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Centura Health has more experts in more places throughout the region. Start your health journey by finding the right one for you.
Heart disease is the leading cause of death in the United States. That's why when it comes to your heart health you want the best care possible. At the Penrose-St. Francis Heart & Vascular Center, we offer comprehensive cardiac services right in your backyard. Our team of highly skilled physicians and clinical caregivers specialize in everything from heart disease prevention and education to diagnostic and treatment services. We offer cutting-edge cardiovascular procedures.
Penrose-St. Francis Heart & Vascular Center works closely with American Medical Response, the Colorado Springs Fire Department and Flight for Life Colorado to treat patients who may be suffering from a heart attack. American Medical Response (AMR) is the designated first response ambulance service of the Emergency Services Agency of the City of Colorado Springs and El Paso County. AMR provides Advanced Life Support care to both emergency patients who have called 911 and to patients being transported between facilities. All ambulances are staffed with Nationally Registered paramedics who have completed the American Heart Association Advanced Cardiac Life Support course in addition to extensive training in cardiac-related emergencies and 12-lead EKG interpretation.
Flight For LifeThe Colorado Springs Fire Department is the first response agency to handle every type of perceived emergency involving the health of people in the community. All firefighters maintain a minimum medical certification of Emergency Medical Technician (EMT) and are capable of providing basic level medical care including Cardiopulmonary Resuscitation (CPR), automatic heart defibrillation (AED), and first aid for injuries. Most of the department's response units also have firefighters with the certification of Paramedic (PM) and are able to provide more highly advanced care including heart monitoring. Current guidelines require "door to treatment" within 90 minutes or less, and we are well within that limit.
Penrose Hospital and St. Francis Medical Center are proud to be Accredited Chest Pain Centers for southern Colorado.
When you're having a heart attack, time equals heart muscle - the longer it takes to unclog a blockage, the more damage your heart will sustain. Penrose Hospital and St. Francis Medical Center are proud to be Accredited Chest Pain Centers for southern Colorado. Hospitals that have received Society of Chest Pain Centers (SCPC) accreditation have achieved a higher level of expertise in dealing with patients who arrive with symptoms of a heart attack. They emphasize the importance of standardized diagnostic and treatment programs that provide more efficient and effective evaluation as well as more appropriate and rapid treatment of patients with chest pain and other heart attack symptoms. They also serve as a point of entry into the healthcare system to evaluate and treat other medical problems, and they help to promote a healthier lifestyle in an attempt to reduce the risk factors for heart attack. To become an Accredited Chest Pain Center, Penrose Hospital and St. Francis Medical Center engaged in rigorous evaluations by SCPC for their ability to assess, diagnose, and treat patients who may be experiencing a heart attack. To the community served by Penrose-St. Francis, this means that processes are in place that meet strict criteria aimed at:
If you or a loved one is experiencing chest pain, call 911 immediately.
The Penrose-St. Francis Heart & Vascular Center performs diagnostic procedures to evaluate cardiovascular function and to identify structural abnormalities, including blockages or heart valve malformations to over 4000 patients annually.
Clinical Cardiology
Clinical cardiology is the diagnosis, management, and prevention of diseases of the heart and blood vessels. Colorado Springs Cardiology, A Centura Health Clinic provides a full range of non-invasive testing, guidance about prevention strategies and prescribe medications to help you control your condition.
Examination & Consultation
A cardiac consultation is an opportunity for patients to speak one-on-one with their doctor about their individual cardiac issues, including current symptoms, personal risks and lifestyle habits that can contribute to these factors. A consultation may also be scheduled for patients who are undergoing surgery soon in order to fully discuss the details of the procedure and any preoperative preparations that may be needed. Consultations for second opinions are also welcome.|
Stress Testing
A stress echo is performed to see how your heart works while you exercise. An echocardiogram taken while you rest, you then exercise, and then another echo is done while your heart is beating fast or if you are unable to exercise, you are given medication (Dobutamine) via an intravenous (IV) needle in your arm which makes your heart react as if your body was exercising.
Ambulatory Monitoring
During Ambulatory Monitoring, an ambulatory electrocardiogram (EKG or ECG) records the electrical activity of your heart while you do your usual activities. Ambulatory monitors are referred to by several names, including ambulatory electrocardiogram, ambulatory EKG, Holter monitoring, 24-hour EKG, or cardiac event monitoring. Many heart problems become noticeable only during activity, such as exercise, eating, sex, stress, bowel movements, or even sleeping. A continuous 24-hour recording is more likely to detect any abnormal heartbeats that occur during these activities.
T his test uses ultra sound (sound waves) to study the structure of your heart and how the heart and valves are working. A probe is passed over your chest and heart which sends out and records these sound waves showing a moving image of your heart on a computer.
Tilt Table Testing
If you have episodes of fainting, a tilt table test is used to investigate if these could be related to your heart. You lie on a special table, which can be angled so you lie down or stand up and you will be attached to a heart and blood pressure monitor which record how your heart rate and blood pressure respond to changes in position. During the test you may have an intravenous needle in your arm so you can be given medication.
Nuclear Cardiology
A Cardiac Nuclear Scan, also known as Myocardial Perfusion Imaging, is a test that uses a radioactive substance, or radiopharmaceutical, to produce images of the blood flow to the heart muscle. When combined with stress testing, the scanning helps determine if areas of the heart are not receiving enough blood, which is especially useful in diagnosing blocked arteries. A cardiac nuclear scan may take three to four hours for the entire test, which includes preparation, a stress test, and imaging before and after the stress test. The radiation exposure during a Cardiac Nuclear Scan is small, and the doses used are safe. However, if you are pregnant, suspect you may be, or are a nursing mother, be sure to let your doctor know. The stress test is also safe, but because the heart is being stressed, there is a small amount of risk. Possible rare complications include abnormal heart rhythms or heart attack. Experienced personnel are available to handle any emergency. We proudly offer Cardiac Nuclear Scanning at Penrose Hospital and St. Francis Medical Center.
The Electrophysiology Lab (EP Lab) is equipped with the latest technology ever to be offered to the Pikes Peak region. Our physicians are well-experienced in all electrophysiology procedures as well as areas of mapping procedures. These include mapping by electro grams from diagnostic catheters with the heart to 3-D mapping with Biosense Webster Carto Sound and St. Judes Ensite, mapping systems that create realistic cardiac chamber geometries or models, display activation timing and voltage data to identify arrhythmias, and guide precise catheter movement. These mapping systems can drastically reduce the amount of X-rays the patient will be exposed to during a procedure. Patient safety is our number one priority in our lab, which is staffed with critical care Registered Nurses. They are physician-trained in scrub techniques for an electrophysiology procedure, whether it's ablation, device implants or laser lead extractions. Their sole concern is the safety and well-being of every patient who enters our lab.
Pacemaker/DefibrillatorImplantation & Pacemaker Clinic
If a patient suffers from a slow or a fast heartbeat, there are implantable devices that will make the heartbeat regular and treat an arrhythmia. Slow heartbeats are treated with pacemakers. Fast, dangerous heartbeats, which may lead to cardiac arrest, are treated with implantable cardioverter-defibrillators (ICDs).
The Penrose Pacemaker Clinic is responsible for the follow-up monitoring of all pacemakers and Internal Cardiac Defibrillators (ICDs). Our clinicians work closely with physicians to provide effective quality care to each and every patient. The patient is seen initially three months after the pacemaker or ICD is placed. All pacemakers or ICDs are then followed on a regular basis, whether it be every three months for an ICD or every six months for pacemakers. As the device ages, inspections may occur more frequently to monitor the appropriate time for replacement.
Each visit to the Penrose Pacemaker Clinic involves a painless inspection of the device, which takes approximately 20 minutes. A large number of information provided by the device is monitored to ensure the device is stable and safe. The clinician is able to determine if any arrhythmias have occurred or therapies have been delivered by the device. Depending on the assessment, the physician is notified and appropriate actions are taken. All inspection reports are submitted to the physicians for review and signatures. Patients are treated on an individual basis and the devices are programmed to meet their lifestyle and needs.
Remote Monitoring - Many patients qualify for remote monitoring. Using state-of-the-art technology, our clinic is able to inspect the device remotely via the internet. This enables the patient to transmit information and receive the same quality care without the need for a hospital visit. This is extremely beneficial for patients who live out of the local area or who are unable to travel. If a patient feels he or she has had a cardiac event, this remote monitoring can be used to assess the device and alert the physician in a timely manner, without the need to be seen in the emergency room or clinic.
Patients are encouraged to contact the Penrose Pacemaker Clinic if there are any problems or questions related to their device. The clinic maintains a 24/7 on-call schedule in order to be available for after-hour emergencies. Our goal is to provide quality care and emotional support to each and every patient. For more information, call 719-776-5000.
Electrophysiology Studies
If you have abnormal heart rhythms (arrhythmias) or palpitations you may need this test. Similar to an angiography, fine tubes (electrode catheters) are fed into a vein and/or artery usually in the groin. They are then gently moved into the heart, where they stimulate the heart and record your heart's electrical activity.
Arrhythmia Ablation
Ablation is used to treat abnormal heart rhythms, or arrhythmias. The type of arrhythmia and the presence of other heart disease will determine whether ablation can be performed surgically or non-surgically. Non-surgical ablation, used for many types of arrhythmias, is performed in a special lab called the electrophysiology (EP) laboratory. During this non-surgical procedure a catheter is inserted into a specific area of the heart. A special machine directs energy through the catheter to small areas of the heart muscle that causes the abnormal heart rhythm. This energy "disconnects" the pathway of the abnormal rhythm. It can also be used to disconnect the electrical pathway between the upper chambers (atria) and the lower chambers (ventricles) of the heart. Surgical ablation procedures used for treating atrial fibrillation can be "minimally invasive" or traditional "open" surgery and may be combined with other surgical therapies such as bypass surgery, valve repair, or valve replacement.
Atrial Fibrillation Ablation During this procedure, a thin wire (catheter) is positioned inside your heart near the pulmonary veins. Radio energy applied to the tip of this catheter is used to cauterize (ablate) the heart tissue around each pulmonary vein. This electrically "disconnects" the pulmonary veins from the left atrium. As a result, the abnormal electrical signals from the pulmonary veins can no longer reach the rest of the heart and trigger Atrial Fibrillation.
Coronary and Peripheral Angiography An angiogram is an x-ray image of arteries and veins which is created using a contrast "dye" to check for such conditions as blood vessel narrowing or enlargement, blockages and possible leakages. The exam is performed using a catheter, a long flexible tube that is gently guided through the blood vessels with the aid of x-ray images on a monitor, or can be non-invasive using magnetic resonance imaging (MRI) or computerized tomography (CT scan). Angiograms are commonly used for assessing blood vessel health in and around the heart, brain, kidneys and in the legs. Cardiologists perform coronary angiograms to look for blockages or other abnormalities in blood vessels in the heart. This procedure involves cardiac catheterization - the use of a catheter which is usually placed in the artery through a puncture site in the groin or arm, and then gently guided into one of the two major coronary arteries. The cardiologist then injects an iodine-based contrast through the catheter and into the artery, which will be visible when x-rays are taken. The contrast highlights blood movement through the artery, and narrowing caused by blockages can be clearly discerned.
Peripheral angiograms use the same procedure with x-rays, dye and a catheter, but are instead performed to examine the vessels to the arms, legs, kidneys, or abdomen. In the legs, blockages causing interrupted blood flow can result in cramps during walking and reduce the healing ability of foot injuries or wounds such as sores or ulcers. Decreased blood flow can also cause legs to become pale or turn slightly blue, or result in colder limbs and decreased nail and hair growth.
Our Cardiac Catheterization Laboratory, or Cath Lab, provides state-of-the-art angiographic assessment of coronary artery anatomy and the flow of blood through the structures of the heart. The Cath Lab is ready 24/7 to assist a patient with life-threatening cardiac or peripheral vascular disease to quickly restore them to optimal health.
Coronary Angioplasty and Stenting
These procedures help manage of blockages in arteries to the heart, legs, kidneys, and carotid arteries to the brain. Angioplasty is generally performed from the artery in the groin or arm to gain access to the blockage requiring treatment. A balloon catheter is placed over a guide wire at the site of the blockage using x-ray guidance. Once positioned, the balloon is inflated, thereby pushing the atherosclerotic material up against the vessel wall. Often, a stent, which is a metal mesh device, is used as scaffolding for the arterial wall after angioplasty. Once deployed, the stent becomes encapsulated through the addition of new lining cells within days of the procedure. Stents have reduced the incidence of recurrent blockages after balloon angioplasty.
Cardiac surgery is done to correct problems with the heart. More than half a million heart surgery are done each year in the United States for many heart problems. The cardiac surgeons at the Penrose-St. Francis Heart & Vascular Center perform more heart surgeries than any other hospital in Colorado. The most common type of cardiac surgery for adults is coronary artery bypass grafting (CABG). During CABG, surgeons use healthy arteries or veins taken from another part of the body to bypass, or go around, blocked heart arteries. CABG relieves chest pain and reduces the risk of heart attack.
Cardiac surgery also is done to:
Traditional cardiac surgery, often called open-heart surgery, is done by opening the chest wall to operate on the heart. Surgeons cut through the patient's breastbone (or just the upper part of it) to open the chest. Many heart surgery can now be done through small incisions (cuts) between the ribs. This is called
minimally-invasive heart surgery. This type of heart surgery may or may not use a heart-lung bypass machine. The results of heart surgery in adults often are excellent. Heart surgery can reduce symptoms, improve quality of life, and increase lifespan.
Coronary Artery Bypass Surgery
Coronary artery bypass surgery (CABG) is done to reroute or "bypass" blood around clogged arteries to improve blood flow and oxygen to the heart. A healthy blood vessel from another part of the body is used to bring new blood flow around the blockage, allowing blood to flow freely again to the heart muscle. Dr. Mehall routinely uses the technique of bilateral mammary artery grafting, a strategy with the highest long-term survival and graft patency. Bypass surgery can be performed either with the heart-lung machine or on the beating heart, depending on the needs of the patient.
Heart Valve Surgery
When a valve doesn't open all the way or leaks, blood doesn't move through the heart's chambers properly. This can result in the heart having to work harder to pump the same amount of blood, or even a backup of blood in the lungs or body. In heart valve surgery, one or more valves are either repaired or replaced. Penrose Cardiac, Thoracic and Vascular Surgery is experienced in all facets of valve surgery, including mitral/aortic/tricuspid valve repair and replacement. Dr. Mehall has particular expertise in minimally invasive mitral valve repair. Successful mitral valve repair has been achieved in over 90 percent of patients to date. Mitral valve repairs are performed minimally invasively without splitting the breastbone in over 90 percent of cases. The average hospital stay following minimally invasive mitral valve repair is four days.
Atrial Fibrillation Surgery
Penrose Cardiac, Thoracic and Vascular Surgery has been at the forefront of atrial fibrillation surgery for almost a decade and was one of the first programs in the nation to pursue surgical ablation of atrial fibrillation. Ablation for atrial fibrillation can be performed on the beating heart without dividing the breastbone, using a variety of minimally invasive approaches depending on the patient's needs. Patients who have atrial fibrillation and are undergoing traditional open heart surgery for other reasons are offered concomitant atrial fibrillation ablation at the time of their open heart surgery. Procedures to treat atrial fibrillation include removal of the left atrial appendage, the major source of strokes in atrial fibrillation patients. The goal of the procedure is to restore the heart's normal rhythm by interrupting certain "short circuits" in the atrium, which can be accomplished in most cases.
Aortic Surgery Aortic surgery can be performed using a traditional open approach, or using an endovascular approach. With endovascular surgery, a graft is guided up through the arterial system into the diseased aorta. The graft is then deployed to exclude blood flow from the diseased area. Not all aortic diseases can be treated using endovascular surgery and your surgeon will discuss the options for your particular problem.
Minimally-Invasive Aortic and Mitro Valve Repair/Replacement
Penrose Cardiac, Thoracic and Vascular Surgery is the leading minimally-invasive cardiac surgery program in Colorado and the only hospital to perform minimally-invasive aortic and mitro valve repair/replacement. Minimally-invasive cardiac surgery is performed without dividing the breastbone and may include robotic-assisted surgery using the da Vinci® surgical robot. Whether robotics are utilized or not, the patient experience is similar and averages only four days in the hospital.
