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Figure 1. Growth curves of war-zone stress symptoms over time. CEL-Anxiety indicates the General Anxiety/Stress index included in the Combat Experiences Log36; CESD-10, the 10-item Center for Epidemiologic Studies Depression Scale43; and PCL-Short, the 4-item version of the PTSD (Posttraumatic Stress Disorder) Checklist.41
Figure 2. The effect of war-zone stressors on posttraumatic stress disorder (PTSD) symptoms for high and low carbon dioxide (CO2) reactivity at predeployment. PCL-Short indicates the 4-item version of the PTSD Checklist.41
Figure 3. The effect of war-zone stressors on anxiety symptoms for high and low carbon dioxide (CO2) reactivity at predeployment. CEL-Anxiety indicates the General Anxiety/Stress index included in the Combat Experiences Log.36
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Telch MJ, Rosenfield D, Lee H, Pai A. Emotional Reactivity to a Single Inhalation of 35% Carbon Dioxide and Its Association With Later Symptoms of Posttraumatic Stress Disorder and Anxiety in Soldiers Deployed to Iraq. Arch Gen Psychiatry. 2012;69(11):1161–1168. doi:10.1001/archgenpsychiatry.2012.8
© 2019
Author Affiliations: Departments of Psychology, The University of Texas at Austin (Drs Telch and Pai), Southern Methodist University, Dallas, Texas (Dr Rosenfield), and University of Wisconsin-Milwaukee (Dr Lee).
Context The identification of modifiable predeployment vulnerability factors that increase the risk of combat stress reactions among soldiers once deployed to a war zone offers significant potential for the prevention of posttraumatic stress disorder (PTSD) and other combat-related stress disorders. Adults with anxiety disorders display heightened emotional reactivity to a single inhalation of 35% carbon dioxide (CO2); however, data investigating prospective linkages between emotional reactivity to CO2 and susceptibility to war-zone stress reactions are lacking.
Objective To investigate the association of soldiers' predeployment emotional reactivity to 35% CO2 challenge with several indices of subsequent war-zone stress symptoms assessed monthly while deployed in Iraq.
Design, Setting, and Participants Prospective cohort study of 158 soldiers with no history of deployment to a war zone were recruited from the Texas Combat Stress Risk Study between April 2, 2007, and August 28, 2009.
Main Outcome Measures Multilevel regression models were used to investigate the association between emotional reactivity to 35% CO2 challenge (assessed before deployment) and soldiers' reported symptoms of general anxiety/stress, PTSD, and depression while deployed to Iraq.
Results Growth curves of PTSD, depression, and general anxiety/stress symptoms showed a significant curvilinear relationship during the 16-month deployment period. War-zone stressors reported in theater were associated with symptoms of general anxiety/stress, PTSD, and depression. Consistent with the prediction, soldiers' emotional reactivity to a single inhalation of 35% CO2-enriched air before deployment significantly potentiated the effects of war-zone stressors on the subsequent development of PTSD symptoms and general anxiety/stress symptoms but not on the development of depression, even after accounting for the effects of trait anxiety and the presence of past or current Axis I mental disorders.
Conclusion Soldiers' emotional reactivity to a 35% CO2 challenge may serve as a vulnerability factor for increasing soldiers' risk for PTSD and general anxiety/stress symptoms in response to war-zone stressors.
There is compelling evidence that combat-related stress disorders, such as posttraumatic stress disorder (PTSD) and depression, are associated with several negative consequences, including somatic symptoms,1,2 anger control,3 substance use disorders,4,5 low income and deficient job performance,1,6 relationship problems,7,8 and suicide.9
Exposure to trauma is a necessary criterion for the diagnosis of PTSD, and some soldiers are affected more than others by war-zone stress. This is not unique to military populations. Epidemiologic data indicate that most Americans (60.7%) have been exposed to a traumatic stressor sometime in their life, yet less than 10% develop PTSD.10 Similarly, although life stress often precedes depression, few of those exposed to stressful life events become depressed.11 These findings clearly point to the need to identify "modifiable" risk factors that increase soldiers' vulnerability to develop significant combat stress disorders in the face of war-zone stressors.
Inhalation of carbon dioxide (CO2)–enriched air has been widely used as an investigative tool in the pathogenicity of anxiety disorders—particularly panic disorder.12-18 Emotional reactivity to a 35% CO2 challenge has been consistently observed in patients with panic disorder19-22 and their healthy first-degree relatives.23,24 Moreover, monozygotic twins were significantly more likely than were dizygotic twins (56% vs 12%) to display CO2-induced panic in response to a 35% CO2 challenge,25 thus suggesting the importance of genetic factors in determining sensitivity to CO2 challenge–induced panic. In a prospective study26 among nonclinical civilian samples, reactivity to CO2 challenge has been shown to predict the subsequent development of anxiety disorders, even after controlling for anxiety sensitivity, which independently predicted increased risk for anxiety disorders.
Relatively few studies have examined emotional response to CO2-enriched air among patients with anxiety disorders other than panic disorder. One study27 has shown that patients with obsessive-compulsive disorder did not display heightened CO2 sensitivity relative to healthy control individuals, whereas patients with panic disorder or panic disorder and obsessive-compulsive disorder showed heightened 35% CO2 reactivity. In contrast, patients with social phobia displayed greater emotional reactivity to 35% CO2 challenge relative to healthy controls while displaying levels of emotional reactivity similar to those of patients with panic disorder.28,29 In generalized anxiety disorder samples, patients have shown increased anxiety symptoms in response to 7% CO2 challenge30 as well as reductions in CO2-induced anxiety after a trial of lorazepam or paroxetine.31 However, one study found that patients with generalized anxiety disorder did not differ significantly from healthy controls and that they were significantly less CO2 reactive relative to those with panic disorder.32
Only 2 studies have reported on CO2 reactivity among patients with PTSD. Talesnik and colleagues33 administered a 35% CO2 challenge to 20 drug-naive PTSD patients and compared them retrospectively with a sample of 39 healthy controls and 17 patients with panic disorder. The PTSD patients' response to CO2 was indistinguishable from that of the healthy controls. Muhtz and colleagues34 evaluated single administration of 35% CO2 to 10 PTSD patients, 10 age- and sex-matched healthy controls, and 8 patients with panic disorder. In sharp contrast to the earlier study of Talesnik et al,33 the PTSD group and the panic disorder group displayed significantly heightened emotional response to the CO2 challenge relative to the healthy controls. Furthermore, some of the PTSD patients reported posttraumatic flashbacks in response to the CO2 challenge.
To date, no studies have examined linkages between heightened emotional response to 35% CO2 and war-zone stress reactions. Based on the aforementioned evidence linking heightened emotional response to CO2 and anxiety disorders, as well as evidence suggesting that CO2 reactivity may serve as a vulnerability marker for subsequent development of anxiety disorders,26 we examined whether emotional reactivity to a 35% CO2 stress challenge before deployment would predict soldiers' vulnerability for PTSD, depression, and general anxiety/stress symptoms in response to war-zone stressors. Based on a diathesis stress model of combat stress, we predicted that emotional reactivity to 35% CO2 challenge (putative diathesis) would potentiate the effects of war-zone stressors on the subsequent development of war-zone stress reactions. The data reported herein are from the Texas Combat Stress Risk Project,35-38 a prospective investigation of genetic, neuroimaging, psychosocial, and cognitive risk factors predicting soldiers' combat stress reactions while deployed in Iraq.
The study sample (N = 158) was drawn from Fort Hood soldiers recruited through announcements to unit leaders. The principal investigator (M.J.T.) and the project manager conducted briefing meetings for potential soldier volunteers from 8 combat and 2 combat support units at Fort Hood, Texas. To reduce the potential for soldiers to feel coerced to participate, unit leaders were not present at the briefing meetings, and an army ombudsman not connected to the study was present during all recruitment sessions. Of the 223 soldiers attending the group orientation sessions, 184 soldiers (82.5%) provided informed consent and completed an extensive 8-hour predeployment assessment at the Imaging Research Center at The University of Texas at Austin. Of the 184 soldiers completing the predeployment assessment, 6 were not deployed and 3 deployed soldiers withdrew from the study. Of the remaining 175 soldiers, 3 refused to participate in the CO2 challenge and 14 soldiers failed to complete any assessments of war-zone stress while in theater.
Study inclusion/exclusion criteria included (1) current Army soldier scheduled to deploy to Iraq within 90 days, (2) no prior deployment to a war zone, and (3) age 18 years or older. The final sample was predominantly male (88.7%) with a mean (SD) age of 24.41 (6.12) years and the following race/ethnicity breakdown: white (72.2%); African American (10.1%); American Indian (12.0%); and Asian, Native Hawaiian, or Pacific Islander (5.7%). In addition, 29 of the 158 participants (18.4%) reported their ethnicity to be Hispanic. The educational level of the sample was as follows: some high school (53.1%), some college (37.9%), undergraduate degree (5.1%), and master's degree or higher (3.9%). Approximately one-third (31.3%) of the study participants were married, 2.8% were living with a partner, 7.9% were divorced or separated, and 57.6% had never been married.
