text:
A series of one-shots that revolve around John, Rogue and Bobby's friendship, before John leaves. Nothing too serious, I intend to keep it light and fun. It's going to get AU eventually. I'm going to either change X2 around or delete it altogether. Depends on what you guys say.
Open: Closed
Categories: X1
Number of Stories: 4
Characters: Iceman, Pyro, Rogue
Genres: Friendship, Humor
Warnings: None


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Amid an ongoing challenge from the firm that has operated Boardwalk Hall and the Atlantic City Convention Center for nearly two decades, the Atlantic City Convention & Visitors Authority voted today to award a competing bidder a new contract to manage the facilities.
The ACCVA originally planned to vote on the proposals Dec. 5, but it instead took public comments on the bids during that special session and pushed the vote to its regular board meeting at 10 this morning. During that public comment period, supporters for West Conshohocken, Pa.-based SMG, which has managed the facilities for 17 years, raised concerns about Comcast-Spectacor subsidiary Global Spectrum, the only other firm in the running for the contract. However, the ACCVA board today moved to offer the contract to Global Spectrum.
An SMG spokesman said Global Spectrum's existing operating contracts with major arenas in the Philadelphia region "creates major conflicts to Atlantic City's detriment," as the firm will control concert and event bookings at Boardwalk Hall under its management contract with the ACCVA.
But agency President Jeff Vasser said "the pros of having (Global Spectrum) in Philly outweigh the possible negatives."
"Philly is a huge market for us, so there's something to be said for the power of (Global Spectrum's) database and the opportunities of the Wells Fargo Center, with all of the promotions they can do there on our behalf," Vasser said. "Their incentive will be tied to bringing more events here or more attendants here, so they have an incentive to drive more business here — not to say, 'Ha ha, we got your contract, and now we're going to keep Atlantic City from getting shows.' "
Once the contract is finalized, Global Spectrum COO John Page said the firm will offer its customers at the Wells Fargo Center promotions on events, restaurants and casinos in Atlantic City, which "gives us leverage and gives Atlantic City leverage when you look at those capacities we'll have."
Though the ACCVA still needs to negotiate the contract terms with Global Spectrum —and SMG's current contract is set to expire in less than three weeks — Vasser said "both sides are committed to get this done very fast, and Global Spectrum has assured me that they've done full transitions within two or three weeks before."
While there has been talk of a Jan. 1 takeover, Page said he is "looking to start the transition process with employees as soon as possible," noting the firm typically retains more than 90 percent of existing staff when it takes over facility management contracts from other vendors. Page said the remaining 10 percent usually includes top-level management staff who are legally bound to noncompete agreements.
On Nov. 30, SMG filed a complaint in U.S. District Court and sent a letter to Vasser citing legal flaws in the authority's procurement process for the contract, specifically the inclusion of officials from the Casino Reinvestment Development Authority and the Atlantic City Alliance on the selection committee.
The SMG spokesman said in a statement the company will "pursue its ongoing federal court challenge, as well as all administrative and legal actions available to remedy a clearly flawed authority process."
While Vasser said "it is certainly their right to challenge our award if they choose to do so," he noted "I'm here to bring conventions and events to Atlantic City, so we're moving forward with Global Spectrum's proposal."
"People can always sue, so you can't let that get in the way of doing your business," Vasser said.

subset: commoncrawl


text:
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text:
Boston area remembers the Marathon victims
Boston area remembers the Marathon victims
A woman hugged an MIT police officer after a vigil in Wilmington for slain officer Sean Collier.
Andrew Collier grieved during the vigil for his brother, the MIT police officer killed Thursday.
Julie Maloney (left) and her sister, Cynthia Maloney, attended a vigil in Watertown.
People held candles for Sean Collier at the Town Common in Wilmington.
A woman made a sign during a candlelight vigil for victims of the Boston Marathon bombing at Watertown's Victory Park.
Watertown residents gathered for a vigil a day after a manhunt in the area ended with the apprehension of 19-year-old bombing suspect Dzhokhar A. Tsarnaev.
People gathered at a makeshift memorial for victims near the site of the Boston Marathon bombings at the edge of the still-closed section of Boylston Street.
Saturday's Red Sox game, the first at Fenway Park since the bombings, was a scene of mixed joy and grief.
Neil Diamond sang "Sweet Caroline" during the middle of the eighth inning.
A Red Sox fan held a flag during the broadcast of a memorial program.
Boston police officer Tim Hicks gave 6-year-old Shane Evans a turn on the seat of his motorcycle outside Fenway Park.
Bob Goodman of Watertown, who was at the finish line at the Boston Marathon and lived in the neighborhood where bombing suspect Dzhokhar Tsarnaev was captured, reacted during opening ceremonies.
Law enforcement officers stood at attention during pregame ceremonies.


text:
BOSTON -- The state's highest court has opened the floodgate of opinion by seeking outside briefs in a religious discrimination case against the Acton-Boxboro Regional School District by an atheist family that is challenging the use of "under God'' in the Pledge of Allegiance.
Last month, the state Supreme Judicial Court requested amicus (friend of the court) briefs, which are legal briefs from those who have a strong interest in or views on the subject but are not a party in the lawsuit.
In asking for amicus briefs in the case of John Doe vs. Acton-Boxboro Regional School District & Others, the SJC described the case as identifying "important issues of state constitutional and statutory law concerning the daily recitation of the Pledge of Allegiance.''
Listed in the court docket as filing briefs so far are: the Acton School System, John Doe (the atheist family that filed the lawsuit and wished to remain anonymous), the American Humanist Association, Daniel and Ingrid Joyce, the Knights of Columbus, the Alliance Defending Freedom, and the Massachusetts Family Institute.
The case is scheduled to be heard during the first week of May, but no date has been listed.
The unidentified family, listed only as "John Doe,'' along with the American Humanist Association, a secular-rights group, argue in the lawsuit that the words "under God'' in the Pledge of Allegiance violate the equal-rights amendment in the Massachusetts Constitution.
Fitchburg attorney David Noise, president of the American Humanist Association who represents the family, referred comment to AHA Executive Director Roy Speckhardt, who wrote in a statement: "By tying patriotism to God-belief, public schools not only cast a cloud of suspicion over atheists and humanists, but they also make it impossible for atheist-humanist children to meaningfully participate in the daily exercise of the Pledge of Allegiance.''
He added, "This case is important because it seeks to remedy that discrimination through Massachusetts constitutional and statutory protections.''
The Acton-Boxboro Regional School District and Acton-Boxboro Superintendent Stephen Mills are defendants in the lawsuit.
Mills said in his affidavit in response to the lawsuit that "for both students and teachers, participation in the Pledge of Allegiance is totally voluntary.'' Abstaining from the pledge can be done for no reason, without explanation and without any form of recrimination or sanction, he added.
Mills said the pledge "serves the compelling educational and societal interest of promoting among our youth patriotism, virtue and national loyalty.''
Attorney Geoffrey Bok, representing the school district, declined to comment on the pending case, but wrote in his court brief that if the SJC limits the pledge, "It would establish an unprecedented right of any student or their parent to block public school teachings that are offensive to their religious beliefs, even if the alleged offensive teachings are made totally voluntary.''
The school district has maintained that it abides by a federal law that prohibits punishing students who do not recite the pledge or part of the pledge, so atheist students are free to skip the words they don't like.
Last June, Middlesex Superior Court Judge Jane Haggerty issued a 24-page opinion in which she sided with the school district by ruling that the daily recitation of the pledge with those words did not violate the plaintiffs' rights under the Massachusetts Constitution, did not violate the school district's antidiscrimination policy, and did not violate state law.
Haggerty wrote that the pledge is a patriotic exercise, not a prayer. The judge ruled the phrase "under God" is not a religious truth.
Haggerty noted that the plaintiffs, who admit that the children had the right to refuse to participate in the pledge, asserted that the phrase "under God" was a "religious truth that serves as a daily affirmation that their core religious beliefs are wrong.''
Stressing the historical and traditional context of the pledge, the Acton-Boxboro Regional School System argues that the pledge is not a religious document or ceremony, but rather a patriotic exercise and statement of political philosophy that teachers and students may opt out of it they choose, according to the ruling.
The judge wrote that this case presents a "familiar dilemma in our pluralistic society -- how to balance conflicting interests when one group wants to do something for patriotic reasons that another group finds offensive to its religious (or atheistic) beliefs."
Citing previous opinions, she wrote that the daily flag salute and pledge in schools are "clearly designed to promote patriotism" and "to instill a recognition of the blessings conferred by orderly government under the constitutions of the state and nation."
"The Pledge is a voluntary patriotic exercise, and the inclusion of the phrase 'under God' does not convert the exercise into a prayer," she wrote.
"As recently as 2002, Congress reaffirmed the terms of the Pledge," she noted, "making findings that support the conclusion that including the phrase 'under God' did not transform the Pledge into a religious exercise but rather was intended to reflect the history and political philosophy of the United States."
The Becket Fund For Religious Liberty, which has thrown its support behind the Acton-Boxboro Regional School District, was involved in three previous federal court cases regarding "under God" from the pledge, according to published reports. There was Elk Grove Unified School District v. Newdow, California, 2000 to 2004; Newdow v. Rio Linda Union School District, California, 2005 to 2010; and Freedom From Religion Foundation v. Hanover School District, New Hampshire, 2007 to 2011.
All of the school districts have kept "under God" intact in the pledge.
Noise told the Sentinel & Enterprise in an earlier story that the Massachusetts case will be different from the federal cases that were struck down because the case is focused on an equal-protection argument similar to how gay marriage was legalized in Massachusetts. There is no allegation of bullying or harassment in this lawsuit.
The phrase "under God" was inserted by Congress in 1954 as part of a patriotic effort to distinguish the United States from the Soviet Union, which at that time was considered atheistic. The wording of the pledge was last reaffirmed by Congress in 2002 without any changes.
Sentinel and Enterprise reporter Michael Hartwell contributed to this story.
Follow Lisa Redmond at www.twitter.com/lredmond13.


