text: Promotional Drinkware Custom Imprinted with Your Logo - Hundreds of styles and colors make drinkware the perfect promotional products to showcase your company logo. Proformance Logo Products is your best source for promotional koozies, promotional metal water bottles, promotional coffee mugs, promotional travel mugs and tumblers, promotional sports bottles, promotional cups, promotional coasters, promotional glassware or promotional beverage openers. We offer a great selection, low prices and FREE shipping on all promotional drinkware and accessories. Need help choosing the best promotional drinkware product(s) for your event or marketing campaign or need a sample before making a decision? Contact us and we can help. Look for the Rapid Ship icon next to the product name for drinkware available for our free next day service.


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Blue Book® Suggested Retail Value
Fuel Economy (city/hwy)
There are no 1996 Hyundai Elantra reviews. However, the following might be helpful:
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The Way To Work Car by Rip off Mother from Omaha, Ne on 08/30/2001. Trim: 1996 Hyundai Elantra GLS, Owned 3 years.
Pros: its nice and compact. a good car for an elderly person.
Cons: since I purchase this car, I have had some many problems with the engine knocking, front in brake work, where something by the wheels keep poppin off. Transmission had problems, and was in the shop 2 months after I had purchased the car. 3 times its been in the shop for transmission problems and with the engine light coming on. I feel like I purchase a lemon.
Overall review: Overall, I can't wait until I pay this car off. This car maybe better now as time goes on. But this 1996 was not worth the buy.
Review ID: #201906 Is this review offensive?

subset: commoncrawl


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Deloitte Central Europe Top 500
Insights into the heart of Europe 2008
The Central Europe (CE) Top 500 is a ranking compiled by Deloitte Central Europe of the 500 largest companies in the region. The rankings are based upon publicly available information. Read more about the methodology used in compiling the report.
The CE Top 500 ranking provides an essential map of the challenges that face enterprises and managers in the region. The rankings are accompanied by commentaries on industry trends and a series of conversations with CEOs from leading Central European organizations, who rarely have the opportunity to air their views as a group. The interviews reveal a surprising consensus among executives regarding the main problems their companies face. One particular area of concern is the quality and innovative abilities of Central Europe's workforce, which is becoming more expensive as talent grows more scarce.
Central European Top 500 report highlights:
- Executive summary
- Overview of regional trends and analysis of the Central European market
- CE Top 500 rankings and commentary
- Industry reviews:
- Banking
- Insurance
- Construction
- Energy and resources
- Manufacturing
- Pharmaceuticals
- Technology, media and telecommunications
- In-depth interviews with senior executives
To download the full report visit: www.deloitte.com/cetop500
About Deloitte Central Europe
Deloitte Central Europe refers to a regional organization of entities organized under the umbrella of Deloitte Central Europe Holdings Limited, the member firm in Central Europe of Deloitte Touche Tohmatsu. Services are provided by the subsidiaries and affiliates of Deloitte Central Europe Holdings Limited, which are separate and independent legal entities.
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Wednesday, 14 November 2012 17:00
Arda Ocal (@arda_ocal) of The Score Television Network and the
Baltimore Sun spoke with WWE legend and film & tv star "Stone Cold"
Steve Austin (@steveaustinBSR). Highlights:
- How he's recovering from knee surgery and if he'll ever compete
again and the fact that he would be willing to entertain an offer rfom
WWE and where exactly that process is at right now.
- Discusses the release of the WWE '13 video game in which he is a
focal point, and does it bother him that CM Punk is on the cover.
- Talks about the return of his reality tv series Redneck Island on
CMT. "I consider myself the king of rednecks."
- Why an Austin/Hogan dream match never happened. "I don't think I
just ever wanted to wrestle the guy I guess."
- Finally Austin gives his opinion on the recent CM Punk/Paul Heyman
"Fake Heart Attack" incident and if he thinks it crossed the line. "I
believe in pushing the envelope in an aggressive fashion. But when a
guy dam near dies at ringside, let it go."
EMBED video on your site: src="http://www.youtube.com/embed/ksSmhedffcY" frameborder="0"
Send us a news tip: firstname.lastname@example.com
Note to webmasters/reporters: When recapping news from this site or from our newsletters, please include a link to www.wrestlingobserver.com
For the most in-depth and detailed news and analysis on pro-wrestling and MMA, always turn to Wrestlingobserver.com/Figure Four Weekly Online, the #1 website of its kind on the Internet. Members receive online access to both the Wrestling Observer and Figure Four Weekly newsletters and growing archives, Wrestling Observer Radio with Bryan Alvarez and Dave Meltzer three times per week, the popular Bryan and Vinny Show three times per week, additional radio shows including Figure Four Daily with Alvarez, Mike Coughlin's Five Star Radio, the Dr. Keith Lipinski Show, The Adam and Mike Big Audio Nightmare, Tough Talk and the Karl Stern Wrestling History Show, the infamous BOARD, and more! Members also have full access to the thousands of hours of audio in our radio show archives which date back to 2005. For your convenience, we offer secure online payments using your VISA, Mastercard, American Express, Discover card or PayPal account. Don't miss out on the fun, sign up now! Don't miss out on the fun, sign up now!
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Search results for 'cognac'
AE DOR - Hors d'Age Extra n°9
Vieille Réserve N°9, 40°.
Limited to a few bottles only.Learn MoreExcl. Tax: €1,025.00 Incl. Tax: €1,230.00
Bowen XO
It offers an extremely rich bouquet, characterized by the distinctive presence of subtle floral touches, violets from the Borderies, iris from the Petites Champagnes distilled on the lees.Learn MoreExcl. Tax: €91.67 Incl. Tax: €110.00
Gautier - Pinar del Rio XO
An exceptional Cognac, blended with eau de vie aged up to 25 years. For the connoisseur who will appreciate the marriage of aged Cognacs with quality cigars. A real achievement !Learn MoreExcl. Tax: €70.83 Incl. Tax: €85.00
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Extra old CognacLearn More
Tradition Rare is the perfect gift for the discerning consumer. With Tradition Rare, we wanted to share with you our oldest reserves set aside in Gautier Cellars Paradise. The result is a unique blend of extremely rare Cognac smooth and richly flavoured.Excl. Tax: €117.50 Incl. Tax: €141.00
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GOLD, the sun and light like Cognac XO …Learn More
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Gautier - XO Extra 1755
XO Extra 1755, the finest cognac from GautierLearn More
A blend of very old "eaux de vie", some that have been aged in the "Paradis" wine cellars, this XO Cognac Extra has exceptional complexity and aromatic richness. Its splendid gold marked decanter sublimates the "1755" warm amber and intense colour. A prestigious gift for the true Cognac connoisseurs.Excl. Tax: €71.67 Incl. Tax: €86.00
Hine - Cigar Reserve
Bernard HINE & Nicholas Freeman, the late chairman of UK Havana cigar importers, Hunters & Frankau, combined their lifetime experience to produce this unique cognac, especially created for the cigar connoisseur.Learn MoreExcl. Tax: €74.17 Incl. Tax: €89.00
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ANTIQUE XO is the house's flagship, first blended by Thomas George HINE in 1920.Excl. Tax: €115.83 Incl. Tax: €139.00
Out of stock
ABK6 - VS Pure Single
Gold in colour with amber highlights.
The initial nose has aromas of apricots and fresh grapes which then evolve towards light spice and fruit filled pastry.
The palate is crisp and elegant with good presence and exceptional length.
Many awards at spirits competitions.Learn MoreExcl. Tax: €24.17 Incl. Tax: €29.00
ABK6 - VSOP Grand Cru
Old gold in colour.
The nose is complex with stewed fruit and woody notes which are followed by brioche,
vanilla, apple and cinnamon.
The palate has an excellent full structure with a long finish of vanilla and woody flavours.
Many awards at spirits competitions.Learn MoreExcl. Tax: €32.50 Incl. Tax: €39.00