This study was conducted under a human-use protocol approved by the Office of Research Support and Compliance at The University of Texas at Austin and the Brooks Army Medical Center Scientific and Human Use Review Committee. Informed consent was obtained from all study participants.
Soldiers completed monthly assessments of their war-zone stress experiences using the Combat Experience Log (CEL), a web-based system for assessing war-zone stress in theater.36 Soldiers identified stressors that they experienced from a list of 18 previously validated war-zone stressors (eg, received hostile incoming fire, had been wounded or injured in combat, and received bad news from home). These stressor items were derived from a modified version39 of the Deployment Risk and Resilience Inventory.40 Soldiers indicated which stressors they had experienced since their most recent in-theater CEL assessment (or since deployment to the combat zone in the event of their first response to the CEL system). Moreover, soldiers were allowed to record up to 2 stressors not appearing on the standard list of 18. The number of combat stressors was summed to estimate the level of war-zone stress exposure and used to predict PTSD, depression, and general anxiety symptoms. Soldiers reported approximately 6 (mean [SD], 5.96 [5.34]) war-zone stress exposures per monthly assessment. Additional information on this assessment has been reported.36
Three major domains of deployment-related stress symptoms were assessed each month in theater using the CEL.36 The PTSD symptoms were evaluated using the 4-item version of the PTSD Checklist (PCL-Short).41 The PCL-Short addresses each of the 3 core PTSD symptom clusters: re-experiencing (2 items), avoidance (1 item), and increased arousal (1 item). Despite the brevity of the PCL-Short, a validation study41 indicated that it has a diagnostic accuracy estimate equivalent to that of the 17-item PCL. For the current sample, the internal consistency coefficient of the PCL-Short was 0.72.
Depression during deployment was assessed in theater using the 10-item short version of the Center for Epidemiologic Studies Depression Scale (CES-D).42 The CES-D was developed to screen general populations for the presence of depressive symptoms; thus, its items are designed to be understandable and relevant for all participants regardless of their clinical status. The CES-D has demonstrated excellent psychometric properties and has been widely administered in various measurement modalities, including web-based assessment.43 The current 10-item short version is highly predictive of scores from the full 20-item version (κ = 0.97, P < .001).42 Internal consistency computed from soldiers' first entry of the CESD-10 was 0.72.
The General Anxiety/Stress index included in the overall CEL was designed to provide a brief in-theater assessment of stress/anxiety symptoms during the past 30 days. Soldiers are presented with 18 stress/anxiety symptoms in 3 major domains: cognitive (eg, fear of losing control), emotional (eg, feeling scared), and somatic (eg, tension in muscles). Each symptom is rated on a 5-point scale (1, not at all, to 5, extremely). Internal consistency for this index was 0.92 for the current sample.36
Predeployment assessments were performed at the Imaging Research Center at The University of Texas at Austin. Soldiers typically arrived by 8 AM, usually in groups of 5 to 8, and were monitored by study personnel until dismissal approximately 7 hours later. Participants completed several study assessments, including many that are not the focus of this report. After providing informed consent, participants completed online questionnaires and were interviewed to assess for the presence of current and past DSM-IV diagnoses. The CO2 inhalation challenge occurred between 2 PM and 4 PM and followed procedures similar to those described in other CO2 challenge studies conducted in the Laboratory for the Study of Anxiety Disorders at The University of Texas at Austin.17,44,45 Participants were seated individually in a soundproof room and fitted with an ambulatory heart rate monitor. After a 5-minute resting baseline heart rate was documented, participants watched a 3-minute video containing the rationale, procedural instructions, and a demonstration of the CO2 inhalation procedure. They were then instructed to take a full vital capacity breath of the gas mixture containing 35% CO2/65% oxygen through a plastic mask and to hold it in their lungs for 5 seconds. Participants were then instructed to breath normally until the effects of the gas subsided (approximately 30 seconds), at which point they completed the Acute Panic Inventory (API)46—a widely used self-report instrument for assessing emotional response to CO2 challenge. Consistent with previous research17,26,45 on emotional reactivity to CO2 challenge in nonclinical samples, our primary index of emotional reactivity to CO2 challenge was based on soldiers' rating of the highest level of fear experienced at any time during or after the inhalation. Responses were measured on a scale ranging from 0 (none) to 100 (extreme). In addition, using the work of Colasanti et al,47 we constructed several other CO2 reaction scales from the 29 API items (Table 1).
Soldiers were deployed to Iraq approximately 2 to 3 months after the predeployment assessment. In-theater assessments of war-zone stress experiences and war-zone stress reactions during deployment were obtained monthly using the CEL.
Multilevel, mixed-effects random coefficient regression models (MRMs) were used to analyze the data. Our dependent variables were PTSD symptoms, general anxiety/stress symptoms, and depressive symptoms (together referred to as war-zone stressreactions), measured monthly during deployment. The predictors of war-zone stress reactions in the MRMs included time (months since deployment), time × time, war-zone stressors (assessed monthly during deployment), CO2 reactivity (assessed before deployment), and the interaction between CO2 reactivity and level of war-zone stressor exposure. All predictors (except time) were z -transformed to facilitate the interpretation of results. We used an unstructured covariance matrix to model the relationships between the random effects because all tested restrictions on the covariance matrix significantly increased the deviance statistics for the models.
Following Hedeker and Gibbons' recommendation,48 we decomposed the monthly measure of war-zone stressors into a between-soldier effect (the mean level of stressors reported during the deployment period) and a within-soldier effect (the deviation from the mean level of stressors for each soldier at each point in time, referred to as change in war-zone stressors). Failing to decompose these effects would confound the between- and within-soldier effects, resulting in potentially misleading results.48 Results of the model are reported in Table 2.
A total of 158 soldiers were included in the present analysis. Mean (SD) duration of deployment was 386 (71.75) days. Soldiers provided a total of 1021 monthly assessments with a mean (SD) of 6.5 (5.5) assessments per soldier (range, 1-16). Initial MRM analyses found no effects for race or ethnicity, so that variable was not included in the final analyses. Because sex was associated with the level of depressive symptoms, it was retained in the final models.
Responses to the CO2 challenge varied widely (Table 1 reports the means and SDs on all the API items). Our primary measure of fear reactivity to the CO2 challenge was the soldiers' highest level of fear in response to the challenge (possible range, 0-100). The level of fear reported ranged from 0 to 90, with a mean (SD) of 26.1 (26.2); 50 of the 158 soldiers (31.6%) reported no fear, and 18 soldiers (11.4%) reported actual panic in response to the challenge.
The quadratic growth curves for each measure during the 16-month deployment period are displayed in Figure 1. These curves are similar to those reported36 in an analysis of a subset of these soldiers. The quadratic trend over time was significant for all 3 war-zone stress reactions: PTSD symptoms (b = –0.02, P < .001), general anxiety symptoms (b = –0.06, P < .001), and depression symptoms (b = –0.04, P < .001). The linear trend over time was significant only for general anxiety symptoms (b = –0.19, P = .02), indicating that anxiety symptoms near the end of deployment were lower than those at the beginning of deployment. In general, symptoms steadily increased immediately after deployment, but the increase peaked approximately 8 months into deployment and gradually returned to initial levels (or below, for general anxiety symptoms) by approximately 16 months after deployment.
The MRM analyses indicated that soldiers who reported higher average war-zone stressors had higher levels of PTSD symptoms (b = 0.53, P < .001) and higher general anxiety/stress symptoms (b = 2.19, P = .001). Similarly, changes in a soldier's war-zone stressors were related to concomitant changes in PTSD symptoms, general anxiety/stress symptoms, and depression symptoms (b = 0.23, P < .001; b = 1.50, P < .001; and b = 0.36, P = .02, respectively). Time from deployment was controlled in the MRM models; thus, relationships between changes in stress over time and changes in symptoms were not merely a result of both measures changing in concert over time. The CO2 reactivity was not related to any of our war-zone stress reactions (P > .10 for all comparisons).
We also investigated whether predeployment CO2 reactivity would moderate the soldiers' response to stressful events as they occurred during deployment. Consistent with our hypotheses, predeployment CO2 reactivity interacted with the soldiers' average stress level during deployment to affect anxiety symptoms (b = 0.17, P < .001). Predeployment CO2 reactivity also interacted with monthly changes in war-zone stressors to affect PTSD symptoms and anxiety symptoms, although the relationship with anxiety symptoms did not reach conventional levels of significance (b = 0.18, P = .001 for PTSD symptoms and b = 0.40, P < .07 for anxiety symptoms). These interactions all indicated that soldiers with higher predeployment CO2 reactivity responded to war-zone stressors with more symptoms than did soldiers with lower predeployment CO2 reactivity. To examine the nature of these significant interactions, we used the approach described by Aiken and West49 to compare soldiers with low predeployment CO2 reactivity (1 SD below the mean) with those high in CO2 reactivity (1 SD above the mean). In our sample, CO2 reactivity ranged from 0 to 90 (scale, 0-100), with a mean (SD) of 26.1 (26.2). We examined the MRM-predicted relationship between war-zone stressors and war-zone stress symptoms for soldiers displaying low CO2 reactivity compared with the model-predicted relationship between war-zone stressors and war-zone symptoms for soldiers displaying high CO2 reactivity. This analytic approach has the advantage of probing the CO2 reactivity × war-zone stress interaction using model-based predictions from the full sample as opposed to restricting the analysis to the subsample of soldiers who had either high or low CO2 reactivity,
Consistent with prediction, for soldiers with low predeployment CO2 reactivity, the model predicted no relationship between level of war-zone stressors and either PTSD symptoms (b = 0.05, P = .53) or anxiety symptoms (b = 0.47, P = .58) (Figure 2 and Figure 3). However, for those with high predeployment CO2 reactivity, the MRM predicted a strong relationship between the average level of war-zone stressors and PTSD symptoms (b = 0.41, P < .001) as well as anxiety symptoms (b = 3.91, P < .001) (Figures 2 and 3).
