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The Memphis Newspaper Guild makes it official – filing grievances against Gannett, the new owner of The Commercial Appeal, over the first significant changes in how the paper is put out. Those changes involve abolishing copy editing positions and making them part of the new job of digital producers.
As Republicans were either at the Republican National Convention in Cleveland or watching it on TV last week, "dark money" entered the crowded Republican primary for Tennessee's 8th Congressional district.
The official planning phase has begun for the much anticipated $33 million University of Memphis land bridge, which will safely connect two sides of the university that are currently split by the Norfolk Southern railroad tracks and Southern Avenue.
Five of the six major contenders in the Republican primary for the 8th Congressional District raised a total of $1.8 million from Jan. 1 to June 30 going into the critical last month of the campaign.
Trezevant recently announced that it has named A C Wharton, Jr. to its board of directors. Wharton is the former mayor of both the city of Memphis and Shelby County. An attorney by trade, he has also served in a number of leadership roles, including as director of Memphis Area Legal Services, chief public defender for Shelby County and chairman of the Tennessee Higher Education Commission.
You might call it the calm before the storm. The Aug. 4 election, for which early voting starts July 15, is calmer than usual for the election cycle before a November presidential general election – the only election that more than half of Shelby County voters regularly show up for.
Most of the 13 contenders in the August Republican primary in the 8th Congressional District agree on a lot. They think the country is going in the wrong direction. They believe the policies of a Democratic president are a factor in that, and they support Donald Trump as the Republican Party's presidential nominee.
It's obvious when there are a lot children at AutoZone Park. Even the most harmless infield popup prompts a collective shriek and the hope of a home run.
The long ball may not be what it was at the peak of baseball's steroid era when Barry Bonds, Mark McGwire and Sammy Sosa were cartoon characters, but the game has not turned away from the notion of driving the ball.
A week that will likely end with the funeral of a Memphis Police officer began with a discussion about violent crime that is even at this early point proving to be different from the past discussions we've had at times like these.
First Tennessee Bank has made a few changes to its Memphis-area leadership team that give new and expanded responsibilities to a pair of longtime bank executives.
First Tennessee Bank has announced some Memphis-area executive changes.
Louis F. "Bo" Allen Jr., executive vice president and manager of commercial banking for First Tennessee's West Tennessee region, will be promoted to West Tennessee president on June 30.
The Grizzlies just about have their new coach. He is David Fizdale who comes to Memphis from being an associate coach for the Miami Heat.
The slogan still resonates: When it absolutely, positively has to be there overnight.
All the world came to know that was Federal Express. I can remember knowing it was Federal Express.
Future conversation in Sacramento between new coach Dave Joerger and franchise player DeMarcus "Boogie" Cousins:
Joerger: "DeMarcus, do you get what we're doing here, do you know what you're doing on this play?"
Resurrection Health, a faith-based, evangelical health service organization that's opened a handful of Memphis-area clinics since launching in December 2014, has merged with a larger health system.
While their folks are still getting settled over in the front office at The Commercial Appeal, Gannett announces Monday an $815 million offer to buy Tribune Publishing which would put The Los Angeles Times and The Chicago Tribune in the expanding USA Today family.
More residences are planned for the South End. Home builders Hamilton & Holliman, on behalf of property owners David and Stacy Petringa, recently submitted plans for a 10-lot subdivision at 27 W. Carolina St.
The recent uptick in the residential real estate market is devouring what's left of lot development that lagged during the recession, and tight supply is raising home prices in the Memphis area.
To best understand another man's baseball passion, you must first understand his baseball pain. So if you hope to truly understand Peter B. Freund, new majority owner of the Memphis Redbirds, you must travel back to his youth.
3385 Austin Peay Highway Memphis, TN 38128
Sale Amount: $1.3 million
Sale Date: Feb. 26, 2016
Now that you've had time to behold the large field of contenders in the Republican primary for the 8th Congressional District – all 13 – they are on the road campaigning on the way to the Aug. 4 election day.And it's quite a road with a lot of different scenery.Former U.S. Attorney David Kustoff is one of the seven contenders in the race from Shelby County. He hit the road Monday for three days of stops in each one of the 15 counties in the district.
Two years after a disastrous slate of races for countywide offices, there is a move among younger Democratic partisans in Memphis to shake up the Democrats who represent the city in the Tennessee Legislature.
Not so fast with the off-season. There is a Memphis post-season after all.
And the Grizz found it Thursday like a light at the end of a long-tunnel where a lot of people slipped and fell and can't get up.The light was Houston flaming out at home to Phoenix without the Grizzlies having to make a basket.It's all about the math. Stay in school, young people.
The Republican primary race to fill the 8th District Congressional seat Republican incumbent Stephen Fincher is giving up drew a field of 13 contenders – seven from Shelby County and four from Jackson, Tennessee – at the Thursday, April 7, noon filing deadline for the Aug. 4 ballot.
More residences are planned for the South End. Home builders Hamilton & Holliman, on behalf of property owners David and Stacy Petringa, recently submitted plans for a 10-lot subdivision at 27 West Carolina.
Shelby County Commissioner Steve Basar has called off his plan to run in the crowded Republican primary for the 8th Congressional District, but Shelby County Mayor Mark Luttrell has pulled his petition to join the same crowded field.
The two municipal judges in Bartlett learned this week that they have races to run on the August ballot, not the November ballot they were scheduled to run on.
The addition of two races to the Aug. 4 Shelby County ballot comes two weeks before the April 7 filing deadline for the nonpartisan local races as well as the state and federal primary contests.
The presidential contenders have moved on to other states and closed up their Memphis storefronts.
And the excitement of the national campaigns that burst into town all in one weekend just before the March 1 Tennessee primaries has shifted to the same frenetic political activity in other states.
There probably won't be a special election for Shelby County mayor if current mayor Mark Luttrell gets elected to Congress later this year.
When Regions Bank holds the grand opening for its new Downtown branch at 88 Union Ave. on March 17, one of the things on display will be a vision of what Regions sees as the future of banking.
Shelby County Mayor Mark Luttrell announced Monday, Feb. 29, that he will be a candidate in the August Republican primary for the 8th Congressional District.
Germantown-based Trezevant Realty Corp. has deep roots in the Mid-South commercial real estate market, and the uptick in the economy has more projects moving full-steam ahead.
When it comes to political surprises, the presidential contenders may be the next group on the ballot locally. But they need to up their game if they are going to hold the attention of Memphis voters.With three of the Republican contenders on their way to Shelby County this weekend and probably more making plans, the attention Tuesday shifted dramatically to the open 8th District Congressional seat that isn't on the ballot until the August primaries.
NASHVILLE, Tenn. (AP) – An attorney for sportscaster and TV personality Erin Andrews told a jury Tuesday that Andrews felt horror, shame and humiliation when she discovered that someone had secretly filmed her nude and posted the video on the Internet.
When figures are presented detailing a 456 percent increase in tuition and fees at the University of Tennessee-Knoxville over the last 20 years, the result is usually some serious sticker shock.
That's what happened recently when state Sen. Dolores Gresham presented the Tennessee Tuition Stability Act, a measure designed to rein in tuition growth and make it easier for students and parents to pay for a four-year degree.
Shelby County Commission chairman Terry Roland will not be running in the Republican primary for the 8th Congressional District in August.
One seemingly ordinary winter's night in Downtown Memphis, I was going from event to event focused on work – specifically trying to stay on a schedule in which several things I wanted to cover were happening at the same time.That is usually when you miss the experience that is Memphis on an everyday but definitely not ordinary basis.So I get in a parking garage elevator and on the next floor David Porter – of Stax Records fame – gets on and he introduces me to his friend, Maurice White – the founder of Earth Wind and Fire. They too are trying to be in several places at the same time.As they went their way and I went mine, I remember thinking this is quite a special place.The encounter slowed my stride a bit and took some of the edge off the schedule – noticing for the first time how many people were out on a winter's night in our city having nothing but a good time made better by all of us going our different ways.White, who was from Memphis, died Thursday with his band's music stronger and more relevant than ever.If you grew up listening to EWF when the songs were new, you know that the bright and funky sound and the positive, affirming, and diverse identity of this music was quite intentional at a time when there was plenty going on that could have pushed it the other way.If your parents or grandparents grew up listening to EWF, this music is a part of your family's tradition that calls to mind special occasions and even your own mild surprise the first time you found yourself dancing to it with your children.And if your folks' vinyl record collection from back in the day included Earth Wind and Fire, that was one of the ones you listened to when they weren't around and one of the ones you took with you when you got a place of your own.
The line for the 8th Congressional District seat began forming within half an hour of incumbent Stephen Fincher's announcement Monday, Feb. 1, that he would not seek re-election in the August primaries.
U.S. Rep. Stephen Fincher announced Monday, Feb. 1, that he will not run for re-election in Tennessee's 8th Congressional District.
The seventh-generation agribusiness leader from Frog Jump, Tenn., said in an email that he "never intended to become a career politician."
State Sen. Brian Kelsey calls himself "a proud conservative who likes to get results."
WASHINGTON (AP) — Confidence among U.S. home builders held steady in January even though builders' expectations about future sales dipped slightly.
The National Association of Home Builders/Wells Fargo builder sentiment index stood at 60 in January, matching the December reading, the association reported Tuesday.
When you really get down to it, history is a collection of moments, moments that, when they fall one after the other over the long arc of time, eventually form the tapestry representing who we are.
TRENTON, N.J. (AP) – Laws taking effect at the start of the new year show states diverging on some hot-button issues.
Restrictions on carrying guns will ease in Texas, for example, but will get tighter in California. It will be easier to register to vote in Oregon, but there will be another step to take at the polls in North Carolina.
A norm on the East and West coasts – and an even older tradition in Europe and other international cities – indoor food markets are making their way to the Southeast in cities like Nashville, Atlanta, Little Rock and St. Louis.
It was the middle of the season and the Tigers were rolling along at 7-0. They had climbed to No. 16 in the national polls and Paxton Lynch was being talked about as potentially the best quarterback in next spring's NFL Draft.
The drugs in Kathy Stiltner's car were over-the-counter antacids. The $12,000 in cash was from an inheritance. Still, police took the money – quite legally – and are still fighting to keep it, even after the drug charge was dropped.
Methodist Healthcare is known as one of Memphis' leading health care institutions, but it's also working to spread its institutional knowledge related to things like training and health care management across the globe.
SAN ANTONIO (AP) — The San Antonio Spurs played poorly, were not sharp and heard all about it during a fiery timeout.
Imagine if they had lost.
Kawhi Leonard scored 19 points, Tony Parker had 18 and the Spurs held on to snap the Memphis Grizzlies' four-game winning streak with a 92-82 victory Saturday night.