text:
Search results for 'tufas'
Tufas Complete Set$841.00Ergonomic ridges give setters a massive variety of options of how to use each hold in this, ranging from hand-size pinches to enormous tufa pinches that climbers can make three moves on and still be on the same hold. The Tufas are a moderate to advanced series, good for routes of all grades on the vertical wall and more difficult routes and problems on steeper terrain. The following 11 sets are included:
- Tufa Small Set
- Tufa Medium Set A
- Tufa Medium Set B
- Tufa Large Set A
- Tufa Large Set B
- Tufa XL Set A
- Tufa XL Set B
- Tufa 2XL #1
- Tufa 2XL #2
- Tufa 3XL
- Tufa 5XLLearn More


text:
Requires guy to be wearing tuxedo and girl in a formal gown. Guy sneaks up behind girl and ties her legs together. He then flips her dress over her head, drops his pants and starts doing her from behind. She invariably tries to waddle away and flap her hands at him. He then chases her around the room with his pants at his ankles trying to put his dick back in her.
Dude I totally gave my date the difficult penguin on prom night.
by penguinsforever November 03, 2010
buy the domain for your travel vlog


text:
product description
Related Products:
Murata, Takeo
Carbon Steel
Artisan Made
Carbon Steel - Blue #1 (Aogami)
Japanese/Asian Knives
Paring, Petty and Garnish
Wood - Pakkawood
Maker: Takeo Murata (click to see more by this maker)
Price: $138.00
Item num: 92996
Blade length: 3.10 in.Total length: 7.66 in.Blade height (at heel): 0.92 in.Blade thickness (near bolster): 0.05 in.Blade thickness (at midpoint): 0.04 in.Blade thickness (near tip): 0.03 in.Item weight: 2.60 oz.Shipment weight: 4.6 oz.Blade: Kurouchi finish san mai with an aogami 1 carbon steel core, Rc 64Bolster: Pinned stainless steelHandle: Resin impregnated hard wood (black pakkawood)
Description: This paring knife is a perfect choice for detail tasks - from taking the eyes out of potatoes to removing stems from tomatoes. The short, thin blade combines control and precision.
Takeo Murata, is widely considered to be amongst Japan�s elite group of highly revered bladesmiths. He lives on the island of Shikoku near Kochi. This area, formerly known as Tosa, is well known for its Tosagata-style hand forged knives and garden tools. At the age of 16 Murata-san started his apprenticeship working with his renowned uncle Tokaiji. Murata has become famous for his craftsmanship and ability to forge knives with excellent balance, sharpness and a stark beauty that speaks to Japan�s feudal past.
These beautiful black oxide (known as Kurouchi finish) knives are forged from Aogami No 1 carbon steel. This exceptional steel is particularly high in carbon and tungsten while maintaining limited rust resistance for a carbon steel knife. A fine grain structure and a hardness of approximately 64 (very hard!!) allows for easy re-sharpening and a long lasting, keen edge even through heavy use.
The handle, made from multiple layers of wood impregnated with resin, is riveted to the full length tang and will last a lifetime. Pinned stainless steel bolsters separate the handle and blade.
When knives are hand forged, a natural black oxidation is left on the blade. The traditional black oxide (Kurouchi finish), imparts a limited rust resistance. Particular attention should be paid when washing Kurouchi finished blades as a scouring pad can potentially wear off the black finish. As with other carbon steel knives, we recommend using camellia (tsubaki) oil to avoid rust and oxidation.
Availability: In stock. Usually ships in 1-2 business days