Minimally invasive cardiac procedures include:
Benefits of minimally invasive surgery include:
"Bloodless" Surgery- Blood Conservation Penrose Cardiac, Thoracic and Vascular Surgery is a leader in blood conservation. Meticulous attention to all aspects of blood conservation enables Penrose
Cardiothoracic Surgery to offer cardiac surgery with transfusion rates below the national average. Dr. Mehall has experience performing cardiac surgery on Jehovah's Witnesses.
" It was really very easy. My recovery took no longer than two weeks, and I am doing great now. I just have four little incisions on my right side. I was sore, which was only natural, but I was amazed at how well I got along." --
Marlene S., robotic-assisted heart surgery patient
Surgeons at the Penrose-St. Francis Heart & Vascular Center use minimally-invasive techniques and the da Vinci® Surgical System to perform minimally-invasive cardiac surgery leading the way in state-of-the-art technology. Minimally-invasive cardiac surgery is performed without dividing the breastbone like traditional open heart surgery. These approaches may include video imaging or robotic-assisted surgery using the da Vinci® surgical robot. Patients average only four days in the hospital for most operations. Because the breastbone is not divided, there are fewer restrictions post-operatively and patients can resume normal activities more quickly. With enhanced surgical capabilities, physicians are now able to extend the benefits of minimally-invasive surgery to the broadest possible range of patients.
Minimally-invasive cardiac procedures include:
Benefits of minimally-invasive surgery include:
Talk to your surgeon to find out if minimally-invasive cardiac surgery is right for you.
For patients who have been deemed inoperable for traditional open-heart surgery, a new procedure called transcatheter aortic valve replacement (TAVR) is now available as a treatment option. TAVR is a less invasive alternative to open heart valve replacement surgery and is only offered in southern Colorado at Penrose Hospital.
Transcatheter aortic valve replacement is a less invasive procedure performed by squeezing the valve onto a balloon and inserting it with a catheter, which is sent to the heart for implantation. This insertion is typically done through the groin, however, if the patient does not have suitable access through their leg artery, TAVR can also be inserted via an incision between the ribs and through the bottom end of the heart called the apex. Once the valve is in the right place, the balloon is inflated and the valve precisely positioned. The TAVR procedure is designed to replace the patient's diseased valve while the heart continues to beat - eliminating the need for cardiopulmonary bypass (the use of a heart-lung machine).
Open heart procedure offers
renewed hope for high-risk patients
Gazette, April 13, 2013
Good candidates for TAVR include those with:
Benefits of Aortic Valve Intervention include:
What You and Your Loved Ones Should Before Your Procedure
Vascular surgery is a surgical specialty in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The Penrose-St. Francis Heart & Vascular Center has earned recognition from HealthGrades in the following areas:
Some of the procedures performed at the Penrose-St. Francis Heart & Vascular Center include:Endovascular Aneurysm Surgery In this procedure, a device called an endoluminal stent graft-or endograft-is placed inside the diseased artery to provide support for the weakened artery. The device alleviates blood pressure in the aneurysm, allowing blood to pass freely without pushing on the weakened artery. This procedure can be done in the thoracic aorta, abdominal aorta, iliac artery, or popliteal artery.
IVC Filter Placement and Removal This is an umbrella shaped device designed to catch life threatening clots from traveling to the lungs and causing pulmonary emboli. It is used when a patient cannot safely take anticoagulation, has to suspend their anticoagulation, or has clots refractory to anticoagulation. Some of these devices are removable.
Open Aneurysm Surgery An aneurysm is a swelling or ballooning of an artery due to weakness in the artery wall. This is life threatening if the artery were to burst. In open aneurysm surgery, the artery is freed up above and below the aneurysm and a new artificial artery is inserted.
Lower Extremity Arterial Surgery Many patients have clogging of the arteries that causes blockages and narrowing of the arteries that supply their legs.
Dr. Crepps and
Dr. Kissell do a variety of procedures to treat these blockages. Sometimes they can repair the artery from inside the blood vessel, or by using "endovascular" techniques similar to heart catheterization. These procedures would include stenting, angioplasty, atherectomy, and endografting. Other times they have to do open surgery to bypass or reroute around the blockage with a patient's vein or artificial artery.
Carotid Surgery A carotid endarterectomy is a procedure where the narrowed carotid artery is cleaned out in order to reduce the patient's stroke risk.
Dialysis Access Surgery
Dr. Crepps and
Dr. Kissell place peritoneal dialysis catheters and create hemodialysis fistulas and grafts for dialysis patients. They also do declots and maintenance on these accesses when they develop problems.
Varicose Vein Surgery Our doctors evaluate and treat varicose veins. They start with an ultrasound evaluation to look for venous reflux, or veins that allow the blood to flow backwards. They perform varicose vein surgery including endovenous laser ablation, radiofrequency ablation, phlebectomies, and sclerotherapy.
General Thoracic Surgery & Thoracic Oncology General thoracic surgery includes surgical therapy for a wide variety of both malignant and benign diseases of the chest. Most thoracic surgical procedures can be done using minimally invasive or incisionless (endoscopic) procedures. Some procedures are done with standard open surgical techniques and others require extremely complex surgical techniques that are only done by general thoracic surgeons. We offer all aspects of surgical care for patients with diseases of the lungs, trachea, esophagus and mediastinum.
Some of the conditions we treat include: - Lung cancer
- Gastroesophageal reflux disease (GERD)
- Cancer of the esophagus
- Hiatal hernias
- Swallowing disorders such as achalasia
- Excess sweating, usually of the upper extremity called hyperhydrosis
Some of the procedures we perform inlcude: - Removal of portion(s) of the lung containing cancer, eg, lobectomy, pneumonectomy
- Thoracoscopy or VATS
- Removal of a portion of the esophagus containing cancer and reconstruction of the gastrointestinal tract or esophagogastrectomy
- Laparoscopic Nissen fundoplication
- Laparoscopic Heller myotomy
- Thoracoscopic sympathectomy
- Bronchoscopy and/or esophagoscopy
Minimally-Invasive Thoracic Surgery (also called VATS or Thoracoscopic Surgery) Most patients with lung cancer undergoing operation can be offered minimally invasive surgery to remove the cancer. VATS uses small incisions and avoids spreading or dividing the ribs by utilizing a video scope to guide the surgeon. Because the surgeon works between the ribs with a camera, patients can recover more quickly with less pain and patients are also less likely to have complications from surgery. Patients who need chemotherapy after surgery are more likely to complete all of their chemotherapy and improve the chances of being cured.
Thoracic Oncology-Multidisciplinary Care Penrose Cardiac, Thoracic and Vascular Surgery and the
Penrose Cancer Center, the only National Cancer Institute Community Cancer Center in Colorado, offer an unprecedented level of experience, technology, expertise and collaboration to the southern Colorado communities we serve. Our multidisciplinary thoracic oncology group includes a thoracic surgeon, radiation oncologists, medical oncologists, pulmonologists, radiologists, pathologists, nurse navigators and clinical trial coordinators, and meets weekly to tailor individualized treatment strategies. This approach eliminates unnecessary testing and streamlines the steps leading to definitive care.
Penrose Cancer Center is one of 30 sites nationwide and the only center in Colorado to be selected by the National Cancer Institute (NCI) to participate in the NCI Community Cancer Centers Program (NCCCP) to encourage the collaboration of private-practice medical, and surgical and radiation oncologists. The initiative will bring thousands more Americans into a system of high-quality cancer care, enhancing treatment forunderserved populations, as well as for racial and ethnic groups with unusually high cancer rates.
After a heart attack or major cardiac surgery, patients will stay in our Cardiac Care Unit (CCU), which offers highly specialized care until their condition stabilizes. Our CCU contains extensive heart monitoring and testing equipment as well as a staff trained and certified in heart conditions and procedures. The CCU at Penrose Hospital offers heart patients a custom care experience, close to home. Nurses, physicians, respiratory therapists, dietitians, speech therapists, physical therapists, occupational therapists, resource managers and clergy members all contribute their expertise to meet patients' overall needs.
Penrose-St. Francis Cardiac Rehabilitation helps people recovering from a heart attack, valve or bypass surgery, stent implant or other heart problem. Rehabilitation helps prepare you physically, mentally and emotionally for return to work and normal family and social life. It also helps you slowly and safely get back to normal activities. Our therapists talk to you about changes you can make to help reduce your risk of more heart problems. A physician referral is required for cardiac rehabilitation. Cardiac Rehabilitation can:
Inpatient Cardiac Rehabilitation
Cardiac Rehabilitation Phase I provides educational services for patients hospitalized at Penrose Hospital and St- Francis Medical Center for open heart surgery, congestive heart failure, myocardial infarction, and other coronary artery disease related diagnoses. Trained Cardiac Nurses provide education about recovery, activity and coronary artery risk factor modification to patients and family members.
Outpatient Cardiac Rehabilitation Cardiac Rehabilitation Phase II is designed primarily for patients with a diagnosis of coronary artery disease, open-heart surgery, recent myocardial infarction, angioplasty, stent, or stable angina. This comprehensive program offers prescribed cardiovascular exercise, risk factor modification, education, on-going nursing assessment and referral to nutritionist and behavioral intervention based on individual need. This multifaceted program is designed to limit the adverse physiologic and psychological effects of cardiac illness, reduce risk of sudden death or reinfarction, control cardiac symptoms, stabilize the atherosclerotic process and enhance the patient's psychosocial and vocational status. Cardiac Rehabilitation Phase II Program is reimbursed by Medicare and most other payers. Outpatient Cardiac Rehabilitation is offered at Audubon Medical Campus and St. Francis Medical Center.
For more information on Outpatient Cardiac Rehabilitation, talk to your doctor for a referral or call:
Audubon Medical Campus 3030 N. Circle Drive, Suite 215 (corner of Circle and Union)
Colorado Springs, CO 80909
St. Francis Medical Center - 719-571-1595
The Outpatient Cardiac Rehabilitation Program at Penrose-St. Francis is proud to be the first Nationally Accredited Cardiac Rehabilitation Program in Colorado.
The Cardiovascular and Pulmonary Rehabilitation Program at Penrose-St. Francis Health Services is proud to be certified by the
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Our program was recognized for its commitment to improving the quality of life by enhancing standards of care. We participated in the one month application process which requires extensive documentation of the program's practices. The AACVPR Program Certification is the only peer-reviewed accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by the AACVPR and other professional societies. Each program is reviewed by the AACVPR National Certification Committee and certification is awarded by the AACVPR Board of Directors. Certified AACVPR programs are recognized as leaders in the field of cardiovascular and pulmonary rehabilitation because they offer the most advanced practices available. AACVPR Program Certification is valid for three years.
The Penrose-St. Francis Pulmonary Rehabilitation Program helps people with moderate to severe breathing problems overcome physical limitations resulting from their disease. Candidates for the program include those experiencing lung problems such as:
Each patient's program begins with a comprehensive pulmonary evaluation by clinical experts in pulmonary rehabilitation. Through a carefully planned, integrated and individualized program of supervised physical conditioning, exercise and educational and nutritional counseling, physical capacity is increased and the patient is empowered to overcome their shortness of breath.
Medical EvaluationA comprehensive medical evaluation is conducted by our pulmonary rehabilitation team, then an individualized program is developed based on their findings.Monitored and Supervised ExercisePeople with pulmonary disease often limit physical activity because they are frightened they will become short of breath; lack of activity, however, reduces muscle strength and causes weakness. Our pulmonary rehabilitation program includes exercises and activities tailored to your needs to help participants increase physical capacity and regain control of breathing. By combining exercise with other services patients improve their abilities to carry out activities of daily living with more energy and less difficulty.Educational ProgramsOur education classes focus on COPD and other chronic lung diseases providing you with information about:
Psychosocial SupportPeople who have chronic lung diseases are more prone to depression, anxiety and other emotional problems. Our program offers counseling referrals from a variety of sources.
Pulmonary Rehabilitation helps you improve your quality of life. Even though pulmonary rehabilitation can't cure your lung disease, it can be of great benefit. And, you may notice improved breathing effort and less breathing problems.Additional benefits include:
A physician referral is needed to participate in the pulmonary rehabilitation program. Talk to your doctor to find out if pulmonary rehabilitation is right for you. To learn more about the Penrose-St. Francis Pulmonary Rehabilitation Program, call 719-776.4880.
Audubon Medical Campus3030 N. Circle Drive, Suite 215Colorado Springs, CO 80909Phone: 719-776-4880Fax: 719-776-4866
The Penrose-St. Francis Heart & Vascular Center Aortic Disease Clinic offers comprehensive evaluation and long-term management of patients with all varieties of aortic disease - aortic aneurysms, aortic dissections, aortic ulcers, and stenosis/atherosclerotic disease of the aorta. Any patient with an aortic abnormality will be evaluated and a plan for either continued surveillance or repair will be developed. After either open or endovascular repair, all aortic patients will continue to be followed for life to monitor the repaired aorta and because many develop other aortic diseases or complications. For more information, call 719-776-7600.
The Penrose-St. Francis Anticoagulation Clinic is a service established to monitor and manage the medication(s) that you take to prevent blood clots. Physically, it is a specified location within a hospital or a medical office that is staffed by Pharmacists, Nurse Practitioners, and/or Registered Nurses. This group of providers, working in conjunction with your physician, will test your blood and adjust your dose of warfarin (Coumadin ® or Jantoven ®) as well as other medicines that may be needed (such as heparin shots or Vitamin K, the antidote to coumadin).
Our clinic's primary goal is to minimize and prevent adverse events and hospitalizations related to complications from anticoagulation therapy while maximizing patient benefits. The clinic also strives to develop well-informed, compliant patients by providing comprehensive, ongoing education. The clinic provides consistent follow-up and communication with the referring or primary physician.
Our clinic is staffed by professionals with specialized training in anticoagulation management with Physician Medical Director oversight. Through a comprehensive process which includes on-site laboratory testing using venous blood with immediate results, the clinic monitors the patient's therapy and adjusts dosages according to protocol to maintain a therapeutic International Normalized Ratio (INR). At each clinic visit, the provider also monitors patients for hemorrhagic and thromboembolic complications and provides patient education regarding the safe use of anticoagulation therapy. The provider serves as a resource for physicians to assist in the stabilization of patient's anticoagulation therapy.
Benefits to patients:
Patients may be followed upon written referral from a physician. For more information or to schedule an appointment at the Penrose-St. Francis Anticoagulation Clinic, please call 719-776-3600. Physician referrals may be faxed to 719-776-3610.
The Penrose-St. Francis Heart & Vascular Center provides a multidisciplinary murmur clinic in which patients with heart murmurs are evaluated with echocardiography then jointly by a cardiologist and cardiac surgeon. A collaborative plan for management is then developed and follow-up is arranged. A nurse coordinates the patient's care and facilitates communication with the patient's primary care physician. A screening tool for heart disease is also offered to primary care physicians who can apply it to their patients. Results of the screening test are reviewed by the coordinating nurse and patients with positive findings are brought in for evaluation.
For more information, call 719-77-MURMUR (68768).
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Mountain View
Director: Brooke Morrow
1810 Ozarka College Drive
Mountain View, AR 72560
The KIDS FIRST clinic in Mountain View is the one among the 11 with the smallest enrollment and is located in the community with the least Services. The local Community Health Planning Group was the driving force in persuading KIDS FIRST to locate in their town. They pointed out that the area was greatly underserved with virtually no meaningful Services for young children. The CMS nurse was heard to tell KIDS FIRST administration that, "If you build it, they will come."
Agreeing to become a part of the community, KIDS FIRST located in a commercial building just across from the local hospital and began to accept children into the program. The greatest challenge then, and continuing today, is the lack of transportation. After several years in the community, the program changed location and is now located in a newly renovated building with lots of space for the growing enrollment.
Strong area legislators and city leaders have assisted the program in "getting the word out" and garnering local recognition. Local newspaper owner/editor Rusty Frazier has been a valuable asset, and dedicated staff members keep good things happening for the children they serve.
KIDS FIRST Mt. View works in cooperation with local, area and state colleges to provide observation and training to nursing, early childhood and special education students.
For more information contact us at: 870-269-2110.
Donations made through the UAMS Foundation will benefit the children served in Mountain View.
Please indicate in the Fund Name field that Mountain View is the clinic you wish to support.
Donation Link:

