, etc... I just think about how I am doing this for my health. :)
THANK YOU so much for the suggestions! I know about the taking in fresh fruit overseas thing, I just wanted some ideas so I can survive my 20 hrs. of flights and moving around :P! (I'm travelling alone!).
You could take some packets of instant oatmeal (low sugar or no sugar added) and a spoon. you'd just have to ask for some hot water. Bring along some ground flax seed & cinnamon for extra nutrition!
Jan 20 2010 18:38
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celery and carrots
Diet soft drinks
Jan 20 2010 20:24
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Alpen makes these really good Apple & Sultana bars that are 61calories each.
- you could take a stick of peperoni.
- be careful with fruit, you have to eat it or throw it away before you go thru customs.
Jan 20 2010 21:03
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Small bag of pretzels
Special K or protein bars
Sugarfree gum/mints
100 calorie packs of any cookie or chip you like
Beef or turkey jerky
Raw vegetables such as green beans or sweet peas, bell pepper cut up
I think as long as it's not liquid, they'll allow it, so basically anything solid works.
I have been recently turned onto Sunsweet Ones (prunes, i know) because they are individually wrapped. There is about 20 in the container. I actually DO like them...
And I don't know if you are located near a Whole foods, but their 365 brand has a Plain Oatmeal containing flax... I usually put some Agave Nectar in to give it a sweet flavor, I don't know how you would work that out...
I would bring some tea bags for sure... probably not Smooth Move though : /
Jan 20 2010 23:48
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I fly back and fourth from the UK to the US quite often. I am an apple fiend. I usually take a few apples, a ton of gum, raisins, and a PB&J. I buy bottled water once through security.
Jan 21 2010 10:37
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You can also request a special meal from the airline. They have low cal meal options available as well as about a million other choices.


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Playing: Loading...
On Air:
Tags: play school, playschool, abc, noni hazlehurst, john hamblin
Almost every Australian child grows up watching Play School.
And while the show is pretty politically correct these days, back in the late 80s and early 90s the presenters managed to sneak in a lot of naughty jokes that only the parents watching would have noticed.
But the things left on the cutting room floor are even funnier!
"Noni (Hazlehurst) taught me everything I know, let's put it that way," long-time presenter Simon Burke told news.com.au on the red carpet at the AACTA awards.
"We sang a song once that went:
When the kangaroo bumps with a bumpety bumpHe'll never walk when he can jumpAnd people laugh at him in the streetGoodness gracious what big feet!
"And as the camera was pulling out, Noni said, 'Well you know what they say about big feet, Simon'."
We've found that song, but sadly the big feet comment did not make the final episode.
Play School - Noni and Simon - Outback Thursday - FULL EPISODE
And Noni has her own stories about working with John Hamblin, Play School's ultimate comedian.
"Of course it happens," Noni told news.com.au last year.
"Bearing in mind you had fairly stretched parents watching at home as well who were using the opportunity to sit down and have their child engaged by someone other than them for half an hour, there was occasionally a little double entendre but never at the expense of the child's enjoyment.
"I remember once John Hamblin and I in the closing moments, after we had said goodbye, we were stirring pots which we pretended were filled with soup but they were actually filled with weird ingredients like a door snake which we pretended was a sausage in the soup.
"And John, in that throwaway moment after we'd said goodbye, said, 'Would you like some of my sausage in your soup?' And I said, 'You keep your sausage to yourself, thank you very much'."
Luckily there are a lot of classic Play School moments on YouTube, and you'd be surprised what you pick up on when watching it as an adult. Naturally they all involved John Hamblin. You might not have picked up on them as children, but suddenly everything John has to say is pretty salacious!
Play School - Benita and John - nursery rhyme book
Playschool - John Hamblin and the saucepan with no lid
Play School - Colin, Monica and John - Royal Botanical Gardens FULL EPISODE
Play School - Don, Monica and John - at the beach - FULL EPISODE
Play School - Benita and John - rocking horses and dolls
Play School 1992 with John, Noni and Pauline (HQ)
Play School - Trish and John - dirty squirty part I
Saucy Play School Presenter
Have you found any hilarious Play School moments? Let us know in the comments!
Toronto's Yorkdale Mall can proudly boast that their shopping centre Santa is a total babe!
If you're planning on sending any letters in 2016 you better make sure you allow some extra time for them to arrive
An Instagram account dedicated to photoshopping photos of Kylie Jenner so that it looks like she is doing interesting stuff is even funnier than it sounds.
Southern Cross Austereo

subset: commoncrawl


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Feral Cat Food and Medical Assistance
<< < (4/10) > >>
Georgia-Harris County-
Humane Society of Harris County
P.O. Box 264
Hamilton, GA 31811
Since November 2007 we have begun the following initiatives:
Feral Cat Spay/Neuter Fund — established a small fund to assist in the spaying and neutering of the feral cat population in the county.
Contact them for more information.
Arizona-Cochise County-
Cochise County Humane Society
P.O. Box 1516
Sierra Vista AZ 85636
CCHS is in receipt of an $8,000 grant from the Bonnie Kay Fund at the Community Foundation for Southern Arizona. We are using this grant to spay/neuter/vaccinate Free Roaming Cats (FRC) in the greater Sierra Vista area; purchase additional equipment; provide additional medical care as needed. We are currently working with multiple colonies, the largest of which has about 70 cats. Our continuing goal is to reduce the Free Roaming Cat provide food to Colony Care Givers, when needed;overpopulation through our Trap/Neuter/Return program.
Companion animal and feral cat spay/neuter inquiries, please call 520-803-7385
Sierra Vista Herald January 10, 2010
"Grant money through the state's special license plate program will allow the Cochise County Humane Society to fund spays and neuters for those who might need assistance.
"Arizona's Pet Plate program has awarded the society $7,500 for dog spays and neuters, along with $2,500 designated for the sterilization of free-roaming cats.
"In addition, the Cochise County Sheriff's Office received an $8,000 grant to be used for companion animal spays and neuters. Financial assistance using Pet Plate funds is available at all mobile clinics sponsored by the Cochise County Humane Society. The procedures are performed by Animal Rural Klinic, a mobile practice that travels to Willcox, Elfrida, Whetstone, Tombstone and Sierra Vista.
"Anyone with free-roaming cats in their area or who would like to have their pets sterilized can bring them to one of the ARK clinics for spaying or neutering.
""We ask that you call first to make an appointment and arrange for financial assistance, if it's needed," Redding said. "The number is (520) 803-7385." "
Contact them for more information about help for feral cats.
Humane Society of Central Arizona
(formerly Payson Humane Society)
812 S. McLane Road
Payson, AZ 85547
(928) 474-5590
Fax-(928) 474-4341
Payson Roundup January 9, 2010
The Humane Society of Central Arizona (formerly Payson Humane Society) has received a $5,000 grant from the Arizona Companion Animal Spay/Neuter Committee, to be used to spay and neuter our community's feral cats.
If you or someone you know is feeding Feral cats ~ please call "Payson Friends of Ferals" at (928) 474-1836.
We will help you "trap, spay/neuter, and return them.
Contact them for more information about their feral cat programs.
Faithful Friends
12-a Germay Drive
Wilmington, DE 19804
phone: (302) 427-8514
fax: (302) 427-2855
Public, FREE Pet Food Bank open during public shelter hours for pet owners/colony caretakers in financial crisis All food is donated - supplies limited Dog and cat food/treat coupons NEEDED manufacturer only, non-expired coupons to keep food bank stocked.
Public Adoption and Service Hours
Monday & Tuesday - Closed to Public
Wednesday, Thursday, & Friday: 1:00 pm-7:00 pm
Saturday & Sunday: 1:00 pm - 4:00 pm
For questions about adopting a cat, placing a cat for adoption or humane cat trapping for trap-neuter return program email Kathy at:
Massachusetts-Haverhill, Lawrence, Methuen, North Andover, Andover Groveland-
New Hampshire-Plaistow-Merrimack Valley area-
Animal Rescue Merrimack Valley
PO Box 8006
Bradford, MA 01835-8006
Animal Rescue Merrimack Valley is an all volunteer, non-profit organization that provides:
Spay/neuter/feeding for feral cats
Low cost spay/neuter programs
Care for sick and injured animals
Animal Rescue Merrimack Valley spends thousands of dollars every month on medical care for rescued and feral animals. This money is the lifeblood of our work, without it we cannot continue to help as many animals and low income owners as we do. Please consider making ARMV your charity of choice.
Your Donation Helps:
* Animal care and adoption
* Medical Care for injured and sick animals
* Sponsor low or no cost spay / neuter clinics
Low-no cost spay and neuter information-ARMV programs and the programs of other nearby shelters.
Contact them for more information.
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April 2007
Live at Herbst Theatre
It's a shame the sound is so poor on this live recording by saxophonist-composer Karlton Hester's northern California big band, since the performance was obviously relished by the audience. But often it's impossible to hear the inner parts, which along with the occasional false entrance or clam, leaves a general impression of sloppiness. At times, for example, although one can clearly hear the lead alto and baritone saxophones, the other three saxes are barely audible. And it would have been helpful to know who wrote the arrangements ("Wind Machine" seems to be the unaltered Nestico tune and "April in Paris" the Basie version) as well as who the soloists, some quite good, are.
If it's difficult to judge the quality of the ensemble because of the sound, instances of decent recording do offer some high points. Vocalist Denise Perrier comes through nicely and her sultry voice and tasteful performances of "'S Wonderful," "God Bless the Child" and "Wave" are delightful. Guest altoist John Handy was also recorded well and his virtuoso manipulation of "I Can't Get Started," accompanied only by the rhythm section, is a real pleasure. He's also fine on "In a Mellow Tone" and "A Night in Tunisia."