To assess the clinical significance of the potentiation effect of CO2 peak fear on the relationship between war-zone stressors and PTSD and anxiety symptoms, we examined the differences in the expected outcomes for soldiers with high and low CO2 reactivity (1 SD above the mean vs 1 SD below the mean). When war-zone stressors increased a moderate amount (by 2 stressors) in a particular month, the expected difference in PTSD symptoms between soldiers high and low in CO2 reactivity was predicted to be 0.95, which is equivalent to a moderate to large effect size (Cohen d = 0.72). Similarly, for soldiers who experienced a moderately high level of stressors (6, equivalent to 1 SD above the mean number of stressors), the difference in anxiety symptoms predicted by the MRM for soldiers with high vs those with low CO2 reactivity was 5.68, which is equivalent to a large effect size (Cohen d = 0.91).
Furthermore, we investigated whether the potentiating effects of CO2 reactivity on the effect of war-zone stressors on PTSD symptoms, general anxiety, and depression was specifically related to CO2 reactivity or merely a result of the relationship between CO2 reactivity and other predeployment psychological variables (which could affect war-zone stress reactions). Thus, we repeated the MRM analyses, adding different relevant predeployment control variables (and their interactions with the average level of war-zone stressors and monthly changes in war-zone stressors) as additional predictors of the war-zone stress reactions. The control variables included in the model were trait anxiety (measured by the State-Trait Anxiety Inventory50) lifetime diagnosis of any Axis I disorder (yes/no), and current diagnosis of any Axis I disorder (yes/no). All the significant effects of war-zone stressors and CO2 reactivity remained significant, even when each of these control variables (and their interactions with war-zone stressors) were added (separately) to the MRMs.
Finally, we performed exploratory analyses to determine whether other API-derived CO2 reaction indices explained the significant variance in symptoms more than what was explained by our primary index of CO2-induced fear. Colasanti et al47 used factor analysis to derive 3 separate CO2-induced symptom clusters (respiratory, cognitive, and neurovegetative) based on responses of healthy volunteers to a double inhalation of 4 CO2 mixtures. They found that the respiratory cluster was the best predictor of CO2 fear/discomfort. Although the 29 CO2 reaction items from the API do not directly map onto the 13 DSM-IV panic symptoms, many of the items on the API can be grouped into 1 of these 3 clusters either directly (the API item is virtually identical to the item used by Colasanti et al47) or conceptually (the item clearly fits into 1 these 3 clusters [Table 1]). Because the API included more items than the 13 DSM-IV symptoms, we created 1 additional response cluster (emotional/fear) to separate the cognitive cluster into 2 categories: cognitive and emotional/fear. This was done because some items reflected changes in perception that were not necessarily fearful (Do things and people seem unreal?), whereas others were primarily emotional/fear related (Were you afraid of dying?). We formed scale scores for the 4 clusters of CO2 reactions by adding the items from the API that matched each category. Table 1 reports the means and SDs for these 4 CO2 reaction scales. The internal consistencies of the 4 clusters of responses to CO2 challenge were adequate: respiratory, α = 0.64; cognitive, α = 0.78; neurovegetative/physical, α = 0.79; and emotional/fear, α = 0.73.
To determine whether any of these reaction cluster scores explained significant variance in symptoms beyond what was explained by our primary index of CO2-induced fear, we added each scale, in turn, to our MRMs for each of the 3 war-zone symptoms. Each scale was added as an additional predictor of outcome and as an additional moderator of the relationship between war-zone stressors and war-zone symptoms. Results showed that none of these scales explained significant variance beyond our original CO2 peak fear index for either PTSD or general anxiety symptoms. However, higher cognitive, neurovegetative/physical, and emotional/fear responses to the CO2 challenge were related to higher depression symptoms in theater (b = 1.12, P = .003; b = 0.83, P = .04; and b = 0.96, P = .04, respectively). In addition, higher scores on the emotional/fear composite interacted with changes in war-zone stressors over time (b = 0.49, P = .005), such that the relationship between war-zone stressors and depression symptoms was greater for soldiers with higher emotional/fear reactions to the CO2 challenge.
We sought to test whether emotional reactivity to enriched CO2 inhalation before deployment would predict soldiers' psychological adjustment while deployed in Iraq. A unique design feature of this study was the use of a web-based in-theater assessment of war-zone stress exposure and war-zone stress symptoms. To our knowledge, this is the first investigation to link a potentially modifiable predeployment risk factor to soldiers' level of exposure to war-zone stressors and war-zone stress reactions assessed repeatedly during soldiers' deployment.
The growth pattern of war-zone stress reactions over time was more complex than expected given previous reports51 showing a positive association between war-zone stress reactions and length of deployment. Consistent with an earlier report36 on a subset of soldiers from the present study, all 3 war-zone stress reactions—PTSD symptoms, depression symptoms, and general anxiety symptoms—showed a significant inverted U-pattern in their respective growth curves over time. Stress reactions increased during the first 8 months of deployment but decreased to their earlier levels (or below) during the final 8 months. Perhaps this pattern reflects the effects of habituation or an increased sense of mastery in response to the repeated confrontation of similar war-zone stressors.
Soldiers' reactions to CO2 inhalation at the predeployment assessment were similar to those reported for nonclinical civilian samples.52 The 3 most frequently reported physical reactions to CO2 challenge were lightheadedness, feelings of faintness, and breathlessness—all expected reactions to acute hypercapnia. Soldiers' fear reactions to the CO2 challenge varied markedly across soldiers, ranging from no fear (32%) to panic (11%), with the average soldier reporting mild fear. These data for CO2-induced fear are in sharp contrast to those observed for patients with panic disorder, who report extreme fear, with more than 60% experiencing panic in response to the CO2 challenge.53
In line with previous reports, soldiers reporting greater exposure to war-zone stressors reported higher levels of anxiety, depression, and PTSD symptoms. However, consistent with a stress-diathesis formulation, the impact of war-zone stressors on soldiers' psychological symptoms was potentiated by their emotional reactivity to CO2 assessed before deployment. Specifically, soldiers displaying heightened reactivity to CO2 before deployment reported greater PTSD and anxiety symptoms in response to increased war-zone stressors relative to soldiers displaying low levels of predeployment CO2 reactivity.
It is noteworthy that fear responding to CO2 showed a significant potentiation effect for PTSD and anxiety symptoms but not for symptoms of depression. The observed specificity is consistent with studies54 with civilian samples showing increased fear responding to CO2 challenge among patients with anxiety but not those with clinical depression.
What might explain the observed relationship between heightened emotional response to CO2 and the increased vulnerability to develop anxiety symptoms in response to war-zone stressors? One possibility is that CO2 reactivity is simply serving as a proxy for soldiers' predeployment trait anxiety or the presence of past or current mental illness. We tested this possibility by adding soldiers' level of trait anxiety, presence of any past or current mental illness, and their interaction with stress exposure to our MRM models and found that CO2 reactivity retained its predictive status even after controlling for these variables. These data suggest that the observed potentiation effect of CO2 reactivity is not simply a consequence of its association with other psychological trait variables.
A second possibility is that heightened reactivity to CO2 challenge represents a behavioral marker for a neurobiological hypersensitivity of one's suffocation alarm that would be triggered under times of heightened stress exposure.55 Although the design of our study does not provide a stringent test of this formulation, our exploratory analyses showing that the respiratory reaction cluster did not account for additional variance in war-zone stress reactions beyond that found for CO2-induced fear seems at odds with this formulation.
A third possibility is that CO2 reactivity may function as a more specific vulnerability to respond fearfully to respiratory distress. Hyperventilation is a common reaction to stress in civilian56 and military57 samples. Because respiratory distress often occurs in response to stress-induced hyperventilation,58 it would be expected that soldiers who respond fearfully to the respiratory distress elicited during 35% CO2 challenge might be particularly likely to show increased anxiety symptoms in response to war-zone stressors. Although our data are consistent with this formulation, we cannot rule out the possibility that other genetic or neurobiological factors are responsible for the CO2 challenge findings. For example, there is exciting emergent evidence in rodents linking neurobiological substrates and genetic markers, such as acid-sensing ion channels and the genes that code for them, to fear of suffocation associated with inhalation of CO2.59
Several limitations of the study deserve comment. First, the small sample size may have limited our ability to detect significant relationships between CO2 reactivity and depressive symptoms as well as our power to examine the stability of our findings across subgroups, such as women or racial/ethnic minority participants. Replication with a larger sample is warranted. Although participants were recruited from 10 different army units, we cannot rule out the possibility that our findings may not generalize to soldiers from outside Fort Hood.