Five hundred new companies in 10 years. That's the idea that founded EPIcenter, short for Entrepreneurship-Powered Innovation Center, an organization looking to catalyze the entrepreneurial movement in Memphis.
Megan Warden, who joined Shea Moskovitz & McGhee as an associate attorney this year, represents clients in a variety of family law matters – including division and valuation of marital assets, spousal support, prenuptial agreements, child custody, parenting plans, visitation issues, domestic partnerships and parentage.
Memphis Botanic Garden will continue the 2015 Vine to Wine tasting series with "Aussie Wines" Tuesday, Sept. 29, from 6 p.m. to 8 p.m. at MBG, 750 Cherry Road. Each event features eight wines or cocktails in and light hors d'oeuvres. Tickets are $25 for members or $35 for nonmembers. Visit memphisbotanicgarden.com.
Touchdown Club of Memphis will meet Monday, Sept. 28, from 5:30 p.m. to 8 p.m. at Chickasaw Country Club, 3395 Galloway Ave. Former University of Alabama head coach Gene Stallings is the guest speaker. Cost is $60. Visit tdcmemphis.com.
The Mid-South Fair will be held through Oct. 4 at the Landers Center, 4560 Venture Drive in Southaven. The 159th annual event will feature rides and games, livestock competitions, youth talent show and more. Visit midsouthfair.com for schedule and tickets.
Last week, the University of Memphis football team finished training camp with simulated end-of-week preparation, culminating with a video test Friday night and a mock game Saturday, Aug. 29, at Liberty Bowl Memorial Stadium.
Southwest Airlines will add seasonal nonstop flights between Memphis and Austin, Texas, along with an additional seasonal flight to Orlando.
The nonstop service between Memphis International Airport and Austin-Bergstrom International Airport will operate on Saturdays and Sundays starting Dec. 5 and move to Saturdays only starting Jan. 9. The route will continue being offered on Saturdays through March 5.
First, there was a video because in 2015 there must always be a video.
Before University of Memphis Athletics director Tom Bowen and president M. David Rudd took their turns at the lectern to talk about the public phase of a $40 million capital campaign for athletic facilities, all heads turned toward a screen.
As David May sees it, the Memphis-area real estate market is in the fortunate position of dealing with a bounty of positive surprises lately.
One example the West Tennessee area president for Regions Bank points to deals with home values. Four or five years ago, he explains, if Regions was in the midst of setting up a home equity loan or a refinance for a borrower and ordered an appraisal, the figure that came back was often a negative surprise.
Tennessee's football team has something to prove as it concludes the first week of preseason practices and moves forward to the 2015 season.
The Vols must prove they belong in the national picture in Butch Jones' third year as coach.
JACKSON, Miss. (AP) — Four DeSoto County House Republican incumbents targeted by a pro-school choice group because of opposition to charter schools are among at least nine incumbents who lost party primaries Tuesday.
A shortage of developed lots in Shelby County is dragging down the new housing market, according to homebuilding officials.
Homebuilding activity in Memphis and Shelby County slowed in the second quarter, with builders filing fewer permits and selling fewer new homes than in the same three-month period last year.
WASHINGTON (AP) — Unemployment rates fell last month in 21 U.S. states and were unchanged in 17, as widespread job growth and a shrinking workforce reduce the ranks of those out of work.
Vanderbilt, the smallest and only private school in the SEC, has always lagged the league in attendance.
The Commodores, even during the back-to-back 9-4 teams of 2012 (37,860) and '13 (35,675), failed to fill the stadium (capacity (40,550).
A faith-based, evangelical health service organization that's only halfway through its first year of existence has opened a second clinic to help support its mission of addressing health care disparities in Memphis.
The Knoxville area has a rich legacy of actors who have found success in show business: Patricia Neal, David Keith, Cylk Cozart, David Dwyer, John Cullum, Bruce McKinnon, Polly Bergen, Dale Dickey, Brad Renfro, Johnny Knoxville, perhaps the most famous of all, Dolly Parton, singer/songwriter turned actress.
Real estate is a bit like baseball. It seems easy enough until a person takes a shot at explaining the intricacies of the respective fields.
Training a new agent how to use the various contracts such as the Purchase and Sale Agreement, Confirmation of Agency Status, Disclaimer, Lead Based Paint Disclosure, the various releases, disclosures are as confusing as why a foul ball is a strike unless it isn't on the would-be third strike.
There were a few mildly uneasy days between the arrival of Grizzlies controlling owner Robert Pera in Spain and the news that, yes, All-Star center Marc Gasol would indeed re-sign with the team. And not just for a short-term deal, but a five-year max contract (about $113 million) with a player option after the fourth year.
3600 Elvis Presley Blvd.Memphis, TN 38116Loan Amount: $84 million
Hampered by a severe lot shortage, homebuilding activity in Memphis and Shelby County slowed considerably in May, with builders starting and selling fewer new homes than last year.
Builders filed 67 permits in May, down 17.3 percent from 81 permits filed in May 2014, according to real estate information company Chandler Reports. Builders sold 58 new homes in May, down 23.6 percent from 76 new homes sold last year.
Home Medical Products Inc. has opened a Memphis office by acquiring a local respiratory therapy business.
One of the leaders of a street gang banned last year from the Legends Park area has violated the "no-gang zone" court order and is now charged with drug trafficking.
Steve Nelson, an alleged leader of the Dixie Homes Murda Gang, directed the gang's drug dealing activities from the Shelby County Jail. When he wasn't in jail, he was arrested twice in the Legends Park area for violating the court order that bans gang activity as well as gang members from congregating in the area.
WASHINGTON (AP) – With evidence that the U.S. economy is rebounding from a winter slump, the Federal Reserve will likely signal this week that an interest rate increase is coming – just not quite yet.
Pleased to meet you, hope you guessed our name. Well, hell, Mick, if it's puzzling you, it's Nashville. Music City USA.
We're the national media's flavor of the day – the "It city," which has gone from being a secondary concert market – remember The Beatles played Memphis, not Nashville – to one of the country's prime touring destinations.
Is it now easier for an MLB team, regardless of market size, to seriously compete for a championship than for an NBA team from a similar type market (read: Memphis)?
Short answer: Yes.
As these NBA Finals get underway, with LeBron James and reigning MVP Steph Curry as the headliners, there is an accepted truth – be it in a flyover hamlet or a bigger city on one of the coasts – that no team can truly compete for a title without a superstar.
The Shelby County homebuilding industry surged ahead in April with builders pulling more permits and selling more new homes at higher prices, a positive start to the peak building season.
Builders filed 84 permits in April, a 10.5 jump over the 76 permits filed in April 2014 and a 47.3 percent jump from the 57 permits filed in March of this year, according to real estate information company Chandler Reports, www.chandlerreports.com.
President Barack Obama has nominated U.S. Attorney Edward Stanton III to be a federal judge for the U.S. District Court for the Western District of Tennessee.
Overall home sales in Shelby County were essentially flat in the first quarter while homebuilding activity increased, despite arctic temperatures in February and March that could have put the residential real estate sector in the deep freeze.
WASHINGTON (AP) – For 6½ years, the Federal Reserve has held its key interest rate near zero, and for nearly that long the financial world has speculated about when the Fed will start raising it.
For a baseball coach – one of the best in the business – Tim Corbin owes much of his career to influences from a different athletic endeavor.
New home construction in Shelby County, as tracked by permits, jumped in February when compared to February 2014 while the number of new home sales remained flat.
Builders filed 88 permits in February, up 22 percent from 72 permits filed in February 2014, according to real estate information company Chandler Reports, www.chandlerreports.com. The permits filed in February averaged 2,840 square feet and $188,729, compared to 3,252 square feet and $241,788 in February 2014.
When the National Rifle Association announced that it would hold its 2015 convention in Nashville, the timing was propitious.
In 2010, gun sales and handgun permits were booming, and Tennessee had just enacted a controversial and contested new "guns in bars" law that allowed people with handgun permits to carry concealed firearms into bars and restaurants that serve alcohol.
At one point during a recent Memphis real estate summit a rather remarkable thing happened.
The guest panelists – a banker, a homebuilder and a real estate agent – all agreed on something. 2015 could be a breakout year for the housing market.
You don't need to search the Allan Jones Aquatic Center for a reminder of Tennessee's glory years in men's swimming under legendary coach Ray Bussard.
Hanging from the rafters are 10 SEC championship banners and the 1978 NCAA championship banner. Bussard coached eight SEC championship teams – the first in 1969 and seven consecutive from 1972-78 – and the NCAA title team.
The Cleveland Cavaliers were on a three-game winning streak. The Memphis Grizzlies were on a three-game winning streak. They were each the No. 2 seed in their respective conferences.
It set up to be a very competitive, perhaps even memorable, game. But the Cavaliers' 111-89 victory over the Memphis Grizzlies on Wednesday, March 25, at FedExForum was, as Tony Allen, put it, "an old-fashioned beat down."
You still have time to register for an important event about major trends in the local real estate market, including residential and commercial sales, new housing, foreclosures and lending practices.
Real estate industry professionals will have the opportunity this week to learn more about major trends in the local real estate market, including residential and commercial sales, new housing, foreclosures and lending practices.
WASHINGTON (AP) – Cash-strapped Americans anxious for tax refunds are increasingly turning to payment advances, prepaid cards or other costly services when getting tax preparation help, according to new federal data raising concerns among regulators about whether consumers are fully informed about the fees.
Momentum is building this session for voucher legislation that would allow state dollars to follow students from struggling public schools to private and religious institutions.
But it is hardly etched in stone.
LA Fitness is eyeing a property in the heart of East Memphis for its third Memphis-area location.
The California-based fitness center chain is considering opening its third store in the Memphis market at 1285 Ridgeway Road, according to sources.
KNOXVILLE – Tennessee baseball coach Dave Serrano wasn't pushing the panic button after his team lost two of three games in their season opening series at Florida International University in Miami last weekend.
Despite low gas prices, a backlog on road projects and prevailing winds for fuel-tax reform, Gov. Bill Haslam is pulling back from a gas-tax increase this session.
After floating the possibility of raising the tax in December, the Republican governor appears to be changing course, in part because of his loss in a Senate committee on Insure Tennessee, the Medicaid expansion alternative that failed to make debate in the full House or Senate.
Karen Weddle-West have been approved as the new provost of the University of Memphis by Tennessee Board of Regents Chancellor John Morgan.
Bass Pro Shops will host a job fair to fill 600 full-time and part-time jobs Tuesday and Wednesday, Feb. 3-4, from 8 a.m. to 7 p.m. at the Memphis Cook Convention Center, south exhibit hall, 255 N. Main St. Visit basspro.com/careers for more information.
Bass Pro Shops will host a job fair to fill 600 full-time and part-time jobs Monday, Feb. 2, to Wednesday, Feb. 4, from 8 a.m. to 7 p.m. at the Memphis Cook Convention Center, south exhibit hall, 255 N. Main St. Visit basspro.com/careers for more information.
Karen Weddle-West has been recommended as the new provost at the University of Memphis by University President David Rudd.
On Location: Memphis will host screenings of Oscar-nominated animated short films Tuesday, Feb. 3, at 7 p.m. and Oscar-nominated live-action short films Wednesday, Feb. 4, at 7 p.m. at Malco Studio on the Square, 2105 Court Ave. Tickets are $10 per night and are available at onlocationmemphis.org.
Shelby County homebuilding activity slowed in 2014 as builders filed fewer permits and sold fewer homes than in 2013.
Homebuilders filed 850 permits in 2014, down 8.6 percent from 930 permits filed in 2013 and down 7 percent from 914 permits filed in 2012, according to real estate information company Chandler Reports, www.chandlerreports.com.
Copyright 1995 -
by The Daily News Publishing Co. Inc. - All Rights Reserved