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Ainor Signs exists to service your company's signage needs, and to do so in an affordable manner, independent of the cash flow characteristics, working capital constraints, tax or financing strategies of your organization. Whether it is an operating lease or a finance lease, our credit specialists can explain your options whereby:
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Signpost (Weber, Utah), 1996-10-071
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BOOl Frightmares will make you jump out of your skin. See a&e page 6 L, I J Monday, October 7, 1996 Volume 59 Number 15 , j 4 s -. i Lwt art. te fe M A r " y - - 4 v- us: , J VJ 1 " ' Come one, come all... test your skill at the carnival! TOP: At the Homecoming Carnival this past Saturday, Brittnee Williams, 6, whose father is a student at WSU, tests her skill in knocking down the pyramid cf milk bottles. RIGHT: You have to have a steady hand and a sharp aim to shoot a dart into a styrofoam ball on top of a bottle as Jessica Milne, 9, daughter of a WSU alumnus, found out. Aev degree fills hole By Cathy McKitrick staff writer -Signpost Weber State University's new associate's degree in construction management technology offers construction workers the opportunity to expand their capabilities and move into jobs within the construction industry that require more technical expertise. Dr. Warren Hill, dean of the College of Applied Science and Technology, said some 130 construction, engineering and architectural firms were surveyed to best determine how to design the degree to fit their needs. "More than 80 percent of the companies responded that there was a missing link in the construction industry between laborers and full-blown engineers or project su 4 pervisors," Hill said. Graduates from the CMT program will be outfitted to fill that intermediate need. Roy Bosley, vice president for special projects for Big-D Construction heads up the program's advisory committee, which consists of representatives from Big-D Construction, Jones Richards Associates, Construction, Sprinkel &v Associates and Stacey Enterprises Inc. "The construction industry is very schedule-driven, and computer technology has changed the nature of the industry," Bosley said. "Software programs are used for scheduling, estimating and drafting. We need individuals trained in these areas, who also have supervisory skills." "We'd like to see this program produce individuals who have an ! in industry understanding of methodsand materials combined with hands-on experience who can step into management positions," Bosley said. Keith Allred, who teaches design graphics courses at WSU, also acts as adviser for the new program, which was approved by the Board of Regents in August. "We will be adding 17 new courses as part of this curriculum, and will hire on a full-time faculty member by January," Allred said. "The only school in the state with a similar program is BYU, with their four-year degree." The introductory course, CMT 110, meets the last five weeks of fall quarter. Paul Becraft is one of the students registered for this class. "I've worked construction for the See Degree page 5 Task force to study enrollment decline problem Groups work together with recruiting and telecounseling to solve problem By Leona ). Christensen campus affairs editor -Signpost Provost David Eisler found there were many groups working to strengthen declining enrollment at Weber State University in the past, but a need for communication among the groups still existed. Until now. The solution: create a task force designed to unite and strengthen groups working toward increasing enrollment. Eisler said the university is working on enrollment at micro and macro levels. "Atthe macro level, lhave talked with a lot of constituencies oncampus.- We set up an enrollment management task force," Eisler said. "The idea was to bring together all the different pieces of the groups who were working on enrollment." Although many groups were working on enrollment, Eisler was uncertain if the groups knew what the others were doing. The task force is a means to communicate more effectively and work together. On the micro level, WSU is working on the admissions process by working to monitor enrollment from a student's first inquiry to his or her registration. "We are beginning to look at the type of inquiry we get at Weber State. We are looking at the students we have the most chance of influencing to come to Weber State," Eisler said. "We are going to spend more of our time with those particular students." Additional emphasis is being placed on recruiting students from Weber and Davis counties. Eisler feels it's important that WSU meets the needs of people in Weber and Davis counties. While the university does not want to restrict itself to students from the area, more than 80 percent of WSU students are residents of these counties. WSU is adding telecounseling to its recruitment strategy. "We aren't trying to re-invent the wheel," Eisler said. "What we are trying to do is look at programs with proven track records in terms of helping students make the right decision. "It's not a sales process. What we're doing is providing communication. We are telling potential students about Weber State so they can make an informed decision about what's best for them," said Eisler. The university will be employing outstanding students who have the ability to communicate as tele-counselors. They will contact prospective students by telephone and establish a one-to-one relationship. The task force hopes prospective students will have someone who can answer their questions and will feel that WSU wants them to come. WSU is also working to entice more students to transfer to WSU. According to Eisler, the data indicates that most transfer students come from Salt Lake Community College. Students from Utah State University and the University of Utah are also coming to WSU in high numbers. WSU also re-evaluated the admissions index. The admissions index sets the academic standard for admitting students. It combines grade point average with the ACT test score. Only students who meet or exceed a certain index score are admitted to the university.This process eliminated a group of students with less academic background. "WSU is dealing with a fixed market of students. If it reduces the market by excluding a group of students who were attending school, enrollment will decrease," Eisler said. To compensate for this loss of students, WSU admits students who fall below the required index level and allows them to complete a certificate or two-year degree program. Upon successful completion, students may enroll in upper-division courses. inside post opinion: see page 4 a&e: see page 6 sports: see page 8 classifieds: see page 1 1 crossword: see page 12
Object Description
|Signpost (Weber, Utah), 1996-10-07, Vol. 59, No. 15
|Weber State University
|Associated Students of Weber State University; A generous grant from the Utah State Library and the Institute of Museum and Library Services.
|Weber's current student newspaper, the Signpost, first appeared on September 29, 1937. For two years prior to that time, campus news was disseminated via announcements posted on a bulletin board known as the "Signpost". As a result, the masthead of the first issue of the paper itself featured a rudimentary wooden sign with the title spelled out in rustic-looking letters. Over the years the paper has been published continuously, though the look, size and style has changed several times.
|Date Original
|College student newspapers and periodicals; Weber State University
|Digital Format
|Publisher Digital
|Stewart Library, Weber State University
|Date Digital
|University Archives LD5893.W55 S5, Stewart Library, Weber State University
|Digital Identifier
|Rights Management
|Public Domain. Courtesy of University Archives, Stewart Library, Weber State University.
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WAUKESHA, Wis. (WSAU-Wheeler News) -- A Waukesha teenager who has been missing since Wednesday has returned to her family.
Authorities say 13-year-old Robin Cristina Cardosa apparently ran away. She was safely returned from an unnamed central Wisconsin community.
On Friday, the teen was contacted via social media, leading police to ask for the public's help to locate her. Police are still investigating her motives for leaving.


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Two Grand Prarie police officers were wounded and a suspect was killed ending an hours-long manhunt on Christmas Day.
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Medivac helicopter was requested for two troopers following an accident Wednesday night
An unarmed man who intervened in a confrontation between police and a knife-wielding assailant died of a gunshot to the back
A state trooper was accidentally shot during a gun training exercise at a safety facility on Tuesday and later died
The bombs were not deployed, but they were fully functional and had both trip wires and fuses
Man repeatedly ignored commands to show his hands and made a motion the officer believed looked like pulling a gun


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A Safety Net in Peril
October 15, 2013
A first-of-its-kind study shows programs to help people with mental illness in the Quad Cities are in danger unless something is done soon. "A Safety Net in Peril" is the name of the study by the Vera French and Robert Young Community Mental Health Centers, Genesis and Trinity health systems, and the National Alliance on Mental Illness.
Jeff Lockwood, board president for the Vera French Community Health Center in Davenport, says 10 per cent of children and 25 per cent of adults suffer from some sort of mental illness, but only half the kids and one-third of the adults will seek treatment.
"Mental health is treatable. It's been proven that people who receive treatment have a significant reduction in their stresses and mental illnesses, and improve their quality of life."
And the life expectancy for people with mental illness is 25 years less than for the average person.
Collen Rafferty, board president for the Robert Young Center in Rock Island, says with state and federal funding cuts, it's vital that we do something to support and fund the various local agencies and programs.
"Unfortunately no one in this room is going to escape mental illness, either personally or through a family member, a co-worker, or a friend. So for the sickest and poorest too, the situation really is critical."
Despite having similar goals, she says this is the first time these agencies have worked together. Lockwood and Rafferty say it's vital for local residents to read the report, support agencies with time and money that help people with mental illness, and urge members of state legislatures and Congress to make these programs a top priority.