The potential significance of these findings for the prevention of combat stress disorders deserves comment. Studies using civilian samples have shown that CO2 reactivity can be lowered significantly with brief cognitive-behavioral interventions.17 Given the safety and ease of administration of CO2 challenge, it would be feasible to integrate these brief cognitive-behavioral interventions into the military with the aim of reducing fear responding to CO2 challenge. Whether such training would reduce the development of PTSD and anxiety symptoms among soldiers deployed to a war zone awaits research.
Correspondence: Michael J. Telch, PhD, Department of Psychology, The University of Texas at Austin, 108 E Dean Keaton, Room 3.102, Austin, TX 78712 (firstname.lastname@example.com).
Submitted for Publication: August 9, 2011; final revision received December 3, 2011; accepted January 9, 2012.
Author Contributions: Dr Telch had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work was funded by the US Army Research, Development, and Engineering Command Acquisition Center, Natick Contracting Division; and the US Defense Advanced Research Projects Agency under contract W911QY-07-C-0002 (Dr Telch).
Role of the Sponsors: The sponsors were not involved in the design or conduct of the study; collection, analysis, management, or interpretation of the data; and preparation or approval of the manuscript.
Disclaimer: The views expressed in this publication are those of the authors and may not necessarily be endorsed by the US Army.
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From a 6-year-old birthday girl to a Hicksville corporation, from a local vet to a national food company, people have been stepping up to take care of our homeless pets.
From a 6-year-old birthday girl to a Hicksville corporation, from a local vet to a national food company, people have been stepping up to take care of our homeless pets.
When 6-year-old Sabrina Stevenson of Narrowsburg realized she had gotten so many presents for the holidays that she didn't need birthday presents, her mother, Vicki Guthrie, offered her another option.
They researched animal shelters and their needs, and chose the Dessin Animal Shelter in Honesdale, Pa., as the recipient of Sabrina's birthday gifts. She asked partygoers to bring donations for the shelter instead of gifts for her.
Thanks to her guests, Sabrina donated $80 in gift cards, $40 in cash and an abundance of other pet items and cleaning supplies for the shelter.
"I think it's wonderful that a 6-year-old is thinking of the animals," said a thankful Debbie Moore, manager of the shelter.
Cats are living more comfortably now, thanks to the fundraising events of the Friends of Warwick Valley Humane Society to buy new, spacious cat cages for the shelter at a cost of $4,000.
The money was raised at events ranging from the New York Philharmonic musicians at Warwick Grove, to dog training seminars at Orchard Grove Animal Hospital, to selling chocolate bars. Community businesses and individuals also contributed, and WVHS President Suzyn Barron is extremely thankful.
"The new cages allow us to configure them as needed," she said, "so two bottom cages are open and can house five adult cats comfortably. Since so many adult cats spend many months waiting for homes, it's important for us to provide for their emotional and mental well-being during their stay.
"On behalf of our happy cats, I thank Friends of Warwick Valley Humane Society for their determined efforts in their inaugural year, in which they achieved their immediate goal of funding the purchase of our new and improved cat colony enclosures."
Friends of WVHS is raising money for an off-site adoption center. Donations can be made at alwaysforanimals.org or sent to Friends of Warwick Valley Humane Society P.O. Box 576, Warwick 10990.
After WVHS's washer and dryer died on the same day, South Street Wash and Fold permitted the shelter to use its machines, "for which we are most appreciative," said Barron. But the shelter needed a new washer and dryer, which wasn't in its budget.
The Hercules Corp., a laundry room provider of Hicksville, stepped in and donated a washer and dryer, along with lifetime service.
"I'm a tremendous dog lover, and I will do as much as I can to always help such a worthwhile organization," said Barry Heller, Hercules vice president.
"We are set for life, never having to worry about clean bedding ever again," Barron said.
Flannery Animal Hospital in New Windsor announced recently it is the first in the region to sell FreeHand super-premium dog food and introduce its buy-one-give-one business model, created to help save homeless dogs' lives.
For every pound of dog food sold through the hospital, FreeHand will donate an equal amount of premium-quality food to the Humane Society of Blooming Grove.
"I was happy to join forces with FreeHand and aid its mission by carrying FreeHand food at our hospital," said Dr. Frank Puccio, owner of Flannery Animal Hospital. "It is a cause that means a lot to us, and any time we can give our community an opportunity to support shelters, we are eager to do so."
Participating resellers across the country can designate recipients from a list of local rescue groups and shelters screened and approved by FreeHand. Online purchasers select recipient organizations from a preapproved list provided at checkout. Recipient groups must adhere to strict criteria set by FreeHand to ensure the humane treatment of the animals in their care.
"We have been receiving dog food from Flannery for a few months now," said Missy Veraldo, manager of the Humane Society of Blooming Grove. "We have had at least 20 bags donated to our shelter. The difference in their appearance and coat has been incredible. It has helped their digestive tract, as some of the dogs have highly sensitive stomachs. Flannery has been a great asset to us."
To find FreeHand resellers, visit LendaFreeHand.com/store-finder or call 855-GIVEBAK (448-3225).

subset: commoncrawl


text: MADRID (MarketWatch) -- European stock markets opened lower on Thursday, keying off losses from Asia as investors appeared less optimistic that that U.S. politicians would be able to work out a debt deal. "Technically stock markets across Europe continue to be in good shape, however it can't be excluded that some profit taking will occur ahead of Christmas especially with markets having moved up steadily over the course of the past few weeks without any major pullbacks," said Markus Huber, head of German HNW Trading at ETX Capital in a note. After straight two days of gains, the Stoxx Europe 600 index SXXP, +0.48% fell 0.1% to 281.32, while the German DAX 30 index DAX, +0.32% fell 0.3% to 7,646.02 and the French CAC 40 index PX1, +0.40% fell 0.3% to 3,653.72. The FTSE 100 index UKX, +0.78% was flat at 5,962.19.


text:
Follow us at @WorldSportCNN and like us on Facebook
(CNN) -- When this season's World Cup alpine ski champions stepped up to the podium to receive their prizes, they were following in some famous footsteps.
The Dalai Lama, designer Karl Lagerfeld, Oprah Winfrey and boxing star Wladimir Klitschko have all been there.
No, not the FIS winners' pantheon. Not yet at least (although Vanessa Mae's appearance at February's Sochi Winter Olympics should offer some encouragement to wannabe ski-celebs).
Each has been the recipient of a piece of fine crystal designed and manufactured by JOSKA Kristall, a German glassblowing specialist.
The Bavaria-based company is renowned as the maker of awards presented to many a famous face -- also including Arnold Schwarzenegger, Mikhail Gorbachev and Claudia Schiffer -- but it is perhaps best known for the iconic FIS World Cup globes that are dished out to the kings and queens of the snow.
Some 64 World Cup trophies are awarded yearly to the discipline and overall winners at the various FIS ski, snowboard, Nordic, ski-jump and cross-country World Cup finals events.
Recipients in 2014 have included alpine skiers Anna Fenninger and Marcel Hirscher, who posed for the cameras with the freshest batch after picking up the overall titles for the ladies' and men's events respectively this month.
Yet behind these triumphant images of sporting glory lies a tale of intricate craftsmanship that is as painstaking in its quest for perfection as the preparations of any winter athlete.
A glass apart
Founded in 1960, JOSKA began as a glass-cutting enterprise before later adding a blowing factory, specialist engraving facility and hand-painting operations.
It first manufactured the crystal sphere trophies in 1987, with the first FIS globe handed over in 1989. The process has since become part of winter sports tradition.
Where football has its 18 carat gold World Cup trophy and ice hockey the silver and nickel Stanley Cup, winter sports have the crystal globe.
"Every season we have 33 of the small cups (for the winners of individual events), 17 of the big cups (for the overall winners), 17 for the nations cups and 177 medals of glass," JOSKA's operations manager Alouis Adam told CNN's Alpine Edge series.
"I think of the last 25 years we have made over 2,000 different small and big cups."
Adam says the production of a World Cup trophy spans two days and a number of complex stages.
Each is primarily forged using a 1,200-degree Celsius mass of molten glass which is then painstakingly shaped by JOSKA's glassblowers.
These skilled technicians inflate the hot glass to the required shape via a blowpipe, sweating profusely as they go. After a 24-hour cooling off period, the trophy is brought to a glasscutter who uses diamond disks to carve an intricate snow crystal design into the trophies.
The FIS logos, the relevant discipline and sponsor names are then engraved into the glass.
Once finished, the selected globes are packed up into specially designed shipping cases and transported from JOSKA headquarters to the relevant World Cup venue.
Of the hundreds of globes made each year, only the finest are used -- JOSKA selects the 33 best trophies out of a total of 60 smaller globes produced annually.
An emotional send-off
Having worked at the JOSKA for nigh on 42 years, Adam has seen hundreds of athletes pick up his company's prized trophies.
He attended this month's World Cup finals and was as effusive as ever on witnessing the world's best skiers, snowboarders and cross-country athletes' joy at receiving the fruits of his company's labors.