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29-7/8" W x 26-7/8" D x 47-3/4" H
The placement of model and serial numbers varies by product, but they are most commonly found in one of the following locations:
For additional assistance, please reference our Model Number Locator.
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You can either register your product online or drop your product registration card in the mail. All you need to register is the model and serial number and the date of purchase as shown on your receipt.
If you have any questions about registering your product, please contact Frigidaire at 800-265-8352.
Different products have different controls and displays. Your Owner's Manual has all the information you need, including step-by-step instructions for setting your clock or timer, controlling your temperature settings, enabling different features, and using the child lock.
The material of your cookware impacts how evenly and quickly heat is transferred from your cooktop to the bottom of your cookware. Here are some helpful tips regarding the most popular cookware materials:
Different ranges may have different types of racks. Check your Owner's Manual to see what type of racks your range accommodates.
Most racks can simply be removed by first pulling them straight out until they reach the stop position. Slightly tilt the front of the rack up to slide past the stop position and out of the oven cavity. To insert the rack, first rest the rack evenly on the rack guides on both sides of the oven walls. Next, slightly tilt the front of the rack upward and slide it in past the stop position. Bring the rack to a level position and slide it completely inside the oven.
If your oven is equipped with the Effortless™ Oven Rack system, you can refer to your Owner's Manual for detailed removal instructions. When the oven door is opened, Effortless™ Oven Racks will automatically partially extend from the interior oven glides to give you easier access to your dishes.
To enable PowerPlus™ Preheat, first turn the oven mode selector to PowerPlus™ Preheat and then turn the temperature selector to the desired temperature. The oven will begin heating and a reminder tone will sound when it is time for you to place the food in the oven. When finished baking, turn both oven selectors to the Off position.
To enable Quick Preheat, select the Quick Preheat button and then press Start. Your oven will automatically begin heating to the default temperature of 350 degrees. To set Quick Preheat using a different temperature, select Quick Preheat, enter the desired temperature on the key pad (EX: 3 7 5), and then press Start. A reminder tone will sound when it is time for you to place the food in the oven.
When the convection feature on your range is enabled, you can use Convection Convert to automatically adjust the bake time and temperature of a standard baking recipe for convection baking. Since the convection feature generally cooks food faster than normal baking, your dishes may need less time in the oven than the recipe suggests. Convection Convert automatically lowers the temperature you enter to eliminate the guess work.
To enable Convection Convert on your Frigidaire Professional® range, the oven temperature selector must be in the Off position and the oven mode selector must be turned to Convect Bake. Press and hold both the oven light icon and the clock icon for about 3 seconds, until the "Aut" messsage appears in the display. Press either the - or + key until On appears on the display and the oven chimes an acceptance tone. Simply turn the oven temperature selector to the recipe's suggested temperature and the oven will automatically adjust for convection baking. To turn off Convection Convert, repeat the above steps, but press either the - or + key until Off appears on the display. The oven will chime and temperatures will no longer be converted.
To enable Convection Convert on your Frigidaire Gallery® range, press Convect on the keypad, enter the recipe's suggested temperature, and press Convect Convert. The oven will automatically adjust the temperature. To stop Convect Convert at any time, press Cancel.
To enable Convection Bake, first arrange the interior racks in the desired positions. For multi-rack baking, you can reference your Owner's Manual for recommended rack positions. Depending on your model, either turn the oven mode selector to Convect Bake and the temperature selector to the desired temperature, or press the Convect button, enter the desired temperature on the keypad, and press Start. Since the Convection Bake feature cooks food faster than normal baking, you will want to reduce the recipe's recommended oven temperature by 25 degrees and use the minimum suggested cooking time. Once the oven reaches the desired temperature, a reminder tone will sound, indicating that it is time to put the food in the oven.
Convection Broil should be used to cook thicker cuts of meats that require the direct exposure to radiant heat and the convection fan for optimum browning results.
To enable Convection Broil, first place oven racks in the desired position—check your Owner's Manual for suggested placements. Depending on your model, either turn the oven mode selector to Convect Broil and the temperature selector to the desired temperature, or press the Convect button 3 times, enter the desired temperature on the keypad, and press Start. Since convection cooks food faster than normal roasting, you will want to reduce the recipe's recommended cook time by 25%. You will need to check your food at that time and determine if additional cooking time is needed. To stop Convection Broil at any time, either turn your oven mode selector to the Off position or press Cancel on the keypad.
The Warmer Zone uses a pre-set power level designed to keep hot, cooked foods at serving temperature. Vegetables, gravies, casseroles, soups, stews, breads, pastries, and oven-safe plates can all be kept warm with this feature.
To use, simply set the Warmer Zone control knob to On or press the Warmer Zone button. When you are ready to serve, turn the control knob to Off or press Off on the key pad and the Warmer Zone will begin to cool down.
The Warmer Zone is only designed to keep food warm—do not attempt to heat cold food on the Warmer Zone. In addition, you should only use plates, utensils, and cookware recommended for use with the oven and cooktop on the Warmer Zone.
The meat probe is designed to ensure the internal temperature of your food—specifically roasts, hams, and poultry—reaches a desired "target" temperature and doesn't overcook.
To use, start by inserting the probe into the food and placing the food on the desired oven rack. Next, while the oven is still cool, plug the connector end of the probe all the way into the probe receptacle located on the top left corner of the front, interior oven wall. When the probe is detected, you will hear an acceptance tone and see an icon appear on the oven display. Close the oven door and press the + key to set the desired probe temperature. Use the control knobs to set the oven mode and temperature.
During the cooking process an up arrow icon and the current meat probe temperature will appear in the display. When 75% of the target temperature is reached, the control will chime and the display will show the "Check Food" message. When the target temperature of the food is reached, the control will chime to signal the end of cooking, the display with show the "Food Ready" message, and the oven will automically switch to the keep warm setting (170 degrees). The oven will remain at 170 degrees for up to 3 hours or until keep warm is cancelled.
There are two different types of surface control indicator lights: the element on indicator light and the hot surface indicator light.
The element on indicator light is usually located on the control panel. It will glow when a surface element is turned on. A quick glance at this indicator light after cooking is an easy check to ensure all surface controls are off.
The hot surface indicator light is also usually located on the control panel. It will glow when any surface cooking area heats up and will remain illuminated until the glass cooktop has cooled and is safe to touch.
The Sabbath mode on your range is meant to be used for observance of the Jewish Sabbath and Holidays, during which the oven is only allowed to be started once. When enabled, the Sabbath feature overrides the factory preset energy saving feature that will shut off the oven after it has been on for more than 12 hours.
To enable Sabbath mode, select Bake and choose the desired oven temperature. Next, depending on your model, press and hold simultaneously either the bake time and delay start keys or the oven light and the clock keys for at least 3 seconds. "SAb" will appear on the display. After this, the oven may be turned off at any time by pressing Off. To turn off Sabbath mode, press and hold simultaneously either the bake time and delay start keys or the oven light and the clock keys for at least 3 seconds. "SAb" will disappear from the display. Once the Sabbath feature is enabled the only functions that will work are the numeric key pad and the Start, On, and Off keys. If you wish to use the oven light while using Sabbath mode, be sure to turn on the light prior to enabling the Sabbath feature.
Please reference your Owner's Manual for additional instructions on using the Sabbath feature on your range.
It is very easy to use the Self-Clean feature on your Frigidaire® range; however, before starting a self-clean cycle, it is always recommended to first review your Owner's Manual for important safety tips.
To start a self-clean cycle, first completely empty the oven and storage drawer, remove all oven racks and the temperature probe, and clear all items off the cooktop. Wipe up any excessive spills on the bottom of the oven and then completely close the oven door. After making sure the oven vent area is clear, select Self Clean on the key pad or turn the oven mode selector to Clean. Depending on your model, you may have options for 2-, 3-, or 4-hour clean cycles to choose from. Select a cycle either by pressing the + and - keys on the display or repeatedly pressing the Self-Clean button on the keypad and then pressing Start. The door will lock and CLN will appear on the display, indicating the oven has started heating for the self-clean cycle. The Self-Clean feature will eliminate soils from the oven completely or reduce them to a fine powdered ash. Once the oven has completely cooled, simply wipe away the residue with a damp cloth.
To cancel a self-cleaning cycle early, either press Cancel on the keypad or turn the oven mode selector to the Off position.
With the Steam Clean feature on your Frigidaire® range, you can quickly and easily clean your oven without chemicals or odors. However, before starting a steam clean cycle, it is always recommended to first review your Owner's Manual for important safety tips.
To start a steam clean cycle, first make sure the oven is cooled to room temperature. Remove all racks and accessories and scrape or wipe any loose debris from the oven bottom. Pour 8 oz. (235 ml) distilled or filtered water onto the oven bottom and close the door. Select Steam Clean and then Start on the keypad to initiate the 20 minute cycle. The remaining time will be shown on the display. When the cycle has finished an alert will sound and the End message will appear on the display. Press Off to return to the clock. Stand to the side of the oven when opening the oven door to avoid any escaping vapor. The cycle includes a cool-down period, so you may immediately use a soft cloth or sponge to remove any remaining water. Wipe down the oven cavity and bottom, but do not clean the oven door gasket - if it is damp, leave the oven door open to air dry.
Your Owner's Manual provides helpful tips on caring for all elements of your range, including exterior components like the knobs, stainless steel, and cooktop, as well as interior components like the racks, door, and oven cavity.
You can also purchase cleaners directly from Frigidaire®.
Radiant elements have a limiter that allows the element to cycle on and off, even on the HI setting, in order to maintain the selected temperature level. Cycling off at the HI setting is normal, but it will occur more often if the cookware is too small for the radiant element or if the cookware bottom is not flat. During the off cycle the element will retain enough heat to provide a uniform and consistent cooking temperature.
Yes, it is normal to hear your oven fan running when you turn on the oven, including during preheat. The fan helps circulate heat throughout the oven and will automatically turn on and off during the baking process. The fan may stay on even after you have finished baking and turned the oven off. It will stop once the internal temperature of the oven cools down.
To use your griddle, center it over the left side of the gas burners. Preheat for 5 minutes on the medium to medium low setting, but do not preheat on the high setting—a slow preheat ensures even heat distribution during the cooking process. The high setting may warp the griddle, causing it to heat unevenly.
Instead of heating the cooktop and then transferring the heat to your cookware, induction cooktops use magnetic fields to heat pans directly. Heating will only begin when cookware is properly placed on the cooking zones. This technology comes with several benefits:
Induction cooktops require magnetic cookware. You can test to see if your cookware is induction compatible by placing a magnet to the bottom of the pot or pan. If the magnet sticks firmly, the cookware is induction-friendly.
The most common induction cookware materials include:
For the best cooking results, it is recommended to only use high-quality, heavy gauge cookware on the induction cooking zones and to follow all of the cookware manufacturer's recommendations for use.
Depending on the model, your induction cooktop is equipped with 3 or 4 single induction surface elements: the right front, center, and rear positions. To use, first place correctly sized and induction compatible cookware on the induction surface element. Turn the element control knob to the desired temperature setting. You should start most of your cooking endeavors on a higher setting and then turn to a lower setting to finish cooking. Each surface element will provide a constant amount of heat at each setting. When you are finished cooking, turn the surface control knob to Off before removing the cookware.
Select induction cooktops have a bridge element that is designed to maintain an even temperature setting across two elements to accommodate rectangular or oval shaped cookware, such as a griddle.
To use, first turn the front left control knob to the "bridge" mark and then select a temperature setting. Both the front and rear positions on the left will heat, but you may switch from the bridge to the single element setting at any time throughout the cooking process by first turning the front left control knob to Off. The cooktop will beep and flash the display if the knob is not turned off before switching settings.
Check your Owner's Manual for more information on the bridge induction element.
Both drop-in cooktops and slide-in cooktops can be used in an island, peninsula or a traditional setting. The main difference is that a drop-in cooktop will have the controls on the top while the slide-in will have them on the front. A slide-in cooktop will require special installation.
A slide-in range is designed to slide in and fit flush with your countertop. This is ideal for an island peninsula, and can also be used in a regular setting to showcase a decorative backsplash. With a slide-in range, cooktop and oven controls are at the front of the appliance. A freestanding range is used in traditional installations (against the kitchen wall), and typically has a backsplash with a clock and controls that are on the front, the top, or the backsplash.
A BTU is the amount of heat required to raise the temperature of one pound of water 1˚F. BTUs are used as a measurement of the heating power of gas cooktops or ovens. To decide how much BTU capacity you'd like in your appliance, consider the following:
For cookware to work on an induction surface, it must be magnetic and have a completely flat bottom. In general, most stainless steel and cast iron cookware will work. Here's a simple test: Try sticking a magnet to the bottom of your pan. If the magnet sticks, that cookware should work; if it doesn't, most likely the cookware is not compatible with an induction cooktop surface.
Cookware made of aluminum, copper, or glass is not compatible with an induction cooktop. In addition, some types of stainless steel may not work on an induction surface, or may heat very slowly.
Smudge-Proof™ is a protective coating that is applied directly to the stainless steel appliance that resists fingerprints and cleans easily, making it effortless to keep your kitchen looking beautiful.
Each gas range has a shut-off valve, which supplies gas to the surface burners. To check that this valve is open and working, follow these steps:
When the tab on the valve is facing right, your range should work.
The light will stay on until the cooktop has cooled down.
To self-clean your oven, follow these simple steps:
Note: For safety reasons, the oven door will remain locked until the oven cools down. When it is sufficiently cool, the door will automatically unlock.
To close an open door when it's in the locked position and the door is open, press and hold the oven door light switch while following these simple steps:
You should then be able to close the door.
If you have cast iron grates, follow these steps:
If you have porcelain-coated grates, simply place them in the dishwasher and coat any unfinished areas with a thin layer of cooking oil after washing.
Keep your burner components clean by using a mild non-granular cleaner, such as ammonia or a degreaser. This will ensure that the gas ports do not get blocked. When putting the parts back together, always make sure the burners and caps are level and firmly set in place.
We recommend our Cerama Bryte cleaner, which is specialized for our products. You can purchase a complete cleaning kit from our Frigidaire web page, found in the accessories section of the site.
To keep your oven racks gliding smoothly when you're removing or inserting them, we recommend applying cooking oil along their outer edges.


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The father of murdered schoolgirl Genette Tate, who disappeared in 1978, has backed new talks by police and prosecutors about the prime suspect in the case.
Devon and Cornwall Police have long suspected serial child killer Robert Black of murdering 13-year-old Genette, who was last seen in a rural lane in Aylesbeare, Devon. Her body has never been found.
There is now new hope of a prosecution in the case after Black last year lost an appeal against his latest conviction for the murder of nine-year-old Jennifer Cardy.
He had argued that his trial was prejudiced because details about three other child murders he had already been jailed for were revealed to the jury.
Police told the BBC they are now liaising with the Complex Case Unit of the Crown Prosecution Service to see if the the appeal court ruling has "any bearing on the Genette Tate case".
It could pave the way for police to launch a case against Black based on his previous convictions.
John Tate told the BBC Radio 4 Today programme he feels "pretty happy" that the police are confident in their investigation, although he hoped they had not overlooked any other suspect by spending time focusing on Black.
Asked how he had coped in the decades since Genette went missing, he said it had been difficult as it was never far from his mind.
He said: "You look at everything that it could possibly be to do with her. You just cope very poorly sometimes."
Mr Tate said he believed the police had coped very well with the case, adding: "It's been pretty good... they wanted her DNA and it was taking forever and then we had a new Chief Constable, a female, and within two weeks she had it.
"She put it in a different way, she went privately with it and it worked out perfectly.
"I haven't been disenchanted with them apart from their lack of contact sometimes but what do you do?"
Devon and Cornwall Police said they were "liaising with the Complex Case Unit of the Crown Prosecution Service to ascertain if the 2013 Court of Appeal judgment following the murder of Jennifer Cardy in Northern Ireland (in which Black's conviction and the use of bad character evidence was upheld), has any bearing on the Genette Tate case".
The force added: "This liaison is still at a very early stage and will take some time to complete."
Black was found guilty in 1994 of the three child murders in the 1980s - those of 11-year-old Susan Maxwell, from the Scottish Borders, five-year-old Caroline Hogg, from Edinburgh, and Sarah Harper, 10, from Morley, near Leeds.
His reign of terror finally ended in 1990 when he was caught with a six-year-girl hooded, bound, gagged and stuffed in a sleeping bag in the back of his van in the Scottish village of Stow. He had sexually assaulted her moments earlier.
In 2011 he was prosecuted for a fourth murder - that of Jennifer, who was snatched as she cycled to a friend's house in Ballinderry, County Antrim, Northern Ireland, in 1981.
The paedophile is serving a total of 12 life sentences for murder and kidnap.


