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Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization's sociotechnical system—its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners' awareness of unanticipated consequences that only become evident during HIT implementation.
Healthcare information technologies (HIT), such as electronic medical records (EMR), computerized physician order entry (CPOE), and decision support systems (DSS), may enhance the safety, quality, and patient-centeredness of care, while helping to contain costs and increase efficiency. 1–5 Unfortunately, there have been disturbingly mixed reports on HIT's implementation and outcomes. 4,6–13 A growing body of research and user reports reveals many unanticipated and undesired consequences of implementation. 6,11,13–21 Unanticipated and undesirable consequences, which are usually called unintended consequences, 22 often undermine patient safety practices and occasionally harm patients. 23,24 Unanticipated consequences with desirable results may be thought of as happy surprises, while anticipated undesirable outcomes present opportunities for decisions, clarification of values, and implementation tradeoffs. 22
Managers and clinicians (physicians and nurses) in healthcare delivery systems too often blame undesirable consequences and implementation failures on the performance of the newly introduced technology. 25,26 Although technical flaws often cause problems, many harmful or otherwise undesirable outcomes of HIT implementation flow from sociotechnical interactions—the interplay between new HIT and the provider organization's existing social and technical systems—including their workflows, culture, social interactions, and technologies.
These sociotechnical interactions have been richly documented in the literature on HIT's unintended consequences. This literature provides several conceptual models (or frameworks) that help guide researchers and practitioners. Chief among these are a model of relations among categories of CPOE consequences, 22 a typology of unintended consequences of patient care information systems, 11 a typology of unintended consequences of CPOE, 14 and an empirical study of the prevalence of these unintended consequences. 27 Other studies describe types of errors in CPOE usage 16 and provide a taxonomy of errors associated with CPOE. 28
Unfortunately, many IT users and even some IT specialists, are unfamiliar with this literature or with its practical implications. When hospital leaders, clinicians, or IT specialists assume that HIT will deliver the results promised by vendors, they may overlook likely interplays between new technologies and existing sociotechnical conditions. Similarly, those who assume that computerization routinely enhances reliability may underestimate the safety contributions of clinical judgment, unmediated (direct) communication, and teamwork. 14,29,30
Conceptual models of HIT's unintended consequences contribute to research on such system interactions. They can also help clinicians, healthcare managers, and HIT specialists anticipate some otherwise unnoticed consequences of implementing HIT and thereby turn unintended consequences into anticipated tradeoffs. 22 These models can also help applied researchers and practitioners discern genuinely unforeseeable consequences as these emerge during HIT implementation.
To extend recent work on models of unintended consequences our proposed Interactive Sociotechnical Analysis (ISTA) offers a framework and typology specifying important relationships among new HIT, workflows, clinicians, and organizations. This framework emphasizes the recursive and iterative nature of these relationships and their potential for producing unintended consequences.
To develop ISTA, we combine elements from five research areas. First, traditional sociotechnical systems (STS) research documents dynamic, mutual influences among the social subsystem (people, tasks, relationships), the technical subsystem (technologies, techniques, task performance methods, work settings), and their social and organizational environments. 31,32 Early STS work focused on attaining an optimum balance between the social system—including the needs of the workers and the technologies used in manufacturing and extraction industries. STS analysts articulated a series of design principles. 33,34 Later STS research in healthcare showed how sociotechnical forces shape work processes, which impact employee motivation and patient outcomes. 35,36
Sociotechnical studies of office automation indicate that early designers of management information systems adopted a "rational/static" approach that focused mainly on enhancing information processing efficiency and managerial control. 37,38 This narrow, mechanistic approach overlooks effects of new information systems on employees and their organization and fails to grasp the dynamic and interconnected nature of organizations as systems. In contrast, sociotechnical analysts advocate applying the STS principles of participative design and autonomous work groups to the introduction of new computer systems. 39,40
Second, the closely-related field of ergonomics examines effects of work technologies and physical environments on individuals. 41,42 Ergonomics points to crucial interactions among work organization, patient, provider, and organizational factors. 43 Macroergonomics examines how work organization features, including physical settings, tasks, technology, and organizational arrangements, affect individual stress and performance. 41,44 Ergonomic practitioners design physical, cognitive, and organizational work features that fit peoples' needs, abilities, and limitations.
Traditional sociotechnical and ergonomic analyses stress the benefits of appropriate design of technologies, but they tend to treat designed configurations as stable over time and consistent across contexts. Hence traditional STS and ergonomic research examines how technological features affect people and social systems but does not explore the other side of that relationship: how social systems shape technology and its uses. 45 In contrast, three other research streams recognize that technology and the social world are intertwined and influence one another.
The third body of research includes social construction of technology studies, along with the broader negotiated-order and interpretive traditions on which social construction draws. 46–48 Researchers in these fields show how interactions among technology users—including managers, clinicians, and other healthcare staff—help select, reinterpret, modify, and even create technologies. 49–53 From this vantage point, as people adopt and use technologies, they alter them and transform relations among the technologies and their organizational contexts.
Fourth, technology-in-practice, shows that technologies such as EMR and CPOE are not just shaped by practitioners; they also mediate practice. 54 Healthcare emerges through collaborative work and tight interconnections among people, tools, machines, documents, and organizational routines. 55,56
Social informatics, the fifth research field on which ISTA builds, applies insights from the research just reviewed. Following social construction and technology-in-practice, social informatics explicitly acknowledges the embeddedness of information technologies within organizations and broader social contexts. 45 Thus nearly identical information technologies can be applied and used very differently because of the many, complex interactions among people, between people and equipment, and even between sets of equipment. 57
From the foregoing literature we draw four key features of ISTA:
The ISTA framework encourages us to stop viewing HIT innovations as things, but instead treat them as elements within unfolding processes of sociotechnical interaction. From the viewpoint of ISTA, the results of HIT innovation can never be fully determined by the technology. Sociotechnical interactions are dynamic, emergent, hard to understand, and often surprising—conditions characterizing complex adaptive systems. 58 ISTA thus rejects popular mechanistic assumptions that HIT implementation problems can be solved with more or better HIT and that proper HIT implementation depends primarily on training and technical support. ISTA thus diverges from the prevailing IT engineering approach, which models existing administrative and clinical practices in new HIT solutions, fine tunes them, and freezes these solutions and required user behaviors. 51,59
provides a graphic portrayal of the ISTA framework. It shows interactions among subcomponents of the sociotechnical system that act as major sources of unintended consequences, as reported in the literature and observed by us. Other interaction types could be derived logically, but these do not appear to affect unintended consequences as strongly as the ones shown. The five interaction types are:
Arrows in show the impact of one STS subcomponent on another and correspond to the five interaction types. Arrow 1 shows effects of newly implemented HIT on the Social System subcomponent within the adopting organization. Arrows that pass through a subcomponent show sociotechnical interactions. For example, Arrow 2 depicts interaction between New HIT and the existing Technical and Physical Infrastructures. This interaction in turn shapes HIT-in-Use. Arrow 3 shows the effects on HIT-in-Use of interactions between new HIT and the organization's Social System. Arrows 4 and 5 indicate that, once shaped by the interactions shown by Arrow 3, HIT-in-Use can produce further changes in the Social System (Arrow 4) or in New HIT's formal properties (Arrow 5).
We now review the five types of interaction presented in and in (below).
This type captures processes through which HIT interventions in healthcare organizations alter prior patterns of work, communication, or relationships among clinicians. HIT designers often seek to alter work practices but are too often surprised by interactions with HIT that engender undesirable changes. A well-known study on CPOE provides two examples of such unanticipated interactions. 15
Introduction of CPOE into a tertiary children's hospital reduced bedside nurse-physician interaction about critically ill infants. Nurses had fewer opportunities to provide feedback that sometimes led to beneficial medication changes. CPOE procedures also altered communication between transport teams and the emergency room (ER). Prior to introduction of CPOE, transport teams radioed the ER so ER staff could order medications and complete admission forms before the patient's arrival. When CPOE was launched, transport staff had to provide patient information in the ER, and treatment was delayed until after ER staff entered the data. Resulting delays and reduced clinician interaction may have contributed to higher mortality rates.
Studies of this sort (also 14,60 ) show how HIT implementation can alter or disrupt oral communication among clinicians, even when talk is faster, more clinically accurate, and safer than transmitting information through HIT. The challenge when introducing HIT is to improve problematic and dangerous forms of communication, such as illegible prescriptions, without undermining vital communication flows among clinicians and with patients.
Poor fit between new HIT and existing technical and physical infrastructures is a common source of unintended consequences. Most noticeable to HIT specialists are problems of interface between new and existing IT. These problems are a frequent source of technical failure for new HIT and can lead to poor decisions, delays, data loss, errors, and unnecessary testing. 12,16,59
"Paper persistence" is another common consequence of inadequate integration of new HIT and existing information systems. 14,59 Use of paper was widespread in the five institutions studied by Campbell and her colleagues. 14 In some cases, staff had to print out CPOE orders and then manually reenter them into the local department's clinical information system.
Poor interfaces between HIT and the physical settings in which it is deployed may also lead to HIT uses and workarounds which harm safety, quality, or efficiency. IT designers lacking awareness of ergonomics may overlook simple, yet fateful environmental features, such as the physical ease with which computers can be accessed or moved (Sites F, personal communication, October 2006). Other features of work layout, along with noise, overcrowding, and distracting illumination, affect work healthcare performance and safety 61 and may have unanticipated, negative effects on HIT use. While strategic workstation location can facilitate HIT use, 62 inappropriate physical layouts can extend data-entry time, reduce face-to-face communication, and increase distractions. 16 For example, as staff walk across a busy floor to terminals, encounters with several patients and staff may lead them to forget or garble information obtained at the bedside.
Reinterpretations and negotiations about new HIT often lead to different uses and practices from those intended by HIT's designers. When nurses under heavy work loads encounter cumbersome software requiring multiple screens for medication administration, the nurses often delay medication charting until the end of their shifts. This unsanctioned practice can generate inaccurate recording of medication times and quantities, inappropriate duplication of prescriptions, less efficient communication between physicians and nurses, and reduced efficacy of software safety checks. 16,63
An important reason that HIT-in-use so often diverges from designed HIT is that the original designs fail to reflect ongoing features of the work system and of social relations among practitioners, including collaborative and interactive work patterns. 11 Here is a vivid illustration from an observational study of the introduction of system-wide CPOE into an ICU: 64
Before introduction of CPOE, nurses were used to alerting physicians about changes in patients' conditions. Physicians often gave oral orders to nurses and only signed orders after the nurses had transcribed and administered them. The CPOE required physicians to initiate orders, pharmacists to check them, and clerks to deliver them to nurses for administration. Imposition of this linear workflow led to delays in delivery of orders, left nurses in doubt whether physicians had initiated orders, and sometimes produced divergent printed orders: the physician's original and the pharmacist's modification. In response, nurses continued to initiate orders by making suggestions to physicians. Nurses also frequently interrupted physicians to ensure that orders had been entered into the CPOE system. Moreover, nurses assumed responsibility for deciding what to do when the CPOE system presented them with conflicting medication orders.
Workarounds like these may help preserve important forms of collaboration that are not supported by an HIT design. But such workarounds may also make care less efficient and compromise safety and quality.
This type reflects the recursiveness of HIT implementation. Use of new HIT is altered by the care organization' social system (as in Type 3), but then the HIT-in-use leads to new and additional changes in the social system. Consider the following example:
New HIT (i.e., CPOE and EMRs) allows Infectious Disease (ID) fellows to access information on patients for whom housestaff wish to prescribe newer, expensive antibiotics. The ID fellows seek to limit use of expensive, broad-spectrum antibiotics. Housestaff, however, are often eager to try new antimicrobials and to avoid the ID approval process. Housestaff developed " stealth dosing," waiting until the ID fellows go off-duty at 10 PM to order the restricted antimicrobials. 65 The next morning, ID fellows review the previous night's orders and sometimes demand medication changes. But changing antibiotic regimes can be problematic, so ID fellows let many such orders stand even if they are not ideal. Because ID fellows often take no remedial actions and housestaff can game the system, stealth dosing constrains the ID-fellows' authority and weakens the antimicrobial oversight process.
The beginning of this example sounds like the ICU example (Type 3): Housestaff workarounds lead to unanticipated HIT uses (stealth dosing). But the continuation of the stealth dosing example shows that the HIT-in-use (i.e., workarounds) also affects authority relations.
This type involves an even more dramatic process of recursive change than that described in Type 4. Here users' reactions to new HIT and their local adaptations of it diverge dramatically from the original HIT design. As a result managers and IT designers are forced to reconfigure some HIT features. For instance, in an academic hospital, physicians who enjoyed substantial clinical autonomy objected strenuously to new, fixed-choice EMR templates for recording intake diagnoses. Managers were obliged to accept free-text entry. 63 Here is another example of this type of recursive interaction:
When ordering medications via the computer, some systems incorporate off-the-shelf DSS. These generate warnings about doses or interactions, which quickly become overwhelming, and are ignored as "alarm fatigue" sets in. 11,12 Physician annoyance and ignored warnings lead managers to deactivate the alarms. Subsequently IT designers seek to reintroduce selected warnings that have been approved by in-house clinicians. 66 Another managerial response involves "tiered" alarms, 66 where warning levels mirror possible harm levels: physicians may ignore low-harm alarms, must acknowledge more serious alarms, and must explain overrides of the most serious alarms.
In this case, HIT innovations trigger responses by individuals (ignoring warnings), by managers (removing, then introducing new warnings), and by technology designers (tiered alarms).
ISTA contains both continuities and departures from previous models of unintended consequences and from other previous studies of HIT outcomes. The first two ISTA types are widely discussed in STS and ergonomics. Type 3 is prominent in the literature on unintended consequences but has received less attention from other researchers in information technology and healthcare. Types 4 and 5 are less fully developed in most discussions of unintended consequences and virtually absent from the broader literature on HIT.
shows the relation of the ISTA types to two well-known typologies of unintended consequences. 11,14 ISTA's concepts are more abstract than those in these two studies. Hence ISTA requires just five types to represent eight of the nine categories in the CPOE typology. 14 Only the "negative emotions" type in that typology is not covered by ISTA, because emotion is at the level of the individual user, rather than the group or organization. Similarly, all thirteen sub-types of unintended consequences for patient care IT 11 fit into just three ISTA categories. ISTA focuses more directly on recursive interactions than the typologies of unintended consequences. The limited number of elements and types within ISTA may make it easier for researchers and practitioners to apply.
Growing awareness of HIT implementation's mixed results contributes to its shallow market penetration. 67,68 While some vendors and lobbyists still proclaim HIT as a panacea for an ailing healthcare system, users already know that HIT produces many unanticipated and undesired consequences. They also know that unintended consequences can sometimes undermine quality and safety and can lead to implementation failure.
This paper developed a model of the interactions that produce unintended consequences and illustrated them from the research literature The ISTA model builds on earlier models and draws from diverse research streams, several of which are not widely cited in the HIT literature. ISTA emphasizes emergent and recursive interactions among HIT and existing social systems, technologies, and physical environments. Further research, including observational studies actual HIT use, should document and analyze such recursive and emergent processes in HIT implementation. Then, standardized measures of these concepts could be developed.
While not absolving new technology developers from their responsibilities to offer responsive, safe, and useful products, ISTA places analysis of the dynamics of healthcare organizing 48 at the center of HIT implementation. Many of the most important consequences of sociotechnical interactions emerge as new HIT becomes intertwined with the ongoing sociotechnical system. 11 These developments cannot be fully anticipated during HIT design and implementation planning. To spot such unfolding consequences of sociotechnical interactions, managers, designers, clinicians, and researchers need to carefully track HIT-in-use throughout implementation. This kind of tracking requires continuous or repeated evaluations of IT use and consequences, along with frequent feedback to managers, IT designers, and users. Such formative evaluations—as opposed to post-hoc summative evaluations—can help managers and IT designers address emerging consequences before they harm patients, compromise quality, or undermine implementation.
By emphasizing the complexity and emergent nature of sociotechnical interaction, ISTA encourages practitioners and researchers to view system interactions as opportunities for learning and improvement, rather than as annoying barriers or signs of user resistance. Examining HIT-in-use provides opportunities for understanding and responding to user experiences and emerging needs, for example by changing the pace of implementation or reconfiguring IT properties. Those who successfully installed sophisticated HIT products report on this type of learning. Close and long-term work with vendors, consultants, and internal designers supported an iterative refinement process. 1,4,69,70 The successful systems customized and reconfigured HIT to address its sociotechnical consequences. 69,71 In making such changes, HIT implementers must balance adaptation to local needs and practices against maintenance of standardization and systems interoperability.
In the long run, some of HIT's unintended consequences may play a role in helping HIT designers and healthcare professionals learn to deploy HIT more effectively. Of course, practitioners of HIT and medicine cannot tolerate developments that harm patients; HIT implementation therefore must proceed with caution. Familiarity with the ISTA model can help clinicians, managers, and designers become more aware of critical, unfolding processes in HIT implementation. This awareness will, in turn, help these practitioners realize HIT's potential for improving healthcare safety, quality, and efficiency.
The following individuals made helpful comments on drafts of this manuscript or reported incidents that contributed to our development of the manuscript: David Douglas, MD, Portland VA Medical Center (Portland, OR); Joseph Francis, MD, MPH, Department of Veterans Affairs (Washington, DC); Jennifer Lai, BA, BSN, RN, Hospital of the University of Pennsylvania (Philadelphia, PA); Cynthia Palmer, MS, Agency for Healthcare Research and Quality (AHRQ) (Rockville, MD); Nancy Rodenhausen MS, RN, N.Y. Downtown Hospital (NY); Christine A. Sinsky, MD, Medical Associates, P.C. (Dubuque, Iowa); Frank Sites, RN, Penn E-lert eICU, Univ. of Pennsylvania Health System (Philadelphia, PA); Claudia Steiner, MD, AHRQ (Rockville, MD); Joel L. Telles, PhD, Main Line Health (Bryn Mawr, PA); Prof. Michel Vilette, Argo Paris Tech (Paris, France). The following individuals provided invaluable technical assistance in preparing the manuscript: Sandra Cummings and Mary Rolston of AHRQ's Public Affairs Division and Caryn McManus of AHRQ's Information Resources Center. Shirly Bar-Lev's research was part of her doctoral dissertation in Sociology at Bar Ilan University. Her research was supported by a Dissertation Fellowship from that institution and supervised by Michael Harrison. Ross Koppel was supported in part by a grant from the Agency for Healthcare Research and Quality (P01 HS11530).
This article is written by an employee of the US Government and is in the public domain. This article may be republished and distributed without penalty.
The views expressed in this paper do not necessarily represent those of any U.S. government agency, but rather reflect the opinions of the authors.
IRB approval was not requested.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Minute after the Movie – 22 Jump Street
How To Train Your Dragon 2 wasn't the only major movie sequel to come out this weekend. Channing Tatum and Jonah Hill are back in 22 Jump Street. See what we thought of the film in under a minute.
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Is Zone Alarm not able to do the same as c.o.m.o.d.o firewall? They have two different installation files for 32bit and 64bit systems. They also have it for the free version of their Antivirus and firewall.
Maybe that is the reason why we have some problems with the newest version of Zone Alarm (free) firewall.
I want to use Zone Alarm but it still has to many problems for me, and i run a 64bit system. With XP 32bit system i never had problems. Now i am using vista 64bit system and i and a lot of other users have problems with the internet browsers.
So than is my question if that problem wont be solved with two different installations files: 1 for a 32bit system and one for a 64bit system.
Even when i install zone alarm now on my 64bit system, zone alarm is still put in the program files(x86) of the 32bit system.
Operating System:
Windows Vista 64 bit
Software Version:
Product Name:
ZoneAlarm (Free)
Message Edited by Thomassie on 05-03-2009 03:17 AM
Message Edited by Thomassie on 05-03-2009 03:18 AM