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Coordinated services for child sexual abuse victims and their families
The Foundation's program, Local Funding Partnerships, was designed to continue a matching grants program to establish partnerships between RWJF and local grant makers in support of innovative, community-based projects that improve health and health care for vulnerable populations.This grant project will establish a Family Resource Center to provide comprehensive, coordinated services to victims of child abuse and also to their families. Crisis intervention and support services will be provided during the initial disclosure period and services such as medical exams and treatment as well as housing, food and emergency financial aid will be provided to the victim and family. The program will help families reconstruct a healthy environment and provide specialized treatment services and linkages with appropriate agencies. It is estimated 35 families could be served in year 1, and 75 families per year thereafter, resulting in approximately 1,000 encounters in the first year and 3,500 annually thereafter. RWJF funds will be applied to the health and mental health needs of the children and families served. Local funding partners include: the Kalamazoo Foundation, Irving S. Gilmore Foundation, and the Dorothy U. Dalton Foundation. State and local government agencies, the United Way and other voluntary institutions will finance the costs of the project in the future.
Grant Details
Amount Awarded $349,933.00
Awarded on: 7/13/1989
Time frame: 8/1/1989 - 9/30/1993
Grant Number: 15607
Kalamazoo Child Guidance Clinic
Sharon L. Roepke
Project Director