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You can download Awesome Inspirational Quotes About Success in your computer by clicking resolution image in Download by size:. Don't forget to rate and comment if you interest with this wallpaper.
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Thank you for visiting my blog and reading in this post ,i love sharing what i do and hope that contents of my blog are inspiring to you. Unless stated. All the work on my blog is of my own creation,i encourage you use the creations i share howover suits you best.the content is my sole responsibility as an independent stampin up. Creativity is all about sharing the art we enjoy and i am delight if i am part of that proces for you.If you share any of my work and would like to link back to my blog – thank you.


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The discovery of a large outdoor marijuana cultivation site in Lincoln County has resulted in 700 pounds of harvested pot being destroyed and three suspects arrested and formally charged with trafficking in illegal drugs.
The discovery of a large outdoor marijuana cultivation site in Lincoln County has resulted in 700 pounds of harvested pot being destroyed and three suspects arrested and formally charged with trafficking in illegal drugs.
The cultivation operation was found near NS 3300 and EW 950 Road, which is southwest of Wellston.
"This was a large scale operation that consisted of a growing area, a processing area," and what appeared to be a tent camp where the workers of the cultivation operation were living, an arrest affidavit shows.
As part of an intensive investigation, three suspects were arrested in southwest Oklahoma City.
Arrested on complaints of trafficking in marijuana were Mario Valencia Ochoa, 34; Juan Jose Gutierrez-Campos, 22; and Jesus Arturo Torres-Barraza, 17.
All three are formally charged with felony trafficking in Lincoln County District Court, with Torres-Barraza charged as a youthful offender.
According to the affidavits in the case, investigators with District Attorney Richard Smothermon's District 23 Drug and Violent Crimes Task Force made the marijuana discovery and arrests.
"Investigators seized a large amount of harvested marijuana from this site, which was approximated at around 700 pounds of marijuana," the warrant shows.
The investigation first began last week when Lincoln County Sheriff's Deputy Jack Jackson stopped a vehicle occupied by three males from the Oklahoma City area, according to court documents. Although the deputy wasn't able to get good identifications, he obtained tag information and an Oklahoma City address. That resulted in District 23 Task Force investigators driving to that residence and conducting further investigation over the following days.
Those efforts eventually led to a search warrant for that residence and another home in Oklahoma City. Local task force agents, the Oklahoma Bureau of Narcotics and Oklahoma State Bureau of Investigation executed those warrants.
Interviews followed, revealing several suspects were living at the grow site for about a month to care for the marijuana crop, although the site was reportedly abandoned when a police helicopter was spotted in the area. The affidavit indicates the workers were allegedly to be paid $200 a day for their time, but never were compensated since authorities seized the crop.
According to affidavits, Ochoa also was allegedly involved in running a previous marijuana grow near Seminole that was dismantled by OBN agents.
Investigators have said growing operations of this size have consistently been linked back to Mexican drug cartels.
Watch for updates.


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Linked by Thom Holwerda on Wed 31st Jul 2013 14:12 UTC
From The Guardian:
A top secret National Security Agency program allows analysts to search with no prior authorization through vast databases containing emails, online chats and the browsing histories of millions of individuals, according to documents provided by whistleblower Edward Snowden.
The NSA boasts in training materials that the program, called XKeyscore, is its "widest reaching" system for developing intelligence from the internet.
This is not PRISM - but a different system. The slides are damning, as always.
It validates claims made by Edward Snowden, and makes it clear that US government officials have been lying all along. There's no court order required for any of this - in a supposedly modern democracy. Crazy.


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Police are searching for a parolee from Tompkins County police say stole a vehicle and a magnum revolver from a Manchester neighborhood.
Ontario County Sheriff's Sgt. Tate Colburn said deputies are looking for Christopher Rundt, 23, who is on the run after violating his terms of parole in Tompkins County. Rundt was involved in a head-on crash with the chief of the Ithaca Police Department last Thursday.
Colburn said Rundt is considered "a person of interest" in the case of a stolen green 2011 Jeep Liberty with New York plates from a Manchester address and, from a nearby address, a stolen magnum revolver and Ontario County police ID belonging to a retired Ontario County Sheriff's deputy. The vehicle and revolver were reported missing Wednesday morning.
Colburn said Rundt is considered armed and dangerous. He should not be confronted and anyone with information should call 911.
Rundt is believed to be with a woman based on a young woman being seen with Rundt when he fled on foot from the head-on crash with the Ithaca Police chief. Police reported Rundt stole another car a few days later in Trumansburg, which he later abandoned in Manchester.


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Quote:Until the forum format makes it physically impossible for any other person other then a moderator to respond the CoS Questions Forum it will continue to happen on occasion.
Quote:Until that time how about posting a locked sticky within the CoS Question Area with a headline that says "ONLY MODERATORS ARE ALLOWED TO REPLY IN THIS AREA" or something to that effect. Maybe that will help
Quote: Literacy alone is not a sign of intelligence!
Quote: Quote: Literacy alone is not a sign of intelligence! It is just apart of it.
Quote:"Apart" means "seperate from", i.e. "it is seperate from it".I think you meant; it is just a part of it.Correct me if I am wrong.


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Elmer Setting has been named Chief of the New Castle County Police Department after serving as interim chief since November.
Elmer Setting has been named Chief of the New Castle County Police Department after serving as interim chief since November.
Newly elected County Executive Tom Gordon appointed Setting as interim chief, just days after taking office, after the departure of former chief, Scott McLaren.
New Castle County Council unanimously confirmed Setting's appointment Feb. 26 at its bi-weekly council meeting.
Setting is a 24 year veteran of the County Police department, and has held a variety of rolls, including uniformed patrol, public information officer, and Captain.
"He has a proud past and a bright future," said Councilman Bill Bell (D- Middletown). "He is surrounded by an excellent team."
Fraternal Order of Police Lodge 5 president Michael Zielinski said that he was happy with the decision.
"I am proud to say that I'm 100 percent behind the decision that has been made," he said. "We will butt heads, but at the end of the day we will shake hands."
Several members of the County Police force and police chiefs from municipalities across the county attended the ceremony, where Gordon pinned Setting's new rank to his uniform.
"I will honor this badge," Setting said Tuesday night.
Council President Rev. Christopher Bullock said that he is looking forward to a bright future with the County Police Department.


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Bayhealth will host a seminar on law, ethics and lactation issues on Aug. 22.
Bayhealth will host a seminar on law, ethics and lactation issues on Aug. 22.
Registration will begin at 8 a.m. with the seminar starting at 9 a.m. in pavilion rooms 1 and 2 at Kent General Hospital, 640 S. State St., Dover. The seminar will be led by Liz Brooks, JD, IBCLC, FILCA, a lawyer, private practice lactation consultant and president of the International Lactation Consultant Association.
Sessions include:
- Soap, Latch or IDK? Law and Ethics of Lactation Documentation.
- Looking at Latch: Offering Hands-free Help.
- The WHO Code in Everyday Practice: Real Life Scenarios.
- Dazed and Confused After Discharge: Cases from a Home-visiting IBCLC.
- Who's Your Daddy…Mommy, Surrogate or Donor? Modern Families, Lactation, Ethics and the Law.
- Skilled or Shilled Healthcare? When Commerce Meets Medicine (free evening session).
The registration fee of $50 includes breaks, lunch, parking and syllabus materials, as well as a free evening session. This seminar will be free for Bayhealth employees. CERPs and CMEs will be available. Registration deadline is Aug. 12.
For more information: bayhealthfoundation.org.


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The Knight of Darkness crushes crime in the classic pulp novels that inspired Hollywood's first two Shadow feature films!
First, the bizarre terms of a dead man's will lead to a series of murders that will condemn an innocent man unless The Shadow can unmask the true killer in Walter Gibson's "The Ghost of the Manor" - the inspiration for the 1937 film "The Shadow Strikes."
Then, The Dark Avenger hunts a sadistic blonde murderess and the masked supervillain known as "Foxhound" in Theodore Tinsley's violent novel that was filmed in 1938 as "International Crime."
BONUS: Film historian Ed Hulse unearths rare secrets behind the making of the first Shadow feature films! This instant collector's item showcases the original pulp covers by George Rozen and the classic interior illustrations by Tom Lovell, with historical commentary by Will Murray.
Softcover. 7 x 10. 128 Pages. Black & White (with color cover)


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Page 3 of Delhi has 10 apartments, 1 cabins, 11 condos, 7 houses, 19 villas listed for your review.
Sorry, there is no rental accommodation currently available in Delhi for your search criteria. Please change your search preferences or try a nearby region to increase the number of properties displayed.


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Significant Features of the Property Tax®
Resources About Significant Features
The Lincoln Institute of Land Policy is conducting a very short survey to review the effectiveness of the Significant Features of the Property Tax database. The survey takes approximately two minutes, and your response will be anonymous. We truly appreciate your feedback.