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An innocent pregnant woman has been brutally stabbed to death by a neighbour over a flimsy argument in Kogi State.
Bose Muhammed was brutally stabbed to death by a neighbour
According to information gathered by the police, the incident happened in Kogi State. It was gathered that Hussain Zubairu allegedly stabbed his pregnant neighbour, Bose Muhammed, to death with a pair of scissors.
Zubairu and the pregnant woman lived in the Idogido community of Okene Local Government Area of Kogi state.
She was rushed to a hospital in the area but died on arrival.
According to Punch, the incident happened last Monday when a friend of the deceased visited her. Muhammed and the friend were said to be talking about a lost mobile phone when the suspect interfered.
It was gathered that she cautioned Zubairu not to meddle in their discussion and afterwards, an altercation ensued between both. The suspect was said to have become enraged and descended on the woman with the scissors.
A police source claimed that suspect was described as violent by some residents of the area. He added that some neighbours claimed he was on drugs.
The source said, "Many residents within that area said he was a drug addict but that has not been confirmed. I learnt the woman (Muhammed) had always been trying to avoid him because he was troublesome.
"On that day, the victim and her friend were chatting and he interrupted.
"She told him to mind his business and that infuriated him. He removed a pair of scissors he hid in his trousers, stabbed her in the stomach and fled.
"The woman lost a lot of blood. She was pronounced dead on getting to the hospital. She was pregnant, but was not living with her husband."
The suspect has been arrested by the police while the deceased was buried according to Islamic rites.
The Police Public Relations Officer, Kogi State Police Command, ASP Willy Aya, confirmed the incident.