text:
KDE Wants Open Cloud
A new subproject named ownCloud has emerged from the KDE Camp 2010 conference in San Diego.
KDE developer Frank Karlitschek presented ownCloud, the first real extension of his Social Desktop initiative. Users today no longer have applications only on their desktop, but from numerous online services; however, it's proven difficult (to impossible) for users to combine these apps, such as blogger weblogs with Yahoo graphics.
Help should come from an open technical standard for social online networks and related services. When enough providers start implementing the interface, users can have more independent control of their data and maintain their own clouds. The first potential participant in ownCloud is reportedly Maemo.org and the KDE forums. The technology could contribute to the KDE Get Hot New Stuff (GHNS) framework together with the openSUSE build service.
The ownCloud team currently has ahomepage and a Git repository;. The next two months should produce version 1.0, including a WebDAV interface under an open source license.
Issue 26: Linux Shell Handbook 7th Ed./Special Editions
Buy this issue as a PDF
Mirantis to Refactor OpenStack Fuel for Kubernetes
The company is collaborating with Google and Intel to use Kubernetes as an engine for Fuel
Canonical Joins Document Foundation Advisory Board
The upcoming release of LibreOffice will be available as a snap package
SUSE Joins the Microsoft Test Drive Program
Customers can take a free test drive of SLES for HPC on the Azure Cloud
SiFive Launches a Line of Open Source Chips
San Francisco-based chip company announces their first fully open source chip platform.
Fedora 24 Released
The whole distro gets rebuilt on glibc 2.3
Canonical Announces Cross-Distro Support for Snaps
Ubuntu Vendor tries to solve app packaging and distribution problem across distributions.
ownCloud Forked
Founder of ownCloud launches the Nextcloud project.
HP Enterprise Unveils a Futuristic Computer
Will The Machine change the way future programmers think about memory?
CoreOS Announces Distributed Storage System
The new Torus distributed storage system is available under an open source license on GitHub
Google Beats Oracle in the Android Lawsuit
Juries decides Google's use of Java APIs Was Fair Use