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COLUMBIA, Mo. — The Seneca Indians completed the first day of the 2013 MSHSAA Wrestling Championships on Thursday with eight of their nine qualifiers still alive, and sit in fifth place in the team scores with 22 points.
COLUMBIA, Mo. — The Seneca Indians completed the first day of the 2013 MSHSAA Wrestling Championships on Thursday with eight of their nine qualifiers still alive, and sit in fifth place in the team scores with 22 points.
After one day, the Indians sit behind Brookfield (30.5), Whitfield (28), Blair Oaks (24) and Herculaneum (23) in team results.
Individually, Will Roark, Cole Lankford, Jesse Rhoades, Jalen Skaggs and Jeff Butler all advanced in the winners bracket with first-round victories. Also advancing after losing their first matches and winning in wrestlebacks are Quentin Cotten, Ryker Skelton and Devin Madison.
At 120 pounds, Roark, ranked No. 1 in the class, scored a major decision over No. 8 Reid Steiner of Maysville, 9-1. Lankford (126) made short work of Herculaneum's Jesse O'Dell, dispatching him by pin in 1:58.
In one of the more exciting matches of the morning, Rhoades scored a 10-8 decision over Robert Querry of Plattsburg , 10-8, at 132 pounds. Skaggs grabbed a 7-0 decision over Thomas Mack (Trenton) at 160. Butler had little trouble with Shane Reisen (Principia) at 182, as he rolled to a 12-6 victory.
Cotten, saddled with wrestling one of the first matches of the day at 113 pounds, was pinned by Caleb Osborn (Lathrop) in 36 seconds of the first round, before bouncing back in wrestlebacks to dominate Kohl Bounds (Albany) with a pin in 28 seconds. Skelton was also pinned in his first match at 170 pounds, losing to Andrew McLaughlin (Whitfield) in 1:10. Skelton responded by pinning Gage Franklin (Lawson) in 1:43 in wrestlebacks.
After falling by pin to Josh Riggs (Pattonville) 4:53 in his first match at 220, Devin Madison, like Skelton and Cotten before him, won by pin on his second try, besting Alex Patton (Marysville) in 4:24. Seneca's Dylan West (195) was the only Indian who failed to advance past the first day as he fell in a decision to Justin Hicks (Polo), 12-10, and by pin to Kolby Reeder (Penney) in 15 seconds.
It wasn't a perfect day, and it's still early, but Indians coach Jeff Sill said he was pleased with the performance.
"Overall, I thought we did OK," Sill said. "We got through some first matches and advanced eight out of nine. The more we can keep in it, the better we are as a team. Right now, we've just got to keep plugging along. We're going into (Friday) taking it one match at a time, and we'll let that dictate our success."
Diamond's Jordan Douglas will also advance to Friday after winning his match at 145 pounds with a pin over Ben Glenn (Tarkio) in 2:35.
Friday's action will pit Cotton vs. Kohl Bounds (Albany), Roark vs. Jacob Brock (Lathrop), Lankford vs. Brody Richardson (South Harrison), Rhoades vs. Derrick Swaney (Whitfield), Skaggs vs. Will Tindal (Father Tolton Regional Catholic), and Butler vs. Stephen Conway (O'Hara).
Douglas will face Grant Schottel (Mid-Buchanan).


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Work on the Reedy Point Bridge resumed Monday and will continue throughout the Spring.
Work on the Reedy Point Bridge resumed Monday and will continue throughout the Spring.
On Feb. 25, inspection and construction activity resumed, necessitating the closure of one lane of traffic.
Workers have begun preparing the bridge for sandblasting and painting. Painting will resume when the weather turns consistently warmer.
The project, which was originally scheduled to be completed last year, involves steel repairs and painting. It includes work on the approach and main spans of the 44-year-old bridge.
The cost of the project has increased from $7 million to $10 million.
During the Spring, the bridge will be fully closed for two, one-week periods, for work to be done.
The closure dates have not yet been determined.
Corcon Construction, of Lowellville, OH., is performing the work for the U.S. Army Corps of Engineers.
The company has been carrying out concrete and steel repairs to welds, other deteriorated steel members and the wind linkage, as well as removal of lead paint and application of new corrosion protection.
The Reedy Point Bridge crosses the east end of the Chesapeake and Delaware Canal between Delaware City and Port Penn, Del.
The last major repairs to the bridge were made in 1999 when $888,000 was spent on miscellaneous steel repairs.
In 1995, $2.5 million was spent on anchor and deck span repairs and painting.
The bridge was originally constructed in 1969.


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My bra is trying to kill me.
I know this for a fact because before I put the bra on, I was fine, But after I wore it for 10 hours, I thought I was going to die.
I�d heard about these renegade bras in the news. Bras that suddenly, inexplicably stop caring. It�s like something out of a bad B movie, �When Bras Go Bad.� One day they are very supportive and the next, they just turn on you.
For me it started with the wash. At first I handwashed my bras, but eventually I got tired of the extra work and got a mesh lingeree bag to throw in the washing machine. Everything seemed to work fine, everyone seemed happy, and the bras held their shape nicely.
But then one day I took the bag out of the wash and failed to notice a jail break. The underwire in one of the bras had popped out of the fabric and was poking out dangerously on one side. It was a bra-tastrophe waiting to happen.
It came while I was making dinner. I bent over to lift the roast out of the oven and I felt a sudden, sharp pain in my chest.
�OH! I�ve been STABBED!� I yelled, clutching my right breast.
�Oh, jeez, mom,� said my son, shielding his eyes. �Can you not hold yourself there?�
I glared at him. Here I�d been accosted by my bra and he was worried that I was being inappropriate with myself.
�My brattacked me,� I announced. �I think I have a puncture wound.� I lifted my collar and peered down my shirt.
�And this would be the part where the son leaves the room,� my sympathetic son said as he left the room.
My husband walked over and looked down my shirt.
�This is not a peep show,� I said. �I�m mortally wounded.�
�What happened?�
�I think my underwire busted out of the bra and stabbed me,� I proposed.
�Why would it do that?� he wondered.
�I dunno. Sometimes bras just turn on you,� I said as I stuffed some tissues down my shirt to stop the bleeding.
In all honestly, it wasn�t a major injury. The underwire had barely broken the skin. I was really more offended than wounded. This bra and I had been together a long time and suddenly it had become my enemy. I wasn�t sure what the shelf life was on bras, but I suspected time had run out on mine and it was letting me know in no uncertain terms that it was ready to retire.
�You could sew the underwire back into the bra,� suggested my husband.
I shook my head. �I�m not sure, but I think this bra no longer wants to support me,� I said sadly.
�All good things must come to an end,� agreed my husband.
I nodded and went to finish removing the roast from the oven. But as I bent over, I could feel my jeans take a dive and I knew, without a doubt, that I had just mooned my husband.
I quickly yanked my jeans up and turned to my husband.
He snickered. �I think your underwear is trying to tell you something, too.�
Come share your story about being lost in motherhood on Tracy�s new website, www.lostinsuburbiastories.com, and be eligible to win a free copy of her new book, �Lost in Suburbia: A Momoir.�
Lost in Suburbia: No BRA-dy knows the troubles I've seen
My bra is trying to kill me.


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Last game when the refs made a bad call, we saw at least 4 or 5 beer bottles being thrown down onto the field from the North Endzone/HawksNest area. This pisses me off to no end. As Todd said in another topic, we're better than that 12th man.
And if you're in a section and see someone below you throw something, you damn well better put a stop to it either by peer pressure (yell at them to cut that s**t out and the rest of your section will follow, trust me) or utilize the ushers to get them out of the game.
I was seriously worried about getting a 15 yard penalty when I saw the first ones fly, and then someone threw another beer a few minutes later at a back judge at the back of our endzone. He looked back at the crowd and his hand went to his flag. If I saw who did it, and we got a 15 yarder because of it, you're damn right I'd have taken care of them one way or another.
So don't allow this crap to happen guys. That's all.


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This loose-fit top will keep you at ease all day long !
Material & Care
Hand printed fabrics need special care. Sunlight and Detergents hasten fading. We recommend hand or machine wash separately in lukewarm water using soap or mild detergent. Dye fixers are also strongly recommended.
Do not soak. Hang to dry. Dry clean all quilted items. Do not dry clean gold-prints. Silk and rayon to be dry cleaned only.
For hand embroidered items we recommend dry clean for contrast color fabrics. Hand wash for single color products with dye fixers. The irregularities and variation in the weave and printing etc. are characteristics of the product and are not to be considered as defective.


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|Shoe Style
Shoe Style
This black chelsea from XTI is an A/W essential, with on trend block heel and hiker outsole. Lined in cosy leopard textile and finished with a cushioned footbed. Heel 90mm.
To view our full range of Womens XTI shoes, click here.
Shipping & Returns
At Donaghys we deliver worldwide and have various delivery charges:
On delivery you must be able to sign for items being delivered.
If we do not deliver to your country please contact us and we can try and arrange delivery if possible. We can also send items by airmail courier for a faster international delivery if required. Please contact us for a price.
Security and Payments
All transactions which take place on Donaghys website are processed securely through Sagepay payments if you use a credit or debit card. We also use PayPal. All your payment details are held on Sagepay secure servers or PayPal. Donaghys has no access to any of your card or payment details. All payments are secured through 128 bit SSL encrypted pages.
We may contact your bank if we suspect the transaction is fraudulent in any way, this may cause a delay in processing and dispatching but is in the best interest of the customer.
We offer a free UK returns service for all offers over £49.99. At present this service is only available in the UK. Its quick and easy, just place the items you intend to return in a protective wrapping or a plastic bag, stick the returns label on and pop it into a post office. This free service is based on a maximum of two pairs returned. You can return more than two pairs but they will incur a £3.95 restocking charge for every pair after the second pair returned.