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New Traffic Cameras in the District of Columbia
In the District of Columbia a new type of traffic cameras have been implemented. Starting February 1, 2014, the deployment of several new types of automated traffic enforcement will go into effect. One of the new types include cameras, as part of D.C. Street Safe Initiative. The purpose of these new cameras is to combat aggressive and dangerous driving habits in the District of Columbia. The new cameras are also suppose to track drivers who speed and violate other traffic infractions, such as, rolling through stop signs, crosswalks and intersections and also drivers who "block the box" at intersections.
"Block the box" refers to when a vehicle attempts to cross an intersection on a green light but cannot make it all the way through and then the light turns red, therefore; they are now blocking the intersection and blocking drivers from moving through the intersection in the perpendicular direction, in other words, they are blocking cross traffic.
These cameras were placed, in areas in the District of Columbia, based on the number of crashes and injuries, calls for service, high speed volume, near schools and churches, or in zones where commercial vehicles are prohibited from traveling. Also, they are located at intersections with known speeding problems and in congested areas. The Department of Transportation, Advisory Neighborhood Commissions and community organizations also had a say in where these cameras should be placed.
Therefore; starting February 1, 2014, these cameras will begin taking pictures of offenders and issuing fines. The cameras were installed and suppose to go into effect as of late November 2013, but they needed to make sure that the locations had been issuing warnings for 30 days first, as to make drivers aware of the new cameras.


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Search the contact & biographical information for all KPMG in Ireland partners by function / service area & location.
KPMG supports various charities through monetary donations & organised fundraising events.
The key ingredients of the success of the aviation industry in Ireland are the expertise and innovation of the people and companies involved.
The performance of the agri-business sector is critical to Ireland's economic well-being. KPMG have partnered with the Irish Farmers Journal to produce the second annual agri-business report.
Finance (No. 2) Bill 2013 was published on 24 October 2013. This site will be regularly updated to reflect changes to the Bill as it passes through the various stages of the legislative process, before enactment as Finance (No. 2) Act 2013.
Choose Ireland is KPMG's guide for those considering locating in Ireland. It focuses on Ireland's key selling points, outlining many of the advantages to be considered when locating here.
The KPMG Seminar Series has been developed to help keep you fully updated on a range of highly topical subjects.
The KPMG Alumni programme helps former KPMG people stay in touch with the firm, reconnect with past colleagues and develop valuable business connections.
Whether you're already claiming the R&D tax credit or just considering your eligibility, it's essential to remember that R&D doesn't just happen in the laboratory – quite often it's the work a company would consider to be a day-to-day activity: developing a new product; devising or making improvements to a production process; trying out a new material to reduce costs.
The list is extensive, and with a potential saving of up to 25% of qualifying expenditure, it's worth checking if your activities meet the criteria. See our information flyer for companies in the biotechnology, pharmaceuticals and medical devices sectors, including examples of qualifying activities, a case study and examples of claims we've worked on.
Ken Hardy
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KPMG's R&D incentives practice is Ireland's largest, longest-established and most experienced specialist R&D tax credits practice. With over eight years' experience helping Irish companies claim R&D tax credits, our dedicated multidisciplinary team has the expertise required to help ensure our clients claim their proper entitlement and submit compliant claims to Revenue.
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KPMG, an Irish partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ("KPMG International"), a Swiss entity. All rights reserved.
KPMG International Cooperative ("KPMG International") is a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm.


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YUMA, Ariz. (AP) - A flight simulator for F-35 fighters is the latest facility for the new jets to be completed at Yuma's Marine Corps Air Station in Yuma.
Work on the two-story, 43,150-square-foot flight simulator was part of $150 million worth of construction projects taking place at base.
Sundt Construction is the general contractor on the F-35 projects. Other projects included the construction of 3 new hangars and upgrades to communication and utilities infrastructures.
The Yuma Sun reports (http://bit.ly/SWT67P) Phoenix-based Sundt will build a carrier landing practice training facility at the Barry M. Goldwater Range next.
Yuma will starting getting F-35s later this year and will eventually have five squadrons each with 16 aircraft and one operational test and evaluation squadron of 8 aircraft. They'll replace Yuma's 56 AV-8B Harriers.
Information from: The Sun, http://www.yumasun.com
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LogDator - SediMeter Data Loggerby Lindorm, Inc.
For environmental monitoring as network master, slave, or stand alone. The LogDator allows the collection of data from one or many SediMeters, but it can also be used separately with its own sensors. It can return data immediately on a serial communication line, save data to internal memory, or save data to file on a memory card. It can be offered ...
Delta-T - GP1 - General Purpose Data Loggerby Delta-T Devices Ltd
The GP1 Data Logger is a complete logging solution housed in an IP67 enclosure with battery power. The internal memory can hold >600,000 readings - more than enough for one year's operation (typical). The optional GP-PBA-X50 Precision Bridge Adapter enables a GP1 to log up to 2 bridge sensors such as pressure transducers and strain gauges and ...
Delta-T - GP1 - General Purpose Data Loggerby Delta-T Devices Ltd
GP1 Data Logger, 2 differential analogue voltages, 2 temperatures, 2 pulse counters, Smart relay control.
Delta-T - GP2 - Advanced Data Logger and Controllerby Delta-T Devices Ltd
The GP2 is a powerful new 12 channel data logger that is easy to use, versatile, rugged and reliable. It can log most sensor types and accepts voltage, resistance, current, potentiometer, bridge, counter, frequency, and digital state inputs. DeltaLINK software helps the user set up logging sequences and provides control over reading ...
WQL - Data Loggerby WTW GmbH - a xylem brand
The WQL product line consists of data loggers for water quality monitoring, and are ideal for measurements and data logging over long periods of time. The WQL Series meets all the requirements for continuous pH/ORP and conductivity measurement in ground and surface water, as well as in drinking and wastewater.
Delta-T - DL2e - Data Loggerby Delta-T Devices Ltd
DL2e Data Logger, Battery powered, weatherproof, rugged and portable, Expandable by the user to meet changing needs, Easy programming with Ls2Win Software.
Delta-T - DL6 - Soil Moisture Data Loggerby Delta-T Devices Ltd
Data Logger - DL6, Ideal for Profile Probes, ThetaProbes and SM300 Sensors, Complete solution with IP67 weather-proof case and battery power, Pocket PC interface for data collection and configuration
SDU5000 - Data Loggerby IMR Environmental Equipment, Inc.
Multiple Inputs. Able to log and output data. Up to 18 channels.
Stevens - GOES High Data Rate (HDR) Transmitterby Stevens Water Monitoring Systems, Inc.
The Stevens GOES HDR (high data rate) Transmitter provides access to the NOAA/NESDIS GOES Data Collection System (DCS) and the
Stevens Greenspan - TS 300 - Turbidity Sensorby Stevens Water Monitoring Systems, Inc.
The Turbidity Sensor utilizes a high gain infrared optical system to detect the backscatter intensity of suspended particles in a water medium and a reduction in water clarity. The design includes an advanced optical surface treatment to resist fouling. Digital temperature compensation technology ensures stable performance over a wide temperature ...