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Are there letter writers you wonder about to this day? While I'm away, readers nominate some who stayed in mind.
Dear Carolyn: Both of our sons came home for Thanksgiving. We put up our older son and his family in a hotel; and had our younger son, his new (second) wife and their baby stay in our guest room.
How I wish I had switched. On Friday morning, the new wife said she had bug bites. I said that twice in the past I'd had bites, too, and thought they were from bedbugs. We had done Internet searching and gone to my dermatologist and discovered that bedbugs are not medically dangerous and not the result of uncleanliness. We gave her hydrocortisone and sympathized with her.
That evening, they moved into the hotel. Our son said his wife was absolutely adamant that they get out of our home. She has the reputation of being a "strong" woman, and she earns a very high income, so she is always able to get her way.
My husband and I felt embarrassed and disappointed that she reacted that way, but we are aware that a first-time 45-year-old mother probably had mother-bear hormones at play, and we don't blame our son for giving in to her demands.
But what did that accomplish? She washed everything they'd brought in hot water. My husband thinks she threw away their suitcases.
Our relationship with her is significantly impaired, and she wants me to tell her she did the right thing. I think she overreacted. Does this portend more trouble down the road?
— Anonymous
Dear Anonymous: Expect more trouble — but not just because of your daughter-in-law.
Your contempt for her is breathtaking. Look at your modifiers: "new (second)" wife, "absolutely" adamant, "very" high income, "always" get her way, "first-time 45-year-old" mother.
Unless she's oblivious, your contempt registered. Either find a way to like her, find a way to respect her or get used to tension.
And summon a little respect for the position in which you put this family. Bedbugs might not be " medically dangerous," but they're a repulsive nuisance.
I know you meant no harm. But you're blaming her for the fallout, and you're making that mistake with ill will.
Instead: Call your son; admit you were cavalier about the possible infestation; apologize for exposing them to a headache they don't need, especially with a baby; offer to pay for any treatment that their home might need; and get your home inspected by a reputable specialist. You can't expect his wife to drop her dukes until you drop your own.
Write to Carolyn Hax — whose column appears on Sundays, Wednesdays and Fridays — at tellme@washpost. com.


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CoQ-10 Fast Dissolve - 30 Tablets | 100mg
The Natrol CoQ-10 you trust now in Fast-Dissolve form! Not only will you'll enjoy the benefits of CoQ-10 30 times faster*, it also means it will dissolve completely on your tongue and can be swallowed with liquids! Great for individuals with busy on-the-go lifestyles or have a hard time swallowing dietary supplements.†
As we age, our body's natural production of CoQ-10 slows down, making it harder to convert fats and sugars into energy. Natrol® CoQ-10 Fast Dissolve is a natural dietary supplement and antioxidant that helps cells work more efficiently in the heart and throughout the body.†
Coenzyme Q-10 (CoQ-10), also known as Ubiquinone, is a vitamin-like nutrient that is produced by the body that tends to diminish as we age. Coenzyme Q10 (CoQ10) is necessary for the basic functioning of cells and is an essential component of our cells energy production. Almost all of the body's energy is produced through aerobic cellular respiration, generating energy in the form of ATP (adenosine triphosphate) through a process requiring CoQ-10. Human organs with the highest energy requirements - such as the heart, liver and kidney – require the highest CoQ-10 concentrations.†
CoQ10 is also an antioxidant, which means that it protects cells from damaging free radicals.†
Natrol® CoQ-10 Fast Dissolve:
CoQ10 is commonly recommended by doctors for maintaining a healthy heart.
CoQ-10 Fast Dissolve FAQs:
Q: What is CoQ-10?
A: Coenzyme Q-10 (also known as CoQ10, Q10, vitamin Q10, ubiquinone, and ubidecarenone) is a benzoquinone compound synthesized naturally by the human body. Coenzyme Q-10 is used by cells of the body in a process known variously as aerobic respiration, aerobic metabolism, oxidative metabolism, or cell respiration. Through this process, energy for cell growth and maintenance is created inside cells in compartments called mitochondria. Coenzyme Q10 (CoQ10) is necessary for the basic functioning of cells. Coenzyme Q10 is also used by the body as an antioxidant, which means that it protects cells from damaging free radicals.†
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Q: Is it Ubiquinone or Ubiquinol?
A: Soybean oil helps keep the CoQ-10 stabilized.†
Q: What does "fast dissolve" mean?
A: "Fast Dissolve" is a delivery method whereby the tablet dissolves on your tongue and can be swallowed without liquids. Natrol's unique Fast Dissolve technology allows tablets to dissolve up to 30 times faster than regular tablets.*
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.


text:
The top option in this area, Libertador Trujillo is situated at the corner of the city's main plaza, in full view of the Cathedral. The hotel is 10 minutes away from the Sun and Moon Temples, and from the world's largest adobe city, the pre-Inca ruins of Chan Chan.
We specialize in planning custom trips featuring top quality local hotels, outstanding private guides, and unique excursions. Browse our popular itineraries for this hotel by clicking the link below, then give us a call to discuss your custom travel plans with a specialist.
Click here to see sample itineraries for Libertador Trujillo
Note: The Libertador Trujillo can be incorporated into any itinerary for this region. All trips are completely customizable.


text:
10 December 2016
News and Views
Links and Services
Showcase Journal
A study in the issue of Gastroenterology reports no effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.
Patients with non-celiac gluten sensitivity do not have celiac disease but their symptoms improve when they are placed on gluten-free diets.
Dr Jessica Biesiekierski and colleagues from Australia investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates fermentable, oligo-, di-, monosaccharides, and polyols in subjects believed to have non-celiac gluten sensitivity.
The researchers performed a double-blind cross-over trial of 37 subjects with non-celiac gluten sensitivity and irritable bowel syndrome, but not celiac disease.
Participants were randomly assigned to groups given a 2-week diet of reduced fermentable, oligo-, di-, monosaccharides, and polyols, and were then placed on high-gluten, low-gluten, or control diets for 1 week, followed by a washout period of at least 2 weeks.
The doctors assessed serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue.
The team reported that 22 participants then crossed over to groups given gluten, whey, or control diets for 3 days.
Symptoms were evaluated by visual analogue scales.
In all participants, gastrointestinal symptoms consistently and significantly improved during reduced fermentable, oligo-, di-, monosaccharides, and polyols intake, but significantly worsened to a similar degree when their diets included gluten or whey protein.
The researchers observed gluten-specific effects in only 8% of participants.
There were no diet-specific changes in any biomarker.
The team found that during the 3-day rechallenge, participants symptoms increased by similar levels among groups.
Gluten-specific gastrointestinal effects were not reproduced.
An order effect was observed.
Dr Biesiekierski's team, "In a placebo-controlled, cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in fermentable, oligo-, di-, monosaccharides, and polyols."
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25 U.S. Code § 749 - Taxes; initial exemption; taxes following distribution; valuation for capital gains and losses
No property distributed under the provisions of this subchapter shall at the time of distribution be subject to Federal or State income tax. Following any distribution of property made under the provisions of this subchapter, such property and any income derived therefrom by the individual, corporation, or other legal entity shall be subject to the same taxes, State and Federal, as in the case of non-Indians: Provided, That for the purpose of capital gains or losses the base value of the property shall be the value of the property when distributed to the individual, corporation, or other legal entity.
LII has no control over and does not endorse any external Internet site that contains links to or references LII.


text: This report has only piqued my interest of the rod even more. Sounds like you really love your new rod craigthor. To say that you would want to have in all of your trips in the future is really something special. Craigthor you may now kiss your new bride as you walk hand and handle into the sunset. Have fun and maybe give us another update down the road.


