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Vitamin D deficiency is associated with multiple adverse health outcomes including increased morbidity and mortality in the general population and in critically ill patients. However, no randomized controlled trial has evaluated so far whether treatment with sufficiently large doses of vitamin D can improve clinical outcome of patients in an intensive care setting.
The VITdAL@ICU trial is an investigator-initiated, non-commercial, double-blind, placebo-controlled randomized clinical trial. This study compares high-dose oral cholecalciferol (vitamin D3) versus placebo treatment in a mixed population of 480 critically ill patients with low 25-hydroxyvitamin-D levels at study enrollment (≤ 20ng/ml). Following an initial loading dose of 540,000 IU of vitamin D3, patients receive 90,000 IU of vitamin D3 on a monthly basis for 5 months. The study is designed to compare clinical outcome in the two study arms with the primary endpoint being length of hospital stay. Secondary endpoints include among others length of ICU stay, the percentage of patients with 25(OH)D levels > 30 ng/ml at day 7, ICU and hospital mortality and duration of mechanical ventilation. We describe here the VITdAL@ICU study protocol for the primary report.
This trial is designed to evaluate whether high-dose vitamin D3 is able to improve morbidity and mortality in a mixed population of adult critically ill patients and correct vitamin D deficiency safely.
Trial registration
ClinicalTrials: NCT01130181
Keywords:Critical Illness; Vitamin D deficiency; Cholecalciferol; Vitamin D; Critical care; Intensive care; Vitamin D3
Vitamin D is a key regulator in calcium and phosphorus metabolism and likely confers physiologically relevant pleiotropic functions that include cardioprotective and immunomodulatory effects as well as improvement of antimicrobial action [1-6]. Profound vitamin D deficiency in humans causes rickets in children or osteomalacia in adults together with vitamin D myopathy, whereas low vitamin D levels may be associated with an increased prevalence of a multitude of other diseases [1,6] including an increase in mortality [7,8].
Moreover, a systematic review concluded that intervention with cholecalciferol significantly reduced mortality in predominantly elderly, institutionalized women [9]. To date, only few large interventional randomized trials have investigated the effect of vitamin D on clinical outcomes. The rationale for pleiotropic effects of this substance is based on the fact that the vitamin D receptor (VDR) is almost ubiquitously expressed, and the vast majority of cells respond to 1,25(OH)2D exposure. Hundreds of genes with vitamin D receptor response elements directly or indirectly influence cell cycling, cell proliferation, differentiation and apoptosis [6,10].
Vitamin D in ICU patients
Endogenous synthesis in the presence of UV-B radiation is the main source of vitamin D. Therefore, immobilized and elderly individuals are prone to develop vitamin D deficiency. Low vitamin D levels are highly prevalent in critically ill adults and children [11-18]. Unfortunately, no uniform definition of vitamin D deficiency exists and tissue levels of the major active metabolite 1,25(OH)2D are currently not measurable. Today most guidelines agree, however, that a "low" vitamin D status is present when serum 25(OH)D levels are below 20 ng/ml [1,19]. Special concerns in the ICU setting relate to the issue as to whether the definition of vitamin D deficiency should be the same as in the general population or whether special metabolites of vitamin D should be considered in this definition as well [20]. Insufficient vitamin D levels could affect this population in various ways [21]. Over the last years, several groups have reported on an inverse association between vitamin D levels in critically ill patients and severity of disease including length of ICU stay and mortality [13,14,16,22,23]. Moreover, vitamin D levels decline further during ICU stay [24] which is explained by insufficient replacement of vitamin D via enteral or parenteral nutrition in the absence of UV-B exposure. To date, only few and small intervention studies (n=22-33 patients) that were not designed to demonstrate effects on clinical outcomes have been published [12,25-27].
Vitamin D and proposed clinical effects pertinent to the critically ill patient
Calcium homeostasis and bone turnover
In critically ill patients, hypocalcemia is frequently present and has been related to increased morbidity and mortality [28-30]. Reasons for hypocalcemia are not well understood, but besides elevated levels of IL-6, vitamin D deficiency may play a decisive role [31-34]. Without correction of vitamin D deficiency, calcium levels may be impossible to normalize [29]. To maintain serum calcium levels, parathyroid hormone levels rise and induce accelerated bone resorption which is aggravated by prolonged immobilization ultimately resulting in significant bone loss. Interestingly, even relatively low doses of intravenous vitamin D (500 IU daily) might be able to attenuate this detrimental physiological response [12].
Cardiovascular system
The heart is an important target organ for vitamin D, both on a genomic and nongenomic level [35]. Cardiomyocytes express the VDR. Severe hypocalcemia may cause life-threatening, reversible heart failure [36]. Vitamin D seems to inhibit activation of the renin-angiotensin system as well as the expression of genes involved in the development of myocardial hypertrophy [37]. There is accumulating evidence that vitamin D deficiency may be an important factor in the development of congestive heart failure and sudden cardiac death [38]. In chronic hemodialysis patients, calcitriol supplementation is associated with reduction of cardiac hypertrophy and a reduction of QT dispersion [39], the latter being considered a major risk factor for arrhythmia and sudden cardiac death.
Our group found a negative correlation of 25(OH)D with NT-pro-BNP levels, NYHA functional classes and impaired left ventricular function [38]. Hazard ratios for death attributable to heart failure and sudden cardiac death were 2.8 and 5.0, respectively, when patients with severe vitamin D deficiency (25(OH)D <10 ng/ml) were compared with those considered having optimal serum levels (25(OH)D >30 ng/ml) [38]. The anti-inflammatory properties of vitamin D may play an additional role in congestive heart failure [40]. In animal models, vitamin D deficiency is associated with myocardial hypertrophy and fibrosis leading to aberrant cardiac contractility and relaxation [41,42]. Moreover, calcitriol treatment was able to prevent cardiac hypertrophy under in-vitro conditions or in VDR knock-out animals [41,42].
Immune system/sepsis/inflammation
Vitamin D acts on both the adaptive and innate immunity systems. Most cells of the immune system express the VDR [6]. It enables macrophages to respond to and kill bacterial and viral organisms. In line with this is the observation of impaired macrophage function in VDR knock-out mice [6]. Vitamin D also exerts an influence on epidermal keratinocytes to fulfill their barrier function [43]. Monocytes cultured in severely vitamin D-deficient plasma express less cathelicidines and improve their function with 25(OH)D as well as 1,25(OH)2D [44]. Cathelicidines are important antimicrobial peptides that are of great interest in critically ill patients because they constitute part of the initial defense line against pathogens. They are expressed in epithelia of airways, the bladder and gastrointestinal tract, which are all considered important entry sites of nosocomial infections. Treatment of normal human bronchial epithelial cells with 1,25(OH)2D results in a 10-fold up-regulation of cathelicidin mRNA levels after 12 hours [45]. In septic ICU patients, a positive correlation between circulating 25(OH)D and LL-37 levels, the active fragment of cathelicidin, has been reported [46]. In a large retrospective study, the risk for blood culture positivity was significantly higher in vitamin D deficient critically ill patients [13]. Of interest in this context is also the finding that sepsis incidence and case-fatality rates are significantly higher in winter despite similarities in disease severity during summer time [47].
Severe vitamin D deficiency is associated with myopathy, decreased muscle strength and an increased risk for falls [1]. In intensive care, this may translate to the necessity of prolonged mechanical ventilation and difficulties during remobilization and weaning from ventilatory support in patients with low vitamin D status. In randomized controlled trials, vitamin D supplementation improved muscle strength in elderly patients [48] and decreased the frequency of falls [48-50].
Guidelines and practices
For the general population, the Institute of Medicine (IOM) recommends a daily allowance for adults of 600 to 800 IU [51], while the Endocrine Society Guideline recommends 1,500–2,000 IU of vitamin D3 per day for the at-risk population [52]. Upper daily limits for adults are 4,000 (IOM)–10,000 (Endocrine Society) IU per day. Guidelines for parenteral nutrition recommend 200 IU per day and typical enteral nutrition formulas contain 200–300 IU of ergocalciferol or cholecalciferol per 1000 ml. Available over the counter multivitamin preparations commonly contain 200 IU of vitamin D2 or D3. Currently, there is no intravenous vitamin D-monopreparation available, although high-dose intramuscular preparations may be an option in selected patients.
Rationale of the study and hypothesis
In summary, vitamin D plays a pivotal role in calcium homeostasis and is, based on current knowledge, associated with disease severity and mortality in critically ill patients. Moreover, vitamin D exhibits a number of pleiotropic effects that are of special interest to the ICU patient [20,53,54] However, so far it is unclear whether a low vitamin D status is causally linked to adverse outcomes or merely an epiphenomenon reflecting poor health status. In contrast to previous clinical trials that failed to show a benefit for correcting hormonal insufficiencies in critical illness (e.g. administration of growth hormone or steroids) [55,56], one has to bear in mind that vitamin D not only acts on endocrine, but also autocrine level which allows for tissue-specific control of 1,25(OH)2D regulation and action that may be completely independent of circulating calcitriol levels. As far as we know now vitamin D also has an excellent safety profile with a broad therapeutic window [19,57].
The hypothesis of this first large RCT is that supplementation with a sufficiently large dose of vitamin D leads to a fast correction of low vitamin D status and possibly to clinical benefits, particularly relating to immune, cardiac and muscle function. Because these potential benefits likely occur at various functional hierarchies, we chose "length of hospital stay" as a primary surrogate marker for a change in morbidity in this patient group.