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Source: CityPASS Seattle
Get a taste of all Seattle has to offer and save more than 45% on admission to the city's top attractions.
Redeem voucher for a CityPASS booklet by Feb. 28, 2015; passes are valid for nine consecutive days
Source: Duos Lounge
Duos Lounge boasts a "warm atmosphere and great local live music" (The Stranger). Two can stop by for brunch or dinner with drinks.
Sept. 12, 2014 - Dec. 30, 2014; dinner served Tuesday-Saturday, brunch served Sundays
Source: Alki Tours
Leavenworth's Oktoberfest "will make you feel like you stepped right into Bavaria" (Forbes Travel Guide). Save more than $55 on an all-inclusive trip.
Oct. 4, Oct. 11 or Oct. 18, 2014 only
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Unwind with a massage and sauna session at Madison Park's newly opened City Sweats.
Sept. 25, 2014 - Dec. 30, 2014; closed Mondays
Source: Branzino
Named among Seattle Met's best seafood restaurants, Branzino is a "sexy, amber-drenched beauty in Belltown" (Seattle Met).
Aug. 29, 2014 - Feb. 27, 2015
Source: Parlor Live Comedy Club
Seattle Weekly named Parlor Live Comedy Club the city's Best Comedy Club (2014). Two can catch a show for more than 60% off.
Select show dates through Jan. 25, 2015
Source: Penelope and the Beauty Bar
Embrace the warmer weather and pamper your digits with a mani/pedi at the AAA 4-Diamond Fairmont Olympic Hotel.
Aug. 18, 2014 - Feb. 12, 2015
Source: Sushi Kappo Tamura
Named one of the best sushi restaurants in the U.S. by Travel + Leisure and Bon Appetit, Sushi Kappo Tamura serves "stellar fish" (Seattle Magazine).
Sept. 2, 2014 - Dec. 15, 2014; blackout dates apply
Source: Al Boccalino
Learn the art of Italian cooking at a lesson led by Al Boccalino's chef Luigi DeNunzio, "the maestro behind Pioneer Square's 'Little Italy''' (Seattle Times).
Aug. 22, 2014 - Feb. 7, 2015; Monday-Saturday at 7 p.m.
Source: Float Seattle
Float Seattle earns a 96% rating from Travelzoo users, who say the sensory deprivation floats provide a "relaxing, calming experience."
Aug. 1, 2014 - Nov. 23, 2014 (closed Mondays)
Source: Le Zinc
"Le Zinc serves up a bubbly bistro feel on Capitol Hill" (Seattle Magazine). Sit down to a three-course dinner for two.
July 28, 2014 - Oct. 20, 2014; Sunday-Thursday from 4-6:30 p.m. and 8 p.m. until closing
Source: Argosy Cruises
"If you opt for only one tour while in Seattle, the Argosy Cruises' Tillicum Village Tour ... should be it -- it's unique and truly Northwestern," raves Frommer's.
Select dates through Oct. 26, 2014
Source: All Star Massage & Spa
Save more than 45% on a facial and pedicure at All Star Massage & Spa on Lake Bellevue, which SpaFinder users award more than 4 stars.
June 23, 2014 - Oct. 23, 2014
Source: Paddy Coyne's - Pier 70
Paddy Coyne's offers "impressively authentic Irish fare" (Seattle Met). Stop by its downtown Pier 70 location for dinner and drinks for two.
Sept. 12, 2014 - Dec. 30, 2014
Source: Outer Island Expeditions
Experience the wildlife of the Pacific Northwest firsthand through Outer Island Expeditions' scenic Orcas Island whale-watching tours.
Aug. 16, 2014 - Oct. 30, 2014
Source: Salt Mine Arium
Salt Mine Arium is a European-style spa "sanctuary" where imported Himalayan salt bricks and halotherapy create "an air of tranquility" (Seattle Magazine).
Sept. 10, 2014 - Feb. 6, 2015; closed Sundays
Source: Regatta Bar & Grille at Crowne Plaza Seattle Downtown
For more than 40% off, two can sit down to a three-course dinner at Regatta Bar & Grille in downtown Seattle.
Oct. 1, 2014 - Feb. 28, 2015
Source: Local Craft Tours
Get a taste of Seattle's spirits scene with a chauffeured distillery tour, which "digs deep into the history of the area's Prohibition-era moonshine makers" (Zagat).
Valid select dates through Nov. 23, 2014; dates vary by voucher
Source: Paca Pride Guest Ranch
Farm stays "give city folk a chance to escape urban life" (Seattle Times). Retreat to Paca Pride Guest Ranch in Granite Falls for a two-night yurt experience.
Arrive Monday-Wednesday, Aug. 11 - Sept. 30; daily arrivals Oct. 1 - April 29
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The term eating disorders refers to a variety of disorders. The common feature of all the eating disorders is abnormal eating behaviors. Eating disorders are serious mental health problems and can be life threatening.
Several types of eating disorders require the clinical care of a psychiatrist or other mental health professional. Listed in the directory below are some, for which we have provided a brief overview.
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
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The Tailored Sportsman "Quilted" Clarino™ Belt is designed to complement Tailored Sportsman breeches. This belt features an all-over quilt pattern on long-lasting Clarino and a simple silver buckle. Fits perfectly in the Trophy Hunter belt loops.
The Tailored Sportsman Quilted C Belt is a popular choice to help dress up your breeches. Very classic looking, timeless, quilted Italian leather with an understated stainless steel buckle. These fit any breeches with 2" belt loops.
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Enjoy some good one-liners and bits from your favorite late-night comedians.
David Letterman: "On Monday night the debate was all about the undecideds, but here's what happened. The undecideds decided not to watch."
Jay Leno: "I have to admit, I was one of those undecideds. I couldn't decide whether to watch the baseball game or the football game."
Jay Leno: "One of President Obama's winning points in the debate was about how sanctions against Iran are crippling their economy. And believe me, if anyone knows how to cripple an economy, it's President Obama."
Jay Leno: "Experts say the entire 2012 election could come down to just eight states. Those states are: confusion, dismay, depression, apathy, shock, disbelief, despair, and anxiety."
Receive the latest news, information and commentary customized for you. Sign up to receive Top Producer's eNewsletter today!


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Fire Swamp Princess Bride ShirtProduct Sku: PRBD053
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- This t-shirt shows the Three Terrors of the Fire Swamp: Lightning Sand, Flame Spurts and Rodents Of Unusual Size. These were three obstacles that were met by Buttercup and Westley in the 1987 film, The Princess Bride.
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The Ides of March were unkind to the Bandys girls basketball team.
For three quarters, the Lady Trojans seemed on a path destined for a seventh state championship.
Then came the fourth quarter.
T.W. Andrews outscored Bandys, 20-7, in the final stanza en rout to a 57-51 state-title winning victory against the Lady Trojans in Raleigh.
Below is a look at Monday's spring sports postponements involving Catawba County teams:
St. Stephens at Maiden, ppd.
Girls soccer
St. Stephens at Burns, ppd. April 10
Boys tennis
Maiden at East Burke, cancelled (no make up)
Bunker Hill at St. Stephens, ppd. March 24
Watauga at Newton-Conover, cancelled
After 31 games and four championships, the Bandys girls basketball team is on the cusp of history.
The Lady Trojans have a chance to win the program's seventh state title on the court Saturday.
To read more of this story, pick up the weekend edition (Saturday through Monday) of Catawba County's community newspaper, The Observer News Enterprise, at newsstands throughout the county.
Below is a look at Friday's prep sports scores across Catawba County:
Bunker Hill 13, West Lincoln 3
Maiden 13, Newton-Conover
St. Stephens 4, Hibriten 3
West Caldwell 12, Bandys 6
Watauga at Fred T. Foard, no report
Bandys 9, West Caldwell 1
Bunker Hill 6, West Lincoln 2
Fred T. Foard 4, Watauga 1
Maiden 11, Newton-Conover 1
Below is a look at Thursday's prep sports scores across Catawba County:
Bunker Hill 11, Fred T. Foard 2
Fred T. Foard 6, Maiden 1
Bunker Hill at Wilkes Central, ppd.
Girls soccer
St. Stephens 5, Wilkes Central 0
Boys tennis
Newton-Conover 7, Bandys 2
St. Stephens at Bunker Hill, ppd.
Boys golf
Below is a look at Wednesday's scores and postponements involving Catawba County teams:
Fred T. Foard at Bunker Hill, ppd. to Thursday
Girls soccer
Fred T. Foard 6, Maiden 0
Bandys at North Lincoln, ppd.
St. Stephens at Wilkes Central, ppd. to Thursday
Boys tennis
Fred T. Foard at East Burke, no report
Below is a look at Tuesday's spring sports scores involving Catawba County teams:
East Lincoln 9, Bandys 8
Fred T. Foard 7, Freedom 0
Maiden 5, Bunker Hill 3
Watauga 7, St. Stephens 3
West Caldwell 9, Newton-Conover 0
Bandys 12, East Lincoln 8
Bunker Hill 7, Maiden 2
Freedom 3, Fred T. Foard 2
St. Stephens 10, Watauga 0
Below is a look at Monday's prep sports scores across Catawba County:
Girls soccer
Maiden 2, North Lincoln 1
Boys tennis
East Burke at Maiden, no report
Northwestern 3A/4A golf
1. Hibriten, 158
2. St. Stephens, 163
3. Watauga, 166
4. Hickory, 173
5. South Caldwell, 180
6. Fred T. Foard, 183
7. Patton, 191
8. Freedom, 195
The Bandys girls basketball team tries to advance to the 2A state championship game and claim the 2A West Regional title on Saturday.
The undefeated Lady Trojans (30-0) take on Franklin (24-3) in Saturday's West title game at 1 p.m. at Fleming Gymnasium on the campus of UNC-Greensboro.
Below is a look at Thursday's prep sports scores and postponements involving Catawba County teams:
Patton 13, Newton-Conover 1
St. Stephens 3, West Iredell 0
Bunker Hill at Hibriten, ppd. April 9
Girls soccer
West Iredell 2, Maiden 0
Boys tennis
Hickory at Newton-Conover, suspended