subset: commoncrawl


text:
Stroke: First Response
Wild Iris Medical Education, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Provider approved by the California Board of Registered Nursing, Provider #12300.
Course Availability: Expires August 1, 2016. You must score 70% or better on the test and complete the course evaluation to earn a certificate of completion for this CE activity. Wild Iris Medical Education, Inc., provides educational activities that are free from bias. The information provided in this course is to be used for educational purposes only. It is not intended as a substitute for professional healthcare. Medical Disclaimer Legal Disclaimer Disclosures
Stroke: First Response
Copyright © 2013 Wild Iris Medical Education, Inc. All Rights Reserved.
COURSE OBJECTIVE: The purpose of this course is to present a current and evidence-based discussion of the recommended emergency response for acute stroke.
Upon completion of this course, you will be able to:
- List the basic types, causes, and symptoms of stroke.
- Explain how patients, family, or bystanders should respond to a potential stroke.
- Discuss the actions recommended for emergency responders to potential stroke victims.
A stroke—also called a cerebrovascular accident (CVA) or a brain attack—is a reduction or an interruption of the flow of blood through an artery to one or more areas of the brain within the territory supplied by that artery. The end result is varying degrees of neurological and/or cognitive malfunction lasting longer than 24 hours.
Major Stroke Classifications
There are two major stroke classifications:
- Ischemic stroke, which may occur as a transient ischemic attack (TIA), occurs when a clot, either of local or distant origin, blocks a cerebral artery and causes oxygen deprivation with subsequent tissue damage. The term ischemic refers to an insufficient blood supply. The most common extracranial source of emboli is the cervical bifurcation of the common carotid artery, while the most common sources of intracranial thrombi are the main trunk and branches of the middle cerebral artery.
- Hemorrhagic stroke occurs as a bleed within the brain, often causing tissue damage due to pressure-related changes. Most commonly, intracerebral hemorrhages are caused by rupture of vessels due to long-term atherosclerotic damage and arterial hypertension.
Two types of stroke. (Source: CDC, 2010b.)
Both types of vascular damage—clots and ruptured vessels—may also occur in the spinal cord. These occurrences are referred to as spinal cord strokes. The simple term stroke, however, generally refers to vascular damage to the brain.
The current definition of transient ischemic attack (TIA) endorsed by the American Heart Association is "a brief episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction" (Siket & Edlow, 2013). TIA is sometimes referred to as a "warning stroke" or a "mini-stroke" that results in no lasting damage (CDC, 2010b).
In the United States, most strokes are ischemic and caused by the sudden blockage of a cerebral artery.
Stroke Symptoms
Strokes reduce the blood flow to particular regions of the brain, and the loss of circulating blood causes the affected regions to stop functioning. As a consequence, the patient loses the ability to perform the tasks that are localized in those regions. Loss of blood flow is called ischemia, and both ischemic strokes and hemorrhagic strokes cause neurological deficits due to ischemic damage. In hemorrhagic strokes, bleeding can also cause nonischemic physical damage.
Stroke symptoms depend on the area of the brain that is affected, which is most often the middle cerebral artery or one of its deep branches.
Symptoms can include:
- Numbness or weakness on one side of the body (usually contralateral hemiplegia) or face (e.g., ptosis, or drooping eyelid)
- Confusion, difficulty speaking or writing (expressive aphasia), or difficulty understanding (receptive aphasia)
- Difficulty seeing and/or visual field defects (e.g., homonymous hemianopsia)
- Gait deviations
- Severe headache with no known cause
These particular deficits result from ischemia in brain regions that are especially prone to stroke damage.
TIAs often present as amaurosis fugax, a transient loss of vision in one eye (Panagos, 2012). A TIA can also present with one or more of these symptoms:
- Sudden weakness, numbness, or paralysis in the face, arm, or leg (most often, this occurs on one side of the body)
- Confused, muttered, slurred, or garbled speech
- Difficulty in understanding when someone else is speaking
- Sudden blindness in one or both eyes or double vision
- Dizziness, loss of balance, or loss of coordination
Because TIAs have been associated with an increased risk of acute stroke, it is currently recommended that all patients showing symptoms of TIA be treated as stroke patients. It is estimated that 15% of all strokes are preceded by an episode of TIA.
Epidemiology of Stroke
Stroke is a serious health hazard. On the average, someone in the United States has a stroke every 40 seconds (Go et al., 2013). One person dies of a stroke every four minutes, and it is estimated that 1 of 19 people die of stroke (Roger et al., 2012; Sidney et al., 2013). A recent study of Americans found that "25% of people who had a stroke died within a year and 8% had another stroke within one year. … [Altogether,] 50% died or had another stroke or a heart attack within four years" (Feng, 2010).
Stroke is also an economic drain. The American Heart Association estimated stroke costs of $74 billion in 2010, including the cost of healthcare services, drugs, and lost productivity (Lloyd-Jones et al., 2010).
The morbidity, mortality, and cost of strokes are not spread equally among the population. Those at higher risk include the elderly, African Americans, those of lower socioeconomic status, and residents of the southeastern United States.
Age. Most people who have a stroke are older than 65 years of age. Additionally, the chance of dying from a stroke increases with the patient's age (NCHS, 2012).
Gender. Stroke is most common in people older than age 75, and because women live longer than men, overall about 1.5 times more women than men die of stroke in the United States each year. However, men younger than 75 have a higher incidence of stroke than women of the same age (CDC, 2010a, b).
Racial Demographics. African Americans and Hispanic Americans are at higher risk of death from strokes. Native Americans or Alaska Natives have an even higher risk of stroke (NCHS, 2012).
Age-adjusted death rates for stroke by race/ethnicity and sex, U.S., 1999–2010. (Source: NHLBI, 2013.)
Socioeconomic Status (SES). Low SES is associated with an increased risk of stroke. A lower level of educational achievement is also associated with an increased risk of stroke (CDC, 2012).
Geographic Location. In the United States, living in the Southeast carries with it the highest risk for stroke compared to the rest of the nation's population.
The heavy concentration of strokes in the southeast has given that region the nickname "the stroke belt." (Source: CDC, 2010a.)
Strokes Need Prompt Treatment
At the moment, there is still no effective "in-the-field" treatment for a stroke; for medical care, stroke patients must be taken to a hospital. Moreover, they must be taken quickly, because the clock is ticking for acute stroke victims—secondary damage from strokes increases as time passes, and early intervention can save critical brain tissue. Therefore, stroke victims need to be taken immediately to an emergency department that has the personnel and equipment to provide comprehensive acute stroke treatment.
For stroke management, the motto is "time lost is brain lost." After an ischemic stroke, the amount of irreversible damage increases steadily as long as brain regions remain without sufficient blood supply. In those parts of the affected region that have no blood flow, neurons begin to die in less than 10 minutes. In those areas with <30% of the normal blood flow, neurons begin to die within an hour. In those areas with 30%–40% of the normal blood flow, some neurons begin to die within an hour, but others can be revived for many hours.
The impetus for high-priority emergency stroke treatment began in 1996 when the FDA approved the use of a thrombolytic agent for stroke. For some patients, this drug—recombinant tissue plasminogen activator (rtPA, also known as tPA)—can reverse the neurological effects of an acute ischemic stroke. RtPA must generally be administered within 4.5 hours after a stroke occurs, and the new paradigm considers all stroke symptoms to be potential emergencies in the class of acute myocardial infarctions (heart attacks). Although there has not yet been the same dramatic innovation for treatment of hemorrhagic strokes, which are less common than ischemic strokes, they too require emergency care.
Health professionals cannot assume that their patients know how to recognize potential strokes. Even people who have suffered one or more strokes need education: a survey by the American Heart Association (2010) found that only 55% of patients who had had a stroke could identify even one stroke warning sign.
Educating Those at Risk
All patients at risk for a stroke should be told its signs and symptoms, which include these sudden occurrences:
- Loss of sensation on one side of the body
- Weakness or paralysis on one side of the body
- Problems walking
- Problems speaking
- Problems understanding
- Problems with vision
- A severe headache
Classic signs of a stroke. (Source: NINDS, 2013.)
Patients should be told that if they are having any of these symptoms, they should call 911 or get someone else to call 911.
However, even people who have been taught the warning signs may not realize that they are having a stroke. Some factors contributing to this problem are:
- Stroke can change a person's level of consciousness.
- Stroke can make a person confused.
- Stroke victims can misunderstand the seriousness of their bodies' signals; for instance, pain is a major symptom of illness, but most strokes are painless.
- Stroke victims with damage to their nondominant parietal lobe can lose the ability to recognize that they are ill.
- The person may be in denial.
The Role of Family or Bystanders
Because people may not realize they are having a stroke, it is often the family or a bystander who first realizes that a medical problem is occurring. The public should understand that if there is the possibility that someone is having a stroke, they should not hesitate—they should call 911 immediately.
The signs of a stroke are being publicized through a number of different campaigns (e.g., the American Heart Association and the Stroke Awareness Foundation). A modified form of the Cincinnati Prehospital Stroke Scale (CPSS) (see "Cincinnati Prehospital Stroke Scale" later in this course) has been presented as a simple STRoke test, with the first three letters of stroke standing for:
- Smile. Ask the person to smile. Does their face look uneven?
- Talk. Ask the person to repeat a phrase. Does their speech sound strange?
- Raise your arms. Ask the person to raise both arms. Does one arm drift down?
The sudden appearance of any one of these three symptoms indicates a possible stroke, and members of public are advised to immediately call 911 (Jones et al., 2010).
People often wonder what first aid to give to a stroke victim. The best first aid is professional transport to a hospital, and getting an ambulance is the most important thing that a bystander can do for a stroke victim.
In addition, the one critical medical step that the public should know is how to control external bleeding. First aid providers should be taught to press on a bleeding area until the bleeding stops or an emergency medical services (EMS) team arrives.
When a person calls 911, the operator can give additional guidance for any other necessary first aid (CDC, 2012; Go et al., 2013).
In an emergency, people often feel that time is being lost by waiting for an EMS team to arrive, and family members or bystanders often hurriedly drive patients to the hospital. In fact, however, patients usually get to the appropriate hospital faster if they use the EMS system by calling 911. EMS teams are trained to choose the most appropriate hospital in the region, and this is not necessarily the closest hospital. In addition, the care and assessment that an EMS team gives a stroke victim shortens the time lag between the onset of stroke symptoms and the evaluation and treatment of the stroke.
EMS teams should advocate for widely available 911 capabilities in their region. All landlines and wireless phones should be able to reach local 911 operators. It is also important that the caller's number and location be displayed automatically for dispatchers. At the moment, two telephone systems do not always give 911 operators the detailed locations of callers: Multiline Telephone Systems (MLTS), which are used by many large organizations, and Voice over Internet Protocol (VoIP) services.
The medical care of stroke victims begins with the receipt of a 911 call. Strokes account for about 2% of all 911 calls, but those calls should set off a well-planned and speedy treatment protocol. Thrombolytic treatment of ischemic strokes ideally begins within a 4.5-hour window after the onset of symptoms, and strokes should be given the same priority of treatment as acute myocardial infarctions and trauma (Alspach, 2013; Berglund et al., 2012; Tan & Christensen, 2012).
Besides stabilizing patients, dispatchers and EMS technicians make the first triage of potential stroke victims, collect critical background information, and expedite transport to the nearest hospital equipped to handle strokes. To plan for an effective response, directors of EMS units should:
- Have a stroke protocol written for their team.
- Divide the EMS unit's region into districts according to the nearest emergency department capable of treating acute strokes.
- Schedule regular training sessions that include such activities as having dispatchers and technicians practice using a standard screening test to determine the likelihood that a patient has had a stroke (Mears et al., 2010; Millin et al., 2007).
EMS Dispatchers
In general, EMS telephone operators and dispatchers have these responsibilities:
- Choose, notify, and send the team of responders that is appropriate for each emergency.
- Advise the callers on possible first aid for the victim.
- Get critical background information about the victim.
There are additional responsibilities regarding potential stroke victims:
When assigning response teams, EMS dispatchers need to assess the type and severity of the emergency. To make decisions for stroke victims, 911 operators should be taught how to identify likely stroke symptoms. When a dispatcher is able to flag a possible stroke victim, the EMS team can be given time to review and plan during their outbound trip and to notify the nearest stroke center. Studies have indicated that notifying a primary stroke center significantly improves outcomes (Patel et al., 2011).
Since strokes account for only 2% of all 911 calls, this translates to only four to ten stroke patients each year for the typical EMS team. The infrequency of stroke calls means that EMS operators may not have stroke-appropriate questions committed to memory, so a written set of screening questions should be on each operator's desk.
Normally, the 911 operator asks these questions, using the same sequence:
- Is she/he completely awake (alert)?
- Is she/he breathing normally?
- Is she/he able to talk normally?
- Tell me why you think it is a stroke.
- Movement problems?
- Speech problems?
- Numbness or tingling?
- When did this start (happen)?
(Buck et al., 2009)
A person may have had a stroke if any of the following problems have appeared in the course of a few hours or less:
- Loss of consciousness
- Change in level of consciousness
- Change in behavior
- Confusion or disorientation
- Dizziness, weakness, or vertigo
- Difficulty moving
- Difficulty using hands, arms, or legs
- Difficulty talking
- Difficulty understanding
- Difficulty seeing
- Severe headache
When the caller's description includes any of the preceding signs, the 911 operator asks three stroke questions:
- Does the patient have a new weakness on one side of the body?
- Does one side of the patient's face droop more than before?
- Is the patient's speech more slurred than before?
911 dispatchers decide what type of response is appropriate for each emergency. They choose:
- The skill level and equipment of the EMS response team: basic life support (BLS) or advanced life support (ALS)
- The type of vehicle to send
- The initial speed requirement (e.g., sirens, flashing lights, etc.)
Acute strokes require the same level of emergency treatment as heart attacks and trauma. The current American Heart Association/American Stroke Association guidelines recommend that potential strokes be given the highest level of priority and that EMS dispatchers send the highest level of emergency care available (Jauch et al., 2013).
When available, an ALS team is sent, "fully equipped with ventilation and oxygenation capabilities, including the ability to provide advanced airway maintenance, endotracheal tube checks, end-tidal CO2 monitoring, and ECG monitoring. Ideally, there should be a minimum of two paramedics who are certified in AHA Advanced Cardiovascular Life Support (ACLS) and are prepared to administer all ACLS Class I and Class II interventions on each stroke response" (Acker et al., 2007).
If a choice has to be made, however, speed of transport to a stroke center is the first consideration. Therefore, if an ALS team is not immediately available, a BLS team should be dispatched.
When patients having a stroke are more than one hour's travel time by ambulance from a hospital that is equipped to treat acute strokes, then air transport should be considered. Helicopters or other aircraft can be used to take the EMS team to the patient and then to transport the patient and the EMS team to a stroke center. Helicopters can also be used for secondary transport of patients from a remote receiving emergency department (ED) to a stroke center.