Results from the pilot study relevant for the design of this trial
To optimize study design and ascertain safety and efficacy of the chosen loading dose of 540,000 IU of cholecalciferol, we performed a pilot trial in 25 medical critically ill patients with vitamin D deficiency [25]. Adverse effects like hypercalcemia or hypercalciuria did not occur in this pilot study and vitamin D levels increased significantly in most patients within two days, although 2 out of 10 patients showed no or only a modest rise in 25(OH)D levels at day 7. We therefore chose to continue with the same loading dose, but added monthly maintenance doses of vitamin D to the study protocol.
Justification of high-dose vitamin D3 intervention
The half-life of 25(OH)D following oral cholecalciferol supplementation allows the administration of large doses. In elderly patients with vitamin D deficiency and healthy individuals, large loading doses rapidly and safely normalized 25(OH)D levels [58-60]. However, an annual high-dose intervention was associated with a higher risk of falls and fractures in elderly patients [61]. Some contraindications such as sarcoidosis and other granulomatous diseases also need to be considered before administration of a high loading dose [62,63]. Following publication of the detrimental effects of a high-dose vitamin D intervention on the risk of falls and fractures [61], we decided to nevertheless proceed with the initial study protocol because in our population, a rapid restoration of vitamin D status may still have positive effects on patient immunity and even muscular function. We are aware that smaller doses of vitamin D3 are likely an effective treatment option for most patients with low vitamin D status within months but this time span may be too long during critical illness.
Study design
The VITdAL@ICU trial is an investigator-initiated, non-commercial, double-blind, placebo-controlled randomized clinical trial. This study compares high-dose oral cholecalciferol (vitamin D3) versus placebo treatment in a mixed population of 480 critically ill patients with low 25(OH)D levels at study enrollment (≤ 20ng/ml). Following an initial loading dose of 540,000 IU of vitamin D3, patients receive 90,000 IU of vitamin D3 on a monthly basis for 5 months resulting in a total treatment/observation period of 6 months. The VITdAL@ICU study is conducted at the Medical University of Graz, Austria, a tertiary care university hospital with a catchment area covering the Southeast of Austria (population approximately 1.5 million). It recruits patients from five ICUs: medical (15 beds), neurological (8 beds), cardiothoracic surgery (13 beds) and two mixed surgery units (12 and 10 beds, respectively).
Eligibility criteria for inclusion and recruitment
Upon admission to one of the five participating ICUs, all adult patients undergo screening for study participation. Patients ≥18 years who are expected to stay at the ICU ≥48 hours and are vitamin D deficient (25(OH)D level ≤ 20 ng/ml) are screened for inclusion and exclusion criteria. The following patients are not considered eligible for inclusion: patients expected to die within the upcoming 24 hours, with severely impaired gastrointestinal motility (ileus, gastric volume > 400 ml), contraindication for study drug application (orally or via feeding tube), readmission after participation in the VITdAL@ICU pilot study, enrolment in another intervention trial or documented hypercalcemia (total calcium >2.65 or ionized serum calcium >1.35 mmol/l). Patients with a history of granulomatous disease (tuberculosis, sarcoidosis), recent kidney stones (≤ 1 year) as well as pregnant or lactating women are also excluded from this trial. An overview of the study procedures is given in Figure 1.
Figure 1. Trial procedures flow sheet.
Ethical aspects and informed consent
The institutional ethical committee of the Medical University of Graz, Austria (reference number 21–214 ex 09/10, EudraCT-Nr.: 2010-018798-39), and the Austrian Agency for Health and Food Safety (AGES) approved the study. Informed consent is obtained prior to inclusion into the study according to the Austrian law. The patient can withdraw from the study at any time, without giving any reason and without impact on treatment. A register is kept of all patients evaluated for inclusion and of patients who choose to withdraw from the study.
Patients at each of the five ICUs are randomly assigned to one of the two treatment study groups, "Vitamin D" or "Placebo", in a 1:1 ratio, using the web-based randomization tool "Randomizer for Clinical Trials" ( http://www.randomizer.at webcite). Block randomization is used with patients stratified according to ICU and gender.
Study drug preparation, labeling and intake
The cholecalciferol preparation is provided by Fresenius Kabi, Austria. As placebo, oleum arachidis is used. Identical bottles of study medication containing 180,000 IU of cholecalciferol in 15 ml of oleum arachidis or corresponding placebo are prepared and labeled at the institutional pharmacy. Study medication is stored at room temperature. For usage of the study medication outside of the ICU, the patient, next of kin or continuing caregiver/s are instructed by the study team and receive oral and written information on how and when to take the remaining study medication. Furthermore, they are asked to refrain from additional use of vitamin D over the following 6 months. Additionally, the patient's family practitioner and, if applicable, treating general ward or rehabilitation facility are personally informed or contacted by telephone and instructed about the study.
"Vitamin D": Patients randomized to the "Vitamin D" group receive a loading dose of 540,000 IU of vitamin D3 orally or via feeding tube. This dose equals three bottles of a commercially available vitamin D preparation in Austria: Oleovit D3® solution; concentration of cholecalciferol is 400 IU vitamin D3/drop of oleum arachidis. Total carrier volume is 45 ml. From month 1 to 5, patients receive monthly maintenance doses of 90,000 IU cholecalciferol.
"Placebo": Patients randomized to the "Placebo" group receive oleum arachidis in the same volume and time schedule as "Vitamin D" patients.
Routine low-dose vitamin D supplementation in both study arms during ICU stay
Patients in both study arms are allowed to receive regular low dose (approximately 200 IU per day) vitamin D supplements via enteral and/or parenteral nutrition as deemed appropriate by the treating physicians during stay at the ICU, but are not allowed to receive any vitamin D preparations during their stay at the general ward or at home.
Handling of readmissions to ICU
Patients who are readmitted to intensive care after participation in the VITdAL@ICU trial are not eligible for reinclusion.
Blinding of treatment allocation
All persons involved in patient care of the RCT are blinded to treatment allocation and all study-related activities are carried out in a double-blind fashion.
Primary outcome measures
The primary efficacy endpoint for this RCT is the length of stay (LOS) in the hospital starting from application of the study medication. The end is defined as the time of hospital discharge or death of the patient. Further admissions to rehabilitation facilities are not taken into account. Before unblinding all relevant facilities are independently classified by two study team members.
Secondary outcome measures
Secondary endpoints for this RCT include:
• length of ICU stay starting from application of study medication
• ICU and hospital mortality, 28-day mortality, 6-month mortality
• percentage of patients with 25(OH)D levels ≥ 30 ng/ml at day 7
• duration of mechanical ventilation including CPAP/mask ventilation starting from application of study medication
• need for a tracheostomy during ICU stay
• surrogate markers for cardiac function: need for vasopressor therapy during ICU stay, and duration of such need, NT-proBNP levels
• analysis of biochemical and endocrine variables relevant to calcium- and phosphorus metabolism; 1,25(OH)D and PTH at days 0,3,7, 28 and month 6
• C-Reactive Protein and procalcitonin levels
• clinical parameters at 6 months (falls, Timed Up & Go – test, hand grip strength, lumbar and hip BMD, Quality of life and performance status, number of hospitalizations, number of respiratory tract infections)
• serum cathelicidin levels at day 0 and 7 are planned to be analyzed from frozen samples and will be reported separately
Data collected at study entry
At baseline, data on demographic and clinical characteristics of the patients are obtained. Simplified Acute Physiology Score (SAPS II), presence of comorbidities, medical history, admission diagnosis by category and relevant medication are registered.
The following categories for diagnosis at admission and concomitant diagnoses are predefined:
• Surgical ICU admissions:
• trauma, cardiac surgery, vascular surgery, thoracic surgery, brain surgery, transplantation, other surgical reasons
• Medical or neurological ICU admissions:
• cardiovascular, respiratory, hematological/oncological, sepsis/infectious, gastrointestinal/hepatic, renal, metabolic, neurological, other non-surgical reasons
In addition, we record the need for and the number of days of hemodynamic support and mechanical ventilation including noninvasive ventilation and tracheostomy as well as the quantity and formula of enteral/parenteral nutrition given. Information on insulin requirements and use of antibiotics are registered on day 0, 2 and 6.
Blood and urinary samples
Venous blood samples are taken upon ICU admission and in the morning on days 0,3,7,28 if feasible. Analyses include routine serum chemistry, hematology, markers of inflammation and parameters of calcium and vitamin D metabolism. Additional measurements of markers of metabolism and inflammation as well as other endocrine parameters are planned on stored samples that are frozen and stored at −70°C.
25(OH)D assay
25(OH)D serum levels are measured by ELISA (Immunodiagnostic Systems, Boldon, UK).
Reminder calls and follow-up procedures
All patients who leave the hospital are contacted by telephone on a monthly basis to check for compliance with the monthly intake of the study drug (5 times) and vital status.The long-term follow-up appointment at 6 and 24 months is performed in two ways, dependent on the patient's mobility and preference:
• Variant A (estimated 80%): Follow-up visit by telephone
• Variant B (estimated 20%): Visit at the clinic, including additional:
• Blood and urinary testing (similar to that on days 0,3,7,28)
• Timed Up & Go – Test (in seconds)
• Hand grip strength (in mmHg)
• Dual X-ray absorptiometry (DXA) with bone mineral density (at the hip and the lumbar spine) and body composition
The following data set is collected in all patients:
• Compliance with intake of study drug (number of maintenance doses)
• Additional vitamin D intake
• Falls and fractures since study inclusion (number)
• Respiratory tract infections (number and use of antibiotics)