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|Episode Description
|Thursday, Nov 22, 2012 - 2:30 PM
"Kenneth Feinberg"
The Washington lawyer, whose firm specializes in mediation and dispute resolution, has acted as a government-appointed special master to settle million-dollar claims arising from the 9/11 terrorist attacks, and the BP Deepwater Horizon Disater Fund among other catastrophes. Feinberg's book Who Gets What was published earlier this year. G
|More on WORLD (MT)
|No upcoming shows in database


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text: while (my $Love = $patient) { my $love = $kind and $our_love = true; last;#forever } for ('No amount of tragedy can tear Or break the love I have for you') { $time = "healed our many wounds, But has not erased the memory."; while ("we hold on") { print 'We will stay together.'; last;#forever. } }


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Data markers indicate yearly frequency; error bars, 95% confidence intervals (CIs). Stroke occurred in 125 of 7616 patients (1.6% [95% CI, 1.4%-2.0%]) from 1982 to 1985, 192 of 10 673 (1.8% [95% CI, 1.6%-2.1%]) from 1985 to 1990, 156 of 9277 (1.7% [95% CI, 1.4%-2.0%]) from 1990 to 1995, 131 of 8792 (1.5% [95% CI, 1.3%-1.8%]) from 1995 to 2000, 70 of 5679 (1.2% [95% CI, 1.0%-1.6%]) from 2000 to 2005, and 31 of 3395 (0.91% [95% CI, 0.62%-1.3%]) from 2005 to 2010.
Stroke occurred in 409 of 45 136 patients at risk (excluding 279 with intraoperative stroke and 17 with indeterminate stroke timing). A, Kaplan-Meier estimates of time-related stroke. Error bars indicate 95% confidence intervals. B, Instantaneous risk of postoperative stroke. Components (phases) of risk of postoperative stroke shown, comprising an early peaking phase ending at about day 6 and a constant underlying phase independent of time after operation. The overall hazard function is the sum of these 2 components; the tinted area indicates the 95% confidence band of the overall hazard function.
Error bars indicate 95% confidence intervals.
Error bars indicate 95% confidence intervals. Numbers at risk exclude 17 with indeterminate stroke timing.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Tarakji KG, Sabik JF, Bhudia SK, Batizy LH, Blackstone EH. Temporal Onset, Risk Factors, and Outcomes Associated With Stroke After Coronary Artery Bypass Grafting. JAMA. 2011;305(4):381–390. doi:10.1001/jama.2011.37
© 2018
Context Stroke is a devastating and potentially preventable complication of coronary artery bypass graft (CABG) surgery. Better understanding of the timing and risk factors for stroke associated with CABG are needed.
Objectives To investigate temporal trends in stroke after CABG and to identify stroke risk factors and association with longitudinal outcomes.
Design, Setting, and Patients Prospective study conducted from 1982 through 2009 at a single US academic medical center among 45 432 consecutive patients (mean age, 63 [SD, 10] years) undergoing isolated primary or reoperative CABG surgery. Strokes occurring following CABG were recorded prospectively and classified as having occurred intraoperatively or postoperatively. Complications and survival after stroke were assessed in propensity-matched groups.
Intervention CABG performed using 4 different operative strategies (off-pump, on-pump with beating heart, on-pump with arrested heart, on-pump with hypothermic circulatory arrest).
Main Outcome Measures Hospital complications; late survival.
Results Among 45 432 patients undergoing CABG surgery, 705 (1.6% [95% confidence interval {CI}, 1.4%-1.7%]) experienced a stroke. The prevalence of stroke peaked in 1988 at 2.6% (95% CI, 1.9%-3.4%), then declined at 4.69% (95% CI, 4.68%-4.70%) per year (P = .04), despite increasing patient comorbidity. Overall, 279 strokes (40%) occurred intraoperatively and 409 (58%) occurred postoperatively (timing indeterminate in 17 patients). Postoperative stroke peaked at 40 hours, decreasing to 0.055%/d (95% CI, 0.047%-0.065%) by day 6. Risk factors for both intraoperative and postoperative stroke included older age (odds ratio, 8.5 [95% CI, 3.2-22]) and variables representing arteriosclerotic burden. Intraoperative stroke rates were lowest in off-pump CABG (0.14% [95% CI, 0.029%-0.40%]) and on-pump beating-heart CABG (0% [95% CI, 0%-1.6%]), intermediate with on-pump arrested-heart CABG (0.50% [95% CI, 0.41%-0.61%]), and highest with on-pump CABG with hypothermic circulatory arrest (5.3% [95% CI, 2.0%-11%]). Patients with stroke had worse adjusted hospital outcomes, longer intensive care and postoperative stays, and worse downstream survival (mean, 11 [SD, 8.6] years).
Conclusion Among patients undergoing CABG surgery at a single center over the past 30 years, the occurrence of stroke declined despite an increasing patient risk profile, and more than half of strokes occurred postoperatively rather than intraoperatively.
Stroke is a devastating complication after coronary artery bypass graft (CABG) surgery, occurring in 1.3% of US Medicare beneficiaries each year.1 Because CABG increasingly is being reserved for elderly patients with extensive coronary disease and comorbid conditions, prevalence of stroke after CABG is likely to remain substantial. Many studies have identified patient factors associated with post-CABG stroke2-5; however, information about timing of perioperative stroke and influence of different surgical techniques remains limited.4,6 Some patients develop stroke intraoperatively, with neurologic deficit apparent immediately after awakening from anesthesia; others develop it postoperatively, after initially awakening without neurologic deficit. Some recent studies have observed decreased occurrence of stroke when CABG is performed without cardiopulmonary bypass.7,8
The purposes of this study were to examine prevalence and timing of perioperative stroke, identify patient and surgical factors associated with stroke and its timing, and assess association of stroke with hospital mortality and morbidity and long-term survival.
From 1982 to 2010, 45 432 consecutive patients underwent isolated primary or reoperative CABG surgery at Cleveland Clinic (Table 1 and eFigure 1). Patients who underwent concomitant cardiovascular procedures (valve replacement, repair, aneurysmectomy, carotid endarterectomy) were excluded. Preoperative, operative, and postoperative variables were retrieved from the Cardiovascular Information Registry, a database populated concurrently with patient care. It has been approved for use in research by the Cleveland Clinic institutional review board, with patient consent waived. During the study time frame, details of in-hospital postoperative neurologic events were recorded in standardized fashion. Medical records and data were reviewed by one author (K.G.T.) for all patients recorded as having experienced an adverse neurologic event.
Perioperative strokes were diagnosed by physicians involved in the daily care of patients and confirmed by staff neurologists and imaging (computed tomography or magnetic resonance imaging). Perioperative stroke was defined as any new focal or global neurologic deficit lasting more than 24 hours that could not be explained by another medical process. This included persistent neurologic deficit for more than 72 hours and reversible ischemic neurologic deficit with recovery within 72 hours; it excluded transient ischemic attack with recovery within 24 hours. Temporal onset of stroke was classified as intraoperative if the neurologic deficit was present when the patient awoke from anesthesia and as postoperative if the deficit developed after the patient emerged from anesthesia. Some patients underwent 2 operations on the same day; in that case, timing of stroke was determined with respect to the second operation unless a stroke was already manifest after the first.
Four different operative strategies were used to perform CABG: cardiopulmonary bypass (on-pump) with arrested heart; on-pump with beating heart; on-pump with hypothermic circulatory arrest; and off-pump (eFigure 2). For most of this series, on-pump arrested-heart surgery was the standard strategy. From 1999 to 2004, off-pump CABG was performed routinely by some surgeons. However, throughout the series a surgical revascularization strategy was used to lower risk of atheroembolism in patients with ascending aortic arteriosclerosis; this included on-pump beating-heart CABG, on-pump CABG with hypothermic circulatory arrest, and off-pump CABG. Additional details about these techniques are included in eAppendix 1.
End points included hospital mortality and morbidity, resource utilization reflected in intensive care unit and postoperative length of stay after revascularization, and long-term mortality.
Hospital morbidities (perioperative myocardial infarction, respiratory failure, sepsis, and renal failure) were recorded prospectively, according to definitions of the Society of Thoracic Surgeons National Adult Cardiac Database.9 It was often not possible to differentiate complications as definitely preceding the perioperative stroke or following it; therefore, these postoperative morbidities were considered irrespective of their timing.
In addition, new-onset postoperative atrial fibrillation was considered a time-varying covariable for postoperative stroke. Among patients experiencing a postoperative stroke, documentation of its timing (which was prospectively recorded from continuous postoperative rhythm monitoring throughout the postoperative hospital course) was reviewed by one author (K.G.T.) to identify its occurrence prior to postoperative stroke.
For long-term mortality, vital status was obtained by query of the Social Security Death Master File.10,11 Common closing date for survival analysis was February 26, 2010 (6 months prior to its query to account for delays in posting). The interval from stroke—or date of operation in patients without a stroke—to death or follow-up was calculated for each patient. Nonparametric survival estimates were obtained by the Kaplan-Meier method and hazard functions (instantaneous risk of death) from multiphase parametric modeling.12 Briefly, the latter method was devised to account for nonproportional hazards often present after an intervention. It consists of additive hazard phases, each with a highly flexible shaping function characteristic of early peaking, constant, and late-peaking hazard phases, as characterizes human populations. Each data-driven phase is modulated by risk factors. Because of the method's mathematical properties (orthogonality), the same set of risk factors can be considered simultaneously in each hazard phase. Shaping parameters for each of these phases are provided in eAppendix 2. (For additional details, see http://my.clevelandclinic.org/professionals/software/hazard/default.aspx.)
Analysis of perioperative stroke was performed separately for intraoperative and postoperative stroke. In theory, the multiphase temporal decomposition model used for postoperative stroke could have been used to assess all strokes simultaneously. However, intraoperative stroke represents interval-censored data occurring at an unknown time between anesthesia induction and awakening. Because awakening time was not reliably recorded, separate analyses were performed for intraoperative stroke (non–time-related logistic regression analysis) and postoperative stroke (time-related multiphase parametric modeling). This separate-analyses strategy is a type of time-segmented analysis.13
All analyses were performed using SAS version 9.1 (SAS Inc, Cary, North Carolina). P ≤ . 05 (2-sided) is used throughout as indicating statistical significance (with at least 50% reliability by bagging in multivariable analyses).