When an EMS operator suspects that a call concerns a stroke victim, the operator begins collecting critical background information. For strokes, dispatchers should make a special effort to get an estimate of the time since any potential stroke symptoms first appeared (Berglund et al., 2012; Patel et al., 2011).
- Obtain the patient's medical history, inquiring specifically about:
- Past strokes
- TIAs
- Hypertension
- Diabetes
- Myocardial infarction and other heart problems
- Atherosclerosis and peripheral artery disease
- Bleeding disorders
- Recent surgeries
- Liver disease
- Record the patient's current medications, inquiring specifically about:
- Aspirin, anticoagulants, and antiplatelet agents
- Insulin
- Antihypertensives
- Cocaine, amphetamine, and other "street" drugs
- Alcohol intake
- Note the time when the symptoms first appeared and the last time that the patient did not have the symptoms.
- Ask about any recent injury, inquiring specifically about head trauma.
Written records of the information collected during the first contact with the patient can be critical for emergency department providers when they are making decisions about treatment. EMS operators should have a blank checklist that can be filled in with essential background information. This document, along with the results of stroke screening questions, is then faxed or sent by computer to the ED that is receiving the patient.
Nurse educators are often responsible for teaching first response techniques for strokes to local emergency medical technicians (Cameron, 2013; Ireland et al., 2010). The basic information to be covered is found in the American Heart Association's ACLS provider manual and online (AHA, 2010). Nurse educators place special emphasis on:
- Stroke victims needing immediate care in specialized emergency departments
- Stroke being given the same high priority as myocardial infarction
- EMS teams having written stroke-specific protocols and/or checklists prepared in advance
- Simple stroke assessments, such as the Cincinnati Prehospital Stroke Scale, being quickly completed in the field
- Obtaining needed information from the patient or bystanders, including the time of onset of neurological symptoms or the last time the patient was without neurological symptoms
- EMS teams needing to know the closest acute care stroke hospitals
- After alerting the destination ED, EMS responders then staying in touch with the ED staff for advice
As an EMS instructor, a nurse needs to be able to tailor the emergency response protocols to the local region. First, the nurse must know which medical techniques can be performed by paramedics and emergency medical technicians under local regulations. Second, the nurse must learn which area hospitals are equipped and staffed for treating acute strokes.
A typical EMS team responds to only four to ten stroke patients per year, and it has been estimated that emergency personnel forget about one half of the stroke care instructions by 12 months after a training session. Moreover, the needs of a community, the availability of acute stroke care, and the recommended prehospital assessments and care protocols continue to be updated. Therefore, continuing education courses should ideally be held as frequently as twice each year (Jauch et al., 2013; Patel et al., 2011).
EMS Responders
When they reach the victim, members of the EMS response team follow the standard protocol by assessing the situation and stabilizing the patient. In cases in which there is a question of stroke, paramedics then determine the likelihood of stroke and collect critical background information. Speed has a major impact on patient outcomes, requiring the EMS team to provide as much of the patient care as possible while en route to the hospital (Mears et al., 2010; Millin et al., 2007).
More components of the EMS responders' protocol for likely stroke victims (modified from NHTSA, 2002) include:
Responders first state their name and tell the patient that they are part of the emergency team that has come to help.
ABCs ARE THE FIRST PRIORITY
Manage airway, breathing, and circulation. Ischemic strokes—the most common strokes—tend to leave the patient responsive and breathing autonomously. Hemorrhagic strokes, however, can worsen quickly and deteriorate into stupor or coma with respiratory depression or breathing irregularities. Therefore, even when a potential stroke victim appears to need no airway care, the EMS response team must be alert to the sudden appearance of breathing problems.
After stabilizing the patient, EMS responders assess the patient's level of consciousness, document any signs of stroke, and collect critical background information. It is essential to use a standardized screening test for stroke, as studies have shown that a prescreening test is significantly useful in identifying stroke patients (Berglund et al., 2012). Therefore, first characterize the level of consciousness—A, V, P, or U:
- Alert
- Responds to Verbal stimuli
- Responds to Painful stimuli
- Unresponsive (no gag or cough)
Second, determine the likelihood that the patient has had a stroke using the Cincinnati Prehospital Stroke Scale.
One of the simplest and most widely used stroke assessment tools is the Cincinnati Prehospital Stroke Scale (CPSS), developed by Kothari et al. (1999). This is the recommended tool for EMS assessment (Bray et al., 2010; Govindarajan et al., 2012; Mingfeng et al., 2012).
In the CPSS, the patient is asked to perform three actions. An abnormal response to any of the three indicates that it is likely that the patient is having or has recently had a stroke. The actions and the range of stroke and nonstroke responses are:
- "Can you show me your teeth?"
- Stroke likely = the sides of the face look different
- Stroke less likely = the sides of the face look the same
- "Please hold both arms out in front of you."
- Stroke likely = one arm drifts more or one arm doesn't move
- Stroke less likely = both arms move the same or both arms do not move at all
- "Please repeat this sentence: 'The sky is blue in Cincinnati.'"
- Stroke likely = no speech, incorrect words, or slurring
- Stroke less likely = correct words are repeated without slurring
A stroke that affects the motor system can cause weakness in the muscles of only one side of the face. The request to "please smile" is an attempt to gauge whether the facial muscles contract with equal strength on the right and left sides. In order to make this assessment, some health professionals ask potential stroke victims to try to smile. However, the normal smile of a healthy person is often asymmetric, and an asymmetric smile in a patient can be the result of habit rather than a sign of a stroke.
Instead of asking for a smile, neurologists ask potential stroke victims to "show me your teeth," which is intended to demonstrate a grin that bares both sides of their upper teeth. This task requires the patient to strongly contract facial muscles on both the right and the left sides of the mouth. Weakness on one side produces a lopsided grin that reveals more upper teeth on the stronger side.
The public is often told to use "please smile" because its use requires less explanation, but "show me your teeth" is the preferred stroke test.
Regardless of the information already collected by the 911 dispatcher, paramedics should attempt to collect essential information about the patient (see the "Critical Background Information about Potential Stroke Victims" box above).
Because time is of the essence, responders should gather telephone numbers of relatives and witnesses. If knowledgeable acquaintances are available, they are asked to meet responders at the receiving hospital, or if necessary, to travel with responders. For emergency treatments, it will be helpful if next-of-kin are immediately available for consent.
Records are completed and then passed on to the medical team at the receiving hospital. Ideally, EMS teams will use developed checklists with the essential questions to capture all the critical information.
Marcella has just finished her training to become an EMS first responder. She performed well in all the training classes, but she is still quite nervous about her first call as a full-fledged EMS professional. Within the first half hour of her first shift, Marcella hears the call from the dispatcher about a likely stroke victim. Rushing to the scene, Marcella and her team are greeted at the door by the patient's daughter, who is frantic with worry.
The patient is an 86-year-old African American woman sitting on the sofa. Marcella does an initial visual assessment and notices that the woman's face appears to be sagging on the right side. While another team member is getting the woman's vital signs, Marcella asks the woman to "Smile and show me your teeth." The woman's face clearly shows asymmetry. Then Marcella asks the woman to stretch out her arms as far apart as she can. The woman tries, but Marcella notices that her left arm is drifting down. More certain that the team is dealing with a stroke victim, Marcella asks the woman to repeat the sentence "The sky is blue in Cincinnati." When the woman slurs her words, Marcella tells the other team members that they need to take the woman to the nearby primary stroke center. The team is able to quickly transport the woman, whose vital signs remain stable, in under 10 minutes to the stroke center.
Later that evening, while reflecting on her first day as an EMS professional, Marcella realizes the importance of her stroke training. Within 30 minutes of the onset of symptoms, the woman was examined by stroke specialists and now has a good prognosis for eventual recovery.
Maintaining airway, breathing, and circulation are the first priorities. For strokes, keeping the head flat (i.e., supine or 0-degrees elevation) usually offers better brain circulation than keeping the head elevated, when the flat position does not impair the ABCs.
After stabilizing the patient, time is paramount. As soon as possible, begin transporting the patient to the appropriate ED and continue the rest of the prehospital care en route. Each EMS unit should be provided with maps showing the nearest appropriate ED for stroke management in any area (Jauch et al., 2013).
As they manage the patient, members of the EMS team should make contact with the destination ED. Simply notifying the receiving hospital that a potential acute stroke patient will be arriving has been shown to shorten the eventual time between delivery to the hospital and receipt of treatment (Abdullah et al., 2008). Describing the patient's condition, time of onset of symptoms, and medical history allows the mobilized physicians, nurses, imaging specialists, and pharmacists of the acute stroke team to begin planning.
Information is exchanged between the EMS team and the ED stroke team. The hospital stroke team can tell the paramedics about the size and placement of the IV access that will be needed, and hospital specialists can advise the paramedics about managing complications, such as severe hypertension, hyperglycemia, or cardiac dysfunction.
Additional Prehospital Care
Oxygen. Strokes are crises of insufficient oxygen delivery to the brain, so it is important to keep the patient's blood oxygen saturation at normal levels. Attach a pulse oximeter and treat hypoxemia (in this case, oxygen saturation <95%) with supplemental O2. Currently, there is no indication that supplemental oxygen will benefit a patient who already has normal levels of blood oxygen saturation.
IV access. When acute resuscitation is needed, insert an IV line immediately. Otherwise, consider starting an IV en route after consulting the destination ED. Some key brain imaging studies require large bore IV lines that must be inserted proximally (i.e., no more distal than the antecubital fossa). If the receiving hospital will need a specialized IV line, placing the appropriate line in advance can save time.
IV fluids. Treat shock or significant dehydration with balanced salt solutions (isotonic crystalloids, such as normal saline). Otherwise, saline lock the IV or set the IV to drip the minimum amount of balanced salt solution to keep the line open. In general, the goal is to add only a minimal amount of extra fluid, because overhydration can cause cerebral edema. Another concern is hyperglycemia, which can worsen the injury in a stroke. Therefore, do not use dextrose solutions unless you are correcting hypoglycemia.
Blood glucose level. Hypoglycemia produces symptoms that look like stroke, and persistent hypoglycemia will cause brain injury. Therefore, as soon as possible, check the patient's capillary blood glucose level and treat hypoglycemia with glucose.
ECG. Attach a 3-lead ECG and monitor the patient's heart continuously with two specific objectives:
- Watch for serious cardiac consequences. The brain's reaction to stroke includes an increase in the body's sympathetic tone, and this predisposes a person to arrhythmias and myocardial infarction.
- Screen for cardiac causes. Strokes can be caused by preexisting atrial fibrillation or by atherosclerosis, which can already have caused heart damage that can be seen in ECG recordings.
Hypertension management. Hypertension is a common finding in acute stroke. However, blood pressure management is a delicate matter in the acute phase of strokes, and the choice of treatment depends on a detailed diagnosis that can only be made in a hospital. Therefore, current recommendations are that EMS and nursing personnel not attempt to treat high blood pressure en route to the hospital.
Recently trained as an EMS provider, John takes a call from the dispatcher about an 83-year-old female patient with a possible stroke. On arrival, after taking the patient's vital signs, John notes that the patient has a blood pressure of 200/90 mm Hg, a respiration rate of 28 breaths/minute, and a blue tinge around her mouth. John's supervisor instructs him to place an oxygen mask on the patient, start an IV line, and continue monitoring the patient's blood pressure.
When John asks about the potential dangers of the patient's high blood pressure, the supervisor tells him that during an acute stroke, the current recommendations are to avoid attempting to control blood pressure until the patient can be fully evaluated by medical personnel. John continues to monitor the patient's blood pressure, which remains the same, and her other vital signs. After five minutes on oxygen, John notices the patient's color and her respiration rate normalizing. Another five minutes later, the EMS team and the patient arrive at the hospital, where the stroke team takes over the patient's care.
Strokes, also called cerebrovascular accidents (CVAs), result from limitations in cerebral perfusion, usually due to clots. Occasionally, the reductions in perfusion are accompanied by intracranial bleeding. Symptomatically, all strokes appear as acute impairments in brain functioning. Victims may suddenly have difficulty walking, seeing, speaking, or understanding. A common presentation of a stroke is the sudden loss of sensation or movement on one side of the body or face. Most ischemic strokes are painless, although hemorrhagic strokes can produce severe headache.
Treatment for an acute stroke is given high priority by EMS teams and emergency room personnel. For a stroke, there is a 4.5-hour interval after the onset of symptoms in which thrombolytic therapy (i.e., intravenous administration of rtPA) has a chance to reopen clogged cerebral arteries and save some of the underperfused brain tissue. Given this time constraint, EMS teams have the goal of getting potential stroke victims stabilized, evaluated, and to a primary stroke center in less than an hour.
The early recognition and diagnosis of a stroke is facilitated by using standardized tests, such as the Cincinnati Prehospital Stroke Scale, which can be administered in three to five minutes using no special equipment. Such standardized diagnostic tools give accurate and reproducible predictions of the likelihood that a person has had an acute stroke. It has been shown that 911 operators can even administer the Cincinnati Prehospital Stroke Scale over the phone with the help of cooperative bystanders.
NIH Stroke Scale Training (free online training course)
NIH Stroke Scale Training (free on a mobile phone)
National Institute of Neurologic Disorders and Stroke
NOTE: Complete URLs for references retrieved from online sources are provided in the PDF of this course (view/download PDF from the menu at the top of this page).
Abdullah AR, Smith EE, Biddinger PD, Kalenderian D, & Schwamm LH. (2008). Advance hospital notification by EMS in acute stroke is associated with shorter door-to-computed tomography time and increased likelihood of administration of tissue-plasminogen activator. Prehospital Emergency Care, 12(4), 426–431.
Acker III JE, et al. (2007). Implementation strategies for emergency medical services within stroke systems of care. A policy statement from the American Heart Association/American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council. Stroke, 116, 3097–3115.
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Ireland S, MacKenzie M, Gould L, Dassinger D, Koper A, LeBlanc K. (2010). Nurse case management to improve risk reduction outcomes in a stroke prevention clinic. Canadian Journal of Neuroscience Nursing, 32(4), 7–13.
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Millin MG, Gullett T, & Daya MR. (2007). EMS management of acute stroke—out-of-hospital treatment and stroke system development. Prehospital Emergency Care, 11(3), 318–25.
Mingfeng H, Zhixin W, Qihong G, Lianda L, Yanbin Y, Jinfang F. (2012). Validation of the use of the ROSIER scale in prehospital assessment of stroke. Annals of Indian Academy of Neurology, 15(3), 191–5. doi:10.4103/0972-2327.99713.
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Patel MD, Rose KM, O'Brien EC, Rosamond WD. (2011). Prehospital notification by emergency medical services reduces delays in stroke evaluation: findings from the North Carolina Stroke Care Collaborative. Stroke (00392499), 42(8), 2263–8.
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Tan Y & Christensen M. (2012). The pathophysiology of ischaemic stroke: considerations for emergency department advanced practice nursing. Singapore Nursing Journal, 39(2), 31–39.