text:
It's equally possible to just cut the node off at it's power source. Does anyone know of a (cheap) power strip with a serial[1]/usb[1]/network interface where I can send signals to cut off individual ports power?
If I can't switch off individual power ports, I will need to buy two and have the nodes each manage the opposite node's power.
[1] If it's serial or USB I'll need to use a third node as a proxy to the device, which is annoying, but quite possible.


text: Melissa & Doug Royal Family Wooden Doll Set add fun characters to enhance a full - size castle set! Roll out the red carpet! Here comes the Queen and the King, the Princess, the Prince and two Royal Mounts! With flexible arms and legs, these six wooden figures add the royal touch to castle play. Measures 12 x 2 1/2 x 11 1/2". Fantastic Melissa & Doug quality, at a great price! Order Now! Melissa & Doug Royal Family Wooden Doll Set.


text:
Urban Decay Half Baked
199 reviews
85% would repurchase
Package Quality: 4.3
Price: $$$
Package Quality: 4.3
Price: $$$
Not tested on animals
Urban Decay is a Cruelty-Free Subsidiary.
INGREDIENTSTalc, Ethylhexyl Palmitate, Zinc Stearate, Methylparaben, Propylparaben All Shades May Contain: Mica, CI 77891 (Titanium Dioxide), CI 77491/CI 77492/CI 77499 (Iron Oxides), CI 77007 (Ultramarines), CI 75470 (Carmine), CI 77742 (Manganese Violet), CI 77510 (Ferric Ferrocyanide), CI 77288 (Chromium Oxide Greens), CI 77289 (Chromium Hydroxide Green), CI 77163 (Bismuth Oxychloride), CI 77000 (Aluminum Powder), CI 77400 (Bronze Powder), CI 19140 (Yellow 5 lake), CI 42090 (Blue 1 Lake)
Where to Buy
- When you make a purchase through these links, we may receive a commission from the eBay Partner Network or other affiliates.
Start your review
on 3/6/2017 10:54:00 PM
Age: 25-29
Skin: Dry, Fair, Warm
Hair: Brunette, Curly, Medium
Eyes: Brown
I bought this because Benefit was out of Fawn Over Me, the goldish bronze single I initially went in for. I decided to try this instead because I've heard good things about UD eyeshadows and had always eyed this color, which is the color family I always wear.
I'm warm-toned and pale, with overall dry skin.
For me, this eyeshadow is very meh, and the quality is lacking for the price. This was a very poor substitute for Fawn Over Me, which sweeps on so smooth it's almost like a cream shadow. By comparison, this applies patchy and takes more strokes to apply evenly. It is also much more expensive for the amount of product. I've hit pan after just a few months of occasional wear. I think this is a workable warm-toned color in a palette but really don't think it's worth $20 for a single.
on 7/12/2016 6:20:00 PM
Age: 36-43
Skin: Very Oily, Fair-Medium, Neutral
Hair: Brown, Wavy, Fine
Eyes: Grey
I got this as a duo in Sephora's 2016 Bronze Bares All set 8 things in the set for $39 (the duo was HalfBaked/TwiceBaked). It is the perf pale beige w darker copper flecks almost like. It is prettier than the Clinique duo in Like Mink which is 1 of my other fave duos. The UD is a little edgier (Clinique is more "safe"), but anyways it is soooo pretty! It goes well w Sephora's Cocoa eyeliner. <3!!! Winning!! (Just not real fond of the cannabis-based names).
on 6/24/2015 12:01:00 AM
Age: 18 & Under
Skin: Combination, Medium, Not Sure
Hair: Brunette, Other, Other
Eyes: Brown
Okay so I don't think I included everything I needed to when I last reviewed this product.... So this is an update. This eyeshadow is okay. If I set my primer before applying it the color looks quite nice. I initially didn't like this because it looked like a chunky eyeshadow and was patchy. But that's only when I put it directly on primer without setting it. I've haven't had any issues with my other UD eyeshadows looking patchy. But still, even tho I found a way to make this work, I still don't find anything impressive about it. It's not the most pigmented gold I've used and there are much better gold eyeshadows out there. The quality is just meh... I just wish it wasn't as chunky
on 5/27/2015 9:32:00 AM
Age: 19-24
Skin: Acne-prone, Fair, Neutral
Hair: Blond, Wavy, Fine
Eyes: Blue
This eyeshadow highlights my eyes wonderfully. It's very pigmented, and when used with primer, has excellent staying power. I first used in it a Naked palette, and then knew I was going to use that color up much faster than the rest, so I purchased it separately.
I'm not that partial to how Urban Decay packages their individual eyeshadows, I think they look a little clunky, and the price is pretty high. One package of it will last a long time though, and the product itself is great.
The Naked palettes are the best deal if you think you'll go through more than one of the shades fast enough.
on 4/19/2015 8:03:00 PM
Age: 19-24
Skin: Combination, Fair-Medium, Not Sure
Hair: Blond, Other, Other
Eyes: Brown
One of my favorite urban decay shadows. Can not put this down in the summer when I'm tan. So beautiful
on 4/10/2015 2:59:00 PM
Age: 44-55
Skin: Normal, Medium, Neutral
Hair: Blond, Wavy, Medium
Eyes: Green
If your a shadow lover like I am then you know how awesome Urban decay shadows are regardless the color. Full of pigment, doesn't fade and blends beautifully with other colors. Half baked is my favorite color. I have green eyes and whenever I wear it I always get compliments on my eyes. I like to pair it with one of their dark purples or a deep Aqua green! Awesome any time of year.
on 4/8/2015 1:28:00 PM
Age: 19-24
Skin: Oily, Medium, Warm
Hair: Black, Other, Other
Eyes: Brown
I've had this eyeshadow tucked away in my makeup drawer simply because I haven't got any time to do my eyes before work. Out of curiosity today I decided to use it as a highlighter. WOW! Looks beautiful on my medium-tan complexion. Normally, highlighters make me look greasy and shiny (I have oily skin) but not this one. Though it is intended for eye application, looks fab applied as a highlighter!
on 4/7/2015 1:44:00 PM
Age: 56 & Over
Skin: Dry, Fair-Medium, Neutral
Hair: Blond, Straight, Fine
Eyes: Blue
l o v e the color. It's a great day in day out shadow.
on 4/7/2015 6:12:00 AM
Age: 19-24
Skin: Dry, Fair, Not Sure
Hair: Red, Curly, Fine
Eyes: Brown
I love this eyeshadow. It suits me well, it's awesome to apply and I love to use it. The only reason I would not rebuy this is because I have been using this single shadow since high school and I still have about 6+ months of constant usage before it will be completely used up. It's been at least five years of using this on and off and it's still here. As much as this could be considered a positive tribute, I like to be able to use things up in a reasonable time.
on 2/9/2015 12:59:00 AM
Age: 30-35
Skin: Normal, Fair, Neutral
Hair: Brunette, Wavy, Fine
Eyes: Brown
I love the texture and pigmentation, but Half Baked is too orange for me. I don't like the way I look in coppers (not dark brown copper but brighter penny shades). This is way way warmer than a newly minted penny to me. I can probably pull it off but I dont like it. Still giving it a 3 since the formula rocks and more golden fair skin tones probably would love it, and I can see it being universally appealing on warmer and darker shades.
Popular Eye Shadows
46 Reviews
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1038 Reviews
146 Reviews
63 Reviews
Where to Buy
- When you make a purchase through these links, we may receive a commission from the eBay Partner Network or other affiliates.