• Hospitalizations (number and cause)
• Performance status (Eastern Cooperative Oncology Group (ECOG) Score)
• Quality of life
Data management
Data is manually transferred from source files into paper-based primary CRFs identified by ascending patient numbers specific to respective ICUs. Data are then checked for accuracy and transferred to an electronic CRF by the clinical research assistance team. Extensive verification checks are performed by a study monitor. Vital status at 6 months is recorded for all patients.
Safety assessment
Blinded safety assessment for 28-day mortality is planned after 100 and 240 patients. In case there is a safety concern, a standby data safety monitoring board meeting is planned.
Sample size calculation
The sample size was calculated to detect a difference in mean length of hospital stay of 2 days with 80% power and a significance level of 5%. Using the Mann–Whitney U-Test for sample size calculation, a group size of 234 is needed to show a reduction of 2 days (equivalent to 14%) of the primary study outcome based on a mean hospital stay of 14 days and standard deviation of 7 days for the control group. To consider drop-outs of the study, a sample of 480 patients (240 per arm) was considered appropriate.
Statistical analyses
The primary analysis for comparing length of hospital stay between the two groups will be made using the Mann–Whitney U-test. For secondary endpoints, differences between the two groups will be evaluated with the t test or Mann–Whitney U-test for continuous variables as appropriate and for categorical variables with the chi-square or Fisher Exact test. Survival endpoints will be displayed in Kaplan-Meier plots and compared by the log rank test. Furthermore, linear and logistic regression models will be applied to adjust for age, disease severity and 25(OH)D.
A CONSORT diagram will be reported (Figure 2). Analyses will be performed both on intention to treat and per protocol population with the intention-to-treat population as the primary. To assess compliance with the study protocol, the number of study drug maintenance doses will be reported.
Figure 2. CONSORT flow diagram. All adult patients admitted to five intensive care units (ICU; medical, neurological, cardiac surgery and two mixed surgery units) from May 4, 2010 onward were eligible for inclusion.
Safety endpoints
Safety endpoints comprise vital status (ICU and hospital mortality, 28-day mortality, 6-month mortality) as well as serum 25(OH)D and calcium levels. 25(OH)D and serum calcium levels are measured at day 0, 3, 7 and, if available, at day 28 and month 6 in order to identify vitamin D intoxication and/or hypercalcemia. Following the report by Sanders et al. of a higher risk of falls and fractures in elderly women on an annual high-dose vitamin D regime in May 2010 [61], we decided to add the number of self-reported falls as additional safety endpoint.
The study has been initiated as planned on May 04 2010. Blinded safety analyses for 28-day mortality after 100 and 240 patients did not reveal a difference between the two study groups.
This study is the first large RCT evaluating the role of vitamin D on clinical outcomes in critically ill patients. Therefore, a significant difference in the safety and/or efficacy endpoints will provide important evidence for or against the use of high-dose vitamin D intervention in an intensive care setting and, in the event of a favorable outcome in the intervention group, aid in the design of future larger RCTs adequately powered to detect a possible difference in mortality in ICU patients and possibly hospitalized patients in general.
25(OH)D: 25-hydroxyvitamin D; 1,25(OH)2D: 1,25-dihydroxyvitamin D; BMI: Body Mass Index; CRF: Case Report Form; LOS: Length of stay; ICU: Intensive Care Unit IOM: Institute of Medicine; IU: International units; NYHA: New York Heart Association Functional Class RCT: Randomized Clinical Trial; SD: Standard Deviation.
Competing interests
The funding for this trial was provided by the Austrian National Bank (Jubiläumsfonds, Project Nr. 14143), a grant from the European Society for Clinical Nutrition and Metabolism (ESPEN) and an institutional, unconditional and non-restrictive research grant from Fresenius Kabi, Austria. The sponsors had no influence on study design, patient recruitment or data generation and will not have any impact on the analysis of the results or writing of the manuscript. HD received lecture fees from Fresenius Kabi, Austria and KA received lecture fees from BBraun, Germany and NovoNordisk, Denmark. All other authors have no financial or non-financial competing interests relevant to this study to declare.
Authors' contributions
KA and HD designed the VITdAL@ICU study protocol. KA, CS and HD drafted the manuscript and AB is responsible for sample size calculation and statistical analyses. For the primary report of the clinical results, the authorship will be determined by intellectual and operational contribution. All authors read and approved the final manuscript.
We are deeply indebted to Dr. Helga Warnkross for her extensive and continuous help with this study.
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Pilz S, Marz W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, Boehm BO, Dobnig H: Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography.
J Clin Endocrinol Metab 2008, 93:3927-3935. PubMed Abstract | Publisher Full Text
Kim HW, Park CW, Shin YS, Kim YS, Shin SJ, Choi EJ, Chang YS, Bang BK: Calcitriol regresses cardiac hypertrophy and QT dispersion in secondary hyperparathyroidism on hemodialysis.
Nephron Clin Pract 2006, 102:c21-c29. PubMed Abstract | Publisher Full Text
Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R: Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial.
Am J Clin Nutr 2006, 83:754-759. PubMed Abstract | Publisher Full Text
Nibbelink KA, Tishkoff DX, Hershey SD, Rahman A, Simpson RU: 1,25(OH)2-vitamin D3 actions on cell proliferation, size, gene expression, and receptor localization, in the HL-1 cardiac myocyte.
J Steroid Biochem Mol Biol 2007, 103:533-537. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Tishkoff DX, Nibbelink KA, Holmberg KH, Dandu L, Simpson RU: Functional vitamin D receptor (VDR) in the t-tubules of cardiac myocytes: VDR knockout cardiomyocyte contractility.
Endocrinology 2008, 149:558-564. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Bikle DD: Vitamin D and the immune system: role in protection against bacterial infection.
Curr Opin Nephrol Hypertens 2008, 17:348-352. PubMed Abstract | Publisher Full Text
Liu PT, Stenger S, Li H, et al.: Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response.
Science 2006, 311:1770-1773. PubMed Abstract | Publisher Full Text
Yim S, Dhawan P, Ragunath C, Christakos S, Diamond G: Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxyvitamin D(3).
J Cyst Fibros 2007, 6:403-410. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V: Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis.
J Transl Med 2009, 7:28. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text
Danai PA, Sinha S, Moss M, Haber MJ, Martin GS: Seasonal variation in the epidemiology of sepsis.
Crit Care Med 2007, 35:410-415. PubMed Abstract | Publisher Full Text
Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H: Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals.
Osteoporos Int 2009, 20:315-322. PubMed Abstract | Publisher Full Text
Sato Y, Iwamoto J, Kanoko T, Satoh K: Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial.
Cerebrovasc Dis 2005, 20:187-192. PubMed Abstract | Publisher Full Text
Fosnight SM, Zafirau WJ, Hazelett SE: Vitamin D supplementation to prevent falls in the elderly: evidence and practical considerations.
Pharmacotherapy 2008, 28:225-234. PubMed Abstract | Publisher Full Text
Ross AC, Manson JE, Abrams SA, et al.: The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know.
J Clin Endocrinol Metab 2011, 96:53-58. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM: Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline.
J Clin Endocrinol Metab 2011, 96:1911-1930. PubMed Abstract | Publisher Full Text
Amrein K, Venkatesh B: Vitamin D and the critically ill patient.
Curr Opin Clin Nutr Metab Care 2012, 15(2):188-193. PubMed Abstract | Publisher Full Text
Kempker JA, Tangpricha V, Ziegler TR, Martin GS: Vitamin D in sepsis: from basic science to clinical impact.
Crit Care 2012, 16:316. PubMed Abstract | BioMed Central Full Text
Sprung CL, Annane D, Keh D, et al.: Hydrocortisone therapy for patients with septic shock.
N Engl J Med 2008, 358:111-124. PubMed Abstract | Publisher Full Text
Takala J, Ruokonen E, Webster NR, Nielsen MS, Zandstra DF, Vundelinckx G, Hinds CJ: Increased mortality associated with growth hormone treatment in critically ill adults.
N Engl J Med 1999, 341:785-792. PubMed Abstract | Publisher Full Text
Hathcock JN, Shao A, Vieth R, Heaney R: Risk assessment for vitamin D.
Am J Clin Nutr 2007, 85:6-18. PubMed Abstract | Publisher Full Text
Romagnoli E, Mascia ML, Cipriani C, Fassino V, Mazzei F, D'Erasmo E, Carnevale V, Scillitani A, Minisola S: Short and long-term variations in serum calciotropic hormones after a single very large dose of ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) in the elderly.
J Clin Endocrinol Metab 2008, 93:3015-3020. PubMed Abstract | Publisher Full Text
von Restorff C, Bischoff-Ferrari HA, Theiler R: High-dose oral vitamin D3 supplementation in rheumatology patients with severe vitamin D3 deficiency.
Bone 2009, 45:747-749. PubMed Abstract | Publisher Full Text
Cipriani C, Romagnoli E, Scillitani A, et al.: Effect of a single oral dose of 600,000 IU of cholecalciferol on serum calciotropic hormones in young subjects with vitamin D deficiency: a prospective intervention study.
J Clin Endocrinol Metab 2010, 95:4771-4777. PubMed Abstract | Publisher Full Text
Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC: Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial.
JAMA 2010, 303:1815-1822. PubMed Abstract | Publisher Full Text
Amrein K, Schilcher G, Fahrleitner-Pammer A: Hypercalcaemia in asymptomatic sarcoidosis unmasked by a vitamin D loading dose.
Eur Respir J 2011, 37:470-471. PubMed Abstract | Publisher Full Text
Kallas M, Green F, Hewison M, White C, Kline G: Rare causes of calcitriol-mediated hypercalcemia: a case report and literature review.
J Clin Endocrinol Metab 2010, 95:3111-3117. PubMed Abstract | Publisher Full Text
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Product DescriptionBilled as "the world's strongest bolt action," the Mark V is the rifle that changed the face of American firearms. The Mark V is built around a nine locking-lug low-friction bolt with a 60-degree bolt throw. The factory-tuned, fully-adjustable trigger assures precision and the Pachmayr Decelerator pad lowers felt recoil. This rifle features a scope-mounting base and rings and a 2-position safety. Its wood and metal are in good condition and its bore is in very good condition.