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Which one should I install?
I virtualize a lot, and have an access to my school's MSDNAA, where I can download/"buy" Windows 2008R2. All editions (with SP1).
Which one should I choose?
Standard or
I looked it up on Wikipedia, and Datacenter comes with more features. But does that mean more bloat, and services by default? (I would use the system for desktop use/virtualization/development.)
The main question: They only differ in features, or will the Standard also run faster?


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Steelers not expected to bring back Ike Taylor
Submitted by Dana Draper on January 27, 2015
According to Larry Hartstein of CBSSports.com, the Pittsburgh Steelers are likely to pass on re-signing soon to be free agent cornerback Ike Taylor.
Taylor, 34, sustained several injuries during the 2014 and had 16 tackles in five games.
The cornerback has been with the Steelers for his entire 12-year career.


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Establishing a Resume File
Thank you for your inquiry as to ministerial positions in the Raleigh Baptist Association. In addition to your professional resume' there is several other documents that we have found helpful for search committees. There are two documents which we would like for you to complete:
Philosophy of Ministry Statements
The Ministry Profile
Directions to our new location
820 S New Hope Road
Google directions


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Borrowers looking for a flexible lending solution should explore getting an unsecured loan. It's a great option if your need a small amount for a short period. Borrowing costs are still relatively low so there's never been a good time to submit your loan application.
However to make the process smooth it's better to know in advance the likelihood your application will be accepted or not. Knowing your eligibility statues will save you a lot of hassle in the future. No one wants to apply for a loan only to be rejected. It will stain your credit report so always be cautious when you decide to do so.
Know your loan eligibility
You have to understand the eligibility criteria to give yourself the best chance of being accepted. No two people will ever have the exact criteria when applying for a loan. Lenders will look at your credit report to examine the amount of loan and rates you will be offered. Unsecured personal loans are more geared to people with higher credit, however, if you have a sufficient income, the lender may approve you for the loan.
You may be looking to borrow £8000 but due to a low credit score a lender will only offer £5000 with a high interest and a guarantor to vouch for you. M
eanwhile another borrower asks for £4000 for a car purchase but due to a strong credit history, lenders will be prepared to offer £6000 with more favorable interest rates.
Do your research
Go to Google and search for loan eligibility calculator. This will give you a rough idea of your borrowing credentials and you'll be able to check you eligibility. You will have to fill out a form which includes the loan amount you require, the purpose of the loan, and how long you want to borrow money for. Any loan advisor will recommend going through that process to paint a clear picture of what you can go for.
Remember if you decide to submit an application for an unsecure loan and it gets rejected, it will be tarnish your credit score. So avoid that fate by using the loan eligibility valuator available for reliable sources. Once you get an idea how much you can get then you can make a sensible loan application.
Credit score is sacred
Borrowers should not underestimate the importance of their credit score. It can be the catalyst to getting the most attractive deals on the market. A perfect credit score is the ideal scenario for borrowers but not many manage to achieve such a feat. All you can do is present the best case possible to convince lenders to give you the loan with lowest repayment plan.
That's not to say that you cannot get an unsecured loan with bad credit. There are such loans aimed at people with less than favourable credit history. But yes, you guessed it. Such loans will be very expensive to make the repayments so you have to be completely sure about taking up this option. We recommend checking out Click Finance. They offer unsecured personal loans as well as loans for people with bad credit in the UK.