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In addition to zoning issues that impinge on art venues in rebounding neighborhoods, state budget cuts are hitting traditional arts powerhouses like the Louisiana Endowment for the Humanities (LEH). Michael Sartisky, who serves as LEH's executive director, recently noted that state support for the organization was "slashed by $1.5 million from its level in 2007-08." The consequences were immediate: LEH has suspended its 2011-12 grant cycle.
That means no money — as of Nov. 1 — for LEH programs such as Outreach, Public Humanities, Teacher Institutes for Advance Study, Documentary Film and Radio, and the Louisiana Publishing Initiative.
"We remain fully committed to a sustained fight to reinstate an appropriate level of support from the state that will allow us to resume the funding of crucial programs to benefit communities and institutions across Louisiana," Sartisky wrote in an email blast. "But without appropriate levels of state funding, this simply is not possible."
Sartisky noted that the cuts will hit LEH's partner institutions hardest. "No films will be funded this year," he wrote. "Funding for American Routes (a public radio program), which the LEH supported for more than a decade, is eliminated."
State support for LEH reached $2 million under former Govs. Mike Foster an Kathleen Blanco. Sartisky said that level of funding created an economic impact of $14 million a year and allowed LEH to serve needy communities that lacked the infrastructure to support high-end cultural programs in libraries, museums, schools and other institutions. — Clancy DuBos


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Award-winning British author Dame Muriel Spark is internationally renowned for her witty and engaging tales of life. Short and sophisticated, Reality and Dreams follows the career of self-centered, middle-aged film director Tom Richards. As he turns colorful incidents from his life into glittery, cinematic fiction, his foreboding dreams become all too real. Tom is passionately directing his latest film when he falls from a crane on the set. Awaking in a semi-conscious fog in a hospital room, he suddenly must deal with a comic, surreal procession of doctors, nurses, and out-of-work relatives. In a drugged daze, he dreams of ways to change his life. But some of his hazy visions come true as he recovers, causing Tom's real world to unravel into a distorted soap opera. Muriel Spark is an honorary member of the American Academy of Arts and Letters and winner of the prestigious David Cohen British Literature Prize. Her tantalizing story, Reality and Dreams, won the Arts Council Spring Book Award. With narrator Jenny Sterlin's expert pacing, all of the delicious surprises and the unsettling wisdom in this dark, contemporary comedy burst from the pages.
©1996 Muriel Spark (P)1997 Recorded Books, LLC
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A West Covina man was sentenced to 25 years to life in prison Wednesday after he was found guilty of first-degree murder in the death of his wife.
Tomas Rodriguez Infante, 62, was convicted of killing his wife Charlito Tolentino, 57, in January 2013.
According to prosecutors, Infante was having an affair at the time of the killing. When Infante's girlfriend found out he was married, she broke up with him, Deputy District Attorney Miriam Avalos said.
Tolentino went missing a day after the breakup. Her body was found two days later in the trunk of the family's SUV, which was parked outside the Hawaiian Gardens Casino.
The victim was stabbed and beaten to death, according to the LA County District Attorney's Office.
Infante had initially told West Covina Police that his wife was missing and said that she did not return home from work. The day after he reported Tolentino missing, deputies found her body.
Surveillance video at the casino, cell phone records and blood evidence at the home connected Infante to the crime, the LA County District Attorney's Office said in a statement. Infante's son also testified in court and said that his father told him he killed Tolentino.
Infante was also ordered to pay restitution to Tolentino's sister for funeral costs of nearly $12,000. He was also ordered to pay $5,000 to the Victim Assistance Program.


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Gagne to give all, acknowledges 'regret'
Gagne to give all, acknowledges 'regret'
Re-signed Friday -- after a three-year odyssey through Texas, Boston, Milwaukee and even independent ball in his Canadian homeland -- Gagne said he felt like he was back home when he walked into the clubhouse at Camelback Ranch-Glendale, even though his Dodgers' Spring Trainings were always held at Dodgertown in Florida.
Gagne, 34, is slimmer than when he left, saying his current weight of 231 pounds is only about seven pounds lighter than his playing weight with the Dodgers. He said he keeps the weight down to take pressure off his back, having had two disks removed in 2006.
Of course, there will always be the suspicions that Gagne's obvious weight loss is a telltale sign of something else. For along with the record 84 consecutive saves and a Cy Young Award came the distasteful revelation of performance enhancing drug use through the Mitchell Report.
Gagne didn't detail what he did back then when meeting with reporters Saturday, but he didn't deny it either.
"It is what it is and you've got to accept it," Gagne said. "I've got a lot of regrets and everything, but I have to keep going and just enjoy baseball. Get back to the basics and do what I love, play baseball.
"The whole time I was here was unbelievable. There's a lot of regrets. The Mitchell Report will always be negative, will always be on my resume the rest of my life. People will second guess what I did if I have a good year. That's normal. But for me it's over. I've got to go on."
Gagne opened up more about his past performance-enhancing drug use in an article published Sunday in the Los Angeles Times, during which he admitted to using human growth hormones during "part" of his first tenure with the Dodgers from 1999-06.
"I did [use HGH]," Gagne said. "I hate to talk about it. It just doesn't do anyone any good. But I thought it would help me get better when I hurt my knee. I just don't want that to sound as an excuse.
"I'm so ashamed. It wasn't smart. If I knew what I know now. ... I didn't need it. I regret it so much, just now maybe getting over the guilt. It was stupid."
Gagne was not sure his HGH use ultimately resulted in the numerous injuries that forced him out of the big leagues last year.
"I don't know how it reacts on your body like that," he told the Times, "but from what I've heard, it doesn't help."
Regardless of the circumstances, Gagne was special. Nobody else has come close to that record. He was adored by Dodgers fans and respected by teammates.
"I still don't believe it," he said of his three All-Star seasons with the Dodgers. "I pinch myself how crazy it was. I'm not trying to relive that. It's impossible. All I want is to get back to the big leagues and help this team win a championship. I want to be part of a celebration on the field with champagne. It's what I miss."
When it really was "Game Over" for Gagne in Los Angeles, it was not pleasant. He pitched two innings in an injury-filled 2006, watching from the sidelines as the Dodgers were swept by the Mets in a playoffs that were marred by Joe Beimel's hand injury suffered in a tavern accident.
"That was the worst," Gagne said of being sidelined. "People don't understand unless you go through it. You're paid all that money [$10 million that season] and you want to perform and you can't. Your body won't allow it."
Gagne said his body is ready again to perform.
"I know I've got something left, but I've got to prove myself," he said. "I've got a mountain to climb and I want to do it. I've put myself in a position to succeed. I'm in the best shape of my life mentally and physically."
He did that by pitching last season for the Quebec Capitales of the independent Can-Am League, first having rehabbed a slight tear of the rotator cuff that prompted his Spring release by Milwaukee. Instead of closing, Gagne was a starter in what he called a "controlled environment," throwing every five days without the abuse that relievers take in general, and he took in particular when at his peak, leading to two elbow operations, the back surgery and shoulder problems.
In 17 starts, Gagne went 6-6 with a 4.65 ERA and 64 strikeouts in 102 2/3 innings. He originally was a starter for the Dodgers before moving to the bullpen in 2002.
"Basically," he said of his Can-Am experience, "it was a beer league. Go out, have fun. That's hard to do when you are trying to compete and you're hurting."
Gagne said it won't be easy to make this club, and not just because his fastball is a lot closer to 90 mph than the 100 mph he used to touch. He knows the Dodgers have plenty of relievers and few positions available. He said he wants to play another three or four years, but concedes this is likely his last chance.
But he said he would consider going to Triple-A if he doesn't make the club out of Spring Training, even though his contract ($500,000 guaranteed, $500,000 incentives) includes an out clause.
"I was in the Can-Am League. Triple-A would be like the big leagues," Gagne said. "I talked to Ned [Colletti, Dodgers general manager] -- a good talk. He was really straightforward. I know all the spots that might be open, or not."
He said he'd like to play "three or four years, but I'll start with one day." He was never known to care much for Spring Training or to take it very seriously, usually limiting his game appearances to the minimum. But he said he's three or four weeks ahead of previous years in his training.
"That's what happens when you have to win a job," he said.
As for his return to the Dodgers? It's been a dream, years in the making.
"I've pictured this for five years, or ever since I left," Gagne said, who left Los Angeles after the 2006 season and apparently wrote off his two injured seasons with the Dodgers. "For me, it's like going back home. I never wanted to leave.
"I know everybody here. It's a comfortable environment. I played with these guys when they were kids and now they've come into their own. I felt this was the right time and the right place to be and I look forward to the challenge. When you come up a Dodger, they breed you to be a Dodger. My daughter's name is Bluu."
Ken Gurnick is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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George heads to the home of Dana Zachary in Queens Village, New York. George and his crew surprise her with a rescue, taking her rundown garage and transforming it into the perfect space to accommodate her labor of love.
Published at 10:44 AM PDT on May 15, 2013 | Updated at 9:37 AM PDT on Sep 30, 2013