text:
Forum:AAA image
From Uncyclopedia, the content-free encyclopedia
Forums: Index > Village Dump > AAA image
Note: This topic has been unedited for 4142 days. It is considered archived - the discussion is over. Do not add to unless it really needs a response.
Permission to add this image to AAAAAAAAA!?
- NAAAAAAH. Far too many consonants. --Algorithm (talk) 03:00, 22 March 2006 (UTC)
- 'Agreed. Only Ayes. t o m p k i n s blah. ﺞوﻦ וףה ՃՄ ண்ஸ ފއހ วอฏม +տ trade websites 03:02, 22 March 2006 (UTC)
- Not much here that couldn't be done with the online "acme licence plate maker" - not worthwhile unless you were to GIMP or P'shop the rest of the plate to contain something more originaaaaaaaaaaaaaaaaaaaaaaaaaaaal. --Carlb 14:13, 22 March 2006 (UTC)


text:
Guess Who? -NBA Edition-(Free)
by: HitHot • 278
All Android applications categories
by: HitHot • 278
"Guess Who? -NBA Edition-" is a Pictionary-like game collects many photos & images of top NBA players.
Let's go through a series of top NBA player pictures and see how well you can recognize them.
The sooner you make a correct guess, the higher score you get.
Are you a TRUE NBA FAN? Just download "Guess Who? -NBA Edition-" and have fun with it!
☆ How to play:
1. Click "PLAY" to start.
2. Select your favorite role.
3. Choose the correct answer according to the images.
4. Win special awards when key milestone reached.
☆ Support Android 2.2+ or iOS3.2+ or more
☆ Official Website: http://hithot.cc
☆ Official Facebook: http://www.facebook.com/HitHot.cc
☆ Any Questions? Please leave a message on HitAsk (http://hitask.hithot.cc/tags/5722/).
Keywords: Jeremy Lin, Knicks, Derrick Rose, Michael Jordan, Dirk Nowitzki, Dwight Howard, Dwyane Wade, Kevin Love, Kevin Durant, Blake Griffin
Tags: nba characters gues , теннисист в угадай кто , угадай кто на андроид
from 278 reviews
Download Guess Who? -NBA Edition-(Free)
Free - V1.1.1 - 5M
Sorry ...
This app is no longer available.
Share this app


text:
R. J. Marshburn & Associates
CERTIFIED RISK MANAGERS.com
Additional Insured Coverage for Construction Defects –
General Liability Endorsement CG2010 11/85 edition – is GONE!
Robert J. Marshburn, CRM, CIC, ARM, CRIS, CISC
There is no longer any responsible carrier we know of that will endorse the Commercial General Liability policy for residential construction in California with this edition date of the Additional Insured endorsement for completed operations. It is rapidly becoming unavailable in other states as well. It is also becoming extremely difficult to get for commercial construction.
In the past, this endorsement obtained by Sub Contractors on their policies gave the Additional Insured (the Developer/General Contractor) the ability to not only transfer the completed operations liability of the construction operation for as long as the statue of limitations would allow (usually at least 10 years), but also gave the Additional Insured coverage for the costly defense of Construction Defect Liability under the Sub's policy.
The Additional Insured endorsement that carriers will now accept and use are the newer 1993, '97, 2001 and 2004 versions that only allow coverage for "ongoing operations", not completed operations, and therefore have NO coverage for Construction Defect Liability or defense costs for the Additional Insured. Carriers will generally not issue the ISO CG2037 10/01 combined with the later versions of the CG2010, since it is essentially the same endorsement as the old CG2010 11/85 edition for completed operations.
Those carriers that have in the past issued the CG2010 11/85 for the Subs suffered the long term obligation over many years to defend and pay judgments of the Sub as well as the Additional Insured and have been swamped with claims and costs. A number are now insolvent. The last of the carriers who were still doing so have now pulled the plug on issuing this endorsement to try to avoid the same fate...
Many contractors and carriers are using Wrap Policies (OCIPs, CCIPs, etc.) to cover these exposures, but they contain many dangers and gaps of their own. California will no longer allow the Owner, General Contractor, or Developer to to be indemnified or insured by the subcontractor for these residential wrap-up construction projects!
manage this risk, General
Contractors and Developers are now going to have to be sure that they deal ONLY with
Sub Contractors that:
Do quality work in the first place;
Have a SUPERIOR customer service department that will 'cure' any alleged
defective workmanship by their people in a timely manner;
Do business with subcontractors that are financially sound and will be
there to handle problems with their workmanship 7, 8, 9, 10 years down the road
when the complaints and lawsuits will appear.
They can no longer shift the financial burden via endorsement and be assured of payment by the insurance companies. They will have to be sure the Sub Contractors themselves are reliable, financially sound, craftsmen. Using the lowest bidder with questionable work that creates problems, especially for those without the financial ability to correct any problems, will be far too risky in the future.
Additionally, there is now a need to revise all the Sub Contractor contracts to reflect the new reality.
Fixing problems in workmanship is no longer 'insurable' by means of this Additional Insured endorsement and each contractor will fund the repair out of their own pockets with their own funds... so it is important that they are financially healthy.
Quality, responsible, financially sound contractors with a solid performance record are now going to be in very high demand!
CONTRACTORS now more than ever need qualified, experienced Risk Managers who are
specialists in Contractual, Legal, and Construction Defect matters to develop a
set of Construction Defect Risk Management Protocols that will:
1. Provide quality workmanship with a comprehensive program designed and focused to avoid and prevent Construction Defect issues.
2. Provide the contractual right to cure any alleged problems without costly litigation. This is now a necessity!
3. Devise and install internal service, claims, and legal procedures that minimize costs. A great deal can be done in this area!
4. Avoid, prevent, and minimize potential Construction Defect Claims before they reach the litigation stage. We have innovative ways of doing so!
5. Provide (and revise) sound contractual provisions that provide protections and clarity to all the Sub Contractor contracts to reflect the new reality. There are a number of ways to do this.
6. Devise these protocols to integrate with the SB800 Construction Defect law in California or the "right to repair" laws and case law in your state.
And, bottom line, protect the bottom line…
A Risk Management Specialist managing the costs for Construction Defect claims
is now more important than ever, since these costs will now come directly out of the
pocket of the contractor, NOT the insurance company.
A strong, well implemented set of Construction Defect Risk
Management Protocols will contribute heavily to the bottom line in the
years to come through claims that are avoided completely, or at least
significantly reduced…
widely recognized National Educators
and Consultants specializing in solving Construction Defect and related issues
we are happy to
help you with a personalized program to protect your bottom line in this rapidly
changing area.
If you would like information on how our consulting services can benefit your business, please contact us.
Home I Biographical Profile I What we do I Consulting Services I Useful Information I Consulting Options I Contact Us
© Copyright 1999-2016 R. J. Marshburn & Associates, CertifiedRiskManagers.com. All Rights Reserved.
May not be used or quoted without written permission.


text:
Commuter Services
Commuter Services is committed to supporting commuter students with an intent to foster a sense of belonging at Hawaii Pacific University. We are committed to providing resources and services so our commuter students will feel integrated as part of the campus community. Our vision is to support our students to becoming active members of the campus and local community with the following services:
Community resources for students
- Provide off-campus housing options
- Provide resources for reasonable rates for airport shuttles to and from campus
- Disseminate information on rights and responsibilities living in community more effectively
- Promote awareness regarding personal safety and wellness
- Provide students opportunities to learn more about Oahu
Information and programs for students
- Information on student study and gathering spaces on campus
- We ensure that students have information on effective ways of getting to and from campus
Collaboration with university partners in presenting purposeful social and educational events for students
- Grab N' Go
- Commuter Apprecation Week
- etc.
Commuter Services at HPU is ready to serve the needs of HPU students commuting to our downtown, Hawaii Loa and military campuses. Are there ways you would like us to better serve you? Are there resources you would appreciate on this site? Please stop by our office (MP139) or email us at firstname.lastname@example.com.