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Mahoning County immediately should switch its courthouse, administration and jail buildings from natural gas to steam heat to save about $20,100 annually, an engineering consultant said.
The commissioners heard the recommendation from Chris J. Morrone III, an engineer with CJL Engineering of Youngstown, the consulting firm commissioners hired to perform the energy study of the three buildings.
Morrone urged commissioners to discontinue using the natural-gas- fired boilers in those buildings and return to using steam from Youngstown Thermal, which had been used to heat those buildings before 2006.
The steam would be supplied by boilers that burn wood waste and coal at Youngstown Thermal's North Avenue plant, which heats most of Youngstown State University and many buildings in and near downtown.
Even with today's low natural-gas prices, Morrone told the commissioners during a Thursday staff meeting they could save $7,000 at the courthouse, $7,700 at the county administration building and $5,400 annually at the jail by making the switch.
Carl E. Avers, chairman of Youngstown Thermal, said his company is prepared to enter into contract with the county for three years at a constant rate of $14.50 per thousand pounds of steam.
John A. McNally IV, chairman of the county commissioners, said commissioners will await a report from another consultant, Palmer Energy of Toledo, before they decide. Palmer negotiates for counties on energy procurement.
In their board meeting earlier Thursday, commissioners heard Butch Taylor, business manager for Plumbers and Pipefitters Union Local 396, say oil and gas drilling and related industries offer many local job opportunities for those trained in the construction trades.
"Our membership has increased by 15 percent because of this work," he said of his local, which has about 460 active members.
"What's exciting is that the first processing plant in Columbiana County is going to get started," with construction beginning this fall, he said.
Taylor was referring to the Millennium natural gas processing plant near Hanoverton.
Taylor's local offers a five-year apprenticeship program, where he said participants earn a living while learning on the job, and their only out-of-pocket costs are for books. Apprenticeship applicants may call Marty Loney, Local 396's apprenticeship coordinator, at 330-758-4596.
Taylor said his union and the ironworkers' union will benefit greatly from the Millennium construction project.
"These are long-term jobs. These are jobs that pay very well with benefits," he told the commissioners. "The future looks very bright for us," he added.
Commissioner Anthony T. Traficanti said, "It's going to be one of the largest things this area has ever seen since the steel industry, so we have to prepare for it. We have to get training programs in place. These jobs pay very, very well."
Where are all the fracking and drilling protesters? Youngstown Thermal burns coal right in downtown! Thick, black smoke pours out at night under the cover of darkness.
But these protesters worry about water pumped 2 miles underground? Stupid, stupid.
Steam is a very efficient form of heating; yet, the story neglected to state how much the switch over will cost. Rather, the story stressed savings.
District steam utilities are growing at 11.2% per year because they are the lowest cost method of heating groups of buildings. Youngstown Thermal uses co-generation technology and with waste wood the impact on greenhouse gas emissions are much less than natural gas fueled boiler systems. There is usually no cost to connect to district heating.
Thermal is so old that they are grandfathered in under EPA rules. They spew forth dirty, black exhaust when they burn coal, at night, so that no one can see the black smoke. Daytime they burn gas or sawdust.
Where are all these tree huggers when this coal is burned right in downtown Youngstown? And they worry about fracking two miles underground?


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Penn State Beaver is the perfect place to begin or continue your education.
Beaver campus serves accountants, business and industry leaders, engineers, health care and real estate professionals, and others from a variety of disciplines. We offer an outstanding, internationally-renowned education while providing personal attention at a safe, beautiful, and conveniently-located campus.
For information about any of these programs, please contact Dr. Debra Roach, Beaver campus director of continuing education, 724-773-3767, or contact the Beaver campus Office of Continuing Education, 724-773-3700.
Office of Continuing Education
102 Ross Administration Building
Penn State Beaver
100 University Drive
Monaca, PA 15061
Phone: 724-773-3700
Fax: 724-773-3769
Monday through Friday,
8:00 a.m. to 5:00 p.m.


text: I am planning to switch to this theme and was wondering if there's a way to put a text on the moving picture box located at the upper part of the site. I mean, putting a text on every picture that will be shuffled on the picture box. Appreciate all you response. Thanks!


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Players missing the World Cup due to injury is one of those painful but inevitable realities of sport, but Radamel Falcao has made the best of it and gone to Brazil to watch his Colombia team-mates.
The striker could not recover from a major injury on club duty with Monaco in time for the tournament. But as you can see from the tweet above, he got on the plane to Brazil with his wife, put his Colombia shirt on and made sure to watch the team's opener against Greece in the stadium.
"Hinchas inseparables," written on his shirt, translates approximately to "inseparable fans," and it's a nice example of a player crossing the dividing line between participant and fan.
He was also spotted in the crowd by cameras later on, and, as you can see below, had time to grab a quick selfie with team-mate Fredy Guarin.
Junto a Amaranto, @fguarin13 y Pascual. Siempre apoyando a nuestros compañeros. #VamosColombia #HinchasInseparables pic.twitter.com/FQ0SpBEB2q— Radamel Falcao (@FALCAO) June 14, 2014