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Hilary Duff And Husband Mike Comrie Split
January 10, 2014 7:26 PM
Hilary Duff and Mike Comrie have decided to call it quits. The cause of their separation is unknown, but according to a statement received by HollywoodLife.com, they plan to co-parent their one-year-old son Luca Cruz Comrie.
On the bright side of things, we can expect new music from Hilary in 2014!


text: Vic Symonds | IBDB: The official source for Broadway Information IBDB: The official source for Broadway Information Official Broadway League sites: - sites - broadway.org broadwayleague.com broadwayfanclub.com kidsnightonbroadway.com stagespecs.org tonyawards.com Quick Search For: In This Category: All Show People/Org. Theatre Season Vic Symonds Designer Male Productions ProductionsDate of ProductionsRattle of a Simple Man[Play, Original] Scenic Design by Vic Symonds Apr 17, 1963 - Jul 06, 1963 Find out where Vic Symonds and are credited together © 2001-2015, The Broadway League, All Rights Reserved. (Copyright and Disclaimer)


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If you want a peek into the future of women's health should Republicans succeed in criminalizing abortion, look no further than Brazil. Provisionary Measure 557 (PM 557) signed into law just after Christmas, created a National System of Registration, Vigilance and Monitoring Women's Care During Pregnancy and Post Childbirth for the Prevention of Maternal Mortality (National Registration System).
It's a long name that masks the Orwellian reality Brazilian women now face–compulsory registration with the state of all pregnancies.
Brazilian President Dilma Rousseff created this registry using a power intended only for urgent matters that allows the president to pass a law without congressional approval. Because apparently nothing is as urgent as monitoring each pregnancy in Brazil for evidence of potential criminality.
Even worse, Rousseff created the registry under the guise of trying to address Brazil's high rate of maternal mortality. But PM 557 does not guarantee women access to health exams, or even providers trained in obstetric emergency care. The largest contributing factor in maternal mortality is access to high quality health care in public health facilities and PM 557 takes not one step in the direction of providing women access to quality health care.
What it does do though is to legally compel women to have any child she conceives and specifically places women under state monitoring for this very purpose.
Related Stories:
Florida Wants Abortions Punishable By Life In Prison
Rick Santorum's Right To Choose
Read more: abortion, criminalization of abortion, pro-choice, pro-life, reproductive justice, reproductive rights, republicans, right to privacy, war_on_women
Photo from Emory Co Photo via flickr.
and this is 2012. scary
The world becomes more insane every year! Men have never accepted women's equality.
This is what happens when women allow men to make their decisions, when women dismiss the politics that run their lives. Reclaim your bodies ladies...where is the outrage?
Wow. Big Brother indeed, eh? Scary stuff. Governments around the world (including most Republicans in the US, it seems) apparantly believe that women can't make their own choices and that men are better suited. Strange, considering THEY DO NOT EXPERIENCE EVERYTHING A WOMEN MUST GO THROUGH! What do men know? Nothing!
Wow, that is scary :-(
I don't believe it's about women's mortality, more likely about their emancipation and falling birth rates in Brasil. Good news here: http://www.washingtonpost.com/world/fertility-rate-plummets-in-brazil/2011/12/23/gIQAsOXWPP_story.html?hpid=z2
The book, 1984, becomes a reality.
nano technology of the future, implantation with device that would call 911 should any woman ingest any substance that would cause an abortion. Possible? Sort of a reverse chastity belt. And the church and state would be the only ones to have access to the locks.Rewards for anyone reporting a woman who suddenly appears to have lost a baby bump.
Okay, Now THAT'S scary as hell!!!!!!!
Carole, what civil rights?
Men gave civil rights to black men before women. In both cases they maneuvered to quash those rights with in minutes of the laws passing. I tried to raise a feminist son, not sure it took.
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Karen, Vermont has complete open carry, they had 10 gun deaths last year and 7 of those were suicide Original…
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I watch my little kitten families daily on LAPS and Tiny Kittens...I've been watching Cassidy fight to…
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EAST LANSING, Mich. - Michigan State's ability to seize homegrown talent from basketball-crazy Indiana has paid major dividends for the Spartans for more than 30 years.
First, Plymouth's Scott Skiles wore green and white. Bluffton's Adam Ballinger helped Michigan State win the NCAA championship in 2000. Later, Indianapolis Lawrence North's Chris Hill provided lots of offense.
On Saturday afternoon in the Breslin Center, freshman guard Gary Harris from Hamilton Southeastern scored a game-best and career-best 22 points, and sophomore forward Branden Dawson from Gary Wallace added ...


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Instructor Training Program - Ski or Snowboard
This class is designed for those who may one day become a certified instructor themselves and assisting another instructor is a valuable experience towards that goal. Students who sign up for the Instructor Training Program are eligible to assist instructors with their classes. In exchange for help during classes students will be provided a complimentary lift pass. Age 13-15 yrs.
NOTE: Helmets are mandatory
Please note: There is no availability for Snowboard at this time.