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My Most Important Project Yet
Sequence 01 5 from Paul Overton on Vimeo.The Short Story
One of my missions in life has always been to promote creativity in any way I can and to give a voice to the voiceless when the opportunity arises. This summer, just such an opportunity will be happening right here in Central Massachusetts.
In July, a phenomenal dance group called PUSH Physical Theater, from Rochester, NY will spend three weeks here at our campus, developing a new performance piece with at-risk teens from the area. This is a "first of its kind" residency that I sincerely hope will become an annual event, providing a forum for local youth to tell their stories through dance.
What We Need & What You Get
In order to pull off this feat, we need to raise $12,000 to provide food, lodging, and stipends to the company as well as scholarships for the kids involved.
Being that this is an experiential project and not focused on creating a tangible product like a book or CD, contributors can expect to get frequent updates, rehearsal diaries, and scenes from the final performance. Higher level contributors will also receive tickets to the final performance in Hardwick, MA.
The Impact
During my time in this rural and economically challenged area, I've had the opportunity to connect with some of our local kids through our Youth Center. In listening to their stories, one thing is abundantly clear...they have very few opportunities for creativity or self-expression. They also have a generally dim view of the future. They are not aware of the possibilities that a creative life has to offer and have never had the luxury of studying art, music, or dance, outside of their overcrowded and underfunded classrooms.
This residency will, on a small scale, provide the opportunity to experience what it's like to create something as a team and to simultaneously express oneself through a particular type of physical storytelling. Through trust, partnering, and commitment to the process, students will emerge with a new sense of worth and possibility by the end of the project...and who could ask for more?
Other Ways You Can Help
If you are unable to contribute monetarily, please consider passing this page around to your friends and acquaintances through facebook, twitter, or any other outlets you see fit. Thank you for any help!
Posted by Paul Overton at 4:14 PM 1 comments
Marco Mahler's 3D Printed Mobiles
his shop. Many more designs available. Snap 'em up before these beauties are gone!
Posted by Paul Overton at 4:58 PM 1 comments
3D Printed Track Bike
Posted by Paul Overton at 7:29 AM 0 comments
The Work of Zachary Smith
Love this guy! link
Posted by Paul Overton at 11:47 PM 0 comments
Progressive Prosthetics
I'm absolutely loving these custom prosthetics by Sophie de Oliveira Barata. More here. Thanks to my old friend, Peter for turning me on to these!
Posted by Paul Overton at 9:42 AM 1 comments
Colorful Cable Control
Design Love Fest
Posted by Paul Overton at 7:43 AM 1 comments
Beer Cap Bathroom Floor
Posted by Paul Overton at 6:23 PM 2 comments
The Original Dude Craft
I think this dude would be hard pressed to get one more contraption on that car. So awesome. via
Posted by Paul Overton at 8:41 AM 2 comments
Saint Paddy's Day Papercut from Nick Joyce
Posted by Paul Overton at 9:31 AM 0 comments
The Poster Shop is Now Open
poster shop is finally open and I have 3 of the 5 planned designs up and for sale. Come visit, won't you?
Posted by Paul Overton at 10:39 PM 0 comments
Posted by Paul Overton at 9:58 PM 7 comments
Einstein Quote - Test print
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text:
Battery Powered RCA Portable TV 3.5"
By RCA
Now you can take your favorite channels wherever you go – to the kitchen or workshop, or even outside the house.
- The compact RCA 3.5" Portable TV easily picks up digital TV broadcasts from local stations.
- This portable TV is 7.5"x 4.5"x 2.25".
- Its retractable antenna can be positioned to receive the best signals, and the Model 235a works on four AA batteries. This model features a convenient flip-out stand.
- With its bright LED screen, the RCA 3.5" Portable TV receives over-the-air standard digital TV channels.
- This TV will not act as a TV monitor for traditional cable or satellite content.
- AC Adapter ($25), Car Adapter ($19), and RF Antenna Adapter ($14) -- for plugging into "rabbit ears" antennae -- all sold separately.
- Zippered travel case sized for the RCA Portable TV ($14.99) also available separately.
This item qualifies for free shipping through the U.S. Postal Service Priority Mail. Tracking numbers will be sent ahead of the shipment.


text:
This recipe originally accompanied Warm Chocolate Soufflés with Pistachio Ice Cream .
- Yield
- Makes about 3 1/2 cups
- 1 cup unsalted shelled pistachios
- 3/4 cup sugar
- 2 cups milk (do not use low-fat or nonfat)
- 1/2 teaspoon almond extract
- 4 large egg yolks
- 1 cup whipping cream
- 3/4 cup unsalted shelled pistachios, toasted, coarsely chopped
- Finely grind 1 cup pistachios and 1/4 cup sugar in processor. Bring milk and ground pistachio mixture to boil in heavy large saucepan. Remove from heat. Mix in almond extract.
- Whisk egg yolks and remaining 1/2 cup sugar in medium bowl. Gradually whisk in hot milk mixture. Return custard to saucepan. Cook over low heat until custard thickens and leaves path on back of spoon when finger is drawn across, stirring constantly, about 10 minutes (do not boil). Strain into large bowl. Chill until cold, about 2 hours.
- Stir 1 cup whipping cream and chopped pistachios into custard. Process mixture in ice cream maker according to manufacturer's instructions. Transfer to container and freeze. (Ice cream can be prepared 3 days ahead.)
Nutritional Info
- Calories266
- Carbohydrates24 g(8%)
- Fat17 g(26%)
- Protein7 g(14%)
- Saturated Fat5 g(25%)
- Sodium29 mg(1%)
- Polyunsaturated Fat3 g
- Fiber2 g(9%)
- Monounsaturated Fat7 g
- Cholesterol92 mg(31%)


text:
Columbus lawyer Michael Bivens is accustomed to legal sparring.
But going toe-to-toe with several thousand pounds of metal and machinery — a commercial tow truck, to be precise — is a different matter.
Bivens ended up losing the first round of that fight, but he insists he isn't done yet.
The dispute began last month when Columbus-based A/T Towing & Recovery dispatched a wrecker to the Arbors at Turnberry, an apartment complex near Pickerington, to tow an illegally parked vehicle. But before the driver could complete the job, he was interrupted by Bivens, the vehicle's owner.
Bivens told the driver that he was visiting a resident of the complex. He said he knew he needed a parking permit and had gone inside his friend's apartment to get one.
The attorney explained that he was just returning to the parking lot to hang the pass from his car's rear-view mirror.
When the tow-truck driver refused to back down, Bivens resorted to a tactic that almost certainly wasn't part of his training at Capital University Law School: He called police and planted himself in front of the truck, blocking its exit.
Police allowed the vehicle to be towed.
Bivens got another unwelcome surprise when he tried to retrieve his car — a Lexus RX 330 — from A/T's impounding lot at 1468 E. 4th Ave.
State law limits how much a towing company can charge. Specifically, the Ohio Revised Code says the cost to reclaim an impounded vehicle weighing 5 tons or less is "not to exceed" $90 for the actual towing and $12 per day for storage.
Bivens' bill: $349 — more than three times what the law seemingly allows.
A/T's itemized breakdown included $20 for "dollies," $25 for "admin" and $180 for something labeled "2 HR."
"A $90 tow, because of my protests, turns into a $349 tow — which is ridiculous," Bivens said later in an interview.
A/T Owner Herman Dague told WBNS-TV (Channel 10) that his company is entitled to charge extra to cover "expenses" associated with a towing job. In this case, he said, the "2HR" fee stemmed from Bivens' decision to serve as a human traffic barricade.
"Our time is valuable," Dague said. "He was charged two hours for the wait time."
Asked whether it was his prerogative to assess fees not spelled out in state law, Dague responded: "It's not fair for me to be judge and jury of what he should have to pay — no. (But) is it fair for him to keep my driver at bay, standing in front of the truck, not letting him leave? I mean, is that fair?"
Although the episode was a first for Bivens, other central Ohio motorists have run into similar problems. In the past two years, WBNS has documented numerous instances in which towing companies seemingly charged more than state law allows.
Last summer, two of the region's largest towing companies, Camcar and Shamrock, were named as defendants in a lawsuit centering on such practices.
The suit, pending in Franklin County Common Pleas Court, alleges that Camcar and Shamrock violated state law by charging "thousands of Ohioans bogus administrative fees for towing their cars from private tow-away zones."
Fred Gittes, one of three Columbus lawyers who filed the suit, said at the time that charging excessive fees appeared to be "an industry-wide practice" in Ohio.
"Towing companies are basically thumbing their noses at the law, which is intended ... to protect drivers from unreasonable and predatory charging practices," he said.
Dague indicated that he would consider refunding the extra fees paid by Bivens — but only if the lawyer agreed not to sue his company.
Bivens said he's weighing his options.