"That's a beautiful feeling. I (have) watched all the World Cup finals the last 25 years and we are very proud when the winners have our product," he said.
"This goes out around the world and we are very proud -- the winner looks at the trophy and says it's a wonderful trophy."
JOSKA also manufactures trophies for cycling's Tour de France as well as the German and Polish football federations.
But while fond of these items, Adam believes there is something unique about the World Cup globes.
"(This is an) absolutely special design which displays a globe for the best in skiing," he said.
Those winter sportsmen and women fortunate enough to have their hands on the prized crystal will be sure to agree.
See also: Double world cup joy for Austria
See also: Toe tingling void at top of the alps
See also: Ligety snatches GS title


text:
My plan is to outline some important facts about breast cancer in terms of incidence, mortality, risk factors and possible causes. This discussion will imply something about what can be done both by the individual and our society to help tame this menace. I will then discuss the general conventional management of breast cancer, which generally involves surgery and/or radiation and/or chemotherapy and/or hormonal or anti-hormonal treatment. Following this, I'll discuss alternative treatments for breast cancer, both as adjuncts to conventional treatment and as a replacement in some cases.
I hope that you women in the audience who have not been afflicted with breast cancer will learn some very practical things that you can do to help reduce your risk of developing this disease. For those of you who have had a bout with breast cancer or are currently suffering from it, I hope to provide you with some information that you haven't heard to help improve your chances of long term survival, as well as improve your quality of life.
Breast cancer is the most frequently occurring cancer in women, just as prostate cancer is the most frequently occurring cancer in men. It is the second leading cause of cancer death in women behind lung cancer, just as prostate cancer is the second leading cause of cancer death in men behind lung cancer. The American Cancer Society estimates that in 1995, 182,000 women will be diagnosed with breast cancer and 46,000 women will die from it. One in eight women will be diagnosed with breast cancer during their lifetimes compared to one in twenty women in 1950. The five-year survival rate of women with breast cancer is virtually identical to what it was 30 years ago, implying that in spite of all the hype about early detection and the great advances in the conventional treatment of breast cancer with radiation and chemotherapy, there has really been no significant improvement in treatment.
Staging of Breast Cancer
The staging of breast cancer is important in terms of predicting the prognosis (that is, the course of the disease) and from a conventional medicine point of view, the best conventional approach to a particular patient's breast cancer. The staging of breast cancer involves the size of the cancer in the breast, whether or not it has spread or metastasized to regional lymph nodes and whether or not it has metastasized to distant organs, such as the liver, lungs, bones or brain.
A stage 0 breast cancer is one that is limited to the topmost cell layer and the five-year survival is about 90%. A stage 1 breast cancer a cancer that is less than 2 centimeters (about an inch) in diameter with no evidence of spread to the lymph nodes or distant organs. The five-year survival for stage 1 is about 85%. In a stage 2 breast cancer, the cancer is 2 to 5 centimeters in diameter or the tumor is less than 2 cm, but there is a spread of the cancer to the lymph nodes under the arm. The overall 5-year survival for stage 2 is about 60%. However, the larger the tumor and the more lymph nodes involved, the worse the prognosis. In stage 3, the cancer is more than 5 cm in diameter or the lymph nodes that are involved are fixed to either themselves or to other tissue, such as the skin or muscles. The 5-year survival for stage 3 is about 40%. Finally, stage 4 breast cancer involves either a cancer that is fixed to the chest wall or overlying skin, has metastases to lymph nodes above the collarbone, or has distant metastases to distant organs, such as the liver, lungs, bones or brain. The 5-year survival for these patients is less than 10%.


text:
Over the long haul, stocks tend to gravitate around earnings.
Earnings, meanwhile, tend to gravitate around revenue--which is to say, corporate earnings average about 6% of corporate revenue and move in a range between 4%-8% of revenue, depending on where we are in the business cycle.
Right now, earnings are at about 8% of revenue--the top of the range.
Always before, when earnings have hit this level of revenue, they have soon plunged--back to the average of 6% of revenue or far below it.
Today's analysts are not predicting that earnings will plunge as a percentage of revenue.
On the contrary.
Analysts are predicting that earnings will continue to rise as a percentage of revenue over the next two years, reaching levels that have never before been seen in the recent history of economics (and, possibly, ever).
Check out this chart from GMO's James Montier that shows this consensual hallucination:
And these earnings projections form the basis for the bullish-as-ever stock market calls of most major market strategists.
Do the strategists offer compelling explanations for why they're expecting profit margins to do something they have never done before?
They just assume that earnings will do what they generally do and have done for the last few years--grow.
So, as you finally start to get comfortable with the idea that all that bad stuff is behind us and stocks will now just keep going up, ask yourself this simple question:
Which is more likely?
- Over the next couple of years, profit margins will just keep on rising to levels that have never been seen before
- Analysts are, once again, wrong


text:
Zero tolerance alcohol policy good choice for parents
Restaurants in Germany legally sell alcohol to teenagers after their 16th birthdays and French children drink wine with dinner at an early age, but U.S. parents who follow this relaxed European example, believing it fosters a healthier attitude toward alcohol, should be careful -- it may increase the likelihood that their children binge drink in college. Research conducted by Caitlin Abar, graduate student in human development and family studies and member of Penn State's Prevention Research and Methodology Centers suggested that parents practice a zero-tolerance policy in the home and said that there is no scientific basis to the common belief that prohibiting alcohol turns it into a "forbidden fruit" and encourages abuse. She presented her results at the 2009 meeting of the Society for Prevention Research, Washington, D.C., and they appear in the current issue of Addictive Behaviors.


text: This extensive collection of papers provides histories of the development of nuclear weapons programs in various countries and surveys the effects of the development on human health and the environment. It discusses the nations involved in uranium mining, nuclear material production, weapon testing, and weapon deployment. The authors consistently refer back to the costs of managing radioactive waste, and discuss governmental deception about potential health effects. Information uncovered about the former Soviet Union's nuclear weapons program is also provided.


text:
As quoted from Techdirt regarding yesterday's supreme court rulings,
" As expected, the Supreme Court decided both Grokster and Brand X today -- and, as expected, the results aren't as clear as some people seem to be making them out to be. In the case of Grokster, the ruling was (surprisingly) unanimous that file sharing networks could be held liable for copyright infringement if they take "affirmative steps" to encourage infringement. However, they never say if Grokster and the others in the case did take those affirmative steps, so the case goes back to the lower court to debate that issue. Generally speaking, this sounds like a bad decision, though, not as bad as it could be. It's a bit surprising, given what some of the justices said during the case. However, it looks like they tried to narrowly define how a company could be liable. Unfortunately, by making a company liable for a crime that its technology is used to commit, they're opening up a can of worms that is likely to become quite messy. It certainly looks like Apple, for example, could be guilty for their "Rip, Mix, Burn" ad campaign a few years ago. As for Brand X, the court (six to three) voted that the FCC was right in saying that cable lines don't have to be opened up to competitors, basically agreeing that cable providers are offering an "information" service on privately built lines, rather than telco services on lines built by a taxpayer money through the government monopoly AT&T (Brand X supporters say that cable lines are built with local gov't approval, creating a local monopoly anyway). This one is a lot harder to call as to whether it's a good or bad decision, as the arguments for both sides make some sense (and, both are misleading in some ways). In this case, you can look more at who it's good or bad for -- and despite the way they're reacting, it really might not be good for the cable companies. That's because this will drive competitors to search out alternatives to using cable lines as a means of offering broadband services to end users. Given the cable companies' inability to understand what users seem to want, this opens the door wide for them to shoot themselves in the foot, while other providers move on to things like wireless technology. There are still a lot of challenges in using wireless broadband today -- and certainly some of the same incumbents who create many of the problems in the industry today will also try to stifle wireless competition. However, by closing off cable as an easy way out for independent providers, it's going to just make them that much more interested in wireless options and figuring out ways to route around existing cable and telco providers."


text:
Herkimer, Jefferson, Lewis, Oneida, Onondaga & Oswego Counties
Asbestos Case Management Rules (3/01)
Foreclosure Forms - Administrative Order 5AO2015-84
Individual Court Rules
Jefferson County Supreme Court
Hon. James McClusky
Lewis County Supreme Court
Hon. Charles C. Merrell
Oneida County Supreme Court
Hon. Patrick F. MacRae
Hon. Gerard J. Neri
Onondaga County Supreme Court
- Dedicated Matrimonial Part Rules - Onondaga and Oneida Counties
- Summary Judgment Motion - Onondaga County
- General Rules for Jury Trials
- General Rules for Non Jury Trials
Hon. Deborah H. Karalunas
Hon. Gerard J. Neri
Hon. Anthony J. Paris
Oswego County Supreme Court
Hon. James W. McCarthy
- Civil Motion Rules
- Civil Trial Rules
- Summary Jury Trial Order and Rules
- Matrimonial Preliminary Conference Order
- Matrimonial Motion Rules
eFiling Rules and Protocols
All parties should familiarize themselves with the New York E-Filing Rules (Uniform Rules §§ 202.5-b and 202.5-bb which are available at www.nycourts.gov/efile).