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Swim with Dolphins, Manta Rays & snorkel a Reef. Dolphin Journeys offers fun & education with Wild Dolphins, Manta Rays and Whales (in season). The most magical experiences of a lifetime. Boat 29' cabin cruiser for comfort. Swim guide for safet
Zip through the treetops in an Alaska Rainforest No hand-braking required, your experienced, friendly guides take care of your equipment. Cameras are welcome. Fun activity for the whole family. Top off the trip with axe throwing.
Discover a botanical garden paradise nestled in the midst of the mighty Tongass National Forest. Guided tours aboard easily accessible shuttles escort you through beautifully designed landscapes and into the heart of the Alaskan temperate rainforest.
NAC Tours Bangladesh is an inbound tour operator in Bangladesh, operate group tours purely in Adventure & Eco-tourism concept by a trained tour experts and guide. Please visit our web site to see other Eco-tour programs, booking terms & conditions.
Join SURFit USA for an all inclusive adventure of paddleboarding in Alaska. We paddle along majestic coastlines, glaciers and lots more. Plenty of time to sample the great food, relax in deluxe accommodations and explore the beautiful area.
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City BikesIf you're looking to tame the urban jungle and need a ride that can be used to pound the pavement, check out our city bikes. Bikes for city riding are great for commuting and provide sleek, smooth rides for a range of biking styles. With a huge selection of brands and styles to choose from, the one thing city bikes have in common is being ready to handle sidewalks, pedestrians and traffic all while getting you from point A to point B in style.
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Mena Zaminsky
Alum of Expressive Arts Therapy
Mena Zaminsky LMFT (1999), is an expressive arts therapist, a trained sensory motor psychotherapist with a focus on trauma, and a certified addictions treatment counselor (CATC). Mena served as the director of outpatient services at Walden House and also has a psychotherapy private practice.
She is adjunct faculty in the City College of San Francisco Drug and Alcohol Studies program, where she has taught a variety of classes, including Introduction to Drug and Alcohol Studies, Co-Occurring Disorders, Group Facilitation, and Motivational Counseling.
Mena is also a member of the Drug and Alcohol Studies Community Advisory Board and a past board member of IEATA, where she previously served as the Publications Committee co-chair, newsletter editor, and Artist Committee co-chair.
Mena has taught at John F. Kennedy University and provided trainings in "Using Expressive Arts Therapy in the Treatment of Addictions" in various clinics, including the Haight Ashbury Free Clinics, the Sunset Mental Health Clinic, Napa State Hospital, and the Volunteer Legal Service of the San Francisco Bar Association.
- website: www.creativepsychotherapy.net
- contact: email@example.com 415-420-4464
Return to Expressive Arts Therapy, Expressive Arts Therapy Students and Alumni


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Some Like It HotObserve the Crimson Lasher drinking from 6 Ember Pools. Ember Pools are created by fighting Emberspit Scorpions.
|Help the Crimson Lasher Drink from Ember Pools (6)
DescriptionI've been making progress in my research, <name>. Based on what we've witnessed in the local flora, it's quite possible that your Lasher also accepts superheated liquids as a principal source of nutrition.
I'd like you to help me with a little experiment. The Emberspit Scorpions that inhabit the Magma Springs to the north spew out burning pools of fire during combat.
Take the Lasher and observe his reaction to the scorpions' Ember Pools.
Did it work? So my theory was correct?
RewardsYou will receive: 9 40
|Mark of the World Tree
GainsUpon completion of this quest you will gain:
- 12,870 experience
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A modern dictionary of Catholic terms, both common and obscure. Find accurate definitions of words and phrases.
The emotional satisfaction that arises from the movement of those organs and secretions that aid the act of procreation. This pleasure reaches its peak in a healthy man in the pleasure that accompanies the emission of seed, or in women and youths below the age of puberty in the diffusion of some secretion from the sexual glands. The Catholic Church holds that direct sexual pleasure outside marriage is gravely sinful and never admits of slight matter; indirect sexual pleasure may be either sinful or no sin at all. Direct sexual pleasure is desired and enjoyed in itself and is the privilege only of married partners between themselves. It is forbidden to the unmarried because such conduct would be contrary to the virtue of chastity. Indirect sexual pleasure is not sought for itself but arises from some other action that is performed for a good reason. If there is such a reason, the actions are not sinful, provided a person neither intends the sexual pleasure nor consents to it if spontaneously aroused.
All items in this dictionary are from Fr. John Hardon's Modern Catholic Dictionary, © Eternal Life. Used with permission.


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This is my niece. My beautiful little niece. Actually she's no relation to me, but her mom and I have been best friends for 30 years now. Which is impressive since I am only 35 years old.
Feb. 16, 2012 will always be a day I will remember. It was the day my life, my family's life, all changed. During a routine exam my family doctor found a lump in my right breast, and under my arm. My heart sank and the tears came two weeks later when it was confirmed: stage 4, grade 3. Highly aggressive were the only words I understood. Elevator music started playing in my head. All I could think about were my kids. My teenage headaches waiting for me to get home, and this little girl. My surrogate sister watched and helped raise my children, and I was wondering if I would get the chance to return the favour.
My husband has been by my side the entire time. He has held my hand, wiped my tears, been the sounding board as I screamed in anger, but he never wavered or gave up. He has been my rock, and my reason to keep going. Without him or my kids, I never would have made it through surgery, chemotherapy, unlimited side effects, or the hate I have raging through me right now. Whether it's hate or self pity, I am not sure yet. Still not done. Radiation is happening now, and more surgeries to come.
So we walk. We walk for me. We walk for them. We walk so my kids will have their mom, my niece will have someone to teach her all the fun things, my best friend will still have her giggle mate, and my husband will have his other half. I am walking for my answer to that all important question: why me?
When I figure that out, I am sure to shout from the rooftops. Until that moment, we walk…
Hannah McEdwards


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Ensuring that your household or domestic water supply is clean for use, cannot be done without some form of water purification unit. Unwanted compounds, debris, and bacteria from organic and inorganic materials can cause illnesses for members of a household, if these contaminants are not removed from the supply. Through various channels, these impurities can find their way into the water supply that serves your home. The public water supply can become contaminated while in transit even though tremendous effort is placed in the treatment and conditioning of water at public water facilities run by municipal authorities. Public water systems can carry germs and hazardous parasites, before distribution to residential homes in urban areas; this is the main challenge faced by water treatment facilities. Water borne diseases caused by protozoan water bacteria causes more sicknesses or serious illnesses than any other form of bacterial based pollutant. A water purification using RO membranes can easily remove contaminants from water using modern filtration technologies.
Depending on the water source, homeowners can remove simple impurities such as debris from their water to suspected contaminants such as soluble gases or viruses using the right filtration and purification technology. Homes that are supplied with water from private sources can also make use of filtration units or a water purification based on RO just as well. Reverse osmosis is often the principle technique used in the purification of feed water. Hundreds of purification systems produced today rely on this technology to function. A wide range of pollutants can be removed effectively through reverse osmosis which at times makes it more comparatively more expensive than other purification systems. Other technologies, such as activated carbon are often used in purification systems as well. However, they do not filter near as many impurities as reverse osmosis does. It would be more cost effective to seek out a carbon based filtering system if after conducting a water analysis test you find only pollutants and impurities that can be readily removed from the water supply using this method. Particles that are greater than 0.5 microns are easily removed by activated carbon purification systems. Activated carbon is very popular among homeowners because it is easy to replace during scheduled maintenance and lower in relative cost. Particles that are smaller than 0.5 microns on the other hand, fall within the domain of reverse osmosis filtration units which are a preferable choice. Through reverse osmosis and or ultra violet water treatment, bacteria and protozoa are usually removed. If you are looking for a comprehensive solution for your entire household that will purify and filter against the widest possible range of contaminants then a water purification that uses at least two of the popular technologies, is preferred. In doing so, an activated carbon filter can remove the larger contaminants that would otherwise damage the more sensitive reverse osmosis membrane, while the reverse osmosis membrane can be used solely in the removal of microscopic contaminants that are between 0.0005 and 0.005 microns in size. For added peace of mind, if the unit has a UV filter as well, you will be able to neutralize any biological contaminants that may still be in the water after filtration. It is a sure way to guarantee the success of the purification process.