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The Freshly Bowled station features one-bowl meal choices. It is one of seven concepts in UCLA's new Bruin Plate dining hall.
When UCLA opened FEAST at Rieber a little over two years ago, it made a big splash as the first all-Asian multi-station dining hall on a college campus. Among its plaudits was an FM Best Concept Award for Best Menu. Now the school is at it again with the debut of yet another specifically themed multi-station venue: Bruin Plate, which features only dishes deemed healthy and which emphasizes freshness, sustainability and scratch production. Part of a three-year construction project that also ...
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By Dennis Smith
Consecutive years of hot, dry summers and warm, dry autumns favor grasshopper survival and reproduction. Warm, dry fall weather allows grasshoppers more time to feed and lay eggs.
Spring rains will drown young hoppers when eggs are hatching. Thus, dry weather in the spring favors their survival. Grasshopper eggs are deposited in the soil l/2 – 2 inches deep in weedy areas, fence rows, ditches and hay fields. The eggs hatch in the spring and early summer. Eggs of different grasshopper species hatch out at different times, so young grasshoppers can be seen throughout the spring and early summer. Young grasshoppers, called nymphs, feed for about six weeks. Once nymphs reach the adult stage, they can fly. As weedy plants are consumed or dry in the summer heat, adult grasshoppers can fly from weedy areas and pastures to more succulent crops and landscapes.
Although grasshoppers complete only one generation a year, eggs hatch over a long period of time. Development from egg to adult requires about 40-60 days. Also, eggs of different species hatch at different times so small grasshoppers can be found throughout the growing season. Grasshopper can persist until late fall when old adults begin to die or when a killing frost occurs.
Eliminating weeds will starve young hoppers and later discourage adults from laying eggs in the area. Destroying weeds infested with large numbers of grasshoppers can force the hungry grasshoppers to move to nearby crops or landscapes. Control the grasshoppers in the weedy area first with insecticides or be ready to protect nearby crops if they become infested. Grasshoppers deposit their eggs in undisturbed soil, as in fallow fields, road banks, and fence rows.
Grasshoppers are susceptible to many insecticides. However, insecticides typically do not persist more than a few days and grasshoppers may soon re-invade the treated area. The length of control will depend on the residual activity of the insecticides and the frequency of retreatment. Controlling grasshoppers over a large area will reduce the numbers present which can re-infest a treated area. Dimilin 2L provides long residual of young hoppers but is not effective against adults.
Monitor grasshopper infestations and treat threatening infestations while grasshoppers are still small and before they move into crops and landscapes. Immature grasshoppers (without wings) are more susceptible to insecticides than adults.
Sevin 5 Bait is a ready-to-use bait which can be applied to many crop and non-crop sites, including around ornamentals and many fruit and vegetables.
The biological control products contain spores of a protozoan called Nosema locustae, formulated in a bait. Grasshoppers consuming the bait become infected by the Nosema organism. Some immature grasshoppers die while adults often survive but females lay fewer eggs. Nosema baits act too slowly and kill too few grasshoppers to be much value when the need for control is immediate.
Some insecticides for controlling grasshoppers in the home landscape include: Cyfluthrin, Bifenthrin, Permethrin and Acephate. Always read and follow all label instruction on pesticides.
Products labeled for grasshopper, control in pastures and hay meadows include Malathion, Mustang Max, Sevin, Dimilin and Karate. Producers using these products are reminded to follow all label instructions. These products vary on the number of days required from application to harvest or grazing.
Find additional information on grasshopper control on the Texas AgriLife Extension Service web page at gregg-tx.tamu.edu/
References to commercial products or trade names is made with the understanding that no discrimination is intended and no endorsement by the Texas AgriLife Extension Service is implied.
Dennis Smith can be contacted at the Gregg County Extension Office by e-mail at email@example.com or telephone at: 903-236-8429.
Extension programs serve people of all ages regardless of socioeconomic level, race, color, sex, religion, disability, or national origin.


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|September 2, 2012
|Posted by Madeline @ Food, Fitness, and Family under Family
Hi friends!
I am just popping in to give you guys an update! I am so very happy to start off saying that my dad is recovering from surgery and doing well. He ended up having quadruple bypass surgery on Thursday afternoon. Today is Day 3 post-op and we will see what it holds. The road to recovery is going to be long, difficult, and painful but my dad is super strong and has an excellent support system cheering him on. My days have blurred together since touching down in Phoenix on Wednesday.
I hope that you liked Erin's guest post on Friday. I have a few more lined up for this week from some of my favorite bloggers and friends. I am super excited to share them with you! Now that the worst is behind us, I will be around more too 😉 Your prayers and thoughts have definitely been felt by myself and my family. I truly appreciate all the texts, tweets, Facebook messages, and comments that you guys have left me. This community is AH-MAZING!
It's incredible how much closer families get when crisis happens. My sister, step-mom, and myself have been on a rotating schedule so that one of us is almost always at the hospital advocating for my dad and torturing him with the incentive spirometer … more on all that later 😉 This experience has given all of us a renewed perspective on what REALLY matters in life … the people we love.
My sister is always one step ahead of me and bribed the nurses already too:
A basketful of delicious cake pops from the same baker she hired for my baby shower. I may or may not have had a few myself … the red velvet is to die for!
She also made sure that our dad KNEW how much she loved him …
My dad has a "huggy pillow" to hold against his chest incision when he gets up, coughs, etc. We could also sign it. I am happy to let Heather think whatever she wants if it helps her sleep better at night … we all know that I am the favorite 😉
I am taking Chris to the airport this morning before hitting up the gym. I am so thankful he was able to come back with me … he is my ROCK. I also NEED to get working out because I need the energy and endorphins equally. A good workout helps get my mind in the game and keeps me sane Then it's back to the hospital to hang out with the padre! Hope your Sunday is full of whatever makes you happy!
13 Responses to Update
so glad to hear things are going well!
Lindsay @ The Lean Green Bean recently posted..Bean Bytes #4
What wonderful news! It is so nice that you were able to see some light from this situation in the form of a renewed appreciation for family and the precious time we get with them
Erica {EricaDHouse.com} recently posted..Stuck in a Food Rut
I am so so glad that your dad is resting and recovering with his loving family by his side. It sounds like Hope really helped! And thank you so much for the opportunity to guest post, I had a blast!
Erin @ Girl Gone Veggie recently posted..Big Money
Oh, Madeline, I am so happy to hear this
Loooove the cake pops – your sister is so sweet!
I am so glad he is doing better!! I know you are spending a lot time at the hospital but at least it is time spent with your dad! I know he is so thankul for having such a great daughter! Love You!
Amanda recently posted..SEC Football Saturday
I'm glad to hear things are going well. Wishing your dad a speedy return to health and your family strength to get through!
Great news! What a relief that the worst is behind you. I'll continue to send prayers your way!
Laura recently posted..Running for SLOS: A mom's story of grief and hope
Of course you're the favourite daughter haha!! That's awesome about your dad and super nice of you guys for giving the nurses cake pops – I bet they appreciated that one. I would!!
I see that you did get a run in today…awesome! I never did because I'm kinda stuffed up, so I'll live through your run 😉
char @ char eats greens recently posted..my return to juicing
Great news!!! Go Dad!
Mindy Artze recently posted..Run the Women's Half St. Pete with me!
What wonderful news. I am so happy everything went well. Prayers are still with you & your family on this up and coming journey you all we be on <3
Jessie recently posted..MIMM & Product Review
That is wonderful news about your dad! With all those cake pops, I wouldn't be surprised if he was the favorite patient.
So glad to hear things are going so well! Continued thoughts and prayers to you and your family.
Jen@HealthyFoodandFamily recently posted..Camping is for reading
Glad to hear your dad is doing well! Keep your head up! He'll get there!
Sabrina @ Work It Ms Jackson recently posted..Oh My Knee and Speed Work