text:
Andrew Rawnsley's Servants of the People was the heavyweight of the year; Julia Langdon's biography of Mo Mowlam also raised No 10's blood pressure, while everyone was sick to death of New Labour sleaze by the time Geoffrey Robinson's memoirs were published. Michael Heseltine and Paddy Ashdown won plaudits for sanctimony disguised as revelation. But for exposing the true venality and insecurity of power, there could be only two winners.
Alan Clark Diaries: Into Politics
Buy it at BOL
The tip of my penis is numb, there are bags under my eyes, but I feel strangely randy. Why don't the blondes ring? Those Wurzels in Plymouth do go on. They don't even like Enoch. I should get a new constituency. Lost a fortune at backgammon, but had lunch with Margaret and Ian. Passed over again. Think I've got cancer.
Journals of Woodrow Wyatt: Major to Blair
Buy it at BOL
Rupert ignored me. Must be more obsequious. Morton's suggesting Prince Charles had an affair with Camilla. Ridiculous. Must write something to that effect. The Royal Household has congratulated me on my perspicacity. Norman Lamont, what a genius. He's my friend. He's been sacked. He's not my friend. I love Maggie. She's been mistreated. Don't think I've got cancer.
Father and Son
The new genre created by the family credited with creating almost every literary genre since the 1950s, including ones they haven't.
Letters of Kingsley Amis, edited by Zachary Leader
Buy it at BOL
My dear Philip, Sorry not to have written earlier, been up to my neck in the Taffy novel. Hv dn bggrll. My wife has left me. Punishment for not wanting to fuck her. Didn't even want to fuck the Penguin publicity girl. It's me. I'm piling on the pounds. Must be the booze. Bored after a few pages of Mart's latest.
Experience by Martin Amis
Buy it at BOL
I write to commemorate my father. There will be no point scoring, apart from Julian and Eric, and if I name drop it is only because I always have. This is no ordinary autobiography, rather a journey through the unconscious. It is here in the writerly "un" that Delilah and I met. How blessed I am to be able to have relationships that transcend the need to spend time with my children.
The best turkeys are always those from whom so much more was expected.
Honeymoon by Amy Jenkins
Buy it at BOL
There hasn't been a day when I haven't thought about the love of my life. And now I'm getting married to Ed. We get along all right, even though he's not my type. OHMYGOD. The love of my life is in the same hotel and is on honeymoon. It could be straight out of Noel Coward. In fact, it is. "Let's elope in a helicopter," he says. We go to Mexico. "You're not there for me," I say later. "But I'm here," he counters. "But not there." "Meet the love of my life," I tell the girls on my return. In walks Ed.
Down Under by Bill Bryson
Buy it at BOL
Australia is very, very big. Americans know next to nothing about it and as I've got a contract to write a feature for a magazine, I might as well do a book, too. Sydney looks kinda nice, but I can't stay as I've got a train to catch. Two hours in third class is enough, so it's back to first. Look, here's Perth. Hmm, that might have been Melbourne, and Adelaide museum would have been neat if I could have spared the day to wait for it to open.
Despite offerings from Julian Barnes, AS Byatt, Muriel Spark, Margaret Atwood et al, most reckoned it was a mediocre year. There were two novels, though, which did get talked about.
How the Dead Live by Will Self
Buy it at BOL
I hate my fucking junkie daughter, Natty. I hate my other daughter, Charlie. Fuck. I've just fucking died. I'm now in fucking Dulston, the fucking suburb of the dead, with Lithy, my fossilised miscarriage, and Rude Boy, my seven-year-old car-accident victim. Jesus. Fucking Natty's on and off the scag and got herself up the duff. I'm going back. Natty's OD'd. I'm fucking done for.
White Teeth by Zadie Smith
Buy it at BOL
Archie tries to top himself and fails. He's that kind of guy and he lives in that kind of north London multicultural borough. Why should his identity crisis be more important than anyone else's? He marries Clara, a black woman 30 years his junior, and they have a child, Irie, who is also a nerd and so doubly marginalised. Irie loves Millat Iqbal, an Islamic militant. Millat starts to reckon he's a gangster, while his twin Magid returns from Bangladesh an Anglophile. Everyone is very multicultural and very fucked up.
And phenomenon...
Harry Potter and the Goblet of Fire by JK Rowling
Buy it at BOL
Harry, Hermione and Ron assembled in the Great Hall at Hogwart's. "For the first time in hundreds of years the Triwizard cup will be held here," said Prof Dumbledore. Harry represented Hogwart's. His scar burned after two challenges. Voldemort was at hand. The Quidditch pitch was transformed. "Wow," said Harry on page 636. "Kisses, deaths, battles, ghosts and resurrections. I could do with a year off."


text:
2005 Saturn Relay Reviews and Owner Comments
2005 Saturn Relay owners review and rate their 2005 Saturn Relay.
Login to Review This Car
2005 Saturn Relay (3 Reviews)
This is the absolute worst car anyone could ever consider purchasing. Well, seeing that Saturn is no longer around I guess there is no worry. This thing has been nothing but a money pit since we bought it new in July of 2005. In the last 2 years, I have put on 5 brand new alternators, replaced the battery 2 times and have had to replace the starter. In addition, the ABS/Traction light comes on and I have replaced both front hubs twice. The dealer tells us that there is no recall info for the constant "Battery Saver Active" or the "Charging System Failure". I call bull crap on that one. I have replaced the battery terminals and even ran a new ground wire as per Saturn's advice. Please if others are having the same issues, let me know. Email me at:
Thank you,
Thank you,
We've had our 2005 2+ Relay for six years. We've had one warranty repair and one repair out of warranty. So far we are completely pleased with our minivan "Bessie"
This is an extremely reliable and family focused vehicle


text:
(MOBERLY, Mo., AP) — The president of Moberly Area Community College will become the new president of a community college in Bentonville, Ark.
Evelyn Jorgenson said Wednesday she will leave the Moberly school at the end of this academic year. She'll start her new job at Northwest Arkansas Community College on July 1.
Evelyn Jorgenson has been president of the Moberly school of 16 years. In that time, the school constructed several new buildings, including the Graphic Arts/Fine Arts Center, the McCormick Commons and the Residential Center. The college also is planning a new facility in Hannibal.
The Columbia Daily Tribune reports (http://bit.ly/Urvd8V) the school started study abroad and online degree programs during Jorgenson's tenure.
Information from: Columbia Daily Tribune, http://www.columbiatribune.com


text:
Julianne Moore turns to celebrity trainer David Kirsch to look red-carpet ready. Here, David Kirsch shares the workout celebrity mom Julianne Moore uses to get in shape.
Get Slim All Over
A combination of cardio and strength training quickens weight loss. Do 30 minutes of cardio three times a week and light weights twice a week.
Get Six-Pack Abs
- Lie faceup holding a stability ball with your arms extended over your head.
- Raise arms and legs to meet over your abs and place the ball between your ankles.
- Repeat movement, taking the ball into your hands.
- Do 3 sets of 10, 3 times a week.
Work Your Butt with Sumo Sidekicks
- With feet wider than shoulder-width apart, bend knees past 90 degrees.
- Stand and kick right leg to side at hip height.
- Repeat on left.
- Do 20 reps 3 times a week.
Get more celebrity workout plans and tips here!
Originally published on FitnessMagazine.com, January 2009.


text:
Growing performance demands. Enhanced compliance and security regulations. Increasing business and operational risks inherent with competing in a global market. Amid these and other trends, the concept of governance, risk, and compliance (GRC) has become a frequent boardroom topic.
To evaluate how your company measures up against competitors consider the following:
Is your GRC dashboard integrated with performance management?
A converging view
Traditionally viewed as separate organizational silos, these disciplines today are converging to become an
integrated enterprise framework. Organizations in all industries have matured their perspectives on GRC and are expanding their initiatives to cover an integrated and enterpriselevel view of risk and compliance.
GRC defined
Based on standards and the work of various professional associations and regulatory agencies, we define the three key components as follows.
Governance. The culture, policies, processes, laws, and institutions that define the structure by which companies are managed. Corporate governance includes relationships among stakeholders, the board of directors, management, and organizational goals.
Risk. The effect of uncertainty on organizational objectives. Risk management involves coordinated activities to direct and control an organization toward fulfilling opportunities while mitigating the negative
consequences of events.
Compliance. The act of demonstrating adherence to external laws and regulations, as well as corporate policies and procedures. Compliance management involves the practice of coordinated activities to ensure the company stays within internally and externally mandated boundaries.
Integrated metrics to enhance decision making
An integrated GRC platform applies key risk indicators (KRIs) and key compliance indicators (KCIs) alongside
management's key performance indicators (KPIs) to provide a dashboard of information for decision making. As a result, management gains visibility of external and internal business environments so that it can protectand grow value within established risk tolerance and legal boundaries.
West Monroe Partners' GRC methodology covers both corporate and IT governance, enabling you to establish an effective framework for decision making and behavioral change. We align GRC elements and principles at the strategic, tactical, and operational levels, while at the same time integrating and managing the most essential processes related to a variety of activities.
A comprehensive methodology
West Monroe Partners' GRC methodology incorporates the following activities:
Benefits—economic and otherwise
A comprehensive GRC solution guides activities throughout the governance, risk, and compliance lifecycle from the corporate to the IT levels. By doing so, it produces an array of benefits:


text: photo © 2008 Dr. Wendy Longo | more info (via: Wylio) Right now it's 6pm on Saturday in California. There's a possibility that I'm no longer in my home state however, as the rapture was to come on Saturday May 21st, 2011 at 6 o'clock in each time zone. If this is indeed the case, [Read More…]


text:
Twittelator for iPad and Twitter
By Big Stone Phone
Open iTunes to buy and download apps.
Twittelator for iPad is the ultimate way to experience Twitter on your iPad.
Absolutely nothing was taken for granted when redesigning Twittelator for the iPad. Every graphic and interaction was distinctly tailored to create a best-of-breed Twitter experience.
- Beautifully designed and visually rich interface
- Shoot/upload video and snapshots on iPad 2
- Post to Facebook Wall too
- Friends' tweets are presented persistently in landscape
- See images inline in your friends' tweets feed
- Messages are presented in a chat view
- Set customizable wallpapers
- Discover nearby Twitter users
- Create and manage drafts
- Terrific multiple account support
- Post photo and audio tweets
- Automatically splits up long tweets to allow longer messages
- All this amongst a rich set of other highly tuned features
What's New in Version 2.7.1
You can choose Library Photos in iOS7 once again!
iPad Screenshots
Customers Also Bought
- Category: Social Networking
- Updated: 12 December 2013
- Version: 2.7.1
- Size: 17.3 MB
- Languages: English, Japanese
- Developer: Stone Design Corp
- ©2008-2013 Stone Design Corp. All Rights Reserved.
Compatibility: Requires iOS 5.0 or later. Compatible with iPad.