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Stephan Pastis has been drawing comic strips since he was a little kid. Without any formal training, he created cartoons for every school newspaper from elementary school through law school.
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A trend happening in the social space a lot these days is the use of your latest post to Twitter to be used as your Facebook status, and nothing could be driving me crazier. Why is this happening? Are people really that lazy? Not understanding the difference between the mediums? People really enjoy bad grammar? I have no idea what the answer is, but I'm here to beg and plead for this little trend to stop, now.
As the use of Twitter has grown by leaps and bounds in the few years it has been alive, the definition of the service has grown along with it. In the beginning, it truly was about "what you are doing?". Now, it's more like "what conversation are you having?". As we amass followers, many who live in the same city as we do, hang out in the same social circles, and work in the same industry, conversations begin to take place within Twitter. The conversation that you're having in Twitter with fellow PubCon attendees really doesn't have anything to do with what's going on with you, the singular entity. So why would you send your latest tweet to Facebook?
Chances are that a good majority of the people you are following on Twitter are also your friends on Facebook, so why would you want to give them duplicate content? As we immerse ourselves further and further into the social space, the chatter gets louder and more intense. So when I see your eight tweets in a row about how awesome Jack Bauer is, do I really want to roll over to Facebook and see the same thing? And in really poor grammatical form as well? Not so much. So why would you send your latest tweet to Facebook?
Do you see a pattern forming here? Help us all out and take that little plugin right out of Facebook and draw a line in the sand between the two mediums. Because, seriously, Alison Groves is tired of reading your duplicate content.


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Betsey Johnson
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Dub's Dread Golf Club
1 Reviews
- 12601 Hollingsworth Rd, Kansas City, KS 66109
- (913) 721-1333
- www.dubsdreadgolfclub.com
|18 total holes at facility
|Green fees - $20 to $54 (estimate)
|Designed by Jug McSpaden
|Built in 1966
|Zoysia Grass
|Driving Range: Yes
|Public golf course
Dub's Dread Golf Club is an 18-hole regulation length golf course in Kansas City, Kansas. This medium-length layout has 3 sets of teeboxes for a fun, but challenging golfing experience. Online tee times may be available at Dub's Dread Golf Club or at nearby golf courses, usually offered at a discount from the normal rate.
|Course Rating
|Back Tees
|Golf Pro: Chris Medrow
|Course Superintendent: Jimmy Anglotti
Note: The information is normally correct, however, occasionally there will be inaccuracies. If you happen upon something that needs to be updated, please go to this page.
Tee Times for Dub's Dread Golf Club (and other courses)
4 Stars (1 Reviews) - Last updated on July 15, 2014
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The score on Yelp is 4 out of 5. That score is an average of 1 ratings, and it is rounded to the nearest 0.5. Also note that sometimes Yelp excludes from that score any reviews that that it classifies as "not recommended."
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Scrubs: My Inconvenient Truth
What worked this week? Well, having Tom Cavanagh come back to play J.D.'s older brother Dan always helps. But, like last week, we had a refreshing lack of insanity, punctuated by some funny situations that came out of the characters' personalities instead of zippy lines.
As I mentioned, there weren't many repeatable lines in this episode, except for maybe sad-sack Ted's description of how his mom rides with him on his bike. And the most interesting visual joke was the head-shaped sweat stain Ted leaves on Kelso's pillow. But otherwise, nothing that stuck out. The one fantasy sequence, where Turk and J.D. suffer the consequences of asking Carla to get on the new patient scale (below left) didn't quite land the way it should have.
What was funny in the cold open was Cox's effort to drown J.D.'s whining out with white noise, and the horrific prank Turk and Dan played on J.D.
Back to the Dorian brothers in a second. It's interesting that so far this season, there's been a limited amount of J.D. / Cox interaction. Yes, last week Cox gave J.D. a Coxian talk about being a parent, and this week he told J.D. in no uncertain terms that he needs to grow up. But those scenes are the only meaty ones between mentor and mentee. I miss 'em. Seeing Cox bait and ridicule Elliot about being a hypocrite about a patient who isn't eating just didn't have the same impact as even past Cox/Reid showdowns, much less the harangues he gives J.D. Maybe it's because Elliot deserved this one, getting self-righteous about how all the doctors are hypocrites. And Cox's lifting and carrying of Elliot over to the scale made me feel a wee bit uncomfortable. If this was real life, Elliot would have sued Cox in an eye blink.
Because the show was part of NBC's "Green is Universal" week, they needed some environmental plot. So it seemed fitting to give it to the Janitor, driver of an ancient gas-guzzling van and stuffer of dead animals. I thought his best punishment was the wasp's nest in the cars of people who parked in the carpoolers' spots. Turk didn't seem to get too swollen from all the stings, though...
Ok, now on to the main plot. Yes, J.D. needs to grow up. He can't drive a scooter to go see his kid, who Kim has conveniently moved 40 miles away (which means we likely won't see little Sammy until the finale). The "Hedging Symphony" was an interesting way to show that everyone -- including Elliot! -- felt the same way as the audience in general has for some time. I thought it worked OK; I just liked the looks on everyone's faces as they hesitated to tell J.D. the truth (Sarah Chalke's faces were the best... she looked like she was in pain at times). It was a nice turn of events to have former loser Dan tell his little brother that he needs to grow up. And watching Cavanagh do a funny dance and ask a lot of questions didn't hurt matters, at all. In fact, I kind of wanted to see more of Dan, on this episode and on the show in general; it's hard to believe that it's been almost two years since been on the show.
Oh, now that I think of it, Turk's basketball face and the fake bouncing J.D. was doing with it was pretty funny, especially when J.D. went "between the legs." Also, any reference by Carla to how much more intense J.D. and Turk's guy love is than the one she and Turk have is always amusing.
And when Carla told Elliot and Janitor that all they're doing is being human, I was saying to myself, "didn't Carla just say that a couple of weeks ago?" Of course she did, and we flashed back to that moment, with Carla saying "pay attention so I don't have to say this again in two weeks." Nice circular moment by the writers; I wonder if they inserted that joke in the premiere at the last minute when they realized what was going to happen in episode three.
So we're going down the path of J.D. finally becoming a man (for crissakes, it's about time; the guy is 32!). I'm very curious to see where we're going with this. Even if we *do* get that J.D. / Elliot reunion that only half the fans really want, at least both people might be better able to handle the relationship. Otherwise, what's the point of getting them together again, right?
|Tom Cavanagh
|165 (16.1%)
|Heather Graham
|153 (14.9%)
|Heather Locklear
|24 (2.3%)
|Elizabeth Banks
|24 (2.3%)
|John Ritter
|52 (5.1%)
|Michael J. Fox
|187 (18.3%)
|Richard Kind
|6 (0.6%)
|Scott Foley
|13 (1.3%)
|Freddy Rodriguez
|27 (2.6%)
|Brendan Fraser
|373 (36.4%)


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Bank by Phone 1-888-735-7676
Mr. Bryant is the President of Florida Business BancGroup, Inc. and the President and Chief Executive Officer of Bay Cities Bank. Prior to joining Bay Cities Bank he held senior management positions with SouthTrust Bank and GE Capital. Mr. Bryant serves on the Board of the Florida Banker's Association, Independent Bankers Bank and Tampa Christian Community School. He is also active in the CEO Council, Leadership Tampa Alumni, and coaching youth sports.


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Montreal Gazette ""I like the way he plays," Lafleur said Wednesday after handing out the Guy Lafleur Awards of Excellence to top student-athletes in the Quebec university and junior ranks. "He shows up every night and gives 100 per cent. I think he's a great influence on his teammates. "A captain shouldn't be..." May 28
USA Today "It's easy to judge a player's excellence on his All-Star nods or big offensive numbers. There are a lot, however, who do more than the surface stats may indicate. Let's take a look at some of the most underrated players: Center: Mathieu Perreault, Winnipeg Jets Your pick of Jets forwards..." February 11
Montreal Gazette "Brendan Gallagher was a reluctant veteran Tuesday. The 21-year-old Edmonton native was among 25 top NHL prospects/rookies participating in the NHLPA's rookie showcase at Mastercard Centre. A finalist for league's top rookie award last season the Montreal Canadiens forward shared the spotlight..." August 28
Buffalo News "NHL awards season has begun. The league has announced the finalists for the Calder Trophy, given annually to the Rookie of the Year. The three candidates are Brendan Gallagher of Montreal, Jonathan Huberdeau of Florida and Brandon Saad of Chicago. Voting, done by the Professional Hockey..." May 06
NHL.com "Montreal Canadiens winger Brendan Gallagher, center Jonathan Huberdeau of the Florida Panthers and left wing Brandon Saad of the Chicago Blackhawks are the 2012-13 finalists for the Calder Memorial Trophy, the NHL announced Monday. The Calder Memorial Trophy is awarded to the League's top..." May 06
Montreal Gazette "When Brendan Gallagher was picked in the ninth round of the Western Hockey League's bantam draft in 2007, he stood about 5-foot-3. He was probably the smallest player in the draft of 14-year-olds turning 15, said his father, Ian Gallagher. Gallagher's smaller stature has sparked doubts about..." March 07
Montreal Gazette "Brendan Gallagher will be returning to the Canadiens' lineup Saturday night and everyone is hoping that he picks up where he left off before he suffered a concussion last week. Gallagher lined up with David Desharnais and Max Pacioretty at practice in Brossard and coach Michel Therrien said he..." February 23