Risk Factors for Intraoperative Stroke. Multivariable logistic regression was used to identify factors (eAppendix 3) associated with intraoperative stroke. Bagging was used for variable selection.14 Briefly, for this machine-learning technique, 250 data sets of size 45 432 were formed by random sampling of the original data set with replacement (bootstrap samples); on average, about two-thirds of patients are present in each sample, and the remaining are duplicates. Automated forward stepwise regression with backward elimination was performed for each bootstrap data set, with an entry criterion of P ≤ .15 (2-sided) and retention criterion of P ≤ .05. These results were stored. Frequency of occurrence of variables across all models constituted the aggregation step. In addition, some variables were clustered (such as linearizing transformation of scale of continuous variables formulated in preparatory data analysis) and counted as a single concept. Variables or clusters of variables that entered more than 50% of the 250 models (median rule) were chosen for the final model.
Targeted interaction analyses, including age and type of surgical support technique, were performed to identify possible modulation of main effects associated with intraoperative stroke.
Some data were not routinely assessed, recorded, or abstracted for blocks of years. Thus, we analyzed the data initially in blocks of years. Missing-value indicator variables were then created to manage these variables as interaction terms in the final comprehensive analyses. Otherwise, missing values were so sparse that simple-means imputation was used.
Risk Factors for Postoperative Stroke. Patients experiencing an intraoperative stroke were excluded from this analysis. For the remaining patients, the interval from end of surgery to documented occurrence of postoperative stroke was calculated from medical record review. If a patient did not experience a postoperative stroke, this interval was censored at time of hospital discharge or hospital death. Nonparametric estimates of freedom from postoperative stroke were obtained by the Kaplan-Meier method and instantaneous risk by multiphase parametric hazard modeling.12 This method yielded information about the time-varying instantaneous risk of stroke; identified 2 phases of postoperative stroke risk, an early peaking phase and a constant-hazard phase; and permitted identification of different risk factors for these 2 phases (so-called nonproportional hazards). Bagging (as described earlier) was used to identify factors (eAppendix 3) associated with postoperative stroke simultaneously for each hazard phase.
Both hospital death and hospital discharge are competing risks for postoperative stroke. Among the 45 136 patients who did not have an intraoperative stroke, 713 died in hospital without a stroke (1.6%); 285 deaths (40%) occurred within 5 days, the point at which 95% of postoperative strokes had occurred. Although large in number, we considered this to be a sufficiently small proportion of the total sample to ignore.
Propensity Matching. To assess association of stroke with hospital outcomes and time-related survival, propensity matching was used to assemble groups of patients having similar characteristics with and without perioperative stroke. Initially, a parsimonious model was developed using multivariable logistic regression and bagging, as previously described (eAppendix 3). Then, clinically relevant variables not found to be significantly associated with perioperative stroke were added to the parsimonious model to form a variable-rich propensity model (54 variables, C = 0.73) (eAppendix 3). Using this semisaturated model, a propensity score (probability of stroke) was calculated for each patient. Greedy matching was used to identify patients from the no-stroke group to form a 1:4 propensity-matched control group, well matched according to standardized differences (eFigure 3).15 All patients with stroke were matched. The matched pairs spanned the spectrum of CABG (eFigure 4).
Hospital outcomes were compared using the χ2 test for categorical variables, Cochran-Mantel-Haenszel test for trend for ordinal variables, and Wilcoxon rank-sum test for length-of-stay (skewed) variables. Comparisons were between all patients experiencing and not experiencing a perioperative stroke (unadjusted comparison) and between propensity-matched patients experiencing and not experiencing stroke (adjusted comparison). Unadjusted and propensity-matched survival was similarly compared using the log-rank test.
Presentation. Continuous variables are summarized by mean (SD) and categorical variables by frequency, percentage, and, for outcomes, 95% asymmetric binomial confidence intervals (CIs). For consistency, CIs used throughout are 95%, equivalent to ±2 SEs. All P values are 2-sided.
Among 45 432 patients, 705 (1.6% [95% CI, 1.4%-1.7%]) experienced a stroke. Occurrence of stroke peaked in 1988 at 2.6% (95% CI, 1.9%-3.4%), then slowly declined at 4.69% (95% CI, 4.68%-4.70%) per year (P = .04) (Figure 1), despite increasing patient risk profile, such as higher prevalence of preoperative stroke (eFigure 5), hypertension, and diabetes (eFigure 6), as reflected in Society of Thoracic Surgeons risk scores ranging from 1.4 in 2000 to 1.8 in 2008. Of patients experiencing stroke, intraoperative stroke occurred in 279 (40%) and postoperative stroke in 409 (58%); timing was indeterminate in 17 (2.4%).
Instantaneous risk of postoperative stroke peaked 40 hours after surgery, and by day 6 it had decreased to a constant hazard of 0.055%/d (95% CI, 0.047%–0.065%) (Figure 2). The hazard function comprised 2 phases: an early peaking hazard phase and a constant-hazard phase.
Risk factors common to both intraoperative and postoperative stroke were older age, smaller body surface area, previous stroke, preoperative atrial fibrillation, and on-pump CABG with hypothermic circulatory arrest (Table 2 and Table 3, eTable 1). Overall risk of intraoperative stroke was 0.35% (95% CI, 0.27%-0.44% [59/16 852]) for patients younger than 60 years, 0.70% (95% CI, 0.59%-0.84% [121/17 167]) for those between 60 and 70 years, and 0.87% (95% CI, 0.71%-1.1% [99/11 396]) for those 70 years and older (Figure 3). Overall risk of postoperative stroke was 0.49% (95% CI, 0.39%-0.61% [83/16 793]) for those younger than 60 years, 0.93% (95% CI, 0.79%-1.1% [158/17 046]) for those between 60 and 70 years, and 1.5% (95% CI, 1.3%-1.7% [168/11 297]) for those 70 years and older (eFigure 7). As number of arteriosclerotic comorbid conditions increased, stroke risk increased (eFigure 8).
Intraoperative Stroke. Specific additional risk factors for intraoperative stroke were peripheral and carotid arterial disease, previous cardiac operation, worse preoperative clinical condition, left ventricular dysfunction, circumflex stenosis greater than 70%, and on-pump arrested-heart CABG (as well as on-pump CABG with hypothermic circulatory arrest [Table 2, eTable 1]). Different surgical techniques were associated with different risks of intraoperative stroke. Unadjusted rates of stroke were highest among patients who had on-pump CABG with hypothermic circulatory arrest (5.3% [95% CI, 2.0%-11%]) and lowest among those who had off-pump CABG (0.14% [95% CI, 0.029%-0.40%]) and on-pump beating-heart CABG (0% [95% CI, 0%-1.6%]). Risk of intraoperative stroke was intermediate for those undergoing on-pump arrested-heart CABG (0.50% [95% CI, 0.41%-0.61%]).
Although demographics of patients differed among these surgical technique groups, particularly with respect to older age in the groups undergoing on-pump CABG with hypothermic circulatory arrest and on-pump beating-heart CABG (eTable 2), these differences in intraoperative stroke risk according to surgical technique remained statistically significant in multivariable analysis (Table 2, eTable 1). In targeted analysis, intraoperative stroke risk increased with advancing age when either on-pump arrested-heart CABG or on-pump CABG with hypothermic circulatory arrest was used (on-pump arrested-heart: 0.32%, 0.60%, and 0.58% for patients aged ≤60, 60-70, and >70 years, respectively; on-pump with circulatory arrest: 0%, 3.0%, and 8.2% for patients aged ≤60, 60-70, and >70 years, respectively) but not when either off-pump CABG or on-pump beating-heart CABG was used (off-pump: 0.15%, 0.32%, and 0% for patients aged ≤60, 60-70, and >70 years, respectively; on-pump beating-heart: 0% at all ages) (eTable 3, eTable 4, eFigure 9).
Postoperative Stroke. An additional factor specific to the early hazard phase for postoperative stroke that appeared to lower the risk of such strokes was new-onset postoperative atrial fibrillation. That is, occurrence of new-onset postoperative atrial fibrillation was not associated with increased risk of postoperative spoke. Additional risk factors specific to the constant-hazard phase of postoperative stroke included left main stenosis, treated diabetes, less use of internal thoracic artery grafts, and earlier date of operation (Table 3, eTable 1).
Patients who experienced a stroke had substantially worse hospital outcomes, even after propensity adjustment for preoperative factors: 19% mortality (95% CI, 16%-22% [136/705]) vs 3.7% (95% CI, 3.1%-4.5% [105/2820]), P < .001; 44% prolonged ventilation (95% CI, 32%-57% [31/70]) vs 15% (95% CI, 12%-20% [53/343]), P < .001; and 13% renal failure (95% CI, 11%-16% [92/705]) vs 4.3% (95% CI, 3.6%-5.1% [122/2820]), P < .001 (eTable 5). They also experienced substantially longer intensive care unit (median, 120 vs 48 hours; P < .001) and postoperative (median, 14 vs 7 days; P < .001) lengths of stay (eTable 5).
Long-term survival was assessed from 469 644 patient-years of follow-up, with mean follow-up among survivors of 11 (SD, 8.6) years and 10% of patients undergoing follow-up for more than 24 years. Patients experiencing a perioperative stroke had an unadjusted survival of 70% (95% CI, 69%-72%), 37% (95% CI, 35%-39%), and 12% (95% CI, 11%-14%) at 1, 10, and 20 years, respectively, compared with 95.3% (95% CI, 95.2%-95.4%), 68% (95% CI, 67%-68%), and 35% (95% CI, 34%-35%) among those not experiencing a perioperative stroke (log-rank P < .001) (Figure 4). Propensity-matched survival among patients not experiencing a perioperative stroke was 91.9% (95% CI, 91.4%-92.4%), 54% (95% CI, 53%-55%), and 22% (95% CI, 21%-22%) at the same time intervals (log-rank P < .001) (eFigure 10A). This was mainly attributable to a higher, more prolonged early risk of death to about 3 months (eFigure 10B); patients with stroke surviving beyond this point had a risk of death only somewhat higher than those without stroke (hazard, 7.2%/y [95% CI, 6.6%-8.0%], 9.1%/y [95% CI, 8.5%-9.7%], and 12%/y [95% CI, 11%-14%] at 1, 10 and 20 years, respectively, vs 3.3%/y [95% CI, 3.1%-3.5%], 7.8%/y [95% CI, 7.6%-8.0%], and 10%/y [95% CI, 10%-11%], respectively).
Stroke remains one of the most devastating and disabling complications of CABG surgery, with great clinical and economic implications for patients and the health care system.4,16 These implications are expected to remain substantial, despite improving surgical and anesthetic techniques, because of the increasing risk profile of patients undergoing CABG. Previous attempts to identify the subset of patients at increased risk of stroke have focused on identifying clinical risk factors, whereas few studies have examined timing of stroke after CABG.3,16,17 Understanding the risk factors specific to the timing of postoperative stroke should be beneficial in identifying the cause of the stroke and developing preoperative, operative, and postoperative strategies to predict and prevent stroke.