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Hunter Bivin – OL – 4-star (Owensboro, Kentucky)
- Rivals: 4-star, #12 OT, #162 overall
- ESPN: 4-star, #5 OT, #82 overall
- 24/7: 4-star, #4 OT, #43 overall
Competition: Auburn, Florida, Georgia, Kentucky, LSU, Michigan, Ohio State, Oklahoma, Wisconsin
Analysis: Bivin is a tough, versatile offensive line prospect with great size and an even better attitude. I hate using the word "nasty" when describing any prospect ever since Charlie Weis used the term and it ended up becoming a punch line, but Bivin does have that nasty streak in him that you need in an offensive lineman. He isn't a technician of a lineman and isn't the most athletic, but he is a big, mauling offensive lineman who works hard and has the physical tools and mentality to be a dominating offensive lineman on the college level.
Bivin is rated as a 4-star prospect at tackle by all of the major recruiting services, but he has the versatility to play center as well. He could potentially outgrow that position if he gets much taller though. As a tackle, Bivin could potentially play on either side of the line because of his ability to block in space. Any offensive lineman with offers from SEC schools like Florida, Georgia, and LSU should have any Notre Dame fan very, very excited.


text:
I'm also asking site visitors:
The more I look at it, the more it strikes me as regional rather than standard. It might even be a class thing- I'm going to check.
OK. Thank you, tdol. And I am looking forward to the result.Originally Posted by tdol
I'm also asking site visitors:
The more I look at it, the more it strikes me as regional rather than standard. It might even be a class thing- I'm going to check.
My mother would follow the BE pattern.
Originally Posted by tdol
By the way, what do you mean by "a class thing"? Is it a social class or something?
tdol?Originally Posted by Taka
I was wondering that before I spoke to my mum. She's a tradityionalist and I was wondering whether I had been brought up to follow a certain line on something (like 'if I were'), but she went for your view. However, she did say she didn't like the wording and would go for 'Have this toy in case he cries'. With this version, I can see no other interprtation. Maybe there has been a generational change and I have absorbed the American usage.
.... Next stop a teacher of about my age.
Actually, I have just tried a brother and he agreed with the BE version. Maybe I've spent too long in the company of the likes of Mike.
Hmm...interesting.Originally Posted by tdol
So, what you mean by "a class thing" is some sort of difference between generations or the different situations where you are?
There are language choices that are predominantly made by a social class. For example, somepeople think that the word 'toilet' is a working class term. We are still a class conscious society in Britain, though less so.
Ah! So my first interpretation was right.Originally Posted by tdol
Thank you, tdol!


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An anonymous tip and DNA evidence led police to arrest and question a suspect in the slaying of three women in the Roseland neighborhoods, police say.
Police say the suspect's DNA matches DNA found on all three of the women, who were found strangled in abandoned buildings.
The Roseland killings were one of the most prominent crime stories last year in Chicago.
Full story at the Chicago Tribune.
Published at 1:03 PM CDT on May 29, 2010 | Updated at 1:15 PM CDT on May 29, 2010


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Saturday, Nov. 8, 2008 | 11:07 p.m.
Statistics leaders
Expanded coverage
Boulder City's postseason may have ended with a 39-20 opening round defeat at Virgin Valley Saturday, but the team's mood following the game was not filled with sorrow.
Though tears flowed due to the close of another football season, the Eagles knew that by finishing the season at 5-5, they did more than any prognosticators, maybe even themselves, believed they could.
After all, the team was coming off a 3-7 record a year ago and a 1-8 mark the year before that. Boulder City even broke in a new coaching staff to boot, but never stopped working.
"These guys gave me a great effort, the best I've ever had from a group," first-year coach Alex Kazel said. "No one will ever know how far they came from May to now. With a brand new system and new coaches, this year was supposed to be a struggle. But these guys far exceeded what most people thought they would do."
The coach said the team will return 8-9 players on offense and 5-6 on defense that received significant playing time next year. He added the Eagles would be a force to be reckoned with in 3A for years to come.
Tight end and linebacker Shane Levin predicted the team would continue to grow under its new leadership.
"The program has improved 100 percent from last year," Levin said. "These coaches are the best I've ever had. Learning a whole new offense was tough but next year the guys should be pretty good at it."
The Eagles had chances to win at Virgin Valley early as they took a 20-14 lead into halftime, but five second-half turnovers doomed their offense as the Bulldogs scored 25 unanswered points to close out the game.
Boulder City scored the game's first points when Chris Leach scooped up a Virgin Valley fumble caused by Steven Kaposta and returned it seven yards for a touchdown midway through the first quarter. The Bulldogs scored on their next possession when Terran Leavitt connected with Daniel Gleave for a 20-yard touchdown on the last play of the first quarter.
Boulder City reclaimed the lead on a one-yard quarterback keeper by Jake Phillips, but a second failed two-point conversion made the score 12-8. Virgin Valley answered again its next series on a seven-yard run by Leavitt. The lead then changed a third time when the Eagles scored again on an 11-yard run by Leach.
The wheels then came off for Boulder City early in the third quarter when Virgin Valley's Jonathan Gleave intercepted a Ryan Washburn pass and returned it 90 yards the other way for a touchdown. On its next drive, Boulder City fumbled and the Bulldogs recovered at the Eagles' 17-yard line.
Gleave scored on a 17-yard pass from Leavitt moments later to give Virgin Valley a 26-20 lead.
"Every game we've lost this year we've had turnovers and made those mistakes," Kazel said. "You can't win ball games when you turn the ball over as many times as we did especially against a good team like Virgin Valley."
Boulder City fumbled again on the ensuing kickoff and the Bulldogs scored four plays later on a 11-yard run by Colton Teerlink. Virgin Valley added a six-yard touchdown by Teerlink to ice the game shortly after another Boulder City interception.
"We had a bunch of turnovers, but we played our hardest," running back Spencer Sasarita said. "We thought we had a chance to take this game. But this season was a big turnaround from previous records we've had at BC. We wish we could have gone farther but we did better than probably anyone expected."
Christopher Drexel can be reached at 990-8929 or [email protected].


text: An audience with the Queen of Soul doesn't come cheap. Then again, hearing the legendary Aretha Franklin sing in a relatively intimate setting has the potential to be priceless. Franklin, who is approaching her 71st birthday, performs 8 p.m. Saturday, March 9, at Harrison Opera House, 160 Virginia Beach Blvd., Norfolk. Tickets, available from Ticketmaster, range in price from $81.90 to $113.25. What's the chance of Franklin turning in a magical performance? Hard to say. Reviews of shows in Los Angeles, New York, Las Vegas and Detroit last summer described her concerts as ranging from inconsistent to satisfying. Just to catch you up, Franklin's most recent album is "A Woman Falling Out of Love" from 2011. For more on the show, visit http://www.sevenvenues.com or call 664-6464.


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"We're going back to our roots," says John Loiacono, executive VP of software at Sun. "By taking our eye off the ball and not meeting some of the demand, we let business slip away. Now we're ready to take that business back," Loiacono says.
Schwartz unveiled technology to lure back financial companies.
Wall Street remains a multibillion-dollar market for Sun, which was a major supplier of high-end workstations and servers to financial-services companies in the early 1980s. That market would be substantially larger if Sun hadn't made a number of miscalculations in the late '90s, Loiacono says. Among the missteps: not adequately addressing the price-performance ratio with its servers and, at one point, discontinuing R&D to make its Solaris operating system easier to use on x86-based systems.
As the market for servers based on the x86 hardware standard promoted by Intel and AMD grows, and sales of systems based on proprietary hardware such as Sun's Sparc microprocessor decline, Sun has needed to make its operating system and other software able to run on industry-standard computers.