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Draft Recommendation Statement
Note: This draft Recommendation Statement is not the final recommendation of the U.S. Preventive Services Task Force. This draft is distributed solely for the purpose of pre-release review. It has not been disseminated otherwise by the USPSTF. It does not represent and should not be interpreted to represent a USPSTF determination or policy.
This draft Recommendation Statement is based on an evidence review that was published on April 23, 2013 (available at http://www.uspreventiveservicestaskforce.org/uspstf13/suicide/suicideart.htm).
The USPSTF makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or symptoms.
It bases its recommendations on the evidence of both the benefits and harms of the service, and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decisionmaking to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.
This draft Recommendation Statement was available for comment from April 23 until May 21, 2013, at 5:00 PM ET. A fact sheet that explains the draft recommendation in plain language is available here.
Screening for Suicide Risk in Adolescents, Adults, and Older Adults: U.S. Preventive Services Task Force Recommendation Statement
Summary of Recommendation and Evidence
The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults in a primary care setting.
This is an I statement.
Go to the Clinical Considerations section for additional information about suggestions for practice regarding the I statement.
Table 1 describes the USPSTF grades, and Table 2 describes the USPSTF classification of levels of certainty about net benefit.
Suicide was the 10th leading overall cause of death in the United States in 2009. Rates of suicide attempts and deaths vary by sex, age, and race/ethnicity. Psychiatric disorders and previous suicide attempts increase suicide risk (1, 2).
There is insufficient evidence to conclude that screening adolescents, adults, and older adults in primary care adequately identifies patients at risk for suicide who would not otherwise be identified based on an existing mental health disorder, emotional distress, or previous suicide attempt.
Benefits of Detection and Early Intervention/Treatment
There is insufficient evidence on the benefits of screening adolescents, adults, and older adults for suicide risk in the primary care setting.
Evidence is inadequate on whether interventions reduce suicide risk in patients identified through primary care screening or comparable methods; most evidence for treatment effectiveness is in very high-risk populations who were not discovered through screening, such as those who present to an emergency department because of a suicide attempt.
Harms of Detection and Early Intervention/Treatment
There is insufficient evidence regarding the possible harms of screening adolescents, adults, and older adults for suicide risk.
The USPSTF concludes that the evidence is lacking on screening for suicide risk, and the balance of benefits and harms cannot be determined.
Clinical Considerations
Patient Population Under Consideration
This recommendation applies to adolescents, adults, and older adults in the general U.S. population without an identified psychiatric disorder.
Suggestions for Practice Regarding the I Statement
Preventable burden. In 2007, suicide accounted for over 1.3 million years of potential life lost (YPLL) before age 85 years, which is nearly 4% of the total YPLL in the United States (3). Suicide is one of the top five leading causes of death for teens and adults ages 10 to 54 years (1). Past studies estimate that 38% of adults (50% to 70% of older adults) visited their primary care provider within 1 month of committing suicide (4). Nearly 90% of suicidal youth were seen in primary care during the previous 12 months (5). Given that most people who die from suicide have a psychiatric disorder and many have been seen recently in primary care, clinicians should consider asking these patients about suicidal ideation and referring them for psychotherapy and/or case management.
Potential harms. There is insufficient evidence on the potential harms of screening for suicide risk.
Costs. The monetary cost of screening for suicide risk is minimal. Additional time would be needed in the primary care visit to accommodate screening.
Current practice. In a study of U.S. primary care providers, suicide was discussed in 11% of encounters with patients who had (unbeknownst to their providers) screened positive for suicidal ideation (6). Similarly, 36% of U.S. primary care physicians explored suicide in encounters with standardized patients portraying major depression or adjustment disorder, or those who sought out antidepressants (7). Less than one quarter of surveyed primary care pediatricians or family practice physicians in Maryland reported that they frequently or always screened adolescents for suicide risk factors.
Assessment of Risk
Suicide risk varies by age, sex, and race/ethnicity. The following groups have rates of suicide deaths that are generally above the average rate: American Indian/Alaskan Natives ages 14 to 65 years and nonHispanic whites older than age 18 years, whose risk continues to rise past the age of 75 years. The highest rates are seen in American Indian/Alaskan Natives ages 19 to 24 years and nonHispanic whites older than age 75 years. Among adolescents, Hispanic girls are at especially high risk for attempting suicide (8).
Elevated risk is also associated with the presence of a mental health disorder, such as depression, schizophrenia, posttraumatic stress disorder (PTSD), and substance use disorders. About 87% of patients who die as a result of suicide meet the criteria for one or more mental health disorders before their death. A lifetime history of depression more than doubles the odds of a suicide attempt among U.S. adults, and depression is likely present in 50% to 79% of youth attempting suicide, though it may not always be recognized. Other important risk factors for suicide attempts include serious adverse childhood events; lesbian, gay, bisexual, and transgender status; access to lethal means; and possibly a history of being bullied, sleep disturbances, and chronic medical conditions such as epilepsy and chronic pain. In males, socioeconomic factors such as low income, occupation, and unemployment are also related to suicide risk (8).
Among older adults, additional risk factors such as social isolation, spousal bereavement, neurosis, affective disorders, physical illness, and functional impairment all increase the risk for suicide. Risk factors of special importance to military veterans include traumatic brain injury, separation from service within the past 12 months, PTSD, and other mental health conditions (8).
Although there is inadequate evidence to determine if screening for suicide in the general asymptomatic population should or should not be done, providers should consider identifying patients with risk factors or who appear to be experiencing high levels of emotional distress and referring them for further evaluation (8).
Screening Tests
The screening tools used in the studies reviewed varied. One example is the Suicide Risk Screen, which uses a 20-item screener embedded in a broader self-report questionnaire administered in high schools to youth at risk of dropping out. Another tool consists of three suicide-related items targeting primary care patients with prescheduled appointments. The sensitivity and specificity of tools generally ranged from 52% to 100% and 60% to 80%, respectively. The instruments showed a wide range in accuracy, but data were very limited, and no instruments were examined in more than one study (8).
Most effective treatments to reduce suicide risk include psychotherapy. The most commonly studied psychotherapy intervention was cognitive behavioral therapy (CBT) and related approaches, including dialectical behavior therapy (DBT), problem-solving therapy, and developmental group therapy. Other nonCBT approaches included psychodynamic or interpersonal therapy. Whereas most of these specific treatments are not customarily administered by the primary care provider in the office, patients can be referred for these therapies. The primary care provider can play a continued role in the care of these patients by monitoring them during the process, providing followup, and coordinating with other care providers (8).
Other Approaches to Prevention
In addition to approaching the problem of suicide from an individual level in primary care, other approaches are being implemented at community, regional, and national levels. In the health care system, laws requiring coverage parity between mental health and physical health disorders will give more people the ability to access care for psychiatric problems associated with suicide, such as depression. Efforts to coordinate care between programs that address mental health, substance use, and physical health can also increase access to care. Global activities that have been shown to be correlated with lower suicide rates in other countries include detoxification of domestic gas in the United Kingdom and discontinuation of highly toxic pesticides in Sri Lanka. These actions were associated with 30% and 50% reductions in suicide, respectively, providing evidence that engineering controls can be effective. Activities such as installing barriers at frequent suicide jump spots may also be effective (9, 10).
On an individual level, patients with a history of suicide attempt or suicidal ideation should not have easy access to means that may be used in suicide attempts, such as firearms and other weapons, household chemicals or poisons, or materials that can be used for hanging or suffocation (9).
Useful Resources
The USPSTF recommends that physicians screen adolescents and adults for depression when appropriate systems are in place to ensure adequate diagnosis, treatment, and followup (available at http://www.uspreventiveservicestaskforce.org). Additionally, in 2012, the Surgeon General and the National Action Alliance for Suicide Prevention released the National Strategy for Suicide Prevention, which includes goals and objectives for action (available at http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/full-report.pdf).
The Community Preventive Services Task Force also has related recommendations regarding collaborative care approaches to managing depression, mental health parity policy, and home-based depression care for older adults (available at http://www.thecommunityguide.org/mentalhealth/index.html).
Other Considerations
Research Needs and Gaps
A number of key areas need further research to improve the evidence base for screening. For screening to be effective, more information is needed on the performance characteristics of screening tests, particularly among average-risk adolescents. Studies examining the benefits and potential harms of targeted versus general screening would also be helpful. The possibility of incorporating technology into large-scale screening studies should also be explored.
Treatment studies in screen-detected populations are needed in all age groups. Targeting those at high risk, such as Native Americans and Hispanics, may be important to determine if there are tailored therapies that are more effective in these populations. It is critical that more investigations be conducted on the benefits and risks of interventions targeting both general and high-risk adolescents. Trials including interventions aimed at parents have shown some promise and should be further explored.
It would also be valuable to replicate trials in adults that focus primarily on the process of care (including quality of care and patient adherence), rather than the specific content of the treatment sessions, as the latter have shown moderate-sized but statistically nonsignificant effects.
Investigating ways to link clinical and community resources might also lead to other possible methods to help patients at risk for suicide.
Burden of Disease
In 2009, suicide was the 10th leading cause of death in the United States, leading to almost 37,000 deaths, for a rate of 11.8 deaths per 100,000 individuals (1). Although suicide rates in the United States held steady from 1990 through the early 2000s, the rates have generally been increasing over the last decade, particularly between 2005 and 2009 (11).
Scope of Review
In 2004, the USPSTF concluded that the evidence was insufficient to recommend for or against routine screening by primary care clinicians to detect suicide risk in the general population, and issued an I statement, given that there was no evidence at that time that screening for suicide risk reduced suicide attempts or mortality. The USPSTF noted that there was limited evidence on the accuracy of screening tools to identify suicide risk in the primary care setting, including tools to identify individuals at high risk. The USPSTF also found insufficient evidence that treatment of individuals at high risk reduces suicide attempts or mortality. The USPSTF found no studies that directly addressed the harms of screening and treatment for suicide risk. As a result, the USPSTF could not determine the balance of benefits and harms of screening for suicide risk in the primary care setting.
In updating the 2004 recommendation, the USPSTF reviewed a systematic review of current evidence on screening adolescents, adults, and older adults for suicide risk in a primary care setting.
Accuracy of Screening Tests
The USPSTF reviewed four studies that evaluated the accuracy of screening instruments to identify individuals at increased risk for suicide. Of these, two were conducted in adolescent populations that were considered at increased risk for suicide. One was conducted in an outpatient mental health setting in patients who had a prior diagnosis of depression (12). The second was conducted in a school setting and consisted of a questionnaire administered by research staff to students at risk for school dropout (13). A single additional study involved primary care patients age 65 years or older (14), and the final study involved primary care patients ages 18 to 70 years (15).
Each study used a different tool to screen patients for increased risk of suicide. All four studies were considered to be fair quality. A strength of these studies was that they each applied the same reference standard to all screened participants and recruited the sample from a single identified population. As mentioned previously, however, neither of the adolescent studies was conducted in a primary care setting and both recruited participants who were already at increased risk of suicide. Only one of the four studies reported that the reference test was independent of the screening test (14). An additional concern was the lag time between the screening and the reference tests, with only one study conducting both the screening and reference tests within 24 hours of each other. Lag times for other studies were either not reported or ranged from 2 to 35 days.
Effectiveness of Early Detection