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Top 20 best Minnesota musicians: #20-11
Photo by Emily Utne
Top 20 best Minnesota musicians: #10-1
Minneapolis music scene named second-best in the U.S.
50 cool facts about the Minnesota music scene
Minnesotans need to remember to exhale sometimes -- especially fresh on the heels of being ranked as the number two music scene in the country. Shouldn't it be enough to simply enjoy a rich history of quality musicians blossoming from fertile local soil? For those times when worrying that people in Athens, New York, or Des Moines are having more fun than us becomes too much to bear, we've prepared this exhaustive list of the best acts to come out of the North Star State. It's an artistic blanket that fits nicely over a chipped shoulder or a bruised ego in a pinch. -Reed Fischer
20. Doomtree
Origin: Hopkins and Minneapolis | Active: 2001-present | Songs: "Bangarang," "Goodbye," and "Drumsticks"
Probably the best way to explain the Doomtree collective to an unknown is to call it the Wu-Tang Clan of the Minneapolis indie scene. Each member has their own well-respected, distinctive style that sets them apart from one another but when formed together, it's deadly entertaining. Members include P.O.S, Dessa, Sims, Mike Mictlan, Cecil Otter, Paper Tiger, and production genius Lazerbeak. What's scary about this group is even after 10-plus years turning out great music and shows they are just getting started. It's safe to say that the Doomtree clan ain't nuthin' to fuck wit. -Lars Larson
19. Walt Mink
Origin: St. Paul | Active: 1989-97 | Song: "Shine" (Directed by a 22-year-old Sofia Coppola and shot/edited by Spike Jonze)
Named after their favorite psychology professor at Macalester College, Walt Mink lurked on the hazy periphery of the Twin Cities music scene in the '90s. Their blistering debut, Miss Happiness, is one of the best records of the decade, and third album, El Producto, was the fledgling music review site Pitchfork's first perfect 10.0. After original drummer Joey Waronker left to be in Beck's band in '94, the group experienced record label difficulties, and Walt Mink lost a bit of their direction and potency. But their place in Twin Cities music history is secure based on the strength of their superb studio output alone. -Erik Thompson
18. The Suicide Commandos
Origin: Minneapolis | Active: 1974-1979 | Song: "Burn It Down"
They were together for barely five years, and they released only one studio album (plus a live one), but it's safe to say that without the Suicide Commandos, there'd be no Minneapolis punk as we know it. Granted, it didn't take much to parse out what Chris Osgood had in mind when he shouted, "Burn it down! Burn it down!" But then that was the point: The Commandos were all about energy and enthusiasm, a giddy squall of feedback and wiry hooks that may as well have announced the end of the world. Anyone since who's hit a power chord or turned the volume up to 11 owes these guys a debt of gratitude. -Jeff Gage
17. The Jayhawks
Origin: Minneapolis | Active: 1985-present | Songs: "Blue" and "Waiting for the Sun"
It's easy to pinpoint what got the Jayhawks to stand out in a flock of alt-country bands -- the voices. Gary Louris and Mark Olson's clear, intertwining tenors stood in stark contrast to the gruff, cigarette-raw delivery that traditionally dappled their mid-'90s contemporaries' work. Although the band's lineup seems to be constantly in flux, the quality of the songcraft has thankfully been far more stable. Tomorrow the Green Grass from 1995 is the easy favorite for its heft of weeping solos ("Miss Williams' Guitar"), a novelty Grand Funk Railroad cover ("Bad Time"), and crystalline beauty of "Blue." -Reed Fischer
16. Dillinger Four
Origin: Minneapolis | Active: 1994-present | Songs: "Noble Stabbings!!" and "Last Communion"
Dillinger Four might be the only band anyone gives a shit about that still has an Angelfire domain for their official website, but they've kept things far more current in the cred department. We have guitarist Erik Funk to thank for the majesty of is his property, Triple Rock Social Club, and the rigorous punk work with bandmates Paddy Costello, Billy Morrisette, and Lane Peterson. And unlike a lot of bands that eventually wussed out, these guys have stayed true to a balance of skinned-knuckle intensity and hooks for days. D4's habit of holding humor and political discourse in a tight, raised fist results in catchy statements like "A Floater Left With Pleasure in the Executive Bathroom." After all, getting brains to pogo along with bodies is a doubly visceral experience. -Reed Fischer
15. Lifter Puller
Origin: Minneapolis | Active: 1994-2000 | Song: "Let's Get Incredible"
Sure, the Hold Steady is one of the most beloved bar bands in America, but
14. The Jets
Origin: Minneapolis | Active: 1985-present | Songs: "Crush on You" and "Make It Real"
Back before everyone had to put a damn ukelele in their song, plenty of the best-known Jets jams were sultry synthesizer catnip for Adult Contemporary program directors. Overall, the group's mid-'80s output was an undeniable pop machine that had a good number of folks mentioning the eight Wolfgramm kids in the same breath as the Jacksons. Thanks to Nero, "Crush on You" has endured into the dubstep era, but the original still rules to this day. -Reed Fischer
13. Soul Asylum
Origin: Minneapolis | Active: 1983-present | Song: "Sometime to Return"
Folks frequenting the right Twin Cities bars in the late '80s and '90s were bound to eventually run into Soul Asylum frontman Dave Pirner. The band finally broke big in 1992 with the triple-platinum selling Grave Dancers Union after working tirelessly in their early days to cultivate a passionate local following with riveting live shows and steadily improving studio efforts. And while that runaway success eventually took its toll on the band (as did the sad passing of bassist Karl Mueller), Soul Asylum are poised to reconnect with their longtime fans on their forthcoming new record, Delayed Reaction, which is due out in July. -Erik Thompson
12. Low
Origin: Duluth | Active: 1993-present | Song: "Murderer"
Low's patented slowcore style is akin to the muted, protracted sound of sheets of ice breaking during the first throes of spring in their native Duluth. While they certainly keep you waiting for the payoff within their sedate songs, Low were radically different from the flannel-covered, guitar-fueled angst that colored much of the '90s. Signing to the venerable grunge label Sub Pop in 2005 has given an added push to Low's career, and their recent output has taken on a welcome restless edge, while thankfully still allowing for the occasional tranquil moment. -Erik Thompson
11. Brother Ali
Origin: Minneapolis | Active: 1998-present | Songs: "Forest Whitaker," "Take Me Home," and "Uncle Sam Goddamn"
In a medium that is currently dominated by rented Maybachs and soft Canadians, Brother Ali is a fresh breath of chilly Minnesota air. The North Side native has cemented himself as one of the top draws in this game, and even shared a stage with Justin Timberlake. The Rhymesayers vet puts on a must-see live show, and always turns out great product. While other rappers are rocking leopard-print leotards, Ali keeps it real with his no-nonsense yet humorous attitude, insightful lyrics, and soul -- so much soul you think Stevie Wonder is going to pop out his chest. Singed, sealed, delivered, he's ours. -Lars Larson
Top 20 best Minnesota musicians: #10-1
Minneapolis music scene named second-best in the U.S.
50 cool facts about the Minnesota music scene
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Visual-Spatial Difficulties
The National Center for Learning Disabilities (2009) acknowledged several ways the brain recognizes and interprets visual information:
- Visual Discrimination – visually distinguishing one object from another
- Visual Figure-Ground Discrimination – distinguishing a printed object from its background
- Visual Sequencing – recognizing a pattern of symbols, images, or words
- Visual Motor Processing – using information taken in by the eyes to coordinate body movements
- Visual Memory – recalling information seen recently (short-term memory) or a long time ago (long-term memory)
- Visual Closure – identifying an object when only parts of it are exposed
- Spatial Relationships – understanding the relationship of an object situated in space to oneself.
Typical Classroom Characteristics with Visual Spatial Processing Difficulties
- Difficulties finding similarities and differences of letters, colors, shapes and patterns
- Difficulties with locating specific information on a printed page
- Difficulties with distinguishing an image from a similar background
- Difficulties with reading a paragraph: skipping lines, rereading the same line, etc.
- May reverse letters, numbers, and words
- Repeats incorrect spelling of familiar words
- Difficulties remembering number sequences (e.g., locker combinations, phone numbers)
- Difficulties with letter size and spacing; writing outside the margins or the lines; crowding letters together or spacing them too far apart
- Difficulties copying from a board or book
- Bumps into things while moving around
- Difficulties recognizing objects with missing items (e.g., elephant missing a trunk)
- May have a poor sense of time
- Difficulties gathering information from charts, graphs, maps, etc.
- Has difficulties remembering and differentiating left and right
- Struggles to assemble puzzles
- Difficulties with tracing or cutting skills
- May easily become exhausted with schoolwork
Suggested Responses, Accommodations, and/or Modifications
- Have a peer to verify that the notes are clear and organized.
- Give instructions orally to reinforce written ones. 1
- Practice with locating items within pictures (e.g., "I Spy" books and "Where's Waldo?"). 1
- While reading, use a sheet of paper or index card to cover up other words to help prevent distraction or confusion. 1
- Enlarge the print on pages copied from books and worksheets.
- Provide opportunities for the student to give answers orally.
- Fluctuate voice, and use hand gestures to enhance lessons and conversations. 1
- Give an overview of the lesson: beginning, middle, and conclusion so the student can get the "whole picture." Explain the major concepts, before focusing on the detailed ones.
- Use computers. Allow the students to use computers to type written assignments and other school work if possible. It is difficult for them to produce neat handwriting and to process the information at the same time.
- Provide breaks during lectures/writing so the student can reflect on the information.
- To minimize distractions seat the student at the front of the classroom. Keep work space free of clutter and extra distractions that is not required for the task.
- Allow them to dictate or tape record written work. Allow use of a tape recorder to record class lectures. Provide copies of notes clearly spaced and written or typed on a page.
- Give extra time to complete assignments or tests.
- Use a phonics approach for spelling.
- Use interactive notebooks – written notes with pictures.
- Discipline the child in private and be very aware that any negative messages can gravely offend the child causing him/her to withdraw completely. 1
- Encourage color coding. Color code subjects – everything pertaining to that subject is one color. Encourage the use of highlighters for main points, vocabulary, etc.
- Encourage asking questions for clarification. Have the child paraphrase information to check for understanding. 1
National Center for Learning Disabilities (2003) Visual Processing Disorders by Age Group. Available online at http://www.ldonline.org/article/25153 1
National Center for Learning Disabilities (2009) Visual Processing Disorders. Available online at http://www.ncld.org/ld-basics/related-issues/information-processing/visual-processing-disorders 1
Helpful Handouts
Handout: Visual Learning Disabilities. (n.d.) Produced by Memphis Neurology. Available online at http://www.memphisneurology.com/pdfs/handout_visual_ld.pdf 1
Print Version
1 Especially beneficial for parents


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My Views On News And Other Happenings
27 Jun 2012 1 Comment
by Regina in Blessings, Bloggers, Blogging, ChariTs Inspirational Creations, Creativity, Facebook, Friends, God, Houston, Interview, Jewelry, LinkedIn, Person Of Interest, Social Networking, Twitter
Please visit my other spots:
Previous ENTREPRENEURIAL SERIES – Day 11
This interview was interesting and inspiring. I live the jewelry. Do you make anything in clip ons?Thanks Regina for building up my awareness of small businesses available to me, just by networking with you.
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During the operation of a grinding circuit (GC) in mineral processing plant the main purpose of control and optimal operation is to control the product quality index, namely the product particle size, into its technically desired ranges. Moreover, the grinding production rate needs to be maximized. However, due to the complex dynamic characteristics between the above two indices and the control loops, such control objectives are difficult to achieve using existing control methods. The complexity is reflected by the existence of process heavy nonlinearities, strong coupling and large time variations. As a result, the lower level loop control with human supervision is still widely used in practice. However, since the setpoints to the involved control loops cannot be accurately adjusted under the variations of the boundary conditions, the manual setpoints control cannot ensure that the actual production indices meet with technical requirements all the time. In this paper, an intelligent optimal-setting control (IOSC) approach is developed for a typical two-stage GC so as to optimize the production indices by auto-adjusting on line the setpoints of the control loops in response to the changes in boundary conditions. This IOSC approach integrates case-based reasoning (CBR) pre-setting controlling, neural network (NN)-based soft-sensor and fuzzy adjusting into one efficient control model. Although each control element is well known, their innovative combination can generate better and more reliable performance. Both industrial experiments and applications show the validity and effectiveness of the proposed IOSC approach and its bright application foreground in industrial processes with similar features.
A not-for-profit organization, IEEE is the world's largest technical professional organization dedicated to advancing technology for the benefit of humanity.© Copyright 2016 IEEE - All rights reserved. Use of this web site signifies your agreement to the terms and conditions.


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ATLANTA (AP) - The House is set to take another stab at a
measure that would double the state homestead exemption from $2,000
to $4,000.
The proposal passed the Senate in February at the urging of
Republican leaders. But it failed to win the needed two-thirds
majority in the House this month.
The chamber is expected to debate the proposal again Wednesday.
The proposal would allow votes to decide whether to expand the
homestead exemption.
Critics said it would force local governments to cut services or hike property taxes.


text:
Carl Aubock
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