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Friday Double Feature dedicated to BRUUUUUUCE, thought we'd make you aware of a used car you might be interested in — [lastfm] Bruce Springsteen[/lastfm]'s '57 Chevy Bel Air Convertible. The car that inspired songs like "Born to Run" and "Thunder Road" has a stating bid of $390,000 but is expected to draw close to half a million. It includes the original title and insurance card from The Boss.[photogallerylink id=44414 align=left]With half of our
This was the first automobile Bruce bought after he signed to Columbia in 1972, but was forced to sell the ride in '76 because the car stood out too much once he started gaining fame and popularity. View the online auction here.
Audio: Little Steven Walks You Through The History Of Chicago
Video: Bruce Springsteen & The E Street Band Perform "Songs From The Promise"
Clarence Clemons Of The E Street Band Goes Gaga
Video: Neko Case Raffling Off Car From "Middle Cyclone" Album Cover For Charity


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Northrop Grumman, the $34.8 billion defense contractor, appointed Kenneth Bedingfield corporate vice president and said he will become controller and chief accounting officer once the company files its 2011 annual report. He succeeds Kenneth Heintz, who is retiring. Bedingfield, 39, joins Falls Church, Va.-based Northrop Grumman after 17 years at KPMG, where he most recently served as national client leader of the U.S. aerospace and defense audit practice and audit partner.
Ashland, a $6.5 billion manufacturer of chemical products, named Eric Boni treasurer and vice president. He replaces J. Kevin Willis, who was named vice president of finance for Ashland and controller for Ashland Specialty Ingredients. Boni, 42, most recently was the Covington, Ky.-based company's director of business analysis and was its director of investor relations from 2007 to 2010. Boni has served in both corporate and commercial roles since joining Ashland in 1994.
Gannett Co., the McLean, Va.-based publisher of USA Today and other newspapers with $5.4 billion in 2010 revenue, named Teresa Gendron controller and vice president. She succeeds George Gavagan, who will continue as chief accounting officer until he retires in February. Gendron, 42, joins Gannett from NII Holdings, formerly Nextel International, where she served as controller. Earlier, she was NII's assistant controller and served as a senior manager in KPMG's audit practice.
Comerica, the Dallas-based financial services company with $2.6 billion in 2010 revenue, appointed James Herzog treasurer and executive vice president. He replaces interim treasurer Michael Michalak, who was named executive vice president of planning, forecasting, analysis and enterprise risk. Herzog, 49, most recently was divisional finance officer for Comerica's business bank. Since joining the bank in 1984, he has worked on forecasting and planning, pricing and reviews of strategic business lines.
Sterling Construction, a $459 million Houston-based civil construction company, named its controller and chief accounting officer, Elizabeth Brumley, to the additional roles of CFO and executive vice president. She succeeds Joseph Harper Jr., who will continue as executive vice president. Prior to joining Sterling earlier this year, Brumley, 55, was CFO and vice president of finance at Bristow Group. She also served as controller at Maxxam and GulfMark Offshore, and worked at Arthur Andersen.
ION Geophysical Corp., a $444 million provider of geophysical technology, services and solutions, named Gregory Heinlein CFO and senior vice president. He succeeds R. Brian Hanson, who continues as the Houston company's president and COO. Heinlein, 48, most recently was CFO and COO at Genprex. Previously, he was treasurer and vice president of global sales and marketing for Freescale Semiconductor and served as treasurer at Fisher Scientific and Great Lakes Chemical Co.
NetScout Systems, a $290 million computer systems company in Westford, Mass., named Jean Bua CFO. She replaces David Sommers, who was named executive vice chairman. Bua, 52, joined NetScout in 2010 as chief accounting officer and vice president from American Tower Corp., where she was executive vice president of finance and treasurer. Earlier, she was corporate controller at American Tower, and controller, chief accounting officer and senior vice president at Iron Mountain.
Aricent Group, a $278 million innovation and technology services company, appointed Mick Lopez CFO. He succeeds David Freedman, who is leaving the East Brunswick, N.J., company. Lopez, 52, most recently was vice president of corporate finance and operations at Cisco Systems. Previously, he served as vice president of strategy and business development at Tyco International and CFO at ADT Security Systems. Lopez also spent 16 years at IBM in strategy and finance positions.


text:
Spoilers ahead!
A few not-so-shocking giveaways about this week's new movie releases, including Justice League and Frank Serpico
Matthew Lickona 6 p.m., Nov. 17
On Saturday morning, Gary Stein, the Marine Sergeant who ran the anti-Obama Facebook page, "Armed Forces Tea Party," will know if he has a future in the Marines.
On that day, an "administrative separation board" will hear his case and decide whether to discharge him for violating the the "Uniform Code of Military Justice," which prohibits servicemen and women of participating in political clubs or organizations, especially those openly critical of the President.
On the Facebook page, which he started in 2010, Stein bashed the Obama Administration over the Affordable Care Act and for running up the national debt. After the profile went public, Stein's superiors warned him about the site. He then took it down, only to put it back up again.
Now, in addition to lambasting Obama over health care and out-of-control spending, the Facebook page has turned to fundraising.
"Thank you to the great people that gave to Gary Stein's defense fund," read a post on Sunday. "We nearly raised $300 in one day from $5 donations! [Armed Forces Tea Party] members are awesome."
According to the Navy Times, fter Saturday's hearing, board members will present their recommendation to Brigadier General Daniel Yoo, who will then make the final decision.


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I love the DVR functionality in Nintendo TVii! But I do not have a Tivo and am not planning on getting one. I have Verizon Fios and was wondering if Nintendo would connect to my DVR on My Verizon FiOS.
I love the DVR functionality in Nintendo TVii! But I do not have a Tivo and am not planning on getting one. I have Verizon Fios and was wondering if Nintendo would connect to my DVR on My Verizon FiOS.
going to have to wait until launch day and test. sorry none of us know how.
Site Rules/Guidelines
Ultimate Guide to Wii U Forums
Forum Leaders/Staff
See anything wrong? Report it! Click the /!\ triangle in the bottom left of each post!
I seem to remember Nintendo stating that, as of right now, the functionality is only limited to TiVo, but is working to add other DVR's to the mix over time.
What if all we have is an antenna to get local channels? Will TVii be compatible with our ghetto setup?
Nintendo ID: Had to bring the first one back about to do the update now
Just enjoying hanging out with you guys and gals having a good time.
BoA Song of the Day: ID; Peace B
I just hope that Nintendo TVii can talk to my little ghetto Comcast cable box (it's not the fancy DVR or anything, just a little freebie) and not change the channel on my TV. I would assume that it asks for my TV brand as well as my cable box so it can switch my Input back to the TV and then changes the channel on my cable box.
I wonder how far the universal remote goes...I wonder if it can control my Yamaha receiver....
Adam Levine: Where do you live, MelMartinezFan?
MelMartinezFan: Where do you live, Adam?
Adam Levine: If I'd tell you that, I'd have to kill U!
I'd like to stay the optimist and say that the reason for the delay (and not at launch) was to help build their relationships with other TV providers so that they could offer extra DVR functionality and not just be a Tivo exclusive.
It really wouldn't be very hard to work with dvr's like directtv's, lince they already know the remote commands, and the directtv dvr's dlna so it could easily query for what shows were available and send the remote commands to get them playing. Let's hope they do.
The DLNA component of the DVR is absolutely pointless. Accessing it from a secondary device yields no show list, and trying to send something over DLNA to play on the TV is a dead end. It only provides encrypted communication for their whole home DVR system.
The Wii TVii will only work with a DirecTV or Dish DVR if they choose to allow it.
Really, my panasonic blu ray players still show a list of shows, I curse them every time I try to stream something from serviio to them and see the 3 directtv boxes listed in the list, you can't play the encrypted content, and serviio still feeds shows to them. It is amazing how stupid companies like Direct tv can be, they are going to put themselves out of business with all the stupid self imposed restrictions they put on everything. I've been planning on cutting down from 3 dvr's to a single non dvr sd box, since I can stream 99% of what I want to except for the rare football game, and news you can't find streamed live.
Bringing back my first thread Do you think we will ever see support for other DVRs?
NNID: jaguar
3DS Friend Code: 4098-2940-4769
R.I.P. Iwata. We'll all miss you.
Thanks for the interest, but please don't bump month long threads.
Switch Friend Code: SW-3997-7816-3766
3DS Friend Code: 0533-8845-6374
Steam ID: Max_Lazy_10
Origin ID: Max_Lazy_10


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10 Satisfying Feelings Every 'Type A' Person Will Understand
10 Satisfying Feelings Every 'Type A' Person Will Understand Type A personalities have a reputation for being intense, emotional and not the healthiest of personality types. A number of studies associate Type A personality with increased rates of high blood pressure, heart disease and stroke. However, Type A's also enjoy an upside with their heightened…Read more


text:
Where is tree?
Multi-family building was designed in the historic district of Berlin. Location of existing trees and directly influenced the design of the facade of the building. The movable external blinds was placed graphic depicting a tree that is now on the plot.
Graphics showing the green helped to "save" existing greenery. Movable panels made it possible to create multiple unique combinations of elevation, and the lace facade has offered a beautiful light effects.
Project was made during internship in Synarchitect office in Berlin.
Thank You!