The USPSTF found no direct evidence that screening for suicide risk is associated with improved health outcomes in asymptomatic adolescents or adults. Although studies evaluating screening were more likely to be conducted in a primary care population, studies assessing the effectiveness of treatment were predominantly conducted in patients known to be at high risk. In particular, many treatment studies were of patients with previous suicide attempts or who had a history of mental illness, such as borderline personality disorder or depression. The proportion of patients in control groups with a history of suicide attempts in treatment studies ranged from 11% to 68%, evidence that the study populations were at high risk for suicide (8).
Three broad treatment approaches to suicide prevention have been evaluated: psychotherapy, enhanced usual care (approaches designed to improve the quality or format of recommended treatment, or improve patient adherence to usual care), and medications. Of those, psychotherapy providing specific treatment approaches showed better outcomes than enhanced usual care, and very few studies addressed medications. Suicide attempts were reduced by a pooled average of 32% in 11 psychotherapy trials in adults. Interventions that focused on enhancing usual care showed little impact on suicide deaths, suicide attempts, or related outcomes. A single large trial of older primary care patients reported a 20% reduction in the relative risk of a combined outcome of suicide attempts and ideation; however, the study involved education and training of a volunteer sample of general practitioners, who may have been more motivated to improve their practice than a random sample of general practitioners (16).
Minimal data are available on the effectiveness of using medications in preventing suicidal behavior. The lone study was a short-term, fair-quality trial that assessed the use of lithium (17). The study reported hazard ratios that suggest a possible benefit for suicide attempts but were not statistically significant. There was a statistically significant lower rate of suicide deaths per patient-year in the intervention group; however, the study had high attrition rates and there were only three suicide deaths.
There is a limited evidence base for treatment interventions in adolescents. Study populations primarily consist of participants at high risk for suicide, most with recent suicide attempts or acute suicidal ideation. The effect of treatment to prevent suicide on suicide deaths could not be determined, as there was only one death in any of the three trials that reported this outcome. Suicide attempts were not reduced with psychotherapy treatment at 6 to 18 months. The confidence interval on the pooled effect was wide and crossed zero, ranging from a 25% reduction in risk to a 31% increase. Therefore, the possibility of harm or benefit cannot be ruled out with the existing evidence on psychotherapy trials (8).
The one enhanced usual-care study in adolescents also had a population of high-risk patients, all of whom had a history of suicide attempts, threats, or ideation (18). Although the study was rated fair quality, the groups were not entirely comparable at baseline, and retention was somewhat variable. The study did not find any differences between the groups in suicidal ideation, depression, or hopelessness at the 12-month followup, thus providing no evidence of treatment benefit.
Potential Harms of Screening
Three studies reported on the potential adverse effects of screening. One was a trial of depressed adults in four primary care practices in the United Kingdom. The other two were conducted in high school settings.
In the adult study, no statistically significant increases in suicide attempts or ideation were seen at 2 weeks following screening (19). The trial, however, had a relatively small sample size (n=443) and limited power. Additionally, differential ascertainment may have biased the results, as a higher proportion of participants who were screened withdrew consent for followup (6.6% of screened vs. 2.2% of unscreened).
In both high school-based studies, students were randomly assigned to screening for suicide risk on one of two occasions, 1 to 2 days apart. The items used to screen for suicide risk were embedded in an instrument that addressed broader mental health issues. The larger trial (n=2,342), conducted in six high schools in New York, randomized the students at the classroom level (20). No immediate increase was reported in students reporting suicidal ideation or mean suicidal ideation scores.
The second study, conducted in Australia, was much smaller (n=308) and found no differences between the two groups in anger, confusion, depression, fatigue, or tension, based on the Profile of Mood States, immediately after being screened for suicide risk or completing other mental health items (21). "Vigor" was the only characteristic that was reported to be higher in those screened. After both groups had completed the suicide risk screening items, 8.9% reported that the suicide-related items were moderately or very distressing, whereas 31.5% found them to be "a little distressing."
Because of the paucity of data and study limitations, the possibility of short-term harms from participation in suicide screening itself cannot be dismissed. Other potential harms of screening include harms that may result from treatment in screen-detected individuals after referral.
Very few treatment trials among adults reported any adverse events. One CBT trial reported that none of the suicide attempts were thought to be a result of study participation (22). In a study of a video-based problem-solving intervention, none of the participants withdrew because of worsening symptoms (23). A study of writing as a means for reducing suicidal ideation reported that three participants asked to speak with a supervisor because they had become upset after writing or because their writing reflected current suicidal ideation (24). Not enough data were available to draw conclusions on whether harms occurred due to screening in adults.
Of the 11 adolescent psychotherapy treatment trials reporting suicide attempts, four noted nonstatistically significant increases in suicide attempts, ranging from 22% to 113% (25-27). One was a very small trial that had few events and very wide conference intervals associated with the effect; however, the others likely had enough events to represent stable, though still statistically nonsignificant, effects. Thus, the possibility of harm due to treatment cannot be ruled out in currently or recently suicidal adolescents undergoing therapy.
In the one medication trial that evaluated treatment with lithium, a higher percentage of participants in the treatment group withdrew from the study due to adverse events compared with the placebo group (13% vs. 2%), though the statistical significance was not reported and overall dropout rates were similar between the two groups (17).
Estimate of Magnitude of Net Benefit
The USPSTF found inadequate evidence on the diagnostic accuracy of screening tests for suicide risk, the effectiveness of treatment, and the harms of screening or treatment. In attempting to build a chain of indirect evidence from screening to treatment to beneficial health outcomes, the link between screening and treatment is problematic, due to the poor fit between the populations in the two bodies of evidence. Even in the treatment studies with high-risk populations, few studies had enough statistical power to detect differences in suicide deaths between control and intervention populations. Therefore, the USPSTF concludes that the evidence on the benefits and harms of screening is lacking for adolescents, adults, and older adults.
Update of Previous Recommendation
In 2004, the USPSTF concluded that there was insufficient evidence to recommend for or against routine screening by primary care clinicians to detect suicide risk in the general population (I statement). After reviewing the new data from studies since the last review, the USPSTF again concludes that there is insufficient evidence to determine the balance of benefits and harms of screening for suicide risk.
Recommendations of Others
Several groups have recommendations or have commented on screening patients for suicide risk. The American Academy of Child and Adolescent Psychiatry recommends that clinicians be aware of patients at high risk for suicide (28). The American Academy of Pediatrics recommends that pediatricians ask questions about mood disorders, sexual orientation, suicidal thoughts, and other risk factors associated with suicide during routine health care visits (29). The American Medical Association states that all adolescents should be asked annually about behaviors or emotions that indicate recurrent or severe depression or risk of suicide, and physicians screen for depression or suicidal risk in those with risk factors such as family dysfunction, declining school grades, and history of abuse (30). The American Academy of Family Physicians is currently updating its recommendation. The recommendation of the Canadian Task Force on Preventive Health Care mirrors the 2004 USPSTF recommendation, in that it found poor evidence to include or exclude routine evaluation of suicide risk during a periodic health examination (31).
Table 1: What the Grades Mean and Suggestions for Practice
Table 2: Levels of Certainty Regarding Net Benefit
|Level of Certainty*
|The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
|The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by factors such as:
As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.
|The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of:
More information may allow an estimation of effects on health outcomes.
*The U.S. Preventive Services Task Force defines certainty as "likelihood that the USPSTF assessment of the net benefit of a preventive service is correct." The net benefit is defined as benefit minus harm of the preventive service as implemented in a general, primary care population. The USPSTF assigns a certainty level based on the nature of the overall evidence available to assess the net benefit of a preventive service.
1. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Leading Causes of Death Reports, 1999–2009. Atlanta: Centers for Disease Control and Prevention; 2012.
2. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Injury Mortality Reports, 1999–2009. Atlanta: Centers for Disease Control and Prevention; 2012.
3. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Years of Potential Life Lost Reports, 2009. Atlanta: Centers for Disease Control and Prevention; 2012.
4. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159(6):909-16.
5. McCarty CA, Russo J, Grossman DC, et al. Adolescents with suicidal ideation: health care use and functioning. Acad Pediatr. 2011;11(5):422-6.
6. Vannoy SD, Robins LS. Suicide-related discussions with depressed primary care patients in the USA: gender and quality gaps. A mixed methods analysis. BMJ. 2011;1(2):e000198.
7. Feldman MD, Franks P, Duberstein PR, et al. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-8.
8. O'Connor E, Gaynes B, Burda BU, Williams C, Whitlock EP. Screening for Suicide Risk in Primary Care: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 103. AHRQ Publication No. 13-05188-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2013.
9. Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294(16):2064-74.
10. Sarchiapone M, Mandelli L, Iosue M, et al. Controlling access to suicide means. Int J Environ Res Public Health. 2011;8:4550-62.
11. National Center for Health Statistics. Health, United States, 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2012. Accessed at http://www.cdc.gov/nchs/data/hus/hus11.pdf on 12 April 2013.
12. Holi MM, Pelkonen M, Karlsson L, et al. Detecting suicidality among adolescent outpatients: evaluation of trained clinicians' suicidality assessment against a structured diagnostic assessment made by trained raters. BMC Psychiatry. 2008;8:97.
13. Thompson EA, Eggert LL. Using the suicide risk screen to identify suicidal adolescents among potential high school dropouts. J Am Acad Child Adolesc Psychiatry. 1999;38(12):1506-14.
14. Heisel MJ, Duberstein PR, Lyness JM, et al. Screening for suicide ideation among older primary care patients. J Am Board Fam Med. 2010;23(2):260-9.
15. Olfson M, Weissman MM, Leon AC, et al. Suicidal ideation in primary care. J Gen Intern Med. 1996;11(8):447-53.
16. Almeida OP, Pirkis J, Kerse N, et al. A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Ann Fam Med. 2012;10(4):347-56.
17. Lauterbach E, Felber W, Muller-Oerlinghausen B, et al. Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial. Acta Psychiatr Scand. 2008;118(6):469-79.
18. Robinson J, Yuen HP, Gook S, et al. Can receipt of a regular postcard reduce suicide-related behaviour in young help seekers? A randomized controlled trial. Early Interv Psychiatry. 2012;6(2):145-52.
19. Crawford MJ, Thana L, Methuen C, et al. Impact of screening for risk of suicide: randomised controlled trial. Br J Psychiatry. 2011;198:379-84.
20. Gould MS, Marrocco FA, Kleinman M, et al. Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA. 2005;293(13):1635-43.
21. Robinson J, Pan YH, Martin C, et al. Does screening high school students for psychological distress, deliberate self-harm, or suicidal ideation cause distress—and is it acceptable? An Australian-based study. Crisis. 2011;32(5):254-63.
22. Brown GK, Ten HT, Henriques GR, et al. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA. 2005;294(5):563-70.
23. Fitzpatrick KK, Witte TK, Schmidt NB. Randomized controlled trial of a brief problem-orientation intervention for suicidal ideation. Behav Ther. 2005;36(4):323-33.
24. Kovac SH, Range LM. Does writing about suicidal thoughts and feelings reduce them? Suicide Life Threat Behav. 2002;32(4):428-40.
25. Donaldson D, Spirito A, Esposito-Smythers C. Treatment for adolescents following a suicide attempt: results of a pilot trial. J Am Acad Child Adolesc Psychiatry. 2005;44(2):113-20.
26. Greenfield B, Larson C, Hechtman L, et al. A rapid-response outpatient model for reducing hospitalization rates among suicidal adolescents. Psychiatr Serv. 2002;53:1574-9.
27. Hazell PL, Martin G, McGill K, et al. Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial. J Am Acad Child Adolesc Psychiatry. 2009;48(6):662-70.
28. American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. J Am Acad Child Adolesc Psychiatry. 2001;40(7 Suppl):24S-51.
29. Shain BN. Suicide and suicide attempts in adolescents. Pediatrics. 2007;120(3):669-76.
30. American Medical Association. Guidelines for Adolescent Preventive Services. Chicago: American Medical Association; 1997. Accessed at http://www.ama-assn.org/ama1/pub/upload/mm/39/gapsmono.pdf on 12 April 2013.
31. McNamee JE, Offord DR. Prevention of suicide. In: Canadian Task Force of the Periodic Health Examination (eds). The Canadian Guide to Clinical Preventive Health Care. Ottawa, Canada: Minister of Supply and Services; 1994.
AHRQ Publication No. 12-05188-EF-2
Current as of May 2013
Internet Citation:
U.S. Preventive Services Task Force. Screening for Suicide Risk in Adolescents, Adults, and Older Adults: Draft Recommendation Statement. AHRQ Publication No. 12-05188-EF-2. http://www.uspreventiveservicestaskforce.org/uspstf13/suicide/suicidedraftrec.htm