text:
Office Hours: 10AM - 2PM
Phone: (610) 566-1725
Email Us -->
Running a Household Still at the Colonial Pennsylvania Plantation
with Clarissa Dillon Ph.D
Currently an inactive event.
Stills were used for more than just moonshine in colonial times. Join us and watch
Clarissa Dillon operate a replica 18th-century still that will produce peppermint water, a medicinal. There are two possible products from the process of distilling. It depends on the liquid put into the still: water in, water out or alcohol in, alcohol out. Colonial housewives were very familiar with both processes. Those with stills produced medicinals, cosmetics and various household preparations. There will also be a display of various products using 18th-century receipts.SORRY, NO TASTES!
Clarissa has worked as a teacher, writer and consultant on 18th century housewifery for forty years. She was a founding member of the Past Masters in Early American Domestic Arts. Visit Clarissa's website at http://www.clarissadillon.info for more information.
Search Site:


text:
ELY, Minn. (AP) — A researcher who helped make a worldwide star of a Minnesota black bear by airing her birth on the Internet says he believes the animal is dead.
The bear, named Hope, went missing in mid-September. Lynn Rogers, a researcher at the North American Bear Center in Ely (EEL'-ee), said he was contacted Tuesday by a hunter who said he shot and killed the bear.
The hunter told Rogers he didn't know the bear was Hope when he shot her Sept. 16. Rogers said he's confident the bear was Hope because every other female bear known to be in that area of northern Minnesota was accounted for.
Rogers declined to give the hunter's name. He also says criticizing the hunter won't help his center's research and education efforts.


text:
Uncyclopedia:Pee Review/User:Bobofosho2/Ventura, CA
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edit user:bobofosho2/Ventura, CA
I created this article like a film noir dectective movie. Cheers and thanks-Bobofosho2 02:21, 9 July 2008 (UTC) Bobofosho2 02:21, 9 July 2008 (UTC)
|I didn't find anything humorous about this article - At all.
|The idea sucked. I think you might be better applying your time elsewhere, the concept isn't funny to begin with.
|Prose and formatting:
|Your main issue might be the parentheses. You need less of them. Also, run-on sentences are a no-no. There's this rule that basically says 'all or nothing' in reference to capitalization. There are some words, we don't capitalize in headers…Like 'the' for example. But mostly, if you're going to make some things all caps, you've gotta do it with everything else, too.
As for formatting, you're having issues with ugly text. I'm seeing a lot of blocks of text that are aren't very nice looking. So you might want to fix that to make it easier on the eyes.
|I have this distant feeling you tried to find relevant pictures. These ones, however, were not it. I think I see some semblance of hiding relevance somewhere…If only they were funny, though. All in all, I think you need some pictures that make a bit of sense with article, and have some humor value.
|This is an average of your other scores, basically.
|Final Score:
|Sorry to say this, but I feel like this article is a waste. Something that will be deleted in a few days. It might be worth your while to apply your time to a different concept, with hopefully better results. Good luck.
I gotta say, I didn't think this was so bad. It's an interesting way to approach a town article, and the style alone makes me chuckle a bit. OK, so it does feel random here and there, but this is a massive improvement on your previous stuff, Bobofosho, and a real step in the right direction. Reviews are a matter of opinion, of course, but I'd have scored this significantly higher - you might want to get a second opinion there. --UU - natter 09:32, Jul 17
- Agreed. It's an interesting and unique take on a town article. My first suggestion would be to put in a bit of film noir lingo, "dames" and "joes", that sort of thing. The pics aren't that great and the captions that go along with them don't help at all. Other than that, just polish it up a bit and I think it's mainspacable (is that a word?). -OptyC Sucks! CUN17:17, 17 Jul


text: Home > Projects > Energy Efficient > Q&A: Protecting Below-Grade Framing Energy Efficient Q&A: Protecting Below-Grade Framing Fanning Clapboards By Henri de Marne Login or Register to download the PDF version of this article. (413.58 kB) A.Henri de Marne responds: All stained or painted wood siding will absorb water. Protective coatings help reduce absorption, but do not prevent it, especially after some weathering time. Plus, moisture is absorbed through shiplap joints, the tongues and grooves of solid-board siding, and the bottom edges of clapboards. Also, as any wood moves with the changes in the climate, thirsty, unpainted surfaces become exposed. Then there is capillary attraction between two meeting surfaces, which can drive moisture well beyond the exposed parts of any uncoated wood.All these conditions make wood siding vulnerable to moisture. If it stays wet, it won't be long before you have mildew problems. Once mildew sets in deeply, no surface power-washing, even with added chemicals, will reach deep enough to get rid of it entirely. Login or Register to continue reading


text: By CORALIE CARLSON, Associated Press Writer KEY WEST, Fla. - Like Superman emerging from a phone booth, Armando Parra steps out from the bathroom of his old-time barbershop transformed into the Chicken Catcher, dedicated to ridding this island town of nuisance fowl. AP Photo Related Links •Key West Hires a Chicken Catcher (NPR) •Key West Chicken Catcher - official site To some, Parra is a hero clearing out the birds that tear up lawns, sneak inside houses to perch in Christmas trees and leave a carpet of droppings in their wake. To others, he's a villain, snatching beloved roosters and speckled hens from neighborhood streets where they delight tourists and residents alike. Wearing shorts and a mostly unbuttoned shirt emblazoned with "Key West Chicken Catcher," the 63-year-old Parra climbed into his two-tone blue van and started another patrol one recent afternoon. full story: http://story.news.yahoo.com/news?tmpl=story&u=/ap/20040317/ap_on_re_us/chicken _catcher -------------- next part -------------- An HTML attachment was scrubbed... URL: http://lists.envirolink.org/pipermail/ar-news/attachments/20040317/e7239316/attachment.html