This study demonstrated that stroke more commonly occurs postoperatively than intraoperatively; identified common as well as specific risk factors for strokes occurring intraoperatively, early postoperatively, and late postoperatively; compared not only the risk of stroke associated with off-pump CABG vs on-pump arrested-heart CABG, but with 4 different surgical strategies; noted that new-onset postoperative atrial fibrillation is not associated with increased risk of postoperative stroke; and observed that stroke increases early risk of morbidity, mortality, and resource utilization overall and among propensity-matched patients but that survivors of stroke have a late survival similar to that of patients not experiencing a stroke.
In this study, prevalence of stroke was 1.6% among patients undergoing CABG, lower than the 3% reported by Roach et al.16 However, over the last 3 decades, occurrence of stroke has decreased despite increasing patient risk profile. This is most likely the result of improving preoperative assessment, intraoperative anesthetic and surgical techniques, and postoperative care.
Contrary to the report by Salazar et al,18 we found, as have some other investigators,4,16,17 that most strokes occurred postoperatively rather than intraoperatively. Instantaneous risk of postoperative stroke peaked around postoperative day 2 and by day 5 had decreased to a constant hazard of about 0.055%/d.
Intraoperative strokes may result from emboli, thrombosis, or hypoperfusion. Previous studies have identified arteriosclerotic emboli from intraoperative manipulation of the aorta as the main culprit.19,20 We similarly identified factors associated with arteriosclerotic burden as major risk factors for intraoperative stroke. Preoperative and intraoperative imaging (eg, computed tomography, intraoperative transesophageal echocardiography, and epiaortic echocardiography) may be used to assess ascending aortic arteriosclerosis.21-23 If it is found, surgical techniques could be used that avoid or minimize aortic manipulation to eliminate risk of arteriosclerotic embolization. These include alternative cannulation sites, such as the axillary artery,24-26 off-pump CABG, or on-pump beating-heart CABG with minimal or no aortic manipulation.
In addition to atherosclerotic embolus, intraoperative hypoperfusion is a potential cause of stroke during CABG and highlights the importance of maintaining adequate blood pressure during both cardiopulmonary bypass and manipulation of the heart during off-pump CABG.27,28 Hypotension with resulting hypoperfusion may occur during retraction of the heart in off-pump CABG; hypotension also may occur at any time during on-pump surgery from vasodilatation.
The timing of postoperative stroke reflects 2 types of risk: a constant "background" risk that persists after surgery, reflecting arteriosclerosis in this population; and an unexplained peak risk around postoperative day 2. The inflammatory process and hypercoagulability after surgery might provide some explanation for this peak. Identifying the etiology of this postoperative risk factor for stroke may lead to better strategies to prevent it, whether through more aggressive use of antithrombotic and antiplatelet agents, prophylactic prevention of atrial fibrillation, or both. The constant background risk of stroke is demonstrated in this study to have decreased over time, and that risk contributed most to the downward trend of stroke over the last 20 years.
We found off-pump CABG and on-pump beating-heart CABG to be associated with the lowest risk of intraoperative stroke, on-pump arrested-heart CABG with slightly higher risk, and on-pump CABG with hypothermic systemic circulatory arrest with the greatest risk. Both off-pump CABG and on-pump beating-heart CABG can be performed with minimal aortic manipulation, and therefore they likely lower the risk of stroke by decreasing the risk of aortic arteriosclerotic embolization. Although these findings are nonrandomized, they suggest that off-pump and on-pump beating-heart CABG may reduce stroke risk. This potential benefit must be weighed against the greater risk of incomplete revascularization, lower graft patency, and worse 1-year outcomes reported for patients undergoing off-pump CABG.29-31 A surgical revascularization strategy should enable optimal surgical coronary revascularization while keeping the risk of stroke low. In patients at high risk of intraoperative stroke, such as the elderly or those with aortic arteriosclerosis, off-pump CABG or on-pump beating-heart CABG with no or minimal aortic manipulation may be best. However, in patients at low risk of stroke, such as those without aortic arteriosclerosis and minimal arteriosclerotic burden, on-pump CABG is likely the best option to provide optimal surgical revascularization and minimal risk of stroke. Future trials will be needed to investigate these proposed strategies.
Although atrial fibrillation continues to be a common postoperative problem with peak incidence on the second day,32 suggesting a possible mechanism for the early peaking hazard phase of postoperative stroke, an unanticipated finding was that there was no increased risk of stroke with new-onset postoperative atrial fibrillation. In fact, new-onset atrial fibrillation was associated with a lower risk of postoperative stroke. To treat new-onset atrial fibrillation, we initially try early medical conversion or electroconversion and, if atrial fibrillation recurs or is persistent, rate control and anticoagulation. This strategy appears to be associated with not only preventing an anticipated increased risk of postoperative stroke but perhaps with actually lowering the risk.
Patients experiencing a stroke after CABG also experienced substantially more hospital morbidity, mortality, and resource utilization than those not experiencing a stroke.16 However, late survival of patients who survived a stroke was similar.
This study has several strengths and limitations. Among the strengths are that we included operations performed over nearly 3 decades; data collection was concurrent, prospective, and detailed; and trends could be observed according to time of operation and surgical technique.
The study also has several limitations. First, the classification of the timing of stroke occurrence is arbitrary and sometimes challenging in the setting of anesthesia and postoperative delirium and other complications. Second, we were unable to determine whether each stroke was embolic, thrombotic, or hypoperfusive in etiology. Third, patients may experience competing risk of death prior to stroke. Fourth, our comparisons of the association of surgical technique and stroke risk were observational and may be confounded by unmeasured covariates. Fifth, these results represent findings at a single academic medical center and may not be generalizable to US practice.
Among patients undergoing CABG surgery at a single center during the past 30 years, the occurrence of stroke declined despite increasing patient risk profile, and more than half of strokes occurred postoperatively rather than intraoperatively. Clinical presentation and surgical technique were specific to intraoperative stroke, but age and arteriosclerotic burden were associated with both intraoperative and postoperative stroke. Further studies are needed to develop better strategies to minimize the occurrence of stroke among patients undergoing CABG.
Corresponding Author: Joseph F. Sabik III, MD, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195 (email@example.com).
Author Contributions: Dr Blackstone and Ms Batizy had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Tarakji, Sabik, Bhudia, Blackstone.
Acquisition of data: Tarakji, Bhudia.
Analysis and interpretation of data: Tarakji, Sabik, Batizy, Blackstone.
Drafting of the manuscript: Tarakji, Sabik, Batizy, Blackstone.
Critical revision of the manuscript for important intellectual content: Tarakji, Sabik, Bhudia, Batizy, Blackstone.
Statistical analysis: Batizy, Blackstone.
Obtained funding: Sabik, Blackstone.
Administrative, technical, or material support: Sabik, Blackstone.
Study supervision: Tarakji, Sabik, Blackstone.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Sabik reported receiving honoraria from Medtronic Inc for presentations on coronary artery bypass surgery techniques. No other authors reported disclosures.
Funding/Support: This study was funded in part by the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research, held by Dr Blackstone.
Role of the Sponsors: The study sponsors had no role in the design and conduct of the study; the collection, analysis, and interpretation of the data; or the preparation, review, or approval of the study.
Institutional Review Board Approval: Preoperative, operative, and postoperative variables were retrieved from the Cleveland Clinic Cardiovascular Information Registry, a database maintained concurrently with patient care. It has been approved for use in research by the Cleveland Clinic institutional review board (IRB), with patient consent waived. Supplemental IRB approval was obtained to abstract details of each stroke and occurrence of new-onset postoperative atrial fibrillation in relation to stroke.
Additional Contributions: We thank Joan M. Alster, MS, and Jing Feng, MS, Department of Quantitative Health Sciences, Cleveland Clinic, for additional statistical support; and Tess Muharsky Parry, BS, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, for editorial assistance. None of these individuals received compensation for their contributions.
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Fin fan here, but I come in peace! Great game yesterday! And more importantly to both our franchises, some great games by our rookie QB's!
I thought Wilson played great yesterday. Not to sidetrack this thread, but like I've seen most of you comment on here, I was surprised you didn't air it out more with him. Our secondary is horrendous, and our run defense is one of our biggest strengths. I figured you'd air it out to go after that weakness more. Wilson sure didn't display any reason not to air it out… as I thought his play was fantastic for a rookie. He is definitely dangerous with his legs, and made us pay for it multiple times… both when running for yards, as well as rolling around, buying time, and finding an open WR (how many times did he do that yesterday to pick up first downs???).
I'm sure you all are happy with Wilson, as I'd have to believe he is the steal of the draft so far. To get a QB in the 3rd round? That's awesome. I was a huge fan of Wilson coming out in the draft. The only one (obvious) concern I had was his height, as I believed that if he was 6'4, he would have been our pick at #8 overall instead of Tannehill (I'm quite pleased with our QB though!). Wilson has the experience, athleticism, arm, and intangibles that you'd have to love… and so far the height seems to be a non-issue.
Speaking of Tannehill, what are your thoughts on him as a QB? This may have been the first look at him that a lot of you have had, so what were your impressions? What are your feelings on his future outlook as a QB? Did yesterday's performance either confirm or change your perception of him prior to the game?
I'll tell you what… one thing both our franchises are happy about is that they picked the right year to invest in a QB. This class is unbelievable IMO! I've never seen anything like it…