General questions about e-filing should be addressed to the E-Filing Resource Center at (646)386-3033 or email@example.com.
Onondaga County Protocol for Case Filings New York State Electronic Filing (NYSCEF)
- Hon. Gregory R. Gilbert
- Hon. Hugh A. Gilbert
- Hon. Donald A. Greenwood
- Hon. Deborah H. Karalunas
- Hon. James P. Murphy
- Hon. Gerard J. Neri
- Hon. Anthony J. Paris
- Hon. James C. Tormey
Oneida County Protocol for Case Filings New York State Electronic Filing (NYSCEF)
ADR Roster of Neutrals
PART 146 Guidelines For Qualifications And Training Of ADR Neutrals Serving On Court Rosters
Fifth Judicial District Roster of Neutral Evaluators and Mediators


text:
It is hard to follow a Daley into the mayor's office here. There is no instruction book. Richard M. has been sitting there for 22 years, a little longer than his father, Richard J., sat in the mayor's office when he was creating "the city that works."
Rahm Emanuel, scheduled to take office May 16, knows that well, and with the blush fading from a first-round victory in the mayor's race on Feb. 22, he is moving with characteristic aggressiveness to put his stamp on the office.
That is prudent, because the nation will be watching. With its pension deficits, its billion-dollar budget shortfall, its troubled public schools, and its bubbling array of social challenges, Chicago may well become the laboratory for addressing the problems that plague big cities in hard times.
But if anyplace in America has a good track record for attacking problems, it sits here in its sparkling architectural glory, flat in the center of the nation's heartland. Chicago may be the most American place in America, forged by an array of brutally efficient moguls and an army of immigrants who built the railroads, chopped up and shipped pigs and beef to feed the nation, tapped mayors who built enduring political traditions that ran from vile to visionary and left a legacy of prosperity across generations.
RELATED OPINION: Chicago Mayor Daley's greatest legacy – and gift to Rahm Emanuel
Now comes Mr. Emanuel and his "moving forward" mantra – "Together, as one city with one future" – which he first tossed out on election night. It echoes on all the news shows, the theme he probably hits most often when he is asked about his plans.
He is, perhaps even more so than any other Chicago mayor, a pragmatist with a question at the center of the administration he is about to lead: "What do we need and where can I get it?"
Despite the city's reputation as a solid blue Democratic political playground (there have been no Republican mayors since Big Bill Thompson, the most corrupt in the city's history, was dumped during the Great Depression), Chicago seems to work best when political labels are ignored and real dealing steps in. That pragmatic philosophy fits the city like a good winter boot.
Chicago remains a segregated city by race (not as segregated as that description would suggest), but it was segregated by nationality long before African-Americans began arriving in vast numbers in the early 20th century. Emanuel and every successful politician before him reaching back into the 19th century recognized that reality.
No one wins in Chicago without building coalitions that stretch across every description imaginable, the very process Emanuel used in structuring his February victory. He captured 3 of every 4 wards. Keeping that connection with all the slices in this most ethnic American city will help determine whether Emanuel succeeds, or succumbs to dreaded one-termer's syndrome.
This is not yet Emanuel's city. No one erases the legacy of a Daley very quickly or very easily in a Chicago that is wedded to both their names and their styles.
Even the younger Daley, the outgoing Richard M., was just marginally regal enough, without the polish, to make it seem that he was at the top of a machine, although that was not actually the case. Where his father, Richard J., "the Boss," was as much of a brute as he needed to be and had lots of levers to pull to prove it, Richard M. was almost wonky, more a technician of city government than commander of it.
Still, Emanuel is no neophyte to Chicago's ways. In Congress, he represented the Fifth District, which includes Old Town, Lincoln Park, Lakeview, and Uptown, where the city stores much of its most delicious real estate and influence. He raised money for Richard M.'s campaign. He was a confidant for legions of Chicago politicians, among them President Obama.
He made millions as an investment banker after his years in the Clinton White House. He knows where all the unmarked political graves and land mines are. He's going to need all that knowledge, and more, not to mention the pepper he delights in bringing to every job he has held.
Emanuel will have to come in charging, his reputation for toughness and aggression on full display, says Paul Green, a political scientist at Roosevelt University in Chicago and a stalwart on the mayoral watch for many years. "The pretty card has been played," says Dr. Green of Daley's determined campaign to beautify what had once been the grittiest city in America with parks, flowerpots, rooftop gardens, and bike paths. The city sparkles, but the problems loom just beneath the surface.
"Now he's going to have to deal with the financial stuff. That's where it's at," says Green. "I think the big thing with Emanuel is, can he keep intimidating people? I think his intimidation skills are stupendous."
"It's a weak mayor/strong council situation, so the only way you get the council to not act like a bunch of idiots is to intimidate them. I think that is what you have to do, and blowing your top at the correct time is a real advantage.... The city council's the Pips and Rahm's going to be Gladys Knight."
Green, who co-wrote "The Mayors: The Chicago Political Tradition," believes the only time the city progresses is when it has a strong leader in city hall. Throughout history, when the city council was in control, Chicago "went down the tubes."
Traditionally, it has been all but impossible to weld the city's 50 wards – whose aldermen make up one of the largest city councils in the country – into a single identity because they remain as ethnic and unique today as they did during the Great Depression, when Mayor Anton Cermak created the first genuine Democratic machine.
"You could never have a real vision for the city, or a real reformer, because the people's idea of reform stopped at the boundary line of their own ward or parish," Green says. "But once Cermak got in and that machine got rolling, it was a democracy – but they played with a different card. They showed that machines could provide services as part of the machine, just as long as it was your guys providing the services."
Then and now, fear has a lot to do with it.
Both Daleys became forces of nature. This was very effective over the four decades father and son held the mayor's office, interrupted for just a while after the old man's death during a frenzied interregnum that included Chicago's first woman mayor, Jane Byrne, and its first black mayor, Harold Washington.
"The mayor has to crack the whip," Green says. "That used to be Emanuel. But now he's acting like Mother Teresa. I don't know how long that is going to last."
Mother Teresa, actually, with a website, a top-notch staff helping him to fill positions, and a valuable capacity for saying less than you might think you are hearing. He has called for adding 1,000 police officers, for instance, which sounds good until one realizes it's going to be hard to find the money for them. Also, crime numbers are way down.
But gang violence remains the rotting core of otherwise impressive crime statistics and the media driver behind perceptions. The police are said to be unhappy with the city's leadership, too. Even a couple hundred new cops would help with that.
Chicago has been getting little tastes of how Emanuel will govern since the election. His every policy decision and new hire is proclaimed on his new website, which looks a lot like the kind of website Mr. Obama used in his campaign.
Emanuel has collected an array of key aides in education, transportation, finance, and public safety; pushed them to the front; and let them speak weeks before he took office. He has said he did not want the city to think he was letting the moment pass without giving an idea of where his administration would go.
Veteran Chicago business columnist David Greising wrote that the new mayor went outside to fill most of those jobs, an important political message that will help separate him from the legacy of Daley, who turned to insiders 22 years ago to fill his first administration.
Emanuel has been magnanimous in victory. For now, the character who played the bad boy's role in the Obama administration – that vulgar chief of staff always ready to unleash a practiced collection of obscenities to make his point and help push through monumental legislation on health care and finance – is somewhere off stage. No muttered phrases, no surprising gestures come from the mayor-elect.
That might have worked in a more stuffy Washington. But obscenities won't get you very far in Chicago, where they are generally used by some people as punctuation. Besides, there will be plenty of time for tough talking later.
Just now, the man who swept from the president's staff into the mayor's office on a $14 million wave of campaign contributions (no one else came anywhere near in that category) is the personification of sweetness and light, at least in public, which may be smart. Historically, one of the most important challenges for Chicago mayors is to be liked. A forgiving electorate will go a long way toward helping a mayor who is liked and who keeps the place plowed in the winter and sparkling in the summer.
Still, it may be fortunate that Emanuel was classically trained in ballet as a youth because he is walking on eggshells in some respects. He has to be careful not to load too much blame on Daley for the city's problems, even as he moves quickly to identify them and present some solutions.
Bruce Dold, chief of the Chicago Tribune's editorial board, sat with Emanuel for a long Web-streamed interview in front of a packed audience at the Field Museum a few weeks after the victory and a few weeks before the swearing in.
Emanuel was the perfect opposite of his tongue-tied and occasionally eruptive predecessor. He was so comfortable he stopped at one point to pull up his socks. He made a lot of jokes, smiled abundantly, said his mom was happy with his victory, and at every opportunity underlined the challenges that will define his first 100 days in office: There is a billion-dollar deficit, the pension system is nearly broken, the school system still struggles despite "reforms," the transit system is wobbly, and, worst of all, someone else swept in a long time ago to pick all the low-hanging tax-and-revenue fruit.
In short, he is stepping into a mess.
Emanuel has shown the vague shape of his proposed solutions, although he is decidedly short on specifics, a sign he is preparing for battle. As a revenue source, the word "casino" is in the air, with the new Trump hotel, jutting, glass-encased, into the sky. Emanuel says he could accept a casino in Chicago, but that drew demands for a referendum from gambling opponents.