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HVAC, Plumbing & Electrical Services Frisco, TX
In Frisco, air conditioning in the summer is a must! Berkeys is there for you 24/7 to take care of any problem you may have with your air conditioner. Plumbing problems? Berkeys' licensed technicians are here to help. We will repair, tune-up and install / replace all brands of Air Conditioners, Furnaces, Hot Water Heaters or Water Treatment systems.
Frisco BBB and Ft. Worth Better Business Bureau Accreditation and Rating (Berkeys Maintains an A+ Rating for Several Years)
Here's a shortlist of the services offered by Berkeys:
Our Plumbers in Frisco, Texas Offer:
- Toilet Repair & Replacement
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Please let me know if you're looking for a htoaur for your blog. You have some really good posts and I believe I would be a good asset. If you ever want to take some of the load off, I'd absolutely love to write some articles for your blog in exchange for a link back to mine. Please shoot me an e-mail if interested. Many thanks!
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If you know Jean-Claude Van Damme from such films as Universal Soldier and Timecop - and why wouldn't you? - then JCVD will come as a surprise.
A shock, even, and a most welcome one at that: JCVD is a fantastic movie. Mabrouk El Mechri, who directed and co-wrote the film, deconstructs almost everything about the action hero: the quality of his movies, the path his career has taken, even the travails of his personal life. And Van Damme doesn't just gamely play along. He seizes the opportunity and delivers a performance on par with Mickey Rourke's Oscar-nominated turn in The Wrestler.
The comparison is apt. Both films are reclamation projects involving actors whose careers and personal lives were on the downslope. Both boast knockout performances. And both include scenes in which the characters talk about their fortunes but clearly are talking about the actors' real-life selves.
That's more explicitly so in JCVD, which is no surprise. Van Damme plays a version of himself, a fading action star named Jean-Claude Van Damme, reduced to making movies that are terrible, even by his standards, to pay the bills. The bills are mounting, what with tax problems and legal fees; he's embroiled in a nasty custody battle over his daughter. The judge asks her which parent she wants to live with. She chooses her mother because the kids at school make fun of her father's movies.
How bad have things gotten? Van Damme loses a part to Steven Seagal, who's willing to cut off his ponytail for the job.
Van Damme heads back to his native Brussels, Belgium, where he's still a national hero. When he goes to a post office for a wire transfer, he wanders into a robbery and, through a series of mix-ups, the authorities believe he's behind it.
Inside the post office, all his movie moves (which we see in a hilariously over-the-top sequence at the beginning of the film) are of no use, except for, in one funny scene, amusing a robber. Instead of beating up his captors, Van Damme is forced to try to outwit, or at least outlast, them.
As Van Damme waits with the other hostages, he contemplates his life. In one amazing scene, he faces the camera and speaks directly to the audience, the character Van Damme talking about the mistakes he has made in his life - mistakes that the real Van Damme also has made.
El Mechri plays with time, moving back and forth in the narrative to good storytelling effect.
Van Damme is outstanding - a sentence as odd to write as "The Arizona Cardinals are in the Super Bowl." Yet both statements are true.
It helps that the film is mostly in French; Van Damme's comfort with the language makes him all the more convincing. Had he not been - playing yourself is a difficult gig, supposedly - JCVD could have been a disaster, another forgettable Van Damme flick.
But it's not. Van Damme is so good, and El Mechri's storytelling so entertaining, that JCVD takes its place alongside The Wrestler as one of the unlikeliest but most welcome comeback vehicles in ages.
Reach Goodykoontz at 602-444-8974 or firstname.lastname@example.com. Read his blog at goodyblog.azcentral.com.
Jean-Claude Van Damme appears in "JCVD."
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Irrigation within Arkansas primarily occurs on cultivated cropland acres. The 2007 report shows that within cultivated cropland, irrigation increased while conversely nonirrigated cultivated cropland decreased.
While Arkansas has an abundance of good quality ground water in most parts of the state, ground water is being depleted faster than the rate of recharge in the primary agricultural area for cultivated crops.
Though there is a critical decline of ground water in the aquifer beneath these increasingly irrigated acres, NRCS uses its programs and technical expertise to install systems that convert from ground water use to surface water use utilizing the state's abundant annual rainfall (40-50").
Along with the U.S. Army Corps of Engineers, Arkansas Natural Resource Commission (ANRC), and Irrigation District Partners, NRCS is planning and implementing several irrigation water conservation/management projects within Arkansas in our most productive agricultural areas. (Figure 15)
(Figure 15) - Irrigated Cultivated Cropland
Last Modified: 02/02/2011
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Remember when we told you how in Star Wars, a single TIE fighter pilot saved the rebellion by colliding with Darth Vader before he could shoot down Luke? Turns out he wasn't the only remarkably inept bad guy who ended up doing the heroes a huge favor. For example ...
6RoboCop: Dick Jones Confesses to a Cyborg That Records Everything
The pivotal scene in RoboCop plays out like so: Through a combination of expert police work and being a robot, RoboCop tracks down the man who shot him earlier in the film. RoboCop finds out that the bad guy is working for Dick Jones, one of the top executives at OCP (the company that runs the police department). It turns out Jones ordered the assassination of fellow OCP executive Bob Morton as revenge for creating RoboCop and upstaging his own proposal for a technological law enforcer.
A "Robo-Bot."
The problem is that as soon as RoboCop goes to arrest Jones, his body starts shutting itself down:
"If I can only act with my mouth, then by gosh it's gonna be the best mouth acting anyone's ever seen."
Jones, instead of just having RoboCop hauled out to a dumpster, patiently explains to him that he added a secret directive to RoboCop's program that prevents him from acting against any member of OCP management. During his villain monologue, he also admits to having ordered Morton's death -- but there's absolutely nothing RoboCop can do about it because of his programming. Finally, Jones sends his giant robot and a bunch of SWATs to kill RoboCop, because he can.
Holy shit. No amount of RoboCopping can get him out of this one.
Look! He's still human after all.
But the Villain Saved the Day:
Look, we know that flamboyant movie villains like to explain their master plan to the trapped hero -- James Bond has heard more confessed sins than your average priest. But boasting of your plan to RoboCop is like confessing directly into a security camera. He's a machine that records everything he sees and hears -- his memory is admissible in court as evidence.
And his fist is a flash drive.
We know Jones should have been aware of this because a) he was familiar enough with RoboCop's programming to insert a new directive and b) RoboCop was actually playing an audio clip of the killer shouting "I WORK FOR DICK JONES!" as he walked toward Jones' office.
Perhaps Jones was under the impression that if RoboCop dies all the files inside him stop existing, like someone who throws away a laptop full of incriminating porn because the monitor is broken. Following that analogy, the scene when RoboCop plays Jones' confession in front of the entire OCP board would be like the moment when the computer's owner finds out that one of his personal videos has 3,000,000 hits on YouPorn. Hey, Dick -- even if RoboCop "died," somebody could have recovered his hard drive (or whatever he has in there) and copied the files off of it to nail your ass.
Explaining the secret directive to RoboCop turned out to be a monumentally stupid decision, too: This is something that RoboCop couldn't have known otherwise, because this particular directive never shows up in his Robovision (unlike the others). When Jones is exposed, RoboCop more or less tells everyone at the board that he can't touch him because he's an OCP employee -- and so the OCP president kindly fires Jones on the spot to allow RoboCop to deal with him however he sees fit.
John McClane is a goddamn plagiarist.
If Jones hadn't told RoboCop that he can't hurt OCP executives, Robo probably would have assumed that the directive forbid him from hurting Jones only, regardless of where he worked ... which actually would have made a lot more sense as a directive anyway.
5Return of the Jedi: Emperor Palpatine Sucks at Setting Traps
At the climax of Return of the Jedi, Luke learns that his friends have fallen into an elaborate trap: The Emperor intentionally leaked the plans of the new Death Star to the Rebels while making them think that it wasn't operational yet. As soon as all their forces are gathered at the same place, they find out that it totally was.
As the Emperor put it, "Everything that has transpired has done so according to my design" -- yes, even meeting the damned Ewoks. The whole reason Han, Leia and the others went to Ewok-ville is that the Emperor secretly fed them the location to a shield generator supposedly protecting the Death Star, but that, too, was part of the trap.
In other words, the Rebels may think they're making some progress, but each victory just brings them closer to ultimate defeat. As they arrive at what they believe is their goal, they are essentially a woman tied up on the train tracks in front of an approaching train, only in this case the woman has tied herself there because she thought that's how you derail the train.
"If I had a mustache I'd be twirling it, but I am completely hairless."
But the Villain Saved the Day:
There's only one problem with that plan. As part of the trap, the Emperor makes the Rebels on Endor believe they're attacking the Death Star's shield generator. And as bait for said trap, he uses the actual shield generator. As a reminder, the Rebels have already blown up an unshielded Death Star before, and this one has a big-ass hole in the side. He knows it's completely vulnerable without those shields. It's like setting a mousetrap where the cheese is rigged to a bomb, and if the mouse doesn't eat it, you die.
They should have built a shield generator for the shield generator.
Sure, the Emperor had a bunch of Stormtroopers waiting to ambush the Rebels, but why even take that risk? Why not tell them the shield station was somewhere else? Like for example in any of the other eight nearby moons that don't have indispensable equipment in them, which they could've then blown to shit with the giant laser as soon as the Rebels landed.
OK, so telling them how to shut down the shield is one thing ... but did the Emperor also have to give them complete and accurate plans for the new Death Star? He could have easily fudged a few details, causing Lando to fly the Millennium Falcon into a wall.
"Well, GPS says to go right ahead, so ..."
When you think about it, the Ewoks did more to endanger the Rebel Alliance than the Emperor, since they delayed Luke's group getting to the shield generator with their off-putting hijinks, which could have been fatal to the fleets waiting for the shield to be taken down. That's right: The Ewoks are better villains than the Emperor.
As any Stormtrooper could have told you.