text:
Weight loss improves metabolic syndrome (MetS) factors, but risk may return with weight regain. This study was designed to determine if exercise training can maintain improvements in MetS risk factors during weight regain. In a randomized control trial,102 overweight or obese (body mass index 25.0–39.9 kg/m2) men and women (age 21–52 yr), with characteristics of the MetS, lost 10% of body weight with supervised walking/jogging at 60% of maximal oxygen consumption (V̇o2max) (−400 kcal/session), 5 days/wk, and caloric restriction (−600 kcal/day) over a 4- to 6-mo period. After weight loss, 77 remaining subjects underwent programmed weight regain (+50% of lost weight) for 4–6 mo with random assignment to two groups: no exercise (NoEX) or continued supervised exercise (EX). Blood pressure, regional fat, glucose homeostasis, lipids, and inflammatory markers were assessed at baseline, post-weight loss, and post-weight regain. Groups were compared by two-way repeated-measures ANOVA on the 67 subjects. After weight loss (9.7 ± 0.2% of body weight), significant (P < 0.05) improvements were observed in almost all parameters assessed. Following weight regain (54.4 ± 1.6% of lost weight), the NoEX group exhibited deterioration in most metabolic markers, while the EX group maintained improvements in V̇o2max, blood pressures, glucose homeostasis, high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), oxidized LDL, and other markers of inflammation, but did not maintain improvements in triglyceride and cholesterol concentrations or abdominal fat. Results of this design of controlled human weight regain suggest that aerobic exercise can counter the detrimental effects of partial weight regain on many markers of disease risk.
- lifestyle intervention
- abdominal fat
- glucose homeostasis
- lipoproteins
americans are experiencing an obesity epidemic, with US adults and children gaining weight at unprecedented rates, and the increased prevalence of lifestyle-related diseases such as Type 2 diabetes and cardiovascular disease (CVD) is accompanying this weight trend (9). Although obesity itself is a risk factor for chronic diseases, most of the increased risk of disease may be associated with the clustering of risk factors termed the metabolic syndrome (MetS). Epidemiological studies suggest increased prevalence of morbidity and mortality in individuals with the MetS (17), and estimates of the national medical expenditures attributed to the MetS have surpassed $80 million (28).
Weight loss, whether by energy restriction, increased energy expenditure, or a combination of the two strategies, is an effective way of improving metabolic health, as indicated by beneficial changes in insulin sensitivity (15), abdominal adiposity (11, 15), blood lipid profile (35), markers of inflammation (7), and blood pressure (5). The benefits of weight loss are clear in the scientific literature; what is less clear is the impact of exercise during cycles of weight loss and regain, which are common in overweight individuals (21). Recent data suggest that weight often is regained in a short period of time (14, 26, 31, 32), and even chronic exercisers may gain weight over time (34).
Results from numerous studies indicated that weight loss is not necessary to achieve the beneficial effects of exercise training on chronic disease risk parameters of insulin sensitivity (3), abdominal obesity (29), lipoprotein profile (27), C-reactive protein (CRP) (20), and blood pressure (5). Given that exercise is effective with or without weight loss, it follows that exercise may be beneficial even during periods of weight regain. In support of this concept, epidemiological studies suggest that fitness dramatically reduces the risk of death in overweight men (2, 22), and physical activity reduces the risk of adverse events in overweight women with coronary heart disease (CHD) (33). Collectively, these results suggest that exercise training may improve risk status regardless of weight.
Improved health profile in the face of weight gain has important implications to national health policies. In high-risk adults, the retention of beneficial metabolic effects may play an important role in preventing disease symptoms and events. Using a novel model of controlled weight regain in humans, the purpose of this study was to determine if aerobic exercise training effectively maintains improvements to MetS variables during partial weight regain. We hypothesized that exercise training would prevent deterioration of metabolic parameters during controlled weight regain.
Study Participants
The primary criteria for participation were overweight to Class II obese [body mass index (BMI) 25–39.9 kg/m2] and sedentary, i.e., no more than one systematic exercise session over 30-min duration per week over the previous 4 mo. Subjects were weight stable for the previous 3 mo, as determined by questionnaire. All subjects had at least two characteristics and 60% had three to five characteristics of the MetS as defined by the third report of the National Cholesterol Education Program (8). Subject characteristics and incidence for individual MetS variables are presented in Table 1. There were no significant differences between groups on any baseline characteristic.
Exclusion criteria included diagnosed cardiovascular disease or diabetes or disease symptom according to the American College of Sports Medicine (1), smoking, menopause, or medications or supplements (e.g., fibrates, statins, metformin, thiazolidenediones, antihypertensives, fish oil) that could affect weight loss or variables of the MetS. One-hundred two subjects (37 men, 65 women) started the study, and 67 subjects (27 men and 40 women) completed both phases. All participants provided written informed consent as approved by the Health Sciences Institutional Review Board at the University of Missouri. The study was registered in ClinicalTrials.gov [identifier: NCT00543985 (http://www.clinicaltrials.gov/ct2/show/NCT00543985?term=metabolic+syndrome&state1=NA%3AUS%3AMO&rank=6)].
Weight loss treatment protocols.
All subjects were assigned individual exercise and diet programs designed to induce a loss of 10% body weight titrated over a 4- to 6-mo period (Fig. 1), which for most participants was a rate of loss of ∼0.2–0.4 kg/wk. The average daily energy deficit required for an individual to achieve this amount of weight loss over the 6-mo period was estimated from the initial body weight and an energy deficit of 7,700 kcal for 1 kg of weight loss. A combination of increased energy expenditure and decreased energy intake was used to achieve the target daily energy deficit.
The exercise program for weight loss consisted of supervised walking or jogging exercise in a fitness center within the Exercise Physiology Lab complex at the University of Missouri. To prevent lower extremity injury or discomfort in this previously sedentary population, a ramping protocol was used to attain the desired level of training. Week 1 consisted of treadmill exercise at ∼50% of aerobic capacity (V̇o2max) or 75% of maximal heart rate (HRmax) for 20 min/day, 5 days/wk. Weeks 2 and 3 consisted of treadmill exercise at ∼50% of V̇o2max for 30 and 45 min/day, respectively, 5 days/wk. By week 4, subjects were training at the desired intensity of 60% of V̇o2max for 45 min/day, 5 days/wk (>200 min/wk, 2,000–2,500 kcal/wk) (4), where they remained for the duration of the study. The exercise intensity was monitored daily by the personal trainer assigned to the subject. In addition, stationary cycling and elliptical exercise were used for recovery/rehabilitation when muscle or joint injuries occurred. This quantity of exercise paralleled that recommended by the Institute of Medicine (4). The weight loss was monitored one to two times weekly, and adjustments to the exercise and diet prescription were made as necessary. The average kilocalorie deficit targets were ∼450 kcal/day for exercise (measured V̇o2) and 600 kcal/day for diet.
At the beginning of the study, a nutritionist met with the subjects to discuss overall dietary health (e.g., food pyramid, importance of fruits and vegetables, dairy, etc.), present simple strategies to reduce energy intake, and teach subjects how to read and interpret food labels. The nutritionist met with each subject to evaluate habitual diet and develop an individualized plan to reduce energy intake. Subjects kept a daily food intake record throughout the study, and a study nutritionist utilized the records each week to provide each participant with specific suggestions on how to modify the diet to achieve the prescribed energy deficit. Total energy and macronutrient composition of the diet were estimated at baseline, post-weight loss (PWL), and post-weight regain (PWR) from the written daily food records using the Food Processor software, version SQL (ESHA, Salem, OR).
Weight regain treatment protocols.
The second phase of the study was 4- to 6-mo duration and was the primary focus of the research. After completing the weight loss phase of the study, subjects were randomly assigned to two groups: partial weight regain with no exercise training (NoEX) or partial weight regain with exercise training (EX) (Fig. 1). For randomization, subjects were divided into pairs based on sex and the time scheduled to finish the weight loss phase. The first participant in the pair to complete the weight loss phase was assigned to either the EX or NoEX group based on a coin flip, and the second participant of that pair was then assigned to the other group.
Subjects who were randomized to the NoEX group discontinued exercise training and were provided an energy intake prescription designed to cause regain of 50% of the lost body weight over 4–6 mo, with focus on the addition of healthy dietary energy. In addition, each subject in the NoEX group was required to report to the lab a minimum of 1–2 days/wk for weigh-in, diet diary analysis, and counseling. Utilizing the daily food records, modifications to the diet prescriptions were made as needed.
Subjects in the EX group continued to exercise at 60% V̇o2max, as reassessed by a second maximal stress test for 5 days/wk as in the weight loss phase. During the regain phase, at least three exercise sessions per week were performed under supervision in the fitness center. The 1–2 days/wk unsupervised sessions were monitored using pedometers, heart rate (HR) monitors, and activity logs. Others have shown that unsupervised exercise sessions can be monitored accurately using pedometers or accelerometers (13, 30).
Thus, in the EX group, the target positive energy balance was achieved only by increasing energy intake. The dietary energy intake was increased from the weight loss phase based on the new body weight and the exercise kilocalorie deficit. The dietary intake was adjusted weekly by the study nutritionist or assistant as necessary with the goal to regain steadily over the 4- to 6-mo period. Healthy snacks (e.g., protein bars, dried fruits, and nuts) were provided during the regain period to help participants meet energy intake goals.
Outcome variables.
Measurements on outcome variables were performed at baseline, PWL, and PWR. For a given subject, a single technician made all measurements at the three time points. Weight was measured using a Toledo scale sensitive to 100 g and height measured using a wall tape calibrated to 0.1 cm. Waist circumference was measured to the nearest 0.1 cm with a spring-loaded metal tape. Body composition was estimated using QDR-4500A dual X-ray absorptiometry (Hologic, Shelby Township, MI).
After the subject sat quietly in a padded chair for 15 min, systolic (SBP) and diastolic blood pressures (DBP) were measured using a standard aneroid sphygmomanometer. Each subject underwent a cardiologist-supervised treadmill stress test to volitional exhaustion using the Bruce protocol to assess V̇o2max using a True One 2400 (Parvo, Sandy, UT) metabolic cart.
Computed tomography (CT) on a Siemens Somatom Sensation 4 (Forchheim, Germany) was used for determination of cross-sectional abdominal adipose tissue at the level of the L4–L5 vertebral disc space as described by Kelley et al. (12, 16). Using a blinded, single technician strategy, total abdominal adipose tissue (TAT) was divided into visceral (VAT) and total subcutaneous (TSAT) by manual tracing along the borders of the abdominal wall musculature. TSAT was further subdivided into superficial (SSAT) and deep (DSAT) compartments by a manual tracing along the subcutaneous fascia.
To standardize food intake before each testing session for measuring blood parameters, each subject used a self-selected 48-h diet with 12-h fast before baseline blood collection and then repeated this "personalized" 48 h diet before each blood sampling day. An attempt was made to have all subjects' weight stable for 2 wk before and during the posttesting periods.
Following a 48-h dietary control with 12-h fast, blood samples were collected, separated in a refrigerated centrifuge for plasma and serum, and stored at −80°C until analyzed. All samples (baseline, PWL, PWR) from a given subject were analyzed in a single run. We previously observed that plasma volume corrections were not necessary due to the similar timing in association with exercise (48 h post-training session) for each testing time period (unpublished data). A given female subject had blood collected at the same phase of the menstrual cycle (follicular or luteal) during each testing period.
Glucose, triglyceride (TG), and cholesterol concentrations were measured with colorimetric kits (Thermo, Arlington, TX). Plasma high-density lipoprotein (HDL)-cholesterol (C) and subfractions, less dense HDL2 and denser HDL3, were determined using a modified heparin-MnCl2-dextran sulfate method (6), and low-density lipoprotein (LDL)-C was calculated according to the Friedewald equation (10). Insulin and C-reactive protein (CRP) were measured with an immunoassay system (Immulite 1000, Siemens, New York). Oxidized LDL (oxLDL) concentration was analyzed with a commercially available enzyme-linked immunosorbent assay (ELISA) (Mercodia, Uppsala, Sweden). TNF-α and its soluble receptor two (TNFRII) were assessed using ELISA kits (R&D Systems, Minneapolis, MN). Homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were calculated and used as estimates of insulin resistance and sensitivity, respectively. Coefficient of variation averaged 2.0% and was less than 4.5% for all analyses.
Statistical analysis.
A priori power analyses were conducted to calculate the samples sizes needed to detect the effect sizes of interventions at PWL vs. PWR. All participants were treated as one group in the weight loss phase and treated as two groups in the weight regain phase (Fig. 1). We calculated that an n of 34 participants per group would detect a medium effect of d = 0.50 at power = 0.80, α = 0.05.
Values are presented as means and SE, and α level was set at 0.05 for all comparisons. To verify changes in the metabolic parameters with weight loss, data from the phase 1 weight loss, the single group was analyzed using a one-factor (time) ANOVA with repeated measures (baseline vs. PWL) (Fig. 1). For phase 2 weight regain, data were analyzed using a group (NoEX and EX) by time (baseline, PWL, and PWR) ANOVA with repeated measures on time. Bonferroni adjustment was applied when there were multiple comparisons for a variable.
Of the 102 subjects who began the study, 67 subjects, ages 21–52 yr, completed both phases of the study and were included in the statistical analysis and are characterized in Table 1. The dropout rate at the end of weight loss was 27% and after both phases was 31%. Subjects completed 96% of all assigned exercise sessions during both phases (%compliance = no. of sessions attended/total no. of sessions required × 100). The average exercise performance during the study was 4.8 sessions/wk and 2,000 kcal/wk. The incidence of MetS characteristics at baseline and PWR is listed in Table 1.
Dietary analysis of each time point is summarized in Table 2. Although groups were not formed at baseline, the group means are presented to assess retrospectively changes between baseline and PWR. Dietary intake of each macronutrient was reduced during the weight loss phase and then tended to go back toward baseline values during the regain period. Carbohydrate and calcium in the EX group and energy, carbohydrate, and fiber in the NoEX group were significantly different between baseline and PWR.
As prescribed, subjects lost 9.7% of body weight during the weight loss phase and gained back 54.4% of the lost weight in the regain phase (Fig. 2). BMI paralleled body weight changes (Fig. 2) as did percent fat, in which the total group exhibited a significant loss of 3% fat during weight loss and each group a significant increase of 1.3% fat during regain. V̇o2max was significantly increased by 11% during the weight loss period and then was maintained during the regain period in the EX group but decreased significantly by 7% during regain in the NoEX group (Fig. 2). In addition, significant reductions in DBP and SBP were maintained in the EX group, while the NoEX group exhibited a significant increase in SBP during weight regain (Fig. 2).
All measured markers of glucose homeostasis were significantly improved during weight loss. Insulin, HOMA, and QUICKI were maintained in the EX group during regain but not in the NoEX group (Fig. 3). All lipids and lipoproteins were significantly improved after weight loss although HDL-C was a trend only (Fig. 4). Cholesterol and TG concentrations generally deteriorated following the regain phase in both groups. HDL-C continued to increase and was significantly different from baseline in both groups during regain. HDL2-C also remained significantly higher than baseline in both groups during regain (data not shown). LDL-C was maintained in the EX group but not in the NoEX group after regain (Fig. 4).
Waist circumference and abdominal adipose tissue compartments were significantly reduced with weight loss and then increased significantly in both groups with weight regain (Fig. 5). However, the PWR mean remained lower than baseline in both groups for all variables. SSAT and DSAT (data not shown) results each paralleled those of TSAT.
OxLDL concentrations were decreased following weight loss, and the reduction was maintained during weight regain in the EX group (Fig. 6). Inflammatory marker changes were small, but TNFRII was significantly reduced with weight loss, and CRP and TNF-α concentrations were significantly lower than baseline after regain in the EX group only (Fig. 6). The CRP result may have been due in part to the nonsignificantly higher baseline value in the EX group (0.62 ± 0.12) vs. the NoEX group (0.39 ± 0.12).
The results of the weight loss phase confirm the positive impact of exercise training and weight loss on the MetS variables and extend our understanding of the comprehensiveness of these effects. The primary hypothesis tested was that the two groups would respond differently to the weight regain. Using a novel controlled weight regain model, these results show for the first time in humans that exercise can maintain most aspects of metabolic health during partial weight regain. The EX group exhibited maintenance of V̇o2max, resting DBP and SBP, glucose homeostasis, LDL-C, HDL-C, and oxLDL. The results for insulin sensitivity (QUICKI) and resistance (HOMA) (Fig. 3) follow other data, which indicated that acute or chronic exercise has a marked impact on glucose homeostasis regardless of weight loss (3). Our results extend this finding and further suggest that exercise has a beneficial impact on insulin sensitivity and other metabolic parameters even in the face of weight gain. Although HOMA and QUICKI have limitations as markers of glucose homeostasis, intravenous glucose tolerance tests performed on a cohort of subjects in this study confirmed the results of the QUICKI analysis (24). The ability of exercise to maintain the improvements in these metabolic variables despite the weight regain highlights the potential of this treatment strategy in the prevention of Type 2 diabetes and associated health care costs.
Lipid and lipoprotein parameters were beneficially affected by the weight loss, but the impact of the regain on lipids was variable (Fig. 4). While others have reported improved lipoprotein profile induced by exercise training with weight loss (35) or without (27), maintenance of HDL-C, LDL-C, and oxLDL during weight regain is a novel finding and suggests a powerful impact of exercise on these important CVD risk factors despite weight regain. Others have reported negative effects on lipoproteins during follow up to a weight loss program, presumably caused by the weight regain (18). The reason for the significant increase in HDL-C in the NoEX group during regain is unclear. This result could indicate a delayed response to the exercise accumulated during the weight loss period. Slentz et al. (27) reported on the stability of HDL-C for 14 days after a training program comparable to ours. On the other hand, the increased HDL-C also could result from the increased total cholesterol concentration observed during the regain period.
In contrast to most outcome variables, exercise did not maintain the improvements in abdominal fat, cholesterol, or TG concentrations. The lack of maintenance in TG and cholesterol concentrations in the EX group was most likely due to the increased intake of cholesterol, saturated fat, and trans fat, PWL vs. PWR (Table 2). Aerobic exercise has been shown to have a potent impact on reducing abdominal fat (15, 25). However, exercise training had virtually no impact on maintaining the reductions in abdominal adiposity during the weight regain period (Fig. 5). This unexpected finding could be due to differences in the weight changes among studies. In previous studies there was an extended period of energy balance (29) or energy deficit (15), whereas participants in the present study were in a state of positive energy balance during the weight regain phase. These results suggest that the ingestion of excess energy can result in adipose fat accumulation in the abdomen despite concomitant exercise training.
Reductions in abdominal adiposity have been linked to improvements in other metabolic variables, most notably insulin sensitivity (11, 15), suggesting that changes in insulin sensitivity and abdominal adiposity would occur in parallel during weight regain. However, these two variables did not change equally during the weight regain period in the EX group. This result suggests that other factors related to exercise training, such as improved cardiovascular fitness (V̇o2max) or reduced systemic inflammation (oxLDL, TNF-α), may be driving the maintained improvement in insulin sensitivity during weight regain. Regardless, the results of the present study suggest that it is necessary to maintain reduced body weight to stabilize reduced abdominal fat stores.
The danger of weight regain without exercise is highlighted in the present study. In the NoEX group, the weight loss-induced benefits to metabolic parameters were rapidly lost. That is, in the absence of exercise, even partial weight regain produced significant detriment in health status within a 6-mo period. It may be noteworthy that several markers were back to near pre-study values, i.e., the PWR value was not significantly different from baseline (e.g., SBP and DBP, HOMA, and oxLDL) even though only half the weight was regained. In another study, 12 women who participated in 16 wk of aerobic training and then detrained for 6 wk regained all the lost body weight (4.9% body weight) and exhibited complete return of the lipoprotein profile to baseline values (18). In addition, recent work on rodents demonstrated that weight regain was caused in part by weight loss-induced metabolic aberrations that were normalized in a group undergoing exercise training (19). The possibility also exists that the negative health changes in outcome measures during weight regain in NoEX could have been due to the cessation of exercise training, not necessarily solely due to weight regain. In support of the "detraining" concept, results from a recent report demonstrated that reduced activity had a negative impact on metabolic health even without weight gain (23).
Although the results point to the ability of exercise to maintain the metabolic effects of weight loss, the magnitude of the effect is debatable. In most cases, the NoEX group exhibited deterioration in metabolic markers, while the EX group maintained these parameters during regain. However, except for DBP and insulin concentration, the NoEX and EX groups were not significantly different from each other on any other parameter at the end of the regain period. It could be argued that to be more confident of the exercise impact, the two groups should be significantly different at the end of regain period on most variables. This was not the case. Thus the interpretation of a positive impact of exercise is based on less definitive comparisons between the PWL and PWR time points within each group. On the other hand, the EX group exhibited lower incidence of achieving threshold on three of the five MetS variables than the NoEX group following regain (Table 1). When only those subjects with ≥3 MetS variables at baseline were analyzed, results were similar to those for all subjects; that is, only HOMA was significantly different between groups after regain. The data indicate that the groups were separating on most variables during the regain period, and an extended time period (e.g., 1 yr) may produce more conclusive results. It is also possible that a different exercise regimen may better counter the effects of weight regain than the moderate aerobic prescription. For example, a higher intensity exercise with shorter duration could be used or a different mode such as resistance training. However, it may be difficult for overweight subjects to tolerate higher intensity exercise.
Prescribing weight regain in human research carries an ethical dilemma. Support for this approach can be rationalized given the overwhelming number of individuals who regain weight and thus the potential importance of the findings gained from this design. Dietary markers suggested that the healthiness of the participants' diets was not compromised during regain vs. baseline, as only the reduction in fiber in the in NoEX might be considered detrimental. This lack of overshoot in the regain diet is noteworthy considering that the EX group had to compensate with extra energy from diet for the increased energy expenditure during exercise (Table 2). On the other hand, the carefully controlled diet during the regain period may have partially accounted for the protection provided by exercise. However, the deterioration of the metabolic variables in the NoEx group, who also were using "healthy" overeating to gain weight, suggests that diet was not a part of the protection during the regain period. In addition, in the regain diet only CHO and calcium were different during regain vs. baseline and the energy intake was similar baseline vs. regain in the EX group, suggesting that exercise at least has the ability to protect if a person returns to the pre-weight loss diet. However, the study design does not allow conclusions on whether exercise could counter a less healthy or more excessive diet during a regain period.
Most individuals who participate in exercise and diet programs are successful at losing weight. However, it is also common for many of these individuals to relapse and regain the weight. To our knowledge this is the first human study to examine the role of exercise in countering the potential detrimental effects of this weight regain on MetS variables and overall health status. This model offers unique potential for studying weight regain in humans. In conjunction with a relatively standard aerobic exercise prescription, we were able to titrate caloric intake using daily food records and weekly dietary counseling to achieve an individualized controlled weight regain program.
In conclusion, the results of this study suggest that exercise may counter the detrimental effects of partial weight gain on many markers of metabolic health and disease risk. In contrast, weight regain without exercise produces generally detrimental effects on these markers.
This study was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant R01-DK-067036 and National Heart, Lung, and Blood Institute Grant T32-AR-048523.
No conflicts of interest (financial or otherwise) are declared by the authors.
We thank Joseph Donnelley, EdD, James Sowers, MD, and Craig Stump, MD, PhD, for input and participation during study planning and initiation. We also thank Junor Chelif, MD, and Guru Govindarajan, MD, for assistance in supervising stress tests, and Thomas P. LaFontaine, PhD, for serving as the project safety officer. We greatly appreciate the work of the many graduate students who served as personal trainers and monitors for the subjects.