He told the Field audience he has already moved to slash $75 million from Daley's current budget (Daley has slipped quietly out of the klieg lighting save for a round of neighborhood farewells). He said he wants a frank conversation on the cost side of the city equation. He told the audience he wants everyone's ideas and is not interested in lapsing into the old Chicago way of unleashing tribes against one another.
What he wants from the unions, he said, is what they can give to help him solve the problem. They need to understand that the pension for firemen is in jeopardy. Something has to happen to resolve it now – but not an increase in property taxes, which he resists.
Charter schools that operate under conditions that provide flexibility in collective bargaining are one part of the education solution, he says. But he pointed proudly to success in the state legislature in pushing bills that would give Chicago a longer school day and a longer school year (both of which are now the shortest among big urban districts) and open the door to pushing out tenured teachers who can't do the job.
Parents are a crucial part of the formula for success in education, the new mayor told the Field audience. The city has to find a way to get them more involved in the fortunes of the schools, and in the futures of their own children.
Emanuel is not shy about anything. In an earlier interview, a reporter tried to paint him into the "mayor versus city council" corner, but he would have none of it. He accused the reporter of old thinking and said he wanted to govern in concert and cooperation with the 50 council members, the public employees, the teachers, the parents, the taxpayers, with everyone.
The media picking and poking, a blood sport here, seems mostly to be on hold for the moment. That's in part because a mayor who is not a Daley is such a novelty. Emanuel is like a candidate who fell from the sky and was anointed, much to the chagrin of an abundance of old-fashioned locals who were upended by Daley's sudden decision last year not to seek reelection. No one had time for preparation.
There was nowhere to hide from Emanuel's campaign. At elevated railroad stops early in the morning, at coffee shops after that, at favored lunch places and well on into the day or night, Emanuel, hand out and smiling warmly, might show up anyplace. That was intentional. He said early on that the goal for any mayoral candidate in Chicago is to be out with the people, becoming known. By Feb. 22, it was the rare commuter who didn't have at least passing contact with the persistent Emanuel.
It was not an ideological campaign. Without a lot of specifics, he focused on fixing the city's problems and moving ahead for everyone. In the election, no one else even came close.
He will have to keep reaching out to all the city's various ethnic groups and social classes to rule with any kind of authority. Chicago, like many American cities, is a classic melting pot.
The Germans, then the Irish and Eastern Europeans, the Indians, now the Mexicans and Central Americans and the latest waves of Russians and West Africans all settled here, kept their cultures alive in clearly defined parishes and neighborhoods, yet managed to function as one big city.
Up on Devon Avenue, where Chicago almost runs out of city on the north side, Pakistanis, Indians, Russians, Orthodox Jews, the occasional Chinese restaurateur and butcher selling goat meat or live chickens all live in redolent, prosperous peace. To this day, when you ask someone where they live, the answer is likely to be a Parish name – "St. Ben's" or "Old St. Pat's" or a ward. Only a scratch-and-sniff map could deliver an adequate sense of the kind of ethnic mix that makes up modern Chicago.
It has become fashionable to claim the city faces its worst problems ever as Emanuel takes office. But that seems a tad hyperbolic given Chicago's robust history. Created in the 1830s by bold, greedy visionaries who raised it from a pestilent bog along the lake, the most important part of the town burned to the ground in 1871, but was rapidly rebuilt.
Chicago survived wave after wave of truly creative, defining political corruption. A political convention turned into a police riot in 1968. It was indeed a racial tinderbox in the Civil Rights Era.
Before that, two of its favorite mayors, Carter H. Harrison, who called the city his bride and said it was destined for greatness, and Cermak, builder of the modern political machine, were assassinated, the first at the close of the great 1893 World's Fair and the second in Miami during a visit with President Roosevelt in 1933.
Chicago survived all that and thrived. Along the way, it created one of the nation's most engaging skylines, nurtured too many social and progressive movements to list, and became the home of a collection of great universities. In 2008, it gave the nation its first black president.
Beyond the cliché of Al Capone and liquor-turf machine-gun battles during Prohibition, Chicago's big legacy may be machine politics. Yet Emanuel will not be able to turn to the structure invented by Cermak, and perfected by the first Daley, even if he wanted to. Lawsuits and investigations and reform have limited the ability of the machine to operate.
Power now resides in the world of finance, being able to raise money for big development and civic projects, not in the old world of favors for ward bosses and precinct captains. It remains a place where an aggressive US attorney can still make a name and scratch lots of notches into his gun, perhaps by settling on rumors that a governor once known as "Elvis" was trying to market a US Senate seat. But the schemes are not as transparent or as abundant as they were in the day when patronage provided thousands of job opportunities, and payoffs came in brown paper bags.
One respected political consultant, Don Rose, says Emanuel has the chance to make a final break with the felonious politics of the past, one Richard M. Daley could not make because of his connection with his father and the big machine he constructed. "We don't need any of the old-school politics here," Mr. Rose says. "Daley could not leave it behind.... Most of it was not necessary for reelection, and we don't think Daley was dollar dishonest, but the old ways were just not necessary."
In Rose's view, although no one has accused either of the Daleys of profiting from public office, both of them were too astute to be unaware of corruption around them. Those who got in trouble under the latest Daley fell from grace. Rose argues the message from the very beginning (and the message Emanuel should send) should have been: "Don't do that. I will not accept that."
It's the difference between an ethos that says not even the appearance of impropriety will be tolerated and the need to occasionally throw some embarrassed miscreant under the bus.
"Take the chance of being a one-term mayor by doing the right thing about economics, by doing the right thing with the schools, by doing the right thing about patronage waste – take that chance," says Rose. "My sense is that the people will stand behind you if you do that."
• Charles M. Madigan is presidential writer in residence at Roosevelt University in Chicago.


text:
"Remission" of Stage IIIB Non-small Cell Lung Cancer (NSCLC)
My mother was diagnosed with non-small cell lung cancer stage IIIB. She has completed her 6 treatments of chemotherapy (taxol). The tumor has shrunk from 4cm to about the size of a thumbnail. Her doctor has now told us that he will do follow-up scans and blood work and that we will see him in 6 weeks. Is this stage considered remission or must the tumor have completely disappeared? Do you believe that there are any possible treatments that will make the tumor completely disappear? Any information would be much appreciated.
Barbara Campling, MD , Medical Oncologist, responds:
Your mother has stage IIIB non-small cell lung cancer that has been treated with 6 cycles of chemotherapy. Usually, stage IIIB non-small cell lung cancer is not surgically operable. Depending on the situation, chemotherapy or radiation therapy may be used. Often these two forms of treatment are given concurrently to help shrink down or even, in a minority of cases, to eradicate the tumor. In your mother's situation, the tumor has had an excellent response to chemotherapy. This is called a partial remission. A complete remission is when the tumor disappears so that it cannot be seen on imaging. However, unfortunately, even if a lung cancer goes into a complete remission following chemotherapy, it usually eventually starts to grow again.
It is hard to say without having a chance to examine your mother and see all of her scans whether any further treatment would be appropriate at this stage. It is unlikely that any more chemotherapy would cause any further shrinkage of the tumor. If radiation therapy was not recommended at the outset, consider asking your medical oncologist about if your mother would not be a candidate for radiation therapy. If she is a candidate, radiation therapy to her residual primary tumor might be helpful to cause further shrinkage of the tumor and to delay recurrence. The results of her follow-up scans should be helpful in deciding whether any further treatment is indicated.


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Dr. Latimer to Join Lehman College in September 2014 from the University of Florida
Lehman College has announced that Dr. William W. Latimer has been named founding dean of the School of Health Sciences, Human Services, and Nursing. Dr. Latimer comes to the Bronx after serving as the Elizabeth Faulk Professor and Chair of the Department of Clinical and Health Psychology in the College of Public Health and Health Professions at the University of Florida.
Lehman College's new School of Health Sciences, Human Services, and Nursing consolidates under one academic roof several departments – Health Sciences; Nursing; Social Work; and Speech, Language, and Hearing Sciences.
"I feel deeply honored and very fortunate to be the inaugural dean of this new School at Lehman College and have the opportunity to lead an exceptional group of faculty, students, and staff," said Dr. Latimer. He will begin in his new post on September 2, 2014.
Dr. Latimer's program of research has been published extensively and continuously funded by the National Institutes of Health (NIH) for the past 20 years. He has secured more than $25 million in NIH funding to study the epidemiology, prevention, and treatment of infectious disease and drug dependence, with a focus on neurobehavioral risk factors of disease, treatment engagement, and outcome. He previously spent 11 years on the faculty at the Johns Hopkins Bloomberg School of Public Health where he directed two large training programs for U.S. and international fellows in public health and allied health professions funded by the NIH and the U.S. State Department, respectively.
Dr. Latimer also serves as producer and host of public radio WUFT's Public Health Minute, which airs throughout northern and central Florida. It focuses on research findings and practical health advice provided by top researchers and clinicians in allied and public health. Dr. Latimer also directs two large clinical trials to prevent infectious disease and treat addiction in Baltimore, Maryland and Pretoria, South Africa.