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Lisa Hartling, MSc; Finlay A. McAlister, MD, MSc; Brian H. Rowe, MD, MSc; Justin Ezekowitz, MB, BCh, MSc; Carol Friesen, MA, MLIS; Terry P. Klassen, MD, MSc
Acknowledgments: The authors thank John Russell and Michelle Tubman for administrative and technical support.
Grant Support: This paper was produced by the University of Alberta Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland. Dr. McAlister is supported by the Alberta Heritage Foundation for Medical Research and is the University of Alberta/Merck Frosst/Aventis Chair in Patient Health Management; Drs. Ezekowitz and McAlister are supported by the Canadian Institutes of Health Research Research (CIHR); and Dr. Rowe is supported by a Canada Research Chair from the CIHR.
Potential Financial Conflicts of Interest: Authors of this paper have received funding for Evidence-based Practice Center reports.
Requests for Single Reprints: Finlay A. McAlister, MD, MSc, 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada; e-mail, firstname.lastname@example.com.
Current Author Addresses: Ms. Hartling: Aberhart Centre One, Room 9424, 11402 University Avenue, Edmonton, Alberta T6G 2J3, Canada.
Dr. McAlister: 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada.
Dr. Rowe: 1G1.43 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112th Street, Edmonton, Alberta T6G 2B7, Canada.
Dr. Ezekowitz: 2-51 Medical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2H7, Canada.
Ms. Friesen: Aberhart Centre One, Room 9420, 11402 University Avenue, Edmonton, Alberta T6G 2J3, Canada.
Dr. Klassen: 2C3.00 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2B7, Canada.
Hartling L, McAlister FA, Rowe BH, Ezekowitz J, Friesen C, Klassen TP. Challenges in Systematic Reviews of Therapeutic Devices and Procedures. Ann Intern Med. 2005;142:1100-1111. doi: 10.7326/0003-4819-142-12_Part_2-200506211-00010
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© 2016
Published: Ann Intern Med. 2005;142(12_Part_2):1100-1111.
DOI: 10.7326/0003-4819-142-12_Part_2-200506211-00010
The authors discuss 3 challenges in conducting and interpreting any systematic review that are particularly relevant for systematic reviews of therapeutic devices or surgical procedures: 1) inclusion or exclusion of grey literature, 2) the role of nonrandomized studies, and 3) issues in applying the results to clinical care that are unique to the surgical and therapeutic device literature. The authors also discus s empirical evidence related to these topics and illustrate how reviewers in the Agency for Healthcare Research and Quality's Evidence-based Practice Center program have dealt with these challenges in developing evidence reports for decision makers and clinicians about therapeutic devices or surgical procedures.
Therapeutic devices and surgical procedures are often evaluated in nonrandomized studies or small single-center trials. While some may question whether systematic reviews in this area should be performed given the limitations of such studies, we believe that these reviews should play a key role in helping to inform decisions about the implementation of new technologies or procedures. By summarizing the available evidence, systematic reviews can highlight gaps in the evidence base that clinicians and policymakers require to make informed decisions.
We highlight 3 challenges that may arise in conducting and interpreting any systematic review that evaluates the efficacy or effectiveness of therapeutic devices or surgery. We also review the empirical evidence relevant to these methodologic issues in general and present the evidence specific to devices or procedures where it is available. We do not focus on the importance of assessing study quality because another article in this supplement addresses this issue (1).
In this article, we use the U.S. Food and Drug Administration (FDA) definition of a therapeutic device (2) as "an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is . . . intended to affect the structure of any function of the body . . . and which does not achieve any of its primary intended purposes through chemical action within or on the body . . . and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes."
Therapeutic devices and surgical procedures obviously vary greatly in complexity and costs; however, the issues we discuss here are universal irrespective of the type of device or procedure. They include the following: 1) Should grey literature be included in systematic reviews of devices or procedures? 2) Should nonrandomized studies be included in systematic reviews of devices or procedures? and 3) What applicability issues are unique to studies of devices or procedures?
In discussing these issues, we use examples to illustrate how reviewers in the Evidence-based Practice Center (EPC) program and other authors dealt with them.
Grey literature generally refers to reports that are difficult to locate or retrieve by using the electronic databases commonly employed to identify studies for inclusion in systematic reviews (for example, MEDLINE, EMBASE, and CINAHL). A common misconception is that the grey literature is a homogeneous collection of works. Rather, it includes many different types of documents that can vary substantially in design, quality, and extent of peer review (including internal company reports, documents submitted to the FDA, theses and other dissertations, conference abstracts, book chapters, personal correspondence, and even personal Web pages or blogs) (3, 4). Table 1 highlights several online resources for grey literature databases, such as SIGLE (System for Information on Grey Literature in Europe) and Web sites from North America and Europe. While abstracts are the most common type of grey literature included in systematic reviews (5-7), the type most relevant to systematic reviews of devices is reports from manufacturers or the FDA. The FDA enforces regulations to ensure the effectiveness and safety of a medical device before granting marketing clearance (2). The FDA reviews of the safety and efficacy data collected through this process for approved devices are publicly available (except for data considered proprietary or confidential) and generally contain far more detail than is typically presented in journal publications.
Table 1.
A second common misconception is that grey literature is static. Given the substantial time lags between completion of studies and their publication in medical journals (4.2 to 4.8 years for studies with significant results and 6.4 to 8.0 years for those with nonsignificant results), it is not surprising that some studies initially identified as "grey literature" have been published by the time a systematic review is published or read (8, 9).
While the goal of a systematic review should be to compile the evidence in an unbiased manner, opinions on the appropriateness of including grey literature in a review differ. For example, while 78% of meta-analysts stated that unpublished data should definitely or probably be included in systematic reviews, only 47% of journal editors agreed; 30% of editors reported that they would not publish a review that included unpublished data (10). Of the first 988 systematic reviews published in the Cochrane Library, 56% included grey literature; in most cases, however, the unpublished information merely provided data that supplemented published studies (11). Among the 27 evidence reports on devices and surgery produced through the EPC program in 2004, only 9 included any grey literature (Appendix Table).
Proponents of searching for and including grey literature in all systematic reviews argue that excluding grey literature may result in biased estimates of the effectiveness of an intervention (7, 12, 13). While the existence of publication bias (that is, significant results are more likely to be published, and more likely to be published in English, than nonsignificant findings) has been well documented (5, 13), the question should really be framed in terms of whether including grey literature removes the potential for bias related to sample size (which includes publication bias as well as bias arising from systematic differences in methodologic quality). Indeed, it could be argued that including grey literature in a systematic review may introduce bias if the search for grey literature is not systematic, if only some of the grey literature is uncovered, or if only low-quality trials are uncovered (5, 10). Thus, it is not surprising that even systematic reviews that include unpublished trials can still demonstrate substantially asymmetric funnel plots (a graphical indication that sample size–related bias may exist) (5).
If we accept that including the grey literature does not remove the potential for sample size–related bias in a systematic review, a second (and perhaps more relevant) question is whether inclusion of grey literature substantially affects the results of systematic reviews. For example, of 159 systematic reviews reporting comprehensive searches for grey literature, only 38% found any unpublished trials and only 9% of the 1635 trials eventually included in these reviews were unpublished (indeed, despite the comprehensive search strategies, only 10% "were published in a journal not indexed in MEDLINE") (5). Although the amount and importance of grey literature will vary by topic area (Table 2), 3 empirical studies comparing systematic reviews across a wide variety of topic areas that did include grey literature versus those that did not found little difference between the effect estimates derived from published trials and those derived from published and unpublished trials (5, 14, 15). Furthermore, in stratified analyses of 159 systematic review comparisons, nondrug interventions showed less difference between published and unpublished trials than drug interventions (5). Of course, these are only 3 analyses. Given the heterogeneity between the systematic reviews within each of these studies, it is appropriate to acknowledge that in some areas of health care, particularly those in which there is little published evidence or the intervention is new or changing (as is frequently the case for devices or surgical procedures), discrepancies between published and "grey" trials may be sufficient to justify devoting resources to systematically searching for grey literature.
Table 2.
In addition to weighing the often substantial opportunity costs of devoting time and resources to searching for grey literature, 3 other concerns drive us not to recommend routinely including unpublished data in systematic reviews. First, results presented in abstract form may be inaccurate or unhelpful. For example, only 33% of abstracts presented at a pediatric surgical meeting contained the same data as the subsequent publication, and the conclusions were similar in only 70% of the abstract–manuscript pairs (the conclusions were consistently weaker in the full manuscript than in the abstract) (16). Moreover, there may be a "window of opportunity" during which abstracts are potentially useful: Early abstracts may assist in identifying randomized, controlled trials (RCTs) but may have only preliminary, incomplete, or inaccurate data, while late abstracts may not provide any data in addition to those already published (17).
Second, it is sometimes difficult to judge the quality of reports in the grey literature, an essential part of any systematic review since low-quality trials are associated with overestimates of treatment effects (18). Indeed, assessment of trial quality is especially pertinent for surgical trials, which are often small and difficult to blind (19, 20). For example, only 2% of abstracts of randomized trials presented at the American Society of Clinical Oncology conferences reported the method of allocation concealment, and only 14% reported the method of blinding (21). Indeed, reflecting our skepticism about data presented in abstract form, only 3 of the 27 EPC reports on devices and surgical procedures accepted abstracts for inclusion. While some may argue that this problem is unique to abstracts, it has been shown that even FDA reports are less likely to appropriately describe methods of randomization, blinding, and allocation concealment than published journal articles (15).
Third, we believe that readers should be skeptical about unpublished data if the data are provided directly by the manufacturer of the device without the opportunity for peer review (22). It has already been well documented that industry-funded research is less often published or presented (23), takes longer to be published when it is accepted for publication (23), and is almost 4 times more likely to report outcomes favoring the sponsor than nonindustry funded studies (24).