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Summer is officially here, folks, and what better way to spend your summer than in the great outdoors? Hit the beach! Take a hike! Go for a swim! Or, if you're like me, you're bound to be connecting with Mother Nature by pitching a tent, lighting a fire, and sleeping under the stars.
That's right. Camping. And your very own geeky camping stuff!
Now, I know what you're thinking: camping is not exactly the most geeky activity out there. It involves being out of cell phone range with no wifi or outlets to plug into. While camping is all about disconnecting from technology and communing with nature, I assure you that there are ways to sneak around that and still be able to keep up your geeky appearance.
Geeky Camping Stuff
Here are ten geektastic items for you to bring along on your next camping trip!
1. TARDIS Tent: It's Bigger On The Inside
The TARDIS takes the Doctor through all of time and space in his travels, so why not let it take you through your travels through time and sleep in your own TARDIS Tent. Though this tent may not be bigger on the inside, there's still plenty of room for a Doctor and his companion.
2. Sleep Inside a Tauntaun
Follow Han's survival tactic and cuddle up at night inside of a ThinkGeek Tauntaun Sleeping Bag. Just hope they don't smell as bad as they do on the outside!
3. Gimli's Axe To Slay Any Wild Beasts/Trees
Bad news: your camping party has determined that it's your turn to go collect wood for the fire. Well why not make your firewood gathering a bit more epic with a replica of Gimli's Axe. Great for chopping down wood, plus any Orcs or Uruk-hai that get in your way.
4. Micro-Jet Lighter Torch
Forget everything you ever learned from Girl Scouts or Boy Scouts about building a fire once you've got the MicroJet Lighter Torch. This baby ensures a much easier campfire-building process. Watch your campfire ignite with just the simple press of a button.
5. R2-D2 Folding Chair
Relax in your R2D2 Folding Armchair and enjoy the great outdoors with your best droid buddy.
6. Lightsaber Flashlight Not Able To Harm Bears
Don't you hate it when you wake up in the middle of the night and nature calls? It means dragging yourself into the creepy, dark woods that in no way harkens imagery from that one scene in Snow White that so desperately scared you as a child, just so you can do your business. Well, now you can feel a little safer with your very own lightsaber flashlight.
Now you'll be safe from whomever you may encounter in the forest, be it Darth Maul or a bear. (Warning: this flashlight will not actually protect you from a legit bear. Unless you chuck it at its head. And then run.)
7. Super External Battery – Very External, Very Battery
Ah the great outdoors. Camping's all about getting away from technology, becoming immersed in nature, and finding yourself… still, you can't quite seem to kick that Angry Birds habit, can you? With the ThinkGeek iGeek Large Capacity Portable Charger, keep your apple products fully charged throughout your whole stay in the woods. Just try to stop playing Fruit Ninja for five seconds and enjoy nature, all right?
8. Chemistry Camping Cups and Plates
When packing your eating utensils and dishware, be sure to pack some stackable periodic table coffee mugs and salt molecule bowls. So long as you're out in the middle of nowhere, may as well educate yourself.
9. Wieners and Marshmallows On A Sword
Make Jon Snow proud by sticking your marshmallows with the pointy end of your Swashbuckling BBQ Sword from ThinkGeek. Show those hot dogs who's the true King of Westeros.
10. Pac-Man Blanket is Made of Warm
Cuddling up with your loved ones around the campfire is the perfect capper to a day of camping, and what better to cuddle up underneath than a ThinkGeek Pac-Man fleece blanket. Perfect for both warmth and the excuse to make Pac-Man sound effects throughout the entirety of your trip.
Thanks to Julia for this geektastic post! I LOVE IT LIKE THE SON I NEVER HAD!