"Our new School grew out of Lehman's focus on education, excellent programs in health sciences, and a commitment to improving the health and well-being of the Bronx communities we serve and beyond," said President Ricardo R. Fernández. "We welcome Dr. Latimer's academic and administrative leadership as he guides the School of Health Sciences, Human Services, and Nursing in confronting 21st century problems."
Health and wellness is one of the fastest-growing sectors of the U.S. economy and has become a big concern in the Bronx, where residents face challenges like few other communities – poverty, high-risk schools, the lack of medical care, a shortage of nutritious food, and more. Working with community partners, Dr. Latimer and the School will take a leading role in confronting these problems. Nursing and social work are already two of Lehman College's most popular majors. The launch of new School is a case of perfect timing for the Bronx, New York City, and the nation, says Dr. Latimer.
"The education and professional training of health practitioners, educators, and researchers as well as the delivery of health care in the United States are undergoing unprecedented transformations," he said. "The forward-thinking vision of President Fernández to found a new School of Health Sciences, Human Services, and Nursing provides a basis to both inform and respond to these critically important transformations by positioning Lehman College at the forefront of dialogues and debates on health care."
"Dr. Latimer is the right person for this exciting yet difficult task of creating a new school—one that is demanded by student need, the economy, and the job landscape," said Dr. Anny Morrobel-Sosa, Provost of Lehman College. "I know that Dr. Latimer will help us meet these challenges."
Dr. Latimer received his Ph.D. in clinical psychology from the University of Rhode Island; an M.P.H in epidemiology from the University of Minnesota; and a Master's Degree in developmental psychology from Teachers College, Columbia University. He graduated Phi Beta Kappa, Magna Cum Laude from Hobart and William Smith Colleges.


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Tagged: Gateway Clipper
Valentine's Day – Spring Training 2011 Begins
Valentine's Day brought the first workout for many Major League Baseball Teams. The Pirates first workout was today in Pirate City.
The Pirates have made some changes from their 2010 105-loss team. Gone are manager John Russell and under performers Zach Duke, Adam LaRoche, Lastings Milledge, and Delwyn Young. In are new faces such as Kevin Correia, Matt Diaz, Scott Olsen, Joe Beimel, and Lyle Overbay.
One interesting thing that the Pirates are featuring this year are the Spring Training Jerseys, which will also be used during batting practice.
Pedro Ciriaco gets ready to take some cuts:
Ryan Doumit runs through some catching drills:
Unfortunately, I didn't take these pictures, they were posted by Pirates Tribune Review beat writer Rob Biertempfel.
I will be headed down to spring training in early March though – so keep an eye out for that!
In the meantime, on Sunday Feb 13th, when the Pirates were checking in at Pirate City, we were taking advantage of the 45 degree temperatures, exploring a trail along the Monongahela River.
What began as dinner by the river, ended in a hunt for a beaver dam, as we encountered at least 40 trees that beavers had chopped down and dragged away.
A look at a tree that was just too much for a beaver to take down.
We spent about an hour on this little 'adventure,' but failed to find any dams, despite looking all along the river.
The next day, while the Pirates were working out in Florida, I was enjoying Valentine's Day.
I decorated a table and served breakfast:
Went to work, came home, and went on a dinner and dancing cruise on the Gateway Clipper.
A view of downtown from the Gateway Clipper as we approached from the Allegheny:
Passing PNC Park:
I also took a video of us passing PNC Park.
It was like 25 degrees with 30 mph wind, so I was quite frozen after taking that video – you're welcome.
I'm looking forward to the 2011 season so I have some more baseball related stuff to report on.
It's a custom made baseball case in the shape of home plate that displays 30 baseballs. Each shelf has tiny divots for the balls to be placed in.
The case has a lock and key too! It opens from top to bottom.
This means I'm going to have to start compiling a list of the top 30 balls from my collection of 1,122.


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Dear Customers! Please read our conditions of purchase: Private and retail purchase: 1. Unfortunately Polish Post doesn't provide cash on delivery (COD) in foreign service, so we are only able to send you the ordered goods as soon as we receive your payment on bank account. 2. Cost of delivery depends on the weight of the package - we send by Polish Post or UPS (we choose cheaper option every time) Packages are sent by prioritaire post. Cost of delivery depends on the pack weight: - up to 100g 3,50 EUR - from 100g to 350g 5,00 EUR - from 350g to 500g 6,50 EUR - from 500g to 1000g 10,50 EUR - from 1000g to 2000g 19,50 EUR For the pack weight bigger than 2000g the cost of delivery is individually established - depends on actual weight. Official and wholesale purchase: 1. For all companies registered as EU importers/exporters - for the order's amount higher than 50,00 EUR we can make the official export with 0% VAT rate (netto prices); 2. Cost of delivery depends on the weight of the package - we send by Polish Post or UPS (we choose cheaper option every time) 3. About retail prices - you can refer to our multilanguage website www.100hz.pl - prices in EUR 4. Wholesale prices depends on quantity - please send the list of products with quantities you want to buy 5. Prices don't depend on turnover - prices depend only on quantity of each line e.g.: order 50 lines at 1 pc - retail prices, 5 lines at 10 pcs - medium wholesale, 1 line 50 pcs - wholesale 6. Payment - on our bank account. We send parcels after getting the money on our account. If our requirements find your acceptance please confirm it, so we will prepare proforma invoice with final prices and all necessary bank coordinates. IMPORTANT!
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Our Values
Life Transformation
Life Church values life development for every Christian. Every believer is to develop into Know-Grow-Go Followers of Jesus Christ. Life development means that all Christians are disciples and should actively pursue spiritual growth. Every disciple is to yield himself or herself to the leadership of Jesus Christ. Whole-hearted commitment to Jesus Christ is not only the biblical norm for the believer, but anything less falls short of God's ideal. Disciples are to demonstrate a lifestyle of Christ-likeness in their attitudes and actions, which involves living out the Christian faith in every area of life.
Life Church values authenticity. No false fronts are necessary. The goal is to create an environment where people can be themselves and not have to pretend to be someone they are not. People can come as they are outside and inside. The church is to be a kaleidoscope where different gifts, personalities, passions, and interests all shine brightly and are all valued. No "cookie-cutters" are needed. Valuing authenticity also includes the freedom to fail. No one is faultless, so perfection is not a requirement. Rather, what is needed is a genuine honest approach to life that strives for Christian growth but admits failure along the way.
Keeping Relevant
Life Church values relevance. The truth of God never changes, but that the culture in which the truth is communicated and applied is ever changing. Therefore, understanding the culture and ministering the truth of God's Word in the most effective way possible is essential. To do this, the worship services are upbeat, relevant, ordered, and contemporary. More concern is given to effectiveness than with adherence to tradition. Creativity, innovation, flexibility, and adaptability are all encouraged. The church must be culturally relevant while remaining doctrinally pure resulting in a message that is not transformed, but translated.
Evangelism, Church Growth, and Missions
Life Church values evangelism, growth, and missions. Jesus said that he came to seek and save those who are spiritually lost. He also said that just as the Father had sent him, he was sending his followers. He commissioned Christians to reach out and make disciples of all nations. Consequently, Life Church strives to be a mission base that reaches out through missions and church starting endeavors to all the peoples of the world, especially Unreached People Groups (UPG). All healthy life grows, so if the church is to be healthy, it too must grow. Therefore, priority is given to ministry efforts that will grow the church and extend the kingdom of God. When a choice must be made between serving the needs on the inside or reaching outside to others, Life Church is committed in advance toward ministry to those outside the church.
Lay Ministry
Life Church values lay ministry. There is no distinction between the clergy and the laity. Everyday lay people are part of the body of Jesus Christ and have been uniquely created to serve God. This divine design involves spiritual giftedness, heart, abilities, personality, and experiences. It is the responsibility of the church to train, encourage, and actively help members find the place where God has designed them to serve both inside and outside of the church. At Life Church, every member is a minister.
Investing in Relationships
Life Church values authentic relationships. Life-change happens best in small groups. Therefore, Life Church is committed to small groups as the best way of building relationships, stimulating spiritual growth, caring for needs, and developing leaders. Loving relationships should permeate every aspect of church life. Because relationships with friends, neighbors, co-workers, family members, and others are the most effective means of sharing the life-impacting love and hope of Jesus Christ, members are encouraged to maintain friendships with unchurched people.
Non-Churched People
Life Church values unchurched people who are not experiencing a growing relationship with Jesus Christ and desires to reach the numerous unchurched young adults in the greater northwest Austin area. Because they are important to God, they are equally important to Life Church. Time, energy, and resources should be devoted to pursuing those out of fellowship with God as Jesus Christ did when he was on earth. This outward focus is woven into everything that the church does. Outreach orientation requires meeting people as they are and where they are. The goal is to communicate the Gospel of Jesus Christ in a simple, practical, and easy-to-understand manner in order to create a "safe place" where unchurched people can hear the challenging Christian message in a manner that connects with their everyday life.
Life Church values excellence. God desires the best that his followers have to offer. Excellence honors God and inspires people. Believers are to do their best because, ultimately, they are not just serving other people, but God, himself. Therefore, in all facets of ministry at Life Church, members will seek to maintain a high standard of excellence and professionalism in order to bring glory to God. Offering God the best also includes giving him the best of the believer's time, talents, and treasures.