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Murgot Deepforge
This NPC can be found in Alterac Valley (3).
Quotes (3)
- Murgot Deepforge yells: Seasoned units are entering the battle!
- Murgot Deepforge says: Great! Let's keep those supplies coming, people!
- Murgot Deepforge says: Thanks for the supplies, <name>!
GainsAfter killing this NPC you will gain:
- 5 reputation with Frostwolf Clan (stops at Revered)


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Map It
Map City Services
LouisvilleKY.gov Links
Tuesday May 4, 2010
Classes Held in Newly Renovated Main Library
The Louisville Free Public Library and Jefferson County Public Schools have joined forces to present a new and more expansive series of adult literacy classes and services as announced today by Mayor Jerry Abramson, JCPS Superintendent Sheldon Berman and Library Director Craig Buthod.
The partnership grew out of an increasing demand for additional educational services to adults entering and re-entering the workforce or seeking higher education attainment. Currently, the JCPS Adult and Continuing Education Division is funded by Kentucky Adult Education to serve more than 9,000 adults annually. More than 800 adults earn their GED through the Jefferson County Program each year.
The Library will dedicate the second floor of the historic Carnegie Library's west wing and include furnished classroom and administrative space as well as state-of-the-art wired learning services and resources. The area was already under renovation as part of the Main Library's repair and restoration activities resulting from the August 2009 flood. Funding for the project is provided by the Library Foundation as part of the Main Branch Landmark Initiative.
JCPS is providing professional staffing, nationally approved curricula and assessment services and will offer a regular schedule of classes as well as selected classes on demand, particularly those associated with GED attainment and college preparation. The program also provides opportunities for trained volunteers.
"We need to support all of our residents who want to prepare for new or better jobs or want to attend college," said Mayor Abramson. "What better way to accomplish these goals then to bring together two of our community's finest institutions, both with the mission and resources to support such important work."
"We are committed to bringing our students of all ages and levels together with the resources they need where they need them," said Superintendent Berman. "When we reach out to provide educational attainment to our challenged students of today, we are reaching across generations to better ensure that their children will seek and be served by lifelong learning."
Together, the two organizations will identify and recruit potential participants through their daily work with students who have had their education interrupted or adults who are in a challenging and volatile job market.
"Many of our patrons at the Main Library are working on furthering their education," said Buthod. "We're excited to be able to offer greater resources to help them reach their educational goals. As in so much of what we do, JCPS is a natural partner."
While the designated space for the classes is still under construction, it is expected that the adult literacy program will be fully operational by this fall.
The Main Library is hosting a Grand Re-Opening of its new renovations and restoration on Sunday, May 15, from 1:00 pm until 4:00 pm. The entire community is invited.
The Main Library was built in 1908 and the north side section added in 1969. The library on York Street sees an average of 2,200 visitors per day. It is open Monday through Thursday from 9 am until 9 pm and Friday and Saturday from 9 am until 5 pm.
The Louisville Free Public Library connects the residents of Louisville and Jefferson County to knowledge and information at 18 locations and on the Web at www.lfpl.org. For more information, go to www.lfpl.org or call 502-574-1611.