In sum, while in an ideal world reviewers would attempt to identify all relevant unpublished literature (and would be successful in doing so), time and resource constraints often compromise the identification and inclusion of grey literature. The search for unpublished trials should become easier as prospective trial registries (for example, Current Controlled Trials [http://www.controlled-trials.com]) become fully functional; however, until these registries attain their goal of capturing 100% of trials, reviewers must continue to carefully consider whether grey literature is likely to be common and influential for their topic of interest. A particularly useful source of information related to devices is available through unpublished FDA reports. We believe that grey literature, including FDA data, should be sought when little evidence for a topic has been published (15) and when the intervention is new or changing, but that exhaustive searches of the grey literature are less necessary when large trials have already been published (15, 25). Regardless of the approach taken, researchers undertaking a systematic review should explicitly state whether they sought or included grey literature (26), and they should conduct sensitivity analyses to assess the impact of grey literature on treatment effect when they include unpublished studies (10). If reviewers choose to search for grey literature, they should use a systematic approach that targets known sources of grey literature rather than relying on select references to which the reviewer has been alerted in an ad hoc manner. Reviewers should also evaluate the findings with respect to the quality of reports, be they published or unpublished (10), and to the sponsoring agency (24). Regardless of whether a review contains grey literature, reviewers should evaluate and discuss the possibility of sample size–related bias and present the results and recommendations in light of the potential for bias (26).
Nonrandomized studies include experimental studies (such as quasi-randomized trials) and observational studies with controls (such as controlled before–after studies, concurrent cohort studies, and case–control studies) or without concurrent controls (such as before–after studies, cross-sectional studies, and case series) (27). The fact that most published articles (68% to 87% of feature articles and brief communications in Annals of Internal Medicine, BMJ, and The New England Journal of Medicine) are nonrandomized studies underscores the value placed on this type of research by clinicians (28). Historically, there has been little randomized-trial evidence in the areas of devices and procedures, and it is estimated that RCTs account for less than 10% of the evidence base for surgical interventions (19). In fact, of 7295 trials indexed as RCTs in MEDLINE from 1990 to 1996, only 1% had device or devices as key words (29); of 9373 references in MEDLINE for pediatric surgery, only 0.3% were RCTs (30).
The inclusion of study designs other than RCTs in systematic reviews of therapy has been discouraged for decades given concerns about the various and well-described biases inherent in studies with nonrandomized designs (27, 31, 32). The extent of bias associated with different nonrandomized study designs, however, can vary tremendously and is at times unpredictable in direction and magnitude (33). A comprehensive review compared results obtained from randomized and nonrandomized studies for 82 clinical topics (27). Among the 8 meta-epidemiologic studies reviewed, 2 studies found close agreement in their estimates of treatment effect (34, 35), while the other 6 found that randomized and nonrandomized studies produced different results; for 5 of these studies, however, the differences were not consistent in direction (33, 36-40). The results are likewise inconsistent when restricted to surgical interventions; the results of randomized and nonrandomized studies do not consistently differ in their estimates, and the design that produces the more extreme result varies. Little evidence is available to compare results from randomized and nonrandomized studies for devices; therefore, no specific conclusions can be drawn. On the basis of the existing evidence, Deeks and colleagues (27) could not make firm conclusions regarding the value of randomization because of the conflicting results and limitations in the studies reviewed. In their analyses, Deeks and colleagues (27) used a resampling procedure to assess the effect of comparing patients within 2 multicenter trials (1 of which was a large trial of endarterectomy) with nonrandom concurrent or historical controls. They found that the biases associated with these 2 designs can significantly affect the results of a systematic review and that the effects are sensitive to differences in case mix. In the surgical example, historical controlled studies overestimated the benefits of endarterectomy, while the concurrent controlled studies produced results similar to those of the RCTs (Figures 1 and 2). Although multivariate models can be used to adjust for differences in covariates and case mix between comparison groups in nonrandomized studies, even advanced statistical techniques, such as instrumental variable analyses, can never completely remove concerns about confounding by indication (41).
The distribution of results indicates systematic bias (average odds ratios in the randomized, controlled trials and historical controlled studies were 1.23 and 1.06, respectively). Adapted with permission from reference 27: Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7:iii-x, 1-173.
The distribution of results revealed that 9% of studies within each design had statistically significant findings. Adapted with permission from reference 27: Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7:iii-x, 1-173.
While RCTs are usually cited as the highest level of evidence for judging the efficacy of therapeutic interventions (42), "randomization should not be seen as a reliable proxy for overall quality" (43). Indeed, well-conducted nonrandomized studies may be more valid than poorly conducted RCTs (36, 44). In some situations, moreover, RCTs are unethical or impractical, and clinicians and policymakers must rely on lower levels of evidence (45). Certainly, nonrandomized studies may provide evidence that complements RCTs (particularly concerning issues of effectiveness in clinical practice versus efficacy in the trial setting) (33, 44, 46). Furthermore, for questions on patient safety of a new intervention, observational studies may in fact be a better source of evidence than RCTs (which are almost never sufficiently powered to detect rare adverse events because of inadequate sample size or duration of follow-up) (47, 48). These RCTS also tend to enroll younger and healthier patients who have conditions other than those usually encountered in clinical practice. This may lead to underestimates of adverse event rates when the intervention is applied in real-world settings. Indeed, 14% of trials published in 7 general medical journals in 1997 did not refer to adverse effects at all, 38% did not provide information on adverse effects by treatment group, and 46% provided no details on the severity of adverse effects (49). Thus, it is not surprising that only 27% of 2467 published systematic reviews evaluated safety as a secondary outcome (and only 4% included it as a primary outcome) (47). Nonrandomized studies were included for safety outcomes in all 18 EPC reports on devices and surgery that evaluated safety (Appendix Table).
Randomized, controlled trials are also often insufficient to assess safety outcomes because of inadequate or differing definitions of adverse events and severity (45, 49-54); variable or inadequate methods of monitoring or detection within trials (51, 52, 55, 56); or poor reporting of the numerators and denominators in safety data (45, 49-51, 53, 54, 57). For example, an analysis of 82 studies reported that these studies used 41 different definitions and 13 different grading scales for surgical wound infection (58). Indeed, definitions of "surgical death" often vary among studies, and deaths after discharge from the hospital are not often reported (59). Recognizing these flaws, trial reporting guidelines now contain specific recommendations for documenting information on adverse events and effects (60).
Many possible sources other than RCTs provide evidence on safety. Although large, observational studies are necessary to evaluate rare, serious adverse effects (61, 62), we believe that studies with noncomparative designs should not be included in systematic reviews because of their inability to establish causality (45). Thus, while postmarketing surveillance studies can be useful (47, 50), information from this source should be used cautiously because reporting may be nonsystematic (50), rare adverse effects may be underreported (61), and the lack of a control group may overestimate the incidence of common, less serious adverse effects that are not directly related to the specific therapy (63).
Evidence from nonrandomized studies may be particularly relevant in areas lacking RCT evidence: Seven percent of systematic reviews in the Cochrane Database of Systematic Reviews (those published in The Cochrane Library, Issue 2, 2004) found no randomized trials and concluded that there was no evidence upon which to make informed decisions. Randomized evidence is especially lacking for devices (29) and surgical procedures (19, 30, 64, 65)—for example, nearly one quarter of systematic reviews of orthopedic surgery reported no RCTs in their specific topic area (66).
The lack of RCT evidence for medical devices or surgical procedures arises from several factors (29). First, the FDA does not require RCTs for new devices (67), in contrast to the general requirement of 2 RCTs for new-drug applications (29). Second, unlike researchers conducting drug trials, clinicians require specific training or skills for device or procedural trials (29). Once a surgical procedure has been developed, refined, and standardized to the point at which it would be appropriate to be evaluated in a randomized trial, collective clinical equipoise may no longer be present (68, 69). Furthermore, despite examples of the usefulness of sham surgeries in demonstrating the lack of efficacy of certain surgical procedures (such as arthroscopic knee surgery [70], internal mammary artery ligation [71, 72], and intracerebral fetal tissue grafting in older patients with Parkinson disease [73]), they are controversial because they expose "control" participants to surgical risks without any potential for benefit (74, 75). Finally, 2 facets of the device industry limit rigorous evaluation. In general, the device industry consists of small enterprises that may lack economic resources to do research of any kind (29, 67). Furthermore, the constant and rapid evolution of devices makes it difficult to determine the optimal time for evaluation (67). In the early stages of development, there may still be uncertainties over application of the technology (for example, which patients are most likely to benefit and how the device will interact with other evolving technologies) (69) and less experience and familiarity with the technical skills necessary for optimal outcomes (76). If the evaluation comes too late, the device may have already been adopted into clinical practice and consumer expectations (69).
In 21 EPC reports, reviewers included nonrandomized evidence for evaluating efficacy: 20 of these included studies without concurrent controls. Moreover, 7 EPC reports relied solely on nonrandomized evidence for evaluation of some surgical interventions: liver transplantation (77); total knee replacements (78); and procedures for managing uterine fibroids (79), chronic central neuropathic pain after spinal cord injury (80), breast abnormalities (81), incidental adrenal masses (82), and cataracts or glaucoma (83).
Reviewers should consider several practical issues when deciding whether to include nonrandomized studies in systematic reviews. First, because nonrandomized studies make up most of the medical literature and the indexing of designs other than RCTs is less precise and reliable (84), the number of studies identified by an open literature search is dramatically greater than a search restricted to RCTs. Second, controversy exists over the appropriateness of performing a meta-analysis of nonrandomized data and the concern that such analyses may produce spurious results (85-87). Third, the assessment of methodologic quality, an essential part of any systematic review, is more problematic for nonrandomized studies than for RCTs. For example, 1 report identified 194 quality assessment tools for nonrandomized studies but found that almost all were flawed (27). Indeed, only 2 of the 25 EPC evidence reports evaluating devices or surgery that included nonrandomized studies used validated tools to assess methodologic quality. In most cases, the EPC reviewers generated their own list of quality criteria. Finally, inclusion of nonrandomized studies has implications for data extraction (for example, different forms may be required for different designs) (88). Despite these challenges, the development of reporting guidelines for meta-analyses of observational studies is an important evolution in the area of systematic reviews, and increasing numbers of meta-analyses of nonrandomized studies are being produced (87).