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We are headed for Venice for the first time and once again reaching out to my fellow CH's. every trip to Italy you have helped me immensely to make great choices, please help me put it together again with your favorites and suggestions. We favor local places, budget is not big deal if the food and service are worth it. Atmosphere and views are always appreciated. I adore seafood but my hubby does not so if you have a place or two that I could satisfy his tastes with some meat dishes that would be terrific.
4 fine dining experience suggestions would be great
4 or 5 great for large lunches and on those days we can skip a big dinner and enjoy some lighter fare in the evening.
a great spot for pizza
any must dine at would be greatly appreciated. I am now going to start scouring the threads and compile my initial list.
thanks Kindly


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The 4 Moms of 35+ Kids [3] are answering questions about bedroom arrangements, family meetings, and church camp.
Here are the questions we got from readers on our 4 Moms Facebook page [4].
Some of you have all girls and one boy. What age does he get his own room?
Our only boy [5] is now 16 and has his own room, but he has occasionally shared a room with a sister.
When he was 5 years old, there was a short period of time that he shared with Madison, our oldest [6] and his closest sibling in age.
Then when he was 11 years old, he shared a room with his baby sister, Emelyn [7], who he is still very close to today.
Ideally, a boy would not share a room with a sister, but having an only boy and 7 sisters presents a special challenge. We are blessed now to have plenty of space to give him his own room [8], but when we didn't we made do the best we could.
Do you conduct family meetings? If so, how do you structure them?
We do have family meetings, but not on a regular schedule. When we are going on vacation [9], as we will be soon, and need to talk about travel arrangements and logistics, or as we are starting a new school year [10], or if we have a special announcement to make we will call a family meeting.
It usually goes something like this:
Mom and Dad: Everyone come to the dining room table. We have some things to talk to you about.
Random Kid: You're pregnant again?!
Me: No, I'm not pregnant. We need to talk about packing for vacation.
Kids: (disappointed) Awwww!
I would say we find a need to call family meetings once every couple of months, but we would be fine with having them more or less, as needed.
Since we eat dinner together around the table, we do a lot of informal meeting anyway.
Do you do sleepaway camp? (You know, like the week long Christian camp thing kids go on with their youth groups.) If you do, at what ages? If you don't, why not?
Once our kids approach the age of 12 or 13, we consider whether they are mature enough to spend a week away from us at church camp. We have allowed some to go earlier than others, and we have revoked the privelege of going to camp if a lack of making good decisions at home is seen.
We like that our children who go to camp are there with siblings who will gladly rat out any mischief or disrespect. Thankfully, this has never had to be reported to us.
Now, be sure to see what questions are being answered by the rest of my 4 Moms team.
- The Common Room [11]
- Life in a Shoe [12]
- Raising Olives [13]