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3 Reasons Why These Growth Stocks Will Soar
Matthew is a member of The Motley Fool Blog Network -- entries represent the personal opinion of the blogger and are not formally edited.
Will Rogers was famous for saying, "only buy stocks that go up. If they don't go up, don't buy them." That sounds good, but in practice it's much harder to actually accomplish. However, by answering these three simple questions you'll be able to invest better and find growth stocks that truly soar.
What's Their Addressable Market?
The technology might be breakthrough or the concept might be pretty cool, but if there is no addressable market to serve then the odds of them pulling in any profits is pretty slim. One look at Amazon's (NASDAQ: AMZN) addressable market and you'll see that they've only begun their run. They compete in a four trillion dollar market yet only five percent of those retail sales are done online. Amazon just has a fraction of those sales meaning they can grow for decades if they keep disrupting.
Another company with a massive addressable market is Arcos Dorados (NYSE: ARCO). As the exclusive franchisor of McDonald's (NYSE: MCD) in Latin America their market is twice the size of Mickey D's US business. They have less than 2,000 restaurants to serve their market while there are over 14,000 golden arches stateside. That's a lot Big Mac Shacks to build.
Are They Differentiated?
More specifically, do they have a better product than what's currently on the market or have they developed a disruptive technology? Natural gas engine innovator Westport Innovations (NASDAQ: WPRT) has developed the technology that is replacing dirty diesel with cheaper, cleaner natural gas. That's both a better product as it saves money and a disruptive technology as it is replacing a decades old standard technology.
Another company disrupting a decades old business is Facebook (NASDAQ: FB) which has begun to disrupt how companies market to their customers. Now branding isn't about attaching the brand to a celebrity but it's more valuable if your friend likes the brand first. Their social network will continue to disrupt how we transact by making it more social and relational than ever before.
Do They Have a Sustainable Competitive Advantage?
Finally, and most importantly is to consider if the company's current competitive advantage can endure. Arco's for example has a 20 year exclusive agreement with McDonald's to franchise and grant franchises in Latin America which includes a 10 year renewal option. That exclusive contract will give them a very large head start on any would be competitor should one be granted a license.
Westport's advantage is in their leading intellectual property with more than 400 patents either granted or pending. That's nearly three times as many as their nearest competitor. Their technology and IP advantage is encouraging other companies to partner with them instead of compete against them.
For a company like Facebook, their addressable market is their competitive advantage. Nearly a billion people use their platform each month. These users have given Facebook more data and usable connections to create a multibillion dollar ad platform. They have limitless possibilities in monetizing their platform because their fans aren't going anywhere else.
Finally, with the "earth's largest selection" and cost advantage over their brick and mortar peers, Amazon is able to continue to grow and take market share. They've also developed disruptive technology that's put many a brick and mortar peer out of business. They've disrupted how we read books and they've done so because they see their profit model differently than their competitors. CEO Jeff Bezos recently said, "We want to make money when people use our devices, not when they buy our devices." They've taken that advantage to build a very loyal customer base.
I believe that these four growth companies will soar for decades to come. That's why I've added each one to my virtual "No Drip, No Mess" portfolio and have invested in most of them personally. Do you have a favorite growth stock that I could consider for my next buy? Post your company and how answers the three simple questions in the comment box below.
latimerburned owns shares of Westport Innovations and Arcos Dorados and has options positions on McDonalds and Facebook. The Motley Fool owns shares of Amazon.com, Arcos Dorados, Facebook, McDonald's, and Westport Innovations and has the following options: long JAN 2014 $20.00 calls on Facebook. Motley Fool newsletter services recommend Amazon.com, Facebook, McDonald's, and Westport Innovations. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.If you have questions about this post or the Fool's blog network, click here for information.