In sum, when enough RCTs are available to examine the efficacy of a given intervention, these should form the evidence base for decision making (27). Nonrandomized studies should be used to complement RCT evidence when information on long-term effects and safety outcomes is required. When RCTs are unavailable, reviewers should identify reasons for lack of RCT evidence and review the evidence from nonrandomized studies. Reviewers should define the designs to be included a priori and document them in the review protocol. Reviewers should also present nonrandomized evidence in the context of potential biases and discuss the likely influence of these biases on treatment effect estimates. When nonrandomized studies are included, methodologically stronger studies (89) should be considered first—in particular, we believe that inclusion of a control group (preferably concurrent) is essential to allow valid conclusions to be drawn from nonrandomized studies. All evidence, be it from randomized trials or not, should be graded for methodologic quality by using components that are informed by empirical evidence and, where possible, by using validated methods. Results from systematic reviews based on nonrandomized studies need to be interpreted on a case-by-case basis and should consider the magnitude and consistency of the observed effects, as well as the biases and limitations inherent in different study designs. Existing guidelines should be followed in reporting the results from systematic reviews of nonrandomized studies (87).
After deciding that a research study (whether a nonrandomized study, an RCT, or a systematic review) is internally valid, the clinician or policymaker then must decide whether this evidence applies to their patients or situation, respectively. This is no easy task, even when the evidence is not hampered by the all-too-common problems of imprecision due to small numbers, brief follow-up periods, surrogate outcomes of limited clinical relevance, and restricted enrollment of highly select subsets of patients. These threats to applicability are common to studies of drugs and medical interventions, as well as those of devices and surgical interventions; other articles discuss these problems fully (90, 91). In this section, we focus on threats to applicability that are unique to studies evaluating devices or procedures.
First and foremost, patient eligibility criteria are of particular importance in interpreting studies (and systematic reviews) of devices and surgical procedures. This encompasses 3 key points. First, devices or procedures should be considered only for patients similar to those in whom they have been tested. For example, an EPC report demonstrated that cardiac resynchronization therapy was efficacious in patients with heart failure who have underlying bundle-branch block and low ejection fraction. Whether this intervention benefits patients with heart failure who do not exhibit these features is unknown (indeed, benefit is doubtful since the device addresses the hemodynamic problems resulting from bundle-branch block).
Second, and perhaps less apparent, the assumption that "overall trial results apply to most patients with that condition" (91) does not hold for surgical or device intervention studies. Thus, while the relative benefits of drugs generally do not differ across patient subgroups, at least across the usual spectrum of underlying risks (92-94), the mortality relative risk reduction associated with such surgical procedures as carotid endarterectomy, coronary artery bypass grafting, and devices (such as those providing cardiac resynchronization therapy) are all greater in patients at higher baseline risk (95-97). This paradox arises because the potential long-term positive effects on the outcome of interest are balanced against short-term negative effects on that same outcome for surgical or device interventions: Since periprocedural risks are absolute and similar irrespective of the patient's long-term baseline risk for the outcome, the long-term relative benefits are greater in patients who are more likely to develop the outcome without intervention. For example, the risk for death with implantation of a cardiac resynchronization device is the same—0.4% (95% CI, 0.2% to 0.7%)—for patients who have a 1% 1-year mortality risk without cardiac resynchronization therapy and for patients with a 10% 1-year mortality risk (97).
Third, while we can often safely assume that drugs beneficial in young patients (such as antihypertensive agents or statins) are also beneficial in older patients with the same target conditions, this assumption does not hold for surgical procedures or devices. For example, while the perioperative mortality rate in 2 trials that proved that carotid endarterectomy prevents stroke in patients with high-grade carotid stenosis was only 0.1% to 0.6% (98, 99), both trials restricted enrollment to younger patients, and population-based studies have shown that average perioperative mortality rates in older patients are substantially higher than in younger patients (1.9% to 3.6%) (100, 101). However, a recent analysis of data from acute care hospitals in 7 states showed that carotid endarterectomy procedure rates increased more in older patients than in younger patients after publication of these trials (100).
In addition to considering the patient eligibility criteria in device or surgical trials, the reviewer should also focus on the eligibility criteria for providers and institutions—abundant literature has shown clear relationships between hospital and physician volume and outcomes (102-104). For example, both of the carotid endarterectomy trials cited earlier were conducted in large-volume hospitals by surgical teams with low perioperative complication rates (98, 99). Indeed, the benefits in both trials were highly sensitive to perioperative complication rates: It is estimated that the relative risk reduction for disabling stroke with carotid endarterectomy decreases by 20% for every 2–percentage point increase in the absolute rate of perioperative stroke (105). Although both groups of trialists explicitly cautioned that "readers not apply our conclusions too broadly . . . the study surgeons were selected only after audits . . . confirmed a high level of expertise" (98, 99), subsequent analyses of carotid endarterectomy procedures in the United States have shown that surgical teams whose complication rates and operative volumes would have rendered them ineligible for the trials now perform most endarterectomies (100, 106). Not surprisingly, the in-hospital mortality rates after carotid endarterectomy are almost 10-fold higher in the "real-world" setting than in the trials included in the systematic review.
Some trials of devices randomly assign patients after the device is implanted. For example, 8 of the 9 trials in an EPC report on cardiac resynchronization therapy used this approach, and only patients who had the device successfully implanted (approximately 90% of those who underwent the procedure) were randomly assigned to have the device turned on or off (97). This design, similar to the run-in period used in some pharmaceutical trials, does not affect the internal validity of the trials since the randomly assigned groups should still be balanced for unmeasured confounders. However, it does affect the tests of statistical significance (leading to narrower CIs and greater chance of type I errors) and may lead to overestimates of treatment benefits and underestimates of adverse effects (since these studies do not include patients who could not tolerate the procedure or those in whom implantation was unsuccessful) (107). Unfortunately, there are no accepted methods for adjusting results for the effects of the "run-in period" before randomization. While some authors advocate recalculating effect estimates as if the run-in had not been used (thus including prerandomization events in the relevant treatment group) (107), we suggest that the effect estimates should be derived from the postrandomization data but the conclusion prominently state that the reported effect estimates are a "best-case" scenario and probably represent the ceiling of what may be expected from a device or surgical procedure when used in clinical practice.
The effects of most technologies, such as devices and surgical procedures, tend to change over time. The benefits of technological innovations should theoretically improve over time (since, as providers become more experienced with the techniques, procedural complications should decline and selection of patients likely to benefit most should improve); however, as outlined above, this trend is often countered by the trend for innovations to diffuse nonselectively beyond those settings in which it was shown to be beneficial (thus increasing complication rates and reducing, if not negating, potential benefits). The uncertain effects of a device or procedure over time are compounded when the design of the device or the features of the procedure have rapidly evolved. Thus, earlier studies may show different outcomes than later studies. Furthermore, our ability to extrapolate from published studies to clinical practice for devices or procedures may be limited by any imprecision in the description of the device or procedure in the literature.
Given periprocedural complication rates, almost all interventions that involve a surgical procedure (including those to implant a device) have survival curves that cross at some point—that is, patients in the procedure group will have worse short-term outcomes but better long-term outcomes (if the procedure is beneficial). Thus, the benefits of the procedure appear smaller the closer to the procedural date one looks. This has implications for the pooling of data in a systematic review (implying that effect estimates from different time periods should not be pooled indiscriminately) as well as applying the results of the systematic review to make projections on long-term patient outcomes.
In sum, in making or drawing conclusions from systematic reviews of devices or surgical procedures, it should not be assumed that the efficacy and safety seen in clinical trials conducted in highly select subsets of patients cared for by highly select providers from highly select institutions will translate into similar safety and effectiveness rates when applied in usual practice, particularly over time as devices and surgical techniques evolve. Thus, the systematic reviewer and the reader must be particularly cautious in highlighting the patient, provider, and institutional eligibility criteria; the type of device or procedure; and the length of follow-up. Furthermore, the reviewer should highlight in the report that the reported effect estimates for any device trials that randomly assigned patients after the procedure had been performed probably represent the best-case estimates for efficacy of the device when used in clinical practice.
While systematic reviews of RCTs are considered the gold standard for evidence, they are not infallible. Indeed, in many instances, large RCTs have disproved the results of previous systematic reviews (108). While advances in the methods of systematic reviews in the past decade should result in more valid conclusions, many of these advances are most relevant to reviews of pharmacologic interventions. Many issues specific to devices and surgery require further evaluation. The merits and drawbacks of including grey literature and nonrandomized studies need to be carefully considered on a case-by-case basis for each clinical topic, and reviewers need to carefully consider the external validity of their findings and comment on issues of applicability for decision makers (Table 3). Unless the issues we raised in this manuscript are explicitly addressed in a systematic review of a therapeutic device or procedure, we believe clinicians faced with extrapolating from the evidence to clinical practice and the policymaker faced with deciding whether to support implementation of that device or procedure should be cautious.
Table 3.
Appendix Table.
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The 2012 college football season has almost come to an end, and it is time to start looking towards 2013. The Texas A&M football team will return most of their two-deep on offense and should again be one of the top offenses in the nation.
The Aggie coaches will not know who they have to work with on offense until after the NFL draft deadline passes. Offensive tackles Luke Joeckel and Jake Matthews are both considered likely first round draft picks if they declare for the draft as juniors.
If the two juniors declare then it will cause some shuffling on the offense line. If they both decide to come back, then the Aggies will return seven of the 11 starters on the offensive side of the ball.
The Ags offense is still a relatively young one with a lot of youth throughout the two-deep. This is a look at the projected depth chart for the A&M offense in 2013.