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This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
The ability to restore American chestnut (
The American chestnut (
The chestnut blight (
To date, American chestnut restoration has largely focused on producing a blight-resistant tree through a backcross breeding technique with resistant Asian parental species, [
After decades of blight-resistance and hypovirulence research conducted by several programs, chestnut reintroduction trials are underway [
Pure American chestnut seedlings respond positively to increased light in the field and under controlled environmental conditions [
Prior to the arrival of blight in eastern North America, chestnut dominated a wide range of forest site types (3). Incidence of blight was related with topo-edaphic conditions, including elevation [
To our knowledge, this is one of only a few studies within the natural range of the species that has empirically tested the response of American chestnut planted under two contrasting light regimes created through shelterwood regeneration prescriptions [
In this study, we examine survival, growth, and blight development of American chestnut seedlings five years after planting. Our objectives were to quantify differences in survival, height and ground-line diameter growth, and chestnut blight development between two shelterwood regeneration treatments that created contrasting understory light conditions. We also conducted exploratory analysis to test effects of seedling quality at planting, chestnut blight development, and competitive position on subsequent growth and survival.
Our study was conducted in the Bent Creek Experimental Forest (35.5° N, 82.625° W), located in the Southern Appalachian Mountains about 16 km south of Asheville, NC in Buncombe County. This watershed of 2400 ha ranges in altitude from 600 m in a broad intermountain basin to 1100 m along two primary ridges. Annual temperature averages 13 °C; the frost free season averages 157 days. Precipitation averages about 120 cm annually and is evenly distributed throughout the year. Geologic formations primarily consist of Precambrian gneisses and schists. Soils are generally deep (>99 cm.), and predominantly acidic (pH < 5.5). Ultisols of the Evard-Cowee complex are common on gentle slopes of lower elevations; Inceptisols of the Tuckasegee-Cullasaja complex are common in coves and steeper mountainous slopes.
Arborescent vegetation on upland sites consists of a high canopy (>30 m) of deciduous hardwoods. Dry sites on mid to upper slopes and ridges are occupied primarily by xerophytic oaks: black (
American chestnut was a predominant species throughout most upland stands of the experimental forest until about 1930, when approximately 80 percent of trees in the region had been infected with the chestnut blight [
The study was installed in three distinct forest stands, each stand averaged 1.3 ha in size and were not disturbed significantly by humans or by natural disturbances during the past 50 years. The stands represented a range of site quality conditions and a soil moisture gradient from xeric to mesic, with one stand transitional between xeric and mesic (
Topographic characteristics of the stands.
|Moisture regime
|Elevation (m)
|Aspect (degrees)
|Steepness (percent)
|Surface shape
|Site index for
Each stand was divided into two approximately equally sized treatment areas and was randomly assigned one of two silvicultural treatments. Two shelterwood regeneration treatments were studied, including a two-age shelterwood harvest, and a midstory-removal treatment. Both treatments represent different stages of an even-aged regeneration system, but result in markedly different light levels to the developing understory [
The midstory-removal method is the first stage of a shelterwood regeneration harvest, designed to improve light quantity and quality to the understory to promote oak recruitment until the commercial harvest is conducted [
Height and ground-line diameter (GLD) measurements were taken at planting and in years 1, 2, 3, and 5 after trees entered into dormancy (November through March). Height was measured to the nearest 0.01 m from the ground line to the tallest terminal bud. Ground-line diameter was measured to the nearest 0.1 mm using digital calipers. Chestnut blight was identified on the base of the tree as a slightly raised canker or a sunken, discolored area on the stem, and was sometimes accompanied by the appearance of stromata (orange fruiting bodies) on the smooth bark surrounding cankers [
We used SAS [
We used generalized linear mixed models to test treatment effects on our binomial response variables, chestnut blight and survival. We used PROC GLIMMIX to test if the presence/absence of chestnut blight was affected by silvicultural treatment using the variable year as a split plot factor [
Normality of residuals were tested using the Shapiro-Wilk test for normality for each linear mixed model. Our tests met normality assumptions for the residuals, so no transformations were required. Homogeneity of variance assumptions were tested for each linear mixed model by examining residuals
For each linear mixed model and generalized linear mixed model, we calculated estimates of the empirical best linear unbiased predictors (EBLUPS) and associated T-tests for the random-effects parameters using the SOLUTION option in the RANDOM statement to determine how trees within each stand differed from the average for the population, which was set to zero. We felt these tests were important because we predicted the random variable, stand, would affect growth and survival due to differences in site quality among stands (
Trees that had developed chestnut blight by year 5 were excluded from the height and GLD ANOVAs because we wanted to extrapolate our results to the chestnut trees being bred for blight resistance that will putatively be resistant to blight but behave like a pure American chestnut [
Exploratory analyses that were not part of the original experimental design were conducted to determine if differences in growth existed between trees with and without chestnut blight and between trees that were and were not free-to-grow. We added the presence/absence of chestnut blight as a treatment effect to the above-mentioned ANOVA model for height to determine effects of chestnut blight and interactions with year and treatment. We used linear mixed model ANOVA with repeated measures to determine if free-to-grow status affected height and GLD growth in the two-age shelterwood stand (we did not assess free-to-grow status in the midstory-removal treatment). We also conducted a
Survival did not differ between silvicultural treatments for any year (F < 0.32, df = 2,
Least-squares means for percent survival within silvicultural treatments and raw means across treatments with associated standard errors in parenthesis for each year after planting American chestnuts.
|Year after planting
|Two-age shelterwood
|84 (8)
|87 (8)
|86 (2)
|78 (11)
|81 (11)
|79 (3)
|75 (10)
|75 (11)
|75 (3)
|63 (11)
|72 (11)
|67 (3)
The highest annual rate of mortality occurred in the first growing season for both treatments. The two-age shelterwood treatment in the subxeric stand had EBLUP with significant T-values for every year, indicating that this experimental unit had lower survival than predicted for the average of the population. In contrast, the two-age shelterwood treatment in the xeric stand had an EBLUP at year 5 of 25, with a significant T-value, indicating this experimental unit had higher survival than the average predicted for the population. No other EBLUPS for stand or stand by treatment interactions for survival were significantly different than zero.
Main effects of treatment (F = 36.5, adjusted df = 3,
By the second year, trees planted in the two-age shelterwood were 0.50 m taller in height and 5.8 mm larger in GLD compared to trees planted in the midstory-removal. At the end of the fifth growing season, trees in the two-age shelterwood were 3.11 m tall and 30.4 mm in GLD, which was 2.36 m taller in height and 16.8 mm larger in GLD compared to trees in the midstory-removal. Trees in the two-age shelterwood grew 0.51 m in height and 4.3 mm in GLD per year on average compared to 0.04 m in height and 1.0 mm GLD per year in the midstory-removal treatment. In the midstory-removal treatment, trees grew significantly in GLD from years 2 to 3 and from years 3 to 5, but did not grow significantly in annual increment before year three. Trees did not grow significantly in annual height growth increment for any year in the midstory-removal treatment. Trees in the two-age shelterwood grew significantly in annual height and GLD increment in every year. Trees in the two-age shelterwood were significantly taller in height and larger in GLD after three growing seasons compared to trees at the end of the fifth year in the midstory-removal treatment. The EBLUPS for each random level were not significantly different than zero for height or GLD, indicating that stand and stand by treatment interaction effects on growth were minimal.
Height and ground-line diameter with associated standard error bars for five years after planting American chestnuts in two silvicultural treatments. Asterisks, positioned above the two-age shelterwood line, indicate significant differences between the two treatments within a year. Plus signs, positioned above the two-age shelterwood line or below the midstory-removal line, indicate significant differences between that year and the year prior within silvicultural treatment.
In the
Height and ground-line diameter with associated standard error bars for five years after planting American chestnuts in two silvicultural treatments for two seedling size class groups. Asterisks, positioned above the two-age shelterwood lines or below the midstory-removal lines, indicate significant differences between the two size classes within year and silvicultural treatment.
Height differences between size classes were significant for years 0, 1, and 2 in the midstory-removal treatment, but differences were not detected in years 3 or 5. GLD differences between size classes in the midstory-removal treatment were significant only for the year of planting. In the two-age shelterwood treatment, trees in the Large size class had similar GLD by year 2 and similar height by year 3 compared to Small size class trees in year 5. Seedling size class did not affect fifth year survival (F = 1.6, df = 4,
By the fifth year after planting, 28 percent of living trees in the two-age shelterwood developed chestnut blight compared to 13 percent in the midstory-removal (
Least-squares means for percent of trees with blight. Standard errors are in parenthesis. Means followed by the same lowercase letter indicate differences between silvicultural treatments within and among years are not significant. Means followed by the same uppercase letters indicate differences among years across silvicultural treatments are not significant. Live trees and trees dead for less than one year were examined for blight.
|Year after planting
|Two-age shelterwood
|Across treatments
|Number of trees examined for blight
|0 (3) b
|1 (3) b
|10 (3) b
|11 (3) a,b
|15 (3) a,b
|9 (3) b
|28 (3) a
|13 (3) a,b
The effect of year was significant (F = 14.9, df = 12,
Trees with blight did not differ in height (F = 0.2, adjusted df = 6,
By the second, third, and fifth year, 79, 77, and 74 percent of trees were free-to-grow, respectively, in the two-age shelterwood stand. Free-to-grow status did not have a significant overall effect on height (F = 9.5, df = 2,
Height and ground-line diameter least-squares mean differences between American chestnut trees that were free-to-grow and overtopped for 2, 3, and 5 years after planting. Means followed by the same letter indicate differences were not significant between free-to-grow and overtopped trees within and among years for each growth variable.
|Year after planting
|Height (m)
|Ground-line diameter (mm)
|1.08 d
|1.24 d
|15.2 c
|16.3 c
|1.80 b,c
|1.44 c,d
|21.1 b
|16.3 c
|3.52 a
|1.99 b
|34.5 a
|20.0 b
The EBLUPS for each random stand level were not significantly different than zero, indicating that stand effects on free-to-grow status were minimal.
Chestnuts were capable of fast growth under high-light conditions and low canopy cover of the two-age shelterwood stand, growing on average approximately 0.51 m in height and 4.3 mm in GLD per year. Other studies found that American chestnut maximizes photosynthesis under high-light conditions similar to other shade intolerant species [
The fast growth of chestnuts and high percent of seedlings that were free-to-grow in our study may have been partially related to herbicide treatments for competition that were implemented at planting and three years after planting. Chestnut may not have been as competitive as natural vegetation on sites without aggressive treatment of competition. We conducted a
If managers choose to underplant in a treatment similar to the midstory-removal used in this study, they can expect to have the same height and GLD growth at year 5 in the midstory-removal treatment, as they would have in year 3 in the two-age shelterwood harvest; thus, managers can expect to lose two years of height and GLD growth for the first five years trees grow in a commercial two-age shelterwood harvest on similar stands in the southern Appalachians. GLD had greater growth relative to seedling size at planting compared to height in this treatment; trees grew 57 percent of their original GLD and 36 percent of their original height after five years. Root development is closely associated with GLD growth in chestnut and other Fagaceas species [
Seedling quality at planting was not an
No evidence of site type effects on growth or free-to-grow status was evident in this study, but lack of replication limited our interpretation of the site type gradient and its interactions with silvicultural treatment. Rhoades and others [
Our results did not support previous findings that found blight disease was more prolific in open environments, compared to understory sites [
We did not detect a difference in overall height growth between seedlings with blight and seedlings without blight in any year, indicating that a response to the disease did not include a change in growth. Paillet [
Based on our results and previous studies, the two-age shelterwood treatments would be the most efficacious method of establishment for American chestnut seedlings on similar sites to those in this study. However, midstory-removal treatments may provide appropriate planting areas if chestnut planting material becomes available prior to harvesting of potential planting sites. This treatment may be particularly desirable on federal lands where harvest operations can be delayed due to NEPA processes or extension allowed under contract due to unfavorable timber market conditions. We explored questions that deserve attention in future research that could impact operational approaches for chestnut restoration. Although not empirically tested, seedling grading and competition control to keep seedlings free-to-grow may decrease time needed to establish a competitive chestnut seedling, and would decrease associated costs and resources needed for successful restoration.
The authors thank The American Chestnut Foundation for providing the experimental material for this study. The authors also acknowledge Leila Pinchot, Pinchot Institute, and Charles Rhoades, USDA Forest Service for early reviews of this manuscript. Two anonymous reviews also greatly improved the manuscript. The staff of the Pisgah National Forest, particularly Ted Oprean, was instrumental in helping establish harvest areas and conducting herbicide treatments. Arnold Saxton, The University of Tennessee, provided statistical analysis advice for this manuscript. Data collection assistance by USDA Forest Service, Southern Research Station employees, Jacqui Adams, Kenny Frick, and Tracy Roof, was also greatly appreciated.
The authors declare no conflict of interest.


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