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- Infowars - http://www.infowars.com -
Strange Rumbling Sound Reported in San Diego; Military Activity Cited
Posted By steve_watson On June 30, 2012 @ 8:04 am In Featured Stories,Old Infowars Posts Style,Tile | Comments Disabled
R. Stickney, Lauren Steussy and Monica Garske
NBC San Diego
June 30, 2012
Residents from Chula Vista to Oceanside reported a large rumble around 12:45 p.m. Friday.
Two months ago, when San Diegans heard a similar sound, there was evidence of chaff on weather radar. Chaff is a material sometimes emitted during military exercises.
On Friday, however, Tina Stall with the National Weather Service said there was no visible chaff in the area at the time the noise was reported.
"There was indeed an atmospheric tremor, or 'skyquake,'" Walker said. "The likely cause of these 'skyquakes' is routine military activity very far off the coast of San Diego (at least 50 miles away) in zones that are designated military training zones."
Typically, we don't hear these "skyquakes." But when the wind reaches speeds of over 100 miles per hour, the sound can reach parts of San Diego, Walker said.
A spokesperson from Camp Pendleton said Marines are not training with anything unusual. They often train with various military equipment and will be training with tanks both Saturday and Sunday.
Article printed from Infowars: http://www.infowars.com
URL to article: http://www.infowars.com/strange-rumbling-sound-reported-in-san-diego-military-activity-cited/
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A late rally came up just short as the 16th-ranked Wisconsin football team dropped a hard-fought 24-21 loss to No. 7 Georgia in the Outback Bowl Saturday afternoon. Trailing 24-6 late in the third quarter, the Badgers rallied for a pair of touchdowns but could not quite complete the comeback.
An attendance of 62,414 looked on at Raymond James Stadium as UW completed its season with a 9-3 record and the Bulldogs finished at 10-2.
Georgia got on the scoreboard first as it marched down the field on the opening drive of the game. Brandon Coutu culminated the 12-play, 78-yard drive with a 20-yard field goal to put the Bulldogs ahead 3-0.
The Badgers failed to score on their first drive and were forced to punt, but UW got the ball back right away as Scott Starks forced a Thomas Brown fumble and Jim Leonhard recovered at the Georgia 22. Mike Allen was able to convert on a field goal from 46 yards out to tie the game 3-3 with 5:47 left in the first.
Wisconsin got back into scoring position late in the quarter as a poor punt gave it the ball at the Bulldogs 49-yard line. Six plays later, Allen connected on a 44-yard field goal to put UW up 6-3.
Georgia reclaimed the lead with 7:38 remaining in the second quarter as David Greene connected with Fred Gibson on a 19-yard touchdown pass to give the Bulldogs a 10-6 lead they would eventually carry into halftime.
The Bulldogs extended their lead early in the third quarter by tallying a pair of touchdowns. Georgia got a lucky bounce as Greenes pass deflected off a Bulldog player and into the hands of fullback Jeremy Thomas who took it in 24 yards for the score. The lead grew to 24-6 with 6:33 left in the third as Thomas Brown raced 29 yards up the middle for the touchdown.
Just when it appeared that the Bulldogs may begin to pull away, the Badgers rallied back. John Stocco completed 4 of 5 passes for 75 yards on a scoring drive that was capped by a 19-yard pass to Darrin Charles to get UW within 24-13.
Wisconsin had a pair of great chances to cut into the lead further early in the fourth quarter, but Allen missed on a 37-yard field goal attempt and another drive that started at the Georgia 31 ended in a fumble.
The Badgers had first-and-goal at the Georgia 5 midway through the fourth, but David Pollack sacked Stocco and simultaneously stripped the ball away from him giving the Bulldogs the ball.
However, three plays later Greene was intercepted by UW freshman linebacker Andy Crooks who jumped a screen pass and returned it 11 yards for a touchdown with 4:13 remaining. Stocco completed a pass to Jonathan Orr for a two-point conversion to pull Wisconsin within 24-21.
That was as close as the Badgers would get, though, as Georgia was able to run out the clock to earn the win.
Wisconsin had 230 yards of total offense, compared to 460 for the Bulldogs. Anthony Davis rushed 21 times for 79 yards for the Badgers to finish his career in fifth place on the Big Tens all-time rushing list. Stocco completed 12-of-27 passes for 170 yards and one TD.
Wisconsin Head Coach Barry Alvarez Postgame Quotes
On playing in the Outback Bowl:We were treated in a first-class manner. We felt this city opened their arms. The treatment we had was truly special. Its a first-class bowl game. It certainly doesnt have to take a back seat to anyone, and doesnt.
On the Badgers performance:We lost to a very good Georgia football team, a team thats strong on both sides of the ball. I didnt think we played particularly well, yet I liked the way our guys competed. We gave ourselves a chance. But we really made to many mistakes and Im not pleased with that. We did a lot of good things too. I take my hat off to Georgia; theyre a good football team that deserved to win.
On being down to Georgia 24-6:Georgia certainly had all the momentum at the time. But our quarterback made a couple throws and that just kind of got the adrenaline flowing and he got a little rhythm. Weve been inconsistent offensively all year. But we got moving and I think that picked up our entire sideline. The momentum swung back to us for a little over a quarter and gave us a chance.
On using instant replay:Im in favor of instant replay and I did mention to the officials that Im sure theyll be using it soon.
On Georgia tailback Thomas Brown:Hes extremely quick. We missed a lot of tackles, but I think he had a lot to do with our missed tackles. He finds a seam, never stops his feet from running, and is always moving north and south. Hes a very impressive runner. Again, we had the momentum and he made some plays; he made it happen for them.
On Georgias defensive effort:They didnt do anything that we hadnt seen. Their safeties support very hard, yet they also play coverage. We didnt have to make any adjustments; we were trying to get north and south. We werent getting much of a seam. We saw that in film. Theyre pretty impressive. Their big guys in front dont get much movement. If you take the ball out those linebackers can run you down. Theyll run as fast as your backs. But they didnt do anything we didnt anticipate.
On quarterback John Stoccos performance:I thought he was off to start the game. He missed some throws early on that could have given us some momentum. But in the middle of the third quarter I thought he got his rhythm and really played well and did some good things on a couple drives. He missed some things early. He wasnt very sharp early in the game.
On finishing the season with a three-game losing streak:Quite frankly I think we overachieved this season. I think this is a football team that had a lot of adversity, had key players hurt. We werent consistent offensively all year. Yet we found ways to win. We won three games in a row and scored one offensive touchdown and still won the games. We lost to a very good football team this week, lost to a very good football team in Iowa. We won nine games, found a way to win games. We played in a January 1st bowl game and played probably a top five team and when its all said and done, Georgias going to be a top five team. You always want to win, but I think you have to be realistic in the same respect.
On Georgia defensive end David Pollack:I thought he was solid. I thought he played hard. Hes a guy that you want to know where he is. Thats what disappointed me at the end of the game; we turned him loose down there in the end zone, down there deep.
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text: Lower East Burnside is about to be stunned and shocked, but mostly just straight prettified. Next door to the Plaid Pantry on a once cracked-out corner along the busy thoroughfare, a spankin' new seven-story building will rise from an empty lot later this spring. Designed by Portland's Works Partnership Arc... More


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10 Family Resorts Worldwide 2007
Family travel is a lot more sophisticated than it used to be. The short-attention-span, text-messaging, iPod-playing generation has new holiday demands, as do their parents—who expect indulgent spa treatments, championship golf and Ducasse-worthy dining. From circus school and crocodile-spotting to falconry and four-by-fouring in the latest Land Rover, hotels and resorts are finding creative ways to satisfy savvy broods. Read on to find the best places for discovering ancient ruins, enjoying an African boma and hiding away on a tropical isle.
Situated on Colorado's Beaver Creek Mountain, The Ritz-Carlton, Bachelor Gulch blends the pioneering spirit of the American West with Rocky Mountain luxury. This year-round destination resort has plenty of family activities—a sizeable spa for Mom (children ages 5-15 can enjoy mini-treatments), championship golfing for Dad and, for kids, a supervised program that offers nature hikes, scavenger hunts, rodeo field trips and more. Families may opt to stay in a Residential Suite, a new style of accommodations created especially for nuclear groups.
Set on 880 oceanfront acres on Oahu's North Shore, Turtle Bay Resort is a virtual family playground. While the 'rents are busy golfing the Palmer or Fazio courses, kids will be indoctrinated into island culture as they tackle Hawaiiana crafts projects: lei making, hula instructions, explorations of tidal pools, kite flying and more. And as long as you're in residence, the chips off the old block might as well hit the resort's five miles of perfect beach and ocean trails—with boogie boarding, surfing, snorkeling and scuba instruction.
This village resort, set on World Heritage parklands on Australia's northeast coast (in Queensland's Whitsunday Island group), may be the kid-friendliest place ever. Its Family Festival Program, offered at select times throughout the year, is wildly fun and ambitious. Activities include treasure hunts, cartooning instruction, a rock star contest with real instruments, a car rally of ride-on cars, circus school with flying trapeze lessons (under the tutelage of a professional), and even talent workshops held by Australia's top children's talent agency.
Wherever children under 18 can stay free, eat free and play hard is probably a good place. Here, surrounded by 600 wilderness acres and miles of white sand beach, you'll be treated to beachside accommodations and unique outdoor adventures. Yes, you'll be provided with bikes and kayaks, but where else can you hike in the world's only jaguar preserve, take a river cruise to spot crocodiles, and explore a cave system used by the ancient Mayan civilization?
Touting first-rate facilities for the entire family, Bovey Castle enjoys a spectacular countryside setting on Dartmoor in Devon. Activities such as falconry and visits to historic homes will keep mom and dad occupied. Children will delight with pony trekking at the Miniature Pony Centre, a woodland adventure camp, a trampoline, a water slide, volleyball, and, on rainy days, Playstation 2, Scalextric, Lego, videos, movies and painting. The Castle's Equestrian Centre also offers riding lessons—and don't forget that you'll be staying in a real castle!
The name of this eco-friendly resort says it all. Here, on this self-contained tropical Fijian island, the whole family will enjoy an adventure similar to that which Captain Jack Sparrow might have experienced. Children will be endlessly entertained with a variety of activities such as crab hunting, story telling, snorkeling trips, coral viewing via a glass bottom boat, shell collecting and fish feeding—in addition to complimentary canoeing, wind surfing and Hobie Cat sailing. Plus every night you'll be sleeping in a way cool bure.
Hidden in the hills of Provence and surrounded by picturesque medieval villages, this forested resort is ideal for sophisticated fams. Two golf courses and a spa villa should satisfy parents' need for escape. Younger guests will gravitate towards woodsy outdoor activities like canoeing, hiking and horseback riding. Day trips can also be arranged to visit the Oceanographic Museum and Aquarium in Monaco or to the perfume factory in Grasse. And bathtime will be extra enjoyable with child-size bathrobes and children's toiletries.
Kids will definitely be mesmerized by everything on offer at the first Disney park opened outside the U.S. You'll need at least a week to make your way through Critter Country, Fantasyland, Adventureland, Tomorrowland and more. Unique to this locale, the Tokyo Disney SeaPark is a water-themed dreamland for exploring—the Lost River Delta, Mermaid Lagoon and Mysterious Island (among others). Take a time out between rides at Ikspiari, the resort's shopping, dining and entertainment complex. Just riding the monorail that circles the resort is a blast!
The Hilton Los Cabos Beach & Golf Resort
This resort hotel in Los Cabos, Mexico, beckons with adventure from the moment you arrive. It claims the only area beach that allows swimming, for starters. And then there's whale watching, watching the sea turtles return each season, and swimming with dolphins. You can also hike the desert and nearby mountains—a favorite trek is to the Santiago waterfalls—or embark on remote ecological excursions across rugged terrain populated with unique plants and animals. Horseback riding on the beach rounds out the thrills.
Conrad Pezula
Hugging South Africa's Southern Cape coastline, this private estate resort is a sanctuary of luxury and indulgence. Families will enjoy an authentic African experience along with gourmet cuisine, a superb spa, championship golfing, tennis and a range of children's activities—sports-based obstacle courses, horse-drawn carriage rides, a petting zoo and professional riding instruction at the stables. And everyone will enjoy a scenic flight in the resort's state-of-the-art helicopter, delivering gorgeous views of the surrounding Sinclair Nature Reserve, Knysna and the Indian Ocean.


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Take the family on a secluded getaway to Eleuthera while saving $200 per night.
For $750 per night, spread out in a four-bedroom villa at the 4-star Sky Beach Club. This deal for travel through July 1 also includes a massage for two and $200 dining credit for stays of five nights or longer.
Stay in an ocean-view villa with plunge pool and whirlpool. While at the hotel, relax on the private beach, take a dip in the ocean-front infinity pool, or grab a cocktail at the swim-up bar.
Note: Does not includes 16% tax and 10% resort fee.
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Our Night With Oscar
EDITORS NOTE: Rachel Beltran (BFA/Digitial Arts '17) is one of our many talented Digital Arts students. She, along with some classmates, had the opportunity to go to Los Angeles to check out the Academy Award nominated animated and short films. She was kind enough to share her experience with us. It didn't really hit me


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Maudie R. Mudford, 75, a resident of Mountain Home, formerly of Muleshoe, Texas went to be with the Lord on Friday, May 18, 2012 at the Good Samaritan Society.
She was born August 21, 1936, in Baileyboro, Texas to the late Claude and Clara Harvey Coffman. Maudie loved church very much, growing up in church from a little girl. She began playing piano in church at nine years old. Maudie worked as a bookkeeper for several years as well as farmed with her first husband, W.L. Speck. On January 5, 1997, in Muleshoe, Texas, Maudie married Jerry Lee Mudford. In 2001 Maudie and Jerry relocated from Muleshoe to Mountain Home. Maudie was a member of the Mountain Home Baptist Church and was active in the choir. She was preceded in death by her parents; her first husband, W.L. Speck ; a brother, Harvey Coffman and a niece, Cherlyn Mainor.
Survivors include her husband of 15 years, Jerry Mudford of Mountain Home; a daughter and son-in-law, Sandra Kay and Michael Walker of Arlington, Texas; two step-daughters and step-sons-in-law, Kathy and Joe Ambriz of Muleshoe, Texas and Brenda and Shane Kirk of Joshua, Texas; a sister, Jeannine Rundell of San Angelo, Texas; two sisters-in-law, Lela Sue King (Doyle) of Muleshoe, Texas and Sandra Speck of Lubbock, Texas; two uncles, Chester Coffman of Big Spring, Texas and Roger Harvey(Margaret) of Amarilllo, Texas; four aunts, Rena Mae Coffman of Grand Junction, Colorado, Freda Shuttlesworth of Amarillo, Texas, Fredda Harvey of Cedar Park, Texas and Carol Harvey of Melbourne, Florida; seven grandchildren, Aaron Walker, Kristin Ambriz, Christopher Ambriz, Brittany (Eddie) Alavarado, Matthew Ambriz and Brianna and Lacie Kirk; two great grandchildren, Bethany and Emma Grace Alvarado; numerous nieces and nephews and other relatives and friends.
The funeral will be held at 10:00 a.m., Monday, May 21, 2012, at the Mountain Home Baptist Church with Dr. Tommy Cunningham and the Rev. Bill Hughes officiating. Burial will be 10:00 a.m., Wednesday, May 23, 2012 in Muleshoe Memorial Park Cemetery under the direction of Conner-Hankins Funeral Home.
Honorary pallbearers will be the Adult 4 Sunday School Class and Leroy Shepard.
The family will receive friends from 2:00 p.m. to 4:00 p.m., Sunday at the Conner-Hankins Funeral Home.
In lieu of flowers, memorials may be made to the Mountain Home Baptist Church.
The online obituary and guestbook are available at www.conner-hankinsfuneralhome.com.


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rhodium and CZ chain link necklace
designer's notes
Simplicity never goes out of style. Trust Jardin to add a delicate, polished touch to any ensemble.
color: Rhodium Fashion jewelry Rhodium chain links CZ stones throughout Spring ring clasp closure 15'' drop with 1'' drop All measurements are approximate Metal / CZ; Imported; style# 323860801